CCHS to Consider Changes at Booker

DAYTON—At their regular board meeting last week hospital administrators addressed what CEO Shane McGuire characterized as “a significant care hole” in the local community for patients who do not need long term nursing care, but require some assistance with activities of daily living.

McGuire also said there is a need to trim the financial loss at Booker Rest Home, which is about $500,000, annually.

“How can we absorb another half-a-million-dollar loss at Booker?” McGuire asked the commissioners.

McGuire said the state is performing greater scrutiny of nursing homes to see if patients really need to be there. Five of the patients currently in BRH don’t meet state criteria for long term care, McGuire said.

Also, reimbursement rates are lower for patients who don’t need long term care, but continue to stay in the facility, he added.

“We make patients better, and then they don’t meet the criteria for long-term care. They do okay, and then crash back in,” he said. “Where do we send them if they don’t meet the criteria?”

McGuire said some financial relief can be accomplished by moving those nursing home residents into assisted living, which is more cost effective for all parties involved.

Chief Nursing Officer at DGH Stephanie Carpenter agreed.

One day in the Booker Rest Home costs $235 for a private room, and the total monthly cost is around $6,000, she said.

With that in mind Carpenter and McGuire are working on a plan to set aside six beds in the facility specifically for assisted living residents. McGuire said the Department of Health will license up ro seven beds, with good reimbursement rates.

Carpenter said she needs to check into state regulations, to see if a mix of Medicare Part A swing beds, nursing home beds and assisted living beds can be intermingled.

An audit firm specializing in Medicare Part A billing will be looking into the current nursing home census and the payment model, McGuire said.

When that is done he said that he will present several options to the finance committee, and to the board, for consideration. McGuire also tossed out the idea that the hospital district could partner with another entity to build an assisted living facility.

“We have enough property here,” McGuire said. But for now the administration will look into setting aside a few beds for assisted living. “We can dip our toe in,” said McGuire.

Hospital renovation and enhancement project update

Construction on the hospital remodel is tentatively slated to begin June 27, McGuire told the commissioners. The current total estimated project cost is firming up at $5,643,226.55, with an 8% contingency, but costs are not final until construction documents are at 90%, and the MACC is established, said McGuire.

A mandatory pre-bid conference last week was well attended, with four electrical contractors touring the facility, ensuring good competitive bids, McGuire said. A sealed bid opening is slated for June 2, with bid openings in Spokane and Dayton over the phone. The construction documentation set for the project can be viewed at build.cchd-wa.org.

Cash flow and financial statements

McGuire told the commissioners that the April financials show a good trend year to date, but may present a false sense of security.

“We are working to manage cash aggressively as we still run a new operational loss, on an ongoing basis,” he said.

McGuire said that some of the loss may be offset by the 2016 Medicare Cost report, which is eighteen months away.

“The community tax support we receive occurs in April and October and has covered our operating deficit,” he said. “Year to date we show a positive bottom line of $25,780, after non-operating (tax) revenue is added in,” said McGuire.

McGuire also said there are some liquidity issues. The Centers for Medicare and Medicaid Services will provide a one-time reimbursement of $368,682 in September, and $291,444 in tax revenue will be received in October, he said.

McGuire said he will work on creating a contingency plan to support operations through the cash-tight period, and will look into the possibility of interest-bearing warrants with the Columbia County Treasurer, and a line of credit with Banner Bank.

Outreach and business enhancement initiatives

McGuire said that he, respiratory therapist Tom Anderson and Dr. Lewis Neace met with Walla Walla General Hospital CEO Monty Knittel and cardiologist Dr. Douglas Whysham about the need to create on-site cardiology services in the CCHS clinics. The idea is to have two physicians provide four hours of clinic time in each of the clinics, once a week each. Stress echo testing in the RT lab would also be offered on those days, he said.

Anther business opportunity is wound care for diabetics supported by hyperbaric chambers, McGuire said. “Reimbursement for hyperbaric therapy is good,” he said.

McGuire said they are looking at a model with a company called Healogics to place two chambers on site, paid for by monthly fees.

Code Compliance and Quality Assurance

Code Compliance Officer Cheryl Skiffington is developing a handbook of CCHS standards of conduct for the board to review.

Quality Assurance Officer Janet Ihle, shared with the board some highlights from the annual Critical Access Hospital Evaluation for 2015, which is a summary of accomplishments and challenges as related by department heads, committee managers, directors and leaders.