Hospital Board moves forward with nursing home de-licensing, tax bill brings pressure

by C.F. David

In a two part meeting on Thursday, the Cimarron Memorial Hospital Board moved forward with its plans to de-license the nursing home.

The Boise City News mis-reported that CEO Dave Peyok would be present; he did however converse with the board and citizens by conference call.

In the business meeting, Peyok told the board that the IRS has been contacted, and at his request an officer has been assigned.

Peyok continued that he hoped the agent would be giving a timeline for which the amount owed could be repaid.

He told the board that April’s payment had been paid but that the facility owed more than $500 thousand in payroll taxes and that the bill had been growing since the second quarter of 2005 up until 2007.

Peyok told the board that there was very little chance of having interest waived but it was possible to have the penalties waived in such cases.

The board has had discussions with Farmer Stockman’s Bank, and with a plan in place the bank is prepared to loan the amount needed to be sure and have money into the third quarter to have money to focus on other things.

In the report from the nursing home, Donna Cain informed the board that they have 20 residents with four in the hospital and eight making plans to move.

“They think if the waiver doesn’t go through they need to plan ahead she said.

Citizens speak

After the board adjourned and  reconvened after Executive session, the board again adjourned and reconvened at the Senior Citizens Center.

Board member Lois Burkhalter started the meeting by informing those present that they [the board] had learned about two weeks ago about the tax liability.

“We received a tip that the IRS was going to close the facility,” she explained.

Burkhalter then told the crowd that with this information Peyok, at Bastrop, Texas, had  persuaded his CFO, (with 14 years experience), to come on board, (at no cost), to help negotiate with the IRS.

“We were faced with losing everything, or making a plan to save something,” Burkhalter added.

Susie Williams, from Keyes and a former Cimarron County Commissioner stood and gave the board her condolences, and told them she knew the decision couldn’t be helped.

Addressing Peyok she said she knew that things similar had been done in other states, but told him “...nothing is easy in Oklahoma.”

“After 365 days what will happen to the residents, assuming the waivers go through?” she asked.

“Is that still up in the air?”

Peyok replied “Yes.”

“Basically to save the hospital we are bringing the costs from the nursing home to the hospital,” Peyok explained.

“The nursing home is losing money.”

He explained that the 15 residents supported by Medicaid wouldn’t be paid for unless the waiver went through.

“This would be the first state that didn’t get a waiver,” he said.

A listener asked what he felt the increase would be in dollars; he responded $200 to $400 thousand. They then asked how that was possible by losing all the residents.

He then explained that the figure wasn’t based on the number of patients, but on costs, adding that the federal government would pay 101 percent, that if it cost $10 to run the hospital it would receive $11 back. (Consultant Keren Jannsen explained that this example is of course an over simplification as to how the plan would work.)

“It’s my understanding that Oklahoma operates differently than other states,” Willams said.

“It’s [Medicaid] Federal,” Peyok responded.

Williams shook her head.

Questions came up about patients who were private pay, and Peyok explained that they would form a group and negotiate a daily rate.

Another listener asked if he [Peyok] was 100 percent sure this would save the hospital.

“Pretty much,” he answered.

“You need to be here so we can talk to you personally,.” the man said.

Peyok explained that it took a board about three years to grasp that this will work and a facility could be saved.

“It took me two years top believe,” he said.

“I can’t guarantee it, but I’ve never had one close,” he said.

He then encouraged the families to contact their Medicaid representative.

“This would be the first state not to let the patients to stay.”

“Where are we going to get the people to put in the hospital,” asked Helen Etling.

“We don’t need them,” answered consultant Keren Jannsen. (While checking facts of the story, Jannsen explained [rightfully so] that what she meant was  that a high census was not necessary to keep the hospital open.)

Nursing Home Administrator Donna Cain asked why, if this would work hadn’t the facility received these dollars in the past.

“Because you were affiliated with a long term facility which has more square feet,” Peyok explained.

Former board member Dwilene Holbert told the board and Peyok that she knew something needed to be done to keep the doors open, but that she was concerned about her mother, a resident.

“Right now, she has to pay $524 a month with $50 left for her incidentals. Medicaid pays for all her medicines, and what they pay for medicine exceeds her Social Security check. My concern is that my mother has enough to take care of her self.”

“It’s scary,” she said.

“If there was a way not to disrupt the residents, it would have been done,” Peyok said.