Hospital Audit Shows Improvement in 2024 Operating Revenues

Texas County Memorial Hospital ended 2024 with total operating revenues of $41,880,547, a 5.5 percent increase over 2023, the TCMH board of trustees heard at their monthly meeting on Tuesday.

David Taylor, senior manager at Forvis Mazars in Springfield, MO, presented the annual financial audit report at the meeting. “The increase in total operating revenue led to a $1,272,653 rise in unrestricted net position, which represents the overall financial outcome after accounting for all revenue and expenses in 2024,” Taylor said. “I commend TCMH for achieving a 5.5 percent increase in total operating revenue while keeping their expense increase to just 4.5 percent. It is particularly challenging to grow revenues more than expenses given the pressures of inflation and other challenges facing the healthcare industry today.”

According to Taylor, the hospital’s total cash and investments exceed $10.5 million, while its debt stands at just over $13 million. “Having more than $10 million in the bank and reducing the USDA bonds to $13 million is impressive, as most organizations of similar size do not have such a significant amount of cash on hand with minimal debt,” Taylor said. “Additionally, the terms of the existing debt with the USDA are very favorable, featuring a long amortization period and a low interest rate.”

Taylor reported that the hospital’s net position had increased by $2.1 million over the past two years. “This indicates that the hospital owns a greater proportion of its assets rather than relying on financing,” Taylor said. “This is another example of the strong financial stability of the healthcare organization.”

Taylor recognized the significant contribution of the Healthcare Foundation in securing additional capital for the hospital. “Over the past decade, the Healthcare Foundation has raised more than $10 million from external sources,” Taylor stated. “This achievement is a key differentiator that distinguishes TCMH from its peer hospitals, as it raises additional funds through outside donations and grants.”

Taylor reported that the days cash on hand for 2024 at year-end were just under 100 days.

“This metric reflects the hospital’s ability to operate for almost three months without collecting anything from patients or insurance companies,” Taylor stated. “You have essentially doubled your bank balance compared to 54 days cash on hand pre-COVID.”

Taylor praised TCMH for its outstanding financial management as a rural hospital. “As a rural hospital, you face many challenges, but your position is strong enough to face them,” Taylor said.

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

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

In other business, Jerri Crump was sworn in for a five-year term on the TCMH Board of Trustees.  Jim Perry, OD, TCMH Board of Trustees chairperson, administered the oath of office to Crump. She has been serving as a board member since August 2024, having been appointed by the Texas County Commission to fill a position vacated by a resignation in February 2024.

The TCMH Board of Trustees unanimously voted to approve officer positions for the upcoming year, with Perry as chairperson, Ross Richardson as vice-chairperson, and Joleen Durham as secretary.

April Crites, TCMH quality and risk management director, shared recent patient satisfaction scores with board members. “Our emergency department has seen an overall increase of 59 percent, which is the highest since December 2023,” Crites reported.

Additionally, Crites noted that outpatient ambulatory surgery scores have once again improved. “We are pleased to report that these scores have increased from 87 percent to 89 percent among all facilities monitored by Press Ganey. This has also elevated our top box score average to nearly 92 percent,” she added.

Crites presented the hospital’s first-quarter Quality Assurance and Performance Improvement (QAPI) data.

“During the first quarter, the hospital successfully improved stroke outcomes by utilizing RapidAI software and retained six patients for treatment at TCMH, thus avoiding transferring to other healthcare facilities,” Crites stated. “Many of our patients are grateful that we have the technology to treat them close to home.”

Crites also mentioned that the Medical Office Complex has positively impacted our community health by reaching out to families, educating parents on the importance and benefits of well-childcare, and scheduling children’s appointments.

“About 15 percent more United Healthcare Medicaid children were seen in the clinic during the first quarter due to the staff’s efforts,” Crites reported. “We hope to continue increasing these numbers and closing the gap.”

Crites highlighted that Shelby Ellison, in case management, has been addressing the social determinants of health (SDOH) as part of the first-quarter QAPI plans.

“Shelby successfully contacted 270 out of 299 patients during the first quarter,” Crites said. “She collaborates with patients and their families to help them understand diagnosis, address questions and symptoms, explain medications, provide resources, and schedule appointments. This process has proven effective in reducing readmissions to the hospital.”

Courtney Owens, TCMH chief nursing officer, informed the board members that Home Health of the Ozarks received an unannounced visit from two state surveyors on April 7 for a comprehensive federal and state survey.

“The survey went exceptionally well, with the surveyors offering high praise for the team’s processes and overall performance,” Owens shared. “I am very proud of Cheryl Maley, the Home Health director, and her staff for their outstanding work.”

Additionally, Owens stated that the pharmacy department completed its biannual IV room inspection. They passed the inspection successfully, with the only recommendation to adjust the pressure gauges for better compliance.

Linda Pamperien, TCMH chief financial officer, presented the March financials, which reflected an increase of $296,885 in overall revenues from budgeted monthly expectations.

“Our inpatient volumes increased $205,942, a 15 percent increase from our budgeted monthly expectations,” Pamperien said.

According to Pamperien, the hospital had 95 admissions in March, up 31 admissions from the same time frame in 2024, with 260 admissions year-to-date.

The financial report reflected that the hospital’s profit/loss report showed a positive bottom line for March, with a decrease of $199,353 and a year-to-date profit of $33,888. The earnings before interest, depreciation, and amortization (EBIDA) for the respective month were positive at $68,481, and the year-to-date EBIDA was positive at $825,765.

In other news, Owens reported that the hospital recently hosted a site visit for the Pediatric Readiness Coalition, which included a simulation exercise, a skills lab, and a facility walk-through survey. She explained that the coalition consists of pediatric care specialists from SSM Health Cardinal Glennon, CoxHealth, and various regional EMS agencies. The goal of the visit was to enhance pediatric emergency preparedness throughout our healthcare system.

“TCMH had 51 staff members participate in the high-impact training modules,” Owens stated. “Additionally, 30 individuals from various external agencies took part in the training. This collaborative effort will help to strengthen regional readiness and improve inter-agency coordination.”

Pamperien informed the board members that Carla Crews has accepted the position of Radiology Director in anticipation of Ann Hamilton’s upcoming retirement.

“We are excited to welcome Carla into this new role,” Pamperien said. “With thirty years of experience in radiology, including the last five years at TCMH, we are confident she will excel as she leads the radiology team into the future.”

Bill Bridges, TCMH chief executive officer, said Kristina Grant, DO, family medicine and obstetrics physician, and himself traveled to Jefferson City on April 8.  This visit was part of the 143rd House District Day sponsored by State Representative Bennie Cook. During their time there, Bridges and Dr. Grant met with Cook, State Senator Brad Hudson, and Governor Mike Kehoe to discuss economic development opportunities for Texas County. They also experienced the legislative process firsthand and learned about upcoming legislation for 2025.

Present at the meeting were Taylor; Crites; Owens; Pamperien; Bridges; Helania Wulff, public relations and marketing; Hollis Tidmore, MD, chief of staff; Anita Quick, controller; and board members Perry; Joleen Durham; Jennifer Hugenot; Jerri Crump, and via teleconference Ross Richardson.

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