A tour of the new facility, facility relocation, the audit report from BKD and addition of privileges were topics that headed the monthly meeting of the Ringgold County Hospital board Monday evening.
Plant inspection committee
For the plant inspection this quarter, the board met at the building site for a tour of the new facility.
Facility relocation
The hospital is starting to plan moving from the old facility to the new facility. Ian Endacott with Healthcare Relocations came to the hospital and met with all of the departments and talked through the whole move. After going through each department, Endacott put together a draft of a move schedule. The move will begin on December 16. Healthcare Relocations will arrive late on December 14. December 15 will be spent preparing for the move. Department moves will start on Wednesday, December 16. Departments that can move in total will move on December 17. Inpatient moves will be on Sunday, Dec. 20.
Endacott told Winkler that he will return sometime in November to review the department move schedule, make sure each department has a move guide and hold a packing seminar to discuss how to label and perform a mock patient move. Endacott will not return again until December 14 for the real move.
Audit report
Phil Brummel of BKD, LLP was present and led the board through the audit report.
Cash and noncurrent investments decreased in 2009 by $233,476 or 40 percent and decreased in 2008 by $81,636 or 12 percent, respectively. Cash was invested in expanding specialty clinic services and the new orthopedic clinic during 2009. Operating revenue increased by $2.5 million, or 17 percent, over 2008.
The Hospital reported a bottom line of $(453,534) for 2009 with the most significant change being the increase of depreciation expense of $988,103 on the old hospital facility capital assets that will be disposed of when the Hospital moves to the new hospital facility. Operating expenses, without the impairment, increased 13 percent due to increased utilization and the addition of new services. If the Hospital did not have to recognize the additional depreciation of $988,103, the Hospital’s bottom line would have been a profit of $534,569, which would have been an increase in the bottom line of $402,436 or 39 percent from 2008.
The Hospital issued $14,480,000 in revenue bonds and $8,700,000 in bond anticipation notes to fund the construction of a replacement Critical Access Hospital in October 2008.
Addition of privileges
The board approved the following request for additional privileges: L. Keith Madison, M.D., privileges to perform thoracentesis and paracentesis.
Administrative report
Hospital administrator Gordon Winkler told the board that Dan Cunning with United Country has had several inquiries about leasing space in the old facility. Cunning approached Winkler about the possibility that if leasing doesn’t work out, would the board be open to the idea of auctioning the building as a way to dispose of the facility. The board preference would be to sell the facility but agreed to have Cunning work on a proposal for auctioning the building.
Winkler stated that due to changes in the Center for Medicare and Medicaid Services (CMS) regulations, which have taken more of an independent corporate approach to Durable Medical Equipment Providers, Ringgold County Hospital has decided that they can no longer be in the business of durable medical equipment. Since October 1 RCH has worked toward consignment with Hammer Medical for walkers, etc., DJO for soft goods like splints and Apria for equipment like oxygen concentrators and respiratory supplies.
The orthopedic program is growing and is in need of an orthopedic coordinator. Wayne County Hospital, Davis County Hospital and Ringgold County Hospital have jointly hired, through the Mercy networking department, Jen Moore, who has worked in Ottumwa as an orthopedic assistant and is licensed as a radiology technician. She will work with the program development, equipment coordination and develop a standard approach to surgery between the three facilities. She will also assist in the operating room and be the communication link between Dr. Homedan and others.
Winkler discussed the implications of the state’s budget as it concerns health care. The revenue estimating conference met and projected a deficit of $415 million. The governor recommended a cut of 10 percent across the board to be made up in the remaining three quarters. The Medicaid side of health care is responsible for $71.8 million of that budget. The federal government is now matching 77 percent of the Medicaid budget, which currently has a $39 million surplus.
The Department of Human Services is considering using the surplus of this year and next year to fund their part of the reduction. They cannot reduce their services or enrollees. In 2009 Medicare added 31,749 individuals to the program. Presently there are 350,000 enrollees in the Medicaid program.
Ringgold County Hospital’s Medicaid business is less than 10 percent because it does not handle maternity or mental health. Most of RCH’s Medicaid business is clinic visits.
Winkler stated that the hospital has been working with RadAdvantage to provide after hours radiology coverage and is close to having everything in place for the electronic backup in the radiology department.
The hospital is working on open house schedules an a grand opening for the new facility. The public grand opening is being scheduled for Sunday, December 13, from 1:30 to 5:30 p.m. RCH put together a publication for its 50th anniversary and plans to put one together for the opening of the new facility.
Winkler showed the board the photo taken by the crew of Mercy helicopter of the approach to the landing pad at the new facility.
The sanitary sewer connection has been made and tested. The flow rate was 127 gallons per minute.
New business
Jack Cook was present to discuss the possibility of having a cornerstone laid for the hospital, a Masonic tradition of dedication. Faith Lodge in Mount Ayr is working in combination with Topaz Lodge in Kellerton in offering to lay the cornerstone for the new replacement hospital. The Grand Lodge officers would show up at the ceremony. The board chose to discuss the Masons’ offer further.
Financial
Overall revenue was 7.4 percent under budget for the month. Revenue continues to grow and that the fall months are typically the lower utilization months.
Medicare contractuals are higher than budgeted due to patient mix.
Wages and benefits are under budget overall by two percent. Purchased services and supplies are down a little with the lower volume.
Cash flow has been really slow but has picked up in October. The hospital has not been paying invoices as quickly as they normally do but have been able to catch up to within one week of the invoice due dates as of October 16.
Overall cash flow for the month was a negative $345,194. Operations generated $1,206,791. Capital expenditures were $1,260,486 and $17,359 was paid in principal payments. All of the capital expenditures are related to the construction project except for one.
Supplies and expenses are under budget with orthopedic supplies and implants overbudget (due to utilization for the month), dialysis drugs over budget and lab supplies under budget. All departments are working hard to keep expenses down due to a significant slowdown in cash receipts.
Overall, operating expenses are 33.1 percent underbudget for the month. Just a reminder, budget for items such as depreciation, utilities, etc. reflect a blend of six months in the old facility and six months in the new facility.
Depreciation will be way underbudget until the expense for the new facility starts in December. There is also minor equipment budgeted for the new facility that hasn’t been purchased or expensed yet.
The hospital received $74,492 in county tax aid this month. Investment income shows a positive $14,105 this month. This number continues to decline as they use the construction funds that are invested.
The hospital had a negative operating margin of $31,183, which gives a positive bottom line after other non-operating revenue of $70,659 for the month. Year to date they have a $49,510 loss on the bottom line.
Patient Care
Admissions in acute care were 25, compared to 28 last month and 32 in the previous year. Acute patient days were 75 month-to-date compared to 84 last month and 105 in the previous year. The average daily census is 5.04 month-to-date compared to 4.47 last month and 5.11 in the previous year.
Figures in ancillary services procedures for the month included ambulance, 35; dialysis, 150; emergency room, 171; laboratory tests, 11,807; minor procedures, 61; physical therapy procedures, 524; X-ray procedures, 332; respiratory therapy procedures, 222; surgical procedures, 20; CT scans, 64; ultrasound exams, 38; mammography exams, 44; MRI exams, 18; nuclear scans, 20 and infusion therapy, 153.
Mike Kemery was not present at the meeting.