North Big Horn Hospital District receives good financial news

Erin Mullins

Revenues are strong in the North Big Horn Hospital District.
Revenues were ahead of budget by more than a quarter million dollars for the month of November, said Chief Financial Officer Darcy Robertson at the December 19 North Big Horn Hospital District Board of Trustees meeting.
Financial volumes ranged from slightly below to slightly ahead of budget, Robertson said, but overall were good. Outpatient was the biggest driver of financial volumes. There is a $623,000 payable to Medicare for the fiscal year 2023, she said. In April, the hospital had a large receivable of $553,000 that they had to reimburse Medicare for, and the hospital had to pay an additional $70,000.
Robertson explained the reasons for the high payable cost to Medicare.
“They set the expenses way too high. So, our volumes weren’t where they needed to be to keep those expenses where they are, so we have to give some of that money back,” she said.  “Second, we didn’t get any credit for the ED transition to mostly clinical space … but we do have the opportunity to file an amended cost report after we get the architect map.”
There is nothing unusual to report about expenses, Robertson said, which have been consistent all year. The hospitals net income is ahead by $6,067 for the five months ending in November.
North Big Horn Hospital District CEO Eric Connell said that he is seeking feedback from the board on proposed ideas for financial sustainability and career development initiatives, and that the board would vote on these in the next meeting.
Connell said that the hospital is working on an engagement survey which will be given out in January. The survey will focus on the areas that were the five lowest in last year’s survey. The survey will most likely be the first all-staff email of 2024, he said.
The hospital is working on updating their bylaws so that their peer review is more up to date on what the Centers for Medicare and Medicaid asks as well as creating supporting policies for these bylaw changes, Connell said.  These updates are being drafted and will be ready for proposal at the end of the month.
The board reappointed medical staff privileges for Sameh Abuerreish, MD and requested medical staff privileges for Trinh Nguyen, DO, Scott Paulsen, MD, Johnathan Righetti, MD, Jeffry Lindenbaum, MD, Gregory H. Cross Jr., MD, George Knight, MD, Dean Bruschwein, MD and Davis Shang-Wen Mann, DO. Most of the last eight approvals were for radiology privileges.
The board approved an increase in clinical privileges for Adam Fieber, CRNA because he worked under Dr.Michael Hill for six months. Fieber was already working for the hospital, Connell said, but he was approved for expanded duties.
Connell said the hospital has been working to bring a mobile MRI to the hospital a few times a month. After some research, the hospital has decided to work with Monida Shared Imaging, an organization that has two mobile MRIs which are owned by a number of medical facilities in Montana.
Connell said that he is recommending that the hospital buy the unit instead of renting it, because there is a discount in the MRI fee when it is purchased. Additionally, the machine would provide immediate return on investment for the hospital, he said.
The unit would be paid off over a period of five years. After the unit is paid off the hospital would receive ownership distributions. The minimum share necessary to participate in the venture is a one percent ownership in the MRI, Connell said.
Connell said he is recommending that the hospital doesn’t buy an excessive number of shares because while he knows the MRI machine would currently be profitable, he doesn’t know if it always would be.
The preference is to initially have the MRI at the hospital for a half day every week, he said. If there is more demand, the machine could be used more frequently.
The board approved the purchase of one share of the Monida MRI machine.
The hospital is pursuing a better online scheduling interface, Connell said. The platform will connect to medical records and allow people to make an online appointment. The hospital is not reducing their in-person scheduling staff, he said, just providing another option to schedule. Each appointment scheduled online will cost the hospital 7.5 cents with an estimated overall monthly cost of $103, which the hospital will cover for patients, Connell said.
The online scheduling platform will be through Tonic/Artera. The configuration fees for the program are estimated to be $5,000. One reason to allow for online scheduling is a lot of people try to make appointments outside of business hours, particularly late at night, Connell said.
The hospital approved the online scheduling through Tonic/Artera.
The final item of business was a new meal virtual planning program for the district, MealSuite Interface through Billings Clinic IT. The program moves meal orders for patients from physical papers to a virtual interface that can be printed off and can integrate with medical records.
Robertson says this will simplify the work CNAs need to do for meal planning and save paper.
“The CNAs can take the tablet around, and they can say, like, Room 103, and it’ll say ‘Brian Christiansen’ and show a picture to make sure that they have the right person, and they can load up their meal choices for the week instead of just for the day, which is what they’re doing now,” Robertson said. “I mean, it’s not going to be completely electronic. But it is going to help out immensely with the amount of food that they process and the food that they have to throw away because they’ve been calculated for too much. They aways want to do too much just in case.”
Robertson clarified that the hospital already has MealSuite, but that this is a new and better interface. The program will also make it easier for CNAs to understand patients’ allergies and medications. The board approved the new meal system.