The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, July 26, 2018. Present were Joe Doubet, Vice Chairman; Robert Neese, Treasurer; and members Dwight DeRosear and Lori Fulk. Others present were Dr. Randy Tobler; CEO, Dr. Jeff Davis, CMO, Dr. Lisa Rollison, COS, Michael Brandon, Controller, Elizabeth Guffey, RN, CNO, Angela Schmitter, RHIT, Stephanie Ketchum LPN, QI Data and Virtual Health Coordinator, Lori Nelson, RN, RHC Supervisor, and Brenda Prather, recording secretary.

In the absence of Chairman Ebeling, Vice Chairman Doubet called the meeting to order at 5:30 p.m. Approval of the Open Session Agenda was approved by majority vote. Approval of the Executive Session Agenda approved by majority vote. The consent agenda and approval of the June 28, 2018, minutes were approved by majority vote.

Michael Brandon, Controller, reported that the June financials will be deferred until the audit is complete.

Chief of Staff, Lisa Rollison, DO, presented a report from the Quarterly Medical Staff meeting that was held on July 23, 2018, with these highlights:

Suzie Lister provided an update to the medical staff regarding issues with financial navigation, billing and AVEC.

Dr. Rollison reported that the Medical Executive team works weekly with Medical Staff Coordinator, Kristin Hyde to maintain current credentialing/privilege documentation.

Dr. Rollison reported the Peer Review process is functioning well, while working out administrative procedures & routines.

The Team Care model used in Dr. Davis’ clinic is improving chart completion while clinic administration continues to address documentation compliance on an individual basis.

Dr. Rollison gave a report on the Tiger Cub Care (Employee Child Care Center). She reported the fundraising for the Center’s start up costs is at $10,000. Regarding the Center’s physical plant, she reported that the Division of Fire Safety rejected initial submitted plans for building alterations and requested plans drawn by a certified architect which was initially estimated at $10,000. Scotland County native, Casey Hull completed the job for less than $1,000 and the plans have been resubmitted and approval is awaited. The facility demolition and construction is delayed due to this. Additionally the Division of Fire Safety has specifications regarding a range and hood in the food service area. The current compromise for the facility is a residential hood with a modified menu which does not include fried foods. Under operations for the Tiger Cub Care, Kimberly Campbell has resigned from the Facility Director position. Kristal Phillips is considering accepting the interim and possibly permanent director position. Enrollment will begin when the fee/tuition structure and remodel completion date are finalized. The board discussed fee structure, hours of operation and delays of the project. Budgeting for an initial operational financial loss was acknowledged. Board members expressed unanimous ongoing support of the project and the importance of the child care center for present employees and future recruitment/retention.

Randy Tobler, MD, FACOG, Chief Executive Officer, gave an administrative report with these highlights:

Under operations, Dr. Tobler gave a population health update and reported that the hospital is continuing to develop Annual Wellness Visits (AWV), Gaps in Care Analysis (GICA) visits, and Chronic Care Management visits (proactive visits to patients with cardiovascular and diabetes diagnoses) and transferring existing CCM patients from Care Sync to High Performance Network, the partner in this project to help patients remain well, delay or avoid illnesses, and avoid unnecessary acute care for existing ones.

Tobler reported that SCH is negotiating a switch to a different lab vendor pending final contract negotiations, guaranteeing at least 7% savings.

Regarding the employee healthcare plan, the hospital has launched the preferred network of Blessing Hospital and MU Hospitals and their respective physician groups, with all other services except emergencies requiring referenced based pricing. Ongoing employee reminders are in process to minimize disruption.

Regarding the revenue cycle improvement project, Dr. Tobler reported that the AVEC partners continue to work claim denials aggressively, with a priority system emphasizing highest value and timely filing constraints. The hospital failed to meet one of the Electronic Medical Records Meaningful Use metrics required by Medicaid in 2017. This involved direct messaging of patients by clinicians through the patient portal. The auditors believe that this will result in penalties on payments for Medicare services and eligibility for future incentives. Dr. Tobler reported the reason the metric was not met was due to the untimely resignations of full-time Informatics staff monitoring the Meaningful Use metrics. Dr. Tobler reported he is working with Missouri Hospital Association and appealing to Centers for Medicare and Medicaid and Congressional delegates to reinstate future incentives.

In virtual health, the contract with MU Telehealth Network was approved by the board. The technology is in place for virtual visits starting with dermatology from MU in the near future. Additionally, a psychiatrist in Columbia is anxious to see virtual patients from the hospital. Dr. Tobler reported that there will be periodic video conferences through Mizzou’s telehealth initiatives to allow clinicians to schedule training/learning sessions on various health care topics such as dermatology and the opioid crisis.

Dr. Tobler reported that the BKD Strategic Affiliation Readiness Project is nearing completion for data collection. A stakeholder questionnaire for internal and external distribution along with live interviews with SCH Staff, administration and board are among the last information gathering steps.

He reported on commercial insurance contracting adding SCH’s requests for fair reimbursement have been uniformly disappointing. This is not unique amongst peer hospitals and Dr. Tobler is planning to work with the attorney to devise an aggressive communication strategy to get the insurance companies’ attention and at least engage in serious negotiations.

Dr. Tobler reported that Elizabeth Guffey, RN, CNO and Oncology Program Coordinator, was featured in the Missouri Hospital Association “Hospital Heroes” video, featuring outstanding staff across the state. He reported that Dr. Davis is expanding geriatric outreach at Clark & Knox County nursing homes. Scotland & Schuyler county nursing homes have exclusive attending physicians from SCH which marks a growth area for us in the market.

Dr. Schneider met with the inpatient care physicians to discuss expanded urology surgical procedures he will perform and the post op care needed overnight for those patients. SCH is working with Dr. Wolkowitz to train one of its nurse practitioners to become part of his SCH team and see patients for routine follow up appointments. This will open his visits at SCH for more new patients and complex established patient access and procedures.

A Southern Illinois University Family Medicine Resident made a site visit on July 23rd in hopes of being the anchor physician at the Lancaster Medical Services next summer.

Under personnel, Employee Experience and Patient Experience Committees have been formed and first meetings have been scheduled. Leadership training will be introduced at the Supervisors’ meetings with the first topic being Emotional Intelligence.

Dr. Jeff Davis gave the Chief Medical Officer report with highlights noting that the Senior Management Team continues to meet to discuss cost saving measures and strategies for improving hospital financial performance. Dr. Davis has met with Dr. Tobler to discuss clinician management, retention & recruiting. He has also met with clinics manager, Lori Nelson, RN, regarding clinics personnel/staffing and workflow.

Under clinician relations, Team Care, as a pilot project, is going well in Dr. Davis’ clinic and improves chart completion and clinician satisfaction.

The 340B pharmacy program formulary review is complete and he has been communicating with clinicians regarding medication selection.

Dr. Davis reported that Dr. Eldon Frazier, Family Practice, sees patients at Memphis Medical Services on Wednesdays and Fridays. Dr. Frazier continues to be the Medical Director and Collaborating Physician for Marilyn Day, FNP, at the Wyaconda Medical Services.

Currently, due to scheduling conflicts, the ophthalmology cataract surgery program has been suspended. The hospital is seeking a new physician.

Dr. Kahn provides neurology services including nerve conduction studies and now sees patients on Thursdays.

Dr. Dana Valencia has been added as a second cardiologist and does procedures in the Operation Room which increases the invasiveness of the cardiology program to keep many procedures local.

Under recruitment and retention, Kelsey (Davis) Humes, DO, is working in the Urgent Care and will join SCH full-time in August 2019, while Aurora Bell, DO, will also join SCH in August 2019 with primary location at Lancaster Medical Services. Dr. Bell will provide inpatient pediatric and newborn nursery coverage.

Under external activities, Dr. Davis attended the American Osteopathic Association annual House of Delegates meeting advocating for healthcare in rural communities.

In Old Business, Dr. Tobler reported that the old incinerator was removed and disposed of and repairs have been completed to the boiler room wall.

The budget that was approved in June was amended to reflect the total cost of the TEE upgrade ($21,000) (Transesophogel echocardiography) to the radiology budget. Approved by majority vote.

Also discussed was the necessity for replacement of the obstetrics (Women’s Center) security system due to its obsolescence by the end of December. Additionally, the med/surg telemetry system is imminently obsolete and a one year extension on service/parts has been identified. Replacement will be necessary by FY’20. This results in a net $43,000 savings for FY’19 budget.

In New Business, Dr. Tobler reported that the annual review of the SCH Hospital Wide Policy and Procedure Manuals/Plans was due. Signatures by the CEO and Board Chairman will complete the process. Approved by majority vote.

Dr. Tobler presented the current credentialed physicians with temporary privileges and reappointment status. Approved by majority.

He reported that the annual operating budget had been submitted to the Missouri Ethics Commission as required.

A change of date to the August meeting was approved by majority vote. The meeting will be on August 30th. This change of date along with the annual Tax Hearing notice will be published.

The Medical Staff Bylaws need to be amended in order to maintain compliance with EMTALA regulations requiring a formally designated QMP (Qualified Medical Person) who would be qualified to conduct or triage a Medical Screening Exam (MUSE) in the emergency department. No changes in current operations are needed; all current ED clinicians have the appropriate license under the new Medical Staff Rule. This action was carried out to amend the medical staff by-laws at the July 18 meeting. Approved by majority vote.

Executive Session:

Those present for closed session were DeRosear, Doubet, Neese, Fulk, Dr. Tobler, Dr. Rollison, Dr. Davis, Michael Brandon & Brenda Prather.

In closed session, the following items were discussed:

Legal actions and contracts in negotiation.

Michael Brandon exited.

Personnel was discussed.

Meeting adjourned at 8:15 pm.