The Kiowa District Hospital is a tax-supported entity that relies on local and county taxes and also reimbursement through Medicare. As a small rural hospital, KDH has status as a Critical Access Hospital. Those reimbursement rates vary based on a healthcare facility's volume of business in a complicated formula. Critical Access Hospitals see a larger reimbursement rate per patient service to offset less volume than a larger urban facility.

At the late October regular monthly meeting of the KDH board of directors CFO Janell Goodno had arranged a phone call with their auditor BKD. The BKD representative on the phone was Casey Johnson who discussed the hospital's interim cost report. This helps determine reimbursement rates.

The auditor's call revealed KDH is currently in a payable status to Medicare near the million dollar mark. KDH and the auditor are working on ways to offset that payable such as equipment purchases, supply costs, etc.

Goodno said the Medicare rate fluctuations are due to KDH's “rollercoaster in our volume.” To make her point, Goodno said reimbursement was some $6,000 per day with rate changes in September. After filing a cost report, KDH got the rates reduced to $4,600 per day for acute care and $4,300 for skilled care. In Medicare's attempt to recoup some of the hospital's payable status, reimbursement rates were reduced to $1,500 for acute and $1,491 for skilled, Goodno said.

However, the auditor said that as of Jan. 1, 2019, KDH Medicare rates are set to again increase. Goodno provided the board with those reimbursement rate changes for all services provided.

KDH Statistics and Financials

Goodno gave statistics for September 2018. Total hospital admissions were 18 with 81 total days of acute and swingbed care. Of that total 65 days were swingbed.

The hospital had 526 total outpatient visits and 338 clinic visits in September. The manor's patient census was 24 on Oct. 25.

For the hospital in September they had total contractual adjustments of $267,020, that made net patient revenue $643,405. That equated to $655,910 total operating revenue.

The hospital's operating expenses show a reduction in Cohesive's management fee, larger payments than usual for electronic health records due to the conversion costs with Cerner, etc. Total operating expenses were $654,474. So the hospital showed a gain of $1,435.

Adding in $80,047 of mainly tax revenue, the hospital was in the black by $81,482 at the end of September.

The manor had total operating revenue of $141,671. Total operating expenses were $127,040 for a gain of $14,631. With the addition of $5332 mainly tax revenue, the manor ended the month in the black $19,963.

The board gave manor administrator John Fonang a round of applause for a good job financially and also for using zero agency nursing care, which is more expensive. This positive figure helps the manor's overall loss for the year of $66,883 which Goodno pointed out is “much better than last year” when the manor's loss was $337,619.

The combined hospital and manor balance sheets at the end of September showed total combined loss at $232,163.

Goodno pointed out that KDH has seen a nice reduction in accounts receivable with the net figure $656,340 at the end of September.

The board approved all the financial information.