The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Monday, January 21, 2019, for the joint Medical Staff/Board of Directors meeting Board members present: Curtis Ebeling, Chairman, Joe Doubet-Vice Chairman, Bob Neese-treasurer and Members  Dwight DeRosear and Lori Fulk.  Absent: Judy Wilson, Secretary

Others present:  Dr. Randy Tobler; CEO, Dr.  Jeff Davis, CMO, Dr. Lisa Rollison, COS, Michael Brandon, Controller, Elizabeth Guffey, RN, CON, Dr, Miller-Parish, Dr. Heather Martin, Dr. Shane Wilson, Teresa Kirchner, NP-C, Dr. Neil Hoyal, Jessica Christen, NP-C, Stephanie Henley Pippert, NP-C, Dr. Joey Hassien, Heliene Tobler,  Angela Schmitter, RHIT, Lori Nelson, RN, RHC Supervisor, Alisa Kigar, Marketing/Public Relations, Missy Smith, HR Coordinator, Kristin Hyde, EA & Med Staff Coordinator and Brenda Prather, recording secretary, and Lee Shultz.

The meeting was called to order at 5:32 pm.  Public comment was offered by Lee Shultz, RN.

Dr. Randy Tobler introduced a presentation from Crossriver Quality Health Partners (CQHP). CQHP is a clinically integrated network (CIN). A CIN is a collection of health providers, such as physicians, hospitals, and post-acute specialists that join together to improve care and reduce costs. 

Presenting were Dr. Chris Solaro CQHP Executive Director, Dr. Michael Bukstein CQHP Board of Directors, Chair, Jordan Kiel, CQHP Executive Administrator.

Dr. Solaro discussed purpose, structure, governance and history of CQHP.  Crossriver Quality Health Partners is a group of healthcare providers from this region who have made a collective commitment to performance improvement by focusing on the quality and efficiency of care for the patients they serve. They are able to work together to help achieve their common healthcare goals.

CQHP is sponsored by the Blessing Health System, which is funding the start up costs, and members includes the physician groups from Southern Illinois University Medical School, Blessing Physician Services and the Hannibal Clinic.

In the first year of operations, using the self insured Blessing Employee group as an example of achievements through collaboration, improved health outcomes as well as substantial cost savings have been realized.  Patients benefit from an emphasis on value driven healthcare, and insurers, including Medicare, will share cost savings with groups like CQHP that commit to best practices.  SCH has been invited to join CQHP. There is no joining fee should SCH apply and be accepted.  General consensus of board, along with Med Staff leadership was to enter into agreement with Crossriver Quality Health Partners.

Dr. Tobler introduced a second presentation by Tycon TMi- Aftermarket Solutions Group representatives Jeff Escott and Ken Kalicak (Project Manager) of Thermal Mechanics, Inc. in Chesterfield, MO.

TMi Thermal Mechanics provides HVAC equipment and integrated building control solutions. Mr. Escott and Mr. Kalicak discussed the future HVAC control installation and maintenance of the hospital’s system. Their presentation outlined the process of evaluating current equipment, identifying priority items, and creating an emergency operations plan for the HVAC system.

As a result of this project, the hospital environment will be more comfortable and stable, with anticipated energy expense savings of 10-15%.  The Board has previously approved this replacement of the obsolete control system. 

A final presentation for the evening was given by Elizabeth Guffey, RN, BSBA, BSN, OCN, CEN, Chief Nursing Officer.  She reported that recently SCH had lost one of three full-time respiratory therapists; there is a critical shortage of these professionals. All options have been exhausted to fill this position.

Quality services are being maintained with the two remaining RT staff and additionally trained nurses.

She introduced an innovative tele-health company called rtNOW founded and operated by Respiratory Therapists.  She explained that rtNOW uses the latest technology to connect healthcare professionals, and patients, with a licensed respiratory therapist to the bedside, giving staff greater confidence, maximizing resources, and providing a helpline at the bedside. Curt Merriman, RT, from rtNOW demonstrated the audio/video technology proposed for use at SCH.

Testimonials from nurses at other facilities were displayed. Discussion followed on recruitment efforts (over several months/years) but to no avail and the need to explore this avenue for supplemental staffing needs.  The board agreed to pursue Tele-Respiratory Therapy after management has done due diligence in seeking alternative vendors and bidding.

Michael Brandon, Controller, presented the Financial Report for December.  

Gross patient revenue for December was $4,041,480;

Bad Debt, Charity Care and other Deductions for December was: ($336,719.98 );

Net Patient Revenue, December: $2,084,250;

Net Patient Revenue Per Day, December: $57,325;

Total Operating Expenses for December $1,913,050  

Expenses per day for December was $59,755;

Total Operating Profit/Loss December: $153,555.43;

December Tax Revenue: $42,522;

Net profit/loss before depreciation for December was $276,395

Net loss YTD ($647,340)

The monthly after depreciation positive margin helped stabilize the year’s financial performance.  YTD the loss is significantly less than FY 2018.

The Medical Staff conducted the annual meeting to elect officers. The medical staff voted to retain current officers: Chief of Staff- Dr. Rollison, Vice-Chief of Staff-Dr. Wilson and Secretary- Dr. Martin.   Officers will begin 2019-2020 term in April.

Under the medical staff report, Dr. Rollison reported that she and Dr. Davis participated in Tri County Electric’s annual Employee Education Day, both presenting healthcare related seminars for the employees.  Dr. Rollison reported that consensus among the Medical Staff is favorable toward pursuing collaboration with Crossriver Quality Health Partners and moving forward.

Randy Tobler, MD, Chief Executive Officer, gave an administrative report, starting with OPERATIONS:

340B Contract Retail Pharmacy – He reported that due diligence is in place and all legal and regulatory hurdles addressed to enable the hospital’s acquisition of Memphis Community Pharmacy, enabling seamless operation of the 340B retail pharmacy at both Memphis Medical Services and the recently installed Medifriend Automated Prescription Vending satellite at Lancaster Medical Services.

He noted that the federal government shutdown raises concerns in sequencing all that must occur in precise and rapid order to achieve uninterrupted patient care goals.  The revenue cycle reorganization has identified many opportunities to automate and improve speed and accuracy in billing services, and as a result claims and cash are flowing now.

The Texas A&M Vulnerable Rural Hospital Technical Assistance Grant has been submitted for up to $100,000 value in services to be awarded to 22 selected rural organization for the purpose of helping vulnerable, but currently strong organizations, like ours, in developing collaborations, utilizing technology and other innovations to sustain robust services in their communities.

Dr. Tobler reported under the MEDICAL STAFF/ALLIED HEALTH agenda that Dr. Heather Martin has communicated her intent to not renew her contract after August 1, 2019, and the Quality/Risk Manager has resigned. 

Under PERSONNEL: The Virtual Health Coordinated and Quality Dept. assistant has resigned.  Hiring for vacant Financial Navigator and Hospital Patient Access (Registration) positions are in progress.

Jeff Davis, DO, Chief Medical Officer, reported that Senior Management had met and discussed hospital inpatient diversion recently, due to staffing. He is finalizing the recruiting of an FP for Lancaster and Memphis Medical Services, to start in August.

Under Old Business, a motion was moved and approved to authorize Dr. Tobler to execute final documentation for completion of Asset Purchase Agreement and Facility Space, Personnel, Lease and Support Services Agreement for Memphis Community Pharmacy.

In New Business, Elizabeth Guffey, RN, Director of Nursing, described the policy and procedures in place to outline and clarify inpatient hospital diversion. She reported there have been no patient transfers/diversions to other facilities due to lack of appropriate staffing over the last six months. 

In other New Business, Dr. Tobler announced the District 5 Board of Director position was filed by a sole candidate, Joni Lloyd.  There will be no election required in April.

Executive Session:

Those present for closed session were Ebeling, DeRosear, Doubet, Neese, Fulk, Dr. Tobler, Dr. Davis, Dr. Rollison, Missy Smith and Brenda Prather, Recording Secretary.

The following items were discussed:  Legal actions and contracts in negotiation. Personnel.

Meeting adjourned at 9:50 pm.