Board of Trustees Monthly Meeting - Public Session. Mary Katherine King, Executive Assistant

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1 St. John s Medical Center P.O. Box 428 Jackson, Wyoming Committee: Board of Trustees Monthly Meeting - Public Session Meeting Date: August 22, 2013 Minutes Prepared By: Mary Katherine King, Executive Assistant Members Present: Members Absent: Others Present: Michael Tennican, Chair Barbara Herz Bruce Hayse, MD Joe Albright George Poore, MD Zach Hall Scott Gibson Lou Hochheiser, MD, CEO Marty Trott, MD John Kren, CFO Lynn Kirman, CNO Gary Trauner, COO John Payne, DO Alisa Lane Candace Geatz Pat Weber Chuck Herz Jim Johnston Terry Hayden Patty Hartnett Becky Frisbie Catherine Cullinane Catherine Holland Mary Katherine King Call to Order The public Board meeting was called to order at 3:01 p.m. by the Board Chair, Mike Tennican. The public meeting was immediately adjourned to convene in executive session. The public Board meeting was reconvened at 4:00 p.m. Special Announcements Teton Pines Women s Golf Association Oncology fundraising Patty Hartnett, Chair of the of the Teton Pines Women s Golf Association, and Becky Frisbie, Co-chair, presented The St. John s Hospital Foundation with a check in the amount of $50,000. Proceeds were raised in the 2 nd annual golf tournament, Tee it Up for Oncology. This year's tournament proceeds will go toward the WGA s total pledge of $150,000 for the hospital s oncology expansion project. Eddie Kolsky: The Steve Winograd Memorial Tennis Tournament

2 Page 2 of 6 Catherine Cullinane and Catherine Holland, on behalf of St. John s Diabetes Education staff, presented tennis pro Eddie Kolsky a plaque in recognition of his tireless support and devotion to raising awareness of and funding for diabetes in our community. Founded by Mr. Kolsky in 1999, The Steve Winograd Memorial Tennis Tournament has raised over $300,000 for St. John's Diabetes Education program. The proceeds from last week s tournament and dinner will benefit the St. John's Diabetes Education. These funds have helped support professional education for hospital staff, purchase equipment, and provide financial assistance to patients. Finance Committee Report Mr. Gibson reported on July 2013, the first month of the new fiscal year. Inpatient Revenue for July came in at 29% under the budgeted amount and Gross Outpatient Revenue was 3% under the budgeted amount. Mr. Gibson noted that the Finance Committee, in an oversight capacity, examines why the shortfall occurred and also makes certain that management understands why it occurred. Mr. Gibson stated the committee was impressed that management understood in a disciplined detail. The fluctuation can primarily be attributed to several key physicians taking time off during the month of July. In July 2012, the number of bad accidents specifically bike and car accidents increased markedly; and July 2013 resulted in far fewer accidents which required surgery or inpatient care, which explains the 29% reduction in inpatient revenue. The committee examined outmigration, but concluded that it was not a factor. In summary, Mr. Gibson stated that Finance Committee is confident management has a solid handle on the business model and our vulnerability to volume. Dr. Hochheiser commented that in addition to surgery being down, OB was also down; it was lean overall. This is a reminder of the variation that can occur in a hospital with a small number of beds. Ms. Herz remarked that the committee is concerned by missing budget by $1 million and it cannot happen for multiple months. She noted the committee is taking discussions seriously. Mr. Kren gave an overview of the monthly financials for July Cash flows from operating and non-operating activities totaled $1,371,789. We ended with 225 days cash on hand. Patient days came in at 532 with 16,605 surgical minutes, and we delivered 33 babies this month. Inpatient Revenue for July came in at $3,604,000 which was 29% under the budgeted amount of $5,097,000 and Gross Outpatient Revenue totaled $6,997,000 which was 3% under the budgeted amount of $7,175,000. This directly correlates to the statistics which came in 23% below budget in inpatient days and 57% below budget in inpatient surgical minutes (the prime indicators for inpatient revenue). Although the outpatient surgical minutes were also down, we saw an increase in ER visits, observation hours, imaging, home health, and rehab. Revenue deductions were also less than budget due to the decrease revenue. In all, July activity resulted in a Total Net Revenue amount of $7,020,000 which is over a million dollars less than the expected amount of $8,080,000 and $892,000 off of the July 2012 net revenue of $7,913,000. Expenses came in at $6.6 million versus budget of $6.9 million. Comments from the Chair No comments from the Chair.

3 Page 3 of 6 Minutes Dr. Poore moved to approve the minutes from the meeting held on July 24, Mr. Albright seconded the motion, which passed unanimously. Old Business No old business. New Business Ms. Herz thanked Mr. Hall for circulating to the Board an advertisement in the weekly paper that offers helpful information on upcoming health care reforms and accessing insurance. Concerned that many in our community are not aware of the changes, Ms. Herz and others Board members encouraged the hospital to develop initiatives to inform the population of these changes and ways to access insurance. Suggestions discussed were links on the hospital s website, information at the check-in desk, cards in the physicians offices, etc. Discussion ensued about Medicare and the fact that at this point Wyoming is not participating in Medicaid expansion. Although, SJMC continues to feel expansion would benefit people in our community and the state. Mr. Albright shared a letter he received from a St. John s patient who received a pre-arranged transfusion during his visit to Jackson. The letter thanked the Oncology Infusion Center staff for their excellent care, competence, and service. Dr. Hochheiser commended the Infusion Center staff, noting that patients traveling through Jackson are increasingly utilizing our Infusion Center for treatments. Board Committees and Medical Staff Reports and Action Items JCC Committee Mr. Hall commented on the results of recent cardiology clinic survey, including the issue of patient access to the visiting specialist within an acceptable timeframe. That item led to a more in-depth discussion about the visiting specialist program, including the following aspects: A) potential use of cardiology telemedicine, B) compensation of visiting specialists, and C) the evolving relationship with the University of Utah. JCC discussed progress with computerized physician order entry (CPOE). Mr. Hall stated that presently, SJMC s electronic medical record is a hybrid of paper record and electronic record. Due to deficiencies in the system, the switch has been slow; none of the CPOE programs on the market today are intuitive or completely user friendly. Gary Trauner added that Paragon Version 12 will be implemented next month, and Version 13 a more user-friendly version should be in place six months later. Dr. Hochheiser remarked that we have made substantial progress over the last year; we met Meaningful Use Stage 1 and we are on track to meet Stage 2. Many of the issues with the

4 Page 4 of 6 software are due to the fact that as they roll it out, the government changes the rules and the software companies must respond. Mr. Hall reported that the JCC received an update from Dr. Travis Riddell, the Teton County Public Health officer. Dr. Riddell intends to actively work with the Public Health Department to improve the health of our community. Dr. Riddell sees the relationship between St. John s and the Public Health Department as crucial and will work toward a closer collaboration between the two entities. Dr. Riddell will further develop these ideas and present them to JCC in a future meeting. Mr. Hall stated that Dr. Domsky brought up the issue about encouraging staff physicians to use the hospital operating rooms. Approval of Credentialing Items Dr. John Payne presented the credentialing items recommended for Board approval at the August MEC and JCC meetings. These items included: Initial Appointments and Reappointments. Dr. Poore moved to approve the credentialing recommendations as presented. Ms. Herz seconded the motion, which passed unanimously. Dr. Payne noted that there were no policies or Medical Staff Bylaws changes for consideration this month. Medical Staff Report Dr. Payne stated Mr. Hall covered most of the items, including the robust discussion on cardiology. They are trying to obtain dependable data on how long it takes for patients to see our visiting cardiologists. Dr. Katz will speak with the visiting cardiologist to determine if he has the ability to increase his presence here, both physically and via telemedicine. SJMC is in the process of evaluating our needs more accurately. Facilities Committee Jim Johnston reported the chillers are online and on full automatic. When outside temperatures drop below 55 degrees, they operate through our heat exchanger, resulting in considerable energy and cost savings. We will start the new boiler in September and shut down the four existing ones. Labor & Delivery/Surgery/Oncology are dried in and moving along as scheduled. Most plumbing and electrical is complete, and fireproofing in Central Sterile is finished. Costs for the remainder of fireproofing are expected at the September Board meeting. Mr. Johnston said that the project is on schedule, and that he expects to open the three areas by the end of October. Organization Committee Mr. Albright announced that the committee has selected a new Board Advisor. He turned the topic over to Mr. Hall for introduction. Mr. Hall motioned that the Board invite Liz Masek to become an Advisor to the St. John s Medical Center Board of Trustees. Mr. Albright seconded the motion, which was approved unanimously.

5 Page 5 of 6 Mr. Albright reported that the committee received drafts of nine policies for review. The committee will discuss the policies at the Organization Committee meeting scheduled for September 17 th. Compliance Committee Mr. Albright stated the recent committee meeting focused on HIPAA and coming into full compliance with the Omnibus Rule by September 23, Staff and administration have been working on a number of items, including revising various documents and policies, as well as the Compliance Program Summary. To be proactive, SJMC has engaged the services of an IT firm HIS PRO. The firm will perform a two-stage audit, examining 1) HIPAA compliance and 2) technical security. The next Compliance Committee meeting is scheduled for November 20, Strategy Committee Mr. Tennican reported that the committee is working on a plan that focuses on high-level strategic initiatives that will serve as a guideline for administration. The committee has been making good progress, much of which has been driven by Dr. Hochheiser. The committee intends to present the plan to the Board no later than the October Board meeting. Mr. Albright suggested that when the Strategic Plan is scheduled to be presented to the Board, St. John s Medical Center should make a public announcement so that community members are aware of the meeting and may offer their input. CEO Report Dr. Hochheiser announced that three long-time employees of SJMC will retire at the end of this month. We will honor Diane Bircher (32 years at SJMC), Bev Boynton (30 years at SJMC), and Janet Woodland (17 years at SJMC) at a retirement party on Thursday, August 22 nd at 2:00 in the Living Center courtyard. In the area of patient safety and quality, Dr. Hochheiser noted that staff is reviewing the Quality and Safety program as part of recruiting a new manager. The MRI has had some glitches, resulting in down time, but Siemens has installed new software. Lynn Kirman, CNO, has taken over the role of Patient Safety officer, to replace Candy Geatz who has assumed the role of Risk and Compliance Officer. Ms. Kirman has implemented a variety of safety initiatives. In the area of outreach, Dr. Hochheiser stated that Teton Valley Hospital will visit SJMC to complete an MOU. He is scheduled to travel next month to visit the Pinedale and Big Piney clinics, and local events such as the Relay for Life and Oncology Outreach have been successful. The Active Trails Wellness program continues to draw visitors from St. John s, many of whom had never visited Grand Teton National Park. Thus far, six St. John s Medical Center employees have been prize winners. SJMC continues to collaborate with the Teton County Library on Lunch Time Learning programs. Words on Wellness is SJMC s new speaker series. Author, speaker, and health advocate Kris Carr will speak in Jackson on October 19 th at the Center for the Arts, as part of the SJMC Words on Wellness speaker series. This event is sponsored by the Charles Engelhard Foundation, and 100% of the proceeds will be donated to the SJMC oncology survivorship program.

6 Page 6 of 6 As an update on the wayfinding project, Dr. Hochheiser gave a slideshow presentation created by Takeform, Inc. Takeform has performed a full assessment, with the goal of helping our visitors navigate more easily through the hospital campus. The scope of the project covers the entire SJMC campus, including the Professional Office Building area. Foundation Report No Foundation Report. Commission Report Mr. Phibbs was unable to attend. Public Comments None. Next Meeting The next regular monthly meeting will be Friday, September 27 with public session at 4:00 pm and executive session beginning at 3:00 pm. Adjournment Mr. Hall moved for adjournment of the public session. Ms. Herz seconded the motion, which passed unanimously and the meeting ended at 5:51 pm with no return to executive session. Respectfully submitted, Mary Katherine King, Executive Assistant

Sherry Wieters, Executive Assistant

Sherry Wieters, Executive Assistant St. John s Medical Center P.O. Box 428 Jackson, Wyoming 83001 307-733-3636 Committee: Board of Trustees Monthly Meeting - Public Session Meeting Date: December 17, 2012 Minutes Prepared By: Sherry Wieters,