HGH Board Brief July 24, 2018

Trustees present: JoAnn Casalez, Chairman; Michelle Miller, Secretary; Richard Cook, Bill Hammargren, Jennifer Hood, and Ken Tipton. No Trustees were absent.

Medical Staff Report

Medical Staff By-Laws

HGH Chief of Staff Len Perkinson said Medical Staff, which includes all physicians at the facility, are nearly finished revising their by-laws. Dr. Perkinson said the physicians will be voting on the new document at their August meeting, bringing this multi-year project to a successful close.

Opioid Crisis

Additionally, Dr. Perkinson updated the board on the local, state and national opioid epidemic. He said the issue has nearly reached a "boiling point" for both providers and patients.

Legislation that took effect in January 2018 has made it nearly impossible for providers to provide ongoing treatment locally; as of right now, no HGH providers are prescribing opioid medications for chronic pain. This means that patients are now required to seek treatment from pain specialists out of area, creating new financial and physical burdens.

"It's not that our doctors don't want to prescribe," said Dr. Perkinson, "they can't. It is such a huge burden to monitor these patients, and the situation is forecast to get worse."

He added, "My heart, as a provider, goes out to every one of these people."

Dr. Perkinson said the combined healthcare system, community and medical staff needs to petition the state medical board for "tools" that will help providers find appropriate solutions for their patients. "As a healthcare district we need to create a consensus statement that says 'enough is enough.'"

The board agreed that a combined letter from all eight member hospitals of the Nevada Rural Health Partners network would be more powerful than a single letter from HGH. Chairman Casalez also asked that the hospital help educate the community regarding the local opioid crisis. Trustee Jennifer Hood agreed: "Let us all get smart and educated about what is going on here."

EMS Report

EMS Chief Sean Burke brought the board up to date on HGH EMS Rescue's month:

  • The second of three ambulances to receive replacement chassis in southern California is back in service.
  • A hospital-wide "Shelter in Place" drill on Friday, June 22, went well; an "after-action report" identified several areas for improvement.
  • A paramedic team and ambulance (pictured above) were dispatched to the Martin Fire Inter-Agency Team.
  • HGH EMS Rescue is the only rural hospital in the state to participate in the ODMAP partnership initiated by the State of Nevada Attorney General's Office. ODMAP is software that provides real-time overdose surveillance data across jurisdictions that can help mobilize an immediate response to an overdose spike.
  • The number of behavioral health transfers doubled this month.
  • Trustee Jennifer Hood asked that EMS include overdose numbers in its monthly report.

Administration Department Report

  • QA Report - Quality Services Director Lisa Andre shared that the hospital's patient survey company HealthStream has been purchased by Press Ganey. This was disappointing as Press Ganey has not historically provided the same quality of service as HealthStream. However, Press Ganey has promised an increased level of service, so Lisa said the hospital will remain with Press Ganey for all but inpatient surveys. She also shared that the hospital did very well during a recent federal Critical Access Hospital survey. Some needed improvements will be outlined on the "Statement of Deficiencies," which will arrive in about three months. However, none of the deficiencies were patient-related.
  • Revenue Cycle Report - Chief Financial Officer Sandi Lehman provided an update on the hospital's efforts to streamline its revenue cycle. She commended Business Office Manager Shauna Barsanti for suggesting that the group begin at the end of the cycle and work backwards to identify issues. Sandi said that has been very effective.
  • Mental Health Update - Trustee Jennifer Hood updated the board on the Family Support Center.
  • Community Giving Committee Update - Community Education and Development Director Nicole Maher said the HGH Community Giving Committee met for the first time. The group decided on a mission statement and principles of giving. The group also invited representatives from Newmont Mining Corporation to share information about the "Legacy Fund" giving program.
  • Strategic Quarterly Report - CEO Art Frable discussed the possibility of offering low-cost blood testing to the community on a monthly or quarterly basis. He also reviewed updated policies at the hospital regarding nylons and tattoos. Tuition reimbursement will now be available to all staff, rather than just nursing. He is reviewing the possibility of working with local hospice providers to offer in-hospital respite care. The hospital's bed charge will have to be at least commensurate with what Medicare would pay. The hospital is reviewing new Electronic Medical Records programs, including athenahealth. Additionally, the Nurse Health Line in partnership with REMSA came online June 15. The number of patient calls continues to increase. HGH will not pay REMSA for the service until all marketing efforts are in place and the hospital is seeing steady utilization.
  • HR Policy on Evaluations - Human Resource Manager Rose Green said all hospital managers and supervisors are working on completing staff evaluations on time. If staff evaluations are not done in a timely manner, employees will still receive merit increases; however, staff will not receive a merit increase if they delay completing mandatory health- and policy-related actions.
Financial Reports

Chief Financial Officer Sandi Lehman shared the financial reports for June 2018. The hospital finished out the 2018 fiscal year with its highest gross revenue ever:


CEO Art Frable noted that amount does not include any price increases. The hospital's assets total $107.8 million, up from $98.2 million last year.

Business Items-Other Reports

1. Board of Trustees Administration / election of board chairman and board secretary / Board - Trustees re-elected JoAnn Casalez Chairman and Michelle Miller Secretary for the remainder of 2018.

Trustee Bill Hammargren made the motion to re-elect JoAnn Casalez chairman; Trustee Ken Tipton was second. All trustees voted yes with the exception of Trustee Richard Cook who voted no.

Trustee Bill Hammargren also made the motion to re-elect Michelle Miller secretary; Trustee Jennifer Hood was second; the vote was unanimous in the affirmative.

2. Hospital Administration / proposal and terms and conditions for office space lease for Bradford Granath, M.D. / Administration - CEO Art Frable has initiated discussions with Dr. Brad Granath to lease office space in the Rural Health Clinic wing of the hospital.

Trustee Bill Hammargren made the motion to approve Administration to negotiate a lease with Dr. Brad Granath; Trustee Michelle Miller was second. The vote was unanimous in the affirmative.

3. Hospital Administration / Nevada Division of Health Care Financing and Policy re-validation application requirements for HGH to maintain provider privileges to participate in the Nevada Medicaid program / Administrator-CFO-Chairman - This item was tabled.

Next Meeting

The next meeting of the Humboldt County Hospital District Board of Trustees will take place beginning at 5:30 p.m. Monday, August 27, in the HGH Sarah Winnemucca Conference Room. The meeting agenda as well as past meeting agendas and minutes are available at https://www.hghospital.org/about-us/leadership/hospital-board-meetings/

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