The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, June 27, 2019. Board members present: Curtis Ebeling-Chairman, Joe Doubet-Vice Chairman, Lori Fulk-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear and Joni Lloyd.

Personnel present: Dr. Randy Tobler, CEO; Dr. Jeff Davis, CMO; Dr. Lisa Rollison, COS; Michael Brandon, Controller; Elizabeth Guffey, RN, CON; Angela Schmitter, RHIT-Compliance; Suzie Lister, Revenue Cycle Manager; Lori Nelson, RN, RHC; Missy Smith, HR; Alisa Kigar Marketing Director; Jamie Kice, Maintenance; Abigail Manco, Day Care Supervisor; Lacie Snyder, RN; Robin Seppelt, LPN; Stephanie Henley-Pippert, NP; and Brenda Prather, recording secretary.

Guests: Donetta Fountain, Pam Shalley, Joanne Aylward, Noralyn Armstrong, Jan Slayton, Sandra Blake and Heliene Tobler.

The meeting was called to order at 5:39 p.m. After approval of the Open Session Agenda and Executive Session Agenda, Chairman Ebeling offered public comment. Sandra Blake read a letter from Lee Shultz.

The Quality Corner report was given by Terri Schmitt, QI and Safety Director via teleconference. She shared a power point presentation focusing rationale and procedure of the new Policy & Procedure titled Service Recovery for Patient Complaints and Grievances.

Michael Brandon, Controller, presented the Financial Report for May.  

Gross patient revenue for May was $4,125,477; Bad Debt, Charity Care and other Deductions for May was: ($881,050); Net Patient Revenue, May: $1,522,615; Net Patient Revenue Per Day, May: $56,657; Total Operating Expenses for May $1,836,377; Expenses per day for May was $59,715; Net Profit/Loss May: $(428,065); May Tax Revenue: $44,932.57; Net profit/loss before depreciation for May 2019 was ($338,805); Net loss YTD ($1,824,040); Net Profit (Loss) YTD FY 2018 ($1,569,242); Net loss YTD before Deprecation ($374,393)

Michael Brandon reported another Meditech (Electronic Medical Record Platform) problem discovered by AVEC (Revenue Cycle Management Solutions). This has resulted in exaggerated bad debt estimates, artificially increasing apparent losses.  

Further discussion ensued on the trend of under-utilization of services by the community. It remains unclear why SCH’s value-driven, high quality care, safety initiatives and wide variety of specialty services are being accessed at other facilities more remote.

Dr. Randy Tobler gave the Administrative Report, starting with Operations. On June 25th he attended a meeting at Hannibal Clinic, hosted by Crossriver Quality Health Partners (CQHP) at which clinician dashboards were finalized, geared to measure and report quality performance.

On June 7th he attended an affiliation meeting with Blessing Health System Senior Leadership, along with Dr. Davis, Elizabeth Guffey and Michael Brandon. At the meeting discussion was focused on mutual vision of sustainable healthcare throughout our service regions.

Dr. Tobler reported that the City of Memphis miscalculated an electric service meter reading at the hospital and the City has made adjustments to correct future billing.

He is reviewing, in advance, upcoming employee health plan renewal.

He gave an Environment Control System update, with comments from Jamie Kice, Maintenance Supervisor.

Dr. Tobler reported that SCH hosted six local employers to discuss a direct contracting payment model. This model bypasses the insurance industry’s control of the revenue stream. The goal is to keep quality care local and more affordable for the vast amount of basic healthcare services accessed.

He reported that Patient Suggestion boxes will be placed in all patient access points.

The ATM in the main lobby is being removed by the Bank of Kirksville’s on account of regulatory changes.

Dr. Tobler reported that the disposal of excess equipment during the recent City-Wide Garage Sales netted $350.

SCH received a large professional liability premium dividend from Hospital Services Group (Provider of Medical Professional Liability Insurance). 

Under Dr. Tobler’s Medical Staff report, he reported a developing plan for pain management expansion through CRNA (Certified Registered Nurse Anesthetist) services.

Under Dr. Tobler’s Personnel report, he announced that Nick Herrmann, PharmD assumes hospital Director of Pharmacy duties on July 1.

He discussed a new approach for internal communication called “Townhall House-calls”. He will begin rotating department to department for CEO communication directly with that group of employees. This is in response to poor attendance of previous all-employee Town Hall Meetings.

Dr. Davis submitted the Chief Medical Officer report with these highlights. S.T.R.E.T.C.H. L.A.P.S. took place on June 10 and departments are becoming more engaged. He reported on Participating in MHA (Missouri Hospital Association) Quality Initiative webinar June 24th and the Crossriver Quality Health Partners Depression Screening/Meditech meeting at SCH on June 25. He reported the Service Line Analysis Committee met on June 18 to discuss data. He met with Lori Nelson, RN, Clinics Supervisor and clinicians on chart completion and improved documentation for AVEC. He attended an Advanced Traumatic Life Support course in St. Louis and he has been elected as Missouri’s Caucus Chairman of the American Osteopathic Association House of Delegates.

Under Old Business, tree removal at LMS and MMS was discussed with rebid criteria.

Chairman Ebeling reconfigured the Affiliation Committee members to include Chief Medical Officer, Chief Nursing Officer and Chief Financial Officer, Chief Executive Officer, Chairman Ebeling, Joni Lloyd and Bob Neese.

Regarding the EMS/Ambulance separation terms, Dr. Tobler reported a letter received from Ron Tinkle regarding terms of the agreement. Dr. Tobler will follow up and finalize transfer of management and extend repayment period to six (6) months per unanimous vote.

Dr. Tobler gave the 340B Discount Drug Program report along with the annual meeting of SCCHDS (Scotland County Community Health Development Services) and the SCH Foundation. There was discussion on the distinction in programs and services between Memphis Community Pharmacy and the two independent, privately owned retail 340B contract pharmacies. Dr. Tobler reported that the SCCHDS d/b/a Memphis Community Pharmacy is performing well with margins that will flow through the Foundation as dividends to benefit Hospital services. Per motion and unanimous Board approval, SCH will invite independent regional privately owned retail pharmacies to enter into 340B contracts, with standardized terms, operating conditions and dispensing fees currently in place with the independent, privately owned retail 340B contract pharmacies.

Regarding the Knox County clinic, Administration is looking at different operational models. Per unanimously approved motion, SCH will proceed, contingent on updated proforma and USDA approval to authorize SCH CEO to contract with consultant to complete certification process.

Guests exited at 7:50 p.m.

Under New Business, the Scotland County Memorial Hospital (dba Scotland County Hospital) District Bylaws Amendments regarding annual election of directors, annual meeting schedule, regular meeting date changed to last Tuesday of each month was approved by a unanimous vote.

Michael Brandon gave the 2019-2020 budget presentation. Proposed operating and capital budgets for fiscal year 2019-2020 were approved by unanimous vote.

Dr. Tobler reported that there is a new revised Policy & Procedure (P & P) review process which has policies converted to an Intranet program. Administration & the P & P Committee are in the process of cleaning up policies, revising, approving, consolidating in preparation for review by the Board in July.

The Board approved to extend the Depository Agreement with Bank of Kirksville by unanimous vote.

The Board approve the Manager Agreement for the SCH CEO to join the CQHP Board.. Dr. Tobler will contribute the reimbursement received from the CQHP board meetings to SCH.

Board correspondence received and filed in the Board records.

Remainder of guests exit.

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

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

Meeting adjourned at 10:52 p.m.

The Board invites the community’s questions and suggestions. If a local tax payer wants to hear the discussions about their local hospital, please attend the board meetings. Public comment policy and request for time are available online at and at the hospital’s Administration Office. The next meeting is Tuesday, July 30, 2019, in the hospital conference room at 5:30 p.m.