Hospital Board Votes to End Agreement With AVEC Health for Billing Services

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The Scotland County Hospital Board of Directors met in regular session on Tuesday, May 26, 2020, via Zoom Meeting and in person. The Open Session was broadcasted 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 members and Administration present, in person:  Chair-Lori Fulk, Vice Chair- Joni Lloyd, Secretary-Joseph Doubet, Treasurer-Robert Neese

Absent:  Nicholas Hatfield.

Others attending in person:  Dr. Randy Tobler, CEO, Maureen Kahn, CEO/President Blessing Corporate Services (BCS), Patrick Gerveler, CFO/Exec Vice President BCS, Dr. Celeste Miller-Parish, COS, Dr. Jeff Davis, CMO, Elizabeth Guffey, RN CNO, Michael Brandon, Controller, Ken McMinn, IT Director.  Present via Zoom: Board member-Dwight DeRosear, Cathie Overhulser-HR Director, Terri Schmitt-QA/Safety Director, Meagan Weber-Therapy Director, Angela Schmitter-Health Information and Compliance Director, and Brenda Prather, recording secretary.

Chairman Fulk called the meeting to order at 5:37 pm. Motions were moved and unanimously approved for the Open Session Agenda, Executive Session Agenda, Consent Agenda and Approval of Minutes. The Open Session agenda was approved with an addition of Environmental Service Contract for Edina Clinic under New Business.

Under Quality Improvement/Safety Committee, Terri Schmitt outlined revisions to the organization’s Strategic Plan. Revisions were tabled until next month due to other revisions that will be incorporated for efficiency.

FINANCIAL REPORT

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

Gross patient revenue for April: $2,884,455

Net Patient Revenue for April: $1,301,990

Net Patient Revenue Per Day, April: $54,400

Expenses per day, April: $57,160

Total Operating Expenses for April: $1,391,875

Net Profit/Loss for April: $477,885

Net profit/loss before depreciation for April  2020:  $563,755

Net profit (loss) YTD FY ’20: $930,075; Net Profit (Loss) YTD FY ’19: ($1,395.953)

Net profit (loss) YTD before Depreciation: $70,664

Blessing Health System Report by Blessing Officials: The organization is documenting everything relating to COVID-19 expenses. It is unclear, at this time, what expenses will be considered offset through government subsidies. There is an Open House for the new Medical Building at 48 & Main, on July 31. A typical Open House cannot be carried out under current health guidelines The reopening of Illinois businesses was discussed. Blessing officials had positive remarks regarding today’s visit around Memphis with business owners and other members of community. It was evident to Mrs. Kahn and Mr. Gerveler that community support for SCH was strong. They received many positive comments, along with some suggestions and critique of billing and larger concern of SCH services being taken away. These concerns were addressed along with correcting some of the rumors that SCH was being purchased. During the day they visited with and visited the following:

Ryan Bergeson-Superintendent of SCR-1

Derek Weber-Executive Director of Northeast Missouri Planning Commission

Batina Dodge-County Clerk

April Wilson-Prosecuting Attorney

Jack Sumption-Christian Church Pastor/Secretary of Ministerial Alliance

Jeff Behrens-Small Business Owner and Leader in Rotary

Angela Westhoff-Small Business Owner

Joe Fulk-Branch manager of Exchange Bank-Memphis Branch

Lunch at Lacey’s Diner

Memphis Mercantile-Small Business Owner

Country View Store-Small Business Owner

ADMINISTRATIVE REPORT

Under Operations, Dr. Tobler gave a report on the COVID-19 Response. He reported that the multidisciplinary team meets at least weekly and virtually as needed.

Highlights through 4/27/20: SCH COVID situational status-No COVID (+) inpatients to date, inpatient census has improved modestly to 60-70% normal, 116 COVID tests sent to date, 5 positives (none since mid-April), 1 pending. Resources-We have appealed to state referenced supply chains to address a critical shortage in surgical masks. The increase in traffic through the facilities has depleted our supply. Open market suppliers are demanding unreasonable prices and inordinately high order quantities. Community is asked to bring their own purchased or made masks until we can replenish supplies. Mrs. Kahn volunteered to supply a bridging supply of surgical masks from Blessing until our order arrives later this week. Board and hospital leadership expressed their appreciation.

Facilities – Wyaconda Medical Services is open again. Civic leaders from that community have requested our long-term planning strategic plans regarding the building based on their interest in repurposing it for city hall.

Patient services: SCH continues to individualize clinic visits through face-face and virtual visits. Phlebotomy and COVID testing continue, though with less demand, at the Main entrance as a drive through/curb-side service. Volumes are at 80% of recent pre-COVID utilization.

Business Recovery: After much deliberation and evaluation of the science, and in view of the low known disease prevalence in our community, the medical executive and surgical committees have recommended selective rather than routine pre-op, pre-procedure COVID-19 testing.

Expense management: SCH is implementing a call-back/hire-new strategy to responsibly deploy SBA PPP resources received on May 12, 2020, for a 2-month interval (ending with the July 7 payroll):1) Restore furloughed staff to full duty in former tasks if demand is restored. 2) Create hybrid positions with part former task/part new task for others Post for new (population health, accountant) or vacant positions (patient access, registration).  COVID-19 relief funds: SCH became eligible for and received SBA PPP funds. Additional Rural Health Clinic and Missouri Hospital Association funding sources are deposited, earning interest and in separate accounts to be accessed for lost revenues or pandemic response costs.

Population Health: Recognizing the rewards for SCH patients’ health and the financial health benefits to SCH if successful, SCH has developed a model that bolsters the organization’s  ability to encourage patients to obtain preventative and chronic disease management services (screening, monitoring, treatment compliance).

Caravan Collaborative Pathways Accountable Care Organization: No change in performance thresholds resulting in remediation. SCH is performing within the parameters expected.

Crossriver Quality Health Partners (CQHP): Policies for distribution of earned incentives to the various entities have been developed and are pending CQHP Board approval this week. SCH will need to determine its formula for distribution to eligible clinicians. CQHP leadership expressed their encouragement and satisfaction with SCH’s contributions and collaboration with the Blessing/CQHP team in the parallel CQHP/ACO initiatives.

“Penthouse” HVAC Renovation: Several calls with MO Department of Energy Loan Assistance Program personnel regarding the anticipated loan, project timeline and SCH-funded portion flexibility.

Revenue Cycle: SCH has a mutual high-level agreement to terminate the relationship with Avec, with details in negotiation. SCH will transition to the SCH/Blessing shared services model to bring the long and difficult project of modernizing and optimizing SCH billing processes to completion with this partnership. Goals: 1) Recover outstanding accounts receivable and target industry standard achievement; 2) Improve clean claims to minimize unnecessary insurance follow up and denials management; 3) Improve billing accuracy and minimize service recovery to levels our patients expect and deserve.

Edina Clinic: Staffing is completed and the clinic opens next week, with a ribbon cutting scheduled for Thursday, June 11 at 12:15.  Medical Staff: Dr. Ly Phan has begun twice monthly part-time general surgery Fri-Sunday coverage. He and Dr. Miller-Parish are available for scheduled Saturday appointments from 10AM-12 PM, concurrent with Urgent Care hours.  Dr. Robert Remis (Urology) successfully started Urology clinic. Dr. Jay Nastav has applied for and received staff privileges.  He will be providing some coverage for Dr. Miller Parish.

Personnel: All personnel have been advised that flexibility is a non-negotiable expectation of employment, given the nature of the health care industry’s pace of change, compounded by fallout from COVID-19 and it’s still unpredictable impact on demand, funding, and regulatory atmosphere.

Advocacy: Dr. Tobler reported that he, as well as Dr. Davis are advocating for more than COVID-specific revenue replacement or expense funding from the several buckets of relief funding accessed. Given the chronic underfunding by Medicare and Medicaid for the majority of SCH services (payer mix reality).  Two points are stressed: 1)  Forgive the funds tied to COVID management costs/losses; 2)  Reform Federal and State funding for their insured beneficiaries to realistically reflect true expenses. Dr. Tobler and Dr. Davis will appear to the SC Commissioners to use SCH for county wide, free COVID Antibody testing to determine true cumulative disease prevalence and assist in managing county resources and possible future surges.

CHIEF MEDICAL OFFICER REPORT

Dr. Davis report highlighted these areas: Caravan Accountable Care Organization and Crossriver’s Physician Champion and ITAQ/PICC meetings resumed in April and have continued. SCH has re-opened clinical visits in the Rural Health Clinics as well as continuing Virtual Health program. Also, closely monitoring for COVID outbreak in surrounding community while doing non-vulnerable elective procedures in the Surgery Center beginning May 1. Ongoing advocacy efforts regarding HHS stimulus monies with Cong. Sam Graves, Sen. Roy Blunt, Sen. Josh Hawley, Sen. Cindy O’Laughlin and Rep. Greg Sharpe.  Reducing burden of regulation and requirement of expenses directly tying to COVID. Participated in 1 Facebook Live program for the community regarding COVID this month. Working with IT and Informatics on Crossriver Quality Health Partners data accuracy of Clinician Reports as well as Caravan ACO measures and initiatives. Caravan ACO Population Health Team, Sheila voluntarily furloughed but has worked prn. Tabitha Whitstock, MA resumed Annual Wellness Visits by virtual visit SBA PPP furloughed workers brought back will assist with increased data mining and identifying patients needing checkups or prevention testing. Docs-Who-Care continue occasional Emergency Department coverage as well as inpatient coverage on those evenings. This has been reduced as Haley Shrum, NP, who has returned and the hiring of Cari Blackburn, NP, and Marissa Burgess, PA-C, for Emergency Department shifts. Honored to be named the Missouri Association of Osteopathic Physicians and Surgeon’s 2020 Physician of the Year in May.

OLD BUSINESS

Hospital committees have been developed by Dr. Tobler and Dr. Miller-Parish along with selected department heads. The committees are comprised of members of hospital wide staff, Board and Medical Staff. A motion was moved and unanimously approved to accept these committee assignment. In January the HVAC renovation plan was approved, with the estimate for the “penthouse” upgrade from its original and now obsolete technology and engineering at $900,000, pending funding. Since then, communication has taken place with the Department of Energy. The resulting project estimate submitted for the Energy Savings Loan was not to exceed $1,200,000. The Board consensus is to move forward with discussions to fund entire project, spreading out repayment over no less than 2 years. A motion was moved and unanimously approved to move forward and fund the entire project. Dr Tobler also commented that USDA will need to give official project approval and additionally was very pleased with the partnership with Blessing Health System (BHS).

NEW BUSINESS

A motion was moved and unanimously approved for one physician receiving Associate privileges: Jay B. Nastav, DO General Surgeon. After discussion with competing contractors, references and negotiation with Lewellen’s Professionally Cleaning in Kirksville, Dr. Tobler recommended contracting for their housekeeping services at the Edina clinic. A motion was moved and unanimously approved to contract with Lewellen’s.

CLOSED SESSION

Those Present: Onsite: Fulk, Lloyd, Doubet, Neese, Dr. Tobler, Dr. Davis, Michael Brandon, Elizabeth Guffey, Maureen Kahn and Pat Gerveler. Via Zoom: DeRosear and Brenda Prather

Matters discussed: The Board discussed termination process to disassociate with Avec. A motion was moved and unanimously approved to do so. The Board discussed restructuring the SCH Human Resources Department to utilize Blessing Health Services Human Resources management in accordance with successful shared services models used at their other affiliates. A physician contract was discussed. Blessing officials exited at 8:32 pm. Chairman Fulk emphasized the strong community support exhibited by business and townspeople during the tour today.

Meeting adjourned at 8:50 pm.

The next board meeting is on June 30, 2020, at 5:30 pm in the Library Conference Room. There are limitations on visitors allowed in the Hospital at this time and no guests will be allowed in the meeting. According to CDC guidelines, social distancing will be practiced by board and staff in attendance. The meeting will be on Facebook Live. Public Comment Policy and Request For Time on a Board Meeting Agenda forms are available online at www.ScotlandCountyHospital.com. Due to the limited visitor policy, citizens can complete the form and scan and email to caring4u@scotlandcountyhospital.com or mail to Administration at SCH, 450 E. Sigler Avenue, Memphis, MO, 63555. The form must be received by 9 am on 6/30/20.