MEETING MINUTES. Members Present

Transcription

1 District Hospital Leadership Forum 2012 Board of Directors Wednesday, October 17, :00 a.m. 2:30 p.m K Street 14 th Floor (at the California Chamber, California Room) Sacramento, CA MEETING MINUTES Members Present Alameda Hospital: Debi Stebbins, CEO Doctors Medical Center San Pablo: James Boatman, CFO El Camino Hospital: Michael King, CFO El Centro Regional Medical Center: David Green, CEO & Alex Wells, CFO Hi-Desert Memorial Healthcare District: Lionel Chadwick, CEO Secretary John C. Fremont Healthcare District: David Hill, CEO Kaweah Delta Health Care District: Lindsay K. Mann, CEO President Lompoc Valley Medical Center: Jim Raggio, CEO Treasurer Marin General Hospital System: Richard Reid, VP & Controller Mountains Community Hospital: Charles Harrison, CEO Palomar-Pomerado Health: Bob Hemker, CFO/Michael Covert, CEO Pioneers Memorial Healthcare District: Daniel Smith, CFO Salinas Valley Memorial Hospital: Jennifer Stone, Vice President San Gorgonio Memorial Hospital: Mark Turner, CEO Sierra View District Hospital: Michael McGinnis, CFO Tahoe Forest Hospital: Robert Schapper, CEO Tri-City Medical Center: Larry Anderson, CEO Vice President Tulare District Healthcare System: Doug Dickson, CFO Washington Hospital: Christopher Henry, CFO Members by Teleconference Antelope Valley Hospital: Cheryl Tong, CFO Coalinga Regional Medical Center: Sharon Spurgeon, CEO Corcoran District Hospital: Jonathan Brenn, CEO Hazel Hawkins Hospital: Ken Underwood, CEO Kaweah Delta Health Care District: Gary Herbst, CFO Lompoc Valley Medical Center: Bob Baden, CFO Oak Valley District Hospital: John McCormick, CEO Palo Verde Hospital: Peter Klune, CEO Tri-City Medical Center: Alex Yu, CFO Staff Present Stephen Clark, Director David Vance, Director Sherreta Lane, VP, Finance Policy and Economic Analysis Steve Clark & Associates Gary Ray, Legal Counsel Ottone Leach Olsen & Ray LLP Kathryn Scott, Legislative Advocate Meghan Loper, Legislative Advocate

2 District Hospital Leadership Forum Board Meeting October 17, 2012 Page 2 Capitol Strategies Group Dave McGhee, CEO Tom Petersen, Executive Director ACHD Speakers and Guests Duane Dauner, President California Hospital Association William Abalona, Partner Foley & Lardner LLP Peggy Wheeler, VP Rural Health and Governance California Hospital Association A. CALL TO ORDER & INTRODUCTIONS Lindsay Mann called the meeting to order at 10 a.m. and those present and participating via phone introduced themselves. B. EXECUTIVE SESSION Forum Dues & Budget: Jim Raggio discussed changes in the dues structure and proposed budget for 2013 (effective January 1, 2013). It was noted that under the new dues structure as more members participate the level of dues for individual hospitals is lessened. Members inquired as to some clarifications with some of the budget items. Steve Clark also raised the idea of having a policy that members pay dues annually, then allowing for deviations if any hospitals made special requests for which payments could then apportioned over the course of the year. ACTION by MOTION: Larry Anderson motioned for approval of the 2013 Dues Structure and Budget and annual payment plan. The motion was seconded by Debi Stebbins. All were in favor. Bylaws Revisions: Gary Ray next discussed changes approved by the Executive Committee to the Bylaws. Four changes are being proposed; 1. Adding a third class of non-voting associate members 2. Modifying the terms of the current directors serving 2 year terms of office by changing their terms to 3 years effective with approval of the slate of Board of Directors 3. Changing the Executive Committee structure to six members by adding a critical access hospital to the Executive Committee 4. Approving the formation of an ad hoc nominating committee to prepare a slate of director and officer candidates for Board consideration. ACTION by MOTION: Chad Chadwick motioned for approval of the Bylaws changes. The motion was seconded by Michael King. All were in favor.

3 District Hospital Leadership Forum Board Meeting October 17, 2012 Page 3 Additional Policies: Mr. Ray spoke of the need to add additional policies that came about when completing the IRS 990 Form. Mr. Ray created, with board member assistance, three policies for approval which are a conflict of interest policy, whistleblower policy, and records retention policy. ACTION by MOTION: Mr. Anderson motioned for approval of the additional three policies. The motion was seconded by Mr. Raggio. All were in favor. C. CHA REPORT Duane Dauner, President of CHA provided an update on several issues related to the upcoming elections. He also spoke on other matters related to the Forum both at the State and Federal level. One of particular concern is to explore how the Forum can continue protect their current funding levels from future reductions as the State continues to address its financial crisis. Mr. Dauner discussed an initiative effort, involving a further extension of the provider fee that could be a mechanism for the District hospitals to address protection of current funding. This will be further explored between Forum staff and CHA. D. DHLF BUSINESS Approval of Board Meeting Minutes: Minutes related to both the August 7, 2012 and August 28, 2012 Board Meetings were distributed and reviewed by members. ACTION by MOTION: Mr. Raggio motioned for approval of both Board Meeting minutes. The motion was seconded by Mr. Anderson. All were in favor. DHLF Financial Report: Mr. Raggio discussed the financial report distributed to all members of the Board. ACTION by MOTION: Mr. Raggio moved for a motion to approve the financial report and Mr. Anderson seconded the motion. All were in favor Board Meeting Schedule: Both Mr. Clark and Ms. Lane explained the rationale behind the dates and frequency of the 2013 proposed Board Meetings. Members provided input and it was determined that some of the dates needed to be changed. Staff was directed to develop a new meeting schedule for 2013 to present to the Executive Committee for approval. In addition, Mr. Ray made mention that the Bylaws require members meet in the first month of each year. The members felt that language should be amended to read the first quarter in each year. ACTION by MOTION: Mr. Chadwick moved for a motion to approve the change in the Bylaws and Mr. Raggio seconded the motion. All were in favor. Website Update: David Vance provided a brief update regarding the progress and upcoming completion of the District Hospital Leadership Forum website.

4 District Hospital Leadership Forum Board Meeting October 17, 2012 Page 4 E. EXECUTIVE COMMITTEE REPORT Board Meeting Call-in Option: Mr. Clark discussed the need for all members to actively participate and attend Board Meetings in person whenever possible. He added that the schedule of annual in-person Board Meetings was being reduced from four to three to allow for and encourage greater in-person attendance. NDPH Hospital Engagement: Ms. Lane gave a brief update on hospital involvement related to both the DSRIP plans and other programs. There is concern that some hospitals will be left out of supplemental program funding opportunities due to their non-responsiveness to various requests from DHLF staff. Robert Schapper provided some suggestions related to helping CAH hospitals comply. Mr. Raggio also reminded the Forum on the roles of Forum assistance versus consulting assistance, and encouraged those that needed additional help in order to ensure their adequate participation in these funding pools to seek such outside assistance. Benefits of Membership: Mr. Mann reiterated the need for membership and recognized the addition of El Centro and other new members in attendance. Mr. Clark added that current membership has increased to 33 hospitals. Non-Voting Associate Membership: Mr. Anderson and Mr. Raggio discussed changes in terminology regarding the associate membership that earlier was added to the bylaws allowing for affiliates that are non-hospital members to pay dues and participate with the Forum in some fashion. Pros and cons were outlined and much discussion was held on this topic. Although the bylaws were modified to include the Associate membership option, the Board requested that the Executive Committee re-evaluate the revision related to the non-voting associate members to ensure that all possible implications of such an action are well thought out, determine how this change would be implemented and if it should be reconsidered Board/Executive Committee Composition/Structure, Bylaw Changes and Nomination Slates: These items were already discussed and acted upon under the Executive Session of this meeting. The nominating committee comprised of Jim Raggio and Michael Covert from the Executive Committee will present for approval the slate of Directors and slate of Officers at the annual meeting in the first quarter of F RECAP/UPDATE Preparing for Healthcare Reform: Bill Abalona delivered a brief report to the board regarding two current cases pending before the United States Supreme Court which may have implications for the future activities of the Forum. First, he recited several aspect of an amicus curiae brief filed by the American Hospital Association in a case where the federal Department of Justice and the Federal Trade commission are trying to stop a proposed hospital merger. The case is not directly significant to the hospitals in the Forum, but the brief filed by the AHA outlines the problems facing hospitals which are driving them all across the country to merge and consolidate operations to become more efficient and have better access to capital. These factors are largely related to health care reform s impact upon hospitals, and include: Medicare payment reduction of more than $150 billion over ten years; vastly

5 District Hospital Leadership Forum Board Meeting October 17, 2012 Page 5 expanding patients covered by Medicaid (and thus underpaid); capital needs associated with IT and EHR meaningful use ; volume based purchasing; and others. Although district hospitals are likely precluded from traditional merger/acquisition consolidations, a case now before the Supreme Court may allow districts to enjoy some features of consolidation without implicating antitrust laws heretofore considered applicable. The case, FTC v. Phoebe Putney Health System, is a Georgia case where state law allows health authorities to be formed and operate hospitals in a manner similar to California s district hospital law. The principal issue before the Court is whether the state action doctrine allows public entities which operate hospitals to be exempt from federal antitrust laws where it can be demonstrated that the activity in which they engage was reasonably contemplated by the enabling legislation. This is much broader than the traditional interpretation of the state action doctrine applied by enforcement agencies. If the Court takes the broader interpretation of the state action doctrine, it may open up new possibilities for combined activity by district hospitals. It was suggested that the Forum should follow the case carefully, and revisit the issue after a decision has been issued Progress Report on State Budget Action: Ms. Lane provided an update on the DSRIP plans and reminded everyone of the required timeline for completion. She also spoke about the current work taking place in moving toward the reimbursement goals set out by the Forum Board for each of the three new payment system funding years. While the Department was originally receptive and amenable to making the new funding work for District hospitals, recent action by DHCS staff has not been consistent with that commitment. As a result Forum staff is concerned goals and approaches as outlined by the Board will be difficult, if not impossible to achieve. Forum staff will be meeting with DHCS following the Board meeting and will once again reiterate the DHLF goals and approaches for achieving these goals. The Board suggested that DHCS be reminded of the commitment made by Secretary Diana Dooley to the DHLF that this new program was a State and District hospital partnership and that DHCS would work closely with the DHLF to make this new funding mechanism work successfully to meet such goals. The Board indicated that if the Department was not receptive then alternative action would be considered. Provider Fee Distributions: Ms. Lane provided a quick update as to the timing of Provider Fee Grant distributions that currently are taking place and will continue over until December 31, Session/Upcoming Election: Both Kathryn Scott and Meghan Loper provided material on propositions and other 2012 bills affecting District hospitals. They reviewed the legislative accomplishments of 2012, notably the chaptering of SB 1081 (Fuller) relating to the Low-Income Health Program (LIHP). ACHD Update: Dave McGee and Tom Peterson provided an update on several important issues on which ACHD focused during the 2012 legislative session (relating to healthcare districts without hospitals and the revenues received and healthcare district staff salaries). It is likely these themes will continue in 2013 requiring both ACHD and DHLF attention. G. GOALS AND OBJECTIVES/LEGISLATIVE ACTION Implementation of DSRIP and CPEs for Medi-Cal and Uncompensated Care Next Steps: Ms. Lane spoke again of the goal to achieve the Forum s overall funding objective initiated as a result of the State Budget changes to Medi-Cal inpatient acute care payments to non-designated public

6 District Hospital Leadership Forum Board Meeting October 17, 2012 Page 6 hospitals. Staff is focused on helping hospitals file their DSRIP plans by the deadline and then working with the State to finalize the Medi-Cal and uncompensated care portions of the new funding program. Further instructions will be provided to the group once staff receives the needed instruction from DHCS. Defense on Future Budget Action What is Anticipated: Ms. Scott discussed implications to the State budget if Proposition 30 (tax increases) does not pass. Additional reductions across the board likely will be considered in this event. Future Waiver/Opportunities to Improve Federal Funding: Mr. Clark spoke of the Forum s ongoing efforts to look for new and additional funding streams. He also explained past opportunities realized by the Forum and now with the State budget changes being forced upon District hospitals how the Forum adapted its effort to address this new situation. However, this temporary diversion will not divert the Forum from its initial goals and objectives. A brief discussion ensued regarding potential challenges (from the State, Feds and other stakeholders) that will come with identifying new funding opportunities Legislative Session: Ms. Scott mentioned that each hospital should consider what issues may be addressed via legislation as the DHLF determines its 2013 legislative agenda. As revised budget cuts may begin as early as December, it s important to get any new legislation in now to protect District hospital funding. A Special Session of the Legislature has been called (likely to begin in January) with the purpose of addressing implementation of federal health care reform, however it is possible other health care issues may also be included in the Special Session. H. OTHER BUSINESS Mr. Clark informed the group of a newly created non-hospital-based clinic supplemental reimbursement program. Members were requested to advise staff if their Districts had any of these non-hospital-based clinics that might be able to take advantage of this funding opportunity. I. ADJOUNMENT The meeting was adjourned at 2:30pm.