Hospital officials confident of district’s financial health

by laurie d. morstad

Chairman Jeff Grant and interim CEO Vince DiFranco opened the South Big Horn County Hospital District board meeting with recognition of the service of a longtime employee.

Jim Thomas retired in October; he most recently worked in laboratory services.

Thomas, with more than 15 years as an employee, stated his appreciation.

“I found I was unable to handle retirement and have taken another job,” he said.

Once he completes his training on federal standards, Thomas will be a state-certified inspector of medical facilities throughout Wyoming.

Joy Osbon, CPA, while presenting the financial report, noted that the month of November was a three-payday month, which affects the total numbers. For the month, the district saw an overall loss of $128,000, with a year-to-date balance of a negative $342,000. Osbon said a quarterly Medicaid reimbursement check of $528,000 just received was not factored in the financial report. She said $200,000 of that amount is already committed.

Joining in on financials. DiFranco noted that while hospital days are down, they have had numerous swing beds filled. The emergency room, he noted, “had the highest revenue of this fiscal year at over $300,000.” Clinic visits are holding their own; the clinic visits were slightly above budget. Grant again noted that all departments are handling their expenses, “well below budget as well.”  DiFranco, Grant, and Osbon assured that the district is entering the new year in a good financial position.

DiFranco said they were fully staffed. To guarantee standard-of-care, the hospital will be staffed with two RNs 24 hours a day. Although they may assist at times in the clinic or nursing home, they will not be counted in staffing patterns elsewhere in the facility.

DiFranco brought up the agenda item for renewal of the contract with Yellowstone Radiology. He said the maximum amount that the district could be held responsible in the contract is $10,000. The board voted unanimously to renew that contract. Radiologists Dr. Cross and Dr. Graham of Yellowstone Radiology had signed the contract prior to board approval.

The district board also voted unanimously to renew the contract with AirMed for air ambulance service. The cost for every resident in the district to be covered for air transport by AirMed is $56,784. Residents of the district will have no out-of-pocket expense; however those patients with private insurance, Medicare or Medicaid should expect their insurer to be billed first.

The district continues to look at teleheath services. DiFraco said in November that 29 hospitals in Wyoming are using this service. He has a meeting with Eastern Montana Telemedicine out of Billings on Jan. 14. The company will set up a fixed ER and hopefully a portable unit with visor that could then be used for consults with ER doctors and other specialist in real time via telehealth. DiFranco sees this of benefit also to aid nurses in care until a physician is onsite.

DiFranco has applied for a grant via the Helmsley Charitable Trust as “they are very devoted to telemedicine for the frontier states region.” If approved, 100 percent of the initiation fees and 75 percent of the service fees would be covered in the first year of the three-year grant. The amount, while still significant, would graduate down over the following two years, DiFranco stated. Helmsley Charitable Foundation works well with Avera, a telemedicine company.

Board member Margie Triplett voiced her support. She said the doctors and specialists at the call center are not doing other duties elsewhere. They would remain on videoconferencing for the duration of patient need. DiFranko added, “The initial response will be from a board-certified emergency room physician.”

Grant asked if this access to specialists’ support would increase the chance that some patients could remain local. This is a reasonable expectation for many patient situations, according to DiFranco. “Elsewhere it has increased the number of admissions and decreases transfers at rural hospitals,” he said.

The emergency medical director of Avera, Dr. Kelly Rhone, meet with Dr. Andrew Roberts, Dr. James Aurand and Sarah Watt, P.A., on Dec. 5 to discuss their service.

Regarding another grant, DiFranco stated, “We have received a grant for support of the telephone/internet connectivity fees in the amount of $2,100 for 2017 expenses … in 2018 we expect this award to be over $30,000 for expenses incurred this year.”

Grant said “the Wyoming Retirement Center is once again being reviewed by the state. I made a phone call to Tom Forslund, Wyoming Department of Health, and said, ‘Listen here’s the idea: we want to keep (the WRC) here; we want to keep the jobs here; we want to keep the patients here. We have an aging nursing home that’s going to need redone, and if there is a way that this district could up end up economically taking it over, managing it, and having a place for the nursing home residents we have and we could take care of all kinds of issues all in one.’

“Here’s what their plan is: The Joint Appropriations Committee is going to have a study done by October 2019 to have some final options to present to the committee and the legislature.”

They are going to look at the same options: 1) Close it, which according to Grant, no one wants; 2) leave it was a state facility; 3) sell it outright, or 4) privatize it and allow someone else to run it.  Grant described this option as a possibly amazing opportunity for the district and the citizens of south Big Horn County.

Although a ways in the future, Grant wants the board to stay on top of it. He suggested the new board connect with those doing the new survey and communicate the benefit to BHC to continue proving care for residents and their family.

The final report from the legislature should be done in 2020.

The board recognized the service of Jeff Grant and Mitch Shelhamer for their years on the hospital district’s board.

Mary Watts, Michael McColloch and Connie Werebelow won their election in November and will join Todd Denny and Margie Triplett on the board in January. Werbelow has served since October after being appointed to a vacated seat.

Following an executive session, the board extended the contract of interim CEO DiFranco until July 31, 2019. The newly seated board will be tasked with decision-making for the next CEO of SBHCHD.

Grant said, “Vince is doing a great job and the new board would be lucky to have him long term.”

The next meeting of the district hospital board is at 5:30 p.m. on Jan. 22, 2019.