BOARD MEETING: Regular Meeting DATE: May 26, 2020 MEMBERS PRESENT: Mary Irvin, Kenneth Clay, Kenneth Cochran, Ronnie Festavan, David Norman, Brenda Smith, Patricia White. MEMBERS PRESENT VIA TELECONFERENCE: Robert T. Green, Jr., Helen Godfrey-Smith MEMBERS ABSENT: None TIME CALLED TO ORDER: 3:32 p.m. OTHERS PRESENT: David Jones, CEO, Pam Hughes, COO, Dakota Robinson, CFO, Mary Coil, Foundation Executive Director / Marketing Director, Walter D. (Doug) White, Hospital Attorney (Via Teleconference), Britney Stringham, Administrative Assistant, Ross Hansen, IT Director, Lanell Audirsch, Admin. Asst. LOCATION: NCMC Café and Via Teleconference – Conference ID 626 735 880 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 – Kenneth Clay offered the Invocation. Robert T. Green, Jr. led the group in the Pledge of Allegiance. III. Approval / Amend Agenda – Brenda Smith made a motion to approve the agenda as presented. David Norman seconded the motion. The verbal vote: Yeas: Mary Irvin, David Norman, Ronnie Festavan, Kenneth Clay, Pat White, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nays: None. Absent: None. Abstain: None. The motion passed by unanimous vote in favor. IV. Community Comments – Mary Irvin, Chair, inquired if there was anyone from the community logged on. Dakota Robinson stated there were no visitors logged on. V. Minutes – Regular Meeting April 28, 2020 – The minutes of the Regular meeting held April 28, 2020 were mailed prior to today’s meeting for review. Brenda Smith made a motion to approve the minutes of April 28, 2020 as mailed. Pat White seconded the motion. Mary Irvin asked if there was any discussion or corrections to be made regarding the April 28, 2020 minutes at this time. There were none. The verbal vote: Yeas: Mary Irvin, David Norman, Ronnie Festavan, Kenneth Clay, Pat White, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nays: None. Absent: None. Abstain: None. The motion passed by unanimous vote in favor. VI. Foundation Report – Mary Coil, Foundation Executive Director / Marketing Director, gave her report VII. Chief of Staff Report – Mary Irvin noted that since Dr. Woods is not here at this time, if he is able to come we will move into that spot if that is acceptable with everyone. There were no objections. VIII. Old Business – 1) Purchase of ADP HR System Update: David Jones said I will give a quick update on this. They are slowly rolling things out in the system but as far as the full implementation it will probably the first of the year before it is completely done. IX. 1) Review of April 2020 Statistics – Dakota Robinson: Dakota stated the trend this month will look a lot better than it looked the previous month. We were at 133 inpatient days. There were actually two declining months in a row from 172 in February to 133 in March and then in April it increased 64% up to 219. Surgeries for the month of April were basically completely shut down when it comes to elective surgeries. The only surgeries that we were doing were C-sections and emergency surgeries. Dakota continued noting that Endoscopies were zero. Dakota said these people didn’t just magically get healthier. The number in the ER went from 522 to 283 which, that has got to be a historical low. Looking at Mammographies is another elective area pretty much closed down – zero for the month of April. Newborns, actually was a busy month. They had 11. We did 1,695 visits in the Vivian Clinic for the month of April down from almost 1,900 the month before. We don’t see quite the reduction in Plain Dealing but we do see a reduction from 554 to 527. Benton was our one outlier last month which actually saw a slight increase. This month they saw 429 opposed to 401 last month. The Fitness Center as of the month end was still closed. That since has reopened. Are there any questions on the Statistics? There were none. Dakota asked Helen Godfrey-Smith and Robert Green if they could hear everything o.k. They responded yes. 2) Review April 2020 Financials – Dakota Robinson: Dakota stated moving into the Financial Analysis. If you look at the Balance Sheet on page 1, you will see that there is one added line item. Usually we have just two – CD’s and Bank Accounts. This month we have the PPP program – that is what I will refer to as the Payroll Protection Program. If you look at just the line item bank accounts which is typically what we’ve got reported in this sheet, if you remove the PPP and Certificates of Deposit, we are right at 85 Days Cash on Hand. That is increased from 74 in the previous period. If you add in the Certificates of Deposit and the Payroll Protection Program you are little over 141 Days Cash on Hand. Going down to Assets Whose Use is Limited, we always talk about the Sales Tax Fund. Mr. Festavan and I were having a conversation before the meeting in just what is the sales tax going to do around here, he noted that the Town of Vivian was the only one in the area that did not see a decrease in Sales Tax Revenue. Last month we didn’t really see a decrease but nobody had at that point recognized a decrease, hopefully, as a hospital service district, being a larger area, hopefully we can see similar numbers as what the Town of Vivian did. Looking at page 2 of the Balance Sheet, this is the Liability Section, you will see that one noted difference would be Notes Payable under Long Term Liabilities. It increased to $25 million. We also look at Salaries and Wages. One of the things that we see in Salaries and Wages, I would expect to be about $80,000 to $90,000 more than what we were the previous month. That number was reduced down to a little over $30,000. One of the areas that is continuing to stay steady, not seeing significant increases, is Employee Benefits and Payroll Taxes. This is directly related to the self-funded insurance plan. If you look at Total Operating Expenses on the month compared to the prior year, $1.94 million compared to $1.97; that’s a reduction of $34,000 and if you look on the year, we’ve had an increase of a little over $1 million dollars in expenses, about 5%. Another bright area that we see, we see 340B revenue, $135,000. We’ve seen reductions in numbers in the clinic go down, but we’ve also seen telephone calls go up. We’ve seen refills over the phone go up. Part of that, even though we might not capture it on some of these stats we’re still capturing the prescriptions and we are still capturing the medications for all the patients that we do have and we’re going to have the future. When we budgeted numbers we looked at adding Benton on as a 340B side. We got that done but we’re still trying to get the kinks out of the software. We are very close with that. Are there any questions on the Income Statement? There were none. One of the things that we see when we have a drastic reduction in revenue is it affects the AR Days. The AR day calculation is Accounts Receivable over basically divided by one day’s worth of revenue for that month. We saw increase from 57 days to 65, almost 66. What we’ll see with a pickup of revenue, hopefully in the month of April, catching up some of that AR that was outstanding in the month before, hopefully we we’ll see that number decrease slightly and then continue over time back into that range of 45 to 50 that we’ve seen over the past twelve months pretty much on consistent basis. We will watch that closely. When you look at page 5 – Departmental Revenue and Expense for one month. Looking at page 8 – the Budget – the meat and potatoes of the Financial Statement. You will see, obviously, that the Gross Revenue is significantly under budget and so are the Contractual Adjustments. It equates over into the ten month year to date. We are at $16 million in revenue, budgeted for $17.9, but we over estimated our expenses. We have been able to control those. In a way it helped up to make up a significant portion of those deficits. You see in the Salaries and Wages column is down $434,000. That is a 3.7% decrease or coming in below budget. If you look at expenses as a whole we are at $20.9 million and we budgeted for $21.6 million, a difference of a little under $700,000. That helps eat into the revenue deficit. In Non-Operating Revenue and we clearly blow it out of the water. Are there any questions on the budget? There were none. Looking at the Vivian Clinic, on the Statistics page, they had almost 1,700 visits. This is one of the areas I guess when you look at revenue and expenses it is done a little bit different to the rest of the hospital. Typically in a business, hospitals for that matter, most of your costs are fixed, whether they hourly fixed or salary fixed, that kind of thing. Our providers are wRUV based and they took the brunt of some of these losses in the clinics due to decreased numbers. It isolated the clinics a little bit from incurring significant losses even though they had a reduction in visits, the Vivian Clinic saw a slight profit of $14,000. Then we see the same thing across the other two clinics. A slight reduction in visits at Plain Dealing with a slight profit of $2,541 and the same in Benton they had a profit of a little over $6,000. The change in the payment arrangement with those clinics sort of insulated those clinics. Dakota asked if there were any questions on the Financials and Statistics. There were none. Mary Irvin stated if there were no questions or further discussion she would entertain a motion to approve the April 2020 Statistical and Financial Reports as presented. Pat White made a motion to approve the Statistical and Financial Reports as presented subject to audit. David Norman seconded the motion. The verbal vote: Yeas: Mary Irvin, David Norman, Ronnie Festavan, Kenneth Clay, Pat White, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nays: None. Absent: None. Abstain: None. The motion passed by unanimous vote in favor. X. New Business – 1) Rough Draft of Fiscal Budget 2021: David Jones said I would like to start out and applaud Dakota and his team and the Department Heads and everybody that has worked on getting this budget together. Budget items were discussed. No action was taken. There has been no small feat but everyone has thrown together, especially the Department Heads, they’ve bore the brunt of just about everything here. They have done an outstanding job with this as well. XI. Administrative Reports: 1) NCMC – Pandemic Update: David Jones stated hopefully next month we will have a normal Administrative reports. We get daily updates on new COVID throughout the state, number of ventilators, number of inpatient admissions throughout the state. Those numbers have steadily declined. Which is fairly normal with a respiratory virus and this is no different. That being said this will increase again; make no mistake that this is not going to continually go down to zero and stay at zero. As soon as the fall rolls back around and the weather starts changing, the cool weather starts coming again there will be more COVID infections. I would say it would be miraculous to have some type of vaccine by the first of the year. Very realistic sometime middle summertime next year will they have something like that. The masks are probably a part of our lives. China has been doing it for the better part of two decades. They are used to it. Our positive patients that we have been seeing here have decreased, the nursing home has seemed to calm down. They had some deaths and quite a few infections. We will find out how long that immunity lasts over time. They are more prepared as far as how to deal with people coming in the building, how to deal with positives and isolation now than they were two months ago. That is going to be a continual worry spot. Any nursing home. Our planning in our crisis mode has shifted into a policy and procedure mandate. By the time fall rolls around we will have policies in place that will help us to prepare for one; set par levels for PPE. What to do with temperature checks and how to deal with people and employees that are positive temperatures. We will have that system in place and nobody will be questioning what do we do with a 99.9 temperature or what do we do with somebody with this or that. There is a lot of things we learned on the fly and adjusted and went with it. The CDC helps but they have changed their guidelines four times since this began on what to do with employees that are positive. I would imagine it’s probably going change again by the time this rolls around again. We at North Caddo Medical Center, especially Dr. Woods and Dr. Chance, have been very integral in just about everything we’ve done. They have stepped forward and been the lead and therefore we’ve got some solid backing when it comes to medical staff and from a physician level. Financial was a big concern throughout the last month and one half. We were actually able to experience Hospital Week. We didn’t blow it out like we normally do. We’ve really been able to get back in touch with healing – healing is physical and spiritual. We’ve really been able to refocus on the spiritual end of it as well. We’ve got a group of employees that voluntarily meets in front of the building by the flag pole every day to pray for the patients and everything else. In my opinion, morale is as high as it has been since this began. It’s certainly not pre-pandemic, in my opinion, because it just is still an unknown factor out there. There has been a lot of trial by fire, there has been a lot of hardening from the nurses, the doctors and the respiratory therapist, laboratory techs, radiology tech, physical therapy, housekeeping – everybody now is used to dealing with COVID and what to do with it. Our goal is to treat every patient that walks in the door. That is what we do every single day regardless of whether they are HIV positive or COVID positive or whatever they have. We’ve gotten refocused and we’ve gotten back on that. There have been some positives to come out of this. That is where we are as far as the pandemic goes. Our Days Cash on Hand is very strong. David Jones said it has been a heck of a roller coaster and it is not over by any means, but honestly that is healthcare. Does anybody have any questions for me that has popped up or anything at this point? Brenda Smith said I do have one. In your report you were talking about searching for a possible alternative in Benton. We are looking for a bigger building, right? David Jones said the building has been an issue for about a year and one half to two years. They only have four exam rooms. We cannot have two providers there at once. One provider that is fairly busy will fill four exam rooms quickly. Having Dr. Mc Common and Jere there at the same time is almost an impossibility. We do it on occasion but it is jam packed whenever we do. Statistics wise, I don’t know if you caught it but they were the smallest decrease that we had. Their brand is there. Jere has done a marvelous job in building what the brand is for our clinic there and of course Dr. Mc Common has augmented that whenever she comes as well. But Jere has done an outstanding job and there really is a lot of potential to expand and if we expand that and potentially hire another mid-level to go in there with them we really feel that clinic will be filled up within another six months to a year with that other provider. We are starting to do some baseline look for some properties around and see what we can do. There is an empty lot right next to the build that we are in now that comes up for sale, goes off for sale, comes up for sale, goes off for sale, we think it is back for sale. We are trying to find out some baseline numbers. Brenda Smith noted that it is a good location. David Jones said it is an excellent location. Mary Irvin thank Mr. Jones. Ronnie Festavan asked David Jones to expound on the rest of those paragraphs there. Any word on the property in Blanchard? David Jones said we haven’t gotten any good word. That is something, Mr. Festavan, I assume in the next six months there will be some other properties come open for sale that fall within our geographical target area. Ronnie Festavan thanked Mr. Jones. There was no further discussion. 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.) Cornelius Bos, M.D. – Requests Courtesy Privileges in the field of Radiology for the period or May 26, 2020 to May 31, 2021. 2.) Dawood Malik, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of May 26, 2020 through May31, 2022. 3.) Thomas Vreeland, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of May 26, 2020 through May 31, 2022. 4.) Brent Boudreaux, M.D. – Request Courtesy Privileges in the field of Radiology for the period of May 26, 2020 through March 31, 2022. 5.) Mansour Mirfakhraee, M.D. – Requests Courtesy Privileges in the field of Radiology for the period of May 26, 2020 through April 30, 2021. ADVANCE PRACTICE PROFESSIONALS
APPOINTMENTS/REAPPOINTMENT: None. EXTENSION REQUEST: None.
VOLUNTARY RESIGNATIONS: 1.) Adam Green, M.D. – Voluntary resigns his privileges in the field of Radiology effective 05/04/2020. 2.) John Chang, M.D. – Voluntary resigns his privileges in the field of Radiology effective 05/18/2020. 3.) Adam Hecht, M.D. – Voluntary resigns his privileges in the field of Radiology effective 05/18/2020. 4.) Mary Phillips, M.D. – Voluntary resigns his privileges in the field of Radiology effective 05/18/2020. Kenneth Clay made a motion to approve the Medical Staff Reappointment and Voluntary Resignations as presented. David Norman seconded the motion. The verbal vote: Yeas: Mary Irvin, David Norman, Ronnie Festavan, Kenneth Clay, Pat White, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nays: None. Absent: None. Abstain: None. The motion passed by unanimous vote in favor. XIII. Executive Session: Mary Irvin noted there is no need for an Executive Session. Mary Irvin noted that at this time Brenda Smith lead us in prayer prior to the meeting adjournment. XIV. Adjourn – There being no further business Mary Irvin called for a motion to adjourn. Kenneth Clay made a motion to adjourn. Kenneth Cochran seconded the motion. The verbal vote: Yeas: Mary Irvin, David Norman, Ronnie Festavan, Kenneth Clay, Pat White, Brenda Smith, Kenneth Cochran, Robert Green, Helen Godfrey-Smith. Nays: None. Absent: None. Abstain: None. The motion passed by unanimous vote in favor. The meeting adjourned at 5:00 p.m.
North Caddo Hospital Service District
North Caddo Medical Center
David C. Jones, Secretary
Approved by the Board of Directors at the regular meeting held June 23, 2020