The Salem Memorial Hospital Board of Directors met April 18, and during the meeting board member Mike Swyers addressed the chair asking for two points of order. First, he said that newly-elected board member Willie Strader should be sworn in before the meeting continued so that he may participate in votes. Second, he requested that the contract renewal with the Rural Hospital Group on the agenda be moved to closed session. He said there was potential for the discussion to involve personnel and other issues that he felt shouldn’t be brought up in open session.
Addressing the first point of order, board president A.J. Seay asked for a motion to change the agenda to swear in Strader. The motion was made and passed unanimously.
Seay then called for a motion to address the contract renewal. Attorney Mark Weaver said there were no closed session provisions specifically for contract negotiations.
“It’s if you have competitive contracts that you don’t want released. You’re not required to go into closed session really for anything unless you’re trying to protect some private information that might offend someone or hurt someone,” said Weaver.
“That’s probably the case,” replied Swyers.
The board then discussed subheadings under which the contract renewal could be moved to closed session. A motion was made by board member Ray Bruno to move the renewal, and the vote passed 3-2.
Upon further discussion, Seay said he as chairman could vote. Bruno said past precedent was that the chairman only votes during a tie.
Weaver disagreed.
“You told me that,” said Bruno.
“I never told you that, you’re the one that stated it,” replied Weaver.
“No, you and Dennis both told me that, you did,” said Bruno.
“No, Robert’s Rules of Order says in a small body, nobody gives up their right to vote, unless it’s set in writing that you agreed to that,” said Weaver.
“I disagree,” said Bruno.
Replied Weaver, “Well, if you’re going to rely on something that I said (a long time ago), that I don’t remember, fine.”
After more discussion, it was determined that Robert’s Rules of Order dictated that the chair could make or break a tie, and if his vote made a tie, the motion fails.
After a moment of silence in the room, Weaver turned back to Bruno.
“If you’re going to do this, Ray, I’m going to start bringing up everything you’ve ever said, ok? That I either think I remember or not,” Weaver continued. “So don’t start that. I mean it. And, I’ve got some things here that you don’t want me to bring out in this body, so just stop it. I mean it! I didn’t say that.”
“I’m not sure I like your tone, Mark,” said Bruno.
“I know you don’t, but you’re getting used to it, aren’t you?” replied Weaver.
Seay eventually said he would abstain, and the item was moved to closed session with the 3-2 vote.
Strader was then sworn in for his position on the board.
CEO Wayne Reid gave an administrator’s report. He said new cameras and phones were on track for a go-live in June. He also said the new lab interface would go live in May.
Reid said he had several meetings with the long-term care center, and a meeting was set for next week to talk about the team’s needs.
He said there was a signed agreement for a new lab tech, which was a long time coming, according to Reid.
Reid showed the board the new ambulance wraps on one of the new ambulances. He said another ambulance was also being wrapped. He said the vehicles were running well and are very popular among the EMS team.
Reid then discussed the hospital’s cash position, which is trending up, according to charts presented.
“This is when the management group came in and sort of stabilized things, so from about October on is when we started realizing a cash position change, and that represents the strong work of a lot of people that are in this room,” said Reid. “We saw cash go from a little over $400,000 a week to a little under $600,000 a week total cash.”
He showed patient revenue.
“This is cash collection based on patient activity, the average is just below $400,000 a week, for the middle part of 2022. Then, this has been the cash collection. Pretty stable since about December of last year. So we’ve seen the cash collection go from just shy of $400,000 a week, to right at $500,000 a week.”
Reid said the team had done a wonderful job.
Point of Service collections were presented.
“When RHG got here, they began to focus on point of service collection, and during that period of time we had about $2,000 a week. We really started in December focusing on that, and we’ve essentially tripled that average.”
“There’s people in this room that are responsible for that,” said Reid, as a round of applause rose from the room.
Days in Accounts Receivable were reported as trending down. Reid said it had peaked at around 115 days, and is now down to 60. Reid said as “bad debt” comes off, he expects AR days to decrease to the 40s or 50s.
Reid then presented information from the yearly HIDI report. He said SMH’s Dent County market share in 2022 had improved from 25% in 2022 to 37.2% in 2023. Reid said the numbers represented an 11.9% market increase, or a 47% improvement in market share in Dent County for the first quarter of 2023.
The meeting then moved on to old business. Reid addressed a kitchen drain proposal, as well as a clinic architect proposal.
“Both of those two things, we’ve requested funding from the state for,” said Reid.
The board moved on to discuss medical staff bylaws. Board members said there was no changes to report on the bylaws at the moment, but that there may be some changes to the bylaws coming in the future. During discussion, board members said there would be more discussion in May. A motion was made to approve the bylaws as presented. The motion passed 4-0-1.
During new business, a report on accounts payable was presented. Total AP as of April 14, 2023 was reported at $1,582,367.30, with $168,863.73 of that amount not due yet, and $675,805.07 at 0-30 days.
During a legislative report, it was reported that representative Ron Copeland, along with members of the media and hospital administrators, had toured the hospital April 14. Seay said he felt that they had been able to discuss the hospital’s needs with Copeland.
“We reached out to him a month ago, and I sent a wish list of what we wanted,” Seay said. “He said he would try his best to get us in the budget, and he did get us in the budget, $1 million for capital improvements.”
Seay said he had reached out to other representatives since to persuade them to keep the money in the budget.
“We’ve got a team supporting us on the House of Representatives side to keep that $1 million,” said Seay. “Now it has to be in the Senate side. Justin Brown is working on it, and he said he thinks it will make it on the budget side.”
Seay said both the House and Senate both must agree to keep the cash in the budget.
Seay also discussed a $3 million dollar grant he says that Dent County has received for 17 years. He said they would be speaking to representatives and the county commission to attempt to secure a portion of that money for the hospital.
Reid presented a summary of operations report.
“Inpatients continue to be strong, medical/surgical was strong, our Swing Bed admissions were very strong, observations doing very well. Our inpatient census days were a little off the budget,” said Reid. “Our acute care patients per day was 10.”
He presented outpatient numbers. He said outpatient registrations were stronger than budgeted, lab tests were up, and that the radiology department was doing a “spectacular job.” He also said home-health visits have been strong.
Reid discussed emergency room visits.
“ED was a little light, but not terribly bad,” said Reid. “Some of this we’re going to see, because we’ve expanded hours in our clinic, so some of the patients that we would normally have coming to our ER are able to access our clinic.”
He said ambulance runs were very strong, and dry runs were a bit more than he’d like to see.
The board reviewed patient transfer reasons.
Then, Reid showed the balance sheet for the month of March. Total current assets for the prior year were reported at $11,498,242, with $18,915,251 in liabilities. As of March 31, current year assets were reported at $8,245,167, and liabilities were reported at $16,218,892, a -$2,696,359 change.
The board discussed a Small Rural Hospital Improvement Program (SHIP) grant that the hospital received.
“We ended up with the SHIP grant for about $260,000. What that went to was those windows we put in over at the clinic. Our system at the emergency department, we paid for that. We still have a balance due, but that’s expected, because we just went live with it, so once it’s live and we know it’s accepted then we’ll make that other payment,” said Reid.
Current operating expenses for the hospital year to date were reported at $22,519,207, compared to prior year to date expenses, which were $23,342,176. A loss of $674,485 has been posted year to date, compared to a loss of $1,469,416 during the prior year, year to date.
Operating expenses for the clinic were reported at $2,089,971 year to date, compared to $1,645,473 during the prior year, year to date. The clinic shows a year to date loss of $172,959, compared to $466,054 last year, year to date.
Days of cash-on-hand were reported at around 40 days. Board members discussed the hospitals position in 2011, and said it was a similar position to where they are today, noting that the cash position is far better than it was in 2015.
The board then discussed 340B revenue. Revenue for the month of March was reported at $53,919, $87,319 of which came from Moser Pharmacy, the largest contributor to the hospital’s 340B revenue.
A Chief Nursing Report was given by Chief Nursing Officer Ashley Sullins.
Sullins reported that there were a number of open nursing positions in the hospital, including one full-time RN for Home Health, one full-time RN for night shift at the emergency department, two full-time RN/LPNs for night medical/surgical, two full time RN/LPN for day medical/surgical, and various PRN positions.
Sullins said that 595 COVID tests were performed from January to March, 62 of which returned positive results. Seven of the positive results were employees. The community infection rate is low, according to the report, with a moderate transmission rate. As of the time of the report, there were two active cases in Dent County within the past seven days.
A total of 679 flu tests were performed, with 11 returning positive results, two of which were hospital employees.
Sullins reported that she had met with SBU Salem Cap Stone Candidates, and spoke with students to hopefully retain some as employees.
She also said she visited East Central Hospital, who she said was interested in using SMH facilities as a site for clinicals.
Sullins said the RTC advisory board would meet April 19 in Rolla, and that SMH would be visiting Salem High School May 4 and May 8.
Sullins reported that staff had been doing various webinars lately to update Conditions of Participation.
A Human Resources report was given. It was reported that no employees left during the month of March, and there were 10 new hires: three full time, one part time, and six PRN positions. A total of 16 employees were reported to have resigned during the first quarter of 2023. Three cited personal reasons, health, or family obligations as the reason they left. One left citing wages and their schedule. Four left through job abandonment, or a “no call, no show”. Three left because they said they were dissatisfied with the job, supervisor, or facility. One left due to retirement, and four were listed as “PRN Not Working”.
An update from the SMH foundation was presented. Reid said there had been discussion about volunteers to search for grants for the foundation.
Reid said a Golf Tournament will be held June 2 at Spring Creek Golf Club. He said the next meeting of the foundation would be June 7.
A Community Champion update was given. Reid reported that preliminary approval had been granted for a clinical/nursing education suite, with a cost savings of $30,000.
Reid reported that the IT Department has been working on WiFi mapping of all facilities, with a cost savings of $4,000.
He said a ToRCH application was in process. According to Reid, if the hospital is selected, it could receive $3 million per year for three years.
Reid said a CPAPW meeting with the Dent County Developmental Disabilities Board was attended by a hospital employee, and that HRSA grants would be coming soon, which the hospital would apply for.
During the marketing report, Reid said SMH has been working with KSMO Radio and Salem Publishing Company to place ads. Reid said he wanted to transition from ads to testimonials.
“We do such good work here, and I want us to take credit for that, and that will help us connect what we do to the human face of who we do it for,” said Reid.
The next meeting was scheduled for May 16 before the meeting went into closed session.
• In closed session, the board voted 4-2 to extend the contract of Rural Health Group for one year with a 30-day out, according to minutes from the meeting.
The motion was made by Willie Strader and seconded by Judy Thompson. Voting yes were Strader, Thompson, chairman A.J. Seay and Wanda Tatom. Voting no were Ray Bruno and Mike Swyers.
The same motion was brought up earlier in the closed session and ended in a 3-3 tie, with Tatom voting no the first time. Procedures allow for a motion to be presented twice, but not three times, according to the release.
A second closed session motion was made by Swyers to hire another consulting firm (he presented no name of a consulting firm) and to hire William Giles as a temporary CEO. It was seconded by Bruno. The vote failed 4-2 with only Swyers and Bruno voting yes.
SMH hired Rural Hospital Group in February of 2022. RHG and its partners have worked with over 800 hospitals in 42 states, a large percentage being rural providers. RHG was founded to help keep health care accessible to rural communities through professional management. RHG leaders have extensive experience developing and operating hospitals in rural settings.
RHG was brought into SMDH by the Board of Directors for an initial period of 90 days to assist the hospital in responding to the financial crisis sweeping the rural hospital industry which has partially been caused by the ongoing global pandemic.
