Exclusive: CRMC immediate future in Council’s hands

By Michelle Price
Special to the UCBJ

Cookeville City Council to consider CRMC budget in Thursday’s meeting

COOKEVILLE – The current services of Cookeville Regional Medical Center (CRMC) are on the line this week as the Cookeville City Council considers the hospital’s fiscal year 2022 budget.

Councilmen Mark Miller, Eric Walker and Chuck Womack have each expressed concerns about the proposed budget in recent meetings. Miller and Womack have indicated they would consider voting against the budget as presented unless certain changes were made.

Thursday’s council meeting will feature a public hearing and the first reading of the proposed 2022 budget. If the budget fails to receive at least three votes in favor of its passage, CRMC will be forced to revert back to operating on the previous year’s budget. That would leave an approximate $13 million shortfall in expected expenses due to additions and improvements the medical center has enacted in the past year.

So, what gives if the CRMC budget is not passed?

While there has been no public statement from CRMC officials regarding what cuts would have to be made, certain jobs and services would most definitely be affected. In recent months, CRMC has purchased Upper Cumberland Urology Associates and the outstanding 50% share of the Upper Cumberland Physician’s Surgery Center to prevent the loss of these services to the community. Other improvements have been made to continue expanding services and offering a high quality of care, many of which were not included in the 2021 budget and, therefore, would technically not be funded in 2022 without a new budget.

“During the last 18 months, we’ve made some investments in the vascular lab; we’re redoing the cath lab; we brought on board a cardiologist who specializes in imaging; we’ve got structural heart physicians now; a new vascular surgeon,” said CRMC Board of Trustees Chairman Allen Ray. “These surgeons and doctors are doing procedures in Cookeville now. That will keep people from having to go to Nashville or Knoxville or somewhere else to have those procedures. We hope we’re saving time. We know we’re saving lives by doing that.”

In fiscal year 2021, CRMC moved forward with plans to become only the second Robotic Center of Excellence in Tennessee. The new da Vinci Xi robotic system has allowed surgeons to perform minimally invasive surgeries that before were open surgeries. This has decreased the pain patients feel and the subsequent use of opioids in addition to speeding recovery. Other benefits include the reduction of blood transfusions, complications, ICU admissions, complications, readmissions and a shortened length of stay.

Operating revenue for the Upper Cumberland Physician’s Surgery Center and its 28.5 FTE jobs wasn’t included in last year’s 2021 budget. Neither was the second da Vinci Xi robot to complete the Robotic Center of Excellence. 

“This budget contains dollars that will continue to provide comprehensive health care to our community, continue to employ our almost 2,450 employees and continue to expand and grow our medical center,” offered CRMC CEO Paul Korth during the City Council work session on June 1. “We’re adding approximately 100 new jobs and adding 10 new physicians to the medical center in our FY’22 budget.”

Salaries and wages combined with employee benefits total $146,915,316 – about 45% of the hospital’s total operating expenses. The average salary at CRMC is about $45,000 with nurses getting close to $50,000 a year. Salaries for medical professionals are very competitive due to the shortage the nation is currently experiencing. 

To ensure that CRMC salaries are competitive with other hospitals its size, the hospital uses an independent third-party company to provide salary surveys using outside market data in order to create a formula for each position. This formulaic method creates ranges based on level of experience, the region, size of the facility, service lines offered and more. The surveys are updated every year. CRMC’s system has been in place for years and uses the same processes as other hospitals and health systems across the state and region.

But staffing is just one part of the budget.

“It is a very complex budget,” said Korth. “Our operating budget this year is budgeted for $345,900,000 in revenue. Our expenses are just a bit over $321 million. Our net income is about $7 million. Our total capital expenditures are $12,700,000 and our expansion budget is $10,500,000. All capital projects and expansion projects will be done out of cash reserves, so there is no borrowing needed.” 

New physicians, new procedures

In order to remain competitive, CRMC is constantly evaluating service lines and looking for areas to improve. Often times, that requires finding new talent to fill certain roles or to bring new services to the community. Here’s a sampling of what has most recently changed at CRMC.

For those who need a correction to a prior spinal fusion or have put it off, there is a new option available at Cookeville Regional Medical Center. Neurosurgeon Dr. Walter Jermakowicz offers a relatively new procedure called XLIF – eXtreme Lateral Interbody Fusion. He’s completed this procedure on six patients since he joined the team at Tier 1 Orthopedic and Neurosurgical group last August, with all experiencing great outcomes.

Dr. Jermakowicz is only one of the new physicians that CRMC has hired since the last budget was approved. 

Interventional Pain Management specialist Dr. David Burstedt, PT, joined the practice of Tier 1 Orthopedics in September. He is trained in both basic and advanced image-guided interventional procedures for acute and chronic spine and joint pain. 

In May, Dr. Michael Pahl joined the team at Tier 1 offering orthopedic surgery and sports medicine. Pahl and his family come from southern California where he has practiced the last decade. 

Dr. Evan Sanford joined the medical staff at Cookeville Regional Medical Center in August specializing in Otolaryngology – Head and Neck surgery. He joins the practice of Upper Cumberland Ear, Nose and Throat located at 100 West 4th.

In September, CRMC and Tennessee Heart added interventional cardiologist Carlos Podesta, M.D., to their medical team, bringing the number of cardiologists on staff to 13.  Cardiologist Tim Fournet also returned to Tennessee Heart where he is seeing patients in the office setting only.

The Cancer Center in September added Deborah Jiang, MD, MS, to its medical staff as a radiation oncologist, and in December, Sheila Shope, NP, a full-time quality improvement (QI) coordinator joined the team. 

CRMC even added a neurohospitalist, Gustavo Silva, M.D., to its medical staff. The role of a neurohospitalist is to work in the hospital and focus on inpatient neurological disease. 

Rajiv Sinanan, MD, a specialist in nephrology, joined the staff at Cookeville Regional Medical Center and the office of Cumberland Kidney Specialists with fellow nephrologists Dr. Anju Mendiratta and Dr. Virin Ramoutar at 221 North Oak Avenue. Dr. Sinanan has a special interest in polycystic kidney disease and glomerular diseases.

And finally, in January, CRMC was able to find the perfect fit in Urologist Rick Smith, MD, to work with fellow urologist Dr. Lee Moore at CRMG Upper Cumberland Urology Associates located at 320 North Oak. 

The Cookeville City Council meets Thursday, June 10, at 5:00 p.m. in the City Hall building. The meeting is open to the public.

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