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Hospital district hits cash flow bottleneck

Medical records system causes major billing issues

Ongoing problems with the electronic medical records system have led to a situation where Crook County Medical Services District is experiencing serious issues with cash flow.

Though she expects the business office to catch up with the billing in the near future, CEO Micki Lyons requested a transfer of $500,000 from the board of trustees’ account last week to cover payroll and other costs until the issue is resolved.

While happy to consider the request, the board expressed concern that the issue is still not resolved.

The problem relates to older items that have not yet been billed, creating a situation where the accounts receivable is sitting at around $3 million – three times higher than is considered normal for the district. This, unsurprisingly, has left the district short of cash on hand.

Chairman Mark Erickson commented that the trustee account from which Lyons requested the transfer contains the district’s mill levy money, which is in fact intended for day-to-day operations. For this reason, he said, he has no issue granting the request from that account.

“The bigger part of the problem is that we don’t have money coming in,” he said.

Brent Fowler added input to the discussion from his perspective as an incoming board member.

“I really don’t want to hear you complain about it – I want to know what some of the solutions are,” said Fowler.

“You are the guys who are working the system, so therefore you should be the guys who come to us and say we can do this, we can do this and we need to do this and do that, so we can help make that decision is this a viable decision on what to do. That’s how I like doing my business.”

Lyons acknowledged the concern and explained that it’s not something that can be fixed overnight.

“This is a slow process to see any change,” Lyons said.

Staff have been working through to identify problems and bottlenecks, she said, but, “It takes time”.

Lyons assured the board in no uncertain terms that nobody is dismissing the issue.

“Frankly, I don’t sleep at night because I get that it’s urgent, but you can’t snap your fingers and it’s fixed,” she said.

Spending Cuts

The board questioned whether overspending was contributing to the issue.

“I don’t feel this is a spending issue. I feel this is a getting-money-in-the-door issue,” Lyons said. The earning potential is there, but the district is not receiving all the money it is owed.

However, according to Lyons, the idea of spending cuts isn’t being ignored either. It isn’t necessarily a matter of just cutting the budget, she said; instead, multiple cost-saving measures are being explored.

For example, she told the board that discussions are being held over the possibility of going to low-census staffing in the long-term care unit when the patient number is low enough; cutting unnecessary advertising; and working on food ordering in the light of recent inflation.

The board agreed particularly with the low-census staffing, with Trustee Sandy Neiman commenting that this will have a big impact and Chairman Mark Erickson stating that the district should always look to staff at the appropriate levels for patient numbers.

Meanwhile, Lyons said, she expects to be fully staffed in terms of nurses again in the near future, which means it will be possible cut the cost of traveling nurses, “which has been a huge expense” but a necessary one.

Additional Input

Fowler suggested part of the problem may be that individual doctors within the district are seeing very different numbers of patients each day – some 16, some just four – and this is causing a waiting time.

The result of this, he said is that, “People are getting turned away and they’re going to Gillette and they’re going to Spearfish and I know this to be a fact because I talk to these people all the time”.

If some doctors are seeing fewer patients because they’re “old and worn out,” Fowler suggested maybe it’s time to replace them.

“I’m tired of hearing that there’s a hospital in Spearfish. I live in Sundance,” he said. The more patients that are coming through, the more money is coming in.

Lyons said that she knows waiting times are an issue and has been having conversations with staff about how to fix it. It’s not an issue with the providers not wanting to see patients, she said, it’s “a bottlenecking situation”.

Erickson agreed that gatekeeping appears to have existed between patients and providers, stating that CCMSD has a great team of providers who would be “willing to take on more patients than even want to come through the door”. The problem lies in the ‘script’ used when booking appointments with patients, which is under review.

Training for receptionists, setting up minimum patient numbers per day and other improvements may go a long way to solving this, Lyons said. She also urged people experiencing problems getting into the clinics to let her know directly, as she can only solve problems that she is aware of and would like to hear both sides, “Because usually the answer is somewhere in the middle”.

Erickson added his thought that board members should ask for more information if approached by patients experiencing issues, so as to be able to offer constructive data that will assist in solving any problems.

“I’m not a shove-it-under-the-rug kind of person,” said Lyons, stressing that she actively wants to smooth out any problems within the district.

“I want to fix the problem, I want there to be a fantastic healthcare organization. I don’t want us to go back to where we were by any means, so I am all about any suggestions you have – but I need solutions, I need ideas.”

Future Expectations

In response to a query from Erickson about whether $500,000 will cover the need, Lyons said that she expects her request to cover the rest of the year, excepting any unforeseen events.

Lyons also stated that she is hopeful to see the district make a big impact on the backlog before the board meets again in December. Meanwhile, the district is in the process of switching to a new electronic medical records system after an internal steering committee completed an extensive vetting process to choose a new one.

A motion was passed to move $500,000 from the trustee account into the general fund.

 
 
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