From David Emery
The April Board Meeting was a Webex Virtual meeting arranged by the hospitals IT staff. The Board Chair, Sarah Carlsen, called the meeting to order at 5:00 p.m.
Opening & Reports
An extensive consent agenda was passed. Items included:
1. Minutes for the March Board meeting.
2. Minutes for following committee meetings: Quality Board, Budget and Finance, and Governance and Planning.
3. Antibiotic Stewardship Policy
4. Revision to Medical Staff Manual: Chapter 4, section 2.5
5. Appointment of Infection Preventionist & Infection Prevention and Control Plan Policy.
Hospital Chief of Staff Report—Ben Flannery, MD. A question was raised about the availability of albuterol. Flannery reported that he was not aware of a local problem, especially now that the flu season is over. The Medical Staff files were approved as presented.
Discussion/Action Items
1. Mental Health Approaches—Sandy Mulford, Consultant. By default, NH&C receives and holds patients with mental health problem since there aren’t appropriate alternatives available. NH&C assembled a work group to identify the needs of these nontraditional patients. Several sources of care were considered including online options, outside consultants, and more mental health training for existing hospital staff. Consulting arrangements are being made with a local mental health provider and with a regional mental health provider.
Executive and Committee Reports
1. CEO Report—Steve Underdahl. CFO Scott Edin passed away. Funeral and remembrance will be held on April 29, in Amery WI. Eric Guth is serving as Interim CFO. a) Strategic: Hospital providers and nursing homes nationwide are facing major financial challenges and it is only going to get worse. Expenses are increasing faster than revenues. Locally, the PERA (Public Employees Retirement Association) has a substantial deficit that will add to the stress. Providers such as NH&C must quickly develop a survival strategy focusing on needs versus wants. b) Operations: Both staffing and finances continue to be stressed. The auditor (Clifton, Larson Allen) is performing service line analysis to help determine the contributions of the major service lines offered by NH&C. c) Policy: it appears that a bill limiting the right of municipal hospitals to claim state tax refunds to cover unpaid accounts will pass. This will reduce annual revenues at NH&C by about $1M, further adding to financial problems.
2. CFO Report—Eric Guth, Interim CFO. The Net Operating Loss for March was $1.7 million. In addition, unrealized investment losses on the portfolio were $1.1 million. Net Income from Operations for Q1 of 2023 was -$4.9 million. An argument was made that the government needs to update its’ payment plans (primarily Medicare and Medicaid or M&M). At the origin of the plans in the mid 1960s, public payers, such as M&M, accounted for about 30% of total hospital payments. So if M&M paid at cost of service or below, hospitals could make up the difference from private payers such as Blue Cross/Blue Shield providing the other 70% of payments. Currently, government payers account for 54% of revenue at NH&C. As private health insurers consolidate and grow they gain negotiating power vis-à-vis hospitals such as NH&C and their payments no longer cover the cost gap. The federal government needs to realign their payment structures.
The meeting was officially paused while the non Board members exited the website, and then the Board went into a closed session.
Announcements
Next meeting: May 25, 2023
