Progress on 1 Percent Projects

LUSK - Chairman Mark Groh called the May 28 Niobrara County Hospital District board meeting to order at 5:30 p.m. The agenda approved as presented and meeting minutes from the April meeting were approved as presented.

Public Comments:

Ms. Larson discussed an article that she had read in a board training newsletter that recommended having patient testimonials at the beginning of every board meeting as a way of making sure the Board and administration looks at situations from the patient’s perspective. Mr. Boldon has not received a lot of feedback lately from the public either negative or positive. There was a patient complaint and Mr. Nelson had followed up with that concern.

Financial Reports:

As of the end of April the operating account balance was $311,000. What is sitting there at the end of April is the cost report money. All money was spent with expenses. However, as of the end of May the balance is $200,000 ahead of Cost report balance and all payables are correct. The numbers for April don’t look good however there is a significant turn around coming for the end of May. Interest for the spent funds will be booked at the end of the Fiscal Year. Groh recommended reassessing where those funds are deposited to make sure that the hospital is optimizing for interest rates.

Aging report for receivables for the end of April shows an outstanding balance of $2.2 million. The hospital has been recovering many accounts during the month of May. The goal was $1 million. While that goal was not made the department did come close. LeSeur handed out an interim report with the different projections for the month of May. Through the 3rd of June there is another $370,000 still sitting on the Medicare floor that will be collected by then. Projected revenues will be, as of June 3, estimated $1.44 million. The collections will not be included any more. To compare apples to apples from the end of May to June 3 then you would need to adjust receivables by $370,000. This results in a 1$.9 million end of May compared to $1.4 million to date (current). Projection doesn’t include private pay, private insurance or Medicaid. Adjusted categories for the projections versus the existing aging receivables report allows for more accurate projections. The decline in collections is attributed to Nick working a lot. Dee and Nikita are contributing more to those “problem” accounts. DNFB was at around 6 days as of last week. Charge entry timeliness was an issue but has been cleaned up now.

Report shows $274,000 of open payables for the end of April. $165,000 current so payables are coming down. The district has reached a repayment agreement with the county for the $500,000. There were no promises or terms just an agreement that the hospital will be paying back as it can. Will pay as can on a monthly basis if possible. Expecting to pay back everything for cost report from what we are looking at right now which is almost $300,000. Right now the cost report auditor is working on a program specifically for the hospital that will be paid for by a grant so that numbers can be plugged in to calculate where the hospital sits.

The audit is still in progress. LeSeur is expecting a draft by the June meeting. There are no items remaining that the auditors are uncomfortable with.

In April patient revenue was at $874,000. Bottom line is $884,000 income before expenses. Swing beds are still strong. Total expenses $790,000 comparative profit of $93,000. The board inquired about buying out the leases. Karl addressed this that as long as the cash position is increasing the better long term decision is to leave that in lease because the district is able to recognize a greater portion of the expense of a lease in the cost report than with purchased equipment. The hospital does have the option to purchase but it is better as of right now to leave on lease. Maintenance agreements really disadvantage a facility after purchasing equipment. YTD income is $613,000. Take off SPET income since can’t use that. Purchased services were $95,000 this month. Athena was big because of cost report. Had to pay Athena 11/12ths of the cost report amount.

The board inquired about some individual checks that were issued and showed in the check register. These items were either ECF refunds, contract nursing and rent checks.


Goal was to have a 0 bottom line once the special tax fund was taken out. Profit is equal to the special tax income. This is considered a break even budget. To begin the calculations for this LeSeur started with the averages for the entire previous fiscal year. Tax levy money was taken as what was received in previous year. Broken out by month. LeSeur emphasized that it will take another year of this specific budget process and categories to obtain a really good expense history to move forward with a more aggressive budget. Adjustments with expenses. Depreciation was adjusted. Acute care has all of the extra care categories out of ECF, PT, Pharmacy, Clinic. All revenues broken out are categories that expenses can be broken down for comparison. The rest is in support departments. Central supply, social working, billing, etc. that don’t have revenue associated with them. Averages were adjusted to hit the break even. LeSeur feels this is a very realistic predictive adjustment. The managers will take the budget and add it to their own departments. Going to be training managers to manage their own budget on an ongoing basis. Start keeping track of where we were sitting on the cost report and improving contractual adjustment calculations so the district can more accurately run information. The payback to the county is nowhere in the budget since that will be completely based on cash.

The board discussed making a payment to the county prior to September. Administrationi agreed to maintain open dialogue with the county commissioners and make sure they know where the district sits and that payback is being discussed in an onging way. The board advised administration to make a payment of $10,000 in the next 60 days.

Kody Nelson, Administrator spoke to activity volumes for the month of April. The volumes for the clinic have remained steady. Providers 170 and 169 and 42 for nurse clinic visits third provider 15. MTM it is mirroring last year’s numbers. Lab is up slightly. Outpatient visits are there but not impactful. ER visits are up in April, very busy. Strong swing bed days. Number of inpatients are up. Starting to pick up referrals from other facilities. Community members are fighting more to stay here/be transferred here. ECF was at 18. Several deaths so not full now, down to 16. Do have a waiting list but most of the people on it are simply not ready to be admitted.

No policies for review.

Roof project update: This project is 99% done. Getting the architect in to give final approval. Dan was satisfied with the contractor and the work that was done. Tub room is next on the list. The problem is that it is pushed back to August because had to wait for bids. The hospital sought out a reduced bid from the awarded company based on some changes in detailed items of the bid. Nelson will get specifics from the Facility Director to pass on to the board. The tub room needs redesigned much better. CTA started the project before HMS came on board. The architect that did it has been let go since then.

Update on the 340B program. Been seeing payments from the program coming in. $1300 in the black with that program. Nelson was please to report that the process works and now the district can begin optimizing those numbers and options.

The next round of computer replacements will be happening in the next month. Another 20 units will be switched out. The hospital is in the process of obtaining the bid to get them changed out. 1% money will be used for this. The new computers that have been done already are working much more efficiently and are better according to staff.

It is necessary to make some concrete repairs next to the ECF. The facilities director has put this out for bids right now. Upgrades to the rooms are being done utilizing hospital auxiliary funds. The emergency generator needs fixed (the turbo will be about $10,000) so that the hospital can say they have a generator and then need to obtain another one to get to code. Doesn’t meet codes for the hospital The existing generator no longer meets requirements for the hospital based on government requirements. Will try to have Purchase Order and invoice date prior to June 30. Trying to negotiate a discount for purchasing Sundance and Lusk together.

The board will be doing a cost report training and CAH finance training. 4-7 p.m. on Monday July 22.

New Business:

Approval of temporary signing privileges given to Kody and access privileges for LeSeur. Moved that LeSeur have online access to view all accounts including SPET account. Motion carried.

Moved that for transfers from SPET account to operating one of the two approvals may be via telephone and there other will be a physical signature permission. Motion carried. Move that Kody Nelson be given purchase order signature privileges. Motion carried.

Board toured the facility and then adjourned.




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