TCMH CEO Wes Murray outlined the results of a feasibility study on expansion to the board during a meeting last week.

The Texas County Memorial Hospital bottom line is back in the black and inpatient numbers continue to climb, board members heard last week at their monthly meeting. Inpatient numbers have steadily risen all year, but the hospital slipped into the red after February.

In her financial report, Linda Pamperien, chief financial officer at TCMH, explained that hospital inpatient numbers are up by 119 admissions as of July 31 compared to hospital inpatient numbers from the same time in July 2009. Year-to-date, 1,056 patients have been admitted to the county hospital.

“In July, volumes were up in all departments except for two,” Pamperien said.

TCMH ended July with a positive bottom line of $53,669, bringing the year-to-date balance out of the red and up to $28,370.

“We forecasted that the addition of more physicians to the hospital’s medical staff would drive our volumes up and help us achieve a financial turnaround,” said Wes Murray, chief executive officer at TCMH.

Dr. John Paulson, family medicine physician at the TCMH Medical Complex in Houston, began seeing patients full-time in July. Dr. Gretchen Price, internal medicine physician at the TCMH Medical Complex, began seeing patients part-time in August and will begin full-time work in September.

Additionally, TCMH opened a new medical clinic in Mountain Grove in May. The clinic is staffed full-time by Sheri Stofer, a physician assistant, and part time by Dr. Michael Moore, a family medicine physician. Dr. Charlie Rasmussen is also seeing obstetrics patients in Mountain Grove one afternoon a week.

Murray and Pamperien also presented the financial portion of the feasibility study recently completed by BKD, LLC, in Springfield, the hospital’s accounting firm.

TCMH embarked upon the feasibility study in an effort to obtain United States Department of Agriculture (USDA) funding for the hospital’s expansion project. Last summer, the USDA expressed interest in trying to fund the TCMH project with federal loan money released in 2009 as part of the Economic Recovery Act. The funding was to be available until Sept. 30, 2010.

TCMH was required to submit a financial feasibility study along with the application for federal loan funding. If approved, TCMH would obtain low-interest funding to expand the physical size of the hospital creating a new, larger emergency department and private medical surgical patient rooms and to remodel and renovate several hospital departments such as obstetrics, intensive care and surgery.

The USDA application and feasibility study were turned in to the state USDA office in August, and the state planned to turn the information in to the federal USDA office on the 24th of the month.

“The financial feasibility study looks very positive for us in regards to the expansion project,” Murray said. “Unfortunately, when the state USDA officials recently looked at the balance of funds they had remaining to give out in the state for economic recovery and disaster assistance, the balance was at ‘zero.’ “

USDA officials explained to TCMH administration that all of the Economic Recovery Act funds and disaster recovery funds, including some funds that had already been allocated to USDA projects around the state, were taken away from the USDA to fund recently passed legislation – the Education Jobs and Medicaid Assistance Act of 2010.

The act, signed into law by President Obama on Aug. 11, provided $26 billion to state governments for education and Medicaid program assistance. Funding for the new bill was made possible by reducing the economic recovery and disaster assistance funds.

Despite the setback, Missouri USDA officials proceeded to deliver the TCMH application and feasibility study to the federal USDA office in Washington, D.C. State USDA officials and TCMH administration are making contact with federal legislators regarding the TCMH project and the USDA economic recovery funding.

“All of the work that has been put into this has again been put on hold,” Murray explained, adding that despite the setback with USDA funding, the “thorough feasibility study can be used to achieve the goals of the hospital.”

The financial portion of the feasibility study projects detailed hospital revenues and expenses for the next five years, utilizing information such as numbers of physicians employed by the hospital, funding the hospital expects to receive for electronic health records and cash the hospital has on hand.

“This study shows that TCMH can finance the projected expansion project,” Murray said.

In 2008, TCMH planned to utilize bonds to finance the project. The financial market collapse in late 2008 made utilizing the traditional bond market unfeasible due to a sharp rise in interest rates, and expansion plans were placed on hold.

The USDA funding was in the form of a loan from the federal government, and TCMH hoped to take advantage of the low USDA loan interest rates to utilize more money for the actual expansion project rather than paying a higher interest rate.

TCMH will continue to try to work with USDA for project funding as well as looking at other financing options for the project.

Earlier in the year, the federal government released information regarding “meaningful use” for electronic health records and what healthcare facilities must do to achieve “meaningful use” status and to receive special federal funding for electronic health records.

TCMH sent some of the hospital’s information technology staff to an electronic health record conference earlier in the month to identify what TCMH needed to do to achieve “Stage 1, Meaningful Use.” The hospital began implementing electronic medical records in 2005.

Based on information from the conference, four additional steps are required to be in place for 90 days at TCMH for the hospital to meet the 14 core requirements set by the federal government. TCMH must have in place a Linux server, an interface management system, medication reconciliation system and electronic file management system.

“The majority of meaningful use criteria have been met,” Pamperien explained to board members. TCMH had already allocated $46,000 in the 2010 capital budget to purchase the medication reconciliation system.

To meet the additional requirements, Pamperien requested and board members unanimously approved $45,434 to purchase the Linux server and the electronic file management system. The outside laboratory service that TCMH contracts with will provide the interface management system to the hospital at no charge.

“We need to have all of this in place by the end of the year, so we can use it for at least 90 days,” Pamperien explained.

In spring 2011, TCMH will be in line to receive $1.6 million from the federal government for achieving meaningful use of electronic health records.

“We are very fortunate,” Pamperien explained. “We have done so much for electronic medical records, and we are much further ahead than many other facilities.”

Pamperien believes that the $1.6 million will “come close” to covering what TCMH has expended in the past decade as the hospital added technology throughout the hospital and clinics. Additional federal funding for electronic health records will be available in future years, too, but the largest chunk will be paid in 2011.

Murray explained that 20 percent of healthcare facilities are expected to be in the “penalty phase” for electronic medical records by 2014, which means the federal government will begin fining those facilities that are not achieving meaningful use.

“I’m glad we are this far ahead in the process,” said Omanez Fockler, TCMH board of trustees chair.

In other news, TCMH is planning to step up patient awareness of the inpatient surveys used by the hospital to collect patient satisfaction data.

“A good percentage of TCMH inpatient surveys are returned,” said Joleen Senter Durham, director of public relations and member of the TCMH Customer Quality Team. “However, we hope to stimulate conversations with our patients and staff members to encourage more surveys to be returned.”

Durham pointed out that many people believe they should only return a survey if the experience was negative.

“Our goal is that every patient has a very good hospital stay,” she said. “We need our surveys to reflect good and bad comments to know what we are doing well and what areas need improvement.”

Hospital inpatients will soon see a sample survey on their dietary trays each day. Small posters asking patients to fill out surveys that may be received after they return home will also be placed in each inpatient room.

Present at the meeting were Murray; Pamperien; Durham; Colette Briggs, infection control nurse manager; Dr. Charles Mueller, chief of staff; Dr. Charlie Rasmussen, vice chief of staff; and board members Fockler, Mark Hampton and Mark Forbes. Board members Jane Kirkwood and Janet Wiseman were not present.

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



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