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The Scotland County Hospital Board of Directors met in regular session on Tuesday, July 28, 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 attending in person: Chair-Lori Fulk, Vice Chair- Joni Lloyd, Secretary-Joseph Doubet, Treasurer-Robert Neese,
Absent: Nic Hatfield
Others attending in person: Dr. Randy Tobler, Maureen Kahn, CEO/President BHS, CEO, Dr. Celeste Miller-Parish, COS, Dr. Jeff Davis, CMO, Dr. Davis- Humes, Dr. Aurora Bell, Stephanie Henley-Pippert, NP, Jessica Christen, NP, Terri Schmitt-QA/Safety Director, Michael Brandon, Controller, Alisa Kigar, Marketing Director, Ken McMinn, IT Director.
Present via Zoom: Dwight DeRosear, Dr. Julia McNabb, Angela Schmitter-Health Information and Compliance Director, Jenna Williams, NP, Dr. Neil Hoyal, Dr. Shane Wilson, Dr. Joey Hassien, and Brenda Prather, recording secretary.
Chairman Fulk called the meeting to order at 5:40 pm. Motions were moved and unanimously approved for the Open Session Agenda, Executive Session Agenda, Consent Agenda and Approval of Minutes with these additions: Medical Staff Meeting convene to discuss formulary to be inserted prior to Consent Agenda, Consent Agenda item J. Contracts,SCH BOD Policy Payer Program and Incentive Income Distribution and Retention, Old Business-B. HVAC Purchase Grant. There were no public comments.
The Medical Staff met and there was a discussion concerning amendments to the SCH Drug Formulary.
Under Quality Improvement/Safety Committee, Terri Schmitt, QIS/Safety director, presented the graphics and tables comprising quarterly summary of reporting data. Data is reported on a monthly or quarterly basis to HRSA’s Medicare Beneficiary Quality Improvement Project (MBQIP), Medicare.gov. Hospital Compare, and Meaningful Use quality and safety reporting
The Financial Report was deferred. Michael Brandon stated there were no financials this month in preparation for audit, which has been scheduled for the first week in September. Dr. Tobler added that the number of days cash on hand, as obligated by USDA loan, was appropriately met.
Blessing Health System Report by Maureen Kahn: Mrs. Kahn reported that telemedicine is being utilized at a rate of about 15%. This is a growing popular choice by patients and very appreciated by farmers. Additionally, she reported that psychiatrists are pleased about using telemedicine for home visits. Blessing purchased and implemented remote monitoring devices to enable safe care at home for patients with chronic conditions, i.e. O2 saturation and blood pressure cuffs compatible to medical records. Specialty clinic physicians are using telehealth for preliminary visits, then follow up in-person, as appropriate or required. Governor Pritzker visited Quincy on Monday, July 27, 2020, and alerted Adams Countians they are one of four counties seeing a significant rise in COVID-19 cases and he reprimanded the idea of not wearing masks. Blessing is preparing for staffing if schools are not traditionally open to students. Blessing will be providing a learning room for children and equipment will be provided for internet access. Blessing Maintenance Director recently completed an assessment of the SCH facility. A compliance audit will be scheduled, in HR, IT, etc. Job description for SCH Chief Operating Officer will be completed after strategic plans for SCH and BHS goals are available. She and Pat Gerveler continue to get acquainted with staff and the community while receiving positive feedback of familiar goals in success of hospital and management program, understanding the facility limits but also understanding it all comes with change. Blessing has lowered pricing on CT, MRI, and almost every imaging test about 60% because they were experiencing some in their community driving to St. Louis and price shopping. She reported that BHS was receiving interpretations that, in some instances, the surgeons were uncomfortable or questioning. Blessing feels they can provide a better-quality product and can get the volume back. Since June. Blessing has been much busier, even without ads, just word of mouth. Hannibal Clinic has also cut pricing. Blessing is coordinating with two area employers to provide employee health care. They are preparing a business plan based on predictions post COVID-19 relating to unemployed population. BHS purchased Brown Pharmacy to be their 340B contract pharmacy. Currently developing and will open a couple of free clinics in the downtown area. Mrs. Kahn reported Blessing, too, has been very frustrated with COVID-19 testing.
ADMINISTRATIVE REPORT: Under Operations: COVID-19 Response-CEO, Dr. Randy Tobler reported that SCH has no COVID (+) inpatients to date, 1 active COVID patient in Scotland County currently, 9 total cases/356 total tests done here (positive rate of 3.6%). County wide, 11 total cases, 1 death (not cared for at SCH). Currently there are not imminent critical supply shortages at the current demand. Facilities-Access remains limited and universally screening. Patient services-Volumes are 85-90% in clinic and at pre-COVID levels for inpatient on average. Business Recovery-We received guidance from Centers for Medicare/Medicaid that the Payroll Protection Program funds used to cover payroll expenses, when forgiven, will need to be offset from operating expenses on the cost report, to avoid duplicative reimbursement. Dr. Tobler reported this is neither favorable nor un-expected news. Expense management-We are managing capital and operating expenses with the assumption that all COVID related funds will apply only to those excess costs and lost revenues incurred during the emergency, anticipating no “make-up” forgiveness beyond those to help with the chronic below-cost funding of governmental insurance (Medicare/Medicaid) beneficiaries. SCH is asking employees who travel out of state to call the COVID hot line for guidance on precautions when returning home and to work. Under Population Health-We are advertising for a Population Health nurse to work with the Pop Health Coordinator, due to a resignation. Caravan Collaborative Pathways Accountable Care Organization (ACO): We are working on capturing Annual Wellness Visits conducted and coded that are not being picked up due to billing delays. Dr. Tobler reported that he signed, on behalf of SCH, a group letter from our ACO to House and Senate committee chairs supporting S. 3951/HR 7190-Increasing Rural Health Access during the COVID-19 Public Health Emergency Act of 2020-which establishes a pilot program supporting remote monitoring technology to sustain and expand access to rural health during the Covid-19 emergency. Crossriver Quality Health Partners (CQHP)-SCH received a performance and quality incentive distribution of $8,089.20 in behalf of its participating clinicians for the 2019 Performance Year. Each clinician’s incentive amount has been calculated by CQHP and will be awarded after a contract amendment is executed. SCH will retain the same percentage of the incentive as other participating entities. Overall, CQHP achieved 61.8% of its overall goal in 2019 (for its contracts with the Blessing and Hannibal Employee Health Plans), resulting in a total incentive of $370,818. “Penthouse” Renovation- Financing through the DNR Energy Savings Loan Program has been finalized and approved by USDA. Construction will start in September. Rooftop units will be delayed due to COVID-related supply chain disruption but will not interfere with installation of the overall project. GPS ionization (anti-microbial technology applying to virus and bacteria including COVID and influenza) is already in the proposal. It is believed that retrofitting the rest of the Hospital and Clinic with GPS technology is eligible for HHS COVID funding. Revenue Cycle-A contract with Blessing was executed to code and file current claims insurance while SCH staff manages Accounts Receivable and self-pay accounts. Edina Clinic-We are addressing a long list of minor needs to satisfy criteria for a certifying inspection. SCH Foundation-The Foundation held its annual meeting on 7/20. Topics addressed were FY2019 and potential future fundraising activities and capital funding projects. Medical Staff-Drs. Phan and Nastav provided extended coverage for Dr. Miller-Parish’s well-deserved break after a long stretch of continuous surgical call. Abigail Neiters, Nurse Practitioner is completing her collaborative review period in the Emergency Department and will start solo shifts 7/28. Personnel-Human Resources functions are split between existing personnel with appropriate competencies and with backup from Blessing upper management where necessary. Several very productive meetings with Blessing’s Vice President of Human Relations have resulted in a plan to consolidate the related HR and Quality functions under a unified support service. Several employees have added retirement withholding concordant with the lifting of match freeze. Advocacy-Constitutional Amendment 2, on the August 4 ballot, is an opportunity for many currently uninsured individuals in our service area to become eligible for Medicaid coverage at the 138% of Federal Poverty Level, up from the current 21%. The Missouri Hospital Association endorses it due to increased access to health care and the resulting improvement in overall population health and economic benefits, referencing studies illustrating net improvements to the business and personal economies of Missourians. Specific to SCH and other perennially economically challenged facilities, there will be substantially reduced uncompensated care. Data on rural hospital sustainability show that those hospitals in Medicaid-expansion states are at much lower risk of financial failure and closure
Dr. Tobler stated he would be out of town on the date of the August meeting, Tuesday August 25. He asked the Board whether they would be open to him attending via Zoom, or if they prefer to reschedule. Consensus was to keep the same schedule for meeting and Dr. Tobler would utilize video conferencing.
CHIEF MEDICAL OFFICER REPORT:
Dr. Davis’ report highlighted these areas: Recently the Senior Management Team has developed a new employee performance evaluation process and implementation of lifting the wage freeze as well as developed a framework for a new Human Resources relationship with Blessing Health System’s People and Performance Optimization Department (PPO). He further reported that Jay Nastav, DO, will begin surgery clinic and coverage 2 days per week beginning in September. Dr. Davis reported that he is faculty for a live virtual CME course held by the Montana Osteopathic Medical Association in August.
Dr. Tobler and Terri Schmitt, outlined the Interim Performance/Competency Evaluation Policy developed in conjunction with the recent release of wage freeze. A motion was moved and unanimously approved to accept the policy.
A motion was moved and unanimously approved for a resolution which authorizes CEO Tobler to execute and enter into the HVAC equipment lease purchase agreement with De Lage Landen Public Finance LLC (Noesis), excluding the ‘Opinion of Counsel’ section.
NEW BUSINESS- Terri Schmitt outlined the history of revisions to HR policies, incorporating change of structure in Human Resources and rolling all such references into the following three policies: Just Culture-Coaching, Counseling and Discipline Policy, Employee Concerns Policy, Employee Grievance Policy. A motion was moved and unanimously approved to accept the policies. Based on the Medical Staff’s credentialing report, a motion was moved and unanimously approved to accept the ten clinicians listed for reappointments, removal, temporary privileges and pending credentials.
CLOSED SESSION-Onsite: Fulk, Doubet, Lloyd, Neese, Dr. Tobler, Terri Schmitt.
Via Zoom: DeRosear and Prather
Matters discussed-a former employee’s request, as well as, Maintenance Department staffing after assessment by Blessing.
Meeting adjourned at 9:24 pm.
The next board meeting is on August 25, 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 firstname.lastname@example.org or mail to Administration at SCH, 450 E. Sigler Avenue, Memphis, MO, 63555. The form must be received by 9 am on 08/25/20.