NOTICE OF REGULAR BOARD MEETING OF

NOTICE OF REGULAR BOARD MEETING OF THE UPPER SAN JUAN HEALTH SERVICE DISTRICT dba PAGOSA SPRINGS MEDICAL CENTER

Tuesday, October 15, 2019, at 5:30 PM The Board Room (direct access – northeast entrance)

95 South Pagosa Blvd., Pagosa Springs, CO 81147

AGENDA

1) CALL TO ORDER; ADMINISTRATIVE MATTERS OF THE BOARDa) Confirmation of quorumb) Board member self-disclosure of actual, potential or perceived conflicts of interestc) Approval of the Agenda (and changes, if any)

2) PUBLIC HEARING ON THE PROPOSED 2020 BUDGET FOR USJHSDa) Open the Public Hearing on the proposed 2020 budget

i) CEO direction for 2020ii) CFO’s overview of the budgetiii) Questions/comments of the Boardiv) Questions/comments of the public

b) Close the Public Hearing

3) PUBLIC COMMENT (This is an opportunity for the public to make comment and/or address USJHSDBoard. Persons wishing to address the Board need to notify the Clerk to the Board, Heather Thomas, prior tothe start of the meeting. All public comments shall be limited to matters under the jurisdiction of the Boardand shall be expressly limited to three (3) minutes per person. The Board is not required to respond to ordiscuss public comments. No action will be taken at this meeting on public comments.)

4) REPORTSa) Oral Reports (may be accompanied by a written report)

Chair Greg Schulte Dir. Kate Alfred and Dir. Karin Daniels Dir. Dr. Jim Pruitt and Dir. Karin Daniels Chief Executive Officer, Dr. Rhonda Webb

i) Chair Reportii) Contractsiii) Strategic Planningiv) CEO Reportv) Finance Report CFO, Chelle Keplinger and Treasurer, Dr. Campbell

b) Written Reports (no oral report unless the Board has questions)COO-CNO, Kathee Douglas i) Operations Report

ii) Medical Staff Report Chief of Staff, Dr. Ralph Battels

5) CONSENT AGENDA (The Consent Agenda is intended to allow Board approval, by a single motion, of

matters that are considered routine. There will be no separate discussion of Consent Agenda matters unless

requested.)

a) Approval of Board Member absences:

i) Regular meeting of 10/15/2019

b) Approval of Minutes for the following meeting(s):

i) Regular meeting of: 08/27/2019

c) Approval of Medical Staff report recommendations for new or renewal of provider privileges.

6) DECISION AGENDA (Matters to be discussed and possible action by the Board)

7) EXECUTIVE SESSIONThe Board reserves the right to meet in executive session for any other purpose allowed pursuant to C.R.S.

Section 24-6-402(4) and such topic is announced at open session of the meeting.

8) OTHER BUSINESS

9) ADJOURN

USJHSD FY 2020 Assumptions for Proposed Budget - UPDATED USJHSD Board Packet, 10-15-2019

Page 1 of 3

PUBLIC HEARING 2.a.


Page 2 of 3

PUBLIC HEARING 2.a.


Page 3 of 3

PUBLIC HEARING 2.a.

USJHSD Proposed Budget - UPDATED USJHSD Board Packet, 10-15-2019

Page 1 of 7

PUBLIC HEARING 2.a.


Page 2 of 7

PUBLIC HEARING 2.a.


Page 3 of 7

PUBLIC HEARING 2.a.


Page 4 of 7

PUBLIC HEARING 2.a.


Page 5 of 7

PUBLIC HEARING 2.a.


Page 6 of 7

PUBLIC HEARING 2.a.


Page 7 of 7

PUBLIC HEARING 2.a.

ORAL REPORTS 4.a.i.

USJHSD Finance Report USJHSD Board Packet, 10-15-2019

Page 1 of 1

Finance Committee & CFO Report, USJHSD Board Meeting on October 15, 2019

This report provides highlights of PSMC’s August financials and the discussions of the Board’s Finance Committee

that met on September 17, 2019.

1) August Bottom Line: PSMC had a total net gain of $79,451 in August. This net gain is actually a good result

given that August had a very high budgeted expense due to three payrolls and deductions to revenue for charity

care and bad debt were twice higher than budget. PSMC was able to have a net gain for the month by meeting

budget on expenses and exceeding budget on gross revenues. PSMC’s August financials were:

a) $5,719,164.00 in gross revenue (exceed budget by $350K);

b) $638.00 in net revenue (net revenue it the gross revenue after deductions for charity care, bad debt and

contractual deductions of payers - Medicare, Medicaid and commercial insurers);

c) $79,451.00 in net income (net revenue plus grants/donations/340b and less expenses)

d) $660,422.00 net gain year-to-date in 2019. PSMC’s total net gain year-to-date of $660,422, which is less

than budget but slightly exceeds 2018 YTD.

2) Revenues: Outpatient revenue was in excess of budget.

3) Deductions to Gross Revenues for Payer Contractuals, Charity and Bad Debt: Each month PSMC has

deductions to its revenue for bad debt, charity care as well as deductions made by third-party payers (Medicare

and commercial insurers) that are referred to as payer contractuals. Deductions for the month of August were

15% above budget. Year to date, PSMC’s charity care and contractual deductions by payers has greatly

exceeded budget resulting in a little more than 2 million greater deductions to PSMC revenue than budgeted.

4) Expenses: PSMC continued to do a good job holding down expenses, although we were flat with budget for

the month of August, year-to-date, expenses continue to be under budget by 2% (which is nearly $500,000).

August was a month with three payrolls – this happens twice a year and those months have a particularly high

expense.

5) Cash and collections:

a) PSMC increased operating cash from $5.1 MM in July 2019 to $5.2MM in August of 2019. This is not a

large increase but we did have a cash outlay of three payrolls in August so the increase was good.

b) Patient collections were $3.04 MM for the month, 63K less than forecasted. It is a priority for us to collect

co-pays and deductibles at the time of service.

c) As of the end of August, PSMC is at 58 days of gross A/R; and PSMC’s gross accounts receivable balance

decreased $600K to $10.64 MM. We continue diligently working the A/R and are hitting some targets

that we not did expect to hit until December.

6) Progress Report Re Consultant’s Recommendations to Increase Days of Cash: PSMC presented and

discussed in depth with the Finance Committee the status of progress on the consultant’s recommendations.

Per direction of the Board, until the goals are met, staff will provide the Board with a written monthly report

and an oral report quarterly (in May, August, & November).

ORAL REPORTS 4.a.v.

FINANCIAL PRESENTATION

YTD AUGUST 2019

ORAL REPORTS 4.a.v.

1

Summary of Financials

July YTD

Gross Revenue $ 35,026,226

Net Revenue $ 18,380,406 52.48%

Expenses $ 20,485,173

Grants, 340B and Tax Revenue $ 2,685,738

Grants and 340B $ 1,596,474

Tax Revenue $ 1,089,264

Net Income $ 580,971

GROSS REVENUE

07,500,000

15,000,00022,500,00030,000,00037,500,00045,000,000

YTD

40,745,389 39,686,52938,060,619

Actual Budget Prior Year

- 2,000,000 4,000,000 6,000,000 8,000,000

10,000,000

August

5,719,164 5,368,362 5,189,510

Budget Prior Year

350,802

6.53%

529,654

10.21%

1,058,860

2.67%2,684,770

7.05%

Actual

ORAL REPORTS 4.a.v.

2

GROSS REVENUE

$3,300,000

$3,600,000

$3,900,000

$4,200,000

$4,500,000

$4,800,000

$5,100,000

$5,400,000

$5,700,000

$6,000,000

$6,300,000

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

FY 2019 FY 2018 FY 2017 FY 2016

NET PATIENT REVENUE

04,000,0008,000,000

12,000,00016,000,00020,000,00024,000,00028,000,00032,000,00036,000,00040,000,000

YTD

21,398,534 22,451,229

20,714,718

- 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000

August

3,018,228 3,017,590 2,704,216

Prior Year

638

0%

-314,012

-11.61%

-1,052,695

-4.69%

683,816

3.30%

Actual Budget


ORAL REPORTS 4.a.v.

3

NET REVENUE

$1,000,000

$1,250,000

$1,500,000

$1,750,000

$2,000,000

$2,250,000

$2,500,000

$2,750,000

$3,000,000

$3,250,000

$3,500,000

$3,750,000

$4,000,000

$4,250,000

$4,500,000


FY 2019 FY 2018 FY 2017 FY 2016

EXPENSES

04,000,0008,000,000

12,000,00016,000,00020,000,00024,000,00028,000,00032,000,000

YTD

23,699,527 24,178,435 23,141,809

- 750,000

1,500,000 2,250,000 3,000,000 3,750,000 4,500,000

August

3,214,354 3,212,373 2,889,789

1,981

0%

324,565

11.23%

-478,908

-1.98%

557,718

2.41%



ORAL REPORTS 4.a.v.

4

EXPENSES

$-

$250,000

$500,000

$750,000

$1,000,000

$1,250,000

$1,500,000

$1,750,000

$2,000,000

$2,250,000

$2,500,000

$2,750,000

$3,000,000

$3,250,000

$3,500,000

$3,750,000

$4,000,000


FY 2019 FY 2018 FY 2017 FY 2016

NET INCOME

(1,000,000) -

1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000

YTD

660,422

1,770,911

622,130

- 500,000

1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000

August

79,451 206,034

47,530

-1,110,489

-62.71%

38,292

6.16%



ORAL REPORTS 4.a.v.

5

NET INCOME

$(600,000)

$(350,000)

$(100,000)

$150,000

$400,000

$650,000

$900,000

$1,150,000

$1,400,000

$1,650,000

$1,900,000

$2,150,000

$2,400,000

$2,650,000

$2,900,000

$3,150,000


FY 2019 FY 2018 FY 2017 FY 2016 FY 2015

Summary of Financials

August YTD

Gross Revenue $ 40,745,389

Net Revenue $ 21,398,634 52.52%

Expenses $ 23,699,527

Grants, 340B and Tax Revenue $ 2,961,315

Grants and 340B $ 1,815,991

Tax Revenue $ 1,145,324

Net Income $ 660,422

ORAL REPORTS 4.a.v.

6

DAYS IN ACCOUNTS

RECEIVABLE

0

10

20

30

40

50

60

70

80

90

100

Jun-18 Aug-18 Oct-18 Dec-18 Feb-19 Apr-19 Jun-19 Aug-19

71.9 72.2 70.2 69.4 70.1 70.5 76.6 76.5 76.3

78.4

69.9 68.6 69.6

61.4 58.0 60.0 58.0

53.0 54.0 54.0 53.0

61.0 57.0

62.0 65.0

53.0 49.0

54.0 53.0 49.0

Gross Net

DAYS CASH ON HAND

0

10

20

30

40

50

60

70

80

90

100

Jan-18 Apr-18 Jul-18 Oct-18 Jan-19 Apr-19 Jul-19

48.6 49.4

44.3 45.1 40.7

33.9

43.0 38.8 40.2

43.2 48.9

52.4

38.3 41.2

36.4

47.4 50.3

39.3

46.1 46.8

ORAL REPORTS 4.a.v.

7

CASH COLLECTIONS

$-

$250,000

$500,000

$750,000

$1,000,000

$1,250,000

$1,500,000

$1,750,000

$2,000,000

$2,250,000

$2,500,000

$2,750,000

$3,000,000

$3,250,000

$3,500,000

$3,750,000

$4,000,000


FY 2019 FY 2018 FY 2017

ORAL REPORTS 4.a.v.

Page 1

2019 Budget Difference Variance 2019 Budget Difference VarianceRevenue

2 In-patient Revenue

3 In-Patients 285,857$ 362,600$ (76,743)$ -21% 2,512,444$ 2,574,460$ (62,016)$ -2%

4 Central Supply 4,438$ 132,610$ (128,172)$ -97% 747,996$ 941,531$ (193,535)$ -21%

5 Surgery 26,224 90,529$ (64,305)$ -71% 427,001 704,116$ (277,115)$ -39%

6 Swing Beds 1,424 - 1,424 13,866 - 13,866

7 Total In-patient Revenue 317,943 585,739 (267,796) -46% 3,701,307 4,220,107 (518,800) -12%

8 Out-patient Revenue

9 ER 908,448 799,803 108,645 14% 6,478,714 6,131,823 346,891 6%

10 Lab 582,708 588,348 (5,640) -1% 4,134,822 4,445,296 (310,474) -7%

11 Ambulance 221,524 249,910 (28,386) -11% 1,458,161 1,749,370 (291,209) -17%

12 Clinic 434,058 407,844 26,214 6% 3,293,235 2,945,540 347,695 12%

13 Imaging 926,811 987,507 (60,696) -6% 6,960,308 7,511,493 (551,185) -7%

14 Central Supply 228,089 148,455 79,634 54% 1,371,845 1,105,165 266,680 24%

15 Surgery 455,612 280,246 175,366 63% 2,749,924 2,086,276 663,648 32%

16 Oncology 402,050 217,656 184,394 85% 2,014,386 1,877,283 137,103 7%

17 Other 574,065 580,706 (6,641) -1% 3,969,966 3,714,687 255,279 7%

18 Total Out-patient Revenue 4,733,365 4,260,475 472,890 11% 32,431,361 31,566,933 864,428 3%-

19 Professional Fees 667,856 522,148 145,708 28% 4,612,721 3,899,489 713,232 18%-

20 Total Patient Revenue 5,719,164 5,368,362 350,802 7% 40,745,389 39,686,529 1,058,860 3%

21 Revenue Deductions & Bad Debt

22 Contractual Allowances 2,555,793 2,396,384 159,409 7% 19,142,706 17,715,676 1,427,030 8%

23 Charity 81,289 33,131 48,158 145% 663,253 244,928 418,325 171%

24 Bad Debt 311,011 157,014 153,997 98% 1,633,125 1,160,752 472,373 41%

25 Provider Fee & Other (247,157) (235,757) (11,400) 5% (2,092,329) (1,886,056) (206,273) 11%

26 Total Revenue Deductions & Bad Debt 2,700,936 2,350,772 350,164 15% 19,346,755 17,235,300 2,111,455 12%

27 Total Net Patient Revenue 3,018,228 3,017,590 638 0% 21,398,634 22,451,229 (1,052,595) -5%

28 Grants - 180,000 (180,000) -100% 82,380 855,116 (772,736) -90%

29 Other Operating Income - Misc 219,517 152,103 67,414 44% 1,733,611 1,351,153 382,458 28%

30 Total Net Revenues 3,237,745 3,349,693 (111,948) -3% 23,214,625 24,657,498 (1,442,873) -6%

31 Operating Expenses

32 Salary & Wages 1,612,709 1,675,379 (62,670) -4% 12,455,866 12,660,578 (204,712) -2%

33 Benefits 372,430 338,551 33,879 10% 2,181,336 2,410,440 (229,104) -10%

34 Professional Fees 12,486 20,523 (8,037) -39% 183,046 159,170 23,876 15%

35 Contract Labor 24,361 31,168 (6,807) -22% 163,085 248,853 (85,768) -34%

36 Purchased Services 159,311 160,359 (1,048) -1% 1,298,593 1,232,406 66,187 5%

37 Supplies 507,295 455,540 51,755 11% 3,129,475 3,278,198 (148,723) -5%

38 Rent & Leases 38,263 47,846 (9,583) -20% 355,349 382,603 (27,254) -7%

39 Repairs & Maintenance 46,326 51,670 (5,344) -10% 363,090 408,977 (45,887) -11%

40 Utilities 32,661 40,072 (7,411) -18% 335,212 321,884 13,328 4%

41 Insurance 29,743 17,501 12,242 70% 213,849 140,005 73,844 53%

42 Depreciation & Amortization 152,673 162,168 (9,495) 1,256,571 1,253,101 3,470 0%

43 Interest 88,826 86,243 2,583 3% 725,393 689,944 35,449 5%

44 Other 137,270 125,352 11,918 10% 1,038,662 992,276 46,386 5%

45 Total Operating Expenses 3,214,354 3,212,373 1,981 0% 23,699,527 24,178,435 (478,908) -2%

46 Operating Revenue Less Expenses 23,391 137,320 (113,929) -83% (484,902) 479,063 (963,965) -201%

47 Non-Operating Income

48 Tax Revenue 56,060 47,880 8,180 17% 1,145,324 1,125,180 20,144 2%

49 Donations - 20,834 (20,834) -100% - 166,668 (166,668) -100%

50 Total Non-Operating Income 56,060 68,714 (12,654) -18% 1,145,324 1,291,848 (146,524) -11%

51 Total Revenue Less Total Expenses 79,451$ 206,034$ (126,583)$ -61% 660,422$ 1,770,911$ (1,110,489)$ -63%

Current Month Year-to-Date

Income Statement - - - August 31, 2019

Pagosa Springs Medical CenterORAL REPORTS 4.a.v.

Page 2

2019 2018 Difference Variance 2019 2018 Difference Variance

Revenue

2 In-patient Revenue

3 In-Patients 285,857$ 350,236$ (64,379)$ -18% 2,512,444$ 2,455,799$ 56,645$ 2%

4 Central Supply 4,438$ 105,905$ (101,467)$ -96% 747,996$ 1,007,841$ (259,845)$ -26%

5 Surgery 26,224 65,452$ (39,228)$ -60% 427,001 609,378$ (182,377)$ -30%

6 Swing Beds 1,424 - 1,424 13,866 - 13,866

7 Total In-patient Revenue 317,943 521,593 (203,650) -39% 3,701,307 4,073,018 (371,711) -9%

7 Out-patient Revenue

8 ER 908,448 830,366 78,082 9% 6,478,714 5,978,824 499,890 8%

9 Lab 582,708 557,588 25,120 5% 4,134,822 4,223,072 (88,250) -2%

10 Ambulance 221,524 244,268 (22,744) -9% 1,458,161 1,591,052 (132,891) -8%

11 Clinic 434,058 465,041 (30,983) -7% 3,293,235 3,064,598 228,637 7%

12 Imaging 926,811 1,021,273 (94,462) -9% 6,960,308 7,084,233 (123,925) -2%

13 Central Supply 228,089 118,619 109,470 92% 1,371,845 1,794,836 (422,991) -24%

14 Surgery 455,612 260,804 194,808 75% 2,749,924 1,284,746 1,465,178 114%

15 Oncology 402,050 174,829 227,221 130% 2,014,386 1,464,432 549,954 38%

16 Other 574,065 555,212 18,853 3% 3,969,966 3,905,113 64,853 2%

17 Total Out-patient Revenue 4,733,365 4,228,000 505,365 12% 32,431,361 30,390,906 2,040,455 7%

- -

18 Professional Fees 667,856 439,917 227,939 52% 4,612,721 3,596,695 1,016,026 28%

- -

19 Total Patient Revenue 5,719,164 5,189,510 529,654 10% 40,745,389 38,060,619 2,684,770 7%

20 Revenue Deductions & Bad Debt

21 Contractual Allowances 2,555,793 2,490,732 65,061 3% 19,142,706 17,432,552 1,710,154 10%

22 Charity 81,289 83,759 (2,470) -3% 663,253 330,854 332,399 100%

23 Bad Debt 311,011 261,111 49,900 19% 1,633,125 1,152,649 480,476 42%

24 Provider Fee & Other (247,157) (350,308) 103,151 -29% (2,092,329) (1,570,154) (522,175) 33%

25 Total Revenue Deductions & Bad Debt 2,700,936 2,253,241 447,695 20% 19,346,755 17,345,901 2,000,854 12%

2,485,294

26 Total Net Patient Revenue 3,018,228 2,704,216 314,012 12% 21,398,634 20,714,718 683,916 3%

27 Grants - - - 82,380 133,159 (50,779) -38%

28 Other Operating Income - Misc 219,517 189,628 29,889 16% 1,733,611 1,650,915 82,696 5%

29 Total Net Revenues 3,237,745 2,893,844 343,901 12% 23,214,625 22,498,792 715,833 3%

30 Operating Expenses

31 Salary & Wages 1,612,709 1,572,089 40,620 3% 12,455,866 12,348,256 107,610 1%

32 Benefits 372,430 261,441 110,989 42% 2,181,336 2,091,140 90,196 4%

33 Professional Fees 12,486 9,759 2,727 28% 183,046 144,439 38,607 27%

34 Contract Labor 24,361 54,745 (30,384) -56% 163,085 352,781 (189,696) -54%

35 Purchased Services 159,311 128,607 30,704 24% 1,298,593 1,002,177 296,416 30%

36 Supplies 507,295 348,229 159,066 46% 3,129,475 2,915,529 213,946 7%

37 Rent & Leases 38,263 35,445 2,818 8% 355,349 363,351 (8,002) -2%

38 Repairs & Maintenance 46,326 32,788 13,538 41% 363,090 338,886 24,204 7%

39 Utilities 32,661 34,752 (2,091) -6% 335,212 264,820 70,392 27%

40 Insurance 29,743 13,552 16,191 119% 213,849 122,134 91,715 75%

41 Depreciation & Amortization 152,673 175,054 (22,381) -13% 1,256,571 1,570,821 (314,250) -20%

42 Interest 88,826 87,611 1,215 1% 725,393 704,833 20,560 3%

43 Other 137,270 135,717 1,553 1% 1,038,662 922,642 116,020 13%

44 Total Operating Expenses 3,214,354 2,889,789 324,565 11% 23,699,527 23,141,809 557,718 2%

45 Operating Revenue Less Expenses 23,391 4,055 19,336 477% (484,902) (643,017) 158,115 -25%

46 Non-Operating Income

47 Tax Revenue 56,060 41,479 14,581 35% 1,145,324 1,138,564 6,760 1%

48 Donations - 1,996 (1,996) -100% - 126,583 (126,583) -100%

49 Total Non-Operating Income 56,060 43,475 12,585 29% 1,145,324 1,265,147 (119,823) -9%

50 Total Revenue Less Total Expenses 79,451$ 47,530$ 31,921$ 67% 660,422$ 622,130$ 38,292$ 6%

Pagosa Springs Medical Center

Income Statement Comparison - - - August 31, 2019Current Month Year-to-Date

ORAL REPORTS 4.a.v.

Page 3

Current Prior Current Prior

1 Assets Month Month Liabilities Month Month

2 Current Assets Current Liabilities

3 Cash

4 Operating 3,114,204$ 3,041,457$ Accts Payable - System 639,007$ 397,312$

5 Debt Svc. Res. 2016 Bonds 878,731 878,731 Accrued Expenses 1,253,287 1,205,439

6 Bond Funds - 2016 Bonds 106 106 Cost Report Settlement Res 1,096,049 1,073,378

7 Bond Funds - 2006 1,205,695 1,169,004 Wages & Benefits Payable 807,418 1,394,995

8 Capital Escrow - - Deferred Revenue 1,500 1,500

9 Total Cash 5,198,736 5,089,298 Current Portion of LT Debt-2006 320,000 320,000

10 Current Portion of LT Debt-2016 320,000 320,000

11 Accounts Receivable Total Current Liabilities 4,437,260 4,712,624

12 Patient Revenue - Net 4,721,499 4,939,510

13 Other Receivables 306,229 323,937 Long-Term Liabilities

14 Total Accounts Receivable 5,027,728 5,263,447 Leases Payable 239,410 247,932

15 Equipment Lease (Wells Fargo) 284,579 292,798

16 Inventory 1,564,644 1,557,213 Bond Premium (Net) - 2006 236,890 238,003

17 Bond Premium (Net) - 2016 135,942 136,366

18 Total Current Assets 11,791,108 11,909,958 Bonds Payable - 2006 8,705,000 8,705,000

19 Bonds Payable - 2016 9,920,000 9,920,000

20 Fixed Assets Total Long-Term Liabilities 19,521,821 19,540,099

21 Property Plant & Equip (Net) 8,632,395 8,779,557

22 Electronic Health Record (Net) 8,205 9,437 Net Assets

23 Clinic Expansion 13,377,405 13,377,405 Un-Restricted 9,745,929 9,745,929

24 Work In Progress 59,755 48,962 Current Year Net Income/Loss 660,422 580,971

25 Land 101,000 101,000 Total Un-Restricted 10,406,351 10,326,900

26 Total Fixed Assets 22,178,760 22,316,361

27 Restricted

28 Other Assets Total Net Assets 10,406,351 10,326,900

29 Prepaids & Other Assets 395,565 353,304

30 Total Other Assets 395,565 353,304

31

32 Total Assets 34,365,433$ 34,579,623$ Total Liabilities & Net Assets 34,365,433$ 34,579,623$

Balance Sheet - - - August 31, 2019


ORAL REPORTS 4.a.v.

Page 4

Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 YTD Total

Activity 31 30 31 31 31 31 28 31 30 31 30 31 31 243

2 In-Patient Admissions 38 36 29 21 39 37 29 40 31 27 39 38 31 272

3 In-Patient Days 118 92 82 51 110 121 69 114 98 79 89 118 85 773

4 Avg Stay Days (In-patients) 3.1 2.6 2.8 2.6 2.8 3.3 2.4 2.9 3.2 2.9 2.3 3.1 2.7 2.8

5 Swing Bed Admissions 0 1 0 0 0 0 0 1 0 0 0 0 1 2

6 Swing Bed Days 0 2 0 0 0 0 0 4 0 0 0 0 2 6

7 Avg Length of Stay (Swing) 0.0 2.0 0.0 0.0 0.0 0.0 0.0 4.0 0.0 0.0 0.0 0.0 2.0 3.0

8 Average Daily Census 3.8 3.2 2.6 1.7 3.5 3.9 2.5 3.8 3.3 2.5 3.0 3.8 2.8 3.2

Out-Patient Visits

9 E/R 592 543 473 425 629 481 451 543 462 563 561 702 616 4,379

10 Observ 44 35 34 41 41 28 33 32 27 40 25 36 47 268

11 Lab 1,847 1,579 1,655 1,429 1,642 1,636 1,340 1,577 1,670 1,621 1,609 1,818 1,762 13,033

12 Radiology/CT/MRI 1,016 886 1,068 827 936 951 785 940 858 925 872 1,057 1,021 7,409

13 OR/IP 10 4 16 5 6 9 7 5 10 5 2 12 3 53

14 OR/OP 74 70 79 80 103 69 63 80 91 86 80 80 104 653

15 Clinic 2,282 1,911 2,177 1,986 1,876 2,074 1,806 1,845 2,166 1,990 1,881 1,997 2,087 15,846

16 Spec. Clinic 185 170 205 217 191 220 182 230 255 210 177 219 213 1,706

17 Oncology Clinic 53 54 66 47 67 105 58 83 62 53 54 80 71 566

18 Oncology/Infusion 28 39 13 10 26 72 65 67 63 45 42 80 68 502

19 Infusion 171 147 163 105 87 68 78 85 77 72 81 79 67 607

20 Total O/P Visits 6,292 5,435 5,871 5,167 5,488 5,704 4,861 5,482 5,731 5,605 5,382 6,148 6,056 44,969

21 EMS Calls 190 159 141 109 183 143 158 147 126 139 142 180 168 1,203

22 EMS Transports 117 91 81 65 104 80 89 89 71 82 85 106 105 707

23 EMS Transports to PMH 69 58 51 35 66 50 61 53 45 42 45 60 71 427

24 Pct Transports to PMH 59% 64% 63% 54% 63% 63% 69% 60% 63% 51% 53% 57% 68% 60%

Revenue25 In-Patients 350,236$ 311,055$ 279,614$ 148,914$ 318,145$ 394,382$ 232,790$ 327,249$ 414,875$ 157,241$ 312,074$ 395,667$ 285,857$ 2,520,135

26 I/P Surgery 65,452$ 22,269$ 119,028$ 39,591$ 58,419$ 64,523$ 59,713$ 38,086$ 84,396$ 37,200$ 16,432$ 92,736$ 26,224$ 419,310

27 I/P Cental Supply 105,905$ 25,228$ 276,903$ 114,009$ 100,886$ 144,856$ 111,485$ 91,392$ 89,950$ 68,713$ 50,578$ 186,584$ 4,438$ 747,996

28 Swing Beds -$ 282$ -$ -$ -$ -$ 2,124$ 5,993$ 4,325$ -$ -$ -$ 1,424$ 13,866

29 Lab O/P 557,588$ 479,240$ 520,915$ 453,135$ 486,761$ 500,011$ 423,230$ 470,221$ 515,778$ 516,896$ 524,709$ 601,269$ 582,708$ 4,134,822

30 Radiology 214,958$ 178,540$ 179,460$ 161,556$ 196,159$ 185,449$ 163,531$ 170,271$ 187,043$ 185,644$ 186,721$ 206,417$ 202,275$ 1,487,351

31 CT 503,307$ 467,015$ 387,371$ 361,248$ 510,570$ 382,171$ 305,898$ 424,440$ 379,843$ 409,375$ 431,646$ 570,936$ 451,277$ 3,355,586

32 MRI 217,236$ 200,947$ 240,985$ 191,374$ 186,194$ 217,490$ 184,650$ 193,076$ 194,634$ 188,326$ 177,562$ 207,417$ 192,754$ 1,555,909

33 Ultrasound 55,987$ 35,447$ 60,941$ 55,567$ 78,823$ 105,780$ 88,754$ 36,023$ (61,441)$ 64,796$ 37,763$ 47,687$ 54,646$ 374,008

34 Mammography 29,785$ 20,920$ 59,130$ 17,784$ 19,286$ 24,405$ 22,875$ 25,069$ 19,863$ 24,002$ 17,296$ 28,085$ 25,859$ 187,454

35 Central Supply 118,619$ 137,553$ 91,525$ 86,405$ 265,535$ 147,515$ 134,964$ 185,387$ 158,411$ 150,851$ 150,997$ 215,631$ 228,089$ 1,371,845

36 Surgery 260,804$ 260,218$ 268,858$ 272,667$ 470,313$ 316,120$ 248,135$ 345,018$ 379,472$ 348,051$ 316,301$ 341,216$ 455,612$ 2,749,925

37 ER O/P 830,366$ 742,756$ 670,448$ 614,811$ 985,893$ 717,546$ 666,530$ 778,836$ 706,836$ 813,226$ 824,415$ 1,062,877$ 908,448$ 6,478,714

38 Other Out-patients 114,676$ 76,636$ 108,849$ 69,565$ 40,947$ 39,782$ 30,945$ 88,344$ 230,858$ 108,296$ 98,714$ 112,281$ 71,882$ 781,102

39 Oncology/Infusion 174,829$ 151,807$ 199,419$ 223,609$ 228,992$ 229,290$ 153,729$ 213,484$ 236,642$ 155,825$ 209,563$ 413,803$ 402,050$ 2,014,386

40 Infusion 365,990$ 320,627$ 341,658$ 281,212$ 250,794$ 202,596$ 264,878$ 235,409$ 209,730$ 313,812$ 307,268$ 328,542$ 402,050$ 2,264,285

41 Pharmacy O/P 74,546$ 99,209$ 108,621$ 61,419$ 118,239$ 82,186$ 94,570$ 141,141$ 145,275$ 123,552$ 88,683$ 149,039$ 100,133$ 924,579

42 Clinic 465,041$ 380,301$ 484,973$ 443,786$ 402,748$ 429,242$ 370,578$ 365,526$ 445,218$ 412,284$ 406,483$ 429,846$ 434,058$ 3,293,235

43 Spec. Clinic 35,851$ 32,409$ 41,730$ 43,662$ 43,949$ 45,803$ 35,546$ 48,260$ 51,105$ 44,715$ 36,218$ 46,787$ 46,022$ 354,456

44 Oncology Clinic 9,615$ 11,235$ 13,303$ 10,448$ 13,105$ 21,747$ 13,255$ 16,752$ 26,356$ 18,006$ 14,209$ 18,210$ 20,257$ 148,792

45 Physician Fees 394,451$ 463,559$ 452,021$ 324,057$ 569,697$ 449,173$ 431,975$ 515,264$ 571,574$ 458,533$ 463,936$ 617,441$ 601,577$ 4,109,473

46 Ambulance 244,268$ 165,393$ 198,039$ 140,262$ 210,338$ 162,613$ 175,839$ 164,166$ 169,708$ 146,380$ 181,349$ 236,582$ 221,524$ 1,458,161

47 Total 5,189,510$ 4,582,646$ 5,103,791$ 4,115,081$ 5,555,793$ 4,862,680$ 4,215,994$ 4,879,407$ 5,160,451$ 4,745,724$ 4,852,917$ 6,309,053$ 5,719,164$ 40,745,390

Monthly Trends

ORAL REPORTS 4.a.v.

Page 5

1 In-Patient

2 Admissions:

3 Acute 31 43 (12) 272 346 (74) 327 289 38 13%

4 Swing Bed 1 - 1 2 - 2 - - - #DIV/0!

5 Total 32 43 (11) 274 346 (72) 327 289 38 13%

7 Patient Days:

8 Acute 85 130 (45) 773 922 (149) 851 733 118 16%

9 Swing Bed 2 - 2 6 - 6 - - - #DIV/0!

10 Total 87 130 (43) 779 922 (143) 851 733 118 16%

12 Average Daily Census:

13 # Of Days 31 31 243 243 243 212

14 Acute 2.7 4.2 (1.5) 3.2 3.8 (0.6) 3.5 3.5 0.0 1%

15 Swing Bed 0.1 - 0.1 0.0 - 0.0 0.0 - 0.0 #DIV/0!

16 Total 2.8 4.2 (1.4) 3.2 3.8 (0.6) 3.5 3.5 0.0 1%

18 Length of Stay:

19 Acute 2.7 3.0 (0.3) 2.8 2.7 0.2 2.6 2.5 0.1 3%

20 Swing Bed 2.0 #DIV/0! #DIV/0! 3.0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0%

21 Total 2.7 3.0 (0.3) 2.8 2.7 0.2 2.6 2.5 0.1 3%

23 Revenue: -

24 Acute 316,519 585,739 (269,220) 3,687,441 4,220,107 (532,666) 4,073,018 3,551,425 521,593 15%

25 Swing Bed 1,424 - 1,424 13,866 - 13,866 - - - #DIV/0!

26 Total 317,943 585,739 (267,796) 3,701,307 4,220,107 (518,800) 4,073,018 3,551,425 521,593 15%

28 Revenue Per Pat Day:

29 Acute 3,724 4,506 (782) 4,770 4,577 193 4,786 4,845 (59) -1%

30 Swing Bed 712 #DIV/0! #DIV/0! 2,311 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

31 Total 3,655 4,506 (851) 4,751 4,577 174 4,786 4,845 (59) -1%

33 Out-Patient

34 Out-Patient Visits

35 E/R 616 615 1 4,379 4,630 (251) 4,601 4,009 592 15%

36 Observ 47 43 4 268 299 (31) 285 241 44 18%

37 Lab 1,762 1,877 (115) 13,033 13,618 (585) 13,351 11,504 1,847 16%

38 Radiology/MRI/US/CT 1,021 1,284 (263) 7,409 9,427 (2,018) 7,607 6,591 1,016 15%

39 OR 104 80 24 653 604 49 680 596 84 14%

40 Clinic 2,087 2,104 (17) 15,846 15,920 (74) 16,669 14,387 2,282 16%

41 Oncology Clinic 71 35 36 566 294 272 335 282 53 19%

42 Oncology Infusion 68 35 33 502 294 208 229 201 28 14%

43 Infusion 67 120 (53) 607 611 (4) 805 634 171 27%

44 Total 5,843 6,193 (350) 43,263 45,697 (2,434) 44,562 38,445 6,117 16%

45 Spec. Clinic 213 139 74 1,706 855 851 761 576 185 32%

46 ER Physician 616 615 1 4,379 4,630 (251) 4,601 4,009 592 15%

47 Out-Patient Revenue

48 E/R 870,185 763,254 106,931 6,192,240 5,851,614 340,626 5,708,113 4,922,062 786,051 16%

49 Observ 38,263 36,549 1,714 286,474 280,209 6,265 270,711 226,396 44,315 20%

50 Lab 582,708 588,348 (5,640) 4,134,822 4,445,296 (310,474) 4,223,072 3,665,484 557,588 15%

51 Radiology 202,275 233,253 (30,978) 1,487,351 1,762,356 (275,005) 1,605,799 1,390,841 214,958 15%

52 CT 451,277 452,961 (1,684) 3,355,586 3,472,701 (117,115) 3,389,312 2,886,005 503,307 17%

53 Ultrasound 54,646 57,132 (2,486) 374,008 431,664 (57,656) 391,322 335,335 55,987 17%

54 MRI 192,754 220,014 (27,260) 1,555,909 1,662,328 (106,419) 1,519,090 1,301,854 217,236 17%

55 Mammography 25,859 24,147 1,712 187,454 182,444 5,010 178,710 148,925 29,785 20%

56 Central Supply 228,089 148,455 79,634 1,371,845 1,105,165 266,680 1,026,683 908,064 118,619 13%

57 OR 455,612 280,246 175,366 2,749,924 2,086,276 663,648 2,052,899 1,792,095 260,804 15%

58 Clinic 434,058 407,844 26,214 3,293,235 2,945,540 347,695 3,064,598 2,599,557 465,041 18%

59 Oncology Clinic 20,257 12,483 7,774 148,792 94,316 54,476 73,068 63,453 9,615 15%

60 Oncology Infusion 402,050 217,656 184,394 2,014,386 1,877,283 137,103 1,464,432 1,289,603 174,829 14%

61 Other 574,065 580,706 (6,641) 3,969,966 3,714,687 255,279 3,905,113 3,349,901 555,212 17%

62 Total 4,532,098 4,023,048 509,050 31,121,992 29,911,879 1,210,113 28,872,922 24,879,575 3,993,347 16%

63 Spec. Clinic 46,022 29,960 16,062 354,456 200,732 153,724 161,793 125,942 35,851 28%

64 Physician 581,320 467,222 114,098 3,960,681 3,510,125 450,556 3,288,766 2,903,930 384,836 13%

65 Total 647,599 509,665 137,934 4,463,929 3,805,173 658,756 3,523,627 3,093,325 430,302 14%

66 Ambulance

67 Ambulance Calls 168 1,203 1,229 1,039 190 18%

68 Ambulance Transports 105 707 715 598 117 20%

69 Transports to PMH 71 111 427 717 (290) 420 351 69 20%

70 Transports to PMH % 68% 60% 59% 59%

71 Transports to Other 34 280 295 247 48

72 Transports to Other % 32% 40% 41% 41%

73 Revenue: 221,524 249,910 (28,386) 1,458,161 1,749,370 (291,209) 1,591,052 1,346,784 244,268 18%

74 Revenue Per Transport: 2,110 2,062 2,225 2,252 (27) -1%

75 Total Revenues 5,719,164 5,368,362 350,802 40,745,389 39,686,529 1,058,860 38,060,619 32,871,109 5,189,510 16%

Pagosa Springs Medical Center - - - Statistical Review

Statistical ReviewAugust Prior Y-T-D

VarianceY-T-D Actual

Prior Y-T-D

Actual Difference

Current Month

Actual

Current Month

Budget Variance

Y-T-D

Actual Y-T-D Budget Variance2019

August August

ORAL REPORTS 4.a.v.

Page 6

0-30 Days 31-60 Days 61-90 Days 91-120 Days 121-150 Days 151-180 Days 181+ Days TotalPercent of

Total

Accts sent to

Collections

2 Medicare 1,691,392$ 229,619$ 108,028$ 106,796$ 75,811$ 65,373$ 322,893$ 2,599,913$ 24%

3 Medicaid 447,473 31,642 53,429 41,858 55,534 19,409 191,728 841,074 8%

4 Third Party 2,101,163 1,166,940 463,443 320,716 172,046 341,071 1,462,256 6,027,634 57%

5 Self-Pay 249,925 215,442 138,852 223,019 104,278 24,283 211,213 1,167,013 11%

Current Month Total 4,489,953$ 1,643,643$ 763,753$ 692,390$ 407,669$ 450,136$ 2,188,090$ 10,635,634$ 100% 572,029Pct of Total 42% 15% 7% 7% 4% 4% 21% 100%

Jul-19 5,080,360$ 1,280,941$ 915,491$ 549,247$ 607,257$ 419,655$ 2,387,501$ 11,240,452$ 1,106,517Pct of Total 45% 11% 8% 5% 5% 4% 21% 100%

Jun-19 4,199,727$ 1,555,291$ 715,848$ 712,192$ 504,973$ 621,808$ 3,338,661$ 11,648,500$ 0Pct of Total 36% 13% 6% 6% 4% 5% 29% 100%

May-19 3,938,706$ 1,192,758$ 857,202$ 558,303$ 705,693$ 728,901$ 3,078,535$ 11,060,098$ 0Pct of Total 36% 11% 8% 5% 6% 7% 28% 100%

Apr-19 4,446,750$ 1,328,789$ 769,877$ 796,122$ 801,322$ 354,704$ 3,166,854$ 11,664,418$ 8,002Pct of Total 38% 11% 7% 7% 7% 3% 27% 100%

Mar-19 4,313,656$ 1,360,981$ 995,434$ 985,732$ 562,545$ 619,342$ 3,353,760$ 12,191,450$ 122,172Pct of Total 35% 11% 8% 8% 5% 5% 28% 100%

Feb-19 3,846,150$ 1,550,896$ 1,137,950$ 652,196$ 726,272$ 667,524$ 3,164,610$ 11,745,598$ 355,801Pct of Total 33% 13% 10% 6% 6% 6% 27% 100%

Jan-19 4,374,575$ 1,664,567$ 771,356$ 866,764$ 765,154$ 559,863$ 3,411,981$ 12,414,260$ 310,436Pct of Total 35% 13% 6% 7% 6% 5% 27% 100%

Dec-18 4,810,234$ 1,205,387$ 956,941$ 872,250$ 675,156$ 652,620$ 3,339,239$ 12,511,827$ 310,436Pct of Total 38% 10% 8% 7% 5% 5% 27% 100%

Nov-18 3,575,135$ 1,298,788$ 913,800$ 740,723$ 766,567$ 666,776$ 2,695,762$ 10,657,551$ 112,443Pct of Total 34% 12% 9% 7% 7% 6% 25% 100%

Oct-18 4,188,615$ 1,292,841$ 891,836$ 836,368$ 811,636$ 594,372$ 2,923,499$ 11,539,167$ 217,192Pct of Total 36% 11% 8% 7% 7% 5% 25% 100%

Sep-18 3,879,192$ 1,290,689$ 1,088,210$ 1,042,678$ 794,963$ 582,678$ 2,960,063$ 11,638,473$ Pct of Total 33% 11% 9% 9% 7% 5% 26% 100% 302,125

Aug-18 4,290,838$ 1,576,042$ 1,231,421$ 977,015$ 676,478$ 606,305$ 2,737,973$ 12,096,072$ Pct of Total 35% 13% 10% 8% 6% 5% 23% 100% 48,619

Jul-18 4,783,854$ 1,759,771$ 1,145,364$ 727,948$ 726,411$ 537,560$ 2,635,767$ 12,316,675$ Pct of Total 39% 14% 9% 6% 6% 4% 21% 100% 24,966

Jun-18 4,334,347$ 1,685,871$ 885,716$ 689,267$ 639,055$ 576,480$ 2,411,492$ 11,222,228$ Pct of Total 39% 15% 8% 6% 6% 5% 21% 100% 195,130

May-18 4,159,005$ 1,795,159$ 1,208,334$ 721,961$ 670,041$ 495,647$ 2,003,816$ 11,053,963$ Pct of Total 38% 16% 11% 7% 6% 4% 18% 100% 47,472

Apr-18 3,697,643$ 1,605,576$ 863,079$ 713,382$ 586,190$ 391,762$ 1,698,496$ 9,556,128$ Pct of Total 39% 17% 9% 7% 6% 4% 18% 100% 256,717

Mar-18 3,922,575$ 1,408,723$ 1,095,293$ 660,255$ 439,343$ 299,008$ 1,759,366$ 9,584,563$ Pct of Total 41% 15% 11% 7% 5% 3% 18% 100% 139,778

Feb-18 3,744,129$ 1,569,800$ 882,931$ 495,048$ 310,715$ 273,375$ 1,772,313$ 9,048,312$ Pct of Total 41% 17% 10% 5% 3% 3% 20% 100% 40,116

Jan-18 3,910,094$ 1,418,969$ 658,794$ 398,631$ 399,145$ 263,261$ 1,774,826$ 8,823,719$ Pct of Total 44% 16% 7% 5% 5% 3% 20% 100% 33,378

Dec-17 3,530,341$ 998,668$ 567,335$ 594,879$ 431,479$ 322,934$ 1,657,210$ 8,102,848$ Pct of Total 44% 12% 7% 7% 5% 4% 20% 100% 825,723

Nov-17 2,955,885$ 1,037,274$ 679,925$ 592,310$ 581,053$ 435,072$ 1,984,898$ 8,266,421$ Pct of Total 36% 13% 8% 7% 7% 5% 24% 100% 26,231

Oct-17 3,659,774$ 1,357,490$ 752,198$ 717,416$ 562,600$ 312,224$ 1,893,353$ 9,255,056$ Pct of Total 40% 15% 8% 8% 6% 3% 20% 100% 218,112

Sep-17 3,724,332$ 1,319,138$ 1,012,183$ 671,452$ 445,286$ 377,867$ 2,175,487$ 9,725,747$ Pct of Total 38% 14% 10% 7% 5% 4% 22% 100% 407,406

Aug-17 4,131,866$ 1,552,324$ 893,339$ 624,164$ 490,221$ 431,099$ 2,449,394$ 10,572,407$ Pct of Total 39% 15% 8% 6% 5% 4% 23% 100% 341,071

Jul-17 4,612,446$ 1,520,180$ 853,133$ 632,738$ 581,650$ 552,521$ 2,298,997$ 11,051,665$ Pct of Total 42% 14% 8% 6% 5% 5% 21% 100% 103,289

Jun-17 3,963,167$ 1,339,294$ 815,790$ 672,144$ 657,236$ 453,649$ 2,101,821$ 10,003,101$ Pct of Total 40% 13% 8% 7% 7% 5% 21% 100% 129,723

May-17 3,851,718$ 1,136,727$ 1,030,085$ 770,865$ 477,918$ 354,848$ 1,972,569$ 9,594,730$ Pct of Total 40% 12% 11% 8% 5% 4% 21% 100% 115,443

Apr-17 3,715,423$ 1,582,605$ 1,084,223$ 603,091$ 399,012$ 291,308$ 2,050,804$ 9,726,466$ Pct of Total 38% 16% 11% 6% 4% 3% 21% 100% 391,892

12 Pct Settled (Current) 67.6% 40.4% 24.4% 25.8% 25.9% -421.4%

13 Pct Settled (Jul from Jun ) 69.5% 41.1% 23.3% 14.7% 16.9% -284.0%

14 Pct Settled (Jun from May) 60.5% 40.0% 16.9% 9.6% 11.9% -358.0%

15 Pct Settled (May from Apr) 73.2% 35.5% 27.5% 11.4% 9.0% -767.9%

16 Pct Settled (Apr from Mar) 69.2% 43.4% 20.0% 18.7% 36.9% -411.3%


Cerner/Healthland Accounts Receivable for Hospital by Payor and Days Outstanding -- As of July 31, 2019

ORAL REPORTS 4.a.v.

Page 7

31 28 31 30 31 30

Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19

31 31 30 31 30 31

Jul-19 Aug-19 Sep-18 Oct-18 Nov-18 Dec-18

12 Medicare 33% 21 97,225$ 673,768$

13 Medicaid 7% 35 97,225$ 238,201$

14 Blue Cross 15% 48 97,225$ 700,018$

15 Commercial 26% 65 97,225$ 1,643,098$

16 Self Pay 19% 150 97,225$ 2,770,906$

17 Total: 100% 6,025,991$

18 97,225$

19 62

61Net Days in A/R 53 49 54 54 53

Net Patient Rev/Day (2 month Avg) 93,602$ 97,225$ 87,436$ 86,304$ 80,953$ 84,267$

Net Accounts Receivable 4,939,510$ 4,721,499$ 4,737,306$ 4,650,770$ 4,261,223$ 5,111,778$

Net Patient Revenue 3,009,707$ 3,018,228$ 2,629,201$ 2,634,021$ 2,308,147$ 2,839,498$

85,762$


Pagosa Springs Medical Center - - - Net Days in A/R 2019

2,703,510$

53

77,105$ 90,251$ 89,001$

4,645,356$

49 54

Net Patient Rev/Day (2 month Avg) 88,961$

Net Days in A/R 57

2,897,839$

Gross Days in A/R Target

Pagosa Springs Medical Center - - - Gross Days Target

2,523,644$

Net Accounts Receivable 5,096,441$ 4,830,219$ 4,992,507$ 4,763,720$ 4,371,767$

Net Patient Revenue 2,676,087$

78,315$

1,968,516$ 2,601,105$

6562

9

10

2

3

4

5

7

8

ORAL REPORTS 4.a.v.


Financial Forecast

Statement of Cash Flows

Cash Flows from operating activities August, 2019

Change in net assets 79,451

Adjustments to reconcile net assets to net cash

Depreciation and amortization 154,210

Patient accounts receivable 218,011

Accounts payable and wages payable (345,882)

Accrued liabilities 47,848

Pre-paid assets (42,261)

Deferred revenues -

Other receivables 17,708

Change in bond premium (1,537)

Reserve for third party settlement 22,671

Inventory (7,431)

Net Cash Provided by (used in) operating activities 142,788

Cash Flows from investing activities

Purchase of property and equipment (12,852)

Work in progress -

Proceeds from sale of equipment/(Loss) -

Net Cash Provided by (used in) investing activities (12,852)

Cash Flows from financing activities

Principal payments on long-term debt -

Proceeds from debt

Change in Prior Year Net Assets -

Change in leases payable (16,741)

Net Cash Provided by (used in) financing activities (16,741)

Net Increase in Cash 113,195

Cash Beginning of Month 5,089,298

Cash End of Month 5,198,736

Check -

ORAL REPORTS 4.a.v.


Revenue and Usage by Financial Class

July, 2019

Financial Class Inpatient MTD Outpatient MTD Total MTD % MTD

Auto/Liability Insurance - 49,838.20 49,838.20 0.87%

Blue Cross 18,255.00 875,764.10 894,019.10 15.63%

Champus - 5,494.00 5,494.00 0.10%

Commercial Insurance 83,778.00 685,548.03 769,326.03 13.45%

Medicaid 10,418.00 940,450.35 950,868.35 16.63%

Medicare 186,348.70 1,988,085.57 2,174,434.27 38.02%

Medicare HMO 53,501.00 376,961.09 430,462.09 7.53%

Self Pay 3,637.00 235,336.05 238,973.05 4.18%

Self Pay - Client Billing - 12,696.00 12,696.00 0.22%

Veterans Administration (774.00) 151,201.04 150,427.04 2.63%

Workers Compensation - 42,625.40 42,625.40 0.75%

Total 355,163.70 5,363,999.83 5,719,163.53 100.00%

Financial Class Inpatient YTD Outpatient YTD Total YTD % YTD

12/31/18

% YTD

12/31/17

% YTD

12/31/16

% YTD

Auto/Liability Insurance 8,016.00 387,089.20 395,105.20 0.97% 1.05% 1.24% 1.11%

Blue Cross 672,374.00 5,884,237.01 6,556,611.01 16.09% 15.42% 15.90% 15.83%

Champus - 30,722.00 30,722.00 0.08% 0.08% 0.07% 0.19%

Commercial Insurance 336,298.01 4,318,696.92 4,654,994.93 11.42% 13.08% 11.79% 13.08%

Medicaid 533,387.00 7,120,455.08 7,653,842.08 18.78% 18.22% 20.28% 21.56%

Medicare 2,072,707.80 12,997,240.14 15,069,947.94 36.99% 36.75% 35.27% 35.90%

Medicare HMO 412,892.70 2,344,330.20 2,757,222.90 6.77% 4.47% 3.55% 2.76%

Self Pay 208,906.00 1,676,770.75 1,885,676.75 4.63% 5.40% 6.96% 5.26%

Self Pay - Client Billing - 70,730.00 70,730.00 0.17% 0.18% 0.19% 0.17%

Veterans Administration 156,790.02 830,647.86 987,437.88 2.42% 4.13% 3.58% 2.74%

Workers Compensation 26,505.00 656,594.37 683,099.37 1.68% 1.22% 1.17% 1.37%

Total 4,427,876.53 36,317,513.53 40,745,390.06 100.00% 100.00% 100.00% 99.97%

Blank 0.00%

HMO (Health Maint Org) 0.03%

Total 100.00% 100.00% 100.00%

ORAL REPORTS 4.a.v.

ACTION DEADLINE MAY JUNE JULY AUG. SEPT OCT NOV

REDUCE EXPENSE

From 12/31/18 level staffing, reduce FTEs and contractors (as

practical and through attrition, if possible).ongoing

10

positions

10

positions

10

positions

9

positions

9.5

positions

As possible, restructure positions to reduce expense. ongoing4

positions

4

positions

5

positions

5

positions

5

positions

Amend/change service agreements to reduce expense. ongoing 40% 44% 55% 55% 78%

Develop and implement process for collecting coinsurance for

patients.7/31/2019 100% 100% 100% 90% 90%

Create and implement a plan to terminate lease for use of off-site

space.6/30/2019 75% 95% 100% 100% 100%

Subject to challenges with hiring, replace 2 emergency room night-

shift RNs with paramedics.5/31/2019 0% 0% 0% 100% 100%

IMPROVE REVENUES COLLECTED

Implement coding software to enable PSMC to compute payments on

Medicaid EAPGs to assure accuracy of payment.10/31/2019 10% 10% 20% 30% 30%

From 12/31/18 levels, develop and implement processes that should

decrease denials by 50% (denials related to pre-authorization,

medical necessity and otherwise).

10/31/2019 25% 30% 30% 50% 50%

Outsource billing for out-of-state Medicaid, motor vehicles and

worker comp claims.3/1/2019 100% 100% 100% 100% 100%

Contract with a third party for coding to improve accuracy. 2/1/2019 100% 100% 100% 100% 100%

From 12/31/18 levels, implement process to improve timely filing of

clean claims to decrease denials by 50%.9/30/2019 100% 100% 100% 100% 100%

Develop and implement a plan to reduce gross days of A/R to 68

(from 12/31/18 level of 76.6 gross days of A/R).7/31/2019 88% 93% 81.16%

100%

(61.43)100%

Engage contractors if 68 days not achieved on 7/31/19 9/30/2019 n/a n/a n/a n/a n/a

Develop and implement a plan to reduce gross days of A/R to 62

(from 12/31/18 level of 76.6 gross days of A/R).12/31/2019 52% 54.70% 47.80% 100% 100%

Create and implement a career matrix program for billing office to

reduce turnover and enhance stability of collections.1/31/2019 100% 100% 100% 100% 100%

If matrix does not produce improvement, evaluate

alternatives.1/1/2020 n/a n/a n/a n/a n/a

MANAGEMENT AND PLANNING

Evaluate and develop/implement a plan to reduce ongoing expense

for MRI.12/31/2019 0% 0% 0% 0% 0%

Evaluate the feasibility of providing physical therapy services for all

outpatients.10/31/2019 0% 0% 0% 20% 20%

Evaluate the feasibility of expanding pain management services. 12/31/2019 0% 20% 20% 75% 75%

Evaluate and develop/implement a plan to address time allotted in

the RHC for patient visits and improve Medicare productivity in the

RHC.

10/31/2019 10% 10% 20% 75% 95%

Operationalize offering swing bed services for orthopedic patients

pending hiring of appropriate staff.8/31/2019 80% 100% 100% 100% 100%

Develop a monthly cash forecast to allow management to predict

progress relative to the cash goal and measure days of cash.6/30/2019 0% 100% 100% 100% 100%

Compute Medicare productivity for the RHC monthly. 6/30/2019 10% 100% 100% 100% 100%

Evaluation and develop/implement a plan to decrease PSMC’s

expense for employee health insurance benefit for employee’s

spouse and children.

7/1/2019 75% 100% 100% 100% 100%

Evaluate and develop a plan for efficient IT/Phone support at a lower

cost (current contract for support does not end until 12/31/2020).12/31/2019 25% 50% 80% 100% 100%

Evaluate and develop/implement a plan to reduce professional hours

in Oncology program to better address current and projected

demand.

12/31/2019 20% 20% 100% 100% 100%

Evaluate the feasibility of refinancing the 2006/2007 bonds. 12/31/2019 0% 0% 10% 100% 100%

Evaluate the feasibility of increasing veteran use of the RHC. 12/31/2019 0% 0% 10% 100% 100%

USJHSD Management Progress Reporting Tool USJHSD Board Packet, 10-15-2019

Page 1 of 1

ORAL REPORTS 4.a.v.

71

2 0 0

1018

1

19

0 1 3

0

10

20

30

40

50

60

70

80

90

100

Nu

mb

er o

f 9

11

Res

po

nse

s

EMS 911 Response

2019

125Total 911 Responses:

4

Breakdown of EMS Standbys

Fire/SAR/LE/USF

Paid

Special Event (Not Paid)

Refusal

Total Standbys

4

3335

0

10

20

30

40

50

Nu

mb

er o

f In

terf

acili

ty T

ran

spo

rts

Total Interfacility Transports

2019 2018

Operations Report for August 2019

EMS: August

USJHSD Operations Report USJHSD Board Packet, 10-15-2019

Page 1 of 9

WRITTEN REPORTS 4.b.i.

0

16

0 0 1 0

12

30 1 0

0

5

10

15

20

25

30

35

40

Nu

mb

er o

f Tr

asn

po

rts

Interfacility Transports by Destination

00.5

11.5

22.5

33.5

44.5

5

Flight/ShuttleCrew

3rd/4th Crew Dispatch Error Assist at PSMC Walk-In EMS Public Assist

0

5

2

0 0 0

"Oth

er"

Cal

ls

Other EMS Calls

2019

EMS: August


Page 2 of 9


Oncology/Infusion:

Oncology Visits Infusion Encounters Oncology Infusions/Injections

2019 71 67 68

7167 68

0

10

20

30

40

50

60

70

80

90

100

Oncology/Infusion

Oncology Visits Infusion Encounters Oncology Infusions/Injections

August


Page 3 of 9


ED:

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2019 481 451 543 462 563 561 702 616 552

2018 619 532 554 470 532 589 713 592 543 473 425 629

0

100

200

300

400

500

600

700

800

Nu

mb

er o

f p

atie

nts

ED Yearly Volume Comparison

2019 2018

28 2931 36

0

100

200

300

400

500

600

Admits Transfers

Nu

mb

er o

f P

atie

nts

ED Inpatient Admissions and Transfers Monthly Comparison

2019 2018

August


Page 4 of 9


Average Daily Census

19.8

Average Length of Stay (in hours)

2.2

2

1

3

0

0

2

4

6

8

10

12

14

Diagnostic Imaging Gen Surg Ortho Bed Avail

Nu

mb

er o

f Tr

ansf

ers

ED Resource Related Transfers

ED: August


Page 5 of 9


Inpatient :

Average Daily Census Average Length of Stay (in days)

3.9 2.8

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2019 37 28 40 31 27 39 38 31 25

2018 50 41 44 34 33 44 41 38 36 29 21 39

0

10

20

30

40

50

60

Inp

atie

nt

Ad

mis

sio

ns

Inpatient Admission Comparison

2019

2018

August


Page 6 of 9


Diagnostic Imaging:

1370

1021

1412

1016

0

200

400

600

800

1000

1200

1400

1600

Procedures Patients

Diagnostic Imaging Stats by Month

2019 2018

2019

2018

0

20

40

60

2D Echo Stress Echo

2019 49 12

2018 55 8

49

12

55

8

Cardiology 2D Echo & Stress by Month

2019 2018

August


Page 7 of 9


Lab:

5002

1762

4954

1847

0

1000

2000

3000

4000

5000

6000

Tests Patients

Lab Test & Patient Volume by Month

2019 2018

Clinic

1648

439

1706

487

0

200

400

600

800

1000

1200

1400

1600

1800

PCP Encounters Speciality Clinic Encounters

Rural Health Clinic Encounters by Month

2019 2018

Clinic :

August

August


Page 8 of 9


23

17.4

0

5

10

15

20

25

30

35

Average Daily Walk-Ins

2019 2018

Surgery

0

10

20

30

40

50

60

GI Cases General Ortho ENT GYN Eye PainMgmt

Other

51

11

25

6

0 0

13

0

41

12

19

0 13

8

0

Surgery Cases by Month2019 compared to 2018

2019 2018

Clinic : August


Page 9 of 9


USJHSD Medical Staff Report

USJHSD Board Packet, 10-15-2019

Page 1 of 1

THE UPPER SAN JUAN HEALTH SERVICE DISTRICT DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER

MEDICAL STAFF REPORT BY CHIEF OF STAFF, RALPH BATTELS October 15, 2019

I. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS FOR THE USJHSD BOARD ACCEPTANCE

OF NEW POLICIES OR PROCEDURES ADOPTED BY THE MEDICAL STAFF:

II. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS FOR THE USJHSD BOARD ACCEPTANCE

OF PROVIDER PRIVILEGES (ACCEPTANCE BY THE BOARD RESULTS IN THE GRANT OF PRIVILEGES):

NAME INITIAL/REAPPOINT/CHANGE TYPE OF PRIVILEGES SPECIALTY John Brach, MD Initial Appointment Courtesy/Ophthalmology Ophthalmology

Maysun Ali, DO Reappointment Telemedicine/Teleneurology Neurology & Vascular

Neurology

Brett Bartz, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Pediatric Radiology

Joshua Borgstadt, PA-C Reappointment AHP/Family Medicine Family Medicine

Judith Cole, RNFA Reappointment AHP/Registered Nurse First

Assistant

Registered Nurse First

Assistant

Richard Coursey, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Interventional Radiology

Tyler Green, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Interventional Radiology

Corinne Reed, DO Reappointment Active/Family Medicine,

Hospitalist, Osteopathic

Manipulative Therapy

Family Medicine

Aaron Singh, PA-C Reappointment AHP/Family Medicine Family Medicine

William Webb, MD Reappointment Active/Orthopedics General Orthopaedics

III. REPORT OF NUMBER OF PROVIDERS BY CATEGORY

Active: 17

Courtesy: 28

Telemedicine: 122

Allied Health Professionals: 29

Total: 196

WRITTEN REPORTS 4.b.ii.

USJHSD Regular Board Meeting Minutes

08/27/2019

Page 1 of 4

MINUTES OF REGULAR BOARD MEETING Tuesday, August 27, 2019

5:30 PM The Board Room

95 South Pagosa Blvd., Pagosa Springs, CO 81147

The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its regular board

meeting on August 27, 2019, at Pagosa Springs Medical Center, The Board Room, 95 South Pagosa Blvd.,

Pagosa Springs, Colorado.

Directors Present: Chair Greg Schulte, Vice-Chair Matt Mees, Director Kate Alfred, Director Dr. Jim

Pruitt, and Director Karin Daniels.

Director(s) Absent: Treasurer-Secretary Dr. King Campbell and Director Jason Cox. (The noted absences

were excused due to prior notification.)

1) CALL TO ORDERa) Call for quorum: Chair Schulte called the meeting to order at 5:30 p.m. MDT and Clerk of the

Board, Heather Thomas, recorded the minutes. A quorum of directors was present and

acknowledged.

b) Board member self-disclosure of actual, potential or perceived conflicts of interest: There were

none.

c) Approval of the Agenda: The Board noted approval of the agenda.

2) PUBLIC COMMENTThere was no public comment.

3) PRESENTATIONPSMC Orthopedic Surgeon, Dr. William Webb, presented the attached PowerPoint presentation

regarding the orthopedic service line.

CONSENT AGENDA 5.b.i.


08/27/2019

Page 2 of 4

4) REPORTSa) Oral Reports

i) Chair Report

Chair Schulte presented and discussed the attached summary regarding potential revenue

sources for the Archuleta County Combined Dispatch. Chair Schulte noted the Dispatch

subcommittee is close to completion of proposed revisions to the current 10-year-old

Intergovernmental Agreement (“IGA”). The subcommittee will then present the revised IGA

to the four entities for review and approval.

Director Dr. Pruitt noted his disapproval of the District continuing to be a financial

participant of the Combined Dispatch. A discussion ensued regarding the positive aspects of

being a part of the Combined Dispatch.

ii) Contracts

Director Alfred advised the Board that the Contracts Committee met today, 08/27/2019,

and reviewed current employment contract format, which will continue to be used without any

changes.

Director Alfred further noted that salaries of current providers were reviewed against those

recently published in MGMA’s salary survey, which resulted in no concerns regarding the

current contracts.

iii) Strategic Planning

Item intentionally struck from agenda. There was no report.

iv) CEO Report

CEO Dr. Webb stated July and August were very busy revenue months and recognized the

hard work of everyone at PSMC.

CEO Dr. Webb noted CMS requires an annual program evaluation (included in the Board

packet) which CDPHE would request to review upon an inspection. The annual program

evaluation summarizes what the total program scope of services were for 2018. The annual

program evaluation will be presented to the Archuleta County Commissioners next week

during the required USJHSD annual report to the County Commissioners.

CEO Dr. Webb advised the Board that the HVAC project has been delayed until after the

first of the year (2020) due to not receiving final details and numbers on certain items, which

cause concerns for winter construction due to snow and inclement weather.

CEO Dr. Webb stated she sat on a public panel regarding affordable and work place

housing in Pagosa Springs, noting it was well attended. The discussion was primarily the way

housing has an effect on the health of a community.

CEO Dr. Webb advised the Board employee forums have recently been created to

encourage discussion amongst the organization. Facts about the hospital, including the history

and financial status of the organization were discussed.

CEO Dr. Webb noted an issue regarding the “For Sale” signage near the Pruitt Building,

stating a patient voiced concern that PSMC was for sale due to the sign’s location by the



08/27/2019

Page 3 of 4

entrance to PSMC. CEO Dr. Webb advised that PSMC is not for sale, and is seeking grant

monies to assist in purchasing new signage, with a marquee, to place near Highway 160.

CEO Dr. Webb ended by advising the Board that PSMC’s Controller, Johna Lederhouse,

who has worked at PSMC for five years, is moving. CEO Dr. Webb and members of the Board

voiced their appreciation for Ms. Lederhouse’s years of service.

A discussion ensued regarding jurisdiction of new signage placement.

v) Finance Report

CFO, Chelle Keplinger, presented and discussed the financial PowerPoint presentation,

highlighting that July ended with the highest-ever gross revenue for the District.

Chair Schulte asked a question regarding tax revenue. CFO Keplinger answered.

CFO Keplinger recognized the Patient Financial Services Department, noting the

attendance of Director of Revenue Cycle, Debbie Campbell, and a few of the employees from

Patient Financial Services – Robyn Nembhard, Robin Whitman, Deana Condon and Tina

Corley, and congratulating the department for their accomplishment in achieving a drop of 20

days in AR to 55.96 days. The Board noted their appreciation for their hard work.

CFO Keplinger then presented and discussed updates to the Management Progress

Reporting Tool.

CAO Ann Bruzzese discussed the summary to the Board regarding evaluation of

refinancing the 2006 bonds as presented in the board packet. Director Dr. Pruitt asked a

question regarding a range of potential savings. CAO Bruzzese answered.

Director Alfred noted that she appreciates the Management Progress Reporting Tool and

suggested to change the report by placing any item still pending at the beginning of the

report and any item completed placed at the bottom of the report. Only items of

discussion would be those not yet completed. The Board noted their consent and approval of

the change to the Reporting Tool.

b) Written Reportsi) Operations Report

Director Dr. Pruitt asked a question regarding the cost of air transports. COO/CNO Kathee

Douglas and CEO Dr. Webb answered.

ii) Medical Staff Report

Director Dr. Pruitt asked a question regarding the initial appointments of the telemedicine

specialists listed within the Medical Staff Report, whether they were for emergency or clinic

services. COO/CNO Douglas answered. Director Dr. Pruitt then asked a question regarding

the status of procuring telemedicine services for the Clinic and psychiatric services. COO/CNO

Douglas answered.



08/27/2019

Page 4 of 4

5) CONSENT AGENDA

Director Daniels motioned to approve the noted Board member absences, the minutes of the

regular meeting of 07/23/2019, and the Medical Staff report recommendations for new or renewal of

provider privileges.

Upon motion seconded by Director Alfred, the Board unanimously approved said consent agenda

items.

6) DECISION AGENDA

Chair Schulte gave an overview of Resolution 2019-07, regarding adjusting the meeting schedule

in September and October and affirming the days and times that the Board will meet each month for

the remainder of 2019.

Director Dr. Pruitt motioned to accept Resolution 2019-07. Upon motion seconded by Director

Daniels, the Board unanimously accepted said resolution.

7) EXECUTIVE SESSION

The Board did not meet in executive session.

8) OTHER BUSINESS

CEO Dr. Webb reminded the Board of the upcoming Open House to commence Thursday, 09/26/2019

at 5:30 p.m. Notice will be provided to the public regarding a possible quorum due to Directors’ presence

at the Open House.

9) ADJOURN There being no further business, Chair Schulte adjourned the regular meeting at 6:45 p.m. MDT.

Respectfully submitted by:

Heather Thomas, serving as Clerk of the Board


Documents

NOTICE OF REGULAR BOARD MEETING OF