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HGH Board Brief October 22, 2019

Trustees present: JoAnn Casalez, Chairman; Michelle Miller, Secretary; Bill Hammargren; Ken Tipton; and Gene Hunt.

Medical Staff-Hospital Department Reports

Medical Staff Report

HGH Chief of Staff Paul Gaulin presented the Medical Staff report for October. He noted that:

  • The Cerner Electronic Health Record implementation is on schedule and physicians are being trained on the new system.
  • The medical staff bylaws are close to being complete.
  • Recruiting efforts for new providers at Humboldt General Hospital continue.

Administration Department Report: CEO

Burning Man

HGH EMS Rescue Chief Sean Burke reported on the 2019 Burning Man event. Chief Burke said HGH has completed the second of a three-year contract. In all, staff members (including 58 temporary employees) worked 336 12-hour shifts to provide more than 400 on-site transports to medical care, as well as 29 off-site transports (up seven from the previous year). According to Chief Burke, staffing and logistics were also much improved over the previous year.

Among future challenges, Chief Burke noted that next year, anyone providing Radiology services must be licensed by the State of Nevada. In addition, EMS's reserve ambulances and trailers are showing their age. Chief Burke strongly suggested the hospital not renew its contract with Burning Man for another cycle beyond 2020, as it would mean a substantial capital outlay to replenish the service's reserve vehicles and trailers.

Cerner Update

HGH Chief Financial Officer Sandi Lehman updated board members on the hospital's coming conversion to the Cerner Electronic Health Record platform. She noted that hospital personnel continue to work with Cerner consultants to test data within the system. The CareStream Radiology interface for the system will be delayed until after January 2020; however, the testing for the Quest Laboratory interface will be complete this week. Validation of that connection will begin next week but will not be complete in time for implementation of the new system on November 11.

Chargemaster Review

HGH Chief Financial Officer Sandi Lehman also reported on a comprehensive overview of the hospital's chargemaster. Sandi said HGH's pricing has been compared with 13 Nevada hospitals (12 of them rural). Changes to HGH's pricing have been made based on review of individual items and not overall charges. These changes will result in a total estimated reduction of Net Patient Revenue of $12,870. The changes will become effective on November 1, 2019.

HR Report

Interim Human Resource Director Rick Roche provided board members with some statistics regarding the hospital's workforce. Currently, the hospital has 274 full-time and 8 part-time staff members. The hospital has received 240 applications since April 2019 and has brought on 82 new hires over that period. Additionally, since April 2019, HR has overseen 30 voluntary (including retirements) and involuntary terminations of employment.

Rick said the hospital's key recruitment efforts are focused on filling positions for two CRNAs, an OR manager, an OB manager, registered nurses, and pharmacy, respiratory and laboratory personnel.

Rick said approximately 95% to 100% of performance evaluations are being completed on time. Supervisors are given 60-90 days advance notice of their need to complete the evaluations. Following a question from Secretary Michelle Miller, Rick said supervisors are notifying supervisors of their due dates via email and phone calls per HR's internal system flags. Trustee Gene Hunt wondered what happens if supervisors miss employees' performance evaluation deadlines. Secretary Miller said part of the problem is the hospital does not have a standardized policy requiring a minimum standard and expectation. Chairman JoAnn Casalez said the board previously discussed a policy that would include an "automatic progression" for employees if their supervisors did not complete evaluations on time. Rick said he would verify that such a policy is in place and would bring it back to the board at their November meeting. Trustee Bill Hammargren said he would like to see recent statistics on how many evaluations have not been completed by supervisors. "Provide a number, not a percentage," he said.

As part of his report, Rick also shared that the hospital's soon-to-be payroll/HR system has been purchased by Kronos. That system is set for a January 1 implementation; training will begin in November. Following a question from Secretary Miller, Rick said even with the many variables that come with the new company ownership, he believes the change is necessary and valuable. He said if necessary, the hospital can transition to a new product in a few years.

Rick also shared that the hospital will host a benefits fair for employees in December, including open enrollment opportunities and vendors from Aflac, Colonial and other medical/dental insurance providers.

CEO Report

HGH Interim CEO Karen Cole provided an update on new HGH physicians, including:

  • Dr. Rommel Adajar, an internal medicine specialist, began October 7 in Clinic H.
  • Dr. Andrew Wesely will begin hosting a pain management clinic two days each month beginning in November.
  • Dr. Shane Draper and Dr. Quinn Lindstrom will begin hosting a podiatry clinic three days each week beginning January 1.

Additionally, CEO Cole shared information about other providers at HGH. Humboldt General has offered a job-sharing position to two CRNAs, who would fill a third nurse anesthetist position at HGH. In addition, Tina Carbone, a former HGH OR nurse, will now serve as a nurse practitioner in the Walk-In Clinic, while Perry Guthrie, also a nurse practitioner, will serve as a locum family practitioner.

Regarding recruitment efforts, CEO Cole said Family Practice/OB physician Subha Rajan will begin practicing at HGH in April; Dr. David Masuck, a current Family Medicine Residency physician, will begin practicing at HGH in the fall.

CEO Cole said she also is working to recruit a family practice resident at Mercy Medical Center in Iowa. She is currently working with three recruitment firms including Fidelis, Delta and Merritt Hawkins.

Remodel Project

CEO Cole discussed the remodel-expansion of the former Physical Therapy and Cardiac Rehab departments into the new Pharmacy space. She said the work is coming along well and crews are working well within the healthcare environment. She said crews lost some time due to a delay in the timing of the pharmacy casework; however, Sletten Construction is hoping to fill in any time gaps with a remodel-expansion of Humboldt General's cafeteria.

Crews have finished all drywall work in the PT-Cardiac Rehab space and are now painting and preparing for the installation of new vinyl flooring.

CEO Cole also shared that the hospital is looking to introduce its sleep medicine services following the Cerner software conversion in November. Additionally, she is working with Practice Administrator Robert Johnson and Social Worker Jennifer Slovernick to explore telepsych options.

CEO Cole further shared that the medical staff bylaws are in the hands of the medical staff officers. She suggested board members review the hospital's bylaws during a corporate retreat. She proposed two possible dates: January 17-18 or January31-February 1.

Consent Agenda

Board trustees approved the meeting minutes for the September 24, 2019, meeting. Additionally, board members approved medical staff applications for appointments, reappointments, provisional and temporary privileges for 10 medical providers.

Financial Reports

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

For September, patient utilization was over budget for all areas of the hospital with the exception of OR. Income from operations was $285,533 compared to budgeted income of $57,963. Operating revenues were higher than budget by approximately $522,000, and operating expenses were higher than budget by approximately $295,000, mainly due to two things:

  • Deductions from revenue of approximately $831,000, which is the result of an increase in volumes and continued accounts receivable cleanup; and,
  • An increase in salary and wages due to the Burning Man event and sign-on bonuses for providers.

Additionally, non-operating revenues were approximately $280,000 over budget; a net income of $960,000 was approximately $507,000 over budget; and, the hospital's restricted cash of approximately $17,000 is related to nursing home patient funds held in trust for residents.

Business Items-Other Reports

1. Hospital Administration-Laboratory/ proposal to purchase procalcitonin machine for laboratory/ Administration - Board members unanimously approved a $35,000 budget to purchase a procalcitonin testing machine that will assist in the diagnosis of sepsis. Currently, patient samples sent to reference labs for testing are not returned in a timely manner, making the eventual results of little use to physicians.

2. Hospital Administration / proposal to restate the independent contractor agreement to engage the professional services of Charles Stringham, M.D. to provide the air ambulance medical director services / Administration - Board members unanimously agreed to restate the hospital's independent contractor agreement with Dr. Charles Stringham to continue to provide air ambulance medical director services.

Trustee Comments

Chairman JoAnn Casalez facilitated a discussion to schedule a special meeting for November 19 and reschedule the board's December meeting to December 17.

Secretary Michelle Miller said she would like to discuss the board's plans for 2020 in light of the coming election year.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in special session at 5:30 p.m. Tuesday, November 19, in the Sarah Winnemucca Conference Room.

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