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by Samantha White
Representatives from Eide Bailly LLP, a certified public accounting and business advisory firm, presented the results of a yearly financial audit that it conducted at Harney District Hospital (HDH) to the board during the Harney County Health District Board of Directors meeting held Dec. 12.
The Eide Bailly auditors said they began the audit for this year by taking a preliminary look at the hospital’s financial situation. They then met with HDH Chief Financial Officer (CFO) Catherine White who explained the hospital’s financial procedures. Next, the auditors conducted a walk-through to determine whether those financial procedures were followed. The auditors also conducted some tests that the CFO was not notified about in advance.
Both auditors said that the hospital’s management was great to work with and very responsive to the audit.
After conducting the two-week audit, the auditors wrote recommendations, which they presented to the board. They also used a database system to collect information about Oregon hospitals that are similar to HDH. The data was used to explain how HDH compares with other critical-access hospitals, serving a similar patient mix and conducting similar types of procedures.
Overall, the auditors found that HDH improved its cash and assets this year. In fact, the average daily amount of cash on hand tripled in comparison to the previous year.
However, the auditors found that the hospital incurred some debt when it built its new facility.
However, the auditors said, Burns has a healthy population, meaning that people are staying in the area, which keeps patients coming into the hospital and helps the hospital pay its debt.
The auditors also explained that hospital management faces factors that it can and cannot control. For example, management cannot control the number of patients who come into the hospital, but it can control hospital expenses, the salaries that it pays its staff and the amount that it charges for its procedures.
The auditors said they found that HDH is above average for efficiency in terms of staff, adding that staff salaries are typically a hospital’s greatest operating expense. The auditors also found that HDH charges quite a bit less than the average hospital for in-patient procedures. The auditors said the management is able to decide how much to charge for each procedure, and HDH management has expressed that it does not want any additional charges to come out of the pockets of its patients. However, the auditors said increased procedure costs may be covered by insurance providers. The auditors said HDH can pay to have the cost of each procedure evaluated to determine whether the price should be raised or lowered.
John and Vicky Clemens addressed the board regarding an issue involving their daughter that occurred in October.
“As concerned parents, we are just checking into it,” Vicky Clemens said. “This is not a heat-seeking mission.”
HDH Chief Executive Officer (CEO) Jim Bishop said he will respond to John and Vicky Clemens in writing.
Dr. Tom Fitzpatrick attended the meeting to discuss the Mobile Health Clinic, a full-service health clinic that serves patients in rural Harney County.
Fitzpatrick had been providing the clinic through HDH, but the hospital decided to stop offering the service Dec. 6.
Fitzpatrick said he will begin offering the service through Mountain Sage Medical in January for continuity.
The board also discussed a response to Dr. Oleg Reznik’s request to receive half of the sign-on bonus that he was given when he signed a contract to work full time for HDH Family Care for three years. Reznik requested to terminate his contract with HDH Family Care so that he could go to work for Mountain Sage Medical Clinic.
“The board does not have to take any action,” Sam Caizza, board chair said.
Chief Nursing Officer Barb Chambers reported that, “Demands on healthcare providers are getting worse by the day.”
She explained that providers are required to complete a large amount of paperwork and analysis in order to obtain reimbursement from Medicare. She said that it is becoming overwhelming.
“We anticipate that it is just going to get worse,” she said. “I wonder how a facility this size can afford enough staff to handle it. Every day there are more regulations.”
CEO Bishop agreed, stating that providers throughout the U.S. are facing this problem, but that it is especially difficult for smaller facilities.
“When you are small, you don’t have enough people to handle [the paperwork]. We need people to just process paper,” he said.
In other business, the board:
• discussed the coding system used on hospital bills. Board member Bob Otley said that a patient complained that the codes were not defined, making it difficult to understand the charges. CFO White explained that patients first receive a detailed bill, which explains all of the charges. They then receive statements, which are not as detailed. White said patients can call her any time they have questions about their bill;
• will hold its retreat Jan. 25. Caizza said the board will discuss its roles and responsibilities and its relationship with the hospital’s CEO and staff during the retreat. He said he is also open to suggestions for other discussion topics;
• reminded its members to update their Health Insurance Portability and Accountability Act training;
• learned that Dr. Sarah Laiosa moved up her start date and began working at HDH Family Care Dec. 3.
The next meeting of the Harney County Health District Board of Directors will be held Jan. 23 at 6 p.m.