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An accident occurred at 7:45 Wednesday morning in Dent County on Highway 19 about a mile south of the Highway B/K junction. According to the highway patrol report, 17-year old Matteo Presti of Salem became distracted while driving a 1995 Ford Mustang northbound and traveled off the right side of the roadway. Presti overcorrected, returned to the roadway, crossed the centerline and struck a 2001 Pontiac Grand Prix driving southbound by 63-year old Alfred Orcutt of Salem. Orcutt sustained moderate injuries and flown by Air Evac to Mercy Hospital in St. Louis. An occupant in the Pontiac, 62-year old Jesus Hernandez of Salem, suffered moderate injuries and was taken to the Salem Memorial District Hospital by Salem ambulance. Presti also suffered moderate injuries and was taken to the Salem Memorial District Hospital by the Salem EMS. Everyone involved was wearing a seat restraint at the time of the accident. Both vehicles were totaled and removed from the scene by Whitaker’s Towing of Salem. The Dent County Sheriff’s Office and the Dent County Fire Department also assisted the highway patrol.

The Salem Memorial District Hospital Board of Directors received their 2014 audit report from Eddie Marmouget from BKD Accounting Firm. Marmouget said it was clean audit, free from any material weaknesses and very few adjustments were needed. He credited hospital Chief Financial Officer Becky Cunningham for her outstanding work for the second straight year. Marmouget reported that cash was down for the year ended June 30^th, 2014 while accounts receivable were up leaving an increase in current assets, but he warned that with more and more people with higher deductibles on their insurance policies, the hospital needs to keep a wary eye to make sure the receivables don’t get out of hand. Marmouget said the days in accounts receivable on June 30^th was 51 which is better than the average for Rural Missouri Hospitals of 58 days, and close to the average for Critical Access Hospitals at 50. The Salem Hospital had cash on hand as of June 30^th at 67 days which is up from 62 days last year and even with the Critical Access Hospital Average, it was below the 104 days for hospitals in rural Missouri. Marmouget said the hospital has little long-term debt and their total debt to equity ratio was at 7.7%, down from the 10.2% they had last year and way below the average of most Critical Access Hospitals who stand at 36.7%. This basically reflects the hospital has continued to pay cash for their equipment improvements over the years. The age of the equipment at the Salem Hospital averages about 10.5 years and that is actually on par with most rural hospitals in Missouri that stands at 10.3 years. The statement of operations for 2014 shows a decrease in the net position of the hospital of $86,300, but Marmouget did remind the board they received almost $900,000 in 2013 in a reimbursement for the electronic medical conversion that helped provide for an increase in net position in 2013 of $57,608. However, the statement for cash flows showed the hospital actually had an increase in cash for the year of $176,414. Marmouget said the hospital net operating margin was -3.3% while the rural Missouri average is 0.4%. He said the Salem Hospital’s main income generator is Medicare which makes up 81% of their income while the average for Critical Access Hospitals is 67%, so the 2% reduction with Sequestration making reimbursement 99% has hurt the Salem Hospital as that amount doesn’t even cover the cost of service. Marmouget indicated that the Salem Hospital continues to be a bargain for hospital services as their average gross price per adjusted discharge comes in at around $8,000 while the Rural Missouri Hospital average is close to $23,000. He said operating expenses per adjusted discharge also is outstanding coming in at around $4,000 while the Rural Missouri Hospital average is close to $8,000. He did say the hospital should review their collection history and self pay reserves due to the higher deductibles, and to prepare for reductions in payments for the rural health clinics, swing bed reimbursements and the 340B drug program. He also said that there would be FRA program cuts in 2014 due to Missouri not participating in the Medicaid Expansion. Marmouget warned the board that the federal government is trying to find savings in many areas due to the anticipated jump in Medicare distributions due to the Baby Boomer wave, and may actually change reimbursements to cover the cost of episodic care rather than individual care. In wrapping up his assessment, the Salem Memorial District Hospital had a strong audit and continues to provide a quality health care service at a very affordable price.

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