Board Meeting - December 19, 2006
The regular meeting (rescheduled from December 11, 2006 due to a weather related power outage) of the Board of Commissioners of Whidbey Island Public Hospital District was called to order at 6:01 p.m. by Board President, Roger Case, M.D. Present were Commissioner Case, Commissioner Zaveruha, Commissioner Schoenknecht and Commissioner Miller. Commissioner Saugen was not present at the meeting. Chief Executive Officer, Scott Rhine, Chief Financial Officer, Doug Bishop, Chief Information Officer, Tom Tomasino, Chief Nurse Executive for Home and Community Services, Judy Moore, Chief of Staff, Dr. Terry Lee, Dale Roundy, Esq., Trish Rose, Mary Pierzchala, Randy White, Dr. Nancy Neubauer, and Alex Louden were also present.
President Case asked if there were any points of order to discuss, of which there were none.
Agenda items added were Resolution #272 and Board items.
Minute Approval
Minutes from the November 13, 2006 regular Board meeting were approved as presented.
Educational Presentation – Digital Mammography/Dr. Nancy Neubauer and Randy White
Scott Rhine, CEO introduced Dr. Nancy Neubauer, Director of Women’s Breast Imaging at Providence Hospital in Everett and Randy White, Diagnostic Imaging manager for Whidbey General Hospital (Dr. Neubauer also provides radiology coverage at Whidbey General Hospital). Dr. Neubauer talked about this exciting opportunity to acquire state of the art technology in a hospital our size thanks to the generosity of Bob and June Sebo. Dr. Neubauer stated this is a huge undertaking and a big investment. There are multiple vendors that offer the digital mammography, the top three being Hologic, GE and Siemens. Dr. Neubauer reported that digital mammography has been available for about six years. Computed mammography is another option, and has just been released by Fugi and just recently approved by the FDA. Mr. Rhine stated that the Sebos have offered to increase their donation to $450,00 due to the high cost of the equipment. After much study and consideration, it is being recommended that the hospital purchase the Hologic digital mammography equipment for the hospital with the Sebo donation. It is also recommended at this time that the hospital lease digital screening mammography equipment at the purchase cost of $259,000 for South Whidbey. This would then make our total mammography system, fully digital. Medical studies have shown that radiologists are able to pick up more malignancies sooner with the new technology. Because it is not clinically feasible to offer both the older technology and the newer digital technology in the same system, the hospital will have to close the north end screening mammography clinic in Oak Harbor. We hope that patients will be willing to drive the extra ten miles to Coupeville for the improved equipment and technology. At a future date if funding becomes available, another unit can be acquired. Once the system has been installed and staff are fully trained and knowledgeable with the new system, the time for digital studies should be significantly reduced allowing for the hospital unit to keep up with the demand from Oak Harbor and Central Whidbey. Randy White noted that he intends to extend hours for appointments into the evening, and will continue to offer Saturday appointments. Commissioner Miller stated that the hospital would need a good marketing campaign for the new services. After further discussion, Commissioner Zaveruha made a motion, seconded by Commissioner Schoenknecht to approve the purchase of the hospital Hologic digital mammography equipment and the lease for South Whidbey. Motion carried. Mr. Rhine thanked Alex Louden and the Foundation for assisting with the funding. Mr. Rhine will talk with Mr. Sebo tomorrow, and will also work on ways to acknowledge this gift in memory of Mr. Sebo’s first wife. Tom Tomasino reported that he does not have a date for the delivery of the equipment.
Quality and Patient Safety
No separate report for this meeting, included in educational presentation.
Medical Staff Report
Dr. Terry Lee, Chief of Staff presented the following medical staff appointments and reappointments for approval:
Jane Mays, M.D. – Affiliate Active Staff Reappointment
Susan L. Jones-Kubeska, DO – Affiliate Active Staff Reappointment
Commissioner Schoenknecht made a motion, seconded by Commissioner Zaveruha to approve the Affiliate Active Staff Reappointments as presented. Motion carried.
Warren B. Howe, M.D. – Courtesy Staff Reappointment
Frank M. Sheridan, M.D. – Courtesy Staff Reappointment
Jay Ham, M.D. – Courtesy Staff Reappointment
Ronald Pinson, DMD – Courtesy Staff Reappointment
Commissioner Schoenknecht made a motion, seconded by Commissioner Zaveruha to approve the Courtesy Staff Reappointments as presented. Motion carried.
Erin E. Aas, ARNP – Allied Health Professional
Commissioner Schoenknecht made a motion, seconded by Commissioner Zaveruha to approve the Allied Health Professional appointment as presented. Motion carried.
Dr. Lee announced the resignation of Nancy Covington, M.D. pathologist effective November 14, 2006.
Commissioner Case read Resolution #272 for Chief of Staff recognition for Dr. Lee, whose term as Chief of Staff ends December 31, 2006. Dr. Lee was commended and acknowledged for his contributions and effective leadership. Commissioner Miller made a motion, seconded by Commissioner Schoenknecht to approve Resolution #272. Motion carried. Dr. Lee gave credit to Mr. Rhine for being an outstanding leader and partner to the medical staff and the Board. The Administrative Team presented Dr. Lee with a plaque acknowledging his contributions and efforts over the last two years.
Individual Items: (Discussion and/or Action)
- Resolution #273 Interlocal Agreement to Participate in Joint Contracting for Healthcare Services Delivery – Doug Bishop reported that this resolution was prepared by attorney, Brad Berg authorizing the District to enter into the amended interlocal agreement, delegating authority to the Superintendent or his/her designee to represent the District in all matters pertaining to the Western Washington Rural Health Care Collaborative PHD joint operating Board except when doing so would indebt the District for any amount over $10,000. Doug reported that we are one of four associate members, and have one vote collectively. Joint ventures on compliance, contracting and other negotiations are discussed in this group. Dues are $8,000 per year, which will be recouped through teleconferencing equipment from the University of Washington. Meetings are held once a month.
Commissioner Miller made a motion, seconded by Commissioner Schoenknecht to approve Resolution #273 as presented. Motion carried. - District Operating Budget for 2007 – Mr. Bishop reviewed the operating budget for 2007 and indicated that net income was slightly positive, but essentially a breakeven budget at this point. Administration and management have reviewed current services and feel without some significant changes, it would be very difficult to increase net income significantly. Mr. Rhine presented a spreadsheet that showed the "profitability" by major services. It indicated that the hospital itself generated an operating margin of 8.18%; however, other needed community services were costing the district or being subsidized by the hospital operations. These services included home health and physician services. Mr. Rhine reviewed the components of the physician services and pointed out that the majority of the funding was going towards subsidizing the obstetrical program, the proposed orthopedic services, the two new internal medicine physicians on South Whidbey, and to a lesser extent ENT services, the hospitalist program, and payment for on call services. Mr. Rhine noted that the Eide Bailey Company who is doing our cost report, is also helping us look at medical practices. Commissioner Schoenknecht asked for statistics on patients going off island for services, and also on what services are going well. Doug Bishop stated that the operating budget will be a challenge all year, and that it will take tough decisions to make any changes. After further discussion and review, Commissioner Schoenknecht made a motion, seconded by Commissioner Zaveruha to approve the 2007 operating budget as presented with work to continue on improvements to the bottom line. Motion carried.
- District Capital Budget for 2007 – Doug Bishop presented the capital budget for approval, stating that there is $6.3 million projected for priority one capital purchases in 2007, with $1.6 million to be funded out of hospital operations. It was noted that without sufficient operating income, these budget items could not be purchased, even though approved by the Board. It was also noted that the recently approved capital lease helped address current equipment needs. After review and discussion, Commissioner Zaveruha made a motion, seconded by Commissioner Schoenknecht to approve the capital budget for 2007 as presented. Motion carried.
- Discussion of Pandemic Flu Preparation Plan – Tabled to January meeting.
Staff and Status Reports by Administration
Administrator’s Report – Mr. Rhine reported that he and Mr. Bishop met with Linda Moore, CEO of Goosefoot and that she will meet with her board soon regarding a purchase and sale agreement in Bayview for property to build EMS quarters. Ms. Moore will also talk with her board about the proposed healthcare services center that the hospital plans to lease from Goosefoot to consolidate healthcare services on the south end. If the Goosefoot board approves of these projects as presented, written documents are expected by the end of the year.
Roger Meyers, EMS manager, has been working with the fire districts regarding the BLS units. South Whidbey Fire District has opted not to participate. The hospital’s paramedics have expressed some concerns that the hospital district may be involving the fire districts and Oak Harbor Fire Department more than it should and that the hospital district needs to maintain control of the EMS services. It has been pointed out that both hospital district and the fire districts need to work together in order to do what is best for the communities served. Roger Meyers, Carolyn Pape, Human Resources Director, and Scott Rhine have met with the paramedics to address their concerns. The next meeting with the fire chiefs is January 10, 2007.
Over the next months, Tom Tomasino will work with Debbi Williams, Rehab Services manager, to address patient backlog and sleep center issues. It has been difficult to get patients set up for their initial assessment with the physician, and the hospital has contracted with Dr. Francisco Vega from Providence Everett to help with this. Patient assessments will be done in Everett and sleep studies in Oak Harbor.
Administration announced plans for reorganization at the last managers meeting, with emphasis placed on a two-person deep leadership model. Mr. Rhine shared the draft organizational plan that had been shared with the managers.
Whidbey General Hospital Foundation - The Foundation has formed a selection committee comprised of Mike Cann, Bert Speir, Carmen McFadden, Carol Kerley, Scott Rhine and Erin Jackson. Six candidates will be interviewed for Foundation Director the first Thursday in January, 2007; with selection expected by the end of January.
Financial Report – Doug Bishop, CFO reported that cash was improved in October, however, revenues below budget by 3%, and contractuals above budget. The hospital district showed a negative income of $341,000 for the month of October.
Doug believes that November financial statements will have a negative bottom line as well.
December has been busy, and there is hope that it will be a good month financially for the hospital. Revenues have been strong, annualized just over $8 million.
Medicare will perform a desk audit on the hospital’s 2005 cost report. The State auditors may be here the first week in January, however Doug has not had confirmation on that.
Operations Reports - Tom Tomasino reported that there have been two meetings with the Ritter Construction Company. They have toured the facility, and given us a draft schedule and timeline for their work. Construction related items will go through the Building Committee before being brought to the Board.
There have been four patients diverted for critical access through November, and November average census is 16.2 and length of stay is good.
Judy Moore commended the staff for a great job during the power outage, noting outstanding and essential coordination. A precautionary email was sent to Olympia with the potential of going over the census limit during the power outage, which is allowed in emergency situations with notification. Elective surgeries were canceled. It was noted that cafeteria revenues doubled on Friday, December 15th due to the power outage.
Mr. Rhine will email the 100-day objectives to the Board.
Commissioner Miller talked about patient loyalty on the dashboard report, asking what the definition is. Tom Tomasino asked that the Board let him know what changes they wanted on the dashboard report and he would make sure the changes are made. The Board indicated they should review this regularly and will do so at the upcoming retreat.
Trish Rose, Community Relations manager, reported that the PULSE went to the printer yesterday, and will have spectacular covers of the recent snowfall. There also will be two articles by Commissioner Case in this edition.
Board Items
- Board Holiday Gift – Board members will each give $25.00 to be put towards a need for the hospital. It was noted that last year they purchased toys for children to play with in the hospital lobby.
- Potential Board Retreat Dates – The Board would like to have a retreat early in the year, possibly February. President Case asked that Board members send him dates they are available and the best date will be selected.
- Board Committee Assignments – President Case raised questions about Board Committee assignments, processes for conclusions and recommendations, review of hospital resolutions with a book of resolutions to be put together, and rules for Board membership on hospital committees to be more formal. President Case feels there needs to be more clarity on who has what responsibilities. President Case stated that he believes that committees make recommendations to Mr. Rhine for action, and Mr. Rhine decides what comes to the Board. It was decided that the Board would draft a resolution in the Board Retreat outlining Board responsibilities on hospital committees. Board committee assignments will be kept the same until the Board retreat. Commissioner Zaveruha talked about adding community advisors with healthcare expertise to various meetings to add to the depth of expertise and evaluation. This may also help to define the focus of various topics. It was noted that several committees have community representatives on them, including Quality, Finance and Ethics. Commissioner Zaveruha would like this to be discussed further at the Board retreat.
Public Questions or Comments
There were none.
Consent Agenda Items:
- Commissioner Miller made a motion, seconded by Commissioner Schoenknect to approve the list of surplus items as presented. Motion carried.
- After review and discussion, Commissioner Schoenknecht made a motion, seconded by Commissioner Zaveruha to approve the write offs as presented in the amount of $415,591.11. Motion carried.
- Vouchers audited and certified by the auditing officer as required by RCW 40.24.080, and those expense reimbursement claims certified as required by RCW 42.24.090, have been recorded on a listing which has been made available to the Board. Commissioner Miller made a motion, seconded by Commissioner Schoenknecht to approve vouchers #100076 and #100341 in the total amount of $12,807.45. Motion carried. Commissioner Zaveruha abstained from the review, discussion, vote and written approval of these vouchers due to a potential conflict of interest.
Vouchers audited and certified by the auditing officer as required by RCW 40.24.080, and those expense reimbursement claims certified as required by RCW 42.24.090, have been recorded on a listing which has been made available to the Board. Commissioner Miller made a motion, seconded by Commissioner Schoenknecht to approve vouchers #381398 to #381418, #100010 to #100669 excluding #100076 and #100341, in the total amount of $4,130,216.60. Motion carried with all commissioners voting.
There was no executive session (RCW 42.30.110(I)) to discuss matters involving potential litigation.
There being no further business or public comments, the meeting was adjourned at 9