Study Finds TCMH Exceeds Industry Benchmarks in Revenue Cycle and Physician Practice Management

Texas County Memorial Hospital exceeded industry benchmarks in key financial and operational indicators board members heard at their monthly meeting on Tuesday.

Linda Pamperien, TCMH chief financial officer, presented Revenue Cycle Management and Physician Practice Management assessment results from Forvis Mazars, LLP, a public accounting firm. Pamperien, along with hospital and clinic operations and billing staff, has been working on TCMH’s key performance indicators (KPI) in these two areas since the Delta Regional grant program started in 2023.

“Forvis Mazars was extremely complimentary of what we had done,” Pamperien said.

Revenue Cycle Management (RCM) and Physician Practice Management (PPM) are key functions that support the financial and operational health of the hospital and its clinics. RCM includes the end-to-end process of managing patient revenue from registration and coding through billing, claims submission, payment posting, and accounts receivable follow-up to ensure accurate and timely reimbursement. PPM focuses on physician practice operations, including provider productivity, coding accuracy, patient access, scheduling, billing, and collection processes such as point-of-service collections. Together, these functions support strong financial performance and efficient operations across hospital and outpatient settings.

Pamperien shared that when Forvis Mazars first assessed TCMH’s RCM and PPM operations, the hospital implemented a weekly interdepartmental meeting with clinic managers, medical records, billing, and registration staff, helping address operational challenges and improve overall performance.

The reassessment highlighted improvements in accounts receivable efficiency and billing turnaround times. Pamperien emphasized the importance of timely coding and billing as an ongoing priority.

“Coding, billing, and quick turnaround times on both have been a major focus for us,” Pamperien said.

Key improvements included reductions in both gross and net accounts receivable days, along with significant declines in aging receivables. Gross days in accounts receivable improved from 42 to 38.1 days (benchmark: 50.2), while net days improved from 48.1 to 30 days (benchmark: 46.5). Accounts receivable over 90 days decreased from 18.7% to 9.3% (benchmark: 28.3%), and over 180 days decreased from 5.9% to 3.6% (benchmark: 5%). Billing turnaround time also improved significantly to approximately 0.4 days, compared to a 6.6 day benchmark.

In physician practice management, Pamperien highlighted strong gains, particularly in collections and aging accounts receivable. Accounts receivable over 90 days improved from 34.3% to 16.4% (benchmark: 20.4%), while point-of-service collections increased from 44.4% to 53.6% (benchmark: 52.8%), exceeding best practice levels.

Pamperien credited cross-departmental collaboration for improved communication and outcomes.

“We’ve all learned a lot through this process,” Pamperien said. “It’s been good for relationships because we’re working together for the greater good.”

The collaborative effort includes clinic managers, medical records, billing, and registration teams who meet regularly to address operational challenges and improve workflows.

The hospital also continues to work with external consultants on charge master review and physician coding and documentation education to further enhance compliance, accuracy, and revenue integrity.

Pamperien emphasized continued momentum in strengthening revenue cycle operations and clinical documentation practices, building on the success of the reassessment.

In other business, April Crites, TCMH quality and risk management director, presented patient satisfaction data to board members and highlighted overall improvements across multiple areas. Inpatient scores increased by 7 percent overall, while emergency department scores rose 9 percent. Outpatient ambulatory surgery scores also improved, increasing 2 percent.

“Gains were seen across inpatient, emergency, and outpatient services in both nursing and provider categories,” Crites said. “While the improvements were modest in some areas, they were consistent across the board and reflect ongoing progress in how patients experience their care from admission through discharge. These steady gains show that our efforts to improve communication, responsiveness, and overall patient experience are making a measurable difference.”

Bill Bridges, TCMH chief executive officer, shared that the hospital remains actively engaged in regional and state discussions on the Rural Health Transformation Program, with local participation drawing attention at a recent Missouri Hospital Association District 5 meeting.

“Almost half of the responses on the mapping tool came from Texas County,” Bridges said. “That strong participation from our employees and community is one way we’re staying involved and making our voice heard.”

The program is expected to provide funding for facility improvements, with approximately $43 million statewide for renovations. Early discussions have included TCMH’s obstetrics services, though details remain uncertain.

“There may be a 10 percent match,” Bridges said. “We’ll need to explore a capital campaign or other options to come up with $350,000 to $450,000, depending on the scope.”

Board members expressed concern that TCMH may be required to provide matching funds for money designated for capital improvement at rural hospitals that are already facing losses from Medicaid and Affordable Care Act cuts.

Bridges noted that plans are still evolving. “We don’t know exactly what the final plan will look like, but we’re monitoring it closely and will evaluate next steps as more information becomes available.”

TCMH board members also approved a resolution supporting a Missouri Department of Transportation grant application through the Missouri Elderly and Disabled Transportation Assistance Program. The hospital is requesting $23,701, representing approximately half of the budgeted cost for the TCMH Medivan transportation service for the year. The funding, which aligns with the state fiscal year beginning in July, will help offset operational expenses and ensure the continued availability of this important transportation service for patients in the community.

“Our TCMH Medivan is critical for many of our patients who rely on us to get to appointments and access care,” Bridges said. “Support like this helps us continue providing that access and meeting the needs of our community.”

Pamperien announced that Matthew Eskew was promoted to respiratory therapy director. Eskew has been with TCMH for the past 10 years and has approximately 17 years of experience in respiratory care. In addition to his work in pulmonary rehabilitation, he has supported multiple areas, including the hospital’s sleep lab.

“We’re excited to have Matt step into this role,” Pamperien said. “His broad skill set and years of experience will be a tremendous asset to the department.”

Helania Wulff, TCMH public relations and marketing director, highlighted the third Texas County Travel Tour, scheduled for Friday, March 27, with stops in Houston and Cabool. She noted that the tours serve as an opportunity to highlight the many resources available throughout Texas County while also fostering connections among participants.

“These tours are a great way to showcase our communities and all they have to offer,” Wulff said. “They also provide valuable opportunities for networking and building stronger relationships across the county.”

Pamperien presented the February financials, which reflected a decrease of $1,254,976 in overall revenues below budgeted monthly expectations.

“Our inpatient volume decreased $398,535, a 28.9 percent decrease, and our outpatient revenue decreased $859,638, a 10.6 percent decrease from our budgeted monthly expectations,” Pamperien said.

Pamperien noted that overall expenses for the month of February were down $591,254, a 14.5 percent decrease.

According to Pamperien, the hospital had 71 admissions in February, down 49 admissions from the same time frame in 2025, with 196 admissions year-to-date.

The financial report showed the hospital’s earnings before interest, depreciation, and amortization (EBIDA) were negative at $127,524 for February.

Present at the meeting were Pamperien; Crites; Bridges; Wulff; Courtney Owens, chief nursing officer; Christopher Baldwin, MD, chief of staff; board members Jim Perry, OD; Ross Richardson; Joleen Durham; Jennifer Hugenot, and Jerri Crump.

The next meeting of the TCMH board of trustees is Tuesday, April 28, at noon in the hospital board room.