SPECIAL BOARD MEETING · 2019-09-17 · Michael Karch, MD – Orthopedics Appointment to Active Staff Larry Silver, MD – Anesthesiology Sarah Sindell, MD – General Surgery

2018 Press Ganey Guardian of Excellence Award Winner

2017 Hospital Quality Institute Award Winner

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Mammoth Hospital P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104

www.mammothhospital.com

METICULOUS CARE * MEMORABLE PEOPLE * MAJESTIC LOCATION

SOUTHERN MONO HEALTH CARE DISTRICT

SEPTEMBER 2019 MONTHLY BOARD MEETING AGENDA (REVISED)

In compliance with the Americans with Disabilities Act (ADA), if you need special assistance to participate in or to attend this meeting, please contact the District Board Administrative Assistant at Mammoth Hospital by telephoning (760) 934.3311. Notification 48 hours prior to the meeting will enable the District to make reasonable arrangements to assist with accessibility to this meeting.

Date: September 19, 2019 Time: 8:00 a.m. Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546 Stephen Swisher, M.D., will attend via videoconference and will be located at 200 4th Ave. N. Nashville, TN 37219.

I. CALL TO ORDER

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

III. PUBLIC COMMENTS

IV. CHIEF OF STAFF REPORT

V. ADJOURN TO CLOSED SESSION

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

http://www.mammothhospital.com/

Southern Mono Health Care District Board of Directors Meeting Agenda September 19, 2019

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2. Debra Esterces v. Southern Mono Healthcare District, USDC Eastern District Case No. 2:18-cv-01121-TLN-KJN.

3. Susan Corning v. Mammoth Hospital, et al., USDC Eastern District, Case No. 2:18-cv-02295-TLN-EFB.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code §54956.8).

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report. 2. CEO Report. 3. CFO Report. 4. CNO Report. 5. CMO Report. 6. CIO Report. 7. HR Report.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155)

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

CREDENTIALING Initial Appointment to Provisional Staff Janelle Clark, PsyD – Behavioral Health Christopher Winkle, MD – Womens Health Fareed Ramzi Asfour, MD – Infectious Disease (Tele) Sarah Ruberman, MD – Pediatrics Mary Bissell, MD – Pediatrics Reappointment to Active Staff Pete Clark, MD – Family Medicine Louisa Salisbury, MD – Pediatrics Timothy Cragun, DO – Dermatology Brian Gilmer, MD – Orthopedics Michael Karch, MD – Orthopedics Appointment to Active Staff Larry Silver, MD – Anesthesiology Sarah Sindell, MD – General Surgery Locums Tenens Coverage

Lucienne S. Bouvier MD - OB/GYN Dates of coverage: 6/25/2019-7/3/2019, 9/24/2019 – 10/1/2019


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PERSONNEL MATTERS (Government Code §54957) 1. Review of the Quarterly Work Comp Report 2. Tom Parker, CEO.

VI. REPORT ON CLOSED SESSION

VII. PUBLIC COMMENTS

VIII. CONSENT AGENDA (All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

August 18, 2019 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

IX. COMMITTEE REPORTS

1. Finance Committee (Meets Monthly) Stephen Swisher, M.D., Dave Anderson

2. Physician Compensation and Relations Committee (Meets Ad Hoc) Laurey Carlson, Joanne Hunt

3. Employee Relations Committee (Met August 26, 2019) Yuri Parisky, M.D., Joanne Hunt

4. Quality Assurance Committee (Met September 13, 2019) Stephen Swisher, M.D., Joanne Hunt

5. CEO Annual Review Committee (Meets Ad Hoc) Laurey Carlson, Dave Anderson

6. IT Steering Committee (Meets Quarterly) Stephen Swisher, M.D., Yuri Parisky, M.D.

7. Facilities Committee (Meets Bi-Annually) Yuri Parisky, M.D., Laurey Carlson

8. Board Member Recruitment Committee (Meets Ad Hoc) Laurey Carlson, Dave Anderson

9. Ad Hoc, Special, or Other (as needed) Committees

X. CHIEF EXECUTIVE OFFICER’S REPORT

XI. FINANCE REPORT 1. August 2019 Financial Narrative. 2. Investment Report.


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XII. BOARD EDUCATION 1. Mammoth Hospital Year in Review. 2. Board Education and National Rural Health Association.

XIII. OLD BUSINESS

There is no old business to discuss.

XIV. NEW BUSINESS

1. Review of the Quarterly Retirement Plan Performance: 403 (b) and 457 Employee Retirement Plans by Sarah Vigilante, Human Resources Director.

2. Presentation of the Patient and Family Centered Care (PFCC) Annual Report. 3. Declaration of Surplus District Property, Equipment and Supplies.

XV. CREDENTIALING

Initial Appointment to Provisional Staff Janelle Clark, PsyD – Behavioral Health Christopher Winkle, MD – Womens Health Fareed Ramzi Asfour, MD – Infectious Disease (Tele) Sarah Ruberman, MD – Pediatrics Mary Bissell, MD – Pediatrics Reappointment to Active Staff Pete Clark, MD – Family Medicine Louisa Salisbury, MD – Pediatrics Timothy Cragun, DO – Dermatology Brian Gilmer, MD – Orthopedics Michael Karch, MD – Orthopedics Appointment to Active Staff Larry Silver, MD – Anesthesiology Sarah Sindell, MD – General Surgery Locums Tenens Coverage

Lucienne S. Bouvier MD - OB/GYN Dates of coverage: 6/25/2019-7/3/2019, 9/24/2019 – 10/1/2019

XVI. FUTURE BUSINESS

The next Regular meeting will take place on Thursday, October 17, 2019 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN



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BOARD OF DIRECTORS REGULAR MEETING MINUTES

Date: August 15, 2019 Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546 Attendance of Board Members: Dave Anderson, Chair; Laurey Carlson, Vice Chair; Treasurer; Joanne

Hunt, Secretary; Yuri Parisky, Member at Large. Treasurer Stephen Swisher, M.D., attended via videoconference from 7228 6th Avenue NW, Seattle, WA 98117. Attendance of Staff Members: Tom Parker, Chief Executive Officer; Melanie Van Winkle, Chief

Financial Officer; Kathleen Alo, Chief Nursing Officer; Craig Burrows, M.D., Chief Medical Officer; David Baumwohl, Legal Counsel; Sarah Rea, Recording Secretary.

Absent: Mark Lind, Chief Information Officer;

I. CALL TO ORDER Chair Anderson called the meeting to order at 8:01 a.m.

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values lead by Joanne Hunt.

III. PUBLIC COMMENTS There were no Public Comments.

IV. CHIEF OF STAFF REPORT The Chief of Staff Report was reviewed in Closed Session.


Southern Mono Health Care District Board of Directors Meeting Minutes August 15, 2019

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V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:04 a.m.

VI. REPORT ON CLOSED SESSION The Board reconvened to open session at 9:19 a.m.

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

2. Debra Esterces v. Southern Mono Healthcare District, USDC Eastern District Case No. 2:18-cv-01121-TLN-KJN.

3. Susan Corning v. Mammoth Hospital, et al., USDC Eastern District, Case No. 2:18-cv-02295-TLN-EFB.

David Baumwohl reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING AND THREATENED LITIGATION for the above items; no action was taken.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8).

David Baumwohl reported there were no matters to discuss: no action was taken.

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report.

David Baumwohl reported that Dr. Tim Crall, Chief of Staff, was not present. Dr. Richard Koehler, Vice Chief of Staff, requested attendance to Closed Session at 8:05 a.m. The request was approved. With Dr. Koehler present, the Board discussed Quality Assurance and the Chief of Staff report. Dr. Koehler made some comments; no action was taken. Dr. Koehler left the meeting at 8:09 a.m.

2. CEO Report. David Baumwohl reported that QUALITY ASSURANCE issues were reported by and discussed with Tom Parker, CEO. No action was taken.

3. CFO Report. David Baumwohl reported that QUALITY ASSURANCE issues were reported by and discussed with Melanie Van Winkle, CFO; no action was taken.

4. CNO Report.


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David Baumwohl reported that QUALITY ASSURANCE issues were reported by and discussed with Kathleen Alo, CNO, and that the CNO gave a presentation regarding the quarterly Quality Assurance summary. No action was taken.

5. CMO Report. David Baumwohl reported that QUALITY ASSURANCE issues were reported by and discussed with Craig Burrows, M.D., CMO. No action was taken.

6. CIO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Mark Lind, CIO, due to the absence of the CIO. No action was taken.

7. HR Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Sarah Vigilante, Human Resources Director. No action was taken.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155) 1. Review of the Quarterly Performance Improvement Report

David Baumwohl reported that the QUALITY ASSURANCE QUARTERLY SUMMARIES were reviewed; no action taken.

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

David Baumwohl reported HEALTH CARE FACILITY TRADE SECRETS were discussed regarding Sierra Park Clinics/Mammoth Hospital; no action was taken.

CREDENTIALING

Initial Appointment to Provisional Staff Mary Bissell, MD – Pediatrics Sarah Ruberman, MD – Pediatrics Reappointment to Active Staff Eric Bourne, MD – Anesthesiology Dennis Crunk, MD – Family Medicine Sarah Sindell, MD - Surgery Reappointment to Courtesy Staff Marianne Cuttic, DPM – Podiatry


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David Baumwohl reported the foregoing physician CREDENTIALING was not discussed; no action was taken.

PERSONNEL MATTERS (Government Code §54957) 1. Tom Parker, CEO.

David Baumwohl reported that PERSONNEL MATTERS were discussed; no action was taken. Staff and legal counsel, with the exception of the CEO, exited Closed Session at 8:33 a.m. No action was taken. Closed session ended at 9:12 a.m.

VII. PUBLIC COMMENTS Lorrie Gould, Mammoth Hospital Auxiliary Vice President, reported the following:

1. The Mammoth Hospital Auxiliary initially budgeted $175,000 for Capital Outlay in the next fiscal year. However, at its Board meeting on August 14, 2019, the Auxiliary decided that it will only offer $150,000 at this time for large scale purposes, and the remaining $25,000 will be decided throughout the year.

2. One of the Cast Off’s volunteers is setting up a Facebook page for the Auxiliary. The information on this page will include hours, volunteer information, coming events and places to contribute comments. The name of the page will be Cast Off Thrift Store—Mammoth Hospital Auxiliary.

3. Saturday August 17 is National Thrift Shop Day. Celebrations include special sale items, contests and hourly prizes, as well as snacks and beverages.

VIII. CONSENT AGENDA

(All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

July 18, 2019 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

Laurey Carlson moved, seconded by Yuri Parisky, to approve all items on the consent agenda as presented in the packet. Chair Anderson asked for comments; a brief discussion ensued including clarification on a portion of the CNO report, opioid treatment and a discussion of employee exit interviews. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

IX. COMMITTEE REPORTS

1. Finance Committee (Meets Monthly) Stephen Swisher, M.D., Dave Anderson

Details from the Finance Committee Meeting will be covered in the Financial Report.


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2. Physician Compensation and Relations Committee (Meets Ad Hoc) Laurey Carlson, Joanne Hunt

There was no Physician Compensation meeting; no report.

3. Employee Relations Committee (Meets Bi-Annually) Yuri Parisky, M.D., Joanne Hunt

There was no Employee Relations Committee meeting; no report. The next Employee Relations Committee meeting is scheduled for August 26, 2019.

4. Quality Assurance Committee (Meets Quarterly)

Stephen Swisher, M.D., Joanne Hunt

There was no Quality Assurance Committee meeting; no report. The next Quality Assurance Committee meeting is scheduled for September 13, 2019.

5. CEO Annual Review Committee (Meets Ad Hoc) Laurey Carlson, Dave Anderson

There was no CEO Annual Review Committee meeting; no report.

6. IT Steering Committee (Met July 25, 2019) Stephen Swisher, M.D., Yuri Parisky, M.D.

There was an Information Technology (IT) Steering Committee meeting this month; minutes were included in the Board packet.

7. Facilities Committee (Meets Bi-Annually)

Yuri Parisky, M.D., Laurey Carlson There was no Facilities Committee meeting; no report.

8. Board Member Recruitment Committee (Met July 29, 2019)

Laurey Carlson, Dave Anderson

There was a Board Member Recruitment Committee meeting; minutes were included in the Board packet.

9. Ad Hoc, Special, or Other (as needed) Committees There are no Ad Hoc, Special, or Other (as needed) Committees at this time.

X. CHIEF EXECUTIVE OFFICER’S REPORT

Tom Parker, CEO, had no additions to his written report.


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XI. FINANCE REPORT

1. July 2019 Financial Narrative. 2. Investment Report.

Melanie Van Winkle, CFO, reviewed and presented the Financial Statements, included in the packet via PowerPoint presentation. Ms. Van Winkle reported the July Net Gain was $669,000 which resulted in a favorable budget variance of $1,000. The year-to-date Net Gain was $669,000 which resulted in a favorable year-to-date budget variance of $1,000. Days of cash-on-hand were at 377.9 at the end of July.

XII. BOARD EDUCATION

Sierra Star Memorial Wall.

Talene Shabanian, Mammoth Hospital Foundation Manager, presented a concept for the Sierra Star Memorial Wall.

XIII. OLD BUSINESS There was no old business to discuss.

XIV. NEW BUSINESS

1. Review and approval of the updated Southern Mono Health Care District Statement of Investment Policy.

Yuri Parisky, M.D., moved, seconded by Laurey Carlson, to approve Resolution 17-02: Statement of Investment Policy. Stephen Swisher, M.D., commented that several items in the Statement of Investment Policy are not addressed in the monthly investment summary as presented to the Board. A brief discussion ensued, and it was decided that Melanie Van Winkle, CFO, would revise the monthly summary to match the policy. Legal counsel stated there were no material changes to the policy. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

2. Review and approval of the updated Southern Mono Health Care District Bylaws. Yuri Parisky, M.D., moved, seconded by Joanne Hunt, to approve the revised Southern Mono Health Care District Bylaws. Legal counsel stated there were no substantive changes. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

3. Quarterly Review of New & Revised Policies. Joanne Hunt moved, seconded by Yuri Parisky, M.D., to approve the Quarterly New and Revised Policies as listed. David Anderson asked for discussion, there was none. A vote was taken; the motion passed


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unanimously. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

4. Quarterly Review of New & Revised Contracts. Laurey Carlson moved, seconded by Yuri Parisky, M.D., approve the Quarterly New and Revised Contracts as listed. Chair Anderson asked for discussion, there was none. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

5. Discussion Regarding Board Education and Self-Assessment and Approval of Proposal from Via Healthcare Consulting.

Tom Parker discussed this topic. Regarding Board Education, Yuri Parisky, M.D., asked that these come as an email instead of in the Board packet. Tom Parker will be putting together a list of education topics for the Board, which will be sent out via email. Tom Parker presented the Board Self-Assessment proposal from Via Healthcare Consulting. Joanne Hunt moved, seconded by Laurey Carlson, to approve the proposal. David Anderson asked for discussion, there was none. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

6. Approval of OSHPD Attestation Letter. Tom Parker explained the purpose of this letter. All of the Board members will sign this letter and it will be sent to OSHPD.

7. McFlex Parcel: Approval of Mono County request for temporary use and access over a portion of SMHD’s McFlex parcel.

Tom Parker discussed this topic. Yuri Parisky, M.D., moved, seconded by Joanne Hunt, to approve Mono County’s request for temporary use and access as indicated on the agenda. This will be in form of a license agreement. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

8. Review and approval of professional services agreement between Southern Mono Healthcare District and Adrian Jaffer, M.D., for the provision of rheumatology professional services.

9. Review and approval of professional services agreement between Southern Mono Healthcare District and Lindsey Urband, M.D., for the provision of orthopedic professional services.

10. Review and approval of professional services agreement between Southern Mono Healthcare District and Christopher Winkle, M.D., for the provision of OB/GYN professional services.

11. Review and approval of professional services agreement between Southern Mono Healthcare District and Ramzi Asfour, M.D., for the provision of infectious disease professional services.


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Yuri Parisky, M.D., moved, seconded by Laurey Carlson, to approve the contracts as listed above. David Anderson asked for comments, there were none. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

12. Declaration of Surplus District Property, Equipment and Supplies. Chair Anderson moved, seconded by Laurey Carlson, to approve the disposal of surplus District property, equipment and supplies presented to the Board and to direct staff to dispose of it in the manner most beneficial to the District. The surplus District property, equipment and supplies presented have nominal or no value and are to be disposed of in a reasonable and appropriate manner as approved by staff. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

XV. CREDENTIALING

Initial Appointment to Provisional Staff Mary Bissell, MD – Pediatrics Sarah Ruberman, MD – Pediatrics Reappointment to Active Staff Eric Bourne, MD – Anesthesiology Dennis Crunk, MD – Family Medicine Sarah Sindell, MD - Surgery Reappointment to Courtesy Staff Marianne Cuttic, DPM – Podiatry

Yuri Parisky, M.D., moved, seconded by Laurey Carlson, to approve the appointments as listed above with the exception of Dr. Sarah Sindell, who will be reappointed in September. A discussion followed regarding Dr. Marianne Cuttic’s appointment to Courtesy Staff. A roll call vote was taken; the motion passed unanimously. David Anderson, yes; Laurey Carlson, yes; Stephen Swisher, M.D., yes; Joanne Hunt, yes; Yuri Parisky, M.D., yes.

XVI. FUTURE BUSINESS The next Regular meeting will take place on Thursday, September 19, 2019 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN

There being no further business, the meeting was adjourned at 10:14 a.m.

2018 Press Ganey Guardian of Excellence Award Winner 2017 Hospital Quality Institute Award Winner

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DATE: September 19, 2019 TO: Board of Directors FROM: Kathleen Alo, CNO RE: CNO Report, Regular Meeting of the Board of Directors

Strategic Plan Updates

Title Description Update

Implement Beta HEART Program

Beta HEART is a multi-year collaborative sponsored by Beta Healthcare to guide organizations in implementing a reliable and sustainable culture of patient safety that is grounded in a philosophy of HEART: Healing, Empathy, accountability, Resolution, and Trust. In an endeavor to reduce harm in health, 5 domains will be implemented over the course of 3-5 years.

We have successfully completed 2 of the 5 domains in the Beta HEART program: Care for the Caregiver and the Culture of Safety. Mammoth Hospital will be formally recognized for this at the Annual Beta Healthcare Symposium in September. Mammoth Hospital will be starting the Communication Domain this fall.

Journey to Become a High Reliability Organization

Mammoth Hospital will continue to progress toward high reliability, adopting the Joint Commission framework outlining the four stages of organizational maturity that define milestones for each of the 14 specific characteristics of a health care organization.

Four ISO (International Organization for Standardization) internal audits have been completed. ISO audits help to continually improved processes and increase safety and reliability in our organization. The audits already completed in 2019 are:

1) Medical Staff maintenance of records

2) Sterile Processing 3) Surgical Consent Process


Mammoth Hospital Report to the Board of Directors CNO Report July 18, 2019

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4) BioMed Preventive Maintenance/Calibration

Managers and Supervisors of these areas are now working on their plans of corrections.

Select Operational Updates People

• Congratulations to Heather Landen, Laboratory Assistant, who was recognized for taking over the Point of Care Testing Program. Her thoroughness and attention to detail has improved our processes in Point of Care Testing.

• Congratulations to Brandy Wilt, Med/Surg Supervisor/Educator, for revising the Clinical Orientation program. The program allows for online learning and hands on competency assessment in a very clear and concise format.

Quality

• The Quality Department has focused activities on Survey Readiness and Just Culture training. Lenna Monte, Director of Quality, held a lunch and learn on DNV accreditation surveys, including: How to prepare, what to expect during a survey, and what is expected after a survey.

• Just Culture training included: Three videos assigned to staff, a launch of an intranet site training and a standing agenda item at management team regarding staff reaction to Just Culture and Just Culture stories.

Service

• Cammy Staker, Peri-Operative Director, has launched a monthly newsletter for the staff. Topics include: Press Ganey results and comments, operational information on new equipment etc. and a “Super Star of the Month” staff recognition area. Cammy’s goal is to engage staff and recognize outstanding performance.

Growth

• Kathleen Alo and Cammy Staker are co-chairs of the OR 3 Build Committee, which was established in August. The Committee will address surgeon input, timelines, OSHPOD approvals, architect scheduling, engineering timeline, and equipment needs.



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DATE: September 19, 2019 TO: Board of Directors FROM: Craig Burrows, CMO RE: CMO Report, Regular and Annual Meeting of the Board of Directors

Strategic Plan Provide the medical services locally that are most needed by the community.

• Grow surgical services: Our plastic surgeon, Dr. Monson, started seeing clinic patients last month. We now have 4 anesthesiologists in the rotation to accommodate 2 anesthesiologists being on per day Monday-Friday. Planning continues for opening of the third OR in 2020. We also see the continued increase in joint replacement patients as was predicted nationally. Patients requiring joint replacement is anticipated to increase by 600% across the country. This will likely result in the need for additional anesthesiology coverage, OR staff, and Med/Surg staff.

• Improve Behavioral Health Services: As of September 2019, we will have 3 full time therapists. We also have a psychiatrist on staff for consulting on our patients in conjunction with our therapists, and we are hopeful to expand his role.

• Tele-Medicine: We are looking into a tele-medicine solutions which may pave the way for services in neurology, psychiatry, orthopedics, and even physical therapy.

• Pediatrics – As of October of this year we will have 4 full time pediatricians

• Address substance abuse management: We have a grant to help get this program going, and are looking to have MAT for opioid addiction. We are also applying for designation as an opioid safe hospital. There are a number of physicians on staff obtaining their X-waiver in anticipation of this service line. I will be participating in a training seminar along with the behavioral therapy team later this month.

Medical staff ACO Participation: As a participating member of the Caravan Health ACO, the administration has elected to move into a track that will require us to take on risk as an organization with respect to how well we care for patients and document that care. Specific areas of importance include Annual Wellness Visits, Annual Medicare Wellness Visits, and the documentation of Hierarchal Condition Categories, or HCCs, specifically addressing diabetes, heart failure,


Mammoth Hospital Report to the Board of Directors CMO Report September 19, 2019

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arrhythmias, vascular disease, kidney disease, and COPD. All providers are being educated on this, as it ultimately impacts all them to some extent. Renown Medical Center: We continue to try and enhance our relationship with Renown with respect to transfers, exchange of information for inpatients and outpatients, and to discuss further areas for improved patient access to care, such as cardiology and neurology. The opioid epidemic: Dr. Swisher and Dr. Burrows have X-waivers from the DEA, which is the first step in allowing patients to be seen and managed with Buprenorphine in the Mammoth Hospital Health System. We now have several other physicians X-waivered, including Drs. Howell, Clark, Ward, Bassler, Walker, and Hummel, as well as Cara Crosby, FM PA. We are also in the process of applying for a designation from California Health Compare as an Opioid Safe Hospital. Criteria for this includes having a MAT program as well as a standardized treatment regimen for opioids across the entire hospital system. The orthopedics department has already started work on this, and we expect to use the work done by that department to create a similar template for the entire hospital. Multidisciplinary Peer Review Committee: This formation of this committee has been slow in coming, but we anticipate the first meeting to take place by the end of the year, and then will meet at least quarterly to review cases regarding patient management by our medical staff. This will be a much more robust assessment than the current interdepartmental process. Cerner: Efforts continue to enhance our providers’ experience with the EMR. We recently completed an internal survey regarding opinion on Cerner, and now are actively working to take steps to improve functionality and satisfaction. Of note, we are now putting out short video segments to help our providers understand and learn different aspects of what the EMR can do for them. We also have hired a new informaticist. Lastly, we have done a sprint in the PACU to improve their workflow, and are in the process of the same exercise for the PT department. I am also a participant on the physician advisory committee for Cerner to provide feedback on different platforms and offer suggestions to improve the physician experience. Medical Staff – Physician Recruitment Orthopedics: Dr. Steven Knecht has been very busy in his practice as a foot and ankle specialist since beginning his practice with us in July 2019.


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Urology services: Dr. Paul Polishuk from San Diego continues with a clinic week every other month, and has plans to be here every month beginning in January 2020. Pediatrics: Dr. Mary Bissell and Dr. Sarah Ruberman will be starting in September 2019 as well. The practice model is to be staffed with 4 pediatricians, with 2 providers in clinic every day, and one provider on call. Between now and September, we are still using Locums providers to fill in the schedule. This includes Dr. Guzman, who just completed her last rotation, and Dr. Lyons. OB/GYN: From now through much of the summer, Dr. Carol Darwish will be been alternating weeks with Dr. Larry Fakinos. Dr. Fakinos has assumed a full time position as of January 7, 2019. Dr. Chris Winkle has accepted our offer to join our staff, and will begin full time in November 2019. Maureen Fakinos, NP has been seeing patients in the Women’s Health Clinic since April 2019. Psychiatry: Jacob Eide and Eryn Coffey continue to be very busy, and are working with Dr. Charles Saldanha to expand his roles here. Dr. Saldanha currently works in a consultative model where he meets with our behavioral health providers weekly, and does some tele-psyche on the more complicated patients. The anticipation is he will expand his services in this community. In the meantime, Dr. Janelle Clark will begin her practice here in September 2019. Anesthesia: Dr. Nat Parker is now full time as of June 2019. Coverage currently consists of Dr. Jon Bourne, Dr. Larry Silver, and Dr. Eric Bourne. Additional coverage in the next few months consists of Dr. Caroline Saba, who currently resides in Arizona, but is also potentially interested on providing coverage on a regular basis. With plans to build out the third OR, we anticipate the need for additional anesthesia coverage. This is to be discussed with anesthesiology group. Family Medicine: Dr. Alex Budiman left the clinic practice May 24, 2019 for Colorado mostly for personal reasons. Dr. Serra Tranmer left in July 2019. Staffing will continue with Drs. Ward, Clark, and Crunk, and Carolyn Korfiatis, NP and Cara Crosby, PA. There are not immediate plans to add another provider, but Dr. David Bridgeman, one of our hospitalists, has expressed interest in relocating to Mammoth full time in the next 1-2 years. Plastic Surgery: We are anticipating that Dr. Ben Monson will begin a plastic surgery clinic in August 2019. Dr. Monson is currently with the Air Force and is stationed in Las Vegas. He plans to do a clinic and operate once a month. Infectious Disease: Dr. Ramzi Asfour has signed on with us to be our ID consultant. He will be providing ID coverage on a consulting basis, hopefully starting in the fall of this year. PA for the Specialty clinic: We are currently interviewing for this position to help stabilize the Urology and ENT service lines, as well as potentially Plastics and Cardiology.


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Neurology: As of this meeting, we will have interviewed a neurologist who is interested in doing a clinic several days a month. PICC Line Placement We are planning to send one of our nurses in October 2019 for training on this procedure so we may offer it to our patients every day of the week. Currently Dr. Harrell of Radiology performs this service.


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DATE: September 19, 2019 TO: Board of Directors FROM: Mark Lind, Chief Information Officer RE: Section reports for the Biomed, Environmental Services, Facilities, Information

Technology, Laboratory and Medical Imaging departments, for the Regular Meeting of the Board of Directors

Executive Summary

Strategic Goals – CIO Execute the Facilities Development Plan.

• Expand clinic space for specialty practices, dentists and laboratory. o The Specialty Clinic remodel is progressing nicely. Interior framing and plumbing

are now complete, and work has started on the electrical systems. Next up is cement for the entryway, exterior stone work, and the utility space followed, by window and door installations. Planned date for completion is December 30.

o Conceptual layouts for the Dental and Laboratory expansions have been accepted by the stakeholders, and our architect will now move on to the detailed design and drawings. The goal is to take this project to public bid in the early spring for a summer start. Lab and Dental clinic remodel projects scheduled for completion in the Fall of 2020.

• Improve pedestrian safety and parking for Medical Office Building. o The project to widen and straighten our upper driveway is now nearing completion

with the final asphalt to be laid the week of September 9. o The Medical Office Building staircase project is progressing nicely, with all demo

complete. The contractor has the landing area prepared and is installing the forms for the landing and walkway concrete. Concrete scheduled to be poured the week of September 16. The new steel staircase structure to be installed no later than the week of September 30.

o The replacement of the main driveway to the Administrative and Admitting entrance will be started in the last two weeks of September. This project will involve the removal of the driveway that is currently failing with re-grading of the slope and replacement of the curbs and roadbed. A challenging aspect of this project is the re-routing of our patient driveway to the ED, along with EMS, fire and


Mammoth Hospital Report to the Board of Directors Information Technology Report September 19, 2019

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police traffic to the upper lot driveway. Signs along with flag personnel to be deployed to ensure smooth traffic flows during this project. The project is scheduled to be complete in early October.

• Improve exterior way-finding main campus. Our final upgrade to our wayfinding signs is the upgrade to the SPORTS building monument sign to add “General Surgery” to better direct patients to the correct location. This upgraded sign to be installed in October. We also ran emergency power to the main monument sign adjacent to our South driveway as it directs traffic to the Emergency Department.

o Increase employee housing inventory. Upgrades to the second floor of the South Gateway Apartment building are nearing completion with painting, fixtures and furniture upgrades complete. This floor will be used for short term hospital staffing as well as on-call staff. The final upgrade is the replacement of the old carpets with laminate flooring in the call condos, with this scheduled to be done the week of September 23. We have allocated seven apartments for our on-call needs, with the remaining apartments on the second floor being used for clinic travelers and a few providers.

o Maintain our medical imaging devices to provide high quality and high availability solutions to meet our patient care needs. There has been significant progress on the MRI replacement this past month. The old equipment has been completely removed and recycled. Currently the MRI room is being upgraded with an expansion of the foundation, new walls, electrical, cooling, and support equipment all being installed. Our vendor, Canon, is promising an end of October turn up for the new MRI modality.

▪ We also have a capital budget item in the place to replace our primary x-ray equipment, as it is now more than 13 years old and nearing end of life. The x-ray machine will be replaced in Q3 of FY ‘20.

o Convert underutilized space in A Building. Immediate change of use is not practical due to coding constraints. The long-range planning for the replacement of the inpatient wing is nearing completion for the programming and master planning process. Meetings have been held with the department managers, providers and key stakeholders for each of the areas being impacted. Presentation of the master planning documents is pending for our Medical Executive Committee (MEC). The results of the efforts will be communicated to the Board through the Facilities Steering Committee at its next meeting in October.

Fully adopt and optimize our investments in information technology.

• Improve the Hospital IT infrastructure to enhance performance, reliability, disaster preparedness, and security. This past year, we have completed a full security validation of both our wired and wireless networks. Secureworks completed their analysis of both key systems. Remediation steps were planned and completed based on the findings of these assessments. The IT team has also updated its disaster preparedness plan, security risk assessment (a CMS requirement) and continue to perform individual department assessments. Daily monitoring and management of our active firewall and perimeter defense solutions has now been fully implemented.


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o Optimize wireless coverage and reliability to allow for unhindered use of mobile devices by providers and staff as required with our new electronic workflows. Project complete.

o Enhance and expand our existing device integration with the EMR to improve clinician workflow and to provide real-time patient results and monitoring to clinical staff. Work starts this month to integrate our two new Mortara EKG modalities with Cerner. Physician waveform review and documentation will be integrated in the EMR as part of the standard workflow. The project has received final approval, is scheduled to start the week of September 30, and is expected to take roughly six weeks to implement.

o Continue to provide support to providers and staff to enable their optimized use of our Cerner and associated EMR systems. The first step in our initiative to become a Cerner reference site was completed with an EMR Satisfaction Survey being completed for all areas of the hospital. Senior management also met with Cerner management to obtain their commitment to supporting this initiative, which they provided. The survey helped us to determine which departments and functions of the hospital had the lowest satisfaction scores. We are using this data to inform our remediation plan, which involves using Agile techniques to focus our team on specific areas for short durations of time in order to drive rapid improvements for those areas. To date, we have completed the Sprint in the PACU department and are re-sending the satisfaction survey to that team to gauge how we did in terms of improving user satisfaction with the EMR. A larger-scale project is now under way for the PT/OT department with an assigned team working to document workflows and to determine where the therapists are struggling with their documentation. The Sprint team is working to implement workflow improvements, screen optimization, and document optimization in order to drive efficiencies and improve the user experience. For those improvements that involve additional system build or modification, we have the commitment of Cerner management to prioritize their response. So far, we have over 50 documented improvement items and will be meeting to prioritize which items will be addressed in the Sprint. Beyond current efforts, the improvement team will be working to identify which areas need focus once we complete the Sprint in PT/OT.

• Board Committees o IT Steering Committee. No meeting held in August. The meeting frequency is

quarterly. Next meeting scheduled for Thursday, October 22 at 12 p.m. o Facilities Steering Committee. No meeting held in August. The committee meets bi-

annually. Next meeting scheduled for Wednesday, October 16 at 12 p.m.


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Department Summaries

Biomedical Engineering Summary:

On-time compliance was 100% for the 102 Non-Life Support equipment preventative maintenance orders (PMs) in August. There were six life support PMs performed during the month with a compliance rate of 100%. We had no high-risk medical device PMs in the month.

We had 33 repair work order surveys for Biomedical Engineering in August. All responses were that the requester was “Satisfied” for a 100% result. We had one “No Opinion” response and no “Unsatisfied” survey responses.


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IT Summary:

IT opened 311 work orders in August, roughly equivalent to the July volume of 315. Work order survey responses for IT/Telecom were 100% positive in August, matching the same excellent results in July.


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Facilities Report:

Facilities Department Performance FY 2020

Performance Indicator Threshold/

Benchmark/ Target

Jul Aug Sep 1st Qtr Annual

Maintenance

PM Work Orders Scheduled - 1618 1392 3010 3010

PM Work Orders closed to Date - 1562 1362 2924 2924

PM Completion Percentage 95% 96.5% 97.8% 97.2% 97.1%

Utility Outages - 0 1 1 1

Utility Failures/ User Errors 0 0 0 0 0

Monthly Generator/ ATS Testing 100% 100% 100% 100% 100%

Fire/ Life Safety

Fire Alarm Testing Completed 100% 100% 100% 100% 100

Monthly Fire Drills Completion 100% 100% 100% 100% 100

False Fire Alarms/ Human Induced 0 0 0 0 0

Security

Security Incidents Reported 0 0 0 0 0

Environmental Services

High Touch Cleaning Scores 85% 85% 90% 87% 100%

Hazardous Spills 0 0 0 0 0

Dashboard Remarks:

8/16/19- Utility Outage (Loss of Power)

Construction Projects

Projects in Progress: Percent Complete Notes

Autoclave Replacement 50% 2nd Sterilizer being removed. New sterilizer slated to arrive on 9/5/19

MRI Replacement 20% Concrete flooring removed

Specialty Clinic 23% Framing walls

Mob Staircase replacement 25% Removing grade and stair landings

Bishop Clinic HVAC Install 100% Installation completed on 8/7/2019

Upcoming Projects:

Driveway Repair Loading Dock

Dental / Lab remodel


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Laboratory Report:

August volumes for all laboratory testing were 7,476, 6.2% over budgeted test volumes of 7,015. Volumes were down 6.17% from the July total testing volume of 7,938. In FY ‘19, total lab test volumes were 6,995 for August 2018, indicating a significantly higher testing volume this year for the second month in a row. Year to date test volumes are 15,414 tests, up 4.7% from the year to date test volumes in FY ‘19 of 14,697. Medical Imaging Report:

Medical Imaging test volumes were 1,699 for August with CT, X-ray and Mammography test volumes being significantly over budgeted volumes. August volumes were down slightly overall at 1.9% from the July number of 1732. Year to date test volume is 3,431 on a budgeted test volume of 2,897 for a 15.6% positive variance.



DATE: September 19, 2019 TO: Board of Directors FROM: Sarah Vigilante, HR Director RE: Human Resources Report, Regular Meeting of the Board of Directors

Strategic Updates


Realign and Rebalance the Management Structure: Develop ongoing leadership training

The District will invest in management in an ongoing basis in order to ensure our managers are primed to lead our teams to deliver the best patient care possible.

• Ongoing management training led by staff at each management team meeting.

• A second round of Just Culture training was conducted in the spring of 2019.

• Another round of supervisor training will be held in September and October of 2019 through the Management Center.

• A new manager orientation has also been developed to ensure managers have the tools to get started from day one.

• Enhanced new manager training conducted with all new supervisors/managers.

Develop the potential of the Mammoth Hospital Foundation

Develop philanthropic support for Mammoth Hospital and its mission.

• Individual donation toward a dental chair in the Dental Clinic expansion received.

• Recruited Gary Myers to the Foundation Board.

• Updated Board bylaws.

• Greater focus on donor gratitude: Auxiliary donor wall will begin this year.

• $5,000 donation from MMSA to Rhiannon’s Kids.

Select Operational Updates

• We will be engaging Gallagher Consulting to assist us with a review of our compensation practices. Gallagher has a large breadth of experience with healthcare facility compensation program consulting and we are looking forward to engaging them in this process. Our goal is to complete this review by the end of the calendar year.

Mammoth Hospital Report to the Board of Directors Human Resources September 19, 2019

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• We are preparing for the upcoming Annual Appeal for the Mammoth Hospital Foundation. The goal with this initiative will be to raise money for new technology while also bringing awareness to the upcoming capital campaign on the new Hospital building to be completed in the coming years.

• The HR office recently completed two new PDCAs which resulted in cleaning up dates in Kronos and Halogen as well as improving the onboarding and separating procedures for contractors/travelers working on the premises. We are very proud of these process improvements.

• Marketing is working on provider video bios to appear on our website and recently put out a very heartwarming patient story video on social media that has had a very wide publicity reach.

• Tina Villa, the new Medical Staff Coordinator, is now reporting to Sarah Vigilante, HR Director, and will soon be relocating into the HR office. The goal with this move is to ensure smooth onboarding and credentialing processes for physicians and improve communication with the HR team and others. Tina will continue to meet with Dr. Burrows for related medical staff issues.

Finance Committee Minutes Date: Monday, August 12, 2019 Time: 4:30 pm Location: CFO Office Attendees: Dave Anderson; Melanie Van Winkle; Kathleen Alo; and Slavka Crouthamel. Absent: Stephen Swisher; Tom Parker. The meeting was called to order by Dave Anderson at 4:30 pm.

Agenda Item:

Discussion/Conclusion/Action

Follow-up

Review of Minutes • July 15, 2019 minutes were reviewed by Dave Anderson. No changes were requested.

Revenue Cycle Finance Financials – June 2018 Melanie went over the balance sheet with the group.

• FY19 numbers are now final. Cash and investments at $71.7 M, up ~$2.5 M.

• AR dropped ~$.5 M.

• Payroll up a little due to timing of year end. Melanie reviewed the PowerPoint presentation with the group:

• Have finalized numbers for FY2019. Difference: up $5-6 M total operating revenue.

• $14.8 M bottom line – almost $10 M above budget.

• Dr. Knecht almost doubled his guarantee amount in the first month.

• Collections $7.2 M, possibly highest on record.

• Cash $71.7 M, 378 days cash on hand.

• Auditors are here this week. Slavka has asked them to look at high risk items first.

• Audit Report will be presented to the board in October.

• There was discussion about capital expenditures coming out of cash; ~$5 M.

• See financial PowerPoint.

Other Business • There was no other business.

• Next meeting: Monday, September 16, at 4:30 pm.

Meeting adjourned at 4:45 pm.


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BOARD OF DIRECTORS EMPLOYEE RELATIONS COMMITTEE MEETING MINUTES

Date: August 26, 2019

Place: Mammoth Hospital Administration, CEO Office 85 Sierra Park Road Mammoth Lakes, CA 93546

Attendance of Board Members: Yuri Parisky, M.D., Member at Large.

Absent: Joanne Hunt, Secretary.

Attendance of Staff Members: Tom Parker, Chief Executive Officer; Sarah Vigilante, Human Resources Director; Sarah Rea, Recording Secretary.

I. CALL TO ORDER

The meeting was called to order at 3:08 p.m.

II. NEW BUSINESS

1. Third Party Administratoro Currently utilize Delta Health Systemso Due to operational issues such as reimbursement errors and customer

service concerns we will be switching our TPA.o This will have limited impact on staff however new insurance cards will

be distributed and there will be a new number for customer serviceinquiries.

Sarah Vigilante, HR Director discussed what Mammoth Hospital currently uses Delta for: Employee Assistance program, life insurance, vision and dental. Physician insurance was briefly discussed, as well as the nature of independent contractor status of physicians in hospitals.

2. Compensation Surveyo California Hospital Association (CHA) – Southern California Compensation

Survey for non-management, management, and executiveso Recently completed a comprehensive review of all hospital positions and

compared them to the 239 positions surveyed in the April 2018 survey.

MINUTES NOT YET REVIEWED BY COMMITTEE



Southern Mono Health Care District Employee Relations Committee Meeting Minutes August 26, 2019

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This survey had 198 facilities participate. These facilities vary in size and are broken down by number of beds, FTEs, budget, etc.

o When a position is not shown in the CHA data, we review online comparables, call other facilities, and also survey locally. An example of this is the dental hygienist.

o Recent review of this data resulted in increasing the salary ranges for over 148 staff level positions (this includes all RNs going up by 7%), 7 supervisors, and 16 management roles.

o Effective July 1, 2019, anyone who is currently below the bottom of the range will be moved up to the new bottom. This will impact about 57 employees. Anyone who is within $1 of the bottom of the new range after the adjustment will receive a one-time 3% increase in pay to account for peer salary compression. This impacts about 34 employees. Anyone who is currently topped out, will be eligible for a merit increase instead of a lump sum starting in July.

o This year we anticipated the California minimum wage increase (set to increase to $15/hour by 2022) and so raised all of the lower income positions to starting at $15/hour minimum.

o Important to also consider “other compensation”. This includes: ▪ Night differential (25% of current pay rate or up to $4/hour and

$11/hour for RNs) – CHA compared at 8.5% for night ▪ Evening differential ($2.25/hour for hours after 3pm) – CHA

compared at 5.4% for evening ▪ On-call ($7.25/hour for clinical and $6.25 for non-clinical) – CHA

compared at $6/hour o Average salary increase in CHA data was 2.2% over the past 5 years - MH

is 4.2%



3



4

*CHA Northern data has an RN at $50-$70/hour. Sarah Vigilante discussed the compensation survey. New pay range adjustments for Mammoth Hospital employees occurred on July 1, 2019.

3. Compensation Consultant o Will review best practices in the areas of:

▪ Salary administration (range analysis, hiring practices, pay equity) ▪ Labor Market Benchmarking ▪ Salary Structure ▪ Cost of living adjustments ▪ Pay equity and exemption status ▪ Performance Management impact on individual pay ▪ Market competitiveness of total compensation package ▪ Searching for firm with healthcare experience

o Goals are: ▪ Facilitate the payment of competitive salaries that will support the

attraction of the best employees ▪ Enhance employee morale by assuring internal equity in

compensation levels ▪ Prevent the potentially high costs of undesirable turnover by

augmenting the ability to retain our best performers ▪ Avoid costly, time-consuming litigation by assuring that base pay

policies and practices are in compliance with all applicable wage and hour and non-discrimination laws, including the California Fair Pay Act

▪ Timeline: by the end of the year or sooner



5

Sarah Vigilante discussed the hiring of a Compensation Consultant. A discussion ensued regarding the CHA data—Mammoth Hospital typically uses a southern data compilation. A consultant may be able to provide us with a more refined snapshot of data. Sarah Vigilante stated that a consultant will aid in Mammoth Hospital’s effort to be more equitable and transparent. A discussion was held regarding hard-to-fill roles in the Hospital. A discussion was held regarding employee retention and satisfaction. Sarah Vigilante presented a list of new managers who have been hired or promoted in the past year. A discussion was held regarding staffing. A discussion was held as a follow-up to why potential employees have turned down jobs. Mostly, the reasons were personal, though one respondent cited pay and housing as an issue.

III. FUTURE BUSINESS The next Employee Relations Committee Meeting will be scheduled for 2020 once Board officers are determined for the coming year.

ADJOURN

There being no further business, the meeting was adjourned at 3:58 p.m.




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BOARD OF DIRECTORS QUALITY ASSURANCE COMMITTEE MEETING MINUTES

Date: September 13, 2019 Place: Mammoth Hospital Administration, Conference Rooms A&B 85 Sierra Park Road Mammoth Lakes, CA 93546 Attendance of Board Members: Stephen Swisher, M.D., Treasurer; Joanne Hunt, Secretary. Attendance of Staff Members: Tom Parker, Chief Executive Officer; Kathleen Alo, Chief

Nursing Officer; Lenna Monte, Director of Quality; Stephanie Stanton, Quality Improvement Coordinator; Jaymee Davis, Quality Improvement Specialist; Sarah Rea, Recording Secretary.

I. CALL TO ORDER

Lenna Monte called the meeting to order at 9:01 a.m.

II. NEW BUSINESS

1. Review/Approval of Minutes Joanne Hunt motioned, seconded by Stephen Swisher, M.D. to approve the minutes from the June 18, 2019 meeting. The minutes were approved.

2. Beta HEART Program

Stephanie Stanton discussed the Beta HEART Program and the two domains Mammoth Hospital is currently working on—Culture of Safety and Care for the Caregiver. The next domain we will tackle will be Communication. Stephanie Stanton discussed Event Management Teams. A discussion was held regarding Care for the Caregiver and Code Lavender.

3. PDCA Projects

Jaymee Davis discussed a laterality PDCA for X-Ray. A discussion was held about other PDCA projects.




Southern Mono Health Care District Quality Assurance Committee Meeting Minutes September 13, 2019

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4. PFCC Annual Report The PFCC Annual Report was presented and discussed. The merging of several committees was discussed.

5. Patient Satisfaction Data Review Quarter 3 HCAHPS data was discussed.

6. Survey Readiness - ISO Internal Audits

Lenna Monte discussed preparation for the DNV survey and the ISO Internal Audit training, which eight Mammoth Hospital employees participated in. Four internal audits have already been completed and two more are scheduled for the near future.

7. Review PI Committee Meeting Minutes 7.8.2019, 8.12.2019

The PI Committee Meeting Minutes were included in the packet and were reviewed by the committee members prior to the meeting.

III. FUTURE BUSINESS

The next Quality Assurance Committee Meeting is scheduled for December 17, 2019 at 1:30 p.m.

ADJOURN

There being no further business, the meeting was adjourned at 9:52 a.m.



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DATE: September 19, 2019 TO: Board of Directors FROM: Tom Parker, CEO RE: CEO Report, Regular Meeting of the Board of Directors

Strategic Plan Updates


Realign and Rebalance the Management Structure

Change organizational reporting structure to reflect growth in the organization.

Completed.

Remain united in Vision, Mission, Values, and Philosophy

Continuously communicate with all staff to ensure connectedness to our mission.

Tom Parker has begun holding Town Hall meetings for all staff and providing all employees and medical staff with an update email of his Board report following Board meetings.

Note: Each strategy in the Strategic Plan has a Senior Manager assigned as lead. Updates on strategies are now part of each Board Report submitted by Senior Managers. CEO 90 Days In: Update As reported previously, I have identified a number of priorities for my work.

Project: Update:

Build out and move to specialty clinic

Demolition of the old admin building is complete and construction has begun with an expected completion by year end.

Redesign of clinic management structure

Complete. Tom Parker and Craig Burrows, MD, have met with providers in Family Medicine, Women’s and Pediatrics clinics to check on the effectiveness of the change. Generally, the redesign has gone well. The focus is now on establishing effective working relationships where managers are new to a clinic.

Re-launch of new hospital wing project

Planning costs have been included in the proposed 2020 budget. Department meetings have been held to solicit input on operational changes and needs to be considered in the plan. The


Mammoth Hospital Report to the Board of Directors CEO Report September 19, 2019

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steering committee will meet September 30 and October 1 with the architect to review masterplan options along with goals for service delivery, internal circulation, vehicle wayfinding and parking, and utility yard location. The committee will also work on the plan for medical staff input and feedback through the planning process.

Resolve dispute with Northern Inyo Healthcare

Despite the ongoing difference in opinion with respect to the definition of new services, Dr. Kevin Flanigan and I have resumed meeting to explore ways we can collaborate. Topics discussed include shared resources during disaster response, joint promotion of mammography services, and Medication Assisted Therapy for opioid dependence.

Establishment of a formalized physician retention program

Current focus has been on critical need to fill recruitments in OB/GYN and Pediatrics as well as those that expand capacity and scope of services. Progress has been made in the following other disciplines: Orthopedics, Urology, Psychiatry, Anesthesia, Family Medicine, Plastic Surgery, and Infectious Disease. For more details, please see the CMO report.

Continued implementation of “High Reliability Organization” vision

ISO Audit training has completed for new staff auditors. Four ISO (International Organization for Standardization) internal audits have been scheduled. ISO audits help to continually improved processes and increase safety and reliability in our organization. The audits for 2019 are: 1) Medical Staff maintenance of records 2) Sterile Processing 3) Surgical Consent Process 4) BioMed Preventive Maintenance/Calibration A Beta HEART steering committee has been created to review the Domains of the program and decide on which Domains to work on. Goals have been met and related discounts on insurance premiums have been achieved for the Culture of Safety Domain. We are currently working on the Care for the Caregiver Domain and expect validation by BETA this year. We will also add to this year’s work the Communication and Transparency Domain.

Begin regular educational segments at board meetings and special education sessions for the board and senior

Education session was held on June 7 facilitated by Via Healthcare. The education focused on Board and management roles and responsibilities. The education for this month’s meeting will be a presentation of accomplishments in the 2018-2019 fiscal year.


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management team on a periodic basis

Proposed topics for future education sessions are as follows:

• Healthcare Issues and Trends

• ACOs and Population Health Management

• Quality, Safety, and Performance Improvement

• Healthcare Finances and Resource Allocation

• Governance (annual)

• Credentialing

• Human Resources

• Provider Burnout

• Advance Practice Clinicians changing the practice of medicine

• Telemedicine

• Legislative Updates

• Public Health Issues

• Behavioral Health

Become a Cerner showcase site

The initial EHR User Survey has been completed, with 178 responses representing 40% of the total Cerner users. The overall average score on the 5-point scale is 3.3. Departments with the lowest score were Chemo, ED, Lab, OR, PACU, and PT. Department-focused “sprints” are now being conducted to resolve system problems and provide individualized training as needed. Following each sprint, departments will be surveyed again to assess the impact on satisfaction with EHR use. PACU has completed its sprint and is now taking its survey. Another sprint is underway in PT.

Become a fellowship site for orthopedic surgery

Working on becoming a sponsoring institution through the ACGME and then applying as a new program.

Collaborate with other community organizations in meeting child day care needs

I will represent the Hospital on a new group convened by Mono County that will work on the development of a child care facility. In addition to the Hospital and County, organizations represented include Mammoth Mountain, Town of Mammoth Lakes, and Mammoth United School District. The next planning meeting is scheduled for September 30.

Launch a grant-funded Medication Assisted Therapy program for opioid dependence

An initial grant was received from The Center at Sierra Health Foundation for $125,000. Another grant has been recently approved by the California Bridge Program for $125,000. Plans are to start seeing patients in January of 2020.


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Select Operational Updates

• August Increase in Net Assets (Net Income) was $742k, favorable to budget by $155k. This furthered the favorable budget variance year-to-date to $238k. Net income year-to-date is now $1.4m.

• The fiscal year 2019 pre-audit financial results have been finalized. The year ended with $14.8 million Net Gain or 18.2% total margin.

• The HCAHPS report for the Second Quarter of 2019 shows that 91% of respondents would recommend Mammoth Hospital, putting the hospital in the 97th percentile rank when compared to all hospitals in the Press Ganey database.

• We will be engaging Gallagher Consulting to assist us with a review of our compensation practices. Gallagher has a large breadth of experience with healthcare facility compensation program consulting and we are looking forward to engaging them in this process. Our goal is to complete this review by the end of the calendar year.

• Kathleen Alo and Cammy Staker are co-chairs of the OR 3 Build Committee, which was established in August. The Committee will address surgeon input, timelines, OSHPD approvals, architect scheduling, engineering timeline, and equipment needs.

• Upgrades to the second floor of the South Gateway Apartment building are nearing completion. This floor will be used for short term hospital staffing as well as on-call staff.

• Work order survey responses for IT/Telecom were 100% positive in August and July. Respectfully submitted, Tom Parker, CEO



MEMORANDUM ============================================================================== DATE: September 19, 2019 TO: The Board of Directors FROM: Melanie Van Winkle, CFO & Slavka Crouthamel, Controller SUBJECT: Financial Statements for two months ended August 2019 ============================================================================== This memorandum presents an overview of Mammoth Hospital financial operations.

BALANCE SHEET

The August month end Cash balance was $70.3 million – $1.4 million lower than July due to lower collections than prior month ($6.2 million).

Net Patient Accounts Receivable was $10.7 million which is $266 thousand lower than prior month

Debt service fund decreased by $1.4 million due to Mono County General Obligation Bond payment

Accounts Payable and Accrued payroll increased over $1.5 million due to the timing of payments to the month end

Patient refunds decreased by $362 thousand due to timing of receipt of Blue Cross checks at the end of July that was posted in August

General Obligation Bonds decreased by $1.1 million due to principal payment as mentioned above

FINANCIAL INDICATORS

Cash Collections in August were $6.2 million; $200 thousand below goal of $6.4 million. Gross AR days decreased to 62.4 from 64.9 in July (65 goal) AR over 120 days decreased to 21.0% at August month end compared to 25.3% in July - target is

to be under 25% Gross revenue was $11.4 million in August which is $700 thousand dollars higher than budget

and $2.1 million higher than prior year.

Southern Mono Healthcare District Report to the Board of Directors Financial Report September 19th, 2019 VOLUMES

Month of August summary:

Inpatient days were 148 – higher than budgeted by 11 days, but lower than last year’s inpatient days at 165. Case Mix index was 1.465 – which is higher than July due to a higher proportion of inpatient than labor and delivery days.

Total surgeries were 134 in August. Inpatient surgeries were 37 (budget 42) and Outpatient surgeries were 97 (budget 74):

o Endoscopies & Colonoscopies were 46 (same as prior month)– 21 cases over budget Emergency Department visits in August were 1,041 – over budget by 124 visits and higher than

last August by 200 visits Clinic visits were 4,032, lower than budget by 86 visits.

INCOME STATEMENT

Month of August

Revenue: Total Gross Revenue of $11.4 million was $700 thousand higher than budget due to higher outpatient volumes in emergency room, outpatient surgeries and ancillary services

Total Operating Revenue was $6.2 million which is $255 thousand lower than budget Contractuals and allowances against Gross Revenue:

o The actual collectable revenue was 54.1% of Gross Charges which is lower than budget, due to the higher mix of outpatient volume compared to inpatient

August 2019 Expenses:

OPERATING EXPENSES Current Budget Variance %

Variance Brief Comments

Salaries $1,988 $2,224 $236 11% Favorable variance is due to early in fiscal year - this will even out over the year.

Benefits 754 879 125 14% Lower than budget due to favorable IBNR actuarial adjustment

Professional services 1,406 1,399 (8) -1% Corresponding to professional fee and clinic reveue at budget

Contract services 36 68 32 48% Lower than budget due to lower contracted professionals working

Supplies 585 619 34 5% Lower than budget due to lower pharmaceutical costs

Services 737 721 (16) -2% Higher than budget due to several operational manteinance costs

Total Expenses $5,507 $5,910 $403

Southern Mono Healthcare District Report to the Board of Directors Financial Report September 19th, 2019 Net Gain

August’s net gain was $742 thousand compared to a budgeted gain of $587 thousand

Year to Date

Total Gross Revenue of $23.4 million is higher than budget by $1.6 million and $2.2 million higher than last year at this time (major increase in outpatient revenue)

Total Operating Revenue (collectable revenue) was $12.6 million which is $542 thousand lower than budget and $649 thousand higher than last year due to slightly unfavorable payer mix

Total Operating Expenses of $11.3 million are $776 thousand lower than budget, and $46 thousand lower than prior year

o Salaries and Benefit expense represents the largest YTD favorable variance of $553 thousand due to several positions unfilled vs budget and summer vacations

o Professional Services (physician payments) is $116 thousand over budget – due to higher volumes

Year to date Net Gain of $1.4 million or 11.2% Total Margin which is $239 thousand higher than budget and $793 thousand higher than last year.

9/10/2019

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - August 31, 2019

Unaudited Unaudited Audited

August 31, July 31, Prior Month June 30,

ASSETS 2019 2019 Change 2019

CURRENT ASSETS:

Cash (135 days operating expenses) $25,219,786 $25,154,719 $65,067 $19,609,830

Cash (reserved for building projects) 35,089,123 36,606,899 (1,517,777) 39,687,872

Investments 9,971,302 9,962,279 9,023 9,956,578

Total Cash 70,280,211 71,723,897 (1,443,686) 69,254,280

Patient accounts receivable 21,489,177 22,201,429 (712,252) 22,033,263

Less: Allow. for bad debts and contractuals (10,842,953) (11,289,131) 446,178 (10,553,766)

Net patient accounts receivable 10,646,223 10,912,298 (266,074) 11,479,496

Inventory 1,866,597 1,855,371 11,226 1,857,904

Prepaid expenses & deposits 797,075 817,032 (19,957) 739,481

Other current assets 1,065,448 614,014 451,434 448,300

Total Current assets 84,655,555 85,922,611 (1,267,056) 83,779,462

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 9,486,272 9,486,272 0 9,486,272

Debt service fund 292,641 1,659,212 (1,366,572) 1,659,212

Restricted by contributors 229,919 270,456 (40,537) 152,560

Total Assets Limited As To Use 10,008,832 11,415,941 (1,407,109) 11,298,045

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 7,768,033 7,768,033 0 7,768,033

Buildings and improvements 54,277,030 54,277,030 0 54,203,335

Equipment 32,476,659 32,449,504 27,155 32,418,660

Construction-in-progress 519,432 410,430 109,002 357,886

Total Property, Plant and Equipment 95,041,155 94,904,998 136,157 94,747,915

Less: Accumulated depreciation (54,137,243) (53,780,563) (356,680) (53,412,736)

Less: Accumulated amortization (2,077,080) (2,077,080) 0 (2,077,080)

Net Property, Plant and Equipment 38,826,832 39,047,355 (220,523) 39,258,099

Total Assets $133,491,219 $136,385,907 ($2,894,689) $134,335,606

Page 1

9/10/2019

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - August 31, 2019

Unaudited Unaudited Audited

August 31, July 31, Prior Month June 30,

LIABILITIES 2019 2019 Change 2019

CURRENT LIABILITIES:

Accounts payable and accrued expenses $2,450,652 $3,156,744 ($706,093) $2,854,315

Accrued payroll-related liabilities 3,032,404 3,881,139 (848,735) 3,575,948

Patient refunds 173,135 535,152 (362,018) 199,734

Due to third party payers 129,757 461,282 (331,525) 250,000

Accrued interest on long term obligations 34,502 235,140 (200,638) 199,206

Current portion of long-term debt 1,130,000 1,130,000 0 1,015,000

Health plan IBNR 738,000 828,000 (90,000) 828,000

Total Current liabilities 7,688,450 10,227,458 (2,539,008) 8,922,203

LONG-TERM DEBT:

Unamortized bond premium 1,044,719 1,055,388 (10,668) 1,066,056

Capital appreciation interest payable 9,572,581 9,488,849 83,732 9,405,117

General Obligation Bonds 12,509,555 13,639,555 (1,130,000) 13,754,555

Total long term debt 23,126,855 24,183,791 (1,056,936) 24,225,727

Total Liabilities 30,815,305 34,411,249 (3,595,944) 33,147,930

NET ASSETS:

Invested in capital assets net of related liabilities 14,569,976 13,733,564 836,413 14,017,372

Restricted - expendable for specific operating activities 229,207 269,877 (40,670) 151,981

Restricted - expendable for debt service 9,778,913 11,145,485 (1,366,572) 11,145,485

Unrestricted 76,686,806 76,156,647 530,159 60,995,187

Year to date earnings 1,411,011 669,087 741,924 14,877,652

NET POSITION: 102,675,913 101,974,659 701,255 101,187,676

Total Liabilities and Net Position $133,491,220 $136,385,908 ($2,894,689) $134,335,606

Page 2


Statement of Revenues & Expenses - August 31, 2019

Prior Month Actual Budget

Variance to Budget Prior Year

Variance to Prior Year OPERATING REVENUE Actual Budget

Variance to Budget Prior Year

Variance to Prior Year

(000s omitted)/1000

$2,521 $2,849 $2,951 ($102) $2,245 $604 Inpatient services $5,370 $6,016 ($646) $6,539 ($1,168)

6,432 5,904 5,091 813 4,485 1,418 Outpatient services 12,336 10,396 1,940 9,487 2,849

2,198 1,849 1,899 (50) 1,703 146 Professional fees services 4,047 3,869 179 3,611 436

872 811 773 38 905 (95) Clinic services 1,683 1,542 141 1,568 114

12,023 11,413 10,714 699 9,338 2,075 Total Gross Revenue 23,436 21,823 1,613 21,205 2,231

(4,778) (5,015) (4,010) (1,006) (3,683) (1,332) Contractual & other discounts (9,794) (8,170) (1,623) (8,444) (1,350)

(388) (445) (165) (281) (78) (367) Charity write offs (834) (335) (498) (131) (702)

(486) 222 (173) 395 (62) 283 Provision for bad debts (265) (353) 88 (791) 526

- - - - - - Supplements/Settlements - - - 1 (1)

6,370 6,174 6,366 (193) 5,515 659 Net Patient Revenue 12,544 12,964 (420) 11,840 704

36 30 94 (64) 414 (384) Other operating revenue 66 188 (123) 120 (55)

6,406 6,204 6,461 (257) 5,929 275 Total Operating Revenue 12,610 13,152 (542) 11,961 649

OPERATING EXPENSES

$2,006 $1,988 $2,224 236 $1,829 (159) Salaries $3,994 $4,547 553 $3,694 (300)

812 754 879 125 859 105 Benefits 1,566 1,779 213 1,643 77

1,541 1,406 1,399 (8) 1,300 (106) Professional services 2,948 2,832 (116) 2,706 (242)

31 36 68 32 103 67 Contract services 67 147 80 261 194

687 585 619 34 650 65 Supplies 1,272 1,259 (13) 1,538 266

690 737 721 (16) 592 (146) Services 1,428 1,476 49 1,477 50

5,767 5,507 5,910 403 5,332 (175) Total Expenses 11,274 12,040 766 11,319 46

639 697 551 146 597 100 OPERATING GAIN (LOSS)/1000 1,336 1,112 224 641 695

$359 $348 $362 14 $278 (70) Depreciation & amortization $708 $735 28 $673 (35)

$279 $349 $189 $160 $320 $29 Operating Gain (Loss) after Depreciation $628 $377 $251 ($32) $660

NON-OPERATING INCOME(EXPENSE)/1000

$0 $0 $0 - $0 - Gain (loss) on sale of property $0 $0 - - -

- - 5 (5) - - Donation income - 9 (9) - -

215 215 223 (8) 187 28 Bond property tax revenue 431 446 (15) 408 23

(117) (117) (117) (0) (114) (4) Bond interest expense (235) (235) (0) (231) (4)

269 269 272 (3) 194 75 Property tax revenue & interest income 539 544 (5) 432 107

22 26 16 10 11 14 Interest expense 48 32 16 42 6

390 393 398 (5) 279 114 Total Non-Operating Income (expense) 783 796 (14) 650 132

$669 $742 $587 $155 $598 $144 Increase in net assets - net gain (deficit) $1,411 $1,173 $238 $619 $793

10.4% 12.0% 9.1% 2.9% 10.1% 1.9% Total Margin 11.2% 8.9% 2.3% 5.2% 6.0%

August-19 Year-to-Date

Page 3


Statement of Cashflows - August 31,2019

July 31, 2019August 31,

2019Current YTD

Operating ActivitiesReceipts from and on behalf of patients 7,504,406$ 5,046,888$ 12,551,294$ Payments to suppliers and contractors (3,000,363) (3,209,921) (6,210,284) Payments to and on behalf of employees (2,512,967) (3,680,751) (6,193,718) Other receipts 35,754 30,121 65,875

Net Cash from Operating Activities 2,026,830 (1,813,663) 213,167

Noncapital Financing ActivitiesProperty taxes received 405,222

Net Cash from Noncapital Financing Activities 202,611 202,611 405,222

Capital and Related Financing ActivitiesPurchase of capital assets 102,873 190,367 293,240 Principal payments on long-term debtCapital contributions 117,896 (158,433) (40,537) Interest paid 2,231 2,231 4,462

Net Cash used for Capital and Related Financing Activities (36,959) 34,164 257,164

Net Cash from Investing ActivitiesPurchases of investmentsMaturity of Investments - Investment income 111,115 101,898 213,013

Net Cash (used for) from Investing Activities 111,115 101,898 213,013

Net Change in Cash and Cash Equivalents 2,581,814 (1,474,990) 1,088,566

Cash and Cash Equivalents, Beginning of Period $70,595,746 73,177,560$ $68,936,534

Cash and Cash Equivalents, End of Period 73,177,560$ 71,702,570$ 70,025,100$

Reconciliation of Cash and Cash Equivalents to the Balance Sheets

Cash and cash equivalents (including restricted cash) in current assets $63,420,831 $60,309,041 $60,309,041Cash and cash equivalents (including restricted cash) in noncurrent cash 9,756,728 9,716,059 9,716,059

Total cash and cash equivalents $73,177,559 $70,025,100 $70,025,100

Reconciliation of Operating Income (Loss) to Net Cash from Operating Activities

Operating income (loss) 271,039 340,857 611,896Adjustments to reconcile operating income (loss) to net cash from operating activities

Depreciation and amortization 367,827 356,680 724,507 Changes in assets and liabilities

Receivables 922,675 (795,575) 127,100 Inventories 2,533 (11,226) (8,693) Prepaid expenses and other (691,565) 633,971 (57,594) Accounts payable and third-party settlements 849,129 (1,399,636) (550,507) Accrued liabilities 305,191 (848,735) (543,544) Estimated liability for health care costs - (90,000) (90,000)

Net Cash from Operating Activities 2,026,829$ (1,813,663)$ 213,166$

Page 4


Key Statistical Data - August 2019

Prior

Month Actual Budget

Variance

to Budget Prior Year

Variance

to Prior

Year Hospital Statistics Actual Budget

Variance

to Budget Prior Year

Variance to

Prior Year

31 31 31 31 Days in month 62 62 62

Acute Patient Days:

12 15 4 11 3 12 ICU Days 27 14 13 16 11

102 129 117 12 137 (8) Med/Surg & Telemetry Days 231 242 (11) 282 (51)

16 4 16 (12) 25 (21) Labor & Delivery Days 20 38 (18) 49 (29)

130 148 137 11 165 (17) Total Acute Patient Days 278 294 (16) 347 (69)

4.2 4.8 4.4 0.4 5.3 (0.5) Average Daily Census (ADC) 4.5 4.7 (0.3) 5.6 (1.1)

25.7% 29.2% 33.7% -4.5% 37.0% -7.8% % of IP Revenue to Ttl Revenue 27.4% 33.5% -6.1% 37.3% -9.9%

2.0 2.4 2.0 0.4 2.5 (0.1) Average Length of Stay (ALOS) 2.2 2.1 0.1 2.5 (0.3)

66 61 68 (7) 66 (5) Discharges 127 142 (15) 141 (14)

1.327 1.465 NA NA 1.488 (0.023) Case Mix Index 1.401 NA NA 1.412 (0.01)

Other Key Hospital Statistics:

1,113 1,041 917 124 841 200 ED Visits 2,154 2,058 96 1,905 249

688 660 460 200 358 302 Observation Hours 1,348 1,049 299 785 563

9 4 10 (6) 10 (6) Deliveries 13 24 (11) 24 (11)

30 37 42 (5) 51 (14) IP Surgeries 67 82 (15) 97 (30)

106 97 74 23 74 23 OP Surgeries 203 144 59 144 59

136 134 116 18 125 9 Total Surgeries 270 226 44 241 29

79 89 88 1 87 2 MRI Procedures 168 166 2 174 (6)

208 206 168 38 170 36 CT Scans 414 354 60 369 45

71 85 62 23 52 33 Mammography Procedures 156 120 36 103 53

157 128 122 6 119 9 Ultrasound 285 252 33 251 34

1,217 1,192 1,008 184 1,063 129 Radiology 2,409 2,005 404 2,063 346

1,732 1,700 1,448 252 1,491 209 Total Imaging 3,432 2,897 535 2,960 472

7,985 7,498 7,015 483 7,020 478 Lab Tests 15,483 14,331 1,152 14,751 732

7,359 7,422 7,147 275 7,147 276 Pharmacy Units 14,781 15,429 (648) 15,428 (647)

2,132 2,216 2,170 46 2,110 106 PT/OT Visits 4,348 4,192 156 4,121 227

Clinic Visits

1,601 1,544 1,619 (75) 1,719 (175) Family Medicine clinic 3,145 3,247 (102) 3,447 (302)

183 205 200 5 121 84 Behavioral Health clinic 388 400 (12) 208 180

309 315 300 15 398 (83) Women's clinic 624 600 24 723 (99)

393 416 383 33 400 16 Pediatric clinic 809 766 43 739 70

574 619 624 (5) 615 4 Ortho Mammoth clinic 1,193 1,110 83 1,039 154

333 294 369 (75) 249 45 Ortho Bishop clinic 627 700 (73) 462 165

204 117 90 27 184 (67) Specialty clinic 321 260 61 378 (57)

141 89 75 14 75 14 Surgical clinic 230 150 80 149 81

494 433 458 (25) 479 (46) Dental clinic 927 891 36 948 (21)

4,232 4,032 4,118 (86) 4,240 (208) Total Clinic visits 8,264 8,124 140 8,093 171

August-19 Year-to-Date

Page 5

Mammoth Hospital Mammoth Hospjtal

All Statistical Analysis Statistical Analysis

Budget

Dept # Dept Name Unit of Service Desc

Jul

2019

Aug

2019

Sep

2019

Oct

2019

Nov

2019

Dec

2019

Jan

2020

Feb

2020

Mar

2020

Apr

2020

May

2020

Jun

2020

Budget

Aug 2020

Actual

Aug 2019

YTD

Total

YTD

Budget

% of change

to Budget

Level of

concern

6010 ICU Patient Days 12 15 4 3 27 14 93% 193%

6170 Med/Surg Patient Days 77 79 71 82 156 160 -3% 98%

6170 Telemetry Patient Days 25 50 46 55 75 82 -9% 91%

7400 L & D Patient Days 16 4 16 25 20 38 -47% 53%

Total Acute Patient Days 130 148 137 165 278 294 -5% 95%

6380 Observation Patient Days 29 28 19 15 56 44 29% 129%

6380 Observation Hours 688 660 460 358 1,348 1,049 29% 129%

6530 Nursery Patient Days 16 4 20 21 20 41 -51% 49%

7400 L & D Pre-delivery hours 89 62 80 90 151 192 -21% 79%

7400 L & D Deliveries 9 4 10 10 13 24 -46% 54%

7080 Family Medicine Clinic Patient Visits 1,601 1,544 1,619 1,719 3,145 3,247 -3% 97%

7080 Behavioral Health Clinic Patient Visits 183 205 200 109 388 400 -3% 97%

7050 Women's Clinic Patient Visits 309 315 300 398 624 600 4% 104%

7090 Pediatric Clinic Patient Visits 393 416 383 400 809 766 6% 106%

7160 Ortho Mammoth Clinic Patient Visits 574 619 624 615 1,193 1,110 7% 107%

7140 Ortho Bishop Clinic Patient Visits 333 294 369 249 627 700 -10% 90%

7180 Specialty Clinic Patient Visits 204 117 90 184 321 260 23% 123%

7110 Surgical Clinic Patient Visits 141 89 75 75 230 150 53% 153%

7060 Dental Clinic Patient Visits 494 433 458 479 927 891 4% 104%

Total Clinics 4,232 4,032 4,118 4,228 8,264 8,124 2% 102%

7010 ED Patient Visits 1,113 1,041 917 841 2,154 2,058 5% 105%

7040 Ambulance Work days 22 22 22 23 44 44 0% 100%

7420 Surgery Minutes 18,285 17,235 13,488 15,105 35,520 26,825 32% 132%

7420 IP surgeries Procedures 30 37 42 51 67 82 -18% 82%

7420 OP surgeries Procedures 106 97 74 74 203 144 41% 141%

7420 Colo/Endo Procedures Procedures 46 46 25 26 92 50 84% 184%

7427 PACU Minutes 17,745 16,200 15,687 15,300 33,945 30,483 11% 111%

7500 Lab Tests 7,985 7,498 7,015 7,020 15,483 14,331 8% 108%

7590 EKG's IP Procedures 29 28 29 37 57 53 8% 108%

7590 EKG's OP Procedures 172 189 126 127 361 293 23% 123%

7641 Chemotherapy Patient Visits 37 56 23 16 93 41 127% 227%

7710 Pharmacy Units 7,359 7,422 7,147 7,147 14,781 15,429 -4% 96%

7720 Respiratory Unique Patients 718 630 383 402 1,348 794 70% 170%

7630 Radiology Patient Visits 1,217 1,192 1,008 1,063 2,409 2,005 20% 120%

7635 Mammography Patient Visits 71 85 62 52 156 120 30% 130%

7660 MRI Patient Visits 79 89 88 87 168 166 1% 101%

7670 Ultrasound Patient Visits 157 128 122 119 285 252 13% 113%

7680 CT Scan Patient Visits 208 206 168 170 414 354 17% 117%

Total Imaging Procedures 1,732 1,700 1,448 1,491 3,432 2,897 18% 118%

7770 Mammoth PT Visits 1,143 1,198 1,172 1,172 2,341 2,230 5% 105%

7772 Bishop PT Visits 727 793 732 675 1,520 1,450 5% 105%

7773 Bishop OT Visits 107 76 116 116 183 234 -22% 78%

7790 Mammoth OT Visits 155 149 150 147 304 278 9% 109%

Total Visits PT/ST/OT 2,132 2,216 2,170 2,110 4,348 4,192 4% 104%

Southern Mono Healthcare DistrictLAIF Investment

9/12/2019

Balance as of July 31 2018 43,250,569

Deposit 8/10/2018 1,000,000Withdraw 8/17/2018 (800,000)Deposit 8/24/2018 650,000Withdraw 8/31/2018 (250,000)

Balance as of August 31 2018 43,850,569

Deposit 9/7/2018 900,000Withdraw 9/21/2018 (150,000)Withdraw 9/28/2018 (200,000)

Balance as of September 30 2018 44,400,569

Withdraw 10/12/2018 (600,000)Interest 10/15/2018 236,905Withdraw 10/19/2018 (100,000)Withdraw 10/26/2018 (100,000)

Balance as of October 31 2018 43,837,474

Deposit 11/2/2018 400,000Deposit 11/9/2018 150,000Withdraw 11/16/2018 (200,000)Withdraw 11/23/2018 (1,000,000)Deposit 11/30/2018 250,000

Balance as of November 30 2018 43,437,474

Deposit 12/7/2018 850,000Deposit 12/14/2018 1,350,000Withdraw 12/21/2018 (700,000)

Balance as of December 31 2018 44,937,474

Deposit 1/4/2019 500,000Deposit 1/11/2019 900,000Interest 1/15/2019 267,760Withdraw 1/17/2019 (600,000)Deposit 1/25/2019 900,000

Balance as of January 31 2019 46,905,235

Withdraw 2/1/2019 (150,000)Deposit 2/8/2019 550,000Deposit 2/15/2019 100,000

Balance as of February 28 2019 47,405,235

Withdraw 3/1/2019 (150,000)Withdraw 3/22/2019 (700,000)Withdraw 3/29/2019 (200,000)

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

Southern Mono Healthcare DistrictLAIF Investment

9/12/2019

Balance as of March 31 2019 46,355,235

Deposit 4/5/2019 400,000Deposit 4/12/2019 300,000Interest 4/15/2019 293,509Withdraw 4/26/2019 (600,000)

Balance as of April 30 2019 46,748,744

Deposit 5/3/2019 2,100,000Deposit 5/10/2019 2,900,000Deposit 5/17/2019 900,000Deposit 5/24/2019 350,000Deposit 5/31/2019 650,000

Balance as of May 31 2019 53,648,744

Deposit 6/7/2019 4,500,000Deposit 6/14/2019 1,100,000Withdraw 6/21/2019 (900,000)Deposit 6/28/2019 750,000

Balance as of June 30 2019 59,098,744

Withdraw 7/5/2019 (850,000)Deposit 7/12/2019 850,000Interest 7/15/2019 332,401Withdraw 7/19/2019 (500,000)Deposit 7/26/2019 1,300,000

Balance as of July 31 2019 60,231,146

Deposit 8/9/2019 300,000Withdraw 8/16/2019 (650,000)Deposit 8/23/2019 550,000Withdraw 8/30/2019 (600,000)

Balance as of August 31 2019 59,831,146

Deposit 9/6/2019 2,850,000Deposit 9/13/2019 200,000

Balance as of September 13 2019 62,881,146

Z:\BankAccounts\LAIF\LAIF Activity.xlsx


Investments Summary - August 31, 2019

Certificates of Deposit (CDs)

Interest

RatePurchase Date Maturity Date Broker Cost Basis

Estimated Current

Market Value

Percentage

of Funds

Benchmark

Comparison

Third Fed Svgs & Ln Assn Of 2.00% 11/24/2014 11/25/2019 Union Banc Investment Services 247,000 247,096 0.35%

Capital One Bk Usa Natl Assn 2.10% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 247,094 0.35%

Discover Bk 2.10% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 247,101 0.35%

Goldman Sachs Bk USA NY 2.20% 11/26/2014 11/26/2019 Union Banc Investment Services 247,000 247,094 0.35%

State Bk India NYC 2.20% 12/5/2014 12/5/2019 Union Banc Investment Services 247,000 247,180 0.35%

Ally Bk Midvale UT 2.05% 11/24/2017 11/24/2020 Union Banc Investment Services 247,000 247,906 0.36%

BMW Bk NA Salt Lake 2.05% 11/29/2017 11/30/2020 Union Banc Investment Services 247,000 247,914 0.36%

American Exp Fed Svgs Bk 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 247,953 0.36%

American Express Centrn 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 247,953 0.36%

Capital One Natl Assn VA 2.10% 12/6/2017 12/7/2020 Union Banc Investment Services 247,000 248,079 0.36%

Wells Fargo Bank Natl Assn 2.10% 12/8/2017 12/8/2020 Union Banc Investment Services 249,000 250,096 0.36%

Sallie Mae Bk Slt Lake City UT 2.10% 12/13/2017 12/14/2020 Union Banc Investment Services 247,000 248,094 0.36%

2,966,000 2,973,562 4.26%

Government / Agency Securities

Federal Farm Cr Bks Bond 1.8% 1.80% 11/21/2014 11/12/2019 Union Banc Investment Services $5,011,900 $4,997,700 7.16%

Federal Farm Cr Bks Bond 2.23% 2.23% 11/20/2017 11/15/2022 Union Banc Investment Services 2,000,000 2,000,040 2.87%

$7,011,900 $6,997,740 10.03%

$9,977,900 $9,971,302

Local Agency Investment Fund (LAIF)

Interest

Rate

Beginning

BalanceActivity Ending Balance

2.57% $60,231,146 ($400,000) $59,831,146 $59,831,146 85.71%

Total Investments $69,809,046 $69,802,448

Note 1: These investments comply with the Districts Statement of Investment Policy and with Government Code §53600.

Note 2: The District has the ability to meet all scheduled expenditures for the next 6 months.

For Period Ended: August 31, 2019

Tables and Graphs

DRAFT

FINANCE COMMITTEE DRAFT September 16, 2019

Page 1

VOLUMEInpatient Volume

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Admissions - All Excluding Nursery

Current Year Prior Year 2 Years Ago Budget

1.5

2.5

3.5

4.5

5.5

6.5

7.5

Average Daily Census - All Excuding Nursery


0

10

20

30

40

50

60

70

Inpatient Surgery Volume


Page 2

Outpatient Volume

80

90

100

110

120

130

140

150

160

Clinic Volume (per day) - All Clinics


0

200

400

600

800

1,000

1,200

1,400

Emergency Department Volume


20

30

40

50

60

70

80

90

100

110

120

Outpatient Surgery Volume


Page 3

REVENUEGross Charges

-

1,000

2,000

3,000

4,000

Thousands

Gross Inpatient Revenue


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Thousands

Gross Outpatient Revenue


-

100

200

300

400

500

600

700

800

900

1,000

Thousands

Gross Clinic Revenue


-

500

1,000

1,500

2,000

2,500

3,000

Thousands

Gross Professional Fees Revenue


Page 4

Net Revenue

1,000

3,000

5,000

7,000

9,000

11,000

13,000Th

ousands

Net Patient Revenue


1,000

4,000

7,000

10,000

13,000

16,000

19,000

22,000

25,000

Net Revenue per Adjusted Patient Day


FY 2017 FY 2018 FY 2019 Aug-18 Apr-19 May-19 Jun-19 Jul-19 Aug-19

YTD FY

2020

Budget FY

2020

Payer Mix

Medicare 18.5% 19.6% 22.4% 27.2% 24.6% 18.6% 24.9% 26.2% 27.9% 27.0% 20.2%

Medi-Cal ** 21.4% 21.6% 21.1% 22.3% 18.6% 25.7% 19.7% 20.1% 17.3% 18.7% 20.5%

Blue Cross * 22.1% 22.5% 21.5% 22.5% 22.8% 22.2% 20.8% 16.6% 19.8% 18.2% 22.5%

Commercial * 29.2% 28.3% 28.0% 22.1% 28.5% 27.8% 27.8% 29.2% 28.7% 28.9% 29.5%

Self Pay ** 2.9% 2.5% 2.2% 3.3% 0.3% 0.8% 2.5% 3.2% 2.1% 2.6% 2.7%

Other * 5.7% 5.5% 4.7% 2.6% 5.3% 4.8% 4.2% 4.7% 4.3% 4.5% 4.6%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Page 5

Revenue Cycle

50%

60%

70%

80%

90%

100%

110%

120%

130%

Cumulative Cash Collections as a % of Net Collectible Revenue


0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Jul

Au

g

Sep

Oct

Nov

Dec

Ja

n

Feb

Mar

Ap

r

May

Jun

YT

D

2019

2018

2017

Th

ou

san

ds

Th

ou

san

ds

Monthly Collections

'Current Year" 'Year to Date" 'YTD Budget"

'Prior Year' 'Two Years Ago" 'Budget'

24

30

36

42

48

54

60

66

72

78

Millions

Cash Balance

Current Year As of June 30 Prior Year 2 Years Ago

50

100

150

200

250

300

350

400

Cash Days on Hand


Page 6

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

AR Days Outstanding - Gross


35.0

45.0

55.0

65.0

75.0

85.0

95.0

AR Days Outstanding - Net


0%

5%

10%

15%

20%

25%

30%

35%

% A/R > 120 Days

Current Year 'Prior Year' 2 Years Ago Budget

Payer 1 to 30 31 to 60 61 to 90 91 to 120 121 + Total

Blue cross $1,768,938 $613,933 $329,371 $171,999 $95,422 $2,979,662

Commercial $2,493,413 $1,280,062 $565,467 $361,545 1,111,762 5,812,249

Medical $1,950,691 $666,411 $371,052 $138,388 369,988 3,496,529

Medicare $2,802,985 $405,834 $82,510 $6,993 186,524 3,484,846

Other $513,638 $310,212 $142,236 $41,064 592,803 1,599,952

Self Pay $369,208 $643,610 $435,404 $372,847 2,122,170 3,943,240

Total $9,898,874 $3,920,062 $1,926,039 $1,092,835 $4,478,669 $21,316,478

Percent of Dollars Over 120 Days 21.0%

Page 7

ExpensesSalaries, Wages and Benefits

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Thousands

Salaries, Wages and Benefits


300

500

700

900

1,100

1,300

1,500

Thousands

Benefits


Page 8

Full Time Equivalents

200.0

220.0

240.0

260.0

280.0

300.0

320.0

340.0

Productive Full Time Equivalents


230.0

250.0

270.0

290.0

310.0

330.0

350.0

370.0

390.0

Paid Full Time Equivalents


-

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Productive FTEs per Adjusted Occupied Bed


5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

Labor Cost per Productive Time Equivalent


Page 9

Professional Fees, Services and Contracted Services

500

700

900

1,100

1,300

1,500

1,700

1,900Th

ousands

Professional Fees


-

50

100

150

200

250

Thousands

Contracted Services


-

200

400

600

800

1,000

1,200

Thousands

Services


Page 10

Supplies

200

300

400

500

600

700

800

900

1,000

Thousands

Supply Expense


400

900

1,400

1,900

2,400

2,900

Supply Expense per Adjusted Patient Day


Page 11


________________________________________________________________________________________________________




DATE: September 19, 2019 TO: Board of Directors FROM: Sarah Vigilante / Darin Kaylor / EPOCH Consulting

RE: 2nd Quarter 2019 Retirement Plan Update _____________________________________________________________________________

12/31/2018

3/31/2019

6/30/2019

Total Plan Assets $27,328,501** $30,507,953 $31,822,730 Average Account Balance $77,418 $85,219 $89,391 Active Participants(Eligible) 246(442)* 247(441)* 247(447)*

*there are 356 participants with a balance **just over $1million was rolled out of the plan during 4Q2018.

Overview: YTD 2019 the market has continued its upward trend. As of 6/30/19, the S&P5000 Index has posted a positive return of 18.54% and the US Aggregate Bond Index has produced 6.11%. Volatility has continued and the 403b is allocated 63% stocks and 37% fixed income and cash equivalents. The 37% represents the ‘shock absorbers’ to hold against market volatility. Participation remains steady, but we are always looking for ways to bolster employee engagement. We continue to provide a comprehensive retirement presentation at every new employee orientation and reminders to contribute throughout the year. Annualized Historical Performance vs. S&P500 Index as of 06/30/2019:* 1 year 3 year 5 year 10 year 403b: 3.94% 10.00% 7.84% 11.96% S&P 500 Index: 10.42% 14.19% 10.71% 14.70% *actual account performance per individual will vary. Timeframes longer than one year are annualized returns. Assets have only been in the illustrated funds since the transition to


Southern Mono Health Care District Report to the Board of Directors Retirement Plan Summary September 19, 2019

Page 2 of 3

Lincoln on 2/4/15 and fund changes as of 2/7/2017 & 11/28/17. Performance is hypothetical past performance vs. S&P500 Index for stated periods. The ‘Lincoln Stable Value’ balance is not reflected in these performance numbers. We will continue to benchmark our plan and the investments that are made available to our employees. The Investment Policy Statement (IPS) and quarterly monitoring reports will keep us up to date on our investment lineup. As such, one fund remains on the watch list- T.Rowe Price Intl. Value. The one fund represents 2% of plan assets. Should this fund not improve it will be added to the ‘replacement list’. Plan Highlights: Participation: 65% of full/part time staff participate (Industry Benchmark* 74.5%) . Participation has held steady since the last report. We currently have 356 participants with an account balance, 247 are deemed active, and 223 full or part time contributors. Many per diem employees do not work enough hours to become vested, thus they do not participate in the plan. Most retirement plans do not allow per diem employees to participate. Average Account Balance: $89,391 (Industry Benchmark* $55,619) Average Number of Investment Options Held: 9.7 (Industry Benchmark* 4.7) Top funds in the portfolio based on asset level: Fixed Fund: $4,278,244 Vanguard S&P500 Index: $4,003,801 Dodge & Cox Stock Fund: $2,749,380 Loomis Sayles Core Bond Plus: $1,988,236 American Funds EuroPacific Growth: $1,915,202 Invesco Equity and Income: $1,765,068 Vanguard Small-Cap Index: $1,677,878 Vanguard Mid-Cap Index: $1,594,576


Page 3 of 3

Participation by Age:

Average Balance by Age Group: (average balance is $85,219)

*Benchmark: Healthcare, Not for Profit Benchmark as provided by Lincoln Financial

03/31/2019 06/30/2019

Ages <20 $0 $0

Ages 21-30 $9,997 $9,919

Ages 31-40 $36,929 $37,404

Ages 41-50 $76,758 $81,596

Ages 51-60 $135,134 $140,321

Ages >61 $168,430 $173,534


________________________________________________________________________________________________________




DATE: September 19, 2019 TO: Board of Directors FROM: Lenna Monte, Director of Quality RE: Patient and Family Centered Care Annual Report FY19

Patient and Family Centered Care Annual Report FY 2019

Overview/Background Mammoth Hospital has embraced Patient and Family Centered Care (PFCC) as a part of our “Patients First” philosophy. The Patient and Family Centered Care (PFCC) Steering Committee oversees the activities and recommendations of the Patient and Family Advisory Council (PFAC – community members) and the Improving Patient Experience Committee (IPEC – multidisciplinary staff members and one PFAC member). These teams are well established and continue to foster a compelling culture change throughout the facility. The actions of these teams reflect our belief that involving patients and families as full participants in their care is essential to the design and delivery of optimal service with the goal of promoting quality, safety, and satisfaction. The PFAC consists of six community members with diverse backgrounds and various levels of personal experience with the hospital, either as patients themselves or as family of patients. PFAC members are required to submit an application and go through a vetting process prior to officially becoming part of the Council. In FY 19, the Council was co-chaired by two Mammoth Hospital employees: The Patient Experience Manager and the Quality Improvement Specialist. The IPEC is made up of internal hospital department managers, Quality department staff, and key staff members who interact with patients regularly (for example, the Population Health Nurse). The IPEC is co-chaired by the same individuals who chair the PFAC. The PFCC Steering Committee includes members of Mammoth Hospital’s administration and oversees recommendations made by the PFAC and IPEC. The Steering Committee is responsible for bringing those recommendations forward to stakeholder departments and the rest of Hospital administration. All three committees meet on a quarterly basis.



PFCC Accomplishments FY 18-19 In FY 18-19, the PFAC met four times and the IPEC met three times. Below is an overview of accomplishments for the fiscal year:

• Reviewed and suggested improvements for the Med/Surg discharge packets,

resulting in updated, user-friendly packets that were also more cost-effective.

• Reviewed and suggested improvements for an updated Surgical Consent form,

resulting in an easy-to-read/easy-to-understand format.

• Developed a “How to have a safe hospital stay” pre-admit brochure/handout for

patients explaining how to prepare for their hospital visit.

• Suggested improvements for ambulatory surgery patient satisfaction, resulting in

the following:

o Installation of communication white boards.

o A stop light system to monitor noise level.

o Provided feedback regarding Labor & Delivery services, including

advocating about the importance of continuing to offer such services in

this community.

o Brainstormed ideas about how to address food insecurity issues in the

community.

o Implemented Spanish-language patient satisfaction surveys.

PFCC Vision for FY 19-20 In the interest of efficiency, the PFCC Steering Committee and the IPEC will be collapsed into a single internal committee focused on improving patient satisfaction and the patient experience. The PFAC makeup will remain the same; however, meetings will be shortened from their current 4-hour length to 1.5-2 hours. The IPEC and PFAC will both focus on data-driven improvements to the patient experience and will continue to serve as a sounding board for Hospital managers to receive feedback from the perspective of the patients. Further, we will leverage the valuable insights of our PFAC members to assist in identifying potential interventions to address areas of need identified through the recent Community Health Needs Assessment.

Documents

SPECIAL BOARD MEETING · 2019-09-17 · Michael Karch, MD – Orthopedics Appointment to Active Staff Larry Silver, MD – Anesthesiology Sarah Sindell, MD – General Surgery