BOARD MEETING:  Regular Meeting   DATE:  January 28, 2020    MEMBERS PRESENT:  Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Patricia White.      MEMBERS ABSENT: Robert T. Green, Jr. (arrived at 4:42 p.m.)  TIME CALLED TO ORDER:  4:02 p.m.   OTHERS PRESENT: David Jones, CEO,  Pam Hughes, COO, Dakota Robinson, CFO, Dr. John Woods, M.D., Chief of Staff, Mary Coil, Foundation Executive Director / Marketing Director, Lanell Audirsch, Admin. Asst.  LOCATION:  NCMC Events Center  BOARD CHAIR: Mary Irvin    SECRETARY:  David Jones    I.  CALLED TO ORDER – Mary Irvin, Board Chair called    the   meeting to order.   II. Invocation and Pledge of Allegiance – Brenda Smith offered the Invocation.  Helen Godfrey-Smith led the group in the Pledge of Allegiance.    III. Approval / Amend Agenda – Brenda Smith made a motion to approve the agenda as presented. Helen Godfrey-Smith seconded the motion. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: Robert T. Green, Jr.  Abstain: None.  The motion passed by unanimous vote in favor.   IV. Community Comments – Mary Irvin, Chair, noted there were no signed Visitor Recognition Cards requesting to address the Board.  V. Minutes – Regular Meeting December 19, 2019:  The minutes of the Regular Meeting held December 19, 2019 were mailed prior to today’s meeting for review.  Mary Irvin noted that on page one under #VI., the Minutes, the third line down, a correction needs to be made to change the name of Robert Green, who was absent, to Mary Irvin. Pat White made a motion to approve the minutes of the Regular Meeting held December 19, 2019 with the amendment as noted. David Norman seconded the motion.   The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: Robert T. Green, Jr.  Abstain: None.  The motion passed by unanimous vote in favor.  VI. Foundation Report –  Mary Coil, Foundation Executive Director / Marketing Director, thanked Mary Irvin and began by saying I wanted you to know save the date of August 29th. We will have our annual fund raiser like we did last year at the Petroleum Club. It will be at the Petroleum Club again. We are looking at some different things to go on like we did last year but I will say that we did put a deposit down on the same band which is very popular and we have had many requests. As you know we probably sold out three weeks prior to the event date last year, so we are looking at doing pre-sales to try to get that sale out even earlier.  Mary Coil asked if there were any questions. There were none. Mary Coil thanked the Board.  VII. Chief of Staff Report –   Dr. John Woods, Chief of Staff, stated what we are basically trying to work on right now is for Ochsner to get some type of OB/GYN coverage for Dr. Sharpe like we had spoken about previously. We are waiting on Dr. Sharpe and Dr. Taylor to draft a document stating this is their concerns and there is their needs and once we get that we are going to work with Dr. Eric McCathran, who is very familiar with our facility. He is one of the higher ups of LSU/Ochsner and has been around for a long time. Kenneth Cochran stated that Dr. Mc Cathran is a North Caddo graduate. Dr. Woods said he is a really great guy. Mary Irvin thanked Dr. Woods.   VIII. Old Business – 1) Purchase of New Chemistry Analyzer Update: David Jones stated that the Chemistry Analyzer is all but ready to roll. They actually have to do quite a bit of testing with side by side of the old instrument and the new instrument. It is one of the laboratory required things. By the next Board meeting that will be in full use and they will come and get the old one.  2) MRI Injector Update:  The MRI Injector is in and up and running. I talked to our Radiology Director yesterday. She said we did 8 MRI’s last week.    IX. 1) Review December 2019 Statistics – Dakota Robinson:  Dakota Robinson noted all the Statistical and Financial reports are in the booklet today. There is a trend for this month that is a good trend. The numbers increased pretty much across the board when we look at each and every department. When we look at Admissions, you will see there was a 44% increase, from 47 admissions to 68. Even more impressive, in the Swing Bed, those when from 11 to 16. You will see the Swing Bed program, the emphasis we have put on that over the past few months, we think, is working. This year alone, we have 719 Swing Bed days compared to 468 last year – a 53% increase. It has been a good area for us here the past six months. Looking at the In-patient Days, we see that same trend. We went from 140 to 217. These are Acute Days. That is a 55% increase there alone. With the increased Admissions, that goes hand in hand with the Average Daily Census we averaged about 12 people either in the Swing Bed program or an Acute Bed for the month of December. That is actually the highest number that we’ve had since March of 2019. Endoscopies were down slightly from 11 to 7. ER went from 472 in the month of November up to 518. We look at that over a 6 month period this year versus last year, we have had right at 3,000 total visits through 6 months in 2020 fiscal year and we had 2,500 the previous year – about a 500 patient increase and most of that has come in the past three or four months. Mammography is sort of distorted on this page a little bit. You can see they were back up in their average range to 36. They are back up and running in their new area. Newborns – there were 4 newborns last month. This fiscal year we have had 38. The Vivian Clinic saw 1,818 patients. We did have a provider out. That influenced the number slightly. The Plain Dealing Clinic saw an increase of 545 to 620 and on the year they are outpacing their previous year’s number as well. The Benton Clinic remained flat but had a small increase from 459 to 473 and they had a significant increase this year in the number of patients of almost 700. The Fitness Center, you see we are at the end of that curve that was December, not January. Any questions, comments or concerns on the statistics. There were none.   2) Review December 2019 Financials – Dakota Robinson: Just a brief overview for the month. We have been waiting on the UCC Funds and the Cost Report payment. We know what that is going to be. Typically in December we can start usually seeing some of those come through. We haven’t seen either of them come through yet. The Cost Report, we have a remit, which we know it will pay out within the next three to four days so we will get about $400,000, I would assume, at the end of this week for the Cost Report. If you look at page 1 of the Balance Sheet, you will see in the month of December, Total Cash Unrestricted right at $3.8 million dollars. The previous month a little over $3.8 million. If you look at that without the CD’s that is almost 44 Days Cash On Hand and it is 53, almost 54 Days Cash on Hand with the CD’s included. Continuing on page 1, we are still above the prior year’s Cash Balance of $3.4. Everything else looks good. You look at the Sales Tax Fund. That has since rebounded to $644,000 and there will be a payment, I believe in February, that will go out that will be an interest and principal payment. In February’s Financials, we see that adjust down a little bit more. I believe that we got an analysis of the calendar year Sales Tax alone increased 5% last calendar year. At the bottom of the page, Other Assets, you see there is $1.4 million in Asset Not in Service. That is directly related to the construction. We are working right now to get that converted on to the depreciation schedule and we will move that into Capital Assets – Building and Building Improvements, hopefully within the next two months. Looking at page #3, we will look at the Income Statement. You will see that we brought in almost $3.8 million in Revenue. For the year we are a little above $21 million. The good thing about this year compared to last year, last year we continually ran contractual adjustments, contractual adjustments were high. We knew we looked at it, they were high constantly. When we got to the Cost Report that is why it sort of netted a Cost Report of $800,000 is because of some of the contractual adjustments and rates that we had set. When we get into Expenses you will see that we had a little over $1.2 million in Salaries and Wages. Mary Irvin thank Dakota for presenting that information.   (Robert T. Green, Jr. arrived at 4:42 p.m.)  Dakota Robinson continued stating the AR saw a decrease from 64 to almost 46. A lot of that is due to the increase in revenue in the month but you see that sort of cyclical. In the month of July we did see a month where we had 44. I do want to point out in the Non-Operating Revenue under Grants there is a line item there is a line item for $338,000. $200,000 of that is the donation from the Foundation for the purchase of the MRI. Sales Tax Revenue, I did discuss that where we saw an increase of 5% over the last calendar year and on the fiscal year it is still coming in above what we saw in the previous year. 340 B Revenue – we did $147,000 in the month of December; on the year $704,000 compared to $655,000. We’ve also seen the increase in that program as well. I believe we did sign up 12 new contract pharmacies and we also registered Benton Medical. We will see all of that roll live on April 1st.  Hopefully we can see those numbers continue to climb upwards. I don’t know what that ceiling is yet but I do expect that to continue to increase. That led to an increase in assets or profit of $124,267 and on 6 months of $594,000. Are there any questions. There were none.   Dakota continue stating if we look at the Departmental Revenue and Expense – I’m not going to spend too much time here, but if you look at it from the previous year you will see that a lot of our departments are in a very good position. Going to the Budget page on page 8, you will see that we were very close to the Gross Revenue budgeted number – off by $100,000, but we made that up in the Contractual Adjustments budgeted of almost $2.1 million. We saw some Contractual Adjustments of a little under $2 million dollars. We were only off $30,000 on that Patient Revenue and it was for the good. If we look at the year we see that a few of those months – October, November – where we saw the decline numbers eats into that number a little bit and we are off $800,000 in Net Patient Revenue. We drop down into Salaries and Wages. We budgeted for those and we are still underneath that number. We did creep above the Employee Benefits and Payroll Taxes. I was discussing with the Finance Committee that is mainly a function of how we take the expected total cost of that plan over a twelve month period, divide it by twelve and that is just what that number is. It is not surprising that we over budget in that category by $60,000. What I would like to see and I will keep track of it and discuss it each meeting, is that that number either stays close or as we go month to month we will continue to slide below that budgeted number. Looking at Total Expenses, we budgeted for almost $13 million. At this point we are at $12.5. Then we bump into Non-Operating Revenues, obviously the biggest line item on here is Grant Revenue – it is directly related to the UCC dollars that are coming in.  Dakota continued stated turning to page 9 – the Vivian Clinic turned a profit of $116,790 that is up from a loss in the previous month in November. They also saw 1,818 patients. Plain Dealing Clinic saw 620 patients and their curve went down with a minor loss of $9,000. The Benton Clinic saw 473 visits. The new rate has been established. At the last meeting we knew what the new rate was. Pam and her staff have rebilled those claims. We’ve got one payer back. Pam noted that United Healthcare has. Dakota said he believes they paid $11,000 in old claims and that was done in January. Since those claims have already been paid, those claims have already been adjusted on the system. What it will effectively do, we always look at that contractual adjustment number in the clinics and more specifically in the Benton Clinic. It started high and we have gradually seen it decline. That $11,000 in reimbursement from the insurance companies will reduce the contractual adjustment in that clinic which will increase the profit in that clinic once we get all of that posted. They did have a slight loss of almost $2,000. I would make the assumption that is going to flip in the next period and we will see that sustain especially with the new rate. Mary Irvin asked how far back did they allow you to rebill. Pam Hughes replied back to September 5th. Dakota it doesn’t generate a lot but $11,000 in a clinic setting is good and that is just one payer. Brenda Smith asked if that is one of the bigger healthcare payers. Pam said it is about the same. There are five of them. Dakota asked if there were any questions related to the Financial Statements. There were none. Mary Irvin stated she would entertain a motion to approve the December 2019 Statistics and Financial reports. Pat White made a motion to approve the Statistical and Financial reports as presented subject to audit. Brenda Smith seconded the motion.  The vote:  Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.    X. New Business – 1) Approval of Purchase of Maintenance Agreement for CT and Mammography:  David Jones stated we have a couple of items under new business. The first one is the purchase of a couple of maintenance agreements for our CT Analyzer and our Mammogram Unit. If I could have a motion and a second. The CT purchase of maintenance is a four year agreement for $136,120. That will be broken into four yearly payments of $34,030 and then the Mammography Unit is $38,922. Those maintenance agreements are with the manufacturers. Mary Irvin asked if the Mammogram is by the year. David Jones replied yes that is correct. Dakota Robinson stated all of these amounts are things that we have had. This is not new so they are budgeted numbers and they are reflected in the budget.  Helen Godfrey-Smith said she will move for acceptance of these purchases of our maintenance agreements. I think Mr. Jones pointed out how important these agreements are because we don’t have back up units. We have to have immediate responses when we have issues with these machines. David Jones said you will get a passionate amen from our Chief of Staff on that.     David Norman seconded the motion. Mary Irvin said if there is any discussion related to these purchases. We only have one CT and we only have one Mammography Unit. If they are down we don’t do CT’s and we don’t do Mammograms. You have to have maintenance on it. It isn’t like things that any given tech can go in and fix on these units. There is one tube inside the CT unit that costs somewhere between $25,000 to $45,000 – just the tube itself. Mary Irvin said these purchasing maintenance agreements are from provider of the equipment. David Jones said that is correct. Ronnie Festavan asked is there a deductible with them. David Jones replied no Sir. Mary Irvin stated it covers most parts, not just the labor. David Jones replied that is correct. It covers night time service, weekend service, those kinds of things. Mary Irvin asked if there were any other questions. There were none. She asked for a vote. The vote:  Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.   2) Purchase of ADP HR System:  David Jones said the second one is a new piece of software, one that we have been evaluating for quite some time. Our payroll system is run by ADP and they have a HR portion of their overall package that we would like to purchase. The purchase price is $19, 296 but that won’t be the realized price and I will go into why that is if I could get a motion and a second. It will be lower. Brenda Smith made a motion to purchase the ADP HR System Software. Pat White seconded the motion. David Jones said Dakota has been spearheading the research and use of the system. David Jones asked Dakota to explain the price and the function of the software. Every year we have to file 1094’s and 1095’s which tells the IRS how much the employee’s and their dependents health insurance costs. We use an outside vendor for that to prepare that form and it is $4,000 each year. This software prepares that so it takes it off the staff and it is already a price that we are already in for $4,000 is included in that. Since we already do have the payroll function and the time and attendance function through ADP, we negotiated a discount of $6,000 per year on that piece of software. It really brings the realized cost of that below the $10,000 mark – a little over $9,000. Basically what it does is the automation of the HR process from beginning to end. Do you have any comments Mr. Jones? David Jones said that is it. It automates processes that we have been doing manually for a very long time. We’ve been talking about doing this internally, purchasing something like this, even when Lanell was doing HR. We had looked at some software to help automate things. We just haven’t pulled the trigger for one reason or another. Kenneth Cochran asked if this would not result in any reduction in employees. David Jones said we have reduced that employee already. That doesn’t have anything to do with the purchase of this. We do have a couple of staff members that are carrying that load. I still have plans to replace that employee but with pause to evaluate that as time goes on.  Mary Irvin stated it is an essential expense to modernize what we are doing. Ronnie Festavan asked is there training that comes with this program. David Jones and Dakota replied yes Sir. Ronnie Festavan asked is it included it this. Dakota replied yes Sir. Dakota said I will say the one thing about ADP is that ADP has initial training and then every time we pick up the phone to deal with any issue there is no fee. It is all encompassing. We can call them 100 times yesterday, 100 times today and it is already paid for. Ronnie Festavan said I see here it says 4K recurring cost. Is there a yearly cost, is there a maintenance cost to it? Dakota said yes the $19,000 is a yearly cost. That is why I’m saying that $4,000 is a yearly reoccurring expense that we already have that is encompassed in this $19,000. The 4K will go away. David Jones replied correct. Ronnie Festavan said but you will incur $19,000 or a wash of about $15,000. Dakota replied no, about $9,000. David Jones said and then the $6,000 we are getting a discount because we are buying a bundle with the existing service we already have. Ronnie Festavan said so net cost? Dakota replied $9,286. Ronnie Festavan ask a year? To get everything we’ve talked about. David Jones and Dakota Robinson replied yes Sir. Ronnie Festavan said that is what I need to know. Thank you. Mary Irvin said that is very affordable. Helen Godfrey-Smith asked budget wise how much was it costing us before this add on. Dakota replied ADP said we are at about $55,000 for all payroll, time and attendance. All of those functions. Dakota said we shopped that around. We were even on Willis Knighton’s system. I can tell you that we were paying that before or more. Helen Godfrey-Smith said I guess what I am trying to make clear for me and the Board what was our cost in 2019 versus what will it be in 2020 so if it was $55,000 it will be roughly $64,000 this year. David Jones replied yes.    Mary Irvin can give them that example of how many deductions that an employee here at North Caddo can claim. Dakota said I think in our deduction list we are over 40 different types of deductions that can take place for one employee. Mary Irvin said that in itself is a feat.     Mary Irvin asked if there was any further discussion about the ADP purchase. There was none.  Mary Irvin called for a vote. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.     XI. Administrative Reports – David Jones said under current activity Dakota and myself were fortunate enough to attend the LHA Winter Symposium the early part of last week. There was very good networking, time to which the Governor attended the first evening session. From a lobbying and networking standpoint, there were two standout speakers in my opinion. Oddly enough the very first speaker and the very last speaker. The first speaker spoke on leadership and how to evaluate people. A major take away of myself of one of the things that they said from a personnel standpoint, in selecting personnel that we typically hire them for what they do and fire them for who they are. Evaluating more of the person as opposed to what skills the person brings to the table is, from my experience that is extremely true. We also had a retirement party internally in the hospital and those kind of things and the Board members are always welcome to come to. Going forward we are going to get that and get that active and hopefully get it to populate your own calendars to remind you of events and those kind of things. Mary Irvin said we are working on that. David Jones said that is coming and that is all I have for current activity.     XII. Medical Staff Report – 1) Recommendations – Dakota Robinson: Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval. Dakota noted that we are bless right now to get a Hematology/Oncology doctor here that will be doing a clinic once a week between him and his mid-level – Dr. Manish Dhawan, M.D.   Pam Hughes stated that he will be here on February 17th which will be his first day.  Dakota said that is a good addition to our staff.      MEDICAL STAFF APPOINTMENTS:    1.) Manish Dhawan, M.D. – Requests Courtesy Privileges in the field of Hematology/Oncology for the period of January 28, 2020 through January 31, 2021.  MEDICAL STAFF REAPPOINTMENT: 1.)Travis Henley, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of January 28, 2020 through January 31, 2022.   2.) Karen Caldemyer, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of January 28, 2020 through January 31, 2022.   3.) Rafik Ben Abda, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of January 28, 2020 through November 30, 2021. ADVANCE PRACTICE PROFESSIONALS  APPOINTMENTS / REAPPOINTMENT:    1.) Alisha Lowery, FNP – Request Courtesy Privileges in the field of Hematology/Oncology for the period of January 28, 2020 through January 31, 2021.   EXTENSION REQUEST:  1.) Brian Cornelius, CRNA – Request extension pending completion of reappointment application.    VOLUNTARY RESIGNATIONS:  None.         Robert T. Green, Jr. made a motion to approve the Medical Staff Appointment, Reappointments, Advance Practice Professional Appointment, and Extension Request as presented.      Kenneth Clay seconded the motion. The vote:  Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.      XIII. Executive Session – Mary Irvin stated she entertain a motion to go into Executive Session for the purpose of Strategic Planning. David Norman made a motion to enter into Executive Session for the purpose of Strategic Planning. Brenda Smith seconded the motion. The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor. There will be a brief break. The Executive Session was entered into. No action was taken during the Executive Session. Helen Godfrey-Smith made a motion to enter back into regular session. Robert T. Green, Jr. seconded the motion.  The vote: Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.  XIV. Adjourn – There being no further business, Mary Irvin called for a motion to adjourn.  Kenneth Clay made a motion to adjourn. Robert T. Green, Jr. seconded the motion.  The vote:  Yeas: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Helen Godfrey-Smith, Pat White. Nays: None. Absent: Robert T. Green, Jr.  Abstain: None. The motion passed by unanimous vote in favor to adjourn.  The meeting adjourned at 6:28 p.m.

 

North Caddo Hospital Service District

North Caddo Medical Center

Vivian, Louisiana

__________________________________

David C. Jones, Secretary

Approved by the Board of Directors at the regular meeting held February 25, 2020