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by Brenda Grose
Mental health and the crisis of adequate care options headlined discussion at the regular monthly board meeting for Ringgold County Hospital trustees on Monday, September 26.
While mental health care has been a focus for quite some time within the medical community in general, it was noted recent pledges of federal money for mental health have not been followed with dollars, at least in Ringgold County and the trend of increased mental health care needs continues upward.
While lack of dollars for mental health care has long been a problem nationwide, Amy Mobley, CNO, stated, “Mental health care is now a struggle on a routine basis and we are seeing more and more of those patients in the ER. It is also becoming more difficult to find in-patient care for patients needing admission to a mental health facility.”
When questioned by the board about the “why” providers are seeing more cases of patients in need of mental health care, Clinic Medical Director, Dr. Katie Wilcox, stated, “It could, in part, be contributed to patients seeking care more readily, it could be Covid related due to the isolation created, and also could be due to the neuro “after effects” for patients who have had Covid.”
Even with the difficulty in finding additional resources, RCH continues to provide mental health care through their regular providers, monitors potential need through questionnaires filled out at every patient visit regardless of the reason for the visit and does currently provide telemedicine mental health care for Senior patients through Senior Life Solutions. RCH also utilizes Osceola Mental Health Center by making referrals; however the center has only three beds for patients needing in-patient care.
In addition, RCH has responded to the crisis by contracting with PMC Health, the telemedicine provider, who provides care for Senior Life Solutions patients. Due to the good working relationship with PMC and Senior Life Solutions, a nurse practitioner (AARNP) has been selected from that practice who can serve patients of all ages. The AARNP will be available via virtual appointments two days per week once the new EMR system being set up for implementation is available. No set time frame for availability of these contracted mental health services has been announced, as it hinges on the new EMR system being available. CEO, Joe Mangiameli did share a general timeline with implementation of the EMR taking potentially 3-4 weeks, 30-60 days (more likely 60) to obtain credentialing for the provider, then time needed to set up provider billing and training for the new nurse practitioner to the EMR system-all which could run into early 2023.
Board member, Mike Hopkins, shared his knowledge as a psychologist, “economics, concern for finances and jobs, as well having only one psychiatrist in a 75 mile radius who is in Creston, also plays a part in the mental health crisis and increasing mental health issues.”
He went on to state, “the number of bipolar and personality disorders has increased. These mental health disorders are treatable with medication but not curable and with no one to monitor use of the medications it makes regulation hard.”
Hopkins concluded although mental health has become more acceptable within society, “some people are still reluctant to seek help, due to a remaining (real or perceived) stigma.”
Rounding out the discussion, Sandra Christensen, Trinity Health (formerly Mercy One) liaison added that resources are not coming in across the board and payer reimbursement is not there as it should be. CEO Joe Mangiameli agreed, while clarifying RCH’s primary goal and commitment is to serve all patients with the best possible care and that RCH is not here “to turn a profit”; however, reimbursement is necessary for a viable revenue cycle.
Missy Walter, CFO, provided the financial report for August 2022. Walter stated gross revenue for the month ended ahead of budget by nearly $400K. While in-patient revenue came up short by $22K, out-patient revenue made up for the drop in in-patient days coming in well over budget by $359K mostly due to other surgical implant charges. Primary and Specialty Clinics also were over budget by $63K with more ortho and general surgery visits as well as Rural Health Clinic visits. Total operating revenue was $2.4M for the month, ahead of budget by $280K.
On the expense side, salaries and wages, as well as benefits were under-budget. Contract labor still showed some higher expense due to acute and mental health contracted staff. Supplies and pharmacy drugs were higher than budgeted, but coincided with wound care supplies needed for outpatient procedures. Total operating expense was $2.2M for the month, under budget by $61K. The month of August finished with a net gain of $322K; year-to-date bottom line shows a loss of $396K.
Walter also informed the board that the Medicare advance payment loan is now due. During the Covid pandemic, Medicare issued advance payments (prepayment for future claims) in the form of a loan. Since accepting the advance payment funds, repayment has been regularly withheld from normal Medicare claim remits. A balance of $986K remains and will need to be repaid either as a lump sum payment or by taking a loan to extend the repayment. Walter went on to explain that the loan being considered would be repayable at any time, would carry a 4% interest rate and could provide a good safety net. Christensen, added this type of loan would be considered a hardship exception. The loan could be a needed bridge of cash flow as the hospital and clinic convert to the new EMR system. No decision on the loan was made.
Mangiameli gave his report as CEO and stated focus this past month has been on the revenue cycle at RCH. He has contracted a service that will review RCH receivables and evaluate the revenue cycle, particularly how billing is handled and how quickly it gets sent out. It is hoped this team’s evaluation will be a tool to better forecast and get access in a more timely fashion of a weekly picture of finances at RCH. Mangiameli also stated two new positions, a financial analyst and a biller, will be added to the finance department.
In miscellaneous items:
• Max Buckner was present to address concerns about the flag at RCH flying during inclement weather. The concern was satisfied after explanation and discussion. The board thanked Buckner for his concern.
• Dr. Morgan has submitted his resignation effective in October. One of the ER providers will take over care of patients previously seen by Dr. Morgan.
• Kudos to RCH were shared by several board members who related positive hospital and clinic experiences related to them recently. In response, Mangiameli stated, “Service excellence at RCH is not just a pitch, it is a purpose.”