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HGH Board Brief July 28, 2020

Trustees present: JoAnn Casalez, Chairman; Michelle Miller, Secretary; Bill Hammargren; Ken Tipton; Gene Hunt; and Alicia Cramer.

Hospital Department Reports

Clinic Update

HGH Practice Administrator Robert Johnson, PA, provided an update on the HGH Clinics. Numbers are up in all clinics; from July 12 to July 25, providers saw 1,669 patients. A supervision policy for mid-level providers has been completed and approved by Medical Staff and processes implemented. Women's Health has provided patient alternatives. OB/GYN Roger Brecheen, Nurse Midwife Merleen Grover, and FP/OB Subha Rajan are all delivering babies. Dr. Vernonica Janhunen and Dr. Rajan are providing children's care, and two new physicians are slated to join the clinic: Dr. David Masuck on August 1, 2020, and Dr. Brittany Smith in September/October 2020.

Infection Control Update

Infection Preventionist Janet Sturtz reviewed the hospital's current visitation guidelines for each department. All visitors to the hospital must be screened for fever, COVID-like symptoms and recent exposure; if a visitor cannot pass the screening, he or she is directed to the HGH Screening Clinic. If a patient who has an appointment does not pass the screening, he or she is referred to the Screening Clinic or Telemedicine. Once enough screeners are hired, the hospital will open the garage entrance. Infection Preventionist Sturtz introduced Trustees to the UV-C disinfectant robot that was approved last month; she said it is a great addition to the hospital's infection control measures.

Cerner Financial Update

Cerner representative Wayne Hass provided a recap on the hospital's charge capture through its new Electronic Health Records system. HGH has seen an increase in revenue over the past several months; July was stronger than June and August appears very optimistic. Wayne said the overall goal is to get cash in the door; all parts of the revenue cycle are being vetted to that end. Board Secretary Michelle Miller expressed her disappointment with the amount of time it has taken Cerner to arrive at this point, as AR days have increased substantially since the conversion. She said she expects Cerners' full accountability. CEO Tim Powers said he will share each week's progress with Secretary Miller; Wayne Hass will also present at the August meeting regarding ongoing progress.

CEO Report: Tim Powers

Rural Residency Director

CEO Tim Powers said Dr. Lacy Fettic, a candidate for the Rural Residency Director position at HGH, came for a site visit; current director Dr. Robert Westling will be retiring at the end of October. CEO Powers said Dr. Fettic is a native of Orovada and is looking to return to the area from Reno, where she works with the University of Nevada Reno School of Medicine. CEO Powers said UNLV's Dr. Elissa Palmer and Dr. Aron Rogers are also excited about the prospect. The hospital will move forward with establishing a contractual relationship with Dr. Fettic.

EMS Director Search

CEO Tim Powers said the hospital conducted site visits with the two candidates for the EMS Director position. Staff also participated in "meet and greets" with the candidates and followed up with staff surveys. CEO Powers said both candidates are highly qualified. He and Interim CEO Karen Cole reviewed the survey results today and are prepared to move forward with one candidate and make an offer tomorrow.

Consent Agenda

Board trustees approved the minutes for the following meetings: June 30, 2020. Additionally, board members approved medical staff applications for appointments, reappointments and privileges for four medical providers.

Financial Reports

CEO Tim Powers presented financial reports for June 2020:

  • Gross Patient Revenue for June was $8.8M compared to budget of $8.2 M and prior YTD of $8.9M. June gross patient revenue was up approximately $5.0M from May. This significant increase reflects the significant bounce back demand for clinical services which has continued into July. June YTD revenue was $97.6M compared to budget of $98.6M and prior YTD Of $92.0M. Despite the erosion of revenue caused by the pandemic team over year gross patient revenue grew 6%.
  • Contractual Allowances and Bad Debt for June were $816K or 7% of gross patient revenue compared to budget of $3.3M, 40% of gross patient revenue, and prior year of $6.7M, or 74% of gross patient revenue. Prior year numbers contained the adjustment for the full year cost report. The low contractual and bad debt percentage for June contains the final true up of our calculations based on the entire year’s performance. June YTD contractual adjustments and bad debt were $47.0M, 48% of gross patient revenue compared to budget of $41.2M, 42% of gross patient revenue, and prior year of $46.7M, or 51% of gross patient revenue.
  • Net Patient Service Revenue for June was $8.1M compared to budget of $4.9M and prior year of $2.6M. This increase was primarily the result of the reduced contractual adjustments for the month. June YTD net patient service revenue was $50.6M compared to budget of $58.0M and prior year of $46.2M. The increase in net patient service revenue year over year was a result of organic revenue growth in the organization.
  • Operating Expenses for June was $5.8M compared to budget of $5.3M and prior year of $5.0M. The spending increase is primarily a result of efforts at the end of the fiscal year to make certain all costs have been properly accounted for to close out the fiscal year. June YTD spending was $62.4M compared to budget of $57.0M and prior year of $51.3M. The increase in spending year over year is primarily a result of increased labor dollars from onboarding additional providers as well as costs related to the Cerner EMR conversion.
  • Net Operating Income/Loss for June was $2.6M compared to a budget loss of $(323K) and prior year loss of $$(2.4M). The income for June was a result of the reduction in contractual allowances and bad debt. June YTD net operating loss was $(11.0M) compared to a budget of $933K and prior year loss of $(5.1M). The increase in the organization’s operating loss was primarily a result of increased spending and higher contractual allowances and bad debt year over year. Non-operating expense for the month of June was $9229K) compared to budget of $61.3K and prior year of $(29.2K). The month included $333K gifting to Great Basin College, the second annual installment of a three year commitment. June YTD non-operating revenue was $6.6M compared to budget of $4.4M and prior year of $7.1M. Net income for June was $2.4M compared to budget of a loss of $(262K) and prior year loss of $(2.4M). Income for the month was a result of significantly lower contractual allowances and bad debt. June YTD loss was $(4.5M) compared to budget of $5.3M and prior year of $2.0M. The combination of increased contractual allowances and bad debt along with increased spending were the primary forces behind the erosion in the organization’s performance in 2020.
  • Days Cash on Hand at the end of June was 208 days. The increase in days cash on hand is a result of approximately $5.4M in various stimulus funds and grants distributed by various federal agencies to deal with the pandemic. Without these funds, days cash on hand would be 172 days.
  • Days Sales Outstanding (DSO) was 101 days.

Business Items-Other Reports

Hospital Administration-Nursing / proposal to purchase five Hillrom Centrella smart beds at an estimated cost of $42,500 / Nursing-Administration - Trustees unanimously approved the purchase of five Hillrom Centrella smart beds at an estimated cost of $42,500.

2. Hospital Administration-EMS / proposal to purchase 50 powered air-purifying respirators (PAPR) at an estimated cost of $65,000 / EMS Director-Administration - Trustees unanimously approved the purchase of 50 Powered Air-Purifying Respirators at an estimated cost of $65,000.

3. Hospital Administration-Respiratory / proposal to purchase two Hillrom EKG machines and associated IT interface and service agreement at an estimated cost of $64,000/ Respiratory Manager-Administration - Trustees unanimously approved the purchase of two Hillrom EKG machines and associated IT interface and service agreement at an estimated cost of $64,000.

4. Hospital Administration-Laboratory / proposal to purchase Atellica immunoglobulin testing instrument and associated IT interface and water supply at an estimated cost of $140,000/ Lab Supervisor-Administration - Trustees unanimously approved the purchase of an Atellica immunoglobulin testing instrument and associated interface and water supply at an estimated cost of $140,000.

5. Hospital Administration/ proposal to purchase six Well Screen kiosks to provide screening services for hospital entrances at an estimated cost of $37,500 / Administration - Trustees unanimously agreed to purchase six Well Screen kiosks to provide screening services at the hospital entrances at an estimated cost of $37,500.

6. Hospital Administration-Accounting / request to authorize attestation to accept Provider Relief Funds of approximately $6.1 million / CFO-Administration - Trustees unanimously agreed to authorize attestation to accept Provider Relief Funds of approximately $6.1 million.

7. Hospital Administration / request to designate eligible COVID-19-related expenses for possible reimbursement from the Cares Act funds received by other local governments / Administration - Trustees unanimously agreed to designate eligible COVID-19-related expenses for possible reimbursement from Cares Act funds received by other local governments.

8. Hospital Administration / proposal to complete kitchen-exhaust upgrade / Administration - Trustees unanimously agreed to table this item.

9. District Administration / terms and conditions of employment agreement with Tim Powers to provide administrator-chief executive officer services / Board of Trustees - Trustees unanimously agreed to approve the terms and conditions of the employment agreement with Tim Powers to provide administrator-chief executive officer services.

Trustee Comments

Trustee Alicia Cramer thanked Shelly Smith for her accounting work in Long Term Care.

Secretary Michelle Miller announced that the "Fork in the Road" food truck will be at HGH from 5 p.m. to 7 p.m. Thursday, August 13, for all staff as a way to say good-bye to Interim CEO Karen Cole. Staff are reminded to follow social distancing rules.

Chairman JoAnn Casalez thanked all HGH staff; she said she is excited to welcome new CEO Tim Powers.

CEO Tim Powers thanked Controller Kim Plummer for staying apprised of the Cares Act funding. He said the funding involves a very complicated process, and Kim has made herself aware of the requirements, successfully overseeing that process on behalf of the hospital.

Chief Operating Officer Tiffany Love petitioned Trustees for authorization to purchase several negative pressure devices that can turn regular patient rooms into COVID patient rooms. Legal Counsel Kent Maher said the request was not on the agenda, but he counseled staff to make the decision regarding their needs and bring the purchase back to the board for ratification.

Interim EMS Director Jordan Kohler thanked the Board for the opportunity to serve in his interim capacity over the past several months.

Shelly Smith thanked Long Term Care Director Robin Gillis and staff members Michel Carden, Jacqueline Dalley, Jennifer Slovernick and Jasmine Ibarra for their help in successfully addressing LTC's accounting issues.

Next Meeting

The Humboldt County Hospital District Board of Trustees will meet next at 5:30 p.m. Tuesday, August 25, in the Sarah Winnemucca Conference Room.

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