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Hospital Board Discusses Paid Time Off Policy to Help Address Staffing Issues

The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Monday, December 23, 2019. Board members present: Lori Fulk-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear and Joni Lloyd. Administrative personnel present:  Dr. Randy Tobler; CEO, Michael Brandon, Controller, Elizabeth Guffey, RN, CON, Angela Schmitter, RHIT-Compliance, Lori Nelson, RN, RHC Supervisor, Lezah Cline, QIS Specialist, Cathie Overhulser, HR Director, Alisa Kigar, Communications Specialist, and Brenda Prather, recording secretary. Guests:  Sandra Blake

Treasurer Neese called the meeting to order at 5:30 p.m. A motion was moved and approved for the Open Session Agenda. The Consent Agenda was unanimously moved and approved.

Quality & Safety

Lezah Cline reported educational training for Just Culture completed for the most part.

Financial Report

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

Gross patient revenue for November: $3,755,840

Net Patient Revenue for November: $1,850,515

Net Patient Revenue Per Day: $60,345

Expenses per day: $59,815

Total Operating Expenses for November: $1,747,135

Net Profit/Loss for November: $191,105

Net profit/loss before depreciation for November 2019: $278,495

Net profit (loss) YTD 2019: $85,629 ; Net Profit (Loss) YTD 2018: ($800,893)

Net profit (loss) YTD before Depreciation: $514,282

Administrative Report

Operations: Dr. Tobler reported on the population health initiative through Caravan Health (an Accountable Care Organization partner – ACO).  He reported on the final pre-launch meeting with the ACO implementing team and launch is planned for 1/1/20.

Data and analytic leaders from Crossriver Quality Health Partners (CQHP) and Blessing Hospital led a training session for all clinic staff with implementation meeting with clinicians and nurses scheduled 1/14/20.

Questions on how patients are educated on the aspects of participating in the ACO were addressed by Angela Schmitter. She reported that upon registration, patients will receive a brochure describing how they may choose to opt in or opt out of the ACO tracking program. Compliance criteria will be followed and SCH will provide perpetual education to patients.

Regarding the revenue cycle, Dr. Tobler reported that call volumes on patient statements have moderated compared with the previous two billing cycles. Two of the three candidates for the Revenue Cycle Manager have been interviewed.

The Clear Gage patient financing option will offer another option for patients to gain access and SCH to reduce exposure to bad debt. Clear Gage financing option goes live 01/01/20.

Under Personnel, Dr. Tobler reported on staffing for the Emergency Department; There are two part-time doctors who will not be returning after 12/31/19 and the full-time Nurse Practitioner is moving to part-time. Staff have been hired to replace these changes in staffing.

A replacement for the current full-time Certified Registered Nurse Anesthetist (CRNA) has been identified and placed in Memphis by LifeLinc, the contracted CRNA service, and will start 1/1/20.

Chief Medical Officer Report

Dr. Davis participated in monthly S.T.R.E.T.C.H. L.A.P.S., Physician Champion Meeting with CQHP and Caravan ACO and participated in the Crossriver HCC coding educational seminar.

He reported he interviewed the new Population Health Nurse candidates with the Human Resources Coordinator and Clinic Supervisor, with plans to offer the position soon.

Dr. Davis reported that Dr. Edward Goetten, ER physician, announced his retirement and Dr. Shane Wilson, Internal Medicine, continues afternoon office hours 4 days per week at Memphis Medical Services.

The Emergency Department and inpatient care now has telehealth coverage for nights and weekends with on-site Nurse Practitioner presence in house.

Dr. Davis reported he is working to find coverage for c-section call as well as future General Surgery call with the upcoming departure of Dr. Rollison.

Old Business

Dr. Tobler discussed community education on a program that would offer local businesses to save on employee health insurance coverage. The program is called Care in America.

There is a web site that provides information and background on this healthcare coverage available on Select tab “Care in NE MO”. This program has monthly premiums that range around $400/employee or $800/employee and family.

Care in America would enable enrolled employees to receive care from SCH at no extra cost to employee for all but a few very costly services (for example, cancer and some other infusions, implantable devices, which would be covered as they are now with a backup insurance included in the plan). Services not available at SCH would be covered with pertinent deductibles or coinsurance, applicable with the backup included insurance, used as it is now for traditional plans. Previous conditions are accepted in this healthcare plan. The only demographic criteria required from employers are a census of employees, i.e. name, birth date, gender, and zip code.

Access to the program is available at any time during the year. There is no specified enrollment time period, however, in order for the plan to be offered and the backup insurance to be included in the premium, at least 1,000 employee enrollees are required to sign up, with only a census with name, gender, zip, birth date required.

Any company that has employees, including small LLCs or large concerns, may enroll their employees. Questions from interested brokers, employers or employees can be directed to Dr. Tobler or Alisa Kigar at 660-465-8511. We are developing an informational campaign and have a target start date of April 1, 2020.

New Business

There was discussion on the current Benefit/Sick Time policy. Dr. Tobler reported that the binary system of separate vacation and sick time creates problems resulting in unexpected absences being freely accessed, leading to staffing problems in critical clinical areas. In discussions with the Employee Experience Committee, there is interest in adopting a PTO (Paid Time Off) Policy system or other adjustments that would enable paid leave for other than employee and children. Also, it is common for other area facilities use the PTO system.  A motion was moved and unanimously approved to have leadership, in conjunction with the Employee Experience Committee, develop a PTO policy that incorporates grandfathering in existing sick leave benefits accrued per employee. Proposal to be prepared for the January meeting.

Dr. Tobler made the board aware of an almost critical situation with OB staffing was averted during the holiday week. This is due mainly to limited OB trained staff and slow on-boarding of new trainees due to low volume, compounded by the previous benefit/sick leave discussion. Low staffing and holidays took its toll.

Elizabeth Guffey, RN, CNO and Dr. Tobler explained solutions proposed during a recent departmental meeting and endorsed by the nursing staff, including 4-6 hour shifts on holidays to allow time with family, accelerated training with online and in-person opportunities. Mandatory call will be implemented to begin in January.

Also discussed was progress in developing a global OB package for patients, with combined fee for both OB care and delivery, and incorporating standard basic labs and imaging in the package.

Guests exit and short break is taken.

Closed Session

Those Present: DeRosear, Fulk, Lloyd, Neese, Dr. Tobler, Cathie Overhulser, Elizabeth Guffey, Michael Bandon and Brenda Prather.

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

Under Legal, there was a brief discussion on a draft proposal received from Blessing Health System regarding affiliation matters. A full discussion was deferred to a special meeting, time to be determined, with full Board attending.

Under Personnel, Anesthesia coverage and the new Certified Registered Nurse Anesthetist was announced. Another discussion was about a Workers’ Comp employee that was offered a position, allowing employee to work with limited physical duty. The employee declined the offer. A physician concern was discussed. A Maintenance/Housekeeping concern was discussed.

Meeting adjourned at 8:00 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 regularly scheduled meeting date is Tuesday, February 25, 2020, in the Hospital conference room at 5:30 pm.