State of the District Year End 2018

What you need to know in brief…

  • 2018 ended with earnings of $1.2M (likely an all-time high)
  • Debt remains at levels double similar facilities which will need to be addressed
  • Rural hospitals/clinics continue to struggle across the Nation
  • Dr. Sam Artzis and Dr. Kal Kelley have joined the District
  • Dr. Garcia is offering ultrasound guided injections for treatment of pain
  • Dr. Kelley will resume colonoscopies and EGD’s in April here in the District
  • Bill Hartman PA-C from Providence Orthopedics is now seeing patients here in the District
  • We are now offering tele-Endocrinology through Grand Coulee Medical

Want to know more?  Please read the full update from our CEO, Aaron Edwards, MHPA…

Greetings from your healthcare team at Ferry County Health!  We hope your 2019 is off to a good start.  Here follows a brief on the “state of the District” and some items we think you might like to know about.

Let’s start with some numbers, 2018 was a pretty good year for the District.  We finished the year with earnings of roughly $1.2M (M = million) and an operating margin of 6.6%.  This is likely an all-time historical high for the District.  We were stronger than the following benchmarks we monitor for facilities like ours; the west has been averaging a scary -3.99% and a razor thin 1.89% for the State (the nation has been trending at around 0.99%)*.  However, nationwide the normal for the healthcare industry as a whole was pushing 13% while companies in the S&P 500 averaged around 10%**.  This demonstrates how fragile rural healthcare facilities are in comparison to industry as a whole (more on that later).  Keep in mind that while 2018 was a good year for us it isn’t even close to the normal for other businesses across the nation.  Why was our performance so much better than past years?

  • You are trusting us more and more by getting your healthcare locally here with us. We had increases in clinic, radiology, lab, physical therapy, occupational therapy, and hospital visits.  Most impactful to our bottom line, you chose to rehab with us after your surgeries and other major procedures done out of town (this is known as our swing bed program).  Thank you!
  • We clawed back $200K (K= thousand) in past overpayments of State Business and Occupation Taxes (we were able to go back 5 years).
  • We found areas where the State underpaid us with various incentive programs and collected on that.
  • Began participation in a Federal 340B program.
  • We worked hard at accurate billing to our various payers (Medicare, Medicaid, Aetna, etc.) to ensure we get paid for the work we do (insurers are experts at denying payment and we’ve upped our game in preventing this – more work is needed in this area).
  • We had stable staffing in key areas such as our medical staff providers, nurses, physical therapists, and administration (instability = huge increase in costs and difficulties in continuity of care).

Though these are very positive things we still face significant head winds.  The University of North Carolina (UNC) carefully tracks rural hospitals financial performance and maintains a list of hospitals likely to close as well as those that have closed since 2010.  I am happy to say this year we were interviewed by UNC as we, at least for the present, have moved off their list of hospitals likely to close.  Over 98 rural hospitals have closed since 2010, 210 are currently listed as an “extreme risk” of closure and 673 are at “risk” of closure (which is 1 out of every 3 rural hospitals across the nation)***.  While we are thrilled to be making progress away from danger we can’t rest.  We still have had volatile financial performance over the past 5 years and have an inappropriate amount of debt.  In fact we currently carry $5.2M (remember M = million) in debt and worked hard to bring debt down by roughly $300K last year (those of you quick with math will realize how long it will take to pay our debt off at that rate).  Over $1M of our debt is due a little less than a year from now.  We are working hard on a plan to meet that obligation.  Our debt as a percentage of capitalization is roughly 52% (roughly double what similar hospitals have in the west and in our State).  Beyond that we have a hospital facility that was built in 1973 which, while we work to keep up to date, will need significant remodel soon (to say nothing of coming equipment replacement needs).  This either means more debt or increased tax payer support from the community.  The District and community will need to grapple with this in the months and years to come no doubt.  There is just no way can we “earn” our way out of our debt load and keep up with increasing cost to deliver care, upgrade our facility and upgrade our equipment without community support. We welcome your feedback and questions on this subject.

Enough said on financial matters, let’s talk about what is new and coming soon to your Ferry County Health:



  • Starting early this year we began working with a tele-behavioral health vendor to help connect our community members with much needed counselling/psychiatric services across most of your insurance carriers.
  • Bill Hartman PA-C with Providence Orthopedics is now visiting the District once a month to help our patients with their orthopedic surgery needs.
  • We have started tele-Endocrinology visits with Dr. Hsu from Grand Coulee Medical.
  • In April we will welcome the endoscopy services of Dr. Kal Kelly (some of you might recognize him from the Kettle Falls/Colville area). We look forward to again offering screening colonoscopies and EGD’s.
  • Dr. Richard Garcia has been offering joint injections for the treatment of pain. Many of you are taking advantage of this new service offering.
  • We welcomed Dr. Samuel Artzis to our ED and hospital provider team and will soon have Dr. Kelley joining as well.
  • The District has replaced its ultrasound machine with a new state of the art machine (significant improvement for Echocardiogram’s, etc.).

This is just a few of the new things we offer across Ferry County Health.  Please see the clinic if you are interested in these new services.

As always, we appreciate your support by trusting us with your care!


Aaron C. Edwards, MHPA

Superintendent and CEO, Ferry County Health


*National Rural Health Resource Center

**National data from Standard and Poor’s

***National Rural Health Association 2016 Rural Relevance: Vulnerability to Value Study