Tiffany Means, CEO of Eureka Springs Hospital, didn’t hold back when discussing issues that led to the December termination of former chief financial officer Cynthia Asbury.
Means spoke candidly for more than 17 minutes during the Eureka Springs Hospital Commission’s monthly meeting on Monday, Jan. 19.
Means told commissioners she had previously attempted to be more transparent at times in presenting financial information but “was not met with willingness to do so.”
Commissioners commented one after another on how they appreciated the new transparency from Means and interim CFO Doug Hoban and looked forward to putting the past behind and moving forward.
“Thank you for the report, for the clarification of the things that have been kind of floating, but inaccessible to my ability to read what we were looking at before, and to have the feeling that we will be provided with factual basis to decide that we’re operating effectively or not,” commissioner David Carlisle said.
“Yeah, you know it’s one of those things that I feel a lot more confident now in hearing what Tiffany and Doug had to say about what’s going on and what the fixes are and the transparency that’s to come, and so great job, guys,” commissioner Willie Daniels added.
CEO LAYS IT ALL OUT
Means didn’t mince words in her first public comments after the Eureka Springs City Council voted 5-1 on Jan. 12 to remove former commission chair Sandy Martin.
Means laid out the issues leading up to Asbury’s termination, which came after a series of financial snafus were discovered — including more than $200,000 in unpaid invoices due to electronic medical records vendor Oracle.
Many of the points Means raised to commissioners were similar to questions asked repeatedly by members of city council over the past year.
“I want to begin by grounding today’s discussion in what matters most, our patients and our community,” Means said. “Every decision I make as CEO is guided by one responsibility, to protect access to safe, reliable healthcare for the people of Eureka Springs and the surrounding region. Transparency, accountability and stewardship are not optional in that responsibility. They’re essential.”
Means quickly focused on the hospital’s financial woes, saying the issues did not begin in 2025.
“Many of the operational regulatory and financial challenges discussed today did not originate in 2025,” she said. “The years 2023 and 2024 represented a pivotal period for Eureka Springs Hospital, during which, in my assessments, have been weak accountability, poor financial structure, ineffective decision making, and contributed to unresolved deficiencies entering into the year 2025. These conditions, including financial disorganization, lack of cost strategy, limited revenue optimization, and extensive regulatory plans of corrections that was cited on in November of 2024 were in place prior to my arrival.”
After assuming her role as CEO, Means said she conducted a “very thorough professional assessment of the past plan of corrections,” including available financial policies, regulatory history and organizational performance.
“While those findings were serious, they provided the foundations to learn from what did not work and move decisively toward disciplined accountable operations,” she said. “Just for example, presently, I meet with leaders oneon- one each month. It is an accountability model to ensure they are fully supported, have their resources to perform their job duties, and assure all rule and regulatory compliance is being followed strictly, closely and with safe practices.”
‘I HAD A LOT OF QUESTIONS’
When Means became CEO, the latest Forvis audit from 2024 had just been released.
After studying it indepth, she told commissioners, she had many questions.
“As a new leader, I took the audit seriously,” she said. “Even though I just had got it that day, I listened. I listened how they presented. I had a lot of questions. I made notes. I kept that binder there with me. I tried to fully understand its findings, implications and underlying causes, being just 45 days in. I had a lot of questions, important questions about the material weaknesses and significant deficiencies identified. I did make efforts and connected with our external auditors at that time in October with Forvis, and the two presenters that were here. I requested further explanation so I could responsibly assess what those findings meant for the hospital, our patients and our future. I spoke also with the financial supervisor of client services of the Rural Health Redesign Center, a support of our REH model.”
Means said she dug deeper over the past six months.
“As I began requesting support information internally, it became clear that accessing complete and reliable financial data would take time,” she said. “Information was fragmented, difficult to reconcile, and in some cases, raised more questions than answers. That process did not bring immediate clarity. It led to deeper inquiry. Over the past six months, as part of my fiduciary responsibilities to this community, I have continued to assess, verify, evaluate our financial position. The combination of unresolved audit concerns, limited transparency, and ongoing inconsistency made it clear that a more comprehensive review was necessary.”
After Asbury’s firing— with still no clarity on whether that was Means’ decision alone or there was input from Martin and/ or other members of the commission — the CEO reached out to Hoban and quickly began to collaborate with the veteran hospital CFO on ESH’s financial issues, she said.
“Following the termination of our former CFO, my interim CFO, Doug Hoban, and I re-engaged … on January 6th,” Means said. “That discussion again confirmed together the need for immediate corrective action and marked a clear transition towards financial accountability and stabilization. The 2024 audit and subsequent internal reviews identified material weaknesses and significant deficiency and a systematic breakdown in financial controls and oversight. This has been validated again with our current interim CFO, Doug Hoban.”
Means laid out “key specific areas” with commissioners that led to financial questions.
“Financial reporting and monthly closed processes were not reliable, resulting in material errors in reported financial information,” Means said. “Patient accounts receivable were not being adequately monitored, affecting revenue accuracy and cash forecasting. Accounts payable controls were insufficient, creating risk that material errors would not be detected in a timely manner. Capital assets were not being properly tracked, requiring audit adjustments to correct balances. Accrued payroll was incorrectly calculated, distorting current liabilities and impairing cash flow planning.
“Leases were not recorded in compliance … requiring material corrections. Subscription- based IT arrangements were not recorded in compliance … also requiring corrections. Most importantly, cash reconciliations were inaccurate or incomplete, leading to audit adjustments. These findings directly impact our ability to forecast cash, plan responsibly and ensure long-term stability.”
Many of those issues still had not been resolved as of late 2025, Means reported.
“Reviewing rolling monthly financials through November 2025 revealed that many of these issues had not been corrected,” she said. “Deductions from revenue ranged from 35 percent to as high as 111 percent in a single month. Bad debt expense was largely unrecorded. Depreciation expense remained unchanged for nearly 10 months.”
Because of all the issues, Means told commissioners that Hoban was not prepared to present the December financials.
“Doug and I have been working very closely in trying to validate accuracy, completeness, accessibility of underlying data. Integrity must come before speed,” she said.
Also discovered recently were issues involving “multiple vendor contracts,” Means reported.
“These findings were not taken lightly and reflect our commitment to transparency again, accountability and patient-centered financial practices,” she said. “Eureka Springs Hospital identified multiple vendor contracts, Doug and I, that had not been reviewed or updated in several years. Leadership initiated a comprehensive review of all active contracts to ensure the hospital is not being billed for services that are no longer provided or required. Contracts are being updated as appropriate, and in several cases services are being competitively bid to secure better pricing and ensure responsible stewardship of public funds.
“In November, issues with accounts receivable processes were identified, and that required immediate attention. These gaps highlighted breakdowns across billing workflows that directly impacted patients. We acknowledge these failures and affirm that care does not stop at discharge. It continues through the accurate, ethical, and timely billing. Corrective actions are actively underway At this time, we are retraining and restructuring our front-end admissions and registration workflows to ensure patient identification and insurance information are collected accurately, completely and consistently at the time of service. These improvements are critical to preventing downstream billing errors and protecting patients from unnecessary financial hardship.”
In late 2025, Means said the hospital began receiving information from past patients who received collection notices for amounts due to the hospital dating as far back as 2024. In fact, most were receiving notices for the first time, she said.
“In December, we began receiving calls from patients regarding their 2024 services, where patients reported receiving collection notices without having previously received clearer, timely billing statements,” Means said. “Doug and I immediately initiated an investigation into these concerns. This is what we have found so far. During the week of December 29th, we investigated the following … during the migration from Legacy to Oracle occurred, lack of documented review of affected accounts prior to collection replacement was not done. Accounts (were) originally placed with a former collections vendor, RMC, which later sold those accounts. That was in December of 2024. They sold these accounts for our current agency, Mid-South. We had a phone conversation with Mid-South because we were receiving lots of contacts from patients that they were just receiving the bill for their first time from 2024. It was later identified by Mid-South that they never addressed the bucket of RMC collections off the list. They never did anything with that for a year. So when they recognized that they did not do anything, this is when the letters went out and this is where the patients started calling the hospital going: ‘Why am I receiving this bill from a 2024 perspective.’
“So we’re working on that to correct that. We’ve obtained the list and we’re vetting through all of those items, but it takes time. There’s a lot of delayed collection activity that resumed again approximately one year later (and) is resulting in patient confusion and concern. We take this very seriously, and I’ve talked to many patients on the phone personally.
“So we’re actively reviewing all impacted accounts to ensure billing accuracy, compliance, and appropriate patient communication is conducted. Collection activity is being evaluated and solutions are being pursued that align with regulatory requirements and our mission to serve patients with integrity, fairness and transparency. A revised financial and billing policy has been developed to strengthen oversight. Vendor accountability, billing timeliness and patient protections. This policy is currently moving through the formal process right now and reflects our commitment to sustained operational improvement and public trust.”
‘WEAK MANAGEMENT DISCIPLINE’
With its commission chair and CFO now gone, where does the hospital go from here to solidify its finances?
That’s a question Means didn’t shy away from in addressing commissioners.
“… What happened? So what does it mean? Now what must we do differently? So what happened?” she said. “Again, over the past three years, the hospital experienced poor organizational structure, weak management discipline, inadequate compliance and flawed financial operations. So what do we do now?
“The conditions we are addressing today fundamentally weakened the hospital’s ability to operate responsibly. Inadequate financial structure, inconsistent leadership accountability, and poor regulatory discipline did not simply create bad reports. They impaired decision- making, obscured true performance, delayed corrective action and placed unnecessary strain on staff and patients. When financial systems lack integrity, leaders cannot accurately forecast cash and thus strategically control costs or plan sustainability. When accountability is unclear, problems persist instead of being resolved.”
While many problems originated in previous years, those issues were ignored in 2025, Means said.
“When compliance issues are not corrected thoroughly, risk compounds, affecting licensure confidence, payer relationships and public trust,” she said. “These issues did not suddenly appear. However, their consequences surfaced clearly in 2025, left unaddressed, and they would have continued to erode operational stability, increase patient and staff burden, and threaten the hospital’s long-term viability. So, that reality required a clear break from past practices and a disciplined shift in how this organization is managed.
“So now what? We’re going to close that chapter. We’re rebuilding structure, accountability, controls and culture.
“As a national winning collegiate coach teaches, mediocrity and high achievement do not mix. Today, at Eureka Springs Hospital, we’re committed to high performance, best practices, compliance and patient-centered care. This is not personal, it’s professional. We are moving towards serving our community beyond emergency care by expanding access, strengthening, continue. Continuity, engaging our community in belief and trust, and keeping care local. I stand firm on our pillars of what we are committed to. Patients first. We center every decision on what is best for those we serve. People matter. We invest in growth, accountability, and performance. Progress always. We lead through innovation, technology and regulatory excellence. Leadership is tested when systems must be rebuilt while care continues every day. I believe this hospital can be stabilized and strengthened by truth, standards and patient-centered leadership. I am fully accountable for leading this hospital forward, deliberately, transparently and in service to the people who depend on us. This work requires patience, discipline and the courage to correct course While care never stops. We’re doing that work every day. Eureka Springs Hospital will remain open, grounded in its mission, and lead with integrity because our patients, our staff and this community deserve nothing less.”
‘WAS NOT MET WITH WILLINGNESS’
After some brief input from commissioners, Means got a bit more pointed on the subject of her attempts to become more transparent regarding the financial issues facing the hospital during her monthly reports to commissioners.
“I think it was when I came on, I tried to share transparency in the presentation in a better way, but it was not met with willingness to do so,” she said. “But I think moving forward, and actually Doug and I talked about this, how we present the future is definitely going to give you a more clear picture. It’s going to be more transparent, and I think it will also give those out in the community a better understanding as well when we’re fully sharing everything in our meetings that should be and that should be on our financials ….
“So I think that the council has brought this up many times, and going back and reviewing those things and I reiterated that as well that moving forward some of these items are going to be added to the financials in February.”
NEW CFO CHIMES IN
Hoban, who was actually under contract the same day as Asbury’s dismissal and who has extensive experience with hospitals in Missouri and Texas, gave his input on the financial situation the hospital is facing.
“I’d just like to add to Tiffany’s comments about, as I onboarded, we felt the first and most necessary was to meet with the auditing company that provided the audit back in September,” he said. “And there were numerous issues identified and weaknesses. The most significant being the cash management. I think it’s no secret that it’s been noted the commission has seen over a 38 percent decrease in the cash reserves of the operation in the past year. To begin to shore that up, we now have daily access to the local bank account. It’s checked every morning. Outstanding checks are identified, so we know at any one point in time the amount of dollars that are so-called floating, written but not yet presented to the bank. Obviously, the commission is putting things in place to ensure that you all as the commissioners are aware of when transfers are requested, moving money from our lockbox where all the inflow of cash comes, to our operating account, which is where all of the expenses come out of.
“Hopefully, we can continue to keep track of that and improve on that as we go forward. The other comment I would like to make is noted in the audit was the fact of the huge swings in contractual reserves on a monthly basis, along with the bad debt recorded on a monthly base. As Tiffany commented, there was huge swings ranging from 35 percent on the low end in one month to 111 percent of the gross revenue generated in that month. In meeting with the auditors, there was discussions back in September of using a model of what’s outstanding to try to best average out or approximate what the contractuals should be going forward. In addition, that calculation would be used to determine the reserves for bad debt, and entries should be made associated with that model. To the best of my investigation, it does not appear that that model was ever implemented as we continue to see the huge swings.”
ANYTHING ‘ILLEGAL?’
Of all the input provided by commissioners, the most direct question came from Daniels.
“The only questions I might have is that there hasn’t been anything, let’s say, illegal done?” Daniels asked Hoban.
“I can’t say for sure, but I think most issues have been identified was just a lack of indepth review,” Hoban responded.
NEW CHAIRMAN
The commission unanimously voted to appoint Daniels to replace Martin as commission chair, a practice that takes place with all commissions each January.
A vote to elect a new vice chair or secretary, however, did not take place.
Also at the meeting, it was announced that a new air-evac service, from the company Survival Flight, is set to make ESH a “base location,” sometime this fall, commissioners were told.
NEXT MEETING
The commission announced there won’t be a workshop in February. The commission’s next regular meeting will be held at 1 p.m. Monday, Feb. 16.
CEO SUMMARY
Means later provided the Times-Echo with a written summary of her remarks at Monday’s meeting. That summary can be viewed at https://www.eurekaspringstimesecho.net/?p=52360
