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Northfield Hospital Board Meeting - February 23, 2017

February 26, 2017 at 11:21 am
By Dave Emery


1. Board Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved. Charlie introduced new Board member, David Koenig.


1. Hospital Chief of Staff—Dr. Reister. Reister reported that they are seeing many cases of flu.   The Medical Staff is considering a change in policy to hold meetings annually rather than quarterly.  Since the hospital added hospitalists to the medical staff, the clinical physicians in Northfield rarely come to the hospital, and the meetings are poorly attended.  Reister asked for approval of the applications for Medical Staff membership and privileges.  Motion approved.  A Board member asked why most of the applications were for mental health providers?  NH&C recently contracted with a mental health organization to provide telemedicine consults for emergency room patients.  The organization has a large staff of mental health providers all of whom need to have privileges since consults are handled by the first available provider. 

2. Chief Medical Officer—Dr. Meland.  Meland reported that males seem to have more serious flu symptoms than females this year.  Employees are wearing the NH&C branded garments that the institution made available, and they look good.

3. CEO Report—Steve Underdahl. The review process for a new Electronic Health Records (EHR) system continues.  Site visits are underway to hospitals similar in size to NH&C to see the systems in operation at a real-life setting.   In response to a rising chorus of questions concerning the possible closing of the long-term care facility, a sheet was distributed to Board members with Frequently Asked Questions and Answers.  Underdahl reiterated that a change would be in response to changing needs of the community and a need for long-term (10 years) sustainability as reimbursement is changing, demographics are changing, patterns of care and technology are changing, etc.  The new orthopedic arrangement is going well, and new services will likely be added in Northfield.  Work continues on the possibility of creating a hospital foundation.  Staff is working on incorporating Sterling Drug into a local urgent care center.  A new Human Resource Director has been hired by NH&C. 

There is considerable interest in what happens if the ACA is replaced.  Underdahl reported that he has spoken on the topic and has other engagements scheduled.  Underdahl distributed a report to Board members on replacing the ACA based on House Speaker Ryan’s “Better Way Plan”.  Underdahl characterized the report as “a compass rather than a map”—indicating a general direction but few details.  Block grant funds are a major part of Ryan’s proposal, but the structure of the grants and the details remain open.  Discussion followed.  It was commented that,  “block grants always mean less money eventually.”  And, “85% of Medicaid funds go to the elderly and disabled. Who is going to support the other necessary services when the cutbacks occur—the state on MN?”  Board members urged the Administration to explore organizing independent hospitals in MN to be a more effective lobbying force.  Underdahl then tossed out the question: Should we lobby to block repeal of the ACA, or lobby to shape the new plan?           

3. Financial Report—Scott Edin.  Edin reported that January was a busy month due to the flu: inpatient admissions were down but acuity and length of stay were up.  Clinic visits were up 20%; Emergency room visits exceeded 1000 for the first time.  The topic then turned to PERA (Public Employees Retirement) again.  A broad-ranging discussion followed, ranging from reforms of PERA, to the possibility of replacing PERA, to more short-term measures to deal with the immediate problems.  The short-term solution was basically to ignore the PERA liabilities in assessing performance and considering employee bonuses.  Long-term, the Finance Committee (now incorporating new member David Koenig) will explore options.  The PERA liabilities can’t be ignored, but they appear semi-random in amount and are assessed very late in the financial year so budgeting for them is almost impossible.  An employee bonus proposal will be brought to the Board at the March meeting.      

4. Strategic Planning—Steve Underdahl and Matt Anderson (consultant).  Anderson was attending to start the environmental scanning process ahead of the Board Retreat in April.  Anderson’s method was PESTEL—look at the political, economic, social, technical, educational, and legal environments to identify opportunities and challenges.  Political—murky! Economic—some form of payment reform (changing incentives and reducing cost) is coming.  MD productivity is declining as older MDs retire and newer MDs want a real life.  Social—the Medicare and Medicaid populations are growing rapidly; people want more care options as they age; millennials want more convenient care; society is anxious about their health care.  Technology—telemedicine consults are increasing.  The military is doing robotic surgery via telemedicine.  The role of genetics in medicine is expanding as is the role of artificial intelligence, e.g. IBM’s Watson.  Education—The workforce in MN will peak in 2019, and then decline until 2028.  Is there a more efficient process for educating and training health care providers?  Education is a social determinant of health. Legal—as information technology expands, data sharing and privacy problems expand.  Are health insurers too big to fail?  What makes us think that the health insurers are any smarter than bankers?  Other—Google already has all the prices/costs of health care services around the nation.  What happens when the information goes public?  Which health care services will always remain local?  Which will remain regional?  What does that mean for NH&C?  Anderson asked Board members to ponder these issues and bring questions and comments to the next Board meeting. 

5. Community Relations—Steve O’Neill.  The Board had budgeted $70,000 for community health grants in 2017.  The committee reviewed past grants and will bring grant recommendations to the March Board meeting.  A proposal to fund community health screenings will be delayed until after the Rice County Community Health Survey results are known.  The committee will work on a plan to connect NH&C to the new state legislators in the service area.


Consent Agenda

The consent agenda was passed.  Items on the agenda included:  Minutes for the January Board meeting and Minutes for a Governance and Planning Committee meeting.


Presentations/Discussions/Action Items

1.  Branding and Signage Update—Julie Nikolai-Sullivan.  Nikolai-Sullivan reviewed the work of the past 2 years and displayed the changes in branding.   The branding focus was shifted from talking about the hospital or clinic to relating to a potential patient.  A proposal was presented to approve $288,000 for new and improved signage in the NH&C system.  The item was in the 2016 capital budget.  The motion was approved.

2. Nursing Patient Care Update—Tammy Hayes.  Hayes described the Patient Advocate Plan implemented in 2014 and the Include Always plan.  The plans have resulted in several important changes in hospital procedures and have improved patient satisfaction measures.  US News and World Report recognized the long-term care facility at the hospital as one of their “Best Nursing Homes in MN.”

3. Clinic Improvement Plan—Kathleen Meier.  Meier reviewed the results of a consultant’s study.  One recommendation was to remodel part of the current clinic space to make it more efficient.  Also, the clinic patient satisfaction survey was dramatically shortened, put on-line, and emailed to patients within days of their service.  The result has been at least a 4-fold increase in the response rate.  The growing volume of patient visits to the clinics is an indication that the clinics are getting it right. 

4. Election of Board Officers—Charlie Mandile.  The slate of officers nominated at the January meeting was approved.  Charlie Mandile is Board Chair; Virginia Kaczmarek is Vice Chair, and Charlie Kyte is Secretary Treasurer.     

5.  A Board member requested the administration to prepare a one-page “elevator speech” for Board members that would promote the NH&Cs.  

The meeting adjourned at 9:30 p.m.

Next meeting:  March 30, 2017

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