BOARD MEETING: Regular Meeting DATE: March 28, 2017 MEMBERS PRESENT: Helen Adger, Kenneth Clay, Robert T. Green, Jr., Mary Irvin, David Norman, Helen Godfrey-Smith, Bruce Walker, Patricia White MEMBERS ABSENT: Brenda Smith TIME CALLED TO ORDER: 5:30 p.m. OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Dakota Robinson, Controller, Lanell Audirsch, Admin. Asst., Allison A. Jones, Attorney, Doug White, Hospital Attorney, Mary Coil, Foundation Director/Marketing Director, Beth Thomas, R.N., John Woods, Chief of Staff, Mike Gray, 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 Green offered the Invocation and David Jones 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. Pat White made a motion to approve the agenda as presented. David Norman seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Mary Irvin, David Norman, Bruce Walker; Nays: None; Absent: Helen Adger, Kenneth Clay, Brenda Smith, 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 February 28, 2017: The minutes of the February 28, 2017 Regular Board meeting were mailed prior to today’s meeting for review. David Norman made a motion to approve the minutes of the regular meeting as mailed. Pat White seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Mary Irvin, David Norman, Bruce Walker; Nays: None; Absent: Helen Adger, Kenneth Clay, Brenda Smith, Helen Godfrey-Smith, Abstained: None. The motion passed. VI. Old Business: 1) Construction Update – David Jones asked Pam Hughes to give the Construction Update. Pam Hughes stated that they are saying April 29th to be completed. Next week we are supposed to move parking lots and they are supposed to pour the other drive way if weather permitting. The Gift Shop and the Chapel are almost complete. They are going to move the entrance next week over so they can finish the other side then they will start taking the fire escapes down and start the work left on the inside. David Jones said it looks like little things to be done but it is meticulous things that are to be completed. The weather slowed down the parking lot to some degree. Bruce Walker said he has checked and looked a few times. He inquired about the material that would be used and was informed it would be hot asphalt on both sides. Pam Hughes said they are waiting until they get all the curbing built on the other side so they can come in on the weekend and do it all at once. David Jones said we are hoping it goes as planned – barring rain. He noted the number of rain days and bad weather days they have that are built up in the contract; they could probably go another four or five months and they would not exceed their max time from a contract standpoint. It is what it is. There are parameters that they get to claim for bad weather days – not just rain. If the percentage of the worksite is muddy and wet enough they get to claim those days until it dries significantly. Bruce Walker stated he was glad we got the contractors that we got. David Jones noted they are ready to finish up the job. They are locked in to the dollar figure that was bid. David Jones stated he is giving an estimate of $1.25 to $1.5 million dollars under budget for this project. That came by way of contingency money that is still left. The management of the project by Pam Hughes, and the management of the project and what she has done as far as purchase of equipment and staying up-to-date on cost and expenditures, and McInnis doing what they have been doing, we are still looking pretty strong as far as coming in under budget. There is some possibility for us to go forward with expanding Radiology to include the MRI unit that the Foundation is working on; which is going to need to happen anyway because there is no place for that big piece of equipment to go into and keep us on budget. Radiology and the Emergency Room are side by side. We are looking at ways to possibly give Dr. Woods a few more rooms and do the Radiology expansion and keep it within our budget. This is in the initial phases of planning from that standpoint. Pam said she would like to thank Stacy Alexander, Director of Nursing. She bought and saved a lot on the equipment purchases. David Jones said Pam Hughes wore out one pair of rubber boots and her hard hat has nicks in it. She has done an exceptional job. Pam said the crew said they hate to leave this project. 2) Dialysis Clinic Partnership Update – David Jones stated under New Business – #1 – we are at the end of doing our portion which is a small piece. We have had to be sure all our (T)’s were crossed and (I)’s dotted. We will talk more about that under new business. Hopefully you will see some construction in the next couple of months. 3) Tribridge Financial Upgrade Update – David Jones asked Dakota Robinson, Financial Controller, to report on the Tribridge Financial Upgrade Update in the absence of Allyson Allums. Dakota Robinson stated that we are actively upgrading right now. We started that last week. We will actually be in the testing phase starting next week for three weeks. Hopefully by the next Board meeting we will be live and ready to go. David Jones noted that this is totally upgrading our entire billing piece; all the financial management of the hospital. Dakota stated we were on version 2010. There are two versions per year – we were about 14 versions old. This is much needed. Dakota noted that our 340B program will be live on April 11th. David Jones noted that this is the Pharmacy program; the outpatient Pharmacy pricing program. We have high expectations for this program. We will be adding an update later on this year to give a financial picture of what this program is accomplishing. VII. 1) Review February 2017 Statistics – Allyson Allums: Dakota Robinson, Financial Controller, presented the February Statistical Report. As you can see admission were up this month. There were 70 Admissions and 66 Discharges with Total Days Stayed –193. The Average Length of Stay – 2.9 Days. Total In-patient Days – 197. The average Daily Census – 7.04. Our Total Occupancy Rate was 46.90%. Total Surgeries for February (In-patient – 3 / Outpatient – 3). Endoscopies performed in February – 15. The total Emergency Room patients seen – 469. Swing Bed Admission – 12. There were 123 Total E.M.S. runs in February. Observation Patients for February – 44. There were 3 Newborns in February. The total Patient Visits for the Medical & Surgical Clinic is 2007. The Plain Dealing Clinic saw 735. Benton Medical saw 117. There were 44 Mammograms for February. 2) Review February 2017 Financials – Allyson Allums – Dakota Robinson presented the Financials. Hospital Revenue over Expense. Revenue –$3.3 Million, Expense – $2 million with a profit of $73,405. The AR Days for all three facilities – 45; for the hospital only is at 44 days. Plain Dealing Clinic – Revenue over Expense. Revenue –$174,000, Expense – $90,000 with a profit of $50,147. The total patient visits of 735 is the highest they have seen in a while. David Jones noted that this is the first full month the new Nurse Practitioner was working and it is the shortest month of the year. The 735 number seen is a window of what we could see over the months and years. Medical and Surgical Clinic – Revenue over Expense. Revenue – $540,000 Expense – $292,000 with a profit of $25,000. Benton Clinic – Revenue over Expense. Revenue –$33,000 Expense – $18,000 with a loss of $6,000. David Jones noted that reimbursement at the Benton clinic is not the same as the two clinics in the northern part of Caddo and Bossier Parish. This is because Benton is not a rural health clinic. Their Medicare and Medicaid rates and how many patients they see is probably half of the rural health clinic. We are looking to remedy that. Pam Hughes and Rachel Bouchard had a conference call this morning going over that. He wanted to explain that figure a little more. Dakota Robinson reported that Bad Debt Expense is about average at 5.8%. Days cash on hand – 26.78 days. Self-Funded Insurance – for this month is at $100,000 in expense and our aggregate reimbursement for claims that exceeded the limit of $40,000, we received $739 reimbursed to us. We at $565,000 for the year. The historical average for last year at this time was $600,000. We are trending in the right direction on the self-funded insurance this year. This is good because that can cost you a lot of money. David Jones noted that March is trending as a good month as well. The census has been steadily climbing. Pat White made a motion to accept the Statistical and Financial Reports as presented pending the audit. Helen Adger seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Helen Adger, Mary Irvin, David Norman, Helen Godfrey-Smith, Bruce Walker, Nays: None; Absent: Kenneth Clay, Brenda Smith Abstained: None The motion passed. VIII. New Business: 1) Leasing of Property at 818 South Spruce Street – David Jones stated that this is the property that is right across the street on the corner lot. We have an agreement that he would like Doug White, hospital attorney, to speak on. Doug is involved in looking at the terms of the agreement with the contractor Fresenius is using to build the building. They will sublease it out, have this gentleman to build the building and he will turn around to sell the building back to Fresenius. We thought about doing this to begin with but there were too many issues to deal with. Our goal is the dialysis clinic. We own the property. This gives us a little part in the business. This is the quickest route to get the dialysis clinic up and running. We had to do some fair market value analysis on the lease amount. We did this and we had one appraisal; the second came to us and said he could charge us to do what we have already done. This is what it is per square foot and this is how many square feet you have. You can do the multiplication as well as he can – I can charge you $10,000 to do this. David Jones then called John Wells, our auditor, to make sure he knew what took place. We do have an official appraisal and what the other appraiser comments were. He sent it back to the person that will be leasing the property and told him he wanted the maximum amount of $8,000 per year; which was no problem. Fresenius developed the lease and sent the wording to David Jones. He reviewed it and had some corrections added in. Corrections were made and returned to David Jones. David Jones then sent it to Doug White. Doug White had some initial corrections which have been corrected. There are a few more things that Doug wants to change as well. Doug White stated that there is an old saying in law if you read a contract, it is an education. If you don’t read the contract is it eventually called an experience. He read this and there is collective bargaining in this. There is a release of all the default provisions. He is going to go through it in some detail and turn it into something favorable for North Caddo. It is going to require some tweaking. It will take a few days to do this. David Jones would like the authorization to sign this once Doug White has put his stamp of approval on it so that we can expedite getting this project off the ground. Doug stated that this a fifteen year seven/five year renewal periods at the option of the lessee. His crystal ball is very foggy – he does not know that in fifty years, the way of medicine, if dialysis will even be state of the art in fifty years – who knows. There is a lot to do here but fifty years is an awful long time. David Jones stated that they are building a million dollar facility and basically saying if they pull out they leave us the million dollar facility. They want something from us saying we are not going to jerk the rug from beneath them. They put an investment in the property and want to run a business. Ultimately the building will be ours if they decide they are no longer interested. We will have a 5,000 square foot building. That line of business is not going away in the near future – that is for sure. Fifty years from now, we may all be gone at that point. In the next 10 years people aren’t getting healthier in the United States. David Jones said once the Attorney is 110% satisfied with the wording of the contract. Bruce Walker inquired if we have the price we will be getting. The answer was yes – $8,000 a year. Pat White made a motion that Mr. Jones be authorized to sign the contract for Fresenius Dialysis center once it is approved by the attorney. The motion was seconded by Bruce Walker. There was no further discussion. The vote: Yeas: Robert T. Green, Jr., Pat White, Helen Adger, Mary Irvin, David Norman, Helen Godfrey-Smith, Bruce Walker, Nays: None; Absent: Kenneth Clay, Brenda Smith Abstained: None The motion passed IX. Administrative Report: 1) NCMC – Current Activities – David Jones stated that thanks to the efforts of the doctors, particularly Dr. Woods, we have had a lot of interest in surgeons that want to come and use our facility. They have heard that we have this beautiful hospital. We had one individual and a group to come up. Once they take a look at it they are very interested. We have been told there is another doctor that has interest. It is to the point, that if he does not come up this week, David Jones said he will decide one or the other. At this point, Helen Godfrey-Smith inquired if this would be a possibility of income for the hospital. Mr. Jones replied yes. Our surgical area is an area that can produce revenue. Helen Godfrey-Smith asked, from a use standpoint, do we use the surgical center for our patient care? Do we have the time available for the additional service? David Jones replied yes. There are some things we can do, from a nursing standpoint, but some things get complex to some degree – staff training period figuring out what to do and we do not have intensive care beds. If the patient is at an acute level the surgery can be done here. Many things that are being sent to other facilities that should be done here. Dr. Woods said that one of the doctors in the group that we talked to is very familiar with operating in small communities and he understands that we want to keep the business here in town and do the procedures that we can do here. He is going to try to do small outpatient procedures first – gallbladders, hernias, appendectomies – all those types of out-patient surgeries, we can easily do here that we are sending out. The good thing about having a group is specifically for call. That is the main problem we get into with individual surgeons – one doctor trying to cover 24/7 and follow up. We did have a surgeon coming but he lives out of town. The follow-up is dismal. David Jones stated that you also worry about, from a group versus an individual standpoint, is Dr. Nawas. We had Dr. Nawas coming up when he first was beginning his practice – great doctor, with a huge following here. He does not know if anyone followed him in Bossier. His clinic is ridiculously busy now. It became cost prohibitive for him to leave that clinic to come up here. He could stay at his home base and see even more than coming here– why would he do that? Getting an individual surgeon may end up being the same way. Once he became so busy in Shreveport or Bossier, why would he come here? If he was from here and had family here, then maybe he would see it as a service type thing. None of these people do. The group is actually bringing on a partner and they are wanting to expand. They want the business. David Jones states it is a win, win type situation. As Dr Woods said, when you have one guy – how many times at 2 a.m. in the morning before he starts getting wore out and Dr. Woods has a potential appendix or something going on that he needs to talk to him about. It becomes a situation to where sooner or later it just becomes unattainable for one person to keep doing financially. Helen Adger noted that our operating room is impressive. David Jones stated that the head surgeon came and he stated that is the way an Operating Room should look. Dr. Woods said the accessibility of the OR is set up well so the surgeon can see what is needed and well lighted. David Jones said from the recruitment standpoint – we have an OB/GYN that is interested. She is still in residency. She is well thought of. Dr. Taylor and he, David Jones, had dinner with her and her husband. She asked all the right questions. She was concerned about call; concerned about surgical backing. We are trying to get some of these things in place before we go back to her with a plan. Helen Godfrey-Smith inquired when she would be out of her residency. David Jones replied next June. She asked if that timing is good for our plans. David Jones said it could be a little better but Dr. Taylor is trying to make his final decision on how he would like to see the next ten years of his career to go. His clinic has picked up quite a bit, his speed on the electronic records has picked up. Dr. Taylor said by next Friday, he will give David Jones a solid commitment on what he wants to do. If he doesn’t go in the Emergency Room, Dr. Woods and David Jones has some thought. There is another resident that is third year – great residents. These three are the best group of three we have had so far. One is interested in following Dr. Woods’ path. And we do have a slot open in the Emergency Room. Dr. Taylor will have the first decision whether he wants to do that or not. It’s tough making those decisions. Dr. Taylor is telling David Jones that next Friday the will be able to give him something that he is going to commit to. David Jones said he will probably have a few witnesses in the room whenever that statement is made. David Jones stated that for current activity – that is pretty much it. Helen Godfrey-Smith, talking about the team of surgeons that might come in, what would be the approval process – would it be similar to what we do for individual doctors when we approve and give them privileges of the hospital. Would each individual have to go through the process? David Jones replies they will. All doctors have to go through the credentialing process. David Jones, stated that Beth Thomas is here tonight. She has about 12 titles. One of those, she is in charge of our Infection Control for the hospital. She has graciously agreed to put something together to speak to the Board on, similar to how Mrs. Bouchard did last month. We have all of these little processes going, so we hope to have each one of them to speak on. It gives you someone new to put a face and title to and go forth. 2) Infection Control Committee Report – Beth Thomas stated she does a little bit of everything – Infection Control, Employee Health, Employee Education, back up for OB, OR, and ER. Mr. Jones asked her to tell what the Infection Control Committee has done. She provided the Board with a copy of the Agenda for the meeting held in January. She noted those individuals on the committee – two physicians, Housekeeping, Lab, Pharmacy and Surgery Personnel added to the committee. They review what is done on a daily basis; cultures on patients of the hospital to identify any trends coming through the community. They review new drugs that are best for treatments, cost analysis of drugs. Employee TB skin testing is done on an annual basis, she does N95 mask fit-tests for employees involved in direct patient care. A new federal mandate is Antibiotic Stewardship. The nursing staff and residents have been trained in January. She went to her first training in May. All of the 70 hospitals represented in that meeting were all at ground zero. This is coming from CDC and Medicare – it’s nationwide. It is being an Antibiotic Stewardship where the doctors are controlling antibiotic resistant organisms. The more antibiotics that are prescribed that are not needed, the more resistant the bacteria can become. They are wanting us to decrease the antibiotic usage. One of her new jobs is making sure the patient in on the right antibiotic for the right amount of time; must note as to why they are on it; can use one that is cheaper unless harmful to the patient’s kidneys; can we switch to this one now. She gets questionable looks from the doctors sometimes. She will go to another meeting on this June in Alexandria. The Infection Control committee goes over the Housekeeping products used to make sure we have the best, newest and brightest out there that kills all the bacteria that we see coming through here; that is the least toxic to our patients and staff and kills the most bacteria. Right now we are using Quant – with four different killing agents in it – it kills bacteria, viruses, spores – kills it all. James Martin and Leon Jackson do a good job of infection control in-service training of their employees on how to do the proper cleaning for each department; on what needs to be done. Additional information provided to the Board is a report that is received from Willis Knighton system regarding the organisms and susceptibility of different antibiotics. Additional information provided was regarding the Antibiotic Stewardship. These are samples of Stewardship programs. It goes over that it requires help from everybody in the hospital; the physicians have to support them wholeheartedly; the Pharmacist has to be up-to-date on what is available and what we can use for the community. The patients need to understand that IV antibiotics are not always the best, sometimes a pill will work also. It can aggravate some patients wanting IV’s when a culture shows that pills will help you better and will let you be at home while you recover. It is going to require a lot of her time in computers because, starting in 2018, she will have to enter data into the CDC database with all of this. The CDC is sending her educational pamphlets to provide patients and put in the clinics and give to Board members. It goes over why we are doing this – the whole program is to protect our future generations because these bacteria are mutating enough that the antibiotics won’t kill them. She stated there are some scary statics in some of this information. David Jones noted that hospital acquired infections at our hospital is extremely low. This has always been a bragging point of ours. This is the doctors, nurses, Infection Control Committee, giving it the importance it should have. It is a team effort for certain. Mr. Jones thanked Beth Thomas for her presentation. 3) Foundation – Mary Coil, Foundation Executive Director, reported the Foundation has decided not to do a Gala this year. They are going to try to do something different. She spent the day at Los Paloma, where we are looking to do a sporting clay shoot on July 15th. We are also planning to play Bingo for those who are not interested in shooting skeet. We are looking forward to that event, involving in different groups that we haven’t involved before; haven’t been involved in the Gala; reaching a different demographic and at the same time having a casual event to keep our name out in the community and our relations with our donors. We are looking forward to that and it will be something new and exciting for us. There will be more to come in the next few months. It will be here before we know it. She asked them if July 15th will be a good day, even though it will be hot. They assured her that all skeet shoots were in the summer time because you can’t get close to hunting season. XI. Medical Staff Report: 1) Recommendations – Allyson Allums – Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval: MEDICAL STAFF APPOINTMENTS: 1. Kathryn Wagner, M. D. – Requests Provisional Privileges in the field of Radiology for the period of March 1, 2017 through March 31, 2018. 2. Michelle Goin, M. D. – Requests Provisional Privileges in the field of Radiology for the period of March 1, 2017 through March 31, 2018. 3. David Burdette, M. D. – Requests Provisional Privileges in the field of Radiology for the period of March 1, 2017 through March 31, 2018. 4. Glen Mason, M. D. – Requests Provisional Privileges in the field of Radiology for the period of March 1, 2017 through March 31, 2018. 5. John Nwankwo, M. D. – Requests Provisional Privileges in the field of Radiology for the period of March 1, 2017 through March 31, 2018. MEDICAL STAFF REAPPOINTMENTS: 1. Chi-Tai Peter Lau, M.D. – Requests Courtesy Privileges in the field of Emergency Medicine for the period of March 1, 2017 through March 31, 2019. 2. Russ Savit, M. D. – Requests Courtesy Privileges in the field of Radiology for the period of March 1, 2017 through March 31, 2019 ADVANCE PRACTICE PROFESSIONALS APPOINTMENTS/REAPPOINTMENT: NONE. EXTENSION REQUEST: NONE. VOLUNTARY RESIGNATIONS: NONE. Pat White made a motion to accept the Medical Staff Recommendations for Medical Staff Appointments, Reappointments. Helen Godfrey-Smith seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Helen Adger, Kenneth Clay, Mary Irvin, David Norman, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: Brenda Smith, Abstained: None The motion passed. 2) Chief of Staff Comments: Dr. John Woods, Chief of Staff, stated that Mr. Jones covered most of what he was going to mention regarding new physicians. Mr. Jones covered that pretty well. Everything else is running smooth and everybody is doing fine. David Jones noted that the Security Department is doing great works here at the hospital. Dr. Woods agreed. David Jones stated that no less than 6 employees sent him emails thanking him for the Security. There have been several texts and emails asking him to thank the Board for this. Mike Gray is doing a great job and the staff is extremely professional. It has taken a load off the employees. Thank goodness we have not had too many bad situations. It is just a matter of time before a tragedy will strike again and those are the times you can’t put a dollar figure on what they will bring to the table when it comes to something like that. Robert Green stated that the word gets out in the community that we now have security. Dr. Woods said police presence will help keep the bad situations away. Helen Godfrey-Smith said as the community is aware of that presence, then you avoid the drama. XII. Executive Session: None. XIII. Adjourn: There being no further business Kenneth Clay made a motion to adjourn. Bruce Walker seconded the motion. The vote: Yeas: Robert T. Green, Jr., Pat White, Helen Adger, Kenneth Clay, Mary Irvin, David Norman, Helen Godfrey-Smith, Bruce Walker Nays: None; Absent: Brenda Smith. Abstained: None. The motion passed. Meeting adjourned at 6:30 p.m.