Crook County Medical Services District

CROOK COUNTY MEDICAL SERVICES DISTRICT

BOARD OF TRUSTEES MINUTES

September 25, Wednesday, 2019, 3:00 p.m. – CCMSD Conference Room

Persons in Attendance: Sandy Neiman, President; Trish Habeck, Trustee; Joey Kanode, Trustee; Mark Erickson, Trustee; Connie Lindmier, Secretary-Treasurer by phone.

Bonnie LeSueur, HMS; Karl Rude, HMS by phone

Kyle Ridgeway, legal by phone

Call to Order: President Sandy Neiman called the meeting to order at 3:00 pm.

Public Comments: none

Agenda: Trish Habeck made the motion to approve the agenda as presented. Joey Kanode seconded the motion. Motion carried.

Approval of Minutes: Board treasurer - Joey Kanode made the motion to approve the minutes with addition of Board Treasurer’s corrections to show motion made by Trish Habeck, seconded by Joey Kanode. Trish Habeck seconded the motion. Motion carried.

Audit Report: Board must sign audit report. We need to get a copy for the board members to sign.

Financial Report: Bonnie LeSueur

Mark Lyons is training Alena ….. on a new dashboard so we can get the additional reports we requested, and need in order to have clear financials.

Bonnie LeSueur stated that Cash on Hand may not be useful. Sandy Neiman stated that we have to know where we sit.

Bonnie LeSueur stated that when we have deviation factor – ex: payroll – numbers can be scewed. Mark Erickson stated that it is an important number. We want to watch those numbers - cash on hand – closely. By the example that the trainer showed us, we also want to watch salaries to net patient revenue. Are we managing staffing to patient revenues well?

Board training this month was very insightful. Mark Lyons from Casey Peterson and Kyle Cameron from Rural Health trained well. Kyle Cameron had stated that numbers the way they are, are very concerning to them. Sandy Neiman stated that Kyle Cameron asked if we knew how close to closing we were a year ago. We said no.

Bear Lodge Rehabilitation - reviewed

AR Aging: is very high. $1,771,140.83. With high deductibles majority of patients will be on a payment plan for a fairly long term. We may continue to fight it. It will continue to climb.

Discussion followed concerning Medicare changes where a person cannot sign up for supplemental insurance on specific levels of Social Security/Medicare as of January 1, 2020. Is this going to affect our patient receivables?

Bonnie LeSueur stated that State average is 60 days. If we look at our 60 days, we are less than the State average.

Discussion: We need to watch our 61-90 day average and see if that stays close each month.

Sandy Neiman asked if we should add a finance charge back in. Mark Erickson suggested we ask Mark Lyons about this.

Discussion followed.

Athena system does not transfer to self-pay until insurance/Medicare pays. Causes delays in payment on multiple levels.

Balance Sheet: reviewed

HMS has not brought HMS billing breakdowns.

Income Statement: reviewed. Income up. Expenses trending similar. Ex: staffing etc. same. Staffing high right now. Can be disastrous. Traveling staff is high. July was low, August was high.

Bank Listing: working on removing construction account, etc.

Check Register: reviewed. RN & CNAs shortages are nationwide problem. Even if we have to raise wages, would be better off than paying traveling nurses. Had directed Nathan Hough to work with RCR to settle the bills – some from 2017. Had to finance Yellowstone Insurance bill as well. Discussion on advertising in newspaper, radio, etc.

Vendor Aging: reviewed

Payroll: Mark Erickson made the motion to ratify payroll for $356,2134.65 to include:

8/9/2019 - $180,793.9078

89/23/2019 - $175,440.68 = $3356,234.65 Joey Kanode seconded the motion. Motion carried.

Board Treasurer’s report:

Super Now: Balance $8.241.09 as of 9/19/2019

Checking: $1,664.58 as of 9/19/2019

Joey Kanode made the motion to ratify the Board Treasurer’s report. Mark Erickson seconded the motion. Motion carried.

Balance for 340B is $139,000.00. We will have Nathan discuss with Vila when he returns.

OLD BUSINESS:

CT Remodel Helmsley: Inspection finished. 8/22/2019

CT – Devils Tower FFA is willing to put a sign for free honoring Freida Dent. A template needs to be made up so Board can approve the sign. Discussion followed concerning size, type, etc. We also need a sign stating CT machine (unit) was provided (donated) by Leona Helmsley Foundation, and a sign that Powder River donated for ER. = three signs.

PreCorps – ER

Leona – CT

Freida Dent – honorarium in CT room

The FFA will do them with their laser.

Hulett Clinic / Foundation: Judy Hutchinson of the Foundation was not able to call in. Board discussed updates known so far. Donor lists and contacts are in process. Mike Burke – Karl Rude, Mike Burke, Judy Hutchinson, Sandy Kellogg, Van talked. Mike & Van are working on a general floor plan, elevation view. Sandy Neiman asked who is paying for it. Mike’s company does some work up front, and his hope is to get contracts. Karl Rude stated the letter going out to the architect.

Ownership structure should be good, and Mark Lyons, Karl Rude, Judy Hutchinson are working to insure structure and facility, etc., so that it works together.

Ex: providers specialists using facilities, etc. Joey Kanode asked if physical therapy use of clinic is valid, and use is ok. Mark Lyons had discussed this with the board. May have to have fire wall between parts of the building to insure each rental space is separate – Foundation is landlord, hospital rents from Foundation or landlord.

Old building – better to sell building if provider / PT / other is not qualified. Options were discussed.

CEO Report & Management Report:

Moorcroft clinic – Bill for Tucker electric – completed. Verify after Nathan returns.

Hallway Ceiling – on hold

Privileging – blank form was shown to the Board (Micki Tucker was sample). Bonnie LeSueur passed around forms to have the Board sign.

Vote to sign: Joey Kanode made the motion to sign approvals for credentialing and privileging for all providers current CCMSD employ. 9 – nine – MarkErickson seconded the motion. Motion carried. Providers include: James Larsen, MD; Heith Waddell, MD; Ashley Harmon, NP; Robert Cummings, PA; Warren Shaulis, NP, Wesley Davis, NP; (Mrs. Davis, NP); Micki Lyons, NP; Kenda Huseby, NP.

LTC – still have openings in LTC. 27 residents in LTC as of today.

Website – Joey looked at it. It is looking good.

Generator – Two bids were received - Dak Generator/Energy Solutions and Caterpillar. Dak is the current provider. Bonnie recommended we go with the current company. $20,000.00 is cost plus. Mark asked options for adding a larger tank.

Discussion: 1000 gallon tank, etc. Continuator package. Total cost not to exceed $20,000.00 for freight from factory & installation. Generator - $75,000.00 with current smaller tank. = $95,000.00. Cost for 1080 gallon tank lasts 2 days. Cost is same price.

Mark Erickson made the motion to proceed with purchasing generator from Dak Generator & Gen Energy Solutions not to exceed $95,000.00 total. Joey Kanode seconded. Motion Carried.

Ambulance prices – Joey had asked Linda Fritz what the county pays to all 4 entities in the County. Total amount Sundance has now in line items is $30,000.00. We need to have a discussion with Sundance.

****Connie will write a letter to Sundance City Council to request to be on the agenda to discuss ambulance. And ambulance replacement. Discussion followed.

Policy – bid limits for Board. Karl was going to write a policy. Add to old business for next month.

Updates –

HCaps surveys – check results next months.

Beds – none

NEW BUSINESS

Strategic planning meeting with Kyle Cameron and Kap Wilkins from National Rural Health Resource Center

Discussed in Board training in Sept 5. Highly recommended to do this by trainers.

Joey Kanode made the motion to resume in 5 minutes – at 4:41 p.m., while the internet connection is corrected (internet down short time) Mark Erickson seconded the motion. The Board came back into session at 4:48 p.m.

Strategic Planning Meeting: Discussion concerning dates of October 17 3:00 pm Thursday and 9:00 Friday October 18.

Most prefer Friday October 18th, full day – 9:00-4:00 or 5:00

Connie will contact Kyle Cameron & Kap Wilkins to verify if Friday all day works.

Joey Kanode made the motion at 4:53pm to go into Executive Session to discuss legal issues. Mark Erickson seconded the motion.

EXECUTIVE SESSION

Mark Erickson made the motion to go out of Executive Session at 5:57 p.m. Discussion only. Joey Kanode seconded the motion.

Adjourn

Mark Erickson made the motion to adjourn at 5:58 pm. Joey Kanode seconded the motion. Meeting adjourned.

Next Meetings:

October 18 (if verified) Friday, 2019. – Strategic Planning meeting.

October 29, Tuesday, 1:00 p.m. Hospital Conference Room If Kyle Ridgeway is not available he will have another attorney available for consultation.