Pawnee Commission answers the questions

The Pawnee County Commission recently conducted a question and answer session with questions received from a Pawnee County citizen’s group. The following are some of the questions and answers provided.
QUESTION 1  — What is the county’s plan to make up for budget shortfalls?
A — Pawnee County’s annual budget is always determined by the amount of revenue available. If the total revenue decreases Pawnee County will reduce services to match the budgeted revenue available.

QUESTION 2 — Of the monies raised by the tax increases, what has the money been spent on? It was assumed this QUESTION was referring to the 2009 increase added to the mill levy for the Pawnee County Health Fund and the 1 percent county wide retail sales tax approved in 2009 by Pawnee County voters to be used for Pawnee County health care services.
A — Please refer to the General Ledger handout provided by the Pawnee County’s clerk’s office.

QUESTION 3 — What issues do we face regarding federal changes to critical access rules, and what is the backup plan if we lose our designation?
A —  A very good question, but there has been no discussion of eliminating the Critical Access Hospital program. That possibility is unlikely because the more than 1,330 hospitals currently enrolled in the program provide much needed access to care for rural patients who reside in every congressman’s and senator’s district across the entire nation. We will continue to have ongoing communication with our delegates in Washington DC about the importance of healthcare in rural communities as we would encourage every citizen in Pawnee County to do the same thing.

QUESTION 4 — How much has been raised annually by the 1 percent sales tax increase and how do sales tax revenues overall compare to values before the increase?
A —  In 2010 the tax raised $554,074. In 2011 the tax raised $761,150. In 2012, the tax raised $801,485. There has been an increase in sales tax revenues each year.

QUESTION 5 — In looking at budget numbers we see that the Pawnee County Sheriff’s Department, Road and Bridge and Health Department are the major expenses. Can you provide budget breakdowns for these departments, including but not limited to salaries and benefits?
A — Pawnee County Road and Bridge spent $2.1 million in 2011. Pawnee County Sheriff spent $950,730 in 2011. Pawnee County Health Department spent $366,964 in 2011.

QUESTION 6 — What services are we contracting from Hays and how much are we paying for those services?
A — PVCH contracts services from HMC per the Hospital Services Agreement between PVCH and HMC. PVCH or Pawnee County does not directly pay HMC any dollars as a management fee. HMC allocates costs to Medicare related to the cost to manage PVCH.
This allocation varies each year and is based on actual costs to manage PVCH. Medicare pays these costs back to HMC in lieu of management fee paid by PVCH. It is important to note, that neither PVCH nor Pawnee County pays a single dollar to HMC for its management services.

QUESTION 7 — Who is responsible for personnel decisions at PVCH?
A — All personnel decisions at PVCH are made by local leadership via the PVCH organizational chart. PVCH operates under the direction of the PVCH operating board, HaysMed and PVCH Medical Staff with the PVCH Administrator reporting to each group.

QUESTION 8 — Regarding the hospital, is it the intention to keep each department head local, answering local administration? How about the open CNO position?
A — For every department that the hospital has, it has a respective local leader who answers to local administration. If additional support is needed, each department has the ability to reach out to their respective peer at HMC for guidance. The open CNO position has been filled by a local candidate who will report directly to the PVCH administrator.

QUESTION 9 — Is the hospital administrator considered to be local, and how much is he required to be in-house?
A — The hospital administrator is local and resides in Pawnee County.
The current hospital administrator has resided in Larned since he was hired in March of 2010. As a full-time equivalent for PVCH, the administrator has the same requirements as any PVCH full-time equivalent.

QUESTION 10 — What are the details regarding the hospital chaplain? How many hours is he contracted for, what is being paid for this service, what are his duties and why was the volunteer system abandoned?
A — The Hospital Chaplain is an as needed employee that is available to patients and employees who are dealing with difficult situations.
He helps manage the emergency on-call chaplain list for clergy who have volunteered to assist at PVCH. PVCH believes that having spiritual support is a vital component to healthcare. Since he was hired, he is averaging about three hours a week or less which is equivalent to approximately $180 per month to support spiritual needs of the patients and staff of PVCH.

QUESTION 11 — How many positions are there in each hospital department, how many are filled and of the unfilled positions, how many do you plan to fill?
A — PVCH employs 30 nursing; 7 laboratory; 3 radiology; 6 respiratory therapy; 4 physical therapy; 4 dietary; 3 environmental services; 3 maintenance; 1 medical records; 3 admissions; 5 administration; 1 materials management; 1 case manager; 2 part-time pharmacy; 1 part-time maintenance; 1 part-time medical records; and 24 PRN per diem nurses. Currently there are two full-time, two part-time and three as-needed positions open.

QUESTION 12 — Do local candidates have priority in hiring when qualifications are equal?
A — PVCH hires employees based on qualifications for the position. PVCH is an equal opportunity employer that does not discriminate based on where the employee resides.

QUESTION 13 — Is Pawnee Valley Medical Associates a Hays entity or a Pawnee County entity?
A — PVMA is a HaysMed (HMC) entity. All providers and staff are employees of HMC. HMC leases the clinic space from PVCH at a rate that is based on fair market value (FMV) per square foot.

QUESTION 14 — What is the financial arrangement with the building downtown (the old Ritzman’s building)? Do we lease that space or do we own it? Will that continue to be used by the hospital once we are in the new building, and if so, who will pay for it?
A — It is privately owned and is leased by HMC for the space that they use and is leased by PVCH for the space that PVCH uses. The dollar amount of the lease is based on FMV per square foot. The part presently leased by PVCH will no longer be needed by PVCH once the new hospital is complete and PVCH will have no further expense for the lease of that space.

QUESTION 15 — Is there still a plan to develop a community oversight board? If so, what is your timeline?
A — There is a plan in place to appoint a Board of Advisors for PVCH. This will take place upon completion of the hospital and when the commission feels that the hospital is functioning and running smoothly. No date is set at present to do this.

QUESTION 16 — Have you considered having a critical access audit done by a firm familiar with critical access hospitals?
A —The year end financial statements for PVCH were audited by an independent firm, Wendling Noe Nelson & Johnson LLC. This firm does the majority of the independent audits of Critical Access Hospitals across the state of Kansas.

QUESTION 17 — Earlier this year Matt Heyn was given authority to authorize changes in contractor bids up to $15,000, as long as it was only one per week. What has been the total effect of the changes approved by Matt Heyn? Is there a cap on how much he can authorize total?
A — Since Mr. Heyn was given the authority to make changes with a cap of $15,000 the total amount spent is $180,146. All the changes that add up to that number were recently discussed in an open session meeting of the Pawnee County Commission. Mr. Heyn is required to report all such changes to the Pawnee County Commission; however there is no weekly or total limitation. The changes made by Mr. Heyn were all in the best interest of the hospital and were made in a timely fashion which saved time and cost. Purchases Approved by PVCH Administrator included $14,366 for Lab Humidification Equipment; $14,960 for Changes to Access Control System; and $14,498 for Bio-Lab Labor.

QUESTION 18 — Has the county looked into potential cost savings if the city and county police force was combined?
A — There was a study done in 1991 at a cost of several thousand dollars and it was decided at that time that it was not in the best interest of Larned or Pawnee County to go further. I have since visited with a county commissioner from Riley County and he assured me there were no cost savings realized with the arrangement.

QUESTION 19 - How often are tax sales held? In a recent Tiller notice (12/11/12) it was stated that Keenan Law Firm did the work for the most recent sale. How much was paid for the service and why wasn’t it handled locally?
A —  Pawnee County has conducted a property tax foreclosure action in each of the last two years. Dennis Keenan conducted the Sheriff’s Sale in the most recent case January 10, 2013 and collected $11,650 at the sale. Prior to the sale Pawnee County collected $53,652 in unpaid property taxes as a result of Keenan’s efforts. The bill from the Keenan Law Firm has not been submitted at this time as the case is still active. Pawnee County has engaged this firm in the past on several property tax collection cases, each of which has resulted in a satisfactory conclusion for Pawnee County. Pawnee County contracted with this firm for such services regarding the most recent case at an hourly rate of $175.

QUESTION 20 — Has the county explored potential cost savings in privatizing construction of county bridges and roads?
A —  Pawnee County regularly compares the costs of in-house construction versus using a private contractor for such projects. It is our experience that Pawnee County can provide that service for the community much less expensively than private contractors

QUESTION 21 - Has the county considered collaboration with other counties on equipment, personnel or other elements?
A — Pawnee County currently collaborates with each of our contiguous counties regarding equipment.

QUESTION 22 — Has the county explored sharing the cost of a civil engineer, if needed, with surrounding counties?
A — Pawnee County hires civil engineering firms for specific projects. It is cost prohibitive to employ a full-time civil engineer in a county the size of Pawnee County.

QUESTION 23 — When the county holds budget meeting ahead of budget approval how much community involvement are you hoping for? Has the county considered holding budget hearings at night to better accommodate the working public? Also, can you make the budget information provided to the public more legible, and can you provide that information in digital form?
A — The Pawnee County commissioners welcomes anyone that is interested in attending the budget approval process. Because the budget process involves discussions with all department heads as well as other county employees it would be very difficult to accomplish that task during evening meetings. The Pawnee County clerk will provide a draft copy by email when requested.

QUESTION 24 — Since property valuation has risen from $54 million in 2005 to $61.5 million in 2011, is it feasible to lower the mill levy by 25 mills?
A —  In 1982 the assessed valuation for Pawnee County was $64,442,094 it then moved lower to a low of $44,214,880 in 1996 and it was not until 2012 that it again reached the level or exceeded the valuation of 1982. It is not feasible to lower the mill levy by 25 mills. That would be an annual revenue reduction of $1,627,730.

QUESTION 25 — What is the purpose of the foundation and how does it differ from the missions of the CHO and CHC?
A — The mission of the PVCH Foundation is to financially support the hospital and healthcare throughout Pawnee County and to advance quality healthcare in Pawnee County for the benefit of the citizens of Pawnee County. The leadership of the CHO and the CHC should be consulted regarding the missions of each of those organizations.

QUESTION 26 — Is it customary for the hospital administrator to sit on the board of the hospitals foundation, let alone be the chairman of the board?
A —  It is customary for a hospital administrator to be on a particular hospital’s foundation board. As a professional healthcare spokesperson, this individual can help provide guidance for the board’s fundraising activities. The PVCH Foundation Board of Trustees annually nominates a chairperson which could be any member of the foundation’s board per the foundation by-laws.

QUESTION 27 — What has been done to replace our Director of Nursing position? I understand this is to become a Chief Nursing Officer, but what are the qualifications for the position and why is it necessary to have a CNO instead of a DON?
A — The open CNO position has been filled by a local qualified candidate. The title was changed to become more consistent with traditional Critical Access Hospital organizational charts. There is no difference in the responsibilities and duties of the DON vs CNO.

QUESTION 28 — We understand that Hays Med is in the process of converting to strict BSN-level nurses. Does PVCH plan to institute this same requirement?
A —  Requiring PVCH to become a strict bachelor of science nursing staff has not been discussed with PVCH leadership at this time and is not anticipated.

QUESTION 29 — Is there a bonus to Murray for having the construction done on time? If so how much?
A — There is no bonus that is paid to Murray for having construction done on-time or ahead of schedule.

QUESTION 30 — If there is $1 million saved in construction — what is it being used for besides blinds or patient lifts?
A —  As of Feb. 17, 2013, there were $1.02 million project savings, which includes all changes made that were offset by the project savings. Additionally, any remaining savings will be used to pay for upcoming capital equipment improvements over the next two years.

QUESTION 31 — Have you considered allowing open community access to hospital board meetings? Is there a possibility of a board with direct community representation other than county commissioners?
A — The Pawnee Valley Community Hospital Board through its representatives appears before the Pawnee County Commissioners each month to update the Commission concerning all aspects of the operation of PVCH. Those meetings generally occur on the afternoon of the third Monday of the month. They are open to the public and the Commission encourages any interested citizen to attend. The Pawnee County Commission is the only entity that represents every citizen of Pawnee County so there is no other board available to properly oversee PVCH.

QUESTION 32 — What are the commissioners doing to engage with hospital employees, to make sure you have an accurate assessment of employee opinions, concerns and moral?
A —  We, as commissioners, try to visit with PVCH staff and administration as often as possible.We also make a special effort to attend all PVCH employee social functions.