RIVERSIDE MEDICAL CENTER BOARD OF COMMISSIONERS REGULAR MEETING The regular monthly meeting of the Riverside Medical Center Board of Commissioners was held on Thursday, June 26, 2014, at 4:05 p.m. in the Hospital Cafeteria. The meeting was called to order by Lionel Jones, Chairman at 4:05 p.m. INVOCATION Board Member Gill gave the Invocation. PLEDGE OF ALLEGIANCE Board Chairman Mr. Lionel Jones called for the Pledge of Allegiance. ROLL CALL Board Clerk Sherae Killingsworth, call the roll. Those present: Lionel Jones; Lavern Jenkins; James Knight; Barry Kennedy; James Thomas; Rachel Gill; Mark James, M.D.; Pamela Breland; Gerald King; and Violet Tate. Guests present: Kyle Magee, M.D., CEO; John Allen, Hospital Attorney; Christopher Foret, M.D.; Ben Lott, Assistant Administrator/VP Clinical Services; Lesia McQueen; Michael Magee, John Seal; Claire McGuire; Carol LeBlanc; Shad Jenkins; Crystal Lyons; Frank Voelker, M.D.; Mark Watson; M.D.; David Phelps; Marty Rogers; Cammie Magee; and Sherae Killingsworth. APPROVAL OF MINUTES The minutes of the regular meeting held on May 29, 2014 were reviewed and approved by Mr. Thomas seconded Mr. Breland as presented. FINANCE AND CAPITAL PLANNING COMMITTEE REPORT Mr. Jenkins reviewed the minutes of the Finance and Capital Planning Committee meeting held on June 24, 2014, a complete copy of which is on file with these minutes. PUBLIC PARTICIPATION There was no public participation. ADOPT 2014 TAX MILLAGE Mr. Jenkins stated that per the correspondence received from the Washington Parish Tax Assessor it is time to set the millage for the year 2014, copy of which is on file with these minutes. He reported that 18 mils will be set for acquisitions and maintenances. Upon review, a motion was made by Mr. Jenkins seconded by Ms. Gill to authorize Dr. Magee to execute the affidavit and resolution with an 18 mill rate. Motion carried. ELECTRONIC HEALTH RECORD (EHR) & HOSPITAL INFORMATION SYSTEM Mr. Magee presented for review Electronic Health Record (EHR) & Hospital Information System contract to the Finance Committee, a copy of which is on file with these minutes. He said that a Request for Purchase (RFP) was completed for the system. Administration is recommending the Cerner EHR system in the amount of $2,132,436. The contract is for seven years. A spread sheet for the impact of the Medicare Incentive Payment for Critical Access Hospital s and how the system will be considered an allowable cost under the incentive program. He also discussed the monthly cash flow summary regarding the current CPSI system and the difference over a seven years period with CPSI costing $204,557 more
BOARD OF COMMISSIONERS MEETING PAGE 2 OF 7 ELECTRONIC HEALTH RECORD (EHR) & HOSPITAL INFORMATION SYSTEM than Cerner over that time period. Administration feels the system is superior product and will help us meet stages of attestation for the meaningful use requirements. We can receive additional products for the system by obtaining reference credits for hosting open house site at our hospital visits as well as reference FINANCE AND CAPITAL PLANNING COMMITTEE REPORT calls. Upon review, a motion was made by Mr. Jenkins seconded by Ms. Breland to approve the contract as presented. Motion carried. HOSPITAL TELEMETRY & PATIENT MONITORING SYSTEM Mr. Magee presented for review Hospital Telemetry & Patient Monitoring System contract to the Finance Committee, a copy of which is on file with these minutes. He provided three quotes for the telemetry and patient monitoring from Mindray, Nihon Kohden and Philips. Administration is recommending Mindray in the amount of $290,425 for equipment in required departments and was the lowest of the quotes. The lease will be for five years. Mr. Lott said the contracts for Philips and Data Scope are expired and we have been working on a month to month agreement. The monitors in the ICU are beyond use of life and we have begun having services issues with them. In order to have a functional ICU, Mr. Lott requested ICU be added to the agreement. Upon review, a motion was made by Mr. Jenkins seconded by Ms. Gill to approve the lease as presented. Motion carried. CHIEF FINANCIAL OFFICER S REPORT Mr. Magee said the cash balance as of today is $1.8 million. The account payable is at $923k. Mr. Magee stated there were 47 admissions for the month which was 3 patients more than last year compared to a budget of 68 and prior year of 44. He reported that there were 47 observation stays compared to 10 last year. There were 110 acute, 86 swing bed and 43 observations patients days with a total decrease of 16% compared to last year. The average daily census of all admissions including swing bed, acute and observation for the month is 7.71. Mr. Magee reported that during May the acute average daily census was 3.55 compared to 4.48 for the prior year and 6.55 budgeted. The swing bed census average was 2.77 for the month of May. The average length of stay for acute during the month of May for the hospital was 3.06 and for swing bed is 7.82. The average length of stay for acute Medicare for May is 3.37 days which was an increase from last month at 2.70. Total equivalent patient days for the month were 1,295 compared to a budget of 1,159 and prior year of 1,146. Total emergency department visits were 1,257 for the month, compared to 1,337 for prior year and 1,275 budgeted. There were 86 surgical procedures performed during the month compared to budget of 61 and prior year of 53. There was a 14% increase or 39 additional surgery cases year to-date. There were 1,761 outpatient registrations during the month with 8,584 year-to-date which is an increase of 4% or 306 registrations from prior year. There were 194 FTE s for May compared to 175 for the prior year and 186 budgeted. The increase in FTE s was due to overtime and cash in. Accounts payable days were at 57 for May and 48 for the prior year. Mr. Magee said less than 60 days on an average to pay our vendors is right within our range. Total Patient Revenue for the month of May was $4,019,097 which was under budget but 7% higher than the prior year. There continues to be a drop in inpatient revenue by 35% year-to- date. Total Other Revenue for May was $292,627. Total Gross Revenue for May was $4,311,725. Total Deductions from Revenue for May was $2,291,262. He presented the contractual allowances for Medicare and Medicaid
BOARD OF COMMISSIONERS MEETING PAGE 3 OF 7 CHIEF FINANCIAL OFFICER S REPORT (Continue) broken down by inpatient and outpatient by payer for Medicare, Medicaid, Bayou Health Plans, Champus, Franklinton Rural Health Clinic, and Pediatric Internal Clinic. Mr. Magee stated a breakdown by Medicaid and Medicare contractual allowances with the total contractual allowance for May is $1,375,940. The year to date contractual allowances is $6,567,421. The breakdown by Medicare allowance for the Franklinton Rural Health Clinic is ($11,645) and the year to date is ($47,211). He reported that the Pediatric Internal Clinic Medicare allowance is $4,917 for May and the year to date is $24,378. Total breakdown by commercial other allowance is $611,441 for the month and $3,135,607 year-to-date for the hospital. Net revenue for May was $2,020,463 which was above budget and a 24% increase compared to last year. Personnel expenses totaled $1,126,921 for the month which was over budget by $18,172. Other operating expenses were $743,810 during May which was under budget by ($37,408). Total Operating expenses for May were $1,870,730 which was less than budget by ($19,237). The net operating profit for the month of May was $149,733 compared to a budgeted profit of $19,805. Non-operating profit for the month was $9,924. The hospital experienced a net profit for the month of $159,657. The itemized list of the income statement was emailed to the committee in detail prior to the meeting. The current assets were $5,194,641 with current liabilities at $3,348,213 providing a current ratio of 1.55 for June, 1.74 for May and the prior month was 1.37. Mr. Magee stated that the current ratio measures the ability of the hospital to rely solely on its liquid assets to pay current liabilities. Mr. Magee stated that we would like to see that number greater than 2. Mr. Magee presented a Cash Flow Statement for May 2014 which identified the activities of the hospital that are generating or consuming the cash. The total Operating Cash on Hand is $1,820,253 which equals 31 days cash on hand a decrease from 32 for the prior month. He said expenses per day average are $58,251 for May and the prior month was $58,098. The daily operating revenue is $56,433 which is a difference of $1,881. The average daily cash on hand for May was 34 days and April was at 22. He presented a graph of cash on hand on a day by day basis for the month of May. Mr. Magee reported that the slope of the curve on the graphs represents show how much we have increased our cash position. The average days cash on hand for 2014 is 21 with the highest being at 32 and the lowest at 13. Mr. Magee presented a cash projection statement and graph from May 2014. Mr. Magee stated the projection was created based off historical data from collections and expenditures. Mr. Magee reported that there were no capital expenditures during the month of May 2014. Total capital expenditures for the year were $146,885. Mr. Magee reviewed the Accounts Receivable Analysis totals and graph. Gross Accounts Receivable as of May 31, 2014 was $6,849,984 which reflected an increase of $454,926 from April. Total days of gross revenue uncollected were 55.88 compared to 54.09 for the prior month. There was an increase of 1.79 for the May and a decrease the prior month was at 1.97. Net days uncollected were 61.16 for the prior month and 63.25 currently compared to December 31, 2013 of 54.02 days. He reported the State average benchmark is 55.64. Mr. Magee presented a graph with gross accounts receivable days from May 2012 through May 2014 which reflects an upward trend slope currently, a copy of which is on file with these minutes.
BOARD OF COMMISSIONERS MEETING PAGE 4 OF 7 CHIEF FINANCIAL OFFICER S REPORT (Continue) There was one recipient that qualified for the Charity Program during the month of May in the amount of $2,039.98. The year-to-date written off balance for the Charity program is $13,249.44. The monthly listing of the amounts written off as bad debts for the month of May were presented and reviewed at the meeting, which was approved by Mr. Jones and seconded by Ms. Breland as presented. Motion carried. Accounts written off as bad debts during May 2014 totaled $236,405. The year-to-date bad debt is $1,389,454. A summary of the bad debt accounts was presented showing the percentage of the accounts that were payor type versus stay type. He reported that the accounts written off as uncollectible in May for the Franklinton Rural Health Clinic were $265.96. He reported that the accounts written off as uncollectible in May for the Pediatric and Internal Medicine Clinic were $256.49. The year-to-date write off for both clinics is $522.45. Mr. Magee said the Profit and Loss Statement was emailed to the Committee in detail prior to the meeting. MEDICAL STAFF REPORT The last meeting of the Riverside Medical Center Medical Executive Staff was held on June 19, 2014. The Quality Council Committee continues to review quarterly indicators for all departments. The MEC approved the Stroke Protocol Policy as presented by the Quality Council Committee. Upon review, the Medical Executive Committee approved the Patient Consent Content for Remote Monitoring and Use of Electronic Devices as presented by the Quality Council. The Committee approved the tpa Patient Consent Form as presented. The MEC approved the following manuals: Cardiac Catheterization Laboratory Policy & Procedure Manual Nutritional Services Policy Procedure Manual The Committee discussed recommendations and requirements for the Medical Staff Representative position on the Board of Commissioners which will be recommended to the Parish Council at the next scheduled Medical Staff meeting. The MEC requested approval from the Board of Commissioners for the policies, consents and manuals as presented. Upon review, by Mr. Jenkins seconded by Mr. Thomas to approve the policies, consents and manuals as presented. Motion carried. PATIENT CARE REPORT Mr. Lott presented the Patient Care Report for June 26, 2014, a complete copy of which is on file with these minutes. The operational report is as follows: The in-patient census is low and the supervisors are making adjustments as necessary. We continue BOARD OF COMMISSIONERS MEETING
PAGE 5 OF 7 PATIENT CARE REPORT (Continue) to follow and review admissions closely. We are actively seeking an experienced RN for the cath lab. Marty Rogers and Crystal Lyons are working with HR for recruiting as well as through a search agency. Nursing services has implemented bedside rounding report at shift change and minimum hourly rounding to improve quality and perception. The Supervisors continue to review all transfers in real time and will make recommendations for review in ED Quality. We continue to review complaints and quality indicators to report to ED Quality. C&M is also reviewing physician statistics for improvement and incentives. We started seeing a downward trend in LWBS. For May, the LWBS rate was 2.47%. Also, the door to physician time is trending down at 33 minutes for May. The Cardiac Rehab service continues to grow. We have 9 current patients and we have had 5 graduates so far. The 340B Drug Program is still going well for employees. We should have an idea of savings after this month s end. As far as the retail side of the program, we are currently at a standstill because CPSI s platform can t meet the reporting requirements. IT and Pharmacy are working with CPSI and Sentry to get the data extracted for the reports required by Sentry to qualify patients. Once that is complete, we can move on to phase 2, which is the build and go-live. We anticipate that the Pyxis pharmacy cabinet interface will go-live in the ED by July 10. Quint Walker is currently testing the interface. Mr. Lott said the IT Help Desk is in place and seems to be working out great. IT has closed over 700 tickets since the system was put in place. The computer virtualization is complete and all Microsoft licenses are up-to-date. We are working on MU requirements for our Stage 1-year 2 attestation. There was a proposed rule from CMS that may delay some of the Stage 2 requirements. We are awaiting the final decision which should be released sometime in July. We recommended changing EHRs from CPSI to Cerner with anticipated go-live in April 2015. This will be a lengthy process but will improve housewide efficiency in the long run. The Hologic DEXA Scanner is installed and in use. The Toshiba R & F Fluoro Room install started on June 25 and should be completed within three weeks. The Toshiba TRAD X-Ray Room will be installed after the R & F Room is functional. The Hologic Mammo Room is set to be installed starting July 29. Toshiba has been on-site providing education for staff on the new equipment. Mr. Lott reported that we are working on an agreement with Acadian Air for cath patient transport as well as Northshore EMS for ground transportation. Jeffrey Vince is working on updated contracts for the blood culture and microbiology instrumentation for the Laboratory Department. Also, we are looking at devices to perform ACTs, a requirement for cath patients. Mr. Lott reported that the procedure numbers are improving for the Surgery Department. The staff continues to prepare for Dr. Nicholson with getting supplies needed for procedures. Call schedules are set for offering surgery after hours. We had a HHS survey on June 16 to review our disaster preparedness and grant participation. We received some ideas for improving our processes in the disaster manual. We should receive a survey report in the coming week s region 9 STEMI and stroke protocols. Acadian Air is now providing helicopter services in Washington Parish for trauma patients. They are called in the field by LERN and they are able to perform a hot load for transport to tertiary care. BOARD OF COMMISSIONERS MEETING
PAGE 6 OF 7 PATIENT CARE REPORT (Continue) The Performance Improvement and Risk Management are as follows: Post ED Visit Follow Up Phone Calls: The May phone calls yielded a 99% satisfaction rate. 100% of patients stated they were kept informed during their stay and understood their discharge instructions. J.L. Morgan and Associates: Overall May satisfaction was at 91%, for the ED 90%, Inpatient was at 88%, and Outpatient was at 95%. Our med verify rate was 99% for May 2014. This is above the hospital set threshold of 90%. Planning and Development: Physician training was performed by Dr. Dumont from Tulane for the Telestroke program. All protocols and policies have been approved. We are waiting for HCA and Tulane to schedule a trial run so we can go live. Martha Gragg from HCA is set to be on site on July 1. The policies have been approved and some equipment is starting to come in. Marty Rogers will be going to training the week of July 7 th with Toshiba. The building construction should be complete by July 11. After that, Toshiba can begin installing the equipment which will take approximately three weeks. Mr. Lott introduced Marty Rogers to the Board of Commissioners. We had a planning meeting with members from STPH to plan a mock STEMI transfer. This is in an effort to strengthen our transfer relationship with STPH and ensure improved patient outcomes. The STEMI drill is tentatively scheduled for July 15. We have been working diligently to evaluate hemodynamic equipment for all areas of the hospital as the leases we currently have are up on the patient monitor system. Additionally, we will have to replace the equipment in ICU because of the age and dependability of the current equipment. Mr. Lott was appreciative of the Board approving the Mindray hemodynamic monitoring equipment for all areas including Surgery, ED, Station 2, and ICU. He will keep the board updated on the progression of installation. ATTORNEY REPORT Mr. Allen stated that he has prepared and forwarded letter regarding the Attorney General Opinion as to 340B program and 25% discount for Board Members. He reviewed the Cerner contract, addressed concerns with administration, spoke to counsel opposite on multiple issues. Mr. Allen also reviewed and certified Cerner Lease Agreement Researched and provided statutory documents on Medical Staff representative requirements. There were multiple small issues and several email communications between Mr. Allen and the Administrative team. Mr. Allen stated that he has contacted Ms.Griffin on the By-laws and will be scheduling a meeting with the Administrative team to discuss the revisions. MANAGEMENT REPORT Dr. Magee reported that Dale Tate has accepted the offer to come back to work at the Franklinton Rural Health Clinic and will be here sometime around Labor Day. He said Dr. Deavens has decided to stay in Georgia for personal reasons. Dr. Magee said that he and Mr. Magee have diligently been working with Dr. Anderson from Bogalusa but Bogalusa offered him an academic position. We still have one candidate that we are still pursing and one local prospect that is very interested. We have plans to hire another Nurse Practitioner once the Franklinton Rural Health Clinic gets in the new space. Dr. Magee stated that we are working on transitioning the Pediatric Internal Medicine Clinic to rural health designation as well as preparing for the future move of the FRHC to the new space once the remodel is complete. We contracted BOARD OF COMMISSIONERS MEETING
PAGE 7 OF 7 MANAGEMENT REPORT (Continue) Matchett-Vueleman by the recommendation of Chris Kohlenberg to assist us with the licensure and accreditation process. He said that we anticipate a DHH survey in the next eight weeks for the PI Clinic and process completion by or before December. We will keep the Board updated on the progression. Dr. Nicholson will be at work beginning Monday, June 30. A memo and schedule will go out to all staff and Medical Staff. Riverside Surgical Practice clinic space has been remodeled and is mostly ready, with the exception of a few pieces of equipment. He thanked the Maintenance crew for doing an outstanding job with the clinic and encouraged everyone to go see the clinic. The Maintenance crew will now be doing the renovations to the Curves building so we can move Wound care in that building in the near future and will also give them the additional day they requested. Dr. Magee said we are excited that Dr. David Allen, a podiatrist is in the process of purchasing Dr. Brain Fussell building and look forward to the additional procedures in the Surgery Departments as it continues to grow. PUBLIC PARTICIPATION Ms. Breland recommended having prayer announced over the intercom at hospital. She stated that other hospitals do and she would like to see it implemented here. She stated those that do not want to participate are not required or mandatory. She said that Dr. Magee can assist with the process and we need to seek God s Blessings for this hospital. A motion was made by Mr. King seconded by Mr. Thomas to table the matter until John Allen can make sure no issues will be involved. Ms. Claire McGuire, Chairman of the RMC Foundation, announced that employee s now have the availability to contribute to the foundation through payroll deductions. She further said that everyone on the foundation committee is working diligently to see the foundation grow and any contribution will be greatly appreciated. She is excited about all the projects being implemented at the hospital. Ms. McGuire extended to everyone to please make a monetary donation to the foundation because 100% of the funds go back into the hospital. Ms. McGuire requested that all contributions be given to Sherae Killingsworth in Administration. EXECUTIVE SESSION A motion was made to adjourn to Executive Session for Strategic Planning by Mr. Thomas, seconded by Mr. Knight. The public was excused at 5:15 p.m. A motion was made to adjourn Executive Session and reconvene the meeting by Mr. Jenkins, seconded by Mr. Thomas. The meeting was reconvened at 5:50 p.m. Upon reconvening the meeting, Mr. Jones reminded the Board of Commissioners to review the CEO Evaluation and turn the evaluation into Ms. Killingsworth by July 11, 2014. ADJOURNMENT There being no further business to be brought before the Board, the meeting was adjourned at 5:51 p.m. E. Kyle Magee, M.D., Secretary