PSMC Foundation Keyah Grande Gala Fundraising Event · 2018-06-26 · v) Finance Report CFO Chelle...
Transcript of 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
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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.
Annual Program Evaluation - 2017
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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
Pagosa Springs Medical Center
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
Pagosa Springs Medical Center
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.
Annual Program Evaluation - 2017
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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.
Page 1 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.
Page 2 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 $10.05MM. Part of the
balance in A/R relates to Medicaid EAPG issue with their claims processing system.
Also, staffing changes (new leader who is first focusing on system changes and some
staff departures/replacements) in the business office has caused a slight delay in working
the A/R.
7) Other – Audit of 2017 Financials:
a) Mike Nelson with Chadwick, Steinkirchner, Davis & Co., P.C. went over the 2017
audited financial statements and noted that the audit went well, the PSMC staff provided
everything that was requested and no disagreements arose during the course of the audit.
The auditor concluded that (1) revenues and expense were as expected and within the
guidelines of budget requirements, and (2) staff has presented the financial statements
fairly in all material respects and in accordance with generally accepted accounting
principles.
ORAL REPORTS 4a.v.
Page 1
2018 Budget Difference Variance 2018 Budget Difference VarianceRevenue
2 In-patient Revenue
3 In-Patients 247,129$ 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.
Page 2
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%
Pagosa Springs Medical Center
Income Statement Comparison - - - May 31, 2018 Current Month Year-to-Date
ORAL REPORTS 4a.v.
Page 3
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
Pagosa Springs Medical Center
ORAL REPORTS 4a.v.
Page 4
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.
Page 5
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.
Page 6
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%
Pagosa Springs Medical Center
Cerner/Healthland Accounts Receivable for Hospital by Payor and Days Outstanding -- As of May 31, 2018
ORAL REPORTS 4a.v.
Page 7
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
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.
Pagosa Springs Medical Center
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.
Page 1 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.
Page 2 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
WRITTEN REPORTS 4b.i.
Page 3 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.
WRITTEN REPORTS 4b.i.
Page 4 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
WRITTEN REPORTS 4b.i.
Page 5 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.
WRITTEN REPORTS 4b.i.
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.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
DECISION AGENDA 5.a.
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.
Page 1 of 3
MINUTES OF REGULAR BOARD MEETING
Tuesday, May 22, 2018
5:30 PM
The Board Room
95 South Pagosa Blvd., Pagosa Springs, CO 81147
The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its regular board
meeting on 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.
Page 2 of 3
Item intentionally struck from agenda. There was no report.
ii) Contracts
Item intentionally struck from agenda. There was no report.
iii) Strategic Planning
Item intentionally struck from agenda. There was no report.
iv) Foundation Report
Item intentionally struck from agenda. There was no 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.
CONSENT AGENDA 6.a.i.
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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.
6) EXECUTIVE SESSION
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
CONSENT AGENDA 6.a.i.
Page 1 of 2
MINUTES OF WORK SESSION
Friday June 1, 2018
12:30 PM
The Board Room
95 South Pagosa Blvd., Pagosa Springs, CO 81147
The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its 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.
Page 2 of 2
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:
Heather Thomas, serving as Clerk to the Board
CONSENT AGENDA 6.a.ii.
Page 1 of 2
MINUTES OF SPECIAL MEETING
Wednesday June 6, 2018
12:30 PM
The Board Room
95 South Pagosa Blvd., Pagosa Springs, CO 81147
The Board of Directors of the Upper San Juan Health Service District (the “Board”) held its 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.
3) EXECUTIVE SESSION
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.
Page 2 of 2
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:
Heather Thomas, serving as Clerk to the Board
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.