The governing board for the Scotland County Hospital met October 26th in regular session in the SCH Library. Those Present included Curtis Ebeling-Chairman (5:45pm), Joe Doubet – Vice Chairman, Robert Neese – Treasurer, (6:04 pm) and members Dwight DeRosear and Lori Fulk. Judy Wilson was absent.

Others present included  Dr. Randy Tobler; CEO, Dr.  Jeff Davis, CMO, COS Dr. Lisa Rollison, Michael Brandon, Controller, Elizabeth Guffey, RN, CON, Missy Smith, HR Coordinator, Lori Nelson, RN, Clinic Supervisor. Suzie Lister Financial Navigator, and Brenda Prather, recording secretary.

Consent Agenda

Approval of Minutes 9/28/17, Special Meeting 10/30/17 and consent agenda.  Motion by Doubet to approve open session minutes of 9/28/17 and consent agenda items B-K which are attached.    Second to motion offered by DeRosear.  Motion approved by majority vote. Highlight by L. Nelson of MIPS measures in the clinic.  Report period is 10/1/17-12/31/17; CNO Nursing Report; Disaster Committee-agenda only; HIM Update; HR Update; Material Mgmt. Report; QI/Safety Committee; RHC Report; Supervisor Mtg; P&P/P&T Committee-Med Staff Approval; Contracts; External audit by EC First; Internal and external cybersecurity audit; Therapy contract with Regional Home Care, Inc.

Financial Report – Michael Brandon, MBA

Finance Report, Balance Sheet, Income Statement, Stats-AR were presented by Brandon. Reminder that representatives of BKD will be presenting the 2016-2017 FY Audit next month at the November 27th meeting. Supervisors and Medical Staff will be invited.

Approval of October 2017 A/P.  Motion by Fulk to approve A/P listing.   DeRosear offered second.  Motion approved by majority vote.

Joint Advisory – Dr. Lisa Rollison, Chief of Staff-

Medical Staff Meeting was held Monday, October 23rd.  Staff Attendees included: J. Christen, J. Davis, J. Hassen, N. Hoyal, S. Henley-Pippert, T. Kirchner, J. McNabb, C. Miller-Parish, T. Rohr, L. Rollison, R. Tobler, J. Williams, and S. Wilson

Presentation regarding MIPS (Merit-Based Incentive Payment System) was given by Heather Ayer, RN BSN. Lengthy discussion regarding the involved MIPS Quality Measure Points and their capture (or lack thereof) by our EMR was conducted.

Submitted CNO report included an article relating to nationwide nursing shortages. The staff engaged in a discussion involving ways to show appreciation to nurses and to attract and retain quality nursing staff.

The topic of chart completion and provider performance expectation was raised. A vigorous discussion ensued.

Factors contributing to non-compliance were voiced including walk-i volume challenges, IT/EMR pitfalls, time management practices, and lack of efficacy of our current policy toward non-compliers. Strategies for offsetting these factors were discussed.

Team Care was discussed with reference to how the system affects chart completion. During the initial learning curve, more chart time is actually required, with time eventually improving to below baseline.

Factors contributing to the urgency of timely chart completion including patient safety, financial/billing punctuality, and maintenance of accurate legal record were stressed.

Development of more effective policy that better aligns with industry standards will be pursued. Such policy may include provider fines for late chart completion, initiating at 14 days post-due.

The concept that timely chart completion is an expectation of employment, an existing stipulation of all staff employee contracts, and a matter of professional responsibility was discussed.

Peer Review, including the recent committee meeting, was reviewed. Process streamlining is in progress.

4th Quarter Credentials were reviewed.

Report on Child Care Committee was presented.

Administrative Report – Randy Tobler, MD, CEO


FY’16 cost report adjustment of $161,702 due to SCH notice received from WPS Informatics – We have engaged a Meditech exclusive consulting vendor to assist with solutions requiring more help than our internal staff can provide.  Sonya See, SHNP, will assume managerial oversight, and Heather Ayer, RN will be trained by Tammy Scearce to assume some quality reporting duties she carried over from her Q/I position to the informatics position.

Thelma Norton, RN, will add training and background Meditech duties to her educational and infectious disease roles. We have a defined retainer contract of 80 hours monthly through end of ’17 as a pilot, with the option to continue if the arrangement is efficient and productive.  The priority list, emphasizing revenue cycle functions with some priorities reserved for clinical matters, has been developed and work on projects is in the early progress.  Many thanks to Sonya, Heather and Thelma for “filling their buckets’ as we move forward.

Pharmacy – We have reconfigured pharmacy staffing with redefined Pharmacy Technician roles, and transferring all supervisory functions to the Pharmacy Director, Ginger Ertel, Pharm D. We anticipate less clerical work involved in inventory and billing as a result of the enhanced Pyxis integration with Meditech. Pyxis implementation and sign off on full operational signoff expected by end of November.

SLS (Intensive Outpatient Geriatric Psychiatry) contract executed.  Kickoff meeting to introduce personnel and plan implementation slated for November. Program opens in March.

Monthly Safety Rounds with CEO, CNO, Q/I Manager, Maintenance and Housekeeping supervisors started 10/4.  Many cosmetic and few safety issues identified and are either rectified or in process.  E.g. New concrete on walkway between Women’s Center and MMS replaced.

Sidewalk and ramp to small parking lot between Surgery Center and Annex poured.

Meeting with Maintenance Dept. 10/17 to discuss expectations for projects, to include project scope, drawings, materials list and timeline.  Discussion, relayed to Supervisors 10/25, about the importance of advance notice of projects to allow time to develop required plans.

CareSync (Chronic Disease Management for Medicare patients) program has launched with enthusiastic patients and several clinicians.  Another momentum/check in call with their team scheduled early November.

Medical Staff/Allied Health

Interview with FP Resident at the SIU program (Dr. Dixon faculty) in Quincy. Further discussions for possible employment in 2019 ongoing.

Interview with FNP trainee who will be graduating in winter.  Discussions ongoing.


Tammy Scearce, RN, Informatics, resigned, with last day November 9th.

Nursing shortage continues to challenge staffing. Thanks to supervisory and the other staff who have picked up empty shifts and duties aside from their administrative and core nursing schedules.


A physician targeted video focusing on the opioid crisis and its maternal/newborn impact I recorded is on the MHA website.

I recorded a podcast with Hadley Health Manning, Director of Policy Studies for the Independent Women’s Forum on the Opioid Crisis.

I will be attending the MHA Annual Conference next week.  Request permission for travel, food, registration and lodging support.  Motion by Fulk to approve CEO Tobler’s attendance/expenses. DeRosear offers second.  Approved by majority vote.

CMO ReportDr. Davis

Quality Assurance

Attended QA and discussed results and employee satisfaction surveys

Reviewed dashboard details and discussed MIPS

Reviewed 1 patient complaint

Senior Management

Met with Senior Management discussing strategic plan and management.  Focused on alignment and ACO opportunities. Reviewed recommendations for strategic plan.  Attended Board Retreat on Strategic Plan and Alignment

Meetings with Dr. Tobler and Michael Brandon regarding recruitment, retention, employee satisfaction and personnel management.

Meetings with Lori Nelson, RN, Clinic Manager regarding clinic work flow, Team Care, personnel/staffing, schedule and physician relations.

Clinician Relations

Communicating with clinicians on clinic and hospital workflow/HER, etc.

Working with Kristin Hyde and Dr. Heather Martin, Secretary of Medical Staff, regarding inpatient/OB/Peds physician coverage.

Meetings with Dr. Tobler regarding clinician contract development.

Service Line Development

Team Care project at MMS is underway and going well

NPs have moved to a 10-hour, 4-day work seek.  Still have chart incompletion issues.  Working through dynamics.

Walk-in clinic at MMS and LMS continues to go well Numbers strong.  Still widely utilized.

Memphis Community Pharmacy continues to see increased numbers and providing great service to our patients

Onsite collaboration with Haley Shrum, NP in the ER, Stephanie Henley, NP and Teresa Kirchner, NP at MMS and SCCC and Lois Quenneville, PA at MMS and SCH.  Jessica Christen, NP on pediatric issues in the clinic

Dr. Daniel Schneider has started with Urology services at MMS

Dr. Wolkowitz has started with pain management services at Surgery Center

Dr. Jost will replace Dr. Garriga in November for Rheumatology services.

Recruitment and Retention

Contract presented to Kelsey (Davis) Humes.  2nd year FP resident form Quincy, IL

Other interest from current Urgent Care physician resident from Kirksville with interest in OMM

Interviewed a NP who is seeking us out for job opportunities.  Ongoing discussions with her

Old Business

Strategic Plan follow-up.  Board member responses to worksheet.

Goal on financial performance. Lengthy discussion on pillar priorities, long-term goals, quality, financial, culturally, community. Next month final analysis of pillar expectations will be tabulated and presented.

New Business

Employee Financial Aid Request – Guffey presents request from Chrissie Burkhiser for assistance to attend and complete a BS degree. This is a twelve-month online BSN Degree program through Chamberlain’s School of Nursing, Downers Grove, IL.  She is requesting the full amount of tuition with full expectation to continue working full time. Following discussion and review of letter of recommendation, Motion by Fulk to approve Burkhiser’s request in full with a commitment of eighth years employment from date of financial aid contract. DeRosear offers second.  Motion approved by majority vote.

Revenue Cycle Supervisor Update.

Suzie Lister presented her experience today with a meeting of billing and coding personnel.

Shared her wonderful experience in her meetings with counterpart at Blessing.

Reviewed multiple areas at Blessing, bringing her ideas back to SCH registration staff, billing and coding.  Example: Shadowed HIM personnel at Blessing and brought back question and concept of establishing a discharge check for billing. This has been incorporated by IT. Realizing time of discharged had not been documented/billed appropriately.

Received a tremendous amount of advice, policies, training tools, form template, discipline techniques, suggestions on resolving cultural issues, etc. to bring back and implement.

Established time study of each employee in billing/coding.

Claim denial is a top priority; scheduled for improvement in billing staff efficiency and bottom line.

Meeting with registration next week.  Full staffing should be completed next week with another hire.

Poor consistency to financial arrangement/contract.  They’ve made a payment plan, not performing.

Question: Can patients be fired for consistent non-compliance-failure to pay.  Researching an answer

Board Education Series – Part of annual educational requirement of Public Boards per RSMO §105.666, 1-4.

Module I.  Discussion on Handout “Leadership Habits” and questionnaire.

Reading handout of “Best Practices for Building a High-Performance Board”

Length of this review/discussion approx. 30 minutes.  Reading expectations with completion of check list handout=approx. 1 hour.  Series will continue at November and December meetings.

Nursing Shortage-Literature distributed from Reuters. Interesting article on the current shortage of nursing, how smaller hospitals must compete with large institutions money on recruitment and retention.

Bonus – Discussion

Recent Missouri State audit in other hospitals directs bonuses be tied to performance metrics, defined before the eligibility time period.  The traditional Christmas Bonus will now be a retention bonus based on achieving Board-defined tasks, job performance expectations:

Full time employee-past probation period- $150

Part time employee-past probation period- $100

No active disciplinary action or action taken between this date and 12/9/17

Participated in insurance open enrollment in November

CareLearning up to date

Employed through 12/9/17.  Motion to approve criteria and amounts listed above by DeRosear with Fulk offering second.  Motion approved by majority vote.

Mo. Hospital Audit-Board Alert- The arrival of this resource material from MHA is excellent material to contribute to the educational series for the board members.  Lengthy discussion reviewing key points outlined in MHA Resource and Support documents pertaining to State Auditor conducting a series of audits of county-owned hospitals.  CEO Tobler led discussion on three main areas of focus. (1) State Audit Learning outlining specific objectives of the state audits. (2) Trustee Education and Resources and (3) Community Health Needs Assessment.   Board oversight importance on management of contracts, management compensation, service contracts/billing practices, loan agreement, travel reimbursement, CEO reportable wages, inpatient psychiatric care units, financial condition and computer security to name a few.  B Prather will request webinar material from MHA’s upcoming educational sessions.   Discussion time is allotted for educational purposes. 30 minutes.”

Disposition of Surplus Equipment- Permission to schedule surplus equipment via auction or” yard-sale”. Department supervisors were asked to make a cursory inventory of saleable equipment by Nov. 1.  Motion by Doubet followed by Neese with second.  Approval by majority vote.

Joint Meeting & December Meeting-  It was agreed upon to keep the regular monthly meeting date for December, which falls on Thursday, December 28, 2017 with February 22, 2018 meeting for Annual Joint Mtg. with Medical Staff.

Credentialing Report – Medical Staff has approved the following list of credentialing documentation.  Per recommendation and approval by Medical Staff, Motion submitted by DeRosear to approve.  Second by Fulk.              Motion approved by majority vote.

Full Privileges Given 9/19/17 – Maggie Barnidge, D.O. DWC Associate; Joseph Bass, M.D. HRHS Consulting; Andy Bukaty, D.O. DWC Associate; Christopher Gifford, D.O. DWC Associate; Karl Harmston, D.O. DWC Associate; Daniel Jost, M.D. PSN Associate; Senthil Krishnasamy, M.D. IEC Associate; Farukh Mian, M.D. Argus Consulting; Gary Morsch, M.D. DWC Associate; Christina Pinkerman, CRNA MB Anes; Allied Health; Tabitha Rohr, NP LMS Allied Health; Lorenz Schielke, M.D. Argus Consulting; Michael Turner, M.D. DWC  Associate; Richard Wolkowitz, M.D. PSN  Associate; Jamey Wright, M.D. Argus Consulting

*Dr. Wilson made a motion on 9/19/17 to approve the above listing for full privileges to the SCH   Medical Staff.  Dr. Rollison seconded the motion; motion carries.

Extended Temporary Privileges 10/9/17:

Karolyn Cook, M.D.-DWC

Theodore Cook, M.D.-DWC

*Temporary Privileges will expire 1/7/18. Dr. Martin made a motion to extend temporary privileges on Dr. Karolyn Cook and Dr. Theodore Cook. Dr. Wilson seconded; motion carries.  If there is no activity by expiration date, privileges will not be renewed per Dr. Rollison.  DocsWhoCare are requesting to keep their privileges active at this time due to being their emergency backups, if needed.

Temporary Privileges 10/19/17: John Fortner, Jr., CRNA MB Anes. Allied Health

*Temporary Privileges will expire 1/17/18.  Dr. Wilson made a motion on 10/19/17 to approve temporary privileges on John Fortner, Jr., CRNA.  Dr. Martin and Dr. Rollison both seconded; motion carries.

Full Privileges Given 10/18/17: Eldon Frazier, M.D. for Family Practice-ASSOCIATE; Andrea Graham, R.D., L.D. for Dietician-ALLIED HEALTH; Daniel Schneider, M.D. for Urology-ASSOCIATE

*Dr. Rollison made a motion on 10/18/17 to approve the above listing for full privileges to the SCH Medical Staff.  Dr. Martin seconded the motion; motion carries.

Re-Appointment and Privileges given 10/18/17: Jeffrey Davis, D.O. for Family Practice/Special Procedures/CRNA Supervision-ACTIVE; Marilyn Day, FNP-BC for Family Nurse Practitioner-ALLIED HEALTH; Maria Evans, M.D. for Pathology-ASSOCIATE; Belinda Fender, M.D. for Pathology-ASSOCIATE; Deborah Holte, DPM for Podiatry/Special Procedures/CRNA Supervision-ALLIED HEALTH; Neil Hoyal, D.O. for Emergency Medicine-ACTIVE; Julia McNabb, D.O. for Family Practice-ACTIVE; Jessica Christen, DNP, RN, FNP-BC for Family Nurse Practitioner-ALLIED HEALTH; Stephanie Henley-Pippert, FNP-BC for Family Nurse Practitioner-ALLIED HEALTH; Sonya See, WHNP for Women’s Health-ALLIED HEALTH; Lisa Rollison, D.O. for Surgery Services/Special Procedures/CRNA Supervision-ACTIVE; Lois Quenneville, PA-C for Family Practice

*Dr. Rollison made a motion on 10/18/17 to approve the above listing for re-appointment and privileges to the SCH Medical Staff.  Dr. Martin seconded the motion; motion carries.

Executive Session

Motion by DeRosear to enter Executive Session pursuant to Sunshine Law Sections 610.021 to discuss matters that pertain to: (1) Legal, (3) hiring, firing or discipline of employees, negotiated contracts and (13) individually identifiable personnel information.  Fulk offered second to the motion.  Motion approved by roll call vote:  Fulk yes, DeRosear yes, Doubet yes, Neese yes.   Time is 10:10 pm.

Those Present: Ebeling, Fulk, DeRosear, Doubet, Neese, Dr. Tobler, Dr. Rollison, Dr. Davis, Michael Brandon, Suzie Lister, Missy Smith, and Brenda Prather.

Approval of Executive Session minutes of 9/28/17. Motion by Neese and second by Fulk to approve.  Motion approved by roll call vote: Fulk-yes, DeRosear-yes, Doubet yes, Neese-yes, Wilson-yes.

Motion to exit executive session and adjourn regular open session by DeRosear.     Fulk seconds motion.  Motion approved by roll call vote: Fulk-yes, DeRosear-yes, Doubet yes, Neese-yes. Time is 10:58 p.m.


Motion by DeRosear to adjourn, with second by Fulk.  Motion approved by majority vote.  Time is 10:58 pm.