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Updates and information on Payment Protection loan (PPP) payouts and other COVID pandemic funds received along with ongoing construction projects highlighted discussion at the Monday, April 19, regular monthly meeting of the Ringgold County Hospital Board of Trustees.
Missy Walter, CFO, informed the board an official letter dated March 27, 2021 was received granting full forgiveness for PPP stimulus funds in the amount of $932,100,00. In addition to stimulus funds received, Walter reported accelerated repayable Medicare payments were received on April 14, 2020 against future claims as a way to help hospitals with cash flow at the beginning of the COVID 19 pandemic. These funds were initially repayable beginning August 2020, but as the pandemic continued, the date was extended to begin one year from the date funds were received. These funds have now begun to be recouped. Accelerated funds received included $4.2 million for the hospital and $1.3 million for skilled care. The funds will be recouped at 25 percent of Medicare payments for the next eleven months, then at 50 percent for the following six months and at the end of the six months a demand letter will be received with the balance remaining which will need to be repaid within 30 days or retained as a loan at 4 percent interest. Walter explained a separate banking account was set up when the initial accelerated funds for repayment were received and those funds have been drawing interest. Walter further explained a process has been worked out to transfer the amount withheld from reimbursement as reflected on the daily Medicare remits with entries needed internally to properly reflect the transfer of funds. She went on to say repayment at the end of the loan term will not be an issue.
Walter then outlined the last piece of federal funding received from the CARES Act Funding. A total of $3.5 million was received for COVID related expenses or lost revenue. Qualified related expenses have remained vague, according to Walter, however she stated Molly Kayser, EMS director and staff have gathered quotes and compiled ideas to determine appropriate spending options. Funds must be expensed by June 30, 2021 or the funds will need to be repaid. Written justification for spending are being put together, as well, to further ensure proper expensing of and documentation of funds received through the CARES Act. Items purchased or in process of being purchased include: ventilators; anesthetic machines with ventilator capabilities; one ambulance with UV lights for cleaning and a power cot with precautions for extra space between EMTs and staff; defibrillators; simulators, Lucas compression devices (machines that do compressions) which keep providers from direct contact; appreciation payments to staff; PTO buyback options and the installation of glass partitions in the ED and OR areas. Walter added most purchases were focused on safety and infection control.
Walter finished her reporting with a review of the March financials calling it a “great month.” Inpatient revenue fell short of budget by $29K but Outpatient and Clinic Revenue were both ahead of budget by approximately $380K and $22K, respectively. Operating revenue was $1.9 million, which includes the PPP funds. Overall, gross patient revenue exceeded budget by $373K with net patient revenue at $1.8 million. Walter noted the 340B program is trending downward, as drug manufacturers are inhibiting what can be reimbursed.
On the expense side, contractuals continue to run higher than usual; however, Walter did tell the board she was looking into the numbers and pointed out higher contract labor in several areas using temporary staffing including lab, CRNA coverage, oncology and orthopedic clinics and administrative fees. Benefits continue to run higher than budget also with reinsurance amounts on claims exceeding stop loss amounts. Supplies were over budget due to oncology and other drug expenses. The month was settled with a gain of $1,952,498.
Dr. Bruce Ricker, chief of staff, gave his report summing up the past flu season/COVID 19 statistics for Mount Ayr Medical Clinic. He reported no diagnosed flu cases to date for this past flu season, while the clinic continues to see a few patients, mostly younger, testing COVID positive. Also sharing information on COVID statistics to date, Kathy Schuster, DON, reported one current COVID patient in the hospital with a total of five patients to date since the outbreak March 2020. RCH has a 79 percent COVID vaccination rate for employees.
Administrator, Gordon Winkler gave an update on progress with the ongoing construction projects. Winkler listed several completions for the new retail pharmacy and remodels within the hospital including roofing and capping, dry wall finished and prepped for painting, masonry, window installation for all but the pharmacy drive up, MediaCom cable run in the pharmacy space and the east parking paved, cut and striped. Additionally, wall protection and handrails are on-site and cabinetry has been delivered. Interior door delivery has been delayed, but a company will provide temporary doors to be used until the permanent doors are received. As this project wraps up, Winkler noted INVISION Architects were scheduled to be on site Tuesday, April 20 and final completion date is May 9, with the space available for use May 10. Progress on the hospital pharmacy renovation is also moving on schedule with final completion expected by April 30.
Concluding the meeting with miscellaneous business, Winkler presented a purchase agreement to be approved by the board for the sale of Lot 6 of the Shellway Drive/Dunning Avenue hospital properties. The purchase agreement was approved and a notice of hearing will be set for May 17, immediately prior to the regular monthly board meeting. Following the hearing and during the regular board meeting, the board will pass a resolution to sell the property and will give Winkler authority to take steps to close on the sale. The closing will be May 20.