Board Meeting - September 11, 2006
The regular meeting of the Board of Commissioners of Whidbey Island Public Hospital District was called to order at 6:00 p.m. by Board President, Roger Case, M.D. Present were Commissioner Saugen, Commissioner Case, Commissioner Zaveruha, Commissioner Schoenknecht and Commissioner Miller. Chief Financial Officer, Doug Bishop, Chief Information Officer, Tom Tomasino, Chief Nurse Executive for Home and Community Services, Judy Moore, Chief Nurse Executive for Acute Care Services, Jacque Scott, Chief of Staff, Dr. Terry Lee, Dale Roundy, Esq., Dr. Mark Borden, Trish Rose, Mary Pierzchala, Katherine Baxter, Alex Louden, Carolyn Pape, Gary Taylor and David Marshal were also present.
President Case asked if there were any points of order to discuss of which there were none.
Minute Approval
Minutes from the August 14, 2006 regular Board meeting, and special meetings (annual Leaders Conference) August 18 and August 19, 2006 were approved as presented.
Medical Staff Report
Dr. Terry Lee, Chief of Staff presented the following medical staff appointments and reappointments for approval:
Douglas G. Langrock, M.D. – Active Staff Reappointment
E. Christopher Outlund, M.D. - Active Staff Reappointment
Devin Harrison, M.D. - Active Staff Reappointment
Commissioner Saugen made a motion, seconded by Commissioner Schoenknecht to approve the Active Staff Reappointments as presented. Motion carried.
Christopher E. Price, M.D. – Courtesy Staff Reappointment
Brian E. Eifert, M.D. – Courtesy Staff Reappointment
Steven Y. Chen, M.D. – Courtesy Staff Reappointment
David B. Bork, M.D. – Courtesy Staff Reappointment
Mary M. Kelly, M.D. – Courtesy Staff Reappointment
Juan M. Millan, M.D. – Courtesy Staff Reappointment
Commissioner Saugen made a motion, seconded by Commissioner Schoenknecht to approve the Courtesy Staff Reappointments as presented. Motion carried.
Jeffrey T. Allgaier, M.D. – Courtesy Staff Appointment
Gregory M. Wolgamot, M.D. – Courtesy Staff Appointment
Commissioner Saugen made a motion, seconded by Commissioner Schoenknecht to approve the Courtesy Staff Appointments as presented. Motion carried.
Lesli L. Halvorson, PA-C – Allied Health Professional
Kimberlie G. Stickney, PA-C – Allied Health Professional
Gina L. Bawden, ARNP – Allied Health Professional
Jan K. Wheeler- McInvaille, PA-C – Allied Health Professional
Commission Saugen made a motion, seconded by Commissioner Schoenknecht to approve the Allied Health Professional appointments as presented
Dr. Lee announced the following resignations – Jennifer LeTourneau, DO internal medicine, Kathi Gunn, PA-C Rural Health Clinic family medicine, and Reese Bliek, PA-C Rural Health Clinic family medicine.
The Medical Staff Office policy "Unprofessional or Disruptive Physician Conduct" will be taken for approval to the next MEC meeting. This policy was also reviewed at the Leaders Conference in August.
Dr. Lee stated that the medical staff asked him to ask the Board to look at the hospital financials and use all items necessary to look at expenditures and cost centers. Dr. Lee noted that he will be on the hospital Finance Committee next year and plans to bring more financial information to the medical staff from that committee. Board members would welcome more input from the medical staff on the Finance Committee. The medical staff questions whether a better financial reporting system is needed.
Commissioner Zaveruha commended Dr. Lee for his hard work on the physician behavior policy. Dr. Lee noted that process improvement is wanted, more education and to work better together as medical and hospital staff.
Individual Items: (Discussion and/or Action)
- Flexible Spending Accounts – Carolyn Pape, Human Resources Director, presented a proposal for a benefit enhancement for all employees. Flexible Spending Accounts would provide employees with an opportunity to use pre-tax dollars to pay for un-reimbursed health related expenses and eligible dependent care expenses. Un-reimbursed health related expenses might include co-pays, deductibles, cost share of dental or vision expenses as well as many other out-of-pocket expenses. Other highlights include reimbursement to the employee processed within 48 hours, reimbursements can also be automatically deposited into an employee’s account, and employees can use a "Benny" card (a declining balance card) which provides a simple method to pay for out-of-pocket costs on the spot. Other considerations are IRS "use it, or lose it" rule and a recommendation that a $50.00 monthly minimum be imposed to participate. The cost for this program is a one time set up fee of $950.00 for the hospital. Costs will be offset by savings in payroll taxes depending on the number of participants in the program. The hospital is proposing that this benefit enhancement be effective January 1, 2007. Carolyn noted that the education and enrollment process is complex, and if approved would be underway during the last quarter of 2006. After discussion, Commissioner Miller made a motion, seconded by Commissioner Schoenknecht to approve the Flexible Spending Account benefit as proposed. Motion carried.
- LPN Contract Ratification – Carolyn Pape reported that she, Judy Moore and Jacque Scott recently completed negotiations on the LPN contract. This is a small group, with the hospital currently employing 27 LPNs who work in Med/Surg, Home Health, MAC, Life Center, OR and in the rural health clinics. This contract has recently transferred from SEIU 1199NW to UFCW Local 21, the Union that also represents our EMS, Service Support and Professional Technical employees in three separate contracts. Much of the proposed language changes and new language can be attributed to this change in union. The proposed effective date and duration of the contract is September 1, 2006 through February 28, 2010. During negotiations, the Union suggested including the LPNs as part of the Professional-Technical contract, and although the hospital did not choose to move forward with this concept now, the duration of the contract was negotiated to coordinate with the same duration of the Pro-Tech contract in 2010 so this concept can be reevaluated in the future. Carolyn presented the economic changes, holiday pay for Christmas Eve (evening shift only), increases in PTO accrual rate, and wage increases. After discussion, Commissioner Saugen made a motion, seconded by Commissioner Miller to ratify the LPN contract as negotiated and presented. Motion carried.
- Return to Work Policy – Carolyn Pape presented one change on page two of this policy with additional language regarding light duty positions for employees. After review and discussion, Commissioner Miller made a motion, seconded by Commissioner Saugen to approve the proposed change to the Return to Work policy as presented. Motion carried.
- Employee Handbook Changes - Carolyn Pape presented minor changes to update the employee handbook. Revisions were made under new employee orientation, Patients First training, promotion/transfer and health insurance. After review and discussion, Commissioner Schoenknecht made a motion, seconded by Commissioner Miller to approve the employee handbook changes as presented. Motion carried.
- Resolution #268 – Doug Bishop, CFO presented Resolution #268 for approval which would approve the hospital to advance fund required capital equipment purchases and be refunded once a capital lease has been executed. Mr. Bishop noted that the hospital has not been able to fund capital equipment over the last few years, and that repair bills have been very high in order to maintain the existing equipment. Bids will go out this week to five companies for a five-year capital lease, which will be reviewed by the Finance Committee. After review and discussion, Commissioner Saugen made a motion, seconded by Commissioner Schoenknecht to approve Resolution #268 as presented. Motion carried.
- Cabulance Program Financial Statement – Doug Bishop, Judy Moore, Katherine Baxter, and Gary Taylor presented a report on the Cabulance Program. Currently the program shows a loss of $32,954. Five runs per day are needed to break even, and we are currently at 1.6 runs per day. Education is planned for care centers, which are the source of most of the referrals for this service. Judy Moore noted that while the program is just starting, it is building, and we are finding new needs for the service, such as taking patients to their doctor appointments. These are all private pay trips, and Gary Taylor stressed the importance of booking a ride in advance. There are currently three drivers, one is full time, one part time at sixteen hours and one on-call driver. Judy also noted that this has been a very positive service for patients, the hospital and community, as well as tremendous assistance for families. Most of the service has been on the north end, however there have been a few south end trips. The Board would like another financial update on this program in six months.
- Sleep Lab Financial Statement – Jacque Scott reported that there have been some difficulties with getting this service up and running smoothly, and that there is a positive bottom line of $53,879. We are currently using a consultant with the manager, who has been working from home due to illness. Two technicians have been trained on site and are ready to learn the scoring, which is currently outsourced. There is a two-day turnaround and a cost of $65 per study. Twenty studies per month were projected, and we are currently doing 40 studies per month. Jacque noted that 60 studies would be the maximum the program could handle as currently set up. Plans for the future include getting the program accredited, and there is hope to get Group Health patients. Presently the most referrals come from TriCare, Medicare and Blue Cross/Blue Shield.
Appointments are currently booked out six weeks. Jacque stated that if we were able to work six nights per week, the wait time for appointments could be reduced to three weeks. Jacque hopes to be able to hire a nurse practitioner to do initial consults, and screen patients. Contract re-negotiation is needed to make this program more profitable, which requires a 90-day notice. There are questions whether a medical director is needed, which is $1,000 per month. Tele-medicine is something to be considered for the future. Jacque is working with Doug Bishop and Beth Stout on the financials for this program. Jacque stated that the manager should be back by November, and if one more tech and a nurse practitioner can be hired, visits will be able to be increased. While this program got off to a tough start and we learned a lot, Jacque noted that it is a great service with a lot of potential that we hope we can continue to provide. Day and nap studies were mentioned, as well as sleep problems post operative, and patients identified by the Life Center who may need sleep studies.
Staff and Status Reports by Administration
Financial Report – Doug Bishop, CFO reported that July was a slow month with revenue at $7 million. Cash is under budget by $1 million, and contractuals and operating expenses are both below budget. AR days are at 63. There is a loss of $92,000 for the month.
Year to date revenue is 3.8% under budget, contractuals are 20% over budget and operating expenses are 5% under budget. The bottom line for the year to date is a positive $293,000. Contractuals and bad debts continue to climb.
August had high revenue of almost $8 million. Statistics are looking good for the month, and Doug is optimistic for a good month financially. Inpatient numbers are high, and length of stay is lower than July at 3.1 days. Obstetrics show an increase.
Doug reported that the intermediary has asked for more data, and is evaluating the hospital’s interim rates.
Group Health Medicare settled with the hospital and an $81,000 settlement was received from 2005.
Medicare notified the hospital that they will not be paying us anything from
September 20-September 30, 2006. Payments will be caught up on in October.
Doug reported that the line of credit with Whidbey Island Bank has been increased to $4 million, and will be used to pay the $1.1 million owed to Medicare on the Neulasta issue. Medicare would have charged us 12% interest, and we will pay 6% interest using the line of credit. There is currently a zero balance on the line of credit.
Operations Reports
The Tour de Whidbey put on by the hospital Foundation is September 23, 2006 raising money for the "Sim Man". There has been good community support this year, and good media coverage.
The Friends of Home Health and Hospice will hold their biggest fundraiser of the year on September 16, 2006 – a luncheon, style show, silent and live auction.
The Cancer Art Show will be held in November.
Commissioner Case questioned the high numbers on readmits and Infection Control on the Dashboard Report. Judy Moore noted that the definition of readmit was under discussion, and may be redefined after the first of the year. This is something that Arlene Johnson and Katherine Baxter have been working on over the last six months. They are looking at case management staff, working with Dr. Roof, Medical Director for Quality, and tracking key indicators in real time.
Jacque Scott reported that two ER staff members who are on FEMA teams, were called to respond to the impending hurricane Ernesto. These staff members were gone for six days, however no hurricane developed.
Tom Tomasino thanked everyone for their participation and input at the Leaders Conference. Tom reported that a new electronic locking system has been installed on all outside doors to the hospital. The system is run by computer. Tom is not issuing any cards for the system yet, he will wait until a new time and attendance system is installed. The keypads at the ramp, Emergency Department and back door still have the same numbers. Tom thanked John Bitting for securing a Homeland Defense grant for this new security system.
A new contract for the physician portal is being sent for Tom to review. Tom stated that work on installing the portal would begin soon.
The clinical documentation system has been a slow work in progress, with many change requests by both physicians and nurses. Process problems are getting solved.
Board Items
Commissioners Case, Schoenknecht, Saugen and Miller are available for a special Board meeting if needed on September 21, 2006 or September 22, 2006 in the morning, if the EMS levy does not pass or validate in the September 19, 2006 election.
The Board felt the Leaders Conference held in August was very positive, with good input and good presentations.
Commissioner Schoenknecht reported that the new assisted living project, Maple Ridge, has broken ground in Freeland.
Public Questions or Comments
There were none.
Consent Agenda Items:
- After review and discussion, Commissioner Saugen made a motion, seconded by Commissioner Miller to approve the write offs as presented for August in the amount of $349,460.64. Motion carried.
- Vouchers audited and certified by the auditing officer as required by RCW 40.24.080, and those expense reimbursement claims certified as required by RCW 42.24.090, have been recorded on a listing which has been made available to the Board. Commissioner Miller made a motion, seconded by Commissioner Saugen to approve vouchers #379100 and #379162 in the total amount of $11,695.50. Motion carried. Commissioner Zaveruha abstained from the review, discussion, vote and written approval of these vouchers due to a potential conflict of interest.
- Vouchers audited and certified by the auditing officer as required by RCW 40.24.080, and those expense reimbursement claims certified as required by RCW 42.24.090, have been recorded on a listing which has been made available to the Board. Commissioner Miller made a motion, seconded by Commissioner Saugen to approve vouchers #378748 to #379530, excluding #379100 and #379162, in the total amount of $4,379,264.004. Motion carried with all commissioners voting.
Executive Session (Section 42.30.110(c)
At 7:50 p.m. President Case announced the Board would go into Executive Session for a legal discussion pertaining to real estate pricing, which would take approximately twenty minutes.
The Board came out of Executive Session at 8:10 p.m. There was no action taken.
There being no further business or public comments, the meeting was adjourned at 8:12 p.m.