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Annual Hospital Audit Shows Strong Financial Position Despite Year End Loss

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Texas County Memorial Hospital ended 2015 with a net position of -$2,071,369 in excess revenues over expenses hospital board members and administration heard at their monthly meeting on Tuesday.

Texas County Memorial Hospital board of trustees chairperson, Dr. Jim Perry, OD (left), administered the oath of office to Omanez Fockler, returning board member at the meeting on Tuesday.

Texas County Memorial Hospital board of trustees chairperson, Dr. Jim Perry, OD (left), administered the oath of office to Omanez Fockler, returning board member at the meeting on Tuesday.

Stephanie Weis, partner at BKD, LLP of Springfield, MO and David Taylor, senior manager at BKD, presented the annual audit report at the monthly meeting.

“2015 was an atypical year for operating results,” Weis said, citing the loss of two doctors in the first quarter of 2015, which led to lower operating revenues of $1,848,391.

Audit results also showed that expenses at the hospital dropped by $475,145 in 2015, which Taylor described as “not common”.

“A substantial portion of expenses are fixed in a hospital of your size,” Taylor said. “It’s very hard to be responsive to volume changes, but you were able to control expenses that were controllable.”

In 2015, grants and donations to the TCMH Healthcare Foundation totaled $619,196. In 2014, grants and donations totaled $1,180,978. Although the Healthcare Foundation funds are designated for specific purposes, the numbers are included in overall year end fiscal results.

“The funds you have received for grants and donations are very strong,” Taylor said. “Numbers like these are not typically seen in a hospital of your size.”

Although revenues at the hospital were down in 2015, TCMH continued to invest in the hospital with capital purchases totaling $500,940.

TCMH made principal payments of $747,356 on the major construction project completed in 2014, and depreciation expenses made up a good portion the hospital’s losses in 2015.

“A lot of this year’s loss is related to depreciation,” Taylor said. “If you take out the depreciation, 2015 showed a ‘true decrease’ of about $450,000.”

The audit report showed a decrease in accounts receivable of over 12 percent for 2015, most of which is third-party insurance collections for clinic-based billing. Auditor called the decline “favorable”.

“Our report shows that you are doing what you can to watch any funds that are going out the door,” Taylor said.

TCMH had 83 days of cash on hand—the days the hospital could operate without bringing in any funds. The rural Missouri hospital average is approximately 50 days of cash on hand.

Construction projects at TCMH have the average age of the hospital facility down to about 10 years which is at or below Missouri hospital averages.

The debt to capitalization ratio at TCMH is at 50 percent, which Taylor called “not too high”. TCMH is in line with other hospitals in the nation.

“Your balance sheet is good, and your financial position is strong,” Taylor told board members.

Taylor pointed out that revenue from the 340b pharmaceutical program helped offset losses in 2015, and he noted that TCMH plans to grow those revenues in 2016. Additionally, TCMH has hired Dr. Cory Offutt, a family medicine and obstetrics physician that will begin working full-time in the hospital and clinic in July.

In 2015, TCMH brought $14,127,908 in Medicare and Medicaid funds into the hospital. Due to the patient population in the area TCMH relies heavily on federal funds.

Taylor spoke to board members about the shift that hospitals are experiencing as Medicare makes payments for healthcare related to value rather than volume.

“TCMH experienced some value-based payments in 2015, and there are more of those to come in the future,” Taylor said.

Taylor explained that understanding the financial path for risk-based reimbursement versus the traditional fee for service payment method is not entirely known.

Beginning this April, a pilot program for hip and knee replacement was put into place in major-metro areas of the state. Hospitals are given a bundled bulk payment for the joint replacement, and with the joint replacement, the hospital assumes a 90-day responsibility for the patient post-discharge.

“The bottom line for each joint replacement is dependent upon improving the outcome of the patient,” Taylor said. “This is forcing conversations on the coordination of care for patients.”

Taylor and staff at BKD anticipate that more healthcare procedures and services will be placed into “bundled” payments, placing the hospitals at risk financially.

As a result of the anticipated changes to the payment delivery methods for the hospitals they serve, BKD has hired non-CPA staff to help the accounting firm better understand the clinical side of the business.

BKD sends an audit team to TCMH each March, spending about a week pouring over hospital financial information from the previous year. The firm takes about a month to complete the audit information including expense statements, balance sheets, statement of cash flows and other information that comprises the financial report documents presented at the April board meeting.

BKD uses historical TCMH data and data from other healthcare facilities for comparison purposes during the audit. BKD also has access to the latest information regarding hospital payers which helps the firm reach concrete numbers in the final audit report.

“As our numbers show, there was not a significant change from the numbers you reported internally to those we are reporting,” Weis said. “You did a good job making decisions throughout 2015 based on your internal results.”

In the hospital administrative report, Wes Murray, chief executive officer, explained that he and Joleen Senter Durham, physician recruiting director at TCMH, visited the Cox Family Medicine Residency Program in Springfield where they talked with residents about TCMH.

“We had a very productive meeting and provided lunch for about 15 people,” Murray said, adding, “We spoke with them about moonlighting in the ER, rural residency rotations in the clinic or surgery department, weekend hospitalist work, and full-time opportunities after residency.”

Durham noted that several of the current residents have roots in the Ozarks.

“Most residents will take a job within 100 miles of where they complete residency,” Durham said. “We are very fortunate that Cox allows us the opportunity to meet with their residents regularly.”

Ron Prenger, CoxHealth representative, pointed out that the Cox residency program was recently allowed to add an additional resident, and the program hopes to add more slots for residents in the future.

Linda Pamperien, chief financial officer at TCMH, presented the financial report for the month of March.

“Inpatient volumes were below budgeted expectations, but outpatient volumes were above budgeted expectations for an overall revenue of $23,261,” Pamperien said.

Due to Medicaid payment remittance for three weeks instead of two in the month of March, contractual adjustments were higher, coming in at almost 68 percent.

With the higher contractual adjustment, TCMH ended the month of March with negative bottom line of $132,017.53, creating a neative year-to-date bottom line of $35,996.74.

Present at the meeting were Weis; Taylor; Murray; Pamperien; Durham; Prenger; Anita Kuhn, controller; Dr. Jonathan Beers, TCMH chief of staff; and board members Jim Perry; Mark Hampton; Omanez Fockler, and Janet Wiseman.

The next meeting of the TCMH board of trustees is Tue., May 24 at 12 p.m. in the hospital board room.


Therapists Receive Certification in Specialized Therapy for Patients with Parkinson’s Disease

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Area residents with Parkinson’s disease have the opportunity to receive LSVT BIG, a specialized physical therapy available through Texas County Memorial Hospital and TCMH Home Health of the Ozarks.

Christie Koch, left, and Ellen Willis, right, have received their LSVT BIG certification.  Cabool resident and former Texas County judge, Brad Ellsworth, has worked with the TCMH physical therapy department for Parkinson’s disease-related therapy, but he hopes to utilize the LSVT BIG therapy in the future.

Christie Koch, left, and Ellen Willis, right, have received their LSVT BIG certification. Cabool resident and former Texas County judge, Brad Ellsworth, has worked with the TCMH Physical therapy department for Parkinson’s disease-related therapy, but he hopes to utilize the LSVT BIG therapy in the future.

Ellen Willis, physical therapist and director of the physical therapy department at TCMH, and Christie Koch, physical therapist assistant at TCMH Home Health of the Ozarks, completed LSVT BIG training and passed the test for certification.

“I am very excited to be able to offer this therapy for our patients,” Willis said, explaining that she and Koch jumped at the opportunity to get the training when it was recently offered in Missouri.

The training included work with a community volunteer, and Willis noted that even in the short time of working with the volunteer during the training program, the volunteer showed improvement in their movement.

“LSVT BIG specifically addresses amplitude of movement with patients suffering from Parkinson’s disease,” Willis said.

Willis explained that Parkinson’s disease—a neurological process that affects the brain’s ability to receive dopamine—can start in patients as young as 30 or 40 years old.

“We are not exactly sure what causes Parkinson’s disease,” Willis said. She explained that Parkinson’s disease symptoms include muscle rigidity, tremors, and changes in speech and gait. After diagnosis, treatments can help relieve symptoms, but there is no cure.

According to Willis, there are five stages to Parkinson’s disease, and any therapy a patient receives in the early stages of the disease can help delay the disease’s progression.

“The greatest improvement with the BIG therapy for Parkinson’s patients is in stages one through three, but it can be done in any stage,” Willis said.
With the new certification, Willis will do LSVT BIG therapy in the hospital physical therapy department, and Koch will do LSVT BIG therapy with patients in their home. Willis will also do in-home assessments with Home Health of the Ozarks patients before Koch implements the therapy program.

“We have had many patients at TCMH that would benefit from BIG therapy, and it’s important that those in the beginning stages of Parkinson’s disease understand that early intervention is very important,” Willis said.

Parkinson’s disease slows a person’s movement and speech. It’s not uncommon that handwriting will become smaller, speech will become softer, walking and other movement will be slower and less animated. Ultimately, Parkinson’s disease will completely cripple a patient making the person unable to move and speak.

“BIG therapy identifies the specific needs of each patient such as shaving, removing a wallet, putting on socks and shoes, walking, and more in the initial assessment,” Willis said. “We develop a therapy program of seven exercises along with functional activities that we do with the patient for 16 one-hour sessions—four consecutive days a week for four weeks.”

The patient is asked to practice their exercise program at home during the therapy regimen. After the prescribed program is complete, the patient continues their daily exercises at home, checking in for a “tune up” in three to six months and meeting with a therapist as needed.

“It’s amazing to watch the changes in a patient before and after therapy,” Willis said. She described a Parkinson’s patient with a shuffling gait before therapy, and after therapy the patient will swing his or her arms while taking steps and holding their head up.

“BIG therapy carries over to other facets of the disease, too, improving speech and handwriting because of better movement techniques that carry over from therapy,” Willis said.

According to Willis LSVT BIG therapy can benefit patients for up to two years.

“The therapy program calibrates internal movement cues,” Willis said.

Willis noted that many Parkinson’s patients are home bound or they cannot easily travel to the hospital for therapy, so Koch will do LSVT BIG therapy in the home following Willis’ initial assessment of the patient in his or her home.

Like all physical therapy, a patient must receive a doctor’s order for the initial assessment.

“Most insurance will cover BIG therapy,” Willis said. She noted that some of the therapy techniques used for BIG therapy are also valuable for use with other neurologic disorders.

“Christie and I are looking forward to bringing BIG therapy to patients in the area for the first time,” Willis said.

Depending upon the need for BIG therapy, Willis hopes to have other TCMH physical therapy staff train and receive their LSVT BIG certification in the future.

For additional information about LSVT BIG therapy, contact the TCMH physical therapy department at (417) 967-1201.


Christie Koch is Employee of the Month

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Texas County Memorial Hospital has named Christie Koch of Bucyrus the March employee of the month.

Christie Koch (center), Texas County Memorial Hospital March employee of the month, with Ellen Willis, physical therapy department director (far left) and Krista Elliott, Home Health of the Ozarks director.

Christie Koch (center), Texas County Memorial Hospital March employee of the month, with Ellen Willis, physical therapy department director (far left) and Krista Elliott, Home Health of the Ozarks director.

Koch is a physical therapy assistant for TCMH Home Health of the Ozarks. Koch has worked at the hospital since 2013. Koch received two nominations for the award from TCMH directors—Krista Elliott of Home Health of the Ozarks and Ellen Willis of the physical therapy department.

“Christie has great rapport with her patients,” Elliott said, describing Koch’s “positive attitude” at all times in working with patients and co-workers.

As the physical therapy assistant for Home Health of the Ozarks, Koch works with the hospital’s physical therapy department to provide physical therapy to patients in their own homes. Koch volunteers to help out the hospital physical therapy department when there are staffing needs.

“Christie manages her own schedule independently and cost effectively,” Willis said, adding, “She is a valuable asset to TCMH.”

As employee of the month, Koch received a certificate honoring her achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist; Blissful Nirvana Massage, Wher Motors, and Twirlee Q. A reception will be held at the hospital in honor of Koch.

Koch is eligible for the 2016 TCMH employee of the year award.


Endowed Scholarship Fund for Area Youth to Benefit from Give Ozarks Day

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The Texas County Memorial Hospital Healthcare Foundation is raising funds for the TCMH Youth Ambassador Endowed Scholarship through the Give Ozarks program on Tuesday, May 3.

Progressive Ozark Bank donated $1000 to the TCMH Healthcare Foundation Youth Ambassador Endowed Scholarship Fund to kick off the Healthcare Foundation’s Give Ozarks Day project.  Shown here at the check presentation are (left to right):  April Steele, Youth Ambassador Program director; Monica Hunter, TCMH Youth Ambassador; Earleen Holder, Progressive Ozark Bank in Houston, and Jay Gentry, Healthcare Foundation.

Progressive Ozark Bank donated $1000 to the TCMH Healthcare Foundation Youth Ambassador Endowed Scholarship Fund to kick off the Healthcare Foundation’s Give Ozarks Day project. Shown here at the check presentation are (left to right): April Steele, Youth Ambassador Program director; Monica Hunter, TCMH Youth Ambassador; Earleen Holder, Progressive Ozark Bank in Houston, and Jay Gentry, Healthcare Foundation.

Give Ozarks is a one-day surge across the state of Missouri that is part of the national “Give Local America Day”. Community Foundation of the Ozarks (CFO) organized Give Ozarks day to benefit its affiliate members and charitable organizations across the Ozarks region. On May 3rd donors will be able to make online donations at www.giveozarks.org to the Healthcare Foundation to benefit the TCMH Youth Ambassador Endowed Scholarship.

The TCMH Healthcare Foundation is an affiliate member of CFO. Last year, the Healthcare Foundation raised $14,891 during Give Ozarks day which included a $5,000 matching grant from CFO.

This year, Progressive Ozark Bank in Houston has donated $1,000 to the 2016 Give Ozarks effort for the Healthcare Foundation.

CFO will have additional matching funds and prizes available to organizations that rally donors to participate in the 24-hour day of giving on May 3rd.

“Our goal for 2016 is to raise the endowment fund to $19,000. This is will allow us to give scholarships totaling $750 in 2016,” Jay Gentry, TCMH Healthcare Foundation director, said.

The ultimate goal of the Healthcare Foundation is to have an endowment of $25,000 that will cover two annual $500 scholarships for Youth Ambassadors.

“We are excited about growing this endowed scholarship program for the TCMH Youth Ambassadors,” Gentry said. “The Youth Ambassadors volunteered 1,795 hours in 2015 and are an important resource to the hospital.”

The Youth Ambassador program at TCMH allows selected area high school juniors and seniors and college students to volunteer in hospital departments for medical experience. Volunteer duties include passing out fresh linens and filling ice water cups for patients on the medical surgical floors, rocking newborns and greeting visitors in the obstetrics department, and reading to and talking with patients in the hospital’s swing bed program.

With the endowed scholarship, eligible Youth Ambassadors would have an opportunity annually to receive a scholarship toward higher education.

Funds donated to the TCMH Healthcare Foundation are tax-deductible. For donations to be included in the Healthcare Foundation’s Give Ozarks Day fundraising effort, donations must in the Healthcare Foundation’s hands by April 25th or given online May 3rd.

For additional information, contact Gentry at (417) 967-1377 or jay.gentry@tcmh.org


TCMH Healthcare Foundation to Award $6,500 in Scholarships

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The Texas County Memorial Hospital Healthcare Foundation has opened the application window for $6,500 in educational scholarships for the fall 2016 academic year.

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 tenth 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.

Healthcare Services Group Charitable Foundation, the purchasing group that TCMH belongs to, provides matching funds for scholarships given by the TCMH Healthcare Foundation. Those funds are available annually to the Healthcare Foundation and enable the Healthcare Foundation to give out an additional $3,000 in scholarships to area students.

“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 $67,000 in scholarship funds since the scholarship program began ten years ago.

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 planned for early June.

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, 2016. Awards for the scholarship will be announced by September 1, 2016.

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 jgentry@tcmh.org. The scholarship application and complete details are also available at www.tcmhfoundation.org.


Mid-Level Providers Join Doctors in Staffing TCMH ER on Weekends

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Texas County Memorial Hospital will increase healthcare provider coverage in the emergency department during peak weekend times, hospital board members heard at their monthly meeting on Tuesday.

“Like many area hospitals, we are watching our emergency room visits climb, and the acuity level of the patients coming into the ER is also on the rise,” Wes Murray, TCMH chief executive officer, said.

In February, TCMH had 907 patients visited the hospital emergency department. TCMH has physicians that work in the ER 24 hours a day, seven days a week. Since early last year, the hospital has also been using mid-level providers working alongside the ER physicians during peak times in the ER during the week and on weekends. However, weekend staffing with mid-levels providers has not been constant.

Ray Bruno, FNP

Ray Bruno, FNP

Whitney Young, PA

Whitney Young, PA

“Ray Bruno and Whitney Young are going to split weekend work in the ER,” Murray said. “They will work from 2 to 10 p.m. when our ER is usually busiest on Saturday and Sunday.”

Bruno is a family nurse practitioner at the TCMH Walk In Clinic, and Young is a physician assistant at the TCMH Family Clinic in Licking.

“The mid-level providers are able to see patients that come to the emergency room with less acute medical needs,” Murray said, adding that the mid-level assistance helps with overall patient flow during peak times.

Murray reported that the hospital and clinic are gearing up for the arrival of Cory Offutt, MD, a family medicine and obstetrics physician that will join TCMH in July.

Offutt is currently completing his residency at the University of Missouri in Kansas City, and his final two rotations will be at TCMH working in surgery and in the clinic.

“Dr. Offutt is eager to have everything in place prior to starting work here in July,” Murray said.

The residency rotations will provide Offutt the chance to learn the hospital and clinic electronic medical record systems. Offutt is also planning to do an orientation shift in the hospitals’ emergency department so he can provide coverage as an emergency room physician for the hospital from time to time.

Offutt and his wife, Samantha, have found a home in the area, and they plan to move to Texas County in June.

The TCMH laboratory recently underwent a federal CLIA inspection. CLIA stands for “Clinical Laboratory Improvements Amendments” that are part of federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States.

“We received four citations—one conditional and three minor,” Linda Pamperien, TCMH chief financial officer, said.

Pamperien explained that the TCMH lab expected the conditional citation, and with the help of CLIA officials, the problem was fixed. The minor citations have also been addressed.

“The plan of corrections has already been accepted,” Pamperien said. She added “The CLIA inspector was very complimentary of our lab and the services offered by the TCMH lab. He said that our community was ‘very fortunate’.”

BKD, LLC, of Springfield recently completed the field portion of the TCMH annual audit. The field portion included a week with auditors on site at TCMH. Murray and Pamperien will preview the audit findings in mid-April, and the full audit will be presented at the April board meeting.

“Our audit is an ongoing process throughout the year, and nothing was found out of the ordinary when the auditors were on site,” Pamperien said.

Pamperien reported that outpatient volumes almost met February’s budgeted expectations and Home Health of the Ozarks and Hospice of Care reported higher volumes in the month of February. Hospital expenses were also down overall in February.

“Our medical staff continues to do a great job in managing their patients’ hospital stays,” Pamperien said.

The hospital finished the month of February with a positive bottom line of $36,333.26, adding to the year-to-date bottom line of $96,020.79.

Present at the meeting were Murray; Pamperien; Doretta Todd-Willis, chief nursing officer; Amanda Turpin, quality management director; Joleen Senter Durham, public relations director; Ron Prenger, CoxHealth representative, and board members Dr. Jim Perry, OD; Omanez Fockler, and Mark Hampton.

Board members Russell Gaither and Janet Wiseman were not present at the meeting.

The next meeting of the TCMH board of trustees will be Tue., April 26th at 12 p.m. in the hospital board room.


Shanda Melton is Employee of the Month

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Texas County Memorial Hospital has named Shanda Melton of Mountain Grove the February employee of the month.

Melton is a registered nurse in the medical surgical department at TCMH. Melton has worked at the hospital since 2010. She was nominated for the award by John Sawyer, medical surgical department director, and David Phipps, hospital pharmacist.

“Shanda does a fantastic job giving great customer service and interacting with her coworkers and other departments in a very positive manner,” Sawyer said, explaining that Melton is “always pleasant” in the department.

Phipps noted that Melton takes the time to ensure that orders are entered correctly, and Melton asks appropriate questions.

“Shanda’s service and dedication to TCMH are invaluable,” Phipps said.

As employee of the month, Melton received a certificate honoring her achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist; Blissful Nirvana Massage, Wher Motors, and Twirlee Q. A reception will be held at the hospital in honor of Melton.

Melton was also the January 2013 employee of the month at TCMH. Melton is eligible for the 2016 TCMH employee of the year award.

Shanda Melton (right), Texas County Memorial Hospital February employee of the month, with her supervisor, John Sawyer.

Shanda Melton (right), Texas County Memorial Hospital February employee of the month, with her supervisor, John Sawyer.


Missouri Hospital Association President Attends TCMH Board Meeting

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Herb Kuhn, MHA President

Herb Kuhn, MHA President

Missouri Hospital Association president, Herb Kuhn, was a guest speaker at the monthly meeting of the Texas County Memorial Hospital board of trustees in February.

Kuhn periodically visits all of the Missouri hospitals that are members of the MHA. He was last at TCMH in 2013, shortly after the hospital opened the new construction.

Kuhn focused his overview of the current state of healthcare in Missouri on the changing demographics of potential patients in the US. According to Kuhn, the “silver tsunami” of people joining the Medicare rolls is about 10,000 new enrollees daily.

“Today there are 50 million people on Medicare, and there will be 80 million on Medicare by 2030,” Kuhn said.

Kuhn explained that when the Medicare program began there were 4.6 people working per Medicare recipient. Today there are 3.2 workers per Medicare recipient, and in 2030 there will only be 2.3 workers per Medicare recipient.

“Missouri hospitals are being asked to do more with less and to find new and innovative ways to deliver care,” Kuhn said.

Kuhn pointed out that with longer life expectancies, more and more people are over age 85. Those over the age of 85 have the greatest utilization of healthcare services.

Missouri’s current population stands at about 6 million people with 1 million of those residents on the Medicare rolls. By 2030 1.5 million people in Missouri will utilize Medicare.

“This is especially important to note in rural communities because most of these people want to age in place,” Kuhn said.

Kuhn noted the healthcare provider recruiting and retention continues to be a “huge driver” in all hospitals. Telemedicine is becoming an important way to connect with specialized services. Connecting smaller hospitals with a larger tertiary care center is also a key strategy for hospitals in rural Missouri.

Kuhn stressed the importance of rural healthcare facilities in the overall community health from ensuring healthcare coverage for all to helping keep the community safe.

A 2014 MHA study of the primary care physician workforce in Missouri shows that 40 percent of the physicians practicing in the state are 55 or older, and the percentage is even higher for physicians practicing in rural Missouri.

“Many hospitals are doing ‘grow your own’ programs where they reach out to area schools to educate students about healthcare professions,” Kuhn said.

TCMH serves as a training site for physicians in residency, medical students and other ancillary students such as physical therapy nursing and radiology. The Youth Ambassador volunteer program also targets area youth that have an interest in healthcare.

TCMH also participates in the 340b pharmaceutical program that offers prescriptions at a discount for patients seeing a TCMH-based healthcare provider, which Kuhn also discussed.

“The 340b program was designed as a way for Congress to send funds to rural and inner city areas,” Kuhn said. “The program is not popular with pharmaceutical companies, so there will be ongoing challenges for the program.”

Kuhn also discussed the movement in healthcare from a “volume-based to value-based” system. Until recent years, healthcare reimbursement has been based on piecework, i.e., the more a healthcare provider did, the more he or she was paid.

Today healthcare facilities are receiving “bundled payments” or set amounts for certain types of healthcare services. Kuhn called the bundle payments “a whole new level of risk”.

Physicians are also facing changes to their payment models.

“There are no new dollars out there available for healthcare,” Kuhn said. “Will there be enough incentive for physicians to consider practicing in rural areas?”

Kuhn stressed that rural hospitals must ask themselves, “What are we going to do different? How are we going to do it better?”

The need to insure more Missourians was discussed by Kuhn and the board members. Kuhn noted that over 10 percent of the state’s residents were uninsured, calling the numbers “real troubling”.

According to the MHA uncompensated care in Missouri hospitals was over $1.3 billion in 2014.

“Someone, somewhere, every minute of every day is presenting themselves in a emergency department, and they don’t have a way to pay for their healthcare,” Kuhn said.

The MHA has worked for Medicaid expansion and reform in the state for the past few years, but state lawmakers seem unwilling to budge on the issue.

“Medicaid expansion would bring $2 billion in healthcare dollars back into the state each year,” Kuhn said.

Kuhn explained that 50,000 veterans and their family members would qualify and benefit. Local law enforcement would also benefit from an increased availability of mental health services to those without healthcare coverage.

“There is an opportunity cost here, too,” Kuhn said. “Businesses in the community end up paying for the uncompensated care.”

The MHA keeps their finger on the pulse of hospitals in the state by conducting regular “stress tests”.

Kuhn noted that 75 percent of the Missouri hospitals that are “stressed” are rural hospitals.

“We have lost three hospitals in the state,” Kuhn said. “Once that infrastructure is gone, it’s not coming back.”

The MHA continues to build a network of supporters for increased healthcare coverage in the state.

Wes Murray, chief executive officer at TCMH, noted that since 1980 there are 30 million more people in the US and 20 percent fewer hospitals.

Kuhn agreed and asked, “Who is going to take care of our population in the future? How are we going to do it?”

In the administrative report, Murray, and Amanda Turpin, quality management director at TCMH, discussed emergency department wait times.

“The emergency room is the front door of our hospital, and like most hospital ERs, it’s the most criticized department,” Murray said.

Turpin showed board members a website–https://projects.propublica.org/emergency/state/MO—that shows ER wait times for hospitals across the nation. The site breaks down state averages by hospital, and TCMH is included.

The average ER wait to see a physician in Missouri is 23 minutes. TCMH has an average of 24 minutes to see a physician in the ER, which is also the national average.

“We stack up very well to other hospitals in the area and across the state,” Murray said.

In other news, Murray reported that the hospital cafeteria is undergoing a renovation. The renovation work is taking place in the evening and includes new paint, countertops and cabinets.

“The work is being done at night to create minimal disruption for the flow of the dietary staff as well as patients, employees and visitors that use the cafeteria,” Murray said.

TCMH began fiscal year 2016 with a positive bottom line of $59,675.43, according to the January financial report.

Linda Pamperien, TCMH chief financial officer, reported that volumes for the month of January were down and expenses were up with some large annual dues and payments in the month of January.

“Our contractual adjustment was low,” Pamperien said, “Our medical staff did a great job managing the length of stay for our patients.”

Present at the meeting were Kuhn; Murray; Turpin; Pamperien; Doretta Todd-Willis, chief nursing officer; Joleen Senter Durham, public relations director, and board members Dr. Jim Perry, OD; Omanez Fockler, and Janet Wiseman.

Board members Mark Hampton and Russell Gaither were not present at the meeting.

The next meeting of the TCMH board of trustees will be Tue., March 22nd at 12 p.m. in the hospital board room.


Comfort Care Booklets Available to Area Residents

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Texas County Memorial Hospital Hospice of Care has a new booklet—Considering Comfort Care, A Guide for Families—available to area residents.

These booklets are available at no charge to area residents from TCMH Hospice of Care.

These booklets are available at no charge to area residents from TCMH Hospice of Care.

“This easy-to-read guide is a good way to learn about comfort care,” Courtney Owens, TCMH Hospice of Care director, said. “It can be helpful to you or to a family member, and it’s something you may want to discuss with your healthcare provider, too.”

Hospice of Care purchased the booklets with funds from a grant from Hospice Foundation of the Ozarks. The booklet is written by G. Leigh Wilkerson, an experienced critical care and hospice nurse.

“Comfort care is another option for medical treatment, and many times patients and their family members do not understand comfort care,” Owens said, noting that the book explains comfort care and why and when a patient or a patient’s family member might choose comfort care.

The booklet features frequently asked questions and lists online resources and other books regarding comfort care.

The booklets are available at no charge through the TCMH clinics in Licking, Houston, Cabool, and Mountain Grove; through the Mercy clinic in Houston; through TCMH Hutcheson Pharmacy and through the TCMH Hospice of Care office located behind the hospital at the TCMH Office Annex.

You can also request a booklet by contacting the Hospice of Care office at (417) 967-1279 or cowens@tcmh.org.


Sara McDaniel is Employee of the Month

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Texas County Memorial Hospital has named Sara McDaniel of Houston the January employee of the month.

Sara McDaniel (left), with her supervisor, Courtney Owens

Sara McDaniel (left), with her supervisor, Courtney Owens

McDaniel is a licensed social worker for TCMH Hospice of Care. McDaniel has worked at the hospital since 2010. She was nominated for the award by Courtney Owens, Hospice of Care director.

“Sara is the only one that can do her job at Hospice of Care, and she never complains about that,” Owens said, describing McDaniel as “always willing to help out”.

As the social worker for Hospice of Care, McDaniel is responsible for organizing the grief support groups and the annual bereavement tea. Owens said that in McDaniel’s hands, the Hospice of Care events flourish.

“Sara always brings a smile into the office and into our patients’ homes,” Owens said, adding, “She embodies TCMH values.”

As employee of the month, McDaniel received a certificate honoring her achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist; Blissful Nirvana Massage, Wher Motors, and Twirlee Q. A reception will be held at the hospital in honor of McDaniel.

McDaniel is eligible for the 2016 TCMH employee of the year award.


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