Governance

Washington County Hospital

Board of Directors Meeting Minutes

Tuesday, February 23, 2010, 7:00 p.m.

Conference Rooms A and B 
 

Members Present:

Dale Blohm, Chair

Greg Engele

Bill Manier

J. W. Metcalf

Diane Nottmeyer

Rich Tomaszewski 

Members Not Present: 

David Behr, absent 

Others Present:

Nancy Newby, CEO

Tammy Amizich, CNE (exited 8:12 p.m.)

Kim Larkin, CIO (exited 9:10 p.m.)

Elaine Matzenbacher, CFO

Melodie Wilkey, HR Director (exited 8:12) p.m.)

Marc Zerbe, M.D., Medical Staff President (exited 8:50 p.m.) 

Others Not Present:

Ruth Kellerman, QA Coordinator, excused 

Called to Order: 7:00 p.m.

Adjourned:  9:15 p.m. 
 

Meeting Agenda

The agenda of the February 23, 2010, meeting of the Washington County Hospital Board of Directors was presented for review and approval.   

The following amendment was made:

• Add V. F.  Inpatient EHR
• Add V. G.  Legislative Updates
• Add VII. E.  Legal Updates
  

On a motion by Greg Engele and second by J. W. Metcalf, the Board unanimously voted to approve the February 23, 2010, meeting agenda with the aforementioned amendments. 

Introductions and Welcome

Pat Carr, FNP, nor Christine Bening was present.  They will be rescheduled to meet the Board at a later date.

 

Previous Board Meeting Minutes

Finance Committee Meetings Minutes

 

Personnel, Recruitment and Management Contract Review Committee Meeting Minutes

The following meetings minutes were presented for review and approval:

• Board meeting, January 26, 2010. 
• Finance Committee meeting, January 21, 2010.
• Personnel, Recruitment and Management Contract Review Committee meeting, February 18, 2010.
  

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

Financial and Statistical Report

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

Total Patient Revenue was $1,847,142.  Total Provisions were $822,882.  Total Net Operating Revenue was $1,071,999.  Total Operating Expenses were $1,329,240.  Income from Operations was ($257,241), with YTD Income ($624,907).  Total Non-Operating Revenue was $30,973, with YTD Total Non-Operating Revenue of $394,016.  Total Income was ($226,268), with YTD Total Income of ($230,891), as compared to a budgeted $153,819. 

Additional noted items:

• Total Patient Revenues were 11.2% ($233,136) under budget for the month of January.  Outpatient revenue was the only area under budget for the month.  Again, physician vacations may have impacted the volumes.
• Total Operating Expenses were 10.6% over budget in January due primarily to the health insurance.
• Employee benefits are 94.6% ($106,979) over budget this month.  We made another accrual of $39,000 for one third of the quarterly installment that we know will be due to Blue Cross in February.  This assessment was for high claims in October, November and December.
• Salaries were 5.3% over budget in January.  Further analysis shows that there was high IP census on West and in Swing, there were several staff hired that were in orientation, two holidays and several employees out with illness or injury.
• Total noncurrent cash and investments - $1,423,033 compared to last year’s $818,019.
• Admissions were up; however, OP visits, ER visits and OR cases were below budget—resulting from bad weather, poor economy and mild flu season.  Other hospitals are experiencing similar trends.

 

On a motion by Diane Nottmeyer and second by Bill Manier, the Board unanimously voted to approve the January 2010 Financial and Statistical Report. 

Quality Report

Ruth Kellerman, quality coordinator, was not present because she had to attend a disaster-related meeting.

 

Nominating Committee Meeting in March

• The Nominating Committee develops a slate of Board Officers for the upcoming year and presents it to the Board.
• The Nominating Committee will meet on Thursday, March 11, 2010, at 6:00 p.m. in the boardroom.

 

Joint Conference Committee Meeting in March

A quarterly Joint Conference Committee Meeting was scheduled on Thursday, March 25, 2010, at 6:30 p.m. in the boardroom. 

TIF

Tammy presented the following information (copy on file) regarding TIF equipment purchase request from EndoGastric Solutions (EGS):

• EsopheX TIF procedure is an incisionless procedure for the treatment of GERD, which Dr. Urdaneta would like to provide.
• The Board viewed a TIF video presentation at the January Board Retreat.
• WCH would make an up-front purchase of six TIF devices for $20,400.
• Purchase includes all expenses paid training for Dr. Urdaneta (traveling and lodging).
• EGS would provide on-site clinical support for five cases at WCH and would train surgical staff, also free of charge.
• EGS would provide a marketing tool kit and financially support the program by matching dollars (up to $2,000).
  

Discussion ensued:

• WCH would be the only site in southern Illinois performing this procedure.  The nearest areas offering TIF is Paducah and St. Louis.
• Administration stated that the projected two procedures/month are a realistic number with referrals from area physicians and Dr. Ramirez—this would complement his practice.
• Marketing methods were discussed.
• There is no obligation after the initial purchase of six devices.  However, devices may then be purchased one at a time.

 

On a motion by Diane Nottmeyer and second by Greg Engele, the Board unanimously voted to approve the purchase of six EGS TIF devices at a cost of $20,400. 

Board Member Resignation

• Dale Blohm reported that Sandy Alfeldt resigned from WCH Board of Directors for health reasons.  Recently, she had been hospitalized more than once and has been caring for both her elderly mother and an ill aunt. 
• Nancy notified Dave Meyer, chairman of the Washington County Board, of her resignation. 
• Nancy conveyed from Vic Schubert, chair of the Nominating Committee of the Washington County Board, that several candidates have applied for the two vacancies.  Interviews will be conducted the first week in March.  Appointments to WCH Board should be made by mid-April.

 

Employee Cost for Health Insurance

• As discussed at the Board Retreat, it is necessary to consider raising the employee’s contribution to cover health insurance costs.
• Employee rates have not increased for several years and WCH is currently charging less than most area employers.
• As reported, employee claims have been rising monthly this quarter.
• Nancy presented detailed information (copy on file) comparing the current rates and proposed rate increases.
• Rate increases would go into effect May 1, 2010.  Employees would be given a 60-day notice.
  

Discussion ensued:

• J. W. Metcalf felt the increase was drastic and suggested incremental increases, with hopes that claims would decrease over the next six months.
• In response to Bill Manier’s inquiry, Nancy reported that the employee pays less than 1/3 of the premium with WCH paying over 2/3.  Cobra is $1,200/month.
• WCH has an 80/20 plan with Blue Cross Blue Shield of Illinois.
  

On a motion by Bill Manier and second by Diane Nottmeyer, the Board voted to approve the employee health insurance rate increases as presented.  The motion carried with an opposing vote by J. W. Metcalf. 

Inpatient (IP) Electronic Health Record (EHR)

Kim Larkin, CIO, provided the following detailed information: 

MEANINGFUL USE-STAGES, TIMELINES and FUNDING

— Stage 1 – focuses on electronically capturing health information in a coded format, tracking key clinical conditions, using clinical decision support, reporting clinical quality measures and public health information.  First payment year is Federal FY 2011.

—  Stage 2 – using EHR/health IT for continuous quality improvement at the point of care; information exchange in structured format; CPOE and lab results sharing; likely both inpatient and outpatient hospital settings will be affected .  First payment year is Federal FY 2013.

—  Stage 3 – promoting improvements in quality, safety, efficiency; decision support for national high priority conditions; patient access to self management tools; access to comprehensive patient data and improvements to population health.  First payment year is Federal FY 2015. 

From a timing perspective, in order to take advantage of the cost report/depreciation incentives offered to WCH, we would need to have vendor contracts signed and an implementation plan outlined prior to April 30, so that a check could be cut May 1 and the project could get underway.  Meaningful use must be met by January 31 of the following year in order for us to have 90 days of meaningful use in the overlapping months between the hospital fiscal year and the federal fiscal year.  If we choose to delay this project for one year, the same time constraints would apply to the second window of opportunity.  Failure to work within these windows presents a likelihood that expenses associated with achieving meaningful use would not be eligible for the incentives and would run through the cost report in the usual manner. At best, it would split expenses between two hospital fiscal years and significantly delay the cost report settlement and, at worst, likely will reduce the cash back to the hospital.

Another consideration is that the Stage 2 criteria, (details of which have yet to be published) will build upon the functionality generated in Stage 1 thus requiring a sequential installation rather than a concurrent installation. 

The option with the best odds for success is to meet Stage 1 of meaningful use by January 31, 2011, and then have two years available to meet the more technically challenging requirements of Stage 2. 

NEXTGEN, SPHERE and OPUS

With NextGen’s acquisition of Sphere and OPUS, the market strategy is to create a single solution similar to those offered by CPSI, Meditech and others with this offering designed for hospitals of 100 beds or less. We have an opportunity to participate as one of the first three hospitals that will be using this combination of products.  This partnership allows NextGen to have a relatively controlled environment in which to work through the countless number of considerations that are involved in linking three different products. The hospitals receive a significant discount in the purchase price of OPUS and have the added benefit of being able to shape the “new” NextGen.  The corporate goal of this new product line is to merge/rewrite these applications into a true web-based product that is presented to the user as a single product with a single login.

OPUS is the best solution for WCH—financially and strategically.  The cost for us to replace Sphere/OPUS/NextGen would exceed $2 million and could not be done within a nine-month period.   

Legislative Updates

Illinois Medical Liability Reform Law Revoked

• Illinois Supreme Court revoked a previous reform regarding caps on malpractice damages payouts. 
• Illinois will see an increase in the number of medical malpractice cases and a recurrence in loss of physicians, as seen about five years ago.
• Judge Karmeier voted against it and wrote a dissenting response. 
• Senator Luechtefeld wrote an opposing article published in the Sentinel, which may be accessed online.
  

 

Healthcare Reform

• From an IHA report, Nancy conveyed that Obama’s proposed package will hurt the healthcare industry—cuts to hospitals and Medicare. 
  

 

Illinois CAH Funding Opportunity –

• Legislation is being developed to request relief for CAH’s for Medicaid funding—that outpatient services be on a cost-based reimbursement.
• This would cost the State $12 million—less than 1% of the State budget.
• Impact on WCH:  based on 2007 data, WCH would receive over $750,000.
• Committee hearings are scheduled March 2-3.  Nancy and Elaine will attend.  If interested in attending, notify Nancy.
  

 

Community Comments/Questions and Answers

In response to inquiries, Tammy provided answers/clarification regarding the TIF purchase. 

Closed Meeting

At 8:12 p.m. on a motion by Rich Tomaszewski 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)(17)(21).  Blohm AYE, Engele AYE, Manier AYE, Metcalf AYE, Nottmeyer AYE, Tomaszewski AYE.  Motion carried. 

At 9:10 p.m. on a motion by J. W. Metcalf and second by Greg Engele, the Board took a roll call vote to leave closed session and re-enter open session.  Blohm AYE, Engele AYE, Manier AYE, Metcalf AYE, Nottmeyer AYE, Tomaszewski AYE.  Motion carried. 

Board Closed Meeting Minutes

Medical Staff Meeting Minutes

QA/CQI Meetings Minutes

 

Personnel, Recruitment and Management Contract Review Committee Meeting Minutes

The following meetings minutes were presented for review and approval:

• Board closed minutes, January 26, 2010.
• Medical Staff minutes, December 9, 2009.
• QA/CQI Meetings Minutes, November 19 and December 17, 2009.
• Personnel, Recruitment and Management Contract Review Committee closed minutes, February 18, 2010.
  

 

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

 

Medical Staff Credentials and/or Privileges

On a motion by Diane Nottmeyer and second by Rich Tomaszewski, the Board unanimously voted that

credentials and/or privileges be approved/granted as follows:

• Curtis Settlemoir, M.D. – Provisional staff specific to teleradiology services.
• Ethel Grene, M.D. – Provisional staff specific to emergency services.
• Lisa Reis, M.D., cardiology services – status change from Provisional to Courtesy.
• Mary Joelle Curry, M.D., teleradiology services – status change from Provisional to Courtesy.
• Jeffrey Morrill, D.O., teleradiology services – status change from Provisional to Courtesy.
• John Schlepphorst, D.O., teleradiology services – status change from Provisional to Courtesy.
• Jennifer Sharp, M.D., teleradiology services – status change from Provisional to Courtesy.
  

 

Employment Agreement

On a motion by J. W. Metcalf and second by Rich Tomaszewski, the Board unanimously voted to notify Marc Zerbe, M.D., that WCH is exercising the “No Fault” termination clause in his current contract to dissolve our contractual relationship effective September 1, 2010. 

Adjournment

On a motion by J. W. Metcalf and second by Bill Manier, the Board unanimously voted to adjourn the meeting at 9:15 p.m. 

Respectfully submitted,

Richard Tomaszewski, Secretary

Board of Directors

Washington County Hospital