By JANE ANN BIGBEE
Dr. Philip McCune, who is a doctor on the staff of the Family Medical Clinic and Marengo Memorial Hospital, will return in October after an assignment in Iraq. Col. McCune, a member of the U.S. Army Reserve, is expected to provide care for the military in Tikrit until the middle of September unless he is asked to extend his time. His time there will be followed by debriefing before returning here.
Dr. McCune has served in the military since 1968 and in the reserves since 1987. Hospital staff had a potluck meal sendoff for him June 21 before he left for his assignment.
Financial report
The balance sheet showed cash, investments and board designated investments for May of $5,709,563, chief financial officer Nancy Kohrt, CHFP, told the Marengo Memorial Hospital Board of Trustees at their June 22 meeting. The net accounts receivable was $2,698,894.
On the income statement for May, gross patient revenue was $1,335,420 actual, compared to the budget of $1,355,083, or a $19,664 shortfall.
Contractual allowances, $203,451, and bad debt/charity care, $68,494, were both above the budget significantly for the month, Kohrt continued, giving $169,909 shortfall on net patient service revenue. A delay in billing for skilled patients due to implementing new software, Kohrt explained, resulted in fewer payments on accounts for May. The Medicare per diem rate for acute and skilled care declined in February due to the filing of the cost report, giving MMH lower results than the first half of the year. Levels will increase again July 1, Kohrt said.
Net operating revenue was $1,089,712, compared to the budget $1,262,645, or a $172,934 shortfall for the month but $168,845 above budget for the year.
Expenses for salary costs of $567,504 included salaries, provider salaries and payroll taxes, were below budget by $1,068. Employee benefits/IPERS were $110,974, or $2,095 above budget.
Supplies were $68,628, below budget by $20,513; insurance, $21,164, was under by $14,334.
Over budget by $50,131 were contracted services, $246,369. Contracted services include information technology provided by ICE Technologies, and services provided by Visions doing a high volume of rehabilitation therapies. Pharmacy and radiology contracts also were brought up to date during the month accounting for $28,000 of the overage.
Expenses for May were $1,236,865, compared to the budget of $1,235,267, or over budget by $1,597.
The operating loss was $147,153, with an operating margin of minus 13.50 percent. The total net income was a loss of $141,733 with a total margin of minus 13.01 percent.
Year-to-date there is a total net income of $432,874, or $266,536 above budget, with a total margin of 3.12 percent.
Net patient days in accounts receivable were 66.70, compared to 61.77 in April. Contractual adjustments as a percent of revenue were up slightly at 7.9 percent, Kohrt said.
Average full-time employees were 136.46. There were 164 employees of whom 130 were full-time, 12 part-time and 22 on call.
On the comparative income statement, Kohrt said, acute and skilled revenue are down this year compared to last year; extended care and outpatient are up quite strong over last year at this time. Total for this year is $15,310,390 and last year at this time $15,038,000, “so we ran very closely. That’s an increase of 1.8 percent,” Kohrt said.
On expenses, salaries are actually under what they were at this time last year, $6,187,121 versus $6,581,473 last year; however, some of that is taken up by the contracted services being $2,448,882 compared to last year, $2,033,415.
Total expenses are above last year by 0.2 percent, $13,516,322 this year, 13,493,344 last year.
“Our bottom line is slightly above what it was last year at this time,” Kohrt said.
Statistic comparisons
In patient days of care acute and skilled were down (from budget) for May, a trend continuing into June, Kohrt said. They were under budget overall by 87 days including acute, skilled and extended care.
Emergency room cases had a mix of over budget for non-urgent and under in emergent. For operating procedures the pain clinic is holding steady; however, there were no ophthalmology surgeries due to Dr. Lee Birchansky being gone this month, and this is reflected in surgical revenue, Kohrt said.
The Family Medical Clinic visits, 538, were down slightly. Radiology exams, 234, were down by 20 for CTs (computerized tomography), however MRIs (magnetic resonance imagery) were up by 12, holding the revenue fairly steady, Kohrt said. Laboratory tests, 1,886, were down by 104, EKGs were down slightly with cardiac rehab also down slightly. Respiratory therapy was down from budget by 234. Other therapy procedures, 1,111, were up, 217 above budget in physical therapy. Dialysis treatments, 91, and ambulance, 88, were both below budget.
Trustee Marv Carney, who serves on the finance committee, noted they are seven people short (positions open) and are looking to replace those. Carney explained these are not new but replacement positions. Overtime is coming in low, because the hospital is using flex time. Kohrt reminded board members last year they approved a policy about flex staffing, so when volumes are down, employees are sent home.
“We have asked everyone to review those policies and implement them where possible, and we are seeing some results of that this month, Kohrt added.
Mikaela Kienitz, acting administrator, confirmed volumes were down right now, and Kohrt reminded there is a dip (in numbers) every summer, but it’s come a little earlier this summer.
The financial report was approved by the trustees.
Fiscal 2012 budget
Kohrt said the proposed budget, discussed at the May meeting, was sent out again with a three-year forecast.
The budget includes $17,399,645 in patient service revenue. Deductions from revenue include $1,199,124 for contractual allowances and $480,467 for bad debt/charity care. Net operating revenue is $16,101,123 and included $381,070 of other operating revenue.
Expenses total $16,098,345. The figure includes $7,094,163 for salary costs, $1,393,045 for benefits and IPERS, $2,912,412 for contracted services, $1,528,567 for depreciation, $1,067,166 for supplies, $91,506 for professional fees, $596,189 for drugs and $234,839 for utilities. The depreciation line includes items on the capital purchase list for next year, Kohrt said.
Non-operating revenue is budgeted for $93,636.
The budget for operating income is $2,778 and total net income $96,414 with a total margin of 0.60 percent.
On motion by Dr. Sue Davis and second by Carney trustees approved the budget.
Pillar goals
Pillar goals were discussed also at the May meeting, Kienitz reminded trustees. There was no further discussion of these. Trustees approved the goals on motion by Chuck Merritt and second by Daryl Russ.
Trustee Randy Fry commented they may want to revisit them with new leadership. Kienitz suggested trustees could always discuss and changes could be made if needed.
Kienitz said the leadership team will go through them right away with new Chief Executive Officer Barry Goettsch, who started work at Marengo Memorial Hospital July 6.
Trustees approved the pillar goals.
Information technology update
Kienitz gave the information technology (IT) update for the board noting they are working to build CPOE (Computerized Physician Order Entry).
They have completed the wireless project. It is finished and working.
They have started a group using tables and grids of all the things the hospital needs to achieve to meet Meaningful Use in the winter.
Credentials
Trustees approved courtesy membership credentials for the following providers:
Initial practitioners – David Dierks, DO, emergency room; Brianne Seberger, MD, radiology; Paramesh Ramadugu, MD, and Jody Hornickel, ARNP, both nephrology; Nicola Nicolaisen, DO, emergency room.
Emergency credential ratification/temporary privileges – David Dierks, DO, emergency room, and David Jensen, MD, radiology.
Withdrawing privileges – Richard Highstead, MD, emergency room.
Consent agenda items, including the minutes, credential requests and policy review, the latter subject to a correction, were approved.
Report card
Mikaela Kienitz, acting administrator, gave the May report card as follows:
Service – Increase outpatient satisfaction to at least the 50th percentile, 77th percentile, so exceeding the goal.
Quality – Increase the performance of the Centers for Medicare and Medicaid Services for combined pneumonia, acute myocardial infarction and congestive heart failure to 88 percent, 100 percent for both April and May, average for the year 90 percent.
Finance – Maintain a favorable one percent variance to the budgeted gain/loss as recorded by the income statement, 61.6 percent for May, a decrease from previous months and the lowest for the fiscal year.
Growth – Meet area volume, or unit of service, target as compared to budget as measured internally, 2 percent.
People – Increase employee satisfaction to 60 percent, survey in April 68. “We are happy with the results of the survey,” she said.
Community – Increase the level of community benefit activities to 50, five in May for a total of 80 for the year.
Other information
Kienitz said they will have a day, starting at 1 p.m. July 14, for the staff to celebrate all the wins they have had this year. There will be sundaes and they will show the video of all the “wins and great things that were done this year,” she said. At 5 p.m. they will have a cookout, followed from 6 to 8 p.m. by swimming, and games at the hospital. Kienitz said they have a “pretty high organizational score for the year. The object is to have the employees excited about what we have done this year.”
Kohrt called their attention to information from the Iowa Hospital Association PAC (Political Action Committee) seeking individual contributions. Trustees are asked to fill out and turn in an information sheet to go along with donations to be sent together so Marengo receives credit for the individual donations. They have a goal of $1,000, set by IHA for MMH. Kohrt said the PAC works with the Legislature, promoting health care and hospitals. “We want to support that and hope you will too,” she added.
Next board meeting will be July 27.
Trustees went into closed session under Iowa Code 21.5 (l).
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