By Jerry Morgan, Editor

VAN DYKE – In its first action following a long executive session at the beginning of its meeting, the Board of Directors of the Comanche County Consolidated Hospital District agreed to accept a bid from Alan Striegler to purchase the old DeLeon Nursing Home building, subject to review of the purchase contract presented by the buyer.

The District had earlier advertised for bids on the long-closed facility on Ayers Street. Three bids were received and opened on Friday, May 24. Striegler’s bid of $59,000 was the high bid of the three. The property put up for bid did not include the parking lot directly west of the old nursing home. Striegler indicated his desire to purchase the parking lot as well. The intended use of the facility was not revealed, although Striegler and his partner have requested a meeting with hospital representatives to discuss their plans for the property.

Without discussion, the Board voted unanimously in favor of a motion by Mary Jane Atkins to accept Striegler’s bid. All members were present at the Tuesday, May 30 meeting.

In a similar manner, the Board next voted in unanimous approval of a motion by John Mack Weaver to “accept the report of the evaluation committee and its recommendation for compensation of the CEO.”

Following the meeting, Chief Executive Officer Evan Moore advised that he had been given a 7% increase in his rate of pay and that there was no employment contract involved.

Telephone System Problems

In its first public session agenda item, the Board discussed the continuing problems with the Medical Center’s telephone system. David Pierce with CrossTalk Communications, the telephone system vendor, was present at the meeting at Evan Moore’s request. Hospital employees Bill Moore and Jeanette Luckie were also at the meeting and joined in the discussion.

Luckie commented that random patient surveys had turned up no indications of telephone system troubles in securing appointments at the clinic.

John Mack Weaver stated that he had heard continuing complaints regarding the telephone system and that he knew other Board members had also heard complaints, most involving communications with the clinic.

Pierce commented that the clinic had received 1,619 calls in the previous week and the hospital had received 467 calls. He noted that the number of incoming phone lines, 24 in all, meant that virtually every call placed got through to the CCMC telephone system. However, during the peak call periods, generally between 8:00 and 9:00 in the mornings when most clinic appointments are made, there often were not enough people available to answer every call placed, despite having multiple people working at taking appointments.

Luckie noted that a call queuing system, where calls are automatically placed on hold and answered in the order received, was being investigated. She also noted that calls for a physician’s nurse are generally not answered by a live person since the nurse is normally busy with patient-related work. Those calls are answered by the voice mail system if the nurse is unavailable.

John Weaver and Karen Carr made suggestions regarding training for the system operators to inquire whether the caller is seeking an appointment or not, and to advise them that a call for a doctor’s nurse will likely be answered by voice mail.

Luckie said that physician’s nurses were instructed to check their voice mail at least three times during the work day, at the beginning of the day, right after lunch and at the end of the day. She stated that the average number of daily calls at the clinic has declined from around 2,000 a few months earlier to around 1,500-1,600 currently. She interprets the decline as an indication that people are having more success accomplishing their purpose on the first call.

Evan Moore said that there had been hospital patient complaints about phone calls ringing in to semi-private rooms at all hours of the day. In response, the decision has been made that calls will be placed through to patient rooms only during visiting hours.

Provisions will be made for emergency and family calls, however.

Near the conclusion of the half hour plus discussion, Moore commented that the telephone system had been in a state of constant change as different solutions and methods have been tried to improve service and that they would continue working on it until a more or less satisfactory solution was found.

Quality Improvement and Compliance

Joe Locke reported from his meeting with the hospital’s quality improvement and compliance committee and that in his opinion there were no issues which needed to be reported to the Board and that all matters identified were being dealt with appropriately.

Medical Staff Insurance Requirements

Chief Operating Officer Mike Hare reported that during his process of seeking bids on professional liability insurance for the hospital he had been asked what are the hospital’s requirements for physicians and if those requirements were part of the hospital bylaws. After researching, Hare determined that there was no mention in the bylaws of professional liability insurance requirements for physicians.

Hare presented the Board with a proposed amendment to the Hospital District bylaws which would add a requirement that each member of the hospital medical staff be required to submit satisfactory proof of professional liability insurance in an amount equal to or greater than that determined by the Board.

Evan Moore suggested that the minimum insurance requirements be set at $200,000 per occurrence and $600,000 in aggregate.

The Board unanimously voted both to adopt the proposed bylaws amendment and the insurance limits suggested.

Strategic Planning

Evan Moore presented two quotes from individuals who would conduct a long-term strategic planning session for the Board members, administrators, physicians and key staff. Moore added that he was acting on a request made by Joe Locke in an earlier meeting that a strategic plan be adopted in connection with or prior to the development of the next annual budget.

One quote was from Larry Krupala of the Texas Organization of Rural and Community Hospitals. It was for $3,000 and would entail a session to include a Friday evening and most of the following Saturday. The second quote, which would cover a similar meeting time frame, was from James Alexander, Ph.D., of the Texas A&M University School of Rural Public Health. That quote was for $5,000. Moore added that he thought both quotes were relatively reasonable in price and that the strategic planning session would be held at the hospital.

Mary Jane Atkins inquired if the strategic planning was required and was told by Evan Moore that it was not, but that it was considered to be a standard practice. Mike Hare added that a strategic plan gives the administration direction from a different level.

After agreeing that it would be virtually impossible to hold the planning session before developing the next annual budget, and after a suggestion by Chief Nursing Officer Shannon Steigleder that the Board might wish to see example strategic plans that have been developed by the two planning facilitators under consideration, Evan Moore said he would seek plan examples and would aim for a strategic planning session to be held in the fall.

Pharmacy Department Report

Gyale Pirkle,Director of Pharmacy, noted that he had a very favorable impression of the changes being implemented by Shannon Steigleder, and how well she was working with the various hospital departments.

Pirkle said that beginning in June the pharmacy would cut back its hours of operation on Saturdays and Sundays. Currently the hospital pharmacy is open seven days a week, opening at 6:30 a.m. and closing at 6:00 p.m. The new weekend schedule will be opening at 7:00 a.m. and closing at 1:00 p.m. Pirkle added that Steigleder was in agreement with the planned cutback on weekend hospital pharmacy operating hours.

Pirkle expressed satisfaction with how the doctors were working with the pharmacy on allowing substitution of generics in prescriptions. He stated that just on two injectables, the use of generics was saving the hospital $4-6,000 per month.

Pirkle said the hospital was in the process of changing its drug supplier and that he expected tremendous cost savings to result in addition to improvements in the billing process. He stated that the hospital’s drug costs were currently running around $71,000 per month.

Pirkle reported that he had been successful in consolidating multiple drug inventories in the clinic into a single unit and that a considerable reduction in the total drug inventory had been achieved in the process.

Pirkle commented on progress in implementing the pharmacy computer program. When completely installed in both the nursing and hospice departments, the new system will save many manhours and will virtually eliminate patient medication errors. Pirkle cautioned, however, that it will require significant training for everyone involved in its use.

Social Work Department

Rick Goodner and Linda Moore made the Board presentation for the Social Work Department. Between the two, they have coverage from 8:00 a.m. until 8:00 p.m. with on-call consultation in emergency situations.

Goodner said they had been training nurses in how to handle aggressive patient situations and how to defend themselves both physically and verbally. Additional training on the same subject matter is planned for the entire hospital staff.
Goodner reviewed his department’s operating statistics. He commented that one part of his work had been involved with getting indigent patients approved for Medicaid, adding that a total of $116,000 in cost reimbursements had been received in the current calendar year that otherwise would have been charity care or bad debts. This is in addition to helping patients gain access to services that they would not have otherwise received.

Both John Weaver and Evan Moore made comments of appreciation for the work that Goodner and Moore perform.

CEO Report

Evan Moore noted that the hospital recently received an increase in the rate of payments by Medicare and Medicaid for clinic visits, although there was legislation currently under consideration in Congress that would decrease payments by 27%.

Moore discussed the advent of Medicare Advantage Plans being promoted by some insurance companies. He noted that Medicare patients who enroll in such plans are no longer considered to be Medicare patients but are regarded as insured patients. This change of status hurts the hospital in various ways in terms of cost reimbursements. He concluded, “That’s one of the big things on the horizon that’s affecting us.”

Moore reported that the Home Health Department had an unexpected survey that resulted in “zero deficiencies.” Moore said it was a standard survey, but was made a little earlier than would have been expected due to a pending change in state regulations. Moore and Mike Hare both commented on how well things were going in the Home Health Department.

Moore discussed how the hospital industry and health officials worldwide are watching the avian flu situation very closely since it has the potential for a major disaster. He said the hospital has put together an advisory and planning group and has purchased an increased supply of gloves and masks.

Moore and Hare both discussed their proposal to contract for a three year stipend for a recent medical school graduate currently beginning her three year residency in Family Practice at John Peter Smith Hospital in Fort Worth. Since Dr. David Long is leaving and since there may be one or more additional vacancies occur in the medical staff in the next three years either through resignation or retirement, the administrators propose to pay the new physician a $1,500 per month stipend for the next three years. The stipend payments would be a formal loan that would be considered to be repaid if the physician practices at Comanche County Medical for 36 months.

Dr. Howard Dickey was called in to visit with the Board concerning the new physician. He gave her a glowing recommendation.

The Board agreed to put the matter on next month’s agenda and to invite the physician to attend the meeting.

COO Report

Mike Hare reported that April was a good month for surgeries with the budget having been exceeded. Revenues were only slightly below budget. April was another good cash flow month with income of $1.6 million exceeding outgo by $200 thousand. He complimented the business office for their success in improving billings and cash collections.

Hare noted the average in-patient length of stay for April was 3.8 days, another good indicator because it was below the 4.0 days upper limit standard. The average in-patient census in April was 19.4. This was below the budget of 24.

Hare said that there were 25 bone density scans performed in April, and that there have been 35 performed in May. He noted that the service is really catching on with the local area physicians.

Hare said he was excited to report that CCMC has the capability with its new bone density scanner to perform a vertebral fracture assessment. This is a new and relatively low cost service that cannot be obtained anywhere else closer than the Dallas-Fort Worth area. Hare noted that other area hospitals have bone density scanners, but theirs do not have the vertebral fracture assessment capability. Hare said that physicians ordering bone scans will be inclined to add the vertebral fracture assessment to their order since it provides so much more information than a simple bone scan.

Financial Report

Evan Moore gave the financial report in the absence of Chief Financial Officer Pam Rice, who was on vacation. Moore opened his report with a projected graph of hospital revenues by month in the current fiscal year. He pointed out that although April’s revenues were slightly down, that the revenue trend was clearly growing.

Moore noted that contractual deductions from billings are higher than desired and budgeted. He pointed to unfavorable trends in federal and state cost reimbursements as the largest part of the problem. He added that the changes “will be putting constant pressure on the bottom line of the hospital.”

Moore also displayed a graph of expenditures. They were generally in line with the budget.

The bottom line for April showed a loss of $113 thousand. The year-to-date net was a loss of $112 thousand. Moore reminded the Board of the $204 thousand negative prior year settlement recorded in March and commented that without that unexpected event the current year would still show a profit.

Moore said that cash receipts had continued their favorable trend in May and that payables were well under one month’s average expenditures. He noted that improvements are continuing in receivables collections and noted that the hospital now has unspent tax revenues and reserves of around $750 thousand.