[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6501907,"mediaKeyId","5693201-5c84a1f3441822a49a207e413cec5287","parentId",5693201,"title","Tahoe Forest highlights gains on physician alignment, quality bundles; access-to-care remains a challenge","audioSeconds",4049,"startMs",3207000,"endMs",7256000,"viewUrl","/Search/View?dp=1&key=5693201-5c84a1f3441822a49a207e413cec5287&start=3207&end=7256","thumbnailUrl","https://assets.pipeline.soar.com/5693201-5c84a1f3441822a49a207e413cec5287/thumbnail_3207000.jpg","articleUrl","/articles/6501907/California/Tahoe-Forest-highlights-gains-on-physician-alignment-quality-bundles-access-to-care-remains-a-challenge","mediaUrl","https://secure.pipeline.soar.com/6501907-5105c4d8ce094045767006d8684cda55/orig.mp4?Expires=1771093532&Signature=jMbO3hoBOWhH48V1RveHzxU6-zLk62g2drZmR7rEwbMHfchr9~iohq4F-pGypoX4ekL1GJ8D3WoKJ1ZOMowiNXA9LbbUQjLJjdRZTyKg7NDmNzOelw-G~spSWMC3vKRsTXC~bt9UZ3s5zK3xFdwDYunIafDIsUSDo~JB287~-BMF~pbL2wftDnVklum1~du8960gqu0-BkHINElO6qR2vw4azhcoxClVO5gU2u9jP4jPGcfZfM6OS3NYSXuOMyE3U20sROtfrwYBCDlDQYcADwDUJOX4~bOjVcdZQJZsPvn2Bg0jiEbOkqwZTjqlSjmPWJrKqi1wljSOCr2~xA0vhQ__&Key-Pair-Id=KUT5TJCACFTXG","author","Tahoe Truckee Media","date","2025-08-22T21:22:02Z","article","Tahoe Forest Hospital District leaders told the board they made measurable progress last year on several multi-year strategic goals but fell short on access-to-care targets.

At the meeting, Chief Executive Officer Anna Roth and Chief Operating Officer Louie Ward introduced a consolidated dashboard that aggregates the health system's five \"peaks\": community, service, quality, people and finance. The dashboard showed the system met several annual goals: community health initiatives increased, physician alignment rose from roughly the 10th percentile to about the 40th percentile (score rose from 3.1 to 3.7 on a 4-point scale), the hospital met CMS bundle compliance targets in most categories, patient satisfaction exceeded its goal (96.16% vs. a 95.55% target), and days cash on hand met the finance target (243 days at fiscal year-end prior to audit).

Access shortfalls: The board discussed access metrics at length. Using third-next-available appointment measures, the system missed ambitious access goals: new-patient waits targeted under 10 days averaged 47 days; established-patient waits targeted under 20 days averaged 44 days. Leaders and board members cautioned that the third-next-available metric does not capture same-day capacity and that focusing narrowly on the metric could unintentionally reduce same-day availability. Staff said they will seek patient input to define what \"access\" means locally and will bring a detailed plan to the board next month; they described the effort as a multiyear transformation that includes process improvement (Lean), template standardization and potential model redesign.

Physician engagement and quality: Medical-staff engagement and physician alignment were singled out as major wins. Dr. Brian Evans and others said the alignment work involved leadership changes, structured feedback mechanisms and enhanced physician leadership. The quality team reported achieving seven of eight clinical standard-work bundles tied to CMS star metrics, exceeding their annual target.

Nuka conference and community-driven models: A cross-functional team returned from the Southcentral Foundation (the Nuka system) conference in Alaska and described where the district could adapt ideas. Team members said Southcentral's model centers the community as \"customer-owners,\" uses intensive onboarding and a leadership institute, operates a training/\"learning\" center, empowers staff on functional committees, and uses a robust data warehouse to support weekly operational decisions and panel management. Attendees suggested Tahoe Forest explore community-driven design, a local 'transformation/learning center,' clinician-led data teams and more systematic community engagement for service design.

Quotes from the meeting:
\"I'm not here to change you. I'm here to join you.\" — Anna Roth, CEO, describing alignment work with existing local priorities.
\"They refer to patients as customer owners.\" — Dylan Crosby, vice president of facilities, describing the Nuka model.

Next steps: Staff said they will return next month with a detailed access-to-care plan and more dashboard transparency; leaders also proposed piloting selected Nuka-inspired approaches and creating a cross-organizational implementation plan.","mediaType","Video","parentTitle","Tahoe Forest Hospital District Board Meeting, August 28, 2025","oneSentenceSummary","Tahoe Forest Hospital District leaders said physician alignment and clinical bundle compliance improved over the past year, while access-to-care metrics (third-next-available) remain well short of ambitious targets.","taxTitle","Tahoe-Truckee Unified, School Districts, California","taxId",46654,"location","California","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6501912,"Board discusses clearer recredentialing standards as medical staff add cochlear and telecardiology privileges",588,1153000,1741000,"/Search/View?dp=1&key=5693201-5c84a1f3441822a49a207e413cec5287&start=1153&end=1741","https://assets.pipeline.soar.com/5693201-5c84a1f3441822a49a207e413cec5287/thumbnail_1153000.jpg","/articles/6501912/California/Board-discusses-clearer-recredentialing-standards-as-medical-staff-add-cochlear-and-telecardiology-privileges","https://secure.pipeline.soar.com/6501912-e98bcb56ac35b5a9ffd781c0d430d858/orig.mp4?Expires=1771093532&Signature=LlQtlNSxVKcQP0njxY8b2tq0am6FPsJilOs8TF651URvHUOBC5wOAlu8W9~TLs-hnfM2gXF4-5UYZMFjo1sHXTqEnqxZ2k~2TLPtm2IlyAWWupP5D4Vtyns4jBQwRfZ8h9VG0Gxbkso98jcBHSrN9iHj7Vym6v2A1wA7WnXsjG4LRQGmffF17mvdPbQKYT32Tha1NKmJnbTRPCLk9zZM5qGWkfL21qr0IU2Vu4TrcaiM5gTS16cTutKx9QuXNmyWQb3HYD0xI-Mh3vL2KUyN1jLbBRQs8uld4-ekYunsl0aesdcS~fdtfN10T9Ca8vSDx8wsvTEpOu5HHMWCcKTRHw__&Key-Pair-Id=KUT5TJCACFTXG","Directors and medical staff leaders discussed changes to privileging language that would allow Tahoe Forest to offer cochlear implants and launch telecardiology services while clarifying recredentialing standards.

The medical staff executive committee presented a package of credentialing and policy changes that included: adding cochlear implants and osseointegrated implants to the ENT privileging card; a cardiology privileging change to permit telecardiology (remote reads of echocardiograms and EKGs); and routine updates such as wording changes from \"annually\" to \"regularly.\" The committee said most edits were not substantive but essential to keep privileging current.

Why it matters: adding cochlear implant and osseointegrated implant privileges would allow the hospital to perform or credential local surgeons for procedures the medical staff now occasionally refers elsewhere. Telecardiology would allow the district to contract for remote cardiology reads while recruiting an on-site cardiologist.

Discussion and clarification: Several board members expressed concern about phrasing in the reappointment criteria that required \"evidence of the performance of a sufficient volume of procedures in past 24 months,\" calling it vague. Staff and medical leaders acknowledged the intentional vagueness — volume requirements vary by procedure — but agreed to tighten the language. The board directed that the reappointment language be amended to read that sufficient volume will be determined \"by the department chair\" or the \"medical director of cardiology\" as applicable. Medical staff leaders noted that cochlear implants already have a numeric proctoring requirement (two proctored cases or four cases in two years, as reflected in the privileging card). Staff committed to incorporate the clarified phrasing in the reappointment criteria.

Outcome and process: The medical executive committee consent agenda, which included these privileging cards and reappointment language, was presented to the full board for approval. After the board confirmed the specific language change to say volume will be \"as determined by the department chair/medical director,\" the board approved the medical executive committee consent agenda by voice vote (5-0).

Quotes from meeting participants:
\"I would like the wording to be changed, frankly. I would like it as as determined by the director, you know, the medical director of that particular department.\" — Board member (recorded in transcript)
\"We have a medical director of cardiology, Doctor Skolnick, who would determine whether he felt there was adequate volume.\" — Medical staff representative (explaining how the professional judgment process would work)

Next steps: Staff will update the privileging documents to reflect the board's direction and present the precise revised wording in the final paperwork that will be attached to the credentialing minutes and the consent agenda.","The board reviewed proposed medical-staff privileging changes including adding cochlear-implant and osseointegrated-implant privileges and establishing telecardiology privileging. Directors pressed staff to replace vague 'sufficient volume' language with a departmental determination for reappointment.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6501916,"Board approves updated charity-care and collection policies; records closed-session actions",20,121000,141000,"/Search/View?dp=1&key=5693201-5c84a1f3441822a49a207e413cec5287&start=121&end=141","https://assets.pipeline.soar.com/5693201-5c84a1f3441822a49a207e413cec5287/thumbnail_121000.jpg","/articles/6501916/California/Board-approves-updated-charity-care-and-collection-policies-records-closed-session-actions","https://secure.pipeline.soar.com/6501916-70c44e55e25d832491b99a9ec3e6650a/orig.mp4?Expires=1771093532&Signature=VsXSpmKEHcbDN-JNdykxpo0GbmiwiMYU~XmvesjxPnj3xfA9dxePsR2dSNpDhGvBKy1rIqUlmf82IcLP-QXIuABHQVEJ4L2Pdw9oSrurR5IS5f1dMOSe2Oc11f7hND4d40P2AOhOY2VCYB1Xo6PmKjoprqZsmqzbwKRYpJNYHv3XxjiChsbaUxIWjTfpCxwEcB-rizmpqXZH~kJNcShiBXSpIGTksoi~z7yf~V13hL~w3OC7N-~EcifUm3CyeYDaaC4Wlou7V75WDdzCzNWU2rPhskvAKfisUarQstrvWD80Br9kx33r7pz5D06LMjvhMc5AyyTKpvjUr9ytjsHSmQ__&Key-Pair-Id=KUT5TJCACFTXG","Tahoe Forest Hospital District directors voted to adopt revisions to the system's financial assistance (charity care) and credit/collections policies after a state review identified language that needed correction.

The changes respond to a review by California's Department of Health Care Access and Information (HCAI). Crystal (last name not specified), speaking for the staff, said HCAI noted several issues ranging from missing language specifying eligibility at or below 400% of the federal poverty level to required wording about application timing. Staff told the board the corrections were technical and intended to bring the documents into compliance.

Why it matters: the policies explain how patients can seek discounts or charity care and how third-party collections are handled. Staff said financial counselors will continue to guide patients through the process.

What the board approved: The board approved three related policy items by voice vote: the financial assistance/charity care policy, and the credit/collections policy. The motion passed 4-0 with Director Dale absent. The board also approved routine consent items and the medical executive committee's consent agenda, each by voice vote with results recorded on the public meeting record.

Closed-session report: At the start of the open meeting the board reported actions taken in closed session. According to the recitation, the board considered nine closed-session items. Item 5.1 was accepted by unanimous vote; there was no reportable action on 5.2. Items 5.3 through 5.5 were heard under the Health and Safety Code and the reports were approved unanimously. Liability claims from Lori LeClaire (5.6) and Mary Martinelli (5.7), both alleging negligence against Tahoe Forest Hospital District, were rejected by a 5-0 vote. Closed-session minutes (5.8) and medical staff credentialing recommendations were approved 5-0.

Board voting summary (recorded actions)
- Financial assistance / credit & collections policies (HCAI corrections): approved, vote recorded as 4 yes, 0 no, 1 absent (Dale absent). Mover/second: recorded on the public transcript but not identified by full name. Outcome: approved.
- Medical executive committee consent agenda (including privileging and reappointment items): approved 5-0.
- Consent calendar (routine items): approved 5-0.
- Closed-session items: several acceptances/rejections recorded per staff report (see meeting minutes for itemized list).

Staff and board members said the policy updates are procedural fixes required for state compliance and do not reflect a change in eligibility criteria beyond clarifying existing thresholds.","Tahoe Forest Hospital District directors approved HCAI-mandated edits to the district's financial assistance and collections policies and recorded several closed-session outcomes. The board also approved routine consent items and medical staff reappointments.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6501902,"Retirement plan committee and investment manager report healthy returns; staff note market risks",1080,1816000,2896000,"/Search/View?dp=1&key=5693201-5c84a1f3441822a49a207e413cec5287&start=1816&end=2896","https://assets.pipeline.soar.com/5693201-5c84a1f3441822a49a207e413cec5287/thumbnail_1816000.jpg","/articles/6501902/California/Retirement-plan-committee-and-investment-manager-report-healthy-returns-staff-note-market-risks","https://secure.pipeline.soar.com/6501902-b9a9e606233b70c78a04446a87218bdb/orig.mp4?Expires=1771093532&Signature=C~SoryWngtw189Cw~hY22M9Zx9fE5QNHycOgmvYzThVyTEKEJGEudmt9L5Gf7lWNZJSF1CSuBat7RJdoJ06tZ97SqLvddlLNM48eJp146eLA0me~J3ldlwbysppsJfEIe50wSgcLkU0oDbBbeK7vImu4Cij9PhAYSYwj3EV-HmSsHGTwuLy6bIVxZ4xioXhYFgGWicgZcJe19d6-csnMk1R7xymCPKrgpUld-WEnLinNcPHVZWKRYJtDbRHtYBTYCOCRx33DXkVwpjq5WWfcgcMPoA8BC~S9MftSkMgkoCvpY5zUyQ-aGBRbL-NeuToZC6mSTuzc3nK54DNGNvNXHA__&Key-Pair-Id=KUT5TJCACFTXG","Board members received two financial briefings: a semi-annual retirement-plan update from the retirement committee and an annual investment report from Chandler Investment Management.

Retirement-plan update: Brian Latins (representing the retirement-plan committee) said the committee reviewed performance through Dec. 31 and proactively replaced two funds after portfolio-manager departures: MFS Value was replaced with Dodge & Cox and Northern Small Cap Value was replaced with Boston Small Cap Value II. The committee also reviewed the Fidelity Guaranteed Income Direct annuity option and found it met Secure Act fiduciary safe-harbor criteria, allowing participants to select annuity distribution options through the plan's brokerage link. Plan assets rose in the six-month window: the 401(a) employer-contribution plan rose about 9.4% to roughly $101 million and the 457(b) plan rose about 10.2% to roughly $127 million; combined gains were around $20 million in the six months.

Annual investment report (Chandler): Elena Sampson of Chandler presented the operating-reserve portfolio results and market context. Chandler noted slower economic growth, a softer labor market, and mixed inflation signals; markets have priced in possible Federal Reserve rate cuts later in the year.

Portfolio performance and composition: The board was shown an account summary (June 2024'June 2025) in which the operating cash portfolio earned about $3.2 million and reached a market value near $99.5 million. Credit quality was high (large allocations to U.S. Treasuries and AA-rated instruments), and Chandler reported a 1-year total return of about 6.33% for the cash portfolio versus the benchmark; Chandler said that translated to roughly a quarter-million dollars of outperformance versus benchmark since 2021. The quarterly performance also produced roughly $500,000 in earnings in the most recent quarter. The money-market yield in the cash portion was cited at approximately 3.95%.

Compliance and liquidity: Chandler confirmed the portfolios complied with California Government Code requirements for public-entity cash management (discussed as \u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000\u0000) and stressed the emphasis on liquidity to support upcoming capital projects.

Questions from board members covered fees, participant access to one-on-one Fidelity consultations (staff said virtual consultations were available at no extra charge), and whether shifts in corporate spreads might change allocations. Elena said corporate spreads had tightened and Chandler expected to keep allocations conservative with higher Treasury weight in the near term unless market conditions change.

What the board will see next: staff said they are continuing participant education, one-on-one advisory sessions, fee benchmarking, and plan-design discussions (Roth in-plan conversion and after-tax 401(a) contributions). No approvals were needed; these were informational briefings.","The board heard a semi-annual retirement-plan update and an annual investment report. Staff said plan assets rose and select fund managers were replaced; Chandler reported the operating reserve portfolio returned about 6.33% over the year and the money-market yield was about 3.95%.","actionData","errors"]

Article not found

Tahoe Forest highlights gains on physician alignment, quality bundles; access-to-care remains a challenge

Board discusses clearer recredentialing standards as medical staff add cochlear and telecardiology privileges

Board approves updated charity-care and collection policies; records closed-session actions

Retirement plan committee and investment manager report healthy returns; staff note market risks