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.”