FMC Board of Trustees Meeting – August 2024

1. I.   CALL TO ORDER

Curt called the meeting of the FMC Board of Trustees to order at 5:30 p.m. in the FMC Community Room. 

1. II. Public input – There was no public input.

1. III. APPROVAL OF MINUTES

     No additions or corrections to the June 19, 2024 board minutes as distributed.  Elaine moved to adopt approval of the minutes.  Erin seconded the motion.  All aye, 0 nay.  Minutes stand approved as written.  

1. IV. MANAGER REPORTS

1.  Donna Halmans reported to the Board that she has a second employee in the department and that they have gone back to typing some notes, minimizing the use of the transcription company.  Last year’s QA Goal was to lower her uncoded report by 50%, she has beat that goal by more than 50%.  This year’s QA is to look into digital transcription and how many queries she is sending to the providers for clarifications about their notes.  She will run this over a 2 year period so she can compare to see if documentation is improving and keeping queries down.

• Judy McWilliams reported to the board that she has an assistant who is helping her get caught up and help maintain all of the reports that she has to routinely run.  Judy reviewed the QHI report and the HCAHPS report in detail.  She noted that she and her staff are continuing to make follow-up calls to patients who are discharged from our ED.  She reviewed the Antibiotic Stewardship program, Hazard Possibility Survey and last year’s medical errors in detail.  Judy noted that we have a LEAN student here from the MSU College of Engineering who is doing an assessment of the workflow in the purchasing department, and will have a report of her findings, as well as recommendations about possible improvements, by August 9, 2024.

• Susan Stevens went over the growth of “meaningful use” and noted it is getting harder to track but that she is working on it with help from Judy and MIchelle.  She reported that Tylyn Bova, FNP is here and has started seeing patients.  She has done a phone interview with a mid-level and a D.O. and asked the Board if they were in agreement with getting them out here for interviews.  The Board agreed and Susan will set those up and be in contact with the Board. 
•  
• V.  FINANCIALS 

1. AR Project and Discount:  Katie reported that 56% of what was owed with the discount offer was collected and $399,558 will be sent to collections.  The Collection Policy is not ready to be implemented.  We are still working with TruBridge to finalize the statement process, and collection procedure, to keep in compliance with our required window for patients to apply for financial assistance.  Option 1 is to use an automated process which is 140 days (not in compliance), we can turn it over to collections at this time, but we could not engage in extraordinary collection efforts, e.g. wage garnishment, until the full 240 days have passed, and FMC would have to cover the interest fees.  Option 2 would be to set up an internal manual process to send out statements, which would require a full-time person to oversee.  It also opens up a window for errors.  Option 3 would be to purchase the early-out service from Thrive and let them do the manual process for us.  This option is an additional cost to our system.  The board discussed looking into other early-out service companies and having Katie report back to the Board next month.  Another option may be to look into buying EMR access from a larger facility.  Once we finalize how to do the process, we can start notifying patients of our revised collection procedure.  We will also have to look into a different payment porta, as our current set-up doesn’t allow more than one payment plan per patient at a time.

• June Interim Financials: 15 inpatient days and 28 skilled days. Gross Patient Revenue $730,000, $98,000 under budget.  Contractual Adjustments ($517,000) with $250,000 of that due to Medicare because of our census.  Net Operating Revenue $240,000, $600,000 under budget. Expenses $1,035,000, $22,000 over budget.  Operating Loss $795,000, $620,000 on negative side of the budget.    Non-operating Income $114,000, a net loss of $680,000, $548,000 on negative side of budget.  YTD Gross Patient Revenue $9.5 million, $530,000 under budget.  YTD Net Operating Revenue $9.9 million, $315,000 under budget. YTD Total Expenses $12.3 million, $2,180 under budget.  YTD Operating Loss ($2.3 Million), $311,000 on the negative side of the budget.  FY2024 looks like it will show a loss of about $23,000 more than the FY2023.  When we have an annual loss, it pulls from our reserves.  If we do not see improvements, the discussion may need to turn into looking hard at loss-leading departments and what to do about them, in conjunction with looking at contract staff and expenses like that.  Non-Operating Income of $960,000 gives a YTD Net Loss ($1.4 million) $197,000 on the positive side of the budget. YTD STATS, 189 Inpatient days, 195 in the budget.  212 skilled days with 240 in budget.   Ancillary services: ER below budget.  Procedure room and observation hours are ahead of budget. Lab is catching up to the budget, but blood bank is ahead of budget.  EKG, radiology, and mammography are below budget. CT, ultrasound, and MRI ahead of the budget.  Rehab visits are below budget, OT is catching up to the budget. Clinic visits are at 4,125, budgeted for 6,200, this time last year we had 4,924.  YTD Change in Cash Equivalents ($574,000).  There will be some adjusting entries that Margie will do to finalize the June numbers and the auditors will be here mid-to-end of September.  Margie will compile a report to show the departments that are loss leaders vs. the revenue generating departments and have it prepared by the next meeting.

.     V VI.  OLD BUSINESS

1. 3-D Mammography: We were given a proposal to purchase a 3-D mammography machine at a 50% discount, plus a $5,000 rebate and 18 months of warranty.  The warranty itself will save about $3,800 a month, our Foundation has agreed to fund some of the cost, Denbury is willing to put $11,000 toward the purchase, and Margie would like to get a loan to fund the remainder. With a 3-D machine, we have codes that we can use to bill an additional $40,000, and loan rates are at 4% right now. Erin made a motion to allow the purchase of the machine with a loan.  Evelyn seconded the motion.  All aye, 0 nay, motion passed.

• Dr. Campbell Contract Renewal:   David discussed the board’s approval of granting a 3-year lease with the option for an additional 2 years with Dr. Campbell.  David did an analysis on the rental costs for Dr. Campbell, which resulted in a 7% increase.  Dr. Campbell agreed to the increase and signed the contract renewal as negotiated.

• Clinic Manager Replacement:  David updated the Board that we have 3 candidates and have completed interviews and are hopeful to make our selection in the next couple of days. 

VII.     VI.  NEW BUSINESS

1. Lean Study for Purchasing:  Judy discussed this with the board during her report 

• Wi-fi Network Upgrade/New Firewall:  The grant money has been received and the equipment purchased to upgrade the wi-fi network and the firewall.  David will have that all completed during the next few months.

• CAH Licensure Survey:  Surveyors were on site July 10, and did an inspection per MT statutes regarding CAH facilities.  The survey went well with no deficiencies, and they recommended re-licensure for another 3 years.

• 401(k) Change:  MHN Is looking to replace Pinnacle and Transamerica with Finway and Empower as our retirement plan provider.  That is expected to result in lower fees and better service.  It would most likely occur late this calendar year.

• Equipment Failures and Power Bumps:  David went over the enclosure showing all of the estimated costs for the equipment failures that we have experienced since a series of power bumps in April.

• Medical Staff Credentialing:  David presented all of the providers to be credentialed or re-credentialed under our Medical Staff bylaws.  Evelyn made a motion to approve the candidates, Del seconded the motion.  All aye, 0 nay.  Motion passed

• The Board adjourned their regular session having completed the agenda.

VIII.     CLOSED EXECUTIVE SESSION

1. Provider Contract Re-negotiation due in October:  Provider contract that is up in October was voted to offer a one-year renewal agreement at the same terms and conditions.

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s\ Curt Arnell, President

s\ Heather Schwindt, Recorder and Transcriber