HGH EMS Rescue Chief Sean Burke discussed the recent activities of the hospital's Security Work Group. He said the team has consolidated the door lock programs, conducted a physical security inspection, made perimeter security improvements, improved the facility's camera system, reviewed the hospital's security policy, and hosted approximately 70 people for an active shooter training organized by HGH Pharmacist Dave Simsek.
Chief Burke said future efforts will see both an active shooter tabletop exercise in May and a field exercise with local law enforcement in the fall. The team will also continue to oversee security guards and door locks, as well as panic alarm and security lighting upgrades, employee training, and a visitor access policy.
Administration Department Report: CEO
HGH Interim CEO Karen Cole updated the board on physician recruitment efforts.
- 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.
- Roger Brecheen, MD. Roger Brecheen, MD, has extended his agreement with the hospital for 18 months. He will continue to provide OB/GYN services, including minimally invasive gynecological surgeries.
- Sara Thorpe, DO. Sara Thorp, DO, has contracted with Dr. Brecheen to provide Family Practice OB services for one week each month over the next 18 months. Dr. Thorp is interested in coming to the hospital full-time at the end of her 18-month contract with Dr. Brecheen.
- Felipe Gomez, MD. Felipe Gomez, MD, completed an OB/GYN residency in Mexico as well as a Family Practice residency in the United States. He came for a site visit February 23-24 and will be making a decision soon regarding his future employment.
- Shannon Servin-Obert, DO. Shannon Servin-Obert, DO, is seeking a rural hospital/OB position. She may come for a site visit.
- Sheena Dover, MD. Sheena Dover, MD, will complete a Family Practice OB Fellowship in 2020. CEO Cole will speak with her March 1; she may schedule a site visit at the end of March.
- David Masuck, MD. David Masuck, one of HGH's Rural Family Medicine Residency physicians, submitted a letter of intent to work at Humboldt General Hospital following his graduation in June 2020.
- Pediatrician. A pediatrician will be available August 2019. CEO Cole will present that physician's letter of intent at the March meeting of the board.
- Internal Medicine. CEO Cole also shared that she will begin recruiting an Internal Medicine specialist immediately in order to improve patient access to care. She said IM physicians are experts in the diagnosis and treatment of chronic illness, and in health promotion and disease prevention.
CEO Cole also discussed a comprehensive quality assurance/performance improvement program for both the hospital and the medical staff. She said medical staff must perform peer review/professional peer evaluation, as required by statute. This process provides for monitoring the performance of all members of the medical staff. The process includes internal and external reviews, and assists in the initial and re-credentialing of providers.
CEO Cole also discussed a feasibility study for local sleep medicine studies; telepsychiatry; and chronic care management, transitional care and community paramedicine.
HGH Chief Financial Officer Sandi Lehman shared highlights from the November and December financials. November had an operating loss of approximately $900,000, while December saw an operating profit of approximately $31,000.
For January, patient days were under budget month-to-date by 1.39%, and year-to-date by 8.34%. Surgical cases were over budget month-to-date by 16.13% and year-to-date by 11.79%. Rural Health Clinic visits were under budget month-to-date by 9.98% and year-to-date by 17.84%. Operating income for the month was up 256.7% and net income for the month was under budget by 7.84%, at just over $1 million.
Sandi also shared that current days in accounts receivable are 79.4; 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 800 accounts and collected $168,000.
Sandi discussed the Fiscal Year 2020 Budget with trustees. Staff members are currently submitting their budget information; they will meet in budget talks next week. Copies of the draft budget will be distributed to the CEO and board trustees on March 11; the board will hold a budget workshop on March 30; and the board will go over any final revisions to the budget at an April 9 meeting. The FY 2020 Public Budget Hearing will take place on May 28. The final budget must be submitted to the Nevada Department of Taxation by June 1.
Sandi also invited Nick Thate, the Cerner conversion project manager, to update the board. Nick said Cerner's kickoff site visit will take place the week of April 1; the program's scheduled "Go Live" is November 11, 2019.
The board approved the Consent Agenda, including approving the board meeting minutes for January 22, 2019; a proposal to approve a mutual aid agreement to respond to medical emergencies in Malheur County, Oregon; a proposal to purchase an ambulance monitoring system; and a proposal to replace a chiller condenser coil. The voting was unanimous.
Business Items-Other Reports
1. Hospital Administration-Maintenance / proposal to procure services of RF MacDonald to replace-rebuild the unit #2 boiler rear insulated panel and high pressure switch / Maintenance - HGH Maintenance Director Duane Grannis requested $19,985 to replace the unit #2 boiler rear insulated panel and add a high pressure switch. Board trustees unanimously approved the request as presented.
2. Hospital Administration-Maintenance / proposal to enter into agreement with Trane to provide services to review and implement utility rate structure changes with NV Energy to ensure optimal energy savings / Maintenance - HGH Maintenance Director Duane Grannis said that Trane may be able to negotiate a lower rate for the hospital with NV Energy; currently, HGH is at a single rate use 24/7 with no reduction for non-use time. Duane said Trane obtained a significant reduction for the Peppermill Casino in Reno; Trane has promised it can save the hospital at least $45,000 a year. Board trustees unanimously approved the agreement as presented.
3. Hospital Administration / proposal to amend Medical Staff Bylaws / Administration - Interim CEO Karen Cole said the most recent medical staff bylaw revisions were submitted to the board in August; since that time, there has been some consternation with moving forward. She consulted with the same attorney who reviewed the hospital's medical staff bylaws the last time there was a change. He reviewed the current revisions recommended by medical staff and suggested the board move forward in adopting three specific sections of the documents in order to allow all physicians to be more involved as officers. As to the remaining bylaws, CEO Cole suggested that the board schedule a mini retreat where board members, medical staff and hospital administrators can discuss and come to an agreement on their governance roles. CEO Cole will work on a proposed date. Board trustees agreed to pass the proposed revisions to sections 3.01, 3.02 and 3.03 of the HGH medical staff bylaws. The vote was unanimous.
4. Hospital Administration / proposal to implement an obstetrics policy / Administration - Due to recent changes in OB and neonatal providers at Humboldt General Hospital, Interim CEO Karen Cole said the hospital has a particular interest to ensure that there is an OB call schedule. CEO Cole introduced a new policy that says "if you provide OB services here, you will participate in a call schedule." She said this means that if a provider is leaving town, there should be a "good hand off" of that provider's patients, and a sharing of the call overall. She said this is standard practice at other hospitals. She also said call coverage is a very important aspect of recruiting other physicians. Potential candidates are looking for a department that shares call among three or four providers. Board trustees unanimously approved the obstetrics policy as presented.
5. Hospital Administration / proposal to amend the employment agreement with Robert Johnson, PA, to provide clinic director services / Administration - Interim CEO Karen Cole said Robert Johnson, PA, has been working as the Interim Director of Clinic Services for one day each week; he has also worked in the Walk-In Clinic for the other four days each week. Robert has now agreed to accept the position of Director of Clinic Services full-time. The proposed agreement includes a proposed salary commensurate with a clinic administrator. CEO Cole said Robert would like to expand the hours in the Walk-In Clinic. This may entail hiring another full-time clinic provider, which would allow Robert to work part-time in the clinic. Board trustees unanimously approved the amended agreement with Robert Johnson as presented.
6. Hospital Administration / proposal to employ and enter into an employment agreement with David Masuck, M.D. to provide health care services / Administration - Interim CEO Karen Cole said Rural Family Medicine Residency physician David Masuck has signed a letter of intent to provide physician services at HGH following his graduation in June 2020. "He is excited to be able to remain in Winnemucca," said CEO Cole. Board trustees unanimously agreed with the proposal as presented.
Trustee Gene Hunt said the financial statements show that Quail Corner revenues are under budget due to poor utilization. He noted that if the hospital fills those empty beds, it will fix its financial issues at the same time.
Trustee Michelle Miller said she would be willing to help resolve some of admissions issues with Harmony Manor and Quail Corner.
Trustee Jennifer Hood expressed her condolences to the Salla family on the death of their father, Pete.
Trustee Bill Hammargren also expressed his condolences to the Salla family.