NOTICE OF REGULAR BOARD MEETING OF THE UPPER SAN …

NOTICE OF REGULAR BOARD MEETING OF

THE UPPER SAN JUAN HEALTH SERVICE DISTRICT

DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER

Tuesday, March 28, 2017

5:30 PM

Chambers Conference Room, PSMC Main Building (in the new wing)

95 South Pagosa Blvd., Pagosa Springs, CO 81147

AGENDA

Pursuant to the provisions of the Supplemental Public Securities Act, one or more members of the Board may participate in this meeting and may vote on the foregoing matters through the use of a conference telephone or other telecommunications device.

1) CALL TO ORDER; ADMINISTRATIVE MATTERS OF THE BOARD

a) Call for quorum (by Secretary/Treasurer Jerry Baker) 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, Jodi Scarpa, 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: GE Johnson 4) DECISION AGENDA (Matters to be discussed and possible action by the Board)

a) N/A 5) REPORTS

a) Oral Reports (may be accompanied by a written report) i) Chair Report Chair Mark Floyd ii) Campus Planning Chair Mark Floyd iii) Strategic Planning Vice-Chair Greg Schulte (or in his absence, Dr. Pruitt) iv) Contracts Dir. Jerry Baker v) Succession Planning Dir. Kate Alfred vi) CEO Report Chief Executive Officer, Brad Cochennet

vii) Finance Report CFO, Dennis Wilson and Treasurer Jerry Baker viii) Construction Report Jodi Scarpa, Manager of Executive Offices ix) Monthly In-Depth Report Primary Care Clinic, Director Sikendar Fidai

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

i) CAO Report Chief Administrative Officer, Ann Bruzzese ii) CNO Report Chief Nursing Officer, Kathee Douglas iii) CMO Report Chief Medical Officer, Rhonda Webb iv) COS Report Chief of Staff, Ralph Battels

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: 2/28/2017 b) Approval of Medical Staff report recommendations for new or renewal of provider privileges.

7) OTHER BUSINESS

8) EXECUTIVE SESSION

There will be an executive session pursuant to the following subparagraphs of C.R.S. Section 24-6-402(4): (b): to receive legal advice on specific legal questions.

Further, the Board reserves the right to meet in executive session for any other purpose allowed and topic announced at open session of the meeting, in accordance with C.R.S. Section 24-6-402(4).

9) ADJOURN

Operational Review

• Highlights of 2016 Rural Health Clinic Annual Evaluation Report • Opportunities presented by evaluation & actions taken

• Operational Improvements in progress

• Ongoing Initiatives

• Additional clinical services being evaluated

• New Building

• Monthly encounters and “No Show” trends

• Archuleta County population by age

1

Purpose of Evaluation

• CDPHE (Colorado Dept. of Public Health & Environment) requires each RHC to self evaluate and submit report annually

– RHC compliance

• Scope of Service

• Hours of operation

• Mid-level and physician work distribution

• Supervision of mid-level providers

• Peer-to-peer reviews

– Review clinical records

• Encounter analysis

• Financial analysis

• Diagnostic code analysis

• Procedures and policies are current and adhered to

– Self Analysis, and plans to address future needs of the community

2

2016 Annual Evaluation Results

• Continue to have healthy mixture of preventative, acute and chronic encounters – Compared to previous years we are seeing:

• An increase in chronic condition encounters

• Steady growth in behavioral health encounters

• Increasing need for local access to OB/GYN & Cardiology services

• What have we done to address these opportunities – Chronic Conditions

• Working with Cerner to start Chronic Care Management services

• Implement changes in Clinic schedules to support Chronic care patients

– Moved from “Acute Only” to “Walk-In” clinic on Saturdays

– Effective March 27th, changed our weekday clinic schedule to “open” schedule

• Hired a nurse navigator

3

Annual Evaluation Results (continued)

– Behavioral Health • Added second behavioral health specialist, and actively recruiting for

additional psychiatry services

• Increased patient appointment timeslots available for the behavioral health providers (changed “on-call” days to “on-call” and clinic days)

• Changed behavioral health from “Referral Only” to “Standard” schedule

– OB/GYN and Cardiology Services • Adding two new FM physician (starts 10/1/2017); one of them has OB/GYN

experience and interest to practice OB/GYN

• Started a second visiting GYN provider

• Added a part-time Cardiologist, in addition to bi-monthly visit by Mercy Cardiology

Next annual evaluation scheduled for 4Q2017

4

2016 Annual Evaluation: Financial Data Analysis

• Encounters by Insurance Type – Commercial Insurance: 43%

– Medicare: 28%

– Medicaid: 21%

– Self-Pay: 7%*

– Charity care: 1%

* Many of our Self-Pay patients get services at a discounted rate.

In 2016 we gave discounts or write-offs:

Amount: $72,196

Patient receiving these benefits: 985

5

Operational Improvements in progress

• Created a pre-service organization to increase PoS collection and reduce insurance denial / rejection – Merged insurance verification, prior authorization, scheduling and registration

teams

• Telephone Call flow – Completed review of current call flow and identified areas of improvement,

working with Synoptek to implement changes by 4/10/2017

– Introducing telephone receptionists to answer hospital & clinic calls during working hours

• PoC (Point of Care) testing – Starting A1C testing, and investigating other tests that can be done in

Clinic

6

Ongoing Initiatives

• Cerner Enhancements – Continue to develop tools to help us improve patient outcome, meet

quality goals, report provider productivity, clinic efficiencies and financial analysis

• Advanced Care Planning – Working with Cerner to enable this service

• Community outreach / engagement initiatives – Reaching out to school district, employers in county to setup vaccination

drives and physical exams

– Starting efforts to build relationship with other providers in the community

– Investigating starting Medical Assistant (MA) classes for the community

7

Additional Clinical Services being evaluated

• To improve patient compliance and patient outcome

– Follow-up of patients seen by (visiting) Specialty Provider by our Mid-level Provider

– Intrauterine device (IUD) placement

– Osteopathic manipulative treatment

– Shingles vaccination

– Patient & Family support education classes (diabetics, hypertension, Breast Cancer patient support, care giver support group)

8

New Building

• Provides opportunities to integrate primary & specialty (Ortho, Surgery, ENT, GI, Cardio & GYN) clinics – Improve coordination between providers and clinic staff

– Reduce patient anxiety

– Increase efficiencies (staff, equipment, supplies)

• Additional space enables – 2+ exam rooms / provider & additional room for Nurse visits

– Patient privacy for medical and financial counseling; HIPPA compliance

– Dedicated rooms for behavioral health evaluation & counseling

– Separation between patient; HIPPA compliance

9

Monthly Encounters & “No-Show” trend

1. Saturday ‘walk-in” clinic has increased encounters and customer satisfaction 2. Our “No-Show” rate is about 6%; with changes in schedule we expect this to drop to around 4% 3. Behavioral health: Opening of schedule & taking patient w/o referral should increase encounters

10

0.0

500.0

1000.0

1500.0

2000.0

2500.0

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

2015 No show

2016 No Show

2017 No Show

2015 encounters

2016 encounters

2017 encounters

Archuleta County Population by Age group

Age 55+ represents patient with chronic disease 1. Our data aligns with the census data 2. Our plans (services, clinical staffing, schedule) are designed to meets the need of our aging population

40.7

48.4 48.8

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Median Age

11

CEO Report, March 2017 Outpatient Wing: Closing the Loop 3/17 Furniture delivered and installed 3/17 Temporary move of registration: lab, radiology, specialty clinic, new registration

only 3/17 Begin moving clinical furniture and supplies 3/20 Employee family dinner and party in the new space 4/7-4/9 Weekend move, coordinating primary care clinic, plant ops, IT, registration 4/10 Outpatient Clinic open for Family medicine, Internal Medicine specialty, and

Behavioral Health 4/14 Opening reception for Art Show to benefit the new space 4/24 Orthopedics, General Surgery, Gastroenterology, Cardiology, Obgyn, Women’s

Health specialties move to new clinic 6/16 Grand Opening Donor Reception 6/17 Community Grand Opening Festivities 6/19 Art Show closes Remodel 1: PACU, Patient Financial Services 3/23 Pricing confirmed 4/17 Remodel start, pending state permit 6/19 Expected completion

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STORAGEB134

PRE-OP./RECOVERYB151

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(E) PRE/POST OP.B151B

(E) PRE/POST OP.B151C

(E) PRE/POST OP.B151D

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INFUSIONB150

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BLOOD BANK166

SCHEDULINGB162

CENTRAL STERILEB135

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GRAPHIC DESCRIPTIONPRIOR-

ITYTYPE

PARTITION GRAPHIC LEGEND

PARTIAL HEIGHT PARTITION

SOUND PARTITION

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1 HOUR FIRE BARRIER

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0Pa

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EXISTING PARTITIONS ARE SHOWN HALFTONED

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DETAIL

1. SEE PARTITION TYPES, SHEET A7.10

2. HIGHEST PRIORITY PARTITIONS ARE LISTED FIRST IN THE LEGEND.

SUBSEQUENT PARTITIONS DECREASE IN PRIORITY . HIGHER PRIORITY

WALLS TAKES PRECEDENCE, SEE WALL PRIORITY DETAILS.

3. IF A PARTITION IS NOT TAGGED ON THE PLANS, THE PARTITION TYPE

SHALL BE THE DEFAULT PARTITION TYPE AS INDICATED IN THE GRAPHIC

LEGEND ABOVE.

4. IF A PARTITION IS TAGGED WITH A PARTITION TAG, THE PARITION TYPE

IS INDICATED BY THE TAG.

FIRE RATING SCHEDULE PARTITION CONSTRUCTION TYPE

0

1

2

3

4

NON-RATED

1 HOUR RATED

2 HOUR RATED

3 HOUR RATED

4 HOUR RATED

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S SHAFTWALL PARTITIONS

MASONRY PARTITIONS

CONCRETE PARTITIONS

FURRING PARTITIONS

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FULL HEIGHT PARTITIONS

CHASE PARTITIONS

R RETROFIT PARTITIONS

PARTITION TYPE/TAG LEGEND

PARTITION TAGUNIQUE IDENTIFIER

PARTITION CONSTRUCTION

TYPE, SEE SCHEDULE BELOW

FIRE RATING, SEE

SCHEDULE BELOW

PARTITION. SEE GRAPHIC

DESIGNATION SCHEDULE

1Aa

B SECURITY PARTITIONS

1. DIMENSIONS ARE TO FACE OF INTERIOR GYPSUM BOARD, FINISH FACE

OF EXTERIOR WALL MATERIALS, STRUCTURAL GRIDS AND CENTERLINES

WHERE INDICATED.

AREA NOT IN PROJECT SCOPE

NEW PARTITION

(E) PARTITION

PHASE AND SCOPE DESIGNATION

PROJECT NUMBER

DRAWN BY

DATE

REVISIONS

SHEET TITLE

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Boulder Associates, Inc.

www.boulderassociates.com

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LOW

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LEGEND ABOVE.



NC NURSE CALL SYSTEM: EMERGENCY PULL

NURSE CALL

NURSE CALL SYSTEM: DOME LIGHT

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FLOOR DATA OUTLET

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CONVENIENCE OUTLET W/ GROUND FAULT INTERRUPT

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TV OUTLET

CARD READER

DOOR OPENER BUTTON

DOOR RELEASE BUTTON

KEYPAD

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DESIGNATIONS

SYMBOLS

DUPLEX OUTLET

QUAD OUTLET

JUNCTION BOX OUTLET

RECESSED OUTLET (DESIGNATION AS INDICATED BY SYMBOL)

DUPLEX FLOOR OUTLET

QUAD FLOOR OUTLET

DATA OUTLET

PHONE OUTLET

DATA/PHONE OUTLET

SPECIAL PURPOSE OUTLET

SYMBOLS

SYMBOLS

DESIGNATIONS

MISCELLANEOUS

SPECIAL PURPOSE

DATA

R-#

MHO

DESIGNATIONS

RECESSED OUTLET (DESIGNATION AS INDICATED BY SYMBOL)R-#


0

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1 HOUR RATED

2 HOUR RATED

3 HOUR RATED

4 HOUR RATED

A

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MASONRY PARTITIONS

CONCRETE PARTITIONS

FURRING PARTITIONS



CHASE PARTITIONS






FIRE RATING, SEE

SCHEDULE BELOW



1Aa


PROJECT NUMBER

DRAWN BY

DATE

REVISIONS

SHEET TITLE

SHEET NUMBER




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FLOOR PLAN 1/4"

A2.20


CONSTRUCTION

DOCUMENTSFLOOR PLAN GENERAL NOTES

DESCRIPTION DATE

1/4" = 1'-0"A2.20

1 FLOOR 1 - ENLARGED

KEYPLAN - REMODEL 1 AREA

VO

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UP

MHOM

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RAD. OFFICEB138

WOMEN'S LOCKERB148

MEN'S LOCKERB149

CHAPELB120

IT SERVERSB115

IT OFFICEB114

MATERIALS MGMT.B122

PHARMACYB108

FOUNDATION OFFICEB107

FINANCIAL CONSULT

OFFICEB105

FINANCIAL CONSULT

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SOILED LINEN

HOLDINGB118

CLEAN LINEN

HOLDINGB117

HOUSE KEEPINGB116

RECEIVINGB123

SHARED OFFICEC152

IT STOR.C151

JAN. CLOSETC148

ELECTRICAL/

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INFORMATICSC144

INFORMATICS

TRAININGC136

CORR.C147

STAFF SLEEPC145

CORR.B112

CEO OFFICEC100

STORAGEC155

FUTURE STAFF

LOCKER ROOM126

PATIENT RM. 6A136

TOILETA136A

TOILETA137A

PATIENT RM. 7A137

PATIENT RM. 8A138

PATIENT RM. 9A139 PATIENT RM. 10

A140

ISOL./ PATIENT RM.

11A141

TOILETA138A

TOILETA139A

TOILETA140A

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PATIENT RM. 5A135

PATIENT RM. 4A134

PATIENT RM. 3A133

PATIENT RM. 2A132

PATIENT RM. 1A131

TOILETA131ATOILET

A132A

TOILETA133A

TOILETA134A

TOILETA135A

NURSE OFFICE

(2WS)A130

MED. ROOMA127

DR. DICT.A128

NOUR.A129

CORRIDORA143

ANTE ROOMA142

NURSING REPORT/

BREAK ROOMA144

STAFF TOILETA146

HOUSE KEEPINGA147

CLEAN SUPPLYA148

SOILED LINEN HOLDA149

PHONE ROOM / IP

STORAGEA150

MAINT. OFFICE (2

WS)A152

MECHANICALA153

WORKSHOP AREAA155

MEDICAL GASA156

NURSE STATIONA126

HOUSE KEEPINGA125

CORRIDORA124

EMERGENCY

WAITINGA121

(E) VESTIBULEA123

TOILETA122

(E) STOR.A120

(E) TRAUMA/ CASTA119

(E) TRAUMAA118

(E) DECON.A117

TREATMT./ OBSERV.A107


TRIAGE/ TREATMENTA109

GOWNA110

TOILETA111

TRIAGEA112

SOILED UTILITYA113


(E) VESTIBULEA115 CT SCAN

A100

CONTROLA101

DIGITAL RAD./

FLUOR.A102

SPEC. EXAM 4B139

TOILET/ GOWNB140

ULTRASND/ ECHO.B141

CORRIDORB142

OPERATING ROOMB157

SUB STERILEB158

PROCEDURE ROOMB159

CORRIDORB144

HOUSE KEEPINGB145

TOILETB147

EQUIP. STORAGEB154

STERILE SUPPLYB153

LINENB152

STERILE CORRIDORB155

PRE-OP/ RECOVERYB151

PRE/ POST OP.B151B

PRE/ POST OP.B151C

PRE/ POST OPB151D

TOILETB151E

PRE/ POST OPB151F

PRE/ POST OPB151G

CORRIDORB146

CORRIDORB168

LABORATORYB163

PASSAGEB102MEN

B104WOMEN

B103

LOBBYB101

DINING AREAB133

SERVINGB131

DISH WASHINGB132

KITCHENB130

HOUSE KEEPINGB125

DIET. OFFICEB126

STAFF TOILETB124

DRY STORAGEB127

COOLERB128

FREEZERB129

EXAMC117

EXAMC118

EXAMC119

EXAMC120

EXAMC113

EXAMC114

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B.H. EXAMC115

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PREP. LABC122

NURSE STATIONC123

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STORAGEC132 PAYMENT

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RECEPTIONC106

PAT. NAVIGATIONC107

PASSAGE126DCONSULT

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RESPIRATORYC125OFFICE

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CORRIDORC128

OFFICEC129

SITE MAINT.C146

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TOILETC156 MEN'S

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WOMEN'SC161

PASSAGEC158

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RECEPTION105

COPY / WORK106

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BLOOD DRAW120

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BH OFFICE145

GROUP VISIT /

CONFERENCE174

STAFF LOUNGE175

IT131

JANITOR128

MECHANICAL129

CORR.135

PAT. T141

EXAM 5161

EXAM 4162

EXAM 3163

EXAM 2164

EXAM 8139

EXAM 9138

EXAM 10137

EXAM 11151

EXAM 12152

EXAM 13153

EXAM 14154

CORR.160

MA WORK157

CORR.127

CORR.125

EQ. STOR.136

POC TESTING140

PROVIDERS158

BH TREAT.146

PROCEDURE148

SOIL172

WASTE132

STAFF T.168

CLEAN171

STOR.167

ELEC.169

EXAM 15155

EXAM 1165

SOUTH STAIRS-180

F. PUBLIC TOILET109

M. PUBLIC TOILET110

CRASH

CART149

EXAM 6144

EXAM 7143

BH TREAT.147

SHELLED SPACE122

RECEPTION142

CORRIDOR107

NORTH STAIRS-100

VESTIBULE101

LAB T.121

ELEVATORE-100

CORR.166

CORR.156

CORR.150

CORR.170

VITALS273

VESTIBULE107A

CORR.125A

OFFICEC130

OFFICEC131

CONSULTC107A

SAMPLESC134

TOILETC137

ENTRANCEC102

IT STOR.C150

CORR.A103

CORR.B121

LAB OFFICEB164

NURSE STATIONA126B

RoomB113

BLOOD BANK166

PATHOLOGYB167

P.A.T.B161

SCHEDULINGB162

PRE/POST OP.B151A

INFUSIONB150

STERILE

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CLEAN ASSEMBLY/

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TREATMENT/OBSERVATIONA106

MAMMO/DEXAA105

TREATMENT/OBSVERV.A104

MATERIALS MGMT.

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PHARMACY OFFICEB110

NEGATIVE RM.B119

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POSITIVE RM.B113

OFFICEC153

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MASONRY PARTITIONS

CONCRETE PARTITIONS

FURRING PARTITIONS



CHASE PARTITIONS






FIRE RATING, SEE

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1Aa


+##" INDICATES HEIGHT IN INCHES TO OUTLET CENTERLINE.

DEFAULT HEIGHT = 18" IF NO TAG INDICATED

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DATA OUTLET: DEVICE & CABLING N.I.C. - PROVIDE

MUD RING & PULL-STRING ABOVE ACCESSIBLE CEILING

MISCELLANEOUS

INTERCOMIC

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DATE

REVISIONS

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03/27/2017

REMODEL 2 -

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PLAN

2-A2.1


CONSTRUCTION

DOCUMENTS

DESCRIPTION DATE

1/16" = 1'-0"2-A2.1

1 FLOOR 1 - OVERALL - REMODEL 2


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+46" +46"

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ITYTYPE



SOUND PARTITION

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2 HOUR RATED

3 HOUR RATED

4 HOUR RATED

A

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F

H

M

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MASONRY PARTITIONS

CONCRETE PARTITIONS

FURRING PARTITIONS



CHASE PARTITIONS






FIRE RATING, SEE

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1Aa




WHERE INDICATED.

+##" INDICATES HEIGHT IN INCHES TO OUTLET CENTERLINE.

DEFAULT HEIGHT = 18" IF NO TAG INDICATED

TV OUTLET

CARD READER

AUTO-DOOR OPERATOR BUTTON

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DATA OUTLET: DEVICE & CABLING N.I.C. - PROVIDE

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+##"

EHPHARMACY

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113 SF


CORR.B112

ANTE-ROOMB111

POSITIVE RM.B113

NEGATIVE RM.B119

PHARMACY

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ACCESS CONTROLLED AUTO-

OPERATOR DOORS

*ALT #1: TIMER CONTROLLED

AUTOMATIC SLIDING POCKET

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0100

2-A6.10

3

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PHARMACYB108


FINANCIAL CONSULT

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FINANCIAL CONSULT

OFFICEB106

SOILED LINEN

HOLDINGB118

CLEAN LINEN

HOLDINGB117

HOUSE KEEPINGB116

RECEIVINGB123

IT SERVERSB115

IT OFFICEB114

CHAPELB120

SHARED OFFICEC152

IT STOR.C151

JAN. CLOSETC148

ELECTRICAL/

MECHANICALC149

STOR.C150

INFORMATICSC144

INFORMATICS

TRAININGC136

TOILETC137

CORR.C147

STAFF SLEEPC145

TOILETC145A

CORR.B112

CEO OFFICEC100

TOILETC156

STORAGEC155

ANTE-ROOMB111

POSITIVE RM.B113

NEGATIVE RM.B119

PHARMACY

OFFICEB110

MATERIALS MGMT.

OFFICEC157

TV

OFFICEC153

OFFICEC161

OFFICEC162

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(e)122B

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117B

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(e)116

(e)152

162

153

161

(e)144

(e)136

(e)137

(e)136B

(e)107

4 7

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INSTALL NEW VAPOR BARRIER OVER

CUT EXISTING VAPOR BARRIER PER

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CUT EXISTING VAPOR BARRIER IN THE

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AFTER BACKFILL- FOLD DOWN EXISTING

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559 SF

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4 7/8"EQ.

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REMODEL 2 -

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2-A2.2


CONSTRUCTION

DOCUMENTS

DESCRIPTION DATE


1/4" = 1'-0"2-A2.2 2-A2.2

2 FLOOR 1 - PHARMACY ENLARGED PLAN

1/8" = 1'-0"2-A2.2

1 FLOOR 1 - REMODEL 2 - 1/8" FLOOR PLAN

ACCESSORY SCHEDULE - REMODEL 2

TAG DESCRIPTION MANUFACTURER MODEL RESPONSIBILITY COMMENTS

1 ENMOTION AUTOMATED TOUCHLESS SOAP DISPENSER GP PRO - ENMOTION 52053 OF/OI

2 ENMOTION IMPULSE 8 AUTOMATED TOWEL DISPENSER GP PRO - ENMOTION 59498 OF/OI

4 WALL PROTECTION MATCH EXISTING MATCH EXISTING CF/CI MATCH EXISTING BUILDING STANDARD

13C 2" CORNER GUARD - 48" H, 90 DEGREE ANGLE C/S GROUP SSM-20N, ACROVYN 4000, COLOR: 920 ALMOND CF/CI MOUNT DIRECTLY ABOVE BASE

17C (E) FEC - - OF/CI

42 LOCKERS, HALF-HEIGHT - - OF/OI

EQUIPMENT SCHEDULE - REMODEL 2

TAG DESCRIPTION MANUFACTURER MODEL RESPONSIBLITY Type Comments

0100 POSITIVE PRESSURE RECICULATING STERILE ISOLATOR NUAIRE NU-PR-797-600 OF/CI

0101 NEGATIVE PRESSURE TOTAL EXHAUST STERILE ISOLATOR NUAIRE NU-NTE-797-400 OF/CI SEE MECAHNICAL FOR EXUASHT VENTING

104A WIRE RACK SHELVING SYSTEM - - OF/OI EXISTING TO BE RELOCATED

104B WIRE RACK SHELVING SYSTEM - - OF/OI EXISTING TO BE RELOCATED

0105 BIOMEDICAL FRIDGE; MNFR. HELMER HELMER HPR120 OF/OI EXISTING TO BE RELOCATED

0106 BIOMEDICAL FRIDGE; MNFR. PANASONIC PANASONIC MPR-414-PA OF/OI

0107 52" WALL MOUNTED TV - - OF/OI

1" = 1'-0"2-A2.2 2-A2.2

4 TYP. SLAB POURBACK DETAIL - VB UNDER A LAYER OF SAND

KEYPLAN - REMODEL 2 AREA

1/4" = 1'-0"2-A2.2

3 FLOOR 1 - PHARMACY ENLARGED DIMENSION PLAN

Pagosa Springs Medical Center Prepared 3/20/17

Cash Forecast as of end of February 2017 Cash balance 6,900,789

Forecast Months Based on Budget at 12/31/16

(10)

(6) Bond & EMR

(1) (2) (3) (4) (5) Clinic Expan. (7) (8) (9) Interest & (11)

Patient Tax Provider Grants & New Debt/ Total Operating Medicare/Medicaid Principal Total

Collections Revenues Fees Donations Other Leases Collections Expenses Capital Repayment Payments Other Cash Spending Balance

January 2017 (Actual) 2,000,143 7,652 108,671 78,333 160,492 2,355,291 2,356,498 204,689 - 3,688 (18,045) 2,546,830 6,709,250

February 2017 (Actual) 2,088,351 57,747 106,551 117,161 162,866 - 2,532,676 2,133,325 807,439 - 4,600 (317,608) 2,627,756 6,614,170

-

March 2017 (Forecast) 2,167,800 356,190 114,884 149,852 129,698 - 2,918,424 2,456,229 593,550 106,190 2,249 3,158,218 6,374,376

April 2017 (Forecast) 2,350,100 126,390 114,884 206,902 129,698 - 2,927,974 2,289,666 735,550 2,249 3,027,465 6,274,885

May 2017 (Forecast) 2,334,500 206,820 114,884 206,902 129,698 - 2,992,804 2,366,786 500,000 200,000 2,249 3,069,035 6,198,654

June 2017 (Forecast) 2,206,900 126,390 114,884 106,111 129,698 - 2,683,983 2,453,471 300,000 897,859 3,651,330 5,231,307

July 2017 (Forecast) 2,427,800 160,860 114,884 106,111 129,698 2,939,353 2,496,143 300,000 2,249 2,798,392 5,372,268

August 2017 (Forecast) 2,529,500 45,960 114,884 106,111 129,698 70,000 2,996,153 2,493,803 300,000 - 2,249 2,796,052 5,572,369

September 2017 (Forecast) 2,557,800 34,470 114,884 106,111 129,698 75,000 3,017,963 2,390,881 300,000 2,249 2,693,130 5,897,202

October 2017 (Forecast) 2,494,800 11,490 114,884 106,111 129,698 36,500 2,893,483 2,449,832 300,000 2,249 2,752,081 6,038,604

November 2017 (Forecast) 2,404,100 11,490 114,884 131,450 129,698 100,000 2,891,622 2,405,786 300,000 2,249 2,708,035 6,222,191

December 2017 (Forecast) 2,355,300 3,541 129,434 131,616 129,722 68,500 2,818,113 2,505,909 972,026 397,859 3,875,794 5,164,510

Totals 27,917,094 1,149,000 1,378,612 1,552,771 1,620,362 350,000 33,967,839 28,798,329 5,613,254 306,190 1,321,998 (335,653) 35,704,118 5,164,510

791,220 **

at 12/31/17

Bond Requirements (60 days cash) 4,864,035

Amount in Excess 300,475

**Equals total forecasted interest for the Budget year (included in the Bond requirement for cash on hand)

Notes:

(1) Forecast based on a two month lag for budgeted net patient revenues net of provider fee.

(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.

(4) Forecast is based on budget adjusted by YTD actual. Including additional DOLA of $607,000 not included in the budgeted amount relating to Clinic Expansion and 25,000 for Donations.

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

(6) Capital will be funded by new leases, grants and operations.

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

(8) Assumes forecast capital expenditures of $600,000. Also includes $5,013,274 of Clinic expansion and remodel 1 and 2.

(9) Medicare Cost Report Settlement for 2016 of $200,000 and Medicaid Cost Report Settlement for 2013 $106,190 in March.

(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.

(Exess will be reserved for additional Capital request over the bugeted amount of $600,000.

Orginial amount requested was in excess of $800,000)

2017 Budget Difference Variance 2017 Budget Difference VarianceRevenue

2 In-patient Revenue

3 In-Patients 227,122$ 379,728$ (152,606)$ -40% 607,708$ 759,456$ (151,748)$ -20%

4 Surgery 97,849$ 265,045$ (167,196)$ -63% 380,622$ 517,125$ (136,503)$ -26%

5 Swing Beds - - - - - -

6 Total In-patient Revenue 324,971 644,773 (319,802) -50% 988,330 1,276,581 (288,251) -23%

8 Out-patient Revenue

9 ER 721,900 747,424 (25,524) -3% 1,420,649 1,494,848 (74,199) -5%

10 Lab 489,891 523,664 (33,773) -6% 943,730 1,047,328 (103,598) -10%

11 Ambulance 226,219 188,944 37,275 20% 370,532 401,506 (30,974) -8%

12 Clinic 300,675 295,316 5,359 2% 610,053 590,632 19,421 3%

13 Imaging 686,721 691,816 (5,095) -1% 1,358,084 1,383,632 (25,548) -2%

14 Surgery 492,535 416,056 76,479 18% 890,642 832,112 58,530 7%

15 Other 353,915 368,418 (14,503) -4% 769,171 736,835 32,336 4%

16 Total Out-patient Revenue 3,271,856 3,231,638 40,218 1% 6,362,861 6,486,893 (124,032) -2%-

18 Professional Fees 583,967 558,989 24,978 4% 1,149,942 1,124,251 25,691 2%-

20 Total Patient Revenue 4,180,794 4,435,400 (254,606) -6% 8,501,133 8,887,725 (386,592) -4%

22 Revenue Deductions & Bad Debt

23 Contractual Allowances 1,916,380 1,974,207 (57,827) -3% 3,950,830 3,956,009 (5,179) 0%

24 Charity 4,042 14,784 (10,742) -73% 17,019 29,625 (12,606) -43%

25 Bad Debt 167,860 182,788 (14,928) -8% 276,855 366,278 (89,423) -24%

26 Provider Fee & Other (106,551) (114,884) 8,333 -7% (215,222) (229,768) 14,546 -6%

27 Total Revenue Deductions & Bad Debt 1,981,731 2,056,895 (75,164) -4% 4,029,482 4,122,144 (92,662) -2%

28 Total Net Patient Revenue 2,199,063 2,378,505 (179,442) -8% 4,471,651 4,765,581 (293,930) -6%

30 Grants 107,161 109,852 (2,691) -2% 175,494 219,704 (44,210) -20%

31 Other Operating Income - Misc 162,866 129,698 33,168 26% 323,357 259,396 63,961 25%

34 Total Net Revenues 2,469,090 2,618,055 (148,965) -6% 4,970,502 5,244,681 (274,179) -5%

35 Operating Expenses

36 Salary & Wages 1,210,166 1,266,749 (56,583) -4% 2,587,106 2,570,750 16,356 1%

37 Benefits 242,601 246,117 (3,516) -1% 461,963 502,839 (40,876) -8%

38 Professional Fees 59,121 42,526 16,595 39% 99,627 86,502 13,125 15%

39 Contract Labor 57,093 36,209 20,884 58% 116,833 75,878 40,955 54%

40 Purchased Services 101,590 140,318 (38,728) -28% 249,038 288,331 (39,293) -14%

41 Supplies 234,153 271,318 (37,165) -14% 492,783 544,708 (51,925) -10%

42 Rent & Leases 43,574 48,588 (5,014) -10% 86,809 97,242 (10,433) -11%

43 Repairs & Maintenance 34,853 41,947 (7,094) -17% 67,056 84,148 (17,092) -20%

44 Utilities 43,245 37,718 5,527 15% 101,169 83,514 17,655 21%

45 Insurance 10,826 25,166 (14,340) -57% 33,803 50,332 (16,529) -33%

46 Depreciation & Amortization 109,771 117,463 (7,692) -7% 219,543 234,926 (15,383) -7%

47 Interest 47,417 48,665 (1,248) -3% 91,358 97,330 (5,972) -6%

48 Other 96,103 95,230 873 1% 193,636 195,292 (1,656) -1%

49 Total Operating Expenses 2,290,513 2,418,014 (127,501) -5% 4,800,724 4,911,792 (111,068) -2%

51 Operating Revenue Less Expenses 178,577 200,041 (21,464) -11% 169,778 332,889 (163,111) -49%

53 Non-Operating Income

54 Tax Revenue 57,747 22,980 34,767 151% 65,400 34,470 30,930 90%

55 Donations 10,000 40,000 (30,000) -75% 20,000 80,000 (60,000) -75%

57 Total Non-Operating Income 67,747 62,980 4,767 8% 85,400 114,470 (29,070) -25%

59 Total Revenue Less Total Expenses 246,324$ 263,021$ (16,697)$ -6% 255,178$ 447,359$ (192,181)$ -43%

Current Month Year-to-Date

Income Statement - - - Fubruary 28, 2017

Pagosa Springs Medical Center

Current Prior Current Prior

1 Assets Month Month Liabilities Month Month

2 Current Assets Current Liabilities3 Cash Accts Payable - System 982,277$ 393,740$ 4 Operating 6,517,281$ 6,648,221$ Accrued Expenses 2,066,081 2,117,177 5 Bond Funds - 2016 1,125 - Accrued Construction Expenses - - 6 Debt Svc. Res. 2016 Bonds 878,731 879,342 Accrued Capitalized Interest Exp 13,576 13,576 7 Capital Interest 2016 Bonds 6,475 6,476 Cost Report Settlement Res 1,869,818 1,839,818 8 Bond Funds - 2006 & 2007 71,100 35,240 Wages & Benefits Payable 9,205 9,224 9 Capital Escrow 25,789 25,789 Deferred Revenue 795,945 831,848

10 Total Cash 7,500,501 7,595,068 Current Portion of LT Debt-2006,2007 280,000 280,000 11 Current Portion of LT Debt-2016 240,000 240,000 12 Accounts Receivable Total Current Liabilities 6,256,902 5,725,383 13 Patient Revenue - Net 4,398,670 4,330,680 14 Other Receivables 360,108 334,248 Long-Term Liabilities15 Total Accounts Receivable 4,758,778 4,664,928 Leases Payable 221,676 235,571 16 EHR Lease - - 17 Inventory 1,280,206 1,253,992 Bond Premium (Net) - 2007 270,255 271,368 18 Bond Premium (Net) - 2016 148,686 149,111

Total Current Assets 13,539,485 13,513,988 Bonds Payable - 2006 - 2007 9,620,000 9,620,000 Bonds Payable - 2016 10,895,000 10,895,000

20 Fixed Assets 1st Southwest Bank - - 21 Property Plant & Equip (Net) 11,047,547 10,979,833 Total Long-Term Liabilities 21,155,617 21,171,050 22 Electronic Health Record (Net) 867,880 906,352 23 Clinic Expansion in Progress 10,519,594 9,854,383 Net Assets24 Equipment Lease - - Un-Restricted 8,768,657 8,768,657 25 Land 101,000 101,000 Current Year Net Income/Loss 255,178 8,854 26 Total Fixed Assets 22,536,021 21,841,568 Total Un-Restricted 9,023,835 8,777,511 27

28 Other Assets29 Bond Issuance Costs - Net - - Restricted30 Prepaids & Other Assets 360,848 318,388 Total Net Assets 9,023,835 8,777,511

Total Other Assets 360,848 318,388 31

32 Total Assets 36,436,354$ 35,673,944$ Total Liabilities & Net Assets 36,436,354$ 35,673,944$

Balance Sheet - - - February 28, 2017


Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 YTD Total

Activity 31 29 31 30 31 30 31 31 30 31 30 31 31 28 59

2 In-Patient Admissions 52 53 50 39 33 42 49 38 29 36 32 40 48 30 78

3 In-Patient Days 143 135 123 95 97 123 130 82 81 73 100 117 133 82 215

4 Avg Stay Days (In-patients) 2.8 2.5 2.5 2.4 2.9 2.9 2.7 2.2 2.8 2.0 3.1 2.9 2.8 2.7 2.8

6 Swing Bed Admissions 0 0 0 0 0 0 0 0 0 1 0 0 0 0 -

7 Swing Bed Days 0 0 0 0 0 0 0 0 0 3 0 0 0 0 -

8 Avg Length of Stay (Swing) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.0 0.0 0.0 0.0 0.0 0.0

10 Average Daily Census 4.6 4.7 4.0 3.2 3.1 4.1 4.2 2.6 2.7 2.5 3.3 3.8 4.3 2.9 3.6

Out-Patient Visits

13 E/R 645 699 736 497 591 733 779 706 684 552 560 616 600 662 1,262

14 Observ 27 32 44 27 36 33 38 31 33 40 31 23 22 28 50

15 Lab 1,610 1,481 1,818 1,495 1,622 1,738 1,835 1,731 1,643 1,592 1,472 1,547 1,511 1,554 3,065

16 Radiology/CT/MRI 819 843 921 706 812 854 879 934 842 865 782 840 854 856 1,710

17 OR/IP 7 5 5 9 10 13 11 8 4 8 6 10 11 8 19

17 OR/OP 70 70 68 75 56 107 64 87 79 86 98 93 74 85 159

18 Clinic 1,565 1,634 2,068 1,769 1,794 1,742 1,723 2,069 1,754 1,864 1,764 1,747 1,789 1,786 3,575

19 Spec. Clinic 336 314 394 320 325 368 345 429 367 364 324 321 348 382 730

20 Other 21 32 15 19 12 23 32 34 38 34 36 41 21 32 53

22 Total O/P Visits 4,764 4,796 5,675 4,917 4,933 5,243 5,361 6,029 5,444 5,405 5,073 5,238 5,230 5,393 5,393

24 EMS Calls 170 142 185 122 180 175 228 161 170 181 121 222 175 179 354

25 EMS Transports 95 81 114 72 81 96 118 76 103 91 68 112 88 99 187

26 EMS Transports to PMH 59 51 69 52 50 60 69 41 59 56 38 74 57 61 118

27 Pct Transports to PMH 62% 63% 61% 72% 62% 63% 58% 54% 57% 62% 56% 66% 65% 62% 63%

Revenue

31 In-Patients 395,601$ 347,273$ 362,897$ 242,672$ 250,777$ 336,093$ 317,860$ 244,980$ 205,948$ 203,732$ 269,520$ 335,283$ 380,586$ 227,122$ 607,708

31 I/P Surgery 245,782$ 163,759$ 179,350$ 305,837$ 203,376$ 328,122$ 306,577$ 271,353$ 102,525$ 297,996$ 89,249$ 199,841$ 282,773$ 97,849$ 380,622

32 Swing Beds -$ -$ -$ -$ -$ -$ -$ -$ -$ 860$ 1,405$ 3,231$ -$ -$ -

33 Lab O/P 479,145$ 455,204$ 565,033$ 442,723$ 465,409$ 475,196$ 516,760$ 482,868$ 512,361$ 467,298$ 429,817$ 421,567$ 453,839$ 489,891$ 943,730

34 Radiology 128,071$ 142,718$ 149,879$ 112,526$ 138,445$ 155,659$ 160,888$ 150,422$ 157,667$ 134,762$ 128,211$ 153,112$ 147,884$ 155,525$ 303,409

35 CT 256,300$ 284,585$ 335,779$ 289,092$ 293,950$ 337,431$ 420,630$ 301,463$ 300,002$ 281,315$ 234,489$ 297,975$ 301,689$ 317,549$ 619,238

36 MRI 114,591$ 102,567$ 142,291$ 92,097$ 151,695$ 110,162$ 108,774$ 168,109$ 145,927$ 156,183$ 131,111$ 122,318$ 150,458$ 147,409$ 297,867

37 Ultrasound 31,373$ 36,048$ 41,660$ 64,197$ 49,456$ 48,746$ 41,757$ 57,305$ 38,103$ 39,319$ 49,595$ 38,133$ 47,623$ 43,885$ 91,508

38 Mammography 48,266$ 42,770$ 20,016$ 24,692$ 27,008$ 15,985$ 14,351$ 23,980$ 20,343$ 38,143$ 15,868$ 47,258$ 23,709$ 21,003$ 44,712

39 Surgery 424,052$ 502,780$ 345,259$ 358,762$ 369,466$ 510,348$ 395,675$ 469,821$ 500,074$ 442,511$ 490,458$ 371,582$ 398,107$ 492,535$ 890,642

40 ER O/P 665,847$ 718,038$ 772,909$ 548,824$ 637,953$ 794,963$ 852,853$ 732,444$ 707,069$ 662,357$ 562,698$ 728,906$ 698,749$ 721,900$ 1,420,649

41 Other Out-patients 52,751$ 60,632$ 58,967$ 20,743$ 73,795$ 36,601$ 27,192$ 25,324$ 31,482$ 29,470$ 40,893$ 57,496$ 47,292$ 81,831$ 129,123

42 Infusion 189,699$ 191,577$ 195,362$ 140,731$ 154,072$ 186,699$ 257,918$ 284,956$ 260,727$ 194,785$ 156,728$ 290,169$ 291,150$ 123,097$ 414,247

43 Pharmacy O/P 121,008$ 68,761$ 91,672$ 79,782$ 119,978$ 94,370$ 99,946$ 104,606$ 87,814$ 102,392$ 76,457$ 89,616$ 76,815$ 150,337$ 227,152

44 Clinic 225,464$ 267,516$ 315,761$ 282,915$ 288,779$ 268,400$ 284,913$ 324,579$ 256,435$ 319,797$ 266,172$ 315,201$ 309,378$ 300,675$ 610,053

45 Spec. Clinic 127,851$ 134,712$ 160,493$ 130,660$ 140,990$ 134,962$ 145,638$ 170,188$ 143,457$ 177,811$ 130,155$ 160,073$ 160,073$ 165,876$ 325,949

46 Physician Fees 354,220$ 357,045$ 376,780$ 399,334$ 389,438$ 490,967$ 457,591$ 471,416$ 395,538$ 479,102$ 392,870$ 465,781$ 405,902$ 418,091$ 823,993

47 Ambulance 168,160$ 167,384$ 233,742$ 118,174$ 112,680$ 235,379$ 226,458$ 169,698$ 155,352$ 199,976$ 152,084$ 206,561$ 144,312$ 226,219$ 370,531

48 Total 4,028,181$ 4,043,369$ 4,347,850$ 3,653,761$ 3,867,267$ 4,560,083$ 4,635,781$ 4,453,512$ 4,020,824$ 4,227,809$ 3,617,779$ 4,304,103$ 4,320,339$ 4,180,794$ 8,501,133

Monthly Trends

1 In-Patient

2 Admissions:3 Acute 30 51 (21) 78 102 (24) 78 105 (27) -26%4 Swing Bed - - - - - - - - - #DIV/0!5 Total 30 51 (21) 78 102 (24) 78 105 (27) -26%

7 Patient Days:8 Acute 82 137 (55) 215 274 (59) 215 278 (63) -23%9 Swing Bed - - - - - - - - - #DIV/0!10 Total 82 137 (55) 215 274 (59) 215 278 (63) -23%

12 Average Daily Census:13 # Of Days 28 28 59 59 59 60 14 Acute 2.9 4.9 (2.0) 3.6 4.6 (1.0) 3.6 4.6 (1.0) -21%15 Swing Bed - - - - - - - - - #DIV/0!16 Total 2.9 4.9 (2.0) 3.6 4.6 (1.0) 3.6 4.6 (1.0) -21%

18 Length of Stay:19 Acute 2.7 2.7 0.0 2.8 2.7 0.1 2.8 2.6 0.1 4%20 Swing Bed #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0%21 Total 2.7 2.7 0.0 2.8 2.7 0.1 2.8 2.6 0.1 4%

23 Revenue:24 Acute 324,971 644,773 (319,802) 988,330 1,276,581 (288,251) 988,330 1,152,415 (164,085) -14%25 Swing Bed - - - - - - - - - #DIV/0!26 Total 324,971 644,773 (319,802) 988,330 1,276,581 (288,251) 988,330 1,152,415 (164,085) -14%

28 Revenue Per Pat Day:29 Acute 3,963 4,706 (743) 4,597 4,659 (62) 4,597 4,145 452 11%30 Swing Bed #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!31 Total 3,963 4,706 (743) 4,597 4,659 (62) 4,597 4,145 452 11%

33 Out-Patient

34 Out-Patient Visits35 E/R 662 676 (14) 1,262 1,352 (90) 1,262 1,344 (82) -6%36 Observ 28 38 (10) 50 76 (26) 50 59 (9) -15%37 Lab 1,554 1,718 (164) 3,065 3,436 (371) 3,065 3,091 (26) -1%38 Radiology/MRI/US/CT 856 1,041 (185) 1,710 2,082 (372) 1,710 1,662 48 3%39 OR 93 80 13 178 159 19 178 152 26 17%40 Clinic 1,786 1,772 14 3,575 3,544 31 3,575 3,199 376 12%41 Other 32 19 13 53 38 15 53 53 - 0%42 Total 5,011 5,344 (333) 9,893 10,687 (794) 9,893 9,560 333 3%

44 Spec. Clinic 382 - 382 730 - 730 730 650 80 12%45 ER Physician 662 676 (14) 1,262 676 586 1,262 1,344 (82) -6%

48 Out-Patient Revenue49 E/R 642,150 663,352 (21,202) 1,287,699 1,326,704 (39,005) 1,287,699 1,246,106 41,593 3%50 Observ 79,750 84,072 (4,322) 132,950 168,144 (35,194) 132,950 137,779 (4,829) -4%51 Lab 489,891 523,664 (33,773) 943,730 1,047,328 (103,598) 943,730 934,348 9,382 1%52 Radiology 156,875 150,808 6,067 304,759 301,616 3,143 304,759 270,789 33,970 13%53 CT 317,549 338,408 (20,859) 619,238 676,816 (57,578) 619,238 540,885 78,353 14%54 Ultrasound 43,885 49,144 (5,259) 91,508 98,288 (6,780) 91,508 67,421 24,087 36%55 MRI 147,409 123,176 24,233 297,867 246,352 51,515 297,867 217,158 80,709 37%56 Mammography 21,003 30,280 (9,277) 44,712 60,560 (15,848) 44,712 91,036 (46,324) -51%57 OR 492,535 416,056 76,479 890,642 832,112 58,530 890,642 926,832 (36,190) -4%58 Clinic 300,675 295,316 5,359 610,053 590,632 19,421 610,053 492,980 117,073 24%60 Other 353,915 368,418 (14,503) 769,171 736,835 32,336 769,171 684,428 84,743 12%61 Total 3,045,637 3,042,694 2,943 5,992,329 6,085,387 (93,058) 5,992,329 5,609,762 382,567 7%

59 Spec. Clinic 165,876 138,010 27,866 294,402 282,293 12,109 294,402 262,563 31,839 12%63 Physician 418,091 420,979 (2,888) 855,540 841,958 13,582 855,540 711,265 144,275 20%63 Total 583,967 558,989 24,978 1,149,942 1,124,251 25,691 1,149,942 973,828 176,114 18%

64 Ambulance

65 Ambulance Calls 179 354 354 312 42 13%66 Ambulance Transports 99 187 187 176 11 6%67 Transports to PMH 61 95 118 201 (83) 118 110 8 7%68 Transports to PMH % 62% 63% 63% 63%69 Transports to Other 38 69 69 66 3 70 Transports to Other % 38% 37% 37% 38%

72 Revenue: 226,219 188,944 37,275 370,532 401,506 (30,974) 370,532 335,544 34,988 10%73 Revenue Per Transport: 2,285 1,981 1,981 1,906 75 4%

74 Total Revenues 4,180,794 4,435,400 (254,606) 8,501,133 8,887,725 (386,592) 8,501,133 8,071,549 429,584 5%

Pagosa Springs Medical Center - - - Statistical Review

Statistical ReviewFebruary 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 Variance2017

February February

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 1,443,384$ 295,496$ 122,245$ 63,007$ 73,221$ 42,676$ 174,253$ 2,214,282$ 25%

3 Medicaid 752,687 121,501 29,071 23,475 31,937 20,170 95,899 1,074,740 12%

4 Third Party 1,667,811 733,419 300,084 232,498 159,076 235,259 1,024,288 4,352,435 48%

5 Self-Pay 254,269 122,345 138,936 73,705 120,787 95,925 572,537 1,378,504 15%

Current Month Total 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% 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 ########## #### 1,258,133$ 847,083$ 423,465$ ######## ##### 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%

Dec-15 3,997,068$ 1,126,386$ 969,869$ 780,130$ 514,019$ 550,390$ 2,769,506$ 10,707,368$ 146,957Pct of Total 39% 15% 8% 6% 6% 7% 19% 100%

Nov-15 4,050,795$ 1,520,072$ 844,147$ 647,019$ 649,304$ 725,565$ 2,350,829$ 10,460,928$ 277,165Pct of Total 39% 15% 8% 6% 6% 7% 19% 100%

Oct-15 4,337,928 1,304,005 916,249 805,296 787,144 440,378 2,445,626 10,688,570 204,753Pct of Total 41% 12% 9% 8% 7% 4% 20% 100%

Sep-15 ########## #### 1,323,831$ 992,882$ 935,502$ ######## ##### 315,491$ 2,337,468$ 9,902,275$ 0Pct of Total 39% 13% 10% 9% 5% 3% 20% 100%

Aug-15 ########## #### 1,426,700$ ########## #### 608,575$ ######## ##### 531,542$ 2,068,476$ 9,982,694$ 74,409Pct of Total 43% 17% 8% 5% 6% 4% 17% 100%

Jul-15 ########## #### 1,554,907$ 771,925$ 481,680$ ######## ##### 410,041$ 1,989,720$ 9,421,425$ 171,991Pct of Total 43% 17% 8% 5% 6% 4% 17% 100%

Jun-15 3,870,977$ 1,181,919$ 718,276$ 635,491$ 498,966$ 574,898$ 1,910,261$ 9,004,202$ 185,523Pct of Total 43% 13% 8% 7% 6% 6% 17% 100%

May-15 3,145,906 1,373,328 905,979 698,918 649,378 514,777 1,939,546 8,835,723 200,821 Pct of Total 36% 16% 10% 8% 7% 6% 22% 104%

Apr-15 3,409,285 1,549,879 945,104 750,603 594,193 441,264 1,718,137 9,134,222 287,621 Pct of Total 37% 17% 10% 8% 7% 5% 19% 103%

Mar-15 3,398,434 1,339,969 1,003,776 740,705 504,848 462,296 1,786,370 8,947,654 200,687 Pct of Total 38% 15% 11% 8% 6% 5% 20% 103%

Feb-15 3,372,215 1,617,336 962,484 674,262 578,155 388,823 1,711,885 8,950,420 234,667 Pct of Total 38% 18% 11% 8% 6% 4% 19% 104%

Jan-15 3,392,093 1,725,920 883,473 775,583 478,039 444,190 1,720,835 8,979,296 116,061 Pct of Total 38% 19% 10% 9% 5% 5% 19% 105%

12 Pct Settled (Current) 67.4% 53.7% 38.5% 29.0% 3.4% -496.6%

13 Pct Settled (Dec from Nov) 64.3% 39.8% 13.2% 27.6% 19.1% -351.6%

14 Pct Settled (Nov from Oct) 66.8% 37.4% 20.2% 15.6% 15.7% -363.0%

15 Pct Settled (Oct from Sep) 70.1% 46.2% 30.6% 17.1% 22.4% -445.1%

16 Pct Settled (Sep from Aug) 62.3% 38.7% 24.6% 20.4% 10.1% -371.9%


Cerner/Healthland Accounts Receivable for Hospital by Payor and Days Outstanding -- As of February 28, 2017

31 29 31 30 31 30

Jan-17 Feb-17 Mar-16 Apr-16 May-16 Jun-16

31 31 30 31 30 31

Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16

12 Medicare 33% 21 75,791$ 525,229$

13 Medicaid 7% 35 75,791$ 185,687$

14 Blue Cross 15% 45 75,791$ 511,587$

15 Commercial 26% 60 75,791$ 1,182,335$

16 Self Pay 19% 150 75,791$ 2,160,034$

17 Total: 100% 4,564,873$

18 75,791$

19 60

59

9

10

2

3

4

5

7

8

Net Days in A/R Target

Pagosa Springs Medical Center - - - Net Days Target

2,043,346$

Net Accounts Receivable 4,330,680$ 4,398,670$ 4,694,121$ 4,358,140$ 4,141,388$

Net Patient Revenue 2,272,587$

74,738$

2,199,063$ 2,361,180$

61

75,237$


Pagosa Springs Medical Center - - - Net Days in A/R 2017

2,536,763$

62

77,305$ 70,098$ 64,971$

4,400,850$

64 58

Net Patient Rev/Day (2 month Avg) 72,285$

Net Days in A/R 60

1,920,846$

Net Patient Revenue 2,535,361$ 2,295,670$ 2,179,883$ 2,216,384$ 1,541,022$ 2,282,602$

Net Accounts Receivable 4,541,690$ 4,230,297$ 4,041,074$ 4,130,001$ 3,815,073$ 4,039,996$

Net Patient Rev/Day (2 month Avg) 83,172$ 77,920$ 73,358$ 72,080$ 61,432$ 62,500$

65Net Days in A/R 55 54 55 57 62


Revenue and Usage by Financial Class

February, 2017

Row Labels Sum of Inp. MTD Total Sum of Out. MTD Total Total MTD % MTD

Auto/Liability Insurance 9,536.00 28,775.90 38,311.90 0.92%

Blue Cross 106,276.00 603,369.40 709,645.40 16.97%

Champus - 41.00 41.00 0.00%

Commercial Insurance 46,257.00 435,045.30 481,302.30 11.51%

Medicaid 105,750.00 825,010.60 930,760.60 22.26%

Medicare 168,684.00 1,315,269.10 1,483,953.10 35.49%

Medicare HMO 6,837.00 86,974.20 93,811.20 2.24%

Self Pay 18,116.00 218,671.70 236,787.70 5.66%

Self Pay - Client Billing - 8,985.00 8,985.00 0.21%

Veterans Administration 10,455.00 162,722.10 173,177.10 4.14%

Workers Compensation - 24,019.00 24,019.00 0.57%

Grand Total 471,911.00 3,708,883.30 4,180,794.30 100.00%

Row Labels Sum of Inp. YTD Total Sum of Out. YTD Total Total YTD % YTD

12/31/16

% YTD

12/31/15

% YTD

Auto/Liability Insurance 9,536.00 126,607.90 136,143.90 1.60% 1.11% 0.46%

Blue Cross 176,126.00 1,178,229.20 1,354,355.20 15.93% 15.83% 14.09%

Champus - 951.00 951.00 0.01% 0.19% 0.09%

Commercial Insurance 90,191.00 830,641.70 920,832.70 10.83% 13.08% 14.98%

Medicaid 278,247.00 1,693,054.92 1,971,301.92 23.19% 21.56% 20.33%

Medicare 607,489.92 2,464,735.85 3,072,225.77 36.14% 35.90% 35.29%

Medicare HMO 29,660.00 167,478.20 197,138.20 2.32% 2.76% 2.58%

Self Pay 30,685.00 413,810.22 444,495.22 5.23% 5.26% 9.16%

Self Pay - Client Billing - 13,426.00 13,426.00 0.16% 0.17% 0.09%

Veterans Administration 23,659.00 255,985.90 279,644.90 3.29% 2.74% 2.56%

Workers Compensation - 110,618.00 110,618.00 1.30% 1.37% 0.71%

Grand Total 1,245,593.92 7,255,538.89 8,501,132.81 100.00% 99.97% 100.34%

Blank 0.00% -0.35%

HMO (Health Maint Org) 0.03% 0.01%

Total 100.00% 100.00%

PSMC

Clinic Expansion

Summary of Funds

As of January 1, 2017

Expenditures

Total Project

Cost Total Paid TD

Remaining

(including

Contingency)

GEJohnson Per App. # 8 11,137,758.00 7,557,368.00 3,580,390.00

FF&E 464,079.00 36,496.00 427,583.00

IT 200,000.00 100,699.00 99,301.00

Remodel 1 460,679.00 - 460,679.00

Remodel 2 345,321.00 - 345,321.00

HVAC 100,000.00 - 100,000.00

Total Remaining Cost 12,707,837.00 7,694,563.00 5,013,274.00

Funds Available Total Available

Monies

Received in 2016

(or before)

Remaining

Monies for

Project

Bond Funds Construction 8,110,080.00 7,557,368.00 552,712.00

Bond Interest Construction 24,672.00 24,672.00

DOLA Funds Construction 2,000,000.00 942,568.00 1,057,432.00

DOLA Funds Planning 175,000.00 175,000.00 -

Foundation Planning 538,863.00 538,863.00 -

Foundation

Construction/C

ash(Thru Dec) 975,339.00 950,000.00 25,339.00

Foundation Pledges-2014 12,000.00 -




Rebates FF&E 5,800.00 5,800.00

CHF Grant 500,000.00 250,000.00 250,000.00

Operating Cash (2,743,908.00) 3,121,992.00

Total Funds for Project 12,791,130.00 7,694,563.00 5,013,275.00

CAO Report, March 2017

LEGAL Continue to monitor a number of issues including the Hospital Provider Fee. CAO REPORTING AREAS

Compliance and HIPAA Department Mock Surveys: completed a Mock Survey for compliance in 15 of

18 departments. PSMC policy management:

o Total number of medical center policies: 935 o Competency (record of employee electronic review): 91% o Total number of policies in the revision/review process: 341

Our HIPAA security (computer and electronic) annual risk assessment was completed in March of 2017. This assessment reviews compliance with approximately 185 obligations. Between the work of Cerner with our HIPAA Privacy Officer, Anita Hooton, PSMC had nearly perfect results.

Marketing The Marketing Department (Jesse Hensle) continues to complete work

outlined in the multi-year marketing plan: o For orthopedic surgery and general surgery service lines recent

accomplishments include creation of the following: Rack cards (bio and scope of services) Waiting area television slides Print ads Radio ads Display case posters Webpage

o Cardiology service line includes most of the above Other efforts outside the multi-year plan:

o Billboard in Chama o KWUF Good Morning Pagosa radio show the last Friday of the month o Internal messaging via twice per month Pagossip

o PSMC appointment magnets o February awareness – national heart month o Website -- In February there were: 2,203 home page views, and

13,223 Facebook impressions Clinic move

o Key efforts to manage signage and communications to patients for changes and wayfinding.

Outreach (formerly known as Recruiting and Retention) Broadened the scope of responsibility of our Physician Recruiter/Retention

specialist to Outreach. Diane Levison, our Outreach Liason, continues to recruit physicians, support retention, and now works to connect with other healthcare providers in southwest Colorado.

Attended National Association of Community Outreach and Physician Liason training and certification.

Recruiting: This role functions closely with Dr. Rhonda Webb (specific recruiting listed in the CMO report).

Retention: Recognition of provider anniversaries, birthdays and other specialty recognitions.

Outreach in January and February: in-person visit to Mercy Cardiology (with PSMC’s Dr. Lambert) and in-person visit to three local providers.

Dietary Staff with Manager, Brandon Dell’Olio, attended SafeServe Training; all

employees who are not yet SafeServe certified are working on certification. SafeServe is a national program that trains kitchen/dietary staff in such things as: understanding the causes and how to prevent food borne illness; how to avoid consumer allergic reactions through such things as clear meal description and identification of ingredients; safe food handling including personal hygiene and clothing; safe food flow including proper separation of foods, cleaning foods, and food temperatures; safe facility including equipment maintenance and sanitizing/cleaning areas; and regulatory obligations.

January - total non-patient meals served: 1,433 February - total non-patient meals served: 1,391

Housekeeping Added staff due to new Outpatient Clinic responsibilities. Established new work flow to handle expanded responsibilities. Significant effort made to turn the new clinic space from construction “dusty”

to patient ready. Staff with manager, Mitzi Bowman, attended remote training on cleanliness

by the Hospital Consumer Assessment of Healthcare Provider Systems (HCAHPS – the Medicare/Medicaid patient satisfaction metrics).

Human Resources Orientation process being streamlined for efficiency starting April. Our HR

Manager (Mitzi Bowman) has already conducted 6 full-day orientations conducted since the start of the year and change in process will reduce the number by 50%).

Engaged and implemented Healthstream for ongoing computerized training of all employees.

Hosted an employee and family event on March 20th -- served dinner and enjoyed a preview of the new clinic space; 300 persons rsvp’d and more than 250 persons attended.

Medical Staff Office The Medical Staff Office Manager, Krista Starr, works closely with the Chief of

Staff, Dr. Ralph Battels and the CAO. Please see the monthly Chief of Staff report for Medical Staff privileges and policy changes.

CNO Report – March 2017 Clinical Updates

ER o Volume

January volume at 600; averaging 19/day; slightly less volume compared to the previous year (-45 visits)

February volume at 662; averaging 24/day; slightly less volume compared to the previous year (-37 visits)

Spring Break volume lower than previous years

o ED Throughput studies January door to doc time average at 7 minutes – national

benchmark is < 20 minutes February door to doc time average at 7 minutes – national

benchmark is <20 minutes January ALOS (average length of stay) is 1.41 hours – national

benchmark for like facilities is about 2.30 hours February ALOS (average length of stay) is 2.01 hours – national

benchmark for like facilities is about 2.30 hours

o Staffing Hired 2 FT night RN’s; all FT FTE positions filled Continue to post per diem / relief positions to decrease OT Physicians are fully staffed

o Mock CDPHE Survey completed

Much improvement noted

Inpatient o Volume

January volumes at 22 Observation and 44 Inpatients ADC for January was 4.3; ALOS 2.0 days Dulce patients were 10.6% of inpatient/observation volume for

January February volumes at 28 Observation and 30 Inpatients ADC for February was 2.9; ALOS 1.4 days Dulce patients were 8.6% of inpatient/observation volume for

February

o Staffing Unstable at present with 2 nurses out on unplanned leave FT Day Shift position filled by 2 PT staff Continue to post per diem / relief positions

o Transfers in January – For bed availability

0 For specialists/level of care

20 patients transferred from ER to other facilities o General Surgery 1

Not on call 1 o Pediatrics 4 o ICU 1 o ENT 1 o OB 1 o Cardiology 2 o Trauma 3 o Gastroenterology 1 o Nephrology 1 o Urology 1 o Oncology 1 o Pulmonary 1 o Orthopedic 2

Not on call 0

o Transfers in February For bed availability

3 – bed available, but not able to staff For specialists/level of care

33 patients transferred from ER to other facilities General Surgery

Not on call 2 Pediatrics 4 ICU 7 OB 1 Cardiology 4 Trauma 5 Neurology 2 Urology 1 Pulmonary 1 Radiology needs 2 Orthopedic

Not on call 1

Surgery o Volume

January cases at 87, includes 39 GI procedures, 11 general surgery cases/procedures, 28 orthopedic cases, and 6 pain management procedures

February cases at 93, includes 42 GI procedures, 13 general surgery cases/procedures, 24 orthopedic cases, and 6 pain management procedures

o Staffing New Circulator/First Assist starting in May; all FT positions will be

filled Continue to post per diem / relief positions Continue to post FT General Surgeon; interviews/site visits

underway

o Clinic Merger Planning/preparations underway for the smooth transition of

Specialty Clinic to the new outpatient building probably mid-April Likely to move before Cerner / CDM issues completely resolved,

but have contingency plans in place to address any potential revenue and/or volume issues

o New Construction Remodel 1 scheduled to begin April 17 and be completed by mid-

June To include expanded PACU (2 beds) and Infusion space (3

chairs) Sterile equipment storage Relocation of scheduling and PAT Realignment of “red line” space to limit access

EMS

o Volume 175 (total calls) for January; 116 911 calls resulting in transports

with 97% of transports to PSMC; 2 to MRMC 179 (total calls) for February; 108 911 calls resulting in transports

with 98% of transport to PSMC; 1 to MRMC Water / mold prevention mitigation process underway at EMS

building Chief Webb assuming responsibility for Facilities/Life Safety Participated in County education for Emergency and Disaster

Considerations for Executives and Senior Officials

Diagnostic Imaging January total volume at 854 exams February total volume at 856 exams New echo tech here, volume increasing as expected (January 14

exams, February 31 exams) Mammography

ACR evaluation successfully completed; certification granted

Equipment failure – digital x-ray machine down for 1 week this month; exams covered by portable machine and standing station

Laboratory

January total volume at 1511patients February total volume at 1554 patients Preparing for move to the new outpatient building

Heat reduction o Refrigerators/freezers (8) delivered o Pending energy report prior to use/set-up

Blood Bank move; pathology move to commence 4/17/17 when refrigeration is up, running, and validated

Validation for phlebotomy station underway, expect completion within 30 days

Primary Care Clinic o Role is that of support for:

Nursing staff oversight Still looking for strong nursing manager Regular meeting / training for nursing staff

Clinical processes, nurse training Point of Care Testing processes, development Medicare Wellness Visits; regulatory requirements Health Maintenance requirements to improve patient care

Move Exam rooms almost complete Scripting remaining move of supplies, equipment

Chief Medical Officer Report to the Board March 2017

Medical Staff/Recruitment

Efforts continue to recruit a part time Radiologist to help move our breast program

forward. This will be to replace our current physician who is relocating. In the interim,

we will continue our screening mammogram program, but will refer patients who need

diagnostic mammograms to another facility effective April 1st.

Two new Family Medicine specialists are joining the clinic in October 2017. In addition,

we have a Family Medicine practitioner who owns a home here and is interested in

providing back up coverage for our Clinic, ED and Hospital services.

We are interviewing General Surgery candidates to allow us to continue/grow surgery

call and grow this program as our part time Surgeon is retiring in July.

Realizing a nationwide shortage of Psychiatrists, and a community need, we are

modifying our plan for Behavioral Specialist recruitment to include other licensure such

as Psychologists with prescribing privileges.

The Ophthalmologists on our Medical Staff are interested in having clinic and

performing surgery here. We are waiting until after the move to the new building to

accommodate them.

Our new part time Cardiologist, Dr. Lambert, is on site and seeing clinic patients as well

as consults in the ED and Hospital. The plan is to move forward to be able to do

pacemaker interrogations here. We continue to have a good relationship with the

Cardiology group from Mercy in Durango. They see clinic patients here.

An area Plastic Surgeon is pursuing privileges to do both clinic and surgery here on a

part time basis. This will help support our breast program, but is not limited to breast

reconstruction.

Clinic Move- a shared Operational effort

As Per Sikendar Fidai’s presentation.

As Per Kathee Douglas’s written report.

Check-In and Registration people are there effective March 20th- soft move. Identifying

issues to address prior to Primary Care opening there April 10th.

The next phase will be a move of our Surgical Specialists and Medical Subspecialists to

this area.

Pharmacy

Pyxis is in clinic to obtain control of inventory (again shared with Kathee).

Efforts continue to reduce our pharmacy inventory to decrease costs. All changes

approved by P and T committee which has Physician members.

Informatics/Quality Restructuring Update

Sue Schmidt who lead our Cerner implementation has physically relocated and is now

managing Quality and Regulatory reporting, which is mostly dependent on our ability to

report electronically, remotely. She also is responsible for our Cerner relationship. Her

area lends itself to telecommuting very well.

Jen Cole, who managed our Primary Care Clinic in the past and has been in the

Informatics Department is now the manager of this department. She and her team have

been instrumental in this clinic move as Informatics is tied to everything we do.

Our new Quality Manager Aaron Alberter has initiated Leadership Huddles every

morning. This has enabled us to communicate better. Initially this was initiated for the

people involved in the move, but has expanded to all managers. Our feeling is that all

areas, clinical and non-clinical overlap and communication is key to our being able to

move forward The Leadership (Managers) and Senior Leadership (Cteam) attend these

meetings.

Information Technology

This was outsourced 15 months ago and we continue to support this concept as PSMC

has grown, and is growing.

We have added another local person to have “boots on the ground” to solve day to day

problems.

I am happy to provide a detailed analysis of where we were, where we are, and where

we are going upon request.

THE UPPER SAN JUAN HEALTH SERVICE DISTRICT

DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER

MEDICAL STAFF REPORT BY CHIEF OF STAFF, RALPH BATTELS

March 28, 2017

I. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS TO THE USJHSD BOARD REGARDING

NEW POLICIES OR PROCEDURES ADOPTED BY THE MEDICAL STAFF:

RECOMMENDATION DESCRIPTION

Medical Staff PA, NP, and Medical Students Policy Medical Staff Policy

II. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS TO THE USJHSD BOARD REGARDING PROVIDER PRIVILEGES:

NAME INITIAL/REAPPOINT/CHANGE TYPE OF PRIVILEGES SPECIALTY

Michelle Black, MD Initial Appointment Telemedicine/Teleradiology Diagnostic Radiology Richard Bellon, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Neuroradiology Gitesh Chheda, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Mark Dennis, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Louie Enriquez, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Andrew Fisher, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Kristin Freestone, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Donald Frei, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Neuroradiology Jeff Friedland, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Pediatric Radiology Steven Heiss, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Kevin Johnson, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Bobby Kang, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Kevin Lampert, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Michael Otte, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Samuel Scutchfield, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Neuroradiology Joseph Tan, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Shane Wheeler, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology Jeffrey Williams, DO One time, case-specific temporary

privileges Breast Reconstruction Plastic and Reconstructive

Surgery

III. REPORT OF NUMBER OF PROVIDERS BY CATEGORY Active: 18 Courtesy: 26 Courtesy – Locum Tenens: 0 Telemedicine: 85 Allied Health Professionals: 21 Total: 150

MINUTES OF REGULAR BOARD MEETING

As Amended

Tuesday, February 28, 2017

5:30 PM MST

The Great Room, Pagosa Springs Medical Center

95 South Pagosa Blvd.

Pagosa Springs, CO 81147

Pursuant to the provisions of the Supplemental Public Securities Act, one or more members of the

Board may participate in this meeting and may vote on the foregoing matters through the use of a

conference telephone or other telecommunications device.

The Board of Directors of the Upper San Juan Health Service District (the “Board”) held the regular board meeting on February 28, 2017, Pagosa Springs Medical Center, The Great Room, 95 South Pagosa Blvd., Pagosa Springs, Colorado. Directors Present: Chair Mark Floyd, Vice-Chair Greg Schulte, Secretary/Treasurer Jerry Baker, Director Dr. Jim Pruitt, Director Kate Alfred, and Director Matt Mees. Present by phone were Director Dr. Richard Zak, and the District’s Chief Financial Officer, Dennis Wilson.

1) CALL TO ORDER; ADMINISTRATIVE MATTERS OF THE BOARD

Chair Floyd called the meeting to order at 5:31 p.m. MST and Clerk of the Board, Jodi Scarpa, recorded the minutes. A quorum of directors was present and acknowledged by Vice-Chair Schulte and the meeting, having been duly convened, was ready to proceed with business.

The Board noted approval of the agenda.

2) MILESTONE MOMENT: CNOR Strong CNO, Kathee Douglas, presented and acknowledged before the Board a certificate of achievement

recently received from the Competency and Credentialing Institute (“CCI”) recognizing Pagosa Springs Medical Center as being a CNOR Strong facility. (CNOR is a definition not an acronym. CNOR certification is defined as: "the documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing care for patients before, during and after surgery.")

Ms. Douglas explained the significance of this accomplishment advising to be a facility recognized by CCI as CNOR Strong, two criteria must be met: 1. at least 50 percent of eligible perioperative nursing is staff CNOR certified, and 2. the facility consistently recognizes and rewards nurses who become CNOR certified or recertified. Currently, as Ms. Douglas explained, Pagosa Springs Medical Center’s (“PSMC”) perioperative nursing staff is 100 percent CNOR certified and recognized.

In addition, Ms. Douglas advised the Board that PSMC has received top honors with Centura Health, ranking the facility #1 out of eight Rural Critical Access Hospitals with Level IV Trauma.

3) PUBLIC COMMENT The following is a list, in order of presentation, of persons who elected to comment before the Board.

All comments were limited to three minutes or less per person. i) Dr. Pam Kircher ii) Joel Hellwege iii) Bill Beno iv) Mark Disbro v) Kathy Hill vi) Elizabeth Coleman vii) Laura Dunn viii) Alan DeBoer ix) Don Fahrenkrug x) Karl Milburg

4) DECISION AGENDA

a) MEDICAL AID IN DYING ACT i) Overview:

CAO, Ann Bruzzese, presented before the Board and gave a brief overview of the attached CAO Report highlighting information on the Medical Aid in Dying Law.

ii) Physician Medical Executive Committee recommendation report Dr. Ralph Battels, Chief of Staff, presented before the Board the attached Chief of Staff Report

regarding the Medical Aid in Dying Law. Dr. Battels began by emphasizing the complexity of reaching the final recommendation of the Medical Executive Committee (representing the physician staff), stating that the physician staff as a whole were deeply and strongly divided in their personal ethics regarding the issue.

Dr. Battels informed the Board that by a vote of five to one, the Medical Executive Committee recommends Option 1 of Resolution 2017-04 and agrees that PSMC not offer Medical Aid in Dying services at this time and that the issue should be revisited in year 2018.

iii) Consideration of Resolution 2017-04 (3 resolution options were attached in the packet) regarding PSMC offering Medical Aid in Dying services.

Director, Dr. Pruitt, posed a question if a motion may be made prior to a discussion. Vice-Chair Schulte moved to adopt Option 1 of Resolution 2017-04 as recommended by the

Medical Executive Committee that PSMC not offer Medical Aid In Dying services at this time. Director Alfred seconded the motion. Two directors, Dr. Pruitt and Dr. Zak opposed. Further discussion ensued. Questions were asked and answered.

Chair Floyd then ordered a roll call vote: Director Mees: AYE Secretary/Treasurer Baker: NO Vice-Chair Schulte: AYE Director Alfred: AYE Director Dr. Pruitt: NO Director Dr. Zak: NO

Chair Floyd: AYE The motioned passed with four votes in favor of not offering Medical Aid In Dying at this time

and three opposed the motion.

b) JOB DESCRIPTION FOR NEXT CEO AND POSTING SCHEDULE i) Overview

CAO Bruzzese gave a brief overview and recap of the reason for tabling the decision regarding Resolution 2017-03 from the last regular meeting of the Board on January 24, 2017, and advised the Board that per recommendation of the Succession Planning Committee, the job description stands as written subject to minor typographical errors being corrected.

ii) Committee recommendation report Director Alfred and Secretary/Treasurer Baker, speaking as members of the Succession Planning

Committee, both confirmed with the Board the recommendation to accept the CEO Job Description as originally written and amended with typographical errors corrected.

Discussion ensued. Questions were asked and answered. iii) Consideration of Resolution 2017-03

Vice Chair Schulte moved to adopt Resolution 2017-03. Director Alfred seconded the motion. The motion passed with six votes in favor and Dr. Pruitt against.

c) PEER REVIEW ANNUAL REPORT

The annual report of PSMC’s 2016 peer review activities was presented in executive session as such report is maintained as confidential in accordance with the Quality Management Act, C.R.S. Section 25-3-109, et seq. and the Professional Review Act, C.R.S. Section 12-36.5-101 et seq.

d) BOARD’S ANNUAL REVIEW OF CEO

The Board performed an annual review of CEO Cochennet in executive session. Following executive session for the CEO annual review, Secretary/Treasurer Baker moved to

approve one hundred percent of the CEO’s 2016 at risk incentive pay/bonus. Upon motion seconded by Director Mees, the Board unanimously approved.

5) REPORTS

a) Written Reports (no oral reports were presented unless the Board had questions) i) COS Report

No oral report presented. No questions were asked. ii) CNO Report

CNO, Kathee Douglas, advised the Board that the attached CNO report was a 2016 Transfer Summary per previous request from the last regular meeting of the Board on January 24, 2017, by Chair Floyd. Questions were asked and answered.

iii) PSMC Annual Report CEO, Brad Cochennet, presented before the Board the attached 2016 annual report of USJHSD.

No questions were asked. Secretary/Treasurer Baker commented on how well-written the report was and suggested to

possibly distribute the report to the local newspaper (“The Pagosa Springs SUN”) to publish for more wide-spread public view.

iv) CAO Report (CAO Bruzzese presented her report to the Board as overview of the Medical Aid in Dying Act

and overview of the job description for next CEO and posting schedule under the Decision Agenda.)

v) CMO Report Item was originally struck from agenda. There was no report.

b) Oral Reports

i) Chair Report Item was originally struck from agenda. There was no report.

ii) Strategic Planning Item was originally struck from agenda. There was no report.

iii) Campus Planning Item was originally struck from agenda. There was no report.

iv) Succession Planning Item was originally struck from agenda. There was no report.

v) Contracts Director Alfred advised the Board that the Contracts Committee did not meet.

vi) Finance Report Secretary/Treasurer Baker presented before the Board the attached Finance Report, highlighting

revenue deductions bad debts, charity and provider fee combined were one percent under budget, resulting in net patient revenues under budget by five percent. PSMC recorded $30,000.00 in additional reserves for the Medicaid cost report.

CFO Wilson gave an overview of changes being proposed by the governor of Colorado and state legislature relative to the Provider Fee. While it is expected the Provider Fee to approximate what was budgeted for 2017, the changes proposed will result in a state-wide reduction of 43 percent to the Provider Fee to balance the state budget. PSMC’s share of the proposed cuts could approximate $1.1 million. CAO Bruzzese advised the Board that PSMC is supporting Colorado Hospital Association efforts to reach a resolution to this significant issue.

vii) Construction Report Manager of Executive Offices, Jodi Scarpa, presented before the Board the attached graph and

noted that construction is ahead of schedule and on budget. viii) CEO Report

(CEO Cochennet presented his report to the Board as PSMC Annual Report.) ix) Monthly In-Depth Report: Primary Care Clinic, Director Sikendar Fidai

(Upon recommendation of Chair Floyd and unanimous agreement of the Board, this item has been tabled until the next regular meeting of the Board scheduled for March 28, 2017.)

6) CONSENT AGENDA Chair Floyd opened the discussion briefly recounting the items on the consent agenda and inquired of any

questions or objections. Director Dr. Pruitt requested to include the statement: “Director, Dr. Pruitt, requested that the job description include clinical qualifications” to item number four, section c, paragraph i of the Regular Meeting Minutes of January 24, 2017.

Director Alfred moved to approve all items listed in the Consent Agenda: the Regular Meeting Minutes of January 24, 2017, as amended, Medical Staff report recommendations for new or renewal of provider privileges

and PSMC 2016 Annual Report. Upon motion seconded by Secretary/Treasurer Baker, the Board unanimously accepted all items of the Consent Agenda. 7) EXECUTIVE SESSION

The Board met in Executive Session from 7:04 p.m. to 8:06 p.m. MST pursuant to the following subparagraphs of C.R.S. Section 24-6-402(4):

(b): to receive legal advice on specific legal questions; (c): matters to remain confidential pursuant to other federal or state statute – specifically confidential

quality and peer review that are confidential per state statutes C.R.S. Section 25-3-109, et seq. and C.R.S. Section 12-36.5-101 et seq.; and

(f)(I): personnel matters. 8) OTHER BUSINESS

There was none. 9) ADJOURN

Concluding all decision items as noted herein and there being no further business, Chair Floyd adjourned the regular meeting at 8:09 p.m. MST.

Respectfully Submitted, Jodi Scarpa, serving as Clerk for the Board

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