Mikaela Kienitz, CEO, Boone County Hospital, Health Talk, February 06, 2026

Today I'm taking time to visit with Michaela Kinitz. Michaela is the CEO of the Boone County Hospital on our program. And Michaela, thanks for taking time for joining us. Happy to be here, Jim. Well, let's go. It's been a while again.

Last regular meeting before the end of January here was beginning of December. We had snow on the ground. Remember, remember our snow? It was. Yeah. And we just got what? I think you just got the ambulance in. And so.

Yeah, I think we had gotten our newest ambulance in late November there. So that was kind of exciting as the year was, you know, starting to wrap up. So, yeah, we met last early December and then, you know, every year, especially with Thanksgiving always being on a Thursday.

That board meeting always falls on Thanksgiving. So we combined Thanksgiving and November and December into one meeting just to avoid the holidays. Yeah, I was going to say, I don't know why the board doesn't like to meet on Thanksgiving for Christmas Day.

I mean, you know, why not? Anyway, but you do have it again. I the part I mentioned is it's the last time as the board met as the regular board, but you do have your committees, your finance committee, your executive committee, and they do their meetings.

And again, if anything comes up, they can easily handle it. So yeah, absolutely. Well, we it was a while. And the one thing that we got got anyway by being at the end of January is you're through the first half of your fiscal year.

Got a pretty good idea of how things are going and actually a pretty good position right now, December. I hate to say this, but when things start picking up with flu and things like that, business is picking up.

Yeah, I mean, you know, the hospital world is interesting because we don't want people to be sick. We want people to stay well. But when they are sick, it does help us on the business side. So and that's what we do. We're here to care for people. So it has been very busy.

It's very busy right now. Lots of, you know, winter illnesses, flu, COVID, all those things are going around. So we're seeing a lot of that in our clinics and in the hospital, actually. But yeah, we did get through the first half of our fiscal year.

And I think the hospital is in a very good position. Not quite the position that we had budgeted for, but I still think we're in a very good spot. I anticipate us finishing out the year really strong here in this last six months.

A couple of things that happened in the first half of the year. Some of our expenses for health insurance for our staff were higher than we anticipated, so that's affected our our budget in a way that we didn't plan for.

But we think that this year, you know, we've made some changes. We switched back to Wellmark. So we're thinking that that will help us in the second half of the fiscal year here. So insurance is interesting because it runs in a calendar year.

So we had to kind of account for the end of the year with that. And then, you know, it's easy just to look at one month and say, hey, this month kind of took a dip or this month was really strong. But it's really important to step back and look at the big picture.

And overall, we're doing really well. And some of it in like one of the things I noticed was the cash on hand had gone down. But then at the end of December, but then through January, who had gotten some reimbursements and all of a sudden it's back up, the cash on hand's back up.

Yeah, yeah, it's heading in the right direction. I think, you know, one thing that happened in December was we did have three payrolls. And anytime we have three payrolls in one month, it does affect our day's cash on hand.

So and then we haven't received our Medicaid directed payments yet. And those are also accounted for in that number. And so those are going to be coming in here very shortly in the second half of the year. All four payments will come in this last six months.

And so we will see the day's cash on hand go back up. Well, one of the things that in a lot of people don't understand how it's structured. I mean, that's been one of the challenges if someone asks me about it.

But I'll say on this on the matter of home care services and being a critical access hospital. There are upsides and there are downsides.

One of the downsides is some of the services you typically would want to provide to your patients and customer clients, people of Boone County. You just can't do that without suffering a penalty on the other end. Yeah, I mean, that's true.

And I think that that, you know, something that we've been looking very closely at over the last few years, all of the services that are considered non-core services, we've been sort of investigating those and understanding what they mean to our organization financially and what the penalty looks like for having them.

And so with home care and, you know, adult day and some of there's other services too that are ambulance. We've talked about ambulance many times, Jim, that it's outside of those core services.

So Medicare says as a critical access hospital, there's core services and we're going to reimburse you for those services.

And then they say if you choose to work outside of those core services by providing something like home health or adult day, we're going to penalize you for that.

And so one of the things that we talked about when we looked at this was because of that penalty in fiscal year 23, if you combine home care and adult day services, we lost over 1.2 million. And in fiscal year 24, we lost over 900,000. And in fiscal year 25, over 700,000.

Now the issue with that is that at the same time that that is happening, the census has dropped pretty drastically. And I think when we talk about home care, that's because there are other agencies coming into our area.

Lydia could list 11 agencies right off the top of her head and I'm sure that's not all inclusive of the other agencies that are serving Boone County. So there's a competitiveness to this.

And so when you're looking at that kind of a loss and you're looking at a census of 42, in 2020, the census was 84. So it's dropped pretty drastically. You can see where that doesn't really make sense financially.

On the health care side for you guys, one of the things is you like to have your patients be comfortable, be at home if they can. And we could do the services, but we are again, in the end, we get penalized for it. Yeah, we do. And it's hard because we do want them to be at home.

And the thing that's hard about this critical access hospital penalty or these rules is that insurance companies are driving care to the home, right? They're saying, hey, we don't want you to stay in the hospital for a week anymore when you have a baby.

Like we used to do 40 years ago. We don't want you to do that anymore, but we're going to provide all these home services. We want you to use home services. So yeah. But then we get penalized for having home services. They just, the two things conflict a little bit.

And then when we're talking about home care also, Boone County Hospital has been doing home care for a number of years and had that program in place prior to becoming a critical access hospital. Yeah. And so getting those two things aligned has been challenging.

And I know the board and previous administration have been looking at this for a long time. And so that's just, you know, it's just one of those things that's really tough. And as the census has dropped, that's really what's driven the decision is looking at the census.

And if you take those dollars and you divide them by how many people were serving that, that return just doesn't really make sense. On the adult day side, we also get penalized over there. And currently the census is at 2.9 patients. It's a daily census there on average.

And so that's also really difficult. We have more staff than that there in any given day. And so it just starts to, you know, you just start looking at it and trying to wonder what makes the most sense for us and where can we focus our efforts in a different way.

And so we are going to try to grow our public health services. We feel like we can meet more needs that way. We feel like we can serve our mission better.

And, you know, we'll make sure that the people that are transitioning out of those other services will transition them to another entity that can take care of them. And then we want that transition to go smooth.

But, you know, in looking at the long-term sustainability and what's best for the organization long-term, this is just a decision that I feel like, you know, had to be made. Yep. So again, it'll be phased out over the next several months.

And again, that it's going to be one of those things where we do have others services that are available and we'll steer them in that direction. So. Yes, absolutely. That's what we're taking care of there.

Otherwise, numbers fiscally looked really good through the end of the first half. So keep going now. I think that December was a really busy month for us. And so, you know, we had those issues in our OR earlier in the year.

And so I'm not sure if, you know, we reopened in November, our both ORs. But I'm not sure if some of the December was a reflection of that or if some of it was a reflection of the end of the calendar year for folks with their benefits. I think that might be a big part of it too.

Yep. But it was a really busy month. It was our highest revenue month ever in the operating room. So that was really exciting. And we're just seeing a lot of growth like we've talked about before.

We just continue to see that growth and we're really driving those services here and having, you know, our really robust family practice clinics and continuing to offer services that our patients need have really helped to grow the usage of services here at the hospital.

So I remember I think Chris back in December had said at the time, because I didn't visit with you then, I visited with Evan after that. But we did have, again, he did say it was like one of the better clinics doing some of the best business they have had in some time.

So of course they're getting fully staffed and everything again too. Yeah, I think our South Clinic was a little bit slower maybe in November and December than we had hoped for. But also remember that Dr.

Gordon has transitioned from South over to the ER, which has been a really big win in the ER as well. So I know people that he was their physician or are sad that he is left there, but he's a great addition to our ER. So that's a really nice place for him.

Let's talk a little bit about ER because I know that you did get a report on that during the meeting. We had Carla came in and the numbers and some of the things that are going on there are pretty impressive.

Yeah, the ER has been extremely busy taking care of a lot of different types of patients. I think she mentioned that the mental health patients that we've been taking care of behavioral health patients, those are up 60% from the prior year.

We're just doing a lot of great things in there and seeing lots and lots of patients come through there. And the ER is always a really important place for us because for a lot of patients, it's their first impression, their first experience with our organization.

And so we always want to make sure we do a really good job in there. Staff have been working pretty hard on some customer service initiatives, both the nursing staff and the physician staff.

And so I'll be excited to see some of those things continue to pan out and see how that would recommend score or that usage of the ER continues to grow. I was going to say because for most people, if they have to go to the ER, it's probably not a real good time.

So again, being treated quickly and moving through there and having good health, that's really essential to it.

Yeah, I think there's a lot of organizations right now throughout the state and probably the whole entire country where there's a pretty long wait for the emergency department and a lot of that's due to staffing. And we have a pretty quick throughput time.

So you're right that people don't need us until they need us. But we are here and willing and able to help people. And we want to make sure that it's as easy of an experience as possible.

I think the numbers I've seen at Walk-In just have not diminished at all, especially with all the respiratory stuff that's going on. Yeah, the Walk-In stays pretty steady.

You will see some spikes in it as we do see things like influenza and COVID kind of pick up right now during the time of the year.

But something interesting about the Walk-In Clinic is I think that there's about 50, close to 50% of patients there don't have a PCP, a primary care provider.

So that's interesting and it's a statistic that we keep a really close eye on and trying to determine can we convert those patients to using one of our doctors as a PCP or are they commuting in from a different community that doesn't have an urgent care and just trying to watch those numbers closely.

Yeah, that's always one of those things where are you sure you don't want to have a regular family physician? And a lot of them, I guess maybe the younger people in particular, that's kind of a lot of the ways a lot of them are doing it now.

Yeah, I mean I think a lot of that has to do with convenience. And you know when I call to get into my family doctor if I can't get into it and it works for me I'll just use the urgent care cell or the walk-in clinics.

And so you do see a lot of that I think happening in the healthcare world today. Well we wrapped up the year, I mean for births and everything doing pretty well and we're continuing and boy they got, they were tested. They were.

They had a survey, they had the, what is it, the perinatal. The state of Iowa had a perinatal review team. Yeah, they came in and took a look and really were pretty pleased. They were, they had a lot of great things to say.

I sat in on their review of our OB program and you know it's always nice for them to recognize all the hard work that our staff have put in. You know they focused a lot on our silver sleep certification that we have. We're a silver level.

The University of Iowa I believe is a gold level and I don't know that there's a lot of gold levels throughout the state but we're silver level and I think maybe one of the only critical access hospitals to have that designation. They talked a lot about that.

They also talked a lot about breastfeeding and our lactation consultant and the work that she's been doing and so they just had a lot of really great things to say. They touched on our partnerships with the home birth communities and so it was really nice to be part of that.

It's always fun to listen to them and they get such good advice. They do some chart review and say hey in this case you did great. You could have tried this or that as just additional supportive techniques and I think that's really nice to hear from the experts on that.

So it was really good. Our doctors were there. The nurses, a few folks from admin were there as well to listen in and it was great. They were very complimentary of our team. That's and they, I will say Dina and those doctors, they do work pretty hard on that. Oh they do.

Dina put in so much work on our quality program and that's really what they're here talking about is quality and so it's really nice to have them give that good feedback. Let our providers and Dina and the rest of the team know hey we're doing a really great job with this.

We're good at doing OB and so I mean there's always concern I think about smaller OB services and we just do such a great job with our, and a lot of that is attributed to Dina and her hard work with the program.

I mean she takes all that stuff very seriously and we participate in all those quality collaborative opportunities that we can throughout the state. So she's impressive and it shows in the scores and the review that they gave us.

I was going to say that's one of the things that you had said we need to really perform well at BCH because again it's going away in so many areas and we are becoming a dependable location for people to come.

Again with the collaborative efforts with the DULAs and everything that's pretty impressive.

It is impressive and when I think about the number of deliveries we had my first year here which was 2023 I think it was around 86 deliveries and then last fiscal year having you know north of 150 deliveries is really impressive.

The growth is phenomenal and I think that that growth really helps with the competency of our staff and so that's been kind of fun to watch and to see them form those community type partnerships and just really be amazing and you're right and they call that OB deserts and there are a lot of them throughout the state right now and it's really unfortunate that there's a lot of small hospitals that have had to close their OB departments and we are not going to be one of them.

Well it's talk I did want to say that after that back in November when the second OR got back up in operational it hasn't really slowed down at all. Not really no the OR has been very busy.

And that's one of the areas where again with the different things we have with orthopedics and stuff like that going on you do have and that's a good income stream. Yeah the OR is a really good income stream for us and ORCO has been doing well. I think Dr.

Zayed had quite a few cases in December and so that did make a big impact on that as well as other cases, general surgery, podiatry. Dr.

Paulson doing hands and he's very busy and he's so willing to squeeze people in and make sure everybody gets seen and get that surgery and gets taken care of.

He's a great provider we're really happy to have him on our team and we just have a whole plethora of folks that are contributing to that department staying very busy. And people if they wonder yes we still have a lot of cataracts on there.

We still have regular surgeries going on too Dr. Seligman. Yeah Dr. Seligman through general surgery we are doing a lot of cataracts. We've recently seen a few patients that are having cataracts done elsewhere and always trying to remind people we do do them here at BCH.

So just some of those things that happen as healthcare changes over time we just always try to remind what we are doing here in our organization and what you can get done locally. Well as we look forward here again New Year wouldn't you guys start planning for Reg Rye?

Well we started the day that we found out that Reg Rye was going to be here as an overnight stay.

So I know Rob Finley is our new EMS director and he has some ideas and has already started some of the planning process and I think he plans to get a team of folks here at BCH together in the next few weeks to really get started with what that looks like.

And then I've reached out to Chris Blocker with the CBB and asked her you know what does BCH's role look like? What do you need from us? What do you need from EMS? All those kinds of things and so I think as a community we'll be able to pull together and make it happen.

So I think it's one of those where we'll, we have time, we'll work on it, we'll get there. Yes absolutely. I've already been thinking about ER staffing and all the different needs that the community will have. That's going to be busy. It is.

Well then we turn right around and we'll have the fair right before that and everything else we have going on. It's going to be busy summer here. It is and then we'll have Super Nationals again and right back into the fall.

Super Nationals and Farm Progress Show will be stuck in there in the middle somewhere and I know you have people out there for that too so we just keep going ahead. The upside is we will have a chiller in, keep my fingers crossed before it gets warm out. Yeah.

That I, I gotta say I was listening and I kind of chuckled a little bit when Chris said and yes before summer. We'll try to have it all done before summer.

Yes you know so much depends on that equipment working appropriately and you know if the kitchen is hot it gets really warm in the kitchen and in places like that and so it's really important that we do get this addressed prior to the summertime getting here because it just gets extremely warm in the building.

And for people who are wondering no it wasn't planned this year but it is a, you were looking down the road it was going to be in the budget anyway so it'll be done.

It would have been something we budget for next year but like he said they've burned into a couple of issues and we know summer's coming and we all know that there will at least be a couple of weeks of really really really hot weather and so we want to try to get it addressed prior to that.

Alright again it's been busy we're getting, well we got a lot of things going. People get your flu shots if you haven't. It's still not too late I don't believe but definitely. No it's not. If you're sick stay home okay. Yeah and wash your hands.

Wash your hands and cover your cough. Yep. Michaela thanks so much for visiting with us this month getting us updated with what's going on we'll look forward to visiting with you next.

Oh you do have a few other things coming up too ribbon cutting for the ambulance and things like that. That's coming up yep in February I think on the 17th that'll come up.

We did get a very nice donation for our ambulance and so we're grateful for that and so yeah lots of good stuff coming. Alright thanks so much for visiting with us. Thank you Jim.