001can you hear us now yes he said he said great all right it's a little after 5 apologies for the little bit of delay I am going to call this meeting to order let me first start with inquiries of any comments from the public for agenda items or for items that are not currently on the agenda all right board chair comments I Welcome, welcome. I'd just like to start off the meeting with the acknowledgement of the departure of our CEO, John Henley, as many of you know. And I want to, again, say my thanks to him and his leadership over the last four years. He was instrumental in really positioning the hospital with... some really strong foundational what I would call capital projects, even though they weren't all necessarily capital projects. Instrumental, I remember when
002John first came on board with leading the effort to get EPIC installed, which was really key for our affiliation agreement and integration with UCSF. Obviously bringing some very new technology to the organization to help. you know, the community keep pace with technology and delivering care. That would be the Tesla MRI and also most recently the robot. And he has positioned us well and the leadership team well to carry on in his stead and take us into the future. I also want to thank Ben Armfield who is sitting with us here today and looking right at him for agreeing to serve as our interim CEO along with the strong partnership of his chiefs. I'm looking at Don here and Lynn and Brian just walked in and I know Jessica's on the phone. So I thank you
003all. for continuing in his stead and caring forward for the organization and the community. All right. I have obligation to report on three closed sessions that were held over the last month. The first two, one on the 17th and one on the 23rd, were topics of trade secrets and contract negotiations. The third item here, May 1st, was a – yes. Oh, yes, not May. That's correct. So I will announce tomorrow's closed session on May 1st. Yeah, I guess we're a day early today. We are having another closed session, which is a continuum of the prior two regarding trade secrets and contract negotiations. Okay. All right. I'll move into consent calendar. We have four items in the consent calendar. The minutes from the last board meeting, the minutes from the quality committee meeting that took place
004in March, policy for review, and the medical staff credentialing. Any questions, comments? And if not, can I get a motion to approve? So moved. So moved. Second. All in favor? Aye. Any opposed? Great. Next we have an update on 1206B clinic, which is how timely is that? We were just talking about that. I look forward to this. Thank you, Don. Very good. Well, thank you. Thank you for having me. And tonight I will be reporting on the 1206B physician clinics for the calendar year of 2024. Next slide. So topics for discussion include the 1206B and what that means, the history of the clinics, operational overviews of the primary care and surgeons clinic, our quality measures, the age-related health system, volumes, challenges, and what we hope to do next. So I'm going to start by reading
005you the formal definition of the 1206B. It is, as defined by California law, refers to a type of clinic that is exempt from certain licensing requirements. Specifically, it allows physicians to practice in clinics without requiring a separate clinic license if they are practicing within the scope of their license. So these... clinics are often operated by hospitals and health care districts. We have a separate tax ID number from the hospital. So to sum it up, we're exempt from licensing. It's a separate entity operated by the health care district and managed by the hospital. Question. Please. Do you have any insight? Well, first I guess we would ask, when was it established, and what was the impetus for establishing it? That's what I was going to tell you next. Oh, I'm sorry. I'm sorry. Okay. No problem.
006Next I'm going to talk about the history. So the reason behind establishing it's okay. You can ask all the questions you like. The reason behind establishing the 1206Bs was to bring much needed specialists into the valley. So we opened our first clinic in 2016. We leased a building on West Napa Street, 462 West Napa. And Dr. Pari Azari, pain management specialist, and Dr. Sabrina Kidd, colorectal surgeon, were our first providers. Dr. Azari left after about a year. She moved out of the area, and Dr. Kidd stayed with us until 2022. She left, and then she came back, and I'll talk more about that. The family practiced, joined the 1206B program in 2018, and we started with Dr. Subhash Mishra and Dr. Daisy Manuel-Arguelles. We had a physician assistant working with us for a couple of
007years. She moved away last year, and Becky Spear joined us last year, which is a great win for the clinic. And then Roshani Subedi, another NP, joined us in 2025. So she started in March. The Surgeon's Clinic joined the 1206B program in June of 2024. And right now, we just have Dr. Alexandritis in that clinic, but for part of the year, Dr. Kidd was in the clinic as well. Any questions? Okay. So I'm going to provide you with an operational overview about the primary care, and I wanted to point out that running a physician clinic is entirely different than running a hospital department. It was a huge learning curve. Billing is different. The hospital bills facility fees. Physician clinics bill professional fees. We have a separate electronic health record. We don't use Epic. We use
008what's called Athena Health, and it is designed for physician clinics. We are not regulated by the Joint Commission or CIHQ. We have a partnership survey every two to three years, and we always do really well. Next slide. The surgeon's clinic, oh, you know what? Would you mind going back? I'm sorry, I didn't finish this one. So this clinic has 1.6 MDs and two nurse practitioners. Now, the MDs are not included in the overall FTE because they are not employees of the hospital. We cannot employ physicians. We have professional service agreements with them. We have 6.6 FTEs, and that's our medical assistance, front desk reception, authorization and referrals. Our practice manager manages both practices, and we serve approximately 3,000 patients. So it's a very busy practice. The surgeon's clinic, we have one full-time doctor, Dr. Alexandritis,
009and we have a per diem MD, Dr. Natasha Beer. She takes general surgery call, and she bills her professional fees through the 1206B clinic. As I stated earlier, the practice manager is shared. We use Athena Health. and we serve approximately 900 patients in that clinic. And we moved that clinic. They had a separate building. We moved them into the hospital, into one of our old suites, the old cardiology suite, so there was a cost savings there by closing down one building. Quick question. Yes. The primary care insurgents clinic, do they manage their own billing process, or does... The hospital. They manage their own. Do it on behalf. Yes. They manage their own. Oh, yes. They have their own billing system, their own revenue cycle system. Everything. It's all built into the electronic health record. That
010was another huge learning curve. All right. Because departments don't do their own billing. That's what Ben's team is for. Right. And so, you know, when we got Athena, I. the claims were sitting in a holding pattern and I couldn't figure out what was going on and that's when I realized you've got to audit all those and look at all the coding and everything and that's when we realized we needed a practice manager that had experience in all of physician office operations. Next slide please. Okay, so. The family practice is enrolled in the merit-based incentive payment system. It's a mouthful. For short, we call it MIPS. So MIPS is a quality program that was established by Medicare in 2017, and it was designed to tie payments to quality and cost with the plan of providing efficient
011care. Driving improvement in care processes and health outcomes, increasing the use of electronic health records to share information, and reduce costs. So I wanted to go through each of the metrics and explain where we're at. In evaluating the blood pressure metric, The clinic provided me reasoning for that 64% in that not every visit is appropriate to address blood pressure. So if a patient is coming in for like an urgent care type visit because they're not feeling really well, they don't want to talk about their blood pressure. They want to talk about what's going on. So it's something we want to continue to work on and increase that score. We encourage all of our patients age 65 and older to get the pneumococcal vaccination. A lot of people... decline. One, they don't, either they don't want
012another vaccination or they don't know if they've already had one, but there is a way that we can, there's a database we can go into to determine if they've had it. We do screen every patient for suicide risk with our adult major depressive order. And then we also screen for the need for colorectal cancer screening. So with that one, there are some people that just refuse to have a colonoscopy, or others will accept the referral, but they never follow up on it. And then finally, we introduced the implementation of medication practice improvements. And that's about reviewing our patients' medications and making sure that they are taking the appropriate medications, and the appropriate quantities. So oftentimes our patients have several physicians. They have a primary care provider, and they have two or three specialists. And all
013of them are prescribing different medications. And patients don't always understand they need to report all that back to their primary care provider because having that transparency allows our providers. to review for medication interactions and make adjustments. So what we are doing is we ask all of our patients to bring their current medications in at their initial visit and then we have our specialists send consult notes, the ER sends reports. And then if needed, we can also get into the cure system, and that is a database where pharmacy enters controlled substances that are prescribed. And these are just ways that we can monitor the medications that our patients are taking. Dawn, I have a question. Yes. When you're in the emergency room and they're prescribing medications, do these two systems talk to each other so they
014pick up what's being prescribed in the emergency room when you get a referral? No. What happens is we get copies of the reports from the emergency room. Got it. And same with consult notes with specialists. We can update them or scan them into our system. We do a lot of scanning. Yes, ma'am. Sorry, a lot of learning going on. Oh, no, no, please. The MIPS system, is that a state-based incentive system or program? It's Medicare. It's Medicare. It is Medicare. They established this program, yes. Next question maybe for Dan. The quality dashboard here. No, it is not. This is entirely separate. No, we do not. And I'm going to talk more about that because there's an opportunity there. Okay. So we received a bonus. from Medicare for 2023 for our MIPS scores in the amount
015of $13,302. We just submitted our data for 2024 and we won't learn for a couple months what our bonus payment will be this time around. We cannot enroll Dr. Alexandridis into MIPS until her clinic has been established for one year. So in June of 2024, we will enroll her in MIPS and develop relevant metrics for her practice. In 2025? Excuse me, 2025. Yes. Thank you. So did I understand you correctly? You set the metrics or the metrics is set by Medicare? No, we set them. And they give us a long list to choose from. There's a lot. But I think we have some opportunities, and we're always looking for opportunities, and that's why we're going to establish a clinic committee. And our first meeting is in May, and I'm going to talk more about that
016later with what's coming next at the end. And historically, has the clinic received, I guess you'd call it a MIP? A bonus, yes. Yes, we've always gotten a bonus. You know, they're not really looking at the results of the metrics, and I had a hard time understanding that. It's more about that we have a system in place. That you have a process. Correct. And the practice manager told me, well, you could just say satisfied to the board, and I said, no, I don't think that's going to work. Next slide. With Becky Spear joining our team, we have begun offering the age-related health system to our patients, and this is a huge win for the clinic. Patients love Becky, and they love this program. So this allows us to offer age-friendly, evidence-based care for our older
017patients using the 4Ms, what matters. medication, mentation, and mobility. We want our patients to receive proactive, personalized care. By focusing on those four M's, we can help them maintain their independence and well-being, and that's what's truly important for our older patients. And if you don't mind, I have to share a quick story. So Becky called me to tell me that she had a patient that was turning 100 years old, and she wanted to have a little birthday party for her. So she bought some cupcakes, and we had a balloon, and we all went over there, and we sang happy birthday, and that patient was so happy. And if you'd seen the smile on her face, it just melted our hearts. But those are the kinds of things we do, and that's what Becky does, and
018she's just great. So I had to share that. Another maybe comment or question. Am I correct that aspects of the age-friendly health system are also in practice at the hospital? That is correct. And we hope to be able to extend this to other departments. I'd like to see it offered, you know, maybe in physical therapy. Anyway, but we only have one Becky, so we don't want to stretch her too thin. So next I'm going to review our volumes. For family practice in the surgeons clinic so we did see an increase in 2024 and I attribute that to the addition of more mid levels the surgeons clinic is only based on six months because it did open in June of 2024 and that includes patients from dr. Kidd and dr. Beer across inpatient outpatient and surgeries
019next slide Excuse me, where did you say the surgeon's clinic is? It is in the hospital. And do you remember where the cardiology department was? It's back in the back of the hospital before you go down the hallway to the cafeteria. But it was nice downsizing one building because it saved us quite a bit of money. Ben's smiling over there. So we do have a few challenges, including needing more providers. We have long wait times for new physical exams. Sometimes it's as long as six weeks. And then it's really difficult to accept new patients with the size of our panel. We get calls all of the time, and we try on occasion to accept new patients. I get calls from the community. Most of the panels in the community are closed. And so that's, I
020was talking to Wendy earlier, we need more primary care providers. And space is an issue. The family practice is in a very old, small building. It's narrow halls. Exam rooms are very small. All four providers share one office. Our three medical assistants are sitting in a closet. We took the doors off so they had some air. This is Perkins? This is 270 Perkins, yes. So we're looking for more space, but there's not a lot of options out there. Is there an option to move him into the hospital? Well... Our empty space has been deregulated, so we have the second floor is empty, the emergency room is empty, the old surgical suites are empty, but they all need a lot of work. I think we would be better off leasing space, commercial space, if we could
021find something that accommodated practice. Is Dr. Kaplan in the Perkins? Officer, is he somewhere else? Well, so in addition, this is a separate conversation for another meeting maybe, but we also have what is called a timeshare clinic, and that is where we lease space to physicians. And we used to have Dr. Kaplan in that clinic. And when we moved Dr. Alexandritis into the clinic, we moved Dr. Weiss and Dr. Kaplan out of West Napa Street, planning to have Dr. Kaplan go into the other Perkins address. Well... He's being stretched really thin because he's not only working in Santa Rosa, he's working in Napa, and I think he's working in Petaluma with Providence. And he's come by to see me a couple times, and he'd like to come back, but he can't do so now. So
022the timeshare clinic, we're only subleasing space to Noah Weiss. So we have room for specialists in there. But it wouldn't work for the primary care because, you know, with Dr. Weiss in there, we need at least, I'm going to say, eight exam rooms. The timeshare is at 246 Perkins. It sits behind the 1206B on Perkins. And I'll take you back a few years. We used to have the Women's Health Center there, and that's where our mammogram machine was. Yeah. Next slide, please. So what is next? This is where I'm going to talk about the clinic committee. So the clinic committee is being established to provide overall supervision and guidance of the 1206B clinics, and Dr. Alexandridis has accepted the medical directorship. The committee will focus on the following, an annual review and revision of our
023policies. overseeing quality improvement activities preparing for survey providing support for the clinic providers, and making recommendations for staffing and equipment needs. In addition, Dr. Alexandritis will report up to the medical staff committees as needed. So as I explained earlier, we will have our first meeting in May, and at that time we'll talk about who should be on the clinic. My thought is someone from finance, our quality director, Maybe some of the other physicians in the 1206B clinic would like to join, and then I'd really like to have Becky on there. I will be on it as well as the practice manager. Question? Yes, ma'am. Carefully worded question. Yes. Given that the 1206B is a separate entity under the health care district and managed by the hospital, what role does this board have over that? I
024wish I had an answer. Not only what role, but what accountability. Because when you, and I just was thinking. I think it's the same as any of our other departments within the hospital. Ben, can you help me out here? I mean, the clinic is part of the district, right? That is correct. And we're the board of the district. Yes. Right. But the district. But they're two separate legal entities. Yes, they are with two different tax ID numbers. And that's part of the reason why we want to get this clinic committee going. But when you were talking about setting up, I was actually thinking about how could that committee leverage the resources and committees that are already in place so as not to overburden whoever's going to be on this. I mean, we have a quality
025committee. We have a... Finance committee we have, or is that just mixing apples and oranges? I think it would be hard because of all the things that we hope to achieve within the clinic committee. I don't think we could be assigned to any one board committee. I think we'd have to be on them all. So it would be a multifaceted committee with quality finance, policies like that. And if I could just clarify just really quick on the 12-6B clinic. The financials and the P&Ls of all those clinics run through the hospital's financial statements. So in the financial report, all the numbers, it includes our 12-6B clinic activity. Included in the audit. But the quality metrics do not show in the hospital. They do not, and that's because they're through MIPS is different. That's why we've
026never had it go through that committee. So in addition to establishing the clinic committee, I have a feeling we will be adding more practices. We are getting inquiries from other practices in the Valley about joining the 1206B. And so Ben and I and John, too, had discussed it previously, but we are talking about it now. Are these existing practices? Yes, sir. And what's the value to us? If these practices are existing in full, what's the value to us to bring them on versus recruit providers, you know, get some new people in the community? I think these practices will close without our help. Some of the practices in the Valley, the providers are of retirement age. And the reason for asking us to take over the clinics is because they want to retire. So not only
027would we absorb the clinics, we would be recruiting for physicians and mid-levels. To absorb the panels. Correct. Of those respective. Correct. And because if we don't do this, where are our patients going to go? Most of the clinics are closed to new patients. These are primary care? Yes. And I can't divulge any names because no agreements have been signed. We're just in discussion. But if you consider the chicken and the egg, where are we in finding new providers to absorb? Otherwise, we take a financial risk for somebody who's going to retire, and then we're... I have a plan. Mr. Case. So one of them, I recognize that we need more mid-levels, and I truly believe that's going to be the future. You have to have a supervising physician that is correct. And I just got
028an application for one today. I was so excited. So they're out there. You just got to know where to find them. And I'm not having any trouble recruiting mid-levels yet. But we know there's a huge demand for them. So in addition to adding more practices, we need to recruit more providers. I'm hoping to relocate the family practice into a larger building and then, of course, establish our clinic committee. one more site I just wanted to share all those lovely faces I would like to recognize them they are great teams thank you can I answer any more questions which which one so I'm wondering if you're thinking of the other complex of Perkins that's across the street On the other side of Perkins. So there is an empty building there. It was owned by an ortho...
029Let's see. An oral surgeon. Thank you, Dr. Kittleson. I think it was Dr. Boynton? Yes, it was. Okay. So it's sitting empty, and it's been sitting there for a couple of years. It's not quite big enough. So I've been in discussion with the Quest lab that sits next door because they're willing to give up part of their space. But we need to, you know, we've got to get an architect and talk about that. You know, that's a ways down the road. But something to consider. Dawn is like a hidden dynamo there, just negotiating leases. You know, I find all of this to be, it's a puzzle to solve, and it's fun. So, Dawn, you have these what's next, and what I'd like to know is what's next. So how do we go from here? Are
030you going to be? coming back to us with some proposals? Oh, I'm sure I will be. Okay. So I would like to continue discussions with the providers that I am talking to and then working with Ben to determine if this is something that we can do. And then we have to find more space and recruit. And then I think in conjunction with that, I think just presenting kind of our overall strategy, because I think there's a larger primary care specialist strategy that, you know, I think we need to identify what recruitment vehicle I think makes the most sense for the district. So I think we would like to include kind of that in our whole plan to kind of get this thing kicked off. I know. Thank you. I learned a lot. You're welcome. Appreciate
031it. I do also enjoy a puzzle. Oh, it's fun. Yeah. I would agree with Ben that a strategy, not a long one, just, you know. No, we need to have that discussion. And I'm happy to pop over and brainstorm with you. Please. I will offer my, I don't have a lot of expertise in this area, but I love a puzzle. Good. I look forward to it. Thank you. Thank you, Don. Thank you, Don. Okay, we have two capital requests by Ben. Yes. Yes, so thank you this first request that we are bringing forward is actually an emergency capital request and it relates to a failing air conditioner unit on top of our roof so AC one Which is the hospital's primary rooftop condensing unit and actually supplies the chilled air to two critically? Important areas
032of our hospital, which is the emergency room and our operating room Both of units are at end of life. One unit has failed multiple times over these last number of months. We've tried multiple efforts to. kind of duct tape it for lack of a better term and just repair efforts I think have now gotten to the point where they're just unsustainable and just not cost effective. I think the concern is as we're coming into the summer months a full failure of this unit would require a potentially a full shutdown of our operating room. So what we have in front of you all that we are requesting is the we're asking the board to approve us to proceed with This project with a dollar amount of not to exceed of two hundred fifty thousand dollars. So
033The trick here is kind of the tricky part is this is the lead time for the ordering of these units So we do have a hard bid from Carrier, which is our current vendor that supports the current infrastructure What we don't have our hard bids for some of the other Associated costs that we're still trying to run down and identify, you know what those costs are I think, again, just from a time sensitivity standpoint, I think we were thinking this was probably the best way to move this forward. So that's how we would propose it. If it would, the project comes in over anything over $250,000, we would obviously come back to the board. But I think, again, the more critical component of this is getting the actual units ordered. The lead time that we
034recently received was a big... significant reduction over the lead time that we actually initially had been communicated with and that was a four or five month lead time. So obviously that caused a lot of concern. So obviously. And what's the current lead time? I believe four to five weeks. So but then there's a lot of also coordination to make sure that we've got everything else situated. So we are asking the board to approve this item. With you know the other associated costs with it not to exceed amount of two hundred fifty thousand dollars any questions for Ben Oh, no, I guess that's right. It was in the detail. There was a fairly significant cost. IOR? Oh, Inspector of Record, I believe. And I think that is, you know, we don't know if we're going to
035be required to go through HCI for this project. So I think there's some potential unknowns of, you know, I think some additional costs that could be required, which is I think that being one of them. That's a big number for an inspection. Yes. Okay. I move approval. I second. It's obviously necessary. I don't question that. And if it was just the sake of saying yes, because we need it. But is anyone concerned that we proved a lot of things over the last year and we're not necessarily hitting our numbers correctly? So there is a responsibility on our part not just to approve it, but have confidence that our approval will be done within the box that it's approved. So I guess my question to Ben is, if we do approve it, are you convinced that
036we have this in a nice little box that you're not going to come back to us? Because I don't want you to come back to us. That's a good question. I think the answer to that would have to be no, Dennis. I mean, you know, until we identify some of that scope. No, no, I appreciate that. So that's my concern is do we approve a bigger number because we don't want them to come back? Or do we wait until we have more facts and then we potentially get screwed on me time? Or do we just take some risk because the number's not that big? But I just want you to know that these are the things I'm thinking about as I think about the MRI, this, the lab, et cetera, et cetera, et cetera. I
037completely hear you. I personally am not concerned about... because it's a not to exceed proposal. But what I am concerned about is execution. Well, me both, because we don't have some of the numbers, so it may not amount to the fee, but we actually don't have all the bids, which is kind of where we found ourselves in the last. Yeah, we have Mr. Ryan Eads, who's a... technically a third party. And then we do have Sean O'Brien, who is an internal project manager that started last Monday. So I would say our picture today is, and resources today, are much more robust than they were, you know, four or five weeks ago. But is the first guy the external? Is he doing any project management, or he's just associated with the MRI? He's mainly associated with
038the MRI, I would say, during the transitional period while we're onboarding. I mean, this guy is brand new. I know we could ask him to wait, but my point is he really has something else. Yeah, he's kind of helping out on the periphery on this. Okay. So, I mean, I would even suggest we could come back next month. I think given three, four weeks, we could have, I think, all of the other associated costs, I think, much more dialed in at this point. I mean, just given... The concerns about the time sensitivities, I just wanted to make sure that we got this in front so we could get this, at least the equipment, moved forward. Okay. And that's what you're planning. I mean, if we approve this, you're going to get the equipment before? Yeah.
039Yeah, we will place the order tomorrow. Just want the dialogue. Yep. Yeah, I think I'm a little less concerned about a project like this because we're talking about something that is neat, smaller, you know, it just doesn't have all of the... Do we have the money? Do we have the money? Yeah, we have the money. I mean, it's certainly not what I would want to spend money on, but, you know... I get that. I just want to make sure of that. Okay. Yeah. Okay. Yeah, I'm ready, too. motion to approve I still second all right all in favor thank you so so this next item is a change order submission in relation to our ICU upgrade project so this is an ask that we are asking the board to approve a change order in the
040amount of $28,000 for Ridgeview Builders, and they are the general contractor in the ICU upgrade project. The memo kind of goes into details in terms of what that change order is, and I think specifically relates to some ADA sink clearance modifications as well as some structural framing repair to replace some studs in some of the walls. Bringing this forward today because this individual change order exceeds the 5% of the original contract. So bringing this forward to you today, as you can see in the memo, this would bring, using contingency, bring our contingency down to about $3,000 remaining. Ryan and I have discussed this project at length over these last couple days. We are focused on trying to do what we can to get this project closed out and really trying to do it in the
041timely fashion as possible and within the budget parameters as much as we can. So I guess I will stop there and happy to answer any questions you have at all on this item. When is this project scheduled to end? I think we're in the last phase. So I think originally it was, I think it was originally scheduled to be complete, I believe it was May. I did ask, one thing with Ryan, just for in the next week, let's absolutely try to nail down what that timeline is. So we can kind of come to you with a full, here's when we anticipate this being done. Yeah, I think. Just as Dennis said for this one, it's really important. Many of us were at the MedExec dinner last night, and I was surprised to hear that this
042project has interrupted patient care because I thought when we first reviewed it, we wanted to be assured that it would not impact census, and based on the conversation I heard. And it wasn't directly with me. I just, there was a lot of talking going on. It appears it has impacted care. Okay. I'll need to follow up on that. So we need to get it done. Is that not fair, Don, or to that are out? Yeah. Okay. And can I add to that too, Wendy? It's Jessica, it sounds like. Yeah. Yeah. You know, there was, so this project was done in phases. For the first phase of the project, instead of having four available ICU beds, we went down to three available ICU beds. And that lasted for about. Four or five weeks or so. I
043can't say it impacted patient care every day because we don't often run a full census of four. It did make some logistical problems, but I don't think we ever turned anybody away that needed critical care because of this. Okay. Yeah. It could be, you know, this dinner happens only twice a year, so they could have just been talking about historical things. But thank you for the reassurance that we didn't turn anybody away. Absolutely. Am I reading this correctly that with this change order number four we have what $20,000 less for our contingency but we haven't we are still within the original budget and the contingency. We are with this change order let me I just want to be clear our contingency would go down about $3,000. Yeah okay yeah yeah how close are we to
044finishing? Yeah we are close I mean I you know and that is one of the things I would like to come back with a to this board about just what that final estimation is. You know, we've got committed costs. I think we're trying to understand, like, what that final allotment is to close this project out. I mean, Ryan's been working hard at trying to identify that. We would like to come back, I think, next month with just, you know, we'll do the best we can. I think similar to, you know, what you had asked previously, I don't know if I can answer right now if we're going to stay with... in that time or within those budget parameters. But we are trying to figure that out. I would recommend we bring these back through the
045finance committee. Yep, yep, we can do that. And then we'll have maybe a little more time, and then we can bring them to the board. Does that preempt approving them today, or are you suggesting? You're talking about the latter part. Oh, the latter part. Okay, sorry. Yeah. Second. All in favor? Aye. Aye. Thank you. I would like to suggest, Ben, that you get more of Ryan's time. Yes, we have actually. I think his time is valuable and worth. We've locked arms three times already in the last week. Great, great, great. Yeah. Thank you. All right, I guess we're going to roll right into financial update. Yes. Yeah, so. For March, in terms of performance versus budget, we didn't quite end up meeting our budget targets in March. I will point out I think March was
046the most aggressive month we had in terms of budgeted performance. I will say I do think it's our belief that some of the root causes of missing budget were more one-time items because it really kind of showed up on the expense side for the first time this year. Specifically with, I think, supplies, and then we did see an increase in some of our benefit costs, which, you know. Looking into it a little bit deeper, I really think it's a catch-up of some claims that we've received. And if you actually look at where we're budgeted in our health insurance expense, we're pretty much right on budget for the year. So some of that was a catch-up. We did post an operating EBITDA loss of about $40,000, which still, I mean, it's... if relative to what a
047run rate has been if you you know look at the last couple of years it's actually you know one of our better months, but still fell short of our budget of $415,000. Operating revenues were strong. We were up 5% versus budget. I think more some underlying indicators I think are a little more encouraging. For example, surgical volume, we saw a big increase in surgeries in March. Surgeries increased 20% from February. Orthopedics and GI really drove a lot of that growth, but orthopedics specifically, their volumes increased by, I think it was close to 30% when you compare it to February. Dr. Walter performed 21 surgeries last month, which was good to see. We did 11 cases on the ROSA, which was great. And actually, we're in looking at what our joint... costs have been and you
048annualize out you know what our spend has been since we've gone live with the rosa we are annualizing implant savings of over a hundred thousand dollars so so those are some good things to build on I also think we're seeing some still really good volumes on the outpatient side, especially within PT while construction continues. We're seeing a big increase in volumes in wound care after some targeted, I think, marketing campaigns. So I think those are looking really strong. I think the other... Point I wanted to throw out there was in March we had a great month in cash collections So one of the better months we've had over the last number of fiscal years we collected over I believe is over five million in March, which was great and actually it looks like April is
049Coming in to be just right around that same number. So those are that's certainly encouraging from a finance standpoint You know, we are days cash on hand is looking strong. I will say Our AP went up a little bit last month. Some of that relates to, you know, we did book some liabilities with some upcoming IGTs as well as, you know, some additional costs on some construction projects. You will see that significantly, looks significantly different in April. But I think, you know, overall, just looking year over year, we're up, you know, our operating EBITDA is up a million dollars over budget, up $2 million over prior years. I still feel like we're on a really strong trajectory. I think as we're moving into next fiscal year and looking at cash, I think one of the
050initiatives I really want to take on is just really kind of understanding just the capital needs because that's the other piece to our operating cash. But I think all in all, I still think we're looking to have a really positive financial year this year. MRI, we're still below budget, or I don't know how we have budget. If you look at page 64, we've missed it by take from November to March, a couple hundred. Can we make that up, or are we – the last couple of meetings, John had talked about outreach to different areas and direct marketing and indirect marketing and things like that. Are we seeing any – return from that? Any volume associated with that? Or is this still an epic problem? I mean, yeah, I am tempted to answer yes to both
051of those questions, because I do think we're starting to see some. And I think, correct me if I'm wrong, we've received a couple UCSF. referrals so you know some some progress there and I think we are starting to see some additional referrals from new providers so I think you know that's I think what we're really looking in and drilling into now is just looking at you know where referral patterns have been by payer and by financial class to really understand you know just on the on the private side where some of the opportunities are I think we're 190 exams in April, I think. So I think that's probably going to be where we're going to be coming in at this month as well. So just short of that 200 number. Yeah. Yeah. Yeah. whatever you
052guys can do to see if we can get those volumes up obviously would be great. What are we doing with the 1.5? Is it still running daily or is it running at all? The other MR? So it's not running at all. Is that because we were waiting on a part? Is it fixed? Can someone look into that? No worries. Okay. Isn't it mostly? I'm sorry. Isn't it mostly just because we're not at capacity with the 3T? What we're getting is all for the 3T. Okay. And I know that we just received the service contract for the old to keep that going until we move the new ones. There was a discussion last night at the... dinner about having it available on weekends, Saturday mornings or I forget what the other time was, that some of
053the physicians thought that that would be an opportunity to get more business. Specifically from emergency. Yeah, I think the initial inquiry was from Well, I we were sitting at the table with the entire Napa group They want yeah Right. Well, and they did back off a little they said could we start with a Saturday? Yes You have to consider staffing, training. Those who have trained on the 1-5, can they be trained? We had a hospitalist that wanted it open on the weekends as well. See how you learn at having dinner? I said, see how much you learn when you have dinner with the metal group. They're passionate about their work. Sorry, Ben. No, you're good. I just have one more item just on finance. I mentioned it in my memo. I would be remiss if
054I didn't circle back because I provided some updates the last number of months. We've been vetting a potential switch to a new vendor for our ERP system, which is enterprise resource planning. So that is the modules that house our general ledger, accounts payable, materials management. And, you know, some of these new systems have a lot of really robust tools. And I think ultimately, you know, we need to fit this into our plan to where we do transition over. We made a determination after looking at this that it makes more sense right now to keep what we have because it was going to cost, you know, half a million dollars next year to implement and almost a million dollars over the next five years. And just given the state and just other... things we're trying to
055solve for in terms of capital needs just could not justify that type of investment at this point in time. So we're going to still keep it on the plan for the next couple years, but at this point in time, yeah, we're going to keep with our existing vendor. Yeah, I would just caution not to kick this can down the road too far. Your predecessor was, so it was almost three years ago when we were beginning to implement EPIC. there was a proposal to implement a new ERP at the same time. So this is a vulnerable platform, and it has been for years. Yeah. This does give us an opportunity to see what this vendor – we are going through an upgrade again, so we are going to see what we can do to optimize. But,
056yeah, it will certainly be in our plans in the next number of years to make that switch. Right. Any questions? All right, we have a investment policy update from Ed. So the investment policy was reviewed by the Finance Committee in detail. Unfortunately, last month's board meeting, we had the abridged version. And so we have the full version here. I recommend it for approval. All in favor? Aye. Any opposed? All right. Committee updates? Ed? We didn't meet. A lot of late cancellations. Well, we didn't have a forum. We did not have a forum. Well, we did, yes. We diligently attended a meeting that did not happen because others did not attend. And I were there. We were there, yes. Let the minutes that we're not going to produce note that Dennis and I were there. Okay.
057All right. Any board comments? All right. Meeting adjourned.