Benita Tapia – Simplifying Board Meetings with a Financial Committee

Here’s what to expect on this week’s episode. 🎙️

Benita Tapia, a seasoned professional with 40 years of experience in the surgery center industry, is responsible for prepping and running a quarterly board meeting that addresses Cedars Sinai’s four Beverly Hills locations. Benita meets with a financial committee a week prior to keep these meetings efficient and productive.

This model presents a replicable strategy for other centers aiming to optimize their board meeting processes and financial health:

• The Financial Committee was created to address in-depth financial discussions to streamline board meetings.

• This committee focuses in detail on budgeting, staffing, equipment costs, and financial planning, facilitating focused discussions on financial matters before they reach the entire board.

• The Financial Committee includes some board members and others with financial insight (e.g., JV partners).

• Recommendations from this committee are thoroughly reviewed, ensuring that all decisions align with the center’s goals and financial health.

• This committee has significantly reduced the length and increased the productivity of board meetings.

Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.

Episode Transcript

0:01
Welcome to This Week in Surgery Centers.

0:03
If you’re in the ASC industry, then you’re in the right place.

0:07
Every week, we’ll start the episode off by sharing an interesting conversation we had with our featured guest, and then we’ll close the episode by recapping the latest news impacting surgery centers.

0:17
We’re excited to share with you what we have.

0:19
So let’s get started and see what the industry’s been up to.

0:28
Hi, everyone.

0:28
Here’s what you can expect on today’s episode.

0:31
For the month of April, we will focus our guest discussions on quarterly board meetings.

0:37
So to kick us off, Bonita Tapia is the Administrator and Director of Nursing at 9 O2 One O Surgery Medical Center in Beverly Hills.

0:46
And she joins us for our first episode of the series to talk about how you can simplify your quarterly board meetings by meeting with your financial committee a week in advance.

0:56
Bonita overseas 4 surgery centers, so this helps them to be as efficient as possible with their time.

1:03
In our news recap, we’ll cover four ways generative AI is transforming healthcare, two plastic syringe manufacturers the FDA recommends you stop using immediately where non competes could be banned next.

1:17
And of course, and the new segment with a positive story about a World War 2 nurse who just celebrated her 105th birthday.

1:25
Hope everyone enjoys the episode and here’s what’s going on this week in surgery centers.

1:35
Bonita, welcome to the show.

1:37
Thank you very much.

1:38
Pleased to be here.

1:40
But you know, so the topic today is board meetings within an ASC setting and specifically the role that a financial committee can play within the board process.

1:50
Before we jump in, can you talk a little bit about your background in the industry?

1:54
Yeah, so I’ve actually had 40 years in the industry and I started off as a pre op PACU nurse, OA nurse, then Director of Nursing and then fell into the administrator role.

2:10
I am certified by ASCA, so certified administrator of surgery centres and that’s about it.

2:18
There’s not too much in the surgery centre arena.

2:21
I haven’t done so fantastic and tell us a little bit about your role today at 9 O2 One O OK, so today I’m actually the administrator, I’m the Director of Nursing, so I have quite a broad oversight.

2:37
I have other members of our team that obviously support that.

2:40
So it’s not just a one man show.

2:42
I can assure you you are nothing without the team that surround you.

2:47
Sounds like you wear a couple hats.

2:51
Tell us in terms of different hats, tell us about what role that you play in the board meeting process at nine O 2 and O.

2:59
OK, so a governing board, if you don’t know, Ashley has the oversight of everything in the surgery centre.

3:09
They’re the ultimate responsibility.

3:11
So that’s a huge task in itself.

3:15
And there are several members of the board, including me, and we all have different roles.

3:21
So you’re overseeing everything that goes on, whether they’re transfers, whether there’s quality and obviously financial, the financial health of the facility, but also responsible for policies and procedures, emergency plans, environment of care plans, infection control plans.

3:41
So that is huge, right?

3:45
There are several members of the team.

3:48
I am part of several parts of the Mason, which includes the financial committee, which includes like the medical executive committee.

4:00
And then finally, everything funnels up into that governing board that has the ultimate control.

4:07
Got it.

4:08
And how often does the governing board meet at your centre?

4:14
OK, it meets 4 * a year, quarterly.

4:17
At one point I had one centre and now I have 4 centres that we’re responsible for.

4:23
So it’s really important that if you think that you’re going to, when I had one centre, there was 1 governing board meeting a year.

4:31
But as time goes on, there are so many facets to this board that it would would be practically impossible.

4:38
Just throw everything into an annual government board meeting.

4:42
Sure.

4:42
OK.

4:43
SO44 facilities, you mentioned.

4:45
Now at 1 quarterly board meeting, do you discuss all facilities at the same time?

4:51
Yes, we do.

4:52
We do.

4:53
And try and get it as efficient as possible.

4:57
It’s hard enough getting people to board meetings, let alone if you had four board meetings 4 * a year, right.

5:03
A lot.

5:04
Yeah, that makes sense.

5:05
OK.

5:06
And wanted to talk specifically Bonita about the financial committee that you set up and and pick your brain on that one.

5:14
When you set up the financial committee, what was the problem you were looking to solve?

5:19
What was the reason you guys decided to to to set up that committee?

5:24
OK, so the financial health of the surgery centers is extremely important, but it’s very much in depth.

5:32
There’s a lot of data that goes into each pause.

5:35
So if you think of first of all budget in itself could take the budget for the year and the budget whether you’re meeting it, whether it’s staffing cases, equipment capital gain, cost of cases, that in itself could take a whole meeting.

5:53
And the reason that we decided to come up with a separate Finance Committee is that in the essence of being efficient and also put the people that really have the knowledge of financial in that committee.

6:09
So a lot of times you have clinical people or doctors that may be not quite as financially savvy.

6:17
So to have the right people look at that data ahead of time and make recommendations.

6:24
Otherwise, frankly the finance is honestly the longest thing that takes in the governing board, especially when you come to financial money and at the end of the day if you have members that distribution and how you got to that distribution.

6:41
So that could I tell you I’ve been in governing body Masons till past midnight and frankly I I don’t want to do that.

6:49
I’d rather be in bed because I lose track after a while.

6:52
So that’s how we came about it.

6:54
It was agreed that we’re by the governing board that we could have a financial committee ahead of time and in that committee we will put people that would actually have financial knowledge of some of the things that we needed to address and make decisions on or at least make the recommendations to the governing board.

7:14
I got it.

7:15
So just to to paraphrase you there, it sounds like one of the the things that was taking time maybe creating some roadblocks in the overall governing board meeting were these decisions like budget or other financial decisions like capital equipment that were creating a lot of discussion and and back and forth in the actual board meetings.

7:33
Is that right?

7:34
Yeah.

7:35
So look at capital equipment, that’s just one little pile, right?

7:39
One that you want to make sure that you need that capital equipment.

7:43
One that two you have a performer that you’re looking at.

7:48
Is this a good thing to bring into the surgery center?

7:52
Is it going to bring more cases, more surgeons?

7:55
Is it actually reimbursed by the by the insurance companies or the carriers?

8:00
So that in itself and the cost of it and how long is it going to live and then there’s other capital equipment that we look at the life of, right.

8:09
So we need to know, is this coming to a point where we need to replace it.

8:14
So that is only one portion of the financial committee making sure that you’re on budget, right, Making sure that one you’re going to look at the year ahead and you’re going to decide did you make budget last year is the things that you need to change, is it staffing, is the cost of supplies, is the case cost?

8:36
There’s multiple facets to that.

8:38
Your AR, your reimbursement from your, your carriers, are you meeting those goals, right.

8:45
And then you look another thing is you look at the year ahead like you need to make the goals for the next year.

8:51
So those are just a couple of things.

8:54
The other things we have like expansion going on, right.

8:58
So we need to look how we’re going to fund that expansion.

9:01
Maybe there’s different types of loans to do that.

9:04
Where are you going to bring the cases from and is it worth doing the expansion in the 1st place?

9:09
Is it really viable that you’ve got new cases coming in and what kind of cases that you’ve got coming in?

9:15
And so there’s a lot of data that goes into that too to figure out like is it worthwhile doing Got it.

9:24
And I I like that.

9:25
And those are some meaty topics that you mentioned for the financial committee in terms of budget and historical performance and future performance and and growth.

9:35
Who who sits on the financial committee?

9:38
Those are some important kind of recommendations that are being made.

9:41
There’s is it a subset of the board or other folks, there are both.

9:45
So there is a subset of the board that represents like medical, the medical doctors and then the ones that we had picked for that are the ones that really take a strong interest in the financial and understand it more.

9:59
And then the JV partner which is a hospital and so we pick their financial, a couple of their financial people from the hospital that kind of represents them.

10:11
Then we have a representative, a vice President from the hospital.

10:15
There’s that chief executive and there’s me that really is more on the clinical side.

10:19
This is the equipment that we need.

10:21
This is why we need to purchase it, those things, right?

10:25
Bonita, you mentioned that the financial committee makes recommendations at at the governing board meeting.

10:34
And so is that how the process works?

10:36
So the committee meets before the board meeting.

10:38
The committee, you know, reviews the information, discusses, comes up with a recommendation.

10:44
But that’s not a final decision, right?

10:46
That still needs to be taken in front of the full board.

10:48
Is that how it works?

10:49
Yeah.

10:50
So remember, as I said before, the governing board is the ultimate stop it overseas the whole.

10:56
So those are recommendations, right?

10:59
Ultimately your whole governing board makes that final decision.

11:04
And so the job of the financial committee is 1 to get all the data together, recommend, but also then we will send out a few days before some of the recommendations, some of the data.

11:19
So not all of the data because if a governing board member actually wants to get more in depth because he’s very interested in that, we’re very transparent.

11:29
But sometimes it means them coming on site to see that at least seven days is actually a long time because believe it or not, I’ve gone through governing board meetings and you send it out seven days and they don’t remember right memory thing.

11:45
Usually it’s about 72 hours before and we’re like you have have any questions, please find all your questions 1st.

11:52
And so we try to get those questions ahead of time.

11:56
Again, it saves that issue when we’re on time efficiency when we get to the governing board.

12:04
Got it, got it.

12:04
That sounds like a great process to prepare for that financial committee who’s in charge of of preparing the numbers and the analysis and putting that information together.

12:15
It takes different people to do that.

12:18
It could be a financial controller, it could be actual billing company that’s sending me information regarding AR and accounts and where we are.

12:27
It could be our own financial controller that is like telling us our cash status and when we’re at that, it could be the Chief Executive who really controls our budget and looks at we’re meeting it that we need to have answers of why we didn’t meet certain certain things.

12:47
And then there’s a formula for the big one which is the members distribution that usually has the most questions, right.

12:55
And then OK, your distribution is this.

12:57
We have this expansion going on and I think we need to hold money back until we get these loans and those when it comes to distribution, but particularly for the members, those are probably where the biggest questions come.

13:11
So it’s as I said again it’s a group of people that gets all the data together.

13:16
Depending on what part for me it might be like I need this clinical equipment.

13:21
I know the life of this is going to end within the next six months or you know what, let’s look at this.

13:27
We spent so much money on a contract, service contract, we could have bought this twice over.

13:33
So those are the things that come together, right?

13:36
But it’s group effort who who’s in charge of kind of pulling, summarizing it all together and putting it in the right format.

13:44
We have a wonderful chief executive that pulls it all together.

13:48
As I said, we have multiple facets.

13:51
So his portion, the chief executive, which I love him for doing that, he pulls that part together, I have to pull what’s called the medical executive committee together, which is more the quality, the clinical transfers and everything that occurs in that portion of it.

14:09
And between the two of us, and he’s on that board too, we pull all of this stator ahead, get it to the governing board members ahead of time and then we funnel the questions so that we have an efficient governing board meeting.

14:24
Sounds like great prep.

14:25
Your board members must love it.

14:27
Yeah, it’s all about the prep.

14:29
If anything that I can say is don’t wait to the last minute and gather your documentation and your data ahead of time.

14:38
Pretty much prepped to know what you’re going to do and get it to those governing board members ahead of time.

14:44
And most of all, they want recommendations, OK.

14:49
If they want to question that recommendation, then we’re going to funnel it to the right person on that evening.

14:54
We’re not there till past midnight.

14:56
It’s basically yes, no, yes, no.

14:59
You agree, You don’t agree.

15:01
Everything has been taken care of ahead of time.

15:04
Fantastic.

15:04
It sounds like this has been effective.

15:07
You, you mentioned at the top, hey, we’re looking to solve the problem of board meetings taking a long time and a lot of back and forth on financial decisions has as pulling out the financial committee helped solve that original problem 100%.

15:21
I can tell you that I used to sit there with a PowerPoint, put do the PowerPoint at each one of those slides would probably have questions, especially when it came to financial, which frankly is one of the biggest.

15:36
Financial health is unfortunately one of the most important thing that they are looking for.

15:41
And so those funneled the most questions and kept us there the longest.

15:47
So doing that and I’m the person doing that and I have done in the past just by myself.

15:53
I’m not really an accountant or a financial controller.

15:57
I’m more like administration on the operations of the day, right.

16:02
So all those things that are taken care of ahead of time, it’s 100% better.

16:09
This is great advice.

16:10
I think there’s a lot of other centers and administrators and chief executives that they’re going to benefit from this because we’ve heard this time and time again, which is board meetings can go over and they can get contentious or there can be a lot of back and forth if there’s not the adequate prep and information presented in advance And frankly, 5 hours into a a board meeting.

16:35
But you can’t think straight anyhow.

16:36
So it’s just better to get this done ahead of time, right?

16:40
Right, fantastic.

16:41
OK, beneath it.

16:42
One final question for you.

16:43
And we do this every week with our guests.

16:45
What’s one thing our listeners can do this week to improve their surgery centers?

16:50
I think communication is always a big thing.

16:52
There’s no doubt that communicating the financial information to the governing board, but I’m a big advocate, a patient advocate and we are there for our patients.

17:04
And if I would give you one piece of advice, read those patients satisfaction surveys, your patients will get tell you where the problems are and often like your own staff will be able to tell you all the patients how to fix it.

17:20
Again, I will say it is always a team we are we’re not successful without the team behind us, empower your team.

17:31
I guess that was 11 answer to that right?

17:35
I love it.

17:36
I said one one final question, but I want to ask you just one follow up to that because the patients satisfaction survey is a great info.

17:42
How, how do you disseminate those results across your team?

17:46
OK, wonderful, great question.

17:48
We have a huddle which is on every Monday morning, so at 7:30 every morning all of the staff, any staff can call in.

17:59
They don’t have to be on site.

18:01
They can call into that huddle every Monday morning.

18:05
We view those patients satisfaction surveys, OK.

18:10
It also goes out to the staff.

18:12
So if they couldn’t be there, they will stay on their huddle.

18:15
Those patients satisfaction surveys.

18:18
And as I told you, I have four centers, right?

18:21
I meet with each center once a week and each week this comes up, we will say how do you think that we can fix that?

18:30
And that will be a team and they’re the ones that usually give the answer how they can do this.

18:36
There was times where, you know, this is just one example, but the patients were like the nurses were all of the nurses stations, right.

18:45
The patients were all just waiting to go into surgery.

18:48
Those patients have nothing to do but listen to everything that is going on, right.

18:52
They have nothing else to do.

18:54
They’re waiting.

18:55
They’re anxious and everything.

18:56
So now we have won the documentation.

19:00
If they’re charting, they’ll charge by the bedside.

19:03
So they’re actually with the patient.

19:05
But we also haven’t that they round the staff, round in the waiting room, they round the patients and it’s actually on a big board behind the nurses station that they actually sign off that they have rounded.

19:19
So they’ve checked on every patient and made sure that they’re OK.

19:24
Got it.

19:24
I love it.

19:26
Munia, thanks so much for joining us this week.

19:28
You’re welcome.

19:29
Thank you.

19:34
As always has been a busy week in healthcare, so let’s jump right in.

19:39
Healthcare Dive did a nice roundup of four ways that generative AI is transforming healthcare.

19:46
Before we dive in, I did just want to give a quick refresher on what generative AI is, just because I know a lot of this is new for a lot of us.

19:54
There are two common types of AI generative and predictive.

19:59
When it comes to generative, it’s exactly how it sounds.

20:02
It’s all about creating new content, whether that’s images, text, copy, video, or even software code.

20:08
It’s creating new stuff based on user prompts.

20:13
And then the other common type of AI is called predictive AI and that actually uses a large historical sets of data to recognize patterns across time, draw conclusions and maybe suggest outcomes and future trends.

20:27
So in this instance, we’ll be talking about generative AI.

20:31
And so here are the four ways that our AI is helping to transform healthcare and how they can benefit physicians and patients too.

20:39
So the first one is that AI can document patient encounters and integrate information right into an EHR.

20:45
In a perfect world, the American Medical Association estimates that for every hour a physician spends with a patient, they could spend up to two hours completing administrative work.

20:56
There are tools out there that can automatically transcribe conversations between a clinician and a patient and add that complete story right into the EE Mr.

21:06
for the physician.

21:08
So obviously this not only reduces that admin work, but also allows the clinician to have candid conversations with the patients face to face without needing to worry about typing and taking notes the whole time.

21:20
The second use case is that AI can offer insights into diagnostics and imaging and can improve the accuracy and efficiency of analyzing medical images.

21:31
So imagine radiology, pathology, cardiology.

21:35
This technology can digest and learn from reams and reams of data, and research has already shown that it can catch things in the imagery that sometimes can be overlooked by natural human error.

21:49
And I feel like this is the part of the story where I always like to remind people that this is not by any means replacing the human element, but just supporting and helping.

21:58
Imagine 10,000 mammograms and 200 show something that might be concerning, but four snuck through that human error, naturally missed that AI could then pick up on.

22:10
That’s for human lives that that could be saved and impacted.

22:15
So anyway, the third use case toes the line.

22:18
A little bit of predictive AI, but it can certainly help enhance clinical decision making.

22:23
So if all the records and an EHR are examined, it could help a clinician in making treatment recommendations.

22:31
According to the American Hospital Association, analysis by AI outperformed the modified early warning score, which is a traditional tool used by hospitals to calculate a patient’s risk for declining health.

22:45
And lastly, AI will likely help accelerate drug discovery and development.

22:51
This is crazy number, but on average it can take 10 to 15 years to develop a new medicine at a cost of around $2.6 billion.

23:01
But because AI can be used to automate some processes and and help predict outcomes, there’s a lot of potential here.

23:08
Now this one definitely gives me the biggest pause, but again, just here to make these processes more efficient and I will leave you with this because I thought this was helpful context.

23:18
The American Medical Association recently did a survey and found that 65% of physicians believe AI does offer advantages, particularly when it comes to reducing administrative burdens.

23:32
So that’s 65% of physicians who believe it offers advantages.

23:36
But in practice, only 38% of physicians surveyed said they’re currently using AI in any capacity.

23:43
Now I have to say that 38% is actually way higher than I would have guessed.

23:48
I would have estimated maybe closer to 5 to 10%, but very cool to see the interest and the comfort level rising.

23:56
This next story is a quick one, but I felt it was important to share.

24:00
The FDA has advised all healthcare facilities to stop using plastic syringes from 2 specific manufacturers.

24:09
So the FDA has had an open and ongoing investigation into potential failures with plastic syringes.

24:16
It’s important to know that glass syringes, pre filled syringes and syringes used for oral or topical purposes were not part of this investigations, just plastic.

24:26
And Jeff Sheren, who is the director of the FDA Center for Devices and Radiological Health, said, and I quote, continue to use them as needed only until you are able to transition to alternatives and closely monitor for leaks, breakage and other issues and report any problems to the FDA.

24:48
The concern is that the plastic syringes could leak, break, or deliver the wrong dosage of medication when used alone or with medical devices such as infusion pumps.

24:58
So the FDA sent multiple warning letters to Zheng SU Shenley Medical Production Company based in China, as well as Medline Industries and Seoul Millennial Medical, which market and distribute them in the United States.

25:14
So if you have plastic syringes from that parent company, the Zheng SU Shenley Medical Production Company, unless the syringes absolutely must be used, the FDA is recommending that you stop using them immediately.

25:30
So if you do use plastic syringes, this might be something that you need to look into.

25:33
All right, so we have talked about non competes a few times over the last six months, but there is even more news coming out now.

25:42
So as a reminder, there are four states that have banned non complete non competes.

25:48
That’s California, Minnesota, North Dakota and Oklahoma.

25:53
There are six states that have pending legislation that could ban non competes and Becker’s ASC did a really nice roundup of where each state currently is in their process.

26:03
Let’s go through them.

26:04
The 1st is Illinois and legislation is in the Illinois House and it would make non competes unenforceable.

26:13
The bill applies to Non Solicit Non Solicitation Agreements, Sale of Business, Non Competes, and Agreements Prohibiting Trade Secret disclosures among others.

26:22
It would ban non competes no matter where and when the agreement was entered.

26:26
The bill was introduced and referred to the Rules Committee on February 9th.

26:32
The 2nd state is Maine, so legislation in Maine would ban all non competes except for when a business is sold, when a shareholder sells his shares, or when a partnership is dissolved.

26:43
The bill has passed the House and Senate and was sent to the Governor’s desk on March 19th.

26:48
She is expected to sign the bill into law.

26:51
So I would say out of the six we’re going to go through, Maine definitely seems like it will be the fifth one to ban non competes entirely.

26:59
The third state is Massachusetts, so although Massachusetts already strictly curtails non competes, it is looking to further restrict them in a Senate bill that would make non compete agreements void and unenforceable.

27:12
The bill was referred to the Committee on Senate Rules on March 4th.

27:17
The 4th state is Michigan.

27:19
A bill in the Michigan House would ban any agreement that prohibits an employee from any employment after termination.

27:26
There has been no activity on this bill since it was referred to the Committee on Labor in May of 2023, so that one looks like it may have hit a dead end as we’re coming up on a year of no movement.

27:39
The 5th state is Rhode Island.

27:42
A bill in the Rhode Island House would make non competes unenforceable except in the sale of business context.

27:47
It was introduced and referred to the House Labor Committee on March 13th and then last but not least the 6th state is Wisconsin.

27:56
A Wisconsin Assembly bill would make employee non competes void but would apply to non disclosure agreement.

28:02
I’m sorry would not apply to non disclosure agreements or non competes that are limited to intellectual property owned or licensed by the employer.

28:13
The bill was referred to the Committee on Labor and Integrated Employment on October 12th, so about six months ago.

28:21
So all that to say it is hard to say exactly what will happen with these six states that are in flux.

28:26
Definitely looks like Maine is a shoo in and the closest, but we’ll keep a close eye on all of this and non competes are very limiting for physicians and have been shown to also impact and limit patient care and many other reasons.

28:40
So I hope to see more and more states banning them And to end our new segment on a positive note, Alex Darrow, a former Navy nurse was honored for her patriotic commitment commitment to our country as one of the last living links to Pearl Harbor when she celebrated her 105th birthday surrounded by family, friends and community members.

29:03
So Alice was born in 1919 and enrolled in nursing school.

29:07
After finishing high school.

29:09
She then served as a Navy nurse and worked at Pearl to Hospital in Oakland.

29:13
When Pearl Harbor was attacked on December 7th, 1941, She is considered among the last of the greatest generations in American history.

29:23
Alice shared a fascinating story about how she was present when a naval officer was blown off his boat.

29:31
The Japanese gunman kept firing, but Alice climbed aboard his rescue boat to help anyway.

29:36
The officer was shot in the back but managed to survive, thankfully, and it wasn’t until four months later when when the officer was being treated for appendicitis, that he reconnected with Alice as she was assigned to him as his nurse.

29:51
The naval officer asked Alice if she would marry him if he survived his appendectomy.

29:57
She said she laughed and said yes because she didn’t think he would make it through the surgery.

30:01
Flash forward.

30:03
The couple had gotten married and stayed married for 50 years and had four kids together, so unfortunately he has passed.

30:12
But Alice credits her longevity to her secret to life, which is always have something to look forward to.

30:20
It gets your body and mind ready for what’s next, and of course, family, friends and laughter.

30:26
She has already planned an Around the World cruise later this year with her daughter, and that news story officially wraps up this week’s podcast.

30:35
Thank you, as always for spending a few minutes of your week with us.

30:39
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30:43
I hope you have a great day and we will see you again next week.