After six years of deficits, the Linton Hospital is back in the black, having booked its second straight positive year, and the good news means more improvements can be made, such as the possible addition of a kidney (renal) dialysis unit.

The institution’s biggest loss was $551,042 in Fiscal Year 2003 (April 1, 2002, through March 31, 2003), and it had positive numbers of $116,694 for FY 2007 and $136,759 for FY 2008.

Hospital Administrator Roger Unger said these gains represent less than a two percent operating margin, noting that not many businesses can operate on a margin that low.

“The gains the past two years represent the operating margin before ‘Medicare Adjustments,’” Unger said. “Medicare has required payments ranging from $35,000 to $250,000 per year during the past six fiscal years due to what they calculate as ‘over payments’ for services provided.”

Even with a “positive” bottom line, it is not possible to keep up with building repairs and replacement of equipment, he explained.

“Without the support of the Hospital Foundation and the Hospital District tax, there would be no improvements made,” Unger said.

Unger said the turn around involved multiple changes in the operation—conversion to a Critical Access Hospital for government reimbursement purposes, changes in services offered, reducing employee numbers by about 10 part-time and full-time positions (103 to 93) and reorganizing the hospital and clinics to be more efficient.

“What this means is that the hospital is more stable financially, and our employees have received raises and have somewhat more job security,” Unger said. “By improving the financial situation, we have 93 better-paying jobs instead of risking the loss of the hospital and all of the jobs.”

The hospital has an annual budget of about $4.5 million, and $2 million of that is the payroll.

The Linton Hospital is one of a handful that is operating in the black, and several others around the state are at risk of closing.

“Our challenge is to pay off our debt and to figure out how to deal with potential federal budget cuts,” Unger said. “There is talk that Medicare reimbursements could be cut, along with state payments through Medicaid. That could mean the loss of over $60,000 in income that would have to be made up somehow.”

Unger said government reimbursement for medical services provided to Medicare and Medicaid patients continues to be the Number One challenge for all rural hospitals and clinics. He noted that Medicare pays only 70 percent of a covered patient’s bill while Medicaid pays only about 55 percent. The majority of the people served by the hospital and clinics are senior citizens (Medicare is available at age 65) and a minority of patients are on Medicaid (primarily those under 65 receiving government assistance). However, private insurance companies, such as Blue Cross/Blue Shield, also pay only 70-90 percent of an insured’s bill.

Unger explained that the hospital has high operating costs because it has to be open and staffed 24 hours a day, seven days a week whether or not there are patients.

“If a hospital operated only when it had beds filled, it would be a different story, but we obviously cannot do that,” Unger said. “We’re here for people whenever they need us. That’s our mission as a hospital.”

The hospital is non-profit, so any income over expenses goes into a reserve fund, when possible, to prepare for future expenses. For up to the next 15 years, income will be needed to pay off debt.

Future plans

Unger said one of the priorities in recent years has been to have a kidney dialysis unit as part of the hospital in conjunction with one of the Bismarck hospitals.

“At first, the larger hospitals were not interested in have satellite dialysis units, but that has changed in recent months,” Unger said. “We are now negotiating for a satellite unit and are hopeful that something can be worked out in the next few months.”

Currently, the only dialysis available in the region is in Bismarck, with the next closest to Emmons County being Jamestown.

“It is a hardship for people to have to drive that far three to five times a week, and now the cost of gas has made it an even greater burden,” Unger said. “We would very much like to be able to offer this service.”There are currently at least a dozen people in the area who would be closer to Linton than to the other sites.

A location in the hospital complex will need to be found, and Unger said there are several options, including space in the Prairie Rose Apartments.

Other plans being discussed include:

•Moving the CT scanner from a semi-trailer next to the hospital into the former ambulance garage. The door to the former garage is across the hallway from the X-Ray Department. The area is currently being used for storage.

•Converting from film X-Rays to digital imaging. Digital X-Rays can be e-mailed to radiologists instantly while film has to be mailed, which requires a two- to three-day round trip between Linton and Bismarck. Digital images are stored on computer disks, so very little space is needed to house the disks while many file cabinets and shelves are required for film. Film also has to be developed with chemicals, while digital images are available instantly on monitors.

•Finding a new site for the Campbell County Clinic in Pollock. Unger is working with Pollock officials to figure out how to replace the building which was formerly the Masonic Temple in Old Pollock and was moved to the new town site in 1956. Other sites are being discussed.

•As funds become available, there is a long list of projects, some big and some small, to improve the facilities and to better serve patients, according to Unger.