The Scotland County Hospital Board of Directors met in open session June 22 at 5:30 p.m. in the SCH Library. Present were   Joe Doubet, Vice Chairman; Judy Wilson-Secretary, (arriving at 6:05pm); Robert Neese, Treasurer; members Dwight DeRosear and Lori Fulk. Chairman Curtis Ebeling was absent. Also attending the meeting were Dr. Randy Tobler; CEO, Dr.  Jeff Davis, CMO, Elizabeth Guffey, RN CNO, Missy Smith, HR, Michael Brandon, Controller, Angela Schmitter, RHIT, Lori Nelson, Clinic Supervisor, and Brenda Prather, recording secretary.

QI Quality and Safety Report

Dashboard Prototype.  Heather has obtained data for matrix. Many departments will have their own individual dashboards.  Template graphs of dashboards presented measuring national averages/benchmarks quality followed on clinical outcomes, patient and employee satisfaction, Patient Harms (medication error, falls with injury, pressure ulcers, infections, etc.). Dashboard 2 compared with chart prototype.

Determine Board priorities-action item.  Question to Board at this time: Are there special areas not discussed or mentioned to be added as markers?  Additional areas may be added or changed over times. Motion by Fulk to include this benchmark in monthly meeting agenda.  Second offered by Neese.  Motion approved by majority vote.

With reference to recent QI and Safety Committee meeting, there were some questions regarding:

concerns of painting curbs in multiple areas of the parking lots.

SCCC patients accessing IEC through SCH and MMS hallways. Discussion of policy to be developed requiring attendant from SCCC or MMS offering transport employee.

New door into SCCC, security lock ready to go live.

Discussed readmissions.  CareSync following chronic care patients. Potential reimbursement penalty in the future for CAH, but “brand” penalty with transparency initiatives publicizing our data,  danger of outside physicians’ patients readmitted.  Important to stay on top of CMS data, penalties and incentives.

Financial Report – Michael Brandon, MBA

Finance Report and Balance Sheet, Income Statement, Stats presented to the board. Approval of June A/P.  Motion by DeRosear to approve June A/P listing.  Fulk offered second.  Motion approved by majority vote.

Administrative Report – Randy Tobler, MD, CEO


Received a letter announcing audit for Medicaid FY ‘16 EMR incentive

Consensus from clinical team evaluating BHS EHR recommending no transition from Meditech

Infrastructure and plans for pilot implementation of more efficient MMS workflow in progress.  Dr. Davis’ team will pilot before adopting across all practices.

CCM (Chronic Care Management) initiative progressing with 3rd party vendor (Care Sync) and an internal pilot team (Dr. Davis, Dr. Wilson, Jessica Christen, DNP).  Identification and enrollment process anticipated in 1-2 months.

E-911 update-discussions with Knox County officials indicate “piggybacking” with Macon E-911 efficient and affordable. We are investigating contracted vs. alternative of a home grown dispatching service

Business office buildout in progress.  Move planned early July.

Hail storm 6/17 damaged 2 rooftop air handlers beyond repair. Emergency replacements arrived today and will be replaced by tomorrow start of business.

340B Pharmacy update:  Volume is growing steadily.  Promotional material references the participating pharmacies, and explains the programs advantages to patients and the financial support of our mission.  Our third party vendor confirming 340B eligibility is now able to have a cash discount program.  Demo and implementation anticipated.

Day Care at SCCC exploratory group led by Dr. Rollison ongoing.  Current venue focus: Annex building.  Business plan in development.

Discussion with alternative providers of desired service lines not available through our BHS affiliation ongoing 6/9

Discussion with Hannibal Regional Health system regarding their recent business venture in our service area, expressing our desire to provide the best care and experience for their patients referred to SCH.

CoP (Conditions of Participation) Pharmacy Regulation Webinar 6/19.  Reviewing, adjusting and creating P and P as needed.

Phone call with Loretta Prater PhD, Chair of Missouri Foundation for Health Community Advisory Council discussing funding opportunities for an intergenerational, community-collaborative, sustainable “Food is Medicine” program on our campus.  Exciting possibilities connecting many SCH, SCCC, and community constituencies.

Medical Staff

Pain Management Service contract with PSN for services of Dr. Richard Wolkowitz executed.  Start date TBD, likely in August, following credentialing.  One day initially, with potential of more.

Contract sent to part time Neurologist, awaiting response

Dr. Hoyal assumed E.D. Medical Director 6/1, Docs Who Care will be supplying Mon/Tues. E.D. coverage and overnight med/surg coverage starting 7/1

Internal medicine physician contacted and after initial interest has declined further discussion.


Elizabeth Guffey, RN accepted new Chief Nursing Officer position which expands DON role and is added to the executive leadership team (CEO, Controller, CMO, COS, CNO). She will continue to administer the E.D. and Oncology service. We welcome her servant-leader style, and proven problem-solving abilities

Revenue Cycle Manager applications received, interviews and selection will be completed by mid-July

Conference Highlights

SLU 27th Annual Geriatric Conference, June 5-6. Attended with Dr. Wilson.

Supported by the NE regional AHEC office in Kirksville, speakers from around the world and locally presented talks and workshops on health aging and the management of patients with MCI (Mild Cognitive Impairment) and Dementia.  Headlines:

Programs emphasizing lifestyle interventions (nutrition, activities, “brainwork”) perform as well or better than medicines alone for MCI and established dementia

Universal screening for frailty, muscle loss, nutritional and cognitive status of patients using a 5-minute tool (Rapid Geriatric Assessment) identifies a target population for early intervention.  The Medicare Annual Wellness Exam is a great opportunity to administer this screening test-handout

Polypharmacy is a growing and serious problem in an aging population with multiple conditions, cared for by multiple clinicians.

Early intervention slows progression

Mediterranean diet is healthy for prevention and treatment of geriatric decline

Perry County Hospital in SE Missouri has an extraordinary, effective and comprehensive program funded by a community children/seniors tax.

Dr. Tobler previewed and led discussion on the questionnaire used by St. Louis University Rapid Geriatric Assessment

MHA Leadership Forum, June 15-16.   Highly recommended Board try to attend next year: May 16-18, 2018

Directed to Hospital Trustees and Executives, aimed at identifying industry trends, challenges, and strategic solutions


The fiduciary responsibility of trustees is intimately dependent on engagement with Quality and Safety:  Carrots/Sticks/Brand

The new normal is that payers (government and commercial) are paying for value, not simply volume

Value = Quality/Cost

Quality= Outcomes + Safety + Patient Experience

Change is here to stay

Changed Payment: VALUE, More risk for providers, Transparency

Changed Care: Population health, Focus on the 20% of patients that use 80% of resources

Changed Experience: Patient engagement, Consumerism rules

Data collection and analysis is critical to successful transition to the new normal

Hospitality creates a healing environment and engages patients àWin-win

One journey of a large public indigent hospital involved culture transformation. The organization’s mantras/values: OWN IT, SEEK JOY, DON’T BE A JERK

Integration into networks a likely necessity

National Health Policy will NOT abandon the current trajectories (above) set under ACA

Nursing workforce is getting younger as baby boomers retire.  Good news: Large increase in nurses with BSN and APN degrees in the next 10 years.   Challenges: Aging/sicker patient population’s needs cannot be met solely by nurses, particularly in context of physician shortage.  Teams of contributors (social work, pharmacists, therapists, community resources, churches, health departments, social agencies) will be needed to deliver care in a different way.  Nurses are not presently engaged with concepts of Value replacing Volume.

Millennials will dominate the workforce shortly.

Managing millennials’ expectations of work-life balance is hard

AHA and MHA have resources on their respective sites.  Recommended summer reading! – handout

SCH should have a dedicated self-inspection of our future strategic direction recognizing industry trends, patient expectations, our capital muscle, and paths to achieving our mission and vision

CMO ReportDr. Davis

Quality Assurance

Attended the QA & S committee meeting with Directors DeRosear and Fulk.  Reviewed minutes. Discussed on patient accident/injury outside on our campus.  Discussed options for prevention and improved safety/patient flow to IEC.

No physician complaints reviewed since last board meeting.

Senior Management

Met with Senior Management discussing strategic plan and management and administrative issues.

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

Meetings with Lori Nelson, RN, Clinic Manager regarding clinic work flow, personnel, scheduling and physician relations.

Clinician Relations

Ongoing communication with clinicians regarding clinical operations.

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

Meeting with Jessica Christen, NP to discuss processes, chronic disease management clinic and clinician satisfaction.

Service Line Development

Traveled with Lori Nelson and delegation from Informatics, nursing and administration to Blessing Hospital at the end of May to review their outpatient family medicine clinic workflow design.  Have been working with Lori and Libby on nurse scribing piece.  Working with Lori on Patient Access Representative process design and location.  Making a concerted push for SCH brand model of Team Care at MMS.  Planning a 2 clinician pilots with future plans of rolling out and training the rest of the clinicians the model for improved patient access, patient satisfaction, nurse and clinician satisfaction and timely EHR chart/record completion.

Teresa Kirchner, NP is working full-time and collaborating with me.  Some days very busy.  Others a little lighter.  Depends on Walk-In Clinic volume.

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

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.

Recruitment and Retention

Merritt Hawkins FP search has thus far only turned up one lead.

Decided not to move forward with Dr. Jim Bowers in Lancaster.

Contract in place with Tabitha Rohr, NP at Lancaster.  Will begin July 31st.

Participated in discussions and phone contact with IM physician from Kirksville.  Currently not looking good.

Dr. Tobler had 2nd year resident from Blessing Hospital who is from the area visit this week.  Met briefly with them.  Will begin working on new contract for her to review.

Old Business

Bank Depository Agreement Update. After the May meeting and action by Board to continue banking services through Bank of Kirksville, provided the interest rate could be increased, M. Brandon contacted Bank of Kirksville regarding this condition. He learned that, in fact, the rate would actually be decreasing. With this information, Brandon has submitted letters to other local banks requesting their bids for these services.   To be presented next month.

New Business

2018 Capital and Operating Budget. M. Brandon detailed assumptions and analysis, proposed rate increases, revenues, expense trends, departmental capital budget items which encompasses the proposed budget documents. Following discussion and questions, Motion was made by DeRosear to approve both Capital and Operating Budgets as proposed    Wilson offers second to the motion and this carries by majority vote. Signatures from Vice-Chairman Doubet and Treasurer Neese were obtained.

Approve Hospital General Liability Insurance Proposal in the amount of $114,135 ($118,349 in 2016).  Motion to approve continued coverage with HSG by Neese with second from Fulk.  Motion approved by majority vote.

D & O Insurance, (Directors and Officers) Motion by DeRosear to extend coverage for Director’s & Officers Liability, Employment Practices Liability and Third-Party Liability, however decline the crime coverage.  Second by Fulk. Motion approved by majority votes.

Executive Session

Motion by Neese to enter Executive Session pursuant to Sunshine Law Sections 610.021 to discuss matters that pertain to: Sections (1) Legal Matters (13) Individually identifiable personnel information.  Wilson offered second to the motion.  Motion approved by roll call vote:  Fulk yes, DeRosear yes, Neese yes, Wilson yes.  Time is 8:30 pm.

Those Present:    Doubet, Fulk, DeRosear, Neese and Wilson, Dr. Tobler, Dr. Davis, Missy Smith, and Brenda Prather.

Approval of Executive Session minutes of 5/25/17. Motion by DeRosear and second by Wilson to approve.  Motion approved by roll call vote: Fulk-yes, DeRosear-yes, Neese-yes, Wilson-yes.

Motion to exit executive session and adjourn regular open session by Fulk with DeRosear offering second.    Motion approved by roll call vote: Fulk-yes, DeRosear-yes, Neese-yes, Wilson-yes.  Time is 10:22 pm

Dr. Tobler queried board interest in scheduling a casual Saturday strategic planning event later in the fall with board members, senior, leadership team.  General consensus was in agreement and a date will be suggested.


Motion by Fulk to adjourn, with second by DeRosear.  Motion approved by majority vote.  Time is 10:22 pm.