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July 17, 2014 Issue

Renovation under way
Digging out of the red
Candidates face runoff

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Renovation under way

By Carol McLeod and Megan Johnson
Staff Writer / Apprentice


“They just finished up with the air conditioning unit and are getting ready to install the new ceiling. They are also doing some minor electrical work,” Robert Yonchak said.

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Yonchak, the county’s purchasing and safety coordinator, said the renovations in the county’s courtroom should be complete in time for the court session scheduled next month.

“We hope to be finished Aug. 11. There is a court session scheduled for Aug. 11; and, we hope to have that session in the new courtroom. So far everything is going well; and, they are moving along on schedule,” he said.

During the work, court is being held in the Louisville City Hall. Trials were not scheduled during the renovations; although, other court proceedings are being held at city hall.

The county will pay the contractors, JW Spratlin & Sons Construction from Lincolnton $250,000. Yonchak said funding for the majority of the work is coming from the current SPLOST.

“The money was set aside for this reason,” Yonchak said.

There have been no unexpected issues, he said.

Chairs and other miscellaneous items are being paid out of the law library fund, which is controlled by the law library board, Mestres said.

The administrator said the renovation consists of primarily safety issues, ADA compliance and the new air conditioning system.

Yonchak said after the courtroom reopens, people will notice new carpet, new chairs in the jury box and new chandelier lighting.

“We have addressed some of the security concerns,” Mestres said.

“We’re pleased with the plans and progress and are excited to unveil the result of this work to the public in August,” he said.




Digging out of the red

By Parish Howard
Editor/Publisher

One year ago Jefferson Hospital’s finances were dangerously upside down.

The county was asked for additional support. A half million dollar loan was sought and eventually a third party management company was contracted in an attempt to save the hospital.

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“We were inside 90 days of cash and we knew we couldn’t wait until we had zero cash to close, because you will have obligations when you close,” said Ray Davis, Chairman of the Hospital Authority. “Without the reassurance and presence of Pioneer, we as an Authority would probably have had to take action.”

That action could have involved drastically cutting services or closing the doors all together.

“When we took over, if we had paid off all the bills the hospital had we would have needed another million bucks (to remain operational),” said Steve Widener, Pioneer Health Services’ interim CEO for Jefferson Hospital. “Today, we are $350,000 ahead if we had to pay off all of our bills. So that’s about a $1.3 million gain.”

A recent review of the hospital’s financial statements shows increases in revenue over last year’s first five months and a decrease in expenses. Together, for the January through May period, it spells 139 percent or a $768,650 turnaround in the hospital’s cash position.

“A year ago I had $250,000 or $300,000 in the bank and owed people $800,000 or $900,000,” explained Matt Clark, the hospital’s controller. “Today I have $1.1 million in the bank and owe $600,000.”

Clark was quick to explain that with hundreds of thousands of dollars in payables and an overall payroll that is around $225,000, their margin is still pretty close. In fact, a review of the financials show that the loss from operations for the first five months of 2014 was around $220,000. Still, everyone agrees that things are looking up.

The Challenge
Hospital financial reports show more than $1.265 million in loss from operation in the first five months of 2013.

Last year the hospital asked the county commissioners for an additional $200,000 a year to help offset indigent care expenses. Bill Easterlin, the hospital authority’s vice chairman, told commissioners that, “we are dangerously close to running out of money.”

The county voted unanimously to provide the hospital with $200,000 a year for the next five years.

At that time Davis said that the hospital had been “bleeding between $200,000 and $300,000 a month” for some time.

The Hospital Authority voted to seek help in Pioneer Health Services, a rural healthcare company with experience in the Critical Access Hospital industry.

In June of 2013 the Hospital Authority signed a five-year management contract with Pioneer, who for the previous several months, had been reviewing hospital operations in all departments and developing a plan to stem the financial losses.

The Changes
Within days of Pioneer officially taking over June 1, 2013, some of the hardest reductions were made.

By the time the dust cleared, some 23 full-time equivalent positions were cut for an annual savings of $887,327.

“During that period there were many who became involved in a personal sacrifice by offering someone else the opportunity to stay by retiring early or making some other arrangement,” Davis said. “And we proved to each other that we could weather a storm of that type.”

The staffing reductions were the single largest expense cut the hospital saw last year, but the savings also include the addition of several new positions. These include two new PAs for the clinics and ER (one of which was a replacement for a resignation), a community educator and a PRN physical therapist.

Shortly after the cuts, management also began restructuring staffing and reviewing other contracts.

Adjustments in the emergency room resulted in annual savings of about $305,000.

“We had this company who provided doctors to work in the ER and we got rid of them,” Widener said. “We brought in Jennifer Tanner (a physician’s assistant) and now we are expanding on that concept. We found putting Jennifer in the ER during the day increased our emergency room admissions. Now we’re admitting another 10 to 15 patients a month.”

Admissions equal more revenue. Widener said the previously contracted ER doctors were more likely to send patients to Augusta hospitals or send them home.

“Admissions from the emergency room are up,” Widener said. “Last year in the first three months we admitted 116 and this year we have admitted 144. That’s a huge amount of money. We’re also way over budget on swing beds. For the year we’ve had 21 (through March) and only planned on admitting nine swing beds for the first three months.”

At the first of April the hospital census was averaging 8.7 for the month and 6.5 for the year.

“We are real close to budget and we have the census growing every month a little bit more,” Widener said.

Another major change Pioneer has made is in the specialty doctor payment model.

“We were paying them all like a salary, but we’ve changed that to where they do their own billings and collections,” Widener said.

This change was difficult, Davis said, and the hospital lost several specialists who had previously been coming one or two days a week.

“That was one of those painful changes,” Davis said. “We sent people away who were convenient and respected. But the reason was simple, they were costing us money to be here. And now the ones who are coming back have made different agreements and will not cost us money but will become a source of not only income, but personal care.”

The hospital has already brought in a new cardiologist and is working on contracts in dermatology, urology and gynecology. This change alone is predicted to save them another $315,500 annually.

Other contract changes, which were mostly brought in-house, involved things like Utilization Review, which saves $56,000 a year and lawn care, which saves another $10,404.

“There’s a lot of little things, like our sterilizers; we used to spend $7,000 or $8,000 a year to have them maintained,” Widener said. “Now we do that ourselves.”

Every contract is under review and they are looking for savings everywhere they can, Clark said.

Widener said he is currently working on a project to take the facility’s 106 printing devices down to 61.

“We’ve been buying 51 toners, now we’re just going to buy five. We’re going to replace it all new and see about $40,000 a year in savings.”

But it is not all about savings. So far this year, revenue collection is also up more than $1.8 million.

Part of this comes from the additional money from the County Commissioners. But this year the hospital has also replaced an old unit with a digital mammography unit purchased through a USDA Federal grant.

“I guess it impresses me that we went through all these changes but we were still able to get that new technology in here to serve the patients,” Clark said. He expects this new equipment to bring in an additional $120,000 a year in revenue.

“We’ve also completed during this past year a review of our chargemaster to bring it in line with industry norms or standards,” Clark said. “It’s basically a list of charges for CT scans and everything. We hadn’t changed that in 15 years. And it’s still lower than most places.”

Management estimates this should result in an additional gross revenue increase of about 10 percent.

Widener said they have also improved their billing and are doing a better job collecting.

Clark said the last two months were probably the highest collection months he has seen.

“We’ve done all of this while implementing and updating our digital medical records,” Clark said. “While we’ve made these cuts and changes, we’ve also kept up with the times. All of our X-rays and lab work can be looked at electronically.”

The Vision
“We cast our lot with Pioneer basically on their firm’s reputation,” Davis said. “They said what they were going to do and they delivered it. And we are grateful. We have respect for them professionally. They helped us do the difficult things that no one wanted to do. Today as we look at the outcome, we see the difficult things were definitely necessary.”

Through Pioneer, Davis said, the hospital has had access to consultants and experienced professionals it never would have be able to afford.

“We wait not to see how much we’ve lost, but now we wait to see how much we might have made,” Davis said.

Last month the hospital was within $11,000 of breaking even. That loss is down from the $250,000 to $300,000 Davis said it was bleeding a year ago.

“We have been in survival mode for quite a while and part of our vision has to be moving beyond survival mode to increase services and being adaptive to what’s going on,” Davis said.

Management is currently exploring the option of expanding its rapidly growing physical therapy department, investing in more space and additional positions.

And they are investing in their own future.

“We just approved action to begin moving electronic medical records into the clinics, which is a necessity,” Davis said. “I’m not sure if it is going to result in any kind of economic return but we just have to do it. It’s the standard that is expected. If you come to the emergency room at three in the morning then we should have the ability to pull up what medications you are on instead of having to put you through all that.”

As decisions are made on the state and national level that impact rural healthcare, Davis said Jefferson Hospital will keep its eyes on its mission, which has always been to provide quality community-based primary healthcare to the citizens of Jefferson County and the surrounding counties.

“Our vision will always be that,” he said.




Candidates face runoff

By Carol McLeod
Staff Writer

A runoff election is scheduled for Tuesday, July 22, and will be held in Glascock and Jefferson counties. Both elections are for statewide positions; however, Glascock County also has a runoff for the Board of Education seat in the Mitchell district.

That race is between incumbent Don Hilson and Greg Johnson and is nonpartisan.

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The state positions for Republican voters are for United States Senate between Jack Kingston and David Perdue; state school superintendent between Mike Buck and Richard Woods.

Republicans in Jefferson County also have a choice for US Representative of the 10th Congressional District. They may vote for either Mike Collins or Jody Hice.

For Democrats, the choice for state school superintendent is between Alisha Thomas Morgan and Valarie Wilson.

Susan Gray, the elections superintendent for Jefferson County said all polling places will be open Tuesday from 7 a.m. until 7 p.m.

Information from the Secretary of State’s office reminds voters who voted in the primary and declared a party will have to vote with the ballot for that party.

Someone who voted democrat in the primary must vote democrat in the runoff. Likewise, those who voted republican in the primary must vote republican in the runoff.

Anyone who voted nonpartisan is allowed to vote democrat, republican or nonpartisan. There are no nonpartisan races in Jefferson County.

The race for the school board seat in Glascock County is nonpartisan.

Anyone who did not vote in the primary but is voting in the runoff may choose the party.

The General Election will be Tuesday, Nov. 4. The deadline to register to vote in that election will be Oct. 6.










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