BBGH Board Report - kotanow.com- Scottsbluff Area News, Sports, and Weather

BBGH Board Report

The Box Butte General Hospital (BBGH) Board of Trustees met Monday evening and heard several presentations on the progress of a wide variety of projects being implemented at the hospital.

As HIM Manager Claudia Olafson said during the last presentation of the evening, "As you can imagine after listening to all the information tonight, we've got a lot on our plate this year."

The first presentation was by Occupational Therapist Dr. Kate Brummer and Clinical Pharmacist Dr. John Argyle. The two presented information on the Collaboration And Proactive Teamwork Used to Reduce (CAPTURE) Falls project through the University of Nebraska Medical Center (UNMC).

"BBGH is one of 19 Nebraska hospitals participating in the project," Ms. Brummer reported. "Sixteen of those are Critical Access Hospitals (CAHs) like we are." The reason so many CAHs are in the project is that those types of hospitals have a greater portion of senior patients (the demographic where falls are more likely to occur) than larger, urban hospitals.

The CAPTURE Falls Project has a large number of employees and departments participating. "Our committee has members from Pharmacy, Rehabilitation, Social Services, Nursing, Environmental Services and more," Ms. Brummer said.

One change in procedures instituted at BBGH was having each patient in the Patient Care Unit wear color coded socks indicating what level of risk that patient has for falling: Green for low fall risk; yellow for moderate to high fall risk, and red for high fall risk. Patients wearing yellow or red socks have to have a gait belt around their waste that staff can hold on to in order to easily provide support when walking; being transferred from bed to a chair; or other types of assistance.

Mr. Argyle provided the Trustees with statistical information on the number of falls over the years; when a majority of falls occur during a 24 hour period (mostly at night when a patient tries to go to the bathroom without assistance); implementation issues that have occurred and action taken to resolve them; as well as other data. The new coding system for patient fall risk was instituted the last two months of 2013. While data for those two months are positive, more is needed to see if these new procedures are having a sustained effect.

Clinical IT Specialist JaeAnn Bradt, RN, was present to update the Trustees on the hospital's ongoing compliance efforts in regard to federally mandated Electronic Health Records (EHR) Meaningful Use. She reviewed why the program was instituted, saying Meaningful Use defines the use of EHR; establishes a set of standards that are standard nationwide for portability, as defined by the Centers for Medicare & Medicaid Services (CMS); and establishes funding incentives or penalties for hospitals that meet or do not meet minimum standards in core categories.

She said there are three stages to Meaningful Use implementation, with the first stage starting in 2011. Stage 2 is being implemented this year, and Stage 3 to start in 2016. "Stage 3 could be delayed, as was Stage 2," Ms. Bradt said. She presented a series of graphs showing how implementing EHR over that past year has improved core standards at BBGH well above the minimum required by CMS. Because the hospital has successfully passed attestation tests, it has benefited by an already received $538,500 incentive payment from Medicaid, with another $38,723 incentive payment to be received soon from Medicare.

Ms. Olafson was the last presenter. She reported on the efforts BBGH is making to successfully implement the federally mandated migration from International Classification of Disease (ICD)-9 coding to ICD-10 by October 1, 2014. ICD is the title for the list of codes used by healthcare professionals to code healthcare services in order to be properly reimbursed by CMS and private insurance companies.

The increase in complexity from ICD-9 to ICD-10 was amply illustrated when Ms. Olafson said the number of diagnostic codes rose from 13,000 in ICD-9 to 68,000 in ICD-10. The number of procedure codes went from 3,000 to 87,000. The United States is the last developed country in the world to adopt ICD-10. Other countries have been using it for years.

"As a matter of fact, European countries are scheduled to implement ICD-11 next year, so we'll still be one level behind," she concluded. "But I've been told the change from ICD-10 to ICD-11 isn't nearly as intense as ICD-9 to ICD-10."

The Trustees also conducted the following business.

They recognized Brooke Shelmadine for being the January Employee of the Month, as well as Austin Sheldon, DPT, for his completion of Post-Graduate Orthopedic Manual PT Residency. They were also introduced to new employees Delores Fritzler, cook; Kate Smith, cook assistant; Breyona Hooton, Limited Radiation Tech; Mandie McGregor and Mary Ohrtman, greeters.

After unanimously approving the consent calendar, Special Services Director Mary Mockerman gave the monthly Quality Management and Safety report, focusing on the importance of Near Miss Event reporting. "That is the most valuable source of data for identifying patient safety priorities and for measuring progress on the issues that are identified as needing improvement. She also informed the Trustees that BBGH will transition to QSTATIM, an on-line incident reporting system, in March. Occurrences will be sorted according to incident type and location.

She said the system has a robust reporting feature that enhances the hospital's ability to analyze trends and monitor sustained improvement. The hospital is also conducting its third Hospital Survey on Patient Safety (HSOPS). The tool assesses a hospital's culture of safety by measuring the willingness of staff to report unsafe conditions and how responsive its leaders are to those reports.

The CAPTURE Falls Initiative will be referenced in this year's HSOPS.

BBGH Chief of Staff Timothy Narjes, MD, reported that the Medical Staff approved a protocol for Tysabri, a medication treatment for patients with Multiple Sclerosis (MS). Local MS patients will no longer have to travel outside of Box Butte County to receive their infusions. Additionally, he was excited about information Pediatrician Janell Grant brought to a recent staff meeting regarding subcutaneous infusion for children. He said with children, infusion using regular IVs into a vein is often hard to do because of the smaller size of the vein or artery, while subcutaneous infusion under the skin at certain sites of the body reduces the challenge. Staff is currently being trained on the procedure.

Chief Operating Officer Lori Mazanec presented the December financials, with December closing with a change in net position of ($756,000). This compares to a positive change of $217,000 one year ago. Total Patient Service Revenue of $3,405,000 was $629,000 short of the month's projections. Outpatient and swing bed services came in a combined $306,000 behind predictions. Clinic services were ahead of projections $2,500. December operating expenses were $697,000 over budget.

The debt issuance costs associated with the closing on the interim financing for the construction project were a primary factor for the month's operating expense overages. Debt issuance costs totaled $626,000 for December. Ms. Mazanec later explained that due to a change in accounting principles with the Governmental Accounting Standards Board (GASB), debt issuance costs should be recognized as an expense in the period incurred. The old standard said to capitalize debt issuance costs and then amortize (expense) it over the life of the bonds. BBGH is considered a governmental entity so it has to follow GASB pronouncements to be in compliance with Generally Accepted Accounting Principles (GAAP).

GASB65 was issued to become effective with the hospital's current reporting year (7-1-13 to 6-30-14). For the 2013 year-end reporting period BBGH elected to early adopt GASB65 and thus the audited financial statements were restated to write-off all the previous existing debt issuance costs. BBGH made this adoption after the current year's budget was approved and in place. The month's operating loss totaled $770,000. Half way through this budget year, operations have delivered a loss of $17,000. Taken together with revenue from non-operating sources our year-to-date change in net position stands at $52,000, 93% lower than the projected $727,000.

CEO Dan Griess provided an update on the construction project, saying the dirt work for the basement and footings for the addition are taking shape, and that forms for pouring cement and placement of steel rebar should be installed soon. He also said the hospital's architects report that the addition's design is 95 percent complete and will soon be sent to the printers after final tweaking is done. "We're on schedule," he concluded.

Mr. Griess asked the Trustees to approve an expenditure not to exceed $25 per employee and $250 for the Employee of the Year award for the annual BBGH Recognition Event to be held at the Performing Arts Center February 7.

After unanimously approving a short list of credentialing requests, the board entered Executive Session at 8:15 pm for the annual CEO Evaluation. They re-entered open session at 9:32 and adjourned at 9:33 pm with no action taken. The next board meeting will be held Monday, February 24, at 7:00pm in the BBGH Alliance Room. As always, the public is invited to attend.

Box Butte General Hospital is an equal opportunity provider and employer.

 

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