HGH Board Brief December 17, 2019

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

Medical Staff-Hospital Department Reports

Medical Staff Report

There was no medical staff report.

Administration Department Report: CEO

Cerner Update

HGH Chief Financial Officer Sandi Lehman updated board trustees on the hospital's conversion to the Cerner Electronic Health Record platform. All managers continue to participate in a daily revenue meeting; together they are working through the hospital's processes to capture all charges. The hospital received its first insurance payment the week of December 2, 2019. There are still some claim edits and workflows to work through.

Sandi reported that the reference lab interface went live the week of December 2, 2019; the radiology interface will go live in January 2020.

Additionally, Sandi said her team continues to assess how to best approach self-pay payments through the Apex system, a part of the original Cerner purchase. Apex does not allow merged billing. A possible solution may come through the sequel report, which would merge patient statements from Cerner and Medhost, the hospital's former electronic health record. The first Cerner-generated bills will go out in January 2020. Insurance claims are going out daily; some are being held pending the resolution of some issues.

Good News Update

HGH Director of Community Education and Development Nicole Maher presented a "Good News Update" to trustees. She noted that October is National Breast Cancer Awareness Month, which is an excellent awareness opportunity. However, this year created a public relations dilemma with the soon-to-arrive 3D Mammography machine. Nicole said the hospital wanted women to understand the technological benefits that would accompany the new mammo machine, but did not want to lose the revenue and momentum that accompanies October’s mammo month promotions. Additionally, if the hospital scheduled women for appointments with the current 2D machine and did not alert them to the fact that a more advanced machine was coming, it could risk losing women’s trust as their hometown healthcare provider.

The solution was a "Kickoff Celebration" that helped maintain momentum for October's emphasis on mammography screening, while also promoting HGH's coming 3D machine. The results were good: 70 women participated in the "Kickoff" event; 111 women got mammograms during October (HGH's highest month ever); and the "Kickoff" and other October promotions helped build excitement for the January 11, 2020, 3D Mammo Open House.

Additionally, Nicole reported:

  • Approximately 104 people have taken advantage of "Healthy You Fridays" reduced blood-screenings over the past year. Response has been very favorable from patients and providers.
  • The sixth annual "Cookies with Santa" event drew more than 180 children and their parents to the EMS station for professional photos, cookies, milk and candy canes. Additionally, donated toys were given to the Frontier Community Action Agency, while donated food went to the Winnemucca Food Bank.
  • The HGH Nurse Health Line has been in place for 18 months and Humboldt County's numbers are very favorable for total incoming calls, tracked records, protocols started and protocols completed.

Physician Update/Recruitment

HGH Interim CEO Karen Cole updated board trustees on new and recruiting physicians:

  • Andrew Wesely, MD - Dr. Wesely, a Pain Management specialist, hosted his first pain management clinic on November 13. He will return on December 18-19.
  • Shane Draper, DPM, and Quinn Lindstrom, DPM - Drs. Draper and Lindstrom will orient/set up clinic at Humboldt General Hospital January 3; they will begin seeing patients January 6-8.
  • Subha Rajan, MD - Dr. Rajan, a Family Practice/OB physician, will begin her practice at HGH in April 2020. She has obtained a Nevada license.
  • David Masuck, MD - Dr. Masuck, currently Chief Resident of Humboldt General Hospital's Resident Physicians, will join the HGH Physicians Clinic in fall 2020.
  • Brittani Smith, MD - Dr. Smith, a Family Practice/OB physician, came for a site visit on December 1 and was well received. Discussions continue concerning a possible contract. She is planning a return visit with her boyfriend.
  • Dr. Muhad - Dr. Muhad, a Family Practice Resident at Mercy Medical Center in Iowa, will come for a site visit from January 11-14, 2020.

CEO Cole also updated the board on the status of other providers at HGH:

  • CRNAs - Tom Mouritsen has joined Humboldt General Hospital as a third CRNA.
  • Perry Guthrie - Perry is a locum Nurse Practitioner working in the HGH Walk-In Clinic.
  • Raafat Khani, DO - Dr. Khani is a locum Internal Medicine specialist, providing family medicine services.
  • Pamela Sherwill-Navarro - Pamela is a locum Nurse Practitioner, providing family medicine services in Suite A of the HGH clinic.

CEO Cole updated board trustees on new staff members are HGH including:

  • COO - Tiffany Love, PhD, APRN, FACHE, will begin as the hospital's new Chief Operating Officer on January 13, 2020.
  • CNO - Leeann Cushway, RN, BSN, MSN, will begin as the hospital's new Chief Nursing Officer on January 27, 2020.

CEO Cole said other key recruitment efforts at HGH include the search for an HR Manager, an OR Manager, an OB Manager and a Clinic Nurse Supervisor.

Remodel Projects

The Pharmacy Department will move into their new space in January 2020.

CEO Cole updated the board on the various expansion-remodel projects at HGH:

  • Pharmacy - Pharmacy will move into their new space in January 2020. There are some issues that need resolution, including air balancing of the new IV hood and completion of department cultures.
  • Physical Therapy and Cardiac Rehab - Construction will likely begin on January 6.
  • Cafeteria - Expansion and remodel of the cafeteria is also slated for the new year.

MedX AirOne Update

CEO Cole updated the board on the hospital's evolving relationship with MedX AirOne, the owner of HGH AirOne. She and Trustee Bill Hammargren met with MedX President Joel Hochhalter. The Comm Center that is currently stationed at Humboldt General Hospital will move to Elko in February. Two of HGH's Comm Center employees will transition to work in Elko, while five other HGH Comm Center employees will transition to other positions within Humboldt General Hospital. One staff member opted to seek employment elsewhere. Andrew Loveless will act as the new Interim Flight Base Manager and will report directly to both CEO Cole and Joel Hochhalter.

Health Insurance Employee Meetings

CEO Cole reported that A & H Insurance, the hospital's new insurance broker, is hosting a series of employee insurance open enrollment meetings from December 11-December 20. Employees can choose from a variety of Anthem PPO and HSA products as well as Anthem dental and vision insurance.

IT Conversion Update

CEO Cole updated the board on the Cerner IT conversion. Cerner continues to work through clinical workflow issues in OB. OB's unique system requires data from its old and new systems in a convenient format.

CEO Cole said volumes at the hospital rebounded nicely following the November 11 conversion to the Cerner system. The hospital's lowest volume week was November 25 with 377 visits. By December 2, volumes were up to 604, with 588 the following week.

CEO Cole said the multiview module and financials remain the greatest challenges with the Cerner conversion, specifically with relation to coding and charges.

Long Term Care Survey

Two inspectors surveyed Harmony Manor and Quail Corner for four days the week of December 2 as part of a federal re-certification survey. They did not issue any substandard citations. A Life Safety inspection followed the week of December 9. CEO Cole said staff has started to address opportunities for improvement while awaiting official reports.


Staff participated in a CMS webinar on Monday, December 16, to review changes to the Medicare Conditions of Participation for Critical Access Hospitals. The webinar discussed the emerging importance of antibiotic stewardship, which Pharmacist Cody Bright and Hospitalist Timothy Musick will head up at HGH. Additionally, CEO Cole said, per CMS guidelines, board members will need to appoint Janet Sturtz as HGH's Infection Preventionist.

CEO Cole also discussed developing a compliance plan with Linda Lilleboe; consulting with Midwest Health Care for a comprehensive review of HGH's Rural Health Clinic; and the upcoming 340B audit.

Upcoming Events

CEO Cole reminded board trustees of the Corporate Bylaws Mini-Retreat scheduled for February 28-29. She also encouraged trustees to participate in the 24th Annual Western Regional Trustee Symposium, which will take place June 10-12, 2020, in Reno, Nevada.

Consent Agenda

Board trustees approved the minutes for the November 19, 2019, meeting. Additionally, board members approved medical staff applications for appointments, reappointments and privileges for 6 medical providers.

Financial Reports

CFO Sandi Lehman presented the financial report for October 2019 to the HGH Board of Trustees. Sandi said the hospital saw record patient service revenue of $10.5 million during October. Patient days, Emergency Department visits and clinic visits were all over budget, while surgical cases were under budget. Net income for the month was under budget by 79.25%. Year to date, net income is up 35.66%.

Business Items-Other Reports

The Canon Ultimax-I Multipurpose X-Ray System

1. Hospital Administration-Radiology / proposal to purchase a fluoroscopy and digital radiography system for radiology / Radiology Director-Administration - HGH Trustees unanimously approved the purchase of a new fluoroscopy and digital radiography system for the HGH Radiology Department. The current machine, which was purchased in 2002, has reached its end of life and has not been in operation since 2018. The Canon Ultimax-I Multipurpose X-Ray System will cost $497,537, which includes new flooring, paint and some electrical and installation updates to the room where the machine will be housed.

2. Hospital Administration / Hospital District fiscal year 2018-2019 financial audit report / Dingus Zarecor & Associates-CFO-Administration - The public accounting firm of Dingus, Zarecor & Associates issued a clean, unqualified opinion for the year ended June 30, 2019. The firm noted one significant deficiency in how the hospital reports its contractual adjustments. The hospital disputed the finding, however, noting that its adjustments are based upon historical information and management's professional judgement to best estimate which accounts receivable should be written off based on its payors. As part of their audit, the firm also suggested some opportunities for strengthening the hospital's internal controls and operating efficiency.

Mark Reyka, CRNA

3. Hospital Administration / proposal to enter into an employment agreement with Mark Reyka, CRNA, to provide services as director of CRNA services/ Administration - Board trustees unanimously approved an employment agreement with Mark Reyka to provide services as director of CRNA services, a role he has been filling for some time.

4. Hospital Administration / proposal to enter into an employment agreement with Mark Reyka, CRNA, to provide CRNA staff services / Administration - Board trustees unanimously approved an employment agreement with Mark Reyka to provide CRNA staff services.

Rommel Adajar, MD

5. Hospital Administration / proposal for professional services agreement with Rommel Adajar, MD, to provide medical director health care services / Administration - The board unanimously approved an agreement with Dr. Rommel Adajar to provide medical director services for long term care. Dr. Westling has been providing these services over the past year on an interim basis; CEO Cole said Dr. Adajar is happy to now assume the role.

6. Hospital Administration-Maintenance / proposal to replace and possibly relocate the kitchen hood and dishwasher exhaust fan / Maintenance Director-Administration - The HGH Board of Trustees unanimously agreed to replace the hospital's kitchen hood and dishwasher exhaust fan and relocate them to the roof for ease of maintenance access. Cost should not exceed $50,000.

7. Hospital Administration / proposal to approve medical staff bylaws/ Administration - Board trustees unanimously approved the medical staff bylaws. CEO Cole said potential changes are already in the works. "This should be a living document," she said, and noted that medical staff should be encouraged to make amendments as needed.

8. Hospital Administration / proposal to authorize administration to execute amendments to provider agreements to make the terms for providing employee health insurance benefits consistent for all employees / Administration - HGH Trustees unanimously agreed to authorize administration to amend provider agreements to make provider health insurance benefits consistent with all HGH employees.

9. District Administration / proposal to authorize the board chairman to engage the services of an executive search firm to provide candidates for consideration as the district chief executive officer/ Board - Board members unanimously agreed to engage the services of B.E. Smith, an executive search firm, to provide chief executive officer candidates for Humboldt General Hospital.

Trustee Comments

Trustee Gene Hunt applauded the purchase of the new fluoroscopy machine. He noted that medical staff discussed the machine and their need for its services.

Secretary Michelle Miller encouraged the board to set dates for a budget workshop and follow-up meeting. Members agreed to meet Saturday, March 14, for the budget workshop and follow up at their regularly scheduled board meeting in March.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next at 5:30 p.m. Tuesday, January 28, in the Sarah Winnemucca Conference Room.

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