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VAN DYKE -- The Board of Directors of the
Comanche County Consolidated Hospital District, the governing body of
the Comanche County Medical Center, held its regular monthly meeting
on Tuesday afternoon, September 26, at the hospital.
Board members Charles Mazurek, John Mack
Weaver, Gale Easley, Joe Locke and Mary Jane Atkins were present.
Karen Carr was absent. The meeting was conducted by Charles Mazurek,
Board president. The following article was prepared from a recording
of the meeting. The reporter was not present.
The first order of business was to
approve a resolution adopting a property tax rate for 2006 of 25 cents
per $100 taxable property valuation, the same total rate as in 2005.
The rate was adopted by unanimous vote on a motion by Joe Locke.
Chief Executive Officer Evan Moore noted
for the record that 16.3268 cents of the total was dedicated to
satisfaction of bonded indebtedness from construction of the hospital,
and that of the remaining 8.6732 cents, 6.14 cents was used for
support of the ambulance service, leaving only around 2.5 cents for
support of hospital operations. Each cent of property tax generates
approximately $51,000 in tax revenue.
A Board presentation by Air Evac Lifeteam
regarding its membership program had been set on the meeting agenda,
however, no representative from the company was present and the matter
was skipped.
The next matter involved the approval of
the minutes of two previous meetings, both of which were approved on
unanimous votes.
Medical Staff Report
Dr. Howard Dickey, chief of staff, then
gave the medical staff report to the Board.
Dr. Dickey said that the medical staff
had met on the prior week and voted to recommend that the Board
approve an amendment to the medical staff bylaws. The change was to
change a reference to “Hospitals” and the subsequent definition that
the word as referring to DeLeon Hospital and Comanche Community
Hospital, to read “Hospital-Comanche County Medical Center.” The Board
acted unanimously to approve the change.
Dr. Dickey reported that the medical
staff had also met with a nuclear medicine company that was being
considered to supply such services to the hospital. Dr. Dickey said
that 8-10 nuclear stress tests per month was considered to be the
break-even point for the service. The company can also provide CT
scans and bone scans. Dr. Dickey noted that given the number of
exercise stress tests currently performed at the hospital, he felt
confident that the number of nuclear stress tests would be sufficient
to meet the company’s minimum quantity levels.
Evan Moore said that he had been active
in researching the nuclear medicine prospect as well, and had reviewed
the company’s proposal. He noted that the reimbursement rate to the
hospital was not as much as the company had projected it to be.
Dr. Dickey said that this was the last
week of trying to service the emergency room with only four or five
physicians. Dr. Hutchins will return to service next week and Dr. Todd
Davis will start work at the hospital next week as well. He noted that
Dr. McCrory and Dr. Fagan had agreed to work two days a week, which
frees the other physicians up to work in the clinic more.
Dr. Dickey stated, “The schedule works
out pretty good for the time being, until we can get some more doctors
in. We talked with Evan (Moore) this week about continuing to recruit
(physicians). I still think that needs to be a priority. We need at
least one or two more physicians. But there are no real prospects out
there right now.”
John Mack Weaver asked if hiring more
physician assistants could help out any.
Dr. Dickey responded that the clinic was
operating well, but the problem with physician shorthandedness was in
the Emergency Room, where a P.A. or a Nurse Practitioner would still
require the services of a physician to back them up, and that doesn’t
really help solve the problem.
The Board then adjourned into closed,
executive session to consider medical peer review reports and consider
the reappointment or appointment of various medical professionals to
either the active, consulting or courtesy medical staff.
Following the resumption of the public
session the Board acted unanimously on a motion by Gale Easley,
seconded by John Mack Weaver, to approve the recommendations of the
medical staff regarding the credentialing of medical staff.
Drs. Peter Fagan and Garry Todd Davis
were appointed to the Active Medical Staff. Drs. Richard Byrd and F.
Michael Schultz were reappointed to the Courtesy Medical Staff. Drs.
Deanna Belli and Martin Bell were appointed to the Consulting Medical
Staff.
Reappointed to the Consulting Medical
Staff were Drs. V. Amilineni, Johnny Bliznak, Michel Dumas, Larry
Jordan, Timothy Lillick, Wm. Matthew, W. Michael Montgomery, Steven
Nitke, Ashish Patel, Dixon Presnall, Jack Ransey and Eric Schackmuth.
Physician employees Sharon Blackwood, R.N. and Walt Kionka, R.T. were
also reappointed.
The Board next acted on a unanimous vote
to approve the annual review of the Nursing Policies and Procedure
Manuals as presented by Chief Nursing Officer Shannon Steigleder.
The Board heard a presentation on the
Hospice care operation and staffing given by its Director, David Moss,
RN. After the presentation and the answering of various questions,
Evan Moore told the Board that the hospital had recently received an
increase in payments from Medicare for hospice care.
Kristi Taylor, RN, Director of Home
Health then reviewed the operations and staffing of that hospital
department for the Board. Taylor stressed how her department was
working to assure that it operated within its available external
funding and did not cost the hospital. At the conclusion of her
presentation, Evan Moore noted that her department was operating ahead
of budget for the first two months of the new fiscal year, “One of our
bright spots” as he described it.
Ambulance Service
Evan Moore then asked EMS Director Danny
Owen to discuss ambulance needs with the hospital Board.
Owen noted that three of the hospital’s
five ambulances were getting to be maintenance problems. He said that
most of the time the hospital was keeping four of the five ambulances
busy, and when one was in the shop that the fifth ambulance was vital.
Owen said, “It doesn’t happen very much,
but when we have two ambulances in the shop, it completely shuts us
down on patient transfers.” Other ambulance agencies or helicopter
services are required in those instances.
Owen said the hospital’s oldest ambulance
was a 1993 model. He added that the EMS service was being required to
make some expensive repairs to its ambulances. He said that even
though they were being well maintained, that the wear and tear of
daily service with multiple drivers was hard on the equipment. He
guessed that the average miles per month for each vehicle was in the
3-4,000 mile range. All units operated are diesel-powered.
The Board asked several questions and
discussion ensued regarding different truck and motor makes and the
relative advantages thereof.
Evan Moore noted that if the Board
mandated a cut back from five to four ambulances, that there would be
times during the remount of ambulance boxes onto a new vehicle, with
it being out of service for three months or more, when the hospital
would likely have only two vehicles in service, the minimum required
for the county, one north and one south.
Moore said that the Board was not being
asked to approve anything at the current meeting because he expected
to find out whether a requested $50,000 ambulance grant would be
available before the next regular Board meeting. He then added, “Our
recommendation is that we go with five (ambulances).”
Owen commented that it didn’t happen
often, but that there had been times when all five ambulances were in
service at the same time. He added that the fifth truck that was not
being regularly used did not cost the hospital a great deal when not
in service. It is primarily used for local area patient transfers, but
does provide a lower cost ambulance availability when needed than
would leasing a temporary use unit.
Owens said that the EMS’s other equipment
was in good shape and that their primary need was to begin a program
of ambulance truck replacement.
Joe Locke asked if the location of a
fueling facility at the hospital would help out in EMS operations.
Owen responded that it probably would
because sometimes they had to stop during a patient transfer to refill
the ambulance vehicle, and sometimes had to make special trips into
town to purchase fuel.
John Mack Weaver offered the suggestion
that the Hospital might be able to purchase fuel through the County
fuel contract and possibly obtain County assistance in obtaining a
fuel tank and pump. He suggested that the administration investigate
the possibility with County officials.
Administrative Reports
Evan Moore noted that the Hospital
District’s paid time off policy was being re-examined by an employee
committee in light of achieving some payroll expense savings.
Moore noted that the hospital was being
assisted by the legal staff of the Texas Association of Rural and
Community Hospitals in a matter relating to the licensing of physical
therapy services at the two wellness centers.
Moore discussed what he had learned at a
recent meeting concerning the imminent re-basing of DRG (Diagnostic
Related Group) payments by Medicare to be based on performance. He
noted that the importance of accurate and complete physician’s
documentation of all medical services and conditions was growing.
Moore stated, “We’ve got some ground to
make up in that area. We’ve got to do a bunch of improvement on that,
and how we document. But the quality indicators that we’re reporting
now...we’re doing everything we can to get the maximum payment.”
In response to a question from Joe Locke,
Moore indicated that the new computerized medical records system will
be a big help in accomplishing the needed improvements.
Moore then gave the Board some good news
when he said the consensus was that rural area hospitals would benefit
by more than a 3% revenue increase under the new Medicare hospital
reimbursement system.
Shannon Steigleder told the Board that
the new Medicare hospital cost reimbursement system would require
extensive documentation retraining for the nursing staff as well.
Moore commented further on the new
Medicare reimbursement plan by noting that the DRG’s would be
increasing in number and subcategories. He emphasized how important it
would be for the nursing department to be assisting the physicians
while the patients were being treated to insure that proper
documentation was achieved in order to maximize Medicare hospital
reimbursement payments.
Moore added, “It’s a major, major change,
and I’m glad we have two smart ladies to help us get through it.”
Various Board members asked clarifying
questions about the new reimbursement plan.
Moore reviewed how the wireless, handheld
electronic notepads being used by the physicians in the new system
will enable them to receive lab results while in the patient’s room or
elsewhere in the hospital. The physicians will also be able to sign
their orders electronically by means of a fingerprint scanner, thus
greatly reducing the production of paperwork and the delays involved
in obtaining physician reviews and signatures.
2007 Board Election
Moore began describing the complexities
of the May 2007 Board election, noting that it would be the first
where the election would be by place and to involve the use of
electronic voting machines. He noted that planning work was already
beginning to have everything in place by election time.
Moore noted that pre-clearances would
need to be completed for the electronic voting machines and the number
of polling places determined. Agreements with other entities
conducting elections on the same date and programming of the limited
number of available electronic voting machines will have to be
completed as well.
Moore concluded, “There’s just a ton of
things that have to be done between now and the election.”
John Mack Weaver offered his opinion that
having five polling places open, rather than just two, would not be
that much more expensive and would be preferable.
School districts and municipalities
normally have elections at the same time as the hospital Board
election.
Board members discussed where to have
polling places for the Hospital District’s Board election, as well as
issues related to numbered places on the Board. No substantive
decisions were reached or voted upon.
Bid on Old Comanche Hospital Clinic
Building
Evan Moore discussed a bid of $13,000 for
the clinic building adjacent to the old Comanche hospital building.
The bid was made by Clyde Jordan, president of CHJ3 Real Estate LLC.
The bid stipulated that the District would provide an ingress/egress
access easement of approximately 10 feet adjacent to the north
property line in order that the doors on the north side of the
property might be used. It also requested that a level I environmental
assessment of the property be made.
Portions of the old hospital building are
in the process of being deeded to Comanche County and are currently
being used by the offices of adult probation and emergency management
services.
In earlier discussions the Board had
discussed a desired sale price that was much higher than the bid
amount.
The Board took no action on the bid.
Operations Report
Chief Operating Officer Mike Hare
presented the operational statistics report for August, noting that
special procedures and surgeries totalled 46, slightly below the
budget of 50. He added that the previous month had been above budget
and that the following months should also be above budget. Several
physicians were out on vacation during the month.
Hare noted that August cash receipts of
$1,385,651 were above the targeted level of $1,375,000, but added that
expenditures of $1,534,544 were unfortunately above the cash receipts.
Patient discharges were slightly above
budget and the average length-of-stay was below the Medicare LOS
standard of 4.5 and the hospital’s target of 4.0, another favorable
August result.
The average patient census of 20.0,
however, was slightly below the budget target of 21.5. Emergency room
visits of 514 were above the 490 in the budget.
Patient visits to the clinic of 2,044
were well above the budget standard of 1,860, and well above the July
total of 1,721.
Hare commented that he had no news to
report on the possible sale of the old DeLeon Nursing Home building.
“They have until the 14th of October to make a move,” Hare noted, “and
as of this date I have nothing to report.”
Financial Report
Evan Moore said that he was hoping that
Chief Financial Officer Pam Rice would be at the meeting to make the
financial report, but that she was on her way back from a meeting and
was currently unavailable.
Moore referred to the August financial
statements included in the Board book. He noted that although cash
balances were up in August over July, cash was currently tight.
Moore commented that a half million
dollar certificate of deposit had been purchased at Comanche National
Bank and would be used as security for a half million dollar line of
credit.
Moore explained the move, “We made the
decision to go ahead and, rather than spend the cash and not have it
there at all, we would put it in CDs and then borrow against it as we
needed it, and, hopefully, we would pay back the loans quicker than we
would put cash in reserve. So that will allow us to keep some cash in
reserve.”
Moore added that the hospital currently
had a positive bank balance, even though it had released checks that,
if all were suddenly cleared, would require borrowing against the line
of credit. He added, “We’ll wait until we absolutely have to have it
to borrow against it.”
Moore noted that they were now into the
period discussed earlier when Medicare was withholding all payments,
and added that if the hospital could make it until the following week
that it would be in a “little bit better shape.”
Moore said an effort was underway to work
with all departments in the hospital to put off all purchases that
were non-essential. Moore said that a memo was going out cancelling
all travel unless it was mandatory. “We’re turning lights out. There’s
nothing too small to save all the money we can,” Moore stated. “We’re
working on air conditioning, changing temperatures and that type of
thing to save on electricity.”
Patient service billings of $2,348,435 in
August were 99% of the budgeted total. Contractual deductions and bad
debt provisions of $1,059,000 were 105% of budget, leaving net patient
revenues of $1,317,302 at 95% of budget.
Operating expenses in August of
$1,534,544 were 106% of budget. Property tax and other non-operating
revenues and expenses were close to budget.
The August net loss was $139,492. A net
income of $15,351 was budgeted for the month.
Moore noted that the hospital was still
in the slow period of the year. He added that they were looking very
hard at overtime wages paid and planned to bring that cost area down.
Moore said he expected things to look
better as the flu season and winter months began. He added, “We never
like to see the red numbers, but at this point in time, it’s a fairly
common occurrence, this point in the year.”
In response to questions from Board
members, Moore discussed various initiatives to save on operating
expenses and why certain costs were over the budgeted levels.
Moore was encouraged by the Board members
to work hard in all hospital departments to cut operating costs. Moore
responded, “There are no sacred cows in this. We’re looking at
everything!
Other Business
The Board approved payment of accounts
payable due and owing and re-approved the public funds investment
policy already in effect, both by unanimous vote.
The adoption of a revised budget for the
fiscal year was tabled at Evan Moore’s request. Moore cited the fact
that the contractual adjustment numbers had not yet been received from
the Hospital District’s accounting firm, Parrish Moody & Fikes.
The interlocal agreement between the
Hospital District and Comanche County concerning the transfer of title
to parts of the old Comanche hospital building was reviewed by Evan
Moore.
Moore read from a lengthy list of special
provisions that had been added to the agreement outlining the joint
use of the property. The Comanche County Commissioners Court had
earlier acted to approve the interlocal (a term referring to contracts
between different governmental entities) agreement.
Moore commented at the end of reading the
special provisions, “We have approved this in the past, but because
there were some minor changes to it, I wanted to bring it back for
this Board to approve it. It is signed by James R. Arthur, County
Judge.”
Mike Hare commented that he thought the
hospital’s share of the building’s common metered electrical bill was
a bit high.
Moore described the rationale that he and
County Commissioner Garry Steele had used in arriving at the sharing
percentages, based primarily on floor space occupied, but also giving
consideration to the electrical demands of the parked ambulances.
The Board then acted on a unanimous vote
to approve the interlocal agreement and then promptly adjourned. |
