Family Health Center Board of Directors Meeting Agenda Date: Wednesday, March 4, 2015 Time: 5:30 PM Place: 1057 12 Avenue, Longview, WA Longview Clinic Conference Room Enter through the Medical Clinic A lobby OR through the exterior door to the conference room hall (door code is 365802) th AGENDA Item Call to Order & Introductions • Guests: PRESENTATION/EDUCATION • 2014 Incident Report Summary ACTION ITEMS • Minutes of February 2015 Board Meeting Facilitator Rick Huckaby Julie Nye Rick Huckaby • CEO Report & Quality Indicators Report o Approval of 2015 Sliding Fee Conversion Charts Dian Cooper • Finance Report o Approval of 2015 Fees Melissa Taylor/Pam Spears • Appointment to Clinical Staff – Credentialing & Privileging: o Claudia Sloan, MD o Rhonda Ramm, ARNP o Maree Purdy, ARNP Other Business • Board Assessment Discussion Alisabeth Buck/Julie Nye Rick Huckaby Adjourn If you will be joining by phone, please inform Lorri Hickam prior to the meeting. Dial 1 877 309 2070 Access Code: 287-576-117 1 Incident Report Review 2014 2 Total Reports Received 2013: 102 2014: 62 3 39% Categories 4 • • • • • • • • • • • • Medication Errors Diagnosis Related Patient Rights Employee Health/BBP Exposure Patient Behavior Employee Misconduct Slips/Trips/Falls: Patient Slips/Trips/Falls: Employee Equipment/Instruments Workplace Safety Emergency Security/Structural Damage/Loss of Property Medication Errors 2013: 29 2014: 11 5 Diagnosis Related 2013: 4 2014: 0 6 Patient Rights Privacy Breach/HIPAA 2013: 23 Privacy Breach/HIPAA 2014: 10 7 Employee Health/BBP Exposure Contaminated Needle Stick: 2013: 1 2014: 5 Sterile Sharps/Needle Stick: 2013: 4 2014: 1 Contaminated Sharps: 2013: 1 2014: 1 Exposure to blood/body fluids 2013: 1 2013: 2 8 Patient Behavior Disruptive in public: 2013: 7 2014: 5 9 Employee Misconduct 2013: 4 2014: 4 10 Slip/Trip/Falls/Injury: Patient 2013: 4 2014: 4 11 Slip/Trip/Fall/Injury: Employee 2013: 6 resulted in L & I claim 2014: 6 resulted in L & I claim 12 Equipment/Instruments 2013: 1 2014: 1 13 Workplace Safety 2013: 7 2014: 1 14 Emergency 2013: 1 patients, 0 employee 2014: 3 patients, 2 employees 15 Security/Structural Damage/ Loss of Property 2013: 4 2014: 4 16 Conclusions • All incidents resolved • Reporting rate decreased this year & we will step up efforts to encourage reporting • Reporting promotes environment of safety & mitigates risk to FHC • Provides educational opportunities • Helps us to identify areas for process improvement 17 FHC Board of Directors Meeting Minutes Location: FHC Conference Room Date: Wednesday, February, 2015 Present: Rick Huckaby, Alisabeth Buck, Carlos Carreon, Charlotte Caudle, Jeane Conrad, Wanda McBee, Melissa Taylor, Cynthia Washington-Mattson, Carleen Wolgamott Dian Cooper, Janice Emery, Gerry Melgar, David Meyers, Julie Nye, Tina Pond, Amber Rosewood, Pam Spears Nancy Bell, Julie Merchant Staff: Absent: Minutes recorded by Lorri Hickam Topic/Discussion D = Decisions; M = Motion(s); A = Action(s) ACTION ITEMS The following action items were discussed: - Approve Agreement & Plan of Merger The Executive Boards of Family Health Center and DAPC met and recommend that we proceed with the merger. The financial proforma shows a break-even over time. The proposed date of the merger is April 1st. Prior to April 1st, Finance, HR and Facilities will start integrating. Two or three people on DAPC’s board will be able to take a seat on FHC’s board. - Minutes of January 2015 Board Meeting - CEO Report & Quality Indicators Report United Way Accounting Support Mental Health License - Finance Report M - A motion was made by Wanda, Melissa seconded, to adopt the Agreement and Plan of Merger. Board approved. One abstention. M – A motion was made by Wanda, Melissa seconded, to approve the January 2015 Board Minutes. Board approved. M – Carlos made a motion to support the CEO in the exploration of the mental health license in the State of Washington, and to approve the CEO Report. Wanda seconded, Board approved. M – Cynthia made a motion to approve the Finance Report as distributed, Carlos seconded. Board approved. OTHER BUSINESS Update on 14th Avenue building - Dian received the inspection on the building. She asked the owners to drop the price $50,000 to take care of the inspection items. She is still waiting to hear from the owners. Set Board Development Committee Meeting Date - Jeane is the sole person on the committee. Rick will send out an email asking for volunteers. The email will include the tasks and responsibilities of the committee members. Board Assessment - The last page of the Board packet is the assessment. Dian will also email the assessment to board members. Please fill out the form and bring it to the next meeting for discussion. 18 FHC Board of Directors meeting February 25, 2015 Page 2 of 2 With no further business, the meeting was adjourned at 6:40pm. The next board meeting will be held on Wednesday, March 4th at 5:30pm in the large conference room. ________________________________ Wanda McBee Secretary of the Board 19 Our Mission: To promote, encourage and provide health service in order to improve the quality of life through sound nutrition, education, preventive healthcare and the empowerment of choice Our Vision: 20 FHC Strategic Plan Goals 2012-2016 January 7, 2015 Update Quality Goal #1: Exploring alternative service delivery models Achieve agency-wide level 3 certification as a Patient Centered Medical Home (PCMH) Maintain service delivery for DL-U recipients The DLU program ended with the implementation of ACA and Medicaid Expansion in 2014 Develop group visits for a minimum of one chronic disease states Quality Goal #2: Health Plan Goal Improvement Achieve Targeted Health Care Plan Goals Quality Goal #3: Maintain Patient Satisfaction as A Priority 80% of patients surveyed rate their service satisfaction at the highest level Quality Goal #4: Sustain A Stable Work Force Meet or exceed the national benchmark on employee opinion survey We did not participate in the Staff Pulse survey in 2014 Clinical Goal Meet annual Meaningful Use Goals We are analyzing whether pursuing Stage 2 and 3 Goals is a viable strategy for FHC in 2015 Financial Goals Monitor Fiscal Health through industry best practices Identify future possible facility expansion needs Board adoption of a capital/special projects reserve policy Other Goals Community Collaboration: Work collaboratively with other entities in the community that serve FHC patients to improve access and minimize duplication of services Disease Prevention/Patient & Family Education: Provide health education/disease prevention/health outreach activities to patients and the community Future Funding Opportunities: As opportunities arise, apply for new funding that supports FHC mission, and contributes to strategic and financial sustainability goals Board Goals Board Succession Plan Developed and Adopted Board Advocacy: Lead Board member participation in grassroots advocacy efforts in support of FHC and FHC's mission 21 FHC is the Lead Organization for Cowlitz County for ACA insurance assistance Our Progress: SLIDING FEE CONVERSION CHARTS: I recommend Board approval of these charts so that we meet the April 1 target for implementation. 2015 -- Effective April 1, 2015 COWLITZ FAMILY HEALTH CENTER FAMILY PLANNING SLIDING FEE CONVERSION CHART Category B Family Planning GROSS FAMILY INCOME: 100% Discount - Zero Fee <100% FPL # IN FAMILY INCOME: 1 MONTH YEAR 2 3 4 5 6 7 8 Category C 75% Discount Category D 50% Discount 150% FPL 200% FPL 250% FPL Category F 0% Discount >250% FPL $981 $1,471 $1,962 $2,452 $2,453 $11,770 $17,655 $23,540 $29,425 $29,426 MONTH $1,328 $1,991 $2,655 $3,319 $3,320 YEAR $15,930 $23,895 $31,860 $39,825 $39,826 MONTH $1,674 $2,511 $3,348 $4,185 $4,186 YEAR $20,090 $30,135 $40,180 $50,225 $50,226 MONTH $2,021 $3,031 $4,042 $5,052 $5,053 YEAR $24,250 $36,375 $48,500 $60,625 $60,626 MONTH $2,368 $3,551 $4,735 $5,919 $5,920 YEAR $28,410 $42,615 $56,820 $71,025 $71,026 MONTH $2,714 $4,071 $5,428 $6,785 $6,786 YEAR $32,570 $48,855 $65,140 $81,425 $81,426 MONTH $3,061 $4,591 $6,122 $7,652 $7,653 YEAR $36,730 $55,095 $73,460 $91,825 $91,826 MONTH $3,408 $5,111 $6,815 $8,519 $8,520 YEAR $40,890 $61,335 $81,780 $102,225 $102,226 For family units with more than 8 members, add $346.67 monthly or $4160 annually for each additional member. Fees based on gross income and family size. Required services are not denied because of an inability to pay. After reasonable collection efforts have failed, patients may be restricted to urgent care services only (required family planning, urgent primary care, and emergency palliative dental) until payment of the outstanding balance 22 Category E 25% Discount 2015 -- Effective April 1, 2015 COWLITZ FAMILY HEALTH CENTER PRIMARY CARE SLIDING FEE CONVERSION CHART A nominal fee will be charged for Primary Care & Dental A visits. Dental B visits slide to 50%. Category B Dental B Primary Care, Behavioral Health & Dental A 50% Discount 100% Discount - Nominal Fee GROSS FAMILY INCOME: <100% FPL # IN FAMILY INCOME: 1 MONTH Category C 37% Discount 75% Discount 133% FPL Category D 24% Discount 50% Discount 166% FPL Category E 12% Discount 25% Discount 200% FPL Category F 0% Discount 0% Discount 201% FPL $981 $1,305 $1,628 $1,962 $1,963 YEAR $11,770 $15,654 $19,538 $23,540 $23,541 2 MONTH $1,328 $1,766 $2,204 $2,655 $2,656 YEAR $15,930 $21,187 $26,444 $31,860 $31,861 3 MONTH $1,674 $2,227 $2,779 $3,348 $3,349 YEAR $20,090 $26,720 $33,349 $40,180 $40,181 4 MONTH $2,021 $2,688 $3,355 $4,042 $4,043 YEAR $24,250 $32,253 $40,255 $48,500 $48,501 5 MONTH $2,368 $3,149 $3,930 $4,735 $4,736 YEAR $28,410 $37,785 $47,161 $56,820 $56,821 6 MONTH $2,714 $3,610 $4,506 $5,428 $5,429 YEAR $32,570 $43,318 $54,066 $65,140 $65,141 7 MONTH $3,061 $4,071 $5,081 $6,122 $6,123 YEAR $36,730 $48,851 $60,972 $73,460 $73,461 MONTH $3,408 $4,532 $5,656 $6,815 $6,816 YEAR $40,890 $54,384 $67,877 $81,780 $81,781 8 For family units with more than 8 members, add $346.67 monthly or $4160 annually for each additional member. Fees based on gross income and family size. Required services are not denied because of an inability to pay. After reasonable collection efforts have failed, patients may be restricted to urgent care services only (required family planning, urgent primary care, and emergency palliative dental) until payment of the outstanding balance Financial Goals: Attorneys for the 14th Avenue building owners are in communication with our attorney, so I anticipate movement on the building purchase in the next couple of months. FHC/DAPC Merger: We will be recruiting for a Director of Behavioral Health as we assume DAPC’s chemical dependence licensure and add mental health licensure to the scope of the merged organization. Steve Burgon will be meeting with Gus and me to work through the legal list for the merger. Pam is working with Gus on a plan to bring the financial and data entry staff from DAPC into the Finance Department and to combine accounting and financial reporting. Organization chart attached. Operations: Productivity charts attached. Year to Date productivity should be 8% to meet our productivity target. 23 January productivity achievements for each provider were shared companywide. Our care coordination department continues to underperform at the start of its third year. PRODUCTIVITY PERFORMANCE TO TARGET 2015 Legend Over 90% 75-90% Under 75% Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Medical Dental Care Coordination Behavioral Health MSS WIC Goal is 90% or better of target. Quality Goals: We received Level 3 Patient Centered Medical Home certification for Longview, Kelso, and Woodland. Wahkiakum’s application is still in review. We’ve completed submission of the Uniform Data Set Quality of Care and Health Outcomes and Disparities report. We had some issues with data integrity for how the denominator of some of the measures was pulled and made appropriate corrections. In 2015 we will focus on improvement in these and other core measures, as well as improvement in our patient satisfaction measures. This increased focus will be reflected in the 2015 Continuous Quality Improvement/Assurance Plan that will be presented to the Board for action at the April meeting. Areas where we improved from 2013 are highlighted in green. Quality of Care/Health Outcomes 2014 2013 2012 2011 Childhood Immunizations (2 Y Old - revised 2013 not comparable to prior years) 72.37% 68.29% 20.00% 5.81% Cervical Cancer Screening (Revised 2013 not comparable to prior years) 48.57% 48.94% 43.56% 52.86% Blood Pressure Control (<140/90) 70.81% 75.88% 73.59% 78.56% Diabetes Control (HbA1C<9) 72.91% 77.02% 74.41% 69.30% Depression Screening & Follow-up 49.98% 68.30% 74.00% 49.00% 3-5 year olds w recall dental service 38.50% 47.00% 55.00% 44.00% Children & Adolescents w Weight Screening & Follow-up 35.70% 45.71% 58.57% 45.71% Adults w Weight Screening & Follow-up 35.29% 23.97% 23.32% 24.29% Tobacco Use Screening & Cessation 80.59% 57.81% 52.86% 50.00% Asthma Treatment 83.90% 79.31% 85.71% 60.70% Cholesterol Treatment 65.85% 65.34% 62.46% Heart Attack/Stroke Treatment 77.58% 74.42% 72.07% 24 Quality of Care/Health Outcomes Colorectal Cancer Screening HIV Linkage Care 2014 2013 2012 36.37% 28.56% 24.29% 2011 60% Other Goals - Community Collaboration: Open enrollment has been extended, so our navigators and the navigators of our community partners continue to help people enroll in Qualified Health Plans. Overall, we’ve had a very successful open enrollment period. 25 FHC/DAPC Merged Organization Chart Effective 4/1/2015 CEO Administrative Services Coordinator Medical Director CIO Procurement/ Training Specialist Associate Medical Director Primary Care Prescribing Providers Help Desk Clerk CFO Community Relations Liaison Associate Dental Director Accountant(s) Outreach & Enrollment Worker(s) Dentists Accounting Clerk(s) Dental Director Behavioral Health Prescribing Providers Deputy Director/ COO Facilities Manager Behavioral Health Director Facilities & Kitchen Staff Behavioral Health Site Manager(s) Quality Director Primary Care/Public Health Director Primary Care/Public Health Site Managers Billing Clerk(s) Billing Clerk/Certified Coder(s) Human Resources Manager Behavioral Health Clinicians & Support Staff Primary Care & Public Health Staff Human Resources Specialist(s) 26 Human Resources Assistant(s) JANUARY - DEC. 2015 PATIENT ENCOUNTERS Combined Medical Achieved 2014 Achieved 2015 Target 2015 Variance 2015 YTD 48,864 4,550 65,940 (61,390) YTD % J 78% 7% Combined Dental Achieved 2014 Achieved 2015 Target 2015 Variance 2015 YTD 21,529 1,877 29,160 (27,283) YTD % J 101% 6% Care Coordination Achieved 2014 Achieved 2015 Target 2015 Variance 2015 YTD 4,713 345 7,932 (7,587) YTD % J 50% 4% Behavioral Health Achieved 2014 Achieved 2015 Target 2015 Variance 2015 YTD 5,974 496 5,808 (5,312) YTD % J 95% 9% MSS Achieved 2014 Achieved 2015 Target 2015 Variance 2015 YTD 4,237 394 4,548 (4,154) YTD % J 93% 9% 27 F 3890 4550 5495 (945) 83% M A S O N D 4159 4369 4158 4337 4503 3813 4333 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) 5495 (5,495) M A M J J A S O N D 1625 1892 1975 1855 1844 1867 1798 1685 1889 1683 1828 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) 2430 (2,430) M A M J J A S 430 387 433 403 421 428 410 661 (661) 661 (661) 661 (661) 661 (661) 661 (661) 661 (661) 661 (661) M A M J J A O 381 661 (661) S N 377 661 (661) O D 288 329 661 (661) N 661 (661) D 483 516 647 474 571 592 453 459 511 367 446 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) 484 (484) F 297 394 379 15 104% J 3993 F 455 496 484 12 102% J 3966 F 426 345 661 (316) 52% M 3864 F 1588 1877 2430 (553) 77% A 3479 M A M J J A S O N D 317 309 352 331 377 381 370 376 380 352 395 379 379 379 379 379 379 379 379 379 379 379 WIC Achieved 2014 Achieved 2015 Target 2015 Variance 2014 28 YTD 17,658 1,521 20,856 (19,335) YTD % J 84% 7% F 1609 1521 1738 (217) 88% M A M J J A S O N D 1442 1488 1538 1326 1520 1541 1439 1425 1580 1314 1436 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) 1738 (1,738) Medical 6000 5000 4000 2014 Achieved 3000 2015 Achieved 2000 2015 Target 1000 0 J F M A M J J A S O N D Dental 3000 2500 2000 2014 Achieved 1500 2015 Achieved 1000 2015 Target 500 0 J F M A M J J A S O N D Care Coordination 700 600 500 400 2014 Achieved 300 2015 Achieved 2015 Target 200 100 0 J 29 F M A M J J A S O N D Behavioral Health 700 600 500 400 2014 Achieved 300 2015 Achieved 2015 Target 200 100 0 J F M A M J J A S O N D Maternity Support Services 450 400 350 300 250 2014 Achieved 200 2015 Achieved 150 2015 Target 100 50 0 J F M A M J J A S O N D WIC 2000 1800 1600 1400 1200 1000 800 600 400 200 0 2014 Achieved 2015 Achieved 2015 Target J 30 F M A M J J A S O N D 31 32 33 34 35 36 37 38 39 40 41 42 Revenues by Type thru January 2015 550,000 450,000 350,000 250,000 150,000 50,000 Jan Feb Mar Apr May Jun 15 15 15 Jly Aug 15 15 Sep Oct 15 15 Nov 15 15 15 15 Patient Fees Grants/Contracts Capitation Dec 15 Total Other Revenues and Expenses thru January 2015 1,200,000 1,075,000 950,000 825,000 700,000 Jan Feb Mar Apr May 15 15 15 Jun Jly Aug Sep 15 15 Oct Nov 15 15 15 15 15 15 Total All Revenue Dec 15 Total Expenses Net Income Comparison Thru January 500000 400000 300000 200000 100000 0 -100000 Jan Feb Mar Apr May Jun Current Yr Net income/(loss) 43 Jly Aug Sep Oct Prior Yr Net income/(loss) Nov Dec Revenue & Expense by Business Line Through 1/31/15 1,500,000 1,000,000 500,000 0 Total Revenue & Support 44 Total Expense Cowlitz Family Health Center MEMO DATE : March 4, 2015 TO : Board of Directors FROM : Pam Spears, CFO SUBJECT : 2015 Pricing Fee Analysis __________________________________________ _____________________________ Request: Consider a motion to the Board of Directors to approve the 2015 pricing fee analysis effective April 1, 2015. Medical and Dental charges do not exceed 10% of the cost to provide those services with supply and vaccine charges based on acquisition cost plus reasonable allocation of overhead to process those items. History: Medical and Dental charges are based on the cost to provide those services which is updated annually through a fee analysis. Supplies and vaccine charges are based on acquisition cost plus a reasonable mark-up to include overhead to process those items. Each service we provide, whether medical or dental, has a relative value unit (RVU) assigned to it which tells us how much labor time is necessary to provide that particular service. The pricing fee analysis uses that RVU value per service and allocates our agency’s costs to that unit value to come up with the cost to provide that patient service. For example, if a routine office visit has a value of 2 RVU associated with that service and it costs our agency $50 dollars per 1 RVU, the calculated charge for that office visit would be $100. (2 multiplied by $50 is $100). Beginning January 1, 2015, Medicare payments are based on a national FQHC PPS rate that is adjusted up or down based geography, or the centers established rate, which ever is less. Fiscal Impact: The largest percentage of our client base has fixed fee rates of reimbursement; therefore changes in charges have little impact on their rates. The fee changes do not affect those clients that are on a 100% sliding fee scale. How does this support our mission statement?: Annual monitoring and adjustment of our fees is necessary to ensure a stable and fiscally sound operation to continue to provide quality services to our clients and is industry best practice. Finance Staff Recommendation: Consider a motion to the Board of Directors to approve the 2015 pricing fee analysis effective April 1, 2015. 45 Agree Strongly Agree Somewhat ISSUES RELATED TO THE BOARD’S OVERALL ROLE AND RESPONSIBILITIES The Board seems to be unclear about what its role ought to be The Board and the CEO sometimes seem to have different ideas about the responsibilities and authority each should have The Board never seems to have time to explore external challenges and opportunities that the organization might face and decide whether these will require changes in its future direction The Board rarely holds “creative thinking” sessions aimed at trying to find new ways the organization could develop Plans exist on paper but they don’t get implemented. Other concerns drive what actually gets done The Board does not regularly assess how the organization is doing in achieving the mission effectively and efficiently The Board is confused about the role in fund raising for the organization ISSUES RELATED TO THE BOARD’S FORMAL STRUCTURES AND OPERATING PROCESS Some Board committees are not all that useful anymore Some Board committees are unclear as to their responsibilities and authority The agenda for meetings is too full of “routine’ motions or items “for information only” Once the Board has finished discussing something, it is not clear who is going to do what and when A few members seem to dominate discussions and this discourages quieter Board members from contributing ISSUES RELATED TO THE COMPOSITION OF THE BOARD AND DEVELOPMENT OF BOARD MEMBERS We do not pay enough attention to deciding the kind of new Board members we need and actively going out to recruit them We don’t do a very good job of orienting and training new Board members ISSUES RELATED TO THE INFORMAL CULTURE OF THE BOARD The Board does not handle crises well. It either avoids dealing with them or looks for someone to blame rather than resolving them The Board does not regularly and systematically assess its own performance and change itself if it thinks it can improve As far as I know, many Board members have contacts among people who might help the organization but they are not encouraged, or given the opportunity, to make use of them Little effort is made by Board members to get to know one another and develop “team spirit” in the group BOARD LEADERSHIP ISSUES There is a kind of “inner group” that seems to run things on the Board and those who are not part of it sometimes feel left out As far as I know, the Board President is reluctant to speak to Board members who don’t carry out their responsibilities properly As far as I know, the relationship between the CEO and the Board President is quite formal: they don’t talk much “off the record” How could our Board improve our governance and support of FHC in 2015? What educational topics or other presentations would enrich our Board performance in 2015? Your Name (optional) 46 Disagree Somewhat Disagree Strongly Not Sure Does Not Apply
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