TCMH Shows Profit in '07; Looks Toward Building Project

Texas County Memorial Hospital had $793,898 in excess revenues over expenses, the TCMH board of trustees and administration heard at last week’s monthly board meeting.

Stephanie Weis, senior manager at BKD, LLP of Springfield, presented the annual audit report.

“You had another remarkable year. You have weathered well the change in the mix of patient services, ” Weis said, noting that inpatient discharges are down for the second year in a row at the hospital.

Medicare and Medicaid, the largest payer groups at TCMH, showed a $1.6 million drop in 2007 compared to 2006, but they still brought in $14.4 million to the county hospital.

“That’s indicative of a solid performance for the hospital,” Weis explained.

Uncompensated care rose again for this hospital, up to $4.61 million in 2007 from $3.54 in 2006. This number is reflection at the local level of the numbers of patients who are uninsured and unable to pay for their healthcare. Since 2005, uncompensated care at the hospital has almost doubled.

“It’s important that you keep the community aware that this hospital is not funded by taxes,” Weis said, explaining that in many county hospitals the county residents assume that county taxes help foot their personal bill, so there’s little incentive to pay for services.

Weis encouraged the hospital to consider setting an expectation for upfront collections of payments or co-payments in the hospital and clinics.

“Many hospitals have a policy that sets the tone to accept payment when service is rendered,” she said.

Following the annual audit, gross revenue for the hospital in 2007 was $54.5 million with an excess of revenues over expenses of $793,898. Weis noted that the 2007 numbers were “another year of solid performance.”

BKD sends an audit team to TCMH each March, spending about a week pouring over hospital financial information from the previous year. The firm takes about a month to complete the audit information including income-expense statement, balance sheets, statement of cash flows and other information that comprises the 26-page financial report document, which was presented at the April board meeting.

Weis noted that BKD uses historical TCMH data and numbers from other healthcare facilities for comparison purposes during the audit. BKD also has access to the latest information regarding hospital payers, which helps the firm reach concrete numbers in the final audit report.

Capital investments at the hospital in 2007 were not as large as those in 2006, which included a new clinic and MRI. But the average age of the facility and equipment at TCMH dropped to 7.1 years, down from 7.7 years in 2006. Weis noted that among the county hospital’s peers, the average facility and equipment age is 8.6 years old.

TCMH continued to operate efficiently with an operating margin – operating revenues over operating expenses – of 2.31 percent in 2007.

Days patients spent in the hospital in 2007 were 3.49, down from 3.50 days in 2006, so patient acuity remained about the same.

TCMH continues to provide a wage and benefit package to employees that is competitive with the rural Missouri average. In 2007, the average salary expense at TCMH per full-time equivalent personnel was $40,718. The rural Missouri average is $42,950.

Weis commended the hospital’s board and administration on the capital improvements made at TCMH in 2007 and recent years.

“Your community deserves this,” she said.

Weis also recommended that a “formal forecast” showing the projected five-year financial picture be done by the hospital before a proposed hospital expansion project.

Wes Murray, chief executive officer at TCMH, agreed that a five-year financial forecast would be done in the next few weeks. In addition to the financial forecast, Murray reported that JE Dunn, the construction firm managing the expansion project, will make a presentation to the board at the May hospital board meeting.

Also at the meeting, Steve Nyquist, a consultant with Salient HealthVentures, spoke with the hospital board regarding consulting work he’s doing for TCMH regarding customer service initiatives and the upcoming hospital expansion project. The Delta Regional Authority has provided the funding for Nyquist’s work, which has a value of $18,000.

Nyquist reported that after initially meeting with the hospital’s administrative team, several department managers, physicians and community members, he found that people are “proud of the hospital” and feel that it’s “a part of the community.”

“There is a strong sense of understanding the mission of TCMH – caring for patients,” Nyquist explained.

Nyquist is continuing to work with the hospital to improve “relational excellence” at the facility, focusing on the attitudes and behaviors of the people who work at the hospital and how they affect everyone who visits the hospital.

“There’s always room for improving our care,” Murray said. “What Steve brings helps to motivate and remind our department managers of our customer service needs.”

During the meeting hospital board members elected new board officers for the 2007-2008 year. Omanez Fockler will serve as chairperson, Janet Wiseman as vice-chairperson and Jane Kirkman will serve as secretary. A resolution was also signed accepting the results of the April election in which Mark Forbes was re-elected to a board member position.

In other business, Linda Pamperien, chief financial officer, reported that the hospital had a positive bottom line of $61,240 in March, with a year to date balance of $227,726. The average daily census for the month was 16.

Present at the meeting were Murray; Pamperien; Weis; Nyquist; David Taylor, supervisor at BKD; Doretta Todd-Willis, chief nursing officer; Joleen Senter Durham, director of public relations; Charles Mueller, M.D., chief of staff; John Duff, M.D., Cox Health representative; David Rosemann, director of environmental services; and board members Wiseman, Fockler, Kirkwood and Forbes. Board member Larry Southern was not present.

The next meeting of the TCMH board of trustees is noon Tuesday, May 27, in the downstairs meeting room of the hospital.

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