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VAN DYKE -- The Board of Directors of the
Comanche County Consolidated Hospital District, the governing
authority of the Comanche County Medical Center and Doctors Medical
Clinic, met in regular session on Tuesday, August 29, to set a
proposed property tax rate for 2006, among other matters.
Two directors, John Mack Weaver and Mary
Jane Atkins, were absent. The meeting was chaired by Charles Mazurek
with directors Joe Locke, Gale Easley and Karen Carr comprising the
balance of the quorum.
The minutes of the previous meeting were
unanimously approved without discussion or change.
Medical Staff Report
Drs. Howard Dickey and Dwayne Miller were
present for the medical staff report portion of the meeting.
Chief of Staff Dr. Dickey, who has
responsibility for medical staff scheduling in the CCMC Emergency
Room, noted that the medical staff is having a “pretty rough time” in
August and September making sure that all ER shifts are covered.
Dr. Dickey noted that as of September 15,
a total of four physicians who have previously been sharing ER duties
will have either left the hospital or quit working in the ER. Dr. Long
moved out of the area at the end of July, Drs. Gilmore and McCrory
have begun working at the Brownwood Regional Medical Center ER, and on
September 15, Dr. Reeves will move out of the area.
Dr. Peter Fagan began working at the CCMC
ER in August and received praise from Dr. Dickey for how well he
performed his duties.
Dr. Dickey described how an emergency
room physician contract service had been contacted regarding ER
coverage during September, but added that he believed the schedule had
now been worked out to provide ER coverage with staff and local
physicians.
Dr. Dickey stressed that the use of
outside contract physicians for ER coverage was not desirable, adding,
“We know our patients, and they know us.”
Dr. Todd Davis will begin work at CCMC in
October and that will provide some needed relief, bringing the number
of physicians working in the ER back up to seven.
“It’s getting pretty tough,” is how
Dickey described the physicians’ work situation in covering both the
Emergency Room and the Doctor’s Medical Clinic. He added that it was
not easy for physicians to get a full week of clinic work in while
working the ER overnight during certain nights.
CEO Evan Moore stated that the Brownwood
Regional ER recently increased their physician pay rates to a level
more than 50% above the comparable CCMC pay rate.
Dr. Miller stated that it was hard to
compare emergency rooms. He noted that in the emergency rooms in
larger hospitals they have surgeons, cardiologists and other
specialists on call. Here, however, physicians have more total
responsibility for their ER patients, at least until they have been
transferred to another medical facility.
Local physicians are also responsible
during nights and weekends for emergency medical situations that arise
in the hospital and in the surrounding area.
Dr. Miller commented that the stress
levels were significantly higher in a setting such as the CCMC
Emergency Room because of the greater level and scope of
responsibility, even if the patient load might not be as high as at
the Brownwood hospital, for example. “After a 12 hour shift, you’re
exhausted,” is how he described it, adding that it takes 24 hours to
recover.
Dr. Miller stated that he was concerned
that it was going to be hard to keep some of the younger physicians
working here because of the stress, particularly when better paying ER
work was available nearby.
“You have to pay for what you get,” Dr.
Miller said, adding that an ER physician staffing service could cover
the need, but would cost anywhere from twice to half again as much as
the present physcian cost.
Dr. Miller said the heavy medical
responsibility and the long work hours required, when combined with a
comparatively low pay scale, made CCMC a difficult sale for a new
physician seeking a work location.
Dr. Dickey indicated that they were not
seeking sympathy for themselves, noting, “It’s the route we chose. We
dug part of the hole ourselves.”
Dr. Miller quickly added, “I don’t want
to do anything different, and I won’t do anything different, and I’m
going to be here if I get $2 an hour, just to keep the hospital
going.” He later added, “What would help is if we had three or four
more doctors. That’s the solution.”
Joe Locke noted that when the subject of
emergency room physician pay had been discussed that it was agreed
that it would be re-examined again in six months, and that it was now
time to look at the matter again, to survey the pay rates at other
area and comparable hospitals.
Charles Mazurek agreed, stating that the
matter would be given some consideration.
Executive Session
The Board then adjourned into executive
(closed to the public) session for consideration of the medical peer
review and reappointment of various consulting medical staff and
allied health professionals, and for consideration of the report of
the quality improvement and compliance committee report.
In recent Board meetings, the QI/Compliance
Committee findings had been relayed to the full Board in open session
by the the Board members who are QI/C committee members, Joe Locke and
Gale Easley.
The Board held a relatively long, 40
minute executive session.
Dr. Howard Dickey attended the early
portion of the executive session when the medical staff reappointments
were apparently considered. The longer portion of the session occurred
after Dr. Dickey’s departure.
Following the resumption of the public
session, Gale Easley offered a motion to approve the reappointment of
Drs. David Blackwood, Lon Walder, Nageswari Daggubati and Udaya Swarna
and also John Gilbert, CRNA. Karen Carr seconded the motion and the
vote to approve was unanimous.
No vote was taken on Dr. Avi Deshmukh,
who was also on the list of physicians considered for reappointment.
There were unofficial comments heard that additional information was
needed on Dr. Deshmukh’s application and that it would possibly be
reconsidered at a future meeting.
No Board discussion nor actions were
taken in regard to the QI/Compliance report.
Administrative Reports
Chief Nursing Officer Shannon Steigleder
gave a very positive report on recent developments in the nursing
department. She noted the hospital now has set up four isolation
medical supply carts in response to the need for more than the initial
one.
Another recent innovation involves the
use of EMS paramedics for performing the initial triage (initial
medical assessment) on patients entering the emergency room during
normal business hours when EMS personnel are on duty.
Steigleder reported on grant applications
and continuing work on preparedness for a flu pandemic.
Chief Executive Officer Evan Moore
described the successful Healthcare Foundation gala that was held on
the prior Saturday evening, noting that it had grossed over $53,000 in
receipts. All related expenses had not yet been tallied, but were
estimated at around $10,000. “We were very, very pleased and very
happy with the outcome,” Moore said.
Administrative aide Kathy Johnson
indicated that they all learned a lot in producing the gala and that
another was likely to be conducted in the following year.
Moore discussed recent contracts with Air
Evac Lifeteam, the company that operates the air ambulance service
based in Brownwood that serves CCMC. Air Evac is planning to sell
annual memberships to individuals that cover the uninsured costs of
air ambulance services. The company is interested in cooperation with
the hospital in the effort.
Moore discussed a quote the hospital had
for a new ambulance in the amount of $87,000. He said the hospital
needed to replace its oldest ambulance. Moore said that the hospital
needed to begin replacing one ambulance each year.
Directors discussed whether the hospital
could cut back on the number of ambulances operated from five to four.
Moore also presented two bids for used
vans for replacing the hospital’s van, noting the existing van is no
longer dependable, and that the newer vans would get significantly
better fuel mileage. The lowest bid was for around $16,000. The van
would be used for employee travel for training and other purposes.
After lengthy consideration, Joe Locke
offered a motion to accept one of the two identically-priced lower
bids for a van. Gale Easley seconded and the vote of approval was
unanimous.
Moore next discussed that he was
investigating getting the hospital into nuclear medicine, the
equipment for which could be housed in the room currently used as the
X-ray file room. That particular room will soon no longer be used for
its original purpose since the advent of digital X-ray imaging at the
hospital has eliminated the creation of new X-ray film images.
Non-exercising cardiac stress tests could
be conducted with the nuclear medicine equipment, a much needed and
profitable service according to Moore. He emphasized that a proposal
was not currently being put forward, but that discussions with
possible vendor/partners were under way and something could be ready
for consideration as early as the next board meeting.
Shannon Steigleder reviewed the large
number of sophisticated tests than could be performed by the nuclear
medicine equipment.
Moore added that work was underway on a
possible physical therapy building to be constructed at the hospital
site. He had a visit with Jim Polkinghorn, the hospital architect,
earlier that same day regarding the new structure.
Moore said that Polkinghorn would
research the project and come up with building sizing and projected
costs. Moore also added that he was investigating the possibility of
obtaining grant funds for the possible construction project.
Moore also discussed when and how to
conduct a strategic planning session for the Board.
He was asked to provide more information.
Chief Operating Officer Mike Hare pointed
out that July’s surgeries and special medical procedures were well
above the budget. Patient discharges were on budget and the average
patient census was only slightly below budget. Emergency room visits
were virtually on budget, however, clinic visits were only 92% of
budget.
Hare noted that the prospective
purchasers of the old DeLeon Nursing Home building had requested an
extension of time to October 12, which had been granted. He added that
the prospective purchasers very much want to complete the deal and
that the City Council had approved the operation. He added that any
time you have to deal with the state to get approvals, it takes a
while.
Hare stated that he had been advised
earlier in the day by the hospital’s Workman’s Comp insurance carrier
that it had assessed CCMC an additional $70,000 in premiums to cover
claims filed in the previous year under the policy.
Hare noted that loss experience thus far
in 2006 had been very favorable.
Hare stated that the ring road that
circles behind the hospital will be blocked on the north side of the
hospital to prevent potential accidents with rapidly departing and
arriving ambulances.
Financial
Chief Financial Officer Pam Rice reviewed
the monthly financial statements. She noted that in July contractual
deductions and bad debts were up as a percent of revenues.
Total patient service billings were 95%
of budget, which Rice said was to be expected for a summer month with
a level-loaded revenue budget. Excessive deductions from revenue,
however, resulted in total operating revenue that was only 78% of the
budgeted total.
Operating expenses in July were at 93% of
budget. The bottom line net income for July, however, showed a loss of
over $218,000.
Rice said that she was very pleased with
the average number of days calculation in accounts receivable, 67.7.
She added that cash was still coming in like it should be and that the
hospital still held almost a half million in cash reserves above and
beyond bond service requirements.
Despite the foregoing, Rice expressed
concerns over cash flows in the coming weeks citing payment slowdowns
in Medicare and Medicaid and final cost settlements from prior years.
Rice noted that the Whitestone Assisted
Living facility was paid current on amounts due to the hospital for
services.
Rice said that accounts payable were
higher than desired and that they were working with vendors on setting
up payments.
She noted that the August bond payments
had been made in full and that the next payments were due in February.
Rice presented the periodic public funds
investment report which was unanimously approved by the Board.
Following a break in the meeting, Rice
presented an investment alternative called TexSTAR (STAR-Short Term
Asset Reserve) managed by First Southwest Asset Management. A lengthy
list of counties and municipalities participating in the plan along
with a chart of recent investment yields were presented.
Following a brief discussion, in which it
was noted that TexSTAR was on the list of approved investments for
public funds, the Board acted unanimously on a motion by Gale Easley,
seconded by Karen Carr, to authorize CCMC to participate.
Proposed Tax Rate Set
The Board labored for more than an hour
over a proposed property tax rate.
Pam Rice explained that the property tax
values growth would not provide as much increase in tax revenues as
assumed in the hospital’s budget. She presented a schedule that showed
projected property tax revenues under four different rate assumptions
ranging from the current 25¢ per $100 taxable property valuation to
38.96¢.
Rice noted that each additional cent in
the property tax rate would raise an additional $51,800 in tax
revenue.
Evan Moore discussed plans for changes in
the Medicare reimbursement rates to shift from pricing-based to
cost-based. He indicated that the change would likely have a negative
effect upon hospital revenues.
Moore added that the hospital had
inadequate cash reserves to earn a bond rating sufficient to easily be
able to borrow any needed funds.
Joe Locke indicated that he did not feel
that $50,000 would either make or break the hospital. He asked Moore
if there wasn’t $50,000 of savings that could not be found in the
current budget.
Moore responded that he planned to “look
into that.”
Locke added that he recollected that the
Board had promised the taxpayers that they would not raise the rate
above 25¢.
Later, after better than a half hour of
discussion, Locke offered a motion to leave the Hospital District’s
combined property tax rate at 25¢, the same rate as the previous year.
After calling for a second and receiving
none, Charles Mazurek seconded Locke’s motion and then called for more
discussion.
Both Karen Carr and Gale Easley expressed
concerns regarding the small budgeted operating surplus for the
current fiscal year and their belief that a higher tax rate would
provide greater financial assurance for the hospital.
After another half hour of discussion and
hesitation, both Easley and Carr indicated that they could reluctantly
go along with the 25¢ rate motion.
The vote to approve the 25¢ rate proposal
was unanimous. |
