LAKE FORK HEALTH SERVICE DISTRICT BOARD OF DIRECTORS MONTHLY MEETING AGENDA

Transcription

1 LAKE FORK HEALTH SERVICE DISTRICT BOARD OF DIRECTORS MONTHLY MEETING AGENDA MISSION STATEMENT The mission of the Lake Fork Health Service District is to enhance the quality of life in our community by promoting wellness and providing quality health services with care and compassion while exercising fiscal responsibility. Monday, October 15, 2018 Moseley Health Care Complex, Zeller Wellness Center I. CALL TO ORDER- Approximately 9:00AM II. ROLL CALL III. WORKSHOP A. Executive Director Report Financial-(Scott, Dr. Carr, Jessica) 1. Review August 2018 Financials 2. Review 2019 Preliminary Budget Business Development-(Jami, Mike) Community Relations-(Janel, Jerry) Personnel-(Dr. Carr, Jessica, Janel & Jami)- Consider update to organizational chart under Executive Director. Policy Update- Admin 6- To add item #8, All patients will be empaneled to the MD/Medical Director. B. Presidents Report C. Medical Director Report 1. Consider adding verbiage to employee guidelines concerning no requirement for FMLA and protecting employment of minority classes when extended leave is requested D. Dental Director Report E. Any other items IV. MEETING AGENDA ITEMS A. Consider any updates to the meeting agenda B. Approval of minutes from prior board meetings- 09/17/2018 C. Consider motion to revise policy Admin 6, to include item 8, All patients will be empaneled to the MD/Medical Director. V. CITIZEN COMMENTS FROM THE FLOOR VI. ADJOURN Times stated are approximate and the agenda may be modified as necessary at the discretion of the Board.

2 III. A. September 2018 Business Manager Report Review A/R log to identify that old claims are being resubmitted. Send monthly bank statements to CPA for reconciliation. Assist CPA with questions. Send website update information to Dan Wampler. Print Amex statement and attach appropriate documentation. Prepare and review AP documents for Cindy. Send provider on call schedule to Jerry Gray. Monitor cross check exceptions as well as unsigned/unsaved notes. Prepare information for the September 17 regular board meeting and staff meetings and post agendas. CPR class reminder. Attend regular board meeting and provide reports. Attend staff meetings. Assist with time clock as needed. Review timeclock records and submit to Cindy for payroll. Work with additional insurance companies on Dr. Carr/Ashley s credentialing. Request and record volunteer board hours. Assist with evaluations. Communicate with ins company ref to employee ins changes. Communicate with Ashley ref to new employee questions. Communicate with Dan ref to fall risk template. Work on report for RMHP RAE program. Arrange for Reach out & Read site visit. Prepare 2019 preliminary budget. Arrange for budget committee meeting. Continue to monitor and update licenses, certifications, and insurance. Submit charts for review for PA. Coordinate staff training outside of office. Submit education request to endowment. Attend ACO webinars. Approve schedules and enter into EMR. Submit ad info to newspaper and work on advertisement for paper as requested by board. Communicate with Purdue University ref to Jennifer. Arrange for meeting with Gunnison physicians. Submit cancellation request for current employee insurance and make request for new employee insurance effective Jan All other tasks as assigned.

3 LAKE FORK HEALTH SERVICE DISTRICT MONTHLY AND YTD INCOME STATEMENT AUGUST 31, 2018 III A. Financial 2018 MONTHLY ACTUAL 2018 AUG YTD JAN FEB MAR APR MAY JUN JUL AUG ACTUAL BUDGET ACTUAL Ordinary Income/Expense Income 421 Medicare Incentive Payment 10,378-1,649 5,448-2, ,814 16,667 10, Rental Income ,635 2,667 2,385 Dental Income 5,406 7,978 14,410 3,394 13,845 15,775 9,840 14,801 85,448 78,713 76, Patient Services Revenue 21,645 23,895 16,378 17,754 23,906 37,942 41,981 33, , , , Medical Records Copy Fee Medicare Audit-Cost Report ,344 5,344 26, Total Income 37,769 31,998 32,852 26,736 37,893 56,131 52,216 53, , , ,206 Expense 642 Donations Charitable Contributions Dental Expense 5,836 5,798 10,808 3,996 3,174 9,103 10,721 9,920 59,355 59,757 60, Accounting 59 2,264 2,597 6, ,740 11,800 18, Advertising 1,082 1, , ,070 5,667 6, Audit, LFHSD ,450-4,450 2,800 4, Bank Charges Bank Credit Card Fees ,790 2,333 2, Books & Magazines Cash Over Short (1) 630 Collection Agency Fees Computer 12,187 3,858 1,887 5,198 4,578 1,549 2,940 2,303 34,499 13,800 29, Contract Labor 2,100 1,350 1,461 1, ,159 19,200 3, Courier ,983 2,333 2, Dues & Subscriptions 135 1, , ,182 5,372 3,433 3,175 AUG 2017

4 2018 MONTHLY ACTUAL 2018 AUG YTD JAN FEB MAR APR MAY JUN JUL AUG ACTUAL BUDGET ACTUAL 656 Entertainment/Meals , Education,Staff 1,001 1,114 2, ,373 5, ,925 8,967 7, Insurance 11,104-4,559 10,871 4,457 12,177 6,193 1,434 50,794 47,600 47, Interest Expense Lab - Hospital Processing Radiologist Interpretation , Licenses & Fees ,960 5,067 5, Personnel Expenses 34,186 44,043 38,232 42,899 48,522 45,288 56,556 77, , , , Pharmacy Consultant ,754 2,100 1, Postage ,725 2,000 1, Recruiting ,428-1,876 1, Repair & Maintenance 2,053 1,669 4,220 2,283 1,107 2,965 2, ,142 20,496 26, Supplies 3,824 4,310 1,591 5,444 5,638 1,204 6,816 7,841 36,667 50,100 55, Telephones ,126 5,000 5, Utilities 2, (718) 1,195 1,296 (2,856) 1,472 1,419 4,700 12,889 8, Waste Management 971 1, , ,732 1,078 8,185 9,133 10, Suspense (714) (56) (249) (408) (65) Total Expense 78,037 70,916 70,430 86,166 74,389 80,107 99, , , , ,904 Net Ordinary Income (40,268) (38,918) (37,578) (59,430) (36,495) (23,976) (47,338) (52,841) (336,844) (326,504) (324,698) 890 Donation Income 2, , ,545 6,919 2,333 3, Grant Income - - 1, , Interest Earned , , Health Service District Revenue 40,000 40,015 40,015 40,008 40,030 40,179 40,706 40, , , ,871 Total Other Income 43,029 40,246 41,393 40,599 40,354 42,443 41,406 42, , , ,668 AUG Health Services District Expens 1,518 5,680 3,685 1,789 6,995 1,676 1, ,646 17,442 26,838 Net Income 1,244 (4,352) 130 (20,621) (3,137) 16,791 (7,630) (11,130) (28,705) (17,884) 24,132 Adjustment needed to prorate 2017 taxes to be consistent with 2018 (35,884) (28,705) (11,752)

5 III. A. Budget LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Income Dental Income Adjustments (36,061) (33,022) (32,182) (34,946) (26,930) (33,755) 3 year average Patient Income 118, , , , , ,000 Mid 2018 X 2, Less December Dental Incentive Total Dental Income 82,829 91, , , , ,245 Patient Income Adjustments (168,073) (172,259) (256,610) (142,316) (185,436) (165,000) Insurance Incentvie 2,268 1,100 Estimated, Medicaid Qtr Cap Payment Patient Service Income 475, , , , , ,000 Excpected pt count X $ visit avg Total Clinic Income 307, , , , , ,100 Other Income 5,599 9,218 7,542-7,000 Delete, Listed as MCR Incentive, Rental Inco Services 480 1, Health Fair Reimbursment Overpayment (1,282) - - Medical Records Copy Fees year average Medicare Incentive 23,561 22,278 15,075 39,628 25,000 5,000 ACO & Other Medicare Incentive Payments Rental Income 3,994 4,325 2,580 4,000 4,200 3 year average Medicare Cost Report 54,435 31,215 36,805 37,000 40,000 40,800 3 year average Total Other 83,595 66,731 63,027 80,812 76,625 50,550 Total Income 474, , , , , ,895 Page 1 of 7

6 LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Expenses Dental Expenses Billing 4,164 5,805 6,068-5,500 N/A, Billing clerk is employee Advertising Estimated Accounting ,255 2,750 1,200 3,300 Based on current billing by CPA Firm Dental Payroll Taxes 2,961 3,290-3,392 3,494 See dental wages Repairs and Maint , year average Dental Wages (Dentist) 37,243 41,386 49,285 40,744 39,900 41,100 See dental wages Dental Office Supplies year average Dental Lab 5,175 5,307 5,957 4,070 5,500 5,500 3 year average Dental Insurance 1, ,000 1,000 3 year average Dental Travel 2,422 2,720 4,645 3,600 5,424 3,024 See dental wages Dental Professional Pay(Hygie 11,625 13,720 16,005 14,760 13,080 13,080 See dental wages Dental Supplies 9,067 7,879 6,622 8,282 8,000 8,000 3 year average Dental Dues and Subscriptions year average Denta Work Comp Dental License Fees Dental Tuition and Fees 100 (69) year average Dental Memberships 1,426 2,926-1,740 2,200 3 year average Page 2 of 7

7 LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Service Agreements 1, Dental other 4,939 3,136 1, ,100 3,100 3 year average - Total Dental Expense 80,780 87,234 95,804 77,430 89,636 86,563 Acounting LCAMC 8,466 6,065 9,564 7,970 9,000 5,000 CPA LFHSD 2,469 2,714 2,490 2,700 2,600 Bookkeeping 3 year average, Cindy Young Billing Fees 18,632 25,090 19,262 14,900 6,000 5,000 Tina switched to employee Advertising 2,107-2,800 LFHSD ,000 LCAMC 1,139 11,781 8,792 7,500 Audit- LFHSD 4,000 4,100 4,250-4,200 4, Bank Charges 2,448 2, , ,500 Combined with below, Stmts, CC Charges Bank Card Fees 1,631 1,680 4,547 2,502 3,500 Books and Magazines Cash Over Short year average Computer - Maintenance Contracts 17,885 29,454 27,440 28,912 12,000 18,000 Include EMR, Less- No WSB Software 2,729 3,331 2,685-3,000 3,000 3 year average Services 5,370 2,446 9,857 27,540 3,300 27,500 Mid 2018 X 2,Dan Wampler, IT Hardware 1, , ,200 1,000 3 year average Internet 447 1,188 1,089 1,188 1, year average Courier 2,140 2,310 3,542 2,826 3,500 2,900 Mid 2018 X 2, Lab courier to Gunnison Dues and Subscriptions 4,875 2,247 5,414 7,972 5,150 8,000 Expected inc due to MD memb, licenses Page 3 of 7

8 LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Staff Appreciation 692 2, Mid 2018 X 2, staff meetings, birthdays Staff Training 9,861 13,114 10,825 23,994 13,450 14,000 Expected inc, Cont Edu, Conf Insurance - Employee Health 41,863 44,853 51,347 55,890 51,600 44,600 If we change to CEBT, 6 employees Malpractice 9,444 8,889 15,165 15,918 12,500 11,200 3 year average Property and Liability 7,014 7,885 7,930 16,908 7,300 7,600 3 year average Lab year average, Womens Wellness Radiologist Interpretation 5,596 5,754-2,000 2,000 If utilized Licenses and fees 4,190 7,181 8,155 4,506 7,600 6,500 3 year avg, QHN, Dosimetry, Clinic Fees Personnel Expense - Payroll Tax 30,777 40,000 44,252 38,874 44,128 45,323 Refer to wages Wages 365, , , , , ,441 Refer to wages Workman's Comp 13,215 6,091 14,486 14,999 7,000 7,500 Average, 2017 had 2 years combined H S A 6,250 6,950 6,450 5,500 5,600 7,200 6 $100 per month Other (Contract & Other) 36,347 13,325 20,154 28,800 - No contract labor expected Pharmacy Consultant 2,757 3,155 2,506 2,506 3,150 2,800 3 year average Postage 2,336 2,225 2,307 2,794 3,000 2,200 3 year average Recruiting 896 1, Mid 2018 X 2 Repair and Maintenance - - Building 13,450 6,809 15,168 11,472 7,000 11,809 3 year average Cleaning 15,378 15,861 16,022 13,226 16,244 10,770 Refer to wages Equipment 11,608 4,605 3,251-5,000 6,500 3 year average X-ray 5,128 1, ,500 2,500 3 year average other 1,620 3,896 1,000 1,600 3 year average Supplies - Page 4 of 7

9 LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Pharmacy 41,795 41,556 34,533 17,832 34,950 23,000 Mid 2018 X 2 with buffer Lab 16,144 18,659 19,607 11,042 18,800 18,000 3 year average Medical 2,455 10,228 9,285 7,004 10,000 7,300 3 year average Office 10,986 9,117 10,387 7,812 10,200 11,700 3 year average General , ,200 Other Telephone 6,527 6,798 7,204 6,178 7,500 6,500 3 year average Utilities - Cable Mid 2018 X 2 Electric 14,607 15,775 13,218 10,938 14,500 14,500 3 year average Propane 8,466 22,583 17,615 11,426 19,000 16,200 3 year average Water Sewer year average EMS Reimbursement (15,671) (15,000) (19,028) (19,956) (15,627) (16,566) 3 year average Waste Management 13, Bio Waste 14,148 12,397 8,522 11,000 8,500 Mid 2018 X 2 Sanitation 2,465 2,732 2,230 2,700 2,200 Mid 2018 X 2 Other 4,740 (4,551) (980) - Gifts Donations year average Interest Expense Total Clinic Expense 753, , , , , ,022 Net Operating Income (360,510) (399,634) (507,428) (437,253) (404,569) (423,690) Page 5 of 7

10 LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Other Income and Expense Donation Income 7,137 3,865 4,741 10,044 3,500 5,200 3 year average Grant Income 1, , Interest Income ,295 3,390 1,075 3,400 Mid 2018 X 2 1% Motor Vehicle year average Sales Tax 141, , , , , ,000 3 year average Property Tax 319, , , , , ,000 Based on 2018 Estimated Specific Ownership Tax 22,246 23,551 23,429 24,000 23,500 23,000 3 year average, Part of Prop Tax Pymt Total Other Income 492, , , , , ,200 District Expense Dues and Memberships 300 5% Treasurer's Fee 14,832 17,512 16,685 15,696 15,593 15,700 Based on % of property tax income BOD Expense's 1, year average BOD Training 30-1, New board members Page 6 of 7

11 LAKE FORK HEALTH SERVICES DISTRICT PRELIMINARY BUDGET 2019 Count ACTUAL Preliminary Budget Method Used Projected Budget Budget Legal Fees 358 3,431 27,825 15,526 5,000 5,000 Estimated Public Officials Liability Ins 1,543-1,550 1,500 Accounted for differently in the past BOD Election Fees Advertising - 1,100 BOD Seminars 590-1, year average Other 3,213 2, ,500 3 year average Total Other Expense 19,963 23,894 46,955 31,616 26,163 25,590 Net Income 111,796 82,424 (42,348) 28,157 58,362 39,920 Net Income PER FINL STMT (76,494) (103,051) (212,998) 28,157 58,362 39,920 FUND BALANCE TOTAL 298, , ,848 Total Net Revenue 1,078,453 1,040,095 Total Expenses 1,020,091 1,000,175 Net Income (Loss) 58,362 39,920 Total Expenses 1,020,091 1,000,175 Total Expenditures 1,020,091 1,000,175 Capital Expenditures 10,000 10,000 Contingency Expenditures 15,000 15,000 Total Appropriated Expenditures 1,045,091 1,025,175 Page 7 of 7

12 Lake Fork Health Service District III. A. Personnel Board of Directors Medical Director (MD, DO) Executive Director Dental Director (DDS) Senior Physician Extender & Clinical Supervisor Nursing Services Ancillary Services Education & Training Mid-Level Provider (PA, NP) Laboratory Billing Reception Scheduling IT Accounting CPA House Keeping/ Facilities Personnel Board Admin Dental Tech Dental Hygienists Pharmacy Sonography X-ray Education & Training Nursing Schedule, Business Matters, HR

13 LAKE FORK HEALTH SERVICE DISTRICT BOARD OF DIRECTORS-SPECIAL MEETING IV. B Today s Date is Monday, September 17, I. The regular monthly meeting of the Lake Fork Health Service District was called to order by Janel Warren at 9:00am. The meeting was held in the Moseley Health Care Complex. II. Roll Call: In attendance were board members: Janel Warren, Jerry Johnson, Scott Beedy, Mike Schell, and Jami Scroggins. Nancy Zeller, Dr. Bruce Uchida, and Dr. Gina Carr were also present. Jessica Whiddon is the recording secretary. Board of Directors: President: Janel Warren Vice-President: Jami Scroggins Secretary: Mike Schell Treasurer: Scott Beedy Board Member: Jerry Johnson III. Workshop Executive Director Report- Medical patient counts through July 2018 were 1985 vs 2577 through July of A difference of 592 less patients. Dental patient counts through July 2018 were 454 versus 439 through July of A difference of 15 more patients. Behavioral health saw 16 patients in July. Financial- Reminder that we adjusted property tax income to span over the entire year, so you will note significant changes in the tax income but it will balance out by years end. This will also effect monthly net income for this year. Profit and loss through July 2018 shows dental income up by about $6,500. Medical income is down by approximately $36,700. Total income is down by $20, Dental expense is $ more than July Staff education remains up by about $6,500 due to extra courses. Personnel expenses are up by about $7,000 due to adding Dr. Carr to payroll. Repairs and maintenance are down by about $3,600. Supplies continue to be down by about $8,800. Utility expenses are down by approximately $7,400. Waste management is down by about $1, Net ordinary income is about $29,900 less than July of Donation income is up by about $3,300. Total other income is showing as down by $50,500 mostly due to the difference in property tax reporting. Net income is -$18, due to tax reporting. Looking at the budget vs actual through July 2018, dental income was budgeted at $68,800 but is actually $70,600 so we are about $1,700 better than expected. Medical

14 income is budgeted at $148,600 with an actual income of $183,500 so we are $34,800 ahead of budget. Total income is approximately $17,800 better than budget. Dental expense is around $2,800 below budget. Personnel expenses are about $5,000 below budget. Supplies are around $15,000 below budget. Total expenses are approximately $7,900 below budget. Net ordinary income is budgeted at -$310,000. Actual is -$284,300 so we are around $25,000 better than budget. We ve collected around $3,300 more in donation income and $1,000 more in interest income than budgeted. Final net income is budgeted at -$40, with actual being -$18, We are $21, better than budget as of July Finance committee will meet within the next month to review the 2019 preliminary budget so that can be presented at the October board meeting. Business Development- Center for Mental Health plans to be here once per week to see patients. On-site PT has ended for this summer. Community Relations- Will submit advertisement of available services to Silver World. Clinic will remain open on Sundays. Personnel- We would like to welcome Ashley Mines, PA and family to town. Ashley begins employment effective the first week of October. Storm Gozzola has agreed to continue employment for 2 years as a medical assistant once medical assistant course is complete. Endowment approved a request for new tables for the conference area. Outdated supplies are donated to mission s ministries. A. Consider any updates to the meeting agenda: NONE B. Consider approval of minutes from prior month s board meeting: Motion: Approval of Minutes for the meetings- 08/20/2018. Motion: Janel Warren Second: Mike Schell Vote: All vote yes. Motion Carries

15 V. REPORTS A. President Reports: Janel has heard good things about Dr. Carr and also that being open on Sundays is important to the community. B. Medical Director Reports: Dr. Carr is now serving as the public health medical director. Plans are in the work to perform community education sessions. The summer intern students were helpful around the clinic. Jessica is working with staff on PDSA cycles and was instrumental with getting Center for Mental Health here quickly when Donna Sue departed. We will continue to work on integrating behavioral health within the clinic. Staff is doing a good job with ordering. The SDA conference was enlightening and Dr. Carr would like to share some of that info with the board. Will try to set strategic planning meeting time soon. Key leadership challenge program info has been given to the board and staff. Please provide any input you may have. Consider discussion about PERA benefits for employees. C. Dental Director- Things are going well. Consider school dental education program. No amalgam separator needed. EPA rescinded that decision. Consider service fee increase in 2019 to keep up with costs of supplies. Consider ad in the Silver World to promote available services and additional information about the dental and medical clinic. V. CITIZEN COMMENTS FROM FLOOR: None VII. Consider motion for executive session per C.R.S (4)(e) Determining positions relative to matters that may be subject to negotiations, developing strategy for negotiations, and instructing negotiators. (10:02am) Motion: Jerry Johnson Second: Janel Warren Vote: All vote yes. Motion Carries Resume regular meeting at 10:45am.

16 VIII. Consider motion to increase the executive director hourly pay to $26.00 per hour effective at the beginning of the current pay period. Motion: Approval of increase of executive director pay. Motion: Janel Warren Second: Jerry Johnson Vote: All vote yes. Motion Carries Adjourn Meeting is adjourned at 10:45am. Next meeting will be October 15 at approximately 9:00 a.m. in the Zeller Wellness & Education Center in the Mosley Health Care Complex. (President) Date (Secretary) Date (Recording Secretary) Date

17 IV. C Lake Fork Health Service District Category: Administrative Page 1 of 1 Policy: Patient Check-In Policy Number: ADMIN-06 Effective Date: 11/01/09 Last Revised Date: 11/05/2015 Reference: 42CFR491.7(b)(2)-Policies and Lines of Authority Last Reviewed Date: 11/20/2017 Purpose: 42CFR491.7(b)(2) requires that this organization s policies and its lines of authority and responsibilities are clearly set forth in writing. Statement of Policy: The Lake Fork Health Service District interprets 42CFR491.7 (b)(2) to include administrative policies that cover topics including patient registration. Therefore, this clinic shall maintain an efficient process for established patient check-in to include changes to demographic, insurance, consents, and medical history information useful to provide care. Health care providers will make every effort to see patients at their appointed time, with the understanding that emergent and/or unscheduled urgent problems of other patients may result in delays or even rescheduling. Procedure: 1. Greeting patients and visitors is the responsibility of the receptionist. All visitors and patients are to be greeted pleasantly and treated courteously. 2. The patient is responsible to verbally advise the receptionist of their presence in the clinic upon their arrival. 3. The receptionist shall note the patient s arrival in the computer system, confirm the electronic chart, and pull the patient s physical chart. 4. Same-Day appointments are reserved on our schedule. 5. Work-In (Walk-In) patients will be accommodated as possible and shall be seen on a first come, first served basis, or triaged appropriately. 6. At the time of check-in the receptionist should confirm their current contact information (address, , phone number and insurance company status) and make any changes to the patient s record. 7. The receptionist may change information as necessary in the system to ensure correct billing. 8. All patients will be empaneled to the MD/Medical Director.