MINUTES. Present: Carol Humphrey Peggy Cuvala David Cox Ron Hodge Mike LaPlante Richard Schumacker Dan Hammes

Transcription

1 BENEWAH COMMUNITY HOSPITAL GOVERNING BOARD MEETING Thursday, May 24 th, :00 a.m. Francie Walters Board Room, Benewah Community Hospital, St. Maries, Idaho MINUTES Present: Carol Humphrey Peggy Cuvala David Cox Ron Hodge Mike LaPlante Richard Schumacker Dan Hammes Staff Anthony Koroush Marlana Martin Rebecca Plante Lori Minier Kristi Masterson Kent Long Kathy Tweedy Other Kirt Fredericks, RBC Wealth Management Johnathan Wright, VP of Operations, Cerner Community Works Joe Stuckel, Client Results Executive, Cerner Community Works 1. Call to Order Chairman Hammes opened the meeting at 6:56 a.m. 2. Executive Session ************************************************************************************ At 6:56 a.m., a motion made by LaPlante, second by Humphrey, to adjourn to executive session per Idaho Code (1)(b) Personnel and Idaho Code (1)(j) Provider Contract. The motion passed. Present at this time: Hammes, Cox, Humphrey, Schumacker, Cuvala, LaPlante, Hodge, Koroush, and Plante. Plante exited at 6:57 a.m. The board came out of executive session at 8:03 a.m. and called for a short recess. ************************************************************************************ Martin, Plante, Masterson, Long, Minier, Tweedy, Wright, and Stuckel entered at 8:09 a.m. 3. Regular Session- Meeting reconvened for regular session at 8:10 a.m. Minier introduced Wright and Stuckel to the Board. 4. Approve Minutes A motion made by Hodge, second by Cox, to approve the meeting minutes from April 25, 2018, May 3, 2018, May 9, 2018, May 16, The motion passed. 5. Open Forum/Visitors 5.1. Jonathan Wright and Joe Stuckel, Cerner Wright stated that BCH is now 95 days past golive. Wright stated that they are making strides every day on remaining issues. A Cerner consultant is onsite this week working with Billing staff. Wright stated that we are in-line with their expectations at this point. He is hoping billing issues will be cleared up within two weeks. Testing and educational gaps have been identified. Tweedy stated that she does not believe this has been accurate; discussion regarding the current issues and the current consultant not having much attention to BCH. She did provide a lot of print outs and education for the billing staff which is great; improving the way to do Method 2 billing, which has been helpful. Fixing the backlog is more painful. Discussion regarding charges disappearing and some duplicating. Tweedy stated that we still don t have claims dropping to secondary correctly. The Cerner Billing Consultant is saying that the posters don t know how to post; they self-taught themselves

2 as Cerner trainers did not train them. Tweedy stated that all statements have to be manually looked at, some are correct, but a lot have errors. Tweedy isn t even sure if statements are getting mailed to patients, as we haven t seen any come back yet. Tweedy stated that her department is upside down. The RCAT (Revenue Cycle Activity Team) need activities to be looked at and help put structure in place and include the correct players at the table. We are still having issues with the current billing as well as the older billing. $305,000 cash came in last week, we should have $350,000 - $400,000 coming in weekly. We have approximately 4,000 claims going out each week, previously was 3,500. Hammes stated that the help Cerner provides sounds like it is good help, but it is sporadic. Hammes asked if we can assign someone to get older bills out. We do have Extended Billing Office (EBO) services with Cerner, our contract includes 90 days, and we can get this team re-engaged when we are ready. Tweedy stated that we have used them a little bit, and it was just causing problems due to the number of claim errors. Billers are nervous about this. A lot of charges are having to be manually manipulated. Need to set up a work plan, spelling out what needs to be done based on Tweedy s processes, so the EBO follow our processes, not just what they want to do. Stuckel and Wright will look at getting this started for billing. Wright will sit down with Tweedy and DeeDee (the Cerner Billing Consultant) to get a work plan together today. Martin exited at 8:29 a.m. Wright will work with Tweedy to set up a phone call with the Billing team and EBO before they touch any claims. Will need an oversight person to check in with to report how many claims were pushed out, so we can validate how things are looking. Martin and Fredericks entered at 8:31 a.m Kirt Fredericks, RBC Wealth Management Fredericks explained why he and his partner moved from Wells Fargo Advisors to RBC Wealth Management. The fees will be identical to what they were with Wells Fargo Advisors. This is not a Hospital expense, but Fredericks let the Board know that everything will be mapped over identically (Employee retirement plans). Fredericks informed the Board that his office would be sending the consulting contract at a later date that would need Hammes signature as the document was not ready for signature today. Martin stated that the few employees who responded to the hospital wide were supportive of moving the hospital plans over to RBC Wealth Management with Fredericks. The Board thanked Fredericks for meeting with them and providing more information. Martin and Fredericks exited at 8:38 a.m. Cerner cont.: Cerner will look at opportunities for continued onsite support. Will start going after older claims on Tuesday, May 29 th (after Memorial Day). Martin entered at 8:39 a.m. Tweedy knows that Cerner will work, but at this time, she does not trust the system. Tweedy stated that we are under the impression that as of May 5 th, statements have been going out, yet we have not seen any patients come in to pay. We question if the bills are going out. APEX (vendor that sends out statements) will not talk to Tweedy, this has to go through Cerner, and it sometimes takes a week to hear back. Wright stated that they will bridge the gap between APEX and BCH. Masterson stated that she went to DA2 training to learn to write reports, and she met staff from other facilities that seemed to have had the same issues as us. Seemed like all our pieces were in line, then the Cerner wipeout messed everything up. Other hospitals say this as well, so it is not just us. Staff here tested so much, and once we went live, the system was different. This is a failure on the Cerner side, not just with us, but with other hospitals as well. Wright stated that he has done over 400 implementations in his 20 years, and the financial portion is always the most difficult as all hospitals are different. Would like to have some insight on what training occurred and what the formalized process was. Wright gave an example of a CAH that went live 4/23/18 and has already billed over $6 million. Wright assured the Board they are here to fix things and make it right. Cox thanked Cerner for the commitment to fix issues. Tweedy stated that she will

3 continue to work as hard as she can, but she needs 100% of Cerner s dedicated help. Wright hasn t looked back to see what was lost in the Cerner refresh, but he will look into it. Hammes stated that we were quite a ways into this until we finally got the help from Cerner. Long stated that any clinical task that is done that drops a bill should be required fills; a lot of processes are not being completed. Supply chain charges in the ED, if entered manually helps supplies with virtual inventory, but if it is done that way, the scanner cannot be used. Cerner had some great people here, but the communication and cross training per departments was horrible. We were not thrown scenarios to test with tasks. Long explained more issues on the nursing side. Wright thinks these are all set-up issues. One item included in our Cerner contract is an optimization visit, which usually occurs 6-9 months after go-live. This would include senior people onsite for nursing and revenue cycle, to look at system wide items (look at ways for less clicks and better processes). May fast track this so this will occur sooner. Wright asked for a list of issues from Long. Generally, one optimization visit is offered in the 1 st year, from there, if another was needed, it would be at an additional fee. Minier stated that total AR is at 4.5 million. DNFB is just over $2 million. Wright stated that we need to look at what will be the new normal. Hodge exited at 8:56 a.m. We need to establish what we want AR to look like normally. The Board asked Wright for an expected timeframe for getting the old claims out. Need to look at this with Tweedy before can give a firm timeframe. Is there a way to recapture missed charges? There is a revenue integrity process, the Cerner Billing Consultant is already starting to run some of this now. Long stated that we are having a lot of issues with Med. Rec. as well. Hodge entered at 8:58 a.m. Schumacker exited at 8:58 a.m. Masterson gave an example of a patient with 25 home meds that the med. rec ended up showing 76 home meds. Masterson stated that she has been working with an analyst on this. Physician experience will be onsite July 16 th. Koroush stated that Wright will have a tour of the facility after the meeting and staff has been notified so they can bring questions to him. Stuckel explained what he does in his position and has weekly phone calls with Koroush and Minier; he is our long-term Cerner guy. Cerner views this as a partnership, not just a vendor relationship. Wright, Stuckel and Tweedy exited at 9:03 a.m. Long will get with Wright today to talk about the charging issues. Discussion regarding an interface with the OR that Cerner showed staff that we did not have in our contract. This was also a service we did not have with the old system. Discussion followed regarding issues. 6. Presentation Agenda None. 7. Medical Staff Koroush presented the reappointment files that were approved by the Medical Staff at their May meeting as Dr. Wheeler was absent from the meeting Reappointments W. Scott Spence, M.D. - A motion made by Hodge, second by Cox, to approve Dr. Spence s 2-year reappointment. The motion passed William Wheeler, M.D. A motion made by Humphrey, second by Hodge, to approve Dr. Wheeler s 2-year reappointment. The motion passed. 8. Board Committee Reports 8.1. Performance Improvement Committee LaPlante briefed the Board on what departments reported at the May PI Meeting. LaPlante explained Grasham s Materials Management project with capturing lost charges. Koroush let the managers know at the PI meeting that the DNV contract will be cancelled after our next survey. Draper will continue to do internal audits to keep us compliant Finance Committee Financials packets were not distributed as Cerner files stopped processing April 13 th. Files came over May 22 nd and validation started on the 23 rd.

4 Approve April Financials Hammes stated that in two weeks, the board will have a mid-month meeting that will include the April Financial discussion. April Financial approval tabled until mid-month meeting Audited Financials Hammes stated that the Build America bonds make up about 50% of the payable to Medicare. For 2017 total, the payable is approximately $1 million. We will most likely have $220,000 payable for Moving forward, we should not get hit as this is now built into the 2018 cost report assumptions. As we reduce expenses, we have to contact Noridian to let them know so an adjustment can be made to avoid the payables (this can be done in June). We were previously told differently from our experts about the Build America Bonds. This was caught by a new auditor at Noridian, Minier pushed this to Eide Bailly, who employs a previous employee of Noridian. Minier stated that they requested additional information for the bond. The board would like to know why EideBailly didn t see this as a red flag; discussion followed. The Board is making cost cuts because of issues we cannot control such as these payables to Medicare. The Board would like the audit draft prior (maybe 2 weeks) before the board meeting moving forward. RFPs will be sent out this year for auditors. Discussion regarding decline in outpatient surgery. The Board asked some questions in regards to the 2017 audited financials. Change language regarding expanding services (intended to imply expanding volumes). Discussion regarding Charity Care and receivables. Statement of Net position, liabilities, capital lease obligations down substantially (due to paying down C-Arm, Pyxis). Will go up in 2018 due to the extended payment plan with Medicare. Discussion regarding leases affecting the cost report, claiming interest. Minier stated that the Management Discussion and Analysis (MD&A) is something that she provides after reviewing the audit and due to focusing on Cerner issues, she was unable to get this done timely. A motion made by Hodge, second by Humphrey, to allow Koroush to sign for submission 2017 Audited Financials. The motion passed Medicare Cost Report The 2017 Medicare cost report is a payable of $402,000, notifying Medicare today that Audit is approved and will get the formal cost report. This is final and due May 31 st. A motion made by Cox, second by Hodge, to approve the 2017 Medicare Cost Report. The motion passed Board Nominations and Bylaws/Policy Committee Cuvala stated that the Board Nominations and Bylaws/Policy committee did not met this month Medical Staff Committee Hodge stated that at the May Medical Staff meeting, Pharmacist Tyson Frodin suggested reducing some injectable antibiotics on the formulary in efforts to reduce cost and waste, and he received the Medical Staff s blessing. 9. Board/CEO Staff Communications 9.1. Board Rounding Cox stated he has talked with Board members who will be rounding with staff. Rounding activities will begin again in June. Departments will be assigned to those rounding; this will go out next week Old Items Revisited None.

5 10. Administrative Reports/Questions Martin stated that a CMA student attending the NIC CMA program who lives in St. Maries is doing her clinical rotation here currently. The feedback we have received is that her rotation is going very well. If she continues to do well, we will offer the open CMA position to her. IHA s President Brian Whitlock will be onsite to meet with Koroush next week. Koroush stated that there is no specific agenda for this meeting, he will just be in the area. Cox asked Koroush to ask Whitlock for an update with Board Policy samples from IHA. Hammes asked about PotlatchDeltic sending new employees to Spokane to get Physicals. Discussion regarding what it would take to build an occupational health program at BCH, which we cannot do with current cash issues. Long has been talking with Dr. Winters at Northwest Specialty to get advice on what is needed for this program. A Case Manager in charge of this program would be a necessity; discussion followed. The board thanked staff for their reports. 11. Communications BetterCARE Report Masterson stated that BetterCARE Memorial Walk will be September 22 nd. There are six teams so far and looking to get more Board Education No education provided. Meeting adjourned at 9:45 a.m. Respectfully submitted, Approved by: Dan Hammes, Board Chairman Rebecca Plante, Board Secretary