Board of Trustees Monthly Meeting - Public Session. Board Advisors Absent: Lety Liera

St. John’s Medical Center P.O. Box 428 Jackson, Wyoming 83001 307-733-3636 Committee: Board of Trustees Monthly Meeting - Public Session Meeting Da...
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St. John’s Medical Center P.O. Box 428 Jackson, Wyoming 83001 307-733-3636

Committee:

Board of Trustees Monthly Meeting - Public Session

Meeting Date:

July 21, 2016

Minutes Prepared By:

Mary Katherine King, Executive Assistant

Members Present: Michael Tennican, Chair Barbara Herz, Vice Chair Scott Gibson, Treasurer Liz Masek, Secretary (phone) Joe Albright Cynthia Hogan Bruce Hayse, MD

Members Absent:

Board Advisors Present: Zach Hall

Board Advisors Absent: Lety Liera

Others Present: Lou Hochheiser, CEO John Kren, CFO Joan Palmer, CNO Karen Connelly, CCO Lance Spranger, CIO Thomas Kinney Betty Zernik Amy Russian Pat Weber Alisa Lane

Marty Trott, MD Mark Hettinger Marc Domsky, Do Ellen Gallant, MD John Goettler Melissa Cassutt, JH News & Guide Mary Katherine King

Call to Order The public board meeting was called to order at 3:03 p.m. by Chair Mike Tennican. The public meeting was immediately adjourned to convene in executive session. The public board meeting was reconvened at 4:05 p.m. Comments from the Chair Mr. Tennican commented on the June 30th joint board meeting with the SJHF Board and the SJMC Board of Trustees. The boards discussed major facility needs, the current financial situation and major sources of funding. They also discussed the likely increase in need for and importance of philanthropic support from the Foundation as we move forward. Both boards approved unanimously the formation of the Joint Committee on Major Initiatives. The committee’s goal is to share objectives between boards, including projects and initiatives that may require philanthropic support. Approval of Minutes A motion was made, seconded, and unanimously carried to approve the minutes of the June 30, 2016 Board of Trustees regular meeting. CEO Report Recognitions  Lou Hochheiser shared a grateful patient letter from a physician visiting the area who required care in the ED. He expressed gratitude to Dr. Reyes and Nurse Campbell for the professional and compassionate care he received. Concerns  Lou Hochheiser stated that there are a number of patients treated at St. John’s who are addicted to drugs and alcohol. While SJMC does a good job taking care of their medical conditions, our

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community lacks some of the resources needed to help these individuals change their behavior, particularly patients with drug issues. Our community needs to examine and upgrade how we are handling this situation. Upcoming Events  St. John's Hospital Foundation is hosting a birthday party for St. John's Medical Center on Sunday, July 31st from 4:00 p.m. until 8:00 p.m. at Snow King Ball Field. This free concert includes the Grammy Award Winning Bluegrass band The SteelDrivers, Brett Moyer and friends, and the Hoot All Stars. Plan to attend this family-friendly afternoon event to say thank you to our community for 100 years of support.  September 9, 2016 marks the 100th anniversary of the dedication ceremony of the first St. John’s Hospital. To commemorate this day, the public, staff and supporters of the hospital are invited to attend a ceremony at St. John’s. A time capsule will be installed on campus and we will formally announce the Huntsman Cancer Institute affiliation. Dr. Paul Beaupre, the new CEO, will attend and Governor Matt Mead will speak.

Power Outage  The greater Teton area experienced a lengthy power outage this week. CIO Lance Spranger reported that no electronics were damaged. The back-up generators engaged immediately. I Can Again Campaign  Karen Connelly reported on the #ICanAgain Campaign that launches next week. The patientcentric campaign uses stories of local members of the community who received surgery at SJMC who are now able to return to the lifestyles and hobbies they once enjoyed. The initial launch includes a story of one patient who received cataract surgery who can now paint again, and a second story is from a patient who came to our Peak Joint Replacement Center for a hip replacement. Less than three months later she trekked in Nepal. The campaign is story-driven and lifestyle focused. It is aligned with marketing priorities and is integrated with digital marketing. To view the stories, visit tetonhospital.org/stories. Finance, Audit and IT Committee Report – Scott Gibson reported on the July 18th Finance Committee meeting. Based on preliminary data for June, the Medical Center is 8.3% over in gross revenue for the portion of the month. We have seen an increase in patient volume this summer, which is likely due to an increase in tourism for the parks 100th Anniversary. Presentation of the Proposed Budget for the Fiscal Year 2016 Mr. Gibson stated that the members of the Finance Committee have reviewed and unanimously approved the FY 2017 SJMC Proposed Operating and Capital Budget. Lou Hochheiser gave a general overview of the budget process and discussed the key drivers and assumptions that were made to arrive at the basis for this year’s budget. The drivers addressed included: 

Price Increase – As we have done in the past, the hospital will keep the price increase below the national hospital services CPI increase. This was a careful decision, but deemed important to keep down the cost of services for our community members. For example, our new 3-D Digital mammography machine was installed, but we are not raising prices on mammograms. This is largely due to the St. John’s Hospital Foundation role in raising funds from the community to help support this.

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Volumes –Inpatient volumes are expected to decline, and expect to see outpatient volumes increase. There is a dissonance between the model to lower the length of stay but with an emphasis on reducing readmission rates. Deductions – Thus far the Medical Center has been able to preserve our level of reimbursement by working with our third-party reimbursers. We will likely see lower reimbursements in the future. Expenses – The hospital will continue watch expenses, be efficient in our use of supplies, and control costs. As vendors raise rates at a rate higher than CPI and we increase at lower than CPI, this creates a dissonance. Healthcare Landscape – The healthcare landscape is constantly changing. There has been a major shift by CMS toward paying providers based on the quality, rather than the quantity of care they give patients. CMS is moving away from fee for service toward alternative payment models that reward value, improve outcomes, and reduce costs.

Dr. Hochheiser commented on the impact St. John’s has on the community. As Teton County’s largest year-round employer, St. John’s fiscal health has a significant impact on Jackson’s economic vitality. The hospital supports the local community in the form of wages and benefits. In addition to direct employee wages and benefits, St. John’s supports Jackson’s economy through the purchase of supplies from local vendors and contracted services with local vendors. St. John’s offers a considerable amount of uncompensated care to our community and continues to reinvest in the community. John Kren stated that St. John’s Medical Center developed the proposed budget for the fiscal year (FY) ending June 30, 2017 with critical input from Department Managers, the Finance Team, the Finance Committee, and the Board of Trustees. Several assumptions were made to arrive at the basis for the FY 2017 budget. These assumptions include a 3.0% average price increase (historically, the Medical Center has aimed for a rate increase at or below the national hospital services CPI which was calculated at a 4.1% increase for the last five months of 2016), a 2% inpatient volume decrease, a 2% outpatient volume increase, and a Living Center average daily census of 47 residents. An increase in both employee compensation and the cost of employee health insurance was projected. The proposed FY 2017 operating budget provides for an overall increase in net assets of $6.2 million which will be applied to existing capital needs, including debt service and equipment expenditures. This figure reflects a projected operating gain of $63,000 which is netted with a projected nonoperating revenue amount of $6.1 million. The non-operating revenue includes district tax revenue, interest, and other income and contributions. It is important to realize that due to the relatively small size of St. John’s Medical Center and the community population, this budget is highly sensitive to small changes in revenue, volume, payor mix, collections and expenses. Barbara Herz noted that if we assume an increase or decrease in volume of 1% to 2% it impacts the bottom line by $3M to $5M. She also noted that with the exception of surgery and imaging, all other services in the hospital are subsidized. Mr. Tennican commented that one of the primary reasons the hospital’s financial results have exceeded expectations in recent years is because the message of quality of care is getting out in the community. People are choosing to have surgeries performed at St. John’s rather than traveling elsewhere for services.

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The budget proposal ended at 4:53 p.m. Mr. Gibson asked that the board postpone the discussion on the budget to give time for all to review the information for the minimum 30-minute requirement before taking action. Mr. Tennican asked for public comment. No public comment was made. Joint Committee on Quality & Safety – Mike Tennican updated the board on the JCQS meeting held on July 19, 2016. Mr. Tennican reported that Richelle Heldwein, Director of Risk and Compliance, is working with HR on implementing a new video surveillance policy. With a recent increase of national scares and attacks, we are enhancing security and monitoring. Mark Hettinger shared with the board a report he recently presented to the JCQS on readmission reductions. In 2014, we formed a Readmission Steering Committee to oversee and review all 30-day readmissions. Multiple department workgroups were established to give monthly reports. Actions taken improved our readmission rates almost entirely across the board, which are now in-line with the national rate in all readmission areas. We now work more closely with the patient and family throughout the patient stay, and have increased patient follow up after they leave. A full-time pharmacist is now on the patient floor meeting with the patient and families. The social service team plays a critical role in this process; he expressed gratitude for the work they do to make sure the patient is taken care of after discharge. We will close out the steering committee, but will continue with reporting and multidisciplinary discharge planning meetings to review patient status and determine readmission risk level. Approval of Credentialing Items Dr. Domsky presented the credentialing items as approved unanimously at the July MEC and JCQS meetings. These items include: Initial Appointments, Reappointments, Resident Rotations, Change in Privileges, and Practitioner Resignations. Mr. Gibson moved to approve the credentialing recommendations as presented. Ms. Herz seconded. The motion passed unanimously. Policy Revisions There were no policy revisions presented. Facilities Committee - In Jim Johnston’s absence, Lou Hochheiser gave the Facilities Committee report. Notices have been placed in the Jackson, Denver, Idaho Falls and Salt Lake City newspapers for sealed bids for the Lobby reception and wellness corridor expansion and renovation project. To date, Mr. Johnston has received a request for drawings and specs from four companies. A mandatory pre-bid meeting will be held at 10:00 a.m. on July 27th for any questions and a walk through to discuss the scope of work. The architects from CTA will also participate in the walkthrough. All bids are due by noon on August 12th. CTA will vet the candidates and bids. The committee will meet and award the construction contract to a not-to-exceed amount of $2.4 million, as approved by the board on June 30th. Dr. Hochheiser reported that Mr. Johnston has been nominated for and accepted the position of president elect for the Wyoming Healthcare Society of Engineers. He has also been assigned to the Wyoming Department of Health’s committee to review and vote on any construction rules and regulations changes, additions, and deletions.

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Human Resource Committee – Cynthia Hogan reported on the Human Resources Committee meeting held on July 19, 2016. The committee discussed updates to the employee handbook and received information on the transmittal of the ACA 1095-C form (the IRS form that provides information about the health coverage offered by an employer). The HR Committee is currently reviewing the on-call policy and the surveillance policy. The committee also discussed API install implementation. Foundation Report - John Goettler updated the board on the Foundation activity:   

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Welcome to Our Healthy Community Update: Total raised to date is $2.3M. Fundraising for 3-D Digital Mammography is going well. The Auxiliary pledged $250,000 and the Teton Pines Women's Golf Association pledged $150,000. The Foundation has secured additional donations toward the $600,000 goal. The Foundation hosted an Art & Healing reception on Tuesday, July 19 from 5:30 to 7:30 pm in the courtyard of the Professional Office Building. The event showcased several curated exhibits recently installed in the POB. Guests had the opportunity to meet the artists who are partnering with SJHF on the new Art & Healing Program. The Foundation will have a booth at the Farmer's Market on Saturday at the Town Square from 8:00 a.m. until 12:00 noon. Please stop by and say hello. A percentage of all Farmer's Market sales will go to Meals with a Mission. Friday, August 12 through Sunday, August 14 is the 15th Annual Steve Winograd Memorial Diabetes Tennis Tournament. Even if you do not play in the tournament, board members are invited to attend the dinner on Sunday evening at Jackson Hole Golf & Tennis Club. On September 14th, Bob and Colleen Grady are hosting an event to meet the new CEO, Dr. Paul Beaupré. Monday, September 26th is the 25th Annual St. John’s Auxiliary Charity Golf Tournament. This year the tournament will take place at Shooting Star.

Old Business Joe Albright reminded that board that September 9, 2016 marks the 100th anniversary for the dedication of the first St. John’s Hospital. From approximately 10:30 to noon on September 9th we will host a time capsule ceremony and Huntsman affiliation event at St. John’s. New Business No new business. Next Meeting The next regular monthly meeting will be Thursday, August 25. Public session begins at 4:00 p.m. Adjournment Barbara Herz moved to adjourn the public meeting. Scott Gibson seconded the motion. Motion passed unanimously. The meeting adjourned at 5:30 with no return to executive session. Respectfully submitted, Mary Katherine King, Executive Assistant