Loading...
HomeMy WebLinkAbout1983 - 1985 N I rRow 1310 Scrl turc Strcct MEMORIAL EIOSPITAL Dentntt TX 76201 (817) 387.5861 FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS Thursday, December 11, 1986 7100 p.m. Medallion Room AGENDA I. Call to order II. Reading and Approval of Minutes III. Report of Hospital Management Professionals, Inc. A. Administrator S. Corporate Representative IV. Report of Hospital Liaison - Reorganization V. Committee Reports A. Audit Report FY 1986 - Ernst & Whinney B. Finance Committee C. Medical Staff Departments & Committees VI. Report of the Medical Staff President Vl:. Report of the Medical Director VIII. Old Business A. Emergency Room Coverage for Psychiatry B. CT Scanner - Updato XI. New Business A. Personnel Policy B. Capital Equipment Requests & Financing C. Recommendations for Appointment to the Medical Staff & Allied Health Professional Staff D. Other X. Executive Sessions Pursuant to Article 6252-17 VATCS A. To Discuss Personnel Matters, Section 2(g) B. To Discuss Legal Matters, Section 2(e) C. To Discuss Real Property, Section 2(f) XI. Adjournment 1 Uv cw0l BLUE RIBBON COMMITTEE ON FLOW MEMOSIAL HOSPITAL FRIDAY, MARCH 28, 1986 7:00 a.m. ROOM 3011 ACT BUILDING (CLOCK TOWER) TEXAS WOMAN'S UNIVERSITY A G E N D A t, Welcome II, Report to Committee on Legal Developments Regarding 501(c)(3) Ill. Executive Session to Discuss Legal Matters Pursuant to Article 6252-17, Section 2(e), VATCS i V. Adjournment LJ "low F. f A7l;M19QR[Al, f iOSI'[1'Ai, x:3113 Sc'rll,umc sin (-J ! h of uu. l'.\ 71,201 f'i 17) 3,47 5W31 N1, 1,11 MIR CALLED MEETING BOARD OF' DIRECTORS Wednesday, April 91 1966 12;15 p.m. Medallion Room FLOW MEMORIAL HOSPITAL AGENDA - REVISED I• Call to Order II. Capital Financing Request III. Consideration of Management Agreement Between Flow Memorial Hospital Professionals, I and Hospital Management Inc, IV. Executive Session to Discuss Personnel,Matters Pursuant to Article 6252-17, Section 2(g), VATCS V. Executive Session to Discuss Legal Matters Pursuant to Article 6252-17, Section 2(e), VATC5 VI. Adjournment FfOW 131o serlpWrc Sircet ~ MEMORIAL HOSPITAL Denton, TX 76201 18171 387.5861 BOARD OF DIRECTORS Thursday, March 27, 1986 7t00 p.m. Medallion Room MAR 2 $ I AGENDA I, Call to Order II, Reading and Approval of Minutes III. Report of the Administrator IV. Committee Reports A. Finance Committee 8. Management Raferences Committee C. Medical Staff Committees V. Report of FMH Foundation, Inc, VI. Report of the Medical Staff President VII. Report of the Medical Director VIII, Report of Health Care Planning Consultant to Board IX. Unfinished Business A, Physician Recruitment B. Second Floor Renovation C. Patient Handbook D. Energy Grant - Steam Cogeneration Unit E. Report on Employee Pension Plan F, Management Agreethant, X. Now Business A. Patient Transfer Policy B. Nuclear Medicine Contract C. Risk Manager D• Quality Assurance Plan E. Nurse-Midwifery Proposal F. Medical Director Job Description G. Capital Equipment Request and Financing H. Recommendations for Appointment to the Medical Staff XI. EXBCUtiVe Session - to discuss personnel matters pursuant Article 6252-17, Section 2(g), VATCS1 and to discuss legal matters pursuant to Article 625217, Section 2(g) VATCS XII. Adjournment HOW i310 Scripuliv Street nrJcntonnton. TX :L 76201 MEMORIAL HOSPITAL 1B 171387 38G1 MAR 13M cirY or I,ri~ ova. , , REVISED AGENDA CI1YIfAMAtFAS~rr!!.F I BOARD OF DIRECTORS CALLED MEETING Friday, March 14, 1986 7100 a.m. Medallion Room Flow Memorial Hospital AGENDA r 1. Call to order II. Consideration of proposals to Provide Liability Insurance Coverage for Hospital III, Executive Sassion to Discuss Legal Matters Pursuant to Article 625217, Section 2(e), VATCS 1 IV, Adjournment %I 1310 Scrlptur~ Sirccl HOW lilon. TX (8817) 387c52o1 MEM0121AL 110SPITAL U.' (171 387~88C 1 D MAR 1 z 1986 j el MaM~r, OF BOARD OF DIRECTORS CALLED MEETING Friday, March 14, 1986 7:00 a.m. Medallion Room Flow Memorial Hospital AGENDA 1. Call to Order 11. Consideration of Proposals to Provide Liability Insurance Coverage for Hospital 211. Adjournment AGE11DA i BLUE RIBBON COMMITTEE ON FLOW MEGIORIAL HOSPITAL 13TH FLOOR, CLASSOCROOTOBEM/FRACULTY198 21. OFF5ICES BUILDING, TPJU , 7:30 B.M. MEETING #4 I. I4elaome. .rr.rr....... II. Approval of Minutes Chair ITT. New Business. A. ReviOW of Options B. Assessment of Options IV. AdJournment. HOW 1310 Scr I})ttire Street MEMORIAL HOSPITAL Denton, TX 76201 (817) 387.8861 i i SPECIAL MEETING yt BOARD OF DIRECTORS Tuesday, October 15, 1985 700 a.m. Medallion Roorn AGENDA I. Call to Order II, DRG/Case Mix Analysis System III. CT Scanner IV. Adjournment t i How 13 10 Scripture , Street MEMORIAL HOSPITAL - Denton, TX 76201 J, CllYpMgtJ1. !JJ.fi M E E T I N G N 0 T I C E BLUE RIBBON COMMITTEE Monday, October 7e 1985 700 p.m. 13th Floor CFO Building Texas Woman's University s ~1 I li, TP I Flow i l 1310 Scripture Street MEMORIAL HOSPITAL Denton, TX 78201 18171387.5881 I 1 1 MEETING NOTICE BLUE RIBBON COMMITTEE Monday, September 30, 1985 700 p.m. 13th Floor, CFO Building Texas Woman's University t I i i r f ' i ' i M E E T I N G N O T I C E h I PLOW MEMORIAL HOSPITAL BLUE RIBBON COMMITTEE Tuesday, September 29, 1985 8100 P.M. i .23th Floor, CFO Building r i Texas Womans University i i F W Scripture 4 MEMORIAL HOF&ITAL bencon, TX TX 13I ton 7682C201 1 (817) 387.5861 NOTICE OF EMERGENCY MEETING 1 BLUE RI.%BON COMMITTEE Monday, September 23, 1985 8200 13th Floor, CPO Building Texas Womans University i I r; II I I III V i Y.~ f SEP 1 91985 ell nMnMees ~Sr o rtr M E E T I N G N 0 T I C E I I I i BLUE RIBBON COMMITTEE Tuesday, September 31 1985 8100 P.M. 13th Floor, CFO Building Texas Womans University 0 o ~y~' 1 1 I MRMORIAL HOSPITAL 1310 ScrfptIr(, Strcct t)Cnlon, 'PX 76201 (81713,97-5861 BOARD OF DIRECTORS i ThursdaY) August 29, 1985 7:0a p Medallion Room ~ • RUG27pffi ACENDA y Cin I• Call to Order II, Reading and Approval of Minutes (07117185) (07/18/85) III, Report of the Administrator IV, Reports of Committees V' Report of the Medical Staff president VI, Report of the Aiedical Director VII, Unfinished Business A, MaxiCare Proposal B, Energy Grant - Progress Report DC' First Texas Medical Certificate of Need , Te1Med Pape Sys E, Other tem progress Report VIII, New Business A, CT Scan proposal 13' Selection of Auditor ` C, Medical Director of Nurse-Midwifery Program D, Medical Director of Critical Care Units E' Marketing Dopgrtment F' Resolution to Physician Finance Anesthesia Machines G, Malpractice Liability Insurance K Appointments Blue Ribbon to the Medical Staff I, ions other Committee RecommendaC , Ix, LxecuCive Session to Discuss Personnel Matters X, Adjournment 4 s) if HOW 1310 Scripture street MEMORIAL HOSPITAL Denton. TX 76201 (817) 387.8861 5 p,UG 619 August 14, 1985 ~~A111,Ut++3. " C11 M E M O R A N D U M TO: Members of the Board of Directors FROM1 David D. Yoder, Administrator SUBJECT: August Board Mee_ tang The August meeting of the Board of Directors will be held on Thursday, August 29, 1985, at the usual time of 7:00 p.m. ktp eel Denton Record Chronicle City of Denton, City Council Denton County Commissioners Count f t{ V HOW 1310 Scripture Street MEIMORIAL HOSPITAL Denton. 76201 (817► 38 7.5881 BOARD OF DIRECTORS ,IU!• i 5I9F~5 ~ Thursday, July 18, 1985 1 700 Medallion Room I AGENDA 1. Call to Order iI. Roll Call III. Reading and Approval of Minutes IV. Reports of Committees and officers V. Report of the Administrator VI. Report of the Medical Staff President VII. Report of the Medical Director VIII. Unfinished Business A. Maxicare Proposal B. Nurse-Midwifery Program C. Computer Upgrade D. First Texas Medical CON e. JCAH Summation Conference - Overview F. Tel-Mod a. Status of Physician's Summary Suspension H. Other IX. Now Business A. Third Quarter Report B. Resolution Regarding Equipment Purchase C. Other ► X, executive Session to Discuss Personnel Matters XI. Ad3ournm©nt i 80ARD OF DIRECTORS - "I MEMORIAL HOSPITAL CALLED ME"ING !FThe UINESS MINUTES pate Wednesday, July 3, 1985 Page Board of Directors of Flow Memorial Hospital met in ail r r ci?1J~seesig onnatiion. )Ie G (f July 3, 1985, at 800 a a.m. to address the Administrator's ei7Y Q£ eal ,Mary Henderson Willllias. I Williams, Chairman, presided, g n., Mrs, Members resents Dlr. Ralph Havenhill Dr, Don F. Holt also pr©senti Air, Karl Pason Mr. Stanley Monroe Ms. Donna Fielder Dir. Brad Moore Mti', Don Geiger Ms, Mr, Dan Trammell Mr, Kathy Pritchett Ms. Mary If. Williams Abs eo David Yoder Lx afficiei Dr, Lloyd White ents Mr. George Hllz M Ms. Williams called the meeting to order.' she reported that the Task Force has recommended that a Blue Ribbon Committee be developed to guide the development of the i 50lc3 for Flow. Recommendations of 15 people are requested, as determined by the Task Forcer 3 physicians of high standing, 1 Board member (not the chairman), 2 elected officials (1 city, 1 county), 1 CPA, 3 community leaders (at least 1 with a financial background), 2 university representatives (1 representing the nursing profession), 1 health planner, 1 member of hospital administration, and 1 consumer representative. Board members were asked to turn names of individuals who they would like to nominate after verifying that those individuals would be willing to serve. The purpose of this meeting was to address :he Administrator's letter of resignation dated 07/02/6S. At this time the Board moved to executive session to discuss personnel matters, pursuant to Article 6252-17, section 2(g), VATCS. The regular meeting was resumed and Mr. Trammell made a motion to accept Mr. Hausler's J resignation effective 08/02/85, as stated in his letter, Mr. Monroe seconded the motion, Mr. David Yoder was appointed Acting Administrator and it was stated that Mr. Hausler would be asked to serve in a consulting role to Mr. Yoder until OR/02/85. The vote was taken and the motion carried by unanimous voice vote, Mr, Monroe made a motion stating that there are no pending agreements or understandings in regard to management contracts with Flow Memorial Hospital, Mr, Havenhill seconded, and the motion passed unanimously. Mr. Havenhill asked Mr. Yoder to provide figures on the proposed computer system improvements. There being no other business to discuss, the meeting adjourned at 9310 a.m. Respectfully submitted, APPROVED! 4tharine Thompson rftchett Recording secretary Ralph Havenhill Secretary f I M 11`` CX. I r Scripture Street V ROW 1310 Denon, pion, X 6201 MEMORIAL HOSPITAL 1 (817) 387,5861 JUN 2 r 1985 ~J fiS0ICE J 1 f CALLED MEETING OF THE BOARD OF DIRECTORS Saturday, auno 29, 1985 6100 p.m. The Homeof Don F. Holt, MID, Unionhill Road Sanger, Texae A G E N D A 1. Call to Order III Recommendation to city/County III. Adjournment `i ya BOARD OF DIRCCTORS - *,LED FLEETING BUSINESS MINUTES oaf, Saturday, June 29, 1985 _ Pega 1 The Board of. Directors of Flow tdemorial Hospital met in a called session on Saturday, June 29, 1985, at 6100 p,m, at the home of Dr. Don F. Holt, Chairman, presided. Ms- Mary H. Williams, j Members presents Mr. Ralph Havenhill Members absent? Mr. Jeff Hausler Mr. George Hilz Mr. Dan Trammell Dr. Don F. Holt Dr. R. L. White Mr. Stanley Monroe bir. Brad Moore Also present; Mr. Don Geiger Ms. Mary Williams Mr. Don Ciulla Dr. Jim Killingsworth Ms. Williams called the meeting to order and moved to executive session, pursuant to Article 6252-17, Section 2(g), VATCS. No action was taken during executive session, Ms. Williams head a letter from Summit Health in appreciation of the opportunity to present their findings to the Board, Me. Williams stated that the purpose of this meeting is to come to an agreement on the final recommendation to the city and county, and the possibility of a 5010. or. Killingsworth reported that the time factor involved in the process of develop- ing a 5010 averages about eight to twelve monthst then, the city and county must negotiate a lease with a third party. After some discussion the Board voted to recommend thr, formation of a 5010. Dr. Killingsworth reviewed the type of board recommended by the Task Force. This two-part board is appointed by the city and county and replacements thereafter would be approved or rejected by the city and county. The larger board is to be composed of 34 members. This hospital corporation board would set overall hospital policy, select the hospital's chief executive officer, select the executive committee, recommend corporate board appointees to the city and county in the future, be involved in patient community relations, and perform hospital endowment work. The hospital g governing board is actually the executive committee of the larger hospital corporate board and will manage day-to-day implementation of policy, Mr. Havenhill made amotion to have 254 to 33 1/34 of the hospital governing board be composed of physicians. This motion was seconded and tied, Dr. Holt moved to have no less than 254 and no more than 504 of the hospital governing board be physicians. Mr. Monroe seconded the motion and it carried. Following a lengthy discussion of various alternatives for the hospital, DC. Holt made a motion to enter into a 90 day interim contract with Hospital Corporation of America, and during that period of time negotiate with companies which are interested in a longer term management contract. Mr. Hilz asked if we could include that the proposals be on board by July 15. This was agreed. After more discussion, the vote was taken and the motion passed unanimously, Mr. Moore wished to clarify all action taken at this meeting, saying we have established our intent to create a 501c3 non-profit corporation. Ile have set a percentage of physicians for the board, we selected a 90 day interim management company. Ms, Williams stated that the motion was to get a proposal for a 90-day arrangement. Drs. Holt and Killingsworth stated that a company was selected. 148. Williams stated that the figures would have to be acceptable, The Board returned to executive session, pursuant to Article 6252-17, Section 2(g), VATCS, Following the executive session, the meeting adjourned. Transcribed from tape recording, APPROVEDi e ..p I r n HOW 1310ntSerlpture on Street MEMORIAL HOSPITAL Denton, , TX X 76201 (8171 387.8801 ~i C, BOARD ON DIRECTORS IJLi' Thursday, June 20, 1985 7:00 p.m. Medallion Room JUAl 1 8 AGENDA 1. Call to Order IT. Roll Call III. Reading and Approval of Minutos I : IV. Reports of Committees and Officers A. Credentials Committee B. Home Health Advisory Committee V. Report of the Administrator VI. Report of Medical Staff President VII. Report of the Medical. Director VIII. Unfinished Business A. Maxicare Proposal B. Hospital Roof Repair C. Summit Final Report D. Status Report - Nurse-Midwife Program E, Joint Commission on Accreditation of Hospitals N, Budget G. Meeting with Dr. Gershon H. New Elevator I, TWU J. Task Norse Update + K, Critical Care Medical Director L. Mamico M. Other IX. New Business A. Applications for Appointment to the Medical Staff B. Equipment Requests 0. Other X. Executive Session to Discuss Personnel Matters XI. Adjournment BOARD OF DIRECTORS - 1 R MEMORIAL HOSPITAL BUSINESS MINUTES Daie Thursday, Juno 20, 1985 Page l The Board of Directors of Flow Memorial Hospital met in regular session on Thursday, ~j Juno 20, 1985, at 700 p.m. in the Main Dining Room of the hospital. Ms. Mary H. Y\ Williams, Chairman, presided. Members present, Mr. Ralph Havenhill Also prosent, Ms. Linda Brock Mr. George Hilz Mr. Phil Cohen Dr. Don F. Holt Mr. Karl Eason Mr. Brad Moore Ms. Cheryl Gainer tor. Stanley Monroe Dr. M. V. R. Freeman Mr. Dan Trammell Mr. Don Geiger Ms. Mary H. Williams Mr. Bob Herzig Mr. Tom Mazeikas Ex officior Mr. Jeff Hausler Ms. Linda Piatt Dr, Lloyd White Me. Linda Yarbrough Ms. Williams called the meeting to order. Minutes from the meetings of 06/07/85 and 05/30/85 were read and approved as corrected. The agenda of the meeting was rearranged to accommodate the group of citizens present to witness discussion concerning the Nurse-Midwifery Program and the update which Dr. M. V. R. Freeman, Chairman of the Department of Obstetrics & Gynecology, had been asked to present. # Nurse-Midwifery Ms. Williams read a letter by Ms. Linda Brock, Life Planning/ P"ramr Health Services, in support of the Nurso-Midwifery Program. G Dr. Freeman gave a summation of events and information acquired up to this point in time. He stated that the problem was inade- quate care for county patients who were not eligible for assis- tance through the health department and yet were not financially able to seek the care of a physician] and, in conjunction, the inability to obtain malpractice insurance for Lhe physicians who might back up the certified nurse-midwives (CNMs). Dr. Freeman stated that he had received confirmation from one insurance company but only by phone. When he asked the ineurance reprouen- tative if he could have their offer in writing, no written state- ment of insurance coverage was received. Dr. Freeman added that although other hospitals are currently using CNMs, the doctors are doing so without notifying their insurance company. After some discussion, Dr. white added that he believed a possible alternative might be to go outside the country to acquire insurance, such a Lloyd's of London, Dr. White agreed to pursue this possibility, ids, Williams asked if there were any questions from the audience. Ms. Cheryl Gainer, Director of the Nurse-Midwifery Program for Flow, said that she would like to add that this is a nationwide problem for everyone in obstetrical care, she informed the Board that her insurance would continue until its expiration date, At that time Ma. Gainer said they could expect to see an estimated ten times their present premium cost, Ms, Williams asked if anyone could see any reason why the CN148 should not begin prenatal care if nothing else, Mr, Moore said he thought it better to begin somewhere, Mr. Moore made a Y BOARD OF DIRECTORS - FLOW MEMoRrAr, HOSPITAL June 20, 1985 2 otnatailoncare that the certifionroeedsecondnurseed-midwivesmotionanthe bo aldilowtedpasto begin pre- / m. Msed by lr unanimous voice veto. REPORTS OF COMMITTEES AND OFFICERS Credentials Commits Mr, Hausler read the minutes of the Credentials Committee, which were approved by unanimous voice vote. Financial Mr. Eason presented the financial statements dated 05/31/85, r~-- Re ortr Mr. Itllz made a motion to discontinue presentation of the major Vend,)r Analysis, the motion was seconded, and passed unanimously, Mr. Art Weiselogal, Business, Office Manager, was introduced. The above minutes were approved by unanimous voice vote as presented. The financial report, had debt, and charity report were approved as presented. REPORT OF THE ADMINISTRATOR Building Mr. Hausler requested discussion of or concurrence from the Committee, Board regarding planning for the renovation of the following areasr the lobby, administrative offices, emergency roomy medical records, Quality Assurance/Utilization Review Department, physician's lounge, physical therapy, cardiopulmonary, operating room, and ICU/CCU. Mr. Hausler requested that in light of the ` extensive renovations proposed within the hospital that a Building C Committee be created. Mr. Hausler suggested that the committee be composed of Board, medical staff, and members of the administra- tive staff, Mr. Havsnhill made a motion to begin immediately with the planning of these areas, at least to the point of estimating costs. Mr. Hilz seconded the motion. After some discussion the motion to create a committee for the refurbishment of the hospital was passed by unanimous voice vote, Computers Ms. Williams asked what was being done about the need for a new computer system, Mr. Hausler said that we are waiting on two proposals and that it has been decided that we need outside help in selecting a unit. Jeff stated that this is in process, Ms. Williams said she thought a new computer was more important than carpet and asked when they could expect actual information on the subject, Mr. Eason stated that they were shooting for the next Board meeting, but that it takes time to compile information and make comparisons, i Nurss-MidwiEer ' Me. Williams said she understood that the protocols had been P'_o_ tcolsr written but not approved. sonted to the Department of OMr. Vaualer bstetrics &aGynecol had but they been prop declined to sign until the issue of the program isyresolved, had Ms. Williams said she did not understand why they did not sign them, REPORT OF TI1E MEDICAL STAFF PRESIDENT Dr. White reported that the most current situation was the development of quality assurance with the medical staff, as ,,r BOARD OF DIRECTORS FLOW MEMORIAL HOSPITAL 3 June 20, 1985 suggested by JCAH. Dr. Weiss said we do not have adequate C quality assurance with the medical staff but now have guidelines to follow and that he and Dr. Lockwood will be working on that / area, L REPORT OF THE MEDICAL DIRECTOR Dr. Lockwood stated that the JCAH survey was more constructive than critical. He said that they learned a great deal from Dr. Weiss about new programs to regulate quality assurance within the medical staff. This is already underway in Radiology. Dr. Lockwood told the Board that he had been attending as many meetings as he could to let the doctors know what a Medical Director is and can do. lie has been looking into the possibility of subscribing to the Network for Continuing Medical Education for video programs. He is working with Dr. Qureshi on super- vision of the PCU/SCU, and with Dr. McKinney on outpatient and cardiology equipment needs. Mammographic services are booming. Dr. Lockwood showed an advertisement from a newspaper and said that business is good. UNFINISHED BUSINESS MaxiCarei Mr. Hausler reported that the contract proposal is being evaluated by the attorney. He will be meeting with MaxiCare soon. h Roof Repairs This project is underway. The firm has been selected but work r has not begun yet, The coat for both sections is $6,800. Summit. Die, Bob Herzig began this report by thanking the Board for the Final Reports chance to work with them and for the help received from the hospital staff. He then turned the report over to Mr. Phil Cohen, Mr. Cohen went through a list of recommendations for the areas they observed. Mr. Cohan presented to the Board a list of the most significant problem areas observed, lie con- tinued with their proposal. of futur planning, priority objec- tives, and action strategies. Mr. Cohen told the Board that these objectives and strategies would be developed by the hospital staff, medical staff, and the Board. Mr, Cohan then went through each department and gave a summary of what were found to be the most pressing areas of need and gave rocommen- dations for the possible correction of those problems. JCAHs Mr. Hausler said he would present a summation at the next Board meeting. Budg©ts Mr. Hausler stated that the budget had boon presented to the County, and that the City has been sent a copy of the budget. Dr_._Garshons Dr. Gershon, an osteopathic family doctor in tho Pilot Point/ Aubrey area, would like to be considered for the recruitment package. Ile would like to be considered in a joint venture for a radiology suite or room within his office. Ile is from Michigan and was well established there, No formal proposal d.A b 1n f BOARD Or DIRECTORS - rLOW MEMORIAL. HOSPITAL A June 20, 1985 has been developed and he has not yet applied for privileges. New Elevator: Mr. llausler stated that the new elevator was to be installed in July but the company now says it will be September because of problems with the contractor and the manufacturer. Mr, Monroe requested that they be sent a letter telling them we are not happy with this situation. Tt4UI Mr. Hausler has spoken with Dr. Gudmundsen and will be discussing all summer with action expected in the fall. Task rorcei The last meeting of the Task Force was June 23. A subcommittee will be meeting with all of the groups who have submitted proposals to the hospital and has invited the county to participate. Ms, Williams asked if the city was invited. Only those . who were already on the Task Force were invited. This meeting is planned for next week. Critical Care Mr. Hauslor reported that Dr. Qureshi is interested in this Medical Directors position. nr. Holt said lie thought the-position should be advertised, Mr. Hausler noted that the matter has been openly discussed at the Critical Care meeting, where all eligible physicians are in attendance. Mamicos This is the organization which is trying to establish an insurance base in this area. They met with NTSU last week and plan to meet again, Others Mr. Moore stated that he would not vote on any recommendation for a computer that does not come with the recommendation of a large management company such as Summit or HCA, Its said he felt we should look to them and see what they do before going into a new computer upgrade. Low employee morale was also discussed. Applications Applications for physicians wishing to utilize the Home Health to Home Health Service were presented and approved by unanimous voice votas Staffs Drs, John S. Landross, A. Loiselle, John Gunn, J. P. Knochel, Paul Michaelson, J. Teng, and James Dyll. EyApmont Mr. Hauslor stated that we have a request from the Department of RequesCi Anesthesia to purchase six monitors, two with EKG and pressure monitors, one temperature monitor and a strip chart recorder, and four other monitors including just an EKG and stirp chart recorder, The reason for the request is that we have one operating room that does not have a monitor at the present time, and of the five other rooms two moniiors are out of commission and it is likely they will not be lock due to their age, we do have two rented units to fill our needs at this time, Two quotes from PhysioControl and Toktronics (Spacolabs) were given, Mr. Ilavonhill made a motion to purchase either the Toktronics or PhysioControl. Dr. Molt seconded tho motion, and it carried, Mr. Ilausler reported the purchase of three carts for the recovery room and throe for Labor & Delivery. The anosthoaia machines have been delivered, Dr, Molt suggested that the medical staff be notified when new equipment is received. !:4 t I~ BOARD OF DIRECTORS LOW MEMORIAL HOSPITAL 5 June 20, 1985 C Tel-Medi Ms. Williams asked the status of the Tol-Med program. Mr, Hausler stated he would check with Mr. Yoder as he is handling Tel-Mad, Housekeeping Ms, lli1'.iams asked if there had been reductions of staff in and Groundskeeping housekeeping and groundskeeping. Mr, llausler stated that there have been reductions in all areas, and that the poison respon- sible for groundskeeping has been notified of negative comments and given an opportunity to respond. Ms. Williams asked that the awning be repaired, The Hoard moved to executive session, pursuant to Article 6252-19, Section 2(g), VATCS. Following their session Mr. Monroe made a motion to employ Ur. James Killingsworth as consultant to assist Flow in the planning and carrying out of the recommendations of the Task Force and the City and County. The motion was seconded and passed by unanimous voice vote, There being no other business to discuss, the meeting adjourned at 1230 a.m, Respectfully submitted, APPROVED, P-11da Yarb gh, Rea ding Secretary Ralph Havenhill, Secretary , iy f rll`I~ MEMORIAL, HOSPITAL 1310 Scrlplure Street ncnlott, TX 76201 !8171 387.5861 ~ryB3nn,~ns0ike KF~ oe11 BOARD OF DIRECTORS Emergency Meeting Friday, June 7, 1985 12:15 p.m. Medallion Room AGENDA T. Call to order TT• Management Plan for Fiscal Year 1986 III. Adjournment ~i S~ BOARD OF DIRECTORS - F' 'J MEMORIAL HOSPITAL BUSINESS MNUTES bolo Friday, June 7, 1985 _ age 1 The Board of Directors of Flow Memorial Hospital met in a special session on Friday, June 7, 1985, at 12:15 p.mr in the Medallion Room of the hospital. Mary H. Williams, Chairman, presided. Members present: Mr. Ralph Havenhill Absent: Mr. George Hilz Mr. Don F. Holt Mr. Dan Trammell Mr. Stanley Monroe Mr. Brad Moore Ms. Mary H. Williams Ex officio: Mr. Jeff Hausler Also present: Mr. Karl Eason Mr. David Yoder Ms. Kathy Thompson Mrs, Williams called the meeting to order. She explained that the Management Plan for fiscal year 1985 - 86 is the Financial Management Plan for the hospital. She reported that the Finance Committee met on Thursday, June 6, 1985, to raView the budget, some changes were made and Mr. Hilz did approve this budget. The budget does include the HVAC improvements and the computer improvements, Mr. Monroe made a motion to adopt the budget as proposed, the motion was seconded by Mr, Havenhill, By unanimous voice vote the Management Plan for fiscal year 1985 - 86 was approved, There being no other business to discuss, the meeting adjourned at 12:50 p.mr APPROVED I F-"ENfo~ aT`Tp Aaven'51 ecretary ....,n ere u.e..r a Llr llp lY V.11. h BOARD OF DIRECTORS - FLT MEMORIAL HOSPITAL Page 1 BUSINESS MINUTES oa+b Thursday, May 30, 1985 The Board of Directors of Flow Memorial hospital met in regular session on Thursday, May 30, 1985, at 700 p.m. in the Medallion Room of the hospital. Mrs. Mary H. Williams, Chairman, presided. Members present, Mr. Ralph Havonhill Also presentt Mr. Karl Eason Dr. Don F. Holt MMs. r. Don Geiger Mr. Stanley Monroe Ms. Patti Griffith Mr. Brad Moore Mr. Dan Trammell Mr. Willie Lane Ms. Mary H. Williams Dr. R. M. Lockwood Mr. David Yoder r Fx officioI Mr. Jeff Hausler Dr. R. L. White Absents Mr. George Hilz Mrs. Williams called the meeting to order. Minutes from the meeting of April 23 were reviewed and approved by unanimous voice vote. There were no communications to be read. REPORTS OF COMMITTEES AND OFFICERS Finance Committoe Mr. Eason, CFO, reviewed the financial report for the: month of April. Following discussion the Financial Report, Bad Debt, and Charity Reports for the month were accepted by unanimous voice vote. Mr. Eason then presented a Data Processing Report to point out several problems with the existing computer system. Mr. Havenhill made a motion that we find out what it would take to enhance the existing system and/or acquire a new system and have a special meeting when the recommendation is prepared. Mr. Monroe seconded the tgotion and all voted in favor. Mr. Hausler stated that reeommendutions would be sought from consulting groups. Professional Minutes from the meeting of 04/23/85 were reviewed. At this Acti vities meeting the abbreviation list was approved by the committee, Committ_eer a new schedule for reviewing charts was initiated, and records were reviewed for medical records and tissue and transfusion. Critical Caret 'the Critical Care Committee met 05/07/85 to review indicators of care for the Flnargency Room, ICU, and PCCU. In-house deaths and emergency room deaths were raviowed. The medical directorship for CCU was discussed. Joint Conforen_ce, Review of the 05/08/85 minutes provided information about the master plan for the hospital, the upcoming JCAH survey, the newly created position of medical Director, and an update on inappropriate transfers to the hospital. Infection Control 'rho 05/08/85 minutes were reviewed. At this meeting the drug list was reviewed and development of a formulary discussed. Policies and procedures regarding stop orders were discussed. Indicators of care for Dietat,r were presented, as well as those for Infection Control. The April infection rate was 1.14. Flow Memorial Hospital - Board of Directors 2 May 30, 1985 FMH ibundationi The Flow Memorial Hospital Foundation, Inc,, met 05/09/85. It was reported that approved equipment is in operation or on order. Routine business regarding investments and disbursements was conducted. Quality Assurance The minute: of 05/14/85 were presented. At this meeting utilization Utilization review statistics were prevented, the auditor's report given, and Reviews correspondence from NHIC and Medicare reviewed. The Quality Assurance Plan was presented for approval. Dr. Lockwood, Chairman, selected a subcommittee to make the final decision on its approval. Medical The MEC met 05/20/85. Floor plans of building renovations were Executive presented for discussion, The hospital's financial status and capital equipment were discussed. Dr. White welcomed Dr. Lockwood as Medical Director. Recommendations from the Credentials committee for approval of appointments and reappoint- ments to the Medical Staff were recommended to the Board of Directors by the MEC. The Department of Radiology recommended as a result of a survey requested by the MEC, that the privileges of a physician be restricted because it was their opinion that his sonograms were substandard, A motion was made and passed to review other radiological procedures of this physician, Home Healthy The minutes from the Home Health Advisory Committee meeting of 05/24/85 wore reviewed, including information about a home C health aide training program, Medicare denials, and indicators of care. Revisions of the Home Health Policy and Procedure Manual were reviewed and this manual was approved. The Board of Directors approved the Home Health Policy and Procedure Manual I and rr this date, by unanimous voice vote. REPORT OF THE MEDICAL STAFF PRESIDENT Dr. White reported that the medical staff departments are functioning well. The Bylaws need attention and are being worked on and education is continuing for physicians regarding medical staff work, REPORT OF THE ADMINISTRATOR Auxiliarv Mr. Hausler reported a generous donation of the Auxiliary to the Donations neonatal intensive care unit. Meeting with Mr. Hausler reported meeting with Dr. Oudmundsen of TWU, who 7WU Deans verbally indicated a desire to create a stronger affiliation with ' Flow. They agreed to meet again over the summer. Task Forces The task force organized by county and city officials is continuing to meet, Me. Williama requested to have their recommendations by the June Board meeting and stated the Board will have their recommendation regardless of whether the task force has madA a decision Or not. FLOW MEMORIAL HOSPITP . BOARD OF DIRECTORS 3 May 30, 1985 Denton Benefit. The Denton Benefit League donated funds for the purchase of onatl5on:~ - eight EARS units. Retirement: Mr. Hausler announced the retirement of Ms, Ethalee Smith, who was an employee of Flow for 25 years. Master Plan: Mr. Hausler presented floor plans for renovation of the Labor and Delivery Suite and the Medical/Surgical Nursing Station, Dr, Holt made a motion that the Administrative Advisory Committee be authorized to approve the planned renovation if it will cost mor^ than Administration is authorized to approve. The motion carried by unanimous voice vote. A revised floor plan for the Behavioral Medicine Unit was presented. This is a plan to l carry that unit through the next two to three years and has evolved to more than was originally planned, Mr. Hausler also noted that four new beds have been ordered and 54 rooms have been refurbished to date, Elevator: The elevator is on schedule and delivery is expected in mid or late July, Business Office Mr. Hausler announced that a Business Office Manager has been fa--Rger: hired, Mr, Art Weiselogel will begin June 17, Federal wage Mr, Hausler announced that Flow is now under the federal Wage a_nour aw: and Hour Law, which will significantly impact policies and procedures and record keeping, Mental Health Mr, Hausler announced that he met with Mr, Bob Bradford of the Unit. Mental Health Unit, involving new programs available for residential care, Critical Care Mr. Hausler reported that the Critical Care Committee has n t rec or: requested that a director of the critical care unit be secured and stated that he would pursue this. Director of Dr. Via has cancelled his agreement to serve as Director of nes es a: Anesthesia, retroactive to January 1, 1985, Mr, Hausler stated that the Hospital has competent coverage and management through its chairmen of that department. Medical Staff Mr. Hausler provided information about two pc,ssible new physicians ecru menf ffor Flow Memorial Hospital, Dr. Gershon, a family practioner, and another physician who is a specialist in cardiology and critical care from St. Louis. Goals and Mr. Hausler told the Board that the new Goals and ObJectives eat yes: for the institution have been prepared and will be presented with the budget, This is a preliminary document at this stage and is to be reviewed by the Board and some parts of the Medical Staff, Nurse Midwifery Mr, Hausler reported that at the last meeting of the Department Program- of Obstetrics & Gynecology Dr, Freeman introduced the concept of rotation within the department to back-up the Certified Nurse Mid-Wives. Ms, Gainer, director of the service, stated that once protocols are approved then the program can begin, FLOW MEMORIAL HOSPITAL4 BOARD OF DIRECTORS 4 May 30, 1985 Legislation. Significantly legislation passed in the Texas Legislature in the past few days regarding indigent care, Mr. Hausler stated that C he is waiting to see the actual bill in print. The Texas Health Facilities Commissionwill facto out of existance. REPORT OF THE MEDICAL DIRECTOR Dry Lockwood reported that he is getting an idea of where problems exist especially in regard to Medical Staff functions and Medical Staff relations with the Board of Directors and Administration, He said that he would be sending out a news letter to the Medical Staff in the Next few weeks in an effort to make the Staff feel that they are being informed of all i issues concerning them. He also stated that he is attending most department and committee meetings of the Medical Staff. Regarding mammography screening, he stated that this service has been promoted quite well and the number of screenings have gone from three to as many as six to eight per day. UNFINISHED BUSINESS Maxicare Mr. Hausler provided an update on progress with the Maxicare roposa.; proposal and stated that the Hospital plans to take more of a trial period with the urganization before signing the final contract. Attorneys are reviewing the contract document. R~aaddi_ollogi This information was reported above, Services Director; PRO -Memorandum Mr. Hausler provided copies of the revised memorandum of of Understan ng; understanding with the Texas Medical Foundation - Peer Review Organization of Texas. He reported that the document must be signed before June 17, 1985 by all those who wish to participate in the Medicare program. He gave a brief overview of the memorandum's content, stating that it still fails to meet all concerns of 'hospitals in Texas however, for those who wish to continue to participate with Medicare the document must be accepted. Mr. Havenhill made a motion that the document be approved for signature, the motion was seconded and passed by unanimous voice vote. Roof Repair; Mr. Hausler stated that he would be reviewing bids with the Director of Maintenance next week. Prices are considerably higher than was anticipated. Summit Interim Mr. Hausler provided information regarding a meeting between l eeort~:, Board members, himself and representatives of Summit Health which took place in mid-May. Interim recommendations made focused generally on the Business Office, Data Processing and some analysis of JCAH compliance, JCAH: The JCAH survey is scheduled for June 17th & 18th, The Lab will have their survey the week before this, i ~t FLOW MEMORIAL HOSPITF BOARD OF DIRECTORS May 30, 1985 5 Enemy Grant; Mr. Hausler described four (4) recommendations of the consulting C firm regarding the energy grant for Flow Memorial Hospital and stated that our consultant negotiates the final decision regarding this grant. NEW BUSINESS A lications for By unanimous voice vote the Board of Directors approved the po ntment to t e following for appointment to the Medical Staff, as recommended Med ci aT Staff'; by the Medical Executive Committee: Ronald W. Atkins, M.D, - active, Dept. of Surgery, Curtis L. Mosier, M.D. - active, Dept. of Surgery, Allen W, Caruth, M.D, - active, Dept, of Anesthesia. j Applications for reappointment to the Medical Staff were approved If by unanimous voice vote as recommended by the Medical Executive Committee; W. G. Carr, M.D., Michael H. Flynn, Ph. D„ Ray W. Johnson, Ph, D., Jioti N. Patel, M.D „ Lawrence J. Schneider, Ph, D., Paul E. Thetford, Ph. D., W. W. Wrenret, Ph. D. Equipment Mr. Hausler and Dr. Lockwood provided information regarding eguest: possible purchases of Radiology equipment for the near future. They described this equipment and 'indicated that a formal request would be made in the near future, By unanimous voice vote, the Board of Directors resolved to finance the purchase of the Phaco• Emulsifier through the First State Bank of Denton. At 9:45 p,m, the Board of Directors moved to executive session pursuant to Article 1 6252-17, Section 2 (G), VATCS. The regular meeting resumed at 10:15 p.m. The Board of Directors agreed to call a special meeting to evaluate and make a decision regarding the Budget for Fiscal Year 1986, There being no further business to discuss, the meeting adjourned at 10:17 p,m, APPROVED a p aven acre ary it e' BOARD OF DIRECTORS - FL MEMORIAL 130SPITAL d - BUSINESS MINUTES Date April 18, 1985 16 --Jug 4I~+ C.... The Board of Directors of Flow Memorial. hospital m °'r~gq~jr sees. on Thursday, Aril 18, rosided, 1985, at 7100 p.m, in the Medallion Room .-'~~Mg~j;'p;'S~f~•iliams, Chairman, p I Members prosent: Mr, Ralph Havenhill Also present: Mr. Phil Cohen Mr. George Hilz Ms. Cheryl Gainer Dr. Don F. Holt Mr. Don Geiger: Mr. Stanley Monroe Ms. Patti Griffith Mr. Brad Moore Dr, Robert M, Lockwood Mr. Dan Trammell Mr, Bruce Mulligan Ms. Mary H. Williams Ms. F.athy Thompson Ex officio! Mr. Jeff Hausler Dr. R. L. White Mrs. Widlliams called the 3moeting to order. Minutes from the meeting of 03/28/85 were roviewe and approved with one change, in the last paragraph of Page 2, Line 20, the word "renovations" was changed to "refurnishings." Minutes from the called meeting of 04/08/85 were also approved. OLD BUSINESS MaxiCare Proposal: Mr. Hausler reported that the MaxiCare contract is being reviewed by attorneys and will go to the Executive Committee of the Board for approval, Flow continues to work with MaxiCare under a memorandum of understanding at this time, Radiology Mr. Hausler and Dr, Lockwood have been meeting to review the Services Director: contract, which will go to the Exeoutive Committee for discussion. Physicians' Mr, Hausler reported that there were four physicians who did not Liability respond to the question on the reappointment form to indicate if Insurance!, they had liability insurance. He said he had talked with threes of these and each stated he did have coverage, credit. Agreement: Mr. Eason reported that the credit agreement is in final form and being utilized now, both this and the new Financial Admission Criteria will become effective officially on May 1, Architectural Representatives of Harwood K. Smith & Partners will moot with Conaultation: Flow staff on 04/26/85 to review proposed renovations in the Labor & Delivery Suite, Med-Surg Nursing Station, and Behavioral Medicine Unit. NEW BUSINESS j Reviow of Me. Williams noted that the Administrative Advisory Committee is Bylaws: referred to as the Executive Committee, and suggested that the correct name be used. She also requested that the order of busi- ness given in the bylaws be followed. Mr, Monroe moved that the i bylaws be approved without change. Mr, Ilavonhill seconded the f motion, and all voted in favor, The bylaws wore approved this date by unanimous voice vote, BOARD OF DIRECTORS - FLOW MEMORIAL HOSPITAL April 18, 1985 2 C Medical Staff Upon recommendation of the Medical Executive Committee, the ` 7lppointments~ Board of Directors approved reappointment of Bets B, D.O., to the medical staff, with Courtesy Privileges incthock, Department of Emergency Medicine, and appointment of Romeo B. Sangalang, M.D., to the Courtesy Staff in the same departmen#,. Dr. Schenck has been a member of the medical staff since 12/ " but at this time has moved from the Department of internal Medicine to a primary service area of Emergency Medicine. COMMITTEE REPORTS Finance Committee Mr. Eason introduced Mr, Bruce Mulligan of Peat, Marwick, Mitchell & Company, who presented the six month Medicare Cost Report. 'F'inancial statements for the month of March were reviewed by Mr. Eason. A major vendor analysis was presented indicating no accounts past 03/15/85 and Mr. Eason reported all accounts are current, Mr. Monroe congratulated Mr. Eason on an excellent report. Mr. Hilz made e. motion to accept the financial report, bad debt and charity reports as presented. The motion was seconded and carried. A profit and loss analysis of the Behavioral Medicine Unit was presented revealing a net loss for FYE 09/30/84 of $219,240, Ms. Williams requested that this information be given to Dr. Oliver and that he and Administration meet to discuss it. Mr. Eason told the Board that we have a definite problem with C the computer system, as it has reached maximum capacity and can no longer handle all functions. He also presented a letter from PMM with a status report on the Business Office, Mr, Eason reported that upon recommendation of the auditors, a fireproof safe has been acquired for storage of data processing tapes. Medical Records/ Minutes of 03/26/85 were reviewed, including discussion of Tissue & postmortum reports, the abbreviation list, results of a TMF Transfusion: Medicaid review, and routine chart review for medical records. It was noted that the number of delinquent charts is increasing, Home Healthi Home Health Committee Minutes from 03/29/85 were read, Statistical reports of referral sources, Medicare denials, infection control, average length of stay, and a breakdown of patients by age wore noted, Administrative policies were revised and approved. Discharge planning, marketing, and a reduction of "on call" nursing hours were also addressed. Critical Cares Minutes of 04/02/85 were reviewed, including routine indicators of care and review of death charts, duality Aysuranco/ Utilization review statistics were presented at the 04 09 8S Utilization Review indicating a drop in avsraye length of stay at Flo-v' from 9,) in Ling 1980 to 7,3 in 1984. The auditor's report, TMF and Medicare 1• correspondence were presented. Cases of patient transfer to Flow ER were presented for a determination of their appropriatenol ' of medical care. Two of four cases were referred to the medical E%ecutive Committee for action. ~r r l I I BOARD OF DIRECTORS - FLOP! MEMORIAL HOSPITAL 3 April 18, 1985 Credentials Minutes from 04/12/85 were reviewed. On this date the Committees Credentials Committee returned two requests from family practitioners for obstetric privileges to the Department of OD/GYN so that specific qualifications could be addressed. The application of Romeo B. Sangalang, M,D, and reappointment application of Betsy B. Schenck, D.O „ were recommended to the MEC for approval. Medical Executive- Minutes from the MEC meeting of 04/15/85 were read. Tile Director of Quality Assurance presented information about management of patient transfers at another facility. Tha Clinical Dietitian presented information about a now charge structure and the MEC approved the 1983 edition of the DM-1 Hospital Council Diet Manual for use st this :Iacility. Recommendations of the Credentials Committee in regard to requests for obstetric privileges and of the QA/UR Committee in regard to patient transfer cases were approved by the MEC. The MEC recommended the physicians named above for appointment/ reappointment to the medical staff. Postmortum reports and glucometer utilization were discussed, By unanimous voice vote, the above noted committee reports were approved by the Board of Directors. REPORT Or THE MEDICAL STArr PRESIDENT Dr. White reported that the medical staff voted to send copies of letters to other facilities regarding their inappropriate transfers to the Texas Department of Health and the State Board of Medical Examiners. He also reviewed the revisions in the Medical Staff Bylaws in regard to term of office for officers of the medical staff and changing the Medical Records/Tiseue & Transfusion Committee to be the Professional Activities Committee. The Board voted to approved the Bylaws revision. REPORT OF TIIC ADMINISTRATOR • Baylor HCS1 Baylor stealth Care System brought in a team of 14 people to evaluate Flow Hospital and they are expected to make a proposal to lease, manage, or purchase the hospital soon. Denton Childbirth Mr, Hauslor reported that he and members of the Flow staff are Association: meeting with members of DCA, a group active in their opinions of how labor and dolivery should be managed. JCAIIi Mr, Hauslor announced that the JCAH survey will be conducted June 17 and 18, TDII Surveys Mr. Hauslor summarized the results of a Texas Department of Health survey conducted at Flow, which focused primarily on Nursing Services, Dietary, Housekeeping, and the Behavioral Medicine unit. 1'r 1 FLOW MnMORTAI, HOSPITAL - BOARD OF DIRECTORS April 18, 1985 q r ~ There followed a general discussion of the status of the Nurse-Midwifery program, Mr. Hausler a.id Ms. Gainer provided information about the malpractice situation } with physicians and how this type of program is set up at another Texas facility, It was reported that Dr. Freeman, Chairman of OB/GYN, is awaiting written information from insurers who would cover the physicians }tracking the CNMs (certified nurse- ~ midwives). Mr. Hausler stated that he wished to continue on the same course and try to resolve the situation by the next board meeting. I r Ms. Williams asked Mr. Flausler to pursue a relationship between the hospital and f TWU School of Nursing, 1 At 8155 p.m. the Board moved to executive session, Section 2(g), VATCS. The regular meeting resumedatu9:50 pursuant to Article 6252-17, p.m, ~ Mr. Monroe made a motion to approve the contracts between Flow Memorial Hospital and Dr. Robert M. Lockwood, pending review by the hospital attorney and clearing up details. The motion was seconded and carried by unanimous voice vote. The i! contracts are to become effective May 1, 1985. E There being no other business to discuss, the meeting adjourned at 9155 p.m. J Respectfully submittod, APPROVEDI thXN plan, R cording Secretary Ralph Havenhill, Secretary t~ FfOW 1310 Scripture Slreu MEMORIAL HOSPITAL Denton, TX 78201 (817) 387.5861 BOARD OF DIRECTORS + kly2g198 Thursday, May 30, 1985 fit..... J 7+00 p.m. _ C1rYi,;;!-; r Medallion Room AGENDA 1. Call to Order Ir. Roll Call rrl. Reading and Approval of Minutes TV. Reading of Communications V, Reports of Committees and Officers A. Finance committee B. Professional Activities Committee C. Critical Care Committee D. Joint Conference Committee E, Pharmacy s Therapeutics/Dietetics/Infection Control F, Flow Memorial Hospital Foundation, Inc. G. Quality Assurance/Utilization Review Committee H. Medical Executive Committee Vt. Report of the Administrator VIP. Reading of Professional Analysis Report of Medical Sta~f VIII. UrLfinished Business A. Maxicare Proposal A. Radiology Services Director C, PRO - Memorandum of Understanding D. Hospital Roof Repair E. Summit Interim Report F. Status Report - Nurse-Midwifery Program G. Joint Council on Accreditation of Hospitals H. Energy Grant 1. Other rX. New Business A, Applications for Appointment to the Medical Staff B. Equipment Requests C. Other X. Adjournment tt if t .%rr. 10 Scripture Street ~3201 rEORIALHOSPI-rAl, D en(011orr, TX X 768201 (817) 387.8881 80ARD OF DIRECTORS r.i a Thursday, April 18, 1985 APR 1 6 7r0o p,m. Medallion Room MY MANAf AGENDA I• Call to Order TI. Reading and Approval of Minutes 2IT, Old Businoss A. Maxicare Proposal S. Radiology Services Director C. Physicians' Liability Insurance 0• Credit Agreement E. Architectural Consultation IV. New Business A, Review Of Board of Directors Bylaws 8• Medical Staff Appointments V. Committee Reports A, Finance Committee 8. Medical Records/Tissue & Transfusion Committee C• Home Health Advisory Committee D• Critical care Committee E• Quality Assurance/Utilization Review Committee F. Credentials committee G• Medical Executive Committee VI. Report of the Medical Staff President VII, Report of the Administrator Vill, Executive session to Discuss Personnel Matters IX, Adjournment a~ TF LOW 1310 Scripture Street Denton TX 762DI 8201 MEMORIAL HOSPITAL 18171387.5881 BOARD OF DIRtCTOR3 CALLED MEETING Monday, April 8, 1995 6:30 p.m. Medallion Room AGENDA 1. Cali to order It. Consideration of Designation as Charitable Organization III, Educational presentation of. Insurance Program IV, Adjournment s ^4i r r~l ~t POARO OF DIRECTORS -.FLOW AIlsMORIAL HOSPITAL BUSINESS MINUTES , - _ oafs March 28, 1985_..., _P'9' C The Board of Directors of Flow Memorial Hospital met A!'I. ' j f9O;J March 28, 1985, egular session hursday, at 7100 p,m. in the Medallion Room o Williams, Chairman, presided, ry Ft. CI MA AGfAS off Members presents Mr, Ralph Havenhill Also Iresentl Rr. Kati Eason ~ dtr. George Hilz Ms. Kathy Thompson + Dr, Don F, Holt Mr. David Yoder 1 ur. Stanley Monroe tdr. Bradley T. Moors Dir, Dan Trammell Ms. Linda Ashmore Ms :Is, t7ary H. Williams . Cheryl Gainer Mr, Don on Geiger Ex officio: Mr. Bob Herzig Ex Mr. Jeffrey C. Hausler Mr, Henry JohS Dr. R. L. White Dr. R, M, Lockwood 'f Dr. J. H. Oliver The meeting was called to order by Mrs, Williams. Minutes from the meetings of 02/21/85, 03/01/85 and 03/12/85 were reviewed and approved without change. ' At 7104 p.m. the board moved to executive session pursuant to Article 6252-17, l Section 2(g), VATCS, to discuss personnel matters. The regular meeting resumed at 7145 p.m. Ms. -lilliams moved Item IV,J. to the top of the agenda. jLmTit Agreementt Mt. bfoore asked if we have received a copy of the agr wi C Summit Health, Ltd, Ms. Williams stated that she hasethenonlyth copy, IIs. Williams also reported that the Summit consultant will evaluat s od the Baylor recommendations implemented, Mr. Herzigltntheimeeting see if they have IR OLD BUSINESS Medical office Mr. Hausler reported that Mr. Bill Parisi has indicated that he Bui- lain~Cl believes we can still receive funding for the MOB, but the board needs to come to a decision regarding future organization or a . guarantor for a loan. Mr. Monroe recommended that discussion of a name for the building/deferred until development and funding are secured. be Foundation This item will be addressed under the Committee Reports, Rsquestsl Nurse-Midwifery Mr. Hausler reported that the obstetricians who initially expressed , Servic~el a their n interest in backing the nurse-midwives (NMWS) have withdrawn II asauro that if the will continue problem to lnegowith tiate, No malpractice r is required at this time. J~ Admission Critoriat The admission criteria which was presented in January was again discussed, The following sentences of the original document were strickenl Paragraph 3, last sentence (under Self-Pay), Paragraph 5 (Emergency Room), second to last sentence, and the second Paragraph on Page 21 second sentence (under General Hospital Credit Agreemonts). Mr. Moore moved to approve the revised Ij - :s Polito/ Is y 1 { I. BOARD OF DIRECTORS -'FLOW MCN'PTAT• HOSPITAL 2 March 28, 1985 A fission Criteria - Financial, the motion was Seconded, and p ad by unanimous voice vote. Dr. White stated that he would i +e a letter to the members of the medical staff explaining C rLl' the new criteria, City/Countyt ;Is. Williams stated that all of the board members are aware of the city and county's positive response to Flow's request Ear funding. She reminded the board that there will be a meeting of the task force including city, county, and Flow board repre- sentatives on April 10 at 6100 p.m. to discuss issues facing these entities, +MaxiCare Proposalt Mr, Flausler was asked to have an attorney review the MaxiCare proposal. Mr. Monroe moved to authorize the executive committee of the board, along with Mr. Cason, to make a final decision on the MaxiCare contract. Dr. Holt seconded the motion and it carried. Radiology services Dr, Lockwood proposed to the board to serve in a capacity of Directort Director of Radiology at Flow. Included in his proposal were several other areas, such as communication between medical staff, the board, and administration. Fie addressed having a physican in an administrative position as a medical director. Following some discussion of the contract, 1•1r, Moore made a motion to have Mr. Hausler and the executive committee of the board negoti- ate with Dr, Lockwood and bring their recommendations to the board. C The motion was seconded by Mr. Havenhill. Mr, Moore suggested that an attorney also be involved. The vote was taken and carr~ unanimously. JCAHt Mr. Hausler reported that the survey profile for JCAH has been received by the hospital. Ms. Williams asked about the review of the bylaws of the board of directors. It was agreed that these would he provided to the board members and would be addressed at the next regular board meeting. Computer Proposal: The matter of a computer proposal has been put on hold during the 90 day consultation period with Summit Health. Megotiatin~ Mr. Hausler reported that Mr, Doug Adkins of Cardere & Wynne, Attorneyt in Dallas, has been ongaged as the negotiating attorney for Flow in addressing the lease, management, and sale proposalq to the hospital. Other Mr. Hanslor reported that the hospital continues to function under the memo of understanding with Texas Modical Foundation - PROT. No rules or regulations from that entity have been pub- lished and therefore we continue to operate under the memorandum. Mr. Yoder reported that the contract with the elevator company has been signed. That company will work with subcontractors to complete the project. Dr. Hoyt asked if the second floor nursing station could be evaluated by the architects and Mr, Hausler agreed to see that this is done. Mr. Monroe requested that the room renovations begin immodiately, as specified in the recent $10,000 gift for this project. Pis. t•lilliams asked Mr, liausler to follow up nine physicians who did not respond to a question on the reappointment application regarding their BOARD OF DIRECTORS - FL MEMORIAL HOSPITAL :larch 28, 1985 3 Liability insurance coverage, l There was no new business to discuss, COMMITTEE REPORTS cinance_ Committee, Mr. Cason prosentedtho financial report for the month of March, along with the bad debt, charity, and write-off report. Follow- ing discussion, these were approved by unanimous voice vote. Medical Records ~finutes of the meeting of 02/26/85 were reviewed, addressing routine review of tissue and transfusion records. Critical caret At the Critical Care meeting of 03/05/85 routine reports fcr indicators of care and review of death charts were completed, Safet•>> At the 03/08/85 Safety Committee meeting, Mr. Gorton reported that revised safety manuals had been completed and distributed to all departments. Improved systems for managing incident was also discussed. :tedical Cxecutivei The 03/08/85 called meeting minutes were reviewed, in which the committee prioritized requests to the Foundation for capital equipment. j At the 03/18/85 meeting, revision of bylaws regarding formation i\ of a professional activities committee was discussed. Case reviews referred from the Quality Assurance/Utilization Review Committee were also performed, resulting in correspondence from the medical staff president with the chief of staff at a transferring facility, Quality Assurance QA/UR minutes from 03/12/85 were reviewed. Routine reports were given, several easaw of patient transfer from other facilities were reviewed, and the audit report was given. Pharmacy & The P & T/Dietetics/Infection Control Committee met 03/13/85, Therareuticsi addressing questions of dietary consults for patients, the low infection control rate, and a review of the committee's responsibilities,. Foundations At their 03/14/85 meeting, the Foundation voted to purchase two anesthesia machines, a low-close mammography unit, and the Phaco emulsifier. Thoso minutes were approved as presented to the board of directors by unanimous voice vote. Administrator's Mr. Haudler reported that the old CCU is being renovated to Report: accommodate outpatient services, which will begin formally April 22. The Behavioral Medicine Unit has requested development of a locked unit wing. Dr, Oliver explained the need for such a unit, as well as other renovation and repair, Mr. Cason was asked to present a list of write-offs for the behavioral Madicine Unit. Or, Oliver said he didn't know those figures, but believed that the FS ~I " I BOARD OF DIRECTORS FLOW MEMORIAL HOSPITAL ~ March 28, 1985 4 i unit was profitable and should receive a more fair share of i mental health care dollars in relation to mental health earning Mr Eason reported that an analysis of thin is in process and Ile would perform the study, including bad debt analysis. Dr. 1101t made a motion to have Mr, Yoder, Mr, ilausler, a member of the Behavioral Medicine Department, and a member of the board to form a task force to evaluate the needs of this unit and make recommendations. The motion passed unanimously. Mr. Monroe made a motion to go ahead 1 with theremainder of the roof project and authorize Mr. Hausler to accept the best bid for the roof. This was seconded and carried, ar. Elausler announced that Mr. Yoder is now responsible for the Physical Therapy and Medical Records Departments, Mr. Hausler also noted that the CT scan coverage contract now in force with Texscan is not acceptable and alternatives to that service are being evaluated. Dr. Holt suggested that Summit be asked for recommendations in this area. Ms. Ashmore gave a brief update of health promotion activities. There being no other business to discuss, the meeting adjourned at 10x20 p.m. Respectfully submitted, APPROVED why ThOmps~, Recording Secrets' \ v Ralph Havenhlll, Secretary n BOARD OF DIRECTORS - FLO'•r RUMORIAL HOSPITAL _ r BUSINESS MINUTES Doe Monday, April 8, 1985 Balled Meeting The Board of Directors of Flow Memorial Rospital met in a called session +;n Monday, April 8, 19851 at Gr30 p.m. in the Medallion Room of the hospital. 14s. Lary H. II Williams, Chairman, presided. Members presentt Mr, Ralph Havenhill Also presont_I 1•ir. Y,arl Eason Dr. Don F. Holt. Dr. K. L. Ford Mr. George Hilz Pir. Al 'dahlen Mr. Stanley !ionroe Dr. Roger Mullins hir. Sradley T. Moore Air. Bill Parisi Lis. Mary H. 'Ailliams Ats, P•athy Thompson 41 Mr, David Yoder Ex officio, 14r. Jeffrey E. Hausler Dr. R. L, slhite Absent; Hr. Dan Trammels f !i Ms. Williams called the meeting to order. Consideration of Mr. Bill Parisi presented information to the board regarding Designation as_ a possible designation as a non-profit state corporation for the Charitable charitable purpose of hospital care (501c3). Following discussion, Organizationi Dr. Holt made a motion to hire Mr. Parisi and form a non-profit corporation as soon as feasible. There was no second. Xr. ,,Monroe expressed that suggesting such a move to the city and county at I this time would only muddy up the water. The board agreed to defer further discussion until after the meeting between the city, f county, and hospital representativeu. ii ~i Educational Dr. Ford, Dr. :4ullins, and Mr. Hahlen presented information Presentation of about an insurance, peer review, utilization review program Insurance Program that can be marketed to employers. This program is being test marketed in Denton at this time. A general overview of the program's operation and benefits was given. Mr. Moore made a motion to use Flow's name as being initially supportive of the f~ program in this test marketing stage, and that any details of an association would be worked out at a later date, The motion was fII seconded and carried by unanimous voice vote. f other Susinessr The board discussed the five year budget projection to be prov- X111 ided to the city and county, It was agreed that the medical office building, capital improvements, indigent care, and all needs must he included in the projection, Mr. Havenhill stated that the projection must be based on the past record and not what we may hope the legislature will do. Dr. Holt reminded the loard that physicians also provide uncompensated indigent care in addition to that provided by the hospital. Mr. Monroe made a motion to offer a $200 discount on the tdedicare deductible. This was seconded and carried. There being no other business to discuss, the meeting adjourned at 9125 p,m. Respectfully submitted, APPROVEDi thy Th so , Re rding Secretary Ralph Havenhill, Socrdtary . A.r11e ,..b q,. ,look Ch .,,.1N L1.,.14 s• k S FLOW MEMORIAL HOSPITAL BALANCE SIIEliI' March 31, 1985 CURRENT; 1985 1984 _ CUI~RL M 1985 ~ 1484 Cash & Investments $ 686,467 $ 323,660 Current Notes Payable $ 364,898 .~ti $ 226,91,, Patient Receivables 5 405 868 Accounts Payable' 1,175,216 915,558 4,823,207 Accrued Expenses 535,928 448,402 I,esa Allowance ~2.t453,793)_ (2 097 594 Due Govern. Agencies 471368_ 591 916 Net Patient Rec. $ 2,952,075 _ # $ 2,725,613 Other Current Assets 466,486 897,675 Total Current Liabilities $ 2,123,410 - - $ 2,182,786 Total Current Assets $ 4,105,028 $ 3,946,948 Long Term bent 3~ ~ ,293 272 724 J79 1 3~ Total Liabilities $ 2,848,389 $ 3,476,058 ProLetty Plant & Ecui . Land Imporvements $ 183,242 $ 183,242 fund Dalnneei Building 2,951,987 2,943,464 Donnted Capital $ 4,455,779 Equipment 5 077 382 Pled $ 4,455,77. $ 8 212!611 _ 4z$86z810 ges & Cifts 891,297 589,6 , $ 8,016,516 Fund Dal, beg, of yr. (1,521,291) (1,180,404) Lessi Accum. Dep, (5,110,586) (4,697,552) Inc. & Exp. Summary _ 532,879 75 210 Net P. P,& E. $ 3,102,025 $ 3,3I8,964 Tota] fund Bal.. 78998.4 $ 4, 358, 664 $ 3, 789, 854 fetal Unrestricted Funds 7,207 b53V $ 7,2G5~912 Total Unrestricted Puuds $ 73207,053 $ _ 7 265 912 _ - _7 _ I 4 i~ a FLOW MINOR I,,., HOsP 1II',11, [NL'Utll; 5'I'A'I'1't•11iNi' , M;rrch 31, 1'JH5 - MONTH Yf:AR TO DATE 1'111021 ._____.._----------------.-•---.._`.r ACI'UAI; li[JDO[i'f PAIL -Y FAR A("rum, DU[1CIsf VAR. Y711) PATIENT SRRVICE REVENUE'. Inpatient licvct)uc $ 1,670,402 $ 1,449,481 15.2 $ 1,739,037 8,'114,1()2 Out rodent Roventle $ 8)11 ti, 48 ( l.b) $ 7,87'1,413 I 189,938 257 635 5 167,018 1,026,445 944,848 8.6 923,333 ToLrtl Yultont Hevunue $ 1,860,340 $ 1,607,116 1'1.8 $ 1,506,075 } 9,340,607 $ 9,'193,096 1" ( (1) $ 8,71~,74(i DHAIC'I'IONS FROM R11,V14NUJ:: Contractual Adjs. $ 77,457 87,335 (11.3) $ 100,180 505,856 $ 510,598 ( 0.7) $ 496,090 Bad bobts '574,658 171,961 234.'2 217,067 1,77'1,4/18 1,005,061 76.7 1,212,123 Ulhc't' 107,751 - 84,422 27.6 51,116 512,(12( 1i93,42U 9 416, 84 'I'olal Deductions $ 759L870 $ 343,718 121,1 $ 3GH,3Ji3 $ 2,793,330 _ 12 1.._] $ 2,009,079 38: r, $ 2,125,057 Nut Patient Rovneues $ 1,100,470 $ 1,20.3, q9-", (12.9) $ 1,137,712 i 6,547,277 $ 7,384 Other Rovneucs ,017 (11.3) $ 6,610,689 - _3',31j _29,521 27.0 25,179 259,520 175z1)i5 47.5 122.35E 'T'otal Net Revenues $ 1,136,785 $ 1,292,919 (12.1) $ 1,162,891 $ 6,806,797 $ 7,559,982 (10.0) $ G, 793, 045 t11'IiRA'I'1 N0 li\I'1'sN51i5 ( snhrr'les b WageR $ 537,467 $ 572,343 ( 6.1) $ 599,674 3o253,41 $ 3,365,453 ISm)10'ec $cncfite ~ 7 ( 3.3) $ 3,524,936 1 ) 91,811 84,673 814 76,947 465,347 4981065 ( 6.6) 470,169 J'rofrsslonat bees 105,389 121,656 0 3.4) 148,921 902,257 7?9,893 23.6 777,209 Ophcrtlut; 8111)1111 L's 198,758 196,09(1 1.4 ,161 1,099,771 1,170,035 ( 6.0) 1,093,071 r 100, 045 171,6 (8,8) 148,128 845,568 1,059,688 (20.2) 786,015 1'0012 Operating I.xpenscs $ 1,099,470 $ 1,150,208 b,c $ 1r)J 1 ~83 GrG(i lnclanr (hml) t l`1 $ , ~,3(in $ 6,,'23 )134 ( 3.8) $ 616511405 before IlepruciaLlwt $ 43,315 $ 142,711 (69.7) $ 3,06C y 240,437 $ 776,848 (67.4) $ 141640 bopruch t.10n (38,347) (41,000) ( 6.5) ,(39,275) (227,50%) {21,1,000)( 7.5) (234,021) Non-0perating Revcntie 28(;,126 3,691. . _ - iJ,l1.5C _539,9!19 22,146 17 Total Income (LOUK) $ ,._..291,09p $ 105,402 176.2 $ -(24, 65) $ 532,879 $ 512t~94 3.9 $ .(75,2111) na iA } FLOW rIl?Molt l~ 1H031'r'I'Al, COMPARATIVE ANALYSTS ,COUNTS RECEIVABLE; 1 AGING BY DISCHARGE, 1)A1I1E March 31, 1985 % of of DAYS CURRENT MONTH TOTAL PRIOR MONTH TOTAL. 0-30 31-60 $ 1,823,199 35.2% $ 2,032,595 34.7% 61-90 20.9% 984,081 1618% 684,882 12.77 91-120 372 461 G,°/ 59I,620 10.1% 121-150 '5 240,572 4515,471 8,81 151+ 069 1006 19 ,745 6,51 .87 380 ° I $ 5, 3882334 353 23, 1% 100.0% ~ _ 5~85],fi13 100,Q° ACING BY I'n1'P114N'C Ne1'1'l: 0-30 $ 2,576,419 /17,11/ - 31-60 1,303,329 24.2/ 2,742,047 46,2% 61-90 685 070 , 1,208,J08 MAX 91-120 322,769 16.0% 714'447 12.0% 121-150 199,561 J 7% 431,302 7.3% 151+ 301,186 5.6% 273,690 4.6/° _ 561,289 9_5% $ _ 51388,334 100 - 0% $~~5, 431., 023 100.0% REVENU1iS BY FINANCIAL CLASS CURRENT MONTH 3/85_ 2/85 __1/85 12/84 11184_ 10/84 4utljCare $ 455,037 24.5% 28.3% 30.8% 28,1% 20.8% 22.2% >IedICaid 86,111 4.6% 2.9% 2.5% 3.12 2.5% 3.1% Blue Cross 61,704 3.3a / 3.3 5.2/° 6,61 6.9% 5.4/, ° Oommerlca I Ins. 8271649 44.5% 44.11 37.4% 41.41 41.4/ 3clf Pny 429,859 23.1% ° 41.1% 21.4% 23.9/ 22.2/, 28.7/° 26.7% 8 1,860,340 100.0% 100.0% 100:0% 10010% 100.0% J00,Oq )AY5 01: REVENUr IN AA CURRENT MONTH y 2/85 y 1/85 ;toss - 110, l174 121 Jot 60, 60 fig JRT'I'1;01'1+S 6 RIs'COVBRTI(S CUIi1trN'1' r10N'I'il YRAR TO DATE !)176 OU'I.LTIiR5 C3ll(171,111I' rION'I_II YEAR 'I'0 DATE liar lty $~.~244,956 $ 493,202 11 Olscltarllett 4 ---'S lud OOht 780,911 11798,805 over $18,000 lad Ucbt Recoveries 18,830 17,88-3 i r 1 t' y f i 11,014 NGMOR I AI. 110SP [TAi. STATISTICAL STATIiNENT March 31, 1985 CUIIRPNT MONTH YEAR TO )6'I'!s- . - _ PA1'IlN'' UTILIZATION; ACTUAL 1iUDGET % VAR. I'll'IOIt 1'liAll ACTUAL Bl--....I' VAR. PRIOR YEAR Y 2,317 2o811 (17.6) 2,936 14'?52 16,483 -9 _ ( 7.5) I G, 706 Avet'a);e Per Uay~ 74.7 0.7 (17.6) 94 7 78.3 90.6 ( 7.5) 91.3 - Nuwbot'o Pa tlunt I)nys 431 431 (1- - 37~ 1,101 2,646 (16.8) 2 266 - Avuragu Pur Day - - - - _13.9 _ 13.`). -U- 12.0 12. I 14.'i (I6.8) _ 73.1 ICU Pnti(!ut Days_-~_ 123 1.6. (15.8) 1.16 7(19 766 (7.4) 876.__ lurcunt of Occupancy_ 47.-9~ 58.1%' (17.6}.. _ .61 IY- ',O.l- 58, I/ (13.0)' ..Sfi. 3%__. Adrotesionn - 56 5b0 (10.7) 513 3,693 3, I'i3 -'CI-.9)" -3,189- 550 562 ( 2.I) - _534 J,I16 3,130 (0.4) 3,173 Averse Le-n IIof Stn - - - Average b Y_ _ _ _ _ 5.0 4. (1 5-.-S 4.4 ..5.0-. { 1 -2.0) Mudleare & Nedicatd UCiI. 30.5% 30.0% 1.7 _ ~36.27~ 30 57 30.0% 1.7 33.2%v OTHER UTILIZATION: 0.11. Procedures 156 211 {26.1 245 987 1 c c Laboratory 'rests 16,005 15,458 3.5 14,990 89,:!78 90,684 ( 1..6) 1,351 4)_ 91,930 Respirntory Tfler~ :tI Cinants- ~ r2.L 124_ _ 21108 - _-.8 1,976 - 130390 12,364- 8.3 u12,495 _ 9-- - - Radiology fxnms_ _ _ _ _ u - _ 10401 _1~546 9,t+) 1,402 _ 8s.2S7 -9 8 ,063 (.9) _ 582 :mcrguncy Roam Vistts_ 1,278 _ _ -924_ _ 38,.3.- 1,047_ 7,620 .5,924 '18.6 _ 5,970 Physical Ther. Treatmenl"s 479 _ 919_ (47.9) _983_ 3,3110 4,772 (30.0) y 4,92E I)Ictru'y Meals Served 6 1,342 18',814 _(19.1) .191-329.. 99,481, 1.10,x37- 9-9) '111,57.8 PER AMO.'r PATIRNT DAYI Cross Patient Revenue '602.91 $571.72 40,4 $515,96 $_655.39 $569.87 15.0 $535.54 Net 0perntlug Revenue 490.63 459.95 - 6.7 _ 398.39 47'. fi(l 45S. 65 4.1 413.60 _ Operating Expenses- _ - 488.48 423.77 15.3 410.79_ 476.70 428.87 11.2 419.'!.3 i:. Income from Operations 2.14 36.18 {94.1) (12..41 _ ) 9 1 _ '-25. _ 6. - - - _78_ _ {99}_. _ LAROR COST MANAGRMEN'ri 1/ull Time Equivalent E;mployee_ _ 353.5 370.8 ( 4.71 409.1 367.7 370.8J 1 0.8) 408.2 I.T.E. Per Adult i'ntlent Ony_ - 4.7 4.l 111.6 4.4 4.) 4,1 14.6 Payroll os n Y. of 'Co Gil l:xpenaes 471 5~ 48.1%_ of Occupancy based on operational beds Currnot Mottth - 5442% 4 I r n HOW 1310 Denton, Scripture Street Denton, , TX 76201 MEMORIAL HOSPITAL (817) 387.5881 2 6 BOARD OF DIRECTORS Y U~ )n fU i CnYt,4AN,+,rr,' ^'fICF Thursday, March 28, 1985 700 p.m. Medallion Room A G E N D A 1. Call to Order II. Reading and Approval of Minutes r III. Executive Session to Discuss Legal and Personnel Mattors IV, Old Business A. Medical Office Building 1. Funding 2. Development 3. Name B. Foundation Requests C. Nurse-Midwifery Service - Update D. Admission Criteria E. Cityy/County . M&x3.CaYe Pxopar~al O. Radiology Services Director H. JCAH - Joint Commission on Accreditation of Hospitals 1. Computer Proposal J. Summit Agreement K. Negotiating Attorney , V, New Business VI. Committee Reports A. Finance Committee B. Medical Records Committee i i Agerida ' Flow Memorial Hospital Hoard of Directors March 28, 1985 page 2 of 2 C. Critical Care Committee D. Safety Committee E. Medical Executive Committee (03/08/85) F. Quality Assurance/Utilization Review G. Pharmacy & Therapeutics/Dietetics/ infection Control H. Flow Memorial Hospital roundation, inc. 1. Medical Executive Committee (03/18/85) VTT. Report of the Medical Staff President VTTT. Report of the Administrator TX. Adjournment M i t BOARD OF DIRECTORS P")W MEMORIAL HOSPITAL BUSINESS MINUTES Dale Tuesday, March 12, 1985 Page 1 C The Hoard of Directors of Flow Memorial hospital met in a called meeting on Tuesday, March 12, 1985, at 600 p,m, in tho Modallion Room of the hospital, Mrs, Mary H, 14illlams, Chairman, presided. Members presenti Mr, Ralph Havenhill Also presentr Ms, Linda Brock Mr, George Hilz Mr, Karl Eason Dr. Don F, Holt Ms, Cheryl Gainer e1r, Stanley Monroe Ms. Patti Griffith Mr. Brad Moore Mr, Bob Herzig € r4 Dan Trammell Ms, Kathy Thompson ~r Ms, Mary H. Williams Mr, David Yoder Ex officio: Mr. Jeff Hausler L. White Ms. Williams called the meeting to order, He, Thompson summarized the action of the previous meeting of the board (03/01/85). At 6j40 p.m, the board moved to ' executive session, pursuant to Article 6252, Section 2(g), VATCS, At 8104 p,m, the regular session resumed, Or anizational Mr, Moore made a motion to enter into a short term management j nlternativest contract with Summit Health care for 90 days, beginning as soon as possible, but not later than April 1, Further, the executive f committee of the board will make decisions as to negotiations during that period, Mr. Hilz seconded 'he motion and it carried by unanimous voice vote, Ms. Williams stated that she would appoint an ad hoc committee of Mr, Brad Moore, Dr, Don Holt, and herself, to talk with the entities proposing management, leaso, and/or sale contracts, during the time of the short term management with Siunmit and while the city and county are discus- sing a long term solution to Flow's situation. Midwifery Medical Mr. Hausler reported that the physicians had withdrawn their Directors proposal to back up the nurse midwives, Radiology services After s(xne discussion, Dr, Holt suggested that the board continue Directori to review this proposal, Mr. Monroe made a motion to dafor action on this matter until the moxt board meeting. This motion passed unanimously, MEC Requests Minutes from a called mooting of the Medical Executive Committee Capital rqui Wont refloating prioritization and recommendations to the Foundation to purchase capital. equipment was provided. Mr. Hausler gave updated information regarding the prices of this equipment, Mr. Havenhiil moved to present this list to the Flow Memorial Hospital Foundation, 2ne., at their board meeting on Thursday. This motion passed by unanimous voice vote, Executive S ssionr At 8120 p.m. the board moved to executive sossion, pursuant to Articlo 6252-17, Section 2(g), VATCS, The meeting adjourned at 9r01 P.M. Respectfully submitted, APPROVEDI I~ ~ thY 'Chrppn, Re ordinq Secretary Ralph Havanhill, Secretary I HOW 13 10 Scripture Street MEMORIAL HOSPITAL. Denton, TX 78201 (817) 387.5661 ~ r ~ rsa~ l ' BOARD OF DIRECTORS 01 q, Tuesday, March 12, 1985 600 p.m. Medallion Room AG ENDA 1. Call to Ordor II. Organizational Alternatives III. Midwifery ',Iedical Director rH,jytil,, IV. Radiology Services Director V. Adjournment } 5 _BOARD OF DIRECTORS - BUSINESS MINUTES fIOSPI'1'AL Dale - - Friday, ti arch 1, lm5 Page l The Board of Directors of plow ttemorial Hospital met in a cal !l r March 1, Nilliams 1Chairmant2;15 p,m, in the Medallion RC'Om of the hospiaals on eeSMra, riday, , presr.dod, hlarI If. Alembers resent, Dr. Don p, tfolt hlr, SCanle A1so resents tar, Karl F'.aaon Mr, Bradley Monroe Y T. ;7ooro Mr. Don Geiger bfr, ban Trammell tae, Kathy Thompson Its, 'Iary H, I.11113ams Rr, David Yoder l Ex officio t ar, Jeff Rausler Members absonti Dr. R. L. Nhite Mr, Ralph tfavenhill Mr. George uilz The meeting was called to order b ~ Y Ms, Williams, I OLD BUSINESS i 51t Count punk i -Y Mr. Monroe moved to revise an earlier motion regarding request, No resolved to ask Denton County to make Available dtog us immediately the funds set Up in et f thp U of Flow Hospital ($297,000 or 7/12 ofetheborriginalr$500,000) J without restriction as to the use of the funds; however, we port should advise both governing bodies who own plow Hospital that t this money will be used to apply against our accounts payable, Further, we should ask the city and county to make available to us an additional sum of $400,000 for use during the current fiscal year without restriction, Dr, Holt seconded the motion and added that plow has done close to $4 million in uncompensated cars, and this is a short term move, not a final solution, tars, 1 Williams asked Mr. Eason, CFO, if the financial situation is continuing to escalate, Mr. Eason stated that we are beginning to see some turnaround in cash receipts and are making progress. Mr. Monroe stated that he is hopeful that the city and county officials will recognize the gravity of this situation, tars. Williams noted that a permanent solution was asked for last She noted that there are two issues here, one short term and one long term. The vote was taken on Mr, Monroe's motion, and hear, Passed unanimously, Le....,gyl Prososalsi Two proposals for providing legal services to the hospital which had previous.ly been mailed to board members were discussed, Mr Trammell mado a motion to hire an attorney on an as needed basis and not under retainer, hlr, Moore seconded the motion, and all voted in favor, The motion carried, AltornativeI 0rganizational t4s, Filliams stated that this Stem was on the agenda for the purpose of general discussion. Silo stated that Mr. Ilautler had boon naked to request proposals from aompnnios who manage hospitals for any arrangement lease, management, or sale, hausler reported that many proposals have boon received to date, National Medical Enterprises (NME) was askedto provide a short Mr term, trial proposal, and this is expectod at the and of next eare week (OJ/09/95), tor, Moore stated k tms hatfr afterom ruviow, it a tr'MB amd !1Cl1 are abably the two Fir whom we might sock hide for management, temporary management, or management lease, motion to meet again after the NME - bryYS ._1 BOARD OF DIRECTORS rLOW ;!r,%ORIAL HOSPITAL 2 March 1, 1985 C proposal is received. The motion wds seconded and carried, Dr, bolt "uvther resolved to decide at that special meeting if we want to enter in a management contract and if we want to engage a law firm to negotiate with proposing companies. This motion was seconded and all voted in favor, IMN BUSINESS Mid;uife~rr The board discussed the terms of the proposal by physicians to Medical Director: provide back-up to the nurse midwives. Following executive session (see below), it was agLced to consider this contract and discuss it at the next meeting, Radiology At. this time the board moved to executive session, pursuant to 'dedical Director; Article 6252-17, section 2(g), VATCS (1;47 p.m.). At 1;59 p.m, the executive session was concluded. Dr, Holt made a motion to have the two contracts reviewed by an attorney and to discuss them at the next (called) meeting of the board, The motion was seconded and all voted in favor, Dr. Holt then left the meeting. There being no other business to discuss, the meeting adjourned at 202 p.m. Respectfully submitted, APPROVED; r t Kathy Thom o , Reco ding Secretary Don F, Holt, Gt,D „ Vice-Chairman i F:T-jGW MEMORIAL HOSPITAL '310SCRIPTURE (1117)387.5061 DCNTON, TEXAS76201 ! 9 2 ~/90S B O A R D O F D I R E C T O R S c~ CALLED MEETING Friday, March 1, 1985 12115 p.m. Medallion Room Flow Memorial Hospital A G E N D A 1. Call to Order II. Old Business A. Request for City/County Funding B. Legal Proposals C. Organizational Alternatives III. New Business A. Midwifery Medical Director. B. Radiology Services Director IV. Adjournment S6AVINO DENTON COUNTY SINCE 1950 5 =s s FLOW MEMORIAL HOSPITAL 1310SCRIPTURE (817)887.5861 DENTON, TEXAS 76201 1 B O A R D O F D I R E C T O R S Thursday, February 21, 1985 7lOO p.m. Medallion Room Flow Memorial Hospital A G E N D A I. Call to order 11. Reading and Approval of Minutes III. Peat, Marwick, Mitchell & Co, Audit Report IV. Old Business A. Master Plan B. Medical Office Building 11 Development/Management Contract 2. Name C. Elevator Proposals D, Phaco Emulsifier E. Selection of Hospital Attorney P. Midwifery 5e;rvice G. Reappointments to Medical Staff H. JCAH Application I, Insur.ar a Policy Review J. Capital Budget Prioritization K. Admission Criteria L. Guest Relations M. other old Business V, New Business A. Texas Hospital Insurance Exchange Surplus Call B, RelioAnsure C, Maxicare Propose! D. Other New Business SERVINO DENTON COUNTY SINCE 1960 t ~t Flow Memorial Hospital - Board of Directors Agenda - Thursday, February 21, 1985 page 2 of 2 Vi. Committee Reports ' At Finance Conueittee B. safety committee (01/11/85) C. Quality Assurance/Utilization Review (01/15/85) D. Critical Care Committee (01/22/85) E. EKG Committee (01/22/85) F. Joint Conference committee (01/23/85) G, Home Health Committee (01/25/85) H. Medical Records/Tissue & Transfusion (01/29/85) 1. Critical Care committee (02/05/85) 3. Safety Committee (02/08/85) K. Quality Assurance/Utilization Review (02/12/85) G. Medical Executive Committee (02/18/85) Vill Report of the Medical Staff President Viii. Report of the Administrator I tX. Executive Session X. Adjournment i _ I BOARD OF DIRECTORS - Y" I MEIMORIAL HOSPITAL BUSINESS MINUTES Date Thursday, February 21, 1985 Q %5 E, Pegs 1 CI TM, 04';' The Board of Directors of Flow Memorial Iospital met in r y bn vhursday, { February 21, 1985, at 7100 p.m. The meeting was hold in the Medallion Room of the j hospital and Ms. Mary It. Williams, Chairman, presided, i Present: Mr. George Hilz Absentt Mr. Ralph Havenhill Dr. Don Holt 11 Mr. Stanley Monroe Also presents Mr, Karl Cason f tar. Bradloy T. Moore Ms, Kathy Thompson Mr. Dan Trammell Mr. David Yoder Ms. Mary 11, Williams i--~ Mr. Don Geiger Ex officio, Mr.. Jeffrey 2. 11ausler tir. Henry Jobs j Dr. R. L. white Mr, Bruce Milliken Mr. Larry Rayburn II j Ms. Ruth Tansey The meeting was called to order by Ms. Williams, Minutes from the meeting of 01/24/85 were read and approved. i Audit Reporti Rr. Larry Rayburn of Peat, Marwick, Mitchell and Company (Pmm) !I reviewed the financial statements and schedules for the year f ended 09/30/84, with audit report thereon, as well as a letter to management on internal control and accounting procedures. He highlighted the most significant findings from these reports for thu board, emphasizing that uncompensated indigent care is j damaging the financial stability of the hospital and suggesting ~I that more support from owner entities be sought as a necessary step in maintaining the financial viability of the hospital. Mr. Rayburn stated the evaluation of internal controls revealed no material weaknesses and that accounting systems are sound. Following a brief discussion of these reports with board members, Messrs. Rayburn and Milliken departed. OLD BUSINESS Master _Plant The final master plan document from Harwood K. S-Uth & Partners was presented and accepted by the board. Medical Office A proposal from integrated Health Resources International, Inc., building, for development of the medical office building (MOB) was presented. Mr, Monroe moved to postpone discussion of this proposal until it is known if funding f. the project is approved, Mr. Hilz seconded the motion adding that time is needed for board members to examine the document, The motion carried. or, Holt made a motion to postpone discussion of the name of 1408 until the next meeting. Mr, Monroe seconded the motion, which passed by unanimous voice vote. Eleyntor proposals Mr. Hausler proposed the installation of a new elevator in an existing shaft behind the visitors' elevator, It was his i recommendation to accept a bid from Esco for the olevator and structural work for $53,003, as this was th-3 lowest bid and is the same company the other elevators arc serviced by, Mr. Moore moved to approve this purchase as proposed by Mr. 11ausler, Mr, 1111z seconded the motion and it carried. 1 ` t BOARD OF DIRECTORS GLOW MEMORIAL HOSPITAL 2 rekfrLiary 21, 1985 Phaeo Emulsifier; Consideration of approval to purchase the Phaco emulsifier was deferred until the next regular board meeting, selection or Mr. Hausler suggested that this decision he deferred until the Ho. fk Attorneys next regular board meeting because one of the proposals had not yet arrived. The board agreed with this, ;Midwifery Services Mr. Hauslor reported on the activities of the nurse-midwives and stated a contract is being negotiated for physician back-up. Reappointments to Reappointments to the medical staff of the hospital were approved r~ Medical staffs as recommended by the Medical Executive Committee for calendar years 1985 and 1986, f` JCAH Ap2lication2 Mr. Hausler informed the board that he had made application to the Joint Commission on Accreditation of Hospitals for survey. Insurance Policy As requested of him at the January board meeting, Mr. Trammell ReViewi reviewed the insurance policy for directors and officers and reported this date that he believes the policy coverage is adequate. Capital Budget Mr, Hausler described activities undertaken to prioritize capital Prioritizationi equipment requests within each medical staff department. Because of the current schedule of meetings, not all departments have had the opportunity to determine their prioritiosi therefore, the Medical Executive Committeo plan a special session to address this matter after each department has met and before the next meeting of the Foundation, Admission Criteria. The admission criteria proposed at the January meeting was again - discussed. Mr. Cason reiterated the auditors' warning that the hospital cannot continue to operate as we are now and expect to remain viable. The board generally agreed with the standpoint of the admission criteria, but requested that it be evaluated by an attorney before action is taken. Mr. Hausler will see that a legal opinion is procured. Guest Relationai Mr, Haunter reviewed activities of Guest Relations Week, including films on patient relations, telephone etiquette, and other efforts, other= Mr. Monroe made a motion to immediately apply to Integrated Health Resources international, Inc., for the funds that they have advised us might be available. The motion was seconded. Mr. Moore asked if the financing proviously discussed was tied to the proposal for development of the 1408. Mr, Hausler stated he would investigate this. Mr. Moore stated that if these two items are not tied to one another, then he was in favor of the motion. The motion was amended to ineluder if this funding is not contingent upon acceptance of a development agreement for the medical office building. The motion carried, Mr. Monroe then moved to ask Denton County to make available to us immediately the funds set tip in their budget for the support Of Clow lospital ($500,000), loss any payments made to date, without any restriction as to the use of the £undsl however, we I i BOARD OF DIRECTORS - FLOrr MEMORLIL HOSPITAL. 3 February 21, 1985 should advise both governing bodies who own Flow hospital that this money will be used to apply against our accounts payable; anti, to ask the city and county to make available to us an addi- tional sum of $250,000 for use during the current fiscal year. Dr., Holt seconded the motion, amending that we don't consider this amount adequate to cover the $4 million lost last year through uncompensated care. The motion was brought- to a vote and carried. NEW BUSINESS T1112 Surplus Call Mr. Hausler reported that the Texas Hospital Insurance Exchange r~ -1 called for the second half of an assessed surplus payment of $47,291, and this was paid to them on 02/15/85. Following a brief discussion of hospital and physician liability, Mr. Itausler was asked to conduct a survey and report on the number of physicians on the medical stai'£ who carry medical liability insurance. P,alicensure: Mr, Itausler informed the board that relicensure of the hospital has been applied for through the Texas Department of Health, MaxiCare Proposal: A proposal from the firm which bought the First Texas Medical LIMO was presented for approval. This contract arranges for treat- ment of HI-10 patients at Flow. Mr. Hilz moved to accept the Memorandum of Understanding with a 60-day drop-out clause, Mr. Monroe seconded the motion and it carried. Other: Mr, Monroe moved to formally recommend to the City of Denton and Denton County the stablishment of a 50103 nonprofit corporation, The motion was seconded, Mr, Trammell recommended that the matter and its legal aspects be investigated further. Mr. Monroe withdrew the motion. COMMITTEE REPORTS Finance Committoei Mr, Eason highlighted the financial statements for the month of January, 1985. Those were approved as presented by unanimous voice vote, Mr. Eason reported that the 10% discount offered had resulted in $58,901 in payments to the hospital. The majority of these wore in the 0 to 30 day category, while the next largest response was in the 120 day category, Mr. Eason suggested that a discount for payment within a specified time, such as ten days, be considered, Mr. Ililz wished to defer this matter to the Finance Committee. A letter from Post, Marwick, Mitchell & Company (PMM) describing the results of their review of the November, 1984, internal financial statements, was presented to , the board and discussed. A memorandum to PMM, responding to the Audit Report Management Letter, was also reviewed by the board. Mr. Eason noted that Mr. Bill RLchards of PIALM will begin the second phase of consulting work in the business office on Thursday. An equipment proposal for Sr °nstat data processing system was 1 presented by Mr, Eason, alo.-. with justification, a five year cost comparative, systems eomparativo with the current McAuto system and upgrades of the McAusto system with the currant lease and with a now five year lease. Following discussion of the systems, Mr. Monroe moved to defer all action on this matter until the next meeting of the board, Mr. Hilz seconded the motion and stated I30ARD OF DIRECTORS - FLOtd MfiMORIAL HOSPITAL February 21, 1985 that board members would continue to evaluate the alternatives C proposed. Mr. Eason noted that concerns can be addressed in the terms of the contract with Nfostat , while the terms with McAUto are already set. The vote was taken and carried unanimously. Xr, Hilz moved to approve the charity and bad debt reports of $30,676,94 and $74,338.69, respectively, for the month of January, the motion was seconded, and carried, safety Co;nmitteer Minutes of the Safety Committee meeting of 01/11/85 wero reviewed and approved. l -1 Quality Assurance :4r, Hausler highlighted minutes from the O/UR Meeting of 01/15/85 Utilization Review including social service report, introduction of rho new audit coordinator, policies for preprocodure certification with TMF-PROT, a summary of patient cpsestionnairos, and review of medical care evaluations. Critical Caroi The Critical Care Cornmitteo minutes of 01/22/85 were read. These addressed routine reports from the emergency rcom, critical care units, review of death charts, and addressed a case review that could not be completed because of a late autopsy report, Coverage for physicians whose privileges have boon suspended because of delinquent medical records was discussed. rKG Committees The EKG Committee minutes of 01/22/85 wato also roviewed, covering / routine review of EKG readings and discussion of the physician ` billing service, Joint Conferencor Mr, Hausler highlighted minutes of the 01/23/85 meeting which included discussion ofs the master plan, medical cffico building, responsibilities of the committee, a marketing plan, and organiza- tional alternatives. Nome Healths items The minutes of the Noma Health Committee meeting of 01/25/85 were firevienalwded. policysrevisionsvagardingonon-stafflphysician referrals to the service, Policies were also revised to comply with new Texas Department of Health regulations. Medical executive Minutes of the 01/23/85 meeting were reviewed. Case reviews, Committees reappointments, a visit by NHTC and TMF, and equipmont requests to the FMV foundation, Tne,, were discussed, The administrator's report addressed roorgnnization of patient care areas, Dr, ford described changes in 1,iboratory procedures for blood screening, urinalysis , and noted that a physician's order is required for pathology consult if it is to be reimbursed under DRGa. Departments of the medical staff will establish their own dofihition of "reasonable distance" in regard to proximity I:o the hospital while on call. PAtiont transfers from other facilities to the Flow SR wore discussed. Modi-~ cnl Racortsr The 01/29/35 meeting of the Medical Rocorda/Tissue & Transfusion Committee were reviewed, including approval of a now 26em for Cardiopulmonary Services, documentaLion requirements for outpnt'iant services, correspondence from Wlr~PROT, and tho incomplete/delinquent and suspension lists. BOARD OF DIRECTORS - PI,Ow MEMORIAL HOSPITAL 5 Pebruary 21, 1985 Critical Cares Minutes from the meeting of 02/05/85 were read, At this meeting routine reports were given for the emergency room, critical care units, and death charts were reviewed. QA/UR Committoes The QA/UR Committee met on 02/12/85, Minutes reviewed reflected summary of a TMr taro visit, utilization review statistics, tho auditor's report, and DRG statistics by physician, tor. Vento presented a referral form for use by physician advisors. TMF and Medicare newsletters were presented, as were patient questionnaires, Patient transfers were also discussed. ;Medical ExeCUtiVe Minutes from the MEC meeting of 02/18/85 were presented. The Committeet administrator's report addressed renovation of elevators and the financial status of the hospital, The master plan and bylaws revisions were discussed. Prioritization of capital equipment was also discussed. In departmental reports, emergency medicine addressed again issues of inappropriate transfer from other institutions to flow ER, The now policy for crodentialing of physicians who utilize Home Health Services on a referral basis was approved an presented, These minutes wore reviewed by members of the board and approved as presented by unanimous voice vote. REPORT Or THE MEDICAL STAFr PRESIDENT Dr, white stated that since becoming medical staff prosidnnt, ( medical staff business is becoming more and more complex, lie noted that the AMA and TMA have established medical staff sections. Considerable strides J.n streamlining medical staff functions have been made, Dr, white also said many concerns have boon expressed to him about the board's intentions in regard to alternatives for the hospital, REPORT OF THE ADMINISTRATOR Medical Staff. Mr. Hauslor presented a proposed policy for discounts to members Discount Policy: of the medical staff and members of their immediate family, recommending that the balance of the charges incurred be written off, after insurance, for up to 25% of the total bill. There was no objection to this policy and it was approved, uarterly thployee Mr. Hauslor reported that the quarterly employee meetings were Moetingas held recently and loss comment and response than usual was received, He Pelt this was a positive indicator, Employee of the Mr. Hauslor reported that Me, nutty Whitley was awarded Employee Months of the Month for robruary. OP Services$ An Outpatient Services Task rorco Ilan been formed and in developing policies, procedures, and protocols for these newly organized services, Ambulatory surgery is targeted to begin an n formal program 04/22/85, rTral Me, Hauslor statod that 24 of 31 rTS reductions due by the end of rebruary have boon effected. The goal is expected to be met, - i BOARD OV DIRECTORS - FLOW MEMORIAL HOSPITAL PObruary 21, 1985 6 VHE Servicesr Mr, Flausler reported that he had responded to correspondence from voluntary Health Cnterprises regarding services they offer in the area of ambulatory surgery units, skilled nursing facilities (SNFs), and long term care (LTC) facilities, tts will meet with their care epres alentativternatives regarding possible assistance in pursuing such es, P64d Proposals Mr, Hauslor presented a proposal from Peat, Marwick, Mitchell and Company to implement the second phase of their proposal to work with the business office, This involves consultation in the office on a weekly basis to oversee implementation of recommendations from the first phase of their proposal. Mr, Moore moved that this proposal be approved as planned, the motion was seconded, and passed by unanimous voice vote, Videotacei Mr, Hauslor told the board that the tape of the documentary "Crisis at General Hospital" is available for them to view, Ms. Williams oxpronaed that she wished the city and county officials could see the program, Ms. Tansey suggested a joint meeting to view the program and discuss it. There being no other business to discuss, the meeting adjourned at llj06 p.m. Respectfully submitted, APPROVEN #Lhyrh Ison, Raco.ding Secretary Ralph Itavenhill, Secretary , i A FLOW MEMORIAL HOSPITAL 1310SCRIPTURE (817)387.5861 DENTON, TEXAS 76201 Fee 8 ft BOARD 0F D 1RECT0-R r Tuesday, February 19, 1985 7:00 a.m. Medallion Room Flow Memorial Hospital A G E N D A 2, Call to Order 11. Review of Organizational Alternatives Ill. Adjournment SERVING DENTON COUNTY SINCE 1060 4 FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS BUSINESS MINUTES Dal* Thursday, January 24, 1985 Pa go The Board of Directors of Flow Memorial hospital met in regular CessiOn on hJanuary 24, 1985, at 7100 p,m. in the Medallion Room. Mrs, tdary H, Williams, presided, Membeesontl Mr, Ralph Havenhiil Aiec present_1 Mr. Karl Eason Mr. George Hilz Ma, Patti GriffitDr.. Don F. Holt Mr, Don Geiger rr - Mr. Stanley Monroe Mr, Ralph Hawkins Mr. Brad Moore Mr. Scott Miller Mr. Dan Trammell Mr, Bob Smith Me. Mary H, Williams Me. Kathy Thompson Mr. Jeff Haueler Mr. David Yoder Dr, R. L, White Ma. William,, called the meeting to order. Minutes from the meeting of 12/20/85 ware read and approved. Presentation by Messrs. Hawkins and Miller of Harwood K. Sm.1.th & Partners Arohitectal presented the final master plan for FMH, reviewing floor plane on illustration boards, Mr. Hawkins reported that the final master plan document will be delivered to Mr. Hausler no later than Friday, 02/15/85, A four phase program of construction will be included in the plan, permitting hospital operations to continue while construction is underway, The entire project y would take approximately 53 months to complete if there were no breaks between the phases, A fifth phase would be the removal of the behavioral medicine unit to a freentanding facility, if this move were not possible, then an addition to the hospital would be required, Audit Reports Mr, Haueler reported that the audit report would be presented at the February board meeting, OLD BUSINESS Master.Plan1 The master plan was addressed earlier by HKS, Medical Office Mr. Hauslor related that construction meetings have begun with Building) representatives of engineering firms, HKS, and the development group. Financing has not been applied for as the audited financial statements are not yet available. By way of the executive committee of the board, the traditional construction method was chosen rather than the fast track. Certificate of There were no new developments to report regarding the suit eedi appealing the First Texas Medical (PTM) CON. Nurse Midwife Mr, Hausler stated that two certified nurse midwives have been Pr- ocram~ hired and are now drafting protocols, policies and prooedurss, and working to establish the program along with administration, cc Actual services will begin when these details have bean worked out, Clinical space is being sought for the nurse midwives. Mr, Haueler noted that the program includes prenatal, postnatal and postpartum care, Ms. Williams requested that details be worked out with the county before space is acquired and various aspects of the program are finalized. BOARD OF DIRECTORS - FLC EMORIAL TIOSPITAL January 24, 1985 2 Reappointments Mr, ttaus.ler explained that the Medical Executive Committee's to Medical Staffi meeting became rather lengthy and it was decided to continue that meeting on 01/28/85. Reappointments, along with other business, were deferred until that meeting. Mr. Monroe moved to have the reappointments, upon review by the MEC, reviewed by the executive committee for approval. This motion was seconded and carried. Selection of Mr. Hausler reported that he had contacted firms Hospice?. Attorney regarding providing legal services for the hospital, but had - \ not yet received proposals. The board requested that proposals be presented at the February meeting, Development of Mr. Hausler told the board that the revised draft for development Medical Office and management of the MOB construction was sent to Thompson & Building- Knight, Mr, Hausler will meet with Masers. Sutton and Parini on 01/28/85 to review the attorney's suggestions, Me. Williams reminded those present that the executive committee of the board was authorized to make a final decision on this contract and that they will be contacted when the final contract is ready to be approved, Me, Williams asked if delays in the schedule to develop the master plan had affected the cost of the project, and requested a report on this from Mr. Hausler before the next board meeting. In response to Mr, Monroe's questions about `application for financing, Mr, Eason, Chief Financial Officer, explained that the board must accept the audited financials before they can be finalized and that the final audited financials are required before application can be made, NEW BUSINESS Introduction Mr. Hausler introduced Mr. Karl Eason who has accepted the position of CM1 of chief financial officer with Plow. Elevator Proposals Mr, Hausler described a move effective 02/04/85 in which the the pediatric wing will be moved to the third floor and surgical and medical floors will be combined on the second level. Effi- eienciss expected to be accomplished with this move were explained. One strong objection to the move involved the old and somewhat unreliable elevators and the need to move surgery patients between floors, Me, Hausler presented a proposal to replace the two existing elevators for $80,000 and noted that some structural work will be needed (public elevator near front lobby and the elevator near Radiology and OR). Board members preferred to vote on the entire proposal, including bids for structural work. Phaco_Emulsifiere A cancellable order has been placed for a PhAeo emulsifier, Mr. Hausler reported, This equipment was budgeted at $45,0001 however, the actual price will be $49,900. This equipment willbe brought for approval of purchase at the February meeting, ( r d!~ The application for reaecreditation survey has been received by Me. Hausler, He reported that responsible parties are being sent portions of the standards manual so that they may begin preparing for survey. BOARD OF DXRGCTOR9 - .,OW MEMORXAL HOSPITAL January 24, 1985 3 Insurance Policy, Copies of the directors and officers insurance policy were sent to board members, Mr, ttausler asked that he be notified of any concerns regarding this policy, Mr, Monroe asked Mr. Trammell to review the liabilities policy for possible errors and ommisions. COMMITTEE REPORTS r-~ Finance Committee, Mr. Hausler reviewed and highlighted the financial statements ( for December, 1984, Me. Williams requested that the budget be reviewed on a quarterly basis to consider response to changing trends, Me. Eason presented a major vendor analysis which outlined accounts payable and percentage of major vendor to total accounts payable, A hospital credit agreement which would be signed by a patient upon admission and permit the hospital to charge interest on the patient account was also presented, Mr, Eason explained that the agreement was contingent upon review by the hospital attorney. Mr. Moore moved to accept the agree- ment as presented, Mr, Hilz seconded, and the motion carried. Mr. Hausler will see that the document is reviewed by an attorney, Mr, Eason proposed to offer a ten percent discount to all payors to pay their bill in full. This would be a one time offer for a specified period of time and would be advertised in the news- paper as a public notice. Mr, Moore moved to initiate this one r time program as proposed by Mr. Eason and Mr. Hilz seconded the motion. Following discussion the matter was brought to a vote, Mr. Monroe opposed the motion and all others voted in favor. The motion carried. Also presented was an admission criteria that would refer non- emergency, non-indigent, and non-charity patients who have an existing bad debt with the hospital to another facility, Mr, Moore moved that this document be accepted however, after some discussion it was agreed that the document should be reviewed by the board members and addressed at their February meeting, Mr. Moore withdrew his motion. Mr, Eason presented an analysis of Medicare/DRO charges and reimburaemants. The weekly financial report was discussed and Mr. Eason suggested that it be changed to reflect outliers. The financial reports were approved as presented by unanimous voice vote. Critica~ Cara, Minutes from the ritical Care Committee meeting of 12/04/84 were reviewed, reflecting routine quality assurance reports and review of death charts, Safety Committee, Safety Committos meeting minutes from 12/07/84 were reviewed, Policy and procedures for preparation and administration of chemotherapeutic drugs were approved, incident reports roviewed, and subcommittees appointed to review and recommend changes in disaster procedure manuals. ,wcd BOARD OF DIRECTORS - FLO1 I'MORIAL HOSPITAL January 24, 1985 4 Cf Quality Assurance Minutes from the meeting of 12/11/84 were presented. At this \ Utilization Review meeting UR statistics were reviewed, nursing activities reported, and the auditor's report wan given. A case was reviewed as a possible inappropriate transfer, Medical Executive Activities of the Medical Executive Committee from their 12/17/84 meeting were reported by Dr. Lockwood at the December board meeting. At that time Mr. Hausler gave an update to the MEC on the hospital's cash flow status, ER call coverage by suspended physicians, the master plan, and restructure of the meeting schedule of the medical staff was discussed. P & T Dietetics The Pharmacy & Therapeutics/Dietetics/infection Control Committee Infection Control met 01/09/85. Reports were given by Infection Control, Nutritional Services, and the Pharmacy. FMFt~Ft Foundation ~ The Flow Memorial Hospital Foundation met on 01/16/85. Their minutes were reviewed, including routine financial reports and maturation of investments. Officers of the Foundation were re-elected for another term by acolamation, The Foundation board requested to see a list of capital equipment needs that wculd meet their criteria at the next meeting. Medical Executive Minutes from the meeting of 01/21/85 were presented by Dr. White. l! Canmittee1 " T the his meeting grew into a rather length review and discussion of C` and pasroposed the following & Partners The aforementioned minutes were read and approved by the board by unanimous voice vote. REPORT OF THE MEDICAL STAFF PRESIDENT or, White described delays inherent in the currant medical staff system and its saquenoo of meetings. He stated that he would be working with others to resolve this problem and operate he medical staff more effectively, Dr. Holt suggested that the matter of medical staff organization be addressed at the Planning Committee meetings. REPORT OF THE AbMINISTRATOR Utilization The hospital's Utilization Review Plan was presented for ratifl- Review Plana cation. Mr. Hausler explained that this was the same plan which we have been working under throughout 1984 and that it was pre- sentdd without change. Mr. Havenhill moved that the plan be approved, Mr. Hitz seconded the motion, and the motion carried, Guest Ralatonsr Mr, Hausler reported that the Health Promotion Department is providing insorvioe and orientation to improve employee relations, C~ nttitudos, and communication among hospital staff and patients. Onetta Survav Tor 'ir National Heritage Insurance Company (Nt[IC), the intermediary for +±-~TC Medicaid, and Texas Medical. Foundation (TMF-PR0T) have scheduled BOARD OF DIRECTORS =4 MEMORIAL HOSPITAL 5 ' January 24, 1985 a visit 01/30/85 to review ancillary services and procedures under Medicare and Medicaid. They will also be meeting with physicians in a summation conference to explain their findings, Medical Office Mr. Hausler recommended that the board begin to consider a name Building Names for the MOB sr> that it can be used on the sign for the project, the drawings, etc, Mr. Monroe stated he wished to defer this until the next meeting. Tel-Med systems Installation of the system was to have been completed this date. Medical staff members have been given a list of available tapes and the library can now be ordered, Joint Conference Mr, Hausler reported on the Joint Conference Committee, which met Committee) 01/23/85, Thov expressed a desire to pursue possibilities of alternative care facilities. Health Promotioni Beginning Friday, there will be a now program on KDNT radio oallad "Focus on Flow," Contacts have been made with Victor Equipment, TatraPak, eeterbilt, Kiddie Korral, and the Benefit League concerning possible health screening and other projects with them. The TetraPak program is already underway, Medical Office Mr, Hausler notified the board that he has a list of construction Building: ` firma recommended by HKS and that he would like to know of any other local firms that they would like to have notified for bids „ C FTC Reduction) Mr. Hausler reported that efforts are continuing to reduce FTEs to more appropriate levels, He stated there are plans to reduce 30 FTEs by the end of February, and that 13,6 would be by attri- tion, Ile proposed the elimination of existing security force and designating one maintenance staff member to serve in thin capacity 'so that 24 hour coverage would still be provided. This move was approved by the board, Another possibility for reducing staff would be to restructure the schedule for the cafeteria, Mr, Hausler said he would continue to work with the foodaervice director on this. Dr, White recommended that the dietitians be involved no that food available to staff and visitors would be nutritious, EXECUTIVE SESSION At 10r14 p.m, the board moved to executive session, pursuant to Article 6252-17, Section 2(g) VATCS, ADJOURNMENT There being no other business to discuss, the meeting adjourned at 11110 P.M. Respectfully submitted, APPROVEDI Kathy Thompson, Recording secretary Ralph Havenhill, secretary page 1 FLOW MEMORI HOSPITAL STATISTICAL STATEMENT January 31, 1985 CURRENT MONT9 YEAR-TO-DATE tie Actua Pr or ear u ge Actua Pr or Xear 2,934 2,425 31146 Adult Patient Days 10,855 9 565 10 94.7 78.2 101.5 Avg. Per Day ,930 340 88.2 77.8 88.9 5122 299.3 Newborn Patient Days 11832 1,446 11565 161 144 167 Avg, per day - 14.9 11.8 12.7 184 164 152 ICU/CCU Patient Days 572 493 610 16,116 14,424 1592 O.R. Procedures 693 643 679 Lab Tests 21198 21569 35, 069 Rasp. Ther. Treatments 581141 58r946 62,817 853 $39 811 1 ~7 9,577 11612 1,307 1,572 Phy, Thor. Treatments 31096 21210 31119 19,638 16,235 19 605 Radiology Exams 5,967 5,438 4,507 Dietary Meals Served 72,709 67,208 73,746 11031 1,005 987 E.R. Visits 3,976 5,325 3,906 WRITEOFFS A RECOVERIES MOAN T11 CHANTY COUNTY PAYMENTS BAD DEBTS _LAD DEBTS COLLECTIONS Oct. - Dec. $ 80,895 $ 32,113 $716,674 $ 90,119 January 30,677 f 74,339 131794 $111,572 $ 32,113 $791,013 $103,873 P f1 ~2 FLOW MEMORIAL. HOSPITAL INCOME STATEMENT January 31, 1985 YEAR-TO-DATE CURRENT MONTH Budget Actual Prior Year Budget Actual Prior Year PATIENT SERVICE REVPNUEJ $ 1,558,741 $ 1,333,395 $ 1,434,809 Inpatient Revenue $ 5,413'969 $ 50100,05 a $ 5 610,153 t 146860 161,035 146,242 Outpatient Revenue , $ 1,505,601 $ 1,4941430 $ 1,5811051 TOTAL PATIENT SERVICE REVENUE $ 6,023,403 $ 517ti4,064 $ 5,835,505 DEDUCTIONS FROM REVENUES $ $ $ $ 81,781 $ 102,224 $ 1310700 Cou~,ractual Adjs. 327,477 344,072 274,1. 644,504 646,046 570,391 1 099 157,231 155,584 Bad Debts 316 410 &3_4F3 0 206 09 79 090 73 375 60,080 other 79 2j,9 2 830 47,364 Total Deductions from Revenue 2 8 31 1 0 0 $ 1,183,631 $ 1,161,600 $ 1,233,687 Net Patient Service Revenue $ 4117354,,01832 5 4,464154,,82!026 4,.77844,,509 742 26,659 29,622 19,x32 Other operating Revenue $ 1,210,290 $ 4,849,847 $ 4,618,853 $ 4,859,251 101910222 $ 1,252,719 Total Net Revenue $ OPERATING EXPENSES 214,439 $ 2,229,213 $ 2,355,809 $ 515,109 $ 552,528 $ 604,648 Salaries & Wages $ 2, 324,819 308,655 325 683 77,129 790731 87,664 Employee Benefits 474,100 649,437 505,864 1090700 157,783 141,420 Professional. Fees 760,719 710,831 706,598 176,906 214,787 186,036 Operating Supplies 51 ,773 707,431 671,6'" W- 5 1965420 165 414 __1382 117 Other 8 9 $ $ ~ $ 10075,304 $ 1,1701240 0 1,177,883 Total Operating Expenses 4,625,850 4,6010967 4,865,627 $ 1340986 $ 20,982 $ 74,834 Income (Lose) from Operations $ 223,997 $ 17,286 $ 293,624 3,691. 30,287 14,764 105,480 24 ,44.2 7,316 Non-operating Revenue $ 138,661 $ 51,269 j 2j150 Excess of Revenue Over Exp. $ L3kJ7 $ 122,766 318 0.6 i 5 { Page 4 FLOW MEMORIAL HOSPITAL BALANCE SIMET January 31, 1985 ASSETS LIABILITIES AND FUND BALANCE Currents 1985 1984 ~,urrentt 1985 1984 Cash b Investments $ 394,707 $ 347,645 Current Notes Payable $ 283,639 9 187,28. i Patient Receivables Accounts Payable 1,964,349 1,1690324 (Nat of Allowances) 3,220,046 31074,371 Accrued Expenses 423,211 405,347 Other Current Assets 999,246 19006,548 Due Government Agencies _ 47,36 63" 6,469 Total Current Liabilities $ 2,718,567 $ 2,398,423 Total Current Assets $ 4,613,999 $ 4,428,564 Lang Term Debt 11209,683 11259,934 Total Liability $ 399280250 $ 3,658,357 Property, Plant & Equipments Fund Balancaj Lend & Improvements $ 183,242 $ 183,242 Donated capital $ 4,455,779 $ 4,455,779 Building 2,951,987 219430464 Pledges & Gifts 7950052 569,396 Equipment 5,065,363 41884,926 Fund Balance beg. of yr. (1,521,291) 0080,40/j.N $ 8,200,592 $ 8,011,632 Revenue & Expenses Summary _ 122,766 31800 Less Accum. Dopr. (5,034 ' 035) (4,6191002) Total Fund Balance $ 31852,306 $ 4,162,837_ Net P, P & E .32,16 3 6 557 31392s630 Total Unrestricted Funds $ 70780,556 708211194 Total Unrestricted Funds $ 7,780,556 $ 71821,194 ryry.Ia+wVb -li. i s j page 5 FLOW MEMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS January 31, 1985 Current Month Year-To-pate Beginning Balance 137,322 f o , 71T Cash Received from$ Active Patient Accounts $ 11085,328 $ 30668,714 Bad Debt Accounts 13,754 103,873 Cafeteria 9,978 41,969 Appropriations/Donations 49,949 2330947 Other 40,540 124,297 Total Cash 1r 199 549 4 152 800 TOTAL CASH AVAILABLE tea,` 41193,591 Cash Disbursementst Payroll 436,100 21001,641 Payroll Taxes 66,287 276,666 Patient Refunds 3,069 17,482 Capital Assets 125,919 154,944 Notes Payable 38,419 122,796 Other 543x194 115231979 Total Disburesments 1 240 788 4,0971W 8 Cash Balance Cash Investments TOTAL CASH i ~e u 4 i na p page 6 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY January 31, 1985 ~ of Primary Payor Current 31-60 61-90 91-120 121-150 150+ Total A/R - Medicare $ 501,092 $ 282,161 $ 237,892 $ 139,810 $ 55,221 $ 180,038 $1,396,214 ?"_'5% C Medicaid 28,312 26,050 16,689 26,554 71132 39,221 143,948 2.74 f Blue cross 74,69P 49,506 49,062 22,275 13,642 209,183 4.04 Commercial ins. 450,887 329,701 100,707 94,367 44,614 10020,276 19.44 Self-Pay 246,B43 238,799 368,877 299,395 218,768 it 19,488 _21492,170 47x4% $lL301,832 $ 926,217 _773,227 582 401 $ 339,377 ,61,338,737 $5,261,791 100.0 356, 759 In-House Total Accounts Receivable $5,618,550 A/R by % 24.,74 17.68 14.79 11.18 6.5% 25.4% Days of Revenuei Accounts Receivable 113.4 In-House 7.7 Total 121.1 ,'ti r SI f' ge 7 r ^ FLOW MEMORIAL HOSPITAL AM ACCOUNTS PAYABLE SUMMARY January 31, 1985 Current 31-60 6190 91+ Total Trade Vendors $ 327,077 $ 376,050 $ 216,914 $ 474,596 $ 10394,637 Fees Payable 113,249 73,975 79,950 40,493 307,667 Accured Payables 630115 63,115 Estimated Payables 161,480 161,480 Audit Fees 37,E+50 - 37,_450 Total 702,3.7.1 $ 450,025 296:864 515,089 1 ,964 349 ~ t ~i M i Page 8 FLO14 MEMORIAL HOSPITAL OPERATING INDICATOR REPORT January 31, 1985 CURRENT MONTH YEAR-TO-DATE 9-30-84 Budget Actual Variance Budget Actual Variance Actual FACILITY UTILIZATIONt 10,855 9,565 (1290) 51,730 1. TOTAL ADULT PATIENT DAYS 2,994.7 2478.2 ((016 5) 8812 77.8 (10,4) 86.9 2, AVERAGE DAILY CENSUS 5717% 50.1% (7.6%) 56.6% 4919% (6.7%) 55.7% 3. PSRUNST OCCUPANCY 584 517 (67) 2,164 2,047 (117) 6,353 4. ADISISSIONS 586 497 (89) 2,170 2,044 (126) 6023 5, DISCHARGES 5.0 4.3 (•7) 510 6, AVERAGE LENGTH OF STAY 5.0 4.6 (.4) 30,0% 30.8°!, (.8) 32.9% 7, MEDICARE & MAOICAIU UTILIZATION 30.0% 32,8% (2.8%) PER ADULT PATIENT DAYt 8, GROSS PATIENT SERVICE REVENUES S 412.51 G91~18 1478.647 $ 455.90 $ 602.62 41.72 44.78 482.89 36.11 $ 443.411 9, NET OPERATING REVENUES 366.54 482.57 (116,07) 426.15 481.08 54.93 10. OPERATING EXPENSES 46.01 8.65 (37.36) 20.63 1.81 (18. ' 82) 5.16 11, INCOME FROM OPERATIONS 437.95 WRITE-OFFS AND COLLECTIONSt 8010 121.1 41.1% Same as 10107 12, GROSS DAYS IN PATIENT A1R current 71.8 13, NET DAYS IN PATIENT A/R' 6010 69.0 month. 14, BAD DEBT EXPENSE AS A 11.5% 13,7% (2.2%) 18.3X % OF OROSS PATIENT REVNEUE LADOR COST MANAOEMRNT1 40 15. FULL TIME EQUIVALENT EMPLOYEES 370.8 366„9 3.9 370,2 370.18 (2'8) 4.6 16, F.T420'e PER ADULT PATIENT DAY 3.4 4.7 (.8) 7% 47.9% 48,4% (,9X) 90,3x 17, PAYROLL AS A X OF TOTAL EXPENSES 47.9% 47.2% ' v ,i- .fry. n .w ¢.\iph',14. rr.muavN low r d FLOW MEMORIAL HOSPITAL 1J10SCR1PTURE (847) 387.5861 OENTON, TEXAS 76201 BOARD OF DI RECTORS ~,(l 211985 Thursday, January 24, 1985 7:00 p.m. Medallion Rcom A G r N D A I. Call to order IT. Approval of Minutes Ill. Presentation by Harwood K. Smith & Partners 1 IV. Peat, Marwick, Mitchell & Co, Audit Report V. Old Business 4. Master Plan 3. Medical Office Building (MOB) C. Certificates of Need D. Nurse-Midwife Program E. Reappointments to the Medical Staff F. Other Old Business VI. New Business A. Introduction of Chief Financial officer B. Elevator Proposals C. Phaoo Emulsifier D. Joint Commission on Accreditation of 11onpitals E. Directors and Officers Insurance Policy F. Other New Business Vii. Committee Reports A. Finance Committee 8. Pharmacy & Therapeutics/Dietetics/Infaotion Control C. Safety Committee D. Department of obstetrics & Gynecology E. Quality Assurance/Utilization Review P. FMN Foundation, Inc, a. Medical Executive Committee VIII. Report of the Medical Staff President SEAVINQ DENTON COUNTY SINCE 1960 "s t Flow Memorial hospital Aoard of Directors Agenda Thursdity, January 29, 1985 Page 2 of 2 IX. Report of the Administrator X, CXecutive session X1. Adjournment I i i r • FLOW MEMORIAL HOSPITAL t30ARO OF DIRECTORS I.XI BUSINESS MINUTES Do. Phursday, nocember 20, 1985 Peg~ 1 11` 1 The Board of Directors of Clow Memorial fospital mat: in z~gu'!ar ~session on Thursday, December 20, 19841 at 700 p.m, in the ttedallion Room. t a..-,P1a~y H. Williams, I Chairman, presided, Present, Dir. Ralph flavenhill Absents Mr. George Hilz Or, Don Holt Mr, Stanley Monroe Mr. Bradley T. Moore Mr. Dan Trammell Ms, Mary H, Williams Mr, Jeff Hausler Dr, R. M. Lockwood 1 N Ms. Kathy Thompson j Mr. David Yoder i Rr. Don Geiger, Denton Record Chronicle !i The meeting was called to order by Ms. Williams. Minutes from the meeting of 11/29/84 f were reviewed and approved, as well as those from the 12/03/84 called meeting. OLD BUSINESS I 'taster Plan, Mr. Hausler reported that he had met recently with Messrs, 1+~ and Mont Parisi and Sutton of Integrated Health Resources, International, Ino., regarding their proposal of a development management agree- ment for the medical office building (MOB). Mr. Monroe moved that the hospital begin accepting bide for construction as soon as possible, Dr. Ho.t seconded the motion, Mr, Monroe indicated that a minimum of three and perhaps as many as six bids should be taken to determine the lowest price for the eonstruoticn project. Mr, fiauslor asked if price would be the only consideration, and Mr. Moore replied that it would not be necessary to accept the lowest bid, but that he agreed with Mr, Monroe on the number of bide that should be taken. A vote was Vaken and the motion passed unaiimously, Mr. Hausler reported that the revised draft from Integrated Health Resources, International, Inc. had boon passed on to the attorney, The revision includes items noted by the board members and will be roturnod to the board for a decision. Me. Monroe made a motion that the executive committee of the board be appointed to make a final decision on the contract. The motion was seconded and passed by unanimous voice vote. O NI A suit has boon filed in the case opposing the First Texas Medical (rTM) hospital, Mr. Hausler reported there was no other now business regarding the CONS at this lima. Nurso-Midwives, Mr. Hausler reported that a second nurse-midwife has been interviewed and Me, Gainer plane to biro her. lie will set up an interview for tho prospective NMW with the appropriate physicians and expects that she will accept the position, it I! was emphasized Lhat the actual NMW program will not begin 01/17/85, as some time will be needed to establish policies And procedures, i . +1M 71 re .+IIrt X11..11/sI U.. /I,Ha I..,.1. N,I IN V.1-. FLOW MEMORIAL HOSPliV, - BOARD OF DIRECTORS December 20, 1984 2 NF'-J BUSINCSS Reappointments Mr, Hausler reported that the :Medical Executive Committee had to ,,+ledlcal staff, defcirred final Processing of the reappointments until the January meeting of that group, it was agreed to temporarily reappoint the medical staff as is until the January meeting, Dr, Holt moved that this motion he ratified by the board, Mr, Havenhill seconded the motion and it passed by unanimous voice vote. Selection of Mr, Monroe requested an update on the selection of an attorney Hospital ,lttornev for the hospital, Mr. Monroe moved that Mr. Hausler contact any firma he feels are qualified and make arrangements to present proposals at the next meeting of the board, The motion was seconded and passed by unanimous voice vote, COMMITTEE REPORTS finance Committoet Mr, Hausler presented the financial statements for the month of November, along with the bad debt and charity reports, Following discussion Mr, Moore moved that these reports be accepted as presented, The motion was seconded and passed unanimously. Tissue & Minutes of the Tissue & Transfusion/Medical Records Committee Tra~ nsfusion/ Medic` a1 Rtoords, trmeeting of ansfusion charts was made,~ieThe.inoomplete/dolinquent1list was C presented by the Director of Medical Records, There were no suspensions during the most recent review iod and the delin- quoney/incomplete rate was considerably lower than it had been for some time, CKG Committee, Minutes of the 11/27/84 meeting of the EKG Committee meeting were read, Discussion of the billing service for physicians and review of EKG readings took place. "Me Health Minutes of the 11/30/84 Home Health Committee meeting were reviewed, At this meeting the procedures for eredontialing physicians for "home health privileges were discussed, as well as a policy revision for infection control, a summary of the Medicare audit, and routine statistics, A program evaluation for fiscal year 83-84 was presented and 1988 goals and objectives presented, These minutes were approved unanimously by voice vote, as presented. REPORT OF THE MEDICAL STAFF PRESIDENT Dr, Lockwood 8ummariZ0d the Medical Executive Committee meeting of December 17, He reported a long discussion about staff work, relationship of doctors to the hospital, and stated that the committee resolved to evaluate tho way it runs itself, A motion to change the medical staff bylaws so that the chief of staff serves a two year term was approved and passed on to the genera sat their meeting 12/18/05, and will be taken to n vote atthe February general meeting, Dr, Lockwood also reported that the committee fools that the chief of staff holds a significant position requiring him to r FLOW MEMORIAL HOSPITAL - BOARD OF DIRECTORS 3 December 20, 1984 spend more time on staff work, The committee recommends a partial reimbursement for the time devoted. The 5oquency and timing of medical staff and departmental meetings were also discussed, Dr. Lockwood told the board that one of the most interesting and eye opening of his duties as chief of staff was participation in the board meetings, and that it had broadened his notion of how the hospital works, Dr. Holt presented Dr. Lockwood with a plaque from the board, administration, and staff of FMH, and read a poem in his hom.r. r Dr. Lockwood reported that the lov dose mammography unit has been installed and in operation for oi,o week and he will be working with the Director of Health Promotion to promote the service, ADMINISTRATOR'S REPORT Baylor Proposal, Mr. Hausler reported that he has received a proposal from Baylor on strategic planning, it is a five phase program and will be distributed to the board members, City Updates Mr, Hausler presented a copy of the report which was given to the City of Denton by Ms, Williams, The resolution presented was approved 12/04/84, Business Officer Peat, Marwick, Mitchell & Co, have presented a proposal for involvement in the Business Office. The first phase, which is to s analyze the current system and determine needs, will cost the hospital $7,500 and was authorized by executive committee poll. The consultant will begin after Christmas. Ultrasounds The ultrasound unit for obstetrics has been delivered and is in w. use. The unit was purchased by the Foundation and policies and procedures were developed by Dr, Freeman, Mr, Hausler reported that rate increases have been submitted to Blue Cross, There were no new developments to report on the TMF-PROT contract, The agreement with the Director of CCU has been terminated, Mr, Hausler presented the full preliminary report from the Task Force on Indigent Health Care (September, 1984). Mr, Hausler reported to the board a need to oxtand an outstanding note at Pilot Point Bank. Mr. Moore moved that this be approved, Mr. Monroe seconded, and the motion passed. Information regarding Dr. Freeman's genetic screening service was presented to the board. Mr. Hausler chocked with PIA regarding their plans to build a facility in Flower Mound, They stated they have not filed an application for CON and might s consider working with Flow on a project. At 800 p.m. the board moved to executive session pursuant to Article 6252-17, section 2(g) VATC9, There being no other business to discuss, the meeting adjourned at 905 p.m, Respectfully sukmitted, APPROVEDs K thy Th on, Reoo ins socratary Ralph Havenhill, Secretary 1 E s page 1 FLOW MEMORIA., HOSPI'T'AL STATISTICAL STATEMENT ii December 31, 1984 CURRENT MONTH i Y11AR-'I'O-1)A'PF Budget Actual Prior Year Budget Actual Prior Year 21506 21238 21409 Adult Patient Days 71921 71140 71708 1 80.9 72.2 77.7 Avg. Per Day 86.1 77.6 8318 476 394 470 Newborn Patient Days 11310 1,156 11279 15.3 12.7 15.2 Avg. Per Day 14.3 12.6 13.9 134 134 165 ICU/CC11 Patient Days 411 349 443 163 149 155 O.R. Procedures 509 475 527 13,790 15,820 16,523 Lab 't'ests 43,613 37,797 47,225 11882 2,250 21742 Resp. Ther. Treatments 5,943 61147 7,008 673 376 697 Phy. Ther. Treatments 2,193 11631 21308 1,379 10400 1,572 Radiology Exams 41355 4,169 41507 16,804 1.60449 17,720 Dietary Meals Served 53,071 50,727 54,141 971 11235 913 E.R. Visits 2,945 41320 21919 s WRIT13OFFS_&_RECOVERIES Y BAD DEBTS MONTH CHARITY COUNTY PAYMENTS BAD DEBTS COLLECTIONS October $ 51,624 $ 32,113 $ 122,417 $ 38,147 November 15x494 131,427 33,926 December 13,777 4621830 18,046 $ 80,895 $ 32,113 $ 716,674 $ 90,119 i page 2 FLOW MEMORIAL HOSPITAL INCOME STATEMENT December 31, 1984 CURRENT MONTH YEAR-TO-DATE Budget Actual Prior Year f~ud~cet Actual Prior Year PATIENT SERVICE REVENUE: $ 10310,209 $ 102500776 $ 1,316,395 Inpatient Revenue $ 4,055,193 $ 3,766,659 $ 3,7905543 1481793 176,669 143,248 Outpatient Revenue 4621609 5021975 - 463,9)' $ 11459,002 $ 10427,445 $ 1,459,643 Total Patient Service Revenue $ 40517,802 $ 4,269,634 $ 4,254,454 DEDUCTIONS rROM REVENUE: $ 79,377 $ 94,951 $ 49,573 Contractual Adjs, $ 245,696 $ 241,848 $ 142,496 156,113 156,434 142,489 Bad Debts 4830405 4906815 414,807 76 641 76 077 54 414 Other/Charity 237 320 234,545 146 329 ~3T2~T3T $ 7;fi62' $~'~fifi,Q, 76 Total deductions from Revenue $ ` 9 1%T 967;208 $ 703;632 $ 1,146,871 $ 1,099,983 $ 1,213,167 Net Patient Service Revenue $ 30551,381 $ 31302,426 $ 31550,822 29,521 29,724 165374 Other Operating Revenue _88,176 125,205 E53 !O $ 1,1761392 $ 11129,707 $ 1,2291641 Total Net Revenue $ 3,639,577 $ 3,427,631 $ 316069532 OPERATING EXPENSE: $ 572,343 $ 556,685 $ 587,735 Salaries & Wages $ 1,699,330 $ 1,672,685 $ 11750,11, 82,362 73,656 96,485 Employee Benefits 247,690 228,924 2J8,0, 121,068 182,446 126,870 Professional Fees 364,400 491,654 363,444 193,941 132,352 183,385 Operating Supplies 583,773 4969044 522,562 216,829 180,292 169,010 Other 655,353 542,020 _ 513,556 $ 11186,643 $ 11125,431 $ 1,163,485 Total Operating Expenses $ 31650,546 $ 3,431,327 $ 3,387,742 $ [10,151] $ 4,276 $ 665067 Income (Loss) from $ 895011 $ (31596] $ 2810790 Operations .31691 262117. 7,563 Non-Operating Revenue 11,073 750193 __17,126 $ (6t46 O] $ 30,393 73,619 Excess of Rev, Over Exp. $ 100084 71,497 $ 235,916 • Page 4 FLOW MEMORIAL HOSPITAL BALANCE SHEET DECEMBER 31, 1984 Assets _ Liabilities and Fund Balance Current; 1984 1983_- Current; 1984 _ 1983 Cash & Investments $ 472,030 $ 378,825 Current Notes Payable $ 341,629 $181,21' Patient Receivables Accounts Payable 1,961,081 989,587 (Net of Allowances) 31978,484 1,859,468 Accrued Expenses 406,874 472,877 Other Current Assets 1,053007 1_,053,315 Due Government Agencies 413438 -V 637190 Total Current Liabilities $ 2,758,022 $ 21286,937 Total Current Assets $ 5,503,61 $ 4,2911608 Long Term Debt 1,_314145 $ 11352,304 - Property, Plant & Equipment; Total Liability $ 4,0720167 $ 3,6391241 Land & Improvements $ 183,242 $ 183,242 Fund Balance, Building 219790088 219430464 Donated Capital $ 4,456,779 $ 41455,719 Equipment 4,986618 4,881,481 Pledges & Gifts 708,046 569,396 Fund Balance 09/30/83 (685,947) (11180,404) $ 81148,948 $ 8,008,187 Revenue & Expense Summary 71.0497 _ 236,91/- Less Accum. Depr, _L51031 007) 4 679 867) Net P, P & E'~ lib Total Fund Balance 4,549,376 4 080 987. Total Unrestricted Funds 8 621 542 7 719 928 Total Unrestricted Funds $ 8,621x542 1_7,719,9.28 fi page 5 FLOW MIiMORIAL HOSPI'T'AL SUMMARY 1 F CASH RINCHIPTS AND DISBURSEMENTS DECEMBER 31, 1984 Current Month Year-To-Date Beginning Balance $ 63, 863 $ 4017 ,M Cash Received froma Active Patient Accounts $ 966,465 $ 21583,386 Dad Debt Accounts 18,046 90,119 Cafeteria 91643 31,991 Appropriations/Donations 41,650 163,998 Other 24,326 83L757 Total Cash 1_c 060,130 2,953 251 TOTAL CASH AVAILABLE V11123,993 $ 2p994,042 Cash Disbursements Payroll $ 503,220 $ 1,538,591 Payroll Taxes 67,739 210,379 Patient Refunds 41957 13,613 Capital Assets 29,025 Notes Payable 18,302 84,377 Other 392,453 980,785 Total Disbursements 986 671 t._2 i856 720 Cash Balance a S ~i Cash Investments 6 752 326,752 TOTAL CASH 464^,074 Y 464,074 A e-A {5 I.ti'd'lll v.~ ~y l 1 FLOW MENORIAL 110SPITAL AGED ACCOUNTS RECEIVABLE SUMMARY December 31,1984 of Primary Payor Current 31-60 y61-90 91-120 121-150 250+ 'Dotal A/R Medicare $ 292,668 $ 296,588 $ 240,825 $ 105,523 $ 38,697 $ 196,970 $11160,471 22,9` Medicaid 190845 19,400 48,011 11,341 12,333 53,417 164,347 3.2% Blue Cross 68,376 70,505 28,810 33,096 49 - 200,836 08 Commercial Ins. 519,317 283,997 249,096 770819 796 70 1,131,095 22.42 Self-Puy 303,423 298,363 286,032 264,743 235,053 11021,941 21405,555 47.52 $1,203,629 968,853 $ 8521779 488,522 $ 286,928 $1,261 98 $51062,304 100.0% In-house _ 3541248 Total Accounts Receivable X916,552 A/R by % 23.8% 19118 16.88 9,7% 517% 24.92 Days of Revenuer Accounts Receivable 110.2 In-House 7.7 ' TOTAL 117.9 xrsevr;p page 7 FL019 Mh'MORIAL 110SPITAL AGED ACCOUN'T'S 1,AYA13I,E SOMMA11Y December 31, 1984 91-120 Total Current 31.60 61-90 431,664 $ 228,843 $ 255,991 $ 466,303 $ 11382,801 Trade Vendors $ 335, 184 106,735 79,950 10,5.3 77,986 Faos payable 61,990 Accrued Payables 61,990 145,906 Estimated Payables 145,906 35,E 200 Audit Fees 35,200 3^y0II., 793 $ 36504 $ 543,552 $ 11961,081 Total $ 781,495 5y~ _ - - y page a FLOW MEMORIAL HOSPITAL OPERATING INDICATOR REPORT DECEMBER 31, 1984 CURRENT MONTH YEAR- TO- DATE 09 30/84 BUDGET ACTUAL VARIANCE OUDGET ACTUAL VARIANCE ACTUAL FACILITY UTILIZATION; I. TOTAL ADULT PATIENT Of,'(S 21508 2,238 (270) 7021 7,140 2. AVERAGE DAILY CENSUS 8019 72,2 8,7) 06,1 77,6 (788)5) 31,7836 9 3, PERCENT' OCCUPANCY 51.9% 46.35 5.6%) 55.2% 49,76 f5,5%) 55.7% 4. ADMISSIONS 500 6, DISCHARGES 502 4498 97 5} 1,580 11539 41 6,353 6. AVERAGE LENGTH OF STAY 5.0 4,5 1,504 1,556 ~28 6,323 7. MEDICARE R MEDICAID UTILIZATION 30,0% 32,76 (,6) 5,0 4'6 ( 26.0 ,7% 30.0% 30,2% (,2%) 32,9% PER ADULT PATIENT DAY; 8, GROSS PATIENT SERVICE REVENUES $ 581,74 $ 637,82 $ 56.08 $ 570,36 $ 597.99 $ 27.63 9. NET OPERATING REVENUES 469.06 491,50 22, $ 545,05 44 469.48 462.52 10. OPERATING EXPENSES 473,10 502,87 (29,7 1) 448,24 480,58 3'04 443.11 ]I, INCOME FROM OPERATIONS (4,05) 1.91 5.96 11 .24 (32,34} 437,95 (,52) (11.76) 5,16 WRITE-OFFS AND COLLECTIONS: 12. GROSS DAYS IN PATIENT A/R '80.0 117.9 (37,9) 13, NET DAYS IN PATIENT A/R 6010 85.7% some 101,7 14. BAD DEBT EXPENSE AS A (25'7) as 71,8 % OF GROSS PATIENT REVENUE 11,5% 16.8% current (5.3%) month 1813% LABOR COST MANAGEMENT; 1 16, FTE'S 5, FULL TIME EQUIVALENT EMPLOYEES 370.8 368.3 2,5 370,8 376,1 (4,3) 402,6 17, PATIENT DAY EXPENSES 48,28 496.10 .5% 113% 4.31 4,13 082 0.3% (13%~ 47,9% 48.7% ~,08%) 50.3% , :r FLOW MEMORIAL HOSPITAL 1310SCRIPrURE (817)387.5861 DENTON, TEXAS 76201 ,r all r 71984 it BOARD or DI RECTORS ,AL raFr tdN: Thux "ay, December 20, 1984 7:00 p.m. Medallion Room A G C N D A j 1. Call to Order 11. Reading and Approval of Minutes III. old Business A. Master Plan B. Medical Office Building C. Update on Certificates of Need D, Nurse-Midwives IV. Now Business A. Reappointments B. Other New Business V. Committee Reports A. Finance Committee B, Planning Committee C. Home Health Committee D. Critical Care Committee Y"; Safety Committee F. Quality Assurance/utilization Review G. Medical Executive Committee Vr. Report of the, Medical Staff President VII. Report of the Administrator VIII. Executive Seselon to Discuss Personnel Matters IX. Adjournment SERVING DENrON COUNTY SINCE 1950 i BOARD OV DIRECTORS - FLOW MVIORIAt, IIOSPITAL E ' BUSINESS MINUTES Oa+• 'rnursday, November 29- 'y~~ ~ 0 1989 -=.132-~i~f25 ~ ' Pa9•_ 1 Th Board of Directors of Flow Memorial hospital i n met reg Y November 29, 1984, at, 7100 p.m. in the Medallion Room a °th Th sday, Williams, Chairman on Willi presided. it Mrs,'• ry H. Diembors presents Mr. George Hilz Also Dr. Don P, Holt pr4~90tit1 Mr. Ralph Hawkins 'r. Stanley Monroe Mr, Scott Miller Mr, Dan Trammell Dr. Roger D. Nunn Ms, Mary it, Williams Dr, R. L. White Dr, R. M. Lockwood Ms' Barbara Gailey Mr, Jeff Hauslor Ms, Kathy Thompson Mr. Brad Moore Mr. David Yoder Absentr. Mrs. Williams called the meeting to order, Mi were read and approved as presented nutesjfrom thehmeetinghoPa10/29/84 , Request Prom Ms, B ra ra Cal Ms, Barbara GaileY presented information to the Board abortion and about abortion at Flow, requested a firm policy be established disallowing No action was The Board thanked her for coming to speak. taken in this matter. Me' Gailoy left the meeting and the regular order of business was resumed. OLD susmess Master Mr. Ralph Hawkins of Harwood K, C departmental zoning diagram Smith & Partners study of the hoepttal, presented s developed as a result o This plan is based on the assumptions that the professional bu ilding will be oonstvuctad, the laundry will be 's removed the standing facilo psychiatric units will be moved to a free- stationary in deli and where possible hard departments (more St Holt made d motionsu h as radiology) will not be moved, Dr- a to sented and this motion carriedeunanimously floor plans are pre. Medical Office Buildi~ nc-"`"~' Mr- Hausler reported that we are prepared to approach the city lotand county regarding the site of the new building and the p . Ha is working with the law firm of Thompson & Knightonking this matter and developing resolution. A contract from rntegrated Health Resources international, rna, was presented for development management of the project, Mrs, Williams stated they Board needed -ime to review the contract, Dr, Holt moved to review the proposed contract and the resolution to the City Council and call a meeting for 7100 a.m. on Monday, December 13, to review the contract with Messrs, Parisi and Sutton, The motion was seconded and passed unanimously„ CO~ N up'da Mr, Hausler reported that the attorneys have been authorized to proceed with an appeal in the FTM CON and this will be filed briday, ` Nurse-Midwives= ~----W- Mr, Hauslor announced that he had hired Ms, Cheryl Gainer to begin work with plow in January, lg85, another candidate for midwivesoareir gister dlnursesnani certifiedtbyothe Americanrse- College of Nurse-Midwifery, i BOARD OP DIRECTORS - "~)W,MrMORIAL HOSPITAL Thursday, November .?9, 1984 Page 2 - NEW dui TNGSS Laundry dropoAp}'j14r Ha sl°r presented bids from three suppliers of laundry/linen services Angelica, National Linen Service, and Baylor. The most beneficial contract to the hospital was noted to be Angelica. References were excellent. They offer an eight day inventory of linen, would buy Plow's linen and;own all linen. Dr. Holt moved to contract with Angelica. This motion was seconded and all voted in favor. At this time the board moved to executive session, pursuant to Article 6252-17, Section 2(g) VATCS (801 p.m.). The open meeting resumed at 9103 p.m. COMMXTTEE REPORTS Finance Committees Mr, Fiausler reviewed the financial statements for the month of October. The charity and bad debt reports were also reviewed. Mr. Monroe moved that these be approved, the motion was seconded, and passed unanimously, Medical Executives Minutes from the meeting of 10/15/84 were presented. Dr. Lockwood had reported on these at the October Board meetings however, they were not presented and therefore were reviewed this date. Dr. Lockwood had no additional comments. Planning Committee Minutes from the 10/19/84 meeting were presented, This was the initial meeting of an ad hoc committee of the Medical staff which was also highlighted at the last Board meeting by Dr, Lockwood, C There were no additional comments. Medical Records/ The 10/23/84 minutes were presented and reviewed, At this meeting Tissue. & the newly approved suspension policy was discussed, An update was Transfus one given on the status of the PRO in Texas, and the delinquent and suspension list presented. Charts were reviewed. • Critic Carol The minutes of the meeting of 11/06/04 were Routine reports for critical care units and empresented and . ergency roomrwere made and death charts were reviewed, New admission and discharge guidelines were presented for the combined SOU and CCU. Mrs. Williams took this time to read to the Board a letter from the father of a patient who was treated in the ER in January, 1984, Mr. Hausler reported that the case in question had been reviewed by the QA ComMittae'and that treatment was judged to be Appropriate. Foundation' The Flow Memorial Hospital Foundation, inc. Board of Directors met 11/08/84, Along with routine business of reviewing thn financial report, investments and disburseements, a committee was selected by Mr. Lea.to nominate appointees to the foundation Board for the year beginning January 1, 1988. Ms. Lou Nelson, Me, Mary Williams, and Dr. J. it. Jones have been serving terms which end December 31, Mr. HAUgler reported that Ms. Nelson, Ma. Williams and Dr. Arvin Short were nominated, Dr. Holt suggested that these nominations be discussed in executive session, rr SafatYs The Safety Committee met 11/09/84 and minutes of that meeting wsE read this date. Incident reports were reviewed, Christmas decora- tions were discussed, and the food service flooring was discussed. i'j,OW 14EMORIAL IIOSPITAI, - ~ ARD OF DIRECTORS Thursday, November 29, 1984 Page 3 r A URi Minutes from the Quality Assurance/Utilization Review Committee l mooting or 11/13/04 were read, Utilization Review statistics were presented and nursing service activities reported, Mr. Hausler gave a report on the poor review organization, A copy j of a letter which me, Nausler sent to area hospital administrators was reviewed by the committee, P_4 T/Dietetics The Pharmacy & Therapeutics/Dietetics/Infection Control Committee infection Controls met 11/14/84. Pharmacokinetic protocol was discussed, the infection control report was made, and nutritional services and pharmacy gave their reports. Medical Executives The minutes of the meeting of 11/19/04 were resented and Mr. Hausler p reviewed, presented information about the PRO for Texas, the letter to area hospitals regarding appropriate transfers to ER, the hiring of a nurse-midwife, and the hospital's cash flow. The revised capital budget was presented. Dr. Brown presented a case for review which was returned to the Department of Radiology for investigation and report at the next meeting. Departmental and Committee reports were given, Tissue & Minutes from the meeting of 11/27/84 were reviewed. This meeting Transfusions consisted of routine review of charts. All oases were deemed to have been handled appropriately. There was no business to discuss. It was noted that the delinquency rate for medical records is showing improvement, EKG Committee: Minutes from thq EKO Committee meeting of 11/27/04 were read, At this meeting the billing service for cardiologists was discussed and EKO readings wore presented for discussion. A motion was made and seconded to accept these committee minutes as presented. This motion carried unanimously, PRESIDENT'S REPORT Dr, Lockwood reported that the Planning Committee met 11/20/84. Most discussion centered around the capital equipment budget, ADMINISTRATOR'S REPORT PRO-TMF1 ~Mr. Hausler reported that the TMF contract has not been signed. Major points of objection are being negotiated out of the contract and a new one is expected soon. MOB Finaneingi Bonds for the Panhandle Pool have been approved and tho money for which Flow filed a pro-application is available, Ambulntory A task force of Flow staff has requested ueing the CCU area as a Serviceai holding area for surgery out-pationts, t•Ir, tlauslor has suggested conversion of planned surgical areas per the master plan instead, Ilealth Prcmotiono Mr, Hausler described recent activities for health promotion in Denton, We have sought data on larger entities in the community and contacts have been made. This past week BrikPak contracted to have screenings performed monthly and already flu shots have been administered there by Flow, n Iz FLOW MEMORIAL HOSPIT. - BOARD OF DIRECTORS Thursday, November 29, 1984 Page 4 Genetic Screenin i Or, C Freeman has asked Flow to endorse a genetic screening progr for pregnant women at an increased risk of carrying a fetus wit a birth dofect. The program is to begin January, 1985, Info-State This computer firm has proposed to enhance our existing computer system. Work with them in evaluating solutions is ongoing. Director of Mr, Hausler announced that tor, Lyman Daugherty will resign Personnel:- effective 12/14/84. He stated that he will not fill this immediately but function with existing staff, position Ultrasoundi Mr, Hausler reported that he is working with physicians to order ultrasound equipment to be purchased by the Foundation. One unit has been ordered and Dr, grown, Chairman of Radiology, is evalu- ating possibilities for the second piece of equipment. Home Health: The Flow Home Health Service hosted a seminar for ESP along with the Texas Department of Health recently called "Share-A-Homeo" Mr, Hausler thanked the Board members who attended the Employee Awards Luncheon. He also invited the Board to the employee Christmas party and luncheon on December 12, Mr, Hausler announced that Ms, Lin9a Ashmore is representing FMH on the Wellness Council, He announced that Mr. Bob Vento has been appointed Director of Quality Assurance and that he has made an offer to Mr, Karl Eason for the Director of Fiscal Services. r ~,t 10:03 p.m, the Board moved to executive session, Section 2(g) VATCS, There being no other business toprsuant to e 62-17o udiscuss, theArticl at 10:31 p.m. meeting5adjourned Respectfully submitted, APPROVEbi K thy T i on, Re ording secretary Mr, Ralph Havenhill, Secretary J L r Y FLOW MEMORIAL HOSPITAL 1310SCRIPTURE (817) 3875861 DENTON, TEXAS 6_ _I_,~ l 01 L NOV 2 71984 S O A R D O F D I R E C T O R S W CI1 Y N+A b , Thursday, November 29, 1934 700 p.m. ' Medallion Room I A C 9 N D A I. Call to Order II. Reading and Approval of Minutes III, Old Business A. Master Plan B. Medical Office Building C, Update on certificates of Need D. Nurfle-Midwivos IV. Now Business A, Bequest from Me, $a::bara GaileY a, Laundry Proposal C. Other New Business V. Committee Reports A. Finance Committee a.. Critical Care Committee C. FMH Foundation, Inc. D, safety Committee E, Quality Aseuranoe/Utilization Review F. Pharmacy 6 Therapauties/Dietetios/Infection Control G. Medical Executive Committee Vi. Report of the Medical Staff President VII. Report of the Administrator VIII, Executive Session to niscuse Personnel Matters IX. Adjournment SERVING DENTON COUNTY SINCE 1980 BOARD OF DIRECTORS - FLO{J_ MCMORIAL HOSPITAL BUSINESS MINUTES Dale Wednesday, October 24, 1984 h Pago The Board of Directors of Flow Memorial Hospital met in regular session or Wedn aday, October 24, 1984, at 7,00 p.m. in the Medallion Room. Mrs. Mary it. w.illiams" Mnirman, presided. Members presents Mr. Ralph Havenhill Members absent, Mr. George Hilz Dr. Don Holt Mr. Dan Trammell Mr. Stanley Monroe Mr. Brad Moore Alao resent, Mr, Ralph Hawkins Ms. Mary Williams Mr.. Scott Miller Ex Officio, Mr. Jeff 1lausler Mr, Don Geigor - Ms. Kathy Thompson Dr. Robert M. Lockwood Mr. David Yoder Mr. Hausler called the meeting to order and opened the floor to nominations for officers. The following were elected by acclamation to serve as officers of the Board of Directors of Flow Memorial Hospital for the Fiscal Y-sar 1985: Chairmani Mrs. Mary Williams Vice-Chairmani Dr. Don Holt Secretary; Mr. Ralph Havenhill Mrs. Williams took the chair. Minutes of the meeting of September 20, 1984, wars, read and approved by unanimous voice vote, OLD BU52NF,SS 1 U date on CONS, Mr. Hausler reported that Flow's attorney filed a motion for rehearing on November 5 in the matter of First Texas Medical's CON. Wostgate has filed a motion for rehearing of their CON application for an obstetrical unit. As previously agreed by the board, the FTM CON will be appealed if a rehearing is not granted. Master Plan, Mr. Ralph Hawkins and Mr. Scott Miller of Harwood K. Smith & Partners were present to make a presentation regarding the status of the master plan for Flow. Mr. Hawkins reported preliminary findings derived from an analysis of the existing facility and evaluation of the hospital's role in the community, and other statistical data, Development of the actual master plan and schematic plan is anticipated to be complete by the end of November, if not earlier. Medical Office Mr, Hausler reviewed concerns expressed at the last board meeting i Building, regarding the entrance of the MOB, A new plan was presented to the board with a grade level entry on the south p::rking lot entrance. Mr. Hausler reported that Flow has made a pro-application for financing. Mr. Hawkins reviewed details of the MOB plans, Medical Staff Mr, ttau.sler reported that he met with representatives from Baylor UaveloPmenti earlier this month and a proposal from that group is expected soon, i BOARD OF DIRECTORS - 1 d MEMORIAL HOSPITAL Wednesday, October 24, 1984 page 2 Nurse-Midwives Mr, Hauslor reported that he had made an offer to a prospective nurse-midwife. The obstetricians have met her and are supportive of this candidate. It appears that a second and perhaps third person will be needed for this program. NEW BUSINESS Requests for Mr. Hausler described the new system of funding by the County Approval to which provides monies for capital expenditures, The hospital is Purchase Equipment looking at items to extend services and increase revenue. The board discussed requests for approval to purchase items in the budget. A motion was made and seconded to approve purchase of nephro-cystoscopy equipment at $28,210. Mr. '!ausler proposed the purchase of a mammography unit to be placed Ln a satellite location with plans to move the unit to the new MOB upon its completion. Dr. Lockwood described the unit, its technology, and role is detecting breast cancers. The board voted unanimously to approve purchase of this equipment at a cost of $62,000. Also presented were proposals for television systems for the hospital, Following discussion, the board moved to approve a contract with Philips Communications and Television Systems for installation and maintenance of a system costing $32,605, It was noted that this is an operational expense, C Mr. Hausler also presented a design board for the proposed renovation of the lobby and cafeteria areas to increase the image and appearance of those highly visible facilities. Dr, Holt suggested that this matter be deferred until a later meeting, There was no other now business to discuss, COMMITTEE REPORTS Finance Committeo: Mr. Hausler reported that Mr, Charles West, Asst, Administrator for Finance, had resigned. The Director of Fiscal Affairs is out of the office on leave of absence for about six weeks. The financial statements for and of year 1904 were presented and reviewed, Mr. Havenhill moved that the financial reports, charity and lv:id debt reports be accepted. The motion carried unanimously, Mr. Monroe requested a report indicating the strtus of DRGs now and one year ago, Medical Records Minutes of the meeting of September 25, 1984 were presented and Tissue 6 reviewed. Routine review of surgical cases in which specimen Transfusions was reR,rN<r or blood transfuaion wan performed, A motion to approwr, ri~oso minutes as presented was passed by unanimous voice vote. Home Hoalthi The :ard reviewed minutes of the meeting of September 28 in which a new Director of Home Health services was introduced, C Srtistical data and objectives achieved during the months of July and August were presented. These minutes were approved by the board by unanimous voice vote, BOAM OF DIRECTORS - FLC IL14ORTAL HOSPITAL October 240 1984 page 3 Critical Care; The minutes of the meeting of October 2 were presented and read, Tndicators of care were reported and death charts reviewed for appropriateness of management. The temporary combination of CCU and ICU was discussed. A motion to approve these minutes was seconded and passed unanimously, Safe~~ The Safety Committee minutes of October 5 were reviewed, Nursing policies for handling of chemotherapeutic drugs, the back-up -1 water supply and incident reports were discussed, The board i voted unanimously to approve these minutes as presented, duality Assurance Minutes from the meeting of October 9 were reviewed, The selection of the PRO for Texas was reported, that being the Texas Medical Foundation, +!tilization review statistics sere presented and cases were reviewed for appropriateness of care. The auditor's report was presented and Nursing Service activities reported, Radiology QA activities were reported, as were results of the DRO validation update, These minutes were approved as presented by unanimous voice vote, Minutes from the Medical Executive Committee and Medical Records/Tissue C Transfusion Committee meetings of October w(.zo deferred for review at the November meeting, i C REPORT Or THE MEDICAL. STAFF PRESIDENT 1 Dr, Lockwood described a revision in the suspension policy for delinquent madical records which was approved at the last w meeting of the medical Staff, This policy was approved by the board by unanimous voice vote, Dr, Lockwood also reported that t the MEC had expressed concern regarding possible inappropriate transfers to the Flow emergency room. The physicians wish to see this monitored. Refurbishment of the dictation area in medical Records is complete and coffee in now available there, REPORT OF THE ADMINISTRATOR Heat M1 Mr. Nausler wiehod to make the board aware of a heating problem in some patient tare areas resulting from a broken component of a heat exchanger, This is expected to be resolved within a few days. Request to Denton Mr. Hausler reported that a request has been made to the Denton Benefit Leagues - Benefit League for a LifPak G defibrillator costing approximately ~ $8,450. Emergency Room Mr. Haualer reported that the emergency room had brought to Transforst his attention ssveral cases which may be considered inappropriate transfers from other institutions to the Flow emergency room. These were reviewed by the Quality Assurance Committee and over half of them raised concern for the medical appropriateness of the transfer, Mr. Flausler has written a latter to area hospitals to make them aware that transfers will be reviewed in the future, BOARD OF DIRECTORS - I J MEMORIAL HOSPITAL Wednesday, October 23, 1984 page 4 C Planning Committee An ad hoc committee has been formed by Dr. Lockwood to help guide Formed.s administration and the board in decision making for areas such as prioritization of the capital budget and promotion of the hospital. The committee is expected to assist in improving communication between the board, administration, and the medical staff. Ambulatory Surgary The operating room supervisor attended a program recently on ambulatory surgery. This service is provided now but will be extended in a more formal structure next year. Under the PRO - ambulatory surgery will become more heavily utilized. j PROs Mr. Hausler briefly described the structure of the PRO as the federal government's most recent move to assure quality of care and necessity of care which involves objectives to reduce un- necessary admissions. The basic structure of this program was reviewed. Health Promotion Mr. Hausler announced the appointment of Ms. Linda Ashmore as Director of Health Promotion, She will promote Flow to entitiea in this area, accompanied initially by the administrator, assessing an organization's needs and offering Flow's services based on those needs. I Combination The temporary combination of. ICU and CCU was carefully evaluated of ICU and CCUs by Mr. Hausler and discussed with critical care staff, This in not a permanent move, flroplo ey0 Awards Mr. Hausler invited the board members to attend the Employee Luncheons Awards Luncheon on November 7, M United Ways Mr, Hausler commended Mr. Yoder and Ms, Ashmore on a very suecese- LJ ful fund raising drive, The goal of $7,000 was exceeded and ovor $8,000 was pledged, Marketing Effozte Mr, Wauslor updated the board on marketing projects recently completed and underway, New logos were presented for approval and one was selected and approved by the board. EXECUTIVE SCSSION The board moved to executive session pursuant to Article 625217, Section 2(g), VATCS. There being no other business to discuss, the meeting was adjourned at lls10 p.m. Respectfully submitted, APPROVEbs C , 17 0 thy T np on, Re ozding Secretary Ralph Haverihill, secretary I BOARD OF DIRECTORS fRoBUSINESS MINUTES Dale oeptenbeY 20, 1984 ~ 1 19$q The Board of Directors of Flow Memorial Hospital m4lar session gn Thursday, September 20, 1984, at 7x00 p.m. in the Medallion he'tsoep,ital.`Dlxs, Mary Henderson Williams, Chairman, presided. Z ,f Members resents Dr. Don Holt Ex officio present Mr. Jeffrey Hausler Mr. Brad Moore Dr. Lloyd White for Mr. Stanley Monroe Dr, Lockwood Mr. Dan Trammell Ms, Mary H. Williams Also presents Ms. Cathy Ankrom Mr. George Hllz Mr, Gene Gill Members absents Mr, Ralph Havenhill Me. Patti Griffith Dr. R. M. Lockwood Ms. Sally Mudd Mr. Charles West Mr. David Yoder Mrs. Williams called the meeting to order. The minutes of August 230 1984, were read. it was moved and seconded that the minutes be approved as read. The motion passed by unanimous voice vote, OLD BUSYNESS First Texas Mr. Hausler requested a decision by the Board on whether or not medical CONS the certificate of need (CON) granted First Texas Medical would be pursued on an appeal basis into the court system. Currently a rehearing before the commission is being sought. Westgate Medical Center is desiring a response from the hospital Lard on the matter of appeal to determine whether or not they will continue to be a party in this matter. Estimations by the attorneys involved include $1,500 to $5,000 for total cost on a rehearing and $15,000 to $20,000 for costs on An appeal into the court system. Me. Moore suggested that the hospital not pursue an appeal if the rehearing were not successful, Dr. Holt stated he felt that Flow should proceed on into the appeal stage if necessary. Mr. Monroe made a motion that the hospital proceed through the appeal stage if required. The motion was seconded and passed with Mr. Moore opposing the motion. We_ar_gat_e CONS Flow was successful in defeating the application for CON for an obstetrical unit at Westgate Medical Center. At this time it is not known what Westgate'e response will be as the final order has not been issued. i Master Plar, Update Mr. Hausler reported that the department directors survey has bean completed and that 29 physician surveys have been received. The department directors have met with Harwood K. Smith as have the nurses in an effort to explain in detail what each needs, Also some physicians who requested to have been able to talk with the architects. At this point the architects seem to be behind scheduled however, the projected completion date is unknown. Mrs. Williams requested to know where the firm is, according to the schedule. C off ioe Building Mr. Hausler presented the board with the now drawings by the U_pdatos architects, They have proposed a now two-story building with approximately 17,175 square feet. The original "T" shape has been changed also. There will be a covered drive-through where i i I BOARD OF DIRECTORS - FL MEMORIAL HOSPITAL September 7.0, 1984 Page 2 C patients can be picked up or dropped off. There will also be a retail area and a new major lobby entrance. The board was dis- appointed about having to still climb stairs to get to the oast entrance of the building. Mr. Hausler will set up a meeting with Harwood K, Smith & Partnors MKS) and the board to discuss this. Medical Staff Mr, Hausler reported that he had met with representatives of Development: Baylor and their proposal is forthcoming. Nurse-Midwives, Mr, Hausler reported that several nurse-midwife candidates have presented recently. There are six nurse-midwives within the state, three in the DPW area, one from Tuscon, and one from Utah. Interviews are in progress. Drs. Midgett and Bailey have been kept informed and seem to be pleased with progress. Energy Grants Mr. Hausler updated the board on the status of acceptance of the energy grant previously awarded the hospital. The executive committee of the board earlier in the month of September authorized proceeding with this 'grant. Currently proposals are being sought by the hospital in order to assist in the selection of the appro- priate firm to do the technical assistance study, Flow Hospital Mr. Monroe stated he thought it would be beneficial to have the Memorial Fund: members take a tour through the hospital at the next meeting, lie feels that the members will be pleased with the outcome of the city's proposals for helping Flow, I ` NEW BUSINESS I Staff Appointments A motion was made, seconded, and carried to grant membership status to the following physiciana: i Stephen Weinberg, M.D. Active - Orthopedic surgery Alan A, Slomowitz, M.D. Courtesy » Radiation Oncology Mark E. Protoriun, M.D. Active - Neurology There was no other now business to discuss, COMMITTEE REPORTS Finance CommirtOo Mr, West presented the financial reports for August. It was noted that patient days had improved over previous months. Correspondingly, this results in a higher revenue reported for the month. Mr, Hilz moved to accept the financial report as presented and Mr. Monroe seconded the motion. All voted in favor. Medical Executive Cr. White, attending the board meeting in place of Dr, Lockwood, Committool reported on the significant happenings of the most recent meeting of the Medical Executive Committee. Ito reported that the policy recently developed and approved by the Medical Executive Committee L pertaining to the suspension of staff members for delinquent medical records provides for suspension of all privileges at the hoapital, not just the privilege of admitting patients, Dr, White also reported the concerns of the Medical Executive Committee in cradentialing physicians treating patients as part of our 71 BOARD OF DIRECTORS - FL MEMORIAL HOSPITAL page 3 September 20, 1984 C Home Health agency, This matter will be further discussed at the next meeting of the MEC, Dr. White also informed the board about the medical staff's concerns regarding the Joint Commission survey to be hold next summer, Mr. Trammell moved to accept the report of Dr. White and this motion was seconded by Mr. Moore, All voted in favor of the motion. Medical Records Minutes of the August 28 meeting were presented and reviewed. Tissue 6 Mr. Hausler summarized those minutes including a committee Transfusion, discussion on the policy of suspension of medical staff for delinquent medical records, which will be presented to the entire staff for approval at the October meeting. Further, the recent Medicare validation surveys were reported upon per the minutes of that committee meeting and it was noted that glow had fared better in the most recent validation survey than in prior surveys, Flow Memorial Hospital and Westgate Medical Center will work together on their enforcement of the medical records policy, by written agreement yet to be established. The psychiatric depart- ment proposed a modification to the policy on timeliness of completion of final diagnosis which the committee did not accept, Mr. Hilz moved that the committee report be accepted. This motion was seconded and &11 voted in favor of the motion. Critical Care Minutes of the September 4 Critical Care Committee meeting were Committee, presented and reviewed, A motion has been made that pre-operative teaching be performed on every patient scheduled to go to the C intensive care unit following surgery, This motion passed the committee and will be forwarded to the MEC for considoration, Motion to accept this report passed by unanimous voice vote, Joint Conference Minutes of the September 5 meeting of the committee were presented Committaei and reviewed. Items discussed included city and county support of Flow hospital, marketing of the hospital, medical records delin- quency, maser plan update, and medical office building (MW update, a motion to accept this report was made by Mr. Hilz and seconded by Mr. Monroe and all voted in favor of the motion, Safety Committee) Minutes of the September I mooting of the committee were presented and reviewed. An update on the back-up supply of water for the hospital was made and discussion ensued on the emergency power system at Flow hospital, Dr, Holt made a motion to aooopt the report of the Safety Committee and Mr. Hilz seconded the motion, which passed unanimously, Quslit_y_Assuranoe Minutes of the September 11 meeting of this committee were Utilization_ Review presented and reviewed, Cardiopulmonary services were reviewed Committees by the department and typical statistics were also reviewed, A now patient brochure has been developed for distribution to hospital patients and patients in physicians' offices explaining some of the elements of the DRG system. Mr. Hilz made a motion to accept the minutes as presented. Dr. Holt seconded the motion C and it passed unanimously. Pharmacy Minutes of the September 12 meeting of this committee were Therapeutics/ presented and reviewed, The drop in the infection rate at the Dietetics hoapitil was noted, A motion made by Mr, Monroe and seconded Infection Control by 14r. Moore to accept the minutes as 'resented, carried. ROARh OF OIRCCTORS - FL( 4EMORIAL HOSPITAL September 20, 1994 page A C Flow Memorial Minutes of the September 13 meeting of the foundation were Hospital foundation and reviewed. The foundation board members approved presented mant for purchase of. two ultrasound units for the hospitalt one for the obstetrical. department and the second for the neonatal Intensive care unit, A motion was made by Mr. Monroe and seconded by Dr. Bolt to accept the minutes of the Foundation, and all' voted in favor. MEDICAL STAFF REPORT Dr. White noted that he had expressed his concerns on. behalf of the medical staff in earlier conversation at the board meeting; therefore, there was nothing further to report at this time. ADMINISTRATOR'S REPORT New Physicians' Mr, Hausler reported that the date of October 10 has been selected Di,nnsri for the new physicians' dinner. 'Vol-Mod systomr Mr. Hauslor updated the members present as to the atatus of the Tel-Med system, Scripts of the taped measages provided by Tel- Med are to be presented to the medical staff for their review, Upon review and approval by the staff, the tapes will be incorporated into the system, Tel-toed provides a total of 400 tapes on various C health-related subjects, each approximately three to seven m:.nutes long, ER Renovation, With the recent combination of out-patient registration into the the emergency room clerical area, distinction of the registration window for out-patients was necessary) therefore, minor modifica- bons are in progress to separate the registration of the ER patients and out-patients. Medical Records Mr. Nausler reported that at the request of' the board that some Renovation, renovation had been done to the dictation area including enhanced lighting and decor in that area, Peer Review All hospitals are regti:ed to contract with a PRO by November 15, Raniz_ ations, Presently the designation of the PRO for the state of Texas has not been made; howpver, it is highly suspected that the Texas Medical Foundation will receive this designation very shortly, PROs will replace the previous entity of PSRO in most situations except the state of Texas, where there apparently was no active PSRO for some time, PROs will be required to review patients for appropriateness of admission and care and will also be validating the principal diagnosis and asaignmont of the proper DRO, Review of cases will apparently be on a weekly basis provided by an employee of the PRO, This now system is expected to cause delays In the review process as wall as denial of more cases than are currently being treated by hospitals. Patient HandboeF, PNH is In need if an updated patient handbook. Proposals have t-0s1. made to the hospital and two proposals were presented to the ,,A', `iy Mr, Hauslor, Mr, Monroe suggested that more quotes be gazhere6 for this parrioular project from firms who may be . oat ',a of handl,'i,g thf r project; eherofot A, decision on the matLuz was deferred i,,;til more quotes could be presented. e I BOARD OF DIRECTORS - FLOW MEMORIAL HOSPITAL page 5 September 20, 1984 Medical Office A locr. engineering firm is in process of completing the site Building; survey necessary for further architectural development of the building. Further, BKS will meet with interested physicians in the near future regarding the MOB. Some concepts of the planners on this project, including incentives to be provided physicians for their participation in the project, need to be approved by the board. Mr. llaualer was asked to set a m,3oting with HKS representatives for the board approval of certain aspects of the project. Medical staff Recently two physicians had requested membership and privileges ~rovals; on the medical staff of Flow, although both lived at some consi- derable distance from the hospital and outside of Denton County, Therefore the question of appropriateness of ability to respond to emergency situations has boon raised, The medical staff bylaws do address somewhat this particular concern, At present it is planned that Dr, Lockwood and Mr. Hausler will meet with Dr. Via, the department chairman involved, and the representative for the physicians involved in this matter. Denton Benefit Mr. Ilausler noted that the deadline for requesting monies from Leer the Denton Benefit League would be October 4, He noted that P'low Memorial Hospital will submit a request for funding for projects of approximately $10,000, Rotary Club South This service club has asked the hospital if they can become involved in a project at Flow. Certain proposals will be submitted to this service club, , C Voluntary Mr, Hausler reported that he had recently had discussions with Hospitals of ra,~resontatives of the VHA about some projects developed jointly Amorica; to anhance medical staff recruitment, home health, and the delivery modes -..)f care for FMH. Specifically, the.proposal for the alter- nate delivery system has boon made at approximately $60,000 for an initial phase and a necessary second phase of $120,000. Mr, Hausler stated that he thought that the relationship with Baylor may provide a more reasonable alternative to develop these altar- nate delivery forme. Also, Mr. Hausler reported that the firm affiliated with the VHA to do physician recruitment charges $10,060 per recruitment. That firm, located in Louisville, Kentucky, does have good references and comes with high recommen- dations at both VHA and others, Capital Budget previous input from the medical staff regarding their capital Rev_isiones equipment needs having been soant, there has bean another effort to secure an appropriate projection of needs in this area. With that process now complete, there are an additional $993,304 in requests for equipment to be added to the list, of that $993,304, some $700,000 could be deferred to later years, Mr. Hilz moved that the additional requests of the medical staff be approved and incorporated in the existing capital budget for fiscal year 1985, The motion was seconded and passed unanimously. Computer System Mr, 11ausler noted that for information purposes he was discussing C Update; the computer system tonight and at some future meeting of the board there would be a formal request for enhancement of the existing computer system, The advent of DRGa and UB-82 billing forms, as well as other aepecta of reimbursement which could not b9 foreseen even two yearn ago, have placed excassivo, burdens on the existing gytem. :aew .un BOARD OF DIRECTORS - FL, MEMORIAL HOSPITAL page 6 September 20, 1904 C Recent FIedia Mr. Haualnr reported on the recent media coverage of an incident Covera~ce~j where a man claimed to have not been allowed proper treatment by tho hospital, Mr: Hausler noted that the patient and his family had requested a discharge from the hospital, although the patient later claimed that he was sent home too soon, per the headline in the Denton Record Chronicle, The summary of facts in this matter were presented to the board and it was reported that the matter had been reviewed by the Quality Assuran~: Committee and that committee had deemed that the care was qu;te appropriate in this matter, zocL°r Mr, Hausler presented a potential logo for the medical staff depicting two hands joined together and forming the shape of a heart, Board members present rejected the logo as presented and suggested that further ideas be submitted to them. Rescheduling of Mr, West requested that the board consider postponing the October October Mep,.tingj meeting to the last week in October, due to the fact that the annual audit would be in progrosi through the regular meeting date of the board, Mr, Monroe made a motion to hold the board t meeting the last week of October, Dr. Holt seconded the motion and the motion was approve] unanimously. EXECUTIVE SESSION C At 9r45 p.m. the board moved to executive session pursuant to Article 625217, Section 2(g), VATCS. There being no other business to discuas, the meeting was adjourned at 9j45 p.m. APPROVED] p Have i ssoretary j BOARD OF DIRECTORS - FLOW MENORIAL FIOSPITAr, ' f f Flt j Y -"'~~3' ~Yl2S BUSINESS MINUTES Date Thursday, August 23, 1984 ~~r rAL` I .ff!rL_L~i 1 Page 1 The Board of Directors of Clow Memorial Hospital me in {S t 1 C . August 23, 1989, at 7100 p.m. In the Medallion Room HINhGI~y¢9~Qn on hursday, , Henderson Williams, chairman, presided, lary Members pr~sanrl Mr. Ralph Flavonhill Mr, George Hilz rx officio: Mr. Jeffrey E, Hausler Dr. Don C, Holt-+4r Dr. Robert M. Lockwood Mr, Stanley Monroe Also Present: Mr, Brad Moore Col. Richard E. J, Scott Mr. Dan Trammell Ms. Kathy Thompson r-~ Mrs, Mary li, Iilliams Members absent) Nona ' Mrs. Williams called the meeting to order, The minutes of the meetings of June 26 and July 12 were read, Mr. Havenhill moved that they he approved as presented, Mr, Monroe seconded the motion and it passed by unanimous voice vote, OLD BUSINESS Flow itosnitai Col, Jack Scott presented an update on the progress of the Memorrl Fund Flow fospital Memorial Fund, explaining the organization of the U~dace Advisory Committee, 'rho proposed bylaws of the Advisory Committee were presented for approval, Mr, Monroe moved that the bylaws be approved as presented, Dr, Holt seconded the motion, and the bylaws were accepted unanimously, First Texas hlr, Ifausler gave an Firsts) Texas update on the status of the certificate of need application by First Texas Medical, one commissioner stated she needed Mora time to review the transcript of the hearing and the decision was postponed until next Thursday. Concern was expret,r he said, regarding support of Flow by the f, city of Denton and Denton County, It appears that the commission will seek evidence of capital support of Flow by these entities, No now evidence may be presented, only the facts as they stood at 111 the time of the hearing may be considered, wosstTgLe CON; Mr, Nausler stated that there was no new information regarding the Westgate application for an obstetrical unit. it had been indicated that a decision would be made before August 301 however, no recommendation has boon issued at this time. UPjl-data on Master Plant Mr. tiausler reported that the architects have completed a detailed, Y._ accurate floor plan of the hospital as it now stands and have surveyed department directors, Medical staff will also be asked to complete questionnaires regarding the hospital's needs, The project will involve a comprehensive evaluation and developt,iont of a master plan for the oxis+-Ing site and possibly additional construction, U date on Medical Harwood X. Smith & Partners WKS) is seoking bids for soil borings office Building) and a topographic survo to Mr. Hauslar and he statoddtheyoare veryeImpressive,brAlso eauntsd fromdtheocitysandicountysIseneededmto s'ecure asked the property to s on build on. The board agraed to formally approach each entity regarding the property, { t'. BOARD OF DIRECTORS - .mo w MrMORIAL HOSPITAL r- z Thursday, August 23, 1984 Medical Staff Mr. Hauslor stated he had met with represenati.ves of Baylor r Developments Health Care Sy.stems last week and expects to have a proposal from them next week for medical staff recruitment and development, Public Relations/ Mr. fiausler presented the marketing plan for Flow, which included Marketincl: programs and projocts for advertising, public relations, marketing, and promotion of the hospital internally, to the public, and to physicians, He stated the plan is in a draft form and new items will be added in the future, initially, however, research will be conducted and the information gathered will be evaluated so that the most effective projects may be undertaken, Dr, Lockwood stated that the Denton Independent Physicians Association :wishes to promote their affiliation with Plow. Mr. Hausler highlighted the Tel-Med system which providos taped information to individuals who call in and request a specific medical topic. A new patient handbook is also being developed, Approval of Loan: Mr, west stated that this matter need not be addressed until the December board meeting. No action was taken. DRC Exemption for Mr. Hausler reported that the Behavioral Medicine unit of Flow Ls~chlateic warde has been granted exemption from the Medicare DRC payment system. This moans that Medicare psychiatric cases will be paid on a cost basis and a separate provider number is assigned to the psychiatric unit, Nurse-Midwives, Mr. Hauslor reported that two nurse-midwives who were possibilities did not accept positions hero. The Mississippi program was again contacted. A letter was sent regarding the position open at Flow. Mr. fiausler also has interviewed a placement. firm who is sending a proposal soon. One response to an ad for the position was received and another individual will be interviewed tomorrow, Two nurse-midwives are needed to start the program, and it may be that a third will also be needed. NEW BUSINESS public 0 inion During the discussion of the marketing plan, Mr. Hausler addressed Survey= the proposal by EMK Research to perform a public opinion survey for the hospital, Smoking Policies: Mr, Hauslor told the board that now smoking policies have been instigated, Signago has boon placed in the hospital designating smoking areas and the cigarette machine has boon removed, goquest for. Mr. Hauslor presented three requests to,purchase equipment. ~Mroval to Orthopedic power equipment (Zimmer) at $7,040, a dormatone at Purchase EcLiinment $2,9500 and a pediatric gastroscope with accessories (Olympus) at $7,800 were roqusato.l, totalling $17,800. Mr. Havenhill moved that the requests he approved. Mr. Monroe seconded and the motion passed unanimously, COMMITTEE REPORTS Finance Committee Mr, ffilz and Mr. West presented tho financial reports for June and July, 1984, In June a profit of $47,346 was shown. Mr, west i 'F pM 1 toLi t:i':e hoard that a nos biL.ing :.,/seem will I:~ initial... ~7 Dlt%n Cross-Blue Shield on October I f<alled UI3-82. The forms ut .ze numbers rather than wordsf refore, staff are being i` trained now to work with the forms. t In ,Iuly a trend of low patient days was seen, No payment from ` thn county was mado in July, as the money given to Clow to assist in repayment of Medicare was an advance of funds already budgeted. Mr. Monroe stated that he has seen no reference to money for Flow in the city or county budgets. The board requested different information to be presented on the weekly financial report. They asked to see the actual total patients who are outliers and also the number who are over their DRO limit, Mr. Monroe asked if the hospital is now experiencing a cash flow problem, and Mr. 11ausler stated that it is. Mr, Hilz moved that the financial reports, charity and bad debt reports be approved as presented, Mr. Monroe seconded the motion, and all voted in favor. Menial Executive, The minutes of the August meeting were reviewed by Dr. Lockwood. fie reported that delinquent charts were addressed. It is reported that approximately $400,000 in records are not suitable for presenting to Medicare because they lack signatures, are not up to date, the attestation is not signed, or for some other reason. lie stated this is an ongoing problem and suggested that administra- tion work with Westgate to pursue a consistent policy for dealing with this problem, He also suggested sprucing up the area where physicians dictate. He said a tighter ship should be run with respect to staff work. Also discussed was the possible formation of a neonatal bioethics committee, The MIX agreed to support th`1. decision of the pediatricians should they decide to form such a committees however, no action was taken to establish a committee this date, Mr. Havenhill moved that the minutes be approved, Mr. Trammel seco.ded the motion. The motion carried, Medical Racorde Minutes of the June 26 meeting were presented along with the minutes Tissue & y of July 24, The suspension policy for delinquont medical records Transfusion was discussed at' length, In June Dr, Croissant stated that it was felt by the MF.C that the existing policy would be effective if• it were enforced. Tn July the form letters for notification of physicians whose charts are delinquent were presented and approved. Medical records were reviewed for completeness, timeliness and accuracy and all were found to be in order. Dr. Holt moved that the minutes he accepted as prc,sentod, The motion was seconded by Mr. Ililz and all voted in favor, critical caret minutes of the July 3 and August 7 meetings were presented. In the August meeting Dr, Jackson proposed the formation of an infant bioethics committee. Code 99 pediatric drills were conducted, Mr, Ilavenhill moved to approve the minutes, Mr. Hilz seconded the motion, and it passed unanimously. Safes Committee= Minutes from Safety Committee meetings July 6 and August 10 were presented, Disposal of chemotherapeutic drugs was discussed and Q_ 1• a chart for disaster call system distributed, Mr. Ilavonhill moved to approvo the minutes. Mr. Itilz seconded the motion and all present voted in favor of the motion. BOARD OF Drtu:C'VORS - F,t-0tt MEMOKAL HOSPrTAL 4 Thursday, August 23, , :1 -Quality Assilrance/ Minutes of the July 10 meeting ware presented, The minutes Utilization Review from August 14 were also presented and reviewed. QA studies from physical therapy and labor and delivery were presented in August, ,tilt. Havenhill moved f;hat these minutes be accepted. Mr. Hilz seconded the motion, The motion passed unanimously, Pharmacy & Minutes of this committee meeting on July 11 were presented to Therapeutics/ the board, indicators of care were presented. Infection rate Dietetics/ in May was 0 and in Juno, .33%, The minutes were approved by LtFaction Control unanimous voice vote, houndation Roard, Although minutes from the meeting of July 19 were presented for the record, no business was conducted this date because there was not a quorum, Continuing Minutes of a meeting of the CME: committee on July 5 were Medical Education; presented, Mr. Havenhill moved that they be accepted and all voted in favor. EKG Committees Minutes from the meeting of June 28 were presented and reviewed. Cardiologists have not been receiving payment from their billing company, which was engaged February 1, The hospital is not directly involved with this matter. The physicians will be meeting with a representative of the company this month, Mr, Havenhill moved that the minutes be approved and the motion passed unanirtr•jsly, MEDICAL STAFF REPORT ' Dr. Lockwood stated the information from the medical staff had already been covered, ADMINISTRATOR'S REPORT Energy Grants Mr, 11ausler reported to the board that an energy grant had been awarded to Flow. This is a matching grant of $54,680. This is for a study, which would then be followed by application for a grant to implement the recommendations of the .study, Mr, Monroe moved that the executive committee of the board be authorized to make a decision on this matter next week with Mr, Hausler, Dr. Holt seconded the motion and all voted in favor. Nursing Stude_nts Mr, Hausler noted that the hospital is now negotiating contracts with nursing schools in the area for clinical practicum students. Managemant• of. Mr. 11auslor stated that it had been suggested that we look into Behavioral companies to manage 313, HKS has suggosted meeting with a firm Medicines interested in Flow, Mr, Havenhill suggested that the facts he gathered and then to proceed with evaluating proposed managmenet firms, Dr. McKinney; Mr, Hausler reported that Dr. McKinnoy has established his practice now and hosted an open house yesterday, NT State [airs Mr. Ilaunlor doscribed Flow's f,-;hlbit at the North Texas State Fair. A hill-Rom bed will b. isplayed along with a placard listing the memborship of the Flow Hospital Memorial Fund Advisory Committee and one listing services offered, Bumper stickers and brochures will also be provided, BOARD Or WRECTORS - ~ A-1 MEMORTA4 HOSPITAL 5 Thursday, August 23, 1984 Employee Meetings Mr. Itauslor atated that employee meetings were held in duly and there were no maior concerns reported among the employees, l Roof Proj^ct, Thu project to repair the roof of the hospital has be-:,i completed, Mr. Hauslar reported, PPO/Mloi Mr. ilausler s'.ated that possibilities of a PPO or AMO are being nursuod, lie has received correspondence from VfiA and alsL, discussed home health and 0)ysician recruitment with VITA at a meeting August 22. EXtCUTIVE SESSION 1 3 At 10144 p.m, the board moved to executive session, pursuant to Article 6252, Section 2(g) VATCS, to discuss personnel matters. There being no other business to discuss, the meeting was adjourned at 10144 p.m. Raspectful:.y submitted, APPROVEDi T~ l r thy Thom"s on, Rer.Or ing Kathy Ralph Havanhill, Secretary k 'f FLOW MEMORIAL HOSPITAL 1310 SCRIPTURE (817) 387.5861 DENTON, TEXAS 76201 B O A R D O F D I R E C T O R. S D ~~rl. 2 21984 1! f 1 Wednesday, October 24, 1969 7j00 p.m. Cli :Medallion Room Cllr ,t.,i AGENDA i 1. Call to Order II. Approval of Minutes III. Old Business A. Update Status of Certificates of Need B. Status of Master Plan C. Progress on Medical Office Building D. Medical Staff Development E, Nurse-Midwives iS~. New Business A. Requests for Approval to Purchase Equipment 1. Cysto Equipment 2. T.V. Equipment 3. Mammography Unit B. Other New Business V, Committee Reports A. Finance Committee B, Medical Records/Tissue & Transfusion Ct , Home.Health Committee D. Critical Care E. Safety Committee F, Quality Assurance/Utilization Review a, medical executive committee 11, Medical staff 1. Medical Records/Tissue A Transfusion J. EKG Committee Vi. Report of the Medical Staff President VII, Report of the Administrator VIII. Executive Session to Discuss Persowiel Matters IX. Adjournment SEPWNG DF.NTON COUNTY SINCE 1850 I t , 'I FLOW MEMORIAL. HOSPITAL 13)0 SCRIPTURE (817) 387.586) DENTON, TEXAS 76201 B O A R D O F D I R E C T O R 5 D Thursday, September 20, 1984 SEA 1 81984 ~r 7,00 p.m, Medallion Room Y Gf t?ir ,i A G B N n n ANAGEh,~ 1 E 1 1. Call to order IT, Approval of Minutes III. Old Business A, First Texas Medical C014 B. Westgate CON C, Update on MastAr Plan D. Update on Medical Office Building E. Medical Staff Development F, Nurse-Mi&"vab G. tnergy Grant,,-,Technical Assistance H. Flow Hospital Memorial Fund IV, New Business A. Medical Sta'£i Appoinbments B. Utilixati6n:Raview Plan dther;Nos~ Busitla$a, , C. V. Committee` Rdpores,. A. Finance Committee R. Medical Executive Committee C, Medical Records/Tissue & Transfusion D. Critical Care Committee B. 70int Conference F. Safety Committee G. Quality Assurance/Utilization Review H. Pharmacy & Therapeutics/Dietetics/ Infection Control I, FMH Founclatis,n, Inc, VI. Medical Staff Report VII, Administrator's Report VIII. Executive Session IX. Adjournment SERVING V NTON COUNTY SINCE 19$0 FLO'W' MEMORIAL HOSPITAL 010 SCRIPTURE (817),187-6861 DENTON, TEXAS 76201 B O A R D O F D I R E C T O R S c' 84 Thursday, August 23, 1984 LMANKtinf 7100 p,at. Medallion Room f A G E N D A I. Call to Order 1 11. Approval of Minutes III. Old Business A. Flow Hospital Memorial Fund Update B, Status of Certificates of Need C. Update on master Plan D. Update on medical Office Building E. Medical staff Development F. Public Relations / Marketing G. Approval of Loan H. DRG Exemption for p,9ychiatric Ward 1. Nurse Midwives J. Other Old Business IV, New Business A. Public Opinion Survey B, Smoking Policies C. Request for Approval to Purchase Equipment D. Other New Business V. Committee Reports A. Finance Committee S. Medical Executive Committee C. Tissue & Transfusion / Medical Records Committee D. Critical care committee E. safety committee F. Qunlity Assurance / Utilization Review Committee G. Pharmacy & Therapeutics/Diatatics/Infection Control 11. Flow Memorial Icbspital Foundation, Inc. r. Continuing Medical Education VI. Medical Staff Report VrI. Administrator's Report VIII, Executivo Session IX. Adjournment SERKW? DENTON COUNTY SINCE 1950 ilR III BOARD OF DIRECTORS - FLOW MEMORIAL IIOSPITAL BUSINESS MINUTES Dm, Phursda _ Y, June 28, 1984 Pege 1 The Board of Diractors of Clow Memorial Hospital met in a called session on Thursday, June 28, 1984, at 5;00 p.m. in the medallion Room of the hospital. Mrs. Mary 9illiams, Chairman, presided. Members resent, Mr, Ralph Itavenhill Members absent: Mr, reorge tlilz Dr. Don Eiolt Mr. Brad Moore Mr. Dan Trammell Mr. Stanley Monroe Ex officio absence Dr. R. M, Lockwood Mrs. Mary Williams Ex officio, Mr. Jeff Hausler Also present; Mr, Ralph Hawkins Mr, Ronald Skaggs Ms. Kathy Thompson Mr. Charles West The meeting was called to order by Mrs. Williams, Representatives of the architectural firm Harwood K. Smith & Partners introduced themselves, Mr. 11. Ralph Hawkins, ATA, Vice President, and Mr. Ronald L. Skaggs, ATA, Executive Vice President, Mr. Skaggs then made a slide presentation reviewing facilities designed by H2:S, Long range planning proposed for, the hospital would consist of evaluating the area and other services offered therein, defining primary and secondary service areas inclu- C ding population projections, market share, competition, and health manpower. Further, bed requirements and space need would be evaluated, along with analysis of the existing facility, Mr, Hawkins then reviewed in detail the proposal which had previously been presented to the Board. lie stated that planning would include regular meetings with the Board for feedback and decision making and would also include department heads, physicians, nursing, and other employees of the hospital. The master plan would include development of a mission and provide strong direction for the hospital, Mr. Hawkins told the Board that, if agreed on soon, the master plan could be completed by the end of October. Mr. Skaggs also made a presentation for a medical office building (MOB), The design concEpt is an MOB at the and of one wing of the hospital with grade level entrances and three possibilities for further expansion ih the future, The project discussed consisted of about 16,000 square feet, A tour of an 140B in Wiley, Texas, was planned for the following Monday afternoon, Mr. Skaggs and Mr, Hawkins than left the meeting while the Board discussed the master plan proposal, Mr. Monroe made a motion that the proposal by Harwood K. Smith & Partners be accepted, Mr. Navenhill seconded the motion, Mr. Nausler suggested that tasks to be undertaken be prioritized, as the certificate of need hearing was so ' near and they would be needed also to consult with Flow in this matter. The attorneys representing vlow in opposing the proposed Westgate obstetrical unit requested that an architectural firm be retained to advise, and Mr. Itnusler indicated IIKS would be working on this project also, Regarding the M0!1, Mr, Nausler stated he felt it should be pursued. At this point the vote was taken, and all voted in favor of accepting the HKS proposal to develop a master plan for Clow Memorial hospital, Discussion followed regarding construction of a medical office building. said he felt it was premature to act on the IIK9 proposal at this point, MhewNausler aware of other firms which also should be considered, one holdup he noted was the existing agreement with I1BE Corporation, which can be cancelled at any timu with 30 h ti i BOARD OF DIRECTORS - l Al MEMORIAL HOSPITAL Thursday, ;fungi 28, 1984 r days notice, Dr. Holt moved that the agreement with HBE be cancelled. Mr. HaVenhill \ seconded the motion. All present voted in favor of the motion, and it passed unani- mously, Mr. Hausler was asked to arrange for presentations at the next regular meeting of the Board of Directors by HKS and by Medical Building Corporation (MBC). Regarding status of developments with the City and County, Mr. Hausler stated that all activities had been reported by the press and were generally known among the Board members) therefore, no discussion tor.lt place regarding the City and County, i Board members egreed that all would read and prepare information about PPOs and IIMOs for the regular Board meeting in August. There being no further business to discuss, the meeting was adjourned at 6,99 p.m. ACTInt 1. Mr. Hausler. contract with HKS to develop master plant for Flow Memorial Hospital. 2. Mr. Hausler arrange for presentations at the next regular meeting of the Board of Director by NKS and DU3_, 3. All Board members read and pi;,, .r3 information about PPOs and HMOs for the next meeting on August 23. Respectfully submitted, Approvedi Ka by h6 p`on, Rec r retary Ralph Havenhill, Secretary BOARD OF DIRECTORS - FLOW MEMORIAL HOSPITAL BUSINESS MINUTES Dare Thursday, July-12 , 1984 rage 1 / The Board of Directors of Flow Memorial Hospital met in regular session on Thursday, l July 12, 1984, at 7;00 p.m. in the Medallion Room. Mrs, Miry Williams, chairman, presided. Members presents Mr. Ralph Havenhill Members absent, Mr. Dan Trammell Mr, George Hilz Dr. Don Holt Ex officio,- >ri esent Mr. Jeff Hausler Mr. Bradley T. Moore Dr. Robert Lockwood Mr. Stanley Monroe Ms. Mary 11. Williams Also present, Ms. Kathy Thompson Mr. Charlea West ~ i The minutes of. the previous meeting were reviewed by the board. They were unanimously approved as presented. OLD BUSINESS Medical office Mr, James W, Drury and Mr. Robert L. Watkins of Medical Building Building Proposals Corporation presented their proposal for a medical office building (MOB). The firm of Harwood K. Smith & Partners than followed with their proposal, represented by Ron Skaggs, Ralph Hawkins, Bill Sturgeon and John Sutton, After soma discussion Mr, Monroe made a motion to sign a contract with Harwood K. Smith & Partners to design and construct a medical office building for Flow Memorial Hospital. Dr. Holt seconded the motion and it passed by unanimous vote. Cif CountX Ms. Williams stated that the city and county would nor receive Developments copies of board meeting minutes and financial statements after they are approved by the board, as requested by these entities. Certificate of Mr. Hauslsr reported on the progress of the certificate of need Need - OB Units hearing which he had been attending opposing the application for an obstetrical unit at westgate Hospital. Ile stated that Dr, Dan Bailey had testified for Flow, Ile stated that he felt the hearing was qoing wall and the representation for plow was excellent. The primary issue, he said, was distinction of a type of service. The attorneys for Westgate claim theirs will be unique, based on a family centered birthing center. Flow has refuted this point and emphasized that its birthing center provides a continuum of family centered care enhanced by the proximity of the NiCU. Flow Hospital Mr. Monroe reported that members of the advisory committee Memorial rundi and reprecantatives from the city and county had attended a luncheon the day before. A brochure for the new organization has been prepared and will be mailed out by banks in Denton County. 3 Ile stated he would like to see eight to ten more people join from other communities throughout the county, I 1 t BOARD OC DIRECTORS - FLO IEMORIAL HOSPITAL 2 Thursday, July 12, 1984 Baylor Health- Mr, llausler reiterated information about the proposed contract Care System between Baylor TICS and Plow and the fee proposed therein, lie Proposed Contract said consideration of a lower fee was denied. He said the fee seems to be consistent with other affiliates and recommended that it be accepted. Mr. Moore stated that he was opposed to the contract. After some dissuasion Mr. liilz moved that the contract be signed for one year and that arrangements with another organi- zation be sought in the meantime. Those present voted in favor with the exception of Mr. Moore, who opposed the move. Medical Staff Mr. Hausler stated he had been in touch with .epresentatives of Developments Baylor and expects to pursue the medical staff development concept after the certificate of need hearing. This will be a study to evaluate for improvement and identify needs in the area of medical staff recruitment and development. Public Relationsr Dr. Holt presented materials he had received from other medical organizations promoting their services and image and stated that he fait Blow was not getting the word.out about its own services and accomplishments, Mr. Hausler noted that; the medical staff newsletter would be out within the next few days and said the need for more promotion is recognized. He also stated that a formal public relations plan is being developed and will be presented at the next board meeting. r NEW BUSINESS v~ Committee Reports With the exception of the Medical Executive committee, committee r.^.ports were deferred until the next board meeting. Medical Executive Dr. Lockwood discussed the minutes of the MSC meeting, lie reported Committees that Dr. M. V. R. Freeman presented to the MEC the same material he had given at the previous board meeting, noting that Dr, Freeman would make this same presentation to the Poundation, fie also related that the system for handling delinquent medical records was revised. The system has been streamlined and made leas complicated. The penalty for delinquent charts is suspension of admitting privileges. Dr, Lockwood also stated he had asked for physician input to be clearly represented in amendments to the capital budget. A lot of old equipment needs updating and now services need to be added, and he felt that people or groups who have money to donate need to know what is needed. lie stated that there is no list of needed equipment anti no vehicle for communication to the Foundation or other groups. Administrator's The Behavioral Medioine unit of Clow was surveyed July 11 for Roper exemption from DP.Gs. Walter Dick, formerly the director of TDB's licensing division, has left that position and is now working as an independent consultant. Flow has engaged him to evaluate the hospital and he assures us that no problem exists in terms of licensure, HOARD Oil DIRECTORS - i ,W MEMORIAL. HOSPITAL Thursday, July 12, 1984 J A letter from Dr. W. M. Midgett and Ms. Pat Saunders, RN, was presonterl to the board, This was in reference to a change in policy or second call anesthesiologists, Mr. Hausler explaind the system and emphasized that Dr. Via, Chairman of Anesthesia, felt the system was satisfactory. Mr. llausler stated he feels there is no problem with the call system now being used, tie was asked by the board to respond to the letter. Mr. Hausler updated the board on the work of the Denton Ccunty Mental Health Task Force, lie requested the opinion of the board about plan for a freestanding unit on Flow's campus for private patient care and to s4rve the county. Mr, llaualor recommended that we proceed with analysis of the feasibility of such a facility. Dr. Holt recommended that the matter be pursued as proposed, Mr. Hausler announced the Ms. Sally Mudd has been hired as the new director of volunteers and that she will begin in early September. She will be invited to attend the September meeting of the board. Regarding the search for nurse-midwives, Mr. Hausler reported that a letter had been received from one candidate who graduated in Miami and has an friend in Des Moines who also might be interested in working with Flow, Their answer should be known by July 14. Also, Mr. Hausler met with Ms. Donna Miller, a nurae-midwife, and Dr,. Lockwood to discuss Ideas for recruitmen,, of midwives. Ile stated we may become involved with her or other midwives on educational programs, perhaps to start a prenatal care group. Friends of the Family is still working with Flow to determine their appropriate role in the counseling of rape victims. A letter of thanks from Dr. J. J. Feldman was presented to the board. He expressed appreciation for the new automated iron intern. A formal request to purchaee two fetal monitors was presented by the Obstetrics Department. Mr, Navenhill moved that the ;urchase be made and Dr. Holt seconded the motion. All voted in favor. At this time the board moved to exeeutivu session, pu;:suant to Article 6252, Section 2(g) VATCS, to discuss personnel matters. The meeting was rosumed at 11,15 p.m. ;dr. Hilz commanded Mr. Nauslor for his work with the hospital. Each of the board membors stated they wore pleased with his performance and felt he was doing an excellent job. There boir.g not other business to discuss, the meeting adjourned at 1100 p.m. RespeW ully submitted, Approvedi K thy Th tpson, Roco dlnq Secretary Ralph llavenhili, Secretary r,. page 1 FLOW M1:1i0RIAL HOSPITAL STATISTICAL STATEMENT mir 30, 1984 Ct;RRENT 110MT11 YEAR •'TO- DATE " Prior--Year 8uciget________ Actual prior Year - 26,030 24,293 25,586 20850 2,367 2,950 Adult Patient Days 95,0 8910 93.4 95.0 7819 98.3 Average Per Day 3,562 3,752 3,733 390 435 455 newborn Patient Days 13.0 13,7 13.6 13.0 14,5 15.2 Average Per Oay 1,096 934 917 120 95 111 ICU Patient Days 548 288 336 60 27 45 CCU Patient Days 2,019 20063 2,096 219 233 278 OR Procedures 137,548 102,193 139,852 15060 13,856 16,513 Lab 'tests 20,758 2' 2,048 PhysicaloTherapyaTreatmentsnts 15,878 275325 6,054 630 141 909 11,782 13,887 135027 1,290 1,631 1,333 Radiology Exams 1G9,II80 16~i,199 169,840 18,600 16,046 18,758 Dietary Meals Served 9,042 9,386 9,302 g~0 1,153 1,140 Emergency Room Visits 41RITE-0175 & RECOVERIES DAD DEBTS COLLECTIONS MONTH C}IARITY CDUNTY PAYME ITS AD DENS 52,698 $ 5140540 $ 13,956 Oct,~Dec, S 440,750 $ 104,517 795;437 24,749 Jan, -liar, 168,080 88,007 409,944 17,299 April 42,763 , 353,000 49,988 38,217 r 23 301 June 27,597 May 41 ,7313 _ 146,584 _ 31456a _ : - Total + 743 319 R 43DcD23 T_, 82_~!1GlaA~lf~_._ $_1Q¢,20_2 i dnh a Page 2 FLOW MEMORIAL HOSPITAL INCOME STATEMENT JUNE 30, 1984 YEAR-70_DATE~~ 8uicel Actual T I'rlor Year Budget _ Actual _ Prior Year PATIENT SERVICE REVENUE; g 1,326,522 $ 1,220,012 $ 1,4561596 Inpatient Revenue $ 11,938,560 $ 61,632,578 3 10,966,365 146 573 162 901 161,394 Outpatient Revenue _1.319,2.94 1,43!1}!156 _ -1,20f,570 $ 1,473,095 $ 1,382,913 $ 1,617,990 Total Patient Service Revenue $ 13,257,854 $ 13,067,029 $ 12,172,9. DEDUCTIONS FROM REVENUE; S 105,827 $ 128,499 $ 216,638 Contractual Adjustments $ 1,107,000 $ 1,8396,87238 9 $ 3,458,839 123,000 159,199 312,720 Bad Debts 117,749 396,702 459,529 13,0_83 (72,297) 80,011 Other _ $ 241,910 g___ 215,401 $ H- 609,369 Total Deductions from Revenue $ 2,177,190 $ 2,6331269 $ 2,919,739 S 11231,185 $ 1,167,512 $ 1,008,621 Net Patient Service Revenue $ 11,080,564 $ 10,433,760 $ 9,253,196 _ 29,042 35,578 19,436 Other Operating Revenue 261,376 _ 2301051 __232,530 $ 1,260,227 $ 1,203,090 $ 1,028,057 Total Net Revenue $ 11,342,040 $ 10,663,811 $ 9,485,726 OPERATING EXPENSE; $ 601,325 $ 577,999 $ 553,670 Salaries & Wages $ 5,411,923 $ 5,266,859 $ 5,001,389 72,636 64,805 67,054 Employee Benefits 6530727 5'28,240 564,1(-" 109,537 134,910 113,207 Professional fees 985,B33 1,2309965 946,5io 182,519 191,332 218,370 Operating Supplies 11643,208 1,662,174 11616,280 2162022 _--191,904 201,103 Other 1,944,197 11760,769 1_L635,225 u P _ ! _L__ J_.__.. .._L 2 g 1 .1U 099 $ 1,160 950 $ 1 153 404 Total Operating Ex enses $ 10 638 888 $ 10 449 007 9,763 658 $ 78,128 S 42,140 $ (1255347) Income (1.oss) from Operations $ 703,152 $ 214,804 $ (277,932) S _ 5,,266 3._ 14,290 Non-Operating Revenue_ ~U3,205 $w_.236,264 y"78,128 $47,310 4 ~~1y057) Excess of Revenue Over Cxpns, _ ___703,152 Rr~~5181009 ~1^,GGB) N \ Page 3 FLOW 111:MORIAL 110SPITAL EXPLANATION Of VARIANCES JULIE 30, 1984 Variance I'roin Fixed Ou_ diet Current Month Year- o.-Date TOTAL PATIEPIT SERVICE REVENUE $ (90 182 $g901825) 1, Volume Variance 4-~;•T5-3~ T 2, price E Mix Variance $ 159,471 $ 693,881 Comments; 1) patient clays are 6,7% below budget year-to-date which is in line with the trend established in the past couple of years. 2) Actual revenue amounts are 5,6% above budget year-to-date due to formulary increases higher thui were anticipated, TOTAL DEDUCTIONS FROM REVENUE $ 261509 $(456 079) Comments; Higher percentage is still being utilized on bad debts provi- sion than was budgeted, Other category was a positive amount this month due to the advance received from the County. TOTAL OTIIER OPERATING REVENUE $ 61536 1_111_, 3251 Comments; Favorable variance for the month is due to an excellent increase in bad debt recoveries. ' TOTAL OPERATING EXpEPI5E 21119 1-' 89,8(31 Comments; professional fees remain high for thu month and year-to-date primarily because of over $100,000 in CON 'iearings fees and $15,000 per month in CAT scan fees. TOTAL. PION-OPERAI [PIG REVENUE $ 5,206 L303,205 Comments; Budget amounts are reclassed to deduc ions from revenue and - the $250,000 from the City and County is included here, n ass or REVENUE OVER EXPENSE $ (30,782 $ 185 143) I r.\ PLOW fiE?iORIAL HOSPITAL Page 4 BALANCE SHEET JUNE 30, 1984 Assets Liabilities and fund Balance--- Current; 1984 1 983 Current: _ 1984 _ 1983 _ Cash & Investments $ 335,470 $ 661,638 Current Notes Payable $ 203,761 $ 42319N- Patient Receivables 2,987,612 3,423,060 Accounts Payable 995,095 1,013,01. (Net of Allowances) Accrued Expenses 342,245 5570151 Other Current Assets 471,879 590J452 Due Government Agencies 54,447 405,173 Total Current Liabilities $ 11595,488 $ 2,399,267 Total Current Assets ° 3,7940961 $ 41675,150 long Term Debt 1 _ ,Op9,029 __184 4?_q Total Liability $ 2,644,517 $ 3,183,696 Property, Plant & Equipment: Land & Improvements $ 183,242 $ 161,469 fund Balance: Building 21943,464 21943,464 Donated Capital $ 4,455,779 $ 4,455,779 Equipment ~4 912 X709 4,542,718 pledges & Oifts 581,596 561,86)_ Fund Balance 09/30/82 (1,1801404) (177,45 $ 8,0391415 $ 7,647,651 Revenue & Exps. Summary 518,009 41 66~) Less Accum. Oepr. ~4 814,879) S4 340x583) Net P, 1' & E $ 3`;~~6 $ ~;'3b~Total Fund Balance $ 40374,980 $ 4,798,522 Total Unrestricted funds $ 7L019,497 $ 7,982,2.18 Total Unrestricted funds $ 7,019,497 $ 7,962,218 page 5 FLOW MEMORIAL HOSPITAL SUfMARY OF CASH RECEIPTS AND DISOURSUIENTS JULIE 30, 1984 CUIt_REN7 MOIITfI _ ti YEAR-.Y-DATE 0eginning Balance $ 4477,421 - - $ 11,043 Cash Received from; Active Patient Accounts $ 997018 $ 9,247,750 Bad Debt Accounts 23,301 106,902 Cafeteria 10,225 npperopriations/Donations 146,584 722,98 272,111 745,358 Total Cash 1,449,539 10,92_.8,848 Total Cash Available $ 1,926,960 $ 10,339,891 Cash Disbursements; Payroll $ 688,062 $ 4,611,126 Payroll Taxes 111,701 617,146 Patient Refunds Capital Assets 5,1199 154,665 100,623 Notes Payable 17,513 Other 1,083,824 r 150,728 5,099,942 Total Disbursements 1,906,299 101919,230 Cash Balance - Cash Investments $ 20,661 $ 20,661 3065667 306,667 Total Cash 5 327,328 $ 327,328 !ten n>. r~ . Page 6 AGED ACCCOUIITSORECEIVABLETSUMMARY JUNE 30, 1984 Primary Pa~ror Current 31-60 - ~ 0 61-90 91-120 121-150 150 + x of A/R Ile dIcare $ 335,365 g 250,241 $ 105,363 $ 33,622 $ 3,427 $ 24,586 $ 752,810 Nedlcaid 44,230 34,635 18,534 43,203 03 81ue Cross 57 59,129 13,709 213,440 ,390 15,312 5.17; Commercial Ins. 4630639 273,467 72,762 1,14 772 35 Self-Pay 318,407 . 300, 8) 5 400, 541 ~ 216, 703 256 738,169 17,67 241 ,744 9311840 _ 2.,410,050 57.6;Y 1,219,031 $ 8814,536 g 525,210 J In-pause - - _293,763 $ 304,556 $ 9701135 $ 4,187,231 100.0 Total Accounts 18~ 0 620 Receivable _4 A/R by x $ 4,3b7,p51 29.1 I 20.9 12.5 Y 7.0 A 7.3 z 23.2 Days of Revenue; Accounts Receivable 8812 Jr-Pause 4.6 Total 92,8- r Page 7 FLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE SUMMARY JUNE 30, 1984 Current 31-60 61-90 91120 Total Trade Vendors $ 214,296 $ 253,71?. S 32,745 Fees payable 97,789 $ $ 500,753 71,555 64,796 234,1A0 Accrued Payables 72,259 Estimated Payables 766,243 720259 Audit Fees 166,243 21,700 _ " - 21,700 Total $ 572,2 87 $ 325,267 97,541 $ _ _ _ S 995,095 i 6U ti6'OS S3SN3dX3 IU a V SV 11084Vd 'Ll 9'05 ;G9'0 'W OS %609 61.5 £E'V AVO 10110 JIM 83d S,31j '91 8£'V (VZ') Ls'U EE'V (94') 6'9OV 5' llV Ca 2160 9' LlU S33AO1d1J3 1N31VA111(?3 3F1[1 11{13 -SL 9'OlV ~11J3W3JUNVIJ 1509 2lUOV1 G> G'£ ) bG' 8 L 110' 9l 3OIJ3A3d 1 llAd S508U ;,.p S I 10 U SV 3SNUX3 1030 OVO V L 11juom O pg d/V 1N331Ud NI SAVO 1317 '£l 9 L9 auaam WE ) 1,C9 0'08 1b13IlVd Ili SAVU SSU`d'J Zl ~ Z'6G So ouies (4'Zl) 4'ZG ~ , SI40l LO'1llW ONV S:IJO-311UM SNOl1Vii3d0 WOU 3WO3111 it (84'62) (WW190 V9'8 10'LZ {i9'6) 08'01 lV'LZ MN303 UNIMIdO 'OL Z£'98£ (OVIII) Zl'0£V WOO (OL'9L) LV'06~ Gl'VLV S3fMA3L OIJ11V213dO 13N '6 16'9VE V2'£ Z6,80 C1,90 Ol'99 8Z'80c ^ 8L'ZUV S3(1N3A32J DIMS 1N3I1Vd SSOllr,1 '4' £6'94V $ 99'83 $ 64'LES $ ££'509 $ L£'L9 $ 9Z V8• d 88'91., $ AVO 1011Ud 11ffOV 213d llin O1U0103W ONV 32JU0[0311 'l E£ (`/,6'£) %6'££ %0'0£ (a4~) v9O'0£ AV1S d0 N19431 39M AV '9 £'9 O'9 S3021V115SI0 '9 409'9 (90) 8ZL'V V91'9 (V6) £LV 099 SNOISSiWOV 'V V6V'9 (59V) lVl`V 902'9 (66) [IV OLs AO1JUdf1ON JJJ3343d 'E 6'09 (~E'Ol) X9109 k6'09 SnSN33 AJIVO 3OV83AV 'Z ';0'65 (xb'£) %0'05 r4, 04Z6 S0-9) 0'68 0'96 W91) 6'41 0 S6 009' EE l L£L l) £6Z` VZ 0£0' 9Z (£8U } L9£' Z 09fs` Z SAUO 1N I11Ud 11f10U 1U101 l , ;110I1VZIlI1(1 41I110VA 1Uf11~U 30NU121VA WIN 139Of10 301JVI21VA 1Uf110V AMU £9/0£/G6 11U0-01-uV3A Y lI11JOW 117388110 V86 L `0£ 31711I' 180d3d 2IOlmONI ONI1VOdO 1U11cISOll 1V1MIm MO `Id 4 alivd ~ '1 I 7 I Pnge B rl.ow RMORIAL HOSPITAL. OPERATING INDICATOR REPORT JUNE 30, 1984 _CURRENT NOIITH _ YEAR-TO-DATE_ _ 09/30/83 BUDGET ACTUAL VARIAhICF. BUDGET ACTUAL VARIANCE ACTUAL rAC1L11Y UTILIZATION; - - - 1. TOTAL ADULT PATIENT DAYS 2,850 2,367 (483) 26,030 24,293 (1 737) 33,570 2. AVERAGE DAILY CENSUS 9510 78.9 (16.1) 95.0 89.0 ~6,0 92,0 3. PERCENT OCCUPANCY 60,9% 50.6% 10,3%) 60.91/ 57,0" (3.9%) 59,0 4, ADMISSIONS 570 471 ~99) 5,206 41141 (465) 6,494 5, DISCHARGES 567 473 (94) 5,164 4,728 (436) 6,508 6. AVERAGE LENGTH Or STAY 510 510 5,0 5,1 ( 1) 5.3 1. MEDICARE AND MEDICAID UTIL, 30.03; 30, 6'y (,67,) 30.07 33,9" 3.9%) 33,87 PER ADULT PATIENT DAY; B. GROSS PATIENT SERVICE REVENUES $ 516.88 $ 584,25 $ 67.37 $ 509.33 $ 537,89 $ 28.56 $ 486.93 9. NET OPERATING REVENUES 442,18 508.28 66110 435.73 438.97 3.24 345.91 10, OPERATING EXPENSES 414,17 490.47 (75,70) 408.72 430,12 (21.40) 385,32 11, INCOME PROM OPERATIONS 27.41 11,80 (9.61) 27,01 8,84 (18.17) (29,08) WRITE-OFFS AND COLLECTIONS; 12. nROSS DAYS IN PATIENT A/R 80.0 92.8 {12.,8} ^ame as 9912 13. NET DAYS IN PATIENT A/R 60,0 63.1 ( 3.1) current 57.5 14. DAD DEBT EXPENSE AS A OF month GROSS PATIENT REVENUE 15.0111, 18.9?'. ( 3.91!) 15.01, LABOR COST MANAGEMENT; 15, FULL TIME EQUIVALENT EIiPLOYEES 411,5 409.2 2.3 411,5 406,9 4,6 410,6 16, rTE'S PER ADULT PATIENT DAY 4,33 5.19 (.86) 4,33 4.57 (.24) 4,38 11, PAYROLL AS A % OF EXPENSES 50.9% 49.8% 1.105 5019% 50,4% 015% 51,67, .j Page 1 rLO14 MEMORIAL 17SPiTAL STATISTICAL STATEMENT JULY 31, 1934 CURRLNT 4ONT11YEAR-TO-DATE Budget Actual W_Prior Year Dudget Actual Prior Year 2,945 2,326 21593 Adult Patient Days 28,975 26,619 28,179 95,0 75,0 83.7 Average Per Day 95.0 87.5 92.4 403 472 431 Newborn Patient Days 3,965 4,224 4,164 13.0 15,2 13.9 Average Per Day 13.0 13.9 13,7 124 98 76 ICU Patient Days 1,216 1,032 993 62 22 29 CCU Patient Days 610 310 365 219 190 174 OR Procedures 2,238 2,253 2,237 15,06n 145458 14,689 Lab Tests 152,608 146,651 154,541 1,920 11560 1,249 Respiratory Therapy Treatments 19,118 23,906 21,622 630 601 968 Physical Therapy Treatments 6,508 7,926 7,022 1,290 1,462 11399 Radiology Exams 13,072 15,349 14,426 18,600 15,880 17,329 Dietary Meals Served 184,480 180,019 187,949 990 1,243 11187 Emergency Room visits 10,032 10,629 10,489 + 0Hj it-Uj-'rS & RECOVERIES ~i011711 CHARITY COUNTY PAYI4i NTS BAD DEBTS BAD DEBTS _ COLL[CTIONS Oct,-Dec, 3 440,750 $ 52,698 $ 514,540 $ 13,956 Jan,-Mar. 168,080 104,517 795,437 24,749 Apr,-Junto 134,489 272,8OB 1,157,509 68,197 July 56,654 463,151 21,257 $ 799,973 $ 430,023 a 2,930,637 $ 128,159 i ROW MEMORIAL HOSPITAL Pa g e 2 INCOME STATEMENT JULY 31, 1984 __v CURRENT MONTH Budget Actual _ _ prior Year Budget _ Actual Prior Year PATIENT SERVICE REVENUE: - - - - 4 1,326,522 $ 1,196,539 $ 1,182,895 Inpatient Revenue S 13,265,220 $ 12,829,116 $ 12,149,260 ___.-146,573 - 169,754 _ 156,482 Outpatient Revenue 1,465,734 1,604,206 _ 1,363,052 $ 1,473,095 $ 1,366,293 $ 1,339,377 Total Patient Service Revenue $ 14,730,950 $ 14,433,322 $ 13,512,3 DEDUCTIONS FROM REVENUE: II 3 105,827 $ 75,269 $ 187,434 Contractual Adjustments $ 1,0585268 $ 845,107 $ 1,133,659 123,000 209,635 313,178 Bad Debts 11230,000 1,681,364 1,802,730 W 13,083 76,056 66,439 Other 130,832 467,'758 _5,0,405 $ 241,910 $ 360,960 $ 567,051 Total Deductions from Revenue $ 2,419,100 $ 2,994,229 $ 3,486,794 S 1,231,185 $ 1,005,333 $ 772,326 Net Patient Service Revenue $ 12,311,850 $ 11,439,093 $ 10,025,518 29,042 33,124 21,034 Other Operating Revenue 290,420 26 3;174 253,565 t 1,260,227 $ 1,038,457 $ 793$60 Total [let Revenue $ 12,602,270 $ 11,702,267 $ 10,279,083 OPERATING EX,PFNSF: $ 601,325 5 581,842 5 567,352 Salaries & Wages $ 6,0131250 $ 51848,701 $ 5,568,740 94,678 859828 1000999 Employee Benefits 946,780 614,068 918 it-, 109,537 127,850 119,192 Professional fees 11095,370 1,358,815 1,065,7`x. 182,579 196,158 190,288 Operating Supplies 1,825,790 11858,332. 1,802,403 193,990 180,066 __163,436 Other 1,939,800 1,940,834 1,647,036 $ 1,1x2,099 8 1,171,744 $ 1,1411267 Total Operating Expenses $ 11,820,990 $ 111620,750 $..101902,147 $ 78,128 $ (133,287) $ (347,907) Income (Loss) from Operations $ 781,280 $ 81,517 $ (6231064) 11,820 13,960 Non-Operating Revenue $ - 315,025 $ 250,224 - 780128 $ _ 121,4L7 ) $ (333_,941) I'xcess of Revenue Over $ 781,2£10 $ 396,542 E ~37?r 840) - - Expense - Y fLOW MEMORIAL HOSPITAL Page 3 EXPLANATION OF VARIANCES JULY 31, 1984 Variance From Fixed Quiet. Current FTonth --Year-To`-Date TOTAL PATIENT SERVICE REVENUE 1, Volume Variance $ 106,802 ( 297 62g) 2. Price & liix Variance u $-T6tS,r 24 ( Tou"j40 f $ 202,822 $ 900,162 Comments; 1) Patient days are a very low 21 Ow beloar budget this month which dropped the year-to-date days to 8,1" below budget and continues our declining trend, 2) Actual revenues are 6,21, above budget year-to-date due to formulary increases higher than were anticipated. TOTAL DEDUCTIONS FROM REVENUE Comm_ents_.: Higher percentage is still being utilized on bad debts provi- 119,050) 575,129 Sion than budgeted. Other category was very high this month' due to no payment being received from the county because of last months advance to help on the Medicare repayment, TOTAL OTHER OPERATING REVENUE ~ ___"J~ Lt_ Comments Favorable variance for the month is the result of better 4'082 2,246 bad debt recoveries which follow the recent trend, TOTAL OPERATING EXPENSC Cnrrunents: Professional fees remain high for the month and year-to-date $ 1D,355 2003240 because of extra expenses on CON hearings fees and CAT scan fees along with a slight percentage increase in operating supplies expenses, TOTAL NON-OPERATING REVENUE Comments, Budget amounts are reclassed to deductions from revenue and 11,820 $ 3153025 the $250,000 from the City and County is included here. ~ EXCESS OF REVENUE OVER EXPENSE 199 595 J$__384 73Q r LOW MEMORIAL IIOSr1TAL Page 4 BALANCE SHIFT JULY 31, 1984 Assets Liabilities and rund Balance Current: 1984 _ 1983 Current: 1984 yT~ 1983 Cash & Investments $ 343,435 $ 510,588 Current tlotes Payable $ 211,638 3 420,02 Patient Receivables 3,022,861 31062,389 Accounts Payable 1,152,538 gOg,2, (Net of Allowances) Other Current Assets 471,247 Accrued Expenses 363,015 416,918 0912. 4 514,451 Due Government Agencies 54,447 W, 464,841 Total Current Liabilities $ 1,781,638 $ 2,211,031 Total Current Assets $ 3,837,543 $ 4,147,428 Long-Term Debt _1,0269680 744,650 Property, Plant & Equipment: Total Liability $ 2,8081318 $ 2,955,681 Land & Improvements $ 190,356 $ 161,469 fund Balance: a Building 21944,873 2,943,464 Donated capital $ 4,455,779 $ 4,455779 Equipment 4,841, r 575 4,544L329 Pledges & Gifts 581,596 561 JM Fund balance 09130182 (11180,404) (177,452) $ 81076,804 $ 716490263 Revenue & Expense Summary 39G,542 (372 8f.-Less Accum. Depr. (41852,516) (403730660) w Not P, P & E $ 3,2,289 $ 3 Total Fund Balance $ 4 253 513 1_4 6 735 0 Total Unrestricted funds $ 710619831 $ 7,423,031 Total Unrestricted Funds $ 7,061,831 S 7,423,031 . 4 I V 5 page FLOW MEMORIAL HOSPITAL SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS JULY 31, 1984 CURRENT MONTH YEAR-TO-DATE Beginning Balance $ 20,661 $ 11,043 t° Cash Received from; Active Patient Accounts $ 9280404 $ 10,176,154 Bad Debt Accounts 21,257 128,159 Cafeteria 10,498 113,485 Appropriations/Donations 725,851 Other µ _ 40,988 786,346 Total Cash 1,001,147 11,923,995 Total Cash Available $ 1,021,808 $ 11,941,034 Cash Disbursements; $ Payroll 508,152 $ 5,125,278 Payroll Taxes 73,310 069056 Patient Refunds 21,821 1765486 fopital Assets 100,623 I Motes Payable 22,455 173,183 Other _ 381,390 Total Disbursements 1 ,007,128 11 9E6,35B Cash Balance $ 14,680 $ 14,680 Cash Investments 313 060 313,060 Total Cash `2;7fi( s Page 6 PLow MEMORIAL 11OSPI7AL AGED ACCOUNTS RECEIVABLE SUMIJARY JULY 31, 1934 Primary Payor Current .-1-60 61-40 - Y of - - _ _91-1 ?0 121-150 r - - 0 _ 150 + -Tot a I y Y o Medicare S 188,399 $ 171,634 $ 188,563 $ 70,162 $ 21,496 $ 10,344 S 650,648 1~ Medicaid 47,964 39,381 21,102 16,151 39,876 62,569 227,043 5,8;'. Me Cross 61,338 22,790 Commercial Ins. 4 9 84,128 2.1 1,678 215,571 15 Self-pay 333 716 r 707,264 17.9Y - 3'0,1x9 A00,806 296,791 124,502 _ 768,169 2,27A,773 57.71,, 1,123 ,095 4 8DD,215 $ 610,486 $ 383,i0A $ 885,874 g 881,082 $ In-Noose 3,943,856 100.0 Total Accounts 866 Receivable $ 4,191,722 A/R by H 28.5 Y 20.3 y 15." ~ y. 9.7 7 Wti_ 4.7 21.3 Days of ,t ..re; Accounts Receivable 80.5 In-House 5 y Total -86,1 S i! Rage 7 PLOW MEMORIAL HOSPITAL AGED ACCOUNTS PAYABLE SUMMARY duty 31, 1984 Current_ 31-60 61-90 91-120_TotaT r^• Trade Vendors 3 3411,740 5 1c15,123 $ 160,117 $ 3 693,980 Fees Payable 104,322 71,615 71,555 247,492 Accrued Payables 46,515 46,515 Estimated Payables 140,601 140,601 Audit roes 23,950 __23,950 Total S 664,128 $ 256,7313 q 231,672 3 1,152_,538 r` i i w~ 1 ~9e 8 rLow MEMORIAL HOSPITAL OPERATING INDICATOR REPORT JULY 31, 1984 _ CURRENT MONTH - YFAR-TO-DATE 09/30/83 BUDGET ACTUAL VA_RIANCC BUUGET ACTUAL VARIANCE ACTUAL FACILITY UTILIZATION; 1. TOTAL ADULT PATIENT DAYS 21945 2,326 (619) 28 975 26,619 ~ 2. AVERAGE DAILY CENSUS 9510 75,0 ( 20.0) 95,0 07.E (2,35G)~ 33,57 3. PERCENT OCCUPANCY 60.9" 48.1y { }7 8ry,) 60 97 r 4. ADMISSIONS 589 517 (78) (56.1 0 (4,v) 59.OX 5. D[SC}1ARGCS 586 480 17 5 795 5,252 (543) 6,494 6. AVERAGE LENGTH OE STAY 5.0 4.8 1106) 510 5.1 5.1 (1) G 508 12 7. MEDICARE & MEDICAID UTILIZATION 30.01 29.6 4 (.1) 33. 7 . ,4'; 30 30. Oy 33,6H ( 3 , 6?~) 33,8$ PER ADULT PATIENT DAY; 8. GROSS PATIENT SERVICE REVENUES 4500.20 $587,40 $87.20 9. NET OPERATING hEVENUCS $508,40 $542.22 $33,82 $486.93 10, OPERATING EXPENSES 427.92 446.46 18,54 434.94 439.62 4,68 345.91 Il, INCOME. FROM OPERATIONS 401'39 503,76 (102,37) 407,97 436,56 {28,59) 26.53 (57.30) ( 83.83) 385.32 26,96 3,06 (23,90} (24,88) WRITE-OFFS AND COLLECTIONS: f 12. GROSS DAYS IN PATIENT A/R 80.0 86,1 (6 I~ 13, NET DAYS IN PAl'IEPlT A/R 60.0 61.7 {1.7 SAME 99.2 14. BAD DEBT EXPENSE AS A 15.0ry 20.3% AS (5.3%) S7,5 % OF GROSS PATIENT REVENUE '3%) CURRENT 15.0y LABOR COST MANAGEMENT; MONTH 15. PULL TIME EQUIVALENT EMPLOYEES 411.5 393.3 18,2 16. FTE'S PER ADULT PATIENT DAY 4,33 5.24 4.11.5 .6 33 4.64 1} 5,9 4,38 17. PAYRC'.L AS A % OP TOTAL EXPENSES 50,97. 49,7% 1.2% 4'33 5019% 50.3% 656 "136"' ` FLOW MEMORIAL HOSPITAL 1310 SCRIPTURE (817) 387.5861 OENTON, TEXAS 76201 FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS STATUS REPORT TO THE CITY AND COUNTY JULY 3, 1984 ( - FAAspler by the City Council and on behalf of the Board of Memorial Hospital, I offer the following comments to summarizing the status of our hospital: FINANCE - Through May 31, 1984, we show a net profit of $470,664, This g`u is projected to decline through the remainder of this fiscal year as we are in our season of low volume and our expenses are not totally elastic to correspond with the lower revenues attributable to lower volume. We do project a net profit of approximately $300,000 by the time the year ends September 30, To assure that there is not a major a djustment to change the bottom line, such as occurred last year, we have guidelineS, Thqseuarterly Mitchell and Company, our auditing firm. Of course, through your help, Medicare's overpayment of $673,000 has been repaid to them, and we currently have $190,000 in loans to be re- paid associated with that solution. In terms of collections, we currently have 92,7 days of revenue outstanding compared with 108.6 this time last year, We hope to further reduce this index to 80 by the and of our fiscal year. Elsewhere, most other major indexes of financial efficiency have shown significant improvement from last year. STAFFING - As noted in the budget for next year which was distributed to you Tast month, we have determined that reduced staffing of the hospital is indicated without a resultant drop in the quality of the care that can be rendered. Through analysis of our staffin we have decided to reduce our staff by approximately 14%, ?histreduction reflects a 6% decline in volume from last year's budgeted figure and therefore reflects approximately 8% reduction in staffing to achieve greater efficiency in our operations, We are not reducing staff "across the board" but rather have analyzed each department to determine ap- propriate staffing levels in each area, Reductions in staffing are occurring primarily through attrition so that the appropriate staffing levels are reached by the beginning of the fiscal year, October 1, By available comparisons of statistics with other hospitals, we have ar- rived at the appropriate level of staffing to promote a more efficient operation while maintaining our reputation for high quality services, PLANNING - As you could see if you were to reflect on the goals and act ves deve oped and distributed in January of this year, we have seen significant improvements in Flow by our focus on priority objectives, SERVING DE'NTON COUNTY SINCE 1930 t .2- .2- M any of majority he th onrethat list have been accomplished and the Many of the the others as being addressed, Additionally, last week the Board retained the firm of Harwood K. Smith, a distinguished healthcare consulting firm, to address several needs of Flow including the development of a masterplan. The masterplan will be comprehensive in nature including architectural and programmatic plans for the future. The planning process is scheduled to take approximately four months to produce a document reflecting our masterplan. As this project con- cludes we will distribute copies to you. Other activities to be accom- plished include assurance to conformance with applicable codes, upgrading f of facilities in critical care areas, obstetrics, and psychiatry, and the development of a medical office building. CONCLUSION - I hope this summary has been informative as to the status 0 ow, hale we have historically sent copies of financial statements to the respective city and county offices each month, we are beginning this month a new method of distribution of information to you, As per your request, copies of the financial statements and minutes of Board meetings, once approved by the Board will be distributed to each of you. Our understanding is that the individuals associated with the City wish to each receive their reports directly and we have devised a list of mailing addresses for each; while the County individuals wish a copy for each produced and mailed to the County Judgds office for disc- ribution,Please let us know if further changes are requested in this distribution system. Mary Henderson Williams Chairman, Board of Directors I owl BOARD OF DIRECTORS - FLf r _ MEMORIAL HOSPITAL ~ ('1 c.~rl,l,r7•~i ~ . • susrr~ESS MwurES Date Thursday, June 14, 1984 C The Board of Directors of Flow Memorial Hospital mot n re _ June 14, 1984, at 7400 p,m. in the Medalllon Room of asion on T ureday, Chairman, presided, .-Mrs. Mar Williams, Members Present: Mr, Ralph Havenhill Mr. George Hilz Dx o--- foci-o4 Dr. R. M. Lockwood Dr, Don Holt Mr- Jeff Hausler Mr. Stanley Monroe Also Mr. Dead Moore p-- r89°n' Dr. M. V. R, Freeman ~J1 Mr. Dan Trammell Ms. Kathy Thompson Ms. Mary Williams Mr. Charles West Mr. David Yoder The minutes of the previous meeting were presented to the Board. By unanimous vote, they were accepted as presented, OLD BUSINESS CON - Westgate, Mr, Hausler notifed the Board that June 10 was the date to formally enter as a party in opposition to the obatetrical unit at Westgate. Flow did enter its opposition and is represented by the law firm of Sharp and Morse, City/County Mr. Hausler stated that the City and County continue to work Levaippmont andhMr. flauresgaerrdhaveing money discussing Medicare, Mr. Chris Hartung the a possibility of a loan to Flow from the City and are working through the city attorneys, In the meantime, alternatives are being arranged should a loan or loans such as those discussed not come to pass. One alternative is a short terra loan with a local lending institution on the balance due collateralized with certificates of deposit, The City has suggested that Flow retain a lawyer in the matter of City/County responsibilities, Mr. Hausler has been in touch with the hospital in Pittsburgh, Texas, which formerly was a city/ county hospital, to see what information they might provide, since he said he is not aware of anyone locally who might spe- uializo in this area. Mr. Hausler sought direction from the Board and stated that we need to choose an attornoy soon on this matter, Mr, Trammell stated he feels the City rather than Flow should take a position with the County, and advised that Flow should remain neutral, Dr. Holt suggested that a meeting bo called between the City, County, and Flow to determine their positions, Mr. Hausler stated he would like to bring the matter to a head as soon as possible and determine a course. Mr. Hausler was asked by the Board to set up a meeting with the City and County. Status of Mr. Monroe reported that over 20 individuals have agreed to serve Advisory Committoa on the Advisory Committee to the Flow Hospital Memorial Foundation. The organization has not yet selected an official name, is scheduled for noon on July 11, Col. Richard E. J. (Jack)meeting Scott has agreed to chair the meeting and be the chairman of the committee. BOARD OF DIRECTORS - F1P~ MEMORIAL HOSPITAL f 2 Thursday, June 14, 19B4 C Mr. blonroo stated he would like to have at least ton more on the committee, and would like more from communities in the county outside of the City of Denton, lie stated that the group is not interested in direct solicitation, but would be familiar with the needs of Flow and be available to speak for and support the hospital, tie asked that the Board be present at the July 11 meeting. At that meeting he anticipates dividing into three subcommittees: one for publicity, one comprised of the Board and hospital staff, and one in charge of funds, The Board and staff subcomittee would be responsible for selecting where the money raised should be spent. Ile plans for the subcommittees to meet monthly, and the Advisory Board would then gather as a whole quarterly. The first project of the Advisory Board is to prepare a brochure for distribution throughout the community telling what Flow is, its history, etc., and there will be a mailing card in the brochure with a place to fill in, something such as "please accept my donation of . , " Architectural Mr. Hausler informed the Board that he has been ro,✓iewing the Proposali proposals of several architectural firms, and has narrowed these down to five, Of these he selected two who seemed to be moat qualified and experienced to meet the hospital's needs. He reviewed those two proposals for the Board and made a recommen- dation to engage Harwood K. Smith & Partners {HKS). The proposal made by HKS is to develop a masterplan responding to areas of need and the Department of Health's Life and Safety Codes, as C well as specific areas of need noted by the hospital staff and administration, but does not include the medical office building. It does plan for a medical building) however, the actual building project would be proposed separately. HKS proposes to take the master plan to the point of the conceptual with a pre-schematic design of expansion plans, working with existing floor plans, and make specific recommendations regarding project needs. Their package does not include mechanical drawings. Me, Hilz suggested that the Board interview this firm before making a decision. Mr. Hausler noted that both HKS and the Harris group were local and had exoollent references. HKS offers a gamut of services, in- cluding architectural doaign, planning, medical office building capabilities, etc, Their pricing is presented as one fee, while Harris' is broken down by individual project within the proposal. HKS's figure is all-inclusive, Dr, Holt stated he would like to see the Board move based on an administrative decision. Dr, Holt moved that Vlow ask HKS to proceed with their proposal, After some discussion Dr. Holt withdrew his motion. Me. Monroe moved to hold a called meeting of the Board to present their plans to the Board, and to target the week of June 25 for that meeting. Dr. Holt seconded the motion and all voted in favor. At this time Dr. M.V.R, freeman joined the meeting and the ragular order of business was suspended so that he could make a presentation at the request of the Board of Directors. Presentation by Dr. Lockwood road the minutes of the May 10, 1984, meeting of Dr. Preeman the PMH Foundation board in which a member of that Board stated stated that portable ultrasound equipment might bring lawsuits I BOARD OF DIRECTORS - FLlnv MEMORIAL HOSPITAL 3 Thursday, Juno 14, 1984 r to the hospital and advised against the purchase of such equipment because "it is a very hard piece of equipment to justify using," According to Dr, Lockwood, Dr, J. H. Jones indicated the equip- ment was not appropriate, and therefore Dr. Lockwood asked Dr. Freeman, who specializes in the use of ultrasound, to present information on the safety of ultrasound to the Beard and also to the Foundation. Dr. Freeman than introduced himself, stating that he is a board certified gynecologist and has done extensive work with birth defects and teretologyj however, he emphasized that what he presented would be not his own opinion, but opinions of professional organizations and physicians in the United States and internationally, lie also clarified that he was presenting a summary about the safety of diagnostic ultrasound and not therapeutic ultrasound (diathermy). Dr, Freeman quoted the American Institute of Ultrasound in Medicine's October, 1982, statement that ultra- sound has been used for over 25 years and to that date no adverse effects had been reported, Dr. Freeman stated that in all cases it was consistently believed that benefits of ultrasound far outweigh any possible adverse effectat however, according to these organizations, no adverse effects were known, The American College of Obstetricians ad Gynecologists in September, 1983, stated they found no evidence of harmful effects resulting from use of diagnostic ultrasound, Dr. Freeman stated some lawsuits have arisen from incorrect diagnosis, but knew of none associated with the administration of ultrasound, In West Germany and some C Scandinavian countries, he said, two ultrasound exams are required during pregnancy, Dr. Freeman also clarified that no radiation is used in ultrasound, Dr. Lockwood stated that ultrasound is now performed daily and is available for use, Proposed equipment is for use in Labor and Delivery and Nursery, It is needed for critically ill premature infants, and for Labor and Delivery to determine if twine are to be born, if the baby is head first or bottom first, Dr. Freeman's recommendation was that an inexpon- sive linear unit be purchased for L & D, e.nd could probably be purchased for about $19,000, Mr, Hauslor stated that 5451000 w:s budgeted for a portable unit and this was the amount which the Foundation was originally approved. Dr. Freeman stated lie was available to the Board for any information they might need, and said he woui.. speak at the next meeting of the Foundation Board. Dr. Freeman loft the meeting and the agenda was resumed, TWU Consultinpt There was no new business to discuss regarding this subject, CON Pre-application Mr. Hausler reported to the Board that Certificate of Need pro-applications have been filed for a medical office building and for an adolescent psychiatric unit, Ba_ylor_HC5_ Mr, Hausler told the Board that Administration is continuing to Proposed Contracti work on thin. At the previous Board meeting a proposal by Baylor Health Care Systems to charge $15 per bad per month for consult- ation services was presented, Dr. Holt stated that the Board should consider not only the cost of this consulting service, but also untapped resources in edt:ation, as well as other benefits. Mr, llavenhiil moved that Mr. Hausler return to Baylor with a request to nogotiato the proposal. This motion passed unanimously. , 1 I 4 BOARD Or DIRECTORS - CLu,. MEMORIAL 110SPITAL Thursday, June 14, 1984 I / Other old There was no other old business to discuss. i eusinesst I NEW BUSINESS Cinance Com, mitten The Charity Report and Sad Debt Report were reviewed by Mr. Reports West. He noted bad debt collections for May alone were greater than in the first quarter of 1984. He statel that DRG write-offs are not included in the bad debt report because there is no way I to collect them. They are listed under contractual write-offs. ` Mr. West presented a proposed weekly finance report, to be mailed once each week to the Board of Directors instead of the daily report. This new format includes a DRG analysis, as the Board requested. Mr. Hilz moved that the now form be accepted as presented, along with the Charity and Bad Debt Reports, This motion passed unanimously. Mrs, Williams noted the number of people from outside the city and outside the county who utilize FMH, the majority of whom appear to be Emergency Room admissions. ware from the Safety Committee hMr. e Hausler reviewed minutes accepted June asepresentedg of by unanimous vote. 250 1984, were read and the Home Health Minutes of the meeting of May Committee; budget for fiscal year 1984-85 was presented. A Policy and Procedure Manual was also presented. Mr. Havenhill moved that the minutes of the Advisory Committee meeting be approved along with the 198485 Fiscal Year budget and the Policy and Procedure manual, All voted in favor of this motion. EKG CommittoeI The minutes n, the May 22, 1984, meeting of the EKG committeeroup were reviewed. It was noted that the Flow Adult Cardiology changed its name to avoid confusion on the part of its patients. Dr. Qureshi's holler monitoring service is now being utilized on a trial basis. Mr. Monroe moved that ttv"se minutes be accepted As presented. The motion carried unanimously, QA/UR Committee The minutes of the Quality Assurance/Utilization Review Committee meeting were reviewed. me, Hausler explained the, purpose of and need for the position of nurse auditor, Mr. Havenhill moved that the minutes be accepted as presented, The motion carried unanimously, Critical Care Also reviewed were the Critical Care Committee meeting minutes Committees from June 120 1984. Dr. Holt moved that they be aocepted without change, and all voted in favor of that motion, Medical Staff Dr. Lockwood reported that there had been no meeting of the budget would bee Roporti MedicalEio etcapital since Board the told the Board that L discussed at their meeting next week, Medical staff members MOW, BOARD OF DIRZCTORS - FL~a MEMORIAL HOSPITAL 5 Thursday, June 14, 1984 C were sent a form to fill In with their requests for the next fiscal year, which was followed up last week with a letter from Mr. Hausler. The next Medical Staff meeting will be used to review again the proposed equipment and present the results of discussion from the departmental meetings. The list will be reviewed at this Medical Staff meeting and staff will be asked to agree on proposals at the next meeting. This will be a list of what the physicians perceive they need, both in new equipment and replacements. Dr. Lockwood said he would try to have some priori- tization of needs but suggested that could perhaps best be done in a second stage when the amount of money available is known. Administrator's Regarding capital equipment, one request was for a Doppler, and Report: Mr. Hausler stated this has already been purchased, Two items of orthopedic equipment are being acted on now. Manufacturer's information and prices have been requested, Much of the equip- meet requested by Anesthesia has been purchased. Mr. Hausler sent a second letter to all physicans requesting their input for the capital budget. He also presented some facts about the staffing cuts, pointing out that Flow now operates at 4.4 FTC's and his goal is to reach a level of 4.0, while other hospitals operate at 3.0 or less. The cuts are not as severe as some reports may have indicated. Mr. Ilausler reported that he was visited last week by represen- tatives from Hill-Burton. This is an annual required site visit and they found nothing to criticize. They did educate Mr. Hausler somewhat about their program, and expressed to him concern regard- ing the extent of last year's financial loss. They imposed soma reporting requirements to include receiving monthly financial statements and some meeting minutes. Mr. Hausler is seeking a replacement for the director of nursing. Mr, Hausler made clear that he asked for the DON's resignation, which was accepted, and that he was not fired. Mr. Hausler stated that he had talked with one person on staff regarding the interim position. In the meantime ho is seeking a permanent replacement. Mr. Ilausler stated that he would consider in-house as well as outside candidates and reviewed the credential require- ments of the position. , M Mr. Monroe told the Board he felt it was most wise to deaoribe reductions in staff on a percentage basis, and not on a numbers basis when evaluating the current situation. Mr. Hausler took this opportunity to further reinforce what the hospital is doing in regard to staffing. Mr. Hausler said he wanted to make the Board aware of the DFWHC annual awards luncheon which will be on November 15. More information about this event is forthcoming from that organiza- tion. Mr. Ilausler reported on the Taxas Hospital Association Convention in San Antonio, which he, Mr. Yoder, and Ms. Cathy Ankrom attended June 4, 5, and G. r I I BOARD OF DIRrCTORS - FL. MEMORIAL HOSPITAL 6 - Thursday, June 14, 1984 Administrator's one of the discussions which Mr. Hausler participated in concerned Report continuedi liability issues. In Amarillo, Texas, recently a case arose in which Board members wore held personally liable. There were no new developments to report regarding First Texas Medical's application for Certificate of Need. The Board briefly discussed a brochure produced by FTM which was distributed throughout the community. Mr. Hausler reported that Flow is working on a draft of a brochure and planning an ad for the local paper with the purpose of clarifying points misropre- sented in the FTM flyer. The piece produced by Flow would esp^*Jes strengths of the hospital and would not refer specific- ally to FTM's brochure. Dr. Holt recommended a letter to the hospital's professional staff also, and Mr. Hausler said he would write this letter. Equipment Approval Mr. Hausler requested approval to purchase Gould Pulmonary Testing Services System 42 equipment, which is now offered at a reduced price of $16,700. Dr. Holt moved that the purchase be approved, and all voted in favor. other New Business Mrs. Williams read to the Board a letter she received from Mrs. Dixie Clardy. She also read a letter from Mrs. Clardy to the Board thanking them for the plaque presented to her at her tea. Mr. Moore suggested that letters of this type be run in the t newspaper with the Flow logo. It was also suggested that a business could be asked to sponsor such an ad. EXECUTIVE SESSION The Board met in Executive Session at 9141 p.m, to discuss personnel matters, pursuant to Article 6252, Section 2(g) VATCS. Dr. Holt moved to contract with Saylor HCS for a study of F'low's medical staff development. The motion carried unanimously, There being no further business to discuss, the meeting was adjourned at 10121 p.m. ACTIONI Mr. Hausler: 1) Set up meeting between Flow, City and County, 2) Write and distribute letter to Flow profes- sional staff regarding status of the hospital. 3) Engage Baylor HCS to evaluate medical staff development, Respectfully submitted, Approved: 4 Ka by T on Re rding Secretary Ralph Havenhill, secretary i j VLOW MEMORIAL HOSPITAL ' 1310 SCRIPTURE (817) 387.5861 DENTON, TEXAS 76201 B 0 A R D O F D I R E C T O R S Pil- Thursday, July 12, 1989 L :o 7100 p,m. Medallion Room 1884 A G E N D A 1. Call to order IT. Minutes of Previous Meeting III. Old Business A. Medical Office Building Proposal B. City/County Development C. CON .-1- Ile'stgate Obstetrical Unit D, Flow~H69pital Memorial Fund A41Vtisoxy ,Committe4`.Status E. Bays QP:"A' #hCare System Proposed Contract F. MedicAI'Staff'beVelopment a. Public Relations IV. New Business A. Committee Reports 1. Finance Committee 2, Medical Executive Committee 3. Tissue & Trans fusi0n/Medi.;al Records 9. Critical Care Committee 5. Conf:inuing Medical Education 6. Safety Committee 7. Quality Assurance/Utilization Review 8. Pharmacy & Therapeutics/Dietetics/ Infection Control SERVING DENTON COUNTY SINCE 1950 r, C r I PLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS AGENDA July 12, 1984 page 2 B. Equipment Request C. Other New Business V. Medical Staff Report VI, Administrator's Report VII, Executive Session to Discuss Personnel Matters VIII, Adjournment s l FLOW MEMORIAL HOSPITAL, 1310 SCRJPTURE (817) 387.5861 DENTON, TEXAS 76101 B 0 A R D 0 r D I R F; C T 0 R S Called Meeting Thursday, June 28, 1989 5:00 p.m. Medallion Room A G E N D A 1. Call to Order II, Interview with Architect I III, City/County Support Update IV, Adjournment li SERVING DEN TON COUNTY SINCE 1950 'k LOW MEMORIAL III ~ 1310 SCRlPrUfiE (c 17 >c~ ~;,Fl [ ~ i y l , 0 h r: D O F I I c S j-_ f Cal.efi )'eeti(1. i 1 rscav .rune i4 !I!N Q ?AAe 5:00 p,m. f' :!Odallion Rocco A G ? ti ll i r, Call to order I l II• rvie;" With Architect III, city/coul;ty support G;)date . i Adjcaurnment J i 1 ~ I 4 . 7 BOARD OF DIRECTORS - FLr•, MEMORIAL HOSPITAL BUSINESS MINUTES Oil$ Thursd-_ayyJUne 140 1984 1ago 1 C The Board of Directors of Flow Memorial Hospital met n re 1, June 14, 1984, at 7:00 p.m. in the Medallion Room of ~N1"..session on T reday, Chairman, presided, Mra. M Williams, Members Present, Mr. Ralph Havenhill Ex ~ f` icjo! Dr, R. M, Lockwood Mr. George Hilz Dr. Don Holt Mr. Jeff Hausler Mr. Stanley Monroe Mr. Brad Moore Also p_ rm t, Dr. M.V.R, Freeman Mr. Dan Trammell Ms. Kathy Thompson Ms. Mary Williams Mr. Charles West Mr. David Yoder The minutes of the previous meeting were presented to the Board. By unanimous vote, they were accepted AS presented. OLD BUSINESS CON • West ate: Mr. Hausler notifed the Board that June 10 was the date to formally enter as a party in opposition to the obstetrical unit at Westgate. Flow did enter its opposition and is represented by the law firm of Sharp and Morse. City/County Mr. Hausler stated that the City and County continue to work Oevelapment, with Flow regarding the money owed Medicare. Mr. Chris Hartung C and Mr. Hausler have been discussing the possibility of a loan to Flow from the City and are working t;,rough the City attorneys. In the meantime, alternatives are being arranged should a loan or loans such as those discussed not cane to pass. One alternative is a short term loan with a local lending institution on the balance due collateralized with certificates of deposit, The City has suggested that Flow retain a lawyer in the matter of City/County responsibilities, Mr. Hausler has been in touch with the hospital in Pittsburgh, Texas, Which formerly was a city/ county hospital, to see what information they might provide, since he said he is not aware of anyone locally who might spe- cialize in this area, Mr. Hausler sought direction from the Board and stated that we need to choose an attorney soon on this matter. Mr, Trammell stated he feels the City rather than Flow should take a position with the County, and advised that Flow should remain neutral. Dr. Holt suggested that a meeting be called between the City, County, and Flow to determine their positions. Mr, Hausler stated he would like to bring the matter , to a head as soon as possible and determine a course, Mr. Hausler was asked by the Board to set up a meeting with the City and County, Status of State Mr. Monroe reported that over 20 individuals have agreed to serve Advisory Committee on the Advisory Committee to the Flow Hospital Memorial Foundation. C The organization has not yet selected an officio: name, is scheduled for noon on July 11. Col. Richard E. J. (Jack) ea Ling Scott has agreed to chair the meeting and be the chairman of the committee. BOARD OF DIRECTORS - F`' MEMORIAL HOSPITAL Thursday, June 14, 1984 2 Mr. Monroe stated he would like to have at least ten more on the committee, and would like more from communities in the county outside of the City of Denton, He stated that the group is not interested in direct solicitation, but would be familiar with the needs of Flow and be available to speak for and support the hospital, He asked that the Board be present at the July 11 meeting. At that meeting he anticipates dividing into three subcommittees one for publicity, one comprised of the Board and hospital staff, and one in charge of funds, The Poard and staff subcomittee would be responsible for selecting where the money raised should be spent. He plans for the subcommittees to meet monthly, and the Advisory Board would then gather as a whole quarterly. The first project of the Advisory Board is to prepare a brochure for distribution throughout the community telling what Flow is, its history, etc. and there will be a mailing card In the brochure with a place to fill in, something such as "please accept my donation of . , . .'1 Architectural Mr. Hausler informed the Board that he has been reviewing the Proposal, proposals of several architectural firms, and has narrowed these down to five. Of these he selected two who seemed to be most qualified and experienced to meet the hospital's needs. Fie reviewed these two proposals for the Board and made a recommen- dation to engage Harwood K. Smith & Partners (HKS), The proposal made by HKS is to develop a masterplan responding to areas of need and the Department of Health's Life and Safety Codes, as well as specific areas of need noted by the hospital staff and administration, but does not include the medical office building. It does plan for a medical buildings however, the actual building project would be proposed separately. HKS proposes to take the master plan to the point of the conceptual with a pt•e-schematic design of expansion plans, working with existing floor plans, and make specific recommendations regarding project needs, Their package does not include mechanical drawings, Mr, Hilz suggested that the Board interview this firm before making a decision. Mr. Hausler noted that both HKS and the Harris group were local and had excellent references. HKS offers a gamut of services, in- cluding architectural design, planning, medical office building capabilities, etc. Their pricing is presented as one fee, while Harris' is broken down by individual project within the proposal. HRS's figure is all-inclusive. or. Holt stated he would like to see the Board move based on an administrative decision. Dr. Holt moved that Flow ask HKS to proceed with their proposal. After some discussion Dr. Holt withdrew his motion. Mr. Monroe moved to hold a called meeting of the Board to present their plans to the Board, and to target the week of June 25 for that meeting, or. Holt seconded the motion and all voted in favor. At this time Dr. M.V.R, Freeman joined the meeting and the rogular order of business was suspended so that he could make a presentation at the request of the Board of Directors. Presentation b Dr. Lockwood read the minutes of the May 10, 1984, meeting of Dr. Freeman the FMH Foundation Board in which a member of that Board stated stated that portable ultrasound equipment might bring lawsuits BOARD OF DIRECTORS - FLU., MEMORIAL HOSPITAL Thursday, Juno 14, 1984 J C to the hospital and advised against the purchase of such equipment because "it is a very hard piece of equipment to justify using," According to Dr, Lockwood, Dr. J. !I, Jones indicated the equip- ment was not appropriate, and therefore Dr. Lockwood asked Dr. Freeman, who specializes in the use of ultrasound, to present information on the safety of ultrasound to the Board and also to the Foundation, or, Freeman then introduced himself, stating that he is a board certified gynecologist and has done extensive work with birth defects and toretologyi however, he emphasized that what he presented would be not his own opinion, but opinions of professional organizations and physicians In the United States and Internationally, He also clarified that he was presenting a summary about the safety of diagnostic ultrasound and not therapeutic ultrasound (diathermy), Dr. Freeman quoted the American Institute of Ultrasound in Medicine's October, 1982, statement that ultra- sound has been used for over 25 years and to that date no adverse effects had been reported. Dr. Freeman stated that in all cases' it was consistently believed that benefits of ultrasound far outweigh any possible adverse effectst however, according to these organizations, no adverse effects were known. The American College of Obstetricians ad Gynecologists in September, 1983, stated they found no evidence of harmful effects resulting from use of diagnostic ultrasound, Dr, Freeman stated some lawsuits have arisen from incorrect diagnosis, but knew of none associated with the administration of ultrasound, In West Germany and some C Scandinavian countries, he said, two ultrasound exams are required during pregnancy, Dr. Freeman also clarified that no radiation is used in ultrasound, Dr. Lockwood stated that ultrasound is now performed daily and is available for use. Proposed equipment is for use in Labor and Delivery and Nursery, it is needed for critically ill premature infants, and for Labor and Delivery to determine if twins are to be born, if the baby is head first or bottom first. Dr. Freeman's recommendation was that an inexpen- sive linear unit be purchased for L & D, and could probably be purchased for about $19,000. Mr, Hausler stated that 945,000 was budgeted for a portable unit and this was the amount which the Foundation was originally approved, Dr. Freeman stated he was available to the Board for any information they might need, and said he would speak at the next meeting of the Foundation Board. Dr. Freeman left the meeting and the agenda was resumed. TWU Co~ nsultingi There was no new business to discuss regarding this subject. CON Pre-application Mr, Hausler reported to the Board that Certificate of Need pre-applications have been filed for a medical office building and for an adolescent psychiatric unit, Baylor HCS Mr. Hausler told the Board that Administration is continuing to Proposed Contracts work on this. At the previous Board meeting a proposal by Baylor Health Cara Systems to charge $i5 per bed per month for consult- ation services was presented, be, Holt stated that the Board should consider not only the cost of this consulting service, but also untapped resources in education, as well as other benefits, Mr, Havenhill moved that Mr. Hausler return to Baylor with a request to negotiate the proposal. This motion passed unanimously. i BOARD OF DIRECTORS - F1 MEMORIAL. HOSPITAL Thursday, June 14, 1984 4 Other old There was no other old business to discuss, BusinessI NEW BUSINESS Finance Committee The Charity Report and Bad Debt Report were reviewed by Mr, Re orti West, He noted bad debt collections for May alone were greater than in the first quarter of 1984. He stated that DRG write-offs are not included in the bad debt report because there is no way to collect them. They are listed under contractual write-offs. r Mr. West presented a proposed weekly finance report, to be mailed once each week to the Board of Directors instead of the daily report. This now format includes a DRG analysis, as the Board requested, Mr. Hilz moved that the new form be accepted as presented, along with the Charity and Bad Debt Reports, This motion passed unanimously, Mrs. Williams noted the number of people from outside the city and outside the county who utilize rmil, the majority of whom appear to be Emergency Room admissions, Safety Committee Mr, Hausler reviewed the minutes from the June B meeting of the Safety Committee, These were accepted as presented by unanimous vote. h Nome Health Minutes of the meeting of May 251 1984, were read and the Committeei budget for fiscal year 1984-85 was presented, A Policy and Procedure Manual was also presented. Mr. Havenhill moved that the minutes of the Advisory Committee meeting be approved along with the 1984-85 Fiscal Year budget and the Policy and Procedure manual, All voted in favor of this motion. EKG Committee: The mtnutes of the May 22, 1984, meeting of the EKG committee were reviewed, It was noted that the Flow Adult Cardiology Group changed its name to avoid confusion on the part of its patients. Dr. Qureshi's bolter monitoring service is now being utilized on a trial basis, Mr, Monroe moved that these minutes be accepted as presented. The motion carried unanimously. Qrt/u R, CYittee The minutes of the Quality Assurance/Utilization Review committee meeting ware reviewed, Mr. Hauslor explained the purpose of and need for the position of nurse auditor. Mr. Havenhill moved that the minutes be accepted as presented, The motion carried unanimously, Critical Care Also reviewed were the Critical Care Committee meeting minutes Committee, from June 12, 1984, Dr, Holt moved that they be accepted without change, and all voted in favor of that motion, Medical Staff Dr, Lockwood reported that there had been no meeting of the Re ort, Medical Executive Committee since the last Board meeting. He told the Board that the capital expenditures budget would be discussed at their meeting noxt week. Nedical staff members BOARD OF DIRECTORS - FL y, MEMORIAL HOSPITAL Thursday, June 14, 1984 5 were sent a form to fill in with their requests for the next fiscal year, which was followed up last week with a letter from Mr, Hausler. The next Medical Staff meeting will be used to review again the proposed equipment and present the results of discussion from the departmental meetings. The list will be reviewed at this Medical Staff meeting and staff will be asked to agree on proposals at the next meeting, This will be a list of what the physicians perceive they need, both in new equipment and replacements, Dr. Lockwood said he would try to have some priori- tization of needs, but suggested that could perhaps best be done in a second stage when the amount of money available is known. Administrator's Regarding capital equipment, one request was for a Doppler, and Re orti Mr, Hausler stated this has already been purchased. Two items orthopedic equipment are being acted on now. Manufacturer's information and prices have been requested. Much of the equip- ment requested by Anesthesia has been purchased. Mr, Hausler sent a second letter to all physicans requesting their input for the capital budget. He also presented some facts about the staffing cute, pointing out that Flow now operates at 4.4 FTE's and his goal is to reach a level of 4.0, while other hospitals operate at 3.0 or less, The cuts are not as severe as some reports may have indicated. Mr. Hausler reported that he was visited last week by represen- tatives from Hill-Burton. This is an annual required site visit and they found nothing to criticize. They did educate Mr. Hausler somewhat about their program, and expressed to him concern regard- ing the extent of last year's financial loss. They imposed some reporting requirements to include receiving monthly financial statements and some meeting minutes. Mr. Ilausler is seeking a replacement for the director of nursing. Mr. Hausler made clear that he asked for the DON's resignation, which was accepted, and that he was not fired, Mr. Hausler stated that he had talked with one person on staff regarding the interim position. In the meantime he is seeking a permanent replacement. Mr. Hausler stated that he would consider in-house as well as outside candidates and reviewed the credential require- ments of the position. Mr. Monroe told the Board he felt it was most wise to describe reductions in staff on a percentage basis, and not on a numbers basis when evaluating the current situation, Mr. Hausler took this opportunity to further reinforce what the hospital is doing in regard to staffing, Mr. Hausler said he wanted to make the Board aware of the DFWHC annual awards luncheon which will be on November 15. More information about this event is forthcoming from that organiza- tion. Mr. Hausler reported on the Texas Hospital Association Convention in San Antonio, which he, Mr. Yoder, and Ms. Cathy Ankrom attended June 4, 5, and 6. BOARD OF DIRECTORS - F' MEMORIAL 1'OSPITAL Thursday, June 14, 1984 6 Administrator's One of the discussions which Mr. Hausler participated in concerned Report continueds liability issues. In Amarillo, Texas, recently a case arose in which Board members were hold personally liable. There were no new developments to report regarding First Texas Medical's application for Certificate of Need, The Board briefly discussed a brochure produced by FT14 which was distributed throughout the community, Mr, Hausler reported that Flow is working on a draft of a brochure and planning an ad for the local paper with the purposo of clarifying points misrepre- ~~J1 sented in the FTM flyer, The piece produced by Flow would espouse strengths of the hospital And would not refer specific- ally to FTM's brochure. Dr, Holt _ecommended a letter to the hospital's professional staff also and Mr. Hausler said he would write this letter. Equipment Approval Mr. Hausler requested approval to purchase Gould Pulmonary Testing Services System 42 equipment, which is now offered at a reduced price of $16,700. Dr. Holt moved that the purchase be approved, and all voted in favor, Other New Business Mrs, Williams read to the Board a letter she received from Mrs, Dixie Clardy, She also read a letter from Mrs. Clardy to the Board thanking them for the plaque presented to her at her tea. Mr. Moore suggested that la;tters of this typo be run in the newspaper with the Flow logo. It was also suggested that a business could be asked to sponsor such an ad. EXECUTIVE SESSION The Board met in Executive Session at 9141 p.m. to discuss personnel matters, pursuant to Article 6252, Section 2(g) VATCS. Dr. Holt moved to contract with Baylor HCS for a study of Flow's medical staff development. The motion carried unanimously. There being no further business to discuss, the meeting was adjourned at 10121 p.m. ACTION, Mr. Hausleri 1) set up meeting between Plow, City and County, 2) write and distribute letter to Flow profes- sional staff regarding status of the hospital. 3) Engage Baylor HCS to evaluata, medical staff development. Respectfully submitted, Approvedi , Ka by T on, Re rding Secretary Ralph Havenhill, Secretary 1 r: FLOW MEMORIAL HOSPITAL 1310 SCf71ATURE (817) 387.5861 DENTON, TEXAS 76201 1 n 0 A R U O F D I R E C T O R S !I)N #984 •7une 14, 1984 7100 P.M. Medallion Room A 0A I• Review and Approve Minutes Of 11ay Meeting IT. Old Business A. CON - Westgate B• City/County..nevelopnlAnt D C• "status Of Advisory Committee , Architectural Proposal E• TWU Consulting F• CON Pre-application G• Baylor "CS Proposed Contract H• other Old Business ITT, New nusiness A. Committee Reports 1• Finance Committee 2• Safety Committee 3• Home pealth Committee n• Medical Staff Report C. Administrator's Report D, Equipment Approval E• other New gusiness TV- Executive Session to Discuss Personnel Matters V. Adjournment IMINO DEN TON COUNTY SINCE 1950 y ! i i FLO% MEMORIAL HUSSPITAL 1 ~ 1310 SCRIPTURE (817) 387.5861 DENTON, TEXAS 76101 B 0 A R D 0 P D I R E C T O R S Called Meeting ,'k 4y Y 140dnesday, May 9, 1984 r 300 p,m, Medallion Room AA G~Np A I Call to Order II. Baylor Nursing Service Report III• City/County Punding status IV. Plow Development Plans V• Architectural Master Plan Proposal VI, Physician Recruitment Incentives VII. Roof Proposals VIII, Other. Business IX, Executive Session - - Personnel Matters X, Adjournment SERVING DENTON COUNTY SINCE 1950 FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS MEETING Thursday April 19, 1984 ~~tlr! l i~% °'r 1:00 p.m. Medallion Room G/ AGENDA I. Review and Approve Minutes of Previous Meeting 11, Old Business A. Status Report on CON Opposition r 1. First Texas Medical Hospital r 2. -Westgate Obstetrical Unit 3. Psychiatric Institute of America B. Status Report on Proposed Midwife Program C. Announcement regarding Administrative Secretary position 0. Energy Management Status Report E. Status Report - Proposal to City and County F. Status Report on Medicare Repayment G. Physician Recruitment H. Budget progress I. Psychiatric Unit Revisions J. JCAH Interim Survey K. Baylor Study Report - Nursing Service L. Architectural Consultants 111. New Business A. Committee Reports I . Finance Committee - Mr. Hilz 2. Quality Assurance/Utilization Review - Mr. Hausler 3. Home Health Committee - Mr. Hausler 8. Medical Staff Report C. Administrators Report ' D. Any other Now Business 1V. Executive Session to discuss Personnel matters V. Adjournment i FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS MEETING THURSDAY, MARCH 15, 1984 l AR 1 4 981, 7;00 p.m, MEDALLION ROOM AGENDA I. Review and Approve Minutes of Previous Meeting lI. Old Business A. Status Report on CON Opposition 8. Status Report on Proposed Midwife Program C. Announcement Regarding Filling of Business Office Manager Position D. Status Report on Natkin Proposal E. Status Report on Adjustment Due to Medicare F. Any Other Old Business III, New Business A. Committee Reports 1. Finance Committee--Mr, Hilz 2. Foundation Board--Mrs. Williams 3. Quality Assurance/Utilization Review--Mr. Hausler B. Medical Staff Report--Dr, Lockwood C. Administrator's Report D. Any Other New Business IV. Executive Session to Discuss Personnel Matters and Suspense Litigation V. Adjournment I BOARD OF DIRrCTORS ME .ING BUSINESS MINUTES oe,u _ January 19, 1984 Peq~ The Board of Directors of Flow Memorial Hospital met in r on Thursday, January 19, 1984 with the Chairman, Mrs. Williams, ~h~I}on a00 pal, Members present: Also present: z~± Members absent: Mr, Jeff Hausler Mrs, Wilma Fritz Mr, Ralph Havenhill Ms. Laurie Griffith Or• George A1z2 2 Dr, R, M. Lockwood Mrs. Gloria Madewell 1 Dr. Don HPos i Mr, Brad Moore vacant position Mr, David Yoder ,j Mr, Dan Trammell Mrs. Mary Williams For presentation only: Mr. Larry Rayburn, Mr, Bruce Milligan Audit Report--Mr, Larry Rayburn and Mr, Bruce Milligan, from Peat, Marwick, Mitche an ompany were introduced and asked to present their auditors report for fiscal year 1982-83. The report was reviewed page-by-page Mr Rayburn highlighted that there had been a decrease in the ratio of assets to liabilities and an improvement' in accounts payable from the previous year end. He explained the effects of the TEFRA legislation on the reimbursement for costs for Medicare patients, The estimated percentage had been 81% of charges; actual reimbursement rate, however, was 70%, and I~ a refund will need to be paid back to the Medicare Intermediary. Fiscal year 1982-83 ended with an excess of expenses over revenues of $1,002,952. He stated t',at the average length of stay for Medicare patients had increased from the nrevious year and that this is an unfavorable trend. The rate of collection of accounts also exhibited an unfavorable trend; Mr. Hausler, however, stated that in November, a set of specific policies and procedures had been implemented in the Collections Department which should C improve this situation, The Administrator also commented that the loss could be attributed to the reimbursement ratio from Medicare and the uncollectible accounts. The management letter was also reviewed by Mr. Rayburn, and the eight points were addressed by the Administrator as follows: Patient Accounts Receivable--Procedures are now in place as suggested, and the procedures will be monitored to assure their continued implementation, Medicare/Medicaid Cost Reporting--These items are to be discussed with the new controller, C ontract Services--Contracts are being updated and reviewed now, Lon read presentation of cMedical Records who will begin employment on January 23, Disaster Recovery plan--items are being considered and reviewed, Inventory--To be implemented by David Yoder. Cash Management--Although not reviewed yet, Mrs. Fritz will investigate the possibility of investing two of the cash accounts for short-term interest- bearing accounts, Mr. Rayburn stated that he would answer any further questions if necessary or return ! r after the Board members had bad additional time to review the audit report, The minutes of the previous meeting were presented, reviewed, and approved. Old Business: ( Midwife Program.-The Administrator stated that he had sent a memorandum to all obstetricians on staff at Flow requesting that any of them interested in the position of medical director of obstetrics contact him. He had also discuss-d this with the Chairman of the Department of OB/GYN who had suggested that another letter be sent to them Mr, Haunler stated that fie expects a group of obstetricians offe to re o ve the prohlem Further, he stated that monies for the midwPe progra for tie phys c ans BOARD OF DIRECTORS BUSINESS MINUTES Y , P• services would probably notnberforthco9i8ng from the County, although the hospital 2 ~I C expenses for the deliveries of midwives may be included in the County's reimbursement for charity care it there is an excess in the charity allocation for this year, Mr, Ilavenhill moved that the Board authorize the Administrator to proceed with the plans to employ midwives and a medical director for the program; this motion was seconded and passed ed b , =oi cn vote, Opposition to CON--The Administrator reported that a formal request had been filedl with T e`Texas`-Fe-,ITlii"Facilities Commission on January 18, 1984 to oppose the approval ' of a Certificate of Need for First Texas Medical to build an additional hospital in 11 Denton. He added that the opposition is based upon there not being a need for the facility. Cost for defense of this CON application is expected to be approximately $20,000 for Flow. The Board's Executive Committee had approved the expenditure, New Business; C Finance Committee--Mrs. Fritz reviewed the financial statements for the month of December, 1983. She explained that the average daily census for the month had been below budget--at 77; however, revenues had not been below budget due to an increase f in utilization of the specialty areas, Mrs. Fritz stated that from previous year, there has been an increase in the total amount charged-off to Bad Debts and Charity IJ but a decrease in the collection rate. She suggested that this be analyzed, as well analyzing why the present outside collection agency does not collect more, She stated that revenues have increased 15,7%, but that cash collected has only increased 7,6%, Due to the change in the percentage of reimbursement from Medicare, she stated that the hospital must pay back to Medicare $630,000 by the first week of March, Mrs. Fritz suggested that when this amount is borrowed, an additional sum be included in the loan in order to reduce accounts payable. The Bad Debt Charge-Off list in the amount of $65,810 and the Charity Charge-Off list in the amount of $76,133 were presented and reviewed, Mrs, Fritz reported that a certificate of deposit matures January 2? at Pilot Point National Bank; Mr, Moore moved that the Board authorize reinvestment of the CO at Pilot Point for six months at the highest interest possible, and this motion was seconded and approved by voice vote, Mr, Moore moved that tile Board approve the Finan- cial Report as presented, this motion was seconded and passed by voice vote. Founk.lon Repor --Mr, Ilavenhill reviewed the minutes from"the January 12 meeting of the Foundation Board of Directors. He stated that the Foundation had re-appointed Mr, Orr, Mr, Moore, and Dr. McClendon for additional three-year terms, Mr. Hausler stated that he had researched the Bylaws of the Foundation to determine the appropriate procedure for Board appointments, and the Foundation itself appoints its own members, The Hospital Board members discussed this procedure and agreed that it should be amended so that the Hospital Board has final approval of the Foundation's members. Therp was also some discussion concerning one member of the Foundation possibly having a conflict of interest and whether or not he should be asked to resign. A resolution was passed by the Hospital Board of Directors to authorize the Administrator to borrow the $19,900 for the gas sterilizer. The foundation would then make payments to the hospital for the loan, Mr. Havenhill moved that the Foundation Report be accepted; this motion was seconded and passed by voice vote, ualit Assurance/Utilization Review--The minutes of the December 20 meeting of the QA UR Committee were presented and reviewed, The Administrator noted that the QA Department has ch nged its name from Quality Account bilit to Qu lity Assurance The QA manual, goa~s and objectives, had been approved by tFia Comm ttee, pprova~ of the Utilization Review Plan by the Board of Directors was deferred due to approval being tabled by the Medical Executive Committee. BOARD OF DIRCCTORS MC*"` NG .BUSINESS MINUTES DA PG January 19, 19134 ra9o 3 Safety--The minutes from the January 17 meeting of the Safety Committee were presented and reviewed, The Administrator noted that the safety Committee had recom- mended that the utilization of space within the building be assessed to determine if there is additional storage space within the hospital, in lleu of the purchase of a i~ storae Mr, ausler scan e be that afor fence the Is storage of built numerous outside obsolete items Until they can be sold as salvage. The committee members had discussed a new requirement by the JCAH requiring that the building be suitable to the population served and whether or not the present building is accessible to the elderly or infirm -1 patients, Mr. Moore moved that the Safety Committee Report be accepted; this motion ,was seconded and passed by voice votF, Medical Staff R~oport--Dr. Lockwood reviewed the minutes from the January 16 meeting of the ed caT Executive Committee. He stated that they had discussed the plans to incorporate the Birthing Center into the Labor and Delivery Unit, The MCC had also recommended that a policy be implemented which would require that physicians provide a final diagnosis on Medicare patients before the patients could be discharged from the hospital. In this way, Medicare claims could be more quickly filed. Dr. Lockwood stated that he will be working with Dr. Holt and the new Director of Medical Records on implementation of this procedure, Mr. Havenhill moved that the Medical Staff Report be accepted; this motion was seconded and passed by voice vote. Administrator's Report: Count Fund in --The Administrator reported that he had met with the County Judge regarding the 75,000 which was due to the hospital last year from the County. Pre- viously, he had tried to contact the County Auditor 4-5 times, and now the Judge has agreed to follow-up on the question, MHMR--Mr, Hausler stated that he has notified the County Judge that the hospital is not receiving payment for OPC patients of the County, as well as reimbursement for jail patients and balance after Medicaid accounts, The Judge had agreed to readdress the Court about whether these accounts should be reimbursed under charity or indigent care. JCAH--Mr. Hausler stated that the interim survey form has been received from the Joint Commission on Accreditation of Hospitals. He stated that it will be completed and returned soon, Positions--Mr, Hausler reported that he had employed Charles West as controller and teat Tie would begin employment February 20, Also, a new Director of Medical Records, Cathy Ankrom, has been employed and will begin work next Monday, Mr, Hausler announced that the position of Business Office Manager will be vacant February 20 duz to the resignation of Margaret Lester, Cvaluation Forms--The employee performance evaluation forms are now complete, The procedures for utilizing the forms, The specific procedures to be followed with the forms are to be discussed the next day, City Council--A request from the City Manager to schedule another joint meeting with the City Council and hospital Board was discussed, The Board members agreed to meet with them as soon as possible, and Mrs. Madeweil was asked to contact the Board members about a convenient date for the following week, Medical Office Buil_d_i_n~g--The Administrator reported that there had been two meetings scihedu ed for p~y~cians who had expressed an interest in the medical office ~ a BOARD Or DIRECTORS MEETIrM,, BUSINESS MINUTES oai, January 19, 1984 4 building, and only 4-5 physicians had attended the meetings. Mr. Hausler stated that y the poor response was probably due to the dates of the meetings being the week before Christmas and also due to the pending application for building an additional hospital in Denton, It was agreed that following the application hearing another effort be made to determine which physicians might be interested in the building. Representatives from IIBE had stated that it would be necessary to obtain six firm commitments prior ~1 to approval of the building. CME Workshop--Mr. Hausler stated that the infectious disease workshop co-sponsored+ by the'7{ Te`F 'ICoberts Center for Continuing Education and Flow had been well received f'f by those present; however, there had been a loss of $126 due to poor attendance, fI Ba for Health Care System--A nursing survey is scheduled for January lb and 17 for all un s, including the 39 Unit. Results of this survey performed by Baylor Healt Care Systems should be available in about 30 days, Mr, Hauslor stated that he had discussed with Baylor the possibility of educational programs on DRG's with nothing yecl decided; a proposal from Baylor is expected in 3-4 weeks. He noted that Baylor is not yet on the DRG reimbursement system. ORG's--The Administrator reported tat the reporting mechanism for DRG reimbursement has been refined to better show charges versus the reimbursement rate by physician. He will continue to monitor the progress on this. TWU--The Administrator reported that an agreement has been reached to provide approval for TWU nursing students to utilize the 38 Unit for clinical experience in psychiatric nursing. C Orkin--Due to the continued problem with pests, the contract with Orkin has been cancoMU-, and local firms were contacted to bid on providing the coverage at Flow, A contract has been signed with Denton Pest Control for $16,000, and it is expected that the service will be improved. TV Contract--The Administrator reported that the Wells Company has been notified of F1ow`~ s 'intent to cancel their contract for providing television and audio/visual playback services. Another vendor will be sought. EKG Interpr_e~t~atIons--The physicians who interpret EKG'e were notified on Decem eii 2`8 that the o pital will no longer bill the professional component for EKG's and such for them. A meeting will be scheduled in the near future with them to work out the details, Mr, Hausler stated that this was done tc provide a cost savings and explained some other advantages, I Natkin Proposal--A written proposal to follow-up a verbal proposal is expected within Mr y ays rom Natkin, a company that might replace all heating and air condi- tioning systems, Laundry and Dietary equipment at no cost to the hospital. The proposa would he designed to save energy costs with the savings shared between Flow and Natkin. Details will be forwarded to the Board as they become known, TVVPPr~o_gram--Mr. Hausler reported that he had been interviewed on Channel 11's Viewpoint on Saturday morning concerning the differences between profit and not-for- profit hospitals. ( -physician Recruitrtlant--The Administrator was asked if the recruitment contracts were ready for submission to the physicians involved, and lie responded that they had no yet been mailed, Goals and Objectives--The Administrator presented written hospital goals and PI fJ ti BOARD OF DIRECTORS MF'•TIMG BUSINESS MINUTES Pago 5 j objectives for 1904 and the next five years. These were reviewed and discussed by the i { Board of Directors. The Administrator explained that the goals and objectives were correlated to the individual departmental goals and objectives submitted by the directors in 1903, The draft will be submitted to the Medical Executive Committee at their next meeting and will be presented to the department directors on Friday, i~ There was no further business, and the meeting was adjourned at 10;30 p.m. Ralph Haverhill Secretary 9m I 5 MEDICAL STAFF GOAL: To secure an adequate complement of physicians in relevent specialties HOSPItOl o uf their services patients offered,achieve the SPECIFIC OBJECTIVES: 1984 I. M.D. Recruitment a) Develop a recruitment incentive package b Recruit onto Medical Staff a net of five (12131) (active) doctors who will use Flow Memorial Hospital for the ma,iority of their care rendered in the acute setting c) Retain Placement'Service {8/31) d) Consider employing a professional recruiter (2129) (2/29) 2. Medical Staff Relations Development a) Assess physician attitudes and satisfaction in a formal manner b) Implement a regularly produced communique for (3/31) Medical Staff c) S member t least chedule Round-table meetings with every staff (5/1} d) Developaa formalaphysician'relations plan {2/15) 3. Develop services of a Medical Staff Coordinator 4, Propose changes in meeting Schedule to Medical Staff {2/15} 5. Propose methodology for periodic revision of ;iylaws 5. Revise aylaws (4/1) (9/30) r 5 YEAR 7. Ror"ait a net of five phy each physical year sir,ians onto Medical Staff 8, Annually assess h ~ (Ongoing) with Flow MemorialyHospita~ttitudes and satisfaction 9. Meet with ever (Ongoing} to promote very staff member every yearr at least once 10. Review and revise oylaws annually (Ongoing) {Ongoing} 1 f SERVICES GOAL; To Maintain adequate scope of service to met the needs of the population served both present and future, SPECIFIC OBJECTIVES! 1984 1, Analyze utilization of existing services ' (2/29) 2. Further development of Home Health (Ongoing) 3. Ambulatory Surgery (4/30) 4. Development of Rehab Services } (1/31) 5. Development of Cardiology services ' (9/30) 6. Explore Psychiatric Out Patient Services (4/30) 7, Coordination of existing Out Patient Services e (3/31) 8. Social Services/ Discharge C":•;nning (2/1) i a FINANCIAL MANAGEMENT GOAL; To achieve financial stability with an adequate net profit to provide for the expenses of operating Flow Memorial and for providing for its capital needs. SPECIFIC OBJECTIVES: 1984 1. Prospective payment management a), Implementation of a monitoring system (12/31) b) Computer enhancement of DRG assignment 54/30) c) Provide educational program to Medical Staff (2/29) d) Quarterly report of DRG impact to Medical Executive Committee 2/29) e) Monthly report of DRG cases to individual physicians 1/31) 2. Recruitment of a qualified Assistant Administrator-Finance (1/31) 3, Improve Cash Flow in Billing and Collections a) Systemize collections (12/31) b) Reduce total AR "days outstanding" to 80 (9/30) c) Medicaro-average filed=15 days -99% paidb3O days (4/30) d) Other Third Party-average filed=15 days -90% filedn30 days -99,5 paid*60 days (4/30 e) Self Pay-x less than 15% + 150 days (5/31 f) Tracing of all unpaid filings every fifteen days (4/30) 4. Payables management to reduce AR 99% paidm60 days average paidn3C days (7/31) 5. Profit margin-5% (9/30) 6. Meet or exceed budgeted revenues (9/30) 7. Expenses a) Not greater than budgeted (9/30) , b) Categorically analyze expenses reduce in all areas possible (9/30) 8. Prepare adequate budget with input of Board, Medical Staff, Management (611) 1 110 a STRUCTURAL GOAL, To provide functional space for the provision of services included within the scope of services defined. SPECIFIC OBJECTIVES; 194 1, Provide a roof overlay (5/31) 2, Surgical repairs a) Ceilings 67/31) b Plaster walls (7131) c Major room (((9/30) 1) walls 2) floor d) Cabinets e) Windows (3%31 (3/3 3, Recovery Room a) Wall and cabinets (1/31 b) Expand and refurbish lounge (1/31 4. Design space for physicians a General Lounge 9/30) b Library 9/30 c Surgical Lounge 1/31. d Consultation areas 9/30 e Dining Areas 19/30) f) Dictating Areas (9/30) 5, Redesign space for Medical Records a Transcription 9/30 b Filing 9/30; c Copying 9/30 d Assembly 9/30 e Director's office 9/30 f Microfilming 9/30 9 QA, DRG Coordinator, AR Coordinator, MS Sec. 9/30 h Storage 19/301 b. Ancillary space allotment and design (9/30) a) P.T. b) Cardiopulmonary c) Lab, d Radiology e Business Office f Cafeteria-facelift g Kitchen h First floor offices 7. Expand 30 Security area (7/31) Y rti I, S 8. P.T. room renovation a) Ceilings (Ongoing) b) Cabinet repair c) Headwall vinyl d} Wall referbishment e) Window treatments f) Accessory standardizaiton 9. Facelift public areas (9/30} 10. Signage a). internal- directional, informational (8/31) b) External- directional of parking, entry, ER, etc. (8/31) 11. Classroom/meeting rooms (9/30) 12, Master site plan development (9/30) 6 YEAR 13. Construct Medical Office Building (6/85) 14. Expand and redesign existing Labor and Delivery (9/86) 16. Expand Nursery (9/86) 16. Central Supply Redesign (9/85) 17. Signage-facility identification (9/85) r r r+'etE ORGANINAL GOAL; To provide appropriate organizational structure to facilitate the accomplishment of stated goals and objectives. SPECIrIC OBJECTIVES; 1984 I. Establish productivity standards, based upon projected volumes, for every functional area of the hospital ' (2/15) 2, Assess external environment for its potential impact upon services of the hospital 3. Evaluate PPD (Ongoing) (3/31} 4. Establish ongoing planning mechanism 5. Establish arrangements with major groups to give {4/30) incentives to utilize the hospital r 6. Evaluate existing contracts for possible negotiation (Ongoing} a) MD professional components b) Pathology 2129) C) Dietary 3/31 3/31 7, Establish effective anesthesia coverage 8. Evaluate Medical Directorship (6/30) a) General staff b) functional areas (4/30} 1. OD (4/30) 2, CCU 3. EKG 4, P.T. 5. UR 6. Psych 9. Consider ownership form change 10. Redefine responsibilities of to {9/30) R,A#pZgeuien.ts (2/29) ~ 11. Improve attitudes of-arrangements (2/29) 12. Implement hospital wide educational/development program (6/30 13. Assure continued compliance with JCAH, state licensure ) and other applicable standards (Ongoing) 1 1 'EQUIPMENT GOAL. To provide appropriate equipment required to optimize efficiency in providing services according to institutional SPECIAL OBJECTIVES; goals and objectival, r-- 1984 OR. a Tables bLights c1 Stretchers ]/3]) d} Monitoring 9/30) e1 Resuscitation 9/30) 2. Biofeedback 19130)9130) 3. Laundry (9'30) 4. NUAC (9/30) "y7 S, Kitchen (6/30) 6. Develop system to evaluate capital (9130) dispose of obsolete equipment, purchases and to effectively 5~ R (4/30) 7. Purchase a major piece of radiology equipment each fiscal 8. Replace patient television and audiovisual system year (Ongoing} 9. Replace furnishing in twenty patient rooms each fiscal r ngoi 1Q. Replacement of and addition of necessary yea (Ongoing) the hospital in accord with annual capial gbudgett throught (Ongoing) t t' HUMAN RESOURCES GOAL; To maintain an adeobqujaetectiv coesmplement accomplish stated of qualified personnel to , SPECIFIC OBJECTIVES: 1984 1. Analyze FTE's utilized by hospital in total and by departments 2. Design evaluation technique to assure personnel utilized are (1/31) qualified at appropriate levels 3. Continued reviewing of existing employee salary and benefit (5/3O) Program to assure equitable and competitive compensation to employees 4. Continue to seek feedback from employees regarding their concerns (Ongoing) a} Direct Line b Open meetings with Ongoing c Monitored responses to Self evaluations #Ongoing ) 6. Expand format (Ongoing) tool of Flow Notes to be a more effective communication 6. Formalize Employee Recognition Program ((1 30) 6/30} it MARKETING GOAL.: To provide adequate communication to the population served, medical staff, employees, and other relivent parties, regarding services and programs or significant occurances of Flo4+ Memorial Hospital or furtherance of the image of Flow Memorial Hospital through dissemination of information, SPECIFIC OBJECTIVES: 1984 1. Design a hospital logo, slogan or other identification for the hospital . (3/31) . 2, Develop a structured news release program (2129( 3. Develop a tool for analysis~of pa?A ent attitude toward Flow Memorial Hospital (1/31) 4, Develop a speakers bureau progran and presentation (4/30) 5, Revise a general informational bruchure regarding hospital services and features (3/31) s 6. Implement niceties to patients. ie: Stork Club, Birthday acknowledgement, etc, (6/30) 7, perform a market analysis study to indicate existing and potential market segments (6130) 8. Participate in Health Fair (6130) i J s rly` FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS MEETING THURSDAY, FEBRUARY 16, 1984 7;00 p,m, MEDALLION ROOM AGENDA 1984 I. Review and Approve Minutes of Previous Meeting if. Old Business Update Report on Midwife Program B. Update on CON Opposition Plans C. Update on Joint Meeting with City and County D. Any Other Old Business III. New Business A. Committee Reports 1. Finance Committee--Mr, Hilz 2. Quality Assurance/Utilization Review Committee--Mr. Hausler 3, Safety Committee--Mr. Hausler B, Medical Staff Report--Dr. Lockwood 1, 'Consider Approval of Medical Staff Applicants 2. Any Other Medical Staff Business C. Administrator's Report D. Any Other New Business IV. Executive Session to Discuss Personnel Matters V. AdJournment t~ . ~r 'I ' I CITY OF DENTON 1 'MEMORANDUM DATE: August 27, 1981 ' TO: Mayor and City Council 11 City Manager Director of Finance FROM: C. J. Taylor, Jr., City Attorney SUBJECT: Termination of certain contracts between the City of Denton and Denton County, You.have asked this office to advise you on the methods for termination of the following contracts: 1. Denton City-County Ambulance Contract, The contract between the City and the County has the follow- ing provision: 119, This contract and agreement shall continue and be in full force and effect until such time as each party hereto, by notice to the other, may terminate the same, such termination to be effective not less than ninety (90) days after the giving of such notice," Under the terms of this contract, the city may terminate the ambulance contract by giving the county ninety (90) days notice of its intentions to cancel the agreement, 2, Denton City-County Library Contract, The contract dated January 22, 1968 between the City and Denton County for the 'operation of the Citry-County Library contained the following provision: "This contract may be terminated at any time by either party upon the moving party's giving six months written notice of intention to terminate to the other party," By letter Crawford, notified thMarch e City that the County was preaerving Its i Mayor & City Council August 27, 1981 Page Two option to terminate the contract under the above provision should the County vote to reduce its contribution under the agreement. It is not clear, at this point in time, as to whether the contract has been officially terminatedf however, the City or the Coun act b notice oftitsI ntenti ns to.te minaterthe contracting six months 3, Denton City-County Health Department. The Denton County Public Health District or Department was created by an agreement dated in April, 1969 under the terms and provisions of Article 4447a of the Revised Civil Statutes of Texas, This Agreement contains the following provisionst "S. The agreement under which this district is created may be modified from time to time with the consent of all of the governing bodies which are parties thereto, a nd additional counties or cities may be included in the parties, This districts may wbeh dissolved consent by of coall nsent the of all of the governing bodies and any county or city may withdraw from a district upon request of its governing body within the consent of a majority of the remaining governing bodies or by the governing body giving one years notice to each of the other governing bodies of its intention to withdraw. When any county or city ceases to be a member of a district, a health officer for the county or city shall be appointed immediately and he shall resume the performance of the duties vested in that officer." The district was created by the County of Denton, the City of Denton, the City of Pilot Point, the City of Sanger, the City of Flower Mound, the City of Shady Shores, the City of Highland Village, the City of Argyle, the City of Justin, the City of. Roanoke, the City of Lake Dallas, the City of Krum, the City of Aubrey, the City of. Little Mm, and the City of Hickory Creek, Article 4447a of the Revised Civil Statutes of Texas , contains the same provisions as the contract 'which allows a county or city to withdraw from a health district. Pursuant to the terms of the contract and the provisions of Section 11 of Article 4447a, the City of Denton may withdraw from the Health District with the consent of all of the other parties, or by giving one years notice of its intent to withdraw from the district to the other parties to the contract. r. Mayor & City Council August 27, 1981 Page Three 4. Flow Memorial. Hospital Contract. Flow Memorial Hospital was re-organized under Article 44941-1 of the Revised Civil Statutes of Texas by Denton County, the City of Denton and the Board of Directors of Flow Memorial Hospital under a contract dated July 19, 1971. Article VIII of this contract reads as follows: "This contract shall remain in full force and effect until amended or terminated by a majority vote of all of the three parties hereto, separately, unless sooner terminated by the dissolution of the organization under Article 4494-1-1 by joint act of the City and County. The hospital was first organized under Article 44941 of the Revised Civil Statutes of Texas, Neither Article 44941 or Article 44941-1 has any express language providing for the dissolution of a City-County Hospital Board. The Hospital Board has heretofore issued a series of Revenue Bonds and a portion of these bonds are still outstanding, The City of Denton and Denton County approved the issuance of the bonds as required by Article 44941-1 V.A.T.S. The original agreement and subsequent agreements between the County and the City provide for the financial support of Flow Memorial Hospital including provisions for the bonding debt. The contract specifically provides for amendments and/or termination of the contract by mutual consent of the thr<ie parties and we find nothing in the law which would prohibit this, .however, no amendment of the agreement could have the effect of impairing the outstanding bonds of the Hospital Board because of the provisions of Section 16, Article 1 of the Constitution of Texas, City of Aransas b- v. Kee4 ling, (3up.Ct.) 247 S.W. 818. out-standing g and as the unpaid, we seriously doubt Bonds of the Hospital Board are County could terminate the contract under which Flow Memorial Hospital was created and withdraw its support from the hospital. C. J TAYL R, J CJTJRtjs 1 r " f- BOARD OF DIRECTORS •9ws-„tt ~ v~ 1 BUSINESS MINUTES Dale December I.S. 1_983_ The Board of Direckors of Flow Memorial Hospital met in regular session at ' 7;00 p.m. on Thursday, December 15, 1983 with the Chairman, Mrs. Williams, presiding. C f Members present: Members absent: Dr. Victor Alvarez Mrs. Wilma Fritz Mr. Ralph Havenhill Dr. Don Holt Dr. R. M, Lockwood Mr. Dan 'Trammell Mr. Brad Moore Mrs. Gloria Madewell 1 vacancy Mr. George Hilz Mr, David Yoder Mr, Jeff Hausler Mrs. Mary Williams ll The minutes of the previous meeting were presented, reviewed, and approved. Old Business, buthat ilding.oniMondayleveningland proposedstated Medical Office sBciansn nterestedAdministrator be meet ng w t p y Tuesday morning, Mental Health --Th Administrator for Certifistated cation that ahmentalihealthgfaciillty4 Post y o a osp to apple Y 5 of Poli and had received the forms to do so. Also, Hhehhadbmelt elt informthe ed Chithe Countyc and Judge the Denton County Judge about this project. yy that if the hospital became certified as a mental healthhddfitionaliyreimbursement mould not be forthcoming from the County for such patients, , when he had with the psychiatrists about this possibility, they had expressed some concerns--rom the ents pati of ad securitypareasoto hathesndleetpeataddients patients, etc. Mr.oMoorre mlack oved thatethete Administrator continue to investigate this possibility. He proectsthehave C7 Scan He11 ad --Mr. Moore asked If both Mr; flaus er responded that they were. bursement from Blue Cross for the CT scan procedures, which is now less than charges, is almost resolved. New Business- Finance Re ort--Mrs, Fritz reviewed the monthly financial reports. She stated that-t on o R-ovember had ended with an operational profit of $65,110 and analyzed the expenses to budgeted amounts, She emphasized that the salary and employee benefit costs have increased only 2.3% from November, 1982. She reviewed the reimbursements t'o date under the new DRG program for Medicare patients. She stated that so far the total reimbursement has been in excess of charges; however, she stated that tl+is will probably reverse in the next month. The Charity Charge -Off Li Off List the amount $70,669 N and the Sad Debt ausler suggottedCthatepage 13stbeIndelthe the $220,915 were both reviewed, Mr, Bad Debt listing--or all accounts 11Heefurther statedgthatkthe-Business OfficebManager re-worked in the Business Office. has taken a 30 day leave of absence due to illness, The Board discussed the 22% allowance for bad debts and agreed that this percentage should lbemcheckedi nt2-2 month to determine if further adjustments might be in order. Mr. (;yY Finance Report be accepted, Including the adjusted Bad Debt List and the Charity List, This motion was seconded and passed by voice vote. ,I BOARD OF DIRECTORS BUSINESS MINUTES Uefa ~~83 iege 2 Foundation-It was noted that appointments to the Flow Foundation will need to be made or 1984, with the following three-year terms expiring: Mr. Orr, Mr, Moore, and Dr, McClendon. .Suggestions for new Foundation members were discussed, and Brenda Crawford and Mike Gregory were suggested. Mrs. Williams stated that she would be willing to contact Mrs, Crawford to determine if she would be interested in serving on the Foundation. Safety Report--The minutes from the December 2 meeting were reviewed by the Adman s ra or. a stated that a new procedure for safety surveys will be implemented wherein the Safety Director, himself, and the director of the department being surveye will conduct the survey, instead of the other members of the Safety Committee. A revi w of the incident reports for 'the month of November was also distributed. Mr. Hilz moved that the Safety Report be accepted; this motion was seconded and passed by voice vote, Medical Staff_ Report--Or. Alvarez reviewed the minutes from the December 12 meet4 ing oT 7fie ca xecu ive Committee. He stated that the applications from the CRNA's have still not been acted upon due to the necessary protocols not being receive A resignation from Dr, David Steiner had been accepted. Dr. Alvarez reported that the following physicians had been elected at the Annual Medical Staff Meetingg on Tuesday evening. President--Dr. R. M. Lockwood, president-elect--Dr,(Virginia Morelan , Secretary-Treasurer, Dr. R. S, Croissant, and Members-at-Large to the Medical Executive Committee, Dr. P. D. Isbell and Dr. C. A. McAdams. Dr, Lockwood had re- quested appointment of the following physicians as clinical department chairmen: Anesthesia Dr, M. W. Via C Emergency Medicine Dr. B. P. Little Internal Medicine Dr, T. A. Qureshi Pathology Dr. K. L. Ford Pediatrics Dr. G. L. Jackson Psychiatry/Neurology Dr. J. H. Oliver OB/GYN Dr, W. M. Midgett Radiology Dr, J. P. Brown Surgery Dr. J. V. Palermo Also, Dr. Don Holt had been requested to serve on the Medical Executive Committee as Chairman of the Credentials Committee, Mr. Moore moved that the Medical Staff Report be accepted and that the appointment of the department chairmen be approved; this motion was seconded and pas"sed by voice vote. Dr. Alvarez requested that otoscopes and stethoscopes be purchased for the 2A Unit and explained the reasons why these are needed, A plaque was presented to Dr. Alvarez in appreciation of his service to the Board of Directors as President of the Medical Staff in 1983, and he was thanked by all members present. Administrator's Report: JCAH--It was reported that the Joint Commission on Accreditation of Hospitals has rMl'ftad the hospital that all contingencies have been lifted with a clear three- year accreditation awarded. It was noted, however, that the next survey will probably be in 18 months. Civil Rhts Complaint--It was also reported that the hospital had been found innocent by the Department of Civil Rights concerning a complaint about a patient who was transferred to Decatur Hospital. i BOARD OF DIRECTORS BUSINESS MINUTES Dale uecember 15, 1983 Page 3 Physician Recruitment--A sample contract which could be used in recruitment of physicians was s r u e and discussed. An overall guarantee of $60,000 would be offered to the physician, with $20,000 interest-free being available to him upon his move here and a monthly subsidized income thereafter. Mr, Hilz moved that the contrac be submitted to an attorney(s) prior to approval by the Board; this motion was seconde and passed by voice vote. Midwife Program--Mr. Hausler stated that he had met with the obstetricians on NovemEer 22t an ere had been no general agreement about the specifics of such a program. He had met again with the obstetricians on December 13, and it had been generally agreed that a medical director would need to be appointed before policies could be worked on for the midwife program. Further discussion regarding selection of a medical director was deferred until the Executive Session. Birthing Center--The Administrator stated that the possibility of combining the Birthing center into the Labor and Delivery Suite by moving a set of double doors on the Post Partum hallway had been discussed. The staff of the L&D would then be able to take care of the Birthing Center also. The installation of the double doors has been approved by the Fire Marshall. He suggested that this would be a short-term solution to the problem, and the change will be made. County F~uun__d~iin__gg..--Mr, Hausler started that he is not optimistic about the other $75,00 which -the hospital agrees should be paid by the County from their fourth quarter contribution for fiscal year 1982-83. The County Auditor is researching the minutes from the County Commissioners meetings to find documentation of why the County feels they do not owe the hospital the $75,000, Home Health--Due•to a recent survey of the Home Health Service, the department has lost is waiver and now all claims are being reviewed, fir. Hausler stated that he has contacted the Department of Health and Human Services to contest this decision. First Texas Medical--The plans announced by First Texas Medical to build a 50 bed genera acute hospital in Denton were discussed, It was agreed that the hospital should express opposition at the Certificate of Need hearings based upon the occupancy rate of both Flow and Westgate Hospitals, Mr. Hausler stated that the Administrator of Westgate Hospital has expressed that they will also oppose this CON. He stated that he is developing plans for this opposition and has contacted a person who was responsible for past CON work for this hospital, has contacted the Texas Health Facilities Commission and Baylor Health Care System, Un_ emplo iynent Insurance--Based upon the hospital's past experience, the Administra for stated that he had changed to a self-insurance plan. By self-insuring for unemployment, he stated that there may be an annual savings of some $40,000. Recover Room--In order to provide a more sanitary and more quiet area for employees andphysicians to smoke and eat, the Recovery Room is being remodeled to include a glassed lounge, incorporating the present lounge and a portion of the Recovery Room. The cost for this project is ex ected to be $1200. There was some discussion by some surgeons, however, about utilization of this spade instead for enlarged out-patient facilities, Another portion of the Recovery Room will be remodeled for out patients. Position Control--The Administrator reported that a new system is in place which will better control the number of positions within the hospital and whether or not they are filled, This new system is expected to reduce expenses somewhat. , e.a, s BOARD OF DIRECTORS BUSINESS MINUTES De+e _ December 15, 1983 _ Prge 4 Employee Recruitment--Mr, Hausler stated that he has an interview scheduled with an appl cant for the vacant position of Director of Medical Records. He added that C ` the Acting Director of Medical Records had resigned. Three other Registered Records Administrators are to be interviewed soon about this position. Mr. Hausler also re- ported that he has not yet filled the controller's position but will try to make a decision by the next Board meeting. Performance Evaluation--The Administrator stated that he expects the new perfor- mance eve uat on orms to be finalized next week in time to begin the new system of merit salary increased based upon individual performance. Mr, Moore suggested that the supervisor preparing the evaluation also be evaluated himself to determine the validity of the evaluation, •The Administrator was asked if the job descriptions had been reviewed and revised prior to the implementation of this new policy; however, the Job descriptions have not been revised--a publication from the Texas Hospital Associa- tion listing gobs and salary ranges was used, Nursing Service--The Administrator stated that he will meet with the Dean of the College o urs ng rom TWU the next day concerning a management agreement between the hospital and TWU. He also stated that a survey of the Department of Nursing by Baylor Health Care Systems will be re-scheduled for January, Smoking Polic --The Administrator explained that the hospital's policy regarding smoking as een revised to reduce the areas in which smoking would be allowed. Directional Sins--After years of discussion, directional signs have now been Installed by the City directing the public to the hospital. Some revisions in the C locations of the signs are expected, however. Nos ital Loao--The Administrator stated that he had deferred further action on thi projec un a later time, capital Equ immeen_t_-The Administrator reported that the prioritized capital equip- ment st s st n t completed. EmMlo ev a Christmas Party--The Board members were invited to the Employee Christma Luncheon plannd_for a nes ay, December 21. CME Program--Dr, Holt reported that about 7-8 physicians from Denton had attended the in" TR R diseaso workshop co-sponsored by Baylor Health Care System through the A. Webb Roberts Center for Continuing Education and Flow Memorial Hospital, A total of 20 participants had enrolled. Certificate of De osit--Mrs. Fritz reported that the hospital's $90,000 CD at First ~Sttte'Ba` Bank matures the next day, She stated that she had checked with five I local banking institutions to determine what interest rates they would pay at 90 days and at 183 days. Based upon her report, Mr. Moore moved that the CD be moved to the Pilot Point National Bank for 41 days at 9.85% interest, This motion was seconded and passed by voice vote, al"--Mr. Hausler explained the procedures taken for each Medicare patient to determine the amount allowable for reimbursement under the DAG program. He explained ' the steps taken from admission to discharge of the patient. He stated that some of the physicians had requested additional information about the reimbursement rates by diagnosis and specific information about their patient's charges versus what is reimbursed under DRG's, This information is available through the computer and will be dessiminated to them, Since the hospital's computer does not have available the software yet for DRG's for case mix management, the Administrator reported that he had n A l e BOARD OF DIRECTORS ` BUSINESS MINUTES Date DgC@L4gr151. 1953 _ P04' r ordered a Texas Instruments for Linda Ashmore's offic,i; the computer will be able to perform the "grouper" aspect which is needed in determining what diagnosis would be the most appropriate per case. The Administrator was asked to check with Baylor Health Care System to see if they have a computerized program which would benefit this hospital s DRG reimbursements, The Administrator stressed that even though the first few payments since ORG implementation have been in excess of the charges, he is not optimistic that this will continue--rather, the hospital will receive less that charges for Medicare patients in the future; It was also suggested that it might be beneficial to investigate changing one of the nursing floors into a self-care unit or extended care unit which would facilitate early discharge from the hospital, The meeting was adjourned at 9:30 p.m. At 9:40 p.m., the-Board of Directors met in Executive Session pursuant to Article 6252-17, Section 2 (g) V.A.T.C.S. to discuss personnel matters, The Board of Directors reconvened at 11:15 p.m. The following action was taken at that time: The annual salary for the Administrator was raised from $47,500 to $50,000. Approval was given for a position of Medical Director of Obstetrical Services at the salary range of up to $75,000 per year. The Administrator was asked to investigate which obstetricians might be interested in this position. The meeting was adjourned at 11:'30 p.m. Ralph Havenhill Secretary gm .-wA PAD r d4.1. 70 FLOW MEMORIAL, HOSPITAL BOARD OF DIRECTORS MEETING THURSDAY, JANUARY 1g, 1984 f'. 7;00 p.m. MEDALLION ROOM JAN S AGENDA C, Presentation of Audit Report--Peat, Marwick, & Mitchell CI. Review and Approve Minutes of Previous Meeting III, Old Business A. Update on Midwife Program--Mr. Hausler B. Update on CON Opposition Plans--Mr. Hausler C. Any Other Old Business IV. New Business A. Committee Reports 1. Finance Committee..-Mr. Hilz 2. Foundation Board--Mr. Havenhill A. Update on Re-Appointments to Foundation Board b. Consider Resolution to Allow Administrator to Borrow Funds for Gas Sterilizer--To Be Reimbursed by the Foundation Through Monthly Payments to'Hospitai 3. Quality Accountability/Utilization Review--Mr, Hausler a. Consider Approval of Revised UR Plan 4. Safety Committee Report--Mr. Hausler B. Medical Staff Report--Dr. Lopkwood. C. Administrator's Report--Mr, Hausler D. Any Other New Business V. AdJournment r ti FLOW MEMORIAL HOSPITAL - BOARD OF DIRECTORS THURSDAY, DECEMBER 15, 1983 7:00 P.M. MEDALLION ROOM A G E N D A f~fC 1 3 I. Review and Approve Minutes of previous Meeting -~1 IT. Old Business A. Update on Proposed Medical Office Building B. Follow-up on Mental Health Patients' Proposal C. Any Other Old Business IIl, New Business A. Committee Reports 1. Finance Commitltee--Mr, IHilz 2. Consider Foundation Re-Appointments 3. Review Safety Committee Report B. Medical Staff Report--Dr. Alvarez I• Report on Election of Medical Staff Officers 2. Consider Approval of Appointment of Department Chairmen 3. Any Other Medical Staff Business C. Administrator's Report--Mr. Hausler D. Any Other New Business IV. Executive Session for Personnel Matters V. AdJournment BOARD OF DIRECTORS MEETING BUSINESS MINUTES Ue~e November 17, 1983 ' ege~ tfv` - - - The Board of Directors of now Memorial Hospital met in regular session at C 7,00 p.m, one week early on Thursday, November 17, 1983 with the Chairman, Mrs. Willia presiding. Members present: Also present: Members absent: or, Victor Alvarez Mr. Dan Trammell Mr. Mike Carlson, HBE ? `1 vacant positic Mr. Jeff Hausler Mrs, Mary Williams Mrs, Wilma Fritz Mr. Ralph Havenhill Ms, Laurie Griffith Mr, George Hilz Mrs. Gloria Madeweli Dr, Don Holt Mr. Brad Moore The minutes from the October 20 meeting of the Board of Directors and the October 25 joint meeting of the Board of Directors and the Denton City Council were presented, reviewed, and approved. Old Busi-ess; Medical Office Building--Mr. Mike Carlson, from HBE Medical Office Buildings, Inc, presented the loop plans or a two-story medical office building of approximately 15,125 square feet. This proposed building would connect at the end of the east "B" wing, A short connecting hallway would connect the office building9 second floor with the hospital's first floor, Mr. Carlson stated that he would have the cost estimates ready for presentation to physicians in 2-3 weeks, and this process would take about 30 days, His presentation was enthusiastically received by the Board as a means of recruiting new physicians to this hospital and housing other physicians who might want C to re-locate their offices closer to the hospital, as wall as providing a level access to the hospital, Midwife Proposed Pro ram--The Administrator reported that he had discussed the possibility of esta sli fling a midwife program here at the hospital with the Chairman of the Department of Obstetrics and Gynecology, Br, Miller.. He added that a further meeting is scheduled on this topiqq'will all members of tho Department of OB/GYN on Tuesday morning. Also, he noted that he has met with the Director of the City-County Health Department, Mrs, Margaret Hutchinson, regarding the possibilities of Incorpora- ting the pre-natal clinic in the same program, Hellpad--Mr. Hausler stated that the project to build a helipad is now complete except -for-some landscaping, He added that on all take-offs and landings, a security guard stands watch to assure that no one walks into the rotary blades, Two successful transfers by helicopter have already been accomplished, CT Scan--Mr, Hausler also reported that this project is complete except for some trim - work and a chain blockade to keep peopl4 from parking on the pad when unoccupied, Mr. Hausler stated that he had not signed the contract with TranShare as had been authorized by the Board due to the fact that the charges approved by Blue Cross are below the actual costs and charges for the scans. When this problem has been resolved, he will then sign the contract, The schedule for the mobile CT scan service is from 7;30 - 11:00 a.m, Monday through Friday by TexScan and from 2;00 - 400 p.m, on Tuesdays and Thursdays by TranShare, Emergency scans will be done at Westgate Hospital at times when the scanner is not at the hospital, Employee _Health Insurance Fxpense--Mrs, Fritz explained that the amount listed on the previous na'1~' nciaaf s faf m 'ni's under "Employee Health Insurance Expense" is a not amount, including costs for Workman's Compensation, pension plan, monies spent and received from the dental and health insurance, and charges to employees hospitalized 1 BOARD OF DIRECTORS ME'E'TTnG BUSINESS MINUTES o,t, iovember 11, 1983 = i,go 2 In this facility, She reviewed the costs for health insw ance alone prior to thei C change to the self-insurance policy and stated that this self-insurance plan is more cost-effective than the other plan, She was asked to keep checking in the future to rake sure that the plan remains cost-effective. New Business: Financial Re ort_ Mrs. Fritz reviewed the financial statements and charge-off lists for t e previous month, She stated that the average adult patients per day for the month of October was 88--below our budgeted amount of 95. The month ended with an operating loss of $16,544, She explained that she had raised the anount of reserve for potential bad debts from 17% to 22% due to the increased amount of receivables and bad debt accounts. She explained that the auditors have stated that they may add at least $1 million to the reserve for bad debts for year ended September 300 19830 and this will result in a loss for the year, The bad debt charge-off list in the amount of $227,787 and the charity charge-off list in the amount of $293,948 were reviewed, Mrs. Fritz stated that the auditors had stated that based upon the hospital' Inconsistent pattern of removing bad debts last year, they estimated that less than 7% of the self-pay accounts past 90 days will be collected, The Administrator explained what has been done to now resolve the problems In the Business Office and Collections Department by following set procedures for each account's actrIvity, In order to assure that the system is working, two additional employees have been employed on a temporary basis. Mr. Hausler reported that he had requested the fourth quarter payment from the County in the amount of $75000, The County Auditor, however, had stated that the County did not owe the hospital anything further for this year. He stated that there is some confusion from a few years ago when the County changed from a calendar year to a fiscal year, Tie County Auditor is to research the minutes from the Commissioner s Court to determine if the additional $75,000 is due to the hospital, A resolution is expected by the f,rst of next week, Until this has been resolved, it is uncertain what funds will be forthcoming from the County, It was sugggested that the new percentage in reserve allowed for bad debts bu reviewed again in February, Mr, HIlz moved that the Financial Report he approved; this motion toes seconded and passed by voice vote, Foundation--Mr, Havenhill reviewed the minutes of the meeting earlier today of the F ow oun anon, He stated that they had had some discussion regarding fund- raising activities and had determined to delay any such Some concern was expressed by the Board regarding theFoundation's reluctance toar, raise funds for the hospital, and there was further discussion regarding re-appoint- ments to that Board, Mr, Havenhill also stated that a listing of some $188,000 in high priority medical equipment had been presented to the Foundation; the Foundation d had, however, delayed approval of funds for the equipment until a specific request is submitted to them from the Hospital's Board, Mr, Havenhill moved that the Founda- tion Report be accepted; this motion was seconded and passed by voice vote, were ~11_1101 t A ccountabilitt tilization Review--The minutes from the November 8 meetin resn a an rev ewe , `at commee ad reviewed the returned patient questionnnires and had had a discussion regarding the affect of double diagnoses on the DRQ reimbursement, No action was deemed necessary from the review, Mr. Hiiz moved that the QA/UR Report be accepted; this motion was seconded and passed by voice vote. M A BOARD or DIRECTORS MEETING BUSINESS MINUTES uais November 17, 1983 sag. 3 Safety Report--The minutes from the November A, 1983 meeting of the Safety CowiTT e were presented and reviewed. The Administrator stated that exposure badges have been ordered to measure the amount of employees' exposure to othele oxide to assure that the new gas sterilizer is safe. The forty-three incident reports from the month of October had been reviewed, as well as an analysis of all incident reports from the previous 12 months. There was nothing significant noted in any of the reports The committee had reviewed holiday decorations policies. Mr. Havenhill moved that the Safety Report be accepted; this motion was seconded and passed by voice vote. Administrator's Report: Capital E uI mont--The Administrator stated that he would try to have an acceptabl and prioritized list of capital equipment needed, including an explanation regarding the intended use for the equipment, by the December meeting. Positions--Mr, Hausler stated that he had filled the Assistant Administrator position, an -the employee will begin work next week. The Controller's position has not yet been filled, however, Home Health--A the completion of a three-day survey by Medicare, it had been determined a for the next 90 days, all Medicare home health cases will be reviewed prior to payment. The Administrator explained what had caused this action. Texas Medical Foundation--The Administrator reported that he had received a reques from 'tFe exas Med'ioa Foundation to review private-paying patient's medical records, lie stated that he would discuss this matter with other Texas Administrators at a meet- ing tomorrow in Austin, Employee Evaluation Forms--The Administrator stated that ire is still reviewing the samples of new forms, _P__h_,,y_si~~cian Recrultment--Mr, Hausler reported that Dr. Kevin McKinney, a family practitioner who 91111 be completing his residency in June, has agreed to locate in Denton. He stated that Dr, McKinney is interested in our physician incentive package. A contract draft will be presented to the Board r~ the next meeting for approval before forwarding to Dr. McKinney. .Baylor--Mr, Hausler stat,e ~J.-that he and Denise Manning, whom he has elevated to the position of Purchasing l ont attended a meeting at Baylor regarding their new shared services group, The-specifics are not yet available on what will be offered through this new service, however. A new set of VHA contracts had been updated and received, Indi ants Task Force--The Administrator stated that 'he had attended a hearing at the Un vers ty- of Texas at Arlington as a part of a Governor's Task Force on Indigents. Nothing definitive was decided, however. Birthing Center--The Administrator stated that he had met with the Birthing Center staff and the Chairman of the Department of 08/GYN to cattle soma pproblems in staffing of the Birthing Confer, Ile stated that it may be necessary to Inc ludo the Birthing Center into the Labor and Delivery Suite in order to provide a more cohesive service. 110 P Inn pro.ar_am--It was noted that Jim Grant had met with representatives ;r from Texas Woman's University to discuss a proposal to provide management nursing programs at this hospital. A formal proposal will be forthcoming, Mr. Hausler also noted that he had bean invited to address a senior nursing class at TWU and had done so. Also, the faculty at TWU may elect to do a research project on the demographic make-up of indigents at Flow. This will be discussed further with the Department of BOARD OF DIRECTORS MEETIMr BUSINESS MINUTES Wo November 17 Page 4 Hill-Burton--It was explained that the hospital's commitment to Hill-Burton C requiremen s or this fiscal year is $210,000 and that this has already been used during the one month of October, In the future, the Hill-Burton requirements may be written-off on a quarterly basis to spread out the allocation through^ut the year, Hospital L99o--The Administrator suggested that a decision on a new hospital logo be tabled until a later date. Position Control--A new program to place all positions (either filled or unfilled on the compuf_ar to etter control the numbers of employees is being initiated. DRG's--Mr. Hausler announced that the hospital has received two payments so far under `tE new DRO reimbursement regulations. He stated that the payments were delayed however, they have been favorable in that reimbursement has exceeded costs. He stated that he would bring some of the cases to the next meeting for review so that the Board members could see how the new system works, Holi~da~,~_A_ctivities--The Administrator announced that a huffet is being scheduled for aT -e-MPToyees rom noon until 3:00 on December 21. Door prizes wi11 be .warded. Mental Health--There was some discussion concerning a request from.trhe County Judge o temporarily accept mental health patients who are waiting for transfer to Wichita Palls State Hospital or other such facility. He stated that the hospital has accepted these patients in the past. However, under the new Mental Health Code which became effective September 1, 1983, the hospital could denu admittance of the patients He had stated that after December 1, 1983, the patients coo d not be admitted to this facility for holdin unless the 38 Unit becomes certified a:. a mental health facility. ` Mr. Moore moved tha? the Board of Directors act to accommodate the County Judge's regpost until the and of November or until the next Board meeting (if 1ega1 to do so) and to investigate the benefits of becoming certified as a mental health facility. This motion was seconded and passed by voice vote. The meeting was adjourned at 10,30 p.m. At 10;31 p.m., the Board of Directors met in Executive Session pursuant to Article 6252.17, Section 2 (g) V.A.T.C.S. to discuss personnel matters. The Board of Directors reconvened at 1100 p,m., and no action was taken. The meeting was adjourned at 1100 p.m. Ralph Havenhill Secretary gm ~~s f 1 BOARD or DIRECTORS MEETING BUSINESS MINUTES Dale October 20, 1983 Page The Board of Directors of Flow Memorial Hospital met in regular session at 7;00 p.m, on Thursday, October 20, 1983 for its "Annual Meeting," Members present; Also resent; Members absent; None Dr, Victor Alvarez Mrs, Gloria Madowell 1 unfilled vacancy Mr, Jeff Hausier Mrs, Chris Sauer Mr. Ralph Havenhill Dr. Mahlon Freeman Mr, George H11z Dr, W. M. Midgett Dr, Don Holt Dr. Lawrence Slocki Mr, Brad Moore Mr, Dan Trammell Mrs. Mary Williams liov The Administrator opened the floor for nominations for officers of the Board for the fiscal year October, 1983 - September, 1984, Mr, Moore moved that the follow- ing be elected by acclamation; Mrs. Mary Williams--Chairman Mr, Dan Trammell--Vice-Chairman Mr, Ralph Havenhiil --Secretary This motion was seconded and passed by unanimous voice vote, The minutes of the September 22 regular meeting were read by Mrs. Madewell and appr,ved as read, The minutes of the called meetings of October 3 and October 1: ,were approved as presented, Old. Business; Contra t With HMO--There was some discussion regarding the hospital's participa- tion ngreemen w1111Vorth Texas Madcare to provide hospital beds for their HMO enrollees, The Administrator stated that since September, approximately 20 patients from the HMO have been hospitalized at this hospital. There was further discussion regardin liabilities and/or benefits of any termination b of wtne r cthe ontract Would contract. not be until March 8, Mr, Moore moved that the Board of Directors table further consideration of the contract until the February Board meeting, This motion was seconded and passed by a majority voice vote. IndirJent OB Patients--Drs, Freeman, Midgett, and Slocki addressed the problem of the fncreas ng num er oi~'drop-in obstetrical patients, Or, Midgett added that he felt that the majority of the drop-in patients also presented with complications, The Administrator noted that he had discussed the possibility of employing Certified Nursa Midwives to assist with this problem with the Chairman of the Department of OB/ GYN. He stated that some Job specifics would be developed and sent to the Department of OB/GYN for consideration prior to the employment of midwives, Dr. Slocki suggested that physicians be paid to either perform the service of the deliveries or to super- vise the midwives--as an extension of the Emergency Room, This suggestion was further discussed, Until the job specifics are developed, further action was not needed, iitial_rquipment--The Administrator stated that he had met with a small group of department directors to prioritize the capital equipment listed in the 1983.84 budget and would be prepared at the next meeting to present such a list. He stated that the list had not yet boon compared to previous budgets to see if there mi;ht be some equipment items from other budgets which were not purchased and still are needed, It was agreed that the list should also go to the Medical Executive Committee for thei input prior to presentation to the Board of Directors. BOARD OF DIRECTORS 14EETiV BUSlN✓SS MINUTES Deto v~ October, 20, 1983 Pogo givenll oiaacon rac" o ` prior Administrator to asking a that e both i projects be the combined contract in aonel bid, Then bid for the CT scan pad had, however, been given to the same contractor due to his being the lowest bid, He added that the helipad is almost complete, rho City of Denton has requested a Specific Use permit, however, and this will be applied for regarding the helipad, The CT pad is expected to be complete in 10-14 days, Nevi Business; Financial Re ort--Mr. Hilz reviewed the financial reports and Bad Debt Charge-off List a amount o $49,121 and`the Charity Charge-off List in the amount of i- $39,739. It was pointed out that the aged accounts receivable report is now being prepared by doto of discharge, instead of by date of last payment on account; this had bean a recommendation front Baylor Health Care System, Mr, H1lz noted that the accounts payable amount is somewhat higher than usual, This was due, however, to several Neasons--i,e., year and entries into the account, the amount for the gas sterilizer which is to be reimbursed by the Foundation, and two bills arriving this month from Lone Star Gas. Mr, Hilz noted that the net excess of revenue over expenses for year-end was $795,093, Mr, Moore asked Mr, Hausler what his review of the Busines Office procedures had included, and he reported that he had provided them with step- by-step guidelirus for collection of accounts, including a "tickler" file for reminder when each step is to be taken. Mr. Hilz reported on the two certificates of deposit currently held--i,e „ one totalling $164,319 at 14,05% and one totalling $90,000 at 9,04%. There was some discussion regarding the $555,011 loss for the year under the category of employee health insurance expense. Mrs. Ilodewell stated that she under- stood that the amount was a "net" amount, including premiums paid by employees, deduc- tibles paid by employees, and the usual charges on employees' bills if hospitalized in this hospital. Mr, Hb ele, stated that he would check this and have a complete explan - tion at the next meeting, The Administrator was also asksd if he had employed a con- troller yet, and he stated that of the many he had interviewed, there were two whom he felt would have done a good ,lob; however, the salary was not competitive enough to attract either individual to this hospital. Mr. Havenhill roved that the Financial Report be approved; this motion was seconded and passed by vulce vote, Home Health Re ort--The minutes from the previous meeting held on September 23 were pr"resen o en re "ewod, It was noted that the charges for home health services had all been increased. The Administrator explained that the Home Health Department's revenue for the year was down due to a poor volume in the last month of the year, He noted that a recent home health case had been denied, which caused an excess in days of denial over the allowed 2,5%. As a result, the Home Health Department's waiver of 11ability was being suspended for a 90-day period pending an on-site review of appropriateness of care of our Home Health services. The hospital has appealed the case which was denied causing this problem. Mr. Hi1z moved that the Home Health Repor be accepted; this motion was seconded and passed by voice vote, uaifty Accountnbi-l ityl{ltilizatinn aevie --The ,inutes from the October 11 meetin an rd eviewe were prosented d by Mr, Hausler. He stated that he had applied for exemp- tion of the 30 Unit from prospective payment regulations, and that this application had been denied, He expects to be able to appeal the decision,,even though there are currently no procedures for appeal. An amendment to the Utilization Review Plan which d hospital was ifferentlates between the patients on the Psychiatric Unit and the rest of the accepted and that ethedamand en-~,ientatoethe UR Plan ebelapprovedl that tmotiionUwas Report and passed by voice vote. ,Safety k =:t--The minutes front the October 7 meeting of the Safety Committee wero presented and reviewed, The Administrator outlined the events recorded .~i,e „ results of a medication error survey, radiation survey, electrical outage, and BOARD OF DIRECTORS,MEETING 8UVNESS MINUTES Dale yOctober 20, 1983 Page 3 incident reports, The committee had also discussed the need for a storage building; C Mr, Moore suggested that one might be received as a charitable donation and that this possibility should be further investigated, There was no action deemed necessary from the review of the minutes, Mr. Havenhill moved that the Safety Report be accepted; this motion was seconded and passed by voice vote, Medical Staff Ropoorrtt--Dr, Alvarez reviewed the minutes from the October 17 meetinc of the Medical Execuive Committee and the October 1$ meeting of the Joint Medical Staffs, He noted that Dr. Kenneth Wright had resigned from the Medical Staff so that he would not have to take emergency anesthesia call. or, Alvarez also noted that Dr, F. J. Charney had resigned as,Chairman of the Department of Surgery; this resigna- tion, however, would not affect his privileges as a member of the Active Medical Staff Dr, Alvarez proposed that Dr, P, J, Montalbo be approved to fill the vacancy. He note that the Medical Executive Committee had agreed to let the ultrasound technician em- ployed by Or, M, Freeman continue to be able to assist him in his ultrasound testing. Or, Alvarez recommended approval of home health privileges only for the following physicians, all of whom had received favorable recommendations from the Home Health Committee and the Credentials Committee: Dr, Robert Sickle, Dr. Vernon Horn, Or, Howard Kelfer, Dr, Louis Nardizzi, and Dr, Parchuri, Mr, Moore moved that the Medical Staff Report be accepted and the five physicians approved; this motion was seconded and passed by voice vote. Meetings Chan es--It was proposed to change the dates for the November and Decem- ber Board meetings to November 17 and December 15. This was approved, Administrator's Report: Foundation--Mr, Hausler stated that he had not yet met with Mr, Orr regarding the metho oi3 of payment for the gas sterilizer which the Foundation had agreed to purchase. He also stated that he had not yet met regarding what interest the Foundation might have in the medical office building nor what future capital equipment needs we might have , Lr_S an--In order to provide additional service, Mr. Hausler proposed that a con- tract with`Y?,anshare be approved to provide mobile CT scan service, in addition to the already approved contract with TexScan for the service, He,stated that the combinatio of the two would provide better coverage, Mr. Hilz moved that he be authorized to sig the contract with Transhare; this motion was seconded and passed by voice vote, Holipad--Tho Administrator reported that construction is almost complete on the hetip7a. Ire was asked if the electrical line to the CT scan would need to be buried in order for the helicopters to landl however, the pilots had stated that this would not be necessary, The Administrator stated that it is estimated'that the cost for burying the line would be $292000 and this might be considered sometime in the future. Nursing Surva --Mr, Hausler stated that he had requested Jim Grant contact TWU to discuss possas for TWU's serving in some capacity as a resource to the hospital Nursing Department, Following this meeting, TWU'S nursing program is to present a pro posal to the hospital for consideration, Also, Baylor Health Caro System has been requested to perform a consulting study of Nursing Service, Education--A latter has been sent to Baylor Health Care System designating Dr, Loyd Wh and Mrs, Patti Griffith as liaisons for educational programs for the employees and medical staff. Procedures for Indigent--Mr. Hausler stated that he had met with the County Audit r to discus hat proee&ures should be followed for reimbursomant for services to charit patients during this year, It had been agreed that an itemized bill should he submitt i 4101 I BOARD OF DIRECTORS MEETIPIO BUSINESS MINUTES Dale October_ 2Q, 198.3_ Pago 4 to the County for each patient who is designated as "charity." This policy is already ( in effect. United Wa --It was reported that the contributions from employees had reached 102 of the goo »-a total of $5,106,90. Mr. Hausler commended Linda Ashmore, who had coordinated the efforts this year. NEm to ee Meet_in s~--Mr. Hausler stated that he hid scheduled employee meetings on October an an was pleased with comments he had received. He stated that he . and problems that t Impr ving employees howho spital d had received some good ideas to the meetings seem supportive of the correct Salaries--It was noted that the raises in salaries had been in effect for the He parTod he beginning for evaluation of employeesreceived be effective workiOng o on r a 3syand srem would employees lwilloknowrin will be willmbetevairectors luated. in Jan-uary u weeks so that emploee 38 Exemption--Mr. Hausler reported that the Department of Health and Human Services had den ed the exemption of the 30 Unit from the prospective pricing system on the bas of several deficiencies. These deficiencies can be readilly corrected, and the decision will be appealed--as soon as in appeal process is provided by NHS. CME Program--Mr. Hausler distributed a copy of a brochure announcing a half-day works op on nfectious diseases being sponsored by Flow Hospital and Baylor Health Care System's A. Webb Roberts Center for Continuing Education. He stated thtt the brochures were supposedly mailed from Dallas on October; however, several physicians have mentioned that they have not received the brochure, Mr, Hausler stated that he C would investigate the matter to assure that the brochures are mailed, Meatin W1 rtheques_City ameeti_Co_uncil--The Administrator stated that the City Manager had cane m to t ng of the City Council and the Board of Directors for 6;00 p.m. on Tuesday, October 25, The Board of Directors agreed that this date and time would be acceptable, The topics to be discussed will be the midwife p^ogram, long-range planning, and the proposed medical office building. H s ita1 Lo o--.Copies of proposed hospital logos were distributed, Mr. Hausler state t a ss osdick had employed an artist who had been working with her oi; these and will eher rooatdname to health center,name change tr,r the hogpital might be proposed to update the Suspense litlaation--The Administrator reviewed a request from an attorney to receiv n cepy of a former patient's hospital records. He stated that he has 60 days to respond to the request, and he outlined for the Board the events of the case, Dallas/Fort Wor h Hospital Council--It was announced that the date for the Annual Media--warsunc vn or ee-tWT MTFort Worth Hospital Council is Thursday, November 10, 1983, The Board members were asked to lot Gloria Madewell know whether or not they could attend this luncheon, Bugs--The Administrator stated that he is working on correcting the problem of Orkin, whothad mapped outaa plain toatedallevithatatehethihasdproblmet Some alternativer"home' remedies" were also suggested. JCAH--Mr, Hausler stated that we have not yet received notification from the Joints -mission on Accreditation of Hospitals regarding the additional documentation which had been mailed to them in support of the correction of the deficiencies. A r f i i BOARD OF DIRECTORS MEETING BUSINESS MINUTES u-10 October 20, 1983 Page 5 " planning--Work on long-range and short-range plans for this institution are still I begin compT 'ed, The Administrator stated that they should be ready soon, but probably i C not in time for the joint meeting with the City Council next week, VHA--The current list of VHA vendors has been received from Baylor Health Care Systems to enable shared purchasing arrangements. ORG's--The system has now been operational sinc6 the first of this month, The Admin strator stated that there is one sticker placed upon the chart at admission suggesting a preliminary length of stay and then at the 75th percentile, another stick is placed on the chart to alert the physicians that the Medicare benefits are about to expire, Mr. Hausier stated that he had attended a teleconfe-ence in Dallas recently and a two-day conference sponsored by Neat, Marwick, Mitchell--both of which were directed at the ORG regulations. He reviewed some of the negative factors within the system, Midwife Proaram--The Administrator reviewed again what steps he had taken to begs to wo~on imp-fiementation of a program of midwives within the hospital to assist in the obstetrical indigent problem, It wa3 agreed that there should be a medical director of the program and that the hospital would be liable for the midwives. He of the Mefor dical the program within two n meet with the was Department directed of t OB%GYNa some roose President policies Awards Bancuats--The Board members were invited to attend the Annual Employee Awards Event at :0 p.m. on Tuesday, October 25 and the Annual Volunteer Awards Event at 7:00 p^ on Thursday, October 27. { i 1 ui ment--The Administrator proposed that a new Life Pack VII, monitor/defibrillator fibri lator with internal and external paddles, be purchased for the Opera- ting Room and Recovery Room at the cost of $6,450, lie also stated that he wanted to begin replacing the Recovery Room carts one-at-a-time at the cost of $1,800 each, He reviewed the noed for this equipment. He also stated that there is a need for a new Operating Room table, and one is being placed at the hospital for a trial basis to determine if this is the appropriate table. Mr. Havenhill moved that the Board approve paid for t out purchase of operating hfunds-, tPack VII his motion was secothree nded and passed by voice vote. The meeting was adjourned at 10:05 p.m. At 10:10 p.m., the Board of Directors met in Executive Sossion Pursuant to Article 6252-17, Section 2 (g) V,A.T.C,S, to discuss personnel matters. The Board of Directors reconvened at 10:50 p,m,, and the following motions were duly made and approved: ' Approval to terminate the Assistant Administrator for Hospital Services, Approval to increase the salary range for the Controller position to $45,000 per year. Approval to employ an Assistant Administrator at $35,000 per year. The meeting was adjourned at 11:00 p.m. Ralph Havenhill Secretary gm la.- b•O I P ....,.„r.. „r. I,- , .r n.~, a ur it '3CARD OF DIRECTORS MEETING BUSINESS MINUTES -_=Septembb _2 1923 Page The Board of Directors of Flow Memorial Hospital met in regular session at 7;00 P.M. on Thursday, September 22, 1983 with the Chairman, Mr, Wyatt, presiding, Members present; Also present; Member absent; Dr, Victor Alvarez Mrs. Wilma Fritz Mr, Jeff Hausler Ms, Laurie Griffin Mr,.Prad Moore Mr, Ralph Havenhill Mrs, Gloria Madewell Mr. George Hilz Miss Marcia Fosdick Or, Don Holt Mrs, Lee Walker Mr, Dan Trammell Mrs, Mary Williams Mr, A. E. Wyatt OCT 2 4 VC3 The minutes of the previous meeting were presented, reviewed, and approved, Old Business; Mobile CT Scan Service--Mr, Hausler stated that he had received the engineering study and it had been submitted to three companies for bids. Only one bid at $19,820 has been received to date. Estimated construction expected to be three weeks, Mr. Hausler also stated that the necessary hardware ~s been ordered and that the City has run the appropriate electrical lines, It was agreed by the Board, however, that the throo companies bidding for the project should also incorporate within their bids costs for the helipad construction, Mr. Hausler stated that he had received a $1,000 contribution from a local business to help defray the cost of the helipad, Now BBusss; Financia_l~Re~ort--Mrs, Fritz reviewed and dlscussei the financial statements for' the prdv'rous mon11eH 5"`7"'revIowed the Bad Debt Charge-Off list in the amount of $291,024 and the Charity Charge-Off list in the amount of $31,761. She noted that accounts payable today is only $626 OCO, Mr, Hausler stated that he had met with Margaret Lester and Pam Johnson to ~IscUsS re-organization in the Collections Department and had established specific guidelines and steps to follow in collection of accounts, He added that he had personally audited approximately 20 charts to assure that the guide- lianes are being followed, Mrs, Fritz reported on the downward trend in current ifbillties due to improvements in accounts payable, Mr, Havenhill moved that the Financial Report be approved; this motion was seconded and passed by voice vote, ,a d~1_~n.l2enort_-Mrs, Williams reviewed the minutes from the September 8 meet- ing of the F1 ow Foundation, She noted that any plans for fund-rasing have been deforred again. She stated that the Foundation had aggreed to provide the funds for the purcha!;e of a new $19,900 gas sterilizer for the Central Supply Department, Other requests 4,,r funds for three labor beds and one fetal heart monitor had not boon approved, however, The Foundation had requested that a list of all equiJtheY hich might be needed in the next year be presented to them at their next meeting h priorities of importance so indicated by the hospital's Board of Directoa Board agreed that such a list should include items which may have been opproved capital equipment budget for 1982 which were not purchased, The Administgreed 4 to have such a list ready for the perusal of the P,,ard at the October regeting, Joint Conference Re ort--The minutes from the September 7 meeting of int Conference omm tteo were presented and reviewed by Mr, Wyatt, He noted hey had had a lengthy discussion regarding tho new ORO regulations and the i me of the medical staff and hospital work{{ng cosely together to minimize ans, A medical liaison physician , Dr. Lloyd White, had been selected to work lor . ,n,. 4.p 4 A BOARD OF DIRECTORS MEETINr BUSINESS WNUTES Data September 22, 1983 Page 2 Health Care Systems and the A, Webb Roberts Center to establish more educational pro- grams at Flow for the physicians. Mrs. Williams mo•red that the Joint Conference Report be accepted; this motion was seconded and passed by voice vote, Quality Accountability/Utilization Review Report--The minutes from the September 13 meeting o' is committee were reviewed by Mr R usler. He noted that the committe had req,ested 3ime clarification as to when 1V pumps are utilized, and this criteria will be reviewed at a later date, The Respiratory Therapy QA activities had been presented and reviewed, and It, was noted that the respiratory thereapy treatments have decreased, The committee had reviewed the U7 statistics and physician advisor decisio and had reviewed six extended 'stay cases and three cases for medical necessity for admission, Mr. 1111z moved that the QA/UR Report be accepted; this motion was seconu:d i% --~II and passed by Voice vote, No action was deemed necessary from the review. Safety import--The minutes from the September 2 meeting were reviewed, as well as a summary report of 41 of the 62 incident roports for the previous month, The commit- tee had also reviewed the report of recent fire drills. No action was deemed necessar from the review, Mr. Havenhill moved that the Safety Report be accepted; this motion was seconded and passed by voice vote, Medical Staff Report--Dr, Alvarez reviewed the minutes from the September 19 meeting o the Medical xecutive Committee and additionally reviewed the minutes from September 15 called meeting of the Medical Staff designed to present preliminary guidelines for DRG's, Dr, Alvarez stated that the Medical Executive Committee had appointed a strategy committee (SMAC) to plan for future reimbursement legislation and new services, Based upon the favorable recommendation from the Department of Surgery, the MEC had also recommended tha,. Or, John Spencer be taken off of probation and now allowed to perform permanent pacemaker implantations unsupervised, The results of a long-standing isoonzymes audit had been reported to the MEC and the recommendation to keep the ordering of CPK and LDH isoenzymes within the routine coronary care orders. The following applications were presented with the favorable rar.ommendattons from the Credentials Committee, the Medical Executive, and the clln•Ical departmen. to which the individual will be assigned: Allied Health Professional Staff, Jahn 0 nes, Ph,D „ Consultant to the Physician, Psychologist Allied Ilealth )-flofassional Staff; Kellee Jones, Physician's Technician 11 for Dr, Charles Hopkins Mr, Havenhill moved that the Medical Staff Report be accepted and that the probationar period for Dr, spencer be removed and that the two applicants for Allied Health Pro- fosslonal Staff be appointed, This motion was seconded and passed by voice vote. Capital Equipment--Mr. Hausler proposed that the Board of Directors approve the funds for the purchase of the following equipment and explained the reasons for the need: Fetal heart monitor, with accessories $10,467 Adaptor for microscope for hand surgery 51236 X-ray tube replacement 50445 3 labor beds G $21595 each 71785 Dr, Alvarez stated that he felt the medical staff would place the highest ppriority on r the purchase of an additional fetal heart monitor, and the usefulness of all items was discussed. The Administrator explained that he would recommend purchasing only one labor bed at the present time, then purchase another one in 6 months and the third one 6 months later, Mr, Havenhill moved that the Board approve the purchase of all of the above items; this motion was seconded and passed by voice vote. r._'=~r:..s: .-s~=.~~~:.-__:..reac,_: ---<<_-•-s-:.-~z-..-::v-_.:-:lr_y.~ts,,:-~w:ras~•..~--.-rssnm i HOARD OF D1R[CTORS.,+gE[TING BUSINESS MINUTES Nit, September 22, 1983 Page 3 NNeew~Employe~_es--Mr, Hausler Introduced Marcia Fosdick, the new Director of ( Marke i-ng and no Tic Relations. He added that he is still interviewing applicants for the position of Controller, but no decision has yet been made. Nursing--The Administrator stated that he and or, Holt had met with representa- tives of t e Collego of Nursing at Texas Woman's Universit, to investigate the possibility of developing a cooperative agreement between TWU and Flow. He stated that some of the possibilities might be to use the hospital as a model for nursing students and to provide educational opportunities for our nursing staff. He was asked by the Board to continue investigating the possibilities. di a_1-Office Buildinc--It was announced that Mr. Mike Carlson from HBE is ready to discuss w th the hoard re-vitalization of the plans to build a professional office building adjacent to the hospital. It was agreed that a cfllled meeting should be devoted to primarily this topic, and October 11 was set for this meeting. DRG's--The Board was appraised of preparations for implementation of DRG's beginning October 1. It was noted that during the first year, 6% of the hospital's revenue will be affected under the DRG regulations. Nepotism--Mr, Hausler requested the Board to consider whether or not his wife could Tie amp oyed as a staff nurse on a part-time basis at Flow, He reminded the Board that the bylaws state that no person may be paid from hospital funds if such. person is related to the Administrator, within the third degree of affinity or consanguinity, except below the third level of rianagament and only then with the consent of the Board. This was discussed, and the Board agreed that it would be acceptable to employ Mrs. Hausler as proposed. Ps chiatric F.'xeemmti_o~n_--Mr. Hausler reported t'iat a representative from the Depar men' o ea ti and Human Services had surveyed the hospital relative to the hospital becoming exempt under the DRG reimbursement program for the patients on the 36 (psychiatric) Unit, Results will be forthcoming on whether or not the hospital is eligible for this exemption. Mrs. Fritz added that the auditors had recommended receiving the exemption for the 3B patients, JCAH Surve --The Administrator stated that the "evidenco" which had been requesteTby t a Joint Commission on Accreditation of Hospitals to prove that the hospital had made up the four contingency deficiencies is ready to be mailed. He stated that he foresees no problems with the added documentation which is to be sent, Planning--Mr. Hausler stated that he is continuing to work on short and long- range goa s for the hospital. Lea ue of Women Voters--Mr. Hausler stated that he had been invited by the League o omen o ors o address them concerning the need for a community hospital, He stated that he had addressed them and found them receptive to his comments. U lied Wa --The plans for the hospital's participation in the Denton County Unite Way campaign were outlined. A goal of $5000 has been established. TAHGB--The topics which were presented at the recent Texas Association of Hospi'i76_*Govern1ng Boards conference in San Antonio were reviewed. Copies of a glossary of terms relating to DRG's was distributed, . Contract Renewal--A proposed contract renewal from NuMed for nuclear medicine tech6TcaT perF_ me and radioisotopes was presented and reviewed, Mr. Hilz moved that the contract be renewed, This motion was seconded and passed by voice vote. I M nrJ BUSINESS MINUTES Dale September 22, 1983_~-_- Page 4_-_ Dinner for New Physicians--The Board members agreed that the dinner for new physic ans a een beneficial for acquainting them with the hospital and some of the other new physicians, A special thanks was given to Dr. Holt for hosting the dinner at his home, OB Indigents--Mr, Hausler stated that he had met with the County Commissioners about s pro em and had talked with an assistant at the Health Department about the Pre-Natal Clinic, He had also spoken to two representatives from the City, He stated that it is apparent that neither the City nor the County is willing to provide the funds to employ midwives, Mrs, Walker added that she questioned why the City would want to continue as an owner of the hospital if they are not willing to provide funds for anything. Mr, Hausler reminded the Board that funds for midwive's salaries are not in the approved budget; the Board, however, asked him to proceed with the project of employing midwives, A reciation--A plaque denoting the hospital's appreciation to Mr, A. E, Wyatt for h s s x years of service as Chairman and Member of the Board of Directors was presented to him, The meeting was adjourned at 9,20 p.m. At 9;25 p.m „ the Board of Directors met in Executive Session pursuant to Article 6252-170 Section 2 (9) V,A.T,C.S, to discuss personnel matters. The Board of Directors reconvened at 9,50. No action was taksn except to recommend that a called meeting of the Board of Directors be set for October 3 to further discuss personnel matters, Dan Trammell Secretary gm ti Y^JT6rf].-.~=~~~.'-412^S•~'.•:•'~~.`.n"^-:rY'.':.'~^tt1.=-_yc~-Y,-~.=~9'~^' Y•'~~:J L~~>.'C-T3~~^" ^"~-"~`-.LJ:~ .'tLLI rrr BOARD OF DIRECTORS.:'d4LLED MEETING . BUSINESS MINUTES oate Qctobr Page The Board of Directors of Flow Memorial Hospital met in a called session at C : 6:00 p.m. on Monday, October 3, 1983 with Mrs, Mary Williams, Vice chairman, presiding Mr. A. E. Wyatt, Chairman, was not present since his term had expired, Members present: Members absent; Also present; Dr. Victor Alvarez Mr. Ralph Havenhill Mrs. Wilma Fritz Mr. Jeffrey Hausler (I vacant position) Mrs, Gloria Madewell Mr. George Hilz Dr. Don Holt Mr. Brad Moore Mr. Dan Trammoll Mrs. Williams announced that the meeting had been called to discuss incentives for physician recruitment, personnel salaries and benefits, and some old business, New Business; Ph sician Incentive Plan--The Administrator stated that he had contacted three of the four" r c-ty-county osp to s in Texas regarding th3ir programs for physician recruit meet, and he reported his findings. Mr. Trammell recommended that the legal aspects first be researched through law 44941-1 prior to any firm offer being made, and it was also suggested that the Administrator consult with representatives from Baylor Health Care Systems also, Based upon his findings at other Texas hospitals and past experience, the Administrator recommended the following package; Guaranteed first year inCOMe of $60,000 to the physician, with 25% of this being given as "up front" interest-free money Interviewing expenses f,;r physician and spouse Moving expenses This was discussed at soma length. Mr, Hauslor stated that his past experience has ' shown that the new physicians always have more income that the guaranteed amount and thus the hospital did not need to supplement the physician's income, It was agreed that in all cases, the physician's books must be open for auditing purposes. Mr. Moore moved that the Administrator's recommendation be approved with one exception--that if he feels that the $60,000 is too low for a particular physician, approval if first obtained from the Executive Committee of the Board. This motion wa., seconded and passed by voice vote, Salaries and Benefits--Mr. Housler proposed the following salary adjustments which ou 15e-1 ec ve or the pay period beginning October 3; 3% automatic economic adJustment for all employees plus one of the following 4% automatic merit increase for employees with employment anniversary dates of October 1-March 31 1% automatic merit increase for employees with employment anniversary dates of January I-March 31 2% automatic merit increase for employees with employment anniversary dates of April 1-June 30 3% automatic merit increase for employees with employment anniversary dates of July l-September 30 Mr. Ilausler explained that he is working on a valid,, viable performance evaluation system which is planned for implementation January 1984. After that time, employee A I; BOARD OF DIRECTORS CALLED~MEVTNG BUSINESS MINUTES Date wol October 3.x__1~8~ Anuaccrosslthebboardreconomicnadjustmentpwouldbe nadeiannually thebbegirglningmofitheio -s. fiscal year. Additionally, in the event of market conditions, some adjustments might need to be made for certain categories of employees--i.e., x-ray technicians, etc. He added that this plan would seem to be the most appropriate to implement at this tim . Financially, this plan might provid some $144,000 under the budgeted salary expense for the 1983-84 fiscal year. After some discussion, Dr. Holt moved that the Board authorize the Administrator to implement his proposed plan immediately; this motion was seconded and passed by voice vote, Due to the financial burden on cash flow which could be expected in November with the implementation of the Board-approved cash-payout for a portion of unused sick leave, the Administrator recommended this be withdrawn. Instead, he proposed that sick time. time during a beginning not hours used any sick quarter could the date employees of employmented employees e whup to o had 480 schedule A day off as a sick day. Also, due to the expected financial burden, he recommended that the cash pay-out for vacation hours over the one year maximum be withdrawn. Instead, he suggested that employees be allowed to accrue up to two years vacation time only; vacation time would have to either be taken or lost--without any was seconded these and passed recommendations cash pay-out sick options, Dr. and vacation t timoved me; this t mothe tion Board by voiceregarding vote with only one negative vote from Mr, Moore. The Administrator also reminded the Board that under the benefits package they ' approved this spring, the employee Christmas gifts had been deleted. This was dis- cussed as to whether or not to implement the gifts again this year. However, the Board Adminis- provide some other option for Christmas-e,q.,hpatrty, etc, trator agreed would be able to with C' Old Business; Nursing Ice--Dr. Holt suggested that Saylor Health Care Systems be asked to perform an'ov aIT' urvay of the nursing services at Flow Memorial Hospital. After some discussi o, the Board authorized the Administrator to contact Baylor and request this survey. 2e1i.pad--The Administrator stated that there has been a problem voiced by the helicopter pilots regarding the electrical line installed for the mobile CT scanner. ' The 11nQ apparently impedes their taking off, and the possibility of buryin; the line is +1ow being investigated, The site for the helipad has also been ch6iiqud to the area of just north of the other site. New bids are being securred,' In the essence of time, Mr. Moore moved that the Board authorize the Administrator to accept the one bid received to date for $19,820 to construct t',4 CT pad and driveway modifications this motion was seconded and passed by voice vote. The meeting was adjourned at 8;20 p.m, At 8125 p.m., the Board of Directors met in Executive Session pursuant to Article 5252.17, Section 2(g) V,A.T,C.S, to discuss personnel matters. The Board of Directors reconvened at 9.15 p.m, No action was taken, however. Dan Trammell Secretary gin f r f BOARD OF DIRECTORS,-ALLED MEETING BUSINESS MINUTES eefa Page =-=--=--I-- The Board of Directors of Flow Memorial Hospital met in called session at 7:00 p.m. on Tuesday, October 11, 1983 with the Vice-Chairman, Mrs, Williams, presiding, Members present; Also present: Absent: Dr, V. R. Alvarez Ms, Laurie Griffin Mr. Ralph Havenhiil Mr. Jeffrey Hausler Mrs, Gloria Madewell Mr, Dan Trammell Me, George Hilz Mr. Mike Carlson 1 vacant position Dr. Don Holt Me, Brad Moore Mrs, Mary Williams ` Mrs, Williams announced that the meetinc~ had been called to hear a presentation from HBE regarding the proposed office building and to consider renewal of the agreement with North Texas Medicare's Health Maintenance Organization, Medical Office Building--Mr, Mike Carlson, a representative from HBE Medical Office Buildings In St, ours, Missouri, was introduced, He presented and discussed the advantages and disadvantages to such a building and the possible ownership options He stated that no now survey of physicians to determine their interest would be necessary at this time. The four basic ownership methods outlined were hospital ownership, partnership, limited partnership, and condominium, Me, Carlson recommended that the Board consider a combination of the four possibilities and to remain as flexible as possible to meet the various needs of physicians, He stated that the prices quoted within the proposal were based on the assumption that the building would contain some 15,000,9quare feet in rentable space at an average of 1,000 per physician, Cost of the building would be approximately $1,600,000, Me, Carlson agreed to meet with his architects and go over all possible locations for such a build ing, reviewing all topographical information available, He agreed to then propose a building configuration to house some 15 physicians, with the building having expansion capabilities, and with the building site not possibly impeding future growth of the hosptat: `He agreed to present these plans with corresponding costs at the November 17 meeting of the Board of Directors, If the plans are approved by the Board, Mr. Carlson stated that he could then proceed immediately to schedule meetings with the medical staff to introduce the plan, and to meet individually with those who express an interest in the building. Conceivably; the building could be ready for occupancy in 12.15 months from today, The Administrator was asked to discuss with the officers of the Foundation the possibility of the Foundation becoming the general partner in sugh a building, HMO Contract--Me, Moore moved that this item be tabled until the next meeting, The mod on-i" a seconded and passed by voice vote. There was no further business, and the meeting was adjourned at 8;15 p.m. l Mary Henderson Williams, Vice Chairman and Acting Secretary F ? ~I BOARD OF DIRECTORS MEETING r THURSDAY, NOVEMBER 17, 1983 7;00 p.m. MEDALLION ROOM +dOV 1 6 1 33 AGENDA 1, Medical Office Building Presentation--HBE f 11. Review and Approve Minutes of Previous Meetings (October 20 A October 25) III, Old Business A. Update cn Puns for Midwife Program R. Update o,i Helipad Construction C. Report of Completion of CT Scan Project D, Explanacion of Employee Health Insurance Expense Amount E. Anu Other Old Business IV, New Business A, Review of Committee Reports 1. Finance Committee--Mr. Hilz 2. Foundation Board--Mr. Havenhiil 3, Quality Accountability/utilization Review Committee--Mr, Hauslor 4, Safety Committee--Mr. Hausler B. Me0 cat Staff Report--Dr. Alvarez C. Administrator's Report-.-Mr, Hausler D. Any Other New Business V. Executive Session to Discuss Personnel Matters VI, Adjournment is BOARD OF DIRECTORS MEETING THURSDAY, NOVEMBER 17, 1983 7;00 p.m, MEDALL21% ROOM t A G E N D A Nov 1 8 a£C3 1. Medical Office Building Presentation--HBE II, Review and Approve Minutes of Previous Meetings (October 20 & October 25) III, Old Business A. Update on Plans for Midwife Program B. Update on Helipad Construction C, Report on Completion of CT Scan Project D. Explanation of Employee Health Insurance Expense Amount E. Any Other Old Business IV, New Business A, Review of Committee Reports 1. Finance Committee--Mr, Hilz 2. Foundation Board--Mr, Havenhill 3. Quality Accountability/Utilization Review Committee--Mr. Hausler 4, Safety Committee--Mr, Hausler B. Medical Staff Report--Dr, Alvarez C. Administrator's Report -Mrr Hauslor 0. Any Other New Business V. Executive Session to Discuss Personnel Matters VI, Adjournment I r dA i VVV FLOW MEMORIAL HOSPITAL BOARD Or DIRECTORS MEETING, THURSDAY, OCTOBER 20, 1983 7;00 p.m. MEDALLION ROOM I, Call to order II. Election of Officers" Mr.'Hausler A. Chairman of the Board B. Vice Chairman of the Board C. Secretary of the Board III. Review and Approve Minutes of Previous Meetings A. September 22, 1983 B. October 3, 1983 C. October 11, 1983 TV. Old Business A, Consider Renewal of Hospital Participation Agreement with North Texas MedCare, Inc. B. Prioritize Capital Equipment Budget of 1983-84 and Unpurchased Capital Equipment from-1982-83 Budget C. Report on Status of Mobile CT Scan Service--Mr. Hausler D. Paport on Helipad Construction--Mr. Hausler E. Report on Proposed Midwife Program--Mr. Hausler V New Business H11z A. Finance Report--Mr. B. Review Home Health Report--Mr, Hausler C. Review Quality Acc6untability/1101 Wtion Review Report and Consider Amendment to Utilization Review Plan--Mr. Hausler D. Review Safety Report--Mr. Hausler E. Medical Staff Report--Dry Alvarez 1, Consider Approval of New Physicians with Home Health Privileges 2. Any Other Medical Staff Reports F, Administrator's Report 1. Request to Purchase Equipment 2. Any Other' Reports G. Consider Re-scheduling of November and December Board Meetings H, Any Other Business VI. Executive Session to Discuss Personnel Matters VII, AdJournment Y FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS CALLED MEETING OCT 7 2 °3 TUESDAY, OCTOBER 11, 1993 7:00 P.M. MEDALLION ROOM AGENDA I, Discuss With 'oprasantatlve of HBE Proposal for Medical Office Beilding it. Consider Option to Renew Hospital Services Agreement Between Flow Memorial Hospital and North Texas Medicare's Health Maintenance Organization Ill. Executive Session to Discuss Personnel Matters , IV. Adjournment r BOARD OF DIRECTORS MEETING rl~ BUSINESS MINUTES Once =Au$ust._1$ to The Board of Directors of Flow Memorial Hospital met in regular session at C 7:00 p.m, on Thursday, August 18, 1983 with the Chairman, Mr, Wyatt, presidin;, No j/ Board members were absent. Members present: Members absent: None Mr, Ralph Havenhill Dr, V, R, Alvarez Mr, George Hilz Mrs, Wilma Fritz Dr, Don Holt Mr, Jeffrey Hausler Mr, Brad Moore Mrs, Gloria Madewell Mr, Dan Trammell Mrs, Chris Sauer - Mrs, Mary Williams I Mr. A. E. Wyatt SF P 2. g The minutes of the previous meeting were presented, reviewed, and approved, Old Business: HeliDad--The Administrator reminded the Board that the application for approval from the Federal Aviation Agency had been submitted some 45 days ago, If written approval is not received soon, the construction will begin anyway, since approval from the FAA is not essential, T Scan--Since the original site was not ideal, an engineer has selected an alternate site Just outside of the entrance to Medical Records, his written report is expected next week. Construction is expected to begin soon afterwards. C. 3 Medical Records Surva--Copies of the survey of the Medical Records Department prepare y representatives from Baylor Health Caro Systems were distributed, Copies had also been given to the members at the last meeting for their review, Mr. Hausler briefly reviewed the five categories of the survey and stated that he had met with Nancy Howard about its contents, He stated that they had discussed what could be done to better accommodate their space requirements and also that additional coders which will be needed with the new ORO requirements, Nursin ana ement--Mr. Hausler was asked if there have been any further develop.[ ments on arrang ng w TWU to provide a program here in nursing management. He state that he plansito meet with them in the next couple of weeks. Diner for Ne..w~phsicians--The Board members were reminded about the dinner which 1s plan e oT'f r llis w-'physicians at 7:00 p,m. on September 14, New Business: an a1 apart--Mrs. Fritz presented the financial statements which included a propose new condensed financial statement. These were reviewed in some detail, Me, Hausler explained that he had suggested the new format which would present the same information in a more concise manners these will be mailed in advance next month embers resultiforttheevaluate is the now orm. She Mrs. stated Fritz hat income has increased, however, recovery of bad debts has decreased, She pointed out that all revenue-producing departments have an excess of revenue over expenses year, to-date, The Bad Debt Charge-Off List in the amount of $68,250 and the Charity Charge-Off List in the amount of $33,718 were both presented and reviewed, Mrs. Fritz was asked to report on the status of the change to the double-tier pricing index, She stated that Respiratory Therapy, EKO, and Physical Therapy are ready for September 1 implementation, and all other departments will be implemented F i HOARD OF DIRECTORS MEETING BUSINESS MINUTES oaf, __August 18 _1983Page 2 by October 1. She stated that there had been a delay in the implementation of this new index due to the fact that it had been decided that an accross-the-board percentag ' would not be equitable. Instead, each department had been asked to evaluate each of their charges and make recommendations for adjustments which would be both competitive and fair. It was asked'if the hospital has yet been able to purchase through the shared services offered by the Voluntary Hospitals of America. Mr. Hausier responded that r a price list is due soon, and until the price list has been received, this has been delayed. Mr. Moore suggested that the hospital investigating the use of Checktronics to report bad checks and discussed some possible benefits of this system. Mr. Havenhill moved that the Finance Report be approved; this motion was seconded and passed by voice vote. Home Health Report--The minutes from the July 22 meeting were presented and review- a StatlStIos for the number of home visits and census were also reviewed. The Administrator commented that the Home Health Service had received certification from the Texas Department of Health to treat patients who reside borderline to the Denton County boundaries. Dr, Holt movod that the Home Health Report be accepted; thi motion was seconded and passed by voice vote. Duality Accountability/Utilization Review Re art--The minutes from the August 9 meeting of this committee were presents an rev ewe It was noted that the physicia s had discussed the need for improved documentation and guidelines for the now DRG C regulations which will become effective•October 1, Mr, Havenhill moved that the QA/UR Report be accepted; this motion was seconded and passed by voice vote, Safety Report--The minutes from the August 5 meeting of the Safety Committee, as well as a summarized report of 20 of the 31 incident reports, were presented and reviewed. The committee had reviewed all incident reports for the previous six months in which there had been a narcotic medication involved, and the committee had datermin d that the incidents were random in nature. Mr, Moore moved that the Safety Report be accepted; this motion was seconded and passed by voice vote, The Safety Committee had recommended replacement of the gas sterilizer in the Central Supply Department due to some unsafe conditions. The need for this piece of equipment was felt to be of sufficient nature that the $19,900 item has already been ordered, The Board suggested that the Foundation be approached with the possibility of funding this gas sterilizer. r Medical Staff Report--Dr. Alvarez reviewed the minutes from the August 15 meeting of the Medical Executive Committee, He asked the Board to ratify his appointing Dr, M. W. Via as Chairman of the Department of Anesthesia. The Medical Executive Committee had reviewed the proposed capital equipment bud at with the purpose of prioritizing the items, However, the physicians felt that further study was needed on the entire list before such pprioritization could occur, Or, Alvarez presented the following applications which had been favorably recommended for appointment by the Credentials Committee, the Medical Executive Committee, and the clinical departmen to which they might be assigned; Mahlon M, R, Freeman, M.D., Active Medical Staff, WON, Ultrasound Carol Wilson, M,D., Courtesy Medical Staff, Pediatric Nephrology Ezra Joseph, M.D., Courtesy Medical Staff, Emergency Medicine' Rod Clark, Allied Health Professional Staff, Physician's Tech 11 for Drs. Montalbo and pri a 33 physicians for home heath privileges only (sea attached list) t BOARD OF DIRECTORS MEF"TNG _ BUSINESS MINUTES a.«. August 18, 1983 P'g' The applications were reviewed by the Board, Mr. Havenhill moved that the Medical Staff Report, including the appointments as requested, and the appointment of Or, Via C as Chairman of the Department of Anesthesia, be approved; this motion was seconded and passed by voice vote. Obstetrical Drop-ins--Mr. Hausler stated that he had met with the County and subsequent o that meetn had investigated other nurse midwife programs. lie had contacted the American College of Nurse Midwives, the Jeff Davis Hospital Administra- tor, the University of Mississippi Nurse Midwife Program Director, and three other places. He stated that he would recommend that the hospital employ two certified nurse midwives, at the salary of approximately $25,060-$30,000 per year. He stated that the County had indicated an obligation to fund indigent care, but tre salary for the nurse midwives would probably not be included, He recommended that the two nurses deliver the drop-in's, assist at the health clinic, and take care of the newborns of the indigent patients. Mr, Wyatt stated that the obstetricians had informally agreed to take care of the complicated droF-in cases, which would not be seen by the midwives, Mr. Hausler also recommended that the County be billed monthly for indigent care given to patients at Flow Memorial Hospital, Mr, Moore moved that all of these recommendations be approved; this motion was seconded and passed by voice vote. Ph si~ c~ _an Recruitment--The Administrator reported that this is still in the very prelim nary stages "W RE ie Baylor Health Care Systems representatives, 1 Q>:,`ice Building--The Administrator suggested that prior to any firm determ nation about the size of such a medical office building, some deci,ions need C ~t to be made as to present and future needs for physician. He added that he had con- tacted HBE about re-vitalizing their feasibility study and plans for the building, Dr. Holt stressed an urgency to proceed as quickly as possible. C ntroller--The Administrator stated that he had interviewed several individuals fort s post on, but has not yet found an acceptable applicant, He will continue to search for a controller, Public Relations--Mr. Hausler stated that he has made a decision on an applicant for tie pos i' t on of_Oirector of Marketing and Public Relations, and he will make har an offer this,week, D etitian--A new clinical dietitian has been employed to replace Becky Chase, who resigned to return to school, Count Funds--Mrs. Fritz stated that the $75,000 quarterly cont'ibution from the rcounty a een received and placed in an interest-earning account. Currently a $1501000 CD had been purchased at 9,45%, paid off a $130,000 note, leaving a balance of $131,000,. Another investment, a $1259000 at 14,65% interest, matures September, 1984, oals and Ob ectly s--The Administrator stated that he had requested the depart- ment directors write snort-term goals and objectives, and he is in the process of reviewing these, Institutional objectives are to be discussed by a few of the directo s next week, Business Of Mr. Hausler stated that he had talked with Margaret Lester and C- Pam Joinson about some of the recommendations made in the Baylor survey of those departments. Fie plans to have in final form next month a recommended write-off and collection policy for the Board's perusal, 1 s - BOARD OF DIRECTORS MFETTgG Buswess MINUrr:s_ _ Da 1e August 18, 1983 - - - Pago 4 Home Health.-Mr, Hausler stated that there have been no further developments in the propose Tom Westgate Hospital to combine home health services. C' JCAH--The further documentation requested by the Joint Commission on Accredita- revtiionew adas ataddit ca inonal be imancl material needed for the progress report will be sent following the next meeting of the Pharmacy A Therapeutics Committee so that additional antibiotics , United Wa --Ms. Linda Ashmore has been designated chairman of the hospital's Unite acp ign, which is expected to begin next month. ANA THA Convention--Mr. Hausler reported that Ms, Ashmore, Mrs, Hadewell, . B Johnson, rs Mr Dixie'Clardy, and he had attended the combined Americ Association/Texas Hospital Association meeting in Houston the first three days ofspitai August. He stated that much of the information gained from the meetings concerned the new DRG regulations, Salar Surve --Mr. Hausler stated that he is continuing to gather comparison r, on on sa aries at other hospitals and similar gobs withi informe n the communit. Wyatt requested that benefits be included in the survey so that a total package comparison can be made. Education--A meeting has been planned for August 24 with Dr. Boswell from Baylor to discuss a educational opportunities available through the A. Webb Rober*a Center for Continuing Education for the hospital staff and medical staff. Cit 's Re nest--Mr. Hausler stated that he needed the Board's shou a made to the City's request for what funding might ibecneeded nfroat j the City during the next few years--1,e., building improvements, capital equipmentm etc There was no further business, and the meeting was adjourned at 9;40 p.m, t Dan Trammell Secretary 9m r t. • I I ar.1.11 3N (t y f l V L! 116 b LI V 1.,.. j FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS MEETING THURSDAY, SEPTEMBER 221 1983 7;00 p,m, MEDALLION ROOM I, Review and Approve Minutes of Previous Meeting ] II, Old Business A. Report on Status of Holipad Construction B, Report on Status of Installation of Mobile CT Scan Service III. New Business A. Committee Reports 1. Finance Committee--Mr. Hilz 2, Foundation Board--Mrs, Williams 3, Joint Conference Committee--Mr. Wyatt A, Quality Accountability/Utilization Review--Mr. hausler S. Safety Committee--Mr, Hausler B. Medical Staff Report--Dr. Alvarez C. Administrator's Report--Mr. Hausler 1, Consider Purchase of Capital Equipment Items 2. Review of Other Business D. Any Other New Business E. Executive Session to Discuss Personnel Matters IV. Adjournment y' J i+ 1 , l FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS THURSDAY, AUGUST 18, 1983 7;00 p.m. MEDALLION ROOM AGENDA 1. Review and Approve Minutes of Previous Meeting II. Old Business A. Report on Status of Helipad Construction B. Report on Status of Preparation for Mobile CT Scan Service C. Review Baylor Health Care System's Survey of Medical Records D. Any Other Old Business III. New Business A. Review of Committee Reports 1. Finance Committee--Mr. Hilz 2. Home Health Committee--Mr, Hausler 3. Quality Accountability/Utilization Review Committee--Mr. Hausler 4. Safety Committee--Mr, Hausler B. Review of Medical Staff Report--Dr. Alvarez 1. consider Appointment of New Physicians, Allied Health Professionals, and Physicians for Home Health Privileges 2. Consider Approval of Appointment of Chairman, Department of Anesthesia 3. Any Other Medical Staff Business C. Administrator's Report--Mr. Hausler D. Any Other New Business E. Executive Session IV. AdJournment Y 1 lkuo i983 p t i ~M BOARD OF DIRECTORS MEET': _ Fr7: NESS MINUTES o,~a P'9° L_ _ ,luly The Board of Directors of Flow Memorial Hospital met in regularrseSsion at: 00 p,m . on Thursday, July 21, 1983 with the Chairman, Mr Wyatt.p 9 1 Grl r, 1, Members present : t~ z 'e l~ y ff Mr. Ralph Haverhill Dr, W. E. Coleman Mr. Dan Trammell Mr. George Hilz Mr. Jeffrey Hausler A~ G L 2 X885 Dr. Don Holt Mrs, Wilma Fritz Mr. Brad Moore Mrs, Gloria Madewell Mrs. Mary Williams Dr, W. M. Midgett Mr, A. E. Wyatt Mrs. Chris Sauer The minutes from the June 30 meeting of the Board of Directors were presented and approved, Also, the minutes from the July 6 meeting of the Executive Committee I of the Board were presented and approved. Heli ad--Mr. Hausler reported that the employee who had been developing the plans constructions he is back at work, a for ttlie -construction made b the lFAAdprior ntoh hospital, will c be o the site vi Mobile CT Scan--Mr. Hausler reported that the site work is not ready yet for this pro,ieF7 and design engineer will need to be employed to assure the proper location for the unit. The tentative site is outside of the Post Partum floor, A representati be losing t some hospital next from o review c the t plansnpal~Dr. that Holt manufactures commented ththe at we n may will be at week t right now due to not having a CT scan service available, New Business; Finance Reaort--Mrs. Fritz reviewed the financial statements from the month of June. She reported that the average daily adult census for June was 98.6. She reviewed the departments which had increased treatments or procedures and which units had had increased patient days. Mrs. Fritz reminded the Board members that a $250,000 note becomes due August 14 and that a $125,000 CD matures at the same time, Another $125,000 CD would mature September 30. Mr. Hilz moved that the first $1250000 CD, plus any earned interest, he used to reduce the note due on August 14 and that the Administrator negotiate another loan at that time for the balance; this motion was seconded and passed by voice vote, The Bad Debt Charge-Off List in the amount of $70,269 and the Charity Charge-Off List in the amount of $35,112 were presented and reviewed, Mrs. Fritz commented that accounts payable are currently at $62'1,000, She was asked if the policy regarding { post-dated checks has been changed--1.o,, that the accounts payable Clark is r, longer dating the checks in advance of when they are actually mailed; Mrs. Fritz stated that this has been changed, Dr. Holt asked Mrs, Fritz if the double-tier price master is ready, and she stated that she has not yet begun work on this project, Mr. Hausler stated that he would meet with Margaret Lester and Wilma Fritz on the next day to begi work on this, Mr. Hausler reported that he had met with the County Judge and County Auditj regrding the capital equipment budget and had agreed to defer some $644,000 in equipment items t' this would reduce the capital equipment 'funds needed at the begof the year to 5778,000. BOARD Of DIRECTORS MEETING BU SIN BSS MINUTES ea~o Ju1y_Pl, 1983 Paq• 2 There was some discussion regarding what should be done with the next quarterly payment of $75,000 due from the County, and it was agreed that it should be placed in an interest-earning account, such as a Certificate of Deposit or Money Market Security. There was also some discussion concerning the possibility of receiving some funds from the City of Denton to remodel portions of the building, Mr. Hausler.reported that he had received several resumes from persons interested in being employed as controller; also, some ads will be placed in the Dallas and Fort Worth newspapers, Mr. Hilz moved that the Finance Report be approved; it was seconded and passed. Foundation--Mrs. Williams reviewed the minutes from the July 14, 1983 meeting of ' the FT-ow Foun anon, She stated that they had discussed the possibility of fund- raising events; plans are to be presented at their next meeting in September. Mrs. Fri z added that the hospital employees would be willing to assist in fund-raising events. Mr. Moore moved that the Foundation report be accepted; this motion was seconded and passed by voice vote, Quality _ Accountability/Utilization Review Repo~_r_t_--Mr. Hausler reviewed the minutes from the u y meet ng o t e A/U omm t ee, -TNT physical advisor decisions for April and May had been reviewed, They had discussed the increase in retrospective reviews on Medicaid patients had increased and what is being done to correct the problem. Mr. Havenhill moved that this report be accepted; this motion was seconded and passed by voice vote. Safety Committee--The minutes from the July 8 meeting were presented and reviewed. A summary report of 35 of the 50 reports was also reviewed. It was noted that even though other hospitals have reported deaths due to a certain electrical hospital bed, the electrical beds at this hospital at not constructed in a way which would allow a child to get trapped. Mr. Haverhill moved that tl,c.,Safety Report be accepted; this motion was seconded and passed by voice vote. -Mad{.~3s.1 SSta4I1 2ap"4--Dr, Coleman, Secretary of the Medical Staff, attended the meeting in the absence of the president and president-elect, Dr. Coleman reviewed the minutes from the July 18 meeting of the Medical Executive Committee, He explained that the MEC had recommended that Dr, Qureshi be granted the privilege of performing percutaneous transluminal peripheral angioplasty only after he can present documenta- tion of having done three such procedures, Dr. Coleman reported that representatives from Baylor Medical Center will be asked to discuss arrangements for transfer of neuro- surgical patients to that facility now that Denton is without that specialist. The obstetricians had expressed a need for two additional fetal monitors and some smaller labor beds, The Medical Executive Committee had recommended adoption of a new policy for serology testing which would be consistent to a change in Texas law, Effective August 29, 19831 serology testing will not be required pre-maritally; instead, a'RPR testing will be done on the mother's blood at the time of delivery, Mr. Havenhill moved that the Medical Staff Report be accepted; this motion was seconded and passed by voice vote. Dr. Midgett reported that the drop-in problem still exists. He had, in fact, delivered four drop-in patients today. He emphasized that it should be the rosponsi- bility of the County to provide the care for sack patients, It was explained that the hospital had requested funds from the County for the next fiscal year to reimburse the obstetricians and pediatricians for the drop-in patients. After further explanati of the problem, Mr. Havenhill moved that the Board of Directors remind the County about BOARD OF DIRECTORS MEET1,116 BUSINESS MINUTES oe~e Pegs the importance of finding a solution for this problem; this motion was seconded and passed by voice vote. The Administrator agreed to remind the County and to report bac to Or. Midgett and the other obstetricians what the County agrees to do. Administrator's Report--Mr, Hausler reported that a letter had been sent to the County u for request ng payment of the $75 000 quarterly contribution. He stated that he has met with representatives from Baylor Health Care Systems regarding physician recruitment, the Medical Records survey, continuing education for staff and physicians, and the professional office building. The Administrator stated that a letter had been sent to physicians who had designated MedCare as their home health referral that such referrals would not be honored at this hospital; instead, the physicians who desire the use of other home health aggencies should make such orders from their offices, The application for membership in the Voluntary Hospitals of America has been re-submitted by Baylor, and approval should be forthcoming tomorrow. Mr. Hausler stated that he had contacted Mr, George Koob at HB£ to determine the status of the plans for the professional office building, Resumes have been received from p rsons desiring the controller position; additionally, ads have been placed in Dallas and Fort Worth newspapers for the positic. of controller and public relations director, The Administrator reported- that the ultrasound technician has resigned to work in the office of a local obstetric1&n; a replacement is being sought for this position. Also, the Clinical Dietitian has re- signed to pursue a master's degree, and a replacement for this position is being sought, The Administrator stated that he has'discussed with the directors concerned abousome needed improvements in the cleanliness of the building and the maintenance of the r building. Of the items received by the Board as high prioril•y areas, he reported the following actions; Collection performance--He is working with Pam Johnson on plans for improvements. Indigent criteria--No action yet. Budget review--Accomplished Baylor resources--lias met with Baylor; need a priority.of physicians needed. Competition--He has met with the Administrator of Westgate Hospital and the Vice President of First Texas Medical and will meet with the Administrator of Lewisville Memorial Hospital next week. Organizational changes--No action yet. Physician recruitment--He will meet with Dr. Holt and Dr, Alvarez about this. Business Office--Action deferred until the employment of a controller. Drop-in obstetrical problem--Working toward solution. Mr, Moore suggested that Mr. Hausler talk with Mrs, Chris Sauer about the possibility of her writing for the hospital on a part-time basis, He also suggested that he contact Coleen Michaels at the Department of Health and Human Resources in Denton about improving the communication between that agency and the hospital and thereby improving the designation of Medicaid patients, Mrs, Williams asked about the possibility of employing midwives to deliver the drop-ins., Dr. Holt stated that he felt that additional funds for the physicians shoul be provided for`the immediate solution of the problem and that employing of midwives might be a workable long-term solution to the problem. TAHGB Seminar--Mrs, Madewell reported that the Texas Association of Hospital Governing Boards has scheduled a seminar in San Antonio on August 26 and 27, Any of the Board members desiring to attend this workshop should contact her for reservations BOARD OF DIRECTORS MFrv1NG BUSINESS MINUTES De+a Jul _21 i~83 P6q4 - 4 Welcome for New Physicians-.Dr. Holt proposed that the Board of Directors host a dinner or a o ie new p ysicians to welcome them to Flow Memorial Hospital, The C date of September 1.4 was tentatively set for the dinner, and arrangements will be discussed later, The meeting was adjourned at 9:00 p,m. for Executive Session to discuss personnel matters, At 9;10 p,m., the Board of Directors met in Executive Session pursuant to Article 6252-17, Section 2 {g} V.A,T,C,S. The Board of Directors reconvened at 10:00 p,m. No action was taken, and the meeting was adjourned, 1 A. E, Wyatt, Chairman Acting Secretary 9m i t i' i FLOW MEMORIAL HOSPITAL BOARD OF DIRECTORS THURSDAY, JULY 21, 1983 7.00 P.M. MEDALLION ROOM AGENDA 1, Review and Approve Minutes of Previous Board Meeting it. Review and Approve Minutes of Executive Committee of the Bo I! III, Old Business and Meeting A. Status of Helipad B. Construction Status of Preparations for Mobile C7 Scan Service IV, New Business A. Committee Reports 1. Finance Committee,Mr, Hi1z 20 Foundation Board.-Mrs Wiiliams 3, Safety Quality Commjmi t t ;nuee-.-Mr, , Mr, , /Utilization Review--Mr, Hausler 4. Hausler 8• Medical Staff Report-.Dr, Alvarez C, Administrator's Report--Mr, Hausler D Any Other Now Business E, Executive Session to Discuss Personnel Matters V. Adjournment JUL 1 8 5883 4 A BOARD OF DIRECTORS FXpy1 VE COMMITTEE BUSINESS MINUTES Dada i 6 1983 _ The Executive Committee of the Board at 12:15 p,m, on Wednesday, July of Directors of Flow Memorial Hospital met 6, 1983 with the Chairman, Mr, Wyatt, presiding, Mr, Members Gresent; Dan Trammell Mr. Jeffrey Hausler Mrs, Mary Williams Mr, A. E. Wyatt Mrs, Wilma Fritz Mrs. Gloria Madewell Mr, Wyatt reminded the members final approval that the meeting had been scheduled 198344 to consi budget, d er Budget--Mrs, Fritz answered questions regarding the budget and explained that it had been written on the basis of an average of 95 patients per day, The capital equipment portion was reviewed, and two items were deleted--i,e „ a birthing bed at $5,000 and a video camera at $19700 which was a duplication. seconded Mrs. Williams moved that the proposed 1983-84 budget be approved; this motion was and passed by voice vote. - Home fleaith S_a -Letters from physicians designating MedCare Home Health Service as the agency meant when they order home health service wero distributed and reviewed, Since Flow Memorial Hospital has its own home health service, it was agreed that all orders written in the hospital should be forwarded to the Flow Memoria Hospital Home Health Service. For orders should more appropriately physicians desiring MedCare, it was agreed that thes be written at that physician's office--not at the C hospital, It was suggested and approved that a memorandum should be sent to t physicians who had written the letters and explain the hospital's matter and explain what procedure should be followed for ordering alternative services. There was no further business, and the meeting was adjourned at 1;15 p.m. Dan Trammell Secretary S FLOW MEMORIAL HOSPITAL BALANCE SHEET June 30, 1983 1983 1982 1983 1982 Current Assets: f Current Liabilities; Cash--Operating $ 238,219 $ 248,183 Current Notes Payable $ 423,901 $ 3010844 k Interest & Sinking 170 14,481 Accounts Payable 806,186 7199187 Reserve Fund 40,855 209412 Accrued Payroll 539,653 497,069 Repair Fund 20,315 1,847 Due Medicare 150,903 157,396 Group Health Insurance 19000 618 Fees Payable 203',244 1969165 Investments/Board Designated 305,464 4210398 Bond Interest Payable 61999 2,624 Bonds Payable -0. Total Cash & Investments $ 606,023 $ 706,939 Total Current Liabilities $2,130,886 $1,874,275 Accounts Receivable $4 691,895 $2 9470240 Other Liabilities; Less; Allowances 943,760 )3,72 7740) Deferred Income 86,751 87,263 Net Patient Receivables , ff0' Long Term Notes Payable 277,678 4939173 Other Receivables 1769455 172,945 Bonds Payable 420,000 430,000 Inventories 4080634 ; 274,171 Total Liabilities $2,9150315 $2,884,711 Prepaid Expenses 68,650 W 691433 Total Current Assets Ca $5,0071897 $30797,988 Capital: City of of Denton $ 393,165 $ 393,165 Property, Plant & Equipment; County of Denton 11696,871 10696,871 Land Endowment Flow Estate 240,461 240,461 $ 379647 $ 37,547 Fed, Grants, Hill-Burton 108680910 108681910 Building & Improvements 3,067$86 300580386 Federal Grants 256,371 256,3y' Furniture & Equipment 4 541 103 4 564 0 44 417 ~ Pledges and Gifts 561,748 493, -i~ 77 Gen, Fund Ba1,, Beg, of Yr. (291,266) (686,770) Accumulated Depreciation $ 4 339 237) ${4,109,576) Current Year 673,121 181,295 Net Property, Plant & Equip, $3,306,799 _$3,5309774 Total Capital $5,399,381 $4,4449051 TOTAL OPERATING FUND ~$8,314~696 $7,3280762 TOTAL OPERATING FUND $8,314,69b 7 328 762 ;r' c ti Current Ratio 2,35 t., j~ G F n ,V i F1.0W MEMORIAL HOSPITAL Paget STATISTICAL STATEMENT June 30, 1983 CURRENT MONTH YEAR -TO -DATE P RIOR Actual Budget Actual Budget Year-to-Date Adult Patient Days 21939 21850 25,858 25,935 25,149 Average Per Day 98.0 95.0 94.7 95.0 92.1 Newborn Patient Days 445 420 31427 31822 30491 Average Per Day 14.8 14.0 12.6 14.0 12.8 Gross Patient Revenue/ $540.03 $428.88 $459.72 $424.17 $384.87 Patient Day Total Expense/Patient Day $378.56 $356.84 $367.88 $352.91 $331.43 Month Charity. Bad Debt Recovery October $ 510473 $ 960053 $ 50636 November 127,181 117,974 41446 December 61,228 106,636 61566 January 81000 999706 9,934 February 280903 1080131 49092 March 52,295 89,946 12,762 April 20,149 42,208 160021 May 15,406 36,734 30595 June 35,112 70_,269 7,111 $399,737 $767,657 $70,163 3.4% 6.5% .6% ~i FLOW MEMORIAL HOSPITAL STATEMENT OF OPERATIONS/June 30, 1983 Page 3 % of Salaries Supplies Total Direct Operating Revenue Revenue & Benefits & Other Expenses Profit (Loss) Daily Hospital Care 16 $ 251,625 $126,775 $ 130398 $140,173 $111,452 Psychiatric Care 4 570174 34,617 3,007 37,624 199550 OB/Post Partum 2 38,290 18,454 25684 219138 170152 ICU 2 33,275 18,692 21520 21,?.12 12,063 Nursery/NICU 5 84,605 39,223 61245 45,468 399137 Coronary Care Unit 3 48,516 29,423 41078 33,501 15,015 Labor & Delivery/Birthing Center 4 590866 25,133 6,440 31$73 280293 Operating & Recovery 5 71,280 22,963 16,629 39,592 310688 Emergency Room 4 61,615 160777 )",545 45,322 169293 central Supply 8 129,847 79308 b6sl] 6 72,424 57,423 Laboratory/Blood Bank 12 195,228 62,835 62,835 1326393 Radiology/Nuclear Medicine 6 87,278 15,806 22,622 38,428 48,850 ti Pharmacy/IV 17 2760373 11,814 470550 59$64 217,009 Cardiopulmonary 8 128,811 10,002 15,649 33,650 95,1'60 Anesthesia 3 42,732 14,709 13,841 28,551 14,182 1 210307 Total Physical Therapy I U _ 'wjuze ~$4 7 401 2 409 9 810 , r.._ 9.b,/._... j Deductions of Revenue $ (8,45253) $ $ $ $ 84,253 Charity & Bad Debt (186$26) 186,326 Employee Health Ins, Expense 30,182 30,182 300182 Medical Records 600 110117 3,652 14,769 14,169 Gift Shop/Grounds Maintenance 11693 20554 1,414 31968 21375 Cafeteria 11,148 25,917 26,888 52,505 410367 Plant 159274 829745 98,019 98,019 Environmental Services 35,081 109659 45,740 46,740 Fiscal Affairs/Oath Processing 7,558 6,679 14,237 14,237 Business Office/Credit & Collect 22,899 13,782 36,681 36,681 Personnel 3,377 11107 4,484 4,484 Administration 10086 11555 31441 3,441 Quality Control 2,969 421 31390 31390 General & Administrative 120 51,469 51,469 510349 Npreciation 33,046 33 046 33 046 25-11118), -31 ;6'32 " $ T;fi3T -T64 I Gain (Loss) From Operation Non-Operating Revenue 26,168 ~ Foundation 3,122 3 122 Total _$1 359' `$53~,7~4 $T`/3;867 ITEM,3fi6 338""-" ,k { FLOW M E M 0 R I AL HOS P I T A L Page4 STATEMENT OF OPERATIONS/YEAR TO DATE June 30, 1983 % of Supplies Total Direct Operating Revenue Revenue Salaries & Other Expenses Profit (Loss)_ Daily Hospital Care 17 $ 11969,695 $191619571 $ 114,773 $1,2760344 $ 6939351 Psychiatric Care 6 656,242 311,924 289174 340,098 316,144 OB/Post Partum 4 427,995 167,641 21,829 1899476 238,519 ICU 2 265,850 172,536 28,909 2019445 640405 Nursery/NICU 5 6240610 297,699 54,141 3619840 2720770 Coronary Care Unit 3 3675480 277,080 37,826 314,906 520574 Labor & Delivery/nirthing Center 4 427,122 229,104 63,114 292,218 134,904 Operating & Recovery 4 478,716 192,022 127,074 3190096 159,620 Emergency Room 3 390,884 154,367 246,459 4009426 (9,642) r Central Supply 8 975,961 70,694 4349766 5050460 410,501 Laboratory/Blood Bank 10 1,2449690 519,484 5190484 725,206 Radiology/Nuclear Medicine 6 685,495 142,124 1950351 337,475 3489020 Pharmacy/'LV 16 1,944,419 105,551 4019425 5069976 19437,443 Cardiopuln.-nary 8 952,663 179,652 158,119 337,771 614,892 Anesthesia 3 347,973 128,148 94,974 2230122 124,851 Physical TF,,rapy 1 135,599 62 376 o", 638 8-$5669/124 53 Total ~ TIT;1,3~4 $°3 ;n6S ,T~;b b $ 6,198!151 ► , Deductions f Revenue $ (700,692 $ (700,692 Charity & Bad Debt (1,415,205 (1 415,205 Employee Health Ins. Expense $ 231,411 $ 231,411 231,411 Medical Records 49948 102,518 25,624 128,142 1239194 Gift Shop/Grounds Maintenance 159330 160178 120355 28,533 130203 Cafeteria 102,443 237,108 245,540 4820648 380,205 Plant 1370588 553,120 6900708 690,768 :Environmental Services 307,167 87,502 394,659 3940659 Fiscal Affairs/Data Processing 719115 599407 130,522 130,522 Business Office/Credit & Collect 203,324 1179331 320,655 3200655 Personnel 25,668 18,678 44,346 44,346 Administration 53,c15 189869 72,384 72,384 Quality Control 24,299 50641 29,940 29,940 General & Administrative 179263 428,689 4280689 41 1,426 Depreciation 331 835 331 835 8 $l ; f78'?3~l"33';l~'D'2' Gain (Loss) From Operation 46 Non-Operating Revenue $$2388, Foundation ji6;,f136;7T4 $fi51-,5~' Total FLOW M E M 0 P I A L H 0 S P IT AL Pages SUMMARY OF CASH RECEIPTS AND DISBURSEMENTS June 30, 1983 Current Month Year-To-Date Beginning Balance $ 132,103 $ 2,175 Cash Received from: Active Patient Accounts $1,046,881 $81899,972 Bad Debt Accounts 7,111 70,163 Cafeteria 11,786 107,118 Appropriations/Donations 3059045 Other 550618 6879195 r Total Cash $1 121 396 $10069 493 TOTAL CASH AVAILABLE $1,263,'499 T6,~71- Cash Disbursements: Payroll $ 4390748 $4,290,364 Payroll Taxes 65,979 644,837 Patient Refunds 23,623 230,084 Capital Assets 1320295 Notes Payable 18,1478 1609562 Other 458,408 4,366,563 Total Disbursements $1,006t236 $ 9,824,405 Cash Balance $ 747;x` $247126'3 Cash Investments 305 464 $ 305j464 Total Cash 55;127 y $ ~7 Gross Patient Revenue $1 585,495 $11 875,515 Less: Allowances 102 269) 801 659) Net Patient Revenue $lo4U3sZZ6' $ , , Cash Received on Patient Accounts $1,046,881 $8 8990972 Less: Patient Refunds (23 623) 230,084) , Net Cash on Patient Accounts $1,023127 lt669,888 Cash Received as a % of Revenue 69,0% 78,3% t4 is r c,n v1.~y9 s Page 6 PLOW MEMORIAL HOSPITAL AGED ACCOUNTS RECEIVABLE SUMMARY Primary Payor Current 31-60 61.90 91-120 121-150 150+ Total % -of A/R 1 Medicare $ 310,753 $ 435250 $ 18,425 $ 99840 $ 59108 $ 140574 $ 401,950 10,0% Medicaid 120,464 229659 13,284 18,556 110170 20,823 206,956 5,1% Blue Cross 68,534 38,400 71432 51437 956 11273 1229032 3,0% Commercial Ins. 7639240 215,060 108,269 860689 640683 559974 1,293,915 32,0% Self-Pay 5380960 3599398 222,358 161,729 158,372 4010442 1,848,259 45'' , Balance after Ins. 64,703 20,645 15,289 61982 61762 52,436 166,817 4,1% In-House $1,,866,654 $699,412 $385,057 $295,233 $2470051 $546L5 $41039,929 100% 695 144 Total A/R '$4 J3r't0 A/R by % 46.3% 17.3% 9,5% 1.3% 6.1% 13.5% Days of Revenue! Accounts Receivable 92,7 In-House 15,9 Total TWX n 0 111), i i Page 7 S P I T A L F L O W M L AGED ACCOUNTS PAYABLE June 30, 1983 Deferred Payable Current 31-60 60-90 Total Trade Vendors $315,750 $188,091 $103,082 $606,923 Fees Payable 90,254 46,354 49,736 186,344 1 Accrued Payables 42,446 42,446 156,817 1565817 r'Estimated Payable 16,900 Deferred Audit Fee $16,900 $16,900 $6050267 $234,445 $152,818 $1,009,430 PLOW M E M 0 R I AL BAL0NCEPSI T A L HOME HEALTH Page 8 June 30, 1983 ASSETS LIABILITIES Cash $ 55,616 Accounts Payable $ 74,928 Payable Due Flow 3,611 Accounts Receivable $1300534 Accrued Payroll ,10,500 Inventory 11844 Total Liabilities $146111 Total Current Assets $132,378 MI PMENT CAPITAL Furniture & Equipment $ 11615 Pledges & Gifts $ 115 Less Accumulated Depreciation (19346) Gen. Fund Dal., Beg. of Yr, 1130815 $ 269 Retained Earnings Current Yr. 4616 Net Equipment Total Capital $118,546 $132L657 TOTAL OPERATING FUND $132,657 TOTAL OPERATING FUND C 14 Page 9 F L O W M E M 0 STATEMENT OF REMUESTAND EXPENSESM E N E ALT H May 31, 1983 I REVENUES Patient Revenues $30,847 $285,610 Deductions of Revenue _ 6,358) (65,095) ' Net Revenues $24,489 $2200515 EXPENSES Payroll & FICA $19,031 $1810004 Purc, Service 19052 70403 Supplies 1,124 11,241 Travel , 21035 13,220 Employee Benefits 2,762 Depreciation 269 Net Expenses $23,242 $215,899 4,616 Excess of Revenues Over Expenses $ 1,247 I I I r r 1 2 I FLOW MEMORIAL HOSPITAL ^ i BOARD OF DIRECTORS MEETING THURSDAY, JUNE 30, 1983 7;00 p.m. MEDALLION ROOM AGENDA 11 Review and Approve Minutes of Previous Meetings, May 19, May 26, June 14 11. Old Business III. New Business r~l A. Committee Reports ' 1. Finance Committee--Mr. H11z 2. Home Health Committee--Mrs. Madewell 3. Quality Accountability/Utilization Review--Mrs. Madewell 4. Safety Committee--Mrs. Madewell B. Medical Staff Report--Dr. Alvarez C. Update on Status of Helipad and CT Scan Service--Mr. Fortenberry D. Consider Engagement of Audit Firm E. Consider Approval of 1963.84 Budget . F. Consider Feasibility Stufy of Professional Office Building G. Any Other New Business IV. Executive Session to Discuss Personnel Matters V. Adjournment JUN I Y ISO iF l.'W'~^C'1.'YS CIS {~}st r~ii~ ~ Ka .y."RP`~fl ~~i~"~3) ~ 1VL1 i1(ti'~Xi5 ~~3~~~1~A1,1~~41 •%~1~ I ~USINESS MINUTES os}a - "4-" - June 30, 1983 Dave 1 The Board of Directors of Flow Memorial Hospital met in regular session at Q~b p.m. on Thursday, June 30, 1983 with the Chafrman, Mr, Wyatt, presiding, M tubers nrese,it; h 1 ember a bse nt : f ¢ Mr, Ralph Havenhill Dr. V. R. Alvarez MMrs, Mary Williams Mr. George Hilz Mr; Jeffrey Hausler L Dr, Don Holt ~ Mr, Brad Moore Mrs, Wilma Fritz Mr. Dan Trammell Mrs. Gloria Madewall £ttr e'~ Mr. A, E, Wyatt 1~f lily ''a,50'~", , 6 Iii & lso present: Commissioner Wallace Batey County Auditor Don Hill 1883 Mr, Jim Grant 'JU L 2 5 Ms, Faith Gray Miss Pam Johnson Mrs. Margaret Lester Mr, Jeffrey Hausler was welc?med as the new Administrator of Flow Memorial Hospita , The minutes of the May 19, May 26, and June 14 meetings of the Board of Directors were presented, reviewed, and approved, Old Business: CT S_can~Heli ad--It was reported that there are no further developments on these projects, r~i FFo`tenberry, Plant Engineer, is to discuss both projects with Mr. Hausle , low Business; F# a ci a ort--Mrs; Fritz reviewed the financial statements and commented on operations for t e the previous month. She noted that May had produced an operational excess of revenue over expenses of $147,915 and a not excess of revenue over expenses of $175,937, She noted that accounts receivable had increased 8,6 days from the previous month and that accounts payable is $232,036 on June 30, She explained that tho decrease in the amount of accounts payable is due to the efforts of the individual departments in keeping expenses as low as possible, The Bad Debt Charge-Off List in the amount of $34,460 and the Charity Charge-Off List in the amount of $15,406 were re o,' ewed, There was some discussion concerning the large number of bad debt accounts fr Emergency Room patients and whet efforts are made to make positive proof of identification of these patients. Mr, Moore suggested consideration of using Check Tronic as verification of checks, Mr: Hilz moved that the Financial Report be approved this motion was seconded and passed by voice vote, Bud et--The proposed budget for 1983-84 was presented and reviewed, Mrs. Fritz expla ne that the budget is based upon an estimated 95 patients per day with 514,233,000 in net revenues and $139919,000 in expenses. The capital equipment items totaled $1,4249000, including many items which had appeared in previous budgets but which had not been purchased yet, Mrs. Fritz stated that she is working on a 3-5 year plan for capital equipment expenditures, There was some discussion concerning the increase in payroll expenses of approximately 7% and whether or not this expense could remain the same as the 1982.83 amount, Mr. Moore suggested that prior to any pay raises, the Board of Directors receive a roster of all employees with the present and propos?d salaries. In order to allow Mr, Hausler additional time to review the budget, . r.n . I„1 nreo.r tr. ne l..r,, wlvn - ..ON fib I. p l l BOARD OF DIRECTORS ' BUSINESS MINUTES oa,o ~ > June_ 30, 1983 Page 2 Mr, Hilz moved that the Board of Directors approve the budget, subject to any amend- f. ments agreed to by the Executive Committee and the Administrator, and provided that the Board of Directors be consulted prior to the granting of annual raises to employee l' This motion was seconded and passed by voice vote. Mr. Hill commented that the County Commissioners Court would need the budget by July 8, A meeting was then scheduled for Wednesday at noon for the Executive Committee of the Board of Directors to consider final approval of the budget. En a ement of Auditors--A proposal from Peat, Marwick, Mitchell and Company to A perform ie nancaT au it'for year ending September 30, 1983 at the cost of $19,000 plus out-of-pocket expenses was presented and discussed, Mrs, Fritz stated that PH&M had been doing the audit since year ending September 30, 1980, Mr, Hilz moved that the Board of Directors approve the the proposal as presented to include presenta- tion of the audit report in person to the Board of Directors, This motion was seconded and passed by voice vote. Chairt Criteria--Miss Johnson and Mrs, Lester presented a rough draft of new ' triter a for c or ty designation. They explained that they would like to propose that 1 the new criteria be used on a trial basis to determine any needed alterations, It was suggested also that Mr. Hausler study the criteria. Mr. Hill commented that the Texas Legislature may in the near future establish exact definitions for "indigent," It was agreed that the criteria could be used on a trial basis, Home Health Report--The minutes from the May 27 meeting of the Home Health Committee were presented and reviewed, It was reported that no deficiencies had been found during a recent survey of Home Health by Medicare representatives. Census figures and financial status of Home Health were discussed, Mr. Wyatt reported that Mrs, Fogle had been contacted by Westgate Hospital to consider merging of Flow's Home Health Service with a home health service which may be provided by Westgate Hospital, It was agreed that such a merger would not be probable, however, QuaiIt y AccountaLit;t Utilization Review--The June 14 minutes were presented and reviewed. It was noted that the representatives of the committee had met with the Texas Medical Foundation Area Supervisor to discuss the results of her survey of Medicaid admissions and justifications. She made some recommendations which would improve documentation in the medical record which would better assure reimbursement, Mr, Havenhill moved that the QA/UR Report be accepted; this motion was seconded and passed by voice vote, Safet Committee--The minutes from the June 3 meeting of the Safety Committee rese were p n e an~"reviewed, There was a report of the performance of disaster procedures for a drill and an event in the Emergency Room which was classified as a Code 1. disaster, Mr. Havenhill moved that the Safety Report be accepted; this motion was seconded and passed by voice vote. Medical 111 Re nr Dr, Alvarez reviewed the minutes from the June 20 meeting of the Medical Executive Committee and the June 21 meeting of the Medical Staff, He explained that they had discussed the departure of the neurosurgeon and the new appointment of Dr. Via as Medical Director of Anesthesia, He stated that the obstetricians had requested an additional fetal monitor for the Labor and Delivery Suite due to the addition of two new obstetricians to the staff. Dr, Alvarez proposed that the Board of Directors consider approval of two amendments to the Medical Staff Rules and Regulations as follows; G, OBSTETRICAL AND GYNECOLOGICAL DEPARTMENT 2, Regulations r 1 ,u,RCPU,r i 1 BOARD OF DIRECTORS MEETING BUSINESS MINUTES Dele June 30, 1983 Page 3 l b. (2nd sentence) Father or labor coach may be permitted in the Delivery. Room for vaginal deliveries and at C-Sections at the discretion of the attending physician and upon meeting the requirements established by I, the hospital. f J. DEPARTMENT OF PATHOLOGY 21 Regulations d. A pathologist's consultation will be provided on all abnormal test 1 results. Dr. Alvarez commented that an attorney had addressed the Medical Staff on some new r legal aspects involving informed consent and malpractice issues. Mr. Havenhill moved that the Board of Directors accept the Medical Staff Report and approve the two amend- ments to the Medical Staff's Rules and Regulations. This motion was seconded and passed by voice vote. Professional- Office Buildinq--A feasibility study performed by HBE Medical Office Buildings In the a of 1W was presented and reviewed, There was general agreement that a professional office building is important to the survival of the hospital, It was suggested that Baylor Health Care Systems be asked to review the feasibility study and comment on the recommendations made by HBE. The meeting was adjourned at 9:10 p.m, for Executive Session to discuss personnel matters, At 9:15 p,m., the Board of Directors met in Executive Session pursuant to Article 6252.17, Section 2 (g) VIA,T.C.S. The Board of Directors reconvened at 10:00 p.m. No action was taken on any personnel matters, Mrs. Madewell announced that the next Texas Association of Hospital Governing Boards convention has been scheduled for August 26 and 27 in San Antonio. Details are not yet available. She also mentioned that the Annual Media Awards Event of the Dallas-Fort Worth Hospital Council has been scheduled for November 11 with Patrick Buchanan the main speaker. There was no further business, and the meeting was adjourned at 10:10 p.m. i Dan Trammell Secretary fi gm {I j lu Hl<I. 1.1.111 II V.1 r U ~ rte, ' FLOW MEMORIAL HOSPITAL JilN 9 1983 CALLED HOARD OF DIRECTORS MEETING TUESDAY, JUNE 14, 1983 7:00 P.M. MEDALLION ROOM AGENDA 1. Work Session With Department Directors to Review First Draft of Proposed 1983-84 Budget if. Executive Session to Discuss Personnel Matters 4 III, AdJournment t lip, BOARD OF DIRECTORS CA'"fD MEETING ,w. BUSINESS MINUTES Dais ~ _ - -Tuesday, June 19,,_1J8.3_____ :A~4• 1 The Board of Directors of Flow Memorial Hospital met in called session at 7:00 p.m. on Tuesday, June 14, 1983 with the Chairman, Mr. Wyatt, presiding. Present: I Mr, .Ralph Havenhill Mrs, Linda Ashmore Mr. Jim Grant Dr. Don Holt Mrs. Becky Chase Mr. Bill Hoopes Mr. Brad Moore Mr, Lyman Daugherty Mrs. Nancy Howard Mr. Dan Trammell Mr. Jim Everhart Mr. Bill Johnson Mr. A. E. Wyatt Mr. Blake Fortenberry Mrs. Margaret Lester Mrs. Wilma Fritz Mrs. Peggy rogle Mr. Warren Short Mrs. Gloria Madewell Mr. Bob Gorton Mr. Jerry Smith Absent: Mr. George Hilz Mrs. Mary Williams Mr. Wyatt announced that the meeting had been called for a working session with the department directors on the first draft of the proposed budget far 1983-84, Copies of the proposed budget were distributed. Mrs. Fritz reviewed the details of the proposed budget. She stated that it had been based upon an estimated 94 adult patients per day. Some questions raised were about who would be responsible for coordinating ORG planning, criteria for charity qualifications, and capital equipment. There was further questions about whether or not expenses for training/orientation,-employee turnover, and call pay are included thedinconsistencyabetween dthesdepartmental tbudgets randoaslack of guidelines for oupre- paring the budgets. One change was made in the proposed budget--i.e., to combine the indigent and bad debt categories. The meeting was adjourned at 8:45 p.m. for Executive Session to discuss personnel matters. At 8:50 p.m., the Board of Directors met in Executive Session pursuant to Article 6252-11, Section 2 (q) V.A.T.C.S. The Board of Directors reconvened at 9:30 p.m. Professional Office Buiidin --Mr. Havenhill moved that the Board of Directors review the eas biT# y study one by NBE Medical Office Buildings to determine the thisrmotion physicians Mrs, Madewell will the hospital; udy to the Board members prior to the next meeting. ' Re uest to City--There was some discussion concerning funds which might pr a e y e appro requested from the City to provide hospital building improvements, equipment, and professional office building. Charnes--Dr. Holt asked Mrs. Fritz about the status of establishing the two- tier charge system, She stated that this had been accomplished for the Laboratory. She also stated that she is working on establishing two-tier systems for two other hospital departments, Dr. Holt suggested tt•at the two-tier system should be initiated hospital-:vide, and she replied that this could be accomplished in 3-4 weeks with the Business office responsible for correcting Blue Cross bills. The Board agreed that this should be done immediately. 1 BOARD OF DIRECTORS CALLrn MEETIN3 _ BUSINESS MINUTES o•~• Tuesday, _June_14,_ Ign-___-_.__ P•e• County, Funding--There was a lengthy discussion concerning the amount of funds which s"TH Ke requested from the County for fiscal year 1983-84. It was agreed that the request should be for $741,000 ($621,000 charity, $100,000 fees to obstetricia s for drop-in patients, and $20,000 for pediatricians for ;'rop-in patients). NICU--Mrs. Madewell reported that the NICU is currently crowded with a census of 11 +n-Me- 6-bed unit. She jtated that the physicians have been complaining about this situation. She added that the current patients in the NICU were all delivered here and are not transfers. She also stated that there is a set of twins and a set of triplets now in the NICU. The triplets are only the third set delivered at Flow since 1950, - Contro'lerr--The recommendation from Baylor Health Care Systems regarding the addition o "a controller or chief financial officer to Flow was discussed. Dr. Holt moved that the Board of Directors approve the new position at an approximate cost of $37,500 per year. There was no further business, and the meeting was adjourned at 10;45 p.m. Dan Trammell Sooretary 5m _ 4T FL^W MEMORIAL HOSPITAL BOARD OF DIRECTORS MEETING THURSDAY, MAY 19, 1983 ?~Z 7;00 P.m. MEDALLION ROOM AGENDA MAY 1 ? 1983 I. Review and Approve Minutes of Previous Meeting it. Old Business r III, New Business A. Committee Reports 1. Finance--Mr. Hilz 2, Safety Committee--Mrs, Madewell 3, Quality Accountability/Utilization Review--Mrs. Madewell B. Medical Staff Report--Dr, Alvarez k 1. Consider Appointments a, William Joseph Anderson, M.D., Active Medical Staff b, Joann Andrews, M.D., Active Medical Staff c. Hortono Setiawan, M.D., Courtesy Medical Staff d. Patricia Parker, COAT, Allied Health Professional Staff e, Thomas Long, M;D,; Hinton Hamilton, M.D.; Edward Kremer, M.D. for Home Health Privileges C. report from Search Committee--Mr. Havenhill D; Update on CT Scan Service--Blake Fortenberry E. update on Construction of Helipad--Blake Fortenberry F. Report on Health Department Findings--Blake Fortenberry G. Consider Renewal of Service Contracts 1. IBM Copiers H. Consider Proposal for Microfilming Medical Records 1. Consider Contract With Registered Records Administrator for Quarterly Consulting for Medical Records Department J. Consider Request to Purchase Batteries for Simplex System K. Report on Status of Approval to Purchase New 14ospital Van L. Any Other Business IV. Executive Session V, Adjournment