Salem Memorial Hospital Board of Directors met Wednesday, Sept. 25 for the monthly meeting.
All board members were present, including Zach Moser, Dr. Leigh Ann Price, Frank Barnitz, Karen Brown, and Mike Swyers.
CEO Brooke Bollman gave a thorough report on the continuing strategic plan, including quality improvement and risk management.
Some of the main items included:
• a 340B audit was conducted
• Bollman, along with others, are looking at claims and denials for billing. SFOA (Strategic Financial Operational Assessment) will be reassessed since the last time was in 2022. A finalized report will be available in October.
“Really excited to see that. I think with that and some of the other mock audits and surveys that we’re doing, it’s beneficial for us – even through the due diligence process (affiliation) with Phelps (Health),” said Bollman. “We are focusing all of our energy on things that will benefit us either way.”
• Staff celebrated hospital anniversary week and many vendors and organizations were supportive.
• A third-party consultant is in the hospital to conduct surveys and compliance checks on safety, building codes, etc. in regards to the possible affiliation with Phelps Health.
“We are pretty close to having all of the information to them (Phelps Health). We still are hoping, for some time after the first of the year, to move forward. Of course, we still have to work through that definitive agreement, which we may hope to see later this fall,” shared Bollman.
The board voted unanimously to appoint a new board member, planned for the Oct. 29 board meeting, to be held at 6 p.m. The board member will replace Wanda Tatom following her resignation.
Across the board, statistics for the month of August were down, shared Bollman.
Income statement:
• Administration is working to make improvements on the balance sheet.
• Total cash is $1.7 million; days cash on hand is 17. The benchmark for critical access hospitals is 60, so 17 is much lower than what it should be, shared Bollman.
• Employee health insurance is much higher than July. August is $422,431.99 compared to $127,965.11 in July. Several claimants are seeking treatment for cancer, so the bills received are much higher.
• Emergency room visits were down by 50.
• Clinic revenue was up over July to $402,484.05 from $335,052.98 in July.
• The profit for August was $5,156.30. Year-to-date profit is $307,933.44.
• Total operation revenue was $2.1 million.
• Cost savings internally are about $112,000 per month in recent months due to re-shopping contracts with suppliers, cancelling old contracts, and some reduction in staffing.
• A slight decrease in salaries reflects reorganization and staff reductions.
“Included in the allowances and uncollectibles also was recovery of debt, $2,600 for the amount of revenue that we have to meet - our third-party debt company should be really bringing in more than that on a monthly basis. So that's a conversation Mike, as revenue cycle manager, is having with them to see about driving that number of some of those bad debt accounts,” shared Bollman.
Nursing Report:
• The hospital is talking to Dent County Health Center to collaborate on a health needs assessment for the community.
• Two ambulances are down due to bad sensor repairs, so three are on the road.
• Two agency nurses are set to return after one month for a new contract.
Human Resources:
• In August, two CNAs, one registration clerk, one phlebotomist, and one LPN were hired.
• Six full-time employees left in August, some due to staff reductions, including dietary director, director of surgery, CNA, clinic receptionist, IT Support Specialist, and part-time employees and PRN employees.
“We have seen an uptick in staff resigning, including our CFO (Kayla Chamberlain Sept. 6) – which was one of the fears we had moving into an LOI (with Phelps Health),” said Bollman.
“I don’t know if it is indicative of the affiliation – or just maybe the financial hardship of the hospital and concern centered around that,” continued Bollman.
Tabitha Stanfast presented remotely on the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) rating for SMH and the Missouri average.
SMH ranges from 60 percent in February 2023 to 80 percent in January 2024, to around 30 percent in February 2024.
Stanfast explained these are unofficial results shared by the vendor.
Response rates have varied but were quite low in the second quarter, with only 12 responses. The results are only for inpatient services.
Medication process is being discussed within the quality projects currently being assessed.
• Order sets have been created to reduce orders.
• Medication scanning is being set-up for use in the ER.
• Verbal orders have been eliminated except for in emergency situations.
• In July there were 38 total medication errors – and 19 in August. Medication errors are not necessarily errors in medical administration; it is an error in documentation. The computer program used to record medication was not directly communicating with the internal program used.
Dr. Price asked how long the verbal orders would continue. Director of Nursing Amber Hogan explained the process began to cut down on the documentation errors. Discussion was heard about physicians and nurses entering orders in non-emergency situations.
Another quality project was patient experience that assists in accuracy with clerks and registration in general.
The event reporting system is sunsetting. It will now be recorded in the intranet via SharePoint. The documentation will be easier to manage and be reported more often.
Events reported from Oct. 2023 through Sept. 2024 were:
• 123 medication documentation
• 75 falls – includes any units
• 20 device/equipment – could be air conditioning, humidity control, anything equipment related.
• 176 other – mostly were against medical advice, refusals, etc.
The next meeting will be held at 6 p.m. Oct. 29.
