HGH Board Brief September 25, 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 reported that the medical staff by-laws are ready for review by the Humboldt County Hospital District Board of Trustees. Later in the meeting, trustees confirmed that review will take place at the Tuesday, October 30, meeting of the board.

EMS Department Report

HGH EMS Rescue Chief Sean Burke reported that his agency was very successful at providing emergency transport services at this year's Burning Man festival over the Labor Day weekend. He said crews learned a lot of lessons while facing the normal challenges that come with taking part in such a monumental gathering. The group will be even more prepared for next year's event.

The Burning Man operation shut down for about 8 hours last month due to hot and dusty conditions on the playa.

Quality Assurance Report

HGH Quality and Risk Management Director Lisa Andre reviewed highlights from this month's Clinical Dashboard, including 98% compliance with handwashing protocols during a July 2018 surveillance. Benchmark for handwashing surveillance is 90%.

Lisa reminded the board that the hospital has contracted with J.L. Morgan & Associates to provide inpatient surveys. The hospital's relationship with Press Ganey, which currently provides outpatient surveys, will end in December 2018.

The hospital's Critical Access Hospital Annual Review will take place in October. Lisa invited the board to attend; last year Chairman JoAnn Casalez and Trustee Ken Tipton took part. Later in the meeting, the board scheduled the CAH Annual Review for 2 p.m. Friday, October 26.

David Darby

As part of the board's monthly opioid education, Lisa Andre and Dr. Len Perkinson invited a guest to the meeting. David Darby has been Dr. Perkinson's patient for 5-1/2 years and the two agreed they have great reason to celebrate David's success. David said when he first met Dr. Perkinson, he was a "mess." He was taking high doses of opioid medication for chronic pain; if he couldn't access enough medication to curb the pain, he would use alcohol as a pain suppressant. "But Dr. Perkinson actually listened to me," he told the group. "He didn't wash his hands and send me away; he gave me hope that I would end up somewhere [good]."

David said Dr. Perkinson concentrated on helping to restore David to good health; he also helped David understand that he would have to visit a pain specialist monthly, and those visits would be aimed at decreasing his opioid use, not maintaining it. David agreed and today he has gone from 250 mg. doses to 50 mg. doses. David said he expects to eventually quit taking opioids altogether. Plus, as an amazing byproduct of his decreased drug use, he has lost almost 60 pounds!

David said he had tried everything to quit before coming to HGH. Dr. Perkinson agreed the two have both been blessed by their collaboration. "[David] truly is one of the success stories of what can happen with true and proper pain management," said Dr. Perkinson. "This is why it's so important that we, as a medical community, not just wash our hands of the problem."

Further, Dr. Perkinson said if it had not been for the new AB474 law, which aims to help decrease patients' dependence on opioid medications, David would not have experienced the success he did. Dr. Perkinson added he hopes the hospital can continue to try to recruit a pain management specialist to Winnemucca to create more "success stories" like this.

EMR Selection Update

CEO Art Frable updated the board on the selection process for a new Electronic Medical Record (EMR) system. He reminded the board that regardless of which system the hospital eventually chooses, its success will depend on users' willingness to learn the new software. CEO Frable reminded the board that the servers hosting the hospital's current system, MEDHOST, are nearing the end of their lives. The hospital will need to replace those, at a cost of $458,000, if trustees do not purchase a new system; additionally, HGH's contract with MEDHOST has expired and the hospital is paying for services on a month-to-month basis.

Mr. Frable said the most important consideration is achieving an integrated system that can handle all departmental functions. "What we're after is one system--one database--so that wherever you are in the hospital, you can get the information you need," he said. So far the hospital has looked at two systems in-depth: athenahealth and Cerner. HGH staff members have visited both company sites; additionally, both companies have been on-site at HGH to provide demonstrations to the larger body of staff.

Humboldt General will also review Medetec, another software company, in the coming weeks. CEO Frable noted that HGH has also been invited to join Epic, as part of Renown Health; however, that system is actually designed for much larger hospitals. Additionally, being tied to Renown would limit HGH's independence.

Mr. Frable said the hospital plans to facilitate more hands-on experiences for staff members with the various systems in October; he hopes to bring a recommendation back to the board in November.

Trustee Michelle Miller said she is looking for each system to be properly vetted. She said she has signed her name to three software systems during her time as a trustee. She said this time she would like to hear from the staff that will actually be using the software before she makes a decision. She also asked that the companies provide a list of clients that HGH can call for references.

Board Chairman JoAnn Casalez invited HGH Materials Management Manager Theresa Bell to share her recent experiences reviewing the athenahealth and Cerner systems. Theresa said following demos from both companies, Cerner offered the very things that would make her job easier. "It is fully integrated," she said.

Mr. Frable said athenahealth has built its system on "best practices" and the company is building as it goes. Chairman Casalez said she does not want to be part of a system that is "learning." Mr. Frable said the hospital is also looking at athenahealth because it has a funding mechanism that would be significantly less expensive than other companies.

Trustee Richard Cook questioned the previous decision to purchase MEDHOST now that the system no longer seems viable. HGH IT Director Mike Bell said 10 years ago, MEDHOST was the "hot ticket" for a hospital Humboldt General Hospital's size. Now, Mike said MEDHOST no longer meets HGH's needs.

Board Vision for Sustainability and CEO Goals

  • Physician Recruitment. CEO Art Frable said the hospital has hired a firm to specifically recruit for a Family Practice/OB physician. The group also has suggested it could provide locum tenens OB coverage of the HGH Mother and Baby Unit by January, when Dr. Brad Granath said he will no longer provide OB call at night.
  • Physician Access. CEO Art Frable said he is working with Dr. Robert Westling and the Family Medicine Residency physicians to provide more physician coverage in the HGH Walk-In Clinic. He said physician access is the most frequent complaint he receives.
  • Occupational Therapist. CEO Art Frable said the hospital has hired an occupational therapist to work on-site with Harmony Manor and Quail Corner residents. That person will begin in November on a 32-hour/week schedule.
  • Emergency Department Contract. CEO Art Frable said he plans to give the hospital's current ER physician provider, EmCare, notice by January 2019 that the hospital may not renew its contract. He said he received a phone call from UnitedHealthcare, an insurance provider, that they will no longer be a provider for EmCare as of the end of this year. Mr. Frable said he has spoken to two other ER physician providers and is supplying them with information about HGH's ED operation; once they review that information, they will decide if they would like to consider submitting a proposal. Trustee Bill Harmmargren said he feels EmCare has been unresponsive to the hospital's requests for information. He said of the ED provider candidates: "What I want to know is how they're going to deliver medicine here and how they're going to report to the board." Chairman JoAnn Casalez asked that Mr. Frable provide the board with an update on the ED contract process at its next meeting.
  • Harmony Manor/Quail Corner Staffing. Chairman JoAnn Casalez asked for an update on staffing at Harmony Manor/Quail Corner. HGH Chief Nursing Officer Darlene Bryan said staffing is at or near acceptable levels. The facilities currently have 6-8 potential admits.
  • Patient Transport. Trustee Michelle Miller asked about MTM Inc., Nevada's non-emergency transportation manager, which arranges rides to healthcare provider appointments for eligible Medicaid members. She said the transportation service could help opioid patients access pain management specialists out of area. "It could be one more option for them," she said.

Consent Agenda

The board approved the Consent Agenda, including approving the board meeting minutes for August 27, 2018, as well as this month's medical staff applications. Trustee Bill Hammargren made the motion to approve the Consent Agenda; Trustee Michelle Miller was second. Trustees Casalez, Miller, Cook, Hammargren and Hood voted aye; Trustee Tipton abstained as he was absent from the August 27, 2018, meeting.

Financial Reports

Chief Financial Officer Sandi Lehman presented the financial report for August 2018. The hospital's revenues were down by almost $1 million due to low patients volumes throughout the hospital. Additionally, total operating expenses were up slightly due to some depreciation expense. HGH ended the month about $1.4 million under budget; after adding in non-operating revenues such as taxes and interest, the hospital ended at about $485,000 under budget. Trustee Jennifer Hood made the motion to approve the financials and utilization reports; Trustee Bill Hammargren was second. The vote was unanimous in the affirmative.

The hospital audit from Dingus, Zarecor & Associates is nearing completion. The auditors will present their findings to the board during a special meeting on Tuesday, November 6.

Business Items-Other Reports

1. Board of Trustees / Great Basin College (GBC) Foundation request for Humboldt County Hospital District (HCHD) participation in the funding of the proposed GBC Winnemucca Health Sciences Building project / terms and conditions of HCHD funding for GBC Winnemucca Health Sciences Building project / Board Chairman - The hospital board previously discussed a funding request from Great Basin College at its September 10, 2018, meeting. Great Basin College submitted a grant request to the William N. Pennington Foundation to construct a Health Sciences and Technology Building on the Winnemucca campus 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. Great Basin College asked Humboldt General Hospital to contribute $1 million toward the project.

Chairman JoAnn Casalez asked each board trustee to share his or her thoughts concerning the proposed donation:

  • Ken Tipton. Trustee Tipton said under normal circumstances he would not be in favor of donating to such a project; however, the Pennington Foundation grant makes the building a "good buy" for the community. He said it provides a chance for local people to earn degrees; it will also benefit Humboldt General Hospital to have nursing graduates each year--even if those grads do not initially practice at HGH. In considering the hospital's sales, property and net proceeds of mines taxes, Trustee Tipton said he believed HGH could afford to give $1 million to the project over three years, which represents approximately 20% of the net proceeds of mines taxes the hospital is projected to receive during that period.
  • Richard Cook. Trustee Cook said it is not possible to put too much money in education. He said the addition of the building and the expansion of its programs would allow HGH to pick the "best of the best" from among nursing and other graduates. He added the project will increase the sophistication of the entire community.
  • Michelle Miller. Trustee Miller said the building represents a great educational opportunity for the community. However, she said the hospital has been in a negative revenue cycle. Additionally, HGH is looking at a new electronic medical records system that could cost $7 million; a pharmacy remodel is also in the plans. She said she believes the hospital must take care of its staff first. She said she would be willing to match GBC's donation of $100,000.
  • Jennifer Hood. Trustee Hood said she has spent several sleepless nights contemplating the project. She said she keeps remembering herself as a 35-year-old single mother with two young daughters. She said her community college gave her hope and an education that allowed her to become who she is today. She said Great Basin College can create that same hope for local residents today. "It elevates all of us when we educate any of us," she said.
  • Bill Hammargren. Trustee Hammargren said the community helps support Humboldt General Hospital with its tax monies and those funds have been dedicated to building up the hospital plant over the past 12 years. He said the hospital has done so well it even placed $10 million in an investment account. He said he believes the hospital can support the project.
  • JoAnn Casalez. Chairman Casalez said the building is a great opportunity for the community. She said it opens doors for many opportunities, many of which are not apparent at this time, including partnering with medical schools and others to recruit doctors to the area. She said if the hospital constantly focuses on negatives or losses, it is not going to more forward. She said she would like to see more homegrown healthcare professionals. "The only way to do that is to start at this level."

Trustee Ken Tipton moved to donate $1 million divided over three consecutive years to Great Basin College, contingent on the college being awarded the proposed $5 million grant by the Pennington Foundation; Trustee Bill Hammargren was second. Trustees Casalez, Cook, Hammargren, Hood and Tipton voted aye; Trustee Miller voted nay.

2. Hospital Administration-Pharmacy / proposal for expansion of the hospital pharmacy / projected cost of expansion / Administrator-Pharmacy Manager - CEO Art Frable updated board trustees on a proposed remodel of the hospital's current Physical Therapy Department into a new Pharmacy Department. In addition to providing the pharmacy with proper space and functionality, the remodel of the pharmacy space for physical therapy would also be a good fit. Further, the remodel project would ensure the pharmacy would only have to be re-licensed once, just prior to the Pharmacy Department's change of location. Trustee Michelle Miller said the project is also necessary to provide staff members with adequate work facilities, as the current pharmacy space is very small.

Trustee Bill Hammargren made a motion to authorize HGH Administration to contract with CTA Architects for drawings and a bid for the pharmacy remodel project; Trustee Michelle Miller was second. The vote was unanimous in the affirmative.

3. Hospital Administration-IT / proposal to purchase hardware, software and training for a Citrix virtual network for IT / Administrator-IT Manager - HGH IT Director Mike Bell shared a proposal to purchase a Citrix desktop system that would allow him to distribute images or software across all hospital computers through one server. Mike said the system would greatly improve the hospital's computer security and maintenance. The total cost of the project ($101,597) would be spread out over three years; by the fourth year, the hospital's cost would only be $5,403. Mike said a donation of used servers from Renown Health last year will also aid the project. Mike also said the Citrix system will work with any software, regardless of which electronic medical record system the hospital chooses in the future.

Trustee Michelle Miller made a motion to purchase a Citrix virtual network in the amount of $101,597.88 as presented; Trustee Bill Hammargren was second. The motion carried unanimously.

4. Hospital Administration-Finance / determination that certain items of operating room equipment are no longer required for public use and authorization for staff to dispose of the equipment in any reasonable manner / Administrator-CFO - HGH Chief Financial Officer Sandi Lehman presented a list of items that are no longer required for public use, and have been fully depreciated. She asked for the board's permission to remove the items from the hospital's equipment list.

Trustee Bill Hammargren made a motion to determine the items are no longer needed and to authorize staff to dispose of them; Trustee Jennifer Hood was second. The motion carried unanimously.

5. Hospital Administration-Medical Staff / request to schedule a date certain for completion of Board review of proposed medical staff bylaws/ Administrator - CEO Art Frable asked trustees to schedule a time when they could review the medical staff by-laws during an education-type session. Trustee Bill Hammargren said he would like to make sure HGH Legal Counsel Kent Maher has reviewed the bylaws prior to the scheduled review. Mr. Maher said he already reviewed the bylaws. Per Nevada law, the board of trustees has final authority to change and/or approve medical staff by-laws. The board will review the bylaws at its Tuesday, October 30, meeting.

6. Hospital Administration / determination of possible dates to schedule the annual Critical Access Hospital review / Administrator-Board - Chairman JoAnn Casalez and Trustee Ken Tipton agreed to represent the board at the 2018 Critical Access Hospital Annual Review meeting. The board scheduled the meeting for 2 p.m. Friday, October 26, 2018.

7. Board of Trustees / proposal to change the date of the October regular Board meeting / Board - The board agreed to change their regular October meeting from the fourth Tuesday to the fifth Tuesday: October 30, 2018.

Additionally, the board agreed to meet in special session on Tuesday, November 6, 2018, to review the auditor's report and the September financial and utilization reports. The board's regular November meeting will be held on Tuesday, November 27.

Trustee Comments

Trustee Jennifer Hood shared that nine adults have committed suicide in Humboldt County over the past two months. Nine agencies recently met with Sixth Judicial District Court Judge Michael Montero to discuss intervention efforts, including a possible direct mail flyer that addresses suicide warning signs. Trustee Hood said she believes HGH must lead out in suicide-prevention efforts. Possible future efforts may include a community suicide forum at the hospital; a guest presentation by Misty VonAllen, the State of Nevada's suicide coordinator; and more. Chairman JoAnn Casalez said a suicide-related discussion could be added to the agenda; Trustee Hood will advise Administration.

Public Comment

Humboldt County Commission Vice Chairman Jim French, who also serves on the Indigent Accident Fund Board, shared changes that have been made at the IAF. The IAF reimburses counties for the costs to treat indigent accident victims within their communities. To date, it has been very difficult to access those monies; most have gone to University Medical Center in Las Vegas. However, Commissioner French said the board's criteria for funding consideration has now changed. Additionally, the application process is simpler, with an extended deadline for the current quarter through November. Also, trained staff are now available to help applicants through the application process.

Great Basin College Director Lisa Campbell shared her gratitude to trustees for the hospital's donation of $1 million to the proposed GBC Health Sciences and Technology Building. She expressed her desire for continued collaboration between the two entities and promised to keep the board updated on the college's progress toward completing the project.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next at 5:30 p.m. Tuesday, October 30, 2018, in the HGH Sarah Winnemucca Conference Room. The meeting agenda as well as past meeting agendas and board minutes will be/are available at:


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