UNIVERSITY OF VIRGINIA BOARD OF VISITORS MEETING OF THE MEDICAL CENTER OPERATING BOARD FOR THE UNIVERSITY OF VIRGINIA MEDICAL CENTER FEBRUARY 19, 2015 UNIVERSITY OF VIRGINIA MEDICAL CENTER OPERATING BOARD Thursday, February 19, 2015 8:30 a.m. – 1:00 p.m. Auditorium of the Albert and Shirley Small Special Collections Library, Harrison Institute Committee Members: Stephen P. Long, M.D., Co-Chair Edward D. Miller, M.D., Co-Chair L.D. Britt, M.D. Hunter E. Craig William H. Goodwin Jr. Victoria D. Harker Michael M.E. Johns, M.D. William P. Kanto Jr., M.D. Constance R. Kincheloe George Keith Martin Charles W. Moorman The Hon. Lewis F. Payne Ex Officio Members: Teresa A. Sullivan Randolph J. Canterbury, M.D. Dorrie K. Fontaine Robert S. Gibson, M.D. Patrick D. Hogan Richard P. Shannon, M.D. John D. Simon Pamela M. Sutton-Wallace AGENDA PAGE I. II. OPENING COMMENTS FROM THE CO-CHAIRS REPORTS FROM THE EXECUTIVE VICE PRESIDENT FOR HEALTH AFFAIRS A. Remarks from the Executive Vice President for Health Affairs (Dr. Shannon) B. Remarks from the Chief Executive Officer of the Medical Center (Dr. Shannon to introduce Ms. Pamela M. Sutton-Wallace; Ms. Sutton-Wallace to report) C. Medical Center Operations Report (Dr. Shannon to introduce Mr. Robert H. Cofield; Mr. Cofield to report) D. Medical Center FY 2015 Finance Report (Dr. Shannon to introduce Mr. Larry L. Fitzgerald; Mr. Fitzgerald to report) E. Medical Center Capital Projects F. Health System Development 1 2 3 18 25 28 III. EXECUTIVE SESSION • Discussion of proprietary, business-related information pertaining to the operations of the Medical Center, where disclosure at this time would adversely affect the competitive position of the Medical Center, specifically: – Strategic personnel, financial, market and resource considerations and efforts, including: potential joint ventures or affiliations; report on the performance of Culpeper Hospital; other marketing and clinical growth efforts; long range financial plan and assumptions and operating and capital budget assumptions; review of performance measures and metrics; – Confidential information and data related to the adequacy and quality of professional services, competency, and qualifications for professional staff privileges, and patient safety in clinical care, for the purpose of improving patient care; – Consultation with legal counsel regarding compliance with relevant federal and state legal requirements, licensure, legislative, and accreditation standards; all of which will involve proprietary business information and evaluation of the performance of specific personnel. The relevant exemptions to the Virginia Freedom of Information Act authorizing the discussion and consultation described above are provided for in Section 2.2-3711(A)(1), (6), (7), (8) and (22) of the Code of Virginia. The meeting of the Medical Center Operating Board is further privileged under Section 8.01-581.17 of the Code of Virginia. UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: February 19, 2015 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.A. Remarks from the Executive Vice President for Health Affairs ACTION REQUIRED: None BACKGROUND: Richard P. Shannon, M.D., is the Executive Vice President for Health Affairs for the University of Virginia. Before joining the University, he served as the Frank Wister Thomas Professor of Medicine at the University of Pennsylvania Perelman School of Medicine, and as chairman of the Department of Medicine of the University of Pennsylvania Health System. An internist and cardiologist, Dr. Shannon is widely recognized for his work on patient safety. DISCUSSION: The Executive Vice President for Health Affairs will inform the Medical Center Operating Board (MCOB) of recent events that do not require formal action. 1 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: February 19, 2015 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.B. Remarks from the Chief Executive Officer of the Medical Center ACTION REQUIRED: None BACKGROUND: Pamela Sutton-Wallace is the Chief Executive Officer for the University of Virginia Medical Center. Before assuming this position on July 1, 2014, she served as Senior Vice President for Hospital Operations of Duke University Hospital where she was responsible for several key operational areas, including Perioperative, Emergency/Trauma, Diagnostic, Medical-Surgical Critical Care, and Facility and Support Services. Ms. Sutton-Wallace joined Duke in 1997 as an administrative fellow and held several management positions during her 17-year tenure at the Duke University Health System. DISCUSSION: The Chief Executive Officer of the Medical Center will inform the MCOB of recent events that do not require formal action. 2 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: February 19, 2015 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.C. Medical Center Operations Report ACTION REQUIRED: None BACKGROUND: The Medical Center provides a report of significant operations of the Medical Center occurring since the last MCOB meeting. Robert H. (Bo) Cofield has served as the Medical Center’s Associate Vice President for Hospital and Clinics Operations since February 2010. In this position, he is responsible for the effective daily operations of the Medical Center’s inpatient and outpatient clinical services. Before coming to the University of Virginia, he served for 10 years in a variety of leadership roles at the University of Alabama at Birmingham Health System. DISCUSSION: Clinical Operations Ambulatory Operations The Care Connection program has scheduled over 12,000 appointments during the first half of fiscal year 2015. The program is being reviewed, along with other areas in the Health System, by EY (formally Ernest and Young) as part of our Patient Friendly Access effort. The Pulmonary Clinic was the recipient of the 2013-2014 Cystic Fibrosis Foundation’s Quality Care Award for Outstanding Quality Improvement Processes and Accomplishments for its Cystic Fibrosis work. Our program was among nine recipients out of 110 total cystic fibrosis care centers in the United States. Patient Care Services Neurosciences Center of Excellence A University of Virginia Health System physician is playing a key role in advancing the safety and quality of advanced brain surgery. In an initiative coordinated by U.Va. neurological 3 surgeon Jason Sheehan, M.D., Ph.D., FACS, the American Association of Neurological Surgeons, and the American Society for Radiation Oncology are developing a first-of-its-kind patient registry in order to establish national benchmarks for stereotactic radiosurgery (SRS). SRS uses precise, intensely focused radiation beams to target cancerous cells without damaging healthy tissue. The University of Virginia was one of the first health systems in the country to use a Gamma Knife, which is considered the most advanced form of SRS. The patient registry will draw data from 30 high-volume surgery sites throughout the U.S. and produce information from thousands of patients. In a move intended to spur additional, wide-ranging research into SRS outcomes, the neurosurgery organizations plan to make the anonymized data available to the public. The information drawn from this new trove of data is expected to ultimately lead to safer surgeries and refined SRS techniques, among other benefits. The Department of Neurology’s Epilepsy Fellowship has received official accreditation by the Accreditation Council for Graduate Medical Education (ACGME) starting July 1, 2015. We have had an epilepsy fellowship for at least 35 years; however, official accreditation of epilepsy fellowships was just initiated this year by the ACGME. Transplant Center Program of Excellence The Scientific Registry for Transplant Recipients (SRTR) released the semi-annual Program Specific Reports (PSR) detailing outcomes data for all Transplant Centers in the U.S. The University of Virginia’s data reflect the majority of our adult and pediatric solid organ transplant programs performing above the expected and national average for both patient and graft survival outcomes, with several boasting 100% patient survival during the first year. These outstanding outcomes reflect the strong commitment of the entire multidisciplinary team to ensuring our patients receive expert, comprehensive care through every phase of the transplant process from the first evaluation visit, through the waiting period, and posttransplant. Centers for Disease Control and Prevention (CDC) Visit On November 18, 2014, the CDC Rapid Ebola Preparedness (REP) came to U.Va. Health System to review our Ebola planning efforts as a designated Ebola Treatment Center. At the time, the U.Va. Medical Center and Virginia Commonwealth University (VCU) Medical Center had already been designated as Ebola Treatment Centers for the Commonwealth through a cooperative 4 agreement between the Virginia Hospital and Healthcare Association (VHHA) and Dr. William Hazel, Jr., Secretary of Health and Human Resources for the Commonwealth of Virginia. U.Va. and VCU Medical Centers were among 35 (now ~50) CDCdesignated Ebola Treatment Centers across the United States. These designated centers serve regions in the U.S. with a high proportion of returning travelers or residents from West Africa or jurisdictions for the five international airports screening returning travelers for Ebola. Virginia has a large population of residents from West Africa, with the 5th highest number of returning travelers from West Africa, and is home to Dulles International Airport. Ebola preparedness planning at U.Va. has included a large, multidisciplinary group of experts who have developed a comprehensive Ebola management plan and incident management team for the Health System. Representatives from all of our internal groups as well as senior leadership and Secretary Hazel were in attendance during the day long CDC REP visit. The REP team included CDC representatives as well as individuals from six federal and state health associations (ASPR, NIOSH, VDH, VHHA, APIC, SHEA), the University of Nebraska and VCU Health System. In turn, U.Va. Ebola planning team members traveled to Richmond for the CDC REP visit of VCU on November 19. Feedback received from the CDC REP team was very positive with recommendations for continued growth and training. The commitment and readiness of the U.Va. clinical care team members were noted to be significant strengths. U.Va.’s ability to care for both pediatric and adult patients was also noted to be an important strength. CDC supported our readiness to care for an adult patient immediately and a second adult patient and/or pediatric patient in early 2015. They were particularly impressed with the expanded and innovative uses of Telemedicine in many aspects of care and patient support. Laboratory Services received positive comments in relation to their readiness with specific protocols, training/simulation, and readiness checks. U.Va.’s waste management capability was an absolute strength as well. Federal Communications Commission (FCC) Visit The Federal Communications Commission (FCC) announced plans in 2014 to hold a series of roundtable conferences across the United States as a part of their Connect2Health Taskforce to discuss leveraging broadband technologies and telehealth resources to improve access to healthcare and advance economic development. Led by FCC Commissioner Mignon Clyburn, the series, “Beyond the Beltway,” chose the U.Va. Health System and 5 its Center for Telehealth for the inaugural meeting of these national roundtables. Citing the leadership role U.Va. has played in the development of national telemedicine practice and policy, Commissioner Clyburn focused the review on the Health System’s and Virginia’s efforts to enhance the intersection of broadbandenabled technologies and the provision of medical care, particularly in rural and underserved areas. The roundtable served as a forum for discussion about the social and economic benefits of broadband-enabled health care beyond traditional hospital settings. In addition to Commissioner Clyburn, leadership from the FCC, the U.Va. Health System, and the Commonwealth of Virginia attended the event on November 18. Attendees included Karen R. Jackson, Virginia Secretary of Technology; Dr. William A. Hazel Jr., the Commonwealth’s Secretary of Health and Human Resources; Dr. Richard P. Shannon, U.Va. Executive Vice President for Health Affairs; Pamela M. Sutton-Wallace, Chief Executive Officer of the U.Va. Medical Center; P. Michele Ellison, FCC Deputy General Counsel and Chair, Connect2Health Task Force; and Dr. Karen S. Rheuban, Director of the University of Virginia Center for Telehealth. Physician leadership from the U.Va. Center for Telehealth provided a demonstration of multiple telemedicine programs and outcomes, including the C3 patient home monitoring program, the Center’s work in Southside and Southwest Virginia, a tele-stroke connection to Culpeper Regional Hospital with Dr. Nina Solenski, and tele-obstetrics with Dr. Christian Chisolm. The Center for Telehealth also discussed the work within its comprehensive telehealth network that currently spans more than 130 sites within the Commonwealth. The U.Va. Center for Telehealth has used this network to deliver a steady stream of medical and educational services including thousands of hours of distance learning for patients and health care professionals, hundreds of technical consultations that have helped sites across the state go live, and, most importantly, more than 44,000 patient encounters in more than 40 subspecialties. Over the last 20 years, these efforts have saved Virginia patients from traveling more than 15.4 million miles to receive health care. 6 Clinical Ancillary Services Medical Laboratories The Clinical Microbiology Laboratory is now offering new in-house testing which improves turnaround time: • • • A DNA probe test (BD AFFIRM) for the detection and identification of Candida species, Gardnerella vaginalis, and Trichomonas vaginalis nucleic acid; A direct DNA probe test for Mycobacterium tuberculosis on respiratory specimens; Analysis for the presence of the heparin induced platelet antibody (HIT) is now being performed by Medical Labs in the Special Coagulation section. Radiology and Medical Imaging The project to move the MRI units from the pavilion to the main hospital is underway. The design phase is complete. Construction is scheduled to start on the Crispell Drive site in early January in anticipation of a June 2015 delivery of a mobile MRI unit. Radiology’s PACS (Picture Archiving and Communication System) was upgraded in January 2015. The upgrade offers enhanced functionality for the radiologists. Therapy Services With the successful recruitment of a new laryngologist from Vanderbilt, a comprehensive voice clinic has been developed and implemented. This new program involves having a Speech Language Pathologist see patients in conjunction with the physician on clinic days and perform independent treatment sessions on the other days. Patient Experience Office Patient Experience Results: The November 2015 Fiscal Year to date Inpatient (HCAHPS) score of 67.9% (percentage of 9s and 10s for overall hospital rating) is below the goal of 75%. After a strong FY 2014, the FY 2015 goal was increased from 70% to 75%. The trend for FY 2015 is flat and below goal. Key attributes that impacted the overall score were communication with nurses and doctors, responsiveness of staff, and pain. 7 The components of the former Press Ganey Weighted Average have been revised and this roll up of non-inpatient results is now called the Patient Experience Index. The November 2015 Fiscal Year to date index of 86.7 is slightly below the goal of 88.1 and trending favorably from the prior quarter. All managers have identified two behaviors that they will focus on to improve the patient experience. They range from the existing interventions of Daily Leader Rounding, Hourly Nurse Rounding, Bedside Shift Change Reporting, Quiet Time Hours, White Boards, Care Partner Involvement, “Walk with Me,” and Elevator Etiquette programs to more recent changes in family access. To be more patient and family centered, the Medical Center has eliminated visiting hour restrictions. Prior to this change, visitors, except the identified Care Partner, could not see their loved ones between 9:00 pm and 9:00 am. Now the patient (within some guidelines) has the ability to decide who they would like to visit and for how long. The addition of email patient satisfaction surveys has increased the total number of returned patient surveys by 40%. We have also increased the surveys for Medical Practice. The increased number of surveys will enable us to provide more robust physician level reporting of their patients’ experiences. Real-Time Feedback pilots using iPads continue at the University Medical Associates (UMA) clinic and the Emergency Department. These surveys are highly customized to meet the departments’ specific operational needs. The number of completed surveys is exceeding the typical survey mode by multiple factors. The Patient, Family, and Community Advisory Forum met in December 2014. The Forum members received an update on MyChart and then provided direction and feedback on public reporting of quality outcomes and patient experience results. Community Outreach Pathway to a Health Career The Health System will collaborate with others to identify and engage 40 unemployed or underemployed young adults ages 18 to 25 for skills training, mentoring, education, and employment. The goal is to equip them for an upwardly mobile career path in healthcare. We have received a grant from the Jessie Ball duPont Fund in the amount of $128,012 distributed over 24 months 8 to support our pilot “Pathway to a Health Career”. In addition, the Health System will invest $90,000. Internal collaboration between Community Relations, Medical Center Human Resources, Nursing Education, and the Health System Development Office led to the successful grant submission. Commonwealth of Virginia Campaign (CVC) Continuing a decade long tradition of employee giving, the 2014 CVC effort is again projected to be the largest agency of the Commonwealth in dollars pledged. Final totals will be released in February; however, pledge contributions through December 2014 indicated that U.Va. leads in giving. As a result, the majority of Top 10 charities funded by CVC are from the greater Piedmont Area. Environment of Care Art Committee The University of Virginia Health System Arts Committee presented the exhibition, “Through the Photographer’s Eye” in the Hospital lobby from November 7, 2014 to January 9, 2015. Photographer John Hulburt has traveled the world looking for “the perfect light” that shows nature, places, and things in interesting ways, yet many of his photographs feature the beauty of Albemarle County. Teaching photography at the University of Virginia provides him the opportunity to share with others what he has learned in over 50 years of photography. Auxiliary The Lights of Love Tree Lighting and Caroling was held in the University Hospital Lobby on December 11, 2014. Music of the season was presented by the Choirs of Charlottesville High School, directed by Will Cooke. Handmade “Lights of Love” ornaments could be purchased for the tree for $10 each, with proceeds supporting the mission of the U.Va. Hospital Auxiliary to serve Health System patients and families. Facilities The groundbreaking for the Education Resource Center (ERC) was held on December 12, 2014. The ERC, which will be located between the Emily Couric Clinical Cancer Center and the Lee Street Parking Garage, will house Ambulatory Imaging, an Outpatient Pharmacy, Graduate Medical Education support and teaching functions, and meeting space. 9 Nutrition Services An article entitled “Providing Outpatient Nutrition Services Using an Activity Based Costing Method”, co-authored by Wendy Phillips and Cynthia Moore of Nutrition Services and Keith Batt of Environment of Care at the Medical Center, was the featured article in the Clinical Nutrition Management Practice Group of the Academy of Nutrition and Dietetics’ Fall newsletter. Patient and Guest Services Mary Ann Himes and Vickie Marsh of Patient and Guest Services developed a case study for CyraCom, the largest provider of interpretation services operating solely in the U.S., and the second largest provider worldwide. The case study entitled “Video-Remote Interpretation Efficiencies” showcased the benefits of video-remote interpretation (VRI) currently being used at the Medical Center. The case study outlined how the Health System developed a language services program that was strong, cost effective, and high in compliance, that structured a multifaceted language services program, optimized program cost effectiveness, implemented VRI throughout the hospital, and encouraged physician engagement with VRI. On November 18, 2014, Language Assistance Services hosted the Virginia Department for the Deaf and Hard of Hearing (VDDHH) in a demonstration of assistive technology for patients who are deaf or hard of hearing. A display of communication devices to help patients with hearing loss or a voice, speech, or language disorder was available for team members to review. Safety An Employee Safety Fair was held in late October. Displays on employee safety, needle safety, and the latest minimal lift equipment were available for team members to view. Sustainability The Sustainability Workgroup hosted a fall/winter fair to help team members learn ways to reduce energy costs while creating a safer holiday season. There were tips on winterizing homes and cars, choosing safer and cheaper holiday lighting options, and selecting healthier food options from our local bounty. Featured displays were provided by U.Va. Sustainability Partners, the Virginia Extension Office, LEAP (Local Energy Alliance Program), Black Bear Composting, Nutrition Services, and many more. 10 Information & Technology Services The Medical Center and the University Physicians Group have decided to implement the revenue cycle components of our Epic electronic medical record system. This will include systems supporting patient registration, scheduling, and hospital and physician billing. The project is in the planning phase until summer of 2015, at which point the two year implementation will begin. The Medical Center is 30% complete in the project to replace all physiological patient monitors and to add additional monitoring capability. This project will result in both added monitoring functions and more extensive inpatient monitoring throughout the Medical Center. Human Resources Organizational Development On September 30, 2014, the Uteam Leadership Forum was hosted at the John Paul Jones Arena for the first time. Almost 700 leaders from across the Health System were in attendance. This session focused on leadership expectations as well as Be Safe tools and methods to help leaders transform the culture. Kate Ebner, founding Director for the Institute for Transformational Leadership at Georgetown University, joined us as our keynote speaker on the topic of “Coaching: Leading through Communication.” Another forum was held on January 27, 2015 and continued our Be Safe learning journey with a focus on operational stability. Bruce Tulgan, keynote speaker and founder of Rainmaker Thinking, centered his message on leadership behaviors that promote retention and engagement. The Medical Center conducted an employee engagement “pulse” survey from January 14 – 28. The survey included all Medical Center team members hired prior to October 13, 2014, as well as facilities employees, contracted staff, and house staff (i.e., GME residents). We continue to share best practices for improving engagement through a three-part educational series offered to all leaders across the Medical Center. Based on the information being shared in the classroom, we anticipate a slight increase in the engagement mean score. In addition, we plan to offer a similar educational program for front-line team members starting in March. The purpose of the front-line training is to help team members better understand the intent of the Q12 Elements and to empower them with tools and resources that will enhance action planning efforts at the departmental level. 11 The Uteam Leadership Academy is conducting two new series of classes for leaders. The first, entitled “Influential Leadership – Leading in a Be Safe Environment,” is geared towards Administrators and Directors. This series focuses on learning how to motivate and enable vital behaviors which propel the Medical Center towards becoming the safest place to work and receive care. Topics include: coaching to improve performance and development, influencing others, leadership standard work, and promoting personal responsibility. This series incorporates a high level of individual coaching for each participant. The second series, “Developing Leadership Competencies,” will be offered starting in January to all levels of leadership. The content of this series will be based on the low-scoring competencies from 360 feedback surveys that have been conducted over the past three years. The series is designed to incorporate deliberate practice for the following six competencies: Conflict Management, Priority Setting, Planning, Building Effective Teams, Motivating Others, and Confronting Direct Reports. Unlike most of our course offerings, learners do not have to commit to an extended engagement. Instead they are encouraged to only attend the classes that are of interest. Talent Acquisition The Medical Center initiated its “Step it Up” Experienced Registered Nurse and Pharmacist campaign on October 9, 2014. The campaign has a theme of Balance, highlighting the clinical opportunities of our world class healthcare system and all the benefits of living in Charlottesville. Step it Up offers an enhanced employee referral bonus along with a new hire sign-on bonus and relocation assistance for RNs with a Bachelor’s degree and at least two years of experience. As of December 15, 2014, 33 program eligible RNs have been hired including five employee referrals. This is a national recruitment effort, and hiring activity is expected to increase after the first of the year. Through November 2014, the Medical Center hired 302 RNs (194 experienced and 108 Clinician 1) in FY 2015, compared to 174 over the same time period in FY 2014, representing a 74% increase. Recognition and Rewards Uteam Members of the Month The Uteam Members of the Month program recognizes team members for their outstanding service to the Medical Center. Nominations are based on the following criteria: 12 • • • • • Demonstrates a caring manner and a strong customer focus Works well with others Makes the department a better place to work Serves as a role model for others Demonstrates a commitment to patient safety/patientcentered care Recent Uteam Members of the Month are: • • • • • • July - Irene Wing August - 3 East Team Members September - Lillian L. Shoffstall-Tyler October - Liz Cook November - Edward Sidebottom December - Eunice Jones Prior to Halloween 2014, Uteam partnered with Morrison’s to host the annual “No-carve for a Cure” pumpkin decorating contest. More than 20 decorated pumpkins were turned in from various departments throughout the health system and team members, patients, and visitors voted on “Most Unique”, “Most Creative”, “WOW Factor” and “Best Breast Cancer Theme.” Additionally, Uteam served $1 fall treats each Friday and raised $932.00 for the U.Va. Breast Care Program. Uteam has taken the lead on finding locations where breastfeeding mothers who have returned to work can pump breast milk. Uteam has identified breastfeeding friendly spaces throughout the Health System and provided appropriate signage. Renovations to current locations and an additional room will be added in the coming months. During the week of December 8, 2014, Uteam hosted its annual Health System Holiday Celebrations. Uteam hosted tented events at the following locations: • • • • Fontaine – 650 team members attended Northridge/TCH – 250 team members attended Medical Center - Over 9,000 team members attended or were served through Uteam To-go North Fork – 350 team members attended Additionally: 13 • • • Over 1,000 team members celebrated at off-site locations (managers received $10 per team member to design their own celebration) 500 boxes with a personal message from Pamela SuttonWallace and candy canes were delivered to units with team members working the weekend shift Nearly 600 team members working the weekend of December 12 and 13 were served a full holiday meal Similar celebrations were held for team members working Christmas Eve and Christmas Day. All planned events were 100% compostable, and all leftover food was donated to local shelters. Local vendors included Sweethaus Cupcakes, Carters Specialty Breads, and Black Bear Composting. Information booths for Hoo’s Well and the CVC were well attended by team members. Team members enjoyed the photo booth, peer-to-peer recognition activities, and holiday and popular music. Over 400 volunteer slots were filled by senior leadership, management, Human Resources, and Employee Council members. Compensation The Medical Center implemented its market adjustment for team members on November 23, 2014. This adjustment occurred three months early to demonstrate our commitment to retaining our team members. Approximately 70% of team members received some adjustment due to market conditions. Significant market adjustments were made for key patient care positions, primarily Inpatient and Outpatient Nursing, and other key clinical ancillary jobs in specialized areas. Inpatient Registered Nurses (Clinician 2 and above) received an hourly increase of $2.25, while Outpatient Registered Nurses (Clinician 2-Ambulatory and above) received an hourly increase of $1.57. We also increased the minimum hourly hire rate to $11.76. This adjustment aligns with our values of respect and dignity, and helps ensure that some of our lowerpaid team members are paid fairly and competitively for the contributions they make to our patients and the communities we serve. Quality and Performance Improvement Regulatory Update The Medical Center’s unannounced, triennial Joint Commission accreditation survey is expected to occur during February 2015. The week long survey, which focuses on patient 14 safety and will include our home care agency, also provides deemed status approval for our continuing participation in the Medicare program. The biennial, unannounced lab accreditation survey by the College of American Pathologists (CAP) is also due. The 90-day survey window began on October 15, 2014. The Medical Center Blood Bank (MCBB) recently completed a two day survey by the American Association of Blood Banks (AABB), a CAP affiliate. The MCBB was found to be in full compliance with all AABB standards and has been recertified for an additional two year period. Recognition and Awards The Health System had 13 posters accepted for presentation at the 2015 Virginia Patient Safety Summit, which was held in Richmond on January 29 and 30. U.Va. claimed 13 of the 44 available poster slots, more than any other institution in the Commonwealth. Recognition and Awards A federal survey ranked the Medical Center in the top 5% of hospitals nationally for its support of breastfeeding. U.Va. ranked in the 95th percentile in a survey of 2,666 hospitals conducted by the Centers for Disease Control and Prevention (CDC). U.Va.’s overall score on the Maternity Practices in Infant Nutrition and Care survey was 95 out of 100, compared with an average score of 76 among Virginia hospitals and 75 nationally. An article co-authored by University of Virginia School of Medicine researcher Wladek Minor, Ph.D., has been named as one of the most cited scientific papers of all time by the prestigious journal Nature. Citations are used as a measure of a paper’s influence and importance, reflecting how many other researchers reference and build upon the work. Co-written with longtime collaborator Zbyszek Otwinowski, Ph.D., of Southwestern Medical Center at the University of Texas, the work describes groundbreaking software to analyze X-ray diffraction data to reveal the atomic architecture of molecules essential for life. The work was number 23 on the list of the most cited papers, and number seven among papers published in the last 20 years. The Charlottesville Women’s Four Miler set a new fundraising record this year, collecting $375,000 in donations for the University of Virginia Cancer Center’s Breast Care 15 Program. The money raised through the Women’s Four Miler supports various programs at the Breast Care Center, including mammograms and genetic testing for women who would otherwise be unable to afford services, resources for newly diagnosed breast cancer patients, and breast cancer research at the U.Va. Cancer Center. Over the past 22 years, the race has raised more than $2.8 million to support the Breast Care Program. Becker’s Hospital Review has honored the University of Virginia Department of Neurosurgery and the U.Va. Spine Center on its 2014 list of 100 hospitals with great neurosurgery and spine programs. The programs named to the list "offer remarkable spine and neurosurgical care as based on clinical accolades and recognition from various healthcare groups and agencies," according to Becker’s. In recognizing U.Va.'s spine and neurosurgery programs, the national healthcare publication noted that more than 1,500 spine procedures are performed each year and that U.Va. offers a wide array of services in neurosciences. Becker's also highlighted the work of John A. Jane Sr., M.D., who was honored in 2014 with a Governor's Award for Career Achievement. Supply Chain Supply Chain operations continued a redesign effort using lean methodology. The effort focuses on all inpatient units, imaging and the Emergency Department. The expected outcomes will be managed stores closer to the bedside or other care venue, less non-value added time spent traveling and searching for supplies by care givers, and standardized stocking levels and contents of stocking areas. In turn, this is expected to reduce waste within the supply chain. Current test units are 6 Central and 6 West. Working with Patient Care and physicians, Surgical Supply Services continued its participation in an effort to standardize supply utilization by eliminating practice variation. This effort is being led by the Operating Room and Value Management, with major data analysis now complete and faculty-led discussions underway to eliminate unnecessary variation, thereby reducing cost. In an effort lead by U.Va. faculty, Value Management has concluded two significant contracting efforts in Spine Surgery and Orthopedic Surgery (hip, knee, and shoulder replacement) which will deliver an anticipated annual cost savings of 5% of the Operating Room supply budget. U.Va. faculty and Value Management have also started a new effort centered on Structural 16 Heart Surgery and Endovascular Aneurysm Repair. cost savings are in the 7-11% range. 17 Anticipated UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: February 19, 2015 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.D. Medical Center FY 2015 Finance Report ACTION REQUIRED: None BACKGROUND: The Medical Center prepares a periodic financial report and reviews it with the Executive Vice President for Health Affairs of the University before submitting the report to the MCOB. Larry L. Fitzgerald is the Health System’s Chief Financial and Business Development Officer. He has held similar positions with the University of Pittsburgh Medical Center and American Medical International. He has extensive experience with health care mergers and acquisitions, the Medicare and Medicaid programs, and strategic planning. DISCUSSION: After five months of operations in FY 2015, the operating margin for all business units was 4.5%, which was above the budget of 3.6%. In the first five months of FY 2015, our volume has been generally above budget, revenue well above budget as a result of the high acuity of our inpatients, and expenses overall well controlled when adjusted for volume and the acuity of our inpatients. The operating margin for the overall clinical enterprise is supported by a strong tailwind from our dialysis, imaging, and infusion centers, which averaged an operating margin of 23%. For FY 2015, inpatient admissions were 0.6% below budget and 3.2% above the prior year. The variance from prior year can be explained by the addition of Culpeper Regional Hospital on October 1, 2014. Culpeper admits approximately 250 patients per month. On a same store basis, admissions were .9% below the prior year. For the U.Va. Medical Center only, the case mix adjusted average length of stay was 2.90 days, which was above the budget of 2.73 days and above the prior year of 2.87 days. Outpatient clinic visits for the U.Va. Medical Center were 2.6% below budget in total, but 1.8% above the prior year. 18 Total operating revenue was $575.6 million for FY 2015 through November, which was 2.8% above budget and 10.3% higher than the prior year. Total operating expenses were 1.9% above the budget and 11.5% above FY 2014 expenses. However total expenses per adjusted discharge, adjusted for patient acuity, were $10,831 compared to a budget of $11,031. Total paid employees, including contracted employees, were 58 below budget. FY 2014 Employee FTEs Salary, Wage and Benefit Cost per FTE Contract Labor FTEs Total FTEs FY 2015 2015 Budget 6,845 7,389 7,473 $78,111 $79,841 $79,339 171 213 185 7,016 7,601 7,659 OTHER FINANCIAL UPDATES One of the most significant financial issues facing the U.Va. Health System is Virginia’s decision on the expansion of Medicaid. Following the provisions of the Affordable Care Act (ACA), Medicaid Disproportionate Share (DSH) payments to Virginia from the Centers for Medicare and Medicaid Services will drop 12% in FY 2017, with the reduction growing to 39% in FY 2019. The reduction to DSH is manageable if the Virginia General Assembly votes to approve an expansion of the Medicaid program. At this time, all indications are that the General Assembly is not inclined to approve expanded Medicaid during the 2015 Session. Our Long Range Financial Plan assumes that Medicaid will be expanded. If expansion does not occur, we will be required to make a significant change to the Long Range Financial Plan. We are engaged in confidential discussions with several health systems about collaborations and joint ventures. Since the last MCOB meeting we have signed a nonexclusive Affiliation and Collaboration Agreement with the Bon Secours system. Bon Secours first approached U.Va. about the agreement. We are likely to sign one or two similar agreements before the end of the fiscal year. 19 University of Virginia Medical Center Income Statement (Dollars in Millions) Most Recent Three Fiscal Years Description Net patient revenue Other revenue Total operating revenue Operating expenses Depreciation Nov-13 Operating income (loss) Nov-15 Nov-15 $472.8 $502.4 $559.2 $539.5 20.2 19.6 16.5 20.5 $493.0 $522.0 $575.7 $560.0 428.7 453.2 505.2 496.1 32.5 34.1 36.3 36.1 6.0 6.0 8.4 7.4 Interest expense Total operating expenses Nov-14 Budget/Target $467.2 $493.3 $549.9 $539.6 $25.8 $28.7 $25.8 $20.4 Non-operating income (loss) $12.3 $23.5 $7.9 Net income (loss) $38.1 $52.2 $33.7 Principal payment $11.7 $6.3 $6.9 20 $15.6 $36.0 $6.9 University of Virginia Medical Center Balance Sheet (Dollars in Millions) Most Recent Three Fiscal Years Description Nov-13 Nov-14 Nov-15 Assets Operating cash and investments $156.5 $214.6 $207.8 Patient accounts receivables 128.2 129.5 164.4 Property, plant and equipment 741.4 793.8 842.3 Depreciation reserve and other investments 227.0 188.3 198.5 Endowment Funds 428.3 480.3 527.7 Other assets 219.1 263.7 284.8 $1,900.5 $2,070.2 $2,225.5 Current portion long-term debt $22.1 $12.1 $11.8 Accounts payable & other liab 101.3 129.2 130.5 Long-term debt 400.5 436.2 Total Assets Liabilities 464.6 . Accrued leave and other LT liab Total Liabilities Fund Balance Total Liabilities & Fund Balance 21 138.9 143.8 152.0 $662.8 $721.3 $758.9 $1,237.7 $1,348.9 $1,466.6 $1,900.5 $2,070.2 $2,225.5 University of Virginia Medical Center Financial Ratios Most Recent Three Fiscal Years Description Nov-13 Nov-14 Nov-15 Budget/Target Nov-15 Operating margin (%) 5.2% 5.5% 4.5% 3.6% Total margin (%) 7.5% 9.6% 5.8% 6.3% Current ratio (x) 2.3 2.4 2.6 2.4 178.8 208.9 198.5 190.0 Gross accounts receivable (days) 50.6 47.2 47.8 45.0 Annual debt service coverage (x) 4.3 7.5 5.1 5.2 33.1% 33.4% 33.1% 31.8% 8.2% 8.1% 8.1% 8.1% Days cash on hand (days) Debt-to-capitalization (%) Capital expense (%) University of Virginia Medical Center Operating Statistics Most Recent Three Fiscal Years Description Nov-13 Nov-14 Nov-15 Budget/Target Nov-15 Acute Admissions 11,948 12,078 12,470 12,542 Patient days 70,434 71,466 75,097 70,843 1,641 1,529 1,869 1,938 5.72 5.64 5.90 5.40 319,486 337,273 343,457 352,730 25,888 24,660 25,401 24,858 2.04 2.10 2.16 2.10 6,892 7,016 7,601 7,659 Observation Patients - MC Average length of stay - MC Clinic visits - MC ER visits - MC Medicare case mix index - MC FTE's (including contract labor) 22 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 - November FY2015 ADMISSIONS and CASE MIX - Year to Date Actual ADMISSIONS: Adult Pediatrics Psychiatric Transitional Care Culpeper Subtotal Acute Budget OPERATING STATISTICAL MEASURES - November 2014 OTHER INSTITUTIONAL MEASURES - Year to Date % Variance Prior Year 10,113 1,223 505 124 505 12,470 10,187 1,188 507 169 491 12,542 (0.7%) 2.9% (0.4%) (26.6%) 2.9% (0.6%) 10,246 1,202 500 130 12,078 1,869 1,938 (3.6%) 1,529 Total Admissions 14,339 14,480 (1.0%) 13,607 Adjusted Admissions 25,453 25,133 1.3% 23,555 Observation CASE MIX INDEX: All Acute Inpatients - MC Medicare Inpatients - MC 2.03 2.16 1.98 2.10 2.5% 2.9% 1.97 2.10 Actual ACUTE INPATIENTS: Inpatient Days All Payor CMI Adjusted ALOS - MC Average Daily Census Births OUTPATIENTS: Clinic Visits Average Daily Visits Emergency Room Visits - MC Emergency Room Visits - CRH SURGICAL CASES Main Operating Room (IP and OP) UVA Outpatient Surgery Center Culpeper Surgery Center Total Budget % Variance Prior Year 75,097 2.90 490 776 70,843 2.73 463 767 6.0% (4.6%) 5.8% 1.2% 71,466 2.87 467 724 343,457 3,513 25,401 4,958 352,730 3,596 24,858 4,714 (2.6%) (2.3%) 2.2% 5.2% 337,273 3,414 24,660 0 7,412 4,361 570 12,343 7,049 4,585 610 12,244 5.1% (4.9%) (6.6%) 0.8% 7,468 4,192 11,660 OPERATING FINANCIAL MEASURES - November 2014 23 REVENUES and EXPENSES - Year to Date ($s in thousands) NET REVENUES: Net Patient Service Revenue Other Operating Revenue Total $ EXPENSES: Salaries, Wages & Contract Labor Supplies Contracts & Purchased Services Depreciation Interest Expense Total $ Operating Income $ Operating Margin % Non-Operating Revenue $ Net Income Budget Actual $ OTHER INSTITUTIONAL MEASURES - Year to Date % Variance Prior Year 559,165 16,470 575,635 $ 539,455 20,477 559,932 3.7% (19.6%) 2.8% $ 502,434 19,551 521,985 253,367 129,982 121,869 36,308 8,382 549,908 25,727 4.5% 7,920 (0.3%) (9.0%) 1.9% (0.5%) (13.9%) (1.9%) $ 26.4% $ $ 252,608 119,209 124,263 36,133 7,362 539,575 20,357 3.6% 15,687 (49.5%) $ 228,631 116,691 107,921 34,124 5,960 493,327 28,658 5.5% 23,522 33,647 $ 36,044 (6.7%) $ 52,180 $ $ $ ($s in thousands) NET REVENUE BY PAYOR: Medicare Medicaid Commercial Insurance Anthem Aetna Other Total Paying Patient Revenue OTHER: Collection % of Gross Billings Days of Revenue in Receivables (Gross) Cost per CMI Adjusted Admission Total F.T.E.'s (including Contract Labor) F.T.E.'s Per CMI Adjusted Admission Actual $ $ $ Budget % Variance 167,325 $ 114,871 94,068 109,720 41,552 31,629 559,165 $ 177,833 104,862 88,505 108,904 39,017 20,334 539,455 (5.9%) $ 9.5% 6.3% 0.7% 6.5% 55.6% 3.7% $ 29.74% 47.8 10,831 $ 7,601 22.91 28.90% 45.0 11,031 7,659 23.95 2.9% (6.2%) 1.8% $ 0.8% 4.3% Prior Year 165,629 97,666 82,431 101,430 36,340 18,938 502,434 30.61% 47.2 10,681 7,016 23.24 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 - November 30, 2014 Assumptions - Operating Statistical Measures Admissions and Case Mix Assumptions Admissions include all admissions except normal newborns Pediatric cases are those discharged from 7 West, 7 Central, 7 North, NICU and PICU Psychiatric cases are those discharged from 5 East TCH cases are those discharged from the TCH, excluding any Medicare interrupted stays All other cases are reported as Adult 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 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 24 Assumptions - Operating Financial Measures 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 Non-recurring revenue is included Other Institutional Measures Assumptions Collection % of Gross Billings includes appropriations Days of Revenue in Receivables (Gross) is the BOV definition Cost per CMI Adjusted Discharge uses All Payor CMI to adjust UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: February 19, 2015 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.E. ACTION REQUIRED: None Medical Center Capital Projects BACKGROUND: The Medical Center is constantly improving and renovating its facilities. We provide a status report of these capital projects at each MCOB meeting. DISCUSSION: The current Medical Center capital projects report is set forth on the following page: 25 The University of Virginia Medical Center Capital Projects Report February 19, 2015 Scope 1. BOV Approval Date Projected Completion Date Budget Funding Source $20 M Operating Sept. 2013 2017 $202 M TBD TBD 2020 Planning University Hospital 7th & 8th Floor Master Planning A contract was awarded to HKS in January 2014 for design services for the 7th and 8th floors. The project goals are to upgrade and expand capacity for Women and Children’s in-patient programs. The project is currently in design. Construction expected to begin in Summer 2015. Emergency Department/Operating Rooms (Plinth) In the summer of 2013 the Medical Center retained Jones Lang LaSalle and Blue Cottage to conduct a study of the Medical Center’s need to expand the Emergency Department and the interventional platform and a review of inpatient bed need. At the conclusion of the study the Board of Visitors authorized the hiring of Perkins and Will to further pursue the feasibility of expanding the ED and interventional platform (the plinth) and adding a patient bed tower. With the schematic design of the plinth complete, the final scope of the project needs to be confirmed to proceed. 26 Scope 2. Budget Funding Source BOV Approval Date Projected Completion Date Bonds & Other Sept. 2013 2016 Under Construction Education Resource Center $29.4 M A contract to CO Architects was awarded in December 2012 for planning services for the Education Resource Center (ERC) to be located between the Emily Couric Clinical Cancer Center and the Lee Street Parking Garage. The ERC will house Ambulatory Imaging, an Outpatient Pharmacy, GME support and teaching functions, meeting space and a shell floor. Groundbreaking occurred on December 12, 2014. Construction began thereafter. 27 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: February 19, 2015 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.F. ACTION REQUIRED: None Health System Development BACKGROUND: Health System Development will provide reports of recent activity to the MCOB from time to time. DISCUSSION: SIGNIFICANT GIFTS September 1, 2014 – November 30, 2014 A grateful family member committed two gifts in honor of his wife, totaling $1.25 million, to benefit Parkinson’s disease clinical research. A five-year commitment totaling $250,000 will support a collaborative research project in the departments of Neurosurgery and Neurology, and an additional endowment of approximately $1 million will be established through a bequest to benefit future Parkinson’s disease clinical research. An anonymous donor has pledged $375,000 over five years for a current use fund to support the U.Va. Fellowship in Clinical Chemistry and Laboratory Medicine over the next five years. On August 30, more than 3,500 women participated in the Charlottesville Women’s Four Miler, raising $375,000 in support of breast cancer care and research at the U.Va. Cancer Center. A grateful patient and friend of the University committed $250,000 to endow the Melton D. and Muriel Haney Conference focused on compassionate and palliative care. A former School of Medicine faculty member committed $225,056 in support of the Wang Residents Education Fund in the Department of Orthopaedics. A School of Nursing alumna and former member of the School’s Advisory Board pledged $150,000 over five years to the Nursing Compassionate Care Initiative. 28 The ziMS Foundation, founded by Washington Nationals baseball player and U.Va. alumnus Ryan Zimmerman to support Multiple Sclerosis research, made a gift of $150,000 at their annual gala in Virginia Beach in support of Dr. Myla Goldman’s MS research at U.Va. The U.Va. Medical Center received a two-year $128,012 grant from the Jessie Ball duPont Foundation in support of its pilot “Pathway to a Health Career” program, which provides mentoring and training for underemployed and unemployed youth who are interested in pursuing healthcare careers at U.Va. The Department of Surgery received a $125,000 commitment over the next five years in support of surgical resident education from a grateful family. In response to several gifts received for the Joseph Larner Annual Memorial Lecture in Pharmacology, the Larner family has agreed to match gifts on a 2:1 basis up to $100,000 in order to endow the lecture. A friend of the University verbally committed a $100,000 memorial gift in support of melanoma research. Other gifts and pledges received include: • • • • • • • • • • A $62,000 commitment in support for Adenoid Carcinoma research; A $50,000 commitment for unrestricted support of the Cancer Center; A $36,500 commitment in support of Pathology research; A $30,000 commitment toward the Vesna and Slobo Todorovic Excellence in Anesthesia Research Award; Four separate $25,000 commitments for sponsorships of the 2015 Children’s Hospital Main Event; A $25,000 commitment for obstetrics and gynecology; A $25,000 commitment for U.Va. Children’s Hospital; A $25,000 commitment for the Heart and Vascular Center in support of atrial fibrillation research; A $25,000 commitment in support of cancer research; and A $25,000 commitment in support of research in hematologic malignancies. 29 OTHER DEVELOPMENT INITIATIVES Charles Seilheimer, Jr., and his wife, Mary Louise, hosted an event on September 25 at their home to introduce Dr. Richard Shannon and Dr. Tom Loughran to a select group of prospective donors. The event resulted in a $50,000 gift from one of the attendees for the Cancer Center. On October 3, the Health System celebrated the dedication of the Ivy Translational Research Building at Fontaine Research Park. The event included remarks from President Teresa Sullivan; Executive Vice President for Health Affairs Dr. Richard Shannon; Dr. Peggy Shupnik, Professor of Endocrinology and Molecular Physiology and Biological Physics; School of Medicine Dean Dr. Nancy Dunlap; and Ivy Foundation President Dr. Bobby Battle. Other attendees included members of the Ivy Foundation, U.Va. Health Foundation, the Battle family, and key research faculty. The building is the last of several capital projects funded through the Ivy Foundation’s original $45 million gift to the Health System, which also helped fund the Battle Building at U.Va. Children’s Hospital and the Emily Couric Clinical Cancer Center. On October 7, School of Medicine alumni and community members attended a reception in Lynchburg, Virginia, to meet Dr. Richard Shannon, new Medical Center CEO Pamela Sutton-Wallace, and Dean Nancy Dunlap. At the Health Foundation Board meeting held on November 21, Teresa DiMarco (BSN ’73) was elected chair of the Health Foundation Board, succeeding Becky Ruegger (BSN ’73), who retired as chair after a two-year term of office. The board also welcomed new trustees Dr. Jimmy Orr (A&S ’71, MED ’76), and Dr. Christopher Casscells (MED ’81), as well as new Health System leaders Pamela Sutton-Wallace and Dr. Randy Canterbury. 30 DEVELOPMENT PROGRESS THROUGH NOVEMBER 2014 FY 15 (through 11/30/14) $38,000,000 FY 15 Actual (through 11/30/14) $16,439,105 FY 14 (through 11/30/13) $8,636,923 $6,000,000 $2,406,428 $487,079 Total New commitments (Excludes pledge payments on previously booked pledges) $44,000,000 $18,845,533 $9,124,002 New expectancies Total new gifts, pledges, and expectancies $8,500,000 $52,500,000 $2,968,622 $21,814,155 $2,370,000 $11,494,002 New Gifts New Pledges FY 15 Goal 31
© Copyright 2026 Paperzz