The Scotland County Hospital Board of Directors met in regular session on September 28 in the SCH Library. Chairman Curtis Ebeling called the meeting to order at 5:38 p.m.

Those present were: Ebeling, Joe Doubet- Vice Chairman, Judy Wilson-Secretary, (arriving 5:45 p.m.) Robert Neese-Treasurer, and members Dwight DeRosear and Lori Fulk;  Dr. Randy Tobler; CEO, Dr.  Jeff Davis, CMO, Dr. Lisa Rollison, COS, Michael Brandon, Controller, Angela Schmitter, RHIT, Heather Ayer, RN, QI/RM Coordinator, Lori Nelson, RN-Clinic Supervisor, and Brenda Prather, recording secretary.

Financial Report – Michael Brandon, MBA

Brandon offered Report on Self-Pay Collections. $922,990 for 2016 compared to $598,179 in 2017.  Next month conversation on: progress and accountability, are policy changes required, success of procedures, customer service vs. customer accountability.  Hard stop for copays, etc.

Administrative Report – Randy Tobler, MD, CEO


C-arm for ortho, pain management, speech therapy purchased to replace our old one that failed suddenly.  Upgrade would not meet needs, so new one required. Cost $125,400

Stress testing equipment failed and was replaced. Cost: $18,650

Dan Culp consulted regarding utilization of funds received for roof repairs on 9/1. He recommended replacing 4 roof top units and adding a split unit. Further, he recommended budgeting and developing a plan for replacement of the EPDM roof over the next 5 years.  The metal roof damage was cosmetic, not functional, and does not require replacement.

Congratulations to Michael Brandon and the business office staff, especially Sheryl Templeton, Tammy Newland, Lynn Fincher for their participation in BKD field audit, completed timely and putting us on track for a comfortable audit timeline this year.

Day Care update: Visit from state surveyor regarding space and regulatory requirements and visit to Van Buren County Hospital Day Care Center by two nurses.  Dr. Rollison’s working group is planning on a business plan targeting the E annex space.

Pipeline RX began in September.  Basic function fine.

Medical Staff/Allied Health

Tabitha Rohr, FNP started at LMS September 3.

Dr. John Bailey, Orthopedics, started in RHC Monday afternoons 9/11/17, thrice monthly.  Staffing and EMR adjustment has gone smoothly.

Dr. Daniel Schneider, Urologist, started Wed 9/23, twice monthly.  Or readiness and clinic staff have received positive feedback.

Dr. Richard Wolkowitz, Pain Management, started 9/26, monthly.  10 cases his first day.


Cody Arnold, Informatics Supervisor and Laura Colvin, HER Educator, have resigned.  We are evaluating how to efficiently support the HER, including off-site Meditech dedicated consultant vendor.


MHA Rural Advocacy trip to D.C.  September 12 and 13. Emphasis: Preserving the 340B program.  A potential-26% savings impact has been proposed.

Keeping DSH payments whole in the wake of proposed healthcare reform

Regulatory relief.

CMO ReportDr. Davis

Quality Assurance

Attended QA and discussed results and employee satisfaction survey questions.

Reviewed dashboard details and emails of quality data from QA Director.

Currently 2 complaints regarding physician behavior in the ED

Senior Management

Met with Senior Management discussing strategic plan and management.  Focused on alignment and ACO opportunities.  Short term planning for physician staffing needs.  Including Senior Leader Forum at Tobler Residence with focus on Mission, Vision and Future of SCH.

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

Meetings with Lori Nelson, RN, Clinic work flow, Team Care personnel/staffing, 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 Dr. Tobler and Michael Brandon regarding clinician contract development.

Service Line Development

Recruitment and Retention

Old Business

Board Workshop 9/30/17.  Reminder to board members, administrative leadership and medical staff leadership

New Business

Annual CEO Report-  Review of 2016-2017.  Board asked to review and contact Dr. Tobler with any questions.

Highlights: *Implementation of 340B, IMG RX.  *lifted wage freeze *online p7p. *Access email on or off duty.  *QI huge advance this year (med staff leadership support and backing.)  Dashboards, monitoring.  *Financial: Business down, revenues up. Revenue cycle manager, financial navigator improved reimbursement. *Uncompensated care–$2,123,800.

Approve renewal of Malpractice Policy for physicians. $130,075 premium.  Dr. Tobler recommends continuing coverage with this group.   Motion by DeRosear to authorize CEO Tobler to enter into continued contract with HSG for is clinic physician malpractice coverage.  Second by Fulk.  Motion approved by majority vote.

Peer Review- 6 month-review completed by Dr. William Dixon.

Random Drug screen- 6 month-no inappropriate findings.

Employee Financial Assistance Request from Jennifer Clarke.  Jennifer currently works in lab as a medical technician and requests funding for Medical Technologist degree.  Motion by Fulk to approve $1,500 from SCH and she would receive $1,500 matching funds through scholarship by MHA. Second follows by DeRosear.  Motion approved by majority votes

Dates for November and December meetings.  Monday, November 27, 2017.  December remain December 28th.

Lease request for Pyxis.  Review of terms. Bank of Kirksville. 48 months capital lease, 3.6%. $4500/month.   Brief discussion resulted in Motion by Neese to approve lease agreement with BOK for Pyxis med dispensing machine, pending approval by USDA.  Second offered by Wilson.  Motion approved by majority vote.

Approve Meditech licensure amendment.  Amendment to current agreement adding addition licenses for new practitioners using Meditech. Will add 9 users.  Will add amendment to agreement. Motion to approve amendment to current agreement by Neese.  Second by DeRosear.  Motion approved by majority vote.

Renewal of Employee Health insurance.  Recommend to continue current self-insured coverage and change coverage for dental and vision from Guardian to Sun Life.  Pharmacy may see a small change in copay.  Motion by Doubet to approve administration’s recommendation to continue present coverage with modifications to vision and dental plans. Fulk offers second.  Motion approved by majority vote.

Informatics Consulting Contract.  Discussion of resignation of Cody and Laura and thoughts on not filling their positions but to utilize present personnel as a leader with oversight by consulting service “ENGAGE”. Tobler received proposal of 90 day (80 hrs./month).  Recommendation to Board was to enter into a trial period of 3-month pilot period for $10,000.  Motion by DeRosear to authorize CEO Tobler to enter into a 3-month trial period with ENGAGE. Further extended agreement pending on efficiency and effectiveness of service provided.   Second offered by Fulk.   Motion approved by majority vote.

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 and disciplinary action (13) individually identifiable personnel information.  Doubet offered second to the motion.  Motion approved by roll call vote:  Fulk yes, DeRosear yes, Doubet yes, Neese yes, Wilson yes.  Time is 8:06pm.

Those Present:    Ebeling, Fulk, DeRosear, Doubet, Neese and Wilson, Dr. Tobler, Dr. Davis, Dr. Rollison, Heather Ayer, and Brenda Prather.

Approval of Executive Session minutes of 8/24/17. Motion by Neese and DeRosear follows with second 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, Wilson-yes.  Time is 9:33 pm


Motion by Neese to adjourn, with second by Wilson.  Motion approved by majority vote.  Time is 9:33pm.