Henry County Medical Center Board of Trustees Presented with Independent Financial Audit for FY2021; HCMC Continues to Grow Forward Amid COVID-19 Challenges

CUTLINE – Pictured is Sabra Fuller, Board member, and Lisa Casteel with a gift in recognition for her six years of service.  Joining the Board of Trustees is Tiffany McCutcheon who was appointed by the Henry County Commission in November.

Paris, TN – Henry County Medical Center Board of Trustees heard from LBMC on the independent audit for FY2021.  Andrew Bissonette, Senior Partner with LBMC, along with Laura McGregor, Senior Manager, presented the report.  The report was a clean audit for the organization, with only one adjustment that is an entry calculated by the State Comptroller’s Office and given to HCMC concerning the pension actuarial accrual. This is an entry calculated by the State and given to HCMC each year, as well as other entities who participate in the TCRS program.

“The Accounting team is always wonderful to work with,” said Bissonette.  “They are timely, responsive, and we have no issues working with the organization.”

LBMC reported that the State Comptroller’s Office also audited their work of HCMC.  Standard procedures for the State are to review the audit report annually and conduct audits of the documentation approximately every 5 years.  LBMC reported that everything was compliant.

In the independent auditor’s report, LBMC’s expressed opinion of the HCMC financial statements is that financials are presented accurately by management.  There was a net increase in financial position of the organization of $5.6 million, with net revenue increasing $2.0 million and a decrease in long term debt of $4.4 million.  Patient net revenue has remained stable over the past few years.  There was a decrease in salaries and employee benefits mainly due to changes in anesthesia from a status of employment to a contracted service.

LBMC discussed in detail the magnitude of the impact of the pandemic to HCMC from a financial perspective.  HCMC received assistance from the CARES act, Provider Relief Fund, PPE loans, CMS advance payment program, and other grant sources.  The notes to the audit report explain each of these funding sources in detail.

“This is a public report that is submitted to the State Comptroller’s Office and can be accessed publicly on their website,” said Bissonette.

HCMC had a positive bottom line of $5.6 million.  HCMC purchased equipment totaling $2.9 million, and had investment income of $1.5 million.

Dr. Scott Whitby, Board Chairman, asked several questions of LBMC.  One question was to tell about LBMC’s service. Bissonette explained that LBMC has an in-depth experience and expertise in an array of industries.  One of their specialties is Healthcare.  Bissonette’s team works exclusively with healthcare entities conducting approximately 75 audits a year.  Another question asked: “Compared to other clients, is our hospital in poor financial condition?”  Bissonette answered “No”.  HCMC is in a good position with a positive bottom line over the past two years.

Dr. Amanda Finley gave an update on the graduate medical student program.  Everything is on track to have residents beginning in July 2023.  For the services we do not offer such as Endocrinology, several Jackson providers have been very accessible and have offered to be a part of the teaching environment for the students.

“From being at the Rural Health Association of TN (RHAT) annual meeting, we are definitely ahead of the curve in the state,” said Dr. Finley.  “We are a gem in the State, and we are very excited to offer an Internal Medicine Residency Program.”

Our residency team physicians received an award from the RHAT meeting related to scholarly work around COVID-19 patients. The medical students’ poster contest placed second nationally.  As we grow in this program, we will have more scholarly work to present as we find our place among the academic part of healthcare.

“We have graduated eight doctors, with two or three wanting to come back to Paris to practice,” said Lisa Casteel, CEO.  “We are a model in the State and building our healthcare and economic development for the community.”

Casteel began her report with her regulatory and healthcare news.  With President Biden’s Vaccine Mandate, HCMC sent out a policy with the vaccine mandate and approvable exemptions to partners.  Due date for those who require vaccination without an approved exemption is Dec. 4 with the second dose by Jan. 5, 2022.  If HCMC did not abide by the federal mandate, we would not be able to care for approximately 80% of the population we serve.

The Biden Administration is looking to cut some portion of the Medicaid disproportionate share payments and federal uncompensated care pool funding.  HCMC is working with the Tennessee Hospital Association to understand how non-Medicaid expansion states will fair with these potential changes in reimbursement.

COVID-19 hospitalizations have substantially decreased in TN and Henry County.  We are seeing one inpatient at this time.  Our County current positivity rate is 7.4%, which is up slightly from 6.7% last month.  HCMC has had a wonderful response to vaccination by providing access to vaccine with community clinics and PODs.  HCMC held its last community clinic on Nov. 19.

“We are so glad we have been able to grant access and provide education to the community,” said Casteel.  “We will continue to provide education for vaccination, not to say that you need to or not need to get a vaccine, but information about the vaccine.  Part of our mission is to educate the community about healthcare.  We are ending our community clinics because we believe there is substantial access with other entities at this time.  Should we need to assist in the future, we stand ready to serve our community.”

Casteel discussed the Surgery Center and continues discussion on repairs with the owners.  “People have asked if we are paying rent during this time, and the answer is no we are not paying rent at this time.”

HCHC recently had a state inspection with a very good report yielding only two deficiencies.  “I am extremely proud of my staff and the hard work that they have done,” said Sandra Ray, HCHC Administrator.

Casteel also discussed the laboratory services inspection by the College of American Pathologist with a few deficiencies to correct, but overall was a good survey.

In her people report, Casteel recognized Stacy White from Imaging Services for completing a Magnetic Resonance Safety Officer exam.  This will allow us to provide scans to most any implants.  HCMC is also looking into cancer patient CT simulations and pulmonology CT screenings.  Casteel also announced the Department Director of the Quarter, Karen Boase, clinic manager for Paris Pediatrics, for her help with rural health clinics, COVID-19 vaccination efforts, and her willingness to assist with any community events.  She also recognized Star Partner of the Month for November, Mary Catherine Faris, who assisted with regeneron infusions to offer 24 hours a day during the recent COVID-19 surge.

In the complaints and grievances report, we had one complaint and one grievance for October.

Brad Bloemer, CFO, provided the financial report for October.  This fiscal year, we are not fairing as well because of the continuing COVID-19 crisis. Tennessee just experienced yet another wave of increased COVID-19 cases causing us to yet again pull surgical services.   We are being asked to do unordinary things to take care of patients including providing more expensive drugs, buying more equipment and PPE, as well as taking care of higher acuity patients requiring us to take surgeries offline.  Currently, year to date we are at a loss of $1.5 million. And yes, with the clinical crisis, we now look to receive more stimulus funding with the American Rescue Plan and the Provider Relief Fund.

In October, we recorded a loss of $486,000.   In October we had a negative cashflow of $1.3 million due to accounts receivable backlog.   Surgeries were 15% below budget as well as a volume of 5% below budget in the ER.  Other services experienced decreases in volumes.  There were some positives in October with receiving state stimulus funding and having positive investments.  Just as October was better than September, we anticipate November to be a better month based on growth in surgeries and patient volumes.

Bad debts for the month were approved for $610,386.83, which is broken down into three categories:  bankruptcy, charity/financial assistance, and collections.  In total we had 608 accounts written off.

“We were deemed a low-income community by the federal government in 2016,” said Casteel.  “Our bad debts are this amount due to many reasons such as the ability to pay co-pays and insurance deductibles, access to care only through the Emergency Room, and not insured at all.”

“So basically, we provided over $7 million in care and services last year to the community,” said Dr. Whitby.  “We are proud of this because it is a part of our mission.  That is why we are here.”

Bloemer presented the capital equipment requests for anesthesia equipment and an air conditioning unit for HCHC, for a total of $39,307.

The board member self-evaluation was discussed.  In unfinished business, leadership evaluations were discussed.  Troy Buttrey has interviewed four companies and working through scope of practices and will bring back to the board in December.

The HCMC Board meeting for December has been moved to Tuesday, December 21.

Rhonda Crossett, Interim CNO and Women’s Center Director, provided the quality report for the board.  HCMC and HCHC are both four stars.  Our hospital-wide all cause readmission rate is at 2% which is much lower than the state’s average.  This information comes from CMS.  Crossett shared that JCAHO gave us reaccreditation for our total joint replacement program.  She discussed other quality programs and improvements we are working on and excelling at as an organization.

“For the last four years we have been very progressive in our quality improvements,” said Casteel.

Rachel Carroll, Director of Human Resources, provided an employee update for October.  At the beginning of October and the end of October, we had 851 employees.  There were 22 new hires and 22 terminations.  The voluntary termination reasons included more money, ability to work from home, the vaccine mandate, and the drive.  Currently we have 57 open positions with 608 applications and 23 of those being nursing applications.

Sabra Fuller was recognized for her six years of service to the Henry County Medical Center Board of Directors as this was her last meeting.

“I would like to thank all the employees at HCMC for all they do,” said Fuller.  “Please hang in there and don’t let people sway you to make bad decisions about this hospital.”

“Sabra is a quiet leader and an outstanding leader, and we are going to miss her,” said Dr. Whitby.

To learn more about the growth at Henry County Medical Center, go to our website at www.hcmc-tn.org and read about all the services we offer to care for our community.

The next Board of Trustees meeting will be Tuesday, December 21 at 5:30 p.m. at the Henry County Medical Center Classrooms 2 & 3.  The December 6 joint meeting between HCMC and the Henry County Commission details are still being planned out and will be released soon.

About Henry County Medical Center

Located in Paris, TN, Henry County Medical Center is a progressive, integrated healthcare organization committed to serving the healthcare needs of Henry County and the adjoining region. Including a 142-bed hospital and 7 other facilities, the medical center provides a variety of outpatient services, as well as inpatient care. Henry County Medical Center is a county-owned and operated nonprofit institution. For more information: www.hcmc-tn.org.