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Home My WebLink About20163927.tiffNCMC BOARD OF TRUSTEES Regular Session Meeting Monday, August 29, 2016 Attachment 1 Minutes of Regular Session of July 25, 2016 * * - Action Required NCMC Board of Trustees Regular Session Minutes Monday, July 25, 2016 12:00 Noon The Board of Trustees of North Colorado Medical Center met in Regular Session on Monday, July 25, 2016, in the Richard Stenner Boardroom located at North Colorado Medical Center. Dr. Susan Carter declared a quorum and called the meeting to order at 12:05 p.m. ATTENDANCE REPORT NCMC Board of Trustees: Dr. Susan Carter, Catherine Davis, Mark Lawley, Michael Simone, Brian Underwood, and Jason Yeater, with Sean Conway (Commissioner, non -voting member) and Larry Cozad both being Excused Banner Health: Scott Baker (Interim NCMC CEO) - Excused; and Wendy Sparks (NCMC COO) Staff: Ken Schultz (Board Executive) Recording Clerk: Esther Gesick (Weld County Clerk to the Board) PUBLIC COMMENT There was no public comment. APPROVAL OF MINUTES It was MSC (Underwood/Davis) to approve the minutes from the June 27, 2016, Regular Session meeting. COMMISSIONER'S REPORT None. VISITATION REPORTS NORTH COLORADO FAMILY MEDICINE AND PODIATRY RESIDENCY PROGRAM Brian Underwood reviewed his report, dated July, 2016. A written copy of the visitation report is attached as a part of these minutes. There was discussion concerning the Rural Training track, retention bonuses, recruitment incentives, and the need for more Medical Assistant (MA) Certifications. ETHICS AND COMPLIANCE DEPARTMENT Dr. Susan Carter reviewed her report, dated July, 2016. A written copy of the visitation report is attached as a part of these minutes. CEO REPORT or COO REPORT NCMC COO, Wendy Sparks, gave the following report: . Employees - The leadership members are conducting mid -year employee check -ins concerning their goals and inquiring if any additional support is needed. On August 5th, Voice Surveys will begin. She also commented on the excellent teamwork from various Page 1 of 3 July 25, 2016 NCMC Board of Trustees departments while treating patients from an apartment fire mass casualty event. The responding individuals were recognized on June 9, 2016. • Patient Satisfaction - For June, they are hitting 7 out of 10 dimensions and are less than 1% away from hitting target on MD Communication, and they are also working on improving Communication on Meds and Pain Management. • Quality - The Length of Stay for Ops Patients is currently at 26.99 hours, with a target of 24.9. She explained many patients are being released to go home, versus submitted for observation, which actually penalizes the Strategic Initiative target numbers; however, it is often better for the patient. Additionally, they are working to hit target on Blood Utilization; however, they are above target on Reconciliation of Meds. To date, 4.2% of Banner employees have submitted their Advanced Directives, with a target goal of 10%. • Physicians - Ms. Sparks introduced Dr. Allen and Dr. Quinzer who will begin working as a team, starting June 3rd, treating infectious disease. They will have out -patient hours at the Clinic and assist at the Infusion Center, provide wound care and treat any in -patients requiring their services. Leadership is also working hard to involve physicians on more decisions concerning threshold capital, in which they present requests in front of their peers, work to educate the group and ask for their input to help prioritize the known projects. • Financials - For June, the Greeley Community is behind budget by $9.3 million, which reflects the old Colorado Indigent Care Program, now known as the Provider B Program. She explained there was a miscalculation in an inflation rate for NCMC, which resulted in a $9.8 million unfavorable adjustment. There was a $2.1 favorable adjustment, for a net negative impact of $7.9 million. NOCO is behind budget by $4.7, and $4.2 million year-to-date. She commented the general operations have been controlled very well; however, this was simply an unfortunate miscalculation which was not budgeted for. • Master Campus Plan - The Cath Lab is open and the crane will be leaving in August or September. Employees were issued Banner Bucks and enjoyed attendance at the Stampede. In response to Mr. Yeater, Ms. Sparks stated NCMC is hosting various strategy meetings to enhance the ease of access and the online presence for the Banner Medical Group (BMG) clinics. VISITATIONS FOR AUGUST Mark Lawley Michael Simone NCMC, INC. REPORT Ken Schultz stated the NCMC Inc. Board decided to write-off all of the principal and interest payments that were to be paid for the bond issue. The auditors and business consultant agreed to add back $4.4 million from the principal and interests payments for the purposes of adding back what cash was available to service debt, since it was a non -cash expense. They have also been working to move the entire stock and bond investment portfolio away from local retail brokers to institutional money managers. In the process, they attempted to eliminate $2 million in fees, tried to maintain a $7.5 million income stream, and are following Page 2 of 3 July 25, 2016 NCMC Board of Trustees a core and satellite model with 40% of the assets being indexed vanguard funds following benchmarks very closely, and the remaining 60% trying out -perform the benchmarks. Mr. Schultz stated they completed the review of 990 and 990-T, and they are also working on the terms for the 219 -acre Filinger Farm Enclave Annexation (95th/119th Ave. near Conagra and State Farm). He also discussed the initiative ratings on 'Rate' and 'Would Recommend.' Lastly, he is going to recommend the Inc. members eliminate some of the committee meetings and increase the number of formal board meetings from four to nine because it is important for the organization that essentially runs the hospital to have more frequent communication and decision making opportunities. NEW BUSINESS None. PLANNING SESSION No discussion was held on scheduling a future planning session. ADJOURN There being no further business to come before the Board, it was MSC [Simone/Davis] to adjourn the meeting at 1;00 p.m. Respectfully submitted, Esther Gesick Page 3 of 3 July 25, 2016 NCMC Board of Trustees NCMC Board of Trustees Department Report North Colorado Family Medicine and Podiatry Residency Program —July 2016 Department Contact Todd Sohler, Director of Operations, NCFM & Podiatry Residency Program Todd came to NCFM in 2012; previous jobs include Practice Manager at Cheyenne Regional Med Center, Poudre Valley Hospital — FP manager; and Cheyenne Family Practice residency. Todd resides in Ault, His reporting structure is through Banner Medical Group. Department History Podiatry Residency is small — 6 residents total (2 per year of residency —3 years). Managed by Dr. Mike Verdahl. Residents are Banner leased employees. They do not see patients as part of Banner Health; rather their training and patient care are performed through several podiatric practices along the Front Range NCFM — 29 Family Practice residents (typically 9 per class — got two additional starting this year to support expansion to Sterling; three year residency program). Two residents/year work at Sunrise. There is one residency position in Wray, CO (since 1992). Two residents will be in Sterling — spend first year in Greeley and final in Sterling. Dr. David Smith is the NCFM Residency Director (Dr. Jeff Bacon will be new site lead for Banner at Sterling location). Dr. Smith has a passion for Rural Training Track family medicine and is very excited about the opportunity that has been afforded in Sterling. The Sterling site became available through State Funding — State provides funds (Colorado Association Family Medicine Residencies) for three rural training track program sites — currently Ft Morgan (UCH), Durango and Sterling (Banner). NCFM Recruitment/Selection During the period from Sept —Jan every year, NCFM will interview medical students who are looking for a FM residency. Out of 700 applicants, about 135 are interviewed. In February, NCFM Faculty meet to rank the applicants who have interviewed in Greeley. The applicants (simultaneously and independently) rank their choice of residency programs. A national computerized matching is done to place prospective residents with residency programs using this input. NCFM is a well -respected nationally and as such usually matches well to get the residents who they want in the program (residents the faculty desires and a program the resident also wants). Again, NCFM brings on 9 new residents per year and they have not had any trouble filling all 9 slots on an annual basis. Budget Funding for NCFM comes from three main sources: Graduate Medical Education (GME) funding — State and Federal dollars; funds resident salaries NCMC — hospital pays NCFM for providing hospital services. Clinic Budget — revenues generated from seeing patients in the clinic. Todd indicated that NCFM has met its budget the past three years and is currently on budget for the current FY. Resident Retention/Recruitment upon Program Completion NCFM and Banner strongly desire to keep NCFM graduates within Banner Health. While few residents stay with Banner at this point, financial incentives seem to be a major factor. Todd said the average FM resident has $200k in debt at the end of residency. Banner just started providing a retention bonus (loan repayment) to help keep residents ($20,000/year for 5 years ($100k total)) within Banner. Only one FP in the current class is staying in Banner —that physician will be going to Sterling. Professional Staffing In addition to residents, NCFM has 9 FTEs of faculty physicians, 2 Behaviorists (LPC), and 5NPs. Challenges NCFM is currently transitioning to the Cerner EMR (from NextGen). Transitions like this are always challenging. Overall, they are looking forward to the change. NCFM is one of the last clinics to go through this transition which means that many of the issues, that normally accompany this type of transition, have been sorted out elsewhere. NCFM is optimistic that, once implemented, they will enjoy efficiencies in their operations. They eagerly anticipate better compatibility with sharing patient data with NCMC (also on Cerner). On July 1St of this year, State funding for Medicaid was reduced by 13%. (Medicaid is now known in Colorado as Health First). As a result of the decreased funding, most Banner PCP clinics will no longer accept new Health First patients. New Health First patients will be channeled predominantly to Sunrise and NCFM. NCFM's current patient mix is about 67% Medicaid (Health First). The number of patients eligible for Health First has expanded due to new eligibility criteria (ObamaCare). So therefore, managing the increased patient load at a reduced level of reimbursement is expected to be a significant challenge — both financially and operationally. Retention and Recruitment of Medical Assistants (MAs) is a growing challenge — apparently a BMG-wide issue) NCFM employs 12 —13 MAs. While typically a lower paying position within the out -patient clinic setting, the demands for MAs along with the responsibilities assumed by MAs are increasing. Submitted by — Brian Underwood, NCMC Board of Trustees Report to North Colorado Medical Center Board of Trustees Trustee -Susan Carter, M.D., July 2016 (Ethics and)Compliance Department at NCMC Department: Website is extensive and informational. "Banner's Compliance Program clarifies the organization's expectations that all employees will adhere to applicable laws governing their behavior. It meets the requirements of the Federal Sentencing Guidelines for Organizational Defendants and the advice of the Office of the Inspector General of the Unites States Department of Health and Human Services. The Compliance Program also ensures Banner Health can seek reimbursement for services provided to Medicare and Medicaid participants [sic]. The government takes great care to ensure that these funds are distributed appropriately and the health-care providers, who seek reimbursement from Medicare and Medicaid, do so in accordance with the law, Finally, the Compliance Program helps ensure uniformity across Banner Health. The Compliance Program and the policies and procedures that make up the Compliance Program apply equally to employees at all Banner Health organizations." Categories include compliance issue reporting, compliance education, compliance documents, monitoring and auditing, OIG (office of Inspector General) and GSA (General Services Administration) screening. Name of contact: Patricia Gibson, CFO. Patricia is responsible for McKee, NCMC and Fort Collins compliance. This is in conjunction in Colorado with Lori Sehrt, who partners with Horizon lab support and Patricia works mainly in the hospital side. Vicki Gallo is in charge of surgery centers. His_ torn: There was one corporate compliance officer for the entire Western region. Before NOCO, the CFO was essentially the compliance officer, at both McKee and at NCMC they acted as compliance officer at each facility. Now both Patricia and Lori are task -focused. So, as above, there are 4 people that wear the "compliance hat" at NCMC. Services Provided: They have had no corrective actions with pre -authorizations. They monitor the score cards, always working on new score cards. This may be ICD codes, current emphasis on hydration, orthopedic total joints. Education— Banner keeps score cards at each facility. For example, the first quarter compliance regarding and educational module at Fort Collins is 99.5%, McKee was 98.8%, North Colorado Medical Center was 95.4%. When asked if this was volume related, she stated this was just rote numbers. Unfortunately, we score Less than 100% on the code of conduct module. This is the Banner learning center class that can be taken online. If it is taken late, it counts is a miss. It is difficult to get all personnel to take this module on time. Testing and module completion is done based on hire date which makes for confusion as it is not done by the calendar year, so it is a rolling deadline. Comply Line- this is a hot line that any employee from Banner can call in when they feel like they're having any uncomfortable situation. Examples of this are taught during the educational module, and include hostile work environment, sexual harassment, etc. Actually anyone can call for any reason at any time. It is suggested they go through their supervisor and in their manager before calling the comply line, but this is not necessary. I did a brief casual survey of 8 physicians indicated they were unaware that this applied to physicians. Meetings occur every 2 weeks that track research, contacts in the system and mark any changes. They work with billing and regulations. They plan corrective action. For example, opportunity for improvement with managers. They also work with the service excellence leaders. Management Barb Martinson is the Arizona Banner compliance program director. Revenues/Budgets,, Compliance is included in currents, there is no dedicated budget, it is included in CFO duties. Successes: They feel their department is well respected. Staff really cares; they have great leaders that are doing the right thing. They have to deliver much bad news, but feel that most people recognize it is in the best interest of the system. Challenges/Obstacles: There is always something they can do better, they're used to handling change. Deeartmental Need /Requests: Just keeping relationships strong. What Would The Department Manager/Director Like NCMC Trustees To Know: Nothing more specific than mentioned above. Hello