10 W Fallon Ave Baker, MT 59313
Fallon County of Montana

FMC Board of Trustees Meeting – January 2024

FMC Board of Trustees Meeting – January 2024



Wednesday, January 3, 2024

MEMBERS PRESENT                                     ABSENT                          

Curt Arnell, Board President                             Del Espinosa, Member

David Kirschten, Vice President   

Evelyn Neary, Secretary             

Elaine Stanhope, Board Member

Erin Lutts, Board Member

Michele Gray, Board Member

OTHERS PRESENT                                       

David Espeland, CEO                                     

Marjorie Losing, CFO                                     

Heather Schwindt, Recorder

Katie DuCharme, Reporter                    

  1. .   CALL TO ORDER

Curt called the meeting of the FMC Board of Trustees to order at 5:30 p.m. in the FMC Community Room. 

  1. – There was no public input.

     No additions or corrections to the December 5 2023 board minutes or the December 5, 2023 Annual Corporate Meeting minutes as distributed.  Elaine moved to adopt approval of the monthly minutes.  Erin seconded the motion.  All aye, 0 nay.  Erin moved to adopt approval of the Annual Corporate Meeting minutes.  Evelyn seconded the motion.  All aye, 0 nay. Minutes for both meetings stand approved as written.


A. NO SURPRISE BILLING ACT INFORMATION:  Katie reviewed the requirements of the federal No Surprise Billing Act, which all healthcare providers are required to follow.  She presented the difficulties that we have had with adhering to this policy, and how it contributes to FMC having to write off charges related to providers not credentialed with all of our insurance carriers. FMC can only bill for non-credentialled providers if the patient gives written consent through an “Advanced Beneficial Notice” (ABN). In the ER, when a person is deemed stable, we have to give them an estimate of how much we expect the provider charges to be for the visit, a process that can take up to an hour and a half to complete, which has to be accurate within $400.  If these criteria are not met, the patient can dispute the bill.  We can’t afford to staff a department solely for
insurance credentialing, or have an insurance clerk on standby in the ER 24/7.   We also do not have the capacity to educate ER staff with the requirements on billing and in-network providers to have someone available to submit the requirements within the time-frame allotted.  We can bill for room charges, supplies, etc., just not provider charges. We estimate that about $100,000 is written off each year due to this issue.  The most financially responsible way to address it is to continue to use the same providers consistently, and to stay on top of our insurance credentialing for those providers. 

B. NON-COVERED DX SPECIFICS:  Payers (insurance companies) have the right to deem whether some billed services are not medically necessary and can refuse to pay them.  These charges, which have totaled up to $100,000 in a year, end up being a write-off, since appealing the decisions with insurance companies can often fall on deaf ears.  The use of an ABN (Advance Beneficiary Notice) is required for a patient to know that some charges submitted to an insurance company may be denied.  In that case, the patient would still be responsible to pay out-of-pocket.  An internal work-flow process is being evaluated to get ABNs more routinely signed by patients to offset the amount being written off.  Part of the issue has been the way that staff is alerted by Thrive for the need to present an ABN.  Nurses are hesitant to give the ABN to the patient because they are not responsible for making a diagnosis.  The providers are hesitant to present an ABN because it may be forcing a diagnosis before they know what they are diagnosing.  Providers tend to bypass checking the box in Thrive asking them to print the ABN, so they can move forward.  This concern has been brought up at ORCA and Medical Staff.  It is being flagged in the Business Office so we can see where steps need to be put into place to make it a permanent process and reduce the number of write-offs due to not having a signed ABN.

C. AR PROJECT:  As of December 26, 2023, there is still $315,914 outstanding ($7,000 still processing), down from $431,973 when this process started in November 2023.  The board was asked if they thought we should send a personalized letter for each outstanding balance, or just a generic letter as a reminder.  The Board stated they thought that a generic postcard should be sent out to all guarantors that were part of the initial mailing.

November had 18 inpatient days and 21 skilled days.  Gross Revenue $795,000, $33,000 under budget.  Contractual adjustments are positive, since we are still receiving the higher rate from Medicare.  Net Operating Revenue $966,000, $122,000 on the positive side of the budget. Expenses $1,052,000, $39,000 over budget.  Operating Loss ($86,000), $82,000 on the positive side of the budget. Non-Operating income: County reimbursement of $52,000, FMC Investment Account gained $56,000 and interest income accrued $21,000 for the month. contributing $129,000 to our bottom line, to create a net income total of $43,000, putting FMC at $175,000 on the positive side of the budget.  YTD Gross Patient Revenue $3.5 Million, $629,000.00 on the negative side of the budget.  YTD Net Operating Revenue $3.8 Million, $422,000 on the negative side of the budget. YTD Total Expenses $5,089,000, $78,000 on the positive side of the budget.  YTD Operating Loss ($1.2 Million), $343,000 on the negative side of the budget.  YTD Non-operating Income $326,000 YTD Net Loss $880,000, $206,000 on the negative side of the budget. YTD 65 Inpatient days, 82 in the budget.  1,700 swing days with 2,500 in the budget, keeping our census down.  Ancillary services: ER patient count below budget.  Procedure room and observation hours are ahead of budget. Lab below budget, but blood bank is ahead budget.  EKG, radiology and mammogram, are below budget, Ultrasound, CT, MRI ahead of the budget.  Rehab visits below budget but are seeing an increase in their numbers. RHC Visits are at 1,677, budgeted for 2,599. Outpatient encounters are 3,012, budgeted for 3,479.  YTD Change in Cash Equivalents ($146,000).



The FMC by-laws require the Board to pass a resolution to accept the by-laws of an auxiliary organization.  Our attorney noted that for the Auxiliary to fall under our 501(c)3 status, they must have a charter created by FMC which matches the Auxiliary’s by-laws.  The Auxiliary can’t find their charter, so a new one will need to be created by us.  They did submit revised by-laws recently, but will need to be updated to match the new charter.  The Auxiliary will need to approve the new by-laws, then ask the FMC Board to do the same, which will have to happen through a resolution.  A draft of the charter and the by-laws has been sent to our attorney.  Upon her approval, they will need to be given to the Auxiliary Board for approval and then back to the FMC Board.

B. STAT AIR CONCERN UPDATE:  Dr. Sullivan and Dr. Millard got together to discuss concerns with patient hand-over issues that have arisen.  A universal protocol is being discussed so care remains consistent with all transported patients. 

C. RADIOLOGIST COVERAGE UPDATE:  Dr. Jaszczak is stepping back his practice.  We have been looking into other services, but they all seem to have between 20-40 providers to credential.  We are trying to find a smaller practice.  Dr. Jaszczak has agreed to continue day and night coverage, but we will need to continue searching for a alternative. Meanwhile, we need to do our own billing, so we are working to credential him with all of our insurance carriers.


A. ELECTION OF BOARD OFFICERS: Per Erin’s request, annual officer elections were moved up in the meeting and held right after the approval of the minutes.  Evelyn nominated Curt Arnell as President. Erin seconded.  All aye, 0 nay. Elaine nominated Dave Kirschten as Vice President.  Evelyn seconded.  All aye, 0 nay.  Elaine nominated Evelyn Neary as Secretary. Erin seconded.  All aye, 0 nay.  The new officers conducted the remainder of the meeting. 

B. CREDIBLE MINDS V. INTEGRATED BEHAVIOR HEALTH (IBH):  Credible Minds is an app that Fallon County is purchasing through a grant for the use of residents in Fallon County.  It assists with understanding behavior health and outpatient mental health services.  This app can also provide referrals.  Public Health asked that FMC ask its providers to help promote the use of this app, with the limitation that it does not help a person in crisis.  FMC has been offering Integrated Behavioral Health for about a year through its clinic.  The app isn’t a part of that program, but it may prompt a user to seek out professional help at our clinic if merited.

C.MEDICAL STAFF DECISION: DNA TESTING:  Patrick Smith, FNP, approached Medical Staff regarding doing DNA testing to assist with pre-diagnosing some health matters.  Medical Staff met, discussed the topic, and decided to not offer this service at FMC at this time. Their concerns included the procedure still being considered experimental, so it may not be covered by insurance, our potential liability, and that fact that Patrick is not on our permanent staff, so if he is not here to provide that service, we would be unable to do so.

D.PUBLIC HEALTH: COVID TESTING & TB TESTING AND RSV VACCINATIONS:  Public Health has stated that they will no longer be providing COVID-19 or TB tests and will not be providing RSV vaccinations as they do not have the storage space for these items.  RSV is on the rise, especially in the elderly populations.  We have it on hand, but we do not give it out for little to no cost, and Medicare doesn’t cover the full cost.  We do provide Covid-19 and TB tests (that involve a blood draw).  Dr. Sullivan thought it was important that Public Health continue TB tine tests, so he will be talking with them further about that.

E. PROPOSED CONSTRUCTION ESTIMATES:  The Board was presented with the estimated cost for projects that we are proposing to fund with residual Mill Levy money.  All of the work has been discussed with the Commissioners in the past, but construction estimates hadn’t been presented, yet.  We are finalizing the scope of work to fine-tune the numbers prior to getting the proposal to the Commissioners for their approval.  If they agree, we can move forward with bid documents.

F. MEDICAL STAFF CREDENTIALING:  Evan Bell, MD is up for credentialing renewal as a telemedicine provider.  David Kirschten made a motion to accept Dr. Bell as a continued provider, Erin seconded.  All aye, 0 nay.  Motion passed

The Board adjourned their regular session having completed the agenda.



 S\ Curt Arnell, President
S\ Heather Schwindt, Recorder and Transcriber