Texas County Memorial Hospital board members approved a $1.4 million capital budget last week at their monthly meeting. 

The majority of the funds are allocated to complete a new surgery department infill and equipment needs and to make major upgrades to the hospital’s electronic medical records system. Linda Pamperien, TCMH chief financial officer, presented the budget data.

The capital budget — the largest in recent history — is a 49 percent increase over the 2017 capital budget. Pamperien said depending upon how the infill of the surgery department goes, some of the funds might not be needed. The surgery infill is being completed in-house by the hospital’s plant operations staff. Funds of $814,000 are available through the TCMH Healthcare Foundation and a Delta Region Authority grant to help with the cost of the infill and the equipment purchases.

According to Pamperien, the TCMH plant operations department estimates the surgery infill will cost another $500,000 to complete. 

The new surgery equipment needed for the department will be $439,407. The sum includes items such as an endoscope reprocessor at $33,174; an endoscope and tower at $114,574; surgical lights and booms at $170,855; and cleaning and sterilization equipment at $101,260.

“With the addition of Dr. Jason Loden next summer, we need to have the necessary equipment available for he and our current surgeon to do as much as they can,” said Wes Murray, TCMH chief executive officer.

Also in the 2018 capital budget is $375,500 in equipment for computer hardware and upgrades to the hospital’s electronic medical records (EMR) systems. The upgrades include a new server and software and hardware to integrate all of the hospital and clinic EMR.

“Currently, we have two different EMR systems — one in the hospital and one in the clinic,” Murray said. “That was what we had to do 10 years ago when we were just beginning to use EMR.”

As some of these early EMR systems are “reaching the end of their life,” Murray explained that all of the area hospitals are working on integrating their EMR systems so that clinic and hospital information are readily available and to save money on service fees and upgrades in the future.

“We have different fees for licenses and support, and integration will allow us to have one fee for support and a global license,” Pamperien said.

TCMH plans to integrate the EMR under CPSI, the system they use for EMR in the hospital. CPSI, based in Alabama, has been working with TCMH for technology services since 2000. Its EMR is designed for smaller hospitals and healthcare systems like TCMH.

“These types of changes in our EMR are always a difficult process, but it’s what we have to do,” Murray said.

Jonathan Beers, DO, TCMH chief of staff, said the integration process will allow patients receiving care at TCMH clinics and at the hospital to have easily shareable information. Hospital staff can see what’s happened with a TCMH clinic patient before receiving care at the hospital and vice versa.

“This is going to be so much better for our nursing staff,” Beers said. 

Physicians had access to both hospital and clinic EMR for patients, but it was not available in one program nor was it available for ancillary staff. Clinic staff could only see the clinic portion, and hospital staff could only see the hospital portion.  Clinic staff would have to scan in documents from the hospital as part of the clinic record.

“The EMR technology claims to communicate with each other, but it’s actually all very proprietary,” Dr. Jim Perry, OD, chairperson of the TCMH board of trustees and ophthalmologist in Cabool, said regarding his personal experience with EMRs.

Pamperien said TCMH will save $43,000 in annual support fees and receive much better customer service from CPSI than they have received through one of the current EMR vendors.

“This is a big investment, but it will pay off quickly,” Pamperien said.

The other major expenditures in the capital budget were $84,000 to purchase 35 new intravenous pumps and $63,832 to purchase a new fetal monitoring system for the obstetrics department. The new, computerized fetal monitoring system will also seamlessly interface with the new EMR when both are in place.

For the 2017 operating budget, board members approved a net operating budget of $32,652,730 that projects excess revenue over expenses of $118,183.

“With this year’s budget we are accounting for the arrival of three new physicians,” Pamperien said, referring to the addition of Jason Loden, DO, a general surgeon, Teresa Loden, DO, a pediatrician; and Doug Crase, MD, a family medicine physician. 

All three physicians begin work at TCMH in the summer of 2018.

According to Pamperien, there are additional costs with the start of new physicians, but when a physician practice is established, the return on the investment is good for the hospital. 

“Currently each of our top four primary care physicians are generating an average of $2.9 million in inpatient revenue and $1.7 million in outpatient revenue,” Pamperien said. 

The 2018 operating budget anticipates a 4.8 percent increase in inpatient revenue, 6.3 percent increase in outpatient revenue, 5.9 percent increase in emergency department revenue and 5.75 percent increase in swing bed revenue.

Pamperien anticipates the “contractual adjustment”— the difference between the hospital charge and the portion of the charge covered by insurance — will increase in 2018. The 2018 operating budget anticipates a contractual adjustment of 63.2 percent.

In addition to the three new physicians joining TCMH in 2018, two full-time positions are budgeted additions to two departments in 2018. The budget reflects a merit raise for employees in late 2018 and an overall increase in operating expenses of 6.2 percent.

“We are budgeting again to ‘break even,’ and our accounts receivable and cash flow continue to be very good as we look ahead in to the new fiscal year,” Pamperien said.


Board members heard TCMH has received funds totaling about $500,000 from the state of Missouri for the 2012 Medicaid cost report settlement. 

In November, Pamperien reported TCMH had requested help from the Missouri Hospital Association (MHA) to collect $1.2 million from the state of Missouri. The funds were owed to the hospital following Medicaid cost settlements completed for fiscal years 2012, 2013 and 2014.

The funds being held are for services provided by TCMH to Missouri Medicaid patients. The funds are not dispersed by the state until final cost reports are completed for each fiscal year.  The funds that would typically be paid by the state following the cost report settlements were frozen by the governor’s office.

With help from the MHA, TCMH and other hospitals were able to get some of the state funding owed to them.  Funds from the 2013 and 2014 Medicaid cost report settlements are still owed to TCMH.


Inpatient and outpatient revenues were down in November resulting in a negative bottom line of $262,219 and a negative year-to-date balance of $844,099. 

Present at the meeting were Murray; Pamperien; Beers; Doretta Todd-Willis, chief nursing officer; Joleen Senter Durham, director of public relations; and board members Perry, Omanez Fockler, Janet Wiseman and Jay Loveland.

Board member Mark Hampton was absent.


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