Texas County Memorial Hospital

Texas County Memorial Hospital will receive a $357,000 grant from the Missouri Foundation for Health to fund a three-year outpatient cardiopulmonary rehabilitation program, board members heard at last week’s monthly meeting.

Wes Murray, TCMH chief executive officer, said the grant was one of 13 awarded by the Missouri Foundation for Health in the 2016 grant making cycle. Murray said MFH received 197 requests for grant funding during the three funding cycles for “special projects” in 2016. 

TCMH was one of 27 organizations asked by MFH to submit a full grant application for further review and consideration. The TCMH grant was part of $3,790,941 awarded by MFH to 10 different projects in this funding cycle. The funds will cover wages for a full-time respiratory therapist, wages for a part-time administrative support staff member, equipment for the program, transportation expenses for some patients, patient counseling sessions, and smoking cessation products for some program participants.

“This is great news for TCMH,” Murray said. “This grant will help us build on the solid lineup of outpatient primary care services we provide locally.”

Patients will quality for the multi-disciplinary program following testing for lung disease.  The 12-week program will help patients improve lung function and activities of daily living.

Approximately 10 patients complete pulmonary function tests at TCMH monthly. Over half the patients receiving pulmonary function tests at TCMH in the past year would qualify for a pulmonary rehabilitation program because they have moderate to severe lung disease.

The cardiopulmonary rehabilitation program will begin later this year. Dr. Juan Mella, board certified pulmonologist at TCMH, will oversee the cardiopulmonary rehabilitation program. 

“Dr. Mella told me that he already has a dozen patients that he’s identified to benefit from the program, and there are four cardiac rehab patients that are also candidates for the program,” Murray said.

Doretta Todd-Willis, TCMH chief nursing officer, is working with the cardiopulmonary department to plan details regarding patient parking, patient check-in procedures, patient parking and more.  The TCMH plant operations department will renovate two rooms on the hospital’s east wing for use in the program.

The TCMH Healthcare Foundation pursued the MFH grant on behalf of the hospital.  With the inclusion of this MFH grant, TCMH will have received more than $2.5 million in grant funding since the foundation reorganized in 2005, according to Murray.

“I’m very proud that we have been able to capture that amount of funds to benefit the health of the people in Texas County and the surrounding area,” Murray said.


Amanda Turpin, TCMH quality management director, reported that the hospital will have the “best year yet” in 2017 with the “value-based purchasing score” from the Center for Medicare Services (CMS). The hospital is in line to collect an additional 2 percent of payment for Medicare patients seen in 2017.

Since 2012, CMS has looked at hospital data related to patient experience, patient outcomes, clinical process of care and efficiency of care to award a value-based purchasing score.  TCMH met criteria to be included in the value-based purchasing scoring process beginning in 2014. 

With the value-based purchasing program, Medicare takes 2 percent of reimbursement from hospitals across the nation.  The 2 percent cut is then re-distributed to hospitals by Medicare based on each hospital’s value-based purchasing score.

Some hospitals lose the 2 percent in reimbursement for the year.  Some hospitals get a portion of the funds back. TCMH will receive the 2 percent and an additional 2 percent for fiscal year 2017 for all Medicare patients.

Turpin said TCMH received a value-based purchasing score of “66” in 2016 to determine the 2017 Medicare reimbursement rate.  The Missouri state average hospital score was 36 and the national hospital average was 35.

“There are over 3,000 hospitals in the US, and last year only 105 hospitals in the nation scored 66 or higher,” Turpin said.

Turpin cited three key factors to the TCMH score: patient experience, 30-day mortality of pneumonia patients and Medicare spending per beneficiary.

“In comparison to other hospitals, we did exceptionally well on these three factors,” Turpin said.

Turpin believed that the patient experience portion of the score was a big boost to TCMH. 

Turpin and the Customer Quality Team at TCMH continually work on ways to improve patient experience within all areas of the hospital from medical staff interactions with patients to overall inpatient stays to ancillary services provided to patients.

“Most of our hospital inpatients receive a survey after their stay, and we need our patients to complete those surveys and return them,” Turpin said.

About 30 percent of patients at TCMH return their inpatient stay survey, which is on par with the national average for inpatient surveys returned to hospitals.

The hospital also continues to score well in efficiency –– providing care to patients at a lower cost than other hospitals in the state and nation.

“We go into every year hoping that we will break even in value-based purchasing,” Murray said.  “Next year, we are not only getting our 2 percent back, but we’re also getting an additional 2 percent to reward us for the care that we’ve provided our patients.”

The actual dollar amount the additional 2 percent in reimbursement will likely equal approximately $76,000 in the upcoming year depending upon the number and acuity of Medicare inpatients at the hospital.


Todd-Willis presented information on nurse turnover rates at the hospital, comparing TCMH turnover for registered nurses and licensed practical nurses to the south central region and to the Missouri state average. Three years of data was presented.

Registered nurse turnover regionally was at 18.7 percent, at 17.9 percent statewide, and at 16 percent at TCMH in 2016.

“I am very proud to say that our RN nurse turnover rate is consistently less than the regional or state average,” Todd-Willis said.

According to Todd-Willis, LPNs have a higher rate of turnover at TCMH due to the educational offerings in the area that allow LPNs to become RNs. 

“It’s not that we’re actually losing the LPNs, they are moving up into RN positions at the hospital,” Todd-Willis said.

Licensed practical nurse turnover at TCMH was at 28 percent. The state average was 21.8 percent and the regional average was 33 percent.

Texas County Technical College in Houston, Drury University/Cox College of Nursing in Cabool and Missouri State University in West Plains all send nursing students — LPNs and RNs — to train at TCMH as part of their course curriculum.

“We are able to target quite a few graduates from area programs for full-time positions at TCMH,” Todd-Willis said. 

Todd-Willis also  reported the in-house TCMH pharmacy received “zero deficiencies” during the annual survey of the department.


Murray reported that with the number of obstetric providers joining the TCMH medical staff, the TCMH obstetrics department will undergo a facelift in October.

“Dr. Offutt already has 19 new OB patients, and Dr. Groner will be here to start growing an additional OB practice in November,” Murray said.

Currently, TCMH has three family medicine physicians, an obstetrician/gynecologist and a certified nurse midwife that provide complete maternity care. Two locally based Mercy physicians are also on staff and provide OB services at TCMH.

“We anticipate that our OB numbers are going to grow quickly, and we want to give the department a facelift in anticipation of future usage,” Murray said.

The renovation will be completed by in-house staff and during the renovation, the department will be temporarily relocated to the East wing, a secure patient hall where patient rooms are available.


Linda Pamperien, TCMH chief financial officer, reported outpatient numbers were up above budgeted expectations for August, but inpatient numbers were down for the month. Expenses were up for the month due to the renewal of four physician contracts that increased the vacation payable expense on the books, radiology equipment service agreements and additional expenses related to volume increases in certain departments.

TCMH finished August with a negative bottom line of $211,245 and a year-to-date negative balance of $517,001.

Present at the meeting were: Murray; Todd-Willis; Turpin; Pamperien; Joleen Senter Durham, director of public relations; Dr. Jonathan Beers, TCMH chief of staff; Ron Prenger, CoxHealth representative; and board members Dr. Jim Perry, DO, Janet Wiseman, Omanez Fockler and Mark Hampton. Absent was TCMH board member Russell Gaither, who hasn’t attended a meeting since February 2015. State statutes do not address attendance by county hospital board members.

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