The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Thursday, November 29, 2018.   Board members present: Joe Doubet-Vice Chairman, Bob Neese-treasurer and Members Dwight DeRosear and Lori Fulk. 

Vice Chairman Doubet called the meeting to order at 5:38 pm. 

Heather Ayer Heather Ayer, RN, Quality Improvement & Safety, gave the”Quality Corner” report, highlighting facility-wide”dashboards” that track progress in several key areas: Patient Satisfaction, Safety, and Hospital Financial Performance.  Revisions in the patient fall prevention plan were presented by Chief Nursing Officer, Elizabeth Guffey, RN.

Michael Brandon, Controller, presented the Financial Report for October.  Gross patient revenue for October was $3,820,630; Bad Debt,Charity Care and other Deductions for October was: ($151,050), Net Patient Revenue, October: $1,695,095, Net Patient Revenue Per Day, October: $55,225;Total Operating Expenses for October $1,851,280.  Expenses per day for October was $59,605; Total Operating Profit/Loss October: ($191,880), October Tax Revenue: $42,680, Net profit/loss before depreciation for October was($68,740); Net loss YTD ($689,800).

Randy Tobler, MD, Chief Executive Officer, gave an administrative report, startin gwith operations.  Details regarding the employee health plan were discussed.  The Tiger Cub Care Childcare facility is nearing completion with fire/safety inspection to follow. The Child Care Director search is on-going. 

The Revenue Cycle Improvement Project experienced some initial IT connectivity and workflow problems for remote billers/coders. These have been largely resolved and as anticipated with this major process enhancement, Tobler said he expects cash flow hardships for 2-3 months until all processes are 100% functioning.

The Strategic Readiness Analysis is near completion and a presentation is planned soon. 

The Virtual Health Project is experiencing success with Dermatology; Psychiatry is the next specialty to launch. There is discussion with Blessing Physician Services for Pulmonology for the future. 

Dueto the popularity of the Tai Chi courses led by Therapy Services Dept, that class will continue in 2019. 

Dr. Tobler has engaged in an exploratory discussion with a firm providing financing for self-pay obligations for un- and under-insured patients.  This will provide another access-to-care-enhancement for SCH patients. He reported further discussions are in progress after a  positive initial impression.

 Tele-ED: A vendor willing to provide virtual Emergency Department and other hospital services, with vast experience in rural healthcare, submitted a proposal to provide 24/7 on-demand services and this was discussed. 

Clinically Integrated Network: SCH Administration and board members attended a Crossriver Quality Health Partners Board Meeting at Blessing Hospital.  Membership in this organization will drive evidence based quality and cost containment, enabling the hospital to benefit from contracting terms that reward value in patient care.  Dr. Tobler recommended a presentation from Crossriver at the  joint meeting of the board and medical staff in 2019. Dr. Tobler reported on two grant applications that are in process of submission.

Jeff Davis, DO, Chief Medical Officer, gave his report, starting with discussion on meetings he had held with Quality Assurance and Safety staff within the hospital and Senior Management meetings in which strategic initiatives including employee satisfaction survey and clinician engagement regarding the business office reorganization were discussed. In addition, an update was presented on clinician contracting; Dr.Davis’ implementation of Team Care and its utility in other clinical practices at Memphis Medical Services; and his formulary review and clinical oversight of the 340B drug formulary.

Under Old Business, Audit Follow-up-Ambulance Department: Michael Brandon gave a financial report for the Ambulance. 

Dr. Tobler discussed billing changes that are more beneficial for the Ambulance District to operate the ambulance service, rather than under the SCH operating umbrella according to EMS staff with expertise in EMS billing/coding regulations. 

Two recent audits of the contract between the hospital and ambulance district have highlighted the fee schedule basis of payment under the SCH jurisdiction, which is unlike cost based as in the hospital at large.

The ambulance district leadership present at the board meeting validated that discussion, based on their understanding of ambulance billing regulations. 

The decision was made to transition management and operations back to the Ambulance District over a period no later than June 30,2019, pending Ambulance Board approval. 

Regarding Employee Health Insurance:  SCH and employees can save significant premium costs by network modifications that will streamline employee access to care.

In New Business, Dr. Tobler  announced filing dates for the April 2, 2019, election for District 5 Board of Directorship is open from 12/11/18 – 01/10/19. Employee bonuses were discussed and approved with performance contingencies. 

The December Board meeting was set for 12/27/18 with a special meeting in January to hear a presentation about the Strategic Readiness Analysis. 

The Joint Board/Medical Staff Annual Meeting was set for 01/21/19 with an invitation to officials from Crossriver Network to attend.

Executive Session:

Those present for closed session were DeRosear, Doubet, Neese, Fulk, Dr. Tobler, Dr.Davis, Michael Brandon and Brenda Prather, Recording Secretary.

The following items were discussed: A proposed sale offered to SCH by present owner of Memphis Community Pharmacy. Parameters of negotiation were approved. An employee health claim was reviewed.  A potential direct contract with a local facility to provide medical care of employees was discussed.

Legal actions and contracts in negotiation.


Meeting adjourned at 9:07  pm.