The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, April 25th.   Board Present: Curtis Ebeling-Chairman, Joe Doubet- Vice Chairman, Judy Wilson-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear and Lori Fulk.  Also present: Dr. Randy Tobler, CEO, Michael Brandon, Controller, Lori Nelson, RN-RHC Supervisor, Terri Schmitt, MHA, CPHQ, Director QI/ Safety (via conference call), Suzie Lister, Revenue Cycle Manager, Jessica Christen, NP, Alisa Kigar, Marketing and Brenda Prather, Recording Secretary.

Guests: Joni Lloyd, Garth Lloyd, Hunter Lloyd, Connor Lloyd, Taylor Lloyd, Jackson Lloyd, Lee Shultz, Joan Meyer-Kice, Tara Shultz, Sandra Blake, Amy Gaudette, Heliene Tobler, Vickie Baldwin and Ella Neagle.

The meeting was called to order at 5:40 pm. Per SCMH District Bylaws – Article IV, Section 4.2, Scotland County Memorial Hospital District held its annual reorganization of its Board of Directors meeting during the April meeting. After honoring Judy Wilson for her 30 years of service to the Board of Directors from District #5 and swearing in Joni Lloyd to replace Mrs. Wilson, the motion was approved, unanimously, for Chairman Ebeling, Vice Chairman Doubet and Treasurer Neese to be re-elected and the secretary position, once filled by Wilson, to be replaced by Fulk. The 2019-2020 committee assignments were agreed to as follows: Executive: Ebeling & Doubet; Quality & Safety: Fulk & DeRosear; Finance: Ebeling & Fulk; Affiliation: Ebeling, Lloyd and Neese; Disaster: Doubet & Fulk.  The special meeting adjourned.

Garth Lloyd, Hunter Lloyd, Connor Lloyd, Taylor Lloyd and Jackson Lloyd exited the meeting.

The regular monthly meeting opened with Public Comment from Joan Meyer-Kice and Lee Shultz.

The Quality Corner report was given by Terri Schmitt, QI and Safety Director. She reported on the STRETCH LAPS leadership rounding each month. These rounds by core quality team & leadership are reinforcing the values of Safety-Transparency-Respect-Excellence-Trust-Compassion-Honesty and modeling the practices of Leadership-Accountability-Professionalism-Synergy

Michael Brandon, Controller, presented the Financial Report for March.  Gross patient revenue for March was $3,400,835; Bad Debt, Charity Care and other Deductions for March was: ($212,495); Net Patient Revenue, March: $1,716,935; Net Patient Revenue Per Day, March: $56,712; Total Operating Expenses for March $1,836,377; Expenses per day for March was $59,715; Total Operating Profit/Loss March: ($444,250); March Tax Revenue: $53,729.24; Net profit/loss before depreciation for March 2019 was ($195,265); Net loss YTD ($1,208,505); Net loss YTD March 2018 was ($125,351)

A report was made that the Tiger Cub Care Employee Childcare Center will plan to open on May 28th. Final licensure will be forthcoming pending minor compliance items.

Dr. Randy Tobler gave the Administrative Report by explaining the 340B drug program participation. He explained that the boards and officers of the Hospital Foundation and the Scotland County Community Health Development Services are held by whomever occupies the by-laws specified board and officer positions. Hospital Board administrative positions are currently serving those roles to assure ongoing access to affordable 340B medications, savings on those medications used to support Hospital programs and operations and on-site pharmacist consultative services.

There is no personal gain of any form to the SCH Board members or employees from involvement in the organization arrangement, which was drafted by the Hospital’s healthcare attorneys.

Under operations, Dr. Tobler reported on the Medifriend automated medication dispensing machine that is housed at Lancaster Medical Services.

The machine is a satellite of Memphis Community Pharmacy and the first remote pharmacy kiosk approved by the State of Missouri, according to the inspector.

Concerning the Population Health & Wellness Initiative, Dr. Tobler reported that the Hospital has solved the non-local phone number that appears on patient’s caller identification when calls are made to schedule wellness visits.

Clinical staff have been trained in the use of the Mindray Portable Ultrasound for use at bedside at OR, Memphis Medical Services, Emergency Department and Med Surg Floor.

The Surgical scheduling process has been revamped for more patient friendly pre-op education and navigation.

The Show-Me Healthy Woman initiative billing issues have been resolved and patients have been notified of the billing error.

Reporting on Financial Stabilization, Dr. Tobler reported that SCH is in the late stages of developing a retainer based, direct contracting model for SCH services designed to simultaneously provide stable revenue, fill the substantial unfilled utilization and reduce employer expenses for those area employers that provide group health coverage.

Concerning pharmacy services, Dr. Tobler reported discussions with several departments regarding determining goals for staffing and responsibilities addressing identified needs in revenue cycle/EMR integration, clinical coverage, and supervisory roles of pharmacy services. Improved efficiency, quality, safety, staffing redundancy and expense management will result from this new model of hospital pharmacy and Memphis Community Pharmacy coverage.

Dr. Tobler reported on the Maintenance shed fire that resulted in a total loss.

Dr. Tobler reminded attendees that Urgent Care is no longer open on Sundays and only Saturdays, 8 am – 2 pm.

The Hospital was recognized with a Hospital Community Partner Award for cooperation with the SAFE Kit Initiative Project in identifying untested kits through the State of Missouri. The Hospital was also awarded a Gold Award for Quality by the TMF Health Quality Institute.

SCH has been notified that the Hospital will be receiving a Missouri Statewide Interoperability Network Radio to be deployed in the Emergency Department through a Missouri Hospital Association Grant. The radio is a common platform for public safety communications.

It has been reported that the Meditech (Electronic Medical Records Software) servers will become obsolete in 18 months or less and cessation of security support and aging render them nonfunctional. Replacement costs are approximately $450,000. Alternatives were presented.

Under Medical/Allied Staff, it was reported that John Fortner, CRNA, has completed a fellowship in pain management.

John Horner, DO, specializing in Allergy/Immunology and Internal Medicine and Pediatrics will start on May 1.

Under Personnel: Robert Miller has assumed the role of Meaningful Use Coordinator.

The critical nursing shortage and unanticipated staffing shortages are challenging staffing in Med/Surg and OB. Several initiatives are in place to address the shortage including competitive wages and a supportive work environment. Dr. Tobler asked attendees to thank the nursing staff who have taken extra shifts, sacrificed family time and continue to provide exemplary care.

Under Old Business it was reported that all personal finance disclosure statements have been filed with copies on file at the administration office.

Suzie Lister reported AVEC is working on correcting Meditech billing problems and will be on site for an extended time in May at no extra expense to SCH.

Under New Business the Board voted unanimously to approve a contract with ClearGage Patient Financing. This new financing opportunity will give patients a new financing option for deductibles, coinsurance, etc.

The board unanimously voted to approve the Public Comment Policy.

The Board unanimously approved the Property/Casualty Insurance quote.

After multiple failed attempts to dispose of vending machines, printers, etc. via eBay auctions and local advertising, Dr. Tobler suggested the Community Wide Garage Sale, while DeRosear suggested allowing a local computer company to make an offer. The Board unanimously approved to carry on with the Garage Sale if a local vendor was not interested.

Based on obstacles to recruit nursing staff, the board agreed to a wage increase for nursing.

Guests exited at 8:15 pm

Closed Session:

Those present for closed session were Ebeling, DeRosear, Doubet, Neese, Lloyd,  Dr. Tobler and Brenda Prather.

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

Meeting adjourned at 9:15 pmThe Board invites the community’s questions and suggestions. If anyone wants to hear the discussions about your hospital, please attend the board meetings.