SOUTHERN MONO HEALTHCARE DISTRICT JUNE 2020 … · 2020-06-17 · Southern Mono Healthcare District Board of Directors Meeting Agenda June 18, 2020 Initial Appointment to Provisional

2019 Press Ganey Guardian of Excellence Award Winner

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Mammoth Hospital P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.924.4104

www.mammothhospital.com

METICULOUS CARE * MEMORABLE PEOPLE * MAJESTIC LOCATION

SOUTHERN MONO HEALTHCARE DISTRICT

JUNE 2020 MONTHLY BOARD MEETING AGENDA

NOTICE IS HEREBY GIVEN that the Board of Directors of Southern Mono Healthcare District will convene at its regular monthly board meeting at the location and on the date and time set forth below. Pursuant to the current State of Emergency declared by the Governor and Executive Order N-29-20, this meeting will occur and be held via teleconferencing. The meeting will be accessible telephonically to all members of the public seeking to observe and to address the Board of Directors, including giving public comment. To access the meeting, the District has set up a toll-free open conference call. The Dial-in Number is 866.588.5540; Conference Code: 8359004536#. No members of the public may physically be present at the meeting location. Attendance and participation shall be via telephone only.

In compliance with the Americans with Disabilities Act (ADA), if you need special assistance to attend this meeting via telephone, please contact the District Board Administrative Assistant at Mammoth Hospital by telephoning 760.934.3311. Prompt notification prior to the meeting will enable the District to make reasonable arrangements to assist with accessibility to this meeting.

Date: June 18, 2020 Time: 8:00 a.m. Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546

I. CALL TO ORDER

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

III. PUBLIC COMMENTS

IV. CHIEF OF STAFF REPORT

http://www.mammothhospital.com/

Southern Mono Healthcare District Board of Directors Meeting Agenda June 18, 2020

V. ADJOURN TO CLOSED SESSION

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8).

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report. 2. CEO Report. 3. CFO Report. 4. CNO Report. 5. CMO Report. 6. CIO Report. 7. Review and Approval of the SMHD Quality Improvement Plan, FY 2020-2021. 8. Review and Approval of the SMHD Case Management/Utilization Plan, FY 2020-2021. 9. Review and Approval of the SMHD Risk Management Plan, FY 2020-2021.

10. Review and Approval of the SMHD Infection Prevention Plan, FY 2020-2021.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155)

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

CREDENTIALING Re-appointment to Medical Staff David Araya, MD - Hospitalist Don Harrell, MD - Radiology Richard Shedd, MD - Emergency Re-appointment to Affiliate Staff Jason Bishop, DDS - Dentistry Steve Fujimoto, DDS – Dentistry Re-appointment to Locum Tenens Pamela Landsteiner - Dermatology Initial Appointment to Allied Health Chelsea Brown, PA - Orthopedics Re-appointment to Courtesy Staff Richard Brown, MD - Orthopedics


Initial Appointment to Provisional Staff Michael Bryan, MD - Dermatology

PERSONNEL MATTERS (Government Code §54957) 1. Tom Parker, CEO.

VI. REPORT ON CLOSED SESSION

VII. PUBLIC COMMENTS

VIII. CONSENT AGENDA

(All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

May 21, 2020 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

IX. COMMITTEE REPORTS

1. Finance Committee (Met June 15, 2020) Stephen Swisher, M.D., Dave Anderson

2. Physician Compensation, Relations and Retention Committee Laurey Carlson, Joanne Hunt

3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt

4. Quality Assurance Committee (met June 17, 2020) Stephen Swisher, M.D., Joanne Hunt

5. CEO Annual Review Committee Laurey Carlson, Dave Anderson

6. IT Steering Committee (met June 16, 2020) Stephen Swisher, M.D., Yuri Parisky, M.D.

7. Facilities Committee Yuri Parisky, M.D., Laurey Carlson

8. Board Member Recruitment Committee Laurey Carlson, Dave Anderson

9. Ad Hoc, Special, or Other (as needed) Committees

X. CHIEF EXECUTIVE OFFICER’S REPORT

XI. FINANCE REPORT 1. May 2020 Financial Narrative. 2. Investment Report.


XII. BOARD EDUCATION

Presentation of the ED Program by Lori Baitx, ED Manager. Presentation about the Mammoth Hospital Foundation and Introduction to new Foundation Coordinator Gardiner Miller.

XIII. OLD BUSINESS

There is no old business to discuss.

XIV. NEW BUSINESS

1. Review and Approval of the Revised Employee Success Sharing Program for FY2020. 2. Review and approve Management’s recommendation to forego obtaining

earthquake insurance for the District properties. 3. Quarterly Review of New and Revised Policies. 4. Quarterly Review of New and Revised Contracts. 5. Declaration of Surplus District Property, Equipment and Supplies.

XV. CREDENTIALING

Re-appointment to Medical Staff David Araya, MD - Hospitalist Don Harrell, MD - Radiology Richard Shedd, MD - Emergency Re-appointment to Affiliate Staff Jason Bishop, DDS - Dentistry Steve Fujimoto, DDS – Dentistry Re-appointment to Locum Tenens Pamela Landsteiner - Dermatology Initial Appointment to Allied Health Chelsea Brown, PA - Orthopedics Re-appointment to Courtesy Staff Richard Brown, MD - Orthopedics Initial Appointment to Provisional Staff Michael Bryan, MD – Dermatology


XVI. PUBLIC COMMENTS

XVII. FUTURE BUSINESS The next Regular meeting will take place on Thursday, July 16, 2020 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN


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SOUTHERN MONO HEALTHCARE DISTRICT

MAY 2020 MONTHLY BOARD MEETING MINUTES Date: May 21, 2020 Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546 Attendance of Board Members: Dave Anderson, Chair; Laurey Carlson, Vice Chair; Stephen Swisher,

M.D., Treasurer; Joanne Hunt, Secretary; Yuri Parisky, M.D., Member at Large.

Attendance of Staff Members: Tom Parker, Chief Executive Officer; Melanie Van Winkle, Chief

Financial Officer; Caitlin Crunk, Chief Nursing Officer; Craig Burrows, M.D., Chief Medical Officer; Mark Lind, Chief Information Officer; Sarah Rea, Recording Secretary.

David Baumwohl, Legal Counsel, attended via videoconference.

I. CALL TO ORDER

Chair Anderson called the meeting to order at 8:03 a.m.

II. PLEDGE ALLEGIANCE TO THE FLAG AND READING OF THE SMHD VISION, MISSION AND VALUES

The meeting opened with the Pledge of Allegiance to the Flag and the reading of the SMHD Mission, Vision & Values lead by Laurey Carlson.

III. PUBLIC COMMENTS

There were no Public Comments.

IV. CHIEF OF STAFF REPORT Richard Koehler, M.D., was not present at the meeting. The written Chief of Staff report was discussed in Closed Session.


Southern Mono Healthcare District Board of Directors Meeting Minutes May 21, 2020

V. ADJOURN TO CLOSED SESSION

The Board adjourned to closed session at 8:13 a.m.

I. REPORT ON CLOSED SESSION Lindsey Sarullo, Compliance Officer, requested permission to enter Closed Session via videoconference at 8:08 a.m. Permission was granted. The Board took the review of the Compliance Report out of order. The Compliance Report was presented by Lindsey Sarullo. No action was taken. Ms. Sarullo left Closed Session at 8:40 a.m.

CONFERENCE WITH LEGAL COUNSEL – PENDING AND THREATENED LITIGATION Existing Litigation and Significant exposure to litigation pursuant to Government Code §54956.9.

1. Inyo County Local Agency Formation Commission (LAFCO), Northern Inyo Healthcare District v. Southern Mono Healthcare District, Sacramento Superior Court Case No. 34-2015-80002247-CU-WM-GDS; 3rd District Court of Appeal Case Nos. C085138 & C086087.

David Baumwohl reported discussion of CONFERENCE WITH LEGAL COUNSEL on PENDING AND THREATENED LITIGATION for the above items; no action was taken.

CONFERENCE WITH REAL PROPERTY NEGOTIATORS (Government Code § 54956.8). David Baumwohl reported there were no matters to discuss: no action was taken.

QUALITY ASSURANCE – (Health and Safety Code §32155) 1. Chief of Staff Report.

There was no Chief of Staff Report due to the absence of the Chief of Staff.

2. CEO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Tom Parker, CEO. No action was taken.

3. CFO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Melanie Van Winkle, CFO; no action was taken.

4. CNO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Caitlin Crunk, CNO; no action was taken.


5. CMO Report.

David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Craig Burrows, M.D., CMO. No action was taken.

6. CIO Report. David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Mark Lind, CIO; no action was taken.

QUALITY ASSURANCE QUARTERLY SUMMARIES - (Health and Safety Code §32155) 1. Review of the Quarterly Beta Report.

David Baumwohl reported that the quarterly Beta report was reviewed. No action was taken.

2. Review of the Quarterly Performance Improvement Report. David Baumwohl reported that the quarterly Performance Improvement Report was reviewed. No action was taken.

3. Review of the Compliance Report. The review of the Compliance Report was taken out of order and is reported above.

HEALTH CARE FACILTY TRADE SECRETS (Health and Safety Code §32106) 1. Sierra Park Clinics/Mammoth Hospital.

David Baumwohl reported that Health Care Facility Trade Secrets were not discussed. No action was taken.

CREDENTIALING Initial Appointment to Provisional Staff Ross, Mark, MD - Neurophysiology (Specialty Care, Tele-Med) Initial Appointment to Allied Health Chelsea Brown, PA - Orthopedics

David Baumwohl reported the foregoing physician CREDENTIALING was discussed; no action was taken.

PERSONNEL MATTERS (Government Code §54957) 1. Tom Parker, CEO.

David Baumwohl reported a discussion took place with Tom Parker, CEO; no action was taken. Staff and legal counsel left the Board meeting at 8:56 a.m. Tom Parker, CEO, remained in the meeting.


Closed session ended at 9:50 a.m. The Board reconvened to open session at 9:59 a.m.

II. PUBLIC COMMENTS There were no public comments.

III. CONSENT AGENDA (All matters on the consent agenda to be approved on one motion unless a Board Member requests separate action on a specific item) 1. Previous Minutes to be approved:

April 16, 2020 Regular Board Meeting 2. Chief Financial Officer Report 3. Chief Nursing Officer Report 4. Chief Medical Officer Report 5. Chief Information Officer Report 6. Human Resources Report

Joanne Hunt moved, seconded by Laurey Carlson, to approve all items on the consent agenda as presented in the packet. Chair Anderson asked for comments; a discussion ensued involving clarification on the CFO and CMO reports. A brief discussion was held about the May 20, 2020 consultative visit from the California Department of Public Health (CDPH). A vote was taken; the motion passed unanimously. Yes 5, No 0.

IV. COMMITTEE REPORTS

1. Finance Committee Stephen Swisher, M.D., Dave Anderson

Details from the Finance Committee Meeting were covered in the Financial Report.

2. Physician Compensation, Relations and Retention Committee Laurey Carlson, Joanne Hunt

There was no Physician Compensation, Relations and Retention Committee meeting; no report.

3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt

There was no Employee Relations Committee meeting; no report.

4. Quality Assurance Committee Stephen Swisher, M.D., Joanne Hunt

There was no Quality Assurance Committee meeting; no report.


5. CEO Annual Review Committee Laurey Carlson, Dave Anderson

There was no CEO Annual Review Committee meeting; no report.

6. IT Steering Committee Stephen Swisher, M.D., Yuri Parisky, M.D.

There was no Information Technology (IT) Steering Committee meeting this month; no report.

7. Facilities Committee

Yuri Parisky, M.D., Laurey Carlson There was no Facilities Committee meeting; no report.

8. Board Member Recruitment Committee

Laurey Carlson, Dave Anderson There was no Board Member Recruitment Committee meeting; no report.

9. Ad Hoc, Special, or Other (as needed) Committees There are no Ad Hoc, Special, or Other (as needed) Committees at this time.

V. CHIEF EXECUTIVE OFFICER’S REPORT

Tom Parker, CEO, reviewed the following highlights from his written report: 1. A shout out is owed to Mammoth Hospital’s department heads, who put together specific

departmental reopening plans. 2. Mammoth Hospital is returning to elective procedures and ramping up capacity. The Hospital’s

special surgery subcommittee is still reviewing each surgical case with the Medically Necessary Time-Sensitive (MeNTS) score.

3. Clinics are running at approximately 75% of normal volumes. 4. Tom Parker discussed the planned new hospital wing and the vetting of architects for the project. 5. Tom Parker officially welcomed Caitlin Crunk as the new Chief Nursing Officer. 6. Tom Parker discussed OR3 coming online and the OSHPD review of this project. 7. Tom Parker discussed patient satisfaction scores, which are remaining high. 8. Tom Parker expressed appreciation to Westerlay Orchids of Carpenteria, who shipped 400 orchids

to Mammoth Hospital for Hospital Week. 9. Tom Parker discussed COVID testing capabilities, the distinction between in-house testing and send-

out testing, and how tests are billed.

VI. FINANCE REPORT 1. April 2020 Financial Narrative. 2. Investment Report.


Melanie Van Winkle, CFO, reviewed and presented the Financial Statements, included in the packet via PowerPoint presentation. Ms. Van Winkle reported the April net loss was $2,378,000 which resulted in an unfavorable budget variance of $2,874,000. The year-to-date Net Gain was $4,328,000 which resulted in an unfavorable year-to-date budget variance of $217,000. Days of cash-on-hand were at 361 at the end of April. Ms. Van Winkle presented an overview of the COVID-19 emergency funding Mammoth Hospital has received. Ms. Van Winkle presented a revised financial forecast through June 2020. She also discussed the possibility of the state cutting Medi-Cal funding and supplemental funds.

VII. BOARD EDUCATION

There was no Board education this month.

VIII. OLD BUSINESS There was no old business to discuss.

IX. NEW BUSINESS

1. Review of the Quarterly Patient Satisfaction and Patient Experience Reports. The Quarterly Patient Satisfaction and Experience Reports were presented and reviewed in closed session. No action needed.

2. Review and approve amending existing Physician Services Agreements in response to the COVID-19 pandemic in response to the current State of Emergency declared by the Governor.

Dr. Stephen Swisher and Dr. Yuri Parisky both declared a conflict of interest on this item and left the room for the vote. Joanne Hunt motioned to modify and amend the existing Physician Services Agreements in response to the COVID-19 pandemic and in response to the current State of Emergency declared by the Governor for the months of May and June in the same amounts as approved for the month of April 2020. Laurey Carlson seconded the motion. A vote was taken, the motion passed unanimously. Yes, 3; No, 0. There were two recusals, Drs. Swisher and Parisky.

3. Declaration of Surplus District Property, Equipment and Supplies. There was no surplus District property, equipment or supplies to declare.

X. CREDENTIALING

Initial Appointment to Provisional Staff Ross, Mark, MD - Neurophysiology (Specialty Care, Tele-Med) Initial Appointment to Allied Health


Chelsea Brown, PA – Orthopedics Laurey Carlson moved, seconded by David Anderson, to approve the initial appointment to provisional staff of Mark Ross, M.D. A vote was taken; the motion passed unanimously. Yes 4, No 0. Dr. Yuri Parisky abstained from the vote.

XI. PUBLIC COMMENTS

There were no public comments.

XII. FUTURE BUSINESS The next Regular meeting will take place on Thursday, June 18, 2020 at 8:00 a.m. in Conference Rooms A & B at Mammoth Hospital.

ADJOURN

The meeting was adjourned at 11:05 a.m.


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DATE: June 18, 2020 TO: Board of Directors FROM: Melanie Van Winkle, CFO RE: CFO Report, Regular Meeting of the Board of Directors

Strategic Updates Financial Viability Meet Budget Performance on Net Margin and Cash Flow

Title Description Update

Overall meet Budget

• FY20 Net Margin is budgeted at $5.2 million or 7%

• FY20 Cash Flow is budgeted to end at 340 days cash on hand

• YTD Net Margin at May 2020 is $7.4 million & 10% -

• CARES stimulus funds of $6.2 million has helped to offset the loss in volume thus far.

• Days cash on hand at May 31, 2020 was 419 or $94 million.

Involvement in state and national rural health issues

Continue involvement in:

• ACO for Medicare members

• PRIME/QIP3 for Medi-Cal members

• District Hospital Leader Forum (DHLF) for district hospital funding opportunities

• Population Health team providing Tele-Health visits to continue as much care for our Medicare population as possible.

• MH submit the mid-year PRIME report by the end of March.

o Received $477K in May.

• Weekly calls with the CFO’s to ensure we attain all COVID19 Emergency Funds as possible.

• All other activity on hold.

Analyze Service Line Performance

• ID high cost service lines

• Developing reports to be pulled out of

Cerner to start this process.


Mammoth Hospital Report to the Board of Directors CFO Report June 18, 2020

Select Operational Updates COVID-19 recovery: With no new COVID-19 inpatients since March, all areas of the hospital started increasing elective surgeries, procedures, visits, and tests in May. This resulted in improved financial results:

• May’s Gross Revenue was $6.3 million, more than double that in April.

• Mammoth Hospital received $4.6 million from the CARES Stimulus funds for Rural facilities.

• Net Gain for May was $3 million, compared to April’s loss of ($2.4) million.

• Develop priority for service line review

Partner with tertiary hospitals

Potential benefits:

• Exchange physician services

• Improve patient handoffs

• Training for staff

• Shared staffing

• Improve physician satisfaction & retention

• Moving forward to share Ortho Sports Fellowship with Barton. Expect to have 2 Fellows for 6 months starting in November.


Patient Accounts Receivable:

The Accounts Receivable continues to be impacted by COVID-19. While the gross charges generated for May increased, there is still a delay in billed revenue and collections. The AR > 120 aged continue to grow due to a lag in collections of amounts due from patients and inefficiencies between our staff and the payers to work remotely. Calls to patients reminding them of their outstanding bills have resumed after a few months’ hiatus during the height of COVID-19 activities. The billing/collection team members are adding some days back in the office to improve the outcomes of their production. Dawn and her team are focusing efforts to collect and clean up as much as possible prior to year end however they are down 6 staff members due to COVID-19 childcare issues. Financial Audit FY20: The Eide Bailly financial auditors are scheduled to perform their audit of our FY20 books the week of August 17. It is expected they will perform this audit remotely due to COVID-19, but we expect effect on completing the audit to present to the Board in October. Budget 2020/21: Budget activity is still on hold due to COVID-19. As the town opens and elective procedures/visits/surgeries continue to ramp up we will start the budget process again. It is difficult to predict with any level of certainty the volumes for FY21. We may start revisiting the budget activity in late July or August. Thus, hope to bring a FY21 budget to the Board in September or October.

Gross charges generated 9,232,790$ 16,322,401$ 13,880,346$ 9,723,718$ 2,690,963$ 6,426,984$

Discharged Not Final Billed 1,937,940$ 4,973,471$ 3,402,763$ 1,839,332$ 1,412,037$ 2,577,334$

DNFB Days 5.1 11.5 7.1 4.2 4.8 12.9

Revenue billed $13,358,889 $19,613,307 $20,297,777 $16,661,397 $7,803,887 $6,515,359

Clean Claims % 78% 74% 74% 69% 54% 60%

Pt Acct Collections 6,936,877$ 6,508,624$ 7,610,236$ 8,957,230$ 5,309,300$ 3,175,159$

AR balance 22,696,662$ 28,616,138$ 29,210,325$ 24,172,212$ 18,136,068$ 18,829,931$

Gross AR days 60.19 65.94 60.63 55.09 62.07 94.20

AR > 120 days 26.2% 18.6% 19.2% 23.1% 39.4% 40.2%

AR $$ > 120 days 5,952,333$ 5,314,568$ 5,623,151$ 5,572,581$ 7,141,798$ 7,573,743$

COVID19 Impact

May 20Feb 20 Mar 20 Apr 20Jan 20May 19


PRIME – Medi-Cal Improvement Projects In May we received $478 thousand for our mid-year performance on our two PRIME (July 2019 – December 2019). We were able to meet 9/10 quality metrics for the projects. The one missed metric is for depression screening and follow up. Due to the increased targets we expanded the screening from mainly at the Family Med clinic to the Orthopedic clinics to further catch our Medi-Cal population. We are already seeing improved results since December. Most of the District Hospitals in the PRIME program have been negatively impacted by the pandemic over the last few months and unable to further the work to meet the quality targets. Our representatives from the District Hospital Leadership Forum (DHLF) are working with the California Department of Health and CMS to come up with an alternative method for evaluating payment for the year ended June 30, 2020. The current proposal is to use the results of the year ended June 30, 2019, but the details have not been worked out yet.


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DATE: June 18, 2020 TO: Board of Directors FROM: Caitlin Crunk, RN, BSN, CNO RE: CNO Report, Regular Meeting of the Board of Directors

Strategic Plan Updates


Implement Beta HEART Program

Beta HEART is a multi-year collaborative sponsored by Beta Healthcare to guide organizations in implementing a reliable and sustainable culture of patient safety that is grounded in a philosophy of HEART: Healing, Empathy, accountability, Resolution, and Trust. In an endeavor to reduce harm in health, 5 domains will be implemented over the course of 3-5 years.

• Obtained validation in Just Culture and Care for the Caregiver domains.

• Obtained Quest for Zero in OB. This will provide a large savings for Tier II x2.

Journey to Become a High Reliability Organization

Mammoth Hospital will continue to progress toward high reliability, adopting the Joint Commission framework outlining the four stages of organizational maturity that define milestones for each of the fourteen specific characteristics of a health care organization.

• Several Plan-Do-Check-Acts (PDCAs) were put on hold during COVID-19, which are beginning to resurface. During PI Committee, more improvement projects were identified and will be pursued at the department level.

• Units are still using the Just Culture algorithms to ensure consistency across the organization


Mammoth Hospital Report to the Board of Directors CNO Report June 18, 2020

and to keep all staff accountable for safety and quality. Presentations to management team were put on hold due to COVID-19.

• Continuous learning is instrumental in high reliability organizations. Department level education is continually being provided through HealthStream as well as discussion for education days to begin again in the fall.

Select Operational Updates People

• After over two and a half years serving as the perioperative director, Cammy Staker has resigned in her role. She plans to stay on staff as an OR nurse. Due to such high turnover in this role, we will be looking to conduct a Root Cause Analysis (RCA) to help unsurfaced why this is occurring. Phyllis Meneses will be acting as interim until we hire a full-time perioperative director.

• All departments are practicing flexing 10% in accordance with volumes while ensuring patient safety.

• Don Maddox received this year’s Daisy Award. Margy Klammer and Jeri Dostie both achieved Daisy Lifetime Achievement Awards for their hard work and dedication to this organization for several decades.

Quality and Safety

• Lenna and Caitlin have picked back up with the Community Health Needs Assessment (CHNA). Updates will be presented at the July Board meeting.

• Quality measures put in place related to DNV findings have mostly shown a positive impact as compliance rates have been reached; it has been determined that an RCA/PDCA needs to be done regarding pain medication ordering/administration. I have requested that an internal audit be completed on this subject.

Mammoth Hospital Report to the Board of Directors CNO Report June 18, 2020

Service

• Casey Michel is offering tele-med dietary consults at about 60% of her normal volumes.

• We began elective surgeries and procedures with all safety protocols in place. This has been going well and has increased morale for staff.

• Brandy Wilt is training an additional RN in PICC placement. This will allow for more availability to perform this procedure when needed.

Growth

• Continued progression on OR 3. The OR is also working on a project through the EMR to help streamline workflow, documentation and charges.

• Oncology Navigation Committee was started by C. Burrows, Y. Parisky, L. Marusicz and C. Crunk.


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DATE: June 18, 2020 TO: Board of Directors FROM: Craig Burrows, M.D. RE: CMO Report, Regular Meeting of the Board of Directors

Strategic Plan Updates: Provide the Medical Services locally that are most needed by the community.


Grow Surgical Services OR room 3 Expected to go live in late June or early July 2020.

Addition of Ortho PA Chelsea Brown set to start July 7, 2020.

Neurology Need this service in Mono Co. Still looking for neurologist.

Rheumatology Replacement for Dr. Jaffer Ongoing efforts to coordinate with Dr. Michelle Newkirk.

MAT clinic Treatment for patients with opioid abuse

Anticipate beginning this service this year.

Cardiology Desire to increase local services Pre-COVID, I spoke with the CMO of Carson-Tahoe, who is interested in pursuing relationship.

Internal Medicine Establish Outpatient clinic Interview with Dr. Andrew McAlpin later this month.

COVID-19 update: The hospital is rapidly returning to full volumes Clinics have been given the direction to return to full volume capacity, and have ramped up significantly in the last few weeks. Likewise, the OR has returned to its normal block schedule, and elective surgeries are being scheduled and performed on a daily basis. All patients being seen in the facility are being screened for symptoms and temperature prior to entering. All patients having a procedure performed are tested for COVID-19 to maintain our tenet of no allowing the hospital for be a vector for the spread of the virus.


Mammoth Hospital Report to the Board of Directors CEO Report June 18, 2020

We maintain a car clinic for patients suspected of being infected with COVID-19. This is to isolate them from the rest of the facility, thus allowing them to be seen while keeping the rest of the facility safe. COVID-19 in the community As of this writing, there are now 37 confirmed cases of COVID-19 in the community. There has not been a patient with an active infection admitted to the hospital since late March, which validates any newly identified cases are not impacting the hospital’s capacity to care for patients. Therefore, the triggers to move the community forward and open more aspects of business and lodging have not been compromised. The hospital is able to treat all patients without crisis standards of care, test all people with COVID-19 symptoms, and conduct active monitoring of confirmed cases and their contacts as of the time of the Board meeting. Medical staff The Opioid Epidemic With the completion of the Specialty Clinic and the easing of restrictions on which clinic patients may be seen, it is anticipated the Bridge clinic will be able to start seeing patients soon. The hospital has X-waivered providers, behavioral health, and a substance use navigator in place. Multidisciplinary Peer Review Committee This committee will resume regular activity in June 2020. Bylaws rewrite This committee has resumed biweekly meetings to formally update the medical staff bylaws, and we are making good progress. The committee consists of Craig Burrows, DM, CMO, Peter Clark, MD, Rich Koehler, MD, COS, and Lindsey Sarullo, JD. Cerner Efforts continue to enhance our providers’ experience with the EMR. Nearly all the ED physicians have all converted over to dynamic documentation, which is the supported format for documentation. The previously utilized PowerNote format is no longer an area of active research and development on the part of Cerner. In order to improve workflow and process, sprints have been done in the PACU, PT/OT, and Materials Management. Video Visits are now fully integrated into the system, which facilitates telemedicine visits and helps our providers and staff maintain the necessary physical distancing to keep patients and staff safe and minimize the spread of COVID-19.


OR Services Work continues in the area of optimizing efficiency in the OR with respect to minimizing delays between cases. It is anticipated that the addition of a 3rd OR will help in endeavor. Due to the severe shortage of the supplies necessary for rapid in-house testing, all patients scheduled for an elective procedure are being tested for COVID-19 5-7 days of advance with a send-out test. While this is creating a significant inconvenience in scheduling, we are hopeful this is a temporary situation, and that we will replenish our stock of rapid tests by the end of the month. Physician Recruitment Orthopedics: We will be bringing on a new PA in July 2020, Chelsea Brown. She will be working with Dr. Knecht to enhance foot and ankle services. Urology services: Dr. Paul Polishuk from San Diego continues with a clinic week every month. Anesthesia: Coverage currently consists of Dr. Jon Bourne, Dr. Nat Parker, Dr. Larry Silver, and Dr. Eric Bourne. Dr. Caroline Saba, who currently resides in Arizona, is joining the group as a 5th provider. Family Medicine: Staffing continues with Drs. Ward, Clark, and Crunk, and Carolyn Korfiatis, NP and Cara Crosby, PA. There are no immediate plans to add another provider, but Dr. Crunk intends to slow down his practice and potentially retire in December 2020. We will be interviewing Dr. Andrew McAlpin, an internist, in June 2020. He is a colleague of Dr. Koehler’s and is potentially interested in relocating to the area and providing outpatient internal medicine services. Plastic Surgery: Plastic surgery services with Dr. Monson are currently on hold due to limitations in clinic and OR space as well as the COVID-19 pandemic. However, with the opening of the specialty clinic and the 3rd OR, it is anticipated this service line can once again be actively pursued. Rheumatology: We will be losing Dr. Adrian Jaffer to retirement in January, but there is another interested physician, Dr. Michelle Newkirk. Her status to provide services here at Mammoth remain uncertain. Dermatology: We are in negotiations with Dr. Mike Bryan to join Dr. Cragun and provide dermatology services every month of the year. Dr. Bryan will hopefully begin his practice here later this year.


Cardiology: Prior to the onset of the COVID-19 pandemic, I had had some preliminary discussions with the CMO for Carson-Tahoe about adding their cardiologists to our staff as visiting physicians. He was very interested in pursuing this, and we will resume discussions in the weeks to come as the pandemic becomes less of an immediate concern. PICC Line Placement Brandy Wilt, one of our Med/Surg nurses, completed training on this procedure in October 2019, so we may offer it to our patients every day of the week. We also anticipate training Allison Miller, a nurse in the ED, to perform this procedure as well. Dr. Harrell of Radiology also performs this service.


________________________________________________________________________________________________________




DATE: June 18, 2020 TO: Board of Directors FROM: Mark Lind, CIO RE: CIO Report; Regular Meeting of the Board of Directors

Strategic Plan Updates


Execute the Facilities Development Plan

Expand clinic space for specialty practices, dentists and laboratory.

• The building was substantially completed in April. In use by the Family Medicine Clinic as the “Drive Up Sick Clinic” in May. Specialty Clinic moved over week of May 25. Project complete.

Improve pedestrian safety and parking for Medical Office Building.

• Completed projects to widen the upper driveway and replaced Medical Office Building stairs. Both projects greatly improve pedestrian safety. Currently working with civil engineer on South/Upper parking lot expansion. This project on hold pending resolution of pandemic.

Increase employee housing inventory.

• Reorganization of SGSA apartments to incorporate on call and temporary housing for providers and staff is completed. All call units have been cleaned up with paint, laminate flooring, and updated


Mammoth Hospital Report to the Board of Directors CIO Report June 18, 2020

furniture. Overall repairs to the SGSA have also been completed with interior and exterior painting, roof repairs, and repairs to the heating system.

• Long delayed maintenance of our condo inventory has been completed with painting, flooring, and finish work done on all units. Currently working with the new housing committee on the L’Abri condos to repair or replace the stairs and decking. Repairs on hold pending resolution of the pandemic.

Maintain our medical imaging devices to provide high quality and high availability solutions to meet our patient care needs.

• Canon MRI now fully functional and in daily use. Project complete.

• Replacement for the Flouro modality, which is past end of life, has been agreed to by the stakeholders. The preferred unit is a Siemens RAX system which provides flouro, weight bearing X-ray, and limited CT capability. It has been determined that we will need to widen the existing Flouro room in Radiology and move the patient restroom to a different wall to comply with Siemens’ size requirements for this robotic unit. Preliminary designs for the room have been done by our architect and provided to Siemens so that they can provide a


turn-key quote for the project. Project on hold.

• We plan to add a third C-Arm unit to our equipment inventory to allow for the OR3 project. The C-Arm selection was made through soliciting feedback from our surgeons and rad tech team. Project on hold.

• Replacement of the obsolete Ultrasound unit is being planned. Current unit at end of life. Project delayed until next fiscal year (FY’21) due to pandemic.

Convert underutilized space in A Building.

• The project is on hold pending completion of the planned new hospital wing.

Fully adopt and optimize our investments in information technology

Improve the hospital IT infrastructure to enhance performance, reliability, disaster preparedness, and security.

• Selection process for our virtual server host solution started as we are nearing end of life (and support) on our Simplivity hyperconvergence solution. Project delayed until next fiscal year (FY’21).

• Upgrade to our Citrix Cloud web application and virtual desktop solution complete as of May 2019. Recently moved our outside coding company and managers, who access systems remotely, to the new solution. Project complete.

Enhance and expand our existing device integration with the EMR to improve clinician workflow and to provide real-

• EKG integration project with Cerner underway. Rolling out in Family Medicine and Cardiology/Specialty at end


time patient results and monitoring to clinical staff.

of May. Once all workflow issues are well understood, will roll out to the Emergency Department.

• Investigating patient monitoring integration with Cerner. Raizel is a cellular network-based solution that integrates home monitoring devices (blood pressure, weight, glucose) with the EMR to allow the provider to better manage patients with chronic conditions. Work is ongoing to obtain grant funding to allow for this project.

Continue to provide support to providers and staff to enable their optimized use of our Cerner and associated EMR systems.

• Project to move Mammoth Hospital to a Cerner Reference site started in June 2019. Initial project step of surveying all MH Cerner EMR users complete in July with an average score of 3.3 (on a five-point scale, with five being the highest). The agreed goal is to bring the average score up to 4.0 or higher satisfaction rate.

• PACU Department Sprint complete in September. Work done to optimize and standardize workflows, short cuts published, issue with settings persistence take to Cerner and solution found. Follow up survey done which raised the score 0.7, representing a significant increase. Complete.


• PT/OT Sprint is now complete. Roughly 50 separate issues were identified and worked to resolution with Cerner support. Mammoth PT now chosen to assist with integration of new Dynamic Documentation (DynDoc) platform for therapies in the Community Works platform. This key deliverable remains outstanding and about a year away from deployment. As with the Emergency department, DynDoc promises to significantly improve provide documentation efficiency and workflow. Survey performed at project wrap up in May with an improvement from 3.07 to 3.20, so a total of 0.13 (scale of one to five, five being the highest score).

• The Sprint on Perioperative Materials started out very well early this calendar year. We developed a comprehensive project plan with the key stakeholders, pulled in several Cerner experts to assist with our questions, and aggressively started what can be considered a re-deployment of Cerner in Periop/Materials. The goals of the project are to implement inventory


management in the Periop area with real-time and accurate charging of materials using bar code scanning and electronic preference cards. Staffing issues in the OR and the COVID pandemic slowed the project to a stop. In recent weeks, the informatics team has been holding meetings with the stakeholders to review our progress and to work to get the project back on track. Our new goal is to get the implant tracking solution in place in June and the inventory solution in place on July 1.

• The Laboratory Sprint has been placed on hold pending a resumption of normal operations.

• The Chemotherapy Sprint started up the week of May 18. While we don’t have the full Cerner Chemo module, there are significant workflow improvements we can make to get orders and follow up automated and working more efficiently. We expect this project to take about six weeks in total.


Select Operational Updates Facilities Planning and Engineering:

Work was recently completed in obtaining an additional three competitive quotes for our new

hospital wing project. These bids are in current review by the Facilities team and will be ready

to present to our Facilities Steering Committee by late June. The goal is to assess which bid best

fits our needs so that we can work with this firm once we assess the timing of the seismic

compliance requirements for the inpatient wing post-COVID. Given the massive hit the COVID

crisis has made on the district from a financial standpoint, delaying the project is prudent.

The project to fit out our OR3 room is now in full swing. Orders have been placed for all major

pieces of equipment and the engineering is underway with our architect to get the structural,

mechanical and electrical systems documented and submitted to OSHPD for review and

approval. To date, the State has been very accommodating in working through the various

issues. The primary deliverables are the surgical booms, flash sterilizer, in-room storage

cabinets, the stainless-steel nurse workstation, and the storage solution for bulk items.

Unexpectedly, the nurse’s station seems to be the most difficult item to keep on track with a

custom size requirement given the unique layout of the room. There is a strong effort

underway to complete the project in July so that we can expand our surgery capacity.

Finally, the Specialty Clinic project was wrapped up in May, with the Town providing a

permanent occupancy permit. Exam chairs and other equipment were installed and made

ready. The Specialty Clinic team started moving their medical and office equipment over in the

middle of the month and fully moved over the week of May 25. It should be noted that the

Family Medicine “Sick Clinic” has been operating out of the clinic for more than a month. This

clinic continues to operate out of the building given our need to screen patients at their car and

outside of our facilities to manage the infection risk.


________________________________________________________________________________________________________




DATE: June 18, 2020

TO: Board of Directors

FROM: Sarah Vigilante, HR Director

RE: Human Resources Report, Regular Meeting of the Board of Directors

Select Operational Updates

• Hiring is recovering, with seven open positions posted on our website. These are all

positions to replace vacancies created over the last couple of months for various

reasons.

• Our average turnover rate is about 1% a month however in May it was more than

double that at 2.35%. In reviewing the positions that have turned over, I believe much of

it is due to a delay in plans caused by the pandemic since March’s turnover was .58%. I

believe the pandemic is also directly responsible for some of the turnover as partners

lost jobs at the mountain and various other challenges presented themselves during this

time. We have begun a process improvement with our exit interview strategy which is

to have Senior Administrators do an exit interview with an outgoing full/part time

employee. So far this process has been received well by both the employees and the

Senior Admin. The goal of this change is to put the feedback directly into the hands of

the person able to make the improvements. Employees are offered the choice to take a

survey monkey exit interview or to do it in person.

• On April 1, 2020, the Hospital Incident Management Team made a determination to opt

into the provisions in the Families First Coronavirus Response Act (FFCRA). Hospitals are

actually exempt from this law, however the HIMT felt that it was an additional way for

the Hospital to provide employees with a greater safety net and protections during this

time. This allows employees who are unable to work due to school and daycare closures

to take up to 12 weeks off with 2/3 of their wages paid (up to specified wage

maximums). It also allows an employee that is suspected COVID+, or caring for a COVID+

family member, to get 80 hours at their full wages. At this time, we’ve had 55

employees utilize this program in some way. Employees may also utilize their major

medical or paid time off if needed to extend past these timeframes. Major medical is

usually restricted according to hospital policy however we have allowed expanded usage

of this benefit during this time.


Mammoth Hospital Report to the Board of Directors HR Report June 18, 2020

• We have reengaged with our compensation consultant, Gallagher, and are working on

modified options on the compensation program reform.

• We have reopened the Staff Development Coordinator position. This position will be

taking over our Learning Management System (Healthstream) and will be a centralized

role for coordinating both clinical and non-clinical education.

• The Foundation is working on a digital grand opening of the Specialty Clinic building. Six

of the rooms were adopted by individual donors and the Hospital department

management team adopted one of the rooms through their own contributions from

their paychecks.

• The Cancer Outreach Committee is meeting this month to evaluate how to hold a

modified Cancer Outreach Golf Tournament.

• Advertising is focusing on messaging that the hospital is safe and open with telehealth

capabilities.

Finance Committee Minutes Date: Monday, May 19, 2020 Time: 4:00 pm Location: CEO Office Attendees: Tom Parker; Stephen Swisher; Dave Anderson; and Melanie Van Winkle. Via Teams: Slavka Crouthamel; Caitlin Crunk. The meeting was called to order by Dr. Swisher at 4:11 pm.

Agenda Item:

Discussion/Conclusion/Action

Follow-up

Review of Minutes • April 13, 2020 minutes were reviewed. No changes were requested.

Follow-up • There was no follow-up.

Financials – April 2020 Melanie went over the balance sheet and PowerPoint with the group.

• Balance sheet: cash is up to $80 M. $9.4 M increase.

• $1.6 M CARES stimulus.

• $5.7 Medicare Advance payment – have to pay back.

• Medi-Cal supplemental payment $3.2 M.

• Patient accounts receivable has gone down $3 M net.

• Reclassed construction in progress to equipment for the MRI that we hadn’t capitalized yet.

• Took $1.6 M out of liabilities.

• Census very low. A little better in May.

• Only 4 inpatient surgeries in April. Picking up now. 10 outpatient cases. About 50% of normal now, maybe 75 next week and maybe close to normal by June 1.

• Part time specialists starting to come back in June.

• Still paying a lot of hours.

• Brings us to ~$2.3 M loss, biggest Melanie has seen in her time here. $2.9 M budget variance. Still ahead year-to-date, ended 10 months at $4.3 M. Last year at $8 M. Still possible we could get to budget by year end.

• See Financial PowerPoint.

Mammoth Hospital Finance Committee Minutes – May 19, 2020

Page 2 of 3

• AR is being impacted by slow collections. Payers have also transitioned to working offsite which has slowed their processes down.

• Have asked for patient billing reminder call service to resume.

COVID-19 Activities Emergency Funding:

• Close to $18 M in funds received to help us through this period. Do not know of any other available funding right now. Still working on FEMA funds and a small insurance payment from our carrier.

• Flexing does not violate PPP loan. Per diem employees are not guaranteed hours.

Cash Projection:

• Collections much lower in May so far. Collections are typically 2-3 months behind volumes. Still expecting some supplements in June. However, with the stimulus funds and other supplements, we may end the year with ~$91 M cash.

• There was discussion about surgical volumes. Financial Forecast: Melanie reviewed the financial forecast:

• Updated April $2.3 M loss.

• Total operating revenue estimated at $4.3 M for May. June may be even higher, possibly $7-8 M.

• We have put some extra reserves into charity and bad debt.

• Will book Medi-Cal supplements in June; always come at the end of the year.

• COVID emergency funds of $4.6 M will be booked in May.

• Received $6.1 M Medi-Cal supplement which will be booked in June. With similar expenses this puts us at $3.6 M bottom line for June which could bring us to $8.6 M year-to-date net gain.

• Have not put reserves in for success sharing. Will do this in June.

• Annual merit raises may be able to be reinstated – very important to employees.

• There was discussion around possible changes to success sharing in the future. Part of taking a big picture look at compensation package comprehensive review – on hold right now.

Mammoth Hospital Finance Committee Minutes – May 19, 2020

Page 3 of 3

Physician Compensation • Melanie included a memo to the board in the packet. Please review. There was no discussion.

Other Business • There was discussion about the architect selection process for the new hospital wing. We are learning things about the pandemic that we will want to include in the new building wing. Do not want to rush through this process.

• Not sure if auditors are coming on-site in August.

• New staff accountant left about a week ago. Slavka and her team are picking up those tasks. Hopefully will replace the position soon.

Next Meeting • There was discussion about whether Finance Committee meetings should be in person or on Teams.

• Next meeting: Monday, June 15, at 4:30 pm.

• The group decided that the meeting type will be decided on a month-by-month basis by Melanie depending on content.

Meeting adjourned at 5:03 pm.


________________________________________________________________________________________________________




DATE: June 18, 2020 TO: Board of Directors FROM: Tom Parker, CEO RE: CEO Report, Regular Meeting of the Board of Directors

COVID-19 As of May 23, 2020 the duty of managing the hospital’s COVID-19 response and planned transitioned from the Hospital Incident Management Team to the Admin Team. Following this report I have included a copy of my SBAR to the HIMT regarding this transition. Clinics have been given the direction to return to full volume capacity and have ramped up significantly in the last few weeks. Likewise, the OR has returned to its normal block schedule, and elective surgeries are being scheduled and performed on a daily basis. All patients being seen in the facility are being screened for symptoms and temperature prior to entering. All patients having a procedure performed are tested for COVID-19 to maintain our tenet of not allowing the hospital for be a vector for the spread of the virus. We maintain a car clinic for patients suspected of being infected with COVID-19. This is to isolate them from the rest of the facility, thus allowing them to be seen while keeping the rest of the facility safe. As of this writing, there are now 37 confirmed cases of COVID-19 in the community. There has not been a patient with an active infection admitted to the hospital since late March, which validates any newly identified cases are not impacting the hospital’s capacity to care for patients. The return to performing elective procedures has resulted in improved financial results. Details of the financial impact are in the CFO report. Petitions by Mono County to the State to further open local business activity have been granted. We provided attestations that the hospital is able to treat all patients without crisis standards of care, test all people with COVID-19 symptoms, and that the County is able to conduct active monitoring of confirmed cases and their contacts.



Beta HEART Obtained validation in Just Culture and Care for the Caregiver domains. Obtained Quest for Zero in OB. This will provide a large savings for Tier II x2. OR Director Transition After over two and a half years serving as the perioperative director, Cammy Staker has resigned in her role. She plans to stay on staff as an OR nurse. Due to such high turnover in this role, we will be looking to conduct a Root Cause Analysis (RCA) to help unsurfaced why this is occurring. Phyllis Meneses will be acting as interim until we hire a full-time perioperative director. Cancer Program An Oncology Navigation Committee was started by Craig Burrows, MD, Yuri Parisky, MD, Lisa Marusicz and Caitlin Crunk. Its initial work is to develop standardized patient flow and related staff roles. Daisy Award Don Maddox received this year’s Daisy Award. Margy Klammer and Jeri Dostie both achieved Daisy Lifetime Achievement Awards for their hard work and dedication to this organization for several decades. Comprehensive Compensation Review and Planning We have reengaged with our compensation consultant, Gallagher, and are working on modified options on the compensation program reform. Cerner Efforts continue to enhance our providers’ experience with the EMR. Nearly all the ED physicians have all converted over to Dynamic Documentation, which is the supported format for documentation. The previously utilized PowerNote format is no longer an area of active research and development on the part of Cerner. In order to improve workflow and process, sprints have been done in the PACU, PT/OT, and Materials Management. Video Visits are now fully integrated into the system, which facilitates telemedicine visits and helps our providers and staff maintain the necessary physical distancing to keep patients and staff safe and minimize the spread of COVID-19. Cerner Sprints The PT/OT Sprint is now complete. Roughly 50 separate issues were identified and worked to resolution with Cerner support. Mammoth PT has been chosen to assist with the integration of new Dynamic Documentation (DynDoc) platform for therapies in the Community Works platform. Survey performed at project wrap up in May with an improvement from 3.07 to 3.20.


The Perioperative Materials Sprint continues with goal to implement inventory management in the Periop area with real-time and accurate charging of materials using bar code scanning and electronic preference cards. While staffing issues in the OR and the COVID pandemic slowed the project to a stop, the informatics team has recently been holding meetings with stakeholders to review our progress and get the project back on track. Our new goal is to get the implant tracking solution in place in June and the inventory solution in place on July 1. The Laboratory Sprint has been placed on hold pending a resumption of normal operations. The Chemotherapy Sprint started up the week of May 18. While we don’t have the full Cerner Chemo module, there are significant workflow improvements we can make to get orders and follow up automated and working more efficiently. We expect this project to take about six weeks in total. Facilities Projects The Specialty Clinic project was wrapped up in May, with the Town providing a permanent occupancy permit. The Family Medicine “Sick Clinic” has been operating out of the clinic for more than a month and continues to operate out of the back section of the building. The Mammoth Hospital Foundation is working on a digital grand opening of the clinic. Six of the rooms were adopted by individual donors and the Hospital department management team adopted one of the rooms through their own contributions from their paychecks. The project to fit out our OR3 room is now in full swing. We expect to bring the room online in July. Work was recently completed in obtaining an additional three competitive quotes for our new hospital wing project. These bids are in current review by the Facilities team and will be ready to present to our Facilities Steering Committee by late June. Respectfully submitted, Tom Parker, CEO


________________________________________________________________________________________________________




M E M O R A N D U M TO: Hospital Incident Management Team

FROM: Tom Parker, Incident Commander

DATE: May 23, 2020

RE: SBAR - HIMT Transition Plan

SITUATION

The makeup and meeting frequency of the HIMT should be aligned with the current status of the

hospital’s COVID-19 response: Phased reopening.

BACKGROUND

• The HIMT has been operating since early March with the three purposes of: Build surge

capacity, reduce virus transmission in the hospital, and exemplify and advocate for actions that

slow community transmission. We have been successful in these efforts and have begun the

work of returning the hospital to a more normal course of operations.

• The work by members of the HIMT has been exemplary and the HIMT has been an effective

team.

• HIMT members, which include members of the medical staff, have put aside their usual duties in

order to serve on the team.

• Unlike other emergency conditions, COVID-19 is a long-term issue that ultimately requires

hospitals to incorporate its management into their existing administrative structures.

ASSESSMENT

Facts and Findings:

• With the planning work largely done to achieve these goals, the amount of work required by the

HIMT has decreased.

• Some of the members of HIMT are providers who have continued to work in their clinical role

while providing significant contributions of hours and energy to the HIMT. Other provider

members of HIMT are beginning to experience more time constraints due to the current and

future growth of patient care volumes.

• All members of the Admin Team are filling roles on the HIMT.


• Many non-COVID-19 related projects have been put on hold in order to focus time and energy

on HIMT duties.

• Many patients have non-COVID-19 related medically-necessary, time-sensitive (MeNTS)

conditions that require hospital services.

• Social constraints are easing which will likely result in future increases in community

transmission of COVID-19 and related hospital visits and admissions.

• The collective work of the HIMT is of great value. It has been well documented in meeting

minutes, plans, and policies for current and future reference.

Conclusions:

• The Hospital Phased Re-opening affords the hospital with an opportunity to treat patients who

have MeNTS needs. With the easing of social constraints, this opportunity may be of short

duration. Providers serving on the HIMT will be able to reduce the backlog of patients requiring

care if they are not spending time on the team.

• The Admin Team have all been part of the HIMT’s development of the COVID-19 response plans

and policies. They are well prepared to manage the ongoing implementation of those plans and

policies and make modifications to them as needed.

• The Admin Team is capable of incorporating COVID-19 response management into its broader

set of hospital management responsibilities including reactivation of projects that have been put

on hold.

• Non-Admin Team members of the HIMT will continue to be of service to the COVID-19 response

work whether they serve on the HIMT or contribute in an advisory role.

• The long-term nature of the COVID-19 pandemic requires that hospitals incorporate their

response work into their operations and provision of services to non-COVID-19 patients. In

doing so, hospitals move from dealing with COVID-19 in emergency response mode to becoming

“COVID-19 capable“ organizations.

• As in any other emergency situation, a surge scenario where hospital resources are being

strained and the focus of hospital operations returns to the near exclusive management of

COVID-19 patients, the HIMT will need to be reactivated as the organization’s managing body.

RECOMMENDATIONS

The HIMT should discontinue as the body managing the Hospital’s COVID-19 response. The continued

management of the Hospital’s COVID-19 response should be done by the Hospital’s Admin Team.

Prior to the last meeting of the HIMT all duties of non-Admin Team members now serving on the HIMT

should be transitioned to a member of the Admin Team. Transitions should include in-person hand-off

meetings to assure that the Admin Team member taking on the duties is sufficiently briefed and ready

to continue the work.


MEMORANDUM

==============================================================================

DATE: June 17, 2020

TO: The Board of Directors

FROM: Melanie Van Winkle, CFO & Slavka Crouthamel, Controller

SUBJECT: Financial Statements for eleven months ended May 2020

==============================================================================

This memorandum presents an overview of Mammoth Hospital financial operations.

COVID19 Summary of events

The month of May 2020 continued to be impacted by the COVID19 pandemic. While volumes for

elective procedures, surgeries and visits increased during the month, most areas were still around 50%

of budget/normal. It is expected we will continue to see an increase in volumes in June and hope to be

closer to normal by July.

BALANCE SHEET

• The May month end Cash balance was $93.8 million – $13.7 million higher than April

o Received $4.6 million CARES Stimulus payment

o Received $5.2 million for Small Business Administration Loan

o Received $3.6 million from Anthem Blue Cross (ABC) for FY19 Medi-Cal supplemental

o Received $955 thousand for Medi-Cal PRIME based on project metric results for the first

half of FY20 (this is a return of $477K we sent in April, along with another $477K for us

to keep)

• Net Patient Accounts Receivable was $9.8 million which is $315 thousand higher than prior

month

• Other current assets increased by approximately $184 thousand – regular bond revenue accrual

• Equipment increased by $2.1million due to capitalization of the new Specialty Clinic

• SBA Loan liability is a new line added for the $5.2 million Paycheck Protection Program loan

received in May

• Due to third party increased by $4.6 million

o Received $3.6 million ABC FY19 Medi-Cal supplement as discussed above

o Received $955 thousand for Medi-Cal PRIME

FINANCIAL INDICATORS

• Cash Collections in May were $5.6 million – which included the $2.5 million from ABC

• Days Cash on Hand at May month-end was 419 days compared to April of 358 days

Southern Mono Healthcare District

Report to the Board of Directors

Financial Report

June 17, 2020

• Gross AR days increased to 54.7 from 64.5 in May (65 goal) – due to higher volume

• AR over 120 days increased to 40.2% at May compared to 39.3% at April

• Gross revenue was $6.3 million in May which was more than double the $2.6 million in April

VOLUMES

Month of May summary:

• Inpatient days were 76 – compared to 48 in April. Case Mix index was low at 1.184

• Total surgeries were 74 in May, compared to only 14 cases in April.

o Endoscopies & Colonoscopies were 22 in May, no cases performed in April

• Emergency Department visits in May were 418 which is almost double the 262 visits in April

• Clinic visits were 2,614, which is a little higher than the 2,068 visits in April. Many of the part

time visiting physicians are returning for clinics in June

INCOME STATEMENT

Month of May

Revenue:

Total Gross Revenue of $6.3 million was $2.5 million lower than budget due to lower volumes due to

Covid19 containment. Total Operating Revenue was $8.6 million which includes $4.6 million CARES

Stimulus emergency funds

May 2020 Expenses:

OPERATING EXPENSES Current Budget Variance %

Variance Brief Comments

Salaries $2,035 $2,035 ($0) 0%

Benefits 974 839 (135) -16% Higher employee PTO accrual

Professional services 1,390 1,199 (191) -16%

Contract services 76 51 (25) -48%

Supplies 420 589 168 29% Lower volumes

Services 644 644 1 0%

Total Expenses $5,539 $5,357 ($181)

Southern Mono Healthcare District

Report to the Board of Directors

Financial Report

June 17, 2020

Net Gain

• May’s net gain was almost $3.1 million compared to a budgeted gain of $40 thousand – $3.0

million favorable variance. This result is directly attributed to the $4.6 million of CARES Stimulus

Funds received in May.

Year to Date

• Total Gross Revenue of $117.2 million is higher than budget by $4.8 million and $3.6 million

higher than last year

• Total Operating Revenue (collectable revenue) was $73.7 million which is $5.4 million higher

than budget and $3.5 million higher than last year

• Total Operating Expenses of $66.4 million are $2.7 million higher than budget, and $4.4 million

higher than prior year

o Professional Services (physician payments) are $2.2 million over budget – mainly due to

the first 8 months of high volume

o Supplies are $1.0 million over budget due to higher complex surgical cases prior to

COVID19 pandemic

▪ To date, we have spent around $254,000 for additional PPE and supplies for

COVID

o These two above are offset by a $712 thousand favorable Salaries and Benefit net

expense

• Year to date Net Gain of $7.4 million (10.1% total margin) which is $2.8 million thousand higher

than budget and $1.2 million lower than last year

6/10/2020

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - May 31, 2020

Unaudited Unaudited Audited

May 31, April 30, Prior Month June 30,

ASSETS 2020 2019 Change 2019

CURRENT ASSETS:

Cash (135 days operating expenses) $26,138,782 $25,750,833 $387,949 $19,609,830

Cash (reserved for building projects) 65,950,660 52,611,809 13,338,851 39,687,872

Investments 1,748,701 1,749,441 (739) 9,956,578

Total Cash 93,838,143 80,112,082 13,726,060 69,254,280

Patient accounts receivable 18,984,818 18,750,607 234,210 22,033,263

Less: Allow. for bad debts and contractuals (9,186,384) (9,267,278) 80,894 (10,553,766)

Net patient accounts receivable 9,798,434 9,483,329 315,105 11,479,496

Inventory 1,921,995 1,943,619 (21,624) 1,857,904

Prepaid expenses & deposits 489,524 687,618 (198,094) 739,481

Other current assets 726,579 1,052,363 (325,784) 448,300

Total Current assets 106,774,675 93,279,011 13,495,664 83,779,462

ASSETS LIMITED AS TO USE:

Bond funds held in trust by Mono County:

Mono Co Bond Capital Appreciation Fund 10,176,064 10,176,064 0 9,486,272

Debt service fund 992,057 992,057 0 1,659,212

Restricted by contributors 206,366 194,156 12,211 152,560

Total Assets Limited As To Use 11,374,488 11,362,277 12,211 11,298,045

PROPERTY, PLANT & EQUIPMENT:

Land and improvements 7,933,576 7,933,576 0 7,768,033

Buildings and improvements 56,742,372 54,581,493 2,160,879 54,203,335

Equipment 34,550,384 34,448,522 101,862 32,418,660

Construction-in-progress 1,204,625 3,392,535 (2,187,910) 357,886

Total Property, Plant and Equipment 100,430,958 100,356,127 74,831 94,747,915

Less: Accumulated depreciation (57,511,024) (57,113,928) (397,095) (53,412,736)

Less: Accumulated amortization (2,077,080) (2,077,080) 0 (2,077,080)

Net Property, Plant and Equipment 40,842,854 41,165,119 (322,264) 39,258,099

Total Assets $158,992,018 $145,806,407 $13,185,610 $134,335,606

Page 1

6/10/2020

SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - May 31, 2020

Unaudited Unaudited Audited

May 31, April 30, Prior Month June 30,

LIABILITIES 2020 2019 Change 2019

CURRENT LIABILITIES:

Accounts payable and accrued expenses $2,920,465 $2,582,255 $338,211 $2,854,315

SBA Loan 5,265,405 0 5,265,405 0

Accrued payroll-related liabilities 3,548,004 3,288,013 259,991 3,575,948

Patient refunds 158,647 618,291 (459,644) 199,734

Due to third party payers 12,506,417 7,923,998 4,582,418 250,000

Accrued interest on long term obligations 144,211 108,277 35,934 199,206

Current portion of long-term debt 1,130,000 1,130,000 0 1,015,000

Health plan IBNR 888,625 888,625 0 828,000

Total Current liabilities 26,561,775 16,539,459 10,022,316 8,922,203

LONG-TERM DEBT:

Unamortized bond premium 948,704 959,372 (10,668) 1,066,056

Capital appreciation interest payable 10,326,172 10,242,439 83,732 9,405,117

General Obligation Bonds 12,509,555 12,509,555 0 13,754,555

Total long term debt 23,784,430 23,711,366 73,064 24,225,727

Total Liabilities 50,346,205 40,250,826 10,095,380 33,147,930

NET ASSETS:

Invested in capital assets net of related liabilities 15,928,424 16,323,752 (395,328) 14,017,372

Restricted - expendable for specific operating activities 205,787 193,576 12,211 152,041

Restricted - expendable for debt service 11,168,122 11,168,122 0 11,145,485

Unrestricted 73,939,150 73,543,822 395,328 60,995,187

Year to date earnings 7,404,329 4,326,311 3,078,020 14,877,592

NET POSITION: 108,645,812 105,555,582 3,090,231 101,187,676

Total Liabilities and Net Position $158,992,018 $145,806,407 $13,185,610 $134,335,606

Page 2

SOUTHERN MONO HEALTH CARE DISTRICT

Statement of Revenues & Expenses - May 31, 2020

Prior Month Actual Budget

Variance to Budget Prior Year

Variance to Prior Year OPERATING REVENUE Actual Budget


Variance to Prior Year

(000s omitted)/1000

$630 $1,690 $2,150 ($460) $1,734 ($44) Inpatient services $31,114 $28,136 $2,978 $29,868 $1,246

1,364 3,268 4,439 (1,171) 4,811 (1,543) Outpatient services 57,475 55,592 1,883 54,439 3,036

291 864 1,437 (572) 1,712 (847) Professional fees services 20,395 19,811 584 20,840 (445)

345 515 854 (339) 822 (308) Clinic services 8,230 8,863 (633) 8,480 (250)

2,629 6,337 8,879 (2,542) 9,079 (2,742) Total Gross Revenue 117,214 112,402 4,812 113,627 3,587

(770) (2,628) (3,392) 764 (3,965) 1,336 Contractual & other discounts (47,674) (42,941) (4,734) (44,834) (2,841)

(66) (83) (136) 53 (182) 99 Charity write offs (2,389) (1,728) (662) (1,920) (469)

(23) 267 (144) 410 397 (131) Provision for bad debts (974) (1,819) 845 199 (1,173)

- - 83 (83) 1,200 (1,200) Supplements/Settlements 222 917 (694) 2,098 (1,876)

1,597 4,642 - 4,642 - 4,642 HHS Stimulus 6,239 - 6,239 - 6,239

3,368 8,535 5,290 3,244 6,529 2,006 Net Patient Revenue 72,638 66,831 5,807 69,169 3,469

12 22 94 (73) 47 (25) Other operating revenue 625 1,038 (413) 629 (4)

3,380 8,556 5,385 3,171 6,576 1,980 Total Operating Revenue 73,263 67,869 5,394 69,799 3,465

OPERATING EXPENSES

$2,225 $2,035 $2,035 (0) $1,956 (79) Salaries $23,010 $23,967 956 $20,539 (2,471)

920 974 839 (135) 1,338 364 Benefits 9,810 9,566 (244) 9,307 (503)

1,553 1,390 1,199 (191) 1,302 (88) Professional services 17,194 15,008 (2,186) 15,470 (1,724)

140 76 51 (25) 93 18 Contract services 860 687 (173) 1,245 385

298 420 589 168 680 259 Supplies 7,766 6,758 (1,009) 7,227 (539)

561 644 644 1 708 64 Services 7,792 7,718 (74) 8,266 474

5,698 5,539 5,357 (181) 6,077 538 Total Expenses 66,433 63,704 (2,729) 62,055 (4,378)

(2,318) 3,017 27 2,990 499 2,518 OPERATING GAIN (LOSS)/1000 6,831 4,165 2,665 7,744 (913)

$485 $389 $385 (3) $357 (32) Depreciation & amortization $4,005 $4,100 94 $3,905 (101)

($2,802) $2,629 ($358) $2,987 $142 $2,486 Operating Gain (Loss) after Depreciation $2,825 $66 $2,759 $3,839 ($1,014)

NON-OPERATING INCOME(EXPENSE)/1000

$0 $0 $0 - $0 - Gain (loss) on sale of property $0 $0 - - -

- 75 5 70 (0) 75 Donation income 141 100 40 305 (164)

215 215 223 (8) 204 12 Bond property tax revenue 2,370 2,453 (83) 2,242 128

(117) (117) (117) (0) (116) (2) Bond interest expense (1,292) (1,292) (0) (1,271) (20)

317 279 272 7 308 (28) Property tax revenue & interest income 3,252 2,993 259 3,205 47

10 (3) 16 (19) 39 (43) Interest expense 108 266 (158) 301 (193)

425 449 398 51 435 14 Total Non-Operating Income (expense) 4,579 4,520 59 4,781 (202)

($2,378) $3,078 $40 $3,038 $578 $2,500 Increase in net assets - net gain (deficit) $7,404 $4,586 $2,818 $8,620 ($1,216)

-70.3% 36.0% 0.7% 35.2% 8.8% 27.2% Total Margin 10.1% 6.8% 3.3% 12.3% -2.2%

May-20 Year-to-Date

Page 3


Key Statistical Data - May 2020

Prior Month Actual Budget

Variance to Budget

Prior Year

Variance to Prior

Year Hospital Statistics Actual Budget


Variance to Prior Year

30 31 31 31 Days in month 336 336 335Acute Patient Days:

2 3 8 (5) 3 - ICU Days 86 87 (1) 97 (11) 40 62 82 (20) 75 (13) Med/Surg & Telemetry Days 1,177 1,158 19 1,286 (109) 6 11 12 (1) 22 (11) Labor & Delivery Days 88 130 (42) 153 (65)

48 76 102 (26) 100 (24) Total Acute Patient Days 1,351 1,375 (24) 1,536 (185) 1.6 2.5 3.3 (0.8) 3.2 (0.8) Average Daily Census (ADC) 4.0 4.1 (0.1) 4.6 (0.6)

26.9% 30.3% 29.0% 1.3% 23.2% 7.1% % of IP Revenue to Ttl Revenue 32.1% 30.4% 1.7% 32.2% -0.1%1.8 2.5 1.3 1.2 2.0 0.5 Average Length of Stay (ALOS) 2.2 2.0 0.1 2.2 (0.1) 27 31 81 (50) 51 (20) Discharges 627 674 (47) 687 (60)

0.888 1.184 NA NA 1.342 (0.158) Case Mix Index 1.399 NA NA 1.458 (0.06)

Other Key Hospital Statistics:262 418 543 (125) 616 (198) ED Visits 8,639 8,973 (334) 9,226 (587) 58 228 294 (66) 433 (205) Observation Hours 4,934 4,930 4 4,650 284 5 7 7 - 12 (5) Deliveries 59 81 (22) 83 (24)

4 15 26 (11) 23 (8) IP Surgeries 341 366 (25) 421 (80) 10 59 73 (14) 87 (28) OP Surgeries 951 864 87 899 52 14 74 99 (25) 110 (36) Total Surgeries 1,292 1,230 62 1,320 (28)

17 77 81 (4) 92 (15) MRI Procedures 856 870 (14) 911 (55) 43 88 128 (40) 145 (57) CT Scans 1,949 1,855 94 2,034 (85) 7 45 61 (16) 90 (45) Mammography Procedures 782 792 (10) 769 13

76 123 115 8 139 (16) Ultrasound 1,474 1,314 160 1,394 80 268 563 867 (304) 999 (436) Radiology 11,409 11,552 (143) 12,304 (895) 411 896 1,252 (356) 1,465 (569) Total Imaging 16,470 16,383 87 17,412 (942)

2,773 5,221 5,637 (416) 6,436 (1,215) Lab Tests 71,347 67,252 4,095 69,847 1,500 1,881 3,880 7,144 (3,264) 5,047 (1,167) Pharmacy Units 67,805 73,078 (5,273) 70,412 (2,606)

671 771 2,071 (1,300) 2,328 (1,557) PT/OT Visits 20,160 22,313 (2,153) 22,934 (2,774)

Clinic Visits

976 1,081 1,600 (519) 1,647 (566) Family Medicine clinic 15,502 17,000 (1,498) 18,270 (2,768) 335 334 300 34 212 122 Behavioral Health clinic 2,846 3,025 (179) 1,901 945 141 210 360 (150) 370 (160) Women's clinic 3,187 3,840 (653) 3,490 (303) 144 263 467 (204) 403 (140) Pediatric clinic 4,527 4,833 (306) 4,328 199 314 359 627 (268) 542 (183) Ortho Mammoth clinic 5,887 6,561 (674) 6,021 (134) 87 241 412 (171) 277 (36) Ortho Bishop clinic 3,142 4,286 (1,144) 2,815 327 40 78 170 (92) 188 (110) Specialty clinic 1,448 1,550 (102) 1,566 (118) 19 30 75 (45) 92 (62) Surgical clinic 899 825 74 847 52 12 18 471 (453) 510 (492) Dental clinic 3,622 4,828 (1,206) 4,906 (1,284)

2,068 2,614 4,482 (1,868) 4,241 (1,627) Total Clinic visits 41,060 46,748 (5,688) 44,144 (3,084)

May-20 Year-to-Date

Page 4

Mammoth HospitalAll Statistical Analysis

Dept # Dept Name Unit of Service Desc

Jul 2019

Aug 2019

Sep 2019

Oct 2019

Nov 2019

Dec 2019

Jan 2020

Feb 2020

Mar 2020

Apr 2020

May 2020

BudgetMay 2020

ActualMay 2019

YTDTotal

YTDBudget

% of change to Budget

Level of concern

6010 ICU Patient Days 12 15 10 5 2 8 11 14 4 2 3 8 3 86 87 -1% 99%

6170 Med/Surg Patient Days 77 79 76 91 95 111 100 88 63 27 31 66 51 838 856 -2% 98%

6170 Telemetry Patient Days 25 50 26 22 9 35 40 58 30 13 31 16 24 339 302 12% 112%

7400 L & D Patient Days 16 4 8 4 10 10 8 8 3 6 11 12 22 88 130 -32% 68%

Total Acute Patient Days 130 148 120 122 116 164 159 168 100 48 76 102 100 1,351 1,375 -2% 98%

6380 Observation Patient Days 29 28 18 17 10 24 27 31 10 2 10 12 18 206 205 0% 100%

6380 Observation Hours 688 660 434 418 236 574 643 746 249 58 228 294 433 4,934 4,930 0% 100%

6530 Nursery Patient Days 16 4 10 7 11 10 8 10 8 7 12 12 24 103 144 -28% 72%

7400 L & D Pre-delivery hours 89 62 43 17 93 18 42 89 33 47 17 11 106 550 652 -16% 84%

7400 L & D Deliveries 9 4 4 3 7 5 4 7 4 5 7 7 12 59 81 -27% 73%

7080 Family Medicine Clinic Patient Visits 1,601 1,544 1,518 1,522 1,587 1,425 1,652 1,380 1,216 976 1,081 1,600 1,647 15,502 17,000 -9% 91%

7080 Behavioral Health Clinic Patient Visits 183 205 192 285 246 247 287 264 268 335 334 300 212 2,846 3,025 -6% 94%

7050 Women's Clinic Patient Visits 309 315 333 373 328 286 328 303 261 141 210 360 370 3,187 3,840 -17% 83%

7090 Pediatric Clinic Patient Visits 393 416 404 650 507 435 544 458 313 144 263 467 403 4,527 4,833 -6% 94%

7160 Ortho Mammoth Clinic Patient Visits 574 619 553 601 526 617 664 554 506 314 359 627 542 5,887 6,561 -10% 90%

7140 Ortho Bishop Clinic Patient Visits 333 294 286 390 266 339 354 287 265 87 241 412 277 3,142 4,286 -27% 73%

7180 Specialty Clinic Patient Visits 204 117 184 156 181 83 174 124 107 40 78 170 188 1,448 1,550 -7% 93%

7110 Surgical Clinic Patient Visits 141 89 73 125 87 77 123 92 43 19 30 75 92 899 825 9% 109%

7060 Dental Clinic Patient Visits 494 433 372 430 412 382 460 366 243 12 18 471 510 3,622 4,828 -25% 75%

Total Clinics 4,232 4,032 3,915 4,532 4,140 3,891 4,586 3,828 3,222 2,068 2,614 4,482 4,241 41,060 46,748 -12% 88%

7010 ED Patient Visits 1,113 1,041 652 513 480 1,093 1,298 1,166 603 262 418 543 616 8,639 8,973 -4% 96%

7040 Ambulance Work days 22 22 20 23 20 21 22 19 22 20 20 20 22 231 231 0% 100%

7420 Surgery Minutes 18,285 17,235 16,230 20,835 15,330 20,790 24,975 18,720 11,505 1,710 9,795 12,442 14,595 175,410 154,970 13% 113%

7420 IP surgeries Procedures 30 37 30 33 35 46 53 34 24 4 15 26 23 341 366 -7% 93%

7420 OP surgeries Procedures 106 97 84 111 85 113 129 106 51 10 59 73 87 951 864 10% 110%

7420 Colo/Endo Procedures Procedures 46 46 32 32 27 25 49 39 13 0 22 25 41 331 275 20% 120%

7427 PACU Minutes 17,745 16,200 15,345 17,265 14,595 20,325 22,965 17,670 9,525 2,205 9,465 13,419 15,135 163,305 166,145 -2% 98%

7500 Lab Tests 7,985 7,498 7,023 7,240 6,496 7,306 7,637 7,070 5,098 2,773 5,221 5,637 6,436 71,347 67,252 6% 106%

7590 EKG's IP Procedures 29 29 28 27 10 12 28 21 20 9 9 16 17 222 205 8% 108%

7590 EKG's OP Procedures 173 185 117 127 77 131 147 127 71 45 95 86 109 1,295 1,205 7% 107%

7641 Chemotherapy Patient Visits 37 56 52 46 40 29 25 28 28 31 21 20 43 393 228 72% 172%

7710 Pharmacy Units 7,359 7,422 6,263 6,651 5,958 7,520 8,419 7,696 4,755 1,881 3,880 7,144 5,047 67,805 73,078 -7% 93%

7720 Respiratory Unique Patients 718 630 473 427 226 403 429 440 310 148 191 291 489 4,395 3,879 13% 113%0

7630 Radiology Patient Visits 1,217 1,192 928 998 830 1,409 1,663 1,577 764 268 563 867 999 11,409 11,552 -1% 99%

7635 Mammography Patient Visits 71 85 69 123 119 73 72 68 50 7 45 61 90 782 792 -1% 99%

7660 MRI Patient Visits 79 89 94 70 70 75 125 101 59 17 77 81 92 856 870 -2% 98%

7670 Ultrasound Patient Visits 157 128 133 135 136 142 162 161 121 76 123 115 139 1,474 1,314 12% 112%

7680 CT Scan Patient Visits 208 206 156 138 125 248 301 308 128 43 88 128 145 1,949 1,855 5% 105%

Total Imaging Procedures 1,732 1,700 1,380 1,464 1,280 1,947 2,323 2,215 1,122 411 896 1,252 1,465 16,470 16,383 1% 101%

7770 Mammoth PT Visits 1,143 1,198 1,094 1,243 1,038 1,074 1,266 1,041 725 419 453 1,109 1,230 10,694 11,705 -9% 91%

7772 Bishop PT Visits 727 793 687 858 682 746 895 772 465 189 245 712 794 7,059 7,895 -11% 89%

7773 Bishop OT Visits 107 76 106 148 124 115 143 126 77 19 30 121 122 1,071 1,333 -20% 80%

7790 Mammoth OT Visits 155 149 132 167 128 144 155 132 87 44 43 129 182 1,336 1,380 -3% 97%

Total Visits PT/ST/OT 2,132 2,216 2,019 2,416 1,972 2,079 2,459 2,071 1,354 671 771 2,071 2,328 20,160 22,313 -10% 90%

Southern Mono Healthcare DistrictLAIF Investment

6/4/2020

Deposit 5/3/2019 2,100,000Deposit 5/10/2019 2,900,000Deposit 5/17/2019 900,000Deposit 5/24/2019 350,000Deposit 5/31/2019 650,000

Balance as of May 31 2019 53,648,744

Deposit 6/7/2019 4,500,000Deposit 6/14/2019 1,100,000Withdraw 6/21/2019 (900,000)Deposit 6/28/2019 750,000

Balance as of June 30 2019 59,098,744

Withdraw 7/5/2019 (850,000)Deposit 7/12/2019 850,000Interest 7/15/2019 332,401Withdraw 7/19/2019 (500,000)Deposit 7/26/2019 1,300,000

Balance as of July 31 2019 60,231,146

Deposit 8/9/2019 300,000Withdraw 8/16/2019 (650,000)Deposit 8/23/2019 550,000Withdraw 8/30/2019 (600,000)

Balance as of August 31 2019 59,831,146

Deposit 9/6/2019 2,850,000Deposit 9/13/2019 200,000Deposit 9/20/2019 350,000Withdraw 9/27/2019 (650,000)

Balance as of September 30 2019 62,581,146

Z:\BankAccounts\LAIF\LAIF Activity.xlsx

Southern Mono Healthcare DistrictLAIF Investment

6/4/2020

Deposit 10/4/2019 650,000Withdraw 10/9/2019 (250,000)Interest 10/15/2019 373,352Deposit 10/16/2019 150,000Withdraw 10/25/2019 (900,000)

Balance as of October 31 2019 62,604,497

Withdraw 11/8/2019 (600,000)Deposit 11/15/2019 2,995,000

Balance as of November 30 2019 64,999,497

Balance as of December 31 2019 64,999,497

Deposit 1/10/2020 1,800,000Interest 1/15/2020 367,636Withdraw 1/17/2020 (1,000,000)Deposit 1/31/2020 400,000

Balance as of January 31 2020 66,567,134

Deposit 2/7 900,000Deposit 2/13 100,000Depost 2/28 600,000Withdraw 2/17/2020 (200,000)

Balance as of February 29 2020 67,967,134

Withdraw 3/13/2020 (1,500,000)Deposit 3/6 1,000,000Deposit 3/20 100,000Withdraw 3/27 (200,000)

Balance as of March 31 2020 67,367,134

Deposit 4/2 1,500,000Withdraw 4/10 (400,000)Interest 4/15/2020 337,833Deposit 4/16 300,000Deposit 4/27 5,800,000

Balance as of April 30 2020 74,904,966

Balance as of May 31 2020 74,904,966

Z:\BankAccounts\LAIF\LAIF Activity.xlsx


Investments Summary - May 31, 2020

Certificates of Deposit (CDs)

Interest Rate

Purchase Date Maturity Date Broker Cost BasisEstimated Current

Market ValuePercentage

of FundsBenchmarkComparison

Ally Bk Midvale UT 2.05% 11/24/2017 11/24/2020 Union Banc Investment Services 247,000 249,361 0.33%BMW Bk NA Salt Lake 2.05% 11/29/2017 11/30/2020 Union Banc Investment Services 247,000 249,440 0.33%American Exp Fed Svgs Bk 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 249,554 0.33%American Express Centrn 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 249,554 0.33%Capital One Natl Assn VA 2.10% 12/6/2017 12/7/2020 Union Banc Investment Services 247,000 249,554 0.33%Wells Fargo Bank Natl Assn 2.10% 12/8/2017 12/8/2020 Union Banc Investment Services 249,000 251,590 0.33%Sallie Mae Bk Slt Lake City UT 2.10% 12/13/2017 12/14/2020 Union Banc Investment Services 247,000 249,648 0.33%

1,731,000 1,748,701 2.28%

Local Agency Investment Fund (LAIF)Interest

RateBeginning Balance

Activity Ending Balance

1.64% $67,367,134 $7,537,833 $74,904,966 $74,904,966 97.72%

Total Investments $76,635,966 $76,653,667

Note 1: These investments comply with the Districts Statement of Investment Policy and with Government Code §53600.Note 2: The District has the ability to meet all scheduled expenditures for the next 6 months.

For Period Ended: May 31, 2020

Tables and Graphs

DRAFT

FINANCE COMMITTEE DRAFT June 15, 2020

Page 1

VOLUMEInpatient Volume

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0Admissions - All Excluding Nursery

Current Year Prior Year 2 Years Ago Budget

1.5

2.5

3.5

4.5

5.5

6.5

7.5

Average Daily Census - All Excuding Nursery


0

10

20

30

40

50

60

70

Inpatient Surgery Volume


Page 2

Outpatient Volume

50

60

70

80

90

100

110

120

130

140

150

160

Clinic Volume (per day) - All Clinics


0

200

400

600

800

1,000

1,200

1,400

Emergency Department Volume


0

20

40

60

80

100

120

140

Outpatient Surgery Volume


Page 3

REVENUEGross Charges

-

1,000

2,000

3,000

4,000

5,000

Thou

sand

sGross Inpatient Revenue


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Thou

sand

s

Gross Outpatient Revenue


-

100

200

300

400

500

600

700

800

900

1,000

Thou

sand

s

Gross Clinic Revenue


-

500

1,000

1,500

2,000

2,500

3,000

3,500

Thou

sand

s

Gross Professional Fees Revenue


Page 4

Net Revenue

1,000

3,000

5,000

7,000

9,000

11,000

13,000Th

ousand

s

Net Patient Revenue


1,000

4,000

7,000 10,000

13,000

16,000

19,000

22,000

25,000 28,000

31,000

34,000

37,000

Net Revenue per Adjusted Patient Day


FY 2017 FY 2018 FY 2019 May-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20YTD FY

2020

Budget FY

2020

Payer MixMedicare 18.5% 19.6% 22.4% 18.6% 16.1% 23.8% 17.1% 28.8% 31.1% 28.7% 26.0% 20.2%Medi-Cal ** 21.4% 21.6% 21.1% 25.7% 19.8% 12.9% 15.9% 16.4% 23.7% 20.4% 18.4% 20.5%Blue Cross * 22.1% 22.5% 21.5% 22.2% 25.4% 20.3% 21.8% 24.2% 20.1% 22.0% 21.0% 22.5%Commercial * 29.2% 28.3% 28.0% 27.8% 30.0% 36.4% 37.6% 25.0% 22.9% 23.6% 27.8% 29.5%Self Pay ** 2.9% 2.5% 2.2% 0.8% 2.0% 2.2% 1.9% 1.0% 2.2% 2.5% 2.0% 2.7%Other * 5.7% 5.5% 4.7% 4.8% 6.8% 4.5% 5.7% 4.6% -0.1% 2.8% 4.8% 4.6%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Page 5

Revenue Cycle

50%

100%

150%

200%

250%

Cumulative Cash Collections as a % of Net Collectible Revenue


Inc $2.1M in MCL Suppl

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000

Jul

Aug

Sep Oct

Nov

Dec Jan

Feb

Mar

Apr

Ma

y

Jun

YT

D

2019

2018

2017

Th

ou

san

ds

Th

ou

san

ds

Monthly Collections

'Current Year" 'Year to Date" 'YTD Budget"

'Prior Year' 'Two Years Ago" 'Budget'

Incl $2.6M in MCL Suppl

1 7

13 19 25 31 37 43 49 55 61 67 73 79 85 91 97

103

Millions

Cash Balance

Current Year 2 Years Ago Prior Year

50

100

150

200

250

300

350

400

450

500

Cash Days on Hand


Page 6

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0AR Days Outstanding - Gross


35.0

45.0

55.0

65.0

75.0

85.0

95.0

AR Days Outstanding - Net


0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

% A/R > 120 Days

Current Year 'Prior Year' 2 Years Ago Budget

Balance by Major Payer

Payer 1 to 30 31 to 60 61 to 90 91 to 120 121 + Total

Blue cross $1,258,401 $112,051 $574,834 $302,639 $521,000 $2,768,925Commercial $1,309,163 $187,762 $550,792 $694,902 1,458,299 4,200,918Medical $1,316,029 $173,975 $373,075 $304,070 938,873 3,106,021Medicare $1,705,293 $124,038 $22,963 $59,983 182,597 2,094,874Other $406,905 $23,026 $42,076 $239,426 1,390,022 2,101,455Self Pay $241,723 $104,456 $476,688 $654,631 3,082,953 4,560,452 Total $6,237,515 $725,307 $2,040,429 $2,255,651 $7,573,743 $18,832,645

Percent of Dollars Over 120 Days 40.2%

Page 7

ExpensesSalaries, Wages and Benefits

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Thou

sand

s

Salaries, Wages and Benefits


300

500

700

900

1,100

1,300

1,500

Thou

sand

s

Benefits


Page 8

Full Time Equivalents

200.0

220.0

240.0

260.0

280.0

300.0

320.0

340.0

Productive Full Time Equivalents


230.0

250.0

270.0

290.0

310.0

330.0

350.0

370.0

390.0

Paid Full Time Equivalents


-

10.0

20.0

30.0

40.0

50.0

60.0

Productive FTEs per Adjusted Occupied Bed


5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000Labor Cost per Productive Time Equivalent


Page 9

Professional Fees, Services and Contracted Services

500

700

900

1,100

1,300

1,500

1,700

1,900

2,100Th

ousand

s

Professional Fees


-

50

100

150

200

250

Thou

sand

s

Contracted Services


-

200

400

600

800

1,000

1,200

Thou

sand

s

Services


Page 10

Supplies

200

300

400

500

600

700

800

900

1,000

Thou

sand

s

Supply Expense


400

900

1,400

1,900

2,400

2,900

3,400

Supply Expense per Adjusted Patient Day


Page 11

________________________________________________________________________________________________________




Mammoth Hospital Employee Success Sharing Program

Program Details - REVISED 6/3/20

Fiscal Year 2020


Drafted 5/20/19

Mammoth Hospital 2020 Employee Success Sharing Plan

SUMMARY DESCRIPTION AND GOALS The purpose of the Plan is to support the mission and values of the Southern Mono Healthcare District DBA Mammoth Hospital by focusing attention on Quality, Customer Satisfaction, People and Financial Performance. The overriding goal of this Plan is to align employees with business goals and provide them with a better understanding of what contributes to operational excellence. The Employee Success Sharing Plan (Plan) provides lump-sum financial awards to eligible participants. ADMINISTRATION This Plan may be eliminated at any time for any reason or be modified from time to time at the discretion of Senior Management and the Board of Directors. Any disputes that arise out of this Plan should be addressed to the Human Resources Department. Any interpretations of this Plan and decisions made by the Chief Executive Officer or his designee are final. PARTICIPATION AND AWARD ELIGIBILITY For purposes of this Plan, an eligible employee is defined as any employee in all statuses (full time, part time, per diem, seasonal), except for any employees who have other incentive or reward plans in effect. “Hours worked” include regular, overtime, double-time, holiday, education, call productive, jury, major medical, and PTO. In order to participate in the Plan, Mammoth Hospital employees must be hired prior to April 1, 2019 and be an active eligible employee on September 30, the date funds are dispersed. Eligible employees with a total hours worked of 1,580 or above, during the plan year, will be eligible to receive 100% of the award amount. Eligible employees with a total hours worked between 1,185 – 1,579, during the plan year, will be eligible to receive 75% of the award amount. Eligible employees with total hours worked between 790 -1,184, during the plan year, will be eligible to receive 50% of the award amount. Eligible employees with total hours worked between 395 – 789, during the plan year, will be eligible to receive 25% of the award amounts.

Drafted 5/20/19

PAYOUT GUIDELINES Payout Guidelines: Net Gain is the key indicator and trigger for all of the objectives. In order to receive 100% of the award, Mammoth Hospital must meet or exceed 7% total margin. If the budgeted net gain of 7% is not attained, but a total margin attained is 5% or higher (but less than 7%) the maximum award will be reduced to 75% . If the total margin attained is 3% or higher (but less than 5%) the maximum award will be reduced to 50% . If the total margin attained is 1% or higher (but less than 3%) the maximum award will be reduced to 25%. The Total Margin is defined as the percentage of the Net Gain divided by the Total Operating Revenue. Net Gain is defined as the excess of Total Revenue less Expenses plus Non-Operating Income on the District’s Profit and Loss Statement. AWARD DETERMINATION Award determination is based on key objectives. Each objective is tied to measures deemed significant in evaluating company performance and results. Each measure and goal will be determined by Mammoth Hospital Administration and the Board of Directors. Provided that the Net Gain goal is met, each of the objectives will be measured separately by entity for goal achievement allowing each eligible employee the potential to earn a maximum award as set forth in the matrix. Refer to the Plan Matrix for detailed measures, goals and award amount. Each eligible employee can only fall under one entity and their award will be based on that entities measures and goals. If, during the Plan year, an eligible employee changes positions and moves under another entity, the measures and goals of the latest entity, at the end of the Plan year, will apply. Employees with alternate positions will fall under the entity of their level one (home) position. NOTE: For the plan year of 2020, Mammoth Hospital Net Gain budget will be the key indicator and trigger for all of the above stated objectives. Implementation Plan Year Start Date 1 July Plan Year End Date 30 June Pay Out Frequency Annual Pay Out Period September 30 following end of Plan year Form of Pay Out Cash Lump Sum – will be subject to required payroll deductions and withholdings.

Drafted 5/20/19

2020 Employee Success Sharing Matrix Mammoth Hospital

Payout Guidelines: The award amount for the Customer Service & Employee Engagement measure below will be reduced if the Net Gain is not achieved (see Payout Guidelines above). Each objective will be measured separately and paid

out as specified, provided that the goals are achieved.

Objective 2020 Goal Award

Amount

Cu

sto

me

r Sa

tisf

acti

on

Patient Satisfaction Survey Results

Combined weighted average score of HCAHPS (18%) & Press Ganey(82%), surveys

(estimated FY19 result was 93.1%)

Outstanding: Score of 93.0% or better $500$600

Target Plus: Score of 91.5% or better $400$450

Target: Score of 90.0% or better $275$300

Emp

loye

e S

urv

ey

Par

tici

pat

ion

Participation in annual employee engagement/satisfaction survey (excluding staff who are per diem or employees on extended leave of absence during the survey period): DO

TO COVID19 = BETA CANCELLED ALL EMPLOYEE SURVEY’S FOR THE YEAR – THUS THIS CANNOT BE IMPLEMENTED

Outstanding: 80% or greater participation $200

Target Plus: 75% or greater but less than 80% participation $100

Target: 70% or greater but less than 75% participation $50

Fin

anci

al

Pe

rfo

rman

ce

Total Margin

Outstanding: Total Margin is 7% or higher $500$600

Target Plus: Total Margin is at least 5% $400$450

Target: Total Margin is at least 3% $275$300

Total maximum award amount will be $1,200 if the Outstanding goal is achieved for each objective.

Drafted 5/20/19

2020 Supervisor, Manager, Director & Senior Administrators Success Sharing Matrix

Mammoth Hospital

Supervisors have the opportunity to earn up to $1,700. Each of these individuals has goals specified in a Balanced Score Card.

Managers, Directors and Senior Administrators have the opportunity to earn up to an additional 3% of their base annual salary for Success Sharing. Each of these individuals has goals specified in a Balanced Score Card. All goals are approved by the Senior Administrators on or before August 31, 2019. As with the general employees, the maximum award is contingent on the District meeting a Total Margin of 7% or more for fiscal year 2019. If the total margin percentage is 5% or higher, the managers would be eligible for a maximum of 2.25% (3% x 75%), if 3% or higher the maximum is 1.5% (3% x 50%), if 1% or higher the maximum is .75% (3% x 25%).


________________________________________________________________________________________________________




DATE: June 18, 2020 TO: Board of Directors FROM: Melanie Van Winkle, CFO RE: Earthquake Insurance

Our general insurance broker, Miki Fujji of Alliant Insurances Services Inc., provided us with quotes on earthquake coverage for the District properties (see the email on page 2). The District has never had earthquake coverage due to the limitations on the coverage and the very high cost. Below are some estimates of costs and coverage limitations. The best coverage will only allow for $25 million cost reimbursement and would cost ~$182 thousand per year, which is in addition to the ~$95 thousand per year we currently pay for property insurance coverage (see the list of current policies and costs on page 3). We are currently very fortunate to have cash reserves to cover the cost of relatively small damage caused by an earthquake. But if we had a large earthquake it is likely the maximum coverage of $25 million would not be enough to repair or replace our hospital. The replacement cost of the District properties may be well in excess of $100 million. In the unthinkable event of such large earthquake the entire Town of Mammoth Lakes infrastructure would be compromised, and it is unknown if repairing/replacing the hospital would be needed/wanted. Therefore, management does not recommend we obtain earthquake insurance for the District properties. However, we would like the Board to consider this recommendation and either ratify or provide additional direction regarding earthquake insurance. Board Motion suggestions: Option 1: Motion to agree with Managements recommendation to not obtain earthquake insurance for the District properties due to the high cost and coverage limitations. Option 2: Motion to further pursue earthquake insurance coverage at the $_______ coverage limitation level not to exceed a cost of $_____________

Board of Directors Earthquake Insurance June 18, 2020

From: Miki Fujii <[email protected]> Sent: Thursday, February 6, 2020 12:23 PM To: Tabby Mannetter <[email protected]>; Melanie Van Winkle <[email protected]> Cc: Chris Tobin <[email protected]> Subject: RE: Southern Mono - Renewal Meeting I wanted to get you the Earthquake indications we received over to you so that you can show your board. If interested, please let us know and we will send over Bindable quotes. Perils: Earthquake Only Covering: Buildings, Contents and BI/Rents Total Insured Value: $99,328,627 Option #1 – 5% per unit, $100,000 per occurrence Limit: $5,000,000 Per occurrence and in the annual aggregate Estimated Annual Premium: $72,500 before T&F Option #2 – 5% per unit, $100,000 per occurrence Limit: $10,000,000 Per occurrence and in the annual aggregate Estimated Annual Premium: $122,250 plus additional taxes and fees Option #3 – 10% per unit, $100,000 per occurrence Limit: $25,000,000 Per occurrence and in the annual aggregate Estimated Annual Premium: $181,750 plus additional taxes and fees Please take a moment to review and feel free to reach out with any questions. Thank you! Miki Fujii Account Manager Public Entity Group Alliant Insurance Services, Inc.

mailto:[email protected]




https://protect-us.mimecast.com/s/1m7xCZ6rE7HDnNLUKIpED?domain=media.alliantinsurance.com

Board of Directors Earthquake Insurance June 18, 2020

Mammoth Hospital

Insurance Summary 2019/2020

Name of Payee

Name of

Underwriter Type of Insurance

FY20 Annual

Amount

Beta Auto Liability & Physical Damage 16,926.00$

Beta D&O & Trustee Liability 87,044.00$

Beta HC Comprehensive Liability 451,453.03$

Beta Workers Comp - BETArma 669,060.00$

Alliant All Risk Property - HARPP 94,713.76$

Alliant Excess Boiler & Machinery 1,054.00$

Alliant Euclid Vanguard Fiduciary Liability - 457/403(b) Plans 3,376.00$

Alliant CHUBB Underground Storage Tank 695.00$

Alliant ACE American HELP Pollution Liability 6,310.68$

Alliant Crime Ins Program ACIP 2,233.00$

108,382.44$

Total 1,332,865$

Manual Name Document Name/Policy Revision # Approved On

Compliance Reporting of Identified Potential Compliance Violations 6 1/2/2020

Human Resources Employee Referral Program Policy 7 1/2/2020

Maintenance Housing Policy 7 1/2/2020

Human Resources Kin Care Leave Policy 7 1/2/2020

Human Resources Retention Bonus Policy 6 1/2/2020

Human Resources Travel Reimbursement and Compensation Policy 6 1/2/2020

BioMed New Medical Device Acquisition 5 1/2/2020

Clinics Governing Body 5 1/2/2020

Quality Quality Committee - Board of Directors 4 1/2/2020

Case Management Care of the Dying Patient 6 1/5/2020

Case Management Coordination of Care 6 1/5/2020

Med Surg / telemetry Discharge of Mammoth Hospital Patients 7 1/5/2020

Med Surg / telemetry Education of Patient and Family 7 1/5/2020

Case Management Hourly Observation Patients 6 1/5/2020

Respiratory Therapy Medical Director Job Description 6 1/5/2020

Pharmacy Anticoagulation Therapy 7 1/5/2020

Med Surg / telemetry MedicalSurgical and ICU Staffing 7 1/5/2020

Perioperative Tissue Adverse Event 6 1/5/2020

Pharmacy Sample Medications 5 1/5/2020

Pharmacy Pharmacy Department - Emergency Management 5 1/5/2020

Infection Prevention Nasal Decolonization - Nozin 5 1/5/2020

Pharmacy 340B Program Policy and Procedure 1 1/5/2020

Emergency Department Change of shift for Emergency Department Physicians 7 1/24/2020

Emergency Department Emergency Physician Clinical Responsibilities 7 1/24/2020

ICU Non-Procedural Continuous Sedation Infusion Medications 3 1/24/2020

Case Management Case Management Program 6 1/28/2020

Compliance Compliance Standards of Conduct 6 1/28/2020

Laboratory Blood Products Administration 6 1/28/2020

Hospital Wide Nursing Policies Nursing Licensure and Certifications 7 1/28/2020

Maintenance Hazardous Materials and Waste Management Plan 7 1/28/2020

Medical Imaging Reducing Radiation Exposure in the Perioperative Setting 7 1/28/2020

PACU Assesment Prior to Induction of Anesthesia 7 1/28/2020

Central Supply Cleaning and Care of Surgical Instruments 6 1/28/2020

Central Supply Event Related Shelf Life and Sterile Packaging 6 1/28/2020

Central Supply Ortho-phthalaldehyde (OPA) Precautions 6 1/28/2020

PACU Post Anesthesia Care of the Patient with Spinal Anesthesia 8 1/28/2020

Perinatal N001 Neonatal Death, Fetal Demise, and Spontaneous Abortion Procedure 7 1/28/2020

Physical Therapy Emergency Management in Rehabilitation Department 6 1/28/2020

Administration SMHD Conflict of Interest Code 6 1/28/2020

Central Supply Receiving Sterile Supplies brought in by Vendors to the PeriOperative Area 5 1/28/2020

PACU Outpatient procedures at Mammoth Hospital 8 1/28/2020

Central Supply Management of Positive Biological Indicators in Steam Sterilization 5 1/28/2020

Central Supply Sterilizer Record 5 1/28/2020

Central Supply Cleaning of Endoscopic Instruments 5 1/28/2020

Interpreter Services Language Access for Limited English Proficient (LEP) 6 1/28/2020

IT Encryption of Tape and Drive Backups 5 1/28/2020

Infection Prevention Clostridium Difficile Screening and Care of Patients 6 1/28/2020

IT Physical and Technical Audits 5 1/28/2020

Security Physical Security of Patient Health Information 5 1/28/2020

Quality Policy Review and Approval Process 5 1/28/2020

Infection Prevention Ortho-phthalaldehyde (OPA) Use and Monitoring for Endoscopes and Ultrasound Probes 4 1/28/2020

Hospital Wide Nursing Policies Patient Visitors 4 1/28/2020

Case Management Safe Surrender of Newborn 4 1/28/2020

Infection Prevention Cleaning and Sanitizing of Water Cooler Dispensers 4 1/28/2020

Infection Prevention Corrugated Boxes in the Patient Care Area 2 1/28/2020

Laboratory Analytical - Specimen Rejection 4 1/29/2020

Admitting Laboratory Registration 7 1/30/2020

Admitting Important Message from Medicare 7 1/30/2020

Admitting Patient Registration - All Patient Types 8 1/30/2020

Interpreter Services Translation of Written Document 6 2/16/2020

Purchasing Materials Management - Emergency Management 6 2/16/2020

Employee Health Work Restrictions for Personnel with Infectious Diseases 7 2/16/2020

Clinics Scope of Services-Orthopedic Clinic 7 2/16/2020

Quality ISO 9001 Corrective and Preventative Action 6 2/16/2020

Clinics Scope of Practice-General Surgery 4 2/16/2020

Clinics Scope of Practice-Women's Health 5 2/16/2020

Quality Policy Advisory Council Charter 6 2/16/2020

Human Resources Education Reimbursement 6 2/16/2020

Human Resources Alternative Work Schedules 4 2/16/2020

Medical Imaging Radiology Access of Patient Protected Health Information 2 2/16/2020

HIPAA Investigation of Potential HIPAA and CMIA Violations 2 2/16/2020

Human Resources Email Signature 2 2/16/2020

Behavioral Health Behavioral Health Scope of Service 1 2/16/2020

Contract # Vendor NameContract Start

Date

Contract

Termination DateAgreement Type

Evergreen

Agreement

Contract Owner

Primary

Contract Owner

SecondaryContract Tags

8400.686000-

ContractManager-

Vendormate

Vendormate 03/26/2014 03/25/2022 Subscription Yes Andrew Crosby Melanie VanWinkle

CONTRACT

MANAGEMENT

SOFTWARE

8610-

AmericanBusiness

Machines-

Canon Financial

Services, Inc.04/23/2015 10/01/2021

Equipment Lease

AgreementNo Andrew Crosby Melanie VanWinkle

COPIER

LEASE/MAINT

AGREEMENT

7710-

CardinalPharmacy

DistributionAgreem

Cardinal Health 02/10/2016 02/09/2021Contract

AgreementYes

Andrew

KhodaverdianKathleen Alo Pricing Agreement

7710-

McKesson340B

Pricing Agreement-

McKesson

McKesson

Corporation02/10/2016 01/01/2020

Contract

AgreementNo

Andrew

KhodaverdianKathleen Alo

MCKESSON

PHARM 340B/PHS

77100086-

CostControlSolutio

ns-CCS

Cost Control

Solutions, LLC03/10/2018 01/10/2022

Dues and

SubscriptionsNo

Andrew

KhodaverdianKathleen Alo Annual License

7710-

Safeway340BDirect

PricingAgreement-

Safeway Inc. 04/21/2016 04/20/2021 Subscription YesAndrew

KhodaverdianKathleen Alo

340B Pricing

Agreement

74200076-

LithotripsyService-

PacificLithoDesert,

LLC

Pacific Litho 02/11/2016 02/10/2020Equipment Lease

AgreementYes Cammy Staker Kathleen Alo

Lithotripsy Rental

Equip and Service

74700034-

NovaSureDisposab

lesContract-Hologic

Hologic Inc. 02/20/2008 01/01/2022 Disposables No Cammy Staker Kathleen AloOR Disposables

Contract

7420-669000-

JointPoint

Navigation System-

Joint Point

JointPoint, Inc. 03/15/2019 03/14/2020Software License

AgreementYes Cammy Staker Kathleen Alo

Pricing Contract -

Hip Alignment

system

74200069-

MedivatorsSrvcAgr

mt2014-Medivators

Medivators Inc. 03/20/2015 03/19/2020 Service and Maint. No Cammy Staker Kathleen Alo

EQUIPMENT

SERVICE

AGREEMENT

74200050-

BairHuggerWarmin

gUnitsx3-

ArizantHealthcare

ARIZANT

HEALTHCARE

INC. AUGUSTINE

MEDICAL INC.

03/01/2006 01/01/2025 Disposables Yes Cammy Staker Kathleen AloPatient Warming

systems

8530-insurance

payer-Great-WestGreat-West 02/01/2004 01/01/2025

Contract

AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer

8530-insurance

payer-Multi-Plan

PHCS-GEHA

Multi-Plan PHCS-

GEHA02/01/2004 01/01/2025

Contract


8530-insurance

payer-TriWestTriWest 02/01/2013 01/01/2025

Contract


8530-Insurance

Payer- California

Health and

Wellness

California Health

and Wellness03/15/2019 03/14/2021

Contract


85300069-

IntellisoftSoftwareS

olution-

IntellisoftGroup

IntelliSoft Group

LLC03/29/2016 03/28/2020

Software License

AgreementYes Dawn Van Winkle

Credentialing and

Consulting

Services

Agreement

8530-insurance

payer-Global ExcelGlobal Excel 03/20/2006 01/01/2025

Contract


85300086-

PaymentSafeAgree

ment

Experian Health,

Inc04/22/2013 01/01/2025

Dues and

SubscriptionsYes Dawn Van Winkle Melanie VanWinkle Annual License

8530-insurance

payer-MedCare

International

MedCare

International04/07/2004 01/01/2025

Contract


8530-insurance

payer1994-Medi-

Cal

Medi-Cal 04/07/2004 01/01/2025Contract


7500669000-

VenipunctureExtern

ship-Wagner

Training Institute

Wagner Training

Institute, Inc.03/07/2017 03/06/2022

Contract

AgreementNo Jaime Sallee Kathleen Alo

Vendipuncture

Training

75000069-

EPEvaluatorplusCa

pture-

DataInnovations

Data Innovations

LLC04/23/2020 04/22/2021 IT Licensing No Jaime Sallee Kathleen Alo

Single User

Network License


Date

Contract


Evergreen

Agreement

Contract Owner

Primary

Contract Owner


87000069-

CodeFinderSoftwar

eSupport-

3M Health

Information

Systems, Inc

02/10/2018 02/10/2023

Software

Maintenance

Agreement

Yes Jane Grossblatt Melanie VanWinkle Coding Services

71400075-Lease-

RJGInvestments-

UnitB-08-04-2014

RJG Investments,

LLC02/01/2015 01/01/2025 Lease Yes John Chisum Mark Lind building lease

77720075-Lease-

RJGInvestments-

UnitA-08-04-2014

RJG Investments,

LLC02/01/2015 01/01/2025 Lease Yes John Chisum Mark Lind building lease

8450-669000-

Bishop Clinic Air

Handler Service-

Dean's Plumbing &

Heating, INC02/10/2020 02/09/2021 Service and Maint. No John Chisum Mark Lind

Service and

Maintenance

Agreement

84500069-

MediwasteSrvcAgr

eement-Mediwaste

MediWaste

Disposal, LLC02/11/2015 01/01/2025

Contract

AgreementYes John Chisum Mark Lind

Biomedical Waste

Service

8450675000RGJIn

vestmentsBishopOr

thoStorageUnit#5-

RJG Investments,

LLC02/01/2018 01/31/2020 Lease Yes John Chisum Mark Lind Storage Unit Lease

84200050-

MSDSOnlineLicens

e-MSDSOnline

HU-FRIEDY MFG

CO LLC03/12/2012 01/01/2019

Dues and

SubscriptionsNo John Chisum Mark Lind

MSDS Online

Service

84500069-

UndergroundStorag

eTankTesting-

Rich Environmental 04/02/2012 01/01/2021Contract

AgreementNo John Chisum Mark Lind

Underground Tank

Testing

90108320-

128TavernStorage-

NorthlandPropertie

Northland

Properties04/01/2014 12/01/2020 Rental Agreement No John Chisum Mark Lind

Storage building

rental

7680-669000-Post

Processing of

Images-3DR Labs

II, INC

3DR Labs II, LLC 02/11/2019 02/11/2021 IT Agreement Yes Kevin Larsen Mark Lind

Post Processing of

Radiological

Images

7630-669000-

Physicist Testing-

JTC Medical

JTC Medical

Physics03/12/2019 03/11/2021

Professional

ServicesYes Kevin Larsen

Annual Physicist

Services for

Radiology

76300069-

PhilipsiSitePacs3yr-

PhilipsHealthcare

philips Healthcare

informatics04/01/2017 03/31/2024

Contract

AgreementNo Kevin Larsen Kathleen Alo PACS Fee Studies

7635-669000-

SecureView-CAD

Maintenance -

Hologic

Hologic Inc. 04/01/2019 03/31/2022Equipment Lease

AgreementNo Kevin Larsen Mark Lind

SecureView/CAD

Maintenance

8750-

DataSharePatientS

afety-CHPSO

CHPSO-California

Hospital Patient

Safety Organization

02/02/2013 01/01/2025Contract

AgreementYes Lenna Monte Kathleen Alo

Patient Safety

Organization

8720-6860000-

Interqual contract -

Change

CHANGE

HEALTHCARE

TECHNOLOGIES

03/09/2020 03/08/2025Dues and

SubscriptionsYes Lenna Monte Kathleen Alo

Billing Services and

licence fees

87500086-

QualityAssuranceC

redentialingReview-

CCAHN

CCAHN-CA Critical

Access Hospital

Network

04/01/2012 01/01/2025Contract

AgreementYes Lenna Monte Kathleen Alo

Peer

Review,Quality

assurance

services,credentiali7010-

DonorAgreement-

Donor Network

West

Donor Network

West04/29/2011 01/01/2025

Affiliation

AgreementYes Lori Baitx Kathleen Alo Donor Services

7770-

PhysicalTherapyCli

nicalEducation-

UniversityofVermon

t

University of

Vermont07/12/2019 07/12/2024

Affiliation

AgreementNo Lorraine Koenig

Clinical Nursing

Services

7770-

PhysicalTherapyEd

ucation-Regis

University

Regis University 04/03/2019 04/03/2021Professional

ServicesNo Lorraine Koenig Craig Burrows

Physical Therapy

Clinical Education

84300069-

AlertsTrackerInterfa

ce-ECRI

ECRI Institute 01/01/2020 12/31/2020 Membership No Mark Lind

Recall tracking

software

agreement

84800069-

FortiNetSupport-

MitigateSolutionsIn

c.

Fortinet, Inc. 02/21/2020 02/20/2021Professional

ServicesNo Mark Lind

Firewall Network

Security

SOW,Support

Agreement -

84800083-Crystal

EnterpriseSupport-

SAPAmerica

SAP AMERICA INC 02/10/2019 02/09/2020 IT Agreement No Mark LindCrystal Enterprise

Support Agreement

8450-

CountyMcFlexLicen

se-MonoCounty

Mono County 08/25/2019 08/25/2022Contract

AgreementNo Mark Lind

License for McFlex

Boundary Use

8490-Digital395-

CBC

California

Broadband

Cooperative

04/30/2019 08/30/2019Contract

AgreementYes Mark Lind

ELAN Connection-

Mammoth to

Bishop Clinics


Date

Contract


Evergreen

Agreement

Contract Owner

Primary

Contract Owner


84800069-

VMWareSupport-

Insight

Insight Enterprises

Inc04/21/2019 04/20/2021 IT Agreement No Mark Lind

Server

Virtualization

Software Support

8481-669000-

Cerner Community

Works System

Main Agreement

CERNER

CORPORATION04/01/2016 04/01/2023 IT Agreement Yes Mark Lind

Hospital wide EMR

Software

8481.669000-ECG

Machine Integration

with Cerner

CERNER

CORPORATION04/04/2019 04/03/2022 IT Licensing Yes Mark Lind

ECG Machine

Integration with The

Cerner

84810069-Cerner

Community Works-

Cerner Corp

Cerner Corp 04/21/2016 04/20/2023Software License

AgreementYes Mark Lind EMR Software

8610-7520-

physician contract-

LocumsPathology

03/01/2019 01/01/2025 Physician Contract Yes Melanie VanWinkle Tabby Mannetter

7160-Surgical

Outcomes System

Agreement

Arthrex 03/31/2015 03/30/2020Professional

ServicesYes Michael McMahon

Surgical Outcomes

software

8650-

LincolnFinancial20

15

Lincoln Financial

Advisors02/01/2015 01/01/2023

Consulting

AgreementYes Sarah Vigilante

Financial Planning

Services

8610-EMT-Cerro

Coso EMT contract-

KernCommunityCol

lege

Kern Community

College03/04/2019 05/31/2024

Contract

AgreementNo Sarah Vigilante Kathleen Alo

CLINICAL

EDUCATION

AGREEMENT

8650-

VolunteerPolicy

Life Insurance

Company of North

America

03/01/2019 02/28/2020Dues and

SubscriptionsNo Sarah Vigilante Insurance Policy

86500069-

DonorManagement-

BlackBaud

Blackbaud, Inc. 04/10/2018 04/09/2021 Subscription No Sarah Vigilante

Donor

Management and

Affluence

Screening8750-Transfers-

Children's Hospital

Central CA

Transfer

Children's Hospital

Central California04/28/2012 01/01/2025

Transfer

AgreementsYes Stephanie Stanton Kathleen Alo

Transfer

Agreement

86101-1-1985 LAIF

Deposit of moneys

Bank of America

National Trust and

Savings Assoc

04/07/2014 01/01/2023Professional

ServicesNo Tabby Mannetter

Financial Savings

Account

70900069-

NurseTriageServic

es-TriageLogic-LLC

Triage Logic, LLC 03/15/2017 03/31/2020Professional

ServicesYes Tashina Butts Craig Burrows

After Hours Nursing

Triage Phone

Service

Date Purchased Item Description Value Reason for Disposal

4/10/2002 Stryker Cordless Drill w/ Access $0.00 Obsolete

11/25/2003 Stryker Power Driver System $0.00 Obsolete

11/8/2010 Stryker Power Driver System $0.00 Obsolete

3/22/2016 StrykerSystem Power 6 Instrument System $0.00 Obsolete

Motion: “I move that the board finds the surplus property as listed to have nominal or no value and is to be

disposed of in a reasonable and appropriate manner as determined by staff.”

Items below consist of Styker System 5 and Stryker System 6

Documents

SOUTHERN MONO HEALTHCARE DISTRICT JUNE 2020 … · 2020-06-17 · Southern Mono Healthcare District Board of Directors Meeting Agenda June 18, 2020 Initial Appointment to Provisional