REGULAR MEETING MINUTES LAST FRONTIER HEALTHCARE DISTRICT BOARD OF DIRECTORS Thursday, November 30, 2017 at 1:00 pm Council Chambers, City Hall Alturas, California Directors present: Directors absent: Staff in attendance: Staff absent: Michael Anderson, Jim Cavasso and Carol Cullins and Guy Martin Young Dick Steyer Kevin Kramer, CEO; Michele McQuillan, CNO; Patrick Fields, Finance Director; Diane Hagelthorn, Interim Human Resources Director and Dee White, District Clerk Amber Mason, Human Resources Manager 1:00 pm CALL TO ORDER Carol Cullins, Chair called the meeting of the Last Frontier Healthcare District (LFHD) Board of Directors (BOD) to order at 1:00 pm. The meeting location was in the Council Chambers of Alturas City Hall in Alturas, California. 1. PLEDGE OF ALLEGIANCE TO THE FLAG OF THE UNITED STATES OF AMERICA 2. AGENDA Additions/Deletions to the Agenda Kevin Kramer requested that CONSENT AGENDA ITEM 5A.) D. White - Adoption of October 26, 2017 Regular LFHD Board of Directors Meeting Minutes be moved to CONSIDERATION/ACTION ITEM 6D.) Marty Young moved that the Agenda be approved as amended, Michael Anderson seconded and the motion carried with all present voting aye. 3. PUBLIC COMMENT No public comment. REGULAR SESSION 4. DISCUSSION A.) K. Kramer - HRG Financial Summary October 2017 Kevin Kramer presented HRG s October 2017 Financial Summary of the Last Frontier Healthcare District speaking mainly from the dashboard. Cash collections very good; in fact, it was a record. AR days were at 54.8. DNFB was 0.2, which is extraordinarily good. 3 rd party aging over 90 days section, this is nowhere near where we want it to be. Adam and Jon Marshall are working very closely with HRG Kevin will determine what percentage is written off. Clean claims came up to 62%. We are changing the way it is reported. Secondary claims are hitting as dirty claims. We are changing the way this is calculated to come in line with other facilities. DRAFT November 30, 2017 Page 1 of 6
Denial rate is 8% Registration errors are below $40K. Jon is having Patrick run with Accounting and he is now working in Revenue Cycle. 5. CONSENT AGENDA A.) D. White - Adoption of October 26, 2017 Regular LFHD Board of Directors Meeting Minutes MOVED TO CONSIDERATION/ACTION ITEM 6D). B.) M. Kresge Medical Staff Committee Minutes/Committee Reports Medical Staff Committee Meeting September 27, 2017 o Pharmacy & Therapeutics Community July 18, 2017 o Policy Committee September 21, 2017 o Pathologist On-Site Visit Report July 19, 2017 o Pathologist On-Site Visit Report August 8, 2017 o Pathologist On-Site Visit Report September 5, 2017 C.) M. McQuillan Departmental Manuals November 2017 Activities Ambulance CAH/Administration Dietary Environmental Services/Laundry Pharmacy Purchasing D.) M. McQuillan Policies for Review November 2017 Ambulance o Ambulance Attendants o Ambulance Operations o Ambulance Operation for Code Three Driving o EMS Approved Abbreviations o Communication Guidelines o Record Keeping CAH/Administration o Contract Administration Dietary o Manual Dishwashing Environment of Care o Fire Safety Management Plan o Medical Equipment Management o Security Management o Utilities Management Pharmacy o Record Retention Guideline Retail Pharmacy o Controlled Substance Inventory o Controlled Substance Prescription Monitoring Program o DEA Form 222 Ordering/Processing/Receiving o Dispensing CII Controlled Substances o Dispensing CIII V Controlled Substances o Purchasing, Receiving and Storage of Controlled Substances o Theft of Controlled Substances Warnerview Skilled Nursing Facility o Elder Abuse Surgery o Terminal Cleaning of the Operation room Marty Young moved to approve the Consent Agenda as amended, Jim Cavasso seconded and the motion carried with all present voting aye. DRAFT November 30, 2017 Page 2 of 6
6. CONSIDERATION/ACTION A.) P. Fields - October 2017 Financial Statement (unaudited) Patrick Fields presented the October 2017 Financial Statement (unaudited) to the Board. During the month of October 2017, Modoc Medical Center reported net income from operations of $2,036,047, which is significantly better than budgeted ($-181,807). Outpatient volumes and revenues strengthened during the period, while inpatient also declined. Year-to-date, the operating income $1,817,510 compared to budgeted ($-824,882). Net income including non-operating activity is $2,047,175 compared to budgeted ($189,116). Year-to-date Net Income is $2,224,156 against budgeted ($903,072). Marty Young moved to approve the October 2017 Financial Statement (unaudited), Jim Cavasso seconded and the motion carried with all present voting aye. B.) K. Kramer Summary of Large Account Write Off. Marty Young moved to approve the request to write off this account, Michael Anderson seconded and the motion carried with all present voting aye. C.) K. Kramer Resolution #17-10 Resolution Requesting that the LFHD Board Members Authorize Specific Persons to Transfer LAIF Funds Michael Anderson moved to authorize specific persons to transfer LAIF funds, Marty Young seconded the motion. Carol Cullins, Chair, called for a roll call for the vote. Michael Anderson Aye Edouard (Jim) Cavasso Aye Carol Cullins Aye Richard Steyer Absent Guy Martin Young Aye The motion carried by a majority of the vote of the Last Frontier Healthcare District Board of Directors. 6D.) D. White Adoption of October 26, 2017 Regular LFHD Board of Directors Meeting Minutes MOVED FROM CONSENT AGENDA ITEM 5A.) Kevin had changes to: Item 4A.) DISCUSSION Capital Campaign for the New Facility Item 4B.) DISCUSSION Dun & Bradstreet o CCHAN s study of all CAHs in regards to Dun & Bradstreet s studies. Item 7B.) VERBAL REPORTS The spelling of M. McQuillan s name, which was actually correct in the version of the minutes that was distributed to the Board. All changes were made to the October 26, 2017 LFHD Board of Directors Regular Meeting Minutes and may be read in their entirety on the LFHD website. Jim Cavasso moved to approve the minutes of the October 24, 2017 LFHD Board of Directors Regular Meeting Minutes as amended, Marty Young seconded and the motion carried with all present voting aye. 7. VERBAL REPORTS A.) K. Kramer CEO Report to the Board. New Facility o Current work is on detailing the case work and equipment with NMR. The goal is to have final drawings submitted to OSHPD by the end of December for the Hospital Building. That is where the design focus is at right now. o We will send out an RFQ for the CT scanner, RF machine and ultrasound machine so that we can select a manufacturer for those items and so that the design of the RF room and CT room can be finalized. o Parcel mapping is in process. o We received USDA concurrence to our contract with Swinerton today. DRAFT November 30, 2017 Page 3 of 6
Retail Pharmacy o The pharmacy is ramping up. In November the team has averaged 62 prescriptions per day. Monday they filled 135 prescriptions. We are hopeful that we will start generating some revenue ahead of schedule, which was initially budgeted to start in March. In the month of November they are right in line with their prescriptions being what was budgeted. Staffing o Looking for a provider still. We are going to probably have to look at a different structure for delivery of provider services. o Lead Phlebotomist (local person is interested) may be able to transition away from a traveler in that position. o Ultrasound technologist is a position that we are trying to replace. Our current technologist is retiring in February. o Still struggling to find some very key clinical positions and having to use registry staff for those positions (i.e.; Nursing, CLS, Radiology Tech, etc.). o We are currently flying a Project Lead role that will be a person that will oversee or be involved in some of the larger projects for the facility like the New Facility Project, SNF EMR, Collaborative Efforts (i.e.; JPIA, 299 Collaborative, etc.), and others. This role will give the organization another person that has a wider perspective on what is going on with the organization. Other Items o 340B program will experience some pay cuts from CMS. Currently, they pay 6% over the average sales price and that is supposed to be reduced to 22% below the average sales price. Those savings are supposed to be used to raise the payment rate (excluding drugs) for all hospitals by 1.35%. He has not evaluated how this will affect the contract pharmacy relationship with Rite Aid. o The Physical Therapy Agreement with the schools is in place and went effective November 1, 2017. o Christmas Party, December 9, 2017 at the Niles. Cocktails start at 5:00 pm. Dinner starts at 6:00 pm. B.) M. McQuillan CNO Report to the Board Staffing o Staffing in the Acute, ER and SNF for licensed nursing staff continues to be a challenge. CNA staffing is good at the SNF and we will be having another training class in January of next year. o The Director of Nursing for Warnerview position is still open. I will be interviewing a potential candidate tomorrow over the phone. Sandra Pelfrey is in the position as an interim DON until January 13, 2018. Programs o We are hoping to launch a tele-dermatology program at the Clinic soon. Credentialing for this service has commenced. o We are working with the 299 Collaborative and Wipfli to develop a way of sharing and receiving information via a Health Information Exchange with receiving hospitals in California, Oregon and Nevada to be able to help with our patients that are hospitalized there. This will enable us to gather patient information in real time and either admit them back into our Swing or SNF areas for needed rehabilitation or see them for follow up appointments at the Clinic. This will help us with improved care transitions for members of our community. C.) D. Hagelthorn Interim Human Resources Information to the Board. She has been paralleling Amber since October. A lot has not changed. She will be working Tuesdays and Thursdays and anytime that something special comes up. There will be an unemployment hearing tomorrow, and she will be here. She will also be here for things like workers comp; payroll; and attending Board, SLT and Leadership Team meetings. Terri will continue what she is doing. DRAFT November 30, 2017 Page 4 of 6
One project that she is working on is changing our investment broker for our 457b plan (Walt Davis). However, before we do that, we want to survey employees. Amber will be back by end of February or end of March. E.) Board Member Reports None of the Board members present had anything to report. Kevin did report to the Board that we have hit our Norco limit for November as has Rite Aid. Watch for agitated patients. Carol Cullins read, for the record, the items for the Executive Session. Marty Young made a motion to close the Regular Session of the Board of Directors, Jim Cavasso seconded and motion carried with all present voting aye. The Regular Session of the Last Frontier Healthcare District Board of Directors was adjourned at1:50 pm. EXECUTIVE SESSION Executive Session was called to order by Carol Cullins, Chair, at 1:54 pm. 8. CONSIDERATION/ACTION A.) M. Kresge Medical Executive Committee Minutes & Credentialing Items (Evidence Code 1157) Marty Young moved to adjourn from Executive Session and return to Regular Session, Jim Cavasso seconded and the motion carried, with all present voting aye. The Executive Session of the Board of Directors was adjourned at 1:56 pm. RESUME REGULAR SESSION The Regular Session of the Board of Directors was called back to session by Carol Cullins, Chair, at 1:58 pm. 9. CONSIDERATION/ACTION RESULTS OF EXECUTIVE SESSION A.) M. Kresge Medical Executive Committee Minutes & Credentialing Items Marty Young moved to accept the Medical Executive Committee Minutes dated September 27, 2017 and accept the recommendations of the Medical Executive Committee for Privileging/Credentialing, Michael Anderson seconded and the motion carried with all present voting aye. Based upon character, competence, training, experience and judgment, favorable recommendation by peers and credentialing criteria fulfillments, the Medical Executive Committee recommends the following appointment for BOD approval: Matthew Kappen, M.D. Appointment of Provisional privileges in the Emergency Medicine category. Chelsea Pearson, PA-C Reappointment of AHP status/privileges for the above named Allied Health Professional in the Family Medicine setting, as well as progression in status for Provisional. 10.) MOTION TO ADJOURN Michael Anderson moved to adjourn the meeting at 1:59 pm, Marty Young seconded and the motion carried with all present voting aye. DRAFT November 30, 2017 Page 5 of 6
The next meeting of the Last Frontier Healthcare District s Board of Directors will be held on January 25, 2018 at 1:00 pm in the Council Chambers of Alturas City Hall in Alturas, California. Respectfully Submitted: Dee White, Last Frontier Healthcare District Clerk Date DRAFT November 30, 2017 Page 6 of 6