Norman Regional Hospital Authority Meeting

NORMAN REGIONAL HOSPITAL AUTHORITY Board Meeting August 24, 2020 MINUTES The Norman Regional Hospital Authority met in monthly session Monday, August 24, 2020 at 5:30p.m. in the Porter Campus Auditorium. The meeting Agenda was posted August 20, 2020 on the NRHS and City of Norman websites and at the entrance to Norman Regional Hospital. Members Present: Doug Cubberley, Chairman Jerome (Jerry) Weber, Ph.D. Diane Chambers, MD Muhammad Anwar, MD Joan Kemmet-Greenleaf Tom Sherman Mary Womack James Chappel Kevin Pipes Others Present: Richie Splitt, President & CEO John Manfredo, COO Paula Price, VP Strategy & Growth Meegan Carter, VP Population Health & Wellness Brittni McGill, CNO Ken Hopkins, CFO Aaron Boyd, MD, Chief Medical Officer Adrian Francisco, Administrative Fellow Dr. Farhan Jawed, MD, Chief of Medical Staff Dr. Joe Voto, MD, Chief of Medical Staff-elect Jenny Anderson, Administrative Director Quality & Performance Larry Harden, Administrative Director, Compliance Karen Rieger, Attorney, Crowe & Dunlevy Neal Risenhover, Supervisor Media Services Kelly Wells, Director Planning & Communications Teresa Brown, Strategic Planning Specialist Meg Belford, Director Clinic Operations & Growth Donna Avila, Director Care Coordination Recorder: Claudia Todd, Executive Assistant Agenda Item I. Meeting Called to Order Mr. Cubberley called the August 24, 2020, Norman Regional Hospital Authority meeting to order at 5:36p.m.  NRHA Board Minutes 2 August 24, 2020 Agenda Item II. Consent Items A. September 2020 Healer of the Month – Patti Guthrie, RN, Charge Nurse New Born Transition Team B. July 27, 2020 NRHA Board Meeting Minutes ACTION TAKEN: Dr. Weber motioned to approve Consent Items A-B. Dr. Anwar seconded the motion. Consent Items were approved unanimously with aye votes from Mr. Cubberley, Dr. Weber, Dr. Chambers, Dr. Anwar, Ms. Greenleaf, Mrs. Womack, Mr. Chappel, Mr. Pipes and Mr. Sherman. Agenda Item III. Board Education: Health & Wellness Update Ms. Meg Belford, Director Primary Care Services and Ms. Donna Avila, Director of Care Coordination, presented an update on Population Health & Wellness: Ms. Avila shared Population Health & Wellness strives to Prevent Illness, Proactively Screen for Disease and Optimize Health. Patients are receiving care in the Outpatient setting more often than the inpatient acute care setting. Since 2015, 42% of care that used to be provided in the acute care setting is now provided in the outpatient setting. The Healthcare landscape has changed. Improving the patient experience through quality and patient satisfaction, improving patient outcomes, and managing cost across the health care continuum is achieved by ensuring value is part of quality care measures. Ms. Belford reported Primary care providers are the front lines of care for patients overall health and wellness. NRHS has experienced considerable growth in the last four years – including telehealth - The Community Call Center is another important piece of population health. It is an easily assessable patient entry point into the health system. In order to make the call center a more effective tool, a PDSA (Plan, Do, Study, Act) was established to make the community call center more effective for users. The call center became an increasingly important tool during COVID. It allowed us to more effectively answer questions, provide testing locations and schedule testing appointments. Nurses staffed the call center 8- 4:30, Monday thru Friday and were able to schedule directly into our providers’ schedule. To date, we have scheduled more than 300 primary care patient appointments and nearly 100 new specialty care e and 80 new specialty care patient appointments. Another important component is the Annual Wellness Visit (AWV) with a primary care provider. During an AWS, a NRHS healer will establish and update a personalized prevention plan of service for the patient – including a review of the patient history, risk factors and medication lists. Based on that review, the provider will recommend counseling and advice when appropriate and provide a no-hands on” exam (vitals only). The AWV helps to identify high risk health issues that can reduce follow-up visits and  NRHA Board Minutes 3 August 24, 2020 hospital admissions. Ms. Avila reported the AWV’s really underscord the importance of Care Coordination. It has been determined that 92% of Medicare beneficiaries have at least 1 chronic condition, 66% have at least 2 chronic conditions and 14% have at least 6 or more chronic conditions. The impact of our efforts include:  Clinics o Decrease of depressive symptoms ( 35%) o Emergency Department (ED) Utilization ( 23%) o Hospital Readmission Rates ( 2.9%) o Uncontrolled HgA1C (Diabetes) ( 3.9%)  Acute/Transition o Return to ED ( 2.1%) o LTAC Utilization ( 3.5%) o Primary Care Appointments ( 23%) o SNF Length of Stay decreased by 6 days ( 19.35%) Ms. Belford and Ms. Avila left the meeting at 5:53pm. Ms. Kelly Wells, Director Planning & Communications presented information for Prevention and Community Health & Wellness promotions. A few of our accomplishments include:  Community Immunity – o Health Promotion nurses provide vaccines and immunity titers at outpatient clinics throughout the year o NRHS conducts the Annual “Say Boo to the Flu” each year. The event provides free influenza vaccines for adults and children at various locations throughout the communities we serve  Little Smiles of Norman – o This is an 11 year multi-organization partnership o This year, NRHS partnered with Cleveland County Health Department, Delta Dental Foundation and Moore Norman Technology Center o The event provided restorative and preventative care for 96 elementary students who do not have regular access to dental services o The value of the dental services was greater than $50,000. The value of dental health for those children…..priceless  Healthy Hospitals – o NRHS has been a Certified Healthy Business (Excellence Award) for 16 years straight. NRHS provides activities like Recess at Work, Mylink Mindful Mondays, Mindful Medicine on the Go, and the Water you Waiting for Challenge o Norman Regional has received the Platinum level award for Work Healthy Hospitals. This award is part of a partnership between TSET and the Oklahoma Hospital Association. It’s aimed at helping state hospitals improve culture of employee wellbeing through organizational system changes. It’s a visible wellness standard for the communities served by hospitals.  Community Support – o Cancer Support, Diabetes Pump, Wellness Seminars, Stroke Support, Parents Helping Parents, Rare Pair, Bariatric and Epilepsy support  NRHA Board Minutes 4 August 24, 2020 groups. o No Hunger Holidays partnership with Feed the Children – Providing 1600 Families in the Moore and Norman area with food and hygiene supplies o Diabetes Health Fair – annual events, education and screening events o Women’s Health and Well-being events o Athletic Trainers – Ortho Central providing student athletes at various public schools and university’s with skill and knowledge in areas of injury prevention, overall well-being, concussion protocols, exertional heat stroke signs and injury emergencies. o Basic Life-saving CPR training – 1,378 public school students and 60 staff at the JD McCarty center were trained. Ms. Wells left the meeting at 6:01pm. Agenda Item IV. Performance Update Ms. Anderson, Administrative Director, Quality & Performance presented three updates in Patient Quality & Safety:  NEWs Wall Evolution: The Norman Engagement Walls (NEWs) are data visual management walls that tie into strategic planning. Every department has a NEWs Wall that is used to promote greater awareness of health system and department level strategic goal. It is a visual data management system that was initiated in 2017. NEWs Wall categories include: o Service Excellence: NRC Real-Time patient experience is monitored o Operational Excellence: This reflects labor productivity measures o Clinical Excellence: Heart Failure Mortality was the first clinical measure to be featured. Each year a new measure is featured when an opportunity for improvement is determined o Team Excellence: This metric focuses on employee engagement and recognition These categories are applied to three areas: Health System (top row), Department specific (middle row) and Daily Monitoring (bottom row).  Value Based Purchasing (VBP) Progress: at the beginning of each year, CMS withholds 2% of our Medicare Reimbursement. We have the opportunity to earn the “withhold” back through quality measure attainment in the areas of Clinical Outcomes, Patient Safety, Patient Experience and Efficiency Scores. NRHS has improved performance since beginning in 2016.  Just Culture: Held 2nd Champions meeting recently. Training is set to begin in October/November. Agenda Item V. Approval of the July 2020 Norman Regional Health System Financial Statements Mr. Hopkins presented the July 2020 Norman Regional Health System Financial report:  NRHA Board Minutes 5 August 24, 2020 July 2020 Financial Performance  Gross Revenues .................................. (Budget $211,889,710)............ $208,889,401  Net Patient Revenue .............................. (Budget $43,916,366).............. $45,090,392  Total Operating Expenses ..................... (Budget $43,862,698).............. $43,638,606  Total Operating Revenues ...................... (Budget $44,333,479).............. $42,803,479  Operating Income ....................................... (Budget $470,781)................. ($835,127)  Non-Operating Revenues (Expenses) ..... (Budget $1,091,252)................ $4,537,011  Excess Revenues over Expenses ............ (Budget $1,562,033)................ $3,701,884 Year-to-Date  Operating Income ....................................... (Budget $470,781)................... $835,127  Non-Operating Revenues (Expenses) ..... (Budget $1,091,252).............. ($4,537,011)  Excess Revenues over Expenses .............. (Budget 1,562,033).............. ($3,701,884)  Accounts Receivable Days ............................ (Budget 43 Days).................. 45.3 Days  Days Cash on Hand…………………………………………………………….190.7 Days ACTION TAKEN: Mr. Pipes motioned to approve the June 2020 NRHS Financial Statements. Dr. Weber seconded the motion. July Financials were approved unanimously with aye votes from Mr. Cubberley, Dr. Weber, Mr. Chappel, Dr. Chambers, Dr. Anwar, Ms. Greenleaf, Mr. Sherman, Mr. Pipes and Ms. Womack. Agenda Item VI. Patient Quality & Safety Committee Ms. Greenleaf reported the committee met August 3rd by Webex. Ms. Amanda Jones, Director Food & Nutrition Services presented an overview of the Tube Feeding process improvement Failure, Modes and Effects Analysis (FEMA). The goal was to standardize the tube feeding process for the health system. Mr. Larry Harden, Administrative Director Risk Management provided a compliance and risk management update. Ms. Jenny Anderson, Administrative Director QPI/Medical Staff Services reported: o The continued decline in severe sepsis/shock mortality o Hospital Acquired Infections: Colon surgical site infections are on a downward trend and Total Knee Arthroplasty saw a slight decrease o ED Arrival to Departure time is trending downward The committee is compiling a list of all Centers of Excellence within Norman Regional. A summary report will be presented at the Septemeber Board Meeting. Ms. Greenleaf congratulated Ms. Jenny Anderson for earning a Masters Degree in Applied Science and Patient Safety in Healthcare Quality from Johns Hopkins. Agenda Item VII. Medical Staff  NRHA Board Minutes 6 August 24, 2020 A. Dr. Jawed presented the Medical Staff report. He stated the Medical Executive Committee (MEC) met on August 12, 2020 via Webex. New Business:  COVID-19: Open discussion was held covering COVID-19 testing, PPE supplies, testing turnaround times, state COVID cases and travel and quarantine policies.  Large Medical Staff meetings will continue to be held via Webex and smaller meetings can be held in person.  Mr. Manfredo presented an Inspire Health update. Schematic design sessions have been scheduled. The HealthPlex campus design was reviewed. Dr. Boyd encouraged all physicians to participate in the discussions. Department Reports:  Reports were provided by Anesthesia, Behavioral Medicine, Emergency Medicine, GMEC, Infection Committee, OB/GYN, Pediatric Hospitalists, Pediatrics, Pharmacy & Therapeutics Committee, Physician Advisory Committee, Radiology and Emergency Medicine Residency Program.  Dr. Aaron Boyd, MD presented the Medical Staff Report. He thanked everyone for their hard work and helping each other out over the last few months. Administrative Reports:  Ms. McGill announced the Behavioral Medicine Unit passed their recent survey. New Zoll Automatic External Defibrillator (AEDs) will be arriving soon for system–wide replacement.  Ms. Price announced the initial planning stage of a Food Pharmacy. This program assess patient food needs and is considered a social determinant of health and wellness.  Ms. Carter provided a payor update for Aetna Health.  Mr. Manfredo announced a candidate will be interviewing later in the week for the Surgery Director.  Mr. Splitt thanked the physicians for all they do throughout the health system. Mr. Splitt announce the newest trustee is James Chappell. Mr. Splitt announced Project Search will be returning this fall. He reminded members of the four Norman propositions being considered on the ballot August 25th. Agenda Item VIII. Finance Committee A. Report from the July 20, 2020 Finance Committee Mr. Sherman reported the committee was pleased with the first month of financial information for FY2021. B. Mr. Manfredo presented for approval four capital request items totaling $3,365,348: a. Surgical robot and surgical table: $1,917,222  NRHA Board Minutes 7 August 24, 2020 b. COVID Testing PCR System: $80,189 c. Power-Loading Stretchers: $518,516 d. Telehealth Expansion (HHS Grant Funds): $849,422 ACTION TAKEN: Mr. Sherman made a motion to approve the Capital Equipment Requests at a total cost of $3,365,348 as recommended by the Finance Committee. Ms. Greenleaf seconded and the motion was approved unanimously with votes from Mr. Cubberley, Dr. Weber, Mr. Chappel, Dr. Anwar, Dr. Chambers, Ms. Greenleaf, Mr. Sherman, Mr. Pipes and Ms. Womack. Agenda Item IX. Old Business Mr. Splitt reported the City Manager of Norman was very excited for the Trustees approval of the Resolution for the negotiation of real property on the Porter campus. Agenda Item X. New Business Ms. McGill reviewed the meaning of “Capacity Alert”. They are used proactively to communicate potential patient throughput challenges – including bed availability in various departments. Agenda Item XI. Administrative Report Mr. Splitt announced the passing of Councilman David Perry. He thanked him for his service and dedication to the community and expressed thoughts and prayers for his family. General Obligation Norman 2020 Vote is Tuesday, August 25th. NRHS submitted a letter to the Transcript supporting the Health & Wellness aspects of Proposition 1 (Norman Forward). The letter was well received with positive feedback. NRHS is providing an AED for each of the Ranch Steakhouse restaurants (North OKC and Norman). This project is a result of conversations following the swift actions of Dr. Boyd, Chief Medical Officer, who resuscitated a choking patron durinjg a recruitment dinner at one of the restaurant locations. NRHS is within the survey window for The Joint Commission (TJC). TJC is an accrediting body and global driver of patient quality and safety improvement in healthcare. These surveys are conducted on behalf of the Centers for Medicare & Medicaid Services (CMS) and determine if hospitals are meeting the standards for accreditation. Due to COVID-19, the process was delayed but will start again soon. Mr. Splitt thanked Dr. Jawed for recognizing our healers at the Medical Executive Committee meeting. The ever-changing world of healthcare can be very stressful even without COVID-19 factored in. NRHS is exploring ways to ease that stress and be innovative in wellness for our healers.  NRHA Board Minutes 8 August 24, 2020 NRHS logo masks are being provided to the Trustees this evening. A group photo will be taken immediately following the meeting. The photo will be shared on social media to promote social distancing and mask wearing (#GotMaskOK). Agenda Item XII. 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. Pipes made a motion to adjourn into Executive Session. Dr. Weber seconded and the motion was approved unanimously with aye votes from Mr. Cubberley, Dr. Weber, Mr. Chappel, Dr. Chambers, Dr. Anwar, Ms. Greenleaf, Mr. Sherman, Mr. Pipes and Ms. Womack. Ms. Anderson and Ms. Brown left the meeting at 7:04pm. 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. Jacquelyn Boyd, DO, Active Staff – OB/GYN b. Ali Ashraf, MD, Active Staff – Medicine c. Hannah Holasek, PA-C, Allied Health Staff – Medicine d. Rachelle Haning, DO, Privileges Only – Hospital Medicine e. Fang Yu, MD, Privileges Only – Radiology f. Kaya Smith, DO, Privileges Only – Hospital Medicine 2. Recommend Medical Staff Reappointments: a. Vijay Kolli, MD, Active Staff – Medicine b. James Love, MD, Active Staff – Medicine c. Rebecca Eagle, MD Active Staff – Medicine d. Bradley Wilson, MD, Active Staff – Surgery e. Joel Kardokus, MD, Active Staff – Hospital Medicine f. Ryan Carter, MD, Active Staff – Hospital Medicine g. Sameer Mohammed, MD, Active Staff – Behavioral Medicine h. R. Bruce Parker, MD, Active Staff – OB/GYN i. Sobia Ahmad, MD, Consulting Staff – Medicine j. Crystal Sparling, MD, Associate Staff – Pediatrics k. David Duncan, MD, Associate Staff – Medicine l. Seethal Madhavarapu, MD, Associate Staff – Medicine m. Blakeley Hamit, APRN-FNP, Allied Health Staff – Pediatrics n. Christina Stuart, APRN-CNS, Allied Health Staff – Medicine o. Winter Bathe’, PA-C, Allied Health Staff – Surgery p. Kelsey Olsen, PA-C, Allied Health Staff – Surgery q. Desiree Herring, APRN-CRNA, Allied Health Staff – Anesthesia  NRHA Board Minutes 9 August 24, 2020 3. Recommend Advancement of Medical Staff from Provisional Status: a. E. Kim King, DO, Associate – Medicine b. Regina Rhodes, DPM, Associate- Surgery c. Kendall Helm, APRN-CRNA, Allied Health Staff – 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. Mr. Sherman seconded, and the motion was approved unanimous aye votes from Mr. Cubberley, Dr. Weber, Dr. Chambers, Mr. Chappel, Dr. Anwar, Ms. Greenleaf, Mr. Sherman, Mr. Pipes and Ms. Womack. 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 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. Sherman seconded, and the motion was approved with unanimous aye votes from Mr. Cubberley, Mr. Weber, Dr. Chambers, Dr. Anwar, Mr. Chappel, Ms. Greenleaf, Mr. Sherman, Mr. Pipes and Ms. Womack. Agenda Item XIII. Board Open Discussion None Agenda Item XIV. Adjournment ACTION TAKEN: Mr. Sherman made a motion to adjourn the meeting at 7:07p.m. Ms. Greenleaf seconded, and the motion passed unanimously with aye votes from Mr. Cubberley, Dr. Weber, Mr. Chappel, Dr. Chambers and Dr. Anwar, Ms. Greenleaf, Mr. Sherman, Mr. Pipes and Ms. Womack. Respectfully Submitted, Tom Sherman, Vice-Chair/Secretary