SOAP LAKE — Close attention to detail, right down to the smallest purchases, and looking for ways to attract more patients is helping McKay Healthcare & Rehab reduce the amount of money it owes Grant County. Those are among the keys to success in cutting McKay's dependence on interest-bearing warrants, according to administrators.

The facility is still using warrants, where the money junior taxing districts need to pay bills is loaned to them by the county they’re in, Grant County in this case. Junior taxing districts use warrants when they don’t have enough cash on hand to meet obligations.

In March 2016 McKay owed Grant County about $1.3 million, said Grant County Treasurer Darryl Pheasant. But “they’ve been making improvements,” Pheasant said, and as of January 31 the facility’s outstanding balance was about $600,000.

McKay has been generating enough money to cover its warrants since October, he said. “We’re happy with the progress they have made.”

“We just watch everything,” said Mary Nickel, McKay’s administrator-in-training. All expenditures, right down to a bottle of over-the-counter medicine, must be reviewed and approved, she added.

McKay administrators work to generate business, she said, and one way to do that is to answer queries from other facilities that want to refer patients to McKay. It’s her goal to ensure those questions are answered within the day, she said.

McKay was a hospital but has been converted into an extended care and rehabilitation facility. Like many other rural facilities nationwide, it’s in a challenging position. About 70 percent of its patients depend on Medicaid as an insurance plan, Nickel said. Typically Medicaid reimbursement is below the cost of providing care.

One of the keys to overcoming low reimbursement rates, Nickel said, is to use space more efficiently. Currently McKay has room for 42 people, she said, and it’s important to be using as much of that space as possible.

Building the rehabilitation part of the business will be important in the future, Nickel said.

A self-described Soap Lake girl, Nickel said McKay was part of her childhood and teen years. “I grew up right across the street,” and volunteered at McKay after school. But Nickel and her husband are graduates of Soap Lake High School, and so are their two daughters.

She is a graduate of Washington State University, and worked for six years in Quincy. She worked four years as a social worker, she said, and two years as a case manager for state agencies. Her supervisor noticed her enthusiasm for nursing home work, and encouraged her to pursue administrative certification.

“We are needed. This place is needed.” McKay still must use warrants, she said, but her goal is operate without them. “Eventually that day will come.”