Northfield Hospital Board Report: Jan 2018

Opening

1. Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved.

The Consent Agenda was approved. The Consent Agenda included: Minutes for the December Board Meeting; Minutes for a Quality Committee meeting; Minutes for a Budget and Finance Committee meeting; LMCIT Tort Liability Waiver; and ACO policies.

The newly appointed Board members were introduced: Rhonda Pownell, Fred Rodgers, and Pete Sandberg.

Reports

Hospital Chief of Staff—Randy Reister. The hospital has been very busy due to influenza. Dr. Reister recommended that if you have the flu, seeking medical attention within the first 48 hours may be beneficial. However, after 48 hours, he recommended that people just stay home. Don’t put patients and staff at the hospital at risk. The applications for Medical Staff Membership/Privileges were approved.

1. Chief Medical Officer—Jeff Meland. The members of the Medical Executive Committee are very interested in the actions of the Board and would appreciate more interaction with the Board. It was suggested that the MDs be invited to Board meetings and other Board events. It was also suggested that the RNs might be interested. A quote from a recent meeting of the MN Hospital Assoc. was, “Your doctors are the customers of the hospital.” It is critical for NH&C to attract and retain MDs. Meland observed that, “Physician staffing is fragile.”
2. Allina Clinic Report—Dr. Keith Olson. Allina staff recently met with NH&C staff to discuss issues such as readmissions and advanced care planning.
3. NH&C Clinic Report—Dr. Ben Flannery. The clinics have hired a new pediatrician, even though they don’t have an office for her. The Clinics are launching a “baby box” program to reduce infant mortality. The program originated in Finland which distributes a “box” to every new born along with an educational program for the parents.
4. City Report—Brad Ness. The Council is working on the lease agreement for the proposed Senior Services Project, and considering future plans for the land around the hospital. The Age Friendly Survey results for Northfield are on line.

Big Questions

1. Board Retreat Summary—Heather Durenberger(consultant). Durenberger reviewed the Board Governance Retreat held in Dec., focusing on how to make a board more effective. The keys are the people, the culture, the decision-making processes, and the structure and the information processes. A discussion followed that ranged through the various topics, and a wide variety of suggestions was offered. The entire governing process was open to review. The discussion and process will continue, and the topic will be reviewed annually.

Presentations/Discussions/Action Items

1. EHR update/discussion—Scott Edin/Steve Underdahl. Scott reviewed the lengthy process thus far and the options still being considered. The costs for an electronic health records system are very high: $20 – $30 million over 10 years, depending upon the option chosen, since changing the record’s software changes everything: billing, tracking, communicating, labs, data mining, etc. Each of the options presents different problems and has different strengths. Given the pace of change in technology there is a worry that NH&C will commit for $30 million and 10 years, only to have the technology completely change in 5 years. Board members had many questions, trying to get at the incremental costs vis-à-vis the current EHR system. Scott gave an estimate of $1.5 million per year. The projected surplus in the recently approved budget for 2018, is about half of the $1.5 million, raising the question, are any of the options affordable? Board members raised many questions, and asked that a document presented at a retreat be re-circulated. The administration was asked to prepare an online folder of documents relating to the EHR project. Work continues on the technical, legal, financial, and institutional questions. Doing nothing at this time might be an option.
2. Senior Services Project Update—Jerry Ehn. Jerry reviewed the process leading to the current project design: 70 independent/assisted living units, 24 memory care units, all featuring aging in place. The developer for the project is Yanik, and staffing to be provided by the Benedictine Health System. NH&C is simply a facilitator for this project; it is not investing in the project and it will not operate the new facility. New Board members raised questions about the financial aspects of the project, “How does this benefit NH&C?” A short answer was that the project expands senior services in the area, allows NH&C to better meet future community health needs, and may reduce the subsidy that NH&C provides to the current long term care facility. The City Council is schedule to vote on the Development Agreement in February; NH&C is negotiating a shared services agreement with Yanik; Yanik and the Benedictine Health Services are finalizing their agreement. If all goes as planned, construction could start in June 2018.

Executive and Committee Reports

1. CEO Report—Steve Underdahl. a) A Patient and Family Advisory Council (PFAC) has been established for the newly form Accountable Care Organization (ACO). b) Involuntary staffing turnover was 14.8% in 2017, consistent with the industry average. c) There are currently 35 RNs on the RN Clinical Ladder; 29 have achieved RN 2 and 6 have achieved RN 3. d) The clinic in Northfield is out of space. e) NH&C is trying to grow its opioid addiction services. f) Interviewing continues for hospitalist MDs. g) The PERA (retirement program) problems added $3.4 million to operating costs in 2017. h) The recent renewal of the CHIP program is good news since there are 127,000 kids on the program in MN. i) Sadly, the service levels observed in 2017 are likely to be the “new normal” for NH&C. This means that expenses must be reduced going forward, and the administration is seeking a reduction of $2.5 million for 2018.
2. Financial Report—Scott Edin. Business was good in December, but not as good as in 2016 and earlier (the old “normal”). Gross revenue was under budget, deductions/discounts were under budget, bad debt was over budget, expenses were over budget, employee-benefits from the self-insured health insurance program were over budget. Net Operating Income was $528,000 under budget at $2.165 million for FY 2017, without including the $3.4 million non-cash PERA expense. When PERA is included, Net Operating Income becomes negative for 2017. Unfortunately, according to Scott, the post PERA figures are the official numbers and are what will be appearing in the news. This makes NH&C look like it is in a weak financial position and could affect bond ratings and physician recruitment. Publicly owned hospitals in MN are hoping for a PERA fix in the forthcoming legislative session.
3. Budget and Finance Committee—Charlie Kyte. A questionnaire was sent to all Board members and the results will be used to establish a “risk tolerance level” for the investment portfolio and an investment strategy when Cleary Gull Advisors come to the February Board meeting. .
4. Quality Dashboard—Charlie Mandile. Board members were asked to review the Dashboard reports included in the packet.

Roundtable

Several Board members shared their “take aways” from a recent MN Hospital Assoc. retreat. One report was a recommendation to change the wording of the Board motion used to approve physician privileges at the hospital. The intent is to make it clear that a board of physicians, not the Hospital Board, reviewed the requests and recommended granting of privileges.

A motion was passed, thanking retiring Board members, Virginia Kaczmarek and Patricia Christianson for their services.

Meeting adjourned at 10:10 p.m.

Next meeting: February 22, 2018