UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
May 20, 2013
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
4th
Monday, May 20, 2013
8:30 am – 11:30 am
Floor, Emily Couric Clinical Cancer Center
Committee Members:
Edward D. Miller, M.D., Chair
Vincent J. Mastracco Jr., Vice Chair
Helen E. Dragas
Victoria D. Harker
Andrew K. Hodson, MB.Ch.B
William P. Kanto Jr., M.D.
Ex Officio
Teresa A.
Steven T.
Dorrie K.
Robert S.
Members:
Sullivan
DeKosky, M.D.
Fontaine
Gibson, M.D.
Stephen P. Long, M.D.
Constance R. Kincheloe
Charles W. Moorman
The Hon. Lewis F. Payne
Patrick D. Hogan
R. Edward Howell
John D. Simon
AGENDA
PAGE
I.
II.
OPENING COMMENTS FROM THE CHAIR
ACTION ITEM
•
III.
IV.
1
Fiscal Year 2014 Operating and Capital Budgets
GRADUATE MEDICAL EDUCATION REPORT (Mr. Howell to
introduce Susan E. Kirk, M.D.; Dr. Kirk to report)
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,
outreach, Center of Excellence business plan, and
other marketing and growth efforts, including
review of 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
9
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.
V.
RETURN TO PUBLIC SESSION: REPORTS BY THE VICE
PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE MEDICAL
CENTER (Mr. Howell)
A.
Vice President’s Remarks
12
B.
Operations and Finance 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)
13
C.
Capital Projects
31
D.
Health System Development
35
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.
Fiscal Year 2014 Operating and Capital
Budgets
BACKGROUND: The Medical Center’s operating and capital
budgets are consolidated with the University’s overall budget.
At its May meeting, the Board of Visitors acts on the proposed
budget based on a recommendation from the Medical Center
Operating Board.
DISCUSSION: The Medical Center’s 2013-2014 fiscal plan has been
developed while considering the challenge of providing patient
care, teaching, and research services in an increasingly
changing health care industry. The full impact of the
Accountable Care Act will not be fully realized for a number of
years; however, many of its provisions have already been
effectuated. The result will be decreased reimbursements from
government payors and an industry wide erosion of pricing power
with private payors. At the same time, cost associated with
providing quality patient care will continue to have upward
pressure due to increases in medical supply, pharmaceutical, and
medical device expenses, growing administrative burden, and a
shortage of health care workers. These changes require
proactive fiscal planning now to ensure meeting the mission of
the Health System in the future.
To meet these challenges, the Medical Center utilizes a
priority based budget process to align resource allocations with
Medical Center strategies and goals to achieve the Health
System’s strategic planning goal of becoming a top decile
academic medical center based on quality measures. The Medical
Center budget development process is operationally focused and
highly participatory. Patient care service management, support
function management, and physicians have significant roles in
the budget development cycle. The budget process begins with
senior management developing basic budget assumptions such as
discharges, length of stay, and productivity standards which
drive the number of employees.
The budget is consistent with the Long Range Financial
Plan. The budget has been prepared to move the Medical Center
1
toward the goal of a cost structure no higher than Medicare
payments by Fiscal Year 2016. When we began this process, costs
exceeded Medicare payments by 14%. In fiscal year 2013, we
estimate the gap will be reduced to 9%. The final budget
provides each operating unit with a cumulative operating budget
that contains service demand forecasts, required full-time
equivalent (FTE) personnel, and non-labor expenses.
BUDGET AND OPERATING ASSUMPTIONS
Market conditions: For fiscal year 2014, discharges are
budgeted to grow 3.7% from fiscal year 2013 projected levels.
The growth will be facilitated by improved patient flow
resulting from the newly constructed 72 bed tower that increased
physical inpatient bed capacity from 589 in 2012 to 661
inpatient beds in fiscal year 2013. The plan is to staff these
beds as demand grows. Inpatient and outpatient demand for
healthcare services from the existing population is expected to
grow by a weighted average of 4.0%. The Medical Center is also
expected to capture additional market share in high Case Mix
Index (CMI) services by implementing the Centers of Excellence
in the strategic plan. The following table includes historical
and projected patient volumes:
Discharges Medical Center
Discharges Transitional
Care
Adjusted Discharges
Average Length of Stay MC
Average Length of Stay TCH
Actual
2011-2012
28,695
Projected
2012-2013
28,711
Budget
2013-2014
29,548
222
311
398
52,867
5.82
27.85
53,795
5.68
26.62
55,662
5.45
28.00
165,746
818,871
161,300
817,505
160,546
863,550
Patient Days MC
Clinic and ER Visits
Revenues: The Medical Center has seen growth in volumes
over the last year, but a disproportionate share of the growth
has been Medicaid and Medicare patients. One of the Medical
Center’s largest challenges is the unwillingness of government
payors to increase their payments commensurate with the
increases in medical delivery costs. Growth in revenues will
result from the impact of increasing volume and negotiated
contracts that include rate increases.
2
Rate changes: The Medical Center proposes an overall rate
increase of 7.0% to 9.9%, which is commensurate with rate
increases that will generally be implemented in the hospital
industry.
With regard to compensation, the pay-for-performance pool
has been established at $8 million, which includes the impact on
benefit costs and is based on a 3.0% salary adjustment with an
October implementation date. Other salary adjustments such as
market and compensation design adjustments total $4 million,
including the impact on benefit costs.
Expenses: Expenses from operations are projected to
increase by $97.3 million from the fiscal year 2013 projection.
Expenses per CMI weighted adjusted discharges are projected to
increase, going from $10,827 to $11,005 (excluding the
Transitional Care Hospital). The fiscal year 2013 projection
includes a reduction to expenses from the vendor settlement. If
the settlement was excluded, the cost per adjusted discharge
would be $10,926. The fiscal year 2014 expense per adjusted
discharge includes $49 for implementation of the Centers of
Excellence Strategic Initiative and $55 for ICD-10 conversion.
Without the items noted above the fiscal year 2013 cost per
adjusted discharge would be $10,926 and fiscal year 2014 would
be $10,901.
We anticipate that expense per CMI weighted adjusted
discharge included in the budget will be approximately equal to
the academic medical center median expense as shown in the
University Health System Consortium Operational Data Base.
Previous increases in capital investment will result in
additional depreciation expense of $9.4 million for fiscal year
2014. Additionally, interest on capital investments is
increasing by $3.1 million for fiscal year 2014. The Medical
Center’s 2013-2014 fiscal plan accounts for these additional
expenses while preserving its goal of providing high quality and
cost effective health care, education, and research services.
Staffing: The Medical Center’s fiscal year 2014 budget has
been benchmarked with comparable academic medical centers. FTEs
are planned at 7,198, an increase of 300 FTEs from the current
fiscal year projection of 6,898 FTEs. Increased staffing for
the Centers of Excellence and new initiatives accounts for an
increase of 209 FTEs. The remainder of the growth is to support
facility expansion and core program growth for existing
3
operations, including 23 additional FTEs at the Transitional
Care Hospital.
Operating Plan: The rapidly changing health care
environment will require continuous examination of budget
assumptions. Management will monitor budget versus actual
performance on a monthly basis and, where appropriate, make
changes to operations. Also, management will continue to
identify and implement process improvement strategies that will
allow for operational streamlining and cost efficiencies.
The major strategic initiatives that impact next year’s
fiscal plan include:
•
•
•
•
•
•
•
•
Continuous improvement in quality to achieve recognition as
a top decile provider of clinical care among academic
health centers.
Continuation of the collaborative effort between the
Medical Center and the School of Medicine faculty to
realize cost efficiencies on a volume adjusted basis in
preparation for future reimbursement reductions included in
the Affordable Care Act.
Continuation of our efforts to better engage our employees
and enhance patient satisfaction.
Maintaining adequate working capital to foster growth in
capacity, technology, and innovation to meet the needs of
healthcare in Virginia.
Continued investment in the capital requirements of the
Medical Center with the priorities of maintaining the
current patient care infrastructure, planning for the
opening of the Battle Building, Emergency Department
Expansion, and construction of the Education Resource
Center.
Maintain market driven and performance based salaries for
employees.
Fund the Strategic Investment Pool to grow the tri-partite
mission of clinical care, education, and research.
Continue to develop innovative care delivery models in
response to a changing reimbursement environment, including
an Accountable Care Organization and expanded use of
telemedicine to prevent readmissions.
The major risk factors that impact the ability to
accomplish the fiscal plan include:
4
•
•
•
•
•
•
•
•
•
•
•
•
Changes in healthcare reform including State participation,
maintaining the timeline for Medicaid expansion, and
sequestration.
Resolution by the Center for Medicare and Medicaid Services
(CMS) of the sustainable growth rate issue for physicians.
ICD 10 Conversion.
Participation in the 340b drug program.
Maintaining and growing a superior workforce in an
environment where workforce shortages are projected.
Medicare payments at risk due to value based purchasing,
electronic health record meaningful use, and hospital
readmissions.
Cuts in Graduate Medical Education (GME), Indirect Medical
Education (IME) and facility fees beyond sequestration.
Reduced Medicaid funding for Virginia’s Academic Health
Center type one hospitals.
Marketplace changes create a highly competitive
environment.
Centers of Excellence failure to achieve market share and
volume goals.
Outreach objectives are not achieved.
Changes in market dynamics from emerging Accountable Care
Organizations and Clinically Integrated Networks.
A summary of historical and projected financial operating
results is provided as follows:
Actual
(Millions)
2011-2012
Total operating revenue
$1,160
Operating expense
1,082
Operating income
78
Non-operating gain/(loss)
8
Total margin
$86
Operating income percent
6.7%
Projected
2012-2013
$1,179
1,118
61
39
$100
5.2%
Budgeted
2013-2014
$1,275
1,216
59
13
$72
4.6%
Capital Plan: Funds available to meet capital requirements
are derived from operating cash flows, funded depreciation
reserves, philanthropy, and interest income. The Medical Center
faces many challenges regarding capital funding as continued
pressures on the operating margin affect cash flow, while demand
for capital has increased significantly due to space
requirements, technological advances, and aging of existing
equipment. Subject to funds availability, the Medical Center
5
management recommends $106.7 million be authorized for capital
requirements, which includes $5.0 million for contingencies and
$11.8 million for the Strategic Investment Pool.
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Finance Committee, and by the Board of Visitors
APPROVAL OF THE 2013-2014 OPERATING AND CAPITAL BUDGETS AND
ANNUAL RENOVATION AND INFRASTRUCTURE PLAN FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
RESOLVED, the 2013-2014 Operating and Capital Budgets and
the Annual Renovation and Infrastructure Plan for the University
of Virginia Medical Center are approved, as recommended by the
President, the Executive Vice President and Chief Operating
Officer, and the Medical Center Operating Board.
6
Schedule A
University of Virginia - Medical Center
Projected Fiscal Plan
2013-2014
2011-2012
Actual
Revenues
Total Gross Charges
$
2012-2013
Forecast
2013-2014
Budget
3,213,054,891 $
3,472,994,460 $
3,980,437,649
Less Deductions:
Indigent Care Deduction
Bad Debt
Contractual Deduction
Total Deductions
207,515,193
30,942,354
1,858,766,795
2,097,224,342
231,092,503
26,637,760
2,081,114,506
2,338,844,769
274,981,555
56,829,820
2,414,469,007
2,746,280,382
Net Patient Revenue
1,115,830,549
1,134,149,691
1,234,157,267
43,789,793
44,989,869
40,683,803
1,159,620,342
1,179,139,560
1,274,841,070
Expenses
Expenses from Operations
Operating Expenses
Depreciation and Amortization
Interest Expense
1,001,927,811
72,937,492
7,103,475
1,025,405,075
78,603,385
14,396,803
1,110,244,145
88,026,492
17,484,376
Total Expenses from Operations
1,081,968,778
1,118,405,263
1,215,755,013
77,651,564
60,734,297
59,086,057
Miscellaneous Revenue
Total Revenue
Operating Income
Other Gains and Losses
Investment Income & Investment FMV
Net gain from Affiliates
Transfer to UVA
Loss on Fixed Assets
State Appropriation
Other
Total Other Gains and Losses
Revenues and Gains in Excess of Expenses
18,806,090
3,307,351
(286,094)
3,747
(13,974,465)
7,856,629
$
Statistics
Discharges - Medical Center
Discharges - Transitional Care Hospital
Patient Days of Care - Medical Center
Patient Days of Care - Transitional Care Hospital
Clinic and Emergency Room Visits (Excluding Acquired
Practices)
Average Length of Stay - Medical Center
Average Length of Stay - Transitional Care Hospital
7
85,508,193
46,166,414
1,567,616
20,160,610
1,609,815
(7,000,000)
(800,000)
(635,570)
13,334,855
167,793
(8,768,036)
39,133,787
$
99,868,084
$
72,420,912
28,484
222
165,746
5,821
818,871
28,711
311
161,300
8,279
817,505
29,458
398
160,546
11,144
863,550
5.82
27.85
5.68
26.62
5.45
28.00
University of Virginia Medical Center
Operating Financial Plan
(dollars in thousands)
2013-14
Budget
Operating Revenues
Total Gross Charges
2012-13
Projected
2012-13
Original Budget
2011-12
Actual
$3,980,438
$3,472,994
$3,524,144
$3,213,055
Less Deductions:
Indigent Care Deduction
Bad Debt
Contractual Deduction
Total Deductions
274,982
56,830
2,414,469
2,746,280
231,093
26,638
2,081,115
2,338,845
227,688
48,220
2,087,488
2,363,396
207,515
30,942
1,602,918
2,097,224
Net Patient Revenue
1,234,157
1,134,150
1,160,748
1,115,831
40,684
44,990
48,089
43,790
1,274,841
1,179,140
1,208,837
1,159,630
573,893
536,352
88,026
17,484
528,853
496,552
78,603
14,397
540,334
513,554
79,781
16,622
491,862
510,045
72,937
7,103
1,215,755
1,118,405
1,150,271
1,081,969
Operating Income
Operating Income Percent
59,086
4.6%
60,734
5.2%
58,565
4.9%
77,652
6.7%
Other Gains and Losses
Investment Income & Investment FMV
Net Gain from Affiliates
Transfer to UVA
Loss on Fixed Assets
State Appropriation
Other
Total Other Gains and Losses
20,161
1,610
(7,000)
(800)
0
(636)
13,335
46,166
1,568
17,530
1,351
18,806
3,307
168
0
(8,768)
39,134
(800)
0
(2,108)
16,273
(286)
4
(13,974)
7,857
Revenues and Gains in Excess of Expenses
72,421
99,868
74,839
85,508
Add back Depreciation and Amortization
Less Principal Payments on Debt
Cash Available for Capital and Other
88,026
(26,685)
133,762
78,603
(23,003)
155,468
79,761
(23,003)
131,585
72,937
(21,050)
137,392
Capital Funded from Operations
106,692
58,860
96,384
63,399
$27,070
$96,608
$35,201
$73,993
Miscellaneous Revenue
Total Operating Revenues
Operating Expenses
Compensation and Benefits
Supplies, Utilities, and Other
Depreciation and Amortization
Interest Expense
Total Operating Expenses
:
Additions to Cash and Reserves
8
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.
ACTION REQUIRED:
None
Graduate Medical Education Report
BACKGROUND: Susan E. Kirk, MD is the Designated Institutional
Official and Associate Dean for Graduate Medical Education at
the University of Virginia Health System, where she is also
jointly appointed as an Associate Professor in Internal Medicine
and Obstetrics and Gynecology. She is a graduate of Douglass
College and Rutgers Medical School. She completed her
internship and residency, and was chief resident in Internal
Medicine, at the University of North Carolina Chapel Hill. At
the University of Virginia she completed a fellowship, and is
currently board certified in Endocrinology. Her area of
clinical expertise is in diabetes and pregnancy. She is codirector of the High Risk Obstetrical Diabetes Clinic.
The University of Virginia Medical Center continues to
provide one of America’s most highly regarded GME specialty
residency and fellowship training programs. In the past twelve
months, we have experienced the beginning of significant changes
to the evaluation of our trainees’ competence. In addition, an
entirely new infrastructure to assess their involvement in
issues of quality and patient safety has been implemented.
However, our mission remains the same. It is within GME that we
have the opportunity to secure the future of medicine with those
we are training. In the coming year, we will face renewed
challenges of physician workforce needs and healthcare reform.
Therefore, maintaining our excellence in GME at the University
of Virginia and identifying its role in the strategic plan of
the Health System is critical.
DISCUSSION:
The Medical Center has 780 residents and fellows
participating in 105 training programs – 68 programs accredited
by the Accreditation Council for Graduate Medical Education
(ACGME), 31 additional fellowships (non-accredited or accredited
by other than the ACGME), one ADA-accredited dentistry program,
9
and five paramedical programs in chaplaincy, clinical laboratory
medicine, clinical psychology, pharmacy, and radiation physics.
Two significant regulatory changes were mandated by the
ACGME this past year: the Next Accreditation System (NAS) and
the Clinical Learning Environment Review (CLER). With the
implementation of NAS, training programs will begin to evaluate
their residents based on expectations of their developmental
progress (Milestones). Moreover, the ACGME will evolve from
accreditation cycles and site visits to periods of self-study
with annual reporting. The CLER program will center on
evaluation of the Medical Center’s leadership involvement in and
responsiveness to issues of quality and patient safety as they
pertain to GME. Unannounced site visits have begun and will be
performed every 18 months at all academic medical centers. We
expect our visit to occur in the next 12 months. Both the GME
Office and the GME Committee (GMEC) have prepared for these
changes, and we are well positioned to assist in their
implementation.
GME Trainee Statistics
Statistics for fiscal year 2013 are as follows:
Departing Housestaff
Completed training program*
205
Transferred to another program
32
Not reappointed for academic reasons
0
Resigned for personal or academic reasons
4
Terminated from program
0
* Of the 205 residents completing training, 22 were appointed to
faculty positions.
New Appointments
240
Reappointments
524
Accreditation Status
Until July 2013, the current accreditation (or
reaccreditation) process remains in place. The accreditation
status of our programs is as follows:
•
All 68 programs accredited by the ACGME and the Institution
have full accreditation
– 21 core residency programs
– 47 subspecialty/fellowship programs
10
Program success can be measured in part by the length of
the accreditation provided by the ACGME and the 26 specialtyspecific committees known as Residency Review Committees (RRCs).
Of the 68 Accredited Programs, 84% of our programs have been
transitioned into the NAS Self Study program or have very
favorable cycle lengths (four to six years). In 2012, there was
an 11% increase in programs receiving this cycle length or being
transitioned to the new program.
The institution remains on a rigorous mid-cycle review of
its GME programs. There were nine internal reviews completed
for ACGME programs in 2012, and an additional 10 are scheduled
through June 2013. We instituted internal audits of our nonACGME accredited programs during the past year as well, to
ensure that they are compliant with institutional standards.
After July 2013, the institution will transition to annual
reporting of the status of its programs.
National Match
Twenty-seven programs, offering 147 positions, participated
in the 2013 Match. Four positions in the Preliminary Surgery
Undesignated program were purposely unfilled at the time of the
initial match, but they were successfully filled within three
hours of the Supplemental Online Application Program (SOAP). Of
special note, 21 of our 27 programs obtained one or two of their
top 20 ranked applicants. Additionally, just over 25% of the
matched applicants were from Commonwealth of Virginia medical
schools and 24 were graduates of the University of Virginia.
However, our residency programs were very attractive to medical
schools around the country, matching students from 32 states and
the District of Columbia.
Finance
The total direct budget for GME programs for fiscal year
2013 is $48,749,181. Funds to support this program come from
Medicare, Medicaid, other government or industry sources, and
the Medical Center.
In addition to continuing to fund innovative programs to
support education, such as the Master Educators Award, the GME
Innovative Grant Program, and the Certificate Program, the
Medical Center increased salaries and benefits for all graduate
medical trainees in July 2012 to remain competitive with GME
programs nationally.
11
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
V.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 of recent events that do not require formal action.
12
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
V.B.
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 25,000th appointment in
March 2013. For fiscal year 2013 year to date through March,
10,336 appointments have been made with over half coming from
non-University employees and family patients. HealthGrades has
13
accounted for 9.5% (985), inpatient discharge appointments were
7.9% (813), and MedExpress has accounted for 4.1% (426).
Ambulatory clinic visits exceeded budgeted volumes by more
than 17,000 visits for fiscal year 2013 through February.
Outpatient clinic satisfaction exceeded the 50th percentile as
compared to other academic medical centers for four consecutive
quarters through October-December 2012.
Clinical Ancillary Services
Medical Laboratories
Medical Laboratories Point of Care Testing service
implemented the new Roche Accuchek Inform II wireless glucose
meter in all University Hospital locations, procedural areas,
clinics(on and off-site), and dialysis centers. The 318 new
hand-held glucometers are much improved over the previous
instruments with an easy to clean durable housing, centralized
control of test strip lot data, a smaller whole blood sample,
faster results in five seconds, and fewer interfering clinical
conditions. These meters are also beneficial to the new
"Glucomander Program" that is being implemented on the inpatient
units to provide real-time glucose values from our electronic
medical record for better glycemic control.
Imaging Services
The Medical Imaging Reception/Registration staff was
awarded the Uteam “Team of the Month Award” for their
exceptional efforts to increase patient satisfaction. The Team
has significantly improved the patient experience as noted by
numerous positive patient comments and improved patient
satisfaction scores.
Planning has started for the replacement of a CT scanner
and an interventional procedure suite in University Hospital.
Completion of those two projects is scheduled for late summer
2013.
Pharmacy Services
Barringer Pharmacy has expanded their Specialty Pharmacy
Services as of January 1. This initiative is in response to
health plan promotion of specialty pharmacy services to member
employees and patients.
14
Pharmacy completed a successful Pharmacy Residency match
process. All of the Pharmacy residency positions were filled.
Interviews were conducted with 37 candidates for 12 slots from a
total interest pool of over 120 prospective candidates.
The Pharmacy’s drug supply contract with Cardinal
Distribution has been renewed for another three years. This
renewal was effective April 1 and is a collaboratively
negotiated contract between the University of Virginia and
Virginia Commonwealth University.
Therapy Services
On March 14, 2013, UVA WorkMed hosted the Charlottesville
Regional Chamber of Commerce “Business after Hours” Event at the
new Arlington Boulevard site, giving local businesses a chance
to meet the staff and learn about WorkMed programs. There were
130 people at the event.
Community Outreach
The Commonwealth of Virginia Campaign awarded UVA with
their highest honor for exceeding $1,000,000 in employee pledges
for local and regional charities in this annual event that
concluded on January 31, 2013. Total pledge dollars were
$1,072,953 with just over half of the total coming from the
Health System. The table below notes how UVA and our Health
System employees have given over the past decade.
UVA Employee Support through the
Commonwealth of Virginia Campaign
2012
$1,072,953
2010
$910,304
2008
$936,000
2006
$813,125
2004
$636,759
2002
$563,585
Ms. Sara Wilson, Virginia Director of Human Resource
Management, presented the award to Mr. Edward Howell, Vice
President and Chief Executive Officer of the Medical Center, and
Mr. Robert Sweeney, Vice President for UVA Development, at a
celebration held on February 26 in Garrett Hall. Each year over
90% of the pledged dollars from our employees remain in Central
Virginia and the Shenandoah Valley, going to over 525 selected
charities. Major recipients included:
15
•
•
•
•
•
Charlottesville Free Clinic
Thomas Jefferson Area Food Bank
American Heart Association
March of Dimes
Societies for the Prevention of Cruelty to Animals within
central Virginia
Environment of Care
Patient & Guest Services
The UVA Hospital Auxiliary celebrated spring with a
daffodil sale on March 8. Sale proceeds enabled the Auxiliary
to provide a fresh daffodil to each patient at the Hospital on
that day. The Auxiliary also held their annual Book Sale in
March.
On April 4, Flourish, a positive image boutique at the
Emily Couric Clinical Cancer Center run by the Auxiliary,
celebrated its two year anniversary in service to our patients.
Sustainability
The University of Virginia Medical Center won the 2013
Governor's Environmental Excellence Award for Sustainability,
which was presented in a ceremony held on April 10 during the
“Environment Virginia Symposium” at Virginia Military
Institute. Rick Weeks, Department of Environmental Quality
Chief Deputy, presided over the ceremony and Secretary of
Natural Resources Doug Domenech, Department of Environmental
Quality Director David Paylor, and Department of Conservation
and Recreation Director David Johnson were also present for the
event. Bo Cofield, Tom Harkins, and Reba Camp attended the
ceremony and accepted the award on behalf of the Medical Center.
Reba Camp, Chair of the Medical Center’s Sustainability
Committee, was invited to present on healthcare sustainability
at the University Health System Consortium (UHC) Supply Chain
and Clinical Resources Council Meeting in New Orleans in March.
UHC, a national organization of academic medical centers,
recognized the Medical Center with the 2012 Sustainability Award
in September.
Health System Technology Services
Epic Systems
16
Plans are underway to implement an upgrade to all Epic
electronic health record applications to the Epic 2012 version
(Denali) on June 22, 2013. This enhanced code level will
facilitate both new Stage 2 Meaningful Use and ICD-10 builds.
The upgrade also provides numerous visual and functional
improvements to clinical workflows. The upgrade will require
user training for the new applications.
MyChart
The MyChart portal is now available on mobile devices,
specifically the iPad, iPhone and Android. In April, an
expanded release of test results to MyChart was implemented.
All labs are now released to MyChart in three days except
certain sensitive tests that are blocked through state mandate
or Medical Center policy, such as HIV, Huntington’s, genetic,
and chromosomal tests. Additionally, all Radiology and
Pathology reports will be released after an appropriate time
period to allow for physician to patient contact.
Human Resources
Compensation
The Uteam Incentive Plan Opener for Medical Center
leadership (directors and above) was modified to include meeting
targets for catheter associated urinary tract infections (CAUTI)
and central line associated blood stream infections (CLABSI)
rates in addition to achieving Mortality Index of .92 or lower.
This was communicated in late January to impacted staff.
Over 6,000 personalized pay statements were handed out to
employees in one-on-one meetings with their managers to review
and provide each employee with information related to the market
compensation for their positions.
Recognition and Rewards
•
The 2nd Annual Summer Camp Mini-Expo was held on February 11
and 12. The Mini-Expo is a self-service opportunity for
employees to learn first-hand what summer camp options are
available for their families.
•
In an effort to improve recognition efforts across the
Health System, the current Employee of the Month program
was revamped to include the ability to recognize more than
one individual each month and open the nominations to
17
teams, departments, and units. The Uteam Members of the
Month program recognizes individuals, teams, departments,
and units that model the qualities and behaviors of our
RISE Values (Respect, Integrity, Stewardship and
Excellence).
•
•
•
The Medical Center was identified through consumer surveys
as a top hospital for quality and image, earning a 2012-13
Consumer Choice Award from the National Research
Corporation. The awards are based on surveys of more than
250,000 households in 300 markets across the U.S.
Over 14 retirement celebrations were planned this quarter
for employees with over 20 years of service with the
Medical Center.
The UVA Health System and Belk invited all employees to a
private shopping event at the Belk store in the Fashion
Square Mall on Sunday, March 24 from 6:30 p.m. to 9:30 p.m.
Uteam Meetings
Beginning March 18 through April 3, 13 Uteam meetings were
held throughout the Health System. Presentations were made by
Ed Howell, Bo Cofield, Jonathan Truwit, and Brad Haws. The
Uteam meeting is a key strategy in our efforts to build employee
engagement. The meetings give employees the opportunity to hear
directly from senior leaders about the direction of the Health
System and to ask questions about the things they care about the
most.
Recruitment
Human Resources initiated steps to create a hiring
preference for nurses who possess a Bachelors of Science in
Nursing (BSN) upon hire. Although staff who have completed an
Associate in Nursing (ADN) program are still being hired, they
are required them to complete a BSN within five years of their
hire. The RN Residency Program continues to attract interest
with over 200 applicants for 65 openings.
Human Resources continued the roll-out of a staffing
assessment tool to ensure fit with our values by planning to
include all internal applicants and leadership candidates. This
should assist in improving retention and fit.
Organizational Development
18
The Uteam Leadership Academy Best Practices Series will be
expanding efforts beginning this July to reach more leaders
focused on Transactional Leadership. The number of spots
available will double for attendees during fiscal year 2014.
Participants obtain tools that they can immediately implement to
address issues such as trust, engagement, managing change,
accountability, and developing and recognizing employees. In
addition, a new series of classes for leaders has been added
entitled “Best Practices II”. This series will focus on
creating transformational leaders. A six-month pilot series
started in March. Participants obtain tools that they can
immediately use to address topics such as emotional
intelligence, learning agility, motivating and engaging others,
communication and listening, networking and negotiation, and
resiliency. The new series incorporates a high level of
individual coaching with the manager and their supervisor.
The new online on boarding tool that was implemented with
the goal of welcoming new hires to the organization in a more
engaging format, has shown great success. New hires report
being more prepared for their first day in many areas including
knowledge of our mission, vision, and values. They are also
very satisfied with our new employee hiring process.
The Uteam Leadership Academy Informal Leader program
graduated another 40 employees. This three month program is
intended to help employees who do not currently hold formal
leadership roles but lead others informally or play a
significant part in the success of their area. Participants
have reported a change in their own behavior up to 95% of the
time.
Quality and Performance Improvement
Quality and Patient Safety Initiatives
In late January, the Medical Center welcomed a team of
consultants to conduct a mock survey focusing on The Joint
Commission and CMS accreditation requirements. This activity
supports our goal of ensuring that our processes and the
environment continuously meet regulatory requirements. While
some deficiencies were noted, overall the team was very
complimentary of our staff and their dedication to our patients.
The Patient Safety Office retired our existing quality
reporting system in April and implemented an upgraded version.
This upgraded system provides enhanced screens and a more
19
streamlined entry process. The system is invaluable in helping
us identify opportunities to improve the care we deliver to our
patients and continue our journey to eliminate preventable harm.
The Joint Commission officially certified UVA Medical
Center’s heart failure program in January for meeting national
standards for quality care. The certification followed a
rigorous review that included an in-person visit by Joint
Commission surveyors in November 2012.
The Joint Commission notified the Medical Center on April 6
that it successfully demonstrated compliance with meeting the
Chronic Obstructive Pulmonary Disease (COPD) certification
requirements and awarded the Medical Center the Joint Commission
COPD Disease Specific Certification.
Recognition and Awards
The Health System had 189 physicians selected to the 2013
Best Doctors in America® List by Best Doctors, Inc.
School of Medicine Professor Erik Hewlett, MD, received the
state’s highest honor for college faculty. Dr. Hewlett is one
of only 12 educators selected by the State Council of Higher
Education for Virginia to receive the Outstanding Faculty Award
for 2013.
Becker’s Hospital Review selected UVA Medical Center’s
Cancer Center as one of its 100 Hospitals and Health Systems
with Great Oncology Programs.
The U.S. Green Building Council honored UVA School of
Medicine researcher, Matthew Trowbridge, MD, MPH, with a
$350,000 grant from the Robert Wood Johnson Foundation and a
fellowship in recognition of his work designing schools, homes,
offices, and neighborhoods that promote health and well-being.
A $270,000 grant from the Virginia Health Workforce
Development Initiative will establish the Southside Telehealth
Training Academy and Resource Center (STAR) in Martinsville,
which will be operated by the New College Institute and the UVA
Center for Telehealth.
Supply Chain
Supply Chain implemented “Low Unit of Measure” processes in
October, 2012. Operational issues that originally arose have
20
now been resolved with minimal errors in the supply “pick”
process.
This process allowed the Medical Center to
successfully close the warehouse and turn over a significant
portion of the warehouse to the Albemarle County Fire
Department.
CareFusion has been selected to provide and implement a
Point of Use Information System (JittRbud). The system is
scheduled to be implemented in the July-August 2013 timeframe
and will allow for the automatic ordering of supplies without
significant human interface (current process requires
approximately seven FTEs to complete). The system also allows
for rapid dissemination of utilization data and cost data to the
manager of each unit. The system also allows daily monitoring
of supply utilization. Supply Chain Value Management will use
the system’s data to drive standardization and rationalization
efforts across the Medical Center for commodity and low cost
clinical preference items that make up the bulk of inpatient
supplies. The system was selected for its leading technology as
compared to the competition, the simplicity of the end-user
interface, and low maintenance cost.
Public Relations and Marketing
In the first quarter of calendar year 2013, press releases
and media advisories contributed to 1,683 news stories featuring
the Health System across various media outlets. In our primary
service area, the Health System had a 90% share of voice in
media coverage, compared with 5% for Martha Jefferson Hospital
and 5% for Augusta Health. Local coverage included seven
stories in February related to Heart Month. Coverage of cancer
care included the Women’s 4 Miler check presentation, the
importance of being treated at a National Cancer Institute
Designated Cancer Center, and the Medical Center’s efforts to
tailor treatment for lung cancer patients. Stories featuring
neurosciences included coverage of focused ultrasound and a
nutritional supplement that could become an Alzheimer’s
treatment.
Several of our physicians were featured in international,
national, and statewide media outlets:
•
Dr. Jeffrey Elias (Division of Functional Neurosurgery,
Department of Neurosurgery) was interviewed for a BBC
segment on focused ultrasound scheduled to air in May.
•
The Richmond Times-Dispatch highlighted the role of Dr.
Paul Matherne (Division of Pediatric Cardiology, Department
21
of Pediatrics) in developing a statewide newborn heart
disease screening program.
•
ABC 7 in Los Angeles covered a story about a study by Dr.
Jennifer Harvey (Division of Breast Imaging, Department of
Radiology and Medical Imaging) on breast density and
developing a breast cancer risk model.
•
Research by Dr. Mark DeBoer (Division of Pediatric Diabetes
& Endocrinology, Department of Pediatrics) on skim milk
appeared in several national publications, including the
Los Angeles Times.
•
Dr. Chris Holstege (Division of Medical Toxicology,
Department of Emergency Medicine) was quoted in an
abcnews.com story about a woman who appears to have
overdosed on Coca-Cola.
•
Immunity-intelligence link research by Dr. Jonathan Kipnis
(Department of Neuroscience) was featured in Discover
magazine.
•
Dr. Costi Sifri (Division of Infectious Diseases &
International Health, Department of Medicine) was quoted in
a USA Today story about superbugs.
Our most recent issue of Vim & Vigor magazine, which is
mailed to 55,000 households in our primary and secondary service
areas, features our clinicians in articles about Parkinson’s
disease, advanced cardiac imaging tools, healthy aging, hot
flash treatments, stroke rehabilitation, prostate cancer, and
depression in seniors.
Our most recent issue of Physicians Practice magazine,
mailed to about 22,000 licensed, referring physicians across
Virginia, features our clinicians in articles about using
telehealth to help treat stroke patients, islet cell
transplantation, research into treatments for blood cancers,
Alzheimer’s disease, and cancer clinical trials.
Paid advertising efforts included a mix of TV, radio,
print, online and outdoor outlets. In addition to advertising
across local media outlets, Health System clinicians were also
highlighted on NPR and in the Washington Post.
FINANCE REPORT
After eight months of operations in fiscal year 2013, the
operating margin for all business units was 4.8%, which was
above the budget of 4.7%. However, the fiscal year 2013
22
operating margin was impacted favorably by a net credit of $9.8
million from several unbudgeted gains and losses. The operating
margin for all business units would have been 3.6% without those
adjustments.
The Transitional Care Hospital earned $0.5 million in
operating income for fiscal year 2013 through February. The
Transitional Care Hospital has been profitable for eight
consecutive months. Additionally, length of stay at the Medical
Center was reduced by 0.17 days by virtue of Medical Center
patients being transferred to the Transitional Care Hospital.
During the first eight months of the fiscal year, inpatient
admissions were 1.3% below budget and 1.1% above the prior year.
Average length of stay was 5.71 days, which was above the budget
of 5.50 days, but below the prior year’s 5.84 day average length
of stay. Observation patients, outpatient clinic visits, and
surgeries performed at the Outpatient Surgery Center (OPSC) were
all above budget. Capacity at the OPSC increased with the
addition of two modular operating rooms in June 2012, and
volumes through February are 23.6% above the prior year. When
volumes in the main operating room and OPSC are combined,
surgical case volume is 4% above the prior year.
Total operating revenue and operating expenses for fiscal
year 2013 through February were 1.6% and 1.8% below budget,
respectively. After adjusting for volume and average patient
acuity expenses were 1.9% above budget as a result of traveling
nurses and total supplies being over budget.
Total paid employees, including contracted employees, were
100 below budget.
FY 2012
Employee FTEs
Salary, Wage, and Benefit
Cost per FTE
FY 2013 2013 Budget
6,454
6,647
6,816
$74,276
$75,975
$76,514
229
240
171
6,683
6,887
6,987
Contract Labor FTEs
Total FTEs
23
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 to payments with providers in Virginia
over the last year. Mary Washington Hospital went through a
period of being a non-participating provider with Anthem before
the two organizations came to terms for their provider contract.
The Virginia Commonwealth University Medical Center recently
agreed to provider contract terms with Anthem but only after a
lengthy and difficult negotiation. We made a rate proposal to
Anthem which will meet our financial requirements. At this time
Anthem has not responded to our proposal.
The American Taxpayer Relief Act of 2012 (ATRA) was signed
into law on January 2, 2013. It has a number of provisions that
impact the financing of healthcare. ATRA halted the 26.5% cut
to physician payments from the impact of the Medicare
Sustainable Growth Rate, but the money to pay for the increased
payment to physicians was funded largely by new reductions to
hospital payments which total $0.5 million for the Medical
Center in total for the current fiscal year.
Government spending reductions as a result of sequestration
which will reduce Medical Center Medicare payments by $2 million
in fiscal year 2013 and $8.0 million in fiscal year 2014.
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $181.5 million for the
period July 1, 2012 through February 28, 2013, have been written
off. Recoveries during this period totaled $37.8 million.
Bad debt charges totaling $34.8 million have been written
off during the period from July 1, 2012 through February 28,
2013. During this same period, $11.3 million was recovered
through suits, collection agencies, and Virginia refund set-off.
24
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Feb-11
Net patient revenue
Feb-12
Feb-13
Budget/Target
Feb-13
$657.4
$719.9
$753.0
$768.0
19.7
30.1
32.0
30.0
$677.1
$750.0
$785.0
$798.0
595.7
667.5
685.0
697.7
38.7
47.0
52.4
52.7
5.1
4.7
9.6
10.2
$639.5
$719.2
$747.0
$760.6
Operating income (loss)
$37.6
$30.8
$38.0
$37.4
Non-operating income (loss)
$51.7
($2.8)
$25.8
$10.9
Net income (loss)
$89.3
$28.0
$63.8
$48.3
Principal payment
$13.9
$14.0
$15.3
$15.3
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Total operating expenses
25
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal
Years
Description
Feb-11
Feb-12
Feb-13
Assets
Operating cash and investments
$105.4
$64.2
$171.4
Patient accounts receivables
103.2
134.1
119.6
Property, plant and equipment
638.7
698.5
765.5
Depreciation reserve and other investments
221.1
181.5
222.1
Endowment Funds
371.2
397.8
444.3
Other assets
183.3
235.6
207.1
$1,622.9
$1,711.7
$1,930.0
Current portion long-term debt
$9.0
$11.8
$16.2
Accounts payable & other liabilities
95.3
109.6
100.8
Long-term debt
330.3
315.4
417.1
Accrued leave and other LT liabilities
146.3
132.7
129.2
$580.9
$569.5
$663.3
$1,042.0
$1,142.2
$1,266.7
$1,622.9
$1,711.7
$1,930.0
Total Assets
Liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
26
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Feb-11
Operating margin (%)
Feb-12
Budget/Target
Feb-13
Feb-13
5.6%
4.1%
4.8%
4.7%
12.3%
3.7%
7.9%
6.0%
2.0
1.6
2.5
2.4
166.6
147.0
190.0
190.0
Gross accounts receivable (days)
50.1
49.8
46.7
45.0
Annual debt service coverage (x)
7.0
4.3
5.0
5.2
33.0%
29.8%
33.7%
31.8%
6.8%
7.2%
8.3%
8.3%
Total margin (%)
Current ratio (x)
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Acute Admissions
Patient days
SS/PP Patients
Feb-11
ER visits
Medicare case mix index
Feb-13
Feb-13
18,367
18,920
19,124
19,378
110,920
113,132
112,453
112,031
5,969
6,985
6,899
6,635
6.01
5.84
5.71
5.50
451,902
502,744
506,443
499,130
38,683
40,890
40,883
40,938
2.01
2.11
2.04
6,322
6,683
6,887
Average length of stay
Clinic visits
Feb-12
Budget/Target
2.08
Occupancy %
FTE's (including contract labor)
27
6,987
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - February FY13
ADMISSIONS and CASE MIX - Year to Date
Actual
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Transitional Care
Subtotal Acute
Budget
OPERATING STATISTICAL MEASURES - February FY13
OTHER INSTITUTIONAL MEASURES - Year to Date
% Variance
Prior Year
16,265
1,899
767
193
19,124
16,257
2,088
801
232
19,378
0.0%
(9.1%)
(4.2%)
(16.8%)
(1.3%)
15,959
2,055
795
111
18,920
6,899
6,635
4.0%
6,985
Total Admissions
26,023
26,013
0.0%
25,905
Adjusted Admissions
35,588
35,979
(1.1%)
34,730
Short Stay/Post Procedure
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
1.90
2.04
1.95
2.08
28
REVENUES and EXPENSES - Year to Date
($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
Actual
$
752,961
32,066
785,027
Budget
$
% Variance
Prior Year
719,966
30,111
750,077
1.2%
(4.4%)
9.3%
0.5%
5.9%
1.8% $
1.8% $
136.6%
$
332,930
172,033
162,579
47,001
4,715
719,258
30,819
4.1%
(2,801)
32.3%
$
28,018
$
$
$
63,914
$
48,319
Budget
% Variance
Prior Year
112,453
5.71
462
1,092
112,031
5.50
461
1,098
0.4%
(3.8%)
0.2%
(0.5%)
113,132
5.84
463
1,071
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
506,443
3,287
40,883
499,130
3,244
40,938
1.5%
1.3%
(0.1%)
502,744
3,246
40,890
13,004
6,705
19,709
13,452
6,153
19,605
(3.3%)
9.0%
0.5%
13,516
5,426
18,942
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
OPERATING FINANCIAL MEASURES - February FY13
OTHER INSTITUTIONAL MEASURES - Year to Date
(2.0%)
7.2%
(1.6%) $
356,877
171,360
169,488
52,653
10,187
760,565
37,393
4.7%
10,926
$
$
1.95
2.11
768,044
29,914
797,958
352,506
178,852
153,645
52,365
9,591
746,959
38,068
4.8%
25,846
$
$
$
(2.6%)
(1.9%)
Actual
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
($s in thousands)
NET REVENUE BY PAYOR:
Medicare
Medicaid
Commercial Insurance
Anthem
Southern Health
Other
Total Paying Patient Revenue
OTHER:
Collection % of Gross Billings
Days of Revenue in Receivables (Gross)
Cost per CMI Adjusted Admission
Total F.T.E.'s (including Contract Labor)
F.T.E.'s Per CMI Adjusted Admission
Actual
Budget
$ 240,013
91,308
159,084
138,663
20,109
103,783
$ 752,961
$ 251,527
87,135
160,270
135,148
21,688
112,276
$ 768,044
$
32.63%
46.7
11,097 $
6,887
24.86
32.90%
45.0
10,887
6,987
24.31
% Variance
(4.6%) $
4.8%
(0.7%)
2.6%
(7.3%)
(7.6%)
(2.0%) $
(0.8%)
(3.8%)
(1.9%) $
1.4%
(2.3%)
Prior Year
233,609
80,928
148,853
125,520
20,143
110,914
719,966
34.44%
49.8
10,668
6,683
24.18
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 - February 28, 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
29
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)
Year to Date
February
2012-13
INDIGENT CARE (IC)
Net Charge Write-Off
Annual Activity
2011-12
2010-11
154,387
207,515
195,645
Percentage of Net Write-Offs to Revenue
6.69%
6.46%
6.89%
Total Reimbursable Indigent Care Cost
54,668
73,481
69,513
State and Federal Funding
52,438
70,483
66,677
96%
96%
96%
Total Indigent Care Cost Funding As a Percent
of Total Indigent Care Cost
Unfunded Indigent Cost
2,230.47
2,998.03
2,836.12
Annual Activity
February
2012-13
BAD DEBT
2011-12
2010-11
Net Charge Write-Offs
17,915
30,942
25,838
Percentage of Net Write-Offs to Revenue
0.78%
0.96%
0.91%
Note:
Provisions for bad debt write-offs and indigent care write-offs are recorded for financial statement purposes based on the
the overall collectability 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.
30
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
V.C.
ACTION REQUIRED:
None
Capital Projects
BACKGROUND: The Medical Center is constantly improving and
renovating its facilities. We will provide a status report of
these capital projects at each MCOB meeting.
DISCUSSION: The current Medical Center capital projects report is
set forth in the following table:
31
The University of Virginia Medical Center
Capital Projects Report
May 20, 2013
Scope
1. Planning
Education Resource Center
BOV
Projected
Budget
Funding Source
Approval
Completion
$25.4 M
Bonds & Other
Pending
2016
$20 M
Operating
Pending
2016
Date
Date
A contract was awarded to CO
Architects 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
A contract was awarded to Perkins &
Will in November 2012 to provide
planning services for the Master plan
of University Hospital 7th & 8th floors
32
The University of Virginia Medical Center
Capital Projects Report
May 20, 2013
Scope
2. Under Construction
Battle Building:
BOV
Projected
Budget
Funding Source
Approval
Completion
$117 M
Bonds and Outside
N/A
2014
$21.2 M
Bonds
Feb 2008
2013
Bonds & Other
June 2010
2013
Fundraising
The Groundbreaking Ceremony was
Date
Date
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.
University Hospital:
Renovate Radiology Department.
Construction of final phase is
complete. Punch list and final
Health System Precinct:
(52,000 GSF)
$36.5M
Realignment of Lee St. and
construction of new chiller plant.
Realignment of Lee St. to be
complete summer of 2013. Steel
erection for the new chiller plant is
complete. Cooling towers have been
set and the mechanical piping is ongoing. Façade work is on-going.
33
Connective Elements:
$30.3M
Bonds & Other
Create new front entrance to the
Jan 2007
Nov 2010
Hospital, bridge over Lee Street,
Oct 2010
connector building, and expanded
lobby. Structural work complete;
interior finishing and final site work
underway.
34
2014
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
V.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
December 1, 2012 – March 30, 2013
The School of Nursing received a $5 million commitment in
support of its Clinical Nurse Leader (CNL) Program. The gift will
double the size of the current program from 48 to 96 students over
the next five years, will help provide critical financial aid to
these students, will expand the CNL program to a second clinical
site in an underserved area, and will hire faculty to teach the
program’s expanded enrollment.
A $2 million realized bequest was received from the estate of
a medical alumnus in support of the Arthur Ebbert Jr. Scholarship
in the School of Medicine.
A member of the Children’s Hospital Committee and her husband
documented a $1 million planned gift in support of the Battle
Building at UVA Children’s Hospital.
A $1 million contribution was received from Altria for the
balance of the company’s pledge in support of the Virginia Center
for Translational and Regulatory Sciences (VCTRS).
A $750,000 final distribution was received in support of the
Paul H. Wornam Scholarship in the School of Medicine.
Notification was received of a pending $600,000 realized
bequest in support of the diabetes clinical and research program.
The School of Medicine received a $340,885 distribution on a
previously reported estate gift to be used for unrestricted
purposes.
35
A $275,000 estate distribution was received in support of the
Balderson Chair in the Department of Otolaryngology.
A medical alumnus and his wife established a $250,000 planned
gift to fund a scholarship in the School of Medicine.
A $250,000 realized bequest was received for the School of
Medicine Class of 1965 class fund.
A $200,000 gift was received from the Ivy Foundation in
support of the Ivy Foundation Innovations Fund in the School of
Medicine.
A $150,000 contribution was received in support of the GrandAides Program.
A $149,432 distribution was received from the Children’s
Miracle Network for the fourth quarter of 2012, representing an
increase of more than $49,000 over last year’s distribution.
A $147,000 gift of life insurance was received in support of
Pediatric Cardiology.
An in-kind contribution of 10,000 children’s books, valued at
$136,396, was received for distribution to Kluge Children’s
Rehabilitation Center patients seen in specialty clinics
throughout 2013.
A $100,000 contribution was received in support of Dr.
Michael Weber’s melanoma research in the Department of
Microbiology.
A $100,000 contribution was received in support of the Helen
Pappas Family Endowment Fund in the School of Medicine.
A School of Medicine faculty member documented a $100,000
bequest in support of the Department of Pediatrics division of
Pediatric Nephrology.
A UVA alumnus and grateful parent documented a $100,000
bequest in support of neonatal care at UVA Children’s Hospital.
A School of Medicine faculty member committed $100,000
towards the establishment of a chair in the Department of
Dermatology.
The School of Nursing received its first $100,000 pledge in
support of the Nursing Faculty Legacy endowment, a pooled
36
endowment providing permanent resources to the dean for
recruitment, retention, and start-up packages for faculty.
A UVA Health Foundation trustee and his wife, who serves on
the School of Nursing Advisory Board, have committed $100,000
through their family foundation in support of the Rodriguez
Nursing Student Research and Leadership Fund.
A UVA alumnus and his wife contributed $100,000 in support of
the Focused Ultrasound Foundation’s Parkinson’s disease trial at
UVA. The $1.2 million trial will also be funded in part through
an additional $100,000 commitment by a UVA Health Foundation
trustee and her husband.
Other gifts and pledges received include:
•
•
•
•
•
•
•
•
•
A $74,260 commitment in support of the Jack M. Gwaltney, Jr.,
Professorship in Infectious Diseases in the School of Medicine;
$60,860 raised through UVA’s 15th Annual Dance Marathon in
support of the Children’s Miracle Network at UVA Children’s
Hospital;
A $50,000 planned gift in support of the School of Medicine;
A $50,000 commitment in support of the Joseph Berger Memorial
Fund in the Department of Obstetrics and Gynecology;
A $50,000 commitment in support of Dr. Michael Thorner’s
research in endocrinology;
A $50,000 gift in support of Dr. Jeff Young’s research in the
Department of Surgery;
A $50,000 commitment in support of the Teen Health Education
Program;
A $50,000 commitment in support of Dr. David Jones’ lung cancer
research; and
A $50,000 gift to help establish a chair in the Department of
Dermatology.
OTHER DEVELOPMENT INITIATIVES
Representatives from the University development community met
with Altria executives to follow up on President Teresa Sullivan’s
meeting with Altria in November and to discuss next steps for
expanding the University’s relationship with the company through
individual school and program relationships as well as high-level
strategic initiatives.
The UVA Children’s Hospital Main Event “Soiree” gala was held
on February 2. Almost 400 guests attended, including Medical
37
Center Chief Executive Officer Ed Howell, Department of Pediatrics
Chair Dr. James Nataro, and other key Medical Center and
Children’s Hospital leadership. The event raised a record
$256,000 in support of the Battle Building, surpassing last year’s
fundraising total by $39,000.
Former UVA Health Foundation trustee Paul Manning met with
development staff to review his philanthropic projects and
planning for 2013-14, expressing an interest in continued support
of type 1 diabetes as well as learning more about UVA’s efforts in
stem cell research. The Manning Symposium benefactor’s dinner
will be held at Carr’s Hill on April 25.
The Medical Alumni Association held their Annual Meeting in
Williamsburg in February.
The School of Nursing has received more than 45 gifts to date
in memory of Wade Lancaster, husband of emeritus dean Jeanette
Lancaster, who passed away unexpectedly on February 3 while on the
Semester at Sea voyage in Shanghai. The gifts will support the
James Howard Miller Endowed Scholarship, which Wade Lancaster
created to honor Jeanette’s father.
More than 70 guests attended the School of Nursing
Scholarship Celebration Luncheon on February 16.
The Communications team assisted in the production of a
Medical Center direct mail solicitation that was sent to
approximately 25,000 current patients with a message highlighting
UVA’s contribution to better health across our community and
beyond. The team also created various videos and collateral in
support of several engagement and fundraising events, and produced
issues of Investing in Hope and Pulse, which included a campaign
honor roll of donors.
To date in fiscal year 2013, Health System development
officers have made a total of 1,035 face-to-face visits with
donors and prospects.
38
CAMPAIGN PROGRESS THROUGH FEBRUARY 28, 2013
As of February 28, 2013, the Campaign for Health total is
$645,144,533, or 129% of the original $500 million goal.
FY 13 through
2/28/13
New Gifts
FY 12 through
2/28/12
$23,423,249
$26,712,525
$776,060
$1,592,519
Total New Commitments (excludes
pledge payments on previously
booked pledges)
$24,199,309
$28,305,044
New Expectancies
$10,110,316
$2,300,000
Total new gifts, pledges, and
expectancies
$34,309,625
$30,605,044
New pledges
39