The Salem Memorial Hospital Board of Directors met for its monthly meeting Tuesday, Sept. 30, during which the board discussed the proposed operational budget for FY26, along with discussion from hospital CEO Brooke Bollman on attending the National Rural Health Association Conference. Another thing to note was discussion on policy changes for revenue cycle improvements.
In attendance included Bollman, board members Dr. Leigh Ann Price, Mike Swyers, Karen Brown, Zach Moser, and Frank Barnitz.
CEO Report
In Bollman’s report, she shared that much of September’s focus was on education and advocacy, specifically at the administrative level. She attended a HIDI education session on data abstraction with the next step to update and educate on KPI. Further, she attended an MHA Independent Hospital Network meeting, which had a focus on shared resources for facilities not affiliated with larger health systems and looked at ways to ensure sustainability for rural hospitals.
Bollman attended the National Rural Health Association conference in Kansas City with other staff. She shared the conference was highly educational and valuable as a resource, with plenty of constructive conversations. In addition, staff were given the opportunity to have a meeting with Stroudwater staff.
Other September actions included:
• Advanced planning for hospital service line growth (inpatient, outpatient, and long-term care)
• Evaluated capital improvement priorities for upcoming budget cycles
• Explored new technology and tools to improve efficiency and patient satisfaction, specifically around the revenue cycle improvement project
• The hospital’s new website is being wrapped up, with revisions to be approved and launch expected soon
• Implemented monthly compliance reviews and updates
• Working with Stroudwater to conduct charge master and cost report review optimization through MO FLEX program
• Working with the billing team to roll out a plan to bring statements and collections back in-house
• Tabitha Stanfast assisted staff in submitting two grant applications in support of EMS
Upcoming events noted by Bollman included:
• The Dent County Courthouse Anniversary, Saturday, Oct. 4, which SMDH participated in
• Long-Term Care Fall Festival Tuesday, Oct. 14 from 3 p.m.-6 p.m.
• MRPC Banquet at Healthy Dent County Thursday, Oct. 14
• Fundraiser for radiology department Oct. 11
Rural Health Transformation Funds
Other discussions at the National Rural Health Association conference circulated around the One Big Beautiful Bill Act (OBBB) and the Rural Health Transformation Funds being allocated therein.
“At the state level, they put out a Notice of Funding Opportunity,” stated Bollman, following a prompt from Barnitz to discuss further the OBBB Rural Health Transformation Funds. “We’ve submitted comments, both federally and at the state level, just to put our two cents in on what we think the money should be utilized for. All of the states have to apply for the federal funding, and from there, the states will figure out how they’re going to allocate the funds.”
Barnitz asked if it would be correct to understand that the Rural Transformation Funds being allocated is $10 billion nationwide to all 50 states over 10 years, to which Bollman replied the details were not yet set in stone.
“[States] have to argue their case and make their points, and those with more rural populations will have more dollars awarded to them, and those with more metropolitan or more populated areas will have less, is my understanding,” said Bollman. “But again, I don’t think any of it will be determined until the Notice of Funding comes out and the awards are actually received.”
Rural Health Transformation Funds will be awarded by Dec. 31, Bollman confirmed. The deadline for comment for Missouri was Tuesday, Sept. 30. Bollman commented that there is a “good chance” those funds will go to the ToRCH program, along with technology improvements.
New revenue cycle policies
Notably, a new policy approved by the board under new business pertained to the revenue cycle, with Bollman tasked with policy changes.
The discount policy has been updated to include a tax season discount, an incentive to pay an account in full. This will be offered from March 1 to May 31 every year, said Bollman. An employee discount will also be implemented, so a discount is received by employees after insurance has paid. The discounts can be combined. Employee family members are not eligible for the discount. If there is financial assistance already received by any individual, a discount can not be applied.
Terms and conditions were also updated, with Bollman noting payment plans, co-pays, and private payments are to be provided up front. Bollman noted an issue with delinquent accounts for private pay patients or under insured patients. The proposed terms and conditions will hopefully encourage patients to apply for financial assistance through the hospital if unable to pay their bill; otherwise, the hospital is writing it off with no benefit.
“We've got a little over $3 million sitting out there in uncollectibles right now for those who are uninsured, and then we also write off an additional $150,000-200,000 every month for people who do not pay their bills,” stated Bollman, indicating the ongoing issue. “As we continue to talk about financial stability and rural health care, we have to set some boundaries, right?”
Insurance co-pays will be collected from every patient at every visit, and uninsured patients will be asked for a minimum upfront payment of $50 for clinic visits. For patients unable to pay upfront, three options are available: setting up a payment plan, applying for Medicaid with hospital assistance, or filing for financial assistance through a federal program that can cover up to 100% of costs, based on 2025 poverty guidelines. The goal is to set clear payment expectations, especially for patients coming in for routine elective services, while still providing care and ensuring people utilize available assistance programs. Patients will be notified of payment expectations when scheduling appointments to give them time to prepare.
“I know that there's a few concerns about whether or not that will still steer people away, but we've tried to be very conservative about the numbers or minimum payment amounts that we put in place to let people acclimate,” shared Bollman.
Summary of operations
• 45 inpatient admissions for the month of August, regarded as consistent with the month of July. The average so far for the year was reported as 44 inpatient admission.
• Inpatient census days were reported as 125
• Outpatient registrations reported as 1,113, a little more than July
• Emergency room visits were reported as “consistent and growing” at 629. The average was reported as 645 per month for fiscal year 2026. Ambulance runs, 248, with an average of 259 for the year so far.
Income statement
• Gross patient revenue was reported as just over $5 million, up slightly from the month of July ($4.9 million.) The gross patient revenue so far for FY 2026 is $9.9 million.
• Allowances and uncollectibles were reported as up at $3.8 million, with Bollman stating staff have been trying to clear out old accounts. Bollman further elaborated that Accounts Receivable (AR) has been aging and slowly increasing, but staff have maintained the goal to decrease it. It’s $2 million less than it was a couple of months ago, updated Bollman
• Other operating revenue was reported as $293,925.96, with 340B reported as a large part of the amount and continuing to increase every month
• Federal operating revenue for the month of August was $1.4 million
• Under operating expenses, some lab equipment went down which caused the “purchased services” line to increase due to utilization of Texas County Memorial Hospital’s labs. The purchased services for August was reported as $69,890.49, while purchased services for July was $38,430.51
• Under the “small equipment” line, meanwhile, ambulance radios were purchased in July, so there was a significant decrease for August comparatively. In July, it was reported at $33,637.52, while August was reported at $9,689.56
• Total operating expenses for the month of August came to approximately $2.1 million with the total loss for the month reported at $(551,772.07)
• 340B Revenue for the month of August was $101,000
• Days cash on hand was reported as 34 days
Proposed Fiscal Year 2026 Operational Budget
“We have been working with a very wide range of potential cuts to our funding and trying to figure out how to mesh all of those together,” said Bollman on working to put together the budget, despite potential legislative changes. “So, depending on what that funding looks like, we may see additional decreases. We did account for some of that.”
Proposed budget changes include the following:
• An expected gross patient revenue total of $64 million—approximately a $2 million increase from FY 2025, due to outpatient service increases, new service lines to be added, and charge master increases
• If supplemental costs go away, staff expect to recognize that under the “allowances and uncollectibles” line. The FY26 budget “allowances and uncollectibles” line proposes $36 million, approximately a $1 million increase compared to FY25 $35 million
• Other operating revenue is anticipated to decrease to $2.2 million in FY26, as opposed to the $3.4 million of FY25, as insurance reimbursements that came through in FY25 were recognized by staff as “anomalies.”
• The budgeted total operating revenue of FY26 was $29 million, compared to $30 million of FY25.
• Total salaries and fringes budgeted for FY26 was $16 million, compared to $13 million of FY25. It is consistent, noted Bollman, with FY25, of which was $16.4 million
• Other noted major changes included the “purchased services” line, which was budgeted at $627,583.33 compared to $812,348.70 of FY25, due to bringing billing back in house, as well as to the “accounting” line, where staff will be utilizing a less costly Wipfli LLP. which will decrease the line from FY25 $269,274.72 to FY26 $162,500.00.
• The total profit for FY26 as proposed would be $1.8 million
With some discussion, the board unanimously approved the proposed budget for FY26.
Chief Nursing report
Chief Nursing Officer Amber Hogan reported that an LTC RN was hired and will be working weekends. The implemented float nurse position is working well with all nursing departments with hopes of seeing a decrease in overtime usage.
Hogan further reported that a big focus is on education to improve quality of care. An education series with the nursing departments has been implemented to improve the skills of nursing staff. A competency fair is in the works for nursing/clinical staff, with an expected date tentatively expected in November.
Further, Hogan also attended the National Rural Health Association Conference with much of it being targeted toward Critical Access Hospitals and Rural Health Clinics, with plenty of education received on quality and staff retention.
Efforts to reorganize and update nursing policies and procedures are ongoing with Hogan, along with other nursing directors. Many policies are being switched over to procedures. Expectations are that the policies and procedures will be finalized by the November Med-Staff meeting.
Meanwhile, Hogan is working with staff on creating a routine ambulance maintenance schedule, with regular issues with ambulances noted. Hogan noted that the emergency van will be retired, due to costly repairs required that outweigh its value. It has approximately 350,000 miles on it.
Hogan shared that SMDH participated in the Community Health Needs Assessment meeting with the Dent County Health Center (DCHC.) The results have been received with discussions ongoing for result utilization.
Human Resources report
In August, three new full-time employees were hired, including an LPN, Accounts Payable, and a Clinic LPN. Two part-time employees were also hired, including a dietary aide and nurse assistant. In August, employees that departed include one full-time employee and three part-time.
Bollman noted that by the end of October, the hospital will be fully staffed with nurses.
Quality/risk report
Kendra Mobray shared that QR codes to patient surveys are posted in all departments with staff asked to encourage patients to fill them out. Participation in the surveys and feedback is low. Surveys that are received have been positive, however.
August’s risk management is working toward educating and making more cohesive processes across the organization. Mobray shared it was decided it would be best to think about risk management as a whole, with a focus on the organization rather than individual departments, as staff want to provide team based care and integrated care. Total events reported for August were 27, including 17 clinical care events, six care process and coordination events, three staff and workforce events, and one environmental and infrastructure event.
Mobray reminded that the Long-term Care Fall Fair is planned for 2:30 p.m.-6 p.m. Tuesday, Oct. 14, which the public is invited to attend. All nursing homes in the area were invited.
Mobray shared that planning is underway for a skills and competency fair, likely to be held in December. Mock codes have been restarted, with the first held last week and going well so far.
The Dent County Sheriff’s Department will develop de-escalation training.
Leadership will be attending a Root Cause Analysis Survey Readiness Workship given by HSG toward the end of October.
SMDH was approved to receive funding in the next three to four weeks for practicing excellence. The cost, covered by grant funding, will be $30,000 for the first year.
New business
New privileges approved by the board included the following: Antonella Quattromanni, MD; Tanner Riscoe, MD; Roberto Moran, MD; Rodger Campbell, MD; Scott Glover, MD; and Brian Tessaro, MD.
Policies and procedures were approved by the board, including the following:
• Health Information Management (HIM) had several policies retired, with Bollman noting that most pertained to job descriptions. Everything else was reformatted with no further changes to material.
• Pharmacy – two policies needed approval, with one pertaining to the safe use of hypertonic saline and another pertaining to medication management, security and storage.
• Rehab – Reformatting, grammar checking and correction, with only one policy retired regarding department cleaning, which will be covered under a house wide policy through infection prevention
• Swing bed and social services – instead of everything being separated, everything is under one policy for social services and one for swing bed
• Revenue cycle – changes noted above
