For the last eight weeks we have been working diligently to get everything ready for this conversion. Most of this work is done "behind the scenes," as a majority of what is changing has to do with licensing, billing, and documentation. Last week the conversion team from Alabama arrived to train our staff in their respective departments. They were surprised with how versatile our staff is, making multiple comments about all the "hats" our staff wear. We truly do have the best here at BSMC. As of October 1st, we officially became a 25-bed Critical Access Hospital (CAH)!

We have decertified our Long-Term Care and are now solely licensed as a CAH. We will still be able to accept long-term-care residents, and those that are with us now will continue to call BSMC home. The care they receive will not change. The thing that is changing is the licensing in which they receive care. The care received in the ER, Hospital, and Clinic will remain the same. Most of the changes you and our residents will notice come from government guidelines. Converting our LTC (Long Term Care) beds to CAH beds maximizes the costs we report at the end of the fiscal year, which essentially translates to higher reimbursement. According to Leah Griffith, CEO, making this change is part of the facility's strategic plan for the future. "Costs are increasing while reimbursement decreases. Hundreds of CAH's have closed across the country because they can no longer maintain operations under the current and ever-changing conditions and regulations. Our facility faces the added burden of a decreasing census and an aged building in need of repairs and upgrades. We also need to stay competitive with wages while remaining cost-effective for our patients. The BSMC Board of Directors expects to face some tough decisions in the near future and are starting to explore all options to hopefully ensure BSMC remains financially and operationally viable."

The Administration and Board have reached out to Senator Tester's office and two of his staff members with an extensive knowledge base and experience with CAH concerns will be attending the monthly board meeting on October 16th. This will be an opportunity to discuss the facility's concerns as a whole with these two women and establish if they can assist BSMC with our strategic plan for the future. Monthly Board meetings are open to the public, so all community members are welcome. The Board is also currently discussing opportunities for financial assistance with the local county hospital tax district for aid and operation of BSMC. Those discussions have just begun so there will be more updates to come.

Under the new licensing, CMS (Center for Medicare and Medicaid Services) requires that we meet specific standards to receive reimbursement for the care we provide. The alternative would be even lower reimbursements in the form of a percent

decrease across the board. In a nutshell, that means we have to use more technology facility-wide in order to get paid by Medicare. Some of that technology benefits you, like being able to pay your bills and view portions of your medical record online. Other things benefit our staff, like not having to attempt to read each other's handwriting and being able to better track our supplies, which, in turn, increase patient safety and help control costs.

We have purchased a brand-new Electronic Health Record (EHR), called Thrive, from the company Evident. Several Montana CAH's joined together to receive discounted pricing on the software along with a financing arrangement, which saved us from paying for the entire system outright. The system we were using in the hospital and clinic is no longer supported, so this purchase was necessary to continue meeting federal standards. Being that this is an entirely new system, we will have to recreate your patient record in the system. We are asking that you arrive early and bring your Driver's License and insurance cards to your scheduled clinic visits so that all your information is entered correctly. Also, you should bring a current medication list with you to all visits. Please be patient with us as we work to get things "back to normal" in our facility.

You will be able to set up your Patient Portal account at any time. This portal gives you access to your medical record from home. Many of our patients see providers from different offices across the state, for example, your provider here at BSMC, cardiologist, gynecologist and orthopedic doctor. Having that access allows you to view your most recent labs from BSMC when you are at your cardiologist appointment. Parents, you are also able to set up accounts to view your child's records; or, if your parents are elderly, with permission you as their child can view their Patient Portal as well. As stated before, another great feature of the Patient Portal will be the ability to pay your bill online! If you are interested in setting up your Patient Portal, please come into the facility or ask us during your next appointment and we will assist you.

As we delightedly watch the leaves change, we know that change can be beautiful. There is certainly a lot of change happening here at BSMC! We appreciate your patience and continued support. As always, thank you for being the heart of BSMC.