Hospital Board Learns COVID-19 Reducing Facility to 25% Normal Utilization for Outpatient service

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The Scotland County Memorial Hospital (dba Scotland County Hospital) Board of Directors met in regular session on Tuesday, March 31, 2020, via Zoom Meeting. The Open Session was conducted via Facebook Live. In accordance with the Missouri Sunshine Law §610.020.1. As a best practice and if possible, public governmental bodies should take advantage of their website and social media pages to post recordings or live streams of public meetings.

Board and Administration present, in person: Curtis Ebeling-Chairman, Dr. Randy Tobler-CEO, Dr. Jeff Davis, CMO, Dr. Celeste Miller-Parish, Michael Brandon, Controller.  Also attending were Ken McMinn, IT Director and Jonathan Holton IT Specialist on hand for technical assist as required. Board members attending remotely:  Joe Doubet- Vice Chairman, Lori Fulk-Secretary, Robert Neese-Treasurer, Members Dwight DeRosear and Joni Lloyd.

Administrative personnel attending remotely:  Elizabeth Guffey, RN, CNO (from CNO office at SCH) Cathie Overhulser, HR (via audio Zoom) and Brenda Prather, recording secretary.

Two callers from the community connected via audio.

Chairman Ebeling called the meeting to order at 5:33 pm. Ebeling announced the nationwide display of support for healthcare professionals in the SCH Parking Lot (Sigler Avenue) sponsored by Spirit FM 90.7 scheduled for 6:00 p.m.

FINANCIAL REPORT

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

Gross patient revenue for February: $3,336,975; Net Patient Revenue for February: $1,377,245; Net Patient Revenue Per Day, February: $57,405; Expenses per day, February: $57,895; Total Operating Expenses for February: $1,433,805; Net Profit/Loss for February: $ (82,102); Net profit/loss before depreciation for February 2020: $ 4,220; Net profit (loss) YTD FY ’20: $23,610; Net Profit (Loss) YTD FY ’19: $(764,257); Net profit (loss) YTD before Depreciation: $711,285

ADMINISTRATIVE REPORT-

Operations: Dr. Tobler reported on the investigation into the allegation during public comment at the February meeting that SCH had sent out “fraudulent” bills, misstating the place of service of clinic visits occurring at MMS (Memphis clinic), while the patient’s EOB stated WMS (Wyaconda clinic). He reported that it has been confirmed that Tricare (patient’s insurance) assigned the Wyaconda Medical Services location during post-SCH claims management and reporting on the EOB to the patient.  The bill that the SCH Financial Services Department sent to the payer (Tricare) was accurate. There was no alleged “fraudulent” billing. The complainant has been sent a letter.

COVID-19 Response – The multi-disciplinary team meets at least weekly and virtually as needed. The meeting topics covered are: Medical science update, SCH COVID situational status: total/isolation capacity and census, tests sent and status (23 sent, no positive, 1 pending as of 3/31/20), Resources-PPE, Rx availability, test turnaround and swab availability, medical supplies, facilities, disaster/ICS, financial situation, personnel communications, policy/legislative, Q and A.

Dr. Tobler highlighted the COVID-19 responses the hospital has implemented to mitigate risk to the staff and community. He reported on the financial impact of the COVID crisis and the personnel furloughs, elimination of positions, widespread status changes with reduced hours and temporary voluntary pay reduction for salaried employees. Independent contracted specialists have been suspended indefinitely during COVID crisis.

Regarding revenue generation, he reported that revenues started to greatly decrease  starting in early March with patient self-exclusion, followed by the Medical Executive Committee’s decision to restrict all services to only essential on 3/12.  The hospital is operating at about 25% of normal utilization on outpatient services and lower on surgical services. Virtual Visits were launched for the clinics.

The COVID crisis has created a great deal of financial stress on the already difficult financial situation. Dr. Tobler reported all the options that are being investigated: Advanced Payments for Medicare revenues per the CARE Act, FEMA and Care in America-insurers have some actuarial data and a rollout is envisioned. This product would save employers, employees of participating businesses and provide SCH with cash flow.

Population Health Dr. Tobler reported that the High Performance Network (HPN) contract was terminated early and now all Medicare Annual Wellness Visits (AWV), Gaps in Care, Care Coordination and Periodic Prevention Visits will be scheduled by the clinic Population Health team.

The Caravan Collaborative Pathways Accountable Care Organization (ACO) Board meeting was on 3/30.  The focus shifted to COVID response, and how/whether Centers for Medicare/Medicaid Services (CMS) will alter expected ACO reporting and thresholds for shared savings due to the COVID crisis.

Dr. Tobler reported on the “Penthouse” Renovation – the contractor is working with state engineers in order to get an application in for Energy Saving Loan assistance in addressing this needed project.

Regarding the Revenue Cycle, Dr. Tobler reported that there has been much progress with SCH’s aggressive approach to accountability with the billing partner and a recent letter to the editor resulted in correction of a process that was missed during the revenue cycle remodel.  This and other similarly affected accounts have been addressed. Additionally, he reported that an escalation process within the billing office for service recovery has been established as a result of this issue.

Dr. Tobler reported that the Edina Clinic opening will likely be delayed due to the current COVID crisis obstacles, but progress continues on the space renovations in the building.

Under Medical Staff, Dr. Tobler reported that Dr. Ly Phan signed a contract to start in May as a part-time general surgeon, contingent on credentialing. He will provide general surgery coverage Friday – Sunday.

Dr. Tobler reported on many of the specialty services have been suspended until the COVID-19 crisis is over.

Dr. Tobler reported on mid-levels coverage of the Emergency Department. Under Advocacy,

Dr. Tobler reported he had been interviewed by Kaiser Health Network and the Kansas City Star on the struggles of already vulnerable hospitals like SCH with the additional challenges of COVID-19. Dr. Tobler has completed all the requirements to be designated as a Certified Physician Executive (CPE) by the Certifying Commission in Medical Management.

CHIEF MEDICAL OFFICER REPORT

Dr. Davis reported that an initial COVID-19 meeting was conducted on Monday, March 9th and a community emergency response meeting with community leaders was conducted on March 19th. He reported on a meeting on March 19th with clinicians regarding emergency salary reductions. He reported that there are plans to move forward with urology services with Dr. Robert Remis once the clinics open to non-essential visit.

OLD BUSINESS

The Blessing Health System Management Agreement received USDA approval on 3/31.  The final agreement is awaiting final approval from Blessing and deferred to next month’s meeting.

NEW BUSINESS

Ratification of the Finance Committee recommendations was needed. A motion was moved and unanimously approved.

An amendment to the Bylaws was needed. Amendment to Section 3.3   Powers; 2nd paragraph added as formality to enable the Board of Directors to carry out District business and enter into agreements with one or more nonprofit entities which Board deems necessary or advisable for management or for assistance in the management of Hospital.  A motion was moved and unanimously approved.

Property Insurance Renewal was needed by Hawkins-Harrison Agency. The premium last year was $49,000. This year it is $62,500. Only one carrier would underwrite SCH.  A motion was moved and unanimously approved.

CLOSED SESSION

Those present in the SCH Library: Ebeling, Tobler, Davis, Guffey (moved to Library), Brandon. Those present remotely. DeRosear, Doubet, Fulk, Lloyd, Neese, Prather.

Phone in: Cathie Overhulser, HR. Agenda items addressed included legal and personnel.

A motion was moved and unanimously approved to adjourn at 8:15 pm

In order to comply with CDC guidelines during the COVID-19 pandemic regarding social distancing, the April 28, 2020, Hospital Board Meeting, scheduled for 5:30 pm, will be conducted in accordance with the State of Missouri Sunshine Law Guidance for Public Governmental Bodies During a Public Health Crisis or State of Emergency. The Board meeting will be conducted via “Zoom Meetings”. As always, the Board invites the community’s questions, comments and observations. If a community member wants to hear the audio discussions, please contact the Administration Office at the Hospital at 660-465-8511 to be given the audio meeting access phone number and code. Public Comment Policy and Request For Time on a Board Meeting Agenda forms are available online at www.ScotlandCountyHospital.com. Or, due to the NO VISITORS ALLOWED rule,  you can email caring4u@scotlandcountyhospital.com to request a form, complete the form and then scan and return to the same email address or mail to Administration at SCH, 450 E. Sigler Avenue, Memphis, MO, 63555. The form must be received by 9 am on 4/28/20.