(direct access northeast entrance) AGENDA 1) CALL TO ORDER

NOTICE OF REGULAR BOARD MEETING OF

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

Tuesday, November 19, 2019, at 5:30 PM

The Board Room (direct access – northeast entrance)

95 South Pagosa Blvd., Pagosa Springs, CO 81147

AGENDA

1) CALL TO ORDER; ADMINISTRATIVE MATTERS OF THE BOARD

a) Confirmation of quorum

b) Board member self-disclosure of actual, potential or perceived conflicts of interest

c) Approval of the Agenda (and changes, if any)

2) PUBLIC COMMENT (This is an opportunity for the public to make comment and/or address USJHSD

Board. Persons wishing to address the Board need to notify the Clerk to the Board, Heather Thomas, prior to

the start of the meeting. All public comments shall be limited to matters under the jurisdiction of the Board

and shall be expressly limited to three (3) minutes per person. The Board is not required to respond to or

discuss public comments. No action will be taken at this meeting on public comments.)

3) PRESENTATION: Radiology, Jessica Cox, D.O. and Scott McAfee, Radiology Manager.

4) REPORTS

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

Chair Greg Schulte

Dir. Kate Alfred and Dir. Karin Daniels

Dir. Dr. Jim Pruitt and Dir. Karin Daniels

Chief Executive Officer, Dr. Rhonda Webb

CFO, Chelle Keplinger and Treasurer, Dr. Campbell

i) Chair Report

ii) Contracts

iii) Strategic Planning

iv) CEO Report: 2019 Accomplishments

v) Finance Report

(1) October Financials

(2) September Financials

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

COO-CNO, Kathee Douglas i) Operations Report

ii) Medical Staff Report Chief of Staff, Dr. Ralph Battels

5) DECISION AGENDA

a) Consideration of Resolutions for the 2020 budget:

i) 2019-08 – resolution regarding approval of the 2020 budget;

ii) 2019-09 – resolution to set mill levies; and

iii) 2019-10 – resolution regarding appropriation of funds.

b) Consideration of Resolution 2019-11 – authorizing online notice of public meetings.

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 Board Member absences:

i) Regular meeting of 11/19/2019

b) Approval of Minutes for the following meeting(s):

i) Regular meeting of: 10/15/2019

c) Approval of Medical Staff report recommendations for new or renewal of provider privileges.

d) Board Meetings in 2020: Establish USJHSD Board’s regular meeting schedule for 2020.

7) EXECUTIVE SESSION

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

8) OTHER BUSINESS

9) ADJOURN

Page 1 of 8 2019 Accomplishments

TO: Board of Directors FROM: Rhonda Webb, M.D. and PSMC Administration DATE: 11/15/2019 (this report will be updated in January 2020) RE: Accomplishments in 2019

1. ADVANCED CLINICAL SERVICES AVAILABLE TO PATIENTS

a. EMS/Ambulancei. Through grant funds awarded in 2018 from the State of

Colorado Emergency Medical & Trauma Service grant, PSMCobtained automated LUCAS CPR devices and an additionalLifePak15 cardiac monitor. The LUCAS CPR devices will soonbe the industry standard of care for EMS lifesavingintervention in cardiac arrests. With the additional LifePak 15cardiac monitor, PSMC has furnished all 5 of its ambulanceswith standard cardiac monitoring capabilities. In addition,PSMC purchased 5 new ventilators so each ambulance isstocked with a ventilator appropriate for pre-hospital andinter-facility transport needs.

ii. PSMC’s EMS Training program:1. Continues to train the public in CPR, Stop The Bleed,

and use of AEDs (Automatic External Defibrillators).2. Continues to train clinical staff in CPR, ACLS (advanced

cardiac life support), PALS (pediatric advance lifesupport).

3. Commenced training PSMC EMS staff and Pagosa Firestaff in a course to help first responders better managepre-hospital medical emergencies (a NationalAssociation of Emergency Medical Technicians course).

b. Oncology and Infusion Centeri. In its second year of operations, the Cancer and Infusion Center

has seen steady growth of patients and exceeded the volumesset forth in the 2017 business plan presented to StrategicPlanning Committee. Patients are treated by Dr. Virginia Tjan,advanced nurse practitioner Kelly Cesary, and Dr. Bill Jordanwho remains the Medical Director but has transitioned fromfull-time service.

ii. PSMC provides patients with lymphedema services by PSMC’sphysical therapist, Lauren Muir, who is the only certifiedlymphedema specialist in the Four Corners area.

c. Behavioral Healthi. Behavior health staff includes Dr. Kevin Kelly, PhD (half-time),

Celia Lowry, MSW (half-time), and Josh Bramble, LPC (full-time). Demand for appointments is consistently high, andduring 2019, PSMC implemented a new process for patients

ORAL REPORTS 4.a.iv.


who no-show to allow appointment space to be used by another patient. To date, Dr. Kelly has completed four series of Health Brain classes (8 session classes) designed to help those with cognitive decline modify risk factors and make changes to decrease the likelihood of developing dementia.

d. Outpatient Clinic i. In the third quarter, PSMC implemented a comprehensive plan

to improve the scheduling process and efficiency for outpatient clinic patients. As part of the scheduling improvement plan, PSMC made the following changes: restructured outpatient scheduling/discharge to report to the Clinic Director; established definitions to appointment types to be used by all providers; established written protocols for scheduler reference; made changes in Cerner to support scheduling decision-making; established special work flows to accommodate patients meeting with specialists; established guidelines for phone call management; modified the automated call tree for patient efficiency, and established same day scheduled appointments.

ii. Continue to improve utilization of services by offering patients same day out-patient walk-in care to patients; this reduces hospital emergency room visits by patients who are more appropriately treated in an outpatient setting.

e. Cardio-pulmonary i. PSMC increased depth of coverage to seven days per week by

restructuring an existing echo tech position to a dual role as a respiratory therapist and echo tech. Purchased new stress test machines that should be operational in late November.

f. Radiology i. In September of 2019, Dr. Jessica Cox, radiologist, started on-

site. Dr. Cox is able to perform interventional radiology procedures and expand availability of diagnostic mammograms to Monday through Friday. PSMC increased the number of staff with CT certification. Expanded hours of radiology services.

g. Lab i. Expanded lab coverage to 24/7 (first year in PSMC history)

while eliminating call coverage. h. Ear Nose and Throat

i. During 2019, there was consistent increase in ENT patients served by Dr. Scott Cordray. PSMC sent two members of the surgery department to train on new Medtronic equipment.

i. Orthopedic and General Surgery i. Maintain excellent patient satisfaction ratings (98.5%) from

department survey of all surgery patients. Increased the



availability of epidural steroid injection (pain management) to patients. Experienced some increase in volumes resulting from oncology needs for placement of ports and picc-lines (long-term peripheral inserted central catheter line).

j. Swing Bed i. Reinitiated offering rehabilitative services for inpatients

(swing bed).

2. ADVANCED CULTURE AND TALENT a. Hired key personnel including:

i. Administrative staff: 1. Controller (replaces the Controller who moved to Utah). 2. Director of the Outpatient Clinic (this position was

previously outsourced to a contractor, and filled internally by Jason Webb who also remains the Director of EMS/Ambulance);.

3. Director of Ancillary Services (this position was filled internally by Jen Cole as part of a restructuring of manager/director responsibilities).

4. Manager of Radiology (this position replaces the prior manager who remains with PSMC but sought a different role).

5. Infection Control and Quality Coordinator (this position was restructured to a single employee dual role and filled by an existing staff member with significant experience).

ii. Physicians and Advanced Practice Providers (APPs include nurse practitioners, physician assistants, certified nurse anesthetists):

1. Staffing of providers was steady without turn-over. In 2019, the only full-time staffing change is the addition of an on-site radiologist, Dr. Jessica Cox, who started providing patient care on-site in September. Dr. Cox is an employee of Radiology Imaging Associates (a Denver-based company that provides tele-radiology to PSMC).

2. During 2019, PSMC also increased its depth of providers who provide PRN coverage including Dr. Michael Kloep and Dr. Ahmed El-Emawy.

b. Privileged outside providers to enhance the scope and depth of care available to PSMC patients:

i. Dr. John Brach, ophthalmologist; ii. Dr. Kim Furry and Clayton LaBaume, PA, tele-ortho for bone

health; and iii. Dr. Jennifer Rupp and Dr. Carl Salka, tele-infectious disease.



c. Advanced Culture and Education i. Developed a manual for managers and directors to support

them in the performance of their department management. ii. In-process on organization-wide performance improvement

project to make re-tool orientation in an effort to improve performance and reduce turn-over.

iii. Launched an organization-wide training and education Informatics program to enhance orientation and on-going education for staff who use the electronic health record (Cerner).

iv. Medical Staff’s Medical Executive Committee completed an extensive review of the Medical Staff Bylaws and proposed revisions to be finalized and voted upon in early 2020.

3. ADVANCED PSMC’S REVENUE CYCLE AND FINANCIAL GOALS

a. Designed, built and implemented a new general ledger (Multi-View) to achieve efficiencies in the management of departments, month-end process and budgeting. This change was necessary because the Healthland ceased to support the GL platform original used by PSMC.

b. Accomplished the actions to increase PSMC’s days of cash on hand (percentage accomplishments separate written progress report provided to the Board on a monthly basis). Among the accomplishments are:

i. Reduced Accounts Receivable: 1. Reduced gross days of Accounts Receivable from 76.55

days to 53.74 days. 2. Reduced billed days of Accounts Receivable from 62.32

days to 46.51 days. 3. Reduced billed days of A/R in excess of 90 days from

39.61% to 20.82%. ii. Outsourced for improved efficiency and effectiveness:

1. Worker’s Comp and Auto-liability claims; 2. Self-Pay claims; and 3. Out-of-state Medicaid claims.

iii. PSMC improved its clean claim rate from 81.80% to 91.50%. iv. Implemented an on-line bill pay feature. v. Outsourced coding and improved accuracy and consistency.

Outsourcing resulted in an annual reduction in compensation expense of $33,000, and more importantly, coding accuracy improved in 2019 from 65% to over 95%.

vi. From 2018 to 2019, increased point-of-service collections by 24.31%.

vii. Implemented new pre-certification workflow process to reduce denials and achieve efficiencies.



viii. Engaged new company for equipment service contracts for improved service and cost savings.

ix. Reduced expense by restructuring 5 positions and eliminating (mostly through attrition) 9.5 positions.

c. Changed employee insurance broker and achieved some amendments with insurance contracts to begin cost-saving measures related to employee health insurance.

d. Amended 340b pharmacy contracts with Walmart and Kroger to include central fill locations and specialty medication prescriptions (mostly resulting from oncology providers) to maximize 340b revenues. Increased revenues anticipated are anticipated to start in January 2020.

e. In 2019, Colorado Medicaid commenced EMS cost reporting and as a result, PSMC filed its first EMS cost report for a gain of $205,000.

f. Inventory improvements: i. Commenced Surgery & Supply Chain optimization which

involved reorganization of surgery locators to improve the inventory process, revised PAR levels, removed seldom-used supplies, and new labeling system.

ii. Changed how we order scrubs to improve inventory and reduce costs related to loss.

g. Health Information Management (Medical Records) commenced its transition from paper to electronic faxing within Cerner (faxing in Cerner is free). To date, the use of paper in HIM has reduced by more than 50%.

h. Continued charge-master improvements with particular attention in 2019 to surgery (created six case levels), GI (pricing), and anesthesia.

i. Completed evaluation of GPO (group pricing organization) pricing; validated PSMC’s current GPO pricing is best available.

4. ADVANCED PSMC’S COMPLIANCE a. Successful survey by the FDA/State of PSMC’s mammography. b. Expanded the scope of PSMC’s Emergency Operations Plan. c. Improved PSMC’s IT as follows:

i. Brought IT staff in-house to improve security management and responsiveness to employee “help desk” requests or other needs while significantly reducing outsourced IT expenses.

ii. Upgraded the server environment to improve cybersecurity, speed and reliability.

iii. Implemented vulnerability scanning and penetration testing to our cybersecurity program.

iv. Implemented cybersecurity training for all PSMC staff. v. Completed substantial project of converting all of PSMC’s

computer workstation inventory to Windows 10 as required to continue work with Cerner in 2020.



vi. Implemented new software for management of facility security and management of door accesses.

5. ADVANCED QUALITY CARE AND PATIENT SAFETY

a. Quality reporting: i. MIPS: Completed performance year 2018 attestation for MIPS

(Merit-based Incentive Payment System) and received a final score of 100 out of 100. The total payment adjustment for 2020 Medicare Professional Fee billing is a positive 1.68%.

ii. HQIP: Submitted 2019 measure reports for HQIP (Hospital Quality Incentive Program) and awaiting performance award. Received HQIP payment for 2018 report in the amount of $323,241.

iii. MU: Completed performance year 2018 attestation for Medicaid Meaningful Use; PSMC had one eligible provider and received an $8,500 incentive payment.

iv. HPI: Completed performance year 2018 attestation for Hospital Promoting Interoperability. PSMC’s attestation avoids a 1% downward adjustment to reasonable cost reimbursement for Medicare Inpatient billing (this is specific to Critical Access Hospitals).

b. Met all milestones for the State’s new Hospital Transformation Program (HTP). Among accomplishments are: (i) PSMC held two well-attended community meetings to assess healthcare needs in Archuleta County; (ii) held weekly HTP committee meetings to meet milestones including evaluation and selection of HTP initiatives to be undertaken; and (iii) submitted three required reports to the State (a 20-page action plan, a 55-page mid-point report, and a 16-page final report).

c. Successfully completed all requirements to obtain Flex Grant funding to pay for PSMC’s HCAHPS surveys and for 5-years of funding for a consultant to assist with an Electronic Health Record improvement project.

d. Performance Improvement Committee: i. Facilitating 11 active multi-department performance

improvement projects and brought another 4 projects to conclusion.

ii. Selected and implemented a project management tool. The tool is currently being used for HTP, HQIP and FLEX Grant projects and will be expanded for use throughout the organization. Goals include improved project organization, communication and documentation and completion.

e. Installed the latest Pyxis automated pharmaceutical dispensing cabinets with reconfiguration for efficiency and to reduce stock-outs;



the installation of new Pyxis is also at a reduced expense. Built new Cerner-Pyxis interface from ground up.

f. Evaluated multiple new applications associated with the electronic health record (Cerner) and recommended purchase of application supporting behavioral health documentation. This will improve both patient care and compliance with regulatory requirements.

g. Maintained HIMMS7 status by continuing to achieve a high standard of medication administration safety.

6. ADVANCED PLANNING FOR THE FUTURE

a. Capital Planning i. IT – continue to update and implement multi-year capital

replacement plan for computers and associated systems. ii. Facility – continue to evaluate the physical plant in order to

prioritize replacements, maintenance and repair schedule. iii. HVAC – completed adjustments to reduce the scope of the

plans for replacement of surgery HVAC and to reduce the budget consistent with the $911,720 matching grant awarded to PSMC by the Colorado Department of Local Affairs.

b. Strategic Planning i. In advance of further Strategic Planning Committee work,

accomplished updated service-line analysis for orthopedic surgery, oncology, ENT and physical therapy.

ii. Accomplished several internal meetings necessary to make proposals to the Board’s Strategic Planning Committee.

7. ADVANCE PSMC’S COMMUNITY RELATIONSHIPS PRESENCE AND

INVOLVEMENT a. 2019 events:

i. Region-wide emergency operations planning table-top event held on-site at PSMC.

ii. Community Open House and dinner at PSMC. iii. Community Chamber of Commerce “After Hours” event. iv. Community Open House for first anniversary of the opening of

the Cancer & Infusion Center. v. Foundation’s Summer Gala – the most successful fundraising

event in Foundation history. vi. Foundation Heart Beat Ball.

vii. Two well-attended meetings for community assessment of healthcare needs.

b. PSMC employees remain engaged in community boards including: Pagosa Affordable Housing Partners, San Juan Basin Public Health, Community Development Corporation, Chamber of Commerce, Fire District, County Planning Commission, Dispatch Executive Management Board, Archuleta Community Foundation Committee,



Southwest Healthcare Coalition steering committee, Healthcare Coalition Council (state), CDPHE Trauma Chapter Three Task Force (state), and Pagosa Springs Rotary.

c. Pagosa School District: for a second year, supported the high school by offering a year-long student internship program at PSMC. PSMC held sports physicals at the high school campus. PSMC staff presented regarding careers.

d. County: PSMC collaborated with the County for employee health fair providing health screenings and flu vaccinations for County employees.

e. LPEA: PSMC provided an employee health screenings at LPEA for its employees.

f. Suicide prevention task force: PSMC staff participate in multi-county efforts aimed at preventing suicide. Trained three staff in “Zero Suicide”.

g. Library: PSMC participates in book barn project. h. Pagosa Springs Arts Council: supported rotating art work displayed at

PSMC. i. Improved relationship with other Colorado hospitals and healthcare

associations to further the best interests of patient care: i. Ongoing communication between PSMC CEO/CMO and leaders

of other hospitals (in-person meetings with Mercy CEO, CEO of the Heart of the Rockies in Salida, and CEO at St. Mary’s in Grand Junction).

ii. Involvement with Western Healthcare Alliance and attendance at CEO meeting to collaborate on improvements to rural healthcare.

iii. Participation in Colorado Hospital Association and attendance in the Rural Health and Hospital Conference addressing the strategies for sustainable and high-performing rural health.

iv. Participation in HCPF (Medicaid) meeting regarding feedback on the future of Medicaid and ACA in Colorado.

8. OTHER NOTABLE ACCOMPLISHMENTS

a. PSMC was recognized as “Most Wired Hospital”; this designation acknowledges that PSMC leads in the adoption of technology into day-to-day workflows and patient care strategies.

b. PSMC implemented a dog therapy program whereby dogs with specific training and certification visit out inpatients and provide comfort and encouragement.

c. PSMC had a successful and smooth transition of all staff from leased off-site space to inside the PSMC facility.

d. Completed lease with Verizon Communications for a tower on PSMC’s roof to improve communication services for the medical center and for PSMC’s EMS ambulances traveling in the county.


USJHSD October Finance Report USJHSD Board Packet, 11-19-2019

Page 1 of 1

Finance Committee & CFO Report,

USJHSD Board Meeting on Nov. 19, 2019

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

Committee that met on November 15, 2019.

October was an excellent month for PSMC. The Finance Committee stated that PSMC’s finances

continue to improve and the Committee is pleased with the financial progress made during 2019.

1) October Bottom Line: PSMC had a total net gain of $55,921 in October. PSMC was budgeted to

have a loss in October, but instead was able to have a net gain for the month by continuing to reduce

expenses and exceeding budget on gross revenues. PSMC’s October financials were:

a) $5,768,679 in gross revenue (exceed budget by $1M);

b) $3,015,403 in net revenue (net revenue is the gross revenue after deductions for charity care, bad

debt and contractual deductions of payers -- Medicare, Medicaid and commercial insurers);

c) $2,978,621 in expenses ($77,788 less than budget);

d) $55,921 in net income (net revenue plus grants/donations/340b and less expenses)

e) $919,375 net gain year-to-date in 2019. PSMC’s total net gain year-to-date of $919,375, which

is less than budget but exceeds 2018 YTD by a significant sum of $654,384.

2) Revenues: Outpatient revenues exceeded budget.

3) Deductions to Gross Revenues for Payer Contractuals, Charity and Bad Debt:

Each month PSMC has deductions to its revenue for bad debt, charity care as well as deductions

made by third-party payers (Medicare and commercial insurers) that are referred to as payer

contractuals.

Deductions for the month of October were above budget. Year to date, PSMC’s charity care and

contractual deductions by payers has exceeded budget by 17% resulting in 3.5 million greater

deductions to PSMC revenue than budgeted.

4) Expenses: PSMC continued to do a good job holding down expenses. Year-to-date, expenses

continue to be under budget by 3% or $563,410.

5) Cash and collections:

a) A significant success at the end of October is the gross Accounts Receivable fell under 10 million

and staff will strive to keep it there. In October, the collectible net Accounts Receivable on the

Balance Sheet fell from 4.74 million to 3.35 million.

b) During October, PSMC increased cash on hand by almost $800,000 to $6,158,039 (57.2 days of

cash).

c) Cash collections were $2.9 MM for the month, 217K more than the established goal.

6) Progress Report Re Consultant’s Recommendations to Increase Days of Cash: PSMC presented

and discussed in depth with the Finance Committee the status of progress on the consultant’s

recommendations. Per direction of the Board, until the goals are met, staff will provide the Board

with a written monthly report and an oral report quarterly (in May, October, & November).

ORAL REPORTS 4.a.v.1.

USJHSD October Financial Packet USJHSD Board Packet, 11-19-2019

Page 1 of 17



Page 2 of 17



Page 3 of 17



Page 4 of 17



Page 5 of 17



Page 6 of 17



Page 7 of 17



Page 8 of 17



Page 9 of 17



Page 10 of 17



Page 11 of 17



Page 12 of 17



Page 13 of 17



Page 14 of 17



Page 15 of 17



Page 16 of 17



Page 17 of 17


ACTION DEADLINE MAY JUNE JULY AUG. SEPT OCT NOV

REDUCE EXPENSE10 posi- 10 posi- 9

tions tions positions

As possible, restructure positions to reduce expense. ongoing4

positions

4

positions

5

positions5

5

positions5 positions

Amend/change service agreements to reduce expense. ongoing 40% 44% 55% 55% 78% 100%

Develop and implement process for collecting coinsurance for

patients.7/31/2019 100% 100% 100% 90% 90% 100%

Create and implement a plan to terminate lease for use of off-site

space.6/30/2019 75% 95% 100% 100% 100% 100%

Subject to challenges with hiring, replace 2 emergency room night-

shift RNs with paramedics.5/31/2019 0% 0% 0% 100% 100% 100%

IMPROVE REVENUES COLLECTED

Implement coding software to enable PSMC to compute payments on

Medicaid EAPGs to assure accuracy of payment.10/31/2019 10% 10% 20% 30% 30%

50%

(remainder

of work req

by Cerner )

From 12/31/18 levels, develop and implement processes that should

decrease denials by 50% (denials related to pre-authorization,

medical necessity and otherwise).

10/31/2019 25% 30% 30% 50% 50% 100%

Outsource billing for out-of-state Medicaid, motor vehicles and

worker comp claims.3/1/2019 100% 100% 100% 100% 100% 100%

Contract with a third party for coding to improve accuracy. 2/1/2019 100% 100% 100% 100% 100% 100%

From 12/31/18 levels, implement process to improve timely filing of

clean claims to decrease denials by 50%.9/30/2019 100% 100% 100% 100% 100% 100%

Develop and implement a plan to reduce gross days of A/R to 68

(from 12/31/18 level of 76.6 gross days of A/R).7/31/2019 88% 93% 81.16%

100%

(61.43)100% 100%

Engage contractors if 68 days not achieved on 7/31/19 9/30/2019 n/a n/a n/a n/a n/a n/a

Develop and implement a plan to reduce gross days of A/R to 62

(from 12/31/18 level of 76.6 gross days of A/R).12/31/2019 52% 54.70% 47.80% 100% 100% 100%

Create and implement a career matrix program for billing office to

reduce turnover and enhance stability of collections.1/31/2019 100% 100% 100% 100% 100% 100%

If matrix does not produce improvement, evaluate

alternatives.1/1/2020 n/a n/a n/a n/a n/a

MANAGEMENT AND PLANNING

Evaluate and develop/implement a plan to reduce ongoing expense

for MRI.12/31/2019 0% 0% 0% 0% 0% 40%

Evaluate the feasibility of expanding pain management services. 12/31/2019 0% 20% 20% 75% 75%

75%

(remainder

of work

req by prof

liab insurer)

Evaluate the feasibility of providing physical therapy services for all

outpatients.10/31/2019 0% 0% 0% 20% 20% 100%

Evaluate and develop/implement a plan to address time allotted in

the RHC for patient visits and improve Medicare productivity in the

RHC.

10/31/2019 10% 10% 20% 75% 95% 100%

Operationalize offering swing bed services for orthopedic patients

pending hiring of appropriate staff.8/31/2019 80% 100% 100% 100% 100% 100%

Develop a monthly cash forecast to allow management to predict

progress relative to the cash goal and measure days of cash.6/30/2019 0% 100% 100% 100% 100% 100%

Compute Medicare productivity for the RHC monthly. 6/30/2019 10% 100% 100% 100% 100% 100%

Evaluation and develop/implement a plan to decrease PSMC’s

expense for employee health insurance benefit for employee’s

spouse and children.

7/1/2019 75% 100% 100% 100% 100% 100%

Evaluate and develop a plan for efficient IT/Phone support at a lower

cost (current contract for support does not end until 12/31/2020).12/31/2019 25% 50% 80% 100% 100% 100%

Evaluate and develop/implement a plan to reduce professional hours

in Oncology program to better address current and projected

demand.

12/31/2019 20% 20% 100% 100% 100% 100%

Evaluate the feasibility of refinancing the 2006/2007 bonds. 12/31/2019 0% 0% 10% 100% 100% 100%

Evaluate the feasibility of increasing veteran use of the RHC. 12/31/2019 0% 0% 10% 100% 100% 100%

From 12/31/18 level staffing, reduce FTEs and contractors (as

practical and through attrition, if possible).ongoing

10

positions

9.5

positions

9.5

positions

USJHSD Management Progress Reporting ToolUSJHSD Board Packet, 11-19-2019

Page 1 of 1


USJHSD September Finance Report USJHSD Board Packet, 11-19-2019

Page 1 of 1

Finance Committee & CFO Report,

USJHSD Board Meeting on November 19, 2019

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

Finance Committee that met on November 12, 2019.

1) September Bottom Line: PSMC had another good revenue month in September. PSMC’s gross

revenue was $5,047,367, which was over budget by $418,000. Due to charity care, bad debt and

contractual deductions of payers (e.g., Medicare, Medicaid and commercial insurers), PSMC, is

generally paid approximately fifty percent of gross charges. Hospitals are always expensive to

operate but PSMC continued to hold down its expenses, which contributed to PSMC finishing the

month of September with a total net gain of $203,032. PSMC’s total net gain year-to-date is

$863,454, which is less than budget but exceeds 2018 YTD. PSMC budgeted a lower revenue

producing September, so performance was stronger than expected.

2) Revenues: Inpatient and outpatient revenues were both strong in September. Inpatient Services did

not meet budget, but overall outpatient revenue was exceeded budget.

3) Deductions to Gross Revenues for Payer Contractuals, Charity and Bad Debt: Each month

PSMC has deductions to its revenue for bad debt, charity care as well as deductions made by third-

party payers (Medicare and commercial insurers) that are referred to as payer contractuals.

Deductions for the month of September were 32% above budget. Year to date, PSMC’s charity care

and contractual deductions by payers has greatly exceeded budget resulting in a little more than 2.7

million greater deductions to PSMC revenue than budgeted.

4) Expenses: PSMC continued to do a good job holding down expenses, although we were flat with

budget for the month of September. Year-to-date, expenses continue to be under budget by 2%

(which is nearly $500,000).

5) Cash and collections:

a) PSMC increased operating cash in September to $5.4MM from $5.2 MM in August 2019. This

is not a large increase but we continue to increase to meet our bond obligations by the end of the

year.

b) Patient collections were $2.595 MM for the month, 200K less than forecasted.

c) As of the end of September, PSMC is at 53.7 days of gross A/R; and PSMC’s gross accounts

receivable balance decreased $666K to $9.973 MM. We continue to work diligently on the A/R

and are hitting some targets that we not did expect to hit until December.

6) Progress Report Re Consultant’s Recommendations to Increase Days of Cash: PSMC

presented and discussed in depth with the Finance Committee the status of progress on the

consultant’s recommendations. Per direction of the Board, until the goals are met, staff will provide

the Board with a written monthly report and an oral report quarterly (in May, September, &

November).



USJHSD September Financial Packet USJHSD Board Packet, 11-19-2019

1 of 17



Page 2 of 17


Page 3 of 17



Page 4 of 17




Page 5 of 17


Page 6 of 17



Page 7 of 17



Page 8 of 17



Page 9 of 17



Page 10 of 17



Page 11 of 17



Page 12 of 17



Page 13 of 17



Page 14 of 17



Page 15 of 17



Page 16 of 17



Page 17 of 17


USJHSD Medical Staff Report

USJHSD Board Packet, 11-19-2019

Page 1 of 1

THE UPPER SAN JUAN HEALTH SERVICE DISTRICT

DOING BUSINESS AS PAGOSA SPRINGS MEDICAL CENTER

MEDICAL STAFF REPORT BY CHIEF OF STAFF, RALPH BATTELS

November 19, 2019

I. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS FOR THE USJHSD BOARD ACCEPTANCE

OF NEW POLICIES OR PROCEDURES ADOPTED BY THE MEDICAL STAFF:

II. STATEMENT OF THE MEDICAL STAFF’S RECOMMENDATIONS FOR THE USJHSD BOARD ACCEPTANCE

OF PROVIDER PRIVILEGES (ACCEPTANCE BY THE BOARD RESULTS IN THE GRANT OF PRIVILEGES):

NAME INITIAL/REAPPOINT/CHANGE TYPE OF PRIVILEGES SPECIALTY

Kourosh Kahkeshani, DO Initial Appointment Telemedicine/Teleneurology Neurology

Sara Puening, MD Initial Appointment Telemedicine/Telepsychiatry Psychiatry

Harry Siegele, MD Initial Appointment Telemedicine/Telepsychiatry Psychiatry

Michele Siegele, MD Initial Appointment Telemedicine/Telepsychiatry Psychiatry

Kenneth Allison, MD Reappointment Telemedicine/Teleradiology Diagnostic Radiology &

Neuroradiology

John Aucoin, CRNA Reappointment AHP/Certified Registered

Nurse Anesthetist

Certified Registered Nurse

Anesthetist

William Bentley, MD Reappointment Courtesy/Neurology Neurology

Kelly Cesary, ANP-BC Reappointment AHP/NP Oncology &

Hematology and Family

Medicine

Oncology & Hematology

William Jordan, DO Reappointment Active/Oncology &

Hematology

Internal Medicine &

Oncology

III. REPORT OF NUMBER OF PROVIDERS BY CATEGORY

Active: 19

Courtesy: 27

Telemedicine: 120

Allied Health Professionals: 29

Honorary: 1

Total: 196

WRITTEN REPORTS 4.b.ii.

DECISION AGENDA 5.a.










UPPER SAN JUAN HEALTH SERVICE DISTRICT

D/B/A PAGOSA SPRINGS MEDICAL CENTER

RESOLUTION (No. 2019-08) TO ADOPT BUDGET

A RESOLUTION SUMMARIZING EXPENDITURES AND REVENUES FOR EACH FUND

AND ADOPTING A BUDGET FOR THE UPPER SAN JUAN HEALTH SERVICE

DISTRICT FOR THE CALENDAR YEAR BEGINNING ON THE FIRST DAY OF

JANUARY 2020 AND ENDING ON THE LAST DAY OF DECEMBER 2020.

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

(“USJHSD”) has appointed its Chief Executive Officer to prepare and timely submit a proposed

2020 budget; and

WHEREAS, the Chief Executive Officer has caused a proposed 2020 budget to be

submitted to the USJHSD Board for its consideration; and

WHEREAS, upon due and proper notice, published in accordance with the law on

October 4, 2019, said proposed budget was open for inspection by the public at a designated

place, and a public hearing was held on October 15, 2019 and interested electors were given the

opportunity to file or register any objections to said proposed budget; and

WHEREAS, the budget has been prepared to comply with the terms, limitations and

exemptions of laws or obligations which are applicable to or binding upon the District; and

WHEREAS, whatever increases may have been made in the expenditures, like increases

were added to the revenues or planned to be expended from reserves/fund balances so that the

budget remains in balance, as required by law.

NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of the Upper San

Juan Health Service District:

1. That estimated expenditures for each fund are as follows:

General Fund $46,921,370

Debt Service Fund 0

Total $46,921,370

2. That estimated revenues for each fund are as follows:

General Fund

From unappropriated surpluses $10,890,654

From Funds Transfers 0

From sources other than general property tax $36,030,716

From general property tax $1,267,288

Total $48,188,658

DECISION AGENDA 5.a.i.

Debt Service Fund

From unappropriated surpluses $ 0

From Funds Transfers 0

From sources other than general property tax 0

From general property tax 0

Total 0

3. That the budget, be, and the same hereby is, approved and adopted as the budget of

the Upper San Juan Health Service District for the 2020 fiscal year.

4. That the budget, as hereby approved and adopted, shall be signed by the Chairman of

the Board of the District and made a part of the public records of the District.


____________________________________ _____________

Greg Schulte, Chairman Date

Attest: DISTRICT SEAL

____________________________________ _____________

Heather Thomas, Clerk to the Board Date

DECISION AGENDA 5.a.i.

Page 1 of 2; USJHSD Resolution 2019-09



RESOLUTION (No. 2019-09) TO SET MILL LEVIES

A RESOLUTION LEVYING PROPERTY TAXES FOR THE YEAR 2020 TO HELP DEFRAY

THE COSTS OF GOVERNMENT FOR THE UPPER SAN JUAN HEALTH SERVICE

DISTRICT FOR THE 2020 BUDGET YEAR.

WHEREAS, on November 19, 2019, the Board of Directors of the Upper San Juan Health Service District (“USJHSD”) adopted, in accordance with the Colorado local government budget law, the 2020 annual budget; and

WHEREAS, the amount of money necessary to balance the budget for general operating purposes from property tax revenue is $1,267,288; and

WHEREAS, the amount of money necessary to balance the budget for debt service expenses is $0; and

WHEREAS, the 2019 valuation for assessment for the District, as certified by the Assessors of Archuleta, Hinsdale and Mineral Counties, is $289,792,837;

NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of

USJHSD:

1. That for the purposes of meeting all general operating expenses of USJHSD

during the 2020 budget year, there is hereby levied a tax of 3.884 mills upon

each dollar of the total valuation for assessment of all taxable property within

USJHSD for the year 2019, to raise $1,267,288 in revenue.

2. That for the purposes of meeting all debt service expenses of USJHSD during

the 2019 budget year, there is hereby levied a tax of 0.0 mills upon each dollar

of the total valuation for assessment of all taxable property within USJHSD for

the year 2019, to raise $0 in revenue.

3. That the Treasurer and/or the Chairman of USJHSD is hereby authorized and

directed, to immediately certify to the County Commissioners of Archuleta,

Hinsdale and Mineral Counties, Colorado, the mill levy for the District as

hereinabove determined and set.

Upper San Juan Health Service District

__________________________________ ___________


DISTRICT SEAL

Attest:

__________________________________ ___________


DECISION AGENDA 5.a.ii.

Page 2 of 2; USJHSD Resolution 2019-09

[PAGE INTENTIONALLY LEFT BLANK FOR FINAL CERTIFIED ASSESSED

VALUATION AND TAX REVENUES OF ARCHULETA, HINSDALE, AND MINERAL

COUNTIES, AS APPLICABLE]

DECISION AGENDA 5.a.ii.


RESOLUTION (No. 2019-10) TO APPROPRIATE SUMS OF MONEY

A RESOLUTION APPROPRIATING SUMS OF MONEY TO THE VARIOUS FUNDS AND

SPENDING AGENCIES, IN THE AMOUNT AND FOR THE PURPOSE AS SET FORTH

BELOW, FOR THE UPPER SAN JUAN HEALTH SERVICE DISTRICT FOR THE 2019

BUDGET YEAR.

WHEREAS, on November 19, 2019, the Board of Directors of the Upper San Juan Health Service District (“USJHSD”) adopted, in accordance with the Colorado local government budget law, the 2020 annual budget; and

WHEREAS, the Board of Directors of USJHSD has made provision therein for revenues in an amount equal to or greater than the total proposed expenditures as set forth in said budget; and

WHEREAS, it is not only required by law, but also necessary to appropriate the revenues and reserves or fund balances provided in the budget to and for the purposes described below, as more fully set forth in the budget, including any interfund transfers listed therein, so as not to impair the operations of USJHSD.

NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of the Upper San Juan Health Service District that the following sums are hereby appropriated from the revenues of each fund, to each fund, for the purposes stated:

General Fund: $36,030,716

Fund Balance Contingency 0

Debt Service Fund - Net: 0

Unexpended Surplus – General Fund $10,890,654

Unexpended Surplus – Debt Service 0

From general property tax $1,267,288

Total $48,188,658


__________________________________ ___________


DISTRICT SEAL

Attest:

__________________________________ ___________


DECISION AGENDA 5.a.iii.



Formal Written Resolution 2019-11

November 19, 2019

A RESOLUTION AUTHORIZING ONLINE NOTICE OF PUBLIC MEETINGS

WHEREAS, the Upper San Juan Health Service District (“District”) is a quasi-

governmental special district and political subdivision of the State of Colorado and a duly

organized and existing special district pursuant to Title 32, Article 1, C.R.S.; and

WHEREAS, pursuant to House Bill 19-1087, codified in §24-6-402, C.R.S., as of

August 2, 2019, the District is authorized to post full and timely notice of its meetings no

less than twenty-four hours prior to the holding of the meeting on the public website of the

District;

WHEREAS, the District’s website is accessible at no charge to the public, and the

District has provided the website address to the Department of Local Affairs for inclusion

in the inventory maintained pursuant to §24-32-116, C.R.S.; and

WHEREAS, the District will retain one physical location within the District

boundaries designated for posting notice no less than twenty-four hours prior to a meeting

if the District is unable to post a notice online in the exigent or emergency circumstances

such as a power outage or an interruption in internet service that prevents the public from

accessing the notice online; and

WHEREAS, the Board of Directors (“Board”) of the District hereby finds and

determines that transitioning from posting physical notice of public meetings in physical

locations to posting notices on a website, social media account, or other official online

presence of the District has been encouraged by the Colorado General Assembly and is

appropriate, beneficial, and in the best interests of the District.

NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of the Upper

San Juan Health Service District as follows:

1. Designated Posting Location. As of the effective date of this Resolution, and

pursuant to §24-6-402, C.R.S., the District’s designated posting location for

notices of public meetings (regular, special, and study sessions) shall be on the

District’s webpage, accessible online at the following address:

www.pagosaspringsmedicalcenter.org

DECISION AGENDA 5b.


Resolution No. 2019-11

Page 2

2. Designated Physical Posting Location. In the event of exigent or emergency

circumstances such as a power outage or an interruption in internet service that

prevents the public from accessing the online designated posting location or

prevents the District from posting a notice at the online designated posting

location, the District will post notice of public meetings at least twenty-four hours

prior to the meeting at the following physical location within the District:

Pagosa Springs Medical Center

95 S. Pagosa Boulevard

Pagosa Springs, Colorado

Nothing herein shall preclude the District from posting at such physical location,

in addition to posting on the District’s website designated above.

3. Implementation of Resolution. The Board directs the District’s CEO and/or her

designee to update and submit a revised Transparency Notice in accordance with

this Resolution to the appropriate entities, notify the Department of Local Affairs,

or take any other action consistent with or required for implementing this

Resolution.

4. Repealer. All provisions of the District Bylaws, Board policies, or previously

adopted resolutions of the Board of Directors designating a different location for

posting of notices are hereby repealed by this Resolution.

5. Severability. If any part, section, subsection, sentence, clause or phrase of this

Resolution is for any reason held to be invalid, such invalidity will not affect the

validity of the remaining provisions.

6. Effective Date. This Resolution will take effect and be enforced immediately

upon its approval by the District Board, or on August 2, 2019, whichever is later.

DECISION AGENDA 5b.


Resolution No. 2019-11

Page 3

ADOPTED this 19th day of November, 2019.

UPPER SAN JUAN HEALTH SERVICE

DISTRICT

By

Greg Schulte, Chairman

ATTEST:

Heather Thomas, Clerk to the Board

DECISION AGENDA 5b.

USJHSD Regular Board Meeting Minutes

10/15/2019

Page 1 of 3

MINUTES OF SPECIAL BOARD MEETING

Tuesday, October 15, 2019

5:30 PM

The Board Room

95 South Pagosa Blvd., Pagosa Springs, CO 81147

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

meeting on October 15, 2019, at Pagosa Springs Medical Center, The Board Room, 95 South Pagosa

Blvd., Pagosa Springs, Colorado.

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

Director Jason Cox.

Present by Phone: Director Dr. Jim Pruitt

Director(s) Absent: Director Kate Alfred and Director Karin Daniels. (The noted absences were excused

due to prior notification.)

1) CALL TO ORDER

a) Call for quorum: Chair Schulte called the meeting to order at 5:30 p.m. MDT and Clerk of the

Board, Heather Thomas, recorded the minutes. A quorum of directors was present and

acknowledged.

b) Board member self-disclosure of actual, potential or perceived conflicts of interest: There were

none.

c) Approval of the Agenda: The Board noted approval of the agenda.

2) PUBLIC HEARING ON THE PROPOSED 2020 BUDGET FOR USJHSD

a) Open the Public Hearing on the proposed 2020 budget: Chair Schulte opened the Public Hearing

at 5:32 p.m. MDT.

i) CEO direction for 2020

CEO Dr. Webb began, noting the proposed 2020 budget anticipates more conservative

growth compared to previous years. CEO Dr. Webb then advised of the focus on renovation

of the HVAC system, slated to start in January 2020.

CONSENT AGENDA 6.b.i.


10/15/2019

Page 2 of 3

ii) CFO’s overview of the budget

CFO Chelle Keplinger presented and discussed the attached assumptions for the proposed

budget, PowerPoint presentation, and 2020 proposed budget summary.

Treasurer-Secretary Dr. Campbell noted the Finance Committee’s recommendation for

approval of the proposed 2020 budget as presented.

iii) Questions/comments of the Board

Board members noted their appreciation for the hard work of everyone involved in creating

the budget and extended congratulations to the entire team.

Questions were asked and answered.

Chair Schulte advised the Board that per the attached letter from Axis Health System

requesting support for their ATU’s 2020 operations, the requested contribution has been

included within the 2020 budget under “other”. Director Dr. Pruitt noted his disapproval of the

contribution and asked if there would be a vote on the decision to allow contributions to Axis

Health System. Chair Schulte suggested that at the next meeting in November, when voting on

approval of the 2020 budget, a board member may then move to approve the proposed budget

with the exception of voting out the contribution to Axis Health System.

iv) Questions/comments of the public

There were none.

b) Close the Public Hearing: Chair Schulte closed the Public Hearing at 6:03 p.m. MDT.

3) PUBLIC COMMENT

There was none.

4) REPORTS

a) Oral Reports

i) Chair Report

Chair Schulte gave an update on the status of the Archuleta County Combined Dispatch.

ii) Contracts

Item intentionally struck from agenda. There was no report.

iii) Strategic Planning

Item intentionally struck from agenda. There was no report.

iv) CEO Report

CEO Dr. Webb advised the Board that donors, Dayle and Tiffany Wilson, graciously

provided breakfast from Pagosa Baking Company for the entire organization as an act of

gratitude this morning.

CEO Dr. Webb noted that 2019 has proven to be an anomalous year regarding finances as

indicated in the upcoming Finance Report.

CEO Dr. Webb ended highlighting that August ended with a record-high number of

surgeries totaling 107.



10/15/2019

Page 3 of 3

v) Finance Report

CFO, Chelle Keplinger, presented and discussed the financial PowerPoint presentation,

highlighting that there was a net gain for the month of August by meeting budget on expenses

and exceeding budget on gross revenues.

There were no questions.

b) Written Reports

i) Operations Report


ii) Medical Staff Report


5) CONSENT AGENDA

Vice-Chair Mees motioned to approve the noted Board member absences, the minutes of the

regular meeting of 08/27/2019, and the Medical Staff report recommendations for new or renewal of

provider privileges.

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

said consent agenda items.

6) DECISION AGENDA

There was none.

7) EXECUTIVE SESSION

The Board did not meet in executive session.

8) OTHER BUSINESS

There was no other business.

9) ADJOURN

There being no further business, Chair Schulte adjourned the regular meeting at 6:15 p.m. MDT.

Respectfully submitted by:

Heather Thomas, serving as Clerk of the Board




Formal Written Notice of 2020 Regular Meeting Schedule

November 19, 2019

REGULAR BOARD MEETING SCHEDULE FOR 2020

WHEREAS, the Board desires to set its regular meeting schedule for 2020.

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

JUAN HEALTH SERVICE DISTRICT HEREBY RESOLVES AS FOLLOWS:

For 2020, the USJHSD Board of Directors shall meet at 5:30 p.m. on the FOURTH

TUESDAY of each month (exceptions for the months of January, November and December are

as noted below) at Pagosa Springs Medical Center located at 95 S. Pagosa Boulevard, Pagosa

Springs.

SCHEDULE OF REGULAR MEETING DATES:

January 21, 2020 (3rd Tuesday) July 28, 2020

February 25, 2020 August 25, 2020

March 24, 2020 September 22, 2020

April 28, 2020 October 27, 2020

May 26, 2020 November 17, 2020 (3rd Tuesday)

June 23, 2020 December 15, 2020 (3rd Tuesday)

Questions concerning meetings should be directed to the Clerk of the Board, Heather Thomas, at

95 S. Pagosa Blvd., Pagosa Springs, Colorado, telephone number 970-731-3700.

APPROVED by the Board of Directors of the Upper San Juan Health Service District on this 19th day of

November, 2019.

__________________________________________________

Greg Schulte, as Chairman of the Board

CONSENT AGENDA 6.d.

Documents

(direct access northeast entrance) AGENDA 1) CALL TO ORDER