UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
FOR THE UNIVERSITY OF
VIRGINIA MEDICAL CENTER
February 24, 2011
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
Thursday, February 24, 2011
8:30 a.m. – 12:00 noon
Medical Center Dining Conference Rooms
Committee Members:
Vincent J. Mastracco, Jr., Chair
Helen E. Dragas
Andrew K. Hodson, MB.Ch.B
Sheila C. Johnson
William P. Kanto, Jr., M.D.
Constance R. Kincheloe
Randy J. Koporc
The Hon. Lewis F. Payne
Randl L. Shure
E. Darracott Vaughan, Jr., M.D.
John O. Wynne
Ex Officio Members:
Teresa A. Sullivan
Steven T. DeKosky, M.D.
Dorrie K. Fontaine
Arthur Garson, Jr., M.D.
Robert S. Gibson, M.D.
R. Edward Howell
Leonard W. Sandridge
AGENDA
PAGE
I.
II.
REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEDICAL CENTER (Mr. Howell)
A.
Vice-President’s Remarks
1
B.
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)
2
C.
Capital Projects
27
D.
Graduate Medical Education (Mr. Howell to
introduce Susan E. Kirk, M.D.; Dr. Kirk to
report)
30
E.
Health System Development
42
EXECUTIVE SESSION
●
ACTION ITEMS - To consider proposed personnel
actions regarding the appointment, reappointment,
resignation, assignment, performance, and
credentialing of specific medical staff and allied
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, the proposed
dissolution and sale of the Medical Center’s
interest in a joint venture, long range financial
planning, fiscal year 2012 budget assumptions,
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; and
– Consultation with legal counsel regarding
compliance with relevant federal and state legal
requirements, licensure and accreditation
standards, and ongoing litigation.
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:
February 24, 2011
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.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.
1
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 24, 2011
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.B.
ACTION REQUIRED:
None
Finance, Write-offs, and Operations
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 five months of Fiscal Year 2011, the operating margin
for all business units was 5.7 percent, which was above the
budget of 2.8 percent. Total operating revenue was above budget
by 0.5 percent and total operating expenses were below budget by
2.6 percent. The operating margin for the Medical Center
business unit was 4.0 percent against a budget of 0.9 percent.
The Medical Center’s operating margin was budgeted to decline
substantially in the second quarter due to the implementation of
the EpicCare Electronic Medical Record in the ambulatory
clinics, but the impact on volumes and margin was less than
expected. The operating margins for University of Virginia
Imaging, University of Virginia Outpatient Surgery Center, OffCampus Dialysis, and Outreach were above budget through
November.
For the first five months of Fiscal Year 2011, most volume
indicators were above budget, including inpatient discharges,
observation patients, inpatient and outpatient surgeries,
transplants, births, and outpatient clinic visits. Patient days
were slightly below budget and emergency room visits were 4.0
percent below budget. Average length of stay was 6.05 days,
which was below both budget and the prior year. The case mix
index was 1.88 compared to a budget of 1.90.
Inpatient discharges for Fiscal Year 2011 through November
2010 were 0.3 percent above budget and 2.1 percent above prior
year. General Medicine volumes increased by 211 cases (16.4
2
percent) from the prior year. Discharges from several surgical
services, including General Surgery, Orthopedic Surgery,
Transplant Surgery, and Vascular Surgery, increased from Fiscal
Year 2010. Neurosurgery discharges decreased by 161 cases (13.6
percent). Other services which realized declining inpatient
volumes include Gastroenterology (9.5 percent) and Cardiology
(11.6 percent decrease).
Net patient service revenue for the first five months of
Fiscal Year 2011 was 0.4 percent above budget. Total operating
expenses through November were 2.6 percent below the $423.5
million budget. Total labor expenses (including salaries and
wages, fringe benefits and contract labor) were 0.4 percent
above budget. Total supply cost was 4.3 percent below budget.
With the exception of interest expense, all other expense
categories, including purchased services, depreciation, and bad
debt, were below budget.
Total paid employees, including contracted employees, were
three above budget.
FY 2010
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2011
2011 Budget
6,003
6,048
6,107
$69,902
$71,965
$72,139
176
234
172
6,179
6,282
6,279
OTHER FINANCIAL ISSUES
The recently enacted Patient Protection and Affordable Care
Act and the Health Care and Education Affordability
Reconciliation Act of 2010 will impact the healthcare industry
over the next decade in a significant manner, probably greater
than any legislation since the repeal of cost based
reimbursement in the early 1980s. The Medical Center, like all
healthcare organizations across America, is studying the impact
this legislation will have on our business and strategies over
the next decade. One aspect of the legislation is an emphasis
on innovative delivery systems such as the Accountable Care
3
Organization. We are meeting with organizations such as Anthem
to try to better understand the risk and rewards associated with
an Accountable Care Organization.
The Patient Protection and Affordable Care Act of 2010
requires the Secretary of Health and Human Services to establish
a Value-Based Purchasing program to pay hospitals for their
actual performance on quality measures, rather than just the
reporting of those measures, beginning in Fiscal Year 2013. The
Value-Based Purchasing program will apply to the Medical Center.
The proposed regulation was released on January 7. We are
evaluating the impact of the proposed regulation at this time.
In addition, Mary Washington Hospital and the University of
Virginia have recently signed a definitive agreement to form a
joint venture where two University of Virginia cardiac surgeons
will live in the Fredericksburg community and practice full time
at Mary Washington Hospital, and the University of Virginia will
manage the cardiac surgery service line at the hospital. This
joint venture will enhance the quality of care for cardiac
surgery patients at Mary Washington Hospital, and it will
provide the University of Virginia a financial return and an
expanded relationship with Mary Washington Hospital. The first
day of operations for the joint venture will be March 1, 2011.
This is our second joint venture with Mary Washington Hospital;
the first joint venture is for Radiosurgery.
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $95.8 million for the period
July 1, 2010, through November 30, 2010, have been written off.
Recoveries during this period totaled $24.5 million.
Bad debt charges totaling $18.4 million have been written
off in the first five months of Fiscal Year 2011. During this
same period, $7.1 million was recovered through suits,
collection agencies, and Virginia refund set-off.
OPERATIONS REPORT
Clinical Operations
Ambulatory Operations
Employee Connection, a new concierge services program
initiated by the Medical Center on January 4, 2010, has
successfully reached a one year milestone. The program has
provided our Health System and University employees and their
4
families with a direct connection to the Health System through
dedicated Ambassadors who assist with scheduling appointments,
providing guidance on physician referrals, and answering any
questions that arise. The Health System is committed to
providing University employees and their families primary care
appointments within two business days, non-procedural radiology
services within three business days, and specialty care
appointments within five business days. This service has been
very well received over this past year and continues to grow.
As of December 31, 2010, Employee Connection had made
appointments for 3,373 patients, including 1,682 (50%) Health
System employees, 676 (20%) University of Virginia employees,
and 1,015 (30%) family members of University employees.
Approximately 75% of the appointments made for University of
Virginia employees or family members have been for specialty
care and 22% for primary care. The most requested services have
been Family Medicine, Dermatology, Ophthalmology, and
Orthopedics. Access to Employee Connection services has
recently been extended to Klockner Pentaplast employees and
their families.
An Employee Same Day Clinic opened on July 28, 2010, for
employees of the Health System and was formally extended to
employees of the University in December 2010. The clinic is a
component part of the employee benefits package and offers same
day appointments with nurse practitioners for minor illnesses.
As of December 31, 2010, the clinic has seen a total of 655
employees, 150 of whom have asked for a referral to establish
care with a University of Virginia primary care physician.
On December 22, 2010, the State Health Commissioner issued
a Certificate of Public Need for the construction of the Barry
and Bill Battle Building and nine outpatient operating rooms,
which includes the relocation of six operating rooms currently
located in the Ambulatory Surgery Center and the addition of
three new operating rooms.
Inpatient and Procedural Services
In February 2011, the Digestive Health Center introduced a
revolutionary new treatment for gastro esophageal reflux
disease, also known as chronic acid reflux disease. Dr. Bruce
Shirmer began performing a new procedure called Transoral
Incisionless Fundoplication, which treats the root cause of this
reflux disorder. This new procedure involves reconstruction
of the antireflux valve and restores the body’s natural
protection against reflux.
5
The Transplant Center was awarded a $3,000 Venture Award
from the University of Virginia Hospital Auxiliary for piloting
kidney paired exchange. Under the direction of Kenneth Brayman,
M.D., Chief of Transplant Surgery, the planning team consists of
Rob Teaster, Administrative Director, Anita Sites RN, Living
Donor Coordinator, Avinash Agarwal, M.D., Transplant Surgeon and
Scot Sanoff, M.D., Transplant Nephrologist. Phase I of the
plan, which focuses on patient recruitment, began in January
2011. The team expects the first kidney exchange to occur by
May 2011.
The Operating Room began use of the second DaVinci robot,
which was purchased during the summer. Three surgeons on two
services, Otolaryngology and General Surgery, completed training
and are performing proctored cases, while a thoracic surgeon is
participating in case observations. A newly hired Obstetrics
and Gynecology surgeon, who was fully trained upon hire, is also
using the system. The 2nd quarter of Fiscal Year 2011 (October December 2010) saw a 35% growth in the use of robotics compared
to past periods.
Perioperative Services General Electric Centricity computer
systems (Centricity Perioperative Manager and Centricity
Perioperative Anesthesia) were upgraded to a new operating
platform. The Centricity Perioperative Anesthesia product was
also implemented at the University of Virginia Outpatient
Surgery Center this fall. Other off-site anesthesia locations
are also being brought up on this anesthesia product
incrementally.
Surgery Compass, a business intelligence product from The
Advisory Board Company, was on-site to perform an opportunity
assessment of Perioperative Services. A steering committee
formed to oversee this assessment selected two opportunity
goals, one related to day of surgery efficiencies and the other
related to supply cost standardization and utilization.
The Heart Center hybrid lab opened in late summer 2010 and
to date 160 patients have had procedures performed in the lab.
Since opening, the hybrid lab has functioned primarily as a
third cardiac catheterization lab, mostly for pediatric
interventional procedures, pending completion of additional labs
that will allow the hybrid lab to be completely utilized as a
high end bi-plane imaging system combined with the essential
features of an operating room. The lab has accommodated some
complex, hybrid thoracic/interventional procedures that require
surgeons and interventional cardiologists to work
collaboratively with both a surgical team and an interventional
cardiology team. These hybrid procedures include transcatheter
6
aortic and pulmonary valve replacement, mitral valve repair,
high risk implantable cardioverter defibrillator and pacemaker
laser lead extractions, and combined surgical/catheter ablations
for complex atrial dysrhythmias. The enlarged footprint of this
lab enables these procedures to be performed properly, with
adequate space for the equipment and staff required to
successfully and safely perform them. The Siemens bi-plane
imaging system provides state of the art imaging capability,
while the space meets the infection control standards of an
operating room. The imaging system enables pediatric procedures
to be moved away from an older imaging system to this new lab,
which has much better image resolution and radiation reduction
capability. Having this resource available at the Medical
Center reflects the observed evolution toward joint operating
room and interventional procedures. The ongoing collaboration
among surgery, interventional cardiology, and electrophysiology
working to provide the best care for our patients is a credit to
our physicians and other clinicians. The hybrid lab program
provides the Medical Center with a substantial head start in
performing these technologically advanced procedures.
Emergency Services
The Emergency Department continued its pursuit of
excellence and improvement of patient satisfaction. The
Department implemented a new standard procedure in which all
patient evaluations will be performed in private rooms, so that
confidential patient information is not shared in hallway space.
Process improvement initiatives were also implemented to reduce
the amount of time that patients wait in the Emergency
Department until being placed in a room. This has resulted in a
17 minute (37%) reduction in median wait time. Discharge
follow-up phone calls were also implemented to ensure that
patients understand and are following up with appropriate care.
Clinical Ancillary Services
Medical Laboratories
The Medical Laboratories Surgical Pathology gross room
moved to beautiful new space on the second floor of the
University Hospital.
The new lab doubled the former footprint,
allowing for a much needed expansion to improve patient safety
and progression.
The University of Virginia Clinical Chemistry and
Laboratory Medicine fellowship program, one of 20 doctoral
programs in the United States and Canada, was re-accredited for
five years in October 2010 by the Commission on Accreditation in
7
Clinical Chemistry. The program received a 100% approval rating
and it accepts one fellow each year into the three year program.
The positive patient identification system was fully
implemented for inpatient blood collection by the Medical
Laboratory Phlebotomy team. This system will enhance patient
safety by ensuring accurate identification of patients and their
specimens at the bedside. The system is being rolled out to
nursing, and full implementation is anticipated by March 2011.
Pharmacy Services
Phase I of a two part renovation project in the central
pharmacy was completed. Phase I included the installation of
four inventory management carousels, a high speed packager, and
barcode printers. These technologies will reduce medication
dispensing errors and prepare the organization for barcode
medication charting, which will be initiated with the inpatient
EpicCare implementation in March 2011.
Pharmacy Services implemented a contract optimization
initiative to leverage federal contract pricing (340B pricing)
which will reduce inpatient medications expenses by $2 million
over the next 24 months.
Recruitment of ten newly budgeted pharmacists to develop a
team-based approach for inpatient pharmacy services was
completed. The team will consist of a clinical coordinator for
each service line and three to five pharmacist team members who
will verify all orders within the new EpicCare system.
Ambulatory Care Pharmacy Services upgraded the outpatient
pharmacy computer system to facilitate e-prescribing, as part of
the EpicCare Ambulatory implementation in September, 2010.
Implementation of the Epic oncology module (Beacon) in early
December 2010 facilitated the implementation of barcode
medication charting in the clinic environment. This process
will decrease prescribing errors as well as medication
administration errors. As of January 10, 2010, the Pharmacy has
processed 56,969 e-prescriptions with retail pharmacies, 756 eprescriptions for mail orders, and 12,171 e-prescriptions in the
University of Virginia Barringer Outpatient Pharmacy.
Radiology Services
The Radiology renovation in University Hospital continues
to progress. The opening of the new, improved patient waiting
room and the pre and post care area are targeted for midFebruary.
8
As part of the Radiology equipment replacement plan for the
University Hospital, two purchase orders for the acquisition of
advanced imaging equipment were executed:
Replacement of one Computed Tomography Scanner with a next
generation scanner which enables the generation of high
quality images with lower radiation dose. This project
will require moderate room renovation, and the projected
installation date is early spring 2011.
Replacement of the older of two 1.5 Tesla Magnetic
Resonance Imaging systems with the newest 3.0 Tesla
Magnetic Resonance Imaging system, bringing the Medical
Center’s complement of Magnetic Resonance Imaging systems
in University Hospital to two 3.0 Tesla scanners and one
1.5 Tesla scanner. The increased image clarity provided by
3.0 Tesla level imaging is particularly beneficial for
pathological conditions involving the brain, spine, and
musculoskeletal system. This project will require major
room renovation and the projected installation date is
summer 2011.
A Certificate of Public Need application was submitted for
placement of a Computed Tomography scanner in the Emily Couric
Clinical Cancer Center. The public hearing on this request was
held on January 7, 2011, and there was no opposition.
Therapy Services
Effective December 6, 2010, new guidelines were implemented
that require all adult surgical patients to be screened for risk
of obstructive sleep apnea as part of their pre-operative
medical clearance. The surgeon may refer the patient for a
sleep study pre-operatively if the patient is identified as
having a potential for obstructive sleep apnea. In support of
these new guidelines, the sleep lab schedule was expanded to
seven nights weekly to ensure access and timeliness for
requested sleep studies.
Respiratory Therapy Supervisor Daniel D. Rowley, B.S., RRTNPS, RPFT, FAARC, received the American Association for
Respiratory Care 2010 Specialty Practitioner of the Year Award
for the Adult Acute Care Section.
Marc Gilgannon, Physical Therapist Clinician 4, was
selected to be Chairperson of the National Hemophilia Foundation
Physical Therapy Working Group for a two year term, starting
January 2011.
9
Culpeper Regional Hospital
Over the last few months, several providers have been
recruited to work within the Culpeper Regional Health System.
During the first two months of 2011, Culpeper Regional Hospital
is welcoming a general surgeon, two hospitalists, a surgical
physician’s assistant, and a radiation oncologist. There are
also several other candidates in negotiations to begin working
at Culpeper.
The Culpeper Regional Hospital Finance Committee approved
an emergency department renovation project that will increase
the bed capacity of the emergency department by twenty percent
(20%). The project would also allow for a reconfiguration of
the space to provide better business processes, including the
addition of financial counseling and cashier stations,
practices recommended in a revenue cycle consultant report
provided to Culpeper Regional Hospital.
The Radiation Oncology Department at Culpeper Regional
Hospital is currently under construction, with the fourth, and
final, modular building installed at the end of December 2010.
The TomoTherapy machine is expected to be delivered in midJanuary. Allowing time to configure the new machine, the first
patient is expected to be seen during the first quarter of 2011.
In addition to savings already realized by Culpeper
Regional Hospital through switching to Novation, the group
purchasing organization for the Medical Center, Culpeper is now
expecting to see an annual savings of $400,000 on orthopedic
implants through another agreement. These savings are directly
related to the partnership with the University of Virginia.
Medical Center Awards and Recognitions
The University of Virginia Medical Center was recognized as
one of the nation's 50 best providers of cardiovascular
inpatient care by Thomson Reuters, a leading market information
and benchmarking company. This marks the seventh time that the
Medical Center has been named as a top cardiovascular hospital
by Thomson Reuters, which released the 2011 edition of its Top
Cardiovascular Hospitals benchmarking study. Previously the
annual report recognized 100 U.S. hospitals, but this year to
highlight the true industry leaders only 50 hospitals were
recognized.
David A. Peura, M.D., was selected to receive the 2011
Julius Friendenwald Medal, the highest honor of the American
Gastroenterological Association. This award recognizes a
10
physician for lifelong contributions to the field of
gastroenterology. Dr. Peura is past president of the American
Gastroenterological Association.
The 2010 Charles L. Brown Award for Patient Care Quality
was awarded to David Kaufman, M.D., and his team for
“Coordination of Care - The Golden Hours for the <27 weeks
Gestation in the Neonatal Intensive Care Unit". Dr. Kaufman's
team consisted of Jane Dwyer, RN, Sarah Wilson, RN, Robert
Sinkin, M.D., Teresa Dean, RN, Terri Host, RN, Laura Aurisy,
NNP, Ellen Ford, NNP, Elizabeth Epstein, PhD, Janet Glass, RRT,
Timothy Hicks, RRT, Daniele Ottinger, NNP, Brooke Vergales,
M.D., Cheryl Urban, RN, Paula Darradji, RN, Martina Stevenson,
NNP, Catherine O'Donaghue, Lacey Colligan, M.D., and Kamera
Aulie.
The Cancer Center was awarded a Lance Armstrong Foundation
grant to implement their Cancer Transitions program for cancer
patients after treatment is completed. This evidence-based
program was created with recognized experts in key aspects of
cancer survivorship and incorporates information from peer
reviewed literature. It provides patients with practical tools
and resources to help them through their survivorship years.
The Cancer Center will hold two six-week sessions during the
2011 grant year.
EpicCare - The Electronic Medical Record
On December 1, 2010, the Medical Center went live with the
EpicCare Beacon module for cancer infusion. It was a very
successful implementation, with 100 per cent compliance with
creation of orders and over 542 active treatment plans. One
hundred thirty-two clinicians have been trained on Beacon.
Planning continues for go live implementation of the following
Epic modules on March 5, 2011: EpicCare Inpatient, Radiant
(radiology), Stork (labor and delivery), ASAP (emergency
department), and Willow (pharmacy). The 60-day Go Live Risk
Assessment was held on January 5, 2011, and identified two
issues – timely implementation of required supporting interfaces
to third party systems (such as Radiology interfaces) and
validation and testing of financial charges. Additional
resources have been assigned to support these areas of focus.
The 30-day Go Live Risk Assessment is scheduled for February 5,
2011. EpicCare Inpatient Training is well under way. Super
User training was held January 3 through January 14, 2011, and
End User training is being held January 17 through March 1,
2011. Implementation is currently on schedule and on budget.
The Management Review Committee continues to review and address
issues brought forward by EpicCare Ambulatory end users, with
11
the majority of issues having been resolved. With the
implementation of EpicCare, many physicians have begun to use
the electronic medical record for documentation of their care
provided, which has resulted in a significant reduction in
transcription costs.
Human Resources
Uteam Sessions
The October and November 2010 Uteam sessions were a great
success. A total of 561 Health System employees attended these
forums in McKim Hall in October and at offsite locations in
November. Feedback was once again very positive regarding the
content presented and employees’ interactions with Ed Howell and
Bobby Cofield. The number of Uteam sessions was increased to
eliminate overcrowding and the sessions were also enhanced by
the addition of an audio visual setup. Preparations are
underway for the next Uteam sessions to be held in February
2011.
Uteam Leadership Education Forum
The first Uteam Leadership Education Forum was held on
December 20, 2010, at the Boars Head Inn. Over 230 members of
Medical Center Management and Clinical Leadership attended this
event. The three hour educational forum consisted of instruction
and insights on leadership by Ed Howell and members of the
Medical Center Senior Leadership Team, as well as an interactive
breakout activity for the management group. These events will
continue to be held on a quarterly basis in 2011. The Medical
Center is committed to the growth and development of all leaders
and values this endeavor as critical to our success.
Recognition
In early December 2010, Human Resources partnered with
Medical Center Senior Leadership in conducting employee
recognition events featuring Chiefs and Associate Vice
Presidents rounding throughout the Medical Center with carts
stocked with hot cocoa and coffee to spread some winter cheer.
Deliveries were made to day, night, and weekend shifts
throughout the week. Meanwhile, Ambulatory staff received a
special luncheon to recognize its efforts related to EpicCare
implementation. On December 14, 2010, Medical Center Senior
Leadership again recognized staff for its accomplishments in
2010 by donning aprons and serving up hot food at the annual
Holiday Party in the main Hospital Cafeteria. Holiday food
boxes were also distributed on Christmas Eve by members of the
12
Medical Center Leadership Team to be shared among employees
working Christmas Eve and Christmas Day shifts.
Compensation
Several initiatives related to compensation are under way.
Compensation redesign is in progress. Initial recommendations
will be shared and feedback gathered at the Compensation
Committee meeting on February 4, 2011.
All Health System employees who scored a cumulative Fully
Meets Expectations or Consistently Exceeds Expectations on their
2010 Performance Appraisal received a merit based bonus payout
of $400.00 or $525.00 respectively in their regular paycheck on
January 28, 2011. The payout was pro-rated for part time
employees.
Total Compensation Statements were issued on January 31,
2011, to all staff who receive benefits. The Total Compensation
Statements give staff the opportunity to see the total value of
their compensation package, with health and retirement benefits
included along with the employee’s base salary.
Medical Center Payroll is working in conjunction with
University of Virginia Finance to recover employer FICA taxes
for Graduate Medical Education trainees employed from 1995 to
2001. Along with the employer portion of the FICA tax, these
Graduate Medical Education trainees can file a consent form to
receive a refund of their withheld FICA tax. The deadline to
file with the Internal Revenue Service was January 17, 2011.
The initial estimate of the refund to the Medical Center is
approximately $11 million.
Recruitment
The Human Resources Division continues to recruit locally
and abroad for talent. A recent recruitment initiative in
Pittsburgh resulted in the hire of seven experienced nurses,
four of whom come from diverse backgrounds. Over the past 12
months Human Resources has received 15,820 applications and
hired 1,110 new employees.
Quality and Performance Improvement
Accreditations and Surveys
The Medical Laboratories and Department of Pathology
completed a successful inspection by representatives of the
College of American Pathologists (CAP), a team from the Medical
13
College of Wisconsin, on December 7 and 8, 2010. Included was
an American Association Blood Bank inspection of the Blood
Bank. The team of 14 physicians, senior medical technologists,
and residents spent a day and a half examining all aspects of
Labs and Pathology. At the summation conference, all were very
complimentary of the operations and spoke highly of the
involvement of laboratory directors and staff in assuring
quality laboratory results. There were no major findings as a
result of the survey. Typical of all surveys, minor
opportunities for improvement were identified. These fell into
three general areas:
Documentation, primarily of refrigerator temperatures and
corrective actions in response to temperatures identified
as “out of range;”
Required instrument maintenance, including both performance
and documentation of routine maintenance; and
Addition of details to a few existing policies to meet
emerging best practices
The laboratory leaders had 30 days to respond and address the
findings.
Effective January 22, 2011, the Joint Commission reinstated
the ability of the Community Medicine Clinic to test blood
chloride levels. This brought their laboratory practices back
to full compliance.
In preparation for the Joint Commission survey of our
Hospital, Home Health Care, Ambulatory Clinics and Point of Care
Testing Labs, tracer methodology training classes were held to
help assure constant readiness. The tracer method follows a
single patient’s experience throughout the Medical Center.
Several patient tracers are completed monthly with the help of
area managers, Quality and Performance Improvement Staff,
Patient Safety and Risk Management Staff, and members of the
Joint Commission Steering Committee. Data from the tracers are
used to identify improvements to assure continued compliance
with The Joint Commission and other regulatory standards.
As required by the Joint Commission, the Periodic
Performance Review for the Hospital, Home Health Care, and Point
of Care Testing Lab has been completed. The Periodic
Performance Review is a self-evaluation based on Joint
Commission standards and our compliance with those standards.
For those areas out of compliance, an action plan is submitted
and compliance should be reached within 45 days. If compliance
is not achieved within 45 days, the plan will be re-evaluated
and revised. The Medical Center attests to the Joint Commission
14
that the Periodic Performance Review has been completed. The
Joint Commission has changed the interval between accreditation
surveys from 39 months to 36 months to be consistent with
Centers for Medicare and Medicaid Services requirement for home
health and durable medical equipment accreditation. The Medical
Center’s next full survey could occur any time in 2011, but will
be no later than January 26, 2012.
Quality Initiatives and Performance
The Centers for Medicare & Medicaid Services announced that
97 percent of the hospitals subject to Hospital Outpatient-Quality
Data Reporting Program requirements met those requirements and
will receive the full Annual Payment Update for calendar year
2011. The University of Virginia Medical Center was one of the
hospitals meeting these requirements and will receive the annual
payment update.
A new guideline was introduced to promote consistent and
early recognition of the signs and symptoms of sepsis (systemic
infection). Once these indicators are recognized, the clinical
staff will mobilize resources to treat the patient quickly and
appropriately. This guideline is in direct support of continued
efforts to address mortality and expands expertise beyond the
intensive care units to urgently care for all critically ill
patients.
The 2011 Quality Improvement Plan was approved and focuses
on systematically managing the care of each patient in the
safest and highest quality manner possible. The Medical Center
and School of Medicine have identified 17 quality improvement
projects and have identified resources to ensure that the
project teams are successful. These organization wide projects
are in addition to specific departmental activities to improve
patient care.
Anthem, one of the major contractual payors for the Medical
Center, identifies priority initiatives to assure quality
patient care for its members. The Medical Center participated
for the seventh year in Anthem’s “Quality-in-sights: Hospital
Incentive Program”, which is designed to reward hospitals
financially for addressing patient safety, health outcomes, and
patient satisfaction through demonstrated performance and
documented compliance with best practices. Each year data
regarding compliance and performance in these areas is submitted
to Anthem and scored. The Medical Center achieved a score
entitling it to the highest financial award available through
the program.
15
Patient Safety
From November 15 through December 5, 2010, the Medical
Center administered its bi-annual survey on patient safety
culture utilizing the Agency for Healthcare Research and
Quality's safety culture tool. The survey measures ten
dimensions of culture pertaining to patient safety including
supervisor/manager expectations and actions promoting patient
safety, teamwork within units, management support for patient
safety, and feedback and communication about errors. The target
audience for the survey included all Medical Center staff,
clinical faculty, and graduate medical trainees involved in
patient care directly or indirectly. However, the survey was
made available to all Medical Center staff who wished to
participate. There were 2,595 total respondents, approximately
35% of eligible participants. The 2010 total was 150 greater
than targeted participation and 845 greater than the number of
respondents in 2008, with all clinical disciplines represented.
A number of strengths emerged from an initial review of the
results. These included positive responses to statements such
as "People support one another in the unit", "When a lot of work
needs to be done quickly, we work together as a team to get work
done" and "I feel adequately supervised". Potential
opportunities for improvement exist in areas such as "Things
fall between the cracks when transferring patients from one unit
to another" and "Medical Center units do not coordinate well
with each other." Initial analysis of the survey results
indicates that our performance is similar to that of other large
medical centers. Further analysis of the results is being
conducted in order to formulate a specific plan of action in
response to the survey.
On January 26, 2011, the Medical Center Hour's Annual
Jessie Stuart Richardson Memorial Lecture was held in the Jordan
Hall Conference Center Auditorium. Mrs. Sorrel King was the
speaker. The Richardson Memorial Lecture focuses on a different
aspect of patient safety each year and is funded through
donations made by Dr. Donald Richardson, a local physician whose
mother died as a result of a medical error. Mrs. King is a
patient safety advocate and cofounder of the Josie King
Foundation, (www.josieking.org), a nonprofit organization aimed
at eliminating medical errors and increasing patient safety. On
February 22, 2001, her eighteen-month old daughter, Josie, died
from medical errors. The Josie King Foundation’s mission is to
prevent others from dying or being harmed by medical errors. By
uniting healthcare providers and consumers, and funding
innovative safety programs, the foundation’s hope is to create a
culture of patient safety together.
16
Technology Services
Clinical Engineering
Clinical Engineering completed technical assessments on two
dimensional barcode wristbands, stem cell management software
and pyrosequencing technology. They also facilitated, procured,
and outfitted the new equipment for the relocated Surgical
Pathology Laboratory, and have begun coordination and
procurement of the medical equipment for the Emily Couric
Clinical Cancer Center.
Environment of Care
Environment of Care Rounds
Environment of Care rounds continue bi-weekly on inpatient
units, the garages and public spaces in University Hospital.
Approximately 2,719 maintenance items were identified and
resolved during rounds in 2010, which has contributed to
improving work environments and patient safety.
Nutrition Services
The University of Virginia Dietetic Internship Program has
been granted accreditation until 2020 by the Commission on
Accreditation for Dietetics Education.
Two of our registered dietitians were recognized
nationally. Carol Parrish was awarded the Morrison 2010
Clinical Excellence Award from a field of about 1,300 dietitians
within the Morrison enterprise. Kate Willcutts was named
Preceptor of the Year in Area 6 by the American Dietetic
Association which selects one dietitian from each of its seven
areas for this award.
Sustainability
Members of the Medical Center Sustainability Committee
participated in a photo campaign to promote sustainability
initiatives which the committee is undertaking. This was done
as part of the University of Virginia's Campus Sustainability
Day campaign seeking individuals and groups who pledge to
support sustainability efforts for the coming year. More than
150 photographs of people holding dry-erase boards bearing their
commitments appeared on the University of Virginia website. The
Medical Center photo listed reduction of medical packaging,
increased use of green cleaning products, and reduced use of
17
Styrofoam as three of the many sustainability activities the
committee is undertaking
Parking
A joint effort to implement a managed parking program at
the Northridge Medical Park and the Fontaine Research Park has
commenced between the Department of Parking and Transportation
and Health System Parking Operations. The first stage of the
plan took place at Northridge in mid-December. The next phase
in early January focused on informational sessions at the
Fontaine Research Park. The sessions at Northridge and Fontaine
provide parking permit information to employees and
opportunities for a question and answer segment during the
meetings.
Patient & Guest Services
To assist in purchasing food for guests at the Hospitality
House, the Emergency Food Bank will provide a $400 gift card
each month for one year for the purchase of food. Nancy Berman,
a Hospitality House volunteer, a Hospital Auxiliary board member
and a board member of the Emergency Food Bank, facilitated the
discussions with the food bank and will also do the grocery
shopping. The Auxiliary and the Food Bank partnered together to
make this donation possible.
Arts Committee
Tom Harkins, Gloria Smith, and Reba Camp met with Christina
Mullen from the University of Florida and representatives from
the University of Virginia’s Center for Design and Health,
School of Architecture, and Center for Biomedical Ethics and
Humanities of the School of Medicine to discuss the role of the
arts in a healing environment. Ms. Mullen, who later presented
at the Medical School Hour, complimented the Medical Center's
arts program, which includes professional musicians who play for
patients and others who play in the hospital lobby. Members
were also impressed with the placement of art in patient rooms
and public areas and the rotating art exhibit in the hospital
lobby.
The photographs of Vicky Eicher were on display in the
University Hospital Lobby from November 5, 2010 through January
14, 2011. Ms. Eicher, who travelled to the Arctic and Antarctic
on two photograph expeditions, shows her desire to capture
nature through photography in the exhibit entitled “From Pole to
Pole”. While some of the photos were taken from a distance for
18
safety reasons, many are at eye level with the animals of these
regions.
Safety
Medical Center employees are reporting fewer injuries
related to slips, trips, and falls (2010 injuries are expected
to be down 35% from 2009) and from handling patients (expected
to be down 20% from 2009). Visitor injuries related to the
environment of care are also significantly reduced, with 48%
fewer injuries in 2010 as compared to 2009. A group meets
monthly to review injuries from slips, trips, and falls and to
develop action plans to prevent them.
19
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Nov-09
Net patient revenue
Nov-10
Nov-11
Budget/Target
Nov-11
$402.1
$408.4
$425.3
$423.6
10.7
12.0
12.5
12.0
$412.8
$420.4
$437.8
$435.6
372.1
371.5
385.5
394.0
21.9
22.5
23.8
26.2
3.3
2.5
3.3
3.3
Total operating expenses
$397.3
$396.5
$412.7
$423.5
Operating income (loss)
$15.5
$23.9
$25.2
$12.1
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Non-operating income (loss)
($54.3)
$41.3
$36.7
$3.9
Net income (loss)
($38.8)
$65.2
$61.9
$16.0
Principal payment
$5.3
$6.0
$7.2
$5.8
20
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Nov-09
Nov-10
Nov-11
Assets
Operating cash and investments
$17.4
$79.3
$115.8
Patient accounts receivables
58.9
51.4
97.5
Property, plant and equipment
446.6
499.8
610.9
Depreciation reserve and other investments
364.0
352.5
233.1
Endowment Funds
263.8
316.7
362.0
Other assets
112.0
155.1
183.2
$1,262.7
$1,454.8
$1,602.5
Current portion long-term debt
$11.7
$16.2
$14.3
Accounts payable & other liab
87.8
77.2
94.0
229.7
341.3
330.6
90.1
115.3
149.2
$419.3
$550.0
$588.1
$843.4
$904.8
$1,014.4
$1,262.7
$1,454.8
$1,602.5
Total Assets
Liabilities
Long-term debt
Accrued leave and other LT liab
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
21
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Nov-09
Operating margin (%)
Nov-10
Nov-11
Budget/Target
Nov-11
3.8%
5.7%
5.7%
2.8%
Total margin (%)
-10.8%
14.1%
13.0%
3.6%
Current ratio (x)
0.8
1.4
2.0
2.4
189.0
177.8
177.6
190.0
Gross accounts receivable (days)
50.2
45.6
46.1
45.0
Annual debt service coverage (x)
(1.6)
10.6
8.5
5.2
Debt-to-capitalization (%)
28.4%
36.7%
33.6%
31.8%
6.3%
6.3%
6.6%
7.0%
Days cash on hand (days)
Capital expense (%)
22
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Nov-09
Nov-10
Nov-11
Budget/Target
Nov-11
Acute Discharges
12,045
11,330
11,571
11,539
Patient days
74,269
69,688
69,932
70,100
3,235
3,611
3,733
3,588
6.19
6.23
6.05
6.08
268,453
285,891
283,548
267,893
25,249
25,602
24,373
25,397
SS/PP Patients
Average length of stay
Clinic visits
ER visits
Medicare case mix index
Occupancy %
FTE's (including contract labor)
1.96
76.1%
6,408
23
2.05
76.0%
6,179
2.04
72.1%
6,282
2.04
72.6%
6,279
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 - November FY 2011
OPERATING STATISTICAL MEASURES - November FY 2011
DISCHARGES and CASE MIX - Year to Date
Actual
Budget
% Variance
DISCHARGES:
Adult
Pediatrics
Psychiatric
Transitional Care
Subtotal Acute
9,722
1,217
618
14
11,571
9,627
1,409
461
42
11,539
1.0%
(13.6%)
34.1%
(66.7%)
0.3%
9,566
1,192
572
11,330
3,733
3,588
4.0%
3,611
Total Discharges
15,304
15,127
1.2%
14,941
Adjusted Discharges
20,608
20,102
2.5%
20,383
Short Stay/Post Procedure
OTHER INSTITUTIONAL MEASURES - Year to Date
Actual
Budget
% Variance
Prior Year
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
69,932
6.05
457
704
70,100
6.08
458
691
(0.2%)
0.5%
(0.2%)
1.9%
69,688
6.23
455
684
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
283,548
2,933
24,373
267,893
2,793
25,397
5.8%
5.0%
(4.0%)
285,891
2,966
25,602
24
SURGICAL CASES
Main Operating Room (IP and OP)
7,872
7,773
1.3%
7,825
1.88
1.90
(0.9%)
1.87
UVA Outpatient Surgery Center
3,501
3,452
1.4%
3,344
2.04
2.04
0.2%
2.05
Total
11,373
11,225
1.3%
11,169
OPERATING FINANCIAL MEASURES - November FY 2011
REVENUES and EXPENSES - Year to Date
OTHER INSTITUTIONAL MEASURES - Year to Date
($s in thousands)
Actual
Budget
% Variance
Prior Year
($s in thousands)
Actual
Budget
% Variance
Prior Year
NET REVENUES:
NET REVENUE BY PAYOR:
Net Patient Service Revenue
425,349
423,622
0.4%
408,412
Medicare
$ 143,631 $ 137,166
4.7%
132,241
Other Operating Revenue
12,477
11,984
4.1%
11,954
Medicaid
46,414
54,907
(15.5%)
52,935
Total
$
437,826 $ 435,606
0.5% $ 420,366
Commercial Insurance
66,162
70,241
(5.8%)
67,719
Anthem
78,342
70,145
11.7%
67,627
Southern Health
22,956
23,321
(1.6%)
22,484
EXPENSES:
Other
67,844
67,843
0.0%
65,407
Salaries, Wages & Contract Labor
190,883 $ 190,201
(0.4%)
181,718
Total Paying Patient Revenue
$ 425,349 $ 423,622
0.4%
408,412
Supplies
91,247
95,364
4.3%
92,446
Contracts & Purchased Services
88,573
92,015
3.7%
82,664
Bad Debts
14,798
16,488
10.2%
14,683
Depreciation
23,847
26,185
8.9%
22,491
Interest Expense
3,318
3,287
(0.9%)
2,531
Total
$
412,666 $ 423,540
2.6% $ 396,533
OTHER:
Operating Income
$
25,160 $
12,066
108.5% $
23,833
Collection % of Gross Billings
35.96%
35.49%
1.3%
37.53%
Operating Margin %
5.7%
2.8%
5.7%
Days of Revenue in Receivables (Gross)
46.1
45.0
(2.4%)
45.6
Non-Operating Revenue
$
36,691 $
3,896
841.8% $
41,317
Cost per CMI Adjusted Discharge
$
10,249 $ 10,658
3.8% $
9,994
Total F.T.E.'s (including Contract Labor)
6,282
6,279
(0.0%)
6,179
Net Income
$
61,851 $
15,962
287.5% $
65,150
F.T.E.'s Per CMI Adjusted Discharge
24.76
25.15
1.6%
24.74
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
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 - November 30, 2010
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
25
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
Nov
2010-11
INDIGENT CARE (IC)
Net Charge Write-Off
78,224
Percentage of Net Write-Offs to Revenue
6.61%
Annual Activity
2009-10
2008-09
172,917
152,552
6.60%
6.49%
Total Reimbursable Indigent Care Cost
29,569
53,095
52,910
State and Federal Funding
28,362
52,053
52,751
Total Indigent Care Cost Funding As a Percent
of Total Indigent Care Cost
96%
Unfunded Indigent Cost
1,206.41
98%
100%
1,042.00
159.00
Annual Activity
Nov
2010-11
BAD DEBT
Net Charge Write-Offs
14,798
Percentage of Net Write-Offs to Revenue
1.25%
2009-10
30,948
1.18%
2008-09
30,811
1.31%
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 ind
26
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 24, 2011
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.C.
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:
27
University of Virginia Medical Center
Capital Projects Report
February 2011
Scope
Funding
Source
Budget
BOV
Approval
Date
Projected
Completion
Date
TBD
2013
1. Pre-Construction
Barry and Bill Battle Building:
$117 M
Bonds and
Outside
Fundraising
$7.6 M
Bonds
Feb 2008
2011
$21.2 M
Bonds
Feb 2008
2012
General Fund
Appropriation ( @
$25 M) , Bonds
and Outside
Fundraising
Oct 2004
2011
Design started on December 12,
2008. Schematic design approved
by Building and Grounds
Committee November 2009
2. Under Construction
University Hospital:
Add elevators. Structural work for
elevator shaft nearing completion.
Shaft wall enclosures currently
underway.
University Hospital:
Renovate Radiology Department.
Phased construction underway
(52,000 GSF)
Emily Couric Clinical Cancer
Center:
$74 M
(including
added shelled
floor)
Commissioning and punch list
completion continuing. Furniture
and equipment installations are
under way.
University Hospital Bed
Expansion:
July 2006
(B&G
Committee)
June 2007
$80.2 M
Bonds and Health
System Operating
Revenue
Project to increase inpatient bed
capacity in University Hospital by
adding 72 private, ICU-level rooms.
All of the existing hospital space
required for the new patient units
has been captured. Demolition
activities are complete. MEP roughins are on-going. Drywall
installation is in progress on all
floors.
28
Sept 2005
June 2007
2011
University of Virginia Medical Center
Capital Projects Report
February 2011
Scope
Budget
Funding
Source
BOV
Approval
Date
Projected
Completion
Date
$14.3 M
Bonds
Feb 2008
2011
Bonds
Feb 2008
2011
2. Under Construction
*University Hospital:
Add two Operating Rooms and
Magnetic Resonance Imaging
Room with equipment. Shielding
system is complete and interior fitout is nearing completion. Magnet
delivery is scheduled for March
2011.
(2,330 GSF)
*University Hospital:
$15.6 M
Renovate Heart Center invasive
procedure areas. Design is
complete for several phases.
Construction is complete for the
first phase with occupancy in
August 2010. Phase 2 was
completed at the end of October
2010. To facilitate more efficient
patient flow, Phase 3 was broken
into 3a and 3b. Phase 3a is
scheduled for completion in May
2011 and Phase 3b in August 2011.
(21,600 GSF)
*Project modifies original HEP Project
29
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 24, 2011
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.D.
ACTION REQUIRED:
None
Graduate Medical Education
BACKGROUND: Graduate Medical Education remains a cornerstone of
the University of Virginia Medical Center. It is within
Graduate Medical Education that we have the opportunity to
secure the future of medicine with those we are educating and
training. As we develop a clearer view of the challenges of
physician workforce needs and healthcare reform, maintaining
excellence in Graduate Medical Education at the University of
Virginia becomes even more essential. The Medical Center has
approximately 780 residents and fellows participating in 96
training programs – 67 programs accredited by the Accreditation
Council for Graduate Medical Education (ACGME), 32 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 will see major changes to resident duty hour restrictions.
In addition, we will need to enhance and enforce our policies on
resident supervision, especially as they relate to Quality and
Patient Safety measures. It is clear that we will need to
devote additional resources to meet these challenges
successfully. More importantly, those involved in Graduate
Medical Education, both in the Medical Center and the School of
Medicine, will need to work cooperatively and collaboratively
not only to meet these additional demands, but also to continue
to educate our future doctors in an environment that encourages
excellence.
DISCUSSION:
Housestaff Statistics
The training year for housestaff generally is July to June,
although several programs are slightly off-cycle. Medical,
dental, and clinical psychology residents are appointed annually
and reappointed through the Credentials Committee. Statistics
for Fiscal Year 2010 are as follows:
30
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 graduate medical education 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 twenty-six specialtyspecific committees, known as Residency Review Committees;
accreditation of the institution is reviewed and granted by the
Institutional Review Committee. Three new subspecialty programs
were accredited with effective dates of July 2010: Transplant
Hepatology (Internal Medicine), Primary Sports Medicine (Family
Medicine), and Hospice and Palliative Care (Internal Medicine).
In addition, the Anesthesiology Critical Care Program was
reactivated after a 3 year voluntary withdrawal status.
The accreditation (or reaccreditation) process occurs
periodically on a schedule set by the Residency Review
Commmittees 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 67 programs accredited by the Accreditation Council for
Graduate Medical Education and the Institution have full
accreditation
– 21 core residency programs
– 46 subspecialty/fellowship programs
Program success can be measured in part by the length of
the accreditation provided by the ACGME and the Residency Review
Committees. Of the 67 accredited programs, 73% have very
31
favorable cycle lengths (4-6 years); there was a 9% increase in
programs receiving this cycle length in 2010.
•
•
•
•
•
•
•
6 year accreditation –
5 year accreditation 4 year accreditation 3 year accreditation 2.5 year accreditation
2 year accreditation 1 year accreditation –
7 programs
30 programs
12 programs
13 programs
– 1 program
3 programs
1 program
Of the eighteen programs that received an official Letter
of Notification from the ACGME in 2010, 10 received 5-year
cycles, one received a 4-year cycle, six received 3-year cycles,
and one received a 2.5-year cycle. Our average cycle length for
programs increased to 4.3 years.
The Designated Institutional Official and Graduate Medical
Education Committee continue to track common citations received
by programs’ Residency Review Committees. During the past year,
citations received by more than one program included:
Evaluations – Programs failed to document compliance with
one of the required competencies.
Faculty (Clinical Diversity/Supervision) – Faculty must
have subspecialty expertise across a broad range of the
subspecialty, so that the residents are accorded meaningful
patient responsibility with the supervision of a faculty
member at all facilities and sites.
Educational – Two programs had education-related citations.
One lacked scholarly activity in its department, and a
second program was deficient in trainee peer-reviewed
publications and insufficient outcomes in the general
competencies.
All programs which received citations were required to report
corrective action plans to the Graduate Medical Education
Committee.
The institution remains on a rigorous mid-cycle review of
its Graduate Medical Education programs. There were 20 Internal
Reviews completed in 2010 and an additional 10 are scheduled for
2011.
The University of Virginia had its institutional site visit
in March 2010, and was subsequently given a 4-year accreditation
cycle. This represents a cycle length increase of one year
32
since the last site visit in 2006. The ACGME was complimentary
in acknowledging the vast improvements made since 2006.
However, the ACGME gave the institution two citations, one of
which was another citation for violation of duty hours
standards. The other citation noted concern regarding Graduate
Medical Education Committee Oversight and specifically noted the
short accreditation cycles in six of our core programs.
National Match
The Medical Center participates in the National Residency
Matching Program. Participation is required for programs
offering Post Graduate Year 1 positions and is available to
programs offering Post Graduation Year 2 positions. Twenty-nine
programs offering 147 positions participated in the 2010 Match
(17 categorical programs, three preliminary programs, one
primary program, and eight advanced programs). Ten positions in
four programs remained unfilled at the time of the Match, but
those programs filled all open positions within one day.
Analysis showed that programs with the most difficulty filling
their positions were advanced programs which did not guarantee
an earlier preliminary year at the University of Virginia. Of
special note, 20 programs obtained 1-2 positions within their
top 20 ranked applicants.
Finance
The total direct budget for Graduate Medical Education
programs for fiscal year 2011 is $48,749,181. Funds to support
this program come from Medicare, Medicaid, other government and
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 2009, in
order to remain competitive with Graduate Medical Education
programs nationally.
33
University of Virginia Housestaff Salaries
Effective July 1, 2010 - June 30, 2011
50th
Percentile
All Regions*
Median
Southeast
Region*
Program
Level
UVA
Annual
Salary
Medical/Dental
PGY 1
$49,625
$46,717
$45,123
PGY 2
$50,321
$48,406
$46,594
PGY 3
$52,315
$50,406
$48,196
PGY 4
$56,099
$52,599
$49,962
PGY 5
$56,650
$54,689
$51,870
PGY 6
$58,003
$57,000
$54,029
PGY 7
$59,896
$58,909
$55,029
PGY 8
$61,975
$61,059
$57,540
PGY 1
$30,301
PGY 2
$31,251
PGY 3
$32,201
PGY 4
$33, 113
PGY 1
$44,769
PGY 2
$47,301
PGY 1
$33,717
PGY 2
$35,562
Chaplain
Pharmacy
Clinical
Psychology
*2010 AAMC Survey on Stipends, Benefits and Funding
34
Mandatory Reporting of ACGME Requirements
Duty Hour Compliance
Duty Hours tracking and Compliance continue to be a focal
point for the Graduate Medical Education community. The
Graduate Medical Education Committee’s Task Force on Duty Hours
meets monthly to review the programs’ duty hours reports,
Residency Review Committee citations, and the results from both
the annual Residency Review Committee anonymous survey, or
internal reviews results. The Task Force reports its findings
directly to the full Graduate Medical Education Committee.
On-going training in duty hours logging, tracking, and
reporting is scheduled by the Graduate Medical Education Office
for Program Coordinators to ensure accuracy and compliance. The
Graduate Medical Education Office maintains a 24 hour
confidential hotline for the reporting of duty hours concerns.
Residency Review Committee Common Program Requirement changes
effective July 1, 2011, and the recent Institutional citation
for duty hours have necessitated further policy and procedure
revisions. Continued oversight and education on duty hours
compliance continues to be a priority for the Graduate Medical
Education Committee.
Resident Supervision, Responsibilities, and Evaluation
The Designated Institutional Official is directly involved in
monitoring resident performance issues. Each program continues
to update program policies that define the scope of practice and
supervision requirements for residents at each level of
training. In addition to adhering to the Institutional Policy
on Resident Supervision, each program must update and maintain
its own Supervision Policy, which must be stratified by year of
training. Program directors are ultimately responsible in
assigning responsibilities to residents and for evaluating
trainees to determine proficiency in all competencies, including
patient care and medical knowledge. Jeff Young, M.D., Senior
Associate Chief Medical Officer for Quality, is a voting member
of the Graduate Medical Education Executive Committee and
provides recommendations to Program Directors and the Housestaff
Council in their review of each department’s policy on
escalation of supervision.
Competency checklists are in place which provide information
on each resident’s competence to perform specific activities and
procedures and the levels of supervision required. This
information is available to nursing and allied health staff as a
35
reference. These are updated annually in compliance with Joint
Commission standards. This year the database was digitized to
enable the Graduate Medical Education Office to provide the most
current information.
All programs must evaluate trainees regularly and use the New
Innovations system to document the evaluations. Moreover, each
program must evaluate and provide written feedback to the
resident or fellow semi-annually. Finally, each program
director must complete a summary evaluation of each trainee at
the end of his or her training. A copy of this evaluation is
provided to the Graduate Medical Education Office. Faculty
participation in electronic evaluation has increased this year
as programs become more familiar with New Innovations and are
able to better train their faculty and encourage their
participation. Additionally, with software enhancement a number
of programs are moving towards a paperless evaluation process
and their ability to track measurable performance data and
competency achievement continues to increase.
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. For example, in 2009 residents had to complete a
module regarding the safe insertion of central line catheters.
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 the standard
curriculum. For some it is offered in traditional settings,
such as Morbidity and Mortality conferences. Others have
developed highly sophisticated systems to meet the competencies
of Practice Based Learning and Improvement and Systems Based
Practice.
36
Trainees are encouraged to develop their own individual
learning portfolios and to include such items as self-initiated
Practice Based Learning and Improvement projects or chart
reviews, thereby documenting their own involvement in Quality
and Patient Safety issues. In addition, the Housestaff Council,
with broad membership from many of the core residencies and
subspecialty fellowships, participates in these areas. The
Housestaff Council ensures participation by trainees on key
Medical Center and School of Medicine Committees, including the
standing committees of Quality and Patient Safety. The
Housestaff Council Co-Presidents also represent the trainees on
key leadership committees, such as the Clinical Staff Executive
Committee, where Quality and Patient Safety issues are discussed
monthly.
Innovations in Graduate Medical Education
Graduate Medical Education Innovative Grant Program
The Graduate Medical Education Innovative Grant Program
continues to recognize those projects which attempt to
ameliorate resident education. The 2010 Grant Program Award was
given to “Team Training of Crisis Management in Laparoscopic
Surgery,” a proposal designed to expose trainees to critical
situations in a simulated environment utilizing a multidisciplinary team. Principal Investigators are Noah Schenkman,
M.D., (Urology), Peter Hallowell, M.D., (General Surgery), Dana
Redick, M.D., (OB/GYN), Keith Littlewood, M.D.,
(Anesthesiology), Elisabeth Wright, MSE, (Medical Simulation
Center) and Kim Fitzgerald, RN, (OR Nurse Education). The GME
Grant Review Committee continues to place high value on projects
that not only attempt to demonstrate practices which can be
shared with or utilized by other Graduate Medical Education
programs within the institution, but also address the ACGME
competencies in a novel manner.
A second award was presented to Paul Read, M.D., in the fall
of 2010 to support his project “Roaming Resident IPAD Access to
Electronic Medical Records and Internet to Enhance Resident
Efficiency and Productivity.” Dr. Read was one of the 2010
Graduate Medical Education Master Educator Awardees, and this
project was an offshoot of his research efforts.
Review is currently underway for the 2011 Innovative Grant
Proposals, with a decision anticipated in January.
Fourth Annual Graduate Medical Education Research Day
The Fourth Annual Graduate Medical Education Research Day
was held in November 2010. Oral presentations were made by
winners of the Young Scientist Award, the Innovative Grant
37
Award, and trainees who participated in international clinical
rotations. Additionally, a poster session featured 17 poster
presentations from the Young Scientist Award Winners and
additional trainees participating in international clinical
rotations.
Master Educator Awards
The 2010 Master Educator Award winners were Julia Iezzoni,
MD, Pathology, and Paul Read, MD, Radiation Oncology.
Demonstrating a dedicated and longitudinal commitment to
graduate medical education at the University of Virginia, these
two recipients topped an extremely qualified list of nominees.
Graduate Medical Education Certificate Program
The Graduate Medical Education Certificate Program
continues to attract trainees in record numbers. Courses in
Epidemiology, Biostatistics, Global Health and Public Health
offered in 2010 achieved wait list status. One hundred and
twelve trainees have taken at least one course, and another four
will receive a Certificate in January. Because of the program’s
popularity, a needs assessment was performed this fall and
suggestions for program enhancements are currently under review.
Graduate Medical Education Professional Development Programs
The Graduate Medical Education Office has further
solidified its professional development program with a four
pronged plan comprised of program offerings for Faculty and
Staff, Program Directors, Chief Residents, and Program
Coordinators.
Faculty and Staff. The Graduate Medical Education
Institutional Curriculum continues to offer programming designed
to be of interest to the Graduate Medical Education community at
large. Spring of 2010 featured “Mindfulness in Medicine,” a
lecture by Matt Goodwin, M.D. This lecture was the keynote of a
five day series of events, the first annual “GME Week.”
Additionally, the Graduate Medical Education Office sponsors a
“Best Practices in GME” bimonthly brown bag lunch series to
highlight practices in place at the University of Virginia that
are of interest to others in Graduate Medical Education,
including online learning management tools, behavioral
interviewing, and the development of a Wikipedia tool.
Program Directors. Designed to address the professional
development of both new and seasoned Program Directors, the
38
inaugural workshop was held during GME Week and addressed
“Managing the Challenging Resident.”
Chief Residents. With the goal of increasing camaraderie,
enhancing working relationships, and aiding in professional
development, a quarterly series of workshops just for the Chief
Residents was launched during GME Week. The first lecture
featured Darden Professor, Alec Horniman, MBA, DBA, who spoke to
the chiefs on “Summoning Leadership – Skills for your Chief
Year.” The second workshop in the fall addressed legal and
human resource issues in “Managing the Challenging Resident.”
Additionally, instituted by the Chief Executive Officer, the
Chief Residents are invited quarterly to a dinner meeting with
the Chiefs of the Medical Center to discuss and strategize
mission-related issues and ideas.
Program Coordinators. The Program Coordinators continue to
meet monthly to address the administration of the institution’s
Graduate Medical Education programs. This year they hosted
other coordinators throughout the state at a day long retreat on
“Process Improvement in GME Administration.” Organized and
managed by the Program Coordinators, this workshop featured over
100 attendees from the University of Virginia, Eastern Virginia
Medical School, Virginia Commonwealth University, Norfolk Naval,
Carillion, and several community hospitals.
Support of Program Directors and Coordinators
Partial salary support is provided to Program Directors
based on the number of trainees per program.
The Graduate Medical Education Office continues to support
two junior Program Directors per year to travel to national
Graduate Medical Education conferences.
The Graduate Medical Education Office has instituted a
monthly training schedule for the Program Coordinators in
areas such as scheduling, duty hour tracking, use of the
Electronic Residency Application System, and reporting.
The Graduate Medical Education 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 office staff
continues to collaborate with the Graduate Medical
education community in program coordinator professional
development, program scheduling process simplification, and
increasing housestaff access to resources ranging from
39
mental health and stress management to spouse and partner
employment assistance.
The Graduate Medical Education Office initiated the use of
an Electronic Records System called FolderView to store
academic files for residents and fellows. Traditionally,
the complete files were scanned as one PDF document. With
FolderView, organization of the scanned files has been
modified to make retrieving records easier.
Review of Graduate Medical Education Committee
Activities during the Past Year
The following subcommittees of the Graduate Medical
Education Committee met regularly to complete its duties and
report to the Executive Committee of the Graduate Medical
Education Committee:
Internal Review Subcommittee members include faculty,
residents, and Graduate Medical Education Office personnel.
All internal reviews were conducted at the midway point
between Residency Review Committee visits, as required by
the ACGME. Preparation of individual programs for their
Internal Review and Residency Review Committee visit was
supported and organized by the Graduate Medical Education
Office. The subcommittee reviewed all findings from the
Internal Review and reported to the full Committee. Any
necessary Action Items, as well as completion of such, were
recorded in the minutes and documented with the Internal
Review Summary Reports. There were 20 internal reviews
conducted this past year. In late 2010, the Internal
Review Subcommittee initiated a survey of all its nonACGME, non-accredited programs to determine appropriate
Committee oversight.
The Research Subcommittee continued to work collaboratively
with the Office of Vice President for Research in
overseeing approval by the Graduate Medical Education
Committee of research projects with Graduate Medical
Trainee involvement, especially those that involve animals.
The committee meets on an as needed basis.
The Education Subcommittee oversees all off-site rotations
and affiliation agreements. It also reviews all proposed
new programs as well as new educational tracks (for
example, an Integrated Thoracic Surgery Track) and provides
recommendations to the full Graduate Medical Education
Committee. In 2010, the subcommittee recommended for
approval two new programs, eight recurring rotations, and
40
over 50 off-site rotation applications. All were approved
by the Graduate Medical Education Committee.
Resident salaries and benefits were reviewed by the
Subcommittee on Program Director and Resident Support and
recommendations were presented to the Medical Center. The
Subcommittee recommended that stipend levels be increased
by 1.9%, with a larger increase for residents in
Chaplaincy, whose stipends were substantially lower than
other programs in the region. Because of budget
constraints, the Medical Center was able to implement an
increase of approximately 1%.
41
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 24, 2011
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.E. Health System Development
ACTION REQUIRED:
None
BACKGROUND: Health System Development will provide reports of
recent activity to the Medical Center Operating Board from time
to time.
DISCUSSION:
SIGNIFICANT GIFTS
October 1 – November 30, 2010
A $2 million estate distribution was received for
unrestricted use in the School of Medicine. The distribution is
part of an overall gift valued at more than $4 million.
A $1 million bequest was made in support of the University
of Virginia Children’s Hospital outpatient programs and the
Barry and Bill Battle Building.
A parent donor committed $250,000 to the School of Nursing
for need-based student support. The gift will create a $100,000
endowed undergraduate scholarship, a $100,000 endowed graduate
fellowship, and a spendable fund to support undergraduate
nursing research experience.
A donor has pledged $175,000 to the School of Nursing.
A School of Nursing alumnus and her husband pledged
$100,000 for the McLeod Hall renovation project.
A friend of the Health System committed $100,000 in support
of the Emily Couric Clinical Cancer Center.
Other gifts and pledges received include:
Two gifts totaling $60,000 from a single donor in support
of Dr. Craig Slingluff’s cancer research;
A $70,000 commitment from the Dr. R. Pryor Baird III
Charitable Foundation for the Clinical Performance
Education Center;
42
A $50,000 faculty gift in support of the Department of
Endocrinology; and
A $50,000 commitment from the MLG Foundation to the Barry
and Bill Battle Building.
OTHER DEVELOPMENT INITIATIVES
On Saturday, October 9, 2010, the Claude Moore Medical
Education Building was dedicated in a special ceremony that
included an electronic ribbon cutting. The event was hosted by
University of Virginia President Teresa A. Sullivan and Dean
Steven T. DeKosky, M.D., and was attended by more than 200
donors and special guests. Claude Moore Charitable Foundation
trustees Guy Gravitt, Randy Sutliff, and Leigh Middleditch were
present, and Mr. Middleditch provided remarks on behalf of the
Foundation.
On October 20, the School of Medicine submitted its annual
research progress report on the Tobacco Research Program and
certificate of compliance to Altria, which has provided $10
million for this initiative.
On November 16, the School of Nursing celebrated the grand
reopening of the Center for Nursing Historical Inquiry on the
recently renovated first floor of McLeod Hall. Approximately 40
alumni, donors, and friends of the Center, along with faculty
and staff, celebrated with a ribbon cutting and reception
immediately following a nursing history forum lecture.
Over 1,000 donors to Jeffrey’s Gifts received a stewardship
letter updating them on the fund’s progress. Jeffrey’s Gifts
provides special treat bags to pediatric cancer patients and
their families during hospitalization at University of Virginia
Children’s Hospital. The letter has generated several thousand
dollars in new gifts to date.
In October, the fall issue of Virginia Legacy, the School of
Nursing magazine, was mailed to more than 10,000 recipients, and can
be downloaded at http://www.nursing.virginia.edu/Alumni/Legacy. The
fall 2010 online edition of Pulse Online was also made available to
more than 20,000 Health System donors, employees, volunteers, and
medical and nursing alumni. The issue may be found at
http://news.clas.virginia.edu/pulse. Investing in Hope, the Cancer
Programs newsletter, was sent to more than 5,500 recipients in
November, and may be viewed at
http:///.healthsystem.virginia.edu/internet/development/publications/
Investing-in-Hope-FALL10.pdf.
43
Development staff made 109 face-to-face visits with donors
and prospects in November, bringing the fiscal year total to
746.
CAMPAIGN PROGRESS THROUGH NOVEMBER 30, 2010
Through the end of November, the Health System campaign
total is $521,463,035. This represents 104% of the campaign
goal achieved with 86% of the campaign period elapsed. The
following table shows the Fiscal Year 2011 totals as of November
30 for new commitments, including gifts and pledges, as compared
with this same time frame in Fiscal Year 2010.
FY 2011 to date progress
(through 11/30/10)
New gifts
FY 2011
New pledges
Total new commitments
(excludes pledge payments on
previously booked pledges)
44
FY 2010
$16,357,319
$20,551,267
$743,740
$5,174,746
$17,101,059
$25,726,013