It started a little contentiously.

It ended with plans being made for a group lunch.

The joint workshop between with Eureka Springs City Council and members of the hospital administration and commission was held Thursday, Aug. 21, and when it ended, the two sides appeared as close to being on the same page as they’ve been in 10 months.

“I love this meeting and I love the way we have gone from perhaps a little contention, a little unease, and we have going to booking a lunch together,” hospital commission chair Sandy Martin said to close the workshop, which lasted approximately 75 minutes. “I think that this is huge progress ….”

The workshop centered around a handful of questions from council member Rachael Moyer, who has been adamant in recent weeks in requesting information from hospital administration — specifically chief financial officer Cynthia Asbury.

Asbury, with some input from Martin, answered each question from Moyer, who at times, seemed a bit on edge at the answer – or lack thereof – that she felt she received.

Sitting quietly during the back and forth was Tiffany Means, the hospital’s new chief executive officer, who finally chimed in during the latter parts of the meeting during a conversation about the importance of the hospital being more transparent with the public when it comes to regular budget updates that was leaning toward another possible contentious exchange.

“Can I interject a little bit?” Means asked, starting a nearly seven-minute comment that seemed to totally change the dynamic and spirt of the workshop.

“I’ve really watched a lot of the council meetings before I came here,” Means said. “I watched a lot of the commission to gather ideas of what the past has been like, and I think we all understand that. The past at the hospital was pretty rough going, but I think that in my aspect coming in is, we all learn from the past. I hear you, I hear what you’re wanting.

“I think where we need to come in is look at how we present in a manner that fits the needs of the community, right? But being new, I want to go back and look at what are the most common things that are coming up in the past that we can move forward with that we bring forth to the community and to this council. I don’t live in the past, but I learn from the past and I’ve studied a lot of the things that Eureka has gone through.”

A key is how the hospital, under her leadership, puts together a 2026 budget and how it is presented to the community, Means said, including being more prepared moving forward when it comes to anticipating major purchases for the facility.

“I think moving forward, especially when it’s becoming budget season, there’s ways that we can improve in our knowledge by what you’re sharing, how we construct the budget going into the next year,” she said. “Most commonly, in my past, yes we projected end of life of machines, so when we budget something, let’s just say, ‘I think my defibrillator is the end of life at five years.’ OK, so it is a 2023 defibrillator, so in two years, I know that I’m going to need … $15,000 for that expense.

“I think in the past, and I haven’t dove into some of that stuff, I have a feeling that there wasn’t a lot of that projection. So, what happens is, then when you have these things that start hitting, like you’re seeing these numbers, it doesn’t give you understanding of: Why now? Why why all of a sudden did these hit? And I never heard anything about this. So, I think we need to work on being more clear in those projections. And then, when we work on the budget, we can … I plan to meet with all the teams to say, evaluate your equipment. You know, it’s gonna be vital. We are in an AI world right now. We’ve gotta have the most updated technology, especially in rural care.

“If you read everything, and it is strictly trying to keep our … our health care close to home, so it’s vital for us to stay on top of those things. That is moving forward. I can’t represent the past, but I have heard a lot of the things and I’ve taken notes, and when we get together, I think we can present it in a way that’s going to be satisfying, and if not, we need to listen and work together to see what we can do to get that projected out.”

Means said she is learning certain aspects of a city-owned hospital and the need for the community to be aware of how certain things are run.

“There’s some things, that as a business, we try to keep within the realms of the hospital,” she said. “But as I learn more about city-basedowned hospitals, how we deliver the message and what we share in the message is transparency,” she said. “So I hear you, Rochelle. I hear the whole team, and I really look forward to working with everybody. There’s a lot of positives. Right now, I think you hear a lot of negatives of the community and I hear it. Recently this week, I talked to a state surveyor this week and she mentioned that she has gone onto Google and stuff like that and she goes ‘when I was here last year, it was bad. But when I read the reviews, they’re a lot better.’ That’s a good thing. And that’s what we need to focus on, the positive that we need to do for our community. We have a comment was made about the new provider contract that we went with. Vast difference by the surveyor saying, ‘you are going in the right direction. You have some top notch providers here.’And I see that.

“… One of the things that she also said, ‘vast difference at the look inside the hospital. … She’s like, ‘when I came in last fall, I can tell you it was not good. But when I come in this week, it gave me a total impression that the hospital is working hard to move in the right direction.’ And honestly, it looks great. It’s been cleaned up, it’s organized, it has the best of the equipment. Then our next facility that is close to us, we have the same, if not the same equipment. We’re working on education of the staff. And we all know this correlates to generation of revenue and bringing in more services. So I appreciate the questions. I do. I really appreciate the questions, because if we didn’t have the questions then we just always go around assuming and we shouldn’t have that. …” Moyer, who nodded her head in affirmation at times during Means’ comments, said she appreciated what the new CEO had to share.

“We appreciate that. I love to hear your vision and your optimism for what’s going to happen,” Moyer said. “That’s also very reassuring.”

And it led Moyer to one last question.

“I’m curious what, and maybe you don’t have that now, but I’m curious what your plan is to try to reengage with the community, because I do think, I don’t live in the past either, but I know that the past can give us some really important information,” Moyer said. “I constantly hear from people who still have a really negative opinion of the hospital. And I think it’s, I’ll be interested and excited to hear what the plan is to reengage the community in the hospital, because I think that’s a big piece. Now that you kind of have your facilities back in order and things like that, how do you reengage people? How do you reassure them that our hospital is top-notch, is going to provide good care, is on top of the billing correctly, is all those things so that they’re not driving, you know, inconveniently for them and maybe at risk of their own health to another place because they don’t trust what’s here.

“So, I really look forward to hearing more about that. And I personally would be interested in a tour of the hospital so that I can see it for myself. Perhaps we could do that as a group. I think that would be… “

Martin chimed in: “That’s very positive. Thank you for making that…” Means talked about future plans she already has on the horizon — some that she said that are too soon to mention publicly.

“I can share with you my background has been here in Northwest Arkansas healthcare,” she said. “I’ve had a lot of connections with a lot providers over in the Bentonville-Fayetteville area. I have had numerous specialties reach out to me to see what they can do. Numerous. Like they want to meet with us and come over and provide a service. I don’t want to be out loud about what all those are, but even before I came in here, they were excited to see progression and positivity of growth and build, rebuild in this community.

“I think that one of the things community needs is the trust. But it’s about relationships. And we need to work on our relationships, and how we do that is not always you come to me, but I need to come out to you, we need to come out to you. We need to be more transparent, visible, but we also need to invite you into our house and let you feel comfortable to see. I’m excited about the future and it’s just not a selling point. It’s a vital point to this community. Driving over here, I know there’s a lot of population that would like to have their healthcare services performed here instead of driving on a curvy road all the way over to Bentonville if they can do it here.

“ …Working with our medical provider, we meet every week. Our leadership team is working on professional growth and development within ourselves. I’ve done a lot of oneups. And then my first 30 days is to connect, and then move out into the community and start connecting there. So, I think a lot of this is as we work through our budget as well, it’s really difficult, right, when we’re in this world of a lot of fluid movement of not knowing where we’re gonna get reimbursed and how we’re going to get reimbursed. But, I think our role is, let’s bring back life to the hospital and bring back the services and trust to the community. Generate that revenue based off of those services and serve our community in the way that it deserves. And I think they truly deserve that and I fully believe that and I will live that every workday. So it’s just not a selling point; that’s just who I am … that’s the way I’ll be.”

Part of that community trust can start with continuing to replace short-term contract labor with full-time employees who want to live and work in the area.

“Throughout the country, I’ve worked with a lot of nurses and a lot of contracts. They really suck the system with not only they’re not engaged into the hospital and community,” Means said. “They’re great nurses. They come in, but they’re here for a reason, right? They’re here to make as much money as they can, because that’s what a traveler does. What we’re working on is more, our coworkers develop more staff, become more of us, and decrease that labor cost. That is something that right now is creating a negative with some of the contractors that have been here a while, but we also are offering these contractors. We offer them a full-time position. You can stay and be one of us, and we would like for you to be a part of us. But a lot of times, they don’t want to stay. So, it’s like right now, we are getting a lot of applicants for the course that we’re in right now. There’s a lot of word of mouth going around about the transition and the positive. That is moving forward, and the best thing that I can share is we’re creating a culture right now that’s welcoming and forgiving.

“So, we want to welcome you, we’re going to treat you like an individual every single time, and every co-worker is being treated the same as well. So you create a culture that is positive. People will want to work. People will want to come in here and go, ‘I love to work here.’ And that’s what our leadership team is now working on and focusing on is a culture that is like that.”

Again, Moyer was impressed with what she heard.

“I’m so very excited to hear you say that, and I actually have seen on your website postings for permanent positions,” Moyer said. “I think that’s really smart, too, from a community outreach perspective, right? Because if you have members of the community working in the hospital and they’re loving what they’re doing, they’re going to go tell their family. Those people are going to tell their friends. And it’s a real organic, authentic way to show that you’ve turned the page, right? And you’re also putting your … money where your mouth is, so to speak. We care about you enough that we want you here long-term, and that’s a commitment to the community.

“So, I absolutely love to hear that. That is very reassuring to me. I love your optimism, and I’m happy to finally get a chance to interact with you. And, I do believe that positive, strong leadership can do amazing things. So I wish you all the best, and look forward to going through the hospital.”

The council expressed an interest in a group outing to tour the hospital and Means suggested she would have breakfast provided.

“Can we just do a lunch, though, instead of breakfast?” council member David Avanzino asked, bringing laughter from the entire group.

Council members reminded the group that the event, which will likely be scheduled in September or October, would have to be considered a public meeting, and be recorded at least by audio. Council member Terry McClung said it would be a great community event if the tour and visit could be streamed live on Facebook for anyone to view.

“If it has to be publicly posted then our city will see us trying to work together to improve for the betterment of the community,” council member Susane Gruning said.

MOYER’S MAIN POINTS Moyer said she had three main issues to address in the workshop.

The first was confidence in the hospital and how the community trusts the facility’s finances and overall morale. The second dealt with what she called “generalized revenue dropping.”

“So, you have decreased revenue, increased spending. That looks like trouble to me,” Moyer said.

Moyer mentioned the $1.3 million that was recently moved from cash to accounts receivable on the hospital’s balance sheet, and the need for more accurate and specific reporting of accounts receivable information.

Martin said the numbers Moyer requested could be supplied and Asbury reminded council members that even though the Forvis audit for 2024 is complete, current numbers are still being looked at.

“Even though we are wrapping up and we just kind of got our drafts on our 2024 audit, even though that is the ’24 audit, Forvis continuously looks through every month’s financials, every month bank account transactions and everything through current date until they literally issue the final audit,” Asbury said. “I mean, I just sent them all of July’s financial, all of July’s bank statement information, everything. So, yes, the audit is for ’24, but they continuously monitor every transaction and every detail within the financial world of the hospital through current data issuing the previous year’s final audit.”

Moyer then turned to bad debt and why there has been no bad debt reported for 2025 when it has been every other year.

Asbury explained that a better system to try to collect past due bills is more efficient, and so far, there has been no bad debt for the year.

“We have not had any accounts returned to us from the collection,” Asbury said.

“So, everyone’s paying. Everything’s up to date?” Moyer responded.

Asbury replied: “They are either paying us internally or they are in the hands of the collection agency. The accounts are sent to the collection agency and therefore they are … it’s timing.”

A new “sophisticated” system is one of the main reasons why, Asbury told council members.

“…When I came on at the end of 2023, I mean accounts weren’t being worked,” Asbury said. “I mean we had accounts that were three years old and hadn’t even been billed to insurance. I mean so there was a lot of those variables that had to be cleaned up, processes put in place and followed to a T to ensure that we are diligently working and collecting every penny we can. Whether it be from insurance, from the collection agency, from the patient….”

Moyer’s final point dealt with a mid-year budget review — something that Martin said did take place, while acknowledging that this year’s budget was the first one that the hospital commission had.

That comment drew the ire of some council members, with Martin assuring them that a budget would be done each year moving forward.