Important note: I just learned from a local resident who had a number of procedures done at out ot town hospitals that he has found out he could have had those procedures done at Cedar County Memorial Hospital, but his doctors didn’t give him that option. Presumably they wanted more business for their hospital. So, ask questions. It might save you and your family serious money and lots of travel time, plus help keep our hospital in operation.
Editor’s note: I had an appointment to interview Jana Witt, Cedar County Memorial Hospital CEO for the past 9 years, at 2:30 p.m. Thursday, Jan. 17. As I was trying to consolidate my questions for Jana, about 2:15 p.m. the office phone rang and Gwen announced that it was Jana Witt. Jana told me she had been thinking about our interview and had jotted down thoughts and emailed them to me. While we were talking on the phone, the email came through. She suggested I read it over and get back to her with questions. I ran it out and called her immediately.
This is a first for me and really worked well. Jana is kinda like me: She is more comfortable writing than speaking.
Accomplishments in 2018
Thanks to its new Marketing Coordinator, Jeanne Hoagland, Cedar County Memorial Hospital joined Facebook early in 2018. Cedar County Memorial Hospital uses Facebook to get timely information to the public about its services, special events, job openings and important health information.
In a collaborative effort between the Cedar County Health Department and Cedar County Memorial Hospital, low cost lab screenings were offered each month in 2018, rotating between the Cedar County Health Department in Stockton and the Medical Mall Clinic in El Dorado Springs as a convenience for Cedar County residents.
We welcomed two new managers in 2018. Rachel Kauffman, Pharm.D., became our Pharmacist-in-Charge in February; and in March, Tracy Fletcher, CRT, joined our management team in a dual role as Respiratory Therapy and Maintenance Supervisor.
In March 2018, we completed our attestation process for Stage 2 of Meaningful Use. “Meaningful Use” is the term commonly used to refer to the Medicare Electronic Health Record (EHR) Incentive Program. Stage 2 broadened the use of EHRs for health information exchange among providers and included greater integration of features such as e-prescribing and lab results.
Also, in the Spring of 2018, we provided FREE sports physicals at the El Dorado Springs Public School and at Northeast Vernon County. Physicals were provided by Kim Souza, FNP, and John Torontow, M.D. Our staff had a great time, and we really appreciated being invited into the schools to provide this service. In total, just under 200 free sports physicals were provided.
In May 2018, 417 Magazine printed its listing of “Top Doctors” in the 417 area code. This listing include five physicians who practice at Cedar County Memorial Hospital—David Smith, D.O., Emergency Medicine; Clinton Loy, D.O., Emergency Medicine; Roberto Moran-Bojorquez, M.D., Emergency Medicine; James Riscoe, M.D., Emergency Medicine; and Jose C. DeHoyos, M.D., Cardiovascular Disease. We are very proud of our award winning physicians and our medical staff as a whole!
On June 7, 2018, Lynn Fredricksen, RN/BSN, Cedar County Memorial Hospital’s Quality Improvement Coordinator, accepted the Most Zero Harm Measures Award on behalf of CCMH at the Missouri Hospital Improvement Innovation Network (HIIN) Quality Convening in Columbia, MO. The Award acknowledges the top 10 percent of HIIN-participating hospitals with the most zero harm measures reported. (Examples of harm measures are adverse drug reactions, catheter-associated urinary tract infections, pressure ulcers, sepsis, surgical site infections, and venous thromboembolism.)
In July of 2018, the Senior Life Solutions (SLS) program at Cedar County Memorial Hospital was pleased to welcome two new Licensed Professional Counselors, Brooke Malensek and Steven Bearden. Recruitment of these professionals was a major accomplishment for the SLS program and for our community.
In September 2018, we broke our past fund raising records with our “Luau on the Lawn” event located on the hospital campus. This was a great event with fabulous food and entertainment, games and a silent auction. We are so thankful to the hospital personnel and members of the community who came out to support this event!
As most people know, there is a major shortage of Registered Nurses (RNs) throughout the country. Cedar County Memorial Hospital began 2018 with five open RN positions and was happy to report in September 2018 that all RN positions were filled. That continues to be the case as we begin the new year.
Cedar County Memorial Hospital is blessed with a dedicated Auxiliary that operates the hospital gift shop and holds annual fundraisers to raise money to assist the hospital with needed capital equipment. In October of 2018, the Cedar County Memorial Hospital Auxiliary purchased two new vital signs monitors for the Nursing Department to be used in the emergency room and on the medical/surgical unit.
Perhaps our greatest accomplishments of 2018 came in November. On Nov. 1, we went live with our new electronic health records system, “MEDITECH EXPANSE”. This was an achievement many months in the making and reflects a true team effort on behalf of our staff members. On Nov. 5, we received notification from the Time Critical Diagnosis Unit Manager at the Missouri Department of Health and Senior Services that we had been approved as a Level 3 Stroke Center. This was a huge under-taking for our hospital and a major benefit to our community, which was led by our Emergency Department Manager, Amanda Schiereck, RN/BSN.
Editor’s note: Dr. Rick Casey told me that when he suffered a stroke while driving his car on Hwy. 32, he was taken to Cedar County Memorial Hospital and treated in the Stroke Center. Thanks to the expert care and a special shot, Dr. Casey suffers no ill effects from his stroke and was able to return to his medical practice.
In December 2018, the Senior Life Solutions (SLS) program at Cedar County Memorial Hospital was selected as a training site for employees of SLS’s parent company, Psychiatric Medical Care. What a great attestation to the quality of the SLS program located right here in El Dorado Springs.
As the second largest employer in Cedar County, employing just over 140 individuals, Cedar County Memorial Hospital is a major “fuel source” for the Cedar County economy.
Goals for 2019
As we enter into 2019, Cedar County Memorial’s four primary goals focus on quality, finances, people and the community.
1. Quality: Cedar County Memorial Hospital desires to build on its culture of quality and service to assure all those who access the services of Cedar County Memorial Hospital are provided services in a manner that reflects high standards of quality, safety and customer service. We will accomplish this through a variety of strategies, some of which include continuous monitoring of patient satisfaction, making customer service training a priority for our staff and holding staff accountable for providing great customer service, and developing and implementing action plans to address all identified quality and safety issues.
2. Finance: Cedar County Memorial Hospital desires to achieve financial stability and operate efficiently as an organization, while fulfilling the responsibilities of resource stewardship and integrity in all business relationships. Examples of how the hospital will work toward this goal include recruitment of medical providers with the appropriate skills to meet the primary health care needs of Cedar County residents; exploration of new service offerings and/or business relationships; and assuring operational changes are made to adjust to changes in volume.
3. People: Cedar County Memorial Hospital desires to achieve a culture of staff satisfaction and engagement, resulting in high performance. Cedar County Memorial Hospital highly values the contributions of all of its staff members and is committed to hiring and retaining high performing staff. Rewarding excellence and encouraging feedback from managers and staff are examples of strategies to achieve this goal.
4. Community: Cedar County Memorial Hospital desires to provide area residents with a range of healthcare services that are within the hospital’s financial capability and clinical competence. To achieve this, Cedar County Memorial Hospital will utilize creative marketing strategies to assure area residents are aware of the many services offered by Cedar County Memorial Hospital, providing community education opportunities to inspire confidence and trust from the community; and performance of a community health needs assessment in the winter of 2019.
Q. You employ 140 people. What is the payroll?
A. Our estimated annual payroll is $3,290,000.00. This is very important because much of this money goes back into our local economy. Again, we are the second largest employer in Cedar County.
Q. How has the federal government shutdown affected Cedar County Memorial Hospital?
A. To this point, we haven’t been affected. However, we do have concerns about continued funding allocations for some of our County Health Department grants that rely on federal money.
Q. How much are the cash reserves of Cedar County Memorial Hospital?
A. Our cash and investments total $5,634,000.00. Our days cash on hand (which is a measure of the number of days we could continue paying our operating expenses with no additional revenue coming in, given the amount of cash currently available) continues to be well above the average for Critical Access Hospitals in Missouri.
Q. What is the tax levy for Cedar County Memorial Hospital and how much revenue does that bring in each year?
A. The actual current tax levy is 0.1528. The maximum is 0.2000. The actual levy rate is adjusted annually based on a formula provided by the Missouri State Auditor. For our fiscal year ending January 31, 2018, our county tax appropriations were $271,519.00. Our budgeted expenses for that same fiscal year were over $13,600,000.00. Tax revenue funded only around 2 percent of expenses.
Q. How long has the hospital tax levy been at that level?
A. According to research by Marlon Collins, Presiding Commissioner for Cedar County, the original Cedar County Memorial Hospital levy was set at 0.2000 on February 3, 1961. The hospital currently operates under that original levy from 1961. No increases have been requested in 58 years! As a side note, Cedar County Memorial Hospital is the only Missouri hospital that manages its county health department. This means that the hospital’s levy must support both organizations. There is no other county in Missouri with a public Critical Access Hospital and a county health department that has less total tax support for their Critical Access Hospital and county health department combined than Cedar County. Cedar County Memorial Hospital is operating the hospital and county health department with less tax revenue than all but one other public Critical Access Hospital receives to run their hospital alone. In most cases, we are talking a difference of hundreds of thousands of dollars!
Q. Do you still operate a medical clinic in Stockton?
A. No. Our Rural Health Clinic in Stockton closed in 2012. Stockton Lake Walk-In and Primary Care is an independent clinic in Stockton operated by Dr. David Smock. We have good working relationship with this clinic and currently serve as their reference laboratory.
Q. So people can go there and that clinic will send the blood work to Cedar County Memorial Hospital?
A. We send a courier to Dr. Smock’s clinic every day to pick up the laboratory samples for patients of that clinic.
Q. Has stopping delivering babies stopped a huge financial drain on Cedar County Memorial Hospital?
A. Yes, that decision was based both on finances and on the fact that we were delivering so few babies that it was hard for staff to maintain their skills. We stopped delivering babies in 2012. I believe at that time, only 10 of the 36 Critical Access Hospitals in Missouri were delivering babies, and that number has continued to decrease. In 2013, we converted our obstetrics unit into our Senior Life Solutions (SLS) Program. SLS is a hospital-based intensive outpatient psychiatric program designed to diagnose and treat seniors with issues such as depressive or anxiety disorders, unresolved grief, and adjustment disorders. SLS is reimbursed through traditional Medicare, and we can get cost-based reimbursement on the program costs. If you look at the demographics of the communities we serve, a large portion of our population is over age 60. SLS is a program that targets the mental health needs of individuals in this age group. We see so many positive outcomes from this program!
Q. Are you facing increased competition?
A. Of course, and I think most small rural hospitals are. Funding changes have created a competitive environment for rural hospitals, causing many small rural hospitals to close as larger hospitals expand beyond their immediate service areas drawing patients away from their smaller competitors. This is why now more than ever we need area residents to realize the importance of supporting their local hospital.
Q. What do you consider your coverage area?
A. We consider our coverage area to include all of Cedar County and portions of our bordering counties.
Q. Did you mention Critical Access?
A. We became a Critical Access Hospital (CAH) in 2005 and want to maintain that designation. CAH is a hospital designation made possible by the federal government in the Balanced Budget Act of 1997 in response to rapid succession closure of small rural hospitals throughout the country. The ultimate goal of CAH status is to place small rural hospitals in a better financial position by allowing cost-based reimbursement from Medicare. CAH status does NOT mean lower quality. In fact, regulations governing CAHs have requirements in place to maintain a focus on quality.
Q. Any plans to get back into babies?
A. There is no plan to get back into delivering babies. You see more rural hospitals and Critical Access Hospitals getting out of obstetrics simply because you need to do a lot of deliveries to maintain the needed skill set. Also, obstetrics is a very costly service that can’t be supported by low volumes.
We have to be good stewards of the finite resources available to us. This involves constantly reviewing our service offerings to see what is and isn’t being utilized, as well as looking at new services we feel the community could benefit from and would utilize. Senior Life Solutions has been a good example of this.
Q. Are you interested in bidding for the ambulance service?
A. We still have interest. We are just waiting to see if the service goes out to bid.
Q. How are the hospital’s finances?
A. The current fiscal year hasn’t been a good one for us, primarily due to decreased patient volumes and expenses for a new electronic health record, which we had to purchase because our previous vendor sold their system, and the new company chose not to support it. Our loss year to date is over a million dollars. Again, I can’t stress enough the importance of local residents using our services.
Q. Will we have a hospital in five years?
A. “That’s going to be dependent upon how well the community supports us. We’re like any other business here in town. We need our local people to come in and use our services.”
“One of the things we are really going to be working on this year is making sure the community knows what services we offer.”
“Our staff members are required to have the same licenses and certifications as the staff at larger hospitals. We have to meet standards and regulations just like any other hospital. Patients will likely save time and money by utilizing the services we provide locally, not to mention it helps keep the hospital and the 140+ jobs it provides in the community.”
Q. Have you considered merging with another area hospital like Mercy, Cox, Freeman, Citizens Memorial or some other?
A. We have never formally solicited or received any viable offers for affiliation.
Q. Have you considered selling?
Q. What services are offered by Cedar County Memorial Hospital?
A. Off the top of my head these are the services we provide. Undoubtedly, I will miss something; but this should cover most everything.
Hospital inpatient & observation care
Swing Bed Program
Wound Care Program
Outpatient infusions & injections
Specialty Clinics—Neurology, Podiatry, Cardiology, General Surgery, Rheumatology, Ophthalmology
Outpatient surgeries; Endoscopic procedures; Epidurals for pain management
Pharmacy services overseen by a Doctor of Pharmacy—Medication procurement and distribution, Patient education, Medication safety, 340B program participant
Cardiac Rehabilitation Program, which also includes an exercise/wellness component
Dietary Department—Dietician services, Meal services, Nutritional screening & assessment, Nutritional care planning, Nutrition education
Emergency room—An ER physician is on-site 24/7.
Laboratory—General chemistry, Diagnostic immunology, Hematology, Immunohematology, Anatomical pathology
Blood transfusion services
Radiology—Diagnostic x-ray, Computed tomography (CT) scans, Pulmonary embolism studies, Bone density and Dexa scans, Digital mammography, Cardiac echos, dopplers and carotids; Ultrasound; mobile MRI; Cardiac stress testing; Teleradiology
Rehabilitation Services—Inpatient and outpatient physical and occupational therapy–Outpatient therapy is available both at the main hospital and at the Cedar County Health Complex in Stockton.; Inpatient speech therapy; Outpatient aquatic pool therapy in our indoor heated pool; Aquatic fitness (pool) classes
Respiratory Therapy—Aerosol therapy; Spirometry testing; Carbon monoxide oximetry; Chest Physiotherapy; Patient Education; Oxygen testing; Electrocardiography; Capnometry; Sputum sample collection; Cardiopulmonary resuscitation; Arterial blood gases; Oxygen therapy; Airway management and ventilation assistance; Sleep studies; Holter monitoring
Senior Life Solutions—intensive outpatient geriatric psych program
Cedar County Memorial Hospital Medical Mall Clinic Rural Health Clinic
Cedar County Exercise Center in Stockton
Cedar County Memorial Hospital In-Home Services Agency
Cedar County Health Department—Women’s Clinic, Show Me Healthy Women Program, Maternal and Child Health (MCH), WIC Program, Environmental Sanitation Services, Immunizations, Blood pressure checks, Cholesterol screenings, Blood sugar screenings, Strep tests, Pregnancy tests, Lead levels and hemoglobin checks, Flu shot clinics, Heights and weights, Communicable disease assessment and follow-up, Tuberculosis screening and treatment, Birth and death certificates, STD screening and treatment, Car seat checks, Free car seat program, Emergency/Disaster Planning, and more
Q. Is there anything else you want to add?
A. Yes, I want to brag about our staff. We have patients and family members of patients tell us frequently the care they receive at Cedar County Memorial Hospital is second to none. In the upcoming year, I am hopeful we can get more stories from patients about their positive experiences at our hospital out to the community.