The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, May 23, 2019.   Board Present: Curtis Ebeling-Chairman, Joe Doubet- Vice Chairman, Lori Fulk-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear and Joni Lloyd.

Also present: Dr. Randy Tobler; CEO, Dr. Lisa Rollison, COS, Michael Brandon, Controller, Elizabeth Guffey, RN, CON, Angela Schmitter, RHIT-Compliance, Lori Nelson, RN, RHC, Missy Smith, HR, Alisa Kigar, Marketing, Terri Schmitt, QI/Safety via conference call and Brenda Prather, recording secretary.

Guests: Lee Shultz

The meeting was called to order at 5:30 p.m. After approval of the Open Session Agenda, Executive Session Agenda, Chairman Ebeling offered public comment to Lee Shultz.

The Quality Corner report was given by Terri Schmitt, QI and Safety Director via teleconference. She walked the Board through the Quality Assessment Performance Improvement (QAPI) Plan summary that outlines five strategic elements based on the Centers for Medicare/Medicare Services (CMS) guidelines. Board members Fulk and DeRosear are on the Quality Improvement/Safety Committee and offered favorable comments regarding Schmitt’s work. The Board voted unanimously to approve the QAPI Plan.

Michael Brandon, Controller, presented the Financial Report for April.  

Gross patient revenue for April was $3,960,120; Bad Debt, Charity Care and other Deductions for April was: ($881,050); Net Patient Revenue, April: $1,684,530; Net Patient Revenue Per Day, April: $56,657; Total Operating Expenses for April $1,836,377; Expenses per day for April was $59,850; Total Operating Profit/Loss April: ($207,373.70); April Tax Revenue: $44,932.57; Net profit/loss before depreciation for April 2019 was ($67,285); Net loss YTD ($1,395,980); Net Profit (Loss) YTD FY 2018 ($1,381,646); Net loss YTD before Deprecation ($35,585)

Dr. Randy Tobler gave the Administrative Report, starting with Operations. He reported the Clinically Integrated Network (CIN) that the hospital has joined, Crossriver Quality Health Partners (CQHP), and the meeting that he and Dr. Davis attended to discuss the hospital’s role and involvement in various  metrics, informatics, organizational design and involvement with various committees. Dr. Tobler reported that CQHP has improved quality at lower cost in the patient population being served.

Concerning the Medicare Second Payer audit, he reported the SCH Financial Services Department Staff spent the large part of April and May answering questions, establishing and implementing policies and procedures responsive to the remote audit by CMS ensuring our processes aligned with their regulations.

Dr. Tobler reported on the Medifriend Remote Pharmacy Kiosk at Lancaster Medical Services (LMS) and said testing and calibration of the machine to the established list of most prescribed medications and needed 340B medications is under way with Medifriend development staff onsite at LMS and they are working with Pharmacist Nick Herrmann.

Dr. Tobler reported that the Tiger Cub Care Employee Daycare Center is expected to open on May 28th with 17 children enrolled.

Regarding Wyaconda Medical Services (WMS), Dr. Tobler reported on a utilization and staffing analysis by Dr. Frazier (Medical Director), Lori Nelson RN, RHC Manager, and Dr. Davis has determined that WMS will return to being open only on Mondays, effective immediately.

He reported that the Inpatient Pharmacy Director position will be transitioning over the next month to Nicholas Herrmann, PharmD. Ginger Ertel, Pharm D, will be a consultant and 340B drug program independent auditor, as required by regulations.

Regarding Patient Experience, Dr. Tobler reported that administration is investigating self-scheduling clinic appointments through a module in Meditech (the hospital’s Electronic Medical Record/EMR software) which would enhance convenience to patient’s for access to clinic appointments. Additionally, he reported that patients are noting the changes at registration including insurance card presentation at every encounter, and for Medicare beneficiaries, several questions regarding potential alternative/additional payment sources, required by CMS. Dr. Tobler made it clear that the changes are required by the regulating authorities with the goal in either case is a very diligent effort on SCH’s part to avoid denials by insurers.

Regarding affiliation, Dr. Tobler announced a meeting with Blessing Health System leaders and SCH’s Affiliation Committee is scheduled in early June to discuss next steps in a closer alliance, advancing the approach of a shared vision for keeping SCH’s mission of “services close to home,” fueled with Blessing’s clinical and infrastructure support and commitment to supporting local healthcare across the region.

Dr. Tobler told the Board he presented testimony on 4/30/2019, to the Illinois Health Facilities and Services Review Board as part of Blessing Health System’s opposition to Quincy Medical Group’s appeal application for approval of a new Ambulatory Surgery Center. His testimony took the position for the entities to work together to develop a center with equal revenue and governance sharing in the interest of collaboration and avoidance of duplicative services, referencing SCH’s positive collaborating experience with both entities.

Dr. Tobler, Lori Fulk, Elizabeth Guffey and Dr. Rollison reported on the workshops they attended at the Missouri Hospital Association (MHA) Leadership Forum 5/17 and 18. Themes included community engagement, innovative staffing strategies, population health, board governance, negative operating margins for facilities of all sizes, and loyalty, trust-building and how that impacts communications, organizational success and patient centered care. Dr. Tobler said staff will be integrating some of these ideas into SCH operations.

Dr. Tobler then reported on the Emergency Medical Services independence and told the Board that Chairman Ebeling, Michael Brandon and himself attended the 5/20 Ambulance Board meeting to present proposed financial settlement and equipment transfer terms.

He reported he gave a presentation to the Scotland County Rotary Club on 5/8. He reported according to the Board’s instructions, the hospital’s obsolete equipment will be disposed of during the Community Garage Sales on June 6-8.

The Edina Rural Health Clinic final business pro-forma has been developed and has been taken under review.

Under Medical Staff/Allied Health, Dr. Tobler reported that Dr. McNabb will be leaving SCH & LMS as a part-time Family Practice physician effective August 6th. She will remain on staff and serve on an as needed basis.

Marilyn Day, FNP, resigned effective 5/22. Kelsey Davis-Humes, DO, will staff the Wyaconda Medical Services on Mondays beginning in August and in the interim that clinic will be staffed on Mondays with Lois Quenneville, PA.

Lary Ciesemier, DO, with specialty certification in Allergy, Asthma & Immunology has applied for privileges. 

Under Personnel, Dr. Tobler reported on how administration is managing the critical nursing shortage with brief Med/Surg floor diversion status, while recruiting personnel both full-time and agency nurses, during late April and early May. No potential admits were transferred out.

There will be new staff on- boarding in the next few weeks in Clinic and Hospital Registration. These new staff are learning and executing the new and more complicated processes required to maximize insurance payments and in turn reduce denials, accounts receivable, and self-pay obligations of patients.

Dr. Davis submitted the Chief Medical Officer report with these highlights. Aurora Bell, DO, has signed a contract and will primarily have a Family Practice at Lancaster Medical Services and provide inpatient pediatric and newborn nursery coverage at the hospital. She will start in August 2019.

Dr. Davis reported that QMG has hired a new Physician Assistant to assist Dr. Daniel Schneider, Urology, that temporarily had to close his practice at MMS due to the death of his professional partner, Dr. Michael Ouwenga, last fall.  Dr. Davis reported that Dr. Schneider says he hopes to be back in practice at Memphis soon.

Under Old Business, the board unanimously approved Medical Staff Officers, Committees and SCH Facility-wide committees. Committees were approved with the corrections outlined. Medical Staff Officers for 2019-2020 are Rollison-Chief of Staff, Wilson-Vice Chief of Staff, Dr. Martin/Hoyal-Secretary (Dr. Hoyal will step into this position upon Dr. Martin’s departure later in the year).  Michael Brandon gave a report on the revenue cycle by reporting that streamlining electronic insurance claims through AVEC, 80% of claims are now being filed electronically, compared to 20% of the claims being filed electronically prior to AVEC. AVEC and the Financial Services Department staff continue to spend a lot of time working through issues regarding information uploads to AVEC and the Medicare audit. 

And finally, under Old Business, Dr. Tobler and M. Brandon outlined the proposed separation financial agreement offered to the Ambulance District. The Board voted unanimously to accept the financial separation agreement and authorized Dr. Tobler to offer an interest free payment period which may be extended up to six months.  

Under New Business, Board Secretary, Lori Fulk, read a letter from Eric DeRosear praising the care of his mother during her hospital stay.

Board Secretary Fulk and Recording Secretary Prather opened bids for tree removal at Lancaster Medical Services and Memphis Medical Services. Three bids were received for each site. Discussion followed resulting in the decision to reject all bids and defer until scope of bid is revised, insurance coverage confirmed and what equipment would be available. Consideration of SCH maintenance staff removing the trees was suggested.

The Board voted unanimously to approve the hospital liability insurance coverage from Hospital Services Group (HSG).

The final topic of discussion under New Business was a change of date for the monthly hospital board meetings due to scheduling conflicts with monthly board meetings of the Crossriver Quality Health Partner, which has a board seat for each participant’s leaders. The board approved to move the monthly hospital board meeting date to the last Tuesday of each month and reflect this and additional correction to the bylaws. Bylaws amendments will be presented at the June meeting for final review with board meeting dates changing in July 2019.

Guests exited at 7:50 p.m.

Closed Session: Those present for closed session were Ebeling, DeRosear, Doubet, Fulk, Lloyd, Neese, Dr. Tobler, Dr. Rollison, Missy Smith, and Brenda Prather.

The following items were discussed:  Legal actions and contracts in negotiation. Personnel.

Meeting adjourned at 8:45 pm

The Board invites the community’s questions and suggestions. If a local tax payer wants to hear the discussions about their local hospital, please attend the board meetings. Public comment policy and request for time are available online at and at the hospital’s Administration Office. The next meeting is June 27, 2019, in the hospital conference room at 5:30 p.m.