All hospital executives present. All Board members present except Michael Hemeseth and Rod Christiansen.
Consent Agenda: Bd minutes, Budget and Finance minutes, governance and planning minutes. Passed.
Reports
Chief of Staff report. Jennifer Fischer. Credentials committee: files all fine. How’s the employee attitude with the merger? Really good. A lot of work and angst, but merger is perceived as a great move for health care in NFLD. Thanks to Jennifer Fischer for all her work.
Financial Performance Strategic Priorities Updates/Presentation. Eric Guth
Clinical documentation improvement: Goal is same care, better reimbursement. Changes implemented last fall. Positive financial results.
Surgical service documentation changes: used to be straight time-based. Moved to resources used/provider time. Time based-charges on anesthesia. Working to achieve accurate level of care in ED to ensure correct charges. This is all about refining coding practices so hospital gets paid accurately. Comments: changes have been good—resulted in more accurate billing. Will continue to improve as team gets more used to documentation tools. Important to the medical team because they want to be productive for the hospital, want to see their work appropriately recognized. Question: what really is the change? Different notation? Answer: Previously different parts of care documented in different places, so code team did not necessarily see/find everything. Also want to make sure the chart narrative is captured, along with everything else that is documented. This results in coding higher levels of care, to match what is actually provided. Reimbursements are higher when coding is accurate.
Revenue cycle initiatives: Consistently collecting copays and prior balances at most locations. Working toward consistent message, polite and respectful, to patients. Updating text message language, etc. about copays. Make sure messaging is always the same. Means not collecting on the back end, which saves money.
Having data also helps. Can see in report how collections are increasing, can tie to specific day and the individual doing collections—helps maintain and sustain momentum on this. What about with rollout at new clinic? Ready to go. Credit card machines ready to use.
Separated revenue cycle into patient access and back end, which allows for better streamlining and helping front end patient experience.
Denials: previously had no data. Now have data on every denial—why, dollar amount, etc. Allows work groups to dig in and figure out why: payor behavior? Provider behavior? Now 1 in 5 is denied but trying to track avoidable denials and get it down to 15%. Question: Is 15-20% denied, then resubmitted? Yes, then usually collect on everything but 1-2% but that takes a lot of work—why not approved the first time? Often payor specific things. If we get it set up right the first time,we avoid those denials.
Unbilled receivables an issue being addressed: Coding lag time—how quickly sent to insurance. Had ballooned up bcz of staffing issues, PTO. But now under 10 days, which is where we want to be for prompt collections. It’s taken almost 2 years to get to that. Have hired some coders and other staff to help with this. Questions: Does denial rate stay the same as coders get better? Yes. But now have 1-2 people working denials so they can see patterns, etc. and develop knowledge. What portion are denied only because of delay? Bcz public believe this is part of profit loop for insurance co? Of denials, how many cases did nothing change on our end? Not sure. Data and trend spotting will help with this. There are hundreds and thousand of “reason codes” for denials from insurers. What’s hidden is whether insurance actually “needs more info” or is denial just because a box just wasn’t checked. This is a public policy problem that the hospital perhaps has a stake in speaking to. It’s also wasted time for ins co.
Accounts receivable: Continued improvements in staff delineation, as with coding. Claims team, denials team. Vendor chosen for outsourcing low $, high volume accounts. Let a vendor work the under $250 claims for small fee. Hospital is down 3.5 million for accounts receivable. When went live with expansion, saw an AR spike. Change healthcare big spike. But trend is way down on AR by month. Questions: What’s past 10 year look like? Similar, a little lower. But things have changed in healthcare payment. E.g. can only get turnaround on Medicare in certain number of days. Will patients experience anything different with outside vendor? No. Not like a collections company. Patients won’t notice. When get a first denial, does patient get a bill? No. Bill goes out after insurance workflow is finished. Sometimes ins reprocesses claim way later, after it’s been settled, then something like that happens.
Cash acceleration: All this feeds into this metric. Work that feeds into quicker payment for visit. Record amount of cash collected in July measured by payments divided by net revenue. Over 100% for past 4, 5 months. So good cash acceleration at this point.
How do we foresee AR moving when Jan 2027 Medicaid cuts go into effect? Will be a lag. Will either be classified as charity care or bad debt process. Will probably see increase in self-pay at first, but then increase in bad debt. Financial assistance application takes time. Maybe see that effect starting in June 2027. Hospital does not have a high percentage of Medicaid—10%.
Space planning process: facilities mapping happening in all spaces. Have some immediate needs re new hires. Some longer-term priorities. Action plan is to solve some issues for new staff with minimal capital investment. Identifying needs through end of year. Broader facility planning also happening.
CEO Report
Katie and Zander were at MHA meeting. Katie asked to be on MHA trustee council, which plans events, educational pieces, etc. Classes are available to board members.
Tina Smith visited hospital on Tuesday, on short notice. Birth center a particular focus. Hosp has asked federal gov for $2 million to update/expand birth center. That money is separate from rural health transformation dollars. Smith would like to get this completed before she leaves office. Did Smith have any interesting questions/ comments? She was impressed. She had good questions. Amazed at increase in birth volumes here. Staff very engaged. Smith’s team made good social posts about it.
Strategic priorities updates: financial performance on track (see above). Engaged workforce: on track. Survey is live now. Good responses. 60% of staff responded. Goal is 70%. Service Line Growth: At risk. Surgical volume is 12% behind budget. Still working on this. As we push to grow volumes, we are being responsible with resources. Flexing ORs, reassigning staff to other departments on particular days if needed. Hiring also impacts this, e.g. new ENT and GI docs. Hoping we will make up and hit our goal. Will gradually ramp ORs back up as we have more providers. Quality and safety: completed.Implemented CMS program.
Jefferson Rd clinic: on track. Tomorrow is last Allina pt day. We start up September 18. We are in the final stretches of low level detail to make sure transition goes smoothly. During bridge, won’t be able to replace Allina’s 500 patients a day with just our few providers. Making plans for that. So with the three weeks out, what happened to existing patient appointments? Had been blocked, but pts also directed to other providers for this period and being provided info about where to go, how to handle things during the bridge. Urgent care is only closed 2 days. Is schedule full for Sept 18? Providers are intentionally booked 50% that day. There is a lot of activity going on. Separate phone line for Jefferson Rd location. Lots of calls every day. Good collaboration with Allina call center leaders.
Strategic Priorities Planning: timeline and process. Happening over the next several months, moving towards November board retreat then finalizing in December.
Recruitment Priorities: Many recent hires, oncology, emergency, GI, ENT, Women’s Health. Some started in summer, some starting in fall. Women’s Health recruiting in particular. Staff in that area is down bcz of providers out for reasons. Helping that group grow. Recruiting in Orthopedic. Using a recruiting firm in addition to our organic connections. Barriers are geography—national recruiting firm. Salary model is fine. On edge of rural health care system. We try to talk up the great resources we have. Bd is encouraged to be “connectors” if they know providers who may have roots/interest here. Could also tap into the colleges connections—students with medical career aspirations, staying connected with them as they develop careers. Connect with St Olaf pre-med group leadership. What about hospitalist position/laborist? Will have 2 providers with practice focused in hospital. Several others spread across clinic and surgery. Success on birth center side has crowded out non-OB women’s health care.
Quality and Safety: CMS mock survey last week, partnered with external consultant. She spent 3 days here, saw whole system. Gave large list of opportunities for growth. Will eventually have our CMS participation.
Financial Report
July: operating loss was $395, about $226 = Allina expenses. Not bad for summer. July was busy in birth center and in patient. Outpatient also a busy month. Was some of this bcz of bad air quality? Not sure. Clinics also busy in July. Across the board except surgery everything above budget. Excluding Allina, net revenue = collected more cash than expenses. Expenses straightforward. Budget trending down over the year, but now in a good spot to make our break-even budget. Re: Allina, doing fine on budget. Nothing concerning from expense/hiring standpoint. Cash: no issues there. No questions. How does August look? Looks good. Volumes are good. Early projection looks a lot like July.
Committee Reports
Jamie Reister: Community Relations Committee met last Thursday. Got update about marketing and communications. Staff doing great things managing messaging on transition. Overview of print, digital, social media. Positive and enthusiastic tone, timely. Thanks to Betsy and Julie. Hiawathaland bus: interest in having hospital on route. Allina clinic is on route, which is good, esp with urgent care there. Conversation with Hiawathaland has started. MN DOT would not need to be in on it. Talking to other stakeholders like HealthFinders about transportation. Conversation ongoing.
Announcements/Questions? None
Break
Closed Session
