UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
September 19, 2013
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
4th
Thursday, September 19, 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.
OPENING COMMENTS FROM THE CO-CHAIRS
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
development of an accountable care organization,
potential joint ventures or affiliations, 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
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
III.
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.
Annual Compliance Report
2
C.
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)
4
D.
Capital Projects
21
E.
Health System Development
24
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.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:
September 19, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.B.
ACTION REQUIRED:
None
Annual Compliance Report
BACKGROUND: The Corporate Compliance Program was established to
ensure that the Medical Center operates in full compliance with
applicable laws. The Corporate Compliance and Privacy Office
prepares an annual project schedule that reflects potential risks of
noncompliance with state or federal laws and regulations. The
Office reports quarterly to the Corporate Compliance Steering
Committee and to the Audit and Compliance Subcommittee of the Board
of Visitors to seek approval of its annual project plan, provide
updates on the status of completed projects, and inform those groups
of any significant compliance or privacy risks.
DISCUSSION: The Medical Center proactively sought a review of its
compliance with the Privacy and Security Rules created under the
Health Insurance Portability and Accountability Act (HIPAA). The
Health System sought to assess its readiness in the event of an
audit by the Office for Civil Rights, which enforces this Act. The
Office for Civil Rights website posted a sample audit tool and our
consultant used this document to assess compliance with the Privacy
and Security Rules by the Medical Center, the University Physicians
Group, and the School of Medicine. The review was completed in May
2013, and the overall degree of compliance for all entities was
quite good. Leaders are being assigned responsibility for
implementation of the recommended enhancements.
The Medical Center reported its first large-scale privacy
breach to the Office for Civil Rights in November 2012. The breach
resulted from the loss of an unencrypted hand-held device used by
Continuum Home Infusion on-call pharmacists and containing health
information for 1,846 individuals. These individuals were notified
in writing of the breach and were offered credit monitoring when
indicated. The Medical Center found no evidence the device had been
accessed or that it had been found. Education, policy reviews and
enhancements, discipline, and a broader review of similar devices
were implemented.
Connolly is the Medicare Recovery Audit Contractor assigned to
Virginia whose primary purpose is to identify improper payments by
Medicare. The Compliance Office serves on the Medical Center’s
Finance Payor Audit Review Committee, which reviews Connolly’s
2
medical record and claim requests as well as other payor audit
requests. The Medical Center receives approximately 400 medical
record requests every 45 days from Connolly. The reviews focus
primarily on medical necessity and inpatient coding validation among
other identified issues.
On October 1, 2014, the International Classification of
Diseases Ninth Revision (ICD-9) code sets used to report medical
diagnoses and inpatient procedures will be replaced by the ICD Tenth
Revision (ICD-10) code sets. The transition to ICD-10 is required
for everyone covered by HIPAA. The Chief Corporate Compliance and
Privacy Officer is a member of the ICD-10 Executive and Oversight
Committees and the office serves on ICD-10 project work teams. The
ICD-10 project vision is to produce a meaningful plan for ICD-10
implementation emphasizing the importance of complete and accurate
clinical documentation that will support the Medical Center and the
University Physicians Group mission of delivering innovative and
superlative quality patient care, training of health professionals,
and the creating and sharing of health knowledge. Transitioning to
ICD-10 has the potential to have significant financial and
operational impacts for the Medical Center. Diagnosis codes will
expand from 13,000 to 68,000 codes and procedure codes will expand
from 11,000 to 87,000 codes with the latter for use only in United
States inpatient hospital settings.
The Corporate Compliance and Privacy Office additionally
continues to complete special projects, such as overseeing hospital
billing compliance and responding to privacy inquiries from
government and regulatory agencies, providing consultation and
guidance, and preparing and delivering compliance and privacy
education.
3
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.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 30,000th appointment in July
2013. For fiscal year 2013, 14,526 appointments were made through
Care Connection with over half (51.6%) coming from non-University
employees and family patients. HealthGrades accounted for 1,311
(9.0%) and inpatient discharge appointments were 1,131 (7.8%).
The Ambulatory Clinics exceeded the patient satisfaction 50th
percentile for the sixth straight quarter (through June 2013). In
addition, the clinics reached the 60th percentile during the third
quarter of fiscal year 2013, the highest ranking quarter in four
years.
4
Patient Care Services
Continuum Home Health opened its pediatric home care program in
June and is now providing pediatric services throughout Continuum’s
11 county direct service area.
Clinical Ancillary Services
Medical Laboratories
Plans are currently underway to create a Clinical Genomics
Laboratory in the West Complex. This new laboratory will focus on
next generation and whole genome sequencing for patients who fall
into one of three disease groups: (1) inherited disorders, which
include targets for approximately 500 known genetic disorders,
primarily aimed at pediatric patients; (2) a cardiomyopathy/
cardiovascular panel aimed at both pediatric and adult patients; and
(3) a tumor-associated panel including over 40 gene targets for
inherited cancers. The laboratory will focus on patient testing as
well as developing partnerships with researchers and vendors for
clinical trials.
Imaging Services
Mobile mammography screening services were provided to 100
women over a two-day period at the 2013 Remote Area Medical (RAM)
Clinic held in Wise, Virginia in July.
A collaborative effort between the Medical Center’s Imaging
Services and the University of Virginia Imaging Center was initiated
in early August to enable outpatient exams to be scheduled through
one central phone number for any of the imaging sites. Referring
physician offices are now able to call one phone number to access
all outpatient imaging sites and schedule appointments.
Scheduling guidelines have been established and include patient
preferences, other clinical appointments, multiple exams, and next
available time slots.
Pharmacy Services
A new employee-only pharmacy distribution center, the Uteam
Connections Window, recently opened in the Medical Center’s West
Complex offering employees VIP customer service while also
increasing employee prescription capture. A new retail pharmacy
located in the Newcomb Hall Bookstore opened in August. Plans are
also in progress to open a retail pharmacy in the new University of
Virginia Medical Park Zion Crossroads facility and at the Hope
Cancer Care Augusta facility to serve both patients and employees in
those locations. Planning has also been initiated for relocation of
5
the current Barringer pharmacy to the planned Educational Resource
Center building in 2014-2015.
Pharmacy Services initiated a new contract with Pharmedium
repackaging services to facilitate the filling of inpatient pharmacy
CADD pump cassettes. Pharmacy Services is also assessing the 340B
drug pricing program and evaluating a new medication delivery
modality for the Operating Room which uses Radio Frequency
Identification (RFID) technology and dispensing automation to better
ensure accuracy and safety.
The Department of Pharmacy graduated 12 pharmacy residents,
many of whom were retained to accept positions within the Health
System. The Department also completed its first year in partnership
with the Virginia Commonwealth University School of Pharmacy Annex
and is preparing for the next class of students.
Community Outreach
The ninth annual Pink Polo Match was held at King Family
Vineyard on Father's Day with over 2,500 attending the all-day
event. Health System Community Relations staffed the auction and
shirt sales that contributed to the earnings for the activity. This
event supports the Breast Resource Center and the Emily Couric
Clinical Cancer Center.
Community Relations and several clinical areas of the Health
System participated in the inaugural community Health Expo, drawing
over 600 attendees to the downtown Main Street Arena on April 20.
Clinical representation from the Health System included the Hand
Center, Transplant Program, Brain Trauma therapists, and UVA Club
Red, which enrolled over 150 new participants.
The annual RAM Clinic was held July 19 - 21, 2013, at the
Virginia-Kentucky Fairgrounds in Wise, Virginia. During the two and
a half day clinic, over 80 volunteers from the University of
Virginia Health System participated in the event. Our medical team
support provided over 2,400 volunteer hours with additional
participation from the mobile mammography unit and Gynecology
clinic. An extended array of medical services and diagnostic
services were provided.
The Health System and University Office of the Vice President
and Chief Officer for Diversity and Equity partnered with Martha
Jefferson Hospital and the Virginia Department of Health to offer a
community health fair as part of the 24th Annual African-American
Cultural Arts Festival held July 27 at Booker T. Washington Park.
Health screenings offered included blood pressure checks, body mass
index measurements, pulmonary function checks, vision and hearing
tests, and testing for diabetes, kidney disease and peripheral
6
artery disease. Information was made available on numerous health
topics, including aging, Alzheimer’s disease, cancer, heart disease,
stroke, prostate disease, poison prevention, and nutrition.
Environment of Care
Arts Committee
The University of Virginia Health System Arts Committee
presented an exhibition of paintings by Richard E. Bednar entitled
“In the Country” from May 3 to June 28, 2013. Mr. Bednar, an
employee of the Medical Center, enjoys painting portraits, still
life, and daily observances of country life by the James River. A
collection of photographs by Frank Feigert was on display in the
University Hospital lobby from June 28 to August 30, 2013. The
exhibition entitled “Sightings” featured works by Mr. Feigert taken
during his more than 60 years as a photographer.
Environmental Services
Tony Caswell, Director of Environmental Services, received the
2013 Terry Batchelor Award for Leadership Excellence from Crothall
Services Group for embodying the values of integrity and leadership.
Tony was cited for mentoring Environmental Services team leaders and
housekeepers to reduce bed turn times and improve patient
throughput. Out of respect for Tony’s confidence in them and his
innovative teaching and training approaches, the Environmental
Services team leaders wrote and produced a video entitled “Seconds
Matter” featuring a title song sung by a housekeeper to lyrics
written by a team leader. The video is now included as a national
teaching tool.
Facilities
After three years of renovations, the newly expanded University
Hospital lobby opened to the public in mid-July. On July 15, a
ribbon cutting ceremony was held with comments by Patrick Hogan, Ed
Howell, and Dr. Nancy Dunlap. Employees were treated to light
refreshments and live music by the University of Virginia Jazz
Quartet. Key features of the renovated lobby include new front
doors, a new staircase between the first and second floors, and a
new pedestrian bridge from the parking garages.
The two year ICU renovation project was successfully finished
in July, with the completion of renovations to the Nerancy Neuro
Intensive Care Unit (NNICU).
7
Sustainability
The Medical Center’s Sustainability Work Group celebrated Earth
Week in April with educational and interactive displays reflecting
multiple ways in which the Medical Center participates in
sustainability efforts.
Health System Technology Services
The upgrade of the Epic clinical information system to the Epic
2012 Denali platform occurred as scheduled on June 22 without
incident. Virtually all eligible users of Epic completed the
required training for the new version prior to the upgrade. No
significant upgrade related issues have been reported. The enhanced
code level will facilitate both new Stage 2 Meaningful Use and ICD10 build.
As a part of the national mandate by the Centers for Medicare
and Medicaid Services to implement the ICD-10 coding and
classification system on October 1, 2014, the Health System has
formed a multidisciplinary team to manage this effort. Individual
work teams have been created to address specific tasks related to
training and communications, clinical documentation and coding,
revenue cycle and business support, IT System remediation, Epic
improvements, clinical support, and quality.
Human Resources
Employee Engagement
Gallup, the new employee engagement survey vendor for the
Health System, conducted a census survey in July for all five Health
System entities. Overall employee participation in the survey was
77%. Findings from the survey will be shared with Health System
executive leaders on September 4 and 5, and will be used to identify
common areas throughout the Health System that need focus and
improvement. The information will then be shared with Health System
managers through a series of educational sessions in September and
October in which managers will learn how to interpret and
communicate findings and develop action plans.
Recruitment
Medical Center Human Resources has increased its nurse
recruitment efforts, resulting in the hiring of 80 new Registered
Nurses since January 2013. Of the 80 Clinician I hires, 32 were
University of Virginia School of Nursing graduates. Plans are
underway to host another Clinician I hiring event for the 2014
graduating class at the Boar’s Head Inn in October. Plans are also
8
underway to host a “Virtual Job Fair” in October in an effort to
hire more experienced registered nurses.
Medical Center Human Resources has also scheduled a series of
recruiting events in August and September to target markets where
layoffs are occurring at several regional hospitals.
Organizational Development
The Uteam Leadership Academy Best Practices Series expanded
efforts in July to reach more leaders focused on Transactional
Leadership. The number of spots available for attendees has doubled
for fiscal year 2014. Participants obtain tools for use in areas
such as trust, engagement, managing change, accountability, and
developing and recognizing employees. A new series of classes for
leaders entitled “Best Practices II” has been added. This series
focuses on creating transformational leaders, and participants
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 respective
manager and supervisor.
A new program “Onboarding Essentials”, designed to welcome new
hires into the organization in a more engaging format, has shown
great success. Medical Center managers are actively using the
program’s tools and activities. The program focuses on
implementation of eight core activities including behavioral based
interviewing, peer interviewing, the new employee profile, a new
employee “Pleased to Meet You” ID badge, a buddy system, welcome
resources and events, new employee meetings, and recognition.
Follow-up surveys are sent to new employees to gauge the
organization’s effectiveness at implementing the new program.
Preliminary findings show that six of the eight core activities are
being successfully implemented, and action plans are underway to
heighten manager awareness and compliance for all eight core
activities.
The Uteam Leadership Academy Informal Leader program graduated
an additional 60 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.
Employee Recognition and Rewards
The following events and activities were hosted in recognition
and appreciation of the many accomplishments of our valued
employees:
9
•
Outstanding Contributor Awards were presented to five Medical
Center employees: Virginia Friend, an RN Care Coordinator in
the Emily Couric Clinical Cancer Center; Bill Graves, a
Surgical Supply Specialist in Central Sterile Supply; Stephanie
R. Reed, a Physical Therapist on the Physical Therapy Team;
Linda Shifflett, a Patient Care Assistant on 5 East; and Kelvin
Tyree, a Patient Care Technician in the Outpatient Surgery
Center.
•
Employees with 25 or more years of service were honored at the
annual service awards dinner held at John Paul Jones Arena on
June 4. This festive event for employees and guests was well
attended.
•
The “Uteam Market on Grove,” an outside farmers’ market
targeted for Health System employees and families, opened in
June. Over 300 employees participate each week and take
advantage of fresh, locally grown produce as well as breads,
meats, and pies.
•
The UVA Health System and Belk invited all employees and their
families to a private shopping event at the Belk’s store in
Fashion Square Mall on Sunday, August 11. Over 1,500 were in
attendance.
•
Health System Senior Leadership hosted the Uteam Summer Chill
event on August 12 and 13 to thank all employees for what they
do each and every day to give our patients their very best.
Senior leaders handed out popsicles and mini sunscreen tubes in
the East and West Cafeterias and on night rounds in the main
Hospital.
Quality and Performance Improvement
Quality and Patient Safety Initiatives
The Joint Commission certified the University of Virginia
Medical Center’s total joint replacement program for knees and hips
and our stroke program. Each program was reviewed on site in June
by Joint Commission disease-specific care field reviewers who are
practicing clinicians in the specific field. To be certified the
program must demonstrate a systematic approach to care delivery and
a commitment to ongoing data collection and analysis to improve
patient care.
The Virginia Department of Behavioral Health concluded the
review of our psychiatry services in May and the Medical Center’s
10
license to provide inpatient psychiatric services was renewed for
another three years.
The Centers for Medicare and Medicaid Services conducted an onsite review of the Medical Center’s Orange Dialysis facility. No
deficiencies were cited.
The University of Virginia’s Children’s Hospital was the only
entity in the nation to score 100% compliance in the past year with
the Children’s Asthma Care performance measure, one of the National
Hospital Inpatient Quality Measures specified by The Joint
Commission and Centers for Medicare and Medicaid Services.
The laboratory at University of Virginia Hope Cancer Care at
Pantops has been selected as a recipient of the Commission on Office
Laboratory Accreditation (COLA) Laboratory Excellence Award. This
award is achieved by those COLA laboratories that are found to be
compliant with all COLA essential and required criteria at the time
of their on-site survey. Award recipients must have demonstrated
successful proficiency testing for the prior three testing events
and have no valid complaints against the laboratory.
Two Good Catch awards were presented to employees in
recognition of their efforts in anticipating a quality event and
taking steps to prevent a bad outcome. These awards were presented
to these employees and celebrated at the Fridays Before Five
sessions.
Recognition and Awards
U.S. News “Best Hospitals” guide recently honored 10 University
of Virginia programs. The Health System’s Diabetes & Endocrinology
program was ranked 35th in the 2013-2014 guide, placing the program
among the top 3% of U.S. hospitals with a nationally ranked program.
Nine additional programs were recognized as high-performing for
ranking among the top 25% in their respective specialties: Cancer,
Ear, Nose & Throat, Gastroenterology & GI Surgery, Gynecology,
Nephrology, Neurology & Neurosurgery, Orthopaedics, Pulmonology, and
Urology.
For the second consecutive year, the University of Virginia
Health System earned a “Most Wired” award from Hospitals & Health
Networks magazine for implementing and using technology to support
quality and safe patient care. The award is based on a national
survey of hospital technology use. According to Hospitals & Health
Networks’ website, hospitals receive the award “based on progress
in adoption, implementation and use of information technology” in
the areas of clinical quality and safety, clinical integration,
infrastructure, and business and administrative management.
11
The National Association of Epilepsy Centers (NAEC) has
recognized the Health System’s F.E. Dreifuss Comprehensive Epilepsy
Program as a Level 4 Epilepsy Center, the association’s highest
rating. “Level 4 epilepsy centers have the professional expertise
and facilities to provide the highest level medical and surgical
evaluation and treatment for patients with complex epilepsy,”
according to a letter from NAEC recognizing the Health System’s
program.
For consistent efforts to improve stroke care and patient
outcomes, the American Heart Association (AHA) has given the Health
System two awards. The Health System received the AHA’s Get With
The Guidelines® – Stroke Gold Plus Quality Achievement Award and its
Target: Stroke Award for meeting or exceeding a series of quality
benchmarks vital to providing excellent stroke care.
MHAdegree.org has ranked the University of Virginia Health
System 33rd on the list of top 50 most social media friendly
hospitals among the hospitals with a nationally ranked program by
U.S. News & World Report. The rankings were calculated based on the
number of followers and the amount of activity on several social
media platforms. Our social media efforts are led by the Web Team
in the Health System’s Marketing Department.
Supply Chain
A new Pyxis supply technology from CareFusion is currently
being installed. The new system uses a wireless device that
attaches directly to existing storage units to enhance point-of-use
supply inventory automation. The technology enables automatic
ordering of supplies without a significant human interface (the
current process requires approximately seven FTEs to complete). The
technology supports rapid dissemination of utilization and cost data
to managers of each unit.
The Low Unit of Measure order delivery system introduced
earlier this year is now fully operating well within established
parameters. Previously identified issues have been resolved.
FINANCE REPORT
After 11 months of operations in fiscal year 2013, the
operating margin for all business units was 6.4%, which was above
the budget of 4.9%. However, the fiscal year 2013 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 5.5% without those adjustments.
12
During the first 11 months of the fiscal year, inpatient
admissions were 0.2% above budget and 1.8% above the prior year.
Average length of stay was 5.63 days, which was above the budget of
5.50 days but below the prior year’s 5.83 day average length of
stay. The average length of stay was below budget in each of the
three most recent months (March, April, and May). Surgeries
performed at the Outpatient Surgery Center (OPSC) were 8.0% above
budget and 22.9% above the prior year. Capacity at the OPSC
increased with the addition of two modular operating rooms in June
2012.
Total operating revenue for fiscal year 2013 through May was
0.4% below budget and total operating expenses were 2.0% below the
budget.
Total paid employees, including contracted employees, were 117
below budget.
FY 2012
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2013
2013 Budget
6,511
6,667
6,831
$74,594
$76,448
$77,080
230
218
171
6,741
6,885
7,002
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.
In January, 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. Anthem did not accept our
proposal. However, at this time, our differences are reconcilable.
13
Our Health System is currently pursuing a number of initiatives
that focus on the emerging discipline of population health. Among
them is the Center for Medicare and Medicaid Innovation (“CMMI”)
Health Care Innovation Challenge, under which they will provide
funding to programs or projects that take a creative approach to
improving the health of Medicare and/or Medicaid populations. In
July, the Heath System applied for an Innovation Grant for a program
focused on an innovative care delivery model for adults suffering
from Alzheimer’s and children with complex medical needs. While
these are two very different populations, they have many similar
needs. In-home intervention serves as a core aspect of this
program, with medical oversight and management to be administered by
a team of focused nurse practitioners along with other community
support.
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $247.1 million for the period
July 1, 2012 through May 31, 2013, have been written off.
Recoveries during this period totaled $54.9 million.
Bad debt charges totaling $49.9 million have been written off
during the period from July 1, 2012 through May 31, 2013. During
this same period, $18.2 million was recovered through suits,
collection agencies, and Virginia refund set-off.
14
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
May-11
Net patient revenue
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Total operating expenses
Operating income (loss)
May-12
May-13
$925.7
$1,024.0
$1,061.5
$1,069.2
26.7
40.6
42.5
39.6
$952.4
$1,064.6
$1,104.0
$1,108.8
820.2
937.8
950.9
966.2
57.3
66.0
72.5
73.0
7.0
6.4
9.7
15.0
$1,010.2
$1,033.1
$1,054.2
$67.9
$54.4
$70.9
$54.6
$10.0
$35.1
Net income (loss)
$142.2
$64.4
$106.0
Principal payment
$19.2
$19.3
$21.1
15
May-13
$884.5
$74.3
Non-operating income (loss)
Budget/Target
$14.9
$69.5
$21.1
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
May-11
Operating margin (%)
May-12
May-13
Budget/Target
May-13
7.1%
5.1%
6.4%
4.9%
13.9%
6.0%
9.3%
6.2%
1.9
1.7
2.2
2.4
161.5
162.0
193.6
190.0
Gross accounts receivable (days)
46.6
49.7
44.2
45.0
Annual debt service coverage (x)
7.9
5.3
6.1
5.2
31.1%
34.2%
31.4%
31.8%
7.3%
7.2%
8.0%
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
May-11
Acute Admissions
Patient days
May-13
May-13
25,593
26,278
26,748
26,695
153,648
156,624
155,648
154,531
8,130
9,713
8,749
9,232
6.00
5.83
5.63
5.50
636,495
697,180
703,323
696,155
53,696
56,452
55,964
57,008
2.02
2.11
2.05
2.08
6,397
6,741
6,885
7,002
SS/PP Patients
Average length of stay
Clinic visits
May-12
Budget/Target
ER visits
Medicare case mix index
FTE's (including contract labor)
17
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date w ith Com parative Figures for Prior Year to Date - May FY13
OPERATING STATISTICAL MEASURES - May FY13
ADMISSIONS and CASE MIX - Year to Date
OTHER INSTITUTIONAL MEASURES - Year to Date
Actual
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Transitional Care
Subtotal Acute
Budget
% Variance
Prior Year
22,710
2,709
1,049
280
26,748
22,395
2,867
1,105
328
26,695
1.4%
(5.5%)
(5.1%)
(14.6%)
0.2%
22,116
2,838
1,138
186
26,278
8,749
9,232
(5.2%)
9,713
Total Admissions
35,497
35,927
(1.2%)
35,991
Adjusted Admissions
49,997
49,811
0.4%
48,425
Short Stay/Post Procedure
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
1.90
2.05
1.95
2.08
(2.6%)
(1.4%)
1.94
2.11
Actual
Budget
% Variance
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
155,648
5.63
465
1,443
154,531
5.50
461
1,523
0.7%
(2.4%)
0.9%
(5.3%)
156,624
5.83
466
1,431
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
703,323
3,280
55,964
696,155
3,253
57,008
1.0%
0.8%
(1.8%)
697,180
3,241
56,452
17,895
9,257
27,152
18,526
8,568
27,094
(3.4%)
8.0%
0.2%
18,612
7,530
26,142
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
OPERATING FINANCIAL MEASURES - May FY13
18
REVENUES and EXPENSES - Year to Date
($s in thousands)
NET REVENUES:
Net Patient Service Revenue
Other Operating Revenue
Total
Actual
Budget
1,061,500
42,540
$ 1,104,040
1,069,245
39,553
$ 1,108,798
EXPENSES:
Salaries, Wages & Contract Labor
486,429
Supplies
245,294
Contracts & Purchased Services
219,172
Depreciation
72,505
Interest Expense
9,728
Total
$ 1,033,128
Operating Income
$
70,912
Operating Margin %
6.4%
Non-Operating Revenue
$
35,081
495,386
235,711
235,105
72,988
15,008
$ 1,054,198
$
54,600
4.9%
$
14,932
Net Income
$
$
105,993
$
69,532
OTHER INSTITUTIONAL MEASURES - Year to Date
% Variance
Prior Year
(0.7%)
1,023,969
7.6%
40,644
(0.4%) $ 1,064,613
1.8%
462,465
(4.1%)
247,032
6.8%
228,293
0.7%
65,995
35.2%
6,461
2.0% $ 1,010,246
29.9% $
54,367
5.1%
134.9% $
10,076
52.4%
$
64,443
($s in thousands)
NET REVENUE BY PAYOR:
Medicare
Medicaid
Commercial Insurance
Anthem
Southern Health
Other
Total Paying Patient Revenue
Actual
$ 340,466
131,162
221,798
198,169
27,102
142,804
$ 1,061,501
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
Budget
$
363,819
125,105
215,610
189,885
31,367
143,439
$ 1,069,225
33.04%
44.2
10,900 $
6,885
24.34
33.06%
45.0
10,901
7,002
24.26
% Variance
Prior Year
(6.4%) $ 347,951
4.8%
119,648
2.9%
206,206
4.4%
181,603
(13.6%)
30,018
(0.4%)
138,544
(0.7%) $ 1,023,970
(0.1%)
1.8%
0.0% $
1.7%
(0.3%)
34.87%
49.7
10,778
6,741
24.17
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 - May 31, 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
19
18
Other Institutional Measures Assumptions
Patient Days, ALOS and ADC figures include all patients except normal newborns
Surgical Cases are the number of patients/cases, regardless of the number of procedures performed on that patient
Assumptions - Operating Financial Measures
Revenues and Expenses Assumptions:
Medicaid out of state is included in Medicaid
Medicaid HMOs are included in Medicaid
Physician portion of DSH is included in Other
Non-recurring revenue is included
Other Institutional Measures Assumptions
Collection % of Gross Billings includes appropriations
Days of Revenue in Receivables (Gross) is the BOV definition
Cost per CMI Adjusted Discharge uses All Payor CMI to adjust
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 19, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.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 MCOB meeting.
DISCUSSION: The current Medical Center capital projects report is
set forth in the following table:
21
The University of Virginia Medical Center
Capital Projects Report
September, 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
Architectural selection is underway
for design services for the 7th and
8th floor to better align with the
current services provided by
Women and Children’s inpatient
programs.
22
The University of Virginia Medical Center
Capital Projects Report
September, 2013
Scope
2. Under Construction
Battle Building:
Projected
Budget
Funding Source
Approval
Completion
$117 M
Bonds and Outside
N/A
2014
$36.5M
Bonds & Other
June 2010
2013
$30.3M
Bonds & Other
Jan 2007
2014
Fundraising
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:
BOV
Date
Date
Realignment of Lee Street and
construction of new chiller plant.
Realignment of Lee Street 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 ongoing. Façade work is ongoing.
Connective Elements:
Nov 2010
Create new front entrance to the
Hospital, bridge over Lee Street,
connector building, and expanded
lobby. Expanded lobby and new
pedestrian bridge opened July,
2013. New gift shop opened
August, 2013. Work to renovate
existing areas of lobby underway.
Oct 2010
23
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 20, 2013
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.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
April 1 – July 31, 2013
A friend of the Health System is documenting a $1 million
bequest in support of the Amyotrophic Lateral Sclerosis (ALS)
program, one half for clinical research support and one half for
assistive technologies for ALS patients in financial need.
A former University of Virginia professor and his wife, a
University of Virginia alumnus, are documenting a $1 million bequest
for a Neuroscience Research Endowment.
The School of Nursing received a distribution of $525,351 from
a realized bequest.
The Lettie Pate Whitehead Foundation committed $314,000 to the
Schools of Medicine and Nursing for the Whitehead Scholarship Fund.
A current Health Foundation trustee and his wife have committed
a gift of $200,000 in support of the Department of Otolaryngology.
A School of Nursing alumnus is documenting a $200,000 bequest
to the Health System to include $150,000 for the School of Nursing
in support of health literacy programming and/or an outdoor
resiliency space, and $50,000 in support of Volunteer Services in
the Medical Center.
A medical school alumnus committed $100,000 for an endowed
lectureship in the Department of Plastic Surgery.
24
Members of the Department of Orthopaedics contributed $100,000,
which was matched by an additional $100,000 in departmental funds,
to create a named fund in support of a lectureship, research, and
resident travel opportunities in pediatric orthopaedics.
The Cancer Center received a $100,000 estate distribution in
support of the Jennie Flora Triple Negative Breast Cancer Research
Fund.
Other gifts and pledges received include:
•
•
•
•
•
•
•
•
•
•
An $85,000 bequest for the Robert M. Blizzard Professorship in
the Department of Pediatrics;
A $70,000 commitment to establish and provide current use funds
for a named fund for ovarian cancer research;
A $50,000 bequest for unrestricted use in the School of Medicine;
A $50,000 commitment from a member of the Heart and Vascular
Center Advisory Board for the George A. Beller Research
Initiative Fund;
A $50,000 commitment, made over five years, in support of
interventional radiology for fellows;
A $34,000 commitment for a fund supporting the Schools of Nursing
and Medicine;
A $30,000 commitment to support Bioethics and Medical Humanities
research and career development;
A $25,000 gift to the Battle Building at UVA Children’s Hospital;
A $25,000 realized bequest in support of the Department of
Orthopaedics; and
A $25,000 pledge in support of the Battle Building at UVA
Children’s Hospital;
OTHER DEVELOPMENT INITIATIVES
The School of Medicine has finalized an agreement with the Ivy
Foundation to purchase a 68,165 square foot building in the Fontaine
Research Park that will become the Ivy Translational Research
Building. Of the funds remaining after the purchase and
retrofitting of the building for research purposes, $5 million will
be used to create an endowment in the School of Medicine to match
grants provided through the Ivy Innovation Fund. The use of the
remaining funds will be determined following the development of the
School of Medicine strategic plan.
The School of Nursing hosted a reception on April 5 at the home
of Dean Dorrie Fontaine for UVA’s biennial Black Alumni Weekend.
25
The Health System Development office facilitated the April 19
Symposium on Midlife Women’s Health Issues, hosted by the Friends of
Dr. JoAnn Pinkerton.
The Health System Development office facilitated the second
annual Manning Diabetes Symposium and dinner, held on April 25 at
Carr’s Hill.
Medical School Reunion weekend was held April 26-28 with more
than 430 guests attending the weekend events. Health System
Development officers attended to meet with donors and prospects, and
follow-up communications were sent to remind recipients of the June
30 reunion giving deadline.
On May 4, Health System Development staff facilitated the 29th
annual Klöckner Pentaplast Walk for Kids, which raised nearly
$119,000 in support of the Battle Building at UVA Children’s
Hospital.
The School of Nursing hosted a number of events in May,
including Thomas Jefferson Society events on May 14-15, a breakfast
before Final Exercises on May 19, and an alumni event on May 22 in
Boston featuring Dean Fontaine for local alumni and attendees of the
annual American Association of Critical Care Nurses (AACN)
Conference.
The School of Nursing celebrated Reunions weekend on June 7-8,
welcoming guests for an open house as well as its annual Reunions
Luncheon, featuring Dean Fontaine and representatives of the Nursing
Alumni Association.
The Medical Alumni Association hosted a gathering for medical
alumni in the Boston and Providence, Rhode Island area on June 14,
featuring special guest Dr. Richard Pearson, outgoing Associate Dean
for Student Affairs.
Health System Development staff organized a meeting and dinner
at Carr’s Hill on July 9 for UVA and Altria senior leadership in
order to build on the successful relationships that have been
developing within the UVA community and to provide President Teresa
Sullivan and her leadership team with opportunities to share her
strategic plan and strengthen engagement with Altria. Altria’s
leadership also shared their ideas of focus during the discussion,
which covered wide-ranging topics such as leadership, innovation,
compliance, big data, and other key initiatives.
Dean Dorrie Fontaine met with a prominent School of Nursing
donor to share two big ideas for future philanthropic funding –
doubling UVA’s Nurse Practitioner Program and creating a
26
Compassionate Care initiative focused on retaining nurses and other
health care providers in the workforce. The donor expressed a
particular interest in compassionate care, and the School of Nursing
is now developing a follow up proposal.
The Health System Development Office Communications team
created collateral materials in support of development initiatives,
including solicitation materials, video e-blasts for the Cancer and
Children’s Hospital development teams, event-related materials, case
materials, solicitations, and newsletters supporting the
philanthropic endeavors of the Schools of Medicine and Nursing and
the Medical Center.
In fiscal year 2013, development officers made a total of 1,486
face-to-face visits with donors and prospects. To date in fiscal
year 2014, development officers have made 78 visits.
FUNDRAISING PROGRESS THROUGH June 30, 2013
As of June 30, 2013, the final Campaign for Health total stood
at $677,890,794, or 136% of the Health System’s original $500
million campaign goal.
FY 13
(through 6/30/13)
FY 12
(through 6/30/12)
$49,293,780
$35,044,386
$6,415,363
$3,192,139
Total New Commitments
(excludes pledge payments on
previously booked pledges)
$55,709,142
$38,236,525
New Expectancies
$14,413,411
$12,995,001
Total new gifts, pledges, and
expectancies
$70,122,553
$51,231,526
New Gifts
New Pledges
27