Hospital Reports Zero Positive COVID Test Results, No Inpatient Cases

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A report at the June meeting of the Scotland County Hospital Board of Directors revealed SCH has had no COVID-19 inpatients to date, and zero positive results among the 230 tests administered.

The Scotland County Hospital Board of Directors met in regular session on Tuesday, June 30, 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. Others attending in person: Dr. Randy Tobler, CEO, Patrick Gerveler, CFO/Exec Vice President Blessing Corporate Services (BCS), Dr. Celeste Miller-Parish, COS, Dr. Jeff Davis, CMO, Lori Nelson, RN, Supervisor of RHCs, Elizabeth Guffey, RN CNO, Michael Brandon, Controller, Alisa Kigar, Marketing Director, Ken McMinn, IT Director.

Present via Zoom: Board member-Dwight DeRosear, Terri Schmitt-QA/Safety Director, Angela Schmitter-Health Information and Compliance Director, Jeff Escott of Aftermarket Solutions Group/TMI/Daikin, and Ken Kalicak of TMI/Daikin, Isaac Miller, TMI/Daikin, Meagan Weber, Therapy Director, Craig Kurk, Director of Maintenance, BHS, and Brenda Prather, recording secretary.

Chairman Fulk called the meeting to order at 5:40 p.m. Motions were moved and unanimously approved for the Open Session Agenda, Executive Session Agenda, Consent Agenda and Approval of Minutes. Three contracts were approved on the consent agenda: 1) Missouri Foundation for Health Grant/eCare ER/Telemedicine contract-3-year contract. The grant funds the local fiber connection, and decreasing amounts of the operational expenses (75% 1^st year, 50% 2^nd, 25% 3^rd; 2) Revenue Cycle Services-Blessing Hospital-Fair Market Value for 3 FTE offsite staff; and 3) Red Cross Blood Bank.

Under Quality Improvement/Safety Committee, Terri Schmitt and Chair Fulk outlined the Patient and Family Centered Care (PFCC)/Patient Family Advisory Council (PFAC). There was discussion of progress made in policy statement outlining the principles. 

Financial Report

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

Gross patient revenue for May: $2,722,177; Net Patient Revenue for May: $1,394,795; Net Patient Revenue Per Day, May: $53,535; Expenses per day,  May: $56,315; Total Operating Expenses for May: $1,488,510; Net Profit/Loss for May: $985,740; Net profit/loss before depreciation for May l  2020: $1,071,465; Net profit (loss) YTD FY ’20: $2,001,535; Net Profit (Loss) YTD FY ’19: (1,826,128);Net profit (loss) YTD $1,056,405

Blessing Health System Report by Blessing Officials

Blessing recently released the official announcement of affiliation agreement with McDonough District Hospital in Macomb, Illinois.

There is a slight increase of COVID-19 cases. Most are outpatient at this time. The organization continues to track lost revenue due to COVID-19.

Blessing’s Vice President of HR recently spent the day here at SCH. BHS is in the process of completing their budget which ends in September. They are working on building a 90-120-day PPE supply. That can give comfort also, to SCH. They are having significant success in physician recruitment. The whole Blessing system is in the process of being in the 340B pharmacy program and they have hired a pharmacist specialist to provide BHS network wide coverage.

Administrative Report

Under Operations; COVID-19 Response: SCH COVID situational status: No COVID positive inpatients to date; general inpatient census has improved to 70% normal; 230 COVID tests sent to date; 0 active positive. Covid resources – No current or imminent supply shortages at current demand levels.  Facilities- SCH is planning to upgrade the PVC/cellophane between chair barriers with handcrafted ones using steel and Plexiglas. These will be used in other infectious disease outbreaks. The Emergency Department (ED) tent has been of limited utility due to heat and humidity preventing a healthy staff/patient environment. SCH is investigating a “mobile” ED concept for on-site and should regulatory waivers allow, “hot-spot” remote triage unit. Patient services: Specialty clinics are expanded to meet demand, and days are full.

Business Recovery:  SCH is still recruiting to reach required Full Time Employee levels to comply with the Payroll Protection Program. Self-imposed wage and hour restrictions implemented in March were lifted upon receipt of funds in mid-May. SCH will realize full benefit of the funding, in view of extension to 24-week window and requirement for full staffing by 12/31.

Expense management –  SCH continues to carefully balance staffing with changing and best-guess anticipation of Covid-19 surge demand, which recently has not materialized.

Caravan Collaborative Pathways (Accountable Care Organization) – The SCH Accountable Care Organization cohort is performing with savings of $467/beneficiary through Q1 2020; Inpatient acuity is up, while number of inpatients and ED visits are down.

Crossriver Quality Health Partnership (CQHP) – SCH will be included in a distribution to be announced soon reflecting our share of patients, and to be distributed to clinicians per boards (BCS, CQHP, SCH) approved formulas for participation and performance.

“Penthouse” Renovation – SCH has been approved for financing through energy savings of $404,328 construction loan at 2.75% over 10 years and 1% origination fee (total project costs of the loan of $467,760).

Facility Management – Craig Kurk, Maintenance Director at Blessing has provided an assessment tool to help in working with SCH to develop a Facility Master Plan and staffing model.

Revenue Cycle – SCH terminated the agreement with Avec. The SCH team and the Blessing rev cycle managers are working together to continue coding, billing, follow-up and denials management with a contract and recruiting in process to have complete staffing at Blessing in place shortly. 

Edina Clinic – On June 11 the Edina community welcomed SCH and Blessing Senior Leadership at a ribbon cutting. This was the fruition of 18 months of planning and collaboration between community, SCH and Blessing leadership.  Utilization is beating expectations for the new clinic..

340B Drug Program -SCH’s 6th contract pharmacy (Kirksville Pharmacy) goes live July 1st.

Medical Staff – Medical Staff has approved a policy restricting all Tetrahydrocannabinol (THC)-containing products in accordance with Federal Law. 

Personnel – The Human Resources (HR) Director position was eliminated in alignment with other Blessing entities, in order to bring standard, best practices to SCH using the collaborative, shared services model. Leadership level management will reside at Blessing, while administrative and day to day HR functions will stay on-site. At this time, SCH does do not envision other major structural changes.  

Advocacy – SCH is working with MU Extension to explore community engagement with the opportunity for the Care in America Foundation retainer based plan, where subscribers can obtain nearly all routine services at SCH with pre-paid monthly subscription fee, saving enormously for employers, employees and at the same time supporting the hospital’s ability to maintain access to high quality, local care. Weekly Missouri Hospital Association (MHA) arranged calls with Gov. Parson, DHSS Director Dr. Randall Williams, and MO Healthnet Director, Todd Richardson, continued through June 16. The COVID crisis has led MHA to strategically address the chronic threats to rural health care. They have identified the development of novel payment and healthcare delivery systems, and telehealth reimbursement as key strategic focus areas.

Chief Medical Officer Report

Dr. Davis’s report highlighted these areas:

Senior Management Team meeting every Wed and Fri.

Continued discussions on staffing and budgeting for wages and benefits as well as

Strategies of implementation of SBA’s PPP. The team has updates on COVID-19 testing, positive cases, inpatient/outpatient utilization and finances, supplies and status.

Dr. Davis reported that clinic visits have resumed in all locations and clinicians are still utilizing Telehealth visits as needed.  Elective surgeries and procedures for most patients have resumed. Lois Quenneville, PA-C is back full-time seeing patients daily at MMS for walk-in and WMS for afternoon office hours. Edina Medical Services opened June 1 and has seen patients every day. Tabitha Rohr, NP is the  lead clinician. She is off on Wednesdays, and Stephanie Henley-Pippert, NP, and Marissa Burgess, PA, are alternating Wednesdays to provide clinic coverage.

Old Business

A motion was moved and unanimously approved to include a newly developed Policy Management System under Quality and Integration with Blessing Health System to promote Financial Stability and Performance on the Strategic Plan. The HVAC project financing was discussed. Joining the meeting were Jeff Escott, Aftermarket Solutions Group/TMI and Ken Kalicak/TMI to discuss progress of HVAC project and answer questions regarding financing and change from Omnia Purchasing Procurement to TIPS (The Interlocal Purchasing System) resulting in compliance with regulatory requirement for bidding required of political subdivisions to ensure lowest labor and materials project costs. Escott and Kalicak reviewed a new product introduced to eradicate COVID-19 virus in the air. This is not an add on cost, it was already built into the project. Dr. Tobler outlined the current plan for financing which includes an energy savings loan and possibly some grant funding related to Covid. Dr. Tobler reported that there is reason to believe that at a minimum the air quality enhancements, and perhaps the whole project, is eligible under COVID-19 expenses. USDA has approved executing the necessary loan documents and Blessing has agreed to look over the documents. A motion was moved and unanimously approved to move forward.

New Business

fter full review and recommendations of the Finance Committee; a motion was moved and unanimously approved to accept the FY 2020-2021 budget. Under credentialing, based on Medical Staff recommendations, a motion was moved an unanimously approved to accept credentialing for Abigail Nieters, PNP-C, for Emergency Medicine as Allied Health Staff and Frank Welte, MD, for Consulting Staff under Teleradiology. The board discussed lifting the wage and pension match freeze.  The recommendation of senior leadership is to release the wage freeze and initiate eligibility of merit increases. Mr. Gerveler from BHS  explained the BHS merit criteria. Administration will develop and present a plan for this in July that is in general alignment with the Blessing design, tailored to SCH.  The SCH retirement match will be reinstated with the next payroll.  A motion was moved and unanimously approved to lift the wage freeze and pension match. Distribution of quality program incentives was discussed with a  review of criteria for participating in the Crossriver Quality Health Partner.  A motion was moved and approved with 5 yes votes and one abstention to create a general policy & procedure for shared distribution of savings and follow the 90% clinician/10% SCH model for the 2019 CQHP incentive payment. . This ratio is not reflective of general overhead costs, and is designed to engage staff with population health initiatives.  Future SCH-retention is likely to be significantly higher. A motion was moved and unanimously approved to approve the following polices: Patient Visitation Rights, Rural Health Clinics Annual Wellness Visits Procedure, and Medical Marijuana Policy.

Closed Session

Onsite: Fulk, Doubet, Hatfield, Lloyd, Neese, Dr. Tobler, Dr. Davis, and Pat Gerveler.

Via Zoom: DeRosear, Schmitt and Prather

 Matters discussed –  Recent position elimination and a surgeon contract.  A motion was moved and unanimously approved to authorize the CEO to offer a part-time contract Jay Nastav, DO.  A part-time OB/GYN contract was discussed and a motion was moved and unanimously approved to offer a contract to Gary Lee, DO.

Meeting adjourned at 9:24 pm.

The next board meeting is on July 28, 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 7/28/20.