NBHH remains financially stable despite tough economic climate

North Big Horn Hospital trustees and management received accolades for a job well done during a review of its annual audit report by accountants Daniel Juchau and Shar Sheaffer of the accounting firm Dingus, Zarecor & Associates PLLC. Juchau and Scheaffer joined the trustees at their regular monthly meeting via teleconference on January 21. The accounting firm specializes in audits of rural healthcare non-profit organizations, which puts it in a good position to compare NBHH to similar organizations in its review of the hospital’s financial position.

The audit report received an “unqualified opinion” on the hospital district’s financial statement ending June 2024. Juchau said it is “the highest degree of assurance” the audit firm can offer. 

Juchau led the discussion, giving a positive overview of how the hospital is doing financially compared to previous years and other critical access rural hospitals. He said the hospital’s financial statement is similar to prior years. In general, the hospital met most benchmarks for critical access rural hospitals, at times exceeding those expectations.

He emphasized the positive bottom line, which increased from $1.1 million in 2023 to $1.3 million in 2024. He noted that the hospital once again ended its fiscal year in a very strong cash position due in large part to “significant improvement in operating results” and a notable decrease in expenses. He added that the decrease in expenses was “impressive,” adding that the district surpassed industry benchmarks in its operating margin. 

He also pointed out that the district ended its fiscal year with above recommended cash on hand, placing it in a particularly strong cash position compared to similar facilities. He said patient revenue was consistent with other Wyoming hospitals, while uncollectable accounts were lower than other hospitals, with only 2 percent uncollectable revenue.

Trustee Todd Simmons, who also chairs the board’s finance committee, said he thought the hospital has made “huge strides” in improving operating revenue.

Juchau added that the decrease in expenses was “pretty impressive for a critical access hospital in a rural area.”

“With a lot of other facilities we work for, we see an increase in expenses,” he said. “So, keeping them level or decreasing like this is a very good sign.”

Board chairman Dave Winterholler added, “I think the board feels good about how 2024 went. It just shows we are on the right track. We’ve added services, and I think our decision to add those services has been a positive for the community.”

Scheaffer closed the discussion with the following word of caution: “You did have a good year, but this is something you need to keep your eye on, because it’s not a given. With that said, I do think your team deserves kudos for what they’ve built collectively and you (the trustees) probably deserve some acknowledgment, too.”

According to a recent American Hospital Association report, 136 rural hospital closed from 2010 to 2021, with a record 19 closures in 2020 alone. Nine hospitals closed in 2023.

“These include many longstanding pressures, such as low reimbursement, staffing shortages, low patient volume and regulatory barriers, as well as the continued financial challenges associated with the COVID-19 pandemic,” the report stated. “Recently, expenses for labor, drugs, supplies and equipment have also increased dramatically, ultimately causing difficulties in maintaining access to care for people in rural communities.” 

Becker’s Hospital Review reported in August of 2024, that more than 700 rural hospitals are at risk of closure due to financial problems, with more than half of those hospitals at immediate risk of closure. 

By comparison, North Big Horn Hospital has managed to offer more services, to maintain staff and upgrade or add state-of-the-art equipment, while maintaining a positive cash flow and bottom line.