2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
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
SEPTEMBER 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: September 17, 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
Southern Mono Healthcare District Board of Directors Meeting Agenda September 17, 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.
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 Courtesy Staff Richard Brown, MD – Orthopedics Initial Appointment to Tele-Medicine Staff via Proxy-Radiology Direct Radiology Providers Shameem Azizad, MD John Nwankwo, MD
Daniel Baker, MD William Phillips, MD Michael Berven, MD Teppe Popovich, MD John Boardman, MD Paul Ramirez, MD James Brull, DVM, DO Anjali Roy, MD Lawrence Bub, MD William Rusnak, MD Courtney Carter, MD Dishant Shah, MD Dhawal Goradia, MD Shree Shah, MD Kristen Grubb, MD Frank Snyder, MD Laura Hotchkiss, MD Joseph Trudeau, MD Miriam Hulkower, MD Charles Westin, MD Frederick Jones, MD Anthony Willis, MD Russell Kosik, MD Yuming Yin, MD A Bao Nguyen, MD
Southern Mono Healthcare District Board of Directors Meeting Agenda September 17, 2020
Initial Appointment to Tele-Medicine Staff via Proxy-Neurology Specialty Care Providers Jeffrey Cohen, MD Mark Ross, MD
Ron Tintner, MD Venkatesh Nagaraddi, MD Watcharasarn Rattananan, MD
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:
August 20, 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 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 Stephen Swisher, M.D., Joanne Hunt
5. CEO Annual Review Committee Laurey Carlson, Dave Anderson
6. IT Steering Committee 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
Southern Mono Healthcare District Board of Directors Meeting Agenda September 17, 2020
X. CHIEF EXECUTIVE OFFICER’S REPORT
XI. FINANCE REPORT 1. August 2020 Financial Narrative. 2. Investment Report. 3. Capital Expenditure Review
XII. BOARD EDUCATION
Presentation of the Credentialing Process by Susan Craig, Medical Staff Coordinator, and Craig Burrows, M.D., Chief Medical Officer.
XIII. OLD BUSINESS
There is no old business to discuss.
XIV. NEW BUSINESS
1. Review, Update, and Approval of District Conflict of Interest Code. 2. Review and Approve the Credentialing by Proxy Policy & Procedure. 3. Review and Approval of Credentialing by Proxy Agreements with the following
entities:
• Direct Radiology California, P.C.
• SpecialtyCare IOM Services, LLC 4. Quarterly Review of New and Revised Policies. 5. Quarterly Review of New and Revised Contracts. 6. Review and Approval of professional services agreement between Southern Mono
Healthcare District and Dr. Lucienne Bouvier for the provision of OB/GYN Professional Services.
7. Review and Approval of professional services agreement between Southern Mono Healthcare District and Dr. Michelle Newkirk for the provision of Rheumatology Professional Services.
8. Declaration of Surplus District Property, Equipment and Supplies.
XV. CREDENTIALING
Re-Appointment to Courtesy Staff Richard Brown, MD – Orthopedics Initial Appointment to Tele-Medicine Staff via Proxy-Radiology Direct Radiology Providers Shameem Azizad, MD John Nwankwo, MD
Daniel Baker, MD William Phillips, MD Michael Berven, MD Teppe Popovich, MD John Boardman, MD Paul Ramirez, MD James Brull, DVM, DO Anjali Roy, MD
Southern Mono Healthcare District Board of Directors Meeting Agenda September 17, 2020
Lawrence Bub, MD William Rusnak, MD Courtney Carter, MD Dishant Shah, MD Dhawal Goradia, MD Shree Shah, MD Kristen Grubb, MD Frank Snyder, MD Laura Hotchkiss, MD Joseph Trudeau, MD Miriam Hulkower, MD Charles Westin, MD Frederick Jones, MD Anthony Willis, MD Russell Kosik, MD Yuming Yin, MD A Bao Nguyen, MD Initial Appointment to Tele-Medicine Staff via Proxy-Neurology Specialty Care Providers Jeffrey Cohen, MD Mark Ross, MD
Ron Tintner, MD Venkatesh Nagaraddi, MD Watcharasarn Rattananan, MD
XVI. PUBLIC COMMENTS
XVII. FUTURE BUSINESS
The next Regular meeting will take place on Thursday, October 15, 2020 at 8:00 a.m. via Microsoft Teams and on the Mammoth Hospital conference line.
ADJOURN
2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
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
AUGUST 2020 MONTHLY BOARD MEETING MINUTES Date: August 20, 2020 Place: Mammoth Hospital Administration Conference Rooms A & B 85 Sierra Park Road Mammoth Lakes, CA 93546 Meeting virtually via Microsoft Teams and broadcast live on Mammoth Hospital’s conference line. 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; Zack Brown, Director of Clinics; David Baumwohl, Legal Counsel; Sarah Rea, Recording Secretary.
I. CALL TO ORDER
Chair Anderson called the meeting to order at 8:05 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 Chair Anderson.
III. PUBLIC COMMENTS There were no Public Comments.
IV. CHIEF OF STAFF REPORT Richard Koehler, M.D., gave a brief verbal report. A discussion was held about methods of communication within the organization.
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
V. ADJOURN TO CLOSED SESSION
The Board adjourned to closed session at 8:17 a.m.
VI. REPORT ON CLOSED SESSION
The Board reconvened to open session at 9:37 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.
David Baumwohl reported that QUALITY ASSURANCE issues were not reported by or discussed with Richard Koehler, M.D., Chief of Staff. No action was taken.
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.
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
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 Performance Improvement and Patient Experience Report. 2. Review of the Quarterly Beta Report.
David Baumwohl reported that the quality assurance quarterly summaries were discussed, no action was taken.
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 Michael Bryan-Dermatology Initial Appointment to Fellowship Evan Corning-Orthopedics Matthew Fournier-Orthopedics Re-appointment to Active Medical Staff Mel Cherne-Radiology Re-appointment to Courtesy Staff Paul Polishuk-Urology Sharon Meiselman-Radiology
David Baumwohl reported the foregoing physician CREDENTIALING was discussed; no action was taken.
PERSONNEL MATTERS (Government Code §54957) 1. Review of the Annual Workers Compensation Personnel Claims Report.
David Baumwohl reported that the Annual Workers Compensation Personnel Claims Report was reviewed, no action was taken.
2. Tom Parker, CEO.
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
David Baumwohl reported a discussion took place with Tom Parker, CEO; no action was taken.
Staff and legal counsel left the Board meeting at 9:07 a.m. Tom Parker, CEO, remained in the meeting.
Closed Session ended at 9:23 a.m.
VII. PUBLIC COMMENTS There were no additional 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:
July 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
Stephen Swisher, M.D. moved, seconded by Joanne Hunt, to approve all items on the consent agenda as presented in the packet. Chair Anderson asked for comments; a brief discussion ensued including clarification on the strategic plan report, plans for the new hospital wing, Mammoth Hospital’s Elevate program, and physician recruitment. A roll call vote was taken; the motion passed unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.
IX. COMMITTEE REPORTS
1. Finance Committee (Met on August 17, 2020) 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 meeting; no report.
3. Employee Relations Committee Yuri Parisky, M.D., Joanne Hunt
There was no Employee Relations Committee meeting; no report. The next Employee Relations Committee will be held on August 28, 2020.
4. Quality Assurance Committee Stephen Swisher, M.D., Joanne Hunt
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
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. The next IT Steering Committee will be held on October 13, 2020.
7. Facilities Committee Yuri Parisky, M.D., Laurey Carlson
There was no Facilities Committee meeting; no report. The next Facilities Steering Committee Meeting will be held on September 23, 2020. A brief discussion was held about the new hospital wing project.
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.
X. CHIEF EXECUTIVE OFFICER’S REPORT Tom Parker, CEO, reviewed the following highlights from his written report:
1. The Hospital Incident Management Team (HIMT) is now housed within the Admin Team. The Hospital has seen a significant increase in the number of non-COVID patients. Personal Protective Equipment (PPE) supplies are at 60 days supply on hand at surge rates. A new antigen test has been introduced, which has a faster turnaround than previous tests.
2. A significant number of employees are working from home, and the IT department has been giving them a great deal of support with both technology and ergonomics.
3. There have been no staff infected due to their work in the Hospital. 4. Tom Parker discussed the Specialty Clinic and recognized the room donors. 5. Tom Parker discussed the Day of Golf to be held on September 25 to raise funds for the Cancer
Outreach fund. 6. Tom Parker discussed the newly-developed Strategic Plan. Twice a year, a consolidated report will
be delivered to the Board of Directors and monthly updates will be included in the reports produced by the senior managers.
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
There was a question from David Anderson regarding Labor and Delivery being used as a COVID-positive ward. Deliveries are occurring in Med/Surg. A discussion was held about what the trigger would be to move deliveries back to Labor and Delivery.
XI. FINANCE REPORT
1. July 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 July Net Gain was $541,000 which was $128,000 less than FY2020. Days of cash-on-hand were at 425.5 at the end of July.
XII. BOARD EDUCATION
1. Presentation of the Infusion Program.
Lisa Marusicz, RN, presented the Chemotherapy Infusion-Oncology Nurse Navigator Program. There were some comments and questions from the Board. No action needed.
XIII. OLD BUSINESS
1. Review of the FY 2020 Annual Reimbursement and Disclosure. The Fiscal Year 2020 Annual Reimbursement Report and Disclosure was reviewed. Joanne Hunt motioned to approve the FY 2020 Annual Reimbursement and Disclosure. Laurey Carlson seconded the motion. A roll call vote was taken; the motion passed unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.
XIV. NEW BUSINESS
1. Re-establish Mammoth Hospital Patient Grievance Committee, including approval of process and appointment of committee members. Presentation by Lindsey C. Sarullo, J.D., SMHD Compliance Officer.
Lindsey Sarullo, J.D., SMHD Compliance Officer, presented an overview of the patient grievance process approval and suggestion for committee delegation. It was noted that Stephanie Stanton, Risk Manager/Quality Improvement Specialist, reports patient grievances to the Admin Team on a monthly basis. These results are also reported to the Performance Improvement Committee on a quarterly basis, and to the Board through the Quality Assurance Committee. Stephen Swisher, M.D., moved to re-establish the Mammoth Hospital Patient Grievance Committee, including approval of the grievance process and appointment of committee members as presented today by Mammoth Hospital Compliance Officer Lindsey Sarullo, Director of Quality Lenna Monte, and Risk
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
Manager/QI specialist Stephanie Stanton. Joanne Hunt seconded the motion. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.
2. Declaration of Surplus District Property, Equipment and Supplies. None to declare.
XV. CREDENTIALING
Initial Appointment to Provisional Michael Bryan-Dermatology Initial Appointment to Fellowship Evan Corning-Orthopedics Matthew Fournier-Orthopedics Re-appointment to Active Medical Staff Mel Cherne-Radiology Re-appointment to Courtesy Staff Paul Polishuk-Urology Sharon Meiselman-Radiology
Yuri Parisky, M.D., motioned to extend Dr. Richard Brown’s temporary privileges for 31 days. His
credentialing will come to the September Board meeting along with a template of definition of privileges.
Joanne Hunt seconded the motion, a roll call vote was taken, the motion passed unanimously. A roll call
vote was taken, the motion passed unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes;
Joanne Hunt, Yes; Laurey Carlson, Yes; David Anderson, Yes. Yes 5, No 0.
David Anderson moved, seconded by Laurey Carlson, to approve the appointments as listed above with the
change that Evan Corning and Matthew Fournier will be granted provisional appointment, and with the
exception of Sharon Meiselman and Mel Cherne. A roll call vote was taken, the motion passed
unanimously. Stephen Swisher, M.D., Yes; Yuri Parisky, M.D., Yes; Joanne Hunt, Yes; Laurey Carlson, Yes;
David Anderson, Yes. Yes 5, No 0.
David Anderson motioned, seconded by Joanne Hunt, to approve the appointments as listed above for Drs.
Cherne and Meiselman. Yuri Parisky, M.D., recused himself from the vote due to a conflict of interest. A roll
call vote was taken, the motion passed unanimously. Stephen Swisher, M.D., Yes; Joanne Hunt, Yes; Laurey
Carlson, Yes; David Anderson, Yes. Yes 4, No 0. One recusal, Dr. Yuri Parisky.
XVI. PUBLIC COMMENTS There were no additional public comments.
XVII. FUTURE BUSINESS
Southern Mono Healthcare District
Board of Directors Meeting Minutes
August 20, 2020
The next Regular meeting will take place on Thursday, September 17, 2020 at 8:00 a.m. via Microsoft Teams.
ADJOURN
There being no further business, the meeting was adjourned at 11:12 a.m.
2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
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
DATE: September 17, 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
• FY21 Net Margin is budgeted at 7%.
• FY21 Cash Flow is budgeted to end at 340 days cash on hand.
• YTD Net Margin at August 2020 is $1,173 and 9.3%.
• Days cash on hand on August 31, 2020 was 426 or $95.7 million ($30M operating funds, $10M COVID loan funds, and $56M building project fund).
Involvement in state and national rural health issues
Continue involvement in:
• ACO for Medicare members.
• PRIME/QIP3 for Medi-Cal members.
• District Hospital Leadership Forum (DHLF) for district hospital funding opportunities.
• Received a 93% quality score for meeting our CY19 metrics in the ACO.
• Pop Health team will be submitting the final FY20 metric results in September.
• Pop Health team submitted a survey of the quality metrics that we could do for the next 5-year project which could start January 1, 2021.
• Weekly calls with CFOs to ensure we attain all COVID-19 Emergency Funds as possible
Mammoth Hospital Report to the Board of Directors CFO Report September 17, 2020
Select Operational Updates Patient Accounts Receivable:
August activity and ending AR results are very similar to last August. Gross charges generated in August were slightly higher than last July. When compared to August 2019, volumes for August 2020 are similar in most departments; however, the emergency, radiology and clinics are still behind, but getting better. Financial Audit FY20: Slavka Crouthamel and her team are still answering questions of the auditors and supplying additional support. Additional reserves were booked for accounts receivable to better match the
Gross charges generated 11,555,849$ 13,880,346$ 9,723,718$ 2,690,963$ 6,426,984$ 10,796,836$ 12,309,166$ 12,033,202$
Discharged Not Final Billed 3,221,900$ 3,402,763$ 1,839,332$ 1,412,037$ 2,577,334$ 4,662,449$ 2,974,758$ 3,792,185$
DNFB Days 8.7 7.1 4.2 4.8 12.9 21.1 9.1 9.9
Revenue billed $14,854,625 $20,297,777 $16,661,397 $7,803,887 $6,515,359 $10,863,768 $17,790,165 $14,856,894
Clean Claims % 76% 74% 69% 54% 60% 61% 71% 72%
Pt Acct Collections 5,892,417$ 7,610,236$ 8,957,230$ 5,309,300$ 3,175,159$ 3,865,882$ 5,494,875$ 5,689,902$
AR balance 21,315,815$ 29,210,325$ 24,172,212$ 18,136,068$ 18,829,931$ 21,086,988$ 22,446,121$ 23,731,156$
Gross AR days 57.40 60.63 55.09 62.07 94.20 95.47 68.94 62.18
AR > 120 days 21.0% 19.2% 23.1% 39.4% 40.2% 30.9% 28.2% 23.1%
AR $$ > 120 days 4,478,669$ 5,623,151$ 5,572,581$ 7,141,798$ 7,573,743$ 6,506,881$ 6,325,261$ 5,487,955$
Aug 19
COVID19 Impact
May 20Feb 20 Aug 20July 20Mar 20 Apr 20 June 20
Analyze service line performance
ID high cost service lines. Develop priority for service line review.
• Developing reports to be pulled out of Cerner to start this process
Partner with tertiary hospitals
Potential benefits: Exchange physician services. Improve patient handoffs. Training for staff. Shared staffing. Improve physician satisfaction & retention.
• We have a signed MOU with Lake Tahoe Sports Medicine to share the Orthopedic Fellows this year.
• Fellow will start working with Drs. Crall and Gilmer in November.
Mammoth Hospital Report to the Board of Directors CFO Report September 17, 2020
recent collection averages. The financial results are still very strong with a total margin exceeding 17%. We still need to draft the audit report and write the narrative section. It is possible the draft audit report can be presented to the Board in October. Success Sharing 2019/20: The 2019/20 goals for the employee Success Sharing maximum distribution of $1,200 were met and we are targeting a pay out to employees on September 25, 2020. Budget 2020/21: With the August financials completed, we will resume the budgeting process for FY20/21. Monthly historical volumes by department will be reviewed and estimates will be made for the current year. Unfortunately, we have had too many “unprecedented events” that cause more than normal uncertainty for budgeting. Now with the fires and the closing of the National Forest, we are faced with another hinderance to normal visitors in our town. We plan to bring a draft budget to the Board Finance Committee in November or December. For now, we will continue to present financials with a comparison to the prior year monthly numbers—this is a good gage on how we are doing.
2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
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
DATE: September 17, 2020 TO: Board of Directors FROM: Caitlin Crunk RN BSN CNO RE: CNO Report, Regular Meeting of the Board of Directors
Strategic Plan Updates
Title Description Update
Be a High Reliability Organization with Quality outcomes that exceed national benchmarks
Continue to work on process improvement and Just Culture
• Just Culture algorithms are being used during counseling and coaching with employees.
Right size the organization according to demand and community need
Explore new ways to create efficiency of staff and space resources.
• All meetings have been moved to web-based platforms.
• Staffing models designed to be “COVID-capable.”
• The majority of non-clinical staff is working from home when able.
Achieve better than national benchmark scores in customer satisfaction surveys and internal employee and provider satisfaction surveys
Increase awareness of customer issues.
• The Quality team and interpreters have designed a questionnaire to give to patients upon discharge to help identify issues regarding equity and diversity.
• Patient Family Advisory Council (PFAC) looking to recruit more diversity within the group.
Improve retention and reduce turnover
Analyze turnover of staff and providers.
• Quality team issued a survey to the
Mammoth Hospital Report to the Board of Directors CNO Report September 17, 2020
perioperative department, including staff and physicians, to get a better understanding of the turnover of the director role. Improvement project to follow to hopefully reduce turnover in this particular department and role.
Select Operational Updates People
• Staff is continuing to flex to volumes.
• Currently looking to fill the role of OR Manager.
• Dietary Supervisor position is still open. Nancy Vargas has begun her schooling for the role, with an anticipated completion date in eight months.
Quality and Safety
• Standardization of sedation protocols by RNs are being implemented in the radiology department.
• The night shift supervisors are performing annual regulatory training to all RNs.
Service
• Continuing to have successful deliveries and post-partum care on Med/Surg. The OB unit is still set up for COVID-19 patients. We have not had a positive COVID-19 patient in the hospital since August 16.
Growth
• We have acquired more ventilators and Vapotherm machines to have the ability to care for more COVID-positive patients if needed.
2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
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
DATE: September 17, 2020 TO: Board of Directors FROM: Mark Lind, CIO RE: CIO Report; Regular Meeting of the Board of Directors
Strategic Plan Updates
Title Description Update
Improve analytical tools for Population Health (automated vs. Excel)
Implement a Population Health software solution that is scaled to our managed population and community but still provides tools to automate registry management, care coordination, and regulatory reporting.
• Pop Health team worked with IT to select i2i. This solution is offered through Cerner as an integrated solution.
• Project kickoff completed. I2i project team working on integration and gathering reporting requirements. Kate Britton leading project.
Explore new ways to create efficiency of staff and space resources (work from home, additional space, and virtual environment)
• Metric: 10% of patient visits are telehealth.
• Metric: 80% of non-patient facing staff are set up to be able to work from home.
• Cerner Video Visits in place in March. In broad use during initial COVID lockdown through present. Significant improvement in performance with Cerner updates in July.
• Great majority of staff whose job does not require that they be on-site sent home with hospital laptops and support equipment. Massive IT push to facilitate Patient Accounting and other areas June-August.
Mammoth Hospital Report to the Board of Directors CIO Report September 17, 2020
Select Operational Updates Biomedical Engineering:
Two Hamilton ventilators, ordered back in April, arrived this month. The biomed techs are
working to set up, calibrate, and on-board the equipment for use. This brings our Hamilton
(state of the art ventilators) up to three units. Two additional VapoTherm units in service last
month in support of this more recent trend in COVID treatment. Removing some of the
antiquated ventilators we received from various donors to onsite disaster equipment storage as
the are not needed with current patient volumes. This surplus equipment is being carefully
protected and wrapped with plastic as well as being stored in a temperature-controlled location
to ensure it remains ready for use if needed.
Facilities and Safety:
In addition to standard maintenance activities, the team continues to work on projects. New
glass screens were installed in the Bishop Clinic, Women’s Clinic and Dental. We have an OSHPD
project underway to update the Admitting and Financial services windows with proper security
glass also, but this will take time to get through the regulatory process. Updated cameras are
now installed in many locations where we have high patient activity and need to actively
monitor.
The team has also been working to ready our buildings for the winter. Exterior paint touch-up
of the clinics is ongoing. Jeff McMillan will also be installing new coils in our secondary HVAC
unit this coming month. The existing unit has some small cracks in the existing coils due to age,
and we had to wait until cooler weather to take it offline.
In July and August, Trapper Felt, Safety and Security Specialist, implemented a new program to
replace our staff screening team with per diem staff. We had been staffing this function with
staff from our clinical areas. With our greatly increased patient volumes, it was very difficult to
Survey sent to managers this month to measure for established metric of 80% staff able to work at home threshold. Tentative score of 89%, so we seem to be exceeding the threshold. The weighted average for the percentage of time working from home versus at work is 57.2%.
Mammoth Hospital Report to the Board of Directors CIO Report September 17, 2020
keep this key COVID screening function working. Trapper worked with Human Resources to
develop a job description and in hiring staff from the community. The program has gone very
well with these new team members screening all staff as they come on site to the main
campus. Our logs are being kept per State requirements. Kudos to Trapper for stepping up into
this supervisory position and for creating this new function in a relatively short period of time.
Information Technology:
Work has shifted this month to a critical IT infrastructure project. Brian Weller is working on a
major replacement project for our server host solution. We are moving to a Dell integrated
solution to host our 100-plus onsite servers. Our old platform had reached end of life. The new
solution simplifies update and maintenance as our virtual software solution VMWare is now
owned by Dell and software releases are included in our support and validated and bundled
prior to release. This makes it much easier to stay current on releases, with one vendor to deal
with and not several. The project is expected to go well into October. Zero downtime is
projected as we can move server instances in real-time with no impact to the end user.
In Informatics, we released a new EMR Satisfaction survey this month. Last year we started this
process, which uses the results to determine which departments are struggling so that we can
work with them through our Sprint process to effect improvements in EMR setup, optimize
configuration, and provide training to staff and providers. To date, we have completed Sprints
in the PACU, PT-OT, and Perioperative Materials. The Periop Sprint is largely complete but is in
a bit of a holding pattern until we can get the OR3 and associate OR storage projects
completed. We have started a sprint in Chemo, but it is pending due to staff availability at
present. Once the results of this latest survey are reviewed by the EMR Governance Team, we
will identify which additional departments need attention and start new sprint projects. More
to come next month.
Laboratory:
Jaime Sallee, Lab Manager, has completed the process to set up our pathologist, Dr. Payton,
under our CLIA licensing to perform reads from his home office. As he commutes up from
Oceanside, and is only onsite several days a week, this will improve our turnaround time. The
lab will be able to overnight specimens to Dr. Payton for an immediate read any day of the
week, not just Thursday through Saturday. This also provides Dr. Payton some relief in dealing
with weather events or other issues with his long commute. Kudos to Jaime for stepping
through this involved process with CLIA.
Medical Imaging:
Clinical evaluation of the first of the new demo C-Arms for the OR3 and Interventional
Radiology went well this past month. Dr. Harrell reports he is happy with this unit. We have one
additional unit coming this month which is looks promising. Functionality of these state-of-the-
Mammoth Hospital Report to the Board of Directors CIO Report September 17, 2020
art C-Arms is much advanced over the older units, with better automatic tracking to account for
patient movement and clarity of the images.
A project to upgrade our Philips PACS is planned for kick off in September. This will upgrade our
onsite equipment to improve performance and storage as well as update our PACS version to
the current version. Changes to the software release will largely be incremental and of minimal
impact. Training for the Radiologists and Rad Techs to be scheduled when appropriate.
2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
Mammoth Hospital P.O. Box 660 | 85 Sierra Park Road | Mammoth Lakes, CA 93546 | 760.924.4114 | Fax 760.934.4104
www.mammothhospital.com
METICULOUS CARE * MEMORABLE PEOPLE * MAJESTIC LOCATION
DATE: September 17, 2020
TO: Board of Directors
FROM: Sarah Vigilante, HR Director
RE: Human Resources Report, Regular Meeting of the Board of Directors
Strategic Updates
Title Description Update
Redesign Staff Education Program
• Consolidate staff development budget and administration under Human Resources.
• Work with nurse management to develop a strategic education plan for the organization.
• Develop a mentoring program for providers, staff and managers.
• Hired a Staff Development Coordinator with strong nursing education background to start September 14 per diem, then full time in November.
Explore new ways to create efficiency of staff and space resources (work from home, additional space, and virtual engagement)
• Set-up staff to work from home and rotate in the office.
• Conduct orientation via Teams.
• All direct reports are working remotely and splitting time in the office when necessary.
• Several orientation presenters are now presenting via Teams and the conference room has been physically spaced for new hires.
Analyze turnover of staff and providers
• Add exit interview for providers.
• Provide exit interview
• Senior Managers have begun taking over the exit interview process in order to deliver
Mammoth Hospital Report to the Board of Directors HR Report September 17, 2020
information to PI committee.
• Conduct stay interviews.
direct feedback and take action.
Evaluate our recognition programs
• Design recognition programs to enhance employee engagement.
• Management recognition will now be done in the individual departments with Senior Managers recognizing employees personally.
• Grateful patient recognition will be done at the departmental level with the Foundation Coordinator attending a departmental committee meeting to recognize any providers who receive donations in their name.
Conduct a comprehensive review and redesign of our annual performance review and compensation processes
• Develop a compensation philosophy.
• Create a timeline for implementation of changes.
• Pull custom CHA data report excluding Inland Empire.
• Perform detailed salary administration analysis.
• Work with Finance to understand budgetary implications and plan changes for July 2021.
• Senior Leaders met with Gallagher Consulting in June to revisit process.
• Senior Leaders had a special meeting to discuss compensation philosophy and make key decisions going forward.
• Plan presented to Employee Relations committee in August.
• Senior Admin are going over all pay policies in detail as a part of this review. At this time, the pay policy review is 95% completed.
Develop a coordinated onboarding process for providers
• Enhance onboarding process for new providers.
• Currently utilizing a checklist and form to be filled out by providers when they come on board.
• New providers also take a Healthstream course to
Mammoth Hospital Report to the Board of Directors HR Report September 17, 2020
Select Operational Updates:
• 90 employees have utilized FFCRA funds.
• As of September 8, we have not had a single employee exposure to COVID that has been
linked to the hospital. All COVID positive employees have been linked to a household
contact or other employment. At this time, we have <1% of our workforce not working
or on a reduced schedule due to childcare challenges, quarantining due to a household
or other exposure, and/or COVID-19. The staffing challenges that we experienced in July
and August have lessened over the past month, although working parents continue to
experience issues with school closures which are expected for the remainder of the
semester.
Employees Not Working Regular Schedule
26
COVID Sick (includes quarantining)
1
Other Sick 1
Intermittent Childcare Related Absence
24
COVID Kincare 0
• The Mammoth Hospital Foundation Board held a meeting last month and made the selection of an annual appeal item . This year’s item will be a SIM baby to be used by our Labor and Delivery department.
• Mammoth Hospital received a $12,000 annual donation (and pledge) for Rhiannon’s Kids fund which is used by pediatric patients that need to travel out of town for care.
• Employee Health has begun to administer the annual flu vaccines to staff.
• Tina Villa, HR Generalist – Benefits, is now on leave.
• Our widest-reaching social media post was by far our most recent press release on a COVID-related patient death. This post reached over 12,000 people and was shared 93 times. Our second most successful post was a video by Dr. Clark encouraging patients to not delay clinic appointments for routine care. Our clinics have remained below normal volumes and our print advertising has and will continue to be focused on the clinics.
introduce them to Mammoth Hospital policies and procedures.
Finance Committee Minutes Date: Monday, August 17, 2020 Time: 4:30 pm Location: Teams Attendees: Tom Parker; Stephen Swisher; Melanie Van Winkle; Slavka Crouthamel; Caitlin Crunk. The meeting was called to order by Dr. Swisher at 4:30 pm. Not present: Dave Anderson.
Agenda Item:
Discussion/Conclusion/Action
Follow-up
Review of Minutes • July 13, 2020 minutes were reviewed. No changes were requested. Minutes approved.
Follow-up • Dr. Swisher said that ER diagnostic test professional fee capture looks pretty good now.
• No update on the price transparency issue.
Financials – July 2020 Melanie went over the PowerPoint with the group.
• Pretty good collection month. Cash went down about $1.3 M from June to July due to the timing of accounts payable and accrued payroll. Basically reduced liability so cash went down.
• No budget yet. Red line is 3-year average on PowerPoint.
• Clinics not quite back up to regular volume.
• Payor mix was much better in July.
• Increased unemployment - 72 total employees. Benefits expense higher.
• Margin 8.6%, goal 7%.
• Cash $95.3 Total Cash = 425.5 days cash on hand. o $30.2 operating cash (135 days cash on hand), o $9.9 COVID loans/advances (44.5 days cash on hand), o $55.1 cash reserves (246 days cash on hand).
• See Financial PowerPoint.
Healthcare Spending Accounts and Billing
Melanie went over the memo regarding HSA and billing with the group. • See HSA memo.
Mammoth Hospital Finance Committee Minutes – August 17, 2020
Page 2 of 2
• There was discussion about the difference between HSA and FSA accounts. Requirements are slightly different.
• EOB is typically sufficient for flexible spending account documentation.
• We moved away from detailed billing to improve overall complaints about 10 years ago.
• Dr. Swisher agrees with Management’s recommendation not to make any changes to billing detail on patient statements.
Eide Bailly FY20 Audit Late Charge Revenue Postings
• Every year auditors point out how much revenue was generated at the end of the year that was not posted until July. Typically ~$200,000. This year $657,000. $450,000 this year related to surgery. Either way does not affect cash in the bank.
COVID-19 Activities Emergency Funding:
• We have not had any more COVID funding coming in.
• Have been looking at how to allocate COVID19 expenses and lost revenue.
• CFO Report: will probably start picking up on the budget in mid August.
Other Business • Dr. Swisher recommended that we move forward with hospital-wide 5% increase before budget is finalized. This would go to the board for approval at the September meeting.
• Melanie will bring back a recommendation in for the September board meeting.
Next Meeting • Next meeting: Monday, September 14, at 4:30 pm.
Meeting adjourned at 5:05 pm.
2019 Press Ganey Guardian of Excellence Award Winner
________________________________________________________________________________________________________
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
DATE: September 17, 2020 TO: Board of Directors FROM: Tom Parker, CEO RE: CEO Report, Regular Meeting of the Board of Directors
COVID-19 (C19): C19 planning continues to be done by the Admin Team having transitioned those duties from the Hospital Incident Management Team (HIMT). Personal Protective Equipment (PPE) supplies on hand remain high with 60-plus days at surge use rates for all critical supplies needed to manage C19 patients. This includes the new antigen test which provides 15-minute turnaround of results. As of the writing of this report, there have been 163 positive results from C19 testing in the community. That number has plateaued since mid-August. The seven-day positivity testing rate has been at zero since August 27. One new positive test came in on Friday, September 11. To date, there have been no cases of staff having been infected as a result of work in the hospital setting. All COVID-positive employees have been linked to a household contact or other employment. At this time, 1 percent of our workforce is not working or on a reduced schedule due to childcare challenges, quarantining due to a household or other exposure, and/or C19. This is down from 8 percent last month. Labor & Delivery services continue to operate out of Med/Surg. This has allowed for the L&D unit to serve as the inpatient unit for C19+ patients. The new screening team is now fully staffed and under the supervision of Safety and Security Specialist Trapper Felt. Our thanks to clothing brand Johnny Was for donating hundreds of fashionable masks for hospital staff! July Financial Results: Total Gross Revenue of $11.9m in August is $300k lower than July and $466k higher than August of last year. Net Gain in August was $633k, up from the July net gain of $541k and less than last year’s August Net Gain of $741k. Year-to-date Net Gain is $1.2m (9.3% Total Margin) compared to last year at this time of $1.4m (11.2% Total Margin).
Mammoth Hospital Report to the Board of Directors CEO Report September 17, 2020
Budget 2020/21: With the August financials completed, we will resume the budgeting for FY2020/21. Monthly historical volumes by department will be reviewed and estimates will be made for the current year. Note that we have many unprecedented events of late that increase the uncertainty in the budgeting. A draft budget will be presented to the Board at the November or December Board meeting. IT: The IT department began its work on the replacement of our server host in August, moving to a Dell integrated system for hosting over 100 onsite servers. The new system will facilitate simplified updating and maintenance and reduce maintenance-related downtime. Lab: Lab Manager Jamie Sallee has completed the process to set up our pathologist, Dr. Payton, under our CLIA licensing to perform reads from his home office. The lab will overnight specimens to him for immediate reads, greatly improving our turn-around time. Medical Imaging: Evaluation has been completed on the first of the new demo C-arm unit to be used for OR3 and interventional radiology. Dr. Harrell was happy with the unit. Another unit will be demoed and evaluated this month. A project to upgrade the Philips Picture Archiving Computer System (PACS) begins this month. The upgrade is expected to improve system performance and storage. Quality: The Quality team and interpreters have designed a questionnaire to give to patients upon discharge to help identify issues we may have with respect to equity and diversity. Also, the Patient and Family Advisory Council (PFAC) is working to recruit more members with a focus on improving the diversity of the group. The Quality team issued a survey to the Perioperative department including staff and physicians to get a better understanding of the turnover in the director role. The survey information will be used in an improvement project with the goal of reduced turnover in the department and the director role. Foundation: The Mammoth Hospital Foundation Board made the selection for the annual appeal item. The Foundation will raise funds for the purchase of the “SIM Baby” to be used for training of nurses and providers in Labor and Delivery. The simulation baby will provide more realistic hands-on training for low-volume high-risk situations such as neonatal resuscitation. The Cancer Outreach Day of Golf will take place on September 25 with COVID-safe requirements in place to ensure the safety of players and volunteers. The teams are nearly full and we have vendors who are sponsoring in compliance with the safety protocols. HR: Work continues on the comprehensive review and redesign of our annual performance review and compensation processes. Senior leaders met with Gallagher Consulting in June. Subsequently, senior leaders met to refine the compensation philosophy. The draft of the plan was presented to the Board’s Employee Relations Committee in August. As part of the comprehensive review, senior leaders are reviewing all pay policies at the weekly Admin Team meetings; 95 percent of that review process is complete.
2019 Press Ganey Guardian of Excellence Award Winner
MEMORANDUM
==============================================================================
DATE: September 17, 2020
TO: The Board of Directors
FROM: Melanie Van Winkle, CFO & Slavka Crouthamel, Controller
SUBJECT: Financial Statements for two months ended August 2020
==============================================================================
This memorandum presents an overview of Mammoth Hospital financial operations.
BALANCE SHEET
• The August month end Cash balance was $95.7 million – $271 thousand higher than July. Days
cash are 426 days in total.
o Operating cash at 135 days
o COVID advances & loans at 45 days
o Capital/Facility project reserve at 246 days
• Net Patient Accounts Receivable was $11.0 million, which is $617 thousand higher than prior
month.
• Prepaid expenses decreased by $311 thousand compared to July due in part to a $223 thousand
Beta Dividend check received in August, which offsets prepaid expenses.
• Due to Third party payers decreased by $256 thousand mainly due to IGT transfer for PRIME
project funding.
FINANCIAL INDICATORS
• Patient Cash Collections in August were $5.7 million, $280 thousand over prior month. YTD
patient account collections are $11.2 million compared to $13.1 million for the same period last
year
• Gross AR days increased to 67.9 from 64.8.
• AR over 120 days decreased to 23.1% at August month end compared to 27.9% in July.
• Gross revenue was $11.9 million in August – $300 thousand under July, but $466 thousand over
prior year.
Southern Mono Healthcare District
Report to the Board of Directors
Financial Report
September 17, 2020 VOLUMES
Month of August summary:
• Inpatient days were 134 – 4 higher than prior month, but 14 less than August 2019. The Case Mix
index was 1.534, which is higher than our average due to the volume of ICU days.
• Total surgeries were 120 in August compared to 118 in July and 134 in the prior year. Inpatient
surgeries were 34 (prior year 37) and Outpatient surgeries were 86 (prior year 97).
o Endoscopies & Colonoscopies were 49 in August – versus 20 in July and 46 in the prior
year.
• The Emergency Department had 831 visits compared to 943 in July and 1,041 in the prior year.
• Clinic visits finished at 3,305 – lower than July by 178 visits and lower than prior year by 727
visits. The most significant decline was in Family medicine clinic visits – 450 visits less than
August 2019 and 112 visits lower than July 2020 – all FM providers had vacations during the
month of August.
INCOME STATEMENT
Month of August
Revenue:
Total Gross Revenue decreased slightly to $11.9 million versus $12.2 million in July, but was $466
thousand higher than August 2019. Net Patient Revenues as a percentage of Gross Revenue continued
to improve from July to August, 51.5% to 52.7% - due to more favorable payer mix and aging.
August 2020 Expenses:
OPERATING EXPENSES Current Prior
Year Variance
%
Variance Brief Comments
Salaries $2,050 $1,988 $62 3%
Benefits 953 754 $198 26% Health insurance expense increase
Professional services 1,233 1,406 ($173) -12% Lower than last year due to lower clinic, surgery and ER volumes
Contract services 65 36 $30 83%
Supplies 660 585 $75 13%
Services 689 737 ($48) -7%
Total Expenses $5,650 $5,507 $143
Southern Mono Healthcare District
Report to the Board of Directors
Financial Report
September 17, 2020
Net Gain
• The August net gain was $633 thousand compared to July’s net gain of $541 thousand and $741
thousand net gain in August 2019.
Year to Date
• Total Gross Revenue of $24.1 million is $636 thousand higher than the prior year.
• Total Net Patient Revenue (collectable revenue) was $12.5 million, on par with the prior year.
• Total Operating Expenses of $11.4 million are $150 thousand higher than prior year.
o Both Salaries and Benefits are over prior year seeing unfavorable increases of $141 and
$319 thousand, respectively with the highest difference in employee insurance costs.
o Professional Services (physician payments) are $383 thousand under prior year – this is
due to lower volumes for some key areas
o The $123 thousand unfavorable variance in Supplies is offset by a $127 thousand
favorable variance in Services compared to prior year.
• The Year to date Net Gain was $1.2 million (9.3% total margin) compared to the prior year gain of
$1.4 million (11.2 % total margin).
9/9/2020
SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - August 31, 2020
Unaudited Unaudited Unaudited
August 31, July 31, Prior Month June 30,
ASSETS 2020 2020 Change 2020
CURRENT ASSETS:
Cash (135 days operating expenses) $30,242,372 $30,242,430 ($58) $19,609,830
Cash (reserved for building projects) 63,676,097 63,405,021 271,077 75,333,596
Investments 1,743,179 1,743,179 0 1,745,882
Total Cash 95,661,648 95,390,630 271,019 96,689,308
Patient accounts receivable 23,825,084 22,540,069 1,285,015 21,212,228
Less: Allow. for bad debts and contractuals (12,794,757) (12,126,633) (668,124) (11,555,928)
Net patient accounts receivable 11,030,327 10,413,436 616,891 9,656,299
Inventory 1,950,711 1,930,393 20,317 1,945,031
Prepaid expenses & deposits 562,410 874,202 (311,792) 710,431
Other current assets 1,184,098 686,953 497,145 459,465
Total Current assets 110,389,194 109,295,614 1,093,581 109,460,534
ASSETS LIMITED AS TO USE:
Bond funds held in trust by Mono County:
Mono Co Bond Capital Appreciation Fund 10,544,488 10,544,488 0 10,544,488
Debt service fund 1,547,292 1,547,292 0 1,547,292
Restricted by contributors 168,606 142,056 26,550 121,565
Total Assets Limited As To Use 12,260,386 12,233,836 26,550 12,213,345
PROPERTY, PLANT & EQUIPMENT:
Land and improvements 7,933,576 7,933,576 0 7,933,576
Buildings and improvements 56,767,838 56,767,838 0 56,767,838
Equipment 35,497,431 35,497,431 0 35,497,431
Construction-in-progress 441,142 398,281 42,861 329,118
Total Property, Plant and Equipment 100,639,988 100,597,126 42,861 100,527,963
Less: Accumulated depreciation (58,735,034) (58,351,463) (383,571) (57,967,170)
Less: Accumulated amortization (2,077,080) (2,077,080) 0 (2,077,080)
Net Property, Plant and Equipment 39,827,874 40,168,584 (340,710) 40,483,714
Total Assets $162,477,455 $161,698,034 $779,421 $162,157,593
Page 1
9/9/2020
SOUTHERN MONO HEALTH CARE DISTRICT Comparative Balance Sheet - August 31, 2020
Unaudited Unaudited Unaudited
August 31, July 31, Prior Month June 30,
LIABILITIES 2020 2020 Change 2020
CURRENT LIABILITIES:
Accounts payable and accrued expenses $3,152,165 $3,304,015 ($151,850) $3,882,202
SBA Loan 5,265,405 5,265,405 0 5,265,405
Accrued payroll-related liabilities 4,396,041 4,010,730 385,311 4,685,002
Patient refunds 103,982 70,364 33,618 125,809
Due to third party payers 6,117,170 6,374,086 (256,916) 6,197,015
Accrued interest on long term obligations 242,143 211,144 30,999 180,146
Current portion of long-term debt 1,130,000 1,130,000 0 1,015,000
Health plan IBNR 822,000 822,000 0 822,000
Total Current liabilities 21,228,905 21,187,743 41,162 22,172,578
LONG-TERM DEBT:
Unamortized bond premium 916,699 927,367 (10,668) 938,036
Capital appreciation interest payable 10,589,481 10,499,692 89,788 10,409,904
General Obligation Bonds 12,509,555 12,509,555 0 12,624,555
Total long term debt 24,015,734 23,936,614 79,120 23,972,494
Total Liabilities 45,244,640 45,124,358 120,282 46,145,072
NET ASSETS:
Invested in capital assets net of related liabilities 14,682,140 15,101,970 (419,830) 15,496,219
Restricted - expendable for specific operating activities 168,026 141,476 26,550 121,045
Restricted - expendable for debt service 12,091,780 12,091,780 0 12,091,780
Unrestricted 89,117,616 88,697,786 419,830 73,481,336
Year to date earnings 1,173,252 540,665 632,588 14,822,139
NET POSITION: 117,232,814 116,573,677 659,138 116,012,520
Total Liabilities and Net Position $162,477,455 $161,698,033 $779,421 $162,157,592
Page 2
SOUTHERN MONO HEALTH CARE DISTRICT
Statement of Revenues & Expenses - August 31, 2020
Prior Month Actual Prior Year
Variance to Prior Year OPERATING REVENUE Actual Prior Year
Variance to Prior Year
(000s omitted)/1000
$3,333 $3,276 $2,849 $426 Inpatient services $6,608 $5,370 $1,238
5,781 5,940 5,904 37 Outpatient services 11,721 12,336 (615)
2,390 1,994 1,849 145 Professional fees services 4,384 4,047 337
690 669 811 (141) Clinic services 1,359 1,683 (323) 12,193 11,880 11,413 466 Total Gross Revenue 24,073 23,436 636
(5,056) (5,211) (5,015) (196) Contractual & other discounts (10,267) (9,794) (474)
(406) (65) (445) 381 Charity write offs (471) (834) 363 (446) (347) 222 (569) Provision for bad debts (793) (265) (529) - - - - Supplements/Settlements - - -
6,285 6,256 6,174 83 Net Patient Revenue 12,541 12,544 (3)
27 22 30 (8) Other operating revenue 49 66 (17)
6,312 6,278 6,204 75 Total Operating Revenue 12,590 12,610 (20)
OPERATING EXPENSES
$2,085 $2,050 $1,988 (62) Salaries $4,135 $3,995 (141)
932 953 754 (198) Benefits 1,885 1,566 (319)
1,332 1,233 1,406 173 Professional services 2,565 2,948 383
79 65 36 (30) Contract services 144 67 (78)
735 660 585 (75) Supplies 1,394 1,272 (123)
611 689 737 48 Services 1,300 1,428 127 5,774 5,650 5,507 (143) Total Expenses 11,425 11,275 (150)
537 628 697 (68) OPERATING GAIN (LOSS)/1000 1,165 1,335 (170)
$376 $375 $348 (27) Depreciation & amortization $751 $708 (43)
$161 $253 $348 ($95) Operating Gain (Loss) after Depreciation $414 $628 ($213)
NON-OPERATING INCOME(EXPENSE)/1000
$0 $0 $0 - Gain (loss) on sale of property $0 - -
- - - - Donation income - - -
227 227 215 12 Bond property tax revenue 454 431 23
(119) (119) (117) (1) Bond interest expense (237) (235) (2)
270 270 269 1 Property tax revenue & interest income 541 539 2
0 0 26 (25) Interest expense 1 48 (47) 379 379 393 (14) Total Non-Operating Income (expense) 759 783 (24)
$541 $633 $741 ($109) Increase in net assets - net gain (deficit) $1,173 $1,410 ($237)
8.6% 10.1% 11.9% -1.9% Total Margin 9.3% 11.2% -1.9%
August-20 Year-to-Date
Page 3
SOUTHERN MONO HEALTH CARE DISTRICT
Key Statistical Data - August 2020
Prior Month Actual Prior Year
Variance to Prior
Year Hospital Statistics Actual Prior YearVariance to Prior Year
31 31 31 Days in month 62 62Acute Patient Days:
9 18 15 3 ICU Days 27 27 - 114 107 129 (22) Med/Surg & Telemetry Days 221 231 (10)
7 9 4 5 Labor & Delivery Days 16 20 (4) 130 134 148 (14) Total Acute Patient Days 264 278 (14)
4.2 4.3 4.8 (0.5) Average Daily Census (ADC) 4.3 4.5 (0.2) 33.6% 31.9% 29.2% 2.7% % of IP Revenue to Ttl Revenue 32.8% 27.4% 5.4%
2.1 2.7 2.4 0.3 Average Length of Stay (ALOS) 2.4 2.2 0.2
63 49 61 (12) Discharges 112 127 (15)
1.577 1.534 1.465 0.069 Case Mix Index 1.562 1.401 0.16
Other Key Hospital Statistics:943 831 1,041 (210) ED Visits 1,774 2,154 (380) 516 552 660 (108) Observation Hours 1,068 1,348 (280)
4 9 4 5 Deliveries 13 13 -
34 34 37 (3) IP Surgeries 68 67 1 84 86 97 (11) OP Surgeries 170 203 (33)
118 120 134 (14) Total Surgeries 238 270 (32)
85 84 89 (5) MRI Procedures 169 168 1 196 195 206 (11) CT Scans 391 414 (23)
65 68 85 (17) Mammography Procedures 133 156 (23) 146 131 128 3 Ultrasound 277 285 (8) 978 949 1,192 (243) Radiology 1,927 2,409 (482)
1,470 1,427 1,700 (273) Total Imaging 2,897 3,432 (535)
7,468 7,352 7,498 (146) Lab Tests 14,820 15,483 (663) 6,301 6,256 7,422 (1,166) Pharmacy Units 12,557 14,781 (2,225) 2,007 2,044 2,216 (172) PT/OT Visits 4,051 4,348 (297)
Clinic Visits1,216 1,094 1,544 (450) Family Medicine clinic 2,310 3,145 (835)
350 291 205 86 Behavioral Health clinic 641 388 253 307 262 315 (53) Women's clinic 569 624 (55) 357 302 416 (114) Pediatric clinic 659 809 (150) 473 583 619 (36) Ortho Mammoth clinic 1,056 1,193 (137) 272 247 294 (47) Ortho Bishop clinic 519 627 (108) 157 191 117 74 Specialty clinic 348 321 27
53 95 89 6 Surgical clinic 148 230 (82) 298 240 433 (193) Dental clinic 538 927 (389)
3,483 3,305 4,032 (727) Total Clinic visits 6,788 8,264 (1,476)
August-20 Year-to-Date
Page 4
Mammoth Hospital
All Statistical Analysis
Dept # Dept Name Unit of Service Desc
Jul 2020
Aug 2020
ActualAugust
2019
YTDTotal
6010 ICU Patient Days 9 18 15 276170 Med/Surg Patient Days 85 65 79 1506170 Telemetry Patient Days 29 42 50 717400 L & D Patient Days 7 9 4 16
Total Acute Patient Days 130 134 148 264
6380 Observation Patient Days 22 23 28 456380 Observation Hours 516 552 660 1,0686530 Nursery Patient Days 7 10 4 177400 L & D Pre-delivery hours 18 19 62 377400 L & D Deliveries 4 9 4 13
7080 Family Medicine Clinic Patient Visits 1,216 1,094 1,544 2,3107080 Behavioral Health Clinic Patient Visits 350 291 205 6417050 Women's Clinic Patient Visits 307 262 315 5697090 Pediatric Clinic Patient Visits 357 302 416 6597160 Ortho Mammoth Clinic Patient Visits 473 583 619 1,0567140 Ortho Bishop Clinic Patient Visits 272 247 294 5197180 Specialty Clinic Patient Visits 157 191 117 3487110 Surgical Clinic Patient Visits 53 95 89 1487060 Dental Clinic Patient Visits 298 240 433 538
Total Clinics 3,483 3,305 4,032 6,788
7010 ED Patient Visits 943 831 1,041 1,7747040 Ambulance Work days 22 21 22 437420 Surgery Minutes 15,930 17,580 17,235 33,5107420 IP surgeries Procedures 34 34 37 687420 OP surgeries Procedures 84 86 97 1707420 Colo/Endo Procedures Procedures 20 49 46 69
7427 PACU Minutes 13,770 13,695 16,200 27,4657500 Lab Tests 7,468 7,352 7,498 14,8207590 EKG's IP Procedures 16 12 29 287590 EKG's OP Procedures 146 161 185 3077641 Chemotherapy Patient Visits 36 39 56 757710 Pharmacy Units 6,301 6,256 7,422 12,5577720 Respiratory Unique Patients 198 173 630 371
7630 Radiology Patient Visits 978 949 1,192 1,9277635 Mammography Patient Visits 65 68 85 1337660 MRI Patient Visits 85 84 89 1697670 Ultrasound Patient Visits 146 131 128 2777680 CT Scan Patient Visits 196 195 206 391
Total Imaging Procedures 1,470 1,427 1,700 2,897
7770 Mammoth PT Visits 1,089 1,109 1,198 2,1987772 Bishop PT Visits 792 724 793 1,5167773 Bishop OT Visits 54 102 76 1567790 Mammoth OT Visits 72 109 149 181
Total Visits PT/ST/OT 2,007 2,044 2,216 4,051
Southern Mono Healthcare DistrictLAIF Investment
9/9/2020
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
9/9/2020
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
Balance as of June 30, 2020 74,904,966
Interest 7/15/2020 95,034
Balance as of July 31, 2020 75,000,000
Balance as of August 31, 2020 75,000,000
Z:\BankAccounts\LAIF\LAIF Activity.xlsx
SOUTHERN MONO HEALTH CARE DISTRICT
Investments Summary - July 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 247,000 248,156 0.32%BMW Bk NA Salt Lake 2.05% 11/29/2017 11/30/2020 Union Banc Investment Services 247,000 248,237 0.32%American Exp Fed Svgs Bk 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 248,366 0.32%American Express Centrn 2.10% 12/5/2017 12/7/2020 Union Banc Investment Services 247,000 248,366 0.32%Capital One Natl Assn VA 2.10% 12/6/2017 12/7/2020 Union Banc Investment Services 247,000 248,366 0.32%Wells Fargo Bank Natl Assn 2.10% 12/8/2017 12/8/2020 Union Banc Investment Services 249,000 250,377 0.33%Sallie Mae Bk Slt Lake City UT 2.10% 12/13/2017 12/14/2020 Union Banc Investment Services 247,000 248,462 0.32%
1,731,000 1,740,330 2.27%
Local Agency Investment Fund (LAIF)Interest
RateBeginning Balance
Activity Ending Balance
1.36% $75,020,093 ($20,093) $75,000,000 $75,000,000 97.73%
Total Investments $76,731,000 $76,740,330
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.Note 3: The maximum allowed balance of LAIF is $75,000,000.
For Period Ended: August 31, 2020
Tables and Graphs
DRAFT
FINANCE COMMITTEE DRAFT September 14, 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
1.5
2.5
3.5
4.5
5.5
6.5
7.5
Average Daily Census - All Excuding Nursery
Current Year Prior Year 2 Years Ago
0
10
20
30
40
50
60
70
Inpatient Surgery Volume
Current Year Prior Year 2 Years Ago
Page 2
Outpatient Volume
50
60
70
80
90
100
110
120
130
140
150
160
Clinic Volume (per day) - All Clinics
Current Year Prior Year 2 Years Ago
0
200
400
600
800
1,000
1,200
1,400
Emergency Department Volume
Current Year Prior Year 2 Years Ago
0
20
40
60
80
100
120
140
Outpatient Surgery Volume
Current Year Prior Year 2 Years Ago
Page 3
REVENUEGross Charges
-
1,000
2,000
3,000
4,000
5,000
Thou
sand
sGross Inpatient Revenue
Current Year Prior Year 2 Years Ago
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Thou
sand
s
Gross Outpatient Revenue
Current Year Prior Year 2 Years Ago
-
100
200
300
400
500
600
700
800
900
1,000
Thou
sand
s
Gross Clinic Revenue
Current Year Prior Year 2 Years Ago
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Thou
sand
s
Gross Professional Fees Revenue
Current Year Prior Year 2 Years Ago
Page 4
Net Revenue
1,000
3,000
5,000
7,000
9,000
11,000
13,000Th
ousand
s
Net Patient Revenue
Current Year Prior Year 2 Years Ago
1,000
6,000
11,000
16,000
21,000
26,000
31,000
36,000
41,000
46,000
Net Revenue per Adjusted Patient Day
Current Year Prior Year 2 Years Ago
Page 5
Revenue Cycle
50%
100%
150%
200%
250%
Cumulative Cash Collections as a % of Net Collectible Revenue
Current Year Prior Year 2 Years Ago Budget
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
Jul
Aug
Sep Oct
Nov
Dec Jan
Feb
Mar
Apr
Ma
y
Jun
YT
D
2020
2019
2018
Th
ou
san
ds
Th
ou
san
ds
Monthly Collections
'Current Year" 'Year to Date" 'YTD Budget" 'Prior Year' 'Two Years Ago"
24 30 36 42 48 54 60 66 72 78 84 90 96
102
Millions
Cash Balance
Current Year As of June 30 Prior Year 2 Years Ago
50
100
150
200
250
300
350
400
450
Cash Days on Hand
Current Year Prior Year 2 Years Ago
Page 6
40.0
45.0
50.0
55.0
60.0
65.0
70.0
75.0
80.0
85.0
90.0AR Days Outstanding - Gross
Current Year Prior Year 2 Years Ago Budget
35.0
40.0
45.0
50.0
55.0
60.0
65.0
70.0
75.0
AR Days Outstanding - Net
Current Year Prior Year 2 Years Ago Budget
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
% A/R > 120 Days
Current Year 'Prior Year' 2 Years Ago Budget
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
Current Year Prior Year 2 Years Ago
300
500
700
900
1,100
1,300
1,500
Thou
sand
s
Benefits
Current Year Prior Year 2 Years Ago
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
Current Year Prior Year 2 Years Ago
230.0
250.0
270.0
290.0
310.0
330.0
350.0
370.0
Paid Full Time Equivalents
Current Year Prior Year 2 Years Ago
-
10.0
20.0
30.0
40.0
50.0
60.0
Productive FTEs per Adjusted Occupied Bed
Current Year Prior Year 2 Years Ago
5,000
6,000
7,000
8,000
9,000
10,000
11,000
12,000
13,000Labor Cost per Productive Time Equivalent
Current Year Prior Year 2 Years Ago
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
Current Year Prior Year 2 Years Ago
-
20
40
60
80
100
120
140
160
180
Thou
sand
s
Contracted Services
Current Year Prior Year 2 Years Ago
-
200
400
600
800
1,000
1,200
Thou
sand
s
Services
Current Year Prior Year 2 Years Ago
Page 10
Supplies
200
300
400
500
600
700
800
900
1,000
Thou
sand
s
Supply Expense
Current Year Prior Year 2 Years Ago
400
900
1,400
1,900
2,400
2,900
3,400
Supply Expense per Adjusted Patient Day
Current Year Prior Year 2 Years Ago
Page 11
Mammoth Hospital
FY 2020 Capital Plan - Board Summary
Name of Project Budget Actual Spent Balance Funding
Over/Under Budget
IndicatorBUDGETED - BOARD APPROVED
1 Auxiliary Donor Wall 21,600$ 13,500$ 8,100$ Capital $02 Stone Caps on Building Stone Facia 53,900$ 20,807$ 33,093$ Capital $03 Upper Parking Lot Lighting 40,000$ 11,218$ 28,782$ Capital $04 MOB Staircase Replacement 84,500$ 110,934$ (26,434)$ Capital 1.005 Driveway/Entrance Revamp 130,000$ 146,090$ (16,090)$ Capital 1.006 Back Lot Replacement 32,500$ -$ 32,500$ Capital $07 Kronos Time clock Replacement and Upgrade 27,900$ 28,675$ (775)$ Capital 1.008 Cerner Infection Control Module 66,600$ 67,020$ (420)$ Capital 1.009 ECG Machines Integration with Cerner 42,906$ 46,210$ (3,304)$ Capital 1.00
10 Fujitsu 7160 Scanners (11) 10,800$ 10,744$ 56$ Capital $011 Video Laryngoscope 18,000$ 17,698$ 302 Auxiliary $012 Physicians PowerScribe Upgrade (dictation) 49,000$ -$ 49,000$ Capital $013 Desktop Computers (25 units) Update total 52,000$ 23,977$ 28,023$ Capital $014 Family Med Clinic admitting remodel 22,500$ 6,087$ 16,413$ Capital $015 Transport Ventilator 26,300$ 26,217$ 83$ Capital $016 Infant Jaundice meter 8,100$ 8,080$ Capital12 Vision Screener for Pediatric Patients 7,600$ 6,231$ 1,369$ Capital $013 Nurse Call System 341,500$ 15,358$ 326,142$ Capital $014 Siemens RapidPoint 500 Blood Gas Analyzer ** 11,600$ 11,532$ 68$ Capital $015 Welch Allyn ELI 12 lead ECG Unit 12,632$ 13,611$ (979)$ Capital 1.00
1,059,938$ 583,989$ 475,949$
CONTINGENCY 16 Laptop Computers X 20 30,400$ Capital17 Automate Labor and Delivery Door 13,272$ Capital18 ED Fuel Asphalt Repair/Liquid Oxygen 20,264$ Capital19 Lupin Housing Remodel 44,229$ Capital20 Tamarack Housing Remodel 43,387$ Capital21 SGSA "OnCall" room flooring replacement 26,790$ Capital22 Upper Lot Driveway Alignment 19,453$ Capital23 Labor and Delivery Counter Top 6,200$ Capital24 Dental Chairs x 2 26,252$ Capital12 Fluent Management System-Mysosure 47,949$ Auxiliary25 Kronos Mobile App 1,935$ Capital26 System 8 Drill Set 123,541$ Capital27 Vacuum Pump Replacement 17,589$ Capital28 Blanket Warmer - OR2 Insurance replacement-water damage 8,900$ Capital29 Cerner Video Visit Solution 5,000$ Capital30 Replacment of Doors - Entrance A1 and B3 11,310$ Capital31 Replace Sprinkler Heads in all 3 OR's- Recessed Pendants 6,757$ Capital32 Ventilators(Crossvent 3+) 49,620$ Auxiliary33 Transport Ventilators (Hamilton T1) - Auxiliary
Spend in FY20 on Projects From FY1934 Laboratory Fridge for Micro 5,032$ Capital35 New Countertops in PACU 6,797$ Capital36 Third OR - Cabinets 32,878$ Capital37 New Exterior Signage for Facility 24,273$ Capital38 Philips MX500 Patient Monitor 36,933$ Capital39 New AC Units x2 - Bishop PT 3,517$ Capital40 Omnicom recorder for radio conversations 8,615$ Capital
375,062$ 620,892$ (245,830)$ 1.00
BUDGETED - ABANDONED/DELAYED41 Remodel PACU, add office 75,000$ 26,731$ 48,270 $042 Digital X-Ray Room Replacement 490,000$ -$ 490,000 $0
SUB TOTAL 565,000$ 26,731$ 538,270$
Summary of Capital funds FY20 TOTALS 2,000,000$ 1,231,611$ 768,389$ $0
Name of Project Estimated Cost Actual Spent Balance
SPECIAL PROJECTSAutoclave Replacement - 1/2 -$ 229,222$ (229,222)$
1 Autoclave Replacement - 2 of 2 units 273,631$ 495,810$ (222,179)$ 2 Specialty Clinic 1,800,000$ 2,266,618$ (466,618)$ 3 Lab Remodel 100,000$ 3,048$ 96,952$ 4 Dental Clinic Remodel 330,000$ 67,298$ 262,702$ 5 MRI Replacement Project - Estimated total $1.7 million 1,750,000$ 1,721,078$ 28,922$ 6 Chemo Mixing Room 500,000$ -$ 500,000$ 7 OR3 Plan & Build 530,000$ 74,645$ 455,355$ 8 Master Plan -$ 104,257$ (104,257)$
TOTALS 5,283,631$ 4,961,976$ 321,655$
Special Projects
As of June 30, 2020
CIP_Projects_FY_2020_Finance_Reconciliation.xlsx
CONFLICT OF INTEREST CODE
OF THE
SOUTHERN MONO HEALTHCARE DISTRICT
REVISED AND ADOPTED,
AND EFFECTIVE,
September 17, 2020
1
CONFLICT OF INTEREST CODE
OF THE SOUTHERN MONO HEALTHCARE DISTRICT
Section 1. Conflict of Interest Code – Adopted and Revised.
The Political Reform Act (Government Code §§ 81000, et seq.) requires state and local
government agencies to adopt and promulgate conflict of interest codes. The Fair Political
Practices Commission has adopted regulations (2 CCR § 18730) which contain the terms of a
standard or model conflict of interest code. It can be incorporated by reference in an agency code,
and after public notice and hearing, it may be amended by the Fair Political Practices Commission
to conform to amendments in the Political Reform Act. Therefore, the terms of 2 CCR § 18730
(“The Model Code”) and any amendments to it duly adopted by the Fair Political Practices
Commission are hereby incorporated by reference.
Incorporation by reference of the terms of The Model Code, along with the designation of
employees and the formulation of disclosure categories in the Appendices referred to below,
constitute the adoption and promulgation of a conflict of interest code by the Southern Mono
Healthcare District (“District”) within the meaning of Government Code § 87300 or the
amendment of a conflict of interest code within the meaning of Government Code § 87306. The
Model Code and the attached Appendices designating officials and employees and establishing
disclosure categories shall constitute the Conflict of Interest Code (“Code”) of the District and are
revised and adopted hereby. This Code amends and replaces all previous versions of conflict of
interest codes of the District previously in effect.
Section 2. Statements of Economic Interest – Filing Officer.
Designated employees and Board members shall file their statements with the District,
which will make the statements available for public inspection and reproduction as provided by
law. Upon receipt of the statements of the Board and Chief Executive Officer, the District shall
make and retain a copy and forward the originals of these statements to the Mono County Clerk
for filing. Statements for all other designated officials and employees will be retained by the
District.
2
Section 3. Purposes and Goals.
The general purpose and goal of this Code is to afford the public an honest and impartial
government. More specifically, the Board wishes to achieve the following objectives via this
Code:
(1) To assure the independence, impartiality and honesty of public officials
in District actions and decisions;
(2) To inform citizens of the existence of personal economic interests which
may present a conflict of interest between an official’s public trust and
private gain;
(3) To prevent public office from being used for personal gain, other than
the remuneration provided by law;
(4) To assure that District decisions and policy be made in the proper course
according to the proper procedures and considerations;
(5) To prevent special interests from unduly influencing District decisions
and policy;
(6) To assure to the extent possible that District decisions and policy reflect
the public interest; and
(7) To assure that no official will have economic interests which are in
substantial conflict with the proper exercise of his official duties and
powers.
Section 4. Further Definitions.
In addition to the generality of definitions contained in The Model Code, the following
definitions shall apply:
“Board” shall mean the Board of Directors of the District.
“Bylaws” shall mean the Bylaws of the District as they now exist and may be amended or
modified from time to time.
“Chief Executive Officer” shall include the administrator of Mammoth Hospital and the
District.
“District” shall mean the Southern Mono Healthcare District, formerly known as the
Southern Mono Hospital District.
3
“District Law” shall mean the Local Healthcare District Law as set forth in Division 23 of
the Health & Safety Code, §§ 32000, et seq., as it now exists and may be amended or modified
from time to time.
“DNV” shall mean Det Norske Veritas, the accreditation body of the District.
“Facilities” shall mean a District healthcare facility, hospital, clinic, or other establishment
operated by the District.
“Governing Board” shall mean the Board of Directors of the District.
“Healthcare District” shall mean the Southern Mono Healthcare District, formerly known
as the Southern Mono Hospital District.
“Hospital” shall mean Mammoth Hospital.
Section 5. General Provisions.
(1) The Board, except as otherwise provided in the Code, may authorize any officer, or
officers, or agent, or agents, to enter into any contract or execute any contract or execute any
instrument in the name of and on behalf of the District, and such authority to bind the District by
any contract or engagement or to pledge its credit or to render it liable for any purpose or in any
amount. Such authority shall be pursuant to the District Law and the Bylaws, and as so authorized,
may additionally be by resolution or noted in the minutes of the Board.
(2) The fiscal year of the District shall commence on the first day of July of each year
and shall end on the last day of June of each year.
(3) The affairs and financial condition of the District shall be audited annually at the
end of each fiscal year by a certified public accountant selected by the Board and a written report
of such audit and appropriate financial statements submitted to the Board prior to completion of
the first quarterly report of the year. Additional audits may be authorized as considered necessary
or desirable by the Board. The annual audit report shall be reviewed and discussed by the Chief
Executive Officer and the Board, and a summary of the results thereof shall be published in a
newspaper of general circulation as provided for by law.
(4) The Code should be reviewed at least every two (2) years (i.e., biannually) and
revised as necessary.
(5) Any and all remedies provided by the Code, law, operation of law, or otherwise,
shall be deemed to be cumulative, and the choice of implementation of any particular remedy shall
not be deemed to be an election of remedies to the mutual exclusion of any other remedy provided.
4
(6) In the event any term or provision of the Code is deemed to be in violation of law,
null and void, or otherwise of no force or effect, the remaining terms and provisions of the Code
shall remain in full force and effect.
(7) The Code shall be interpreted under and shall be consistent with the laws of the
State of California, the District Law, and the Rules and Regulations of DNV, if applicable to the
governance and accreditation of the District.
(8) No waiver of any breach or violation of any term, provision, article, or section of
the Code shall be construed as a waiver of any succeeding breach or violation of the same. The
consent or approval of the District to or of any action or matter requiring consent or approval shall
not be deemed to waive or render unnecessary any consent or approval of any subsequent or similar
act or matter.
(9) Enforcement of any term, provision, article, or section of the Code shall be by
proceedings at law or in equity against any persons or entities violating or attempting to violate
the Code, either to restrain violation, compel compliance or action, or to recover damages.
(10) The District shall cause updated filings to be made upon the change in the roster of
officers or directors of the Board as the same may occur from time to time with the California
Secretary of State, County of Mono, and any other agency as may be applicable or required by
law.
(11) Unless otherwise stated in the Code, or unless context otherwise requires, the
definitions contained in the District Law shall govern the construction of the Code. Without
limiting the generality of the foregoing, the masculine gender includes the feminine and neuter,
the singular includes the plural, and the plural number includes the singular, and the word “person”
includes a corporation or other legal entity as well as a natural person.
Adopted as revised at the Regular Meeting of the Board of Directors of the Southern Mono
Healthcare District, September 17, 2020.
5
APPENDIX A
LIST OF DESIGNATED POSITIONS
Job Title Disclosure Category (ies)
Member, Board of Directors 3, 4, 5, 6
Chief Executive Officer (“CEO”) 3, 4, 5, 6
Chief Financial Officer 3, 4, 5, 6
Chief Operations Officer 5, 7
Chief Information Officer 5, 7
Chief Medical Officer 5, 7
Chief Nursing Officer 5, 7
Facilities Services Manager 5, 7
Purchasing Manager 5, 7
Human Resources Manager 5, 8
CEO, as Trustee of Mammoth Hospital
Employees’ Retirement Plan (403B)
5, 8
CEO, as Trustee of Mammoth Hospital
Employees’ Deferred Compensation Plan (457b)
5, 8
CEO, as Trustee of Mammoth Hospital
Employees’ 529 College Advantage Savings Plan
5, 8
Exempt Positions
Employees holding secretarial, clerical, or manual positions, and other officials whose
financial interests could not be affected materially by any action, failure to act, or decision taken
by them within the scope of their official duties shall not be required to file statements of financial
interest.
6
APPENDIX B
LIST OF DISCLOSURE CATEGORIES
Disclosure
Category
Required Disclosure
1 All interests in real property located in Mono and Inyo Counties, as well as
investments, business positions and sources of income, including gifts, loans,
and travel payments.
2 All investments, business positions and sources of income, including gifts,
loans, and travel payments.
3 All interests in real property located in the District’s jurisdiction.
4 Any source of gross income of $500 or more.
5 Any reportable gift received from sources in the District’s jurisdiction with a
fair market value of $50 or greater.
6 Any investments and business positions with sources* in the District’s
jurisdiction totaling $2,000 or more at any time during the reporting period.
7 Any reportable investments, business positions and income from sources* in
the District’s jurisdiction that provide leased facilities, goods, equipment,
vehicles, machinery, or services of the type utilized by the District.
8 Any reportable investments, business positions and income from sources* in
the District’s jurisdiction that provide leased facilities, goods, equipment,
vehicles, machinery, or services of the type used by the designated position’s
area of authority.
____________________
* As used in Categories 5, 6, 7, and 8, “sources” refers to any entity located in, doing
business in, planning to do business in, or which has done business during the prior two years in
the District’s jurisdiction.
RESOLUTION OF THE BOARD OF DIRECTORS OF SOUTHERN MONO HEALTHCARE DISTRICT
REAFFIRMING ADOPTION OF THE MODEL CONFLICT OF INTEREST CODE RESOLUTION 20-02
WHEREAS, the Political Reform Act, which is codified in Government Code Sections 81000, et seq. (the “Act”), prohibits public officials from using their official position to influence governmental decisions in which they have a financial interest; requires state and local government agencies to adopt and promulgate conflict of interest codes that identify all officials and employees within the agency who make governmental decisions; and provides that all persons in such designated positions must disclose their financial interests as specified in the agency’s conflict of interest code and as otherwise required by applicable law; and WHEREAS, pursuant to Government Code Section 83112, the Fair Political Practices Commission (“FPPC”) has promulgated certain regulations, set forth in 2 California Code of Regulations (“CCR”) Sections 18109, et seq. (the “Regulations”), to carry out the purposes and provisions of the Act; and WHEREAS, the FPPC adopted 2 CCR Section 18730, which sets forth a model conflict of interest code (“Model Conflict of Interest Code”) that governmental agencies may incorporate by reference along with the designation of the agency’s officials and employees who manage public investments and a list of disclosure categories identifying the types of investments, business entities, sources of income and real property interests that such officials and employees must disclose; and WHEREAS, on or about April 22, 1993, the Board of Directors (“Board”) of the Southern Mono Healthcare District (“District”) has incorporated by reference the Model Conflict of Interest Code, inclusive of any amendments thereto, as the District’s conflict of interest code (the “District’s Conflict of Interest Code”); and
WHEREAS, the Board has periodically reconfirmed its adoption of the Model Conflict of Interest Code, inclusive of any amendments thereto; and updated as necessary its lists of designated positions and disclosure categories; and
WHEREAS, the Board directed the District’s legal counsel and Compliance Officer to complete a biennial review of the District’s Conflict of Interest Code, the Act and the Regulations; and
WHEREAS, the District’s Compliance Officer determined that the FPPC recently amended
the Model Conflict of Interest Code to conform to amendments to the Act and Regulations; and WHEREAS, legal counsel and the Compliance Officer have determined that, except for
inclusion of the District’s Chief Medical Officer being added as a designated position, no substantive revisions to the District’s Conflict of Interest Code are currently required or recommended because the District’s Conflict of Interest Code adopts the Model Conflict of Interest Code, including the amendments, and because there have not been any changes to the designated positions (except as stated above) or disclosure categories set forth in the District’s Conflict of Interest Code; and
WHEREAS, the District would like to reaffirm its adoption of the Model Conflict of Interest
Code, inclusive of any amendments thereto, as the District’s Conflict of Interest Code;
NOW, THEREFORE, upon motion duly made and seconded, be it hereby resolved that:
1. The foregoing recitals are true and correct. 2. The Board hereby reaffirms its adoption of the Model Conflict of Interest Code,
inclusive of any amendments thereto, as the District’s Conflict of Interest Code, as set forth in Exhibit A, which is attached hereto and incorporated herein by reference. PASSED AND ADOPTED by the Board of Directors of Southern Mono Healthcare District, County of Mono, State of California, this 17th day of September 2020, at a regularly scheduled meeting of the Board of Directors held in accordance with the Bylaws of the District by the following votes: AYES: NOES: ABSENT: David Anderson, Chair of the Board ATTEST: Sarah Rea, Secretary to the Board
EXHIBIT “A”
SOUTHERN MONO HEALTHCARE DISTRICT CONFLICT OF INTEREST CODE
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POLICY: Credentialing by Proxy for Telemedicine Providers
EFFECTIVE DATE: 09/17/2020
REVISED DATE(S):
Purpose To outline how credentialing by proxy will be utilized for arrangements between Southern Mono Healthcare District d/b/a Mammoth Hospital (“Mammoth Hospital”) and external telemedicine providers through distant site hospitals or telemedicine entities in compliance with applicable laws, regulations, and accreditation standards.
Definitions Distant Site means:
A site where a health care provider who provides health care services is located while providing these services via a telecommunications system. This is referring to the Distant Site Hospital or Distant Site Telemedicine Entity.
Distant Site Hospital means: A Medicare-participating hospital.
Distant Site Telemedicine Entity means: An entity that provides telemedicine services, is not a Medicare-participating hospital, and provides such contracted services in a manner that enables a critical access hospital using its services to meet all applicable Conditions of Participation, particularly those requirements related to the credentialing and privileging of practitioners providing telemedicine services to the patients of the critical access hospital.
Governing Body means: The board of directors for Southern Mono Healthcare District d/b/a Mammoth Hospital.
Originating Site means: A site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward services originates. This is referring to Mammoth Hospital.
Telemedicine Provider means: A provider who delivers health care services and public health via information and communication technologies (i.e. synchronous interactions and asynchronous store and forward transfers) to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care.
References
• 42 C.F.R. §485.616(c)
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• 42 C.F.R. §485.635(c)(4)(ii)
• MS.18 Telemedicine - NIAHO Accreditation Requirements Interpretive Guidelines & Surveyor Guidance for Critical Access Hospitals (2020)
• California Business and Professions Code §2290.5
• Credentialing by Proxy Guidebook, National Association Medical Staff Services and American Telemedicine Association (2019)
• 3.1 Telemedicine Medical Staff - Mammoth Hospital Medical Staff Bylaws (2015)
Scope / Applicability
The scope of this policy is all arrangements for credentialing by proxy between Mammoth Hospital and a Distant Site Hospital or Distant Site Telemedicine Entity. This policy applies to the Medical Staff Coordinator, the Medical Executive Committee of the Medical Staff, the Director of Quality and the Governing Board of Mammoth Hospital.
Policy For telemedicine services, the traditional credentialing and privileging process is costly and burdensome for both practitioners and hospitals, particularly for critical access hospitals which often lack the resources to fully carry out the traditional credentialing process for every single Telemedicine Provider. Credentialing by proxy is an alternative credentialing mechanism whereby Originating Site hospitals seeking to obtain telemedicine services for their patients can credential Telemedicine Providers who deliver their services from the Distant Site Hospital or Telemedicine Entity by relying on the credentialing and privileging processes and actions of the Distant Site Hospital or Distant Site Telemedicine Entity when making privileging recommendations to its Governing Body. Credentialing by proxy is permitted by both federal and California law provided that certain requirements are met. However, the critical access hospital utilizing this alternative mechanism is still ultimately legally responsible for all privileging decisions. In accordance with the recommendation of the National Association Medical Staff Services, the Bylaws of the Medical Staff of Mammoth Hospital also provide for credentialing by proxy for Telemedicine Providers. It is the policy of Mammoth Hospital to utilize credentialing by proxy for Telemedicine Providers when appropriate and in accordance with applicable laws, regulations and accreditation standards.
Procedure
I. Initial Implementation. 1. Upon receiving confirmation from senior management that telemedicine services
will be provided to Mammoth Hospital by a Distant Site Hospital or Distant Site Telemedicine Entity, the Medical Staff Coordinator requests the Credentialing by Proxy Agreement from Distant Site Hospital. Medical Staff Coordinator or designee then confirms that the credentialing by proxy agreement includes the following stipulations:
• For Distant Site Hospitals: a. Distant Site Hospital is a Medicare-participating hospital. b. Distant Site Hospital warrants that each individual Distant Site
Hospital is privileged at the Distant Site Hospital providing the telemedicine services.
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c. Distant Site Hospital agrees to provide Mammoth Hospital with a current list of the Telemedicine Provider’s privileges at the Distant Site Hospital as well as all data elements necessary for Mammoth Hospital to complete National Practitioner Data Bank queries.
d. Distant Site Hospital warrants that any Telemedicine Provider providing telemedicine Services to Mammoth Hospital holds a license issued or recognized by California.
e. Once privileges are granted at Mammoth Hospital, Mammoth Hospital shall maintain evidence of an internal review each Telemedicine Provider’s performance of these privileges and shall send the Distant Site Telemedicine Entity such performance information for use in the periodic appraisal of the Telemedicine Provider. At a minimum, this information shall include all adverse events that result from the telemedicine services provided by the Telemedicine Provider to Mammoth Hospital patients, as well as all complaints Mammoth Hospital has received about the Telemedicine Provider.
f. Distant Site Hospital agrees to notify Mammoth Hospital within twenty-four (24) hours in the event that a Telemedicine Provider’s clinical privileges be modified or terminated as a result of an identified concern, and within thirty (30) days if corrective actions are taken by the Distant Site Hospital.
g. Distant Site Hospital agrees to notify Mammoth Hospital of any new Telemedicine Provider not less than thirty (30) days prior to the provision of telemedicine services by such Telemedicine Provider to Mammoth Hospital.
• For Distant Site Telemedicine Entities: a. Distant Site Telemedicine Entity warrants that it furnishes services that
permit Mammoth Hospital to comply with all applicable CMS conditions of participation for the contracted services.
b. Distant Site Telemedicine Entity warrants that its medical staff credentialing and privileging process and standards at least meet the standards stated in 42 C.F.R. §485.616(c)(1).
c. Distant Site Telemedicine Entity warrants that each individual Telemedicine Provider is privileged at the Distant Site Telemedicine Entity providing the telemedicine services.
h. Distant Site Telemedicine Entity agrees to provide Mammoth Hospital with a current list of the Telemedicine Provider’s privileges at the Distant Site Telemedicine Entity, as well as all data elements necessary for Mammoth Hospital to complete National Provider Data Bank queries.
d. Distant Site Telemedicine Entity warrants that any Telemedicine Provider providing telemedicine Services to Mammoth Hospital holds a license issued or recognized by California.
e. Once privileges are granted at Mammoth Hospital, Mammoth Hospital shall maintain evidence of an internal review each Telemedicine Provider’s performance of these privileges and upon request, shall send the Distant Site Telemedicine Entity such performance information for use in the periodic appraisal of the Telemedicine Provider. At a minimum, this information shall include all adverse events that result from the telemedicine services provided by the
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Telemedicine Provider to Mammoth Hospital patients, as well as all complaints Mammoth Hospital has received about the Telemedicine Provider.
f. Distant Site Telemedicine Entity agrees to notify Mammoth Hospital within twenty-four (24) hours in the event that a Telemedicine Provider’s clinical privileges be modified or terminated as a result of an identified concern, and within thirty (30) days if corrective actions are taken by the Distant Site Telemedicine Entity.
g. Distant Site Telemedicine Entity agrees to notify Mammoth Hospital of any new Telemedicine Provider not less than thirty (30) days prior to the provision of telemedicine services by such Telemedicine Provider to Mammoth Hospital.
2. The Medical Staff Coordinator sets up an initial coordination call with the credentialing representative of the Distant Site Hospital or Distant Site Telemedicine Entity to ensure alignment as to the go-forward process for the addition and removal of Telemedicine Providers as well as any modifications to the privileges of any such Telemedicine Providers at the Distant Site Hospital or Distant Site Telemedicine Entity. At minimum, the Medical Staff Coordinator shall obtain a copy of the credentialing policy and procedure of the Distant Site Hospital or Distant Site Telemedicine Entity to confirm it is sufficient based on Mammoth Hospital’s current credentialing processes.
3. The Medical Staff Coordinator shall create a file for the Distant Site Hospital or Distant Site Telemedicine Entity for credentialing by proxy. This file should always include at least (1) a copy of the credentialing policy and procedure of the Distant Site Hospital or Distant Site Telemedicine Entity, and (2) the credentialing by proxy agreement once fully executed after approval by the Governing Board.
4. Once the credentialing by proxy agreement is confirmed to contain all necessary elements and the Medical Staff Coordinator has confirmed that the Distant Site Hospital or Distant Site Telemedicine Entity’s credentialing and privileging processes are sufficient, the Medical Staff Coordinator adds the agreement to the agenda for the next Medical Executive Committee meeting for approval. Prior to adding the agreement to the agenda for approval by the Medical Executive Committee, the Medical Staff Coordinator may consult with Mammoth Hospital’s legal counsel as necessary regarding the agreement.
5. Upon receipt of the list of Telemedicine Providers who will be providing telemedicine services to Mammoth Hospital from the Distant Site Hospital or Distant Site Telemedicine Entity, the Medical Staff Coordinator queries the National Practitioner Data Bank for each Telemedicine Provider. The results of such queries are included in the blanket form referenced in step #6 below. This obligation may be waived by the Medical Executive Committee due to urgency and volume of providers needing approval only for Distant Site Hospitals or Distant Site Telemedicine Entities that are Joint Commission accredited.
6. The Medical Staff Coordinator compiles (1) the execution-ready credentialing by proxy agreement and (2) the blanket Telemedicine Staff appointment and privilege delineation form to encompass all Telemedicine Providers for that Distant Site Hospital or Distant Site Telemedicine Entity for submission to the Medical Executive Committee and then to the Governing Board for official appointment of such Telemedicine Providers to the Telemedicine Staff category of Mammoth Hospital’s Medical Staff and for the granting of privileges at Mammoth Hospital to those Telemedicine Providers.
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II. Ongoing Obligations.
1. The Medical Staff Coordinator works with the credentialing representative for the Distant Site Hospital or Distant Site Telemedicine Entity regarding the addition or removal Telemedicine Providers and modification of the privileges of such Telemedicine Providers at the Distant Site Hospital or Distant Site Telemedicine Entity.
2. At the time of reappointment and renewal of Mammoth Hospital privileges or upon the addition of a new Telemedicine Provider, the Medical Staff Coordinator queries the National Practitioner Data Bank for each Telemedicine Provider. This obligation may be waived by the Medical Executive Committee due to urgency and volume of providers needing approval only for Distant Site Hospitals or Distant Site Telemedicine Entities that are Joint Commission accredited. The Medical Staff Coordinator compiles the blanket Telemedicine Staff appointment and privilege delineation form to encompass all Telemedicine Providers for that Distant Site Hospital or Distant Site Telemedicine Entity that are to be newly appointed or reappointed to the Telemedicine Staff, and for the initial granting of privileges for new Telemedicine Providers or renewal or modification privileges already granted to existing Telemedicine Providers at Mammoth Hospital for submission to the Medical Executive Committee and then to the Governing Board. The same process shall be followed for removal of appointment and privileges of existing Telemedicine Providers.
3. The Medical Staff Coordinator has a touch base meeting annually or at an agreed upon frequency with the Distant Site Hospital or Distant Site Telemedicine Entity to review the Telemedicine Providers and credentialing by proxy agreement.
Responsible Department
Implementation, training, and monitoring regarding this policy and procedure are the responsibilities of the Medical Staff Coordinator, the Medical Executive Committee of the Medical Staff, the Director of Quality and the Governing Board of Mammoth Hospital.
Renewal/Review This policy and procedure is to be reviewed annually to determine if it complies with current recommendations, guidelines, mandates, statutes, practices, and Mammoth Hospital operations. In the event that changes are required, the policy and procedure will be updated as needed.
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PHYSICIAN CREDENTIALING AND PRIVILEGING AGREEMENT
THIS PHYSICIAN CREDENTIALING AND PRIVILEGING AGREEMENT (“Agreement”) is made by and between Direct Radiology (“Telemedicine Entity”) and Southern Mono Healthcare District d/b/a Mammoth Hospital (“Hospital”) effective as of this day of , 2020 (“Effective Date”).
The parties hereby agree as follows:
1. Contractor Relationship. Telemedicine Entity is a contractor of services to Hospital. Telemedicine Entity arranges for radiologists employed by or contracted with Telemedicine Entity, to provide remote specialty services to Hospital patients (“Contracted Services”). For purposes of this Agreement, each affiliated radiologist providing or anticipated to provide Contracted Services is a Physician (collectively, “Physicians”). Hospital and Telemedicine Entity shall agree on a process by which Telemedicine Entity may have access to all the necessary patient records from Hospital.
2. Compliance with Conditions of Participation. In accordance with §485.635(c)(4)(ii), Telemedicine Entity shall furnish Contracted Services to Hospital in a manner that permits Hospital to comply with all applicable Medicare conditions of participation related to the Contracted Services, including but not limited to the requirements of §485.616(c) with regard to the distant-site telemedicine entity’s physicians and practitioners providing telemedicine services, as well as the Joint Commission requirements for credentialing and privileging practitioners and Physicians for telemedicine services (collectively, the “Hospital Standards”). Telemedicine Entity represents that its credentialing and privileging standards meet the Hospital Standards.
3. Telemedicine Entity Credentialing and Privileging. Telemedicine Entity warrants that each Physician (i) will be credentialed and privileged by Telemedicine Entity according to Telemedicine Entity’s credentialing and privileging processes and standards; and (ii) shall render Contracted Services within the scope of the Physician’s respective privileges. Telemedicine Entity shall provide Hospital with a copy of Telemedicine Entity’s credentialing policies and procedures upon the execution of this Agreement and shall also provide Hospital with any changes to such policies and procedures during the term of this Agreement.
4. State Licensure. At all times while providing Contracted Services to Hospital, Telemedicine Entity shall ensure that each Physician providing the Contracted Services pursuant to this Agreement shall hold a valid and unrestricted license issued or recognized by the state in which Hospital is located.
5. Decision of Governing Body. Hospital’s governing body has chosen to rely on Telemedicine Entity’s credentialing and privileging decisions for purposes of Hospital’s medical staff determining whether or not to recommend privileges for a Physician. Hospital is responsible for determining whether or not reliance is warranted and for conducting its own internal process in a manner that complies with Medicare conditions of participation and the requirements of Hospital’s accrediting body.
6. Telemedicine Entity to Provide Current List of Privileges. Telemedicine Entity has supplied Hospital with Schedule 1, a list identifying each Physician and the scope of privileges granted by Telemedicine Entity. It is anticipated that this complement of physicians may change from time to time. The following procedures shall apply to any changes to Schedule 1:
(a) Action by Telemedicine Entity: Not later than thirty (30) days prior to any new Physician providing services under the base agreement between the parties, Telemedicine Entity shall provide Hospital with a revised Schedule 1 indicating the name of any new Physicians and an accompanying delineation of
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privileges for each new physician. If Telemedicine Entity has removed a Physician from the roster of physicians anticipated to provide Contracted Services going forward or if the Telemedicine Entity physician loses privileges, Telemedicine Entity will provide a revised Schedule 1.
(b) Action by Hospital upon Receipt of New Schedule from Telemedicine Entity: Hospital shall confirm the Physicians listed on Schedule 1 can provide the Contracted Services by signing and faxing or emailing the updated Schedule to Telemedicine Entity. If the only changes were removals, Hospital agrees that Telemedicine Entity may remove the Physician(s) without waiting for a signed Schedule 1 to be returned.
(c) Action by Hospital to Initiate Removal of a Physician. If Hospital no longer wishes to receive Contracted Services from a Physician for reasons not requiring a hearing, Hospital will request that Telemedicine Entity remove the Physician from the roster, following which, Telemedicine Entity will supply an updated Schedule 1 as described in Section 6(a).
7. Credentialing-Related Materials. Telemedicine Entity shall provide electronic copies of credentialing materials and other reasonable evidence of Telemedicine Entity’s compliance with the Hospital’s standards for each Physician upon request. Telemedicine Entity will not provide Hospital or its agent a copy of any reports it receives from The Data Bank or from a third party vendor or criminal background check services. Hospital remains responsible for querying The Data Bank.
8. Provision and Confidentiality of Quality Related Data.
(a) Hospital Duties. Hospital shall provide Telemedicine Entity evidence of its internal review of each Telemedicine Entity-affiliated Physician’s performance of the privileges, for use in Telemedicine Entity’s periodic appraisal of the Physicians. At a minimum, this information must include:
(i) all adverse events that result from a Physician’s Contracted Services provided to Hospital patients, and
(ii) all complaints Hospital has received about the Physician.
If Hospital is a critical access hospital, Hospital acknowledges it is responsible for periodic evaluation and quality assurance reviews that comply with 42 CFR 485.641(b)(4)(v).
9. Confidentiality. The parties shall treat all credentialing information shared pursuant to Sections 6 and 7 and all quality-related information shared pursuant to Section 8 as privileged and confidential. Such information is to be used for credentialing, quality improvement, and peer review activities only. Each party shall ensure that no portion of any materials or information received from the other party are disclosed by it or its agents to any employee or third party for reasons unrelated to evaluating the physician’s quality and credentials to provide Contracted Services, except as required by law.
10. Term and Termination. This Agreement shall be for an initial term of one (1) year commencing on the Effective Date and ending on the first anniversary of the Effective Date, thereafter, this Agreement shall automatically renew for subsequent one (1) year periods unless otherwise terminated as provided below:
(a) Upon Notice. Either party may terminate without cause on at least 30 days’ prior written notice to the other party.
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(b) Termination upon Material Breach. A non-breaching party may terminate this Agreement for cause at any time upon 30 days’ written notice of intent to terminate. In the event the defaulting party cures such default within such 30 day notice period, the non-breaching party may elect, at its discretion, to rescind the termination notice in writing, in which case this Agreement shall continue in full force and effect.
11. Legislative/Regulatory Modification. If any law, regulation or standard is enacted, promulgated, or modified in a manner that, in the opinion of a party’s legal counsel (i) prohibits, restricts or in any way materially affects this Agreement; (ii) subjects either Hospital or Telemedicine Entity to a fine or penalty in connection with its representations or responsibilities hereunder, or (iii) subjects either party to a loss of Medicare or Medicaid certification or Joint Commission-accreditation because of the existence of this Agreement or the applicable party’s representations or performance of obligations hereunder, then within 30 days following notice from one party to the other, the parties shall complete the good faith negotiation of an amendment to this Agreement or a substitute agreement that will carry out the original intention of the parties to the extent possible in light of such law, regulation or standard and each party shall execute such amendment or new agreement.
If the parties cannot reach agreement on new terms within 60 days following the notice provided hereunder or such earlier date as necessary to avoid substantial penalties or fines, then this Agreement shall immediately terminate, following written notice of termination from either party.
12. Indemnification. Each of the parties shall indemnify and hold the other harmless from and against all claims, liabilities, judgments, fines, assessments, penalties, awards, or other expenses, of any kind or nature whatsoever, including, without limitations, attorneys’ fees, expert witness fees, and costs of investigation, litigation or dispute resolution, relating to or arising out of any breach or alleged breach of this Agreement by either of the Parties, or by their respective employees, subcontractors or agents.
13. Notice. Any notice required by this Agreement shall be in writing and shall be deemed to have been properly given to a party (i) if hand delivered, (ii) if delivered overnight by courier service, effective on the first business day following delivery to such carrier, or (iii) if sent certified mail, return receipt requested, effective three (3) days after deposit in the United States mail, addressed to the address below or as the parties may designate by giving notice pursuant to this Section:
14. Third-Party Beneficiaries. This Agreement shall not confer any benefit or rights upon any person other than Hospital and Telemedicine Entity, and no third party shall be entitled to enforce any obligation, responsibility or claim of any party to this Agreement.
Direct Radiology 1839 N. Government Way, Ste. B Coeur d’ Alene, ID 83814 p. 855.687.7237 f. 855.673.9190
Mammoth Hospital 85 Sierra Park Road Mammoth Lakes, CA 93546
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15. Other Agreements. This Agreement, including all exhibits hereto, contains the entire understanding and agreement of the parties with respect to the credentialing and privileging of Telemedicine Entity Physician. In the event of a conflict between a provision contained in this Agreement and a provision contained in an agreement or arrangement that existed prior to the Effective Date of this Agreement, the terms of this Agreement shall control and govern the actions of the parties.
16. Arbitration. Except for a claim for injunctive relief as provided in Section 8.3, in the event of any dispute, claim or controversy between the parties hereto arising out of or relating to the formation, performance or termination of this Agreement, the parties hereby agree that such dispute, claim or controversy shall be submitted to a single arbitrator in Mono County, California for binding arbitration in accordance with the commercial arbitration rules of the American Arbitration Association. The arbitrator shall decide any such matter in accordance with California law. The arbitrator shall have the authority to award the prevailing party its fees and costs of arbitration, including reasonable attorneys’ fees. Except as otherwise provided in this Agreement, the parties expressly waive any claim of or right to any punitive or exemplary damages, any special, consequential, incidental or indirect damages, specific performance or injunctive or equitable relief (even if a party has been advised of the possibility of such damages). All such arbitration proceedings shall be conducted on a confidential basis. The determinations of the arbitrator shall be final and shall not be subject to judicial review; provided, however, that any award of the arbitrator may be entered in any court of competent jurisdiction. This Section 16 shall survive the termination of this Agreement for any reason.
17. Execution. This Agreement shall not be binding upon Hospital unless signed by Hospital’s CEO/Managing Director.
18. Assignment. This Agreement shall not be assignable by Telemedicine Entity.
19. Counterparts. This Agreement may be executed by facsimile signature, scanned signature or encrypted, digital signature, and by either of the parties in counterparts, each of which will be deemed to be an original, but all such counterparts will constitute a single instrument.
IN WITNESS WHEREOF, the undersigned parties hereto have executed this Agreement as of the day and year indicated below.
Hospital
By:
Direct Radiology
By:
Printed: Tom Parker Printed: Leah McClain
Title: Chief Executive Officer Title: Physician Services Manager
Date: Date:
3013-IM-PCA0102-FINAL.doc [090820] 1 OF 2 CONFIDENTIAL
Privileging and Credentialing Agreement
This Privileging and Credentialing Agreement (“PCA”) is entered into by and among SpecialtyCare IOM
Services, LLC (“SpecialtyCare”) and its managed physician group, Remote Neuromonitoring Physicians, PC
(“RNP”) located at 3 Maryland Farms, Suite 200, Brentwood, Tennessee 37027 and Southern Mono Healthcare
District d/b/a Mammoth Hospital ("Client") located at 85 Sierra Park Road, Mammoth Lakes, California 93546
with reference to the following facts:
RECITALS
WHEREAS, SpecialtyCare’s managed physician group, RNP is accredited by The Joint Commission (“TJC”);
WHEREAS, Client has determined that its Medical Staff may rely on the privileging and credentialing decisions
made by RNP when granting privileges to SpecialtyCare’s Providers; and
WHEREAS, Client desires to efficiently credential and privilege SpecialtyCare Providers who provide Services to
Client.
NOW, THEREFORE, SpecialtyCare and Client agree as follows:
AGREEMENT
1. Medicare Conditions of Participation Compliance
1.1. SpecialtyCare represents and warrants that its medical staff credentialing and privileging process and
standards meet the standards at § 485.616(c)(1).
1.2. SpecialtyCare is a contractor of services to Client and as such, in accordance with § 485.635(c)(4)(ii),
furnishes the contracted services in a manner that permits the hospital to comply with all applicable
conditions of of participation for the contracted services, including, but not limited to, the requirements
of § 485.616(c) with regard to the distant-site telemedicine entity’s physicians and practitioners
providing telemedicine services.
1.3. Each physician or practitioner provided by SpecialtyCare’s managed physician group, RNP is privileged
by RNP for the services to be provided by SpecialtyCare and RNP.
1.4. SpecialtyCare shall provide Client from time to time with a current list of RNP’s physician's and
practitioner's privileges.
1.5. Each RNP physician or practitioner shall hold a license issued or recognized by the State in which the
Client’s facility is located.
1.6. With respect to each RNP physician or practitioner, who holds privileges at the Client, the Client shall
conduct an internal review of the physician's or practitioner's performance of his or her privileges, in
accordance with applicable conditions of participation and shall send RNP such performance information
for use in its periodic appraisal of the applicable RNP physician or practitioner. At a minimum, the
information provided by Client shall include all adverse events that result from the telemedicine services
provided by the RNP physician or practitioner to the Client’s patients, and all complaints the Client has
received about the RNP physician or practitioner.
2. Joint Commission Compliance
2.1. RNP shall be and remain Joint Commission accredited during the term of the Agreement.
3013-IM-PCA0102-FINAL.doc [090820] 2 OF 2 CONFIDENTIAL
3. Documentation
3.1 SpecialtyCare will provide copies of the following documents to Client:
3.1.1 Application
3.1.2 Delineation of Privileges
3.1.3 Award Letter
3.1.4 Licensures
3.1.5 Board Certificates
3.1.6 Hospital Affiliation Verifications
3.1.7 Work History Verifications
3.1.8 Certificate of Insurance Verifications and Malpractice History Inquiries
3.1.9 Peer References
3.1.10 Case Log Data (24 months)
3.1.11 Licensure Verifications
3.1.12 Board Verifications
3.1.13 AMA/AOA profile
3.2 Client will complete the following:
3.2.2 NPDB Query
4. General Terms
4.1 This PCA shall be effective on the last date signed below and shall continue in effect unless terminated in
accordance with Section 4.2.
4.2 Either party may terminate this PCA with thirty (30) days prior written notice to the other party.
This PCA constitutes the entire understanding of the parties with respect to the subject matter hereof and
supersedes any prior understanding between them, whether oral or written, respecting the same subject matter.
IN WITNESS WHEREOF, the parties have executed this Agreement.
SPECIALTYCARE PARENT:
CLIENT:
SpecialtyCare IOM Services, LLC
_________________________________
Signature
By: Jonathan Walters
Title: President, IONM Services
Southern Mono Healthcare District d/b/a
Mammoth Hospital
_________________________________
Signature
By:
Title:
Remote Neuromonitoring Physicians, PC
_________________________________
Signature
By:
Title:
Manual Name Document Name/Policy Revision # Approved On
Laboratory Lab Microbiology Backup Procedures 3 4/30/2020
Laboratory Lab Microbiology Beta Lactamase - Cefinase Disk 3 4/30/2020
Laboratory Lab Microbiology Bile Solubility 3 4/30/2020
Laboratory Lab Microbiology Carbon Dioxide Detection Kit 3 4/30/2020
Laboratory Lab Microbiology Catalase 3 4/30/2020
Laboratory Lab Microbiology Coagulase 3 4/30/2020
Laboratory Lab Microbiology Critical Values 3 4/30/2020
Laboratory Lab Microbiology CSF Culture 2 4/30/2020
Laboratory Lab Microbiology Fyrite Operation and Maintenance 3 4/30/2020
Laboratory General Guidelines for Isolates 3 4/30/2020
Laboratory Lab Microbiology H pylori Urease Testing 3 4/30/2020
Laboratory Lab Microbiology Haemophilis ID Quad Plate 3 4/30/2020
Laboratory Lab Microbiology MRSA Admission Screening Culture 3 4/30/2020
Laboratory Lab Microbiology MRSA Nasal Swab Collection Protocol 3 4/30/2020
Laboratory Lab Microbiology MRSA Select II Agar 3 4/30/2020
Laboratory Lab Microbiology Routine Culture Set-up Protocol 2 4/30/2020
Laboratory Lab Microbiology Stock Cultures 3 4/30/2020
Laboratory Microbiology – IQCP for BD Affirm VPIII 2 4/30/2020
Laboratory Microbiology - IQCP for Commercially Prepared CLSI Exempt Media 2 4/30/2020
Laboratory Microbiology - IQCP for Meridian STAT Campy Antigen 2 4/30/2020
Emergency Department Mammoth Hospital Transport Unit 7 5/4/2020
Emergency Department Nitronox 7 5/4/2020
Emergency Department Radiology-ED Interpretation Discrepancies 7 5/4/2020
Emergency Department Sexual Assault Exam 7 5/4/2020
Emergency Department Unresponsive patient in MRI 7 5/4/2020
Emergency Department Warming Cabinets and Fluid Rotation 7 5/4/2020
Emergency Department Patient Transports by Mono County Emergency Medical Services (MCEMS) 7 5/4/2020
Emergency Department ED Scope of Service 7 5/4/2020
Emergency Department Emergency Department Pain Assessment 7 5/4/2020
Emergency Department Rapid Response Team 6 5/4/2020
COVID COVID Document Control Plan 1 5/7/2020
COVID COVID Surge Charting Plan 1 5/8/2020
COVID COVID Surge Chart Scanning Workflow 1 5/8/2020
COVID COVID Hazard Pay Plan 1 5/12/2020
COVID COVID Logistics Meal Plan 1 5/12/2020
COVID COVID Dietary Surge Plan 1 5/12/2020
COVID COVID Respiratory Therapy Plan 1 5/12/2020
COVID Hospital Housing Use During COVID 1 5/12/2020
COVID COVID Safety and Security Plan 1 5/12/2020
COVID COVID Comfort Care Surge Plan 1 5/12/2020
COVID COVID Alternative Cleaning Plan 1 5/12/2020
COVID COVID Screeter Symptom Review 1 5/18/2020
COVID COVID Screener Pre-Appointment Questionnaire 1 5/18/2020
COVID COVID In-House Testing 2 5/20/2020
COVID COVID Safety Info & Mask Caring Instructions_English 1 5/20/2020
COVID COVID Safety Info & Mask Caring Instructions_Spanish 1 5/21/2020
COVID COVID Screening Entry Points 1 5/21/2020
COVID MH Intubated COVID-19 one-page Sheet 1 5/21/2020
Case Management Discharge Planning 7 5/22/2020
Respiratory Therapy Respiratory Therapists Duties 7 5/22/2020
Pharmacy Automatic Drug Stop Order 7 5/22/2020
Pharmacy Bedside Medications 6 5/22/2020
Pharmacy Computerized Physician Order Entry (CPOE) for Pharmaceuticals 7 5/22/2020
Pharmacy Drug Compounding and dispensing 7 5/22/2020
Pharmacy Drug Information 8 5/22/2020
Pharmacy Drug Procurement 7 5/22/2020
Pharmacy Medication/Drug Recall (Handling of Medications Lacking Quality or Strength) 7 5/22/2020
Pharmacy Medication orders 7 5/22/2020
Pharmacy Prescription Pad Security 7 5/22/2020
Pharmacy Sterile Compounding Quality Assurance Program 7 5/22/2020
Pharmacy Sterile compounding 7 5/22/2020
Pharmacy Theft or impairment 7 5/22/2020
ICU ICU Scope of Practice 7 5/22/2020
Med Surg / telemetry MedicalSurgical Scope of Service 7 5/22/2020
Med Surg Pediatric Pediatric Scope of Practice 7 5/22/2020
Perioperative Scope of Services of the Surgical Services Department 8 5/22/2020
Pharmacy Adverse Drug Reaction 6 5/22/2020
Med Surg Pediatric Pediatric Standards of Practice 6 5/22/2020
Pharmacy MERP (Medication Error Reduction Plan) 3 5/22/2020
Laboratory LIS - Laboratory Downtime Procedure 2 5/27/2020
Laboratory Serology - IQCP for Cepheid Xpert CT NG Assay 2 5/27/2020
Laboratory Serology - IQCP for Cepheid Xpert C. difficile/Epi Assay 2 5/27/2020
Laboratory Chemistry - Calibration Verification 2 5/27/2020
Laboratory ACTM - Acetaminophen 1 5/27/2020
Laboratory ALB - Albumin 1 5/27/2020
Laboratory ALKP - Alkaline Phosphatase 1 5/27/2020
Laboratory ALT - Alanine aminotransferase 1 5/27/2020
Laboratory AMM - Ammonia 1 5/27/2020
Laboratory AMY - Amylase 1 5/27/2020
Laboratory AST -- Aspartate Aminotransferase 1 5/27/2020
Laboratory BUN -- Urea Nitrogen 1 5/27/2020
Laboratory CA 125II 1 5/27/2020
Laboratory CA - Calcium 1 5/27/2020
Laboratory CCRP -- high sensitivity CRP 1 5/27/2020
Laboratory Chemistry Quality Control 1 5/27/2020
Laboratory CHIV -- HIV Ag/Ab Combo Assay 1 5/27/2020
Laboratory CHOL - Cholesterol 1 5/27/2020
Laboratory CK -- Creatine Kinase 1 5/27/2020
Laboratory CREA - Creatinine 1 5/27/2020
Laboratory DBIL -- Direct Bilirubin 1 5/27/2020
COVID COVID Screening Program SOP 2 6/1/2020
COVID COVID Mask and PPE Policy 2 6/2/2020
Laboratory DIG - Digoxin 1 6/3/2020
Laboratory ECO2 -- Enzymatic Carbonate 1 6/3/2020
Laboratory eE2 -- Enhanced Estradiol 1 6/3/2020
Laboratory ETOH -- Ethyl Alcohol 1 6/3/2020
Laboratory FERR -- Ferritin (HM Module) 1 6/3/2020
Laboratory First Sign Drug of Abuse Cup Test 1 6/3/2020
Laboratory FOLA -- Folate (Loci Module) 1 6/3/2020
Laboratory FSH -- Follicle-Stimulating Hormone 1 6/3/2020
Laboratory FT3 -- Free Triiodothyronine (Loci Module) 1 6/3/2020
Laboratory FT4 - Free Thyroxine (LOCI Module) 1 6/3/2020
Laboratory GGT - -Glutamyl Transferase 1 6/3/2020
Laboratory GLU - Glucose 1 6/3/2020
Laboratory HB1C - Hemoglobin A1c 1 6/3/2020
Laboratory HBsAG -- Hepatitis B Surface Antigen 1 6/3/2020
Laboratory HBsAg Confirmatory - Conf 1 6/3/2020
Laboratory HCG - Human Chorionic Gonadotropin (HM Module) 1 6/3/2020
Laboratory HCV - Hepatitis C Antibodies 1 6/3/2020
Laboratory HDL -- High-Density Lipoprotein Cholesterol 1 6/3/2020
Laboratory IBCT -- Total Iron Binding Capacity 1 6/3/2020
Laboratory Iron 1 6/3/2020
Laboratory LIP - Lipase 1 6/3/2020
Laboratory Lytes - Na+ / K+ / Cl 1 6/3/2020
Laboratory MG - Magnesium 1 6/3/2020
Laboratory MYO - Myoglobin 1 6/3/2020
Laboratory LNTP -- N-terminal Pro-Brain Natriuretic Peptide 1 6/3/2020
Laboratory PHOS - Phosphorus 1 6/3/2020
Laboratory PHYT - Phenytoin 1 6/3/2020
Laboratory PRGE - Progesterone 1 6/3/2020
Laboratory FPSA -- Free Prostate Specific Antigen 1 6/3/2020
COVID COVID Inpatient Outpatient Testing 3 6/4/2020
Laboratory TPSA -- Total Prostate Specific Antigen 1 6/4/2020
Laboratory Blood Gases 1 6/4/2020
Laboratory Rubella G (Rub G) 1 6/4/2020
Laboratory SAL - Salicylate 1 6/4/2020
Laboratory Siemens Centaur Chemistry Analyzer 1 6/4/2020
Laboratory Siemens EXL200 Chemistry Analyzers 1 6/4/2020
Laboratory SYPH - Syphilis 1 6/4/2020
Laboratory TBIL -- Total Bilirubin 1 6/4/2020
Laboratory TNI -- Cardiac Troponin I 1 6/4/2020
Laboratory TP -- Total Protein 1 6/4/2020
Laboratory TRIG - Triglycerides 1 6/4/2020
Laboratory TSH -- Thyroid Stimulating Hormone 1 6/4/2020
Laboratory TSTII -- Testosterone II 1 6/4/2020
Laboratory UCFP -- Urinary/Cerebrospinal Fluid Protein 1 6/4/2020
Laboratory URIC -- Uric Acid 1 6/4/2020
Laboratory VANC - Vancomycin 1 6/4/2020
Laboratory VB12 -- Vitamin B12 1 6/4/2020
Laboratory VitD -- Vitamin D Total 1 6/4/2020
Laboratory Leadcare II Procedure 1 6/4/2020
Laboratory Cepheid Xpert® Xpress SARS-CoV-2(EUA) Assay 1 6/4/2020
Accounting Accounting Scope of Service 7 6/8/2020
Accounts Payable Petty Cash Policy 7 6/8/2020
HIMS Contingency Plan for Damaged-Unavailable Records 6 6/8/2020
HIMS Transporting Protected Health Information 6 6/8/2020
HIMS Electronic Health Record Process 6 6/8/2020
HIMS Fax Machines - Setup and Operations 6 6/8/2020
HIMS Paper Document Storage, Retention and Destruction 6 6/8/2020
HIMS Scope of Services of the HIMS Dept 6 6/8/2020
COVID COVID Facility Screening Plan 2 6/8/2020
COVID Employee Health Sick Plan 3 6/9/2020
Laboratory Lab Microbiology Gram Stain Reporting 3 6/10/2020
Laboratory Lab Microbiology Gram Stain 3 6/10/2020
Laboratory IQCP for Cepheid Xpert Xpress SARS-CoV-2 1 6/10/2020
Laboratory IQCP for First Sign Drugs of Abuse Cup Test 1 6/10/2020
COVID COVID Pandemic Cleaning Plan 2 6/15/2020
COVID Visitation During COVID-19 Pandemic 2 6/16/2020
Dietary Manual Ware Washing 6 6/18/2020
Emergency Department Copying Medical Imaging CD'S 7 6/25/2020
Pharmacy Biologicals Storage 7 6/25/2020
Pharmacy Disposal of Outdated or Deteriorated Drugs 7 6/25/2020
Pharmacy Drug and Food Interactions 7 6/25/2020
Pharmacy Enoxaparin Administration Following Neuraxial Anesthesia (Epidural/Spinal Anesthesia) or Spinal Procedure 6 6/25/2020
Pharmacy Gentamycin Dosing and Monitoring 7 6/25/2020
Pharmacy Guidelines for use of parenteral promethazine 7 6/25/2020
Pharmacy Hazardous Materials and Pharmaceuticals 6 6/25/2020
Pharmacy Hospital Drug Formulary 6 6/25/2020
Pharmacy Pharamcy charge capture 6 6/25/2020
Pharmacy Splitting of Unscored Pills 6 6/25/2020
ICU ICU Nurse Practice Guidelines - Infection Control 7 6/25/2020
Dietary Chemical Control 9 6/26/2020
Admitting Authorization Scope of Practice 7 6/29/2020
Admitting Direct Admissions 7 6/29/2020
Admitting Electronic Document Management - Electronic Consent Forms 7 6/29/2020
Admitting Medicare Secondary Payer 7 6/29/2020
Admitting Patient Admission 7 6/29/2020
Admitting Type and Source of Admission 7 6/29/2020
Emergency Department EMTALA: Medical Screening Examinations 7 6/29/2020
Emergency Department Insulin Purchase after Pharmacies are Closed 7 6/29/2020
Emergency Department Mental Health Evaluation and transfer 7 6/29/2020
Emergency Department EMTALA: Patient Transfers from Mammoth Hospital 7 6/29/2020
Respiratory Therapy Chest Physiotherapy 7 6/29/2020
Respiratory Therapy Hand Held Nebulizer 7 6/29/2020
Respiratory Therapy High Humidity Aerosol 7 6/29/2020
Respiratory Therapy IPPB (Intermittent Positive Pressure Breathing) 7 6/29/2020
Respiratory Therapy Incentive Spirometry 7 6/29/2020
Respiratory Therapy Intubation Assist 7 6/29/2020
Respiratory Therapy Oxygen Services 7 6/29/2020
Respiratory Therapy Patient Progress Notes 7 6/29/2020
Respiratory Therapy Respiratory Care Staff Availability 7 6/29/2020
Respiratory Therapy Spirometry (PFT) 7 6/29/2020
Respiratory Therapy Suctioning with an Artificial Airway 7 6/29/2020
Respiratory Therapy Undesirable Side-Effects 7 6/29/2020
Med Surg / telemetry Admission of Patients, Routine 7 6/29/2020
Med Surg / telemetry Continuous Pulse Oximetry Monitoring 7 6/29/2020
Med Surg / telemetry Direct Admissions to an Inpatient Unit 7 6/29/2020
Med Surg / telemetry Emergency Management Plan - MedSurgICU 7 6/29/2020
Med Surg / telemetry Outpatient Procedures on the Medical Surgical Unit 7 6/29/2020
Med Surg / telemetry Safety on the MedicalSurgical Unit 7 6/29/2020
Respiratory Therapy Arterial Blood Gas Puntcture certification 6 6/29/2020
Admitting Observation Form 4 6/29/2020
Emergency Preparedness Evacuation 7 6/30/2020
Emergency Preparedness Equipment and Supplies 8 6/30/2020
Contract # Vendor NameContract Start
Date
Contract
Termination DateAgreement Type
Evergreen
Agreement
Contract Owner
Primary
Contract Owner
SecondaryContract Tags
8480-686000-
VMWare Support-
Bishop Clinics-
Insight
Insight Direct USA 07/18/2020 07/17/2021 IT Licensing No Alasdair Simonds Mark LindVMWare Support -
Bishop Server
84008510-GHX
EDI Data Exchange
Contract-GHX
GHX 06/23/2017 06/23/2021Contract
AgreementYes Andrew Crosby Melanie VanWinkle
GHX SOW for
Cerner
84000022-
PremierGPOMemb
ership-PremierInc
ADVENTIST
HEALTH06/09/2009 06/08/2020
Contract
AgreementNo Andrew Crosby Melanie VanWinkle GPO Agreement
8400669000-
ArthrexPricingAgre
ement-
SequoiaSurgical
Arthrex 08/01/2018 07/31/2020Contract
AgreementNo Andrew Crosby Melanie VanWinkle Pricing Agreement
86100069-
MammothSignedM
asterEquipmentAgr
eement-Mediserve
MEDISERVE,INC 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Andrew Crosby Melanie VanWinkle
Hospital Wide
Equipment Service
Agreement
77100086-
VisualSuperScriptS
oftware-DAA
Enterprises
DAA Enterprises,
Inc.07/23/2013 7/22/2021 Subscription Yes
Andrew
KhodaverdianCaitlin Crunk
Employee
prescriptions
61700076-DVT
Pump Lease-
Zimmer Biomet
Zimmer Biomet 08/01/2018 07/31/2021 Disposables No Brandy Wilt Caitlin CrunkDVT Pump no
charge lease
8530-66900
Reference Plus-
Craneware
CRANEWARE INC. 06/11/2019 06/10/2022Professional
ServicesYes Dawn Van Winkle Melanie VanWinkle
Reference Plus
software -
Craneware
85300065-
BadDebtCollection
Services-EOS.
CSB True North 06/01/2019 05/31/2021Contract
AgreementNo Dawn Van Winkle Melanie VanWinkle
Bad Debt
Collections
8530-insurance
payer-Affordable
Health Care
Concepts
Affordable Health
Care Concepts06/01/1995 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-Beech StreetBeech Street 06/01/2008 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-First HealthFirst Health 06/01/1995 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-Galaxy
Health
Galaxy Health
Network06/12/2003 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-Pacificare
United Healthcare
Pacificare United
Healthcare06/23/2006 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-Interplan
Interplan
Corporation07/01/1997 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-CCSCCS 08/19/1996 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-CHDPCHDP 08/19/1996 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
8530-insurance
payer-Three Rivers
Provider network
Three Rivers
Provider network08/07/2015 01/01/2025
Contract
AgreementYes Dawn Van Winkle Melanie VanWinkle insurance payer
75000069-CA-
660CoagAnalyzer-
Siemens
SIEMENS
HEALTHCARE
DIAGNOSTICS,
INC
06/08/2019 06/07/2024 Service and Maint. No Jaime Sallee Mark Lind
EQUIPMENT
SERVICE
AGREEMENT
75000069-EMD
Millipore Water
System Srvc-EMD
Millipore
EMD Millipore 07/31/2020 07/30/2021 Service and Maint. No Jaime Sallee Mark LindLab Water system
treatment
7500669000-
VenipunctureExtern
ship-Phlebotomy
Training Specialists
Phlebotomy
Training Specialists08/01/2018 01/01/2022
Contract
AgreementYes Jaime Sallee Mark Lind
Phlebotomy
Training
7500669000-Vitek2
Analyzer-MediserveMediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Jaime Sallee Mark Lind Vitek2Analyzer
Contract # Vendor NameContract Start
Date
Contract
Termination DateAgreement Type
Evergreen
Agreement
Contract Owner
Primary
Contract Owner
SecondaryContract Tags
75000076-
RubyHematologyA
nalyzer-
ThermoFisher
ABBOTT
LABORATORIES
INC.
08/12/2020 08/12/2021
Equipment
Maintenance
Agreement
Yes Jaime Sallee Mark LindAnalyzer Service
Agreement
87000069-
MediaWriterD200Sr
vcFee-Hyland LLC
Hyland LLC 06/01/2018 05/31/2020 Service and Maint. No Jane Grossblatt Melanie VanWinkleMedia writer
system
8450-669000-Fire
Alarm Monitoring-
A,C,E-Johnson
Controls
Johnson Controls 06/01/2019 05/31/2020 Fire Safety No John Chisum Mark LindFire Alarm
Monitoring
8450-669000-Fire
Alarm Monitoring-
Primary-Primary
Care Clinics-
Johnson Controls 06/01/2019 05/31/2020 Fire Safety No John Chisum Mark LindFire Alarm
Monitoring
8450-669000-Fire
Alarm Monitoring-
Sport Clinic-
Johnson Controls
Johnson Controls 06/01/2019 05/31/2020 Fire Safety No John Chisum Mark LindFire Alarm
Monitoring
8450-669000-Fire
Sprinkler
Inspection and
Testing-Delta Fire
Delta Fire Systems,
Inc06/01/2019 05/31/2020 Service and Maint. No John Chisum Mark Lind
Fire Sprinkler
Inspection and
Testing
84500075-
CernerOfficeSpace
Rental1401-
SierraVentures,LLC
Sierra Ventures,
LLC06/01/2019 05/31/2020 Rental Agreement No John Chisum Mark Lind Office space lease
84500069-
BoilerEvapCondSrv
c-
GarrattCallahanCo
GARRATT
CALLAHAN CO.06/01/2018 05/31/2020 Service and Maint. No John Chisum Mark Lind Boiler Treatment
90108320-
MMSSUnits-
BenLouie
07/01/2013 01/01/2021 Lease No John Chisum Mark Lind Storage unit rental
8440-
SierraNevadaLodg
e-
CorporateHousing
Sierra Nevada
Lodge08/01/2019 07/31/2021
Contract
AgreementNo John Chisum Mark Lind
Corporate Lodging
Agreement
84400069-
ConriquezCleaning
Contract
Conriquez Cleaning 08/22/2014 11/01/2020 Service and Maint. No John Chisum Mark Lind Cleaning Service
84500075-
OakTreeUnitCStora
ge-AllanBrown
Allan Brown 08/01/2017 07/31/2020 Rental Agreement No John Chisum Mark Lind Storage Rental
8450669000-
LegionellaWMP-
GarrattCallahan
Garratt-Callahan
Co.08/22/2018 08/21/2021
Contract
AgreementNo John Chisum Mark Lind
Legionella Water
Management Plan
8740-
HealthStreamEduc
ationContract2014-
HealthStream
HealthStream Inc. 06/30/2019 06/29/2022Dues and
SubscriptionsNo Kathy Romagnino Caitlin Crunk
RN Inservice
Education
76300069-
MediaWriterD200Sr
vcFee-Hyland LLC
Hyland LLC 06/01/2018 05/31/2020 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
76300069-
PacScanSoftware2
yr-PacsGear
Hyland LLC 06/01/2018 05/31/2020Software License
AgreementNo Kevin Larsen Mark Lind
Software
Agreement
7630-669000-
AfterHoursRadiolog
yService-
DRTTeleRadiology
Direct Radiology
California, P.C.07/22/2020 07/21/2021
Professional
ServicesYes Kevin Larsen Mark Lind
Radiology Reading
Service for night
coverage
76800069-
DiamondSelectCTS
canner-
PhilipsMedicalSyst
Philips Medical
Systems07/20/2016 07/19/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7630669000-
AMX4Portable-
Mammoth-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark LindXray Equipment
Service
7630669000-
DigitalDiagnostVM-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7630669000-
FujiCRX3EDMortB
ort-Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7630669000-
GEBishopProteus-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Kevin Larsen Mark Lind
EQUIPMENT
SERVICE
AGREEMENT
Contract # Vendor NameContract Start
Date
Contract
Termination DateAgreement Type
Evergreen
Agreement
Contract Owner
Primary
Contract Owner
SecondaryContract Tags
7630669000-
GEMammothProte
us-Mediserve
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Kevin Larsen Mark LindXray Equipment
Service
7630669000-
HologicDEXA-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Kevin Larsen Mark Lind
Support-Bone
Densitometry/DEX
A
7630669000-
HologicSapphireUlt
rasound-Hologic
Hologic Inc. 08/01/2018 07/31/2022
Equipment
Maintenance
Agreement
No Kevin Larsen Mark Lind
Support-Breast
Biopsy/Sapphire
Equip
7630669000-
Insight2MiniC-Arm-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7630669000-
MultiDiagnstEleva-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind
EQUIPMENT
SERVICE
AGREEMENT
7630669000-
PulseraC-Arm-O.R
New-Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7630669000-
PulseraC-
ArmOriginal-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7630669000-
QRadiologySystem
MAJ-Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Kevin Larsen Mark Lind Equipment Service
7670669000-
AplioUltrasound-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Kevin Larsen Mark Lind
EQUIPMENT
SERVICE
AGREEMENT
8750 MBQIP
Medicare Benficiary
Quality
Improvement
06/16/2016 01/01/2020 MOU No Lenna Monte Caitlin Crunk
MBQIP Medicare
Benficiary Quality
Improvement Pro
8750-Transfers-
LomaLindaLoma Linda 06/01/2005 01/01/2025
Transfer
AgreementsYes Lenna Monte Caitlin Crunk
Transfer
Agreement
8750-Transfers-
NorthernInyoHospit
al
Northern Inyo
Hospital06/19/2008 01/01/2025
Transfer
AgreementsYes Lenna Monte Caitlin Crunk
Transfer
Agreement
8750-
HospitalPatient
Satisfaction
Surveys-
Press Ganey
Associates, Inc.06/01/2016 05/31/2021
Contract
AgreementYes Lenna Monte Caitlin Crunk
Performance
Measurement
Service
87800069-
TrainingTranslation
sConsulting-
SierraSkyInterpreti
Sierra Sky
Interpreting07/15/2008 01/01/2019
Contract
AgreementNo Lenna Monte Caitlin Crunk
Language
Intepretation and
Translation
7010-Telepsych
Contract for
EDsigned-
CEPAmericaTelehe
CEP America-
Telehealth,PC06/15/2017 01/01/2025
Affiliation
AgreementYes Lori Baitx Caitlin Crunk
Telemedicine
services
7010669000-
Sonosite
Ultrasound Edge
P1500-11-
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Lori Baitx Caitlin Crunk
Equipment
Maintenance
Agreement
7770-
PhysicalTherapyCli
nical Education-
University of St.
University of St.
Augustine06/17/2016 06/16/2021
Contract
AgreementNo Lorraine Koenig Zachary Brown
Physical Therapy
Education
Agreement
7770-
PhysicalTherapyCli
nicalEducation-
SanDiego State
San Diego State
University06/17/2015 01/01/2025
Contract
AgreementYes Lorraine Koenig Zachary Brown
Student Education -
PT
7770-
ClinicalEducationfo
r
PhysicalTherapySt
University of the
Pacific07/12/2010 01/01/2025
Contract
AgreementYes Lorraine Koenig Zachary Brown
Student Education -
PT
7770-
MonoCountyOffice
OfEducationPTSer
vices-MonoCounty
mono county office
of education08/01/2020 07/31/2021
Professional
ServicesNo Lorraine Koenig Zachary Brown
consultation -
education
7772-MOU-BUHS-
MH for ATC
Service
Bishop Union High
School District08/15/2016 01/01/2025 MOU Yes Lorraine Koenig Zachary Brown
Certified Athletic
Trainer Service
8490-685000-
1GBMainCampusIn
ternetCircuit-
Telequality
Telequality, Inc. 06/29/2018 06/28/2021 Telecom Services No Mark Lind
Contract # Vendor NameContract Start
Date
Contract
Termination DateAgreement Type
Evergreen
Agreement
Contract Owner
Primary
Contract Owner
SecondaryContract Tags
84800083-
TeamViewer11Cor
porateLicense
TEAMVIEWER
GMBH06/11/2020 06/12/2021 IT Licensing Yes Mark Lind
8480683000-
VeemBackupReplic
ationLicense-
Insight
Insight Enterprises
Inc06/25/2020 06/25/2023 IT Agreement No Mark Lind
System Back up
and Maintnenace
Agreement
8490-685000-
InternetCircuit-
ENAHealthcare
ENA Healthcare
Services, LLC07/01/2020 06/30/2021 IT Agreement No Mark Lind
Internet Circuit fro
Hospital Campus
8610-669000-
CaseCoordinationf
orJoints-Johnson
and Johnson
07/22/2020 07/21/2023Contract
AgreementNo Mark Lind
Case Coordination
for Total Joints
8480-683000-HPE
Support - Citrix
Workspace
software solution -
Insight Enterprises
Inc08/01/2019 07/31/2020 IT Licensing Mark Lind
It Software &
Hardware Support
84800083-
HiveManagerSubsc
ription-Aerohive-
Invoice
Insight Enterprises
Inc09/28/2019 09/27/2020 IT Agreement No Mark Lind
IT License-100
License for
wireless network
mngmnt
8480669000-
DellServerSupport-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 IT Agreement No Mark Lind Server Support
8481-683000-
Cerner Patient
Kiosk Monthly Fee-
Cerner
Cerner Corp 08/22/2018 08/21/2023Software License
AgreementYes Mark Lind
Shared Computing
Monthly Fee
8481-683000-
Nuance
PowerScribe 360
Upgrade-Nuance
NUANCE
DOCUMENT
IMAGING INC
08/01/2019 07/31/2022 IT Licensing Yes Mark LindPowerScribe Core
Reporting
84810069-
ParticipationAgree
mentHIE-
ManifestMedex
Inland Empire
Health Information
Exchange
08/01/2018 07/31/2020 IT Agreement Yes Mark LindHealth Information
Exchange Vendor
8610-
MammothHospitalP
ropertyInsurance
Alliant Insurance
Services, Inc.07/01/2020 06/30/2021
Contract
AgreementNo Melanie VanWinkle
insurance,HARPP,
APIP
8650-DO FOR
INFORMATION
ONLY DO-16-702-
Beta Healthcare
Beta Risk
Management
Authority
07/01/2019 06/30/2020Dues and
SubscriptionsNo Melanie VanWinkle
Directors and
Officers Liability
Coverage
8610-7160-
physician contract-
knechtstephen
Stephen Knecht,
MD07/01/2019 06/30/2022 Physician Contract Melanie VanWinkle
8610-7160-
physician contract-
urbandlindsey
07/01/2019 06/30/2022 Physician Contract Melanie VanWinkle Tabby Mannetter
7140-669000-M-
Turbo Ultrasound-
Fuji
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Michael McMahon Zachary Brown
EQUIPMENT
SERVICE
AGREEMENT
7160669000-
Sonosite
Ultrasound M-
Turbo
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Michael McMahon Zachary BrownUltrasound annual
calibration
7400669000-
Sonosite
Ultrasound Edge-
P1500-11-
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Nancie Hamilton Caitlin CrunkUltrasound annual
calibration
7720669000-
Ventilator,CpapV60-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Nancie Hamilton Caitlin Crunk
Equipment
Maintenance
Agreement
74200069-
ArthrexScope/Tabl
etRepair/Synergy-
Arthrex
Arthrex 07/01/2018 06/30/2021 Service and Maint. Phyllis Meneses Caitlin Crunk
Arthroscope/Tablet
/Light Guide/Optical
Coupler
74200069-
ArthrexSynergySur
geonsVault-Crall-
Gilmer 3yr-Arthrex
Arthrex 07/01/2018 06/30/2021 Subscription No Phyllis Meneses Caitlin CrunkSurgeons Vault
Software
74200050-
BairPawsWarming
Kit-
ArizantHealthcare
ARIZANT
HEALTHCARE
INC. AUGUSTINE
MEDICAL INC.
07/15/2011 01/01/2022 Disposables Yes Phyllis Meneses Caitlin CrunkPatient Warming
systems
7420-669000-
LumenisLaser-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. Yes Phyllis Meneses Caitlin Crunk Lumenis Laser
Contract # Vendor NameContract Start
Date
Contract
Termination DateAgreement Type
Evergreen
Agreement
Contract Owner
Primary
Contract Owner
SecondaryContract Tags
7420-669000-SII
Sonosite
Ultrasound-Fuji
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No Phyllis Meneses Caitlin Crunk
EQUIPMENT
SERVICE
AGREEMENT
74200069-
OlympusKESupport
Maintenance-
Olympus
OLYMPUS
AMERICAS INC08/15/2017 08/14/2020
Software
Maintenance
Agreement
No Phyllis Meneses Caitlin Crunk
Olympus Software
for Endoscopy
System
74200069-
SterradNXSterilizer-
AdvancedSterilizati
on
ADVANCED
STERILZATION
(JJ)
08/12/2019 08/11/2020 Service and Maint. No Phyllis Meneses Caitlin Crunk Sterilizer service
8610-
InmateMedicalCare-
MonoCounty
Mono County 07/18/2013 01/01/2025Contract
AgreementYes Sarah Rea Tom Parker
County Inmate
Care Agreement
8650-669000-
DocumentRetentio
nLicenseFee-
Treenosoftware
Treeno Software 07/01/2018 01/01/2025Software License
AgreementYes Sarah Vigilante Tom Parker
Document
Retention License
Fee
8650-StayStaffed Sta Stafffed 08/01/2014 01/01/2021 Subscription Yes Sarah Vigilante Tom Parker
Staffing needs
temporary and
permanent
85100076-
NeopostN-
710MailMachine-
MMSWest
Mail Finance Inc 06/01/2017 05/31/2022Equipment Lease
AgreementNo Slavka Crouthamel Melanie VanWinkle
Mail Machine
Lease
85100024-
AuditServices-
EideBailly
Eide Bailly 07/30/2009 01/01/2021Professional
ServicesNo Slavka Crouthamel Melanie VanWinkle Audit services
8750-Transfers-
CedarsSinai
Cedars-Sinai
Medical Center08/20/2010 01/01/2025
Transfer
AgreementsYes Stephanie Stanton Caitlin Crunk
Transfer
Agreement
8750-
PatientComplaints
Software-Verge
Verge Solutions,
LLC08/01/2012 07/31/2021
Contract
AgreementNo Stephanie Stanton Caitlin Crunk
Incident Reporting
and Patient
Complaint Software
8610-7080-
physician contract-
crunkdennis
Dennis Crunk, M.D. 06/01/2019 12/31/2021 Physician Contract No Tabby Mannetter Melanie VanWinklePHYSICIAN
CONTRACT
8610-
7160physiciancontr
act-cutticmarianne
Marianne Cuttic 06/01/2017 08/31/2020 Physician Contract No Tabby Mannetter Melanie VanWinklePHYSICIAN
CONTRACT
8610-6170-
physician contract-
hospitalist-araya-
burrows-park-
Craig Burrows, MD,
Inc.; Araya
Medicine, Inc.; KP1
and 2, Inc.
07/01/2017 12/31/2020 Physician Contract No Tabby Mannetter Melanie VanWinklePHYSICIAN
CONTRACT
8610-7080-
physician contract-
wardchristopher
Christopher Ward,
DO04/01/2019 12/31/2021 Physician Contract Tabby Mannetter Melanie VanWinkle
PHYSICIAN
CONTRACT
8610-7083-
physician contract-
craguntimothy
Timoth Cragun 08/01/2018 07/31/2021 Physician Contract Tabby Mannetter Melanie VanWinklePHYSICIAN
CONTRACT
8610-7060-
physician contract-
fujimotosteven
Steven Fujimoto,
DDS08/01/2017 01/01/2025 Physician Contract No Tabby Mannetter Melanie VanWinkle
PHYSICIAN
CONTRACT
8610-7010-
physician contract-
emergency
Mammoth
Emergency
Physicians
08/01/2016 07/31/2021 Physician Contract Yes Tabby Mannetter Melanie VanWinklePHYSICIAN
CONTRACT
8610-7160
physician contract-
MOI
Mammoth
Orthopedic Institute
(MOI)
08/01/2017 07/31/2022 Physician Contract Tabby Mannetter Melanie VanWinklePHYSICIAN
CONTRACT
7180669000-
Hitachi5500Ultraso
und-Mediserve
Mediserve Inc. 08/01/2018 07/31/2021 Service and Maint. No Teresa Toups Zachary BrownHitachi Ultrasound
Service
7090-2017-6-
UCDavis-
Telemedicine for
Peds
University of
California, Davis
Medical Center
07/01/2018 06/30/2020Affiliation
AgreementYes TR Miller Zachary Brown
Telemedicine
service
86100000_Toiyabe
_Indian_Health_Pr
oject_MOU
Toiyabe Indian
Health Project07/22/2015 01/01/2021 MOU Yes TR Miller Zachary Brown
Toiyabe Health
service MOU
7050669000-
SonositeUltrasound
Edge-P1500-11-
Mediserve
Mediserve Inc. 08/01/2018 07/31/2021
Equipment
Maintenance
Agreement
No TR Miller Zachary BrownUltrasound annual
calibration
1
AGREEMENT FOR PROVISION OF PHYSICIAN SERVICES
THIS AGREEMENT is made this 28th day of August 2020, by and between SOUTHERN MONO HEALTHCARE DISTRICT ("DISTRICT"), and LUCIENNE BOUVIER, M.D., Inc. (hereinafter referred to as "PHYSICIAN"), at the Town of Mammoth Lakes, County of Mono, State of California.
Recitals
A. The DISTRICT is a Local Health Care District duly organized and existing under the
laws of the State of California and more specifically the Local Health Care District Law, Health and Safety Code §§32000, et seq.
B. The DISTRICT owns and operates Mammoth Hospital to provide acute care, full service
medical services to the community in which it serves.
C. PHYSICIAN is an independent practicing physician duly licensed by the State of California and Board Certified in the practice area of obstetrics and gynecology.
D. The DISTRICT has determined that the making and entering into of this Agreement for
the providing of physician services in the area of obstetrics and gynecology is necessary for the provision of adequate health care services to the communities served by the DISTRICT.
E. It is further determined by the board of directors of the DISTRICT that this Agreement
allows the board of directors to ensure that fees and charges for these physician services rendered at Mammoth Hospital are reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health care to all residents within the boundaries of the DISTRICT and visitors to the area.
Agreement
NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS AND CONDITIONS CONTAINED HEREIN, THE PARTIES AGREE AS FOLLOWS:
1. Term of Agreement. The DISTRICT hereby retains the services of PHYSICIAN for a term of three (3) years commencing on or about January 1, 2021 and terminating on December 31, 2023.
Notwithstanding the foregoing, either party may terminate this Agreement prior to the
expiration of any term hereof based on a finding of good cause. Good cause shall be limited to a default by either party herein. In the event either party elects to terminate this Agreement prior to the expiration of any term hereof based on cause or default, such party shall provide written notice to the other, setting forth in enough detail, the nature, extent, and scope of the default. Thereafter, the alleged defaulting party shall have thirty (30) days to remedy, cure, or otherwise correct the default. Should the alleged defaulting party not so remedy or otherwise cure the default within the thirty (30) day-time period, the no defaulting party may immediately terminate this Agreement
The DISTRICT may elect to immediately terminate this Agreement without first
complying with the foregoing provisions regarding good cause and notice of default in the event of:
(1) suspension, revocation, or expiration (without renewal thereof) of PHYSICIAN's license to practice
medicine in the State of California; (2) suspension (for 30 or more days), revocation, or other
termination of medical staff privileges of PHYSICIAN at Mammoth Hospital; (3) PHYSICIAN is
convicted of a felony (4) any event of default which cannot be cured within the time periods set forth
herein; (5) the reputation of PHYSICIAN or DISTRICT is adversely affected by some intentional act
of PHYSICIAN or (6) an emergent situation requiring termination as determined by the DISTRICT
in order to protect against or avoid adverse impacts to patients, staff, DISTRICT personnel or
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facilities, or the health, safety and welfare of the residents and communities served by the DISTRICT.
The DISTRICT has the express right to take action under its Bylaws and the Medical
Staff Bylaws to ensure patient safety; in the event Medical Staff fails to take appropriate action
against any physician who provides substandard care or who engages in professional misconduct
which within the reasonable and lawful discretion of the DISTRICT is jeopardizing public safety, this
Agreement may be terminated by the DISTRICT and the physician may be removed from the
Medical Staff pursuant to the Medical Staff Bylaws.
2. Description of Duties. PHYSICIAN shall personally render the services to Mammoth
Hospital during the term of this Agreement. PHYSICIAN shall obtain the approval of the Chief
Executive Officer ("CEO") or hospital administrator before retaining the services of additional
physician personnel to perform identical services as PHYSICIAN and while PHYSICIAN is
performing such services. This provision shall not apply to substitute temporary staffing, including
locum tenens. See Exhibit A for details of duties and expectations.
1) It is expressly acknowledged by PHYSICIAN that Mammoth Hospital serves
a resort and tourist-based community. In connection therewith, PHYSICIAN's personal attendance
for staffing needs will be required during holiday and other high-volume periods. In order to minimize
the excess costs associated with substitute physician staffing, including locum tenens, PHYSICIAN
shall not take time off or vacations during such peak or holiday periods except pursuant to the
schedule agreed upon by PHYSICIAN and the other OB/GYN who will provide services at Mammoth
Hospital.
2) All physician services provided herein by PHYSICIAN shall be rendered by
PHYSICIAN in the exercise of the utmost degree of skill and care and within the sole and absolute
discretion and control of PHYSICIAN exercising independent professional judgment. The DISTRICT
shall not direct PHYSICIAN in the rendering of physician services hereby, and PHYSICIAN shall
not be considered an agent of DISTRICT.
3) PHYSICIAN shall be a permanent or temporary member of the medical staff
of Mammoth Hospital and shall be in good standing.
4) Performance by PHYSICIAN of his obligations pursuant to this Agreement shall be in compliance with all federal, state, and local laws, rules, regulations, and ordinances, and in full compliance of any such applicable rules and regulations of any governmental or accrediting agency or authorities relating to the licensure and regulations of physicians, medical practitioners, and acute care hospitals.
5) PHYSICIAN shall comply with all rules and regulations established at Mammoth Hospital, including without limitation, the Medical Staff Bylaws and the Bylaws of the Southern Mono Healthcare District, and as all may be amended from time to time.
6) All services rendered by PHYSICIAN hereunder shall be in accordance with the
standards, rules, regulations, and recommendations of the DISTRICT's current and any future accrediting agencies (e.g., DNV, the Joint Commission, and State of California, regardless of whether Mammoth Hospital is so accredited) and of the Medicare Conditions of Participation.
7) PHYSICIAN shall comply with and maintain professional and ethical standards
of conduct with respect to the issue of patient confidentiality. PHYSICIAN shall not use or disclose any protected health information or individually identifiable health information (as defined in the Health Insurance Portability and Accountability Act ("HIPM"; 45 CFR Part 164), the Confidentiality of Medical Information Act (:"CMIA", Civil Code §§56.05, et seq.), or Health.& Safety .Code §1280.15) (collectively, "Protected Health Information" or "PHI") concerning any patient of Mammoth Hospital or its affiliated
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clinics and facilities (whether or not PHYSICIAN renders services to such patient) other than as expressly permitted by this Agreement and the requirements of State and Federal privacy regulations and security standards. PHYSICIAN further agrees to comply with all policies, procedures and directives of the DISTRICT regarding the use and disclosure of Protected Health Information.
8) PHYSICIAN shall diligently and timely maintain, update, make entries in or to,
and file all necessary medical records and billings and charges. Such items include, without limitation, charts, charge slips, billing codes, physician charge codes, transcriptions, assignments of billings and charges, and orders. For the purposes of this provision, "diligently and timely" mean and refer to completing all tasks, including electronic health record task lists, within 48 hours of the time of the event, treatment, service, or transaction. PHYSICIAN shall use the EMR systems in connection with PHYSICIAN's obligations in this sub-paragraph.
9) During the term of this Agreement, PHYSICIAN shall maintain an active presence within the community served by the DISTRICT and engage in community functions. The activities contemplated hereby are to include, without limitation, spending a reasonable amount of time participating in health fairs, wellness awareness programs, school health programs, community education, and other service programs sponsored by the Hospital. At the end of each term year, PHYSICIAN shall provide to the hospital administrator a written report setting forth a summary of activities in compliance with this paragraph if requested to do so.
3. Effect of Consideration. No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is being made for the referral of patients to Mammoth Hospital. This Agreement in no way restricts PHYSICIAN from establishing staff privileges at, referring patients to, or generating business from another entity. PHYSICIAN retains sole and absolute professional discretion regarding PHYSICIAN's patient matters and referral practices.
No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is for any bonus, retention incentives, or otherwise. All such consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is as expressly set forth in this Agreement.
Notwithstanding coverage and staffing obligations of PHYSICIAN as provided for in this Agreement, PHYSICIAN expressly acknowledges and agrees that the DISTRICT has not made, nor does this Agreement provide for, any of the following for the benefit of PHYSICIAN: (i) income guarantees, (ii) promises, representations, or guarantees of patient volumes or business volumes, (iii) exclusivity of medical services provided, (iv) minimum or guaranteed hours or days of coverage or office hours. The DISTRICT retains sole and absolute discretion regarding its business decisions and operations, including facilities and clinics staffed by PHYSICIAN as provided for in this Agreement. This discretion includes, without limitation, hours of operation, staffing, location, and whether to cease or suspend operations. Coverage obligations of PHYSICIAN are subject to and limited by the matters set forth in this paragraph. PHYSICIAN shall have no claims against the DISTRICT, including its agents, representatives, officers, directors, and affiliates, for any damages, loss of income, or otherwise resulting from decisions or actions by the DISTRICT as provided for in this paragraph.
4. Professional Fees to PHYSICIAN.
The DISTRICT shall pay to PHYSICIAN as and for professional services being rendered by PHYSICIAN
pursuant to this Agreement as specified in Exhibit B. PHYSICIAN and DISTRICT have reviewed the
compensation to be paid under this Agreement as outlined in Exhibit B to confirm it is consistent with fair
market value and does not violate of the federal Anti-kickback statute or Stark Act.
5. PHYSICIAN Billings for Patient Services and Care. The DISTRICT shall bill for all patient
services and care rendered by PHYSICIAN and any substitute physicians, including locum tenens,
pursuant to this Agreement. All such physician fees and billings shall remain the property of the
DISTRICT. It is expressly acknowledged and agreed to by and between the parties that the DISTRICT
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will not be realizing a profit in connection with the services being rendered by PHYSICIAN hereby. All
fees and rates for all services rendered and charges shall be set by the DISTRICT and shall be
reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health
care to all residents and visitors within the boundaries of the DISTRICT.
6. Professional Liability (Malpractice) Insurance. PHYSICIAN has two options for Professional Liability Insurance: a) Obtain own professional liability coverage as outlined below or b) request that the DISTRICT add PHYSICIAN to the DISTRICT professional liability policy (see EXHIBIT B for option selected).
a) PHYSICIAN shall maintain professional liability/medical malpractice insurance, which the
DISTRICT approves in advance, and which approval shall not be unreasonably withheld. The DISTRICT shall be a named or additionally named insured under all such policies. All coverages shall include a statement to the effect that "coverage afforded under this Policy will act as primary insurance to that of the certificate holder and additional insured. PHYSICIAN shall provide to the DISTRICT upon reasonable request therefor a certificate or other proof that such insurance is in full force and effect. The limits of any liability policy shall be not less than $1,000,000 per occurrence. Insurance shall be maintained with an admitted carrier licensed by the State of California Department of Insurance with a Best rating of not less than A minus, and coverage shall be in conformance with the Medical Staff Bylaws (and as the same may be amended from time to time). PHYSICIAN shall immediately notify the DISTRICT of any change or cancellation of any insurance policy in effect pursuant to this Agreement. In the event of any notice of cancellation given to PHYSICIAN, PHYSICIAN shall reinstate all such insurance within thirty (30) days of such notice.
b) As of the date of this Agreement, PHYSICIAN has been able to be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto. The DISTRICT shall continue to maintain professional liability/medical malpractice insurance for PHYSICIAN as provided for herein through the current policy of the DISTRICT provided by BETA. In the event such coverage through BETA is no longer available or the DISTRICT procures other coverage for the DISTRICT where the physicians cannot be included as determined by the DISTRICT, within its sole and absolute discretion, the parties shall meet and confer and modify this Agreement accordingly in order to ensure that PHYSICIAN can reasonably meet the obligation to have such insurance in place during the then remaining term of this Agreement.
7. Records. All books, records, patient medical records, and other documents pertaining to or relating to the care and treatment of patients at Mammoth Hospital and the services rendered by PHYSICIAN pursuant to this Agreement shall be and remain the property of the District. Upon termination, PHYSICIAN shall make entries in or to, and file as necessary medical records and billings and charges in accordance with subsection 8 of section 2 of this Agreement, and shall return any and all such property in PHYSICIAN’s possession to District by the date of termination.
8. Warranties of PHYSICIAN. In addition to all other warranties or representations made
by PHYSICIAN in connection with the making and entering into of this Agreement, whether oral or written, PHYSICIAN hereby represents and warrants to the DISTRICT the following:
1) PHYSICIAN is a duly licensed physician in good standing in the State of California. PHYSICIAN is registered with the DEA to prescribe controlled substances without restriction or limitation. Neither PHYSICIAN's medical license nor PHYSICIAN's DEA registration has ever been suspended, revoked, restricted, limited, or terminated. PHYSICIAN has disclosed to DISTRICT any type of disciplinary or corrective action taken by any medical licensing or certification authority, or any reprimand monetary fine or penalty relating to the rendering of medical services by PHYSICIAN. There exists no actual, pending, or threatened disciplinary proceedings against PHYSICIAN that could result in
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5
the suspension or revocation of PHYSICIAN's license to practice medicine in the State of California.
2) PHYSICIAN is under no obligation, restriction or limitation, contractual or otherwise, to any other individual or entity that would prohibit or impede PHYSICIAN from undertaking and performing the duties, responsibilities, and obligations of PHYSICIAN pursuant to this Agreement. The terms and provisions of this Agreement do not affect or violate any agreement or obligation of PHYSICIAN with respect to the ability of PHYSICIAN to practice medicine.
3) PHYSICIAN is an independent physician, i.e., not an employee of the DISTRICT.
4) PHYSICIAN has never been removed for cause from any provider panel of any managed care organization, indemnity insurer or other third-party payer, or independent practice association, PHYSICIAN organization, PHYSICIAN-hospital organization, or other provider network.
5) PHYSICIAN is not a party to any pending malpractice or other patient-related
litigation, nor have any such claims been threatened, including any proceedings against PHYSICIAN before any professional licensing board.
6) To PHYSICIAN's best knowledge, he/she is not a party to any pending
investigation or proceeding the basis of which implicates his/her professional competence or that could lead to a suspension, revocation, restriction, limitation or termination of his/her medical license or medical staff privileges at any hospital. PHYSICIAN has not been involved in a violation of the Stark Law or the Anti-Kickback Statute.
PHYSICIAN shall immediately notify the DISTRICT in the event any of the foregoing representations are or become untrue for any reason. PHYSICIAN’s failure to immediately notify the DISTRICT in this event shall amount to a material breach of this Agreement for which the DISTRICT may immediately terminate this Agreement.
9. Effect of Relationship. This Agreement is not intended to nor shall it create any relationship of partnership, joint venture, employer/employee, master/servant, employment, agency or otherwise. PHYSICIAN is not receiving from the DISTRICT any monetary compensation in the nature of income guarantees, subsidies, referral fees, or otherwise. All compensation provided for herein is for services rendered for professional services of PHYSICIAN as has been expressly set forth herein. PHYSICIAN is at all times acting and performing under this Agreement as an independent contractor and as a medical practitioner and licensed physician in the State of California, with PHYSICIAN specializing in the area of medicine delineated herein. It is the intention of the DISTRICT to obtain the services of PHYSICIAN to ensure that the specialty services of PHYSICIAN are available to carry out health care services for the benefit of the communities served by the DISTRICT and that such services be performed in a competent, professional, appropriate, and efficient manner as set forth in this Agreement.
The DISTRICT shall not direct or supervise the way services are rendered by PHYSICIAN. PHYSICIAN shall render services pursuant to this Agreement within the sole, reasonable, and independent professional discretion of PHYSICIAN.
Unless otherwise required, PHYSICIAN shall have all compensation paid pursuant to
this Agreement subject to Form 1099 reporting. PHYSICIAN shall be fully responsible for the payment of all income taxes and the payment of all appropriate withholding of all payroll taxes and deductions for PHYSICIAN. In connection herewith, PHYSICIAN shall have no claims under this Agreement or otherwise, against the DISTRICT for vacation pay, sick leave or other paid leave, pension or retirement benefits, social security or FICA, worker's compensation, disability, unemployment insurance benefits, or any other benefits afforded to full-time benefitted employees at Mammoth Hospital.
10. Survival of Warranties and Representations. All warranties and representations of PHYSICIAN shall survive both the date of this Agreement and any eventual termination of this
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6
Agreement.
11. Working Space. The DISTRICT shall provide PHYSICIAN with enough working space,
staffing of personnel (including support and clerical staff), and hospital facilities while PHYSICIAN is performing services at Mammoth Hospital, with the intent to enable PHYSICIAN to perform and render services as provided for herein.
12. No Assignment by PHYSICIAN. Due to the uniqueness of services being rendered by PHYSICIAN to the DISTRICT and the specific professional skill, competence, and experience of PHYSICIAN, PHYSICIAN shall not assign, sublet, delegate, or otherwise convey PHYSICIAN's rights and obligations pursuant to this Agreement. Any attempt to so assign by PHYSICIAN shall be deemed null and void and shall entitle the DISTRICT to immediately terminate this Agreement without first having to comply with any notice of default provisions (including those provided for in paragraph 1 above), termination provisions of any DISTRICT Bylaws or Medical Staff Bylaws, or otherwise. In the event PHYSICIAN forms or becomes part of a medical or other professional corporation, partnership, limited liability company, limited liability partnership, or other such entity, PHYSICIAN shall unconditionally guaranty any and all obligations, promises, covenants, and warranties of any such entity as provided for in this Agreement. All liability of PHYSICIAN hereunder shall be joint and several with that of any such entity. In such event, PHYSICIAN shall notify the DISTRICT within thirty (30) days.
13. Remedies. Any and all remedies provided by this Agreement, operation of law, or
otherwise, shall be deemed to be cumulative, and the choice or implementation of any particular remedy shall not be deemed to be an election of remedies to the mutual exclusion of any other remedy provided for herein, by operation of law, or otherwise. Enforcement of any provision of this Agreement shall be by proceedings at law or in equity against any persons or entities violating or attempting to violate any promise, covenant, or condition contained herein, either to restrain violation, compel action, or to recover damages.
14. Attorney's Fees. In the event any action at law or in equity is initiated to enforce or interpret the terms of this Agreement, or arises out of or pertains to this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, costs, and necessary disbursements in addition to any other relief to which that party may be entitled.
15. Notices. Any notices to be given by either party to the other shall be in writing and shall be transmitted either by (1) personal delivery, (2) mail, registered or certified, postage prepaid with return receipt requested, (3) by an overnight delivery service (e.g., Federal Express), or (4) by facsimile or email service with a confirmation copy by regular mail, first class postage prepaid. Personal delivery or mailed notices shall be addressed to the parties at the addresses listed below. Notices shall be transmitted via the contact information listed below. Each party may change that address and facsimile telephone number by giving written notice in accordance with this paragraph. In the event of any mailing, notice shall be deemed given on the 3rd day after deposit. The addresses and facsimile telephone numbers of the parties are as follows:
SOUTHERN MONO HEALTH CARE DISTRICT Attn: Chief Executive Officer P.O. Box 660 Mammoth Lakes, CA 93546 Facsimile Telephone No.: (760) 924-4104 Email: [email protected]
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LUCIENNE BOUVIER, M.D., Inc. 385 L Street Fremont, CA 94536 E-mail: [email protected] Cell Phone: 510-710-3261
16. Integration. It is intended by the parties that this Agreement be the final expression of the
intentions and agreements of the parties. This Agreement supersedes all prior or contemporaneous agreements, either oral or in writing, between the parties hereto and contains all of the covenants and agreements between the parties. No other agreements, representations, inducements, or promises, not contained in this Agreement shall be valid or binding. Any modification of this Agreement shall be effective only if it is in writing and signed by both parties.
17. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the
heirs, executors, administrators, personal representatives, successors, and assigns of each of the parties hereto.
18. Severance. In the event any term or provision of this Agreement is deemed to be in
violation of law, null and void, or otherwise of no force or effect, the remaining terms and provisions of this Agreement shall remain in full force and effect.
19. Governing Law. Venue. This Agreement shall be interpreted under the laws of the State
of California. Exclusive venue for any legal action shall be Mono County, California.
20. Effect of Waiver. No waiver of any breach of any term, covenant, agreement, restriction,
or condition of this Agreement shall be construed as a waiver of any succeeding breach of the same or any other covenant, agreement, term, restriction, or condition of this Agreement. The consent or approval of either party to or of any action or matter requiring consent or approval shall not be deemed to waive or render unnecessary any consent to or approval of any subsequent or similar act or matter.
21. Joint Preparation. This Agreement shall be deemed to be jointly prepared by all parties hereto. In connection therewith, the provisions of Civil Code §1654 shall not be deemed applicable in the event of any interpretation of this Agreement.
22. Access to Records Clause. If this Agreement is for the provision of services with a value of $10,000 or more over a twelve (12) month period, then until the expiration of four (4) years after the furnishing of the services provided under this Agreement, PHYSICIAN will make available to the Secretary, U.S. Department of Health and Human Services, the U.S. Comptroller General, and their representatives, this Agreement and all books, documents, and records necessary to certify the nature and extent of the costs of those services. If PHYSICIAN carries out the duties of this Agreement through a subcontract worth $10,000 or more over a twelve (12) month period with a related organization, the subcontract will also contain an access clause to permit access by the Secretary, Comptroller General, and their representatives to the related organization's books and records. This paragraph shall be in effect only to the extent required by law.
23. Time. Time is expressly declared to be of the essence of this Agreement.
24. Public Document; No Confidentiality. The parties agree and acknowledge hereby that
upon full execution of this Agreement and the filing hereof in the official records and files of the DISTRICT, this Agreement becomes a public document pursuant to the California Public Records Act.
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25. Final Authority. The DISTRICT shall have final authority over all hospital matters,
controls, functions, employment of personnel not employed by PHYSICIAN, and administration. Any interpretation of these matters shall be determined within the sole and absolute discretion of the DISTRICT. It is expressly acknowledged and agreed to by and between the parties that this provision shall in no way be construed as a usurpation, interference, or exercise of any control whatsoever of the right, duty, and obligation of PHYSICIAN to render independent medical opinions and care as provided for herein.
26. Counterparts. Facsimile signature pages shall be deemed original signature pages and
shall be admissible as the same in a court or other tribunal as though such were originals. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but all of which shall constitute one and the same instrument. All of such counterpart signature pages shall read as though one, and they shall have the same force and effect as though all the signers had signed a single signature page.
* * * End of Text***
IN WITNESS WHEREOF, this Agreement is executed as of the day and year first above written. SOUTHERN MONO HEALTHCARE DISTRICT BY: ____________________________________ Tom Parker, Chief Executive Officer ____________________________________ Lucienne Bouvier, M.D., Inc.
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EXHIBIT A
DESCRIPTION OF DUTIES
PHYSICIAN duties/expectations are:
1. Provide clinical services for Mammoth Hospital and Mammoth Hospital Women’s Clinic. It is
assumed that PHYSICIAN will work in the Women’s Clinic 10 clinic days (exception for holiday
weeks) per month.
2. Shared hospital obstetrics on-call services are required, shared by 2 physicians. If the second
OB/GYN ceases to provide on-call services, the DISTRICT shall seek a replacement OB/GYN
as soon as possible and, during the interim period, contract a locum tenens physician(s) to
share on-call services with PHYSICIAN.
3. Women’s Clinic is opened Monday – Friday, except during recognized holidays.
4. Clinic hours for patient appointments can range from 8am – 6pm.
a. Specific hours worked by each provider can vary - coordinate with Clinic Manager to
ensure appropriate staffing is available.
5. Physician agrees to work with the other OB/GYN physician to ensure 1 OB provider provide
patient care during every regularly scheduled clinic day. If the other OB/GYN physician
ceases to provide clinical services at Mammoth Hospital Women’s Clinic, the DISTRICT shall
seek a replacement OB/GYN as soon as possible and, during the interim period, contract (at
the DISTRICT’s expense) a locum tenens physician(s) to share clinical duties with
PHYSICIAN.
6. With two OB physicians it is expected that the OB/GYN physicians will coordinate their
vacation and days off to maintain the normal clinic and hospital on-call coverage. Locums
will not be supplied by the hospital unless one physician is on an extended leave (ie., for 30
or more days) and requests a locum to maintain the needed coverage.
7. PHYSICIAN shall collaborate with the other OB/GYN physician to provide a hospital on-call
and clinic schedule to the Clinic Manager ninety (90) days in advance
8. PHYSICIAN shall participate in regular Women’s Clinic provider meetings (usually once a
month) to maintain good team communication on patient care, participate in the
development of departmental policy and procedure, development of EMR protocols,
focus on operational improvement, solve problems in services delivery, provide in-service
training for staff development, and develop consensus on methods of patient care, patient
education, and group practice.
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EXHIBIT B
COMPENSATION
1. Base Clinic Pay – PHYSICIAN will be compensated at fifteen thousand nine hundred fifteen
dollars ($15,915.00) each month. It is assumed that PHYSICIAN will work in the Women’s clinic approximately 10 clinic days (exceptions for holiday weeks) per month. It is encouraged that the two OB/GYN physicians come to agreement on coverage which equates to 50% throughout the year. If PHYSICIAN is unable to cover her agreed upon 50% coverage and the DISTRICT has to obtain locum coverage this monthly base pay will be prorated to the days worked.
2. Hospital On-Call Pay – PHYSICIAN will be compensated one thousand one hundred dollars
($1,100.00) for each 24-hour hospital on-call shift (if less than a 24-hour shift is worked the daily rate will be prorated).
3. Work Relative Value Unit (wRVU) Production Pay:
a. Clinic and hospital: Work Relative Value Unit (wRVU) Production Pay – PHYSICIAN
will be paid a rate of sixty-three dollars and 67 cents ($63.67) for every wRVU generated in excess of 250 per month.
The wRVU’s are subject to change each January 1st as regulated by the Centers for Medicare &
Medicaid ("CMS") and compensation for procedures that are coded with certain defined
modifiers, as is set forth on the list of modifiers and applicable adjustments (EXHIBIT C).
Pursuant thereto, the DISTRICT will modify the wRVU’s by the CMS adjustment as set forth on
the EXHIBIT C.
Actual amounts collected by the DISTRICT shall remain the property of the DISTRICT as provided
for in Section 5 of the Agreement.
4. Administrative Burden Pay – It is recognized that OB/GYN physicians are burdened with
administrative work associated with patient care. Each month the DISTRICT will pay one thousand six hundred dollars ($1,600.00) to PHYSICIAN. This covers administrative activities including meeting attendance at Maternal Child Health Committee of the medical staff, attendance at clinic staff meetings, attendance at other meetings as needed and participation in Community Birthing Classes.
5. Professional Liability Insurance Coverage Reimbursement – As of the start date it is
expected that the PHYSICIAN will be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto, in accordance with Section 6b. of the Agreement.
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6. Forgivable Recruitment Loan – The DISTRICT shall pay $30,000 to PHYSICIAN to use for
relocation expenses, transitional housing and any other purposes PHYSICIAN deems necessary for establishing a residence in the Mammoth Lakes area to enable PHYSICIAN. Promissory Note is attached as Exhibit D.
7. Medical Staff Dues Deduction - The Medical Executive Committee of the Mammoth Hospital
Medical Staff have directed the DISTRICT to annually deduct medical staff dues from the above compensation the first month of each calendar year (or the first available month when PHYSICIAN has compensation pursuant to this Agreement)
8. Chart Delinquency Fines by Medical Staff - Fines for delinquent charting will be assessed
in accordance with the Medical Staff Fine Policy for Chart Delinquencies. The Medical Executive Committee has directed the DISTRICT to deduct any such fines from your compensation resulting from this Agreement
Timing of payments above (disbursements are processed every Thursday and checks/ACH payments distributed on Friday):
1) Payment for items 1, 2, and 4 above will be paid in arrears following month of services (will be paid not later than the 10th day following month of service).
2) Payment for item 3 above will be paid in arrears the following month of services provided (usually the 3rd week of the month following month of service).
3) Payment for item 6 above will be paid within 30 days of PHYSICIAN coverage commencement.
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Modifiers and Definitions
CMS %
Reimbursement
Adjustments
modifier = 22 = more complicated, complex, technically difficult, or needing significantly
more time than usual 50% increase
modifier = 50 = Bilateral Procedure 50% increase
Modifier 51 = Multiple Procedures 50% reduction
Modifier 52 = Reduced Services 30% reduction
Modifier 54 = Surgical Care Only 21% reduction
Modifier 55 = Post Operative Management Only 79% reduction
modifier = 56 = Preoperative Management Only 90% reduction
modifier = 62 = Two Surgeons 40% reduction
modifier=63 = Procedure performed on infants less than 4 kgs 50% increase
Modifier 80 = Assistant Surgeon 80% reduction
modifier=81 = Minimum Assistant Surgeon 80% reduction
modifier=82 = Assistant Surgeon (when qualified resident surgeon not available) 80% reduction
modifier = AS = non-MD surgical assist 85% reduction
Mammoth Hospital
Modifier Charge Adjustment for Physician Compensation
Effective 9-1-10 (updated 11-30-18)
EXHIBIT C
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Exhibit D
PROMISSORY NOTE (Forgivable Loan)
For value received, the undersigned, Lucienne Bouvier, M.D., hereinafter called Physician,
hereby promises to pay to Southern Mono Healthcare District, a Local Health Care District organized and
existing under the laws of the state of California and more specifically the Local Health Care District
Law, Health and Safety Code 32000 et seq, with its principal office located at 85 Sierra Park Road,
Mammoth Lakes, CA 93546, referred to herein as District, or pay to the order, at PO Box 660, Mammoth
Lakes, CA 93546, or such other place as District may designate in writing from time to time, in lawful
money of the United States of America, without demand, deduction, setoff or counterclaim, the principal
sum of thirty thousand dollars ($30,000). This Promissory Note shall bear no interest, except as provided
in Paragraph 4 below.
1. Payments.
All outstanding principal and accrued interest under this Promissory Note shall be due and
payable on the Due Date (as defined below); provided, however, that so long as Physician continues to
meet the Physician Services Agreement with the District, Physician’s obligation to pay principal and
interest under this Promissory Note shall be forgiven as follows: (i) principal in the amount of seven
thousand five hundred dollars ($7,500) shall be forgiven on December 31, 2021; (ii) principal in the
amount of fifteen thousand dollars ($15,000) shall be forgiven on December 31, 2022; and (iii) principal
in the amount of thirty thousand dollars ($30,000) shall be forgiven on December 31, 2023.
2. Due Date.
The Due Date shall be the earlier of (i) the date of termination or cessation of the Physician
Services Agreement by District, involuntarily for cause, or (ii) December 31, 2023. The loan will be
forgiven in full if the Physician Services Agreement is not terminated prior to the end of the three-year
term by District other than for cause or (iii) by District as a result of death or permanent disability of
Physician.
3. Purpose of Loan.
Physician acknowledges and agrees that District is making this loan to Physician for the express
purpose of recruiting Physician to the area of District’s hospital facility located in Mono County,
California. Physician represents and warrants to District that Physician will use all proceeds of this
Promissory Note for purposes of relocating, temporary housing or any other purposes Physician deems
necessary for establishing a residence in the Mammoth Lakes, California area.
4. Default.
In the event that Physician fails to timely pay any amount or perform any other obligation of
Physician under this Promissory Note, District may, at its option, declare the entire principal sum under
this Promissory Note immediately due and payable. In the event that District exercises this option, or the
principal balance of this Promissory Note otherwise becomes due and payable, all principal then
outstanding under this Promissory Note shall thereafter bear simple interest at the lesser of three and a
half percent (3.5%) per annum or the maximum rate permitted by law. Failure to exercise this option
shall not constitute a waiver of District’s right to exercise the same with respect to any prior or subsequent
defaults.
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5. Attorneys’ Fees.
In the event any legal action or proceeding is required to enforce or interpret any provision of this
Promissory Note, Physician shall pay to District upon demand all costs of collection and reasonable
attorneys’ fees incurred by District in connection therewith.
6. Miscellaneous.
The makers, signers, drawers, guarantors, sureties and endorsers hereof severally waive
presentation for payment, demand, protest, diligence in collecting, notice of dishonor, notice of extension
of time, and notice of protest or nonpayment. The provisions of this Promissory Note shall be governed
by California law.
IN WITNESS WHEREOF, District has executed this Promissory Note as of the 28th day of
August 2020.
____________________________________
Lucienne Bouvier, M.D.
____________________________________
Tom Parker, CEO
Mammoth Hospital
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AGREEMENT FOR PROVISION OF PHYSICIAN SERVICES
THIS AGREEMENT is made this 2nd day of September 2020, by and between SOUTHERN
MONO HEALTHCARE DISTRICT ("DISTRICT"), and MICHELLE NEWKIRK, D.O. (hereinafter referred to as "PHYSICIAN"), at the Town of Mammoth Lakes, County of Mono, State of California.
Recitals
A. The DISTRICT is a Local Health Care District duly organized and existing under the
laws of the State of California and more specifically the Local Health Care District Law, Health and Safety Code §§32000, et seq.
B. The DISTRICT owns and operates Mammoth Hospital to provide acute care, full service
medical services to the community in which it serves.
C. PHYSICIAN is an independent practicing physician duly licensed by the State of
California and Board Certified in the practice area of rheumatology.
D. The DISTRICT has determined that the making and entering into of this Agreement for
the providing of physician services in the area of rheumatology is necessary for the provision of adequate health care services to the communities served by the DISTRICT.
E. It is further determined by the board of directors of the DISTRICT that this Agreement
allows the board of directors to ensure that fees and charges for these physician services rendered at Mammoth Hospital are reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health care to all residents within the boundaries of the DISTRICT and visitors to the area.
Agreement
NOW, THEREFORE, IN CONSIDERATION OF THE MUTUAL COVENANTS AND CONDITIONS CONTAINED HEREIN, THE PARTIES AGREE AS FOLLOWS:
1. Term of Agreement. The DISTRICT hereby retains the services of PHYSICIAN for a term commencing on June 1, 2021 and terminating on December 31, 2021 (stub year). This commencement date is predicated on PHYSICIAN obtaining her California medical license by December 31, 2020 (the commencement date will be proportionately delayed if licensed obtained after). This Agreement shall be renewed automatically for succeeding terms of one (1) year each, unless either party gives written notice to the other at least ninety (90) days prior to the expiration of any term hereof of an intention not to renew this Agreement. The total term of this Agreement shall not exceed three (3) years.
Notwithstanding the foregoing, either party may terminate this Agreement prior to the expiration of any term hereof based on a finding of good cause. Good cause shall be limited to a default by either party herein. In the event either party elects to terminate this Agreement prior to the expiration of any term hereof based on cause or default, such party shall provide written notice to the other, setting forth in sufficient detail, the nature, extent, and scope of the default. Thereafter, the alleged defaulting party shall have thirty (30) days to remedy, cure, or otherwise correct the default. Should the alleged defaulting party not so remedy or otherwise cure the default within the thirty (30) daytime period, the nondefaulting party may immediately terminate this Agreement
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The DISTRICT may elect to immediately terminate this Agreement without first
complying with the foregoing provisions regarding good cause and notice of default in the event of:
(1) suspension, revocation, or expiration (without renewal thereof) of PHYSICIAN's license to practice
medicine in the State of California; (2) suspension, revocation, or other termination of medical staff
privileges of PHYSICIAN at Mammoth Hospital; (3) PHYSICIAN is convicted of a felony (4) any
event of default which cannot be cured within the time periods set forth herein; (5) the reputation of
PHYSICIAN or DISTRICT is adversely affected by some intentional act of PHYSICIAN or (6) an
emergent situation requiring termination as determined by the DISTRICT in order to protect against
or avoid adverse impacts to patients, staff, DISTRICT personnel or facilities, or the health, safety
and welfare of the residents and communities served by the DISTRICT.
The DISTRICT has the express right to take action under its Bylaws and the Medical
Staff Bylaws to ensure patient safety; in the event Medical Staff fails to take appropriate action
against any physician who provides substandard care or who engages in professional misconduct
which within the reasonable and lawful discretion of the DISTRICT is jeopardizing public safety, this
Agreement may be terminated by the DISTRICT and the physician may be removed from the
Medical Staff pursuant to the Medical Staff Bylaws.
2. Description of Duties. PHYSICIAN shall personally render the services to Mammoth
Hospital during the term of this Agreement. PHYSICIAN shall obtain the approval of the Chief
Executive Officer ("CEO") or hospital administrator before retaining the services of additional
physician personnel to perform identical services as PHYSICIAN and while PHYSICIAN is
performing such services. This provision shall not apply to substitute temporary staffing, including
locum tenens. See Exhibit A for details of duties and expectations.
1) It is expressly acknowledged by PHYSICIAN that Mammoth Hospital serves
a resort and tourist-based community. In connection therewith, PHYSICIAN's personal attendance
for staffing needs will be required during holiday and other high-volume periods. In order to minimize
the excess costs associated with substitute physician staffing, including locum tenens, PHYSICIAN
shall not take time off or vacations during such peak or holiday periods without first obtaining the
written approval of the CEO or hospital administrator. Vacations and extended periods of time off
(i.e., more than two consecutive days), shall be scheduled by PHYSICIAN to occur during non-peak
and non-holiday periods.
2) All physician services provided herein by PHYSICIAN shall be rendered by
PHYSICIAN in the exercise of the utmost degree of skill and care and within the sole and absolute
discretion and control of PHYSICIAN exercising independent professional judgment. The DISTRICT
shall not direct PHYSICIAN in the rendering of physician services hereby, and PHYSICIAN shall
not be considered an agent of DISTRICT.
3) PHYSICIAN shall be a permanent or temporary member of the medical staff
of Mammoth Hospital and shall be in good standing.
4) Performance by PHYSICIAN of his obligations pursuant to this Agreement shall be in compliance with all federal, state, and local laws, rules, regulations, and ordinances, and in full compliance of any such applicable rules and regulations of any governmental or accrediting agency or authorities relating to the licensure and regulations of physicians, medical practitioners, and acute care hospitals.
5) PHYSICIAN shall comply with all rules and regulations established at Mammoth Hospital, including without limitation, the Medical Staff Bylaws and the Bylaws of the Southern Mono Healthcare District, and as all may be amended from time to time.
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6) All services rendered by PHYSICIAN hereunder shall be in accordance with the standards, rules, regulations, and recommendations of the DISTRICT's current and any future accrediting agencies (e.g., DNV, the Joint Commission, and State of California, regardless of whether Mammoth Hospital is so accredited) and of the Medicare Conditions of Participation.
7) PHYSICIAN shall comply with and maintain professional and ethical standards
of conduct with respect to the issue of patient confidentiality. PHYSICIAN shall not use or disclose any protected health information or individually identifiable health information (as defined in the Health Insurance Portability and Accountability Act ("HIPM"; 45 CFR Part 164), the Confidentiality of Medical Information Act (:"CMIA", Civil Code §§56.05, et seq.), or Health.& Safety .Code §1280.15) (collectively, "Protected Health Information" or "PHI") concerning any patient of Mammoth Hospital or its affiliated clinics and facilities (whether or not PHYSICIAN renders services to such patient) other than as expressly permitted by this Agreement and the requirements of State and Federal privacy regulations and security standards. PHYSICIAN further agrees to comply with all policies, procedures and directives of the DISTRICT regarding the use and disclosure of Protected Health Information.
8) PHYSICIAN shall diligently and timely maintain, update, make entries in or to,
and file all necessary medical records and billings and charges. Such items include, without limitation, charts, charge slips, billing codes, physician charge codes, transcriptions, assignments of billings and charges, and orders. For the purposes of this provision, "diligently and timely" mean and refer to completing all tasks, including electronic health record task lists, within 48 hours of the time of the event, treatment, service, or transaction. PHYSICIAN shall use the EMR systems in connection with PHYSICIAN's obligations in this sub-paragraph.
3. Effect of Consideration. No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is being made for the referral of patients to Mammoth Hospital. This Agreement in no way restricts PHYSICIAN from establishing staff privileges at, referring patients to, or generating business from another entity. PHYSICIAN retains sole and absolute professional discretion regarding PHYSICIAN's patient matters and referral practices.
No consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is for any bonus, retention incentives, or otherwise. All such consideration being afforded PHYSICIAN by the DISTRICT pursuant to this Agreement is as expressly set forth in this Agreement.
Notwithstanding coverage and staffing obligations of PHYSICIAN as provided for in this Agreement, PHYSICIAN expressly acknowledges and agrees that the DISTRICT has not made, nor does this Agreement provide for, any of the following for the benefit of PHYSICIAN: (i) income guarantees, (ii) promises, representations, or guarantees of patient volumes or business volumes, (iii) exclusivity of medical services provided, (iv) minimum or guaranteed hours or days of coverage or office hours. The DISTRICT retains sole and absolute discretion regarding its business decisions and operations, including facilities and clinics staffed by PHYSICIAN as provided for in this Agreement. This discretion includes, without limitation, hours of operation, staffing, location, and whether to cease or suspend operations. Coverage obligations of PHYSICIAN are subject to and limited by the matters set forth in this paragraph. PHYSICIAN shall have no claims against the DISTRICT, including its agents, representatives, officers, directors, and affiliates, for any damages, loss of income, or otherwise resulting from decisions or actions by the DISTRICT as provided for in this paragraph.
4. Professional Fees to PHYSICIAN. The DISTRICT shall pay to PHYSICIAN as and for professional services being rendered by PHYSICIAN
pursuant to this Agreement as specified in Exhibit B. PHYSICIAN and DISTRICT have reviewed the
compensation to be paid under this Agreement as outlined in Exhibit B to confirm it is consistent with fair
market value and does not violate of the federal Anti-kickback statute or Stark Act.
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5. PHYSICIAN Billings for Patient Services and Care. The DISTRICT shall bill for all patient
services and care rendered by PHYSICIAN and any substitute physicians, including locum tenens,
pursuant to this Agreement. All such physician fees and billings shall remain the property of the
DISTRICT. It is expressly acknowledged and agreed to by and between the parties that the DISTRICT
will not be realizing a profit in connection with the services being rendered by PHYSICIAN hereby. All
fees and rates for all services rendered and charges shall be set by the DISTRICT and shall be
reasonable, fair, and consistent with the basic commitment of the DISTRICT to provide adequate health
care to all residents and visitors within the boundaries of the DISTRICT.
6. Professional Liability (Malpractice) Insurance. PHYSICIAN has two options for Professional Liability Insurance: a) Obtain own professional liability coverage as outlined below or b) request that the DISTRICT add PHYSICIAN to the DISTRICT professional liability policy (see EXHIBIT B for option selected).
a) PHYSICIAN shall maintain professional liability/medical malpractice insurance, which the
DISTRICT approves in advance, and which approval shall not be unreasonably withheld. The DISTRICT shall be a named or additionally named insured under all such policies. All coverages shall include a statement to the effect that "coverage afforded under this Policy will act as primary insurance to that of the certificate holder and additional insured. PHYSICIAN shall provide to the DISTRICT upon reasonable request therefor a certificate or other proof that such insurance is in full force and effect. The limits of any liability policy shall be not less than $1,000,000 per occurrence. Insurance shall be maintained with an admitted carrier licensed by the State of California Department of Insurance with a Best rating of not less than A minus, and coverage shall be in conformance with the Medical Staff Bylaws (and as the same may be amended from time to time). PHYSICIAN shall immediately notify the DISTRICT of any change or cancellation of any insurance policy in effect pursuant to this Agreement. In the event of any notice of cancellation given to PHYSICIAN, PHYSICIAN shall reinstate all such insurance within thirty (30) days of such notice.
b) As of the date of this Agreement, PHYSICIAN has been able to be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto. The DISTRICT shall continue to maintain professional liability/medical malpractice insurance for PHYSICIAN as provided for herein through the current policy of the DISTRICT provided by BETA. In the event such coverage through BETA is no longer available or the DISTRICT procures other coverage for the DISTRICT where the physicians cannot be included as determined by the DISTRICT, within its sole and absolute discretion, the parties shall meet and confer and modify this Agreement accordingly in order to ensure that PHYSICIAN can reasonably meet the obligation to have such insurance in place during the then remaining term of this Agreement.
7. Records. All books, records, patient medical records, and other documents pertaining
to or relating to the care and treatment of patients at Mammoth Hospital and the services rendered by PHYSICIAN pursuant to this Agreement shall be and remain the property of the District. Upon termination, PHYSICIAN shall make entries in or to, and file as necessary medical records and billings and charges in accordance with subsection 8 of section 2 of this Agreement, and shall return any and all such property in PHYSICIAN’s possession to District by the date of termination.
8. Warranties of PHYSICIAN. In addition to all other warranties or representations made
by PHYSICIAN in connection with the making and entering into of this Agreement, whether oral or written, PHYSICIAN hereby represents and warrants to the DISTRICT the following:
1) PHYSICIAN is a duly licensed physician in good standing in the State of California. PHYSICIAN is registered with the DEA to prescribe controlled substances without restriction
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or limitation. Neither PHYSICIAN's medical license nor PHYSICIAN's DEA registration has ever been suspended, revoked, restricted, limited, or terminated. PHYSICIAN has never been the subject of any type of disciplinary or corrective action taken by any medical licensing or certification authority, or any reprimand monetary fine or penalty relating to the rendering of medical services by PHYSICIAN. There exists no actual, pending, or threatened disciplinary proceedings against PHYSICIAN that could result in the suspension or revocation of PHYSICIAN's license to practice medicine in the State of California.
2) PHYSICIAN is under no obligation, restriction or limitation, contractual or
otherwise, to any other individual or entity that would prohibit or impede PHYSICIAN from undertaking and performing the duties, responsibilities, and obligations of PHYSICIAN pursuant to this Agreement. The terms and provisions of this Agreement do not affect or violate any agreement or obligation of PHYSICIAN with respect to the ability of PHYSICIAN to practice medicine.
3) PHYSICIAN is an independent physician, i.e., not an employee of the DISTRICT.
4) PHYSICIAN has never been removed for cause from any provider panel of any managed care organization, indemnity insurer or other third-party payer, or independent practice association, PHYSICIAN organization, PHYSICIAN-hospital organization, or other provider network.
5) PHYSICIAN has disclosed to DISTRICT of any potential or pending malpractice
or other patient-related litigation, nor have any such claims been threatened, including any proceedings against PHYSICIAN before any professional licensing board.
6) To PHYSICIAN's best knowledge, he/she is not a party to any pending
investigation or proceeding the basis of which implicates his/her professional competence or that could lead to a suspension, revocation, restriction, limitation or termination of his/her medical license or medical staff privileges at any hospital. PHYSICIAN has not been involved in a violation of the Stark Law or the Anti-Kickback Statute.
PHYSICIAN shall immediately notify the DISTRICT in the event any of the foregoing representations are or become untrue for any reason. PHYSICIAN’s failure to immediately notify the DISTRICT in this event shall amount to a material breach of this Agreement for which the DISTRICT may immediately terminate this Agreement.
9. Effect of Relationship. This Agreement is not intended to nor shall it create any relationship of partnership, joint venture, employer/employee, master/servant, employment, agency or otherwise. PHYSICIAN is not receiving from the DISTRICT any monetary compensation in the nature of income guarantees, subsidies, referral fees, or otherwise. All compensation provided for herein is for services rendered for professional services of PHYSICIAN as has been expressly set forth herein. PHYSICIAN is at all times acting and performing under this Agreement as an independent contractor and as a medical practitioner and licensed physician in the State of California, with PHYSICIAN specializing in the area of medicine delineated herein. It is the intention of the DISTRICT to obtain the services of PHYSICIAN to ensure that the specialty services of PHYSICIAN are available to carry out health care services for the benefit of the communities served by the DISTRICT and that such services be performed in a competent, professional, appropriate, and efficient manner as set forth in this Agreement.
The DISTRICT shall not direct or supervise the manner in which services are rendered by PHYSICIAN. PHYSICIAN shall render services pursuant to this Agreement within the sole, reasonable, and independent professional discretion of PHYSICIAN.
Unless otherwise required, PHYSICIAN shall have all compensation paid pursuant to
this Agreement subject to Form 1099 reporting. PHYSICIAN shall be fully responsible for the payment of all income taxes and the payment of all appropriate withholding of any and all payroll taxes and deductions for PHYSICIAN. In connection herewith, PHYSICIAN shall have no claims under this
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Agreement or otherwise, against the DISTRICT for vacation pay, sick leave or other paid leave, pension or retirement benefits, social security or FICA, worker's compensation, disability, unemployment insurance benefits, or any other benefits afforded to full-time benefitted employees at Mammoth Hospital.
10. Survival of Warranties and Representations. All warranties and representations of PHYSICIAN shall survive both the date of this Agreement and any eventual termination of this Agreement.
11. Working Space. The DISTRICT shall provide PHYSICIAN with sufficient working space,
staffing of personnel (including support and clerical staff), and hospital facilities while PHYSICIAN is performing services at Mammoth Hospital, with the intent to enable PHYSICIAN to perform and render services as provided for herein.
12. No Assignment by PHYSICIAN. Due to the uniqueness of services being rendered by PHYSICIAN to the DISTRICT and the specific professional skill, competence, and experience of PHYSICIAN, PHYSICIAN shall not assign, sublet, delegate, or otherwise convey PHYSICIAN's rights and obligations pursuant to this Agreement. Any attempt to so assign by PHYSICIAN shall be deemed null and void and shall entitle the DISTRICT to immediately terminate this Agreement without first having to comply with any notice of default provisions (including those provided for in paragraph 1 above), termination provisions of any DISTRICT Bylaws or Medical Staff Bylaws, or otherwise. In the event PHYSICIAN forms or becomes part of a medical or other professional corporation, partnership, limited liability company, limited liability partnership, or other such entity, PHYSICIAN shall unconditionally guaranty any and all obligations, promises, covenants, and warranties of any such entity as provided for in this Agreement. Any and all liability of PHYSICIAN hereunder shall be joint and several with that of any such entity. In such event, PHYSICIAN shall notify the DISTRICT within thirty (30) days.
13. Remedies. Any and all remedies provided by this Agreement, operation of law, or
otherwise, shall be deemed to be cumulative, and the choice or implementation of any particular remedy shall not be deemed to be an election of remedies to the mutual exclusion of any other remedy provided for herein, by operation of law, or otherwise. Enforcement of any provision of this Agreement shall be by proceedings at law or in equity against any persons or entities violating or attempting to violate any promise, covenant, or condition contained herein, either to restrain violation, compel action, or to recover damages.
14. Attorney's Fees. In the event any action at law or in equity is initiated to enforce or interpret the terms of this Agreement, or arises out of or pertains to this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, costs, and necessary disbursements in addition to any other relief to which that party may be entitled.
15. Notices. Any notices to be given by either party to the other shall be in writing and shall be transmitted either by (1) personal delivery, (2) mail, registered or certified, postage prepaid with return receipt requested, (3) by an overnight delivery service (e.g., Federal Express), or (4) by facsimile or email service with a confirmation copy by regular mail, first class postage prepaid. Personal delivery or mailed notices shall be addressed to the parties at the addresses listed below. Notices shall be transmitted via the contact information listed below. Each party may change that address and facsimile telephone number by giving written notice in accordance with this paragraph. In the event of any mailing, notice shall be deemed given on the 3rd day after deposit. The addresses and facsimile telephone numbers of the parties are as follows:
SOUTHERN MONO HEALTH CARE DISTRICT Attn: Chief Executive Officer P.O. Box 660 Mammoth Lakes, CA 93546 Facsimile Telephone No.: (760) 924-4104 Email: [email protected]
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MICHELLE NEWKIRK, D.O. 12225 Olivetta Court Las Vegas, NV 89138 Email: [email protected] Cell Phone: 503-334-6258
16. Integration. It is intended by the parties that this Agreement be the final expression of the intentions and agreements of the parties. This Agreement supersedes any and all prior or contemporaneous agreements, either oral or in writing, between the parties hereto and contains all of the covenants and agreements between the parties. No other agreements, representations, inducements, or promises, not contained in this Agreement shall be valid or binding. Any modification of this Agreement shall be effective only if it is in writing and signed by both parties.
17. Binding Effect. This Agreement shall be binding upon and inure to the benefit of the
heirs, executors, administrators, personal representatives, successors, and assigns of each of the parties hereto.
18. Severance. In the event any term or provision of this Agreement is deemed to be in
violation of law, null and void, or otherwise of no force or effect, the remaining terms and provisions of this Agreement shall remain in full force and effect.
19. Governing Law. Venue. This Agreement shall be interpreted under the laws of the State
of California. Exclusive venue for any legal action shall be Mono County, California.
20. Effect of Waiver. No waiver of any breach of any term, covenant, agreement, restriction,
or condition of this Agreement shall be construed as a waiver of any succeeding breach of the same or any other covenant, agreement, term, restriction, or condition of this Agreement. The consent or approval of either party to or of any action or matter requiring consent or approval shall not be deemed to waive or render unnecessary any consent to or approval of any subsequent or similar act or matter.
21. Joint Preparation. This Agreement shall be deemed to be jointly prepared by all parties hereto. In connection therewith, the provisions of Civil Code §1654 shall not be deemed applicable in the event of any interpretation of this Agreement.
22. Access to Records Clause. If this Agreement is for the provision of services with a value of $10,000 or more over a twelve (12) month period, then until the expiration of four (4) years after the furnishing of the services provided under this Agreement, PHYSICIAN will make available to the Secretary, U.S. Department of Health and Human Services, the U.S. Comptroller General, and their representatives, this Agreement and all books, documents, and records necessary to certify the nature and extent of the costs of those services. If PHYSICIAN carries out the duties of this Agreement through a subcontract worth $10,000 or more over a twelve (12) month period with a related organization, the subcontract will also contain an access clause to permit access by the Secretary, Comptroller General, and their representatives to the related organization's books and records. This paragraph shall be in effect only to the extent required by law.
23. Time. Time is expressly declared to be of the essence of this Agreement.
24. Public Document; No Confidentiality. The parties agree and acknowledge hereby that
upon full execution of this Agreement and the filing hereof in the official records and files of the DISTRICT, this Agreement becomes a public document pursuant to the California Public Records Act.
DocuSign Envelope ID: 2590B3D3-3A52-4A0A-8FA1-661B4201AF7A
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25. Final Authority. The DISTRICT shall have final authority over all hospital matters, controls, functions, employment of personnel not employed by PHYSICIAN, and administration. Any interpretation of these matters shall be determined within the sole and absolute discretion of the DISTRICT. It is expressly acknowledged and agreed to by and between the parties that this provision shall in no way be construed as a usurpation, interference, or exercise of any control whatsoever of the right, duty, and obligation of PHYSICIAN to render independent medical opinions and care as provided for herein.
26. Counterparts. Facsimile signature pages shall be deemed original signature pages and
shall be admissible as the same in a court or other tribunal as though such were originals. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original but all of which shall constitute one and the same instrument. All of such counterpart signature pages shall read as though one, and they shall have the same force and effect as though all the signers had signed a single signature page.
* * * End of Text***
IN WITNESS WHEREOF, this Agreement is executed as of the day and year first above written. SOUTHERN MONO HEALTHCARE DISTRICT BY: ____________________________________ Tom Parker, Chief Executive Officer ____________________________________ Michelle Newkirk, D.O.
DocuSign Envelope ID: 2590B3D3-3A52-4A0A-8FA1-661B4201AF7A
9/7/2020
9/10/2020
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EXHIBIT A
DESCRIPTION OF DUTIES
PHYSICIAN duties are:
1. Provide clinical services for the Mammoth Hospital Specialty Clinic
2. No hospital on-call services are required
3. Part-time medical provider services – maintain regularly scheduled office hours at the
Clinic, with the schedule to be not less than two (2) full workdays per month during each
term year – tentatively set for Friday and Saturday
4. Clinic will be scheduled during the 2nd full week of the month (week that has the 2nd
Monday)
5. PHYSICIAN is required to use the Mammoth Hospital electronic medical record (EMR)
for all patient charting, review of test results, ordering, referrals, etc… Remote access
to the EMR is available and PHYSICIAN is expected to log in as needed for appropriate
patient care issues and follow up.
6. All communications from Mammoth Hospital physicians and staff will either be made
through the EMR or a Mammoth Hospital Web based Outlook email address (which will
be provided). PHYSICIAN is expected to regularly log into these programs.
7. PHYSICIAN shall provide a schedule of requested workdays to the Clinic Manager ninety
(90) days in advance
8. PHYSICIAN acknowledges that he/she will be working in a Rural Health Clinic and due
to flat rate Medicare and Medi-Cal reimbursement per visit, resource intensive visits,
procedures, and treatments are to be avoided. PHYSICIAN should discuss specific high
cost procedures/treatments with the Clinic Manager prior to performing or committing to
perform to the patient.
DocuSign Envelope ID: 2590B3D3-3A52-4A0A-8FA1-661B4201AF7A
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EXHIBIT B COMPENSATION
Below is the fair market (using MGMA & AMGA Rheumatology compensation survey data) compensation terms that the DISTRICT will compensate PHYSICIAN:
1. Production – PHYSICIAN will be compensated at a rate of $70.00 per wRVU generated each month (payments will be made to PHYSICIAN by the end of the following month):
The wRVU’s are subject to change each January 1st as regulated by the Centers for Medicare &
Medicaid ("CMS") for procedures that are coded with certain defined modifiers, as is set forth on
the list of modifiers and applicable adjustments (EXHIBIT C). Pursuant thereto, the DISTRICT
will modify the wRVU’s by the CMS adjustment as set forth on the EXHIBIT C.
Actual amounts collected by the DISTRICT shall remain the property of the DISTRICT as provided
for in Section 5 of the Agreement.
2. Transitional Housing – DISTRICT has an inventory of housing and shall provide housing for PHYSICIAN during the first 3 months of service. This housing will be available the day before through the day after the clinic days. Thus, typically would be Thursday check in and Sunday check out. If PHYSICIAN desires to continue to use the DISTRICT housing after the 3 months, if available, PHYSICIAN will be charged an amount for daily rent.
3. Professional Liability Insurance Coverage Reimbursement – As of the start date it is expected that the PHYSICIAN will be insured under the current DISTRICT policy with BETA Healthcare Group (BETA) with the DISTRICT paying all premiums related thereto, in accordance with Section 6b. of the Agreement.
4. Medical Staff Dues Deduction - The Medical Executive Committee of the Mammoth Hospital
Medical Staff have directed the DISTRICT to annually deduct medical staff dues from the above compensation the first month of each calendar year (or the first available month when PHYSICIAN has compensation pursuant to this Agreement)
5. Chart Delinquency Fines by Medical Staff - Fines for delinquent charting will be assessed in
accordance with the Medical Staff Fine Policy for Chart Delinquencies. The Medical Executive Committee has directed the DISTRICT to deduct any such fines from your compensation resulting from this Agreement.
Timing of payments above:
1) Payment for item 1 will be paid in arrears the following month of services provided (usually the 3rd week of the month).
DocuSign Envelope ID: 2590B3D3-3A52-4A0A-8FA1-661B4201AF7A
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Modifiers and Definitions
CMS %
Reimbursement
Adjustments
modifier = 22 = more complicated, complex, technically difficult, or needing significantly
more time than usual 50% increase
modifier = 50 = Bilateral Procedure 50% increase
Modifier 51 = Multiple Procedures 50% reduction
Modifier 52 = Reduced Services 30% reduction
Modifier 54 = Surgical Care Only 21% reduction
Modifier 55 = Post Operative Management Only 79% reduction
modifier = 56 = Preoperative Management Only 90% reduction
modifier = 62 = Two Surgeons 40% reduction
modifier=63 = Procedure performed on infants less than 4 kgs 50% increase
Modifier 80 = Assistant Surgeon 80% reduction
modifier=81 = Minimum Assistant Surgeon 80% reduction
modifier=82 = Assistant Surgeon (when qualified resident surgeon not available) 80% reduction
modifier = AS = non-MD surgical assist 85% reduction
Mammoth Hospital
Modifier Charge Adjustment for Physician Compensation
Effective 9-1-10 (updated 11-30-18)
EXHIBIT C
DocuSign Envelope ID: 2590B3D3-3A52-4A0A-8FA1-661B4201AF7A
Date Purchased Item Description Value Reason for Disposal Asset Tag:
N/A Shoretel Phone N/A Broken N/A
N/A Dell Monitor N/A Broken 001604
N/A Fujitsu 6110 N/A Broken 003570
N/A Dell 2330dn Printer N/A Broken 003063
N/A Optiplex 5040 N/A Broken 003999
N/A Dell Monitor N/A Broken 002195
N/A Dell Latitude e5570 N/A Broken Serial: 8R6VJC2
N/A Dell Latitude e5570 N/A Broken Serial: 94W7DC2
N/A Dell Latitude e5570 N/A Broken Serial: DQZ8KC2
N/A Dell Optiplex 7010 N/A Broken Serial: D0BT9Y1
N/A Dell Optiplex 7020 N/A Broken Serial: 79MMB42
N/A Dell Optiplex 7020 N/A Broken 003937
N/A Dell Optiplex 7010 N/A Broken 007757
N/A Dell Optiplex 7020 N/A Broken 003923
N/A Dell Optiplex 7020 N/A Broken 003931
N/A Dell Optiplex 7010 N/A Broken 003774
N/A Dell Optiplex 7020 N/A Broken 003844
N/A Dell Optiplex 7010 N/A Broken 003703
N/A Dell Optiplex 790 N/A Broken 003429
N/A Dell Optiplex 7010 N/A Broken 003603
N/AAPC Rack Mounted Power Supply From
PTN/A Broken
Serial: SMT1500RM2U
N/A Dell Server - OpenLink Server1 N/A Broken 003421
N/A Dell Server - OpenLink Server2 N/A Broken 003422
N/A Dell Latitude E5540 N/A Broken 003824
N/A Dell Latitude XT3 N/A Broken 003695
N/A Dell Latitude E5540 N/A Broken 003826
N/A Dell Latitude E5540 N/A Broken 003736
N/A Dell Latitude E5570 N/A Broken Serial: HTSTKC2
N/A Dell Latitude E7470 N/A Broken 003925
N/A Dell Optiplex 7010 N/A Broken Serial: 79TT9Z1
N/A Dell Optiplex 740 N/A Broken 002190
N/A Dell Optiplex 320 N/A Broken Serial: GCMR23J
N/A Dell Latitude E5570 N/A Broken 004881
N/A Dell Latritude E5570 N/A Broken 004892
N/A Dell Latitude E7470 N/A Broken 004852
N/A Dell Latitude E5540 N/A Broken 003737
N/A Sony RMOS551 Tape Drive N/A Broken Serial: 520176
N/A Dell Latitude E5570 N/A Broken 004383
N/A Dell Latitude E7470 N/A Broken 004729
N/A Dell Latitude E5570 N/A Broken 004890
N/A Dell Latitude E5570 N/A Broken 004776
N/A Dell Optiplex 7010 N/A Broken 003716
N/A Dell Optiplex 7010 N/A Broken 003635
N/A Motorola EV2600 N/A Broken Serial: 158TDL3920
N/A Motorola EV2600 N/A Broken Serial: 158TDL3954
N/A WOW Cart Medix T19B N/A Broken Serial: 59IN03HA1528020
N/A WOW Cart Medix T19B N/A Broken 003976
N/A Dell Monitor N/A Broken 1667
The list of equipment below is either no longer functional or so obsolete as to longer be useful to our facility. Please
approve our proposal to dispose of the equipment in the most economically and environmentally responsible way. For the
computers and printers, that will mean donation to a company in Reno that remanufactures them for needy educational
institutions. Some of the equipment may need to go through a recycling program with a marginal per item cost.
September 17, 2020
Obsolete Equipment - Information Systems