The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, June 28, 2018.

Present were Curtis Ebeling, Chairman; Joe Doubet,  Vice Chairman; Judy Wilson, Secretary;  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, Heather Ayer, RN, QI/Safety, Stephanie Ketchum LPN, QI Data and Telehealth Coordinator, Lori Nelson, RN, RHC Supervisor, Missy Smith, HR Coordinator, Suzie Lister, Revenue Cycle Manager and Brenda Prather, recording secretary.

In the temporary absence of Chairman Ebeling, Vice Chairman Doubet called the meeting to order at 5:35 pm.  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 May 24, 2018, minutes were approved by majority vote.  Ebeling arrived at 5:42 pm and assumed chairman position.

Michael Brandon, Controller, presented the Financial Report.  Gross patient revenue for May was $3,956,790; Bad Debt, Charity Care and other Deductions: ($238,167); Contractual percentage YTD was 53.48%; Net Patient Revenue, May: $1,683,336; Net Patient Revenue Per Day, May: $55,152; Total Operating  Expenses for May were $1,823,560.  Expenses per day was $58,860; Total Operating Profit/Loss: ($107,232); May Tax Revenue: $44,525; Net profit/loss before depreciation was ($59,215); May Depreciation Expense: ($128,668); Net loss YTD ($1,569,535).  Approval of accounts payable for May was approved by majority vote.

Randy Tobler, MD, FACOG, Chief Executive Officer, gave an administrative report. Under operations, Dr. Tobler gave a population health update and reported that the Annual Well Visit scheduling call has been reviewed for quality assurance by Communications Specialist Alisa Kigar and RHC Supervisor Lori Nelson and they have worked with our HPN site manager to adjust the calls, emphasizing the educational “what” and “why”.

Dr. Tobler reported SCH is implementing the “Gap in Care” next step in managing health in several target populations starting with Medicare, then Medicaid and commercially insured patients in sequence.  SCH has a Lead Population Health Nurse (Libby Dole) who is mentoring a new LPN to properly staff the growing volume. This program as it is perfected will provide improved health maintenance and overall lower utilization of acute services for our entire community, and provide the evidence that SCH is directly and aggressively pursuing the triple aim of Health Care Transformation:  High Quality/Low Overall Cost/Great Patient Experience.

Dr. Tobler reported that SCH is addressing deficiencies in the recently launched phone answering system at Memphis Medical Services.  Problems with call drops, and inability to hold for reception (defaulting to voice mail immediately) are among the problems.  IT and clinic staff are collaborating on a solution.

Tobler stated the hospital is working on lab contracts, negotiating lower rates and a possible switch to a different lab for send outs.

Employee Health Plan

SCH has signed a direct contract with MU Healthcare for referenced based pricing to complete a comprehensive narrow network (SCH/Blessing Healthcare System/MU Healthcare) that will not require pre-pricing before employees utilize services with MU doctors or facilities.  The hospital is awaiting execution by MU Healthcare to finalize.

Controller Michael Brandon and Tobler attended a roundtable meeting with the Director of Payer Strategies from MU Healthcare on 6/26.

MU is interested in further discussions with a Critical Access Hospital consortium working group to see how our facilities can align in the future.

Tiger Cub Care

A fire and safety inspector provided a list of action items including needed architectural drawings, vented hood for stove, and others which the administration indicated a belief they are surmountable, but at a cost. A revised budget for the center will be presented in July.

AVEC Business Office

Administration had a phone call with AVEC executives on June 26, which was rewarding and revealed substantial collections on claims denials intervention. They are identifying significant process and workflow improvements to align SCH practices with standard operating procedures in modern healthcare facilities.


Dr. Tobler reported that SCH has finalized a price reduction with Pipeline Rx (telepharmacy) and has addressed other procedures to reduce costs.  Additional cost savings and quality improvements have been identified, with providing in-house order validation with available pharmacists being one option to explore.


MU Telehealth leaders did a site visit to SCH.  Dermatology is likely  the first service line through MU.

BKD Strategic Affiliation Readiness Project

Dr. Tobler reported the needed items list is nearing completion and the stakeholder questionnaire has been completed by the leadership team. BKD analysis begins after BKD reviews additional items provided by SCH.

Commercial Insurance Contracting

Calls are ongoing with major insurers. The administration has talked with UHC, Aetna/Coventry and Blue Cross/Anthem.  Dr. Tobler reports the discussions have been disappointing responses thus far, which is consistent with other hospitals’ experiences.

Community Disaster Team

The Scotland County Disaster Group meets at SCH, and the 2nd meeting in June led to initial planning of a coordinated drill between the Health Department, county officials and SCH.

Medical Staff/Allied Health

Senior Life Solutions held a meet and greet for the medical staff with their psychiatrist, Dr. Marcia Shea, on 6/25.


The Employee Survey Response Teams have provided a lot of valuable feedback and some improvements have already been implement. A housekeeper has been hired.  Administration is reviewing salaries and call pay, along with other benefits for nurses in view of the critical shortage.

Regulatory/Industry Trends

MO HealthNet Division is trying to amend the contract with Managed Medicaid Contractors that would severely disadvantage hospitals’ negotiating power.

Dr. Tobler reported  he will attend Physician Leadership Training on July 21 – 22,  planned to address clinician wellness, as a serious and worsening problem in healthcare and he will be applying for Certified Executive Physician certification course to take place in November.

Chief Medical Officer

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 and recruiting.  He has also met with clinics manager, Lori Nelson, RN, regarding clinics personnel/staffing and workflow as well as the significant turnover in clinic staff resulting in challenges.


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

Emergency Department

Docs-Who-Care has reduced coverage to every other week on Monday and Tuesday. Current staff are absorbing the previous shifts they covered.  Dr. Wilson is picking up an evening shift and so is Dr. Davis to reduce costs to the hospital as part of the financial stabilization plan.

Dr. Davis reported he’ll be attending the American Osteopathic Association annual House of Delegates meeting in Chicago in July and he will also be presenting at the Missouri Physician Wellness Retreat in October 2018 in Excelsior Springs.  He will be up for recertification of Board Certification in Family Medicine in 2018 and he is finalizing the Certified Medical Director certification from the Society for Post-Acute and Long-Term Care Medicine.

Old Business

Controller Michael Brandon reviewed the FY 2018-2019 Capital and Operations budget projections of revenues, expenses and service lines with explanation and rationale used during budget preparations.  Motion moved and approved to accept the Capital and Operations Budgets.

Dr. Tobler reported on some changes to Medical Staff Committees which include the former Customer Service Committee will be renamed “Patient Experience Committee” and the former Employee Benefits Committee will be renamed “Employee Experience Committee”.  Membership on each committee is in development. Motion moved and approved to accept the renamed committees.

Suzie Lister, Revenue Cycle Manager, reported on the recent Chargemaster review with Holiday & Associates.

New Business

In new business, Dr. Tobler reported structural repairs needed to the boiler room walls. He reported there are a couple of options.  The board will view the area and discuss options and communicate their recommendations.

Executive Session

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

In closed session, the following items were discussed: Legal & Personnel.  Contracts in negotiation were discussed.

Meeting adjourned at 8:50 pm.