Minutes. Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 April 23, :00 p.m.

Transcription

1 Minutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 April 23, :00 p.m. Present: Mary A. Harden, R.N., Chairman, District 1 Mark Dewane, Vice Chairman, District 2 Susan Gerard, Director, District 3 arrived at 1:03 p.m. Elbert Bicknell, Director, District 4 Terence McMahon, Director, District 5 Others Present: Steve Purves, MIHS, President & Chief Executive Officer Bill Vanaskie, MIHS, Chief Operating Officer Michael Ayres, MIHS, Chief Financial Officer Robert E. Fromm, Jr., M.D., M.P.H., MIHS, Chief Medical Officer Michael Peck, M.D., MIHS, Chief of Staff Louis B. Gorman, MIHS, District Counsel Sherry Stotler, MIHS, Chief Nursing Officer Guest Presenters: Casey Nolan, Navigant Consulting, Consultant Fred Campobasso, Navigant Consulting, Consultant Laurie Wood, MIHS, Vice President Ambulatory and Physician Services Marshall Jones, MIHS, Vice President of Human Resources Wilma Acosta, MIHS, Interim Chief Compliance Officer Michael Fronske, MIHS, Legislative and Governmental Affairs Director Recorded by: Melanie Talbot, MIHS, Executive Director of Board Operations Cynthia Cornejo, MIHS, Assistant Clerk of the Board Call to Order Chairman Harden called the meeting to order at 1:00 p.m. Roll Call Ms. Cornejo called roll. Following roll call, it was noted that four of the five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represents a quorum. Director Gerard arrived shortly after roll call. Pledge of Allegiance The Pledge of Allegiance was led by staff from the Behavioral Health department. Call to the Public Chairman Harden called for public comment. There were no comments from the public.

2 General Session, Presentation, Discussion and Action: 1. Department Spotlight Chairman Harden asked the representatives from the featured department, Behavioral Health, to introduce themselves, describe what they do and how long they have been at Maricopa Integrated Health System (MIHS). o o o Tammy Schoch, RN is a Clinical Research Leader on Unit 9 in the Behavioral Health Annex, has worked for MIHS for four years. Katie Walsh, RN is a nurse in the Behavioral Health Float Pool and has worked for MIHS for seven years. Diana Jarrell, is a social worker and has worked for MIHS for over 30 years. Chairman Harden also recognized Mr. Gene Cavallo, Vice President of Behavioral Health, and Laura Smith, Psych Care Management and Admissions Manager. She thanked the staff for their time and dedication to MIHS. 2. Approval of Consent Agenda: a. Minutes: Approve Special Health Care District Board of Directors Meeting Minutes dated: i. March 3, 2014 ii. March 4, 2014 iii March 26, 2014 b. Contracts: i. Approve Amendment #5 to the Software License Agreement (C ) with Halogen Software Inc. to assist Human Resources (HR) for employee s performance evaluations and related merit increases decisions. ii. iii. Approve four new Cooperative Purchasing Alliance agreements between MIHS and Mohave Educational Services Cooperative ( ), National Joint Powers Alliance ( ), The Cooperative Purchasing Network ( ) and National Cooperative Purchasing Alliance ( ). Authorize, and instruct the Director, Procurement & Contracts to execute hard copy membership agreements or submit online applications to the respective Cooperative Purchasing Alliance. Approve a new agreement ( ) with CareMark for pharmacy benefit administration for Maricopa Integrated Health System patients covered by MercyCare or MMIC c. Board Governance: i. Approve registration fee, commercial travel, lodging, meal & incidentals per diem, and Board per diem/stipend, not to exceed rates allowable under applicable District practices or policies, for Director Gerard to attend The American Hospital Association s Annual Membership Meeting, May 4 7, 2014 in Washington D.C. 2

3 2. Approval of Consent Agenda (cont.): c. Board Governance (cont.): ii. iii. iv. Approve registration fee, commercial travel, lodging, meal & incidentals per diem, and Board per diem/stipend, not to exceed rates allowable under applicable District practices or policies, for Director McMahon to attend The Western Regional Trustee Symposium s 18 th Annual Meeting, June 11 13, 2014 in Henderson, Nevada Approve registration fee for Chairman Harden and Director McMahon to attend The 2014 Arizona Verde Xchange Conference May 1, 2014 in Phoenix, Arizona Approve Mercy Maricopa Integrated Care, Consent in Lieu of Meeting regarding Appointment of Peer and Provider Directors and Bylaw Amendment v. Approve Revisions to the Maricopa County Special Health Care District Procurement Code vi. Approve Revisions to the Maricopa Integrated Health System Authorization and Responsibility Matrix d. Medical Staff: i. Approve MIHS Medical Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, and Resignations for April 2014 ii. iii. iv. Approve MIHS Allied Health Professional Staff Appointments, FPPEs, Reappointments, and Resignations for April 2014 Approve Proposed revisions to the Orthopedic Privileging Criteria to include Admitting Privileges Approve Proposed revision to the General Surgery Privileges with the addition of Non-Core Procedure/Vasectomy Privileges v. Approve Proposed revisions to the MIHS Medical Staff Organizational Manual MOTION: Director McMahon moved to approve the consent agenda. Vice Chairman Dewane seconded. Motion passed by voice vote. 3. Discussion and Possible Action on Report from Navigant Consulting Mr. Nolan stated that Navigant Consulting was tasked with reviewing the report and recommendations presented to the Board by the Bond Advisory Committee. A very high level review was conducted over a short period of time, including looking over the key assumptions and all supporting documentation, having discussions with MIHS staff, conversing with consultants from Navvis and Kurt Salmon, and benchmarking methodologies and assumptions for service line strategies, space programming and summarizing the results. It was concluded that the methodologies and assumptions were generally appropriate, as well as the strategic direction outlined. There were minor adjustments suggested in some areas. 3

4 3. Discussion and Possible Action on Report from Navigant Consulting, cont. Mr. Nolan said upon closer and careful assessment of the methodologies and assumptions around establishing the service area and populations projections, it was determined that the inpatient population projections were overstated; as the market as a whole had been experiencing a modest decline in utilization. The rate of decline may actually be greater than forecasted; which could result in as many as 18,000 fewer discharges in the entire service area. If the market does not grow as quickly as anticipated, when translated to patient days and the bed need; there may be a surplus of up to fifteen beds in the existing plan. While reviewing the behavioral health component of the report, the rate of growth was fairly conservative based on historical data with the MIHS market, as well as other markets around the country. He stated that the emergency room volumes assumptions were appropriate, with the ambulatory care volumes being fairly aggressive; however, that is consistent with the healthcare trends and where the organization needs to move forward. He concluded that the methodologies and sources for establishing the volume assumptions were appropriate and valid. Mr. Campobasso reviewed the facilities plan and the forecasting of anticipated costs associated with the plan. He said that the strategy drives the need for the facilities capacity and that in turn drives the cost for the facilities. The facilities assessment completed by Kurt Salmon was reviewed and it was determined that generally accepted facilities planning practices, methodologies and assumptions were used. When reviewing how the volumes were considered when allocating space, there were no major gaps in the projections with one exception. It appeared that acute care hospital metrics were used to determine the space needed for behavioral health; which affected the cost. When calculating the cost of the facilities, the amount listed is the total project cost and is comprised of construction costs, furniture, fixtures, equipment, and technology. After comparing Navigant s cost assumptions with Kurt Salmon, it was noted that there was an overall variance of $7 million, or less than one percent. A review of the power plant was also conducted and this area would be a tremendous opportunity to become more efficient and could result in future savings up to fifteen percent in energy costs. Mr. Campobasso also noted that this is an opportunity for MIHS to transform the health system into a health care village; which would be a gateway to the community. The initiative would be more than brick and mortar of a hospital; it could result in the transformation of a community. Chairman Harden thanked them for the phenomenal work completed. Director Gerard echoed those thoughts and noted that the information received met the expectations of the Board and she appreciated receiving the information in a short amount of time. MOTION: Director McMahon moved to acknowledge the receipt of the Navigant Consulting s review of the conclusions and recommendations in the Bond Advisory Committee report to the Board of Directors. Vice Chairman Dewane seconded. Motion passed by voice vote. 4. Discuss Plans for Proposed Pendergast Medical/Dental Federally Qualified Health Center Look- Alike Clinic Mr. Vanaskie presented the concept of the Pendergast medical and dental clinic. It has been the goal of MIHS to be considered a community resource, throughout the community. Although many of the outreach activities do not provide direct patient care, they are geared toward helping residents understand what MIHS is and the services provided for the community. Many managers of the Family Health Centers (FHCs) work with various groups and organizations within their own geographical area that has enhanced MIHS s ability to provide care to residents across Maricopa County. The Pendergast School District approached MIHS with this opportunity to serve the community. 4

5 4. Discuss Plans for Proposed Pendergast Medical/Dental Federally Qualified Health Center Look- Alike Clinic, cont. Ms. Wood stated that Pendergast School District is located in the west valley and it obtained $4.6 million in bond reserves and raised an additional $3 million to build a 32,000 square foot community center called The Hope Center. The center has a trifocal mission of meeting the healthcare, educational, and recreational needs of the under-served west valley community. She stated that Phase II is scheduled to be completed in July 2014 and will include five 1,000 square foot shells to house the community partners with similar missions to that of the health center and school district. MIHS is proposing the use of 2,000 square feet to create a shared space of medical and pediatric dental services and this would be a Federally Qualified Health Center Look-Alike (FQHC-LA) Clinic. The plan includes four medical exam rooms, which would be staffed by a nurse practitioner and will treat all ages of the family. The plan will also include three dental exam rooms and will be staffed by pediatric dental residents through the new partnership with Lutheran Medical Center in New York City. Pendergast will also provide an office space for an eligibility specialist at no additional charge. She stated that a lease agreement will be ready for approval next month; however, a rate per square foot has been agreed upon. MIHS will be offering medical services six days a week, ten hours a day. Pediatric dental services will be offered three days a week; however, there will be equipment and ability to expand to six days a week. Based on volume projections, payer mix, and the expectation of obtaining FQHC designation, a positive return on investment is anticipated. In addition to the positive financial implications, the project also has a strong alignment to various elements of the strategic plan. Those elements include; improving community health, enhancing the patient experience, caring for the whole person, meeting emerging patient care needs, and teaching and training providers for the future. She stated that there is also literature replete with positive outcomes for both the educational and healthcare domain for school based health centers. There are eighty school based sites in Arizona, of those 62 percent are sponsored by a hospital or medical center. The remaining are either grant or school districted funded. Ms. Wood reviewed the potential risks of the project; one being the lack of volume or correct payer mix to achieve the positive return on investment. She noted that the nearest FQHC clinic is approximately five miles from The Hope Center. The Maricopa Health Centers Governing Council Executive Committee and the Finance Committee have reviewed and approved the proposal. The proposal will be presented to the full Maricopa Health Centers Governing Council in May. Vice Chairman Dewane asked if there would be behavioral health services on site to provide counseling services in treating the whole person. Ms. Wood said that there were plans to incorporate behavioral health services. Chairman Harden asked if it is anticipated to perform conscious sedation on site. Ms. Wood said that would be addressed once the program is underway. Until that is determined, if the need should arise, the patient would be referred to the main campus. The role of dental hygienist will also be reviewed after the program begins operation. Chairman Harden questioned when documentation would be submitted to Health Resources and Services Administration (HRSA). Ms. Wood plans on submitting the documents within days of final approval. Vice Chairman Dewane commended staff on the timing of the presentation. The project is a great opportunity for the organization and the community. 5

6 5. Discussion and Possible Action on Implementation and Outcomes of the Maricopa Integrated Health System Strategic Plan Elements Mr. Purves reviewed the framework used to ensure that staff s efforts are focused toward the strategic plan. There are three specific tasks being performed; two have been in place, the third is newly implemented. The first effort is the annual Chief Executive Officer (CEO) strategic goals; which include ten Board-approved strategic goals that direct the attention of senior administration toward the priorities of the MIHS strategic plan and the six key strategies within the plan. There are regularly scheduled updates and discussions with the Board that will focus the efforts and allow for progress reports on the strategic implementation. The second effort is the annual CEO performance goals; which are quantitative goals within the five pillars of financial, service, growth, people, and quality. These goals direct the attention of senior administration toward performance improvement and are metric based objectives that enable the organization to assess the progress of the goals quarterly. The third effort is the annual operating plan, which combines the overall strategic plan and the six key strategies and translates into the operating plan with priorities and is accounted for in the budget. Each initiative is assigned an executive sponsor and needs to align with the strategic plan and immediate impact with results realized in fiscal year The initiatives are not necessarily dependent on capital, as access to capital funds is limited. It has also been recognized that the initiatives need to engage the medical staff, to ensure the plans are implementable through a set of action steps, timelines, and accountabilities that creates a framework and discipline surrounding the ongoing efforts. Mr. Purves stated that the initiatives established for fiscal year 2015 include managing the care of members in the health plans (Maricopa Health Plan [MHP] & Maricopa Care Advantage Plan [MCA]), expanding services to meet community need, improving access to care, enhancing community outreach, meeting emerging care through an expanded network, exercising prudent stewardship of resources, maximizing community return on existing assets, evaluating programs to improve performance, managing community resources efficiently, and teaching and training for the future by building a coalition of academic programs. There are also some additional areas to focus on, including; caring for the whole person by expanding behavioral health services, expanding outpatient services to meet the demand and needs of special populations, and engaging partners to support the community initiatives. He stated that the Board would be receiving additional information, including how the initiatives are being monitored and the executive sponsor for each. Director McMahon clarified that the additional information would be provided to the Board in May. 6. Discussion and Possible Action on the Maricopa Integrated Health System Employee Medical Benefits Plan Mr. Jones stated senior administration discussed the need for offering employees an additional option for medical benefits; an MIHS only network. Unfortunately, Cigna, the current plan administrator, was unable to administer a custom network plan due to contracting constrictions. It was determined in late November 2013 that there would be a need for a new third party administrator (TPA). After reviewing all options, UMR was selected based on a variety of reasons; including a savings of $1.2 million. Director Bicknell asked if the savings projected was based off Cigna s proposed renewal rate. Mr. Jones stated the projected savings was a comparison with the current rate. The savings would be greater if compared to the proposed Cigna renewal rate. He reviewed the plans that would be available to offer employees with UMR; the two plans currently being offered to employees will continue to be offered, as well as a new MIHS only plan. 6

7 6. Discussion and Possible Action on the Maricopa Integrated Health System Employee Medical Benefits Plan, cont. He reviewed the disadvantages of ending a long term relationship with Cigna, including the disruption rate of twelve percent of employees and an overall disruption of human resources systems that need to be rebuilt. He stated that there were advantages, including the excellent customer service provided by UMR. Due to the projected savings, employee premiums will not increase and there are now significant savings to those employees that opt for the MIHS only plan. There will informational meetings to discuss each medical plan prior to open enrollment. Vice Chairman Dewane asked if there would be a negative financial impact for employees, including copay or out of pocket expenses. Mr. Jones reiterated that the premiums for employees would remain the same. There were minor changes in co-pays and co-insurance; which is standard to maintain some savings. He noted that the benefits package offered to MIHS employees is compared to that offered in other hospital and health care systems, as well as the private sector, and the MIHS benefits package remains generous. Director Gerard said that although saving money is beneficial for the employer, the primary reason for seeking a new TPA was to create an MIHS only network. She asked if there would be a significant cost savings for employees who opt for the new plan. Mr. Jones reviewed the premium rates, co-pays, co-insurance requirements for each plan. He reiterated that there will be informational meetings to review the specific restrictions with the new plan, to ensure employees fully understand the plan and do not chose based solely on the premium rate. He also reviewed the voluntary benefits; such as vision, dental, and life insurance. Chairman Harden asked for a clarification on the number of enrollees. She also questioned the amount of the contract that will eventually come before the Board for approval. Mr. Jones said that there are over 3,000 employees. He stated that the amounts listed on page 8 of the presentation represented the amount of medical expenses for health benefits, not the cost to administer the benefits; that amount is just over $1 million. Mr. Purves stated that MIHS is self-insured and the amount of $35 million is paid to provide coverage to the employees and that is what UMR will be managing. Chairman Harden asked Mr. Gorman if it were appropriate or legal for employees to provide personal/protected health information (PHI) to UMR, since there is not a contract in place as of yet. She also asked when a contract was expected to come before the Board for approval. Mr. Jones stated that a contract is anticipated to be complete and ready for approval in May. There are a number of Memorandums of Understanding (MOUs) between MIHS and UMR in place. Chairman Harden asked what the anticipated cost of the contract is. Mr. Jones stated that he did not have the information available at the moment; however, he will forward information to the Board. Chairman Harden questioned if there was a contingency plan in place for those that are in the middle of receiving treatment. Mr. Jones said it would be nearly impossible to account for all receiving treatment; however, a contract is being negotiated with the Cancer Treatment Center of America, to ensure any employees or family members would be able to continue treatment at their facility. 7

8 6. Discussion and Possible Action on the Maricopa Integrated Health System Employee Medical Benefits Plan, cont. Chairman Harden questioned if open enrollment could begin without a contract in place. Mr. Gorman stated that he would provide legal advice in executive session if needed. Mr. Purves said the Approval, Authorization and Responsibility Matrix states that the Board is to approve employee benefits; it does not specify which employee benefits, however, the intent is health benefits. Upon review of the information presented, should the Board agree that the general level of benefits is acceptable; the Board s responsibility has been met. Due to the amount of the contract to be approved, the Board will be presented with that information when it is available. Mr. Gorman stated that since a contractual relationship has not been established between MIHS and UMR, a business associate agreement (BAA) would be in order. This agreement should be in place prior to the beginning of the open enrollment period, which begins on May 19. Chairman Harden questioned if a contract could be completed prior to May 12. Ms. Acosta clarified that under the Health Insurance Portability and Accountability Act (HIPAA), communicating PHI to UMR would be completely appropriate for employees to do, even without a contractual relationship; however, it is good practice to have a BAA in place. Director Gerard expressed her frustrations of not being provided information in a timely manner and being asked to approve items after the fact. She stated that the Board members were elected by the voters of Maricopa County. The Board has many responsibilities, including fiduciary responsibilities. She suggested senior administration review the process of getting pertinent information to the Board in a timely manner. 7. Discussion and Possible Action on Maricopa Integrated Health System s 2014 Legislative Agenda and/or the District s Position Regarding Current or Proposed State and Federal Legislative Items Mr. Fronske reviewed the current status of the legislature and noted that the session is expected to conclude soon. A budget had been passed and he reviewed the key health components. He provided the status of various bills that were tracked throughout the session. Director Bicknell noted the recent ruling in the case the regarding the expansion of the Medicaid program. He asked for an update. Mr. Fronske stated that the court ruled that those that brought the lawsuit had standing; however, it would need to be proved that the imposition of the tax on the hospitals was in violation of Proposition 108. A lengthy court process is expected. Director Gerard questioned if there was an active amendment referencing the request for Arizona Department of Health Services (AHDS) to re-bid the Regional Behavioral Health Authority (RBHA). Mr. Fronske explained that at this point, a conference committee is the only option to attach an amendment. There are obvious vehicles for such an attachment; however, all possibilities are being watched very closely. 8. Presentation on Maricopa Integrated Health System Nursing and Patient Services Ms. Stotler reviewed the efforts of staff to continue toward the Magnet status. She noted the areas of focus include quality, professional certifications, employee satisfaction, advanced degrees, community outreach, and collaboration or interprofessional interactions. 8

9 8. Presentation on Maricopa Integrated Health System Nursing and Patient Services, cont. Ms. Stotler stated that when considering the application for Magnet status, there will be an emphasis on the core indicators; falls with injury, hospital acquired pressure ulcers, catheter associated urinary tract infections, and central line associated blood stream infection. With regard to patient satisfaction, MIHS recently began utilizing American Essential Hospitals, formally known as the National Association of Public Hospitals, to analyze the data. Patient safety and individual accounts of care given are also reviewed in the application for Magnet status. There have been a number of positive changes staff has implemented for improved patient safety. There is also a requirement to submit data in 34 other areas focused on quality. Many of those areas also pertain to DNV accreditation, other national registries, and process improvement projects focused on at MIHS. There is also an emphasis on nurses to obtain certification in their area of specialty. According to Magnet, registered nurses (RN) not only include those that provide patient care at bedside and leadership, the requirements also include those in non-patient care, such as informatics; if a nursing degree is required. Since the implementation of this recognition in March, over 200 employees have been acknowledged for achieving certification in their area of specialty. To meet the requirements under employee satisfaction, MIHS participated in a Morehead Employee Engagement survey, which includes all MIHS employees. There was also participation in the National Data for Nursing Quality Indicators; which was for only for registered nurses within the organization. The majority of the results outperformed the mean of the benchmark, with exception of fundamentals of quality nursing care. In an effort to meet the Magnet requirements for advanced degrees, MIHS established a goal of all registered nurses to receive a Bachelor of Science in Nursing (BSN) degree by 2020; currently 50 percent of nurses have obtained a BSN or higher. There are a number of resources available for employees; such as tuition reimbursement offered by MIHS, the Nursing Perpetual Scholarship funds offered through the Maricopa Health Foundation; and partnerships with the educational institutions. Vice Chairman Dewane asked if once the goal is achieved, if MIHS will encourage all incoming nursing applicants to have a BSN or higher. Ms. Stotler stated that beginning in July, MIHS will require a BSN or higher; many hospitals in the community are doing the same. Director Bicknell asked if MIHS supported advanced degrees, once the BSN was achieved. Ms. Stotler stated that there are opportunities available for those that wish to pursue an advanced nursing degree. There have been nursing employees that now work for District Medical Group (DMG) as advanced practice nurses. Vice Chairman Dewane asked if employees were receiving an increase in their compensation for receiving their BSN. Ms. Stotler said that there is a clinical ladder in place for employees and increases in their compensation can be realized, should the employee follow that process. Director McMahon asked if there was a negative impact on employee retention. Specifically, are employees leaving the organization once a degree in earned to make more money at another organization? Ms. Stotler said that the majority of employees stay with the organization after obtaining their BSN; a two year commitment is asked of all employees that take advantage of tuition reimbursement. Director McMahon asked what the advantages were for requiring the nurses to obtain a BSN. 9

10 8. Presentation on Maricopa Integrated Health System Nursing and Patient Services, cont. Ms. Stotler stated that there would be a more collaborative work environment, an additional level of competence, and improved patient care. She said that when it comes to community outreach, MIHS participates in a number of activities; nursing participates greatly in many activities. These events include the Teddy Bear Clinic, community health fairs, March of Dimes events, the American Heart Association Heart Walk, and the Arizona Donor Network. She noted that the nursing staff is also participating in interprofessional collaboration projects throughout the organization to improve patient outcomes. These activities include collaborative rounds and participation in interprofessional committees including pharmacy and Value Analysis Teams. 9. Status Update on HomeAssist Health, the Newly Non-Profit Corporation Created to Provide Non- Skilled Personal Care Services Mr. Vanaskie said that there has been a great deal of work being done to ensure HomeAssist Health is operational by July 1, There are various transitional steps that are required, including acquiring adequate facilities, office staff, and ensuring all of the infrastructure necessities are in place. That includes accounts payable, human resources, payroll, scheduling, documentation for the care rendered, hiring practices, and policies and procedures. An essential element is ensuring the transition from one company to another is seamless, not only on the business end, but for the clients as well. This is also important for the employees transitioning to HomeAssist Health. Ms. Stotler re-iterated the amount of work completed, including obtaining the AHCCCS identification number, Employer Identification Number (EIN) from the federal government, and filing the trademark application. The Worker Adjustment and Retraining Notification (WARN) letters are prepared and are scheduled to be mailed. She stated that all employees are aware of the changes to come and there has been positive feedback. It was also noted that the contracts are being reviewed by a not-for-profit group. There has also been a need for software to manage scheduling, billing, and tracking clients and caregivers; one has been identified and it developed for this type of service. Staff has been working with the finance department to ensure there will be a general ledger and accounting functions in place. Health benefit solutions are also in the process of being explored. She stated that a centrally located facility had been secured and there are other not-for-profit businesses in the area with similar clientele. Chairman Harden noted that when the proposal for HomeAssist Health was presented to the Board for approval, an advantage of its creation would be to increase the ability to obtain contracts. Ms. Stotler stated that all payers currently working with Complete Comfort Care have been contacted and the feedback has been positive and the transition is expected to go smoothly. 10. Review the Monthly Chief Financial Officer Report Chairman Harden requested an explanation as to why the Board did not receive the dashboards and financial statements in a timely manner. Mr. Ayres stated that the organization converted the general ledger to a new system on March 1 and there were a few challenges encountered. The timeline to submit the information could not be met. He noted that staff also reviewed the data from January 1 forward, due to the changes made in the reimbursement system, to ensure that the assumptions previously made were appropriate and accurate. The delay is not expected to be repeated. Director Gerard asked if the operational and quality dashboards were produced as a result of the financial data. 10

11 10. Review the Monthly Chief Financial Officer Report, cont. Mr. Ayres stated that many of the key indicators are based on the completing of financial information; some of the information is independent, however, it is included in the financial package. Director Gerard said that the information contained in the dashboards was too important not to be discussed on a monthly basis. Due to the language on the agenda, the information cannot be discussed. Chairman Harden requested to receive dashboards for the months of March and April for discussion at the May meeting. Director Gerard also questioned the amount of information received. It was her understanding that the Board was to receive minimized reports. Mr. Ayres stated that the reports would be redesigned at the beginning of the fiscal year. 11. Reports to the Board of Directors; Discussion and Possible Action: a. Graduate Medical Education - Result of Match Week b. Quarterly Contract Approvals and Asset Disposal Report Dr. Fromm referenced the Graduate Medical Education report and stated that all first year programs were successfully matched. Chairman Harden questioned and received clarification on several items on the Quarterly Contract Approvals and Asset Disposal report. 12. Concluding Items a. Future Agenda Items b. Board Member Requests for Future Agenda Items or Reports c. Comments i. Chairman and Member Closing Comment ii. President & Chief Executive Officer Summary of Current Events Chairman Harden requested a document to review for the employee health benefits prior to May 12. Director Gerard stated that it is expected that the key indicator dashboards would be discussed at the May meeting. Director Harden congratulated Dr. Fromm on his appointment to the Arizona Medical Board. Mr. Purves thanked Mr. Fronske for all of his work during the current legislative session. He stated that there are various projects underway in the communication department; including the production of community and nursing reports. The goal of the improved communication is to have the community understand how care is delivered and why MIHS is relevant to the community. He also mentioned the various upcoming professional appreciation dates; including Administrative Professional Day, Laboratory Week, Emergency Medical Services (EMS) Week, Nurse s Week, and Hospital Week. This is an opportunity to thank employees for all that they do. He reviewed the news coverage received surrounding a recent tanker fire and those who were injured were brought to the Arizona Burn Center for treatment. 11

12 12. Concluding Items, cont. Mr. Purves noted that the Board would be receiving additional reports highlighting the outreach activities in the community. There will also be improved communication to employees of MIHS, in particular any action taken by the Board. Director Bicknell thanked the public relations team for their hard work. Adjourn MOTION: Vice Chairman Dewane moved to adjourn the April 23, 2014 Special Health Care District Board of Directors Formal Meeting. Director Gerard seconded. Motion passed by voice vote. Meeting adjourned at 3:25 p.m. Mary A. Harden, R.N., Chairman Special Health Care District Board of Directors 12