Mikaela Kienitz, Chief Executive Officer, Boone County Hospital, Health Talk, May 01, 2026

On our program today we're visiting with Makayla Kenitz, CEO of the Boone County Hospital, Makayla. Thanks for taking time to visit with us. Thanks for inviting me, Jim. Well, we've gotten the last meeting in April taken care of for the board. They got that part done. Actually, it went fairly quickly for you, but I'm going to go, let's start with the finance part. Through the end of March you had that. I know that Chris has said, you know, we only really have a couple of months to go May and June before we hit the end of the fiscal year. They had a little bit of a recovery, got some of the Medicaid payments in and stuff like that, but still pretty positive where you're at right now as far as even being at your budgeted numbers. Yeah, I think March was a really, really positive month for the hospital. I know that lab in particular had their largest revenue month ever in the history of the hospital. So that's good. And when you're seeing things like that throughout the organization, it just leads to a really strong positive position for that month. But, you know, year to date, the hospital is doing really well. And like you said, we've got a couple of months left here in the fiscal year and really, really hoping to see that continued recovery from sort of a slow start earlier in the year. And so, you know, I think we're expecting still three more DPP payments. I know he's mentioned that we did receive one in April. So that would be the second one. So we've got one in March, one in April. We'll have two more coming yet in the fiscal year. Additionally, we received some tax dollars in April. So while at the meeting we were talking about March financials, I think we know what's happened in April. And so it's looking really strong. And I think we're going to see that really good rebound for the fiscal year. And I do think that we'll end up meeting or exceeding our budget. No, we did get the update. The departmental report was from the lab. And again, that was one of the things you mentioned about increased traffic there. We're seeing increased traffic. And one thing they've been doing and really working on is even though the volume's gone up, they have really kept their expenses down at the same time, adding new opportunities. Again, as far as tests are done, wellness tests. Yeah, she's adding in some new wellness tests. And then, you know, patients will suggest or have recommendations. And we know we work with our provider group and then we add those other additional tests to wellness tests. They've also spent a lot of time probably over the last maybe six to 12 months adding some tests for occupational health. So I know that Daisy in particular had a couple of tests that they wanted us to add for their employees. And so we've been working on doing that. And so we have seen that increased traffic. In addition, we've seen a lot of increase to our inpatient numbers. And so that also affects lab. And so they're seeing a lot of volume from the inpatient unit. So again, they're a pretty positive department and moving along pretty well. So again, one of the things that I know we talked about you mentioned, the increased volume. How much more can it increase? So I mean, because if you add new things, obviously gives you a new opportunity to do more, more testing and more lab work. But is it just volume wise, traffic wise people coming in that sort of thing? Yeah, I mean, I think that, you know, a lot of our outpatient services are driven through the clinics, of course, that's where those orders are coming from. And a lot of it is from our facility, but we also do take orders from outside facilities for some of those services that we provide. And so really, I do think that we're kind of seeing this increased trajectory of volume. And we've been seeing that for the last year or two. And I mean, I really think we're kind of at the tip of the iceberg. I think there's quite a bit more volume that we could see come to Boone County Hospital that we haven't really captured yet. And so I think that's, you know, we keep trying to get out there, share what our services are, make sure that we're doing good job marketing. And so I really do think that over the next several years, we will continue to see the volume increase. Well, we do have a lot of other things that are going on. I know that one area that you had talked about where you needed to make some adjustments, that was home health, where again, all the patients now have been transferred out, at least out of home health, home care. Yeah. And we still have a couple out at adult day. Yeah, we still have a couple people that we're serving at adult day, and we'll continue serving them through the majority of the month of June. I think it's a little bit easier to transition our home health and homemaker patients to other services in the area where there's not another adult day center in Boone County. And so that makes that a little bit more challenging for those folks. So we're continuing to work through that with them and figure out what their plans will be after our service closes. But it is, you know, a good feeling that we were able to get everybody transitioned to another service and all of the patients in home care and homemaker are being cared for. Well, we've got that going on at the same time. I know a lot of work being done in preparation for Raghbri too, because that has an impact. And that's going to have an impact on your South Clinton. Yeah, it's going to have a really large impact on our organization. You know, a lot of activities are going to be happening right around the South Clinic. And so getting to the clinic is going to be really challenging. So we're talking about what that means for the organization. I think with Story Street being the main kind of thorough way for bikes, the North Clinic will also somewhat be affected with how most folks get to the clinic. So we're going to be working on that as well. And then, you know, what does it mean for our emergency department? But I think that, I think Laura reported yesterday that, you know, between working with the Raghbri folks, the Raghbri officials, and then working with the Raghbri committee here in Boone, and then the group in Ogden. You know, we've been working on First Aid, what does EMS look like? What does it mean for our Ogden clinic? I think that they're going to be setting up some Raghbri, sort of, they have like a bike shop that's available. And so that'll be directly in front of our clinic. And so what does that mean for our clinics? And how do we make sure that we're able to support, you know, the Raghbri riders and help them get where they need to go and get the services that they need? So there's a lot of coordination that has to happen for an event this big. And so our teams have been working pretty hard on that. I was going to say, over the years, I've watched different things. And Raghbri, it's not the same kind of Raghbri that folks would remember 15 years ago when they overnighted here. This is, it's aged a little bit. And they've learned some new things. They have actually have a pretty good number of physicians. And I go back to thinking of Dr. Vermillion, I'm sorry. But they've got a number of physicians and nurses that are participants and also provide a lot of medical backup for Yeah, I think that they have some of their own teams. And those teams all consist of physician and some nurses. And they do a lot of the fluids, IV fluids and some of that care that really does help alleviate some of what the emergency room will see and need to take care of. And so I think that's really nice because, you know, they go through a lot of small communities. And it's very overwhelming for organizations like our hospital or our EMS service to have that volume of people that need care. And so it's really nice that they've sort of stepped up what they send along with the ride to help off, you know, take care of some of that. Sure. I was one of the things that I noticed, especially when you guys were reviewing your dashboard, which are basically the goals and things like that. We are seeing some pretty good volumes. Yeah, we're seeing a lot of really good volumes. You know, our OB volumes are up and continuing to rise kind of like we have seen in years past. I think Dina said that we're expecting to deliver about 154 babies by the end of this fiscal year. So the next few months should be, you know, pretty busy. But as we look at other things like our outpatient test and visits, which includes like lab and therapy and things that, you know, we talked about earlier, we're really starting to see some of that stuff pick up. And that's, you know, growth above and beyond what we saw last year. And so we're pretty excited about the volumes that we're seeing here. And then the other thing that I mentioned earlier was the inpatient being busier. And it's really interesting how in the organization sets a goal and our team is aware of it, you know, they just sort of spring into action. And I know that Addie, our social worker, and Lisa Page, the director of our med surge page unit, they've worked really hard to get some more admissions in our inpatient unit, you know, working with referrals from the other facilities around us and that kind of a thing. And so you're really seeing that reflected in these numbers. It's exciting. And again, that's been one of the challenges. You recently did go to Washington, part of the American Hospital Association, I think, part of that. What happened when you were there? What were you talking to everybody about? So I was there with a group of other CEOs and leaders from the Iowa Hospital Association. And so we went and met with our legislators. And we were really talking about the impact that the direct payment program has had on Iowa hospitals. And, you know, we know that the one big beautiful bill sort of outlines a bit of a winding down somewhat of those programs. And, you know, we just really wanted to make sure that they understand what it's meant to us to have that funding and then what it will mean if those actually do end up winding down. And so it was really nice to kind of tell them some of the stories that we're seeing, like for us in particular, you know, it's really offset a loss in our OB services and helps make those services, you know, really viable. And so it's really, you know, it was kind of a good experience to get to go out and see the other hospital CEOs and myself, you know, just get to watch that experience and see the legislators really understand what it means to be, you know, leading a hospital in Iowa on the front lines and having them understand what their decisions mean to us. So it was fun to kind of go advocate. And then, you know, there was a lot of talk about the future of healthcare and AI and just some of those different things that are kind of upon us and what is going to happen in the future and what it looked like. Healthcare is so complex and changing constantly. So it was a really good experience to go advocate. I think it's one of those, because so often they talk about rural healthcare, rural healthcare, this and that. And even here at the state level, the rural healthcare part, I think Iowa was one of the first to pursue some of those dollars for rural healthcare. Yeah, the rural healthcare transformation program, we spoke about that a little bit with them as well. And we were the first state to pursue those and to be awarded them. And it's been really good. And I think that, you know, they, they did try to make a really big effort to get those dollars out to the rural areas. But, you know, being first sometimes comes with some kinks. And so we, you know, talked to them about our experience with the program that Iowa in particular has in place and in some of the things that we'd like to see potentially be a little bit different in the future with getting those dollars and what we're able to use them for. And so, but it was, you know, it was really good to talk to them about that and to understand kind of their perspective to one on the rural healthcare transformation funds. I was going to say so often, yeah, well, this is what the intent is. And this is what practical application is. It might be different. More often than not, it is different. Yeah. I mean, it's one thing to have, you know, an idea and a theory about how it's going to work and then trying to put that into practice is sometimes a completely different thing. So. Well, we keep, keep forging ahead. That's, I did want to say something cool looking portal for those that haven't done the portal. I like the new update that you look on that. So that's pretty interesting. And I know the board did talk a lot about the portal and some of the, some of the things they thought might be issues, but I know the pre-registration was one of them they talked about. So. Yeah. I mean, I think there's some new things available on the portal besides the fact that it did get an upgrade and has a new appearance. I think that, you know, we've been working pretty hard on getting forms and in pre-reg and different things out on the portal so that folks don't have to fill out all those forms once they get to their appointment. So I think that that is going to be really nice and beneficial, but I think there's also always kinks to work out. And so I think that's kind of what the board was talking about yesterday was, you know, for personal experience, you know, they're saying, I ran into an issue where I had to fill out the same thing a few different times. And you know, that's always good to get that feedback. We're always interested in how we can make it better for patients. So it's nice to have that firsthand experience. Well, we keep going forward and did want to ask about the physicians. I mean, we haven't had much turnover really, again, even with your physician assistants. Yeah, we haven't really had a lot of turnover in physicians. You know, recruiting has been really challenging. So when Dr. Gordon left the South Clinic and moved over to the emergency room, it sort of created a gap. And I think it's just been a little bit challenging to recruit. And so they're doing a lot of work and there's less of them at this point than their husband. You probably remember back a day when there was 11 or 12 physicians with Dr. Teal and Dr. Logan and Dr. Melhaus and, you know, quite a big group of them. And so we're not really in that same exact position today, because I think recruiting family practice has become more and more challenging. And so, you know, they're just looking at different models and ways to do that same work, but that maybe work a little bit better in their lives. And so we're trying to work through that and see what, you know, a different coverage model for the hospital might look like for them, because our providers do everything. You know, they have this full spectrum medicine. They get to be in the hospital. They get to be in the clinic. Some of them do OB. Some of them do colonoscopy. They all kind of have their thing that, you know, is a specialty for them, but they do a lot. And we really respect them and appreciate them and want to try to make that, you know, as easy as we can for them. I was going to say, even patients use the facilities in the physicians differently than they did 10, 12, 15 years ago. Yes, absolutely. I mean, you know, we have a lot of different things too than we did then. As far as we've got telehealth opportunities, we've got all sorts of, we've got more clinics, you know, it's just, it's just things have changed a little bit. And I think that there's some influence out in the community that, you know, can make sometimes practicing medicine different than it was 10 or 15 years ago, like you said, COVID changed a lot of things for us. And so just continuing to make sure that that we're helping be supportive towards them. Well, I do know that since we last had visited, we did have the project, what, project 99, the county nine, the county projects that the 99 county project. I knew there was a 99 in there somewhere, but we did have the boon one. And again, done virtually, way people can follow along with it, participate. But it is an effort to try to increase awareness. And as we saw from our boon county numbers, now we're in the top 30. Yeah. Yeah, I think that, you know, Lydia's doing a really nice job of trying to, like you said, increase awareness, bring that information to folks and continuing to work on that. And when you look at our community health needs assessment from a few years ago or from this year, actually, compared to a few years ago, the cancer being a issue for folks rose to the top 10. And previously it was not on the top 10. And so it's really interesting because I think that people are becoming more and more aware of what's going on. And I think anytime we get a chance to educate folks and talk about what can we do differently, how can we tackle this? There's always a lot of value in that for our folks. And we want to be the leader of that. We want to be their resource and the place that brings that information to the people that we serve. Well, it's again, it's going to be one of those ongoing battles. I know mental health was another one and we're using solutions. Yeah, we've got senior life solutions that's happening here. We've got Bryals Christensen. He's one of our mental health providers. We use something called ITP through the ER, which connects patients that are having a mental health crisis to professionals in that arena. And so there's a lot of different ways to kind of tackle that, but it feels like the crisis for mental health just continues to grow. And it's very challenging. And I don't see that need really going away or lessening in the future. Just within the last couple of weeks had ITP Doug Wilson on that with Sheriff Godzicki and Abby Swank from the jail administrator about the services they are providing at jails. And he did say at the time, he said, yes, we also work with the ER at the Boone County Hospital. So yeah, yeah, we find them to be a really valuable resource for us. And it's mental health awareness month this month. So we're doing a lot of activities here for our staff and patients alike for this month of May. So, you know, I think it's something we all need to be paying attention to. Well, we do have a couple of things coming up. We got some recognitions. I know that are going to be out there over the next couple of, well, next week or so, I'm guessing, recognitions for what the DAISY Award, among others. And I heard there was a lot of nominations. We had a lot of nominations. We do our DAISY Award for our nurses. And then we have a last year, we started a Rosa Award for all of our other staff. And there was a lot of nominations for both of those. And so on May 8, I believe we'll be giving out the DAISY Awards. And then during the next week, which is Hospital Week, we'll be giving out our Rosa Awards. And so we're really excited about that. It's always, always great when we get to recognize our staff for their amazing contributions. And when you get a chance to read or hear those nominations, it is so fulfilling to see the difference that our staff are making in the lives of the people that we serve. It is amazing. And a lot of those people are the ones that fill out the nominations. A lot of them are coming from actual patients. And it is, it's very heartwarming to see. And we did see some of the improvements, some of the data that came out in the, in the dashboard. I know, like in the ER, making some changes on how they're providing their services there. Again, a lot more communication. How's that? I'm going to say more communication. Yeah, you know, the ER is making a big effort to increase that would recommend score. And it jumped like 30% since December. So in about six months, they've made some pretty drastic improvements on that score. And, and that's really good. They've been working on something called commit to sit. And that's where our staff commit to going in and sitting down and engaging with the patient, rather than standing in the patient, maybe feeling like you're not quite as engaged in your, you know, maybe more ready to leave versus sitting and really feeling like you're taking the time. And so we have that. And then there's also something that's called the big close, where the nurse and the physician go in and they make sure to go over the discharge instructions. And when they're doing that, they say, you know, here's what you came in with. And here's all the things that we did for during your visit today that we did to address your issue that you came in with. And, and I think some of the, the reasons that we've sort of tried those two tactics to start with is we were whenever there was any type of concern or someone that, you know, wasn't giving us the highest scores that they could, we sort of saw a trend of like, I didn't feel heard. And so we want to make sure that people know we're, we hear you. Here's all the things that we did. If there's something else that we can do, giving them that opportunity to say, what, what about this or what about that or ask questions. So it's been really, really good for patients. And I think it's also really good for our staff. Well, we did mention again that Reg Brice going to have an impact on traffic to and from the clinics for a day there. Did want to ask about facilities, things like that. Again, the constant update people need to remember. We, we have an older building and we got constant things that need to be upgraded and taken care of. Things are going pretty good. Yeah, you know, the building continues to have struggles. It is a pretty old facility. And so, you know, recently we replaced a ground chiller and I know that that was approved maybe at the last board meeting, but that got done earlier this week. And so that'll be nice for going into summer. And then we've been working on some issues with that we've had recently with hot water. And so we were starting to work through those. But yesterday, the board did approve getting a land option assigned over to the hospital from the Boone Economic Growth Corporation. And so, you know, that gives us the opportunity for some possible future developments. And I think the board is looking really hard at what the future looks like for Boone County Hospital. And you know, you know, I've talked many times about our facility master planning and, you know, is it, we look at everything from either doing nothing all the way up to a new facility. And, and, you know, I think we're looking pretty closely at what will we be able to do. And so some pretty exciting news, I think, and, and gives us a really, a really bright future. All right. Appreciate you taking time visiting with us. And we look forward to keeping up with all of this. And folks, don't forget, sign up for the Trestle Hustle coming up in June, was it June? June 20th. Down in Madrid. Support the foundation. There we go. Thank you.