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HGH Board Brief November 27, 2018

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

Medical Staff-Hospital Department Reports

Medical Staff Report

HGH Chief of Staff Len Perkinson said Medical Staff has initiated its peer review process again. This ongoing process is designed to assess each practitioner's clinical competence and professional behavior. Additionally, Dr. Perkinson said Medical Staff is anxiously awaiting approval of its by-laws by the hospital board.

EMS Department Report

Photos from the 2018 EMS Refresher hosted by HGH EMS Rescue

Chief Sean Burke updated the board on HGH EMS Rescue's activities over the past month. Chief Burke said November included many community outreach activities such as the annual EMS Refresher for 77 EMR, EMT and AEMT professionals across northern Nevada. Additionally, the agency hosted a Paramedic Refresher, mostly for in-house staff, as well as a new Critical Care Paramedic Refresher.

HGH AirOne has been conducting Remote LZ Familiarization exercises

Chief Burke said HGH AirOne crews have been conducting Remote Landing Zone Familiarization exercises with first responders across Eureka, Lander and Pershing counties, to help HGH's air ambulance pilots and crews become more familiar with remote landing locations.

HGH EMS Rescue Education Coordinator Dylan Angus with the University of Utah Burn Center Team

HGH EMS Rescue Education Coordinator Dylan Angus also coordinated a training with the University of Utah Burn Center team, who flew to Winnemucca in mid-November to teach Advanced Burn Life Support to HGH and HGH EMS Rescue staff members. Chief Burke said the training was very well received.

In other news regarding mental health, Chief Burke said overdose issues are trending upward, while mental health transfers remain steady at about five trips per month to the Reno area.

Quality Assurance Report

HGH Quality Services Director Lisa Andre shared the following highlights from October's "Clinical Dashboard":

  • Median time to ECG - 2 minutes as compared to 8 minutes for the previous quarter; benchmark is 8 minutes.
  • Influenza immunization for patients - 95% as compared to 94% for the previous quarter; benchmark is 90%.
  • Median time from arrival to discharge for ED patients - 106 minutes as compared to 134 minutes for the previous quarter; benchmark is 108 minutes.
  • Physician compliance with opioid prescribing requirements in ED - 95% as compared to 97% for the previous quarter; benchmark is 92%.
  • ED physician response time - 95% as compared to 92% for the previous quarter; benchmark is 92%.
  • Inpatient satisfaction - 85% as compared to 64% for the previous quarter; benchmark is 73%.

Lisa also shared that she was able to meet with the Nevada Rural Hospital Partners Risk Manager Work Group last month. That group began in 2003 as an ongoing way to help rural hospitals stay current on pertinent issues. Lisa said the group has been working on updating a visitors policy for area hospitals to counteract potential actions by a "First Amendment" group which has been known to videotape "public" hospital areas, compromising patient privacy. Lisa said the work group discussed signage that will clearly define hospital policy with regard to visitors. "If you want to be here, you must have a reason," said Lisa of visitors to HGH.

Lisa also responded to a question from Trustee Michelle Miller regarding the percentage of inpatients who take part in the hospital's survey process. Lisa said those figures will be provided by J. L. Morgan, the hospital's surveyor, at the end of the calendar year as part of an "overview picture" that will include information on how many patients qualified to survey and how many were actually surveyed. Lisa said Critical Access Hospitals like HGH are not required to survey patients; larger hospitals, on the other hand, could lose 30% of their revenues based on poor survey results. However, Lisa said HGH wants to participate in the survey process in order to assess its quality of care and how it might improve.

Board Vision for Sustainability and CEO Goals

HGH CEO Arthur Frable shared the following information with board members:

  • Orthopedic Contract. Mr. Frable has been in discussions with Dr. John Campbell, the CEO of Synergy, Surgicalists, Inc., to re-structure the contract for in-house orthopedic services. Mr. Frable said Dr. Campbell has suggested areas for increased reimbursement for the hospital.
  • Emergency Department Contract. Mr. Frable has received a proposal from Medicus, a potential Emergency Department provider; that group has scheduled a visit in December. He has also asked for a proposal from Northern Nevada Emergency Physicians, an all-board certified group. He has yet to hear from a group named TeamHealth. Mr. Frable said Northern Nevada Medical Center is also looking for an ED provider; HGH may be able to "piggyback" with NNMC.
  • Reduced-Cost Labs. The hospital's first "Healthy You Fridays" reduced-cost blood screening event was held Friday, November 16. In all, five women and two men took advantage of the $98 blood panels. The hospital will continue to offer the same discounted panels on the first and third Fridays of each month.
  • Resident Physicians Contract. Humboldt General his still waiting for a contract from the University of Nevada Las Vegas School of Medicine, which will allow HGH's Resident Physicians to staff another medical clinic at the hospital.
  • Pain Management Clinic. Andrew Wesley, MD, a pain management specialist from Reno, may begin coming to Winnemucca for two days each month starting in January.
  • FP/OB Services. Sara Thorp, MD, a family practice OB physician, may be interested in practicing part-time at HGH. She will make a site visit on Friday.
  • Dr. Andrew Conlu. Dr. Andrew Conlu, one of HGH's hospitalist physicians, has been named the top Internal Medicine Physician for Nevada for 2018.
  • Mandate to Post Charges. Starting January 1, the Centers for Medicare and Medicaid Services will require hospitals to post their charges on the internet. HGH has over 50,000 charges in its master charge table, so those will be posted in order to comply. However, the hospital hopes to improve the user-friendliness of that information in the future.

Financial Report

HGH Chief Financial Officer Sandi Lehman shared highlights from the September and October financials. September's operating revenues fell below budget projections by 8%, although total operating expenses were under budget by 2%, for a change in net assets of $276,208 fiscal year-to-date (a variance from budget of -7%).

For October, operating revenues were up 3% while expenses were under budget by 4% for a modest gain of $13,700. This resulted in a change in net assets fiscal year-to-date of just under $1.2 million, as compared to budgeted earnings of $396,312. The board unanimously approved the financials as presented.

Consent Agenda

The board approved the Consent Agenda, including approving the board meeting minutes for October 30, 2018, as well as this month's medical staff applications. The voting was unanimous.

Business Items-Other Reports

1. Hospital Administration / Hospital District fiscal year 2017-2018 financial audit and budget report / Administrator-CFO-Dingus Zarecor & Associates - Shaun Johnson, a CPA and partner with Dingus Zarecor & Associates, presented a financial audit and budget report for Humboldt General Hospital for the year ended June 30, 2018. Mr. Johnson reported that the financial statements that were presented to his company present fairly, in all material respects, the financial position of the hospital as of June 30, 2018, including any changes in the hospital's financial position and its cash flows. In addition to detailing the auditing process, Mr. Johnson also shared financial indicators for the hospital, and made recommendations for increased security measures in the year in the come. Board trustees unanimously approved the audit and cost report as presented.

Trustee Michelle Miller is flanked by Cerner's Andy Fisher (at left) and Greg Gillis at right. Trustee Miller was instrumental in helping vet the Cerner electronic medical records system prior to the board's approval Tuesday.

2. Hospital Administration / licenses, solutions, hardware, services and terms and conditions of proposal from Cerner Corporation for an electronic medical records system / Administrator - Board trustees unanimously approved entering into an agreement with Cerner Corporation for an electronic medical records system. The agreement is subject to attorney review of the contract. Staff members shared their selection process with the board, which included site visits, reference phone calls, and on-site demonstrations. The system will cost approximately $8.5 million over the course of 10 years and will streamline all departments an all patients into one system.

3. Hospital Administration / report and guidelines for charitable giving efforts through the HGH Community Giving Committee and HGH / Committee - This item was tabled.

Trustee Comments

Trustee Michelle Miller thanked the HGH staff members who participated in the Cerner electronic medical records selection process.

Board Chairman JoAnn Casalez also thanked staff for their participation in the EMR selection process. She said, "It matters to us that the people with boots on the ground are involved."

Trustee Bill Hammargren thanked Trustee Michelle Miller for her involvement in the EMR selection process.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next in special session at 5:30 p.m. Wednesday, November 28, 2018, in the HGH Sarah Winnemucca Conference Room. Meeting agendas, board minutes and more will be/are available at:

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