Missouri Hospital Association President Speaks to TCMH Board

               Herb Kuhn, president of the Missouri Hospital Association (MHA), spoke to the Texas County Memorial Hospital board of trustees at their monthly meeting on Tuesday.

Herb Kuhn, Missouri Hospital Association president

                Kuhn last visited TCMH in 2011 to honor TCMH employees for their donation to the MHA’s HERO Fund that was created to assist the healthcare providers affected by the natural disasters in the state.

                “This is a hospital that lives the mission,” Kuhn said, referring to his previous visit and encounters with TCMH employees.

                It was also Kuhn’s first visit to the hospital since the new construction was opened for patient care.

                “What a great community asset you have here,” Kuhn said, calling the new construction “impressive”. 

                During his informal talk with the hospital board, Kuhn specifically focused on the health status of the state of Missouri, likening service on a hospital board in today’s healthcare environment to trying to listen to an analog radio—“the signal is not very clear, but we do know where we are going.”

                Kuhn presented data showing Missouri ranking “eighth from the bottom” in overall rankings of the health of all 50 states and Texas County ranking 101^st out of 115 counties in overall health rank in the state.

                “We have a lot of health issues in our state,” Kuhn said listing obesity, heart disease, high blood pressure, diabetes, poverty and smoking as some of the health issues.

                “This is not a problem,” Kuhn said, “It’s an opportunity.”

                Kuhn has an extensive background in healthcare policy formerly serving as director for the Center for Medicare Services (CMS) and currently serving as a commissioner on the Medicare Payment Advisory Commission.  Kuhn and the staff at MHA are also actively involved in healthcare legislation as it relates to Missouri hospitals on a state and a federal level.

                Kuhn noted that over 850,000 residents of Missouri are not currently insured, and Medicaid recipients in the state have the highest utilization of the emergency departments in the state.

                “Five percent of Medicaid recipients use 52 percent of the Medicaid funding in the state,” Kuhn said.

                Healthcare and legislative policy makers are looking for solutions, according to Kuhn.  He explained that Missouri hospitals are “in a world of hurt”, trying to shoulder the cuts made as part of the Affordable Care Act and the lack of Medicaid expansion in the state of Missouri.

                Kuhn ticked off notable losses to healthcare in the state—Heartland Hospital in St. Joseph stopped running the local ambulance service, Liberty Hospital cut numerous positions at their facility; the University of Missouri Hospital and Barnes Jewish Hospital currently have a hiring freeze.

                “With Medicaid expansion and the health insurance exchanges, we may be able to get the number of uninsured in the state down to six or seven percent,” Kuhn said.

                Kuhn explained that many hospitals, members of law enforcement, state business leaders, community chambers of commerce as well as the state chamber of commerce supported the expansion of Medicaid in the state of Missouri, but the state legislators are still determining the course of action to take regarding the expansion on Medicaid.

                Kuhn also discussed the “new healthcare marketplace”—healthcare exchanges—that will open up on October 1^st, allowing the uninsured or self-insured to shop and compare value of various health insurance products.  Missouri’s health insurance exchange will be set up by the federal government since Missourians opted out of creating their own exchange program.

                “The real issue is enrollment,” Kuhn said.  “Hospitals like TCMH will have to help uninsured folks determine if something is available to help patients with their insurance needs.”

                Currently there are approximately 3,800 uninsured patients in Texas County, according to Kuhn.  Kuhn also noted that the “very poor” will still be left out of the process, and those individuals will continue to need healthcare that hospitals like TCMH will have to provide regardless of the individual’s ability to pay for services.

                “There has been a big shift in healthcare,” Kuhn said, calling healthcare services “a piecework system”–payment is made for services when they are completed.

                “The piecework system is highly inflationary, and it will be as long as we continue to treat each individual sickness,” Kuhn said.

                Kuhn explained that the current system traditionally treats people when they are sick rather than trying to help people manage their health so they don’t become sick.

                “We need to get out of the sickness model,” Kuhn said.  “How do we straddle the current payment system and change the way people think about their healthcare going forward?”

                Wes Murray, chief executive officer at TCMH, thanked Kuhn for taking the time to visit TCMH and complemented him on doing a “tremendous job” at the MHA.

                “We tend to live in our own bubble,” Murray said, “And it’s important to know that at TCMH we’re facing the same issues being faced by hospitals across the state.”

                Following Kuhn’s presentation, Murray gave his administrative report.  He explained that the renovation portion of the construction project is “going well” and few “unknown” problems were uncovered in the demolition portion of the renovation.

                Construction crews are currently renovating vacated areas such as the emergency and radiology departments to create new office space and to increase the size of patient care areas as well as adding more storage space for departments like laboratory, cardiopulmonary and education.

                Internally, the TCMH maintenance department is renovating an area near the obstetrics and intensive care unit, building a new space for the hospital’s in-house pharmacy.  The current space occupied by the in-house pharmacy will be part of the removal of the South wing to build the tornado safe room and new surgery department.

                “Demolition of the South wing will begin on September 9^th, and we will open bids for the construction of the tornado safe room on September 10^th,” Murray explained. 

                Fundraising for the new construction is nearly complete, according to Murray.  The TCMH Healthcare Foundation is in the process of selling tax credits that will help fund the remainder of the $3.2 million capital campaign project.

                Murray reported that Dr. Joshua Wolfe is already seeing lots of patients in the Licking and Houston clinics, and he’s taking on established and new obstetrical patients.

                “Dr. Wolfe is off to a good start, and we are continuing to recruit for a full-time family medicine and obstetrics physician at the TCMH Medical Complex in Houston,” Murray said.

                Doretta Todd-Willis, chief nursing officer, reported that a new influenza vaccine policy is in place at TCMH for the 2013 influenza season.

                “We are requiring that all TCMH personnel receive the influenza vaccine,” Todd-Willis said, explaining that the new policy echoes Centers for Disease Control recommendations for healthcare workers. In future years, TCMH could be penalized by the Center for Medicare Services if at least 90 percent of employees don’t receive the vaccine.

                “This policy is better for the safety of our patients, and we do not want to risk losing some of our reimbursement by non-compliance,” Todd-Willis said.

                Inpatient and outpatient revenues at TCMH were down for the month of July, and contractual adjustments for the month were also higher due to a larger number of Medicaid patients and self-pay patients.

                Pamperien noted that one self-pay patient came in through the emergency department very ill and stayed at TCMH for several weeks.

                “The patient wasn’t able to access outpatient care because they didn’t have insurance,” Pamperien said.  “When the patient finally came in the ER, they were very sick.”

                Pamperien explained that TCMH was able to help the patient get Medicaid to cover some of the hospital bills, but the reimbursement for Medicaid is very low compared to the actual hospital charges accrued by the patient during their stay.

                “We’re happy to get the Medicaid reimbursement for that patient, so we are at least reimbursed for something,” Pamperien said.

                Omanez Fockler, chairperson of the TCMH board of trustees, remarked on the importance of a community hospital providing care to anyone that needed it.

                “The public needs to know about these patients that receive care at TCMH when there is no other care available,” Fockler said.

                Board members agreed that such patients drive up the cost of healthcare for everyone.

“Unfortunately, this patient is not a unique challenge for us,” Pamperien said.  “Many times, the patients that we take care of here come to us because they have difficulty finding appropriate care.”

                TCMH ended the month of July with a negative bottom line of $64,055.81and a year to date negative balance of $636,121.13.

                Murray reminded board members that TCMH has one year of monthly bond repayment obligations of $80,000 each month that will continue through July 2014.

                “We knew we would have these payments going into our new construction,” Murray said, “But they will be done next summer.”

                In 2004 TCMH restructured a general bond obligation to save almost $3 million and to reduce repayment time by 11 years.                 

Present at the meeting were Murray; Pamperien; Todd-Willis; Dr. Schaun Flaim, chief of staff; Joleen Senter Durham, director of public relations; Dr. Charles Mueller; and board members, Fockler; Mark Hampton, and Dr. Jim Perry, OD.

Board members, Janet Wiseman and Russell Gaither, were absent.        

The next meeting of the TCMH board of trustees is Tuesday, September 24 at 12 p.m. in the downstairs meeting room of the hospital.