On the drawing board is the construction of this 8.1 million project on the Texas County Memorial Hospital campus. (Rendering by H Design Group)

Texas County Memorial Hospital board members approved 2011 capital and operating budgets last week at their monthly meeting.

The hospital’s 2011 capital budget came in at $696,188 — slightly more than the $690,818 approved in 2010.

“Once again we have taken a conservative stance in our budgeting,” said Wes Murray, TCMH chief executive officer.

TCMH planned the current 2010 budget based on the addition of three new physicians working full-time at the hospital and in hospital-owned clinics. However, two of those three physicians did not begin their employment with TCMH until the last half of the year. Murray called 2010 a year of “digging out” from 2009 when hospital revenues fell.

“I honestly hope we are terribly wrong in our projections for 2011 – to the good, of course,” Murray said, citing variables such as government reimbursement rates and the potential of recruiting additional physicians.

The ’11 capital budget includes a $70,000 contingency fund and $98,000 for a new ambulance to replace an older ambulance of the six ambulances that TCMH has in service.

The budget also includes $57,000 for a new X-ray machine for the TCMH Family Clinic in Licking, where Dr. John Paulson will begin working full-time in January. The budget includes $55,000 for a new ultrasound machine for the TCMH Medical Complex in Houston, where Dr. William Wright and Dr. Charlie Rasmussen practice obstetrics and regularly utilize ultrasound services for their patients.

Thirty-five thousand dollars has been budgeted for a new ventilator, and $36,000 has been included for a new stress testing machine.

The hospital’s 2010 operating budget projects gross operating revenue of $61,652,923 and net operating revenue of $27,430,238.

“We planned the operating budget for 2011 by looking at the revenue generated at the hospital this year,” said Linda Pamperien, chief financial officer at TCMH.

Pamperien attributes the uptick in hospital revenue at the end of 2010 to the addition of new physicians referring to hospital surgeons, admitting inpatients and ordering additional outpatient tests and procedures.

“We are hopeful that we will have continued growth in inpatient revenues and outpatient revenues in areas such as MRI and lab,” Pamperien said.

Pamperien noted that the hospital may see additional funds in 2011 from achieving “Stage One Meaningful Use” and receiving additional reimbursements for laboratory services and “super rural” ambulance service.

“We’re not counting on any of those funds until we actually see them,” Pamperien said.

Murray cautioned that “not knowing what Medicare and Medicaid will do” forces the need to take a conservative line in the budget process.

“We could be terribly hurt by not planning for cuts,” Murray said.

Pamperien also pointed out that uncompensated care at the hospital rises every year. “There is no way to project the amount of care we will provide that we will not receive payment for,” she said.

After projected expenses, the 2011operating budget proposes a $278,813 net profit for TCMH at the end of the year, reflecting a 1 percent profit margin.

The operating budget increases personnel at the hospital by one full-time person that will work in the hospital’s information technology department.

In other business, Murray reported that the Texas County Commission has signed a letter of agreement with the U.S. Department of Agriculture to assist the hospital in proceeding forward with obtaining an $18 million low-interest loan to expand and renovate the hospital beginning in 2011.

Murray; Pamperien; Omanez Fockler, chairperson of the TCMH board of trustees; and John Hammons, the hospital’s legal counsel; met with the commission early in December to discuss needs of the hospital and the USDA as well as discussing the commission’s involvement in hospital business.

“Our meeting with the commissioners provided an opportunity to bring in our attorney to provide some education on the dos and don’ts of the county hospital and the commission’s responsibility to the hospital,” explained Murray.

Following the meeting, some language in the USDA letter was tweaked and a side agreement was signed by TCMH noting that the county is not responsible for hospital debts, which is in accordance with state statutes regarding county hospitals.

“Our attorney helped explain there are limits and boundaries to the commissioners’ involvement in the day-to-day operations of the hospital, and there are risks and liabilities in stepping over those limits and boundaries,” Murray said.

Fockler explained that she asked the commissioners to speak with Murray regarding hospital business first.

“Wes doesn’t speak independently of us,” Fockler said. “He is our spokesperson and speaks for us. I reiterated to the commissioners that the hospital expansion project will provide better patient care for the citizens of our county.”

Murray explained that TCMH will continue to work with the Texas County Commission. Signatures from the commission will be needed on additional documents from the USDA as the hospital’s project continues.

Physician recruiting efforts at TCMH have shifted again toward recruiting a full-time physician for the new TCMH Mountain Grove Medical Complex and recruiting an additional full-time physician for the TCMH emergency department.

The TCMH Family Clinic in Licking had taken priority in hospital recruiting efforts in July when the full-time physician in Licking resigned.

“Dr. Paulson will begin seeing patients full-time in Licking in early January,” Murray said.

To assist in providing patient care throughout the county, Paulson began seeing patients one and half days a week at the Licking clinic beginning in September. Paulson’s patient volume has continued to increase at the Licking clinic, according to Murray.

“Dr. Paulson and his wife decided that working full-time in Licking would be a good fit for Dr. Paulson,” Murray said.

Paulson believes that many of his patients in Houston will follow him to the Licking practice.

TCMH interviewed a physician for the Licking practice in early December, and that physician is considering the possibility of working in Houston with the vacancy created by Paulson.

The hospital also hopes to hear by the end of the year from a physician that is seriously considering the Mountain Grove clinic opportunity.

Pamperien presented the financial report for November. Inpatient and outpatient volumes were up for the month. Inpatient admissions at the county hospital are up by 131 admissions compared to admissions at the end of November 2009.

TCMH had a positive bottom line of $11,330 for the month. The hospital’s year-to-date bottom line is $115,832.

Present at the meeting were: Murray; Pamperien; Doretta Todd-Willis, chief nursing officer; Dr. Charles Mueller, chief of staff; Dr. Charlie Rasmussen, vice chief of staff; Joleen Senter Durham, director of public relations; and board members Fockler, Janet Wiseman, Jane Kirkwood and Mark Hampton. Board member Mark Forbes was absent.

The next meeting of the TCMH Board of Trustees is noon Tuesday, Jan. 25, in the downstairs meeting room of the hospital.



Once again we have taken a conservative stance in ourbudgeting.

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