Crisis highlights improvements to CCMSD finances

Shunting electronic medical records from one system to another has left Crook County Medical Services District (CCMSD) with a temporary shortfall of $2.3 million.

In the old days, says Mark Erickson, Chairman of the Board of Trustees, this would have been a significant problem.

But now, after efforts have been made to shore up CCMSD’s financial situation, it’s just a setback that needs a little admin work to solve.

“Everybody is going to get paid, there’s no need for any panic,” assures Erickson. “We can weather this storm.”

Contract Dispute

The issue has arisen due to a contract dispute with the company that previously handled CCMSD’s electronic medical records system (EMR).

The board moved to replace its EMR in December, 2022, on the basis that it was proving a bottleneck for productivity, preventing medical providers from getting patients through the door and requiring more administrative work than was necessary. It was also believed to have caused serious billing issues.

At the suggestion of a steering committee led by Wesley Davis, Chief of Staff, the board opted for Cerner. After the system was adapted to work for CCMSD, Cerner went live in March.

It was at this point that problems began.

After CCMSD codes the services provided to a patient, this information is handed over to the EMR provider for invoicing. All records that were held by Evident at the time of the switchover were stopped due to the contract dispute and can no longer be accessed by CCMSD.

These records represent an estimated $2.3 million in billable services.

There is usually somewhere in the region of 45 days from the moment care is provided to the moment that payment begins to come in, says Erickson.

So while Cerner began billing soon after the switch between EMR systems was made, with a short delay due to the turnover process, there exists a 45 to 60 day period at the end of CCMSD’s time with Evident for which no invoices have or can currently be sent.

Steps to Solve

The situation is not ideal, Erickson says, because for every day that Evident sits on the invoices, the chance they will become uncollectable increases.

The goal, he says, is to reach what the board is colloquially referring to as “Cerner-land”: the moment when the first invoice payments sent out by Cerner begin to flow in.

“Once the faucet turns on, then it flows again,” Erickson says.

In the meantime, the board needs to keep things running. Once in “Cerner-land”, he says, the board will work to replenish the money borrowed from its accounts.

By the time last week’s meeting rolled around, the board had already met in special session to move money from holding accounts, such as for construction, in order to fill a funding gap.

A couple more steps were taken to ensure that CCMSD can continue to meet its expenses in the short term, such as the biweekly $310,000 for payroll.

For example, at the suggestion of Board Member Sandy Neiman, around $30,000 was moved from the Moorcroft and Hulett accounts.

The board will also not be attempting to hurry the purchase of employee housing in Sundance.

Meanwhile, following the conversation, the board moved into executive session for legal advice. While not specifically announcing that the decision which followed was related to the EMR issue, the board directed its attorney, Kara Ellsbury, to enter into negotiations on CCMSD’s behalf.