Mikaela Kienitz, CEO, Boone County Hospital, Health Talk, July 2, 2026

Today, visiting with Mikaela Kenitz, Mikaela, the CEO of the Boone County Hospital on our Health Talk program. Mikaela, thanks for joining us. Thanks for inviting me, Jim. Well, here we are. We wrapped up your last, I'm just going to call it the last regular meeting for the fiscal year, the end of June. You're going to pass up on the one in July. Yeah, we won't be meeting in July. We're going to skip that one. A lot of folks are on vacation. So we do have, again, it was a pretty quick meeting. You had a lot of written reports, administrative reports, I know things like that. Did want to just cover some of the things that we know came up that you did. You guys do it every time your organizational goals dashboard. Basically, it's just the goals that you kind of set for yourself. And you still had a whole month of June to go, but had some pretty good numbers so far for the fiscal year. Yeah, we had some really good numbers, a lot of green on our spreadsheet, which we really like to see. I think we've seen a lot of improvement in the would recommend score, which is our service pillar. And we're very proud of that score moving over this year. That's a hard needle to move. And so, you know, we've seen that rise all the way up to 92% for the year right around 90%. But that's that one we're really very proud of. And then also we've done a lot of work on our people goal this year and really focusing in on being competitive with wages and benefits. And we surveyed our staff here a month or two ago and came up with 80% on that. And we had a goal of 75. So we're really excited about that goal as well this year. That's good. That's happy workers. Yes, exactly. I mean, you know, it's a competitive world out there in healthcare. And so we're really excited when you know, our staff are feeling like they're getting rewarded for the hard work that they're doing. And at the same time too, you know, if they are feeling good about their jobs, because they're dealing with people who are not probably having the best of days. Yes. Yeah. I mean, you know, that's what we do. We take care of people on their worst days and their best days. And so I really, you know, and the way that our staff feel about their position here at Boone County Hospital is really important to us meeting our mission and giving that care that patients need and deserve when they're here. Well, I know, and again, some of the other areas we've talked about in the past to the quality of safety, especially in C-sections doing things like that. You did have, you had some pretty good goals in there as your staff has done exceptionally well. And the numbers of births just keep coming in. It keeps climbing. We have a couple days left of June here, but we're sort of on track for around 156 deliveries, I think. And so that's almost double what it was when I started here. So we've seen a lot of growth in our family birth center and our staff there have really, really picked up. It's been busy the last two months in family birth center, extremely busy. And so we've had some staff from the Med Search Peads unit float over and help in that area. And so that's been really, really positive for our team and for our patients. And so that's going good. That also did, because we were so busy in those couple of months, it also did increase our C-section rate just a little bit. So we'll be interested to see what that looks like at the end of June. And that's one thing too, if for those that haven't listened or haven't heard us talk about it before, you made this effort. And again, we have a great staff of physicians that do, do births and do childbirths. But you also work with a lot of others, home births and doulas and things like that. We do have, you got a pretty well-rounded program. We do have a pretty well-rounded program. We've got some really great providers on our team and a lot of really great nursing staff. And, you know, different of our different nursing staff within our team have different certifications. So we sort of have all of the certifications, you know, covered. And so that's really nice too. And it does help round out our program. But we have been trying to do some outreach and working with the home birth community and various different providers in the area. And so that has really helped us to grow our service as well. And I also think, you know, word of mouth has been big for us. And, you know, I'm frequently hearing stories out in the community about a great experience that someone had in our birthing center. And so, you know, I just think that those things have really helped us with the growth that we've been seeing over the last few years. I know one of the things that happened before we did have talked a little bit about it. But you had the board, you made the presentation to the board that we were going to probably start working or we were going to willing to start working with some people that did home births. And as you mentioned, the word of mouth really spread in that community that if you have a client, a patient and you need some assistance, because not everybody's a fan of going to the hospital. But Boone County Hospital would be the one that could help them out. Yeah, definitely. I think that, you know, we see a lot of are we hear a lot that people feel very welcome here and we're very open to, you know, supporting their choices. And we understand people's desires to do things differently. And so I think definitely the word has gotten out that we're open to helping that community. And so we have seen a lot of increase in growth from that community. Definitely in the last, definitely probably in the last 12 months, we've seen more of that than we had previously. But it's been a good partnership and we've reached out to those communities. And, you know, we've talked to them and had them come in. We've had some joint meetings to help them really understand the things that we need to be able to take care of the patients for them. And that has really, I think, solidified some of that growth that we've been seeing. They feel comfortable here. We've worked together with them. We've been very accepting. And so I think that's really changed the perspective on if your home birth does fail, and you have to go to the hospital where you can feel the most comfortable doing that. So I know that in our staff, you have a really strong staff that does work together pretty well for birthing. Yeah, we have a super strong staff here. I think that, you know, we have a lot of staff with different certifications, like I said, and they just get along really well. And we just have, you know, it's a little bit of a niche for the type of OB care that we do here. And I feel like, you know, they just are a great team. And they always make sure that patient wishes are respected and they just work really well together. And that, you know, is from everybody from nursing staff to the OB providers, to the family practice docs who help with newborns. And, you know, when there's C-sections and things like that, our family practice doctors are right there, anesthesia is right there, surgery staff. So it takes a lot of departments within our organization to, you know, really run a strong service that way. But everyone steps up and we have really, really great outcomes and very proud of them and excited for the growth of the service. Let's talk about a couple of the other things that have been growing here in the past year. Again, we had a little bit of a transition among capital ortho, but Dr. Zayed is starting to pick up a lot of business. Yeah, he's been really busy. I think he had been doing around, you know, three cases each day that he was here and now he's recently increased that up to four. And so it's been kind of fun to watch our orthopedic service line grow a bit. And I'll be interested to see what will happen in fiscal year 27 with that and see if we can get even some more cases done. So he's been extremely busy. I think last week, he and Kirby saw about 48 patients on their clinic day. And I think Dr. Paulson was here also and saw 47, I think. So all the orthopedic services across the board have grown extensively and have been very busy. And so that's really good to see. And for those that don't know with capital ortho, a lot, some of the procedures are done here, some may be done elsewhere, but it depends on each patient what each case calls for. Yeah, it does. And, you know, there are some things that we don't do here at Boone and we want patients to get their service at the safest place for them. But of course, we do everything that we can do here locally. And that's really our goal is to bring that service access to that service to the hospital here so that folks don't have to travel unless it's absolutely necessary. Well, and on the other side too, on the financial side of it, that's that is good for us. Yeah, it is. Ortho is one of the, you know, big revenue producers for us. And so it's good because that helps us offset some of the services that aren't as good at producing revenue. And so it's really important to our mission and to our organization that we have a strong ortho line. Well, we do have a number of other things to talk about. But I did want to ask because I know I listened to Chris give a brief, brief presentation on it. We talked about it last time about days cash on hand, which is one of those things that a lot of people just kind of why why are you so worried about that? Because, well, I can remember and I know you've heard the stories when there wasn't that much cash on hand. Yeah. And so you've always had and I told you last time I thought 182 was pretty aggressive goal. But you're getting really close to that. Yeah, I think the end of June, we're around 147. And I think that he anticipates us ending the year closer to in the 160s. We had some cash that came in for May, but wouldn't then get posted until June. We have some more direct payment funds coming in. And then of course, our operational growth has been like we just talked about, it's been booming. So we do anticipate June being a very strong month and cash wise, I think that's going to affect us. And so the days cash on hand, I think, you know, when when people are asking why is that important, it's the number of days that we could operate without any revenue coming in. And so we like to share that number with our staff and we'd like to help them understand how strong the organization is. It's really an indicator of the financial strength of the organization. And I think 120 days is kind of the standard. And so we're we're beyond that. We do see hospitals that have a very large amount of cash on hand. And then a lot of hospitals have a very small amount of cash on hand. And so, you know, that 120 was our goal, I think two years ago, just like, Hey, let's see if we can get to that number. And now we're surpassing that. And for fiscal year 27, I think we anticipate being somewhere in the 170s. And so that's really exciting for our hospital. It says a lot about the growth that we're experiencing and and the stability and what the future might look like. That's probably one of the big things, just the consistency, just if we can stay there, maybe add a little bit each time because costs go up. Yeah, they do. You're you're right about that. So it's been interesting to watch that because the cost per day to run the hospital has increased, you know, quite a bit in the last couple of years that we as we've invested a lot in staff and technology and those kind of things. And so you do see the cost going up. And so that does affect the number of days of cash on hand. And so it's been kind of a fun equation to watch. But you know, it's it's good. And it's a really good indicator of things to come. I know at the last meeting, since we're talking finances, let's keep on that a second. But I know the last meeting, Chris did give a brief kind of a brief summary about the fiscal year budget 27 starts, you know, beginning of July and away we go. He did say that anticipating roughly what about a 7% gross revenue increase, I think he said he was that was what was anticipated budgeted. And again, reasonable, it looks like compared to the last couple of years. So yeah, I think that's a good strong, you know, you know, when we ever we do the budget, you're making your best guess at what will happen and basing that on what's happened this last year and what kind of, you know, growth we're going to continue to see. And there's lots of factors that play into what that number ends up being. But I think you know, we're anticipating some increased some new providers and hopefully some increased outpatient visits in our clinics. And then that will drive growth in the hospital also looking at, you know, continuing to grow that orthopedic service line and senior life solutions. And so there's a lot of things that really play into that number. But yeah, we are looking at another strong year. And we know that the Medicaid Directed Payment Program is not going to change at all next year. I think that, you know, when the earlier this year, the federal government made some changes. And so that program could start to see some change, but it won't be until fiscal year 28. And so right now, we, we feel very strong about the budget that we proposed. So confident that things are going to keep going in that direction. And again, you've made other steps on the benefit areas some on the health insurance side. Again, you have a, you have a sizable premium there. You've got a number of people. Yeah. And that's, that's a big part of the cost of operations. It is. And you know, we, we invest a lot in our people and we want to do that. And, and we want to have good people that work here. And so, you know, it is, it is expensive. And this year, we had a little bit of a struggle with some of our insurance claims from actually from the previous year. And so they kind of hit into this year. And so we did make a change. And so it'll be good to see that improvement next year in the budget. But also, you know, it is costing us a lot to offer those things. And for those that wonder, yes, they do, you do kind of have a rough plan for your capital. CIP, I call it capital improvement plan. You got capital expenditures and number of different areas that are going to be needed. And just bottom line is those are regular things that need to be taken care of, whether it be equipment, whether it be facilities, you're somewhere around 2.2, 2.25 million or so. Yeah. Right around there, I think, you know, it's actually one of the smaller years of the capital expenditures that we've planned for. And so I think that's somewhat reflective of all of the capital expenditures we've done over the last few years. And so a lot of equipment and things have been replaced, but you have to continually look at what's going to be coming up down the road. You know, there's, I think there's an ambulance in there again. There's some facility projects in there. And so, you know, it's one of those things that we will always have this sort of big capital expense plan each year because stuff wears out and we want to have the best equipment and the best facilities to take care of patients. We have all our chillers working, don't we? Yeah, for now. Yeah. And this heat, we should be able to tell for sure that they're all working. Well, that's okay, because I suggest to people that in the heat, you may want to stop by the atrium part there and maybe sit down and cool off a little bit if you need to. Yes, we're always a designated cooling center. You can always step in and maybe get something from the cafeteria there, too. Yeah, or the gift shop. Yeah. So we have that. I did want to ask, well, I know with all of that going on, but let's talk a little bit, because we did touch on the fact that the board did agree to take an option on some land so facility-wise. Again, people need to remember, everybody talks about the new area, basically the new operating area, 20-plus years old. Yeah, absolutely. The newest part of the hospital was built in 2000. And so it's 26 years old and really starting to see some, really one of the issues with that that we're really starting to see is that we're outgrowing that space. And so I think that's always something that we're taking into consideration and we're constantly looking at our facility master plan and trying to determine the best solution for the growth and the future services that we want to provide here. And so we've done a really extensive facility master planning project over the last three and a half or so years. And so the board hasn't fully voted on anything or really decided anything other than getting the option on the land at this point. But I do think that it's going to be really important that we do a good job with our facility master planning because of what we're seeing and the age of our building. It's not going to happen overnight, but people should know. And again, you basically have been looking and taking a look at what's been happening, growth and what areas where you need it for the last since you've been here anyway, even before that the board was looking at. Yep. And I think that it's kind of been a long ongoing process, but there's a lot of factors that play into it. I think there's a section of our building that dates back to in the 40s. And so that part of the building is extremely old and the infrastructure in it is extremely old. And some of those things are costly to keep going. And so we have to sort of evaluate all of that as we're making the right decision, the long-term decision for the future of the hospital. So a couple of different things I wanted to hit on too before we end up for this time on the program, but diabetes education continues. It's one of those areas where we knew we needed to see some expanded

service and we are seeing it. And a lot of people getting referred to it too. Yeah. And Jess is the nurse or the dietitian that does our diabetes ed. And she is absolutely amazing. And I encourage everyone to take advantage of that service. She does such a great job and she has seen a lot of growth. And so that's been really good. It's been well supported by our providers. And let's talk about some of the community things because I know food for kids already going on. Yes, food for kids has kicked off. Yep. They're going and we've got a lot of other things that are happening. So now let's touch on what's coming here and we won't talk about it until after it's been here, but Raghbri. Raghbri is coming for sure. So we're doing that. We know that's the case. Gearing up and I know because they kind of have their own medical team that comes with them, it seems like, but they always got to have a resource, especially when you get an overnight town. Yeah, they have their medical team that travels around with them. And so that's very helpful to the, you know, communities that they're traveling through. But when you're the overnight stay, you really have to have a lot of planned out resources. And so Rob Fenley and Lydia Billings have been really working on what our EMS plan is going to look like, what our first aid plan is going to look like, both in Ogden and in Boone, because Ogden is the town just before the end. Yeah, there'll be a lot of folks that stop there. And so we have that set up for some, I think the city of Ogden is doing their own first aid, but our clinic will be open for walk-in. And so we've thought about that a lot and they'll have EMS of course there. And then here in Boone, we have multiple first aid stations planned out along with our ambulances will be strategically placed throughout Boone so that we can, you know, get places because I think all of those bikers coming into town and all of their support vehicles travel around town is going to be kind of challenging. And so he is strategically working on where the ambulances will be located during that timeframe. And so, you know, we've also staffed up our emergency department. We know that we'll have a surge there. And then we've done a lot of planning around our walk-in clinic and as well as our North and South clinic, travel will be kind of difficult to get to those. And so, but I do think that they will both be open if folks need services that day. So, and that's part of it will be regular, I'm guessing, appointments and stuff. They'll try to schedule around those so that, yeah, try to avoid this as much as they can. Yeah. And I believe also like our elective surgery stuff, we're kind of pushing that back a little bit too. We really want folks to be able to get here for their services and not be frustrated and wayfinding I think is going to be challenging. And so we're trying to adjust the things that we can adjust to accommodate for the influx of folks into Boone and so. But I mean, I think that we're about as ready as we can be. We're a couple of weeks out now and looking forward to it getting here. And I am really proud of our team. I know we've had a huge team of folks working on it. Carla from the ER, Laura, RCNL, Robin Lydia, like I said, there's been a large group and I'm really proud of them and the efforts that they've put into this. It's not easy. No. Well, it's not. And we know even the last time when they just passed through Boone County, we had issues and there were issues in the hospital had to be a part of it. So Yes. Yep. And you know, I think that happens in every overnight town there. The hospital does end up having to, you know, help solve some of those things. And we're ready to do that. And we're happy to help out. We're excited that Reg Brice coming to Boone. It's just a lot of work to get it all figured out. So we do it right. Well, into the new fiscal year, fiscal year 27. I know you've got some new goals and all of those things are set up. Next regular meeting is not going to come up towards the end of August, however, but people need to remember they can still support the Food for Kids program. They can drop off things at the grocery stores where they have drop off locations, or they can bring it into the hospital, drop it off at the atrium as well, or just make a donation and Lisa can go and fill out the order whatever way she needs to. So yes, we would love any support for our Food for Kids. You know, we give a lot of meals out throughout the summer and it's a really, really strong program and really proud of it. I think our team, our community pillars, really proud of it. And so we're happy to take any type of donations that folks want to contribute to that program. There is clearly the need out there after doing this for three years. So we're absolutely willing and happy to take any donations that folks want to give or any support they want to give for that program. All right. I appreciate you taking time visiting with us, giving us an update on what's been happening. Thanks so much. And we'll talk to you again. Oh my goodness, I'll figure out somebody else to visit with you the next time. And we'll talk about maybe just how well we did during Raghbri or something like that too. So I know there's, we'll have things to cover and talk about. But we'll look forward to that. And then next board meeting coming up the end of August. Yep. Sounds good, Jim. Thank you. Thank you.