Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY Board Meeting September 23, 2019 MINUTES The Norman Regional Hospital Authority met in monthly session Monday, September 23, 2019, at 5:30 p.m., in the Norman Regional Hospital Board Room. The meeting Agenda was posted September 19, 2019 on the NRHS and City of Norman websites and at the entrance to Norman Regional Hospital. Members Present: Doug Cubberley, Chairman Joan Greenleaf Muhammad Anwar, MD Tom Sherman, Vice Chair/Secretary James (Jeff) Kimpel, Ph.D. Jerome (Jerry) Weber, Ph.D. Diane Chamber, MD Kevin Pipes Mary Womack Others Present: Richie Splitt, CEO & President John Manfredo, COO Brittni McGill, CNO Paula Price, VP Strategy & Growth Ken Hopkins, CFO Meegan Carter, VP Population Health & Wellness Karen Rieger, Attorney, Crowe & Dunlevy Dr. Farhan Jawed, MD Chief of Staff-Elect Lisa White, Manager Performance Improvement Kelley Wells, Director Planning & Communications Jenny Odom, Staff Attorney Jamie Roberts, Critical Care Clinical Outcomes Specialist Robin Yoder, Manager Clinics Informatics & Care Coordination Danny Kelley, Administrative Director HIT Teresa Breinholt, CVICU Unit Secretary Ron Breinholt Donna Avila, Director Care Coordination Darnell Burgess, Administrative Director Ambulatory Services LeAnn Richardson, Administrative Director Population Health Gina Morgan, Director Finance Jennifer Minnis, Manager Case Management CDI & MSMES Jessica Harris, Transition of Care Nurse Navigator Kristin O’Neal, Manager Transition of Care Denny Hinkle, Manager Nurse Van McKnight, Director Patient Care Services Teresa Brown, Strategic Planning Specialist Ryan Neafcy, JC Penny Leadership Board Fellow  NRHA Board Minutes 2 September 23, 2019 Bryce Ell, Administrative Fellow Becky Robins – BKD Jessica Elsberry – BKD Carley Williams – BKD Stuart England, Floyd Law Firm Jeff Raley, Floyd Law Firm Recorder: Claudia Todd, Executive Assistant Agenda Item I. Meeting Called to Order Mr. Cubberley called the September 23, 2019, Norman Regional Hospital Authority meeting to order at 5:32 p.m. Agenda Item II. Introduction and Recognition of Outstanding Healers A. October 2019 Healer of the Month – Teresa Breinholt, CVICU, Unit Secretary introduced by Jamie Roberts, Critical Care Clinical Outcomes Specialist. Mr. Cubberley introduced Ms. Roberts who presented Mrs. Breinholt as the Outstanding Healer for October 2019. Ms. Roberts stated Teresa has worked at Norman Regional since 2002 and has had the pleasure of working with her the last 10 years. She is an expert at what she does and trusted preceptor for all new employees/healers. She is the glue of the unit and they notice it when she is not there. Her personal traits really set her apart. She is very aware of the needs of others. She always has extra pairs of reading glasses in case anyone might need some. She is able to relate to patients and their families and is a comfort to them. She is one of the biggest donators of PTO hours to coworkers and always the first to donate items to the baskets the department puts together for various events. She has even invited a coworker into her home until she was able to get back on her feet. Mrs. Breinholt thanked them for the honor. She stated Norman Regional is a great place to work. She never wants to be the boss, but she will be bossy. Mr. Cubberley congratulated and thanked Mrs. Breinholt on behalf of the Board for his outstanding dedication, professionalism, compassion, and positive attitude that continues to make Norman Regional Health System a caring, high quality system. Ms. Yoder, Ms. Breinholt, Mr. Breinholt, Ms. Avila, Ms. Burgess, Ms. Richardson, Ms. Morgan, Ms. Minnis, Ms. Harris, Ms. ONeal, Mr. Hinkle and Mr. McKnight left the meeting at 5:36 pm. Agenda Item III. Approval of August 2019, Norman Regional Hospital Authority Board Meeting Minutes Mr. Cubberley asked for approval of the August 26, 2019, Board Meeting Minutes.  NRHA Board Minutes 3 September 23, 2019 ACTION TAKEN: Dr. Weber made the motion to approve the July 22, 2019, Board Meeting Minutes as presented. Ms. Greenleaf seconded the motion, and the motion was approved unanimously with aye votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Dr. Kimpel, Mr. Pipes, Ms. Greenleaf, Ms. Womack, Dr Chamber and Mr. Sherman. Agenda Item IV. Bond Approval Presentation Mr. Hopkins introduced Mr. Jeff Raley and Mr. Stuart England from the Floyd Law Firm. Mr. Hopkins highlighted key points from the 2019 Bond Issuance Executive Summary Memo. He reported the current bond of $147,875,000 will mature in 2037. The new tax-exempt revenue bond is anticipated to be a fixed rate bond. It is proposed to be a 30-year term structure and will wrap around the existing bonds, maintaining a level debt service. Mr. Hopkins reviewed the bond issuance process, plan of finance scenarios and repayment. Mr. Raley briefly reviewed the steps of this process. ACTION TAKEN: Dr. Kimpel made a motion to approve the Bond Resolution as recommended by the Finance Committee. Mr. Pipes seconded and the motion was approved unanimously with votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Mr. Pipes, Mr. Sherman, Ms. Greenleaf, Ms. Womack, Dr, Kimpel and Dr. Chamber. Agenda Item V. 2019 Audit Presentation Mr. Hopkins introduced Carley Williams, Becky Robins and Jessica Elsberry from BKD, our outside auditor. He thanked Gina Morgan for her work in preparing for the audit. Mr. Williams reported the NRHS finance committee reviewed the full audit one week ago. Ms. Robins reported that BKD issued an unmodified clean opinion for Norman Regional Health System (NRHS) as they have every year. Significant accounting policies were provided in one section. There were no Audit adjustments made and no over writer control discrepancies. The areas they reviewed were Patient Accounts Receivables, 3rd Party Payer Elements, Reserves in Workers Compensation and Health Insurance, General and Professional liability and Defined Benefit Pension Plan Estimates. Mr. Williams reviewed the Balance Sheet and Income Statement within the audit. He reported no significant changes from years past. He reviewed graphs displaying benchmark points for NRHS as compared to Standard & Poors and other Urban Hospital systems. On each of these, NRHS met or exceeded benchmarks.  NRHA Board Minutes 4 September 23, 2019 ACTION TAKEN: Mr. Sherman made a motion to approve the 2019 Audit Report as recommended by the Finance Committee. Dr. Kimpel seconded and the motion was approved unanimously with votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Mr. Pipes, Mr. Sherman, Ms. Greenleaf, Ms. Womack, Dr, Kimpel and Dr. Chamber. Mr. Williams, Ms. Robins and Ms. Elsberry left the meeting at 6:08pm. Agenda Item VI. Performance Updates A. Ms. White introduced Ms. Roberts who presented the report on Central Line Blood Stream Infections. A central Line is IV access that is placed in a large vein in the neck, chest, groin or arm that empties near the heart. It allows for quick treatment with fluids and essential medications.  About 1 in 20 patients get an infection each year while receiving medical care  41,000 bloodstream infections strike hospital patients with central lines each year  37,000 bloodstream infections happen each year to kidney dialysis patients with central lines A central line associated bloodstream infection (CLABSI) is a serious infection that occurs when bacteria or viruses enter the bloodstream through the central line. There are three specific methods to prevent a CLABSI: 1. Evidence Based Protocol (EBP) insertion practice checklist is used:  Hand Hygiene  Appropriate Skin Antiseptic use and dry time  Full Barrier Precautions:  Sterile gloves  Sterile gown  Car  Mask  Full Body sterile drape 2. Remove Central Line ASAP, decreasing Central Line days:  Daily review of reason for Line  Limit reasons for use of Central Line 3. Central Line Care:  Use of CHG patch at insertion site  Sterile Dressing changes every 7 days or as needed  Swab caps on every port  Vicra and tubing changed every 72 hours  Scrub the hub A Central Line Team was developed to operationalize the checklist use. We are  NRHA Board Minutes 5 September 23, 2019 below the national average of 0.741. Our average is 0.728. Ms. White, Ms. Roberts and Mr. Hinkle left the meeting at 6:14pm. B. Patient Safety Huddle Update……………………...……………………….Ms. McGill Ms. McGill provided an update on the daily safety huddles. This venue continues to evolve based on the needs of the organization and what is occurring each day.  In response to concerns on Violence against healthcare workers; rolled out evidence based risk tool to be used in all departments. Using signage outside patient rooms to designate when 2 employees are required when entering.  Central Lines reported on daily basis  Moving Tele sitter cameras between facilities when video monitoring assistance is needed  Drug shortage issues have been addressed  Follow-up in the afternoon with afternoon bed huddles to prepare for next day patient placement Agenda Item VII. Approval of the August 2019 Norman Regional Health System Financial Statements Mr. Hopkins presented the August 2019 Norman Regional Health System Financial report:  Inpatient Volume – improved slightly from last month, still remain below budget  Clinics – improvement from last month  Outpatient Volume –  Surgery improved from last month  Cath Lab had a slight decrease August 2019 Financial Performance  Gross Revenues .................................. (Budget $188,609,553)............ $196,980,942  Net Patient Revenue .............................. (Budget $40,961,682).............. $39,469,844  Total Operating Expenses ..................... (Budget $40,136,635).............. $40,498,332  Total Operating Revenues ...................... (Budget $41,384,499).............. $39,987,945  Operating Income .................................... (Budget $1,247,864)................... $510,387  Non-Operating Revenues (Expenses) ..... (Budget $1,154,307)................. ($106,163)  Excess Revenues over Expenses ............ (Budget $2,402,171)................. ($616,550) Year-to-Date  Operating Income .................................... (Budget $2,307,583)................... $107,503  Non-Operating Revenues (Expenses) ..... (Budget $2,308,614).............. ($1,817,754)  Excess Revenues over Expenses ............ (Budget $4,616,197)................ $1,925,257  Accounts Receivable Days ............................ (Budget 43 Days).................. 45.9 Days  Days Cash on Hand…………………………………………………………….214.2 Days  NRHA Board Minutes 6 September 23, 2019 ACTION TAKEN: Mr. Pipes motioned to approve the August 2019 NRHS Financial Statements. Dr. Weber seconded the motion. August financials were approved unanimously with aye votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Dr. Kimpel, Mr. Pipes, Ms. Greenleaf, Ms. Womack, Dr. Chamber and Mr. Sherman. Agenda Item VIII. Strategic Planning Committee Dr. Weber reported for the Strategic Planning Committee which met on September 9th.  Chris Miller, Manager of Post Anesthesia Care Unit provided information on the Healer Engagement Survey results. We have four semiannual reporting outcomes from the report. The first engagement survey was offered in January 2018. In June of 2019 the results from those surveys had increased in all areas. We are constantly working to improve scores.  Teresa Brown, Strategic Planning Specialist provided an update on the Plan, Do, Study and Act (PDSA). This is the Provider integration process. Each of the elements will be reviewed and discussed often for improvement options.  Paula Price reviewed a few components of the FY20 Strategic Plan, following health behaviors and social determinants.  John Manfredo provided an update on Inspire HEALTH. An architect and engineering firm has been selected by NRHS. Bond approval will allow NRHS to execute an agreement with the firm. We will utilize an integrated delivery process to design and construct Inspire Health projects. The idea behind that process is to have the construction manager, architect and engineer at the table with our healers in order to move through the building process. Agenda Item IX. Medical Staff Dr. Mantooth was absent. Dr. Jawed presented the Medical Staff report on her behalf. He stated the MEC met on September 11th, 2019. New Business:  Jake Cleveland, Resident Coordinator provided a presentation on Enhanced Medicaid Reimbursement. This program provided the opportunity for physicians to earn a higher reimbursement rate for Medicaid patient services for providers who work with ER physician residents.  Dr. Mantooth reported LUA, the secure texting app was shut down by the company providing it. Four vendor demos were conducted and a trial will be set up once a vendor is selected. This will be tested with a small group of providers. Department Reports:  Anesthesia Department – Dr. Voto reported a presentation was given on Enhanced Medicaid, reviewed department indicators, discussed emergency call issues for night cases, discussed variances, reviewing excessive signing issues with Meditech documents.  Cardiology Department – Dr. Gautam reported order sets updated by HIT, doing well in ECHO reading goals, revising the TAVR privilege form, reviewed department indicators, discussed patient transfers directly to ICU instead of Cath NRHA Board Minutes 7 September 23, 2019 lab and the STEMI notification process was discussed regarding communication with the ER.  Emergency Department – Dr. Porter reported they were focused on the structural organization of the department, discussed how to utilize the PA’s and physicians so every patient is seen by both providers, reviewed moonlighting privileges for 4th year ER residents and Mr. Manfredo provided an Inspire HEALTH update.  Hospital Medicine – Dr. Shahsavari reported a presentation was present on Enhanced Medicaid Reimbursement, discussed the appropriate use criteria for Radiology, 2 new Hospitalists onboarding within the next month, discussed secure texting, reviewed department indicators and utilization reports.  Pediatric Department – Dr. Stoltenberg reported they reviewed late preterm bilirubin protocol and standards, reviewed NICU new probiotic usage and drawing blood cultures, discussed challenges with pediatric patients admissions at Porter specific to staff as certified PALS, new pediatric handouts being used for AAP certifications, department reports were reviewed and breastfeeding statistics were discussed.  Physician Advisory Committee – Dr. Mantooth reported options for secure texting applications were discussed, reviewed mid-level providers are needing to co-sign on different documents and a demo was presented on the appropriate use criteria.  Residency Update – Dr. Cody reported the annual update for the ACGME was recently completed, reported the residents had seen 72,231 patients this last year, 200 hours of didactics were provided and NRHS hosted the 3rd annual Central Oklahoma EMS Conference in November 2018 which hosted over 200 participants and 3 new peer review publications were released and about 28 hours of lectures were provided outside of the hospital.  Surgery Department – Dr. Chace reported they reviewed the Scrub Tech First Assist position and will reevaluate in summer of 2020, discussed supply stocking at HeathPlex and Porter campuses, reviewed standing reports, surgeons voted to use Stryker for robots.  Medical Staff - Dr. Boyd had no information to report. Administrative Reports:  Ms. Carter reported the Health Club relocated to the former Fitness One location on Rock Creek Road. It opens September 17th.  Ms. Price announced the project start of improving provider integration, recruitment and orientation of new physicians and APPs since new provider numbers have increased.  Mr. Manfredo reviewed the Physician Wellness survey for March 2019, general emails sent out to provide Providers with resources, provided an update on Inspire HEALTH.  Ms. McGill thanked the Medical Executive Committee for efforts in decreasing severe sepsis mortality over the past year.  Mr. Splitt provided a further update on Inspire HEALTH reporting they have hosted over 60 stakeholder sessions and community events, reviewed the freestanding ER options and presented the Navigant recommendations for the Behavioral Health and Substance Abuse facility.  NRHA Board Minutes 8 September 23, 2019  Mr. Cubberley announced the introduction of $120M in Bonds for Inspire HEALTH at the September Board Meeting. They will return to City Council on September 24th to present the Inspire HEALTH proposal. Open Discussion:  Dr. Ashfaq presented an update on infections. C-Diff had a marked improvement this past year. Cases dropped to 5. Agenda Item X. Finance Committee A. Report from the August 19, 2019 Finance Committee Mr. Cubberley attended the meeting on Mr. Sherman’s behalf. He reported information for the Audit, Bond, Financial Statements were reviewed and approved earlier in the Board Meeting. The Presentation for the Gainsharing/Incentive Compensation goals for FY20 and Capital Equipment will be presented for the Boards consideration. B. Mr. Hopkins reported the Gainsharing/Incentive plan proposals were included in the packet. The previous year’s incentive comp plan was very successful in the clinical, service and team goals. Proposed for the next year, NRHS set the threshold higher for continual improvement in patient care and financial performance. The targeted maximums were set more aggressively. ACTION TAKEN: Mr. Sherman made a motion to approve the Gainsharing/Incentive Compensation Goals for FY2020 as recommended by the Finance Committee. Mr. Pipes seconded and the motion was approved unanimously with votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Mr. Pipes, Mr. Sherman, Ms. Greenleaf, Dr, Kimpel, Ms. Womack and Dr. Chamber. C. Ms. Carter presented for approval one capital request item totaling $278,127: a. Buildout at Norman Regional Moore for new Counseling Center space. ACTION TAKEN: Dr. Weber made a motion to approve the Capital Equipment Request, cost $278,127 as recommended by the Finance Committee. Dr. Kimpel seconded and the motion was approved unanimously with votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Mr. Pipes, Mr. Sherman, Ms. Greenleaf, Dr, Kimpel, Ms. Womack and Dr. Chamber. Agenda Item XI. Old Business Mr. Splitt reported the early stages of planning on the Cleveland County Healthy Living Block “The Well” have begun. We are beginning the initial designs of the space and will continue to work on and modify that design. Mr. Cubberely reminded the Board to turn in the evaluations for the CEO and the self- evaluations for the Board. He requested those be turned in by the end of September to be reviewed at the October Board meeting.  NRHA Board Minutes 9 September 23, 2019 Agenda Item XII. New Business Ms. Price reported the Norman Regional Healer Engagement Survey June 2019 results were presented at the Strategic Planning Committee meeting on September 9th by Team Excellence Chair Chris Miller. He will provide an overview of the Healer Engagement Scores at the Finance Committee meeting on October 21 st. Dr. Weber provided information on the campaign “Paint the Town Pink”. The NRHS Foundation will again sell the small pink and white flags to display in honor of or in remembrance of those struggling with cancer. Buttons will also be for sale. The EMSTTAT vehicles will display pink banner for support. There will be many activities throughout the month beginning with the unveiling of the Pink Sphinx aka the Botero Sculpture at 10am on October 30th on the lawn of the OU Museum of Art on the campus. Agenda Item XIII. Administrative Report Mr. Splitt provided an update from the Indoor Aquatics & Multi Sports Complex Ad hoc Advisory Committee reported which met the prior week for the first time. They are in very early discussions on sustainability for the facilities proposed by Norman Forward. The group is also discussing design and the many possible uses of the facilities. Mr. Splitt reported the membership buyout of Medical Park West is almost complete. This process is anticipated to be completed before the next Board Meeting. Mr. Splitt provided an update on Inspire HEALTH. We have hosted over 71 Healer forums, meetings and Community Forums since May. We will continue to host these events and invite the public to attend. The east side property is being considered by the seller in 2 weeks. We should have an update by the next Board Meeting. We have provided the City Council with a copy of our Letter of Intent for Inspire Health projects and the possible acquisition of city-owned property on the Porter campus. We are preparing to present the Bond Issuance resolution to City Council on September 24th. 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 ACTION TAKEN: Dr. Weber made a motion to adjourn into Executive Session. Dr. Anwar seconded and the motion was approved unanimously with aye votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Mr. Pipes, Dr. Kimpel, Ms. Greenleaf, Ms. Womack, Dr. Chamber and Mr. Sherman. Ms. White, Ms. Wells, Ms. Brown and Mr. Kelley left the room at 7:26pm.  NRHA Board Minutes 10 September 23, 2019 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. Shari Jones, MD – Medicine b. Rahal Kahanda, MD – Surgery c. Latha Nachimuth, MD – Hospital Medicine d. Nzube Okonkwo, MD – Hospital Medicine e. Sabrina Young, DO – Medicine f. Preeti Jhaveri, MD – OB/GYN g. Sean Dossett, DO – Anesthesiology h. Michael Gearhart, DO – Emergency Medicine i. Alec Watson, MD – Emergency Medicine j. Shaylea Beach, DO – Medicine k. Brandon Funk, PA-C – Surgery l. Bradley Brown, PA-C – Emergency Medicine m. Taylor Herzer, PA-C – Emergency Medicine n. Christopher Smith, DO - Hospital Medicine o. Kate Petrilla, DO – Hospital Medicine 2. Recommend Advancement of Medical Staff for Additional Privileges: a. Spencer Baird, DO – Hospital Medicine 3. Recommend Medical Staff Reappointments: a. Ryan Wilson, Do – Emergency Medicine b. Kyle Toal, MD – Surgery c. Samuel “Ed” Dakil, MD – Surgery d. Mark Moses, MD – Surgery e. Michael Merkey, MD – Medicine f. Charles Anderson, MD – Surgery g. Jeffrey L’Hommedieu, MD – Emergency Medicine h. William Swearingen, DO – Medicine i. Scott Hosler, DPM – Surgery j. Leighann Price, APRN-CRNA – Anesthesia k. David Argo, APRN-CRNA – Anesthesia C. Request to Adjourn Out of Any Such Executive Session and Return to Regular Session ACTION TAKEN: Dr. Weber made a motion to adjourn out of Executive Session and return to regular session. Dr. Kimpel seconded, and the motion was approved unanimous aye votes from Mr. Cubberley, Dr. Anwar, Mrs. Greenleaf, Dr. Weber, Dr. Kimpel, Dr. Chamber, Ms. Womack, Mr. Pipes and Mr. Sherman. 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.  NRHA Board Minutes 11 September 23, 2019 D. Proposed Vote to Approve or Disapprove the Medical Executive Committee Recommendations Regarding Credentialing of the Referenced Medical Staff Members as Listed in XII B 1-3. 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 XII B 1-3. Mr. Pipes seconded, and the motion was approved with unanimous aye votes from Mr. Cubberley, Dr. Anwar, Dr. Kimpel, Ms. Greenleaf, Dr. Chamber, Ms. Womack, Mr. Pipes and Mr. Sherman. Agenda Item XV. Board Open Discussion Mr. Splitt explained the process for the Bond Issuance presentation for the City Council meeting on Tuesday, September 24th. Agenda Item XVI. Adjournment ACTION TAKEN: Mr. Sherman made a motion to adjourn the meeting at 7:38p.m. Dr. Weber seconded, and the motion passed unanimously with aye votes from Mr. Cubberley, Dr. Anwar, Dr. Weber, Mr. Pipes, Dr. Kimpel, Ms. Greenleaf, Ms. Womack, Dr. Chamber and Mr. Sherman. Respectfully Submitted, Tom Sherman, Vice-Chair/Secretary