UNIVERSITY OF VIRGINIA BOARD OF VISITORS MEETING OF THE MEDICAL CENTER OPERATING BOARD FOR THE UNIVERSITY OF VIRGINIA MEDICAL CENTER September 13, 2012 UNIVERSITY OF VIRGINIA MEDICAL CENTER OPERATING BOARD Thursday, September 13, 2012 8:30 – 11:15 a.m. Small Auditorium, Harrison Institute Committee Members: Edward D. Miller, M.D., Chair Helen E. Dragas Victoria D. Harker Andrew K. Hodson, MB.Ch.B Patrick D. Hogan William P. Kanto Jr., M.D. Constance R. Kincheloe Stephen P. Long, M.D. Vincent J. Mastracco Jr. Charles W. Moorman The Hon. Lewis F. Payne Ex Officio Teresa A. Steven T. Dorrie K. Robert S. Gibson, M.D. R. Edward Howell John D. Simon Members: Sullivan DeKosky, M.D, FAAN, FACP Fontaine AGENDA I. ACTION ITEM II. III. PAGE 1 Albemarle Arthritis Associates, LLC Acquisition REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE MEDICAL CENTER (Mr. Howell) A. Vice President’s Remarks 3 B. Annual Compliance Report 4 C. Operations and Finance Update, including report from the Finance Working Group (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) 7 D. Capital Projects 26 E. Health System Development 29 EXECUTIVE SESSION ● To consider proposed personnel actions regarding the appointment, reappointment, resignation, assignment, performance, and credentialing of specific medical staff and health care professionals, as provided for in Section 2.2-3711(A)(1) 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. ● 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, outreach and other marketing and growth efforts, review of Health System Clinical Strategy Performance Dashboard, and 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; and – Consultation with legal counsel regarding compliance with relevant federal and state legal requirements, licensure, and accreditation standards, and ongoing litigation and arbitration matters; all of which will involve proprietary business information and evaluation of the performance of specific personnel. The relevant exemptions to the Virginia Freedom of Information Act authorizing the discussion and consultation described above are provided for in Section 2.2-3711 (A) (1), (6), (7), (8) and (22) of the Code of Virginia. The meeting of the Medical Center Operating Board is further privileged under Section 8.01-581.17 of the Code of Virginia. UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: September 13, 2012 COMMITTEE: Medical Center Operating Board AGENDA ITEM: I. Albemarle Arthritis Associates, LLP Acquisition BACKGROUND: At the May 21, 2012 Medical Center Operating Board meeting, a resolution was approved to acquire substantially all of the assets of the Albemarle Arthritis Associates, LLP medical practice. The Medical Center desires to amend the resolution. Since the proposal was submitted in May, we have determined that the space originally planned will not accommodate the program. Accordingly, a different site has been identified in the same area that will meet current and projected needs. As a result of the additional square footage and an increase in the cost per square foot for renovations plus contingency, the total facility cost has increased. We have also determined that the projected returns on a very conservative basis are slightly less than we originally projected. DISCUSSION: Albemarle Arthritis Associates, LLP is a threephysician practice located in Charlottesville. The practice operates a small infusion center that performs 1,400 infusions annually. The practice will be acquired and converted to a provider-based clinic, and the infusion center will be enlarged to perform at least 2,200 and as many as 4,500 infusions annually. The three physicians will be employed by the University of Virginia Physicians Group. This acquisition will improve access for the Medical Center’s infusion patients, expand the referral base for more complex care, and provide strong financial performance, with projected operating income over $1 million and operating margin in excess of 15% by the end of year four. The acquisition cost for Albemarle Arthritis Associates, LLP, is $200,000 plus the appraised value of the equipment, which is likely to be less than $50,000. We will be required to build out new space to accommodate the physicians, recruit an additional rheumatologist, and expand the number of infusion chairs at cost not to exceed $1,650,000. The all in cost to acquire Albemarle Arthritis Associates, LLP, including working capital of $600,000 until they are generating positive cash flow, is not to exceed $2,500,000. 1 The total cost reflected in the initial pro forma that was relied on for the May 21, 2012 resolution was $1,200,000. The increased cost of $2,500,000 reflects a need for additional space, the identification of a different site in the same area, an increase in the cost per foot for renovations, and the addition of a contingency. As a result of the additional square footage and an increase in the cost per square foot for renovations plus contingency, the total facility cost has increased. We have also determined that the projected returns on a very conservative basis are slightly less than we originally projected. ACTION REQUIRED: Approval by the Medical Center Operating Board, the Finance Committee, and by the Board of Visitors APPROVAL TO ACQUIRE_ALBEMARLE ARTHRITIS ASSOCIATES, LLP WHEREAS, the Medical Center Operating Board and the Finance Committee find it to be in the best interests of the University of Virginia and its Medical Center for the Medical Center to purchase substantially all of the assets of Albemarle Arthritis Associates, LLP; RESOLVED, the University, on behalf of the Medical Center, is authorized to acquire substantially all of the assets of Albemarle Arthritis Associates, LLP on such terms to be contained in a definitive agreement between the parties at a total investment not to exceed $2,500,000; and RESOLVED FURTHER, the President of the University or her designee in consultation with the Vice President and Chief Executive Officer of the Medical Center, and with the concurrence of the Chair of the Medical Center Operating Board and the Chair of the Finance Committee, is authorized to negotiate the terms of such acquisition, including execution of the definitive agreement, contracts, and all other documents necessary for the closing of the transaction, on such terms as the President of the University or her designee deems appropriate, and to take such other action as the President of the University or her designee deems necessary and appropriate to consummate the foregoing. 2 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: September 13, 2012 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.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. 3 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: September 13, 2012 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.B. ACTION REQUIRED: None Annual Compliance Report BACKGROUND: The Corporate Compliance Program was established for the Medical Center by the Board of Visitors in 1997. The purpose of the program is to ensure that the Medical Center operates in full compliance with applicable law primarily related to Medicare and Medicaid billing and reimbursement compliance. Today our Corporate Compliance and Privacy Office also includes oversight of HIPAA (Health Insurance Portability and Accountability Act) and patient privacy. The Corporate Compliance and Privacy Office prepares an annual project schedule to coincide with potential risks of noncompliance with Federal or State law or other regulations in the areas of billing, reimbursement, and privacy. The Office reports quarterly to the Corporate Compliance Steering Committee and to the Audit and Compliance Committee of the Board of Visitors and seeks approval of its annual project plan, provides updates on the status of completed projects, and informs those groups of any significant compliance or privacy risks. DISCUSSION: An important component of the Corporate Compliance Program is the Compliance Code of Conduct that defines the basic principles that the Medical Center, its clinical staff, employees, and agents must follow. The Compliance Code of Conduct is based on the mission and values of the Medical Center and was revised this year to incorporate elements such as the Health System’s strategic plan quality initiatives. The annual Corporate Compliance and Privacy project schedule is developed after review of the Office of Inspector General (OIG) Work Plan, review of industry publications, and feedback from members of Medical Center management to identify potential risk areas for the Medical Center. In addition to auditing and monitoring, the Office provides guidance on regulatory issues, offers education on compliance and privacy topics, and performs documentation, hospital billing, and privacy audits to assess the Medical Center’s compliance with Federal and State statutes, regulations, policies, and 4 procedures. The project schedule is based upon the risk analysis of the institution, regulatory publications and fraud alerts, management requests, and required follow-up to government settlements or audit review action plans. Scheduled compliance projects focus on reviewing the accuracy of the Medical Center’s inpatient claims, outpatient claims, and procedure area claims by assessing whether documentation in the medical record supports the services that were billed, confirming that the services were medically necessary, and determining that all provided services were correctly submitted on the claim. Privacy auditing and monitoring is another scheduled project and includes monthly site audits of clinical and operational areas to assess the effectiveness of physical, administrative, and technical safeguards for protected health information. In conjunction with the site audits, random electronic medical record accesses are reviewed to determine whether access to patient information is for work-related reasons or for other legally recognized purposes. The Office also reviews electronic medical record access for specific patients. Such a review will occur, for example, when a patient requests a review of access to their record or when the Office determines that the record of a high-profile patient could invite unauthorized access. Since June, 2012, the Office has enhanced its auditing and monitoring capabilities with the FairWarning® software. With FairWarning®, the Office receives daily alert reports that identify potentially inappropriate electronic medical record access, such as “family snooping” (staff or employees accessing the record of a family member). The Office investigates all suspected and reported protected health information privacy violations, completes a risk assessment to determine if a breach occurred, and reports all breaches of protected health information to the Department of Health and Human Services as required by law. The Office additionally completes special projects and provides consultation and education. Special projects include billing compliance and privacy inquiries from governmental and regulatory agencies such as the Department of Justice, the Office of the Inspector General, the Centers for Medicare and Medicaid Services, and the Office of Civil Rights, or from new enforcement actions announced through fraud alerts and other communication sources. The Office prepares and delivers the mandatory compliance and privacy training programs for all Medical Center employees, 5 submits bimonthly privacy reminders for Medical Center management, and provides departmental and area specific presentations as requested. The Office provides management and staff guidance on regulatory and contractual issues, clinical research, billing rules, new ventures, policy and procedure development, the electronic medical record, and interpretation of regulations and laws. The Office is represented on several committees to offer guidance related to compliance and privacy issues, including Grievance, Ethics, Health Information Management, Laboratory Compliance, Joint Commission Steering, and Operations Leadership. Connolly, the Recovery Audit Contractor assigned to Virginia to reduce improper Medicare payments, began limited activity with the University of Virginia earlier this year and in June, 2012, the Medical Center received its first complex review for 400 medical records. The Office serves on the Payer Audit Review group that reviews Connolly medical record and claim requests as well as other payer audits for correct claims and payments. Educating our workforce, developing trusting relationships, following the law, and reporting suspected noncompliance continue to be critical elements to enhance the culture of compliance for the Medical Center’s Corporate Compliance Program. 6 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: September 13, 2012 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.C. ACTION REQUIRED: None Operations, Finance, and Write-offs, BACKGROUND: 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 Medical Center Operating Board. In addition, the Medical Center provides an update of significant operations of the Medical Center occurring since the last Medical Center Operating Board meeting. 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. 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. FINANCE REPORT After 11 months of operations in fiscal year 2012, the operating margin for all business units was 5.0%, which was above the budget of 4.9%. The operating margin for the hospital and the Outpatient Surgery Center was 3.7% against a budget of 3.8%. The operating margins for UVA Imaging and Off-Campus Dialysis were above budget for fiscal year to date through May. The operating income for UVA Hope Cancer Care is slightly (0.1%) above the budget. The Medical Center participated in a class action lawsuit against CMS alleging that CMS had incorrectly computed changes in payments to hospitals for 2004 through 2011. The lawsuit was 7 settled in favor of the hospitals, and the net benefit to the Medical Center is $8,205,826. Through May, the Medical Center has already recorded 67% of the gain, and the final 33% will be recorded in June. During the first 11 months of the fiscal year, inpatient discharges were 1.4% above budget and 2.7% above the prior year. Average length of stay was 5.98 days, which was above the budget of 5.83 days, but below the prior year’s 6.00 average length of stay. The longer than expected length of stay can be partially explained by a Medical Center case mix index of 1.94, which was above the budget of 1.90. Observation patients, outpatient clinic visits, emergency room visits, and surgeries performed in the main hospital operating rooms were above budget and above the prior year. Total operating revenue for fiscal year 2012 through May was 2.5% above budget. Total operating expenses were 2.5% above the $1.015 billion budget. The majority of the operating expenses in excess of budget continue to relate to UVA Hope Cancer Care (“Hope”). The budget for Hope was prepared six months before the date of purchase. While Hope’s operating income was budgeted properly, revenue and expenses were not budgeted accurately. Total paid employees, including contracted employees, were 14 below budget. FY 2011 Employee FTEs Salary, Wage and Benefit Cost per FTE Contract Labor FTEs Total FTEs FY 2012 6,147 6,511 $72,917 $74,594 2012 Budget 6,578 $73,761 250 230 177 6,397 6,741 6,755 OTHER FINANCIAL ISSUES The Anthem provider contract terminates for both the Medical Center and the University Physicians Group on December 8 31, 2014. Over 18% of the Medical Center’s net revenue is received through the Anthem contract. Anthem has taken an aggressive stance 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 emergency medicine physicians at Augusta Health are currently non-participating providers with Anthem. The Virginia Commonwealth University Medical Center recently agreed to provider contract terms with Anthem but only after a lengthy and difficult negotiation. In anticipation of a difficult negotiation with Anthem, we are planning a negotiation strategy now. Our first step was to consult with the University Health System Consortium in May. The negotiations with Anthem will begin in earnest in the fall. We anticipate that the Anthem negotiations will become a subject for the Medical Center Operating Board over the next year. WRITE-OFF OF BAD DEBTS AND INDIGENT CARE Indigent care charges totaling $230.6 million for the period July 1, 2011 through May 31, 2012, have been written off. Recoveries during this period totaled $58.0 million. Bad debt charges totaling $45.7 million have been written off during the period from July 1, 2011 through May 31, 2012. During this same period, $18.5 million was recovered through suits, collection agencies, and Virginia refund set-off. OPERATIONS REPORT Clinical Operations Ambulatory Operations Care Connection, our concierge services program offered to Health System and University employees and their families and to selected companies within our community, has successfully reached a new milestone. Over 15,000 appointments with Health System providers have been made since the program’s inception in January 2010, with 5,000 having been made in the last six months. Seventy-three percent of the appointments were for Health System and University employees while 27% were from outside the University. Primary care appointments were 19% while specialty appointments made up 78% of the visits and Radiology made up the remaining 4%. 9 The University of Virginia Health System recently entered into a collaborative agreement with MedExpress Urgent Care. MedExpress is a national urgent care provider with over 75 locations that recently opened a location in Charlottesville on Pantops. Patients seen at MedExpress who need follow-up care will be referred to Care Connection to make an appointment. Referrals have been limited as MedExpress builds its business, but we anticipate they will grow over the next several months. The University of Virginia Health System went live with HealthGrades’ Patient Direct Connect Program in July. Patient Direct Connect is an online marketing tool that enhances searches of physicians. The Health System anticipates that this program will increase exposure of our physicians and result in additional volume growth of several thousand outpatient visits per year. Patient Care Services University of Virginia Children’s Hospital Consistent with our long range plan, the first phase of the transition of inpatient and outpatient services at Kluge Children’s Rehabilitation Center (KCRC) to University Hospital, the new Children’s Hospital Battle Building, and other Medical Center locations began in late August. The first phase includes moving KCRC acute care inpatients to the pediatric inpatient unit at University Hospital. Once the first phase is complete, the Medical Center will no longer provide inpatient rehabilitation care for patients younger than 15. After exploring local options and evaluating the specific needs of these patients, it was determined that this population would best be served at larger rehabilitation centers outside the Charlottesville area. The Medical Center will work with families who may need this care in the future to help them find an appropriate facility. An internal committee will work in the coming months to develop a new model of care that will enable most patients to bypass inpatient rehabilitation and move directly to outpatient rehabilitation. Other services at KCRC will continue to be provided at that facility while planning continues for the eventual move to the other locations in the spring of 2014. The transition from KCRC will address the challenges of the aging facility at KCRC, the low census, and the need to provide the most up-to-date practice to our patients. Our goal is to provide our dedicated staff with improved access to services and specialists to better and more efficiently serve our patients. 10 Emergency Services The Medical Center’s Emergency Services department participated with other regional emergency services to create and enhance transmission of 12-lead electrocardiograms from the field to the University of Virginia Emergency Department and to other emergency rooms surrounding the Charlottesville community. These efforts have included purchasing and installing the required modems and software applications, with much of this effort having been put into operation within the last six months. This effort has required significant coordination and collaboration among pre-hospital organizations and Medical Center experts. The impact of this effort is significant and enhances our emergency readiness as a Medical Center and ultimately saves lives. Nursing The Medical Center’s Magnet redesignation journey is well under way. A multi-disciplinary team has been working on issues identified in a gap analysis. Focused groups have been formed to work specifically on nurse - physician relationships, community outreach, and nurse sensitive indicators. The nurse sensitive indicators reported by the Medical Center include blood stream infections; urinary tract infections; restraint use; falls; ventilator-assistive pneumonia; hospital-acquired pressure ulcers; and four nurse specific patient satisfaction questions (managing pain, careful listening, education for medications and discharge, and courtesy/respect). Actions taken to improve processes that impact these nurse sensitive indicators have already resulted in drastic improvements in our monitoring metrics. Improvement has been achieved on every indicator, with seven out of the 10 indicators performing above benchmark. Clinical Ancillary Services Endoscopy The Endoscopic Retrograde Cholangiopancreatography (ERCP) laboratory suite in Digestive Health was recently renovated. The improved lab now offers a larger space to accommodate the increased complexity and acuity of this patient population. The fluoroscopy equipment used in this technique was also replaced to provide state of the art digital imaging. 11 Imaging Services The Nuclear Medicine Department introduced new, highly sensitive biomarkers that provide enhanced imaging for the detection of Alzheimer’s disease, earlier detection of skeletal metastasis in order to monitor response to therapy, and better evaluation of patients with suspected Parkinsonian syndromes. Phase 3 of the Radiology Department master plan renovation is complete, and all of the new reading rooms are now operational. Replacement projects for CT and MRI have also been completed. Phase 4 of the project is well under way with completion expected before the end of 2012. The next major department project will be the replacement of one of the two Neuro-Interventional suites. Medical Laboratories The Blood Bank has achieved improvements in blood product wastage and appropriate product utilization. Four years ago, annual platelet wastage was over $100,000. This year total wastage was $28,000, a 72% reduction. Enhanced monitoring of fresh frozen plasma transfusion resulted in a 28% decrease in usage this past year, yielding a savings of $156,520. Plans to evaluate a new coagulation technology to be located near the Operating Room are underway with the goal of providing real time values to guide evidenced based transfusion practice. The Molecular Laboratory launched a new testing methodology for Chlamydia trachomatis and Neisseria gonorrhea which has increased specificity, is fully automated and has greatly reduced the need for repeat testing. This new instrument has an open platform, which means that lab-developed molecular tests can be adapted for use on this device. Pharmacy Services The Virginia Commonwealth University School of Pharmacy – University of Virginia Division opened on August 20, 2012. Rooms being used for the program have been outfitted with state of the art distance learning technologies. Twelve new pharmacy residents began post graduate training at the Medical Center in July. The Barringer Outpatient Pharmacy has implemented automation technology to improve the patient experience by decreasing overall turnaround time for prescriptions. The Medical Center is the first in the nation to employ this solution for an 12 outpatient pharmacy. Technology was also recently upgraded to make it easier for waiting patients to be identified and “cued” for more prompt service. Plans are in development to use the Barringer Pharmacy after-hours to fill all non-waiting and mail order prescriptions. A new web based ordering tool for specialty Pharmacy areas is now in use. The tool streamlines the ordering process for clinics and decreases the need for last minute inventory procurement. The tool will also enhance Pharmacy’s ability to search for drug requisitions for recalls of medications. A new software program is also being used for tracking protocol documentation in investigational drug trials. Therapy Services The Sleep Disorders Center successfully completed separate site accreditation surveys by the American Association for Sleep Medicine at the 1222 JPA and Pantops locations. Full accreditation was recommended for both locations. University of Virginia-WorkMed relocated from the Fontaine Research Park to 1910 Arlington Blvd in August. The new location will provide significantly more space, which will allow for growth in services. UVA-WorkMed provides occupational health and wellness services for University of Virginia and Medical Center faculty and staff and to 61 companies located within our surrounding community. Community Outreach The annual Remote Area Medical (RAM) Clinic was held on July 27-29, 2012 at the Virginia-Kentucky Fairgrounds in Wise, Virginia. This was the 14th year that the University of Virginia has participated. During the two and a half day clinic, over 250 volunteers from the University of Virginia Health System registered, treated, and provided lab work, education, and prescriptions to an underserved population. An extended array of medical services and diagnostic services was provided. The Medical Center sponsored and participated with the following community organizations: Westminster Canterbury Resident and Staff Health Fair; Boys and Girls Clubs of Charlottesville; Blue Ridge Medical Center, Nelson County; Bike Safety Program, Nelson and Greene County Schools; UVA Medical Center National Volunteer Week; Pink Polo Breast Cancer Awareness; Monticello Area Community Action Agency (Men Who Cook); Alzheimer’s Association of Central Virginia; University 13 of Virginia Skin Cancer Screening; Ronald McDonald House at the University of Virginia; and the Hearing Foundation at the University of Virginia. Electronic Medical Record The Medical Center successfully met the Stage 1 hospital requirements for Meaningful Use, the CMS Medicare and Medicaid Electronic Health Record (EHR) Incentive Program. Stage 1 requirements include data capture and reporting of core objectives and clinical quality measures from the electronic medical record (Epic) during a 90-day period that met specific goals, as well as attestation of our demonstration to the requirements. The Medical Center submitted attestation to CMS for the Medicare EHR Incentive Program, enrolled in the Medicaid EHR program, and also has sent a letter to Anthem attesting to the progress of the Medicare submission for its Quality Hospital Incentive Program (QHIP). Environment of Care Arts Committee An exhibition of the works of Virginia artist, Julia Kindred, was on display in the University Hospital Lobby from May 4 to June 28, 2012. The exhibition entitled “Paths of the Piedmont” featured paintings done by Ms. Kindred at locations throughout the area. Lee Nixon, Jr., also a Virginia native, displayed his works at the hospital in an exhibition entitled “Luminous Rural Paintings” from June 29 to August 31, 2012. Environmental Services A Real Time Locating System for tracking equipment has been installed at University Hospital. The system allows for tracking of “tagged” equipment located within the hospital. Once equipment is tagged, it can be tracked quickly to provide better response times for needed equipment. The system is being piloted in University Hospital and may be expanded to other areas of the Health System. Facilities Intensive Care Unit renovations continue at University Hospital. In July, the Medical Surgical Intensive Care Unit (MSICU) returned to its newly refurbished location on 3 East and Medical ICU patients were moved into the newly refurbished MICU 14 on 3 West. Renovation of the Thoracic Cardiovascular PostOperative Unit (TCVPO) is currently under way. Parking and Transportation In celebration of National Bike Week, University of Virginia Parking and Transportation offered classes to Medical Center employees to help them learn the basics of bike commuting. Other programs to help employees save energy and be more sustainable, including ride sharing and the use of public transportation, are also available. Patient & Guest Services In late May, the University of Virginia Hospital Auxiliary hosted their annual Spring Luncheon at Alumni Hall. Medical Center leadership joined in the celebration to recognize the Auxiliary Volunteers for their service, commitment, and contributions to the UVA Health System. In 2011, the Auxiliary provided $28,140 in funding for Venture awards, $33,600 in scholarship funding to train health professionals, and $85,000 in fixed contributions to support services that directly benefit patients and their families. One thousand and eighty-eight Auxiliary Volunteers donated 88,731 hours of service in 2011. Sustainability To help celebrate Earth Week, the Sustainability Workgroup had informational exhibits about the Medical Center’s sustainability efforts on display in the Dining Conference Rooms. They shared information on the ROSE (Reusable Office Supply Exchange) program, recycling, LEED buildings, and more. Workgroup members were available to talk with employees about the programs and give them information on how they can help create a more sustainable work environment. Human Resources Compensation The Medical Center developed a new timeline of its compensation actions for the year. Performance based increases will be moved from January/February to September/October in order to synchronize with the performance review period, which now corresponds to goals associated with the Medical Center’s fiscal year. Market adjustments will occur in January 2013. 15 In addition, a mid-year Paid Time Off (PTO) cash-out was initiated in June. Employees with over 40 hours of accrued PTO were eligible for the cash-out opportunity. Employee Recognition, Rewards, and Uteam Numerous opportunities to recognize the contributions of Medical Center employees and Uteam education sessions occurred during the past several months. Some of the events held included: Hospital Week Celebrations took place in early May 2012 across the Health System with over 4,300 meals served in one day by the Medical Center’s executive leadership team as a “thank you” to employees for their attention to the quality of care delivered each and every day to patients. At 52 offsite locations, over 2,200 employees were also served fresh, locally grown/homemade treats accompanied by signage and letters of appreciation from the executive leadership team. Human Resources partnered with the Professional Nursing Staff Organization in coordinating efforts to celebrate “Week of the Nurse”, which occurred the same week. A resource fair was held during Hospital Week with over 1,000 employees visiting 15 vendors to learn more about benefits and perks offered at the Medical Center. Uteam Perks launched a summer discount ticket program giving all Health System employees deep discounts on admission to popular theme parks and local movie theatre tickets. Employees were offered free financial awareness and planning courses on-Grounds. Professionals from the UVA Credit Union offered employees assistance with tasks from basic budgeting to complex retirement planning. “Employee of the Month” celebrations were held to recognize individuals nominated by their peers. In addition, 34 retirement celebrations were planned for employees with over 20 years of service with the Medical Center. A series of Uteam meetings was held during the last three weeks in August at the Medical Center complex and at offsite locations. The meetings focused on the Medical Center’s clinical strategy and accomplishments achieved to date, the potential impact of health care reform, and Medical Center operational updates. Ed Howell, Bo Cofield, Brad Haws, Dean DeKosky, and Jonathon Truwit participated 16 and shared their collective vision of our recent successes as a Health System. Employee Engagement The Medical Center administered a census engagement survey to over 7,000 employees June 4 through June 18. A total of 5,775 (82%) employees, including Graduate Medical Education (GME) Trainees, participated in the 51 question survey. The Medical Center achieved an overall engagement index score of 70.31 which exceeded both our target goal of 69.1 and our stretch goal of 69.8. Communication of the engagement results occurred throughout the Medical Center in August. Recruitment A new recruitment manager was hired with specific focus on sourcing. Efforts to be more aggressive in hiring have been effective, and in the past fiscal year new hires increased by 19.4%. The Medical Center is in the process of enhancing its selection process with an expansion of the TestSource tool which focuses on organizational fit and position. Efforts to better retain current employees are also under way. Organizational Development The Uteam Leadership Academy continues to offer programs that enable new and experienced managers to successfully meet the challenges of leadership. The second cycle of the New Leader Orientation program is in progress. Facilitated by Medical Center executive leaders this program helps attendees to be successful managers at the Medical Center. Forty-eight employees have completed the Informal Leader program, which is intended to help employees who do not hold formal leadership roles but lead others informally or play a significant part in the success of their area. Thirty-one employees have graduated from Best Practices in Management, a six-month program focused on areas identified in past employee engagement surveys. Quality and Performance Improvement The Quality Committee and the Clinical Staff Executive Committee approved a recommendation that the Quality Improvement Plan be based on the fiscal year rather than calendar year. A recommended Quality Plan with associated priority projects was submitted to the Quality Subcommittee of the Medical Center Operating Board for consideration and approval at the August 17 2012 meeting. All quality metrics will now be reported based on the fiscal year as opposed to calendar year. Supply Chain Implementation of the Low Unit of Measure distribution program commenced the first of September. This program enables the Medical Center to achieve many efficiencies including: Closure of the Ivy Road Warehouse and realization of efficiencies in inventory management, par unit order generation, par unit restocking, receiving, accounts payable exception management, and end user satisfaction. These improvements and efficiencies will be realized in inventory, worked FTEs, and associated expense reductions; major reduction of internal fleet operations; reduction of response time to end users; and improved accuracy in charge capture and financial transactions with suppliers. Provides a platform for full utilization of efficient Electronic Data Interchange (EDI) functionality that resides in People Soft and in partnership with our EDI vendor. Provides a platform for implementation of Point of Use Materials Information System that will provide capability to automatically generate orders from end users. Health System Recognitions and Awards The Medical Center’s partnership with the School of Medicine and the School of Nursing, more than any other factor, defines its character. This is especially important as both schools are highly regarded. The School of Medicine placed 19th in primary care and 25th in research in the 2013 U.S. News & World Report rankings. The School of Nursing ranked 15th in the most recent U.S. News rankings for nursing schools, which were issued in 2012. Because of its reputation, the School of Medicine has been able to attract some of the best physicians in the nation to practice at the Medical Center. Fifty-three physicians from the University of Virginia School of Medicine were included in the latest edition of America's Top DoctorsTM, which recognizes physicians considered among the top one percent in the country in their medical specialties and sub-specialties. Best Doctors in America® 2011-12 by Best Doctors, Inc. named 195 University 18 of Virginia physicians. This is the highest number of physicians that UVA has ever placed on this list. The Medical Center recently received a safety rating score of 39 by Consumer Reports. However, we did receive aboveaverage ratings in patient experience and high marks for our use of the Epic electronic medical record and for the appropriate use of radiology scans. 19 University of Virginia Medical Center Income Statement (Dollars in Millions) Most Recent Three Fiscal Years Description Net patient revenue Other revenue Total operating revenue Operating expenses Depreciation Interest expense Total operating expenses Operating income (loss) Non-operating income (loss) May-10 May-11 May-12 Budget/Target May-12 $923.4 $949.6 $1,054.4 $1,040.4 26.0 26.7 40.6 27.5 $949.4 $976.3 $1,095.0 $1,067.9 840.9 844.0 968.3 936.8 49.9 57.3 65.9 65.9 6.2 7.1 6.5 12.6 $897.0 $908.4 $1,040.7 $1,015.3 $52.4 $67.9 $54.3 $52.6 $71.7 $74.3 $10.1 $6.5 Net income (loss) $124.1 $142.2 $64.4 $59.1 Principal payment $15.9 $19.2 $19.3 20 $19.3 University of Virginia Medical Center Balance Sheet (Dollars in Millions) Most Recent Three Fiscal Years Description May-10 May-11 May-12 Assets Operating cash and investments $119.7 $94.8 $99.6 Patient accounts receivables 67.6 102.2 135.0 Property, plant and equipment 554.7 659.7 722.5 Depreciation reserve and other investments 268.7 217.2 248.0 Endowment Funds 342.3 393.6 411.6 Other assets 167.2 177.9 232.4 $1,520.2 $1,645.4 $1,849.1 Current portion long-term debt $23.0 $24.6 $28.7 Accounts payable & other liab 97.3 76.6 111.0 Long-term debt 329.9 315.8 398.7 Accrued leave and other LT liab 106.2 133.6 132.1 $556.4 $550.6 $670.5 $963.8 $1,094.8 $1,178.6 $1,520.2 $1,645.4 $1,849.1 Total Assets Liabilities Total Liabilities Fund Balance Total Liabilities & Fund Balance 21 University of Virginia Medical Center Financial Ratios Most Recent Three Fiscal Years Description May-10 Operating margin (%) May-11 May-12 Budget/Target May-12 5.5% 7.0% 5.0% 4.9% Total margin (%) 12.2% 13.5% 5.8% 5.5% Current ratio (x) 1.6 1.9 1.7 2.4 174.0 168.8 159.4 190.0 Gross accounts receivable (days) 45.2 47.1 47.9 45.0 Annual debt service coverage (x) 8.2 7.9 5.3 5.2 34.7% 31.1% 34.2% 31.8% 6.3% 7.1% 7.0% 7.7% Days cash on hand (days) Debt-to-capitalization (%) Capital expense (%) University of Virginia Medical Center Operating Statistics Most Recent Three Fiscal Years Description Acute Discharges Patient days May-10 May-12 25,593 26,281 25,917 153,058 153,648 157,218 151,145 8,181 8,130 9,442 8,131 6.20 6.00 5.98 5.83 624,161 636,495 694,306 657,837 53,333 53,696 56,452 54,880 Average length of stay ER visits May-12 24,765 SS/PP Patients Clinic visits May-11 Budget/Target Medicare mix index Occupancycase % 2.05 FTE's (including contract labor) 6,219 22 2.02 76.0% 6,397 2.08 72.1% 6,741 2.04 72.6% 6,755 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 FY12 OPERATING STATISTICAL MEASURES - May FY12 DISCHARGES and CASE MIX - Year to Date Actual DISCHARGES: Adult Pediatrics Psychiatric Transitional Care Subtotal Acute Budget OTHER INSTITUTIONAL MEASURES - Year to Date % Variance Prior Year 22,119 2,838 1,138 186 26,281 21,630 2,765 1,274 248 25,917 2.3% 2.6% (10.7%) (25.0%) 1.4% 21,640 2,670 1,241 42 25,593 9,442 8,131 16.1% 8,130 Total Discharges 35,723 34,048 4.9% 33,723 Adjusted Discharges 48,431 46,830 3.4% 45,703 Short Stay/Post Procedure CASE MIX INDEX: All Acute Inpatients Medicare Inpatients 1.94 2.08 1.90 2.04 1.9% 2.2% 1.90 2.02 Actual Budget % Variance Prior Year ACUTE INPATIENTS: Inpatient Days Average Length of Stay Average Daily Census Births 157,218 5.98 468 1,431 151,145 5.83 450 1,523 4.0% (2.6%) 4.0% (6.0%) 153,648 6.00 459 1,540 OUTPATIENTS: Clinic Visits Average Daily Visits Emergency Room Visits 694,306 3,243 56,452 657,837 3,073 54,480 5.5% 5.5% 3.6% 636,495 2,975 53,696 18,612 7,530 26,142 17,764 7,997 25,761 4.8% (5.8%) 1.5% 17,509 7,649 25,158 SURGICAL CASES Main Operating Room (IP and OP) UVA Outpatient Surgery Center Total OPERATING FINANCIAL MEASURES - May FY12 23 REVENUES and EXPENSES - Year to Date OTHER INSTITUTIONAL MEASURES - Year to Date ($s in thousands) NET REVENUES: Net Patient Service Revenue Other Operating Revenue Total Actual Budget 1,054,447 40,645 $ 1,095,092 1,040,398 27,495 $ 1,067,893 1.4% 47.8% 2.5% EXPENSES: Salaries, Wages & Contract Labor Supplies Contracts & Purchased Services Bad Debts Depreciation Interest Expense Total Operating Income Operating Margin % Non-Operating Revenue 462,465 247,032 228,294 30,477 65,995 6,461 $ 1,040,724 $ 54,368 5.0% $ 10,076 $ (1.3%) (9.1%) (3.9%) 9.8% (0.1%) 48.8% (2.5%) $ 3.3% $ Net Income $ $ 64,444 456,631 226,506 219,818 33,788 65,922 12,622 $ 1,015,287 $ 52,606 4.9% $ 6,453 59,059 % Variance Prior Year $ 949,567 26,716 976,283 56.1% $ 432,188 200,704 187,261 23,832 57,303 7,092 908,380 67,903 7.0% 74,263 9.1% $ 142,166 ($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 Discharge Total F.T.E.'s (including Contract Labor) F.T.E.'s Per CMI Adjusted Discharge Actual $ $ $ 353,671 124,030 213,757 188,253 31,118 143,618 1,054,447 Budget $ $ 35.91% 47.9 10,797 $ 6,741 24.21 333,960 143,006 180,263 193,510 44,146 145,513 1,040,398 35.31% 45.0 11,053 6,755 25.56 % Variance 5.9% $ (13.3%) 18.6% (2.7%) (29.5%) (1.3%) 1.4% $ 1.7% (6.4%) 2.3% $ 0.2% 5.3% Prior Year 304,804 130,521 164,525 176,616 40,291 132,810 949,567 36.59% 47.1 10,179 6,397 24.66 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, 2012 Assumptions - Operating Statistical Measures Discharges and Case Mix Assumptions Discharges 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 or Rucker 3 All other cases are reported as Adult Short Stay Admissions include both short stay and post procedure patients Case Mix Index for All Acute Inpatients is All Payor Case Mix Index from Stat Report Other Institutional Measures Assumptions Patient Days, ALOS and ADC figures include all patients except normal newborns Surgical Cases are the number of patients/cases, regardless of the number of procedures performed on that patient 24 Assumptions - Operating Financial Measures Revenues and Expenses Assumptions: Medicaid out of state is included in Medicaid Medicaid HMOs are included in Medicaid Physician portion of DSH is included in Other Non-recurring revenue is included Other Institutional Measures Assumptions Collection % of Gross Billings includes appropriations Days of Revenue in Receivables (Gross) is the BOV definition Cost per CMI Adjusted Discharge uses All Payor CMI to adjust, and excludes bad debt MEDICAL CENTER ACCOUNTS COMMITTEE REPORT (Includes All Business Units) (Dollars in Thousands) Year to Date May 2011-12 INDIGENT CARE (IC) Net Charge Write-Off 188,856 Percentage of Net Write-Offs to Revenue 6.43% Annual Activity 2010-11 2009-10 195,645 172,917 6.89% 6.60% Total Reimbursable Indigent Care Cost 71,388 73,954 53,095 State and Federal Funding 68,475 70,936 52,053 Total Indigent Care Cost Funding As a Percent of Total Indigent Care Cost 96% Unfunded Indigent Cost 2,912.62 96% 98% 3,017.31 1,042.00 Annual Activity May 2011-12 BAD DEBT Net Charge Write-Offs 30,477 Percentage of Net Write-Offs to Revenue 1.04% 2010-11 2009-10 25,838 0.91% Note: Provisions for bad debt write-offs and indigent care write-offs are recorded for financial statement purposes based on the overall collectibility of the patient accounts receivable. These provisions differ from the actual write-offs of bad debts and indigent care which occur at the time an individual account is written off. 25 30,948 1.18% UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: September 13, 2012 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.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 Medical Center Operating Board meeting. DISCUSSION: The current Medical Center capital projects report is set forth in the following table: 26 The University of Virginia Medical Center Capital Projects Report September 2012 Scope BOV Projected Approval Completion Date Date N/A 2014 Bonds Feb 2008 2013 Bonds & Other June 2010 2013 Budget Funding Source $117 M Bonds and Outside 1. Under Construction Battle Building: Fundraising The Groundbreaking Ceremony was held on June 9, 2011. Structural concrete work is nearing completion on the Penthouse slab. Interior framing and mechanical rough-ins are progressing. University Hospital: Renovate Radiology Department – $21.2 M (52,000 GSF) construction of final phase under way *Health System Precinct: $36.5M Realignment of Lee St. and construction of new chiller plant. Realignment of Lee St. to be complete this summer. Steel erection for the new chiller plant is under way. 27 The University of Virginia Medical Center Capital Projects Report September 2012 Scope Budget BOV Projected Approval Completion Date Date Bonds Feb 2008 2012 Bonds and Health Sept 2005 Funding Source 2. Construction Complete University Hospital: $7.6M Add elevators – The new elevators are in place and in use. University Hospital Bed Expansion: $80.2 M System Operating Project to increase inpatient bed Revenue capacity in University Hospital by June 2007 2012 adding 72 private, ICU-level rooms. All patient units are complete with Floors 3, 4, and 5 occupied. Only commissioning activities remain. *University Hospital: $6.7M Bonds Relocation of helipad to roof of University Hospital. Helipad and associated elevator work is substantially complete. Helicopter flights began in early July with ramp up to full usage in late July. 28 Nov. 2010 2012 UNIVERSITY OF VIRGINIA BOARD OF VISITORS AGENDA ITEM SUMMARY BOARD MEETING: September 13, 2012 COMMITTEE: Medical Center Operating Board AGENDA ITEM: II.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 March 1, 2012 – June 30, 2012 The Schools of Medicine and Nursing each received a $3 million gift credit as part of a larger $15 million University commitment to establish a new, interdisciplinary Contemplative Sciences Center. A $2.2 million bequest was documented to establish the Orr Professorship in Women’s Oncology in honor of Dr. Peyton T. Taylor, Jr. A $1 million bequest was made in support of the Chairman’s Discretionary Fund for Otolaryngology – Head and Neck Surgery. A $1 million estate distribution was received for unrestricted use in the School of Medicine. A $1 million expectancy was documented to endow two fellowships in the School of Medicine, one in general medicine and the other in neurology. The contributions of several Health Foundation trustees and Nursing Advisory board members enabled the School of Nursing to conclude its campaign for the renovation of McLeod Hall, raising more than $1 million to finish Phase II of the renovation campaign, and surpassing the overall $12 million renovation campaign goal with a total of more than $15 million raised. A $798,000 realized bequest was received in support of the W. T. Moore, MD Professorship in Obstetrics and Gynecology. 29 An agreement was reached between the Department of Pediatrics and the Charlottesville Area Community Foundation (CACF) for annual disbursements from a $617,000 CACF endowment to support the Karen Jargowsky Professorship in Pediatric Hematology and Oncology at UVA Children’s Hospital. A Health Foundation trustee and his spouse added to their existing unitrust, bringing the total benefit to the School of Medicine to almost $1 million, and committed an additional $25,000 in support of the McLeod Hall Nursing Renovation project. The Nursing Annual Fund exceeded its FY ’12 goal, raising a total of $357,544 in unrestricted funds for the School of Nursing. Various corporate partners contributed $125,000 in support of the UVA Children’s Hospital through the Children’s Miracle Network. On May 12, the 28th Annual Klöckner Pentaplast Walk for Kids took place to benefit the Battle Building at UVA Children’s Hospital. Donations from the walk, including additional support from Klöckner, totaled $125,000. A $122,169 realized bequest was received in support of the Class of 1957 gift for the Claude Moore Medical Education Building. A Health Foundation trustee made a $100,000 gift in support of the UVA Children’s Hospital, as well as an additional $50,000 gift to the Pancreatic Cancer Research Program in support of the research of Todd Bauer, M.D., and Kimberly Kelly, PhD. A $100,000 estate distribution was received in support of scholarships for undergraduate nursing students. A $100,000 gift was received in support of parapsychology research in the Department of Psychiatry and Neurobehavioral Sciences. A $100,000 gift was received in support of the Orthopaedic Research Fund in the School of Medicine. Other gifts and pledges received include: $90,000 raised from the 37th Annual Charlottesville 10-Miler in support of lung cancer research; 30 A $75,000 commitment to fund the Jack M. Gwaltney, Jr., Eminent Scholars Professorship in Infectious Diseases in the School of Medicine; A $71,000 bequest in support of the pediatric orthopedics clinic in the Battle Building; A $50,000 commitment to the School of Medicine Class of 1966 scholarship fund; A $50,000 pledge in support of the School of Nursing McLeod Hall Renovation project; A $50,000 bequest to the School of Nursing in support of the Lucie Kelly Faculty Leadership Award, the Center for Nursing Historical Inquiry, and the Beta Kappa chapter of Sigma Theta Tau, the nursing honor society; A $50,000 realized bequest in support of the Paul H. Wornam Scholarship in the School of Medicine; A $50,000 gift in support of the Grand Aides initiative in the School of Medicine; and A $50,000 charitable gift annuity to benefit the School of Medicine. OTHER DEVELOPMENT INITIATIVES On March 29, the Patients & Friends Steering Committee hosted a “Hot Topics in Cancer” Forum for more than 120 community members featuring innovations in pancreatic care and research. On March 30, Mr. R. Edward Howell and Steven T. DeKosky, M.D, FAAN, FACP, participated in a meeting with Medical Center volunteer board leaders regarding the Health System’s strategic planning process. The School of Nursing sent its first ever solicitation mailing to parents of second through fourth-year students in March. In May, a targeted email solicitation during National Nurses Week generated more than $23,000 in gifts. On April 5, the School of Nursing, School of Medicine, and Health System hosted a joint reception in Richmond for alumni, friends, and donors featuring Mr. R. Edward Howell, Steven T. DeKosky M.D, FAAN, FACP, and Dean Dorrie Fontaine. In April, a School of Nursing alumna hosted an event in her home to introduce UVA President Sullivan to select alumni, parents, and friends and to showcase UVA’s cross-disciplinary research. Later that month, parents of a current nursing 31 student hosted an event featuring Dean Dorrie Fontaine for alumni, parents, donors, and prospects. An event was held on April 18 to celebrate the artists, donors, and volunteers who contributed to the art in the Emily Couric Clinical Cancer Center. The School of Nursing held various events on June 1-2 to celebrate its annual Reunions weekend, including lunch on the McLeod Hall Patio, a tour of the newly renovated McLeod Hall and the Claude Moore Nursing Education Building, a talk by Dean Dorrie Fontaine and Jonathon Truwit, M.D., Senior Associate Dean for Clinical Affairs, and an Open House at Pavilion IX for alumni and friends. The Health System Development Communications team produced spring issues of Virginia Legacy, Investing in Hope, and Pulse, and collaborated on various solicitations and other communications for the Cancer Center and Children’s Hospital teams. As of June 30, Development officers made 1,727 face-to-face visits with donors and prospects. CAMPAIGN PROGRESS THROUGH June 30, 2012 Through the end of June, the Health System Campaign for Health total was $608,402,152. This represents 122% of the original $500 million campaign goal. The following table shows the fiscal year 2012 totals as of June 30 for new commitments, including gifts and pledges, as compared with this same time in fiscal year 2011. FY 12 to date (through 6/30/12) New Gifts New Pledges Total New Commitments 32 Compare FY 11 (through 6/30/11) $35,044,386 $41,050,953 $3,192,139 $4,967,146 $38,236,525 $46,018,098
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