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Home My WebLink About20192345.tiffNCMC Board of Trustees Regular Session Minutes Monday, May 20, 2019 12:00 Noon The Board of Trustees of North Colorado Medical Center met in Regular Session on Monday, May 20, 2019, in the Richard Stenner Boardroom located at North Colorado Medical Center. Mark Lawley, Chair, declared a quorum and called the meeting to order at 12:00 p.m. ATTENDANCE ROSTER NCMC Board of Trustees: Mark Lawley, Catherine Davis, Kay Kosmicki, Brian Underwood, and Jason Yeater, with Kevin Mullin, Michael Simone and Sean Conway (Commissioner, non- voting member) being Excused Banner Health: Margo Karsten (NCMC CEO) -Excused, Derek Strader (NCMC C00) Staff: Jeff Carlson (INC. Board Exec. Dir.) Recording Clerk: Esther Gesick (Weld County Clerk to the Board) PUBLIC COMMENT - There was no public comment. APPROVAL OF MINUTES It was MSC (Kosmicki/Yeater) to approve the minutes from the April 29, 2019, Regular Session meeting. NCM CEO/COO REPORT Derek Strader reported the Reinsurance Bill has received significant push back, so the financial impact may be softened. He stated the mid -year Hospital Transformation Program (HTP) plan was submitted, focusing on service to the Medicaid population, therefore, the NOCO alliance sees its fair share of payor mix and is hopeful the State will consider the local practice as an example. Mr. Strader reported April was not as strong financially, but they did make the budget due to a surge of patients during the last two weeks, including some referrals to the NICU. He noted the critical units are at maximum capacity with a high acuity patient care due to a variety of reasons. Mr. Lawley referenced a recent news article which cited NCMC was awarded the "2019 Best of the Best" at the annual Leadership Matters Conference, where McKee also won the "Customer Obsessed" and the BMG won "Best Clinic". Mr. Underwood thanked Banner/MD Anderson for sponsoring the Cancer Tennis Tournament event. Mr. Strader mentioned several other departmental highlights throughout the community. He also noted a growing trend for Dementia patients where it is more cost effective to transfer them to another facility that is equipped to treat them, versus the cost for a lengthy stay. n Page l of 2 U-emmun; cAttong O(o/Q‘1/1`1 May 20, 2019 NCMC Board of Trustees 2019-2345 COMMISSIONER'S REPORT Commissioner Conway was excused. Mr. Strader stated the Paramedic Service is now centralized on the NCMC campus and the County intends to use the M Street facility for the Coroner's Office. In response to Ms. Kosmicki, Mr. Strader explained the NCMC parking lot shuttle has transitioned from a golf cart to a minivan to enhance safety. He also mentioned the pink ambulances which will help promote the Banner/MD Anderson brand. VISITATION REPORT FOR JUNE 24, 2019 Mark Lawley and Jason Yeater NCMC, INC. REPORT Jeff Carlson reported the NCMC Inc. Board of Directors should be able to allocate grants ranging from $5,000 to $1 million for various non-profit organizations in the area. NEW BUSINESS Mr. Underwood questioned whether there is a need for monthly meetings and suggested the possibility of moving to a bi-monthly structure. Mr. Lawley offered to visit with the County Attorney concerning any options for amending the bylaws for visitation requirements while ensuring compliance with the provisions of the lease. VISITATION REPORT FOR MAY 20, 2019 INTERVENTIONAL RADIOLOGY: Char Allen, RN BSN / RN Manager / Medical Imaging Nursing Support/ NCMC, MMC, and Richard Coursey, MD Interventional Radiology, were present and provided an overview of the Interventional Radiology Department. Following the meeting, Brian Underwood submitted a summary of the presentation and related discussion, a written copy of which is attached as a part of these minutes. Ms. Davis prepared and delivered a note of thanks. ADJOURN There being no further business to come before the Board, it was MSC [Yeater/Underwood] to adjourn the meeting at 1:10 p.m. Respectfully submitted, Esther Gesick Page 2 of 2 May 20, 2019 NCMC Board of Trustees NCMC Trustee Report Interventional Radiology Services Presenters: Char Allen, RN BSN — Medical Imaging Nursing Manager Richard Coursey, MD — Interventional Radiology Report: Brian Underwood May 20, 2019 This presentation gave the Trustee Board a glimps at the emerging and expanding technology of interventional radiology (IR). And the result has been unanticipated and positive growth of services to NCMC (and McKee). Dr. Coursey is one of two Interventional Radiologists (from Radiology Imaging Associates, P.C.) currently contracted by Banner Health to provide IR services at Banner Health facilities in Northern Colorado. YTD, both NCMC and McKee have attained their annual budget targets for IR services (phenomenal growth) and an additional IR is anticipated be recruited by August 2019. IR provides many treatments to facilitate patient care from pain management to surgery to oncology care. Apparently treatments through IR are continually evolving and NCMC has been able to exploit this for the benefit of its patients in a significant way. The Banner/MD Anderson partnership required an expansion of IR services for various modalities related to chemo and radiation therapy for cancer patients. But the addition of IR services has opened up an entire spectrum of services and capabilities. Quite frankly, to a non -clinician, IR sounds like the stuff Dr. McCoy was doing on Star Trek years ago. Patients are receiving non-invasive surgery which allows them to go home on the same day the procedure was performed. Many times, the use of medications is being reduced. Pain is being identified at its core so that the source of pain is actually receiving treatment verses the point where the patient feels the pain. Chemo drugs (beads) are non -invasively placed directly within the organ (i.e. "targeting" the liver) thereby increasing effectiveness and lessening side effects of cancer treatment to the patient. There is significant growth potential related to this field of medicine. There are also challenges related to the expansion of services. The presenters mentioned the potential benefits of an additional CT scanner as well as pre- and post -surgery recover areas specifically for IR. (Following the presentation, NCMC Administration explained that the needs are well-known and that there are also organization changes that are being implemented to continue to improve and expand the availability of services.) This was a very interesting presentation to the Trustee Board. Both Char Allen and Dr. Coursey were extremely engaging in their presentation — patient care is at the forefront of their minds and actions. Dr. Coursey seems to be very sensitive to potential interruptive dynamics of new technology as it relates to other providers. Overall, the expansion of IR services is a significant plus for NCMC and its patients. r MINIM a tNDOVASCULP Radiology Imaging Associates P.C. Painful Conditions Treated By Vascular/Interventional Radiology (RIA) Servicing Banner Hospitals in the Northern Colorado Area Head/Neck/Face Pain i. TMJ (Botox/steroid injections into muscles of mastication) 2. Migraine Headaches/Trigeminal Neuralgia (SphenoCath procedure, steroidal trigger point injections, Botox injections) 3. Occipital Neuralgia and/or myofascial pain of upper back/neck (Trigger point injections using steroid or Botox) 4. Upper Extremity Radiculopathy (Cervical epidural steroid injections, selective cervical nerve root blocks) 5. RSD or Complex Regional Pain Syndrome of the upper extremities (Stellate ganglion block) Upper Extremity Pain 1. Post Mastectomy pain (Steroidal blocks of upper extremity nerves) 2. Painful hand/wrist joints (Steroidal injections of hand/wrist/finger joints) 3. Biceps Tendinitis (Long head of biceps steroid injection) 4. AC joint arthritis (AC joint steroid injection) 5. Intra-articular shoulder pain (Shoulder joint steroid injection) 6. Elbow pain (Targeted steroid injections of shoulder joint or adjacent anatomy) Mid/Lower Back Pain 1. Lower extremity radicular pain (Lumbar epidural steroid injections, selective nerve root blocks of lumbar or sacral nerve roots) 2. Lumbar facet joint pain (Facet joint steroid injections, facet joint radiofrequency ablation) 3. Quadratus Lumborum muscle strain/pain (Targeted image guided steroidal trigger point injections) 4. Sacroiliac joint pain (SI joint steroid injections, SI joint radiofrequency ablation, SI joint fusion/arthrodesis) 5. Lumbosacral pseudojoint pain (Targeted steroidal injections) 6. Piriformis muscle syndrome pain (Targeted piriformis muscle steroid injection/ Botox injection) 7. Vertebral body fractures (Vertebral augmentation with Kyphoplasty/Vertebroplasty) RlAEndovascular.com 8. Neurosurgical/Ortho Spine work up of radiculopathy (Discogram) Thoracic/Abdominal/Pelvic Pain 1. Chest wall pain (Targeted intercostal nerve blocks) 2. Abdominal nerve entrapment (Targeted nerve blocks) 3. Inguinal nerve pain after hernia repair (Targeted nerve blocks) 4. Post vasectomy testicular pain (Targeted blocks, RFA/Cryoablation) 5. Abdominal pain (Celiac ganglion block/neurolysis 6. Pelvic pain (Superior Hypogastric Ganglion block/neurolysis and Ganglion Impar block/neurolysis) 7. Sacrum reconstruction with cement 8. Sacroiliac joint pain (SI joint steroid injections, SI joint radiofrequency ablation, SI joint fusion/arthrodesis) Lower Extremity Pain 1. RSD/Complex Regional Pain Syndrome (Lumbar Sympathetic Ganglion Blocks/Neurolysis) 2. Refractory non -healing wounds from arterial insufficiency (End stage vascular disease) 3. Knee Pain before or after knee replacement (Steroid Joint injections, Genicular Nerve Blocks/Genicular Nerve Radiofrequency Ablation 4. Hip Pain before or after replacement (Steroid Joint injections, Hip Joint Radio Frequency Ablation) 5. Refractory foot pain (Highly targeted peripheral nerve blocks/neurolysis/ Cryo or RFA) 6. Phantom Limb Pain (Blocks and/or Cryoablation/RFA) 7. Bursitis of pelvis or greater trochanteric bursitis (Targeted steroidal injections) Foot/Ankle Pain 1. Refractory non -healing wounds from arterial insufficiency (End stage vascular disease) 2. Tarsal Tunnel Syndrome (Posterior Tibial Nerve block/Tarsal Tunnel injections) 3. Refractory foot pain (Highly targeted peripheral nerve blocksjneurolysis/Cryo or RFA) 4. Phantom Limb Pain (Blocks and/or Cryoablation/RFA) 5. Ankle joint arthritic pain (Targeted steroidal in J ections) 6. Subtalar joint arthritic pain (Targeted steroidal injections) 7. Lisfranc joint arthritis pain (Targeted steroidal injections) 8. Toe pain (Targeted joint steroidal injections, injections to treat Gout) 9. Plantar fascia/bone spurs (Targeted steroidal injections) If your patient has a unique painful condition not specifically listed in detail on this document, please contact us directly to discuss other options which may be available. The vast majority of these therapies are image guided, using US, CT, or fluoroscopy to ensure a very reliable and precise delivery of medication/treatment. To refer a patient either to our clinic for consultation or to have a procedure scheduled, please call Banner Central Scheduling at 970.810.6070. r a E.1 4D VASUJEAR Radiology Imaging Associates P.C. PC PainfulConditions 9-26-18 r a RADIOLOGY Fluoroscopic Procedures GI: • Esophagram/Barium Swallow • Modified Barium Swallow with Speech • Sialogram • Upper G.I. Series • Small Bowel Follow Through • Barium Enema -Single and Double Contrast • T -tube Cholangiogram • Nasogastric/Enteric Tube Placement • Chest Fluoroscopy for Diaphragmatic Motion GU: • Cystography • Voiding Cystourethrography • Retrogram Urethrograpy rograpy • Loopogram • Hysterosalpingogram Invasive Nonvascular/Pain Management • Arthrograms (Shoulder, Hips, Wrist, Elbows) • Pain Management Injections O Joints (Shoulder, Hips, Knees, Wrist, Elbows, SI) O Tendons (Bicep Tendon, Iliopsoas) o Epidural Steroid Injections • Lumbar Punctures • Myelograms • Thoracentesis • Paracentesis • Abscess, Fistula, or Sinus Tract Study • Injection for Sentinel Node Localization To schedule an appointment call Banner Scheduling at: 970.810.6070 To reach a Radiologist call the RIA Physician Connect line at: 720.493.3777 www.riaco.com (e) 2017 Radiology Imaging Associates. All rights reserved. Case Study - ClotTriever® Endcx'ascular Treatment of Left Lower Extremity DVI Procedure Date: May 9, 2019 Richard Coursey, MD Interventional Radiology North Colorado Medical Center :/ III 89 y/o • Female • Referred from ER • DUS confirmed unilateral left iliofemoral thrombus • ER did not administer heparin • Due to previous ischemic events she was not lytic eligible • No IVC filter or stents INARI • Patient in prone position • Left popliteal vein accessed • Venogram of iliofemoral region revealed substantial acute & sub acute thrombus burden • IVUS confirmed: clot location, approx. age of clot and patent IVC • 4 passes with ClotTriever® catheter • 100% clot removed • Ballooned & stented • 109 -minute total case time • NO thrombolvtics were required for this procedure Pre and Post Procedure Venograms INARI Clot Removal INARI 1v16DICAL Case Study - ClotTriever® Endovascular Treatment of Right Lower Extremity DVT Procedure Date: May 12, 2019 :r IK INARI .MEDICAL• Richard Coursey, MD Interventional Radiology North Colorado Medical Center Presentation & Procedure 1k • 71 y/o • Male • Referred from Burn Unit • Patient underwent 48 hours of catheter directed thrombolysis to address below -the -knee thrombus • Floor didn't follow orders and stopped administering tPA 12 hours prior to the procedure • No IVC filter or stents • Patent IVC INARI • Patient in prone position • Right popliteal vein accessed • Thrombus in femoral-popliteal region required PTA for proper positioning of ClotTriever® sheath • Venogram of iliofemoral region revealed substantial sub -acute thrombus burden. 4 passes with ClotTriever® catheter • 100% clot removed • 55 -minute total case time Pre and Post Procedure Venograms Clot Removal INARI MEDIC:_ • s Case Study - FlowTriever® Endovascular Treatment of Acute Pulmonary Embolism Procedure Date: May 14, 2019 Procedure Date: 2019 C INARI MEDICAL Richard Coursey, MD Interventional Radiology North Colorado Medical Center Presentation & Patient Baselines • 78 -year -old, female patient presented in the E.R. and was diagnosed with acute pulmonary embolism. Due to abdominal surgery within the last 45 days she was not lytic eligible. CTA showed significant right heart strain with bi-lateral thrombus. °INARI O2: Pre -Treatment Parameters Age: Gender: Neuro Status: Cardio Status: RV/LV Ratio: 78 Female Stable Stable N/A HR: 114 BP: 95/62 94 PA Pressure: 50116132 Pre Images 0 MEDICAL POSt Irlidges INARI Pre & Post Vitals Pre -Treatment Parameters RV/LV Ratio: HR: BP: O2: PA Pressures: N/A 124 95/62 94* 50 116 132 * Nasal cannula @ 4L INARI UL:ICAL Post -Treatment Parameters RV/LV Ratio: HR: BP: O2: PA Pressures: N/A 114 116/78 96* 28110119 * Nasal cannula @ 3L Clot Removal INARI MEDICAL Hello