The governing board of the Scotland County Hospital met on Thursday, December 28th at 5:30 p.m. Present were Curtis Ebeling-Chairman, (arriving 6:00 pm), Joe Doubet- Vice Chairman, Judy Wilson-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear, Lori Fulk (arriving 5:40 pm.) Others present were Dr. Randy Tobler; CEO, Dr.  Jeff Davis, CMO, Michael Brandon, Controller, Elizabeth Guffey, RN, CON, Heather Ayer, RN, QI/Risk Management, Alisa Kigar, Ashley Harvey, RN, Lacey Snyder RN, Missy Smith, HR and Brenda Prather, recording secretary.

Financial Report – Michael Brandon, MBA

The finance report showed Patient Revenue – Gross Patient Revenue November 30, 2017 – $3,311,760


Contractual and SCH discount percentage YTD is 53.22%

Net Patient Revenue November 30, 2017 – $1,666,590

Net Patient Revenue per day $52,895

Expenses November 30, 2017 – $1,773,555; Expense per day – $58,005

Net loss (after Depreciation) November 30, 2017 – ($113,100)

Net Profit (before Depreciation) November 30, 2017 – $17,020

Net Loss YTD (after Depreciation) November 30, 2017-($937,026)

Net Loss YTD (before Depreciation) November 30, 2017-($291,792)

Approval of December A/P.  Motion by Neese to approve.   Wilson offered second. Motion approved by majority vote.

Mr. Ebeling arrives at 6:00 pm and resumes lead of the meeting.

Administrative Report – Randy Tobler, MD, CEO


Hospital License renewed for CY 2018

$15,383 professional liability refund from MLA for SCH Physician Group (clinic based physicians)

$22,500 payable to Medicaid for PY 2015 adjustment to HER incentive payment, notice received, reviewed and approved by our auditor.

HIDI (MHA’s Healthcare Industry Data Institute) senior staff member was on site and led SCH leadership and marketing specialist in a webinar 11/29, to instruct on building reports to track utilization/market trends.

Senior Life Solutions (SLS) (mental health care for the elderly) kickoff meeting 11/29 with SLS leadership, regional manager and all involved SCH staff.

Memphis Community Pharmacy staff hosted an informational meeting 12/6 for SCH clinical staff to update them on 340B operations and hear suggestions for improvement in products/services

Townhall meetings AM and PM 12/18 for employees discussing recent employee survey, committees to address 4 areas of concern, FY 2017 clinical and financial summary and overview of Strategic Planning process

Tour and visit of SCH by Rep. Craig Redmon 12/19, listening to leaderships concerns for patient care and our expectations from Missouri healthcare policy, including overregulation, Managed Medicaid introduction into our area, Anthem’s policy of retroactive denial of unilaterally determined “unnecessary” E.D. visits, the growing disparity between cost/reimbursement of healthcare threatening our long term sustainability, duplication of services, sponsored by the state, and unfair competition as a result.

Digital Radiology equipment (cassettes and software) contract in final negotiations.  Charge master review vendor review in process.  Recommendation will be brought for January meeting consideration

Board invited to attend meeting with Blessing Administration, Wednesday, January 3, 2018 2 pm.    Curtis Bob and Wilson Affiliation Committee

Medical Staff/Allied Health

Pain Management (Dr. Wolkowitz-monthly) and Urology (Dr. Schneider-2 x monthly) practices growing rapidly with patient comments uniformly favorable.

Dr. Eldon Frazier (Family Practice) clinic started 12/1.  Seeing walk-ins, same day and scheduled appointments, daily census growing as anticipated.  Reports from receptionists are very positive.


Staffing shortages aside from Nursing have led to our recommendation to the Board for generalizing the just approved Critical Nursing Shortage Compensation Policy.


I recently completed the annual American Board of Obstetrics and Gynecology annual recertification and safety requirements

Plan on pursuing Certified Physician Executive or MBA through American Association of Physician Leaders

CMO ReportDr. Davis

Quality Assurance and Safety

Attended QA Committee Meeting and discussed quality results, progress on employee focus groups, and strategic planning status.

Reviewed dashboard details and discussed HCAHPS scores.

Senior Management

Met with Senior Management following November Board Meeting to work further development of the strategic plan.  Reviewed board recommendations for strategic plan.  Discussed current hospital management strategies.

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

Meetings with Lori Nelson, RN, Clinic Manager regarding clinics personnel/staffing, scheduling and physician relations.

Attended Medical Executive Committee meeting.

Attended Webinar from HIDI/MHA on data extraction and current results.

Clinician Relations

Meetings with Dr. Tobler regarding clinician contract development.

Clinician job performance reviews and contract discussions conducted this month.

Service Line Development

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 continues with Urology services at MMS.

Dr. Wolkowitz continues with pain management services at Surgery Center.

Dr. Jost has replaced Dr. Garriga for Rheumatology services and continues seeing patients.

Dr. Eldon Frazier began at MMS for Family Medicine services December 1.  Seeing several patients.  Not many scheduled patients yet.  Overflow/walk-in.

Dr. Senthil Krishnasamy will be providing cataract surgery and ophthalmology services in January.

Old Business

Child Care Project Update.  Ashley Harvey and Lacie Snyder outlined the Business Plan, Balance Sheet and description of start-up costs for “Tiger Cub Care” pilot day care for employees’ children. Discussion followed; resulting in Motion by Fulk to approve and move forward. Motion approved by majority vote. Discussed options for additional employee and/or community capital funding events.

Patient Financial Responsibility Policy had revisions to section III- Financial Assistance.    Motion by Neese to approve revisions.  Second to motion given by Doubet.  Motion approved by majority vote.

Approve Annual Report Amendments with audited financials.  Motion by DeRosear to approve with updates. Fulk seconds and motion approved by majority vote.

Amend and Rename Critical Nursing Shortage Compensation Policy changes to reflect areas of the facility that may be affected by staffing shortages.  Motion by Fulk to approve Critical Staffing Shortage Compensation policy. Second offered by DeRosear with approval by majority vote.

New Business

Board Education Series, Module I, II and III–Review and attestation forms completed for year.

Strategic Plan Update.  Ongoing; upon completion, draft will be present for final approval.

Approve MHA Membership Dues.  Motion by DeRosear to approve, Neese seconds. Approves by majority vote.

National Health Service Corp-.  Due to changes in application criteria and following discussion and recommendation by CEO Tobler, Motion by Fulk to suspend program participation.  DeRosear seconds.  Approved by majority.

Approval of Medical Staff Appointments- Motion by Fulk to accept the list of reappointments per medical staff approval.        DeRosear seconds and 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 Matters, (3) Hiring, firing and discipline of employees (13) individually identifiable personnel information. Neese offered second to the motion.  Motion approved by roll call vote:  Fulk yes, DeRosear yes, Doubet yes, Neese yes, Wilson yes.  Time is 8:30 pm.

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

Approval of Executive Session minutes of 11/27/17. Motion by DeRosear and second by Neese to approve.  Motion approved by roll call vote: Fulk-yes, DeRosear-yes, Doubet yes, Neese-yes, Wilson-yes.


Discussion of physician employment contracts.

Legal.   Discussed affiliations and upcoming discussion with current affiliate Blessing Health System.

Motion to exit executive session by Doubet.  Second by Fulk.  Motion approved by roll call vote:  Fulk yes, DeRosear yes, Doubet yes, Neese yes, Wilson yes.  Time is 9:45 pm.


Motion by Doubet to adjourn, with second by Fulk.  Motion approved by majority vote.  Time is 9:45 pm.