Hospital Board discusses recruitment, write-offs

The Adams County Hospital District No. 2 Board of Commissioners discussed future recruitment for physicians, continuing write-offs and approved for East Adams Rural Healthcare to become a smoke-free campus during the May 24 meeting.

EARH recently interviewed and offered a position to a doctor, which the physician ultimately declined to take a position in Idaho instead. Commissioner John Kragt voiced his concern about the ability to attract a physician who is interested in doing both clinic and ER work.

Kragt said he believed the doctor would have accepted the position if he would have only been in the clinic, and questioned the likelihood of finding one individual who was interested in working in both ER and clinic. He mentioned the possibility of dividing the two positions.

Dr. Marty Sackmann said in the medical field, there is a definite shift for doctors wanting to focus on family practice.

Sackmann recommended discussing the matter in length with Kragt and CEO/CFO Gary Bostrom in order to determine the best course of action in attracting future physicians.

Bostrom and Sackmann agreed segmenting the jobs would be less intimidating for potential doctors, and is most likely the future of healthcare to have division of doctors. Currently, the District’s doctors have on-call shifts in the ER and also rely on locums.

During the financial update, Bostrom explained the District is continuing to have write-offs for the Medicaid pharmaceutical billing issue from the previous year. While the write-offs have reduced the Districts accounts receivable (AR) days, the adjustments may affect the 2017 financials and record a loss for the District for the year.

The total pharmaceutical write-off totals nearly $500,000 between 2017-18, Bostrom explained.

After moving on to discuss additional financial topics, Commissioner Jerry Crossler stated he wanted to readdress the write-offs. Crossler expressed his extreme frustration regarding the issue, and wanted to know how it became an issue, and also what the District was doing to prevent future mistakes.

“This is our fault, and it stops at this table,” Crossler stated.

Bostrom explained the issue began in regards to swing bed patients in the previous East Adams Care Center. Pharmaceuticals were billed for the patients, but the medication is not reimbursable through Medicaid.

Inland Northwest originally believed the funds were reimbursable, but after a year it was determined they were not, Bostrom said.

The issue was discovered when the intermediate swing beds were moved into EARH, and CNO Jennifer Pepperd assured the commissioners the issue has been remedied to ensure it does not occur again.

Bostrom explained he does not oversee the day-to-day operations, and he relies on employees to honestly communicate their status of work when asked. He added he had been assured by a previous employee that the issue was fixed, when it truthfully had not.

Representative Joe Schmick attended the meeting and explained EARH is not alone with issues, such as the Medicaid pharmaceutical write-offs. Schmick stated the healthcare sector is a nightmare, and a lot of hospitals are going through the same or similar situations.

Kragt addressed the situation and the potential need for the CEO and CFO position to be two separate roles in the future. He was adamant to explain he was not placing the blame on Bostrom, but simply had concerns about one individual completing two substantial and important roles in the District.

Bostrom explained Eide Baily is providing the District with recommendations on how to proceed, as well as providing ideas for overseeing billing and cross checking everything. Bostrom said this will also include training providers with the coding, and helping the billing department for the next four months.

Crossler ended the discussion by stating, “I think we owe the public transparency” in regards to the billing issues.

Pepperd presented regarding smoking safety at the EARH facility. She explained the majority of long-term care facilities are smoke-free, but EARH currently allows patients and employees to smoke on the premises.

There is a dedicated area outside for employees to use for smoking, but patients have to use a different location, she explained. Pepperd said her primary concern is patient safety and the potential liability involved with transporting a patient outdoors to smoke.

There is currently one patient in long-term care who is a smoker, and Pepperd explained that individual would be grandfathered in and allowed to continue to smoke while in EARH’s care.

Pepperd estimated 10 employees currently smoke, but they already smoke on the sidewalks around the facility or in their vehicles. EARH’s health insurance has an incentive package for employees who quit smoking, and Pepperd said the administrators could work with the employees who smoke to utilize those services.

Pepperd said the best way to avoid potential problems with patients and employees, and to improve the safety of all individuals at the facility, is to create a smoke-free campus on a set date. Campus includes the hospital, as well as the buildings owned by the District, including on-call housing.

Kragt made a motion for EARH to become a smoke-free campus on July 1. During discussion, Crossler expressed his frustration with making decisions at meetings without proper time to review documents before taking action.

The motion was passed with Ross Heimbigner, Eric Walker and Kragt in favor, and Crossler and Stacey Plummer opposed.

Pepperd and COO Dina McBride explained they will host a roundtable discussion with the District employees who currently smoke to determine alternatives for appropriate smoking areas off campus.

The Commissioners also addressed issues with wind drafts from helicopters landing at the facility. It has been an ongoing problem, but Bostrom said it is medically necessary so there is very little the District can do.

Bostrom said Life Flight has been asked to adjust flight patterns when possible to limit the amount of down draft on houses surrounding the hospital. Bostrom said EARH staff visited a home that had recent damage to a trampoline, but he stated it is not EARH’s responsibility to pay for the damage.

“It is our responsibility to get it taken care of, but not to pay for it,” Bostrom stated.

Sackmann provided a medical staff update, explaining the new CEO from Deaconess Hospital and her medical staff attended a recent meeting at EARH. Sackmann stated Deaconess is interested in furthering relationships in the region and are working with EARH to make patient transfers easier.

He added this is positive for EARH as it will allow the District to promote their services for potential patients in the region.

Bostrom provided an update regarding mammography, explained the services will return to EARH for half a day, once a month. The mobile unit will be located in radiology, and the service is being shared with the Odessa Hospital District.

EARH has also signed an agreement for student training with the University of Washington, Bostrom explained. The District now has agreements with all schools for student training, he added.

Bostrom also explained the ongoing roof leak will be fixed by Leone and Keeble. They will replace a portion of the roof, and reseal additional portions of the roof to remedy the issue. The flooring the in nurses station has also been replaced, Bostrom added.

The meeting concluded with Schmick discussing Critical Access Hospitals. Schmick said the future does not look good, but legislators and CAH administrators need to work together to continue to provide adequate care.

Schmick said the issue is attracting an adequate workforce to small districts, especially in regards to mental health.

“Critical Access Hospitals are need and dear to my heart,” Schmick stated. “What hospitals look like will change, but the need will stay.”