By Bob Steenson, firstname.lastname@example.org
It’s not official yet, but the Board of Supervisors tentatively agreed Monday morning to contribute $250,000 to the Floyd County Medical Center to help the hospital meet a financial challenge.
The hospital had asked for $500,000, citing changes in the state’s Medicaid system management that had reduced reimbursements by more than $740,000 between the fiscal year that ended June 30, 2018, and the previous fiscal year that ended June 30, 2017.
“In a nutshell, the reduction in Medicaid reimbursement wiped out our bottom line,” Rod Nordeng, medical center administrator, had said previously.
As of Dec. 31, the county hospital had about $86,000 of operating cash on hand, or about enough to cover 1.1 days of expenses, he said. Most other Iowa county hospitals have 80 to 100 days of operating cash on hand.
Supervisors have been struggling with how to deal with the hospital’s funding request. After a $100,000 request last year, the board decided to not give the hospital anything.
This year, supervisors said, they wanted to give the hospital something to show their support, but didn’t think they could approve the entire $500,000 request.
For about two decades, the hospital has not asked for any funding from the county, Nordeng has said, and Floyd County Medical Center is currently the only county hospital in the state that does not receive county funding.
That has been a point of pride for the hospital, Nordeng said, but now the change in Iowa to privatized Medicaid management and the reduction in reimbursements has caused a shortfall the hospital can’t quickly deal with.
At the Board of Supervisors planning session Monday morning, the supervisors said they support the hospital, but questioned what was going to change in the future to stop the financial shortfall.
“I’m just not seeing the plan for the future,” said Supervisor Linda Tjaden. “That’s my biggest concern. Anybody in a business situation, if you’re in that situation now you need a plan to try to resolve it, or at least work toward it.”
Supervisor Chairman Doug Kamm said, “If we give that to them, do they just continue business as they are? When you’re in a small business and you don’t have any cash, you change things. Are they going to change things?”
Tjaden said, “It’s good that we’re going to be showing the hospital we do care about them. We do. But again, if we don’t resolve some of the issues, or try to at least get toward a future plan, this is going to be an ongoing, every-year thing.”
Contacted after the supervisors’ meeting, Nordeng told the Press, “I think we have been making the necessary changes in cost reduction.”
That included closing the Nashua Clinic, transferring the operation of the Meals on Wheels program to another community group, and making reductions in staff, he said.
“But we’re also proactively looking at new sources of services and revenue,” Nordeng said, pointing to the recent hire of a certified nurse midwife to attract more obstetrics patients to the hospital and provide more women’s health care at the clinic, the addition of vein procedures in the operating room that will quickly pay for the equipment that was needed, and the addition of a diabetes educator.
These programs are meeting unmet needs in the community and are new sources of revenue, he said.
“We appreciate the support from the supervisors,” Nordeng said. “We recognize they’re in a challenging situation. We’ll continue to look for opportunities to increase revenue and service and areas where we can reduce cost.”
Supervisor Tjaden said she was concerned that the hospital administration didn’t seem to be working to resolve the state managed care operators situation that it says is the major cause of its financial problem.
“I’m not seeing anything like, ‘We’re manning the troops, we’re going to tackle those issues,’” she said. “I just didn’t hear that.”
Tjaden said she had been in touch with area legislators Sen. Waylon Brown, R-St. Ansgar, and Rep. Todd Prichard, D-Charles City, and they said they were trying to work on issues that health care providers have identified in the state’s new private Medicaid management system, but she also said that Brown, who is in the majority party, told her he isn’t optimistic changes will take place.
Supervisor Roy Schwickerath said it’s time for the hospital to begin discussing a change from its current status as a memorial hospital, run by a board of commissioners who are appointed, to a county hospital managed by a board of directors who are elected by the voters. Such a board would have the power to levy taxes on its own to support the hospital.
Schwickerath made the point that deciding on county funding for the hospital is only one part of the many duties of the Board of Supervisors. If a voter doesn’t like the decision a supervisor makes regarding hospital funding, that’s only a small part of his or her job.
A hospital board of directors would be directly responsible to the voters for any decisions it makes regarding hospital management or tax-supported funding, he said.
It would take approval at a county-wide vote to make the change in status, Nordeng has said previously.
“I for one will support figuring out what we have to do to change their status,” Schwickerath said Monday. “If we need to do that, we do. Somebody’s gotta put it on the ballot.”
Tjaden said she would confer with the county attorney regarding the procedure required to change status from a memorial hospital.
Supervisors continue to work on the county budget for the next fiscal year that will begin July 1, and no final decisions on funding or tax rates have been made yet.
Also at the meeting Monday morning, the board:
• Discussed the process to hire a full-time IT (information technology) person for the county. The county will begin advertising for the position soon, with the hope that someone can be found to begin work in the next couple of months.
• Heard an update on the county law enforcement center and courthouse updates project. Tjaden said the construction manager, Samuels Group, is ready to present a revised project cost estimate to the project core group — Tjaden, County Auditor Gloria Carr and County Sheriff Jeff Crooks — possibly yet this week.
If the project cost estimate is above the $13.5 million approved by county voters last year — as preliminary estimates have been because of changes in the courthouse part of the project — the Board of Supervisors will need to make decisions on additional funding sources and/or project priorities.