The Scotland County Hospital Board of Directors met in regular session on Thursday, March 29, 2018.  Those present were Curtis Ebeling,-Chairman (arriving at 6:05 pm), Joe Doubet-Vice Chairman, Judy Wilson-Secretary, Robert Neese- Treasurer, Members: Dwight DeRosear; Lori Fulk (on conference call in).

Others present: Randy Tobler, MD, CEO, Jeff Davis, DO, CMO, Michael Brandon, Controller, Elizabeth Guffey, RN, CNO, Angela Schmitter, RHIT, Missy Smith, HR Coordinator, Lori Nelson, RN, RHC Supervisor, Heather Ayer, RN, QI/Safety, Alisa Kigar, Marketing, Brenda Prather, recording secretary, Ashley Harvey, RN, Andrea Graham, RD, Stephanie Ketchum, LPN, Ken McMinn, IT Supervisor, Meagan Weber, DPT.

Vice Chairman Doubet called the meeting to order at 5:35 pm.

Michael Brandon, Controller, presented the Financial Report.  Gross patient revenue for February was $3,274,982; Net Patient Revenue Per Day was $55,052; Contractual percentage YTD was 52.36%; Expenses for February were $1,729,510; Expenses per day were $59,837. Net profit for February was $35,305; Net profit before depreciation was $163,100; Net loss YTD ($1,331,090).  Approval of accounts payable for February was approved by majority vote.

Randy Tobler, MD, FACOG, Chief Executive Officer, gave an administrative report with these highlights – Operations: Majority of time this month spent on identifying and contacting highest expense/potential highest savings SCH needs to yield cost containment & financial stability.

Major structural changes will be needed to achieve the savings SCH needs, recognizing the regional market and overall industry dynamics. SCH can only mitigate, not reverse market share drains to larger nearby facilities/systems as recent acquisitions by larger systems have eroded outpatient and some inpatient utilization substantially.

Employee healthcare costs must be controlled; they are the number one expense line after salaries. Service lines will need data driven objective decision making in deciding what SCH looks like going forward. SCH has a commitment from the Care Coordination team to drive the “Medicare Beneficiary Population Health” (Annual Wellness Visit/Gap identification/Chronic Care Management) Initiative at our Clinics, while High Performance Networks supports the team, administratively, in the background. The team is Dr. Wilson, Jessica Christen, DNP and Libby Dole, RN.

Employee Town Halls presentations on 3/6, both am and pm, to review financial position, educate staff on the drastic changes in reimbursements and market conditions that are largely responsible for our financial position, and the importance of making every patient experience a “Ritz-Carlton” one, both clinically and customer service, in order to retain and grow market share. Our patient survey reviews are excellent, and the drive for excellence must continue to grow the reputation of excellent services, close to home.

The Quarterly Community Discussion Forum was conducted on 3/21.  Great reviews, though we continue to be disappointed with attendance, and will review other formats/times to gain more community input and engagement with our operations, per the Board-approved Strategic Framework.

Tobler gave a presentation to Schuyler County Rotary. Tobler, Lister and Kigar met with Western’s Smokehouse CFO on 3/19 to explore opportunities to increase their employees’ utilization of SCH & clinics services.

The Employee Survey Committees have self-selected for engaged, regular participants and achievable, affordable recommendations are forthcoming.  The Senior Life Solutions launch has been a huge success. Senior Life Solutions Officials report the SCH start is among the best they’ve had regionally.  Scotland County Care Center Laboratory Services has resumed utilizing SCH Lab services, effective Feb. 19. SCH provides on-site phlebotomy there 3 days a week, with SC Care Center staff obtaining samples at other times.  Reports from SCCC Administrator are that operations are running smoothly.

Meetings in March with wo HVAC Control Vendors to address the looming problem of the obsolete control system.  This will be a necessary budget item in FY’19.

Congratulations to the Clinic Nursing Staff and Manager Lori Nelson and Heather Ayer, Q/A manager for helping the SCH Clinics earn exceptional marks on MIPS (Merit Based Incentive Payment System) which will result in up to 4% higher reimbursement for clinic physician fees from Medicare in 2019.

Medical Staff/Allied Health: Dr. Miller-Parish was the guest on “Healthy U” on 3/27.  The topic was colon cancer/screening to mark National Colon Cancer Awareness Month. Dr. Iqbal Khan has started Neurology clinics at MMS, with Nerve Conduction and Electromyography testing, currently once monthly. Dr. Eldon Frazier, Family Practice Physician, is moving to Wednesdays with a stop at Wyaconda Medical Services on his way to MMS to see patients and fulfill collaborating obligations with Marilyn Day, NP.  The transition from Dr. McNabb to Dr. Frazier collaborating will be completed in 1-2 months.  Final negotiations with Dr. McNabb for her transition to part-time are taking place. Personnel: Department heads and staff continue to slash costs by filling voids left by attrition.

Contracts: Contract with Holliday and Associates for Chargemaster and Pricing Review executed.  Contract with Dr. Wolkowitz for per diem rental of Pain Management equipment executed.  Personal: Tobler attended the MHA Conditions of Participation Conference along with Compliance Officer, CNO and Quality Improvement/Risk Manager. The themes emphasized new requirements of Emergency Operations and the hazards of EMTA violations along with the statement of Intent of the Bureau of Hospital Standards Director to have a more amicable relationship between surveyors and the surveyed.

Jeff Davis, DO, Chief Medical Officer, presented the CMO report with these highlights: Dr. Davis attended the regular Quality Assurance & Safety meetings and discussed quality results, progress on employee focus groups and safety issues. Attended meetings with Senior Management Team to discuss cost saving measures and strategies for improving the hospital financial performance.  He attended a meeting with Clinic manager and Lead Clinic Receptionist regarding clinic personnel/staffing, scheduling and work flow.  Davis reported that Dr. Wolkowitz continues with pain management services at Surgery Center. Dr. Wolkowitz is only able to accommodate a few new patients per clinic because of follow ups. Dr. Dana Valencia has been added by Blessing Hospital as a second cardiologist.  There is a planned change in the ED schedule beginning in May with Docs-Who-Care reducing to coverage every other week on Mondays and Tuesdays.  Current staff will absorb the previous shifts they covered in order to reduce costs to the hospital.  Davis reported that outside of his hospital and clinic responsibilities, he currently serves as the Post-Acute and Long Term Care Medical Director at Scotland County Care Center, Clark County Nursing Home and Knox County Nursing Home; Serving as EMS Medical Director at Clark County Ambulance District and Knox County Ambulance District; Serving as Scotland County Coroner and the Immediate Past President and Executive Committee Member at Missouri Association of Osteopathic Physicians and Surgeons.

In Old Business, the board had a conference call with the SCH employee health insurance broker to discuss possible options to modify current health plan tiers and enter into Reference Based Pricing with outside network facilities. This is an employer trend in and outside of healthcare among employers to reduce expenses for employee health insurance benefits.  The SCH self-funded healthcare plan is the number one expense item on the ledger after salaries.  Some pre-authorizations are required for certain procedures/testing.  Discussion and questions regarding possible hurdles in transitioning to a high quality, narrow network environment for SCH employees..  Following call, other questions were raised and Dr. Tobler will follow up.  Majority vote in favor to authorize CEO Tobler to research and answer the remaining questions and, unless complications arose, move forward with transition to 2 tier plan default, with goal of 3 tier plan, identifying a “preferred” 2nd tier at best negotiated price and immediate commitment and prepare a cancellation letter to HealthLink.  There was a lengthy discussion regarding BKD’s Affiliation Advisory Services which involves a complete operational assessment through 2 phases with an a la carte design, ensuring no all-or-nothing commitment.  Majority vote in favor to authorize CEO Tobler to enter into Phase One Strategic Readiness Assessment Analysis by BKD.

Tobler reviewed line by line of the Financial Stabilization Action Report progress. Alisa Kigar presented the completed Strategic Plan and Values Statements. Majority vote in favor to approve the Strategic Plan as presented and defer decision on the Values Statements until next month, allowing the board to study to document.

Ashley Harvey, RN, reported on the progress of the employee child care center, Tiger Cub Care.  A director has been offered the position and accepted, pending background check and employment paperwork.

“Noodles and Doodles” is scheduled for April 14th as a fundraiser for the Tiger Cub Care start up costs and the SCR-1 High School & Elementary Art Department.  More fundraisers are being planned.

Lori Fulk exited conference call at the beginning of New Business.  In new business, the Parking Policy was discussed and with majority approval passed.

The SCH Safety Plan was explained by Heather Ayer, RN, QA/Safety Supervisor.  Ms. Ayer volunteered to be the Patient Safety Officer.  Majority approved and passed the plan.

Tobler directed a discussion regarding the EMS department financial performance and reporting concerns of the Ambulance Board of Directors.  Tobler reported that Controller Michael Brandon finished an extensive accounting of revenue and expenses showing substantial loss.  BKD rendered opinion on the accounting, confirming substantial SCH subsidy to operate EMS services.  Accounting results and BKD opinions on coding and billing practices will be presented to EMS board in April.

Majority approval to move the April hospital board meeting to April 24th, same time and location.

Tobler discussed property liability insurance negotiations with current vendor which netted a significant reduction in the original renewal quote.  No other carriers offered a quote.  Majority approval of the negotiated renewal rate with current vendor.

The Bank of Kirksville requested a board resolution to formalize the Pyxis purchase lease.  Majority approval and signature obtained.

Executive Session:

Those present for closed session were Ebeling, DeRosear, Doubet, Neese, Wilson, Tobler, Davis, Rollison, Smith and Prather.

In closed session, the following items were discussed:

Legal & Personnel.  Smith exits.  Contracts in negotiation were discussed.

Meeting adjourned at 11:55 p.m.