Mikaela Kienitz, CEO, Boone County Hospital talks about the recent meeting of the hospital Trustees. She comments on the strong financial showing and so far this fiscal year. She talks about the increase in the use of medical services and the efforts to continue the growth.
Transcript
On our program today, we're visiting with Mikaela Kinnitz, CEO of the Boone County Hospital. Mikaela, thanks for taking time to visit with us. Thank you for the opportunity, Jim. Hey, we've had, you've had busy week and a half or so here for a board meeting for the hospital. Got a lot of things done at that one and then a special meeting where you did some strategic planning, just get together and do a lot of organizational things or a long range planning. I call it long range goal setting more. Yeah, I mean, we try to do that every now and again with our board, make sure we're on track for where we're going for the future. As we got out of our regular, your regular meeting that you held there right at the end of May, you know, and I know one of the things that came up because obviously, Angie gave the organizational goals. You do those dashboards all the time, but again, she did say, or I think maybe it was you that said it, but next time we're going to be taking a look at what we're going to put in the plan for next year, the next fiscal year, you use a fiscal year calendar for that. Yep. So the fiscal year will end here at the end of June. And so at our June meeting, which is pretty late in the month, we'll be looking at and getting our goals for the fiscal year 27 approved. So it will change the dashboard just a little bit. I think a lot of the goals that are in our dashboard are the benchmarks that we try to kind of stay consistent with. And so there'll be a little bit of change to it, but probably not anything drastic. I was going to say there's, but the only thing is we keep going up on those births. I don't know how to say that. That's okay. That's one of the things that basically was one of the things we were shooting for. It was, you know, I think that last year, I think we delivered like 151 or so. And I think this year we're on track for about 155 for the fiscal year. So we are planning on a very busy June and July here with deliveries. We know that we have a couple of busy months. And to prepare for that, we've been, you know, working with some of our staff and like the MedSurg Peeds Unit and cross training them over into the Family Birth Center. And so just been trying to get ready for a couple of busy months, but it is really fun to see our births keep continuing to climb. And I know people would say, well, do we have that many from Boone? It's not just Boone. They come from all over for you now. Yeah. We do have quite a few patients coming from outside of our service area. Most of that's related to home births. But you know, I think some people just get the, you know, just hear the word and they really enjoy the kind of care that we give. And so we are seeing kind of our circle broaden for where we're getting those folks from. I know one of the, one of the things that on the medical side, the quality safety part is you try to decrease the primary C-sections. You're getting down there, you'd like to be 16% or less and kind of just hovering right around that area. Yeah. We're kind of staying right around that 16, the state sets some goals around primary C-section rate related to the Directed Payment Program. And so we're overall at a 16% when we look at just Medicaid patients for around 7%. And so that's a win for that program and keeping that number down. But I think we do a pretty good job of holding on and holding that number where we, where it should be. Because you know, you don't want to be doing things unnecessarily. I'm kind of picking things off those goals because not a lot of people come and sit in a board meeting or actually understand about all the different kind of goals and things you set for yourselves. But the 30-day readmission, again, that's something where, and that's at any hospital. So if you want, say, you have somebody come in, get them discharged, you really don't want to have them have to come back to the hospital. Exactly. I mean, when we think about quality, right, we think all the time about what does that mean for me as a patient? That means that I'm, you know, I'm not getting an infection, I'm not having a fall, I'm not having to come back to the hospital, whatever happened at the hospital while I was there was, you know, appropriate care and it's kept me from having to be readmitted. So we work really hard on that score as well. And I think right now we're around 2.9% overall and so that's a really good readmission rate. So we're really proud of that and we keep working with our teams and all of our staff know our goals. And so all the staff that, you know, do inpatient care, they know about this and so they're working to make sure that we're not readmitting people. That's a challenge. And again, some people, I don't, I'm not going to say they like to come back because they enjoy it, it is not, it is not usually a good time for them if they have to come to the hospital. Right. Exactly. Well, among the other things I know they go on and we'll talk a little bit about the financing because I know we had at least from the May meeting, I didn't have the finalized May numbers, but had through the month of April anyway, pretty good numbers and the expectation that May was going to also give you some pretty good numbers. And basically for the year, the way it operates and again, a lot of people would be just kind of lost in a lot of it, but you have a budget and again, that's pretty much a wild guess as you're setting that up. You kind of use your data and everything and Chris kind of works away at it and you guys go back and forth on it. So you have the budget, but you have your actual and then you've got, anyway, the challenge is to try to keep on the positive side, the black side and we are, you're doing a good job on that. Yeah, you know, you're right. We do set a budget and really we do use data and things to try to make our best estimation of what will happen in the next year and our department directors do a wonderful job with budgeting. They all come to their budget meetings prepared. They've really thought about, you know, what's the service going to do? How much growth, what might we see? All those different things. What kind of staffing levels will we need if we see that growth because so you're going to make the revenue on the growth side, but you've got this extra expense on the staffing side and so we try to make our best guess at having all of those things line up. But and, you know, sometimes we're right on and sometimes we're off a little bit. So the beginning of this year was a little bit of a struggle with some of our insurance costs. It didn't do exactly what we thought it might do. And so we've been kind of recuperating from some of that. But at the end of the year here, it's looking like things are going to pan out pretty good. I think April was our highest revenue month ever on record. And so it's kind of funny because I think the month before that with the highest revenue was March. And so it's fun to see us kind of breaking those records and a lot of that is related to growth. We've just seen so much growth. We've seen a lot about patient growth, physical therapy has seen a ton of growth. And so, you know, it's just been really busy. And I think that that's a testament to people utilizing our services and and us working hard to make sure number one, people know what services we have. But number two, trying to find and bring in the specialist that people want to see here locally in Boone. So there's a lot of of parts and pieces that work into how well we do financially. But I think this year is going to pan out to be really good. I think and I know you have a pretty, I thought it was a very aggressive goal for days cash on hand. But I mean, I thought it was pretty exceptional where you were at a year ago. But I don't know how close you're going to get. But it may not reach a 182 days, but you're going to be up there pretty good. I tried to stay really optimistic about the days cash on hand goal. You know, I think the lowest we got was what it looks like about 114 with the lowest we got in this year. And, you know, it's a little bit like, oh, dang it, we're not going to get to that goal. But I think that we could get very close to that. I would guess maybe around 180 or so. So, you know, the Directed Payment Program affects that goal and they changed that program a little bit this year where we didn't get our quarterly payments quarterly. And so we've seen some, a lot of those payments here within the last few months of the end of the year. And so that's, you know, impacting those big jumps at the end of the year. But I'm really hopeful that we get to that. I keep trying to, you know, be a cheerleader for the team. We're going to get there. But I think we'll get real close. So, it's exciting. And that's it. And again, it's a variety of things again with that. Having the traffic really is big things too. Yeah, I mean, the operational growth is really the big key element, right? Because that's where we want to focus because we don't know what will happen with some of those other dollars. But the main thing that here we're trying to do is grow and see our organization be very self-sustainable. So, we've got that going on. We've got, you know, tax, levy dollars. We've got the DPP. We've got a lot of different things that go into that day's cash on hand. The other thing to think about on the day's cash on hand is that as we grow, so do our expenses. And so does the amount that it costs to run the hospital for a day. So, we kind of have to take that into account as well as we're looking at the day's cash on hand goal. There's a lot of pieces changing. A lot of, yeah. If one's going up, others are going up as well too. Right, exactly. We'll always have that challenge. Yep. I think, and one of the things I was looking at, still 182, that's pretty, I think pretty aggressive. Like you said, with some of these directed payments coming in towards the end, you can jump up there pretty quick. Yeah, I mean, between March and April, we jumped up by 25 days almost, day's cash on hand. And so, we keep seeing that throughout the end of the year, then we will be pretty close. And just so listeners understand, we talk about day's cash on hand, that's much better than what it was like 30 years ago, when it was like less than a week. Yeah, frequently I hear our staff, even some of the board members referring and recalling that and saying, I remember when we had seven days cash on hand 20, 25 years ago and we're in a much different position and so, it's interesting that conversation is usually coupled with the conversations about record breaking revenue and record breaking volumes and it's just really fun and exciting to lead the organization through a lot of this change that we're seeing in growth and utilization and so, you know, it's just been something really special, I think, to be part of. And one of the things that I look at is really, that's a commitment by the board to have a team that's going to help work in that direction. Exactly. That's the big thing. They have to be committed to making this work. Yeah, you know, there's, it takes, we have to be aggressive, we have to be aggressive about growth, we have to be aggressive about our financial position and really being all committed and sort of on the same page with where we want to go and how we want to get there and it, you know, some of those decisions are tough but we're really making some of those big improvements so that the future stays really bright. I was going to ask you about a couple of different things. We know that the, our labs, and we touched on this, I think, just a little bit last time about how their volumes have gone up and then our lab director had departed to another position but he had a traveling one come in and she said, oh, I like it here. I think I'll stay. Geez, it's been so, it's kind of a whirlwind and her name's Amanda and she's just amazing and so she did come in through a travel agreement that we had through agency and, and she was here one day and said, I love it here. You know, I think this place is amazing and so we also feel the same about her and we're really excited that she's accepted the position to stay here as our full-time lab director. She's going to do a great job. She's got a lot of good experience in lab leadership, so that'll be nice. You did mention a little bit about the growth in some of the other services, the rehab services in particular, they have really been going. Yeah, they've grown a lot. I think we're seeing the number of evaluations that we're doing, just skyrocket, you know, some of, we've seen some of that, I mean, almost double, I think, in the last two years. We've been kind of looking at it and watching it since we've taken on that service ourselves and we've just seen a lot of growth and so we keep kind of running into the problem of space, especially in our gym, if you've been to it, you know, that it's tight in there and so trying to add staff to meet the needs of the patients, but then having these space constraints has been something kind of to deal with. So one of the things that we're doing is renovating what was the business office space because the business office has relocated out to the South Clinic and so we are changing that space here in the hospital to be some more therapy space, so occupational therapy and I think some of the work screen stuff that we do will be in the old business office space, which is, you know, great, it's a great use of space and it gives them a little bit of room to spread out so we can see more patients. Yeah, and that's one of the things too. If before it was, we could see a couple of patients and then all of a sudden we've got even more because you're offering that service. It is a service where people can get it right here. Yeah, they can get it right here. They can get in quickly. You know, we have great staff. People build those relationships with the staff and they just love them and, you know, it's a service where, you know, people come back time after time again if, you know, because it's a recurring service and so it's good and we have a lot of different modalities in there. We have OT-PT and then speech therapy and so in the last year, so we've worked really hard to send our employees in that area to some special certifications. So we're doing dry needling. We're doing lymphedema treatment. We weren't doing that before and so as we keep adding those special services, we are going to see those referrals grow and people will be able to get even more care here locally. Well, I know that among other things, I'm hard to say that we're looking at four physicians. I mean, it's still an ongoing recruitment thing. We're still looking for family practitioners. We are trying our hardest to recruit in some, you know, more family doctors. Always looking for that and so we've had, you know, a little bit of shifting around within our medical staff. We know Dr. Gordon came over to the ED. There's, you know, we'd like to add to our FBC team. There's, it's a lot. They take call a lot and so we're just keeping trying to recruit and so T.C. has been working so hard on that and, you know, we've been pretty lucky in the past where someone knew someone and we've been able to kind of sort of easily recruit people, but that's not really the case right at this moment. And so working with some recruiters out there and trying to find our some, some additional help for our team. And want to point out you're not the only one out there. Yeah. That's it. It is competitive out there. So it's very competitive and I think there's a shortage of physicians as well as nurses and so and some other modalities as well. So we're going to continue to probably struggle a bit with it, but you know, and like you said, it's, it's everywhere, but I want to really make sure that we have, you know, enough providers so that the ones that we have aren't just completely, you know, tired and exhausted and that we're making sure that there's enough providers for to handle the load of all the patients that want to come into the clinic and working on that access to care and that, that requires us to build that group. And I know for those that do have a physician, yes, you don't always get to schedule your appointment like a week in advance. It's usually several weeks in advance. That's how busy they are. I know they are really busy and so we try to watch those wait times, you know, like you mentioned a week. Sometimes it might be a month or two months and depending on the kind of visit that it is, if it's a, you know, physical, it's generally can wait a little bit longer than I'm sick today. But, you know, we try to watch those numbers and that helps us identify when we need to add to our provider team. You know, what, wow, this is looking like the wait starting to get longer. We need to add more folks and to help us. So we've been looking at the team. We've been looking at, you know, the number of physicians, the number of nurse practitioners and physician assistants and how that could help our team. We've just been really looking at all of the options and trying to make sure that we are, you know, available for patients and making sure those wait times are reasonable. So new younger people tend to do their doctor shopping on their phone. Yeah. And it's, I mean, that's what happens. They'll go to the walk-in clinic and then they'll say, well, we try to get you referred to somebody. Still doing, I mean, you know, that seems to be the new trend. Yeah. You know, we see a lot of people that come to our walk-in clinic and it feels like kind of no matter what we do that percentage of folks that use our walk-in clinic without a PCP that don't have a PCP is around, you know, that 50% mark. And so, and they come kind of from all over. So it's not from Boone County or Boone again, but it's interesting. And so trying to help those folks get established with a primary care provider is important. But I still think some people really just like that. I just want to go when it's convenient for me. I'm going to go to the walk-in if I need something. And that's okay too. And that's, you know, one of the reasons we have that service. But we really do try to use that as a tool to get folks aligned with someone who can do that long-term primary care for them. But, you know, and then we also are looking at other options like we've been working on improving our portal and so that there can be different methods through the portal and then also telehealth, you know, we continue to do that kind of care because there's just, I think that people just like they need variety and everybody wants to try to get their care differently. Well, I know that one of the things where we've seen a little bit of a shift in direction, obviously, is the renewal or redirection of public health. And they're making some big strides right away. Yeah, you know, they're out in the community doing a lot of different things. I think right away they did that 99 counties, cancer public event where folks could hear about Boone County in particular. And so that was one of the big things they did. I think they did ride your bike to school day in Madrid. And so they're out in the community starting to really get involved in doing things. And I'm really proud of them. I'm proud to see them out in the various communities, not just in Boone, but in addition, some of the smaller communities around us. And I think that's really great. And I am really excited to see what they do and how they grow. Are we seeing more and again, I'm going back several years on what public health was many years ago, you know, that's where we always had the vaccination, the clinics and things like that. Well, that's readily available through a lot of pharmacies, things now. But the big thing seems to be education. Once again, getting that education out there. Yeah, getting the word out there and educating. And that's, you know, a lot of public health is about education. And so I know that Lydia has a lot of plans to educate and get, you know, partnerships built with schools and whatnot as just one of the examples of ways to get education in different community outreach type things. But, you know, as far as immunizations go, we do still do them through public health, but all of our clinics also offer vaccine for children's programs. So that is where, you know, you can get your vaccines for free if you qualify. And so having that within the clinics, I think just catches people while they're there for their childhood visit. And so they can just get the vaccines when they're right there that way. So that's a decrease in immunizations that happen in our public health department, specifically, a little bit, but not completely. We still have it going on kind of in all the different areas. Well, we did have during the month of May, obviously, hospital week. We also had recognition for, and you said there was a lot of entries for like the Daisy Awards, things like that, the Rose Awards. We did have several people recognized. We did. We had two Daisy Award winners. Morgan Umphen, she was a clinic nurse, and now she's transferred over to public health. And then Allison Stevens, one of our OR nurses. Those were the two Daisy Award winners this year. And I think there were over 34 nominations, which is the biggest that we've had for the Daisy Award this year. So that was really exciting. And then the following week at hospital week, we recognized Addison N. She's our social worker on the MSP unit, and she just does some really amazing stuff. And so she got recognized for her care for patients. And then Ethan Patterson, our director of rehab services, was the other one that was recognized. And there were some really, really amazing stories for all of the people that were nominated. They, their nomination gets submitted with why they should be nominated or why they should be chosen. And, you know, it just is so, makes your heart so full to read all of those. And to think about all of the amazing things that our staff do for patients here. And we could not be what we are without those people. They're amazing. Yeah, pretty good stories there too. Well, some things that are coming up that people might want to know about is you are going to have a couple of SHIP counselors coming on to help later this summer, early in the fall, I guess. And they're training right now. So they'll be starting in August and September to start meeting with people getting ready for the, you know, the following year. And, and no matter how many times I will do stories on it and stuff like that, people when you say you got to start taking a look at what's happening with Medicare and what you got to do here, it just gets overwhelming. Absolutely. And a SHIP counselor, they won't answer all your questions, but they'll give you direction. Yep, they'll help give you guidance and answer some of what they can. And I think that's going to be really nice to have that in Boone. We haven't had it in our county. We're one of the only counties without actual SHIP programs. So we're really excited to be kicking that off and being able to be a resource for folks. Believe it or not, our counselors all retired several years ago. That was the problem. And we have Food for Kids. Yep, they're getting that going. Coming up here in a couple months. Yep. Yep, couple weeks here. Couple weeks, yeah. Yep. June 16th, I think through August 6th, it looks like is when Food for Kids is going to kind of run and it'll be the same as it has been in past years, Tuesday, Wednesday, Thursday, at the various communities, Ogden, Boone, and Madrid. We did some different stuff this year with our staff to encourage them to donate food for that, you know, extra jeans days and things like that. So that folks want to contribute to that really important community event. Well, there's a lot more things we could talk about, but I'm out of time. Well, I mean, there's so many. There's so many cool things that are going on. You know, I know specialty clinics. So we've got some adjustments in what some of the physicians are going to be doing. OR has just been busy. Busy, yep. And that was part of what slowed us down there, you know, late last, well, early in the fiscal year because one OR really put a little bit of a little, little, yeah, little hiccup in some of that. Yeah, yep, a big hiccup kind of. It did put a damper in our, you know, our ability to do some of the things that we'd like to do and in our revenue for the year. But we're making up for that now that it has been busy in there. We've added extra cataract days. It's just, it's been really good. Well, I do appreciate you taking time visiting with us, letting us know what's happening. And we'll keep updated with you. Got another meeting coming up here at the end of June. So we'll get an idea of how we're looking as we get into the new fiscal year. That sounds great, Jim. Thanks for having me.
About the Author
