Paris, Tenn.–The Henry County Medical Center Board of Trustees had a lot to think about during Thursday night’s busy monthly meeting, with administrative changes, COVID-19, staff shortages and finances at the top of the list.
Hospital CEO Lisa Casteel addressed changes with administration, including the resignation of Director of Nursing Neely Ashby, recruiting plans, building solutions and other issues that have been discussed in a series of management meetings over the last two weeks.
With the meetings, she said, “We found that isolation bring misinformation” and that the management will be working on healing and improving communications.
Vice President Troy Buttrey chaired the meeting in the absence of Dr. Scott Whitby, who was attending a meeting on medical students with Dr. Amanda Finley.
Dr. Joe Mobley, III, represented the hospital medical staff in Dr. Yemane’s place. Mobley shared that he is proud of the medical staff during this time and is happy to see improvements being made in surgical services. As a collective group, he told those in attendance, they have been resilient and look forward to a continued strong medical staff.
“Two things I would like to share is that with travelers here because of the shortage, it’s shocking to hear that many places don’t even have scrub techs on staff,” Mobley said. “It validates we are not the only ones going through this. Secondly, it is such an opportunity and a responsibility to have the residency program, so the medical staff are dedicated to making these students good physicians with the environment here and we have to ensure that we have the ability to give them the experiences they need.”
Buttrey asked the staff about the impact of staffing and the restrictions with COVID-19. Mobley said surgical volume is significantly down and they have tried to prioritize based on the needs and issues within the hospital.
“I do believe that this will get better and it hurts to cancel someone’s surgery, but it’s challenging and we are doing the best we can to provide the care we can to the community,” Mobley said.
Buttrey addressed morale and shared that the board is extremely proud of the medical staff and the HCMC staff for what they have done to take care of patients during this time.
“September was probably one of the worst months we have ever had with over a $1 million loss because of the reduction in patient admissions and surgeries,” said CFO Brad Bloemer. “The good news is that we have stimulus funds that will be coming to us in November and it should be significant.” The next phase of funds targets the needs in rural health care.
In September, the hospital incurred more expenses including travelers and higher contract pay without stimulus funding available. In surgery, it was below budget at 32%. Admissions were below budget at 46%. Work expenses were up by 3.3% and we saw investment losses of $162,000. Contract labor was $300,000 in one month alone.
“September was the first month that increases in salary were seen and it impacted our expenses for the month as well as the contract labor and crisis pay,” said Bloemer. “Year to date we have seen almost $900,000 in contract labor.”
October statistics will not be favorable because of reduced surgical cases and reduction in admissions because of the COVID-19 surge.
“We are working on improvements with staffing and surgical cases in November,” said Casteel. “With staffing plans and potential surgical volumes, December and January will see more volumes, but we do not have a crystal ball to predict how the sub-Delta variant or other variants will impact us.”
Part of working on improvements will be working on budgets and determining how to do work differently with staffing and even reducing or changing services we provide at HCMC. We are having a struggle with not just nursing but also with positions in housekeeping, registration, and food and nutrition.
“The good news is that even with the loss in September, we were able to improve and sustain cash due to turning over accounts receivable,” said Bloemer. “Our balance sheet is still very strong.”
Under new business, Buttrey discussed having a third-party firm to conduct leadership evaluations. It would be a comprehensive management assessment that would evaluate the skills of the management staff and provide the ability to educate staff moving forward. A report is compiled and provides constructive criticism to help the organization be stronger.
“So many families depend on this hospital, and I believe it could assist with morale and ensuring that the hospital is here for the future,” said Board Member Jamey Tosh. “It’s like a therapist, a reboot for the organization.”
Tosh discussed how it has been utilized at Tosh Farms. They have conducted at least four during his tenure there. Cost is determined by how comprehensive the evaluation is and how many people are involved.
The board approved to move forward with finding and choosing a consulting firm by gathering proposals to do the comprehensive management evaluation.
Casteel discussed the strategic plan and balanced scorecard, focusing on value objectives during the meeting.
Casteel began her part of the meeting with regulatory and healthcare news. With President Joe Biden’s vaccine mandate, HCMC is currently reviewing the OSHA draft COVID-19 Emergency Temporary Standard and determining how to move forward with HCMC’s policy and mandate. Due to the hospital’s revenue source being primarily Medicare and Medicaid sources, she said, “We will need to abide by the mandate to ensure that we do not have funds withheld.”
She also discussed the federal funding that is going to be released in Phase 4 Provider Relief Fund. We have applied and hope to receive additional funding relief in November.
In regards to COVID-19, numbers have decreased substantially in the state and Henry County. HCMC has closed its COVID-19 unit and hope to be back at staffing 29 beds on 3rd Tower next week. Casteel shared current COVID-19 statistics with those in attendance. HCMC will continue to participate with educational materials for vaccine hesitancy as well as access places for vaccines.
“We do plan to stand down our community vaccine program after November 19 because access is not an issue at this time,” said Casteel. “We are excited we were able to provide the vaccine to the community.”
In regards to administrative news, beginning January 3, a full-time cardiologist, Dr. Dor, will be joining HCMC with St. Thomas as a full-time locum for a year. The hospital hopes he will decide to join the team and the community. Anesthesia coverage will be improved in November with more CRNAs coming on board to assist with surgery.
Casteel discussed several awards that HCMC recently received. HCMC Women’s Center was awarded a Center of Excellence in Education and Training for Infants and Families Affected by Neonatal Abstinence Syndrome. This certification is from the TN Initiative for Perinatal Quality Care. HCMC was one of 30 hospitals awarded with the goal of standardizing care for infants and families affected by neonatal abstinence syndrome.
Additionally, as part of the Delta Regional Community Health Systems Development grant in addressing population health needs, HCMC chose Behavioral Health and launched a program in May called #SilencetheShameTN to address mental health an addition through personal videos and telehealth services. The campaign was shared with Delta as well as a National Hospital Marketing conference where the platform and information in the program was awarded the Gold Award for Best Service Line Campaign.
HCMC also received Institutional Accreditation form the ACGME Review Board with initial accreditation effective July 1, 2021. Next steps include much more work over the upcoming years and a site visit in September 2023.
Bad debts for the month were approved for $601,865.84.
Prior to the HCMC Board of Trustees meeting, the members in attendance watched two videos produced by TN Hospital Association for their annual meeting. The first was a recognition video of THA Small and Rural CEO of the Year, Lisa Casteel. The second was one featuring TN hospitals and employees documenting the work with COVID-19 for the past 20 months.
Casteel received her honor during the THA Annual Meeting earlier this month. Both are a testament to healthcare and the dedication seen during this difficult time.