Northfield Hospital Board Meeting: March 2019

Opening

  1. Steve O’Neill called the meeting to order at 6:30 p.m. The Agenda was approved.Bob Shepley was welcomed to the Board.

One item was removed from the Consent Agenda, for correction, and then the Consent Agenda was passed.   The Agenda included Minutes for the following meetings: February Board Meeting, Governance and Planning, Budget and Finance, and Community Relations. Also included were a revision to the Governance & Planning Job Description, revision to Board Approval Policies, and the Health Awards Recommendation for 2019.

The Health Awards Recommendations for 2019 were:

HealthFinders                                                            $20,000

Northfield Healthy Community Initiative               $15,000

Northfield Community Action Center                     $11,000

Northfield Promise                                                      $10,000

Northfield Area United Way                                      $  4,000

Northfield Area Family Y                                          $  3,000

Laura Baker Services Association                            $  2,000

Infants Remembered in Silence                                $  2,000

Hope Center                                                                  $  1,500

Age Friendly Northfield                                            $  1,500

Ruth’s House                                                                 $  1,000

Area Food Shelves (3 @ $750 each)                           $  2,250

Some Board members recused themselves from the vote due to connections with Grantees.

 

Reports

  1. Hospital Chief of Staff—Dr. Tom Holt. Holt provided the Board with a detailed description of the credentialing process for Medical Staff Membership. The Credentialing Office at NH&C handles the background checks and routine inquires. Re-credentialing is required after 2 years.  Physician Assistants (PAs) and Nurse Practitioners (NPs) must also go through the credentialing process.
  2. NH&C Report—Dr. Ben Flannery.Flannery reported that work is proceeding on the clinic expansion project.
  3. City Report—Brad Ness.Plans are being finalized for the 3rdSt. project, including a “no whistle” train crossing.  A listening session of Accessory Dwelling Units (ADUs) was held on Wed.  Some citizens were concerned that the ADU recommendations from the Planning Commission removed too many requirements.  The Mayor and City Administrator were complemented on the State of the City Report.

 

Annual Audit Report

Auditor, Rob Schile from CLA.   The report was “clean”: no significant problems were encountered with accounting policies, estimates, financial statements, and internal controls. Some enhancements to computer security were recommended.  Schile then compared financial rations for NH&C to those of a group of MN hospitals. NH&C fit within the parameters of the other hospitals; slightly better on some and slightly worse on others. CLA’s perspective is that the political environment for health care will be challenging: gridlock in Congress, continuing legal challenges to the ACA, and pressure from the government (HHS and CMS) to make health care more efficient and less costly.  Schlie complemented the financial staff on their work, and thanked them for their cooperation.

 

Strategic Discussion

Environmental Scanning Part 2.  Steve Underdahl CEO. Underdahl continued the overview of the US health care sector in preparation for the upcoming strategic retreat.  Among the changes are: revenue sources have shifted from 60/40 inpatient/outpatient in 2007 to 50/50 in 2017; ED visits have risen by 20% for heart and respiratory issues, while mental health visits are up by 50%;  Medicare and Medicaid payments have risen from 40% of the total in 2007 to 60% in 2017; the percentage of hospitals affiliated with a system has doubled to 65% between 2000 and 2018; per-person health care spending continues to rise faster than wages and incomes; increased spending is being driven by increasing prices, not increasing utilization of services; the number of people in MN over the ages of 65 will double between now and 2045; rural areas are aging faster than urban areas; the number of old-old people (over the age of 85) will double between 2020 and 2040, meaning more complex medical issues; insurers will push to fund procedures such as dialysis and colonoscopies outside of hospitals; retail clinics such as the 1,100 Minute Clinics and 9,700 CVS clinics will be the front door of the medical system; 74% of employer-provided health insurance plans now offer Tele-Health services; the for-profit providers such as OptumCare will only provide outpatient services—physicians are a revenue source—hospitals are a cost.   Where does NH&C fit in this environment?

 

Presentations/Discussion/Action Items

  1. Approval of Ambulance Replacement—Jerry Ehn. Ehn reviewed the material presented at the February Board meeting. A motion was made to approve the purchase of a replacement of Ambulance 315 at a cost of $230,000. Motion passed.
  2. Nursing Services Update—Tammy Hayes.Hayes reviewed recent changes in nursing services for the various departments.  Medical-Surgical Dept. instituted a RN training program for Med-Surg to upgrade the skills of RNs in an attempt to deal with staffing challenges. The program has been very successful. 18 of the 22 RNs starting the program are now working in NH.  This has resulted in fewer overtime hours and a reduction in salary costs.  Home Care and Hospice has implemented a Healthcare First Billing process that saves staff time and ensures that all visits are billed.  The Emergency Dept. has adopted a Pediatric Tool Kit to reduce pediatric patient anxiety. Surgical Services is working to clear smoke from laser and electrosurgical procedures in the surgical suites.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) Strategic—the Patient Facing Technology and Social Determinants of Health projects both need some action. Progress is being made on the design of the hospital and clinic expansions.  b) Operations—the financials for Feb. were okay, and March will be better.  The staff will execute the energy saving options, identified by a consultant rather than an outside vendor. c) Policy—the State Legislature is debating making the patient privacy policy in MN more consistent with national legislation. A Board member added that rural access to broadband communication is necessary to accommodate the new healthcare technology as well as to promote local economic development.
  2. Financial Report—Scott Edin. There was a Net Operating Loss of $264,000 in February, but that was $22,000 less than budgeted. Inpatient days and ED visits were down sharply, but a higher proportion of patients had commercial insurance which pays NH&C at a higher rate than Medicare & Medicaid. The ED was busy setting broken bones due to icy sidewalks and streets.  Day’s Cash on Hand was down slightly.
  3. Quality Committee—Charlie Mandile.The committee held an orientation session for its new members.

 

Roundtable

The Board raised a question concerning the “2-times to the Board” purchasing policy, as was followed with the ambulance approval above.  Board members felt that most of the time they were prepared to vote on the purchase after the first presentation.  Further discussion suggested that if the item was in the Capital Budget for the year, a single presentation should suffice, unless serious questions were raised regarding the purchase.

 

Meeting adjourned at 9:05 p.m.

Next meeting:  April  25, 2019

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