The Greenwood County Hospital (GWCH) will soon return bone-density scanning to its radiology services, following the loss of Dexa bone scans in April of this year.
During the monthly GWCH Board of Trustees meeting, held on Thursday, Sept. 24, CEO Sandra Dickerson presented a proposal noting a $28,000 investment that would restore the Dexa bone scans that were discontinued after the hospital stopped using the mobile mammography service and began providing mammograms in-house. It was shared that Radiology Director Cody Ray located software that would allow the hospital’s existing CT scanner to perform bone-density scans. The proposal would bring the service back without requiring the hospital to purchase a separate Dexa machine or find additional space within the radiology department.
According to Dickerson, the software would be depreciated over three years, resulting in an annual depreciation expense of about $9,333. At an estimated reimbursement of approximately $305 per scan, the hospital would need to perform roughly 31 scans annually to offset the software cost alone. Dickerson said previous volumes had exceeded that threshold and indicated they believe demand would support bringing the service back.
A traditional Dexa machine is roughly the size of a tanning bed and would require the hospital to identify an appropriate location. The proposed software would instead use the hospital’s existing CT equipment, requiring no additional space beyond what is already available in radiology.
The hospital purchased its CT scanner in 2021, and the equipment is owned free and clear. Staff currently working in radiology would be able to perform the scans, according to the discussion. The board discussed two potential approaches to acquiring the CliniQCT technology: purchasing the software outright or exploring a lease arrangement. The board ultimately approved purchasing the software outright.
The meeting also included comments and questions from members of the public, including Adam Colangelo, Dick Rucker and Jeff Sowder.
Colangelo asked why the hospital had not originally applied for the Employee Retention tax credit, related to the COVID-19 pandemic. Dickerson explained that the hospital had previously consulted with its auditing firm and attorney, who advised holding off because other cases showed hospitals having to repay the credit. The hospital has since revisited the issue after developments involving other healthcare organizations and litigation concerning the IRS’s interpretation of the program.
During GWCH’s Aug. 27 meeting, Dickerson shared the hospital had filed a claim seeking approximately $1.4 million through the Employee Retention Credit, a refundable tax credit available to qualifying businesses and tax-exempt organizations that retained employees during the pandemic. Dickerson said a tax law firm reviewed the hospital’s documentation and determined it qualified for the credit. The tax firm, handling the claim, is working on a contingency basis and would receive 40% of any successful recovery, leaving the hospital with an estimated $840,000. The process could take up to a year to complete, she said.
Sowder asked about an approximate $92,000 payment the GWCH Foundation approved for the mammography machine following the hospital’s Gala. The funds currently remain in the donated line item of the hospital’s checking account, with Dickerson noting GWCH is having difficulty processing a payment as the company is only wanting to accept a monthly ACH payment, which is currently set at $6,000. GWCH staff plans to reach out to the sales representative directly to see if they can assist with the process.
Rucker questioned how the amended budget compared with the budget presented to county commissioners earlier in the year.
CEO Dickerson and CFO Butch Forrest explained that the original budget was based largely on forecasts because the budget had to be submitted to the county commission by June 1. The discussion returned to the question of historical averages and whether five years of information could provide a more useful basis for projecting revenue and expenses.
The board also discussed 1099 contractors. Four individuals were identified as working under 1099 arrangements, with two described as essentially fulltime. The board questioned whether those costs should be broken out with payroll. It was noted that Great Plains Health Alliance (GPHA) would look into the matter and examine whether those expenses could be separated into individual line items.
The board also reviewed the hospital’s financial position, including an August loss of approximately $21,902. The board reviewed several individual expenses and payments.
The hospital also increased its budgeted 340B expense by about $465,000. The board questioned the assumptions being used to project future revenue, particularly whether the hospital was being sufficiently conservative.
Dickerson explained that the hospital’s historical analysis typically looks beyond a single year, often using five years of data when developing projections. Board members discussed whether to apply historical data from previous years more broadly to individual departments. CFO Forrest also noted that he had each department assist with the budget process to ensure figures aligned with their projected spending/ revenue.
The discussion also addressed Medicare reimbursement. Hospital officials said certain room rates had increased significantly, with reimbursement reportedly increasing from approximately $2,000 per day to about $3,200 per day. Board members also questioned whether the hospital is charging appropriately for its services given inflation and rising costs. It was noted that some rates had not been changed for several years and that work remains underway to evaluate and update rates.
CEO Dickerson provided the medical staff report, noting that they met on Sept. 15 with members discussing research involving GLP-1 medications and vitamin D deficiency, as well as stroke care. The medical staff also discussed the BioFire 5 system, which was described as having broader acceptance among insurance companies.
The Director of Nursing provided an update that included swing-bed services. The hospital continues to pursue additional swing-bed opportunities.
CEO Dickerson reported continued difficulty recruiting qualified candidates for the open position at Eureka Clinic. An applicant had recently been interviewed and offered a position but declined. The hospital is considering using a head-hunting firm to assist with recruitment.
As of Sept. 30, the electronic health record transition was complete. Leadership reported that AthenaNet items are being closed out, with the remaining payment runout period scheduled. After that period, the hospital expects to be completely operating in Cerner. When asked how the staff has responded to the new system, Dickerson responded that AthenaNet and Cerner are fundamentally different systems. AthenaNet was described as being more revenue- driven, while Cerner is more clinically focused. Staff experienced some challenges during the transition, including the increased need for scanning, but Dickerson said employees are beginning to recognize the value of the new system because it provides greater visibility into patient information and clinical activity.
Board member JJ Smith asked Jim Blackwell with GPHA to provide a synopsis of the services being provided under the agreement between GWCH and GPHA at a future meeting.
The current strategic plan for GWCH expires Dec. 31 and a work group will be formed to develop a plan covering 2027 and 2028. The hospital expects to present the new plan to the board in November. Board members Smith and Kevin Hough volunteered to serve on the strategic plan committee.
The hospital also continues to pursue outside funding opportunities. CEO Dickerson shared that she heard back from KDHE who recently informed them that its Emerging Technology grant application was not selected. Leadership said the hospital will continue applying for grants and noted that other organizations’ successful grant applications have created opportunities for GWCH to access certain services at no charge, including Avel e-Care coverage in the emergency department and on the hospital floor on nights and weekends.
Several GWCH policies were approved as presented.
The board held a 10-minute executive session for contract negotiations with CEO Dickerson and HR Director Janel Palmer. No action was taken.
The board reviewed the quality and committee reports.
The board approved the following appointments: Matthew S. Towsley, MD, Radiology Consulting; and the following through Teleradiology Consulting: Sarah Kurian, MD; Ellen Yetter, MD; John Burns, MD; Susan Gutschow, MD; Kenneth Kim, MD; Michael Applebaum, DO; Charles Horner, MD; and Sandeep Reddy, MD. The board also approved the following re-appointments: Gale Crouch, APRN, Allied Health; Timothy Gronline, MD, Teleradiology Consulting; and Rachel Jimenez, PA, Allied Health.
The meeting adjourned at 7:33 p.m.
The next board of trustees meeting is slated for Oct. 29 at 5:30 p.m.
