The Three Rivers Hospital Board of Commissioners called a regular meeting to order at 4:04 p.m. Monday, June 30, 2014 in the Hillcrest Commons Area, 415 Hospital Way, Brewster, WA 98812. The presiding officer was Vicki Orford, Chair. A quorum was present, including: Vicki Orford, Chair Tracy Shrable, Secretary Mike Pruett, Member Cherri Thomas, Member Others present: J. Scott Graham, Chief Executive Officer Jennifer Munson, Chief Financial Officer Rebecca Meadows, Dir. of Community Relations and Marketing Anita Fisk, Director of Human Resources Gretchen Aguilar, Chief Nursing Officer Jennifer Marshall, Administrative Assistant Bob Johnson, Radiology Manager Janet Hanke, CSS Clinic Manager Agenda The board approved the agenda after noting Resolution 2014-10 was a final resolution, not a draft. Minutes The board unanimously approved minutes from the May 12, 2014 regular meeting. M. Pruett motioned, C. Thomas seconded. Consent Items Bad debt in June was $113,761.88 and charity care was $28,242.73. Vouchers: 73861-73895 $268,103.86 73791-73860 $147,576.87 73740-73790 $389,818.44 73659-73739 $154,722.28 73608-73658 $312,108.75 73560-73607 $108,231.57 73484-73559 $366,907.78 Payroll gross total: $683,880.28 5/11-5/24 $239,992.83 5/25-6/7 $225,416.55 6/8-6/21 $218,470.90
Med staff applications: See attached. T. Shrable motioned to approve the consent agenda items. M. Pruett seconded, and the motion passed unanimously. Old Business V. Orford suggested an amendment to Article V of the Board of Commissioners bylaws to add the Building and Planning Committee as Section 1.4. See attached. M. Pruett said he is in favor of the changes. V. Orford said the board should be able to sign off on the finalized bylaws next month. New Business S. Graham presented an award to J. Hanke from the Washington State Hospital Association for her efforts in enrolling residents into Washington Apple Health or private health insurance plans under the Affordable Care Act. J. Hanke thanked WSHA and the Three Rivers Hospital administration for nominating her. B. Johnson presented a proposal to purchase a new ultrasound machine from Toshiba. He explained that aside from the older machinery causing some patient discomfort, image quality is outdated and local providers have been referring patients elsewhere as a result. The cost of the new Aplio 500 machine would be $126,918 including a five-year extended warranty, broken down into $2,347 per month. It would be an increase of $776 per month over what the hospital is currently paying for the older Aplio 80 machine. J. Munson asked B. Johnson to seek two more quotes to compare to Toshiba s offer, per hospital policy. The board agreed to table the proposal until the July 28 meeting. The board unanimously approved proposed amendments to the medical staff s bylaws as presented. C. Thomas motioned to approve the changes, and T. Shrable seconded. See attached. Resolution 2014-10: J. Munson presented a final resolution to surplus some mammography equipment. M. Pruett noted that it has been discussed before. J. Munson said there is a buyer for the equipment, Metropolis of New Jersey. A motion was made by M. Pruett and seconded by C. Thomas to approve Resolution 2014-10 as presented. The motion passed unanimously. Physician Report None. Administrative Report S. Graham said he thinks the month and a half since he came on board has gone smoothly.
He identified several areas he plans to focus on: improvements to the facility, provider recruitment, major equipment purchases, ongoing leadership development, financial viability, quality care, and communications not only with the community, but with hospital staff and the board. He said the board will see an uptick in spending as the hospital continues to recruit providers and staff and purchase upgrades. He said it s a short-term investment that should have a long-term payoff. M. Pruett said looking at strategic planning for financial stability and improvements is a breath of fresh air and he hopes this approach will be well-received. S. Graham said one of the facility s more urgent needs is moving the emergency room to the clinic s current location. He said R. Meadows is working with a grant writer to find funding for that project. S. Graham said moving the ER would trigger other projects, such as finding a new home for the clinic. He said some pharmacy upgrades are needed to be in compliance. The room needs a hood for better air circulation. He will meet with pharmacy manager Lawrence Timbal to discuss the most cost-effective way to complete the project. S. Graham said a lot of interviews have been conducted with potential providers in the last few weeks. He said two nurse practitioners have signed letters of intent to work in the clinic and could come on board in August and September. The administration team has also interviewed ob-gyns and plans to invite interested providers here to tour the facilities. He reported having a constructive meeting with Mike Hassing, CEO of Family Health Centers. S. Graham said all the physicians indicated their continued support of the hospital and they are discussing collaborative opportunities. He also met recently with Dr. Peter Rutherford, CEO of Confluence Health. S. Graham said the rumor is patients are being sent to Wenatchee, but he wants them to come here because the best health care is local health care. He said his sense was Dr. Rutherford is supportive of continuing the discussion. For equipment needs, S. Graham said he s working on identifying priority projects and is seeking staff input. J. Munson said she is keeping a list of requested projects on the capital budget, but it hasn t been prioritized. S. Graham presented a draft of the new organizational chart. He said the main change is the addition of the new Director of Operations and Continuous Improvement, Melanie Neddo, who will answer directly to the CEO. Clinical Quality is still under the purview of the Chief Nursing Officer, but the CEO will oversee quality as a whole since it is the hospital s No. 1 priority. The board supported the changes. See attached. S. Graham said WSHA has given the hospital a stipend of about $8,000 for its success in preventing elective Cesarean sections before 39 weeks. The stipend is part of TRH s participation in the LEAPT program and is received quarterly. J. Munson said the hospital has received a total of about $30,000 for the year. G. Aguilar said the OB staff is excited about the new program, and gave credit to Karen Hurley and Dr. James Wallace for helping lead it.
S. Graham reported he is still active in AWPHD and WSHA; he is president of the AWPHD. He said all public hospitals that are part of that organization are in distress because reimbursement doesn t cover continually rising costs. He said TRH is faring better than many other facilities but needs to maintain fiscal discipline and focus on improving quality and efficiency. C. Thomas asked if TRH s attestation period for Meaningful Use Stage 2 would start in July. J. Munson said the Meaningful Use committee meets weekly and the staff was getting ready to start on time. S. Graham said he spoke with Edgar Arellano and was told the hospital would be ready. S. Graham reported on the WSHA Conference in Chelan last week. He said cost reimbursement is being watched carefully in Washington, D.C. and may be done away with completely, which would be bad news for TRH. He asked the board and community to talk to our senators and representatives about the importance of cost-based reimbursement for rural hospitals. He has also been appointed to the Psych Bed Conversion Work Group. He said to serve psychiatric patients, TRH needs to ensure critical access funding, training for hospital employees, security for the staff, building modifications to ensure safety, public education and transitional housing. He said the group asked TRH if it would be willing to participate in a pilot program. He said the hospital would be willing if the aforementioned conditions are met. S. Graham said he has met with some members of the press and was interviewed by KOZI. He has also met with leaders of the Three Rivers Hospital Foundation, who said they would like to have a page on the hospital s website for online donations. He said the hospital is looking at revamping its website now, and J. Marshall will help boost TRH s Facebook presence to keep the community informed. A sub-committee of the Okanogan County commissioners health committee meets next on July 14. S. Graham said he would like to hire Foster Pepper PLLC as the hospital s new attorneys. The hospital has been represented by Stamper Rubens, but Foster Pepper specializes in representing Critical Access Hospitals and rural hospitals. The board indicated their support, and V. Orford asked that TRH send a letter to Stamper Rubens notifying them of the change. Finance Report J. Munson said Washington Casualty representatives visited the hospital, and there has been a reduction in the premium to $91,000, about $7,600 per month lower. She will start sending out 2015 budget packets and is working on an amended 2014 budget for the next board meeting. Her finance report included April and May figures. She noted that although patient days were up, revenues were down from the same time last year. That s because swing bed days were higher, but there weren t as many surgeries. S. Graham said other area hospitals are also experiencing a reduction in surgeries. Warrants are $1.5 million as of today.
J. Munson received notification that TRH will undergo a Meaningful Use audit. Quality Report G. Aguilar delivered the report since Raine Beeson was out of town. She said feedback numbers are going down rather than up, but she thinks it could be because some telephone surveyors speak broken English and are difficult to understand. S. Graham said the hospital also receives written feedback from patients that helps guide patient care. M. Pruett said the hospital should provide some feedback to the company that conducts the surveys, or perhaps seek a different company. V. Orford said TRH should seek quotes from other companies. Education V. Orford read the renamed A Brief Definition of Generation X. See attached. Upcoming Dates Board training on the Open Public Meetings Act will be July 17. The board will host a strategic planning retreat on July 22. The next regular board meeting is scheduled for 4 p.m. July 28. Public Comment V. Orford said she heard several times during the Chelan WSHA conference that the hospital made a smart decision in hiring S. Graham. Adjournment: A motion was made by T. Shrable and seconded by C. Thomas to adjourn the meeting at 5:50 p.m. Motion carried. Vicki Orford, Chair ABSENT WITH PERMISSION Jerry Tretwold, Vice-Chair Tracy Shrable, Secretary Mike Pruett, Member Cherri Thomas, Member