Past Events

Letter Writing July 21 9am-noon

Join us at The Hideaway Saturday, July 21anytime between 9 am and noon for this month’s League letter writing get together. Our focus is the upcoming decision about the addition of a citizenship question to the 2020 US Census. The League has a formal statement opposing the addition of a citizenship question and the public comment period ends August 7th. We’ll provide paper, pens, stamps, background information and sample letters -you just need to show up, have a drink, and write! Drop by whether you can stay for 15 minutes or two hours and bring a friend.

This year, our local League plans to do a series of letter writing events to provide education for members, action opportunities, and a chance to get together with other League members.

Information from the MN League of Women Voters:
Earlier this year, Secretary of Commerce Wilbur Ross announced that he had directed the Census Bureau to add a question about citizenship status to the 2020 Census. The Department of Commerce is accepting public comments until August 7th on the use of a citizenship question in the U.S. Census. We need as many people as possible to respond with comments to oppose this decision. This will demonstrate there is a strong public voice that opposes this decision.

Secretary Ross disregarded the advice and recommendations of Census officials, including six former Census Bureau directors from Republican and Democratic administrations, who stated in aJanuary 26th letter to the Secretary, “We strongly believe that adding an untested question on citizenship status at this late point in the decennial planning process would put the accuracy of the enumeration and success of the census in all communities at grave risk.

For more on the 2020 Census, you can watch our video from the presentation at the High School this spring: https://www.youtube.com/watch?v=pvSP1PWjZ9Q

Northfield Hospital Board Report June 2018

Headlines:

  1. Groundbreaking for new senior care facility anticipated in mid July.
  2. Charity Care by NH&C totaled $135,297 in 2017.
  3. Revenue recapture (seizing tax refunds) totaled $717,895 for 2017.
  4. Supply chain remodeling cost estimated at $392,000.

 

Opening

  1. Chair, Charlie Mandile, called the meeting to order at 6:35 p.m. The Agenda was approved.

The Consent Agenda was approved.  The Consent Agenda included Minutes for the May Board Meeting, Minutes for a Community Relations Committee Meeting,  Minutes for a Special Budget and Finance Committee Meeting, Minutes for a Special Governance and Planning Committee Meeting, Entrance and Parking Easement, Government Data Practices Act Policy, Compliance and Ethics Program Policy, Temporary Privileges Policy, Disaster Privileging Policy.

 

Reports

  1. Hospital Chief of Staff—Randy Reister. No report.  The applications for Medical Staff Membership/Privileges were presented to the Board.  The Board approved the applications.

 

 Presentations/Discussions/Action Items

  1. Supply Chain Remodel—First Look—Scott Edin. The hospital is implementing a 2-bin supply system that will reduce the inventory held in departments, and store inventory remotely in a central location.The system has been implemented in the ER Department and Obstetrics, but space limitations have constrained implementation in the Operating Room.  The proposal is to move all inventory into the basement of the new Endoscopy Center, which will require enclosing a loading dock and constructing a caged storage area.  The estimated cost is $392,000.  Extensive discussion followed regarding the cost of the project, possible savings, and the sense that the proposed project is a “third best” option that leaves many problems unsolved.  The administration was urged to rethink the project once more, and bring a recommendation to the Board at the July meeting.
  2. Compliance 101—Part 2—Laura Peterson, Compliance Officer. The presentation continued Board education on their responsibilities to oversee the fiscal practices of the hospital with regard to Medicare and Medicaid. Violations are violations regardless of the intent of the Board and prosecution may be both criminal and civil. Peterson identified several areas of high risk.  The Board was asked to consider how the institution and the Board are structured to oversee compliance issues, the Code of Conduct, the reporting system, and internal controls.  Peterson said that in her judgment, the Compliance Officer had the authority, autonomy, and resources to conduct a robust compliance program.  It was noted that the Compliance Officer reports directly to the Board rather than the CEO.  The roles of Legal Counsel and Compliance Officer are combined at NH&C (Laura Peterson), which could create a conflict of interest, but outside legal counsel is retained whenever a compliance complaint is received.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) work and progress continues on a wide variety of projects.  There are data transmission problems to Caravan with the Accountable Care Organization; the rules governing the appointment of Board members to the Foundation will be revised; a new strategy for market surveys is being explored; a new productivity-benchmarking program is being implemented.  b) Price transparency was the primary topic at a recent American Hospital Association regional meeting.  Health care providers in MN appear to be much further advanced with this trend, due to the high percentage of high-deductible insurance polices in the state.  When they have the chance, patients are price shopping for health care in MN. Underdahl reported that in his experience, “People aren’t much interested in the actual cost of health care; they care about what the health care costs them.”  c) Underdahl interpreted the appointment of Atul Gawande to be CEO of the new Amazon-driven health care coalition to portend major changes/disruptions in the delivery of health care.
  2. Financial Report—Scott Edin. May was a good month. Net Operating Revenues for March were $337K over budget, and Deductions were under budget. The result was a Net Operating Income of $230K.  Income from operations is above budget for the year thus far, but June has been a slow month.
  3. Annual Report of MN Attorney General’s Agreement on Hospitals & Debt Collections—Scott Edin. The Board reviewed their compliance with the agreement between the MN AG and hospitals in MN regarding the prices charged uninsured patients, charity care, and collection practices. The hospital judged itself to be in compliance with the agreement. NH&C sent 78 accounts/18 patients to its outside collection agency in 2017, resulting in $57,697 collected. Prior collection actions executed in 2017 resulted in $67,201 of wages garnished by the collection agency.  Internally, NH&C collected $717,895 from revenue recapture (seizing tax refunds); and $348,701 from collection actions, for an average collection ratio of 1/3.  (It was noted that patients do not like it when their tax refunds are seized.)  The hospital’s procedure is to first attempt to assist patients in finding payment sources and to work with patients on a payment schedule before sending the accounts to collection. The CFO and CEO review all accounts sent to collection. No complaints were received by NH&C in 2017 against the collection agencies.  Charity Care in 2017 totaled $135,297.
  4. Quality Committee—Charlie Mandile. The Committee is continuing to study opioid prescribing practices.
  5. Governance and Planning Committee—Charlie Mandile. Work on a CEO evaluation policy is almost complete. The policy follows the process used in 2017 that seeks input from all groups affected by the hospital.  The policy won’t specify the use of an outside consultant, as has been done in recent years, but will recommend the practice.  The outside consultant adds credibility to the survey results and provides a wider window on the CEO market in MN.  The Committee will bring the policy proposal to the Board in July for a vote.

 

Roundtable

The Senior Services building project will likely break ground in mid July.  The City Council approved the last required agreement earlier in the month.  A ground- breaking ceremony will be announced.

Meeting adjourned at 9:10 p.m.

Next meeting:  July 26, 2018

Northfield Hospital Board Report: May 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 April Board Meeting and Minutes for a Governance and Planning Committee Meeting.

Reports

  1. Hospital Chief of Staff—Jeff Meland for Randy Reister. The applications for Medical Staff Membership/Privileges were presented to the Board. The Board approved the applications.
  2. Chief Medical Officer—Jeff Meland. Dr. Fulco has been working with the hospital to form a high-risk breast cancer registry and support group. The addition of 3 new hospitalists to the staff appears to be encouraging the retention of higher acuity patients at NH&C.
  3. NH&C Report—Dr. Ben Flannery. The Express Care Clinic in downtown Northfield is up and running. Three new associate providers have been added to the staff.  The feedback from patients has been positive.

 

Presentations/Discussions/Action Items

  1. Approval of City/Hospital Governance Committee—Rhonda Pownell and Charlie Mandile. This item was brought back to the Board after some editing. The motion would establish a temporary committee composed of 3 City Council members and 3 NH&C Board members. The charge to the committee is to explore best practices for working together and building a stronger relationship.  The committee will bring recommendations within 6 months, and then could be disbanded.  Motion passed.
  2. Patient Care Update: Include Always—Tammy Hayes. This is a Minnesota Hospital Association campaign to establish a functioning Patient and Family Advisory Council in every hospital to provide a new perspective on care and a shift in the culture of hospitals.  The Council is up and running at NH&C, but they hope to add additional members to broaden the perspective.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) The Open House for the Express Care Clinic was well attended.  The Clinic will be open weekends starting June 9th.  b) The initial data from the ACO (Accountable Care Organization) indicates that there are significant differences between current medical practices at NH&C, and the goals of the ACO.  An example is the “annual wellness visit” recommended by Medicare and the ACO, but not currently promoted by NH&C. There is work to be done in order to meet the goals of the ACO.  c) staff is continuing to study the electronic health record problem. d) the long term care facility at NH&C again received a 5-star rating. This is the 7thyear in a row that the facility has been so recognized.  d) planning for the ambulatory surgical center continues.  e) the cost rebasing effort continues; another $1 million needs to be cut.  f) the Omnibus Supplemental Spending Bill vetoed by Gov. Dayton contained financing to counter the opioid epidemic.  g) a health price transparency bill did pass and the clinics will now be required to post prices for their 25 most frequently billed services. h) The MN Health Records Act did not pass so providers in MN will continue to be held to higher privacy standards for patient records than providers in other states. This can complicate interstate sharing of medical records.  i) a revision to the Workers’ Compensation program will reduce the revenue NH&C receives from Workers’ Comp.
  2. Financial Report—Scott Edin.  Net Operating Revenues for March were $222K over budget, and Deductions, Bad Debt, and Operating Expenses were under budget. The result was a Net Operating Income of $421K.  Income from operations is well above budget for the year thus far.  It was noted that even years (2014, 2016, etc.) seem to generate much better financial results than the odd years.  Maybe 2018 will continue this pattern?

 

Roundtable

A Board member inquired as to whether the art work displayed in the hospital related to the clientele; can patients see themselves in the art?

Meeting adjourned at 8:50 p.m.    Closed Session began.

Next meeting:  June 28, 2018

Northfield Hospital Board Report: April 2018

Opening

  1. Chair, Charlie Mandile, called the meeting to order at 6:35 p.m. The Agenda was approved.

The Consent Agenda was approved.  The Consent Agenda included Minutes for the March Board Meeting, Minutes for a Budget & Finance Committee Meeting, Minutes for a Quality Committee Meeting, Minutes for a Governance and Planning Committee Meeting, and Credentialing Policies.

 

Reports

  1. Hospital Chief of Staff—Randy Reister. Reister presented the applications for Medical Staff Membership/Privileges. The Board approved the applications.
  2. Chief Medical Officer—Jeff Meland. Meland reported that a Data Manager has been hired to improve documentation. The project was started with the physicians in the Emergency Department and will expand to other physicians. The Clinical Executive Committee is reviewing strategies to grow the practices.

 

Big Question

Environmental Scan—Matt Anderson, VP, Minnesota Hospital Association.  Anderson presented the MHA’s Health Care Policy Trends and Forecasts to the Board in preparation for their May retreat.  Political gridlock continues to plague both Washington DC and St. Paul, which makes forecasting difficult.  But gridlock doesn’t preserve the status quo: the problems continue to get worse as the population ages, the Medicare Trust Fund shrinks, etc.  The good news is that funding for CHIP was extended for 10 years and the Medicare Low-Volume Adjustment was extended for 5 years.  CHIP covers 4000 children in MN, and the Medicare adjustment provides approximately $1 million per year to NH&C.  Outpatient hip and knee replacement is growing.  The MN legislature will address the opioid crisis, but the branches of gov’t. are arguing about how to fund it.  Mental health will likely receive more funding at the state level.  There will be legislation in MN to protect vulnerable adults.  State demographics indicate a rising number of elderly patients and a shrinking workforce.  Private health insurance is changing: 95% of privately insured patients in MN now have a high-deductible ($1500 or more) plan.  Studies show that primary care utilization declines 18% with high-deductible plans. Consolidation of health care providers continues, and HMO’s in MN can now be for-profit.

 

Presentations/Discussions/Action Items

  1. City of Northfield Orientation & Strategic Plan/Work Plan—Ben Martig, City Admin. Martig reviewed the documents that govern the city-hospital relationship, i.e., the City Charter and City Codes, and the City’s Comprehensive Plan as it applies to the current site of the hospital. Mayor Pownell then discussed the City’s Vision Statement, Mission Statement, and Strategic Plan for 2018-2020.  Pownell stressed that a successful relationship between the City and the Hospital Board requires the parties to work together.
  2. Compliance 101—Laura Peterson. The Office of Inspector General, USDH&HS, investigates fraud and mistakes in Medicare claims filed by health providers. The estimate is that the loss due to fraud and mistakes is about $60 billion per year. Peterson reviewed the Hospital Board’s obligation to monitor the activities of NH&C.  The duties of the Board members are to act in good faith, be loyal to the institution, and to care by reviewing the performance of the CEO, the institution’s finances and policies, and to ensure an effective compliance plan.  Directors may be held individually responsible for violations by the institution.
  3. City/Hospital Governance Committee—Mayor Rhonda Pownell and Board Chair Charlie Mandile.Pownell and Mandile jointly recommended the creation of a City& Hospital Governance Committee to propose models and practices that would foster a stronger working relationship between the two entities. The committee would consist of 3 NH&C Board members including the Chair; 3 City Council members including the Mayor; plus the City Administrator and the CEO of NH&C as ex-officio members.  The Mayor would recommend the members for confirmation by the City Council.  The committee would meet monthly and submit recommendations within 6 months.  Board members expressed their support for the goals of the project, but raised two major concerns. First, the charge to the committee seemed one sided: the City was going to educate the Board on their responsibilities to the City, without the Council considering the powers and independence granted the Hospital by the City Charter.  Two, the appointment process appeared to be controlled by the Mayor and City Council.  Mayor Pownell explained that nomination and Council approval is the City’s standard procedure for creating committees.  Extensive debate followed.  The proposal was sent back to the committee for amending, in the hope that the differences between the parties could be resolved. The proposal will come back for a vote at the May Board meeting.

 

Executive and Committee Reports

  1. CEO Report—Steve Underdahl. a) discussions are continuing on the electronic health records problem. b) The ACO held its first Board meeting. c) the Northfield Express Care Clinic is up and running.  A second staff person has been hired for the clinic.  d) The MHA and 3M have created new analytical software for use by hospitals.  e) The project to “rebase” (reduce) expenses is having a beneficial effect. f) NH&C was recertified as a Level IV trauma center.  CEO Underdahl expressed kudos to the Emergency Dept. and the Quality Data Dept. for their work.  g) It is rumored that Walmart is seeking to add Humana, an insurer, to the pharmacies and clinics it already owns.  h) United Health Care earned $2.84 billion in profits for Q1 of 2018.

2.Financial Report—Scott Edin.  Net Operating Revenues for March were $192K under budget, but Deductions, Bad Debt, and Operating Expenses were also under budget. The result was a Net Operating Income of $292K.  Net Income was still negative for Q1 of 2018.  The hospital’s ability to seize tax refunds dramatically reduced bad debts in March and April.

  1. Governance and Planning Committee Report—Charlie Mandile. The annual review of the CEO will take place in a closed session immediately following this meeting.
  2. Quality Dashboard—Charlie Mandile.The Quality Committee continues to refine the quality data that Board members should see monthly.  Their latest ideas can be seen in the Information Packet sent to Board members.  Charlie expressed the desire to have more time at a future meeting to discuss these results, but there was not sufficient time tonight.  Charlie asked Board members to email their suggestions to him.

 

Roundtable

Board Retreat in May.

Meeting adjourned at 9:17 p.m.    Closed Session began.

Next meeting:  May 31, 2018

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