Past Events

Census 2020: Crucial and Controversial

Please join us at our upcoming Democratic Practices Action Group’s next event, an education presentation at Northfield High School auditorium on Monday April 16th at 7pm. This event is co-sponsored by the City of Northfield and the Northfield High School and will feature Susan Brower, MN State Demographer (and alum of St. Olaf Social Work program) and Marcia Avner (former Policy Director for the MN Council of Non-Profits for 18 years) and consultant and advocate for the US Census. Join us to learn about the relevance, the process, and the challenges with the upcoming census.

Please email us at president@lwvnorthfieldmn.org if you have any questions.

Census2020_Letterhead (1) (1)

Northfield Hospital Board Meeting Report

Opening

  1. Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved.

The Consent Agenda was approved. The Consent Agenda included Minutes for the February Board Meeting, Minutes for a Budget & Finance Committee Meeting, and a revision of the Communicating Outcomes to Patient Policy.

 

Reports

  1. Hospital Chief of Staff—Reister/Meland. Meland thanked Charlie Mandile for his presentation at a recent Medical Executive Committee meeting. The physicians appreciated the opportunity to connect to the Board. A motion to approve the applications for Medical Staff Membership was passed.
  2. Chief Medical Officer—Jeff Meland. See above.
  3. NH&C—Ben Flannery. Clinic personnel are assisting with the process of staffing the Express Care clinic to facilitate cooperation between the two groups.
  4. City Report—Ness/Pownell. Mayor Pownell thanked the NH&C staff who attended the recent State of the City presentation.

 

Audit Report

Rob Schile—CliftonLarsonAllen. Schile reported that the audit went well. The opinion was unqualified; there were no audit adjustments or issues. Schile complemented the financial staff at NH&C for the quality of their work. NH&C appears to be in solid financial shape. Schile then discussed issues for the health care sector of the economy. Revenue growth is slowing for health care providers due to pricing pressures by insurers, high deductible private sector insurance polices, and an increasing number of patients on Medicare. Expenses are rising due primarily to labor costs, drug costs, and electronic health record costs. These costs will continue to rise and providers need to “rebase” their cost structures. Moody’s recently down graded the outlook for this sector of the economy to “negative.” The pace of change in the sector is accelerating and Alex Azar, Secretary for HHS, will push payment reform and cost controls. The industry is moving toward “value based” payments rather than fee-for-service. Successful strategies from the past may not work in this new environment. Change will be a challenge.

 

Big Questions

  1. Enterprise Risk Management—Bill Bojan, CliftonLarsonAllen. “Enterprise Risk Management (ERM) in healthcare promotes a comprehensive framework for making risk management decisions which maximize value protection and creation by managing risk and uncertainty and their connections to total value.” ERM requires the coordination of management, the Board, and risk monitors and a paradigm shift in the organization so all decision makers include risk factors in their decision processes. Bojan will continue to work with management at NH&C to instill ERM in thought processes.

 

Presentations/Discussions/Action Items

  1. 3-D Breast Tomosynthesis Mammogaphy—Vicki Stevens. (Second presentation) 3-D mammography is becoming the standard of care for screening and diagnostic exams. Replacement of the current system is in the 2018 capital budget at a cost of $425,000. A new 3-D would cost $356,000 if the purchase is made by March 31. A motion to approve the purchase passed.
  2. Relocation of Cardiac Stress Tests—Jerry Ehn. (Second presentation) Cardiac stress tests are currently co-located in an ER exam room. The proposal is provide Cardiac Stress Tests with its own room, and to add another ER office. The project is in the 2018 capital budget at $250,000. Estimated cost is $223,000. A motion to approve the project passed.
  3. Approval of Investment Policy—Charlie Kyte. The Budget and Finance Committee recommended a few changes to the Investment Policy approved at the February Board meeting. Motion passed.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) The ACO is up and running. A recent study suggests that the minimum size to survive may be much larger (50,000 – 100,000 insured) than the current ACO. b) The Electronic Health Records project with Olmstead Medical Center is moving ahead now that OMC has a new IT Director. c) The Do The Next Right Thing banquet honored Ashja, Monica, Melissa, and Laura. d) Staff are being introduced to the Process Improvement Project. e) The arrangement with a Mayo dermatology specialist is being discontinued due to costs. The dermatologist’s services will be available in Cannon Falls and Rochester. f) A re-examination of the Worker’s Compensation contract indicates that NH&C has been under-reimbursed recently and NH&C is now rebilling the program. g) The Express Care Clinic will open weekdays beginning on April 9th. A “Grand Opening” will be scheduled later when the clinic is fully staffed. h) PERA conversations continue, but no legislation will be forthcoming in this session of the MN Legislature.
  2. Financial Report—Scott Edin. Net Operating Revenue was $241,000 over budget in February, thanks in part to the “Revenue Recapture Program” which allows NH&C to seize individual tax refunds to cover past due bills. The RRP has generated about $600,000 over the past year. Net Income was negative for the month (-$155,000) but the loss was less than budgeted.
  3. Budget and Finance Committee—Charlie Kyte. The committee discussed the suggestions in the Management Letter from the auditor. A Board member asked about “best practices” regarding how many years a health care provider should use the same auditing firm. Board members suggested that it was common to use the same auditing firm for at least 6 years. There is a learning curve for an auditor with each new new nonprofit client. NH&C re-bids its auditing services every 3 years.
  4. Governance and Planning Committee—Charlie Mandile. The committee is planning to use essentially the same CEO evaluation process this year as it used last year. This would include hiring Walt Flynn as a consultant for one more year. Charlie asked for “a sense of the Board” regarding the proposed procedure with the intent to insure that the process is “transparent.” After some discussion it was decided that no motion was necessary until the committee brought a formal policy proposal to the Board at a later meeting.
  5. Quality Committee—Charlie Mandile. The committee met to organize and to discuss the agenda for the coming year. The work of the committee is made more complex by the web of regulatory restrictions, and the move to value-based payments by Medicare. “Finance is what keeps the doors open this year; quality is what will keep the doors open in the future.”

 

Roundtable

Board Retreat Preparation—Steve Underdahl and Charlie Mandile. Board members are not required to read everything in the manuals prepared for the retreat.

Meeting adjourned at 9:18 p.m.

Next meeting: April 26, 2018

Northfield Hospital Board Report Feb. 2018

Opening

  1. Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved.

The Consent Agenda was approved. The Consent Agenda included Minutes for the January Board Meeting.

 

Reports

  1. Hospital Chief of Staff—Randy Reister. A motion to approve the applications for Medical Staff Membership was passed.
  2. Chief Medical Officer—Jeff Meland. Charlie Mandile will meet with the Medical Executive Committee regarding their interest in Board actions.

 

Big Questions

  1. Investment Advisor: Representatives from Cleary Gull Advisors were present to discuss their investment services and philosophy with the Board. The discussion started with an analysis of a survey completed by Board members earlier in the year. Board members exhibited a broad range of backgrounds regarding investment experience, risk tolerance, and concerns.   Still, most Board members were comfortable with an expected return/risk level of 4 – 6% per year on the portfolio. Concerns were a) limiting risk so that the institution did not get into a financial bind and be forced to merge into a larger health care system; and b) not to invest the funds at the peak of the stock market. Backus, from CGA, explained the firm’s approach is to examine the financial assets of NH&C; the liabilities; and financial operations, and then choose a portfolio strategy on the “efficient frontier” of risks and rewards. Funds will be moved into equities (stocks) in 2 phases in 2018 up go 30% of the $55 million portfolio, planning to achieve an annual return of 4.5 to 4.9%. About 65% of the portfolio will be in bonds (fixed income) and 5% in “complementary” investments.

The Budget and Finance Committee proposed a few changes to the hospital’s Investment Policy. After much discussion, the Board decided to authorize CGA to begin investing funds immediately; to approve the Investment Policy Statement in its present form; and to bring policy changes proposed by the B&F Committee to the March Board meeting. Steve Underdahl thanked the B&F Committee for all the work they put into this project.

 

Presentations/Discussions/Action Items

  1. Northfield Clinic Space Challenges—Jerry Ehn. The Northfield Medical Clinic is out of space. Options being considered are realigning provider schedules, increasing evening hours, shifting services to other clinics in the system, and opening the Express Care Clinic. An architect was retained to identify the types of space required to meet current and future needs. Space needs were estimated to be between 8500 to 14,000 sq. ft. and costs between $4.9 and $8.9 million. The new space would be located on the North side and adjacent to of the existing hospital-based clinic. More work will be done evaluating the various options and the issue will come back to the Board in March. If space were added, the financing would likely come from existing NH&C funds.
  2. 3-D Breast Tomosynthesis Mammogaphy—Vicki Stevens. 3-D mammography is becoming the standard of care for screening and diagnostic exams. The current 2-D mammography system is 12 years old. Replacement of the current system is in the 2018 capital budget at a cost of $425,000. A new 3-D would cost $356,000 if the purchase is made by March 31. 3-D screening is reimbursed at a higher rate so the new system will pay for itself in about 2 years. Several Board members were willing to give immediate approval for the purchase, but the Chair resisted, citing Board procedures. The project will come for approval at the March meeting. Board purchasing procedures will be a topic for a later date.
  3. Relocation of Cardiac Stress Tests—Jerry Ehn. Cardiac stress tests are currently colocated in an ER exam room. The proposal is to relocate medical imaging film generated by out-of-date technology from current office space to the basement, as the film is rarely consulted. The vacated space would then be used to provide Cardiac Stress Tests with its own room, and to add another ER office. The project is in the 2018 capital budget at $250,000. Estimated cost is $223,000. The project will come for approval at the March meeting.
  4. Board Committee Assignments—Charlie Mandile. Charlie announced that he had met individually with each of the Board members to determine their interests with regard to committee assignments. The Governance and Planning Committee will now also function as an Executive Committee for the Board. The Chairs of committees will serve on the G&P Committee as will the Chair and Vice Chair of the Board. The G&P Committee will consist of Charlie Kyte, CC Linstroth, Charlie Mandile, Steve O’Neill, and Steve Underdahl.
  5. Election of Officers—Charlie Mandile. Charlie brought a recommendation for Board officers in 2018: Charlie Mandile for Chair; Steve O’Neill for Vice Chair; Charlie Kyte for Secretary-Treasurer.  The slate was approved by Board vote.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) Work began on a set of criteria for developing strategic relationships: “Do they help us do good? Do they help us succeed?” etc. The Board suggested adding another: “Do they help us do something new?” Work will continue. b) Planning is underway for the Strategic Retreat in the spring. c) Construction of the Express Care site is completed and staffing is underway. d) Work continues on the Electronic Health Records project. e) The Accountable Care Organization (ACO) is up and running. The formal kickoff has been rescheduled. f) The new risk management software is being tested. g) Work continues on finding a solution to the PERA problem—perhaps a two-tier retirement program could pass the state legislature. h) Two new hospitalists have been hired and a new OB/GYN is starting in May. i) Good news—CHIP program funding has been extended for 10 years and the Medicare Low Volume Adjustment funding has been extended for 5 years. The Medicare funding will add close to one million dollars of revenue for 2018. j) Bad news—the uninsured rate in MN rose from 4.3% in 2015 to 6.3% in 2017. Further declines are anticipated.
  2. Financial Report—Scott Edin. Business was better than expected in January, but NH&C still operated at a loss of $277,000. This was about half of the budgeted loss. Again, a larger share of patients were on Medicare and Medicaid, so the discounts were higher than budgeted: 56.9%, meaning that the hospital was paid less than 50 cents for each dollar of billed charges. The hospital is expected to about break even over the first half of 2018.
  3. Budget and Finance Committee—Charlie Kyte. The NH&C did not achieve the bonus threshold of a 3% operating margin in 2017, so there will not be a general employee bonus program this year. Bonuses for management personnel will be reduced, but a bonus pool of $242,000 was approved. Management bonuses will be based on individual performance assessments.

 

Roundtable

Meeting adjourned at 9:25 p.m.

Next meeting: March 29, 2018

Caucuses this Tuesday, February 6!

Here is the recent LWVNCF Caucus event video.

Caucuses open at 6:30pm and registration at 7pm.
GOP: Northfield High School

DFL: various sites:
Precincts Meeting at the Northfield Middle School:
Bridgewater Twp. – Room 162
Dennison City – Cafeteria
Dundas – Cafeteria
Lonsdale City – Cafeteria
Northfield Twp. – Room 171
Northfield W-1 P-2 – Auditorium (left front – facing the stage)
Northfield W-2 P-1 – Room 160
Northfield W-2 P-2 – Room 161
Northfield W-3 P-1 – Room 163
Precincts Meeting at Carleton College – Weitz Center:
Northfield W-1 P-1 – Room 236
Northfield W-4 P-1 – Room 230
Precinct Meeting at St. Olaf College – Buntrock Commons (Black Ballroom):
Northfield W-4 P-2
Precincts Meeting at the Forest Township’s Town Hall:
Erin Twp.
Forest Twp.
Shieldsville Twp.
Webster Twp. P-1
Webster Twp. P-2
Wheatland Twp.

MinnPost had a nice post on this year’s election-related events and a handy calendar here.

Northfield Hospital Board Report: Jan 2018

Opening

  1. Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved.

The Consent Agenda was approved. The Consent Agenda included: Minutes for the December Board Meeting; Minutes for a Quality Committee meeting; Minutes for a Budget and Finance Committee meeting; LMCIT Tort Liability Waiver; and ACO policies.

The newly appointed Board members were introduced: Rhonda Pownell, Fred Rodgers, and Pete Sandberg.

 

Reports

Hospital Chief of Staff—Randy Reister. The hospital has been very busy due to influenza. Dr. Reister recommended that if you have the flu, seeking medical attention within the first 48 hours may be beneficial. However, after 48 hours, he recommended that people just stay home. Don’t put patients and staff at the hospital at risk. The applications for Medical Staff Membership/Privileges were approved.

  1. Chief Medical Officer—Jeff Meland. The members of the Medical Executive Committee are very interested in the actions of the Board and would appreciate more interaction with the Board. It was suggested that the MDs be invited to Board meetings and other Board events. It was also suggested that the RNs might be interested. A quote from a recent meeting of the MN Hospital Assoc. was, “Your doctors are the customers of the hospital.” It is critical for NH&C to attract and retain MDs. Meland observed that, “Physician staffing is fragile.”
  2. Allina Clinic Report—Dr. Keith Olson. Allina staff recently met with NH&C staff to discuss issues such as readmissions and advanced care planning.
  3. NH&C Clinic Report—Dr. Ben Flannery. The clinics have hired a new pediatrician, even though they don’t have an office for her. The Clinics are launching a “baby box” program to reduce infant mortality. The program originated in Finland which distributes a “box” to every new born along with an educational program for the parents.
  4. City Report—Brad Ness. The Council is working on the lease agreement for the proposed Senior Services Project, and considering future plans for the land around the hospital. The Age Friendly Survey results for Northfield are on line.

Big Questions

  1. Board Retreat Summary—Heather Durenberger(consultant). Durenberger reviewed the Board Governance Retreat held in Dec., focusing on how to make a board more effective. The keys are the people, the culture, the decision-making processes, and the structure and the information processes. A discussion followed that ranged through the various topics, and a wide variety of suggestions was offered. The entire governing process was open to review. The discussion and process will continue, and the topic will be reviewed annually.

 

Presentations/Discussions/Action Items

  1. EHR update/discussion—Scott Edin/Steve Underdahl. Scott reviewed the lengthy process thus far and the options still being considered. The costs for an electronic health records system are very high: $20 – $30 million over 10 years, depending upon the option chosen, since changing the record’s software changes everything: billing, tracking, communicating, labs, data mining, etc. Each of the options presents different problems and has different strengths. Given the pace of change in technology there is a worry that NH&C will commit for $30 million and 10 years, only to have the technology completely change in 5 years. Board members had many questions, trying to get at the incremental costs vis-à-vis the current EHR system. Scott gave an estimate of $1.5 million per year. The projected surplus in the recently approved budget for 2018, is about half of the $1.5 million, raising the question, are any of the options affordable? Board members raised many questions, and asked that a document presented at a retreat be re-circulated. The administration was asked to prepare an online folder of documents relating to the EHR project. Work continues on the technical, legal, financial, and institutional questions. Doing nothing at this time might be an option.
  2. Senior Services Project Update—Jerry Ehn. Jerry reviewed the process leading to the current project design: 70 independent/assisted living units, 24 memory care units, all featuring aging in place. The developer for the project is Yanik, and staffing to be provided by the Benedictine Health System. NH&C is simply a facilitator for this project; it is not investing in the project and it will not operate the new facility. New Board members raised questions about the financial aspects of the project, “How does this benefit NH&C?” A short answer was that the project expands senior services in the area, allows NH&C to better meet future community health needs, and may reduce the subsidy that NH&C provides to the current long term care facility. The City Council is schedule to vote on the Development Agreement in February; NH&C is negotiating a shared services agreement with Yanik; Yanik and the Benedictine Health Services are finalizing their agreement. If all goes as planned, construction could start in June 2018.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) A Patient and Family Advisory Council (PFAC) has been established for the newly form Accountable Care Organization (ACO). b) Involuntary staffing turnover was 14.8% in 2017, consistent with the industry average. c) There are currently 35 RNs on the RN Clinical Ladder; 29 have achieved RN 2 and 6 have achieved RN 3. d) The clinic in Northfield is out of space. e) NH&C is trying to grow its opioid addiction services. f) Interviewing continues for hospitalist MDs. g) The PERA (retirement program) problems added $3.4 million to operating costs in 2017. h) The recent renewal of the CHIP program is good news since there are 127,000 kids on the program in MN. i) Sadly, the service levels observed in 2017 are likely to be the “new normal” for NH&C. This means that expenses must be reduced going forward, and the administration is seeking a reduction of $2.5 million for 2018.
  2. Financial Report—Scott Edin. Business was good in December, but not as good as in 2016 and earlier (the old “normal”). Gross revenue was under budget, deductions/discounts were under budget, bad debt was over budget, expenses were over budget, employee-benefits from the self-insured health insurance program were over budget. Net Operating Income was $528,000 under budget at $2.165 million for FY 2017, without including the $3.4 million non-cash PERA expense. When PERA is included, Net Operating Income becomes negative for 2017. Unfortunately, according to Scott, the post PERA figures are the official numbers and are what will be appearing in the news. This makes NH&C look like it is in a weak financial position and could affect bond ratings and physician recruitment. Publicly owned hospitals in MN are hoping for a PERA fix in the forthcoming legislative session.
  3. Budget and Finance Committee—Charlie Kyte. A questionnaire was sent to all Board members and the results will be used to establish a “risk tolerance level” for the investment portfolio and an investment strategy when Cleary Gull Advisors come to the February Board meeting. .
  4. Quality Dashboard—Charlie Mandile. Board members were asked to review the Dashboard reports included in the packet.

 

 

Roundtable

Several Board members shared their “take aways” from a recent MN Hospital Assoc. retreat. One report was a recommendation to change the wording of the Board motion used to approve physician privileges at the hospital. The intent is to make it clear that a board of physicians, not the Hospital Board, reviewed the requests and recommended granting of privileges.

A motion was passed, thanking retiring Board members, Virginia Kaczmarek and Patricia Christianson for their services.

Meeting adjourned at 10:10 p.m.

Next meeting: February 22, 2018

Beyond Voting: Making Your Voice Count

On Thursday January 18th at 7pm at St. John’s Lutheran Church, we have organized a presentation called Beyond Voting: Making Your Voice Count.

This is caucus training that seeks to answer the questions of why and how to caucus. At the event, Kevin Dahl, our former DFL legislator will address why to caucus, while Jennifer DeJournett, the Director for Minnesota of the American Majority, a conservative training organization will present on how to caucus. We will also provide examples of resolutions and recommendations for writing them. As the League is a non-partisan organization, we aim to provide multiple perspectives to our members and information to enable all of us to take action and participate in our communities.

While that night we will all learn far more, we want to share a few teasers in this invitation:

Why caucus?

  • Because among other activities, we will be involved in nominating the party’s candidate for governor in each of the parties at our precinct caucuses
  • Because caucuses provide the opportunity to enact grassroots democracy where you can bring the resolutions about issues that you care about to your party and try to move them up the party platform. It is the most grassroots democratic moment in the upcoming year to help shape political party plans.

How to caucus?

  • Caucuses will be held on February 6th. Please hold that date to be an active citizen. We will provide you with more information as to where you caucus as well.

Come learn more on January 18th. If you need transportation, please let me know and we will seek to provide it for you. If you have questions, please feel free to send those my way as well.

Looking forward to seeing you January 18th!

Adrienne Falcon

president@lwvnorthfieldmn.org

League Caucus training poster

 

 

 

 

Northfield Hospital Board Meeting Report

Opening

  1. Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved.
  2. The Consent Agenda was approved. The Consent Agenda included: Minutes for a Joint City Council/Hospital Board meeting; Minutes for the November Board Meeting; Minutes for a Community Relations Committee meeting; Minutes for a Special Budget and Finance Committee meeting; Revision to the Medical Staff Manual.

 

Reports

  1. Hospital Chief of Staff. The applications for Medical Staff Membership/Privileges were approved.
  2. Chief Medical Officer—Jeff Meland. No report.

 

Presentations/Discussions/Action Items

  1. Accountable Care Organization (ACO) Launch—Stacie Rice. ACO’s “are groups of doctors, hospitals, and other health care providers, who come together to coordinate care for their Medicare fee-for-service patients. “ ACO’s are required to serve a minimum of 5000 Medicare beneficiaries. NH&C currently serves only 1400 so it has partnered with other communities through Caravan Health for a 3-year trial. The purposes of the trial are to provide a better patient experience and to prepare for the industry shift to reimbursement models based on wellness and health. Four of the ACO partners are located in Idaho, and 6 are in MN. The ACO and Medicare will share any cost savings achieved in 2018. New practices developed in the ACO will apply to all patients served by NH&C. NH&C will add a “Population Health RN” and Dr. Felland from the Lakeville Clinic will serve as the “ACO Provider Champion”.   An ACO Launch Meeting is scheduled for Tuesday, Jan. 23, 2018 in the hospital Conference Center.
  2. Home Care Quality—Tammy Hayes. Quality and patient satisfaction measures have improved in 2017, but some care quality measures remain below the National Reference Standards. Progress will continue.
  3. Approval of Nurse Call/Code Blue System—Tammy Hayes. The need and the system details were presented at the Nov. Board meeting. The Board approved an expenditure of $515,000 to purchase a Rauland 5 nurse call system for the Northfield facility.
  4. Foundation Funding—Charlie Mandile. Charlie requested a small, one-time donation of $5000 to the Northfield Hospital Foundation to create an account with Northfield Shares. Northfield Shares will provide administrative services to the foundation for a fee. The donation was approved.
  5. Annual Donations Pool—Charlie Kyte. The Budget and Finance Committee recommended a community donation pool of $70,000 to be dispensed in 2018 to communities served by NH&C. The B&F Committee also recommended $115,900 pass through to the Northfield Park and Recreation Program for 2018. (This is year 2 of a 3-year agreement.) Motion passed. There was no increase in the 2018 funding due to a very tight operating budget for 2018. It was noted that Health Finders Collaborative will receive subsidies for lab fees of approximately $80,000, and lease costs of $16,000 from NH&C in 2018.
  6. Recommendation on Investment Advisor—Charlie Kyte/Scott Edin. The Budget and Finance Committee recommended the investment firm of Cleary Gull from Milwaukee to supervise equity investments. The current fixed income advisor will be retained. Cleary Gull will survey all Board members to determine the best risk-tolerance level for the equity portfolio. Motion passed. The Budget and Finance Committee will meet with Cleary Gull in January.
  7. Operating Budget for 2018—Scott Edin. The Operating Budget for 2018 basically assumes 2018 service and revenue levels will be constant (changes less than +/- 1%) with the exception of ambulance runs (+6%) and clinic visits (+12%). Expense items projected to increase in 2018 are salary expenses (+4.4%), Drugs (+3 – 4%), and medical supplies (+2.1%). Budgeted revenue for 2018 is $108.3 million; budgeted expense is $107.5. Projected Net operating income for 2018 is positive, but less than the figure for recent years, not including whatever accounting costs may be dictated by PERA adjustments. 2018 is projected to be a tight fiscal year. The Board approved the budget.
  8. Capital Budget for 2018—Scott Edin. Capital expenditures are projected at $10.9 million for 2018, including $3.6 million for remodeling of the Northfield Clinic and $2.4 million for an ambulatory surgery center. It is anticipated that $4.5 million of the amount would come from reserves.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) The City Council is considering a change to the lease agreement with St. Olaf College to permit construction of the senior care facility. b) NH&C and Olmstead Medical Center are still negotiating over implementation of an electronic health records system. It appears that the cost to NH&C may be significantly higher than expected. c) The telemedicine project with Mayo and Stanford Univ. is proceeding.   If successful, it will allow NH&C to keep sicker patients. d) a market survey is planned for 2018, but changes in communication technology (cell phones) has made land-line surveys less reliable. Alternatives are being considered. e) The Advanced Care Planning project is proceeding. f) The billing and coding processes are back on track. g) The 4th quarter patient and revenue surge experienced in recent years has not materialized in 2017. This may require some rethinking of expenses. h) The repeal of the insurance mandate in the ACA is projected to lead to a major decline in enrollment. This is not fair to insurers as the more healthy people are most likely to opt out. A series of meetings with state and national politicians is anticipated.

A request was made that any material sent to the City Council also be sent to Board members.

  1. November Financial Report—Scott Edin. Services were over budget, including Home Health Visits (+21.9%), CCIC (+19.4%), Births (15.4%), etc. Net Operating Revenue and Operating Expenses were both over budget. The result was a Net Operating Income for Nov. of $301 thousand. Net Income was reduced as a result of the increase in government (Medicare and Medicaid) payers that receive a larger discount than the private payers. As a result the cumulative Net Income is below that of recent years at this date. The days-cash-on-hand is 224 days.
  2. Quality Committee Report—Charlie Mandile. Patient ratings are improving. Staff is being added as new problems are encountered (e.g. increasing workplace violence).
  3. Budget and Finance Committee—Charlie Kyte. No report. Steve Underdahl thanked the committee for all the work they have done in recent work on the 2018 budget, the investment advisor, and other tasks.

 

Roundtable

Charlie Mandile reported many positive comments on the recent retreat.

 

Meeting adjourned at 8:54 p.m.

Next meeting: January 25, 2018

Northfield Hospital Board Report

Opening

Chair, Charlie Mandile, called the meeting to order at 6:30 p.m. The Agenda was approved.

The Consent Agenda was approved. The Consent Agenda included Minutes for the October Board Meeting; Minutes for a Governance and Planning Committee meeting; Revision to the Emergency Medicine Privilege Request Form; Medical Staff Polices; and Compliance Policies.

Reports

  1. Hospital Chief of Staff. The applications for Medical Staff Membership/Privileges were approved.
  2. Chief Medical Officer—Jeff Meland. Recruiting medical providers is becoming increasingly difficult, but providers appear to be interested in working with NH&C.
  3. NH&C Report—Ben Flannery. The remodeling and expansion of the Northfield facility is underway. NH&C has hired a neo-natal/pediatric practitioner who is upgrading the care provided in the system.
  4. Allina Medical Clinic Report—Keith Olson. The clinic is adding a physician assistant in March. Allina is working with ICSI on the opioid crisis and is willing to share the results. Allina is also working on reducing readmissions at District One Hospital and would share the results.

 Presentations/Discussions/Action Items

  1. Hospice Quality—Tammy Hayes. The problems that led to lower satisfaction and quality ratings in the hospice program for 2016 have been resolved. Patient satisfaction is over 90% on 2017 surveys and the HIS quality-of-care measures were 100% achieved in 2017. CEO Underdahl praised Tammy Hayes’ work on this project.
  2. Nurse Call/Code Blue System—Tammy Hayes. The internal communication system/nurse call system/Code Blue System is at the end of its useful life. The proposal is to replace the current system with the Responder 5 system at a cost of $515,035. The Responder 5 system offers many more communication options for both patients and staff and will reduce the noise level in patient rooms. The Responder 5 system is already deployed in the recently remodeled sections of the hospital. Given the need to connect to the Responder 5 system already in place, this is a no-bid purchase.   The Board will vote at the Dec. meeting.
  3. Foundation Board Nominations—Charlie Mandile. Charlie asked for 3 Hospital Board members to serve on the Board of the new hospital foundation. The new Board’s task in 2018 will be to organize and establish procedures for the foundation. Four additional foundation Board members, including 2 community members, will be added in 2019. It is likely that the hospital will provide $5,000-$10,000 of initial funding to launch the foundation and establish financial ties.
  4. December Board Retreat—Charlie Mandile. The Board has hired Heather Durenburger to facilitate the retreat and she has talked individually with all Board members. An agenda for the retreat was shared along with a reading for the retreat, “Three Phases of a Board’s Evolution.” In response to a question, Charlie stated his hope that a document describing board procedures and expectations would emerge from the Retreat. Any such document would require periodic/annual updates.
  5. EHR (Electronic Health Records) Update—Steve Underdahl. NH&C is exploring the potential for partnering with Olmstead Medical Center (OMC) in Rochester to share an EPIC electronic medical records system. This would be an expensive project, perhaps $20 million over 10 years for NH&C, but it would allow NH&C to be with the same software vendor as the Mayo and Allina systems. Northfield and OMC would run the standard/non-customized system, unlike Mayo and Allina, but the standard system can be continuously upgraded, a plus. Work is going forward on three fronts: establishing a financial model for the arrangement, drafting contractual/legal documents, and exploring EPIC compatibility with the operation of NH&C. Teams from NH&C are currently working with OMC and EPIC personnel to determine compatibility. A decision on the OMC/EPIC option is expected early in 2018.

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) The City Council and the Hospital Board held a joint work session on Tuesday evening 11/28/17 to discuss the proposed Senior Services project. Steve reported NH&C is working to support the City staff as they consider the project. b) NH&C has contracted with a firm to help with “enterprise risk management,” i.e., how can we best deal with the multitude of threats in our environment? The contract will provide software and consulting time. c) NH&C’s participation in an ACO (Accountable Care Organization) will go live in January. The purpose of participation is to gain experience with what many perceive as the evolving Medicare payment system featuring financial rewards and penalties depending on how the hospital delivers care. There are no financial penalties in the system for 2018. d) Strategic partnerships with HCMC and OMC are being explored. e) The Medicare Low-Volume Program that ended in October will reduce NH&C revenues by $300,000 in 2017 and by $1 million in 2018. f) The self-funded employee health insurance program operated by NH&C will not run a surplus in 2017. It was commented that recent studies show that individuals with high- deducible health insurance coverage behave similar to persons who are uninsured. The uninsured avoid using the health care system until they turn up in the emergency room. g) A cultural sea change is underway, and NH&C is reviewing policies and procedures with respect to sexual harassment.
  2. Financial Report—Scott Edin. October was busy but the proportion of payments by Medicare and Medicaid was higher than budgeted, so the discount was higher than budgeted. The Net Operating Income was positive but almost $300,000 under budget.
  3. Community Relations Committee—Steve O’Neill. The committee received community requests for donations totaling $125,000. The budget is $70,000. The committee will bring a list of awards to the Dec. meeting. Should the budgeted amount be increased for 2018?

Roundtable

The Budget and Finance Committee received and reviewed proposals from 10 investment firms. The Committee will interview 3 – 4 firms and will recommend an investment adviser at the December Board meeting. Recent changes in state law now allow NH&C to invest in a wider variety of financial instruments.

Meeting adjourned at 8:25 p.m.

Next meeting: December 21, 2017