HGH Board Brief May 26, 2020

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

Medical Staff-Hospital Department Reports

Administration Department Report: CEO

Thank You

Interim CEO Karen Cole thanked medical staff, county leadership, administrators and others who have helped with the pandemic in any form. She said it has taken a community. She acknowledged HGH Chief Nursing Officer Leeann Cushway as well as all HGH staff. She also acknowledged the HGH Trustees and their leadership. She expressed gratitude to Humboldt County community residents for their continuing care and concern for employees and the hospital. "The people in the trenches have worked very hard and deserve this kind of recognition," she said.

Field Hospital Response

HGH EMS Rescue is dismantling the field hospital at the Winnemucca Event Center. Interim CEO Karen Cole said that Richard Whitley, the director of Nevada Health and Human Services, shared in an email that he was grateful Humboldt County identified a possible need and took action by building up the field hospital. He said he appreciated the leadership at both the hospital and Humboldt County. CEO Cole thanked staff for their contributions to Humboldt General Hospital’s COVID-19 response.

EMS Report

Interim EMS Director Jordan Kohler reported that EMS responded to 213 calls in April. He will include full statistics for January through March at next month's meeting. EMS has seen an increase in 9-1-1 calls and transfers. The service is currently calling or visiting 115 community paramedicine patients under the direction of Gricelda Soto, due to COVID-19 and admissions from physicians within the hospital. Johnathen Prichard is pursuing various grants to help with EMT students and educators. The field hospital at the Winnemucca Event Center was demobilized; Tom Stephen was an outstanding contributor to that. Trustee Ken Tipton asked what constitutes a non-billable call. Interim Director Kohler said a call may be canceled, or a patient may refuse to be transferred. He said most months, approximately 55% of calls are billable; in April that number rose to 61%.

COVID-19 Update

Chief Nursing Officer Leeann Cushway presented the COVID-19 update as follows:

  • April 16 - The state conducted a Long Term Care survey for Infection Control. There were no findings and no recommendations.
  • May 1-8 - HGH received two allotments of rapid test kits. The hospital's policy allows for the kits to be used to test critical patients who will be cared for on Acute; to test transfer patients; and to test Long Term Care residents when needed.
  • May 4 - The HGH Screening Clinic changed locations to the main hospital campus.
  • May 6 - The EZ Lab opened in the HGH Wellness Center. The service was recently expanded to include all patients.
  • May 11-17 - HGH approved policy and procedures governing the reactivation of elective surgeries.
  • May 13 - The state conducted a Critical Access Hospital survey for Infection Control. Again, there were no findings and no recommendations. Surveyors were impressed with HGH's operation.
  • May 14-18 - Humboldt County Emergency Management facilitated a community-based COVID-19 screening for all Humboldt County residents at the Winnemucca Event Center. In all, 721 people were tested with one positive result.
  • May 20-21 - All staff and residents at Harmony Manor and Quail Corner were tested for COVID-19 per mandatory state regulations.
  • May 25 - COVID Corner was decommissioned and returned to the OR for normal operations. It has been three weeks since HGH had a COVID-19 hospitalization.

Additionally, CNO Cushway said daily surveys continue for both the hospital and Long Term Care.

Chief Operating Officer Report

Humboldt General Hospital opened the EZ Lab the week of May 11. The off-site lab in the HGH Wellness Center is open from 7:30 a.m. to 9:30 a.m. each morning; in all, 34 patients have taken advantage of the service. The lab was originally designated for older and immunocompromised patients; however, COO Tiffany Love said the service was eventually opened to expectant mothers and finally all patients. She said Administration is monitoring use to see if this is something the community wants, or if HGH should seek other options.

HGH is in the process of finalizing a contact with a speech language pathologist for Long Term Care. This person lives locally and can respond within 24 hours for consultations. COO Love said the hospital is very happy to bring this service to the organization.

The HGH Sleep Medicine Program will launch June 1 with appropriate COVID-related precautions.

The Fluoroscopy suite in Radiology is complete and in use. Dr. Wesely also has committed to use the service for his local patients who need pain medicine treatment.

HR Report

HR Director Didi Almendares detailed the various resources that are available to address employee mental health during the COVID-19 pandemic. Employees may participate in group or individual Employee Assistance Program counseling services under the Pool Pact agreement. Director Almendares said she has shared other available resources with staff, including information about a Disaster Distress Helpline and a program specific to physicians and first responders.

Physician Staffing Update

Interim CEO Cole provided an update on physician staffing:

  • Dr. Subha Rajan, FP/OB, began April 27
  • Dr. Brittani Smith, FP/OB, will begin fall 2020
  • Dr. David Masuck, FP, will begin fall 2020
  • A psychiatrist continues to show interest in HGH
  • Merritt Hawkins is beginning a search for an OB/GYN

Remodel Project

Owner representative Mike Sheppard is working with Sletten Construction to finish construction flooring and kitchen hood projects in the cafeteria, as well as various projects in the Pharmacy.

EMS Director Search

Interim CEO Cole said administrators have conducted three video interviews for the EMS Director position. Several more interviews will take place in the next two weeks. Once the list of candidates is narrowed down, administrators will schedule site visits.

Consent Agenda

Board trustees approved the minutes for the following meetings: April 28, 2020; May 5, 2020; May 8, 2020: and May 9, 2020. Additionally, board members approved medical staff applications for appointments, reappointments and privileges for 11 medical providers.

Financial Reports

Interim CFO Tim Powers said Shelly Smith is going to take over the revenue cycle position.

CFO Powers presented financial overviews from April 2020 to the board:

  • Gross Patient Revenue for April was $7.9M (budget $8.2M / prior year $8.5M); year-to-date, $85.4M (budget $82.2M / prior year $74.0M).
  • Contractual Allowances and Bad Debt for April were 51% (budget 40% / prior year 52%); year-to-date, 54% (budget 42% / prior year 48%).
  • Operating Revenue for April was $3.9M (budget $4.9M / prior year $4.3M); year-to-date, $39.5M (budget $48M / prior year $39.2M).
  • Operating Expenses for April were $5.0M (budget $4.7M / prior year $4.5M); year-to-date, $50.9M (budget $47M / prior year $41.4M).
  • Net Income for April was $37K (budget $643K / prior year $431K); year-to-date, $5.9M (budget $4.9M / prior year $3.3M).
  • Accounts Receivable decreased to 79.5 days from 83 days in March.
  • Days Cash on Hand increased to 198 days, up from 188 days in March.

CFO Powers said while operating results are not anywhere near where HGH wants or expects them to be, the hospital has made significant inroads in managing its receivables better, creating a better environment for the revenue cycle process, and maintaining days cash on hand.

Trustee Tipton asked what HGH can do to improve its revenue cycle moving forward. CFO Powers said HGH must continue to take control of its relationship with Cerner to ensure that Cerner is functioning according to contract/expectations. Second, HGH admitting staff must capture as much data as possible at first contact with each patient. CFO Powers said other important initiatives such as reducing overtime dollars and sourcing other avenues of stimulus funds are very important, although there is still some question as to how and where stimulus funds may be used.

CFO Powers said the final budget for HGH is due to the state on June 1.

Business Items-Other Reports

1. Hospital Administration-Finance/ public hearing / FY2020-2021 tentative budget and amendments to budget / submission of final budget / CFO-Administration - Trustees held a public hearing for the FY2020-2021 tentative budget and amendments; there was no public comment. Trustees unanimously approved the tentative budget as submitted.

2. Hospital Administration-Housekeeping/ proposal for purchase of portable automated ultraviolet germicidal disinfection equipment and service plan / COO-Administration - Trustees unanimously approved the purchase of a Surfacide Dual Emitter UV-C system at a cost of $70,928.

Trustee Comments

Trustees agreed to conduct on-site interviews with HGH's two CEO candidates on Monday and Tuesday, June 8-9. Additionally, the June board meeting was moved to June 30.

Chairman JoAnn Casalez and Trustees Ken Tipton and Alicia Cramer all expressed appreciation to HGH staff, medical staff and administrators for their work during the COVID-19 outbreak. Trustee Cramer also thanked Lily Avalos with the Frontier Community Action Agency for sharing bilingual information about COVID-19 with the community.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next at 5:30 p.m. Monday and Tuesday, June 8-9, for CEO candidate interviews in the Sarah Winnemucca Conference Room.

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