Case Studies 

A. Leadership of Financially – Bleeding Critical Access Hospital Departs Suddenly

What’s the story?
A recently renovated, beautiful county health care center consisting of a critical access hospital (CAH), surgical services, oncology care, and a Rural Health Clinic (RHC) was experiencing significant financial losses and the sudden departure of senior management. Cash-on-hand was becoming inadequate to make payroll.  The county had no ability to help financially.

What happened?
Solutions staff quickly covered leadership departures in the CEO, COO, CFO, HR Director, and Rural Health Clinic (RHC) Director roles.

Improvements were made in revenue cycle and cost management to achieve the organization’s first positive financials in at least a couple of years.

The Board had particular concern with potential employment discrimination allowing Solutions staff to update human resource functions including payroll and hiring practices.

Financial improvements included re-establishment of vendor contract use for $600K savings/year and adjustment of past cost reports for a gain of nearly $1 million.

The organization also received several finance and marketing suggestions from Solutions leadership that were implemented to continue improving financial performance and position the organization as a regional market leader.

Solutions leadership recruited and mentored new senior management that has remained with the organization for several years. Solutions staff also oversaw preparation for accreditation reviews and achieved the highest state score for Ebola preparation.

B. Sole Community Hospital: From Considering Bankruptcy to Becoming Regional Leader  

What’s the scoop?
Other consultants offered this large sole community hospital a bankruptcy filing and lay-off of 80 to 100 staff members - during the holidays.

Solutions management pulled the hospital away from a bankruptcy cliff and avoided a massive lay-off.  Teaming with local leadership, Solutions created a bottom line and managed cash to build the foundation for successful refinancing.

Are there some details?
A sole community hospital was forced to consider a major layoff and bankruptcy after significant financial losses, bond covenant failure, pressure from lenders, and aborted merger negotiations.

Solutions leadership, working as the CEO and CFO, produced a positive net margin in the first month with immediate fiscal controls on discretionary spending and beginning improvements in revenue cycle.

Over several months, Solutions staff realigned revenue cycle management and built data tools, doubling billing output, reducing days in accounts receivable, and accumulating 35 days-of-cash on-hand.

This financial reset was a wonderful support for the excellent clinicians working in and with this hospital.

With its improved cash position, the hospital was able to acquire refinancing and improve strategic positioning for important service lines. The wonderful story continues...

With financial stabilization, this health system was also primed to become affiliated with a renowned physician-led health system.  The completion of the affiliation positions the local providers to become the market and quality-of-care leader in its region.  The integrated approach to services will allow the citizens of this rural region access to a full continuum of health care services.  Plans are already in the works for expanding local outpatient surgery, supporting pediatric care with access to specialized services, and strengthening primary care.

C. County Providing Emergency Loan to County Hospital to Make Payroll

What happened here?
A large county hospital was facing the inability to make payroll and the county board was nervously – and unhappily - providing emergency funding.  With Solutions staff working in chief restructuring officer (CEO) and chief financial officer (CFO) roles, client operations were turned to positive cash flows and emergency loans were paid.  The client was set on a return to its market leadership position.

Solutions leadership immediately lead cost-management efforts including re-negotiation of vendor contracts.  While a large layoff was initially projected in order to reach a positive net margin, other financial and operational improvements minimized the restructuring to 6 FTEs (full-time equivalents).

Given many gaps in executive leadership, a new senior management team was established and mentored.
Solutions leadership also calmed staff and community concerns regarding restructuring and possible closure.

Solutions work continued in the longer-term by participating in the recruitment of permanent leadership, as well as completing open cost-report work for a positive adjustment of nearly $2 million.

D. Financially Distressed Hospital in Conflict with County Board of Supervisors

What happened here? 
This was another Midwest county hospital in trouble with its County Board of Supervisors due to poor financial performance.  Solutions leadership restructured revenue cycle and finance operations to improve the situation.  Solutions also moved quickly to capture area talent in a successful permanent CEO recruitment.

What are the details?
Re-establishment of the working relationships with physicians and the hospital board was the top accomplishment, allowing all other improvements to take hold.
Solutions leadership also followed client wishes, abbreviating its contract and improvement work in order to recruit an excellent CEO who would have otherwise left the area without prompt offers and negotiations.

Solutions leadership also filled gaps in pharmacy, finance, and radiology while the hospital was named a Top 100 Critical Access Hospital by iVantage.

E. Hospital’s Nursing Home Under Intense Regulatory Pressure

What’s the story?
A health system’s newly-acquired hospital was experiencing frequent unannounced regulatory site visits and intense state oversight regarding the quality of care in the 70-bed nursing home.  The hospital was also in a potentially vulnerable financial situation with high employee turnover, gaps in leadership, and potential loss of surgical services.

What happened next?
Solutions leadership returned the nursing home to substantial compliance with quality of care regulations.  Acting in the CEO, COO, and CFO roles, Solutions staff mentored the remaining executive team through the pressure while also revitalizing Medical Staff relationships, peer review, and credentialing.
In particular, Solutions leadership addressed employee turnover issues in Nursing, Lab, and Surgical Services, in the latter preventing loss of anesthetists and key surgeon for area hospitals.

Several cost management steps taken helped stabilize client performance with approximately $650K in financial improvements.   Solutions staff also addressed community concerns about the nursing home in partnership with the hospital’s health system.

F. Supporting Successful Merger Negotiations for “Tweener” Hospital

What’s the story?
Merger negotiations by a low-volume rural Prospective Payment System (PPS) “Tweener” hospital could be potentially compromised or even fail given the hospital’s significant financial losses and lack of cash flow.

Then what happened?
Solutions leadership functioning in COO and CFO roles immediately enhanced revenue cycle operations and expense management to stabilize the hospital and achieve $3.5 million+ annual financial improvement. This improvement assisted in completion of health system affiliation and long-term sustainability of the hospital for its community.

Hospital staff were mentored and educated by Solutions leadership through a period of high stress and financial difficulty.  The calming influence of Solutions staff helped the permanent staff participate effectively in making the financial improvements.

G. County Hospital Failing Bond Covenants

So what’s the story here? 
A county-owned health care center that already received regular and significant county tax support was failing its bond covenants.  The county was also ultimately responsible for the bond.  Patient volume had dropped a great deal at the same time additional providers had been recruited.

The County Board of Supervisors was concerned, especially given the perception that the hospital seemed to be declining to address its cash management issues.

Oh, and then the CEO decided, rather suddenly, to retire.

What happened?
Solutions leadership educated the hospital board on the opportunities they had as part of the transitional CEO recruitment process.

Given the opportunity to help, Solutions staff effectively worked as a chief restructuring officer turning operations to achieve a positive operations cash flow.  Part of the turn involved a restructure of provider staffing to reduce costs.

Staffing was stabilized in other clinical areas, too.  This allowed a reduction in cost for travelers.  Gaps were filled with excellent area recruitments.

This all essentially happened during the historic COVID-19 pandemic.  Solutions also acquired $4.8 million in pandemic funding and partnered with physicians to increase patient volumes to levels not seen in more than a year.

Solutions leadership built a strong relationship with the county public health leadership in maintaining staff and community health and safety.  The county experienced no confirmed COVID-19 cases, a rarity in the state.
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