(direct access northeast entrance) agenda 1) call to order...
TRANSCRIPT
NOTICE OF REGULAR BOARD MEETING OF
THE UPPER SAN JUAN HEALTH SERVICE DISTRICT dba PAGOSA SPRINGS MEDICAL CENTER
Tuesday, August 27, 2019, at 5:30 PM
The Board Room (direct access – northeast entrance)
95 South Pagosa Blvd., Pagosa Springs, CO 81147
AGENDA
1) CALL TO ORDER; ADMINISTRATIVE MATTERS OF THE BOARD
a) Confirmation of quorum
b) Board member self-disclosure of actual, potential or perceived conflicts of interest
c) Approval of the Agenda (and changes, if any)
2) PUBLIC COMMENT (This is an opportunity for the public to make comment and/or address USJHSD
Board. Persons wishing to address the Board need to notify the Clerk to the Board, Heather Thomas, prior
to the start of the meeting. All public comments shall be limited to matters under the jurisdiction of the
Board and shall be expressly limited to three (3) minutes per person. The Board is not required to respond
to or discuss public comments. No action will be taken at this meeting on public comments.)
3) PRESENTATION: Orthopedic Service Line, Bill Webb, M.D.
4) REPORTS
a) Oral Reports (may be accompanied by a written report)
Chair Greg Schulte
Dir. Kate Alfred and Dir. Karin Daniels
Dir. Dr. Jim Pruitt and Dir. Karin Daniels
Chief Executive Officer, Dr. Rhonda Webb
i) Chair Report
ii) Contracts
iii) Strategic Planning
iv) CEO Report (‘18 Annual Review, Hospital)
v) Finance Report CFO, Chelle Keplinger and Treasurer, Dr. Campbell
b) Written Reports (no oral report unless the Board has questions)
COO-CNO, Kathee Douglas i) Operations Report
ii) Medical Staff Report Vice Chief of Staff, Dr. Corinne Reed
5) CONSENT AGENDA (The Consent Agenda is intended to allow Board approval, by a single motion, of
matters that are considered routine. There will be no separate discussion of Consent Agenda matters unless
requested.)
a) Approval of Board Member absences:
i) Regular meeting of 08/27/2019
b) Approval of Minutes for the following meeting(s):
i) Regular meeting of: 07/23/2019
c) Approval of Medical Staff report recommendations for new or renewal of provider privileges.
6) DECISION AGENDA
a) Consideration of proposed Resolution 2019-07, adjusting the meeting schedule in September and
October and affirming the days times that the Board will meet each month for the remainder of 2019.
7) EXECUTIVE SESSION
The Board reserves the right to meet in executive session for any other purpose allowed pursuant to C.R.S.
Section 24-6-402(4) and such topic is announced at open session of the meeting.
8) OTHER BUSINESS
9) ADJOURN
PAGOSA SPRINGS MEDICAL CENTER
Annual Program Evaluation
2018
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
2
INTRODUCTION
In compliance with Medicare’s Conditions of Participation for Critical Access Hospitals, Pagosa
Springs Medical Center (PSMC) evaluates its total program of services each year. We review
the appropriateness of the utilization of services from a medical necessity standpoint, the quality
and efficiency of our services and the satisfaction of the patients we serve.
Because we strive to provide the highest quality healthcare that is easily accessible to our rural
population, we review trends in demographics, referral patterns and the input from our
community when evaluating our program.
Using patient comments, community meetings and surveys, we evaluate the satisfaction of the
community with our service, facility and overall environment of care.
A robust peer review program provides assurance that our medical services are of the highest
quality, with any issues identified and addressed promptly. Review of quality measures,
performance improvement activities and policies and procedures allows use to make process
changes that are necessary to support excellence in clinical practice.
The results of this evaluation are provided to leadership and the Board of Directors as a tool for
strategic planning.
SCOPE OF SERVICES
Pagosa Springs Medical Center is fully licensed and accredited as a Critical Access Hospital. It
has eleven acute care/swing beds and seven Emergency Department beds. It is a designated
Level Four Trauma Center.
Clinical Diagnostic/Treatment Services
Anesthesia Services
o General and local anesthesia
o OP pain management
o IP pain management
Cardiopulmonary Services
o Respiratory Therapy
o EKG
o Event Monitoring
o Stress Testing
o Echocardiography
o Basic Pulmonary Function Testing
Case Management/Discharge Planning
Diagnostic Imaging
o General Radiology
o Bone Densitometry
o Ultrasound
o CT
o MRI
o Mammography
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
3
Dietary
o Dietitian Consultation (by contract)
Emergency Medical Services (Ambulance)
o EMS Training Center
ACLS, PALS, TNCC, BLS certification
Community Outreach
AED
CPR
Stop the Bleed
EMT-B certification
Emergency Department
o Trauma Services – Level 4 certification
o Tele-neurology (by contract)
o Tele-psychiatry (by contract)
Infusion Therapy
o Therapeutic Phlebotomy
o Oncology Infusions
o IV Hydration
o Medication Administration
Inpatient/Observation Services
o Adult and Pediatric Medical/Surgical
Subject to extenuating circumstances (e.g., transfers precluded due to
inclement weather), Pagosa Springs Medical Center does not admit
pediatric patients who weigh less than 10 kilograms (22 pounds).
Laboratory Services
o Blood Bank
o General Laboratory Services
o Pathology (by contract)
Oncology
o Provider clinic
o Chemotherapy injection, infusion, and/ or irrigation
o Genetic Counseling
o Patient Navigation
o Survivorship
Pharmacy
o IP pharmacy only
o Participates in 340B program
Rehabilitative Services
o Swing Bed
o Physical Therapy (Inpatient and Outpatient)
Surgical Services
o General Surgery
o Orthopedic Surgery
o Gastroenterology
o Ophthalmological Surgery
o Ear, Nose and Throat Surgery
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
4
o Gynecological Surgery
o Pain Management Services
Support Services:
Administration
Compliance
Credentialing/Medical Staff Office
Employee Health
Environmental Services
Financial Accounting
Health Information Management
Human Resources
Informatics
Information Technology
Marketing and Communication
Materials Management
Patient Financial Services
Patient Registration and Pre-service
Plant Operations and Life Safety
Quality and Patient Safety
Risk Management and Legal
Community Services:
Community Education
Patient and Family Information and Education
2018 PROGRAM EVALUATION
Sources of Data
PSMC used the following sources of data for the 2018 program evaluation:
Concurrent Case Management
Quality Council Minutes
Performance Improvement Committee Minutes
Occurrence Reports
Patient Satisfaction Surveys (HCAPHS)
Community Feedback
Demographic and Economic Profiles
Hospital Generated Statistical Reports
Statistics Generated by Outside Agencies
Evaluation of 2017 Initiatives
Trends in Health Care Demographics
The 2019 County Health Rankings published by the state of Colorado indicates that Archuleta
County’s population continues to grow at approximately 0.3% per year and in 2017 was 13,316.
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
5
The age demographic for Archuleta County is unique in that over 25% of the population is
greater than 65 years old. Only 16.7% of the population statewide is over 65.
Archuleta County continues to have a substantial number of residents living at or below the
poverty level, approximately 20%. The median income is just over $50,000 compared to the
statewide median income of $64,000. Approximately 14% of the population in Archuleta
County is uninsured.
Colorado Department of Public Health data shows that 77.8% of residents have a personal
doctor, which is better than the State at 74.8%. The ratio of patients to primary care doctors is
1,170:1, again better than the State ratio which is 1,230:1. Access to mental health providers is
limited with the ratio of patients to providers being 830:1 compared to the State at 300:1.
County Health Rankings for Colorado counties puts Archuleta County at 27 out 60 in the Health
Factors Category and at 13 out of 60 for the Health Outcomes category for 2019. Health Factors
include Education, Employment, Family and Social Support and Community Safety. Health
Outcomes include Tobacco Use, Diet and Exercise, Alcohol and Drug Use, Sexual Activity,
Access to Care and Quality of Care.
PSMC Hospital Generated Statistics
Item 2017 2018 Change
Emergency Department visits 8017 6671
Inpatient Days 1267 1190
Length of Stay 3.0 2.6
Clinic Visits 21906 24603
Specialist Visits 3366 4957
Behavioral Health Visits 1285 1509
Walk-in Clinic Visits 663 5604
Mammography Procedures 920 865
MRI Procedures 884 1076
Ultrasound Procedures 1086 1137
General Radiology Procedures 7795 7511
CT Scans 2761 3437
Gastrointestinal Procedures 486 451
General Surgery Procedures 121 124
Orthopedic Surgery Procedures 328 334
ENT Surgery Procedures 0 9
Eye Surgery Procedures 6 20
Pain Management Procedures 68 97
Infusion Therapy Procedures 987 1763
Laboratory Tests 18942 19656
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
6
Community Input
In March of 2019, PSMC held a Community Partners Meeting to solicit input from other health
care providers and the public on gaps in medical services in the county. Approximately 40
persons attended and we gained valuable insight on the “state of health care” in Archuleta
County. Several gaps in care were identified including the availability of mental health services,
treatment options for substance use disorders and specialty care for complex chronic conditions.
Evaluation of Our 2017 Initiatives
We mention first two RHC-based initiatives from 2017 in this report of 2018 because they had a
direct impact on the utilization of the Emergency Department (ED). In 2018, the number of ED
visits fell by almost 17%. We consider this to be a reflection of care that was previously
delivered in the ED now being more appropriately delivered in the RHC setting as a result of the
2017 initiatives. This saves our patients the cost of a much more expensive ED visit.
Expansion of clinic hours – PSMC expanded the hours of its Rural Health Clinic (RHC) by
adding early morning appointments with limited success. These appointments were frequently
unfilled and we have since limited the availability of early morning appointments.
Availability of walk in visits –Increasing the availability of walk-in visits to PSMC’s Rural
Health Clinic has been very successful in increasing patient access to primary care and reducing
utilization of the emergency department for situations that are more appropriately handled in a
clinic setting. There were 663 visits in 2017 and 5,604 in 2018.
Combining of the Primary Care and Specialty Clinics – We successfully integrated the
primary care and specialty clinics under the Rural Health Clinic umbrella, improving patient
satisfaction, maximizing staff efficiency and improving the referral process.
Added a part-time Cardiologist – Cardiology visits continue to grow. The number of visits
doubled in 2018 to 474.
Added Ophthalmological Surgery – Service continues to grow with a 233% increase from
2017.
Infusion Therapy - PSMC continues to experience significant growth in this department.
Service 2017 2018 Change
Blood Transfusion 36 48
IM Injection 14 44
IV Hydration 15 39
IV Infusion 418 654
IVIG 12 56
Portacath Flush 27 97
SQ Injection 25 193
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
7
Evaluation of 2018 Initiatives
Renovation of Surgical Services - Renovation plans included upgrading the Procedure Room to
an Operating Suite and upgrading PSMC’s HVAC system. PSMC’s HVAC is inadequate to
support the increased demand of surgery and oncology services. In 2018, PSMC applied for and
received a grant from Colorado’s Department of Local Affairs (DOLA) of $910,000 toward the
HVAC project. In 2019, PSMC anticipates completing final plans and pricing for the project.
The HVAC project construction is currently planned for 2020.
Revenue Optimization for Surgical Services and Supply Chain – PSMC undertook a joint
project with Cerner to optimize charge capture and streamline complex processes for Surgical
Services. We have just now completed this transition and do not yet have data to evaluate its
success.
Charge Master Revision – PSMC enlisted Cerner’s help with a complete revision of the Charge
Description Master in order to improve our clean claims rate, reduce denials, reduce manual
interventions by billing staff and optimize charge capture. We are still collecting data to evaluate
the success of this project.
The Center for Cancer and Blood Disorders (new service line in January 2018)
Service 2017 2018 Change
Chemo SQ NA 6
Chemo Infusion NA 134
Chemo IV push NA 17
Chemo IM NA 17
Peripheral Lab Draw NA 87
Therapeutic Phlebotomy 168 341
Oncology Clinic Visits NA 535
The Oncology Business Plan completed in 2017 estimated expected patient volumes and
revenues. PSMC projected unique patient volume at 100 for 2018; we exceeded that volume
expectation with 175 unique patients. The Oncology Business Plan projected 4.4 million in
revenues from drugs, professional fees, and infusion services. Actual revenues for 2018 were 2.4
million. However, PSMC identified a miscalculated assumption in the original Oncology
Business Plan for professional fees of about 1 million, leaving PSMC about1 million short of the
corrected projected revenues.
Expanded participation in the Pharmacy 340B program – Positive financial benefit of
$626,056.45.
Therapeutic Phlebotomy 168 341
Not Classified 272 30
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
8
Outpatient Physical therapy services (new service line in 2018) – We added capability for
outpatient visits to provide bridge services due to prolonged wait times for access to local
physical therapy providers.
Outpatient Physical Therapy visits for PSMC employees (new service line in 2018) – We
added capability for outpatient visits for our employees to mitigate prolonged wait times for
access to local physical therapy providers.
Speech Therapy (new service line in 2018) – We added a part-time speech therapist to meet
inpatient needs.
Hired a new CFO – Successfully recruited and hired replacement for retiring CFO.
2018 Quality and Performance Improvement Activities
Emergency Preparedness -
The organization has made significant progress / improvements in the area of Emergency
Preparedness.
Policy/procedure and staff training for Active Shooter was completed in February 2018.
All emergency preparedness policies and procedures were reviewed and revised. We
added required policy and procedures for Code Brown (Winter Storm), Code White
(Hospital Evacuation), Code Orange (Hazardous Spill), Code Purple (Pandemic, Possible
Exposure to Serious Infection), Code Pink (Infant Abduction), Code Silver (Active
Shooter), and Code Dr. Mary Fisher (Combative Person).
PSMC activated our Emergency Operations Plan eight times in 2018. PSMC activated
for:
o Code Green - Generator Outage on 1/20/18
o Code Green - Gas Leak in the Kitchen 2/10/18
o Code Green - Phone Outage on 10/10/18
o Code Green - Phone Outage on 11/8/18
o Code Green - Phone Outage 12/8/18
o Code Black - 12/13/18
o Code Brown – 12/27/18
o Code Green - Capacity 12/28/18
PSMC participated in a tabletop Internet Failure Exercise on 1/31/2018 sponsored by
Mike Hill, HCISPP from Cerner and a Southwest Colorado Healthcare Coalition
Capacity Surge Test on 10/18/2018.
Required Quality Reporting -
Quality Payment Program / Merit-Based Incentive Payment System (MIPS): PSMC
completed PY 2018 submission, achieving a final score of 100 out of 100
points. Performance resulted in a positive payment adjustment of 1.68% for the 2020-
billing year.
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
9
Eligible Hospital (EH) Promoting Interoperability: PSMC completed PY 2018
submission, including the EH eCQM requirement.
Eligible Provider (EP) Medicaid Meaningful Use: PSMC completed PY 2018
submission for one provider, including the EP eCQM requirement. No other providers
met the 30% Medicaid encounter requirement.
Medicare Beneficiary Quality Improvement Program: PSMC completed submission for
Q4 2018 Outpatient Quality Reporting measures including AMI, CP and ED. This allows
us access to $12,000 for HCAPHS services and consulting services through the SHIP
Grant.
Hospital Quality Improvement Program (HQIP): The hospital submitted all required
documentation and received a Supplemental Payment of $323,241.
Electronic Health Record/Informatics – The informatics department provided support for
multiple improvement projects including:
Revenue Cycle optimization
Charge Master Revision
Surgical Services and Supply Chain Optimization
Dragon Medical One conversion
Transition to DynamicDoc
Attaining HIMMS level 7
Patient Safety Activities
Achieved HIMMS Level 7 in March 2018. PSMC is the smallest independent hospital to
achieve Stage 7 recognition, a designation only 6.5% of US hospitals have achieved.
HIMMS levels represent the progressive utilization of the electronic health record to
promote patient safety.
Successfully completed a comprehensive Patient Safety and Risk Management
Assessment by our malpractice carrier. Only one recommendation resulted from that
survey.
Patient Satisfaction Efforts
Conducted daily rounding on 100% of inpatient population, allowing for immediate
service recovery when appropriate.
Provided immediate service recovery for on-site patient complaints by having the Quality
Manager interact with patients at the time of the complaint.
Used the Clarity Event reporting system to track to resolution all patient complaints
Information Technology
Participated in achieving HIMSS Analytics Level 7 Designation
Began preparations for Enterprise-wide Windows 10 Hardware refresh
Began preparations for migration from Server 2008R2 to Server 2016
Completed 3rd Party Audit of Information Technology Environment to audit performance
of outsourced IT Management Company
Following results of the 3rd Party Audit – hired IT Manager to start the transition away
from outsourced IT Management to re-appropriate IT Operations internally at PSMC.
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
10
Peer Review Program
PSMC has established a comprehensive peer review program to insure the quality and
appropriateness of medical services. Results of peer review are reported to the Peer Review
Committee where findings are discussed and actions recommended. Peer review results are
considered in the appointment process. The table below lists the components of the medical peer
review program.
Provider Peer Review Triggers List
Clinic
Clinic Random Peer Review (goal of 2% or minimum of 10/yr.)
Specialty Clinic Random (goal of 2% or minimum of 10/yr.)
ED Reviews
ED Random Peer Review (goal of 2%-only required if 2% not met by other ED
triggers below)
All obstetrical and newborn cases
ED Transfer out (transferred out via flight only)
ED AMA
ED Deaths
Inpatient Reviews
Inpatient Random Peer Reviews (goal of 2% or minimum of 10/yr.)
All inpatient re-admissions for same diagnosis w/I 30 days
All inpatient with LOS > 7 days
All inpatient stays ≤ 24 hours
All transfers from IP to another facility
IP Deaths (unexpected only)
All hospital acquired Infections
Surgery Random Peer Reviews
Random Surgery Reviews (goal of 2% or minimum of 10/yr.)
All post-op surgical infections
Unplanned return to OR
Unplanned ED visit within 24 hours after an OR procedure
Anastomotic Leaks
GI lab Perforation
Unanticipated Need for Transfusion
Post Op DVT
Unexpected OR Outcomes
Malignant Hyperthermia/adverse reaction to anesthesia/anaphylactic shock or IV
conscious sedation complications
CRNA Random Peer Reviews (goal of 2% or minimum of 10/yr.)
General Standing Peer Reviews
All hemolytic transfusion reactions
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
11
All requested from providers, administration, nursing, risk management, and
quality
All mortality cases (unexpected IP, all OP, ED, OR)
Medical Staff Additions
LAST NAME FIRST NAME PRACTICE AREA GROUP NAME
Alonso-Jeckell Yaima Telepsychiatry MindCare Solutions/Health ONE
Virtual Network
Armentano Stephanie Licensed Clinical
Social Worker
Axis Health System
Bentley William Neurology Pagosa Springs Medical Center /
Colorado Permanente Medical Group
Bidart Chad Cardiology /
Telecardiology
Mercy Cardiology Associates
Bishop John Surgery Pagosa Springs Medical Center /
Gunnison Valley Hospital
Borden Kelly Teleradiology Radiology Imaging Associates
Bryant Kevin "KD" Licensed Professional
Counselor
Axis Health System
Cesary Kelly Oncology &
Hematology
Pagosa Springs Medical Center
Crete Ryan Teleradiology Radiology Imaging Associates
DeNault Michelle Telepsychiatry MindCare Solutions/HealthONE
Virtual Network
Denier Jamie Licensed Social
Worker
Axis Health System
Dickerson Elliot Teleradiology Radiology Imaging Associates
Farmer Tracy Licensed Clinic Social
Worker
Axis Health System
Fidai Gulzar Hospitalist Pagosa Springs Medical Center
Fisher Kerry Oncology &
Hematology
Pagosa Springs Medical Center
Foster Bridget Licensed Clinical
Social Worker
Axis Health System
Fuller Samuel Teleradiology Radiology Imaging Associates
Golden Louis Teleradiology Radiology Imaging Associates
Harlan Josiah Licensed Professional
Counselor
Axis Health System
Hill Jason Teleneurology Blue Sky Neurology/HealthONE
Virtual Network
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
12
Hosey Anne Licensed Professional
Counselor Candidate
Axis Health System
Jackson Grace Telepsychiatry MindCare Solutions/Health ONE
Virtual Network
Jordan William Oncology &
Hematology
Pagosa Springs Medical Center
Kelly Kevin Psychology Pagosa Springs Medical Center
Lampe Emily Teleneurology Blue Sky Neurology/HealthONE
Virtual Network
McCarthy Paul Pathology Pueblo Pathology Group
Messina Taylor Licensed Professional
Counselor
Axis Health System
Newman Suzanne Telepsychiatry MindCare Solutions/HealthONE
Virtual Network
Newsome Calvin Family Medicine &
Neurology,
Gastroenterology,
Cardiology, ENT
Support
Pagosa Springs Medical Center
Primary Care Clinic
Norwood William Surgery Norwood Surgical Specialists / Pagosa
Springs Medical Center
Palusinski Robert Cardiology /
Telecardiology
Mercy Cardiology Associates
Parrisbalogun Stefani Telepsychiatry MindCare Solutions/HealthONE
Virtual Network
Patel Nishant Teleradiology Radiology Imaging Associates
Phelps Dennis Orthopedics Pagosa Springs Medical Center / UC
Health Orthopedics
Potts Scot Pathology Pueblo Pathology Group
Reuter Gregory Teleradiology Radiology Imaging Associates
Richards John Teleradiology Radiology Imaging Associates
Ropp Benjamin Pathology Pueblo Pathology Group
Sanchez Linda Licensed Professional
Counselor
Axis Health System
Splichal Aron Teleradiology Radiology Imaging Associates
Stahl Cosette Teleradiology Radiology Imaging Associates
Tjan Virginia Oncology &
Hematology
Pagosa Springs Medical Center
Voigts Kerri Emergency Medicine Pagosa Springs Medical Center
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
13
Policy and Procedure Review
Pagosa Springs Medical Center utilizes a cloud-based software system for the management of
policies and procedures. At the beginning of 2018, there were 1762 policies, procedures and
contracts under management. The annual review and revision of documents is fully automated,
with reviewers receiving notification that they have documents to review via email each week.
There is a custom approval process for each document consisting of between four and six
reviewers including a member of leadership.
In addition to the mandatory annual review, documents are available for revision whenever
necessary and proceed through the entire approval process for each revision.
Staff members are assigned to read all policies and procedures that are relevant to their position.
Completion of assignments is monitored and department managers are responsible for staff
compliance.
Staff has immediate access to all relevant documents and are required to read and sign off on all
documents related to their job role.
2019 Planned Initiatives
Improving Cash on Hand -
At the end of 2018, PSMC had 53 days cash on hand. PSMC’s planned initiatives for 2019 to
improve cash on hand include reducing expense, improving collection of revenues, and some
management and planning activities aimed to increase cash. With respect to reducing expense,
PSMC will (as possible) do the following: reduce the number of employees and contractors
through attrition; terminate use of off-site leased space; and amend service agreements to reduce
expense. With respect to improving collection of revenues, PSMC will do the following:
outsource billing of out-of-state Medicaid, motor vehicles and worker comp claims; outsource
coding to improve accuracy; implement processes to decrease denials related to preauthorization
and medical necessity; and implement processes to improve timely filing of clean claims to
decrease denials. With respect to management and planning, PSMC will do the following:
operationalize offering swing bed services for orthopedic patients; evaluate and develop a plan to
improve outpatient clinic productivity; evaluate and develop a plan to decrease PSMC’s cost to
PSMC for employee health insurance coverage; evaluate and develop a plan to reduce the cost
of the MRI lease; evaluate and develop a plan for more efficient IT/phone support; and evaluate
the feasibility of expanding pain management services.
Hospital Transformation Program -
In the fall of 2018, the Colorado Department of Health Care Policy and Financing (HCPF) began
a statewide initiative designed to change how health care is provided to Medicaid beneficiaries.
The program requires hospitals to develop relationships with community partners, develop
initiatives that improve care and cut costs. HCPF has developed a package of indicators that will
be used to measure the hospitals performance. At stake is a portion of the hospitals supplemental
payment each year. This is a huge undertaking for a small CAH, but crucial for moving to value
based payments.
PSMC has committed a key group of personnel to this five-year project.
ORAL REPORTS 4a.iv.
Annual Program Evaluation - 2018
14
Possible programs related to this project are:
Hospital Social Services;
Clinic Social Services;
Chronic Disease Management;
Expanded Behavioral Health Services;
Zero Suicide Initiatives;
Depression Screening / Suicide Risk Assessment for all patients;
Increasing partnerships with area agencies to reduce patient barriers to achieving health
and wellness.
HVAC Renovation -
Planned renovation of hospital HVAC system tentatively scheduled for April 2020 to include:
Procedure Room renovation as OR suite;
RTU 2 upgrade to meet Surgical Services demand;
Control systems related HVAC system function and monitoring capabilities;
VAV replacement to improve current HVAC function as well as save energy;
Revision of Pharmacy negative pressure rooms to meet new standards.
Planning for the renovation will occur throughout 2019.
Improve Access to Care -
Revise scheduling protocols to increase outpatient appointment availability.
Continue to improve access to providers by expanding hours of service.
Add additional neurology services to augment a neurologist who plans to retire.
Explore telemedicine for Psychiatry and other specialties.
ORAL REPORTS 4a.iv.
USJHSD Finance Report USJHSD Board Packet, 08-27-2019
Page 1 of 1
Finance Committee & CFO Report,
USJHSD Board Meeting on August 27, 2019
This report provides highlights of PSMC’s July financials and the discussions of the Board’s Finance
Committee that met on August 20, 2019.
1) July Bottom Line: PSMC had an all-time record for gross charges in July of just over $6.3MM, which
exceeded budget. Due to charity care, bad debt and contractual deductions of payers (e.g., Medicare,
Medicaid and commercial insurers), PSMC, is generally paid approximately fifty percent of gross
charges. Hospitals are always expensive to operate but PSMC continued to hold down its expenses,
which contributed to PSMC finishing the month of July with a total net gain of $545,977. PSMC’s
total net revenues year-to-date of are $580,971, which is less than budget but slightly exceeds 2018
YTD. Like most businesses in Pagosa Springs, PSMC’s net revenues are lower for the first half of the
year and increase during the summer. PSMC budgeted a strong July and we congratulate our staff for
meeting patient demands and helping so many.
2) Revenues: Inpatient and outpatient revenues were strong in July. Inpatient Surgery and Imaging were
the only departments that did not hit their budgeted revenue.
3) Deductions to Gross Revenues for Payer Contractuals, Charity and Bad Debt: Each month PSMC
has deductions to its revenue for bad debt, charity care as well as deductions made by third-party payers
(Medicare and commercial insurers) that are referred to as payer contractuals. Deductions for the
month of July were 4% below budget, which helped result in July’s positive bottom line. Year to date,
PSMC’s charity care and contractual deductions by payers has greatly exceeded budget resulting in a
little more than 1 million greater deductions to PSMC revenue than budgeted.
4) Expenses: PSMC continued to do a good job holding down expenses, and we were 6% under budget
for the month of July (this is nearly $200,000 under budget for the month). Year-to-date, expenses
continue to be under budget by 2% (which is nearly $500,000).
5) Cash and collections:
a) PSMC increased operating cash in July to $5.1MM from $4.5 MM in June 2019.
b) Patient collections were $2.7 MM for the month, 375K more than forecasted. The patients from
PSMC are starting to utilize our payment portal more and we are glad to report that 110 patients
used it to pay their balance in full or to set up a payment plan in July.
c) As of the end of July, PSMC is at 62 days of gross A/R; however, PSMC’s gross accounts
receivable balance increased $180K to $11.24 MM. We continue diligently working the A/R and
are hitting some targets that we not did expect to hit until December.
6) Progress Report Re Consultant’s Recommendations to Increase Days of Cash: PSMC
presented and discussed in depth with the Finance Committee the status of progress on the
consultant’s recommendations. Per direction of the Board, until the goals are met,, staff will
provide the Board with a written monthly report and an oral report quarterly (in May,
August, & November).
ORAL REPORTS 4a.v.
FINANCIAL PRESENTATION
YTD JULY 2019
ORAL REPORTS 4a.v.
1
GROSS REVENUE
0
7,500,000
15,000,000
22,500,000
30,000,000
37,500,000
45,000,000
YTD
35,026,226 34,318,16732,871,109
Actual Budget Prior Year
- 2,000,000 4,000,000 6,000,000 8,000,000
10,000,000
July
6,309,053 5,576,680 5,466,348
Budget Prior Year
732,373
13.13%
842,705
15.42%
708,059
2.06%2,155,117
6.56%
Actual
GROSS REVENUE
$3,300,000
$3,600,000
$3,900,000
$4,200,000
$4,500,000
$4,800,000
$5,100,000
$5,400,000
$5,700,000
$6,000,000
$6,300,000
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
FY 2019 FY 2018 FY 2017 FY 2016
ORAL REPORTS 4a.v.
2
NET PATIENT REVENUE
04,000,0008,000,000
12,000,00016,000,00020,000,00024,000,00028,000,00032,000,00036,000,00040,000,000
YTD
18,380,406 19,433,639
18,010,502
- 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000
July
3,009,707 3,125,538 3,213,107
Prior Year
-115,831
-3.71%
-203,400
-6.33%
-1,053,233
-5.42%
369,904
2.05%
Actual Budget
Actual Budget Prior Year
NET REVENUE
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,250,000
$3,500,000
$3,750,000
$4,000,000
$4,250,000
$4,500,000
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
FY 2019 FY 2018 FY 2017 FY 2016
ORAL REPORTS 4a.v.
3
EXPENSES
04,000,0008,000,000
12,000,00016,000,00020,000,00024,000,00028,000,00032,000,000
YTD
20,485,173 20,966,063 20,252,021
- 750,000
1,500,000 2,250,000 3,000,000 3,750,000 4,500,000
July
2,867,179 3,060,981 3,037,247
-193,802
-6.33%
-170,068
-5.60%
-480,890
-2.29%
233,152
1.15%
Actual Budget Prior Year
Actual Budget Prior Year
EXPENSES
$-
$250,000
$500,000
$750,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,250,000
$3,500,000
$3,750,000
$4,000,000
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
FY 2019 FY 2018 FY 2017 FY 2016
ORAL REPORTS 4a.v.
4
NET INCOME
(1,000,000) -
1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000 7,000,000
YTD
580,971
1,564,876
574,600
- 500,000
1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 3,500,000
July
545,977 585,074 557,193
-983,905
-62.87%
6,371
1.11%
Actual Budget Prior Year
Actual Budget Prior Year
NET INCOME
$(600,000)
$(350,000)
$(100,000)
$150,000
$400,000
$650,000
$900,000
$1,150,000
$1,400,000
$1,650,000
$1,900,000
$2,150,000
$2,400,000
$2,650,000
$2,900,000
$3,150,000
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
FY 2019 FY 2018 FY 2017 FY 2016 FY 2015
ORAL REPORTS 4a.v.
5
DAYS IN ACCOUNTS
RECEIVABLE
0
10
20
30
40
50
60
70
80
90
100
Jun-18 Aug-18 Oct-18 Dec-18 Feb-19 Apr-19 Jun-19
71.9 72.2 70.2 69.4 70.1 70.5 76.6 76.5 76.3
78.4
69.9 68.6 69.6
61.4 60.0 58.0 53.0 54.0 54.0 53.0
61.0 57.0
62.0 65.0
53.0 49.0
54.0 53.0
Gross Net
DAYS CASH ON HAND
0
10
20
30
40
50
60
70
80
90
100
Jan-18 Apr-18 Jul-18 Oct-18 Jan-19 Apr-19 Jul-19
48.6 49.4
44.3 45.1 40.7
33.9
43.0 38.8 40.2
43.2 48.9
52.4
38.3 41.2
36.4
47.4 50.3
39.3
46.1
ORAL REPORTS 4a.v.
6
CASH COLLECTIONS
$-
$250,000
$500,000
$750,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,250,000
$2,500,000
$2,750,000
$3,000,000
$3,250,000
$3,500,000
$3,750,000
$4,000,000
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
FY 2019 FY 2018 FY 2017
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ORAL REPORTS 4a.v.
ACTION DEADLINE MAY JUNE JULY AUG. SEPT OCT NOV
REDUCE EXPENSE
From 12/31/18 level staffing, reduce FTEs and contractors (as practical and through attrition, if possible). ongoing 10 positions 10 positions 10 positions 9 positions
As possible, restructure positions to reduce expense. ongoing 4 positions 4 positions 5 positions 5 positions
Create and implement a plan to terminate lease for use of off-site space. 6/30/2019 75% 95% 100% 100%
Amend/change service agreements to reduce expense. ongoing 40% 44% 55% 55%
Subject to challenges with hiring, replace 2 emergency room night-shift RNs with paramedics. 5/31/2019 0% 0% 0% 100%
IMPROVE REVENUES COLLECTED
Outsource billing for out-of-state Medicaid, motor vehicles and worker comp claims. 3/1/2019 100% 100% 100% 100%
Contract with a third party for coding to improve accuracy. 2/1/2019 100% 100% 100% 100%
Develop and implement process for collecting coinsurance for patients. 7/31/2019 100% 100% 100% 90%
Implement coding software to enable PSMC to compute payments on Medicaid EAPGs to assure accuracy of payment. 10/31/2019 10% 10% 20% 30%
From 12/31/18 levels, develop and implement processes that should decrease denials by 50% (denials related to pre-
authorization, medical necessity and otherwise).10/31/2019 25% 30% 30% 50%
From 12/31/18 levels, implement process to improve timely filing of clean claims to decrease denials by 50%. 9/30/2019 100% 100% 100% 100%
Develop and implement a plan to reduce gross days of A/R to 68 (from 12/31/18 level of 76.6 gross days of A/R). 7/31/2019 88% 93% 81.16% 100% (61.43)
Engage contractors if 68 days not achieved on 7/31/19 9/30/2019 n/a n/a n/a n/a
Develop and implement a plan to reduce gross days of A/R to 62 (from 12/31/18 level of 76.6 gross days of A/R). 12/31/2019 52% 54.70% 47.80% 100%
Create and implement a career matrix program for billing office to reduce turnover and enhance stability of collections. 1/31/2019 100% 100% 100% 100%
If matrix does not produce improvement, evaluate alternatives. 1/1/2020 n/a n/a n/a n/a
MANAGEMENT AND PLANNING
Operationalize offering swing bed services for orthopedic patients pending hiring of appropriate staff. 8/31/2019 80% 100% 100% 100%
Develop a monthly cash forecast to allow management to predict progress relative to the cash goal and measure days of cash. 6/30/2019 0% 100% 100% 100%
Compute Medicare productivity for the RHC monthly. 6/30/2019 10% 100% 100% 100%
Evaluate and develop/implement a plan to address time allotted in the RHC for patient visits and improve Medicare
productivity in the RHC.10/31/2019 10% 10% 20% 75%
Evaluation and develop/implement a plan to decrease PSMC’s expense for employee health insurance benefit for employee’s
spouse and children.7/1/2019 75% 100% 100% 100%
Evaluate and develop/implement a plan to reduce ongoing expense for MRI. 12/31/2019 0% 0% 0% 0%
Evaluate and develop a plan for efficient IT/Phone support at a lower cost (current contract for support does not end until
12/31/2020).12/31/2019 25% 50% 80% 100%
Evaluate and develop/implement a plan to reduce professional hours in Oncology program to better address current and
projected demand.12/31/2019 20% 20% 100% 100%
Evaluate the feasibility of providing physical therapy services for all outpatients. 10/31/2019 0% 0% 0% 20%
Evaluate the feasibility of refinancing the 2006/2007 bonds. 12/31/2019 0% 0% 10% 100%
Evaluate the feasibility of increasing veteran use of the RHC. 12/31/2019 0% 0% 10% 100%
Evaluate the feasibility of expanding pain management services. 12/31/2019 0% 20% 20% 75%
USJHSD Management Progress Reporting Tool USJHSD Board Packet, 08-27-2019
Page 1 of 1
ORAL REPORTS 4a.v.
TO: Board of Directors of PSMC/USJHSD RE: Evaluation of for refinancing the 2006 bonds DATE: 8/23/19
The consultant’s report requires that PSMC evaluate the feasibility of refinancing the 2006/2007 bonds (note: the 2007 bonds have been fully paid). As part of evaluation, PSMC worked with David Lucas of Sherman & Howard (attorney who works solely in bonds and has helped PSMC in the past) and Jason Simmons of Hilltop Securities, Inc. (specializes in evaluation and advising on the bond market and has helped PSMC in the past).
The end result of the evaluation is that PSMC should consider “refinancing” the 2006 bonds when they mature in March of 2021 because it is likely that a refinance would result in overall savings to PSMC due to reduced interest rates. We obviously cannot know what the market will be like in 18 months, but Hilltop Securities stated it is more likely than not that bond rates (currently at or near an all-time low) would be lower than our current rates (current rates are 5% through 2021 and 4.85% through 2036). There are options to “refinance” the bonds prior to their maturity but these options are not as desirable as waiting until maturity because penalties/premiums for early refunding would reduce/eliminate the savings otherwise resulting from the refinance.
Sherman & Howard affirmed that it is appropriate and legal for PSMC to refinance the 2006 bonds (without further voter approval) so long as we terms of the May 2, 2006 ballot question which should not be an issue (note, the approved ballot question requires no greater than par debt of $12,000,000, repayment costs not to exceed $33,500,000, effective interest rate not to exceed 8.5% and redemption prior to maturity not to exceed premium of 3%).
ORAL REPORTS 4a.v.
60
1 0 010
22
2
27
0 00
102030405060708090
100
Num
ber o
f 911
Res
pons
es
EMS 911 Response
2019
122Total 911 Responses:
0
6
2
Breakdown of EMS Standbys
Fire/SAR/LE/USF
Paid
Special Event (Not Paid)
Refusal
Total Standbys8
44
23
0
10
20
30
40
50
Num
ber o
f Int
erfa
cilit
y Tr
ansp
orts
Total Interfacility Transports
2019 2018
Operations Report -
EMS
August 2019
July
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 1 of 9
WRITTEN REPORTS 4b.i.
0
23
1 1 1 0
17
1 0 0 00
5
10
15
20
25
30
35
40
Num
ber o
f Tra
snpo
rts
Interfacility Transports by Destination
0
0.5
1
1.5
2
2.5
3
Flight/ShuttleCrew
3rd/4th Crew Dispatch Error Assist at PSMC Walk-In EMS Public Assist
0
2
0
3
0 0
"Oth
er"
Calls
Other EMS Calls
2019
EMS
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 2 of 9
WRITTEN REPORTS 4b.i.
Oncology/Infusion
Oncology Visits Infusion Encounters Oncology Infusions/Injections2019 80 79 80
80 79 80
0102030405060708090
100
Oncology/Infusion
Oncology Visits Infusion Encounters Oncology Infusions/Injections
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 3 of 9
WRITTEN REPORTS 4b.i.
ED
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2019 481 451 543 462 563 561 7022018 619 532 554 470 532 589 713 592 543 473 425 629
0
100
200
300
400
500
600
700
800
Num
ber o
f pat
ient
s
ED Yearly Volume Comparison
2019 2018
38 4130 36
0
100
200
300
400
500
600
Admits Transfers
Num
ber o
f Pat
ient
s
ED Inpatient Admissions and Transfers Monthly Comparison
2019 2018
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 4 of 9
WRITTEN REPORTS 4b.i.
Average Daily Census
22.7Average Length of Stay (in hours)
2.3
32
1 1
0
2
4
6
8
10
12
14
Diagnostic Imaging Gen Surg Ortho Bed Avail
Num
ber o
f Tra
nsfe
rs
JulyED Resource Related Transfers -
ED
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 5 of 9
WRITTEN REPORTS 4b.i.
Inpatient
Average Daily Census Average Length of Stay (in days)
4.7 2.5
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec2019 37 28 40 31 27 39 382018 50 41 44 34 33 44 41 38 36 29 21 39
0
10
20
30
40
50
60
Inpa
tient
Adm
issio
ns
Inpatient Admission Comparison
2019
2018
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 6 of 9
WRITTEN REPORTS 4b.i.
Diagnostic Imaging
1482
1057
1337
993
0
200
400
600
800
1000
1200
1400
1600
Procedures Patients
Diagnostic Imaging Stats by Month
2019 2018
2019
2018
0
10
20
30
40
2D Echo Stress Echo2019 38 92018 33 2
38
9
33
2
Cardiology
2019 2018
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 7 of 9
WRITTEN REPORTS 4b.i.
Lab
5299
1818
4954
1816
0
1000
2000
3000
4000
5000
6000
Tests Patients
Lab Test & Patient Volume by Month
2019 2018
Clinic
1518
448
1504
437
0
200
400
600
800
1000
1200
1400
1600
PCP Encounters Speciality Clinic Encounters
Rural Health Clinic Encounters by Month
2019 2018
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 8 of 9
WRITTEN REPORTS 4b.i.
20.8
17.4
0
5
10
15
20
25
30
35Average Daily Walk-Ins
2019 2018
Surgery
0
5
10
15
20
25
30
35
40
GI Cases General Ortho ENT GYN Eye PainMgmt
Other
24
13
35
7
0 0
13
0
30
10
39
0 0 0
7
0
Num
ber o
f Cas
es
Surgery Cases by MonthJuly
Clinic
USJHSD Operations Report USJHSD Board Packet, 08-27-2019
Page 9 of 9
WRITTEN REPORTS 4b.i.
USJHSD Medical Staff Report
USJHSD Board Packet, 08-27-2019
Page 1 of 1
THE UPPER SAN JUAN HEALTH SERVICE DISTRICT
DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER
MEDICAL STAFF REPORT BY VICE CHIEF OF STAFF, DR. CORINNE REED
August 27, 2019
I. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS FOR THE USJHSD BOARD ACCEPTANCE
OF NEW POLICIES OR PROCEDURES ADOPTED BY THE MEDICAL STAFF:
II. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS FOR THE USJHSD BOARD ACCEPTANCE
OF PROVIDER PRIVILEGES (ACCEPTANCE BY THE BOARD RESULTS IN THE GRANT OF PRIVILEGES):
NAME INITIAL/REAPPOINT/CHANGE TYPE OF PRIVILEGES SPECIALTY
William Eckhart, MD Initial Appointment Telemedicine/Teleneurology Neurology
Kathryn Lundvall, LPC Initial Appointment AHP/Licensed Professional
Counselor
Licensed Professional
Counselor
Ashley Smith, MD Initial Appointment Telemedicine/Telepsychiatry Psychiatry
David Weiss, MD Initial Appointment Telemedicine/Telepsychiatry Psychiatry
III. REPORT OF NUMBER OF PROVIDERS BY CATEGORY
Active: 17
Courtesy: 29
Telemedicine: 121
Allied Health Professionals: 29
Total: 196
WRITTEN REPORTS 4b.ii.
USJHSD Regular Board Meeting Minutes
07/23/2019
Page 1 of 3
MINUTES OF REGULAR BOARD MEETING
Tuesday, July 23, 2019
5:30 PM
The Board Room
95 South Pagosa Blvd., Pagosa Springs, CO 81147
The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its regular board
meeting on July 23, 2019, at Pagosa Springs Medical Center, The Board Room, 95 South Pagosa Blvd.,
Pagosa Springs, Colorado.
Directors Present: Chair Greg Schulte, Vice-Chair Matt Mees, Treasurer-Secretary Dr. King Campbell,
Director Kate Alfred, Director Dr. Jim Pruitt, Director Karin Daniels, and Director Jason Cox.
1) CALL TO ORDER
a) Call for quorum: Chair Schulte called the meeting to order at 5:30 p.m. MDT and Clerk of the
Board, Heather Thomas, recorded the minutes. A quorum of directors was present and
acknowledged by Treasurer/Secretary Dr. Campbell.
b) Board member self-disclosure of actual, potential or perceived conflicts of interest: There were
none.
c) Approval of the Agenda: The Board noted approval of the agenda.
2) PUBLIC COMMENT
Katie Harr, newly appointed Archuleta County Combined Dispatch Manager, introduced herself
to the Board and noted that she looks forward to working with the District.
3) REPORTS
a) Oral Reports
i) Chair Report
Chair Schulte discussed the recent meeting of the IGA subcommittee of the Archuleta
County Combined Dispatch Executive Management Board held on July 1, 2019, noting that
he asked the attending SUN reporter to leave the meeting, not realizing there was an inadvertent
quorum present.
Chair Schulte further explained the subcommittee serves as an advisory body to the
Dispatch Executive Management Board. Chair Schulte reported that Vice-Chair Mees has
CONSENT AGENDA 5b.i.
USJHSD Regular Board Meeting Minutes
07/23/2019
Page 2 of 3
volunteered to serve on the subcommittee with Chair Schulte, unless another Board member
desires to be considered.
Chair Schulte advised what was discussed at the July 1 meeting noting that the next meeting
is to be held July 29 at Town Hall, and will be open to the public.
Questions were asked and answered.
ii) Contracts
Item intentionally struck from agenda. There was no report.
iii) Strategic Planning
Item intentionally struck from agenda. There was no report.
iv) CEO Report
CEO, Dr. Webb advised the Board that she had recently attended the Colorado Hospital
Association (“CHA”) CEO Forum consisting only of CEOs of the CHA-member hospitals,
noting highlights of what had been discussed at the forum. A discussion ensued.
Questions were asked and answered.
v) Finance Report
CFO, Chelle Keplinger, presented and discussed the financial PowerPoint presentation
noting additional verbiage to the presentation.
Director Alfred asked a question regarding if the reported reduction in revenue in June
might possibly be due to reduction in population during that month. CFO Keplinger answered.
Director Dr. Pruitt asked questions regarding what month the Charge Master had been
updated, about surgery revenues, about a typo in the monthly trends report on lines 26 and 27.
CFO Keplinger, CNO-COO Kathee Douglas and Controller Johna Lederhouse answered.
Questions regarding gross and net revenue were asked and answered.
b) Written Reports
i) Operations Report
There were no questions.
ii) Medical Staff Report
There were no questions.
4) CONSENT AGENDA
Director Dr. Pruitt motioned to approve the noted Board member absences, the minutes of the
regular meeting of 06/25/2019, and the Medical Staff report recommendations for new or renewal of
provider privileges. Directors Cox and Daniels noted abstention from approval of the minutes of the
regular meeting of 06/25/2019 due to their absence from the meeting.
Upon motion seconded by Treasurer-Secretary Dr. Campbell, the Board unanimously approved
said consent agenda items with noted abstention by Directors Cox and Daniels.
5) EXECUTIVE SESSION
CONSENT AGENDA 5b.i.
USJHSD Regular Board Meeting Minutes
07/23/2019
Page 3 of 3
The Board did not meet in executive session.
6) OTHER BUSINESS
There was no other business.
7) ADJOURN
There being no further business, Chair Schulte adjourned the regular meeting at 6:18 p.m. MDT.
Respectfully submitted by:
Heather Thomas, serving as Clerk of the Board
CONSENT AGENDA 5b.i.
UPPER SAN JUAN HEALTH SERVICES DISTRICT
D/B/A PAGOSA SPRINGS MEDICAL CENTER
Formal Written Resolution 2019-07
August 27, 2019
WHEREAS, the Board of Directors of Upper San Juan Health Service District
(“USJHSD”) desires to adjust its regular meeting schedule for September and October of
2019.
NOW, THEREFORE, THE BOARD OF DIRECTORS OF THE UPPER SAN JUAN
HEALTH SERVICE DISTRICT HEREBY RESOLVES to change its regular Board of
Directors meeting schedule as follows:
Cancel the regular meeting on Tuesday, September 24, 2019, and instead the Board
will attend the PSMC Community Open House on Thursday, September 26, 2019
from 5:15 p.m. until 7:15 p.m.
Cancel the regular meeting on Tuesday, October 22, 2019, and instead hold a
special meeting of the Board of Directors on Tuesday October 15, 2019 (to allow
presentation of the 2020 budget prior to the October 15th statutory deadline).
The resulting schedule for the Board of Directors will be:
o Thursday, September 26th from 5:15 to 7:15 p.m.;
o Tuesday, October 15th at 5:30 p.m. (standard agenda, presentation of August
financials and presentation of the 2020 budget);
o Tuesday, November 19th at 5:30 p.m. (standard agenda, presentation of
September and October financials, approval of the 2020 budget); and
o Tuesday December 17th at 5:30 p.m. (standard agenda and presentation of
November financials).
_____________________________________________
Greg Schulte, as Chairman of the Board of Directors of USJHSD
DECISION AGENDA 6.a.