Mikaela Kienitz, CEO, Boone County Hospital, Health Talk, March 5, 2026

Today I'm visiting with Michaela Keenan, CEO of the Boone County Hospital. Michaela, thanks for taking time to join us. Thanks for having me, Jim. Well, we've wrapped up another month. You had the board, they had their regular monthly meeting.

Probably not as long as some of the others they've had, but pretty important, you had a really good presentation from Dina Sitzma. Yeah, Dina came and presented about the Family Birth Center and she does such an amazing job.

She really talked a lot about the growth that we've been seeing in our Family Birth Center over the last few years and some of the things that have contributed to that, like our partnership with the home birth community and working on some of the quality collaboratives throughout the state.

And so it was a really good visit. She's a great director. I know that, and, you know, it was two years, is it two years now that you came? Oh, this is, I'm just starting my fourth year. Fourth year, see, I'm losing track already here.

But I was going to, one of the first things you said, this is an area where we want to really focus and keep, you know, offering these services again because it's important. And then you ended up surrounding yourself.

You got a whole bunch of really good physicians that are really interested in this and you're attracting a lot of attention.

We are, you know, I think a lot of the success that we've seen is attributed to our providers and they have done such an amazing job and they just have a little different practice style. And so I think patients really appreciate that.

We talked yesterday about the fact that they do a really good job of talking to patients about the plan that they want for their birth and really trying to respect that plan and work through that plan as much as they possibly can.

And then having those conversations that things don't go exactly according to that plan. And so I think that's really important in growing the service. And then, you know, we continue to work on our outreach with other entities too.

So we still have a partnership with BND and then we have been working on growing a partnership with Dallas County and we have our first shared patient with them. So we're really excited to see that sort of the model kind of change and grow.

And I think you make a good point, you know, there at least in the last couple of years have been two other hospitals that have closed their OB services. And so that makes a total of about 41 throughout the state since 2000.

And so I think that's important that, you know, we're really keeping growing and keeping focusing on those efforts so that the OB deserts really start to go away in the state instead of continuing to be something that we have to deal with.

I know one of the things, and you guys, we've touched on this briefly before, but having the midwives or at least making them aware that, you know, you're willing to work with them. And they talk amongst themselves.

They do talk amongst themselves and there's a lot of social media chatter within that group of folks related to, you know, where to go, who's accepting of the home birth community.

And so we have found that that's probably where we've grown the most in that community is through that kind of word of mouth and chatter that we're seeing out there. But in the last two years, we've worked hard to partner with them.

We've invited that group of providers to come on site here, talked about like what things are we capable of doing, what things should go somewhere else if they feel home birth at home.

And just talking about, you know, what kind of things we need from the patient ahead of time just in case if they end up needing to come to the hospital.

And so that's been a really nice partnership and it gives those midwives, you know, an opportunity to ask questions and really understand what would happen if the patient came here. I know.

And on the patient side of things, because I don't know if it was Dina that said it or maybe you said it, but or maybe, you know, somebody said it about the fear of the medical community.

And especially for people that are having having births and want to do it maybe at home or, you know, I don't necessarily want to go there because they automatically do C-sections or things like that.

And that's something that they they've learned by participating or finding out about this that that's not a high priority in Boone. Right.

Dina is the one that mentioned that and, you know, she was talking about the fact that, you know, why is the home birth options seem to be growing so much right now was the question that she was asked.

And I think the fear of the medical community is definitely one of the things that has led to that. But yeah, you're right. You know, we want, like I said, we want to follow that patient's plan as much as we can.

We don't just want to jump to C-sections or or, you know, other options. We want to try to work through that patient and letting their plan occur as much as it possibly can. So I think that that's been really, really good for that community.

And it's been I think it's gotten the word out about us that, you know, this is a safe place to go. They will try to respect your plan. They will work with you to have your birth go as close to what you want it to be as possible.

So I think that's been a really good thing for our growth. One of the things she had mentioned too is that unlike larger hospitals, all our people have to know how to do everything pretty much. And that's a big thing too, having the staff that that can do that.

Yeah, you know, we have a really, really talented group of folks that work in that department. I think she mentioned that we're training a new nurse and you know, it does take a while. And so it's been nice with training her that we have more volume than we had a few years back.

So I think last year we delivered around 151 babies. In the first year I was here, we delivered around 84, 86 ish somewhere in there. So we've grown a lot in that, excuse me, in that three years.

And so, you know, I think that it's important that we're able to have that volume so those staff can stay competent in all that they do. And she's right. Our nurses do a labor and delivery postpartum. They do newborn baby.

And I think in a bigger facility, those would be three separate specialties and our staff do all of it. So it's really important to have that volume to keep them competent in all of those things. At that end, you have a good working team of physicians. Oh, absolutely.

They're the best. They just and they talk. They know what who's doing what and again, I get, you know, just already having to bring the get more patients in and stuff. They they'd like this stuff. Yeah, they're doing well. Passionate about it. Yes, they are.

I didn't want to ask it too because I know that you did talk a little bit about community social worker that you've got but rather recently started and seems to be awfully busy. Yeah, her name's McKenna and she started at the beginning of the fiscal year.

So I think last summer we hired her and sort of kicked off that. Sort of a facet of social work that we hadn't been doing previously. So last year our providers brought forth a need.

They you know, they really felt like we need someone to help align some of these outpatient services for folks. We have patients that come in.

They have needs and then there's just so many so many of them and so much volume of that that work that we weren't keeping up with it and our inpatient social worker. Addie wasn't able to keep up with all of that either. And so it has been amazing having McKenna here.

She's already since being on her own in about October. She's already gotten 250 referrals. Some of that's like nursing home placement helping people get lined up with different resources out in our community.

So it's just been really really good and I'm really excited to see it grow and see what happens. You know what her volume looks like at the end of a year and it's just one of those things where we need to reimagine how we can serve people better.

Throughout the community and and that's you know, she said she actually told us she said there's a lot of people that I talked to when I'm doing like the nursing home placement and different things.

They're like we've never heard of a community social worker and it just has been it just has been really great for our patients.

It's one of those where yeah a lot of people don't think about it but for a lot of people well unless they have absolute close family members here if they're moving from one care into another something like that. They just started looking for somebody to help the law.

Yeah and a lot of people don't know really how to navigate the health system. So you know I now my loved one now needs to go to a nursing home. What are the steps for that? How do I do that? Who do I call?

All of those things and so they end up frequently asking their primary care providers about it and then primary care providers are able to have McKenna help and that's that I think is the very beneficial part for people is just they don't know what to do and we're there to help them.

Well we she sounds like she's keeping awfully busy which is which is that's good.

That's what we like is and it does cover some of those things too that when we go back to our community health needs assessment that loneliness and that part of it you know because people aren't really well who do I go to who do I see and again that cut that give somebody that can steer them in that right direction.

So yes exactly. We're looking for. Let's talk a little bit about I know finances everybody always goes out. How does that go. Days cash on hand probably not where you would like it but actually total operations in the net net income looking pretty good here through seven months.

Yeah you know I was really happy with the way it ended up looking January turned out to be a really really good month for us and you know the inpatient units been quite busy but it's not all seasonal stuff.

Like we would expect there's just been a lot of sick folks and so you know that has contributed to some of this positive financial changes for us but that day's cash on hand said that around one twenty four right now I think last month it was one twenty three.

We will see that change here in the next few weeks. I think as we start receiving the Medicaid directed payments that we've been anticipating all year.

Usually we get those quarterly but we haven't gotten any yet the fiscal year and so we'll end up getting four payments and within the last five months of the fiscal year so that will change our day's cash on hand quite a bit and then tax dollars will come in and sell.

You know along with operational growth and ongoing operations that have been quite strong and so I think Chris mentioned yesterday that historically he he looked back and has seen that the second half of the fiscal year has been positive for us.

Historically and so I think that we're both feeling really positive about where we're at financially and and I'm hoping that we meet that one hundred eighty two days cash on hand which is our organizational goal for finance this year so I'm staying really optimistic about it.

Well would you when you guys said one hundred eighty two days and I'm going wow that's that's a good goal.

It's a big goal you're right that's the stretch goal but you know if you don't aim for the stars you're not going to get there so we're working hard to get there and I think that I do think it's possible so that's exciting.

Well one of the other things I know at the same time while all that's going on and I know we depend on people unfortunately not feeling well when they go to the hospital so that's the downside of it.

It is the downside you know we also do a lot of preventative stuff here to keep people well so it's a little bit of a little bit of both.

The one of the other things I wanted to say is I know on the business side of it you do have people constantly looking for ways to save yourself some money and you've had a pretty good I mean you're seeing some pretty good results here obviously would always like to see see more.

But I know when I look at it in what you're doing I call this kind of a cost avoidance because you're doing something that is going to actually avoid additional expenditures in months to come.

Yeah I think that one of our goals this year has been related to elimination of waste and that could be financial waste of course which is easier to measure than some of the other you know waste which would be like processes that have been done for a long time and we have extra steps or printing things we don't need to print that kind of a thing.

So we've been looking at all types of efficiency and ways to improve our processes but I think what you're particularly talking about is we've spent a lot of time in this last year really looking at a lot of our contracts we have contracts for everything which I think many people don't probably recognize like we have contracts for you know equipment and different things that we need to provide clinical care but then we also have contracts for like coffee and coffee creamer and different things that we need to do.

Different things that you know the hospital just uses and so we've been looking at all of those contracts and working with vendors because each year they suggest an increased rate and we've been looking at you know making sure that that is in line with all the other increases we've seen some that are really really outrageous and so working with the vendors to say you know no we're not going to be able to commit to that for the next five years we need you to bring that down and many of them do many of them do bring those down and so that's going to save money ongoing.

Yeah I was gonna say to one of the perfect example that everybody sees schools city the whole work trying to ensure your buildings and stuff like that.

Oh yes absolutely I mean insurance is one of those things that we see change every single year just like we all do at home right and so trying to trying to keep a pulse on all the many things that we do here in the organization and find ways to save it has been really important to us.

Well I know that we also I did want to ask how other aspects were going again surgery we didn't didn't have too much of a report on that this time during this part of the meeting or your this most recent meeting but I know orthopedics they've been going pretty strong since we got the second operating room open last November I think things have been pretty busy down there.

Yeah it's been pretty busy December with our busiest month ever in the operating room and in January just followed right along with that I think Dr.

Zayed had a day of surgery that he wasn't able to be here for so that I think that transition and moved to the very beginning of February that affected our January numbers a little bit but.

it's been really really good and I think they're very happy to have their rooms back open again. And Dr. Zayed since you mentioned him of course he's relatively new from capital but people seem to like him he's doing a pretty good I think they like like his service.

Yeah I think things are going really well with him.

We did want to ask because I know Chris brought it up you had to because it's that time of the year your tax asking and did a lot of discussion on it last year really talked a lot about it and actually became one of the hospitals that joined that list of being able to.

Dedicate funds towards ambulances again you have a line item for that now but the rate right now you're not looking at much for any changes coming up here in the next next fiscal year.

No I don't anticipate a change to our levy rate at all you know the discussion yesterday was pretty minimal compared to last year like you said last year we worked.

To increase our levy rate to offset some of our loss that we incur on for operating the ambulance service and I think we were one of two hospitals that.

Own an ambulance service that were not tax loving for that specifically so that was the big change last year we didn't change anything related to like the hospitals rate but.

So this year it will just stay I anticipate it just staying exactly where it's at right now so the levy rate won't change at all and you know in the coming years I think the board is.

Is really cognizant of you know taxes and and looking at what that means to the people that we serve and so you know I think each year we do talk about it and we want to make sure that we're doing a good job of.

Of being careful with those dollars I know the end he had a lot of the numbers to present to him but they like to kind of like be at least in the middle of the package don't really want to lead it if they don't have to but.

And again, but being kind of in the middle of the pack is. Pretty solid place to be so again we're offering a lot of services and again it is a county hospital so you do have other responsibilities. And that's why you get that loving.

Yeah I mean that levy helps us offset a lot of our services that we provide such as ambulance that we've been talking about quite a bit and clinics and some of the other services that are not critical access hospital services but services that we need here in our community.

All right, a couple other things I wanted to ask about I do know that. Community events that's one of the things you you have encouraged to really have again that's part of your organizational goals. Keeping pretty much right on pace and don't even have to get the rag by yet so.

Right we are we are trying to be engaged in our community as much as possible in this last month you know I I went to. One of the days that the school did at the Boone high school and they had our ambulance staff was there and our therapy staff was there and so.

It's just really important to be out there whenever we can and and getting our name out there and in helping and being a partner and in those types of events is really important and right now like we're running a food drive so that we can.

You know help folks in our community that are struggling with that, and so I think that there's always something going on here where we're trying to support our community.

Well, we got a lot of those things that are happening and again keeping very busy there so I gotta ask traffic right now this time of the year we've seen a lot of flu lot of a lot of respiratory issues going on for people some covid in there as well still have all of those things.

Again walk in clinic seems to be keeping awfully busy, but all our other clinics seem to have pretty good pretty good volumes.

Yeah, I think there's a lot going on with winter sickness like you said there's some respiratory stuff there actually been quite a bit of respiratory stuff quite a bit of influenza we've seen a peak in that.

And then also like you said some COVID has been happening, and so I think that stuff has been keeping us pretty busy.

It's typically a busier time of year for us right now sometimes you know you'll have that busy time in August before school gets started and everybody's kind of starting to.

Think about fall, then you have a little bit of a lull and then you'll have another uptick in the winter here and we're really seeing that respiratory illness uptick right now and.

And folks are you know using our walk in and getting into their provider and so on, which is what we would like them to do if they're not feeling well, you know so it's been been a busy time.

I did want to say again, one of the other things obviously last time we talked we talked about the decision by the board to do away with home health and also to do away with.

The adult day transitioning out of that it's been moving forward again doesn't happen overnight, but we are seeing a transition.

Yeah, it's the transition away from those two services has has begun I think there's a number of patients that have already transitioned out of home health.

Which some of that happens naturally as patients discharge from home health services and then some of that their case workers at their insurance have helped to get them switched over to a.

A different home health care agency and then some of our staff are also transitioning a couple have decided to take a position elsewhere and then some have been applying here and for open positions within the hospital so we're working through all of those different things that.

You know, need to take place for that to occur and then I think the last step is that Lydia has contacted all of the different payers and the certifying bodies and letting them know hey we're not going to have this service anymore.

And I know the the other part is your goal is to reinforce public health and their presence in the in the county and the services that they make available so kind of kind of transitioning over to that as well.

Yeah, we're going to work really hard on growing our public health services and we're adding a couple positions to that department right now and so.

I think that'll be exciting and and we earlier you know we talked about the China and we talked about our community social worker and and all of those things and when we talk about the community social worker that really demonstrates the needs that are out there from a public health perspective and so.

I think that lydia is really excited to work on some of that public education and and addressing those things that the China show like cancer care and diabetes and.

And just some of the different mental health some of the different things that came up on that that we could do a lot more with and so that's where we're excited that you know push our efforts that direction.

All right busy time a lot of things happening at the Boone county hospital and once again people if you're feeling sick don't go stay stay home cover your cough wash your hands yeah I got all the regulars in there Michaela thanks so much for visiting with us this month we'll look forward to talk to you again next time.

Thank you, Jim.