Hospital finances still a quagmire

The interim chief financial officer of Eureka Springs Hospital said he is not yet confident in the hospital’s financial reporting after audit adjustments revealed a swing of more than $1.2 million from previously reported numbers.

At the Eureka Springs Hospital Commission’s regular meeting on Monday, April 20, interim CFO Doug Hoban gave an update on his research into hospital finances over the past couple of years, and said he’s still not comfortable sharing current numbers until there is a better grasp of what has happened in the past.

“We have completed all financial activity associated with the 2024 annual audit,” Hoban told commissioners. “As previously presented in September of 2025, ….  Forvis delivered the Dec. 31, 2024, audited financial findings. During that presentation, several audit adjustments and reconciling items were identified, resulting in updates to previously reported financial statements. The preliminary financial statements that were presented to this commission reflected a Dec. 31, 2024, net income of over $1 million. 

“Unfortunately, the auditor proposed, and management recorded adjustments totaling over $1,275,000 in deductions,” Hoban said.

An additional adjustment of $15,313 resulted in a net loss of $250,000 for the fiscal year ended Dec. 31, 2024.

“That is why I will not present numbers that I do not feel confident in,” Hoban said. “All audit-related adjustments have now been fully recorded, reconciled and closed in accordance with auditing standards for 2024.”

Hoban told commissioners that the hospital continues to work with the company it is contracted with for its financial platform to reconcile past errors.

“We have completed and validated December 2025 financial statements,” he said. “At this point, financial reporting remains in a reconstruction and validation phase as we address system configurations, workflow alignments, and revenue cycle processes. Because of this, current financials should be considered preliminary and subject to ongoing review.”

Hoban said the hospital’s immediate priority is completing the Medicare cost report, due May 31.

“We are actively working with Forvis to ensure all required documentation needed to complete that and submit within the deadline required,” Hoban said.

At the same time, the hospital is working to complete December 2025 closing entries, reviewing revenue cycle processes, and providing documentation for the 2025 audit, the CFO told commissioners.

“Our approach remains focused on ensuring that all financial information presented to this commission is accurate and fully supported, compliant with regulatory and municipal reporting standards, clearly identified as audited, unaudited, or preliminary as applicable,” Hoban said. “We will continue to provide updates as financial reporting reaches appropriate levels of validation and confidence.”

Hospital CEO Tiffany Means echoed Hoban’s statement on delayed financial reporting.

“According to the rule through the Arkansas municipality, we have to have validation,” Means said. “We have to have true numbers. And, if you present false numbers, that leads to... a false impression or risk for not providing accuracy. So, … when we’re still working out the fragmented process, still trying our hardest to get to the true number. And to be fair, we’re just not there yet. This is years in the making. We’re having to go way back to correct, to move forward, to make them accurate, OK? So, this isn’t a three-month bill. I can’t put a time limit on it, but this is where we are today and it’s following the rule of Arkansas. We cannot bring valid numbers to you today.”

Hoban was hired as interim CFO in December, shortly after the hospital terminated former CFO Cynthia Asbury. The Eureka Springs City Council removed commission chair Sandy Martin in January.

FULL STEAM AHEAD

Commissioners also got an update on other topics from Means, who continued to report progress on the behind-the-scenes work going on to clean up issues she has discovered since taking over last August.

“As we continue to work on our stabilization and strengthening Eureka Springs Hospital, I want to remind you that we remain committed to transparency, accountable leadership, and being grounded in our mission: patients first, people matter, progress always,” Means said. “Over the past month, our focus has remained consistent: Identify, validate, and correct system-level challenges while continuing to deliver safe, high-quality care to our community.”

The CEO said the past month has been similar to previous months.

“Our discoveries remain consistent with the prior reporting,” she said. “We have system-level gaps across revenue cycle, operations and compliance. However, what has changed is our execution and measurable progress. So, our ongoing issues are revenue cycle disruption tied to system configuration, workflow gaps and credentialing delays,  inconsistent financial reporting due to system limitations and posting delays, and historical operational misalignment impacting sustainability.”

The hospital is “actively rebuilding our systems with discipline and accountability,” Means added.

‘MAJOR ACHIEVEMENT’

Means also shared an array of positives, including an update regarding a validation survey.

“On April 15, 2026, we received a 100 percent cleared CMS validation re-survey,” she said. “No findings, no conditional-level deficiencies. This follows a CMS notice received on March 3, 2026, related to a reported … concern from July 5, 2025. Immediate action was taken on March 3 once we received that letter. A plan of corrections was submitted and was accepted on the first submission.  Our staff were fully educated, clinical documentation improvements implemented and 100 percent chart audits conducted.

“The surveyors returned for validation and confirmed full compliance with what we said we would implement. One surveyor noted a transformation in the hospital and commended the team’s professionalism, compliance and culture of care. I’m exceptionally proud of the entire staff, the leadership team and the work done to ensure we are compliant, safe and providing high-quality care to our community.”

Means announced that the UAMS Women’s Health Mobile Unit will be at ESH on June 9, and is working with the Eureka Springs Chamber of Commerce to spread the word about what the service will offer the community.

Another upcoming event will be the ribbon cutting and “blessing” of the hospital’s new survival flight services at 10 a.m. May 18.

FOCUSED ON THE FUTURE

Means said all the work going on is to ensure the future is bright and stable.

“If you look at 2024, and then you think, ‘OK, we fixed that.’ Now we go into 2025, which we know month to month wasn’t closed out,” Means said. “We know some of these things that we’re just trying to remedy along the way.

“But, there’s three things: the past, the present, and the future. So, the past wasn’t good. The today’s time, we’re trying to make it better. The future is, it will be better.”

Commissioners asked if Means felt better about billing and other past issues.

“I feel confident that we’re better,” Means said. “But, the system is still not great. So, what I mean by that is right now we’re working out a negotiation, a render negotiation with Oracle to fix our revenue cycle optimization. So, it wasn’t configured correctly in 2024, it was 30 percent operational when they went live.

“We also know that we have contractual agreements with our insurance payers that have not been updated in some time, as an example. So, we’re going back through and working through at how we can get contractuals made for that. …”

NUMBERS, OPINIONS IMPROVING

Commissioners learned that hospital visitor numbers continue to surge, with 232 ambulance visits year-to-date, compared with 85 during the same time frame a year ago.

In addition, the hospital has seen 370 patients so far in 2026, according to Velvet Shoults, the hospital’s clinical nurse executive.

“We used to average about two patients a day,” Shoults said. “Just to give you an idea, in the last probably 10 days, we’ve been averaging right around 13.”

Community outreach has also been positive, Shoults said, including a recent presentation to the Holiday Island Rotary Club.

“… It’s really nice to go and hear people say positive things,” she said. “We can’t make everybody happy every time — it’s not going to happen — but the overwhelming majority of the patients are coming back saying they appreciate the providers, the nursing staff, the tenants and the turnaround time getting them in, getting them out.”