VTH Board Minutes 10/25/2018

Informational

(Parkland Technician Program, VTH Disinfectant, Equine Locum, ER Discharge, Research Policy, Stringsoft)

• Parkland Technician Program – Update: the meeting on Oct. 4^th identified some deficits in the programming we are providing, specifically with regards to LA.  These concerns are being addressed (J. Byrd and A. Duncan).  Parkland proposed a pay-by-student contract model.  This was considered and a recommendation was made to VCM Dept. Head to decline proposal.  Meeting set for next week for further negotiations.
  
  
• BS committee switched to Rescue from Germosolve as disinfectant.  Concern about how our dishes are going to be disinfected; JW will look into this.
• Equine surgery section requests for 8 weeks of locum, as Stewart was covering ER emergencies at night and clinical services; 25% of his salary is being paid for by clinical skills; VTH board approves
  
  
• Intern concerns about having to finalizing their reports prior to their shifts being over; getting RDVM complaints about not getting the discharge info timely.  Natalie Lamphier, Michelle Jaeger, Drs. Tonozzi and Haraschak developed a client ‘go home’ to be finalized at discharge, sent home with client, and that can also be faxed to vet.  Transfer form was also modified to include prompt to offer return to RDVM as owner option.
  
  
• Interns requested an evening once a month to (2-3 hrs) to meet socially.  This request will be honored.
  
  
• Research policy; Friday morning discussion, please attend
  
  
• Stringsoft inquiry and update requested from Devon and SANDS; IT is meeting with business office, inventory/storeroom in prep for Stringsoft implementation; they are moving to weekly meetings with Stringsoft to facilitate process.
  
  
• Quarterly AITS maintenance broke the process for uploading reports.  Efforts to address this problem are a priority and are on-going.

Pharmacy

(Status, Short-term plan, hours, long-term plan)

• The pharmacy underwent a comprehensive review by an experienced pharmacy director from NS State.  The report is available for review in BOX.  A summary of the recommendations and our intent is provided.
• The pharmacy has a waiver to allow for minimal operation of the pharmacy w/o a pharmacist being present.  However, current turnover has complicated this.  Dr. Shelby Williams resigned.  Our staff hourly pharmacist, Leslie Horner, was going to leave after Shelby came and she has agreed to stay and will take the legal responsibility of Pharmacist in Charge (PIC); she will work M-F mornings; Brian relinquishing PIC and will continue to work as staff pharmacist.  A search is being launched to hire a new clinical pharmacist, with the intent that the individual chosen will have the acumen to be lead.
• Currently there is no manager for the pharmacy for HR oversight, Stringsoft, etc.  Planning to hire back Art Siegel to oversee pharmacy management until able to hire another pharmacist
• Report said that the extended pharmacy hours losing money in the 6-7p and recommend to go 8a-6p M-F and keeping 8-noon Saturday; Change the pharmacy tech hours for them to leave at 6:15p, not leaving at 6p; new schedule would be implemented on Dec 3^rd.  Board Approved schedule change.

Service Closing (Dentistry, CC)

• Board approves plan for Dentistry to close
• Critical care is planning to close; recommend that in the future when there is a critical mass of doctors, CC not be allowed to close.

Central Laundry 

• Support staff and techs are supportive of a central laundry system that will be outsourced; cost that we do not incur currently and hope to make up by our techs not doing laundry; the laundry room will be next to the junior surgery.
  Board voted and passed 

MRO Ward/ Policy

• BS Committee is going to reevaluate the process to repurpose the old neuro/onco/primary ward as the MRO ward to have the examinations of those patients not occur in the island outside

Accounts Receivable / Gift Account Management 

• The amount of money owed to the VTH has become significant.  When clients do not pay at discharge, the VTH Business Office attempts to collect the balance from the owner.  If they are unsuccessful, the balance is sent to campus and they attempt to collect.  Campus either works out payment, or they send the balance to collections.  This process is taking a lot of time and man-hours at many levels.  The VTH Business Office has run a report, organized by service (ER accounts sent to collections is $68K, Equine $127K, less than half < 90 days old); point that need to evaluate is how is this happening and how old are these?  JW will investigate.  The VTH is currently paying 24 hour coverage in SAC receptionist and those individuals could take payment for LAC if client is brought over when LAC admissions is not staffed.
  
  
• Board suggested sessions with the house officers to explain process/importance.
  
  
• Board suggested topic for a Friday morning seminar with the house officers and the receptionists about asking for $ and keeping credit card on files, etc.
  
  
• There are numerous gift accounts.  Margaret Caston will be the primary contact person; plan to meet with service chiefs next month and then meet with them quarterly to advise of what accounts they are responsible for over-seeing.
  
  

Projects Update: Equine Surgery Renovation

• Equine surgery caseloads have increased and need to work to improve the OR suites
• This fiscal year board approved equine treadmill (need to find the location)
• Need a lameness assessment area; there is an uncovered paddock currently; Iowa state has a covered, unheated arena, could have a similar situation with the paddock here, suspect it would be about $400-500K and recommend that we go to advancement
• Facilities is working on the hay barn to create ambulatory truck parking and to enhance security and lighting in the area.  Exploring options for cameras outside.
• Plans for funding these initiatives will be coming to the board in a piecemeal approach, rather than a capital request

Dermatology Requests

Previous discussion RE Dermatology: Board requested more information about how the service will look with the 2^nd faculty member; Open 100% of the time; increase from 1080 to 1750 appointments without overbooks

• Exam room 116 (just west of phone room) will be designated as Derm exam room.  Installing lockable closet to secure video otoscope.  When Derm not receiving, exam room available for use by other services
• Requesting another technician for the service; Dermatology is 8% below revenue, VTH Board wants more info

Budget Items

(1st quarter Financial Report; I/R requests; Dermatology; Support services (HR/ BO/ IT); ER Support; Imaging Support) 

See the sheets provided

• Total revenue 3.1% below prior year, the most of this loss is from September
     -Most accurate area is ER (due to VetStar not being able to track case transfers),
      -Question about RT cases, should be under onco, but could be under radiation
        -Rehab is 20% below last year, likely dt decrease in ortho
        -Case numbers 7% below last year; taking out Farrier and Shelter med then only 0.7% below prior year on volume, but the revenue is 3.1% lower than previous year; decrease in the higher level procedures
• Question about line item CE, meetings, and business meals.
• 950K needed for the expansion project; will be okay
• I/R requests $230K commitments to next year’s budget which will increase 2% to price; how do we know that every position is needed
  What is the case load, how many students served and what about the safety, board completion rates, job placement rates, etc.; Departmental recurrent funds are depleted, which has historically been 50% VTH and 50% VCM due to increase in the residents
• Board asked that VTH and VCM Heads make determination about relevance of requests this year.

Other Business:

(Radiation Oncology foster program; New business)

• Dr. Selting is proposing a foster program for Rad Onc patients here for treatment; volunteer program for students.  Students enrolled would be available to make arrangement with owners of patients; liability form would need to be filled out and reviewed by legal

• Ward 4 painting coming off

• Discussion after meeting about technicians and implication of loss of float technician