Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY Board Meeting June 25, 2018 MINUTES The Norman Regional Hospital Authority met in monthly session Tuesday, June 25, 2018, at 5:30 p.m., in the Norman Regional Hospital Board Room. The meeting Agenda was posted June 21, 2018, on the NRHS and Norman websites and at the entrance to Norman Regional Hospital. Members Present: Tom Clote, Chair Doug Cubberley, Vice Chair/Secretary Joan Greenleaf Muhammad Anwar, MD James (Jeff) Kimpel, Ph.D. Tom Sherman Jerome (Jerry) Weber, Ph.D. Kevin Pipes Diane Chambers, MD Others Present: Robin Mantooth, MD, Chief of Staff Farhan Jawed, MD, Chief of Staff-Elect Richie Splitt, President and CEO Meegan Carter, VP Population Health & Wellness Paula Price, VP Strategy & Growth Brittni McGill, CNO John Manfredo, COO Dr. Aaron Boyd, CMO Michael Laird, Crowe & Dunlevy Jenny Anderson, Director QPI & Medical Staff Services Lisa White, Manager PI & Medical Staff Services Molly McCool-Hare, Business Planning/Operations Specialist Cindy Gilmore, LEAN Specialist Brian Loftus, Business Planning/LEAN Specialist Courtney Blau, Admin. Dir. Risk Management & Compliance Kelly Wells, Director Health Promotion & Community Relations Danny Kelley, Administrative Director HIT Jennifer Alinger, HIT Assistant Julie Beed, RN, PCU Charge Nurse Laura Winters, Manager PCU Dr. Tom Whalen Sally Clote April Whalen Lindsay Cavin, RN PCU Joy Hampton, Norman Transcript Reporter Recorder: Doris Gonzalez, Executive Assistant  NRHA Board Minutes 2 June 25, 2018 Agenda Item I. Meeting Called to Order Mr. Clote called the June 25, 2018, Norman Regional Hospital Authority meeting to order at 5:32 p.m. Agenda Item II. Recognition of Mr. Tom Clote for his Outstanding Service as NRHA Board Member and Chair Mr. Cubberley shared a momentous and historic summary of Mr. Clote’s seventeen- years of service on the Norman Regional Hospital Authority Board. Noting through his untiring dedication and exceptional leadership, he assisted NRHS in sustaining superior medical care for the region. Mr. Cubberley thanked Mr. Clote on behalf of the Board for his commitment to the Health System and Board, presenting him with an “End of the Trails” statue in appreciation and recognition of his service on the NRHA Board. We all will surely miss Mr. Clote. Mr. Clote thanked everyone for the opportunity to serve on NRHA Board. He noted that Norman Regional Health System is safe on both the board and with our leadership team. He thanked the group for allowing him to serve. Mr. Splitt thanked Mr. Clote for his service and presented Mr. and Mrs. Clote a gift in recognition of their 41 years of marriage. Agenda Item III. Introduction and Recognition of Outstanding Healers A. July 2018 Healer of the Month, Julie Beed, RN, Progressive Care Unit (PCU) Charge Nurse – Laura Winters, Manager ICU/PCU Mr. Clote introduced Ms. Winters who presented Ms. Beed as the Outstanding Healer for July 2018. Ms. Winters noted that Ms. Beed started her career at Norman Regional in 1984 and shared the employee’s accomplishments, outstanding teamwork, work ethic, vast knowledge base, positive attitude, and her compassion toward patients, families and co-workers. She is truly an asset to the Progressive Care Unit and Norman Regional Health System. She exemplifies the “Norman Way” and well deserving of this honor. Ms. Beed stated she was honored to be recognized as Healer of the Month, grateful and proud to work with the very best healers ever, and that Norman Regional Health System is a great organization for which to work. Mr. Clote congratulated and thanked Ms. Beed 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. Dr. Whalen, April Whalen, Sally Clote, Julie Beed, Laura Winters, Danny Kelley, Jennifer Alinger, and Lindsay Cavin left the meeting at 5:41 p.m.  NRHA Board Minutes 3 June 25, 2018 Agenda Item IV. Approval of the May 29, 2018, Board Meeting Minutes Mr. Clote asked for approval of the May 29, 2018, Board Meeting Minutes ACTION TAKEN: Dr. Weber made the motion to approve the May 29, 2018, Board Meeting Minutes as submitted. Mr. Sherman seconded the motion, and the motion was approved unanimously with aye votes from Dr. Anwar, Mr. Cubberley, Dr. Kimpel, Dr. Chambers, Dr. Weber, Mr. Pipes, Ms. Greenleaf, Mr. Sherman, and Mr. Clote. Agenda Item V. Performance Updates Ms. Anderson provided the Quality & Patient Safety Update highlighting the following:  Patient Safety o Reportable Events –  Medication Related Events – The Sentinel Event Determination Team (SEDT) reviews all variances to see if they caused harm, determine how we could have prevented the event, and develop action plans when trends are noted.  Falls with Injury – The Falls Committee meets monthly to review falls. They reviewed the Johns Hopkins Falls Program they put in place to ensure everyone is following the program and made a few tweaks to the program.  An immediate post-fall huddle called by the nursing staff ensures everything was done appropriately and determines if anything could have been done to prevent the fall. We are starting to track controlled lowering, which is when a healthcare provider sees individual falling, rushes to the individual and assists them to the floor. It still counts as a fall but with our ICOUGH program, there is more opportunities for control lowering.  C-difficile continues to increase. We are making changes to documentation screens, computer pop-up messages on ordering, and starting to review all hospital-acquired cases with the Infectious Disease physicians.  Surgical Site Infections (SSI) – We have seen a decrease in these cases this year. A colorectal checklist was developed, joined Improving Surgical Care and Recovery (ISCR) Cohort for improved surgical care through all of periop (starts in the physician office and goes through discharge), and we are currently developing a checklist and order sets for Hips/Knees. Having the involvement of the surgeon and anesthesiologist has been a huge help to develop the right strategies.  Central Line Associated Bloodstream Infection (CLABSI) – With the implementation of the Vascular Access Specialist Team (VAST), we have seen a decrease. They continue to perform observations and teaching on proper barrier precautions and insertion techniques, proper hub prep prior to access, proper changing of tubing as appropriate, and removal protocol.  Quality and Performance Improvement o Stroke Program Recognition – This year Norman Regional Health System received the Get With the Guidelines – Stroke Silver Plus Quality Achievement Award from the American Heart Association/American Stroke Association. The requirements for the “Silver” Award:  Meet 85% or high compliance to core standard levels for care, as out outlined  NRHA Board Minutes 4 June 25, 2018 for a consecutive 12 months period.  Meet 75% or higher compliance in 7 of 10 stroke quality measures during the same consecutive 12-month period.  Meet a three-level Honor Roll requirement, which they received the highest level “Honor Roll-Elite Plus, which is time to thrombolytic therapy within 60 minutes in 75% or more of acute ischemic stroke patients treated with IV tPA (they achieved 81%) and within 45% in 50% of acute ischemic stroke patients treated with IV tPA ( they achieved 52.4%).  They strive to receive the gold award next year, which requires the same standards consistently met for 24 months. o Vizient Hospital Improvement Innovative Network (HIIN) Outcomes  Sepsis – The Porter Campus Baseline Sepsis Mortality Rate from January 2014 thru September 2016 was 17.78%. We are currently at 15.77% a 10.3% improvement. When we annualized that improvement, NRHS avoided 15 cases of Sepsis Mortality.  SSI Colon – NRHS went from a 1.96% to a 1.17%, which is a 40.1% improvement and avoided four (4) cases for the year.  The Centers for Medicare and Medicaid Services goal is a 20% reduction in harm and a 12% reduction in readmission across the nation. NRHS submitted data on 26 metrics in these two categories. o Patient Experience – Inpatient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Calendar Year 2018 data through March  Communication with Nurses (Always) – Through the entire quarter they are above the goal of 78.84. Interventions done were hourly rounding, standardized call light answering process, and leadership support.  Communication with Physicians (Always) – For the year they were a little under the goal of 80.32% at 79.83%; however, for February and March 2018 they were above the goal of 80.41% at 82.37%.  Health System Real-Time -- Would Recommend Trends – From inception to last week, trending upward. Agenda Item VI. Approval of the May 2018 Norman Regional Health System Financial Statements Mr. Hopkins presented the May 2018 Norman Regional Health System Financial report highlighted the following:  May System Inpatient Volumes – Admissions were strong in May. Discharges were 7.4% above budget with a favorable Average-Length-of-Stay and strong Cath Lab and Surgery. Despite this stronger volume, there was pressure on net revenue due to weaker than expected payer mix, decrease SHOPP revenues, higher denials than budgeted and low Case Mix Index.  May System Outpatient Registrations – System Outpatient volumes were also strong in May. Overall outpatient visits were 7.7% higher than budget and included strong Cath Lab and surgeries. Clinics registrations continue to outpace a tough budget. May 2018 Financial Performance  Gross Revenues .................................. (Budget $158,386,308)............ $168,017,644  Net Patient Revenue .............................. (Budget $35,088,140).............. $35,036,740  Total Operating Expenses ..................... (Budget $33,990,460).............. $34,604,613  NRHA Board Minutes 5 June 25, 2018  Total Operating Revenues ...................... (Budget $35,500,783).............. $35,486,508  Operating Income .................................... (Budget $1,510,323)................... $881,895  Non-Operating Revenues (Expenses) ........ (Budget $587,918)................... $689,120  Excess Revenues over Expenses ............ (Budget $2,098,241)................ $1,580,015 Year-to-Date  Operating Income .................................. (Budget $15,411,656).............. $14,387,796  Non-Operating Revenues (Expenses) ..... (Budget $6,223,098).............. $11,617,222  Excess Revenues over Expenses .......... (Budget $21,634,754).............. $26,004,718  Accounts Receivable Days ............................ (Budget 46 Days).................. 44.5 Days  Days Cash on Hand .................................................................. ................ 220.3 Days ACTION TAKEN: Mr. Sherman motioned to approve the April 2018 NRHS Financial Statements. Dr. Weber seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Mr. Cubberley, Dr. Kimpel, Mr. Pipes, Dr. Chambers, Ms. Greenleaf, Mr. Sherman, Dr. Weber, and Mr. Clote. Agenda Item VII. Medical Staff A. Report from the June 13, 2018, Medical Executive Committee (MEC) Dr. Mantooth reported that MEC met June 13, 2018, and highlighted the following:  Discussed the Probiotic Protocol Trial where patients on antibiotics were started on probiotics in an effort to decrease the number of C.diff cases within the System. As patients were discharged, they were recommended to remain on the probiotic for a total of five days. This trial began January 16, 2018. The conclusion was that the estimated total annual cost saved by using the Probiotic Protocol was $110,667. There were no adverse effects during this trial. Currently starting to change all antibiotic order sets to start a probiotic. Discussed the cost of the probiotics once the patient is discharged. The ongoing discussion is going to be, should we give the patients the probiotics they need to complete their course and what would be the cost and how will that impact the savings. Currently we are not providing the probiotics to the patients on discharge. They are recommended to purchase them.  Discussed the Penicillin Testing Trial – Screening all patients who listed Penicillin as an allergy. Two Hundred eighty one patients with penicillin allergies listed were tested. Five of the 281 patients were to receive a Penicillin Antibiotic and all five tested negative. There is talk about expanding this as well because there are many patients admitted and may not be on a penicillin antibiotic this time, but return and it would be nice to have a verified test result of non-allergy to penicillin. Talking about the cost of this additional test.  Discussed and approved leaving the critical Potassium low value of 3.0 for both inpatients and outpatients.  Reviewed and approved the 2019 Utilization Review Plan.  The Provider Satisfaction Survey results were presented noting that for FY2018 they will be targeting nursing, Emergency Department residents, and Advanced Practitioners. Ms. McGill presented initiatives that the nursing staff will be taking in response to the provider Satisfaction Survey. A suggestion was to consider bringing back the Nurse Extern Program because the quality of nurse from that program was  NRHA Board Minutes 6 June 25, 2018 superior. Ms. McGill stated she would look into getting this program revived. She said they were also working on a standardized patient hand off tool and from that, each floor could customize patient handoffs that better fit their department.  Discussed and approved adding the Physician Disruptive Behavior Policy addition to the Medical Staff Bylaws, which will be voted on by all Medical Staff before sending to the Board for final approval.  Discussed and approved adding the proposed Recusal Policy to the Medical Staff Bylaws, which will be voted on by all Medical Staff before sending to the Board for final approval.  Department/Committee Reports o Health System Quality Patient Safety Committee – Ms. Anderson reported that NRHS is currently at 59% overall for sepsis, the state is at 49% and the nation is at 50%. Four units have begun trialing the ICOUGH program and have received valuable feedback for the system-wide roll out. NRHS continues to struggle with C.diff, Colons look good, but hip and knee infections have increased. Ms. Blau gave a compliance report and discussed the Star Rating noting that the System will remain a 3 Star while they look at their methodology. o OB/Gyn Department – Dr. Parker provided an update on the Laborists Program, noting the program will start July 18, 2018. o Emergency Medicine Department – Dr. Hoos-Reinke reported the following:  Discussed the changes they made to the pneumonia care map  One of the Emergency Medicine residents is in the process of developing guidelines for opioid dispensing within the ED.  Dr. Zimmerman gave her first “Quality Pearl” presentation on pre-oxygenation prior to intubation. She will be presenting different Quality Pearls monthly.  Discussed blood culture contamination rates and how they are increasing and they are working on a plan to reduce that rate. o Radiology Department – Dr. Webber announced that Moore now has a mammography machine and a Dexa machine. Discussed the VRAD delays due to being short staffed.  Reports from the Medical Staff – Dr. Boyd discussed the following: o Administration will be sending a survey to all physicians regarding physician burnout. o NRHS investigating ways to better integrate APPs into the Medical Staff so they feel they have a voice. o He expressed his appreciation for the pharmacists and Infectious Disease Physician for all they have done and are doing. He stated they are a great asset to our Health System. o Talked about ideas to shorten the time physicians sees patients initially. o Discussed the changes to Rehab. Hospitalists will start doing medical consultations on Rehab patients since the census has increased significantly.  Reports from the President o Announced that an Administrative Fellowship Program will be starting at NRHS. There will be an interview process and one person will be chosen for the fellowship yearly. o Navigant has received NRHS’s data, is gathering more information and could possibly present to the next MEC meeting. o Thanked Mr. Clote for his seventeen years of service on the NRHA Board and noted that Mr. Cubberley will become the Board’s incoming Chair.  NRHA Board Minutes 7 June 25, 2018 Agenda Item VIII Patient Quality and Safety Committee Ms. Greenleaf reported the Patient Quality and Safety Committee met on June 4, 2018, and received a comprehensive report by Ms. Anderson. Ms. McDade, Ms. Johnson, Mr. Branum and Mr. Brawner provided a TeleTracking update. TeleTracking, which went live in March 2017 with a Transfer Center, Pre-Admit Tracking, Transport Tracking, and Bed and Patient Tracking, follows the patient from admission to discharge. It gets our rooms cleaned quicker because it gives the signal to the Environmental Tech that the room is vacated and ready to be cleaned. This makes the room ready for the next patient more quickly. It might be nice for them to provide an update to the Board. The Committee’s focus priorities will include infections, sepsis and mortality. Agenda Item IX. Strategic Planning Committee Dr. Weber reported the Strategic Planning Committee met Monday, June 20, 2018, to receive a year-end update on the Health System’s 2018 Strategic Plan. The meeting focused on the four focus area goals, objectives and expected year-end targets.  In the Focus Area of Service Excellence: o The Norman Way customer service handbook was implemented system wide. o The patient feedback survey question, “Would you recommend this facility” has reduced the variability in the rating and improved overall.  In the Focus Area of Operational Excellence: o Norman Regional has achieved key financial performance goals in every indicator with the exception of operating margin, which is 0.3% off target at end of May 2018. o Health System primary and specialty provider clinics have experienced growth in overall patient visits and in new patients. o In general, health system service lines and ancillary services experienced growth in procedures, testing, surgery volumes, both in inpatient and outpatient setting.  In the Focus Area of Clinical Excellence: o The Health System has made good progress in population health that uses better care management of patients with chronic disease and healthcare spending. Specifically in the areas of hip and knee joint replacement, reduction in Medicare spending per beneficiary (MSPB), in length of stay, and in readmissions due to Urinary Tract Infections (UTI). o We have seen improvement in hospital readmissions for pneumonia, acute myocardial infarction, heart failure, coronary artery bypass grafting and chronic obstructive pulmonary disease.  In the Focus Area of Team Excellence: o Implemented the Gallup Engagement Survey and exceeded the employee participation target Agenda Item X. Finance Committee A. Report from the June 18, 2018, Finance Committee Mr. Cubberley reported the Finance Committee met June 18, 2018, and highlighted the following: NRHA Board Minutes 8 June 25, 2018  Ms. Price provided a year-end comprehensive review of the FY2018 Strategic Plan.  Mr. Kott, Director of Supply Chain Management, presented an overview of the recent Gallup Q12 Survey. Q12 Survey measures employee engagement and we exceeded our target of 60%. We are using the feedback we received from the survey to develop department action plans, which are being implemented. The next Q12 Survey will be in July.  Discussed the proposed resolution and related draft documents regarding Medical Park West, LLC. Approved forwarding the resolution to the Board for final approval.  Reviewed a retirement amendment that includes a Roth feature added to the NRHA retirement plans. This amendment clarifies our intent and practice with respect to in-service distributions of rollover funds. Approved forwarding the proposed amendment to the Board for final approval.  Reviewed the Key Performance Indicators (KPIs) noting the following: o Point of Service Collections were $366K for May but down slightly from the goal of $400K o Underpayments Recovered, as a percent of Total Identified was very strong at 35% ($166K for May vs. $25K average). o Insurance Aging did “go yellow” in May, but has actually been trending worse over the last two months due to insurance companies hanging on to their money longer and challenging claims.  Mr. Hopkins provided an extensive May 2018 Financial Report  Charity Care YTD was $8.9 million  Bad Debt for April YTD was $16.8 million  Community Contributions was $1.1 million  Mr. Hopkins presented a projection of how the current year (FY2018) is expected to end. He noted the improvement in key financial ratios from the prior year and the primary goals for the FY2019 budget, which are: 1) consistent with long- range forecast, 2) continue building capacity for BHAG, 3) support growth and strategic initiatives and 4) accommodate for reduction in SHOPP.  Mr. Hopkins highlighted the following for the FY 2019 NRHS Budget: o Net Revenue of $436.8 million o Operating Expense of $427.5 million o Operating Income of $14.1 million (3.2% operating profit margin) o Capital Budget of $15 million (not including potential MPW buyout) o Days Cash on Hand target as of June 30, 2018, is 230 days o Target MADS Coverage of 4.1 o Target Cash to Debt Ratio of 152.7% o Target Deb to Cap Ratio of 33.1%  Six capital requests were presented for approvals totaling $753,114: o Xenex Germ-Zapping Robot X 2 - $200,416 o Provation Licensed Software for Gastroenterology -- $107,167 o Advanta 2 Med/Surg Beds X 31 - $203,836 – Will replace med/surg beds purchased in 2003-2004 that are at end of service o Bassinets X 30 - $85,195 o REMISO Advance -- $99,456 – This will link all Beckman analyzers in the Lab to view/monitor/systematically run the instruments via one workstation o Beckman Coulter Urine Analyzer X 2 -- $57,044  NRHA Board Minutes 9 June 25, 2018 B. Recommend Approval of the FY2019 NRHS Budget ACTION TAKEN: Dr. Weber made a motion to approve the FY2019 Budget as Recommended by the Finance Committee. Mr. Sherman seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Dr. Weber, Dr. Chambers, Dr. Kimpel, Ms. Greenleaf, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Mr. Clote. C. Recommend Approval of the Proposed Resolution and the 2018 First Amendment to the Eligible Deferred Compensation Plan as Forwarded by the Finance Committee ACTION TAKEN: Dr. Weber motioned to approve the Proposed Resolution and the 2018 First Amendment to the Eligible Deferred Compensation Plan as Forwarded by the Finance Committee. Mr. Sherman seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Dr. Weber, Dr. Chambers, Dr. Kimpel, Ms. Greenleaf, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Mr. Clote. D. Recommend Approval of Capital Equipment Purchase Requests ACTION TAKEN: Dr. Weber made a motion to approve the Capital Equipment Requests totaling $753,115 as recommended by the Finance Committee. Ms. Greenleaf seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Mr. Cubberley, Dr. Kimpel, Dr. Chambers, Mr. Pipes, Ms. Greenleaf, Mr. Sherman, Dr. Weber, and Mr. Clote. Agenda Item XI. Old Business Mr. Splitt announced that the two Germ-Zapping Robots approved tonight would go into the System’s two surgical departments on Porter and HealthPlex campus to assist in the overall Infection Prevention efforts. He complimented the Infectious Disease physicians and the team for assisting them with what they do. They have been very responsive and supportive in our efforts. Agenda Item XII. New Business There was none. Agenda Item XIII. Administrative Report Mr. Splitt provided an update on the following:  We have established an Administrative Fellow program and had our first interview process with two candidates presenting a power point presentation at the Executive Team meeting. We selected the top candidate and once the individual accepts we will pass that along to the group. This is a one-year fellowship guaranteed unemployment at the end of the year.  NRHS has been looking for opportunities to connect with the talents and programs of the University of Oklahoma. The JC Penny Leadership Center Fellows Program  NRHA Board Minutes 10 June 25, 2018 through the OU Price College of Business is one such opportunity. OU is in the process of identifying potential undergraduate students who would serve as a non- voting member of the NRHA Board for one year. Once the candidates are identified, we will circulate the resumes to the Board for review and selection.  The Orthopedic Surgeon conducting the recent Joint Commission Survey for the disease specific certification around total hips and knees and hip fractures was very complimentary of our team and the outcomes achieved. He had some recommendations for improvement and we await the final report.  Provided an update on Blue Cross & Blue Shield’s ongoing contract negotiations and the Blue Distinction for Bariatric Surgery. The Board will be updated on the progress. Agenda Item XIV 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 to Discuss Real Property/Appraisal Pursuant to 25 Okla. Stat. Section 307 B.3, and to Discuss Annual Evaluation of the CEO Pursuant to 25Okla. 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 Ms. Greenleaf, Dr. Anwar, Dr. Kimpel, Mr. Sherman, Dr. Chambers, Mr. Cubberley, Mr. Pipes, Mr. Clote and Dr. Weber. Ms. Anderson, Ms. White, Ms. Gilmore, Ms. McCool-Hare, Ms. Blau, Mr. Loftus, and Ms. Wells left the meeting at 6:50 p.m. B. Medical Staff Recommendations Regarding the Medical Staff Members/ Applicants as Listed in XIV.B 1-4 Below. 1. Recommend New Provisional Medical Staff Appointments: a) Karen Sargent, MD, Active Staff – OB/GYN Hospitalist b) Kinde Aguilar, MD, Active Staff – OB/GYN Hospitalist c) Matthew Wood, DO. Active Staff – Emergency Medicine Dept. d) Jordan Shuart, PA-C, Allied Health – Hospital Medicine Dept. e) Stephanie Parsons, APRN-CNP – Pediatrics Department f) Dustin Brooks , PA-C – Surgery Department g) Theresa White, DDS, Active Staff – Surgery Department* 2. Recommend Advancement of Medical Staff from Provisional Status: a) Nigam Sheth, MD, Active Staff – Anesthesia Department b) James Thorp, MD, Active Staff – Radiology Department c) Timothy Geib, MD, Consulting Staff – Surgery Department d) William Parsons, APRN-CRNA, Allied Health – Anesthesia Dept. e) Brittney Wicks, APRN-CNP, Allied Health – Hospital Medicine Dept. 3. Recommend Medical Staff Reappointments: a) Jeffrey Cook, MD, Active Staff – Cardiovascular Medicine  NRHA Board Minutes 11 June 25, 2018 b) Michael Sellers, MD, Active Staff – Cardiovascular Medicine c) Sherri Durica, MD, Active Staff – Medicine Department d) Thomas Merrill, MD, Active-Affiliate Staff – Medicine Department e) Paul Plusquellec, MD, Active Affiliate Staff – Medicine Dept. f) Gary Ratliff, MD, Active-Affiliate Staff – Medicine Department g) Thomas Urice, MD, Active-Affiliate Staff – Medicine Department h) Angela Vines, APRN-CNS, Allied Health Staff – Cardiovascular Med. Dept. Ms. Price, Ms. Carter, Dr. Boyd, Mr. Hopkins, Mr. Manfredo, Ms. McGill, Dr. Jawed, Dr. Mantooth, Mr. Laird, Ms. Gonzalez, and Mr. Splitt left the meeting at this time. 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. Dr. Weber seconded, and the motion was approved with aye votes from Dr. Anwar, Dr. Kimpel, Dr. Chambers, Dr. Weber, Mr. Sherman, Mr. Cubberley, Ms. Greenleaf, Mr. Pipes, and Mr. Clote. 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. Mr. Splitt rejoined the meeting at this time. D. Proposed Vote to Approve or Disapprove the Medical Executive Committee Recommendations Regarding Credentialing of the Referenced Medical Staff Members as Listed in XIV B 1-3 ACTION TAKEN: Dr. Chambers motioned to approve credentialing items as recommended by Medical Executive Committee and Credentials Committee of all referenced Medical Staff members listed in XIV B 1-3. Dr. Kimpel seconded, and the motion was approved with aye votes from Ms. Greenleaf, Mr. Cubberley, Dr. Chambers, Dr. Anwar, Dr. Weber, Dr. Kimpel, Mr. Sherman, Mr. Pipes, and Mr. Clote. E. Proposed Vote to Approve or Reject the Resolution for the Real Property/Appraisal as Recommended by the Finance Committee ACTION TAKEN: Mr. Pipes motioned to approve the Resolution for the Real Property/Appraisal as Recommended by the Finance Committee. Dr. Kimpel seconded, and the motion was approved with aye votes from Ms. Greenleaf, Mr. Cubberley, Dr. Chambers, Dr. Anwar, Dr. Weber, Dr. Kimpel, Mr. Sherman, Mr. Pipes, and Mr. Clote.  NRHA Board Minutes 12 June 25, 2018 F. Proposed Vote to Approve Annual Evaluation of CEO ACTION TAKEN: Dr. Kimpel motioned to approve the Annual Evaluation of CEO as Recommended by the Governance Committee. Ms. Greenleaf seconded, and the motion was approved with aye votes from Ms. Greenleaf, Mr. Cubberley, Dr. Chambers, Dr. Anwar, Dr. Weber, Dr. Kimpel, Mr. Sherman, Mr. Pipes, and Mr. Clote. Agenda Item XV Board Open Discussion Mr. Splitt presented an update on the Strategic Alignment of Compensation noting completion and approval of the Performance Unit Plan (PUP) by the Performance Unit Plan Committee and signed by the NRHA Chair and Vice Chair/Secretary. Agenda Item XVI. Adjournment ACTION TAKEN: Mr. Sherman made a motion to adjourn the meeting. Dr. Anwar seconded, and the motion passed unanimously with aye votes from Ms. Greenleaf, Dr. Chambers, Dr. Weber, Dr. Anwar, Dr. Kimpel, Mr. Sherman, Mr. Cubberley, Mr. Pipes, and Mr. Clote. Respectfully Submitted, Doug Cubberley, Vice-Chair/Secretary