Keeping North Big Horn Hospital in good repair top priority

CEO Eric Connell reported on the status of facility improvement projects underway at North Big Horn Hospital and New Horizons Care Center at the monthly meeting of the hospital board of trustees on April 16.
Connell said a roofing project and work on the patio at the care center is nearing completion and should be finished before the next board meeting.
“Work on the care center roof is moving forward nicely,” he reported. “The new roof membrane is installed, and the leaks are repaired. Sheet metal work is ongoing this week, and the patio pavers will be installed and the project will be completed by this time next month.”
Lab manager Kathy Walker reported that the lab at the hospital has moved to a temporary location while an improvement project takes place at the lab. The temporary location is next to where the lab is normally located. She said there were no disruptions of service during the move and that the project is on schedule with no anticipated delays.
Trustee Todd Simmons and chief financial officer Darcy Robertson reported on financial matters. Simmons noted that budget preparation is in the works with capital requests at around $2.5 million. Simmons said it seems like $1 million is a more responsible number to keep up with needed repairs and upkeep, with an eye toward future needs.
 “We’ve asked senior leadership to take their wish list to a needs list to an absolutely must have list,” Simmons said.
This prompted a discussion among the trustees about the importance of keeping the facility up to date and in good repair.
Robertson noted that several departments have had higher revenue than expected but have kept their costs in check.
Connell summarized the financial status of the district in general. He noted that March volumes in the hospital were down, which impacted revenue. He reported that outpatient revenue was significantly higher than budgeted, which helped overcome that deficit. He also noted an accrual cost adjustment had also impacted patient revenue, resulting in a loss of $295,000 for the month.
Connell said cash and accounts receivables were impacted again this past month due to a cyber security attack on a payment clearinghouse contracted to handle payments.
“We made a decision to move to another clearinghouse due to the continued delays,” he said. “The new clearing house is now functioning, and we should see accounts receivable days and cash improve in the coming months to close out the fiscal year.”
Simmons and Robertson updated the trustees on a situation where someone tried to cash a fraudulent check but was thwarted in the attempt by the Bank of Lovell.
Simons noted that future check orders will be stamped “must cash within 90 days” to prevent uncashed checks for lingering too long in circulation.
Robertson and Simmons asked the board to approve a plan to offer a substantial discount on all receivables that have been deemed uncollectable. The discount, which was approved by the board, will not apply to current, collectable receivables. Simmons argued that receiving a portion of money that was otherwise uncollectable would be better than receiving none at all.
Trustees discussed a large employee retention tax credit (ERC) in the amount of $2.7 million due from the Internal Revenue Service related to losses incurred during the COVID-19 pandemic. Both Simmons and Robertson cautioned that the funds have not be received yet and recommended holding them for a few years, once received, to be sure the funding passes an eligibility review before spending.
 In other matters, director of nursing Michael Henley said he is working to get the VOS (visual observation specialist) program up and running again. He said the program “fell by the wayside” in recent months. The program takes pressure off regular staff by employing specially trained citizens to assist watching over patients who are held under observation due to suicide ideation.
In a hospital census report, Henley reported that one patient admitted during the month of March was diagnosed with COVID-19 during the stay. He noted that four patients were admitted for observation due to electrolyte imbalances, and four were admitted for respiratory symptoms and chronic obstructive pulmonary disease (COPD). An additional five patients were admitted for observation for suicidal ideation, intractable pain, anemia, hypotension and congestive heart failure. Two observation patients were converted to inpatient level care, one to swing bed care.
The hospital had a total of seven swing bed patients. Three were referrals from Billings Clinic, and one was accepted from Cody Regional Health. There was also one admission in March for extended recovery after a total knee replacement surgery.
Connell noted that Kathy Nunn was promoted to the newly created assistant administrator position at the care center. Certified nurse anesthetist James Ellis began the interventional pain management clinic this week. Connell said he was pleased to report that the hospital was able to successfully treat a 10-month-old respiratory syncytial virus (RSV) patient, saving the family from the inconvenience of transferring the patient to another facility.
Quality Director Catherine Herman presented a summary of patient surveys taken following clinic visits. The surveys show improvement in the timeliness of appointment, care and information, provider communication with patients, respect toward staff and overall ratings of providers in general. Several providers received additional written comments from patients that were very favorable.
Kathy Walker talked about ACA requirements to offer translation and sign language services to patients who need them. She said the hospital uses an outside firm to help with these services.
The trustees approved a proposal from Billings Clinic to set up QPath, a point of care ultrasound workflow manager. The system will cost $4,250 per year, which includes licensing and support from Billings Clinic.
The option of changing the trustees meeting from its regular time to accommodate the schedule of its outside attorney Scott Kolpitcke was brought up for a vote but was tabled for a second time while trustees consider other options. Kolpitcke attended board meetings twice last year.