Governance

Washington County Hospital
Board of Directors Meeting Minutes
Tuesday, August 24, 2010, 7:00 p.m.
Conference Rooms A and B

Members Present:                             
Dale Blohm, Chair                              
David Behr via teleconference                       
Jim Cange                                           
Greg Engele                                        
Victor Lopez                                       
Bill Manier                                          
J. W. Metcalf                                      
Diane Nottmeyer                                
Rich Tomaszewski            

Others Present:
Nancy Newby, CEO
Tammy Amizich, CNE (exited 8:35 p.m.)
Christine Bening, HR Coordinator (exited 8:35 p.m.)
Ruth Kellerman, QA Coordinator (exited 8:35 p.m.)
Kim Larkin, CIO (exited 8:35 p.m.)
Elaine Matzenbacher, CFO

Other Not Present:

Marc Zerbe, M.D., Medical Staff President, absent

Called to Order:         7:08 p.m.
Adjourned:                 9:38 p.m.

Meeting Agenda
The agenda of the August 24, 2010, meeting of the Washington County Hospital Board of Directors was presented for review and approval. 

The following amendments were made:

• Add:          IV., F.  Update:  Vijay Aher, M.D., Urologist – Nancy Newby
• Add:          IV., G.  Schedule Buildings and Grounds Committee Meeting – Nancy Newby
• Add:          IV., H.  Update:  Midwest Emergency Department Services (MEDS) – Nancy Newby
• Add:          IV., I.  Update:  Golf Tournament – Elaine Matzenbacher
• Delete:       IV., A.  Audit Year-End Report – McGladrey & Pullen – Report postponed to September

On a motion by J. W. Metcalf and second by Greg Engele, the Board unanimously voted to approve the August 24, 2010, meeting agenda with the aforementioned amendments.

Previous Board of Directors Meeting Minutes

Finance Committee Meetings Minutes
The following meetings minutes were presented for review and approval:

• Board of Directors, July 27, 2010. 
• Finance Committee, July 15 and 27, 2010.

On a motion by Greg Engele and second by Victor Lopez, the Board unanimously voted to approve the aforementioned meetings minutes.

Financial and Statistical Report
Elaine Matzenbacher, CFO, presented the Financial and Statistical Report for July 2010.  Highlights of the report were:

Total Patient Revenue was $2,144,232.  Total Provisions were $951,813.  Total Net Operating Revenue was $1,297,818.  Total Operating Expenses were $1,289,382.  Income from Operations was 8,436, with YTD Income ($157,725).  Total Non-Operating Revenue was $48,864, with YTD Total Non-Operating Revenue of $114,696.  Total Income was $57,300 with YTD Total Income of ($43,029), as compared to a budgeted $20,871.

Additional noted items:

• Total Patient Revenues were 0.9% ($19,662) under budget for the month of July.   All inpatient service areas were down, however, the outpatient areas did well.
• Non-Operating Income was 33.3% over budget as there were several ICAHN grants recognized in the month.
• Contractual Adjustments were 2.8% over budget in the month.  Charity care was $2,965.
• Other Operating Revenue was significantly over budget ($57,940) in the month as the Department of Health and Family Services (Medicaid) caught up the monthly assessment program payments.
• Salaries were 3.4% under budget in July.
• Employee Benefits were .9% under budget this month.

On a motion by Bill Manier and second by Rich Tomaszewski, the Board unanimously voted to approve the July 2010 Financial and Statistical Report.

QA Report
Ruth Kellerman, QA Coordinator, provided the following detailed report about Quality and Core Measures implemented at WCH:

• Core Measures are one way to compare the quality of care which hospitals provide.  Core Measures set national standards of care, and hospitals are then measured on how often they provide recommended treatments known to achieve the best results for patients with certain medical conditions or surgical procedures.  Measures are based on scientific evidence, and health care experts and researchers are constantly evaluating the evidence to ensure that the measures and guidelines are kept up-to-date.
• These Core Measure were developed by The Joint Commission (TJC; WCH’s accreditation organization), derived largely from a set of quality indicators defined by the Centers for Medicare and Medicaid Services (CMS).  They have been shown to reduce the risk of complications, prevent recurrences and otherwise treat the majority of patients who present at a hospital for treatment of a condition or illness.  Core Measures aid hospitals to improve the quality of patient care by focusing on the actual results of care.
• There are 27 Core Measure altogether, in four categories:  (1) acute myocardial infarction (heart attack); (2) community-acquired pneumonia; (3) congestive heart failure; and (4) surgical care improvement project.  Under each category, key actions are listed which represent the most widely accepted, research-based care process for appropriate care in that category.
• Focused discussion regarding community-acquired pneumonia and protocol followed at WCH. 
• Time from registration to administration of first antibiotic – national goal is six hours; WCH goal is four hours
• ER admission and administration of antibiotic in ER
• Blood culture prior to administration of first dose of antibiotic
• Review whether patient had pneumonia vaccine and flu vaccine
• Provide education for smokers

Quarterly Status Reports Regarding Strategic Plan and Budget

• Nancy reviewed in detail the Strategic Plan and Financial Quarterly Report, with all areas meeting or exceeding goals (copy on file).
• A quarterly “WCH Report Card” will be published in the Nashville News.

OPUS Update
Kim provided the following update:

• The December 6, 2010, go live date for OPUS has been postponed because of delays from the Lab’s Omnitech software issues related to three different interfaces.  We don’t want to bring up OPUS before Omnitech.
• Also, NextGen is upgrading OPUS software this week in Austin—another good reason to hold off—avoid an upgrade shortly after going live.
• Even with these delays, we are within the goal of January 31, 2011, to meet Meaningful Use timeframe requirements.

Capital Request:  EndoSoft

• Tammy reported that current GI hardware and software are aged.  The current proprietary vendor, Olympus, is no longer supporting the equipment as of January 1, 2010.  We’ve been experiencing shutdowns and printer problems—all patient care and patient safety related issues. 
• Tammy presented a bid from EndoSoft for GI software which is stand alone, flexible, may be used with our hardware and scopes, and images may be stored and then reported on PACS.  Bid of $22,200-25,000 includes:
• $7,200 for the core application
• $15,000 for the interface
• onsite free training
• one year warranty
• 50% payment at signing and 50% payment at go live time (approximately four to six weeks implementation timeframe)
• will require Electromec time figured into bid
• negotiations are ongoing at this time
• Olympus bid includes:
• $15,085 without interface
• One day training fee of $1,400
• Does not include cost of exclusive scopes, hardware, printers, etc.
• Dr. Ramirez performs 10-15 procedures each week.  He approves of the EndoSoft product.  This is an immediate need because of above mentioned patient issues.
• Some Board members expressed that they don’t like these “rush” requests and would like more advanced notice of equipment needs.  Administration responded that we have a budgeted equipment list but, because of our poor financial picture, no purchases are being made except on an emergency basis; subsequently, this “rush” request.
• The Board asked that another bid be obtained, and this will be done.  If needed, a special Board meeting may be called for action.

WCH Bylaws Review
The Executive Committee will meet Tuesday, September 14, 2010, at 7:00 p.m. for periodic review of the WCH Bylaws.

Update:  Vijay Aher, M.D., Urologist
Dr. Aher has provided outpatient clinic urology services since mid-2008.  WCH received his letter of resignation from the Medical Staff effective August 23, 2010.  He has relocated to Marion, Illinois, and is affiliated with Heartland Regional Medical Center.  Recruitment efforts for another urologist are underway.

Update:  Midwest Emergency Department Services (MEDS)

• Nancy reported that:
• MEDS has presented nine ER physician candidates to date.  The interview/tour process has been very positive; however, WCH has declined one applicant.  MEDS start date is October 1, 2010.
• Dr. Urdaneta has been covering additional shifts during August and is scheduled to cover even more shifts during September.
• Marketing was discussed regarding publishing an article/ad to announce the new contracted services and to welcome new ER staff.

Update:  Golf Tournament
Elaine provided the following report:

• Kick-off meeting was held August 20.
• Victor Lopez created a flyer which was circulated at the Board meeting. 
• The flyer noted that donations will go toward a fund for digital mammography equipment.
• A reply form is also being created.
• The lunch and dinner meal will remain the same as last year—brown bag lunch and pizza dinner.

Buildings and Grounds Committee Meeting
Nancy will schedule a Buildings and Grounds Committee meeting to address some issues. 

ER Registration and Switchboard Services

• Nancy stated that ER registration staff are responsible for switchboard coverage during the week on days and evenings.  On nights and weekends, nursing staff cover ER registration and the switchboard.  Subsequently, in order to meet nursing needs, the switchboard may go unattended or be redirected to west wing nursing station which can be frustrating and confusing to both staff and incoming callers.
• Administration has reviewed the situation and suggested that the current phone system be adjusted to utilize automated switchboard capabilities at no additional cost. 
• The automated feature was initially declined when the system was installed because strong objections were received. 
• It was questioned whether Board members would have any objections at this time, and several did.
• Discussion ensued regarding implementation and service details. 
• Board consensus was to pilot the automated service for a 30-day period.  If the public responds negatively, then it may be discontinued.

Community Comments/Questions and Answers
In response to reporters’ requests, clarification was provided regarding EndoSoft equipment, ICAHN and the WCH Golf Tournament.

Closed Meeting
At 8:35 p.m. on a motion by Jim Cange and second by Greg Engele, the Board took a roll call vote to enter closed session under Open Meetings Public Act 88-621 Sections 2(C)(1) (5) (17)(21).  Blohm AYE, Behr AYE, Cange AYE, Engele AYE, Lopez AYE, Manier AYE, Metcalf AYE, Nottmeyer AYE, Tomaszewski AYE.  Motion carried.

At 9:37 p.m. on a motion by Jim Cange and second by Diane Nottmeyer, the Board took a roll call vote to leave closed session and re-enter open session.  Blohm AYE, Behr AYE, Cange AYE, Engele AYE, Lopez AYE, Manier AYE, Metcalf AYE, Nottmeyer AYE, Tomaszewski AYE.  Motion carried.

Board of Directors Closed Meeting Minutes

Medical Staff Meeting

QA/CQI Meetings
The following meetings minutes were presented for review and approval:

• Board of Directors closed, July 27, 2010.
• Medical Staff, June 2, 2010.
• QA/CQI, May 20 and June 17, 2010.

On a motion by Rich Tomaszewski and second by Greg Engele, the Board unanimously voted to approve the aforementioned meetings minutes.

Medical Staff Credentials and/or Privileges
On a motion by Greg Engele and second by Bill Manier, the Board unanimously voted that
credentials and/or privileges be approved/granted as follows:

• Nadeem Ahmed, M.D. – Provisional staff specific to pulmonology services.
• Mark Friedman, M.D. – Provisional staff specific to cardiology services.
• Curtis Settlemoir, M.D. – Status change from Provisional to Courtesy, teleradiology services.
• William Stafford, M.D. – Status change from Provisional to Courtesy, emergency medicine services.

Adjournment
On a motion by Diane Nottmeyer and second by Bill Manier, the Board unanimously voted to adjourn the meeting at 9:38 p.m.

Respectfully submitted,
Richard Tomaszewski, Secretary
Board of Directors

WCH Board

Administrative Team

Nancy Newby, Chief Executive Officer

Tammy Amizich, Chief Nurse Executive
Kim Larkin, Chief Information Officer
Elaine Matzenbacher, Chief Financial Officer

Christine Bening, Human Resources Coordinator
Ruth Kellerman, Quality Coordinator

>  2010 board meeting dates
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