Hopkins County Hospital District Board CEO Ron Folwell reported the district to be “doing fairly well” financially, and the director of EMS services reported April to be a good month for the service in the three counties they serve.
For the first 7 months of the year, the hospital district’s net income was $3.944 million, which means the district “made $811,000 on a consolidated basis for the hospital,” Folwell told HCHDB members at their meeting Tuesday night.
Tax revenues, he reported, were $14,000 less than last year for the month. Overall, that’s $621,000 greater than last year for the 7-month period, which Folwell attributed to an increase in valuations.
Rent incomes, are up $60,000 for the year. Folwell noted that there was a 2 percent increase last year.
“Labor costs actually look decent compared to last year for the month. For the month, we’re 2.4 thousand greater than last year, 13.4 greater than budget. …. I think we’re holding our labor costs fairly consistent,” Folwell reported.
Among those labor costs are benefits such as insurance. The hospital board heard proposals Tuesday night from Monica Blakeley, vice president and employee benefits consultant at IPS Advisors, a division of HUB International. Afterward, the hospital board selected a plan that would only be a $55 across the district increase, plus additional options for employees who choose a higher level of or additional coverage.
Cash flow, operating cash provided by operating activities, was $6.2 million, for the 7 months, the hospital district CEO reported.
“We’re in good shape from the government standpoint,” Folwell said. “Our cushion, net revenue is $2.9 million. For days of cash on hand we’ve got 98. We are required to keep 60 days,” Folwell said. “All in all, I think the district is in really good shape financially.”
One thing to potentially consider in the future is refinancing bonds at a lower interest rate for a cost savings in repayment amounts, according to Folwell.
April was a good month financially for the EMS department, with operations in all three counties — Delta, Franklin and Hopkins Counties — finishing the month in the black, said Brent Smith director of EMS services.
“So, in the financial on the expense side, we’re driving in the right direction. One of the positive things, our billing company does a 12-month look back. They compared it to the last 12 months. April 1, 2017-March 2018, April 1, 2018-March 2019., I wanted to point this. Gross charges and cash collections have both increased. The variance from year to year, some gross charges $1.6 milllion up, cash collection a little over half a million up to the good for the 12 months look-back,” Smith said.
Volume of patients increased, with 268 total transports more this year during this time frame, Smith said.
He reported a positive shift in payer mix as well: Medicare has dropped 1.9 percent, but commercial insurance has gone up 2.02 percent.
“Which is good because commercial insurance is required to pay more than the Medicare allowable rate. So that’s a positive shift,” Smith told the board
He reported a 2.26 percent decrease in private payments.
Levels of service are billed six different ways — specialty care transport, ALS, ALS Emergency, ALS non-emergency, BLS emergency and BLS network — based on the way Medicare set it up several years ago.
“The positive thing is we’ve had 2.5 percent increase in ALS runs over BLS. ALS receives higher reimbursement, which also means we are seeing a higher acuity of call. It’s not the sore throat people. The 2.5 percent increase required more of a paramedic in the back to manage the care of the patient. That’s looking really good. That comes from our billing company,” the EMS director said.
Smith too reported a 24.57 percent no transport rate, that is EMS was called to the scene but the no one is taken to the hospital from the call location.
“Compared to all of their other clients in their billing mix, which they have over 100 clients, the average rate is at 32.8 percent. Their own explanation to us was our organization has an excellent transport rate,” Smith noted
The EMS director says that indicates the people who need care are being taken to the hospital and a higher acuity of calls.
“What do they say about our actual collection rate, what we actually collect, compared to what’s billed? How do we compare with their other clients?” HCHDB member Kerry Law asked.
Smith told him that” they had no recommendations at this time in the analysis and recommendations section of the report.”
“Overall gross charges, class collections have increased with volume, agencies average cash per transport has improved as well: positive shift in power mixes,” Smith said.
“They don’t compare us to their other clients?” Law asked.
“They do. I do know we are performing better than a lot of their clients, but I don’t think I actually have that on me,” Smith said.
“That 25 percent no transport rate, do you have that broken down into what those consists of?” HCHDB member William Dietze queried.
“I can get that for you. I will tell you the highest is going to be motor vehicle accidents and falls. A lot of times we go out there and we may have four patients, but none of them called for the ambulance. People driving by called for the ambulance. So, we still have paperwork saying they’re not actually going to the hospital, but they’re not actually billed for that,” Smith answered.
“In falls, we get a lot of falls where maybe they slipped off their chairs and we don’t pick them up, as in we picked them up off the floor just not to the hospital for injury, ” Smith added. “I monitored those every month, and falls and motor vehicle accidents are the highest always.”
“I’m talking about if they’re recommended to come and they refuse to come,” Dietze said.
“No, we don’t break it out like that,” Smith said.
HCHDB President Suzanne Thomas asked about “high flyers,” people who call frequently for EMS to be take to the hospital, but don’t need to be transported to the hospital.
“Due to our population out here, we do have some, but I wouldn’t say it’s as excessive as in the urban areas,” Smith said.
There was an individual in Franklin County EMS used to respond to a lot, as much as three times a week, when Hopkins County EMS started providing service there. A check of the records recently showed the person had only been carried by EMS three times in the last year, Smith noted.
Those type of calls typically occur in spurts, often ending when people move or pass away. He said there’s not an abundance of that, but when there are, there are different variables that contribute to the rise in numbers.
Then, there are other instances, where EMS is called upon frequently to assist at a residence while a patient is undergoing a health situation, then are no longer needed as their health improves.
For instance, Smith said, one patient had some disabilities due to a stroke and had a lot of needs while going through therapy. As the individual’s health improved, EMS was called upon less frequently to respond.
“A lot of those ones that routinely access the ER, know what to say, where we can’t say no, where we assume liability if we’re saying you’re not really having chest pain,” Smith noted.
The EMS director reported that as best he can tell, a new transport record was set in Hopkins County last month.
“In April, Hopkins County, specifically Hopkins County, we had 446 transports. That was a record for us as far as I can go back. We’ve never transported that many patients in any month in the history of our service, or at least as far as I can go back on the records,” Smith said.
HCHB member Tim Kelty asked why there were few or no transports in Franklin County.
Smith said a significant portion of the “no transfer” patients in Franklin County are from accidents on Interstate 30. EMS often responds to multiple crashes along the same stretch of I-30 in Franklin County during the rain. Those increase in frequency when it’s raining.
Delta County and Franklin County had a strong month too, Smith reported.