Hospital Board discusses temporary solution for EMS, approves 2018 budget for the District

After nearly three months of discussion, the Adams County Public Hospital District No. 2 Board of Commissioners received an update on the temporary solution for the decline in Emergency Medical Services (EMS) personnel. The current EMT staff members were having a difficult time filling shifts, but reports by Dr. Marty Sackmann and CEO/CFO Gary Bostrom said the issue is fixed for the time being.

Sackmann explained the EMS shortage discussion has been occurring during medical staff meetings for more than three months. The shortage of EMTs is a universal problem, not unique to East Adams Rural Healthcare, Sackmann explained.

The temporary resolution was a change in the scheduling of EMTs to ensure there are emergency responders available 24 hours a day. Sackmann said EARH is continuing to research additional options as well as ways other EMTs from surrounding hospital districts may be able to provide support.

Sackmann said all of the EMTs responded well to the scheduling change and understood the need to have every shift covered. He explained that when those employees were asked to step up, they all responded positively to the challenge.

Bostrom said EMS Coordinator Roni Kinney coordinated the scheduling effort and was able to fill all of the vacant EMT slots. There are currently a total of 14 EMTs employed with the district, and Kinney reported a full crew would consist of 20 individuals.

Out of the 14 EMTs, seven are locals who have additional employment, and two work at the clinic during the day. Three EMTs come up twice a month from the Tri-Cities to respond to calls and assist with housekeeping duties at the facility.

Kinney reported Washtucna is down to two EMTs, and both individuals assist Ritzville with EMS, housekeeping and clinic responsibilities.

The EMT shifts are typically 12-hours and the new schedule has them at varying times in order to be provided with more assistance.

With a change in the state law, the ambulance can now be operated by one first responder and one EMT. The first responder course is 40 hours and teaches individuals how to assist EMTs at the scene, as well as how to operate the ambulance. The EMT course is 165 hours, and more in-depth.

Kinney reported there will be a first responder course in January or February of next year, which will include five members of the Ritzville Fire Department, as well as other hospital employees. There is also interest in hosting another EMT course when there are more interested individuals.

The future scheduling will be EMTs signing up for shifts first, and then first responders filling the vacant spots on the calendar. This change will hopefully allow the district to provide ambulatory services without issue.

The District will continue to advertise for EMTs on their website, as there is a continual need.

Bostrom provided updates for recently completed audits and reviews within the departments at the hospital. The Department of Health completed their survey of the laboratory, and Bostrom said the report came back well and there will not be another audit for two years.

The State Auditor’s also will not return for two years, following a positive financial review for the District. Bostrom said the recent review for the Physical Therapy department also came back clean.

At a recent meeting of the Grand Columbia Health Alliance (GCHA), Bostrom said they discussed the issues hospital districts in the region are currently facing. While the largest issue is staffing, there is also a concern for professional assistance and service availability.

For services, Bostrom said GCHA is currently researching the possibility of sharing mammography services between districts. This could mean busing patients to Moses Lake for mammograms, or to other hospitals within the Inland Imaging network.

Previously, the mammography services were provided via a mobile unit that came to EARH once a month. A change in the digital recording of images prevented the mobile unit from being able to accommodate the updates.

To purchase a mammography machine, the cost is between $300-500,000, Bostrom explained, which is not a practical expense for the District.

Bostrom provided the Commissioners with a financial update, saying the District was over budget by $35,085 for the current month. The Deductions from Revenue were also over budget by $263,293.

The District currently has a net loss of $103,656 for the current month, and a year to date net income loss of $15,992. Bostrom added at this time last year, the District had a year to date loss of $700,888 for the hospital alone.

The Commissioners also reviewed the budget for the second time, after meeting on Nov. 9 for the first initial review.

During the Nov. 9 meeting, Bostrom made an adjustment to add $40,000 for the GCHA

Inland Imaging requested changing receiving accounts from 90 days to 45 days.

Bostrom said the District needs to stay with 90 days from the date of service, mainly because of provider delays with finishing charts. The goal is to be down to $2 million by May 2018.

The budget also includes funds to complete the installation of a new roof on the Physical Therapy building. The estimated cost for the project is $15,000 and the project will be completed in 2019.

The 2018 includes project three percent increase in costs for emergency department visits, clinic visits, charge increases, salary increases and non-salary inflation factors.

For contracted labor charges, the budget includes a reduction of $439,000 by hiring additional nursing staff instead of contract them with an added $30,000 in recruitment costs.

There is also an expected increase of 13 percent for health insurance fringe benefits, and an additional $50,000 for the new sick leave law.

Bostrom said an adjustment of the total net income now moves the budget total to $37,462 because of an increase in the non-operating budget.

The Commissioners approved the budget, and will sign the budget resolution at the Dec. 21 meeting.

Ross Heimbigner abstained from voting in regards to the budget.