Lake Named Employee of the Month

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Texas County Memorial Hospital has named Stephanie Lake of Houston the March employee of the month. 

Lake is a clerk and coder in the medical records department at TCMH, and she has worked for the hospital since 2004.  Lake was nominated for the award by Krista Elliott, education director at TCMH.

 “Stephanie provides training on patient privacy for every new employee,” Elliott said, adding, “She takes this subject very seriously, and she’s very thorough.”

Elliott called Lake a “behind the scenes” co-worker that is a “valuable member of the TCMH team”.

“Stephanie works on the weekend when her department needs help catching up, and she’s willing to help out when others in the department have to be out,” Elliott said.

As employee of the month, Lake received a certificate honoring her achievement; a pin; $100 cash; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card; gift certificates to Paws N Claws, D&L Florist and Janstiques, and cd of the month from Big Country 99.  A reception will be held at the hospital in honor of Lake.

Lake is eligible for the 2014 TCMH employee of the year award.

Stephanie Lake (center) is the Texas County Memorial Hospital March employee of the month.  Also shown--Micki Cummins, medical records department director (left) and Krista Elliott, education department director (right).

Stephanie Lake (center) is the Texas County Memorial Hospital March employee of the month. Also shown–Micki Cummins, medical records department director (left) and Krista Elliott, education department director (right).

Healthcare Foundation to Award $5,500 in Scholarships

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The Texas County Memorial Hospital Healthcare Foundation plans to award $5,500 in educational scholarships for the fall 2014 academic year.  The organization is currently accepting applications for the scholarships.

The TCMH Healthcare Foundation Educational Scholarship Program is designed to assist students that are pursuing or planning to pursue education in a healthcare related field or students currently working in healthcare that are pursuing additional education for their current career. 

The Healthcare Foundation is in its eighth year of awarding scholarships in the fall and the spring.  Students from towns across the county have received the scholarships.

In addition to two scholarships from the TCMH Healthcare Foundation, the Healthcare Foundation will also award the “Dr. Joe L. and Judith T. Spears Memorial Scholarship” and the “Dr. Eugene Charles Honeywell Memorial Scholarship”.  Both are endowed funds that are awarded to a deserving student annually.

“Educational scholarships are a major focus area of the Healthcare Foundation,” Jay Gentry, TCMH Healthcare Foundation director, stated.  “The board of directors of the Foundation recognizes the need to assist areas students in their educational endeavors with hopes that the student will return to or stay in the Texas County area to provide healthcare services to area residents after receiving additional education.”

The Healthcare Foundation has awarded over $40,000 in scholarship funds since the scholarship program began.

Endowed scholarships provide some of the educational funds, and the Healthcare Foundation hosts an annual golf tournament to raise money for the scholarship program.  The annual golf tournament is scheduled for June 14, 2014.

Eligible students for the scholarships must be accepted to or currently enrolled in an accredited university, college or post-secondary training program.  Residents of the TCMH service area—all of Texas County and Mountain Grove—and students that are graduates of Texas County and Mountain Grove schools are eligible to apply.  Applicants already pursuing a career in a healthcare organization, or applicants planning to pursue a career in a health field with direct patient care are eligible to apply for the scholarships.

The scholarship application asks for information about the student and requires a short essay about the student’s career and educational goals.  Applicants are also asked to list community involvement activities on their application, and they may be asked to meet with Foundation board members for a short personal interview. 

The deadline for the fall scholarship applications is July 1, 2014.  Awards for the scholarship will be announced by September 1, 2014.

For more information about the scholarship program or to receive an application, contact Gentry by phone at (417) 967-1377 or 1-866-967-3311, ext. 4202 or by e-mail at  The scholarship application and complete details are also available at

Swing Bed Services Are Growth Area at TCMH

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                Texas County Memorial Hospital has experienced steady growth for swing bed patients in the past five years TCMH board members heard at their monthly meeting on Tuesday.

                “With new, expanded information available from the Hospital Industry Data Institute (HIDI) we are able to compare our swing bed days and discharges with other hospitals across the state,” Wes Murray, TCMH chief executive officer, explained.  “Since 2008, our number of swing bed discharges has grown every year.”

                A swing bed admission is for a patient that has had at least three days of hospitalization in an acute care setting for a condition such as stroke or surgery.  Patients are admitted to a hospital swing bed where they can receive round the clock care while continuing to recover.

                Swing bed patients have access to a social worker and case manager, many types of therapy, weekly physician visits, a dietician and other services available through the healthcare facility. 

                According to Murray, many patients and their family members choose to be transferred to TCMH for swing bed care after a hospitalization at a larger healthcare facility.  Some patients also are changed over to swing bed status while at TCMH for a surgery or other illness if the patient requires additional care.

                In 2008 TCMH had 28 swing bed discharges compared to an average of 78 discharges at other hospitals in the state.  In 2013 TCMH had 175 swing bed discharges compared to an average of 91 discharges at other hospitals in the state.

                “Our physicians are really embracing the swing bed process,” Murray said.          

Murray described swing bed care as “less intensive”, but important in a hospital where the average patient age is over 70.

                “Hospitals everywhere are managing their average length of stay for patients more aggressively, so the need for swing bed care is rising,” Murray said. 

                The HIDI data also shows that TCMH swing bed patients average shorter long term stays than swing bed patients at other hospitals in the state.  In 2013 the average length of stay for a TCMH swing bed patient was 3.63 days and the statewide average was 5.49 days.

                “Swing beds are very beneficial for our patients and for the families of the patients,” Murray explained.

                Murray credits the uptick in swing bed usage to Dr. Jeffrey Kerr, emergency department medical director at TCMH.  Kerr also works as medical director at several area nursing homes, and he has a strong background in geriatric issues. 

                “Dr. Kerr began encouraging our medical staff in utilizing swing beds with their hospitalized patients, and he educated our physicians about the importance of accepting new swing bed patients that were transferred from other hospitals,” Murray said. 

                Kerr and his staff in the TCMH emergency department also provide education to patients and their family members about the option of returning to TCMH for swing bed care when needed.

                “As our physicians’ knowledge of the service has grown, so have the number of patients we are caring for through swing bed at TCMH,” Murray said.

According to Murray, swing bed care is covered by most private insurance, including Medicare.  Private insurers may require prior authorization for swing bed care and vary in coverage options.

In order to qualify for Medicare reimbursement of a swing bed stay, the patient must have spent at least three days within the last 30 days in an acute setting.  Medicare will cover 100 percent of a patient’s stay for the first 20 days, as long as the patient is receiving skilled services of some type.  These skilled services incude IV medication, diabetes management, physical or speech therapy, respiratory therapy, frequent medication changes, lab monitoring or surgery that includes dressing changes or other post-op care.

On the twenty-first day of a patient’s swing bed stay, Medicare will continue to pay 80 percent of the cost and the patient is responsible for the remaining 20 percent of the cost if there is no co-insurance.  Medicare replacement may cover the co-insurance portion and require prior authorization.

                Murray also reported to board members that recruiting efforts at the hospital have been strong over the past few weeks.  Four candidates with obstetrical training have been brought to the hospital to interview for a position at the TCMH Medical Complex in Houston.

                “I have several additional obstetrics providers identified, and one is scheduled to visit on Friday,” Joleen Senter Durham, director of physician recruiting at TCMH, said.  “We are hopeful that one of these candidates will be the right fit for us as well as find their own right fit here at TCMH and in our community.”

                Durham reported that she also has a site visit scheduled for a family medicine provider for the TCMH Mountain Grove Clinic and for a mid-level provider that grew up in the area.  She continues to recruit for a general surgeon, too.

                Leroy Wombold, MD, a general surgeon from Phelps County Regional Medical Center in Rolla, will provide general surgery coverage and do a general surgery clinic at TCMH one and a half days a week beginning in April.  Lowell Fisher, DO, also a general surgeon from Rolla, has been providing surgical coverage at TCMH since late 2013, and he will continue to provide coverage at the facility.  Charles Mueller, MD, current general surgeon at TCMH, has extended his time at the hospital through the end of April.

                “A lot of time and effort has gone into contacting physicians to provide for our coverage needs as well as our long-term recruiting needs,” Murray said.  “Although it is not a quick process, Joleen has made some strong contacts through her recruiting efforts,  and one or more of those individuals may work out as full-time employees of TCMH.”

                Also at the meeting, Murray reminded the hospital board members that the Wright/Texas County 9-1-1 office located on the TCMH campus does not pay rent or utilities to the hospital for the space they have used since the service’s inception.

                “There is a tax measure on the upcoming election ballot that would help fund Wright/Texas County 9-1-1 through a county sales tax,” Murray said, noting that the loss of the service “would place an additional burden on the hospital”.

                Murray explained that TCMH has been involved in the Wright/Texas County 9-1-1 board meetings because the majority of calls into the service require an ambulance to be dispatched.

                “They have their own board and operate independently of the hospital,” Murray said, explaining that some “miscommunication” has indicated that TCMH would take over Wright/Texas County 9-1-1. 

                “We do not have a plan to take over Wright/Texas County 9-1-1, and if the service is no longer available, we will go back to dispatching our own ambulances,” Murray said.

                During the summer, TCMH will provide some space to the Cox College of Nursing/Drury University nursing fundamentals cohort.  The cohort is enrolled in the Cox/Drury Cabool campus, but the space is not available for the cohort to use at this time.

                “We will make available a few rooms on the East wing for the cohort to use until their new space is ready,” Murray said, explaining that the students and the school are “very excited” about the opportunity to use actual hospital space.

                “The school will place one of their simulator mannequins in one of the rooms, and the students will be exposed to a real hospital environment and real hospital rooms,” Murray said.

                Dr. Jim Perry, OD, TCMH board member and Cabool resident, complimented the efforts of Drury and Cox working together to bring additional nursing education to the area. 

                “Nursing training available through Drury in Cabool is such a good thing for area students because the students that complete the program can make a living anywhere,” Perry said.

                The February financial report reflected a drop in inpatient and outpatient revenues for a $32,221.43 loss, but the year-to-date balance is positive at $8,436.70.

                “Last year we took a major hit with the February financials, and this month is much better than 2013,” Linda Pamperien, chief financial officer at TCMH said.

                Pamperien reported that the February financials show interest accrual on the recent capital project for both January and February.  Because the expansion project is not complete, loan payments have not yet begun.  Pamperien also pointed out that TCMH has three payments left on a bond note for capital improvements done in 2000.  That note will be retired in July.

                “The field portion of the 2013 annual audit has been completed,” Pamperien said.  “BKD will present the audit at next month’s meeting.”

                BKD, LLC from Springfield does the annual audit which includes an onsite review portion that is done each year in March.

Present at the meeting were Murray; Pamperien; Durham; DorettaTodd-Willis, chief nursing officer; Dr. John Duff, and board members Perry; Janet Wiseman; Mark Hampton, and Russell Gaither.

Board member, Omanez Fockler, was not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., April 22 at 12 p.m. in the hospital board room.

Kelley Named Employee of the Month

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Texas County Memorial Hospital has named Brandi Kelley of Seymour the February employee of the month.

Kelley is a medical lab technician in the laboratory at TCMH, and she has worked for the hospital for almost two years. She was nominated for the award by Kirby Holmes, laboratory director at TCMH.

“Brandi sees every department, employee, patient and patient’s family member as a customer, and she takes personal pride in providing them with good customer service,” Holmes said.

Holmes explained that Kelley works independently, solving problems with they arise and taking responsibility for her work.

“Within two weeks of being assigned to the night shift, Brandi was able to troubleshoot a complex hematology analyzer problem, and kept testing going without interruption,” Holmes said, adding that Kelley was “very dependable”.

As employee of the month, Kelley received a certificate honoring her achievement; a pin; $100 cash; a special parking place in the TCMH lot; one day of paid vacation; a membership in the TCMH Fitness Center; a $50 gift card; gift certificates to Paws N Claws, D&L Florist and Janstiques, and cd of the month from Big Country 99. A reception will be held at the hospital in honor of Kelley.

Kelley is eligible for the 2014 TCMH employee of the year award.

Brandi Kelley, the Texas County Memorial Hospital February employee of the month, is shown here with her supervisor, Kirby Holmes.

Brandi Kelley, the Texas County Memorial Hospital February employee of the month, is shown here with her supervisor, Kirby Holmes.


Patient Portal Provides TCMH Patients with Online Access to Healthcare Services

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Texas County Memorial Hospital clinic patients will have access to healthcare services via a new “patient portal” that began this week, TCMH board members heard at their monthly meeting on Tuesday.

The web-based program was required to meet Stage 2 Meaningful Use guidelines set by the federal government which has provided financial incentives to healthcare providers that meet federal mandates for electronic medical records.

A screen like this appears in the patient portal allowing patients to make an online appointment request their healthcare provider.

A screen like this appears in the patient portal allowing patients to make an online appointment request their healthcare provider.

“The patient portal can be accessed through the hospital’s website,” Wes Murray, TCMH chief executive officer, explained. “Patients that visit a TCMH clinic will be given a PIN (personal identification number) so they can set up a personal account.”

The portal allows patients to see information regarding exams with healthcare providers at TCMH. Clinic bills can be paid through the portal. Immunization records can be printed. Medication refills can be requested. Patients can contact clinic staff, and appointments can be made.

“Our patients will be able to direct questions to their healthcare provider through the portal,” Murray said. “The questions will go to the physician or mid-level provider’s nurse in the form of an e-mail.”

Murray explained that currently the patient portal is only for TCMH clinic patients. Hospital records are not accessible via the portal.

An additional feature of the portal is that an entire family can be set up on one portal account. For example, a parent can manage all children that are TCMH patients under one account. Parents will have to get a PIN for each family member, but once the PIN is obtained, each family member can be added.

The portal is not optimized for mobile devices, but all features of it are accessible on mobile devices. The TCMH information systems department expects that mobile optimization will come to the site in the future.

“I think this is a great benefit to our patients, “Dr. Schaun Flaim, chief of the TCMH medical staff, said to board members. “I think this will increase efficiency in communicating with our patients.”

Murray noted that since Monday all TCMH patients coming in for appointments are receiving information about the portal. During their visit, they are offered a PIN to set up an account on the portal. Patients may also contact the clinic and request a PIN before coming in to the clinic.

TCMH continues to look at ways to maximize clinic space and to meet area healthcare needs. The recent hospital remodeling project has freed up space that can be used for a surgical suite containing office, exam and reception rooms.

“We have space in the TCMH Medical Complex here in Houston that does not receive the higher ‘rural health clinic’ reimbursement,” Murray said.

In the upcoming months, the general surgery suite in the TCMH Medical Complex will be moved to an area inside the hospital. The move will open up additional offices and exam rooms for patients and mid-level providers to extend healthcare services in the TCMH Medical Complex.

According to Murray, part of the extension of services will include walk-in clinic that patients will be able to access without an appointment. The walk-in clinic will be staffed by mid-level providers.

“Utilizing our clinic space to provide healthcare without an appointment will make the clinic space more productive and help more patients get established with TCMH providers,” Murray said.

Walk-in clinic services are still in the planning stages, but Murray hopes that Debra Buckle, an established family nurse practitioner with TCMH, and Chip Lange, a recently hired physician’s assistant, will be able to staff the clinic.

“This will help patients that have non-emergency needs that cannot get in to see a doctor,” Murray said. “They will be able to see someone in the clinic rather than go to the ER.”

TCMH also continues recruiting efforts for additional obstetrics healthcare providers and a general surgeon.

“We recently interviewed a certified nurse midwife and an OB/GYN specialist,” Murray said. “We have a general surgeon visiting next week, and we are working on additional dates to bring in other providers for interview in March.”

Also at the meeting, TCMH board members unanimously approved a temporary easement to the City of Licking in front of the TCMH Family Clinic in Licking.

The city has grant funds available to repair and widen sidewalks in the city. Sidewalks will be handicapped accessible when the project is complete. The easement is granted for 90 days from the beginning of the sidewalk construction project.

Murray also presented information to the board members about Missouri Senate Bill 763 and House Bill 1616 which would amend current laws that do not allow county hospitals to talk with each other about certain aspects of daily operations or provide services across county lines.

“This bill would allow county hospitals to combine efforts to save money,” Murray said.

The bills were specifically crafted to benefit hospitals in Central Missouri,that are looking for ways to continue to provide healthcare in their community without losing their independence.

“These bills could have benefits to all county hospitals in our state,” Murray said.

In the January financial report, Linda Pamperien, TCMH chief financial officer, explained that belt-tightening at the hospital over the past six months has had a positive effect on the bottom line.

In January hospital volumes were down and expenses were up slightly, but the hospital eked out a positive bottom line of $40,658.13, starting the facility off in the black for the year.

“We have been committed to reducing expenses at TCMH, and it is paying off,” Pamperien said.

Overall employee hours were down at the hospital in 2013 by 25,000 hours, an equivalent of 12.6 full-time employees. The reduction in hours saved the hospital $214,000 in payroll expense in 2014.

“We did not have any layoffs, and some jobs lost due to attrition have been absorbed by the affected department,” Pamperien said.

Pamperien commended the hospital’s department managers and the employees that have played a role in taking on additional responsibilities and managing their time efficiently.

“We will continue to do whatever we can to save funds and to operate as efficiently as possible,” Pamperien explained.

Present at the meeting were Murray; Pamperien; Flaim; DorettaTodd-Willis, chief nursing officer; Joleen Senter Durham, public relations director; Dr. John Duff, and board members Omanez Fockler; Dr. Jim Perry, DO; Janet Wiseman; Mark Hampton, and Russell Gaither.

The next meeting of the TCMH board of trustees is Tue., Mar. 25 at 12 p.m. in the hospital board room.


Hospital Offers Free Cancer Screening

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The American Cancer Society designates the month of March as colorectal cancer awareness month. In observance of colorectal cancer awareness month, Texas County Memorial Hospital is offering free colorectal cancer screening during the first week of March.

Area residents may contact TCMH for a free colon cancer screening kit from Monday, March 3 through Friday, March 7. The screening includes a fecal occult blood test kit for individuals who are over 50 or for individuals who are younger if they have risk factors for colorectal cancer. The kit and information about colorectal cancer will be mailed to participants. Instructions will be included with the kit.

Colorectal cancer is the number two cancer killer in Texas County and the rest of the United States.

However, the American College of Gastroenterologists calls colorectal cancer one of the most preventable and curable types of cancer when detected early. One way to detect colorectal cancer early is to be screened using the fecal occult blood test.

The American Cancer Society recommends that individuals over the age of 50 who are at average risk follow one of five screening options: yearly fecal occult blood test; flexible sigmoidoscopy every five years; yearly fecal occult blood test plus sigmoidoscopy every five years; double contrast barium enema every five years or colonoscopy every 10 years. An individual who has a family history or a personal history of colorectal cancer, polyps, or inflammatory bowel disease may begin colorectal cancer screening at an earlier age as directed by a physician.

There are several symptoms to colorectal cancer. Symptoms may include a change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days; a feeling of needing to have a bowel movement that is not relieved by doing so; rectal bleeding or blood in the stool; cramping or steady abdominal pain or weakness and fatigue.

Other health conditions may also cause these symptoms. Only a physician can determine the cause of suspicious symptoms. Individuals should discuss any symptoms with their physician as early as possible.

To request a free kit or additional information about colon cancer, contact Krista Elliott, education coordinator at TCMH, by calling 1-866-967-3311 or (417) 967-1340 or e-mail Elliott at Please leave your name, address and phone number when calling or e-mailing for a kit.

All kits must be returned to TCMH by April 30, 2014 for processing.




The Perfect Place for Chip Lange

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                According to Chip Lange, his parents are “only slightly disappointed” that he didn’t return home to Cuba, MO to practice medicine and work on the family farm.  However, Lange considers his new home in Houston, MO to be the “perfect” location for practicing medicine, and it’s “just the right distance” from home, too.

                “Areas like Texas County need medical help the most,” Lange explained, adding, “I grew up in a small town, and I understand the importance of treating people I know.”

                Raised in Cuba, Lange always had an interest in pursuing a career in a healthcare field.  While working toward an undergraduate degree in biomedical psychology at Westminster College in Fulton, Lange learned about the role a physician assistant (PA) plays in the healthcare field.

                “Physician assistants have a broad base of knowledge that allows us to work in a wide range of healthcare fields, and we are trained to collaborate with doctors, nurses and other members of the healthcare team,” Lange said. 

Chip Lange, PA-C

Chip Lange, PA-C

                Lange liked the “teamwork component” as well as the flexibility and lifestyle options a PA has.

                After completing his undergraduate degree, Lange began the PA program and the University of Toledo in Ohio.  Lange’s final rotation in the program was at Texas County Memorial Hospital working under Dr. Schaun Flaim at the TCMH Medical Complex.

                “The University of Toledo program is two years—a year in the classroom and in a medical setting and the final year doing rotations in various healthcare settings,” Lange said.

                Although Lange’s PA training rotations covered all aspects of healthcare, he tried to focus on rural settings for his primary care training.  After growing up in rural America, Lange was confident he wanted to take his healthcare knowledge back to a small town.

                “I wanted to get lots of exposure to all types of healthcare issues and learn as much as possible,” Lange said.

                Lange’s connection with TCMH came through his fiancée, Amber Lockhart, a newly hired English teacher at Houston High School.  Lockhart grew up in Leasburg, MO, and she took the full-time job in Houston last fall. 

Lange opted to do his final PA rotation in a location that would be near Lockhart.

                “While at TCMH, I’ve worked primarily under Dr. Flaim, but I’ve also been able to work with Dr. Kerr and other members of the TCMH team,” Lange said.  “I’ve been exposed to many different things, and the final rotation put the finishing touches on my training.”

                Upon relocating to Houston, Lange joined the volunteer fire departments for Houston—city and rural.  Lange trained as an emergency medical technician in college, and after becoming an EMT, he joined the Central Callaway County Fire Department so he could gain experience providing hands on patient care.

                “Fire departments can always use extra help, and it’s a great opportunity for me to use what I know,” Lange explained.

                At TCMH Lange found the healthcare providers he was working with to be very open and helpful due to prior experience with the PA field.  Lange quickly realized that he wanted to work at TCMH full-time after completing his PA training.

                “This is a great opportunity for me,” Lange said, adding that it’s also convenient to work in the same town as his fiancée.

                “I have been able to share my ideas about how I might be utilized as a PA at TCMH, and everyone has been open to them,” Lange said.

                Lange hopes to work in the clinic as well as the TCMH emergency department.  Lange is even working with the TCMH Healthcare Foundation in pursuing a grant that would allow him to make home visits to patients that have conditions that make them a high risk for readmission following a hospitalization or that are unable to be seen in the clinic due to limitations.

                “I like the idea of working in a place where I will not be stuck in one location,” Lange explained.  “I don’t mind being asked to float from place to place where I’m needed most at the time.”

                Lange passed his board certification exam in January, and he’s waiting on his licensure to come through before he can see patients on his own.  His first assignment as a PA at TCMH will be to fill in for Dr. Gretchen Price, internal medicine physician at the TCMH Medical Complex in Houston, while she’s on maternity leave this spring.

                “I’ve been able to spend time with Dr. Price, meeting her patients, so I hope to help alleviate some of the load for her while she’s out,” Lange said.

                Lange is also planning to be available to the TCMH emergency department to call on him to help with primary care needs in the department during peak times.

                “They will just be able to pick up the phone and call me,” Lange explained. 

                Regardless of where he’s working, Lange is passionate about the work a physician assistant can do in rural America.

                “There’s less cost to an employer in hiring a PA,” Lange said.  “We can try new things, and we’re trained to work on the front lines of healthcare in collaboration with the physician and other members of the healthcare team.”

                In his free time, Lange enjoys sport shooting as well as hunting and fishing.  He is also a Civil War re-enactor and does mixed martial art training. 

                “If it’s outdoors or active, it’s something I want to do,” Lange, an Eagle Scout, said.

Lange and Lockhart will marry on February 15, and they are working toward purchasing a home in Houston.  Both have a strong commitment to community and want to become more involved in Texas County and the new community they call home.

As Lange stated succinctly, “I want to be here.  It’s the perfect place for me.”

Barton Named Employee of the Month

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Texas County Memorial Hospital has named Brenda Barton of Houston the January employee of the month.

Barton is a clerk in the registration department at TCMH, and she has worked for the hospital for 17 years. She was nominated for the award by Rachel Phillips, registration department director at TCMH.

“Brenda is one of those employees that is not just here to do a job; she cares about the future of the hospital and all of our customers,” Phillips said.

Phillips explained that Barton is always willing to work independently or improve or develop a process for the department.

“Brenda recently developed a process to review surgeries ahead of time, which has been very helpful,” Phillips said, adding, “This process has helped us correct any issues before the patient shows up for surgery.”

As employee of the month, Barton received a certificate honoring her achievement; a pin; $100 cash; a special parking place in the TCMH lot; one day of paid vacation; a membership in the TCMH Fitness Center; a $50 gift card; gift certificates to Paws N Claws, D&L Florist and Janstiques, and cd of the month from Big Country 99. A reception will be held at the hospital in honor of Barton.

Barton is eligible for the 2014 TCMH employee of the year award.


Brenda Barton (right) with her supervisor, Rachel Phillips.

Brenda Barton (right) with her supervisor, Rachel Phillips.

Hospital Board Approves the 2014 Capital and Operating Budgets

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                The Texas County Memorial Hospital December board of trustees gave approval for the 2014 capital and operating budgets at their monthly meeting on Tuesday.

                “The capital and operating budgets are reflective of the many unknowns that are ahead of us as a hospital,” Wes Murray, chief executive officer, explained to the board. 

                The $708,954 capital budget is a 6.6 percent decrease from the 2012 capital budget.

               “Some of the big ticket items are repeats because we did not purchase them last year,” Linda Pamperien, TCMH chief financial officer, said.

               A new esophagogastroduodenoscopy (EGD or upper endoscopy) scope is budgeted for $35,904; it was budgeted for but was not purchased in 2013.  A ventilator for $29,390, a lab analyzer for $31,810 and an ambulance for $96,050 are part of this year’s capital budget.

                Electronic medical records items make up a large portion of capital expenditures.  Items totaling $177,917 will help TCMH meet the federal government’s “Meaningful Use Stage 2” requirements.  A $56,114 server will allow the hospital’s radiology department to send digital images at a faster speed for teleradiology reports.

                “Our managers are very conscientious about their department’s capital needs,” Pamperien said.  “They won’t purchase something unless they absolutely have to.”

                 Murray noted that in 2013 “a lot of new equipment” was purchased to outfit the hospital expansion which included new private patient rooms on a new medical surgical floor, a larger emergency department and a radiology suite.

                “We are very fortunate to have replaced many large items within the past year,” Murray said.

                 Board members also approved the 2014 operating budget that projects gross operating revenue of $66,111,752 and net operating revenue of $9,296.

                “We have an operational goal of breaking even this year,” Pamperien said.

                For 2013, Pamperien anticipates a 5.39 percent increase in hospital expenses in areas such as utilities and food costs.  Pamperien explained that the operating budget does not show any anticipated growth in hospital inpatient, outpatient or emergency room volumes.

                Pamperien explained that the operating budget also included an increase in contractual adjustments for hospital patients, a figure which is on the rise annually.  TCMH has begun paying interest on the new construction loan and will have additional depreciation expense due to the new construction, too.

               “We continue to operate very lean,” Pamperien said.  “But we are more fortunate than many other facilities.  Our accounts receivable and cash flow are very good.”

                 Pamperien noted that TCMH is waiting on funds from payor groups like Medicaid.  The federal insurance plan currently owes TCMH over $2 million for services provided over the past few years.  The hospital cannot receive the funds until the government is ready to release them.

                 Pamperien and Murray stressed that without Medicaid expansion in the state of Missouri, the costs of the Affordable Healthcare Act and cuts to Medicare and Medicaid reimbursement from sequestration continue to cost TCMH.  TCMH anticipates that each year the costs will grow.

                 Pamperien explained that hospital service departments would continue to receive scrutiny “to see if they are making money”.

                “We must press forward and do the best we can,” Omanez Fockler, chairperson of the TCMH board of trustees, said.  “We need to utilize every opportunity we have to get funds from anywhere.”

                Dr. Jim Perry, OD, board member, noted that healthcare utilization, including Medicare utilization, is slowing nationally. 

“It seems that there’s an extreme awareness of the cost of healthcare,” Perry said.

Murray presented data from the Missouri Hospital Association showing how payment cuts are affecting TCMH and will continue to affect the hospital in upcoming years if Medicaid expansion does not take place in the state.

“There are very important factors that are affecting the financial side of hospitals,” Murray said.  “It seems to be hitting us harder and more immediately than we anticipated.”

Dr. John Duff, CoxHealth representative, acknowledged that planning is difficult with the fluctuation in hospital volumes and the unknown future of healthcare reimbursement.

“Hospitals and physicians are trying to keep healthcare costs down,” Duff said, adding “And healthcare plans with high deductibles seem to discourage people from utilizing healthcare services.”

“The Missouri Hospital Association projects that TCMH will lose $6 million over the next five years if Medicaid is not expanded in the state,” Murray said.  “Other factors such as high deductibles can also adversely affect our bottom line when people choose to go without healthcare services.”

                Although emergency department volumes have been down, TCMH continues to look at ways to improve patient experience the emergency department.

                “Dr. Randall Qualls recently returned to work for us,” Murray reported.  Qualls left his full-time position in June, but came back to TCMH in early January.

                Doretta Todd-Willis, chief nursing officer, reported that the hospital’s application for a “level 3” stroke designation has been accepted.

                “With a stroke designation, the TCMH emergency department is recognized statewide as a place for potential stroke victims to receive emergency care,” Todd-Willis said.  “The treatment plan for stroke patients that come to our emergency department will be even faster and more streamlined so patients can get the treatment they need as quickly as possible.”

                Todd-Willis explained that the final steps for the stroke designation include a transfer agreement with CoxHealth in Springfield and a site visit by state inspector in April.

                Additionally, TCMH recently hired Carl “Chip” Lange, a physician’s assistant; he will provide patient care in the clinic and help out in the emergency department during peak times.

                “We cannot sustain an urgent care or fast-track in the ER right now,” Murray said, “But Chip can be called in during peak times to help alleviate some of the pressure and shorten wait times.”

                Lange grew up in the Ozarks and completed his final semester of physician assistant studies working under Dr. Schaun Flaim at TCMH.  He sought a permanent position at TCMH after completing his training.

                In the financial report, Pamperien reported that TCMH ended 2013 with 1,763 inpatient admissions—180 admissions less than 2012.  Sequestration, cuts related to the Affordable Care Act and the lack of Medicaid expansion in Missouri combined with a dip in inpatient, outpatient and emergency department volumes left TCMH with a year to date loss of $798,516.09. 

                “I always give a conservative financial report, so these numbers may be improved after our annual audit this spring,” Pamperien said.

                In December, TCMH collected $970,191 in funds from the federal government for reaching set levels of electronic medical records usage.  The federal funds helped offset losses for the year, but TCMH expects to post a financial loss for the year.

Present at the meeting were Murray; Pamperien; Duff; Todd-Willis; Joleen Senter Durham, public relations director; Dr. Schaun Flaim, chief of staff, and board members Fockler; Perry; Janet Wiseman and Russell Gaither.

Board member Mark Hampton was absent.

The next meeting of the TCMH board of trustees is Tue., Feb. 25 at 12 p.m. in the hospital board room.

Grief Recovery Program to Begin at TCMH

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Registration is now being accepted for the “Grief Recovery Method Outreach Program” sponsored by Texas County Memorial Hospital Hospice of Care.

The seven-week Grief Recovery Method Outreach Program will begin Tuesday, February 25th from 5:30 to 7:30 p.m. at TCMH.  Sara McDaniel, a certified grief recovery specialist and social worker with TCMH Hospice of Care, will facilitate the program.  The class is held in the Timmons Education Room at TCMH.

“In coping with grief many people are told to ‘let go and move on in life’, but they don’t know how to accomplish that,” McDaniel said.  “The Grief Recovery Method Outreach Program provides the partnerships and guidance that individuals need to be able to move on with life after a loss.”

The program will provide an action plan for moving beyond death, divorce and other losses such as job loss or health loss.

There is no charge for the program, and the group is open to anyone that is seeking support following a loss.

For additional information or to register for the program, contact McDaniel at TCMH Hospice of Care at 417-967-1279.

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