The Fulton County Hospital Board of Governors met on Monday, Aug. 24 and discussed the potential hiring of a new physician for the hospital. The unnamed physician is a woman from northwest Arkansas who is looking to start up her own practice in Salem. She is board certified in family medicine and would be moving to Salem with her husband, 1-1/2 year-old son and is due to give birth to twins in the coming weeks. The hospital and staff met with the doctor Aug. 29-30 to get to know her and see if she would be a good fit for the hospital.
"She was found through the physician recruitment process we started last month," said Joe Hammond, hospital administrator. "She is very interested in the school system, so we can assume she is interested in being here for a while."
In other business, Alan Himmelstein from Hospital Care Consultants and Emergency Staffing Services gave a presentation to the board about supplementing the hospital's emergency department services and physicians.
"We only do business in rural and suburban communities," said Himmelstein. "We deal with critical care hospitals with generally about 25 beds. Everything we do is outside the metropolitan areas. What you do in the local community is quite different from big city doctors. Your doctors have to be the strongest and the best, because they don't have back-up support."
Himmelstein went on to propose a plan where ESS/HCC would provide 24/7 physician coverage for the Emergency Department and the hospital, along with billing assistance, a board certified medical director on site, and malpractice insurance. Himmelstein touted his program's use of "hospitalists."
"Hospitalist medicine is now 13 years old, founded out in California," said Himmelstein. "Currently there are 26,000 full-time practicing Hospitalists, and by end of the year they think there will be 30,000. Hospitalists exist for four different reasons: They help improve the operations of the hospital, they promote patient safety and quality of care, they improve the primary care physician's quality of life and they improve the inpatient care process."
Costs for the program are $4,000 a month, 80 percent of which is billable to Medicare for reimbursement according to Himmelstein. On the emergency room side, they would bill approximately $114 an hour for their physicians. Several board members expressed concerns over the added cost of running the emergency department, along with employee concerns and the handling of discipline issues.
Hammond remarked that the presentation was merely to open up the concept to the board, and not necessarily to vote on the measure. "This is a concept from a company outside of our organization. Currently, we have the emergency department coverage that has been provided faithfully by Dr. Bozeman for some time," said Hammond. "The hospitalist coverage for the hospital is going to be an important part of our future. For both recruiting physicians, maintaining high quality patient care and offering our physicians who work so hard, to give them a break. If we can do a program like this locally, in house, that would be great. I would like to ask Dr. Bozeman to give some thought to a program like this."
Next on the agenda was a presentation by Ken Harper with the Fulton County Hospital Foundation. The foundation is comprised of people from the Tri-County area including Fulton, Sharp and Izard counties. According to Harper, the foundation in total has provided some 2,900 hours of volunteer work towards projects for the hospital.
"We've raised $11,200 through various events, from donations and fundraisers. We've given back to the hospital, which is our focus," said Harper. "We've donated $4,616 for computers here at the hospital. We donated $2,583 worth of chairs in patient rooms, the recliners. We've also put some carpet in a physician's sleep room. We have room sponsors that we've sold a few of; $500 gets you a small room, $1,000 is for larger clinical rooms and waiting areas. Don't be surprised, but we've sold some of those. You have some very giving people in the tri-county area."
Harper went on to talk about future projects for the hospital, including a gift shop to be staffed by foundation volunteers and an office for the foundation director and volunteer coordinator within the hospital. Harper has also talked with Hammond about an employee deduction to assist the foundation.
"We've established our 501c3, as of February this year, we are a 501c3 acting solely and in part from you," said Harper. "What we give is based upon what the foundation wants to give and those choices are made by the foundation board."
The next item on the agenda was a review of the financial report for the hospital. The hospital's bottom line was in the red by $137,765, due in large part to the drop in census the hospital experienced in June and July.
"Our census recently has been running high teens to low twenties, so we're doing better. With Dr. Bozeman now back and Dr. Arnold, Dr. Phillips and Dr. Moody with patients coming in, we're rolling again," said Hammond.
Board member Bill Pace noticed a large discrepancy in the amount of wages paid between last year and this year, attributed by board member Danny Perryman to the leadership of the former hospital administrator, Angie Richmond and also to extensive overtime paid in July.
"We've got to do some cost cutting," said Pace. "We cannot have this type of deficit each month." Hammond pointed out that the hospital has a certain amount of fixed costs that do not change from month to month, no matter what the patient census is, and reminded the board that the census is returning to more normal levels.
"The largest part of the drop in revenue is due to our physician situation in June and July -- when two physicians are out of service, it cuts down on our patient days," said Hammond. "One thing that has not dipped is our outpatient services -- those have carried us through these last couple of months."
The board next took up the new Board of Governor's bylaws, which had been tabled from the July board meeting. Dr. Arnold raised the concern that the bylaws meet the rules and regulations governing a critical care hospital, so as not to endanger the hospital's status as a critical care facility. Pace also expressed concern over the lack of an indemnity clause within the new bylaws, which was present in the old bylaws, and that the insurance be updated to match the physician's levels of one million and three million aggregate. The Board agreed to resubmit the bylaws to the attorney for additional review and table a vote until the September board meeting.
The courtyard electrical project has been completed. The cost of $16,500 will come out of the hospital's contingency fund. "We have approximately $130,000 dollars in the contingency fund after returning the $77,000 from laparoscopic equipment that was earmarked but never purchased," said Hammond.
The board also tackled the issue of the lease of the building Dr. Kauffman used to lease on the hospital campus. Hammond had the hospital attorney draw up a lease offering the county $800 a month to lease it, and that if the county ever decided to sell it, the hospital would have first right to buy the property. The board voted to take the lease offer to the county Quorum Court for approval.
The board also looked at the option of covering the remainder of the roof in a white reflective material which has brought a sizeable cost savings in utilities to the hospital. "Looking at June and July last year versus this year, there's been a total reduction in utilities of $6,540.75, just from the new part of the roof that has the white coating," said Hammond. "The other side is black right now. Adding the coating will add to our cost reduction on utilities."
The board decided to check with the company who did the work on the roof, to be sure that the coating application would not void their warranty, before moving forward.
A new call system for the swing bed wing was presented to the board by Hammond. "We have a quote on that of $13,900 and it will come out of the contingency fund, not operations," said Hammond. "It will get us up and going in that wing, which is a significant revenue source for the hospital." The call system was approved by the board.
Hammond then asked the board to allow him to classify the old radiology table as surplus property, so it could be donated to North Arkansas College. "The old radiology room has an old rad table in there. We looked into selling it, but no one is interested in it because of its age," said Hammond. "The college is very interested; they will cover the costs of deinstallation and transportation to their radiology department. It would be a significant upgrade for them. The deinstallation of this would be about a $20,000 project. That old radiology room will become the gift shop location that the volunteers in the hospital foundation have been looking for."
A motion was made and passed to designate the equipment as surplus property and donate it to North Arkansas College.
Next up was a new health benefits plan. The current plan available to hospital employees from Blue Cross Blue Shield has a $2,500 deductible, with the hospital paying 70 percent for in network services, and the employee paying 30 percent. For out of network, the hospital currently pays 50 percent and the employee pays 50 percent. "We have employees coming to work sick, their kids going to school sick. Our employees cannot afford to pay $2,500 out of pocket for their healthcare," said Hammond.
Hammond then suggested a self-funded policy, managed by Benefits Management System. "I have experience with them both as an administrator, and as an employee needing to utilize their policy," said Hammond. "We have looked at the self-funded plan. The way it works is that it is partially self-funded. Our maximum exposure per employee is $40,000. Once we get to $40,001, then it passes to the carrier that Benefit Management Systems contracts with. If we were to self-fund on those same parameters as Blue Cross/Blue Shield, we would save $131,659.76 over the indemnity plan with an expected claim exposure of $175,000 cash paid out from the hospital."
Currently, employees pay $333.43 to participate in the Blue Cross Blue Shield indemnity plan. With the self funded plan, employees would pay $114.30. The self-funded plan also offers a lower deductible of only $500. "To go to a $500 deductible, 80 percent paid by the plan, 20 percent by the employee, and 50/50 out of network, we would save $109,676 over the current plan with an expected claims exposure of $190,000 a year," said Hammond.
The board agreed with Hammond that the current deductible was too high, and made a motion and approved the new self-funded benefits plan for hospital employees.
In communications, Hammond informed the board that he was receiving updates from the Arkansas Department of Health concerning the H1N1 virus, and that they anticipate a large number of cases cropping up this fall and winter.
The Board then adjourned into executive session to discuss personnel matters and upon emerging from the session, adjourned the meeting with no additional action taken.