Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY Board Meeting March 26, 2017 MINUTES The Norman Regional Hospital Authority met in monthly session Monday, March 26, 2018, at 5:30 p.m., in the Norman Regional Hospital Board Room. The meeting Agenda was posted March 22, 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. 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 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 Lisa White, Manager PI & Medical Staff Services Molly McCool-Hare, Business Planning/Operations Specialist Cindy Gilmore, LEAN Specialist Courtney Blau, Admin. Dir. Risk Management & Compliance Kelly Wells, Director Health Promotion & Community Relations Joy Hampton, Journalist Norman Transcript Brian Loftus, Business Planning/LEAN Specialist Erin Barnhart, Executive Director Foundation Toby Branum, Manager Nursing Resources Tracey Wooster, RN, Nursing Flex Pool Janet Johnson, Dir. Nursing Resources, One Call, Tele Tracking LeAnn Richardson, Dir. Case Management/Care Transition Robin Yoder, Manager Clinic Care Coordination Karen Rieger, Crowe & Dunlevy Recorder: Doris Gonzalez, Executive Assistant A member of the audience asked to address the Board, but Board Chair Tom Clote  NRHA Board Minutes 2 March 26, 2018 indicated that the matter was not on the agenda; therefore, could not be permitted under the Oklahoma Open Meetings Act and Board policy. Agenda Item I. Meeting Called to Order Mr. Clote called the March 26, 2018, Norman Regional Hospital Authority meeting to order at 5:38 p.m. Agenda Item II. Introduction and Recognition of Outstanding Healers A. April 2018 Healer of the Month, Tracey Wooster, RN, Nursing Flex Pool – Toby Branum, Manager Nursing Resources Mr. Clote introduced Mr. Branum who presented Ms. Wooster as the Outstanding Healer for April 2018. Mr. Branum noted that Ms. Wooster has worked for Norman Regional Health System for eight years and is a perfect example of our ICARE attributes. He shared the employee’s work commitment, positive attitude, accomplishments, and willingness to do what it takes to get the job done in a timely professional manner and be an inspiration while performing those duties. She is truly an asset to Norman Regional Health System and well deserving of this honor. Ms. Wooster thanked everyone for the Outstanding Healer recognition. Mr. Clote congratulated and thanked Ms. Wooster 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. Branum, Mr. Wooster, and Ms. Johnson left the meeting at 5:45 p.m. Agenda Item III. Norman Regional Foundation Update Ms. Barnhart provided an in-depth update on the Foundation accomplishments highlighting the following:  Foundation currently has 25 Board Members  The Mission of the Foundation is to “Enhance Excellent Health Care”. They do that in the following ways: 1) raise funds to events patient programs through grants to departments, 2) award scholarships to Norman Regional employees, and 3) support community health initiatives.  Raise funds o With 320 guests in attendance, including 18 physicians and 25 NRHS Management and Executives $211,600 was raised at the 11 th Annual Ambassador Ball. These funds help support our community initiatives. o With 100% of Management Team and 38% overall employee participation, the iGive Employee Campaign raised $164,492 in January/February 2018.  The funds raised through these campaigns are reinvested into the Norman Regional Health System through Foundation Grants: o In 2017, we awarded $167,000 to our departments and clinics for equipment or materials -- the best tools available to them. o We enhanced the patient experience through purchasing televisions for Porter  NRHA Board Minutes 3 March 26, 2018 Emergency Department and Oncology Unit, a van for the Senior Counseling Services, and white noise machines for several departments. o We took care of our employees by purchasing standing desks for Performance Improvement, Health Wellness Services and other departments. o Grant Applications are coming in and by the end of March we will have about $80,000 available to award. The Foundation awards annual scholarships in the amount of around $50,000 for Norman Regional employees and their direct family members. The average scholarship is about $1,800. Preparations are being made to accept scholarship applications for distribution in May. One of Ms. Barnhart’s personal goals is to provide an endowed fund for every person awarded a scholarship (20-25 endowed gifts). Currently there are four permanently restricted, four temporarily restricted (once the funds are expended that fund goes away), and two new Education/Training Endowed Funds.  Community Initiatives funded through the raised funds include: o $195,000 to our community initiatives (majority is for the nurse and health assistants in the NPS). Health Assistants see about 92,000 students each school year. Many of the children in the free/reduced lunch program do not have a healthcare provider and the Health Assistant Program may be the only healthcare provider they see throughout the school year. o Annual Flu Clinic in Moore o Purchased an AED Machine for the Robin Hill Public School o Purchased a wireless communication system for the Noble EMS  Healer engagement – The Foundation brought back about a year ago the Guardian Angel program. This program provides patients or their family members a way to acknowledge exceptional care giving at NRHS. We have awarded fourteen Guardian Angels to date and Thursday we are going to award two entire departments (Oncology Clinic and Radiation Therapy). All employees within the department will receive Guardian Angel awards.  Ways to assist: o Become Board and committee members – Maximum of 30 o Make a gift  Annual Fund/Monthly Giving  Endowed Fund (dollar to dollar match)  Guardian Angel o Follow us on Facebook – Norman Regional Foundation Ms. Barnhart left the meeting at this time. The minutes will reflect the order of discussion. Agenda Item VI. Approval of the February 2018 Norman Regional Health System Financial Statements Mr. Hopkins highlighted the following from the February 2018 NRHS Financial Statement:  February Hospital Inpatient Volumes – Discharges 13.7% higher than budget, patient days 12.4% higher than budget, and ALOS-CMI were both down from prior month.  February NRHS total Surgical Case were 1% below budget.  NRHA Board Minutes 4 March 26, 2018  February NRHS total Cath Lab cases were 7.4% below budget and 6% below budget year-to-date.  February NRHS Worked FTEs per AOB – remained favorable to budget and was the second best month this fiscal year. February 2018 Financial Performance  Gross Revenues .................................. (Budget $143,085,431)............ $157,204,806  Net Patient Revenue .............................. (Budget $31,731,870).............. $35,593,445  Total Operating Expenses ..................... (Budget $31,203,949).............. $32,557,816  Total Operating Revenues ...................... (Budget $32,128,001).............. $33,007,114  Operating Income ....................................... (Budget $924,052)................... $449,298  Non-Operating Revenues (Expenses) ........ (Budget $587,918)............... -$2,329,357  Excess Revenues over Expenses ............ (Budget $1,511,970)............... -$1,880,059 Year-to-Date  Operating Income .................................. (Budget $10,885,634)................ $9,500,761  Non-Operating Revenues (Expenses) ..... (Budget $4,520,344).............. $10,588,784  Excess Revenues over Expenses .......... (Budget $15,405,978).............. $20,089,546  Accounts Receivable Days ................. .......... (Budget 46 Days) .................. 42.5 Days  Days Cash on Hand .................................................................................. 221.8 Days Mr. Hopkins stated that Moody’s affirmed our current rating of BAA1 and our current outlook of “stable.” This was expected and not bad news. We are hoping to get an increase in at least the outlook next year. Concerns regarding upgrading the rating this year are that they rate sheer size, and they do not like to upgrade ratings off of a stable outlook. They prefer to upgrade outlook first, and then upgrade the rating later. We received good feedback from the rating agency and are pleased with the result overall. ACTION TAKEN: Dr. Weber motioned to approve the February 2018 NRHS Financial Statements. Dr. Kimpel seconded and the motion was approved unanimously with aye votes from Dr. Chambers, Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Kimpel, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Dr. Weber. Agenda Item IV. Approval of the February 26, 2018 Board Meeting Minutes Mr. Clote asked for approval of the February 26, 2018, Board Meeting Minutes ACTION TAKEN: Mr. Sherman made the motion to approve the February 26, 2018, Board Meeting Minutes as submitted. Dr. Weber seconded the motion, and the motion unanimously approved with aye votes from Dr. Anwar, Dr. Chambers, Mr. Clote, Mr. Cubberley, Ms. Greenleaf, Dr. Kimpel, Mr. Pipes, Mr. Sherman, and Dr. Weber. Agenda Item V. Performance Updates Ms. Anderson provided a Quality & Patient Safety Update highlighting the following:  Patient Safety o Hand Hygiene Updates (WIWO)  NRHA Board Minutes 5 March 26, 2018  The System will have another big push on hand hygiene this year pushing it back to the forefront of everyone’s mind. She highlighted the following:  Increase the number of departments participating (IP & OP/Clinics)  Increase the number of observations to 30 per month within each department  Review compliance percentage and observation percentage of each department monthly  Added Hand Hygiene to the NEWs Walls, which will be updated every two weeks with data showing where we are currently with our hand hygiene compliance. Hand Hygiene is the responsibility of everyone in the organization.  Quality and Performance Improvement o ICOUGH is a pulmonary care program that NRHS adapted from Boston Medical’s ICOUGH program that includes early and frequent mobilization, lung exercises, oral hygiene, and patient education in order to reduce hospital acquired pneumonia and acute respiratory failure. o Ms. Anderson presented an overview of the costs of pneumonia, the ICOUGH acronym, and a flier placed in the patient’s room and used as patient education for the ICOUGH program. She presented the ICOUGH checklist that will be placed in the patient’s room to track daily progress, and to encourage health providers and patient/family to fill out throughout the day reflecting the patient’s activities. o ICOUGH trial go live date for PCU, PCCU, Ortho/Spine, and Mother/Baby is April 9, 2018. Will roll out to the rest of the organization soon.  Accreditation Survey 2017 o Received full accreditation through December 9, 2020, for Hospital Program, Behavioral Health Program and Home Medical Equipment Program. o We will continue to have Nursing System-wide Improvement Teams, Accreditation Readiness Teams, and Accreditation Manager Plus and Tracers. o JC puts out Sentinel Event Alerts, which are things they have seen that could lead to adverse patient outcomes and the latest is on inadequate handoff communication. We will develop a team to review our handoff communication and improving upon that communication. It leads to our Strategic Plan that links into our Clinical Excellence and Operational Excellence, which will be begin in late April.  Patient Experience The inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) for December shows improvement in most categories and meets at least the 50th percentile in all except three categories where we showed improvement in two from our previous scores. The third is “would recommend” and that is showing improvement. Ms. Anderson showed a graph (January – December 2017) for Responsiveness of Staff. She noted the December 2017 percentage of “always” was the highest score we have had in quite some time. When starting the NEWs Walls, this item was one that most nursing units chose to focus on under their Service Excellence and have seen a decrease in the number of call lights rolling over to the desk. A Board member commended Ms. Anderson on her presentation.  NRHA Board Minutes 6 March 26, 2018 Agenda Item VII. Medical Staff A. Report from the March 14, 2018, Medical Executive Committee (MEC) Dr. Mantooth reported that MEC met March 14, 2018, and highlighted the following:  Mr. Beyer, Administrative Director Human Resources discussed sexual harassment in the workplace.  Discussed the Rheumatologists proposed call schedule at length and approved the call schedule as presented  Dr. Ingels presented from the Pathology Department proposal to use 2.5 rather than 3.0 for the low Potassium value, which is the standard with the rest of the hospitals within the area and nationally. MEC approved lowering the critical Potassium value from 3.0 to 2.5.  Department/Committee Reports o Hospital Medicine Department – Dr. Shahsavari reported the VAST team would be taking call on Sundays. They are excited about the launch of the new ICOUGH program. o OR Committee/Surgery Department – Dr. McCurdy reported they are maintaining their current status. o Emergency Medicine Department – Dr. Hoos-Reinke reported it is easier to order tPA in Meditech and if patient’s weight is entered into Meditech, Meditech will calculate the tPA doses. Discussed canceling e-scribed prescriptions and the proper way to cancel. Ms. Emmons attended the meeting where there was a lengthy discussion regarding EMTALA. She answered questions and assured the department what they were doing was in line with EMTALA. Noted the OBED is opening in July 2018. The fast track at Norman Regional Moore is being transformed into four inpatient/observation beds. o EM Residency: Dr. Cody reported there were 360+ applicants and they filled their six new residency spots, which will start June 18, 2018. Discussed a monthly M&M conference for the residents. o Behavioral Medicine – Dr. Jawed reported all of their quality measurements were all in green. Ceilings will be replaced in all the rooms on the Behavioral Medicine Unit. Discussed how they are able to set up medications for patients before they leave the floor. If the patient is unable to get the medications once they leave (indigence, and outpatient therapy centers), they will provide them the medications. Discussed the Outpatient Senior Counseling Center and the possibility of a geriatric psych inpatient unit. o Cardiovascular Department – Dr. Gautam reported the department selected their department indicators. They discussed AMI mortality. Working on becoming more compliant with the restraint policy and now have restraint orders automatically pop-up in Meditech for their patients. They made some minor changes to their ACS Level I & II protocols. o Medical Staff Reports:  Dr. LaVon passed away today. She was on staff at NRHS for 42 years.  There will be two Medical Staff Bylaw changes brought to MEC in the near future. o Reports from the Vice President –  Vizient was brought in to help make changes to Surgery and Anesthesia,  NRHA Board Minutes 7 March 26, 2018 which have been made.  Named Kyle Hurley, as the new ED System Manager. He will be working with Dr. Boyd on furthering changes to the ED.  Hired multiple Hospitalists and are working on bringing in nocturnal APPs.  Completed considerable work on the EMR in an effort to make it easier for providers to use.  A 2018 Provider Survey will be distributed in about a month.  Talked about the ICOUGH program, the VAST team coverage on Sunday, and noted the next stewardship program will be Opioid Stewardship. o Reports from the President /CEO  Discussed the Moore inpatient beds, virtual visits have increased, and CNO interviews are underway.  Eleven Xenex robots were taken to Moore, Norman, and Noble public schools. They cleaned over 530 classrooms, 14 cafeterias, 15 gyms, and 43 bathrooms.  February was Heart Health Awareness month and we assisted 206 self- referrals for Heart Scans. Agenda Item VIII Strategic Planning Committee Dr. Weber reported the Strategic Planning Committee met Monday, March 5, and highlighted the following:  Service Excellence team provided an update on the March 1 st system-wide signing day for the Norman Way Handbook. New employees will receive the handbook during orientation and will have 30 days to review and sign the commitment. The measurement used to determine progress on improving the patient experience, is the survey question, “Would you recommend this hospital?” The current score is 73.3% with a target of 77%.  Quality and Reliability team reported the NEWs Walls have been implemented system-wide and department leaders are using the walls to discuss department data and information to improve service and efficiency.  Team Excellence reported on the recent Healer Engagement survey results.  Pediatric Hospitalist Program Committee received an update on the Pediatric Hospitalist Program. Inpatient volumes have increased due to pediatricians adding services and therapies.  Strategic Plan 2019-2023 The planning process for the 2019-2023 strategic plan is ongoing. The Executives and the Strategy & Growth team are currently identifying key performance indicators for fiscal year 2019.  BHAG Ken Hopkins presented information on the updated financial forecast for the BHAG HealthPlex campus consolidation and Porter Transformation planning and implementation.  Gemba Walk Committee members adjourned for a Gemba walk to 3NW Bariatric/Medical-Surgical patient care unit to meet with the manager and staff about their NEWS Wall.  NRHA Board Minutes 8 March 26, 2018 Agenda Item IX. Finance Committee A. Report from the March 19, 2018, Finance Committee Mr. Cubberley reported the Finance Committee met March 19, and highlighted the following:  Ms. Blau presented the 2nd Quarter Risk Management Report highlighting the following: o Falls were down 8 from the previous quarter o Medication variances were lower than the same quarter last year o The number of patient complaints were approximately the same as last quarter and is on a slight downward trend o Patient compliments were slightly up for the quarter  Mr. Hopkins provided the Key Performance Indicators noting the Point of Service (POS) collections were below target for February due to fewer calendar days. However, collections as a percent of Net Revenue was just as strong as the prior month and favorable to target.  Mr. Hopkins provided a Moody’s Bond Update  Mr. Hopkins gave an update on the potential Medical Park West land purchase. We await an additional appraisal, and will continue to gather information, get partner input, and bring back options and suggestions to the Committee.  Mr. Hopkins provided an in-depth February 2018 Financial Report. He reported the following: o Charity Care estimated costs for February was $754,787 and YTD the System provided $6,346,809. o Bad Debt estimated costs for February was $1,478,486 and YTD was $12,480,474 o Community Contributions for February was $107,691 and YTD was $842,376  The Audit Committee met last month and determined that the best practice for audit rotation would be partner rotation, and adopt the most stringent standard currently being used by banks of 5 years on/5 years off for the primary audit partner. Based on this standard, they determined that Kevin Gore should rotate off and accepted BKD’s recommendation of Carley Williams as the system’s new primary audit partner. In May, there will be a pre-audit meeting with BKD and the Audit Committee.  Four capital requests were presented for approvals: o Precision Flow – Ten flowmeters used by pulmonary services and transferable throughout the system – cost $59,750 o Washer/Dryer for HealthPlex – cost $67,625 which includes construction o Security Camera Upgrade in high risk areas and is part of a multi-year plan – cost $56,870 o Risk/Compliance Department Remodel to combine the department employees in to one central area – Cost $ 120,275 B. Recommend Approval of Capital Equipment Purchase Requests ACTION TAKEN: Mr. Cubberley made a motion to approve the Capital Equipment Requests totaling $304,520 as recommended by the Finance Committee. Dr. Weber seconded and the motion was approved unanimously with aye votes from Mr. Clote, Dr. Anwar, Ms.  NRHA Board Minutes 9 March 26, 2018 Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Dr. Weber. Agenda Item X. Old Business Mr. Splitt noted last month we had the Opioid Stewardship presentation and mentioned that we were going to participate in the Vizient Collaborative. We have submitted our charter and hope to engage and collaborate with other facilities to determine what works in terms of prescribing and administering. This collaborative is national and is over a course of 9 months. There are over 20 facilities participating. Agenda Item XI. New Business A. The 2017 Annual Evaluation of the Environment of Care Management Plans ACTION TAKEN: Mr. Pipes moved to approve the 2017 Annual Evaluation of the Environment of Care Management Plans as submitted. Mr. Sherman seconded and the motion was approved unanimously with aye votes from Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Chambers, Dr. Kimpel, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Dr. Weber. Mr. Splitt noted the OBED is the implementation of an OB/GYN laborists program 24 hours 7 days a week at the HealthPlex available to assist our mothers in a crisis. Next month we will bring a capital project request in order to make adjustments in the facility to accommodate needs. Agenda Item XII. Administrative Report Mr. Splitt reported on his recent trip where he was invited to share what we are doing at Norman Regional with a group of hospitals across the country. In his presentation, he mentioned the participation of Board members in Gemba walks with the NEWs walls. That was well received with inquiries afterwards regarding how we are managing that program and how hospital CEOs can get their Board members to participate as you have. Compliments to the Board members, and we will keep sharing our story. Agenda Item XIII. 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: Dr. Kimpel made a motion to adjourn into Executive Session. 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, Mr. Cubberley, Mr. Pipes, and Dr. Weber.  NRHA Board Minutes 10 March 26, 2018 Ms. Richardson, Ms. Yoder, Ms. White, Ms. Gilmore, Ms. McCool-Hare, Mr. Loftus, Ms. Wells, Ms. Blau, Ms. Anderson, Ms. Hampton, and all other guests left the meeting at 7:07 p.m. B. Medical Staff Recommendations Regarding the Medical Staff Members/ Applicants as Listed in XIII.B 1-3 Below 1. Recommend New Provisional Medical Staff Appointments: a) Grant Meltzer, MD, Active Staff – Hospital Medicine Department b) Atmaram Pai Pandiker, MD, Consulting Staff – Medicine Department c) Jeanie Zhang, MD, Privilege Only-Teleradiology Staff – Radiology Dept. d) Robert Miller, MD, Privilege Only-Teleradiology Staff – Radiology Dept. e) Parker Martin, PA, Allied Health Staff – Surgery Department f) Charlysa Brady, APRN-CNP, Allied Health Staff – Emergency Med. Dept. 2. Recommend Advancement of Medical Staff from Provisional Status: a) Chun Kwan, MD, Active Staff – Anesthesia Department b) Ting Chen, MD, Active Staff – Anesthesia Department c) Jeremy Woodson, MD, Active Staff – Surgery Department d) Marianne Bacharach, MD, Courtesy Staff – Emergency Med. Dept. e) Kevin Epperson, MC, Active Affiliate Staff – Medicine Department 3. Recommend Medical Staff Reappointments: a) Michael Villano, MD, Active Staff – Cardiovascular Medicine Dept. b) Andrew Black, MD, Active Staff – Medicine Department c) Daphne Lashbrook, MD, Active Staff – OB/Gyn Department d) Charles “Mike” Rogers, MD, Active Staff – Hospital Medicine Dept. e) Melisa Boersma, MD, Consulting Staff – Medicine Department f) Kiran Prabhu, MD, Consulting Staff – Medicine Department g) Shripal Bhavsar, MD, Consulting Staff – Medicine Department h) Kim Wiese, PA-C, Allied Health Staff – Emergency Medicine Dept. C. Request to Adjourn Out of Any Such Executive Session and Return to Regular Session ACTION TAKEN: Mr. Sherman made a motion to adjourn out of Executive Session and return to regular session. Mr. Pipes seconded and the motion was approved unanimously with aye votes from Dr. Chambers, Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Kimpel, Mr. Sherman, Mr. Cubberley, Mr. Pipes, 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 XIII B 1-3  NRHA Board Minutes 11 March 26, 2018 ACTION TAKEN: Dr. Weber motioned to approve credentialing items as recommended by Medical Executive Committee and Credentials Committee of all referenced Medical Staff members listed in XIII B 1-3. Dr. Chambers seconded, and the motion was approved with aye votes from Dr. Chambers, Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Kimpel, Mr. Sherman, Mr. Pipes, and Dr. Weber. Mr. Cubberley voted aye on all referenced Medical Staff members as recommended by the Credentials and Medical Executive Committees except for item XIII B 3d for which he voted no. Ms. Richardson and Ms. Yoder rejoined the meeting at this time. Agenda Item XIV. Board Education Session: ACO & CPC+ Update Ms. Carter, Ms. Richardson, and Ms. Yoder provided a comprehensive Accountable Care Organization (ACO) and Comprehensive Primary Care Plus (CPC+) Update for 2017. They highlighted the following:  Both ACO & CPC+ initiatives started January 2017  Participants in both are the NRHS employed primary care providers  Goal of both initiatives is to provide high-quality care for the lowest cost possible. Providing the right care, in the right setting, at the right time.  Provided an outline of some of the parameters for ACO vs. CPC+  Official name is Norman Regional Hospital ACO, LLC  Governing Board meets three times a year and is comprised of 11 Primary Care Physicians, 2 Health System Representatives, one Medicare Beneficiary and Clinic Leadership  ACO Committees: o Clinical Transformation Council (CTC) – Guides, implements, and maintains clinical quality, cost savings, and patient satisfaction while overseeing improvement of clinical processes of Norman Regional Clinics o Quality Assurance – Ensures the process of the CTC are achieving desired results o Finance – Oversees the distribution of shared savings  2017 Finance Performance o ACO  Attributed Lives – 6,130  Total Expenditures -- $61,406,524  Expenditure per Beneficiary -- $10,017  Expected Benchmark per Beneficiary -- $9,393 o CPC+  Revenue from Care Management Fees -- $1,023,468  Labor Operating Expenses -- $584,328  Software ACO & CPC+ -- $62,825  Total Operating Expense -- $647,153  Net Operating Income -- $376,315  Ms. Yoder provided an overview of the Key Initiatives highlighting the following: o Population Risk Assessment – 35,000 unique patients o Quality Measures R/T Preventative Care  Annual Wellness Visits  Documentation Improvement Project  NRHA Board Minutes 12 March 26, 2018 o ED Utilization  System influencers, Patient Education, Clinic Culture o Short Term and Long Term Care Management  Follow-up Post ED Visit/Hospital Discharge  Disease Education/Self-Management Skills  Coordination of services between care teams o Population Health Team  Addition of five Population Health Nurses to focus on the preventative side  Ms. Richardson provided an in-depth review of the Inpatient Continuum of Care (Pre-Acute Care, Acute Care, and Post-Acute Care) highlighting the following: o Acute to Clinic  Ambulatory Physician representation on key hospital committee  Acute Case Manager hands off patient to Clinic Care Coordinator for high risk acute (hospital) discharges  Notification to Clinic of ED Patient discharges for follow-up  Notification to Clinic of Inpatient discharges for follow-up o Acute to Post-Acute  Norman Area Care Transitions (NACT)  COPD Readmission Reduction Project  Heart Failure Readmission Reduction Project  Chronic Disease Initiative o Preferred Skilled Nursing Facilities  Weekly Interdisciplinary Rounds to identify barriers and decrease length-of- stay  Reports sent to Primary Care Clinic o Preferred Home Health Providers  Monthly meetings to discuss readmission and care issues  Actively working on decreasing unnecessary use of Emergency Department  New Clinical Transformation Sub-Committee formed o Preferred Hospice Providers  Newly formed  Part of the Chronic Disease Initiative  Chronic Disease Initiative o Showed a slide that showed the future initiatives at NRHS (Black – Acute [ED & Hospital], Red – Clinics or ambulatory, and Blue – Post-Acute or Community) o As we move forward, this structure is what we need to see from all committees and initiatives in order to address the entire continuum of care. You cannot address the continuum unless you communicate to one another. This is how we will improve quality of care and decrease our cost to our patients. Agenda Item XV. Board Open Discussion A Board member requested to verify that there are security cameras in the ED waiting areas so the triage nurse has the ability to see and know what is going on in those areas. Ms. McGill will follow-up on that request. Agenda Item XVI. Closing Comments There was none.  NRHA Board Minutes 13 March 26, 2018 Agenda Item XVII. Adjournment ACTION TAKEN: Mr. Sherman made a motion to adjourn at 7:50 p.m. Ms. Greenleaf seconded, and the motion passed unanimously with aye votes from Dr. Chambers, Mr. Clote, Dr. Anwar, Ms. Greenleaf, Dr. Kimpel, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Dr. Weber. Respectfully Submitted, Doug Cubberley, Vice Chairman/Secretary