Font ResizeRedwood Times
Discussion of financial planning and board procedures were once again the main focus of discussion at the Feb. 25 meeting of the board of governors of the Southern Humboldt Community Healthcare District, along with good news regarding finances, patient statistics, and services.
Four of the five members were present to cover an unusually short agenda. Darryl Cherney was traveling in Africa.
The board quickly dispensed with the consent calendar, including approval of all the included committee reports. Several committees offered no reports this month.
Administrator Harry Jasper led off with a summary of his recent trip to Washington, D.C., where he attended a meeting of the National Rural Health Association and lobbied legislators on behalf of SHCHD.
While he spoke to aides of Senators Dianne Feinstein and Barbara Boxer, Jasper was able to arrange a face-to-face meeting with Congressman Mike Thompson regarding several federal grants that could help the district with much-needed projects.
Most significantly, Jasper discussed SHCHD’s application for a Rural Quality Improvement grant of $300,000 yearly for three years from the Health Resources and Services Administration.
This grant will be used to expand preventative health services in the community by assisting persons suffering from chronic diseases in self-management, training the families of those persons to help in their care, and exploring the use of personal health records for better self-management.
The district should be notified within the next two months whether it has been awarded the grant. If the funds come through, they will be used this year for development of a specific program and outreach to the community.
In 2011 the program will work with diabetes patients and their families, and in 2012 the emphasis will be on cardiovascular disease.
SHCHD is also applying for a U.S. Department of Agricultural rural development grant for an IT project that would enable the district to set up a high tech learning center and development improved electronic billing and patient scheduling systems.
Additionally, the district will be requesting funds to complete the earthquake retrofit within the next federal funding cycle.
Dr. Murat Akalain from the Mammoth Lakes area and his wife, Nancy, spent two days in February visiting the hospital and clinic. Dr. Akalain worked with SHCHD staff in the emergency room, hospital, and Garberville clinic.
The district has hired Dr. Akalain on a temporary basis with hospital privileges. He is also considering a permanent staff assignment, Jasper reported.
Jasper announced that Debbie Scaife, Director of Patient Care Services, recently received a Lifetime Achievement Award from the California Hospital Association.
Board chair Nancy Wilson reported that she and board member Corinne Stromstad have been attending monthly meetings of the Quality Improvement Team (QIT). The team has been reading and reviewing a book of management techniques, “From Good to Great” by Jim Collins.
One precept of the book is that the organization must have faith that it will prevail but confront the “brutal facts” that create obstacles. At its last meeting, the QIT discussed “brutal facts” about poor communication between departments and fears about talking frankly to others.
Headlining the Finance Committee’s report was good news about both patient statistics and revenue. Acute and swing patient beds were both well over budget, and all beds in the Skilled Nursing Facility were filled. This is the highest level of fiscal year 2009/10 with inpatient beds coming in over budget for the second month in a row.
The income statement also looked good, with revenue for the month 7 percent over budget and operating expenses 3 percent under budget. Revenue for the year is close to year-to-date budget and operating expenses are 8 percent under the year-to-date budget.
On the down side, outpatient services were below budget. No mammograms were performed in the last month because the newly-hired technicians have to complete their last step before full certification. They must perform 25 mammograms under supervision before they can be allowed to work on their own at the hospital.
The technicians should complete this last step by the end of February. SHCHD will begin scheduling mammograms again this month.
The district received the cost report settlement it expected from Medicare a little earlier than usual, Jasper reported. On Feb. 19, SHCHD received a payment of $293,000. An additional settlement of approximately $150,000 from MediCal is expected shortly.
Furthermore, adjustments to the cost report mean that Medicare and MediCal will be reimbursing SHCHD at a higher rate than previously. The reimbursement rate is based on cost of all the district’s services, which has steadily increased.
Because of these payments, for the second consecutive month Jasper did not have to exercise his authority to draw down the district’s line of credit to pay vendors. He expects that he will not need to use the line of credit in March.
The sticky part of the financial report is, as usual, the overdue accounts receivable. “Another brutal fact is that in reviewing A/R cycles, balances will remain high as we evaluate how clean our bills are,” Jasper said.
He was referring to ongoing review of the district’s bills prior to sending them to insurers, Medicare, MediCal, and other payors to determine if the bills are accurate and complete.
The district is working with a consultant, Debbie Gallagher, who noted that one of the principal faults of SHCHD’s billing system is not including charges for all the services performed, according to board member Ed Smith, who has been talking with Gallagher.
Smith also cautioned the board to approach “recalcitrant payors” early, giving them no more than 60 days to find errors in the district’s billings. He emphasized the importance of collecting earlier rather than sending tardy payors to collections, which statistically returns only 25 percent of the amount billed.
Jasper pointed out that receivables overdue more than 180 days steadily increased during this fiscal year, totaling $333,000 at the end of January, but they have been going down in February, he said.
In a related subject, Jasper reported that SHCHD’s auditors expect to complete the audit for FY 2008/09 by mid-March. Being able to present the three years of completed audits is very helpful in applying for funding programs, he added.
Following the financial report, the board took up several old business items concerning board procedures and financial planning that had been originally requested by Smith.
First, Wilson announced that Byrd Lochtie of Humboldt Area Foundation will be giving a workshop on board procedures on the evening of April 8. Wilson asked board members to prioritize the topics they would like addressed.
Because all board members will be present at the workshop, this will be an open meeting and the public may attend, Wilson said.
At previous meetings, Smith had asked for several items to be placed on the agenda.
The first item in this series is titled “Development of Detailed Financial Plan Laying Out Measures District Needs to Take to Live Within Limits of Revenue Plus Proceeds of Parcel Tax.”
Ultimately, Smith made a motion to ask Jasper to make a monthly oral report on his progress in developing a strategic plan to accomplish. The goal is to produce a written report that will include a multi-year budget with specific strategies for achieving budget goals within the limits stated.
Wilson seconded the motion to get the discussion on the table. Various members of the board interpreted the wording of the motion differently. They discussed the difference between a budget forecast, which Smith described as “passive,” and the more “active” strategic plan he envisions.
Thompson stated that he would vote no on the motion, not because he was “necessarily opposed,” but because he wanted to see details in writing first. Stromstad agreed, adding that she wanted to be sure the motion would work rather than having to redo it at a later date.
Smith withdrew the motion, and discussion will continue at the next meeting.
Smith’s item requesting a detailed plan for earthquake retrofit financing was more quickly handled.
At Jasper’s suggestion, the board authorized him to apply for a loan from the California State Treasurer of up to $750,000 for completion of the project, although Jasper stated that he expected actual costs to be no more than $600,000.
Jasper pointed out that interest on the loan and depreciation of the improvements would be reflected in the district’s next annual cost reports, thus increasing reimbursement from Medicare and MediCal to help pay the loans.
Several board members questioned how a near-bankrupt state could provide loans. Jasper replied these funds have already been appropriated, and Scaife added that the state legislature does not want to rescind the earthquake retrofit requirements so it has to continue the loan program.
An item to adopt a district policy on pricing and service of goods was continued to the next meeting pending further study, as was an item to adopt some new patient payment scenarios, including a sliding payment scale for low-income patients.
Finally, the board took up the single new business item, developing a “process for presenting issues to board committees for consideration.”
A philosophical difference among board members became apparent during the discussion, with board member Mike Thompson asking that board members bring requests for new projects to the full board before involving staff.
Smith objected, saying this requirement would be a “recipe for cutting off creativity.” He added that he would feel “unhappy” bringing a proposal to the board until he had developed his idea.
”The more formalized the process, the less creativity and the less participation,” Smith said. Requiring the board’s go-ahead first would be “a strait jacket, making one person work in a vacuum,” he added.
Wilson pointed out that the board often has information needed at the beginning of the process. For example, if the proposal is to develop a policy, the district may already have a policy on the books that would serve the purpose.
Jasper used the example of the 215 committee, which was initiated by Cherney several months ago with the board’s authorization. Scaife said that if the rest of the board had been opposed to formation of the 215 committee under SHCHD auspices, denial of authorization would have saved Cherney time and energy.
With the board’s approval, however, Cherney has put together a committee of people with creative ideas about medical marijuana who will make a proposal for action to the board, Scaife went on.
Further discussion using an analogy that compared the district to a ship, with the administrator as the captain, staff as crew, and the board as the representatives of the ship’s owners, remained inconclusive.
Thompson suggested that all the board members “go home and think about it” in preparation for brainstorming at next month’s meeting.
The agenda was completed, except for closed session items, well before 3 p.m., which everyone agreed was some kind of record. The next full board meeting will be held Thursday, March 25, at 1 p.m., in the Dimmick meeting room at the Phelps Hospital in Garberville.
