REGULAR MEETING MINUTES LAST FRONTIER HEALTHCARE DISTRICT BOARD OF DIRECTORS Thursday, January 26, 2017 at 1:00 pm; Council Chambers, City Hall; Alturas, California Directors present: Directors absent: Staff in attendance: Staff absent: Michael Anderson, Jim Cavasso, Carol Cullins, Dick Steyer and Guy Martin Young None Kevin Kramer, CEO; Michele McQuillan, CNO; Amber Mason, Human Resources Manager; and Dee Blondo, District Clerk None 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 Dick Steyer requested that one item from the Consent Agenda Item 6E.) Zero Tolerance Policy Against Harassment, Discrimination and Retaliation be moved to Consideration/Action Item 7D.). Kevin Kramer requested that Discussion Item 5A.) A. Camacho Internet Speed Education December 2016 be deleted from the Agenda. Marty Young moved that the Agenda be approved as amended, Jim Cavasso seconded and the motion carried with all voting aye. 3. PUBLIC COMMENT Pat Cantrell Insurance would not pay $2,000 of bill. MMC is working with her. She personally thanked every BOD member and MMC for taking care of her and thanked the Ambulance staff for their great work. Purchasing could not get gloves for the Likely Fire Department, so she made a $20 donation for 4 boxes of gloves. Thank you for allowing her to sing at Warnerview for 40 years. She loves that the day surgeries are back in place. REGULAR SESSION 4. ANNUAL ORGANIZATIONAL MEETING A.) K. Kevin - Acknowledgment of LFHD Board Director All present thanked Carol for the year of work that she has done as the Chair of the Last Frontier Healthcare District Board of Directors. DRAFT January 26, 2017 Page 1 of 7
B.) Election of Board Officers All the current officers of the Board of Directors agreed to continue in their present positions for another year as follows: Chair Carol Cullins Vice Chair- Marty Young Secretary Dick Steyer Treasurer Michael Anderson Member Jim Cavasso Marty Young moved that all members of the Last Frontier Healthcare District Board of Directors continue serving for the next year in the positions that they have been serving for the past year, Dick Steyer seconded and the motion carried with all voting aye. C.) Board Committees Assignments Design-Build Selection Committee Jim Cavasso & Dick Steyer Finance Committee Michael Anderson, Bobby Ray & Dwight Beeson Quality Council to be determined 5. DISCUSSION A.) A. Camacho Internet Speed Education December 2016 Removed. Will be rescheduled for next month. B.) K. Kramer HRG Financial Summary December 2016 Kevin presented the December 2016 HRG Financial Summary speaking from the Dashboard. Gross revenue down $1.5M. Lost coder in middle of month. Clinic s month of December did not get coded. Over $500K in aging over 90 days. Probability to collect over 120 days is improbable. Most of self-pay are claims with individuals. Currently, our number is dealing with insurances. $500K is a goal. Overall not bad. Clean claims rate still needs work. HRG needs to turn some edits off. This is an area that we can improve upon. Denial rate was pretty good. Industry standard is at 5-10 percent. We were at 8 percent. More refined denials analysis is in the works now. $126K decent month. HRG changed the format of their report. They are trying to summarize more information. HRG and MMC are working on developing a more detailed statement to provide patients with revenue code statements. A random survey of about 50 community members was conducted to see what they would like to see on their statements. Kevin to report back to the Board before he moves forward on this. There will be more detail on statements. C.) J. Cavasso Board Software Jim Cavasso presented several types of software the Board could use to reduce paper. He uses some of these in his work on other Boards. Carol Cullins would like to see some indexing. MMC will provide what the Board needs/wants. Marty Young reads through the paper packet he is provided with. He does not see that it would make a big difference. Dee Blondo will arrange demos and contact other hospitals. Kevin this will depend how much it costs. Benefit vs cost. Dee Some of these softwares also provide Board orientation. Amber Mason gave her opinion of the software that the County is using. 6. CONSENT AGENDA A.) D. Blondo Adoption of December 8, 2016 Regular BOD Meeting Minutes B.) D. Blondo Adoption of December 21, 2016 Special BOD Meeting Minutes C.) D. Blondo Adoption of January 19, 2017 Special BOD Meeting Minutes D.) M. McQuillan Policy & Procedure Manuals Ambulance Central Supply Clinic Emergency Labor & Delivery Information Technology DRAFT January 26, 2017 Page 2 of 7
Performance Improvement Risk Management E.) M. McQuillan Policies & Procedures Administration o Special Tax Appeal Policy Ambulance o Base Hospital Responsibility Clinic o Appointment No-Show Environment of Care o Facility Smoking Policy Human Resources o California Paid Sick Leave o Exclusion Review Policy o Zero Tolerance Policy Against Harassment, Discrimination and Retaliation Moved to Consideration Action Item 7D.) Infection Control o Antimicrobial Stewardship Program Laboratory o Critical Values Reporting Modoc Medical Center o End of Life Option Act Skilled Nursing Facility o End of Life Care Comfort Care F.) M. McQuillan - Policy Log- December 2016 FY 2017 2nd Quarter Approved Policies G.) M. Kresge Medical Staff Committee Minutes Medical Staff Committee October 26, 2016 Environment of Care September 6, 2016 Environment of Care November 2, 2016 Infection Prevention Committee July 26, 2016 Policy Committee October 12, 2016 Pathologist On-Site Visit Report October 21, 2016 Pathologist On-Site Visit Report November 14, 2016 Marty Young moved to approve the Consent Agenda as amended, Dick Steyer seconded and the motion carried with all voting aye. 7. CONSIDERATION/ACTION A.) K. Kramer December 2016 Financial Statement (unaudited) Kevin Kramer presented the December 2016 LFHD Financial Statement (unaudited). Jonathan Marshall has changed the format of the report. Kevin wants an opinion on the change. The financial results for December 2016 show an unfavorable variance of $1.5M to budget. Year-todate is unfavorable $883K to budget. Net Patient Service Revenue is unfavorable to budget by $213K; year-to-date is favorable by $398K. Other Revenue Variance is favorable to budget by $54K. Total Operating Expenses are favorable to budget by $98K. Acute Patient Days were 31, which is unfavorable to budgeted days of 43. Swing Patient Days were 73, which is favorable to budgeted days of 34. SNF Patient Days are 1,094, which meets budgeted days of 1,094. The ER generated 389 visits. The Clinic had 911 visits. There were 0 Observation patients, 1 Surgery and 16 Endoscopies. The Laboratory performed 1,816 tests. Radiology performed 256 X-rays, 41 CT scans, and 50 ultrasound procedures. Physical Therapy had 419 sessions. DRAFT January 26, 2017 Page 3 of 7
Days in Accounts Receivable were 56.9. Days in Accounts Payable were 10.5. FTE total was. Moved $2. M to LAIF in January. It was suggested that Jon add columns to the Income Statement for Month 2016 and YTD. It was requested that FTEs by department be added to the Financial Statement. Dick Steyer moved to approve the December 2016 Financial Statement (unaudited) as presented, Marty Young seconded and the motion carried with all voting aye. B.) K. Kramer Large Account Write-Off Jim Cavasso moved to approve the large account write-off as presented, Dick Steyer seconded and the motion carried with all voting aye. C.) K. Kramer SEMSA/Air Methods PPA Recommendation Mike Williams Operating Officer with SEMSA was present. Kevin presented a spreadsheet of data he had collected to assist in making a recommendation to the Board. Kevin presented a thorough analysis resulting a quite a discussion, with all questions and comments being addressed. Kevin s recommendation is to wait and see. He suggested that we review SEMSA s relationship with Mayers to see how they work. Marty Young moved to accept the recommendation made by Kevin Kramer to hold off on pursuing an agreement with SEMSA at this time, Dick Steyer seconded and the motion carried with all present voting aye. D.) D. Steyer Zero Tolerance Policy Against Harassment, Discrimination and Retaliation (Moved from Consent Agenda, Item 6E.) Dick Steyer stated his concerns. He stated that the Code of California was amended to add extra protected classes. While Amber Mason was working on this policy, she found other areas that needed work. The Union wanted to review the policy. Basically, the Union approved it, but added discrimination and retaliation. These items were not addressed previously. The Union has approved the latest version. Dick Steyer had additional concerns and suggested that legal counsel review this policy before the Board approves it. The Board continued the discussion and many concerns were voiced. Dick Steyer moved that this item be tabled to allow legal review of this policy before Board of Directors approval, Marty Young seconded and the motion carried with all voting aye. 8. VERBAL REPORTS A.) K. Kramer CEO Report to the Board. Retail Pharmacy o We have hired a manager. o The anticipated opening of the retail pharmacy is May 15, 2017. o Pharmacy software contracts have been signed. o OTC items are being planned right now. o Rough drafts of policies and procedures are completed. o Working on formulary, licensing, DEA, NCPDP, NPI, insurance contracts, inventory, signage, etc. Provider Update o Two residents are coming this year; one in March and one in June. We received some funding from Vesper Society to assist with the costs associated with those residencies. DRAFT January 26, 2017 Page 4 of 7
New Facility o Currently working on Criteria Documents to assist bidders by giving them enough information to provide us with a price to build the facility (i.e., space program, room sheets, equipment lists, narratives [civil, mechanical and electrical engineering] and outline specifications. o Also currently working on refining the Design-Build Agreement. ACA Update o Full repeal without replacement would hurt us. o Key priorities: Keep MediCal expansion in place. MediCal rates need to be increased, if possible. Repeal with replacement is being urged. Supplemental reimbursement programs could be reduced or eliminated depending on how the federal government sets up their funding model. o Key statistics: Estimated 30 million more people uninsured in three years if repealed. Estimated $59 billion in reduced revenues to hospitals. Estimated $25 billion in demands for uncompensated care. 56 percent of Federal funds to states are currently made to MediCaid. (This could change under Block Grand Funding scenario where Feds would cap their funds based on historical rates and experience. All additional costs funded by states. B.) M. McQuillan CNO Information to the Board. Staffing o Acute 1 RN opening filled of 2, with another applicant for part-time work. o ER 1 RN opening filled of 2; we continue to post. Programs o PRIME Program EMR vendor contract has been signed with eclinicalworks. Lead Care Coordinator and Care Coordinators positions have been approved by the Union. The positions have been posted and applications are coming in. Interviews with Lead Care Coordinator position candidates will take place next week, then the Care Coordinators the following week. o CNA class in collaboration with College of the Siskiyous will start on February 6, 2017. We are hoping to have 6 students that will finish the class on March 28, 2017. o Oxy-Fee ED discussion. o Medical Waste/Sharps Disposal bins have arrived. Michele will be working with Stacy at MCPH to develop policy and procedures for use. Lassen Community College was here yesterday to discuss collaboration to have MMC to become a clinical training site for their Nursing programs and possibly their medical assistant, emergency medical technician and certified nurses assistant programs. Alliance for Workforce Development just received a grant to align education and workforce resources through stronger industry, education and workforce partnerships in Lassen and Modoc Counties, with the end result being better economic vitality through an educated workforce and sustainable businesses. The Alliance has contracted Rudeen Monte as a consultant to: o Conduct a survey of employers to analyze employer needs and workforce opportunities. o Explore opportunities with local colleges. o Facilitate collaborative approaches among employers and colleges toward improving access to education and jobs for local residents. C.) A. Mason Human Resources Information to the Board. Union o Proposed a new performance evaluation template to be used with all staff. Currently, managers are all using different forms. Pending approval from the Union, the forms will go into effect on July 1 and management staff will be provided an in-service on how to complete the forms and best practices when conducting a performance evaluation. Training o All staff training will occur on February 7 and 8. o The training will be presented by Butte College and focus on Understanding Your Strengths and a Path to Success. DRAFT January 26, 2017 Page 5 of 7
o Unlike previous years, when it was only offered to full-time staff, this training is open to ALL staff. Legislation o Prop 64 Adult Use of Marijuana Act o This law specifically states that it is intended to allow public and private employers to enact and enforce workplace policies pertaining to marijuana. o Policy has been updated and is being reviewed by the Union. No changes to policy; a clarification on what is prohibited was added. Minimum Wage o All represented positions recognized an increase due to the minimum wage increase ($10.00 to $10.50 per hour). Minimum wage will go to $11.00 per hour next January and increase a dollar each year until 2022 when it will be $15.00 per hour. o Once minimum wage reaches $15.00 per hour for all businesses, wages could then be increased up to 3.5 percent for inflation, as measured by the Consumer Price Index. D.) Board Member Reports Each BOD member reported on what they have seen in the facility and/or what has been heard in the community. Marty Young o Water fee for geothermal. Will we pay the school for the hot water we will use? This should be worked out now. Kevin has initiated conversation with Tom O Malley of the school district to discuss this subject. We need to know what the cost is going to be. o Alzheimer s Cost of care for memory care. Could we pursue home health? Recommends a feasibility study. Michele pointed out that this program is currently unattainable because we simply cannot hire and maintain a sufficient level of staffing for the program. MMC had a study performed regarding assisted living. Kevin suggested that a feasibility study be included in next year s budget. o Carol Cullins there is a program available that will help people with activities of daily living (ADLs). Medicare pays. It is run through Social Services. Then State pays their wages. This level is already available in the area. Program is subsidized. o Michele Lakeview tried it and could not get licensed staff. Dick Steyer We have already committed to funding for piping. We do not know what the heat will cost. Jim Cavasso Regarding the visit to Susanville by Michael, Michele and Megan. They brought back fairly negative comments at the time. Today s comments were all mostly positive. Michael seemed to be fairly positive. Carol Cullins nothing at this time. Carol Cullins, Chair, read the Executive Session items for the record. Jim Cavasso moved to close the Regular Session of the Board of Directors meeting and move to Executive Session, Dick Steyer seconded and the motion carried, with all voting aye. The Regular Session of the Board of Directors closed at 3:16 pm. EXECUTIVE SESSION Executive Session was called to order by Carol Cullins, Chair, at 3:18 pm. 9. CONSIDERATION/ACTION A.) M. Kresge Medical Executive Committee Minutes (Evidence Code 1157) B.) M. Kresge Privileging/Credentialing (per Evidence Code 1157) C.) C. Cullins Performance Evaluation of CEO [per Gov t Code Section 54957.6(a)] Marty Young moved to adjourn from Executive Session and return to Regular Session, Jim Cavasso seconded and the motion carried, with all voting aye. The Executive Session of the BOD was adjourned at 3:34 pm. DRAFT January 26, 2017 Page 6 of 7
RESUME REGULAR SESSION The Regular Session of the Board of Directors was called back to order by Carol Cullins, Chair, at 3:35 pm. 10. CONSIDERATION/ACTION RESULTS OF EXECUTIVE SESSION A.) M. Kresge Medical Executive Committee Minutes October 26, 2016 Dick Steyer moved to accept the Medical Executive Committee Minutes dated October 26, 2016, Jim Cavasso seconded and the motion carried with all voting aye. C.) M. Kresge - Privileging/Credentialing Based upon character, competence, training, experience and judgment, favorable recommendation by peers and credentialing criteria fulfillments, the Medical Executive Committee recommends the following appointments for the BOD approval: Barbara Gilbertson, D.O. Appointment of Provisional privileges in the Family Medicine category. Paul Schultz, M.D. Appointment of Provisional privileges in the Ophthalmology category. Chelsea Pearson, PA-C Progression in status from Provisional as well as reappointment of AHP status/privileges in the Family Medicine category. Dick Steyer moved to approve the Privileging/Credentialing as presented, Marty Young seconded and the motion carried with all voting aye. C.) C. Cullins Performance Evaluation of CEO It was determined that no action was needed or taken on this item. 10.) MOTION TO ADJOURN Jim Cavasso moved to adjourn the meeting at 3:35 pm, Marty Young seconded and the motion carried with all voting aye. The next meeting of the Last Frontier Healthcare District s Board of Directors will be held on Thursday, February 23, 2017, at 1:00 pm in the Council Chambers of Alturas City Hall in Alturas, California. Respectfully Submitted: Dee Blondo, Last Frontier Healthcare District Clerk Date DRAFT January 26, 2017 Page 7 of 7