Hospital Board discusses budget

During their Tuesday night meeting, the Hot Springs County Memorial Hospital Board of Trustees were presented with the proposed budget for the fiscal year 2020 by Chief Financial Officer Shelly Larson.

“We are coming off of a year in which we saw substantial growth at the hospital,” Larson said. As such, she is concerned about pushing the envelope for continued growth at the same rate, especially with the construction going on. Board members were presented with copies of the budget to read through and bring concerns forward. A final budget will be approved in July.

Among the information in the budget, Larson noted an 8.75 percent increase is expected in gross patient revenue. The discounts and allowances also show an increase of more than 22 percent, though Larson explained part of this is due to Medicare paying the hospital on a cost basis. Because the hospital has higher utilization and higher gross revenue, but no corresponding increase in costs, the cost per unit goes down.

Medicaid also recently completed a change to new payment methodology, Larson said, going from a fee schedule to ambulatory patient classifications and diagnosis-related groups. If the hospital were being paid in that way, she added, it would not survive. In the budget, it’s projected the Medicaid contractual is about 70 percent of what the hospital bills, meaning the hospital gets 30 percent.

An increase in other operating revenue comes from Red Rock Family Practice being enrolled in the 340B program, which allows the hospital to also provide a benefit to the community. Those who are truly on self-pay can receive their prescriptions at a significant discount.

Operating expenses will increase 3.44 percent. Larson said the contract labor line item is one that always seems to sneak up, but they did continue to budget for nursing staff. There will also be some depreciation on the new addition, expected to be completed in January of 2020.

As for non-operating revenue, Larson said the hospital still has its mill levies. There is also the special purpose sales tax, which is restricted to paying the debt on the new building but still has to be included as revenue.

Speaking on the capital budget, Larson said it is $2,975,000 in the next fiscal year, $1,039,000 in fiscal year 2021 and $28,000 in fiscal year 2022.

In other action, the board approved a proposal for the audit from Koerwitz, Michel, Wright and Associates. The firm will perform the audit with a fee of $29,000 to $32,000, not exceeding the upper limit. Larson noted last year’s audit cost about $30,000. Additionally, Larson said, a single audit might be necessary as the hospital received more than $750,000 from the federal government through USDA guaranteed funds; that audit could be an additional $6,000 to $8,000.

A patient loan program was approved. Through the program, the hospital would partner with Pinnacle Bank, and the program would be available for accounts that require payments longer than a 10-month period. Larson explained the hospital would utilize the bank’s system and forms. Patients would complete and sign the forms, and set up payment at a 10 percent interest rate up to five years.

Larson said the program is a nice tool to have in helping patients with the financial obligations they have. There is a $500 minimum to qualify for the loan program and even those with bad credit can qualify.

Also during the meeting, Larson noted the hospital’s days in accounts receivable for April decreased by about six from March, to 59.75. Days cash on hand increased to 66.57, about a 14-day increase over March.

Larson also believes the hospital set a new record for cash collected in one month with more than $2 million. There is also some work on resolving a few issues to meet the accounts receivable and days cash on hand benchmarks.

Larson further reported on some changes that Wyoming Blue Cross/Blue Shield has been doing a system conversion that is causing some issues, which in turn become the hospital’s issues. She noted there have been some cases where patients received payment rather than the hospital, and any patients who receive Blue Cross payments bring those checks to the hospital.

Dr. Hallie Bischoff reported that physicians have begun obtaining ultrasound probes and tablets to which the probes can connect — a cost of $2,000 each, using their own money — and there will be some training on the devices over the summer. Bischoff said this is a new trend, though they will still be using imaging with an ultrasound tech if necessary. However, she noted, the probes and tablets can allow for quick scan for things such as blood clots, collapsed lungs or fluid around the heart, and a quicker start to treatment. It will also be helpful in providing visual assistance for insertion of IVs.

Bischoff said the ultrasound provided with the probes and tablets is quick and will be beneficial in obstetrics to ensure a baby is doing fine.

Bischoff also reported things are going well with getting a solid staff at the hospital that works well together, and it’s reassuring that we will hopefully have permanent staff at the facility and not have to pay the expense for travelers.

Hospital CEO Margie Molitor announced Linda Veylupek, PHR, is the new Human Resources Director at the hospital, and will be starting June 24. She is a longtime Wyoming resident with family in the Lander/Riverton area.

Molitor further reported the room is done for nuclear medicine, and the new machine is expected for delivery this week.

The board recently asked the high school art classes for input on a new logo, as the hospital will be changing names to Hot Springs Health, and Molitor expressed appreciation for the students’ help as they had some insightful and thought responses. A logo has been decided upon, but will be revealed at a later time.

Molitor noted the logo had to be approved so signage can be ordered.

Next month, Molitor said, the Community Health Needs Assessment will be presented to the board for their approval.