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HGH Board Brief January 22, 2019

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

Consent Agenda

The board approved the Consent Agenda, including board meeting minutes for November 27, 2018; November 28, 2018; December 5, 2018; and, December 18, 2018. The board also approved pending medical staff applications. The voting was unanimous.

Tabled Agenda Items

Board trustees tabled the Medical Staff-Hospital Department and Financial reports.

Business Items - Other Reports

1. Hospital Administration-EMS / proposal to supply and install new flooring for the EMS station / EMS Director. HGH EMS Rescue Chief Sean Burke explained to board members that the existing floors at the EMS station are at least 10 years old and are in poor condition. He received two local bids for floor repair; the work can be completed in February. The board unanimously agreed to hire Quality Floors in Winnemucca to provide new flooring at the EMS station at a cost of $15,065.20. The capital budget expense is a line item in EMS's current budget.

Current flooring at the EMS station

2. Hospital Administration-EMS / proposal to approve a memorandum of understanding with City of Winnemucca to use city property to provide rapid, short-term support and deployment of resources in response to a mass casualty incident or other incident requiring multiple air ambulance services aircraft / EMS Director. HGH EMS Rescue Chief Sean Burke told trustees that Humboldt General Hospital currently maintains an FAA certified landing pad, and has the ability to land one additional helicopter in the adjacent parking lot. However, a mass casualty or other disaster response may require additional landing spots. A Memorandum of Understanding between HGH and the City of Winnemucca would allow the hospital to land additional air ambulance helicopters at the park facility across from the HGH Emergency Department. Board trustees unanimously approved the proposed MOU; according to HGH Legal Counsel Kent Maher, the Winnemucca City Council also approved the MOU earlier Tuesday, January 22, 2019.

HGH AirOne and Elko AirOne

3. Hospital Administration-Administration / proposal to adjust the call-pay fees payable to Bradford Granath, MD for OB call services / CFO-Administrator.  Hospital trustees unanimously agreed to increase obstetrics call pay for Bradford Granath, MD, retroactive to July 2018. HGH Chief Financial Officer Sandi Lehman said hospital administration believes an increase in OB pay will assist in attracting new faculty to the facility. Additionally, Resident Physicians in the University of Nevada Las Vegas Rural Family Medicine Residency need to increase the number of maternity deliveries they perform in order to meet accreditation requirements, and to have a higher quality educational experience. Additional compensation will incentivize faculty to include the residents in as many deliveries as possible.

Dr. Bradford Granath with Humboldt General Hospital's first three Resident Physicians: Drs. Samaan Sattarzadeh, Rodney Sholty and Christopher Vlasek. The hospital currently has four Resident Physicians: Drs. James Denisar-Green, David Cummings, Hind Elsanousy and David Masuck. Two new residents will join the faculty in July.

4. Hospital Administration-Human Resources / salary survey review / proposal to adjust wage and salary scales / HR Director. Board members unanimously approved a proposal from HGH Human Resource Director Rose Green to increase the starting hourly pay rate for medical assistants and certified medical assistants. Non-certified medical assistants with three or more years of recent experience will be paid at the certified medical assistant level. Rose said the hospital has had difficulty recruiting and retaining medical assistants. The new pay rates will take effect on February 4, 2019, and will affect five existing employees.

Humboldt General Hospital's medical assistants and certified medical assistants will be positively affected by increases to the pay rate schedule that were approved at the January 22, 2019, meeting of the HGH trustees.

5. Hospital Administration-Audit / auditor report of FY 17-18 expenses exceeding budget due to unbudgeted depreciation expenses and unplanned professional fees / proposal to prevent future budget report discrepancies by enhancing expenses monitoring / CFO-Administrator. As part of a plan of corrective action, HGH Chief Financial Officer Sandi Lehman apprised the board that the hospital was $2.6 million over budget per the audited financial statements for the fiscal year ended June 30, 2018. The over expenditure was the result of under-budgeted depreciation expense related to new construction at the hospital and unplanned professional fees related to the Rural Family Medicine Residency Program that were incurred at the end of the year. Sandi said the hospital will take steps to closely monitor the budget to avoid future discrepancies.

6. Hospital Administration-Finance / proposal to procure professional services to review charge master coding and descriptions and conduct pricing comparisons / CFO-Administrator.  HGH trustees unanimously agreed to contract with Independent Healthcare Consultants to conduct a charge master and billing compliance review, and pricing review, for Humboldt General Hospital at a total cost of $20,900 plus billed travel expenses. Typical practice is to have a full charge master review completed every three years; the review has also been recommended by the hospital's current audit firm, Dingus Zarecor & Associates. The last charge master review was completed in late 2015; the last pricing study/review was completed in 2016. HGH Chief Financial Officer Sandi Lehman said a clean charge master will be important as the hospital transitions to the Cerner electronic medical record system this fall, as it is one of the most important building blocks for building the patient accounting and billing components of the project.

7. Hospital Administrator-EMR / proposal to adjust the budget and procure project manager professional services for the conversion to the Cerner EMR system / CFO-Administrator. Board trustees agreed to amend the budget with regard to engaging a project manager for conversion to the Cerner electronic medical record system. HGH Chief Financial Officer Sandi Lehman explained that the project manager will provide guidance and project management services to the hospital to ensure a successful conversion to the new EMR. The current approved amount for this professional service, which was approved at the November 2018 board meeting, is $150,000; however, Cerner has recommended the hospital work with Wipfli, LLP CPAs and Consultants at a proposed cost of $265,000 -- requiring the budget be adjusted by an additional $115,000.

8. Hospital Administration-EMR / proposal to adjust the budget and procure additional electronic equipment to facilitate end user access and use of Cerner EMR system - CFO-Administrator. Hospital trustees approved an addition of $75,000 to the Cerner conversion budget in order to purchase end user devices related to the coming electronic medical record system. Chief Financial Officer Sandi Lehman said that during initial conversations with the Wipfli company about project management services, the hospital discovered that some of its current computers, signature pads and other equipment may need to be upgraded. Those replacements and upgrades were not anticipated or budgeted when the initial Cerner budget was approved in November 2018.

9. District Administration / review and evaluation of the services of B. Leonard Perkinson, MD, as a District FPOB physician / proposals, terms and conditions of the continued employment or separation from employment of B. Leonard Perkinson, MD, as a District FPOB physician, including, but not limited to, termination, suspension, reprimand, mentoring, retention, or "no action," and authorization to execute any document relating to terms and conditions of the continued employment or separation from employment (a closed session may be held to consider character, alleged misconduct, professional competence, and physical or mental health pursuant to NRS 241.030) / Board of Trustees. At the start of this agenda item, Trustee Jennifer Hood recused herself from the discussion and vote; then, HGH trustees moved into closed session to consider the character, alleged misconduct, professional competence, and physical or mental health of HGH FPOB Dr. Len Perkinson, pursuant to NRS 241.030. Following more than two hours of deliberation, board members reopened the session and unanimously agreed that based on job performance only relating to charts, Dr. Perkinson is in default of his contract. The board provided the physician with 30 days notice, and said they will require a plan of improvement to be completed within one week by the CEO and Dr. Perkinson that will clearly outline expectations for the physician. The board will review Dr. Perkinson's progress with regard to that plan in 30 days. Trustees also recommended that during the 30-day period, Dr. Perkinson not see patients to allow sufficient time to complete the plan of action. Data will be collected to determine if there are potential deficiencies that impact the chart completion process. More information about this agenda item is available at https://www.hghospital.org/news/2019/january/humboldt-general-trustees-cite-doctor-for-contra/

Trustee Comments

Trustee Gene Hunt requested that the board agenda a time to discuss recruiting existing Resident Physicians to remain at Humboldt General Hospital following their graduation. CEO Karen Cole told Trustee Hunt that Dr. David Masuck, a current Resident Physician, has expressed interest in staying at HGH following his graduation in June 2020. "We are moving forward with those kinds of discussions," she told the board.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in regular session at 5:30 p.m. Tuesday, February 26, 2019, in the HGH Sarah Winnemucca Conference Room. Meeting agendas, board minutes and more will be/are available at:

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