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EPHC board discusses obstetrics and plans for the future

Michelle Romero of Infection Control opened with information on the approaching flu season and ways the community can access flu shots and covid boosters. “Our clinics are administering our Pfizer booster,” Romero said. “Approximately 50 community members were vaccinated against covid with the Pfizer vaccine last week in Graeagle, and that went really well.”

Romero noted that there was a lot of demand from the community for the vaccine.

“We’re also approaching flu season,” Romero said. Clinics at EPHC are now offering both regular and high-dose flu vaccines, with a flu vaccine drive-thru event in Graeagle on Tuesday, October 4 and another will be held at the Portola campus on Friday, October 7. Both events will run from 11 a.m. to 1 p.m. Moderna covid vaccines will be made available by appointment for those who choose, all that is required is a phone call to the nearest EPHC clinic.

Chief Nursing Officer report

With Chief Nursing Officer Penny Holland in a training session, Chief Executive Officer (CEO) Doug McCoy reported on her behalf that the transfer to the new EMR, or electronic medical record system, was going smoothly thus far.

Skilled nursing facility

Skilled Nursing Facility or SNF manager Lorraine Noble reported that there were 27 residents at the skilled nursing facility in Loyalton and 25 residents in Portola, with four new admits coming in. “Staff is working very hard,” Noble said. “Our most recent CNA class finished a couple weeks ago,” Noble said, explaining that there are six students orienting one-on-one with seasoned nurses on the floor at EPHC currently. Noble spoke of starting a new class as soon as possible, but that there was a need for applicants that want to work at EPHC. “Most California colleges require folks to have their CNA in order to go into an LVN class, and a lot of folks are looking to take a class because of that, but we want folks to work for us and not go away.” When it comes to SNF staffing in Loyalton, Noble reported that there were one full-time day shift nursing position and a full-time night shift nursing position open for applicants, and some per-diem positions are open at the Portola EPHC campus as well.

In terms of infection control, there were no SNF resident positive tests to report as of the meeting, with one staff member that tested positive. Any time a staff member tests positive for covid, all residents are tested for the next two weeks.

“We are doing all appropriate screenings and antigen testing for visitors, and we’ve been pretty busy,” Noble said.

McCoy noted that the retention rate for CNA classes at EPHC was currently at 87 percent. “I think that is a really positive metric to highlight,” he noted.

Rehab department

Director of Rehabilitation Jim Burson gave more information on the outpatient pediatric occupational therapy clinic that will be located at the same building as the Loyalton Skilled Nursing Facility.

“The clinic is within a 500 square-foot space currently being used for storage, and it is completely separate from the SNF itself, with a separate entryway,” Burson explained.  “We expect to begin operations by the end of the year.”

Burson also noted that the new EMR system, Cerner, would help with same-day cancellations and no shows once implemented.

Burson also reported that the ground-breaking for the new therapy and wellness center in Portola was still slated for Spring 2023, with 12-14 months of expected construction.

“The August patient census reached a new high of 148 department-wide, counting inpatient, skilled nursing as well as outpatient,” he said. “The therapy and wellness center had its second highest daily patient treatment average since our opening of March of 2020.”

Burson then reported that the department was working to develop a rack card with Big Fish Creations, which will be given to patients checking out of medical clinics who have been prescribed therapy, and also placed in clinic lobbies.

“The card explains the benefits of therapy and features our clinicians,” Burson said. “We continue our search for qualified speech and language pathologist and are hopeful that we will find a speech therapist soon.”

CFO report

For the month of August, EPHC posted a net loss in the amount of $517,893, after budgeting for a net loss of $291,045.

Gross revenues were under budget by $105,511 and inpatient revenues were under budget by $66,739. Gross Accounts Receivable were $7.3 million as of August 31 of this year, and cash decreased 9.99 percent as last years’ cash included $3,721,205 in IGT (Intergovernmental Transfer) monies.

“We haven’t seen as much activity in the month of August, so hopefully that means we have a good, healthy community base,” McCoy said. “We are looking forward to being able to increase our offerings to the community. Overall, we are still working very well financially and operationally.”

Director of Clinics report

Director of Clinics (DOC) Paul Bruning reported that in the month of August, EPHC clinics had exceeded their 5 percent projected growth target for revenue by over $80,000. “We are now back on track for our revenue and visits target goals,” Bruning said.

He went on to report that he had received final approval on Loyalton as an HPSA, or Health Professional Shortage Area location, and had received preliminary approval for both Graeagle and Portola.

“It will probably take another three months for the state to approve those two locations,” Bruning added.

The Loyalton construction is a bit behind schedule due to plumbing and drainage issues, Bruning noted.
He went on to add that EPHC was having some supply chain issues that have come up recently, which could slow up progress a bit more.

It was then reported that Tahoe Forest Hospital had spoken with Bruning and McCoy recently about the fact that OB physicians do not want to continue to come up to Portola.

“We’re working on possibly lining up with them on APP’s (advanced practice providers) or R’s and adding a telemedicine component to it,” Bruning explained.   “The physician providers will likely discontinue coming up here. We don’t have a date on that yet, we are trying to figure out what that process might look like.”

Bruning then went on to note that the urgent access clinic was doing extremely well. “On Monday they had 22 patients. On Saturdays they are averaging about ten patients a day and are averaging about 16 patients a day in sum total. We hope to continue to exceed expectations.”

Director Whitfield asked why EPHC was doing the HSPA application individually for each clinic rather than as one entire organization, with Bruning explaining that to be impactful for the rural health clinics, each location must be filed individually.

Whitfield then went on to inquire about why the physicians from Tahoe Forest no longer wished to come to EPHC to provide OB services.

“They are not seeing the value in coming anymore,” Bruning said. “They are discontent with the volume that they are seeing here, and they don’t feel it warrants a physician’s presence.”

Director Linda Satchwell echoed Whitfields’ concern. “That’s kind of a big deal,” she said. “I think that will really impact our community – OB docs are a need.” Satchwell pondered whether there would be a way to work with Plumas District Hospital. “It seems like we need somebody local.”

“We are still speaking with them about it,” Bruning said. “We are setting up time to talk in early October. He brought it up on a phone call about a week ago. They don’t want to just abandon the service, but the physicians don’t feel the need for their presence here.”

“How many OB patients do we see in a month?” Satchwell asked. Bruning responded that there were “probably eight to ten, with 40 unique patients in the last fiscal year.”

Whitfield pointed out that there are other reasons that women see an OB through the stages of their life, aside from being with child. “I think there is work to be done to re-recruit them to retain them for our community,” Whitfield said. Satchwell noted that a significant number of patients don’t have cars or money for gas to go to Reno, stressing the need for this service to be provided locally.

“It’s the winter months where we’ve delivered in two in the Emergency Room because people can’t drive in the weather,” Whitfield said. “It’s important that we have that here.”

CEO report

CEO Doug McCoy reported that EPHC was looking forward to getting Cerner live for the community. “This system we expect to be in place for at least the next decade. The new EMR program will provide better access for patients to look at their records, get to scheduling and more,” McCoy said.

McCoy also reported that the new 3D mammogram system was expected to arrive at EPHC after the first of the year.

“We have a number of projects that should coincide – the first quarter of 2023 will be a very busy time, with us bringing on new services and a refresh of our area.”

McCoy then noted that he was very happy with the results of the urgent access clinics. “We will be having a transition as Paul received a great opportunity and will be leaving us on October 21,” he said. “Thank you for all your work, Paul.”

It was noted that there was a transition plan being put in place to shift the position from Bruning to the next director.

McCoy went on to report that “unfortunately, there were no legislative changes or activity to either side” on the topic of seismic compliance and safety.

McCoy noted that EPH’s Customer Service Initiative had to postpone workshops for staff due to covid issues.

“Now we will get started in October, and we are very excited,” he said. “Eight workshop dates sold out in terms of sign-ups in the first week.”

Director Paul Swanson, MD, then proposed a change to the bylaws regarding elections of the chief of staff and vice chief of staff. “We will need to have an election, as we do not currently have a chief of staff,” Swanson said. “We revised the language to a different process, with nominations to. be asked for by email, and we will need board approval of the change to the bylaws.” A motion was made and approved unanimously by roll call vote.

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