UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
September 19, 2002
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
Thursday, September 19, 2002
2:00 – 4:00 p.m.
Board Room, The Rotunda
Committee Members:
Edwin Darracott Vaughan, Jr. M.D., Chair
John P. Ackerly, III
William H. Goodwin, Jr.
William G. Crutchfield, Jr.
Katherine L. Smallwood, M.D.
Eugene V. Fife
Elizabeth A. Twohy
John I. Gallin, M.D.
Ex Officio Members:
George A. Beller, M.D.
Arthur Garson, Jr., M.D.
R. Edward Howell
Leonard W. Sandridge
AGENDA
PAGE
I.
II.
CONSENT AGENDA (Mr. Howell)
● Supplemental Organizational Resolution
ACTION ITEM (Mr. Howell and Dr. Beller)
● Amended and Restated Bylaws of the Clinical
Staff of the Medical Center
III. REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEDICAL CENTER (Mr. Howell)
A.
Vice President’s Remarks
B.
Finance and Operations (Mr. Larry Fitzgerald
to report on Finance; Mr. Howell to report
on Operations)
C.
Capital Projects (Mr. Howell)
D.
Reports Required for Joint Commission on
Accreditation of Health Care Organizations
(Ms. Pamela Cipriano)
1
2
5
6
22
26
IV.
EXECUTIVE SESSION
• ACTION ITEM - To consider proposed personnel actions
regarding the appointment, reappointment, resignation,
assignment, performance, and credentialing of specific
medical staff and health care professionals, as
provided for in Section 2.2-3711 (A) (1) of the Code
of Virginia.
•
Discussion and strategic consideration of proprietary,
business-related information pertaining to operational
efficiencies and operational assessments of the
Medical Center, disclosure of which would adversely
affect the competitive position of the Medical Center,
and the evaluation of performance of departments of
the Medical Center that will necessarily include
discussion of the performance of specific employees of
the Medical Center.
Discussion of proprietary, business-related
information pertaining to the operations of the
Medical Center in comparison with other academic
medical centers, disclosure of which would adversely
affect the competitive position of the Medical Center.
Discussion of proprietary, business-related
information pertaining to payor reimbursement and the
operations of the Medical Center, including
proprietary market and business development
information and strategy, disclosure of which would
adversely affect the competitive position of the
Medical Center.
Discussion of a gift to the Medical Center.
Discussion of strategic and collaborative planning
activities of the Medical Center and the School of
Medicine, which will necessarily involve discussion of
proprietary business-related information
concerning markets, business development and marketing
strategies and activities with related foundations for
the delivery of health care, disclosure of which would
adversely affect the competitive position of the
Medical Center.
Consultation with legal counsel on departments’
performance in compliance with regulatory, licensing
and accreditation requirements, which will necessarily
involve discussion of the performance of individuals
and include proprietary business-related information,
disclosure of which would adversely affect the
competitive position of the Medical Center.
The relevant exemptions to the Virginia Freedom of
Information Act for all of these are provided for in
Section 2.2-3711 (A) (1), (7), (8) and (23) of the
Code of Virginia.
BOARD OF VISITORS CONSENT AGENDA
SUPPLEMENTAL ORGANIZATIONAL RESOLUTION: On January 26, 2002,
the Board of Visitors created the University of Virginia
Medical Center Operating Board and delegated to it exclusive
authority for the governance, operation and management of the
University of Virginia Medical Center. The Board of
Visitors’ resolution creating the Medical Center Operating
Boards sets forth certain duties and responsibilities of the
Medical Center Operating Board and authorizes the Medical
Center Operating Board to adopt resolutions, as necessary and
appropriate, for the governance of the Medical Center.
ACTION REQUIRED: Approval by the Medical Center Operating
Board and the Board of Visitors
APPROVAL OF SUPPLEMENTAL ORGANIZATONAL RESOLUTION
WHEREAS, the Medical Center Operating Board is the
governing body of the Medical Center, and as such, has
responsibility for organizational management and planning;
and
WHEREAS, the Medical Center Operating Board recognizes
the importance of strategic planning to the Medical Center
and desires to acknowledge its oversight role in that
planning process.
RESOLVED that the responsibilities of the Medical
Center Operating Board include oversight of any strategic
planning process undertaken by the University of Virginia
Medical Center.
1
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2002
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II. Amended and Restated Bylaws of
the Clinical Staff of the Medical Center
BACKGROUND: The Clinical Staff of the University of Virginia
Medical Center is governed by bylaws. As specified in the
charge of the Medical Center Operating Board at its last
meeting, the Clinical Staff desires to amend the existing
bylaws and seeks the approval of the Medical Center Operating
Board for such Amended and Restated Bylaws.
DISCUSSION: The University of Virginia Medical Center is an
academic medical center comprised of a teaching hospital,
outpatient clinics, clinic outreach services, and related
health care facilities, which provide inpatient and
outpatient medical and dental services and health sciences
education and related clinical research in conjunction with
the University of Virginia School of Medicine and the
University of Virginia School of Nursing. The Medical Center
Operating Board, as the governing body of the Medical Center,
is responsible for the overall operation of the Medical
Center, including the clinical care provided to patients of
the Medical Center. In accordance with accreditation and
other legal requirements, the Medical Center Operating Board
desires to provide for an organized Clinical Staff for the
Medical Center and to delegate to it the appropriate
responsibility for the provision of quality care given by the
Clinical Staff throughout the Medical Center.
In addition, the Medical Center Operating Board desires
to provide for a system of self-governance of the Clinical
Staff, including the requirements for initial membership on
the Clinical Staff, a mechanism for reviewing the
qualifications of applicants for admission to the Clinical
Staff and a process for their continuing review and
evaluations. Further, the Medical Center Operating Board
desires to establish the Clinical Staff Executive Committee
to serve as the executive committee of the Clinical Staff,
which shall oversee the quality of the clinical care
delivered within the Medical Center, delineate and adopt
2
clinical policy within the Medical Center and serve as the
liaison between the Clinical Staff and the Medical Center
Operating Board. The Amended and Restated Bylaws accomplish
these objectives, and the Clinical Staff has approved them
and submits them for final approval by the Medical Center
Operating Board.
Further, the Amended and Restated Bylaws provide that
the Medical Center Operating Board will establish by
resolution, from time to time, the amount of professional
liability insurance coverage required for each Member of the
Clinical Staff.
ACTION REQUIRED:
Approval by the Medical Center Operating
Board
APPROVAL OF MEDICAL CENTER CLINICAL STAFF BYLAWS, DELEGATION
OF AUTHORITY OVER MEDICAL CENTER CLINICAL POLICY TO THE
MEDICAL CENTER CLINICAL STAFF EXECUTIVE COMMITTEE AND
AUTHORIZATION REGARDING PROFESSIONAL LIABILITY COVERAGE.
WHEREAS, the Medical Center Operating Board serves as
the governing body for the University of Virginia Medical
Center; and
WHEREAS, in accordance with certain legal and
accreditation requirements, the Clinical Staff of the Medical
Center has been established, inter alia, to provide a system
of governance for the Clinical Staff, including a mechanism
for reviewing and evaluating the qualifications of applicants
and re-applicants to the Medical Center Clinical Staff and
responsibility for the provision of quality clinical care
delivered by the Clinical Staff throughout Medical Center
facilities; and
WHEREAS, at its July 2002 meeting, the Medical Center
Operating Board directed the Medical Center to proceed with
revisions to the Clinical Staff Bylaws; and
WHEREAS, the Clinical Staff of the Medical Center has
adopted Amended and Restated Bylaws which provide for the
internal governance of the Medical Center Clinical Staff,
including the requirements for membership on the Clinical
Staff and removal therefrom; and
3
WHEREAS, the Clinical Staff Bylaws create a Clinical
Staff Executive Committee to serve as the executive committee
of the Clinical Staff, with the responsibility for overseeing
the quality of the clinical care delivered within the Medical
Center and adopting appropriate clinical policy for the
Medical Center;
RESOLVED that the Medical Center Operating Board approves
the Amended and Restated Bylaws of the Clinical Staff of the
University of Virginia Medical Center dated September 19,
2002, and delegates to the Clinical Staff Executive Committee
the authority to oversee the quality of clinical care
delivered within the Medical Center and the authority for the
adoption and enforcement of clinical policy throughout the
Medical Center; and
RESOLVED FURTHER that each member of the Clinical Staff
of the University of Virginia Medical Center shall maintain
professional liability insurance coverage in an amount
sufficient to meet the legal limitations for malpractice
actions set forth in Virginia Code Section 8.01-581.15, as
such may be amended from time to time.
4
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2002
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.A.
ACTION REQUIRED:
None
Vice President Remarks
DISCUSSION: The Vice President and Chief Executive Officer
of the Medical Center will inform the Medical Center
Operating Board of recent events that do not require formal
action, but of which it should be made aware.
5
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2002
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.B.
ACTION REQUIRED:
None
Finance and Operations
BACKGROUND: The Medical Center prepares a financial and
operations report and reviews it with the Vice President and
Chief Executive Officer before submitting the report to the
Medical Center Operating Board.
DISCUSSION:
FINANCE: FISCAL YEAR 2002
Fiscal Year 2002 ended below expectations. In general,
inpatient volume was below budget and labor costs were above
budget.
The major determinant of total operating revenue is patient
discharges. For Fiscal Year 2002, discharges were below budget
by 1,587 (5.6 percent) and below prior year by 821 (3.0
percent). Several services were below prior year such as
neurosurgery, inpatient surgery, and obstetrics. Outpatient
volume such as same day patients and outpatient visits, were
above budget and prior year, but not enough to offset the drop
in net revenue from lower discharges.
Total operating revenue for Fiscal Year 2002 was 1.6
percent above budget and 10.3 percent above prior year. The
increase in revenue over prior year is partly the result of the
conversion of the outpatient clinics to provider-based clinics,
which occurred August 1, 2000. In addition, gross charges for
the Medical Center increased an average of 15.0 percent on July
1, 2001.
Total operating expenses for Fiscal Year 2002 were 3.3
percent above the $575.6 million budget and 10.8 percent over
prior year expenses. Salaries and wages, supplies, and medical
center contracts were higher than both budget and prior year.
6
The number of full-time equivalent employees (FTEs) is 134
above budget and 337 above prior year. The increase in FTEs
over prior year is the result of University and HSF employees
transferring to the Medical Center’s payroll, successful efforts
to increase FTEs to permit the opening of more beds, and new
programs in anticipation of increased patient volume. Hospital
and clinic FTEs were:
FY 2001
Hospital FTEs
Clinic FTEs
Total
Annualized
Salary and Wage
Cost per FTE
FY 2002
2002 Budget
4,597
381
4,978
4,849
466
5,315
4,741
440
5,181
$40,337
$43,351
$42,049
Non-recurring contractual adjustments are primarily a
result of the successful effort to obtain Medicare
disproportionate share payments for indigent patients.
The operating margin for Fiscal Year 2002 was 2.0 percent;
however, it includes non-recurring contractual adjustments.
Without the non-recurring contractual adjustments, there was an
operating loss of (0.2) percent.
FINANCE: FISCAL YEAR 2003
The first month of Fiscal Year 2003 has surpassed
expectations, with an operating margin which is above budget.
This results from operating revenue being above budget, while
expenses and full-time equivalent employees are below budget.
For the month of July 2002, discharges are 3.6 percent
below budget and 4.6 percent below prior year. However, patient
days are slightly (.2 percent) above budget, and are 1.1 percent
above prior year due to a higher than expected average length of
stay. The discharges for several services are below prior year,
including pediatrics, neurology, psychiatry, and family
practice. Discharges for neurosurgery and otolaryngology are
above prior year. Outpatient visits (made up of clinic visits
and Emergency Room visits) are 6.8 percent below budget and .6
percent below prior year on an average daily visit basis. Short
stay patients are 9.6 percent above prior year.
Total operating revenue for July is 3.7 percent above
budget and 13.3 percent above prior year. (Note the Medical
7
Center Operating Board approved average rate increase of 5
percent went into effect on July 1, 2002.)
Total operating expenses for July are .7 percent below the
$48.9 million budget and 3.5 percent over prior year expenses.
Salaries and wages and other supplies are below both budget and
prior year expenses. Medical supplies are above both budget and
prior year expenses.
The number of full-time equivalent employees (FTEs) is 162
below budget and 153 below prior year. Hospital and clinic FTEs
are:
Hospital FTEs
Clinic FTEs
Total
Annualized
Salary and Wage
Cost per FTE
FY 2002
FY 2003
2003 Budget
4,785
415
5,200
4,707
340
5,047
4,832
377
5,209
$42,608
$43,018
$43,172
The operating margin for July 2002 is 9.3 percent, which is
above both the budgeted margin of 5.4 percent and the prior
year’s .8 percent margin.
OPERATIONS
For the month of July 2002, labor expenses were 3.3 percent
(162 FTEs) below budget, and 2.2 percent (152 FTEs) below the
expenses for July 2001. On a volume-adjusted basis, labor
dollars were .6 percent over budget. The cost of the travelers
(contract) nurses was $163,000 for July 2002 versus $795,000 in
July 2001, yet this area is 4.5 percent over budget for this
Fiscal Year. The Medical Center has adopted a number of
processes and standards to manage expenses more efficiently, and
we believe their effectiveness is beginning to become evident
after one month.
8
Further, the Medical Center has adopted national
benchmarking standards (HBSI) for operations and budget
purposes. The standard of minimum performance for all areas
(other than the Operating Room) is the HBSI 50th percentile, and
some areas within the Medical Center were identified as not
being in compliance with these requirements. To facilitate our
efforts to meet these standards without the necessity of
employee lay-offs, Medical Center employees in positions
eliminated under the HBSI standards have been and will continue
to be offered positions that were included in the fiscal year
2003 budget but were vacant. As of August 16, 2002, 65
employees were identified for the realignment pool, of which 33
have been successfully reassigned, with reassignment of the
remaining 32 in progress.
9
University of Virginia Medical Center
Income Statement June 2002
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
June 00
Net patient revenue
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Total operating expenses
Operating income (loss)
Nonrecurring contractual adj
June 01
June 02
Budget/Target
June 02
$471.6
$524.8
$581.9
$571.4
9.5
13.5
11.9
13.0
$481.1
$538.3
$593.8
$584.4
427.5
497.7
555.6
536.0
30.8
34.3
34.5
35.0
4.9
4.8
4.6
4.6
$463.2
$536.8
$594.7
$575.6
$17.9
$1.5
($0.9)
$8.8
3.4
13.2
12.9
21.2
$12.0
$30.0
Operating inc after nonrecurring adj
$21.3
$14.7
Non-operating income (loss)
$4.7
$6.8
($0.2)
$9.3
Net income (loss)
$26.0
$21.5
$11.8
$39.3
Debt principal
$3.8
$4.2
10
$4.4
$4.4
University of Virginia Medical Center
Balance Sheet June 2002
(Dollars in Millions)
Description
6/30/2000
6/30/2001
6/30/2002
$60.7
$34.5
$20.2
Patient accounts receivables
53.4
74.2
75.4
Other current assets
29.1
38.6
50.8
Property, plant and equipment
217.4
230.3
233.7
Depreciation reserve investments
157.5
172.7
188.5
Assets
Operating cash and investments
18.5
17.7
14.1
$536.6
$568.0
$582.7
Current portion long-term debt
$4.2
$4.4
$4.6
Accounts payable & other liab
30.9
41.5
44.2
Long-term debt
93.2
88.7
84.0
Accrued leave and other LT liab
13.5
18.3
19.2
$141.8
$152.9
$152.0
$394.8
$415.1
$430.7
$536.6
$568.0
$582.7
Other assets
Total Assets
Liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
11
University of Virginia Medical Center
Financial Ratios June 2002
Most Recent Three Fiscal Years
Description
June 00
June 01
June 02
Budget/Target
June 02
Operating margin (%)
3.7%
0.3%
-0.2%
1.5%
Operating Margin w/ nonrecurring adj (%)
4.4%
2.7%
2.0%
5.1%
Total margin (%)
5.3%
3.9%
1.9%
6.4%
Current ratio (x)
4.1
3.2
3.0
4.0
189.3
154.7
140.0
190.0
Gross accounts receivable (days)
67.7
74.4
65.5
80.0
Average payment period (days)
29.7
33.3
31.8
30.6
7.1
6.7
5.7
8.8
19.1%
17.6%
16.3%
20.0%
7.7%
7.3%
6.6%
6.9%
Days cash on hand (days)
Annual debt service coverage (x)
Debt-to-capitalization (%)
Capital expense (%)
12
University of Virginia Medical Center
Operating Statistics June 2002
Most Recent Three Fiscal Years
Description
June 00
Discharges
Patient days
SS/PP Days
June 01
June 02
Budget/Target
June 02
28,214
27,624
26,803
28,390
149,861
150,121
149,489
157,757
4,356
5,252
7,354
4,958
5.3
5.5
5.6
5.6
499,441
516,351
526,707
510,771
ER visits
57,239
56,688
58,773
56,995
Medicare case mix index
1.8000
1.9081
1.9142
1.8800
Average length of stay
Clinic visits
Net Revenue by Payor
Medicare %
Medicaid %
Blue Cross %
Managed care %
Self-pay, Commercial & other %
Total
39.3%
15.6%
14.3%
6.3%
24.5%
100%
FTE's
4,424
13
39.8%
14.5%
14.3%
6.5%
24.9%
100%
4,978
37.4%
14.9%
16.6%
9.2%
21.9%
100%
5,315
37.9%
12.6%
16.7%
8.4%
24.4%
100%
5,181
6,252
33,876
1.6969
1.9081
Short Stay
Total Admissions
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
Net Income
NET REVENUES:
Total Patient Rev.
Appropriations
Misc Revenue
Total
Less Non-Recurring Contr. Allowances
Operating Revenue Excluding Non-Recurring CA
EXPENSES:
Salaries and Wages
Supplies and Contracts
Purchased Services
Bad Debts
Depreciation
Interest Expense
Total
Operating Margin
Operating Margin %
Non-Operating Revenue
11,799,223
284,427,100
152,898,995
95,731,477
22,513,844
34,468,124
4,613,866
594,653,406
12,014,374
2.0%
(215,151)
246,786,634
143,363,005
93,288,331
14,314,012
34,313,603
4,801,814
536,867,399
14,655,462
2.7%
6,810,537
21,465,999
559,710,474
35,120,339
11,836,967
606,667,780
(12,903,106)
593,764,674
FY 02
1.7115
1.9142
7,991
34,794
9,483
11,691
174
1,398
2,162
1,895
26,803
FY 02
502,853,486
35,120,339
13,549,036
551,522,861
(13,208,005)
538,314,856
FY 01
REVENUES and EXPENSES - Year to Date
9,953
11,980
185
1,441
2,135
1,930
27,624
ADMISSIONS:
Surgical
Medical
Transplant
Obstetrics
Pediatrics
Psychiatric
Subtotal Acute
FY 01
ADMISSIONS and CASE MIX - Year to Date
(45.0%)
15.3%
6.7%
2.6%
57.3%
0.5%
(3.9%)
10.8%
(18.0%)
(25.5%)
(103.2%)
11.3%
0.0%
(12.6%)
10.0%
(2.3%)
10.3%
% Change
14
OTHER:
Collection % of Gross Billings
Days of Revenue in Receivables (Gross)
Cost per CMI & OP-Adj Discharge
Cost per CMI & OP-Adj Day
Cost per Outpatient Visit
Total F.T.E.'s
F.T.E.'s Per Adjusted Occupied Bed
Managed Care
Non-Managed Care
Total Paying Patient Rev.
NET REVENUE BY PAYOR:
Medicare
Medicaid
Managed Care
Commercial Insurance
Other
Total Paying Patient Rev.
79.06%
74.4
6,413
1,180
64.50
4,978
7.62
32,495,865
470,357,621
502,853,486
199,951,705
72,896,689
32,495,865
46,323,151
151,186,076
502,853,486
FY 01
OTHER INSTITUTIONAL MEASURES - Year to Date
12,573
2,541
15,114
516,351
2,261
56,688
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
SURGICAL CASES
Inpatient
Outpatient
Total
150,121
5.5
411
1,440
FY 01
OTHER INSTITUTIONAL MEASURES - Year to Date
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
OPERATING FINANCIAL MEASURES - JUNE 2002
0.9%
0.3%
27.8%
2.7%
(4.7%)
(2.4%)
(5.9%)
(3.0%)
1.3%
(1.8%)
(3.0%)
% Change
OPERATING STATISTICAL MEASURES - JUNE 2002
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - June 30, 2002
72.80%
65.5
7,004
1,256
73.03
5,315
7.84
51,567,853
508,142,621
559,710,474
209,147,009
83,289,372
51,567,853
48,677,077
167,029,163
559,710,474
FY 02
12,436
2,758
15,194
526,707
2,323
58,773
149,489
5.6
410
1,330
FY 02
(7.9%)
(12.0%)
9.2%
6.4%
13.2%
6.8%
2.9%
58.7%
8.0%
11.3%
4.6%
14.3%
58.7%
5.1%
10.5%
11.3%
% Change
(1.1%)
8.5%
0.5%
2.0%
2.7%
3.7%
(0.4%)
1.8%
(0.2%)
(7.6%)
% Change
15
Other Institutional Measures Assumptions
Collection % of Gross Billings includes appropriations
Days of Revenue in Receivables (Gross) is the BOV definition
Cost per CMI & OP-Adj Discharge and Day uses Medicare CMI to adjust
Costs for Cost per Outpatient Visit come from clinic income statement for FY02
For FY01, costs for Cost per Outpatient Visit are direct expenses for clinic departments + adjustment for depr., interest and bad debt (used FY02 figures to adjust)
OP visits used in calculation of Cost per Outpatient Visit are provider based clinic visits only
FTEs are Medical Center FTEs only, does not include contract labor FTEs
Revenues and Expenses Assumptions:
Medicaid out of state is included in Medicaid
Medicaid HMOs are included in Medicaid
Physician portion of DSH is included in Other
Trigon is included in Other
Non-recurring revenue is included
Assumptions - Operating Financial Measures
Other Institutional Measures Assumptions
Patient Days, ALOS and ADC figures include all patients except normal newborns
Surgical Cases are the number of patients/cases, regardless of the number of procedures performed on that patient
Split of surgical cases into inpatient and outpatient based on historical % of SAS discharges (only outpatients would be discharged from SAS).
Note: Actual SAS discharges will be available for the June report per J. McGowan
Outpatient surgical cases do not include those performed at VASC
Admissions and Case Mix Assumptions
Admissions include all admissions except normal newborns
Pediatric surgery cases are included in Pediatrics admissions
Obstetrics surgery cases are included in Obstetrics admissions
Transplant surgery cases are included in Transplant admissions
Transplants include all solid organ transplants and bone marrow transplants
All other surgery cases are counted as Surgical admissions
Surgical cases are defined by DRG
Short Stay Admissions include both short stay and post procedure patients
Case Mix Index for All Acute Inpatients is All Payor Case Mix Index from Stat Report
Assumptions - Operating Statistical Measures
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - June 30, 2002
University of Virginia Medical Center
Income Statement July 2002
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
July 01
Net patient revenue
July 02
July 03
Budget/Target
July 03
$41.3
$46.8
$53.1
$50.8
0.7
0.5
0.5
0.9
$42.0
$47.3
$53.6
$51.7
37.4
43.7
45.4
45.3
Depreciation
2.6
2.8
2.8
3.2
Interest expense
0.4
0.4
0.4
0.4
$40.4
$46.9
$48.6
$48.9
$1.6
$0.4
$5.0
$2.8
Other revenue
Total operating revenue
Operating expenses
Total operating expenses
Operating income (loss)
Non-operating income (loss)
$0.7
Net income (loss)
$2.3
Debt principal
$0.4
16
$0.4
$0.8
$0.4
$1.0
$6.0
$0.4
$0.9
$3.7
$0.4
University of Virginia Medical Center
Balance Sheet July 2002
(Dollars in Millions)
Description
7/31/2000
7/31/2001
7/31/2002
$65.3
$29.7
$32.9
Patient accounts receivables
64.0
81.8
81.9
Other current assets
22.0
45.5
35.6
Property, plant and equipment
217.0
228.8
234.8
Depreciation reserve investments
156.4
178.4
204.3
18.2
15.7
12.6
$542.9
$579.9
$602.1
Current portion long-term debt
$4.2
$4.4
$4.6
Accounts payable & other liab
36.6
49.0
51.2
Long-term debt
93.2
88.7
85.2
Accrued leave and other LT liab
13.3
18.2
18.7
$147.3
$160.3
$159.7
$395.6
$419.6
$442.4
$542.9
$579.9
$602.1
Assets
Operating cash and investments
Other assets
Total Assets
Liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
17
University of Virginia Medical Center
Financial Ratios July 2002
Most Recent Three Fiscal Years
Description
July 01
July 02
July 03
Budget/Target
July 03
Operating margin (%)
3.8%
0.8%
9.3%
5.4%
Total margin (%)
5.4%
1.7%
11.0%
7.0%
Current ratio (x)
3.7
2.9
2.7
4.0
186.3
150.4
164.7
190.0
Gross accounts receivable (days)
73.1
78.7
65.8
70.0
Average payment period (days)
33.5
37.5
37.8
30.6
7.1
5.2
11.7
9.3
19.1%
17.5%
16.1%
20.0%
7.4%
6.8%
6.6%
7.4%
Days cash on hand (days)
Annual debt service coverage (x)
Debt-to-capitalization (%)
Capital expense (%)
18
University of Virginia Medical Center
Operating Statistics July 2002
Most Recent Three Fiscal Years
Description
July 01
Discharges
Patient days
SS/PP Days
July 02
Clinic visits
ER visits
Medicare case mix index
Net Revenue by Payor
Medicare %
Medicaid %
Blue Cross %
Managed care %
Self-pay, Commercial & other %
Total
2,270
2,355
12,789
13,031
13,172
13,144
529
579
582
5.3
5.7
5.8
5.6
39,129
42,694
44,316
48,111
4,996
4,807
5,138
4,926
1.9073
1.8756
1.8916
2.0003
4,607
19
July 03
2,380
42.8%
14.9%
16.0%
9.0%
17.3%
100%
FTE's
July 03
2,334
370
Average length of stay
Budget/Target
46.0%
13.7%
17.2%
8.9%
14.2%
100%
5,200
47.8%
13.2%
22.2%
8.0%
8.8%
100%
5,047
46.5%
13.5%
18.7%
8.4%
12.9%
100%
5,209
594
2,974
1.6536
1.8756
Short Stay
Total Admissions
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
817,601
22,719,133
11,850,679
7,949,751
1,262,162
2,778,709
392,442
46,952,876
382,331
0.8%
435,270
EXPENSES:
Salaries and Wages
Supplies and Contracts
Purchased Services
Bad Debts
Depreciation
Interest Expense
Total
Operating Margin
Operating Margin %
Non-Operating Revenue
Net Income
43,870,739
2,926,695
537,773
47,335,207
NET REVENUES:
Total Patient Rev.
Appropriations
Misc Revenue
Total
FY 02
REVENUES and EXPENSES - Year to Date
829
1,041
15
111
209
175
2,380
ADMISSIONS:
Surgical
Medical
Transplant
Obstetrics
Pediatrics
Psychiatric
Subtotal Acute
FY 02
ADMISSIONS and CASE MIX - Year to Date
6,026,771
22,212,189
12,864,260
8,692,033
1,589,822
2,847,323
394,843
48,600,470
4,990,026
9.3%
1,036,745
50,205,586
2,926,695
458,215
53,590,496
FY 03
1.7996
1.8916
651
2,921
820
1,014
13
118
156
149
2,270
FY 03
637.1%
(2.2%)
8.6%
9.3%
26.0%
2.5%
0.6%
3.5%
1205.2%
1052.8%
138.2%
14.4%
0.0%
(14.8%)
13.2%
% Change
20
OTHER:
Collection % of Gross Billings
Days of Revenue in Receivables (Gross)
Cost per CMI & OP-Adj Discharge
Cost per CMI & OP-Adj Day
Cost per Outpatient Visit
Total F.T.E.'s
F.T.E.'s Per Adjusted Occupied Bed
Managed Care
Non-Managed Care
Total Paying Patient Rev.
NET REVENUE BY PAYOR:
Medicare
Medicaid
Managed Care
Commercial Insurance
Other
Total Paying Patient Rev.
73.42%
78.7
6,695
1,223
64.11
5,200
7.87
3,900,349
39,970,390
43,870,739
20,166,672
6,010,188
3,900,349
3,481,925
10,311,605
43,870,739
FY 02
OTHER INSTITUTIONAL MEASURES - Year to Date
1,065
218
1,283
42,694
2,262
4,807
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
SURGICAL CASES
Inpatient
Outpatient
Total
13,031
5.7
420
126
FY 02
OTHER INSTITUTIONAL MEASURES - Year to Date
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
OPERATING FINANCIAL MEASURES - JULY 2002
8.8%
0.9%
9.6%
(1.8%)
(1.1%)
(2.6%)
(13.3%)
6.3%
(25.4%)
(14.9%)
(4.6%)
% Change
OPERATING STATISTICAL MEASURES - JULY 2002
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - July 31, 2002
69.43%
65.8
6,888
1,187
59.14
5,047
7.23
4,004,375
46,201,211
50,205,586
23,976,902
6,604,385
4,004,375
4,665,861
10,954,063
50,205,586
FY 03
1,163
196
1,359
44,316
2,248
5,138
13,172
5.8
425
103
FY 03
(5.4%)
(16.4%)
2.9%
(2.9%)
(7.8%)
(2.9%)
(8.1%)
2.7%
15.6%
14.4%
18.9%
9.9%
2.7%
34.0%
6.2%
14.4%
% Change
9.2%
(10.1%)
5.9%
3.8%
(0.6%)
6.9%
1.1%
1.8%
1.2%
(18.3%)
% Change
21
Other Institutional Measures Assumptions
Collection % of Gross Billings includes appropriations
Days of Revenue in Receivables (Gross) is the BOV definition
Cost per CMI & OP-Adj Discharge and Day uses Medicare CMI to adjust
Costs for Cost per Outpatient Visit come from clinic income statement for FY02
For FY03, costs for Cost per Outpatient Visit are direct expenses for clinic departments + adjustment for depr., interest and bad debt (used average FY02 figures to adjust)
OP visits used in calculation of Cost per Outpatient Visit are provider based clinic visits only
FTEs are Medical Center FTEs only, does not include contract labor FTEs
Revenues and Expenses Assumptions:
Medicaid out of state is included in Medicaid
Medicaid HMOs are included in Medicaid
Physician portion of DSH is included in Other
Trigon is included in Other
Non-recurring revenue is included
Assumptions - Operating Financial Measures
Other Institutional Measures Assumptions
Patient Days, ALOS and ADC figures include all patients except normal newborns
Surgical Cases are the number of patients/cases, regardless of the number of procedures performed on that patient
Split of surgical cases into inpatient and outpatient based on discharges from the Surgical Admission Suite
Outpatient surgical cases do not include those performed at VASC
Admissions and Case Mix Assumptions
Admissions include all admissions except normal newborns
Pediatric surgery cases are included in Pediatrics admissions
Obstetrics surgery cases are included in Obstetrics admissions
Transplant surgery cases are included in Transplant admissions
Transplants include all solid organ transplants and bone marrow transplants
All other surgery cases are counted as Surgical admissions
Surgical cases are defined by DRG
Short Stay Admissions include both short stay and post procedure patients
Case Mix Index for All Acute Inpatients is All Payor Case Mix Index from Stat Report
Assumptions - Operating Statistical Measures
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - July 31, 2002
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2002
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.C.
ACTION REQUIRED:
None
Capital Projects Report
BACKGROUND: The Medical Center is constantly improving and
renovating its facilities. We will provide a status report of
these capital projects at each MCOB meeting.
DISCUSSION: The current Medical Center capital projects report
is set forth in the following table.
In addition, during fiscal year 2002, the Medical Center
made the following major investment in equipment:
- Neuroangiographic Equipment
$1,600,000
The Medical Center replaced fourteen-year-old
neuroangiographic equipment with the latest in
technology. This advancement has enabled the Medical
Center to provide more detailed and higher quality
information for treatment of cerebral aneurysms and other
vascular malformations and provide improved guidance for
the gamma knife patients, while also reducing radiation
exposure to the patients and staff.
- Angiographic Equipment
$1,200,000
The new angiographic equipment replaced equipment that
was twelve years old. This new equipment provides
superior imaging in its ability to perform digital
imaging runoffs, while reducing both contrast medication
dose and patient radiation exposure.
22
- CT Scanner
$1,000,000
The Medical Center replaced a single row CT scanner with
an eight (8) row CT scanner. This multi-row technology
allows thinner slices to be obtained in faster imaging
times and has resulted in significantly improving the
productivity of the CT service. Additionally, multi-row
imaging has improved the applications of CT imaging with
regard to non-invasive angiographic/vascular and
muskuloskeletal imaging.
-
Software and PCs for Radiation
Oncology and Intensity
Modulated Radiation Therapy
$
500,000
The Medical Center purchased software and necessary
hardware for use in Intensity Modulated Radiation
Therapy, which permits treatment with higher doses of
radiation but greater protection for the patient. This
treatment is especially useful for cancers of the head
and neck, lung, prostate, and gastro-intestinal tract.
23
ATTACHMENT
The University of Virginia Medical Center
Capital Projects Report
BOV
Scope
Budget
PRE-CONSTRUCTION
Hospital Expansion
Project-horizontal
expansion of
University Hospital
and renovation of
entire second floor
to accommodate
complete rebuilding
and expansion of
$58 M
the Perioperative
Services and Heart
Center. Additional
renovations and
expansion for
Interventional
Radiology and
Clinical Laboratory
Breast Care Centerrenovate 7,200 sq.
ft. for a new
Breast Care Center
$1.4 M
that combines
breast imaging and
breast cancer
therapy
Cancer CenterInfusion Center expand existing
$1.25 M
outpatient cancer
center clinic and
infusion center.
24
Funding
Source
Projected
Approval Completion
Date
Date
Bonds @
$54 M
March '99
Hospital
Operating
Revenues
@ $4 M
Sept '05
(Dec '05
–revised)
Bonds
Oct '00
April'03
(May '03revised)
Bonds
Jan '02
March'03
(May '03revised)
South Garage
Expansion – provide
419 additional
parking spaces to
replace those lost
by construction,
potential loss of a
leased lot and for
reserved parking
expansion.
UNDER CONSTRUCTION
Critical Care Unit
Expansion additional 9 beds
to the MICU, TCV-PO
and STICU in
University Hospital
Clinical Office
Building – Fontaine
– provide space for
additional imaging
and clinical care,
including
consolidation of
the Endocrinology
Clinic.
$8.5 M
Bonds
Oct '00
May '04
$3.25 M
Medical
Center
Annual
Capital
Budget
Oct '00
March '03
$16.75 M
Bonds
Jan '02
June '03
25
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2002
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.D. Reports Required for Joint
Commission on Accreditation of Health
Care Organizations
ACTION REQUIRED:
None
BACKGROUND: The Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) accredits the University of Virginia
Medical Center, as well as over 19,000 other health care
organizations. The Medical Center will undergo its triennial
survey by the JCAHO in December 2002. This report highlights
information on four (4) key areas that are essential to share
with the governing body of the Medical Center.
Quality/Performance Improvement - Customer
DISCUSSION:
satisfaction is a barometer for quality of care as perceived by
patients. The Medical Center reestablished a survey process
using Press Ganey Associates, Inc., a company that represents
hundreds of hospitals including academic medical centers. Data
are reported quarterly and provide comparison to selected peer
groups. The University of Virginia Medical Center compares its
scores to other Virginia hospitals and other academic medical
centers. General scores for in-patient areas meet or exceed
benchmarks. Specific focused areas for further attention have
been identified. Other initiatives to improve patient
satisfaction are also under way.
Clinical practice/process improvement has been focused
primarily on two (2) projects. The first, Discharge Cycle
Time, is a Six Sigma project to provide earlier decision
making and communication that results in earlier discharge
times and facilitation of new admissions. The second is an
improvement in the turn around time for reading and reporting
of MRI (Magnetic Resonance Imaging) studies.
26
Patient Rights - The Medical Center continues to monitor
the use of restraints for both medical-surgical safety and
behavior management. The Pain Management Task Force was
established and developed a policy, practice guidelines, an
educational plan and a revised documentation form. The goals of
pain management are to provide as much relief as possible so
that patients may experience the greatest level of comfort.
Patient Safety - The Medical Center evaluated briefings
called “Sentinel Event Alerts” from JCAHO. These Alerts share
approaches to preventing twenty-four (24) high-risk events from
occurring in health care settings. Several changes in systems
were implemented as suggested by JCAHO to enhance safety.
Patient identification was chosen for Failure Mode & Effects
Analysis based on high risk and actual quality data received in
the Quality Office. As a result of noted trends and review of
specific cases resulting in injury, the Medical Center is
currently piloting a Falls Prevention Program and has set a
benchmark goal for falls per 100 patient days. The Six Sigma
Program has reported pilot results on three (3) patient safety
projects including reduced wait time in the Emergency
Department, reduced Operating Room case cart defects in two (2)
services, and identified need and design for Standard Operating
Procedure in MRI to improve film read-by-attending turn-around
time.
Safety and Security - The Bioterrorism Workgroup produced
bulletins for healthcare workers on anthrax, botulism, plague,
and smallpox, and produced Rapid Reference cards for WMD. The
Office of Environmental Health and Safety (OEHS) has trained
personnel who can respond to potential threats. With the
cooperation of the Center for Comparative Medicine, OEHS has
established a laboratory to screen samples for anthrax and other
biological agents should the need arise. Occupational Health and
Safety, Safety, and the OEHS are working together to identify
the level of compliance with OSHA standards, through better risk
identification and evaluation and better education of managers.
Virginia Department of Environmental Quality Hazardous
Waste inspection yielded 0 violations for the 2nd straight year.
A Nuclear Regulatory Commission inspection yielded zero (0)
violations for the 3rd straight inspection. Clinical Engineering
and Safety reviewed MRI safety; Physical Plant replaced ferrous
27
fire extinguishers in the MRI unit and Radiology installed
signage to reduce traffic. The Sharps Injury Prevention Task
Force conducted evaluations of safety devices, selected the
preferred device, and conducted training for staff. A database
to track sharps injuries was created as part of the Sharps
Injury Prevention Task Force and data entry was initiated.
Human Resource Competencies - A centralized Health System
Orientation is offered to all Medical Center employees. In
2001, 1834 new employees attended this orientation. Completion
of orientation is documented on the Mandatory
Training/Competency Validation Form. Each manager is
responsible for reviewing the Role Description Addendum/Skills
Checklist with the new employee and documenting competency in
all required skills by the end of the orientation period.
The Human Resources Center for Organizational Development
(COD) conducts an ongoing needs assessment to determine the
educational needs of Health System employees.
Educational needs vary based on:
• the patient population served and the type and nature of
care provided
• advances in health care management and/or health care
science and technology
• regulatory agency requirements
• change in services provided
The ongoing needs assessment incorporates various resources
as follows:
• information from Quality Improvement initiatives
• performance appraisals of individuals
• peer review
• hospital plant, technology, and safety management
programs
• infection control activities
• training program evaluation forms
COD develops and presents training programs to meet these
needs. A total of 25,943 participants attended training
sessions on a wide variety of topics in 2001. In addition to
general orientation, Patient Care Services oriented 819 new
hires to clinical topics, and 351 staff completed critical care
28
orientation. Other educational responses to identified staff
learning needs include:
• Managers and Supervisors received over 40 instructional
hours in Human Resource classes
• Clerical and service staff received 208 classroom hours
of Medical Information System training
• 15 participants received over 135 hours in English as a
Second Language classes
• 15 participants received over 125 hours in Adult
Continuing Education
Medical Center employee turnover data indicated an overall
reduction from 22.2% to 14.5% (November 2000 to October 31,
2001).
The Medical Center completed performance appraisals for
100% of its employees. 94% were satisfactory, with 12 noncontract staff being terminated for performance and 27 contract
staff being terminated for performance. The distribution of
performance ratings was 6.4% outstanding, 37.4% peak
performance, 55% commendable, and 1.1% needs improvement.
Continuum Home Health (Continuum) - provides three (3)
primary lines of business: home health service, home infusion
and private duty services. Continuum is JCAHO accredited and
separately Medicare/Medicaid certified. Home health services
include the direct provision of skilled nursing, physical,
occupational and speech therapies, home health aides and medical
social work to patients residing within an eleven (11) county
area which includes the counties of Albemarle, Greene, Madison,
Orange, Louisa, Fluvanna, Buckingham, Nelson, Amherst and across
the mountain, the counties of Augusta and Rockingham.
Additionally Continuum offers specialty care through its
Psychiatric Service, Pediatric Service and Perinatal Service,
which is provided in collaboration with the Women’s Place.
Private duty services are provided within these same eleven (11)
counties. In Fiscal Year 2001, Continuum admitted 2,478 new
patients, maintaining an average of 350 direct service patients
per day. Home infusion admitted an additional 330 patients for
pharmacy-only services.
29