Scotland County Hospital Continued To Address COVID-19 Challenges

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The Scotland County Hospital Board of Directors met in regular session on Tuesday, November 24, 2020, via Zoom Meeting and in person. The Open Session was broadcast 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: Nic Hatfield.

Board Members attending via Zoom: Chair-Lori Fulk, Vice Chair- Joni Lloyd, Secretary-Joseph Doubet, Treasurer-Robert Neese, Dwight DeRosear.

Leadership attending in person: Randy Tobler, MD, CEO, Dr. Celeste Miller-Parish, COS, Michael Brandon, Controller, Alisa Kigar, Marketing Director.

Leadership attending via Zoom video/phone: Dr. Jeff Davis, CMO, Maureen Kahn, CEO/President BCS, CEO, Pat Gerveler, EVP BCS, Angela Schmitter-Health Information and Compliance Director, Terry Schmitt, Dir. of Quality Improvement/Safety/Risk/HR Elizabeth Guffey, RN CNO, Ken McMinn, IT Director and Brenda Prather, recording secretary.

The meeting was called to order by Chairman Fulk at 5:30 pm. Terri Schmitt, Quality & Safety Director reviewed highlights from her department and showed a Power Point presentation on the Employee Assistance Program (EAP) outlining the program which offers confidential counseling for employees, via phone app.

Michael Brandon, MBA, Controller, gave the Financial Report.  (See Chart of Financial Report on Page 13)

Mr. Brandon reported the cost report from BKD, the Hospital’s accounting firm, is delayed due to COVID related extension request deadline granted from The Centers for Medicare and Medicaid (CMS). BKD reported to Mr. Brandon that this delay will push the audit back to January 2021, more than likely. In fiscal year 2020 SCH recorded approximately $2,000,000 in Health & Human Services Provider Relief Funds for lost revenues. The rules revolving around lost revenues has been reinterpreted to focus on comparing calendar year 2020 to calendar year 2019. Due to this measurement period, GASB (Governmental Accounting Standards Board) issued guidance that states since the measurement period for lost revenues is calendar year, funds cannot be recorded as revenue until the end of the measurement period. Since the SCH fiscal year end of June 30 is prior to the end of the calendar year, the funds for lost revenue cannot be recorded as revenue in fiscal year 2020. The lost revenues will be recognized in fiscal year 2021 to coincide with the end of the measurement period. Mr. Brandon further explained what this means for fiscal year 2020 and 2021 financials is, the bottom line will decrease by $2,000,000 in fiscal year 2020 and increase by $2,000,000 in fiscal year 2021.

Blessing Health System Report by Maureen Kahn-Mrs. Kahn highlighted these points: Visitors  are limited in their facilities, but still offering visitations. Blessing has 100 staff quarantined at this time. They continue with a large amount of free COVID testing, many people are presenting asymptomatic and testing positive. Nurses from the clinics as well as nursing professors from the Nursing School are filling in for staff shortages. She reported that staff have finished the fiscal year attaining almost 80% of their goals, while Leadership attained 100%. She has requested Strategic Planning with SCH to begin in January.

ADMINISTRATIVE REPORT:

Under Operations, Dr. Randy Tobler, CEO, reported the organization continues to experience high positivity rates and 11/24/20 the hospital experienced the first hospital COVID-19 deaths, one from the in-patient floor and one from the Emergency Department that was transported in by EMS. The number and severity of hospitalized COVID patients has increased, and the medical team, med/surge nursing floor staff and support staff have managed the shortage of receiving beds at larger hospitals by implementing the latest evidence-based treatments. The COVID response team subset met emergently Sunday 11/15/20 to address alarming rates of employee and community positivity, unavailability of out-transfer beds, and impact on staffing. Many adjustments were made for facilities, patient services and financial. Dr. Tobler reported on the COVID vaccine announcing that SCH has executed a Memorandum of Agreement to be a vaccination site. He reported that the Missouri state plan calls for a phased target population approach: I. Healthcare workers, nursing home, long term care patients. II. Adding all essential care workers & high risk populations. III. All residents. Availability is anticipated by as early as Christmas, with increasing production through 2021. Under Population Health: Crossriver Quality Health Partners (CQHP) is exploring obesity management as a special initiative. Compliance: 340B Audit-A working group, which is led by Michael Brandon, met to establish responsibilities for data acquisition and report uploads. Dr. Tobler reported the SCH lab will undergo routine certification inspection 12/1/20. The Pharmacy Informatics Performance Improvement Plan for optimizing pharmacy informatics and is led by Sonya See in cooperation with Pharmacy, IT and Quality Reporting staff. The tangible payoffs will be a reduction in missed charges, and maintaining less cluttered, up-to-date user interfaces for all. Grant Opportunities: SCH will apply for a HRSA SC Rural Health Network (SCRHN) grant with other health entities at the next opportunity. SCH will be a participating site in two Blessing grant applications for the Behavioral Health Outreach Services Development Grant (HRSA) and the Rural Home Hospital Pilot Project (Ariadne Labs). Missouri Hospital Association (MHA) Distinguished Service Award: All Missouri Hospitals were awarded this in recognition of the tremendous, tireless efforts of the caring staff. Personnel: Our appeal for a willing healthcare competent labor pool has met with several calls by volunteers and others willing to work PRN (as needed). Advocacy: Members of the Exec Team have been coordinating with the Communication Department’s aggressive media campaign, recognized by officials at MHA for SCH’s prominent role in rural health advocacy during the recent surge. Appearances have ranged from local to regional and national print (Associated Press-syndicated, USA today), radio (NPR, KMOX and KFTK in STL), and television (“CBS This Morning” and KTVO and WGEM News). Dr. Tobler reported on participating in periodic calls with Gov. Parson and State agency directors, Congressman Graves, and other calls, most under the auspices of MHA. Themes this month: Surge staffing problems, Liability protection and consensus crisis standard of care adjustments, Clarity in Provider Relief Fund utilization, Vaccine distribution planning.

CHIEF MEDICAL OFFICER REPORT:

Dr. Jeff Davis reported that elective surgeries and procedures for most patients were recentlysuspended due to COVID surge. Pre-op testing for COVID is available locally or via NERMC if non-emergent medically necessary surgery or procedure is scheduled. Regarding medical staff, Dr. Stanley Horner suspended services due to moving out of the area. SCH is waiting to hear back from PSN on replacement allergy and immunology clinician. Two nurse practitioners have tendered their resignations. They currently plan to work through the end of the year. Docs Who Care has been contacted and in the process of working out an arrangement for them to provide 2 FTEs for coverage in the Emergency Department. He reported that SCH has reached agreement with a local Family Nurse Practitioner recent graduate to assume duties at MMS and other clinics with a focus on walk-in care, to replace those responsibilities vacated by the departure of 2 ED APNs at the end of the year and a traditional scope Family Medicine locums tenens doctor has been located to assist with coverage during Dr. Davis-Humes’ upcoming leave.

Under Old Business, a proposal has been accepted and executed by USDA for a Deferral Make- Up Agreement. The agreement is to make payments up over the next 18 months.

Under New Business it was announced that the filing period for April 6, 2021, District Board Election begins at 8:00 on 12/15/20 and closes at 5:00 pm on 1/19/21. Robert Neese (District 1) is up for re-election. Neese did not confirm his decision to run. Pat Gerveler from Blessing Health Services described the Blessing Be Well Agreement for Edina Medical Services. Local businesses pay a small fee per employee/month so they can access primary care in multiple areas, 2 sites in Quincy, Canton, Hannibal and Scotland County. This presently covers 650-700 lives. This augments their primary insurance plan. This is sometimes the only way some may access primary care. Dr. Tobler recommended approval of this agreement. A motion was moved and unanimously approved to have the Edina Medical Services clinic in the program. There was discussion on the employee health plan and a review of minimal changes. Because of a positive year last year, SCH obtained about a 10% savings on the catastrophic reinsurance component cost to SCH. A motion was moved and unanimously approved to continue enrollment for SCH employees. A short list of credentials for medical staff was presented for approval a motion was moved and unanimously approved to accept the credentials.

CLOSED SESSION:

Matters discussed: Legal Matters; Hiring, firing or discipline of employees; individually identifiable personnel information.

Meeting adjourned at 8:41 pm.

The next board meeting is on December 29, 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 12/29/20.