Hospital And Nursing Home Commission

The Commission has charge of administration, operation, and maintenance of all hospitals and nursing homes, now or hereafter, owned by the City. The Commission has the power to hire a superintendent of hospitals or nursing homes and all other necessary employees, to fix and pay their compensation, to reimburse officers and employees for expenses necessarily paid or incurred in the performance of their duties, to require a bond of any officer or employee and pay the premium thereon; to effect all necessary insurance; to make repairs of the hospital or nursing home buildings and their contents; to purchase all necessary equipment, apparatus, and supplies; to receive and to accept, with the approval of the Council, on mutually agreeable terms all donations for hospital or nursing home purposes; to establish such committees as it may see fit; and to make rules relating to its own procedures and to the administration, operation, and maintenance of such hospitals. (See Section 2.36 of the City Code for additional information.)

 

 

HOSPITAL COMMISSION MINUTES ARE POSTED ON THIS SITE AFTER FORMAL ADOPTION BY THE COMMISSION

(minutes are adopted at the next regular meeting).

 

2010 Minutes (click here)

 

2011 COMMISSION MEETING MINUTES

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, December 14, 2011

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Trustees:  H. Stuart Johnson, Kay Moline , Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President; Dr. Michael Sparacino, Chief Medical Officer; Patty Roessler, Director of Patient Care, Paula Meskan, Director of Nursing, Dr. William G. Shores, Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Tammie Hudspith, Director of Human Resources, Todd Prafke, City Administrator, Peggy Carlson, Community Liaison; and

Melissa Marshall, Recorder.

 

The regular meeting of the Hospital Commission was called to order at 4:05 p.m. by Chairperson

Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the December 14, 2011 meeting was reviewed. 

ACTION:  A motion was made by Margie Nelsen to approve the agenda as presented.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of November 30, 2011 were reviewed with no corrections or additions.

ACTION:  A motion was made by Kay Moline to approve the regular Commission meeting minutes of November 30, 2011. The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the December 13, 2011 Medical Staff meeting were distributed prior the start of the meeting.  Dr. Osborne reviewed each section of the minutes and noted that the speaker, Dr. Rohaan Meta’s presentation was very informative.  A request to replace the two outdated AED machines located within the facility was approved along with a $1000 donation to VINE Faith In Action.

ACTION: A motion was made by Kay Moline to acknowledge the receipt of the Medical Staff meeting minutes of December 13, 2011.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor. 

                                                                                                                             

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

              Pepper Etters, PA-C                                                 Courtesy Staff, Surgical Physician Assistant

              Pamela Wymore, MD                                                Courtesy Staff, Radiology/CRL

              Claudia Engeler, MD                                                 Courtesy Staff, Radiology/CRL

 

Reappointment to the Medical Staff:

              David Mills, MD                                                        Courtesy Staff, Radiology/CRL

              Matthew Stone, MD                                                  Courtesy Staff, Radiology/CRL

              Jennifer Miller, DDS                                                  Courtesy Staff, Dentistry

 

Change from Provisional to Full Membership:

              Kathryn Eisenmenger-Fuentes, PA-C                     Courtesy Staff, PA/Emergency Dept

              Timothy Klassen, CRNA                                         Courtesy Staff, Nurse Anesthetist

              Meher Rahman, MBBS                                             Courtesy Staff, Gastroenterology

 

Request for Additional Privileges:

                  Patrick O’Brien, MD                                                 Courtesy Staff, Radiology/CRL

              Stanley Kurisko, MD                                                 Courtesy Staff, Radiology/CRL

              Nathan Groebner, MD                                               Courtesy Staff, Radiology/CRL

                                                                                                               

Change from Provisional to Full Membership:

              Heather Dale, PA-C                                                  Courtesy Staff, AHP, PA (GAC)

 

ACTION: A motion was made by Margie Nelsen to accept the recommendations of the Credentials Committee for initial appointment, reappointment, additional privileges and change in status of the medical staff for the above-listed practitioners.  The motion was seconded by H. Stuart Johnson and carried with all members voting in favor.  A motion was made by Margie Nelsen to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested, and approved by the Credentials Committee.  The motion was seconded by

H. Stuart Johnson and carried with all members voting in favor. 

 

FINANCIAL REPORT

 

The financial report for November 2011 was presented by Curt Savstrom, CFO.  Operating Cash On

Hand decreased $90,649 or 3.9 days to 116.9 days; this is primarily due to the payment to Medicare on the interim cost report. The net impact on Total Days Cash on Hand decreased 6.4 days to 238.5 days.  The current ratio remained at 4.1.  The days in Accounts Receivable are currently at 45 days.  Revenue over expense for the month resulted in a loss of ($142,862), and when combined with non-operating income for November showed a net loss of ($138,817), for a margin of -10.40%.  Year-to-date revenue over expense shows a loss of ($344,829), and when combined with non-operating income shows a net loss of ($14,476) or -0.10%.  Year-to-date inpatient revenue is up 66 days compared to November 2010.  This increase is seen in both Acute and Swing Bed days.  Outpatient revenue is up 8% compared to November 2010.  The Clinic revenue continues to increase and is up 72%.  Year-to-date expenses through November are $151,610 higher than 2010, which includes increases in professional fees for ER Physicians, CRNA’s and rental of Imaging equipment and Live Well Fitness.  The recruitment expenses have significantly increased due to the active recruitment of new providers for River’s Edge Clinic.   Interest expense has decreased by $386,000 from 2010, with bond refinancing resulting in a reduced expense of $15,000 per month.  The cost of salaries continues to decrease with FTE reductions and staff turnover. The amount of overtime has decreased dramatically from the previous months.  Benefits are $63,000 lower than last year, which includes the 2010 accrual reversal which made expenses artificially low.  Community Care grants for November totaled $29,936, compared to $8,816 in October.  In November, 23 patient accounts qualified for a 100% write-off.  Board approval for collection activity is $56,441.

 

2012 Budget Assumptions

Colleen Spike, CEO and Curt Savstrom, CFO presented the budget assumptions for 2012.  The expectation is that all departments of REHC will show growth and an increase in revenue though out the upcoming year.

 

Benefits cost will be maintained at the 2011 level and a new employee incentive program has been developed to increase usage of Live Well Fitness.  There have been no changes to any of the other plans offered.  It was determined that a 1% wage increase will be given to all non-union employees at the beginning of 2012, thus ending the wage freeze that was in effect for 2011.

ACTION:  H. Stuart Johnson made a motion to approve the November 2011 financial report as presented.  The motion was seconded by Kay Moline.  H. Stuart Johnson moved to approve the Financial Statements along with payment of bills.  The motion was seconded by Margie Nelsen.  A motion was made by H. Stuart Johnson for payment of write-offs to collection and bad debt and approval of the accounts payable review. The motion was seconded by Kay Moline.  A motion was made by H. Stuart Johnson to table the vote for approval of the budget until the Strategic Planning Session was complete.  This motion was seconded by Jerry Pfeifer. All five motions made and carried with all members voting in favor.

QUALITY / SAFETY REPORT

 

No minutes were available for review.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  Ms. Spike noted that the Community Advisory Group had met and decided to take their show on the road.  In the upcoming months, members will be going to local communities to inform them on what services are available at REHC, obtain feedback on healthcare needs and to present two initiative plans regarding diabetes prevention and stroke recognition.

 

The recruitment process for River’s Edge Clinic is moving forward with a Family Practice physician who is very interested in practicing here along with potential leads on a female Family Practice physician and a male Family Practice physician with a specialty in Dermatology.

 

Ms. Spike noted there has been some interest in the pharmacy space, but no definite commitment to a lease has been made.  REHC has signed an agreement with Veteran Evaluation Service (VES) to provide certain lab tests, x-rays and stress testing to local veterans who meet the qualifications of the program. 

Union negations continue and some economic demands have been presented.

 

Mayor Stand will be appointing someone in January to fill the open Hospital Commission position.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Just Culture- Tammie Hudspith.

             

              River's Edge Hospital & Clinic has been chosen as one of ten hospitals in Minnesota to participate in the “Just Culture” model.  This model is designed to help change an organization’s culture by placing less focus on events, errors, and outcomes and more focus on risk, system design, and the management of behavioral choices.  The term “Just Culture” refers to a values-supportive system of shared accountability where organizations are accountable for the systems they have designed and for responding to the behaviors of their staff in a fair and just manner.  Staff, in turn, is accountable for the quality of their choices and for reporting both their errors and system vulnerabilities.  Implementation of this model will begin by setting a vision and creating awareness facility wide.

                                                                     

 

B.          Board Fiduciary Duties/MHA Video.

 

A video produced by the Minnesota Hospital Association was shown to the Hospital Commission.

Key points in the video included:

              - A review of what fiduciary duty means.

              - How important care and loyalty are when serving in a director’s role.

              - Always ask questions and keep current on healthcare rule changes and the impact there

   may be to the facility you represent.

DIRECTOR’S COMMENTS

 

Peggy Carlson, Community Liaison:  The Red Cross Blood Drive will be held here on January 12 and 13, 2012.

 

MEETING RECESS

 

The meeting was recessed at 5:11 p.m. for a dinner break.

 

The meeting was reconvened at 5:53 p.m. for the Strategic Planning Session.

 

STRATEGIC PLANNING SESSION

 

Colleen Spike presented a 2011 year in review report based on each department.  Overall 2011 was a successful year for many departments within REHC.

 

The departmental highlights include:

 

Hospital - Award for Top 100 hospitals for Women - Successful survey with DNV - Successful High Step program with SPHS	Ambulance - Slight increase in transfers - ACLS paramedic always     staffed in the ER	Cardiac Rehab - Major increase in patient usage - Building of good customer loyalty
ER/UC - Slight volume increase	IV Therapy - Major increase in usage	Laboratory - Continued increase in  procedures
Imaging - Change in procedural count for     abdomen/pelvis CT - Increase in MRI usage	Clinic - Growth in both locations - Hired a Pediatric NP	PT/OT - Ended contract with BLC - Increased outpatient usage
Surgery - Slight increase in outpatient procedures

 

2012 GOALS

 

A listing of departmental goals was presented.  Key areas were highlighted and discussed by the directors.  After review the Commission members brought up thoughts and concerns and were assured that money was budgeted to meet the goals, the board members will be asked to help accomplish the goals as needed and goal progress will be presented quarterly.

                                                                                                 

 

2012 BUDGET

 

After discussion regarding the Strategic Planning Session, a motion was made by H. Stuart Johnson to approve the budget for 2012 as presented.  This motion was seconded by Jerry Pfeifer with all members voting in favor.

 

ADJOURNMENT

 

ACTION:  A motion was made by Kay Moline to adjourn the meeting.  The motion was seconded by Margie Nelsen and carried with all members voting in favor.  The meeting was adjourned at 6:50 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, January 25, 2012 at

12 p.m. This meeting will convene in the Helen G. White Conference Room.  The Finance Committee meeting will be held at 11:30 a.m. 

 

 

 

 

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, November 30, 2011

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Trustees:  H. Stuart Johnson, Kay Moline , Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President; Dr. Michael Sparacino, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control; Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Tammie Hudspith, Director of Human Resources, Peggy Carlson, Community Liaison; and Melissa Marshall, Recorder.

 

The regular meeting of the Hospital Commission was called to order at 12:22 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the November 30, 2011, meeting was reviewed. 

ACTION:  A motion was made by Kay Moline to approve the agenda as presented.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of October 26, 2011, were reviewed. Two corrections were noted.

ACTION:  A motion was made by Michelle Chalin to approve the regular Commission meeting minutes, of October 26, 2011, after corrections are made.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the November 8, 2011, Medical Staff meeting were reviewed.  Dr. Osborne noted that the by-law review process has been completed with minor wording changes made.  A correction was noted regarding the Strategic Planning Process Taskforces.  Dr. Akland, not Dr. Osborne, should be listed as a clinic representative for the Record Keeping and Documentation Taskforce.  The policy and procedure on Procedural Sedation has been referred back to the Emergency Department Committee for further clarification.

ACTION: A motion was made by Jerry Pfeifer to acknowledge the receipt of the Medical Staff meeting minutes of November 8, 2011.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

                                                                                                                             

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

David Brokl, MD                                         Courtesy Staff, Gastroenterology

              Ramon Issa, MD                                         Courtesy Staff, Emergency Medicine

Jennifer Cousins, PA-C                               Courtesy Staff, AHP, Orthopedic Physician Assistant

 

Reappointment to the Medical Staff:

Jennifer Donkin, RD/LD                            Courtesy Staff, AHP, Dietitian

              James Nack, DPM                                      Courtesy Staff, AHP, Podiatrist

              Hope Bollig, PA-C                                      Courtesy Staff, AHP, Surgical Physician Assistant

 

Change from Provisional to Full Membership:

              Heather Dale, PA-C                                    Courtesy Staff, AHP, Physician Assistant (GAC)

 

ACTION:  A motion was made by Kay Moline to accept the recommendation of the Credentials Committee and grant appointment and reappointment for each of the practitioners listed above.  The motion was seconded by H. Stuart Johnson and carried with all members voting in favor.  A motion was made by Margie Nelsen to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested, and approved by the Credentials Committee.  The motion was seconded by H. Stuart Johnson and carried with all members voting in favor. 

 

FINANCIAL REPORT

 

The financial report for October 2011 was presented by Curt Savstrom, CFO.  Operating Cash On

Hand increased to 110.8 days due to increased revenue and receivables; The net impact onTotal Days Cash on Hand increased 9.3 days to 244.9 days.  The current ratio is 4.1 compared to last month’s 4.3.  Days in Accounts Receivable remains stable at 38.11 compared to last month’s 38.9.  Revenue over expense for the month resulted in a gain of $120,582, and when combined with non-operating income for October showed a net gain of $124,780, for a margin of 7.71%.  Year-to-date revenue over expense shows a loss of ($201,966), and when combined with non-operating income shows

a net loss of ($14,476) or -0.10%.  Year-to-date inpatient revenue is up 93 days compared to October 2010.  This increase is seen in both Acute and Swing Bed days. Outpatient revenue is up 21% comparison to October 2010.  The Clinic revenue has increased with a full time physician returning from leave.  Year-to-date expenses through October are $163,764 higher than 2010, with continued increases in professional fees for ER Physicians, CRNA’s and rental of Imaging equipment and Live Well.   Interest expense has decreased by $386,000 from October 2010, with bond refinancing resulting in a reduced expense of $15,000 per month.  The cost of salaries continues to decrease with FTE reductions and staff turnover, though overtime hours continue to increase as in the previous month.  Benefits are $35,000 lower than last year, which includes the 2010 accrual reversal which made expenses artificially low.

Community Care grants for October decreased to $8,816, compared to $17,621 in September.  In October, 23 patient accounts qualified for a 100% write-off.  Board approval for collection activity is $53,193.

 

ACTION:  Jerry Pfeifer made a motion to approve the October 2011 financial report as presented.  The motion was seconded by H. Stuart Johnson.  Kay Moline moved to approve the Financial Statements along with payment of bills.  The motion was seconded by Margie Nelsen.  A motion was made by H. Stuart Johnson for payment of write-offs to collection and bad debt.  The motion was seconded Margie Nelsen.  H. Stuart Johnson motioned to approve the accounts payable review.  The motion was seconded by Kay Moline. All four motions made and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

No minutes were available for review.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  Ms. Spike discussed the difficulties the hospital is experiencing with the HMS system and how important it is for REHC to get a new system.  The EPIC system has the most to offer REHC, including tech support, a complete finance package and a user friendly format.  Looking towards the future, it is expected that 80% of the hospitals in Minnesota will be using the EPIC system. 

 

Dr. Osborne shared concerns about REHC using another operating system when two are already in place in town.  Presently Mayo Clinic Health System- St. Peter uses the Cerner system, but Ms. Spike noted that the majority of organizations in the State are moving to EPIC and that the system used by Mankato Clinic does not have what is needed for a hospital system.

 

Ms. Spike discussed the fiasco with the November 11, 2011 payroll and due to the poor customer service and complexity of the situation; REHC will be changing banking institutions.  A decision has not been made as to which bank but per city rules and regulations, it will be a bank located in town.

 

As the Super Committee was unable to reach an agreement, REHC now has time to contact state legislators about the impact of removing our Critical Access Program status.  A project will begin by administrative staff, after the 2011 budget is final, to show the impact it would have if REHC is no longer deemed Critical Access.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Utility Costs.

 

Tom Wilcox, Director of Environmental Services, presented an overview of the hospitals utility usage and costs.  At this time, 35% or more of the annual Facility & Management budget accounts for utility costs.

There are three types of utility categories:

• Electricity.
• Natural gas, interruptible and firm.
• City services (includes water, sewage and storm water).

 Electricity

On average REH uses 128,833 kWh monthly.  The Medical Office Building (MOB) uses 29,290 kWh monthly.  The average cost increase of electrical use is 5.7% per year.

 

Natural gas, interruptible and firm

Natural gas is used only in the hospital building.  The boilers are on interruptible gas, meaning Centerpoint Energy could request that natural gas to be turned off to allow for usage in another area of town.  If that would happen, the boilers would then run on diesel fuel.  To date this situation has not occurred since the move in 2004 and this agreement provides a discount on gas prices.  Firm gas is used on the rooftop to assist with humidification of the building.  The current cost of natural gas is $0.59 per CCF with the projected rate staying stable.

 

City Services

Due to the efficiently of both REH and MOB, the annual service cost in 2011 is $18, 650 compared to 2010 service cost of $18,425.  In 2010, the cost per square foot in the hospital was $3.00 and the MOB was $1.51.  The leased spaces are not included, as they have separate connections.

 

Mr. Wilcox also discussed the recent cost saving measures at REHC.  With the implementation of the new water osmosis system installed by the City of St. Peter, the softener amount required for portable water has gone done dramatically.  REHC is now using less than 100 pounds of softener salt a month compared to 1,500 pounds of softener salt prior to the osmosis system.  A change in the company used for disposal of confidential documents now costs approximately $270 a month compared to the previous company that was approximately $544 per month.

 

B.          EPIC/Meaningful Use.

Colleen Spike explained that this program provides a financial incentive for the "meaningful use" of certified EHR technology.  Eligible users will receive payments to help pay for the cost of an EHR system.  This system must meet all “meaningful use” guidelines and requirements and our current system of HMS does not.  The government deadline for EHR is 2015, but the benefits to critical access hospitals decreases in 2012.

 

As HMS is not meeting the requirements or the hospital’s needs, it is necessary for REHC to purchase a new EHR.  At this time, Sanford Health is providing the opportunity to “piggyback” onto their EPIC system.  This would allow REHC to met both Meaningful Use guidelines and improve facility wide production with regards to an EHR system.

 

C.          Adverse Event Reporting/MHA Video.

Colleen Spike spoke about the upcoming publication of the Minnesota Department of Health Adverse Event Report.  All hospitals in the state must participate in recording reportable events.  In 2009, REHC had one reportable event relating to a pressure ulcer.  In 2010 and 2011, there were no reportable events.

 

A video produced by the Minnesota Hospital Association was shown to the Hospital Commission.

Key points in the video included:

              - Minnesota was the first state in the nation to begin reporting adverse events.

              - The top four reported events are:

                            - Wrong Site Procedure.

                            - Retained Foreign Objects.

                            - Falls.

                            - Pressure Ulcers.

              - Patient safety/quality should be a topic at every board meeting.

 

DIRECTOR’S COMMENTS

 

Peggy Carlson, Community Liaison:  The consumer advisory group will meet on December 1, 2011 to discuss stroke prevention measures.

 

ADJOURNMENT

 

A motion to adjourn the meeting was made by Jerry Pfeifer, seconded by Kay Moline, and carried with all members voting in favor.  The meeting was adjourned at 1:25 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, December 14, 2011, at

4:00 p.m. This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 3:30 p.m.  This meeting will include a supper meal and strategic planning.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, October 26, 2011

 

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Trustees:  H. Stuart Johnson, Kay Moline , Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President; Dr. Michael Sparacino, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control; Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Tammie Hudspith, Director of Human Resources, Peggy Carlson, Community Liaison; and Melissa Marshall, Recorder.

 

Guest: Shari Brostrom from Pell Insurance.

 

The regular meeting of the Hospital Commission was called to order at 12:21 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the October 26, 2011, meeting was reviewed. 

ACTION:  A motion was made by Kay Moline to approve the agenda as presented.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of September 28, 2011, were reviewed. 

ACTION:  A motion was made by Margie Nelsen to approve the regular Commission meeting minutes of September 28, 2011, as presented.  The motion was seconded by H. Stuart Johnson and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the October 11, 2011, Medical Staff meeting were reviewed.  Dr. Osborne explained the Gustavus Adolphus College student’s scholarship process and noted that no applications have been received at this time.

ACTION: A motion was made by Michelle Chalin to acknowledge receipt of the Medical Staff meeting minutes of October 11, 2011.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor. 

                                                                                                                             

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Nelly Amador, MD, PhD                           Courtesy Staff- Neuro Surgery/Emergency Medicine

Jason R. Sheffler, DO                                 Courtesy Staff – Family Medicine/Emergency Medicine

 

Reappointment to the Medical Staff:

Christopher Fischer, MD                            Courtesy Staff, Nuclear Medicine/Teleradiology

David J. Orcutt, MD                                    Courtesy Staff, General Surgery/Colorectal Surgery

             

 

Teleradiology Staff, Radiology

 

Norman Arslanlar, DO	Thomas Ibach, MD	Robin Parker, MD
Geoffrey Beodeau, MD	Radha Inampudi, MD	Jeffrey Peterson, MD
Brent Bullis, MD	Subbarao Inampudi, MBBS	Michael Plunkett, MD
Neeraj Cehpuri, MD	Steven Jensen, MD	Robert Pollock, MD
Benjamin Crandall, MD	Jon Kane, MD	Paul Rust, MD
Charles Donovan, MD	Eul Kang, MD	Lisa Schneider, MD
Mark Doyscher, MD	J. Denise Krivach, MD	Clark Schumacher, MD
Kevin Edelman, MD	Richard Levey, MD	Scott Sidney, MD
Eduardo Ehrenwald, MD, PhD	Thomas Matson, MD	John Steely, MD
Christopher Engeler, MD	Jason Mehling, MD	Christopher Tillotson, MD
Nazih Farah, MD	Karla Myhra-Bloom, MD	David Tubman, MD
Stephen Fry, MD	James Mylrea, MD	Sara Veldman, MD
Frederick Gramith, MD	John Nobrega, MD	Robert Yost, MD
Douglas Hassell, MD	Frederick Olson, MD
Stephen Hite, MD	Mark Oswood, MD

 

ACTION:  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant appointment and reappointment for each of the practitioners listed above.  The motion was seconded by Kay Moline and carried with all members voting in favor.  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested, and approved by the Credentials Committee.  The motion was seconded by H. Stuart Johnson and carried with all members voting in favor. 

 

FINANCIAL REPORT

 

The financial report for September, 2011, was presented by Curt Savstrom, CFO.  Operating Cash On

Hand has decreased to 105.7 days; Total Days Cash on Hand has decreased 6.4 days to 235.6 days.  The current ratio is 4.33 compared to last month’s 4.15.  Days in Accounts Receivable decreased to 38.9 days which is down 3.9 days from last month.  A recommendation to replenish the Funded Depreciation account with $ 459,000 from operating cash was made by Mr. Savstrom.  Revenue over expense for the month resulted in a loss of ($127,164), and when combined with non-operating income for September showed a net loss of ($122,366), for a margin of -8.86%. Year-to-date revenue over expense shows a loss of ($322,550), and when combined with non-operating income shows

a net loss of ($139,258) or -1.07%.  Year-to-date inpatient revenue is up 41 days compared to September 2010.  This increase is seen in both Acute and Swing Bed days. Outpatient revenue is up in comparison to September, 2010.  The Clinic revenue went down slightly due to a full time physician being on leave.  Year-to-date expenses through September are $177,781 higher than 2010, with continued increases in professional fees for ER Physicians and CRNAs.   Interest expense has decreased by $384,000 from September 2010, with bond refinancing resulting in a reduced expense of $15,000 per month.  The cost of salaries continues to decrease with FTE reductions and staff turnover, though overtime hours have increased in past 3 months.  Benefits are equal to last year and with the change to Hanratty & Accociates, it has helped to keep expenses low.

 

Community Care grants for September continue to increase with a total of $17, 621.  There were 13 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $51,728.

 

ACTION:  Jerry Pfeifer made a motion to approve the September, 2011, financial report as presented, including the approval of unrestricted funds.  The motion was seconded by H. Stuart Johnson.  H. Stuart Johnson moved to approve the Financial Statements along with payment of bills.  The motion was seconded by Kay Moline.  A motion was made by Margie Nelsen for payment of write-offs to collection and bad debt.  Stu Johnson seconded the motion.  Margie Nelsen motioned to approve the accounts payable review.  The motion was seconded by Jerry Pfeifer. All four motions made and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

The minutes from the September 21, 2011 Quality Management Committee meeting were reviewed.  Kristin Schultz noted that the Quality Health Indicators will have a new look starting in November.  The new format will allow for a better representation of the factors that are currently being measured.

ACTION:  A motion was made by Kay Moline to acknowledge receipt of the Quality Management Committee meeting minutes of September 21, 2011.  The motion was seconded by Margie Nelson and carried with all members voting in favor. 

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  Ms. Spike noted the banner located on the front of the hospital building and multiple signs that have been placed around the building announcing River’s Edge Hospital & Clinic as a Top 100 Hospitals amongst women.  Progress is being made on moving towards an Electronic Health Record (EHR).  A meeting with Sanford Health in regards to River’s Edge joining on their Epic system has been scheduled.  Ms. Spike noted that the meeting is strictly about EHR’s and there is no intention of becoming a Sanford Health facility.

 

Ms. Spike acknowledged the letter from the Minnesota Department of Health regarding the FluSafe program.  To date, 95.4% of employees have been vaccinated.

 

 

QUALITY / EDUCATION / OPERATIONS

 

A.          REHC Insurance/Malpractice Policy Update

             

Sheri Brostrom from Pell Insurance presented a basic overview of the policies that are currently written for River’s Edge Hospital & Clinic.  At this time, Pell Insurance is the only company who writes our insurance policies.  Ms. Brostrom also noted that the Foundation is listed on all current policies.

 

              Current policies held by River's Edge Hospital & Clinic include, but not limited to:

• Building insurance;
• Personal Property insurance;
• General Liability;
• Physician Malpractice insurance;
• Business Interruption; and a
• Crime Bond.

 

 

With the increase in technology usage and the capability of technology, Ms. Brostrom discussed policy options that are available.

 

Internet Protection Coverage- This policy helps to protect against losses due to unauthorized

access, data thief, viruses and security breaches.

 

Computer Coverage- This policy protects the use of computers that River's Edge Hospital &

Clinic owns, including the laptops which has a transit policy clause.

 

Colleen Spike referenced the Star Tribune article and the letter from Eide Bailly, LLP regarding patient data theft on laptop computers.  Ms. Spike said that this is a very real issue and REHC needs to look at precautions they can take, which could include Internet and Computer coverage policies.

 

B.          Provider Peer Grouping.

The measurement is used to determine the cost of care over the quality of care.  In the initial report, REHC was high in quality and low in cost.  There have been multiple appeals which may affect our measurements in the next report.  It is very important for clinics to provide high quality with low cost to do well in this report.

 

C.          Hospital Commission Secretary/Treasurer Vacated Position.

A motion was made by Kay Moline to approve Colleen Spike as the seconded signee on all checks.  Colleen will also sign off on the Commission Meeting Minutes.  This will be temporary until a replacement for the position is found. The motion was seconded by H. Stuart Johnson with all members voting in favor.

 

D.          Replacement Commission Member.

Gil Carlson and Colleen Spike have met regarding the replacement of the vacated position and the recruitment process will soon begin.

 

E.           In Memory of Helen White.

Gil Carlson spoke about Ms. White’s 33 years of employment, dedication and service to the hospital.  In honor of her work and commitment, Gil Carlson made the suggestion of changing the name of the conference rooms to The Helen White Conference Suite.  A plaque would be put up in honor of Ms. White.  A motion was made by Kay Moline to adopt the name change and was seconded by Jerry Pfeifer with all members voting in favor.

 

F.           Holiday Meeting Dates.

With the upcoming holidays, the November Commission Meeting will be held on its regularly scheduled date and time of November 30, 2011.

 

The December Commission Meeting will be changed to Wednesday, December 14, 2011 with the Finance Board meeting at 3:30 p.m. and the Commission Meeting at 4:00 p.m.  A supper will be provided and strategic planning and approval of the 2012 budget will be on the agenda.

 

 

DIRECTOR’S COMMENTS

 

Tom Wilcox, Director of Environmental Services:  The Foundation has funded a pre-owned van specifically for food transport and MCHS-Mankato courier runs.  The current diesel truck will need to be outfitted with the snowplow and is very inefficient in fuel usage for these types of tasks.

 

Tammie Hudspith, Director of Human Resources:  There will be no premium increase for the upcoming year in regards to health and dental insurance.  Employee forums will be held along with a benefit fair for all employees to attend.  On November 16, 2011, the annual employee craft fair will be held in the conference rooms.

 

Paula Meskan, Director of Nursing:  50 students from St. Peter High School are participating in the High Step program which is in its second month.  The lesson plans have been laid out and will focus on many different areas of healthcare.

 

Curt Savstrom, CFO:  Was recently a presenter and a moderator at the Minnesota CPA non-profit conference.  November 16, 2011, is Give to the Max Day.  All Minnesotans are encouraged to give a donation to local charities and groups.  The Foundation has been enrolled and gifts can be made either on-line or by direct donation.

 

ADJOURNMENT

 

A motion to adjourn the meeting was made by Michelle Chalin, seconded by Jerry Pfeifer, and carried with all members voting in favor.  The meeting was adjourned at 1:22 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, November 30, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, September 28, 2011

 

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Trustees:  H. Stuart Johnson, Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President; Dr. Michael Sparacino, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control; Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Patty Roessler, Director of Patient Care and Ancillary Services; Tammie Hudspith, Director of Human Resources, Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; and Paulette Redman, Recorder.

 

Absent:  Helen White, Secretary-Treasurer; Kay Moline, Trustee.

 

The regular meeting of the Hospital Commission was called to order at 12:27 p.m. by Chairperson Gil Carlson.

 

ANNOUNCEMENT OF AWARD

 

Colleen Spike announced that the River’s Edge Hospital and Clinic has been designated a Top 100 Hospital in the Nation for Patient Experience by WomenCertified® in the class of hospitals of 100 beds or less.  The designation incorporates HCAHPS scores along with additional criteria important to women for patient satisfaction.  An article about the designation was featured in “USA Today” and will be featured in the “Modern Healthcare” magazine.  REHC will be promoting this designation over the next year.  Gil Carlson congratulated Ms. Spike on behalf of the Commission.

 

APPROVAL OF AGENDA

 

The agenda for the September 28, 2011, meeting was reviewed. 

ACTION:  A motion was made by Michelle Chalin to approve the agenda as presented.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of August 31, 2011, were reviewed. 

ACTION:  A motion was made by Margie Nelsen to approve the regular Commission meeting minutes of August 31, 2011, as presented.  The motion was seconded by Stuart Johnson and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the September 13, 2011, Medical Staff meeting were reviewed.  Dr. Osborne noted that the bulk of the meeting was spent reviewing proposed revisions to the Medical Staff Bylaws, and also discussing a strategic plan for the Medical Staff for 2012.  Focus areas to be included in the strategic plan will include readmissions/discharge planning, medication reconciliation, the peer review process, and record keeping and documentation.

ACTION: A motion was made by Jerry Pfeifer to acknowledge receipt of the Medical Staff meeting minutes of September 28, 2011.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Patricia Fahey Bacon, FNP                       Courtesy Staff, AHP, Family Nurse Practitioner

Nadia Malik, MD                                        Active Staff, Family Medicine

Trudi Parker, MD                                        Teleradiology

 

Reappointment to the Medical Staff:

              Richard Kim, DDS, MD                            Courtesy Staff, Dental/Maxillofacial Surgery

              Richard Cauley, CRNA                               Courtesy Staff, AHP, Nurse Anesthetist

 

              Move from Provisional to Full Membership:

              Michael Sparacino, DO                                Active Staff, Family Medicine

 

              Withdrawal from Medical Staff:

              Elmer Calica, MD                                       Courtesy Staff, Emergency Medicine

              Anne Reddy, MD                                        Teleradiology

 

ACTION:  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Michelle Chalin and carried with all members voting in favor.  A motion was made by Stuart Johnson to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

FINANCIAL REPORT

 

The financial report for August, 2011, was presented by Curt Savstrom, CFO.  Operating Cash On Hand has increased to 108.8 days, Total Days Cash on Hand is 242 days.  The current ratio is 4.15 compared to last month’s 3.87.  Days in Accounts Receivable decreased from 50.7 days last month to 42.8 days.  Revenue over expense for the month resulted in a loss of ($127,294), and when combined with non-operating income for August showed a net loss of ($71,098), for a margin of -5.67%. Year-to-date revenue over expense shows a loss of ($195,391), and when combined with non-operating income shows a net loss of ($16,896) or -0.15%.  Inpatient, Outpatient and Clinic revenues are all up in comparison to August, 2010.  Year-to-date expenses through August are $190,410 higher than 2010, due to increases in professional fees for ER Physicians and CRNAs, use of contract labor and temporary labor, supplies, repairs and maintenance, and leases/rental for the new CT scanner, mammography equipment and Live Well rental.  Interest expense has decreased by $374,000 from August 2010, with bond refinancing resulting in a reduced expense of $15,000 per month.  The cost of salaries and benefits has decreased in comparison with 2010.  Overtime hours increased in August.

 

Inpatient utilization is up 11 days compared to August, 2010, due to an increase in swing bed days.  Outpatient utilization is up 22%; but average revenue per visit has declined approximately $39 per visit.  Clinic revenues continue to grow.

 

Community Care grants for August totaled $10,197, compared to $15,103 in July, 2011.  There were 23 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $57,814.

 

ACTION:  H. Stuart Johnson made a motion to approve the July, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

The minutes from the August 24, 2011, Quality Management Committee meeting were reviewed.  Kristin Schultz noted that the committee members received and reviewed many different types of reports.  Included were departmental quality program updates, required reports and reports detailing overall quality processes within the facility.  Commission members wanting to know more about the detail within the reports may contact Kristin Schultz.

ACTION:  A motion was made by Margie Nelsen to acknowledge receipt of the Quality Management Committee meeting minutes of August 24, 2011.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  Ms. Spike reported on the Provider Peer Grouping designation as noted in the report.  Initial results show that REHC has fallen into the designation of being a high quality/low cost facility, which is the preferred designation.  She will be reporting further on this topic at the October meeting.  Additionally she noted an upcoming Regional Trustee meeting to be held in Northfield.  Commission members wishing to attend should contact Ms. Spike.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Bad Debt vs. Community Care.

Curt Savstrom and Sheri Schmidt presented information on uncompensated care.

--Uncompensated Care:  Measure of care for which we are not going to receive payment.

--Charity Care:  Care for which the hospital never expected to be reimbursed because of a determination of patient’s inability to pay.

--Bad Debt:  Expected to be paid but cannot obtain reimbursement because patient is unable or unwilling to pay.

Uncompensated care does not include Medicare/Medicaid underpayment costs or contractual allowances.  Patients receive Community Care brochures and the opportunity to apply for this program.  The hospital also offers payment structures to patients to help them meet their payment obligations.  Persons who are turned over to charity care do not go to collections or revenue recapture.  At the time an account is turned over to bad debt or collections, information is also sent to the State’s revenue recapture program in hopes of receiving payment from the person’s tax refund money.

 

B.          MHA Workforce Study.

Tammie Hudspith reported on the findings from a Minnesota Hospital Association survey looking at workforce issues.  Employees at greatest risk for turnover include employees with less than five years service and employees over age 55 with greater than five years service.  REHC has 104 employees that fall into the first category and 23 who fall into the second category.  Based on information regarding availability of healthcare workers, REHC anticipates they will be able to replace employees in the event of employee turnover.

 

DIRECTOR’S COMMENTS

 

Tammie Hudspith, Director of Human Relations:  The annual review with the health insurance company went very well.

Peggy Carlson, Community Liaison:  REHC will have a presence at the Senior Expo being held on Thursday from 3-6 p.m.  Additionally, “Girls Night Out” information and activities will be held in the Medical Office Building atrium on October 6 from 5-8 p.m.  A purse sale will be held that same day to benefit the Foundation.  An educational session on stroke will be held on October 12 with information presented by a speaker from the Neuroscience Institute.

 

ADJOURNMENT

 

A motion to adjourn the meeting was made by Jerry Pfeifer, seconded by Michelle Chalin, and carried with all members voting in favor.  The meeting was adjourned at 1:10 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, October 26, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, August 31, 2011

 

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Helen White, Secretary-Treasurer;  Trustees:  H. Stuart Johnson, Kay Moline, Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President; Dr. Michael Sparacino, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control; Sheri Schmidt, Director of Business Services; Paula Meskan, Director of Nursing; Tom Wilcox, Director of Environmental Services; Patty Roessler, Director of Patient Care and Ancillary Services; Tammie Hudspith, Director of Human Resources, Peggy Carlson, Community Liaison; Don Lowe, RN, and Paulette Redman, Recorder.

 

Absent:  None.

 

The regular meeting of the Hospital Commission was called to order at 12:21 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the August 31, 2011, meeting was reviewed.  A request was made to indicate  that item VII-C would be a motion item, and that VII-D would be a roll call vote.

ACTION:  A motion was made by Kay Moline to approve the agenda as revised.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of July 27, 2011, were reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the regular Commission meeting minutes of July 27, 2011, as presented.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the August 9, 2011, Medical Staff meeting were reviewed.  Dr. Osborne reported on the results of the ED audit that had been completed looking at appropriateness of transfer.

ACTION: A motion was made by Jerry Pfeifer to acknowledge receipt of the Medical Staff meeting minutes of August 9, 2011.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

              Gwen Krogwold, PA-C                                 Courtesy Staff, AHP, Surgical Physician Assistant

              Ali Latefi, DO                                               Courtesy Staff, Urology

 

                                                                                                                             

 

Request for Additional Privileges:

              Doua Her, MD                                             Courtesy Staff, Emergency Medicine

              Lori Krome, MD                                          Courtesy Staff, Emergency Medicine

              Vivian Fischer, MD                                      Courtesy Staff, Emergency Medicine

              Robert Christensen, MD                               Courtesy Staff, Emergency Medicine

              Alpana Singh, MD                                       Courtesy Staff, Emergency Medicine

 

              Withdrawal from Medical Staff:

              Kevin Sirmons, MD                                     Courtesy Staff, Emergency Medicine

 

ACTION:  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant appointment or change in status for each of the practitioners listed above.  The motion was seconded by Helen White and carried with all members voting in favor.  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

FINANCIAL REPORT

 

The financial report for July, 2011, was presented by Curt Savstrom, CFO.  Operating Cash On Hand has increased to 93.5 days, Total Days Cash on Hand is 235 days.  The current ratio is 3.87 compared to last month’s 3.99.  Days in Accounts Receivable is currently at 50.7 days which is an increase compared to last month’s 48.4.  Revenue over expense for the month resulted in a gain of $33,235, and when combined with non-operating income for July showed a net gain of $38,914, for a margin of 2.55%. Year-to-date revenue over expense shows a loss of ($68,098), and when combined with non-operating income shows a net margin of $54,201 or 0.52%  Inpatient, Outpatient and Clinic revenues are all up in comparison to July, 2010.  Year-to-date expenses through July are $36,231 higher than July, 2010, due to increases in professional fees for ER Physicians and CRNAs, use of contract labor and temporary labor, supplies, and leases/rental for the new CT scanner.  Interest expense has decreased by $357,000 from July 2010, with bond refinancing resulting in a reduced expense of $15,000 per month.  The cost of salaries and benefits has decreased in comparison with 2010. 

 

Inpatient utilization is up 5 days compared to July, 2010, due to an increase in swing bed days.  Outpatient utilization is up 23%; but average revenue per visit has declined approximately $77 per visit.  Clinic revenues continue to grow.

 

Community Care grants for July totaled $15,103, compared to $35,886 in June, 2011.  There were 39 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $77,625.

 

ACTION:  H. Stuart Johnson made a motion to approve the July, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Helen White and carried with all members voting in favor.

 

 

QUALITY / SAFETY REPORT

 

Report tabled until September meeting.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  Ms. Spike highlighted the discussions with Gustavus Adolphus College and the potential loan repayment program for physicians in critical access hospitals.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Cardiac Rehab Program

Don Lowe, RN, presented an overview of the cardiac rehab program.  He defined what cardiac rehabilitation is, including the three phases of rehab.  He reviewed the types of diagnoses appropriate for rehab, and reviewed the typical program components, duration and frequency of visits.  He emphasized the team approach that is used, involving the patient, their cardiologist and primary care provider, the nurse, exercise physiologist, dietician, pharmacist and social services.  Cardiac rehab visits have increased from 307 year-to-date in 2010 to 663 for 2011 through July.  Mr. Lowe also reported that River’s Edge will begin providing exercise stress testing under the supervision of Dr. Sparacino.

 

B.          Nash Finch Pharmacy Lease.

Nash Finch has notified River’s Edge that they will not be renewing the lease for the Quality Pharmacy.  An offer was made to Nash Finch to extend the lease for a year at the current rates, but the decision was made by Nash Finch to close the pharmacy and consolidate it with their downtown pharmacy.  Colleen Spike had contacted both Walgreen’s and CVS to see if they have any interest in a pharmacy at this site.  Quality Pharmacy will be closing on September 9.  The lease will be paid through February, 2012.

 

C.          Replacement of X-Ray Tube.

An x-ray tube and voltage transformer in the Imaging Department have required replacement.  The voltage transformer was covered under the UHS contract, the x-ray tube was not.  Cost of replacing the x-ray tube was $11,840 for the tube, $700 for labor, and $400 for freight, for a total of $12,940.00. 

ACTION:  A motion was made by Jerry Pfeifer to approve payment of $12,940.00 for replacement of an x-ray tube.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

D.          Closed Meeting / September Marketing/Strategy Session.

Ms. Spike made a request to hold a closed meeting for the purpose of discussing strategic partnerships, lease/tenant relationships and other marketing strategies.  The meeting would be attended by Hospital Commission members, the CEO, CFO, Community Liaison, REHC Directors and the City Administrator. 

ACTION:  A motion to hold a closed meeting was made by H. Stuart Johnson and seconded by Margie Nelsen.  A roll call vote was taken, with a yes vote indicating approval to close the meeting.  Voting “Yes” were Jerry Pfeifer, Michelle Chalin, Margie Nelsen, Kay Moline, Helen White, H. Stuart Johnson and Gil Carlson.  Voting “No”:  None.  The closed meeting will be held on Wednesday, September 21, 2011, at 12 noon.

                                                                                                               

 

DIRECTOR’S COMMENTS

 

Tammie Hudspith, Director of Human Relations:  Work is beginning on employee benefit plans for next year.

Paula Meskan, Director of Nursing:  There are 53 high school students involved in the High-Step program for the coming year.  Students will be divided into two groups.  Participating in the program are students from St. Peter, Cleveland, St. Clair, Nicollet and Montgomery.  The High-Step program has donated a Smart Board to River’s Edge.

Peggy Carlson, Community Liaison:  An organization fair will be held at Gustavus on September 13, and plans are underway to participate in a Senior Expo on September 29.

Kristin Schultz, Director of Quality, Risk Management and Infection Control:  Flu shots will be available after Labor Day.  A high dose vaccine will be available for patients age 65 and older.  A new micro-needle will be available for middle-aged patients.

Colleen Spike, CEO:  Ms. Spike noted that September will likely see a drop in activity in the LeCenter Clinic, as Dr. Sparacino will be spending additional time in St. Peter during the month.

Curt Savstrom, CFO:  A new laparoscope arrived last week.  The laparoscope, at a cost of $47,000, was paid for by the Foundation.  He also noted receipt of a Medicare payment of $522,000.

H. Stuart Johnson:   Mr. Johnson congratulated Ms. Spike on the recognition received for DNV accreditation.  He also expressed appreciation for care he has recently received from the facility.

                                                                     

ADJOURNMENT

 

A motion to adjourn the meeting was made by Kay Moline, seconded by Helen White, and carried with all members voting in favor.  The meeting was adjourned at 1:22 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, September 28, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, July 27, 2011

 

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Helen White, Secretary-Treasurer;  Trustees:  Kay Moline, Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President; Dr. Michael Sparacino, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control; Sheri Schmidt, Director of Business Services; Paula Meskan, Director of Nursing; Tom Wilcox, Director of Environmental Services; Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; and Paulette Redman, Recorder.

 

Absent: H. Stuart Johnson, Trustee.

 

The regular meeting of the Hospital Commission was called to order at 12:20 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the July 27, 2011, meeting was reviewed.  A suggestion was made to include a standing agenda item regarding Medical Staff privileges on future agendas.

ACTION:  A motion was made by Kay Moline to approve the agenda as presented.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of June 29, 2011, were reviewed. 

ACTION:  A motion was made by Michelle Chalin to approve the regular Commission meeting minutes of June 29, 2011, as presented.  The motion was seconded by Helen White and carried with all members voting in favor.  

 

MEDICAL STAFF

 

No report.  The Medical Staff did not meet in July.

 

FINANCIAL REPORT

 

The financial report for June, 2011, was presented by Curt Savtrom, CFO.  Total Days Cash on Hand is 225 days.  The current ratio is 4.01 compared to last month’s 3.96.  Days in Accounts Receivable is currently at 48.4 days which is a decrease compared to last month’s 56.9.  Revenue over expense for the month resulted in a loss of ($59,003), and when combined with non-operating gain for June showed a net loss of ($53,492), for a margin of -3.74%. Year-to-date revenue over expense shows a loss of ($101,332), and when combined with non-operating income shows a net margin of $15,289 or 0.17%  Inpatient, Outpatient and Clinic revenues are all up in comparison to June, 2010.  Year-to-date expenses through June are $79,706 higher than June, 2010, due to increases in professional fees for ER Physicians, CRNAs, supplies, repairs and maintenance, and leases/rental for the new CT scanner.  The cost of salaries and benefits has decreased in comparison with 2010.  Interest expense has decreased by $340,000 in comparison to 2010 due to bond refinancing.

 

Inpatient utilization is up 42 days compared to June, 2010, due to an increase in swing bed days.  Outpatient utilization is up 25%; but average revenue per visit has declined approximately $82 per visit.  Clinic revenues continue to grow.

 

Community Care grants for June totaled $35,886, compared to $10,454 in May, 2011.  There were 21 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $45,603.

 

ACTION:  Helen White made a motion to approve the June, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Kay Moline and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

Kristin Schultz noted the certificate of accreditation received from DNV in which the hospital and clinic were awarded full accreditation for a three-year term.  Ms. Schultz noted that corrective action plans have been developed and implemented for each of the nonconformities that were identified during the recent DNV survey.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  Ms. Spike discussed provisions in State and Federal budgets that call for nonpayment or penalties for Medicare and Medicaid readmission cases, returns to the ED and for healthcare-associated conditions.  River’s Edge has formed a multidisciplinary task force to look at hospital and ED readmissions and take steps to decrease rates of readmission. 

 

Ms. Spike also noted the 50/50 ticket fundraiser for the Foundation that will take place at the Nicollet County Fair.  A planning meeting for the Commission will be held on August 17, 2011, from 12 noon until 4 p.m.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Physician Recruitment.

An ad has been run for a nurse practitioner for the River’s Edge Clinic with little response.  An interview was held today with a pediatric nurse practitioner.  Colleen Spike has contacted Merritt Hawkins, who will begin looking for a family physician for the Clinic to replace Dr. Chaska.  The cost of using this recruiting firm includes a $3000 down-payment plus advertising costs, and a closing fee at the time of a successful recruitment, for a total of approximately $24,000-$26,000.

 

B.          Legislative Impact Update.

Colleen Spike presented information on the effects of the compromise budget bill that was passed by the State legislature.  Included is a $700 million payment shift from K-12 education, $1.04 billion in general fund cuts, and $809 million in cuts from Medicaid.

 

              Provisions include:

• Early MA enrollment survived.
• Coverage preserved for 140,000 low income Minnesotans.
• No Medicaid surcharge increase.
• Phase out Minnesota Care Tax by 2019.
• Elimination of rebasing.  Current Medicaid reimbursement is set at a 2002 level.

• New 10% reduction in inpatient Medicaid payments.  Inpatient rates will be 26% below 2002 costs.
• 5% reduction in outpatient facility rates.
• 3% reduction in physician rates.
• Managed Care Provisions call for $277 million in provider payment cuts.
• Reductions to Medicare cross-over payments for dual-eligible patients.

 

Funding for rural capital improvement and rural hospital planning and transition care grant programs stayed in place, but funding for the summer intern program and health careers program was eliminated.

 

C.          Strategy Planning Meeting for August.

              Planning and Goal Setting meeting set for Wednesday, August 17, 2011, from 12 noon until 4

p.m.

 

DIRECTOR’S COMMENTS

 

Peggy Carlson, Community Liaison:  The Red Cross Blood Drive will be held at River’s Edge next week on Thursday and Friday.

                                                                     

ADJOURNMENT

 

A motion to adjourn the meeting was made by Jerry Pfeifer, seconded by Michelle Chalin, and carried with all members voting in favor.  The meeting was adjourned at 12:56 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, August 31, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, June 29, 2011

 

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Helen White, Secretary-Treasurer;  Trustees: H. Stuart Johnson, Kay Moline, Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President;  Kristin Schultz, Director of Quality and Infection Control;  Sheri Schmidt, Director of Business Services;  Paula Meskan, Director of Nursing;  Patty Roessler, Director of Patient Care;  Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; and Melissa Marshall, Recorder.

 

Absent: Dr. Michael Sparacino, Chief Medical Officer.

 

At 12:01 p.m. a tour was provided of the Kohl’s Mobile Simulation Center for all meeting attendees interested.

 

The regular meeting of the Hospital Commission was called to order at 12:33 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the June 29, 2011, meeting was reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the agenda as presented.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of May 25, 2011, were reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the regular Commission meeting minutes of May 25, 2011, as presented.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

The minutes of the Special Commission meeting of June 14, 2011, were reviewed. 

ACTION:  A motion was made by Margie Nelsen to approve the Special Commission meeting minutes of June 14, 2011, as presented.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

MEDICAL STAFF

 

Dr. Elizabeth Osborne, Medical Staff President, verbally summarized the Medical Staff meeting minutes and noted that the presentation given by Dr. Sparacino regarding “When Enough is Enough, and What is Enough”, was both interesting and thought provoking.

 

A.          Medical Staff Meeting Minutes.  The minutes of the June 14, 2011, Medical Staff meeting were reviewed.

ACTION: A motion was made by Michelle Chalin to acknowledge receipt of the Medical Staff meeting minutes of June 14, 2011.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Josser E. Delgado, MD                               Telemedicine Staff-Radiology

Jeffrey Eikanger, CRNA                           Courtesy Staff, AHP- Nurse Anesthetist

Christopher Pippert, CRNA                       Courtesy Staff, AHP- Nurse Anesthetist

Anne Flatau, CST                                        Courtesy Staff, AHP- Surgical Technician

                                                                                                               

Reappointment to the Medical Staff:

              Vivian Fischer, MD                                     Courtesy Staff- Emergency Medicine

 

Change in Status – Active to Courtesy:

              Benjamin Chaska, MD                                 Active Staff- Emergency Medicine/Family Medicine

                                                                                                  Change to Courtesy Staff designation

 

ACTION:  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Kay Moline and carried with all members voting in favor.  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Helen White and carried with all members voting in favor.

 

FINANCIAL REPORT

 

The financial report for May, 2011, was presented by Curt Savstrom, CFO.  Total Days Cash on Hand is 222 days.  The current ratio is 3.96 compared to last month’s 3.8.  Days in Accounts Receivable is currently at 56.9 days which is an increase compared to last month’s 51.6.  Again noted the reason for the increase is due to increase in receivables with an increase in revenues and delays in documentation completion for billing purposes.  Revenue over expense for the month resulted in a gain of $240,668, and when combined with non-operating gain for May showed a net gain of $266,919, for a margin of 14.89%. Year-to-date revenue over expense shows a loss of ($42,330).  Inpatient, Outpatient and Clinic revenues are all up in comparison to May, 2010.  Year-to-date expenses through May are $110,843 higher than May 2010, due to increases in professional fees for ER Physicians, CRNA’s, supplies, leases/rental for the new CT scanner and an increase in the bad debt provision.

 

Inpatient utilization is down 11 days compared to May, 2010.  Outpatient utilization is up 28%; but average revenue per visit has declined to approximately $109 per visit. 

 

Community Care grants for May totaled $10,454, compared to $12,677 in April, 2011.  There were 18 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $68,927.

 

ACTION:  Kay Moline made a motion to approve the May, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Stu Johnson and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

Kristin Schultz presented the Readmission audit report for the first quarter for Inpatient Medical.  Based on review criteria, there were no surprise re-admits to the hospital and patients that were re-admitted have chronic health issues.  The report also noted no barrier issues to report.

 

Ms. Schultz also presented the Return to ED audit report for the first quarter for the Emergency Department.  The report noted one opportunity to improve regarding educational information and communication.  Emergency Department staff will continue to obtain information from the patient’s previous visit to help build on to the current visit.

 

The audit process will continue and another report will be presented for the second quarter.

                                                                                                                               

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  In regards to the possible state shutdown, the impact to River’s Edge Hospital & Clinic is very minimal.  An area that will be directly impacted is licensing.  A review of all personnel who require a license to practice is being performed.  If a license is not current, those personnel will not be allowed to practice.  Any personnel who have applied for a license will be allowed to practice with a confirmation of application on file.

 

Ms. Spike also noted that she is continuing to meet with representatives from both Mankato Clinic and The Orthopedic and Fracture Clinic.  Any actionable items will be presented to the Commission Board for approval.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Kohl’s Mobile Simulation Center Tour.

             

              This mobile simulation center allows healthcare professional to practice pediatric and neonatal

              emergency care in a risk free environment.  All scenarios are recorded and then participants

              review the footage to see possible weaknesses and also strengths.  Emergency Department staff

              from REHC will participate in a four hour session in the morning and staff from Minnesota

              Valley Hospital in Le Sueur will participate in a four hour session in the afternoon.  This is a

              unique and valuable opportunity for any healthcare professional to participate in.

 

B.          REHC Marketing Plan.

             

              Peggy Carlson presented a review of the current marketing plan developed by Envision.  The

Plan is based on a five year span and Ms. Carlson reviewed what has been accomplished and

what the future goals are for the upcoming years.

 

• 2008- The facility name change was implemented which included the standardization of e-mail and the development of a newsletter.
• 2009- “Whole Person” Participation in events and clubs was used to implement the new name change.  The REHC website was established.
• 2010- “Whole Family” The Le Center Clinic was opened, a billboard was placed on Highway 22, a Women’s Expo was held on campus and classes and seminars were held on a variety of topics.  A consumer advisor group was established and the service of drug screens and breath alcohol testing was announced to area business.  This resulted in a gain of six commercial accounts.
• 2011- “Whole Family” expanded- The focus is now on outreaching to people in the 29-35 age range.  The concept of a campus providing multiple services in the same area will continue to be marketed.
• 2012- “Whole Life”- Want to provide ways to serve the continuum of life though education and classes.  Use of cross-marketing and establishing relationships with people will be the primary goal.

                                                                                                                                           

              River’s Edge Hospital & Clinic campus will be the first in Minnesota to have a physical       connection between a hospital, clinics, nursing home, senior living and a pharmacy.

 

              Marketing Challenges:

• Public education of choices in healthcare services.
• Keeping current with changing technology.
• Development of a QR code to be used with Smart phones.

 

C.          Laboratory Equipment.

             

              Curt Savstrom presented an acquisition proposal to the Commission Board for the approval to

              purchase two new analyzers for the laboratory. The new analyzers are:

 

• Abbott Architect c4000 Chemistry Analyzer.
• Abbott Cell Dyn Ruby Hematology Analyzer.

             

              The current chemistry analyzer is eight years old and has broken down several times.  A break

              down results in the lab samples being sent off-site for testing.  This analyzer was scheduled to

be replaced in 2012.  The current hematology analyzer is over eight years old and is the oldest

in the area.  This analyzer has also reached its expected life

 

              Abbott has offered a $5,000 price reduction on both analyzers and free shipping on the

              hematology analyzer if both are purchased now.  Another incentive to purchased now is that Abbott will provide training for two laboratory staff on both analyzers.

 

              The REHC Foundation has approved $46,025 toward the purchase of the chemistry analyzer,

              thus requesting approval from the Commission to use $41,025 out of the hospital funds.

              The amount of $62,500 is being requested to use from the hospital funds for the purchase of

              the hematology analyzer.  The total asking amount to the Commission is $103,525.  If

              approved by the Commission, then an approval will need to be given by the city council.

 

ACTION:  A motion was made by Stu Johnson to approve the purchase and funding for both Abbott analyzers.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.

 

D.          Signage Issue.

             

              A letter written to Rich Grace at Mayo Clinic Health System-Mankato was included in the

              Commission Meeting packet.  The signage in question has been removed at the expense of

              REHC and will not be replaced until correct procedure is followed by Mayo Clinic Health

System.

 

E.           Commission Bylaws Review.

             

              Every three years the Commission Bylaws must be reviewed.  Review will need to be

completed by the end of 2011.  The bylaws must include and meet city guidelines, state

guidelines, federal guidelines and DNV guidelines.  Commission Board members Michelle

Chalen and Todd Prafke have volunteered to review.  Colleen Spike, Curt Savstrom and Kristin

Schultz have also volunteered to assist in the reviewing process.  Any changes will be brought

to the Commission for approval. 

 

DIRECTOR’S COMMENTS

 

Michelle Chalin, Vice-Chairperson: Has requested that item C. Granting of Privileges should be added permanently to the agenda under the Medical Staff header.  This is an action that requires a motion.

 

Margie Nelsen, Trustee: Complimented Peggy Carlson on the marketing presentation.

 

Sheri Schmidt, Director of Business Services: Noted that although the number of days outstanding is still high, many payments have been received.

                                                                     

ADJOURNMENT

 

The meeting was adjourned at 1:38 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, July 27, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, June 29, 2011

 

 

Present:  Gil Carlson, Chairperson;  Michelle Chalin, Vice-Chairperson;  Helen White, Secretary-Treasurer;  Trustees: H. Stuart Johnson, Kay Moline, Margie Nelsen, Jerry Pfeifer;  Colleen Spike, CEO; Curt Savstrom, CFO;  Dr. Elizabeth Osborne, Medical Staff President;  Kristin Schultz, Director of Quality and Infection Control;  Sheri Schmidt, Director of Business Services;  Paula Meskan, Director of Nursing;  Patty Roessler, Director of Patient Care;  Peggy Carlson, Community Liaison; 

Todd Prafke, City Administrator; and Melissa Marshall, Recorder.

 

Absent: Dr. Michael Sparacino, Chief Medical Officer.

 

At 12:01 p.m. a tour was provided of the Kohl’s Mobile Simulation Center for all meeting attendees interested.

 

The regular meeting of the Hospital Commission was called to order at 12:33 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the June 29, 2011, meeting was reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the agenda as presented.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of May 25, 2011, were reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the regular Commission meeting minutes of May 25, 2011, as presented.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

The minutes of the Special Commission meeting of June 14, 2011, were reviewed. 

ACTION:  A motion was made by Margie Nelsen to approve the Special Commission meeting minutes of June 14, 2011, as presented.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

MEDICAL STAFF

 

Dr. Elizabeth Osborne, Medical Staff President, verbally summarized the Medical Staff meeting minutes and noted that the presentation given by Dr. Sparacino regarding “When Enough is Enough, and What is Enough”, was both interesting and thought provoking.

 

A.          Medical Staff Meeting Minutes.  The minutes of the June 14, 2011, Medical Staff meeting were reviewed.

ACTION: A motion was made by Michelle Chalin to acknowledge receipt of the Medical Staff meeting minutes of June 14, 2011.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Josser E. Delgado, MD                               Telemedicine Staff-Radiology

Jeffrey Eikanger, CRNA                           Courtesy Staff, AHP- Nurse Anesthetist

Christopher Pippert, CRNA                       Courtesy Staff, AHP- Nurse Anesthetist

Anne Flatau, CST                                        Courtesy Staff, AHP- Surgical Technician

                                                                                                               

Reappointment to the Medical Staff:

Vivian Fischer, MD                                 Courtesy Staff- Emergency Medicine

 

Change in Status – Active to Courtesy:

Benjamin Chaska, MD                                 Active Staff- Emergency Medicine/Family Medicine

                                                                                                  Change to Courtesy Staff designation

 

ACTION:  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Kay Moline and carried with all members voting in favor.  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Helen White and carried with all members voting in favor.

 

FINANCIAL REPORT

 

The financial report for May, 2011, was presented by Curt Savstrom, CFO.  Total Days Cash on Hand is 222 days.  The current ratio is 3.96 compared to last month’s 3.8.  Days in Accounts Receivable is currently at 56.9 days which is an increase compared to last month’s 51.6.  Again noted the reason for the increase is due to increase in receivables with an increase in revenues and delays in documentation completion for billing purposes.  Revenue over expense for the month resulted in a gain of $240,668, and when combined with non-operating gain for May showed a net gain of $266,919, for a margin of 14.89%. Year-to-date revenue over expense shows a loss of ($42,330).  Inpatient, Outpatient and Clinic revenues are all up in comparison to May, 2010.  Year-to-date expenses through May are $110,843 higher than May 2010, due to increases in professional fees for ER Physicians, CRNA’s, supplies, leases/rental for the new CT scanner and an increase in the bad debt provision.

 

Inpatient utilization is down 11 days compared to May, 2010.  Outpatient utilization is up 28%; but average revenue per visit has declined to approximately $109 per visit. 

 

Community Care grants for May totaled $10,454, compared to $12,677 in April, 2011.  There were 18 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $68,927.

 

ACTION:  Kay Moline made a motion to approve the May, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Stu Johnson and carried with all members voting in favor.

                                                                                                 

QUALITY / SAFETY REPORT

 

Kristin Schultz presented the Readmission audit report for the first quarter for Inpatient Medical.  Based on review criteria, there were no surprise re-admits to the hospital and patients that were re-admitted have chronic health issues.  The report also noted no barrier issues to report.

 

Ms. Schultz also presented the Return to ED audit report for the first quarter for the Emergency Department.  The report noted one opportunity to improve regarding educational information and communication.  Emergency Department staff will continue to obtain information from the patient’s previous visit to help build on to the current visit.

 

The audit process will continue and another report will be presented for the second quarter.

                                                                                                                               

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  In regards to the possible state shutdown, the impact to River’s Edge Hospital & Clinic is very minimal.  An area that will be directly impacted is licensing.  A review of all personnel who require a license to practice is being performed.  If a license is not current, those personnel will not be allowed to practice.  Any personnel who have applied for a license will be allowed to practice with a confirmation of application on file.

 

Ms. Spike also noted that she is continuing to meet with representatives from both Mankato Clinic and The Orthopedic and Fracture Clinic.  Any actionable items will be presented to the Commission Board for approval.

QUALITY / EDUCATION / OPERATIONS

 

A.          Kohl’s Mobile Simulation Center Tour.

             

              This mobile simulation center allows healthcare professional to practice pediatric and neonatal

              emergency care in a risk free environment.  All scenarios are recorded and then participants

              review the footage to see possible weaknesses and also strengths.  Emergency Department staff

              from REHC will participate in a four hour session in the morning and staff from Minnesota

              Valley Hospital in Le Sueur will participate in a four hour session in the afternoon.  This is a

              unique and valuable opportunity for any healthcare professional to participate in.

 

B.          REHC Marketing Plan.

             

              Peggy Carlson presented a review of the current marketing plan developed by Envision.  The

Plan is based on a five year span and Ms. Carlson reviewed what has been accomplished and

what the future goals are for the upcoming years.

 

• 2008- The facility name change was implemented which included the standardization of e-mail and the development of a newsletter.
• 2009- “Whole Person” Participation in events and clubs was used to implement the new name change.  The REHC website was established.
• 2010- “Whole Family” The Le Center Clinic was opened, a billboard was placed on Highway 22, a Women’s Expo was held on campus and classes and seminars were held on a variety of topics.  A consumer advisor group was established and the service of drug screens and breath alcohol testing was announced to area business.  This resulted in a gain of six commercial accounts.
• 2011- “Whole Family” expanded- The focus is now on outreaching to people in the 29-35 age range.  The concept of a campus providing multiple services in the same area will continue to be marketed.
• 2012- “Whole Life”- Want to provide ways to serve the continuum of life though education and classes.  Use of cross-marketing and establishing relationships with people will be the primary goal.

                                                                                                                                           

              River’s Edge Hospital & Clinic campus will be the first in Minnesota to have a physical       connection between a hospital, clinics, nursing home, senior living and a pharmacy.

 

              Marketing Challenges:

• Public education of choices in healthcare services.
• Keeping current with changing technology.
• Development of a QR code to be used with Smart phones.

 

C.          Laboratory Equipment.

             

              Curt Savstrom presented an acquisition proposal to the Commission Board for the approval to

              purchase two new analyzers for the laboratory. The new analyzers are:

 

• Abbott Architect c4000 Chemistry Analyzer.
• Abbott Cell Dyn Ruby Hematology Analyzer.

             

              The current chemistry analyzer is eight years old and has broken down several times.  A break

down results in the lab samples being sent off-site for testing.  This analyzer was scheduled to

be replaced in 2012.  The current hematology analyzer is over eight years old and is the oldest

in the area.  This analyzer has also reached its expected life

 

              Abbott has offered a $5,000 price reduction on both analyzers and free shipping on the

hematology analyzer if both are purchased now.  Another incentive to purchased now is that Abbott will provide training for two laboratory staff on both analyzers.

 

              The REHC Foundation has approved $46,025 toward the purchase of the chemistry analyzer,

thus requesting approval from the Commission to use $41,025 out of the hospital funds. The amount of $62,500 is being requested to use from the hospital funds for the purchase of the hematology analyzer.  The total asking amount to the Commission is $103,525.  If approved by the Commission, then an approval will need to be given by the city council.

 

ACTION:  A motion was made by Stu Johnson to approve the purchase and funding for both Abbott analyzers.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.

 

D.          Signage Issue.

             

              A letter written to Rich Grace at Mayo Clinic Health System-Mankato was included in the

Commission Meeting packet.  The signage in question has been removed at the expense of

REHC and will not be replaced until correct procedure is followed by Mayo Clinic Health

System.

 

E.           Commission Bylaws Review.

             

              Every three years the Commission Bylaws must be reviewed.  Review will need to be

completed by the end of 2011.  The bylaws must include and meet city guidelines, state

guidelines, federal guidelines and DNV guidelines.  Commission Board members Michelle

Chalen and Todd Prafke have volunteered to review.  Colleen Spike, Curt Savstrom and Kristin

Schultz have also volunteered to assist in the reviewing process.  Any changes will be brought

to the Commission for approval. 

 

DIRECTOR’S COMMENTS

 

Michelle Chalin, Vice-Chairperson: Has requested that item C. Granting of Privileges should be added permanently to the agenda under the Medical Staff header.  This is an action that requires a motion.

 

Margie Nelsen, Trustee: Complimented Peggy Carlson on the marketing presentation.

 

Sheri Schmidt, Director of Business Services: Noted that although the number of days outstanding is still high, many payments have been received.

                                                                     

ADJOURNMENT

 

The meeting was adjourned at 1:38 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, July 27, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Tuesday, June 14, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Helen White, Secretary-Treasurer; Trustees: H. Stuart Johnson; Kay Moline, Margie Nelsen, Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Michael Sparacino, MD, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control; Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Paula Meskan, Director of Nursing; Patty Roessler, Director of Patient Care; Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; Paula O’Connell, City of St. Peter Director of Finance/Treasurer; Doug Montgomery, EideBailley Consultant; Ann Lauer, Senior Accountant; and Melissa Marshall, Recorder.

 

Absent: Dr. Elizabeth Osborne, Medical Staff President.

 

The special meeting of the Hospital Commission was called to order at 2:00 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the June 14, 2011, meeting was reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the agenda as presented.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

INTRODUCTIONS

Colleen Spike introduced Dr. Michael Sparacino as the new Chief Medical Director.

 

Curt Savstrom introduced Doug Montgomery, Consultant, from EideBailly, LLP.

 

ANNUAL AUDIT REPORT

 

Doug Montgomery, representing EideBailly, LLP, presented the results of the financial audit for the year 2010, as outlined in the formal report.

 

Mr. Montgomery noted the financial statements and management letters that were distributed for review.  He then discussed the following:

• Communication with the Board
  • Identifying the auditor’s responsibility- no changes with a noted clean audit.
  • Significant accounting policies- no changes in any accounting practices.
  • Management judgments and accounting estimates and qualitative aspects of accounting practices- certain items in the audit are based on estimates.
  • Difficulties encountered in performing the audit- no significant difficulties were noted.
  • Disagreements with management- none.
  • Management consultations with other independent accounts- none.
  • Other matters discussed prior to retention- none.Internal control matters-

    - Material weakness- this size of a hospital does not support a fully staffed accounting department.  The senior accountant position has allowed for checks and balances within financial statements.

    - Significant Deficiencies-limited office staff and resources.

  • Management discussion- purpose and objectives and the mission and vision.

 

Mr. Montgomery proceeded to summarize current industry trends on the following topics:

• Healthcare Reform
• Federal and State Budgets
• Rising costs and reduced reimbursement
• Shift in payer mix
• Economic downturn

 

Mr. Montgomery reviewed the balance sheets and presented statistics comparing River’s Edge Hospital & Clinic to Minnesota Critical Access hospitals and to all hospitals in the state of Minnesota.  The figures compared the 2010 data to 2006, 2007, 2008 and 2009.  Days cash on hand for year end stood at 252 which is a decrease from 2009 at 283 days.

Days in accounts receivable stood at 50 with a current ratio of 3.8 and an average payment period of 44 days.

 

The Statements of Revenues, Expenses, and Changes in Net Assets were reviewed. 

Mr. Montgomery noted that expenses are up from 2009, but with the addition of the

Le Center Clinic, this increase was expected.  Operating margin for 2010 was -3.7% with a total profit margin of – 8.4%.  The contractual allowances were also down from 31% in 2009 to 28% in 2010.

 

A SWOT analysis was provided and Mr. Montgomery noted that accounting was no longer a weakness as in previous years.

 

DISCUSSION AND CONSIDERATIONS

Mr. Montgomery and EideBailly, LLP, after reviewing the market and the organization’s position have recommended three areas to consider.  They are:

• Physician Recruitment.
• EMR & Process Alignment.
• Operations.

 

ADJOURNMENT

The meeting was adjourned at 2:50 p.m.

 

NEXT MEETING

The next regular meeting of the Hospital Commission will be Wednesday, June 29, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 p.m.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, May 25, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Trustees: Kay Moline, Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Dr. Elizabeth Osborne, Medical Staff President, Benjamin Chaska, MD, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control, Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Paula Meskan, Director of Nursing; Tammie Hudspith, Director of Human Resources; Patty Roessler, Director of Patient Care; Peggy Carlson, Community Liaison; Gary Swedberg, Pharmacist; Paulette Redman and Melissa Marshall, Recorders.

 

DNV Staff Present:  Woody Conway, Generalist/Life Safety Surveyer, Louise Moondancer, RN, Clinician, and Albana Kakacheva, Generalist.

 

Absent:  Helen White, Secretary-Treasurer; Stu Johnson, Trustee, Margie Nelsen, Trustee, Todd Prafke, City Administrator

 

The regular meeting of the Hospital Commission was called to order at 12:17 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the May 25, 2011, meeting was reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the agenda as presented.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of April 27, 2011, were reviewed. 

ACTION:  A motion was made by Kay Moline to approve the regular Commission meeting minutes of April 27, 2011, as presented.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

The minutes of the special Hospital Commission Planning meeting of April 20, 2011, were reviewed. 

ACTION:  A motion was made by Michelle Chalin to approve the special Commission Planning meeting minutes of April 20, 2011, as presented.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

DNV SURVEY EXPLANATION

 

Woody Conway, Generalist/Life Safety Surveyor gave a brief overview of what DNV is about and how they are here to create a partnership with River’s Edge Hospital & Clinic. There are two different types of non-conformance issues.

• NC I- Meaning there is a systematic break-down and patient safety is a concern.
• NC II- Meaning there is a good process in place, but minor issues can still be found.

 

Correctional Time-Line

• NC I- Ten (10) calendar days to acknowledge the issue and implementation of a solution within thirty (30) days of the report.
• NC II- Ten (10) calendar days to acknowledge the issue and implement a plan of correction.

                           

ISO Compliance Standards Time-Line

• River’s Edge Hospital & Clinic has three (3) years to obtain. Full compliance is due in 2014.
• First year is looking at the Critical Access Hospital and NIAHO standards.
• Second year DNV will do a Gap Analysis.
• Third year will be a survey of NIAHO standards along with ISO compliance.

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the May 10, 2011, Medical Staff meeting were reviewed.  Dr. Osborne noted the case presentations given on the theme “When Enough is Enough.”  She also reported work is continuing on Bylaws revision, and an audit of ED transfer cases is underway.

ACTION: A motion was made by Jerry Pfeifer to acknowledge receipt of the Medical Staff meeting minutes of May 10, 2011.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Robert Christensen, MD                                         Courtesy Staff, Emergency Medicine

 

Reappointment to the Medical Staff:

              Elizabeth Osborne, MD                             Active Staff, Family Medicine

              Ashley Brenden Panagiotakis, PA-C         Courtesy Staff, AHP, Physician Assistant-Surgery

              Stephen Fridinger, DACBF                       Courtesy Staff, Chiropractic Radiology/Teleradiology

 

Change in Status – Provisional to Full Membership:

              Angela Brown, ST                                       Courtesy Staff, AHP, Surgical Technician

              William Lee, MD                                         Courtesy Staff, General Surgery

              Elmer Calica, MD                                       Courtesy Staff, Emergency Medicine

              Sarah Davis, CNP                                       Active Staff, AHP, Nurse Practioner, Rheumatology

 

ACTION:  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Kay Moline and carried with all members voting in favor.  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Jerry Pfeifer and carried with all members voting aye. 

FINANCIAL REPORT

 

The financial report for April, 2011, was presented by Curt Savstrom, CFO.  Total Days Cash on Hand decreased to 222 days.  The current ratio is 3.8 compared to last month’s 3.48.  Days in Accounts Receivable is currently at 51.6 days. The reasons for the increase include increased utilization, staff turnaround, and a clarification of Medicare standards requiring that all documentation in the medical record must be complete and signed/dated/timed before the bill can go out. We will continue to work with physicians and staff to improve processes.  Revenue over expense for the month resulted in a loss of ($99,840), and when combined with non-operating gain for April showed a net loss of ($49,405), for a margin of -3.65%.  Year-to-date revenue over expense shows a loss of ($198,142).  Inpatient, Outpatient and Clinic revenues are all up in comparison to April, 2010.  Year-to-date expenses through April are $327,046 higher than 2010.  Expenses that have increased over 2010 include professional fees, purchased services, supplies, utilities, repairs/maintenance and leases/rental.  Interest expense has decreased due to bond refinancing.  Salaries have also decreased.

 

Inpatient utilization is down 12 days compared to April, 2010.  Outpatient utilization is up 24%; but average revenue per visit has decreased by about $120 per visit. 

 

Community Care grants for April totaled $12,677, compared to $4,648 in March, 2011.  There were 37 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $88,366.

 

ACTION:  Kay Moline made a motion to approve the April, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

Kristin Schultz presented and referred to the Quality Health Indicators charts included in the Commission Meeting booklet. Two areas that are currently being focused ont are: Percentage of readmission of patients with the same diagnosis within 30 days, and Percent of return ER visits for the same diagnosis within 72 hours. These scenarios are currently being audited and Kristen will present at the next regular Commission Meeting a report for the first quarter. Key points that are being looked at are:

• Length of first stay.
• Type of discharge instructions given.
• Reason for readmission.
• Length of second stay.
• What barriers, if any, were involved.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  In addition, she reported that both the

Le Center Clinic and River’s Edge Clinic trend is going up. She spoke about being surveyed and the difference between other accrediting organizations and DNV’s process. The other accrediting organizations have a more punitive approach, while DNV provides tips and ideas for solutions. These are items that are not included in the final report. After meeting with DNV, they were very complimentary of River’s Edge Hospital & Clinic.

 

Dr. Sparacino will be attending the June Commission meeting, as he is replacing Dr. Chaska as the REHC Medical Director.

 

Ms. Spike also gave a reminder about the Minnesota Board of Trustee Conference. Gil Carlson is planning on attending.  Other trustees wanting to attend should notify Ms. Spike.

The SEIU has met once for negotiations, but further discussion needs to happen. The next meeting is scheduled for May 26, 2011 at 4 a.m. at River’s Edge Hospital.

QUALITY / EDUCATION / OPERATIONS

 

A.          Eide Baily Audit Report.

              The Audit Report and Cost Report review is completed.  The approximate payment from

Medicare is $400,000, which is 74%, up from the previous 73%.  An amount of reserve from that total needs to be determined.  

ACTION:  A special meeting will be held on June 14, 2011 at 2 p.m. to review audit findings.

 

B.          DNV Survey.

Arrived earlier than expected, but it appears that the survey is going smoothly.

 

C.          Compliance Policy.

The policy with proposed edits and revisions was included in the Commission Meeting packet. 

ACTION:  A motion was made by Jerry Pfeifer to approve the revisions and edits as listed. 

The motion was seconded by Kay Moline and carried with all members voting in favor.

 

D.          Self Assessment Survey.

Gil Carlson reviewed some of the sections that showed low scores. The survey with the results is included in the Commission Meeting packet.

 

Section 2, Part B- We fully understand our responsibilities and relationships with the medical staff and have effective mechanisms for communication with them.

• What is the responsibility of the hospital commission?

                      - Management Oversight responsibility

                      - Quality Oversight responsibility

                      - Financial responsibility

Each topic will be broken down separately at future meetings.  Each topic will be listed on the agenda with 10-15 minutes devoted to further discussion.

 

Medical staff member have asked to be informed about what is discussed at the Commission Meetings.  Dr. Osborn has begun including a report from the Hospital Commission at each Medical Staff meeting.

 

Section 2, Part E- We require, receive on a regular basis, and discuss malpractice data reflecting our hospital experience and the experience of individual physicians who we have appointed to the medical staff.

• Any event involving malpractice would be discussed within an executive sessions and the event of this is very rare.

                                                                                                 

Section 5, Part E- We periodically review the hospital’s top management succession plan to assure ourselves of leadership continuity.

• Colleen Spike, Patty Roessler and Tom Wilcox will all be retiring around the same time. A clearer and more detailed plan will be created and adopted closer to that time.

 

Section 6, Part C- All members of the board participate in an orientation program and a regular program of continuing education.

• Colleen Spike has and will continue to support any and all Commission members who would like to attend continuing educational programs.

 

              Jerry Pfeifer, Trustee, questioned the title of the survey.  Who does “self” actually refer to? Is

it to be perceived as an individual or a governing board?  After general discussion, the perception of “self” should be considered as a whole.

 

DIRECTOR’S COMMENTS

 

Michelle Chalin, Vice-Chairperson:  Ms. Chalin wished Dr. Chaska well on his new endeavors.

 

Jerry Pfeifer, Trustee:  Also wished Dr. Chaska well.

 

Benjamin Chaska, MD:  Dr. Chaska thanked Colleen Spike for her leadership during his time at River’s Edge.

 

Paulette Redman, Recorder:  Introduced Melissa Marshall to the Commission.  Ms. Marshall will be serving as the Back-up Recorder.

 

Tammie Hudpsith, Director of Human Resources:  Thanked Kay Moline for being on the union bargaining committee.

 

Peggy Carlson, Community Liaison: The Women’s Expo was very successful.  Several appointments were booked at River’s Edge Clinic as a result of the publicity.

 

There is a River’s Edge Hospital & Clinic team participating in the Relay for Life on June 17, 2011.  There is room for more staff members to join.

 

River’s Edge Hospital & Clinic was represented at the Le Sueur Inc. Wellness Fair. Many inquires came about the services provided here at River’s Edge Hospital & Clinic.

 

Kay Moline, Trustee:  Ms. Moline took this opportunity to say good-bye to Dr. Chaska and thanked him for the job that he has done.

                                                                                                               

ADJOURNMENT

 

ACTION:  A motion was made by Kay Moline to adjourn the meeting.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.  The meeting was adjourned at 1:16 p.m. 

                                                                                   

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, June 29, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

A Special Commission meeting will be held on Tuesday, June 14, 2011, at 2 p.m. to review the financial audit results.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, April 27, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Helen White, Secretary-Treasurer; Trustees:  Stu Johnson, Kay Moline, Margie Nelsen, Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Benjamin Chaska, MD, Chief Medical Officer; Kristin Schultz, Director of Quality and Infection Control, Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Paula Meskan, Director of Nursing; Tammie Hudspith, Director of Human Resources; Patty Roessler, Director of Patient Care; Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; Dr. William Shores, BLC Medical Director; and Paulette Redman, Recorder.

 

Absent:  Dr. Elizabeth Osborne, Medical Staff President.

 

The regular meeting of the Hospital Commission was called to order at 12:20 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the April 27, 2011, meeting was reviewed. 

ACTION:  A motion was made by Michelle Chalin to approve the agenda as presented.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of March 30, 2011, were reviewed. 

ACTION:  A motion was made by Kay Moline to approve the regular Commission meeting minutes of March 30, 2011, as presented.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the April 12, 2011, Medical Staff meeting were reviewed.  Dr. Chaska noted the presentation given by Dr. Mohammad Ranginwala on mantle cell lymphoma.

ACTION: A motion was made by Margie Nelsen to acknowledge receipt of the Medical Staff meeting minutes of April 12, 2011.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Christopher LaFleur, CRNA                                      Courtesy Staff, AHP, Nurse Anesthetist

 

Reappointment to the Medical Staff:

              Benjamin Chaska, MD                                 Active Staff, Emergency Medicine/Family Medicine

              Carolyn Bowles, MD                                   Active Staff, Rheumatology

              John Jacobsen, MD                                     Active Staff, Allergy/Immunology

              Kay Herman, PA-C                                    Courtesy Staff, AHP, Surgical Physician Assistant

              Richard Lowry, OPA-C                               Courtesy Staff, AHP, Orthopedic Physician Assistant

Change in Status – Provisional to Full Membership:

              Kristin Holland, MD                                   Active Staff, Family Medicine

              A. Peter Troedson, MD                              Active Staff, Family Medicine/Emergency Medicine

 

ACTION:  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Michelle Chalin and carried with all members voting in favor.  A motion was made by Margie Nelsen to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Kay Moline and carried with all members voting aye. 

 

FINANCIAL REPORT

 

The financial report for March, 2011, was presented by Curt Savtrom, CFO.  Total Days Cash on Hand increased to 231 days.  The current ratio is 3.48.  Days in Accounts Receivable is currently at 44.5 days.  Revenue over expense for the month resulted in a gain of $16,440, and when combined with non-operating gain for March showed a net gain of $22,249, for a margin of 1.50%. Year-to-date revenue over expense shows a loss of ($148,737).  Inpatient, outpatient and Clinic revenues are all up in comparison to March, 2010.  Year-to-date expenses through March are $320,780 higher than 2010, but $46,000 lower than last month.  Expenses that have increased over 2010 include professional fees, purchased services, supplies, utilities, repairs/maintenance and leases/rental.  Interest expense has decreased due to bond refinancing.  Salaries have also decreased.

 

Inpatient utilization is up 9 days compared to February, 2010.  Outpatient utilization is up 23%; however average revenue per visit is down about $118 per visit. 

 

Community Care grants for March totaled $4,648.  There were 23 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $53,105.

 

ACTION:  Helen White made a motion to approve the March, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Stu Johnson and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

Kristin Schultz presented a composite listing of quality measures that are monitored and reported.  Measures come from a variety of sources and are used to assess the type of health care we are providing and to compare measure results with other facilities, with goals of helping patients achieve better outcomes and for the facility to function more efficiently.  The list of measures continues to grow, and contains different types of measures, including

• Process measures – how well we do a particular process.
• Outcome measures – results of processes.
• Patient experience measures – patient satisfaction surveys.
• Structural measures – conditions the care is provided in.
• Composite measures – multiple performance measures combined to get an overall picture.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  In addition, she reported the new food services are working well following correction of some initial issues with food temperatures.  She also stated that union negotiations will begin in May.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Mission / Vision Revision.

A revised Mission/Vision statement was presented, which now reads, ”River’s Edge Hospital & Clinic provides quality health services that value all dimensions of health including mind, body and spirit.  Our goal is to improve the health of all individuals we serve through continuous, measureable improvement in patient satisfaction, clinical quality, patient safety and operational effectiveness.”

 

The change in the statement was to include the term “patient safety.”

 

B.          High Step Program.

Tammie Hudspith reported on the success of the High Step program that was run over the winter in conjunction with the South Central Service Cooperative and the St. Peter High School.  The program involved 20 students interested in health care careers, along with their instructor, coming onto the REHC campus three mornings a week for 17 weeks.  The students received classroom instruction and hands-on experiences presented by REHC employees, covering a range of health care careers and activities.  The program went very well, and interest is high for the 2011-12 school year, with 81 students wanting to participate, 50 from the St. Peter school district and 31 from other school districts.  The number of students will be narrowed down through an interview/criteria selection process.

 

C.          IT Capital Request.

Curt Savstrom presented a recommendation for replacement of the REHC server.  The server currently in place, an IBM 520 server, no longer has the capacity to run the updated versions of the hospital’s HMS computer software.  The plan recommended is to upgrade to a new IBM 7 iSeries 720 server, move the current 520 server into a back-up role, and remove the current back-up IBM 270 server from service.  The costs of purchasing the new equipment versus moving to an ASP service (Application Service Provider) were evaluated, with the purchase cost proving to the lower than an ASP model. 

ACTION:  A motion was made by Kay Moline to recommend approval of a capital expenditure of $103,144.15 for the purchase and installation of a new IBM 7 iSeries 720 server.  The motion was seconded by Stu Johnson and carried with all members voting in favor.   The recommendation will be forwarded to the City Council for action.

 

D.          Job Description and Self Assessment Survey.

Drafts of a proposed Commission member job description and self assessment survey had been distributed to the Commission members.  Colleen Spike noted that the term “Commissioner” is used by the City of St. Peter, the Minnesota Hospital Association uses the term “Trustee” and other hospitals and organizations use the term “Board members.”  All three terms are used within these documents.

 

ACTION:  Recommended changes to the job description document should be forwarded to Colleen Spike.  Changes will be incorporated and revised documents brought back to the May Commission meeting.  A motion was made by Helen White to approve the Self Assessment document as distributed.  The motion was seconded by Kay Moline and carried with all members voting in favor.  The Self Assessment document will be mailed to each of the Commissioners for completion, with tabulated results to be discussed at a future meeting.

 

E.           Goal Setting Priorities and Future Meeting Dates.

In follow-up from the April 20, 2011, Commission planning meeting, the top priorities to work on were identified as

              1)           OB Services.

              2)           Relationships with physicians.

              3)           Strategic partnerships.

              4)           Sustainable model at “X” $ level.

              5)           Peggy Carlson to present overall marketing strategies at a future Commission meeting.

ACTION:  Wednesday, August 17, 2011, and Wednesday, November 16, 2011, were set for future Commission planning meeting dates, with meetings to be scheduled for 12 noon to 4 p.m.

 

DIRECTOR’S COMMENTS

 

Benjamin Chaska, MD:  Dr. Chaska announced that he will be leaving his position as Chief Medical Officer and clinic physician as of June 1.  He extended his personal gratitude to the Commission members for their working relationship over the eight years he has been at River's Edge Hospital & Clinic. 

 

Todd Prake, City Administrator:  Mr. Prafke reported that the City Council approved Stu Johnson as the new Hospital Commission member at their meeting last Monday.  He also noted that the demolition of the old hospital and nursing home should be completed by June 15, 2011.

 

Peggy Carlson, Community Liaison:  A Women’s Health Expo will be held in the Clinic atrium on Tuesday, May 3, 2011, from 5:30 to 8 p.m.  Mrs. Minnesota, Breanna Ludeman, will be the keynote speaker.  Breakout session topics will include stroke prevention for women, financial health, bone health, exercise and nutrition, aromatherapy, and education about medications.  There will also be information available about the services provided at River's Edge Hospital & Clinic, as well as bone density scans, blood pressure checks and facial skin scans.

 

Tammie Hudpsith, Director of Human Resources:  Staff members will be hosting a fundraising event for the walkers participating in the Susan G. Komen 3-day walk later in the summer.  The hospital is also sponsoring a team of walkers who will be participating in the Arthritis Foundation walk.

 

EXECUTIVE SESSION

 

The Commission meeting was adjourned at 1:32 for an Executive Session.  The Executive Session was called for the purpose of dealing with a legal issue and discussion of regulatory issues.

 

The Executive Session was adjourned at 1:42 p.m. and the regular Hospital Commission meeting was reconvened.

 

ADJOURNMENT

 

ACTION:  A motion was made by Jerry Pfeifer to adjourn the meeting.  The motion was seconded by Michelle Chalin and carried with all members voting in favor.  The meeting was adjourned at 1:43 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, May 25, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, March 30, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Helen White, Secretary-Treasurer; Trustees:  Kay Moline, Margie Nelsen, Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Dr. Elizabeth Osborne, Medical Staff President; Kristin Schultz, Director of Quality and Infection Control, Sheri Schmidt, Director of Business Services; Tom Wilcox, Director of Environmental Services; Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; Dr. William Shores, BLC Medical Director; and Paulette Redman, Recorder.

 

Absent:  None.

 

The regular meeting of the Hospital Commission was called to order at 12:19 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the March 30, 2011, meeting was reviewed.  Dr. Osborne requested that an item be added under the Medical Staff section to discuss a hospital policy/procedure.

ACTION:  A motion was made by Jerry Pfeifer to approve the agenda as amended.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of February 23, 2011, were reviewed. 

ACTION:  A motion was made by Helen White to approve the regular Commission meeting minutes of February 23, 2011, as presented.  The motion was seconded by Michelle Chalin and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the March 8, 2011, Medical Staff meeting were reviewed.  Dr. Osborne noted the presentation given by Dr. Mohammed Solaiman on mantle cell lymphoma, the outline Dr. Chaska presented regarding the process for assessing provider performance, the proposed allocation of Medical Staff funds, and the transfer audit currently underway.

ACTION: A motion was made by Michelle Chalin to acknowledge receipt of the Medical Staff meeting minutes of March 8, 2011.  The motion was seconded by Kay Moline and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Kathryn Eisenmenger Fuentes, PA-C       Courtesy Staff, AHP, Emergency Medicine

Timothy Klassen, CRNA                         Courtesy Staff, AHP, Nurse Anesthetist

Meher Rahman, MBBS                           Courtesy Staff, Internal Medicine/Gastroenterology

 

Reappointment to the Medical Staff:

Lon Knudson, MD                                   Courtesy Staff, Pediatrics

Timothy Bachenberg, MD                        Active Staff, Emergency Medicine/Family Medicine

 

Change in Status – Provisional to Full Membership:

Eric Evans, MD                                     Courtesy Staff, Pathology

Nathan Groebner, MD                            Courtesy Staff, Radiology

 

ACTION:  A motion was made by Kay Moline to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.  A motion was made by Michelle Chalin to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Helen White and carried with all members voting aye. 

 

C.          Hospital Policy/Procedure.  Dr. Osborne inquired whether the Hospital Commission had taken action to change a policy and procedure regarding assignment of admitting physicians for ED patients who do not have local providers.  She noted the process is not currently being followed as outlined in the policy, but that changes to the policy have not come before the Medical Staff Executive Committee for action.  The Hospital Commission has not reviewed or otherwise taken any action regarding this policy.  Colleen Spike noted there have been some administrative decisions made that have affected the policy as outlined.

              ACTION:  Issue referred to the Medical Staff Executive Committee.

 

FINANCIAL REPORT

 

The financial report for February, 2011, was presented by Curt Savtrom, CFO.  Total Days Cash on Hand declined to 197.9 days.  The current ratio remains strong at 3.42.  Days in Accounts Receivable is currently at 45.7 days.  Revenue over expense for the month resulted in a loss of ($100,010), and when combined with non-operating gain for February showed a net loss of ($77,652), for a margin of

-7.08%.  Inpatient, outpatient and Clinic revenues are all up in comparison to February, 2010.  Year-to-date expenses through February are $304,488 higher than 2010, and $34,502 higher than last month.  Expenses that have increased over 2010 include professional fees, purchased services, supplies, utilities, repairs/maintenance and leases/rental.  Interest expense has decreased due to bond refinancing.  Salaries have also decreased.

 

Inpatient utilization is up 46 days compared to February, 2010, but down 18 days from January.  Outpatient utilization is up 25%; however average revenue per visit is down about $100 per visit.  Deductions from revenue are $91,283 higher than last year due to increased revenue amounts.

 

Community Care grants for February totaled $13,359.  There were 13 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $94,768.

 

Mr. Savstrom reported that the financial audit has been completed, noting again the issue of weak internal controls due to the small size of the staff. 

 

 

ACTION:  Kay Moline made a motion to approve the February, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Helen White and carried with all members voting in favor.

 

QUALITY / SAFETY REPORT

 

Minutes from the last meeting of the Quality Council on January 20, 2011, were available for review.  The Quality Council has combined with the Patient Safety Committee to form the Quality Management Committee.  The minutes from the March 17, 2011, Quality Management Committee were also available for review.  Kristin Schultz noted that Helen White and Michelle Chalin are serving as Hospital Commission representatives to this committee.  The first meeting of the Quality Management Committee was primarily an organizational meeting.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  In addition, she noted the following:

• Paula Meskan was introduced as the new Director of Nursing, previously her title was Senior Nurse Manager.
• An updated organizational chart was presented.
• A letter has been received from CMS with official notification that the hospital has been reclassified as a rural hospital and is no longer a metropolitan hospital.
• New department managers include Trudi Schaefer in HIM, Val Elwood, RN, in Surgical Services, Kelly Kennedy, OT, in PT/OT Services, and Rochelle Quam, RT, in Imaging.  Interviews have begun for a new manager for the River’s Edge Clinic.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          HCAHPS Summary Report.

Kristin Schultz presented data from the inpatient/swing bed patient perception surveys from December, 2010, through February, 2011.  Categories that showed decreased scores included physician communication with patients, nurse communication with patients, pain well controlled, and education regarding medicines.  Ms. Schultz noted that part of the issue with physician communication may be that swing bed patients are included in the surveys, and physicians do not make daily visits for swing bed patients unless warranted.  Nursing will be adding this information to the patient orientation process for swing bed patients.  Nursing also continues to work on the patient education process and is doing audits on every chart to look at documentation regarding pain management.

 

Categories that showed improvement in scores included overall hospital rating and recommendation, response of hospital staff and discharge information.

 

B.          Bargaining Unit Negotiation Team.

              The vote for unionization passed by a margin of three votes, and thus the hospital will be

entering into negotiations with the SEIU.  The bargaining team will include Colleen Spike, Tammie Hudspith, Patty Roessler and Paula Meskan.  Mark Mathison, the consulting attorney from Gray, Plant & Mooty, will also be a part of the first meeting.  It is anticipated that this meeting will take place in April.

 

 

Ms. Spike also referred to an anonymous letter containing negative comments that had been sent to area legislators signed by “the employees of REHC.”  Ms. Spike has since received calls or signatures of support from at least 70 employees, including a letter from one of the hospital’s paramedics, which was read to the Commission. 

 

Ms. Spike noted that staffing changes in the ambulance service and ED have resulted in some disgruntlement of employees; however the changes have aleady shown an improvement in ambulance response time and improvement in finances.

 

Dr. Osborne shared a recent positive experience with care given in the ED, and commended the staff on the quality of care provided.

 

ACTION:  Ms. Spike asked for a Commission volunteer to sit on the bargaining team.  Interested commissioners should contact Colleen Spike.

 

C.          Date and Time for a Planning Meeting in April.

Colleen Spike inquired about establishing a date and time to have a separate planning meeting for the Commission.  The purpose would be to have more time to discuss hospital goals and the impact on the community.

ACTION:  Wednesday, April 20, 2011, was proposed for a date, with the meeting to be held from 12 noon until 4 p.m.

 

DIRECTOR’S COMMENTS

 

Michelle Chalin:  Inquired as to the status of the open Commissioner seat.  Todd Prafke reported that 8-10 people have been approached regarding this position, but he has yet to get a ‘yes’ response.

 

Todd Prake, City Administrator:  Mr. Prafke noted that the old hospital building and nursing home are currently being razed.  The project is on schedule and should be completed by June 15, 2011.  The 1939 header stone has been brought up to River’s Edge.  Utilization of the property is still undecided.

 

Peggy Carlson, Community Liaison:  The next Red Cross Blood Drive will be held at the hospital on April 25 and 26.  A Women’s Health Expo will be held on May 3, 2011, in the Medical Office Building atrium.  A team of walkers is being put together to participate in the Arthritis Walk that will be held on April 29.  Educational classes that are on the schedule include “Smoking Cessation,” “Arthritis Exercise,” and “Eat This, Not That.”

 

ADJOURNMENT

 

ACTION:  A motion was made by Jerry Pfeifer to adjourn the meeting.  The motion was seconded by Kay Moline and carried with all members voting in favor.  The meeting was adjourned at 1:15 p.m. 

 

NEXT MEETING

 

The Planning Meeting will be held on Wednesday, April 20, 2011, from 12 noon until 4 p.m.

 

The next regular meeting of the Hospital Commission will be Wednesday, April 27, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, February 23, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Helen White, Secretary-Treasurer; Trustees:  Kay Moline, Margie Nelsen, Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Dr. Benjamin Chaska, Chief Medical Officer; Dr. Elizabeth Osborne, Medical Staff President; Kristin Schultz, Director of Quality and Infection Control, Sheri Schmidt, Director of Business Services; Tammie Hudspith, Director of Human Resources; Tom Wilcox, Director of Environmental Services; Peggy Carlson, Community Liaison; Todd Prafke, City Administrator; Dr. William Shores, BLC Medical Director; and Paulette Redman, Recorder.

 

Absent:  None.

 

The regular meeting of the Hospital Commission was called to order at 12:22 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the February 23, 2011, meeting was reviewed.  An item was added to section VI – Upgrade for ECG machines.

ACTION:  A motion was made by Kay Moline to approve the agenda as amended.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of January 26, 2011, were reviewed. 

ACTION:  A motion was made by Jerry Pfeifer to approve the regular Commission meeting minutes of January 26, 2011, as presented.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the February 8, 2011, Medical Staff meeting were reviewed.  Dr. Osborne reported on the Medical Staff discussion regarding the use of mid-level practitioners in the Emergency Department, a three-month transfer chart audit that will be implemented in March, discussion on medical staff compliance with chart completion, and the process implemented for reviewing and updating Medical Staff Bylaws.

ACTION: A motion was made by Michelle Chalin to acknowledge receipt of the Medical Staff meeting minutes of February 8, 2011.  The motion was seconded by Margie Nelsen and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Initial Appointment to the Medical Staff:

Heather Dale, PA-C                      Courtesy Staff, AHP, Family Medicine Physician Assistant

 

Reappointment to the Medical Staff:

              John Springer, MD                        Courtesy Staff, Orthopedics

              Richard Harrison, OPA-C             Courtesy Staff, AHP, Orthopedic Physician Assistant

              Julie Buettner, DC                         Active Staff, AHP, Chiropractor

 

Change in Status:

              Lori Krome, MD                           Courtesy Staff, Emergency Medicine

Change from Provisional to Full membership

              Timothy Bachenberg, MD            Change from Courtesy to Active Staff, Emergency Medicine

 

Withdrawals from the staff include Kathryn Blain, CRNA, Courtesy Staff, Anesthetist; and

Billie Jo Grieve, MD, Courtesy Staff, General Surgery.

 

ACTION:  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant appointment, reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Helen White and carried with all members voting in favor.  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Helen White and carried with all members voting aye. 

 

FINANCIAL REPORT

 

The financial report for January, 2011, was presented by Curt Savtrom, CFO.  Total Days Cash on Hand increased slightly to 231.9 days.  The current ratio remains strong at 3.38.  Days in Accounts Receivable is currently at 48.3 days.  Revenue over expense for the month resulted in a loss of ($99,594), and when combined with non-operating gain for January showed a net loss of ($93,336), for a margin of -6.77%.  Inpatient, outpatient and Clinic revenues are all up in comparison to January, 2010.  Expenses are $172,893 higher than January 2010, but are $187,394 below December, 2010.

 

Inpatient utilization is up 36 days compared to January, 2010.  Outpatient utilization is up 22%; however average revenue per visit is down about $75 per visit.  Deductions from revenue are higher than last year due to increased revenue amounts.

 

Year-to-date expenses are up by $172,893 compared with last year.  Salaries are slightly below January, 2010, and $16,000 below last month.  Professional fees are up compared with January, 2010, primarily due to increased costs for ER physicians and contracted anesthetist services.  Purchased services are up by $28,000 over January, 2010, due to ambulance and housekeeping contract labor, and temporary nurse staffing.  Supply and utility expense is up compared with last year.  Interest expense is down $15,000 per month due to bond refinancing.

 

Community Care grants for January totaled $46,871.  There were 54 patient accounts that qualified for a 100% write-off.  Board approval for collection activity is $84,404.

 

ACTION:  Helen White made a motion to approve the January, 2011, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Kay Moline and carried with all members voting in favor.

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  She noted the ballots for unionization have been distributed to a group of 32 employees.  Balloting will be completed on March 1, 2011.

 

Ms. Spike updated the Commission on the status of the application to restore the hospital’s rural classification within the Medicare program.  At the point where Mankato-North Mankato were reclassified as a Metropolitan Statistical Area, REHC also became part of this area by virtue of being located in Nicollet County.  Maintaining Critical Access Hospital status will be dependent upon being reclassified as rural.  The application process was started a year ago with the application being sent to six different people in the Medicare system over the course of the year. 

 

Hospital representatives are meeting with county and city employees regarding preparations to deal with potential flooding this spring.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Upgrade of ECG Machines.

The hospital currently has two ECG machines, both of which will reach their “end of life” status on March 31, 2011, meaning there will no longer be support for their upkeep available.  Two options were presented – upgrading the machines by replacing the electronic boards at a cost of $6,810 for both machines, or replacement of the machines for $7,795 each.

ACTION:  A motion was made by Jerry Pfeifer to approve the cost of $6,810 for upgrading the electrical board in each machine.  The motion was seconded by Margie Nelsen and carried with all members voting in favor.   The expense will be paid for from operating funds, although a request will also be brought to the Foundation for possible funding.

 

B.          Trustee Job Description.

              A sample trustee job description was distributed for review.

ACTION:  Commission members to review sample job description and provide feedback to Colleen Spike regarding suggested changes.  Kay Moline will work with Colleen to revise the document and bring it back to the Commission members at the March meeting for further discussion.

 

C.          Board Self-Assessment.

A document designed for Commission members to perform a self assessment was presented.  Use of such an assessment would be helpful in determining education that would benefit Commission members.

ACTION:  Kay Moline and Colleen Spike to review document for applicability to River’s Edge and to make changes accordingly.  Document to be brought back to March meeting; suggestion made for Commission members to come at 11:30 a.m. to complete the assessment prior to the meeting.  Decision to be made if the assessment should be done quarterly or annually.

 

D.          Five-Year Strategy Plan.

Colleen Spike reviewed the five-year Strategy Map with the Commissioners.  Major categories reviewed included:

• Finance/Economy:  Goals set to reduce the budgeted loss down to $1 million for 2011, $500,000 in 2012, and to break even in 2013.  Fundraising opportunities for the REHC Foundation to include selling 50/50 tickets at the Nicollet County Fair this summer.  Fundraising needs will likely include purchase of a new ambulance.
• Consumers/Demographics:  Public Health will be mandated to perform a community health survey every five years.  Critical Access Hospitals are exempt from this requirement, although survey results may affect services provided.  Uninsured and underinsured patients will remain an issue.

• Information Technology:  Legislated requirements requiring changes in information technology will continue to be big issues.  Curt Savstrom has initiated talks with the Fairview Health System as to the possibilities of working under their “umbrella” to utilize the Epic electronic health record system.
• Billing and Insurance:  Ongoing challenges with complexity of third party billing and conversion to ICD-10 coding system.
• Hospitals and Physicians:  Good base of physicians at River’s Edge Clinic, will continue to work to get schedules full.  No plans for further recruitment until schedules are full.  Recruiting for OB/GYN services will be re-evaluated once current practice is full.  OB/GYN not currently part of plans.
• Quality / Patient Safety:  The first survey under the DNV accrediting body is expected to take place in April of this year.
• Human Resources:  A wage freeze is currently in place.  Addition of union activity related issues may need to be addressed in this plan.
• Strategic/Market Issues:  WOW factors being identified and highlighted.  Continued evaluation of clinic presence in LeCenter.  Future of Accountable Care Organizations and their impact on REHC is unknown at this time.

 

Further discussion highlighted a desire for the Commission to identify what the focus of the Commission should be in reaching goals on the strategic plan.  Also of value would be an opportunity to brainstorm and look at the bigger vision for the health care campus, evaluating the strategic plan from five years ago with the current status and then looking forward.  Topics mentioned for initial discussion included:

• Where are we in the marketplace?
• Daniels Clinic in the marketplace.
• Aging community.
• OB services.
• Consumers/Demographics -- #2 on Strategic Plan.

 

DIRECTOR’S COMMENTS

 

Jerry Pfeifer, Trustee:  Mr. Pfeifer thanked Colleen Spike and Curt Savstrom for the presentation they made to the City Council regarding the REHC budget.

 

Tammie Hudspith, Director of Human Resources:  Openings for managers of the Imaging Department and Therapy Department have been filled with internal candidates.

 

Peggy Carlson, Community Liaison:  A Women’s Health Expo will be held on May 3, 2011, in the Medical Office Building atrium.

 

ADJOURNMENT

 

ACTION:  A motion was made by Michelle Chalin to adjourn the meeting.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.  The meeting was adjourned at 1:20 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, March 30, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, January 26, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Helen White, Secretary-Treasurer; Trustees:  Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Dr. Benjamin Chaska, Chief Medical Officer; Dr. Elizabeth Osborne, Medical Staff President; Kristin Schultz, Director of Quality and Infection Control, Sheri Schmidt, Director of Business Services; Patty Roessler, Director of Nursing and Ancillary Services; Tammie Hudspith, Director of Human Resources; Tom Wilcox, Director of Environmental Services; Peggy Carlson, Community Liaison; Paula Meskan, Senior Nurse Manager; Linda Nelsen, Benedictine Living Community Administrator; Dr. William Shores, BLC Medical Director; and Paulette Redman, Recorder.

 

Absent:  Kay Moline, Trustee; Margie Nelsen, Trustee.

 

The regular meeting of the Hospital Commission was called to order at 12:22 p.m. by Chairperson Gil Carlson.

 

Chairperson Gil Carlson turned the meeting over to Colleen Spike, CEO.  Commission members were asked to complete the following forms:  Confidentiality of Patient Information; General Authorization and Release, and Public Officers’ Interests in Contracts.

 

ELECTION OF OFFICERS

Commission members were presented with ballots to vote for members for the offices of Chairperson, Vice-Chairperson, and Secretary-Treasurer. 

ACTION:  The ballots were completed and votes tallied.  Commission members voted into office:  Chairperson – Gil Carlson, receiving 4 votes; Vice-Chairperson – Michelle Chalin, receiving 3 votes; Secretary-Treasurer – Helen White, receiving 3 votes. 

 

Colleen Spike turned the meeting over to Chairperson Gil Carlson.

 

APPOINTMENT OF COMMITTEE MEMBERS

 

Committee appointments were made as follows:

              Finance Committee:  Helen White.  Remaining position left open at this time.

              Quality / Patient Safety:  Helen White, Michelle Chalin.

              REHC Advisory Group:  Kay Moline, Margie Nelsen.

 

APPROVAL OF AGENDA

 

The agenda for the January 26, 2011, meeting was reviewed.  An item for review of Quality Council meeting minutes was added.

ACTION:  A motion was made by Michelle Chalin to approve the agenda as amended.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

APPROVAL OF MINUTES

 

The minutes of the regular Hospital Commission meeting of December 15, 2010, and the Special Commission meeting of January 12, 2011, were reviewed. 

 

ACTION:  A motion was made by Jerry Pfeifer to approve the regular Commission meeting minutes of December 15, 2010, and Special Commission meeting minutes of January 12, 2011, as presented.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

MEDICAL STAFF

 

A.          Medical Staff Meeting Minutes.  The minutes of the January 11, 2011, Medical Staff meeting were reviewed.  Dr. Osborne reported that the Medical Staff had recommended a change in the Medical Staff Bylaws to combine the Quality Council and Patient Safety Committee into one committee, and also recommended discontinuing the Medical Advisory Panel.

ACTION: A motion was made by Jerry Pfeifer to acknowledge receipt of the Medical Staff meeting minutes of January 11, 2011.  The motion was seconded by Helen White and carried with all members voting in favor. 

 

B.          Medical Staff Credentialing.  A report from the Executive/Credentials Committee was

presented for review.  A recommendation was made by the Credentials Committee to approve medical staff membership and granting of privileges to the physicians and allied health professionals listed on the report:

 

Reappointment to the Medical Staff:

              Bret Cardwell, MD                        Courtesy Staff, General Surgery

              Mareve Kayfes, MD                     Courtesy Staff, Radiology

 

Change in Status:

              William Shores, MD                      Change from Active Staff to Honorary Staff

 

Withdrawals from the staff include Kenneth Preimesberger, MD, Teleradiologist.

 

ACTION:  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant reappointment or change in status for each of the practitioners listed above.  The motion was seconded by Helen White and carried with all members voting in favor.  A motion was made by Jerry Pfeifer to accept the recommendation of the Credentials Committee and grant clinical privileges to each of the practitioners listed above, as requested and approved by the Credentials Committee.  The motion was seconded by Helen White and carried with all members voting aye. 

 

FINANCIAL REPORT

 

The financial report for December, 2010, was presented.  The report is preliminary, with a final report to be completed following the annual audit in March.  Total Days Cash on Hand is at 223 days.  The current ratio remains strong at 3.38, a drop from 3.66 last month.  Days in Accounts Receivable is currently at 49 days.  Revenue over expense for the month resulted in a loss of ($137,680), and when combined with non-operating gain for December showed a net loss of ($82,822), for a margin of  -5.42%.  Year-to-date there is a net loss of ($2,011,374), for a margin of -11.10%.

 

Inpatient utilization is down 14.8% compared with 2009.  Outpatient utilization is up 8%; however average revenue per visit is down about $100 per visit.  Clinic revenues continue to grow.

 

 

Year-to-date expenses are up by $553,138, or 3.2% higher than last year.  Overall compensation is 2.7% higher than last year, and this would include additional MD hires and PTO pay-outs at the end of the year.  Professional fees are up 15%, primarily due to increased costs for ER physicians.  Purchased services are up 8% due to ambulance contract labor, housekeeping, and temporary accounting and financial assistance.  Also included in the total expense is a $250,000 charge for refinancing the bonds.

 

Community Care grants for December totaled $31,288.  There were 33 patient accounts that qualified for a 100% write-off and 10 accounts that received a 50% write-off.

 

ACTION:  Helen White made a motion to approve the December, 2010, financial report as presented, along with payment of bills, write-offs to collection and bad debt, and accounts payable review.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor.

 

QUALITY / SAFETY

 

A.          Quality Council Meeting.

              The minutes of the October 21, 2010, meeting were available for review.

ACTION:  A motion was made by Michelle Chalin at acknowledge receipt of the Quality Council meeting minutes of October 21, 2010.  The motion was seconded by Jerry Pfeifer and carried with all members voting in favor. 

 

ADMINISTRATIVE REPORT

 

The written report submitted by Colleen Spike was reviewed.  She also presented an update on the REHC/BLC contracts.  The current contracts held for laundry, dietary and PT/OT services will terminate on March 31, 2011.  REHC will be contracting with TCS to provide laundry services for the facility, and with A’viand for food service.  The PT and OT staff members who have been working at BLC will have their hours absorbed into the hospital staffing.  There has been an increase in business over the past year for PT and OT and there is a need for additional help.

 

Utilization statistics for the River’s Edge Clinic were reviewed.

 

Ms. Spike also noted the following:

• Emergency Management is currently planning to participate in a regional disaster drill in June that will center around a flooding situation; however, planning is also underway to be ready for the potential of real flooding in the spring.
• The hospital has been recertified as a Level 4 Trauma Center.
• A pediatric simulation center will be on site at REHC for training purposes on June 29, 2011.
• Helen White and Colleen Spike attending the recent Minnesota Hospital Association Trustee Conference.
• The new CT scanner is currently being installed.

 

QUALITY / EDUCATION / OPERATIONS

 

A.          Minnesota Adverse Health Events.

The 2010 report on adverse health events occurring in the state of Minnesota has been released.  There were 305 events reported throughout the state, resulting in 10 patient deaths and 97 cases of serious injury.  There were no reportable events occurring at REHC.  The most frequently occurring events were 118 Stage 3-4 pressure ulcers, 83 surgical/procedure events, and 80 falls.  Root causes of events include such factors as rules/policies/procedures not being followed, communication issues, environment or equipment issues, lack of training, barriers, and fatigue/scheduling. 

 

Paula Meskan, Senior Nurse Manager, reviewed programs that REHC has in place to minimize adverse events. 

• Fall Prevention:  There are standard interventions that are implemented for all patients, as well as interventions used when a patient is determined to be at high risk of falling.  The number of falls in the facility has decreased over the last two years, with the current rate being less than the benchmark of 4 falls per 1000 patient days.
• Medication Events:  Actions taken to reduce errors include implementation of an electronic medication administration record, use of a Pyxis dispensing system, a process for medication reconciliation and patient/family education.  All errors and near misses are reviewed and rated – there have been no errors that have attained a “severe” rating.  In 2010 there were 27 reported errors, correlating to a 99.97% accuracy rate.
• Pressure Ulcers:  There are standard interventions that are implemented for all patients, and additional interventions for patients identified to be at high risk.  REHC has had no reportable events in either 2009 or 2010.  The last reportable event occurred in 2008.
• Surgical Site Infections:  Standard interventions are in place, including appropriate use and timing of antibiotics, hair removal and maintenance of normothermia.  There were two reported surgical site infections in 2009 (205 surgeries) and 0 in 2010 (197 surgeries).
• Surgical Site Verification:  A three-step process has been implemented to assure surgery is performed on the correct surgical site.

Kristin Schultz, Director of Quality, Infection Control and Risk Management, reported on the REHC program in place to prevent Healthcare Associated Infections.

• Healthcare Associated Infections:  Nationwide approximately 1 of every 20 hospitalized patients will contract a HAI.  Actions taken at REHC include implementing a multidisciplinary team approach, ongoing surveillance, implementation of guidelines, principles, recommendations, policies and procedures, education, training and reinforcement.  The number of reported HAIs at REHC has fallen from 3 in 2005 to 0 in both 2009 and 2010.  The 2011 goal is again to have 0 HAIs reported.

 

B.          Adverse Event Zero Tolerance Policy.

In response to the increased number of reported adverse events over the past year, the Minnesota Hospital Association will be drafting a “Zero Tolerance Policy” for rules and policies/procedures not being followed within hospitals.  The MHA is asking that hospitals educate their Hospital

Boards regarding the Board’s responsibility in overseeing efforts to improve patient safety and decrease adverse events.  Once the policy has been developed, MHA will be asking that the Hospital Boards implement the policy across the state.

 

   

C.          Union Update.

Question and Answer boxes have been located within the facility to allow employees to submit anonymous questions regarding union activity.  The questions are being reviewed with answers being sent via e-mail to all employees.

 

D.          Rural Metropolitan Statistical Area.

Blue Earth and Nicollet Counties have been declared to be a metropolitan statistical area.  Because Nicollet County is included in this declaration, in order to maintain status as a Critical Access Hospital, REHC had to petition Medicare to be declared “rural.”  This letter was sent to Medicare in April, 2010, and has received no response to date.  The Minnesota Hospital Association has brought this to the attention of Minnesota legislators, who will be working on behalf of REHC to finalize the declaration of REHC’s rural status.

 

DIRECTOR’S COMMENTS

 

Colleen Spike, CEO:  Efforts to improve timed/dated signatures on documentation have been ongoing and the number of noncompliant signatures has dropped since tracking began in August.  Statistics from August through December were reviewed.

 

Dr. Ben Chaska, Chief Medical Officer:  Dr. Chaska noted the newly elected officers of the Medical Staff are Dr. Elizabeth Osborne -- President, Dr. Scott Rassbach -- Vice President, and Dr. Michael Sparacino – Secretary-Treasurer.  He also noted Dr. Shores’ change to Honorary Staff status and thanked him for his years of service to the community of St. Peter.

 

Peggy Carlson, Community Liaison:  

• The Nicollet County Leadership Group will be holding their regular meeting at the hospital next week and will receive a tour of the facility while here.
• REHC will be one of the sponsors of the Relay for Life to be held in June.
• Outreach efforts to other facilities in the community have been initiated.

 

ADJOURNMENT

 

ACTION:  A motion was made by Jerry Pfeifer to adjourn the meeting.  The motion was seconded by Helen White and carried with all members voting in favor.  The meeting was adjourned at 1:28 p.m. 

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, February 23, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 p.m.

 

 

RIVER’S EDGE HOSPITAL & CLINIC COMMISSION MEETING

River’s Edge Hospital & Clinic Conference Room

Wednesday, January 12, 2011

 

 

Present:  Gil Carlson, Chairperson; Michelle Chalin, Vice-Chairperson; Helen White, Secretary-Treasurer; Trustees:  Kay Moline, and Jerry Pfeifer; Colleen Spike, CEO; Curt Savstrom, CFO; Dr. Benjamin Chaska, Chief Medical Officer; Dr. Elizabeth Osborne, Medical Staff President; Patty Roessler, Director of Patient Care and Ancillary Services; Tom Wilcox, Director of Environmental Services; Sheri Schmidt, Director of Business Services; Tammie Hudspith, Director of Human Resources; Kristin Schultz, Director of Quality, Risk Management and Infection Control; Todd Prafke, City Administrator; Jude Kyoore, City Administrative Intern; and Paulette Redman, Recorder.

 

Absent:  Margie Nelsen, Trustee.

 

The special meeting of the Hospital Commission was called to order at 12:16 p.m. by Chairperson Gil Carlson.

 

APPROVAL OF AGENDA

 

The agenda for the January 12, 2011, meeting was reviewed.  Item III – Legal Matter – was added to the agenda and moved to the beginning of the meeting.

 

LEGAL MATTER

 

Attorneys Mark Mathison and Meghann Kantke from the law firm Gray, Plant and Mooty were present for this portion of the meeting.  Mr. Mathison and Ms. Kantke gave attorney-client privileged information regarding a legal matter.

 

REVIEW OF BHS AGREEMENTS

 

Colleen Spike presented proposed service agreements between the Benedictine Health System (BHS)/Benedictine Living Community-St. Peter (BLC) and River’s Edge Hospital & Clinic.

• PT/OT agreement:  BHS has opted to take Option 1 of the REHC therapy proposal.  The option calls for REHC to provide PT/OT therapists and assistants as well as a PT helper.  Compensation would be provided to REHC of $47.40/resident/treatment.
• Dietary:  BHS proposes to raise the charge per tray from $8/tray to $12-$16/tray depending on the diet.
• Laundry:  BHS is proposing raising the laundry charge for soiled linen from $.49/lb. to $.60/lb.

 

The dietary proposal from BHS would result in an approximate cost increase of $35,529 for 2011.  The cost for handling the soiled laundry would increase by approximately $12,045 for 2011, a combined increase in cost of $47,574.  The REHC proposal for PT/OT services would generate a positive revenue/expense of $43,183 per year, compared with the current ($151,097) deficit of revenue/expense.

 

Proposals for potential new service providers were reviewed.

Laundry:  A proposal from a company called TCS was received.  Their rate would be $.48/lb. for clean linen.  Additionally, TCS would supply the linen.  The approximate cost of this proposal would be $28,907/year.  Taking into account the savings on linen purchases, the TCS proposal would be $10,867 per year less than the BHS proposal. 

Dietary:  A proposal from A’viands was reviewed.  A’viands also provides dietary services for the CBHH and CARE facilities.  Their proposal was to provide meals at a cost of $6.50/tray, resulting in a yearly cost of $42,023.  This proposal would be $45,255/year less than the BHS proposal.

 

Colleen Spike proposed that the current agreements for all three services – dietary, laundry, and therapy, be left in place and allowed to sunset on March 31, 2011.  After March 31, each party would have the opportunity to enter into other agreements if they so choose.  The extended time frame would provide time for an orderly changeover to a new service provider. 

 

ACTION:  Colleen Spike will propose to BHS that all three agreements remain at current rates/services with sunset date of March 31, 2011, after which BHS and REHC may enter into other agreements.  At that time, contract decisions for REHC will be made by REHC administration.

 

ADJOURNMENT

 

ACTION:  A motion was made by Jerry Pfeifer to adjourn the meeting.  The motion was seconded by Helen White and carried with all members voting in favor.  The meeting was adjourned at 1:08 p.m.

 

NEXT MEETING

 

The next regular meeting of the Hospital Commission will be Wednesday, January 26, 2011, at 12 noon.  This meeting will convene in the River’s Edge Hospital Conference Room.  The Finance Committee meeting will be held at 11:30 a.m.