Hospital district makes additional loan to EACC

A $200,000 loan for another month of operations at the East Adams Care Center (EACC) facility proved to be the largest discussion for the second consecutive month at the East Adams Rural Healthcare Board of Commissioners meeting Aug. 27.

EACC Administrator Josh Hannum presented to the board regarding the progress of collecting billing payments and the needs of the facility. Hannum said the facility has grown by six patients, with two of those patients being Medicare.

Since the license transfer in May, EACC staff have been working to be recognized as a licensor by the state. Hannum said they are still trying to be recognized as a vendor by Medicare.

Hannum said they finally were able to put through a batch for payment Medicaid and HMO insurance claims from May, totaling $152,559.14. The request came back denied, but Hannum had already resubmitted the information on Thursday night.

The facility has been able to accept pay for the private-pay residents in the facility, but the revenue collected is not sufficient to operate the facility off of and does not give a clear estimate of how much revenue EACC is bringing in.

Hannum said due to the inconsistent revenue stream and the backlog of billing, EACC needed to ask the hospital district for an additional $200,000 for operations during the upcoming month. The request brings the total amount loaned for the facility to $1 million.

CEO/CFO Gary Bostrom explained EACC is a new business, and like all new businesses, there are start up costs involved.

Hannum explained he believes the EACC facility can collect multiple months of revenue from Medicaid in the next month, and hopefully Medicare, in order to begin paying back the hospital district.

EACC has to payback the loan or “money transfer” when the facility has collected enough to maintain operations at the care center.

With feedback from residents in the audience inquiring how long the hospital district can continue to fund the facility without affecting the hospital’s budget, Bostrom said the district will continue to fund EACC to ensure the facility stays open, but within reason.

When the commissioners become uncomfortable with the amount of money put in, Bostrom said the board would discuss appropriate action.

The income between the two facilities remains separate, Bostrom explained, and EACC is expected to begin collecting payments in the next two or three weeks.

Bostrom explained the district does not believe EACC will ever payback the loan in full, and he said that is common with hospital districts that also operate a nursing home.

Commissioner Stacey Plummer said it has always been the intention of the hospital district to help the community, and the board made the decision to accept the donation of the facility from Life Care to ensure the nursing home could remain in Ritzville.

The amount of revenue the facility potentially brings in has always been a concern, but the hospital district is not currently willing to suspend operations at EACC.

The Board of Commissioners approved the $200,000 loan to EACC, with Ross Heimbigner abstaining from the vote.

Hannum also updated the board regarding the tub and shower situation at EACC. It has been a priority item for the facility to upgrade the subpar bathing facilities since assuming responsibility of the nursing home.

The budgeted amount for the project is $31,000 for installation of a new tub.

Hannum said the tub provides easy access to transfer residents in, has a quick filling time to prevent the residents from having to wait for the tub to fill slowly, provides additional skin care, and helps provide the resident with the ability to bathe with ease.

The board unanimously approved for Hannum to complete the tub and shower project at EACC for the amount of $31,000.

Director of Nursing at EACC, Gayla Ceremello, presented to the board explaining she was still working on the strategic plan for the facility. She said the current focus is infection control and working on prioritization. The staff have also been conducting resident interviews to determine the needs of the residents.

With the remodel construction for the hospital in full swing, Bostrom updated the board about the current progress of the remodel, as well as discussed operations for the past month.

Bostrom advised the board members about a change to the recommendations provided by the Building Committee. Initially, the committee had recommended postponing the construction of the enclosure around the generator and chiller until the completion of the hospital construction project.

On Aug. 25, Bostrom received information regarding masonry work being completed at the facility in the upcoming weeks. It is financially beneficial to have the masons complete the enclosure while they are onsite instead of returning later, Bostrom said.

The board unanimously agreed to complete the project while the masons were onsite to save costs, and also help reduce the noise produced by the generator.

Bostrom updated the board about the construction project, explaining the concrete floors had been poured in the basement and first story level on the new addition. The steel structure work should also be started by Aug. 31 for the clinic addition, Bostrom said.

Along with construction projects at the hospital, the district has been actively working to improve the aesthesis of the remaining buildings the district owns. The roofing project on the administration building and landscaping project at the provider’s house have been completed, and the maintenance staff is now working on painting the trim on all the buildings.

Bostrom said especially during the construction project, it is important to maintain the buildings and be good neighbors to those residents surrounding the district.

Throughout the last two months, Bostrom reported the hospital district has received 12 public records requests. He emphasized the need to have a new website created for the district where public meeting minutes and agendas can be posted, as it would help subside the amount of requests to have them published electronically.

“We believe that when the new website is completed and we are able to provide our monthly board meetings with all the related information that should give the public ready access and to provide a better service for the community,” Bostrom stated in his report.

Bostrom also updated the board regarding the modular unit in regards to the physical therapy department. He explained the department is proposing to utilize the unit as a physical therapy building and for it to be attached to EACC.

Bostrom said he is working with the City of Ritzville to see if the addition is feasible with the zoning of the facility. If not, Bostrom said the department might be utilizing the administration building after the remodel of the hospital is complete.

The Finance Committee recommended to the board to move forward with a Chargemaster review. Bostrom said with last year’s price changes, it is appropriate to review the charges to ensure the district is in line with requirements. The cost for the review is $9,000, plus out-of-pocket expenses.

Bostrom said the decision to have the review again is due to multiple customers questioning the prices for certain services.

The Board also voted in favor of having RHC Managed Care Reconciliation be completed for the 2011-2013 years. The state has mandated the audit because the district has Medicaid managed care in the clinics.

Dingus, Zaaecor and Associates, PLC, estimated a cost of $12,000-$18,000 to complete the audit.

Bostrom updated the board that the district’s audit still has not been completed, but he believed they were close to completion.

Bostrom reported on the financials of the district, stating the current month’s revenue was over budget by $258,855, and deductions from revenue were over budget by $197,404.

The Finance Committee report stated that in July, Bostrom booked $309,649.80 in Meaningful Use reimbursements. The district previously booked $328,826 in Meaningful Use reimbursements in 2014, the report continued. The total to date is $638,475.80.

Bostrom reported the accounts receivable decreased by $321,027 for the month, but cash collections in August totaled $550,000.

The year to date income for the district is $1,031,688.

Due to the higher construction estimated, the Building Committee presented a list of recommendations to the board of alternates that could be postponed. The completion of the alternates is dependent upon the amount of money left in contingency at the completion of the hospital remodeling project.

The Board agreed to omit alternates including the largest savings of landscaping for a cost savings of $32,586; an alteration to the elevator operation system saving $62,943 and repointing only 25 percent of bricks on the building for a cost savings of $51,418.

The alternate changes also regarded modifications to the insulation thickness requirements, nurse call station and telecommunications system.

Also included in the board packet, Emergency Medical Services Coordinator Roni Kinney provided the board with the ambulance runs in July 2015 and the total number of runs to date.

The ambulance runs have increased by 13 runs in comparison to July 2014, with a total of 63 runs last month.

The year-to-date runs are 352 at the conclusion of July, and the ambulance crew recorded a total number of 586 runs in 2014.

The next Board of Commissioners meeting is schedule for Sept. 24 at 5:30 p.m. in the Clinic Lobby.