UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
May 21, 2012
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
Monday, May 21, 2012
8:30 – 11:15 a.m.
The Great Hall at Garrett Hall
Committee Members:
Vincent J. Mastracco Jr., Chair
Helen E. Dragas
W. Heywood Fralin
Andrew K. Hodson, MB.Ch.B
Patrick D. Hogan
William P. Kanto Jr., M.D.
Constance R. Kincheloe
Mark J. Kington
Ex Officio
Teresa A.
Steven T.
Dorrie K.
Robert S.
Members:
Sullivan
DeKosky, M.D.
Fontaine
Gibson, M.D.
Randolph J. Koporc
Stephen P. Long, M.D.
Edward D. Miller, M.D.
Charles W. Moorman
Jonathan B. Overdevest
The Hon. Lewis F. Payne
E. Darracott Vaughan Jr., M.D.
R. Edward Howell
John D. Simon
Michael Strine
AGENDA
PAGE
I.
II.
III.
CONSENT AGENDA
•
Amended and Restated Bylaws of the Clinical Staff
of the Medical Center
ACTION ITEMS
A.
Fiscal Year 2013 Medical Center Operating and
Capital Budgets
B.
Valley Health Stereotactic Radiosurgery Joint
Venture
C.
Albemarle Arthritis Associates, LLP Acquisition
REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEDICAL CENTER (Mr. Howell)
A.
Vice President’s Remarks
1
2
9
11
13
B.
Annual Buchanan Report and Clinical Presentation
(Mr. Howell to introduce Reid B. Adams, M.D., and
Todd W. Bauer, M.D.; Dr. Adams and Dr. Bauer to
report)
14
C.
Graduate Medical Education (Mr. Howell to
introduce Susan E. Kirk, M.D.; Dr. Kirk to
report)
16
IV.
D.
Operations, Finance, and Write-offs (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
and Write-offs)
25
E.
Capital Projects
41
F.
Health System Development (Mr. Howell to
introduce Ms. Karen Rendleman; Ms. Rendleman to
report)
44
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
strategic joint ventures and other growth
efforts, performance of Culpeper Regional
Hospital, 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 CONSENT AGENDA
I. AMENDED AND RESTATED BYLAWS OF THE CLINICAL STAFF OF THE
MEDICAL CENTER: Approves revisions to the Bylaws of the Clinical
Staff of the Medical Center.
In accordance with accreditation and other legal
requirements, the Medical Center Operating Board has provided
for an organized Clinical Staff for the Medical Center and has
delegated to it the appropriate responsibility for the provision
of quality care given by the Clinical Staff throughout the
Medical Center. In addition, the Medical Center Operating Board
has provided for a system of self-governance of the Clinical
Staff, including the requirements for initial membership on the
Clinical Staff, a mechanism for reviewing the qualifications of
applicants for admission to the Clinical Staff, the procedures
for the granting of clinical privileges to practice medicine
within the Medical Center, and a process for continuing review
and evaluation for membership and clinical privileges. The
Amended and Restated Bylaws of the Clinical Staff of the Medical
Center set forth these rights and responsibilities.
The Bylaws were last adopted on September 15, 2011. The
Bylaws Committee of the Clinical Staff Executive Committee has
proposed certain revisions. The Clinical Staff Executive
Committee has approved the revisions and submits them for
approval by the Medical Center Operating Board.
ACTION REQUIRED:
Approval by the Medical Center Operating Board
APPROVAL OF AMENDED AND RESTATED BYLAWS OF THE CLINICAL STAFF OF
THE MEDICAL CENTER
RESOLVED, the Medical Center Operating Board approves the
Amended and Restated Bylaws of the Clinical Staff of the Medical
Center. These amendments, which are appended to this resolution
as an Attachment, shall be effective as of May 21, 2012.
1
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.A. Fiscal Year 2013 Medical Center
Operating and Capital Budgets
BACKGROUND: The Medical Center’s operating and capital
budgets are consolidated with the University’s overall budget.
At its May meeting, the Board of Visitors acts on the proposed
budget based on a recommendation from the Medical Center
Operating Board.
DISCUSSION: The Medical Center’s 2012-2013 fiscal plan has been
developed while considering the challenge of providing patient
care, teaching, and research services in an increasingly
changing health care industry. The full impact of the
Accountable Care Act will not be realized until fiscal year
2015; however, a number of its provisions have already been
effectuated. The result will be decreased reimbursements from
government payors and an industry-wide erosion of pricing power
with private payors. At the same time, costs associated with
providing quality patient care will continue to have upward
pressure due to increases in medical supply, pharmaceutical, and
medical device expenses as well as a shortage of health care
workers. These changes require fiscal planning now to ensure
meeting the mission of the Health System in the future.
To meet these challenges, the Medical Center has adopted a
priority based budget process to align resource allocations with
Medical Center strategies to achieve the Health System strategic
planning goal of becoming a top decile academic medical center.
The Medical Center budget development process is operationally
focused and highly participatory. Patient care service
management, support function management, and physicians have
significant roles in the budget development cycle. The budget
process begins with senior management developing basic budget
assumptions such as discharges, length of stay, and productivity
standards which drive the number of employees. An effort is
made to maintain overall consistency with the Long Range
Financial Plan. The final budget provides each operating unit a
cumulative operating budget that contains service demand
forecasts, required full-time equivalent personnel, and nonlabor expenses.
2
BUDGET AND OPERATING ASSUMPTIONS
Market conditions: For fiscal year 2013, discharges are budgeted
to grow 2.0% from FY 2012 projected levels. The growth will be
facilitated by improved patient flow resulting from bed
expansion as bed capacity is increased from 589 to 661 inpatient
beds by June 30, 2013. Outpatient service demand is budgeted to
grow 0.4% from FY 2012 projected levels. The budget recognizes
the addition of two Outpatient Surgery Center operating rooms,
increasing total operating room capacity from 34 to 36 for FY
2013. Additionally, the Transitional Care Hospital has 40 beds
that will be fully operational by June 30, 2013. The following
table includes historical and projected patient volumes:
Budget
2011-2012
Discharges Medical Center
28,004
Discharges Transitional Care
276
Adjusted Discharges
51,102
Average length of stay MC
5.61
ALOS Transitional Care
29.00
Patient days at MC
157,047
Clinic & ER visits
778,081
Projected
2011-2012
28,182
182
52,024
5.84
34.00
165,074
816,070
Budget
2012-2013
28,750
360
54,274
5.50
29.00
158,125
819,365
Revenues: The Medical Center has seen growth in volumes over
the last year, however, a disproportionate share of the growth
has been Medicaid and Medicare. One of the Medical Center’s
largest challenges is the unwillingness of government payors to
increase their payments commensurate with the increases in
medical delivery costs. Growth in revenues will result from the
impact of increasing volume and negotiated contracts that
include rate increases.
Rate changes: The Medical Center proposes an overall rate
increase of 7.0% to 9.9%, which is commensurate with rate
increases that will generally be implemented in the hospital
industry.
With regard to compensation, the pay-for-performance pool
has been established at $8 million, which includes the impact on
benefit costs and is based on a 3.0% salary adjustment with an
October implementation date. Other salary adjustments such as
market and compensation design adjustments total $5 million,
including the impact on benefit costs.
Expenses: Expenses from operations are projected to increase by
$99.0 million from the FY 2012 projection. Expenses per case
3
mix index (CMI) weighted adjusted discharges are projected to
increase from $10,696 to $11,118 (excluding the Transitional
Care Hospital). We anticipate that expense per CMI weighted
adjusted discharge included in the budget will be approximately
equal to the academic medical center median expense as shown in
the University Health System Consortium Operational Data Base.
Previous increases in capital investment will result in
additional depreciation expense of $9.1 million for fiscal year
2013. Additionally, interest cost on capital investments will
increase by $9.6 million for fiscal year 2013. The Medical
Center’s 2012-2013 fiscal plan accounts for these additional
expenses while preserving its goal of providing high quality and
cost effective health care, education, and research services.
Staffing: The Medical Center’s FY 2013 budget has been
benchmarked with comparable academic medical centers. Full-time
equivalent personnel (FTEs) are planned at 7,009, an increase of
321 FTEs from the current fiscal year projection of 6,688 FTEs.
Increased staffing in inpatient care services and ambulatory
clinics accounts for an increase of 279 FTEs, which includes 42
additional FTEs at the Transitional Care Hospital. The
remainder of the growth is primarily for program and facility
expansion.
Operating Plan: The rapidly changing health care environment
will require continuous examination of budget assumptions.
Management will monitor budget versus actual performance on a
monthly basis and, where appropriate, make changes to
operations. Also, management will continue to identify and
implement process improvement strategies that will allow for
operational streamlining and cost efficiencies.
The major strategic initiatives that impact next year’s
fiscal plan include:
•
•
•
•
The continuation of the collaborative effort between the
Medical Center and the School of Medicine faculty on
documentation of clinical care and its coding.
The continuation of the collaborative effort between the
Medical Center and the School of Medicine faculty on supply
cost.
The continuation of our efforts to better engage our
employees and enhance patient satisfaction.
The impact on operations from the completion of
construction for the hospital bed expansion.
4
•
•
•
•
The impact on operations from increased volumes at the
Transitional Care Hospital and the Emily Couric Clinical
Cancer Center.
Continued integration of information technology services
through the Electronic Medical Record project.
Acceleration of patient progression in the Medical Center’s
inpatient units, operating rooms, and emergency department.
Integration of the Hematology Oncology Patient Enterprises
(HOPE) physician practice into the Health System.
The major risk factors that impact the ability to
accomplish the fiscal plan include:
•
•
•
•
•
•
•
•
•
Changes in healthcare reform, including maintaining the
timeline for reduced reimbursement while delaying mandatory
coverage.
The Supreme Court ruling on healthcare reform expected in
the summer of 2012.
Debt ceiling cuts.
ICD 10 conversion.
Maintaining and growing a superior workforce in an
environment where workforce shortages are projected.
Medicare payments at risk due to value based purchasing,
electronic health record meaningful use, and hospital
readmissions.
Further cuts in Graduate Medical Education (GME), Indirect
Medical Education (IME) and Facility Fees by the Centers
for Medicare and Medicaid Services.
Reduced Medicaid funding for Virginia’s Academic Health
Center type one hospitals.
Marketplace changes creating a highly competitive
environment.
A summary of historical and projected financial operating
results are provided as follows:
Actual
(Millions)
2010-2011
Total operating revenue
$1,072
Operating expense
984
Operating income
88
Non-operating gain/(loss)
73
Total margin
$161
Operating income percent
8.2%
5
Projected
2011-2012
$1,157
1,099
58
13
$71
5.0%
Budgeted
2012-2013
$1,257
1,198
59
16
$75
4.7%
Capital Plan: Funds available to meet capital requirements are
derived from operating cash flows, funded depreciation reserves,
philanthropy, and interest income. The Medical Center faces
many challenges regarding capital funding as continued pressures
on the operating margin affect cash flow, while demand for
capital has increased significantly due to space requirements,
technological advances, and aging of existing equipment.
Subject to funds availability, Medical Center management
recommends $96.4 million be authorized for capital requirements,
including $5.0 million for contingencies, $11.3 million for the
Strategic Investment Pool, and $8.0 million for Culpeper
Regional Hospital investments.
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Finance Committee, and by the Board of Visitors
APPROVAL OF THE 2012-2013 OPERATING AND CAPITAL BUDGETS AND
ANNUAL RENOVATION AND INFRASTRUCTURE PLAN FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
RESOLVED, the 2012-2013 Operating and Capital Budgets and
the Annual Renovation and Infrastructure Plan for the University
of Virginia Medical Center are approved, as recommended by the
President, the Chief Operating Officer, and the Medical Center
Operating Board.
6
Schedule A
University of Virginia - Medical Center
Projected Fiscal Plan
2012-2013
2010-2011
Actual
Revenues
Total Gross Charges
$
2,840,663,649
2011-2012
Forecast
$
3,145,032,475
2012-2013
Budget
$
3,524,144,327
Less Deductions:
Indigent Care Deduction
Contractual Deduction
Total Deductions
195,644,888
1,602,918,430
1,798,563,318
202,988,065
1,820,459,038
2,023,447,103
227,688,367
2,087,487,683
2,315,176,050
Net Patient Revenue
1,042,100,331
1,121,585,372
1,208,968,277
29,751,071
35,605,947
48,088,576
1,071,851,402
1,157,191,319
1,257,056,853
Expenses
Expenses from Operations
Operating Expenses
Depreciation and Amortization
Interest Expense
Bad Debt
887,030,414
63,428,344
7,724,616
25,837,665
985,282,844
70,641,194
7,058,769
36,508,501
1,053,887,538
79,761,454
16,622,476
48,220,020
Total Expenses from Operations
984,021,039
1,099,491,308
1,198,491,488
87,830,363
57,700,011
58,565,365
79,172,793
3,221,659
717,386
(9,459,699)
73,652,140
11,000,616
3,458,929
81,362
(1,238,566)
13,302,341
17,529,598
1,350,768
(800,000)
(1,806,948)
16,273,418
Miscellaneous Revenue
Total Revenue
Operating Income
Other Gains and Losses
Investment Income & Investment FMV
Net gain from Affiliates
Loss on Fixed Assets
State Appropriation
Other
Total Other Gains and Losses
Revenues and Gains in Excess of Expenses
$
Statistics
Discharges - Medical Center
Discharges - Transitional Care Hospital
Patient Days of Care - Medical Center
Patient Days of Care - Transitional Care Hospital
Clinic and Emergency Room Visits (Excluding Acquired
Practices)
Average Length of Stay - Medical Center
Average Length of Stay - Transitional Care Hospital
7
161,482,503
$
71,002,352
$
74,838,783
27,933
51
165,646
2,220
755,417
28,182
182
165,074
6,188
816,070
28,750
360
158,125
10,440
819,365
5.93
27.57
5.84
34.00
5.50
29.00
University of Virginia Medical Center
Operating Financial Plan
(dollars in thousands)
2012-13
Budget
Operating Revenues
Total Gross Charges
2011-12
Projected
2011-12
Original Budget
2010-11
Actual
$3,524,144
$3,145,032
$3,216,218
$2,840,663
Less Deductions:
Indigent Care Deduction
Contractual Deduction
Total Deductions
227,688
2,087,488
2,315,176
202,988
1,820,459
2,023,447
210,583
1,869,742
2,080,325
195,645
1,602,918
1,798,563
Net Patient Revenue
1,208,968
1,121,585
1,135,893
1,042,100
48,089
35,606
29,950
29,751
1,257,057
1,157,191
1,165,843
1,071,851
540,334
509,722
79,761
16,622
48,220
494,526
490,756
70,641
7,059
36,509
498,880
486,677
71,939
13,771
36,859
454,518
426,077
63,428
7,725
25,838
1,198,491
1,099,491
1,108,126
984,021
Operating Income
Operating Income Percent
58,565
4.7%
57,700
5.0%
57,718
5.0%
87,830
8.2%
Other Gains and Losses
Investment Income & Investment FMV
Net Gain from Affiliates
Loss on Fixed Assets
State Appropriation
Other
Total Other Gains and Losses
17,530
1,351
(800)
0
(2,108)
16,273
11,001
3,459
81
0
(1,239)
13,302
6,774
1,367
(800)
0
(288)
7,053
79,173
3,222
717
0
(9,460)
73,652
74,839
71,002
64,770
161,482
79,761
(23,003)
131,585
70,641
(21,050)
120,593
71,939
(20,988)
115,721
63,428
(17,450)
207,460
96,384
53,725
88,345
66,178
$35,201
$66,868
$27,376
$141,282
Miscellaneous Revenue
Total Operating Revenues
Operating Expenses
Compensation and Benefits
Supplies, Utilities, and Other
Depreciation and Amortization
Interest Expense
Bad Debt
Total Operating Expenses
Revenues and Gains in Excess of Expenses
:
Add back Depreciation and Amortization
Less Principal Payments on Debt
Cash Available for Capital and Other
Capital Funded from Operations
Additions to Cash and Reserves
8
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.B. Valley Health Stereotactic
Radiosurgery Joint Venture
BACKGROUND: The Medical Center desires to form a limited
liability company with Winchester Medical Center to open a
Radiosurgery Center to provide stereotactic radiosurgery and
stereotactic body radiation therapy services (“SRS services”) at
Winchester Medical Center.
DISCUSSION: The Radiosurgery Center will expand the Medical
Center’s clinical enterprise in northern Virginia. The center
will be modeled on the Medical Center’s other off-Grounds
radiosurgery centers at Riverside Hospital and Mary Washington
Hospital. The University of Virginia Physician’s Group, through
the departments of Neurosurgery and Radiation Oncology, will
provide and be compensated for development services to prepare
for operations and medical direction services, which will
continue for several years of operations. The Medical Center
will be a 15% owner of the center without making any capital
contribution.
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Finance Committee, and by the Board of Visitors
APPROVAL TO ENTER INTO A JOINT VENTURE TO ESTABLISH A
RADIOSURGERY CENTER AT WINCHESTER MEDICAL CENTER
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
form a limited liability company with Winchester Medical Center
to provide stereotactic radiosurgery and stereotactic body
radiation therapy services in northwest Virginia; and
WHEREAS, Section 23-77.3 of the Code of Virginia grants
authority to the Medical Center to enter into joint ventures;
9
RESOLVED, the University, on behalf of the Medical Center,
is authorized to form a limited liability company with
Winchester Medical Center to provide stereotactic radiosurgery
and stereotactic body radiation therapy services in northwest
Virginia; and
RESOLVED FURTHER, the Executive Vice President and Chief
Operating Officer of the University, 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 joint venture,
including execution of the definitive agreement, contracts, and
all other documents necessary for the closing of the
transaction, on such terms as the Executive Vice President and
Chief Operating Officer of the University deems appropriate, and
to take such other action as the Executive Vice President and
Chief Operating Officer of the University deems necessary and
appropriate to consummate the foregoing.
10
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.C. Albemarle Arthritis Associates, LLP
Acquisition
BACKGROUND: The Medical Center desires to acquire substantially
all of the assets of the Albemarle Arthritis Associates, LLP
medical practice.
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 20% by the end
of year four.
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; and
11
RESOLVED FURTHER, the Executive Vice President and Chief
Operating Officer of the University, 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 Executive Vice President and
Chief Operating Officer of the University deems appropriate, and
to take such other action as the Executive Vice President and
Chief Operating Officer of the University deems necessary and
appropriate to consummate the foregoing.
12
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.A.
ACTION REQUIRED:
None
Vice President’s Remarks
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.
13
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.B. Annual Buchanan Report and Clinical
Presentation
BACKGROUND: Mr. Ward Buchanan, a 1914 graduate of the
University’s Law School, left a $52.6 million bequest to create
an unrestricted endowment fund for the University of Virginia
Medical Center. Interest earnings from the Ward Buchanan Fund
are being used to provide seed funding of unique, “clinically
differentiating” programs at the Medical Center. The annual
interest amounts to approximately $2.3 million and, with
matching funds, up to $5 million will be available. Funding
will be provided for a maximum of three years for each new
clinical program.
DISCUSSION: As in past years, a request was sent to all School
of Medicine clinical department chairs and clinical staff
members to submit Letters of Intent describing proposed
clinically differentiating programs.
In order to receive funding, the programs must demonstrate
that an 11% return on investment over a three-year period and 7%
net operating margin in the third and final year of funding
could be achieved. Programs must be clinically differentiating
and set the University of Virginia Medical Center apart from
other academic medical centers and hospitals in the area. In
addition, up to 25% of Buchanan funding may be used for Clinical
Trials Research that is part of a differentiating clinical
program.
Using these criteria, the Buchanan Endowment Programs
Committee recommended that two programs receive funding this
year. The Vice President and Chief Executive Officer of the
Medical Center and the Vice President and Dean of the Medical
School made the final decision and concurred with the
Committee’s recommendations. The two programs are:
Dermagram – Total Body Photography for Melanoma Screening:
This program will develop a formal process for technology-based
skin cancer screening and patient outreach.
14
High-Risk Pancreatic Cancer Clinic: The clinic will provide
comprehensive, evidence-based screening for high-risk pancreatic
cancer patients.
Reid B. Adams, M.D., Professor of Surgery, and Todd W.
Bauer, M.D., Assistant Professor of Surgery, will report on the
High-Risk Pancreatic Cancer Clinic.
15
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.C.
ACTION REQUIRED:
None
Graduate Medical Education
BACKGROUND: The University of Virginia Medical Center continues
to provide an excellent environment for physicians-in-training
to receive their GME in specialty residencies and fellowships.
It is within the realm of GME that we have the opportunity to
secure the future of medicine with those we are educating and
training. Despite uncertainties in healthcare reform and funding
for GME, as well as anticipated changes in accreditation
requirements, the training programs at the University of
Virginia Medical Center remain solid in their development of
innovative, compassionate, and skilled physicians. The Medical
Center has 757 residents and fellows participating in 107
training programs – 68 programs accredited by the Accreditation
Council for Graduate Medical Education (ACGME), 33 additional
fellowships (non-accredited, or accredited by other than the
ACGME), one ADA-accredited dentistry program, and five
paramedical programs in chaplaincy, clinical laboratory
medicine, clinical psychology, pharmacy, and radiation physics.
Because of recent regulatory changes mandated by the ACGME,
2011 brought major changes to resident duty hour restrictions as
well as more specific requirements in resident supervision,
hand-offs of care, and fatigue awareness, especially as these
measures relate to Quality and Patient Safety measures. The
Graduate Medical Education Committee (GMEC) and the staff in the
GME office have worked diligently to ensure that our programs
are compliant with all ACGME requirements, both old and new.
16
DISCUSSION:
Graduate Medical Education Trainee Statistics
The training year for GME trainees generally runs from July
to June. Medical, dental, and clinical psychology residents are
appointed annually and reappointed through the Medical Center’s
Credentials Committee. Statistics for FY 2012 are as follows:
Departing Housestaff:
Completed training program*
Transferred to another program
Not reappointed for academic reasons
Resigned for personal or academic reasons
Terminated from program
233
13
2
4
1
* Of the 233 residents completing training, 27 were
appointed to faculty positions.
New Appointments
230
Reappointments
531
Accreditation Status
Accreditation of GME programs and the institution is
provided by the ACGME. Accreditation is accomplished through a
peer review process and is based upon standards and guidelines
established by 26 specialty-specific committees, known as
Residency Review Committees (RRCs); accreditation of the
institution is reviewed and granted by the Institutional Review
Committee (IRC). The pharmacy residency program created new
subspecialty tracks within their residency. Effective July
2011, the additional tracks of Pharmacy Informatics and Oncology
were added to the curricula.
The accreditation (or reaccreditation) process occurs
periodically on a schedule set by the RRCs and is based upon
documentation provided by the program director and by a reviewer
following an on-site visit of the program. The current
accreditation status of our programs is as follows:
•
All 68 programs accredited by the ACGME and the institution
have full accreditation
–
–
21 core residency programs
47 subspecialty/fellowship programs
17
Program success can be measured in part by the length of
the accreditation provided by the ACGME and the RRCs. Of the 67
accredited programs, 82% of our programs have very favorable
cycle lengths (four to six years); there was a 10% increase in
programs receiving this cycle length in 2011.
•
•
•
•
•
•
6 year accreditation – 7 programs
5 year accreditation -- 35 programs
4 year accreditation -- 14 programs
3 year accreditation -- 9 programs
2.5 year accreditation – 1 program
2 year accreditation -- 2 programs
Of the 15 programs that received an official Letter of
Notification from the ACGME in the past 12 months, seven
received five-year cycles and eight received four-year cycles,
demonstrating longer accreditation cycles with nothing less than
a four-year cycle year be awarded. Our average cycle length for
programs has steadily increased since 2006 and is currently 4.6
years. Note that the ACGME recently announced that a revised
accreditation system will be implemented beginning in July 2012
(the Next Accreditation System or NAS). In this new system,
maximum accreditation cycles will be lengthened to 10 years.
The Designated Institutional Official (DIO) and GMEC
continue to track common citations received by program RRCs.
During the past year, many fewer citations were received by our
programs. A common citation was inadequate case volume. In
most cases, this was due to errors in the logging of cases,
however, there is speculation in some of the specialties that
the shortening of duty hours may be preventing trainees from
gaining exposure to some of the less common procedures. The
GMEC routinely asks for updates from programs if this citation
has been received.
The institution remains on a rigorous mid-cycle review of
its GME programs. There were 19 Internal Reviews completed in
Academic Year 2011-2012 and an additional 20 are scheduled for
Academic Year 2012-2013.
National Match
The Medical Center participates in the National Residency
Matching Program. Participation is required for programs
offering Post Graduate Year 1 positions and available to
programs offering Post Graduate Year 2 positions. Thirty
programs, offering 150 positions, participated in the 2012 Match
(18 categorical programs, three preliminary programs, one
18
primary program, and eight advanced programs). Two programs
(five positions) remained unfilled at the time of the Match.
This was the first year that the National Residency Matching
Program offered its Supplemental Offer and Acceptance Program
(SOAP) for unfilled programs and unmatched students. The five
positions at UVA were filled within hours of the opening of the
SOAP program. Preliminary analysis of the Match showed a wide
geographic diversity among medical students who chose to further
their training at the University of Virginia. In addition,
there were fewer international graduates matched to UVA than in
previous years.
Finance
The total direct budget for GME programs for fiscal year
2012 is $49,270,263. Funds to support this program come from
Medicare, Medicaid, other government or industry sources, and
the Medical Center.
In addition to continuing to fund innovative programs to
support education, such as the Master Educators Award, the
Graduate Medical Education Innovative Grant Program, and the
Certificate Program, the Medical Center increased salaries and
benefits for all graduate medical trainees in July 2011 to
remain competitive with GME programs nationally.
UVA Graduate Medical Education Trainee Salaries
Effective July 1, 2011 - June 30, 2012
Program
Level
UVA
Annual
Salary
50th
50th
UVA
Median
Median
Percentile Percentile
Annual
Southeast
Southern
All
All
Salary
Region*
Region*
Regions*
Regions*
Medical/Dental PGY 1 $50,250 $49,625
$48,677
$46,717
$46,942
$45,123
PGY 2 $51,000 $50,321
$50,343
$48,406
$48,439
$46,594
PGY 3 $53,000 $52,315
$52,323
$50,406
$50,128
$48,196
PGY 4 $56,750 $56,099
$54,556
$52,599
$51,719
$49,962
PGY 5 $57,500 $56,650
$56,804
$54,689
$53,577
$51,870
PGY 6 $58,750 $58,003
$59,139
$57,000
$55,816
$54,029
19
Program
Level
UVA
Annual
Salary
50th
50th
Median
UVA
Median
Percentile Percentile
Annual
Southern Southeast
All
All
Salary
Region*
Region*
Regions*
Regions*
Medical/Dental PGY 7 $60,500 $59,896
$61,044
$58,909
$$57,509
$55,029
PGY 8 $62,500 $61,975
$62,800
$61,059
$60,052
$57,540
Chaplain
PGY 1 $30,604 $30,301
PGY 2 $31,564 $31,251
PGY 3 $32,523 $32,201
PGY 4 $33,444 $33, 113
Pharmacy
PGY 1 $45,217 $44,769
PGY 2 $47,775 $47,301
Clinical
Psychology
PGY 1 $34,054 $33,717
PGY 2 $35,917 $35,562
*2011 AAMC Survey on Stipends, Benefits and Funding
Mandatory Reporting of ACGME Requirements
Duty Hour Compliance
Duty hours tracking and compliance continue to be a focal
point for the GME community. The Graduate Medical Education
Subcommittee’s Task Force on Duty Hours meets monthly to review
the programs’ duty hours reports, RRC citations, and internal
reviews results. In addition, the ACMGE has created a new
oversight body, the Monitoring Committee, which reviews the
results of the annual anonymous survey of residents and fellows
and reports areas of duty hour non-compliance to the program and
institution. The Task Force reports its findings directly to
the full GMEC where corrective action plans are developed, if
necessary.
All programs have adapted well to the RRC Common Program
Requirement changes that went into effect on July 1, 2011. The
most substantial change was to Post Graduate Year 1 (PGY-1),
where interns are restricted from working more than 16-hour
shifts. In rare instances of duty hour violations, the Task
Force and DIO have removed trainees from the patient care
20
environment until violations were corrected. Continued
oversight and education on duty hours compliance continues to be
a priority for the GMEC.
Resident Supervision, Responsibilities, Curriculum and
Evaluation
The GMEC updated and approved its supervision policy during
the past year to better define the role of the attending
physician and his or her supervision of residents. In addition,
the policy is now compliant with ACGME requirements that mandate
direct supervision of the most inexperienced residents at all
times. In addition, the GMEC and the Clinical Staff Executive
Committee (CSEC) approved a set of criteria that clearly outline
when trainees are expected to contact their supervising
physician in the event of changes to a patient’s status.
Program directors are ultimately responsible for assigning
responsibilities to residents and for evaluating trainees to
determine proficiency in all competencies, including patient
care and medical knowledge. These standards will be
substantially revised in the next calendar year, as the ACGME
has mandated the use of ‘Milestone’ evaluations for all
trainees. Milestone evaluations will require direct observation
of trainees in all aspects of patient care prior to their
advancement to the next academic year. The GME office sponsored
an initial series of Milestone workshops for Program Directors
and Coordinators that introduced the broad concepts and
implementation deadlines.
Resident Participation in Quality and Patient Safety Initiatives
At the institutional level, both mandatory and voluntary
educational initiatives involving Quality and Patient Safety are
offered. All incoming residents are required to take part in
the following educational activities: Abuse or Neglect,
Prevention and Investigation; Advanced Care Planning; Blood Gas
Sample Identification; Bloodborne Pathogen and Infection
Control; Pain Management; Acute Care Insulin Administration; and
Procedural Sedation. They also must complete mandatory
computer-based learning modules on Basic Quality and Patient
Safety issues. The Medical Center also offers elective
education in our Institutional Lecture Series that covers such
important topics as Fatigue Awareness, Metrics and Process
Improvement, Sentinel Events, and Ensuring Patient Safety.
Each individual residency or fellowship program must offer
training in Quality and Patient Safety as part of its standard
curricula. For some, it is offered in traditional settings such
as Morbidity and Mortality conferences. Others have developed
21
highly sophisticated systems to meet the competencies of
Practice Based Learning and Improvement and Systems Based
Practice.
In 2011, the Medical Center offered competitive awards of
$5,000 to GME trainees proposing studies designed to enhance
quality or patient safety. Eight awards were given to residents
and fellows. Topics included:
•
Identification of central line change violations and their
root cause in the Neonatal Intensive Care Unit
•
Frequent use of computers in the Neonatal Intensive Care
Unit by healthcare workers: Does it change the risk of
infection in this vulnerable population?
•
Allergic emergency preparedness in community medical
clinics providing immunotherapy to UVA patients
•
Nursing initiated management of infusional unfractionated
Heparin in the acute care setting using a weight-based
Heparin dosing nomogram
•
Assessment of obstetrical checklists to improve patient
outcomes and staff communication
•
Reducing accidental dislodgement of the Percutaneous
Endoscopic Gastrostomy (PEG): the PEG “SafetyBreak” device
•
Reducing health care associated infections in our child
psychiatry clinic
•
Paying residents for performance following myocardial
infarction
Innovations in Graduate Medical Education
Graduate Medical Education Innovative Grant Program
The Graduate Medical Education Innovative Grant Program
continues to recognize those projects that aim to enhance
resident education. The area of emphasis in 2011 was ideas
related to innovative techniques in GME, especially those which
explored methods designed to (1) fulfill criteria for the ACGME
Outcomes Project or (2) utilize milestones in the evaluation of
GME trainees. The 2011 Innovative Grant was awarded to Patrick
Northup, M.D., in Gastroenterology for his proposal
“Development, Implementation, and Validation of an Electronic,
22
Milestone-Based Procedure Evaluation System for the Procedural
Medical Subspecialties.” The Graduate Medical Education Grant
Review Committee continues to place high value on those projects
that not only attempt to demonstrate practices which can be
shared with or utilized by other GME programs but also address
the initiatives in quality and patient safety in a novel manner.
Fifth Annual Graduate Medical Education Research Day
The Fifth Annual Graduate Medical Education Research Day
was held in November 2011. Oral presentations were made by
winners of the Young Scientist Awards (seed grants awarded to
trainees by the Housestaff Council), the Graduate Medical
Education Innovative Grant Awards, and trainees who participated
in international clinical rotations. Additionally, a poster
session featured 18 poster presentations from the Young
Scientist Award Winners and additional trainees participating in
international clinical rotations.
National Presence
The GME office presented a poster on both the Graduate
Medical Education Innovative Grant Program and the Annual
Research Symposium at the 2011 Association for Hospital Medical
Education National Meeting.
Master Educator Awards
The 2011 Master Educator Award winners were Andy Wolf,
M.D., from the Department of Medicine and John Gazewood, M.D.,
from the Department of Family Medicine. Demonstrating a
dedicated and longitudinal commitment to GME, including direct
involvement with their respective residency programs, these two
recipients topped an extremely qualified list of nominees.
Graduate Medical Education Certificate Program
The program planning process has been enhanced, leading to
additional course offerings and earlier development of the
schedule, both leading to increased participation. 2011-12 saw
26 trainee participants in the Certificate program representing
14 different specialties. Fourteen trainees completed the four
courses required to achieve the certificate this year.
23
Support of Program Directors and Coordinators
•
•
•
•
Partial salary support is provided to Program Directors
based on number of trainees per program.
The GME office continues to support two junior program
directors per year to travel to national GME conferences.
The GME office has instituted a monthly training schedule
for the Program Coordinators in areas including scheduling,
duty hour tracking, Electronic Residency Application
Service, and reporting, among others.
The GME office provides additional support by its continued
participation in the robust monthly Graduate Medical
Education Coordinator Council meetings, Graduate Medical
Education Committee meetings and Housestaff Council
meetings. The GME office staff continues to collaborate
with the GME community in the following areas: program
coordinator professional development, program scheduling
process simplification, and increased access for all
Housestaff to resources from mental health and stress
management to spouse and partner employment assistance.
24
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.D.
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 the Executive Vice President and Chief Operating
Officer of the University 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.
FINANCE REPORT
After nine months of operations in FY 12, the operating
margin for all business units was 4.1%, which was below the
budget of 4.9%. The operating margin for the hospital and the
Outpatient Surgery Center was 2.5% 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 March. UVA
HOPE is exceeding its operating income budget by 51%.
During the first nine months of the fiscal year, inpatient
discharges were 1.8% above budget and 3.5% above the prior year.
Average length of stay was six days, which was above the budget
of 5.83 days. The longer length of stay can be partially
explained by a Medical Center CMI of 1.95, 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 FY 12 through March was 0.8%
above budget. Total operating expenses were 1.6% above the
$828.1 million budget. The majority of the operating expenses
in excess of budget relate to HOPE. We prepared the budget for
HOPE six months before the date of purchase, and we budgeted
HOPE operating income accurately but did not accurately budget
revenue and expense.
25
Total paid employees, including contracted employees, were
32 below budget.
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2011
FY 2012
2012 Budget
6,122
6,477
6,560
$72,947
$74,362
$73,550
263
228
177
6,385
6,705
6,737
OTHER FINANCIAL ISSUES
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 with providers in Virginia over the last year. In
January, Mary Washington Hospital went through a period of being
a nonparticipating provider with Anthem before the two
organizations came to terms for their provider contract. The
emergency medicine physicians at Augusta Health are currently
nonparticipating providers with Anthem. The Virginia
Commonwealth University Medical Center recently agreed to
provider contract terms with Anthem after a lengthy and
difficult negotiation. In anticipation of a difficult
negotiation with Anthem, we are planning the negotiation
strategy at this time. Our first step is to consult with the
University Health System Consortium which is scheduled for May.
The negotiations with Anthem will begin in earnest in the fall.
We anticipate that the Anthem negotiations will become a subject
for discussion with the Medical Center Operating Board over the
next year.
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $189.0 million for the
period July 1, 2011 through March 31, 2012, have been written
off. Recoveries during this period totaled $45.3 million.
Bad debt charges totaling $37.4 million have been written
off during FY 12. During this same period, $13.6 million was
recovered through suits, collection agencies, and Virginia
refund set-off.
26
OPERATIONS REPORT
Clinical Operations
Ambulatory Operations
University of Virginia Employee Connection and Care
Connection completed their second year since inception and
continue to grow and to be recognized as a valuable benefit to
the University community and to the community organizations to
which access has been extended. Over this two year period,
Employee Connection and Care Connection have accommodated over
10,000 patient visits, with 80% of the visits being University
of Virginia employees and their family members. 77% of visits
were first time visits to the services being requested. The
programs continue to grow, with access to services recently
being extended to City of Charlottesville employees. University
of Virginia Continuum Home Health is now utilizing Care
Connection to schedule follow-up clinic appointments for
patients who have recently been discharged from the Medical
Center.
Patient Care Services
Continuum Home Health
Virginia Premier contracted with University of Virginia
Continuum Home Health to administer its "Bridge Program", an
initiative to reduce hospital readmissions for selected clinical
conditions. This program currently targets patients being
discharged with a primary psychiatric diagnosis or a primary
diabetes diagnosis. The program consists of one hospital visit
prior to discharge and one home visit within 48 hours of
discharge from the hospital. Continuum will be providing this
program for Virginia Premier patients at the University of
Virginia Medical Center who meet criteria, as well as those
patients at Culpeper Regional Hospital, Martha Jefferson
Hospital, Augusta Medical Center, and Rockingham Memorial
Hospital.
Patient Progression Initiative
The Medical Center’s 11-month, on-site patient progression
consulting engagement with Huron Healthcare has been
successfully completed. Since the project was initiated in June
2011, significant achievement has been made in reducing overall
27
average length of stay for patients from 6.2 to 5.8 days. This
reduction has been achieved through implementation of many
successful process improvements to enhance patient flow over the
past eleven months, as well as identified mechanisms and roles
to enable better communications for care coordination.
Implementation has been achieved with numerous demonstrated
positive outcomes, some of which are highlighted below:
•
•
•
•
Emergency Department Flow Improvements: 11% reduction in
length of stay from 5.28 hours to 4.52 hours; 21%
improvement in patient at door to patient in room time from
38 minutes to 30 minutes; 30% improvement in disposition
decision to departure for discharged patients from 43
minutes to 30 minutes
Care Coordination Improvements: 60% point improvement in
anticipated discharge entered within one day of admission
from 30% to 90%
Surgical Flow Improvements: Day of surgery pre-evaluation
testing visits reduced by 27.4%; new pre-evaluation testing
“phone” visit option currently used for 11.9% of preevaluation testing visit encounters
Care Management Unit-Based Model: implemented the role of a
nurse Case Manager, ensuring appropriate patient level of
care and safe discharge; expanded the role of the Social
Worker, ensuring capacity to address psychosocial and
family support needs for our patients; confirm efficient
use of hospital resources by focusing on appropriateness of
patient admission
Management oversight of the patient progression work plan
and outcomes monitoring transitioned from Huron Healthcare to a
Medical Center oversight leadership group. Patient progression
monitoring metrics and outcomes were identified and are now
published weekly in management reports. A risk analysis was
performed to identify processes and issues that need priority
focus for further improvements and monitoring. This is critical
to be certain we continue to improve our patients’ progression
in care and appropriately continue to reduce our length of stay
in the Emergency Room and inpatient units.
Medical Laboratories
The Core Laboratory replaced its high volume chemistry
analyzers with two new Abbott ci16200's and its 10-year-old
urinalysis system with a new Siemens Automated Urinalysis
Workcell. Both of these new technologies will have a major
impact on improving turnaround times. It is expected that the
new chemistry analyzers will reduce the actual testing time
turnaround by 50% and the urinalysis analyzer by 20%.
28
Pharmacy Services
Pharmacy Services installed a Talyst Outpatient Will Call
carousel in the Barringer Outpatient Pharmacy. This automation
enables the pharmacy staff to more safely and efficiently sort
and organize filled prescriptions awaiting pick up by employees
and patients. It utilizes bar code technology and two patient
identifiers to ensure identification of the right person with
the right stored prescription which increases the level of
service and safety to our patients.
The Accreditation Council on Pharmaceutical Education
surveyed the planned Virginia Commonwealth University School of
Pharmacy – University of Virginia division in March and will be
recommending accreditation of the program which is scheduled to
open in August 2012.
The American Society of Health System Pharmacists completed
their initial accreditation visit for three new pharmacy
Residency programs (Information Technology, Oncology and Health
System Pharmacy Administration) and found no areas of noncompliance. This means that full accreditation of these
programs is expected at the next American Society of Health
System Pharmacists Commission on Accreditation meeting in
August.
Pharmacy Services has acquired a license for designation of
its outpatient pharmacies as a chain pharmacy. This will allow
University of Virginia branded pharmacies to expand more easily
with the needs of the Health System.
Radiology and Medical Imaging
Two of the computed tomography scanners at University
Hospital East were upgraded to the latest generation of scanning
technology, equivalent to the technology used in the computed
tomography scanner installed in the Emily Couric Cancer Center.
In early April 2012, Radiology will begin to offer breast
tomosynthesis imaging services to patients at the Medical
Center’s Breast Care Center. This unique mammographic technique
will make it possible to better see hidden abnormalities in
women with dense breast tissue.
Culpeper Regional Hospital
Culpeper Regional Hospital recently welcomed two
specialists in breast surgery, Dr. David Brenin and Dr. Anneke
Schroen, to the University of Virginia Multi-Specialty Clinic.
29
The addition of these physicians brings world class breast
surgery to the Culpeper community and compliments the growing
oncology service line that is already provided by other
University of Virginia programs including HOPE, Radiation
Oncology, General Surgery, and infusion therapy.
The Culpeper Hospital has been actively engaged in
strategic planning for capital allocation, including
infrastructure upgrades as well as construction of a cesarean
section suite and an endoscopy suite.
Health System Technology Services
Epic Electronic Health Record
An orchestrated plan to upgrade the Medical Center’s Epic
software to the 2010 version was conducted April 2-20 and was
completed.
Culpeper Medical Associates, LLC initiated a project plan
with University of Virginia Medical Center and University of
Virginia Physicians Group to implement the Epic electronic
health record in Culpeper Medical Associates primary care
clinics. The system will be implemented on a rolling basis
beginning in July with complete installation by August 2012.
The goal is to have the Culpeper Medical Associates offices use
Epic prior to beginning measurements for Meaningful Use on
October 1 for the 90 days then remaining in the calendar year.
Human Resources
Medical Center Human Resources released a new web site
which is much easier to navigate for employees and provides
numerous enhancements for accessing employee and leadership
resources. The site provides employees an easy way to obtain
answers to human resources questions through a more organized
and intuitive search capability.
Human Resources announced a change to the full-time
employment definition. Over 700 employees were moved from 0.9
flex staff status to full-time, enabling these employees to
qualify for full-time benefits. This has been a major source of
satisfaction for employees.
Compensation
In keeping with the Medical Center’s compensation strategy
and the FY 2012 operating budget, 5,499 employees received a
merit adjustment in the form of an increase or bonus in their
30
February 10, 2012 paycheck. This was a total investment by the
Medical Center in its employees of $5,885,977.
Recognition and Rewards
Numerous activities to recognize the contribution of
Medical Center employees occurred over the past several months.
Some of the events included:
•
•
•
•
Over 3,000 bowls of chili were served by the Medical
Center’s executive leadership team to employees as a thank
you for their attention to the quality of care delivered
each and every day to patients (offsite locations were
treated to donuts and cider);
Over 6,700 units of ice cream were distributed in
University Hospital and delivered to off-site locations in
celebration of the Medical Center’s successful Joint
Commission survey;
A summer camp expo was held in the Medical Center to
introduce many local summer camps to employees to help them
with decisions about where their children might spend their
summer;
Employee of the Month celebrations were held to recognize
individuals nominated by their peers.
Engagement
The Medical Center is committed to conducting regular
employee engagement surveys to identify how to achieve an
engaged workforce. In July 2011, over 80% of Medical Center
employees participated in a full census engagement survey that
allowed the Medical Center to identify opportunities to improve
the work environment and work life of employees. Senior
leadership used the survey feedback, as well as other feedback
obtained from employee roundtables held by each senior leader,
to commit to specific actions and to implement new initiatives
and recognition programs.
In February 2012, the Medical Center administered a “pulse”
employee engagement survey. Unlike a census survey, a pulse
survey collects information from a smaller sample of the total
employee population. One thousand employees were randomly
selected to participate in the pulse survey. Fifty-four percent
of those invited participated in the survey. Results of the
pulse survey showed a statistically significant increase in
employee engagement from 68.27 to 74.47 (on a 100 point scale),
which exceeds the organizational goal of 69.1 and the benchmark
of 71.0 for healthcare organizations using the same survey.
Specifically, the survey showed significant improvement in the
likelihood of employees referring a friend or family member for
31
care and that employees are more proud to work at the Medical
Center. It was noted that employees felt this greater sense of
pride in the organization due to the support they receive,
improved communications they now receive from senior leadership,
and a better understanding of the direction of the Medical
Center shared by senior leadership. Employees also noted that
they would like to see additional strides made in retaining high
performers and addressing low performers.
Organizational Development
The first Uteam Leadership Academy Informal Leader program
was successfully completed with 60 employees graduating. This
program is intended to help employees who do not currently hold
formal leadership roles but lead others informally or play a
significant part in leading the success of their area. The
program received excellent feedback from the class participants
as well as from their supervisors. The first cycle of the New
Leader Orientation program was also completed. Medical Center
executive leadership serve as the facilitators for this program,
which provides an opportunity for attendees to learn how to be a
successful manager in an intimate educational setting with
meaningful dialogue. The Medical Center has also initiated a six
class series titled “Best Practices in Management” for anyone in
a management position. The topics presented are based on areas
identified in past employee engagement surveys. Participants
obtain tools they can immediately implement on topics such as
trust, engagement, managing change, accountability, and
developing and recognizing employees.
Uteam Meetings
A series of Uteam meetings was held during the first three
weeks in April at the Medical Center and at off-site locations.
Ed Howell, Bo Cofield, and Jonathon Truwit shared their
collective vision of our recent successes as a Health System.
Ed Howell’s presentation focused on the use of “always” words
and events to enhance everyone’s engagement and line of sight in
providing superlative quality and service to our patients and
families. Bo Cofield provided a current update of the Medical
Center’s operational performance and initiatives, including
overall goals, patient progression successes, and continued
expansion efforts. Jonathon Truwit provided an overview of a
new shared leadership concept for the Health System and how it
will foster communication and cross-disciplinary dialogue
throughout the Health System. Each session was well attended
and the feedback received from employees was very positive.
Many said they had personally felt a positive change in the
culture throughout the Medical Center and pointed specifically
32
to “employees every day going the extra mile to help visitors
and patients find their way,” “employees treating each other
with kindness and respect,” and “the transparency and frequent
communication upper leadership has with its employees, and how
feedback is taken seriously.”
Quality and Performance Improvement
Quality and Patient Safety Initiatives
The Quality Committee of the University of Virginia Medical
Center announced the winner of the 2011 Charles L. Brown Award
for Patient Care Quality: “Improving Outcomes of the Total Joint
Arthoplasty Patient: Validating Safety and Enhancing Mobility.”
The project team included Andy Poole, PT, MSHA; Joel Anderson,
RN; Quanjun Cui, M.D.; Wendy Novicoff, PhD; Matthew Kinney, BS;
Greg Cooper, PT; Stella Prevost PT, MS, CCS; Patrick Hennelly,
PT; Laura Schapiro; Peter Simons, PT, MSHA; and Michelle
Longley, RN, GNP. This effort by the Physical Therapy
Department, the Department of Orthopedics, 8 West, 6 East and
the Department of Public Health Sciences is a true demonstration
of collaboration and teamwork in improving patient care.
The Virginia Hospital and Healthcare Association and its
partners hosted an inaugural Virginia Patient Safety Summit in
Richmond in February. The purpose of the conference was to
create a dynamic forum for active learning and collaboration as
hospitals, health systems, and health care professionals pursue
top-tier performance in clinical quality and patient safety in
the Commonwealth. The interactive program was designed as a
multidisciplinary forum that included physicians, nursing,
ancillary services, quality and patient safety officers, health
system administrators as well as those engaged in undergraduate
and graduate education. The University of Virginia Medical
Center was well represented at the Summit with eight poster
presentations, 12 employees in attendance, and Dr. Jeff Young,
Senior Associate Chief Medical Officer for Quality, a featured
speaker.
Environment of Care
Patient & Guest Services
The American Cancer Society’s Daffodil Day was celebrated
at the Medical Center on March 23 with daffodils being
distributed to all patients at University Hospital. Daffodils
were also available for visitors and staff to purchase.
33
Flourish Boutique, located in the Emily Couric Clinical
Cancer Center, celebrated its one-year anniversary with a sale,
raffle and refreshments the week of April 2-6. All funds raised
will go to help our cancer patients.
National Volunteer Week was celebrated the third week in
April. Events were planned throughout the week to recognize the
importance of our volunteers and to say “thank you” for all that
they do at the Medical Center.
Arts Committee
There was an exhibition of photographs by the
Charlottesville Camera Club on display in University Hospital
Lobby from March 2 to May 4, 2012.
34
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Mar-10
Net patient revenue
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Total operating expenses
Operating income (loss)
Mar-11
Mar-12
Mar-12
$738.4
$772.6
$844.4
$848.4
20.6
21.9
33.2
22.5
$759.0
$794.5
$877.6
$870.9
674.9
698.3
782.8
763.9
40.4
45.2
53.3
53.9
5.1
5.8
5.3
10.3
$720.4
$749.3
$841.4
$828.1
$38.6
$45.2
$36.2
$42.8
$5.3
Non-operating income (loss)
$57.2
$58.7
$5.9
Net income (loss)
$95.8
$103.9
$42.1
Principal payment
$13.0
$15.7
$15.8
35
Budget/Target
$48.1
$15.8
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Mar-10
Mar-11
Mar-12
Assets
Operating cash and investments
$97.2
$126.4
$33.6
45.6
101.2
142.2
Property, plant and equipment
540.0
651.0
711.1
Depreciation reserve and other investments
322.5
210.3
178.9
Endowment Funds
328.0
378.2
409.4
Other assets
164.5
182.9
233.9
$1,497.8
$1,650.0
$1,709.1
Current portion long-term debt
$9.6
$7.4
$9.9
Accounts payable & other liab
94.2
95.7
98.7
Long-term debt
341.1
330.2
315.4
Accrued leave and other LT liab
117.5
160.2
128.8
$562.4
$593.5
$552.8
$935.4
$1,056.5
$1,156.3
$1,497.8
$1,650.0
$1,709.1
Patient accounts receivables
Total Assets
Liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
36
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Mar-10
Operating margin (%)
Mar-11
Budget/Target
Mar-12
Mar-12
5.1%
5.7%
4.1%
4.9%
Total margin (%)
11.7%
12.2%
4.8%
5.5%
Current ratio (x)
1.4
2.2
1.6
2.4
186.9
175.3
138.1
190.0
Gross accounts receivable (days)
44.5
45.3
48.2
45.0
Annual debt service coverage (x)
7.8
7.2
4.8
5.2
36.0%
32.7%
29.7%
31.8%
6.3%
6.8%
7.0%
7.8%
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Mar-10
Acute Discharges
Patient days
Mar-12
Mar-12
20,155
20,771
21,498
21,127
124,805
125,748
128,718
123,066
6,548
6,749
7,690
6,564
6.20
5.99
6.00
5.83
504,746
518,150
565,525
537,056
43,649
43,757
46,196
44,491
2.06
2.01
2.09
2.04
6,200
6,385
6,705
6,737
SS/PP Patients
Average length of stay
Clinic visits
Mar-11
Budget/Target
ER visits
Medicare case mix index
FTE's (including contract labor)
37
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 - March FY12
OPERATING STATISTICAL MEASURES - March FY12
DISCHARGES and CASE MIX - Year to Date
Actual
Budget
% Variance
DISCHARGES:
Adult
Pediatrics
Psychiatric
Transitional Care
Subtotal Acute
18,091
2,367
901
139
21,498
17,638
2,254
1,039
196
21,127
2.6%
5.0%
(13.3%)
(29.1%)
1.8%
17,494
2,151
1,095
31
20,771
7,690
6,564
17.2%
6,749
Total Discharges
29,188
27,691
5.4%
27,520
Adjusted Discharges
39,540
38,219
3.5%
37,095
Short Stay/Post Procedure
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
1.95
2.09
1.90
2.04
OTHER INSTITUTIONAL MEASURES - Year to Date
Actual
Budget
% Variance
Prior Year
2.6%
2.3%
1.89
2.01
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
128,718
6.00
468
1,212
123,066
5.83
448
1,242
4.6%
(2.9%)
4.5%
(2.4%)
125,748
5.99
459
1,256
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
565,525
3,135
46,196
537,056
2,966
44,491
5.3%
5.7%
3.8%
518,150
2,957
43,757
15,253
6,141
21,394
14,485
6,531
21,016
5.3%
(6.0%)
1.8%
14,322
6,321
20,643
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
38
OPERATING FINANCIAL MEASURES - March FY12
REVENUES and EXPENSES - Year to Date
Actual
Budget
% Variance
($s in thousands)
NET REVENUES:
Net Patient Service Revenue
Other Operating Revenue
Total
844,369
33,233
$ 877,602
EXPENSES:
Salaries, Wages & Contract Labor
Supplies
Contracts & Purchased Services
Bad Debts
Depreciation
Interest Expense
Total
Operating Income
Operating Margin %
Non-Operating Revenue
374,757
196,982
186,157
24,942
53,249
5,301
$ 841,388
$ 36,214
4.1%
$
5,950
Net Income
$
42,164
Prior Year
848,403
22,504
870,907
(0.5%)
47.7%
0.8% $
772,558
21,957
794,515
(0.9%)
(6.6%)
(3.5%)
9.8%
1.2%
48.6%
(1.6%) $
(15.3%) $
$
371,555
184,830
179,880
27,640
53,905
10,322
828,132
42,775
4.9%
5,301
353,483
164,428
158,167
22,239
45,185
5,820
749,322
45,193
5.7%
58,673
$
48,076
(12.3%) $
$
$
$
$
12.2%
$
103,866
OTHER INSTITUTIONAL MEASURES - Year to Date
($s in thousands)
Actual
Budget
% Variance
Prior Year
NET REVENUE BY PAYOR:
Medicare
$
276,840 $ 281,084
(1.5%) $ 255,956
Medicaid
96,190
102,707
(6.3%)
93,525
Commercial Insurance
172,390
146,013
18.1%
132,960
Anthem
149,805
158,184
(5.3%)
144,042
Southern Health
24,347
40,241
(39.5%)
36,643
Other
124,797
120,175
3.8%
109,431
Total Paying Patient Revenue
$
844,369 $ 848,403
(0.5%) $ 772,558
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
$
35.44%
48.2
10,633 $
6,705
24.01
35.31%
45.0
11,045
6,737
25.56
0.4%
(7.1%)
3.7% $
0.5%
6.1%
36.28%
45.3
10,352
6,385
24.91
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 - March 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
39
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)
INDIGENT CARE (IC)
Net Charge Write-Off
Percentage of Net Write-Offs to Revenue
Year to Date
March
2011-12
159,138
6.68%
Annual Activity
2010-11
2009-10
195,645
172,917
6.89%
6.60%
Total Reimbursable Indigent Care Cost
60,154
73,954
53,095
State and Federal Funding
57,700
70,936
52,053
Total Indigent Care Cost Funding As a Percent
of Total Indigent Care Cost
Unfunded Indigent Cost
96%
2,454.29
96%
98%
3,017.31
1,042.00
Annual Activity
BAD DEBT
Net Charge Write-Offs
Percentage of Net Write-Offs to Revenue
March
2011-12
24,942
1.05%
2010-11
25,838
0.91%
2009-10
30,948
1.18%
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.
40
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.E.
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:
41
The University of Virginia Medical Center
Capital Projects Report
May 2012
Scope
Under Construction
Barry and Bill Battle Building:
BOV
Projected
Budget
Funding Source
Approval
Completion
$117 M
Bonds and Outside
N/A
2014
$7.6M
Bonds
Feb 2008
2012
$21.2 M
Bonds
Feb 2008
2013
Bonds and Health
Sept 2005
Fundraising
The Groundbreaking Ceremony was
Date
Date
held on June 9, 2011. Structural
concrete is progressing with work on
the 2nd Floor.
University Hospital:
Add elevators. The new elevators are
in place but are not in use awaiting
completion of the new elevator
lobbies, which are nearing
completion.
University Hospital:
Renovate Radiology Department –
University Hospital Bed Expansion:
(52,000 GSF)
$80.2 M
System Operating
Project to increase inpatient bed
Revenue
capacity in University Hospital by
adding 72 private, ICU-level rooms.
All patient units are complete with
Floors 3 and 5 occupied. Only
commissioning activities remain.
42
June 2007
2012
*Health System Precinct:
$36.5M
Bonds & Other
June 2010
2013
BOV
Projected
Realignment of Lee St. and
construction of new chiller plant.
Realignment of Lee St. to be
complete this summer. Foundation
work is underway for the new chiller
plant.
Scope
*University Hospital:
Budget
Funding Source
Approval
Completion
$6.7M
Bonds
Nov. 2010
2012
Relocation of helipad to roof of
University Hospital. Helipad and
associated elevator work is complete
and undergoing commissioning
activities. Relocation of air handler
intakes is underway.
* Project modifies original HEP project
43
Date
Date
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
May 21, 2012
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III.F.
ACTION REQUIRED:
None
Health System Development
BACKGROUND: Health System Development will provide reports of
recent activity to the Medical Center Operating Board from time
to time.
DISCUSSION:
SIGNIFICANT GIFTS
December 1, 2011 – February 29, 2012
Altria Corporation made a $2 million pledge payment in
fulfillment of its remaining $4.5 million commitment to the
University of Virginia Health System to establish the Virginia
Center for Translational and Regulatory Science (VCTRS) at the
University of Virginia.
A School of Medicine alumna and her spouse, also a graduate
of the University of Virginia, made a $1,500,000 bequest in
support of Alzheimer’s and diabetes research.
The School of Nursing received a $350,000 trust
distribution for support of undergraduate education and training
for Virginians interested in a nursing career.
The Lettie Pate Whitehead Foundation pledged $297,000 in
support of nursing and medical scholarships for female students
in the 2012-2013 fiscal year.
More than 425 guests attended the 2012 Children’s Hospital
Main Event, which was held on February 4 at Keswick Hall. The
event raised more than $216,000 in support of the Battle
Building and other Children’s Hospital initiatives.
A Health Foundation emeritus trustee fulfilled $200,000 of
a remaining $405,824 pledge balance in support of the Transplant
Center.
The Fred Banting Foundation made two gifts totaling
$119,090, of which $91,301 will go to the School of Medicine
44
Artificial Pancreas Research Fund and $27,789 to the Diabetes
Technology Center.
Friends of the Health System made a $100,000 planned gift
in support of the Blackford Cancer Research Fund.
A $100,000 commitment in support of the Battle Building was
received from the BamaWorks Fund of the Dave Matthews Band
through the Charlottesville Area Community Foundation.
Friends of the Health System made a $100,000 pledge and
$50,000 pledge payment to establish an endowed fund in support
of Dr. John Densmore’s cancer research.
A medical alumnus and his spouse pledged $100,000 for a
naming opportunity in the Claude Moore Medical Education
Building.
Other gifts and pledges received include:
• A $95,278 gift through the ziMS Foundation in support of
Multiple Sclerosis research;
• An $85,000 commitment to the School of Nursing for the McLeod
Hall renovation;
• A $63,000 grant to the University of Virginia Children’s
Hospital Fitness Clinic’s “Growing Up Healthy” program;
• A $50,000 commitment in support of the Grand-Aids initiative;
• A $50,000 commitment through the Berne Carter Foundation for
the 2011 Carter Foundation Award; and
• A $50,000 unrestricted commitment to the School of Medicine.
OTHER DEVELOPMENT INITIATIVES
Several events and activities took place to promote the
University of Virginia Children’s Hospital and Children’s
Miracle Network, including a private dinner at the home of Dr.
Tim Garson; the annual University of Virginia Dance Marathon,
which raised more than $39,000 for pediatric hematology and
oncology research; a Children’s Miracle Network IHOP Pancake
breakfast; and a “Champions of UVA Children’s Hospital”
leadership annual giving solicitation.
Health System Development staff provided University of
Virginia Campaign vice chair John Nau with an update on the
progress of the pancreatic cancer research program to facilitate
his assistance with the Health System’s efforts to strengthen
relationships with private foundations and with potential
legislative contacts.
45
The Health System Development Office hosted a presentation
on February 28 by Health Foundation trustee emeritus Paul
Manning and his staff regarding his DOVA cause-marketing
initiative Discussions are underway to determine how this
collaborative program may provide annual support for various
University areas, particularly the Children’s Hospital.
The Health System Communications team created an end-ofyear stewardship flash video highlighting philanthropy, sent
several event and volunteer-related eblasts, and provided
assistance on a variety of fundraising events and needs.
To date in FY 2012, Development officers have made 1,024
face-to-face visits with donors and prospects.
CAMPAIGN PROGRESS THROUGH 2012
as of 2/29/2012
Through the end of February, the Health System Campaign for
Health total is $588,122,258. This represents 118% of the
original $500 million campaign goal. The following table shows
the FY 2012 totals as of February 29 for new commitments,
including gifts and pledges, as compared with the same time in
FY 2011.
New Gifts
FY 12
FY 11
(through 2/29/12) (through 2/28/11)
$26,712,525
$27,067,834
New Pledges
Total New Commitments
(excludes pledge payments on
previously booked pledges)
46
$1,592,519
$1,619,648
$28,305,044
$28,687,482