Texas County Memorial Hospital ended 2021 with a net position increase of about $9.3 million hospital board members and administration heard at their monthly meeting  Friday.  The number represents a significant improvement over the county hospital’s losses in 2019 and includes funds received to assist TCMH during the Covid 19 pandemic.

David Taylor, senior manager at BKD, LLP of Springfield presented the annual audit report at the monthly meeting.

“TCMH increased the net position of the hospital with the majority of the impact from the Federal Provider Relief Fund of $6.2 million, the PPP (paycheck protection program) loan forgiveness of $2.2 million, and gain from storm damage of $1.6 million,” Taylor said. “These are one-time amounts and larger than we are normally accustomed to.”

Taylor explained that the one-time items will not repeat in the future. “When you look at how the hospital performed with those large items removed, the hospital actually operated at a loss in 2021,” he said. “The hospital experienced an operating loss of $2.2 million in 2021 due mostly to Covid 19 pandemic-related expenses.”

Taylor provided information regarding the current healthcare industry from an accounting point of view with hospital board members.  He said that Medicare recently announced a 3 percent update to inpatient payments.  In normal times, this would be considered a good increase compared to the usual 1 to 2 percent increase. 

“Unfortunately, the 3 percent increase is not even close to what healthcare organizations are facing right now in terms of what they have to pay to retain people and in supply costs,” Taylor said. “If inflation keeps outpacing cost increases, things could deteriorate quickly, TCMH doesn’t get the opportunity to negotiate with Medicare and Medicaid in terms of reimbursements.”

Taylor explained that state Medicaid expansion should be a long-term positive to hospitals, but it’s too early to determine the benefit in terms of how many people will be enrolled and what the net impact will be on hospitals.

In 2021, TCMH had a decline of $3.3 million in current assets.  Taylor explained that most of the decline resulted from the repayments of Medicare advanced payments in 2021, which is functioned like a short-term loan. 

Taylor commended TCMH, “It is good to see the offset of the hospital actively investing back into the plant operations with equipment such as the new MRI (magnetic resonance imaging), surgery department in full, and other capital projects.”

Taylor reported that the days cash on hand for 2021 at year end was 175 days, however when everything is paid back our true days cash on hand will be 145 days.

“A key distinction that separates TCMH from other hospitals of the same size is the ability to raise additional funds for the hospital through outside donations and grants,” Taylor said.  He pointed out that in the past nine years, the healthcare foundation has brought in over $5.9 million from outside sources.

Taylor commended TCMH for an outstanding job in managing through the pressures of expenses and revenues at a rural hospital. “It takes a huge effort to attract extra funding into the hospital to try and stabilize the hospital’s financial position,” he said. “The current environment has been much more difficult compared to the pre-covid environment with inflation and labor challenges.” 

Taylor said the hospital should be applauded for successfully navigating through the past two years and emerging in a stronger financial position. 

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 expense statements, balance sheets, statement of cash flows and other information that comprises the financial report documents presented at the April board meeting.

BKD uses historical TCMH data and data 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.


In other business, Jim Perry, OD was sworn in for another five-year term on the TCMH board of trustees. Jay Loveland, TCMH board of trustees’ vice chairperson, administered the oath of office to Perry.

The board voted unanimously to retain their 2021 officer positions for the upcoming year with Perry as chairperson, Loveland as vice chairperson, and Durham as secretary.

Linda Pamperien, TCMH chief financial officer, presented the March financials which reflected overall revenues down significantly by $664,250 from budgeted expectations for the month.

“Our inpatient volumes took the biggest hit and were down $781,360, a 43.2 percent decrease from budgeted expectations,” Pamperien said.

The contractual adjustments at TCMH – the difference between the charge for care provided and the amount of money the hospital receives for the services – were higher for the month.  After a review of 20 patient accounts, the result was a total of $702,564 in contractual adjustments, with seven of these accounts being Covid patients.

Pamperien noted that the hospital’s overall expenses were down $400,060 for the month. 

“The decrease in covid cases over the past several weeks resulted in a significant reduction to our monthly expenditures,” Pamperien said. “Our Covid expense was under budget by $123,966 for the month.”

The hospital ended March with a negative bottom line of $566,631 and a year-to-date loss of $964,191.

Pamperien discussed the onboarding of Dr. Hollis Tidmore, general surgeon, and the need for a doppler transceiver to perform various vascular procedures. The board approved the purchase of the additional equipment for the hospital to further advance surgical procedures.

“We are hearing lots of positive comments about Dr. Tidmore,” Pamperien said. “We are glad to have him at TCMH and the additional services he will offer to the community.”

Chris Strickland, TCMH chief executive officer, said the hospital is concentrating on finding ways to bring in additional revenue with adding different service lines, completing the surgery center, and promoting  the surgical program.

April Crites, TCMH quality director, discussed the recent quality assurance and performance improvement first quarter results.

“Our dietitian is now assessing all of our inpatients and not just physician referrals,” Crites said. “This is an important part of quality care for our patients.”

Helania Wulff, TCMH director of physician recruitment, said the hospital is actively recruiting physicians. Two family medicine physicians who intend to practice obstetrics as part of a future practice recently visited the hospital from Texas.

Jeff Gettys, TCMH Healthcare Foundation director, highlighted recent projects by the Healthcare Foundation.  A $1 million dollar USDA grant has been approved, and the hospital is moving forward on the progress of the new surgery center with architectural drawings being completed in about a month.

Gettys announced the upcoming TCMH Healthcare Foundation golf tournament on Saturday, June 11mat the Oakwood golf course in Houston. 

Gettys said the TCMH Healthcare Foundation is offering multiple $1,000 fall 2022 semester scholarship opportunities for those pursuing a career in healthcare.  The application deadline is July 1.

Present at the meeting were Taylor; Perry; Loveland; Durham; Pamperien; Strickland; Crites; Wulff; Gettys; Jonathan Beers, DO, chief of staff; Courtney Owens, chief nursing officer; Renina Pearce, medical staff coordinator; and board members Steve Pierce and Allan Branstetter.

The next meeting of the TCMH board of trustees is noon Tuesday, May 24, in the hospital board room.

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