UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
November 14, 2013
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
4th
Thursday, November 14, 2013
8:45 – 11:45 a.m.
Floor, Emily Couric Clinical Cancer Center
Committee Members:
Stephen P. Long, M.D., Co-Chair
Edward D. Miller, M.D., Co-Chair
William H. Goodwin Jr.
Victoria D. Harker
Andrew K. Hodson, MB.Ch.B
Michael M.E. Johns, M.D.
William P. Kanto Jr., M.D.
Ex Officio Members:
Teresa A. Sullivan
Nancy E. Dunlap, M.D.
Dorrie K. Fontaine
Robert S. Gibson, M.D.
Constance R. Kincheloe
George Keith Martin
Charles W. Moorman
The Hon. Lewis F. Payne
Patrick D. Hogan
R. Edward Howell
Richard P. Shannon, M.D.
John D. Simon
AGENDA
PAGE
I.
II.
III.
OPENING COMMENTS FROM THE CO-CHAIRS
REMARKS FROM THE EXECUTIVE VICE PRESIDENT FOR HEALTH
AFFAIRS
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, Center
of Excellence business plan, other marketing and
growth efforts that support strategic
initiatives, long range plan assumptions, review
of the Health System Clinical Strategy
Performance Dashboard, and other 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, 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
IV.
RETURN TO PUBLIC SESSION: REPORTS BY THE VICE
PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE MEDICAL
CENTER (Mr. Howell)
A.
Vice President’s Remarks
1
B.
Dean, School of Medicine’s Remarks
2
C.
Operations and Finance Report, including the
Continuum Home Health Care Annual Report (Mr.
Howell to introduce Mr. Robert H. Cofield and Mr.
Larry L. Fitzgerald; Mr. Cofield to report on
Operations; Mr. Fitzgerald to report on Finance)
3
D.
Capital Projects
22
E.
Health System Development (Mr. Howell to
introduce Ms. Karen Rendleman; Ms. Rendleman to
report)
25
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 14, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
IV.A.
ACTION REQUIRED:
None
Vice President’s Remarks
BACKGROUND: R. Edward Howell has been the Vice President and
Chief Executive Officer of the University of Virginia Medical
Center since February 2002. Prior to joining the University of
Virginia, he served for eight years as Director and CEO of the
University of Iowa Hospitals and Clinics. He has over 30 years
of experience in administration and leadership of academic
medical centers.
DISCUSSION: The Vice President and Chief Executive Officer of
the Medical Center 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:
November 14, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
IV.B.
ACTION REQUIRED:
None
Dean, School of Medicine’s Remarks
BACKGROUND: Nancy E. Dunlap, MD, is the Dean of the School of
Medicine. Prior to joining the University of Virginia, she
served as physician-in-residence with the National Governors
Association Center for Best Practices in Washington, D.C.
Previously, she held numerous appointments with increasing
responsibilities at the University of Alabama at Birmingham
(UAB). Dr. Dunlap received a bachelor of arts degree from
Wellesley College, a medical degree from Duke University, a
doctoral degree in microbiology from UAB, and an MBA degree with
distinction from the University of Michigan at Ann Arbor.
DISCUSSION: The Dean of the School of Medicine will inform the
Medical Center Operating Board (MCOB) of recent events that do
not require formal action.
2
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 14, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
IV.C.
ACTION REQUIRED:
None
Operations and Finance Report
BACKGROUND: The Medical Center provides an update of
significant operations of the Medical Center occurring since the
last MCOB meeting. The Medical Center prepares a periodic
financial report, including write-offs of bad debt and indigent
care, and reviews it with University leadership before
submitting the report to the MCOB.
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.
Larry L. Fitzgerald is the Medical Center’s Associate Vice
President for Business Development and Finance. 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.
OPERATIONS REPORT
Clinical Operations
Ambulatory Operations
UVA Care Connection scheduled its 32,000th appointment in
August 2013. Of the 3,457 appointments made through August of
fiscal year 2014, 45.2% have come from UVA employees and their
families. HealthGrades accounted for 264 (7.6%) and inpatient
discharge appointments were 250 (7.2%).
3
Clinical Ancillary Services
Medical Laboratories
In October 2011 the Blood Bank and Transfusion Medicine
Service changed the process for review of transfusion audits.
This change has led to a 5% reduction in red cell transfusions
and a 10% reduction in plasma transfusions. In addition to the
impact on blood conservation, this change resulted in a savings
of $261,000 during fiscal year 2013.
The Clinical Microbiology and Molecular Diagnostics
Laboratories will soon implement a new, FDA-cleared rapid test
for identifying a variety of gram positive bacteria and their
associated antibiotic resistance markers, including MRSA and
VRE.
Imaging Services
Breast tomosynthesis (3D mammography) is now available at
the Northridge site. A second tomosynthesis unit will be
installed at the Breast Care Center in the Hospital West
Complex.
The Mobile Mammography Van participated in a “Big C New Me”
presentation for cancer survivors at the Belk department store
in Charlottesville on September 21, 2013.
Pharmacy Services
We continue to expand ambulatory pharmacy services to
better meet the needs of our patients, including UVA employees.
•
The Uteam Connections Window, an employee prescription
pick-up window in the Hospital West Complex, is now
providing an average of 380 employee prescriptions per
week.
•
With the initiation of the fall semester, we opened the UVA
Bookstore Pharmacy at the Student Bookstore in Newcomb Hall
serving UVA students, faculty, and staff.
•
The Specialty Pharmacy has expanded to provide greater
value and service to the UVA Health Plan. For the Health
Plan, this has reduced the average cost per claim from
$2,986 in 2012 to $1,818 in 2013.
4
Investigational Drug Services was expanded with an
additional Pharmacist to support the Cancer Center of
Excellence.
Intravenous immunoglobulin (IVIG) and Albumin use guidelines
implemented by the Pharmacy and Therapeutics Committee in
collaboration with several clinicians resulted in more
appropriate treatment for patients and will generate an
estimated savings of $500,000 for the first quarter of fiscal
year 2014.
Therapy Services
UVA-WorkMed - Hoos Well Biometric Screening Project. With
less than two weeks remaining in the initial schedule, some
9,000 participants have received Hoos Well biometric screenings
and 1,000 more have submitted screening information from their
physicians. Given the demand, an additional 288 appointments
have been scheduled.
The Pulmonary Function Testing (PFT) Center has expanded
from two locations in the Primary Care Center to four locations.
The Faculty and Employee Assistance Program (FEAP) expanded
its services to UVA–Wise on August 1. FEAP has partnered with
Telemedicine to provide 1:1 counseling and seminars for the
college’s 368 employees.
Community Outreach
Patricia Cluff, Associate Vice President for Strategic
Relations and Marketing, was a presenter at the Society for
Healthcare Strategy & Market Development annual meeting on
October 1, 2013. The presentation was titled “Whose Reputation
Is It?” and provided a case study on the impact of social media
on individual and institutional reputation.
Community Relations engaged in more than 15 outreach events
in September and October. Four-hundred thirty-five (435) Health
System employees participated in the United Way Day of Caring,
TCH hosted a community health fair with over 300 attendees, and
45 volunteers participated in the Rural Area Medical (RAM)
clinic in Grundy.
5
Environment of Care
Arts Committee
The University of Virginia Health System Arts Committee
sponsored an exhibition entitled “Places I’ve Been” in the
University Hospital lobby from August 30 through November 1,
2013.
Environmental Services
Housekeeping Week was held September 8-14 and presented an
opportunity to express appreciation to Environmental Services
employees for all they do throughout the year to support patient
care.
Nutrition Services
October 7-13 was Healthcare Foodservice Workers’ Week.
Special events were held throughout the week to show
appreciation to all of the food service employees at the Medical
Center.
Patient and Guest Services
In fall 2013, Volunteer Services, in partnership with
Madison House, is onboarding 380 undergraduate students to the
Medical Services program. Student volunteers will provide
services in a variety of areas throughout the Health System,
helping to enhance the patient and family experience while
gaining hands-on training.
The UVA Hospital Auxiliary Gift Shop relocated to its new
location in the expanded hospital lobby in August. In early
September, the Auxiliary held a Book Fair and sponsored “Sips &
Sunsets for Scholarships,” a wine tasting to benefit the UVA
Hospital Auxiliary Health Scholarship Fund. The event was held
at the Prince Michel Wine Shop atop Carter’s Mountain, and music
was provided by the UVA Jazz Combo.
Health System Technology Services
A new decision-making committee, the Clinical Information
Systems Oversight Committee (CITOC), has been formed to provide
guidance and decisions concerning the Medical Center’s clinical
information systems and their uses. The committee reports to
6
the Clinical Staff Executive Committee (CSEC) and has broad
representation from the Medical Center, the School of Medicine,
the University of Virginia Physician’s Group, and medical and
administrative staff. It is co-chaired by the Chief Medical
Information Officer (currently being recruited), and the Chief
Information and Technology Officer.
Human Resources
Employee Engagement
Employee Engagement scores have been received from Gallup,
and we have begun the education of the managers who have
received scores. Gallup reported that in general we were on
track for a first-time user of the Gallup tool. However, our
score placed the Medical Center in the 29th percentile of the
Gallup Healthcare database. Knowing this is not where we want
to be, Organizational Development is working with senior
leadership on the new approaches taught to us by Gallup that
focus on Discovery Meetings to develop Impact Plans for further
development.
Recruitment
Human Resources introduced Group Hiring events in an effort
to reduce vacancies for entry-level positions. The first event
for Patient Care Assistants yielded 54 new hires in two days.
This concept has enhanced a positive talent pipeline.
The Operating Room as well as Labor and Delivery had
success in filling vacancies by hosting weekend on-site job
fairs.
We are planning for fiscal year 2014 Registered Nurse
graduates and have streamlined the hiring and onboarding
process.
Compensation
The Medical Center will provide merit increases effective
September 29, 2013. Eligible employees will receive increases
of 2.75% for a Fully Meets Expectations performance evaluation
and 3.75% for a Consistently Exceeds Expectations evaluation.
The projected cost of merit increases is $8 million and has been
included in the budget for the fiscal year.
7
The fiscal year 2013 Uteam Incentive Plan will pay a 7.98%
bonus to eligible Directors, Administrators, and Chiefs for
performance on goals related to Mortality, Infection Control,
Quality, Adjusted Discharges, and Operating Margin. In fiscal
year 2014, Managers will participate in a similar plan.
Organizational Development
The Uteam Leadership Academy recently finished the pilot
session for a new series of classes entitled “Best Practices
II.” This series focuses on creating transformational leaders
and helping participants obtain tools for use on issues such as
emotional intelligence, learning agility, motivating and
engaging others, communication and listening, networking and
negotiation, and resiliency.
Recognition and Rewards
Uteam Meetings
During July and August, Uteam Meetings were held throughout
the Health System to bring information to employees. Some 846
employees attended, and a recording of the meetings, including
the question and answer sessions, was uploaded to the Uteam
website.
Events
On August 13, Uteam hosted the “Great Summer Chill” to
thank employees for all that they do for our patients.
Employees were able to fill out recognition cards addressed to
their peers to recognize their hard work and commitment to
patient care. Senior Leadership participated by handing out
red, white, and blue popsicles to employees at lunch time and
again during night rounding.
With the help of the Belk department store, we hosted a
shopping event for Health System employees and their families.
Food, games, and other activities, along with a live band, were
provided to create an evening of discounted shopping and family
fun for the more than 1,500 Health employees that attended.
Uteam Market
The Uteam Farmer’s Market on Grove was held every Thursday
from June 6 through September 5 from 3:00-7:00 pm. More than
3,000 employees attended the market during these 13 weeks.
8
Recognition and Awards
The UVA Health System received the Institution of Higher
Learning Champion of Health Care award from the Virginia
Association of Free and Charitable Clinics. Dr. Mo Nadkarni was
also recognized for his leadership and other contributions.
Supply Chain
The new Pyxis supply technology from CareFusion is
currently being installed. This system uses a battery-powered
wireless device that attaches directly to existing storage units
to enhance point-of-use supply automation. The technology
enables automatic ordering of supplies without significant human
involvement.
The
Outcomes
from key
Center’s
new Value Management Structure and Medical Economic
Committee is well underway and input is being gathered
stakeholders. The new structure will drive the Medical
ongoing supply expense management efforts.
Continuum Home Health Care Fiscal Year 2013 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, Augusta, and Rockingham. Additionally,
Continuum offers specialty care through its Psychiatric Service
and an interdisciplinary Wound Care Team. Continuum expanded
its offerings by launching a Pediatric Service in June 2013.
Home infusion provides services in the same 11 counties
(with Continuum providing any needed direct home health
services) and also provides pharmaceutical services on a
statewide basis and out-of-state basis as needed to patients
residing in North Carolina and West Virginia. For home infusion
9
patients residing outside of Continuum’s direct 11 county
service area, Continuum works with another Medicare certified
home health agency to provide any required direct nursing
services.
Operations – I BUILD
Home Health
FY08
FY09
FY10
FY11
FY12
4,004
4,750
4,906
4,814
Total Visits 49,748 48,740 51,881 59,367 52,944
49,670
Admissions
3,876
3,748
Home Infusion
FY08
FY09
FY10
FY11
FY12
FY13
FY13
Admissions
1,168
947
1,152
1,317
1,545
1,471
Total
Therapy Days 69,168 72,402 76,352 84,632 97,534 106,899
While home health growth has been flat, home infusion
continues to remain strong as many patients become repeat
patients. Of note, home health provided a conservative number
of visits per patient while achieving publicly reported patient
outcomes which exceeded both state and national levels, a
performance level unmatched by any other agency in Central
Virginia.
Continuum home infusion increased its therapy days by 10%
in fiscal year 2013. Many home infusion patients may be repeat
patients or may remain on service for life (i.e., cycles of
chemotherapy, tube feeding, and Total Parenteral Nutrition
patients), so this growth in therapy days is significant.
Continuum’s CMI (a measure of patient acuity) for fiscal
year 2013 was 1.42, which again exceeded the national average of
1.29 and is a direct reflection of the complexity of patients
that Continuum routinely manages.
Significant differences in payer mix continue to exist
between the 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 (63%). Medicare Parts A & B coverage for home
infusion therapy is limited, with commercial payers and Medicaid
continuing to be the primary payers. Medicare Part D
10
prescription drug plans have significantly helped many patients
avoid costly out of pocket expense.
Despite ongoing reductions in payer reimbursement, both
home health and home infusion continue to generate positive
operating margins. Continuum continues to provide services
critical to the institutional priority of timely and effective
patient discharge and meeting the post-hospital needs of
indigent patients, even those going to other 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 operating margins this year is especially significant
in light of the recent proliferation of for-profit entities,
creating a highly competitive local home health market.
Some accomplishments this year include:
•
•
•
Successfully completed a full Medicare home health survey
in November 2012 with no deficiencies,
Launched a pediatric home care service in June, and
One of Continuum’s RNs achieved Geriatric Certification.
I HEAL
Continuum continues to demonstrate positive movement in all
measured patient outcomes as reported by the Centers for
Medicare/Medicaid Services (CMS) Home Health Compare. For
fiscal year 2013, Continuum outperformed all local area home
health agencies, both proprietary and hospital based. In
October, Continuum exceeded clinical outcome results in all 22
categories in both state and national comparatives. Two new
outcomes were added in April and Continuum is already at or
better than state average performance in both, but still has
opportunity for improvement in “ED visit without admission”
where it is 1% higher than the national level.
Continuum has continued to support two UVA employees who
reside in the two UVA-Habitat “Health Houses” in Charlottesville
by providing ongoing telehealth remote patient monitoring and
clinical nursing support. Continuum communicates vital sign
trending reports to the patients’ physicians to facilitate
effective chronic disease management.
In fiscal year 2012, Continuum developed a program to help
reduce blood clots in orthopedic patients by working with the
UVA Orthopedic team to test an anticoagulation medication
11
(Coumadin) protocol that has eliminated bleeds and hematomas.
Data analysis was completed in fiscal year 2013, validating the
efficacy of the protocol, which was subsequently approved by the
Pharmacy & Therapeutics Committee.
Quality/Outcomes – I CARE
CMS requires that home health agency patient satisfaction
scores (HHCAPS) be publicly reported. For fiscal year 2013,
Continuum’s patient satisfaction scores exceeded both state and
national targets for all the included indicators. Continuum
home health also continues to maintain excellent Press Ganey
patient satisfaction survey scores with an overall mean of 92%.
Continuum home infusion improved its overall patient
satisfaction scores to 94.6%. In fiscal year 2013, both
Continuum’s home health and home infusion programs experienced a
95% likelihood of being recommended.
Continuum achieved excellent patient outcomes in a number
of quality focus areas, all of which represent performance
levels better than state and national standards:
• Patient fall rates were 0.3%, as compared to national
average for home health patients of 1.3%. Continuum
implemented a new best practice fall risk assessment this
year, the only one that has been validated through
research specifically in the home care arena.
• Patient reports of improvement in pain were at 74.9%, as
compared to national at 68.2%.
• Dyspnea improvement was 86.8%, as compared to national at
68.6%.
• Improvement in surgical wounds was 93.6%, as compared to
national at 89%.
• Continuum reduced its patient readmission rate to 17%,
which is in line with both state and national levels.
• Although Continuum manages many patients at home with
indwelling urinary catheters who are at great risk for
infection, its re-hospitalization rate due to urinary
tract infections (UTIs) was 0.8%, as compared to a
national average of 1.4%.
FINANCE REPORT
After three months of operations in fiscal year 2014, the
operating margin for all business units was 6.7%, which was
12
above the budget of 5.8%. With the exception of Outreach, each
business unit exceeded its budgeted operating margin through
September.
During the first three months of the fiscal year, inpatient
admissions were 1.5% below budget and 2.2% above the prior year.
Average length of stay was 5.55 days, which was above the budget
of 5.45 days but below the prior year’s 5.74 day average length
of stay. Surgeries performed in the Main Operating Room were on
target with the budget, while Outpatient Surgery Center cases
were 1.8% below budget. Total surgeries were 3.3% above the
prior year.
Total operating revenue of $308.7 million for fiscal year
2014 through September was 2.5% below budget, but 5.9% higher
than the prior year. Total operating expenses were 3.4% below
the budget, but 5.3% above fiscal year 2013 expenses due to an
increase in purchased services. Fiscal year 2014 purchased
services are higher due to the fact that in fiscal year 2013 the
Medical Center received a $10 million litigation settlement.
Total paid employees, including contracted employees, were
264 below budget.
Employee FTEs
Salary, Wage and
Benefit Cost per FTE
FY 2013
FY 2014
6,619
6,729
6,990
$75,738
$76,972
$77,711
258
166
169
6,877
6,895
7,159
Contract Labor FTEs
Total FTEs
2014 Budget
OTHER FINANCIAL
The Anthem provider contract terminates for both the
Medical Center and University Physicians Group on December 31,
2014. Over 18% of the Medical Center’s net revenue is received
through the Anthem contract. Anthem has taken an aggressive
stance against increases in payments to providers in Virginia
over the last year.
13
The Medical Center has offered two rate proposals to
Anthem, either of which would meet our financial requirements.
In recognition of the higher costs associated with inpatient
transfers from other hospitals, the Medical Center requested a
20% increase in rates for transferred cases. All other business
would be subject to the annual inflation factor of 5%. Anthem
has rejected our proposals and has instead offered a nominal
rate increase of 2% for inpatient services and 1% for
outpatient.
A quote from the October 14, 2013 issue of Modern
Healthcare says, “Experts say conflicts are heating up
nationally between insurers trying to sell affordable plans in
exchanges and healthcare providers with high overhead costs,
including children’s hospitals, academic medical centers and
safety-net facilities with large Medicaid and Medicare
populations.” That quote is a good description of the Medical
Center. With no notification, Anthem classified the Medical
Center as a “Tier Two” hospital for their insurance exchange
product. This means that the Medical Center would only be paid
50% of the contract rate and the Medical Center would be
required to collect the remaining 50% from the patient. It is
our intent to negotiate with Anthem to move to “Tier One”
status.
Our Health System is currently pursuing the following
initiatives that focus on the emerging discipline of population
health:
•
We filed an application to participate in CMS’s Medicare
Shared Savings Program. This program will provide us with
a financial incentive to better manage the health care
needs of a defined Medicare patient population. The
Program stands to bring together care-givers crossing a
wide spectrum as we focus on the overall health of this
population. To the extent we are successful, it will make
sense for us to develop similar initiatives with our
commercial insurers.
•
Along with Carilion, Riverside, and Aetna, we are
finalizing an agreement to become co-owner of MajestaCare,
a Medicaid plan developed and currently owned by Carilion
Clinic. Aetna will serve as our administrative partner,
and they will be transitioning their recently acquired
Coventry Medicaid membership into the MajestaCare plan. As
a co-owner of MajestaCare, we will have the opportunity to
bridge the gap between insurer and provider, and together
14
•
the hospital systems and Aetna will work collaboratively
and under common interest to effectively coordinate the
care of our patients and to achieve our ultimate goal of
improving the health of patients throughout the
Commonwealth.
In August, the Health System submitted a proposal for a
$2.7 million grant to the Center for Medicare and Medicaid
Innovation (“CMMI”) and its Health Care Innovation
Challenge program. If awarded, the three-year grant will
pilot the use of in-home medical interventions to improve
quality outcomes and reduce health care costs for two
chronically ill patient populations: adults suffering from
Alzheimer’s disease and children with complex medical
conditions. The Health System’s proposal was submitted in
partnership with the Virginia Center for Health Innovation
and is supported by Virginia’s Secretary of Health. CMMI
plans to announce its grant awards in January 2014.
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $69.0 million for the period
July 1, 2013 through September 30, 2013, have been written off.
Recoveries during this period totaled $12.4 million.
Bad debt charges totaling $12.1 million have been written
off during the period from July 1, 2013 through September 30,
2013. During this same period, $4.0 million was recovered
through suits, collection agencies, and Virginia refund set-off.
15
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Net patient revenue
Sep-12
Sep-13
Sep-14
Budget/Target
Sep-14
$267.1
$277.9
$297.3
$306.3
8.8
13.5
11.3
10.2
$275.9
$291.4
$308.6
$316.5
241.5
250.5
264.0
273.6
17.4
19.4
20.3
20.9
1.8
3.7
3.6
3.7
$260.7
$273.6
$287.9
$298.2
Operating income (loss)
$15.2
$17.8
$20.7
$18.3
Non-operating income (loss)
$4.9
$7.8
($0.9)
$3.3
Net income (loss)
$20.1
$25.6
$19.8
$21.6
Principal payment
$6.1
$7.0
$2.1
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Total operating expenses
16
$2.1
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Sep-12
Sep-13
Sep-14
Assets
Operating cash and investments
$91.9
$108.2
$202.1
Patient accounts receivables
116.8
131.3
131.4
Property, plant and equipment
680.6
738.0
795.8
Depreciation reserve and other investments
203.4
232.6
211.0
Endowment Funds
410.0
425.6
462.1
Other assets
230.7
272.2
234.6
$1,733.4
$1,907.9
$2,037.0
Current portion long-term debt
$22.8
$26.3
$14.5
Accounts payable & other liab
122.0
129.8
117.3
Long-term debt
315.7
398.8
Total Assets
Liabilities
421.0
.
Accrued leave and other LT liab
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
17
138.7
127.8
167.6
$599.2
$682.7
$720.4
$1,134.2
$1,225.2
$1,316.6
$1,733.4
$1,907.9
$2,037.0
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Sep-12
Sep-13
Sep-14
Budget/Target
Sep-14
Operating margin (%)
5.5%
6.1%
6.7%
5.8%
Total margin (%)
7.2%
8.6%
6.4%
6.8%
Current ratio (x)
1.4
1.5
2.5
2.4
165.6
169.7
204.7
190.0
Gross accounts receivable (days)
48.0
50.2
46.0
45.0
Annual debt service coverage (x)
5.0
4.5
7.7
5.2
30.4%
33.3%
33.0%
31.8%
7.4%
8.4%
8.3%
8.2%
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Sep-12
Acute Admissions
Patient days
Sep-14
7,262
7,421
7,535
41,818
42,541
42,923
43,319
2,541
2,749
2,303
2,618
5.81
5.74
5.55
5.45
188,557
186,917
195,262
197,759
15,689
15,997
15,015
15,414
2.17
2.05
2.06
2.08
6,546
6,877
6,895
7,159
Average length of stay
ER visits
Sep-14
7,135
SS/PP Patients
Clinic visits
Sep-13
Budget/Target
Medicare case mix index
FTE's (including contract labor)
18
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 - September FY14
OPERATING STATISTICAL MEASURES - September FY14
ADMISSIONS and CASE MIX - Year to Date
Budget
% Variance Prior Year
Actual
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Transitional Care
Subtotal Acute
6,315
740
294
72
7,421
6,364
773
298
100
7,535
(0.8%)
(4.3%)
(1.3%)
(28.0%)
(1.5%)
6,204
711
279
68
7,262
Short Stay/Post Procedure
2,303
2,618
(12.0%)
2,749
9,724
10,153
(4.2%)
10,011
14,347
13,929
3.0%
13,500
Total Admissions
Adjusted Admissions
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
1.92
2.06
1.95
2.08
(1.5%)
(1.0%)
1.89
2.05
OTHER INSTITUTIONAL MEASURES - Year to Date
Actual
Budget
% Variance
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
42,923
5.55
466
436
43,319
5.45
471
422
(0.9%)
(1.8%)
(1.1%)
3.3%
42,541
5.74
463
436
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
195,262
3,286
15,015
197,759
3,331
15,414
(1.3%)
(1.4%)
(2.6%)
186,917
3,221
15,997
5,097
2,581
7,678
5,097
2,627
7,724
0.0%
(1.8%)
(0.6%)
4,946
2,490
7,436
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
19
OPERATING FINANCIAL MEASURES - September FY14
REVENUES and EXPENSES - Year to Date
OTHER INSTITUTIONAL MEASURES - Year to Date
Budget
($s in thousands)
Actual
Budget
($s in thousands)
Actual
% Variance Prior Year
% Variance Prior Year
NET REVENUES:
NET REVENUE BY PAYOR:
(5.7%) $
92,367
306,319
(2.9%)
277,898
Medicare
$
95,763 $ 101,521
Net Patient Service Revenue
297,368
11.0%
13,456
Medicaid
61,649
59,880
3.0%
55,854
Other Operating Revenue
11,310
10,189
46,927
54,006
(13.1%)
48,109
Total
$
308,678 $
316,508
(2.5%) $ 291,354
Commercial Insurance
Anthem
62,199
57,222
8.7%
50,975
Aetna
20,875
21,400
(2.5%)
19,064
11,529
Other
9,955
12,290
(19.0%)
EXPENSES:
(2.9%) $
277,898
132,978 $
139,301
4.5%
132,025
Total Paying Patient Revenue
$
297,368 $ 306,319
Salaries, Wages & Contract Labor
64,208
(4.7%)
67,138
Supplies
67,212
70,058
8.9%
51,350
Contracts & Purchased Services
63,843
20,924
2.8%
19,367
Depreciation
20,342
Interest Expense
3,566
3,692
3.4%
3,661
$
298,183
3.4% $ 273,541
OTHER:
Total
287,941 $
Collection % of Gross Billings
30.63%
30.76%
(0.4%)
31.95%
Operating Income
$
20,737 $
18,325
13.2% $ 17,813
45.0
(2.2%)
50.2
Operating Margin %
6.7%
5.8%
6.1%
Days of Revenue in Receivables (Gross)
46.0
10,741
3,348
(128.2%) $
7,791
Cost per CMI Adjusted Admission
$
10,476 $ 11,030
5.0% $
Non-Operating Revenue
$
(945) $
7,159
3.7%
6,877
Total F.T.E.'s (including Contract Labor)
6,895
24.36
5.3%
24.84
Net Income
$
19,792 $
21,673
(8.7%) $ 25,604
F.T.E.'s Per CMI Adjusted Admission
23.08
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 - September 30, 2013
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, NICU, PICU and KCRC
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
20
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
MEDICAL CENTER
ACCOUNTS COMMITTEE REPORT
(Includes All Business Units)
(Dollars in Thousands)
INDIGENT CARE (IC)
Net Charge Write-Off
Percentage of Net Write-Offs to Revenue
Year to Date
September
2013-14
Annual Activity
2012-13
68,291
2011-12
234,088
7.03%
207,515
6.66%
6.46%
Total Reimbursable Indigent Care Cost
24,182
82,890
73,481
State and Federal Funding
23,195
79,509
70,483
Total Indigent Care Cost Funding As a Percent
of Total Indigent Care Cost
Unfunded Indigent Cost
96%
986.62
96%
96%
3,381.93
2,998.03
Annual Activity
BAD DEBT
September
2013-14
2012-13
Net Charge Write-Offs
9,601
26,891
Percentage of Net Write-Offs to Revenue
0.99%
0.77%
2011-12
30,942
0.96%
Note:
Provisions for bad debt write-offs and indigent care write-offs are recorded for financial statement purposes based on the overall collectibility
of the patient accounts receivable. These provisions differ from the actual write-offs of bad debts and indigent care which occur at the time
an individual account is written off.
21
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 14, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
IV.D.
ACTION REQUIRED:
None
Capital Projects
BACKGROUND: The Medical Center is constantly improving and
renovating its facilities. A status report of these capital
projects will be provided at each meeting of the Medical Center
Operating Board.
DISCUSSION: The current Medical Center capital projects report
is set forth in the following table:
22
The University of Virginia Medical Center
Capital Projects Report
November, 2013
Scope
Budget
Funding
Source
BOV
Approval
Date
Projected
Completion
Date
1. Planning
Education Resource Center
$25.4 M
Bonds &
Other
Pending
2016
$20 M
Operating
Pending
2016
$117 M
Bonds and
Outside
Fundraising
N/A
2014
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, and other
meeting space.
University Hospital 7th & 8th Floor
Master Planning
Architectural selection is underway for
design services for the 7th and 8th floor to
better align with the current services
provided for Women and Children’s inpatient programs.
2. Under Construction
Battle Building:
The Groundbreaking Ceremony was held
on June 9, 2011. Structural concrete work
is complete. Structural steel work is
complete. Interior framing and mechanical
rough-ins are on-going. Glazing and
masonry operations are on-going.
23
The University of Virginia Medical Center
Capital Projects Report
November, 2013
Scope
Funding
Source
Budget
BOV
Approval
Date
Projected
Completion
Date
2. Under Construction (continued)
Battle Building:
$117 M
Bonds and
Outside
Fundraising
N/A
2014
$36.5M
Bonds & Other
June 2010
2013
$30.3 M
Bonds & Other
Jan 2007
2014
The Groundbreaking Ceremony was
held on June 9, 2011. Structural
concrete work is complete.
Structural steel work is complete.
Interior framing and mechanical
rough-ins are on-going. Glazing and
masonry operations are on-going.
Health System Precinct:
Realignment of Lee St. and
construction of new chiller plant.
Realignment of Lee St. to be
completed summer of 2013. Steel
erection for the new chiller plant is
complete. Cooling towers have been
set and the mechanical piping is
complete. Façade work is complete.
Substantial completion occurred in
October. Commissioning and testing
is ongoing.
Connective Elements:
Create new front entrance to the
Hospital, bridge over Lee Street,
connector building, and expanded
lobby. Expanded portion of lobby
and new pedestrian bridge opened
July, 2013. New gift shop opened
August, 2013. Work to renovate
existing areas of lobby underway.
Oct 2010
Nov 2010
24
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
November 14, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
IV.E.
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
August 1 – September 30, 2013
A School of Medicine alumnus and his wife verbally
committed a $1 million bequest, to be divided between medical
scholarships and plastic surgery resident education.
A School of Medicine alumnus documented a percentage of his
estate, currently valued at approximately $165,000, in support
of the Department of Anesthesiology.
Friends of the Health System made an additional $150,000
contribution to their named Charitable Remainder Trust in
Hematology/Oncology.
A School of Medicine departmental chair committed $105,263
in support of the Chester Research Fund in the Department of
Neuroscience.
A friend of the Health System committed an additional
$100,000 to the Battle Building at UVA Children’s Hospital.
Other gifts and pledges received include:
•
A $75,000 gift to the Department of Ophthalmology in
support of Aniridia syndrome research;
25
•
•
•
•
A $70,000 total commitment to establish a named fund for
ovarian cancer research and to provide additional funding
for current use;
A $51,257 gift to the Department of Surgery for a named
fund for surgical residents;
A $50,811 gift for discretionary use in the Department of
Ophthalmology; and
A $50,000 estate distribution in support of a named
endowment in the School of Nursing.
OTHER DEVELOPMENT INITIATIVES
Health System Development staff and Dr. Paul Levine hosted
a dinner for a donor to acknowledge significant gifts to the
Department of Otolaryngology.
On August 29, the School of Nursing Alumni and Development
office hosted a luncheon to celebrate recipients of GENEX
scholarships.
On September 9, the owners of a local restaurant hosted a
fundraising dinner to express their gratitude to Dr. Howard
Goodkin for his exceptional care of their son. The event, which
raised a total of more than $20,000, benefitted the Adolescent
Epilepsy Clinic and Transitional Program at UVA.
Health System Development Communications produced and
mailed the summer issue of the UVA Cancer Center development
newsletter, Investing in Hope.
Through September 2013, development officers have made 633
face-to-face visits with donors and prospects.
GIVING SUMMARY (July 1, 2013 through August 31, 2013)
New gifts
New pledges
Total new commitments
(excludes pledge payments on
previously booked pledges)
FY 14
FY 13
(through 8/31/13) (through 8/31/12)
$1,349,970
$1,852,889
$307,895
$79,000
$1,657,865
$1,931,889
New expectancies
Total new gifts, pledges, and
expectancies
$1,000,000
$2,657,865
26
$1,857,067
$3,788,956