By Jerry Morgan, Reporter

VAN DYKE -- Progress was reported on a variety of areas, including financial, at the regular monthly meeting of the Board of Directors of the Comanche County Consolidated Hospital District on Tuesday, February 27.

All six Board members were present, including Board president Charles Mazurek, and members Gale Easley, John Mack Weaver, Karen Carr, Joe Locke and Mary Jane Atkins.

Hospice Care Survey Yields Bad Results

The first action item on the agenda, however, was not generally viewed as progress. Kristi Taylor, recently appointed as the hospital's Director of Home Care Services, reported that the results of a survey of the hospital's hospice care program were "not good."

Hospice care is a program designed to meet the unique needs of patients who have been diagnosed to be in terminal condition. The surveyor from the state's Department of Aging and Disability Services found numerous deficiencies in documentation.

Taylor reported that Interim Administrator Kurt Meyer had made a temporary hire of Ellen Eisenrich, who had originally helped set up the hospice program in Comanche. Eisenrich is the wife of Dr. Forrest Eisenrich, a medical staff member at Doctors Medical Clinic. Eisenrich will work for 45 days as a consultant in helping respond to the deficiencies noted by the surveyor.

Taylor noted that Eisenrich was very familiar with hospice care regulations and the operational details of the program. She expressed optimism that the resurvey, scheduled to occur in 45 days, would prove to be much more successful than the first.

Several deficiencies were related to the Hospice policy manual. Taylor described the changes to the manual suggested by the surveyor and asked the Board for their approval of the changes. Most of were fairly minor updates for personnel changes and to comply with changing federal and state regulations. One of the changes involved the designation of Chief Nursing Officer Shannon Steigleder as the Hospice Care Administrator and Kristi Taylor as the Alternate Administrator.

The Board approved the proposed changes on unanimous votes.

Kurt Meyer commented that he didn't see anything in the survey results that would prevent the hospital from continuing to offer hospice services, and complimented Ellen Eisenrich for volunteering to help out in the effort to address the deficiencies noted in the survey.

Later, outside of the meeting during the executive session, Dr. Forrest Eisenrich described the problems identified as not involving patient care, but substandard documentation that accrued gradually during various changes in hospice care administrators.

Medical Staff Report

Dr. Howard Dickey reviewed the medical staff's peer review recommendations for reappointments to the courtesy medical staff and for additional privileges for an existing staff member. He also noted discussions that had occurred between the medical staff and the medical records administrator regarding the deadline for completion of discharge records and the compromise that had been reached.

The Board approved the change to the medical staff policy manual on a unanimous vote before adjourning into executive session.

Executive Session

A lengthy, hour and a half executive session followed. The Board agenda listed topics to be considered as including the medical peer review recommendations, consultation with an attorney involving litigation and settlement of a contractual dispute and related debt to the District, and to consider employment of a chief executive officer.

Following the conclusion of the executive session and a meeting break, Charles Mazurek announced without elaboration that the administration had been authorized to deal with the litigation and settlement of the contractual dispute and related debt. A Board member later described the matter as “no big deal” and that it had essentially already been settled.

The Board then acted on unanimous votes to approve the reappointment of Drs. Neil Bealka and William Simpson Jr. to the courtesy medical staff and Rachel Hilliard as an allied health professional. A request for additional medical privileges for Dr. Michael Chiang was tabled until the following month's meeting in order to check with the medical practice insurance company involved.

The Board next considered the sale of two real estate properties.

The first was the old Comanche hospital clinic building located at 101 W. Mill, which Mazurek noted had been advertised for bids. He then was handed a single, sealed envelope by Kurt Meyer who affirmed that it was the only bid received. Mazurek opened the envelope and announced that it was a bid from the Caring for Comanche County, Inc., in the amount of $35,000. A $1,000 escrow check was attached to the bid.

Mazurek expressed his recommendation that the bid be accepted. Karen Carr made a motion to accept the bid, Gale Easley seconded the motion and the vote of approval, without discussion, was unanimous.

The next property considered for sale was 407 S. Texas in DeLeon, the old DeLeon Hospital and Clinic complex (not including the Kimmell Wellness Center).

Mazurek commented, "Several groups and individuals have an interest, as you all know, some in all of the property, some in part of the property. If the Board desires to pursue selling it at this time, well then I recommend that we advertise it and put it out for bids similar to the way we did with the Comanche clinic, with one difference being that since there is more than one parcel over there that we bid it by parcel and in total. I would also recommend that we include the same restriction on it that we did on this (the Comanche clinic) property."

John Mack Weaver added, "(The) restriction would be that there would be no hospital or clinic business conducted on that property."

Weaver also requested that the Board retain the right to reject any and all bids received, and Mazurek responded that the provision would be included in the bid specifications as prepared by the District's legal counsel.

Mary Jane Atkins made a motion to authorize the sale as recommended by Mazurek, John Mack Weaver seconded, and the vote of approval was once again unanimous.

Joe Locke asked if the executive committee (consisting of Mazurek, Weaver and Locke) would get together to determine the appropriate parcel boundaries and Mazurek answered in the affirmative.

CEO Report

Interim Administrator Kurt Meyer was called upon for an administrative report. His report was relatively brief, but covered a wide range of activity.

Meyer stated, "From operational efficiency, with the changes that were begun by Shannon (Steigleder, Chief Nursing Officer and briefly Acting Administrator), we have continued forward from there. We have a total of $606,000 is salary changes with reorganization. We have, as we told you, made multiple changes in the organization, restructuring, and we will continue to monitor as we need to, adjusting staff as necessary."
Meyer noted that the hospital is now participating in the Broadline Purchasing Group for hospital supplies.

He noted that he had brought in consultants from PHNS, the hospital management consulting group that Meyer works with, to assist in dealing with the hospital's information systems, and that they had been on site, making evaluations of available systems and software, improving security and developing a comprehensive technology strategy for the future. He noted that the hospital's environmental system, heating and air conditioning, did not have a backup computer system available. Meyer told the Board that Gilbert Juarez has been hired as an on site technician.

Meyer pointed out that patients were now being asked for co-payments and deductibles at the time of registration. He added that the health information management has improved from having almost $700,000 in the unbilled pipeline to only $171,000, which reflects a significant reduction in the backlog of uncompleted patient charts and a speedup of sending out billings. He noted that through February 26 the hospital had filed over $2.5 million in medical claims, compared to $2.2 million in January.

Meyer noted that a person had been assigned billing follow-up duty in the business office, and had already worked about 650 accounts representing about a half million in gross billings. He added that patient charts are being reviewed for proper coding.

Meyer noted that they had had a meeting with Cross Timbers Community Health Center representatives to explore opportunities to better serve the needs of the public. He said that the Kronos time keeping system for payroll would be implemented on a live basis in the following week.

Meyer briefly noted his additional involvement in the jail inmate healthcare costs situation, the hospice care survey, emergency room issues (as discussed by Dr. Dickey in executive session) and contract files and standards.

Clinical Overview

Shannon Steigleder discussed streamlining of operations in various departments. She noted that the hospital had 31 patients that morning. She discussed in service staff training for the nursing staff and announced the hiring of two new Registered Nurses. She said the Hospice department has 60 patients and the reorganization of staffing. She reported that Home Health has 40 patients under care. The lab has been restructured where technicians will work 12 hour shifts. Carole Mahan is the new director of surgical services. The emergency room has seen 445 patients through the first 26 days of the month.

Directors asked about progress on various elements of the hospital's comprehensive software and technology implementation and were told that another 30 days were needed before the pharmacy system could be implemented and that the computers on wheels carts that would be used by the nurses would follow after that, possibly as far as six months away.

Mary Jane Atkins excused herself from the meeting at this point.

Financial Report

Chief Financial Officer Pam Rice displayed various computer generated charts for the directors. She noted that surgical revenues in January had been below expectations because the laparoscopic equipment was not fully operational for the entire month, but expected to see good improvement in future months.

The average daily census for acute patients was 18.1. The expenses trend chart showed expenses trending down. Some of the more significant expense reductions in purchased services and workers compensation insurance, however, were the result of accounting accrual downward adjustments. She noted the favorable effects of changes in the hospital's paid time off policy will be realized in coming months.

Rice displayed a chart showing the number of full time equivalent employees by month that showed a drop of over 20 since early December. She noted that some of the drop was not in fewer personnel, but in cutbacks in scheduled hours.

Charles Mazurek noted that not all of the staffing cutbacks were yet reflected in the chart and that further reduction was to be expected.

Other charts displayed progress in reducing accounts payable and in notes payable. In response to a director's question, Rice said the total accounts payable had dropped from $1.3 million to approximately $1 million.

Rice added that the cost report settlement had been received in February and that it was, at $402 thousand, larger than expected. She said that Medicare was also adjusting their cost reimbursement payments to the hospital for the current fiscal year and that she anticipated receiving another $250 thousand in the following week. Current reimbursement rates for the balance of the year are being made at higher rates as well.

Tax receipts have been coming in from end of year and January collections. A total of $525 thousand of those receipts have been placed in the bond interest and sinking fund toward a total of $608 thousand needed. She expects more than enough tax funds yet to be received to fund the bond payments that will be due in August.

Rice pointed out that the hospital has $562 thousand of prior year tax funds in a certificate of deposit available that are being retained for emergency use if needed. "We are looking really good right now," Rice noted. "I know it's probably a temporary thing, but with all of our changes, we are planning on improvement for that."

Rice pointed out that the January statement of revenue and expense showed a monthly profit of $149 thousand. There was a $39 thousand gain from the sale of the old DeLeon nursing home building and $48 thousand in contributions, most of which came from the Healthcare Foundation for the purchase of laparoscopic surgical equipment. The hospital's operating loss for the month (before tax income, donations and non-operating gains) was only $1,600. "That was very positive," was her summation.

The year-to-date net loss was now reduced to $90 thousand, almost $300 thousand better than the revised budget figure.

John Mack Weaver stated, "That's a good report, and it's good to see those FTE's (full time equivalent employees figures) come down. We've been trying to work on that for a long time and it's good to see progress."

Rice responded, "Things are looking good!"

Although not discussed in the meeting, it was learned that CFO Pam Rice has given the hospital notice of her intent to resign in order to accept a position in private industry. Both she and hospital officials indicated her departure was on good terms.

Board of Directors Election

Following the routine approval of accounts payable and owing and the authorization for Kurt Meyer to approve and file the Medicaid Cost Report for the hospital's prior fiscal year, Charles Mazurek opened discussion of the coming Board of Directors election to be held in May.

Kathy Johnston explained that the Board needed to formally order the election. She discussed filings with the Department of Justice and the need to authorize the County Clerk to appoint the election judges and alternates. Voting is planned to be held in five locations, Comanche, Gustine, Proctor, Sidney and DeLeon.

The Board acted unanimously on three separate motions to authorize Board president Charles Mazurek to sign the Department of Justice letter, to order the election and to approve the contract with Comanche County to conduct the joint election and to authorize the county to appoint election judges.

At Charles Mazurek's request, Kathy Johnston distributed Board candidacy filing forms to the five directors remaining in the meeting. She noted that one other possible candidate had picked up candidacy documents but had not yet filed completed forms.