The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, October 25, 2018.   Present: Curtis Ebeling- Chairman, Joe Doubet-Vice Chairman, Judy Wilson-secretary, Bob Neese-treasurer and Members  Dwight DeRosear and Lori Fulk.  Others present: Dr. Randy Tobler; CEO, Michael Brandon, Controller, Elizabeth Guffey, RN, CNO, Heather Ayer, RN, Quality Improvement & Safety, Stephanie Ketchum, LPN, QI Data and Virtual Health Coordinator, Lori Nelson, RN, RHC Supervisor, Missy Smith, HR Coordinator, Suzie Lister, Revenue Cycle Manager, Alisa Kigar, Marketing, Olivia Steele, RN, Med-Surg Supervisor and Brenda Prather, Recording Secretary.  Also present were Dr. Jeff Davis, Chief Medical Officer and Dr. Lisa Rollison, Chief of Staff.

Guests present were: Lee Shultz, RN and Valerie Brown, RN.

Chairman Ebeling called the meeting to order at 5:35 p.m.  Public comment was offered by Lee Shultz, RN.  Valerie Brown, RN, from Senior Life Solutions gave a six month update on the program.

Michael Brandon, Controller, presented the Financial Report for September.  Gross patient revenue for September was $3,469,284; Bad Debt, Charity Care and other Deductions for September  was: ($107,718.16 ), Net Patient Revenue, September: $1,695,625, Net Patient Revenue Per Day, September: $55,405; Total Operating Expenses for September $1,919,810.  Expenses per day for September was $59,565; Total Operating Profit/Loss September: ($358,580), Net profit/loss before depreciation for September was ($233,195); Net loss YTD ($497,920).

Lisa Rollison, DO, Chief of Staff, reported on staff relations.  She reported that Dr. William (Bill) Dixon had sent a complimentary letter regarding excellent patient care at SCH, following his bi-annual external peer chart review.  Dr. Rollison reported that with the business office partners, there will be significant pressure on physicians, NPs and PAs to become more timely with chart completion.  She gave an update on the Tiger Cub Care Employee Childcare Center, reporting there is a USDA grant for which the Center is eligible and that a potential candidate has been identified to interview for the Center Director position.

Randy Tobler, MD, Chief Executive Officer, gave an administrative report, starting with operations.  He reported administrators had met with representatives from the employee retirement plan noting some changes may be offered to enhance savings/match.  He reported the Business Office has been reorganized and it is now called the Financial Services Department.  He also reported that BKD, the hospital’s accounting firm, is conducting a strategic readiness analysis in which leaders inside the hospital and clinics and community thought leaders are being interviewed and surveyed regarding the hospital’s current status, services and future needs.  Dr. Tobler has talked with pharmacy partners to enhance on-site hospital services and reduce expenses.  Regarding Medical Staff/Allied Health, Dr. Tobler reported LifeLinc Anesthesia assumes anesthesia services in mid-November. It is likely the primary anesthetist serving us currently will continue after the change.  Under Advocacy, Dr. Tobler reported that he participated in a CEO panel of rural physicians in Washington DC to inform congressional healthcare staff about the acute challenges threatening sustainable, accessible, quality rural healthcare.  The panel was sponsored by the Missouri Hospital Association.  He also attended the quarterly Missouri Hospital Association North District Rural Hospital Council meeting in which active legislative and advocacy issues were discussed.

Jeff Davis, DO, Chief Medical Officer, gave his report, starting with discussion on meetings he had held with Quality Assurance and Safety staff within the hospital and Senior Management meetings in which strategic initiatives including employee satisfaction survey and clinician participation in optimizing Financial Services restructuring were discussed.  Dr. Davis reported he had been a presenter at the Missouri Physician Wellness Retreat earlier in the month.  Additionally, he reported that he had completed both the computer examination and the hands-on practical testing for recertification of Board Certification in Family Practice.  He has been notified he passed the hands-on practical exam and the computer examination has not yet been scored and released.  He is finalizing all testing and paperwork for Certified Medical Director certification from the Society for Post-Acute and Long Term Care Medicine.

Under Old Business, the board was requested to complete the Governance Leadership Survey by December 2018 meeting.  Dr. Tobler discussed with the board proposed facility-wide dashboards focusing on: Daily Operating Revenues vs. Expenses; CAHPS (Consumer Assessment of Healthcare Providers and Systems) scores for both the Hospital and Clinics; Patient Care Incident/Harm; and Facility Culture Surveys.  Heather Ayer, RN, BSN, Quality Improvement Supervisor clarified these sectors in further detail.  The dashboards will be used at Board, Medical Staff, and Departmental Meetings to align performance goals along the 4 emphases in the Strategic Plan.

In New Business, Dr. Tobler further discussed the employee retirement plan employer match for employee contributions using illustrations for various deferment/match combinations.  The Board adopted a policy increasing the match for employees choosing a higher level of wage deferment. He also reported that an invitation from Crossriver Clinical Integrated Network was given to our administration and board to attend their dinner and board meeting in November and accumulate more information.  The Crossriver Quality Health Partners, sponsored by Blessing Health System, is a group of healthcare providers from our region who have made a collective commitment to performance improvement by focusing on the quality and efficiency of care for the patients they serve, by implementing best practices across the Network. As a result, they will be able to achieve improved patient outcomes at reduced costs, and show the value participating entities are bringing to their patients. This will in turn enable more favorable contracting for the participants.  Those that are planning to attend that meeting are Ebeling, Doubet, Neese, Elizabeth Guffey, RN, Randy Tobler, MD & Lisa Rollison, DO.  Other New Business involved setting a meeting date for the November Hospital Board Meeting due to the Thanksgiving Holiday.  General consensus is to move the meeting date to Thursday, November 29, 2018, at 5:30 pm, while a special meeting will be held on Monday, November 12, 2018, at 5:30 pm to review the annual audit.   A request from an employee was approved, including a matching grant from HSG, the Hospital’s professional liability insurer, for tuition towards her education to pursue certification as a surgery technician through Indian Hills Community College.  The Board approved a modification of the employee health plan, eliminating reference based pricing and returning to HealthLink Network which will now offer a wider physician network, and less potential disruption for employees who receive care outside the Hospital or it’s preferred facilities (Blessing Health System and University of Missouri Healthcare), contingent on contractual termination notifications.

Executive Session:

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

In closed session, the following items were discussed:

Legal actions and personnel matters.

Meeting adjourned at 9:15  pm.