The Scotland County Hospital Board of Directors met in regular session on Thursday, May 24, 2018.  Those present: Curtis Ebeling-Chairman (arriving at 5:43 pm), Joe Doubet-Vice Chairman, Judy Wilson-Secretary (arriving at 7:15 pm), Robert Neese-Treasurer, Members: Dwight DeRosear and Lori Fulk.

Others present: Dr. Randy Tobler, CEO, Dr. Lisa Rollison, COS (via conference call), Elizabeth Guffey, RN CNO, Michael Brandon, Controller, Lori Nelson, RHC Supervisor, Ken McMinn, IT Supervisor, Stephanie Ketchum, LPN QA Data Abstractor and Brenda Prather, Recording Secretary.

In the temporary absence of Chairman Ebeling, Vice Chairman Doubet called the meeting to order at 5:33 pm.  Approval of the Open Session Agenda was approved by majority vote.  Approval of the Executive Session Agenda approved by majority vote. The consent agenda and approval of the April 24, 2018, minutes were approved by majority vote.

Michael Brandon, Controller, presented the Financial Report.  Gross patient revenue for April was $3,759,131; Net patient revenue per day was $55,238; Contractual percentage YTD was 53.31%; Expenses for April were $1,788,255.  Expenses per day was $58,863; Net profit before depreciation was ($1,755); Net loss YTD ($1,381,655).  Approval of accounts payable for April was approved by majority vote.

Randy Tobler, MD, FACOG, Chief Executive Officer, gave an administrative report with these highlights – Operations: Well Visit/Chronic Disease Management program, focusing on proactively engaging all our patients to get their annual checkups, plus “gap” care for those who are missing needed follow-up for diabetes/cardiovascular related diagnoses is underway.  High Performance Network is extraordinarily customer (our patients and our staff) friendly, service oriented and solutions focused for the normal hiccups in starting a new program.  Discussed call received by one board member.  Perhaps more explanation of purpose of call/service is required for initial contact.  Staff will work with call center to explain more details of the program on each call before asking to schedule the appointment.

The hospital has launched automated answering version 2.0 at Memphis Medical Services to accommodate the decrease in receptionists and direct access to clinicians’ staff more promptly.  A few years ago, this met with resistance.  Dr. Tobler encouraged feedback from the board and all staff as patrons respond to the new telephone call prompts at the clinic.

Calls to Memphis Medical Services at 465-2828 phone number, will result with the following five options: Press 1 – For emergencies / Scotland County Hospital; Press 2 – for office and walk-in hours; Press 3 – for the offices of Dr. Davis, Stephanie Henley-Pippert, Teresa Kirchner or Lois Quenneville; Press 4 – For all other physicians and mid-level clinicians at Memphis Medical Services;  All other calls, please press 0 to reach Memphis Medical Registration.

Meetings were held with staff regarding highlights of new employee health plan emphasizing free preventative benefits (previously an allowance of $500), incentives to use Blessing Hospital, other “preferred” facilities, and 340B pharmacies to maximize employee out-of-pocket savings, and new protections for “out of network/Reference based pricing” with a reasonable total out-of-pocket cap were met with approval.

Intermittent short-term diversion from Med-Surg admissions was needed around Memorial Day, and infrequently other times as new nurses are brought on board and yet more are recruited.

Dr. Tobler reported on an inpatient pharmacy meeting which proved to be productive with Senior Management of Pipeline Rx (Telepharmacy vendor) to discuss pricing, discrepancies in order volume, and service issues.  All issues addressed with resolution, including 8% reduction in fees, in recognition of our financial situation.  Additional cost savings in our inpatient pharmacist staff realized through cost reductions offered by Director of Pharmacy and identifying economical staffing alternatives.

Dr. Tobler along with Stephanie Ketchum, LPN, (Virtual Health (Telehealth) Coordinator) and Elizabeth Guffey, RN, will be meeting with Blessing and MU telehealth experts to begin a service line development plan.  Dr. Tobler and Sheryl Templeton, CFO, had a productive meeting with United Health Care contracting rep to renegotiate insurance reimbursement terms.  Dr. Tobler reported it’s a high priority to meet with other insurance companies to renegotiate better reimbursement terms, prioritized by volume and weakness of existing contract.

Under Medical Staff/Allied Health, Dr. Tobler reported on an interview with a Family Practice physician candidate on 4/23, but declined to make an offer as the candidate was determined to not be the best fit. The Executive Team continues to investigate novel retention tools.

Under Personnel: Dr. Tobler reported that Ashley Tharpe, RN, is the new OB supervisor.  She is one of the experienced OB nurses and a certified lactation consultant.  Being unable to identify a new housekeeping supervisor, CNO Guffey is acting supervisor and is occasionally the evening  housekeeper.  Stephanie Ketchum, LPN, assumed an additional role of Telehealth Coordinator.

Under Regulatory/Industry Trends, Dr. Tobler reported that the Missouri Legislature passed several significant bills.  These are the highlights: Improved Federal Reimbursement Allowance tracking and payment safeguard; Budget debate restored $106 million in Medicaid payment cuts for Missouri hospitals, but still resulted in an overall cut in Medicaid payments; Synchronized federal and state survey standards; Fixed Anthem Emergency Department and out of network coverage; Expanded Medicaid telemedicine coverage; DUI blood draws require consent or a search warrant; Expanded proximity standards and flexibility for collaborative practice arrangements.

Under Personal, Dr. Tobler reported he attended a Physician Leadership Training with courses in Emotional Intelligence and the Science of High Reliability.  The principles of Emotional Intelligence will be part of our supervisor Leadership Training Modules (per the Strategic Plan) and the High Reliability nuggets will be incorporated where appropriate into the Quality/Safety programs.  Additionally, later in the month he attended the Missouri Hospital Association Leadership Forum.  The emphasis was on tips for healthcare trustees and executives leading in uncertain times; healthcare professional burnout, management and prevention strategies; and, choosing to be emotionally intelligent in an era of chaotic healthcare industry transformation.

In Old Business, Dr. Tobler gave an update on financial stability efforts.  Cumulatively, projected savings over the next year are projected to be $388,400, with yet to be realized savings in the employee health plan and contract negotiations in progress.  Additional revenues are anticipated from the commercial insurance renegotiations as well.  He discussed departmental cost savings measures for contracted services, vendors, etc. that supervisors are negotiating.  Cost savings reports were submitted by Elizabeth Guffey, RN, for the following departments: Lab, Radiology, Nursing, Pharmacy, Housekeeping, Cardiopulmonary, Wound Care, Senior Life Solution, Maintenance, Social Work, OB and Oncology.  Travis Onken prepared a report on Materials Management. Ken McMinn submitted one for IT/Meditech contracting.  Alisa Kigar submitted a report for Public Relations/Marketing.   Work is underway to prepare for a possible USDA grant for Tiger Cub Care (In-house employee child care).

In new business, Michael Brandon, Controller, discussed the Finance Committee meeting that was held on May 22nd.

The meeting was held to discuss the capital and operating budget for FY ’19. The finalized budget will be presented at the June meeting.

Nelson, Ketchum, Brandon & McMinn exit.

Executive Session:

Those present for closed session were Ebeling, DeRosear, Doubet, Neese, Fulk, Tobler, Rollison (via conference call), Wilson (arrives at 7:15 pm) and Prather.

In closed session, the following items were discussed:

Legal & Personnel.  Contracts in negotiation were discussed.

Meeting adjourned at 7:40 pm.