Northfield Hospital Board Meeting: December 2021

The December Board Meeting was a Webex Virtual meeting arranged by the hospitals IT staff.  The Board Chair, Fred Rogers, called the meeting to order at 5:05 p.m. 

Opening & Reports    

1.  The Consent Agenda was approved.  Items on the Consent Agenda included: a) Minutes for the Nov. Board Meeting; Minutes for a Community Relations Committee Meeting; and b) approval of Northfield Community Services Recreation Program Agreement.  The Agreement specifies that NH&C will pay the City $126,032 in Dec. 2021, and again in May and Nov. of 2022 to fund the Rec Program.       

2. Chief of Staff Report:  Dr. Monty Seper.  Applications for Medical Staff privileges and membership were approved.  

3.  In response to a request, Dr. Seper and Dr. Meland described recent COVID experiences in NH: the volume in huge; it is very difficult to move patients to higher level care hospitals; there are no ICU beds available; patients end up spending long periods in the ER or being discharged early; there are no beds for emergency patients; 

“The public needs to know . . . “that conditions at the hospital are difficult. 

Presentation/Discussion/Action Items

1. Long Term Care Quality Update: Tammy Hayes.  The Quality Assessment and Assurance Committee meets quarterly and reports to the Hospital Board.  The Committee, composed of staff from a variety of departments, reviews the extensive quality data collected for Medicare and Medicaid.  The facility seeks to achieve a 5-star rating in the various categories, and achieves it in many categories.  The challenges are ongoing.    

2. NH&C 2026 Visioning: A Single Payer Future?  Kip Sullivan, Health Care For All MN.  Sullivan expressed concern over the future of small hospitals.  On the demand side, affordability of care is diminishing due to increasingly large deductibles.  On the supply side, industry-broad consolidation is occurring—in both providers and insurers.  Bigger insurers can demand larger discounts from providers; so providers must get bigger to counteract the demands.  Where does that leave NH&C?   

Sullivan traced the current situation to a misdiagnosis of the problem in the 1960s: the rising cost of health care was attributed to overuse of health care services rather than rising prices for services. In spite of sparse evidence, in the inflationary environment of the late 1960s, the blame was placed on “greedy docs” and fee-for-service pricing. The proposed solution was the HMO Act in 1973 incentivizing the creation of Health Maintenance Organizations incorporating capitation, risk sharing, and utilization review. The HMOs bargained with providers for larger discounts while enrolling a healthier population.  Traditional health insurers responded by adopting the same strategies.  As the negotiation strength of the payers increased, the providers also found strength in size, and mergers among providers increased.  Faced with increased payer scrutiny of the services they provided, the providers responded with increased rules, increased record requirements, “up-coding”, and increased administrative personnel.  The result has been an explosion of administrative costs in the health care sector and rising national expenditures.  Recent federal efforts to slow the rising costs by promoting patient  “shopping” for health care are likely to be frustrated by the lack of transparency in health care prices, the fact that insured patients are spending “other people’s money”, and that only about 10% of total health care dollars are spent on “shopable” items.  

The Single Payer Bills that have been introduced in Congress feature one payer who will negotiate health care budgets (not prices) with providers; establish uniform fee schedules for MDs, and negotiate drug prices.  Administrative costs, alone, in health care, are projected to decline from 34% to about 18%: a huge saving.   

Executive and Committee Reports

1. CEO Report—Steve Underdahl.  a) COVID: COVID cases in the hospital are at a record level. The staff is stressed. The monoclonal antibodies treatment program is up and running.  NH&C has added an online hospitalist consulting staff, and it has already proven useful.  The clinic in Kenyon continues to go well.  The Northfield Urgent Care Clinic will open at its new location in Feb. c) Operations: volume continues strong.  COVID expenses are growing.  “Thank you” payments were made to staff in Nov. “People are tired.” Especially tiring to staff is dealing with abusive COVID deniers who are now hospitalized with COVID.   

2. Financial Report—Scott Edin.  Patient volume continues surpass earlier estimates for inpatient, outpatient, and clinic visits.  Net Revenue for Nov. was $289,000 over the forecast.  Investment results have turned negative to the tune of $745k for Nov.  Year-to –date, Operating Income is $199k, including COVID related grant income.    

Announcements

The Board thanked Jessica Petersen White and Dr. Robert Shepley for their service.  Their terms expire Dec. 31.  

Next meeting:  Jan.  27, 2022 

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