CCHS Preserves Quality of Life with Palliative Care Program

Board Looks at Budget and Renovations

DAYTON-The first reading of the preliminary budget for 2018 was held at the Public Health District board meeting in October. The commissioners have approved a special meeting for November 15, at 3 p.m. in the Administration Board Room at Dayton General Hospital for the second reading and adoption of the 2018 budget.

Palliative care

Stephanie Carpenter, RN, CNO talked about progress on the development of the new Palliative Care program at CCHS, targeted for 2018.

Palliative care and hospice care are not the same, according to CEO Shane McGuire.

While both provide comfort, palliative care begins at diagnosis, and at the same time as treatment, and is patient-centered.

"Someone diagnosed with COPD . . . you want to start having those conversations early on with your loved ones. You want to have conversations in the disease state and not wait until the last minute," he said.

"Are you going to do chemotherapy on a 98-year-old patient who has cancer? If we had gotten in front of them sooner, we could preserve a quality of life for the patient and a magnitude of solace to the family," he said.

Carpenter said a Palliative Care Committee, made up of representatives from Acute Care Services, Booker Rest Home, Dayton and Waitsburg clinics, Social Services, Home Health Care Coordination, Marketing, and Ministerial Support, has been meeting every month since April, to get plans in place.

Carpenter said she has received End-of-Life training and plans staff training for those who will be on the front line for patients.

Six weeks ago DGH became a member of the state Rural Palliative Care Initiative. Rural Critical Access Hospitals have been invited to work with their communities to form Rural Palliative Care Community Teams, and DGH will be involved with seven other rural communities sharing tools and information.

"Palliative Care Programs maximize hospital efficiency and lower costs. The majority of hospitals today are losing money treating Medicare and Medicaid patients, while increasing government revenue shortfalls are jeopardizing hospital financial health," according to the Center to Advance Palliative Care.

McGuire said he is "very passionate" about the program and believes that it will meet the objectives of Accountable Community Organizations.

Cash flow and financial statements

The Congressional Budget Office collected at 63.7%, up from 52.7% the prior month, with a way to go to reach the goal of 75%, McGuire said.

A strong three-month average of $1,941,530 in revenue has just completed, he said.

McGuire said there has been little increase to the bottom line in spite of working a lot harder for it.

"We're working our tails off and not seeing a lot of it on the bottom line. I don't feel terrible about that. We are a cost-based reimbursed hospital. By design, we're not supposed to make money. We're supposed to break even," McGuire said.

"On a side note, as we increase depreciation of the renovation project, it will place a higher burden on our net bottom line, taking more depreciation expense from revenue, but those expenses also go onto the cost report and assist our position with CMS (Center for Medicare and Medicaid Services) and cost-based reimbursement," he said.

McGuire said, "We anticipate booking additional CMS payables ($ 600,000 owed back) in the coming months as the interim cost report only reflected underpayment for Jan. – June. We are near the end of October and still being underpaid by CMS for Medicare patients," he said.

"The construction project went a long way to help with the long term sustainability of the organization. It recharged our depreciation schedule which benefits cost-based reimbursed hospitals and CMS Medicare cost-based reimbursement."

McGuire said there is no telling when CCHS will receive CMS payables from the interim cost report.

"It is hanging out there," he said.

Controller Tom Meyers' summary of the financial statement for September

Gross patient revenue in September was about budget level.

Statistical volumes for services about average.

Cash position held steady, and Medicare receivables could arrive as early as November. October and November also provided a tax collection boost for semi-annual tax payments received for operations.

Deductions decreased substantially in September, as the Medicare underpayment now due is recognized.

The above impacts provide a booked gain of $154,000, after taxes and non-operating revenues are taken into account. Year-to-date there is a gain of $560,000, unaudited. This is still an operating income loss of 783,000.

"The old phrase, "Cash is King" best describes our current situation. Controlling expenses and collecting our receivables should improve our cash position," Meyers said in his summary.

Hospital renovation and enhancement project

Phase 4 is complete, and all remodeled spaces are occupied.

Phase 5 is moving at break- neck speed, and should be complete by Nov. 15.

The CREA board of directors has agreed to advance a loan to CCHS for the new Hyperbaric Wound Care Center.

McGuire said there is $69,000 left in Negotiated Support Services, that will come back to CCHS. That is subject to change if pressure is placed on the budgetary line item, in addition to some funds that have not been spent in the general budget. Both contingency funds have been spent to zero, he said.

Work continues on the part of the Greater Columbia Accountable Health Communities organization to seek funds for projects in the county in; Behavioral Health, YWCA, Public Health, Columbia County Sheriff's Department, and others, McGuire said.

McGuire said CCHS would be paid for sharing Behavioral Health services with other rural hospitals in Pomeroy and Colville, and he is seeking collaboration through Washington Rural Hospital Access Preservation on that.

As a member of the Magnolia-Evergreen Accountable Care Organization McGuire was recently one of the panel guest speakers on the topic of benefits and challenges for a rural facility participating in ACO Initiatives, he said.

McGuire plans to discuss home and community services offerings and support for people in the hospital district when he meets with Jessica Bowditch at Aging and Long Term Care.

Changes are occurring in the clinics and McGuire said patient satisfaction and productivity are goals for both clinics.

There have also been workflow changes at the clinics to accommodate patient-centered medical home and ACO efforts. Work continues on integrating behavior health into primary care, he said.