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PVHC officials:billing issues still a problem

It’s not a good sign when an organization’s chief financial officer must preface her monthly financial report with statements such as, “There are many obvious problems with this report. ... Note that the balance sheet is out of balance.

The cash flow statement is wrong. ... We have three different cash numbers; they should all be the same ... We do not have explanations at this time.”

But that’s the position that Sandra Ehman, chief financial officer for Powell Valley Healthcare, found herself in when she presented her August report to the PVHC board in late September.

The root cause of the problem is ongoing difficulties in getting bugs worked out in NextGen, Powell Valley Healthcare’s health information technology system. For the first several months this year, the system wasn’t able to generate bills. Now it is beginning to generate bills, but it isn’t tracking charges and accounts receivable correctly on the financial report.

Bill Patten, Powell Valley Healthcare chief executive officer, told the board the backlog of unbilled charges has doubled the number of days of accounts receivable from the goal of 45 to 91 and affected the organization’s bottom line.

“Total dollars in (accounts receivable) is $16 million,” he said. “When you do all of the adjustments for contractual allowances, bad debt, all that, it comes down to an AR of $8 million. So, if we go down to 45 days, that means that we have $4 million in potential revenue that we can collect.”

The goal is to collect that money while maintaining normal cash flow, he said, which would improve Powell Valley Healthcare’s financial picture considerably.

In the meantime, Patten said he may need the board’s permission to increase PVHC’s line of credit, which it took out when the NextGen adventure first began more than a year ago.

Powell Valley Healthcare signed an agreement to purchase the electronic medical records system in December 2011 under the leadership of Mike Lieb, who served as interim chief executive officer before Patten was hired.

Lieb set an aggressive schedule, leaving its implementation to Patten, who delayed it by two months. Even so, when the system went live in summer 2012, it was so dysfunctional that it eventually was taken off-line for more work. In January, a second go-live went better, but problems still remain.

The billing and accounting difficulties also have taken their toll on the PVHC business office, which operates out of the Fitch Building.

The former business office manager resigned in August, and an interim manager, Lynn Cheramie, is working to get the problems solved and the office in line.

“We’re taking it piece by piece,” Cheramie told the board. “We’re going through everything to make sure everything’s correct. ... Now we’re tracking how much is dropped, how much we submit for payment.

“I’ve empowered those people in the business office: If it’s wrong and you can fix it, fix it now,” he said. “That’s all there is to it.”

Cheramie, who was hired through HealthTech, which provides management services for Powell Valley Healthcare, said, “When I walked into the business office, staff seemed confused ... jumping from project to project.”

But “they’re coming around,” he said. “I’m proud of them. ... They’re a good group; they just needed some direction.”

Still, Cheramie said, “I feel very, very, very confident that the next month is going to be difficult for the people in the business office, because they have a lot of catch-up and a lot of cleanup. They’re going to have to go through accounts two and three times. But we’ll get through it.

“My job is to make their jobs as easy as possible and give them the information and all the tools they need to do their jobs.”

He also is working to resolve billing problems for patients, and help those who qualify to connect with Medicaid or resources to help them pay their bills.

“I’m trying to get a Medicaid eligibility person in house,” he said. That person will be the go-to person for everybody who is self-pay.”

Cheramie said he understand’s the board’s frustration with NextGen.

“I’ve got the same opinion of NextGen as everyone else does,” he said.

But he said he believes the problems can be worked out. With so much invested in the NextGen program, he advised the board to stay the course.

“It’s a work in progress. We will not fail. There is no way we can fail,” he said. “I do not fail. I never fail. I’ve done this for 30 years.”

Patten said Cheramie has no other obligations, so he plans to keep him here until the problems are completely resolved.

Ehman said she continues to work with NextGen representatives to find and resolve bugs in the program. They had just found a bug in the program that, when resolved, should help sort out the July report, she said.

Patten told the board he recently attended a meeting with other health care providers who have purchased one or more components from the NextGen system. While a few reported few problems — and it seemed those organizations had purchased fewer components — most have had similar difficulties, he said.

But he also was hopeful that things would improve. NextGen has hired a new senior vice president, Jonathan Isaacs, an engineer by training.

Patten said Isaacs told the group that NextGen had “over-sold” the system by representing it could do things it wasn’t capable of. But he was going to work to see that problems were fixed to make the system work as it was represented.

Patten said that admission was refreshing, and he hoped it was an indication that things would improve soon.

For the immediate future, he said, “Our focus shifts to the financial statements to get complete information out of the system. Until it is complete, I can’t begin to say whether it is accurate.”

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13 comments

  • posted by Disgusted taxpayer

    October 29, 2013 3:48 pm

    Birdie,if Powell is so hunky dory,why have many left there? Butter the toast any way you like,it will NEVER fix Powell's internal problems.

  • posted by Birdie

    October 28, 2013 8:58 am

    I think it's unfortunate that the people of Powell have so much to say when they don't have all the facts! This is your town, your hospital. The people here at PVHC work their hardest to provide the best care and it's hard to see the positive when you only want to see the negative. Come and walk the halls of PVHC and you will see all the caring people that do all they can in spite of the challenges put before us. Thank you for the ones that support us and believe in us. I don't support the Powell Tribune or Ilene Olsen for feeling like they need to be so negative. This kind of reporting does no good for YOUR community. There is always two sides and why would you want to damage your home town hospital and community with your pick and choose reporting. Leaving out important information that would have changed the reality of the situation. Even with all this negativity put on the hospital and it's employees--I know we will rise above and continue to treat our patients with respect and do our jobs the best we can. I know Powell is filled with people of intregity and high character. It's too bad there are those that feel like they need to continue with all the negativity. It damages your community and thats never a good thing.

  • posted by clipstein

    October 26, 2013 7:35 am

    Wow Wow PVHC gets ripped for 800,000 and can not balance the books and you have the guts to call someone an idiot?????? Wow. oops forgot you are entitled! I do not have to say anything more the proof is there. just read the other comments. By the way I did leave and many others in other states say it is the best thing you did......Why does powell have a negative growth?????

  • posted by Michelle

    October 25, 2013 3:26 pm

    I absolutely support everything you are saying Lynn!! I am a former buisness office employee and I do know how hard the staff works. Please do not listen to anything that this idiot Clipstein has to say. This is a bitter person who says nothing positive about anything in Park County but refuses to pack his bags and leave. I sure hope these people have the time to head to Billings in the dead of winter when there life is on the line, PVHC would be better off not ever treating them.

  • posted by Mike Wilson

    October 24, 2013 11:28 am

    Well, Hello there Lynn J. Cheramie III.
    I like your expressed support for PVHC,you are there so you should be in support of what it is attempting to accomplish as an organization.
    Individuals should get off of the train if you don't like the direction it is traveling. It is for this reason staff are leaving PVHC, they choose not to be on the train as it seems to have derailed.
    "Show" it can be a great organization instead of "Talk" about it being a great organization. An efficient and effective organization does not talk about it-it shows it by doing what it does best.

  • posted by Disgusted taxpayer

    October 24, 2013 11:01 am

    Yeah,well,Lynn.. the problem is we all go on paying out the nose for mistakes and then have to go elsewhere to get fixed right.So in the end,going elsewhere is easier on our wallets,and Powell is not the only place this goes on in Wyoming.

  • posted by clipstein

    October 24, 2013 10:46 am

    wow miss cheramie if people cannot see the hogwash you are trying to feed for what it is???? Cannot even balance the books? how much more is there. Right now questioning is there a another Cardwell by a different name in our midst?????? Now for medical went there once and then had to go to Billings clinic to have all the tests redone right.....you don't what I have to say john pung 307 202 1901

  • posted by Lynn J. Cheramie III

    October 24, 2013 9:50 am

    My name is Lynn J. Cheramie III and Powell Valley Healthcare enlisted me to identify issues in systems and processes and assist in expediting resolutions.

    At every turn hospital administration, board, medical staff and employees have done everything necessary to effect a positive change for the facility, which in turn benefits a very large service area.

    I am not a Superhero by any means but, I've worked in healthcare long enough to know that everyone at this facility has gone above and beyond to keep this facility here for you. The integrity, loyalty, honesty, dedication or intelligence of these people should never be questioned.

    Hindsight serves to create 2 avenues of travel, one being criticism, which does no good for anyone and the other, learning from your experiences and improving everything going forward. It's sad that it seems like the only time administration, board, medical staff or most importanly the employees hear anything good from the community it serves. They mostly hear only criticism.

    If everyone pitched in and supported Powell Valley Healthcare maybe, just maybe you would get more than you ever dreamed of, something you would be proud of and would only applaud.

  • posted by Disgusted taxpayer

    October 23, 2013 8:09 am

    Maybe they need to charge $100 for a penny band aid,instead of $20, they would be rolling in the dough.I sure have seen plenty of Park County vehicles at Billings hospitals and Doctors offices,so "someone" hasn't been doing their job in Pork County.Not surprising.

  • posted by clipstein

    October 23, 2013 6:59 am

    lettem go broke. had spaghetti dinner to raise money for hospital aux. and never got a thank you. had one for the free clinic and it took 18 months to get a thank you.......oops forgot they think they are entitled......and the ones powell looks down their noses at always said thank you, need help we will be there........ now is my turn to say thank you to Frannie-Deaver.... Maybe Powell could learn about class from them.

  • posted by Cindy Roberts

    October 22, 2013 9:00 pm

    Yup....knew it all along. Seems like a new CFO is in order, to me.

  • posted by clipstein

    October 22, 2013 10:19 am

    wow every time you think you have heard it all...... 800,000 this and how much more is there? is it any wonder why the bills are so inflated? who is accountable? this is our money and you do work for the public???? is there any thing in park county straight????

  • posted by Mike Wilson

    October 22, 2013 9:41 am

    Superhero Cheramie to save the day!
    What a mess!!! Dairyland, Healthland, NextGen-millions spent with nothing to show and need to borrow more money. Leadership at PVHC do not know how to "Lead"-yes this means the CEO, V.P.'s PVCC Assistant Administrator.
    Care Center used to have 96-100 residents at all times-recently down to low 80's while individuals aging and requiring additional services are increasing in numbers and PVHC clearly needs the money-the Care Center is making less.
    PVHC sure seems to be full of excuses-must be what leadership is working on all day-excuses.
    Bring the Director back that was in charge of Social Service-with what I witnessed of his knowledge, professionalism and personality through the decade he was there, PVHC would be thriving. He and other's left for a reason and I think the community is beginning to understand more as to the "why" Doctors and Director are leaving.

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