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VAN DYKE -- A relatively light agenda and
no closed, executive sessions produced one of the shortest Hospital
Board regular meetings in many months.
The approval of new contract forms for
clinic physicians and the hiring of a new chief financial officer
highlighted a meeting that featured generally favorable progress
reports.
The Thursday, August 30, meeting was held
in a partitioned section of the hospital dining room. It was conducted
by Board president Gale Easley and attended by the full compliment of
members including vice president Joe Locke, secretary Karen Petty and
members Charles Mazurek, Janna Morris and Billy Ray Evans.
Prior to the start of formal business,
Sharon McCarty spoke briefly to the Board members and others present
regarding the Comanche County Healthcare Foundation's plans for a
Fifties Fever Fun(d) Raiser to be held on Saturday, September 29, at
the Evans Farms Sale Barn near Proctor.
Tickets to the dinner and auction are
currently being sold by Foundation Board members. In the DeLeon area,
John Mack Weaver at 893-6837 has a good supply of tickets.
Tax Rate Public Hearing
The first order of business was a public
hearing on the Hospital District's proposed 2008 property tax rate.
Chief Executive Officer Kevin Storey noted that the hospital's
operating budget for the current fiscal year was lower than that of
the previous year.
It was also noted by various Board
members that the tax rate remained unchanged at 25 cents per $100
taxable valuation. The only reason that projected tax collections will
increase by approximately $50,000 is due to property valuation
increases.
Around two thirds of the tax revenues are
exclusively dedicated to the repayment of bonded indebtedness.
There were no members of the public
present to pose questions or make comments, and the tax rate hearing
was soon closed. The minutes of the two previous Board meetings were
unanimously approved.
There were no members of the hospital
medical staff present to give the Medical Staff report.
Hiring New Chief Financial Officer
Approved
CEO Kevin Storey noted that Board action
was required to hire or dismiss the hospital's Chief Financial
Officer, and thus he presented the name of Thomas Lett for formal
hiring approval.
The Board had met with and interviewed
Lett at an earlier special called meeting. He was described as a 30
year veteran in hospital accounting and currently serving in a similar
capacity at a hospital in southeast Texas.
Storey noted that Lett has received
excellent references both from previous employers and from the
accounting firm that audits both Comanche County Medical Center and
many other Texas hospitals, including the one where Lett was currently
employed. Storey said if he received Board approval and Lett cleared
background and drug screening checks that he would hire him as the
hospital's new CFO.
Joe Locke made a motion to authorize the
hiring and Karen Petty seconded. Billy Ray Evans inquired how Lett's
meeting with other hospital staff had gone and Kevin Storey responded
that the meetings and other interviews had gone well.
The vote of hiring approval was
unanimous. Lett is expected to begin his duties at CCMC in the first
week of October.
Physician Contracts Approved
Kevin Storey then began discussion of new
contract forms that would be used for renewal as the existing
contracts with hospital clinic physicians expired, several of which
already had expired at the end of July.
Storey noted that physician payments
under the new 24 month contracts were primarily based on the volumes
of patients served, with provision included for higher payment for the
additional time required for new patients.
Physicians are considered to be
independent contractors and not an employee of the District. They are
required to maintain medical malpractice insurance, however, under the
new contract the District will reimburse some policy costs.
There are also provisions in the new
contract to reimburse physicians for participation in committee and
utilization review meetings.
Storey noted that at least three
physicians had unexpired contracts that would not initially be
affected by the new contract, but that the new contract forms would be
utilized upon the expiration of their existing agreements. Otherwise,
the new physician contracts would take effect in September.
In response to Board questioning, Storey
stated that the physicians seem to be pleased with the new contract in
that it rewards their hard work. He added the contracts were arranged
so that when the physicians made more money, that so did the hospital.
He later noted that the contractual arrangements had been carefully
negotiated and were not typical of physician employment contracts
around the state.
Discussion led into the hospital's general pricing for various
services which is embodied in a document referred to as the
chargemaster.
Storey commented that the chargemaster
has been under review and that it will soon be revised, with some
prices going up and a few going down. He noted that Comanche County
Medical's pricing for various services is often the lowest in the
area, and then added that he doesn't mind being the low price leader,
but that you had to balance costs, Medicare reimbursement rates and
competitive pressures when setting service pricing.
Storey stated that the hospital planned
to continue offering discounted pricing for patients who are willing
and able to pay for services at the time of delivery.
Gale Easley called for a return to
consideration of the proposed standard physician contract. Charles
Mazurek offered a motion to approve it as presented, Janna Morris
seconded and the vote of approval was unanimous.
Executive Report
CEO Kevin Storey joked that his report
would now be shorter since the chargemaster updating process had
already been discussed.
He reported that progress is being made
toward restoring electrical service to the old DeLeon Hospital
building in order that the DeLeon Independent School District can
proceed with verification of the continued functioning of the heating
and air conditioning.
Janna Morris, who now works in the DISD
Administrative office, confirmed that the electrical service had been
restored to the hospital building.
Storey noted that, with minor exception,
the Hospital District has completed removal of its equipment and
stored materials from the old hospital building and most of the
clinic. He said that some desks and chairs that were not needed had
been left for the school's use.
As for the three offices in the old
clinic building that still had hospital property stored, Storey said
he had been informed that portion of the property would be the last
part that the school would be making use of.
In addition to the standard physician contract having been completed,
Storey reported that a contract for a new staff physician has been in
the works and is nearing completion. He noted that he has been
provided names of an internal medicine physician and two radiologists
who may be candidates to join the CCMC staff. Storey added that a
female physician, native to the area, who is in the last two years of
her residency may provide the first opportunity to use the contract
being prepared.
Storey said he would have a report on the
projected financial impact of the chargemaster update by the next
Board meeting.
A Product Evaluation Committee comprised
of members from several different departments in the hospital has been
organized by Materials Manager, Rick Sanchez to evaluate current and
new products used at the hospital.
Storey reported that two new pieces of
analytical equipment had been recently obtained in the laboratory at
no cost other than supplies used. He added that the cost of lab
testing supplies used with them were 50-60% less than previously paid.
He added that Sanchez was looking at two other contracts related to
lab equipment in hopes of an early termination and replacement with
better and lower cost alternatives.
The ultimate goal was to significantly
reduce the percentage of lab tests that have to be sent outside the
hospital, in addition to saving costs.
Storey stated that various current and
prospective vendors for computerized information systems have been on
site at the hospital to seek or propose solutions for problems that
have been identified with the existing systems.
Efforts are also currently underway to
hire a new human resources director.
Clinical Report
Chief Nursing Officer Shannon Steigleder
reported that the current medical and surgical patient census was
currently on the low side, but had been "exploding at the seams" as
recently as the prior week.
Steigleder reported that an area hospital
had sent letters to nurses working at CCMC touting higher shift pay
differentials available there. She noted that CCMC had made pay rate
adjustments for nights and weekends in order to keep her experienced
nurses from leaving for higher pay.
Steigleder said that the hospital had
hired two new nursing school graduates, both of whom had passed their
licensing exams.
A Performance Improvement Committee has
been established, staffed by patient care personnel, to develop
recommendations and action plans for improving the work environment
and to assist in meeting Medicare cost reimbursement criteria. The
committee will meet quarterly.
Emergency Room visits at 410 were also
down in July, however, hospital admissions of ER patients held steady
at 105.
Steigleder noted she was searching for a
night RN position as one of the existing staff is leaving at
mid-September.
There were 80 surgeries and special
procedures in June and 68 in July. There are 42 home health patients
and the number is growing rapidly. Additional staff hiring for that
service is anticipated. There are 19 hospice patients, also a growing
number.
Financial Report
In the absence of a Chief Financial
Officer, Kevin Storey also provided the monthly Financial Report. He
referred to a series of 25-month trend graphs that he had prepared for
the Board as an summary of the hospital's financial performance.
The graphs showed patient discharges of
140 in July, level with July 2006 and well above July 2005. Total
patient days were around 575, below the July 2006 number and above the
July 2005 level. The average daily census was around 17, well below
July 2006's 21, and slightly above the July 2005 figure.
The average length of patient stay was around 4.2 days, lower and more
favorable than the figures from one and two years earlier. Both
surgeries and emergency room visits were below the prior year levels.
Medicare provided 57% of total hospital
revenues, and Medicaid an additional 11%, the two sources combined
accounting for over two thirds of hospital revenues.
The hospital reported a loss of $20,644
for July. Storey noted that problems in the purchasing system had
overstated expenses for July by $30,000, however. He described
additional accounting system problems related to vacations and
benefits accruals that had been spotted and corrected prior to
preparation of the income statements.
Storey stated that patient revenues in
July of approximately $2 million were down by $422 thousand from June,
and yet the hospital would have reported a slight profit if not for
the purchasing system cost overstatement. "That's still pretty good,"
he concluded.
In other good news, Storey pointed out
that cash balances were growing and that the hospital now had
undesignated cash reserves, above and beyond the bond payment
provisions, to meet more than three employee and physician payrolls.
Accounts payable have also been reduced
and were reported to have been only $476,977 on the morning of the
meeting, the lowest it has been in a very long time.
In recent months accounts payable had
been running well over $1 million, and the hospital's independent
auditor recommended a healthy level would be around $600,000.
Storey noted that they have been able to
put $10-15 thousand every two weeks into the "rainy day" cash fund,
thanks to the efforts of managers to control spending. He added that
the full effect of the credits achieved by improved purchasing had not
yet been realized. He anticipates continued additions to the cash
reserves.
Although not included in the prepared
reports, Storey responded to a query from Gale Easley on the revenue
days in accounts receivable. He said that they were basically level
with the prior month, in the upper 60 days, again a favorable reading.
Board members seemed generally pleased
with the financial reports, one commenting that it was good to have
money in the bank to pay the hospital's bills.
The next item of business was the routine
approval of payment of accounts payable due and owing as funds were
available.
The meeting was then adjourned,
approximately one hour and five minutes after it began. |
