HomeMy WebLinkAbout20163926.tiffNCMC BOARD OF TRUSTEES
Regular Session Meeting
Monday, July 25, 2016
Attachment 1
Minutes of Regular Session of
June 27, 2016 *
* - Action Required
NCMC Board of Trustees
Regular Session Minutes
Monday, June 27, 2016
12:00 Noon
The Board of Trustees of North Colorado Medical Center met in Regular Session on Monday,
June 27, 2016, in the Richard Stenner Boardroom located at North Colorado Medical Center.
Dr. Carter declared a quorum and called the meeting to order at 12:00 p.m.
ATTENDANCE REPORT
NCMC Board of Trustees: Dr. Susan Carter, Larry Cozad, Mark Lawley, Michael Simone, Brian
Underwood, Jason Yeater, and Sean Conway (Commissioner, non -voting member), with
Catherine Davis - Excused
Banner Health: Scott Baker (Interim NCMC CEO) and Wendy Sparks (NCMC COQ)
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 (Simone/Yeater) to approve the minutes from the May 23, 2016, Regular Session
meeting.
CEO REPORT or COO REPORT
NCMC COO, Wendy Sparks, gave the following report:
. Employees - The new NOCO CEO, Margo Karsten, will start on August 5th. On June 3rd
the NCMC Volunteer and Scholarship presentation was made to students choosing to
enter into a healthcare field. In response to Brian Underwood, she stated 7-8 scholarships
were awarded, with the amounts being raised by volunteers working in the Gift Shop, etc.
. Patient Satisfaction - For the month of May, NCMC hit target on 5 of the 10 dimensions,
and is striving for 80% or higher. Ken Schultz commented the percentage does not give a
clear perspective because it is not clear whether the results are tied to Banner rules or
the higher independent NCMC challenge. Ms. Sparks offered to bring more detailed
information next month on the specific categories and possibly a graph to show where
they rank in relation to the standard bar. Jason Yeater also requested a comparison on
the ranking of NCMC both regionally and nationally.
• Quality - One of the Quality Strategic Initiatives is Observation/Length of Stay in which
the target is to have a patient discharged at 24.92 hours; NCMC is currently achieving
26.99 hours. She reported they are doing really well, since many patients are discharged
prior to requiring observation status. Dr. Carter commented there may be a need for
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June 27, 2016 NCMC Board of Trustees
some education of physicians on how they complete reports to help ensure a better
reflection of how patients are being treated and discharged. Ms. Sparks stated they are
also looking at platelet transfusions and the usage of red blood cells; the lab is leading the
initiative to meet this goal by the end of the year. The Reconciliation of Med Order
Initiative is above target. The Getting Banner Employees to Complete Advanced
Directives - YTD 3.5% have them completed and they are striving for 10%. She noted
many have them done and just need to scan them into the Cerner database. Lastly, on
June 2-3, the FDA conducted an unannounced inspection of the Blood Donor Center,
which received only a few minor recommendations, but otherwise, did great.
. Physicians - Recruiting is ongoing and many physicians recently started or will be coming
soon. Two Infectious Disease physicians will be starting in July, an Anesthesiologist has
been hired, and they are still recruiting for Pediatrics, Internal Medicine and Neurology.
Scott Baker commented there will be 16 new doctors starting between July and October.
In response to Mark Lawley, Ms. Sparks stated some are replacement positions and others
are new FTE positions.
. Financials - The Greeley Community is $720,000 ahead of budget for the month of May,
and Year -to -Date they are behind budget by $2.4 Million. The NOCO area is ahead of
budget by $1 Million for the month of May, and Year -to -Date they are ahead of budget
by $523,000,
. Public Relations - She reported concerning a mass casualty incident about a week ago
involving an apartment fire and nine patients who all arrived at the same time. She stated
the staff handled it very well and the leadership intends to send out an email message
acknowledging all of the great work that everyone did.
. Master Campus Plan - The second Cath Lab (cardiac catheterization) opened on June 20th,
so they are both open.
COMMISSIONER'S REPORT
Commissioner Conway reported that the new lane on Berthoud Hill is now under
construction, the Crossroads project will begin within the next 60 days, and they have
initiated a request for proposals for the Highway 34 Planning and Environmental Linkages
(PEL) Study which will go out next year. He stated the County Assessor submitted an overall
preliminary assessment of just over $8.9 billion, which is a strong sign of building and
economic activity. He explained this is down from an all-time high; however, it is still the
second highest assessment for Weld County. He reported the County Road 49 construction
has begun on the south end and they are working north, including utility relocation which
should be completed in the next 3-4 weeks and then they will begin laying cement. In
response to Ken Schultz, he explained the Assessor's Office does a reappraisal every two
years; however, a preliminary assessment is provided annually for the benefit of special
districts so they can adjust their mill levies and set their budgets. He also commended the
work of the County's Financial Director, Don Warden, who has managed the County budget
through several decades of economic ups and downs.
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June 27, 2016 NCMC Board of Trustees
VISITATION REPORTS
PATIENT FINANCIAL SERVICES
Mark Lawley reviewed his report, dated June 14, 2016. A written copy of the visitation report
is attached as a part of these minutes. Ms. Sparks elaborated on the Patient Census matrix
and explained the Patient Financial Services is a corporate division that is situated locally but
reports up to a corporate office. Their work is a safeguard for the patients to ensure the
insurance coverage is determined prior to a procedure. There was also discussion around the
ability to track whether certain patients opt to not have a procedure or have it done
elsewhere and how to account for that.
ENDOSCOPY DEPARTMENT
Larry Cozad reviewed his report, dated June 20, 2016. A written copy of the visitation report
is attached as a part of these minutes. There was discussion regarding charging in -patient
rates for out -patient procedures which are conducted within the hospital and the competitive
draw backs to not having a separate out -patient facility.
CLINICAL PERFORMANCE ASSESSMENT AND IMPROVEMENT (CPAI) DEPARTMENT
Jason Yeater reviewed his report, dated June 27, 2016. A written copy of the visitation report
is attached as a part of these minutes.
VISITATIONS FOR JULY
Dr. Carter
Brian Underwood
NCMC, INC. REPORT
Ken Schultz reported on the new UC Health facility proposed to locate in southwest Greeley
and the potential impact of losing high -end patients. Scott Baker commented the argument
for the need of additional beds is questionable based on the continuing improvement or
advancement in medical technology and procedures that require less patient time in the
hospital. He stated there will need to be increased emphasis on strengthening relationships
with local private practices and adding more Banner physicians. Commissioner Conway
stated the Greeley community would be better served if the facility located near the lower
income parts of town to better serve that demographic, and he hopes to see similar
community engagement from UC Health as that provided by NCMC.
NEW BUSINESS
None.
OTHER BUSINESS
None.
PLANNING SESSION
No discussion was held on scheduling a future planning session.
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June 27, 2016 NCMC Board of Trustees
ADJOURN
There being no further business to come before the Board, it was MSC [Yeater/Underwood]
to adjourn the meeting at 1:26 p.m.
Respectfully submitted,
Esther Gesick
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June 27, 2016 NCMC Board of Trustees
444
Visit conducted by: Mark Lawley
On Date
6/14/2016
Department
Patient Financial Services
Cassandra Gardner- Admitting Director
Department History
Approximately Sixteen years ago the department consisted of 20 to 30 full time employees. At that time the department primarily dealt with
insurance billing and auditing.
Service(s) Provided
The services provided today involve registration of patients, financial options for patients, assist patients in understanding insurance benefits for
services being rendered, find other funding mechanisms, if necessary, for those not insured or for those where insurance doesn't cover the cost of
the procedure(s), serve as cashier, provides financial counseling, works with Medicaid, also provides emergency room registration and performs
ambulance billing. If a patient does not have the ability to pay they have other resources available to staff such as the Colorado Indigent Fund,
Medicare, Turkey Trot Funds etc.
The ultimate goal is to get patients pre -registered fur procedures, work through the insurance and payment issues with the patient.
Number of staff:
80 FTE 70 here and 10 at Banner Fort Collins
Revenues/Budgets if relevant
N/A
Successes:
Patient Financial Services has several goals in place. The primary goal is to have patients pre -registered at least 5 days before any procedures
and payment resolved. Currently this is accomplished 90% of the time with the target being 95% of all patients pre -registered and billing issues
resolved. In the last 45 days the number of patients registered 5 days before has increase to 93%. Approximately 7.1 million has been collected
up front with a collection goal of 2% of all revenue upfront. Each FTE processes about 4 accounts per hour.
The department processes about 50,000 accounts per quarter
Challenges/Obstacles
Stay on top in changes in the insurance world and government regulations.
Departmental Needs/Request
Summit View location needs furniture upgrades. Patients comment all the time on the condition of furniture.
Manager's suggestions for improvement
None noted.
What would the department manage/director like NCMC, Inc. to know, if anything?
Appreciate Admin Staff meeting with employees; the interaction is very positive.
Notes/Miscellaneous
None
eozad
NCMC Trustee Report
NCMC Endoscopy Department
Interview Date: June 20, 2016
Submitted June 27, 2016
Trustee: Larry Cozad
NCMC Trustee Report
Department History: The Endoscopy department has been around since the 80's. Nobody was quite
sure of the exact time of the inception. The department currently occupies the old OR and has been
there since 2006.
The department averages about 28 patients per day with a high of 42 patients per day.
Name of contact: Christie Pence RN, BSN
History of contact: Ms. Pence has been at NCMC managing the Endoscopy department for 1 year and 9
months. Prior to that Ms. Pence was in Topeka, KS where she worked in the OR and ICU departments.
She has been an RN for 25 years and a manager for 12 years. Ms. Pence is a `hands on" manager
meaning that she is will jump in when needed and work side -by -side with her staff to ensure all patient
care is completed in a time efficient manner.
Services Provided:
Colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum
and colon).
Esophagogastroduodenoscopy (EGD) to scope the upper digestive tract including the esophagus,
stomach and duodenum.
Bronchoscopy which is a scope to examine your throat, larynx, trachea and lower airways.
Endobronchiai Ultrasound Bronchoscopy (EBUS) is a Is relatively new procedure used in the
diagnosis of lung cancer, lung infections, and other diseases that cause enlarged lymph nodes or masses
in the chest.
Endoscopic ultrasound (EUS) allows your doctor to examine your esophageal and stomach linings as
well as the walls of your upper and lower gastrointestinal tract.
Endoscopic Retrograde Cholanglopancreatography (ERCP) is a specialized technique used to study
the bile ducts, pancreatic duct and gallbladder.
Number of Staff: full-time and part-time and what fields: The department currently has 10 full time RN's
and 5 full time Tech's. This includes 3 new RN's and 2 new Techs in the past 2 months. They have RN's
travel in from McKee on Mondays to help with the high work load on Mondays and so that those nurses
get additional experience. The range of experience of the current staff is 10 - 40 years.
Revenues/Budgets if Relevant: Ms. Pence did not provide a specific budget number but noted that they
are 100% in compliance with their budget. She also noted that Randy Sullivan has allowed them recently
to purchase some new specialized equipment that will help with staying on the cutting edge of patient
care.
Successes: The additional staff, the longevity of the current staff and years of experience of the current
staff are a testament to the success of this department. Also the advanced equipment and training of the
staff allows the department to offer very advanced procedures as compared to other facilities.
Challenges/Obstacles: Scheduling. Ms. Pence noted that when the new doctor's offices opened,
scheduling was changed to be done between doctor's office and NCMC's scheduling department and
there have been lots of error. Errors include patients showing up that were not scheduled, were
scheduled for the wrong procedure or showing up at the wrong time. Some of these errors were due to
lack of specific knowledge within the scheduling department. Other times this is miscommunication from
the doctor's offices. Scheduling previously was done directly between the doctor's office and the
Endoscopy department. As time goes on these errors have been reduced but are still an ongoing
concern.
Regardless of the errors the staff does their best to ensure every patient gets their procedure if at all
possible that same day by fitting them in wherever they can. This sometime cause the patient to have
extraordinarily long wait times after preparing and fasting.
Another challenge noted by Ms. Pence is that the department is expected to operate under an operating
room protocol rather than an outpatient protocol. She feels this can add additional layers of compliance
that are not necessary for the level of service and patient care they provide. Particular with regard to
patient recovery.
Departmental Needs/Requests: No specific needs noted at this time. The additional staff has helped
with the overall workload management.
Suggestions for improvement, Continuing to stay ahead of the curve with the latest equipment,
procedures and staff training are of great importance to Ms. Pence. This will allows NCMC's Endoscopy
department to remain one of the best in Northern Colorado.
What Would The Department Manager/Director Like NCMC Trustees To Know: Ms. Pence said that
Wendy Sparks and Tiffany Hettinger recently toured the department and that the staff really appreciates
that management took the time to come by and visit them.
June 27, 2016
Jason Yeater
5427 West 6f1' Street
Greeley, CO 80634
(970) 381-6782
Northern Colorado Medical Center (NCMC) Board of Trustees Report
Clinical Performance Assessment and Improvement (CPAI) department
DEPARTMENT CONTACTS
Dorma Eastman RN, BSN, MSM, CPHQ (Northern Colorado area Director of CPAI services)
DEPARTMENT HISTORY
If you want to change health care, change reimbursement and that is exactly what has been occurring in
some drastic ways in the last 10-15 years. In fact, it could be argued that the health care industry has
changed more in the last fifteen years than it did during the previous forty. Payers expect to pay
less for better outcomes. This change in expectations has prompted the formation of a
department inside the hospital that is focused on the processes and outcomes of the patients as
the industry changes from process -driven reimbursement to outcome -based reimbursement. The
Clinical Assessment and Improvement Department (CPAI) also analyzes the data collection and
reporting procedures involved in corresponding with CMS and private insurance companies and
attempts to identify areas that need improvement while adhering to current government
standards. The CPAI is that department and will continue to play a vital role in the
administration of the hospital.
SERVICES PROVIDED
The CPAI department works in the background looking at the outcomes of procedures and
processes to ensure the highest quality of care and safety for patients. They collect data to ensure
they are appropriately reporting to the Centers for Medicare and Medicaid (CMS) as well as
private insurance. Initially the department's goals were to accurately report back information
regarding the processes used in patient treatment and the hospital's ability to adhere to best
practices established by CMS. Today, however, CMS and other agencies are less interested in
the processes used in patient care and are more interested in patient outcomes. This has propelled
a change in the type of data collected by the department and prompted many different
conversations with other departments as to how to improve patient outcomes. The CPAI
department mines information by using each department's proprietary software and combines it
into a common report. That report is transmitted to CMS, who uses the data to reimburse the
hospital. The report is also used in reporting to the public. It is the hope of CMS that consumers
will use the data published in the report to choose which provider they use in the future. The data
contained in the reports has thus far proven immeasurably valuable in the day-to-day operations
of the hospital.
Yeater 2
In fact the CPAI reported data is now being tied to reimbursement, as CMS is reimbursing
providers that reach their predetermined bench marked outcomes. So when a patient is seen, the
hospital is reimbursed based on the patient's diagnosed related group but if the patients outcomes
meet or exceed the CMS bench mark of this diagnosed related group, the hospital receives full
payment. This full payment translates to a lot of money for the hospital making the work of the
CPAI department that much more critical.
ACCOMPLISHMENTS
The CPAI department continues to improve the quality of care patients receive. They credit this
improvement to their thorough examination of the data regarding patient safety as well as the
work they have done in creating best practice procedures resulting in improved patient outcomes.
This is especially apparent in the outcomes of patients who underwent hip and knee replacement
surgery. Northern Colorado Medical Center currently ranks among the top 10 percent of
hospitals nationwide in which positive outcomes were reported following hip and knee
replacement surgery. They are pleased to be in the lowest percentile nationally for adverse
reactions disclosed for hip and knee procedures. Additionally, the CPAI department has formed a
patient safety council whose role is to analyze safety data and negative outcome reports to
determine if there are opportunities to improve upon services performed.
CHALLENGES/OBSTACLES
One of the CPAI department's biggest challenges lies in competing priorities. The people and
departments the CPAI department interacts with are extremely busy. As a result, it can be
difficult to get the practitioners and administrators to focus on ways to improve outcomes, The
CPAI has the challenge of trying to get the practitioners to set the day to day operations to the
side and think outside the box in ways to improve efficiency and improve patient outcomes.
Making it more difficult is that regulations and safety standards are fluid and constantly changing
so that what is common practice this year might be invalid next.
DEPARTMENT NEEI)S/REQUESTS
One of the CPAI department's requests is for improved technology at their meetings. The CPAI
utilizes technology to meet with and discuss findings with clinicians and administrators. It is not
uncommon for department to get to a conference room 30 minutes to 1 hour before a meeting
because of fear that the current technology will not work. This results in a lot of wasted time and
the need for an easy -to -use, reliable teleconferencing and online meeting tool. Their experiences
with programs such as GoToMeeting and Skype have not always proven effective and has them
searching for a tool that more closely fits their needs. Additionally, the various proprietary
programs inside departments are unable to communicate with one another which accounts for a
great deal of time spent in rote data entry and repetition.
Yeater 3
CLOSING NOTES
Manager's Suggestions for Improvement:
Dorma Eastman, Director of CPAI services, is excited with where Banner Health is going. She
loves her role in supporting the leaders of the hospital, She has expressed that this is the most
excited she has felt in her 20+ year career in healthcare because of her role in teaching people
how to manage and improve outcomes in their busy lives.
What the CPAI Department Wants Leadership to Know:
The CPAI department is aware of how hard the leaders of the hospital are working. The
individuals in the CPAI department are very focused on improving outcomes. With change often
comes anxiety and distress, but Dorma believes that continuing to work through the issues will
lead to a happy, cohesive team dedicated to improving the quality of healthcare received at
NCMC.
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