CAH CFO-Administrator Forum: CARES Funds and Audits - CAH CFO-Administrator Forum

CAH CFO-Administrator Forum: CARES Funds and Audits

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On December 4th, 2020, EqualizeRCM sponsored a forum for CFOs and CEOs of Critical Access Hospitals, where participants compared notes and shared best practices regarding CARES Funds and Audits with the invited expert, Rick Reid of The Rybar Group.

Here are the highlights of the discussion:
  • CAHs currently have plenty of money: “We have more money than I’ve ever seen in my career working as a CFO for CAHs.(David Usher, CFO of Edwards County Medical Center)
  • The guideline changes are causing hesitancy to spend Provider Relief Fund (PRF) money: “One frustration is that the guidelines have changed multiple times and healthcare entities have made decisions based on prior guidance.(Dennis Boyd, the CFO of Cohesive Healthcare Management). It’s even more frustrating, as the consultants/accountants have lots of varying advice on funds. Everyone is looking for answers and what others are doing.
  • Tracking loss of revenue is too difficult; some CPA firms have offered and then given up on their tracking software; logistics of tracking time (e.g., for incident command) is proving too much for the CAH teams in many cases.
  • While COVID started earlier in the year, the biggest impact is now: “COVID is impacting harder now than at any time before.(Greg Porter, Rio Grande Hospital). It impacts patient load, staffing, and other resources. CAHs finally started seeing overflow patients from larger PPS hospitals.
  • Use it or lose it: “We are increasingly willing to spend the PRF money – it’s certain that you will have to return it if you haven’t spent it, and there are a lot of justifiable needs.
  • All administrators are working closely with the clinical personnel to ensure that the spendings are justified and well documents. Rick recommended to look at state $ criteria which might be useful guidance; e.g., was the capital expenditure already planned pre-COVID vs. that’s not the way capital expenditures work in practice where we have a wish list of $2M but only $500k to spend. But the main the criteria to use is whether the funds are used to:
    • Prevent
    • Prepare for
    • Respond to coronavirus.
  • Hazard pay/bonus: Have been common concerns and practice for many, and again, is justified by a reasonable basis. Most take position that in a CAH, unlike large multi-building facilities, all jobs come into contact with COVID risk – “I, the CFO, sit next door to the CT.” Here are a few examples:
    • We pay hazard bonus for all, because a) all are at risk, and b) to retain staff.
    • We are looking to use PRF funds to pay for extra nursing shift bonuses.
    • We paid $5/hour across the board for a 12-week period.
  • There are still no guidelines or timelines on audits. As an example, FEMA still auditing Katrina (2005).

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The CAH CFO-Administrator Forum, sponsored by EqualizeRCM, seeks to provide Financial Administrators of rural health facilities an opportunity to participate in focused events, share insightful ideas, discuss challenges and solutions, but most importantly collaborate and communicate with like-minded professionals in the industry. The Forum is designed to provide support that many leaders in rural hospitals do not have. We are excited for you to be a part of this valuable experience.