Northfield Hospital Board Report: April 2018

Opening

1. Chair, Charlie Mandile, called the meeting to order at 6:35 p.m. The Agenda was approved.

The Consent Agenda was approved.  The Consent Agenda included Minutes for the March Board Meeting, Minutes for a Budget & Finance Committee Meeting, Minutes for a Quality Committee Meeting, Minutes for a Governance and Planning Committee Meeting, and Credentialing Policies.

Reports

1. Hospital Chief of Staff—Randy Reister. Reister presented the applications for Medical Staff Membership/Privileges. The Board approved the applications.
2. Chief Medical Officer—Jeff Meland. Meland reported that a Data Manager has been hired to improve documentation. The project was started with the physicians in the Emergency Department and will expand to other physicians. The Clinical Executive Committee is reviewing strategies to grow the practices.

Big Question

Environmental Scan—Matt Anderson, VP, Minnesota Hospital Association.  Anderson presented the MHA’s Health Care Policy Trends and Forecasts to the Board in preparation for their May retreat.  Political gridlock continues to plague both Washington DC and St. Paul, which makes forecasting difficult.  But gridlock doesn’t preserve the status quo: the problems continue to get worse as the population ages, the Medicare Trust Fund shrinks, etc.  The good news is that funding for CHIP was extended for 10 years and the Medicare Low-Volume Adjustment was extended for 5 years.  CHIP covers 4000 children in MN, and the Medicare adjustment provides approximately $1 million per year to NH&C.  Outpatient hip and knee replacement is growing.  The MN legislature will address the opioid crisis, but the branches of gov’t. are arguing about how to fund it.  Mental health will likely receive more funding at the state level.  There will be legislation in MN to protect vulnerable adults.  State demographics indicate a rising number of elderly patients and a shrinking workforce.  Private health insurance is changing: 95% of privately insured patients in MN now have a high-deductible ($1500 or more) plan.  Studies show that primary care utilization declines 18% with high-deductible plans. Consolidation of health care providers continues, and HMO’s in MN can now be for-profit.

Presentations/Discussions/Action Items

1. City of Northfield Orientation & Strategic Plan/Work Plan—Ben Martig, City Admin. Martig reviewed the documents that govern the city-hospital relationship, i.e., the City Charter and City Codes, and the City’s Comprehensive Plan as it applies to the current site of the hospital. Mayor Pownell then discussed the City’s Vision Statement, Mission Statement, and Strategic Plan for 2018-2020.  Pownell stressed that a successful relationship between the City and the Hospital Board requires the parties to work together.
2. Compliance 101—Laura Peterson. The Office of Inspector General, USDH&HS, investigates fraud and mistakes in Medicare claims filed by health providers. The estimate is that the loss due to fraud and mistakes is about $60 billion per year. Peterson reviewed the Hospital Board’s obligation to monitor the activities of NH&C.  The duties of the Board members are to act in good faith, be loyal to the institution, and to care by reviewing the performance of the CEO, the institution’s finances and policies, and to ensure an effective compliance plan.  Directors may be held individually responsible for violations by the institution.
3. City/Hospital Governance Committee—Mayor Rhonda Pownell and Board Chair Charlie Mandile.Pownell and Mandile jointly recommended the creation of a City& Hospital Governance Committee to propose models and practices that would foster a stronger working relationship between the two entities. The committee would consist of 3 NH&C Board members including the Chair; 3 City Council members including the Mayor; plus the City Administrator and the CEO of NH&C as ex-officio members.  The Mayor would recommend the members for confirmation by the City Council.  The committee would meet monthly and submit recommendations within 6 months.  Board members expressed their support for the goals of the project, but raised two major concerns. First, the charge to the committee seemed one sided: the City was going to educate the Board on their responsibilities to the City, without the Council considering the powers and independence granted the Hospital by the City Charter.  Two, the appointment process appeared to be controlled by the Mayor and City Council.  Mayor Pownell explained that nomination and Council approval is the City’s standard procedure for creating committees.  Extensive debate followed.  The proposal was sent back to the committee for amending, in the hope that the differences between the parties could be resolved. The proposal will come back for a vote at the May Board meeting.

Executive and Committee Reports

1. CEO Report—Steve Underdahl. a) discussions are continuing on the electronic health records problem. b) The ACO held its first Board meeting. c) the Northfield Express Care Clinic is up and running.  A second staff person has been hired for the clinic.  d) The MHA and 3M have created new analytical software for use by hospitals.  e) The project to “rebase” (reduce) expenses is having a beneficial effect. f) NH&C was recertified as a Level IV trauma center.  CEO Underdahl expressed kudos to the Emergency Dept. and the Quality Data Dept. for their work.  g) It is rumored that Walmart is seeking to add Humana, an insurer, to the pharmacies and clinics it already owns.  h) United Health Care earned $2.84 billion in profits for Q1 of 2018.

2.Financial Report—Scott Edin.  Net Operating Revenues for March were $192K under budget, but Deductions, Bad Debt, and Operating Expenses were also under budget. The result was a Net Operating Income of $292K.  Net Income was still negative for Q1 of 2018.  The hospital’s ability to seize tax refunds dramatically reduced bad debts in March and April.

3. Governance and Planning Committee Report—Charlie Mandile. The annual review of the CEO will take place in a closed session immediately following this meeting.
4. Quality Dashboard—Charlie Mandile.The Quality Committee continues to refine the quality data that Board members should see monthly.  Their latest ideas can be seen in the Information Packet sent to Board members.  Charlie expressed the desire to have more time at a future meeting to discuss these results, but there was not sufficient time tonight.  Charlie asked Board members to email their suggestions to him.

Roundtable

Board Retreat in May.

Meeting adjourned at 9:17 p.m.    Closed Session began.

Next meeting:  May 31, 2018