Mikaela Kienitz, Chief Executive Officer, Boone County Hospital, Health Talk, October 30, 2026

On our program today, taking time to visit with Makayla Keynuts, Makayla, the CEO of the Boone County Hospital in Makayla. Thanks for taking time visiting with us. Thanks for having me, Jim. Well we had another regular meeting for the board and I want to point out to everybody, the next one is not going to be very regular because you hit the holiday time here. So you're going to have a meeting in December, but did have October's regular meeting and got updated on quite a few things. Yeah, we had the October meeting last week. The next meeting is December 10th. Kind of, we meet in the middle of Christmas and Thanksgiving, so that's the plan for that. But I think one of the big things at the October board meeting was that we said farewell to Troy Thompson, who's been a long-standing board member for Boone County Hospital. He started, I think in 2013 is when he first joined the board and then he was the board chair for 10 years or so before Bob took over that spot. And so we had a farewell for him and we're really grateful for all that he's done for the hospital. And he's done a lot for me too. And so, you know, I just, it's bitter sweet. I'm excited for him and his retirement, but we will miss him on the board. You got a good board member to replace him though. Exactly. We got, Jamie Ung has joined the board and I think he's going to be a great addition to our team. He had previously served on the foundation board, he's got a lot of finance and economic development background, and so he's going to bring a lot to the board too. And for those that wonder, I will say, you guys have taken from that foundation board a couple of times here. A couple of times. Yeah, it sounds like that's happened. This is the first time that we've gotten a new board member since I've been at the hospital, but I do think that prior to this, they also did take from the foundation board. So, you know, luckily the foundation board allows us to find people that are really interested in the hospital and really support our mission. And so, you know, it's kind of a natural place to look, I guess. Anyway, then the tough part now is Rachel's got to fill it, but I understand there are a couple of people that have expressed an interest in being on the board. So foundation board. Yes, I think so. I think that Jamie's wife, Sean, is one of the people I think that will possibly fill that spot on the foundation board. So they're working through that process. Well, we'll let them do it. That's the one thing that you, as the CEO, I mean, you spend time with both those boards because it's very important at least on the financial side. The board knows where the hospital's going, what the hospital board is prioritizing in the direction they're headed. Yeah, I think that is really important to the board members. We talk a lot about our building project discussion and things like that with our foundation board because it is really important that they know, you know, the vision that the hospital board sees for the organization and kind of what our next steps look like, and then they can help be supported in those efforts. Well, let's talk a little bit about some of the things from this meeting. And again, I know that in a, we'll just see how things are progressing. I think a big thing, obviously, finances, we always take a look at that. The financial, you have a finance committee that keeps updated on everything. And then the overall presentation to the board. I like to say we're looking positive, but not quite at that budgeted level yet. Yeah, I mean, it's the year starting out very similar to other years. It's a little better than last year, but it's kind of following the traditional trend. It takes a little bit for the kind of the everything to get caught up with what we planned in our budget. And I think we'll see that intersection happen probably in January or February. And that's kind of where we thought last year, too. So it takes us about six months to hit our budgeted bottom line. And then we start really seeing that growth happen. And so we're kind of following that same path this year. But, you know, it's been, it has been pretty busy this in September. The ER saw 700 patients and I don't think that's happened since 2017. So we're still seeing that growth. And I think later in the year, it'll be better reflected in the finances. Well, but the other part is if your revenues have been going up, so of your expenditures, because you are seeing those people and you are expending. Again, salaries, that's the big thing. Having, having people there to take care of. Yeah, salaries is our biggest expense. And, you know, we've taken a pretty bold approach over the last two years to improve our compensation for our staff. And so, you know, we are seeing that right now. And so you're seeing that expense. And additionally, we have some openings in our staffing. And so we've been using some traveling agency staff as well. And so that the expenses are going up just like you said, just as the same as the revenue is. And look at just so people, you know, they might think, well, how much is that? Well, total operating for September was 5.6 million. See, they need, yeah, folks, we do spend a lot of dollars to operate our, our medical facilities, but you get the revenue with it too. Yeah, exactly. I mean, I think that, you know, when we talk about last year, at the end of the year, when we talk about growth revenue, we ended the year with $113 million gross revenue. And so, you know, you're, we're going to see that continue throughout this year. And hopefully we exceed last year even, and that, that would be great for us. I think, you know, we like to see the hospital position in a, a really good spot so that we can continue to provide services to the people that we serve. I think one of those, one of the things that I want to ask in, in particular, and see what, because I'm sure you guys have had discussions about it, but we know on the political side with everything that's going on, people keep talking about the Medicaid issues that'll be coming up after the beginning of the year and stuff. What are you, what kind of concerns are we looking at, or is the board looking at, or are you being cautious about what you might be looking at as we start to see some changes in that federal level? Yeah, I think for this fiscal year, we feel pretty confident on the Medicaid directed payment, not going down at all. But next year, I think we do anticipate that there'll be a decrease in that. Um, and, and we've sort of forecasted that out and, and projected and looked at how that's going to affect us. And I think that if we continue to see, uh, growth and a lot of, um, revenue from that, uh, it will somewhat offset a bit of that, um, decrease in those payments. And so I think that we're not, we're not super concerned at this point. Of course, we don't like to see those payments go down. We do serve a lot of Medicaid population and, and we've benefited from the Medicaid directed payments. And I think a lot of that is related to our OB services. It's, it's a higher percentage of Medicaid patients in that area. And so the more that we've seen our OB grow, the more we've also seen our Medicaid directed payments grow because they're based on Medicaid utilization. So I think we're, you know, we're concerned and we're, we're staying cautiously optimistic about, um, what it's going to look like in the future, but also trying to make sure we're making plans for if that, you know, what that will look like ultimately when it, it gets down to the Medicare payment level. I know that, uh, and that's one of those things that we've seen some other larger facilities start to take steps for reductions because it depends on their specific area and what they are analyzing. For us, we're looking that we will probably have an impact, but not immediately, probably in another year or so. Yeah. That's what I think is going to happen. Um, and you know, last year I went to Washington, DC, and we were all advocating, um, for our hospitals and for those payments and how much they've really helped a lot of the rural healthcare, um, the critical access hospitals in the state of Iowa. And, um, you know, we worked really hard on that. And I think that, I think that the message was heard, but ultimately there's the, um, rural healthcare transformation program that's in place right now that's infusing a lot of money into rural healthcare, but they're just, they're not the same. Um, and so in, in our feeling, one doesn't really replace the other, but I, I feel like, um, you know, at, at the federal level, they feel like they have given a lot of money to rural healthcare. And so, you know, it's just one of those things. You just kind of have to see how things are going to play out. Well, we know that, uh, there's a couple of different things to going on. I wanted to go back to, you mentioned OB and, uh, the numbers that you're looking at for this year, obviously you had a very, very good year last year for babies being delivered at our hospital. And, uh, we do know there's still, uh, we have that, we have that higher level now and we see, because OB, uh, practice is not at every hospital now. We're seeing some patients coming here for this. Yeah, we've had quite a bit of growth in the last few years. Um, I think last year we delivered around 157 babies. And I think, um, we met with Dina, she's the director of our family birth center last week, and she told us that she feels based on, you know, what they know, because they do get a little advanced notice, um, that she thinks we'll hit the same numbers this year, if not a little bit more. And so it's been really good to see that growth. It has been a bit taxing on our providers. And so we've been doing a lot of recruitment for providers that want to do a BNC section. And so, um, it's been, it's been really good to see the growth. And we've got great staff and, and so I think patients just really enjoy the care that they get here. And there's a lot of word of mouth out there that's contributing to that growth along with, you know, our marketing efforts and things like that. But, um, really we, we do a really good job and we spend a lot of time with our patients and I think that it shows. I think on the, uh, on the other side of it, as this is going on, and you're hoping then that as these patients have their babies here, they continue to come back to see your physicians. And it looks like, uh, we have pretty active, pretty active growth in that area. Yeah, we do. And I think that, um, you know, part of the reason that we want to offer OB services is that we get to provide that sort of whole lifespan of care that way and we get to retain those patients, especially when they're pediatric. We don't lose them to, um, you know, different communities where I think we might, if they were delivering there and so that it is nice for our providers. They really enjoy doing that, that full spectrum medicine, getting to spend time with patients, families, um, the moms, the babies, the siblings. And so I think that that's, that's really, uh, sort of a specialty that we have here going on and in Boone. And it, it is really important to our providers. Well, we do know that, uh, on the provider side, we did see a shift going on with Dr. Severson, uh, we, uh, how's the, the recruitment going? I know you had, uh, had one that had already pretty much wanted to come to the Boone County hospital, another one that was considering it. Are we still on the positive side here? Yeah, we've gotten, um, two, uh, new doctors that have signed contracts. They are going to be joining us in 2028. So they're finishing up their residencies. One is going to do, um, family practice and OB, and then the other will do family practice OB and C-section. And so that those have been really great. Um, it's been really great to get those additions to our team, but I think that he's continuing to recruit and we've interviewed another physician last week. She's got another one coming in November that does, um, family practice, OB, C-section and scopes, so that she's very well rounded. So hopefully we can recruit her here. Um, so I think we're, we're, what, what's interesting is what we're seeing is a lot of the physicians that want to join us, want to do OB in some fashion. And so that's been really nice that we actually have that service and, and have, you know, that to offer them. And, and in a way, over time, I think we've talked about this before, but over time that's really helped us get a lot of our physicians because there's not a lot of places that offer that full spectrum care and they're looking for that. And so, so that's been really nice for us. Um, Dr. Sevison will move mostly to the ER starting in January. Um, she just wanted to change in her practice and I think that it will be really good for her, but she is going to continue to help us cover OB services. One kind of long weekend every month for the next two years into those, until those new grads get here and, and we're able to get them oriented and started out. So she's kind of helping to bridge the gap. Well, considering that we started building off her when she came here anyway. So, uh, yeah, she, she laid the groundwork for a lot of it. And a lot of it did attract a lot of good, uh, good providers in that area. The other one I know you're still working on and, uh, had any luck with, uh, orthopedics, uh, are, are we having any luck there? That's, that's a challenging area. It is challenging. We, um, have been working with capital orthopedics to keep Kirby here. He is the PA that's been helping out in our organization. And so he'll keep coming here to see patients and again, kind of bridging the gap and patients, you know, will have to go to broad lines to have their surgery done for while we're continuing to recruit for a full-time orthopedic surgeon. And it does take a little bit of time. I, I anticipate six months or so of, of recruiting. And so we've just started that process. So, um, I think it'll be a little bit before we actually see a candidate here. At the meantime, uh, again, working with capital, uh, so Kirby does this. You are still working with capital orthopedics down at broad lines. Yes, we are. Yeah. In the meantime, it's just, we don't get them to come here as often. Right. Well, we still have Dr. Paulson. Yes. We have Dr. Paulson and Dr. Um, Erickson does put an ankle. So we have a lot of things covered here. It's just those, um, just sort of that general orthopedics and joint replacement. So that'll be covered through the capital, um, agreement for a little bit here where Kirby will see them and he'll do, um, post-op care here too. And so patients will come here. They'll see him. They'll go to Bradley and have their surgery and then come back and see Kirby directly after. So we're maintaining everything that we can here at, at Boone while we try to do our recruitment for our full-time orthopedic surgeon, which I think will be really nice because it'll give people a lot more access to care. And we're also seeing in the specialty clinics, a couple of new faces over there. Yeah. The specialty clinic has grown. So that's been, um, really good. We've, um, been working also with Dr. Greco to try to grow our chemotherapy offerings and just seeing lots of good growth in that area. So, uh, we keep, keep working on all those things. All the things neurology is, uh, or not neurology, but, uh, nephrology. Yeah. Because, uh, you have an, you know, urologist there and, uh, he gets pretty busy from what I hear. We do have an, uh, urologist here. He comes from McFarland and he has been great. And I do think his clinic's been really busy. And so possibly at some point we'll look at trying to grow how much time he spends here. Well, we keep working on all of those things. Let's talk a little bit about all the other activities that, uh, happen. And one of those, of course, is, uh, one of the things you like to do is keep the community, uh, going out there. One of the things I did on the air when they started talking about, uh, the, uh, Medicare open enrollment and, uh, the, uh, Medicaid part D and what's shifting and different advantage plans that are changing. And what do you do? I said, call the hospital. They now have a ship counselor and that, uh, we haven't had one for a while. It's nice to have one there. I always tell people, I said, they're not going to give you, they're going to give you choices. They're not going to give you the exact answer. So they, they'll say, these are your choices. You know, this one will do this. This will do that. Yeah. They do education and that's, they try to educate folks and help folks, um, you know, so that they feel like they can make the right decisions about their, uh, plans, but interesting, we do have a new ship volunteer. Um, and we're going to have another one that's starting in January, but this open enrollment period will be over by then. But, um, we moved that person into an office and when we checked their voicemail, they had 66 voices waiting for them. So you're on air, um, message, it works. It's, it's one of those, that's a, you know, if that's what it takes, uh, unfortunately it gets so cumbersome for most people. You're looking at all these different things and just having someone help you walk through it is, that's the big thing. So it's absolutely, it's really challenging and, and you want to make sure that you're making the right decision because it's a decision that you have to live with for that next year. And so, um, I do, I am, I'm grateful that we have that service now. Obviously the need is there. And so it's, that's going to be really great. Some of the other, what are some of the other areas that we have? I know you did, uh, ladies night out, uh, that was a little earlier here this month. Uh, again, October breast cancer awareness month is, uh, again, one of the big things to build around on that. And looks like you had pretty positive turnout for that. Yeah. We had a good turnout for ladies night out. It was early in October. And I think that our physicians put together a really nice, um, presentation that a lot of people, you know, took note of and, and fat and, and listen to them talk about sort of the changes that our bodies make, you know, over time. And, and so it was really interesting. And they gave a lot of really good information for folks to take away. And then a lot of our departments had sort of, um, educational boots set up and, and people sort of made the rounds and it was a really nice event. I think we've, we saw a few more people than we had last year. So each year we're seeing a little bit of growth in that. I think this is the third year that we've done ladies night out. Um, and then in November on the 13th, we have the harvest festival coming up and the theme is around the world this year. Um, and so this is the last week to get tickets for $50. I think next week, the ticket price increases a little bit trying to encourage that early, early, um, ticket sales. And so I think Rachel is excited and has, she's done, her and her team have done a lot of, of work on this. And I think it's going to be a different event than we've ever had because there's more can be more interactive. And so I think it'll be, it'll be really good. And we're hoping a lot of people attend that. So does she have some more help, Rachel? I mean, you know, she stepped up to replace, uh, Sarah. And again, she had worked with her for a number of years. So, uh, it has a good idea about how all the things come together. But is she still, uh, getting a little bit of assistance from folks? Um, Lisa Schmidt, our marketing director and Rachel, they work pretty closely together and so they help each other quite a bit, but on the harvest festival in particular, she has a committee of volunteers from our community. There's a couple of our staff on that and they help do a lot of the planning and a lot of the, um, going out to different businesses and things like that. And so Rachel's done a really, really good job since taking over for Sarah. And, and you know, just, I, we do try to keep an eye on how much help she's going to need as we move forward and we see our events kind of growing. And we've had, you know, record number this year at every event that we've had. So I'm excited to see how harvest festival turns out and, and kind of keep, uh, you know, analyzing where she's at. The participation has, has not diminished. That's for sure. No, and that's good. We want to have that participation. We want to be meet reaching out to the people that we serve. Are we seeing, uh, again, I know because the hospital is one of the bigger employers here locally. And, uh, are we seeing a lot of the staff helping to support a lot of this as well? We have. So Rachel this year has worked pretty hard to get out to the different department meetings and try to touch base with folks. One of our goals for harvest festival this year was really to get more of our staff and our physicians, um, present at the event. And so we are seeing that staff are signing up and, and that's been exciting to see that kind of growth. And then she also has a campaign that's called be the one in 100. And so we try to, um, encourage our staff to contribute to the foundation with their paycheck and, um, you know, she's gotten a lot of folks participating in that compared to previous years. So it's been nice to, to get out to those departments and talk about what is the foundation, how can you help support it? How does the foundation give back to the hospital and help support, you know, either their area or, you know, like last year, the foundation helped support an ambulance. I think that's really helpful for the staff to understand the process and how that works. And so she's done a really good job of going out this year and talking to people. And I think that's helped encourage people to sign up to contribute and they can contribute from, you know, any amount they want, they can contribute from $1 to $100 to $200, whatever they want to do. Um, we are happy to have them all participating. Well, before I let you go and we run out of time, do you want to remind people that, uh, in many of them have probably voted early? Cause I know a lot of people do and go out and vote early. But when you turn that ballot over, look for those hospital board members. We have four incumbents that are seeking reelection, uh, Brian Reimers, Lisa Cobertus, Meredith Nerum and Bob Getchman, uh, now chairman of the board. So, uh, don't forget to, uh, cast your vote. They're non-partisan folks. It's a non, the non-partisan part of the ballot. It's the people that spend time. And I want to say, uh, it's not like highly reimbursed. Shall I, I'll be confident in saying that they don't get reimbursed at all. They are so giving up their time. And I was going to say, yeah, bad school board members, nobody, they don't get paid. I know. And it's, it sounds maybe like it doesn't take a lot of time, but it, they do. They, they give a lot of their time to the hospital or the school, whichever, um, entity they're supporting, you know, they give a lot of time and effort and energy. And I am extremely grateful for our board members. They do a lot to help the organization move forward and, and to support me and to support our teams. And they're just amazing people. And so yes, please think of them when you're voting. And, uh, by the way, yes, they do a lot of continuing education board training too. They do, they do a lot of that. So, uh, there's a lot more time that a lot of people think when they just say, wow, the hospital board know a lot of big responsibility there because it is one of our biggest operations. As you said, uh, what was it revenues? A hundred 13 million last year. Yeah. A hundred and 13 million. Yeah. That's a, that's a big number. Big numbers to work with too. Hey, I appreciate you taking time visiting, uh, December 10th, right? Yes, that's the next meeting next meeting. And, uh, we'll, uh, make arrangements to visit after that. Thanks. Sounds good. Thank you, Jim.