HERMANN – When the final bill for the latest audit of Hermann Area District Hospital arrived, it was like adding insult to injury.

Not only was the audit of 2023 — presented several weeks ago to the hospital board by auditing firm Wipfli — yet another skeptical assessment of the healthcare facility’s ability to continue functioning, but the bill for coming to that opinion was higher than initially agreed upon — and caught HADH administrators by surprise.

Originally set to cost $9,500, the audit’s final price tag was $11,250, said Administrator Bill Hellebusch during Monday night’s regular monthly session of the hospital’s Board of Directors. The audit – the seventh review of the hospital by the accounting firm — was begun with the understanding that the hospital would be notified if any extra work was needed that might increase the cost. “That did not happen,” Hellebusch said. “I was never made aware of extraneous things that came up” during the review, he added.

He described a telephone call with a Wipfli official about the larger-than-agreed-upon cost. “That call did not go the way I had hoped it would,” Hellebusch said.

The price tag of the audit only made the annual review more frustrating for the hospital administrator. Indeed, Wipfli’s auditor recognized the progress made in shoring up the hospital’s financial footing during Hellebusch’s brief tenure as administrator and noted actions that could be taken to further improve financial conditions, but the conclusion reached in the company’s report to the board remained the same as in the previous half-dozen audits: There is a “growing concern” by the auditors that the hospital would be in business in a year’s time.

“I had concerns with how that entire audit was run,” Hellebusch told the board, noting that the accountant checking the hospital’s records was on site for only a day and a half.

The bottom line for the administrator is that a different auditing firm is needed – more to see where the hospital is going rather than where it’s been, financially speaking. “I think it’s time anyway,” he added, noting that most businesses don’t stay with the same auditing firm for so many years. “I think it’s time for a change,” he said.

“I feel like this relationship is fractured,” Hellebusch added.

“When do we need a new auditor?” asked Director Trigg Render.

“I needed to work on that yesterday,” Hellebusch replied, referring to the need to get a new firm acquainted with the hospital as it reaches the calendar’s midpoint. Also, the administrator wants a new firm to perform a mid-year financial assessment — something short of a full-blown audit — to possibly suggest moves headed into the second half of the year.

Meanwhile, the administrator said May figures show the month to be the latest in a string of successful months at the hospital. “We had a decent patient volume month,” he said, noting that swing-bed patients continue to be the strongest part of the facility’s operations, up over 82 percent from the level a year ago.

Swing-bed patients are those patients who do not need additional acute care but might not be ready to return home, such as being in need of therapy treatment to function properly after returning home. Indeed, HADH is building a solid reputation in the region as a therapy center – one of the reasons for the increase in swing-bed referrals from Mercy and other hospitals in the region. Hellebusch said he is continuing to meet with other hospitals to increase referrals to HADH.

Director Dave Johnson asked what might be reason for a lack of referrals from other hospitals in the region.

Hellebusch said it might be a matter of not getting the word out, pointing to the first referral from Capital Region Hospital in Jefferson City. “We never saw any swing-bed referrals” from Capital Region prior to this one, he said. “They didn’t know we were here,” Hellebusch added to illustrate the need to promote HADH to other hospitals.

“We’ve been to UM (University of Missouri Medical Center) several times now,” he said. “We’ve been to Cap Region.”

Johnson said the experience of those patients referred to HADH could be used to help promote the hospital. “I believe we’ve gotten some good feedback from the patients,” Johnson said.

Dr. Michael Rothermich offered a more practical reason why swing-bed numbers haven’t been higher up to this point. He said there was a concern that an adequate number of staff be in place to accommodate an increase in swing-bed patients, pointing out that it would not be good to attract additional patients and force them to wait for treatment because of a lack of staff.

Therapy services are being bolstered to accommodate more patients, but more staffing is needed. Hellebusch said the Rehabilitation Department has openings for a physical therapist and a physical therapist assistant. Those are positions that are difficult to fill at this point, he said. “It is is a hard job market right now,” he said.