At this month's Fulton County Hospital Board of Governor's Meeting, an executive session with Dr. Kauffman began the precedings. No comments were made following the executive session, but hospital sources say Dr. Kauffman wanted to address the board and let them know he was working towards getting his license re-instated, and hoped that once that had occurred, he might be able to continue his working relationship with the hospital. The Board apparently made no guarantees, choosing to wait on the medical board's decision regarding Dr. Kauffman's license.
Next on the agenda were the financials. The hospital saw a loss of $51,090 in August, which is much improved from the $130,000 loss in July. Administrator Joe Hammond said the facility is still in a bit of a slump, but starting to make a turnaround. The amount of overtime was a large issue for board members, topping out at $21,557. Board member Bill Pace felt more restrictions on overtime should be put in place, even proposing a comp time system instead.
"We as a board have a responsibility to see that the hospital is operating in a professional manner and an efficient manner," said Pace. "We paid $21,557 in overtime last month. Almost half of our loss last month was in overtime. We have a responsibility to manage the financial affairs of this hospital."
Hammond pointed out that several departments had significantly cut their overtime hours over the past month, and would continue to do so moving forward. He also stressed the need for overtime in certain critical areas.
"We will continue to do our best," said Hammond. "I've asked every department head to keep a close eye on it. But we're here to serve the people first."
Hammond went on to point out that because of the hospital's cost-based reimbursement methodology with Medicare, the increased expense of overtime gets factored in to their reimbursement, on an average of about 70 percent reimbursement of costs overall.
As for the proposal of comp time, most of the board was in agreement that it would not be a viable system within the hospital environment.
"Comp time becomes an accounting nightmare to keep up with," said Hammond. "If someone takes a week off, then we have to hire someone for a week to cover them -- and we may not be able to. It becomes a financial snowball. It takes all 130 employees to provide 24/7 services to this community. We cannot at the end of the day, put our pencils down in the ER and go home. In healthcare, it just doesn't work. You have to depend on bodies in those positions to provide the care. We have to be ready for whatever comes."
The board then looked at average patient days and saw a trend where from January to May, numbers were in the mid to high 30s. In June, however, those numbers dropped significantly into the 20s. "We're gaining a bit now that Dr. Bozeman is back on the roster," said Hammond. "I look to see us in the mid 30s moving forward. An average of 30 or 31 will pay the bills and then some. I expect us to be back close to the high 30s in the next couple months, especially if Dr. Kauffman is able to come back."
The hospital will also be monitoring the patient length of stays for inpatients, as last month they were a bit over the 96 hours allowed at an average of 4.14 days. The hospital's critical care designation could be jeopardized if the year to date average goes above 4.0. Currently, the hospital is at 3.85, and Hammond seemed confident that with proper management, they would be able to remain below the 4.0 required to keep their critical care access designation.
Holds, observations and discharges will also be added to the physicians statistics moving forward, per a recommendation from Dr. Arnold to more accurately reflect the amount of work each of the physicians do.
The board once again took a look at the new bylaws drawn up by the hospital attorney. There was a concensus among the members to add back in the verbiage from the original bylaws to the current bylaws presented by the attorney before a final approval could be given. Hammond will see to it that the documents are properly merged and present them to the board at the October meeting.
The hospital's contingency fund is just about exhausted, clearing the way for them to apply for new loans from the USDA. As of Sept. 20, the account had a balance of $119,559.30. The hospital used those funds for a variety of projects including tile for the swing bed hall, putting the radiology lab onto the back-up generator system in case of another bad winter storm such as last year's ice storm, preparing for the new FEMA emergency management services trailer that will be housed on the back side of the hospital included the pouring of a concrete slab, some plumbing work and new tools for the maintenance department. Hammond also was able to complete the purchase of new beds and furniture for the swing bed hall.
"We were able to get beds, visitor seating, over-bed tables and recliners and cabinets for the swing bed hall for $60, 310.85," said Hammond. The remainder of the fund was spent on a new call system for the swing bed hall that was approved at the last board meeting, and asphalt to finish paving the parking lot. The hospital was left with $419.62 which they could apply towards the principle on their new addition loan or on striping for the parking lot. "We have accomplished a wise use of the fund and will zero it out to apply for grant USDA money and long term loan USDA money which will be available through next October," said Hammond. "They have to allocate it all by October 2010, and we'd like to help them do that. We'll get those applications in and get that moving right away."
At the last board meeting, a concern had been raised about possibly voiding the warranty on the roof of the hospital addition if the white energy saving coating was applied to it. Hammond reported that the warranty would, in fact, remain valid, whether the hospital added the coating of the roofing company. The cost to do so will be about $30,776 for materials. Hammond also noted that the hospital saved an additional $2,300 in electric cost, last month compared to the same period last year, thanks to the coating on the main roof.
The issue of hospital benefits was brought to the table, and Hammond told the board that he had approached their new health benefits partner with a request regarding personal life insurance. Previously, the hospital had provided $15,000 term life policies for all employees. Hammond would like instead to offer each employee a term life insurance benefit that would be equal to one time their salary. "I asked the new administrator for insurance that would be equal to one time their annual salary, and they gave a rate of 19 cents per thousand, which would be a cost of $587 a month," said Hammond. "We could provide all of our employees with a life insurance benefit equal to one time their annual salary which would be a great comfort to a lot of our employees." The board agreed with Hammond and approved the measure.
In the past, the board made a choice to change the personal time off methodology from an accrual basis to a block basis. This included no personal time off allowed during an employee's first year of employment, and then on their anniversary date they would have a lump sum of whatever number of weeks or days they are allotted based on years of service. Hammond addressed the board about changing that methodology back to an accrual basis. "At the time, there may have been a reason for reverting to the block basis, but most organizations today use an accrual basis," said Hammond. "40 hours plus 48 holiday hours per year, divided by 26 pay periods, with that personal time off accruing based on hours worked. The reality is that people need time off on their first year -- it's much easier to track and account for on an accrual basis. I would like to ask the board to reinstate the accrual basis for personal time off." After some debate about the amount of time allowed to be accrued, and different caps that would be placed on that amount, the board decided to let Hammond come up with an accrual based plan to present to them at the October meeting.
There is one year left on the hospital's lease of two of its current ambulances. The hospital currently operates two Dodge Sprints and has a 2001 Ford back-up ambulance. "We need to start looking at replacement costs for two new ambulances, and perhaps keeping the old ambulances for parts," said Board Chairman Al Roork. "I would ask the board to consider giving ambulance administrator Tim Rogers and Mr. Hammond the okay to go ahead and look into our options for new ambulances. We pay about $1,600 a month now for our current leases and that is actually paid by the county for us. If the funds are there, I believe they will continue to cover our lease costs." Currently, Fulton County makes the lease payments and the hospital covers the maintenance on the vehicles. "We have to have at least three ambulances at all times, because there are times where one is at an accident, one is on transfer to Little Rock and we get another call," said Roork. The board agreed to have Hammond and Rogers begin research into purchasing or leasing two new ambulances.
Next up, Administrator Hammond brought up the need for a Strategic Planning Process for the hospital. "When I was first hired, I asked the board for 90 days to get settled in and then to enter into a strategic planning process," said Hammond. "What I propose is to do it in two phases -- the governance part and then the operational part. I propose that we take a Saturday morning, meet somewhere away from the hospital and get into a facilitated session running through early afternoon, with our goal to be to come out with a consensus of the board members for what we want to do moving forward with the hospital. What's our vision for this hospital and this region for the future? What are the values held commonly by the board of governors that we then as employees and staff internalize and operationalize in the process at the nuts and bolts level. I want the common mission, vision and values to cascade through the organization," said Hammond. The board agreed to have Hammond suggest an agenda and dates at the October meeting.
Next, Hammond asked the board to approve the service contract for the hospital's voice products maintenance for the fusion software that was approved and installed about six months ago. The system is an integral part of the dictation system for the hospital and allows doctors to give digital signatures to orders. The Board agreed to approve the $5,366.88 for the maintenance agreement for the year.
Two banking issues were then presented. One, a line of credit with the Bank of Salem and the other a designated checking account for the new health benefits plan. The line of credit is renewed each year by a board resolution. The board approved the resolution to continue to keep the line of credit open.
"Denise opened a designated bank account for our payment of claims through our self funded health benefits plan," said Hammond. "This checking account is for that purpose only. We do need it approved by the board to open this account." The board then approved the new account.
Finally, on the physician recruitment front, the hospital had Jason and Janelle Shives come and visit. He is a doctor of osteopathy, currently doing his residency in Orlando, Fla., where he'll finish in June. "We spent last Wednesday with them to tour the county and surrounding area," said Hammond. "It's a long time since I've been so impressed with a young physician. They are committed to living in a rural area, and raising a family in a rural area. They are looking for a home and acreage and he is planning on doing a whole range of family practice. He really is a remarkable fit for our medical staff and our community. This is an excellent time in our history for just such an individual to come in and establish a long term practice here." The hospital will continue to keep the lines of communication open with the Shives, as they interview with other communities in the Midwest. Hammond hopes to be able to sit down and talk numbers with them in the near future.
As for the female doctor who recently visited with the board members, she has chosen a position in Branson and will settle there with her family.