Summary of the October Meeting of the
Highlands-Cashiers Board of Directors

In order to keep the public better informed about Highlands-Cashiers Hospital, we are providing a summary of the more significant actions and discussion items coming before the hospital’s board of directors at its meeting on Thursday, Oct. 23, 2008.

• Board Chairman Bud Smith welcomed and introduced several new board members who were present at the meeting. In attendance were Ron Hogan, Lynn Dillard, Chief of the Medical Staff David Wheeler, MD, and new Foundation president Earle Mauldin. The fifth new board member, Frances Oakley, was out of town and unable to attend. 

• Kris Keen, manager of Information Technology for the hospital, unveiled a new website for the Fidelia Eckerd Living Center. The site is being implemented in phases and is being designed by Jonathan Brodman of the IT Department. He showed board members the initial version  of the site currently on the web, but also gave the board a peak of the next version, which utilizes Flash generated graphics. The Eckerd Center site can be accessed by going to www.eckerdliving center.com, or through the hospital’s website at www.highlandscashiershospital.org (click on the tab at the bottom). The new site features information on the nursing center, its mission, services, key administrative staff, and activities, as well as a Resident’s Bill of Rights. 

• Griffin Bell, Jr., co-chairman of the Patient Care Committee, gave an overview of the committee’s purpose, composition, and measures taken to monitor the quality of patient care and maintain the hospital’s high standards. The committee meets quarterly, and has approximately 15 members, half of which are administrative staff and half of which are from the medical staff.  Frank Leslie, vice president of operations then reported on two projects the committee has under way. 

Leslie said the hospital now has new software that helps track and report any patient care incidents. The software not only replaces a paper system, but instantly notifies the clinical department managers responsible of an incident, as well as the hospital risk manager. He also said the hospital’s Medication Verification Team continues to explore both procedures and systems available to prevent errors in dispensing medications. The hospital traditionally has a very low rate of medication errors, and currently utilizes a hand-held, bar-code based computer system to track medications. However, the hospital is always looking to improve technology and the rate of staff compliance.

 

• Hospital President and CEO Ken Shull gave the financial report. He reviewed the financial statistics for the month of September.  He reported the average daily census was down slightly last month from the prior year (10.1 compared to 11.20 last September), and the total number of patient days also declined by about 10 percent. However, the total number of patient days for the fiscal year, which ended Sept. 30, was roughly the same as in the prior year (within two percent). The year just ended saw big increases in both the number of inpatients and observation patients, but those jumps were offset by a decline in the number of swing-bed patients and the length of time they were under care. 

Still, gross revenue was up significantly for September (nearly $2.2 million compared to $1.8 million), but so were contractual adjustments, which rise along with revenue. Most of those reductions to gross revenue represent charges the hospital cannot collect from Medicare. Three quarters of the hospital’s business comes from patients covered by that program. Net revenue for the month (nearly $1.6 million was also more than the prior September, but Shull said the hospital still showed an operational loss (before depreciation) of $63,000 for the month. While that was less than during the same month last year, it was worse than budget projections. The hospital had projected more net revenue and had hoped to show a small profit (before depreciation) for the month.  

 

• Julian Franklin, chairman of the Program and Facilities Committee reported that the committee discussed the need to study the corporate structure of the hospital and how it impacts reimbursement under Medicare’s designation as a Critical Access Hospital. The hospital wants to see if restructuring by spinning off the nursing facility and physician clinics could improve the hospital’s level of reimbursement from Medicare. Shull covered the subject more fully later in the meeting. 

 Also under study by the committee is the utilization of space in medical office buildings located on the hospital campus to see if any cost-savings are possible. The committee has also been meeting with representatives from Trehel Corporation regarding the renovation of the existing Cashiers Medical Office Building. Preliminary drawings have been presented and now are being taken to the next level with more detail and color. The project will likely be done in phases, he said.

 

• Dr. Don Mullen reviewed the accomplishments of the Governance Committee during the past year. Those included approving a new set of hospital bylaws, reworking the committee structure, conducting performance evaluations of board members,and the CEO, and identifying new board members to serve for the coming year. The new directors have been elected and two have already been through board orientation, he said. Two other members still need to undergo orientation. 

He reported that the Governance Committee is now recommending adding a new board committee. He said the Fidelia Eckerd Living Center Committee would be composed of board members as well as members of the administrative staff of the Living Center.  Following a brief discussion, the board voted to form the committee and asked Chairman Smith to appoint its members.

 

• Although the Medical Staff did not meet in October, Chief of Staff David Wheeler, MD, briefly discussed  the need for more primary care physicians, especially as Dr. Mark Wagner leaves to become a hospitalist in South Carolina and Dr. Mark Heffington moves to the coast. He reported on some joint recruiting efforts by the hospital and Mountain Area Family Medicine to bring either an internist or family practice doctor to the area as soon as possible. He said the loss of Dr. Wagner from the  emergency room roster of physicians will further stretch the capabilities of the current physicians to provide around-the-clock coverage. 

• During his Foundation Board report, Chairman Earle Mauldin said efforts are already under way to map out a major campaign to raise funds for the renovation of the Cashiers Medical Office building. If the project is to be built in phases, he said, the foundation hopes to be able to raise the money for each phase as it is built. 

• In his administrator’s report Shull said the hospital continues to move forward in developing a partnership with Dr. David Wheeler in Mountain Area Family Medicine and to recruit one or more physicians to replace Dr. Mark Heffington. He said Dr. Mark Wagner’s last day in the officer will be Nov. 21, and that a search is already under way for another primary care physician to serve the Highlands area. The hospital has been exploring ways to provide additional primary care services in the meantime. 

Shull said an outside expert has visited the hospital and is currently studying whether or not there may be legally appropriate ways to financially separate the nursing center, the hospital, and its physician practices that would lead to better financial reimbursement from Medicare. As a Critical Access Hospital under Medicare, Highlands-Cashiers Hospital is allowed to collect its actual costs plus 1 percent for the treatment it provides patients covered by that program. However, some of the administrative and operational costs that would otherwise fall entirely under the hospital’s cost structure now have to be divided among the hospital, its nursing center and the physician practices it owns. The nursing center and physician practices do not fall under the Critical Access system. So spinning off those holdings into separate corporations could perhaps reallocate many administrative costs more fairly, possibly effectively increasing the amount of reimbursement the hospital receives from Medicare.

 

• Finally, Shull reported that Dr. Toby Lindsay’s office in Cashiers had been broken into, and that while a good deal of damage was done to the alarm and the phone system, very little was taken. He said no narcotics are kept on site.