psmc foundation keyah grande gala fundraising event · 2018-06-26 · v) finance report cfo chelle...

NOTICE OF REGULAR BOARD MEETING OF

THE UPPER SAN JUAN HEALTH SERVICE DISTRICT dba PAGOSA SPRINGS MEDICAL CENTER

Tuesday, June 26, 2018, 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) Call for quorum (by Treasurer/Secretary Dr. King Campbell)

b) 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) MILESTONE MOMENT: PSMC Foundation Keyah Grande Gala Fundraising Event

4) REPORTS

a) Oral Reports (may be accompanied by a written report)

i) Chair Report Chair Greg Schulte

ii) Contracts Director Kate Alfred

iii) Strategic Planning Director Dr. Jim Pruitt and Director Karin Daniels

iv) CEO Report (& 2017 CAH Annual Report) Chief Executive Officer, Dr. Rhonda Webb

v) Finance Report CFO Chelle Keplinger,Controller Johna Lederhouse

and Treasurer Dr. Campbell

b) Written Reports (no oral report unless the Board has questions)

i) Operations Report COO/CNO, Kathee Douglas

ii) Medical Staff Report Chief of Staff, Ralph Battels

5) DECISION AGENDA (Matters to be discussed and possible action by the Board)

a) 2017 Audit: As noted in the financial report, the District auditor presented the audit to the PSMC

Finance Committee who received the report without objection or issue. The audit is included in the

Board packet and the scope of the auditor’s work is summarized in its cover letter on pages 3 and 4 of

the audit. Michael Nelson, CPA, of Chadwick, Steinkirchner, Davis & Co., P.C. will be joining the

meeting via teleconference to report the opinion of the auditor.

i) Consideration of Resolution 2018-09 (written resolution in the packet) regarding acceptance of the

2017 audit of the Upper San Juan Health Service District.

6) 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 Minutes for the following meeting(s):

i) Regular meeting of: 05/22/2018ii) Work session of: 06/01/2018iii) Special meeting of: 06/06/2018

b) Acceptance of recommendations set forth in the Medical Staff Report regarding new provider

privileges, renewal of provider privileges and/or Medical Staff policies/forms.

7) BOARD ORIENTATION

8) 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.

9) OTHER BUSINESS

10) ADJOURN

PAGOSA SPRINGS MEDICAL CENTER

Annual Program Evaluation

2017

ORAL REPORTS 4a.iv.

Annual Program Evaluation - 2017

2

Introduction

In compliance with Medicare’s Conditions of Participation for Critical Access

Hospitals, Pagosa Springs Medical Center 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 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.

Sources of Data for the Evaluation

Concurrent Case Management

Utilization Review Committee Minutes

Quality Counsel Minutes

Performance Improvement Committee Minutes

Occurrence Reports

Patient Satisfaction Surveys

Demographic and Economic Profiles

Hospital Generated Statistical Reports

PSMC Scope of Services

Pagosa Springs Medical Center is fully licensed and accredited as a Critical Access

Hospital and is licensed for 11 acute care/swing beds. The hospital has 7

Emergency Department beds and is a designated Level 4 Trauma Center.

Clinical Diagnostic/Treatment Services

Anesthesia

Cardiopulmonary Services

o Respiratory Therapy

ORAL REPORTS 4a.iv.


3

o EKG

o Event Monitoring

o Stress Testing

o Echocardiography

o Basic Pulmonary Function Testing

Case Management

Diagnostic Imaging

o General Radiology

o Bone Densitometry

o Ultrasound

o CT

o MRI

o Mammography

o Nuclear Medicine (by contract)

o Full Time Echocardiography

o Event Monitoring

o Stress Testing

Dietary

o Dietitian Consultation (by contract)

Emergency Medical Services (Ambulance)

Emergency Department

o Trauma Services

o Tele-neurology (by contract)

o Tele-psychiatry (by contract)

Infusion Therapy

Inpatient 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 Pathology (by contract)

o Blood Bank

o General Laboratory Services

Pharmacy

Rehabilitative Services

o Swing Bed

o Physical Therapy

Surgical Services

o General Surgery

o Orthopedic Surgery

ORAL REPORTS 4a.iv.


4

o Sterile Processing

o Women’s Health Program

o Gastroenterology

o Ophthalmological Surgery

Support Services:

Administration

Patient Financial Services

Compliance

Credentialing/Medical Staff Office

Employee Health

Environmental Services

Financial Accounting

Health Information Management

Human Resources Management

Informatics

Information Technology

Marketing and Communication

Materials Management

Patient Registration and Pre-service

Plant Operations

Quality and Patient Safety

Risk Management and Legal

Community Services:

Community Education

Patient and Family Information and Education

Patient Navigation

Trends in Demographics

Based on a 2016 analysis of Physician to Population ratios and DOLA

prediction of population growth, the adult primary care capacity is roughly in

balance with the population. The pediatric capacity remains slightly higher than is

required.

DOLA Demographic and Economic Profile indicates that Archuleta County

population is expected to reach 13,778 by 2020 with most of the growth forecasted

to be in residents over the age of 70. We will continue to monitor patient access to

primary and specialty care.

ORAL REPORTS 4a.iv.


5

Notable Hospital Generated Statistics and Corresponding Actions

Emergency Department Visits (volume increase 3%)

Completed an expansion of the Emergency Department that created two

more beds. It is anticipated that this expansion will be adequate for the near

future.

Primary Care and Specialty Clinic (volume increase 2% in Primary Care)

Added after-hours appointments and walk-in availability, (early morning,

evenings and Saturdays) to meet community need.

Added 2 FTE in DO coverage to accommodate anticipated growth in Primary

Care.

Integrated Primary Care and Specialty Clinics in order to promote better

communication, ease of referral and improve patient convenience.

Added 0.5 FTE in Cardiology; this service line also assumed responsibility for

reading of echo, stress echo.

Diagnostic Imaging (volume increase 7%)

Echocardiography up 59% - employed a part-time cardiologist to provide

consultative services and read tests.

MRI up 15% - investigating flexible staff plan to accommodate increased

volume.

Mammograms up 12% - hired a part-time radiologist to provide consultative

services and read tests. Began fund raising for 3-D equipment.

Infusion Therapy (new service)

Began redesign of Infusion Center to prepare for the addition of Oncology

Performed 987 infusions, plan to begin chemotherapy with the development

of Oncology service line in 2018.

Gastroenterology (primarily screening colonoscopy – volume down 5%)

Coverage is currently adequate.

Surgical Services

Initial expansion of the surgical services area completed, additional

renovation planned for 2018.

Ophthalmological Surgery – not available 2017, restarted in 2018.

General Surgery down 26%

o Coverage is currently adequate.

o Resignation of FT general surgeon, PT general surgeon in 2017.

o Added new FT general surgeon to replace versus the original plan for

augmentation and increased call coverage.

Orthopedic Surgery (volume increase 11%)

o Increased second orthopedic surgeon coverage to twelve weeks/year.

Pain Management down 9%

o Coverage is adequate.

ORAL REPORTS 4a.iv.


6

o Decrease attributed to Medicare reimbursement issues for CRNA’s –

now resolved.

Inpatient Days (volume down 2%)

Acuity has stabilized with an increase of 15% in the length of stay.

Average length of stay was 3.0 days for 2017; still well below 96 hour rule

for a CAH.

Staffing of hospitalist coverage and nursing staff has also stabilized.

Laboratory Services (volume down 3%)

Coverage is adequate.

*Complete Data Trend Report is attached

Performance Improvement Activities

Emergency Preparedness

The organization has made significant progress / improvements in the area of

Emergency Preparedness.

Construction project (Remodel 1) allowed PSMC to complete necessary

electrical coordination studies and work that was not completed with the

original construction, in 2008, of the facility. This work stabilized our

electrical grid and provided much needed redundancy. A second construction

project (Remodel 2) added ED and PACU capacities (ER increased by 2 beds

and PACU increased by 2 beds). Remodel 3 (Oncology) added three Phase-2

PACU beds and doubled the capacity for Infusion (to 6 bays). All listed

projects improve our ability to flex for capacity and surge as required by

Appendix Z.

PSMC planned for Active Shooter Training in 2017. Training and

policy/procedure for Active Shooter was completed in February 2018.

All (100%) emergency preparedness policies and procedures were reviewed

and revised. We added required policy and procedures for Communication

Failure, Water Failure and Winter Storm.

PSMC activated our Emergency Operations Plan five times in 2017. PSMC

activated for:

o Snow storm on 1.4.17;

o Fire Alarm on 6.1.17;

o Internet down on 6.2.17;

o Capacity/surge planning on 6.9.17;

o Phone outage on 9.7.17.

PSMC participated in a Statewide Emergency Preparedness Exercise in June

2017. This exercise tested the ability to activate the Emergency Operations

Center, develop a coordinated response strategy, and manage/sustain a

ORAL REPORTS 4a.iv.


7

response to a public health incident. It was also designed to test the ability

to effectively collect, synthesize, and share information with local and state

partners throughout the duration of the incident. State resources were also

able to test the ordering and acquisition of medicines and supplies from other

regions in the State.

Required Quality Reporting

2017 MIPS submission – PSMC completed a full MIPS submission for PY

2017, achieving a preliminary score of 96.8 out of 100 points. The score

enables the organization to receive up to a 4% positive payment adjustment

on professional fee billing in 2019. As part of MIPS Clinical Practice

Improvement Activities, PSMC created a referral coordinator workflow and

position to completely close the referral loop.

In 2017, PSMC successfully attested to the PY 2016 Medicare EHR Incentive

Program for Eligible Hospitals and the Medicaid EHR Incentive Program for

Eligible Providers.

CMS chart abstracted measures were submitted for all four quarters in

2017. Hospital eCQMs were submitted for Q1 2017.

Electronic Health Record

HIMSS 7 project – PSMC prepared for a HIMSS EMRAM Stage7 review

through much of the second half of 2017. The preparation focused on quality

areas such as closed loop medication and blood product administration;

timely scanning of medically relevant information; CPOE; and pharmacy

review processes. The project also included a comprehensive security review

as mandated by the new HIMSS 2018 rules. PSMC successfully achieved

HIMSS 7 status in early 2018.

Dragon Medical Optimization- several improvements were made to the

current medical dictation system and planning was initiated to replace the

system with more efficient cloud-based software in 2018.

Cerner optimization was completed for HIM; with large scale

optimizations/rebuilds scheduled for Revenue Cycle, Surgical Services, and

Charge Master revision already underway in 2018.

Patient Safety Activities

Blood Bank Bridge

o 145 units of blood, 3 units of platelets, and 2 units of fresh frozen

plasma were administered.

o PSMC has scanned blood prior to administration at 100% for the past

9 months.

Medication/Patient Scanning

ORAL REPORTS 4a.iv.


8

o Medication/Patient scanning in the Emergency Department and

Inpatient Unit remains consistent at 96%.

CPOE

o Remains consistent at 93%

Formation of Performance Improvement Committee consisting of leadership

representatives from all organizational departments. The purpose of this

committee is to vet and sanction all projects requiring resources from

multiple departments for completion. This allows alignment of projects to

organizational goals and the ability to pause or suspend projects when

organizational needs change or resources are needed elsewhere.

Leadership Huddles occur daily to address any identified issues/safety

concerns.

Infection Control Activities

Through active Infection Prevention and Control activities, PSMC emphasizes

patient safety as a top priority. PSMC performs regular surveillance and

reports all hospital associated infections to the National Health Safety

Network. PSMC reported zero MRSA and zero Clostridium difficile in 2017 as

well as zero catheter associated urinary tract infections. PMSC identified and

reported one surgical site infection. Prevention and education activities in

2017 included: hand hygiene staff education and surveillance, sharp safety

education, respiratory etiquette education, antimicrobial stewardship, active

mitigation of construction projects, and an employee influenza vaccination

rate of 96.6 percent.

Patient Satisfaction Efforts

Developed a Patient & Family Advisory Council consisting of representatives

from all patient facing departments and patients and/or family members

from the community. This council provides input to performance

improvement activities that reflect the needs and desires of our patients.

Changed vendors and survey delivery method for the HCAPHS Survey in an

effort to improve response rate by patients.

Conducted daily rounding on 100% of inpatient population, allowing for

immediate service recovery when appropriate, direct, real time patient

feedback and improved returns for HCAHPS survey.

Hired a professionally trained chef to manage our Dietary department

improving the quality, presentation and variety of food services offered.

Surgical Services created a department specific service analysis tool to

collect and improve patient satisfaction. All surgical patients receive post

service phone calls and all outpatient surgical patients receive a paper survey

with a pre-addressed, postage paid envelope to ensure easy returns to

ORAL REPORTS 4a.iv.


9

PSMC. This area of service receives consistently high marks, with almost all

surgical patients being pleased with their care.

Utilization Management Activities

PSMC continues to expand and refine its Utilization Management Program.

MGD Software, supporting Milliman criteria for determining medical necessity

and status of admission has been helpful in managing utilization.

Information Technology Support

We made a significant investment to upgrade our hospital IT servers which

had reached end of life. This new equipment allows us to support faster and

safer management of our virtual environment.

We purchased a second firewall allowing us to perform updates without

downtime, an important improvement in patient safety and staff

convenience.

We upgraded our antivirus and malware tool in response to the increased

number of healthcare hacking incidents.

Survey Preparedness

PSMC achieved a successful five year re-accreditation with the CDPHE in

October of 2017.

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

ORAL REPORTS 4a.iv.


10

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

All requested from providers, administration, nursing, risk management, and quality

All mortality cases (unexpected IP, all OP, ED, OR)

Medical Staff Additions

Primary FIRST NAME PRACTICE AREA GROUP NAME Albritton Ryan Teleradiology Radiology Imaging Associates

Black Michelle Teleradiology Radiology Imaging Associates

Bogitch Ray Teleneurology Blue Sky Neurology/HealthONE Virtual

Network

Bradford Ray Teleradiology Radiology Imaging Associates

Brown Anthony Teleradiology Radiology Imaging Associates

Burrell Christian Teleneurology Blue Sky Neurology/HealthONE Virtual

Network

Cole Judith Registered Nurse First

Assistant

Pagosa Springs Medical Center

Coursey Jr. Richard Teleradiology Radiology Imaging Associates

Cutter Darren Teleradiology Radiology Imaging Associates

Czuczman Gregory Teleradiology Radiology Imaging Associates

D'Amico Kelly Teleradiology Radiology Imaging Associates

ORAL REPORTS 4a.iv.


11

Dalesandro Mark Teleradiology Radiology Imaging Associates

Ensign Brian Licensed Clinical Social

Worker

Axis Health System

Fine Ananda-Kriiya Teleneurology Blue Sky Neurology/HealthONE Virtual

Network

Finke Whitney Teleradiology Radiology Imaging Associates

Fuller III Joseph Teleradiology Radiology Imaging Associates

Gipson Matthew Teleradiology Radiology Imaging Associates

Grande William Teleradiology Radiology Imaging Associates

Green Tyler Teleradiology Radiology Imaging Associates

Hong Yu Teleradiology Radiology Imaging Associats

Jacobsen Richard Licensed Clinical Social

Worker

Axis Health System

Kaminsky Ian Teleradiology Radiology Imaging Associates

Kirkpatrick Aaron Teleradiology Radiology Imaging Associates

Martin Gregory Teleradiology Radiology Imaging Associates

Medina Laura Surgery Pagosa Springs Medical Center / San Luis

Valley Regional Medical Center

Mullins Nathan Teleradiology Radiology Imaging Associates

Paris Brenda Radiology &

Teleradiology

Pagosa Springs Medical Center / Fort

Duncan Regional Medical Center

Pham Bong Family Medicine,

Emergency Medicine,

Hospitalist

Pagosa Springs Medical Center and Primary

Care Clinic / Cornerstar Primary Care

Reed Corinne Family Medicine &

Hospitalist


Reed Ralph Teleradiology Radiology Imaging Associates

Smith Maximilian Teleradiology Radiology Imaging Associates

Smoot Dustin Surgery Spearfish Regional Medical Center / Pagosa

Springs Medical Center

Spencer Elizabeth Teleradiology Radiology Imaging Associates (no longer on

staff)

Stopher-

Mitchell

Ryan Family

Medicine/Hospitalist


Stratil Peter Teleradiology Radiology Imaging Associates

Tinguely Roy Surgery Pagosa Springs Medical Center

Walker Sean Teleradiology Radiology Imaging Associates

Williams Adam Teleradiology Radiology Imaging Associates

Williams Jeffrey Plastic Surgery Jeffrey S. Williams, DO, FACOS, PC (no

longer on staff)

Woods Alyn Teleradiology Radiology Imaging Associates

Yee Dominic Teleradiology Radiology Imaging Associates

Yung Michael Teleradiology Radiology Imaging Associates

Policy and Procedure Review

ORAL REPORTS 4a.iv.


12

Pagosa Springs Medical Center utilizes a cloud-based software system for the

management of policies and procedures. At the beginning of 2017 there were 904

policies and procedures. 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.

In 2017, we added all district contracts and forms to the review process.

This brought our documents under review to 1762 by the end of December. We

anticipate that the number will fall as we review and determine which contracts are

still relevant to our current operations.

Other Notable Activities

Revenue Cycle Improvement

Revenue Cycle Issues Identified:

100% turnover in staff in patient financial services department;

Patient complaints increased;

Growing days in AR.

Revenue Cycle Corrective Actions:

Added new position of Revenue Cycle Director;

Made decision to replace part-time contracted CFO with a full-time CFO;

began search for new CFO;

Schedule Revenue Cycle Optimization with Cerner for early 2018 to improve

workflow/process in Revenue Cycle;

Scheduled Charge Master Optimization with Cerner for early 2018 to

strengthen financial positioning; competitive pricing review will also begin in

2018.

ORAL REPORTS 4a.iv.

of 2

Finance Committee & CFO Report,

USJHSD Board Meeting on June 26, 2018

This report provides highlights of PSMC’s May financials and the discussions of the Board’s

Finance Committee that met on June 18th

.

1) May Top Line: Gross charges surpassed May of 2017 by $450,863; despite increasing gross

revenues by 9.07% over last May, we fell short of our May budget goal by $157K.

2) Revenues:

a) May gross charges were under budget in several departments as follows:

i) Inpatient and Outpatient Surgery including professional fees, $117K;,

ii) Emergency Room $36K;

iii) Clinic $153K;

iv) Inpatient $112K.

b) Gross charges exceeding budget were:

i) Diagnostic Imaging $215K;

ii) Ambulance $17K;

iii) Lab $21K;

iv) Other $92K.

c) Other operating income slightly exceeded budget by $49K:

i) 340B revenues exceeded budget in May by $17K;

ii) EHR Meaningful use by $31K.

3) Revenue Deductions and Bad Debt: On a positive note, payer contractual allowances were

under budget by $111K or 5%; this is commensurate to the under budget variance in gross

charges. Unfortunately, Charity Care was over budget by $33K, but Bad Debt was under by

$36K thus offsetting the charity care overage.

4) Expenses:

a) Also on a positive note, PSMC held operating expenses down to $2.90MM which was

$67K or 2% under budget. The expenses associated with this variance were:

i) Compensation was under slightly by $28K, but there were some department

variations:

(1) Clinic was under by $57K;

(2) Ambulance was over by $49K.

ii) Benefit expense was under budget by $3K, mostly related to worker comp being

under by 7K and retirement being over by $8K.

iii) Supplies were over budget by $4K for the month mainly due to Pharmacy 340B and

Surgery.

iv) Utilities were under budget by $13K due to plant operations proactively managing

utility costs.

v) Other expense was under budget by $34K.

ORAL REPORTS 4a.v.

of 2

5) May bottom line: The operating gain for the month was 31K greater than budgeted,

primarily due to management of expenses. Total Gain for the month was 304K, which was

42K greater than budget.

6) Cash and collections:

a) We finished May with $3.64 MM in operating cash, compared with $4.05 MM in April

2018. As predicted, cash will be tight for the rest of the year relative to our bond

covenants to have 70 days cash on hand on December 31. We have filed out 2017 cost

report and owe $115,098 paid out in May. This was $638,018 less than projected. We

have requested all staff to endeavor to spend less than their budgets and hold expenses

down. Capital will be restricted to absolute essential items.

b) Patient collections were $2.04 MM for the month, $259K less than forecast.

c) PSMC’s gross accounts receivable balance increased $1.5MM to $10.05MM. Part of the

balance in A/R relates to Medicaid EAPG issue with their claims processing system.

Also, staffing changes (new leader who is first focusing on system changes and some

staff departures/replacements) in the business office has caused a slight delay in working

the A/R.

7) Other – Audit of 2017 Financials:

a) Mike Nelson with Chadwick, Steinkirchner, Davis & Co., P.C. went over the 2017

audited financial statements and noted that the audit went well, the PSMC staff provided

everything that was requested and no disagreements arose during the course of the audit.

The auditor concluded that (1) revenues and expense were as expected and within the

guidelines of budget requirements, and (2) staff has presented the financial statements

fairly in all material respects and in accordance with generally accepted accounting

principles.

ORAL REPORTS 4a.v.

2018 Budget Difference Variance 2018 Budget Difference VarianceRevenue

2 In-patient Revenue

3 In-Patients 247,129$ 359,390$ (112,261)$ -31% 1,401,849$ 1,509,438$ (107,589)$ -7%

4 Surgery 155,892 252,723$ (96,831)$ -38% 846,321 1,121,840$ (275,519)$ -25%

5 Swing Beds - - - - - -

6 Total In-patient Revenue 403,021 612,113 (209,092) -34% 2,248,170 2,631,278 (383,108) -15%

8 Out-patient Revenue

9 ER 739,263 775,048 (35,785) -5% 3,452,887 3,778,359 (325,472) -9%

10 Lab 527,316 505,912 21,404 4% 2,536,965 2,592,799 (55,834) -2%

11 Ambulance 175,141 157,843 17,298 11% 975,092 901,960 73,132 8%

12 Clinic 375,177 529,022 (153,845) -29% 1,841,541 2,578,984 (737,443) -29%

13 Imaging 918,625 704,080 214,545 30% 4,149,577 3,479,262 670,315 19%

14 Surgery 426,648 437,055 (10,407) -2% 1,873,621 2,150,894 (277,273) -13%

15 Oncology 270,209 267,858 2,351 1% 750,969 803,574 (52,605) -7%

16 Other 533,038 440,873 92,165 21% 2,263,783 1,972,379 291,404 15%

17 Total Out-patient Revenue 3,965,417 3,817,691 147,726 4% 17,844,435 18,258,211 (413,776) -2%-

18 Professional Fees 491,730 587,659 (95,929) -16% 2,149,362 2,697,967 (548,605) -20%-

19 Total Patient Revenue 4,860,168 5,017,463 (157,295) -3% 22,241,967 23,587,456 (1,345,489) -6%

20 Revenue Deductions & Bad Debt

21 Contractual Allowances 2,148,775 2,259,819 (111,044) -5% 9,730,062 10,661,945 (931,883) -9%

22 Charity 51,596 19,061 32,535 171% 148,259 89,932 58,327 65%

23 Bad Debt 100,980 136,992 (36,012) -26% 622,410 646,339 (23,929) -4%

24 Provider Fee & Other (145,078) (182,822) 37,744 -21% (724,254) (914,111) 189,857 -21%

25 Total Revenue Deductions & Bad Debt 2,156,273 2,233,050 (76,777) -3% 9,776,477 10,484,105 (707,628) -7%

26 Total Net Patient Revenue 2,703,895 2,784,413 (80,518) -3% 12,465,490 13,103,351 (637,861) -5%

27 Grants - 5,167 (5,167) -100% (5,759) 25,833 (31,592) -122%

28 Other Operating Income - Misc 233,318 184,140 49,178 27% 1,054,104 903,247 150,857 17%

29 Total Net Revenues 2,937,213 2,973,720 (36,507) -1% 13,513,835 14,032,431 (518,596) -4%

30 Operating Expenses

31 Salary & Wages 1,569,432 1,597,081 (27,649) -2% 7,745,925 7,830,947 (85,022) -1%

32 Benefits 257,909 261,231 (3,322) -1% 1,305,129 1,326,426 (21,297) -2%

33 Professional Fees 40,745 29,915 10,830 36% 109,450 144,459 (35,009) -24%

34 Contract Labor 60,088 29,427 30,661 104% 231,578 200,935 30,643 15%

35 Purchased Services 120,529 121,831 (1,302) -1% 619,206 599,688 19,518 3%

36 Supplies 379,611 375,156 4,455 1% 1,742,182 1,642,188 99,994 6%

37 Rent & Leases 3,632 51,189 (47,557) -93% 217,500 255,738 (38,238) -15%

38 Repairs & Maintenance 36,876 36,059 817 2% 214,524 181,258 33,266 18%

39 Utilities 27,651 40,698 (13,047) -32% 161,378 232,969 (71,591) -31%

40 Insurance 21,038 18,250 2,788 15% 81,029 91,250 (10,221) -11%

41 Depreciation & Amortization 191,015 186,463 4,552 2% 954,143 944,315 9,828 1%

42 Interest 93,032 87,133 5,899 7% 441,899 435,665 6,234 1%

43 Other 95,329 129,564 (34,235) -26% 535,609 627,908 (92,299) -15%

44 Total Operating Expenses 2,896,887 2,963,997 (67,110) -2% 14,359,552 14,513,747 (154,195) -1%

45 Operating Revenue Less Expenses 40,326 9,723 30,603 315% (845,717) (481,316) (364,401) 76%

46 Non-Operating Income

47 Tax Revenue 264,023 227,430 36,593 16% 827,694 766,080 61,614 8%

48 Donations - 25,000 (25,000) -100% 5,000 125,000 (120,000) -96%

49 Total Non-Operating Income 264,023 252,430 11,593 5% 832,694 891,080 (58,386) -7%

50 Total Revenue Less Total Expenses 304,349$ 262,153$ 42,196$ 16% (13,023)$ 409,764$ (422,787)$ -103%

Current Month Year-to-DateIncome Statement - - - May 31, 2018

Pagosa Springs Medical Center ORAL REPORTS 4a.v.

2018 2017 Difference Variance 2018 2017 Difference Variance

Revenue

2 In-patient Revenue

3 In-Patients 247,129$ 366,151$ (119,022)$ -33% 1,401,849$ 1,467,525$ (65,676)$ -4%

4 Surgery 155,892 280,681$ (124,789)$ -44% 846,321 1,133,045$ (286,724)$ -25%

5 Swing Beds - - - - 6,683 (6,683) -100%

6 Total In-patient Revenue 403,021 646,832 (243,811) -38% 2,248,170 2,607,253 (359,083) -14%

7 Out-patient Revenue

8 ER 739,263 743,385 (4,122) -1% 3,452,887 3,610,163 (157,276) -4%

9 Lab 527,316 484,197 43,119 9% 2,536,965 2,444,507 92,458 4%

10 Ambulance 175,141 160,114 15,027 9% 975,092 874,769 100,323 11%

11 Clinic 375,177 308,215 66,962 22% 1,841,541 1,525,997 315,544 21%

12 Imaging 918,625 709,954 208,671 29% 4,149,577 3,367,321 782,256 23%

13 Surgery 426,648 371,881 54,767 15% 1,873,621 2,179,726 (306,105) -14%

14 Oncology 270,209 - 270,209 100% 750,969 - 750,969 100%

15 Other 533,038 370,466 162,572 44% 2,263,783 1,815,100 448,683 25%

16 Total Out-patient Revenue 3,965,417 3,148,212 817,205 26% 17,844,435 15,817,583 2,026,852 13%

- -

17 Professional Fees 491,730 614,261 (122,531) -20% 2,149,362 2,987,099 (837,737) -28%

- -

18 Total Patient Revenue 4,860,168 4,409,305 450,863 10% 22,241,967 21,411,935 830,032 4%

19 Revenue Deductions & Bad Debt

20 Contractual Allowances 2,148,775 2,165,410 (16,635) -1% 9,730,062 10,243,247 (513,185) -5%

21 Charity 51,596 36,463 15,133 42% 148,259 108,868 39,391 36%

22 Bad Debt 100,980 112,729 (11,749) -10% 622,410 574,244 48,166 8%

23 Provider Fee & Other (145,078) (280,739) 135,661 -48% (724,254) (709,063) (15,191) 2%

24 Total Revenue Deductions & Bad Debt 2,156,273 2,033,863 122,410 6% 9,776,477 10,217,296 (440,819) -4%

25 Total Net Patient Revenue 2,703,895 2,375,442 328,453 14% 12,465,490 11,194,639 1,270,851 11%

26 Grants - 104,167 (104,167) -100% (5,759) 466,042 (471,801) -101%

27 Other Operating Income - Misc 233,318 184,766 48,552 26% 1,054,104 848,344 205,760 24%

28 Total Net Revenues 2,937,213 2,664,375 272,838 10% 13,513,835 12,509,025 1,004,810 8%

29 Operating Expenses

30 Salary & Wages 1,569,432 1,383,660 185,772 13% 7,745,925 6,713,965 1,031,960 15%

31 Benefits 257,909 246,409 11,500 5% 1,305,129 1,214,247 90,882 7%

32 Professional Fees 40,745 20,106 20,639 103% 109,450 173,268 (63,818) -37%

33 Contract Labor 60,088 63,062 (2,974) -5% 231,578 288,193 (56,615) -20%

34 Purchased Services 120,529 122,066 (1,537) -1% 619,206 610,070 9,136 1%

35 Supplies 379,611 303,367 76,244 25% 1,742,182 1,285,622 456,560 36%

36 Rent & Leases 3,632 49,566 (45,934) -93% 217,500 236,917 (19,417) -8%

37 Repairs & Maintenance 36,876 36,008 868 2% 214,524 174,301 40,223 23%

38 Utilities 27,651 28,755 (1,104) -4% 161,378 196,131 (34,753) -18%

39 Insurance 21,038 25,183 (4,145) -16% 81,029 83,194 (2,165) -3%

40 Depreciation & Amortization 191,015 145,152 45,863 32% 954,143 625,065 329,078 53%

41 Interest 93,032 73,518 19,514 27% 441,899 294,430 147,469 50%

42 Other 95,329 165,458 (70,129) -42% 535,609 571,265 (35,656) -6%

43 Total Operating Expenses 2,896,887 2,662,310 234,577 9% 14,359,552 12,466,668 1,892,884 15%

44 Operating Revenue Less Expenses 40,326 2,065 38,261 1853% (845,717) 42,357 (888,074) ##########

45 Non-Operating Income

46 Tax Revenue 264,023 227,547 36,476 16% 827,694 753,238 74,456 10%

47 Donations - 50,000 (50,000) -100% 5,000 225,276 (220,276) -98%

48 Total Non-Operating Income 264,023 277,547 (13,524) -5% 832,694 978,514 (145,820) -15%

49 Total Revenue Less Total Expenses 304,349$ 279,612$ 24,737$ 9% (13,023)$ 1,020,871$ (1,033,894)$ -101%


Income Statement Comparison - - - May 31, 2018 Current Month Year-to-Date

ORAL REPORTS 4a.v.

Current Prior Current Prior

1 Assets Month Month Liabilities Month Month

2 Current Assets Current Liabilities

3 Cash

4 Operating 1,951,102$ 3,177,574$ Accts Payable - System 359,458$ 344,844$

5 Debt Svc. Res. 2016 Bonds 878,731 878,731 Accrued Expenses 1,705,308 1,356,195

6 Bond Funds - 2016 Bonds 566,440 11 Cost Report Settlement Res 1,241,064 1,512,285

7 Bond Funds - 2006 & 2007 1,092,335 840,941 Wages & Benefits Payable 1,023,691 861,237

8 Capital Escrow 28,614 28,583 Deferred Revenue 256,613 288,462

9 Total Cash 4,517,223 4,925,840 Current Portion of LT Debt-2006,2007 290,000 290,000

10 Current Portion of LT Debt-2016 300,000 300,000

11 Accounts Receivable Total Current Liabilities 5,176,134 4,953,023

12 Patient Revenue - Net 4,871,459 4,329,173

13 Other Receivables 266,435 246,605 Long-Term Liabilities

14 Total Accounts Receivable 5,137,894 4,575,778 Leases Payable 366,872 111,957

15 Equipment Lease (Wells Fargo) 405,477 413,358

16 Inventory 1,246,613 1,251,333 Bond Premium (Net) - 2007 253,573 254,685

17 Bond Premium (Net) - 2016 142,314 142,739

18 Total Current Assets 10,901,730 10,752,951 Bonds Payable - 2006 - 2007 9,330,000 9,330,000

19 Bonds Payable - 2016 10,545,000 10,545,000

20 Fixed Assets Total Long-Term Liabilities 21,043,236 20,797,739

21 Property Plant & Equip (Net) 10,545,900 10,179,236

22 Electronic Health Record (Net) 304,349 341,811 Net Assets

23 Clinic Expansion 13,381,964 13,377,405 Un-Restricted 9,393,914 9,626,227

24 Work In Progress 10,945 10,945 Current Year Net Income/Loss (13,023) (317,372)

25 Land 101,000 101,000 Total Un-Restricted 9,380,891 9,308,855

26 Total Fixed Assets 24,344,158 24,010,397

27 Restricted

28 Other Assets Total Net Assets 9,380,891 9,308,855

29 Prepaids & Other Assets 354,373 296,269

30 Total Other Assets 354,373 296,269

31

32 Total Assets 35,600,261$ 35,059,617$ Total Liabilities & Net Assets 35,600,261$ 35,059,617$

Balance Sheet - - - May 31, 2018


ORAL REPORTS 4a.v.

May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May YTD Total

Activity 31 30 31 31 30 31 30 31 31 28 31 30 31 151

2 In-Patient Admissions 37 34 41 47 32 31 26 37 50 41 44 34 33 202

3 In-Patient Days 126 91 124 122 84 88 87 105 113 107 130 87 88 525

4 Avg Stay Days (In-patients) 3.4 2.7 3.0 2.6 2.6 2.8 3.3 2.8 2.3 2.6 3.0 2.6 2.7 2.6

5 Swing Bed Admissions 0 0 0 0 1 0 2 0 0 0 0 0 0 -

6 Swing Bed Days 0 0 0 0 2 0 17 0 0 0 0 0 0 -

7 Avg Length of Stay (Swing) 0.0 0.0 0.0 0.0 2.0 0.0 8.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0

8 Average Daily Census 4.1 3.0 4.0 3.9 2.9 2.8 3.5 3.4 3.6 3.8 4.2 2.8 2.8 3.5

Out-Patient Visits

9 E/R 660 798 908 764 678 578 522 627 619 532 554 470 532 2,707

10 Observ 37 34 32 25 32 31 27 30 29 28 38 30 39 164

11 Lab 1,650 1,698 1,695 1,784 1,605 1,533 1,379 1,435 1,735 1,460 1,627 1,487 1,646 7,955

12 Radiology/CT/MRI 932 927 986 976 908 967 813 911 1,011 879 984 831 938 4,643

13 OR/IP 8 7 13 11 7 8 4 12 12 5 9 8 8 42

14 OR/OP 71 78 65 87 66 88 75 65 71 66 71 71 81 360

15 Clinic 1,578 1,430 1,261 1,537 1,901 1,945 1,871 1,824 2,323 1,965 2,116 1,998 2,040 10,442

16 Spec. Clinic 409 375 433 479 68 77 166 146 57 77 86 98 112 430

17 Oncology Clinic 38 40 41 55 174

18 Oncology/Infusion 3 41 10 53 107

19 Infusion 30 44 42 43 25 32 50 57 97 84 73 91 70 415

20 Total O/P Visits 5,577 5,594 5,669 5,958 5,596 5,512 4,893 5,107 5,942 5,132 5,630 5,127 5,566 27,439

21 EMS Calls 146 201 184 202 163 116 134 178 164 136 161 123 171 755

22 EMS Transports 72 110 101 121 86 54 73 95 90 75 96 68 100 429

23 EMS Transports to PMH 49 75 71 75 56 33 43 62 53 43 59 37 57 249

24 Pct Transports to PMH 68% 68% 70% 62% 65% 61% 59% 65% 59% 57% 61% 54% 57% 58%

Revenue25 In-Patients 366,151$ 242,861$ 337,334$ 319,365$ 227,766$ 227,413$ 231,570$ 302,748$ 344,672$ 278,928$ 307,554$ 223,567$ 247,129$ 1,401,850

26 I/P Surgery 280,681$ 175,872$ 423,059$ 306,960$ 195,482$ 242,078$ 88,793$ 285,868$ 287,279$ 73,059$ 194,021$ 136,070$ 155,892$ 846,321

27 Swing Beds -$ -$ -$ -$ 989$ 2,318$ 21,677$ 13,273$ -$ -$ -$ -$ -$ -

28 Lab O/P 484,197$ 533,979$ 543,729$ 570,171$ 547,345$ 484,081$ 460,926$ 463,811$ 509,294$ 478,845$ 523,775$ 497,734$ 527,316$ 2,536,964

29 Radiology 154,742$ 159,669$ 163,253$ 163,044$ 190,331$ 183,100$ 183,663$ 183,663$ 219,592$ 178,207$ 194,480$ 174,830$ 185,643$ 952,752

30 CT 340,908$ 372,458$ 467,423$ 392,934$ 332,145$ 310,099$ 292,228$ 292,228$ 354,338$ 307,840$ 426,511$ 413,970$ 436,799$ 1,939,458

31 MRI 146,044$ 135,822$ 169,326$ 161,779$ 142,461$ 200,878$ 159,587$ 159,587$ 174,140$ 174,022$ 171,145$ 174,294$ 231,488$ 925,089

32 Ultrasound 47,255$ 42,406$ 37,310$ 26,952$ 34,018$ 49,805$ 38,303$ 38,303$ 46,483$ 42,541$ 51,880$ 36,196$ 47,220$ 224,320

33 Mammography 20,806$ 23,574$ 18,755$ 25,357$ 22,038$ 48,639$ 23,078$ 23,078$ 16,703$ 21,584$ 29,605$ 22,591$ 17,475$ 107,958

34 Surgery 371,881$ 389,696$ 394,079$ 547,732$ 317,183$ 473,993$ 373,060$ 339,314$ 377,587$ 297,122$ 441,192$ 331,072$ 426,648$ 1,873,621

35 ER O/P 743,385$ 897,090$ 978,091$ 832,785$ 735,966$ 644,462$ 584,119$ 722,278$ 754,223$ 647,621$ 722,594$ 589,186$ 739,263$ 3,452,887

36 Other Out-patients 69,091$ 87,725$ 66,445$ 57,805$ 63,306$ 73,432$ 40,240$ 136,929$ 67,790$ 76,101$ 69,919$ 57,900$ 88,087$ 359,797

37 Oncology/Infusion 37,458$ 234,317$ 208,662$ 270,209$ 750,646

38 Infusion 216,906$ 276,079$ 236,958$ 266,384$ 228,824$ 226,112$ 205,920$ 205,920$ 304,683$ 260,564$ 190,671$ 176,524$ 271,043$ 1,203,485

39 Pharmacy O/P 84,668$ 81,152$ 122,541$ 132,526$ 97,126$ 133,619$ 135,484$ 135,484$ 164,335$ 105,699$ 148,217$ 108,665$ 173,908$ 700,824

40 Clinic 308,215$ 290,638$ 242,569$ 324,606$ 356,845$ 395,148$ 340,011$ 342,910$ 392,028$ 357,111$ 340,760$ 376,465$ 375,177$ 1,841,541

41 Spec. Clinic 197,605$ 147,795$ 170,843$ 204,779$ 7,027$ 7,027$ 7,027$ 7,027$ 34,266$ 14,586$ 14,646$ 16,209$ 19,023$ 98,730

42 Oncology Clinic 5,599$ 8,502$ 6,948$ 20,238$ 41,287

43 Physician Fees 416,656$ 404,576$ 500,712$ 537,357$ 369,639$ 418,577$ 349,183$ 373,368$ 417,804$ 317,464$ 465,745$ 355,863$ 452,469$ 2,009,345

44 Ambulance 160,114$ 198,577$ 207,072$ 156,993$ 254,698$ 127,295$ 141,816$ 139,318$ 227,496$ 155,307$ 239,725$ 177,424$ 175,141$ 975,093

45 Total 4,409,305$ 4,459,969$ 5,079,499$ 5,027,529$ 4,123,189$ 4,248,076$ 3,676,685$ 4,165,107$ 4,692,713$ 3,829,658$ 4,775,259$ 4,084,170$ 4,860,168$ 22,241,966

Monthly Trends

ORAL REPORTS 4a.v.

1 In-Patient

2 Admissions:

3 Acute 33 43 (10) 202 181 21 202 178 24 13%

4 Swing Bed - - - - - - - 2 (2) -100%

5 Total 33 43 (10) 202 181 21 202 180 22 12%

7 Patient Days:

8 Acute 88 133 (45) 525 558 (33) 525 515 10 2%

9 Swing Bed - - - - - - - 8 (8) -100%

10 Total 88 133 (45) 525 558 (33) 525 523 2 0%

12 Average Daily Census:

13 # Of Days 31 31 151 151 151 151

14 Acute 2.8 4.3 (1.5) 3.5 3.7 (0.2) 3.5 3.4 0.1 2%

15 Swing Bed - - - - - - - 0.1 (0.1) -100%

16 Total 2.8 4.3 (1.5) 3.5 3.7 (0.2) 3.5 3.5 0.0 0%

18 Length of Stay:

19 Acute 2.7 3.1 (0.4) 2.6 3.1 (0.5) 2.6 2.9 (0.3) -10%

20 Swing Bed #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 4.0 #DIV/0! 0%

21 Total 2.7 3.1 (0.4) 2.6 3.1 (0.5) 2.6 2.9 (0.3) -11%

23 Revenue:

24 Acute 403,021 612,113 (209,092) 2,248,170 2,631,278 (383,108) 2,248,170 2,600,570 (352,400) -14%

25 Swing Bed - - - - - - - 6,683 (6,683) -100%

26 Total 403,021 612,113 (209,092) 2,248,170 2,631,278 (383,108) 2,248,170 2,607,253 (359,083) -14%

28 Revenue Per Pat Day:

29 Acute 4,580 4,602 (23) 4,282 4,716 (433) 4,282 5,050 (767) -15%

30 Swing Bed #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 835 #DIV/0! #DIV/0!

31 Total 4,580 4,602 (23) 4,282 4,716 (433) 4,282 4,985 (703) -14%

33 Out-Patient

34 Out-Patient Visits

35 E/R 532 653 (121) 2,707 3,182 (475) 2,707 3,142 (435) -14%

36 Observ 39 29 10 164 143 21 164 148 16 11%

37 Lab 1,646 1,552 94 7,955 7,954 1 7,955 7,813 142 2%

38 Radiology/MRI/US/CT 938 1,024 (86) 4,643 5,222 (579) 4,643 4,408 235 5%

39 OR 81 76 5 402 372 30 402 432 (30) -7%

40 Clinic 2,040 2,492 (452) 10,442 12,150 (1,708) 10,442 8,859 1,583 18%

41 Oncology Clinic 55 57 (2) 174 188 (14) 174 - 174 #DIV/0!

42 Oncology Infusion 53 4 49 107 11 96 107 - 107 #DIV/0!

43 Infusion 70 27 43 415 114 301 415 159 256 161%

44 Total 5,454 5,914 (460) 27,009 29,336 (2,327) 27,009 24,961 2,048 8%

45 Spec. Clinic 112 127 (15) 430 491 (61) 430 1,876 (1,446) -77%

46 ER Physician 532 653 (121) 2,707 3,182 (475) 2,707 3,142 (435) -14%

47 Out-Patient Revenue

48 E/R 690,224 704,952 (14,728) 3,291,399 3,436,641 (145,242) 3,291,399 3,283,094 8,305 0%

49 Observ 49,039 70,096 (21,057) 161,488 341,718 (180,230) 161,488 327,069 (165,581) -51%

50 Lab 527,316 505,912 21,404 2,536,965 2,592,799 (55,834) 2,536,965 2,444,507 92,458 4%

51 Radiology 185,643 158,808 26,835 952,752 794,040 158,712 952,752 766,260 186,492 24%

52 CT 436,799 329,104 107,695 1,939,458 1,604,382 335,076 1,939,458 1,554,330 385,128 25%

53 Ultrasound 47,220 45,208 2,012 224,320 226,040 (1,720) 224,320 223,972 348 0%

54 MRI 231,488 148,592 82,896 925,089 742,960 182,129 925,089 714,533 210,556 29%

55 Mammography 17,475 22,368 (4,893) 107,958 111,840 (3,882) 107,958 108,226 (268) 0%

56 OR 426,648 437,055 (10,407) 1,873,621 2,150,894 (277,273) 1,873,621 2,179,726 (306,105) -14%

57 Clinic 375,177 529,022 (153,845) 1,841,541 2,578,984 (737,443) 1,841,541 1,525,997 315,544 21%

58 Oncology Clinic 20,238 82,071 (61,833) 41,287 246,213 (204,926) 41,287 - 41,287 #DIV/0!

59 Oncology Infusion 270,209 267,858 2,351 750,969 803,574 (52,605) 750,969 - 750,969 #DIV/0!

60 Other 533,038 440,873 92,165 2,263,783 1,972,379 291,404 2,263,783 1,815,100 448,683 25%

61 Total 3,810,514 3,741,919 68,595 16,910,630 17,602,464 (691,834) 16,910,630 14,942,814 1,967,816 13%

62 Spec. Clinic 19,023 36,674 (17,651) 98,730 192,536 (93,806) 98,730 719,131 (620,401) -86%

63 Physician 432,231 386,843 45,388 1,968,058 2,013,005 (44,947) 1,968,058 2,267,968 (299,910) -13%

64 Total 471,492 505,588 (34,096) 2,108,075 2,451,754 (343,679) 2,108,075 2,987,099 (879,024) -29%

65 Ambulance

66 Ambulance Calls 171 755 755 826 (71) -9%

67 Ambulance Transports 100 429 429 441 (12) -3%

68 Transports to PMH 57 78 249 456 (207) 249 287 (38) -13%

69 Transports to PMH % 57% 58% 58% 65%

70 Transports to Other 43 180 180 154 26

71 Transports to Other % 43% 42% 42% 35%

72 Revenue: 175,141 157,843 17,298 975,092 901,960 73,132 975,092 874,769 100,323 11%

73 Revenue Per Transport: 1,751 2,273 2,273 1,984 289 15%

74 Total Revenues 4,860,168 5,017,463 (157,295) 22,241,967 23,587,456 (1,345,489) 22,241,967 21,411,935 830,032 4%

Pagosa Springs Medical Center - - - Statistical Review

Statistical ReviewMay Prior Y-T-D

VarianceY-T-D Actual

Prior Y-T-D

Actual Difference

Current Month

Actual

Current Month

Budget Variance

Y-T-D

Actual Y-T-D Budget Variance2018

May May

ORAL REPORTS 4a.v.

0-30 Days 31-60 Days 61-90 Days 91-120 Days 121-150 Days 151-180 Days 181+ Days TotalPercent of

Total

Accts sent to

Collections

2 Medicare 1,545,346$ 346,111$ 278,306$ 109,141$ 109,906$ 89,050$ 267,167$ 2,745,027$ 25%

3 Medicaid 943,041 581,518 287,927 175,127 114,418 68,804 296,358 2,467,193 22%

4 Third Party 1,483,359 707,575 508,741 334,235 329,766 196,397 862,974 4,423,047 40%

5 Self-Pay 187,259 159,955 133,360 103,458 115,951 141,396 577,317 1,418,696 13%

Current Month Total 4,159,005$ 1,795,159$ 1,208,334$ 721,961$ 670,041$ 495,647$ 2,003,816$ 11,053,963$ 100%Pct of Total 38% 16% 11% 7% 6% 4% 18% 100% 47,472

Apr-18 3,697,643$ 1,605,576$ 863,079$ 713,382$ 586,190$ 391,762$ 1,698,496$ 9,556,128$ Pct of Total 39% 17% 9% 7% 6% 4% 18% 100% 256,717

Mar-18 3,922,575$ 1,408,723$ 1,095,293$ 660,255$ 439,343$ 299,008$ 1,759,366$ 9,584,563$ Pct of Total 41% 15% 11% 7% 5% 3% 18% 100% 139,778

Feb-18 3,744,129$ 1,569,800$ 882,931$ 495,048$ 310,715$ 273,375$ 1,772,313$ 9,048,312$ Pct of Total 41% 17% 10% 5% 3% 3% 20% 100% 40,116

Jan-18 3,910,094$ 1,418,969$ 658,794$ 398,631$ 399,145$ 263,261$ 1,774,826$ 8,823,719$ Pct of Total 44% 16% 7% 5% 5% 3% 20% 100% 33,378

Dec-17 3,530,341$ 998,668$ 567,335$ 594,879$ 431,479$ 322,934$ 1,657,210$ 8,102,848$ Pct of Total 44% 12% 7% 7% 5% 4% 20% 100% 825,723

Nov-17 2,955,885$ 1,037,274$ 679,925$ 592,310$ 581,053$ 435,072$ 1,984,898$ 8,266,421$ Pct of Total 36% 13% 8% 7% 7% 5% 24% 100% 26,231

Oct-17 3,659,774$ 1,357,490$ 752,198$ 717,416$ 562,600$ 312,224$ 1,893,353$ 9,255,056$ Pct of Total 40% 15% 8% 8% 6% 3% 20% 100% 218,112

Sep-17 3,724,332$ 1,319,138$ 1,012,183$ 671,452$ 445,286$ 377,867$ 2,175,487$ 9,725,747$ Pct of Total 38% 14% 10% 7% 5% 4% 22% 100% 407,406

Aug-17 4,131,866$ 1,552,324$ 893,339$ 624,164$ 490,221$ 431,099$ 2,449,394$ 10,572,407$ Pct of Total 39% 15% 8% 6% 5% 4% 23% 100% 341,071

Jul-17 4,612,446$ 1,520,180$ 853,133$ 632,738$ 581,650$ 552,521$ 2,298,997$ 11,051,665$ Pct of Total 42% 14% 8% 6% 5% 5% 21% 100% 103,289

Jun-17 3,963,167$ 1,339,294$ 815,790$ 672,144$ 657,236$ 453,649$ 2,101,821$ 10,003,101$ Pct of Total 40% 13% 8% 7% 7% 5% 21% 100% 129,723

May-17 3,851,718$ 1,136,727$ 1,030,085$ 770,865$ 477,918$ 354,848$ 1,972,569$ 9,594,730$ Pct of Total 40% 12% 11% 8% 5% 4% 21% 100% 115,443

Apr-17 3,715,423$ 1,582,605$ 1,084,223$ 603,091$ 399,012$ 291,308$ 2,050,804$ 9,726,466$ Pct of Total 38% 16% 11% 6% 4% 3% 21% 100% 391,892

Mar-17 4,190,300$ 1,476,093$ 845,465$ 450,529$ 318,443$ 363,942$ 2,029,126$ 9,673,898$ Pct of Total 43% 15% 9% 5% 3% 4% 21% 100% 0

Feb-17 4,118,151$ 1,272,761$ 590,336$ 392,685$ 385,021$ 394,030$ 1,866,977$ 9,019,961$ Pct of Total 46% 14% 7% 4% 4% 4% 21% 100% 0

Jan-17 3,903,716$ 1,275,933$ 638,686$ 542,660$ 408,051$ 312,916$ 1,820,997$ 8,902,959$ Pct of Total 44% 14% 7% 6% 5% 4% 20% 100% 54,380

Dec-16 3,569,381$ 1,061,155$ 624,981$ 563,713$ 386,633$ 403,217$ 1,661,787$ 8,270,867$ Pct of Total 43% 13% 8% 7% 5% 5% 20% 100% 139,709

Nov-16 3,196,929$ 998,953$ 706,433$ 458,215$ 478,558$ 358,900$ 1,593,016$ 7,791,004$ Pct of Total 41% 13% 9% 6% 6% 5% 20% 100% 63,666

Oct-16 3,343,126$ 1,312,061$ 660,139$ 577,590$ 462,334$ 292,221$ 1,556,264$ 8,203,735$ Pct of Total 41% 16% 8% 7% 6% 4% 19% 100% 191,933

Sep-16 3,478,889$ 1,077,619$ 766,497$ 581,171$ 324,927$ 329,817$ 1,555,750$ 8,114,670$ Pct of Total 43% 13% 9% 7% 4% 4% 19% 100% 256,871

Aug-16 3,557,335$ 1,258,133$ 847,083$ 423,465$ 404,148$ 378,585$ 1,657,660$ 8,526,409$ Pct of Total 42% 15% 10% 5% 5% 4% 19% 100% 155,972

Jul-16 4,093,214$ 1,327,138$ 604,400$ 505,062$ 500,035$ 345,651$ 1,564,559$ 8,940,059$ 189,900Pct of Total 46% 15% 7% 6% 6% 4% 18% 100%

Jun-16 3,915,816$ 1,156,527$ 659,519$ 629,495$ 427,962$ 273,181$ 1,704,197$ 8,766,697$ 320,532Pct of Total 45% 13% 8% 7% 5% 3% 19% 100%

May-16 3,225,508$ 1,308,267$ 917,550$ 579,643$ 352,089$ 454,695$ 1,737,234$ 8,574,986$ 333,330Pct of Total 38% 15% 11% 7% 4% 5% 20% 100%

Apr-16 3,410,161$ 1,449,555$ 770,572$ 554,188$ 493,848$ 396,389$ 1,987,516$ 9,062,229$ 383,504Pct of Total 38% 16% 9% 6% 5% 4% 22% 100%

Mar-16 3,780,550$ 1,374,822$ 729,414$ 612,294$ 466,202$ 463,162$ 1,792,075$ 9,218,519$ 383,504Pct of Total 41% 15% 8% 7% 5% 5% 19% 100%

Feb-16 3,650,243$ 1,253,476$ 904,869$ 542,569$ 563,303$ 385,746$ 2,013,618$ 9,313,824$ 394,830Pct of Total 39% 13% 10% 6% 6% 4% 22% 100%

Jan-16 3,885,604$ 1,601,129$ 816,090$ 809,381$ 590,439$ 439,770$ 2,457,903$ 10,600,316$ 421,442Pct of Total 37% 15% 8% 8% 6% 4% 23% 100%

12 Pct Settled (Current) 51.5% 24.7% 16.4% 6.1% 15.4% -411.5%

13 Pct Settled (April from March) 59.1% 38.7% 34.9% 11.2% 10.8% -468.0%

14 Pct Settled (March from Feb) 62.4% 30.2% 25.2% 11.3% 3.8% -543.6%

15 Pct Settled (Feb from Jan) 59.9% 37.8% 24.9% 22.1% 31.5% -573.2%

16 Pct Settled (Jan from Dec) 59.8% 34.0% 29.7% 32.9% 39.0% -449.6%


Cerner/Healthland Accounts Receivable for Hospital by Payor and Days Outstanding -- As of May 31, 2018

ORAL REPORTS 4a.v.

31 29 31 30 31 30

Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-17

31 31 30 31 30 31

Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

12 Medicare 33% 21 79,799$ 553,005$

13 Medicaid 7% 35 79,799$ 195,507$

14 Blue Cross 15% 45 79,799$ 538,641$

15 Commercial 26% 60 79,799$ 1,244,859$

16 Self Pay 19% 150 79,799$ 2,274,262$

17 Total: 100% 4,806,274$ 18 79,799$

19 60

55Net Days in A/R 61 57 59 59 54

Net Patient Rev/Day (2 month Avg) 85,354$ 86,123$ 77,472$ 72,674$ 69,642$ 67,609$

Net Accounts Receivable 5,193,803$ 4,888,576$ 4,559,201$ 4,306,727$ 3,773,840$ 3,693,611$

Net Patient Revenue 2,780,222$ 2,559,416$ 2,171,473$ 2,261,926$ 1,989,545$ 2,135,881$

78,825$


Pagosa Springs Medical Center - - - Net Days in A/R 2018

2,430,712$

54

80,094$ 79,504$ 79,675$

4,727,332$

61 60

Net Patient Rev/Day (2 month Avg) 78,835$

Net Days in A/R 50

2,163,824$

Net Days in A/R Target

Pagosa Springs Medical Center - - - Net Days Target

2,703,895$

Net Accounts Receivable 3,945,434$ 3,883,635$ 4,366,142$ 4,329,173$ 4,871,459$

Net Patient Revenue 2,751,873$

81,039$

2,052,594$ 2,693,304$

5548

9

10

2

3

4

5

7

8

ORAL REPORTS 4a.v.


Revenue and Usage by Financial Class

May, 2018

Financial Class Inpatient MTD Outpatient MTD Total MTD % MTD

Auto/Liability Insurance 332.00 56,309.00 56,641.00 1.17%

Blue Cross 31,272.00 630,205.45 661,477.45 13.61%

Champus - 2,619.00 2,619.00 0.05%

Commercial Insurance 30,514.00 536,476.25 566,990.25 11.67%

Medicaid 112,680.00 862,389.00 975,069.00 20.07%

Medicare 202,805.70 1,649,808.85 1,852,614.55 38.13%

Medicare HMO 49,612.00 120,039.10 169,651.10 3.49%

Self Pay 5,333.00 214,975.70 220,308.70 4.53%

Self Pay - Client Billing 11,791.70 11,791.70 0.24%

Veterans Administration 28,645.00 264,944.40 293,589.40 6.04%

Workers Compensation - 47,716.00 47,716.00 0.98%

Total 461,193.70 4,397,274.45 4,858,468.15 100.00%

Financial Class Inpatient YTD Outpatient YTD Total YTD % YTD

12/31/17

% YTD

12/31/16

% YTD

Auto/Liability Insurance 4,366.00 243,146.00 247,512.00 1.11% 1.24% 1.11%

Blue Cross 282,116.10 3,163,370.30 3,445,486.40 15.49% 15.90% 15.83%

Champus - 8,098.00 8,098.00 0.04% 0.07% 0.19%

Commercial Insurance 268,989.05 2,569,555.25 2,838,544.30 12.76% 11.79% 13.08%

Medicaid 496,237.70 3,915,885.44 4,412,123.14 19.84% 20.28% 21.56%

Medicare 1,046,281.70 6,736,684.74 7,782,966.44 34.99% 35.27% 35.90%

Medicare HMO 160,786.00 688,641.85 849,427.85 3.82% 3.55% 2.76%

Self Pay 77,823.05 1,106,666.61 1,184,489.66 5.33% 6.96% 5.26%

Self Pay - Client Billing 44,730.70 44,730.70 0.20% 0.19% 0.17%

Veterans Administration 196,493.15 881,511.15 1,078,004.30 4.85% 3.58% 2.74%Workers Compensation 53,147.00 297,437.20 350,584.20 1.58% 1.17% 1.37%

Total 2,586,239.75 19,655,727.24 22,241,966.99 100.00% 100.00% 99.97%

Blank 0.00%

HMO (Health Maint Org) 0.03%

Total 100.00% 100.00%

ORAL REPORTS 4a.v.

Pagosa Springs Medical Center Prepared 6/13/18

Cash Forecast as of end of May 2018 Cash balance 5,988,630

Forecast Months Based on Budget at 12/31/17

(10)

(6) (9) Bond & Lease

(1) (2) (3) (4) (5) Clinic Expan. (7) (8) Medicare/ Interest & (11)

Patient Tax Provider Grants & New Debt/ Total Operating Medicaid Principal TotalCollections Revenues Fees Donations Other Leases Collections Expenses Capital Repayment Payments Other Cash Spending Balance

January 2018 (Actual) 2,208,636 12,256 144,371 - 180,122 92,437 2,637,822 2,727,662 166,315 110,743 5,307 1,153,848 4,163,875 4,462,577

February 2018 (Actual) 1,957,404 56,842 144,371 - 225,337 - 2,383,954 2,441,864 149,435 56,124 3,899 (252,341) 2,398,981 4,447,550

March 2018 (Actual) 2,193,045 390,556 144,371 - 194,135 - 2,922,107 2,672,968 31,347 56,124 4,893 590,988 3,356,320 4,013,337

April 2018 (Actual) 2,039,319 104,016 146,063 (759) 221,191 - 2,509,830 2,508,174 34,367 56,124 6,540 (129,147) 2,476,058 4,047,109

May 2018 (Actual) 2,036,045 264,023 145,078 - 233,318 - 2,678,464 2,612,842 235,371 171,222 8,186 59,460 3,087,081 3,638,492

June 2018 (Forecast) 2,316,600 131,670 144,371 60,334 179,777 - 2,832,752 2,642,006 40,000 382,550 1,136,148 4,200,704 2,270,541

July 2018 (Forecast) 2,685,800 111,501 144,371 30,167 184,140 50,000 3,205,979 2,758,684 24,515 355,009 5,330 3,143,538 2,332,982

August 2018 (Forecast) 2,979,900 47,880 144,371 110,926 184,140 50,000 3,517,217 3,459,476 10,000 5,330 3,474,806 2,375,393

September 2018 (Forecast) 3,039,700 35,910 639,527 60,334 179,777 - 3,955,248 2,572,556 - 5,330 2,577,886 3,752,755

October 2018 (Forecast) 2,795,100 11,970 144,371 60,334 184,140 3,195,915 2,576,073 5,000 (54,500) 5,330 2,531,903 4,416,767

November 2018 (Forecast) 2,527,900 11,970 144,371 60,334 179,777 2,924,352 2,538,327 - 87,469 5,330 2,631,126 4,709,993

December 2018 (Forecast) 2,453,900 18,406 144,371 60,330 133,833 - 2,810,840 2,650,762 3,724 - 496,148 (1,985,998) 1,164,636 6,356,197

Totals 29,233,349 1,197,000 2,230,007 442,000 2,279,687 192,437 35,574,480 32,161,394 700,074 1,220,865 1,687,770 (563,190) 35,206,913 6,356,197

981,635 **

**Equals total forecasted interest for the Budget year (included in the Bond requirement for cash on hand) at 12/31/17

Bond Requirements (70 days cash) 6,356,197

Amount in Excess 0

Other Factors: Probability

Charges not meeting budget, est. at 5% for 6 months (823,000) 0.90 (741,000)

Decrease in gross A/R days, estimated at 10 days 760,000 0.90 684,000

Increase in the provider fee (assumes same re-dist %) 495,863 0.80 397,000

Increase in Clinic payment/visit: Medicare 541,000 0.80 433,000

Notes: Increase in Clinic payment/visit: Medicaid 377,000 0.50 189,000

(1) Forecast based on a two month lag for budgeted net patient revenues net of provider fee. Total 1,350,863 962,000

(2) Forecast is based on the percent of prior year collections for the same time period adjusted for budgeted revenues.

(3) Based on current payment from Colorado Health and Hospitals. There is a potential underpayment of $169,276.

Additional Provider Fee payment expected to receive in September for $495,863.

(4) Forecast is based on budget adjusted by YTD actual, August assumes EMS ambulance grant of $80,000.

(5) Forecast is based on budget adjusted by YTD actual.

(6) Forcast new leases for capital purchases.

(7) Forecast is based on budget excluding depreciation and interest. March and August assume 3 payrolls.

(8) Assumes forecast capital expenditures of $507,637 plus $192,437 Leases.

(9) Medicare Cost Report Settlement for 2015 of $54,619 paid in Jan., and Medicaid Cost Report repayment for 2014 of $280,618 (Paid over first 5 months).

Medicare 2016 Settlement of $75,000 Payable in June., 2017 Settlement of $115,098 paid in May and 2015 EMR receivable of $54,500 in October.

Medicaid 2015 Settlement of $382,796 payable in June. (Hospital only), 2013 RHC receivable of $422,405 in June, and 2014 RHC Settlement of $87,469 payable in Nov.

Payment to Medicare from PSMC review of certain billings Paybable in June $347,159.

Most of the estimated settlement dates are placeholders only, Medicare and Medicaid operate on their own schedules.

(10) Forecast based on lease payments and bond principal and interest payments.

(11) Other balance sheet changes i.e., changes in accounts payable, receivables etc.

ORAL REPORTS 4a.v.

of 5

CNO / COO Report – June 2018

ERo Volume

May volume at 532; averaging 17 / day; less volume compared to the previousyear (- 128 visits)

Significantly increased walk-in availability in the Clinic (averaging 18.3 visits perday for May). While this has direct impact on ER budget and revenue, itrepresents a shift in location of care that is right for patients. The numberscaptured also represent an overall increase in patient volumes.

o ED Throughput May door to doc time average at 5 minutes – national benchmark is < 20 minutes May ALOS (average length of stay) is 2.04 hours – national benchmark for like

facilities is about 1.58 hourso Staffing

Fully staffed pending start of new ER Physician 8/1/18o May 2018 Transfers

No of Transfers Destination

19 MRMC

3 St. Anthony’s

3 UC Health, CO Springs

2 Crossroads/ATU

2 SJRMC

1 Animas

1 Medical Center of Aurora

1 OKU Children’s

1 Porter

1 St. Luke’s

1 Swedish

1 UNM

36 Total

No of Transfers Method

17 EMS

11 Flight

8 POV

36 Total

WRITTEN REPORTS 4b.i.

of 5

No of Transfers Service Resource Related Y/N

10 ICU

4 Surgery Y (four transfers, no call at PSMC)

4 Hospitalist

3 Trauma

2 Psych

2 Cardiology

2 ER for diagnostics Y Ultrasound

2 Neurology

2 Urology

1 Nephrology

1 Pediatrics

1 Hand Surgery

1 Pulmonary

1 OB/GYN

36 Total

Inpatiento Volume

May volumes at 39 Observation and 33 Inpatients ADC for May was 5.35; ALOS 2.61 was days

o Staffing 1.5 FTE nursing staff moving to Oncology; positions posted

o HIMMS metrics continue to be met; medication scanning remains above 96%o Dulce accounts for 12.5% of all Observation / Inpatient admissions

Surgeryo Volume

May cases at 89, includes 40 GI procedures, 9 general surgerycases/procedures, 30 orthopedic cases, 1 GYN, 0 eye cases and 9 painmanagement procedures

For comparison, May 2017 was total of 79 , including 31 GI procedures,12 general surgery, 25 orthopedic cases, 0 GYN, 0 eye cases and 11 painmanagement procedures

Additional clarification – general surgery cases in 2018 will not includeprocedures done in the RHC; before merge of Clinics these wereaccounted for in the Surgery statistics

HVAC

Awaiting bids for necessary updates of HVAC system, due by July 24

Necessary to build volume by utilization of both surgery suites (main ORand procedure room) simultaneously

Pursuing DOLA grant for 50% match funding; will submit grant request inAugust 2018

Proceeding with addition of part time ENT specialist

Projected start date of 8/1/18


of 5

o Staffing Open RNFA/Clinic Surgery RN; remains posted; now adding sign on bonus Open PAT Surgery RN; remains posted; now adding sign on bonus

Remains unfilled; limited candidate applicationso Optimization

Cerner on site, in May to begin optimization, rebuild of surgical services, supplychain solutions

Optimization will correct some system issues that impede workflow, inventory,and billing issues

EMSo Volume – May 2018

CALL BREAKDOWN Standby

911 Response Fire/SAR/USFS/LE 0

To PSMC 57 Paid 0

To MRMC 3 Special Event (not paid) 2

Rotor Wing 1

Cancelled 9 Total 2

No patient contact 16

DOA/pronounced 2

refusals 15

Medical Alarm 0

Lift Assist 0 Other

Total 103 Public Assist 0

Interfacility/Med Transport Flight shuttle w/crew 0

PSMC 3rd/4th crew requests 21

MRMC 18 Dispatch error 0

SJRMC 2 Agency Assist 0

Pine Ridge 3 Assist at PSMC 5

Home/Residence 0 Walk in at EMS 0

Crossroads ATU 2 Total 26

Rendezvous air intercept 0

Stevens Field 11

Cancelled 1

La Plata County Airport 1

Medical Center of Aurora 1

Denver Health 1

Total 40

o Staffing FT EMT-P out for extended MLOA; increasing OT to backfill.


of 5

FT and PT positions are postedo New Ambulance has been ordered (50% matching grant)

Anticipated delivery July 1

Diagnostic Imagingo Volume

May total procedures at 1215 procedures / 938 patients May 2D echos at 36; stress echo at 14

o Staffing Mobile Nuclear Medicine company to visit in the upcoming weeks to bring NM in

to PSMC Exploring a part time radiologist to assist with interventional procedures; need

expected to increase due to Oncology One 0.5 FTE tech positon posted post resignation of one staff member

Laboratoryo Volume

May total procedures at 4461 tests / 1646 patientso Staffing

1 FTE med tech position remains unfilled (weekend night shift); may an offer; stilllooking for appropriate housing

o Survey Readiness Preparing for upcoming COLA survey All policies and procedures have been reviewed and approved

o Pathology Changes for improved service, increased revenue Effective June 6

Oncologyo Volume

Total Infusions for May were 159 Chemo Infusions at 15; up from 9 in April

o Staffing Oncology RN scheduled for maternity leave in July Relief positions have been posted; 1.5 FTE transferring from Inpatient

Additional training will be needed Oncology RN Navigator will also relieve

Rural Health Clinico Volume

Total PCP encounters at 1618 compared to 1578 in May 2017 121 new patients presenting in May 2018 Walk-in volumes remain stable at 18.3 / day No Show Rate is 5%; identical to April 2017 Specialist encounters 422 for May 2018; May 2017 was 249

o Staffing Open positions for:

FT MA – 2; offered to in-house employees, now in training


of 5

Offer extended to RNP to enhance specialty coverage and extendweekday hours to 7 PM; starting July 1, 2018

o Suicide Prevention Team from PSMC (BH providers, CMIO) are actively participating with SJBH to

address suicide prevention in Archuleta County; more to follow as group makesrecommendations

In process of developing a plan to adopt and train to Zero Suicide

BH training July 11

Facilitieso ED Refresho Completed painting, wainscoting in ER Rooms 4, 5, and 6; Trauma Rooms scheduledo HVAC project development underway

Applying for DOLA grant to subsidize at 50% matcho Continue to have items to be addressed from original hospital build (Coordination

Study); awaiting bid from Durango Electric; estimated to be about 30K.


THE UPPER SAN JUAN HEALTH SERVICE DISTRICT

DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER

MEDICAL STAFF REPORT BY CHIEF OF STAFF, RALPH BATTELS

June 26, 2018

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

Chad Bidart, MD Initial Appointment Courtesy/Cardiology &

Telecardiology

Cardiovascular Disease &

Clinical Cardiac

Electrophysiology

Kelly Borden, MD Initial Appointment Telemedicine/Teleradiology Diagnostic Radiology

Ryan Crete, MD Initial Appointment Telemedicine/Teleradiology Diagnostic Radiology

Elliot Dickerson, MD Initial Appointment Telemedicine/Teleradiology Diagnostic Radiology

Kevin Kelly, PhD Initial Appointment AHP/Psychology Psychology

Emily Lampe, MD Initial Appointment Telemedicine/Teleneurology Neurology

Calvin Newsome, FNP-C Initial Appointment AHP/Family Nurse

Practitioner

Family Medicine &

Specialist Support

Nishant Patel, MD Initial Appointment Telemedicine/Teleradiology Diagnostic Radiology

Aron Splichal, MD Initial Appointment Telemedicine/Teleradiology Diagnostic Radiology

Marjan Bolouri, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology

Julie Buchner, MD Reappointment Active/Family Medicine Family Medicine

Andrew Olsen, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Neuroradiology

Kathryn Olsen, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology

David Zander, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Neuroradiology

III. REPORT OF NUMBER OF PROVIDERS BY CATEGORY

Active: 17

Courtesy: 28

Courtesy – Locum Tenens: 1

Telemedicine: 103

Allied Health Professionals: 22

Total: 171

WRITTEN REPORTS 4b.ii.

DECISION AGENDA 5.a.

UPPER SAN JUAN HEALTH SERVICES DISTRICT

D/B/A PAGOSA SPRINGS MEDICAL CENTER

Formal Written Resolution 2018-09

June 26, 2018

WHEREAS, the Board of Directors of Upper San Juan Health Service District

(“USJHSD”) has received from the auditor, Chadwick, Steinkirchner, Davis & Co., P.C., a

verbal and written report on the District’s financial statements for years ending December 31,

2017 and 2016.

NOW, THEREFORE, THE BOARD OF DIRECTORS OF THE UPPER SAN

JUAN HEALTH SERVICE DISTRICT HEREBY RESOLVES to accept the audit report of

Chadwick, Steinkirchner, Davis & Co., P.C. titled: Upper San Juan Health Service District,

Basic Financial Statements and Report of Independent Certified Public Accountants, December

31, 2017 and 2016.

___________________________________________

Greg Schulte, as Chairman of the Board

DECISION AGENDA 5.a.i.

of 3

MINUTES OF REGULAR BOARD MEETING

Tuesday, May 22, 2018

5:30 PM

The Board Room


The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its regular board

meeting on May 22, 2018, at Pagosa Springs Medical Center, The Board Room, 95 South Pagosa Blvd., Pagosa

Springs, Colorado.

Directors Present: Director Greg Schulte, Director Matt Mees, Director Kate Alfred, Director Dr. Jim Pruitt,

Director Dr. King Campbell, and Director Jason Cox.

1) CALL TO ORDER; ADMINISTRATIVE MATTERS OF THE BOARD

a) Director Schulte called the meeting to order at 5:31 p.m. MDT and Clerk to the Board, Heather

Thomas, recorded the minutes. A quorum of directors was present and acknowledged by Clerk

Thomas and the meeting, having been duly convened, was ready to proceed with business.

b) Clerk Thomas affirmed elected (by acclamation) Board members Greg Schulte, Dr. King

Campbell, Jason Cox, and Karin Daniels were, prior to the meeting, sworn-in before a notary and

executed an oath of office and are included on the District’s Directors and Officers insurance

policy.

c) An election of new Board officers followed:

a. Director Mees nominated Director Schulte as Chair of the Board. Director Dr. Pruitt

seconded. The nomination passed unanimously.

b. Director Dr. Campbell nominated Director Mees as Vice-Chair of the Board. Director Dr.

Pruitt seconded. The nomination passed unanimously.

c. Director Schulte nominated Director Dr. Campbell as Secretary/Treasurer of the Board.

Director Mees seconded. The nomination passed unanimously.

d) The Board noted approval of the agenda.

2) PUBLIC COMMENT

There was none.

3) DECISION AGENDA:

Item intentionally struck from agenda. There were no Decision Agenda items.

4) REPORTS

a) Oral Reports

i) Chair Report

CONSENT AGENDA 6.a.i.

of 3

Item intentionally struck from agenda. There was no report.

ii) Contracts


iii) Strategic Planning


iv) Foundation Report


v) CEO Report

CEO Dr. Rhonda Webb introduced Dr. Jason Wallace as Vice-Chief of Staff, sitting in place of

COS Dr. Ralph Battels. CEO Dr. Webb then introduced Chelle Keplinger, incoming CFO.

CEO Dr. Webb noted that a photograph being displayed in the Board Room was donated by

exiting CFO, Dennis Wilson, and offered her personal gratitude to Mr. Wilson for his years of

service to the District. CEO Dr. Webb also presented Mr. Wilson with a gift certificate and a card

signed by employees of PSMC.

The Board offered their congratulations and well-wishes on retirement to Mr. Wilson and

welcomed Ms. Keplinger.

CEO Dr. Webb advised the Board the project for rebuilding Chargemaster in Cerner continues.

CEO Dr. Webb further advised the HVAC system is still in need of updates due to, in part,

increasing number of patients and the relocation and expansion of pharmacy; she then explained an

option for funding of this project would be to apply for a DOLA grant with matching funds.

Chair Schulte gave an overview of DOLA grants and the process for applications, adding that the

Board would have to approve the application for said grant.

Questions were asked and answered.

Chair Schulte advised the Board that he, Vice-Chair Mees and CEO Dr. Webb recently traveled

to Cortez to meet with Southwest Health System’s (“SHS”) Board Chair, Paul Deshayes. Chair

Schulte stated that they were given a tour of Southwest Memorial Hospital, which, like PSMC, has

also recently undergone an expansion.

Vice-Chair Mees stated that it was beneficial to have the knowledge that SHS has had many of

the same struggles as USJHSD, if not more, even though they are double in size compared to

USJHSD. Chair Schulte added the visit provided a good outlook on other hospitals and that it was

fascinating to be able to go and talk about the nature of operations and initial challenges.

Chair Schulte offered the Board the opportunity to attend a presentation by the Colorado

Hospital Association (“CHA”) in Durango on July 23 or 27, 2018. CHA would provide an update

on proposed changes to Medicare and Medicaid, including payment reform.

iv) Finance Report

CFO Wilson began by expressing gratitude to the Board and his colleagues for their continual

efforts making USJHSD as successful as it is now; he added that by being able to provide more

services to the community equates greater strength, which in turn is better for the community.

CFO Wilson presented the attached Finance Report noting that the month of April is typically

one of the slowest months of the year for revenue, though this April ended with close to 11 percent

more in gross charges over 2017. CFO Wilson added that revenue is expected to increase

substantially within the coming months.

CFO Wilson further advised payer contractual allowances were under budget by four percent in

the month of April.


of 3

Questions were asked and answered.

b) Written Reports (there was no oral report unless the Board had questions)

i) Operations Report

Director Dr. Pruitt asked a question regarding the continual use of scanning inventory in Cerner.

The question was answered by COO/CNO Kathee Douglas.

Director Cox asked a question regarding if the reported issues with Cerner were software issues

or user issues, and if the Cerner software interface was customizable. COO/CNO Douglas

answered.

COO/CNO Douglas ended the discussion by reporting to the Board that Cerner recently received

a contract with U.S. Veterans Affairs.

ii) Medical Staff Report

There were no questions.

5) CONSENT AGENDA

Chair Schulte opened the discussion briefly recounting the items on the consent agenda and inquired of

any questions or objections. There were none.

Director Cox motioned to approve the minutes of the regular meeting of 04/24/2018, and the Medical

Staff report recommendations regarding new provider privileges, renewal of provider privileges and/or

Medical Staff policies/forms.

Upon motion seconded by Secretary/Treasurer Dr. Campbell, the Board unanimously approved said

consent agenda items.


The Board did not meet in executive session.

7) OTHER BUSINESS

There was no other business.

8) ADJOURN

There being no further business, Chair Schulte adjourned the regular meeting at 6:05 p.m. MDT.

Respectfully submitted,

Heather Thomas, serving as Clerk to the Board


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MINUTES OF WORK SESSION

Friday June 1, 2018

12:30 PM

The Board Room


The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its work session on

June 1, 2018, at Pagosa Springs Medical Center, The Board Room, 95 South Pagosa Blvd., Pagosa Springs,

Colorado.

Directors Present: Chair Greg Schulte, Vice-Chair Matt Mees, Secretary/Treasurer Dr. King Campbell, Director

Kate Alfred, and Director Jason Cox.

Present by phone was: Director Dr. Jim Pruitt.

1) CALL TO ORDER

Chair Schulte called the work session to order at 12:30 p.m. MDT and Clerk to the Board, Heather

Thomas, recorded the minutes. A quorum of directors was present and acknowledged by

Secretary/Treasurer Dr. Campbell and the meeting, having been duly convened, was ready to proceed with

business.

CAO Ann Bruzzese noted that the advisement of a possible executive session was included on the notice

and agenda in error, as an executive session may only be called at a properly noticed regular or special

meeting where official action may be taken by the governing body.

2) DISCUSSION

Chair Schulte opened by advising the Board the work session discussion was regarding District consent

to the assignment of Goodford LLC’s interest in the Dodie Cassidy building/property to the PSMC

Foundation.

CAO Bruzzese then presented a brief history of the issue advising the Board (as duly noted within the

notice and agenda) that in 2000, the District entered into a fifty-year land lease, through January 31, 2050,

with Goodford, LLC so that Goodford, LLC could construct a building on the leased land. Goodford, LLC

constructed the building that is now known as the Dodie Cassidy building. Goodford, LLC constructed the

building to support the District at a time when the District had no money to construct a building and there

was insufficient space for healthcare-related services. In order to make the space better available to PSMC’s

needs, Goodford, LLC has approached PSMC’s Foundation about acquiring Goodford’s interest in the

building and the leased land. The PSMC Foundation, which exists solely to benefit the District, seeks to

acquire Goodford LLC’s interest so that it can help the District continue to make healthcare available in the

CONSENT AGENDA 6.a.ii.

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Pagosa Springs community.

Chair Schulte advised the Board that the PSMC Foundation Board, which includes Vice-Chair Mees,

Director Alfred and CEO Dr. Rhonda Webb, have met and concluded that it is in the best interest of the

District for the PSMC Foundation to pursue the transaction to acquire Goodford, LLC’s interest in the

building and the remaining term of the lease.Vice-Chair Mees, Director Alfred, and CEO Dr. Webb each

expressed support.

Chair Schulte further advised the Board of the need for District approval of the assignment of interests,

as the assignment of interests from Goodford, LLC to the PSMC Foundation is subject to the District’s

consent and a special meeting will need to be scheduled.

3) SET TIME FOR A SPECIAL MEETING (FOLLOWING 72 HOURS NOTICE)

Chair Schulte proposed to schedule a Special Meeting of the Board for Wednesday, June 6, 2018, for the

sole purpose of consideration of Resolution 2018-08 regarding the District’s consent to the assignment of

Goodford, LLC’s interest in the Dodie Cassidy building/property to the PSMC Foundation.

The Board, noting that some members would only be available by teleconference, agreed to hold a

special meeting on Wednesday, June 6, 2018, at 12:30 p.m. in regards to the aforementioned decision

agenda item.

4) 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.

(Item intentionally struck as executive sessions are not permitted in work session meetings.)

5) ADJOURN

There being no further business, Chair Schulte adjourned the work session at 12:50 p.m. MDT.

Respectfully submitted by:


CONSENT AGENDA 6.a.ii.

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MINUTES OF SPECIAL MEETING

Wednesday June 6, 2018

12:30 PM

The Board Room


The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its special board

meeting on June 6, 2018, at Pagosa Springs Medical Center, The Board Room, 95 South Pagosa Blvd., Pagosa

Springs, Colorado.

Directors Present: Chair Greg Schulte, Vice-Chair Matt Mees, Secretary/Treasurer Dr. King Campbell, Director

Karin Daniels, and Director Jason Cox.

1) CALL TO ORDER

Chair Schulte called the work session to order at 12:30 p.m. MDT and Clerk to the Board, Heather

Thomas, recorded the minutes. A quorum of directors was present and acknowledged by Vice-Chair Mees

and the meeting, having been duly convened, was ready to proceed with business.

2) DECISION AGENDA

Chair Schulte provided a brief introduction of Resolution 2018-08 and inquired of any questions. There

were no questions.

Consideration of Resolution 2018-08

Director Cox motioned to approve Resolution 2018-08, regarding consent to the assignment of lease

from Goodford, LLC to the PSMC Foundation for the Dodie Cassidy Building. Upon motion seconded by

Vice-Chair Mees, the Board unanimously approved said agenda item.


The Board did not meet in executive session.

4) OTHER BUSINESS

CAO Ann Bruzzese advised the Board of the ucoming Colorado Special Districts Association’s Annual

SDA Regional Workshop, to commence Tuesday, 06/12/2018 at 8:00 a.m. and held at Durango Fire

Protection District in Durango. The open workshop applies to all types of districts and will cover topics

specifically applicable to board members. CAO Bruzzese further advised the Board Clerk Thomas would be

attending and that USJHSD will cover the registration cost of the workshop, should any board member wish

to attend.

Chair Schulte advised the Board that he has arranged a informative meeting with Colorado Hospital

Association for Board members of USJHSD, Mercy of Durango, and Southwest Health System of Cortez, to

CONSENT AGENDA 6.a.iii.

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discuss upcoming Mediare and Medicaid changes. The meeting is scheduled for 07/23/2018, from 11:00

a.m. to 1:00 p.m. Location to be determined in Durango.

5) ADJOURN

There being no further business, Chair Schulte adjourned the special meeting at 12:39 p.m. MDT.

Respectfully submitted by:


CONSENT AGENDA 6.a.iii.

Board Orientation By Ann Bruzzese

1. Special District – brief overview

2. Board delegation of responsibilities to PSMC’s CEOa. Generallyb. Communications to the press or public

i. On behalf of the Board vs. on behalf of operationsii. Patient privacy

3. Fiduciary Dutiesa. Good Faith: Duty of Care and Duty of Loyaltyb. Conflicts of Interest (and potential conflicts of interest)

i. Self-disclose and self-disqualify (CRS Sections 32-1-902 and 18-8-308)

4. Open Meetingsa. Public notice/agenda for 3 or more directors gathering to discuss/conduct

District businessi. No chain conversations or emails

ii. Non-substantive matters (e.g. arranging a meeting time)b. Executive Sessionc. Hearingsd. Absences

5. Open Recordsa. PSMC email

BOARD ORIENTATION 7.

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