Board of County Commissioners - Regular Meeting

I'd like to call the meeting in order. We're going to invite Senator Tyson to have a few words.

I pledge allegiance to the flag of the United States of America, and to the republic for which it stands, A few reminders before you get going. Please state your name and title when you first begin speaking. Public comment will be allowed to the extent that it's on topic. Persons participating via Zoom are currently muted. If you have a comment, then please let Mark know via the chat function. Mark will then inform Chairman Trinkle who can take up the comment in a manner that doesn't disrupt the agenda. And if an executive session is needed, then we'll mute and turn off the video. And when we're done, we'll turn everything back on.

Heather, are you there?

I am. Can you hear me? Okay, I've got about five things today. The first is, last week the Kansas Department of Commerce announced a $1 million of available awards for attraction development grants. That could mean the B-29 Museum, the Philly, the Historical Museum, essentially any museum or attraction that needs funds to improve the visitor experience, quality of life, or increase tourism. It's a 60-40 grant. They intend to award about 10 of them, but wanted to just announce that publicly for anybody who might be listening to this, that any of our local attractions might be able to apply for that. uh also last week um connected with the city of sawyer as well as the kansas corporation commission about trying to close out the the national the natural gas grant luckily because the amount of the grant for the city of sawyer barring something unexpected in the next 30 days the project will be under a million dollars so that will avoid the need for a audit for them um so we've been communicating with the kcc about trying to close out the project and any other expense needs that the city would need to have in that final reporting to be paid for by the grant not the city of sawyer The unemployment statistics for the month of July came out. Pratt is at 3.8%, which is the same as the state. Interestingly, both Reno and Kiowa County, so the two counties that border us, are both trending higher. I suspect Pratt County will trend higher given what's happened at the hospital in August, but I'm keeping an eye on the unemployment rate. Currently, well, in July, there were 172 individuals in Pratt on unemployment seeking employment. The state workforce, the local workforce board coordinator has reached out to me last week asking for some assistance with things going on at the hospital connected with Tyson. they've been instructed to talk directly with workforce one so that they have what they need to help both local employers as well as people who've been displaced to make sure that everyone is is able to access the most benefits as possible i did receive an email today from the from the hr director at the hospital asking for some more information i directed them back to workforce one The PAEDC met last Wednesday, reviewed one grant application as well as the updates related to Country Club Estates, the trailer park that has new ownership and significant improvements, and then approved an incentive application for Pratt Family Practice. I'll stop there and stand for any questions.

I don't have any questions.

I don't have any questions. Is it the workforce? I guess I do. Is it the workforce?

Workforce one?

Yeah, I don't know how to put this politically correct. Are they running up against the wall with the hospital? Is that the problem? Or just not communicating?

I think that their leadership communications to them would assist them in knowing, making sure that all the possible programs that are available, they know exactly what people would and would not qualify for. I hope that we knocked down that little hurdle last week. Not 100% certain of that, but it's really about a communication issue.

Okay.

I don't have anything, Heather.

Thank you. Thank you.

Cheryl, do you want to come up?

Cheryl from Pratt Senior Center. I'm just here to ask approval on hiring Shannon back as custodian. She took medical leave and is able to come back now. The other person didn't work out.

I'm not familiar with what exactly happened on the medical leave. Was anything reported to you?

There was no leave.

I think she just spoke about it. She went ahead and resigned due to her health conditions. Is she capable of working now? She is. I talked to her very lengthy. about that and she's gonna go down to 20 hours now so that'll help and she actually is on a trial basis this last week with me and is doing fine as a volunteer yeah just to see if it would work out she assured me that she would be okay oh my god motion to hire

Shannon Crowe part-time as a dishwasher custodian at the senior center for 1194 now.

I'll second the motion. But moving second, we hire, or Pratt Senior Center, hire Shannon Crowe for a part-time custodian dishwasher for 1194 now. All in favor say aye. Aye. Opposed, same sign. Motion carried.

You would probably need new paperwork. She said she'd come and wait until tomorrow. Okay, or if you want, you can stop by and get a part-time employee packet upstairs. Okay. And Susan can get that for you, and that way she can look it over and have it filled out.

Okay. Thank you.

Thank you.

Is it Doug's stuff now? Yep. He said he wasn't coming in.

Correct.

Yep, however you guys want to do it.

we got a bridge contract for uh kirkham michael to inspect our bridges i will note that four of those bridges are in the cities but i make a motion to sign a contract with kirkham michael to inspect I knew how many bridges. I don't remember. Is crap done good enough?

It's a semi-annual bridge inspection.

Yeah. There are 92 bridges. $150 each. 36 fsa off systems six others six others other city of brad's for a total cost of forty one thousand four hundred dollars i'll move that we sign the agreement with kirkham and michael second amendment second we sign the agreement with kirkham and michael to inspect bridges all in favor say

aye aye opposed same sign motion carried you guys can come on up if you want to What's your name? I think that's your name. Yeah.

I'm Perry Akersen, Nexster Energy Resources. I'm Mel Thurk. We're the Nesbitt Flat Solar and the Nesbitt Flat Storage.

Samantha Nesbitt, Project Manager for the Nesbitt Thermal Line and the... Am I?

Mine feels kind of quick. So we're about to finish construction on the solar project. Pretty much all the panels are installed. Now we're just moving to our energization process before we bring the project online. So we'll have a formal commissioning event for that. And once we have those dates, we'll share it with the county. So anyone that wants to attend can come out and see. But everything's pretty much on track for that project to be online in September.

Sounds good.

Great. I'm here today for the NENISCA thermal storage project or the thermal line for our involvement within the project. We are going to be mobilizing pretty soon. So wanted to have a kickoff meeting with the county. So thank you for having us today. We are looking to be mobilizing and having some activities occur for construction starting here in the next couple of weeks with primarily construction happening in the second week of September. um we've engaged with Kirkham and Michael for the pre-inventory of everything so that activity's been done and wanted to come here today to talk through any items with y'all and see if there's any questions or anything from you guys that we could be more diligent in for the project all you're doing is just running along yeah routine you started on um I think we're going to start close to the frat energy site come from that way and go down. We're working with Kirk and Michael, too, on our roadmap for the haul route, and we're thinking we may be having an amendment on that on the southeast 70th Ave. There's a structure that said that it would be best to go around, so I have the document of what we're proposing, and we can go over that with you guys any time today, and then we'll file the official amendment after we've had our kickoff with Kirk and Michael.

Just make sure that Doug's aware. Yes. Yeah.

Yeah. Cause we had our local emergency planning committee meeting Thursday and the people putting in the.

Staking.

The whole, whatever it is, graphite.

Okay.

Deal.

Okay.

They gave a little spiel on it.

Yep.

Yeah.

Yep.

So, and this is all underground. Yes, correct. All underground on board.

And then I think kind of on that note with with how these project there's some synergy on the road utilization. So we've been working with Kirk and Michaels on exactly kind of the cycle of how we appropriately close these out. So I mean, at the end of the day, every project that utilizes any given road, there's going to be a close out for that project once work is complete. So all the roads will be covered. There's just some overlap. We just process an amendment last week on the storage project because we needed water for dust mitigation. And we recognize that where we're pulling the water from, we didn't have that section of the road portioned out for the battery storage. We only had it for the solar. So we went ahead and amended it so that we could have that included. So now the battery storage will be obligated to close out that portion. Yeah. And it worked out three or four days on five weeks ago.

Yeah.

And similar for the thermal storage project, it'll

same like a lot on 70th will get closed out by the final storage project yep are you using the same way down yard for this for your line differently down yard for ours um but it's the same that is in our produce agreement currently we're doing one bridge inspection out there so you might be able to knock one off your list there you go

We got 91 more to go. Well, appreciate that. Nice you guys come in and see us. Wonderful.

Do you have anything else?

Yeah. When did you say you expect to start that?

First to second week of September for starting construction. Amy Nunez, roughly three months three and a half months is what yeah is what we're expecting we're hoping to have this done by the end of the year, no contract. Amy Nunez, Brink is our EPC.

Amy Nunez, Yes. Amy Nunez, All righty.

Amy Nunez, awesome Thank you.

Amy Nunez, appreciate it. We're going to do the minutes. Motion to approve the minutes from August 17, 2026. So moved and seconded, we approve the minutes from August 17, 2026. All in favor, say aye. Aye. Opposed, same sign. Motion carried.

Terry, do you have those tire beds on you? I do. On my head, that work? Do those, man.

Come on up if you want to.

Terry Williamson, Brett County Fire Rescue Captain. Got a new rescue truck here a while back that you guys approved and we've been looking for some tires for it. Most of the tires on the truck are more than 15 years old. They do have tread still on them. However, 15 years, that's quite a long time on tires and you're just looking for trouble, especially on an emergency vehicle. We've got several bids. We got one bid from Ace Auto in Haviland, which was the cheapest bid. It was $1,701. The second cheapest was $1,800, which was Diamond Truck here in Pratt, which is a local company. We did receive a bid from Cooper Tire. It was $2,400. And then most recently, we received a bid from Mitch Withers for $2,100. They're almost all identical tires. They're the Dynatrack. They're not super aggressive. In my opinion, we don't need super aggressive truck tires for that. 95% of our miles stay on roads. And so if we need aggressive tires, we're probably going somewhere we don't need anyway. And so we talked, we talked about using more of a local company, which would be diamond truck center for the amount of $1,800. Um, that's for six tires and they are 16 PI tires.

Yeah.

Dynatrack or not Michelin or, you know, but, um, no more miles in the rescue trucks get on them. They really don't. They, they time out before they wear out.

Yeah.

So the old Rescue 301 that we have has 18,000 miles on it, and it's a 2003 model. So it's 13 years, or 23 years old. Is that a good tire, Tom?

So long.

I'd like to keep it local. I appreciate having been on it. I'd like to keep it local.

I think we should too.

I don't know what you guys think.

I do.

You know. I also would like to keep it local in case we have trouble with the tires. We could just run up to Diamond Truck Center and nothing against Cooper, but their bid is just, in my opinion, too high. Yeah.

I thought Diamond was out of business, but I guess not. And that's for $1,701? Yeah.

I don't know. That's the 1800. 1701 was ace out of half.

It's all sitting this way on my email, so I got to turn it. Well, you can thank your chief for that.

$1,800, right? I'll make a motion we purchase six tires from...

diamond truck center for the new rescue truck for eighteen hundred dollars secondly moving in second we purchased six new tires for the new rescue truck from diamond truck truck center for eighteen hundred dollars all in favor say aye aye opposed same sign motion carried thank you commissioners thank you

do we want to anybody have anything else yeah i have the um well do you guys want to take that up okay yep um and i do have the replacements on my special equipment plan. So this isn't replacing, this is adding, but this will be just two that we don't have to replace next year when it's time to do it. So I can cover that with my special equipment, but I would like to add two whole pads. There are electronic whole books that we use for election. I would like an additional one at our help table and also an additional whole worker checking people entering election to make it a little faster.

I don't have a problem.

I don't either.

Okay.

Perfect.

Make a motion, Ness. Yeah. I'll make a bid. I'll make a motion to

What do you call these things again? Electronic polls.

You've got two units?

Yep, two additional units.

Two additional units from Atkins Election Service for $3,608.

Second the motion. I move and second we buy two e-poll books from Atkins Election Services for $3,608. all in favor say aye aye opposed same sign motion carried will you make sure the minutes show special equipment yep absolutely oh yeah sorry i didn't put that in my motion do we need to talk about number six

I mean, it's up to you guys. The contact that I had with Mr. Newby, I mean, he'd asked that this be placed on the agenda. It sounds like there's subsequent contact with the clerk's office. I told him that if he had information he wanted to present, he needed to get on that agenda. My understanding is that he hasn't provided any information.

I have not received anything.

Sounds good.

Let me check my email.

You got anything, Johnson?

I mean, additionally on data centers, to the extent that the issue comes up, I think most of the public is aware we're working on our comprehensive plan right now. It's something that the gentleman that came in from Adam Jones that discussed an overlay potentially for data centers. So we're aware of the topic. And to the extent action needs to be taken,

it will be taken but it'll be taken in a thoughtful manner yeah I mean we have a process of public hearings and all that yeah all that yeah they're ready to see the comprehensive plan You got anything else, Heather? I want to do the vouchers right now. I'll make a motion to repeal the voucher.

Oh, second it. We'll wait until 3 o'clock until B or group comes in here.

You guys don't have anything on data centers, do you?

That may be seconded yet. OK.

We hadn't voted on it.

Been moved and seconded to pay the vouchers. All in favor say aye.

Aye.

Opposed, same sign. I'll get caught back out. You can sign on this.

How are you?

Good. How's everybody?

Living the dream, sweating away.

Cooler days are coming.

Sooner or later. Sure.

We don't complain about the record bill. The first was $11,638. Thank you. Thank you.

It's just funny for me to even have

AIR FOR A COUPLE DAYS. I THINK THAT WOULD HELP A LITTLE. HOPEFULLY IT DID.

YEAH, RIGHT. MR. HAMM, HAVE YOU GOT SOMETHING YOU WANT US TO TALK ABOUT?

I HAD A QUESTION. SURE, COME ON OUT.

WE'RE KILLING TIME.

WELL, THANK YOU.

I JUST HAD A. MIGHT INTRODUCE YOURSELF.

and I'm here with Ham Auction and Real Estate today. I was just showing a property to someone looking at a building and we left and he called me as he was leaving and said, hey, there's this property over here by the hospital next to, well, I guess it's part of the old EMS and it goes right up around the corner of the grassy field north of the old rehab place. He said, is that for sale? Can that be bought? Can we split that off and build a new business in Pratt?

The part that's currently under contract? Yeah, it's under the bonds. Well, PFP is currently contracted to buy part of it.

Part of it.

Right. Because I thought they were doing the old rehab building.

They bought lots to the north, which leaves six additional lots that are frontage.

So the frontage towards the ditch going west. Going north.

North from the building.

Right. Going north. But what would be available would be the frontage along first street. That's correct. Six lots there, but.

Two, two, two. Yeah. So you'd have two frontage lots and the remaining four would be, to the extent that the county Right. Is interested in selling that.

So I guess that's my question. That's they just need to know, Hey, is the county interested in possibly selling them?

My thoughts are if it's related to the hospital, that's one thing, but if it's not, this would not be related to the hospital, you know, we're already got parking issues there. And so,

that area has basically been dedicated for healthcare purposes.

Yeah. I mean, that's what I have. Yeah. I mean, that's really what the hospital wanted. Right.

And I knew that was part of a future plan. You know, they built all the new parking places there in recent years, but we're still full, which is a good thing. Yeah.

Yeah.

So I just needed to let him know if that's something we would consider or somebody else asked, we told them no to.

Yeah. Okay. If it's related to medical care or something, that'd be different.

Yeah. To my knowledge, this wouldn't be, but it'd be another business in Pratt, which we need.

Yeah. Understand. Yeah.

It's good frontage, good access. It would just be a good location. for another business.

A lot out east. Yeah. Along 54.

It's not a lot in.

Right, but that could be developed. Yes. Okay.

If that helps you. I remember I got an appraisal on that one, didn't we?

Yes, we did.

It's been years ago at this point. Yeah, we'd have to get it reappraised.

There is water, but there's no sewer.

Do you have to, you do your own septic out there?

Yeah, you're in the city zoning, extraterritorial zoning out there too. So you have some city stuff to deal with. Not that you couldn't.

Right.

Oh yeah.

But it's along the highway. It's understood. There's four lots.

Okay. Yeah, I suppose, yeah. It's not lotted yet. It's not. But when they do, it'll be divided into four. Yeah.

Unless somebody buys it all.

Yeah.

Yeah. And somebody could buy two lots and have five acres. Okay. That's a pretty good joke. Yeah.

Yeah.

All right. I'll let them know about that. And this would not be available. That's what I needed to know.

Okay.

So do it.

We'll get out there and find you some more business. I'm Brian. Thank you, guys.

Thank you. Brian, you want to come on up? Sure. If you got something for us.

I'll do it real quick.

Yeah.

Well, let's see. It's not too bad. I do have a part-timer that I'd like to start. He just got his EMT. His name's Riley Nall. Like I said, part-time, so he'll be filling in when he can. He was at the hospital at the switchboard, but he just got his EMT, so he's looking to get into that line of work. So he's got a full-time job, but looking to get part-time. Let's hear it, Pratt.

I'll make a motion. We hire Riley Nall at $1,450 an hour for part-time

second the movement second we hire riley noll for part-time ems at 14 15 arrow favor say aye aye opposed same sign motion carried uh the next thing i need your approval on because it's over the thousand dollars i need to buy some new batteries for our cardiac monitors looking at eight total which would give us two brand new ones per cardiac monitor for the grand total of four thousand ninety seven dollars have the quote if anybody wants to see it. Yeah, this one, I reached out to Stryker themselves, which I actually get a better deal from them. But I do have that. If anybody wants to see that, I can order them direct from them and they'll ship them to me.

I'll make a motion. We buy... Eight batteries for cardiac monitors from Stryker for $4,097.

Second the motion. Good move and second. We're buying eight batteries from Stryker for the cardiac monitors for $4,097. All in favor say aye. Aye. Opponents, same sign. Motion carried.

Is that coming out of your regular budget or something?

Yeah.

We need to sign one.

No, that can come out of regular budget. It's no big deal. The last one I have, I looked at this a few years back and it was nice, but it wasn't what I would consider a necessity. But we're kind of getting to that. It is a company called OneDose. It's an app that would go on the phones, either of our people or the truck phones. They don't have to keep it on their phone. It's tied in with our protocols. So if we get a chest pain, they can type in chest pain. It's going to bring the protocol up, but then if they want to give a medication, it's going to tie directly to that medication. And it'll tell them the exact dose range that we have. And it's come a long way, does a lot of other different things. The nice thing now is it talks to our electronic patient care report. So if we clicked that we gave fentanyl or morphine, it'll document that in the patient care report. It was really designed for pediatric. because when you have a pediatric dose, it's all weight-based. And a lot of our meds are becoming weight-based. So it calculates that. Now we still do the calculation on paper to make sure we're right, but it's kind of one step to make sure we don't make a mistake. There's also a built-in, what we call a MAC check, medication check. They would actually have to scan the medication to make sure they're giving the right medication.

So we're not paralyzing people.

Exactly. There's been a lot of that, which is 100% avoidable. But this kind of gives us that peace of mind. The total cost to start it, because they have to do some implementation, is $3,450. $2,500 a year is what it would be after that. Yeah. But they go in and they put our protocols in. Now, another reason I've kind of been pushing for this here recently is, Sometimes our medications come in different concentrations based on what we can buy. And so all I would have to do is go in there and tell it what concentration we have on the trucks and it would change the dose automatically. So at two in the morning call and they're going, oh, our medication used to be this and this, I'm used to drawing up this. Again, it gives us that peace of mind to know we're not going to make a mistake.

I have to put it in as a correct concentration. Yeah.

but we have, we're, we're about three different vendors. We buy from four different vendors. Now we buy from based on availability. Uh, it's getting crazy out there. Um, but this would definitely for pediatrics was kind of what it, where it started, but now it goes to adults and they've just added so much more to it. Um, I've been on the phone and some webinars with their salesman. And I think for the price, it's definitely, uh, Worth the money.

Yeah.

They do sell a scale that goes on the cot so it could actually weigh the patient. I talked to one of the division chiefs in Reno County. They just went with this. They didn't buy the scale for their trucks. They just said it was too much of a cost and they are expensive. That would add about $8,000 to this. And I'm like, let's not. We have other ways that we can we can get a pretty good weight on the kiddos. So if you're okay with that, the initial cost would be $3,450. And then it'd be another two years after that, $2,500 each year, which again can come out of the regular budget.

Yeah. The motion, the original $3,000.

Should be on that.

I'll make a $3,000. Oh, $1,000. I'll make a motion that we... Buy one dose.

Basically, a medication app.

A medication app for $3,450.

I'll second the motion. I move and second we buy a medication app from one dose for $3,450. All in favor say aye. Aye. Opposed, same sign. Motion carried. That one, no.

Doesn't need a signature either. I'm going to be talking to him again tomorrow on the phone so he can kind of show me the admin side. But just everything I've seen so far, it seems like it's going to be a pretty good deal.

Nice to have a backup.

Yes.

Yeah. You're trying to do math in your head.

Yep. It can be a little crazy. Luckily, knock on wood, we haven't had any mistakes. But all it takes is one and we're in trouble. And the person's in trouble. So...

That's all I've got unless you guys have anything.

We did a pediatric advanced life support with the same company that did our advanced life support class, advanced cardiac life support, free of charge again. So that saved me about $2,500 having those two classes and they were amazing classes. So we're going to have them back for some more continuing ed classes. So we should have our annual inspection coming up next month, but we're gearing up for that. We'll do just fine, I'm sure.

air conditioners still surviving out there? Do they cut them off left and right?

We had to repair the other one, the same one again.

And the crew quarters?

Uh-huh. And then the mini split in the medication room went out, and so we've been calling them and rattling their cage to come get that fixed. Apparently when they came out to fix it, they overcharged it, so now they have to come back and pull everything out and put it back in. So that's on them, and we're not paying for it. We had to pay the initial one, but yep it's just uh gotta have that but at least the crew quarters are cool now that went about a couple weeks without that so that was a little rough for them sure they weren't fighting over different rooms all the rooms were out now one air conditioner does all five rooms yeah i thought there was one for two no the other two uh mini splits one does the medication room and then the uh server room server room yeah so Yeah, they were able to blow some fans and keep it fairly cool back there, but not quite as comfortable as they like. But they didn't complain too much. At least I didn't answer any texts. It all worked.

Well, thank you.

I don't see any questions on Zoom yet.

Hey, Brian, if you want to go upstairs and get a part-time packet for your- The difference in what you might email me? That was last, yeah. All of them have been, they get updated every year with all the 2026 stuff.

Okay, I'll go there. Yep.

Anybody have anything else?

No, at least not right now.

We're just waiting for the Beaver Consulting Services to come in to give us public update on PRMC.

That's at 3 o'clock. You guys don't have to wait around for that, unless you want.

Yeah.

I'm just going to hang around in case you got any more questions on the kickoff for the thermal line construction, or if you wanted to take a look at the proposed produce agreement edits. I have it on my laptop, but nothing's finalized yet.

I'll just send it to Doug, and then he'll send it to us.

Kirkham. I gave the okay on the last one. If it goes that route, that's fine. Just make sure Doug's aware of everything as well.

All right. And we have another additional member with us today. Josh, if you wanted to introduce yourself.

I'm Josh Oakley. I'm the regional one-site manager for the Pratt & Farman, the new Scott.

Two down in Oklahoma and then the one over in Wellington as well.

If they started on your thermal stuff, yeah, brand energy, getting ready to.

Yeah.

I've seen a crane that's there.

Yeah, they told us Thursday. They actually had a drawing of the building with water and what's in them, the graphite and all this stuff. It was pretty interesting.

Because they're going to heat that.

Yeah, that car.

They're going to steam for their.

Yeah, that's where they're going to get their steam to.

That's what I know.

Is this still the first one in the state of Kansas you guys are aware? Yes. It's so far in the library. It seemed cool a couple years ago.

The other one is in South Dakota. And they have two PCC linemen there. And they last week partnered with PCC. And they'll be meeting a bunch more of their students.

You do?

Thank you all.

Appreciate it.

All right. Thanks. Thanks for doing it.

Yeah, of course. Thank you for the information.

Safe travels. Thank you. Yeah.

The JUCO president was saying I think he said they've got 800 and some students out there right now with over 10,000 credit hours. No, my wife is busy. Yeah, he said, what did he say? 87% full on the dorms right now. would probably save them quite a bit of money oh wow motel's probably not happy president told me that okay one reason i knew it

I know that my wife's about to lose her mind out there because she does all the financial aid stuff. And the Fed's program doesn't work. These kids can't get their money. They're all left out. Nothing they've done is right. So they have all this stuff in queue and waiting on the federal government.

John.

Yes, I will say that our ditches are bad in the county and we know it. We've got tractors tore apart. We've got tractors stranded on the side of the road. the new ones aren't going to get here till now maybe till the end of september but they are doing the best they can what they've got bob if you want to come up you can we're not going to start till three better we're going to send it just up here somewhere in the hot seat

We'll just call it up. Is Brett coming in?

I think we had to go see a physician real quick. He should be here in the next five to 10 minutes. Dead on, it's coming.

I met with him for about an hour last Tuesday.

Send me a text.

It's a really small world. He was a resident on my floor when I was a staff assistant at Haymaker Hall at K-State. I had not seen him since college. And he ends up being the interim. So it's just a really... I haven't talked to somebody for about 40 years. When they surface again,

lucky if i remember you after four years he said oh no he said you wrote me up i wrote hundreds made an impression on me i guess so he remembered me more than i remember him

okay what's up dave hello dave we're just we're just waiting so we're done delta well you're not interested at all what are you doing these days i don't know yet just whatever you want I looked at my retirement. I'm going to work till I'm dead, I think.

He's doing a good job for us at Global Methodist. 382 said they were up a few students and Skyline was down a few students this year is what they were saying at the lunch of the day I noticed a lot of schools got reclassified I did especially I saw that I was playing six man this year

Thanks guys playing six man this year.

Is that what they got? I can't remember. I know Cunningham got moved up to eight.

My little tiny middle schoolers on there and he's about this big. I'm hoping that other teams look small too. I told him cross country was really cool and he should just stick with that. Come on, come on.

How you doing? Nice to meet you.

We're just waiting.

Sasha? Yes.

We're just waiting until three. Okay.

It's just you two.

You want to go up?

I'll sit back here.

This is Jack. He's on our county hospital. He's the chair of that board. I know there's a lot of different boards. Maybe it did say he was going to try to join. He was in a trial. You on there?

I don't see him.

yeah there's always that

you didn't have to remind us sorry about that like I had a small panic attack because not not really but I panicked a little bit because um it was on a Tuesday I was like why are we doing this on Tuesday right right and then Mark figured out because I think you were like I wondered about that and we couldn't figure out why it was on Tuesday instead of Monday yeah y'all got crap figured out yes

places in the hospital or the community places to eat uh I end up eating in the hotel a lot but I've had a great steak at uh Uptown at the end I had a couple of hands I had a double burger double hamburger there had uh went to had the taco pizza taco hamburger oh yeah I got the large. I didn't realize it'd be that big. But I powered through.

I feel like never leave a man behind, never leave food behind. I suppose none of those.

Yeah. I heard there's a special secret ingredient.

He said he thought there was a special.

There's a secret ingredient I was told. I don't know. Is it a beef or is it pork or is it a mix? It's pork. Is it 100% pork? I think so.

Because he makes them different than the original Charlie's. Charlie uses different sauce than what he uses. I can't remember if he uses spaghetti sauce. I don't.

don't know we made a paste or we used to have pizza taco wars and down there or two uh-oh last time i had one it was out of the truck but that would have been yours so it's pizacco that's danny hoffman

She, um, yeah, she has it in Hutchison and she's had it there for gosh, over 10 years now. And she does, um, take and bakes, um, down here at the farmer's market. And she gets quite a bit, like in the hundreds, she sells them when she has all of his stuff that he used to have, like the, um, the rafts. Those are so good.

Something cheesy.

Yes. Something cheesy. You can order it. Uh huh. Yep. You can order that. So. but she she likes yeah right there's no there's no pool tables or writing on the walls right right a little bit of action there maybe i heard that was one of the secret ingredients yeah yeah yeah though But she lets you, like Charlie, like I would almost ask for like no sauce sometimes and he would get mad at me. But Danny allows you, like she makes like a supreme one that has like olives and onions and green peppers. Yeah. I know.

Yeah, boy, the temperatures are, you can strap one and put it in the car and drive home from Hutch. Yeah.

I can remember where Charlie was out there by. Isn't it where Dairy Queen's at?

Yeah, on First Street and that strip.

Verizon is now. Go home.

I got a good tour from Gary Barker. He gave me a... He showed me where all the old banks, all the old gas stations, the old high school, the new high school, the competing high school that was not merged 60 years ago.

That's right.

Got a little politics with that question. Yep.

You did quite a tour director.

I did. Yeah. Can't believe how many baseball diamonds you guys have. It's a tremendous community. They're full on the weekends. Yeah, Blight Center, size of a football field. I joined, so.

There are acres and acres of parks in this state, too.

Amazing. Yeah. Back to back, even. Separated by small rivers, maybe. Lemons and Sixth Street, probably.

During Christmas. They said. That's what they said.

Let this go up like November 1.

It goes up right after Thanksgiving, doesn't it? Don't they turn them on Thanksgiving Day? I think so. And then they have a parade and Santa turns them on or whatever.

Well, the amazing thing is how many hotels you have. I grew up in Beloit, Kansas. We had one little tiny hotel. You guys have a lot of choices.

They're pretty well.

Even during the middle of the week. I know. I was shocked how far the hotel I was staying at was.

What a ball tournament here during December.

Yeah. Another minute here. Just to get everybody on zoom and everything. if you do have questions i just ask that you wait till the commissioners and and beeler are done we'll probably answer some of your questions uh if you do have a question and you type it up here on the zoom thing we're going to need your full name for the record and i would just ask that we don't bring individuals into this or talk about your medical conditions or anything like that close enough we're going to get what we get yeah yeah i just i don't want the feed blowing up while we're having a conversation here and so if you could just hold off on your questions still afterwards that'd be much appreciated thank you

Bill, do you want to come up with them? No. Okay. Do you guys want to introduce yourselves? It's 3 o'clock.

Sure. I'm Bob Popple. I'm one of the consultants and the lead consultant on this project with Beeler Consultants.

I'm Brett Coleman. I'm the interim CEO with Beeler Consultants.

So I thought maybe it might help just to kind of talk a little bit about what we've been doing. what we see, and then also I think maybe give you a little view of what you're maybe going to see as we go forward, if that helps. Yes. And then maybe that'll help with, you know, direct questions or something. So I think as are aware, we've been working not quite two months now, seven, eight weeks, and really just, you know, focus on trying to, A, figure out what's going on and status, and then what's necessary to maintain stability of the organization. So Time onsite and then also remote for a number of people on our team. I, Jim Brown, I think you guys have met, our finance, Darrell Nelson, our physician, probably has spent the most time onsite up until the middle of August. Now Brett's here four days a week. And so a lot of time. And we've had a few other people, revenue cycle and some other folks kind of sprinkled in and then done a lot of just phone calls, Zoom kind of stuff as well, just really to understand. So a lot of time spent interviewing physicians, the leadership, the board from the hospital, of course, and trying to just kind of put together a plan that I would say it's kind of in a short term. There's kind of a short term piece, which we're kind of wrapped up now, move to the intermediate, then there's more of the long term. The short term really focused on trying to get the organization to a position of greater financial stability and lots of challenges the organization has, but that's really Just the focus and a piece of it. So in our business, it's two things. It's are you managing your expenses and are you managing revenue cycle, the money coming in? And so that's really the focus is on kind of both of those sets of processes. With the expense reductions, you know, hospitals typically anywhere from 45 to 65 percent of their expense budget is actually personnel. It's just we are a very health care. Health care is a very people intensive work. And so that's a big chunk of the expense that you spend. And so that's also tends to be one of the places that you look for savings. And that's been true over the last several weeks. Just looking at just operations of the hospital, the clinics, how are we doing things and maybe should we be doing them differently? And that's, there's kind of that short-term piece of that. And then really a lot of that's happened in this intermediate session when Brett's here every day. One of the things he's spent a lot of time with the department leaders, which I think have all, Pretty much have all just stood up and really been super helpful, creative, and problem solving. And that's what we want to see because those are the people who are going to carry you. Again, if you're a hospital leader, you know your department leader is the ones who are actually running the place. And you guys have got some good folks here in the community to do that. And that is really showing some folks who really have to just take an initiative. You might talk about something and they're implementing it the next day, which is amazing. So that's good stuff. But so there's that piece on operations and also revenue cycle. And for PRMNC, the focus is pretty much had to look at all parts of that. So we have what we call a front end where you're collecting the information, you get pre-authorizations, except for people to actually have the procedures. Certainly when they're there for their procedure, you're getting them checked in, make sure you get all the data's correct so you can make a claim to an insurance company. And then on the back end is actually the coding, the billing, actual collections um we are seeing um improvement and quite honestly a big part of that is back now would be almost five months ago four months ago they had moved to a new revenue cycle company and i think they've done a good job of kind of a calming the waters and b we're starting to see improvements in what they're collecting and so people are being billed correctly um internally In our industry, we use a term called a clean claims rate. And that had fallen to somewhere in the 40% over the last year and now is above 90%. And that's really been the work of this company and the internal folks at Brett in the last three to four months. Some of that actually predated our involvement. It was kind of the things were getting on the path. I think now Brett working with the local leadership is just making sure it stays on the path and that we continue to see the benefits of that. Because if you're doing a lot of work and you're never collecting anything for it, that does not help your financial situation. And I always want to be fair about that with the patients and also make sure that there's integrity in that revenue cycle system. And I think we're starting to see that that's getting cleaned up. It takes a long time. The piece we actually talked about at the hospital board today is there's certainly some gaps too with what we call payer contracting. And so this is where you have contracts with Blue Cross, Aetna, United, the other big commercial payers. And are you getting a reimbursement rate that's fair as compared to your peers and also to what it costs you to provide a service? And I think not surprisingly, there's gaps there. That's probably true of 102 of the 103 hospitals you would talk to. There's always opportunity to pair contracting, but that's also a longer term. That falls into that one year, two year fix, actually. But again, I think the big part about that was creating stability, making sure we had just knowledge. And I think in the last seven, eight weeks, we've made some strides there. And a lot of it just has to do with the integrity of the information, making sure that stuff's actually accurate. Part of one of our deliverables is actually looking at leadership and also just workforce. There have been adjustments in workforce and that is... Hospital is a little strange about that and that you can't just turn something off because you have patients involved. And so there's kind of a wind down period. So we're actually midst that with a couple of services. We're finding patients new homes while the service is being turned off. And that typically is a 30 day window. And so some of that will come to an end here about the end of this month as well. And so it's some shifts of patients to other services. And the reason for this is purely financial. Um, it's not, does that say anything about the people who are doing the service? Certainly is not necessarily convenient for the patients, but you just, you can't, um, you can't keep providing a lot of services that are losing money when you are struggling yourself financially as an organization. Um, and you know, as with Brett, here's the interim CEO, which is now day nine. Um, I mean, as part of the leadership transition, um, there's a interim chief nursing officer who's also been named. going to try to move that you know find that right person for that role first and saying that though that probably won't happen until sometime in october-ish because it just takes a little bit to go through that process and we want to make sure we get the right person um but we're also optimistic that that person can be an internal uh promotion to be somebody from the organization or from the county uh already and then really the long term is just looking at starting to build kind of these road maps for some of these different areas that'll take you out the next few months or several months. And it kind of depends on the area, what that looks like. One of the things, one of the deliverables will actually be some cash projections. And so the hospital board would actually get, so here's your 13 week projection, here's your 26 week projection, because that's really, you've got to A, keep an eye on that, but two, just kind of have to have an idea of, so what does that look like? last week had some of the best cash collections of the entire year and so that's encouraging um one it means some of the revenue cycle things are starting to happen correctly but also that it starts to provide a little breathing room because at the same time i've been kind of leading a lot of our expense reduction efforts brett's now stepping in to kind of take take on some of that but really to focus on the revenue cycle piece since your revenue hopefully then gets back above your expenses and so that's again we feel like we're making progress with that And it's some of that data kind of lags. So for example, the hospital just finished their pay period on Saturday. And so you've got to go through the payroll processing, uh, all the pieces of that. And so it won't be till later this week that we actually know. So what was our salary expense for that pay period? So we can compare them to the previous ones. And so there's always going to be some data lags, but I think you guys will also see kind of going forward from now on, um, what you'll see is some reductions in expense. both on the salary and the non-salary. And then we're going to hit another plateau because that'll be when everything's been implemented that's been identified so far. And at the same time, you hopefully will see the revenue kind of coming up and then it will also plateau. And what we're trying to do is at a minimum be this, and hopefully it'd be the revenue be higher than the expense. So that's kind of just the focus of the work so far. As far as the, there was in our, you know, part of our arrangement or agreement is to provide some deliverables. And you're going to start to see those in September. Some of those will be just kind of here's the report. There will be a few pages. They're not going to be some lengthy. You can't go past three or four pages or Brett and I lose interest. So we've got to keep it somewhat concise. And I think some of those will be able just to distribute to the hospital board and like to Tyson. And others, I think we're probably going to want to talk through just because you're probably just going to say, what is this? Or what does this actually mean? And so I think you'll get the information. It's just a matter, you know, again, we just probably have to schedule time to walk through that, all that stuff. So I don't know if there's, I don't know if that kind of helps paint the picture. Oh, I guess the look forward is, so of course, Brett's here. We'll have the deliverables. We'll start to A lot of that will come actually in September, probably the last of that in the very beginning of October. And then it's kind of that, by then we'll know where we are with matching up. And so then we'll know what levers we need to start pulling again to try to get things in line. I think we're pretty comfortable that we're in a pretty good spot. We just have to kind of see where everything actually matches up. And then also what you can sustain, because that's really the key issue is the sustainability. We have seen progress in the last few weeks, and I give credit to some of the local finance team. They've been able to get ahead enough on cash that we're able to pay down some of the accounts payable. And so it's just, what does that look like? I think that's really the question. What does that look like over the next six months, 12 months, et cetera?

So what's the total in debt that they are at?

So I'll end somewhere north of 14 million.

It's probably a little more than that. So they have about 11 million accounts payable, 5 million line of credit, give or take. These are round numbers. They're a little lower. Actually, each one I'm giving you is rounded up to the million. Um, so that's, that's 16 and then a longer term one that's right at around million three. So around 17, three, 17.

And I don't know if you guys are aware, but you do have a credit bond payment coming up that I'm going to send that you're not going to make, and we're going to have to.

deal with bond council on that uh i didn't know if you guys knew that well yeah yeah as i say i think so i think there's a right com they're planning to have a another meeting or a conference with you guys about what steps to take yeah it's coming up quick and i know we've reached out reached out to bond council to just identify what's in the surplus sales tax reserve fund to make sure that they'd be able to do a rate of credit if that's what they desire to do

uh on the revenue cycle uh yeah i think tammy and bill when we met in our small groups they got down into the 40 46 or something like that i think when they started and it was going up and you've got it up to 90 now you say yeah the last the last uh few weeks i always mispronounce the vendor's name

Bestra, B-E-S-T-R-A.

Yeah, they've been in the 94, 95% clean. So it's a clean claim going out. Still doesn't mean that like that insurance company is going to pay it. Yeah. But at least the claim is going through all the scrubbers and going to them. Going to them. Correctly.

Is that, and this is just because I know the trouble they were having with their billing program. Is that because of the billing program or it just wasn't done right to begin with or? Because I know at one time they were wanting like $3 million for a new billing program to solve this issue. I'm just curious.

I would say it's a bunch of things. I don't know that there's any one single item that caused that. The actual software itself is just a piece of software. It always comes back to what goes in is What's going to come out? And then also, are there glitches or problems? And I think we have all the above. The way you get to clean claims up is you resolve all those things.

I mean, that's why they were working on it.

Yeah, it's almost like at a point that might have been an April one issue is not now the what's going to be the September one issue with RevCycle. There's still stuff to be done, believe me. But I think we're kind of moving through some of the say lower level issues and now we're to figuring out so why is this or that happening with a claim or group of claims yeah uh the vendor's still okay with you guys nobody's threatened to come hanging from a tree or nobody that one's going to threaten to hang Brett I mean part of this is like you got to keep communication with them And also they have to see that there's progress.

Progress, yes.

And I think with some of the changes, I think they see that there's progress or at least an attempt to have things be done differently. And that does matter. And the vendors are also looking at this very long term. They don't want anything to happen to this hospital either because they just lost a customer. And so I think if they continue to give us some grace and we're able to keep moving more money to them, then it's going to take a long time, guys. You don't dig out of this one.

I understand.

This is a multi-year process to get out from this.

And that's always the end goal here is to keep them to where they can sustain and dig themselves out of the hole.

I think we're pretty optimistic about what we've seen over the last six, seven weeks that we've been here. And I think we might have talked about this when we were meeting individually. There's no reason this hospital cannot be successful. None whatsoever. There's no reason that this place can't be successful. And it's just a matter of knowing what levers to grab hold of and which ones to pull and which ones to push.

Long term, I would even say this hospital has one of the best payer mixes in the state. There's, I would.

I mean, like, yeah, 25. Yeah, the percentage of your patients who actually have insurance, commercial insurance is actually abnormally high. So it means your employers in the county, A, tend to have insurance for their employees, and B, it tends to be reputable. Well, I can tell you that.

How many millions of dollars do you have?

I'm just saying. So when you have a commercial air mix in Pratt County, like around 50%, that's like way high. That's good. And so that's one of the reasons you say this place has all kinds of opportunities to be successful. Yeah.

Is the bank working with you too, I'm assuming, on those loans? Nobody's pulling the rug yet?

No one's pulled the rug. I mean, the EVS, the food service, and the housekeeping company pulled out. But we took it over ourself. So that was Sodexo Marriott. I don't consider that a loss, actually. I mean, the risk is like your implants, your anesthesia, your travelers, the people, nurses, where you don't have a nurse and you're paying a third-party company. You know, those are the kind of liabilities that, to your point, no one can force us into bankruptcy and a for-profit can't force a non-for-profit into bankruptcy so we're not going to go bankrupt because a vendor sued us and said we want to force you into bankruptcy things stop supplying you that's the risk I think is the next 60 days are the the days that where we're still paying out PTO for people we've released so we still have the salary expense we don't have and the revenue is starting to come up so these are the days that i at 60 days i feel like that monkey's going to be off our back and we're going to be in a lot better position so you'll be able to do surgery we're doing surgery we're getting the stuff right now but we just have to we have to it's it's an everyday meeting about who you're going to pay today so and then you have If you have 200 vendors at a hospital, there's 200 people that want to talk to you and you can't do your regular job. If you're talking to 200 people.

I think again, one of the indicators we would watch is that, you know, what's the balance on the line of credit. And if every two weeks it's going down, then that's a sign that you're getting more cash into it.

Yeah.

And so you're starting to close that gap. And again, that's, that's one of the things we would watch and

we see indication that that's what the direction we're going to be headed so yeah that's the number one the two things I ask for every day is how much should we cash that we collect what's our account what's our line of credit and what's our accounts payable those three numbers control if we're making progress or not those are the only three numbers you have to know right now everything else is details so in 60 days you'll kind

have a better picture for your long term?

Well, I think the long term is very optimistic. I mean, I reviewed your Blue Cross Blue Shield contract this weekend, and there's plenty of room for upside. I mean, this hospital can make a lot of money, literally can be very profitable. But to get Blue Cross and Blue Shield to sit down at a meeting like this and discuss rates, they don't even meet with KU, with North Kansas City. They don't care. This is the rate you're going to take. So we'll have to be creative in how we get them to the table. But I have some ideas.

Offer a pizza taco. That was on the table.

I think that's part of the root. It's like there is no, you can't point to any one thing and say this is why we got here. Because there's a bunch of reasons for that. And there's also, there's not one thing that we're going to do that's going to flip the switch the other direction either.

And I didn't mean to have my questions about the revenue side. I just know that they were working on it and they were making progress before you got here. Yeah.

One of the things that happened to with COVID, the hospitals got a bunch of money from COVID. Every hospital was very healthy after COVID. Through COVID and after COVID right then in October of 2020, they got some big grants from the federal government. And then, you know, the, the, credits that they got for FICA and expenses like that. But everyone thought that healthcare would go back to what it was before COVID in terms of volumes and the way people approached healthcare and people haven't. And so you had to adjust your expenses in 21, 22, 23 to the new reality. And if you didn't do that, and then in 24, when they made a change from one billing company to another billing company that was immediately bought out, then you finally got to the right billing company in April of 26. Between the expense and the expense that you thought would be what it had always been, but shifted after COVID and the revenue cycle that happened when you went with a different billing company, those were the two years when you got in your hole. So literally, this is one of those things where this hospital is a great swimmer. They could swim five miles, but if they're underwater for six minutes, it ain't going to be good. So we just got to prevent the six minutes.

Yeah, gotcha. And it sounds like you guys are working on it.

Very much so. Yeah. The Blue Cross thing is a one to two year. I mean, I don't think we could get it done in a year, but I think we could get it done in two years. But it's Blue Cross. It's United. It's Cigna. It's Aetna. It's every payer out there is underpaying you. By Medicare, you're recognized as sole community hospital, which gives you additional reimbursement. So we got to make sure we get the full advantage of that with the payers. Because Medicare does it automatically. These guys may not.

I would fight them for.

Exactly. And maybe they're willing to automatically give you 5% or 8%. We need more. When we're the only hospital doing babies and practically 60 miles, we can't be paid $5,000 or $10,000 for a baby. Maybe we need $15,000 or $20,000. And that's the thing where you're going to just have to hold the line on that.

Well, I think everybody knows dealing with insurance is never fine.

Yeah.

So you guys are kind of optimistic? I have, honestly, I have no doubt if I make it through the next 60 days. I literally have no doubt.

They can take themselves out of it?

I mean, I'm 98% confident. I'm not. I'm 98% confident. I won't say I'm 100 because anything, I could be misreading something. But this hospital has the payer mix that typically should be making $6 to $12 million. So am I confident that we could get to that? Yeah. Will it happen in a time frame that we're not underwater six minutes? That's the part I'm nervous about.

I know that's what you were telling me Tuesday when I met you.

Yeah. David's on and we might check with David.

David, can you hear us? Where'd you go? Oh, there you go.

Yes. Thanks, guys. I can hear you just fine. No, I don't have any questions. Really appreciate the comments and information that have been provided and just very encouraged. By what I'm hearing, that's all good news. Very excited for the incoming leadership. And welcome, Brett. And I just hope that that continues to move forward. Looking forward to hearing about and seeing the progress.

Thanks, David. Frankie, you're on here. You got anything?

He's muted.

Yeah. No, I don't. I think it sounded great.

Okay. All right. Well, I, I feel better. That's fine. Yeah.

I hope the public does too. You just have to have some time to get work through all of it in the future.

We have some questions. Mr. Craig Newby. It's like more like comments. Yeah. Talking about bond payment, that's 30-day eviction notice. I'm not going to do that. And of course, he wants copies of.

Yeah, Craig, to the extent that you want to make a quorum request, you're welcome to email me. You've been provided what I have, though.

I think Mr. Newby dropped off.

Yeah. Yeah, he said he did. Okay. Does anybody else out there on Zoom have any questions or concerns? I'll give you a couple of minutes here to get your questions typed. If you do, don't forget to include your full name. I have heard from around town that they're pretty impressed with this guy.

I think you got the right guy in there. We did too.

I know I met with you for an hour last Tuesday. I was very impressed. You did a fantastic job.

He's got less gray hair than he should have.

Somebody looks like Christmas.

Yeah, exactly. When you come into these hospitals, and I'm not trying to rag on anybody, has there been anybody this much in debt before that you've dealt with?

So the financial situation here is worse than any other place that I've been involved with from the TAB, Mark McIntyre:" yeah it's like when I can't remember is yours, so you have the financial piece which I think we're ever hands around the Community perception piece i've seen this before. TAB, Mark McIntyre:" that's as difficult or more difficult to work through. TAB, Mark McIntyre:" i'm sure, and I think that's we're going to need a lot of folks to pull in on that and it's just by the way it's not about. it is not about the care that's being given. We actually heard from a patient whose father passed here recently at the hospital and just gave a glowing response about the staff who were taking care of that family member, right? And so we gotta make sure people, I mean, you may be upset with this or that policy or change or whatever, but the folks doing the care, just let them do their jobs. And that is rarely where the problems are. PRMC actually has a pretty strong, sustainable, consistent history of good quality care. You guys have been recognized multiple times, the organization has. And I would really worry if that was upside down, as well as the other things, because now you have a third product that's really difficult, and that's harder to fix than the financial. We don't have that issue here, which is good. Um, it allows us to focus on the financial piece and then the, you know, quite honestly, if you want to earn back trust in the community, it just takes time and you gotta demonstrate consistency.

I think financially it's more of a liquidity. So it's like you got a hundred cows and no one will buy one and you gotta beat them and you don't have any money in the bank. And so, you know, that's, it's not really that you don't have plenty of ability to make money. It's more that you have a liquidity crisis.

Yeah. And to the employees, I mean, they're great. Do you have a question?

With the travel staff?

Let me read the question. Jesse Everett says, what can you do to depend less on the travel staff? I'm assuming you prefer to have local employees over travel.

Yeah. So the answer to that is always, You'd always prefer to have your own people than the travel staff. The travel staff, they do fill a need, right? When you have a gap, that's the best, sometimes the only and best way to do that. So there's, with some of the changes that were made, some folks have moved into new roles and the number of travel staff at PRMC will be about half of what it was in July as we roll into September. So about half those folks are exited and out the door. And then it really is, you've got to find the people to fill the hospital. Yeah. Oh no. I mean, it's the same thing everywhere. Um, but it is, you know, what can you, what can you do to move people around? So you don't have to get into that because it's expensive a and B these are not people are going to be with you. I mean, they're not necessarily going to be here in six months. And so that's not helpful to the community. You'd rather have somebody who's here. Hmm.

How's all the physicians working to work with and working with?

So I guess we can both answer this one. So physicians are physicians, right? I don't know that matters about the geography. Right. What they're looking for is a place where they can be a doctor, do their thing. They get support. They get questions answered when they have questions and they get resources. And you can kind of meet. of the basic needs most physicians do just great kind of doing their own thing you guys have an interesting mix here and that you have a independent primary care group and it's it's actually growing that's atypical of what you would see around the state and so that's actually that's a huge asset that you have that um You know, the biggest challenge for rural areas, and it's no different here in Pratt, is you've got some folks who are looking at retirement a handful of years out. And it's the, you've got to strategize now about who you're going to replace with. Because recruiting physicians is not easy. And it just takes a long time to train a physician. I think people always think it's 14 years for a cardiologist. I mean, it's just, you've really got to have a long runway. Even an orthopedic surgeon, their residency is five years. And then if they do a fellowship, it's six, seven, or eight. And so you think about that as when you're thinking about hiring somebody, you've really got to pre-plan. So, you know, the physicians here, I would say for the most part, have actually been pretty open with us about all kinds of stuff. There's people who've got concerns, you know, a lot related to past things. And we've tried to listen one time and then say, we're going to look ahead now. And for the most part, I would say all the physicians are looking ahead. i think they just needed to see that and and sometimes you know quite honestly you just gotta say you just gotta vent and get it off your your chest and if somebody's willing to sit and listen to you do that um then it's kind of you can shift to so now what's the future they're i would say they're all very vested in what's happened in this community there's 100 we can't let anything happen to the hospital we are not gonna we are not gonna let our community down i think that's i i'm yeah i i think that's 100

Yeah, I've met with, I think, most every one of them one-on-one. Super positive. There was a discussion or a rumor going around that we were going to close PMI and G. We're not closing Pratt Medical Internal Group. So I think the physicians are in town. They're going to stay. They're part of the community. They want to help. I think they want You know, when we fix our billing, sometimes we're fixing their billing too. And so, you know, maybe they have reasons to be frustrated historically. And so maybe we've, maybe sometimes you just have to start with, I'm sorry. And I, I think if you're, you can really never be too humble as a hospital CEO, you got, you got me used to eating a lot of crow.

So, you know, I, I think that mix of the two is like, um, it's not, Nobody's blessed with being perfect. And a couple of physicians, I think they've taken ownership of that too. And that just helps. I'm not saying it solves everything. It just helps you get back to, okay, so can we work this out?

I have a lot of friends in Dodge. Apparently you guys got a clinic out there. I don't know what's going on with Dodge, but nobody wants to go there. I'm a little worried about that.

I've talked to the two clinic managers over that. We actually rent two suites of one building. We're going to consolidate into one suite, but we're not eliminating any of the providers there. One, on our side, it's reduced overhead.

I don't know if we can really speak to the issues with the hospital and Dodge. I also hear the same things about there's just a lot of dissatisfaction. I don't. So far for us, that's not been a bad thing. Well, no, I mean, I was telling you, it's not necessarily a bad thing for us. And then some of the specialists, specifically the surgeons, have such a wide circle that they draw patients from. And part of this is because there's not options, right? And so that's why it's important to kind of keep those relationships. But we also have not, we're not going to get involved in somebody else's problems. We got enough of our own to

care of first and i'll tell you from being i've been at three hospitals over the last 21 years i've never seen a hospital that didn't have patients that that were mad at it and people that loved it and people in between and um most there's the people that are mad at it they all think the best care is 100 miles away and the people that love it would never go anywhere else and um The fact that it just came to Pratt is the only surprising thing.

Well, I think a lot of that is just frustration, and I think they'll get over that once you guys get it on the right track. At least I hope so. This has been very good to hear.

We appreciate you coming in and informing the public about it.

Yes. Our pleasure. We're servants to you guys. We appreciate you bringing us in. I think we can make a difference for the hospital and for the community, and we want to do it.

Thank you. Everybody wanted to hear. Susan, you got a question?

Can I ask a question? Sure. Susan Mayberry. I'm a business owner in town. Appreciate everything you guys are doing. I've heard wonderful things. I'm sorry that this happened, but I have a lot of friends that work at the hospital and they're literally physical, mentally sick and don't know their jobs at state. I know you have to cut situations. Are they being, and I'm not asking you to bring in more therapists, are they just being talked to and treated properly and letting them there, not knowing day to day if they can survive or if they're going to have a paycheck?

Well, we do have a company that comes in, I think once a week, is it? that the workforce comes in. Was that once a week or once every two weeks? Once a week on Thursdays. But there's not, the expenses that we've cut, there's not a lot of, there's no deep cuts that I see that are necessary. Going forward. Yeah, going forward. The cuts that have been made are the cuts that have been made.

Thank you.

And I also think, I mean, it's an effort. Brett's making a real effort to be available to the leaders and also to round and be available just to talk to the staff Yeah, I mean, my experience, and that's going to go further than any of us. I have heard great compliments, but they're still scared. Yeah, don't send me a memo. Give me a guy to talk to, or just give me somebody to talk to. And I think that's what we've been trying to do is just make that availability. This process part got to be one of the most stressful things you can take an organization through. Yes. And it also is not immediate. And we actually talked about that internally. Um, is it better to just go like it's Friday and, you know, you make all these changes or do you space it out while you're thinking through things? And also we have patients that we have to consider. So you can't just say, we're going to stop something on Friday necessarily, because it actually may need to be 30 or even 60 days past that Friday. But with the communication piece, um, I would think most people already know. Um, and most people know that people have been, um, that have lost employment, um, Cause I don't think that's been kept like as a secret or anything. I think everybody knows about that. It's that working through piece is a little weird in our industry. It was probably paranoid.

Well, yeah.

And somebody may have been told two weeks ago that your position is going to end three weeks from now and they have to keep working. Right. Which is also different than a lot of other industries where, you know, if you're one of the factories in Wichita, you get your notice and you're done that day. And in our world, it,

typically doesn't work that way and it's just by virtue we've got people we need to take care of and or find them a new place to get care yeah so I think we made the changes up front in general and I think now it's a matter of making sure those changes get implemented but um just helping people find opportunities work smarter not harder um you know In a rural hospital, you wear a lot of hats. I worked at a 25-bed hospital up to a 285-bed hospital, and it's great in a 285-bed hospital because you've got somebody for every title in the world. And in a 25-bed hospital, you may have four people with those titles. And so I do think people are stressed out, but I see a big change in the three. This is my third week coming, so ninth day. um I meet daily with managers and directors and um I think they feel very encouraged when you hear that you had your best cash day that you've had all year long and that you're now at 95 clean claims instead of 45. you know things in a sense kind of happened quickly in terms of the two years of billing it wasn't like this slowly happened over 10 years and so it kind of happened quickly in a sense And so the changes have had to be kind of quick because of the liquidity situation. And I would, the way I would describe it is like, for whatever reason, some people like, you know, I'm not like this, but some people would rather have 20,000 in their checking account and $20,000 on their credit card. Cause they like to have cash, even though they're paying a high credit interest rate. And some people like to have zero cash and 20 zero credit card balance. The hospital for a long time had, if you even look back five years, had kept a fairly high accounts payable balance where they were taken a little bit longer to pay people just as a way of, that's just was the preference of some, whoever was, you know, at that time. So when you have like a 40 day hit to your cash or a 60 day hit to your cash, if you're at zero accounts payable and you have a hit, you go to 60 days. If you're at 60 days and you have a six day, you're at 120 days. And so because of the way that we'd kind of managed accounts payable in the past, it created more stress when there was a liquidity crisis.

I guess my only other comment too would be is organizations get into trouble when they don't react to the environment changing. And you stay out of trouble is if there's some other, something else happens, whatever in the environment, PRMCs just needs to really respond to that in the moment and not wait. And, and so there that's why there may always be future changes. 100% opportunity for that. But it's the, what's the learning is, is to help everybody specifically in leadership understand that part of my role is to respond and always be reading the environment. Because it can be a good read because you're going to get 3% this year from Blue Cross instead of two. Or it could be a bad reading that there's an employer locally who goes out of business and so that you have X more people that don't have insurance. I mean, it's just, what are you doing to always be flexible and respond to what's going on in the world around you? And in healthcare, that can be at federal, state, county, or across the street level. You just have to always be ready to respond to that and not just kind of sit and hope it's going to get better.

There's things, and I'll just add this, sometimes some businesses have different philosophy about how often they raise their prices. Sometimes you might think, well, I'm going to do 2% every year for the next four years, and that'll be 8%. Other people are like, I'm not going to do anything because I don't want people to complain that I'm always raising prices. I'll just do it every four years, take the hit then. raise prices eight percent sometimes when I look at your guys's cost report which is basically your tax return you have areas where Medicare will pay you the greater of whatever you charged or whatever the allowable is sometimes your charges are below your allowable so we need to raise rates and that's something needs to just I think best practices annually um and so there's there's things on the revenue cycle that are related to how much we charge for things too, that we need to, that we're focused on. So, I mean, there's, there's a thousand moving parts in a hospital. That's why you do it for 28 years and you still learn new things. So I think we'll, we're definitely on the road to recovery. And I think everyone's going to, if we get through the PTO payouts over the next 60 to 90 days, whatever they are, and get to the other side. I'm very optimistic.

Thank you. Thank you for all you're doing.

Terry Williamson, community member. What do you see? I know you mentioned 17.3, give or take. I'm a numbers guy. What are you looking at like six months and 12 months down the road? What would you like to see that number decrease to? Oh man, that's a tough one. I know zero, of course, That's not going to happen.

Right. Well, what I would do is I would try and if I, let's say in 17, if I'm at 17, let's just use 17 and let's say I can get it down to 15. What I would do is I would leave the money on the line of credit near the 5 million and pay down my accounts payable so I could get my vendors so that they would see progress first. So I think realistically, you know, six months and you're going to still have payouts. So you really only have four months of, you know, expense benefit. I think your expense benefit could be around a quarter million a month. So you're looking at a million dollars there. I think on the revenue side, you should have at least, I think on the revenue side, you could have even just with the tweaks we're making at least a quarter million. So I think you could have at least 2 million less. I mean, that would kind of be my goal.

In six months.

Yeah. Cause that's really just, That's mostly really just four months of impact. It's starting now. We still have PTO, our big PTO. We have a $60,000 PTO payout September 3rd. You still have big expenses. On the salary side, even though we've made the adjustments, you don't really get the benefit because when people leave, you pay out the PTO.

This path, they can take 10 years to zero out.

Not to say, no, not at all.

It won't be 10 years.

I think you could get, yeah, I think the big thing is your Blue Cross and your commercial insurance. If you, and I think that'll take not less than one year, hopefully not more than two years. You could see increases from your managed care plan. You know, you would negotiate for like a three year because they won't be able to swallow like a 21% in one year. Then maybe they, maybe they can, but they'd probably be, They may not approve that, but they might agree to three, three, three sevens. So you get them 21% increase over three years. So you do three year contracts. So then you, you don't do those all on the same day. So that if you have to terminate one, you're not getting, you're not putting yourself at risk all on one day. So you gotta be smart about those contracts. Say one, one's a two year, one's a four year, one's a three year. And you negotiate for a longer term con. contracts that get you where you want to be, they'll say, we can't get you there the next year. You say, can you get me there in four years, three years? And so you've got to kind of, just to get them to the table, it's going to take six months and they will play go fish forever if they can. You may have to go non-participating with some of the insurance companies, which will make members nervous. They'll send a letter. You can't go to the hospital anymore. They'll try and scare the members. So we have to have a whole strategy around that. That's not just something you just like send a letter and just figure, you know, we'll figure it out when it happens. It's a whole strategy. But that strategy is probably worth $15 million a year when it's all done. But when it's all done, it's probably four years from now. But that's how you get to $6 to $12 million a year.

Sounds like we're good. When's our next hospital update, like a meeting like this?

Well, we haven't talked about that, I guess.

Yeah, I see that.

Yeah, Jesse, but I think we already covered that. Will there be any more layoffs?

I mean, I got ideas that will, like, implementation of, like, I don't wanna name specific jobs, but things that AI will replace that it, it really, I hate to say it. AI is one of those kind of dirty words where it's like, no one wants to use it, but everybody uses it. You hate it and you love it. And, um, but those aren't like 20 FTs, 10 FTs, five FTs. That's one here, one there that's, but it's things that make you more efficient where you're using five people before. Maybe now, you know, only need four because. the technology makes it better. So will there be more layoffs as technology evolves? I think it pretty much gets back to, you got to respond to the environment.

So if volume shifts out of a program, then you've got to look at how you resource the program. I don't know. So I think the layoff, that word has a certain connotation, like you're going to have this date and a bunch of people lose their jobs versus what's quite honestly more normal is that people are responding to what's happening in their market. They're either adding or losing or shifting resources that's what people typically would do and so you know with people leaving you have folks who we terminate for cause there's people who resign on their own and then you have this adjustment um when things are like what we've had to do because things were out of kilter and then you just have what i would say more normal run of the mill this came up yeah we have a new ability to do this differently and so we now used to have four people doing it now we only need three And so arguably, is that a layoff of one? Okay, maybe. I don't know what terminology you want to use. I just think that's, to me, is just more normal. Yeah.

Got to be more efficient.

Well, just take advantage of what is available.

Yeah, good example of that. We have one of our AI ideas is probably maybe save us two FTEs, but we have an opening for those two people somewhere else, and I told them to go talk to them first. before we fill it externally. We're never going to try and fill a position externally that we can move someone internally. We don't want people losing their job.

Some of the people who are in the roles that we're eliminating are actually the ones who are now taking some of the contract nurse jobs. And so we're getting rid of the contractors. We're keeping the people. There's some retraining that we're doing and we're funding the hospitalists. But it's just a way of, so arguably who got laid off? Well, ultimately the contract person.

yeah so i mean again it all depends on some of the semantics i know but it's kind of like so what is actually happening um i know some of them are going to go to work for family practice too i think they had an interest in hiring a few of them yeah yeah hopefully we would want people to find placement here yeah sure i think there with the contract positions that were open there was plenty there was there's been plenty of positions open If you want to work ICU, med surge, the floor, surgery, would you have to train in that department for six months before you felt, before you were released to do that job independently? Probably. But we offered them those jobs. Some people, I mean, and there's, I'm not criticizing people that didn't take those jobs. Some of those jobs are 12 hour shifts. People have kids, they can't work 12 hours. Some people, sometimes those jobs mean you got to lift patients. Some people can't lift patients, you know, so we're not looking to really, um, even the people that have left, we had there and there'll be on average, probably seven. I would, I don't know what the hospital turnover is. Most hospitals, if you're at 10%, you're doing pretty good. So over the next 12 year, next year, you're going to lose 20 people just to, to normal turnover.

Yep. In Kansas, the hospital turnover is just under 20%.

Okay.

So

Yeah. Yeah. I mean, yeah.

10% I 50 people leave just naturally in a year. I mean, you always try to hopefully be less than that.

Yeah. So I'm not optimistic that people, I don't think very many people will lose their job because they didn't have a choice. People lose their job because they don't want the choice.

Yeah.

you think we can have another meeting like this in 30 days hey man when you guys when you guys call the call us to the mountain muhammad shows up i think this has been beneficial for everyone but including the public i appreciate you guys coming in and talking through everything because we get a lot of questions yeah and we didn't have answers so hopefully we got the answers

It might maybe like an early October or something that might, I guess I'm trying to think timing wise.

I'd say 60 days. I'd do 60 days just so I'll have, I told you, I was, I told Morgan 60 to 90. And I think that's kind of the more of the timeline, but I think 60 to 90 days, we're going to, I'll be able to tell you who's rolled off, how, what are, where we're at on expenses. I'm going to create a little dashboard that I'll share with you guys. If you want, that I'll show you kind of like, cause there was, there were plenty of warning signs. So I might create a dashboard so that you won't, there won't be any mysteries. You won't have to look through a hundred pages. You'll look at one page and know if the warning signs are flashing.

We appreciate that.

Yeah.

The simpler, the better.

I don't want to. I appreciate you guys. Thank you. We'll probably be in touch on the credit deal whenever we hear back from Council.

Okay. Sounds good. Thanks, guys. Thank you very much. Thanks, Tyson. Thanks, Roy.

Thanks, Maureen.

Thank you. Anybody have anything else? Second we adjourn. All in favor say aye. Aye. Opposed same sign. We are adjourned.