The Scotland County Hospital  Board of Directors met in regular session on Tuesday, April 24. Present were Curtis Ebeling-Chairman (arriving at 6:55 pm), Joe Doubet-Vice Chairman, Judy Wilson-Secretary (arriving at 5:40 pm), Robert Neese-Treasurer (arriving 5:44 pm), Members: Dwight DeRosear and Lori Fulk. Others present were Dr. Randy Tobler, CEO, Dr. Lisa Rollison, COS, Elizabeth Guffey, RN CNO, Michael Brandon, Controller, Angela Schmitter-HIM/Compliance, Missy Smith, HR, Lori Nelson, RHC Supervisor, Suzie Lister, Heather Ayer QI/ Safety, Alisa Kigar, Marketing, Lynn Fincher-Business Office, and Brenda Prather, Recording Secretary.

The annual reorganization meeting  was called to order by Vice Chairman Doubet at 5:30 p.m. in the absence of chairman Ebeling.   Nomination to retain retain existing officers was approved. Committee appointments were approved by majority to retain existing committees.

The regular monthly meeting commenced.  Approval of Open Session Agenda was approved by majority vote, with an addition  of “ER to OR Procedure” under consent agenda item H-2.    Approval of Executive Session Agenda approved by majority vote. The consent agenda and approval of the March 29, 2018, minutes were approved by majority vote.

Michael Brandon, Controller, presented the Financial Report.  Gross patient revenue for March was $3,919,038; Contractual percentage YTD was 52.79%; Expenses for March were $1,565,107.  Net profit before depreciation was $148,387; Net loss YTD ($1,250,352).  Approval of accounts payable for March was approved by majority vote.

Chief of Staff, Lisa Rollison, DO, presented a report from the Quarterly Medical Staff meeting that was held on April 23, 2018, with these highlights: Representatives and caregivers from the Mennonite faith community were present to discuss burn and wound care methods that are standard in the Mennonite and Amish communities and potential supportive care arrangements with the Hospital.  Dr. Rollison had a report on staff relations and a report on the Tiger Cub Care.

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

Operations: 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.

The team will identify senior citizens and intensively address those with chronic uncontrolled or multiple chronic conditions with a goal of providing improved health, low cost and a positive patient experience.

The primary care clinicians will continue to be responsible for the long term and interim non-chronic problems that arise with these patients.

The in-patient pharmacist, Ginger Ertel and Dr. Tobler are working to reduce pharmacy costs by contesting some charges from the tele-pharmacy vendor, as well as identifying alternatives.

Blessing Health System is revamping the tele-medicine contracts to expand availability of the tele-robot that is on-site and will likely be providing one or more service lines, possibly psychiatry, pulmonology and more.

The Compliance Committee has been conducting Hospital Survey readiness sessions with each department incorporating information given at last month’s Conditions of Participation update presented by MHA and Bureau of Hospital Standards personnel.  Multiple communications and teleconferences with auditors and counsel regarding billing compliance in two focus areas have resulted in some refinements and adjustments in our processes to reflect best billing and compliance conformity.

We have changed housekeeping duties, redistributing to existing staff, and combine with recycling to reduce waste management costs.

Materials Management department is using proactive inventory practices and identifying economies in vendor changes to reduces expenses.

Under Personnel: Barbie Courtright, RN, has resigned as OB supervisor.

Ashley Ward, RN, was the guest on Healthy U Radio Show on 4/17.

Kim Campbell was hired as the Facility Director of the Tiger Cub Care.

A team from SCH has made visits to area nursing schools recruiting May/summer graduates and stimulating awareness of and interest in employment at SCH.

Regulatory/Industry Trends:  Intense lobbying by MHA and hospital administrators and trustees has restored equity among healthcare providers in receiving budget cuts in the Senate bill, as opposed to the House bill, which cuts Hospitals more, relative to their percentage of overall budget.  Please write our legislators encouraging adoption of the Senate language in the conference committee.

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. Frazier sees patients at Memphis Medical Services and had previously taken patients on Fridays and is now moving to Wednesdays beginning in April.

Dr. Davis reported that he is presenting at Midwest Osteopathic Annual Conference in Branson, MO, later in the week.

In Old Business, it was reported that all personal finance disclosure statements have been filed, prior to the May 1, 2018, deadline.

Dr. Tobler gave an ambulance service update.  After roughly a six-month review involving legal and auditor input, this report answers two issues; Substantiation of appropriate billing procedures and Evidences proper reimbursement practices.

This financial report was presented to the Ambulance Board and confirms previous monthly reports and defined the true financial status of the service. The Board discussed various options or possible remedies

Consensus is for Dr. Tobler and Michael Brandon to discuss with the Ambulance Board options on how to improve the financial outlook and recover losses.

Dr. Tobler presented a new model of the employee health plan which involves enhanced incentives for employees to seek care in a high quality narrow network for medical and pharmacy services, with utilization of non-preferred providers incurring greater employee out of pocket expense.

Acceptance of this model will not cause an immediate increase in premium, but will result in significant savings for both the employee and SCH by incentivizing utilization of  our preferred provider partners and 340B pharmacies.

Dr. Tobler has negotiated a deeper discount with Blessing Hospital for the coverage of the vast majority of services not offered at SCH.

Negotiations are in progress with a potential “preferred tier” hospital for employees’ use when domestic services are not available.

Changes to coverage tiers and deductibles would take place July 1.  Motion approved by majority vote to approve modifications in employee health coverage plan as presented.

Employees will be notified of impending changes and date for education on plan change specifics.

In new business, current credit card processing fees and vendor was discussed.  US Bank and Square submitted bids. Michael Brandon analyzed several vendors & recommends US Bank for local presence and online portal, insurance, electronic file, stand alone and price protection in the package.  Motion approved by majority vote to authorize CEO Tobler to enter into contract with US Bank.

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 8:02 pm.