HGH Board Brief March 26, 2019

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

Medical Staff-Hospital Department Reports

Suicide Prevention Presentation

HGH Community Education and Development Director Nicole Maher updated the board regarding a strategic public relations plan she developed on behalf of the Humboldt Connection Suicide Prevention (HCSP) group.

Nicole said local residents, agencies and organizations came together several years ago with the goal of pooling community suicide prevention resources. That resulted in the "Zero Suicide Initiative" Summit in March 2017, where agencies and municipal leaders met to create an action plan that would help provide outreach to people contemplating suicide and their family members.

The plan that Nicole presented outlines how the HCSP group will now conduct that initial outreach, including a proposed website, social media channels, informational materials, video vignettes and more. The proposed budget for the first tier of the public relations plan is $15,000, which the group hopes to split between the hospital, the city and the county. Nicole will oversee implementation of the plan on behalf of the HCSP Communication Committee and Humboldt General Hospital.

Administration Department Report: CEO

HGH Interim CEO Karen Cole updated the board on physician recruitment efforts.

  • Sara Thorp, DO. Sara Thorp, DO, has contracted with Dr. Roger Brecheen to provide Family Practice/OB services for one week each month over the next 18 months. Dr. Thorp was at the meeting and was able to greet trustees. "I'm super happy to be here," she said. "The welcome has been very warm."
  • Alex Curtis, MD. Alex Curtis, MD, has signed an agreement with the hospital to provide Family Practice/OB services; his medical license application for Nevada is slated for consideration in June.
  • Veronica Janhunen, MD. Veronica Janhunen, MD, a board-certified Pediatrician, will join the HGH staff in August 2019. She is a former local resident who is excited to be returning to her hometown.
  • David Masuck, MD. David Masuck, one of HGH's Rural Family Medicine Residency physicians, will join the HGH staff as a Family Practice doctor in August 2020, following his graduation from his rural residency specialty.
  • Internal Medicine. CEO Cole also shared that she has begun working with a firm to recruit a an Internal Medicine specialist. Currently three candidates are being vetted.
  • Additional Recruitment. CEO Cole said the hospital is also working through the recruitment process with one Family Practice and two Family Practice/OB candidates.

CEO Cole also discussed the hospital's current review of long-term care policies. She met with Trustee Michelle Miller and HGH Chief Nursing Officer Darlene Bryan March 20 to discuss staffing, admissions and reimbursement. She said the committee is developing an action plan to address any issues.

CEO Cole further discussed a proposed expansion and remodel of the Pharmacy Department. HGH Owner's Rep Mike Sheppard has indicated the project will go out to bid in April; trustees can expect bids by the April board meeting.

CEO Cole said she has discussed the Rural Family Medicine Residency Program with Program Director Elissa Palmer, MD. Dr. Palmer said she is working to add Dr. Roger Brecheen to the local program faculty as an Associate Professor of Clinical Medicine; she also would like to add Dr. Sara Thorp to the local faculty. Additionally, Dr. Elena Zenkin, who heads up the majority of OB training for the Family Practice program at UNLV, is also interested in covering Women's Health services in Winnemucca.

CEO Cole shared upcoming board meeting dates, including a Budget Workshop scheduled for 9 a.m. Saturday, March 30, in the HGH Sarah Winnemucca Conference Room.

Additionally, the board will meet beginning at 5:30 p.m. Friday, May 10, and 9 a.m. Saturday, May 11, for a Board/Medical Staff Mini-Retreat, also in the Sarah Winnemucca Conference Room.

Financial Reports

HGH Chief Financial Officer Sandi Lehman shared highlights from the February financial statements.

Patient days were under budget month-to-date by 9.4%, and year-to-date by 8.4%. Surgical cases were under budget month-to-date by 6.4% and over-budget year-to-date by 9.3%. Emergency Room visits were over budget month-to-date by 0.3% and year-to-date by 1.8%. Rural Health Clinic visits were under budget month-to-date by 18% and year-to-date by 17.9%. Operating losses for the month were better than expected by 33.9%; net income for the month was $419,694 against a budget of $76,628 for a variance of 447.7%. For the year, net income is $2.4 million against a budget of $670,046, for a positive variance of 265.9%.

Sandi also shared that current days in accounts receivable are slightly up compared to last month; the target is to reduce the number of days to less than 70 by September 30, 2019. She discussed the hospital's strategy to reduce those days, including the current 50% discount promotion on all self-pay balances happening now through May 15. To date, the Business Office has resolved over 2,300 accounts and collected over $600,000.

Sandi discussed the Fiscal Year 2020 Budget with trustees. They will meet for a Budget Workshop Saturday, March 30. The board will go over any final revisions to the budget at a special meeting on Tuesday, April 9. The FY 2020 Public Budget Hearing will take place on Tuesday, May 28. The final budget must be submitted to the Nevada Department of Taxation by Saturday, June 1.

Consent Agenda

The board approved the Consent Agenda, including the board meeting minutes for February 26, 2019, and March 4, 2019; and medical staff appointments, reappointments, provisional and temporary privileges for eight care providers.

Business Items-Other Reports

1. Hospital Administration-EMS / proposal to procure security services for hospital, outbuildings and grounds / EMS Director - This item was tabled until the April board meeting.

2. Hospital Administration-Respiratory / proposal to purchase arterial blood gas analyzer: rapid point 500 / Respiratory Director - HGH Respiratory Manager Dan Clack explained that a blood gas analyzer is able to determine the amount of various gases, like oxygen or carbon dioxide, in a patient's blood. Respiratory's current machine is seven years old and is costing approximately $2,300 per year in maintenance. Dan said as it gets older, it is experiencing more and more problems. Trustees unanimously approved a new arterial blood gas analyzer at a cost of $10,803.

3. Hospital Administration-Pharmacy / proposal to add an additional pharmacist position / Administration-Pharmacy Director - HGH Pharmacy Director Dave Simsek said he and Pharmacist Robert Hall provide 24/7 coverage; however, due to patient volumes and pharmacy workload, they log a great deal of overtime. Dave said CEO Karen Cole helped break down the numbers to show that Pharmacy can justify hiring a third pharmacist, who can be paid using the current overtime wages. Dave thanked CEO Cole for "caring about pharmacy" and seeing a problem and trying to help fix it. Board trustees unanimously agreed to the new pharmacy position.

4. Hospital Administration / proposal to add a nurse practitioner position / Administration - HGH Practice Administrator Robert Johnson, PA, asked hospital trustees to consider adding a nurse practitioner or physician assistant to the Rural Health Clinic staff. Robert said the new person could provide coverage in the Walk-In Clinic so Robert can have time for administrative duties within the clinics. Robert said a second provider could also help HGH expand Walk-In Clinic hours to open earlier, stay open later and perhaps even be open on Saturdays and/or Sundays. Robert said the new person will need to have experience in Urgent Care or Family Practice and be willing to work long hours. "It's just a matter of finding the right person who wants to be in our community," he said. Trustees unanimously approved the new position.

5. Hospital Administration / proposal to add a midwife position / Administration - HGH Practice Administrator Robert Johnson, PA, also requested the board approve a midwife position in order to help create and staff a women's health center in the Rural Health Clinic. The new midwife could see routine OB patients in clinic and perform normal vaginal deliveries, while Dr. Roger Brecheen could see high-risk OB patients and perform high-risk deliveries. This would also free up Dr. Brecheen to be in the OR, where he is an expert at minimally invasive gynecological surgeries. Robert said the growing women's health team, including Dr. Brecheen, Dr. Sara Thorp, and the new midwife, would allow Winnemucca to provide services well ahead of Reno. CEO Karen Cole said Dr. Brecheen has a candidate in mind; that person will contract with Dr. Brecheen. Dr. Brecheen's contract, in turn, will be amended to compensate for the new staff member. Board members unanimously agree to the new position.

David Masuck, MD

6. Hospital Administration / proposal to employ and enter into an employment agreement with David Masuck, M.D. to provide family practice physician health care services / Administration - HGH Trustees approved an employment agreement with Rural Family Medicine Residency physician David Masuck to begin providing physician services at HGH following his graduation in June 2020.

7. Hospital Administration / proposal to employ and enter into an employment agreement with Veronica Janhunen, MD, to provide pediatrician health care services / Administration - HGH Trustees also unanimously approved an employment agreement with Veronica Janhunen, MD, a board-certified Pediatrician, beginning in August 2019.

8. Hospital Administration / proposals for use and occupancy of medical office space / Administration - CEO Karen Cole advised trustees that she and HGH Practice Administrator Robert Johnson, PA, will begin reviewing medical space usage within the hospital. "We want to make sure we are making the best use of our space," she said, noting that certain specialties work better together. She and Robert will be reviewing the Family Practice/OB providers in particular ensure use of the Rural Health Clinic space is efficient and appropriate for patients, providers and staff. Trustee Bill Hammargren said, "I'm a huge proponent of taking this hospital to the next level," noting that it is time to take a fresh look at the hospital's current use of space. Secretary Michelle Miller agreed, stating that with a new Pediatrician coming on board as well as a potential Internal Medicine specialist, "We need to make sure the flow is good. We should evaluate that to make sure we are being as efficient as possible."

Trustee Comments

Secretary Michelle Miller thanked CEO Karen Cole for helping Humboldt General Hospital to progress using a proactive approach. Karen thanked Secretary Miller and said she appreciated the support of board members.

Trustee Gene Hunt thanked HGH Community Education and Development Director Nicole Maher for her presentation regarding a public relations plan for the Humboldt Connection Suicide Prevention group. He said he would like to share some ideas with Nicole following the meeting.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next for a Budget Workshop at 9 a.m. Saturday, March 30, in the HGH Sarah Winnemucca Conference Room. The board will go over any final revisions to the budget at a second special meeting beginning at 5:30 p.m. Tuesday, April 9, also in the Sarah Winnemucca Conference Room.

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

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