Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY Board Meeting January 22, 2017 MINUTES The Norman Regional Hospital Authority met in monthly session Monday, January 22, 2018, at 5:30 p.m., in the Norman Regional Hospital Board Room. The meeting Agenda was posted January 18, 2018, on the NRHS and Norman Websites and at the entrance to Norman Regional Hospital. Members Present: Tom Clote, Chair Muhammad Anwar, MD Diane Chambers, MD Joan Greenleaf James (Jeff) Kimpel, Ph.D. Tom Sherman Jerome (Jerry) Weber, Ph.D. Member Absent: Doug Cubberley, Vice Chair/Secretary Kevin Pipes Others Present: Robin Mantooth, MD, Chief of Staff Farhan Jawed, MD, Chief of Staff-Elect Richie Splitt, President and CEO John Manfredo, COO Ken Hopkins, CFO Meegan Carter, VP Population Health & Wellness Paula Price, VP Strategy & Growth Dr. Aaron Boyd, MD, CMO Brittni McGill, Interim CNO Susie Graves, Interim CNO Jenny Anderson, Dir. Quality, Med Staff Srvs, & ER Residency Lisa White, Manager PI & Medical Staff Services Molly McCool-Hare, Business Planning/Operations Specialist Cindy Gilmore, Specialist LEAN Kyle Hurley, Business Planning Specialist Courtney Blau, Admin. Dir. Risk Management & Compliance Shane Cohea, Director Safety & Security Michael Nabors, Manager Security Services Angie Bruce, Security Officer II Wendy Fiebrich, Manager Volunteer Services Debbie Oliphant, Patient Liaison Joy Hampton, Journalist Norman Transcript Recorder: LaRue Putman, Department Assistant  NRHA Board Minutes 2 January 22, 2018 Agenda Item I. Meeting Called to Order Mr. Clote called the January 22, 2018, Norman Regional Hospital Authority meeting to order at 5:32 p.m. Agenda Item II. Board Proclamation and Recognition Mr. Clote. Chair read the Proclamation recognizing performance excellence during the recent survey process with The Joint Commission. The Board agreed the Proclamation should be forwarded to the Norman Transcript. Agenda Item III. Introduction and Recognition of Outstanding Healers February 2018 Healer of the Month, Angie Bruce, Security Officer II, Security – Michael Nabors, Manager Security Services Mr. Clote introduced Mr. Nabors who presented Ms. Bruce as the Outstanding Healer for February 2018. Mr. Nabors shared the employee’s work commitment, positive attitude, accomplishments, and professionalism, and stated she is truly an asset to Norman Regional Health System and well deserving of this honor. Ms. Bruce thanked everyone for the Outstanding Healer recognition. Dr. Mantooth stated that the Emergency Department works frequently with Ms. Bruce and it is a pleasure to work around her. Mr. Clote congratulated and thanked Ms. Bruce on behalf of the Board for her outstanding dedication, professionalism and positive attitude that continues to make Norman Regional Health System a caring, high quality system. Mr. Cohea, Mr. Nabors, and Ms. Bruce left the meeting at 5:50 p.m. Dr. Anwar joined the meeting at this time. Agenda Item IV. Patient Family Advisory Council Update Ms. Fiebrich and Ms. Oliphant presented a brief history of the Patient Family Advisory Council (PFAC), consisting of nine Patient Family Advisors, five of which are community members and four are NRHS staff. One thing all nine Advisors have in common is that they or a member of their family has been a patient at NRHS. Ms. Fiebrich and Ms. Oliphant serve PFAC as Co-Chairs with the assistance of a 7-member Steering Committee. Projects of PFAC since first meeting in October 2017 were reviewed. Presentation concluded with a brief discussion of 2018 PFAC Goals. Agenda Item V. Approval of the December 18, 2017 Board Meeting Minutes Mr. Clote asked for approval of the December 18, 2017, Board Meeting Minutes ACTION TAKEN: Dr. Weber made the motion to approve the December 18, 2017, Board  NRHA Board Minutes 3 January 22, 2018 Meeting Minutes as submitted. Dr. Kimpel seconded the motion, and the motion unanimously approved with aye votes from Dr. Anwar, Dr. Chambers, Mr. Clote, Ms. Greenleaf, Dr. Kimpel, Mr. Sherman, and Dr. Weber. The minutes will reflect the order of discussion. Agenda Item VI. Board Education Session: Tax Cuts & Jobs Bill: The Impact on Non-Profits Mr. Hopkins led discussion of key provisions in the recent tax cuts & jobs bill, many of which took effect January 1, 2018 and the estimated impact on NRHS.  Repeal of the individual mandate, which will take effect January 1, 2019, is estimated may leave 4 to 13 million people without insurance coverage and may cause premiums to rise by 10%, which would increase the uninsured population, thereby hurting operating margins and cash flow.  Elimination of Advance Refunding Bonds, which is what NRHS used last year with savings of $33-38 million (NPV $20-24 million).  40% Reduction in Corporate Rate (35% to 21%), which causes the effective net benefit of owning municipals (municipal bonds) to drop, rendering them less attractive to investors, which weakens demand for tax-exempt bonds.  Double the standard deduction rate for individuals and an increased estate tax threshold will make charitable contributions less of a tax advantage and may cause a decrease in donations to the Norman Regional Foundation.  Pass-through Income Deduction, will not have a direct impact on NRHS, but should be considered in design of future joint ventures.  Tax-exempt organizations subject to 21% Excise Tax on compensation that exceeds $1 million paid to “covered employees”. This applies to both current and deferred compensation and to severance payments to the extent payments exceeds three times the five-year average compensation. This does not currently affect NRHS. Agenda Item VII. Performance Updates Ms. Anderson provided a Performance Update highlighting the following:  Patient Safety o Critical Results – Compliant Rate was discussed including the rescheduling of the 4 a.m. lab draws to improve the patient experience. Discussion included physician rounding at 7 a.m. and the availability of results at that time, especially in preparation for patient discharge. o Data reflects significant improvement in Multiple Drug Resistant Organisms Infection Rate on targeted units since implementation of Xenex robots in June 2016. We are looking to expand Xenex robot usage.  Quality and Performance Improvement o Emergency Department Throughput:  Median Length of Stay (LOS) for discharged patients at 122 minutes is significantly less than the regional average.  Median LOS for admitted patients at 235 minutes is less than the regional average.  NRHA Board Minutes 4 January 22, 2018  Patient Flow Process – tracking patients from triage to treatment location indicates some improvement with patients consistently reaching treatment location at 5 minutes.  Accreditation o Post Survey Response – 48 elements of performance are being addressed; four elements have been submitted for clarification and possible removal by The Joint Commission, one of which has already been removed.  Patient Experience o Inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) – dashboard was reviewed. Agenda Item VIII. Approval of the December 2017 Norman Regional Health System Financial Statements Mr. Hopkins noted December was a strong month with two good months in a row. Inpatient Cases were up almost 3% better than budget, and days were 2% below budget due to slightly lower Average Length of Stay (ALOS). Discharges were up 3% over the same 6-month period a year ago. Outpatients were rather strong at the mid- year point. December 2017 Financial Performance  Gross Revenues .................................. (Budget $157,214,389)............ $165,838,758  Net Patient Revenue .............................. (Budget $34,662,359).............. $37,128,406  Total Operating Expenses ..................... (Budget $33,808,729).............. $35,042,713  Total Operating Revenues ...................... (Budget $35,075,002).............. $37,492,156  Operating Income .................................... (Budget $1,266,273)................ $2,449,443  Non-Operating Revenues (Expenses) ........ (Budget $587,918)................ $1,443,114  Excess Revenues over Expenses ............ (Budget $1,854,191)................ $3,892,558 Year-to-Date  Operating Income .................................... (Budget $8,507,664)................ $7,515,275  Non-Operating Revenues (Expenses) ..... (Budget $3,405,508)................ $9,767,577  Excess Revenues over Expenses .......... (Budget $11,913,172).............. $17,282,853  Accounts Receivable Days ................. .......... (Budget 46 Days) .................. 42.7 Days  Days Cash on Hand .................................................................................. 220.3 Days ACTION TAKEN: Mr. Sherman motioned to approve the December 2017 NRHS Financial Statements. Dr. Weber seconded and the motion was approved unanimously with aye votes from Dr. Chambers, Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Kimpel, Mr. Sherman, and Dr. Weber. Agenda Item IX. Medical Staff A. Report from the January 10, 2018, Medical Executive Committee (MEC) Dr. Mantooth reported that MEC met January 10, 2018, and highlighted the following:  Reviewed and approved the December 13, 2017 minutes.  Penicillin allergy testing, a 3-month project by a pharmacy resident to test  NRHA Board Minutes 5 January 22, 2018 patients who state they are penicillin allergic to see if they are indeed allergic was approved. There are possibly four patients each week that could benefit from this testing. Studies show risk for anaphylaxis is less than 1%; however, patients are carefully screened to reduce the risk. This may lessen use of the more expensive broad-spectrum antibiotics.  Updated C-diff Protocol was discussed and approved.  The Central Line Removal Protocol was discussed and approved. Infectious Disease physicians have been excellent in taking on more responsibility in this area. The PICC Team may be changing their name to the Vascular Access Team (VAST) to better identify all they will be doing including dressing changes, lab draws, and working towards removal of central lines as soon as possible.  The Scribe Policy was reviewed and approved. Scribes are used mostly in the ED.  The Hospital Medicine Committee reviewed Penicillin Allergy Testing, Central Line Removal Policy, and Divert and Capacity Alert Policies. Agenda Item X. Strategic Planning Committee Dr. Weber reported the Strategic Planning Committee met Wednesday, January 8, and highlighted the following:  The two new Pediatric Hospitalists, Drs. Cook and Laughy, gave information on their goals to increase public and provider awareness about services provided. Dr. Cook noted that other specialties are more willing to accept teenage patients now that there are pediatric consultants available.  The committee received an update on the “Norman Way” customer service handbook which states, ‘be kind, be caring’. Urge you to look at this with care.  An update from Team Excellence was also presented focusing on the Norman Engagement Walls (NEWs walls), optimizing healer engagement around all the strategic imperatives through the health system.  Norman Regional Virtual Care go-live is scheduled for February 1, with rollout to employees February 12 and to the public March 19. .  Committee reviewed information on physician referrals.  Aortic Valve Disease program – reviewed data that focused on surveillance of valve disease as it relates to Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive valve replacement, making valve replacement available to patients who are not candidates for open-heart surgery.  Committee participated in a Gemba walk with Mr. Manfredo to view department NEWs walls. Agenda Item XII. Finance Committee A. Report from the January 15, 2018, Finance Committee Mr. Hopkins reported the Finance Committee met January 15, 2018, at 7:00 a.m. and highlighted the following:  Ms. Blau attended with a 2nd Quarter Risk Management Update reflecting improvement in some areas with no particular concerns to convey.  Key Performance Indicators (KPIs) – Point of Service Cash Collections were a bit challenged in December.  NRHA Board Minutes 6 January 22, 2018  Capital Items were presented for approval: Sonopet Ultrasonic Aspirator $136,472, Moore EMSStat Project $538,920, Mobile Ultima Cardio2 System $106,925. B. Recommend Approval of Capital Equipment Purchase Requests Mr. Manfredo presented the following five capital requests:   Sonopet Ultrasonic Aspirator $136,472 – equipment is used for brain tumor surgeries.  Moore EMSStat Project $538,920 – to refurbish and modernize the Moore ambulance station to include private bedrooms and ADA compliant restrooms. NRHS signed contract with City of Moore for an annual $1 lease until construction is paid back.  Mobile Ultima Cardio2 System $106,925 – Pulmonary Functions Test (PFT) with Cardiopulmonary Exercise Test Treadmill requested by pulmonologists PFT required for every new patient. ACTION TAKEN: Dr. Kimpel made a motion to approve the Capital Equipment Requests totaling $1,959,051 as recommended by the Finance Committee. Dr. Anwar seconded and the motion was approved unanimously with aye votes from Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, and Dr. Weber. Agenda Item XIII. Old Business Mr. Splitt reminded the deadline is today for Board HIPAA compliance. Mr. Splitt thanked the Board for recommending The Joint Commission proclamation to employees. It will be shared with staff. Today free drinks were available in the cafeteria for all healers as a small thank you for their preparation and efforts. Two new heart cath labs have opened at the HealthPlex. Dr. Anwar commented that image resolution is much better in the new rooms. Another benefit is reduced radiation exposure and improved tracking capabilities. Agenda Item XIV. New Business Mr. Splitt welcomed Dr. Mantooth to her first Board Meeting as Chief of Staff, and welcomed Dr. Jawed to his first Board Meeting as Chief of Staff-Elect. They will both be serving in these capacities for 2 years. In December, we had 34 cases of patients with flu. January to date, we are at 80 flu patients, representing a strong uptick in flu cases and the illness going around our community. Agenda Item XV. Administrative Report Mr. Splitt mentioned the following:  NRHA Board Minutes 7 January 22, 2018  Angie Bruce was one of two healers who responded superbly to a patient incident in the ER. Both healers were nominated for “Healer of the Month” and the other will be recognized next month. Both were involved in this one unique situation, reflecting the care and compassion of our healers.  The Joint Commission surveyor, who arrived early this morning for a follow-up survey, commented on the cleanliness of the facility, and the professional and engaged staff. This is Day 45 of our survey process and is the deadline for their return visit. The surveyor commented that he was greeted before he arrived at the front door. As he was waiting in the front lobby, he was impressed as he observed environmental services tech moving furniture to clean. Staff was doing a wonderful job.  The Norman Way handbooks will be distributed to all staff February 14 with a request for commitment (signature) on March 1.  Healer Forums – 11 sessions with more than 500 staff in attendance. Positive feedback about the forums was received.  Our recent facility capacity alerts are driven in part by the influx of flu patients.  The Gallup Q12 Survey has been available to staff since January 15 and is at about 50% after 1 week. Agenda Item XVI. Proposed Executive Session A. Proposed Vote to Convene an Executive Session Pursuant to 25 Okla. Stat. Section 307 B.4. to Discuss with Legal Counsel Pending Internal Peer Review/Credentialing Investigation Regarding the Medical Staff Members/Applicants Listed Below and Pursuant to 25 Okla. Stat. Section 307 B.1. ACTION TAKEN: Mr. Sherman made a motion to adjourn into Executive Session. Dr. Weber seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Ms. Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, Mr. Clote, and Dr. Weber. Ms. White, Ms. Gilmore, Mr. Hurley, Ms. McCool-Hare, Ms. Anderson, and Ms. Hampton left the meeting at 7:07 p.m. B. Medical Staff Recommendations Regarding the Medical Staff Members/ Applicants as Listed in XVI.B 1-3 Below 1. Recommend New Provisional (1-Year) Medical Staff Appointments: a) Michael Pidilla, MD, Active Staff -- Surgery Department b) Shannon Haenel, DO, Active Staff -- Medicine Department c) Jason Bellak, MD, Active-Affiliate Staff -- Medicine Department d) Samarea Webb, APRN-CNP, Allied Health Staff -- Medicine Department e) Alexis Stinnett, APRN-CNP, Allied Health Staff -- Medicine Department 2. Recommend Advancement of Medical Staff from Provisional Status: a) Ahmad Ashfaq, MD, Active Staff – Medicine Department b) Andrew Crabbe, MD, Active Staff – Anesthesia Department b) Andrew Fine, MD, Active Staff – Anesthesia Department d) Mark Lau, MD, Active Staff – Anesthesia Department e) Sumbal Nabi, MD, Active Staff – Medicine Department  NRHA Board Minutes 8 January 22, 2018 f) Jared Adams, MD, Active-Affiliate Staff – Medicine Department g) Jeffrey Goucher, RNFA, Allied Staff – Surgery Department 3. Recommend Medical Staff Reappointments: a) Brian Ellis, MD, Active Staff – Pediatrics Department b) Sudhakara Kunamneni, MD, Active Staff – Pediatrics Department c) Farhan Jawed, MD, Active Staff – Behavioral Medicine Department d) Norman “Paul” Ayers, MD, Active Staff – Cardiovascular Department e) Satish “Steve” Arora, MD, Active Staff – Medicine Department f) Joe Womble, MD, Active Staff – Hospital Medicine Department g) Lucius Doh, MD, Consulting Staff – Medicine Department h) Tan Pham, MD, Consulting Staff – Medicine Department i) Jennifer Smith, MD, Consulting Staff – OB/GYN Department j) Jeanie Loper, MD, Active-Affiliate Staff – Medicine Department k) Michelle Terhune, APRN-CNP, Allied Health Staff – Pediatrics Department l) Lynsey Janzen, PA-C, Allied Health Staff – Cardiovascular Medicine Department m) Nichole Womble, APRN-CNP, Allied Health Staff – Hospital Medicine Department C. Request to Adjourn Out of Any Such Executive Session and Return to Regular Session ACTION TAKEN: Dr. Kimpel made a motion to adjourn out of Executive Session and return to regular session. Dr. Weber seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Ms. Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, Mr. Clote, and Dr. Weber. Mr. Clote noted the Board returned to regular session. There were no decisions or votes taken except to return to regular session and any information shared during the Executive Session is privileged and needs to remain in Executive Session. D. Proposed Vote to Approve or Disapprove the Medical Executive Committee Recommendations Regarding Credentialing of the Referenced Medical Staff Members as Listed in XVI B 1-3 ACTION TAKEN: Mr. Sherman motioned to approve credentialing items as recommended by Medical Executive Committee and Credentials Committee of all referenced Medical Staff members listed in XVI B 1-3. Dr. Anwar seconded, and the motion was approved unanimously with aye votes from Dr. Anwar, Ms. Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, Mr. Clote, and Dr. Weber. Agenda Item XVII. Board Open Discussion Mr. Sherman announced the Foundation Ambassador’s Ball is February 2 and reminded that even if you are unable to attend, please remember the Foundation. Mr. Splitt mentioned an increased student/patient need in the Norman Public School system and the school Nursing Program. The nursing program is partially funded by NRHS and the Norman Regional Hospital Foundation. With over 16,000 students, the  NRHA Board Minutes 9 January 22, 2018 cost to address the growing demand is about $130,000. NRHS will partner with NPS to cover the cost of the increase – a one-time cost increase for this year. Dr. Weber mentioned that Norman Regional is a leader in the country in this public school nursing program partnership. People move to Norman to take advantage of this public school healthcare program because it is so helpful to their families. In a related story, Mr. Splitt stated the Foundation supports a dental program with a free clinic where they provide free toothbrushes to the children. Some of the children share comments like, “you mean I don’t have to share this toothbrush?” Mr. Splitt announced a potential opportunity to select a consultant to assist NRHS with Master Facility Planning efforts. Dr. Mantooth stated the pediatric hospitalists are doing a great job. Agenda Item XVIII. Closing Comments There was none. Agenda Item XIX. Adjournment ACTION TAKEN: Mr. Sherman made a motion to adjourn. Ms. Greenleaf seconded, and the motion passed unanimously with aye votes from Dr. Anwar, Ms. Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, Mr. Clote, and Dr. Weber. Respectfully Submitted, Tom Clote, Chair