Eureka Springs Times-Echo The new CEO of Eureka Springs Hospital is tightening the reins on finances for the remainder of the year.

At the regular monthly meeting of the hospital commission held Monday, Sept. 15, Tiffany Means, who has been in charge of the hospital less than two months, told commissioners that finances will be closely monitored using a cash-flow focused approach in the final weeks of 2025.

“So, I have looked at the operations and developed a 16–week plan for the operations,” Means said to open the Sept. 15 meeting. “During this time, we are gonna be financially tight in the last quarter …. The recommended budget approach that we’re going to take is the operational for best practice. It needs to be a flexible, cashbased, and expense-prioritized budget. What does that mean? The cash flow focused budget is a short-term mode for us. We’e going to shift from long-range planning to strict cash management. We’re gonna forecast weekly, not just monthly. And we’ll be looking at cash inflows and outflows, prioritizing essential expenses in payroll, supplies for patient care, utilities, debt service.”

Department expenses will need to be approved, Means said.

“The second one is a zero- based budgeting approach for the non-essential,” the CEO said. “This will require every department to justify all expenses. Nothing rolls over automatically. We’ll cut or defer non-essential purchases, projects, and contracts until the end of this year. We’ll reduce any discretionary spending. If there’s any right now, there’s none approved or forecasted in that manner.”

The hospital is also going through an organizational revamping to help with labor costs. The hospital has brought in 24 new staff members since May 1, human resources director Jodi Edmondson said, adding that 14 of those are clinical roles.

“Labor is usually 50 to 60 percent of our hospital costs, ands so with that, we’re doing an organizational restructuring for long-term cost savings,” Means said. “We’re reviewing overtime and agency contract labor use. …. We’ll cross-train staff to maximize flexibility. I’m looking at every role in every department to see if we can expand those roles, and I meet with coworkers, tell me what your job is like. Tell me, based on your job description, is this what you are doing and if there’s opportunities for them to expand and cross-train within the hospital. We’ll be looking at those type of things.

“And then we’re just aligning our staff tightly to the census and acuity, which right now we’re core staff, we’re at the basis, but we’ll just continue to monitor that to prevent overtime if we can.” The hospital will ensure that staffing numbers meet the requirements of operating a Rural Emergency Hospital, Means assured commissioners.

“We’re already at base,” Means said. “When we talk lean, we’re already what I call core staff, what our minimum is according to the rules and regs of REH. We are meeting those guidelines.

“We will not cut short based on those rules and regs.”

The hospital will use a “flexible rolling forecast,” instead of a fixed quarterly budget, Means said, adding “we’re going to adjust projections based on revenue collections and census trends.”

“We’re gonna accelerate billing and collections, focus on improving coding and documentation for maximized reimbursements,” she said. “We’ve already shifted to that, and actually in the past week, we’ve recovered some things in some of our documentation that gives us better opportunity to be able to maximize our reimbursement and just ensure that there’s no revenue leakage. That means denials, underbilling, mischarges.

“Next is prioritize mission-critical services. This ensures budget protects core clinical services and patient safety and will defer expansion or non-critical projects. Again, our labor force management is: We’re looking at that weekly. I have a meeting set up with our CFO [Cynthia Asbury] that we’ll be looking at every week. We’ll be look at this agenda and be transparent in that manner. … This recommended budget is again, cash-based, zero-based and flexible ruling forecasts that focuses on short-term actuals, strict labor management, and revenue capture. It is not about long-term growth right now. It’s about ending the year on a good note.”

Commission vice chair Brian Beyler asked if expenses were going to be evaluated weekly.

“What we’re doing is we’re monitoring all of the expenses and the revenue on a weekly basis,” Means said. “Cynthia and I get together and we go over, what does it look like, what did the last seven days look like? So, we can stay on top of it a little bit better.

“Again, this is a short-term plan to finish out the year. When we looked at this opportunity, we feel like this is the best plan for us …” Commission chair Sandy Martin said Means’ approach will help going into 2026.

“This also creates what we’ve been hungry for, that base going into 2026, and her focus is to secure us to the end of the year, and then to get some benchmarks,” Martin said. “That coupled with the reorganization, coupled with all the other internal operations stuff that they’re doing is gonna put us in a great shape. We don’t know where we’ll wind up at the end of the year at our budget workshop. I think we all said we may be in a negative position, we don’t know, but we’ve got to keep it flexible.

“And next year, we’re gonna have to be flexible as well because there are so many unknowns that we’re going into. But, this is a real strong base and a real strong platform to feed off of.”

Martin asked commissioners how they felt about Means’ plan for the remainder of 2025.

“We’re being very aggressive, and that’s what’s great, very aggressive,” Beyler said.

“And very prudent and conservative,” Martin added.

“Two good adjectives, aggressive and prudent,” commissioner Kate Dryer chimed in.

ENGAGEMENT SURVEYS Means also gave the council a little more insight on surveys she expects to roll out to hospital staff in the coming months to gauge employee morale, something she first brought up in comments to the city council at its Sept. 8 meeting.

“…One of my focuses, multi-faceted focuses, is to ensure that we all know where we’re going and how we build a stronger future together,” Means told commissioners. “That’s a platform that I want to kind of stand out on and lead and build and grow together. So, as we move into that, I want to address a little bit about the survey that was brought up in the city council meeting, and then I just want to reiterate to this group that we are going to be doing sometime the first week of October, an employee engagement Survey Monkey type of gauge just to see how they feel where they’re at. We don’t really want to do a formal approach to that because we’ve had some new on-boarded staff, and that would give a short-term type of feel … we want to build towards long-term. So, let’s get them in, let’s get our roots going, let us get the build going with the team, let’s get the pulse of where we’re at right now and see if we can have some building blocks to move to the future. … “So, I think this ensures that the results that we gather are going to be reliable, actionable, and more of a representative approach in the future.”

Means also told commissioners that from May 1 through the end of August, 203 patients received calls from hospital staff surveying their experience visiting the ER.

“These are the patients that we actually got ahold of,” Means said. “We tried to attempt to get ahold of all patient callbacks, but we were not successful in that.

“We had 203 callback patients, and six out of those 203 were negative feedbacks. We tried to do some service recoveries on those patients. But, other than that, 197 patients left a positive report.”

The hospital staff uses a script when reaching out to patients, Means said.

“We ask about how their care was, if there was anything that they are concerned about,” the CEO said. “We have a few questions that we asked them. And then what happens, if there is a negative [feedback], then that is sent to me right now, and so that I want to do a follow-up again with those patients. But, we haven’t received a negative one in quite a while. … I would say in the last 30 days, I haven’t received one negative.”

CFO REPORT

Asbury told commissioners that total charges billed in August were approximately $760,000.

“We’ve brought in someone to help us ensure we’re not missing any charge capture within the clinical … documentation,” she said. “We very quickly identified that we were. We’ve been working to correct that. Tiffany’s got a great plan in place with that with [clinical nurse executive] Velvet [Shoults], so we’re gonna ensure that we are maximizing our reimbursement on all of the patients we see. So, very hopeful within that.”

The lab continues to be fully staffed 24/7, Asbury said.

“With us being staffed it really does increase the incrementals and what we’re billing out 24/7, too,” she said.

Radiology referrals have also increased, the CFO said.

In the income statement report, Asbury reported that the hospital did have another loss for the month.

“Kind of within that, I will say, we’ve been on-boarding additional staff, bringing them up to par to be able to reduce contracts,” she said “I mean you’re going to end up having two employees you’re paying at the same time. So, I mean nothing short of that, we’ve been working down the AR within that since we have brought payment posting in-house. So, we are seeing some of that adjustments hitting in there, more rapid payment posting side of that and kind of cleaning up some of the that.”

Asbury’s budget report to commissioners also included a copy of the hospital’s financial collection policies, including bad debt guidelines. Members of city council have been critical recently, saying the hospital didn’t have a bad debt plan.

“I provided this just for reference, so everybody has it,”Asbury said. “These are our financial collection policies, our self-pay discount policy, along with an information sheet from collection agency, along with our bad debt guidelines, referencing from CMS. These policies have been in place; they are not new. I implemented them in 2022 when I did come on board. That was the initial time because the hospital didn’t have them prior to 2022. So … we implemented these. We’ve continued to revise and keep them up to date.”

CLINICAL UPDATE

Shoults began her report going over clinical volume numbers and information about where patients go when leaving the facility.

“Where do they end up?” she said. “Acute care? Psychiatric facilities? Rehab facilities?”

Commissioners were told that a patient arrived at the hospital with heart issues the morning of the Sept. 15 meeting and within five minutes had received an EKG.

“They spent five minutes in our building before they got their first EKG and 90 minutes before Lifeline lifted on the back of our pad …,” Shoults said.

“The two nurses came out when the pilots kept it running, grabbed our patient and off they went. They were in the cath lab less than 30 minutes from the time they left us with some significant disease … it was a pretty significant save.”

Newly hired staff helped make the experience run smoothly, Shoults told commissioners.

“The staff working today, our new staff to us, maybe have only been with us a couple of weeks, maybe, and they jumped right on that, packaged them up, had everything copied, were on the phone, and that young lady was out the door before we knew it,” she said.

Means agreed. “It was phenomenal to watch that today, to see the teamwork, the handoff of the patient from the clinical side to the flight crew side was just effortless, like they’ve done it a million times before,” Means said. “We got this patient up and going to the cath lab [at another facility] where they needed to be. So, I’m very highly impressed with the team, that’s Velvet’s work.”

Overall, Shoults said volume at the hospital is trending up, although she is still disappointed in the numbers.

“It hits and misses, but honestly, every week … it’s 10 more, 12 more, 11 more than the week before,” she said. “… I feel like we’re making headway. I definitely feel like that our length of stay is down significantly, down to two hours and 58 minutes, and we were running in the four and five hours towards the first of the year.”

‘A COOL PLACE TO WORK’ Shoults told commissioners that the hospital has three new full-time RNs, two part-time RNs, and two new paramedics.

“…The average tenure in these nurses is 15 years, most of them sitting at 30,” she said. “Two of them live local, and the rest of them about a little less than an hour from us. The medics, to give you an idea, one is a retired fire chief and the other one is a current supervisor for regional for Pafford [ambulance service], and they are loving being in the ER.

“So, that takes out three full-time travelers, and we just converted, we don’t have the paperwork signed yet, but they’ve committed to take two more of our travelers from a traveling contract to become ours. So, it will end up getting rid of five travel contracts for us in the next 30 days.”

Two of the travel nurses have agreed to stay on as staffers, Shoults said, adding one of them lives in Rogers and the other in Harrison.

“That must mean that it’s a very positive work environment, I would think, to have travelers say, yeah, yeah, I’m gonna come back and do full time,” Dryer said.

“Yeah, they see change, they like it, they like what they see, and ER nurses will tell you,” Shoults said. “They’ll tell you exactly what they think, good or bad. And so far, the feedback has been positive for them. But, to take out five of them in a swoop, it’s been a whirlwind, especially for Jodi, trying to get everybody on-boarded. …” Three travel nurse contract reductions in a 13-week period saves about $56,000, Means added.

“So again, tremendous work to Velvet and Jodi interviewing, on-boarding, getting them all ready to go,” Means said. “And they’re the ones that basically came to us and said, ‘we want to work here.’ So lots of positives. Well, according to them, the word’s out that it’s a cool place to work.”

“We’ve never been called a cool place. That’s great,” Martin said. “That’s great.”

All of the hires have Trauma Nursing Core Course, Shoults said.

“One of them has a master’s degree, has managed ERs, worked in trauma centers on the East Coast, retired here,” she said. “She actually bought a house in Holiday Island and is finishing travel contracts. She starts with us the first part of November.

“The others are from the Cox, Branson, Lampe, Harrison, Omaha area, kind of down through that area. And one of the part-timers is moving here as well for family. It’s exciting.”

Commissioners were impressed with how things are going on the clinical side, they expressed.

“The competence and the synergy that you guys demonstrate is something I couldn’t have dreamed of six months ago,” commissioner David Carlisle said. “This is really gratifying to see that we are viable,…. and that we’re looking good. It’s great. Thank you.”

‘UNITED IN SERVING COMMUNITY’

After the reports, Means said she is pleased with the support she has received from the commission and city council so far.

“I think my biggest drive right now is that I really appreciate the support of the commission and I appreciate the support of the council,” she said. “It is with great hope that we all can be united in serving in our community and promoting the hospital in a way that is positive to our community that has trust and belief that they can come here, come to our hospital, and they’ll get the best of care. So, moving forward, this is something that I really hope: to have a close relationship with everybody.”

That is key to continued success, Martin said.

“That’s critical moving forward, and I think what’s great about what’s happening now is that we are truly 110 percent focused on hospital business and moving forward and it’s paying off,” the chair said. “We’ve got great leadership that stays focused with that, the commission has always been focused on it, and I think we’ve navigated through the distractions.

“The more we maintain that focus and the focus on the community that we serve. I think more success will come, so I appreciate everybody doing that.”

Commissioners took turns praising the staff and the progress the hospital is making.

“For me, it’s an exciting outlook coming in new on the commission,” commissioner Willie Daniels said. “I see nothing but great stuff coming, so great job everybody.”

Commissioner Sharon Deramus, who was recently approved by the city council to serve another five years on the commission, agreed.

“That’s the reason I re-upped for five more years, because I felt like we were going in a positive way, and I wanted to kind of ride that wave,” she said. “… We are going in a positive and it’s just exciting.”

SPECIAL MEETING ON AUDIT

Martin reminded commissioners of a special meeting scheduled for 10 a.m. on Tuesday, Sept. 23, where representatives from Forvis will present the 2024 hospital audit.

Members of the city council have been invited to attend as well, Martin said.

“We will be voting to accept the Forvis audit and their recommendations,” Martin said. “