The Greenwood County Hospital (GWCH) Board of Trustees discussed financials in length during their routine monthly meeting on Thursday, June 25.
Although the hospital shows a $1.9 million operating loss, hospital officials expect several pending reimbursements and accounting adjustments to significantly reduce that deficit before the fiscal year ends (September).
CEO Sandra Dickerson and CFO Butch Forrest reviewed the April and May financial statements, explaining that several one-time adjustments and reimbursement delays have negatively impacted the hospital’s reported financial position.
Among the largest issues were adjustments to discounts and contractual allowances. In April, the hospital recorded a $290,531 adjustment related to timely filing and documentation issues. An additional $38,500 adjustment for documentation issues was made in May. The hospital also experienced higher-than-average claims through its self-funded employee health insurance plan during April, with claims exceeding the average monthly amount by approximately $128,500. However, administrators said the overall plan remains within budget and continues to cost less than a fully insured employee health plan.
Another accounting issue resulted from changes in how claims from the hospital’s self-funded insurance plan were processed. It was noted that originally, GWCH paid a third-party liability company for all claims. GWCH would then wait three to four weeks before funds were received back to the hospital. Through the process of being switched, it was set up incorrectly. The issue was identified and corrected, but it did cause an increase of $148,000 in the expense line.
CEO Dickerson noted, “These three issues contributed to adjustments that reduced the net income amount. From these two that directly impacted the bottom line, that could have been avoided, were the timely filing/ documentation issues.”
Based on an interim Medicare cost report estimate, GWCH expects to receive approximately $1.2 million in additional reimbursement from the Centers for Medicare & Medicaid Services (CMS). Half of that amount has already been recorded in the financial statements, with the remaining balance to be recorded once the payment is received. It was also noted that Medicare reimbursement rates have not been enough for services that are being provided under the Medicare program, which is why the interim cost report notes a substantial payment coming back to GWCH. It was noted that multiple reasons were attributed to this, including the Part B side of Medicare, which was established by high volumes in the wound care program that no longer exist. Other reasons included inflation and a change made in the pricing methodology used in the pharmacy department. CEO Dickerson said, “When we switched to Cerner, the methodology was changed to average wholesale price, a methodology that continuously changes based on the average wholesale price. The rates are loaded into the system on a monthly basis instead of being evaluated as individual prices change. This change in methodology caused our charges to drop significantly from those of last year.” She continued, “This created a change in the cost-to-charge ratio for that department and essentially, we were being underpaid for most of our pharmaceuticals. We were not recouping the cost of items dispensed out of the pharmacy. This, too is part of the receivable due from Medicare. We have asked Medicare for an adjustment to our Part B payment amount based on the cost-to-charge ratios now. It should be raised from 42% to 61% and we have asked for that to be effective immediately so it will increase our revenue coming in from Medicare for July, August and September.” Once those changes are made, GWCH should see less loss than what they have been experiencing in recent months.
In recent months, the hospital administration also looked into the charge master, including its maximum allowable payment (MAP). It was noted during the meeting that some of the charges were under the MAP rate, meaning GWCH isn’t getting paid enough for the service. Those MAPs were increased in June and should increase revenue coming in for the remaining months of GWCH’s fiscal year.
CEO Dickerson shared that many of the items that GWCH has listed take time to change. “Sudden changes in how we do business can have a dramatic effect on the finances of the hospital, which is why we do things slowly and we don’t react quickly.” She continued, “This method of costing and accounting is a beast that many do not understand unless they live, eat, sleep and breathe it daily. We are working on changing what needs to be changed to positively impact the hospital financials.” During the county commission meeting on Monday of this week, CEO Dickerson said “What we want the community to know is that we are not closing now and we have no plans to in the future.” She concluded by noting that this turbulence is not new to this hospital and GWCH staff will get some things corrected before their fiscal year is over.
CEO Report
During the CEO report, Dickerson shared multiple initiatives that GWCH staff are working on that will bring in additional funding, expand services and long-term planning.
Director of Nursing Sonjia Lemons has worked on a Community Health/Accountable Food is Medicine grant with the Rural Health Transformation program. The grant application is for approximately $120,000. The application was due on June 19, with the announcement expected to come mid-July. The proposal requests approximately $120,000 to support salaries, equipment, travel, training, software, and overhead expenses. The program anticipated awarding seven grants but depending on funding amounts, additional grants could be awarded. Lemons also plans to apply for another grant, focused on emerging technologies. This grant would be to seek funding for 25 inpatient beds and four emergency department beds through grants. The grant would be for hospital smart beds which enhance patient monitoring by detecting vitals like heart rate and respiratory rate through integrated, non-invasive mattress sensors.
Dickerson noted that GWCH has signed a contract with Clinicus to provide Chronic Care Management and Remote Patient Monitoring services for eligible clinic patients. Their current agreement with ChartSpan, has been terminated and Clinicus is expected to launch by Sept. 1.
Through the Rural Health Transformation Program, Great Plains Health Alliance (GPHA) has secured funding for Avel eCare, allowing GWCH to utilize televideo support for emergency department and inpatient services at no cost while grant funding remains available. The service will assist with afterhours admissions, nursing consultations, and timesensitive emergency care.
Dickerson also noted that United States Senator Josh Hawley recently introduced the Rural Hospital Emergency Room Guarantee Act, which would establish a 10-year federal funding program to support rural emergency departments through guaranteed annual payments and additional assistance based on community need.
She also noted that Jennifer Eagleson, APRN at Eureka Clinic, has submitted her resignation, see related article. Dickerson noted that staff is working to recruit a replacement and noted that Eagleson made a tremendous impact on the organization and will be greatly missed.
Other Business
The board approved the consent agenda, which included the June 2 meeting minutes, the May Treasurer’s report and disbursements: payroll/ benefits: $803,819.24 and accounts payable: $297,179.87.
Melissa Jones, Risk/ Quality/Eureka Clinic Director, provided the board with a quality report update.
The board approved the following hospital policies: Discrimination, Drinks and Snacks, Head Trauma Protocol, Membership Dues, Missed Appointment and Stroke Protocol Policy.
Director of Nursing Lemons shared her report, along with a medical staff report.
The following reappointments were approved as presented: Kelsey Bourm, MD – Te l e r a d i o l o g y Consulting; Lisa May, MD Teleradiology Consulting; Carey Hurt, APRN - Allied Health; Lindsay Wells, PA – Allied Health Consulting; Jason Hoke, DO - Family Medicine Consulting.
The next GWCH Board of Trustees meeting is slated for Thursday, July 23, at 5:30 p.m., in the hospital meeting room.
Commissioners Heard Update From GWCH CEO
Greenwood County Commissioners held a short business meeting on Monday, June 29, where they heard from Greenwood County Hospital (GWCH) CEO Sandra Dickerson regarding financials, along with routine business items, before hosting a budget workshop for county department heads.
CEO Dickerson provided an update to the commission, which was also shared during the recent board of trustees’ monthly meeting.
See related article.
Dickerson focused on a variety of items that have caused financial issues at the hospital, ultimately noting that adjustments have been made and increases in revenue should be seen before the fiscal year-end (September). She noted that hospitals don’t have the ability to pivot quickly when making changes as that could cause a ripple effect in the other direction. “It takes thoughtful processes and we must make those changes slowly over time,” she stated. She also addressed comments that are being made regarding the facility closing in the near future. “No, it is not.” She stated. “The fact that it is being said is hurtful for the community,” she continued. Dickerson further noted that the comments could and will drive patients away if they fear the services are no longer available, when in fact, the hospital is working to bring providers to GWCH and expand services. Most recently, Dr. Boxberger returned to offer cardiac care at GWCH.
Commissioner Judd Everitt asked about the loss of a provider at Eureka Clinic. Dickerson said, “Providers come and go. I love Jen (Jennifer Eagleson), she is my provider. I’m not happy about it, but I am happy for her.” See related article. Dickerson noted that during her tenure, this is the third provider at Eureka Clinic, who was beloved by patients who has moved on. Dickerson noted that current providers at Eureka Clinic will provide care to Eagleson’s patients after her last day, Aug. 16; however, hopes to have a new provider in the role by September. Discussion was also held regarding EMS transfer times and how transfer times (time from when the provider makes the decision to transfer and the patient being transferred) have decreased on average by 57 minutes per transfer. The average transfer time is now 149 minutes. Commission Preston Evenson asked why there have been so many transfers, with Dickerson noting that it depends on what the patient needs, as GWCH can’t provide care for all needs (ie, surgical, cath lab, etc.)
A discussion was held regarding funding for the use of the Eureka Downs concourse building during the fair. However, commissioners had questions regarding the use of the facility and tabled the matter until next week’s meeting to allow for representatives to attend for clarity. Last year, the commission approved providing $12,000 for the use of the facility.
The commission approved paying the annual payment for the Eureka Fire Department’s new rescue truck, which is expected to arrive in April 2027. The annual payment, for the county’s portion, is $29,714.98.
Two executive sessions for legal matters were held, for 10 minutes each. The first was with Clerk Deann McCaffree and Counselor Paul Dean, regarding a road issue. The second was with the commission and Dean. No action was taken following either session.
Sheriff Heath Samuels presented budgets for Juvenile Detention and 9-1-1. Samuels noted that both budgets could be decreased and noted that the juvenile detention expenses in recent years have been low. In the future, Sheriff Samuels thought the commission could create a reserve account in the budget to transfer funds to at the end of the year and then decrease the budget annually. The 9-1-1 budget is primarily funded through reimbursements from the state.
The June 22 meeting minutes were approved as presented.
Following the meeting, the commission and department heads were invited to stay for a KAC budget class, in the commission meeting room.
Commissioner Mac Obourn was absent.
The Greenwood County Courthouse will be closed on Friday, July 3, in observance of our Nation’s Independence.
The next scheduled meeting is Monday, July 6, at 9 a.m.
