The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Tuesday, October 28, 2019. Curtis Ebeling-Chairman, Joe Doubet- Vice Chairman, Lori Fulk-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear and Joni Lloyd. Administrative & personnel present: Dr. Randy Tobler; CEO, Dr. Jeff Davis, CMO, Michael Brandon, Controller, Angela Schmitter, RHIT-Compliance, Lezah Cline, Quality & Safety, Lori Nelson, RN, RHC, Missy Smith, HR, Alisa Kigar, Communications Specialist, Kathy Overhulser, HR, Jamie Kice, Maintenance, John Fortner, CRNA and Brenda Prather, recording secretary.

Guests: Sandra Blake, Lee Shultz, Jan Slayton, Brenda Wilson. Jeff Encott, Ken Kalick, Isaac Mille

Chairman Ebeling called the meeting to order at 5:30pm. After approval of the Open Session Agenda and Executive Session Agenda, Chairman Ebeling offered a public comment opportunity. Lee Shultz spoke and exited. Sandy Blake spoke.

Quality & Safety

The Quality Corner report was given by Terri Schmitt, QI and Safety Director via teleconference. She presented the Just Culture policy and coordination into adjoining policies. Tobler pointed out that the group of policies created and implemented by QIS Dept. including Code of Conduct, Just Culture, Safety Event Reporting, and Corrective Action Policy bring SCH into alignment with best practices of the finest facilities nationwide.

The Financial Report was presented by Michael Brandon, MBA, Controller. 

Gross patient revenue for September: $3,639,006

Net Patient Revenue for September: $1,825,665

Net Patient Revenue Per Day: $55,642

Expenses per day: $59,200

Total Operating Expenses for September: $1,851,446

Net Profit/Loss for September: $6,895

Net profit/loss before depreciation for September 2019: $77,945

 Net profit (loss) YTD 2019: ($444,000); Net Profit (Loss) YTD 2018: ($497,922);

Net profit (loss) YTD before Depreciation: $190,040

Joint Advisory with Medical Staff

In Dr. Rollison’s absence, Dr. Jeff Davis, CMO, highlighted the last Medical Staff Meeting which involved discussions about Code of Conduct, Medical marijuana, and routine re-credentialing. Also discussed and to be further developed were levels of medical staff i.e. active, associate, courtesy member and coordinating with Medical Staff Bylaws.

The Medical Staff continues to discuss marijuana, as it relates to Missouri law and SCH policy.

Administrative Report

Dr. Randy Tobler, CEO, opened his report by clarifying that the perception stated by a local resident during a recent meeting with him, suggesting that SCH could become a “micro hospital” was inaccurate. He further explained that both operationally and with respect to affiliation negotiations, all actions taken are meant to avoid downsizing and that worst-case scenario, a new model that CMS is being proposed for endangered rural hospitals to maintain services.

Under the Operations Report, Dr. Tobler reported that 340B Drug Program agreements have been approved with Benzer Pharmacy in Lancaster, Clark County Pharmacy in Kahoka and Scotland County Pharmacy in Memphis to start on Jan.1, 2020. All have registered with the Office of Pharmacy Administration. He reported that the Scotland County Hospital Foundation has been granted 501(c)3 status by the IRS as a Type II Service Organization. There will be fundraising activities, such as the cookbook project, to raise funds to support the Hospital. Under Personnel, he reported that Kathy Overhulser, PHR, has been hired as the new HR Coordinator. Under advocacy, he reported he is on the MHA Medicaid Payment Reform Committee and Rural Hospital Subcommittee, and a slate of recommendations is in progress, with eventual presentation to DHSS and the Governor. He further announced that he will be attending the MHA Annual Meeting later in the month and he has been accepted for American Association of Physician Leaders’ Capstone session next Feb. This will result in Certified Physician Executive designation.

Chief Medical Officer Report

Dr. Davis reported on the Quality Assurance & Safety Committee met on Oct 9. He reported the committee looked at the Just Culture plan for implementation and discussed Code of Conduct success. He participated in three Crossrivers meetings; October 2nd, 8th and 22nd. The Senior Management Team met to discuss 340B Pharmacy contracts, affiliation update, Code of Conduct rollout, Employee health plan discussions, Crossriver metrics data and Caravan ACO progress. He participated in the Caravan Accountable Care Organization (ACO) Kickoff Meeting on Oct 23rd with Caravan and potential population health team members of SCH. He reported that he is in discussions with nurse practitioner candidates for potential clinician at the Edina Rural Health Clinic and SCH is in the beginning phases of looking into a more robust Telehealth coverage for the Emergency Department and inpatient care (nights & weekends) areas with on-site NP presence. Dr. Davis attended the Osteopathic Medical Education Conference in Baltimore, MD with the American Osteopathic Association (AOA) Leadership and will attend the Fundamentals of Physician Leadership through the American Association of Physician Leaders gaining 31.5 hours of CME.

Old Business

Dr. Tobler discussed the Annual CEO Report. He reported to the board the document they have is a draft as final financial audit figures are not available as of this date. He gave updates on the the 340B Drug Program. He reported that Blessing is in complete agreement to partner with SCH on the Edina Clinic project and recruitment of staff is ongoing. He reported that he is waiting on the Blessing Health Services Affiliation/Integration proposal.

New Business

Dr. Tobler reported on the Employee Health Plan Benefits. There was discussion to recommend a change in employee incentive to get services locally, to not raise premiums and no or little change for deductible for local, tier 2 and 3 higher and finally, to raise copay to $50 for tier 2 and 3, and reduce level 1 (SCH) to a $25 copay. Another recommendation is to take away the copay for an emergency room visit and urgent care. A further recommendation is for our Rural Health Clinic-performedtests (such as urinalysis, diabetic capillary blood glucose, pregnancy test, etc) be waived and covered under clinic copay for employees. A motion was moved and unanimously approved to accept these recommendations. Thermal Mechanic Inc. presented their report on contracted renovations to the Oncology service area. Jeff Escott-After Market Specialist, Isaac Mille-Engineer, Ken Kellick-Project Manager gave the presentation which also included a full analysis and strategic plan for the facility’s HVAC system. A motioned was moved and approved regarding the medical staff credentially. The Hospital’s Medical Marijuana Policy was discussed. The board consensus is to continue with developing a conservation approach with the Missouri Hospital Association providing guidance through templates and advisories. Two bids were received for snow removal. Consensus of the board was to open and choose lowest bid. Sports Physicals were discussed. A change in procedure has been recommended in order to considerably lower expenses for the Hospital by offering the MSHAA mandated physicals to students for $10 in the clinic, after hours, with clinicians donating their time.  Board consensus in agreement with recommendations.

Guests exit at 8:20 pm

Closed Session

Those Present: Ebeling, DeRosear, Doubet, Fulk, Lloyd, Neese, Dr. Randy Tobler, Dr. Jeff Davis, Michael Brandon, and Brenda Prather. Jeff Escott, Ken Kalicak and Isaac Miller invited to stay for further negotiation of HVAC.

The following items were discussed: Legal matters and individually identifiable personnel information

Meeting adjourned at 10:30 pm

The Board invites the community’s questions and suggestions. If a community member 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, November 26, 2019, in the Hospital conference room at 5:30 pm.