Trustees present: JoAnn Casalez, Chairman; Michelle Miller, Secretary; Richard Cook, Bill Hammargren, Jennifer Hood and Ken Tipton.
Public Comment
Gina Rackley thanked Humboldt General Hospital and its Community Giving Committee for its donation toward this year's Lowry High School Sober Graduation. Gina, who is the co-chair of this year's event, said the money from the hospital, the City of Winnemucca, Humboldt County, the Winnemucca Convention and Visitors Authority and others helps cover rentals, food, and entertainment costs for the graduation night event; prizes are funded through private donations.
Matt McCarty, the director of the Great Basin College Foundation, updated the hospital board on GBC's progress toward raising $2 million locally in order to qualify for a $5 million pledge from the William N. Pennington Foundation. Matt said GBC currently has $1.5 million total. He expects that following the holidays, donations will "pick up speed."
Medical Staff Report
Dr. Brad Granath represented the HGH Medical Staff Tuesday. He reported that HGH is entering the "interview season" for applicants to its Family Medicine Rural Residency program. In all, over 1,000 physicians have applied to take part in the residency at Humboldt General Hospital. Dr. Granath said there are many qualified applicants; however, he and others have narrowed the field to 10 doctors who will vie for the two available positions. The chosen physicians will spend their first year at the University of Las Vegas School of Medicine before coming to Winnemucca in July 2020 for their second and third years in the program.
EMS Department Report
HGH EMS Rescue Chief Sean Burke reported that HGH EMS Rescue has been participating in ropes training exercises on the back side of Winnemucca Mountain. Chief Burke said crew members routinely have to use the ropes in order to get patients up and over steep embankments and other obstacles, such as in roll-over situations.
Chief Burke shared that Britney McCraney has been named the new EMS Communications Center Manager. She was formerly a watchstander employee who, according to Chief Burke, is tackling necessary issues, pursuing certifications and training, and is even looking for a new space for the center.
Chief Burke said EMS has seen a dramatic increase in mental health 9-1-1 calls and inter-facility transfers. He said the department's experience correlates with the increase in mental health activity in the community. Crew members are being trained in the SafeTALK training program that teaches participants to recognize and engage persons who might be having thoughts of suicide, and to connect them with appropriate resources.
Chief Burke said the number of opioid overdoses has gone down compared to one year ago. EMS and law enforcement believe the most recent spike in overdoses could be due in part to bad batches of illegal drugs.
Quality Assurance Report
HGH Quality Services Director Lisa Andre provided board members with an overview of the quality assurance reports they receive each month as follows:
- MBQIP/Nevada FLEX Program - The Medicare Beneficiary Quality Improvement Project is a quality improvement activity under the Medicare Rural Hospital Flexibility (FLEX) grant program that seeks to improve the quality of care provided in critical access hospitals (CAHs) like Humboldt General Hospital. The project provides an opportunity for individual hospitals to look at their own data, measure their outcomes against other CAHs and partner with other hospitals in the state around quality improvement initiatives to improve outcomes and provide the highest quality care to patients.
- Nevada's FLEX Program - Nevada's FLEX Program measures rural hospital quality improvement and patient safety, including facilitation of a statewide rural hospital quality improvement network and quality reporting among the state's critical access hospitals. The program also measures rural hospital financial, operational, and performance improvement, including facilitation of a statewide rural hospital performance improvement network among Nevada's CAHs, and CAH participation in revenue cycle management activities. Through the FLEX Program, Nevada's rural hospitals were recently named first in the nation for quality improvement.
- LiCON Clinical Indicators – The LiCON Council of the Nevada Rural Hospital Partners (NRHP) chooses patient safety and quality measures specific to Nevada rural hospitals. The council is comprised of 12 rural and small hospitals in Nevada including Humboldt General Hospital. Results are reviewed quarterly by the Risk Managers Work Group to share best practices for improvement opportunities.
- Sentinel Events - A Sentinel Event is any unanticipated event in a healthcare setting resulting in death or serious injury to a patient or patients, not related to the natural course of the patient's illness. HGH tracks any such events.
- Patient Satisfaction Surveys - Humboldt General Hospital participates in several survey functions, including HCAHPS (the Hospital Consumer Assessment of Healthcare Providers and Systems), an inpatient satisfaction survey required by CMS (the Centers for Medicare and Medicaid Services) for large hospitals in the United States. As part of the MBQIP quality measures data collection, HGH also performs non-mandatory inpatient surveys to assess patient satisfaction.
- Infection Control Report - The HGH Infection Control program monitors any hospital-acquired infections, surgical site infections, and hand hygiene surveillance. HGH participates in the NRHP Infection Control Work Group and reports employee influenza vaccination participation to the National Healthcare Safety Network.
Lisa noted that Humboldt General Hospital has participated in six state and federal surveys in 2017-2018 with good success. On October 26, the hospital held its annual Critical Access Review meeting, which is a condition of participation in the CAH program. Every department took the opportunity to share how it is progressing in its quality indicators.
Lisa also mentioned that President Donald Trump recently signed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, which not only expands the use of telehealth to help combat the opioid epidemic, but will also improve prescription drug monitoring programs. Lisa said the legislation will be beneficial to providers who have struggled with the recent changes in opioid laws and regulations.
As part of the October QA report, HGH Nurse Educator Tina Wilson (pictured above right) provided a demonstration of the hospital's Resuscitation Quality Improvement (RQI) Program. Tina reported that Humboldt General Hospital was recently recognized by the American Heart Association and Laerdal for being a member of the RQI Program. In the past, HGH staff members used to refresh their CPR skills every two years; now staff participates in quarterly training on their own that not only increases their confidence but their competency as they respond with life-saving patient care. Tina was instrumental in bringing the RQI Program to HGH; in fact, HGH was the first Nevada hospital to participate! Adreon Fenderson (pictured above left), the RQI Partners Impact Manager for this region, traveled to Winnemucca to present the award. Wilson noted that the RQI Program not only improves local clinicians' skills, but it saves the hospital a great deal of money. Currently, approximately 100 staff members participate in the program.
HGH Emergency Services Manager Robyn Dunckhorst also shared information about Humboldt General Hospital's telestroke partnership with Northern Nevada Medical Center. The program allows HGH physicians to access a neurologist 24 hours a day, 365 days a year, initiating stroke care within minutes of a patient's arrival at the HGH Emergency Department. HGH CEO Arthur Frable said the hospital entered into a relationship with NNMC in 2016; the hospital will now need to renew its contractual relationship with the program in the near future, which is why Robyn shared the demonstration with the board. While the hospital's telemedicine robot is currently only used for stroke, NNMC hopes to expand its program to include multiple specialties such as mental health and cardiology in the future.
HGH CEO Arthur Frable updated the board on the search for a new Electronic Medical Records (EMR) system. Mr. Frable said the hospital is on a deadline to implement a new EMR as the servers that host the current MEDHOST system are coming to the end of their lives; replacing the units will cost approximately $450,000. Mr. Frable said the hospital narrowed its search to two systems: Athenahealth and Cerner. Athenahealth is the newest product on the market; it has only been in the hospital computer business for three years. Cerner, on the other hand, is the second largest system in the country; 42% of all medical records in the United States go through Cerner each year. Mr. Frable said he and staff members plan to visit two California hospitals in the coming weeks to see each system in action with the hope of bringing a recommendation to the board at the November meeting.
Trustee Michelle Miller said she would like to see a "good cross section of departments represented" in those visits.
Trustee Bill Hammargren questioned if the hospital has considered simply upgrading its program through its current EMR MEDHOST, including storing its records in the "cloud." IT Director Mike Bell said HGH already has MEDHOST's most current program. "It would be the same program in the cloud. Nothing changes."
Trustee Ken Tipton asked about Athenahealth's lack of compatible modules with HGH systems, including a blood bank module. Mr. Frable said the company agrees to updates that will benefit all hospitals in its system, not just a single hospital. "So when it comes to an update, it has to be good for everyone," he said. Trustee Tipton responded, "Are they getting better fast enough for us? How long will it take them to build out?" Trustee Miller shared her concern about the company not having a complete package up front.
Board Chairman JoAnn Casalez questioned why hospital staff would continue to investigate Athenahealth when it is clear the company cannot meet HGH's needs. Mr. Frable said he is "intrigued" with the fact that other hospitals have purchased the system. Trustee Miller responded that the hospital should be making decisions "not out of curiosity but out of necessity."
IT Director Mike Bell said he believes Cerner provides everything the hospital needs in one package. On the other hand, Athenahealth can only offer what the hospital has now, which is a handful of different systems tied to one main EMR. Mike said, "At this time, Cerner has floated to the top." Chairman Casalez again suggested the group not continue investigating Athenahealth "if you're telling us today they can't meet our needs."
Mr. Frable said he would still like to consider Athenahealth, noting that the hospital is currently paying more to its current billing company, HRG, than it would pay to Athenahealth, given a contract with that company. The goal, with whatever company is chosen, is for patients to have one patient number regardless of where they are admitted or transferred.
CEO Arthur Frable updated the board as follows:
- 340 Program. Humboldt General Hospital has qualified for the government's 340B program as of October 1. The 340B Drug Discount Program is a federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices.
- Anesthesia Billing. The hospital will now contract with a separate company to do its anesthesia billing. The chosen company currently services over 400 anesthesia providers. HGH Director of Anesthesia Services Mark Reyka told board members the company will not only capture income for the hospital, but will help the hospital stay legally compliant with new rules and regulations. The two-year contract will be effective November 1.
- WIC Expansion. The hospital is working with the University of Las Vegas School of Medicine Family Medicine Residency Program to gain approval for the hospital's Physician Residents to work in the HGH Walk-In Clinic. With the change, the WIC would expand in the future to include evening and weekend hours.
- Pharmacy Expansion. CTA Architects will be on site October 31 to review the creation of a new Pharmacy Department within the current Physical Therapy Department. Regulations require that a pharmacy include bathroom facilities within the department; accordingly, the hospital hopes a bathroom that is currently used by the Hospitalist physicians can be incorporated into the plan.
- Retirement. Dr. Curtiss Mull, one of Humboldt General Hospital's orthopedic surgeons, will retire in May or June of 2019. A new orthopedic physician will be coming to tour HGH on November 9.
- Pain Management Clinic. Andrew Wesley, MD will visit HGH on Friday, November 2, to discuss possibly establishing a pain management clinic at Humboldt General Hospital. The clinic would begin at two days per month.
- Reduced Cost Labs. Starting Friday, November 16, Humboldt General Hospital will begin offering reduced cost lab screenings on the first and third Fridays of each month. Panels for men and women will be offered at a cash- or credit-only cost of $98 each; insurance will not be billed. Each Friday's "clinic" will run from 7:30 a.m. to noon in the HGH Sarah Winnemucca Conference Room. Trustee Bill Hammargren commented he has been working on the reduced labs project for five years.
- EmCare Contract. In response to a question from Chairman JoAnn Casalez, CEO Frable said the hospital will give EmCare, the company that currently provides Emergency Department physician services, notice that it will be considering other ER staffing options. Mr. Frable said the hospital can meet the deadlines necessary to terminate its relationship with EmCare, if necessary.
Consent Agenda
The board approved the Consent Agenda, including approving the board meeting minutes for September 10, 2018, and September 25, 2018, as well as this month's medical staff applications. The voting was unanimous.
Business Items-Other Reports
1. Hospital Administration-Maintenance / proposals from T.L. Snyder Enterprises and Culligan Water to supply, install and plumb a new commercial grade water softener for the laundry / Administrator-Maintenance Director - Board trustees unanimously approved the purchase of a new water softener for the hospital's laundry room after HGH Maintenance was told it was no longer repairable. Both T.L. Snyder Enterprises and Culligan Water submitted bids; Snyder Plumbing was the low bidder. The hospital does 1,000 pounds of laundry a day.
2. Hospital Administration-Maintenance / proposal from LaVoie Roofing, Inc. to remove old roof and install new roofing materials on the house and storage shed at 1145 Harmony Road / Administrator-Maintenance Director - Board trustees unanimously approved a proposal from LaVoie Roofing, Inc. to replace the wood shake roofs on the house and storage shed at 1145 Harmony Road at a cost of $19,000. HGH Maintenance Director Duane Grannis said LaVoie Roofing was the only bidder who responded; the project was budgeted for $40,000.
3. Hospital Administration-Emergency Services / EMS request to enter into and sign an interlocal agreement with the Nevada Department of Transportation to use the NDOT statewide radio system / EMS Director - Board trustees unanimously approved an interlocal cooperative agreement between the Nevada Department of Transportation and the hospital district for HGH EMS Rescue to use the state's emergency radio system while units travel the statewide highway system. The agreement spells out the responsibilities of both organizations as well as the payment of some user fees. The agreement will now be turned over to NDOT for final review and approval.
4. Hospital Administration-Physician Services / request to amend the terms and conditions of the agreement with C. Robert Westling, M.D. to provide physician services / Administrator - Board trustees unanimously approved a proposal to amend the agreement with Dr. Robert Westling, which will allow him to remain at HGH in the capacity of a preceptor to the University of Las Vegas Family Medicine Residency Program through September 2020. As part of the proposal, Dr. Westling will not see patients; his sole responsibility will be to oversee the residency program. Additionally, he will work four days a week; the hospital will pay off any remaining student loan debt at the end of his term; and he will continue to receive the maximum allowable PERS through the term of the contract. Dr. Brad Granath, who is the site director for the Family Medicine Residency Program, said the agreement is a good fit for both the program and the hospital. He said he and Program Director Elissa Palmer are both very pleased with the positive outcome.
5. Hospital Administration-Physician Services / proposed terms and conditions and request to enter into an agreement with Alex Curtis, M.D. to provide physician services / Administrator - Board trustees unanimously approved sending an offer letter to Alex Curtis, MD, to provide Family Practice OB services at Humboldt General Hospital. Dr. Curtis was recruited by Fidelis Partners, a physician recruitment company. He is trained in high volume OB, c-sections and high-risk pediatrics. According to Dr. Brad Granath, he is "eminently qualified and experienced." If Dr. Curtis approves moving forwarding with a contract, the Nevada licensure process is expected to take up to three months.
Trustee Comments
Trustee Ken Tipton said he was upset that his request to Administration to open up Humboldt General Hospital's employee health insurance to review was ignored. The hospital has been with Prominence for many years and Trustee Tipton said he considered his request a directive. Trustee Michelle Miller said she agreed with Trustee Tipton. She said the hospital has not gone out for a full review of its insurance services in 10 years. She reminded staff that the board agreed every contract would be subject to review.
Trustee Jennifer Hood thanked HGH Social Worker Jennifer Slovernick and HGH Director of Community Education and Development Nicole Maher for working to send out a postcard to all Humboldt County households detailing the warning signs of suicide. That postcard should begin arriving in mailboxes in mid-November.
Board Chairman JoAnn Casalez scheduled HGH CEO Art Frable's annual evaluation for 5:30 p.m. Wednesday, November 28. She directed Trustee Miller to gather information about the CEO goals and Trustee Bill Hammargren to follow up regarding quality improvement. That information will be sent to all board members.
The Humboldt County Hospital District Board of Trustees will meet next at 5:30 p.m. Tuesday, November 27, 2018, in the HGH Sarah Winnemucca Conference Room. The board also agreed to change the December meeting to 5:30 p.m. Tuesday, December 18. Meeting agendas, board minutes and more will be/are available at: