Northfield Hospital Board Report June 2018

Headlines:

1. Groundbreaking for new senior care facility anticipated in mid July.
2. Charity Care by NH&C totaled $135,297 in 2017.
3. Revenue recapture (seizing tax refunds) totaled $717,895 for 2017.
4. Supply chain remodeling cost estimated at $392,000.

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 May Board Meeting, Minutes for a Community Relations Committee Meeting,  Minutes for a Special Budget and Finance Committee Meeting, Minutes for a Special Governance and Planning Committee Meeting, Entrance and Parking Easement, Government Data Practices Act Policy, Compliance and Ethics Program Policy, Temporary Privileges Policy, Disaster Privileging Policy.

Reports

1. Hospital Chief of Staff—Randy Reister. No report.  The applications for Medical Staff Membership/Privileges were presented to the Board.  The Board approved the applications.

 Presentations/Discussions/Action Items

1. Supply Chain Remodel—First Look—Scott Edin. The hospital is implementing a 2-bin supply system that will reduce the inventory held in departments, and store inventory remotely in a central location.The system has been implemented in the ER Department and Obstetrics, but space limitations have constrained implementation in the Operating Room.  The proposal is to move all inventory into the basement of the new Endoscopy Center, which will require enclosing a loading dock and constructing a caged storage area.  The estimated cost is $392,000.  Extensive discussion followed regarding the cost of the project, possible savings, and the sense that the proposed project is a “third best” option that leaves many problems unsolved.  The administration was urged to rethink the project once more, and bring a recommendation to the Board at the July meeting.
2. Compliance 101—Part 2—Laura Peterson, Compliance Officer. The presentation continued Board education on their responsibilities to oversee the fiscal practices of the hospital with regard to Medicare and Medicaid. Violations are violations regardless of the intent of the Board and prosecution may be both criminal and civil. Peterson identified several areas of high risk.  The Board was asked to consider how the institution and the Board are structured to oversee compliance issues, the Code of Conduct, the reporting system, and internal controls.  Peterson said that in her judgment, the Compliance Officer had the authority, autonomy, and resources to conduct a robust compliance program.  It was noted that the Compliance Officer reports directly to the Board rather than the CEO.  The roles of Legal Counsel and Compliance Officer are combined at NH&C (Laura Peterson), which could create a conflict of interest, but outside legal counsel is retained whenever a compliance complaint is received.

Executive and Committee Reports

1. CEO Report—Steve Underdahl. a) work and progress continues on a wide variety of projects.  There are data transmission problems to Caravan with the Accountable Care Organization; the rules governing the appointment of Board members to the Foundation will be revised; a new strategy for market surveys is being explored; a new productivity-benchmarking program is being implemented.  b) Price transparency was the primary topic at a recent American Hospital Association regional meeting.  Health care providers in MN appear to be much further advanced with this trend, due to the high percentage of high-deductible insurance polices in the state.  When they have the chance, patients are price shopping for health care in MN. Underdahl reported that in his experience, “People aren’t much interested in the actual cost of health care; they care about what the health care costs them.”  c) Underdahl interpreted the appointment of Atul Gawande to be CEO of the new Amazon-driven health care coalition to portend major changes/disruptions in the delivery of health care.
2. Financial Report—Scott Edin. May was a good month. Net Operating Revenues for March were $337K over budget, and Deductions were under budget. The result was a Net Operating Income of $230K.  Income from operations is above budget for the year thus far, but June has been a slow month.
3. Annual Report of MN Attorney General’s Agreement on Hospitals & Debt Collections—Scott Edin. The Board reviewed their compliance with the agreement between the MN AG and hospitals in MN regarding the prices charged uninsured patients, charity care, and collection practices. The hospital judged itself to be in compliance with the agreement. NH&C sent 78 accounts/18 patients to its outside collection agency in 2017, resulting in $57,697 collected. Prior collection actions executed in 2017 resulted in $67,201 of wages garnished by the collection agency.  Internally, NH&C collected $717,895 from revenue recapture (seizing tax refunds); and $348,701 from collection actions, for an average collection ratio of 1/3.  (It was noted that patients do not like it when their tax refunds are seized.)  The hospital’s procedure is to first attempt to assist patients in finding payment sources and to work with patients on a payment schedule before sending the accounts to collection. The CFO and CEO review all accounts sent to collection. No complaints were received by NH&C in 2017 against the collection agencies.  Charity Care in 2017 totaled $135,297.
4. Quality Committee—Charlie Mandile. The Committee is continuing to study opioid prescribing practices.
5. Governance and Planning Committee—Charlie Mandile. Work on a CEO evaluation policy is almost complete. The policy follows the process used in 2017 that seeks input from all groups affected by the hospital.  The policy won’t specify the use of an outside consultant, as has been done in recent years, but will recommend the practice.  The outside consultant adds credibility to the survey results and provides a wider window on the CEO market in MN.  The Committee will bring the policy proposal to the Board in July for a vote.

Roundtable

The Senior Services building project will likely break ground in mid July.  The City Council approved the last required agreement earlier in the month.  A ground- breaking ceremony will be announced.

Meeting adjourned at 9:10 p.m.

Next meeting:  July 26, 2018