HGH Board Brief August 27, 2018

Trustees present: JoAnn Casalez, Chairman; Michelle Miller, Secretary; Richard Cook, Bill Hammargren, and Jennifer Hood. Ken Tipton was absent.

Medical Staff Report

Medical Staff By-Laws

HGH Chief of Staff Len Perkinson reported that the medical staff by-laws have been completed and were presented to the entire medical staff for their approval at their last meeting. Dr. Perkinson said the biggest change in the document is the elimination of an "associate" category of medical staff participation; all members are now deemed "active" and have a right to vote. However, medical groups of physicians (such as EmCare or the Rural Physicians Group) will count as a single vote.

Additionally, the by-laws now stipulate that medical staff members must have 70% or greater attendance in the previous year in order to be presented as a potential officer. Dr. Perkinson said this will help qualify more physicians for leadership roles.

Dr. Perkinson said the by-laws are medically sound and place a greater emphasis on patient-centered care. He thanked Dr. Brad Granath, who dedicated the past two years to revising the medical staff by-laws. In comparison, the previous revision of the by-laws required four years to complete. The by-laws will now be reviewed by Humboldt County Hospital District Trustees and Legal Counsel Kent Maher and will be presented at a future meeting for discussion and possible approval.

Following a question from Trustee Michelle Miller, Dr. Perkinson clarified that medical staff has jurisdiction over inpatient care and the Emergency Department; medical staff does not provide oversight to the Rural Health Clinic and the Walk-In Clinic as those are outpatient facilities.

Dr. Perkinson further clarified that the medical staff group is an independent body charged with ensuring that inpatients receive quality medical care; as such, all discussions regarding patient care are privileged and "non-discoverable." In the event of a peer review, medical staff can share the final outcome with trustees without disclosing private patient information.

CEO Art Frable said trustees have responsibility for the hospital institution overall, while Trustee Bill Hammargren acknowledged that, if needed, the board could hire an outside firm to conduct an audit on medical staff practices.

Administration Department Report

QA Report

Quality Services Director Lisa Andre said the hospital has opted not to pursue a relationship with Press Ganey for its inpatient surveys. Instead, the hospital has contracted with J.L. Morgan & Associates, which has promised to provide survey results from 25 inpatients monthly, including actual statements from the patients.

Lisa also said the hospital's federal Critical Access Hospital survey on July 24 was "excellent." Surveyors identified some minor preventive maintenance and medical records issues; additionally, some deficiencies--mostly related to the hospital's recent construction--were noted as part of a Life Safety Survey. A "plan of corrections" was forwarded to the surveyors last week. Overall, Lisa said staff did a great job.

Lisa updated the board on the State of Nevada's efforts to curb opioid use. In May 2015, Nevada implemented the Good Samaritan Drug Overdose Act. That was followed by the January 2018 implementation of Assembly Bill 474, which called for large-scale opioid prescribing changes. Then in May 2018, Nevada instituted overdose reporting requirements. Lisa said the intent behind AB474 is to decrease patients' pain medication use to the point they are no longer using opioids. "However, patients are having difficulty understanding that," she said. Dr. Len Perkinson added that if patients do not wish to reduce their drug intake, "we can't treat them."

Adding to the difficulty is there are a limited number of clinics that provide pain management services, and patients have to be willing to begin a drug-reduction program or the clinics will not provide treatment.

CEO Art Frable said a pain management specialist may be interested in coming to Winnemucca on an intermittent basis. He will provide updated information as it becomes available. Trustee Michelle Miller also said she would provide more information on MTM, a non-emergency transportation program for Medicaid patients.

EMR Selection Update

CEO Art Frable updated the board on the selection process for a new Electronic Medical Record (EMR) system. In 2006, Humboldt General Hospital chose to implement MEDHOST; however, many of the things the company promised did not come to fruition. Now, HGH is looking at athenahealth, which has been on site two times; a third visit to HGH is in the planning. The hospital is also considering Cerner. That company visited with medical staff during its initial visit; a second visit is also planned. The hospital may also consider Medetec, a software system designed for smaller hospitals. Additionally, several staff members will visit other hospitals and company locations to gain hands-on experience with the software.

HGH's contract with MEDHOST has expired and the hospital is paying for services on a month-to-month basis. The hospital will also have to buy out Greenway Health, an auxiliary outpatient clinic software, for $167,000, if it moves away from MEDHOST. CEO Art Frable said he and others are anxious to move forward in the interest of time and money. "We are not going to sit on this longer than we have to."

Trustee Michelle Miller said she is looking for each system to be properly vetted. She said staff "sings the praises of a software system, and six to nine months later, they can't get it implemented." She said she wants to make sure the hospital does a good job moving forward, especially since a new EMR will be a multi-million-dollar investment for the hospital.

Board Vision for Sustainability and CEO Goals

  • Dr. Leon Ravin. CEO Art Frable shared details of Dr. Leon Ravin's visit to Humboldt General Hospital. As the statewide psychiatric medical director, Dr. Ravin is focused on critical health care issues such as access to mental health care, transportation of mental health patients, specialty help for rural physicians, and more. CEO Frable said he appreciated Dr. Ravin's efforts to understand the local mental health care situation better.
  • Hospital Surveys. CEO Art Frable also discussed the hospital's change to J.L. Morgan & Associates for inpatient survey services. Additionally, the hospital has opted to implement its own follow-up phone calls to outpatients in other departments with the goal of increasing survey response rates.
  • Pharmacy Remodel. CEO Art Frable said the committee working on the Pharmacy space remodel is considering the possibility of relocating to another departmental space, as the Pharmacy's current location will not allow for such an invasive remodeling project. CEO Frable said the board can review those recommendations during an upcoming board meeting.
  • Physician Recruitment. CEO Art Frable said the hospital has a lead on a good physician. He asked the board to schedule a special meeting to discuss physician recruitment efforts overall in an effort to ensure all members have the same vision moving forward.
  • Trustee Education. CEO Art Frable said the Nevada Hospital Association asked that he serve as a member of its Board Certification Committee. He said the NHA has a program in place to certify hospital board members. Chairman JoAnn Casalez said board members have always been interested in trustee education; however, accessibility has been a problem. CEO Frable said the new certification process is designed to make training more readily available, and to credit trustees for the education they receive during routine board meetings.

Financial Report

Chief Financial Officer Sandi Lehman presented the financial report for July 2018. The hospital ended the month on a positive note with more than $228,000 to the good. Trustee Jennifer Hood made the motion to approve the financials; Trustee Bill Hammargren was second. The vote was unanimous in the affirmative.

The hospital auditors from Dingus, Zarecor & Associates were onsite the week of August 6. They will present their findings to the board in October.

Business Items-Other Reports

1. Board of Trustees / presentation by Great Basin College (GBC) Foundation and request for District participation in the funding of the proposed Great Basin College Winnemucca Health Science and Technology Building - Great Basin Foundation Director Matt McCarty shared information regarding the proposed Winnemucca Health Science and Technology Building. Great Basin College submitted a grant request to the William N. Pennington Foundation to construct the building at a cost of $7 million. The foundation pledged $5 million toward the building pending GBC's ability to raise an additional $2 million before July 2019.

Matt shared that other private contributors including local mines have indicated they would like to see what the hospital pledges to the project before they pledge any donations as part of their 2019 budgets this September/October. Approximately 80% of the building will be purposed toward health science programs, including nursing, while 20% will be dedicated to an Electrical Systems Technology program that would benefit the mines.

Matt said GBC has raised $300,000 toward its $2 million goal; he asked that the hospital pledge $333,000 annually over the next three years toward the project. Legal Counsel Kent Maher said as a district hospital, the board is charged with carrying out the spirit and intent of the law in establishing and maintaining a hospital district. He said the board's decision regarding appropriate use of funding would be, "How does this go to establish or maintain a hospital in the district?"

Trustees decided to table the item until a special meeting scheduled for 5:30 p.m. Monday, September 10, at which time they will discuss the request more specifically and possibly make a decision. They also requested that the HGH Community Giving Committee, led by Chairman Jennifer Hood, meet with Chief Financial Officer Sandi Lehman to vet the project and make a recommendation to the board regarding funding.

2. Hospital Administration / presentation and request for Humboldt General Hospital Community Giving Committee funding / HGH Giving Committee - HGH Director of Community Education and Development Nicole Maher requested that the Humboldt County District Board of Trustees provide initial funding to the HGH Community Giving Committee in the amount of $50,000.

Nicole said HGH's past donations were decided on a case-by-case basis. Now, the Community Giving Committee will provide a more formal giving structure. She said the committee's giving will be focused on increasing the health, wellness and safety of residents within the Humboldt County community. The $50,000 amount is based on average giving totals from past years, although Nicole said an increased focus on the committee's giving principles may exclude some previously funded groups while including others.

Nicole said the committee has produced a set of administrative guidelines as well as an application to request funding. All requests will be made through the office of Community Education and Development. Any money left over from each year's donation efforts will help establish an eventual endowment that will fund larger community causes.

Trustee Bill Hammargren made the motion to approve the HGH Community Giving Committee's funding request in the amount of $50,000; Trustee Richard Cook was second. The vote was unanimous in the affirmative.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in special session at 5:30 p.m. Monday, September 10, in the HGH Sarah Winnemucca Conference Room. The meeting agenda as well as past meeting agendas and board minutes are available at:


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