The Scotland County Hospital Board of Directors met in regular session on Thursday, January 25, 2018.  Those present: Curtis Ebeling,-Chairman (Arriving at 6:00 pm), Joe Doubet-Vice Chairman, Judy Wilson-Secretary, Robert Neese- Treasurer, Members: Dwight DeRosear, Lori Fulk (Arriving 5:40 pm).

Vice Chairman Doubet called the meeting to order at 5:30 pm, in the absence of Ebeling.   Approval of Agenda – Open Session was approved by majority vote.  Approval of Agenda-Executive Session was approved by majority vote.

The Board heard a presentation by a representative of HST Inc regarding implementation of a novel strategy of reference based pricing to significantly reduce cost of off-site healthcare received by the SCH-insured employees. Reference Based Pricing is a reimbursement that uses Medicare and Cost information to determine the prevailing price for medical services, designed to negotiate best pricing available for employees when needing to seek medical treatment in other facilities.  Board voted unanimously to proceed with contracting for this service.

BKD (SCH auditors) gave a presentation regarding the current landscape of consolidation in healthcare. BKD officials reported there are stark challenges to facilities like SCH due to dramatic decreases in government and private reimbursement at a time of increasing costs due  to regulations, healthcare labor and provider market and overall total transformation of the healthcare system.  The presenters went over several strategies for SCH to sustainably fulfill its missions while continuing all services and maintaining financial stability.  BKD officials recommended starting with internal strategic readiness analysis before considering the time lines and types of potential partners.  Board consented to evaluate a proposal for consultation services.

Financial Update

December’s Gross Patient Revenue was $3,744,000; Net Patient Revenue was $1,851,212.90.  Net Patient Revenue Per Day was $52,895. Contractual and SCH discounts to the gross revenue, year to date is 52.74%.

December’s Expenses: $1,991,140

Expenses per day: $59,055

Net loss December 31, 2017 – ($162,765)

Net Profit/loss before Depreciation, December 31, 2017-$(32,595)

Year to Date net loss of $1,099,458.57

Finance Committee meeting planned for 02/01/2018 with finalize plan at the February board meeting.

Lisa Rollison, DO, FACOS, Chief of Staff reported on the 1/22/18 Quarterly Medical Staff meeting with these highlights: The clinicians’ chart incompletion impact was discussed. It was debated whether to have by-law changes or administrative interventions to address the issue. Quality assurance through the Ongoing Professional Practice Evaluation process was discussed. Compliance education regarding collaborative practice compliance assurance was presented and there was an update on the Tiger Cub Care project (Daycare for employees’ children).

Randy Tobler, MD, FACOG, Chief Executive Officer gave an administrative report with these highlights – Operations: Senior Life Solutions geriatric group counseling service is on track for a March 2018 opening; Therapist, Program Director and Patient Coordinator have been hired.

Memphis Community Pharmacy held an informational meeting with clinical staff to update them on 340B operations.

Employee Survey responses were used to form committees to address employee comments/feedback and the employee retirement match eligibility to define threshold work hours was discussed at the Incentives Committee meeting.

In business office reports, the Chargemaster/Pricing review vendors have been contacted as well as business office processes being evaluated for maximum efficiency in coding and billing while syncing with the EMR regular updates that inevitability detect bugs.  The last EMR update bug led to delayed claims filing.

The Board Governance Self-Assessment ad hoc Committee met 1/18.  The committee learned about a new population health/CCM (Chronic Care Management) vendor identified and initial presentation attended on 1/10.  The new vendor emphasizes Annual Wellness Visits (essentially a thorough risk assessment encouraged for all Medicare enrollees). Master agreement through HPC (Heartland Physician’s Corporation) pending, then we anticipate contracting for this health enhancing revenue positive service.

At the 1/15 Ambulance Board meeting, the ongoing deficits with the service were discussed.  A review of EMS coding and billing practices by the Hospital is in progress.

There was a presentation to SCCC Board at their regular January meeting regarding reconsideration of the decision to use another vendor for routine lab services.

Regarding Medical Staff/Allied Health topics, Dr. Tobler reported that the medical staff have been notified of several episodes of patients discovering their high impact results on the portal before notification by ordering clinician.  Medical staff has been informed of  federally mandated  quarantine intervals from time of result to portal posting in order to speak with patient before results are posted on portal.

Dr. Krishnasamy’s first day of cataract surgery went well and Dr. Eldon Frazier, Family Practice Physician at MMS was a recent guest on Healthy U Radio Show.

In Personnel, it was reported that a new staffing model has been implemented in Housekeeping and utilization of the “Critical Shortage” policy for clinic staffing is low.

In Regulatory topics & trends, there’s a new impact of elimination of individual mandate which may mean more uninsured patients.  This would likely increase our bad debt and at a minimum increase contractual as these patients take advantage of the pre-/prompt-pay self-pay discounts.  Positively balancing this is higher employment and wages with the economic upswing.  Dr. Tobler reported on the Governor’s budget proposal with these highlights- Modest growth in revised FY18 revenue growth (to 1.9%) and for FY19 (2.5%), significant cuts in Medicaid spending though as yet undefined “efficiencies”. Funding for opioid abuse programs and major cuts to higher education may not prevail in the legislature and force reductions elsewhere.

Jeff Davis, DO, Chief Medical Officer, was absent but prepared a written report which outlined the past month’s activities as CMO; including QA/Safety, Senior Management, Clinic Relations, Service Line Development and Recruitment.

In old Business, it was announced that Mr. DeRosear was the only candidate to file. No election will be necessary for the district during the April 2018 election.  Strategic Planning Committee will have a report in February and other than awaiting receipt of mutual aid agreements from participating hospitals, the Emergency Action Plan is complete.  Plan approved by majority vote.

In new business, Dr. Tobler requested the March Meeting be rescheduled to March 29. General consensus was in approval.  Dr. Tobler asked that the board approve the Governance Self-Assessment Committee Report after the review of the minutes & report of that meeting. Areas for improvement were discussed.  The board will re-assess next January.  Majority vote in favor.

Regarding Senior Life Solution, the board discussed van specifications & purchase.  The van will be used to support patient care in the  SLS intensive outpatient geriatric psychiatric program program.   The board approved criteria for search, mileage & price limitations.

Executive Session

In closed session, the following items were discussed:

Approval of Executive Session minutes of 12/28/17

Personnel

Prescription criteria under collaborating agreements reviewed.

Discipline and remediation.

Legal

Review of conversation with legal counsel on personnel issues.

Discussed with counsel issues of compliance/assurance.

Discussed timetable/lengthy process of MHRC complaint filed by former employee. No update available at this time.

Meeting adjourned at 10:35 p.m.