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First Certified Nurse Midwife to Join Staff at TCMH

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Tracey Arwood, a board certified nurse midwife, will join TCMH in August, becoming the first certified nurse midwife to join the hospital’s medical staff.

Arwood will deliver babies and provide obstetrical care in the hospital. She will also provide obstetrics and women’s healthcare at the TCMH Mountain Grove Clinic and at the TCMH Medical Complex in Houston.

Arwood comes to TCMH from Garden City, KS where she provides women’s health and obstetrical care as a certified nurse midwife for the United Methodist Mexican American Ministries in Southwest Kansas.

Arwood has a bachelor’s degree in health science from Truman State University in Kirksville, MO and a bachelor of science in nursing from Barnes-Jewish College of Nursing in St. Louis. Arwood’s Master’s degree in nursing came from Frontier Nursing University in Hyden, KY where she also completed the Community Nurse-Midwifery Education Program.

By moving to South Central Missouri Arwood will be closer to her parents in Marshfield. As a National Health Service Corps Scholar, Arwood is able to receive student loan repayment through the National Health Service Corps by working at TCMH clinics which are designated as an “underserved area” by the federal government.

“Obstetrics has always been an important and needed service at TCMH,” Wes Murray, chief executive officer said. “We believe that Tracey will help ease some of the obstetrics load on our physicians as well as bringing a new element of obstetrical care to our patients.”

Arwood has found that nurse midwives are more available and sought out in some rural areas, and she believes that with the shortages of physicians, more women will seek a midwife for their pregnancy.

“I am thankful for all that TCMH is doing to bring me on board,” Arwood said. “I am looking forward to working in an environment that is welcoming and supportive.”

Arwood will collaborate with Christopher Baldwin, MD, a board certified obstetrician and gynecologist at the TCMH Medical Complex. She will divide her clinical time between TCMH patients in Houston and in Mountain Grove.

“Tracey will provide obstetrical services at the TCMH Mountain Grove Clinic, a community where there are currently no OB providers,” Murray said. “Tracey will be a great asset to our hospital and clinics.”

“I take pride in providing specialized care for my patients,” Arwood said. “I plan on being available for them whenever they need me.”

Arwood’s practice is for women of all ages—from birth control to menopause—and she will practice low-risk obstetrics, too.

Arwood will relocate to the area with her husband, Chris, and their daughter, Jaeda, age 2 and son, Corbin, age 4. Arwood will begin working at TCMH on August 4.

Tracey Arwood, CNM

Tracey Arwood, CNM


Pittman Named Employee of the Month

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Texas County Memorial Hospital has named Kelly Pittman of Summersville the July employee of the month.

Pittman is a tech in the TCMH pharmacy department, and she has worked for the hospital for three years. She was nominated for the award by April Steele, administrative secretary at TCMH.

“Kelly is a team player with everyone she works with,” Steele said, explaining that Pittman has provided assistance for patients and staff in the obstetrics and med surg departments on several occasions.

Pittman is known for having a smile on her face and for her courtesy to visitors, patients and staff at TCMH.

“Kelly’s positive attitude and compassion for others is outstanding,” Steele said.

As employee of the month, Pittman 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, Janstiques and Blissful Nirvana Massage, and cd of the month from Big Country 99. A reception will be held at the hospital in honor of Pittman.

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

This is Pittman’s second time to win the employee of the month award. She also won the award for July 2012.

Kelly Pittman, Texas County Memorial Hospital June employee of the month, with her supervisor, David Phipps.

Kelly Pittman, Texas County Memorial Hospital June employee of the month, with her supervisor, David Phipps.


General Surgeon Signs Contract with TCMH

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Linda S. Milholen, MD, a board certified general surgeon, has signed a three-year contract to work full time at Texas County Memorial Hospital.

Milholen will provide inpatient and outpatient general surgery services at TCMH beginning July 28.

Milholen comes to TCMH from St. Francis Hospital in Mountain View, MO where she has practiced full-time since 2009. She also worked at hospitals in Kentucky and Missouri–El Dorado Springs and Bolivar–prior working in Mountain View.

Milholen grew up in Arkansas and attended medical school at Emory University in Atlanta, GA. She did her surgical internship through Tulane University at Charity Hospital of Louisiana in New Orleans. She completed her general surgical residency at the University of Louisville in Kentucky. Milholen is a fellow of the American College of Surgeons.

“We are very pleased with the addition of Dr. Milholen to our medical team at TCMH,” Wes Murray, chief executive officer at TCMH. “We have known Dr. Milholen since she came to the area in 2009, and we believe she will be a good fit for our patients as well as our hospital.”

Murray explained that Milholen will see clinic patients in the new outpatient clinic area that is being renovated inside the hospital. Leroy Wombold, MD, will also see patients in the same location when it’s complete.

“With Dr. Milholen’s full-time employment and the part-time assistance and coverage we also get from Dr. Wombold and Dr. Fisher, most general surgery needs will be covered at TCMH,” Murray said.

General surgery focuses on abdominal areas such as colon, bowels, stomach, pancreas, liver and esophagus. Milholen provides open and laparoscopic abdominal surgeries as well as hernia repair and breast surgery.

Milholen plans to relocate to Houston with her husband, Bruce.

Linda Milholen, MD, general surgeon, has signed a three-year employment contract at TCMH.  Milholhen is shown here with Wes Murray, TCMH chief executive officer.

Linda Milholen, MD, general surgeon, has signed a three-year employment contract at TCMH. Milholhen is shown here with Wes Murray, TCMH chief executive officer.


Hospital Retires Revenue Bonds with June Payment

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On June 18 Texas County Memorial Hospital retired a $5.3 million revenue bond the hospital’s board of trustees heard at their monthly meeting on Tuesday.

TCMH originally sold revenue bonds of $5.2 million in 2000 to finance the renovation of the hospital. The original revenue bonds were initiated for 25 years with an interest rate of 7.2 percent.

Four years later interest rates were at record lows, and TCMH needed $100,000.00 to build a new maintenance shed and $550,000.00 to build the TCMH Medical Complex. The bonds were restructured and refinanced in July 2004 for $5,335,000.00 for 10 years with an interest rate of 4.2 percent.

The restructuring and refinancing saved TCMH $2,886,683.00 in interest payments, and the bonds were retired eleven years earlier than originally planned.

“It’s rare to see bonds initiated and retired in your tenure at a facility,” Wes Murray, chief executive office at TCMH, explained to board members, “But without the refinancing and restructuring of those original bonds, we would not have accomplished so many goals in our strategic plan.”

The hospital’s revenue bonds were repaid from the revenue generated by the hospital and clinics. In the process of initiating the revenue bonds, hospital funds were placed in a bond reserve fund that served as a “rainy day” fund should TCMH have faced hardships that kept the hospital from making the monthly bond payments.

When the bonds were retired, TCMH received $455,182.00 from the bond reserve funds. Those funds were returned to the general operating account.

“This is another great achievement,” Omanez Fockler, chairperson of the TCMH board of trustees, said, calling the bond retirement “a reason to celebrate”.

Fockler was an employee at the hospital when the bonds were initiated. She retired from TCMH in 2000 after 37 years of service as a nurse at the county hospital.

Also at the monthly meeting, board members unanimously approved changes to the TCMH medical staff by-laws. The changes, made by the hospital’s active medical staff and approved by the hospital attorney, will allow mid-level providers to work in the hospital emergency and obstetrics departments.

TCMH plans to use a physician’s assistant to help in the emergency department during peak times. TCMH has also recruited a certified nurse midwife to provide obstetrical care for hospital inpatients as well as seeing obstetrics patients in the clinic.
Jonathan Beers, DO, vice chief of the TCMH medical staff, explained that the by-laws changes did not address hospital privileges and policies and procedures regarding the use of mid-level providers inside the hospital.

“The by-laws allow room for fine tuning with privileging and hospital-specific policies,” Beers said.

Board members also approved the $9,638.00 purchase of an Olympic brand scalpel that simultaneously cuts and coagulates tissue.

Linda Pamperien, chief financial officer at TCMH, presented the equipment request to the board members. “This is a tool that Dr. Baldwin and Dr. Wombold have requested and will use in providing surgical services at TCMH,” Pamperien said.

Christopher Baldwin, MD is a board certified obstetrician/gynecologist that began working full-time at TCMH in May. Leroy Wombold, MD, a board certified general surgeon, provides surgical services at TCMH two days a week.

The special scalpel is also a tool that would be used by a new general surgeon as well. TCMH is currently recruiting a full-time general surgeon that would be employed by the hospital.

Inpatient volumes at the hospital remained down at the hospital for the month of May. TCMH ended the month of May with a loss of $318,065.44 and a year to date loss of $644,162.01.

Pamperien explained that contractual adjustments (the portion of the hospital bill that is actually paid by insurance) in May were high.

“For example, in May we had to write off $53,000.00 after one acutely ill patient’s contractual adjustment,” Pamperien said, adding, “But that’s what we have to do.”

“Inpatient volumes are down across the state and the nation,” Murray said, adding that there is no explanation for the drop in inpatient numbers.

John Duff, MD, vice president at Cox Health in Springfield, agreed with Murray’s assessment, and explained that inpatient volumes were down at Cox Health as well.

“This is just a fact of life right now,” Fockler said. “It’s important that the staff and the public understand that we care for everyone that comes through our doors, regardless of their ability to pay.”

Murray presented some key facts regarding the state health insurance exchange enrollment. Recent statistics show that 152,335 people in the state of Missouri enrolled in the exchange. Eighty-five percent of those enrolled in the exchange received federal financial assistance to be able to afford their health plan.

“The costs of the plans vary across our state, but the Missouri exchange is similar to exchanges in the states around us,” Murray said.

Medicaid expansion continues to be an important issue at TCMH and hospitals around the state.

Murray told board members that 33rd District State Senator Mike Cunningham would attend the July 2014 meeting to speak with board members about state healthcare issues.

Present at the meeting were Murray; Pamperien; Beers; Duff; Fockler; Doretta Todd-Willis, chief nursing officer, Joleen Senter Durham, public relations director, and board members Dr. Jim Perry, OD, and Mark Hampton.

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

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


Dr. Christopher Baldwin Brings New Women’s Health Services to TCMH

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                Dr. Christopher Baldwin believes in small hospitals.

                Baldwin, a board certified obstetrician and gynecologist, recently joined Texas County Memorial Hospital where he is providing obstetrical services and full-spectrum women’s health including surgical services.

                “I have really been impressed with the small hospitals where I have worked,” Baldwin said.

                Baldwin explained that in small hospitals he’s found that many staff members are cross-trained to provide care across multiple disciplines, leading to “outstanding outcomes”.

                “Small hospitals are phenomenally effective with the care they provide despite their geographic location or lack of specialized services,” Baldwin explained, adding that TCMH is not the smallest hospital he has practiced at in his 26 year medical career.

                Baldwin grew up in Springfield, MO.  His father was an obstetrician, and Baldwin and his brother all chose to pursue medical careers.   christopher baldwin

Baldwin was a “science-y” student in high school, and he pursued an undergraduate degree in biology at Westminster University in Fulton.  After completing medical school at the University of Maryland, Baldwin’s interest in surgery led him to pursue an obstetrics and gynecology residency program at Riverside Methodist Hospital in Columbus, OH.

Baldwin first worked for a group practice in Radford, VA where he practiced for six years until the group practice fell apart.  Baldwin relocated to Cullman, AL where he worked as a solo OB/GYN at a hospital “smaller than TCMH” in a town of 13,000.

While in Cullman, Baldwin delivered hundreds of babies each year in addition to providing women’s health and surgical services.  Baldwin worked with midwives in the community and family medicine physicians.

Baldwin’s 12-year practice in Cullman came to an end in 1998 when the hospital closed its obstetrics department after being bought out by a larger healthcare system. 

On a visit to Springfield, MO with his family, Baldwin took a position as a solo OB/GYN in Rolla providing obstetrics and surgical services at Phelps County Regional Medical Center where he worked until last year.

Baldwin explains with a chuckle that most of the decisions he’s made in life have been an “act of God”, and he believes the position at TCMH is another one.

Baldwin and his wife, Susan, were looking at new OB/GYN positions in smaller towns in Oklahoma, Arkansas and Missouri only to have a position open down the road in Houston.

TCMH had not employed a physician that specialized in obstetrics and gynecology, but growing obstetrical needs in the hospital’s service area and a lack of family medicine physicians interested in pursuing a position at TCMH that included a busy obstetrics practice led the hospital to broaden the scope of their physician search.

“Our recruiting efforts for a family medicine physician with obstetrics to fill our position did not produce any results after several months of work, and with increasing need to bring on additional obstetrical hope, we broadened our search to include OB/GYN trained physicians,” Wes Murray, chief executive officer at TCMH, said.

“We believe that adding an OB/GYN to our employed physician mix will enhance the level of services we are able to provide to our patients,” Murray said.

Baldwin is trained to provide prenatal and obstetrical care including Cesarean section.  Baldwin also provides women’s healthcare including a wide variety of gynecological and urogynecological surgical procedures.

“So many women have had to go out of the area for surgeries and outpatient procedures, and Dr. Baldwin will be able to treat them here, close to home,” Murray said, adding that Baldwin’s arrival is a “huge addition” to surgical and women’s health services available in Texas County.

Baldwin believes in the “practice” of medicine with each woman’s specific needs.

“I’m a big individualizer with my patients,” Baldwin said, adding, “Every woman is different.”

With Baldwin’s many years of experience, he’s watched health fads come and go and surgical procedures have changed and improved as well.

“I can do hysterectomies every which way,” Baldwin said, rattling off a handful of ways to perform hysterectomies based on the woman’s specific needs.

Baldwin also does some urogynecological procedures for women with incontinence and other bladder and pelvic health issues.

Routine gynecological procedures also include tubal ligation, dilation and curettage, and birth control counseling and placement of Implanon, Nexplanon and intrauterine devices.  For women with heavy menses, he can do stress endomentrial ablation.  Some procedures are done in the office or in the hospital’s surgical department as an outpatient procedure.

                “While I enjoy doing surgeries, I can usual avoid it by offering non-surgical alternatives for my patients,” Baldwin stressed regarding his practice style.

Baldwin’s clinic practice is based out of the TCMH Medical Complex in Houston.  He sees women for healthcare concerns related to infertility, headaches, fatigue, hormone replacement and sexual desire.

Baldwin shares obstetrical call with the family medicine physicians that provide obstetrical care at TCMH.  The hospital has also recruited a certified nurse midwife—Tracey Arwood—that will collaborate with Baldwin when she moves to the area in August.  Arwood, in collaboration with Baldwin, will do an obstetrics and women’s health clinic at the TCMH Mountain Grove Clinic, too.

Baldwin has been married to Susan for 22 years.  Susan is also from Springfield, and the two grew up not too far apart, but didn’t know each other until adulthood.

“We had to travel the world and date all kinds of people before we met each other,” Baldwin said with a laugh.

The Baldwin’s have two children.  Katie just completed her freshman year at William Woods University.  John will be a senior in high school this year.  They have family members that live in Springfield, and they plan to find a home in Texas County.

When Baldwin is not working he enjoys woodworking, which he affectionately refers to as “sawdust making”.  He plays golf, tennis and enjoys participating in adventure races.

Baldwin has observed healthcare become more and more “corporate”, and he expressed relief in finding a place to practice medicine that was not owned by a larger healthcare system.

“I have been very impressed by what I’ve found here,” Baldwin said.

Baldwin explained that he and his wife have enjoyed settling into small towns.  “The people are so friendly and inviting,” he said.

And best of all, TCMH was “just down the road.”


Cox Named Employee of the Month

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                Texas County Memorial Hospital has named Angela Cox of Willow Springs the May employee of the month. 

Cox is a registered nurse in the obstetrics department at TCMH, and she has worked for the hospital for 15 years.  Cox was nominated for the award by Doretta Todd-Willis, chief nursing officer at TCMH.

 “Angela has excellent OB and nursery nursing skills and knowledge,” Todd-Willis said, adding, “She is very devoted to the department and works very well with staff and physicians.”

Todd-Willis noted that Cox works day or night shifts to help keep the department staffed, and she comes in on her day off to help care for critical infants.  Cox is also the hospital’s neonatal resuscitation instructor and serves on the hospital’s customer service team.

“Angela helps keep the OB department functioning and organized, and her dedication and assistance are invaluable,” Todd-Willis said.

                As employee of the month, Cox 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, Janstiques and Blissful Nirvana Massage, and cd of the month from Big Country 99.  A reception will be held at the hospital in honor of Cox.

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

Angela Cox, Texas County Memorial Hospital May employee of the month, with Doretta Todd-Willis, TCMH chief nursing officer.

Angela Cox, Texas County Memorial Hospital May employee of the month, with Doretta Todd-Willis, TCMH chief nursing officer.

This is Cox’s second time to win the employee of the month award.  She also won the award for May 2003.


Plans for New Surgical Services, Additional Healthcare Providers Underway

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With a new obstetrician/gynecologist and general surgeon utilizing the Texas County Memorial Hospital surgery department and strong recruiting prospects for additional surgeons, the hospital’s board of trustees agreed to expend $25,476.28 to purchase a new five millimeter, 30-degree endoscope at their monthly meeting on Thursday. 

Christopher Baldwin, MD, board certified obstetrician/gynecologist, and Leroy Wombold, MD, general surgeon requested the surgical instrument.  The five millimeter scope will be used for less invasive laparoscopic surgeries.  The smaller endoscope will require smaller incisions for laparoscopic procedures when used.

“This scope will be used regularly by Dr. Baldwin and Dr. Wombold to provide a broader scope of procedures for our patients,” Wes Murray, chief executive officer at TCMH, said.

Laparoscopic surgery uses a thin, lighted tube put through an incision in the belly to look at the abdominal organs.  Tissue samples can be taken, and operations can be performed laparoscopically.

Baldwin uses laparoscopy to find female pelvic organ problems such as cysts, adhesions, fibroids and infection.  He also performs laparoscopic hysterectomies as well as other gynecological surgeries.

Wombold uses laparoscopy to remove gallbladders, to repair hernias and to do partial colon removal among other surgical procedures.

“All of the surgical candidates we have interviewed have requested a five millimeter scope,” Murray said.  “This scope will help us in our ongoing general surgery recruiting efforts, too.”

TCMH currently has two general surgeons that are interested in full-time opportunities with the hospital, Murray reported to the board.

Schaun Flaim, DO, chief of the TCMH medical staff and internal medicine physician at the TCMH Medical Complex in Houston, added that he and the other internal medicine physicians would find a use for the smaller scope from time to time, too.

“There are some tools that come with the scope that could be handy for stopping a bleed,” Flaim said.

Joleen Senter Durham, physician recruiting director at TCMH, reported that since the April board meeting, “great progress” has been made in recruiting additional providers.

“Dr. Baldwin signed a contract with us, and appointments are already being made for him to see patients at the TCMH Medical Complex in Houston,” Durham said. 

“With the signing of Dr. Baldwin, we were able to get a signed contract from Tracey Arwood, a certified nurse midwife that will collaborate with Dr. Baldwin when she begins working here in August,” Durham said.

Arwood contacted Durham in late 2013 seeking a position in Southwest Missouri so she and her family could move closer to her parent’s home in Marshfield.

“Tracey will be able to provide obstetrical care for area patients as well as healthcare services for women of all ages,” Durham said.  “After we met Tracey, we believed she would be a great fit for our patients and hospital team, but we had to recruit a physician that could collaborate with Tracey.”

TCMH plans to use Tracey’s skills to provide obstetrical services at the TCMH Mountain Grove Clinic and at the TCMH Medical Complex in Houston.

“Nobody is currently providing full obstetrical services in the Mountain Grove area, so it will be a great benefit to area patients to have someone regularly available in that area to provide prenatal and postnatal care,” Durham said.

Whitney Young, a physician assistant student, has also signed a contract with TCMH. Young will begin practicing at the TCMH Family Clinic in Licking after she passes her board certification exam in August.

Young is from the Rolla area and has family in Texas County.

“Whitney believes she has found the perfect job,” Durham explained.  “She hoped to find a job working at rural family medicine clinic where she could see patients of all ages.”

Young is currently completing her final medical rotation for her training program working under Joshua Wolfe, MD and Kimberly Olving, PA, at the TCMH Family Clinic in Licking.  Young will take over the position that will be vacated by Olving in late July.  Olving’s husband is being transferred by the Army to Pennsylvania.

“We are very fortunate to be able to find someone like Whitney to step into the position that Kim will leave behind,” Durham said.  “Kim is well liked by all of her patients, but we believe Whitney will also be a great fit for the Licking community and an asset for our clinic.”

Murray reported that the exterior wall shell for the tornado safe room has been erected and plumbing installed for the safe room and the surgical area.  Concrete floors will be poured in both spaces in the next few days.

The 7,000 square foot area for the new Texas County Memorial Hospital surgery department is plumbed and is prepared to receive the concrete for the floor of the department.  The new department will connect with the current East  and ICU/OB wings of the hospital and will be in between the hospital and the tornado safe room which is also under construction.

The 7,000 square foot area for the new Texas County Memorial Hospital surgery department is plumbed and is prepared to receive the concrete for the floor of the department. The new department will connect with the current East and ICU/OB wings of the hospital and will be in between the hospital and the tornado safe room which is also under construction.

Murray presented a resolution of intent to apply for a grant from the United States Department of Agriculture/Rural Development that will be used to enhance patient care efforts and surgical services.  The grant—with a maximum award of $1 million–would come close to completing the interior portion of the surgical department.

“Everyone has done a tremendous job with the capital campaign efforts, and those efforts are ongoing,” Murray said, adding, “This grant would help us move forward with our recruiting and retention efforts in our surgery department as well as continuing to bring our patient care areas into the 21st century.”

TCMH began the most recently completed hospital construction with the plan of eventually building all new patient care areas.  In 2013 the hospital opened a new medical surgical floor, a larger emergency department and a new radiology suite and registration area.  Seventeen additional departments were renovated last year, too. 

With the addition of a new surgery department, TCMH would relocate and renovate the hospital’s obstetrics department and intensive care unit, completing the overhaul of all hospital patient care areas.

Board members unanimously agreed to approve the resolution to pursue the grant opportunity. 

State nursing school inspectors were on site at TCMH with representatives from Cox College of Nursing and Drury University looking at the five East wing hospital rooms that are being used by nursing students during the summer months.  A mannequin has been installed in one patient room to provide simulated patient care. 

“Everyone was very impressed with the use of space on the East wing,” Murray said, describing the classrooms as “a great setting”.

Murray noted that the on campus classroom is an opportunity for the hospital to develop relationships with Cox and Drury stuff as well as nursing students and their instructors.

“We have an excellent opportunity to introduce them to everything we have available at TCMH,” Murray said.

Linda Pamperien, chief financial officer at TCMH, presented the financial report for the month of April.  Outpatient volumes were up for the month at the hospital, but inpatient volumes were down for the month.

The hospital ended the month of April with negative bottom line of $26,549.50 and a year-to-date loss of $326,096.57.

Present at the meeting were Murray; Flaim; Durham; Pamperien; Doretta Todd-Willis, chief nursing officer; Jonathan Beers, DO, and board members, Omanez Fockler; Janet Wiseman; Dr. Jim Perry, OD, and Russell Gaither. 

Board member, Mark Hampton, was not present at the meeting.

This meeting of the TCMH board of trustees was changed to Thur., May 29 when a quorum was not available on Tues., May 27, the usual monthly meeting time.  The next meeting of TCMH board of trustees is Tue., June 24 at 12 p.m. in the hospital board room.


Dr. Christopher Baldwin Signs Contract with TCMH

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Texas County Memorial Hospital inked a three-year deal this week with Christopher O. Baldwin, MD, a board certified obstetrician and gynecologist. 

                Baldwin brings 26 years of experience in obstetrics and gynecology to TCMH as the first obstetrician/gynecologist employed by the county hospital.  Baldwin will be based at the TCMH Medical Complex in Houston, and he will deliver babies and do surgery at the hospital.

                “Our recruiting efforts for a family medicine physician with obstetrics to fill our position did not produce any results after several months of work, and with increasing need to bring on additional obstetrical hope, we broadened our search to include OB/GYN trained physicians,” Wes Murray, chief executive officer at TCMH, said.

                “We believe that adding an OB/GYN to our employed physician mix will enhance the level of services we are able to provide to our patients,” Murray said.

                Baldwin is trained to provide prenatal and obstetrical care including Cesarean section.  Baldwin also provides women’s healthcare including a wide variety of gynecological and urogynecological surgical procedures.

                “So many women have had to go out of the area for surgeries and outpatient procedures, and Dr. Baldwin will be able to treat them here, close to home,” Murray said, adding that Baldwin’s arrival is a “huge addition” to surgical and women’s health services available in Texas County.

                “Dr. Baldwin will be able to provide prenatal and obstetrical care at the Houston clinic, and after birth, infant care can continue in the same clinic through Dr. Wright,” Murray said.  In addition to family medicine, obstetrics and gynecology, internal medicine is also available in the clinic.

                “TCMH is committed to providing primary care services for the entire family, and Dr. Baldwin’s skills will help us increase the level of primary care services available to women in the area,” Murray explained.

                Baldwin will begin seeing patients at the TCMH Medical Complex by June 2.

                Baldwin has a bachelor’s degree in biology from Westminster College in Fulton.  He attended medical school at the University of Maryland in Baltimore.  He did is OB/GYN residency at Riverside Methodist Hospital in Columbus, OH. 

                Baldwin was in private practice in Virginia and Alabama before joining Phelps County Regional Medical Center in 2006. 

                Baldwin plans to relocate to Texas County with his wife, Susan.  The Baldwin’s have two teenage children, Katie and John.

Dr. Christopher Baldwin (right), a board certified obstetrician and gynecologist, signed a contract with TCMH last week.  Baldwin is shown here with Wes Murray, chief executive officer at TCMH.

Dr. Christopher Baldwin (right), a board certified obstetrician and gynecologist, signed a contract with TCMH last week. Baldwin is shown here with Wes Murray, chief executive officer at TCMH.


Floyd Named Employee of the Month

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Texas County Memorial Hospital has named Tamma Floyd of Houston the April employee of the month. 

Floyd is a technician in the TCMH Hutcheson Pharmacy, and she has worked for the hospital since the pharmacy was purchased in 2012.  Floyd was nominated for the award by Anne Kennedy, pharmacist at TCMH Hutcheson Pharmacy.

“Tamma always helps keep the pharmacy running smoothly so customers have the best experience possible,” Kennedy said, adding, “She always has a positive attitude and is extremely dependable.”

Kennedy described Floyd as a “positive role model” to everyone around her.

“If Tamma is asked to do something, she does it without hesitation,” Kennedy said.

As employee of the month, Floyd 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; cd of the month from Big Country 99 and a massage from Blissful Nirvana.  A reception will be held at the hospital in honor of Floyd.

Tamma Floyd (right), the Texas County Memorial Hospital April employee of the month, with her supervisor Anne Kennedy.

Tamma Floyd (right), the Texas County Memorial Hospital April employee of the month, with her supervisor Anne Kennedy.

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


Auditors: County Hospital Remains Strong Despite Down Financial Year

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                Texas County Memorial Hospital had net position of -$527,077 in excess revenues over expenses following the 2013 financial audit the TCMH board of trustees and administration heard at the monthly board meeting on Tuesday. 

Stephanie Weis, partner at BKD, LLP of Springfield, MO and David Taylor, senior manager at BKD, presented the annual audit report, explaining that TCMH had a “strong balance sheet” at the end of a “challenging year”.

Taylor pointed out that the negative bottom line included $863,099 in cash and pledges belonging to the TCMH Healthcare Foundation and $1,060,000 received by TCMH from the federal government for the adoption and implementation of electronic medical records within the hospital.

The growth of the Healthcare Foundation’s assets over the past seven years requires it to be included in TCMH financial statement.  In 2012 the Foundation embarked upon a $3.2 million capital campaign to raise funds to build a tornado safe room and new surgery department which added to the funds held by the Foundation in 2013.

“The $3.1 million raised by the Healthcare Foundation is tremendous,” Weis said, adding, “These funds represent great community support.”

                As the auditors reported after the 2012 audit, the “challenging healthcare environment” has not gone away and it again contributed to lower operating results for TCMH.

                Taylor explained that the hospital’s assets have increased by almost $6 million from $20,753,264 in 2012 to $26,241,752 in 2013 with the opening of new patient care areas and the addition of new equipment for those areas.

                With half year of depreciation included in the audit, the average age of TCMH equipment and facility is 11 years in 2013.  The rural Missouri hospital average is about 10 years of age.   

                Taylor highlighted the fact that TCMH has 106 days of cash on hand.  “If the hospital stopped receiving payments, you would be able to keep the doors open for quite awhile,” he said, explaining that one day of cash on hand is equivalent to $64,000.  The average rural Missouri hospital has 43 days of cash on hand.

                TCMH has 47 day of revenue in accounts receivable, which Taylor called “really strong”.  One day is equivalent to $74,000.

                In 2013, TCMH increased its liabilities by taking on a loan from the United States Department of Agriculture and Rural Development to expand the hospital.

                “This was a big burden to take on, but you are in a very good position with a 30-year loan with a 3.75 percent interest rate,” Taylor explained.

                Taylor and Weis commended TCMH for their work to pay off bonds that will mature in June 2014.

                “It is remarkable for us to see bonds paid off,” Weis said.  “Most places refinance or try to extend bonds rather than pay them off.”

                “The addition of a retail pharmacy in 2012 added additional revenue to the bottom line in 2013,” Taylor said, noting that provider changes at the hospital affected inpatient volumes.

                “We have seen volume declines with the majority of our clients,” Weis said.  “It’s imperative that hospitals act quickly with volumes begin to decline or you can quickly bleed the balance sheet dry.”

                Weis and Taylor commended TCMH for “mitigating losses” at the hospital.

                “Without strong management of expenses and personnel your losses could have been much greater,” Taylor said.

The auditors commented on federal healthcare changes brought on by the Affordable Healthcare Act and the American Taxpayers Act of 2012.

“Historically, the federal government has recognized that over one-third of Medicare recipients live in rural areas, making it difficult for rural hospitals to support capital and technological projects,” Taylor said.

Taylor explained that although some incentives have been provided to rural hospitals to make up for the number of Medicare recipients cared for by rural hospitals, many of the monetary incentives that directly impact the hospitals bottom line have been cut in recent years.

On April 2, 2013, TCMH and other hospitals received an additional two percent reduction in Medicare reimbursement due to sequestration.  Those cuts in payment have not been restored, nor does BKD believe the cuts will be restored.

 Taylor explained that these cuts make the healthcare environment “tough to manage”.

“Healthcare facilities and providers are being audited to death, which has providers utilizing more outpatient services,” Taylor said.  He believes that hospital inpatient volumes will remain flat or continue to decline in future years.

“We are also seeing a shift in where we get our revenue,” Taylor said.  “Commercial volumes are changing and Medicaid numbers are growing.”

Taylor stressed the importance of continuing to monitor payer sources at TCMH.

The auditors commented on Missouri Medicaid expansion explaining that “something will happen” and that the unknown adds to the challenges faced by hospitals in the state.

Taylor offered a list of things that other hospitals are doing to weather the current challenges in healthcare:  practice expense discipline; improve processes in the system; analyze service lines; expand and utilize 340B prescription drug program; seek relationships with other facilities; and search for other funding sources.

“You are doing all of these,” Taylor said, “And you deserve an ‘A+’ for the grants, donations and other funds you have received to make your facility stronger.”

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 income 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.

Prior to the annual audit report portion of the meeting, Omanez Fockler, chair of the TCMH board of trustees, administered the oath office to Mark Hampton of Summersville.  Hampton was re-elected in April to serve a five-year term on the TCMH board of trustees.

Omanez Fockler, chairperson of the Texas County Memorial Hospital board of trustees, administered the oath of office to Mark Hampton of Summersville at the monthly meeting on Tuesday.   Hampton was re-elected for a 5-year term on the board after the April 8th election.

Omanez Fockler, chairperson of the Texas County Memorial Hospital board of trustees, administered the oath of office to Mark Hampton of Summersville at the monthly meeting on Tuesday. Hampton was re-elected for a 5-year term on the board after the April 8th election.

Hospital board members agreed that board officers for the 2013-2014 year would remain the same.  Fockler will serve as chairperson; Janet Wiseman will serve as vice-chairperson and secretary. 

                The new medical staff officers were also introduced to those present at the meeting.  Dr. Schaun Flaim retains his role as the chief of the TCMH medical staff.  Dr. Jon Beers is the new vice chief of the TCMH medical staff.  Dr. Steve Hawkins is the secretary and treasurer of the TCMH medical staff.

                Joleen Senter Durham, director of physician recruiting, reported that physician recruiting efforts have been strong at the hospital.

                “Since our last meeting, we have had two physicians visit, and I have a physician and a mid-level provider scheduled to visit in the next two weeks,” Durham said.

                TCMH hopes to fill the need for physicians in Houston and Mountain Grove and for a general surgeon.

                “I spend a lot of time studying information about potential candidates that are presented to me and screening those candidates to see if they would be a good fit for our hospital and our community,” Durham said.

                When Durham has a candidate that meets the hospital’s criteria, she works with the candidate to schedule a site visit.  The site visits include hospital and clinic tours, time with the staff, a medical staff dinner and a community tour.

                “Sometimes these visits involve finding childcare or meeting other special requests of the provider,” Durham said.  “Everyone that I’ve asked to help has done a great job in making these providers and their families feel welcome.”

                Durham is hopeful that TCMH will reach an agreement with one or more of the providers that have visited the facility in recent weeks.

                Wes Murray, chief executive officer at TCMH, reported that Dr. LeRoy Wombold, a general surgeon, has been seeing patients and performing surgery at TCMH.  Wombold plans to continue to see patients at TCMH even after a full-time surgeon is recruited.

                “Dr. Wombold brings some additional surgical capabilities to TCMH, and he’s doing the surgeries here which help the hospital and our patients,” Murray said.

                Murray also explained to board members that in conjunction with Tuesday’s board meeting, a special team of medical professionals from the state of Missouri were on site doing a survey and interview process for TCMH to receive “level 3 stroke designation”.

                “Dr. Kerr and the emergency department have been working on the steps needed for this designation for many months,” Murray said.  “This team will review our plan and processes for stroke patients, and they will decide if our application for level 3 designation should be recommended for approval to the state.”

                With a stroke designation, the TCMH emergency department is recognized statewide as a place for potential stroke victims to receive emergency care.  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.

                The designations will be awarded statewide at the end of 2014.

                Linda Pamperien, chief financial officer at TCMH, presented the financial report for March 2014 which showed a big dip in inpatient volumes at the hospital.  Although expenses for the month were also down, the decrease in revenues led to a negative bottom line of $308,007.27 for the month of March, and a negative year-to-date bottom line of $299,546.72. 

Present at the meeting were Murray; Pamperien; Weis; Taylor; Flaim; Beers; Durham; Anita Kuhn, controller, and board members, Fockler; Hampton; Dr. Jim Perry, OD and Janet Wiseman.

Board member, Russell Gaither, was not present at the meeting.                                    

The next meeting of the TCMH board of trustees is Tuesday, May 27 at 12 p.m. in the hospital board room.


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