October 2, 2014
The working meeting of the Board of Commissioners for Island Hospital was called to order by President Iversen at 12:00 pm in the Cypress Room of Island Hospital.
Those present were Commissioners Lynne Lang, Ph.D., Paul Maughan, Ph.D., Buzz Ely, MD, Chip Bogosian, MD and Jan Iversen. Also present were Vince Oliver, CEO; Robert Prins, MD, Chief Medical Officer; Tom Bluhm, Information Systems; Shane Taylor, Information Systems; Chris Matala, Supply Chain Management; Kim Graf, Executive Assistant; and Briana Alzola, Anacortes American.
Not present at the Working Board Meeting were Elise Cutter, CFO; Lois Pate, CNO and Kathy Garde, MD, Chief of Staff.
Process Improvements:
Chris Matala provided the Board a GPO review. To date, Island Hospital has seen approximately $420,000 in savings.
Factors which have contributed to this reduction are product pricing, contract access, training and education, cost of change (product changes, contract changing, possible distributor changes). Chris compared two GPO’s, Premier and Amerinet, our current GPO, in order to determine which GPO would allow the most savings for IH.
Results showed that keeping all criteria equal, Amerinet will provide IH with a net saving of $35,000 over Premier and may net even more with stricter adherence to the product list. Strategies 2015 and beyond:
Improve Contract Awareness (IT, Support Services, Financial, Engineering, Clinical) Increase Contract Access
Product Standardization
Chris noted the Supply Chain Management Department will strive to improve operational efficiency, better patient outcomes, and continue looking for cost savings.
Operational Savings:
Tom Bluhm and Shane Taylor demonstrated the proposed plan to begin paperless board books. IH will use a cloud based system which can be access through any mobile device. The program is run on an application called Airwatch Secure Locker. The contents in the file will be “read only”. Shane will look into the possibility of printing and annotation ability.
IS is satisfied with the security features of this program. There is a license fee on each device granted access to the system however the license fee is minimal. Therefore, a Commissioner
could choose to have more than one device on the system. The Board agreed to provide their own personal devices.
The next steps will be for IS to set up the system. At the December 4th Working Board Meeting the Commissioners will bring their personal devices in order for the devices to be approved by IS and gain access to the program. The December Board Books will be sent out electronically pending there are not setbacks with set up.
Tom Bluhm noted that he will send out some informational materials to the Board regarding the program.
Business Opportunities: No Report Given
Strategic Opportunities: Targeted Partnerships:
Vince shared that he has been in discussion with Providence in order to pursue using their physician recruitment services to assist IH with physician recruitment. This service is a separate business within Providence and is called Providence Physician Services and Recruitment.. Vince noted that the cost structure is very competitive and less than what IH is currently paying for searches.
Vince inquired if the Board would have any concerns or conflicts working with Providence. Vince noted that Providence does a great deal of physician recruitment and he is confident their services would assist IH. Commissioner Lang inquired if there is a conflict of interest with this recruiting agreement. Vince remarked that the searches are completely independent and
separate. There will be no Providence logos and the potential candidates will know that positions are strictly IH searches.
Ely remarked that cost savings with contracts is something IH is looking to accomplish; Commissioner Ely suggested IH pursue and evaluate after some time. Vince noted that the contract is on a search by search basis and that IH still has the capability of using different search firms for different positions.
Board agreed to move forward and use Providence Physician Services and Recruitment.
ACN Updates:
Vince shared that an IH ACN Steering Committee has been formed and will meet monthly. The committee members are Vince Oliver, Elise Cutter, Dr. Robert Prins, Anita McCoy, Patty Codd, Dennis Richards and Tom Bluhm.
Boeing contract is currently in its open enrollment period. UW is hopeful their ACN will expand into the eastern part of Washington in the future.
Dr. Prins noted how ACN’s will change the culture with how physicians see patients. He noted the importance of IH being involved in order to stay on top of the healthcare system change. Monthly Discussion:
Code of Conduct:
Vince reported that at the October Regular Board Meeting the IH Code of Conduct will be presented to the Board in the form of a Resolution for approval.
Commissioner Ely inquired with Vince if vendors can be asked to follow the IH Code of Conduct. Vince shared that all vendors check into Materials Management upon entry into IH spaces; Chris Matala will ask vendors to sign the Code of Conduct.
Chelan 2015:
Vince asked that Commissioner let him know by the November Board Meeting if they will be attending the Lake Chelan Conference in 2015. Vince suggested that Commissioner training opportunities in different formats be looked at for the future. Commissioner Lang expressed the importance of Commissioner training with the changes occurring in the healthcare industry. Dr. Prins noted that Kaiser and Commonwealth offer exceptional online training modules
Survey Recap:
Vince presented a PowerPoint presentation which highlighted the survey results. The overall consensus is that the Working Board Meetings will continue into 2015 and begin at 12 noon.
ADJOURNMENT:
There being no further business, President Iversen called for the meeting to be adjourned at 1:30 p.m.
Next Working Board Meeting: November 13th @ 12:30 am in the Cypress Room Featured Speaker: Steve Burton, RN, Surgery.
October 23, 2014
The regular meeting of the Board of Commissioners for Island Hospital was called to order by Commissioner Iversen at 12 noon in the Cypress Room of Island Hospital.
Those present were Commissioners Lynne Lang, Ph.D., Chip Bogosian, MD, Buzz Ely, MD, Paul Maughan, PhD and Jan Iversen. Also present were Vince Oliver, CEO; Elise Cutter, CFO; Kathy Garde, MD, Chief of Staff; Bob Prins, MD, Chief Medical Officer; Kim Graf, Executive Assistant; Anita McCoy, RN, MN, Director, Quality; Gary Preston, PhD, Infection Prevention & Control; Nina Mead, Emergency Preparedness Director; Sandra Sheikh ,RN, Quality
Management Coordinator; Dennis Richards, Community Relations; and Brianna Alzola, Anacortes American.
Public Comments: No comments
CONSENT AGENDA:
After review, Commissioner Maughan made a motion to approve the Consent Agenda. Commissioner Lang seconded the motion. Commissioners, Lang, Maughan, Ely, Bogosian and Iversen all voted aye and the motion carried.
BOARD QUALITY & PATIENT SAFETY REPORT Medical Staff Meeting Summaries: Dr. Garde reported:
Surgery: Block scheduling will be adjusted so that surgeries are completed by 5pm. There is a need to standardize the time-out process. Providers will make recommendations to Steve Burton and the new standardization process will be discussed at the next Surgery Committee Meeting. Emergency Department: The ED is moving towards electronic orders. The ED will generate the holding orders and the admitting physician will generate the standing orders. The State Supreme Court has mandated that mental health patients cannot be held in an ED as a result of insufficient beds elsewhere. IH will ensure that diagnoses are correct and that all ED providers are familiar with the EMTALA requirements regarding patient competency. It has been noted that
Registration time to ED differs from reception time to ED. The numbers have been screwed which causes staffing issues. ED will meet with Kay Steiner and Sandra Sheikh to resolve the issue and standardize.
QA: Dr. Murray has taken over as the Utilization Review Director. Currently, Medicare is overwhelmed with appealed cases and is offering a one-time pay out at 68% for appeal cases. It was decided by IH Finance Department that this buy out would not be beneficially to IH and therefore the payout opportunity was not accepted.
IH has been informed that they will receive a penalty for readmissions for FY2015. The readmissions report is based on:
AMI COPD
Total Hips/Total Knee Heart Failure
Pneumonia
Each Medical Staff Department will review readmission cases. Credentials:
After review, Commissioner Ely made a motion to approve the Credentials List. Commissioner seconded Lang the motion. Commissioners, Lang, Maughan, Ely, Bogosian and Iversen all voted aye and the motion carried.
Quality Management Review/Compliance: Infection Prevention & Control: Ebola Virus
Commissioner Bogosian distributed informational material on the Ebola Virus to the Board. Dr. Gary Preston reported on the IH preventative measures that have been put into place to combat the Ebola Virus.
Dr. Preston noted that it is highly unlikely that IH will see an Ebola case however it is imperative that preventative measures are put into place.
Dr. Preston reviewed the guideline for Screening Ebola Virus Disease (EVD). Admitting
ED and Clinic Triage
Management of Suspected EVD
Laboratory & Patient Care-Test if necessary Manage patient care appropriately
Dr. Preston commended IH in their efforts to prepare for potential patients with the Ebola Virus. Staffing training is still underway.
Commission Maughan inquired about the efforts of the Skagit County Public Health Office in preparation for combating EVD. Dr. Preston noted that the county health department has been very helpful in addressing the current issues. Public health nationwide has changed and our county has done an excellent job with the resources available to them.
FINANCE UPDATE:
Commissioner Lang noted the goals that the Board deemed as most important focus areas during the 2013 Retreat are proving to be fiscally beneficial to IH in 2014.
Elise Cutter reported on the September 2014 financial statements with the Committee and highlighted the following as significant items:
• Patient Volumes – Inpatient admissions for the September 2014 were 248 against a budget of 259 and 236 in 2013. The average daily census for the year 2014 was 26.3 patients compared to 28.7 budgeted and 28.3 for the year 2013. Surgery minutes for year 2014 were 7.1% less than budget and 1.9% below year 2013. Emergency Room visits for year were 16.8% more than budgeted and 16.8% more than year 2013. The total number of outpatient visits was .4% less than budgeted and 3.2% more than in 2013, physician clinic visits were 3.7% below budget and 10.5% more than in 2013. Rural health clinic visits were .7% less than budget and 1.8% less than in 2013.
• Balance Sheet – The hospital collected $7 million in September and paid out $6.3 million which resulted in a slight increase of day’s cash on hand to 110.8 from 107 at the end of August. The days in Accounts Receivable increased to 38.2 from 37.4 days at the end of August, still below the target of 45 days.
• Net Revenue – Net revenue for September 2014 was $6.9 million with actual collection rate of 41.9% which was slightly below the budgeted 42.1%. The improved collection rate is attributable to increased volume, better payor mix and decreased bad debt. We had 35 births for the month. Bad Debt was $196,000 below budget for the month. Year to day, Charity Care is $363,988 less than in 2013.
• Operating expenses – Total operating expenses are $467,000 under budget or 6.7%. The total number of FTE’s for September was 523 which is 18 below budget and 4 more than
September 2013. The Hospital recorded a net operating income for September of $349,000 or 5.1% versus the budgeted income of $18,000 or .3%. The excess margin for September is $448,000 versus budgeted excess of $109,000.
Commissioner Iversen complemented all departments within IH for their efforts to contain expenses and provide quality care.
Commissioner Ely noted the dip in profit in the Wound Care Clinic. Vince shared that he is very optimistic about the future of the Wound Care Clinic. He noted that Dr. Brown is still in the process of hiring staff for the clinic and is collaborating with Providence Wound Care Clinic on ways to expand the IH Clinic. Dr. Brown is currently still a practicing Hospitalist on a part time basis and will begin fulltime work in the Wound Clinic in April of 2015.
ECG Recap:
Elise Cutter reported that the ECG project stemmed from our transition to EMR. Before bringing EMR to the islands, it had been determined that there was a need to improve clinic inefficiencies in order for the EMR transition to be successful.
ECG brought in an analyst, who is familiar with Meditech, to perform clinic operation assessments. ECG spent a day at Fidalgo Medical Clinic in order to evaluate what the end
product should look like. Assessments were then completed at the Lopez Island Medical Clinic and Orcas Medical Center. The evaluations ECG provided included observations, action plans, and benchmarks and provided IH with clear direction and guidance as to how to improve process improvements. Once clinic process improvements are completed within each clinic the EMR transition will begin.
OLD BUSINESS:
Patient Zip Code Data:
Vince presented the WSHA market share data for Anacortes La Conner and San Juan counties. This data is for inpatient care only. IH has requested that WSHA provide the same date for outpatient care in the future. Commissioner Iversen noted that the data clearly demonstrates that IH has very competitive low costs and exceptional patient care.
The Big Five For Life:
Dr. Garde asked for feedback on the “Big Five For Life” book. Those who read the book agreed with Dr. Garde’s idea that the book could have a positive impact on IH employees.
Vince suggested that the ideas within the book be dove tailed with IH Promise Program. Vince asked if Dr. Garde would be willing to be the physician representative on the IH Promise Team. Dr. Garde willingly accepted. Vince will be in contact with Duane Knapp in order to incorporate Dr. Garde onto the Promise Team. Commissioner Iversen noted that the book is very compatible with the Promise Program and will be a great compliment.
Elise Cutter shared that the book may be of interest to the HR staff and that some of the concepts could be incorporated into the hiring process.
Nursing Home Readmits:
Lois Pate reported that she met with Jim Roe and Joe Sladich regarding nursing home readmits. Both Jim and Joe did not have a clear understanding of the impact that readmits had on IH. Both are now aware that in the near future nursing homes will also be impacted when readmits occur. Lois shared that IH has in-service training that is available to their staffs free of charge. Lois noted that many visit to the ER could have been avoided with better staff training. To date, no staff from either local area nursing homes has signed up for training.
Vince shared that local Anacortes nursing homes have subscribed to MINS. He is hopeful they will be up and running by the end of the year. This will be a change for each nursing home however a step in the right direction and will naturally strengthen communication between hospitals and the nursing homes.
NEW BUSINESS:
WSHA Annual Meeting Recap-
Commissioner Iversen reported the Board Intensive Session provided extremely valuable information to Commissioners. Commissioner Iversen will work with WSHA to schedule an intensive training session in early 2015.
Commissioners Maughan, Lang and Iversen shared their meeting highlights with the Board. Commissioner Maughan noted that Board leadership is broadening and will be requiring more involvement with physicians.
Commissioner Lang noted the Commissioners will be asked to take on different responsibilities than they have taken on in the past. They will work more closely with more physicians,
administrators and the local community to determine the community needs. Commissioners will be required to participate in more educational and training modules in order to better understand the ongoing changes within the healthcare industry.
Commissioner Iversen remarked that this is an interesting time in healthcare. There are no guidelines set for the hurdles that hospitals are currently facing. Community members should be included on more hospital committees and strategic planning in order to better determine
community needs. Commissioner Iversen shared that WSHA has a new website that is assessable in order to view hospital quality scores; www.WAHospitalQuality.org.
Commissioners Calendar:
The Board approved the November calendar with no changes. Island Hospital Foundation:
Vince share that the investigation is still ongoing. Once complete all evidence will be passed over to local law enforcement and prosecuting attorneys.
The IHF Executive Committee is in the beginning stages of launching a search for a new IHF Director.
In the near future, the IHF will be sending out letters to the public explaining the steps and the corrective measures that have been taken thus far to correct the fraud found within the IHF. Elise Cutter shared with the Board a check for $5,410 that was presented to the IHF from Skagit Sun for the 2014 berry sales.
ADJOURNMENT:
There being no further business, Commissioner Iversen called for the meeting to be adjourned at 1:50p.m.
_____________________________________ ______________________________________ Jan Iversen, President/Commissioner Chip Bogosian, M.D., Secretary/Commissioner
_____________________________________ _____________________________________ Lynne Lang, Ph.D., Commissioner Paul Maughan, Ph.D., Commissioner
_____________________________________ Buzz Ely, M.D., Commissioner
