BOARD MEETING:  Regular Meeting   DATE:  April 28, 2020    MEMBERS PRESENT:  Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, Robert T. Green, Jr., David Norman, Brenda Smith, Helen Godfrey-Smith, Patricia White.      MEMBERS ABSENT: None   TIME CALLED TO ORDER:  3:30 p.m.   OTHERS PRESENT: David Jones, CEO,  Pam Hughes, COO, Dakota Robinson, CFO, Dr. John Woods, M.D., Chief of Staff, Dr. Jody Chance,  Mary Coil, Foundation Executive Director / Marketing Director, Administrative Assistant, Lanell Audirsch, Admin. Asst.    LOCATION:  Via Teleconference – Conference ID 802-554-599    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 – David Jones offered the Invocation.     Robert Green read from Psalms 27.  Mary Irvin thanked Robert Green. Ronnie Festavan led the group in the Pledge of Allegiance. Mary asked David Norman, Vice Chair to move forward with the agenda due to technical phone issues.     III. Approval / Amend Agenda – Pat White made a motion to approve the agenda as presented.  Brenda Smith seconded the motion. The verbal vote: Yeas: Robert Green, Pat White, Kenneth Clay, Ronnie Festavan, Helen Godfrey-Smith, Brenda Smith, Kenneth Cochran, David Norman, Mary Irvin. Nays: None.  Absent: None.  Abstain: None.  The motion passed by unanimous vote in favor.  Mary Irvin stated a few items of housekeeping. We are teleconferencing. Please be aware if there is a voice in your background mute. Speak your vote and recognize the importance of speaking one person at a time.  Dakota has roll based on who is logged in.  IV. Community Comments – Mary Irvin, Chair, noted we want to invite anyone from the community that me be logged on and may have any comments that they would like to share with the Board please identify yourself with your name and any questions or comments that you would have for the Board. We will open that open that up. Dakota stated there were no visitors noted as signed on. Mary noted for all the Board to know if someone does log we’ll be made aware of that but anyone is obviously invited to log on anytime during the open session.   V. Minutes – Regular Meeting February 25, 2020:  The minutes of the Regular Meeting held February 25, 2020 were mailed prior to today’s meeting for review. Pat White made a motion to approve the minutes of February 25, 2020. Robert Green seconded the motion. Mary Irvin asked if there were any comments to be made regarding the minutes at this time. There were none. The verbal vote:  Yeas: Robert Green, Pat White, Ronnie Festavan, Mary Irvin, Brenda Smith, Helen Godfrey-Smith, Kenneth Cochran, David Norman, Kenneth Clay?. Nays: None.  Absent: None.  Abstain: None.  The motion passed by unanimous vote in favor.  The vote was unanimous in favor of approval.   Minutes – Special Meeting April 7, 2020: The minutes for the Special Meeting held April 7, 2020 were mail prior to today’s meeting for review for approval. Helen Godfrey-Smith made a motion to approve the April 7, 2020 minutes as submitted. David Norman seconded the motion. Mary Irvin asked if there was any discussion or questions regarding that meeting. There was none. The verbal vote: Yeas: Robert Green, Kenneth Clay, Ronnie Festavan, Pat White, Mary Irvin, Brenda Smith, Helen Godfrey-Smith, Kenneth Cochran, David Norman. Nays: None.  Absent: None.  Abstain: None.  The motion passed by unanimous vote in favor.   VI. Foundation Report –   Mary Coil, Foundation Executive Director / Marketing Director, thanked everyone for being present. I did want to tell you that the Foundation has decided to cancel the annual event that is typically held in August. We were planning on the Safari for 2020 but with everything going on right now we felt like it was best to move that to 2021. We are going to be planning something for the fall on a different level but we definitely want to gather with our supporters and be sure they know how thankful we are for them. We are also in the process of participating in “Give for Good” which is through the Shreveport Community Foundation. If anybody is interested in that the website is Give for Good NLA.org/ncmcla. Helen Godfrey-Smith asked Mary to send them a link to that to make it easy for them. Mary said she would.  Mary Irvin said she would like to thank Mary Coil for what she has done with Facebook. If you are not on Facebook it is worth joining just to follow our hospital. It will make you much more informed and she and Administration have done a wonderful job communicating to the community through that forum. I encourage everyone to take the time if nothing else to be a friend of North Caddo Medical Center. Thank you to Mary Coil.   VI. Chief of Staff Report – Dr. John Woods, Chief of Staff, said that it looks like we are on the downstream of the COVID wave for this hospital I believe. We are implementing antibody testing on Monday and that way we can give actual scientific data on who has been exposed, who actually has some immune response to this COVID Virus and it will allow everybody to make a solid decision on what they want to do with their employees. Noted in the care pack that there is approximately $29 billion dollars that is going towards funding of testing. We are going to help to move that along. Beside that the hospital is running very efficient and we hope to get our employees back to work as soon as we can. That is all I have.  Mary Irvin asked if the employees would be a priority. Dr. Woods replied yes. (Mary breaking up bad again. Advised to dial in and asked David Norman to take the Chair.) David Jones stated before we go to Old Business he has invited Dr. Chance to give an update on the clinic to the Board. Where we are sitting from the clinic standpoint. Mary Irvin stated that Dr. Woods and Dr. Chance have been the frontline position and we do appreciate them.  Dr. Chance stated we initiated the antibody testing in the clinic on Monday. As of yesterday I personally tested 4 or 5 people in the clinic. Today we are at approximately 20 to 25 so far just from my patients, not counting Dr. May, Dr. Sharpe and the other physicians. People are very excited to know whether they have been exposed to this virus, if they potentially could have some protection if they get exposed in the future. It’s a very great thing. Hopefully we can keep bringing them in. I have people that want this test done many times. It’s been a great thing so far. Thank you Dr. Chance.   VIII. Old Business – 1) Purchase of ADP HR System Update: David Jones stated there is really not a lot of update. There has been some slight roll out with this but it has been extremely slow, of course, due to the COVID outbreak. This will be on old business until we are completely live with it. Not a lot of news there. David Jones asked if anyone had any questions on that. There were none.  (Mary Irvin rejoined) IX. Review of March 2020 Statistics – Dakota Robinson – Dakota said we are all familiar with the situation that is going on right now with COVID. As we go through the Statistics and Financials we will note the trend there. When we look at Admissions for this month you will see that there was a dramatic decline from the month of February. We’re actually down about 36%. We went from 61 to 39. The good news is we did have 11 Admissions in the Swingbed. If we look at In-patient Days you’ll see that with the reductions in Admissions that carried over to the reductions in In-patient Days. We went in January from a high of 238 to 172 in February and then another 22% down in the month of March to 133. The Average Daily Census for Acute and Swing – Swing has helped out on that and it remains very similar to what it was the previous month. If you look at Endoscopies, it remains the same at 12. In Emergency Room visits had a slight increase from 490 to 522. Looking at Mammographies we had a slight increase from 22 to 27. There was a decline in newborns but in all honesty the month of February was nominally at 11. When we get in to clinics you will see that in two of them we did see a trend. We saw a trend from 2096 visits in the Vivian Clinic in the month of February down to 1,878; about a 10% decline. The first two weeks of April, though, I would say we saw about a 60 to 70% decline in the patient volume. Telemedicine is up and running. We see the same trend continue in Plain Dealing. They went from 649 to 554 – that’s a 14% decrease in that month for similar reasons. One bright spot that we have is the Benton Clinic actually saw more patients. They went from 456 up to 501. On record that’s one of their busiest months, one of their top three months. Obviously with the shutdown the Fitness Center was one of those areas that we had to completely shut down so there are no statistics on this month’s report. Dakota asked if there were any questions on the statistics. Mary Irvin asked if anyone could speak on tele med. Jere in Benton has done a whole lot, too. I think some of the other ones are getting on board now. It is something that we believe is definitely going to be the new normal for healthcare in America.  Dakota stated if you have any questions or comments you will need to unmute your phone. If not we will continue on to the Financial Statement. There were no questions or comments.   2) Review March 2020 Financials – Dakota Robinson:  The Financial Analysis of March was influenced heavily by the COVID virus. Days Cash on Hand, page 1 of the Balance Sheet, you will see that without the CD’s we are sitting at about 74 days Cash on Hand. That’s an increase of almost 10 days from the previous month and then we are at 85 days Cash on Hand. If we look at the increase over last year, last year in unrestricted cash we were sitting at $4.3 almost $4.4 million. One main reason is we saw $221,000 cash infusion from bonus UCC money. If we look at the Assets Whose Use is Limited further down on the page, you will see that the Sales Tax account has $817,000. That account as of today has about $890,000 in it. We have not seen a reduction in report of sales and sales taxes. It has not worked its way down the pipeline yet. Looking at page #3 we will look at the Income Statement. We had revenue of almost $3.4 million on the month. Contractual Adjustments of 1.8. Contractual Adjustments for the month are 55.43% and on the year 53.4%. Those numbers are right in line with what we expect to see. You will see that on Salaries and Wages there was a reduction in March’s salaries and wages almost $105,000. There were changes that were put into place whether it be in Admitting or in the Clinics just to sort of morph PRN positions; what are we filing, what are we not. One area that continues to outpace the previous year is Employee Benefits and Payroll Taxes. The biggest portion of that coming from Employee Benefits. It was at $223,000 for the month of March as opposed to $219.000. Not a significant increase. For the actual nine month period up $245,000 mainly due to excess claims coming in the door. Hopefully we will see those two will start to come together here as we get toward the fiscal year end. If we move down the report, you will see that Professional Services was down by $6,500 and on the year $86,000. If you look at Total Operating Expenses a little over $2 million compared to $2.1 million, and on the year $18.9 million compared to $17.9 million. The Non-Operating Revenue and Expense, you will see that once again the category that outpaces everything is the Grants. In this month we’ve got a $405,000 number booked, that includes a $221,000 bonus payment from the UCC that was discussed. Also, 340B Revenue was down slightly. When clinic numbers decline, and we see less patients, mainly on an outpatient basis, we expect to see a decline in the 340B because that is where those scripts originate from. It wasn’t a significant decline. It was about $5,000 and on the year we are still up $111,000 from the previous year. If you look at an increase in position of profit for the month, you will see that we did an $89,000 profit and on the nine month period it is a little over $1.1 million compared to $710,000 in the previous year. The AR Days did increase slightly from 54 to 57. Looking at the Departmental Revenue and Expense on page #5, you’ll see that it paints sort of the similar picture that we have been talking about. In most all of the departments saw a reduction from the previous periods. Looking at the Budget on page #8 you will see that we budgeted for almost $3.9 million in revenue and we came in about $559,000 below that. We also with that budgeted almost $2.1 million in contractual adjustment and the contractual adjustments came in at $1.8 million. We are not too far off on what we expect there, just about $300,000. That is expected with the statistics that we saw the last two months and on the year the Net Patient Revenue, we are under budget by about $1.3 million. We do make a significant portion of that up when we get down in Operating Expenses. If you look at Total Operating Expenses – $447,000 under what is budgeted. We are coming in at $18.9 million and we budgeted for $19.4 million. Looking at Non-Operating Revenue the story continues. The Grant Revenue surpasses the budget by $1.8 million dollars. At this point the Foundation Revenue, we don’t have a big project going right now so there’s nothing being reported in that line. The 340B and Sales Tax, we are very close to what we expected $30,000 off. If you look at the increase in Net Assets of the profit of $89,000, we budgeted for $13,000 and on the year we are a million dollars over profit wise what we expected in $1,021,000. Overall when we look at the budget we are still in a very good position. Looking at the Financial Analysis of the Vivian Clinic you will see the reduction in visits we also saw a reduction in revenue and profit. They had a loss of $18,866, which they cyclically can have that, but this one is just straight up a result of the reduction in number of visits. Looking at the Plain Dealing Clinic you will see sort of the same picture. They had a profit last month of a little over $10,000 and then this month they actually lost $4,100. Not significant – for the nine months they still have a profit of almost $18,000. They are still in the black. Looking at the Benton Clinic Mrs. Pam and her crew have been rebilling and billing and we’ve gotten some adjustments there. They didn’t see an increase in patients enough that I would educatedly say that they made $30,000 in profit. At this point we will open it up for questions. Dakota ask someone to try to respond. Robert Green responded. Brenda Smith. Mary Irvin. Dakota asked if anyone had questions. Ronnie Festavan asked Dakota to elaborate. Did you say that you were not seeing a downward trend in our Sales Tax or you relying on not receiving March Sales Tax yet? Dakota said basically all I said is on our receivables we have not seen a down turn in that yet. But I know the reporting for Sales Tax can be a month delayed. I expect to see a down turn in Sales Tax. Ronnie Festavan said the reason I asked that. We’re keeping up. You know that Sales Tax is one month back. Whatever you get in April is March Sales Tax. With seventeen days of shutdown in March. Right now as of this morning Sales Tax for the Town was down 17%. Now that won’t end until the last day of April. That is still a fluid number, still a moving target. Just to give you some idea if you are looking at that. The Town is down 17% as of this morning. David Jones stated we completely agree Mr. Festavan. We feel that that trend is probably going to go on for the rest of the year to be totally honest. We will just have to wait to see. Whatever amount of budgeting that you do like we do, we are trying to predict a year ahead budget based on an absolute unknown number. David Jones said absolutely we agree. Ronnie Festavan said that’s all I have. I just wanted to clarify, I wanted to make sure what I heard Dakota say about sales tax. David Jones said yes Sir. Thank you. Dakota asked if there were any other questions, comments or concerns. There were none. David Norman said I think Mary may be having problems. David Norman, Vice Chair, said he would entertain a motion to approve the March 2020 Statistical and Financial Reports as presented. Brenda Smith made a motion to approve the Statistical and Financial Reports as presented subject to audit. Helen Godfrey-Smith seconded the motion. The verbal vote:  Yeas: Kenneth Clay, Ronnie Festavan, Mary Irvin, Brenda Smith, Helen Godfrey-Smith, Kenneth Cochran, David Norman, Robert Green, Pat White. Nays: None   Absent: None   Abstain: None. The motion passed by unanimous vote in favor.   X. New Business – 1) Resolution #3 – 2020 Adopt Current Millage Tax Rate of 4.77 for Tax Year 2020:  David Jones stated under New Business is our yearly resolution to adopt the 2020 millage rate. We are keeping our current rate which is 4.77 for the tax year of 2020. Robert Green made a motion to approve the Resolution #3 – 2020 to Adopt the Current Millage Tax Rate of 4.77 for the Tax Year 2020. Ronnie Festavan seconded the motion. The verbal vote: Yeas: Robert Green, Ronnie Festavan, Kenneth Clay, Mary Irvin, Brenda Smith, Helen Godfrey-Smith, Kenneth Cochran, David Norman, Pat White. Nays: None   Absent: None   Abstain: None. The motion passed by unanimous vote in favor of resolution #3 – 2020.  XI. Administrative Reports: 1) NCMC – Pandemic Update:  David Jones said I just wanted to give an update of the status of the hospital and what has been going on here. I’m trying to keep the Board abreast of what is going on with some updates. We have seen a slight uptick over the last week and yesterday and today with clinic visits. We are seeing probably about a 15 to 20% increase over the week before and this week, today actually, there has been another 10 to 15% increase today alone with antibody tests. We are calling patients telling them that we have the test. We have several employees that have been screened with the test as well. That seems to help and hopefully we will help to alleviate the fear as time goes on. If anybody that would like to come get tested, we are now available to test and we have enough to test. We are cautiously optimistic. We had already taken all the steps that we needed to file for a PPP in the previous application. We have already passed a resolution from the Board, the State Bond Commission okayed it along with all the other hospital service districts, to my understanding. We basically got the new wording from the Small Business Administration. They changed the wording with the intention for entities like us to be eligible. We conferred with the Auditor. They have written an opinion that we are eligible based on our revenue and then legal has issued opinion that we are eligible in a legal manner and then the bank is on board. I just received word probably 30 minutes ago that they had refiled the application and are just waiting for the response from the Small Business Administration at this point. The last time this happened the Small Business Administration gave the bank ten days to fund those loans from the date that the approval was given. I’m going to be optimistic and hope that by tomorrow that we have approval from the SBA and can decide how we move forward.    David Jones asked if anybody had any questions or comments. Ronnie Festavan spoke up and said I have one question. David Jones said yes Sir. Ronnie Festavan asked based on what you said about the testing at the hospital, we have been kicking around here at the latter part of last week. Would it be possible perhaps to get my Town employees in there and get them tested? David Jones replied absolutely. That is what we were talking about. We would easily be able to do that. We can set them up with a doctor. We could bill their insurance and with no co-pay that they would have to pay. Ronnie Festavan asked if they would have to be insured to do that. Could the Town possibly pick up the cost of that also? David Jones replied sure. We bill that to the Town. Ronnie Festavan said those with insurance would be eligible to do it on their insurance but if we had some that were uninsured the Town could pick up the financial responsibility would that be something we could work out. David Jones replied absolutely. Ronnie Festavan said let me get back with you privately perhaps tomorrow and let’s talk about a few details or if you want me to talk with anyone else that would be fine. We would sort of like to pursue that. We don’t have that many employees and we have several that have insurance and the rest of them we can cover the cost of. That is something we would like to do for peace of mind for not only us but our public and our citizens. Understanding that a test one day doesn’t mean a week later, you know, I get that, I’ve told our council members that that we would be glad to pursue that, but that is no guarantee of anything to me really. It is something that I don’t mind to pursuing to do and since you brought it up today that might be convenient for us to partner together to do that. Would that be alright? David Jones replied absolutely. That is what we are ready to do and I guess reading between the lines I guess that is what the government is hoping this will do as well is actually they created this firestorm of fear and are reaching for things to try to help calm and put it out. I think they feel the antibody is one thing that will do that. Absolutely, we can offer it to their family members and file for their insurance as well and I will figure out a reduced cost to charge them as well. Ronnie Festavan said o.k. I will call you tomorrow and we will talk about some details. Thank you.  David Norman asked would there be any other questions. There were none.   XII. Medical Staff Report – 1) Recommendations – Dakota Robinson: Dakota Robinson presented the Medical Staff recommendations for the Governing Board approval.  MEDICAL STAFF APPOINTMENTS: None.    MEDICAL STAFF REAPPOINTMENT:   1) Heather Bracey, M.D. – requests Courtesy Privileges in the field of Radiology for the period of March 01, 2020 to March 31, 2022.  2) Michael A. Nissenbaum, M.D. requests Courtesy Privileges in the field of Radiology for the period of April 01, 2020 to April 30, 2022.   3) Waikeong P. Wong, M.D. – requests Courtesy Privileges in the field of Radiology for the period April 01, 2020 to April 30, 2022. ADVANCE PRACTICE PROFESSIONALS   APPOINTMENTS/REAPPOINTMENT:  None.    EXTENSION REQUEST:  1) Brent Boudreaux, M.D. – requests extension of his current privileges in Radiology upon completion of his reappointment application.    2) Mansour Mirfakhraee, M.D. – requests extension of his current privileges in Radiology upon completion of his reappointment application. VOLUNTARY RESIGNATIONS:   None.    Brenda Smith made a motion to approve the Medical Staff Reappointment and Extension Requests as presented.  Robert Green seconded the motion. The verbal vote:   Yeas: Robert Green, Ronnie Festavan, Mary Irvin, Kenneth Clay, Brenda Smith, Kenneth Cochran, Helen Godfrey-Smith, David Norman, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.    XIII. Executive Session:  David Jones noted there is no need for an Executive Session at this time unless someone from the Board wanted to make one and if so we would have to set up a separate call to do that.  David Norman noted that Helen Godfrey-Smith would dismiss us in prayer.            XIV. Adjourn – There being no further business, David Norman called for a motion to adjourn.  Robert Green made a motion to adjourn. Kenneth Clay seconded the motion. The verbal vote:  Yeas: Robert Green, Ronnie Festavan, Kenneth Clay, Mary Irvin, Brenda Smith, David Norman, Kenneth Cochran, Pat White. Nays: None.  Absent: None.  Abstain: None. The motion passed by unanimous vote in favor.  The meeting adjourned at 4:52 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 May 26, 2020