Tuned In

Today I'm going to take time and visit with Michaela Kenitz. She is the CEO of the Boone County Hospital. Michaela, thanks for taking time to visit with us. Give us a little update on what's going on. Thanks for the opportunity to be here, Jim.

Well, we've had, you had a regular board meeting to wrap up March and obviously big thing out of there, a couple of public hearings. One, a budget amendment for the current fiscal year budget.

And then again, the tax asking, what you're going to be looking at in the next fiscal year. Those are regular business things that come up this time of the year. And basically, well, the board, we did have a sizable, well, increase in your expenditures on the budget amendment.

I'm guessing probably not an over, not a real surprise there. No, I think that overage is related to some health insurance expenses for our staff. And so, you know, it's hard sometimes when the insurance year is a different year than our budget year.

And so we've start budgeting right now, but that we don't start a new year until January for insurance. And so it's a little bit difficult to kind of guesstimate what's going to happen for the full 12 months.

And so that's why we ended up amending the budget because it ended up costing quite a bit more than we had anticipated. Yeah, same thing, watching all the other entities that are trying to do their budgets at this time. It's the same thing.

The tax asking, going to keep it unchanged. We know that is going to result in some additional resources because of valuations. And again, board's comfortable in keeping it there. Yeah, I mean, I think we want to try to just kind of keep it where it's at.

You know, we use our tax dollars to offset some of the services that we provide to the community. And you and I have talked many times about ambulance service and some of the other things that we use those dollars for.

And so I think it's important for people to understand how important tax dollars are to a county hospital. And so our board recognizes that it's important to people and it really matters what we're doing with those dollars.

And so we're just trying to keep that as steady as we can. I don't think that we'll, you know, we don't have a plan to like see that increase or anything like that. But like you said, we will get some more based on the valuations.

And, you know, we just try to keep an eye on that. We like to be kind of in the middle of the pack. I think we're kind of wavering a little away from that at this moment. But next year, again, we'll look at it and kind of see where we're falling and then see what we can do.

It's always that we kind of compare to other critical access hospitals, other county facilities. And again, depends where you're at and what's happening and what kinds of services you're doing too. That's always such a big thing. It really does.

And then, you know, we have to also look at our population. And of course, we're in one of the bigger population areas of critical access hospitals.

And so that does kind of change where you fall and sort of the rankings of how much we get compared to other critical access hospitals. But again, like you said, they don't all offer the same services that we offer. We have a pretty big community.

And, you know, for instance, ambulance calls, we're gonna see around 3,000 calls or a little bit more this year. And in some other communities, in a very similar size to us, we're seeing 1,500 to 2,000 calls.

So there's a lot of things that go into what we think about when we think about our needs for those kind of services that are, you know, just result in public service.

And we need to remember too, again, people, if they forget, remember, we have added, you actually added a portion on there specifically for ambulance for the fleet, maintaining everything else. And again, ambulances are not inexpensive. Yeah, that's true.

About 500,000 around there or so is designated for ambulance specifically. And so we just replaced an ambulance this year. And the foundation helped us with that. But, you know, that ambulance cost around 290,000. And so, and they turn over quickly.

A lot of miles get put on them pretty quickly. And so it's expensive to have an ambulance service. And, you know, the staff are hard to find and there's, you know, competition out there to retain those folks. And so we really do utilize that ambulance levy for that purpose.

Did, I was good at it because I haven't really asked you this question before, but again, being the county hospital, again, Boone County, services are offered and you provide services. I mean, folks, anybody can walk in. And if you need services, you're gonna get some service.

That's what county hospitals do. And I've been kind of watching over the last couple of months again on the, like on the bad debt, the charity care. Those are things people don't really get to see or hear much about. Charity care in particular, again, that's one that happens.

But I haven't noticed like any big increases or anything like that. It looks like most everything is staying pretty solid. It does stay pretty solid. And our staff are aware of our financial assistance program. And so that's where the charity care comes into play.

And, you know, we do help patients and we recognize when patients say, hey, I'm not able to take care of this or is there any assistance available?

Then we sit down with them and try to find out, hey, can we help you get qualified for, you know, some type of insurance programming that maybe you don't have right now or what's available for you?

And if not, then our charity care or our financial assistance program comes into play. And I think as a critical access hospital and as a county hospital, you know, it's our duty to make sure that we are here to provide that care to folks.

It's just, it's part of our mission and part of what we do. I know in one thing, and I'm pretty sure a lot of people wouldn't realize that they think of the hospital, but like when you did the budget amendment and that brought up what total expenditure, it's like 68 million?

Yeah, 71 million anticipated for the next fiscal year. That's spending a lot of money. Yeah, I mean, you know, when you think about our staff and whatnot, a big portion of what we spend on is staff.

And we talk about wages and benefits and all the things that it takes to run an organization, you know. I think last time the auditor was here, well, a couple years ago when he was here, I think it was around 140-ish thousand a day to run the organization.

And now it's probably up between 160 and 170. Inflation's not helping, you know, all the things that we also spend money on related to technology.

And we're talking about different systems, things like AI, things that can help us with stats and all those different kinds of tools that are available to us. And then, you know, again, we have the issue of staffing at times that we're using traveling agency staff.

And that, of course, is more expensive than if we had our own staff in all of our positions filled. And so it's just, it's one of those things, it's kind of a balancing act to make sure that, you know, we have the coverage that we need, but also trying to stay within budget.

Just when people think they might have budgets on different things figured out, then all of a sudden, we've got this to go work on too. Well, one thing you did get your presentation on that has been a growing service, and that is Senior Life Solutions.

It was, Brittany Gus gave that presentation. She had a lot of documentation there for that too, but it is and continues to slowly expand. Probably, I don't know if it's as quick as some would like, but it seems like it's growing fairly well.

Yeah, we opened our second track, and currently that track has, I think, four patients in it, maybe five, but I'm pretty sure, right around that four to five number, and all of those patients that are in that service right now in the second track are from Story County.

And so it's really interesting to watch that service expand and grow and see the needs of people get met. And this service is not available in Story County, so it's really nice.

Brittany does a great job getting out to the community and letting people know that the service is here. And some of those patients have come here for quite a while, and then they graduate.

And then, I think that recently they had an activity where some of the folks that had graduated came back and got to spend a couple hours seeing the new space and all those things.

So it's been a really nice addition to have the second track, and I think that it will fill up sooner than we think. So did they keep busy at it?

And again, is a lot of it, I know she goes out and presents information, but does some of it come from people telling it, I had a very good experience going through this program at BCH? Yeah, I think a lot of it comes from that.

And then the other thing that really helps is referrals from our family providers that know of the service, and they recognize that someone might benefit from it and really get those referrals made over.

You don't have to get a referral for it, but it's just all the different ways that people can hear about the service are valuable. Well, we keep moving forward with that. What are some of the other things that have gone very well? I think surgeries, they have, that's been busy.

If you had a third operating room, I think it would be even busier. Yeah, it's been really busy. I think this last month we saw quite a bit of outpatient busyness, including the OR, like you mentioned.

But in addition, I think imaging has been busy with CAT scans and wound care has been really busy. There's just been a lot of things that have been going on.

And like you mentioned, the OR, it's something that I think we constantly look at as a service that we wanna provide to our community, but it's also a good revenue producer for us. And so we constantly are watching the numbers in there.

And I think that there is a potential that that area could grow more than it is today. And that's stuff that we talk about in the facility master plan, what does the future look like for the organization and how can we serve more people?

I was gonna say that between all the different procedures that can be done there and how many are being done, your staff has quite the balancing act because you have different people coming in, like for cataracts, I mean, they'll come in, you got two different physicians doing cataracts, I think.

Yeah, we do. So it gets really busy in there. It does, and we have two ORs, and one of them is sometimes taken up for C-sections. And so there's quite a little balancing act that happens to try to figure out what can go in what rooms at what time, on what days.

And the schedule is something that we pay close attention to to make sure that we have the space for what we need. And like I said, it would be nice to see that area grow more. Well, we do know that one thing that you guys do every meeting is review your organizational goals.

And in fact, right now you're in the process of starting to take a look at 427, fiscal year 27, that'll be coming up next. And again, you got a lot of things to do there. First of all, this year, we're moving along pretty well in a number of areas, we're pretty solid.

Yeah, I think we kind of do a red, yellow, green look on our scorecard and there's a lot of green on there. And so that makes us pretty happy.

Our service goal, the likelihood to recommend the organization is what we look at to see, would someone tell their friend to come to BCH or their family member? And that's a nationally benchmark score.

And so we really like to see that 89% greater than 89% and we're currently at 92%. And so that needle's kind of hard to move.

And so we're really proud of our staff and their efforts to keep moving that needle and be a place that people would tell their friends, hey, yeah, you should go check out Boone County Hospital and their clinics and get your care there.

I think that says a lot about the organization as a whole. And I always look at the scorecard sort of like the vital signs of our organization and kind of keeping a pulse on how we're doing. And so I'm really, really proud of that likelihood to recommend score.

And along this whole scorecard, like I said, there's so much green and we're doing really, really well at a lot of things. And so this year we have four different quality and safety goals. And the majority of those are green as well.

I know that one of them is based on the Culture of Safety Survey that we did a couple of years ago.

And so we've been working on handoff communication, whether it's I'm taking care of a patient and I'm handing the patient off to you, or excuse me, a different shift, or what's kind of happening with our handoff communication. And so we did some education on that back in January.

We're currently resurveying our staff on just that section to try to see if we're making improvements in that area. And we just want to really keep our finger on how's that going? Do we feel like we have a really good environment around communication?

And if not, what can we do to continue to work on it and hardware those things? So we constantly look at this and just try to share it with the board. It's a nice snapshot for them to see of kind of, overall we have six pillars and kind of overall where are we at?

I know on that one. It's one of those where most people would say, well that just makes sense to be able to do that.

But again, with the amount of traffic, people going back and forth and different people coming in, making sure that you're handing off a patient or someone's care and someone that's coming in knows exactly what's happening here.

Right, and that you're handing it off in a way that, number one, you don't forget something, and number two, that the other person understands what you're trying to communicate with them.

And so the opportunity to ask questions and clarification and all those things are really important. And because the smallest thing can make a difference to a patient and safety is our number one priority. So this really lends itself to not only quality, but to patient safety.

Well, we took a little step back on our cash on hand finances. Now, not a problem. I mean, it's a problem. We would like it to be going the other way. But for those that might be thinking, oh no, we're solid. You've had really good performance.

It's just that that portion of that cash on hand is tailed off a little. Yeah, I think we're gonna see that change here in the next couple of months. You're right that it did take a dip this last month.

But, and Chris, I think during the board meeting talked about that last year at this time we had already received three of the four Medicaid directed payments for the year. And this year we haven't received any yet. And we know that we'll be getting one in April.

And so, and then again in May, and we know what those two are. And, excuse me, we know that they're both, they both exceed what we budgeted them to be. And so that's really good news.

And so I do anticipate seeing that days cash on hand bounce back up, still really optimistic that we'll hit our goal of 180 days cash on hand. But if we don't, I think we'll get really close to that. Not only given the Medicaid directed payments, but also continuing operations.

I think Chris has mentioned that the second half of the year last year was really strong for us. And if that trend continues, the second half of this year should be really strong as well. So do you have to watch both at the state level and the federal level with what's going on?

Absolutely. Because they're both having an impact on what's taking place here. Yeah, I think it's really interesting. There is a lot of different things happening. So we talk about the rural healthcare transformation program.

Those dollars are coming from the federal government and states had to apply for those. And then the entities like us actually have to apply to the state for those dollars. So there's a lot of different types of programs.

And I think each state may be handling their our HTP programs a little bit differently. And so we're looking at that. And then Medicaid directed payment program, of course, it's a federally driven program, but the state helps to make it work out.

And so, you know, we have to kind of work with all of the entities that are involved. And there is a lot going on at the state of Iowa right now when we talk about legislature and different things that are happening.

As you know, they're looking at some different forms of regionalization. I know there was just some legislative changes around regionalization of public health and you know, there's just constant changes.

And I think it's probably one of the fastest moving times that healthcare scene for a long time. And you have to really keep up constantly with what's going on. Just hang in there. Right, hang on. We'll just hang on and then we'll make it through this.

And at the same time, continue to provide service because you still have volume. I mean, the traffic volume I look at on your numbers from all the clinics and everything else. I mean, the volume, the people are coming. Yeah, yeah, we're busy and we're busy across the board.

And like we talked about a little bit earlier, we're especially busy in the outpatient and our outpatient services in the hospital aren't as busy if we don't get those referrals from the clinic.

So it tells you when we're seeing those high numbers on the outpatient services at the clinics have been extremely busy also.

And so yeah, you know, we have somewhat what you might call competing priorities where we have to make sure that we're doing our daily operations and keeping things going so that we can serve people, but then also trying to keep up with all the things that are changing out in healthcare landscape and balance all of that stuff so that we're here long-term and we're able to support folks and to meet our mission.

That's our main goal is to meet our mission. So as Lisa and the others have, they started talking about doing their food program this summer. I figure it's not too far away. I know it's not.

I mean, it's kind of amazing to think about the fact that it's going to be April tomorrow. It's just hard to believe how quickly this year is really flying by. But yes, they have started working on the food for kids and started thinking about that in addition to that.

So that's part of our community pillar. Lydia from Public Health is starting to partner on that community pillar to bring some more healthcare type services into it. So her and Lisa will jointly lead that. And I think you'll see a lot more stuff happening out in the community.

I'll have to get Lydia to come and talk about some of those things she'll be doing. So, and again, that's going to be kind of revamping and rejuvenating public health for Boone County. Yeah, and there's a lot going on right now with cancer.

And you've probably seen a lot about that. There's 99 County report and Lydia is starting to get some information shared out to the public. And what are we going to do about that? And what entities can we work with? Again, it's interrelated to some of the grant dollars.

What entities can we work with to bring some of that info and some of the testing kits and those kinds of things to our county to work with our public folks? And it's all a final goal is let's stay well. Right, exactly. Let's stay well, let's not spread. Yeah.

And again, those issues that, you know, yeah. I think people get a little shocked when they see all the studies that come out with the rankings on cancer and the different kinds of cancer that are affecting people and stuff.

That's, yeah, we would like it not to be where we're at and get it going the other direction. Yeah, I think Laura said we're 30th on the 99 County list, Boone County's 30th. So that'll be interesting to see some of the future plans for dealing with that.

I know last time we did our China cancer care, local cancer care rose to second on our list. And, you know, the prior time we did it, it wasn't on the top 10 at all.

So I think people are starting to pay attention to what's going on around them and starting to really focus in on what's happening and what can we do about it as, you know, a whole and try to preventatively fix whatever we can. Got a lot of things happening. So busy time.

And again, only a few more months to go yet in this fiscal year, but your position right now feel very good. Traffic, everything, the volume of people coming in for procedures and or unfortunately, I'm hoping that our flu and everything else is kind of subsiding a little bit.

Yeah, I think we're starting to see that kind of be We'll go with that. something of the past. Yeah. We'll go with that. Yeah, it's a seasonal transition thing here too. I do appreciate you taking time visiting with us and getting us up to date on what's been happening.

Still have, like I said, what about a third of the year you left to go. So still a lot of different things can take place. Appreciate you taking time visiting with us and look forward to visiting with again next time. Thanks, Jim.