UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
NOVEMBER 13, 2014
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
November 13, 2014
8:15 – 11:30 a.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
Nancy E. Dunlap, 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.
OPENING COMMENTS FROM THE CO-CHAIRS
II.
CONSENT AGENDA
• Trauma Designation
ACTION ITEM
• Acquisition and Renovation of 500 Ray C. Hunt Drive
REMARKS FROM THE EXECUTIVE VICE PRESIDENT FOR HEALTH
AFFAIRS
MEDICAL CENTER FINANCE REPORT (Dr. Shannon to
introduce Mr. Larry L. Fitzgerald; Mr. Fitzgerald to
report)
III.
IV.
V.
VI.
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, and market and
resource considerations and efforts, including:
potential joint ventures or affiliations; other
marketing and growth efforts, including
1
2
4
5
population health and other clinical initiatives;
review of performance measures and metrics and
graduate medical education strategies;
– 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.
PAGE
VII.
REPORTS FROM THE EXECUTIVE VICE PRESIDENT FOR HEALTH
AFFAIRS
A.
Remarks from the Chief Executive Officer of the
Medical Center (Dr. Shannon to introduce Ms.
Pamela M. Sutton-Wallace; Ms. Sutton-Wallace to
report)
B.
Operations Report
12
13
C.
Capital Projects
33
D.
Health System Development
35
E.
Annual Compliance Report
38
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS CONSENT AGENDA
II. COMMITMENT FOR UNIVERSITY OF VIRGINIA MEDICAL CENTER TO
BECOME A LEVEL I TRAUMA CENTER AS VERIFIED BY THE AMERICAN
COLLEGE OF SURGEONS: Supports and approves the application for
verification of the Medical Center as a Level I trauma center.
The Medical Center Operating Board commits to maintain the high
standards needed to provide optimal care of all trauma patients.
The multidisciplinary trauma performance improvement program has
the authority to evaluate care across disciplines, identify
opportunities for improvement, and implement corrective actions.
The American College of Surgeons (ACS) provides criteria
for becoming an ‘ACS-verified trauma center’. This is a
voluntary verification of resources at the Medical Center that
includes a site visit to review criteria established by ACS. The
criteria include the commitment of the institutional governing
body and the medical staff to become a trauma center.
It is in the best interest of the University to obtain this
verification. The University would become the third Level I
Trauma Center in the state of Virginia, joining VCU Medical
Center and Inova Fairfax Hospital.
ACTION REQUIRED:
Approval by the Medical Center Operating Board
APPROVAL TO APPLY FOR VERIFICATION BY THE AMERICAN COLLEGE OF
SURGEONS OF THE MEDICAL CENTER AS A LEVEL I TRAUMA CENTER
WHEREAS, the Medical Center Operating Board finds it to be
in the best interest of the University of Virginia Medical
Center to apply for verification to become an American College
of Surgeons verified trauma center;
RESOLVED, the Medical Center Operating Board supports and
approves the application for verification to become an American
College of Surgeons verified trauma center; and
RESOLVED FURTHER, the Medical Center Operating Board
commits to maintain the high standards needed to provide optimal
care of all trauma patients.
1
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III. Acquisition and Renovation of 500 Ray
C. Hunt Drive
BACKGROUND: The Board of Visitors approves major capital
projects every two years with the update of the Major Capital
Projects Program. This plan was last approved in April 2013.
When the University identifies new projects outside the biennial
update cycle, approval by the Finance and Buildings and Grounds
Committees is required. The Medical Center Operating Board and
the Finance Committee will review the financial plans and the
Buildings and Grounds Committee will review the proposed
projects for inclusion in the University’s Major Capital
Projects Program.
In keeping with the recently approved Health System
strategic plan to establish Fontaine as a predominately clinical
and research park, the Medical Center proposes to purchase and
renovate 500 Ray C. Hunt Drive, a 59,000 square feet office
building, into medical clinics. The property is currently owned
by the University of Virginia Physicians Group.
This project would provide modern clinical space for
Urology, which is presently located in the West Complex in a
challenging location for patient access. It would also allow
Cardiology to combine several clinics located in Northridge and
the Hospital into one comprehensive clinical service, which
would free up existing space in the Hospital and Northridge for
other clinical uses.
The purchase price is estimated between $12.0 million and
$14.0 million, with the final purchase price at fair market
value to be based on two appraisals. The renovation cost is
estimated between $17.15 million and $21.0 million.
DISCUSSION: The University recommends the revision to the Major
Capital Projects Program as follows:
2
500 Ray C. Hunt Acquisition and Renovation
Hospital Operating Funds
$29.15 - $35.0 million
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Finance Committee, and by the Board of Visitors
ACQUISITION OF 500 RAY C. HUNT DRIVE PROPERTY
WHEREAS, the Board of Visitors finds it to be in the best
interest of the University of Virginia for the Medical Center to
acquire the real property located at 500 Ray C. Hunt Drive from
the University of Virginia Physicians Group, at a fair market
value purchase price not to exceed $14.0 million;
RESOLVED, the Board of Visitors approves the acquisition of
the 500 Ray C. Hunt Drive property at a fair market value
purchase price not to exceed $14.0 million;
RESOLVED FURTHER, the Executive Vice President and Chief
Operating Officer is authorized, on behalf of the University, to
approve and execute purchase agreements and related documents,
to incur reasonable and customary expenses, and to take such
other actions as deemed necessary and appropriate to consummate
such property acquisition; and
RESOLVED FURTHER, all prior acts performed by the Executive
Vice President and Chief Operating Officer, and other officers
and agents of the University, in connection with such property
acquisition, are in all respects approved, ratified and
confirmed.
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Buildings and Grounds Committee, the Finance
Committee, and by the Board of Visitors
REVISION TO THE MAJOR CAPITAL PROJECTS PROGRAM, 500 RAY C. HUNT
DRIVE RENOVATION
WHEREAS, the University proposes the addition of the 500
Ray C. Hunt Drive Renovation to the Major Capital Projects
Program;
RESOLVED, the Board of Visitors approves the addition of
the 500 Ray C. Hunt Drive Renovation, estimated between $17.15
million and $21.0 million, to the University’s Major Capital
Projects Program.
3
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
IV. 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 MCOB of recent events that do not require formal
action.
4
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
V. Medical Center Finance Report
ACTION REQUIRED:
None
BACKGROUND: The Medical Center prepares a periodic financial
report, including write-offs of bad debt and indigent care, and
reviews it with the Executive Vice President for Health Affairs
of the University before submitting the report to the Medical
Center Operating Board.
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:
MEDICAL CENTER FINANCE REPORT
After two months of operations in Fiscal Year 2015, the
operating margin for all business units was 5.5%, which was
above the budget of 4.5%.
For FY 2015, inpatient admissions were 1.4% below budget
and 3.1% below the prior year. Case mix adjusted average length
of stay was 2.91 days, which was above the budget of 2.73 days,
but below the prior year case mix adjusted average length of
stay of 2.93 days. Outpatient clinic visits were 7.0% below
budget in total, but 1.3% above the prior year when adjusted for
the clinic days in each year. Visits to the Emergency Room were
2.3% above budget and 3.9% above the prior year.
Total operating revenue was $222.8M for FY 2015 which was
0.6% above budget and 6.6% higher than the prior year. Total
operating expenses were 0.4% below the budget and 9.8% above FY
2014 expenses. Supplies and interest expense were above budget
while labor, contracts and purchased services were below budget.
All expense categories were above prior year expenses.
5
Total paid employees, including contracted employees, were
186 below budget.
FY 2014
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2015
6,668
7,071
$77,611
$79,346
2015 Budget
7,253
$79,562
164
186
190
6,832
7,257
7,443
OTHER FINANCIAL UPDATES
One of the most significant financial issues facing the
U.Va. Health System is the decision on expanded Medicaid.
Following the provisions of the Affordable Care Act (ACA),
Medicaid Disproportionate Share payments (DSH) paid to Virginia
by the Center 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 a manageable reduction if the Virginia
General Assembly votes to approve an expansion in the Medicaid
program. At this time, all indications are that the General
Assembly is not inclined to vote to approve expanded Medicaid.
The Health System Long Range Financial Plan has assumed Medicaid
will be expanded so if expansion does not occur we will be
required to make a significant change to the Long Range
Financial Plan.
The transaction to acquire the remaining 51% of Culpeper
Regional Hospital has closed. A collaborative team from the
Health System and Culpeper Hospital is planning the integration
of Culpeper Hospital into the Health System.
6
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Description
Most Recent Three Fiscal Years
Budget/Target
Aug-14
Aug-15
Aug-13
Aug-15
$190.1
$202.5
$216.3
$213.3
9.9
6.6
6.5
8.1
$200.0
$209.1
$222.8
$221.4
164.0
176.2
193.3
194.5
12.9
13.3
14.0
14.0
2.4
2.3
3.3
2.9
Total operating expenses
$179.3
$191.8
$210.6
$211.4
Operating income (loss)
$20.6
$17.3
$12.2
$10.0
Non-operating income (loss)
$0.2
$0.7
$2.5
$6.2
Net income (loss)
$20.8
$18.0
$14.7
$16.2
Principal payment
$4.7
$2.5
$2.8
$2.8
Net patient revenue
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
7
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Aug-13
Aug-14
Aug-15
Assets
Operating cash and investments
$132.0
$173.2
$200.8
Patient accounts receivables
130.4
128.6
164.1
Property, plant and equipment
736.5
797.1
834.5
Depreciation reserve and other investments
237.1
202.6
203.1
Endowment Funds
418.2
463.9
526.0
Other assets
264.8
231.7
289.6
$1,919.0
$1,997.1
$2,218.1
Current portion long-term debt
$28.1
$15.2
$16.5
Accounts payable & other liab
134.6
111.6
104.4
Long-term debt
398.9
408.4
466.6
Accrued leave and other LT liab
137.2
147.1
181.8
$698.8
$682.3
$769.3
$1,220.2
$1,314.8
$1,448.8
$1,919.0
$1,997.1
$2,218.1
Total Assets
Liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
8
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Aug-13
Aug-14
Aug-15
Budget/Target
Aug-15
Operating margin (%)
10.3%
8.3%
5.5%
4.5%
Total margin (%)
10.4%
8.6%
6.5%
7.1%
Current ratio (x)
1.6
2.4
3.0
2.4
211.8
197.2
207.7
190.0
Gross accounts receivable (days)
46.2
45.5
49.3
45.0
Annual debt service coverage (x)
5.1
7.0
5.3
5.2
33.2%
32.4%
33.6%
31.8%
8.5%
8.1%
8.2%
8.0%
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Aug-13
Acute Admissions
Patient days
SS/PP Patients
Average length of stay
Clinic visits
ER visits
Medicare case mix index
FTE's (including contract labor)
9
Aug-14
Aug-15
Budget/Target
Aug-15
4,921
5,028
4,874
4,942
28,900
29,030
30,135
28,196
1,863
1,505
1,519
1,798
5.81
5.66
5.86
5.40
128,350
133,819
131,977
141,845
10,684
9,843
10,227
9,998
2.03
2.08
2.15
2.10
6,824
6,832
7,257
7,443
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 - August FY2015
ADMISSIONS and CASE MIX - Year to Date
Actual
Budget
OPERATING STATISTICAL MEASURES - August 2014
OTHER INSTITUTIONAL MEASURES - Year to Date
% Variance
4,153
487
185
49
4,874
4,181
487
208
66
4,942
(0.7%)
0.0%
(11.1%)
(25.8%)
(1.4%)
4,293
497
191
47
5,028
Short Stay/Post Procedure
1,519
1,798
(15.5%)
1,505
Total Admissions
6,393
6,740
(5.1%)
6,533
Adjusted Admissions
9,617
9,687
(0.7%)
9,748
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
2.01
2.15
1.98
2.10
1.5%
2.4%
Actual
Prior Year
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Transitional Care
Subtotal Acute
1.93
2.08
ACUTE INPATIENTS:
Inpatient Days
All Payor CMI Adjusted ALOS
Average Daily Census
Births
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
SURGICAL CASES
Main Operating Room (IP and OP)
Off Site Procedures
UVA Outpatient Surgery Center
Total
Budget
% Variance
Prior Year
30,135
2.91
486
307
28,196
2.73
455
290
6.9%
(4.6%)
6.8%
5.9%
29,030
2.93
468
295
131,977
3,307
10,227
141,845
3,531
9,998
(7.0%)
(6.3%)
2.3%
133,819
3,265
9,843
3,207
751
1,620
5,578
2,877
563
1,538
4,978
11.5%
5.3%
12.1%
3,255
177
1,782
5,214
OPERATING FINANCIAL MEASURES - August 2014
10
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
216,263
6,538
222,801 $
213,255
8,190
221,445
1.4%
(20.2%)
0.6% $
202,485
6,563
209,048
95,922
51,149
46,229
13,969
3,269
210,538
12,263
5.5%
2,519
2.5%
(8.1%)
5.2%
0.4%
(11.2%)
0.4% $
22.9% $
$
98,420
47,305
48,785
14,021
2,940
211,471
9,974
4.5%
6,215
(59.5%) $
88,567
45,336
42,303
13,282
2,269
191,757
17,291
8.3%
733
14,782 $
16,189
(8.7%) $
18,024
$
$
$
($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
1
Actual
$
$
$
Budget
% Variance
64,715 $
44,428
36,382
42,435
16,070
12,233
216,263 $
70,300
41,453
34,987
43,051
15,424
8,038
213,255
(7.9%) $
7.2%
4.0%
(1.4%)
4.2%
52.2%
1.4% $
28.84%
49.3
10,912 $
7,257
23.32
28.91%
45.0
11,080
7,443
24.18
(0.3%)
(9.6%)
1.5% $
2.5%
3.6%
Prior Year
66,750
39,360
33,220
40,877
14,645
7,632
202,485
30.81%
45.5
10,198
6,832
22.53
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 - August 31, 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
11
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
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
2
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
VII.A.
ACTION REQUIRED:
None
Chief Executive Officer’s Remarks
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.
12
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 11, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
VII.B.
ACTION REQUIRED:
None
Operations Report
BACKGROUND: The Medical Center provides a report of significant
operations of the Medical Center occurring since the last MCOB
meeting.
DISCUSSION:
Clinical Operations
Ambulatory Operations
The Care Connection program continues to grow in terms of
appointments made for our patients. Over 4,700 appointments
have been scheduled through the first two months of the FY. The
program has also expanded and is now responsible for patient
scheduling functions of the Gastroenterology clinic as it was
transitioned from the Gastroenterology division.
A new patient fall screening tool for the ambulatory
clinics has been developed and is now being piloted among a
small number of providers. The goal is that the tool will help
identify patients who are at risk of falling and provide the
necessary tools and resources to prevent them from occurring.
Dawn Shaver, Clinician 4 for the Neurosurgery Clinics, was
recently chosen to be on the editorial board of the Surgical
Neurology International: Neurosurgical Nursing and will be
reviewing articles that pertain to neuroendocrine issues.
Patient Care Services
Women’s Services
Women’s Services is launching a Certified Nurse Midwife
program. We are currently hiring nurse midwives who will begin
seeing patients by the end of the year.
13
The majority of the Battle Building moves are complete and
work is wrapping up to resolve any remaining Facilities issues
with the project.
Children’s Hospital
The 7th and 8th floor renovation project is in the design
stage with frontline teams working to maximize efficiencies and
flow of these areas.
The Children’s Hospital and Women’s Services are awaiting a
site visit from Baby Friendly USA to complete the final stage of
our application for Baby Friendly designation. The expected
dates of the site visit are December 15-16.
The Battle Building Children’s Services added the
Otolaryngology Clinic on September 16 and the Allergy Clinic on
September 17.
Neuroscience Center of Excellence
Jaideep Kapur, M.D., Ph.D., Eugene Meyer III Professor of
Neuroscience, Professor of Neurology, and Director of
Neuroscience Center of Excellence has received a grant award
from NIH-NINDS for over $21 million to be the principal
investigator for a major multicenter clinical trial for epilepsy
patients (the ESETT Trial).
Nina Solenski, M.D., Associate Professor of Neurology
subspecializing in Cerebrovascular Disease, received an Equit-e
grant from the U.S. Department of Health and Human Services
Health Resources and Services Administration. The EvidenceBased Tele-Emergency Network Program grant will look to expand
capabilities in remote emergency departments and determine the
effectiveness of tele-emergency care for rural patients and
providers.
Christopher Shaffrey, M.D., Harrison Distinguished Teaching
Professor of Neurological and Orthopedic Surgery, Professor of
Neurological Surgery, and Director of the Neurosurgery Spine
Division and Justin Smith, M.D., Ph.D., Associate Professor of
Neurological Surgery, were named as 2 of 18 of the most notable
Spine surgeons in North America in 2014 by Orthopedics This
Week.
John Jane Sr., M.D., Ph.D., who served as Chair of the
Department of Neurosurgery for 30 years, was honored for his 45
years of innovative work to improve patient care. The
Governor’s Award for Career Achievement recognizes individuals
14
who have a record of sustained professional achievement and have
improved the efficiency and effectiveness of services in
Virginia. Dr. Jane is known for pioneering techniques in
craniofacial surgery that have helped children throughout
Virginia and the world. His care for actor Christopher Reeve
following his spinal injury in 1995 led the Christopher and Dana
Reeve Foundation to support U.VA.’s nervous system research.
We continue to expand our pediatric neuroscience offerings
with the addition of new faculty members, Radhika Dhamija, M.D.,
MBBS, who will focus on neurogenetics, James Nicholas Brenton,
M.D., who specializes in pediatric epilepsy and childhood-onset
demyelinating disease (multiple sclerosis), and Laurie Brenner,
M.D., M.A., who will be specializing in pediatric
neuropsychological assessment and the neuroscience of
developmental psychopathology, with particular emphasis on
visual attention in autism, ADHD and 22q Deletion Syndrome.
Finally, we are focusing on the development of a program
involving a multidisciplinary team of neurogenetic specialists
who will offer coordinated care to patients with neurogenetic
and neurocutaneous diseases — from diagnosis to treatment and
management. The team is made up of clinical geneticists,
neurologists, neurosurgeons and genetic counselors, allowing
patients to benefit from the unique perspective of each
discipline. Team members have expertise in the following
conditions:
•
•
•
•
•
•
•
•
Neurofibromatosis (types 1 and 2)
Schwannomatosis
Von-Hippel Lindau syndrome
Tuberous sclerosis complex
Huntington’s disease
Fragile X syndrome
Batten Disease and other lysosomal storage disorders
Other neurological genetic disorders
Heart and Vascular Center of Excellence
Cardiac and Thoracic Surgery
Implementation of thoracic and cardiac surgery huddles
related to patient schedule and flow, daily review of the fiveday cardiac and thoracic operating room schedule, daily review
of the in house consult schedule for potential cardiac surgery,
and implementation of a daily bed briefing. Supplemental
resident coverage has begun to cover peak night shifts on Friday
15
and Sunday evening.
September 12, 2014.
RN
five to
welcome
to make
receive
time.
All changes are effective beginning
Care Coordinators have begun calling all IV patients
seven days before their visit to establish contact,
the patients, and begin the relationship. The goal is
sure patients are scheduled into the right specialty and
the right care, including any diagnostics, at the right
Other goals:
•
•
•
•
•
Improve patient adherence
Gain operational efficiencies/better clinic flow
Enhance patient satisfaction and loyalty
Improve financial outcomes
Improve nurse satisfaction
The Corindus CorPath System is the first FDA-approved
medical device to bring robotic precision and accuracy and
optimize clinical outcomes during coronary angioplasties. The
equipment also minimize the costs associated with complications
through improper stent placement.
Corindus Vascular Robotics, Inc. is a global technology
leader in robotic assisted percutaneous coronary interventions
(PCIs). The company’s FDA-cleared CorPath System is the first
medical device that offers interventional cardiologists PCI
procedure control from an interventional cockpit. Additionally,
the CorPath System reduces radiation exposure up to 95% for the
interventional cardiologist performing the procedure.
This new product was purchased with Heart and Vascular
Center of Excellence funds, and was installed on September 26.
The first interventional cases were performed at U.VA. on
October 1. All PCI operators at U.Va. will be trained to use
this technology.
Magnet
On October 1, the organization submitted the required
documentation to the American Nurses Credentialing Center for
consideration of Magnet designation. The documentation totaled
2,539 pages and included 295 graphs. A team of four appraisers
will review and score the document and determine qualification
for the second phase of the process, on-site evaluation. A
decision about the site visit should be communicated by the end
of January.
16
Transplant Services
On September 22nd, the Charles O. Strickler Transplant
Center took the first steps in revitalizing the Transplant
Patient Assistance Fund by hosting the first Annual Transplant
Golf Benefit. Held at Spring Creek Golf Club, the event drew 29
teams and dozens of community sponsors, while formally joining
both recipients and waiting patients to celebrate hope and the
gift of life that organ transplantation offers. The inaugural
event netted over $50,000 for the Transplant Patient Assistance
Fund.
The Transplant Patient Assistance Fund offers provisional
aid to offset travel expenses for transplant patients in need.
Funds are used to help with the cost of lodging, to reimburse
transportation costs, and to provide nutrition vouchers for the
stressful times that accompany end stage organ disease and organ
transplantation.
Clinical Ancillary Services
Medical Laboratories
The Virginia Blood Foundation (VBF) is a non-profit
organization whose mission is to champion excellence in
transfusion medicine by creating awareness, education, and
excellence in all aspects of transfusion medicine. The VBF
recently gave an $189,000 grant to the U.Va. Blood Bank through
the U.Va. Foundation. The first grant ($109,000) will be used
to purchase three specialized instruments known as rotational
thromboelastometry (Rotem). The Rotem tests patient coagulation
levels and clot strength which helps guide blood product
therapy. This will limit surgical bleeding and reduce red cell
and fresh frozen plasma transfusion. The second grant ($80,000)
will be used to purchase a Cobe Cell Washer, which will enable
the washing of red cell units for neonates on the heart
transplant list.
On September 24, 2014, the Core Laboratory began using new
hematology analyzers along with an updated software program.
The combination of these systems will result in faster
turnaround times for most samples and allow for new in house
testing for Reticulated Hemoglobin (Ret He) and Immature
Platelet Fraction (IPF). Ret He can be used to diagnose and
monitor Iron Deficiency Anemia (IDA) and provide information on
the bio-availability of iron stores in patients undergoing
chronic hemodialysis. The IPF, when used with the platelet
count, can help to determine if a low platelet count is the
17
result of bone marrow suppression or failure of platelet
precursors or the result of an autoimmune process.
Pharmacy Services
Several procedural areas have focused on improvements in
medication use safety. Several projects reduced variability in
product selection and increased accountability, including
implementation of standardized procedural medication trays in 10
off site areas and the implementation of specialized
medication/anesthesia carts in the Battle Building.
Retail pharmacy services worked with revenue cycle to
update our retail pricing methodology. This new pricing
methodology is based on nationally recognized pricing
benchmarks, allows for easier, routine updating, ensures the
continuation of market competitive pricing for U.Va. patients,
and equalizes the prior variability in price points observed by
U.Va. patients as a result of 340B regulations.
Radiology and Medical Imaging
On September 26, the Breast Care Mammography team along
with the comprehensive Breast Care Program team hosted a Breast
Fair open to all Medical Center staff. Presentations included
breast cancer awareness, new imaging technologies, diagnostic
and therapeutic options, and follow up care. In total, 197
staff toured the displays and five staff received same-day
mammography screening services from the Breast Care Center.
The MRI and Interventional Radiology teams have been active
participants along with Facilities Management in plans to begin
the relocation of our MRI services from the existing MRI
pavilion. We will be able to provide all MRI services without
interruption during this extensive renovation project.
Therapy Services
The Chronic Care Coach program, which focuses on assisting
U.Va. team members and their families in managing chronic health
conditions such as hypertension, heart disease, diabetes, and
morbid obesity, is seeing a gradual increase in utilization.
There currently are 18 clients actively involved with the
Chronic Care Coach.
18
Patient Experience Office
The FY 2014 inpatient satisfaction score (HCAHPS) was 70.9%
(percentage of 9s and 10s for overall hospital rating),
exceeding the goal of 70%. The final two quarters of the year
trended slightly below goal. Key attributes that impacted the
overall score were Communication with Nurses and Doctors,
Responsiveness of Staff, and Pain.
The Press Ganey weighted average (88.8) remained equal to
the prior quarter and slightly below goal (90.0).
The 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 remain in place.
In an effort to improve the reliability and speed of
returns of the patient survey, we have added email surveys.
Additionally, we now sample at the physician level as opposed to
site level, for medical practices. These two changes will
increase the number of returned surveys by over 100%. The rate
of return will increase further as more patients provide their
email addresses as part of MyChart signups. The increased
number of surveys will enable us to provide robust physician
level reporting of their patients’ experience.
A real-time feedback pilot using iPads launched in August
at the University Medical Associates (UMA) clinic. Surveys are
highly customized to meet the operational needs of the clinic
and have provided important information about the medical
prescription reconciliation and education processes from the
patients’ prospective. The Emergency Department launched a
three-month pilot for real-time feedback in October, including
the ability to connect patients with additional hospital
services based on needs identified during the survey. This
pilot will be evaluated at the beginning of the calendar year.
Two new advisory forums have been initiated. The Patient,
Family & Community Advisory Forum met in September. Comprised
of patients and families (16 members), physicians (two) and team
members (four), the first meeting explored professional
appearance (uniforms, common colored scrubs, tattoos, etc.) and
adaptation and use of the MyChart portal. The Team Member as
Patient Advisory Forum has met twice. Forum members identified
reasons why team members might not use the Health System for
their healthcare needs. During the second meeting, they shared
concerns regarding billing. Leaders will be providing updates
to the respective Forums about how their input will be used to
19
improve the patient and family experience at the Health System.
Both Forums are expected to meet quarterly on an ongoing basis.
A core group of Health System leaders, physicians, and line
staff met off-site in September to start the process of
developing a Patient Experience Improvement Strategy. Still in
the development phase, this process will identify how we want to
achieve our patient experience objectives and will formulate
long term breakthrough objectives and near-term annual
improvement priorities.
Community Outreach
During the 2014 United Way Laurence E. Richardson Day of
Caring, over 350 Health System team members gave of their time
and talent to help local non-profits and schools with projects
that enhanced their programs. This effort supports our
continued emphasis on volunteerism within the community.
At Remote Area Medicine-Grundy, 28 U.Va. Health System
clinical and non-clinical volunteers provided free medical care
to uninsured and underinsured individuals in southwestern
Virginia. During this day and one-half clinic the volunteers
provided medical care for 166 individuals.
October 1 marked the beginning of the 2014 Commonwealth of
Virginia Campaign. In the past decade, U.Va. team members have
pledged in excess of $8.8M to over 350 local and regional
charities through a post-tax payroll deduction. During the same
period an average of 53% of the total pledge dollars received
have come from the Medical Center, School of Medicine, School of
Nursing and Library.
Environment of Care
Arts Committee
The University of Virginia Health System Arts Committee
presented an exhibition of paintings by Beverly Perdue in the
University Hospital lobby from September 5, 2014 - November 7,
2014. The exhibition entitled “Many Places, Many Faces”
featured works by Ms. Perdue from her thirty years of painting
throughout the United States and internationally.
20
Auxiliary
The U.Va. Hospital Auxiliary presented “Sips & Sunsets for
Scholarships” at the Prince Michel wine shop atop Carter
Mountain on September 19 to benefit the Hospital Auxiliary
Health Scholarship Fund; live music was provided Abby Keller and
the Gabe Planas Trio. Also in September the Auxiliary sponsored
the “Books Are Fun” sale, offering a large selection of books,
gifts and educational products. In October, in recognition of
Breast Cancer Awareness Month, Flourish, a positive image
boutique located on the first floor of the Emily Couric Clinical
Cancer Center, offered special prices on breast cancer awareness
items.
Environmental Services
The second week of September is dedicated annually to
recognizing the hard working team members of the Environmental
Services team. A display in the cafeteria corridor offered team
members the opportunity to learn more about Environmental
Services and express appreciation for the services they perform
throughout the year.
Facilities
Enabling and site work has begun on the Education Resource
Center.
Health System Parking Operations
New patient parking plans were implemented in the 11th
Street Garage to accommodate the opening of the Battle Building
and relocation of the Kluge Children’s Rehabilitation Center and
the Outpatient Surgery Center to the Battle Building.
Nutrition Services
Healthcare Foodservice Workers Week was celebrated from
October 6 to 10. A display table in the East Café breezeway was
available for all team members to stop by and learn more about
the important role the Healthcare Foodservice workers play in
providing meals every day for patients, visitors, team members,
and students.
21
Sustainability
The Health System Sustainability Committee continued to
host monthly events, including the Reusable Office Supply
Exchange (ROSE), enabling team members to shop for free supplies
and drop off new or gently used supplies. Beginning in August,
team members were also able to use “Benton’s List”, a website
for Health System users who have office furniture in good
condition and available for use by team members in other
departments.
Volunteer Services
In partnership with Madison House, 381 U.Va. students have
committed to volunteer with the Health System during the
academic year.
Information & Technology Services
The Health System has its first Chief Medical Information
Officer, Michael A. Williams, MD. Before joining the Health
System, Dr. Williams, a pediatrician, was the Chief Medical
Information Officer for a region of the North Shore Long Island
Health System and for the Medical College of Georgia. Dr.
Williams is assisted by a team of physicians serving part time
as Associate Chief Medical Information Officers for their areas
of specialty.
Technical Services, in conjunction with the University
Information and Technology Services team, has begun the
replacement of all telephones in the Medical Center. The
project will continue through calendar year 2015.
Additionally, a number of new systems and enhancements to
systems are currently being installed. Kronos, a new time
keeping and staff scheduling system, will go live in February
2015. Healthy Planet is a new Epic module that provides
population health management tools and enhanced physician level
quality and performance reporting. Cogito is a new Epic data
warehouse that will provide more accessible data for reporting
and creation of performance dashboards.
22
Human Resources
Recognition and Rewards
Uteam Members of the Month
The Uteam Member of the Month program recognizes team members
for their outstanding service to the Medical
Center. Nominations are based on the following criteria:
•
•
•
•
•
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
The July Uteam Member of the Month was Irene Wing,
Administrative Office Coordinator in the Neurocognitive
Assessment Lab
Uteam hosted town hall meetings at various locations
throughout the Health System in September. Team members
attended to learn about current developments.
Additionally, senior leadership hosted a series of
“Breakfast with Administration” events. High-performing team
members were invited to have breakfast with Bo Cofield, Pamela
Sutton-Wallace and other senior leaders and were encouraged to
provide feedback about programs and initiatives.
On Saturday, September 20, Uteam hosted its first Uteam
Movie Night. Team members throughout the Health System were
invited to bring their friends and family and enjoy a movie
under the stars at Fontaine. The movie was “The Lego Movie” and
over 500 team members and their families attended. They enjoyed
music, food trucks, and kettle corn as they waited for the movie
to begin.
On August 17, a large tree limb fell in the middle of the
Uteam Farmers’ Market causing injuries to seven people,
including two U.Va. team members. As recognition for those who
came to the aid of the injured and those who helped facilitate
the process of caring for the families and team members who were
injured, Uteam hosed a tailgate event at the Virginia vs. Kent
State football game on Saturday, September 27. We recognized
over 90 team members and first responders with the tailgate and
tickets to the game.
23
As we continue to support a culture of giving, Uteam hosted
Summer Giving events every Friday throughout the summer, giving
team members the opportunity to give back to our U.Va.
community. All team member donations went to the Hospital
Auxiliary to support various programs, projects, and services
including:
•
•
•
•
•
•
•
Hospitality House
Clown therapy
Pet therapy
Music therapy
Flourish gift shop
Scholarships for students pursuing healthcare careers
Junior Volunteers summer program
Over the two month period, Uteam donated over $3,000.
Talent Acquisition
The Medical Center completed its “Power of One” nurse
recruitment campaign on August 17. Overall, 204 experienced
registered nurses were hired during the six month campaign.
Based on continued need, a new recruitment campaign was launched
on October 7, focusing on experienced acute care, critical care,
and perioperative nurses and experienced inpatient Pharmacists.
The program has two elements, an enhanced team member referral
program branded as “Stepping it Up” and increased sign-on
bonuses for external candidates with a theme of “Balance”. This
recruitment program will run for six months.
Organizational Development
On June 10, over 485 leaders (including 62 physician
leaders) attended Be Safe Leadership Basics and were given
Train-the-Trainer materials to enable them to deliver Be Safe
Team Member Essentials to every person in their units and
departments by October 1, 2014. Following the October 1
deadline, new team member orientation has been revised to
include a more detailed overview of Be Safe.
On September 30, the Uteam Leadership Forum was held 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, Be Safe tools, and methods
to help leaders transform the culture. Kate Ebner, founding
Director for the Institute for Transformational Leadership at
24
Georgetown University, was the keynote speaker on the topic of
“Coaching: Leading through Communication.”
The annual Health System engagement survey was administered
May 21 – June 4; 79% of Medical Center team members participated
in the survey. The overall Grand Mean score increased from 3.84
to 3.91. Scores increased on almost all engagement items,
particularly those related to teamwork and growth. Even bigger
gains were achieved on items related to team members being
involved in key decisions, freedom to speak out, and
respect. Much of the improvement was due in part to action
planning efforts and progress made within local work units. We
continue to focus on systematic interventions to impact the
opportunities identified in the Employee Engagement Survey
(i.e., ‘knowing what is expected of me at work’, ‘materials and
equipment to do my job’, and ‘ability to do what I do best every
day’).
Since the inception of the Best Practices in Management
series, over 70 leaders have enrolled. Participants attend the
six part series over the course of six months and engage in oneon-one confidential coaching sessions to discuss strategies to
apply the topics and concepts presented in the classroom. One
participant noted that “Carving out time to discuss leadership
with peers, the substantial assessment tools, and the coaching
sessions made this one of the most valuable personal development
experiences I have had at the Health System.” To date, 60% of
participants have seen an increase in engagement scores from
2013 to 2014.
The Uteam Leadership Academy is conducting a new series of
classes for directors and administrators entitled “Influential
Leadership – Leading in a Be Safe Environment”. 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 with each participant.
Quality and Performance Improvement
Regulatory Update
The Amherst and Zion Crossroads Dialysis Centers were
surveyed by the Centers for Medicare and Medicaid Services for
their unannounced triennial surveys in September. Some
deficiencies were noted in infection control, adherence to
25
medical orders, and documentation of water testing retraining.
Action plans were submitted, approved, and implemented. The
dialysis centers are now fully recertified and no further
surveys are anticipated until the spring of 2015.
The Medical Center’s unannounced triennial Joint Commission
accreditation survey is expected to occur between December 2014
and early March 2015.
Recognition and Awards
The Charlottesville Society of Human Resources Management
presented a Human Resource Excellence Award to the Clinical
Faculty Hiring project at their recent annual luncheon. This
collaboration between the Medical Center and School of Medicine
has significantly improved faculty hiring efficiency and
effectiveness and the overall faculty onboarding experience.
A podium presentation and two informational posters from
the U.Va. Health System have been accepted for the upcoming
annual University Health Consortium conference in Las Vegas,
Nevada. The presentation “Moving Quality Metrics to Green:
Nursing and Supply Chain Form Strategic Partnership to Improve
Patient Outcomes” will be presented by Barbara Strain, Director
of Value Management, and David Mercer, Nurse Practitioner for
Wound/Ostomy. The posters are entitled “Building the Innovation
Unit: Revolutionizing the Implementation of Innovative Practices
Through Inter-Professional Leadership” by Joel Anderson, Patient
Care Services; Denise Barth, Quality and Performance
Improvement; and Nann Keenan, Patient Care Services; and
“Connecting the Data Dots: Nursing, Quality & IT Working
Together to Create Tools that Work” by Christine Kelly, Quality
& Performance Improvement.
Recognition and Awards
Becker’s Hospital Review has named the U.Va. Cancer Center
at U.Va. Medical Center to its 2014 list of 100 Hospitals and
Health Systems with Great Oncology Programs. This is the second
consecutive year the healthcare publication has named U.Va. to
the list, and U.Va. is the only hospital in Virginia to be
included on the 2014 list. According to Becker’s, hospitals
named to the list are leading the way in terms of quality
patient care, cancer outcomes, and research.
The University of Virginia Health System has earned a
national award from the American College of Cardiology for
enhancing care for heart attack patients. U.Va. is one of just
55 U.S. hospitals to receive the ACTION Registry-Get With the
26
Guidelines Gold Performance Achievement Award. Hospitals
receive the award for consistent compliance with performance
measures from the American College of Cardiology and the
American Heart Association. The standards focus on improving
care for patients with a type of serious heart attack called a
ST-Elevation Myocardial Infarction (STEMI).
Becker’s Hospital Review recognized the Department of
Orthopedic Surgery at the Medical Center on its 2014 list of 125
Hospitals and Health Systems with Great Orthopedic Programs.
According to the national healthcare publication, programs named
to the Becker’s list “have earned considerable recognition,”
including from other third-party ratings groups. “Exceptional
orthopedic departments often include physicians who provide
outstanding patient care, advance cutting-edge orthopedic
research and treat professional athletes,” Becker’s noted in the
introduction to its list.
The U.Va. Center for Telehealth received a 2014 Governor’s
Technology Award for making it easier to access high-quality
care and health education for patients across Virginia. The
center was honored in the “IT as Efficiency Driver – Government
to Citizen” category for using technology to make it easier for
Virginia residents to access government services. The center
received the award at September’s Commonwealth of Virginia
Innovative Technology Symposium.
Based on a national consumer survey of healthcare quality
and image, the Medical Center has earned a 2014-15 Consumer
Choice Award from the National Research Corporation (NRC).
According to the NRC, the award “identifies the top hospitals
that healthcare consumers have chosen as having the highest
quality and image in markets throughout the U.S.” Awards are
based on surveys of more than 290,000 households of “consumer
perceptions on multiple quality and image ratings,” said the
NRC.
U.Va. Medical Center is one of five academic medical
centers participating in a $7 million project funded by the
Center for Medicare and Medicaid Innovation to improve
communication between primary care and specialty care
physicians. The Medical Center will implement an electronic
consultation and referral platform that is integrated into the
EpicCare electronic medical record.
27
Supply Chain
Supply Chain Operations has successfully completed
implementation of seven day per week delivery of low unit of
measure supplies from our distributor, Owens & Minor. This
effort is already having a positive impact on care giver
satisfaction and is being measured for overall effectiveness.
This additional service represents six months of effort to
arrive at appropriate schedules, fees, service levels, and fill
rates.
Supply Chain Operations has begun 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 care venue, less
time spent traveling and searching for supplies by care givers,
and standardized stocking levels and contents of stocking areas.
It is expected that this will reduce waste within the supply
chain.
Working with patient care and physicians, Surgical Supply
Services is participating in an effort to standardize supply
utilization by eliminating practice variation. This effort is
being led by the Operating Room and Value Management.
In an effort led by U.Va. faculty and assisted by the
Advisory Board Company, Value Management concluding two
significant efforts - Orthopedic Implant and Spinal Implant
contracting.
Continuum Home Health Care FY 2014 Annual Report
Continuum Home Health Care (Continuum) is structured as a
department of the Medical Center and provides two primary lines
of business: home health and home infusion services. Continuum
is accredited by The Joint Commission and is separately
Medicare/Medicaid certified from the Medical Center.
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 11 county area, which includes the counties of
Albemarle, Greene, Madison, Culpeper, Orange, Louisa, Fluvanna,
Buckingham, Nelson, and across the mountain, the counties of
Augusta and Rockingham. Additionally Continuum offers specialty
care through its Psychiatric Service, Pediatric Program, and an
interdisciplinary Wound Care Team.
28
Home infusion provides services in the same 11 counties
(with Continuum also providing any needed direct home health
services), but also provides pharmaceutical services on a
statewide basis and out of state as needed to patients residing
in North Carolina. Coverage in West Virginia and Maryland is no
longer being supported due to the low volume and the increase in
licensure requirements in those states. For home infusion
patients residing outside of Continuum’s 11 county service area,
Continuum works with another Medicare certified home health
agency to provide any direct nursing services required and
provides training as needed to those staff on Continuum’s
infusion pumps.
Operations – I BUILD
Home
Health
FY08
Admissions
Total Visits
FY09
FY10
FY11
FY12
3,876
3,748
4,004
4,750
4,906
4,814
4,850
49,748
48,740
51,881
59,367
52,944
49,670
48,404
FY09
FY10
FY11
FY12
FY13
FY14
Home
Infusion
FY08
Admissions
Total
Therapy Days
FY13
FY14
1,168
947
1,152
1,317
1,545
1,471
1,605
69,168
72,402
76,352
84,632
97,534
106,899
118,375
While home health demonstrated modest growth in patient
admissions, home infusion’s growth continued to be strong as
many patients become repeat patients and increasingly, patients
can be effectively managed at home. Of note, home health
effectively provided a conservative average number of visits per
patient while achieving publicly reported patient outcomes which
exceeded both state and national standards, a performance
unmatched by any other agency in Central Virginia.
Continuum home infusion increased its therapy days by
10.7%. Many home infusion patients are repeat patients or may
remain on service for life (i.e. cycles of chemotherapy, tube
feeding and TPN patients), so this growth in therapy days is
significant.
29
Continuum’s case mix for Fiscal Year 2014 was 1.27,
matching the national average. At one time case mix was viewed
as a reflection of patient acuity, but now with the assignment
of points to only a subset of patient diagnoses used for payment
purposes, case mix no longer accurately reflects the level of
acuity Continuum manages.
Significant differences in payer mix continue to exist
between home health and home infusion business lines, adding to
the complexity of intake and pre-authorization requirements.
Traditional Medicare continues to be the primary payer for home
health services (57%.) Medicare Part A & B coverage of home
infusion therapy is limited, so commercial payers and Medicaid
continue to be the primary payers. Medicare Part D prescription
drug plans have significantly helped many patients avoid costly
out of pocket expense.
Despite ongoing reductions in payer reimbursement due to
sequestration and rebasing, both home health and home infusion
continued to demonstrate positive operating margins. They did
so while continuing to provide services critical to the
institutional priority of timely and effective patient discharge
and covering the post-hospital needs of indigent patients, even
those going to agencies outside Continuum’s direct service area.
Agency responsiveness and the skill level of staff allow
Continuum to support the discharge of hospitalized patients to
their homes when many home health agencies cannot, or will not,
service these patients. Achieving positive margins this year is
especially significant in light of the proliferation of forprofit entities, creating a highly competitive local home health
market.
Some accomplishments this year include:
•
•
•
Pediatric home care services demonstrated continued growth
in FY 2014 with the admission of 90 new patients.
A collaborative pediatric palliative care training program
was developed and implemented with 20 Continuum staff
members and ten Hospice of the Piedmont staff members
trained. Team meetings have subsequently been held on a
monthly basis to ensure that the pediatric palliative
program maintains its readiness to respond to patient
needs.
Ten Continuum nurses were nominated for Professional
Nursing Service Organization Awards this year and Continuum
was featured in a front page Daily Progress article with a
picture highlighting home health nurse skill and competence
requirements.
30
•
•
•
•
•
•
•
A Continuum Registered Nurse was chosen for a Sandridge
Outstanding Contributor award.
With an agency goal of encouraging all Continuum nurses to
become specialty certified, two additional nurses completed
certifications in geriatrics.
Developed and began implementation of a training program
specifically for Continuum home health coders in
preparation for upcoming ICD 10.
Employee Engagement results remained in the highest
percentile category above 75% for overall employee
satisfaction.
Continuum partnered with Broad Axe Care Coordination, LLC
to complete planning and development for the successful
launch in September 2013 of a Care Coordination Center
(C3)for the Health System, whose remote patient monitoring
services are now integrated with those of home health.
Continuum’s Administrator was elected to the board of the
National Association for Home Care and Hospice,
representing Virginia, Maryland, Pennsylvania, West
Virginia and D.C.
Continuum’s Director is serving this year as President of
the Rural Health Association.
I HEAL
Continuum continues to demonstrate positive movement in all
measured patient outcomes as reported by Centers for Medicare
and Medicaid Services (CMS) Home Health Compare. For Fiscal
Year 2014, Continuum outperformed all local area home health
agencies, both proprietary and hospital based. Continuum
exceeded clinical outcome results in all 20 clinical improvement
outcomes when compared to both state and national comparatives
in April, 2014.
Two disposition outcomes measuring “ED visit without
admission” and “rehospitalization” were consistently the same as
state standards and were 1% above national standards, an
outstanding performance considering our role as a department of
an academic medical center that provides care to the area's
trauma, transplant, and high comorbidity patient populations.
Continuum improved the “ED visit without admission” outcome to
exceed state and national standards in the last quarter of FY
2014.
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The Home Infusion staff developed a poster “Good Catch
Program: Error avoidance within a home infusion operation” that
was presented at the National Home Infusion Association Annual
Meeting.
Quality/Outcomes – I CARE
Patient Satisfaction – CMS requires that home health agency
patient satisfaction (HHCAPS) be publicly reported. Continuum
achieved FY 2014 HHCAHPS Overall Rating of 89% 9s and 10s on
Home Health Compare. Press Ganey overall result remained at 92%
in FY 2014. The Home Infusion Therapy Satisfaction Survey score
reached 96% in the first quarter of FY 2014 and 97% in the third
quarter.
Continuum achieved impressive patient outcomes in a number
of quality measures, all of which represent performance levels
equaling or exceeding state and national standards. Of
particular note:
•
Patient fall rates were at 0.5%, as compared to national
average for home health patients of 1.3%.
•
Dyspnea improvement was 81.9% as compared to a national
average of 69.2%
•
Although Continuum manages many patients with indwelling
urinary catheters who are at substantial risk for
infection, Continuum’s re-hospitalization rate due to
urinary tract infections (UTIs) was 0.9% as compared to a
national average of 1.6%.
32
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
VII.C.
ACTION REQUIRED:
None
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:
33
The University of Virginia Medical Center
Capital Projects Report
November 13, 2014
BOV
Approval
Date
Projected
Completion
Date
Scope
Budget
Funding
Source
Education Resource Center:
$29.4 M
Bonds & Other
Sept. 2013
2016
$20 M
Operating
Sept. 2013
2017
$117 M
Bonds and
Outside
Fundraising
N/A
2014
1. Planning
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
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.
2. Construction Completed
Battle Building:
Building opened in June
2014 with the move of Teen
& Young Adult clinic. Peds
clinics moved into the
building in July and
Outpatient Surgery Center
opened in August 2014.
34
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
VII.D.
ACTION REQUIRED:
None
Health System Development
BACKGROUND: Health System Development will provide reports of
recent activity to the Medical Center Operating Board from time
to time.
DISCUSSION:
SIGNIFICANT GIFTS
An anonymous donor pledged $1,390,000 over three years in
support of the Department of Family Medicine and the Grand Aides
initiative.
An emeritus U.Va. Health Foundation trustee committed
$500,000 to extend his support of the type 1 Diabetes Research
Program in the School of Medicine. He also agreed to fund Dr.
David Auble’s research project in epigenetics with a gift of
$132,036, to be paid in three increments as milestones are
achieved.
The Department of Anesthesiology contributed $120,000 in
support of a fund honoring faculty member Dr. Vesna Todorovic.
A Class of 1961 medical school alumnus committed a $100,000
bequest in support of the Gross Professorship in Otolaryngology.
OTHER DEVELOPMENT INITIATIVES
Health System Development staff met with an emeritus U.Va.
Health Foundation trustee to discuss a potential visit this fall
to honor the family’s contributions to the Strickler Transplant
Center. The visit would include the unveiling of a portrait to
be hung in the family’s honor, as well as dinner with Transplant
Division Chief Dr. Kenneth Brayman.
35
A U.Va. Health Foundation trustee is working with Health
System Development staff to facilitate the engagement of an
MD/PhD alumnus on behalf of the Department of Pharmacology. The
department hopes to interest the alumnus, who has founded a
successful biotech company, in returning to U.Va. for a day as a
visiting professor to share his thoughts with students and
Health System leadership about the future of biomedical
research, as well as the Health System’s plans to create a new
venture fund.
On July 24, the Medical Alumni Association hosted a Thanka-thon to allow current medical students to acknowledge donors
to the School of Medicine.
On August 15, the School of Medicine welcomed the Class of
2018 at its 17th annual White Coat Ceremony and Convocation,
presented by the Medical Alumni Association. Nearly 700 guests
attended, including 156 new students, family members, faculty,
and alumni. The Class of 1965, represented by U.Va. Health
Foundation trustee and Medical School Foundation President Dr.
Charles Henderson, donated a personalized white coat for each
new class member.
Dr. Thomas Loughran, U.Va. Cancer Center Director, kicked
off the 32nd Annual Women’s Four-Miler race, which took place on
August 30, 2014 with more than 3,500 individuals participating.
Funds raised from the event will once again support U.Va.’s
Breast Care program.
The School of Nursing Annual Fund raised more than $400,000
for the first time ever, completing the FY 2014 year with a
total of $414,333. This represents 5% growth over the prior
year. In August, the school conducted a Thank-a-thon to
acknowledge first-time annual fund donors and to further engage
them with the School of Nursing.
Health System Development staff are working with Dr. Robert
Carey (RES ’66), former Dean of the School of Medicine and
current Harrison Distinguished Professor of Medicine, on an
initiative to raise funds for a named chair in Endocrinology.
36
DEVELOPMENT PROGRESS FOR FY 2015 Year to Date
Giving Summary through August 31, 2014
FY 15 to date
(7/1/14 - 8/31/14)
FY 15
Annual Goal
New gifts
$38,000,000 $3,351,800
New pledges
Total new commitments
(excludes pledge payments on
previously booked pledges)
New expectancies
$6,000,000
FY 15
YTD
FY 14
(through
8/31/13)
$1,349,970
$17,277
$307,895
$44,000,000 $3,369,077
$1,657,865
$8,500,000
$0
$1,000,000
Total new gifts, pledges, and $52,500,000 $3,369,077
expectancies
$2,657,865
37
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 13, 2014
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
VII.E. Corporate Compliance Program and the
Annual Compliance Report
ACTION REQUIRED:
None
BACKGROUND: The Corporate Compliance Program was established
for the Medical Center by the Board of Visitors in 1997 to
ensure that the Medical Center operates in full compliance with
applicable laws. The Corporate Compliance and Privacy Office
prepare an annual project schedule to coincide with potential
risk areas of noncompliance with Federal or State law or other
regulations. An annual report is made to the Medical Center
Operating Board on the compliance program. The Office reports
quarterly to the Corporate Compliance Steering Committee and to
the Audit and Compliance Committee of the Board of Visitors
where approval of the annual project plan is sought, the status
of completed projects is provided, and those groups are informed
of any significant compliance or privacy risks.
DISCUSSION: The Compliance Code of Conduct is a key component
of the corporate compliance program that defines the basic
principles the Medical Center, its clinical staff, employees,
and agents must follow. The Code is based on the mission and
values of the U.Va. Health System.
The annual Corporate Compliance and Privacy project
schedule is derived from risk assessment models that identify
potential financial or reputational risks for the Medical
Center, and from federal, state, and other regulatory agencies’
enforcement priorities identified in the annual Health and Human
Service Office of Inspector General’s Work Plan and in industry
publications and fraud alert reports. The project schedule also
includes follow-up on work performed in prior years. Projects
are selected to minimize the Medical Center’s risks with regard
to these issues by members of management and the Corporate
Compliance Steering Committee. Medical Center Management is
provided relevant sections of the Office of Inspector General
Work Plan, and their feedback is used to assist the Office in
determining and prioritizing its auditing and monitoring
projects. Senior leaders are asked to identify potential risks
38
in their areas of oversight, and these also are incorporated
into the Office’s project schedule.
Auditing and monitoring are elements of effective
compliance programs as mechanisms to discern whether processes
are working in accordance with established expectations. The
Office conducts documentation, coding and billing audits of
inpatient, outpatient, and procedure area claims, and privacy
audits to assess the Medical Center’s compliance with privacy
laws. The Office also provides guidance on regulatory issues
and education on compliance and privacy topics.
Available hours for the Office are distributed among
scheduled projects, unscheduled projects, training, and
consulting. Scheduled compliance projects typically focus on
reviewing the accuracy of the Medical Center’s claim submissions
by assessing whether documentation in the medical record
supports the billed services, supports the medical necessity of
the provided services, and that all provided services were
accurately billed. The scheduled privacy projects include
monthly site visits to inpatient units, outpatient clinics, and
procedure areas to assess the administrative, physical, and
technical safeguards for protected health information.
Preparing and presenting compliance and privacy training for all
employees accounts for the remaining scheduled projects. The
Federal Sentencing Guidelines for Organizations identify
training as a mandatory component of effective compliance
programs.
The Office allocates hours for unscheduled projects to
allow the compliance program to adapt to changing needs of the
organization. These include 1) consultation on policies and
procedures, changes in regulations and billing rules, new
ventures, and clinical research issues; 2) developing and
conducting targeted compliance and privacy training in response
to newly discovered risks, and updating the Office website or
other communications based on identified compliance or privacy
educational needs; 3) unscheduled compliance projects resulting
from investigations, industry alerts, or management requests;
and 4) unscheduled privacy projects related to investigations,
revising the Health System’s notice of privacy practices,
conducting risk assessments, and providing breach notifications.
Connolly Health Care (Connolly) is the Medicare Recovery
Audit Contractor assigned to Virginia, whose primary purpose is
to assess for improper overpayments or underpayments made by
Medicare. The Compliance Office serves on the Medical Center’s
Finance Payer Audit Review Committee that reviews Connolly’s
medical record and claim requests as well as other payer audit
39
requests. The Medical Center receives approximately 600 medical
record requests from Connolly every forty-five days. The
reviews focus on medical necessity and inpatient coding
validation among other identified issues.
On October 1, 2015, the International Classification of
Diseases Ninth Revision (ICD-9) code sets used to report medical
diagnoses and inpatient procedures will be replaced by the ICD
Tenth Revision (ICD-10) code sets; this transition was to have
taken place on October 1, 2014 but has been delayed a year. The
transition to ICD-10 is required for all health care providers
covered by the Health Insurance Portability and Accountability
Act (HIPAA). The Chief Corporate Compliance and Privacy Officer
is a member of the ICD-10 Executive and Oversight Committees,
and members of the Office staff serve on ICD-10 project teams.
The ICD-10 implementation project provides the Medical Center an
opportunity to focus on documentation improvement, since the
complexity of the ICD-10 code sets, with diagnosis codes
expanding from 13,000 to 68,000 codes and procedure codes
expanding from 11,000 to 87,000 codes, will require considerable
documentation revision and training. Because of that
complexity, ICD-10 has the potential for adverse financial and
operational impacts for the Medical Center. The Medical Center
is revamping its implementation initiatives in anticipation of
the new transition date.
Protecting patients’ health information is a priority in
healthcare, and the Medical Center demonstrates a deep
commitment to maintaining its patients’ right to privacy. The
Federal Health and Human Services Office for Civil Rights, the
enforcement agency for the Health Insurance Portability and
Accountability Act (HIPAA), has recently been provided
additional resources to enforce compliance with the HIPAA
Privacy and Security Rules.
Educating our team members and developing trusting
relationships to enhance the culture of compliance continue to
be critical elements impacting the effectiveness of the Medical
Center’s compliance program.
40