Congratulations to Pershing General Hospital in Lovelock, Nevada, recipient of the Critical Access Hospital (CAH) Recognition Certificate for financial turnaround from the National Rural Health Resource Center (The Center) and Technical Assistance and Services Center (TASC). Pershing was nominated by Nevada Flex Coordinator, John Packham, who pointed out the following ways they are deserving of recognition by meeting the certificate criteria.

On January 31, 2011, Pershing General Hospital (PGH), a district-owned, 20-bed CAH in western Nevada, received their annual independent financial audit for the year ended June 30, 2010 and heard the two words no organization wants to hear: “going concern”. The audit revealed the following measures of financial performance and condition: Net loss for the year of $114,000, net assets of a negative $127,000, three days of cash on hand, and an accounts payable (AP) turnover of 80 days.

Flash forward to December 17, 2013 and the issuance of their independent financial audit for the year ended June 30, 2013. The going concern was already one year removed and PGH could now boast the following indicators of improved financial health: Net income for the year of $1 million, net assets of $1.3 million, 62 days of cash on hand, AP turnover of 46 days, and net accounts receivable days of 42. This financial turnaround not only removed the audit going concern, it also eliminated discussion of a possible takeover of the facility by the State of Nevada, which would have led to the closure of the hospital and the loss of the only 24-7 emergency care for a 60 mile radius.

The dramatic turnaround at PGH began with a top-to-bottom facility assessment by hospital administration of unprofitable service lines and a comprehensive review of community health needs. PGH then pursued an aggressive strategy of managing expenses and aligning services with identified community needs.

Finally, attention was focused on promoting the facility as the first choice for care for community residents and stemming the outmigration for services available locally. These efforts led to strengthened primary-care, emergency, and long term care services at PGH. These strategies also resulted in the addition of two mid-level providers and a primary care physician to bolster outpatient services provided by the hospital, as well as an increase in the nursing home average daily census from 17 to 20, producing an annual increase in net patient revenue of approximately $250,000.

A key component of the turnaround at PGH has been the implementation of objective and understandable financial management tools. This change in management practice and accountability included monthly financial reporting and analysis for both internal and external users, a budget development and management process that included input from all departments, and ongoing board education.

The final piece to the turnaround has been the full implementation and utilization of the Nevada Rural Hospital Revenue Cycle Initiative – a program developed as result of a collaboration between Nevada Rural Hospital Partners and the Nevada Flex Program (Nevada State Office of Rural Health). This initiative has developed tools to improve registration accuracy, charge capture, and denials/contract management. The current program at PGH, as demonstrated by AR days, is currently performing at a best practices level and has been an important contributor to the turnaround. The revenue-cycle tools and financial practices refined at PGH are resources now available to any requesting Nevada rural hospitals.

John Packham, Flex Coordinator, and Gerald Ackerman, State Office Director, presented the certificate to hospital Chief Executive Officer (CEO), Patty Bianchi, and the board of directors on March 26, 2014. “It is critical that health care delivered in Pershing County is affordable, high quality, and necessary to the good health of the entire community,” said Patty Bianchi. “Pershing General Hospital is committed to financial stability, which is key to sustaining access to health services for the community, including 24-7 emergency care for the residents of Pershing County.” State Office Director Gerald Ackerman notes, “Closure of rural hospitals can be devastating to rural and frontier communities, denying local citizens timely access to emergency, inpatient, outpatient, long term care and sometimes even ambulance services.”