BOARD MEETING: Regular Meeting DATE: June 27, 2017 MEMBERS PRESENT: Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Brenda Smith, Bruce Walker, Patricia White MEMBERS ABSENT: Helen Adger, Helen Godfrey-Smith TIME CALLED TO ORDER: 5:30 p.m. OTHERS PRESENT: David Jones, CEO, Allyson Allums, CFO, Lanell Audirsch, Admin. Asst., Mary Coil, Foundation Director/Marketing Director, John Woods, Chief of Staff, Walter D. (Doug) White, Hospital Attorney, Mike Gray, Security LOCATION: NCMC Events Center BOARD CHAIRMAN: Robert Green SECRETARY: David Jones I. Called to Order – Robert T. Green, Jr – Chairperson, called the meeting to order. II. Invocation and Pledge of Allegiance –Robert T. Green, Jr. offered the Invocation and Pat White led the group in the Pledge of Allegiance. III. Approval / Amend Agenda –Robert Green stated that the first item on the agenda is to approve or amend the agenda. Brenda Smith made a motion to approve the agenda as presented. Pat White seconded the motion. The vote: yeas: Robert T. Green, Jr., Kenneth Clay, Pat White, Mary Irvin, David Norman, Brenda Smith, Bruce Walker Nays: None; Absent: Helen Adger, Helen Godfrey-Smith; Abstained: None. The motion passed. IV. Community Comments –Robert Green, Chairperson, noted there were no signed Visitor Recognition Cards requesting to address the Board. V. Minutes – Regular Meeting April 25, 2017– The minutes of the May 23, 2017 Regular Board meeting were mailed prior to today’s meeting for review. Pat White made a motion to approve the minutes of the regular meeting as mailed. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker; Nays: None; Absent: Helen Adger, Helen Godfrey-Smith, Abstained: None. The motion passed. VI. Old Business – 1) Construction Update:David Jones stated that the parking lot is going about as fast as the building did. They said they were going to do the parking lot in two days. They didn’t finish the north part of the parking lot in 2 days. It rained for 3 days. Then they let it dry for most of yesterday and they were back late yesterday afternoon finishing up a small strip on the north side of the parking lot and started on the south side. I think they have the first layer done on the south side. They are saying they will be done this week on the parking lot. They plan to stripe it on Saturday. They will shut the whole parking lot down and stripe the whole thing at once. Come Monday morning we are supposed to have a mostly done parking area of the parking lot from what he has been told. Building wise; I don’t know if you have noticed but there are no red stairwells across the back of the building and they are finishing up the sidewalk; extending it all the way to the Emergency Room. That is pretty much the last major thing that needed to be done to the building. There is a ton of small touch up things that remain to be done. The water wall is close to being finished. Hopefully that will be working sometime tomorrow. For the most part, the building is done. We had a brief meeting to set a date for our Grand Opening. I will inform the Board of this later. 2) Dialysis Clinic Partnership Update: David Jones noted that a couple of trees had been knocked down on the lot and posted them as free for anyone that wanted firewood. There have not been any takers yet. There were some workers there today checking out the grounds. They are supposed to begin some additional clearing on Wednesday, July 5th. Hopefully by March 2018, the building portion of that will be done; depending on the weather. It takes months for it to get okayed by the State. This is not a low bid job so he imagines this will go faster than the hospital did. 3) Surplus Equipment Update: David Jones noted no bids have been received. There was not large items. There will be another list coming because we are trying to get rid of some of the storage building that we have been storing things in for the new hospital. We will get rid of some of the old items to shave some of that down. Bruce Walker asked if it would be hauled to the dump. David Jones replied yes. He said most of it should be discarded but it is a process that must be followed. 4) Radiology and ER Expansion Update: David Jones stated there is no real news on the Radiology or ER Expansion Update yet. We are still waiting on the State to rule on the waiver we put in. There is the requirement to have an ante room in the MRI suite. We have the waiting room which will be right next to the MRI room and we could use it for that. That is what we put a waiver in to the State for. That would reduce the construction by about 180 to 190 square feet which is money savings. There is no need for it at all. We are waiting on the State to rule on that before we actually go to bid to see how much it will be. Mary Irvin inquired about what kind of timeline before this expansion would possibly start. David Jones stated hopefully by Christmas. Mary Irvin stated that she was curious. David Jones stated that it should start within the year. Mary Irvin asked if it would be the same contractor that we have now. David Jones stated that it would go out for bid. He would imagine that the contractor we have now will have a pretty large jump on anybody else because they already have workers here. That would be some cost decrease for them to bid on it because of that. They would not have to move people in. The likelihood of them winning it is pretty strong. Mary Irvin asked about the architecture part; is in the works now – the same company we used for the hospital. David Jones stated yes. Mary Irvin asked what the name of the architecture company is. David Jones replied TEG. 5) Meaningful Use Upgrade Update: Allyson Allums stated that the code for the Meaningful Use Upgrade was installed last week. It is ready to go. When we get ready to attest, everything will be there. David Jones said hopefully that will be the last one we will have to do. It is mostly governmental hoops you have to go though. 6) Reappointment of Robert T. Green, Jr. Update: David Jones asked if there was any update on the reappointment of Robert T. Green, Jr. It was reported that an inquiry had been made of the Commission Clerk on the reappointment status of Robert T. Green, Jr. An email reply from Todd Hopkins, Commission Clerk, was received which stated that the reappointment of Robert T. Green, Jr. will be on the Commission’s agenda for July 3rd for authorization and July 6th for Final Appointment. VII. 1) Review April 2017 Statistics – Allyson Allums: Allyson Allums presented the May Statistical Report. There were 60 Admissions and 58 Discharges with Total Days Stayed –192. The Average Length of Stay – 3.3 Days. Total In-patient Days – 183. The average Daily Census – 5.9. Our Total Occupancy Rate was 39.40%. Total Surgeries for May (In-patient – 6 / Outpatient – 2). Endoscopies performed in May – 15. The total Emergency Room patients seen – 433. Swing Bed Admission – 9. There were 138 Total E.M.S. runs in May. Observation Patients for May- 30. There were 10 Newborns in May. The total Patient Visits for the Medical & Surgical Clinic is 1815. The Plain Dealing Clinic saw 616. Benton Medical saw 158. There were 32 Mammograms for May. 2) Review April 2016 Financials – Allyson Allums: Allyson Allums presented the Financials. Hospital Revenue over Expense. Revenue –$3.3 million Expense – $1.6 million with a profit of $346,000. The AR Days for all three facilities – 58.5; for the hospital only is at 46.9 days. Plain Dealing Clinic – Revenue over Expense. Revenue –$148,000, Expense – $96,000 with a profit of $7,249. Medical and Surgical Clinic – Revenue over Expense. Revenue – $505,000 Expense – $207,000 with a profit of $5l, 000. Benton Clinic – Revenue over Expense. Revenue –$39,000 Expense – $18,000 with a loss of $2,900. The Bad Debt Expense is at 4.0%. Days cash on hand– 27.00 days. Self-Funded Insurance –The total expense was $123,450 for this month and the specific reimbursement, for any claim over $50,000, we received $899. Comparing the last year to this year which is self-funded to self-funded, we are running just a little higher this month – $l,060,000 to $960,000. We have had several large claims. This is the reason for the increase. Brenda Smith commented that Benton is advertising the new addition there. David Jones stated that the Nurse Practitioner was set to start yesterday, however, the State must approve a nurse practitioner’s new affiliation. This has to be applied for by the Nurse Practitioner and was applied for over a month ago. It is just a process to go through. She actually has patients booked which had to be moved until this approval is received. We have very high hopes for her. She is high energy and very proactive in getting patients in. Pat White made a motion to accept the Statistical and Financial Reports as presented pending the audit. Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Helen Godfrey-Smith; Abstained: None. The motion passed. IX. New Business – 1) Approval of Purchase of 3M Encoder Software: David Jones asked Allyson Allums to speak on the purchase of the 3M Encoder Software. Allyson Allums stated that it is time for the annual renewal of our encoder. An encoder is what is used to code all of our charts for their diagnoses that goes on the bills. Currently we are with 3M which is pretty much the leader in the market of encoders – the Cadillac of encoders. We have had them for fifteen years or more. Their quote for continuing is about $2,000 higher than it was last year. It is $22,922.25. We got three quotes just to see if they were comparable with what was out there. We spoke with the other company that Cerner said they had interfaced with – Optum. Optum said they do not interface with Cerner. They said they were going to send the quote, but she has not received a quote. We looked at a company called TruCode, which was another that we researched and found. They were $15,000 to $16,000 but they will not interface with Cerner. She talked with Cerner again and the only two companies they interface with is 3M or Optum and she can’t get a quote from them. She recommends that we stay with 3M. They are tried and true. Bruce Walker asked what the cost is for the 3M software. Allyson Allums replied – $22,922.25. Mary Irvin asked for software that we purchase every year? Allyson Allums said it is the license that you keep renewing every year based on how many coders you have and the different programs. David Jones stated that the encoder is the software that they use to basically change every procedure into a number and every diagnosis into a code of some sort because that is how we are paid. Once we bill it out, then we are paid based off of those codes. Allyson stated that all the code rules and references to make sure you are coding correctly. Brenda Smith asked if this is the same software that the Doctors use. David Jones replied no. This is what our coders use. Brenda Smith made a motion to approve the $22,922.25 for the 3M Encoder Software. Mary Irvin seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Helen Godfrey-Smith. Abstained: None. The motion passed. Robert T. Green, Jr. inquired about the Financials. At the last meeting it was reported that we were supposed to receive some payments. Did we receive them? This was money for the Cost Report. Allyson Allums stated that yes we did receive the cost report payment. This week we started receiving 340B money and FMP money; some additional monies we were looking for. Robert Green, Jr. asked how much the cost report payment was. Allyson Allums stated that she was not certain. David Jones said we received one that was for over $700,000 and a smaller one, and we had to pay one back. That is why Allyson is not certain. Robert Green said he is looking at the amount. Maybe he was looking at cash on hand. He was expecting it to be higher. Allyson stated we are ten days higher than last month. Robert Green was looking for it to be higher. David Jones noted that when it comes in we have to pay the bills with it. Mary Irvin asked when we have to pay money back – how does that work. David Jones stated that they either hold it back from you out of future payments or you write them a check. It typically takes at least 5 to 6 months to get your money but they get theirs right now. Brenda Smith asked about the 340B. The last time we heard we were waiting for the bigger pharmacies. Allyson Allums stated that we received payment from Benzar this week. They had to hold out a $30,000 fee between the two pharmacies for the implementation fees. They held out $20,000 out of this check and we still got a little over $2,000; so those after they take the other two and continue they should be good. Walmart should pay soon and they will owe $10,000 out of that one and the rest will be ours. Once we get those fees out of the way then the money will grow. Dakota is watching it every week. We are excited for the ones coming next. Brenda Smith asked how the patients are finding out about this. It is through the Doctors? The answer is yes. She asked is there any way to get that information out to people who might be a possible patient. The only way that we get 340B money is if they have a documented visit. If they come and use us then they can get the benefit of this. Brenda Smith said she is talking about a marketing tool. There are people that are up against it trying to pay for their medicines. If they knew that is available they may be likely to come here to utilize the program. Mary Irvin said she understands that we are obligated to the implementation fee, so each pharmacy is deducting their implementation fee from our profits. How often do we have to do that? Allyson Allums stated it is one time. Once that fee is paid, then everything is ours. Mary said we pay the pharmacies $10,000 to implement it. Allyson said yes. Pat White said it is a money maker. Mary Irvin said that is fine. The prescriptions are so expensive. David Jones said he wished we had implemented this program six years ago. 2) Approval of Budget for 2017 – 2018: Allyson Allums stated that budget was mailed out to the Board members. The last copy had details at the end of each department and assumptions made within the budget. She did not receive any questions from any of the Board members. If the Board is happy with the budget presented, we ask that you approve it so it can be implemented on July 1, 2017. Robert Green, said after review of the packet, are there any questions. Brenda Smith said she had a couple of questions about the assumptions. The patient revenue is increasing 10%. Was that from the time before we started building that there was an expected increase in patient revenue simply because of completion? Is that the 10%? Can we tell, looking at statistics, we have held our own, does it look as though we are going to meet that 10%? David Jones said he believes so. We will finally be able to open up our surgical wing, we can push our emergency room – it’s not being pushed at this time. There are lots of growth areas that we can pursue and realistically expect the staff to do it now. Whereas, before, it just was not functional enough to go and do things like that. Brenda Smith said back when we had the study done, it is typical that the increase after you build a new hospital, but she was kind of curious as to whether it looked like we were going to actually make that. The other question was when was the last time we did an across the board 4% increase? David Jones replied – last summer. It is not an across the board – it is a merit increase up to 4%. Brenda Smith said is that procedure built into the performance criteria. David Jones replied yes. She said it could be 4% or it could be something below. David Jones said that is correct. On a rare occasion – 0% and on a rare occasion 5% also. Brenda Smith that was all of her questions. Pat White made a motion to approve the Budget for 2017 – 2018 as presented. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Helen Godfrey-Smith; Abstained: None. The motion passed. IX. Administrative Report – 1) NCMC – Current Activities:
David Jones stated there are a lot of things going on. He alluded to it earlier; he wanted to make sure the Board knew that we have established a committee to try to set forth plans for our Grand Opening Ceremony. We will have to revamp the committee now that Mrs. Helen Godfrey-Smith is unavailable. We came to an agreement on a date of August 24th at 2:00 p.m. We are going to have a grand opening on a Thursday afternoon. There were lots of debating on weekend, morning or evening and location. It will be inside the front entrance of the hospital. We have speakers coming. The president of the LHA, Paul Salles. He has invited Mr. Jim Elrod; no confirmation from him. We have reached out to State Senator, State Representative, and our US Congressional Representative. He has not spoken with Doug Dominick yet but will invite him to speak. He will get an agenda to the Board as soon as one is developed. It will be a very exciting time. It is a time to give thanks that the project is done! It will be four years in September since we broke ground. Have you soaked in that number yet? Some ways it seems like ten – then some days it seems like four months. That is currently the center of our activity. There are some things that Mary Irvin wants to discuss. Mary Irvin said she knows that Mary Coil will talk about it more, but on July 15th our hospital is going to have an amazing Foundation event. She knows that Mary Coil has said that if anyone has anything that you would like to contribute as prizes or auction items; whatever the event may hold. She is speaking personally on this and putting this out there for each to consider. As a Board member she would love to be in a position to be able to donate something grand and wonderful as a Board member but she is not in that position. She thought it would be wonderful if any of the Board members would like to pool money together and take it to Missy at New Beginnings to create something wonderful to give to the Foundation to be auctioned off as supporters of that event; whether you are able to be there in body; to show support. That would go far with the employees to see that the Board is supporting the Foundation’s efforts in giving back to our hospital. She brought a handy envelope if someone would like to put something in it. She will give it directly to Missy at New Beginnings. She thought that would be a wonderful way to support Mary Coil and support the Foundation. They certainly do so much to give back to our hospital; things that we are not able to do. It would be good for each one of us to consider giving a little bit back from our own pockets. With us all coming together we could make something nice for the Foundation. If you would like to put something in, that would be great. Robert Green, Jr. thanked Mary Irvin for thinking to do this stating. He will definitely participate. Other members voiced their thanks for this suggestion and agreed to participate. 2) Foundation: Mary Coil thanked Mary Irvin and stated that she knows the Foundation Board members will appreciate that a great deal. She said definitely one of the questions that she is asked from donors; is about the Boards and this is just one more thing you do to support them. She does appreciate that. She stated there are raffle tickets for a 28 gauge shot gun for $20.00 and she has Bingo tickets here tonight for the July 15th event – $20.00 each. These can be payroll deducted. She has forms if you would like to fill those out tonight. The shotgun was donated by Bourn Trucking, Carter Services and Goodwin Welding. Carter Services is the only one that is local. We definitely appreciate their contribution of the shotgun. We are still accepting teams. We have a lot saying they are coming to shoot skeet. She said she is still accepting individuals and team members. It would be great to have a Board team. We are excited with this new venue – it is different. It is mostly men so they don’t like to preregister. We are looking forward to it and appreciate you all being there. If you have any questions about the Bingo tickets or raffle tickets let her know. Mary Irvin asked what the big project they are working on now is. They would like to purchase an MRI for the hospital. That is a million dollar project. They will look at other possibilities along the way as needs come up. There is one that will be going to the Foundation board to see what they think about it. There will be some things to come up between now and a million dollars. Hopefully not too many. Brenda Smith noted that the Board was provided with a copy of the Foundation minutes by Mary Coil. X. Medical Staff Report – 1)Recommendations – Allyson Allums:Allyson Allums noted that there was an error on the mail out regarding Extension Requests. Number (1) on the Extension Requests needs to be removed – Dr. William L. Norwood, Jr. There is not an extension that we are waiting on for him. Brenda Smith stated she was wondering about this. Dr. Woods stated that this is an automatic approval process that gets pushed out. This must be filtered each time and this was over an oversight. Bruce Walker inquired if we were still courting the surgeons? Dr. Woods responded yes. David Jones noted that Dr. Banda was #1 on the Medical Staff Appointment list. Dr. Woods stated they will be coming in July. Brenda Smith asked if these doctors will be bringing patients from Shreveport here. Dr. Woods and David Jones responded no. Dr. Woods said these doctors will be doing surgery on our patients. They want to do the surgery here in this town and promote this hospital. They will hold a clinic once a week just to get the feel and landscape here then start doing outpatient surgeries as they come in and to get their feet wet and see what capacity we can handle then go forward from there. Dr. Woods stated so far, when he sees a patient in the emergency room, he will call Dr. Banda and he has been bringing them down there. The plan is to do the patient procedures here. Allyson Allums presented the Medical Staff recommendations for the Governing Board approval: MEDICAL STAFF APPOINTMENTS: 1. Michael Anthony Banda, M.D. – Requests Provisional Privileges in the field of General Surgery for the period of July 1, 2017 through July 31, 2018. 2. Husein Poonawala, M.D. – Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 3. Kurtis Tedesco, M. D. – Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 4. Mary L. Phillips, M.D. – Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 5. Justin Skweres, M.D.– Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 6. Christopher Morgan, M.D. – Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 7. Edgardo A. Agrait-Bertran, M. D.– Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 8. Taro Aikawa, M. D. – Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. 9. Ryan Campbell, M. D. – Requests Provisional Privileges in the field of Emergency Medicine for the period of June 27, 2017 through June 30, 2018. 10. Michael Colter Gates, M. D.– Requests Provisional Privileges in the field of Radiology for the period of June 27, 2017 through June 30, 2018. MEDICAL STAFF REAPPOINTMENT: NONE. ADVANCE PRACTIC PROFESSIONALS – APPOINTMENTS/REAPPOINTMENT: 1. Jere Thompson, APRN/FNPC– Requests Provisional Privileges in the field of Family Nurse Practitioner for the period of June 27, 2017 through June 30, 2018. 2. Pamela Ann Hall, CST– Requests Provisional Privileges in the field of Surgical Technologist for the period of July 1, 2017 through July 31, 2018 EXTENSION REQUEST: 1. Louis Joseph Sardenga, M.D.– Requests extension pending completion of credential application. VOLUNTARY RESIGNATIONS: 1. Christian Binder, M.D. – Voluntarily resigns Privileges in the field of Radiology as of June 1, 2017. 2. James Anthony Lee, M. D. – Voluntarily resigns Privileges in the field of Pathology as of July 20, 2015 due to retirement. 3. Colleen Hannon, PA-C– Voluntarily resigns Privileges in the field of Advanced Practice Practitioners as of May 12, 2017. 4. William Henry Dennis, M. D. – Voluntarily resigns Privileges in the field of Emergency Medicine as of February 5, 2017. 5. Sanjeevi Tivakaran, M. D. – Voluntarily resigns Privileges in the field of Neurology as of November 30, 2016. Brenda Smith made a motion to accept the Medical Staff Recommendations for Medical Staff Appointments, Advance Practice Professionals Appointments/Reappointment, Extension Request, Medical Staff Voluntary Resignations as corrected. Kenneth Clay seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Helen Godfrey-Smith. Abstained: None. The motion passed. 2) Chief of Staff Comments: Dr. John Woods, Chief of Staff, stated he will be short and brief. He has already talked about Dr. Banda coming in July. That’s probably the only new faces we will see when the new Residents come. It’s going to be a lot of change of personnel. A lot of guys will have to be on their toes. Ironically, he will be out for two weeks next month for National Guard duty. He thinks everybody is prepared and they have their marching orders. We have really good second and third year Residents. Everyone prepares for this on the medical end. They know to watch and babysit and orient them. They get assigned the more baby steps as opposed to the more complex things until they get their feet wet. David Jones noted that he invited the new Chief Resident to the meeting tonight. She has large interest in O.B. and we, the Contract Committee, have actually offered her a contract to come and work here next year. She is a very impressive young woman and not one doctor has said anything negative about her yet. We have some pretty tough evaluators from our medical staff. They speak highly as well. She has been a part of every delivery – going nine for nine or ten for ten in consecutive days. They have one going on right now, so she respectfully asked if she could come to the next board meeting and he said that was quite alright. Brenda Smith asked how that timeframe was going to work out with Dr. Taylor. David Jones stated it should be just right. David Jones said there is more to come. Mary Irvin stated that is good news that the surgeons are coming. XI. Adjourn:There being no further business Kenneth Clay made a motion to adjourn. Pat White seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Kenneth Clay, Mary Irvin, David Norman, Brenda Smith, Bruce Walker. Nays: None; Absent: Helen Adger, Helen Godfrey-Smith. Abstained: None. The motion passed. Meeting adjourned at 6:45 p.m.