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VAN DYKE -- The possible addition of a
new physician to the hospital medical staff and a disappointing
financial report were two of the more notable matters discussed at the
most recent hospital board meeting.
The Board of Directors of the Comanche
County Consolidated Hospital District, the governing body of the
Comanche County Medical Center and the Doctors Medical Clinic, met for
their regular November session on Tuesday, November 27, at the
hospital.
Soon after the 12:30 p.m. start a full
Board membership was on hand. President Gale Easley conducted the
meeting with Board members Joe Locke, Karen Petty, Charles Mazurek,
Janna Morris and Billy Ray Evans participating.
Hospital staff participating included
Chief Executive Officer Kevin Storey, Medical Chief of Staff Dr.
Howard Dickey, Chief Nursing Officer Shannon Steigleder, Chief
Financial Officer Tom Letz, Home Health Department Head Kristy Taylor,
and Administrative Assistant Kathy Johnston.
Executive Session
Following the approval of the minutes of
the prior month's meeting, the Board adjourned into an executive
session of approximately 40 minutes in length to consider personnel
matters and one or more physician contract offers for the Doctors
Medical Clinic. Dr. Howard Dickey was involved in the meeting.
At the conclusion of the executive
session, Joe Locke offered a motion to authorize the hospital's CEO to
continue negotiations, as discussed, to completion. Charles Mazurek
seconded. The Board then voted unanimously and without any discussion
in favor of the motion.
Medical Staff Report
Dr. Dickey stated that he didn't have
anything to report other than there had been discussion regarding a
new nursing recruitment program which had their support.
Easley then noted that the agenda matter
concerning the acquisition of new chemistry technology for the
hospital was tabled for consideration at a future meeting since
negotiations regarding possible equipment commitments were not yet
concluded.
Appoint Home Health Administrator
Kevin Storey told the Board that the
hospital is required to have a Home Health Administrator designated.
He noted that earlier the designated administrator had been former CEO
Evan Moore, and more recently Chief Nursing Officer Shannon Steigleder.
Storey recommended that the Home Health
Department head, Kristy Taylor, be designated as the Administrator, in
line with the more common hospital practice. He also recommended that
Taylor's assistant department head, Pam Miller, be designated as the
Alternate Administrator.
Charles Mazurek offered a motion to that
effect, Karen Petty seconded, and the vote of approval was unanimous.
Storey also recommended an organizational
chart change in which the Home Health, Hospice and CBA/PHC
departments, all under Taylor's direction, be moved from the
supervision by the Chief Nursing Officer to direct supervision by the
CEO.
After only brief discussion, Charles
Mazurek offered a motion authorizing the change, Janna Morris seconded
and the vote of approval was unanimous.
Financial Report
New CFO Tom Letz commented that most of
his time in recent days and weeks had been taken up by work on the
hospital's annual Medicare Cost Report. He reviewed some of the
difficulties he had encountered in the process that arose from the
changes that had occurred in the CFO position during the preceding
year and in the computerized accounting system.
Letz added that the process was nearing
completion with only a few issues remaining and that it was a good
thing because the report was due to be filed at the end of November. A
provisional filing might be necessary with the unresolved items
remaining subject to later revision or amendment, however.
Letz noted that if the report was not
filed in a timely manner that Medicare payments to the hospital would
immediately dry up.
After repeating his optimism that the
cost reconciliation process was nearing completion, he described the
cost report as the biggest challenge he had faced so far in his work
at CCMC.
Letz presented two sets of hospital
income statements, one comparing to the same periods one year earlier,
and the other comparing to the operating budget, which had been loaded
into the computer system during the preceding month.
The income statement showed a net loss
for October of $194,436 and a four month year-to-date loss of
$392,992.
Letz explained that the operating losses
are primarily resulting from patient revenues failing to meet budgeted
and year-earlier levels. Year-to-date net patient revenues are roughly
$250,000 below the prior year's four month total, and $450,000 below
the budgeted four month total. Net patient revenues in October trailed
the October 2006 total by approximately $200,000 and the monthly
budgeted total by $150,000.
Kevin Storey, who had also been serving
as the hospital's CFO prior to Letz' arrival two months earlier,
stated that the loss of Dr. Michael Chiang had hurt the hospital's
revenues more than anticipated, and later noted that Dr. Chiang's
internal medicine practice had made much heavier use of the hospital's
diagnostic services than the family practice physicians.
Storey also pointed out that the
hospital's operating costs were dramatically lower than either the
same period in 2006 or in the budget, being lower by around $330,000
in both comparisons.
Most of the cost savings have been
achieved in the salaries and wages, benefits and payroll taxes line
items, with savings in purchased and contracted services also
contributing.
Storey reiterated his belief that if the
hospital had not lost Dr. Chiang that it would be showing much better
operating results and, likely, profitable results. He added that the
accounting standards being applied are "very conservative".
Letz noted that even with the losses, the
hospital was still operating at a breakeven cash flow, given the
non-cash expense provisions for depreciation and amortization that are
larger than the year-to-date loss.
Storey added that the hospital still has relatively low current
payables, even though up slightly, and it still has more than $1
million in undesignated cash reserves.
He described several other situations
where additional grant and cost report settlement funds were due to be
received totalling around $100,000.
When asked if he had changed his
optimistic view of the hospital's profitability potential after the
losses in the previous four months, Storey responded that it all
depended upon how quickly the hospital could get a new internist
physician working on the staff. He added that he still felt the
hospital had the potential for either a breakeven or a small profit in
the current year. He again noted the significant progress achieved in
lowering both personnel and other operating costs.
Both Storey and Letz described their
experiences with a Medicare program that provides extra funding for
sole community hospitals such as CCMC when the number of patient
admissions drops significantly in a single year. The program is
designed to aid the qualifying hospitals in recruiting physicians.
Storey said it remained to be seen whether CCMC would file for funding
under the program, but that it might likely qualify.
Storey reiterated that he remained
optimistic on the hospital's profitability potential in the current
year, but that it would certainly not be as good as originally
anticipated.
Potential Internal Medicine Physician
Staff Addition
Storey was asked by a Board member about
a potential internal medicine physician addition to the medical staff.
He responded that the physician has been provided a contract to sign
and is optimistic that it will be signed. The prospective physician is
awaiting the conclusion of CCMC's credentialling process before
committing to making the move.
Storey added that a special called Board
meeting in December may be needed for formal approval of the
physician's credentials and granting of staff privileges. He
underscored the need for quick action on getting the unnamed physician
signed to a contract and moving his practice here.
There were other topics mentioned
relating to lab equipment, roof repairs at the old Comanche hospital
building and property taxes that might also be agenda items at the
special meeting.
Storey noted that if things worked as
hoped that the new internal medicine physician could be working here
as soon as early February, although it could be a month or two later.
Storey described the physician as currently having a very successful
practice, but desirous of making a relocation to a more rural setting.
Clinical Report
Shannon Steigleder reviewed hospital
census and other operating statistics with the Board.
CCMC had 121 acute care admissions in
October and 18 observation admissions. There were 428 visits to the
emergency room with 92 admissions resulting therefrom and another 15
transferred to a higher level of care. There were seven major trauma
cases during the month.
October's surgeries and special
procedures were 67 in October, up significantly from 40 in September.
Steigleder described the hospital's
nursing recruitment program set to be initiated on the following day
with emails being sent to approximately 2,800 experienced RNs and LVNs
living within a 100 mile radius of Comanche County offering a sign-on
bonus for three year contracts. Current staff nurses will also be
offered bonus payments in return for signing three year contracts.
Steigleder also discussed training
programs, her plans to create an Admission/ICU RN position and the
Home Health/Hospice operations.
Executive Report
Kevin Storey briefly referred to the
physician recruitment process covered in greater detail during the
executive session. Two physicians, an internal medicine specialist and
a family practice specialist, are the subjects of recruitment efforts.
Storey reiterated the impact that Dr.
Chiang's departure had had upon the hospital's ancillary departments -
the lab, radiology, physical therapy, etc. - all of which are down by
more than 20-25%. He added that other physicians have picked up their
practices, but not by enough to offset the loss from Dr. Chiang. He
concluded that it could have been much worse.
Storey said that Peggy Jordan from DeLeon
will begin work at the hospital on Monday, December 3, as the new
Human Resources Director.
Storey added that Tom Letz had hired a
new Network Manager for the Information Technology department, another
DeLeon resident, David Cisneroz, who will start work in January.
Storey said that he hoped Cisneroz could
also be of assistance during the times when the hospital's telephone
network is down, as it had been on the prior Monday morning. He
discussed steps that had been taken to improve on the reliability of
the phone system and to provide backup telecommunications during any
future failures.
Storey briefly reviewed the status of
investigations underway regarding the acquisition or additional
laboratory analysis equipment and an improved accounting information
system.
The sale of the old DeLeon Hospital
building to the DeLeon Independent School District has been completed
and closed. The construction of a storage building at the new hospital
site is on hold pending settlement of other matters.
Storey announced that the preliminary
2006 Medicare Cost Settlement Report calculations were not yet ready
for disclosure, but looked "very favorable". He indicated the results
would be disclosed at the January meeting.
Storey discussed planned revisions in the
medical peer review process as it applied to specialists, noting that
the planned use of outside medical specialist boards for peer review
is supported by the hospital's medical staff and will better serve the
interests of both the physicians and the hospital.
He closed his presentation with noting
letters of appreciation that have been published in local newspapers
and received by the hospital. |
