Staffing, nursing retention primary focus of EARH Board

The East Adams Rural Healthcare Board of Commissioners returned their focus to staffing during the July 26 meeting. The primary focus for the Commissioners was retaining staff in the nursing department so as to decrease the amount of contractual nurses who work at the facility.

Chief Nursing Officer (CNO) Jennifer Pepperd presented data regarding current nurses and contractual staff members working at the facility.

EARH currently has contracts with OMNI and TruStaff to help fill the nursing positions at the hospital. Pepperd explained EARH is in a staffing crisis, as two full-time TruStaff employees are up for review and another ER nurse recently announced their resignation.

In addition to the changing staff, Pepperd said three employees are currently out, but do have plans to return. She added there is currently a LRC day-shift opening at the hospital.

On average, the cost of a 24-hour shift for an RN through OMNI is $1,008 plus an additional $.56 per mile, and $876 for a TruStaff employee on the same shift. Pepperd estimated an EARH staff member in the same role costs the district an average of $558.

In the LTC/LPN positions, the cost for a 12-hour shift is $576 plus an additional $.56 per mile for an OMNI employee, and $274 for an EARH staff member.

For a 12-hour NAC shift, Pepperd estimated the cost to be between $324-370 plus an additional $.56 per mile for an OMNI employee, and $219 for an EARH employee.

Pepperd explained in a 28-day rotation, the current utilization of OMNI RNs is $14,112 for 14 shifts and covering 25 percent of the shifts. For the same 28-day rotation, TruStaff employees amount for 42 percent of shifts, for a cost of $21,024.

EARH RNs currently cover 32 percent of shifts, with a total cost of $10,046, she added.

For the LTC positions in a 28-day period, EARH employees cover 71 percent of shifts for a cost of $10,968, while OMNI employees have a total cost of $9,216.

Pepperd explained there are eight shifts available in a 24-hour period. Nurses are also required to be on call for 12 hours after their shift. In the RN position, Pepperd said new graduates cannot be hired in the role because it is a supervisory position where the individual is responsible for making calls with patients.

In regards to comparison with other similar healthcare facilities, Pepperd stated she did not believe EARH was offering competitive wages. She added there is a potential to cross-train LPC and RNs, but the RN must have emergency room experience.

Pepperd recommended the Commissioners consider a minimum three percent wage increase for an added 26 percent with the benefit package. She also advised charge and ER nurses are compensated at a higher wage, and recommended a $4 an hour increase is more feasible.

With the staffing crisis, Pepperd recommended a five percent wage increase for nursing staff in order to be competitive with other facilities. This would allow the District to be more desirable to potential employees, and create the potential of reducing the need for contract nursing, she added.

CEO/CFO Gary Bostrom said the matter was brought before the Board because the ask is beyond the amount budgeted for the current year. He agreed with Pepperd, stating there is a crisis and also the potential to reduce the amount of money spent on purchase services.

Commissioner John Kragt expressed his desire to hire more individuals locally and retain them within the community. He also inquired about the potential of a sign-on bonus for new hires.

Pepperd said the majority of hospital districts are offering sign-on bonuses, but she stated she is unsure how the current staff will respond to new hires receiving the bonus. She added the addition of new staff will alleviate the stress of current nurses, and believes they will see it as a benefit, especially if they receive a wage increase.

Kragt made the motion to add a five percent wage increase and a $12,000 sign-on bonus to be reviewed by legal council and kept for a one-year retention, with the CNO and CFO to determine the allocation of the bonus. The motion was unanimously approved, which included a $4 an hour raise for the house supervisor.

Bostrom explained Leone and Keeble resealed the roof around the tower, and the new component has a 10-year warranty. There are three sections of roof that are still waiting for replacement because of leaking issues, he added.

With the ongoing problems with the roof, Bostrom said he is still unsure the problem has been remedied, and stated he did not feel the District should release the $240,000 retainage fee until they are completely positive the issue has been resolved.

Bostrom also recently signed an agreement with Forefront to provide Tele Psychiatry in the local clinic. Patients are able to remotely speak with psychiatrists from the clinic or their homes, with a referral from a doctor.

The patients are billed directly for the service, and the District provides the room. The program is for all area residents who are not covered by Medicaid, as Medicaid patients are already taken care of through the Adams County Health Department.

The District has also signed an agreement with Assured Imaging for portable mammography, Bostrom explained. Assured Imaging will present to EARH medical staff in August to see if there is a possibility of seeing at least 20 patients each time they are in Ritzville.

Bostrom said mammography services could begin as early as October and the service will be held in the hospital’s imaging suite.

The District is also working with Gibraltar Senior Living for EARH to purchase two tracts of land at the East Adams Care Center property. Bostrom said the District would like to keep the building services building.

The Commissioners discussed the financial state of the District, as well as the earlier presented 2017 audit by Dingus Zarecor and Associates during the financial update.

Bostrom explained EARH is under budget by $32,015 for the current month, and deductions from revenue are over budget by $41,262. The District has a net loss of $23,694 for the current month, and a year to date loss of $419,664.

The patient accounts receivable increased by $120,200 and the current days in gross accounts receivable has increased to 199 days. The net days in accounts receivable also increased by nearly 10 days, and is now at 108 days.

Bostrom said Eide Bailey will be at the facility to train providers on coding, as well as complete training with billing department employees. The increase in accounts receivable is not solely an issue because of the billing department, but also because of provider charts that are over 30 days out and have not been complete.

The growing number of days under accounts receivable is a negative trend for the District, and could negatively affect the District to the point of closure if the issue is not resolved. Bostrom explained EARH is significantly higher in AR days compared to all hospital districts, and the issue needs to be fixed as soon as possible.

With the training received by the billing department employees, Bostrom said the goal is for the AR gross days to be at 60 by the time he leaves, or 45 net days. Kragt asked if billing department supervisor Stacie Gibler could attend the next board meeting to present on training and what steps are being taken to fix the problem.

The commissioners also discussed the possibility of moving the warrants and vouchers from the agenda to the consent agenda. Chairman Eric Walker said he believed it would ultimately help shorten meeting time, and would still be included in the board packet for review.

As secretary for the board, Kragt said the reading of the warrants and vouchers does not take long and helps center him because of the amount of money paid. He also expressed concerns with the commissioners not having adequate time to review the document before the meeting.

Commissioner Jerry Crossler made a motion to move warrants and vouchers to the consent agenda, with the information provided in the board packet in the finance committee meeting minutes.

Ross Heimbigner, Kragt and Stacey Plummer voted in opposition of the motion, resulting in the warrants and vouchers remaining on the regular agenda.

At the Aug. 23 board meeting, the commissioners will review a revised Code of Ethics for approval.