“Next Steps” Discussion Regarding the County’s Unpaid Medical Bills

Despite the hospital’s best efforts to try to work with Texas County and their growing inmate medical bills, a resolution has not occurred and the dollars owed to the hospital continue to rise.

“I would like to resolve this issue,” Wes Murray, TCMH chief executive officer said as he addressed the hospital board members at their monthly meeting on Tuesday.

“The hospital had to write off nearly $700K in bad debt in September, almost $675K this month and part of that belongs to the county,” Murray explained.

Murray mentioned that he was told on several different occasions that the county would only pay bills to agencies that they had a contractual agreement with.

The hospital received a letter from Laura Crowley, Texas County Clerk stating in part, “In as much as we have no contract with your organization, we are prohibited from making any payment. If you want to discuss how to obtain a proper agreement you may contact this office and we will advise you of the county’s process for contracting.”

“The county clerk’s letter infers that there is a standard process for obtaining a contract and all that it takes is contacting them to learn it. However, I have made multiple attempts over the past several years to get a contractual agreement, but it has gotten us nowhere,” Murray said as the board members listened to his frustration.

In October, Murray handed a copy of the letter that was sent to the county clerk to the board members. The letter was a timeline of past meetings and offers made in an effort to resolve the issue.

Murray explained that years prior to him becoming the CEO at TCMH, payment terms were agreed upon and the county paid consistently according to those terms. Then at some point, the bills stopped being approved and paid by the county.

“The hospital was never given the courtesy of being informed that there was a decision to change the way the county would handle the bills,” Murray said.

Murray mentioned that although the “dumping of inmates in the emergency department” and misuse of TCMH services has not occurred with the current Texas County Sherriff and staff, the Texas County Sherriff’s Department still needs the hospital’s services from time to time.

“We will continue to send bills to the county even though the bills are no longer being paid,” Murray said. “However, until we reach an agreement with the county, they need to take their inmates elsewhere for their routine care.”

The Texas County Commissioners accept the responsibility to procure healthcare services to inmates of the Texas County Jail by having a contractual agreement in place with an out-of-state company that allows a licensed nurse to perform 18 hours per week of routine medical services for their inmates. The agreement does not cover after hours or emergency services.

Murray offered a better agreement to the county that would provide coverage at the jail and include emergency department services at the hospital. The dollars spent would stay right here in Texas County.

“The last time I made this offer to the county was on March 19 earlier this year,” Murray said. “I have yet to receive any correspondence to the offer.”

“We need to pursue getting a contract with the county, but we need to pursue recouping our dollars that are owed,” Jim Perry, OD, TCMH board of trustees president said. “Texas County residents are the ones that are going to pay to send our dollars out-of-state instead of keeping the dollars here in our own community.”

“We should keep Texas County tax dollars in Texas County,” Perry said.

“I think we need to pursue this,” Omanez Fockler, TCMH board of trustees vice-chair said. “I am tired of seeing the hospital treated suspect to the county officials.”

Murray mentioned to the board members that the hospital sent a Sunshine Law request to the county that was received on October 17, to ask for copies of the contracts that they currently have in place. The correspondence that TCMH did receive was not what had been requested, and was not timely.

Murray reported that Hutcheson Pharmacy successfully opened the doors to their new location right next to McDonald’s on November 25. The new location offers a drive-thru for patient convenience.

“We are just a couple days in at our new location and the drive-thru is already getting a lot of use,” Murray said. “We are thankful to be able to offer this benefit to our patients.”

Some renovation efforts are still taking place in the areas that will become the new location of the walk-in clinic and TCMH Home Health of the Ozarks, but progress is being made to make those areas move-in ready as well.

Murray mentioned that several recent site visits have taken place for physician candidates interested in joining TCMH.

Nicholas Whitenack, MD is a general surgeon and he recently visited TCMH and spent some time exploring the area while he was here. Whitenack is completing his final year of residency at Creighton University Medical Center in Omaha, Nebraska.

“Dr. Whitenack would make a wonderful addition to our medical staff,” Murray said. “We hope to hear in the next few months if we will be able to bring him on-board.”

The second site visit completed was for a full-spectrum, family medicine physician, Timothy Cox, MD who is currently in his second year of residency in Wichita, Kansas.

An additional site visit for a full-spectrum, family medicine physician is planned for mid-January.

“We are working very hard to find talented physicians that can provide the care that our community needs and that our medical staff fully support,” Murray said. “We will always make that our top priority.

Doretta Todd-Willis, TCMH chief nursing officer reported the results and corrective action plan that followed a full Recertification Survey and Life Safety Code/Emergency Preparedness Survey by the state of Missouri that took place on October 22.

Todd-Willis mentioned that TCMH submitted their Plan of Correction within just 9 days of receiving it.

“We hope that our plan will be approved as written as we have addressed every deficiency that was identified and steps of have been implemented to ensure compliance is met going forward,” Todd-Willis explained.

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

There were revenue challenges for the month on both the inpatient and outpatient sides.

“Overall revenues were down $355,106 in October from our budgeted expectations,” Pamperien said. “Inpatient volumes were down $260,994 and outpatient revenue was down $10,869 for the month.”

TCMH closed out the month of October with total gross operating revenue of $6,673,090.22 with net revenues after reductions and contractuals being $2,740,028.73.

TCMH ended the month of October with a negative bottom line of $79,784.22 and a negative year-to-date loss of $1,478,871.22.

Present at the meeting were Murray; Pamperien; Todd-Willis; Amanda Turpin, quality; Rachel Davis, public relations; Linda Milholen, MD; board members, Perry; Fockler; Allan Branstetter; Janet Wiseman; guest, Janet Fraley, Missouri Medicaid expansion advocate.

Board member, Jay Loveland was not present at the meeting.

The next meeting of the TCMH board of trustees is Tuesday, December 17 at 12 p.m. in the hospital board room.