Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY Board Meeting July 23, 2018 MINUTES The Norman Regional Hospital Authority met in monthly session Monday, July 23, 2018, at 5:30 p.m., in the Norman Regional Hospital Board Room. The meeting Agenda was posted July 19, 2018, on the NRHS and Norman websites and at the entrance to Norman Regional Hospital. Members Present: Doug Cubberley, Vice Chair/Secretary Joan Greenleaf Muhammad Anwar, MD Tom Sherman Diane Chambers, MD Member Absent: James (Jeff) Kimpel, Ph.D. Jerome (Jerry) Weber, Ph.D. Kevin Pipes 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 Ken Hopkins, CFO 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 Karen Rieger, System Attorney Crowe & Dunlevy Rachel Jordan, Attorney Crowe & Dunlevy Amanda Jones, Director Food & Nutrition Services Linda Tearl, Food & Nutrition Worker Manuel Delgado, Operations Supervisor Food & Nutrition Benjamin Robinett, Chef Food & Nutrition Julie Mallory, Supervisor Food & Nutrition Recorder: Doris Gonzalez, Executive Assistant Agenda Item I. Meeting Called to Order Mr. Cubberley called the July 23, 2018, Norman Regional Hospital Authority meeting to  NRHA Board Minutes 2 July 23, 2018 order at 5:36 p.m. Agenda Item II. Introduction and Recognition of Outstanding Healers A. August 2018 Healer of the Month, Linda Tearl, HealthPlex Food and Nutrition, – Amanda Jones, Director of Food & Nutrition Mr. Cubberley introduced Ms. Jones who presented Ms. Tearl as the Outstanding Healer for August 2018. Ms. Jones stated Ms. Tearl has worked at the HealthPlex Cafeteria for five years. She shared the employee’s accomplishments, outstanding teamwork, work ethic, positive attitude, and her compassion toward patients, families and co-workers, stating, “She shows us every day how much she loves her job. She is truly an asset to the Food & Nutrition department and Norman Regional Health System. She exemplifies the “Norman Way” and is well deserving of this honor.” Ms. Tearl stated she was honored to be recognized as Healer of the Month. She is grateful, proud to work with the very best healers ever and looks forward to going to work. Mr. Cubberley congratulated and thanked Ms. Tearl on behalf of the Board for her outstanding dedication, professionalism, compassion, and positive attitude that continues to make Norman Regional Health System a caring, high quality system. Mr. Robinett, Ms. Jones, Ms. Mallory, Mr. Delgado, and Ms. Tearl left the meeting at 5:44 p.m. Agenda Item III. Board Education Session: Medical Marijuana – Ms. Rieger Ms. Rieger and Ms. Jordan, Crowe & Dunlevy, presented a comprehensive overview of the Implications of Medical Marijuana for Hospitals and Providers highlighting the following:  Federal Law o Marijuana is still listed as a Schedule 1 drug under Controlled Substances Act, which means there is no recognized medical use from a Federal standpoint o The Drug Enforcement Administration (DEA) prohibits physicians from prescribing Schedule 1 drugs o Recommendation vs. Prescription o Conant vs. Walters (2002 case out of California)  The government prohibited the DEA from revoking a physician’s license for recommending the use of medical marijuana.  The case turned on the First Amendment “Right to Free Speech”, the importance of the relationship between the physicians and the patient and the need to score fully all the potential risk benefits in the connection of marijuana use in particular. The United States Court of Appeals for the Ninth Circuit, stated the government cannot revoke a physician’s license solely for recommending the use of medical marijuana and this remains in place today.  You cannot prohibit the physician from talking to the patient about marijuana use and potentially recommending the use of medical marijuana.  NRHA Board Minutes 3 July 23, 2018 o Physician may not help patient obtain medical marijuana, which is subject to interpretation o If making a recommendation, the physician intends the patient to use it; enabling a means for the patient to obtain a controlled substance would be aiding and abetting. A concern expressed was for a physician to get a license in Oklahoma a physician has to sign off on the license application. Signing that application with the knowledge that patient is going to use that to obtain medical marijuana is going to be aiding and abetting. That is something we do not know at this time. Oklahoma’s ballot language is the most liberal in the country because there is no list of conditions that have been recognized as approved for the use of medical marijuana. In other states, all the physician has to do is to certify that the patient has a specific condition that is on the list. The physician is not recommending or prescribing; they are just verifying they meet the statutory conditions for obtaining medical marijuana. o Mere anticipation of the conduct of a patient to whom a doctor recommends the use of medical marijuana does not constitute a crime.  Department of Justice o Obama-era guidance “Cole Memo” discouraged the Department of Justice (DOJ) to enforce the federal laws in states where it was legal particularly medical marijuana. o January 24, 2018, Trump Attorney General rescinded the Cole Memo.  Rohrabacher-Blumenauer 2014 Budget Amendment o Bars the DOJ from using federal funds to penalize hospital or physicians complying with state medical marijuana laws, which is up for renewal September 30, 2018; o Does not prevent Centers for Medicare and Medicaid Services (CMS) from denying federal funds or The Joint Commission from withdrawing hospital’s accreditation if they are not compliant with the federal statutes.  State Law o State Question 788 legalized the possession, use, cultivation, and sale of medical marijuana. o Some rules were finalized by Oklahoma State Department of Health (OSDH) on July 10, 2018, and signed by the Governor on July 11. o Immediately after, several lawsuits were filed challenging the rules.  Oklahoma Attorney General advised OSDH on July 18 that the following rules are impermissible: o Restricting the sale of smokable marijuana; o Requiring licensed pharmacists as dispensary managers; o Requiring dispensaries to be more than 1,000 feet from a church; o Setting a 12% cap on THC content; and o Requiring commercially-grown marijuana to be grown only in enclosed structures. o OSDH is to convene a special meeting to consider changes to these regulations. The Board president indicated that meeting would take place as soon as possible. o The rules as passed are currently in affect but not likely to be enforced or implemented until we have further action by the OSDH.  Physician Standpoint o Physicians must register with OSDH as a recommending physician (RP) prior to recommending medical marijuana.  NRHA Board Minutes 4 July 23, 2018 o ‘Physician’ means a licensed, board-certified MD or DO with a valid DEA and Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) registration. o Physician may not register if holder of direct or economic interest in a commercial marijuana establishment, grower, commercial grower, manufacturer, or processor. o Oklahoma Anti-kickback Statute prohibits payment for referrals for any payer source.  Physician Standards o Must apply standards a reasonable and prudent physician would follow for recommending or approving any medication. This proves a little difficult for marijuana because there are no FDA approved studies of appropriate uses of marijuana. o Establish a bona-fide physician-patient relationship. It requires at least one in- person “medically reasonable” assessment of the patient by the physician. It cannot be performed totally via telemedicine. o Can be recommended for therapeutic or palliative benefit for the patient o Physician is required to:  discuss risk and benefits of the use of medical marijuana;  provide follow-up care and management of the patient’s medical condition;  maintain accurate and complete medical records;  screen for substance abuse or mental health disorders, and document determination that subsequent medical marijuana recommendations do not present undue risk of abuse, addiction or diversion;  check Oklahoma Prescription Drug Monitoring Program prior to each recommendation.  Physician Prohibitions o May not issue recommendation to females “of childbearing years” without first performing a pregnancy test o May not issue recommendation for self, family members of the first or second degree, co-workers, or employees o Expressed concerns about employed physicians participation  Other Considerations o There is no clear guidance from CMS or JC that would expressly permit medical marijuana in hospital, so risk remains. o Must implement clear policies that comply with CMS and JC requirement.  CMS Conditions of Participation o The hospital must be in compliance with applicable Federal laws related to the health and safety of patients o Under Federal law, the recommendation itself is probably okay but assistance with obtaining and/or administering is not protected. o Both CMS and JC have requirements for self-administration. If the hospital allows the patient to self-administer you must counsel them on how to use it, when to use it, and the risk of using it. This is in direct contrast with the case law discussed earlier, which states all you can do is recommend it. o If the patient comes in with a valid license and their marijuana with them, are they allowed to use it during their hospital stay? CMS states there have to be policies and procedures in place ensuring someone is responsible for issuing an order permitting self-administration. That may go above and beyond a recommendation. o Assessing the capacity of the patient to self-administer and determine if the  NRHA Board Minutes 5 July 23, 2018 patient needs instructions in the safe and accurate administration, identify the medication and visually evaluate the medication for integrity, address the security of the medication for each patient and document the administration of medication in the medical record.  Joint Commission o There is no clear guidance regarding their position on medical marijuana. o Requirements present challenges for allowing self-administration. o Standards under Medication Management states the hospital must define what medications are brought into the hospital to be administered. o Before administration of a medication brought into the hospital, the hospital identifies and medication and visually evaluates the medication’s integrity. o If self-administration is allowed, written processes that address training, supervision and documentation are required. o Staff has to educate the patients on:  Medication name, type, and reason for use  How to administer medication, including process, time, frequency, route and dose  Anticipated actions and potential side effects  Monitoring the effects of the medication The JC requirements seem to elevate it beyond recommendation, which currently is the only thing that is protected under Federal law.  Hospital Policies – Consideration in drafting policy: o It is recommended to have clear policies on hospital position. o Will your physician recommend medical marijuana? Unlikely hospital can ban physicians from recommending, but physicians are not required to participate; regulation give physicians tremendous discretion. o Will you allow patients to possess medical marijuana on premises? May prohibit possession and/or use of medical marijuana on private property. o Will you allow patients to use medical marijuana on premises? Note CMS and JC requirements. o Will you require patients to self-administer or can employees help? Again note CMS and JC requirements for self-administration. o Will you store medical marijuana for patients and if so, where? May not store in pharmacy, rules prohibit licensed pharmacies from dispensing medical marijuana, and may have security store it for the patient. o If medical marijuana is not permitted on premises and confiscated from a patient, It must be returned to the patient upon discharge from hospital. o Smokable forms subject to the same restrictions on tobacco under “Smoking in Public Places and Indoor Workplaces Act” – No smoking in public places.  Insurance o Malpractice insurance – check contracts with payors o Patient insurance – will not cover drugs not approved by FDA o Flexible Spending Account (FSA) and HAS – IRS Publication 502: “You cannot include in medical expenses amounts you pay for controlled substances that are not legal under Federal law, even if such substances are legalized by state law.”  Employers o State Question 788 creates protected class of employees, unless the employer faces loss of federal funding or federal license as a result. o Employees may not be discriminated against based solely on status of license  NRHA Board Minutes 6 July 23, 2018 hold, including hiring, terminating or penalizing an employee solely for testing positive for marijuana on drug test. o May penalize employee for using or possessing marijuana while at work. If you suspect an employee is impaired at work, that can trigger a drug test. If the drug test is positive and that, paired with finding the impairment, can be basis for termination as long as it is well documented. If a compelling circumstance occurs within the hospital when you know it is going to benefit the patient and depriving them of it can have an adverse impact on them, you can get a “compassionate use exception” from the FDA if/when this occurs. The patient has to quality for the trial before the exception is granted. Dr. Jawed requested that this presentation be made at a Medical Executive Committee meeting so physicians can hear this information as well. He stated he does not believe our physicians will be very happy to be a recommending physician. He will speak with the physicians with the understanding that NRHS should treat medical marijuana as we would alcohol and tobacco on all campuses. Alcohol, tobacco and medical marijuana are not allowed on NRHS premises (all three campuses). He also stated he does not believe any of the hospitalists or himself would be willing to engage with a patient who has a prior prescription for medical marijuana because they would have to go through the verification process that it is ok for them to use. From the physician aspect, the system will have full support and will draft policies that does not allow medical marijuana on NRHS campuses. Our argument would be our policy does not allow medical marijuana on our property and not give them any reason of why we do not other than it is not our policy. Dr. Mantooth stated you cannot validate the integrity of the medical marijuana and will not allow it on our campuses. After a question and answer period, it was suggested that NRHS and physicians work on policies that meet the CMS and Joint Commission guidelines and can be enforced. Ms. Jordan left the meeting at this time. Agenda Item IV. Approval of the June 25, 2018, Board Meeting Minutes Mr. Cubberley asked for approval of the June 25, 2018, Board Meeting Minutes ACTION TAKEN: Mr. Sherman made the motion to approve the June 25, 2018, Board Meeting Minutes as submitted. Dr. Anwar seconded the motion, and the motion was approved unanimously with aye votes from Dr. Anwar, Mr. Cubberley, Dr. Chambers, Ms. Greenleaf, and Mr. Sherman. Agenda Item V. Performance Updates Ms. Anderson provided the Quality & Patient Safety Update highlighting the following:  Patient Safety o Pressure Ulcers –  Experienced an increase in All Stages as well as Stages III & IV Pressure Ulcers in CY 2017.  NRHA Board Minutes 7 July 23, 2018  Revisited the Save Our Skin (SOS) program, to ensure practices were current and were helping to keep patients from getting pressure ulcers. A group reviewed the Braden Risk Assessment, which is a skin assessment that is performed on admission and daily on every patient. It provides a score, with interventions tied to the score received from the Braden Risk Assessment. These interventions were not readily available for the nurse when they scored the Braden Risk Assessment, but now whether the patient scores low, moderate, or high risk, on the Braden scale, the interventions for what you do for that intervention is readily accessible. Perform standard odd hour every 2- hour turn for all at risk patients. Educating all nursing assistances about the SOS program as well. Implementing Wound Care Wednesdays so that every Wednesday every patient in the hospital will receive a four-eye skin check by nursing staff who will be checking all of the pressure areas in an effort to decrease the opportunity for patients to get skin ulcers. o Hip and Knee Surgical Site Infections  We have seen an increase in hip & knee surgical site infections over the last 18 months and working with Dr. Kirkpatrick, the new Medical Director of our Total Joint program. We hope to mimic in the hip and knee program the interventions implemented for our colon surgical site infections where we have seen a decrease. Most of the order sets are completed and will go live in August. There will be certain interventions done pre-op, in surgery and post-op in an effort to decrease hip & knee surgical site infections. We have purchased two additional Xenex machines for Porter and HealthPlex campuses for the operating rooms. The focus at the HealthPlex will be on total joint cases. Another initiative was to reduce the amount of movement and interruptions during these surgical procedures. o Overall Surgical Site Infections are on the downward trend.  Quality and Performance Improvement o FY2018 PI Plan Results (Goals for Mortality)  Code Blue – MIT calls or Codes outside of Intensive Care Unit (ICU). The less codes outside the ICU the better your mortality rate tends to be. The goal was set at 35% and we are currently at 43.5%. We joined a Vizient 6-9 month collaborative for “Reducing Risk of Failure to Rescue Events”.  Chronic Obstructive Pulmonary Disease (COPD), Heart Failure and Pneumonia Mortality Rates – We met our goals in heart failure and pneumonia. However, we did not meet our COPD goal. Very few patients follow-up with a pulmonologist after discharge. We are going to work diligently on getting these patients to see a pulmonologist post discharge. We are in a Serious Illness Collaborative through Vizient that is focusing on COPD and in the process of developing a Mortality Review Committee with physician participation and will begin reviewing charts by 2nd quarter FY2019. o FY2018 PI Plan – Emergency Department Goals  Core ED Measures – We will be measuring only two of the five Core ED/OP Measures in FY2019, Median Time Admit Decision to ED Department Time and Median Time ED Arrival to ED Departure. Our targets were set better than the national average in our ED Throughput Measures because we were meeting those national averages. We almost met goals in six measures and met goals in three.  Sepsis – Dr. Hoos-Reinke is the physician champion and joined by two ED residents. We are revisiting the order sets so they flow more to what the ED  NRHA Board Minutes 8 July 23, 2018 does. We are sending letters of missed opportunity to nurses, physicians, attendees and residents and reviewing monthly at the Sepsis Sub-committee meeting.  Medical Staff Audits – in preparation for Joint Commission – All indicators were above target for FY 2018. Action for FY2019 is to drop monitoring twice a year. Medical Record is performing more physician documentation audits. o Patient Experience – Real Time Update  Initiated Real Time Surveys in October 2017, currently surveying 88 units/areas in Outpatient and Inpatient Services, and currently have received 41,096 returned surveys. 81.4% of respondents would recommend some sort of service at NRHS. Agenda Item VI. Approval of the June 2018 Norman Regional Health System Financial Statements Mr. Hopkins presented the June 2018 Norman Regional Health System Financial report highlighted the following:  June System Inpatient Volumes – Inpatient volumes were good in June and were 2% favorable to budget and consistent with Gross Revenue.  Inpatient Volumes for FY2018 – Discharges were 7.7% greater than FY2017 and 4.5% greater than budget. Flu Season and ED-to-ED transfers was a factor in the FY2018’s inpatient growth.  June System Outpatient Registrations – System Outpatient volumes were also strong in June. Overall outpatient visits were 6% higher than budget and outpatient Gross Revenue was 6% favorable to budget, including strong outpatient Cath Lab volumes.  Outpatient Volumes for FY2018 – Hospital outpatient visits were 5% greater than FY2017 actual and 7% greater than FY2018 budget. Clinic visits were 18.6% greater than FY2017 actual and 1.2% below FY2018 budget.  Surgical volume for June was at normal budget level.  Surgical Volume for FY2018 was 2.2% favorable to FY2017 and only 33 0.27% below FY2018 budget.  Cath Lab Volume for June was normal on the inpatient side but very strong on the outpatient side at 10.7% over outpatient budget.  Cath Lab Volumes for FY2018 – Total Cath lab volume was 7.4% better than FY2017 and only 1.5% below FY2018 budget. Second half of year was stronger. June 2018 Financial Performance  Gross Revenues .................................. (Budget $152,712,561)............ $160,264,485  Net Patient Revenue .............................. (Budget $33,823,336).............. $36,339,942  Total Operating Expenses ..................... (Budget $33,007,141).............. $33,211,886  Total Operating Revenues ...................... (Budget $34,229,508).............. $36,636,264  Operating Income .................................... (Budget $1,222,367)................ $3,424,378  Non-Operating Revenues (Expenses) ........ (Budget $587,902)................... $169,675  Excess Revenues over Expenses ............ (Budget $1,810,269)................ $3,594,053 Year-to-Date  Operating Income .................................. (Budget $16,634,023).............. $17,811,874  Non-Operating Revenues (Expenses) ..... (Budget $6,811,000).............. $11,786,897  Excess Revenues over Expenses .......... (Budget $23,445,023).............. $29,598,771  NRHA Board Minutes 9 July 23, 2018  Accounts Receivable Days ............................ (Budget 46 Days).................. 42.2 Days  Days Cash on Hand .................................................................. ................ 224.7 Days ACTION TAKEN: Mr. Sherman motioned to approve the June 2018 NRHS Financial Statements. Dr. Chambers seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Mr. Cubberley, Dr. Chambers, Ms. Greenleaf, and Mr. Sherman. Agenda Item VII. Medical Staff A. Report from the July 11, 2018, Medical Executive Committee (MEC) Dr. Mantooth reported that MEC met July 11, 2018, and highlighted the following:  Ms. McGill presented ICARE awards to Dr. Saria Refai, Neurologist; Dr. Michael Villano, Cardiologist; and Dr. Ahmad Ashfaq, Infectious Disease; recognizing them for their exceptional patient care.  Received a presentation from Navigant regarding NRH’s goal of consolidating to the westside.  Changes to C.diff testing by Pathologists and Infectious Disease physicians will not change how the providers order the test, but will change how they test for C.diff toxin.  Mr. Foster and Mr. Hughes from the Pharmacy presented a drug shortages list and their efforts to combat these shortages. They asked for feedback regarding the information they would like to receive from the Pharmacy & Therapeutics Committee meetings. It was suggested sending a monthly/quarterly memo to the medical staff regarding all pertinent information. Mr. Foster and Mr. Hughes will draft a memo and bring to the MEC for members to review in August. Drs. Shahsavari and Whalen requested a pharmacist attend the monthly Hospital Medicine Department meeting.  Received Dr. Carol Anderson and Dr. Bruce Parker’s requests for removal from the unassigned ED call roster. They have reached the age and years of service requirements noted in the Medical Staff Rules and Regulations and members of the OB/Gyn Department voted and approved their requests. MEC approved their requests to be removed from the unassigned ED call roster.  Discussed C02 critical values. MEC approved to set less than or equal to ten (10) as the low critical value.  Mr. Manfredo announced that all emails sent from a NRHS email address to another NRHS email address are encrypted automatically. For all emails sent outside of NRHS that contain any sort of PHI, “Encrypt” is to be typed within the subject line.  Ms. McGill presented the new patient belongings bag, which is smaller, purple, has a zipper, and a checklist inside each bag. The bags were trialed on Progressive Care Unit (PCU) for three-months, and not one item was lost during the trial. She also talked about the new Patient Communication Board that physicians and nurses can write on the plastic shell to keep their patients updated.  Reviewed and approved forwarding revisions to the General Surgery/General Laser Surgery Privilege form to the Board for final approval.  Department/Committee Reports o Cardiovascular Department – Dr. Gautam discussed the echo turn-around  NRHA Board Minutes 10 July 23, 2018 times and recommended that all inpatient echos be completed within 24-48 hours. They worked on the multiple Heparin order sets condensing them into three (3) sets: Low Intensity, High Intensity and Cardiac. She announced ventilator times are down and there was a 40% reduction in prolonged ventilator times at the Porter Campus. o Emergency Medicine Department – Dr. Hoos-Reinke reported the following:  Dr. Stanek discussed and encouraged the use of Occupational Medicine sheets they have in the ED.  Discussed the Neurology changes and that they will no longer admit patients. Hospitalists will admit all patients.  Reported that Dr. Porter will teach an ultrasound review class to attendings in August  Dr. Zimmerman presented her second “Quality Pearl” presentation “Apneic Oxygenation.” o Hospital Medicine Department – Dr. Shahsavari stated the department discussed the new condensed Heparin order sets, the changes being made to the IV pumps and Pharmacy stopping medication orders when a patient leaves to lower level of care. Hospitalists will begin covering the Rehab Unit. o GMEC/Residency – Dr. Cody stated the discussed the number of learners (PA Students, Medical Students, Nursing Student, etc.) that are in the ED at one time. They are making a master schedule in order to regulate the number of learners that are in the ED at one time. Dr. Cody created an action plan regarding the Emergency Medicine Residents that came from the recent Provider Satisfaction Survey Results regarding improving communication. o Pediatric Hospitalists – Dr. Cook reported they have been doing a lot of outreach to the community and that she is the Director of the Pediatric Hospitalist program. She will also be working with telemedicine, allowing school nurses to contact her to consult on students.  Reports from the Medical Staff – o There was discussion regarding EMSStat run sheets and that ED will scan all EMSStat run sheets into the patient charts so physicians can review them when the patient arrives on the floor. o Due to an increase in CLABSI, a memo was sent to the entire medical staff to use full barrier precautions when placing a central line.  Reports from Vice-Presidents/CNO & President o Ms. McGill announced NRHS has partnered with the Cramer School of Nursing to begin a program that mimics the old nurse extern program. o The Post Critical Care Unit (PCCU) removed all “no-fly” times for patients. Nurses can call and give report at any time and patients will be accepted any time to the floor. Porter ED are taking their own patients to the floors rather than waiting on dis/trans. o Announced that Drs. Eichert and Cochran are now employed physicians. They will be seeing clinic patients in the Physician Performance Center. o Mr. Splitt announced and re-introduced Mr. Doug Cubberley as the new NRHA Board Chair and thanked him for his leadership. B. Recommend Approval of the Revised General Surgery/General Laser Surgery Privilege Form  NRHA Board Minutes 11 July 23, 2018 ACTION TAKEN: Ms. Greenleaf made a motion to approve the revised General Surgery/General Laser Surgery Privilege Form as Recommended by the Medical Executive Committee. Dr. Anwar seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Dr. Chambers, Ms. Greenleaf, Mr. Sherman, and Mr. Cubberley. C. Recommend Approval of the Revised Utilization Review Plan for FY2019 ACTION TAKEN: Mr. Sherman made a motion to approve the Revised Utilization Review Plan for FY2019 as Recommended by the Medical Executive Committee. Ms. Greenleaf seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Dr. Chambers, Ms. Greenleaf, Mr. Sherman, and Mr. Cubberley. Agenda Item VIII Strategic Planning Committee Ms. Price reported the Strategic Planning Committee met on July 2, 2018, to review the FY2019 objectives which were developed to sustain the momentum of FY2018 continuing our growth and to sustain our initiatives. She highlighted the following:  Service Excellence will continue the momentum of the Norman Way Service standards and will utilize real-time feedback from inpatient, outpatient and clinics. Focus groups will also be conducted using the inpatient and clinical PFACS.  Operational Excellence will continue to focus on growth in all service areas of patient care. New this year will be a focus on standardization of processes and procedures across the Health System. The Outcomes and Efficiency Strategic Team will lead this endeavor.  Clinical Excellence will focus on core quality measures that are essential to high quality and reliable patient care. In 2019, another focus will be on implementing a system-wide patient safety plan that has strategic objectives in the four focus areas.  The team will focus on healer engagement, leadership training and supporting the initiatives of Service, Operational, and Clinical Excellence. Agenda Item IX. Finance Committee A. Report from the July 16, 2018, Finance Committee Mr. Cubberley reported the Finance Committee met July 16, 2018, and highlighted the following:  Ms. Blau provided an overview of the 3rd Quarter Risk Report.  Mr. Hopkins provided a detailed June 2018 Financial Report.  Reviewed the Key Performance Indicators (KPIs) noting the following: o Point of Service Collections were down for June, but the overall collections were good based on Days in A/R. o Overall, the Performance Indicators remained strong, and we will review how to improve Point of Service collections.  Charity Care YTD was $9.6 million  Bad Debt for April YTD was $18.7 million  Community Contributions was $1.7 million  Three capital requests were presented for approvals totaling $464,179:  NRHA Board Minutes 12 July 23, 2018 o Preparation for Neurosurgery Clinic - $108,795 – To accommodate two new employed neurosurgeons o Solid State Storage -- $281,009 – This storage request is related to a planned Meditech expansion o Synapse Workstation Software - $74,375 – Cath Lab workstation B. Recommend Approval of Capital Equipment Purchase Requests ACTION TAKEN: Ms. Greenleaf made a motion to approve the Capital Equipment Requests totaling $464,179 as recommended by the Finance Committee. Dr. Anwar seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Mr. Cubberley, Dr. Chambers, Ms. Greenleaf, and Mr. Sherman. Agenda Item X. Old Business There was none. Agenda Item XI. New Business Selection of New NRHA Chair to Fulfill the Remainder of the Current term and Other Officers as Necessary ACTION TAKEN: Ms. Greenleaf made a motion to approve Mr. Cubberley as the new Chair to fulfill the remainder of Mr. Clote’s current term and Mr. Sherman as the Vice Chair/Secretary to fulfill Mr. Cubberley’s current term as recommended by the Governance Committee. Dr. Anwar seconded and the motion was approved unanimously with aye votes from Dr. Anwar, Dr. Chambers, Ms. Greenleaf, Mr. Sherman, and Mr. Cubberley. Agenda Item XII. Administrative Report Mr. Splitt provided an update on the following:  The Healer of the Year presentation and service awards celebration was last week. Mr. James Murunga, RN was the Healer of the Year recipient. At the service awards celebration we recognized Mr. Randy Wallace for his 45 years of service at NRHS.  Announced last week NRHS launched our Emergency Department OB/Gyn Hospitalist program and within the first 24-hours of that program, we had our first precipitous delivery by our OB Hospitalist, which went very well.  Navigant interviews are mostly complete. They presented to the Medical Executive Committee and will be interviewing a couple of physicians in the near future. He asked the board members to let him know as soon as possible if anyone would like to have an interview scheduled. We received an update from Navigant today and they were very complimentary of the Board and our medical staff engagement, consensus regarding strategy, and future goals. Navigant hopes to complete the project and provide a final report by the end of December.  FY2019 strategic planning is well underway. We have a framework for what we want to pursue and have built from our FY2018 plan. As we gather this information and finalize the plan, It will be shared through the board committees.  NRHA Board Minutes 13 July 23, 2018  Sg2, a national think-tank firm, will provide us with a service line deep dive looking at a number of opportunities/possibilities in oncology, urology, cardiovascular service lines, etc., and outpatient services overall.  Mr. Hopkins gave an overview of the Operating Margin Profitability Ratios for all hospitals using the median values used by bond agencies.  The Gallup Q12 Employee Engagement Survey is currently underway. To date we have had over 1,000 of the 3,000+ healers complete the survey. This information will be used to assess engagement in our organization and the things we are doing to provide them with the tools needed to deliver that high-quality care for the best outcomes within their departments. 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 ACTION TAKEN: Mr. Sherman made a motion to adjourn into Executive Session. Dr. Anwar seconded and the motion was approved unanimously with aye votes from Ms. Greenleaf, Dr. Anwar, Mr. Sherman, Dr. Chambers, and Mr. Cubberley. Ms. Anderson, Ms. White, Ms. Gilmore, Ms. McCool-Hare, 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 XIII.B 1-4 Below. 1. Recommend New Provisional Medical Staff Appointments: a) Clayton Nelson, MD, Active Staff – Surgery Department b) Emily Benham, MD, Active Staff – Surgery Department c) Jacob Haynes, MD, Active Staff – Surgery Department d) John Glomset, MD, Active Staff – Surgery Department e) Ronni Farris, MD, Active Staff – OB/GYN Department (Hospitalist) f) Michael Collins, MD, Active Staff – OB/GYN Department (Hospitalist) g) Allen Missoi, MD, Teleradiology Privileges Only – Radiology Department h) Wendell Myers, MD, Teleradiology Privileges Only – Radiology Dept. i) Robert Lile, MD, Teleradiology Privileges Only – Radiology Department j) Emad Yacoub, MD, Teleradiology Privileges Only – Radiology Department k) John Pohl, MD, Teleradiology Privileges Only – Radiology Department 2. Recommend Advancement of Medical Staff from Provisional Status: a) Matthew Malony, MD, Active Staff – Pediatrics Department b) Bilal Ahmad, MD, Consulting Staff – Medicine Department c) Kathryn Walenz, PA-C, Allied Health Staff – Emergency Medicine Dept. 3. Recommend Medical Staff Reappointments: a) Muhammad Salim, MD, Active Staff – Cardiovascular Med. Dept. b) Joe Riddle, MD, Active Staff – Medicine Department c) Rebecca Eagle, MD, Active Staff – Medicine Department  NRHA Board Minutes 14 July 23, 2018 d) James Love, MD, Active Staff – Medicine Department e) Bradley Wilson, MD, Active Staff – Surgery Department f) Steven Jimerson, MD, Active Staff – OB/GYN Department g) R. Bruce Parker, MD, Active Staff – OB/GYN Department h) Sobia Ahmad, MD, Consulting Staff – Medicine Department i) David Duncan, MD, Associate Staff – Medicine Department j) Seethal Madhavarapu, MD, Associate Staff – Medicine Department k) Crystal Sparling, MD, Associate Staff – Pediatrics Department l) Desiree Herring, APRN-CRNA, Allied Health Staff – Anesthesia Dept. C. Request to Adjourn Out of Any Such Executive Session and Return to Regular Session ACTION TAKEN: Ms. Greenleaf made a motion to adjourn out of Executive Session and return to regular session. Dr. Anwar seconded, and the motion was approved with aye votes from Dr. Anwar, Dr. Chambers, Mr. Sherman, Mr. Cubberley, and Ms. Greenleaf. Mr. Cubberley 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 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 XIII B 1-3. Ms Greenleaf seconded, and the motion was approved with aye votes from Ms. Greenleaf, Mr. Cubberley, Dr. Chambers, Dr. Anwar, and Mr. Sherman. Agenda Item XIV Board Open Discussion There was none. Agenda Item XV. 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. Anwar, Mr. Sherman, and Mr. Cubberley.