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Setback in hospital finances for October, board votes to make campus tobacco free

Published: Claiborne Progress

Wednesday, December 2, 2009

by Ashley Collingsworth Staff Writer

The Claiborne County Hospital Board of Directors met in regular session on Tuesday, November 24.

The majority of the meeting was spent discussing the hospital’s finances.

There was a setback in October due to higher than anticipated charity and uncompensated care. The overall organizational loss for the month was $180,682.

Overall, expenses are at or below the previous year’s levels. Both the hospital and the home health department are continuing to focus on the collection of receivables.

Another area of discussion was debt refinancing.

CFO Tracee McFarland presented information concerning the possible refinancing of bonds, which would allow the hospital to receive a better interest rate and avoid the large balloon payments, which the current bond financing requires.

There was a motion and second to authorize the hospital to pursue refinancing for the bonds in question; the motion passed with all board members present in favor.

Other requests approved by the board included a capital request to purchase a new clock system for the hospital and the approval of a Christmas gift to all hospital employees.

The board revisited the smoke-free policy, which was discussed at last month’s meeting.

Administrator Tim Brown had distributed a draft policy before the meeting for the board members to review along with a communications plan and release forms.

Brown also found out through a discussion with County Attorney Jimmy Estep that state law could exempt nursing homes from any hospital policy concerning a smoke-free environment.

The employee parking lots could be exempted from the smoke-free area, which would allow employees to go to their cars during their scheduled breaks.

Other areas of discussion involved what the hospital would do for their employees if this policy were adopted and whether to designate the hospital campus as “smoke free” or “tobacco free.”

After lengthy debate of the proposed policy a motion and second was made to adopt a tobacco-free campus with the exclusion of the specified employee parking lots and the nursing home for patients only. The motion passed with the approval of all present board members.

It was also approved that the hospital would provide and pay for one course of smoking cessation treatment through the hospital pharmacy, which is commenced by any employee within six months from the date of adoption of the policy. The motion passed with a vote of 5 to 1.

Administrator Brown gave the management report and the monthly report on the Baker Cancer Center was presented to the board.

The next Claiborne County Hospital Board will be held on December 22 at 6 p.m. in the hospital conference room.

Hospital Board Considers Smoke Free Campus

Published: Claiborne Progress

Wednesday, November 4, 2009

by Ashley Collingsworth Staff Writer

During the regular Claiborne County Hospital Board Meeting on Tuesday, October 27 Dr. Robert Wilmoth brought before the board the idea of making the Claiborne County Hospital a smoke free campus.

Dr. Wilmoth gave the management report and stated that during the quality management meeting that several members of the staff had complained about the smoking on the campus of the hospital.

“They complained about having to walk through the quote cloud of smoke to get to the front door,” Dr. Wilmoth said, “They want to know if we could implement a smoke free facility for the hospital.”

Middlesboro Hospital is a smoke free hospital and Dr. Wilmoth said they had no problems when they started implanting the policy for the hospital staff.

“The medical staff is hoping the hospital would consider making it a smoke free campus,” Dr. Wilmoth said.

Mayor Joe Tyler Duncan questioned whether it would be both cigarettes and chewing tobacco as well, which brought up making the campus a tobacco free campus.

“You’re prohibited now within 100 feet of the front door not having any smoke,” Attorney Jimmy Estep said, “Any public building that’s got over so many employees has a statute.”

When bringing up the statute board member Mike Robertson asked if the no smoking policy would add to the statute or change it entirely.

“This wouldn’t change the statute, this would make the campus, all our property smoke free,” Estep said.

Board member Bill Debusk asked how the statue would be enforced and Administrator Tim Brown stated that most hospitals make their employees go to the vehicles to smoke.

Smoking in front of public buildings is a misdemeanor offense but the board would have to look into how many feet away from the front door it would have to be.

“You’re not supposed to smoke indoor at all,” Estep said, “So I think what this does is just a policy by us to prohibit smoking on our properties. I don’t think it changes anything or adds anything but it will take away smoking behind that wall.”

The area in front of the hospital entrance is for patients and family only, employees are not supposed to be smoking in that part of the building.

“Hospitals are finally starting to recognize the fact that smoking will kill you,” Dr. Wilmoth said, “I see patients daily whose lives are changed drastically by smoking.”

This opened the discussion about how the policy would be enforced if it were implemented to the campus.

“I think if we are going to be leaders of promoting good health in our community, we have to lead by example,” Dr. Wilmoth said.

Hospital security would be relied on when it comes to enforcing the policy by asking smokers to put out their cigarettes because it would be prohibited.

Board member Bill DeBusk was concerned about the smoke breaks taken by workers.

“There are probably 600 workers and out of those probably 100 or more smoke,” DeBusk said, “If you ask them to go to their vehicles then you would have to add time onto their breaks in order to implement the smoke free campus.”

Dr. Wilmoth said there are no smoking signs everywhere including out by the ER doors but they are not seen because the people that smoke are standing in front of them and the only way to enforce no smoking at entrances would be to adopt a campus wide policy.

“What we would have to do would be to grandfather in the residents that smoke,” Brown said, “Then alter our admission policies that we’re smoke free and eventually become 100-percent smoke free.”

Brown said that he is going to check with other smoke free facilities and see what their admission policies are.

Employees will be offered alternatives to help them quit smoking.

“I believe if we are going to do it, the employees should be offered, free, 100-percent, the opportunity to do it,” Mike Robertson said.

The board will start looking into enforcing the statutes to stop the smoking in the front door of the hospital and looking into implementing a policy and bringing it back before the board next month.

Also, during the quality management meeting it was brought to board member Betsy Shoffner’s attention that the times on any of the clocks in the hospital match. Brown stated that several people had brought the time up and they were working on getting that fixed as soon as possible.

The board approved the quality management report after a motion was made by Shoffner and seconded by Robertson.

Also on the agenda was the monthly financial report along with a review of debt.

September was a loss but the loss was considerably less than months before with a decrease in expenses and the overall revenue held up through the month.

Cash flow for the month of September showed an increase with accounts receivable down under six million.

The posting of payments was up concurrent and there was an increase of collections also accounts receivable was down under four million where they were at the start of the year.

Net revenue per patient is down from 92-thousand to 90-thousand in the 2009 fiscal year.

“We are working hard on the processes where we believe dollars are falling through the cracks,” Brown said, “Such as with insurance that has to be filed within a certain amount of time, also precertification’s through insurances, things like that can add up.”

They are looking for ways to close those holes and capture the money that comes from those services.

The debt the hospital owes was also discussed and reports have been requested that will be broken down by department.

“We had a pretty good month revenue wise,” Brown says, “We’ve got some positive things going.”

The reports will be brought back before the board at the next meeting which will be held on November 24 at 6:00 in the conference room.

Hospital celebrates 50 years

Three longtime physicians who are a big part of the hospital's history were on hand for Friday's anniversary celebration.
From left: Dr. William Smith, Dr. Meredith Evans and Dr. George Day.

“One of the best things to happen in Claiborne County” — that’s how James D. Estep, Jr. described Claiborne County Hospital last Friday during its 50th Anniversary Celebration.

Many local officials, present and former employees and friends of the hospital gathered on a cold afternoon to celebrate the hospital’s 50 years. As County Judge, Estep was seated as chairman of the original board in 1959. The only original board member living, Estep presented a brief history of the hospital.

The process began in July of 1952, when County Judge Kyle Kivett appointed a committee during a regular session of the Claiborne County Court to look at the feasibility of a hospital in the county. In April of 1956 a resolution was passed in favor of the construction of a 40-bed hospital. Fifty-two percent was to be paid by the federal government, 24 percent by the state, and 24 percent by the local government; the county’s share was not to exceed $175,000.

In the November 1958 term of the County Court, the original Hospital Board of Directors was appointed: Estep, Boyd Mason, G.B. Hodges, Neil Walker, Danny Drinnon, Will Fugate, Clarence Russell, Harry Miller, Sr., and Ruth Fulkerson. In January of 1959 the Court approved $80,000 in bonds to purchase equipment for the hospital.

“On July 19, 1959, we dedicated the hospital. United States Senator Estes Kefauver gave the dedication address,” said Estep, adding that the first administrator, Merrill Rayburn, was hired at an annual salary of $5,000.

“I’m honored and pleased that I was asked to do this today,” he said.

Current County Mayor Joe Tyler Duncan recognized past and current board members and spoke about the hospital’s growth over the years.

“I can remember when the only ambulance was a horse and wagon,” he said. “I’m proud of this hospital and I’m proud of how far we’ve come in our county.”

Duncan thanked everyone for supporting the hospital, especially the physicians who refer patients to the hospital.

Longtime hospital employee Brenda McPherson introduced three doctors who are very important in the hospital’s history: Dr. George Day, Dr. William Smith and Dr. Meredith Evans.

“It’s the people who make this hospital,” said Day, who delivered the hospital’s first set of twins.

Smith, who delivered the hospital’s first set of triplets, thanked the community for supporting the hospital.

Evans was the hospital’s first surgeon, practicing there from 1959 until 1985.

“I enjoyed practicing surgery here more than anywhere,” he said, adding, “The people were always very generous and very helpful.”

Tim Brown, current Administrator, talked about future plans for the hospital. Around the first of 2010 the organization plans to open an inpatient rehabilitation unit, he said, adding that they hope to continue working with LMU and its medical school.

“We are positioned well for the future,” he said. “We will hopefully fill a niche for the community.”

Director of Nursing, Kenny Trent, offered a prayer of dedication and the crowd dispersed to enjoy a reception.

Timeline

July 19, 1959 – Hospital Dedication of 40-bed facility

1966 – 20-bed East Wing Addition

December 1968 – Addition of 50-bed Nursing Home

1972 – 25-bed West Wing Addition

November 1972 – Claiborne EMS becomes operational

First run: Floyd Ball (still works for EMS)

First licensed paramedic: John “Sarge” Garland

1981 – New ER Constructed

March 14, 1994 – Home Health Opens

October 12, 1998 – Baker Cancer Center Opens

November 2, 1998 – Opening of 100-bed Nursing Home

December 2000 – Healthcare Foundation Established

March 2001 – New Surgical and Critical Care Wing Opens

May 2002 – Out-Patient Rehabilitation Center Opens in Tazewell

June 2004 – Out-Patient Rehabilitation Center Opens in Harrogate

April 2006 – Sleep Center Opens

April 2008 – Medical Office Building Opens

Claiborne County Hospital

Celebrates 50 Years of Service

Published: The Independent TODAY

Wednesday, October 14, 2009

Claiborne County Hospital and Nursing Home will celebrate its 50th anniversary with a special rededication ceremony Friday from 2 to 4 p.m. at the hospital.

The celebration features a brief presentation of the hospital's history, along with recognition of Drs. William Smith and George Day, tow local family physicians who both have been in practice in Claiborne County for 50 years. There will also be displays of pictures and newspaper headlines from the past five decades.

Claiborne County Hospital opened in July 1959 with a dedication ceremony that was attended by U.S. Senator (and presidential hopeful) Estes Kefauver. Merl Rayburn was the hospital's fir administrator. The ordinal facility had 40 beds, but was expanded over the years and now includes 85 state-licensed hospital beds and a 100 bed nursing home.

The hospital and nursing home is county-owned, and is managed by Restoration Healthcare. "We are proud of Claiborne County Hospital and Nursing Home, and the expansion of services that has occurred over the pat 50 years," said Administrator Tim S. Brown. "Our staff and management will continue to seek out ways to better serve the healthcare needs of the citizens of Claiborne County and the Tri-State area."

Preparation for H1N1 Vaccine

Published: Claiborne Progress

Wednesday, September 30, 2009

   At an informational meeting on Thursday afternoon, Educational Director for the Claiborne County Hospital, Linda Majors introduced key speaker, RN Carol Dunifer.
   Dunifer explained to the audience what preparations are being made for the H1N1 vaccine when it is expected out by mid October.
   She opened up the meeting by allowing those in the audience to ask questions about the H1N1 virus as well give any insight into what they already know.
   The “H” and the “N” in the name for the virus come from the molecular components that make up the particular strain of the virus.
   The reason they are calling it a pandemic flu, which is different from the seasonal flu, is because it stretches worldwide. A pandemic flu does not mean that it is stronger or is going to cause more deaths but it will affect more people across several different countries.
   Dunifer explained that H1N1 is not hitting people over 60 years old like the seasonal flu; it is hitting younger people and those with pre-existing medical conditions.
   The seasonal flu vaccination is already available but the H1N1 is not expected out until mid-October.
   The formula for the seasonal vaccine was already in the making in the spring before the H1N1 virus was present, which is why the H1N1 was not made with the seasonal vaccination.
   The reason you have a yearly flu shot is that the formula changes each year to match the seasonal flu.
   It is safe to do both the seasonal flu and the H1N1 together but if you do not take them together, they then have to be taken four weeks apart because the vaccines are live viruses.
The H1N1 vaccine will be coming out exactly like the seasonal flu vaccine, in shots, individual doses, vials and nasal.
   The H1N1 vaccine is completely different from the seasonal vaccine when it comes to the cost. The Federal Government is going to pay the full price for the H1N1 for 6 months all the way to adult. The vaccine will not be administered to 6 months and under.
   If you get your vaccine at a doctor’s office or pharmacy there could be the possibility that you are going to have to pay for the service but you will not be charged for the medicine but it is entirely free for administration at the Health Department.
   The hardest part when it comes to the number of vaccines they order is the number of people who want the vaccine. The vaccine will be administered to those that are high priority such as pregnant women and children from six months to 24 years old. People that that are 25 to 60 years old with pre-existing medical conditions will also qualify as high priority.
   Patients with asthma will not be more affected by H1N1 than a person who does not have it. They are recommended to take the vaccination to keep the flu symptoms for worsening but it will not hurt their asthma conditions.
   Ten years old and up will only have to have one round of the vaccine but nine years and below will be required to have two rounds of the vaccine.
   Health care workers are encouraged to take the vaccine because of working with patients.
   There will be over 4,500 doses of the vaccine delivered to the Health Department and other doses will be going to other health care providers.
   Dunifer stated that there are calls daily into the Health Department with concerns of the H1N1 virus and the vaccine.
   “People want to know if they have it or not, just like each of us, if we have it, we would want to know,” she said, “We have a sentinel provider in Claiborne County and we’re very lucky, which is Heartland Medical.”
   The state sends the sentinel provider test kits for the virus. They do the testing and the kits are then sent to the state for results. Other providers have to do testing individually and send those into their labs for the results.
   The Health Department gets the bulk of their information from the sentinel provider on cases.
   “H1N1 is here,” Dunifer said, “The information sent in from the sentinel provider shows 100 percent H1N1 because the seasonal flu is not here, samples that have been sent in are not seasonal flu.”
   Dunifer said the symptoms for seasonal flu and the H1N1 virus are similar although with H1N1 there is more diarrhea and vomiting. She said if you are having diarrhea and vomiting without the other symptoms then you most likely are experiencing a stomach virus.
The Health Department keeps track of those with flu-like symptoms and records show that those cases were down in the month of August.
   Medical providers are recommending that people still get their seasonal flu vaccination as soon as possible. The H1N1 vaccine will be available and they would like to have the bulk of people for the seasonal flu vaccination taken care of before the H1N1 is available.
   Another factor when it comes to the number of vaccines ordered is the storage. The vaccines have to be stored in a cool well-vented refrigerator. A large amount of the vaccine cannot be placed in the refrigerator together because it will restrict the airflow and temperature.
   Dunifer recommended carrying hand sanitizer at all times such as before eating, while shopping and keeping it in the car and at work. She also said practicing good health habits will help keep you healthier.
   “People don’t want to do it but decreasing sweets, getting good exercise, adequate sleep, more sunshine and fresh air,” she said, “Eat foot that are high in antioxidants, vitamins, they help, when everyone around you is getting sick and you aren’t you’ll know why.”
   Before closing the meeting, Dunifer discussed the number of deaths when comparing the seasonal flu and the H1N1.
   “You don’t hear about the deaths but there have been a lot of deaths from the seasonal flu in year’s past, more so than the H1N1,” she said, “If there have been deaths with H1N1 it is because there were pre-existing medical conditions. It’s not to be feared as much as the seasonal flu.”
   The seasonal flu vaccine is available now but the H1N1 vaccine will not be available until mid-October. The Health Department is still unsure where the vaccine will be administered.

Hospital Board approves financial report

Published: Claiborne Progress

Wednesday, September 30, 2009

The Hospital Board passed the financial report during a long meeting on Tuesday, September 22.

The financial report was discussed thoroughly over the two-hour meeting. Each member of the board was given their own financial book to follow through as interim administrator Tim Brown talked them through a slide show of the report.

The current position of the cash status for the hospital was $986,000 for ten days of operation. The Net A/R was 6.5 million for 72 days with 3.1 million in current liabilities.

The hospital is showing a $328k Year-to-Date loss with a $50 to $100 cash deficit per month when depreciation was added back.

Looking at July and August number from a cash standpoint is running about $118,000.

Brown showed the board a slideshow presentation that broke down the receivables balance sheet in a 16.5 million range; the overall adjustment was 63 percent.

“We decided to try to get more into the actual carriers,” Brown said, “Cariten was where a large amount of gross revenue came from for the hospital, the bulk is self pay and commercial.”

The hospital has a specific reserve fund to cover for the debt that has accrued during the time that the bill is not paid.

Brown explained that when a patient comes in they accumulate charges. The same amount is sent to the billing companies. If the company pays $2,000 for a $5,000 bill then there is a $3,000 adjustment.

When it was figured out that claims were not going to be paid the amount in the reserve was not enough to cover the debt.

In the adjustment summary, Brown covered each department in the hospital. Home health, private duty nursing and the nursing home and showed the original numbers compared to their adjusted numbers.

“We still have to do the cost report,” Brown said, “But it’s typically a positive gain.”

Brown also said that A/R Initiatives Reports would cover timely filing, pre-certification, medical necessity along with evaluation and renegotiation of insurance contracts. The reports will be handed out and looked over at each month’s board meeting.

“With knowing the numbers we know what direction we can with now with the budget,” said Brown, “We’re going to have to cut expenses and quick.”

At the end of the financial report presentation the board moved to approve the financial report and moved to discuss other business.

Board member Mike Robertson entered the Cancer Center report with a gain of $4,000.

Brown did note that on a positive note that surgeries have been over 200 for the month and radiology procedures are up. MRI’s have been down but X-Ray’s and CT’s have been up with the number of respiratory problems with the season.

ER visits reached 1400 for the month and there were over 222 overall admissions while the nursing home has an average of 88 residents.

“We have a lot of quality care going on here,” Brown said, “I’ve been getting out and talking with patients and families and they are letting me know how they feel things are going.”

Brown said the medical staff has been supportive with the changes in the past couple of months. He said that there are opportunities to work together to improve and to work toward a solution to electronic records.

The hospital is looking forward to celebrating 50 years in operation and will be planning a celebration in late October.

The next scheduled meeting for the board of directors will be Tuesday, October 20.

Hospital approves to keep same audit company for upcoming audit

Published: Claiborne Progress

Wednesday, August 26, 2009

by Ashley Collingsworth Staff Writer

In the first weeks since Restoration Healthcare took over the Claiborne County Hospital, interim administrator Tim Brown reported some good news at the August board meeting.

Brown reported that the numbers were up in the hospital and brought up the annual audit coming up in September. The audit will give the system a better feel for the accuracy of the statements they have been poring over since taking over.

As the board discussed the audit, the question of keeping the same company was brought to the table.

When last year’s audit was completed, it was unknown to both the company and the hospital board that the contract with the company had expired. With the audit coming up the board needed to decide whether to keep the same company or bring in a new one.

Brown felt it would be best to use the same company that they have used for several years.

“We know the organization and have a history with them,” Brown said, “We will just have to bring them up to speed on what has happened this year so they can structure their auditing.”

Brown said that they are comfortable with them on these engagements and that usually in that business you see a turnover of staff but in this company you have a 30-year veteran on the team.

Board member Rob Asbury made a motion to keep Burke, Pearlman, Nebbin & Huggins, PLLC. as the audit company. Board member Mike Robertson seconded the motion and all approved.

Brown also introduced Tracee McFarlan, which is new to the hospital. He said that she spent the first week and a half there looking over processes for payroll as well as cashiers receipts to make sure the cash was in balance.

Board member Mike Robertson asked if they had a chance yet to look over the nursing home numbers and Brown said that they had not yet had the chance.

Robertson suggested going back to look and see if the amount of revenue is comparable and Brown agreed also suggesting that they will look into bringing someone in to look over the numbers with him.

Brown said the independent audit would look over all of the issues in question including those numbers.

Also discussed was the increase in numbers in the hospital from July to August. Expenses are in line with the past already surpassing June.

Brown said that admission is up from June to August and the length of stay looks good. Brown also reported that the nursing home numbers are up with 87 as well as home health visits. The number of CT scans for the month is the second highest month at 871.

Other items approved were the credentialing of several doctors and records now being up to standard.

The next scheduled meeting for the board of directors will be Tuesday, September 22.