PLATEAU VALLEY HOSPITAL DISTRICT MINUTES
July 19, 2004
MEETING CALLED TO ORDER AT 17:15 PM by Helen Spence, President.
BOARD MEMBERS: Helen Spence, Bob Wilson, Frank Wagner, and Clancy Nichols present; Dave Bristol excused.
PVHD STAFF MEMBERS: Dr. Woodyard, Rene Castillo, and Sharon Hill; Dr. Rollins arrived at 6:20 PM. Jessi Clark and Vicki Benning excused.
GUESTS PRESENT: Larry Jokerst, Deb Johns, Chad & Tammy Entwistle, Hank Ward, and Lance Woodyard.
Helen Spence requested a change in the order of the agenda to have Chad & Tammy Entwistle present first and Larry Jokerst second. No objections to the change.
1. CHAD & TAMMY ENTWISTLE PRESENTATION:
- Sharon Hill addressed the questions regarding zoning and the ability to split the property and sell the property:
- Zoned: Commercial
- Property split: No special district requirements. As a public service there should be a notice that the property is for sale to give anyone an opportunity to bid or comment.
- Chad & Tammy summarized their plans for the property to include a home for unwed moms with day care available for the momís to continue education/training. They have talked with counselors at the Job Corps and in the Grand Valley as to the need for this service. They also plan to apply for grants for assistance. The Plateau Valley Health Services Corporation could be of assistance as the pass through of funding with their 501.c.3 status.
- Chad & Tammy are interested in the building and grounds to the east of the brick portion of the building, not to include the kitchen and boiler room to the north.
- 2002 Appraisal was discussed. Les Smith of Bray & Co. was contacted by Sharon Hill and stated that the appraisal done in 2002 was in line and there did not appear to be a need for a new appraisal at this time. The square footage of the old and mid wings is approximately 9608 square feet with a value of approximately $36.00/sqare foot. Tammy stated that the property in Collbran is appraised at $2-18.00/ square foot. Their offer of $108,000 for the older portion of the building and property did not include the mid-wing or kitchen equipment.
- Further discussion concluded that the District needs to review all of the information presented and plan for the sale or lease of the unused portion of the building.
2. LARRY JOKERST PRESENTATION: Larry stated that the need to charge for everything, code for everything and collect the maximum is necessary for the business. Collections at the time of service, especially for tourists and after hours must be done; otherwise the collection rate is less than 50% percent. The opportunity exists to make the clinic grow and be successful. The following excerpt from the written report was presented:
Conclusion and Recommendations
Plateau Valley Clinic is at a critical juncture. From my interviews, it is very clear that you know what you have to do to be successful in the future. TEAMWORK is the key.
The initial recommendations, which are listed in no particular order and is subject to Board direction and approval every step of the way, to carry PVC into its next chapter of providing medical services to residents of Plateau Valley and to tourists and visitors are:
- Begin recruitment of the Business Administrator and plan to have a new person on board by February 1, 2005. A Recruitment Team should be appointed that includes the current Business Administrator, a Board Member, a physician and, perhaps, an outside consultant. This would be followed by a period of orientation from Sharon Hill and others.
- Establish a Marketing Team which includes a Board member, Business Administrator, Plateau Valley Chamber of Commerce, Fire and Rescue Services (i.e. Mike Harvey), a resident of Collbran, Mesa and Molina, a representative from Powderhorn and a Consultant (as needed) to develop and implement a Marketing Plan that includes items referenced in this report. The Marketing Plan should include word of mouth, Plateau Valley businesses, Grand Junction Visitors and Convention Bureau, Grand Junction hotels, Walker Field Airport and the Fruita Welcome Center. A marketing theme that unifies the valley should be developed.
- Have a PVC employee assigned to address situations that arise where a patient is upset or concerned about some aspect of the care received. Sending someone flowers or having the physician or administrator give the patient a call goes a long way.
- Establish a Finance Team which includes a Board member, Business Administrator, a physician and, perhaps, a consultant which monitors financial performance, establishes achievable goals to increase patient volume, establishes clinic policies and addresses issues of increasing revenue and reducing expenses and other issues that arise affecting the financial accountability and performance of PVC.
- Continue to use and expand the use of Monument Medical Consultants for billing and collection services. This company has many employees with years of experience in medical clinic billing and collection.
- Continue the efforts to sell/lease the facility in which the clinic is housed and consider the possibility of moving the Collbran location of the PVC to better establish its identity.
- Establish a clinic in Mesa in a manner, initially, that establishes a short term commitment to allow time to evaluate the potential for success of the location followed after one year by a longer term commitment.
- Continue the efforts to code accurately for services provided and address every problem related to accurate coding quickly.
- Continue to review and update charges to maximize reimbursement that is available from insurance carriers.
- Corollary to the last two recommendations, review insurance contracts to be sure they are up to date and that favor PVC.
- Establish programs that RMHP and other funding sources will subsidize
All of these recommendations come with some cost, time and talent. If the team approach is chosen, the largest commitment will be in talent by using the strengths of each person on the team.
Larry stated the first priority is to begin recruiting a Business Administrator, second to market the clinic to the entire Mesa County including tourists, third fee schedules need to be in line with Grand Junction (Larry reviewed only the uninsured fee schedule which is less than the insured fee scheduleóDeb Johns will get the other fee schedule to Larry for further review), fourth enlarge the finance committee to include policies and procedures, and fifth review insurance contracts to make certain they have a 90 day clause for termination. The Mesa Clinic is a must, if we donít do it someone else will and we canít afford to lose the west end of the valley and the tourist corridor. Larry will be available to adivse by phone and e-mail to assist with a different perspective and in the recruitment process.
The following questions were asked:
- Q: Your practice uses Electronic Medical Records, are they really needed?
- A: EMRís are a must to streamline the practice, assist with proper documentation and coding. They will lessen the filing time and faxing time of reports, but not necessarily lessen the number of staff.
- Q: Are there areas to cut costs?
- A: Reviewed the past three yearís financial statements and the first six months of this year. Larry stated he did not look at areas to cut costs.
- Q: What needs to be included in a Financial Managerís Job Description?
- A: There needs to be 5 or 6 areas:
- Finances which include the reports and daily business activities;
- Insurance Contracts to make certain they are current and giving the practice the biggest bang for the buck;
- Human Resources for employee problems and patient problems with the practice;
- Maintenance and Environmental Services over-sight;
- Must be an excellent representative in the community and do marketing;
- Special District and Corporation compliance; and
- Facilitator availability by phone, e-mail with past business coordinator as things come up that have not been addressed in training.
Larry stated that Plateau Valley Clinic has been successful and will continue to be so. The move to the next chapter will require risk taking and investment. He thanked those present for the opportunity to prepare and present this report.
3. No executive session needed at this time.
4. MINUTES: Corrections: Tim Sarmo from Sermon, Eric Bruton from Burton, and Susanna Lienhard from Lien hard. June 16th minutes need to be corrected: Clancy Nichols excused not absent.
Resolution #1: Be it resolved that the Minutes of the June 16th and July 12th, 2004, meetings be approved as corrected.
Frank Wagner motioned and Clancy Nichols seconded. Motion carried unanimously.
5. CLINIC CONSULTANT REPORT presented by Deb Johns.
- Collections at time of service: MMC is working with Georgia on collecting at the front desk and following the collection policy to the letter. Collections have improved this past month and the receipts are evidence that this is being done.
- Finally we have come to the end of the bad debt write-offs. The last of them will be written off on the 20th.
- Deb Johns will see that a copy of the insured fee schedule is given to Larry Jokerst.
- HMO increase retroactive payments should be received in September.
6. OLD BUSINESS:
- Mesa Clinic Progress Report: Nathalie Ames property and building a clinic are on hold due to the possibility of receiving the Governors Rural Healthcare Initiative Grant. The physicians and Frank Wagner have a meeting set later this week with Nathalie Ames in the clinic conference room.
- Hill Burton Obligation: A Hill Burton representative in Baltimore was asked if the current Plateau Valley Medical Clinic were sold and a new clinic built, would the District be obligated to refund the grant. Verbally she stated that the obligation would end. A written statement was requested and she stated a letter requesting this information needed to be made before a statement could be sent. The request has been sent. In earlier conversations it was implied that the obligation would have to be refunded.
- Service Plan: Must be reviewed and presented to the Mesa County Commissioners soon.
7. NEW BUSINESS:
- Governorís Rural Healthcare Initiative Grant: Scott Rollins presented an overview of the Letter of Intent to apply for this grant. Erika Woodyard handed out the preliminary letter for review by those who had not been at the last meeting. The grant will require community collaboration and possibly matching funds or in kind contributions. Erika questioned whether or not the match or in kind monies needed to be greater. Scott Rollins will be talking to Tim Sarmo to ask if the project would meet the guideline for funding and if matching funds or in kind contributions are required. Scott will also ask Tim for other suggestions.
Resolution #2: Be it resolved that the Board of Directors approve the Letter of Intent for the Governorís Rural Healthcare Initiative for a Mesa Medical Clinic in the amount of $500,000.
Bob Wilson motioned and Frank Wagner seconded. Motion carried unanimously.
8. BUSINESS REPORT: Report presented by Sharon Hill.
||Write Offs/Misc. Inc.
||Net Ordinary Income
Resolution #3: Be it resolved that the Accounts Payable and Payroll Checks (#43160-43231) are approved.
Clancy Nichols motioned and Frank Wagner seconded. Motion carried unanimously.
Resolution #4: Be it resolved that the Board of Directors approves the June write-offs: General Write/Offs $734.20; Medicare $928.19; Blue Cross/Blue Shield $465.45; HMO $570.02; Bad Debt $1159.06; Collection Charge $83.98; CCHP $-9.50; Medicaid $389.55; HMO Contingency $360.34; Hill Burton $1215.16; Courtesy Emp. W/O $5.00; Error Correction $.20.51; State Compensation $31.57; Correct Charges MMC $.00; Physician Incentive $-4537.39; Clean up by MMC $358.40; Refunds to Patients $.00, HMO Contingency $1485.73.
Frank Wagner motioned and Bob Wilson seconded. Motion carried unanimously.
- Finance Committee Report: The Finance Committee met on July 13th and reviewed all of the financial information. The following areas need reviewed as costs exceed budget:
- Physician Professional Liability InsuranceóErika Woodyard stated premiums had increased
- Medical Supplies
- Copy suppliesóProbably due to the election
- Workmenís CompensationóReceived credit of $274.00 and there will be no further billing for 2004
- ES & Maintenance Supplies
- Annual and quarterly payments will be accrued each month instead of expensed as paid
- Legal feesódue to 501.c.3 and election question
- TelephoneóBudgeted for less phones than were needed
- Utilities: A vendor report has been made to compare the utility costs for areas that need further review.
- Rental Space:
- Anita Carver and Hospice have accepted rooms upstairs in the new wing.
- St. Maryís Physical Therapy, Dr. Younker and Janet Thomas-Jessi was going to talk to them last week, Sharon will followl-up this week
- 501. C.3 Application: The additional information has been faxed for approval. Approval of the 501.c.3 application was received today with the reporting requirements.
- Corporation Reporting:
- Annual report is due July 31, 2005. The report for 2004 has been sent.
- Charitable Solicitations Registration is a new requirement. It will need to be done prior to receiving money through the corporation. This can all be done on line as soon as the web site is accessible.
- 2005 Budget Workshop:
- Daily Budget Process and Internal accounting and Audit Process: Time was devoted to good accounting practices and internal controls. Some of the areas that need to be reviewed and/or included in our policies and procedures:
- Review Actual to Budget no less than quarterly to make certain that the total expenses do not exceed those allocated.
- Petty Cash check needs written monthly and reconciled. The reconciliation has been done each month, but a check has not been written monthly. Audit petty cash with Georgia monthly.
- Compare cash receipts with cash deposit daily. Georgia and Sharon implemented this procedure on the 19th and this practice will continue to make certain that receipted monies are deposited daily.
- In addition to stapling a copy of the check to each paid bill, the invoice or statement must be stamped paid. A stamp will be ordered on the 20th.
- Banking services can be bid to find the bank that gives the most service for the least cost. Some districts have a problem with banks not checking for two signatures. Palisades National Bank does check for two signatures and calls when there is only one signature.
- Accounting procedures need to be available and a job description. Both of these are in process.
- Annual Budget:
- The calendar has been received and the process begins in August.
- Final budget is due December 15th.
- The annual audit/budget report is due to the Secretary of State on July 31st.
- Assisted Living Regulations and Medicaid: Christi Laird called and said that new regulations are in place that are very similar to the Nursing Home when it closed and they are issuing fines and sanctions. There are more budget cuts for Medicaid. HMO is kicking Medicaid clients out of their system for non-compliance of HMO requirements. Grey Gourmet funding has been cut at the state level and she did not know how it would affect the program in the valley.
- Web Site: The changes to the web site have been made including the minutes. Please check it out pvhealth.com to make certain all of the changes have been made. Frank Wagner commented on how well our web page had been prepared.
8. FAITH IN ACTION: Report given by Sharon Hill in Vicki Benningís absence.
- The Volunteer appreciation day lunch was very nice and everyone liked their plants.
- 4th of July Yard Sale: The yard sale went very well and most items were sold. The clothes and household things that did not sell went to the food bank for distribution to the needy. The rest of the items are in Vickiís shed for the yard sale next year.
- Fund Raiser: Tonight there will be a fund raiser at Bransonís. There will be music as well as a contest for the best Hawaiian outfit. It will be fun. A portion of shakes sold will go Faith in Action as well as the sale of teddy bears.
- Board meetings have been set to begin again in September. There will need to be another board member appointed due to Gene Mack leaving.
- June Stats: A total of 17 people were served by 45 volunteers who provided 90 hrs of service and 756 miles. There are 6 coalition members who also serve as Board members. One new volunteer recruited to make 45.
9. ENVIRONMENTAL SERVICES: Report given by Rene Castillo.
- The upstairs is being prepared for all ancillary services and the business office move. All other projects are on-going.
10. CLINIC REPORT:
|Total Dr Appt
|Mesa Clinic Dr
|Mesa Clinic Nu
|Mesa New Pt
|Clinic New Pt
- Scott Rollins received the Colorado Academy of Family Practice Physician of the Year award. Erika Woodyard and Michelle Rollins will see that a press release gets into the Plateau Valley Times and The Daily Sentinel.
- Bob Wilson announced that there would be a service and covered dish dinner at the Plateau Valley Assembly of God Church on July 25th honoring the 10th Anniversary of Drís Rollins and Woodyard providing physician services to the Plateau Valley. The service will begin at 10:45 and the dinner will be at noon.
- Drís Woodyard and Rollins reported the Electronic Medical Records package has been decided and the contract would be signed this week.
11. ENERGY IMPACT GRANT
- Architect: Discussed the need to have an architect do the plans for the Energy Impact Grant project. The District expressed the desire to have Frank Wagner be the architect. Clancy Nichols noted that a Disclosure of Potential Conflict of Interest would need to be sent to the Secretary of State if Frank were the architect. Sharon Hill will get the required disclosure to Frank Wagner as necessary.
Resolution #3: Be it resolved that the Board of Directors agrees to retain Frank Wagner to do the architectural work on the Energy Impact Project at a reasonable fee.
Bob Wilson motioned and Clancy Nichols seconded. In Favor: Bob Wilson and Clancy Nichols. Opposed: None. Abstained: Frank Wagner. Motion carried.
12. JULY EVALUATION(S) / RAISES(S):
- Annual: None
- 3 Month: None
Meeting adjourned at 19:34 PM.
Respectfully submitted by,
Sharon Hill, Secretary
Corrected: August 17, 2004