During his financial report to the Lake Health District Board, LHD CEO Charlie Tveit noted that December had seen a loss of $1.2 million. Multiple Board members expressed concern with the loss and the issues that contributed to it.
Tveit told the Board that the deficit was largely due to challenges with patient collections brought on by the transition to a new information system and difficulties brought on by COVID.
“I think it’s probably helpful to understand how much COVID has impacted us,” Tveit said, noting that the local population’s “reluctance” to visit the Hospital has had perhaps the most significant impact.
The downturn is evident in the Hospital’s numbers year-over-year. Lab volume was down 31% in 2020 compared to 2019, rehab patients down 20%, and Wellness Center patients down 16%.
If patients don’t visit the Hospital’s clinic, Tveit explained, then LHD doctors aren’t able to identify cases in need of treatment. And if a patient who does not visit a clinic gets sick enough to visit the ER, sometimes their ailment has progressed beyond what LHD is able to handle. In those cases, the person must be sent to St. Charles Hospital in Bend. Such factors have a negative impact on LHD’s volume and revenue.
Patient charges in December 2020 were not dismal, but Tveit said they were not as much as LHD expected. Additionally, while the District saw “a good bump” in its days cash on hand in November, such was not the case in December.
“Part of that is the holidays and people spending money on other things,” Tveit posited.
But he believes it was LHD’s transition to Cerner, a new hospital information system, that created the steepest uphill climb for revenue generation.
“When we took on the Cerner transition, the revenue cycle team had to use two different systems to collect money,” he described. There were also some cases where LHD did not collect at all.
Tveit added bluntly, “In some cases, the employees that helped us get behind where we need to be — they don’t work for us anymore.”
He called the end of 2020 “ a clean-up time” for the Health District as employees worked to solidify the transition to Cerner and be sure due diligence was being done to follow up with patients and insurance and collect on accounts.
Despite the factors that led to the deficit, Tveit acknowledged, “We are well aware that this is not what we want to see.”
Board Treasurer John Shine expressed, “What concerns me is, looking back over the last several years, we’ve never had a month like that. This is a significant hit. It does concern me. I hope this is a catch-up month, but some of this is financial mismanagement.”
Shine stressed the importance of the process that occurs after a patient is seen to be sure charges are billed timely and then followed through to collection.
“I’d like you to get back to us in two weeks telling us what this was. And one of the nice things about Cerner is it has a bunch of dashboards,” Shine told Tveit.
“You’re right on,” Tveit responded. He said one of the most difficult factors in that process happens when physicians do not get their charting done quickly after seeing a patient, which delays the entire process and then delays the revenue cycle.
On the flip side, he pointed out, “We want doctors to take care of all our patients. If we demand they spend all their time on record keeping, then they’re not able to see as many patients. This is a problem with all health care facilities.”
Board Sec. Jerald Steward said since he has been on the board, LHD has had “four or five business managers,” something he believes has played a role in the revenue challenges.
Shine said LHD must get better at billing insurance and patients in a timely fashion. Referring to the December deficit, he said, “This is what happens when you’re not good at it.”
Tveit immediately responded, “This is what happens when you clean up after a long time.” He said LHD’s physicians have reported that Cerner is difficult to use and that the number of clicks required to input information is “onerous.”
LHD faces the added challenge of currently being without a chief financial officer. Cheryl Cornwell, who served as LHD CFO for seven years, resigned in late 2020 and moved to Washington to be closer to family.
LHD Revenue Cycle Mgr. Susan Pointere offered a positive look at the situation. While she conceded that $1.2 million is “a staggering loss,” she said LHD has “gained so much knowledge moving forward” now that the initial challenges and difficult transition to Cerner have been surmounted.
“We can drill down to who has how many outstanding charts” in order to resolve some of the billing and collection issues, she said. “We are all working hard together and seeing huge amounts of success in our departments. I think everyone is seeing how critical it is to get that information in, in a timely fashion.”
She said the large revenue loss for December is mostly due to billing issues with the former system, which have now been resolved.
LHD is anticipating an additional $2 million dollars coming in around April or May in the form of government reimbursement for expenditures during COVID.
The Board directed Tveit to determine which of Cerner’s dashboards have the most useful information for determining the success and follow-through of charting, billing and revenue.
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