Funding goals — Hospital administrators propose doubling outpatient revenue
At the May 22 Weston County Hospital District board meeting, Tish Miller, the hospital’s chief financial officer, presented an ambitious draft summary budget for fiscal year 2026 that prompted discussion about growth and risk.
The draft summary budget, which trustee Nathan Ballard provided to the News Letter Journal, forecasts $34.9 million in gross patient revenue and $22.1 million in net patient revenue, after accounting for $4.8 million in Medicare deductions, $1.6 million in Medicaid deductions, $1.5 million in bad debt, and $4.8 million in charity and other contractual agreements. Net operating revenue would provide an additional $6.4 million to the hospital’s coffers – with $6 million of that coming from “other retail revenue.”
On the cost side, wages, benefits and taxes would amount to $17.9 million, and other expenses, such as medical supplies and utilities, would amount to $9.9 million. Non-operating revenue, such as funding from grants and the mill levy, would amount to $1.1 million. If the facility can stay on budget for the year, the hospital’s net income would be $1.8 million.
Ballard said he would prefer it if the expenses were $1.8 million less, and told the News Letter Journal that he wants the budget to be $26 million total. His recommendation is based on the fiscal year 2022 budget, since he “has no idea” what the hospital’s current revenue is, noting that even though the clinic’s volume has decreased, the Manor’s has improved. Total spending in fiscal year 2022 was about $26 million, and the hospital had a small surplus, he said.
“The hospital was receiving more non-operating revenue at that time than we are now,” he said. “I am anticipating a revenue of at least $24 million – a reasonable improvement – to support $26 million in spending – assuming we get $2 million in government support, which is normal for us. I want to give the hospital as much spending as I can but still be responsible. In fiscal year 2023, they spent $27 million and they lost $2.3 million. The request for $27.8 million, in my opinion, could easily create a loss of $3 million if the unprecedented revenue does not materialize.”
He pointed out that the net revenue in 2022 was over $23 million with $26 million in expenses, the hospital “broke even.” In 2023, the net revenue was $22 million and the hospital had slightly over $27 million in expenses, even with a mill levy and other financial support – and it still lost $2.3 million. Ballard said that if the hospital suffered that kind of loss in the upcoming fiscal year, it would be devastating.
“That would just about break the hospital,” he said.
Administrators made several budget assumptions to produce the projections used for the budget, including a 5% rise in radiology for more echocardiograms, a 7% rise in Manor revenue through raising the census and an average of a 3% increase on charges. CEO Cathy Harshbarger said at the meeting that all the insurance carriers she knows of will accept 3% to 5% increases annually. The hospital should also be able to increase billable units for physical therapy and occupational therapy and elevate Newcastle Clinic daily visits, the administrators proposed in the budget.
In addition, Miller said she, Harshbarger and Shane Filipi, the hospital’s nursing home administrator, believe Weston County Health Services, a critical access hospital, can increase swing bed revenue by 10% through increased utilization, without having to add staff, though an existing staff member would likely need to become a coordinator for this role of the hospital.
According to the Wyoming Department of Health, CAH are typically more than 35 miles away from other hospitals and have no more than 25 inpatient beds, which could be used as swing beds or inpatient services, and provide, on an annual average, no more than 96 hours of acute inpatient care per patient.
Within several years, the hospital could achieve a swing bed rate of $7,000 per day, up from approximately $1,450 at present — $250 per day for Medicaid and about $1,200 per day for Medicare — according to Miller.
“We need to start utilizing the resources that only CAH (critical access hospitals) hospitals have,” Miller said.
Harshbarger said that she believes the hospital has the capacity to do more – and should.
“I think it’s time for us to pick it up and do a better job of it and get our community around it,” she said.
Essentially, the hospital can see more patients, she told the NLJ.
The budget assumptions also included that the hospital would decrease its use of staffing agencies, and staff salaries would increase as needed, according to the draft summary budget.
Harshbarger said at the meeting that the trio hasn’t built a salary or wage increase in yet, and any raises would likely only be financially feasible later in the year.
Growing revenue?
Trustee Benjamin Roberts said his top concern was the projected doubling of outpatient revenue, up to $24.3 million.
Ballard agreed, indicating he figured that if charges increased 10%, the hospital would need a 90% increase in patient visits.
“It is a push,” Miller admitted. “That’s why it’s a proposed budget.”
Miller said that the hospital wouldn’t see that hike in patient visits on July 1, but it can expect to see that over the course of the fiscal year.
“It’s not like turning on a light bulb. It’s something that we have to make a concentrated effort for and letting the community know what we’re up to,” Miller told the NLJ in a follow-up.
For example, the hospital will need to announce that it has new staff patients can see, she told the NLJ.
Trustee Kari Drost said that because the revenue increase is predicted from multiple sources, it is more likely that the hospital could accomplish it.
Harshbarger said that the hospital must have some growth in business revenue “to engage our staff and improve in our performance efficiencies,” and also noted that the hospital’s deductions from revenue were understated in previous years.
“We weren’t doing the contractuals at the rate we are. We weren’t putting the charity care at 4%, which it’s supposed to be at,” she said. “So there’s some pieces in there that we’ve had to put in as deductions from revenue that just got to call to us to increase our revenue as well.”
Finding and growing that revenue so that the hospital can meet those compliance and quality standards and serve patients is tricky, she said.
However, Ballard said he would be willing to pass a revised budget if
the first quarter of the fiscal year
shows that incoming revenue is very strong and business needs to justify increasing expenses.
Trustee Ted Ertman expressed concern that people would say that the hospital didn’t live within its budget, but Ballard said passing a revised budget could be done in a public meeting with ample public communication. He said that, while he believes the hospital’s operations have improved, he doesn’t have the evidence to prove that it has, so he wants to rely on what has worked in the past.
“We should have an aggressive revenue goal. That’s an aspiration,” Ballard said. “But the expense side is us giving permission to spend, and we have a fiduciary duty to not let this organization spend itself into oblivion.”
Roberts said he’s accustomed to revenues being a realistic projection, not an aspirational goal, and Harshbarger said that the team would work to trim the budget proposal’s expenses and revenue to make trustees more comfortable. She said the hospital will send the draft proposed budget to the county clerk and to the state. (She told the NLJ that the proposed budget will likely change by the date that the hospital is required to submit its budget to the state, which she believes is Sept. 1) The board will review the budget again at its June 19 meeting and set a date to present the budget to the public in July. The public hearing must be held within three days after the budget hearing.
Hospital Happenings
Notes from the May 22, 2025, meeting of the Weston County Health Services Board of Trustees
The Manor’s census has reached 52 out of a total of 58 beds, and staff are working three referrals, according to Shane Filipi, the nursing home’s administrator. Filipi told the News Letter Journal on May 26 that the count remains 52.
CEO Cathy Harshbarger said the hospital currently has 11 participants in its hybrid certified nursing assistant program. Trustee Nathan Ballard, who is on the finance committee, told the NLJ that he estimates that the cost for a full-time CNA is about half the cost of a traveling CNA and that having on-staff CNAs would be “a big win” for residents who would prefer that friends and neighbors have that role.