Sandy Feretto

Redwood Times

The Southern Humboldt Community Healthcare District regular board meeting was on Jan. 24. Board chair Barb Truitt reported that in closed session the board approved resolution 13:01, medical staff appointments/reappointments of doctors Beckord, Bavuso and Vigil. There was no action to report on any other items in closed session.

Human Resources report

During the quarterly report on Human Resources, HR director Linda Feretto was asked by board member Dave Ordonez if she kept a running record of reasons for employee separation from the district. Feretto said that employees have an opportunity to give any feedback they wish on the exit form. She keeps her eyes on reasons given for separations and if any patterns appeared she would notify the board. The several recent separations ran the gamut she said, from personal, medical, and retirement reasons. There do not appear to be any particular trends.

Technology

District administrator Harry Jasper said that he and the district's director of operations, Kent Scown, met with the district's primary architect for master facility planning. There are several locations on campus that are possibilities for CT scan locations. Data is being collected for analysis about the financial and patient benefit of having local CT scan capabilities as well as impacts to the community from not having them.

Director of nursing Sarah Beach updated the board on the work done by the telehealth team. They have identified a coordinator and technical support person and have been scheduling little webinars with California Telehealth Network. A specialist is coming to help train the staff with patient flow processes and telehealth. The team is looking into grants for peripherals, the little devices that can be added onto the system like stethoscopes and other supplies.

Beach said it is in the district's interest to go in with a telehealth group that offers many different specialties for a more general approach. It would work better for them.

Jasper reported on electronic health records. He said the team he is on with Kent Scown, Sarah Beach and Dr. Matuszkiewicz visited the hospital in Weaverville, which is a similar facility with a rural clinic, a skilled nursing facility, and hospital emergency room. Jasper said the visit opened their eyes to the challenges of implementing integrated electronic health records. They found the system there is immature in its ability to integrate financial reporting ability, emergency room, acute care and the rural health clinic together. And that EHR system has no skilled nursing facility electronic health record capabilities.

Jasper said the team had a web demo with Healthland, which is the current information system they use but it also has several challenges of immaturity when it comes to integration. So they are looking at several other options and want to look into other systems in use by others in the Joint Powers Authority.

There will be no loss of incentive payment as long as the district adopts a system by Sept. 30, 2015. Jasper hopes they can let the products out there mature and that they do so quickly.

Because of the district's size, technology integration is really important. Making the wrong choice could cost the district.

Financial

Jasper reported that the board has reordered the strategic plan. First strategy is to develop a workplace that promotes patient and employee satisfaction.

Several areas of focus are being worked on internally. One is hiring a qualified outpatient services director to be a part of the district's community outreach and supervise the clinic, laboratory and radiology departments. They are looking at performance evaluations and reviewing district wages, including market wage review and a merit based wage component.

Brenda Magee is the district's new patient financial services manager and has updated the financial committee on the restructuring of job duties in that department.

The district is seeing improvement with the new self-pay billing. Jasper said they were provided with an update on understanding the third party contracts, which is key to maximizing reimbursement. Jasper, accounting manager Buzz Fish and Magee are attending a regional symposium of the Healthcare Financial Management Association, the national resource for revenue cycle best practices and meeting with financial consultant Ralph Llewellyn on the financial improvement project.

A current goal is to work on departmental budgets, to finalize this year's audit and prepare to have bottom-up departmental budgets so they can prepare to craft next year's fiscal budget. The goal is to have next year's budget by this coming May.

Jasper reported the good news that at the end of December the district had $1.5 million in cash reserves, which represents operating cash of 89 days operating expenses. The target is to have at least 180 days cash on hand. The bottom line remains strong and cash reserves remain strong. Through the end of December the district had a net income of $350,000.

Jasper said that since the last regular board meeting an injunction has been placed on a law that has allowed the state to reduce hospital owned skilled nursing facilities Medi-Cal rates from the present rates back to the 2008 rates less 10 percent. The cut represents a 16 percent reduction for the district. The present rate identified for the year 2011-2012 was $337 per day for Medi-Cal patients, projected to be reduced to the 2008 rate of $286 per day less 10 percent. This equates to approximately $150,000 annual reduction in nursing home rates.

The state is authorized to retroactively implement the rate cut to June 2011, estimated to cost the district about $200,000. Hospital owned nursing facilities throughout the state are estimated to have to retroactively pay $117 million back to the state.

Jasper said the hopeful news is that the California Hospital Association believes there are potential legal remedies for additional injunctions that can stop the retroactive rate cut. Districts are working with Assemblyman Wes Chesbro in reaching out for a egislative remedy. If that is unsuccessful, the district might be able to seek exemption for rural hospitals that operate skilled nursing facilities. There is a worry about the retroactive rate cut and also the rate cut going forward. There are a lot of politics going on with the governor's budget, Jasper said.

Financial analysis on adding home health and visiting nurse services to the district is being done. Hospice and home health are complimentary services. Jasper met with representatives of the local hospice. They are having some funding challenges and staffing changes. Jasper said it may be time to look at Medicare qualified hospice services in Southern Humboldt.

Affiliations

Jasper brought up the possibility of the district affiliating with neighboring hospitals. The district had been approached by Kevin Klackengay, the regional vice president of St. Joseph Hospital, which operates Redwood Memorial in Fortuna and St. Joseph in Eureka. The board has given Jasper the okay to explore the possibility of affiliation as long as the district does not lose its autonomy as an independent health care district and is not restricted from having collaborative relationships with other neighboring hospitals such as Mad River Hospital in Arcata or the Adventist Health System operated Frank R. Howard Hospital in Willits.

Jasper and Truitt have looked at the affiliation agreement St. Joseph has with Healdsburg District Hospital and they would make some tweaks to it. Joe Rogers chief operation officer at Redwood Memorial and Klackengay have said they could come to the February board meeting to present their views on affiliation relationships.

Jasper said that there are known and unknown benefits in such affiliations.

Jasper also discussed potential collaboration with College of the Redwoods. He gave the new CR president, Kathy Smith, a tour. She invited the district to participate in a meeting with Open Door Clinic to discuss the state's expansion program for better health through clinics. There is also the school nursing oversight program.

Jasper is meeting soon with Tina Tvedt of Redwoods Rural Health Center. The board agreed there are many opportunities for collaboration in the changing atmosphere of healthcare.

Other business

The board heard about the steering committee for the Southern Humboldt hazard mitigation plan.

Board self-evaluation will be on the agenda for next time.

The board reviewed changes and revisions to the district's copying policy of public records.

The approval of board resolution 13:02, approval of policies and procedures for immunizations, dietary, infection prevention, patient financial services and department manuals had to be tabled until the next meeting due to a Brown Act noticing requirement.

Board chair Truitt suggested having a strategic plan mid-year review at the next board meeting.

Regarding the strategic plan, Jasper said that after the top four goals were identified almost three years ago in open meetings, management and administration were tasked with implementing them. The last strategic planning meeting was a public forum to get feedback from the community on the four top goals.

The board has taken action by forming a facility committee and reordering the goals. The rest of the specific goals were given to staff to address. The board and the public will hear at the next board meeting mid-year progress reports from staff. The public is encouraged to attend.

The board decided to limit board member comments to three minutes for items that are not on the agenda, as they are for the public. Chair Truitt responded to a question from the public by saying that through public comment or correspondence items of interest to the public may be placed on the agenda for more lengthy discussion by and with the board as needed.

Truitt reported on the community outreach program. The committee is talking about newsletters and articles for the newspapers. The committee wants to hold a community mixer soon to introduce new and returning staff. They are also considering tabling and having informational booths at community events. They want to engage with the community in a variety of ways. Truitt sited the national walk-with-a-doc program to promote exercise by having a stroll with a healthcare professional.

In a brief special board meeting that followed the regular board meeting, the board appointed Scown and Jasper to negotiate in good faith for the property at 729 Cedar Street owned by Steve Wilson. They would open negotiations and bring information back to the board for direction.

Next board meeting will be Feb. 28. It will begin with closed session at 12:30 p.m. with the regular meeting at 1 p.m.