A year after the county Hospital Authority Board began overseeing Glen Rose Medical Center’s operations, two things are missing — the flood of losses that threatened the hospital’s future and much of the uncertainty about its direction.

GRMC still faces some big challenges, but the center’s management, the board and the County Commissioners Court have attacked some of the obstacles that looked daunting a year ago.

In that time, the seven-member board appointed by the court ordered a financial audit to validate the medical center’s balance sheet and an operational audit by Community Hospital Consultants that reported positively on GRMC’s business operations, but identified some limitations with insurance rates. The board also held two town hall meetings to hear citizens’ concerns and answer questions.

“The direction they took was so important for this organization and the community,” Gary Marks, GRMC’s chief executive officer, said. “We’re just very pleased with the action the board members took to establish the foundation of operations. Now we can start focusing on a strategic direction to keep growing this operation and expanding our ability to serve the community.”

The Reporter sat down with Marks, GRMC Chief Financial Officer Ray Reynolds and Hospital Authority Board Chairman Larry Shaw to assess the past year during which the county financed the medical center and the board got up to speed on the complicated business of health care and the issues facing a small, rural hospital and nursing home.

The biggest challenge continues to be the hospital’s heavy load of patients who can’t pay their bills or rely on charity care, as well as the high level of patients on Medicare — about 64 percent, or almost two-thirds — which reimburses below the hospital’s actual costs. The combination continues to hammer the medical center’s bottom line.

“We’re in the black — barely,” Reynolds said.

“Uncompensated care is the telling story of our financial condition,” Shaw added. “There are a significant number of people in this community that can’t pay. Were it not for that issue, we’d be in the black” consistently.

GRMC estimated it provides an average $2.5 million per year in uncompensated care. In 2010 the level rose to $3.05 million.

Moreover, the medical center still faces aggressive competition from Lake Granbury Medical Center, which moved into the Glen Rose market in recent years with a primary care physician — Dr. Aimee Coker — prominent billboards, advertising and a new clinic to be located in the former video store space in the shopping center next to Brookshire’s. The more market share that GRMC loses, the more county funding will be required, the hospital board has said.

GRMC has responded to the competitive pressure and growing community by updating its medical technology, adding digital mammography, a CT scan and attracting more specialists to devote a day or more to seeing patients in Glen Rose instead of them having to drive to Fort Worth or Dallas.

Last year the medical center added a surgeon, Dr. Stephen Erck, to its medical staff. It also unveiled a modern new lobby and emergency room and renovated its rehabilitation center.

The hospital’s affiliation with the Baylor Health Care System will be noted on a new sign soon to be placed out front that identifies GRMC as associated with Baylor Signature Care, which refers to the specialists that GRMC has lined up to provide services.

“We think that’s high added value to this community,” Marks said.

Currently, about six to eight specialists work part-time in Glen Rose and Marks said he expected that number to grow. The medical center is looking to attract a pulmonologist and an oncologist. It’s been able to draw a top orthopedic spine surgeon from the Metroplex, Dr. Mark Kuper.

Looking ahead, the key factor that will determine whether a hospital succeeds in the future will be quality, Marks and Shaw said. While that’s often taken for granted, GRMC measures for it, asking itself whether there are incidents that can be avoided — such as infections patients acquire in hospitals or medication errors.

“After getting through this first year and addressing concerns in the community, quality now has been our focus,” Marks said. “This community has a lot of dedicated employees in this organization The true strength of this operation is the employees and staff here.”

Two issues in the upcoming Texas legislative session stand to affect GRMC — reimbursement for nursing home patients on Medicaid and congressional redistricting, the redrawing of lines for U.S. House of Representatives districts to account for population shifts. Texas ranks 49th out of 50 states in the U.S. for long-term care reimbursement.

This year the medical center also will undertake a massive change as part of the federal government mandate that all hospital records be computerized. The start date for the hospital’s conversion to paperless records is April 1.

Patients can expect to see the registration process more automated, Reynolds said, and will sign documents electronically. They also should see improvements in the billing process, he added.

All the efforts undertaken in the past year should pay off in more people using GRMC instead of traveling to Fort Worth or Dallas for care. That is the key to the hospital’s survival, Marks said.

“We have to grow our volume in the community,” he concluded. “That’s one of our most important strategic goals for this year. Local support for this hospital is the only way to maintain continued viability for local medical care.”