This Week in Surgery Centers: Kate Perlstrom – An Essential Guide to Quarterly Board Meeting Agendas

Kate Perlstrom – An Essential Guide to Quarterly Board Meeting Agendas

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

Kate Perlstrom is the Director of Surgical Services at Providence Mission Surgery Center and is very well-versed in preparing for quarterly board meetings. She shared her repeatable agenda along with tips for holding successful meetings and common mistakes to avoid.

📝 Your repeatable agenda should comply with CMS (or whichever governing body you use) and include:

• Heading
• Call to Order
• Changes in the Agenda
• Approval of Previous Meeting Minutes
• Optional: Consent Agenda
• Reports: financial updates, overview of projects, operations, trends, etc.
• Old Business
• New Business
• Comments & Announcements

💡 Efficiency Tips: Distribute agendas and related documents a week in advance to give board members adequate preparation time. This approach ensures focused and effective meetings, saving valuable time and enhancing decision-making.

❌ Avoid Common Pitfalls: Ensure all agenda items are fully backed by appropriate documentation and adhere to established policies. This prevents procedural errors that could lead to compliance issues.

🤝 Engagement Tip: Regularly soliciting feedback on agenda items from board members can foster more relevant and engaging discussions, ensuring that all critical areas of concern are addressed.

Integrating these practices can lead to more streamlined, effective governance for leaders and administrators aiming to refine their approach to board meetings.

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

Episode Transcript

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.

0:27
Hi, everyone.

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

0:31
Kate Pearlstrom is the director at Providence Mission Surgery Center, and she’s on today to share her essential guide to board meeting agendas.

0:41
This will be the second episode we’ve done.

0:43
Focus on how to make your board meetings as effective as possible, and I think we can all agree that having a repeatable agenda is critical to doing so.

0:52
So Kate shares her nine part agenda tips for holding successful meetings and common mistakes that she’s experienced.

0:59
And after my conversation with Kate, we’ll switch to our Data and Insight segment.

1:04
Typically in this segment, I highlight one piece of benchmarking data that was published in HST State of the Industry report last year.

1:12
However, for this episode I want to look at 3 metrics and how you can use them to drive your AS CS growth strategy.

1:20
And lastly, the countdown to ASCA is over.

1:23
This episode comes out on Tuesday, April 16th, so hopefully you’re listening as you’re traveling to Orlando or maybe you’re hanging by the pool at the Gaylord right now.

1:33
But either way, if you are at ASCA this week, HST will be at booth 709 and we have some really fun prizes that anyone can win.

1:43
We’ll have all our products available for walkthroughs, and then we have two speaking sessions as well that you can add to your agenda right through the Aska App.

1:52
One’s on Thursday, April 18th, titled Unleash the Power of Data to Transform Your ASC, and then the second is on Friday, April 19th, titled How to Prepare For and Navigate Board Level conversations that Nick Latz will moderate alongside Tina Piotrowski and Doctor David Shapiro.

2:11
So please swing by to say hello and I hope to see you all in Orlando this week.

2:16
Hope everyone enjoys the episode.

2:18
And here’s what’s going on this week in surgery Centers.

2:25
Hi, Kate.

2:26
Thanks for coming on the podcast.

2:28
Hi, thanks for having me.

2:30
I’m really excited to have you on.

2:32
Can you share a little bit more about yourself with our listeners?

2:35
Sure, sure.

2:36
My name is Kate Pearlstrom and I am the Director of Surgical Services for Mission Surgery Center and it is A5 operating room surgery center in Mission Viejo, CA.

2:49
Perfect.

2:49
Thank you.

2:50
And we got connected because for the month of April we’ll we’re really focusing on sharing tips and insights into making quarterly board meetings as impactful as possible.

3:01
And I know that’s something you are very well versed in.

3:04
Let’s dive in.

3:05
You have 60 to maybe 90 minutes every quarter to cover a ton of ground.

3:11
So let’s start with the regulatory and compliance perspective.

3:14
Where do you begin there?

3:17
Yes.

3:17
So the very first thing that I would recommend folks do is look at your guidelines, your regulatory guidelines depending on who you are working with.

3:27
CMS is a major one that most of us are working with.

3:30
Not all, but most of us have CMS as a guideline and theirs is Appendix L Looking through Appendix L, it will tell you everything that you need to have covered from a governing body perspective.

3:42
So when you’re looking through there, you can look at it and find out what are the items that must be covered in the board agenda and that the board meetings are responsible for.

3:52
And that’s where you want to begin, whether it’s AAA, HC or Quad A.

3:56
Then those also will have a list of what the requirements are for the agendas.

4:01
Perfect.

4:02
Yeah.

4:02
And I think it’s interesting because obviously we’re we’re going to talk about making the agenda and how important it is to have a repeatable agenda and all of that.

4:11
But the compliance piece of this can’t be overlooked.

4:15
So anyway, thank you for that easy reference, but OK, let’s jive into the repeatable agenda.

4:21
From our perspective, it’s really at the core of making sure you’re not only checking all those governing body boxes, but also making sure that your meetings are as productive as possible.

4:33
So you had shared with me a nine part agenda which we’ll link in the episode notes, but let’s go through that.

4:40
Can you talk us through your nine part agenda that you use?

4:44
Sure, absolutely.

4:45
The beginning of the agenda always needs to have of course the heading, your company’s title, where you’re from, where the meeting’s being held, the date and who’s attending.

4:56
So you want to make sure that you have listed on there who is part of your governing board, who’s attending the meeting obviously and then you can head into the structure of your agenda.

5:06
Within the structure, you want to make sure that you’re showing that it’s the and it was that you’re calling to order.

5:10
It’s a guideline for your meeting minutes.

5:14
First, we’re calling to order.

5:15
That’s letting the head of the board know that it’s time for them to start the meeting and then the documentation will begin.

5:22
The secretary will then record in the meeting minutes what is taking place and when it officially has begun, then you want to go over, are there any changes in the agenda.

5:32
So is there anything that’s on the agenda that needs to be updated or changed and identify that at that time.

5:37
All of this then again will be recorded in the meeting minutes.

5:42
If there’s no changes to the agenda, the next you’re going to move on to some approvals.

5:46
There’s a couple of ways that this can be done.

5:48
One is you can have either a consent agenda, which I can go over in a minute, or you can have where these are just the items that are identified and you talk about them at the meeting.

5:57
One is your previous meeting minutes.

5:59
So you want to go through that and make sure that whatever is documented, everybody agrees that is indeed what took place.

6:06
The benefit to having this in what’s called a consent agenda is that then when you send this agenda agenda document out about a week prior to your meeting, that gives everyone on the committee time to review it and they can actually sit down and go, yes, no, that’s correct.

6:22
Or you know what?

6:23
This looks different and be able to have some impactful feedback when you arrive to that moment in time when you’re all taking the vote that yes, this is accurate or not.

6:32
Otherwise, if you don’t do a consent agenda, you need to make sure that you’re allowing enough time for all the members of the board to look through that document and accurately assess whether it’s appropriate.

6:43
A lot of times when you’re only dealing with 60 minutes or so, you don’t want to waste time with everybody sitting there reading through the documents as you’re going through.

6:52
So being able to have some items like in previous meeting minutes on a consent agenda allows for them to review it in advance.

6:58
Then when it comes time to say oh is everyone approved, they’re like, Yep, approved next and it makes things a lot more efficient and flows a lot better.

7:05
Additionally, things that I include on a consent agenda include the copy meeting minutes.

7:12
So for all of our quality meetings that we have, I have the meeting minutes prepared.

7:16
They’re part of the document that are that is sent out with the consent agenda.

7:20
Also safety meeting minutes, any contracts that are for review, any policies that need to be reviewed or updated or changes that have been made to policies.

7:29
And then additionally, anything from the emergency preparedness plan, because those are typically the items that you’re going to want to cover under this agenda and things that will have supporting evidence that they need to be reviewing.

7:40
So that’s the next thing.

7:41
Then after that, any reports, financial reports for the quarter is usually where this would go.

7:47
So any or any other reports, if you have quality metrics that you’re going to be reporting out, you can put it under different reports for them to see.

7:53
Then the next item would be old business and that’s where you’re going over reviewing things that you’ve talked about previously and maybe there’s somebody that has an update to that.

8:01
But then they can provide for you and new business any new items, plans, strategic planning and development can go here and things that you have for your short term and your long range planning which is typically what you want to cover in that.

8:14
And then comments or announcements would be the 9th item.

8:17
And this also could be called round table where people get an opportunity to go around and go over things that are important to them or any other items that they wanted to discuss and that would cover it.

8:28
That will should get you through the basic agenda.

8:31
Yeah, perfect.

8:32
Few questions.

8:33
Going back to the call to order, you had mentioned that there would be a secretary to obviously record all the minutes.

8:39
Who typically is that person?

8:42
It’s whoever the committee has assigned to do it.

8:44
Sometimes it can be myself.

8:47
For us, we have the secretary of our executive director and so she comes and she does the meeting units for all of us.

8:54
So every organization is going to be set up a little bit different.

8:57
You can have everything from where we’ve got our one room O Rs stand alone centers to somebody like with my facility, we’re affiliated with our larger hospital who’s also a partner.

9:06
So we have the CE suite, the C-Suite from that organization from that hospital is part of our board as well.

9:13
So it’s a little bit of a larger group, but anybody could be the secretary, whoever you would deem appropriate.

9:19
I would definitely not make it somebody who’s running the meeting.

9:22
So the head of the board would not be the person that you’d want to have taking the minutes as well.

9:27
Sure, That makes sense.

9:29
And with that consent agenda, how far in advance do you tip?

9:34
Do you try to send that out?

9:36
I try to get that out a week in advance.

9:39
If you any earlier people are going to forget about the meeting.

9:42
It’s a great time to remind folks, hey, it’s usually a quarterly meeting, by the way.

9:46
And so that way they know, oh, it’s coming up and let’s get ready for it.

9:49
The meeting only needs to be annually, but typically people will do it once a quarter.

9:55
You can do it once a month.

9:56
But just so whatever that cadence becomes, make sure you get your agenda out to the group about a week in advance.

10:03
And do you ever send the slides when you send out the consent agenda or or do you have slides?

10:09
I guess that’s a better question.

10:10
It depends.

10:11
You can do it either way.

10:12
For my board meetings, I don’t have slides.

10:15
I do have medical executive committees and my other committees we do a slide share.

10:19
So I include the printables from those slides into my board committee meeting.

10:23
But ours is very standard with just a paper, basic paper agenda that we stand up to everybody and then the meeting minutes to support it.

10:30
And then any supporting documentation can either be through real paper or you can do it up on the PowerPoint type slide.

10:37
If you do a PowerPoint it also there again, it’s going to depend on how your board is set up.

10:41
Sometimes we’re have a lot of folks that are using different types of zoom or team to make sure that they can get all the committee members present, in which case it would be really beneficial I think to have a PowerPoint structure to show it to everybody, right.

10:54
And then you can link all of your policies to it as well if if that’s easier for you to do.

10:59
Yeah, that’s actually a great call out.

11:01
So do you typically have the option for people to attend in person and also call in or one or the other?

11:09
Yes.

11:10
OK, yes, we do, especially with with the board meeting as well as our medical executive committee meeting when you need to have a quorum for the vote.

11:17
So a lot of times with everybody’s schedules, it gets a little difficult for everybody to be present.

11:22
So if they can’t be physically present, then being present through a teams meeting and they’re still part of that meeting.

11:29
Otherwise then you’re going to where you would need to have if it ended up being via e-mail for some reason, you needed to get something passed through the board, then you would need to make sure that quorum was completely met 100% if it’s done through an electronic vote.

11:42
But if it’s through teams that really has helped a lot of our physicians.

11:45
I think that’s one thing that has come out of our whole COVID situation is having the benefit of these types of meetings and interactions with people.

11:51
That’s made a lot of my physicians a lot more compliant with the being at the meetings with us.

11:56
I know I was going to say we’re all so spoiled now with the option to to dial in, but that’s good at all.

12:03
So your point, I’m sure it really helps with attendance and engagement.

12:06
So why not absolutely.

12:09
My last question about the agenda for you right now, you had mentioned that you could give open up the floor to to board members to make any announcements or share any important messages.

12:19
Do you ask for those in advance so at least you’re aware of what they might share?

12:24
I’m just thinking are they heavier, bigger items or they usually like a reminder or I’m out of the office in two weeks.

12:32
Typically at the board meetings, it’s somewhere in between, but it’s not something that hasn’t already typically been discussed because you need to remember that the meeting minutes for these are something that is showing that you are doing all the things that you’re legally responsible for doing for the center.

12:51
So you don’t need to include Sally Sue’s out of work next week.

12:56
But you also want to make sure that things that are discussed are prepared for in advance.

13:01
There’s no surprises.

13:02
And it’s things that you that show that the center is doing what it’s supposed to do, that the governing board has oversight of what the center is doing, and that everybody’s doing the right thing.

13:13
So you’re monitoring your guidelines, your policies and procedures.

13:17
So the round table is going to be more like, is there something regarding the agenda items or something for the next agenda that the board would like to see.

13:23
And I think that also is very appropriate to reach out to when you send out the agenda, reach out to your board members and say is there anything else that you want to see?

13:31
Is there anything else you’d like to see discussed?

13:33
Is there anything we can prepare for in the future so that they can answer that and in advance and then you’ll be better prepared for it.

13:39
And then also you can help coach to, you know what?

13:42
That may not be appropriate for the board meeting, but let’s talk about that offline, right.

13:46
And then you’re ready for whatever might come your way.

13:49
Perfect.

13:50
Yeah, that makes sense.

13:51
Keep it nice and focused and keep it moving.

13:55
Very efficient, very focused.

13:57
Yeah, I’m sure everyone wants to get out of there after an hour anyway, so I’m sure all of that is appreciated.

14:05
Right.

14:05
Right.

14:05
They’re like, OK, we’re ready.

14:07
Yeah.

14:08
So along those same lines, what are a few tips that you would recommend for just making these meetings as successful as possible outside of having that repeatable agenda?

14:18
Well, I think just making sure you come in very well organized and having evidence to support the items that you’re going over.

14:26
For instance, if you are going over coffee, so you’re going to, you’re going to have your agenda items that are in the different sections.

14:34
So say you’re going over your coffee section, which is the quality section, you want to make sure that OK, if we’re discussing the focus study that took place, have your data ready, have your evidence to support what you’ve been doing.

14:46
That way that you can show the board this is what we’ve been doing and This is why.

14:50
And you can have a good constructive conversation about it.

14:53
You want to make sure, like I said, that you’re using that same agenda template for every meeting.

14:57
It will keep you on task so that people don’t start going rogue and talking about who knows what during the meeting.

15:03
And that way you can get through it in a most efficient manner.

15:06
You want to make sure that you agree on the frequency.

15:09
Like I said some, the requirement for most of the regulatory agencies is that the board meetings are one time per year, but that’s typically not enough.

15:18
There’s a lot to go over and you would have a much longer board meeting I think if you just had it once a year in order to get through all of the items that are necessary and are required of most of these organizations.

15:28
Distributing the reminder at least a week prior.

15:31
And then also meeting with some of the team members that are presenting to the board or are going to be part of the meeting, I think is really helpful about a week or so beforehand.

15:42
So before your meeting starts, it’s nice to like I’ll get with my direct report and say, hey, what do you think?

15:48
Is there anything else that we should go through?

15:50
Here’s what I have planned.

15:51
Am I missing anything?

15:52
Is there any topics that we need to discuss that I don’t have on here and just going through it once with everybody and then that way everybody is again prepared and you can get through it very efficiently.

16:03
Perfect.

16:05
And looking at it from a different perspective, what are some common mistakes that you’ve seen people make in these board meetings or in general with the agenda?

16:16
Any advice there?

16:18
Things to avoid?

16:18
I think one of the biggest things that I’ve seen is that people will put in their agenda something like wanting to grant temporary privileges to a physician and not have all the proper procedural background work done.

16:36
So they’ll want to jump ahead to get something done or push something through the board and they don’t have the evidence to support it.

16:42
They haven’t gone by the proper procedures or haven’t followed their policy or the guidelines of CMS or whatever governing agency.

16:49
If you are doing something that isn’t according to your guidelines or standards and it shows up in your meeting minutes, that’s something you can that can hurt you down the road when you come up for survey.

17:01
Sure, yeah.

17:02
And I think I have to ask these questions because recently I feel like there’s a lot of new ASC administrators who have not had a ton of ASC experience.

17:12
So I love giving these just easy tips and tricks for things that everyone else has learned along the way that maybe others could avoid.

17:22
Definitely have been in that situation where I was very new to this and I came out of the operating room as a nurse and not had never done a board agenda in my life.

17:31
So you come across and go where do I start, where do I even begin?

17:33
And this is definitely where I started, was just going through, opening up my manual and saying what does it say is supposed to be in there?

17:39
And I just started listing them out.

17:41
And those soon become your headings.

17:42
And that’s how you start guiding your way through the process and figuring out what works best for your organization.

17:49
Love it.

17:49
I’m sure a lot of people listening can relate to your experience there.

17:54
So, all right, Kate, we do this every week with our guests.

17:57
What is one thing our listeners can do this week to improve their surgery centers?

18:05
I have seen this on your podcast and there’s a couple of times that I’ve been like, I agree with so many of what they’ve said because it’s hard to pick one thing.

18:12
But I think with regards to this topic, reading Appendix L from CMS, Appendix L, that is just your conditions of coverage for the governing body and management.

18:22
And it will cover everything you need to know to make sure that you are running your board meetings effectively, have the agenda items that you need and we’ll be setting you up for success in the future.

18:34
That is great advice.

18:35
Thanks so much for coming on.

18:38
Thank you.

18:43
Welcome to Data and Insights, where we turn data into dialogue and numbers into narratives.

18:50
Typically in this segment, I will highlight one piece of benchmarking data that was published from HS TS State of the Industry report late last year.

18:59
However, for this episode, I want to look at 3 metrics and how you can use them to drive your AS CS growth strategy.

19:07
Now most AS CS know that they want to grow, but what does that really mean and how do you begin to identify what growth could look like for you?

19:16
Growth could be increasing case volume, adding new specialties, bringing on new physicians, opening more operating rooms.

19:24
There are a lot of different avenues, but in this example, we’ll be focusing on how you can identify which types of cases you should be leaning into in order to increase revenue and propel your center towards sustained success and growth.

19:38
I also want to share that I’m about to throw a lot of numbers and examples at you, but I have all of this written out.

19:46
So if you just follow the link in the episode notes or if you know you lose track at any time, head to the notes, click the link and you can follow along with what I’m saying.

19:56
All right, let’s do it.

19:57
So the three metrics we’re going to be looking at and triangulating to get to your answer are operating room utilization, revenue per OR per minute and average net revenue per case.

20:12
All right.

20:12
So step one, we want to identify total missed revenue.

20:17
So first you need to determine your operating room utilization.

20:23
If you don’t already have this number.

20:24
You can do this by determining the total number of minutes the O Rs available for use each day and then calculate your final percentage by dividing actual surgery time by total available time.

20:38
The second metric you need to calculate is revenue per OR per minute.

20:43
Now this is typically an established metric based on historical revenue data and all you want to do is divide the total revenue per OR by the total operating time per OR.

20:55
And all of this, we’re operating in minutes.

21:00
So I know I’m really oversimplifying this, but again, if you want to follow along, there’s a lot more detail in the written version of this.

21:08
But so now that you have your two numbers, I want to give you an example.

21:13
So let’s say an ASC has the following data.

21:18
Let’s say their total available OR time is 540 minutes per day their OR utilization is 75% and then their revenue per OR per minute is $75.00.

21:32
So to get to the total missed revenue and you’re just going to multiply that 540 minutes by 25% because that’s the amount of time their OR is empty.

21:45
And then you’re going to multiply that number.

21:46
So that’s 135 minutes per day that their OR is empty.

21:50
You’re going to multiply that by $75, which is the revenue per OR per minute getting you to the number of $10,125.00.

21:59
That’s the number.

22:00
That’s their total missed revenue per day.

22:03
Put all of that kind of aside, The second step is that you want to identify the highest average net revenue per case.

22:11
To do this, you just want to add up all the contract fees for all cases in a in a given.

22:17
Count the total number of cases performed during the same.

22:21
So it could be over 90 days, six months.

22:24
And then you want to divide your total revenue by the total cases and that’s your average.

22:29
And assuming your ASC has multiple specialties, you also want to categorize each primary CPT code by specialty so that it’s apples to apples and a little more insightful if you have that average net revenue by specialty.

22:46
So again, oversimplifying this for the sake of this exercise, but let’s say an ASC has a total revenue of $380,000.

22:55
Total cases is 200.

22:57
Dividing 200 into 380,000, you’re looking at $1900 as your average net revenue per case.

23:06
OK, so now you have your three metrics.

23:08
You have your operating room utilization, your revenue per OR per minute and your average net revenue per case.

23:15
What do you do now?

23:16
The third and final step is to create a strategy to bring in more for your lucrative cases.

23:22
So step one helped us understand the scope of the revenue opportunity that remains untapped.

23:29
And then Step 2 helped us understand which specialties and procedures are most lucrative.

23:33
So conceptually, you’re really looking to backfill that open OR time with your most lucrative specialties.

23:41
So next steps could look like actively seeking partnerships or referrals in these specialties, aligning your scheduling habits to prioritize these specialties in cases you can engage in targeted marketing efforts aimed at referring physicians and also patients to increase awareness.

24:00
And then data like this is also perfect to share in your quarterly board meetings too.

24:05
So not only will it showcase your strategic efforts and mindset, but you can also tap into your board’s expertise for how you can lean in and grow using this strategy.

24:16
And ultimately, this approach is not just about filling operating rooms, it’s about filling operating rooms with the most profitable options.

24:24
So I hope you found that helpful.

24:26
And again, head to the episode notes so you can follow along.

24:29
And if you’re like me, I’m a visual learner.

24:32
You can see all the equations and everything I just shared laid out.

24:37
And if you’re interested in more data points and use cases, of course, subscribe to the podcast so that you don’t miss any upcoming segments.

24:44
Or just head to HS CS website to check out the full State of the Industry report to get your hands on even more data.

24:52
And that officially wraps up this week’s podcast.

24:55
Thank you, as always for spending a few minutes of your week with us.

24:59
Make sure to subscribe or leave a review on whichever platform you’re listening from.

25:03
I hope you have a great day and we will see you again next week.