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HGH Board Brief May 28, 2019

Trustees present: JoAnn Casalez, Chairman; Michelle Miller, Secretary; Bill Hammargren, Jennifer Hood and Gene Hunt. Trustees not present: Ken Tipton.

Medical Staff-Hospital Department Reports

Medical Staff Report

Dr. Paul Gaulin, Humboldt General Hospital's Chief of Staff, reported that the reorganization of the OB Department continues with the integration of two nurse midwives; Dr. Roger Brecheen, the lead OB/GYN, is also offering advanced gynecological surgical procedures 24/7.

QA efforts are underway, in part due to the board retreat in early May where board members and medical staff members agreed on medical staff bylaws calling for regular quality assurance review.

The hospital is actively seeking internal medicine and family practice providers who can help alleviate what Dr. Gaulin said are "unacceptable wait times for patients."

Dr. Gaulin reported that Jeremy Hurst, FNP-C, recently completed his psychiatric nurse education.

Dr. Martin Johns, the new medical director for the HGH Emergency Department, recently visited Humboldt General to address patient satisfaction and billing issues.

Hospital Week 2019

Hospital Week at Humboldt General Hospital - May 13-18, 2019

EMS Director Sean Burke reported on Humboldt General Hospital's Hospital Week 2019, which was held from Monday, May 13, through Saturday, May 19. Sean said the week was a great success with participation from both staff and community members. The fun included:

  • Monday, May 13: Administration Open House (87 staff participants)
  • Tuesday, May 14: Community Cleanup Event (26 staff participants)
  • Wednesday, May 15: Health Services Lunch and Learn and HGH AirOne Open House
  • Thursday, May 16: Smoothie Bikes (83 staff participants) and Chamber of Commerce Mixer/Provider Meet and Greet (22 staff and community member participants)
  • Friday, May 17: Employee Recognition Dinner (4 Nurse Residency Graduates, 20 "Nightingale Nurse of the Year" nominees, and 26 "Years of Service" award recipients; Chief Nursing Officer Darlene Bryan was named the 2019 "Nightingale Nurse of the Year")
  • Saturday, May 18: EMS BBQ and Bike Rodeo (Over 200 staff and community member participants)

Sean thanked Jo McClellan and her dietary team for providing all the food for Hospital Week. He specifically mentioned Kim Wilson, a dietary employee, who was especially helpful during the week. In addition to the other activities throughout the week, Sean said there were a few surprise hits, like a hidden pineapple that had staff scrambling to find its hiding place.

Clinic Space Utilization

HGH Practice Administrator Robert Johnson, PA, discussed clinic space allocation at the hospital. In addition to changes that he mentioned at the April board meeting, Robert stated that:

  • Dr. Alex Curtis will practice in the Rural Health Clinic so that he can be near the maternity and pediatric providers.
  • Dr. Cheryll Udani, a locum family practice provider, has the potential to practice full-time at HGH.
  • Dr. Chad Hall is now located in Suite H. The internal medicine specialist will be at Humboldt General for three months; he has the option to extend his contract permanently.
  • Dr. Rommel Adajar, also an internal medicine specialist, will be housed in Suite A. He is expected to arrive in October.

Long-Term Care Update

HGH Chief Nursing Office Darlene Bryan updated board trustees on long-term care. She and Harmony Manor/Quail Corner Director Robin Gillis met with Board Chairman and Secretary Joann Casalez and Michelle Miller during the month. The four continue to work on an action plan to improve the long-term care enrollment process.

Darlene reported that a Certified Nursing Assistant course through Great Basin College finished on Friday, May 24. Humboldt General Hospital sponsored six of the 12 students who completed the course; four of those students have already begun work at the hospital. Additionally, HGH has hired three other full-time CNAs, increasing the long-term care staff by nine. Pending students passing their final CNA exam June 11, long-term care should be fully staffed by the first of July.

Darlene also reported that HGH nursing leaders are interviewing six of Great Basin College's new graduate nurses and will be extending offers to most. She noted that she has appreciated the time and effort of Chairman Casalez and Secretary Miller. "They are good resources with good minds to help us."

Administration Department Report: CEO

HGH Interim CEO Karen Cole discussed physician recruitment:

  • Dr. Veronica Janhunen, a pediatrician, will begin practicing at HGH in August in the Rural Health Clinic.
  • Dr. Alex Curtis, a family practice physician, is expected to be licensed by the State of Nevada in June, after which he will begin practicing at HGH, also in the Rural Health Clinic.
  • Dr. Rommel Adajar, an internal medicine specialist, has signed a letter of intent; he is expected to begin practicing at HGH in October.

CEO Cole noted that Dr. Martin Johns, the medical director for the HGH Emergency Department, was onsite Friday, May 24. He was very engaged and wanted to learn everything he could about Humboldt General Hospital. CEO Cole said he had a good meeting with medical staff and discussed greater collaboration with both surgeons and hospitalists.

CEO Cole said Human Resource efforts have been largely directed at recruiting. Human Resources Director Rick Roche is close to hiring a very qualified Revenue Cycle Director who will replace HGH Business Services Director Shauna Barsanti as she retires. Rick has also been working to streamline the employee orientation process and to incorporate new ideas. He is also working to implement the HRIS Optimum system. HRIS Optimum Optimum is an industry-leading, full-service software designed specifically for Human Resource needs. The system was slated to come online next year, but CEO Cole and Rick are hoping to move that date up to this year to deal with immediate priorities.

CEO Cole congratulated HGH Business Services Director Shauna Barsanti, who will retire this week, after 30 years of service; she also congratulated HGH Maintenance Manager Craig Prest, who also will retire this week after 13 years of service.

CEO Cole also congratulated HGH provider Jeremy Hurst who passed his board exam through Duke University. He is now a dual certified nurse practitioner in both Family Nurse Practitioner (FNP-C) and the new Psychiatric Mental Health Nurse Practitioner (PMHNP-BC).

Consent Agenda

The board approved the Consent Agenda, including the board meeting minutes for April 30, 2019, with Board Secretary Miller abstaining. The board also approved medical staff appointments, reappointments, provisional and temporary privileges for five care providers.

Financial Reports

HGH Chief Financial Officer Sandi Lehman shared highlights from the April financial statements.

Patient days were over budget month-to-date by 5.6%, although year-to-date numbers remain under budget by 5.2%. Surgical cases, however, continue to be over budget both for the month by 26.8% and for the year by 13.6%. Emergency Room visits were over budget month-to-date by 3.3% and year-to-date by 3.7%. Rural Health Clinic visits were under budget month-to-date by 10.6% and year-to-date by 17%. The hospital continues to struggle with clinic visits due to a lack of providers; however, each month the number of clinic visits is getting closer to budget.

Sandi said the hospital saw an operating income loss of $271,536 for the month, although net income for the month was up 109%. For the year, operating income is $2.2 million against a budget of $3.1 million; however, net income is $3.3 million against a budget of $823,318, for a positive variance of $2.4 million or 302.7%.

Sandi said the hospital's AR or accounts receivable days crept up to nearly 90 days by the end of April. Part of that is due to eight residents transitioning to long-term care. Sandi is working on a policy to better handle residents' verification process in the future, so the same problem does not arise again.

Additionally, Sandi said the hospital is working on its "DNFB" or "discharged, not final billed" process. Accounts that are not yet billed at the time of a patient's discharge are listed on the DNFB list. Sandi said the hospital has made great progress over the past months, moving from a category "9/10" to a "5." The hospital's goal is a "3."

Also, Sandi is in communication weekly with HRG, the hospital's billing contractor, to discuss and resolve the aging of its third-party accounts, such as Medicare, Medicaid and commercial insurance.

Sandi reported on the culmination of the hospital's 50% self-pay discount promotion, which ran from February 1 through May 15, 2019. In February and March, the hospital reduced its self-pay balance by $1.1 million. Then in the first two weeks of May, the balance was reduced by an additional $450,000, for a total reduction of nearly $1.6 million.

Sandi also discussed:

  • The State of Nevada is re-basing the cap for long-term care daily room rates effective July 1. Sandi will share those numbers with the Board of Trustees once they are released.
  • As of April 1, Aetna insurance is no longer leasing a preferred network that included Humboldt General Hospital as a preferred provider. HGH is working with Aetna to re-negotiate a direct contract, which should be in force in approximately 3-4 weeks. In the meantime, HGH will honor all in-network rates with Aetna.
  • Sandi said any residents with questions regarding the way their insurance is processing their healthcare claims should contact Sandi directly.
  • Sandi said she is reviewing the latest chargemaster and pricing review with the hospital's supervisors as well as conducting an analysis to see how various price adjustments may affect revenues. She said the hospital will be looking at individual tests such as MRIs and CT scans.

Sandi updated board trustees on the Cerner electronic health record conversion process. The last training--Workflow and Integration--took place May 21-23. Approximately 25 members of the Cerner team conducted over 100 meetings over the course of the three days, including numerous integrated sessions. Teams conducted data collection to build out the new system, and discussed and decided on current and future workflows. Most groups will continue to have weekly calls. The next onsite event, "Train the Trainer," will take place July 9-11, 2019.

Business Items-Other Reports

1. 5:30 p.m. Hospital Administration-Budget / public hearing / fiscal year 2019-2020 tentative budget and any amendments to budget / approval and submission of fiscal year 2019-2020 final budget / Board-Administration - The HGH Board of Trustees held a public hearing for its fiscal year 2019-2020 budget and unanimously agreed to submit the budget to the State of Nevada. Trustee Bill Hammargen thanked staff for their hard work developing the budget.

2. Hospital Administration - Human Resources / determination of critical labor shortage of RN position for operating room department to allow reemployment of retired public employee / Administration-Human Resources Director - HGH Human Resources Director Rick Roche said a national shortage of OR nurses has made it difficult to recruit. He is anticipating a gap of 6-9 months before Humboldt General can get permanent staff in place. In the meantime, he asked for the board's approval to determine a critical labor shortage, allowing a retired OR RN to work at HGH with no detriment to her PERS retirement benefit. "This helps the retiree and it helps us while we attempt to recruit," he said. The board unanimously approved the motion.

3. Hospital Administration-EMS / proposal to purchase KwikKool portable indoor-outdoor air conditioner unit for special events-disasters / EMS Director-Administration - HGH EMS Rescue Chief Sean Burke asked the board to approve the purchase of a 12 ton AC unit that can be used to cool EMS's mobile hospital at both the Burning Man and Night in the Country events; the unit, which also has heating capabilities, can additionally be used in disaster situations. The board unanimously approved the budgeted unit at a cost of $23,306.50.

4. Hospital Administration-Pharmacy / bids-proposals for pharmacy-physical therapy remodel project / award of contract for pharmacy-physical therapy remodel project / Owners Rep-Administration - HGH Owners Representative Mike Sheppard reminded board trustees that Sletten Construction was the lone bidder for the Pharmacy-Physical Therapy remodel at $2.795 million, although approximately $1.5 million was budgeted for the project. Over the past month, Mike has worked with CEO Cole and representatives from both Sletten Construction and CTA Architects to identify areas for cost-savings. After noting some of the potential areas, Mike said, "I think we've done all we can" and encouraged the board to move forward in accepting the bid, noting that the noted cost-saving actions will immediately come into play. The board unanimously agreed to move forward with the Pharmacy-Physical Therapy remodel.

Trustee Comments

Secretary Miller thanked HGH staff for their continued dedication and follow-through with the addition of new providers, programs and patients. She acknowledged that many changes equate to more work and said she was grateful for staff's commitment to the organization.

Trustee Jennifer Hood thanked CEO Cole for bringing the HGH group together "so cohesively and moving things forward at breakneck speed."

Trustee Hammargren reminded patients that if they get a phone call from someone purporting to represent the hospital or its billing company, the representative should be able to identify him- or herself. He asked those with questions to call HGH Chief Financial Officer Sandi Lehman with questions.

Chairman Casalez thanked staff for their dedication.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in regular session at 5:30 p.m. Tuesday, June 25, in the Sarah Winnemucca Conference Room.

Meeting agendas, board minutes and more will be/are available at:

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