Governance

Members Present:

Dale Blohm, Chair
Jim Cange
Greg Engele
Ken Harre
Harry Jankowski
J. W. Metcalf
Diane Nottmeyer
Rich Tomaszewski

 

Members Not Present:
David Behr, excused

 

Others Present:
Nancy Newby, CEO (exited 8:45 p.m.)
Tammy Amizich, CNE (exited 8:15 p.m.)
Kim Larkin, CIO (exited 8:15 p.m.)
Elaine Matzenbacher, CFO (exited 8:45 p.m.)
Melodie Wilkey, HR Director (exit 8:15) p.m.)
Marc Zerbe, M.D., Medical Staff President (exited 8:45 p.m.)
Randy Ragan, Auditor, McGladrey & Pullen, LLP (exited 7:45 p.m.)
Richard Lynch, Auditor, McGladrey & Pullen, LLP (exited 7:45 p.m.)

 

Others Not Present:
Ruth Kellerman, Quality Coordinator, excused

 

Called to Order: 7:31 p.m.
Adjourned: 9:05 p.m.

Meeting Agenda Additions/Corrections
The agenda of the October 28, 2008, meeting of the Washington County Hospital Board of Directors was presented for review and approval.

 

The following amendment was made:

• Add under Business, E. Board Retreat

On a motion by Harry Jankowski and second by Rich Tomaszewski, the Board unanimously voted to approve the October 28, 2008, meeting agenda with the aforementioned amendment.

 

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

• Board meeting, September 23, 2008.
  
• Finance Committee meetings, September 10, 23 and October 1, 2008.

 

On a motion by Greg Engele and second by Harry Jankowski, the Board unanimously voted to approve the above referenced meetings minutes.

 

Financial and Statistical Report
Elaine Matzenbacher presented the Financial and Statistical Report for September 2008. Highlights of the report were:

 

Total Patient Revenue was $1,851,331. Total Provisions were $867,958. Total Net Operating Revenue was $1,022,973. Total Operating Expenses were $1,146,179. Income from Operations was ($123,206), with YTD Income ($735,431.) Total Non-Operating Revenue was $42,355, with an YTD Total Non-Operating Revenue of $460,416. Income prior to Depreciation was ($14,028), resulting in a Total Income of ($80,851) with an YTD Total Income of ($275,015) as compared to a budgeted $55,805.

 

Additional discussion:

• Volume was very low—half of projected budget.
  
• Revenue was down due to uncontrollable factors, e.g., contracturals (increased number of Medicaid patients and uninsured patients, unpaid State reimbursements), poor economy, low patient volume, etc.
  
• Medicaid was above budget. CFO will run a search of visits by county to identify where patients are coming from. Past Medicaid patients tracking has shown that they are primarily from Washington County.
  
• Management continues to focus on controllable factors, e.g., salaries, supplies, other expenses, etc.

On a motion by Harry Jankowski and second by Ken Harre, the Board unanimously voted to approve the September 2008 Financial and Statistical Report.

 

Annual Audit Report
The results of the annual audit report for the year ending April 30, 2008, for Washington County Hospital were presented by Randy Ragan. Mr. Ragan is a partner at McGladrey & Pullen, LLP, which are the certified public accountants engaged by WCH for the audit.

• Mr. Ragan stated that his firm gave WCH an “unqualified opinion” which is the highest opinion an accounting firm can give to a client.
  
• It was also discussed that this was the first year WCH utilized this audit firm, and Mr. Ragan stated that this was the first year for a new set of standards by which audits must be performed.
  
• The Board was presented copies of three reports prepared by McGladrey & Pullen, LLP: (1) The Financial Report, (2) The Report to the Board of Directors and (3) The Financial and Compliance Report.
  
• The Finance Committee (the full Board was invited to attend) was presented all of the audit findings and recommendations in a meeting prior to the Board meeting.
  
• The summary by Mr. Ragan was that WCH has made significant financial improvements over the previous year and that trends were headed in the right direction.

On a motion by Harry Jankowski and second by Greg Engele, the Board unanimously voted to accept the annual audit report as presented by McGladrey & Pullen, LLP.

 

WCH Golf Tournament Report
Elaine gave a final report on the October 3, 2008, WCH Golf Tournament:

• Total net income: $6,601; proceeds will go toward the CT scanner replacement project.
  
• Prize winners were reported.
  
• A total of 14 teams played compared to 11 last year.
  
• Very positive feedback: “good time,” “well run,” “looking forward to next year.

JCAHO Survey

ProAssurance Risk Management Assessment
Nancy gave a preliminary report of the October 6-7, 2008, JCAHO survey:

• No formal survey report has been received to date.
  

• Three surveyors and one surveyor observer arrived unannounced. Surveys were conducted in three areas: (1) Critical Access Hospital, (2) Long-Term Care and (3) Life Safety/Building.
  

• Some items were identified and addressed while surveyors were here.
  

   

• Some additional items were identified which will be corrected:

  
  

  • Board - More involvement needed in strategic planning and quality monitoring.
    
  • Medical Staff – Regarding Bylaws and documentation regulations with specific attention to ongoing peer review and privileging.
    
  • Building issues – Different documentation for fire drills, more load capacity with generator checking and a policy revision regarding safety during construction.
    
  • Pharmacy – Entry after hours by nursing staff. This occurs when needed medications are not in the ER MedDispense cabinet because of limited stock capacity. This may be addressed with an additional cabinet for pharmacy stock which will be an expense. Administration briefly discussed that WCH’s is slated to be a pilot hospital in ICAHN’s after-hours pharmacy telemedicine program in which a pharmacist would review and authorize administration of a prescription. This program will address medication errors and comply with related National Patient Safety Goals which will be mandated in the future.
    
  • LTC medical director – An agreement on file is required. Dr. Goforth has been the LTC medical director (an uncompensated Medical Staff appointment) for years, and a formal agreement was created and signed between WCH and Dr. Goforth.
    
  • Medication management - WCH will contest this item. Surveyor sited that the IV contrast medication in radiology was too warm. WCH’s practice is in-line with the manufacturer’s storage recommendations.
    
  • Fire drills documentation – WCH will also contest this item. WCH’s records are in accordance with Safety guidelines.

  
  

  • A community-wide disaster drill was scheduled the afternoon of October 6. Surveyors had never observed a disaster drill during a site visit and insisted that it not be cancelled because of the survey. The drill was successfully initiated and completed within approximately two hours.

Nancy also reported on a survey conducted on October 21, 2008, by ProAssurance, WCH’s liability insurance carrier:

 

 

• This survey focused on reducing our risk, assuring that we have good policies and practices to reduce liability exposure, and that we know how to handle incidents when they occur.
  
• This surveyor focused on areas of high risk – surgery, ED, OB, physician and staff credentialing and competency.
  
• There were several minor recommendations about policies and documenting staff competency, and all will be addressed prior to receiving the final written report.

  Scheduled Joint Conference Committee
  And Contract Committee Meetings
  Board Committee meetings have been scheduled as follows, and notices will be mailed:
  

  • Contract Committee – Monday, November 3, 2008, 6:00 p.m. in conference room B.
    
  • Joint Conference Committee – Wednesday, November 5, 2008, 7:00 p.m. in the boardroom.

    Board Retreat
    

    • Proposed discussion topics:
    • More Board involvement in strategic planning and quality processes.
      
    • Transparency legislation.
      
    • Finance improvements.
      
    • OB space usage.
      
      
    • Additional topic suggestions should be forwarded to Nancy.
      
    • After a brief discussion regarding a change of location from Okawville golf club to WCH, it was agreed to meet in Okawville.

    Community Comments/Questions and Answers
    A copy of the annual audit report was provided to Dave Volz, Nashville News reporter, per his request.

     

    Closed Meeting
    At 8:15 p.m. on a motion by Ken Harre and second by J. W. Metcalf, the Board took a roll call vote to enter closed session under Open Meetings Public Act 88-621 Sections 2(C)(1)(21). Blohm AYE, Cange AYE, Engele AYE, Harre AYE, Jankowski AYE, Metcalf AYE, Nottmeyer AYE, Tomaszewski AYE. Motion carried.

    At 9:03 p.m. on a motion by Greg Engele and second by Rich Tomaszewski, the Board took a roll call vote to leave closed session and re-enter open session. Blohm AYE, Cange AYE, Engele AYE, Harre AYE, Jankowski AYE, Metcalf AYE, Nottmeyer AYE, Tomaszewski AYE. Motion carried.

     

    Board Closed Meeting Minutes
    The September 23, 2008, Board of Directors closed meeting minutes were presented for review and approval:

     

    On a motion by Greg Engele and second by J. W. Metcalf, the Board unanimously voted to approve the aforementioned meeting minutes.

     

    Adjournment
    On a motion by Ken Harre and second by Diane Nottmeyer, the Board unanimously voted to adjourn the meeting at 9:05 p.m.

     

    Respectfully submitted,
    J. W. Metcalf, Secretary, Board of Directors
    Washington County Hospital