HGH Board Brief June 25, 2019

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

Consent Agenda

The board approved meeting minutes for May 10, 2019; May 11, 2019; and May 28, 2019. Trustee Ken Tipton abstained from voting on all three sets of minutes.

Medical Staff-Hospital Department Reports

Medical Staff Report

Dr. Paul Gaulin, Humboldt General Hospital's Chief of Staff, listed the five physicians whose applications for medical privileges will be approved this month, including Gurpreet Chahal, M.D., Provisional-Emergency Medicine; Iman Bar, M.D., Provisional-Pediatric; Prasada Nalluri, Provisional-Emergency Medicine; S. Mathew Pappy, M.D., Provisional-Hospitalist; and Jason Lasry, M.D., Provisional-Emergency Medicine.

Dr. Gaulin said medical staff continues to work on systematizing the peer review process.

In response to a question from Board Secretary Michelle Miller regarding the current status of the the draft medical staff bylaws, CEO Cole indicated she would address the question in her administrative report.

Administration Department Report: CEO

HGH Interim CEO Karen Cole shared that HGH EMS Rescue's Community Paramedicine program was recognized at the Western Regional FLEX Conference. Tom Morris, Associate Administrator for Rural Health Policy at the Federal Office of Rural Health Policy at HRSA, discussed HGH and four other Critical Access Hospitals that participate in the Nevada Rural Hospital Partners Community Paramedicine Program. Community Paramedicine sends EMS providers into patient homes to assess patients' health status and determine needs. CEO Cole said HGH is thrilled with the recognition and hopes the nation is, indeed, taking a look at what is happening in rural Nevada.

CEO Cole also 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/OB physician, has been licensed by the State of Nevada. He will begin practicing in, after which he will begin practicing at HGH in August, also in the Rural Health Clinic.
  • Dr. Rommel Adajar, an internal medicine specialist, is in the process of signing an employment agreement; he is expected to begin practicing at HGH in October.
  • Dr. Gordon Graham, an OB/GYN, may be available to provide relief to Dr. Roger Brecheen at the HGH Women's Health Clinic.

CEO Cole reviewed "next steps" for adoption of the updated medical staff bylaws. She said she and HGH Legal Counsel Kent Maher will review the bylaws to determine their consistency with what was discussed by board and medical staff members at the mini-retreat. Then, the bylaws will go to medical staff for their review and final approval. Finally, they will return to the HGH Board of Trustees for their review and final approval.

CEO Cole noted that representatives from CTA Architects will be on site Wednesday, June 26, to review and discuss finishes relative to the Pharmacy-PT remodel project.

CEO Cole also said that representatives from Sletten Construction and HGH Owner Rep Mike Sheppard will meet on July 9 or July 10 for a pre-construction meeting.

Dr. Curtiss Mull

CEO Cole thanked Dr. Curtiss Mull, an Orthopedist with Synergy Surgicalists, whose last day will be July 5.

Bryn Echevarria, at far right, is retiring, while Diane Klassen, second to right, will be the new Radiology Manager.

CEO Cole congratulated HGH Radiology Manager Bryn Echevarria, who will retire June 27, after 30+ years of service. She also welcomed Pharmacist Cody Bright, Revenue Cycle Director Jason Mercier and new Radiology Manager Diane Klassen. She said a CRNA candidate is serving in a locum capacity this week; HR is hopeful that person will accept a permanent position with HGH. Additionally, she said HGH continues to try to reduce the number of travelers working at the hospital.

CEO Cole noted that Dr. Martin Johns, the medical director for the HGH Emergency Department, has made two site visits so far and has conducted some peer review. He is working to resolve billing issues and is identifying benchmarks that can be used to assess quality care at the HGH Emergency Department.

Financial Reports

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

Patient days were 99 days over budget for the month, although year-to-date numbers remain under budget by 586 days. Surgical cases continued to be over budget both for the month by 43 cases and for the year by 169 cases. Radiology tests were over budget by 303 tests for the month and 601 tests year-to-date. Lab tests for the month were 2,511 over budget for the month and 6,007 over budget for the year. Emergency Room visits were over budget month-to-date by 116 visits and year-to-date by 336 visits. Rural Health Clinic visits were under budget month-to-date by 343 visits and year-to-date by 4,481 visits. The hospital continues to struggle with clinic visits due to a lack of providers; however, each month the number of clinic visits draws closer to budget.

Sandi said the hospital's net loss from operations for May was $423,360 compared to a budgeted loss of $323,215. This is mainly due to the increase in adjustments from the 50% discount campaign ($259,000 in adjustments in May 2019) as well as the increase in professional contracts in various departments.

May's operating revenues were higher than budgeted by approximately $979,000, while month-to-date non-operating revenues were approximately $1.1 million over budget; Sandi attributed the gain to the receipt of $1.4 million in net proceeds for calendar year 2018.

Month-to-date net income was just over $1 million (approximately $1 million over budget) while year-to-date net income was over $4.3 million (approximately $3.5 million over budget).

Sandi said the hospital's AR or accounts receivable dropped 2.5 days in May, from 89.69 days to 87.11, which she attributed to the reduction in the hospital's self-pay balance as a result of the 50% discount program.

Sandi introduced Jason Mercier to the board. Jason is the new Revenue Cycle Director. Sandi said she is counting on Jason to review the hospital's accounting processes with fresh eyes and to help update action plans to better address targeted issues.

Board Secretary Michelle Miller said she will be meeting with HGH's Financial Committee on a more regular basis. "There is a lot of growth happening," said Trustee Miller. "We need to keep up with the pace of the changes."

Additionally, Sandi explained:

  • Nevada Medicare has re-based the cap for long term care daily rates as of August 1. Accordingly, the hospital will adjust its long term care daily rates; HGH will also offer a 15% "prompt pay" discount for those who cash pay before each month's payment deadline.
  • Humboldt General Hospital has completed the application process to become a preferred provider with Aetna insurance. Until a contract is in place, HGH will honor all in-network rates with Aetna.
  • She is reviewing the latest Chargemaster and conducting an analysis to see how various price adjustments may affect revenues. She said the hospital will begin with an in-depth review of Radiology.

Business Items-Other Reports

1. Hospital Administration / Nevada Public Agency Insurance Pool (NPAIP) liability insurance program / renewal proposal and premium payment from fiscal year 2019-2020 funds / POOL - The HGH Board of Trustees discussed renewal of the hospital's property insurance policy with A&H Insurance, which will take effect July 1. Trustees opted to renew the policy and raise HGH's deductible from $2,000 per incident to $25,000 per incident, for a cost savings of $36,000/year. The motion passed unanimously.

2. Hospital Administration-Budget / proposal to augment the fiscal year 2018-2019 budget and/or transfer funds / CFO-Administration - Board members unanimously voted to approve a total augmentation of $2 million to the 2018-2019 budget.

3. Hospital Administration-Pharmacy / pharmacy remodel project / proposal to purchase Biochemguard exhaust biosafety cabinet for containment and removal of mists, vapors and particulates / Pharmacy Director-Administration - HGH Pharmacy Director Dave Simsek asked the board to approve the purchase of a Biochemguard exhaust biosafety cabinet, or pharmacy hood, right away so that it can be delivered, built and staged in anticipation of the coming pharmacy remodel project. Pre-ordering the unit will ensure that construction will not be delayed at a later date. The board unanimously approved the budgeted unit at a cost of $16,603.84.

4. Hospital Administration-EMS/ proposal to purchase eleven new Zoll cardiac monitors to replace outdated-unsupported cardiac monitors/ EMS Director-Administration - This item was tabled.

5. Hospital Administration-Radiology/ proposal to purchase a fluoroscopy and digital radiography system for radiology / Radiology Director-Administration - CEO Cole recommended that Radiology re-bid this project to take advantage of a potentially large cost savings. Board members unanimously agreed to reject all bids in the public interest.

The current forklift is rated for 3,300 pounds, although it sometimes has to carry 5,000-pound loads.

6. Hospital Administration-Materials Management / proposal to purchase refurbished forklift for materials management / Materials Management Director-Administration - Purchasing Manager Theresa Bell asked board members to purchase a refurbished forklift, rated at 8,000 pounds, for Materials Management at a cost of just under $25,000; the item is budgeted for $25,000. Theresa said MM will recover $2,000 from the sale of its current forklift, which is rated at 3,300 pounds. The board unanimously agreed to the purchase.

7. Hospital Administration / proposal to employ and enter into an employment agreement with Rommel Adajar, M.D. to provide family practice physician health care services / Administration - The board unanimously approved an employment agreement with Internal Medicine Specialist Rommel Adajar, who will join the medical staff in October. CEO Cole said Dr. Adajar is excited to have the opportunity to practice at HGH.

Dr. Robert Westling

8. Hospital Administration / ratification of employment agreement with Robert Westling, M.D. to provide resident physician supervision services for Resident Clinic and Walk-In Clinic / Administration - Board members already agreed to the basic terms of a contract with Robert Westling, MD, to proctor resident physicians in the Family Medicine Residency Clinic and mid-level providers in the Walk-In Clinic. Tuesday, the board was unanimous in formally ratifying the terms of that agreement.

9. Hospital Administration / proposal to use the professional services of and enter into an employment agreement with Robert Westling, M.D. to provide medical director services for Harmony Manor and Quail Corner long term health care facilities/ Administration - Board members unanimously agreed to the basic terms of a contract between HGH and Robert Westling, MD, to provide physician services to the residents of Harmony Manor and Quail Corner. Some details are still in the works; however, HGH Legal Counsel Kent Maher said the bulk of the agreement has been decided. The agreement includes a 30-day termination clause for both parties. CEO Cole said Dr. Westling came to the hospital's aid following the departure of Dr. Robbie Grant, who provided the resident physician services for 17 years. "He has been willing to help take care of these residents and we are grateful," she said.

10. Hospital Administration-EMS / proposal to authorize termination of the memorandum of understanding between Humboldt General Hospital EMS and City of Reno to provide Reno Fire Department with two reserve ambulances / EMS Director-Administration - The board voted unanimously to authorize termination of a memorandum of understanding between Humboldt General Hospital and and the City of Reno. In 2016, EMS transferred two ambulances to Reno Fire to help invigorate that agency's EMS program. In exchange, Reno Fire agreed to provide additional training to HGH EMS Rescue in ropes rescue and hazmat. However, EMS Chief Sean Burke said HGH now needs the units to fulfill its contract with CrowdRX at the annual Burning Man event.

Trustee Comments

Trustee Ken Tipton said it was good to be back following a short absence.

Secretary Michelle Miller, who was conducting the meeting, thanked the group for their patience as she took agenda items out of order to ensure the board had a quorum for those requiring a decision. "I wanted to make sure everything got addressed," she said.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in regular session at 5:30 p.m. Tuesday, July 16, in the Sarah Winnemucca Conference Room.

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

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