Hospital leaders detail more financial findings

More inconsistencies have been discovered in the financial records of Eureka Springs Hospital, CEO Tiffany Means and interim chief financial officer Doug Hoban told the city hospital commission this week.

“… This is why the finances haven’t been accurate,” Means said during a lengthy presentation at the commission’s regular meeting on Monday, March 23.

Means said the hospital’s electronic records system, Oracle Health, was never properly set up. The system still reflected ESH as a critical access hospital instead of its rural emergency hospital designation, which changed in December 2023.

“Oracle Community Work System was identified as approximately 30 percent correctly configured during the implementation and go-live,” Means said. “This resulted in inefficiency and gaps in the revenue cycle process.”

The Oracle discovery prompted Means to address these issues with the company.

“We are currently working with executive revenue cycle leadership to negotiate a full system reset and rebuild,” Means said. “Upon agreement, the rebuild phase is anticipated to take approximately four to six months to ensure accurate and sustainable functionality.”

Means later told the commission that issues with Oracle’s setup were among the first items brought to her attention when she came on board as CEO in August 2025.

“… When I first came here, that was the first thing that was presented to me, that the Oracle build was not right,” she said. “So, I started connecting in October, finally got to some representatives, and had discussions and emails back and forth, mainly on the clinical side. I did not know the revenue side was worse. So when that recognition came about, our meetings became more tense because ultimately, that’s the root of the cause of our major problem. So I could tell Doug, I said: ‘You know, we could have 10 issues, but what are our top two?’ And we need to fix these before we can move on,and Oracle is at the top.”

Means said the issues have prevented the hospital from ensuring accurate billing.

“… It’s just so disrupted right now,” she said "... So they’re gonna come down, we’re gonna make it right. They’re going to build the configuration based on the REH model, because, see, they went in, too, with it being critical access. It wasn’t ever changed, although there are conversations centered around the why behind that. But, that has been recognized by them as well, that it was not configured according to the REH. So, this stems from all the way back to the implementation, right? So if it’s chronically broken, things get worse, you never fix it, it remains broken.”

MORE DISCOVERIES

Another issue recently discovered is that the hospital’s charge master is “outdated by years.”

“And does not reflect current or optimized pricing structure,” Means said. “So what action are we taking? Well, industry costs typically for a charge master review are about $15,000. So, we are working collaboratively with our support network of REH’s to complete updates at a significantly reduced cost …”

Commissioners were told that certain agreements by the previous hospital administration were “excessive.”

“There are certain agreements entered into by the previous administration that were excessive, not operationally practical, and are creating unnecessary financial burden,” Means said. “… We are conducting a comprehensive contract review and actively renegotiating or eliminating non-essential services to align with operational needs and financial stewardship.

“Another discovery is credentialing files and enrollments with Medicare, Medicaid and payers were not consistently or properly completed, resulting in the inability to bill and collect professional fees. … We have discrepancies, again, in our payment adherence and execution of certain payor and vendor agreements, and our attorney has been engaged, and we are actively working through those negotiations and corrective actions to ensure compliance and recovery of payments owed that are paid to us.”

TAKING IT ON TO FIX THINGS

“As CEO, I carry a fiduciary responsibility to ensure that all financial information shared publicly is accurate, properly validated, and presented with a necessary context,” Means said. “This is essential to prevent misinterpretation that could impact hospital operations, workforce stability, and access to care for our community. While we are fully committed to transparency as a municipal-owned hospital, we must also be responsible in how information is shared. Presenting incomplete or unvalidated financial data without context can create unintended consequences for the organization and those we serve.

“Eureka Springs Hospital will remain open, grounded in its mission, and led with integrity because our patients, our staff, and this community deserve nothing less.

“As we continued our comprehension operational review, the interim CFO and I have now fully defined a set of issues that are both significant and long-standing. The scope of these findings helps explain why concerns have persisted over time. What has become clear is that these challenges are rooted in system-level gaps that developed, again, over a number of years. Processes not aligned with best practices missed opportunities for external guidance and operational structures that did not support long-term stability.

“Importantly, this phase of discovery has allowed us to move beyond identifying issues into structured correction. What matters now is that we fully understand these issues. We are not applying temporary fixes. We are implementing corrective actions that address root causes. Our focus is to rebuild Eureka Springs Hospital into an operationally sound, professionally managed and financially responsible organization. One that the community can trust. This work is not about individuals. It’s about systems. We are actively correcting processes, strengthening operational structure, and establishing a stable and accountable foundation moving forward. All efforts are being carried out in close coordination with our interim CFO to ensure full alignment between operational improvements and financial integrity. Given the ongoing financial reconstruction validation process in accordance with standard healthcare financial reporting practices, we are implementing a structured reporting framework to ensure consistency, accuracy and responsible communication at every level. This framework is designed to balance this transparency with our obligation to provide information that is complete, validated, and appropriately contextualized.”

PATIENT CARE GOING WELL

While behind-the-scenes issues remain, patient care continues to be top-notch, Means told commissioners.

“We continue to prioritize safe, timely and high-quality care delivery,” she said. “Focused areas recently are timely screens, patient satisfaction monitoring and improvements, stabilization and transfer compliance, ongoing quality improvement initiatives and an emphasis on safe, consistent emergency care delivery. We continue to strengthen our regulatory compliance through policy validation and updates, staff education and competency tracking, monitoring tools, internal audits, and strengthening documentation and reporting practices. Our focus remains on sustainable compliance and continuous improvement.

The expansion of services has gone well, with more planned, Means said.

“As we continue addressing our foundation operations in close coordination with Doug, we are equally focused on advancing strategic partnerships, expanding services and strengthening our community engagement,” she said.

Means said the hospital has “officially” partnered with UAMS Women’s Health, which will provide monthly clinic services beginning in June.

“Our outpatient infusion center is continuing to open with increasing access to essential therapies close to home and supporting long-term sustainability,” she said. “The internal clinic renovation is on track, and we’ll be completing that by mid-April. … That means that we’re opening up the backside to be what it was previously used as a clinic. We remodeled, put in new floors, and painted. This is a rotating clinic where, if we have specialties come in, which we’re still working on the partnership, and then we still have dermatology and urology across the street. We’re going to be moving them over into that new, cleaned, renovated area, so we’re excited about that.

Means said a partnership with Survival Flight will be celebrated on the first day of its operations on May 18.

“We will host a blessing, dedication and ribbon-cutting ceremony,” Means said.

CFO: ‘SYSTEM-WIDE GAPS’

Hoban said his discoveries in hospital finances echo much of what Means told the commission.

“Over the past several months, questions have been raised regarding the accuracy, timing, and consistency of the financial reporting,” Hoban said. “These questions are both appropriate and necessary as they guide a comprehensive review of the hospital’s financial operations. Since January, we have conducted a detailed and structured assessment of key financial components, including revenue recognition, expense recording, contractual allowances, debt reserves, and cash flow activity. This work has been performed in close coordination with the executive leadership and in alignment with guidance from our external audit and partner, Forvis.

“Through this review, we have identified system-wide gaps within the revenue cycle process that have developed over time and have implemented measures to improve both financial performance and reporting accuracy. These findings reflect the cumulative effect of multiple factors across prior operational periods rather than just a single isolated episode.

“Key factors contributing to this include the electronic health record, the EHR system implementation, which, if you recall, occurred in the CERN, that’s the Cerner system, and that occurred between the fall of 2023 with the go-live date of April 1st of 2024. During this system design and implementation phase, certain data inputs and configurations were not fully aligned with operational workflows and reporting requirements. This has contributed to inefficiencies in the billing process, reconciliation, and financial reporting consistency.”

Hoban told the commission that financial reviews of a period from December 2024 through February showed a “significant” reduction in cash reserves.

“This reflects the cumulative impact of the system and processing gaps previously identified, particularly within the revenue cycle performance, billing accuracy, and timing of the collections,” he said. “Focusing more specifically on the recent performance over the most recent three-month period from December 2025 through February 2026, the average monthly cash inflow was approximately $401,000. The average monthly cash outflow has been approximately $693,000. It is important to emphasize that these figures reflect a period of identified operational inefficiencies and do not represent a stabilized or corrective operating state.

“Financial metrics such as cash flow do not on their own provide a complete and accurate picture of the hospital’s sustainability, particularly during a period of active operational correction, and must be considered alongside the action currently underway.”

In response to the findings, Hoban said corrective actions are underway to “stabilize operations, improve financial performance, and restore reporting integrity.

“These actions include revenue cycle reconstruction and rebuilding the workflow across registration, documentation, charge capture, coding, billing and collection to ensure competent, accurate and accountable revenue cycle processes,” he said.  

“… So, while the challenges identified are significant, they are now clearly understood, and we are beginning to address them through a structured, disciplined, and coordinated approach,” Hoban said. “This work reflects a transition from the discovery phase to action, focusing on correcting root causes, strengthening systems, and improving both operational and financial performance. Through this alignment between the executive leadership and external partners, … we are building a more stable, accountable, and sustainable financial foundation for the hospital. We will continue to provide updates as validation and report as processes progress, ensuring transparency while maintaining accuracy and responsible communication.”

OTHER UPDATES

Pamela Adams, the hospital’s clinical operations manager, said that with the exception of one overnight nurse, clinical services are fully staffed.

“Going to our lab services, they’re fully staffed and operational 24/7, ensuring continuous support for patient care,” Adams said.

In patient number comparisons, Adams said the hospital had 181 ER visits in February compared with 122 during the same month in 2025.

“That was about a 48 percent increase,” she said. “Our EMS volume [in February] was 59 versus 2025 when there was 32, about an 84 percent increase.”

Year-to-date numbers show the hospital has seen 496 patients in 2026, compared with 340 during the same period in 2025, Adams said.

EMS volume so far in 2026 is 162 compared with 81 in 2025.

“That’s a 100 percent increase,” Adams said.   “… What this tells us is that more patients are choosing Eureka Springs Hospital for their care. And EMS utilization is increasing, indicating growing reliance on our emergency services and trust. Trust is very, very important, and our role as a community access point for care is strengthening. More importantly, this growth is occurring while maintaining our focus on patient safety, quality of care, and timely and appropriate treatment.”