UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
June 10, 2010
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
Thursday, June 10, 2010
8:30 – 11:30 a.m.
Medical Center Board Room
Committee Members:
E. Darracott Vaughan, Jr., M.D.,
Daniel R. Abramson
William P. Kanto, Jr., M.D.
Constance R. Kincheloe
Randy J. Koporc
Vincent J. Mastracco, Jr.
Chair
The Hon. Lewis F. Payne
Randl L. Shure
Edward J. Stemmler, M.D.
John O. Wynne
Ex Officio Members:
Steven T. DeKosky, M.D.
John B. Hanks, M.D.
R. Edward Howell
Leonard W. Sandridge
AGENDA
PAGE
I.
II.
ACTION ITEMS
A.
Fiscal Year 2011 Medical Center Operating and
Capital Budgets (Mr. Howell to introduce Mr.
Larry Fitzgerald; Mr. Fitzgerald to report)
B.
Transitional Care Hospital Governing Board
REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEDICAL CENTER (Mr. Howell)
A.
B.
C.
Vice-President’s Remarks
Operations, Finance, and Write-offs (Mr. Howell
to introduce Mr. Robert Cofield and Mr. Larry F.
Fitzgerald; Mr. Cofield to report on Operations;
Mr. Fitzgerald to report on Finance and Writeoffs)
Capital Projects
1
6
7
8
31
D.
E.
Health System Development
Annual Compliance Report (Mr. Howell to introduce
Ms. Lori Strauss; Ms. Strauss to report)
34
37
F.
Annual Buchanan Report and Clinical Presentation
(Mr. Howell to introduce Karen Johnston, M.D. and
A. Bobby Chhabra, M.D.; Drs. Johnston and Chhabra
to report)
40
G.
III.
Electronic Medical Record (Mr. Howell to
introduce Marshall Ruffin, M.D.; Dr. Ruffin to
report)
REPORT BY THE PRESIDENT OF THE CLINICAL STAFF OF THE
MEDICAL CENTER (John B. Hanks, M.D.)
IV. EXECUTIVE SESSION
ACTION ITEMS - 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, fundraising, market
and resource considerations and efforts regarding the
Medical Center, including potential strategic joint
ventures or other competitive efforts and Medical
Center performance measures and metrics;
-
Confidential information and data related to the
adequacy and quality of professional services, patient
safety in clinical care, and patient grievances for
the purpose of improving patient care at the Medical
Center; and
-
Consultation with legal counsel regarding the Medical
Center’s compliance with relevant federal
reimbursement regulations, licensure and accreditation
standards, as well as negotiations concerning
performance of a contract and related litigation; all
of which will involve proprietary business information
of the Medical Center and evaluation of the
performance of specific Medical Center 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.
42
44
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.A. Fiscal Year 2011 Medical Center
Operating and Capital Budget
BACKGROUND: The Medical Center’s operating and capital budgets
are consolidated with the University’s overall budget. At its
June meeting, the Board of Visitors acts on the proposed
budget based on a recommendation for endorsement from the
Medical Center Operating Board.
DISCUSSION: The Medical Center’s 2010-2011 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 cost 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. In addition, in Fiscal Year 2011, the Medical Center
expects to continue its growth in surgery and to care for
patients with high acuity illnesses.
The Medical Center budget development process is clinically
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, standards for
the number of employees, and inflation. This information is
communicated to Medical Center managers and ends with each
operating unit providing a cumulative operating and capital
budget that contains service demand forecasts, required fulltime equivalent personnel, and non-labor expenses.
BUDGET AND OPERATING ASSUMPTIONS
Market conditions: For Fiscal Year 2011 discharges are budgeted
to grow 2.9 percent from Fiscal Year 2010 projected levels. The
growth will be facilitated by improved patient flow resulting
from bed expansion. Outpatient service demand is budgeted to
grow 3.2 percent from Fiscal Year 2010 projected levels. The
budget recognizes operating room capacity increasing from 26 to
28 for Fiscal Year 2011 as well as increasing bed capacity from
575 to 585 inpatient beds. The opening of the Transitional Care
1
Hospital will add 40 beds. The following table includes
historical and projected patient volumes:
Budget
Projected
2009-2010 2009-2010
29,173
26,834
Discharges: Medical Center
Discharges: Transitional Care
Hospital
Adjusted Discharges
Average Length of Stay: Medical
Center
Average Length of Stay:
Transitional Care Hospital
Patient Days
Clinic and ER Visits
Budget
2010-2011
27,451
51,817
47,897
172
49,122
5.90
6.19
6.00
172,051
725,003
166,131
727,119
27.23
164,571
750,028
Revenues: The Medical Center’s Fiscal Year 2011 budgeted payer
mix remains consistent with that of 2010. One of the Medical
Center’s greatest challenges is the unwillingness of government
payers 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 with rate increases.
Rate changes: The Medical Center proposes an overall rate
increase of 7.0 percent to 9.9 percent, which is commensurate
with rate increases that will generally be implemented in the
hospital industry.
Expenses: Expenses from operations are projected to increase by
$61.0 million from the Fiscal Year 2010 projection. Expenses
per case mix index (CMI) weighted adjusted discharges are
projected to increase, going from $10,618 to $10,866. 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 HealthSystem Consortium Operational Data Base.
Previous increases in capital investment will result in
additional depreciation expense of $9.9 million for Fiscal Year
2011. The Medical Center’s 2010-2011 fiscal plan accounts for
these additional expenses while preserving its goal of providing
high quality and cost effective health care, education, and
research services.
Staffing: The Medical Center’s Fiscal Year 2011 budget has been
benchmarked with comparable academic medical centers. Full time
equivalents (FTEs) are planned at 6,322, an increase of 108 FTEs
2
from staffing at the current Fiscal Year projection of 6,214
FTEs. The Transitional Care Hospital accounts for 53 of the FTE
growth.
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 of Culpeper Regional Hospital on volumes.
The impact on operations from the completion of
construction projects, including the Transitional Care
Hospital at Northridge, the Emily Couric Clinical Cancer
Center, and the hospital bed expansion.
The effort to modernize and integrate information
technology services through the Electronic Medical Record
project.
The major risk factors that impact the ability to accomplish
the fiscal plan include:
A nationwide shortage of health care workers that could
negatively impact our ability to maintain appropriate
staffing.
Maintaining an adequate number of physicians in areas
experiencing a national shortage.
Advancements in medical technology that could alter
expenses and/or revenues very quickly.
The emerging impact of the Patient Protection and
Affordable Care Act and the Health Care and Education
Reconciliation Act of 2010.
Inflation for medical devices and pharmaceutical goods that
could exceed the budget assumptions.
3
Enhanced scrutiny by Federal regulators as the Commonwealth
of Virginia is scheduled to be included in the Federal
Recovery Audit Contract Program.
The continued poor financial status of the Commonwealth of
Virginia and its potential impact on funding for Medicaid
and Indigent Care programs.
Economic pressures and uncertainty regarding cash flows
from investments and non-operating income.
A summary of historical and projected financial operating
results are provided as follows:
Actual
(Millions)
2008-2009
Total operating revenue
$992
Operating expense
952
Operating income
40
Non-operating gain/(loss)
(83)
Total margin
($43)
Operating income percent
4.0%
Projected
2009-2010
$1,011
960
51
69
$120
5.1%
Budgeted
2010-2011
$1,074
1,021
53
9
$62
4.9%
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 $81.2 million, including $5.0 million for
contingencies and $8.0 million for Culpeper Regional Hospital
investments, be authorized for capital requirements.
ACTION REQUIRED: Approval by the Medical Center Operating Board,
the Finance Committee, and the Board of Visitors
RECOMMENDATION REGARDING FISCAL YEAR 2011 MEDICAL CENTER
OPERATING AND CAPITAL BUDGETS
WHEREAS, the Medical Center Operating Board has reviewed the
Fiscal Year 2011 Medical Center operating and capital budgets;
RESOLVED, the Medical Center Operating Board endorses and
recommends to the Finance Committee and to the Board of Visitors
approval of the Fiscal Year 2011 Medical Center operating and
capital budgets.
4
Schedule A
University of Virginia - Medical Center
Projected Fiscal Plan
2010-2011
2008-2009
Actual
Revenues
Total Gross Charges
$
Less Deductions:
Indigent Care Deduction
Contractual Deduction
Total Deductions
2009-2010
Forecast
2,352,360,333
$
2010-2011
Budget
2,601,528,198
$
2,916,349,366
152,552,257
1,235,461,889
1,388,014,146
166,709,872
1,451,208,213
1,617,918,085
196,730,550
1,674,711,756
1,871,442,306
964,346,188
983,610,113
1,044,907,060
27,802,321
27,427,966
28,611,420
Total Revenue
992,148,509
1,011,038,079
1,073,518,480
Expenses
Expenses from Operations
Operating Expenses
Depreciation and Amortization
Interest Expense
Bad Debt
861,369,340
52,312,975
7,677,340
30,810,757
863,031,137
53,818,073
6,822,068
35,952,375
909,553,627
63,760,061
7,057,355
40,256,005
Total Expenses from Operations
952,170,412
959,623,652
1,020,627,048
39,978,098
51,414,427
52,891,431
(64,009,848)
1,732,315
(14,160,762)
(6,220,623)
(82,658,918)
51,129,291
2,450,364
9,399
22,123,000
(6,893,097)
68,818,957
14,632,583
1,450,000
(800,000)
(6,081,681)
9,200,902
Net Patient Revenue
Miscellaneous 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
5
(42,680,820) $
120,233,384
28,554
26,834
174,735
166,131
704,771
727,119
6.14
6.19
$
62,092,333
27,451
172
164,571
4,684
750,028
6.00
27.23
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.B. Transitional Care Hospital Governing
Board
BACKGROUND: The Board of Visitors is required to approve a
governing board for the University of Virginia Transitional Care
Hospital.
DISCUSSION: The University of Virginia Transitional Care
Hospital has its own provider number for Medicare reimbursement
through the Centers for Medicare and Medicaid Services (“CMS”).
CMS requires that each entity with a provider number have its
own governing body and that the designation of the governing
body be officially recorded. The planned opening date for the
University of Virginia Transitional Care Hospital is June 28,
2010.
ACTION REQUIRED: Approval by the Medical Center Operating Board
and the Board of Visitors
DESIGNATION OF THE MEDICAL CENTER OPERATING BOARD AS THE
GOVERNING BOARD OF THE TRANSITIONAL CARE HOSPITAL
RESOLVED, the Board of Visitors approves the designation of
the Medical Center Operating Board as the governing board of the
University of Virginia Transitional Care Hospital for The Joint
Commission purposes, responsible for overseeing and directing
the operations of the University of Virginia Transitional Care
Hospital as delegated by the Board of Visitors.
6
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.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.
7
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 11, 2009
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.B. Finance, Write-offs, and Operations
ACTION REQUIRED:
None
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
At the end of nine months of Fiscal Year 2010, the
operating margin for all business units was 5.1 percent, which
was above the budget of 4.7 percent. Total operating revenue
was below budget by 2.7 percent and total operating expenses
were below budget by 3.1 percent. The operating margin for the
Medical Center business unit was 2.7 percent against a budget of
3.0 percent. All other business units (UVA Imaging, UVA
Outpatient Surgery Center, Off-Campus Dialysis, and Community
Medicine) posted operating margins which were above budget.
After nine months of Fiscal Year 2010, the Medical Center
continues to experience the patterns of Fiscal Year 2009 and the
earlier months of Fiscal Year 2010, with admissions below
budget, observation and post procedure patients above budget, a
high average length of stay (6.19 days), and a very high case
mix index.
Inpatient admissions for Fiscal Year 2010 through March
were 7.5 percent below budget and 6.1 percent below prior year.
General Medicine volumes have decreased by 502 admissions (17.2
percent) from the prior year. Other services which realized
declining inpatient volumes include Neurology (10.7 percent
decrease), Psychiatry (10.9 percent decrease), and Cardiology
(7.7 percent decrease). Births for Fiscal Year 2010 through
March have decreased by 9.7 percent from Fiscal Year 2009 and
were 14.9 percent below budget. The decreasing number of births
8
explains much of the decline in admissions for Obstetrics and
Gynecology (9.4 percent decrease).
A few services have seen growth in inpatient volumes.
Admissions to the Hematology Oncology service have increased by
11.6 percent from the prior year, and admissions to the Neonatal
Intensive Care Unit have increased by 23.7 percent from Fiscal
Year 2009.
Net patient service revenue for the first nine months of
Fiscal Year 2010 was 2.9 percent below budget, primarily because
of the admissions shortfall. Total operating expenses through
March were 3.1 percent below the $743.1 million budget. Total
labor expenses (including salaries and wages, fringe benefits
and contract labor) were 1.6 percent below budget. Total supply
cost was 0.4 percent below the $167.4 million budget. All other
expense categories, including purchased services, depreciation
and bad debt, were below budget.
Total paid employees, including contracted employees, were
26 below budget.
FY 2009
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2010
2010 Budget
6,143
6,034
6,063
$68,286
$70,731
$71,728
234
180
177
6,377
6,214
6,240
OTHER FINANCIAL ISSUES
The construction of the University of Virginia Transitional
Care Hospital is nearing completion, and the first patient will
be admitted in late June or early July. The Transitional Care
Hospital adds 40 beds to the Health System. Additionally it
meets a patient need by providing an environment of care
designed specifically for patients who require inpatient care
for 25 or more days.
9
The recently enacted Patient Protection and Affordable Care
Act (H.R. 3590) and the Health Care and Education Affordability
Reconciliation Act of 2010 (H.R. 4872) will significantly impact
the health care industry over the next decade, probably more so
than any legislation since the repeal of cost based
reimbursement in the early 1980’s. The immediate effect on the
Medical Center is that payments from Medicare will drop $1.1
million in Fiscal Year 2011. The Medical Center, like all
health care organizations across America, is studying the impact
this legislation will have on our business and strategies over
the next decade.
The Medical Center has been working with Mary Washington
Hospital to create a new, jointly owned Radiosurgery Center in
Fredericksburg. The Radiosurgery Center will provide stereotactic
radiosurgery and stereotactic body radiotherapy, treatments not
currently available in Mary Washington's service area. After Mary
Washington’s Certificate of Public Need application was denied
twice, they teamed with the Medical Center and received a
Certificate of Public Need for a linear accelerator in February.
University of Virginia physicians will guide the
Radiosurgery Center team in selection, installation, and use of the
new equipment. The Radiosurgery Center is expected to be
operational in August 2011.
The Medical Center has a longstanding relationship with
Virginia Commonwealth University regarding pediatric cardiac
surgery, with a University of Virginia surgeon traveling to
Richmond to perform surgery since 2006. This relationship is
being expanded to create a Joint Program for Pediatric Cardiac
Surgery Services. University of Virginia surgeons will continue
to perform surgery at both institutions and will now also
provide medical direction for this program at VCU. The joint
program will provide comprehensive and collaborative care,
education, and research in order to become recognized as a
regional and national center of excellence and to increase
volumes for both hospitals by reducing outmigration. Virginia
Commonwealth University will provide partial funding for the
University of Virginia’s recruitment of an additional pediatric
cardiac surgeon. The final details of the program are being
worked out, and both parties expect the agreement to be signed
soon.
10
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $155.3 million for the
period July 1, 2009, through March 31, 2010, have been written
off. Recoveries during this period totaled $38.5 million.
Bad debt charges totaling $28.4 million have been written
off in the first nine months of Fiscal Year 2010. During this
same period, $12.5 million was recovered through suits,
collection agencies, and Virginia refund set-off.
OPERATIONS REPORT
Clinical Operations
Ambulatory Operations
The new concierge services program, UVA Employee
Connection, that launched on January 4, 2010, for Health System
faculty, staff, and their families was extended to University
faculty and staff on February 1, 2010. This program provides a
direct connection to the Health System through a dedicated phone
staffed by Ambassadors. These Ambassadors assist with
scheduling appointments, provide guidance on physician
referrals, and answer any questions that arise. The Health
System has 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 by the University community
and employees and faculty members have provided positive
feedback about the helpfulness and timeliness of the service.
As of April 16, UVA Employee Connection has made appointments
for 824 patients, including 404 (49%) Health System employees,
165 (20%) University of Virginia employees, and 255 (31%) 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 25% for primary care.
The most requested services have been Dermatology,
Ophthalmology, Orthopedics, and Family Medicine.
Inpatient and Emergency Department Operations
Clinical Care Services has changed its name to Patient Care
Services to more closely describe who they are and what they do.
A significant addition to the team, Scott Croonquist, RN, MS,
will be responsible for the Adult Inpatient, Psychiatric and
Emergency Services. Inpatient focus has been on improving
11
patient care satisfaction, improving quality outcomes, and
ensuring safe clinical care. Two specific activities that are
proving to be great patient satisfiers are Hourly Rounding and
Bedside Report. The Chief Nursing Officer made rounds on one of
the units where a patient responded, “I’ve never been kept so
informed in all my hospital stays.”
Two other inpatient initiatives have been implemented with
the intent of improving the patient experience. A new
multidisciplinary Pain Committee has been established to
implement new standards and monitor the improvement plan.
Another initiative focuses on making staff more sensitive to the
incidence of pressure ulcers developed while a patient is
hospitalized and the types of preventive actions to be taken to
reduce these occurrences. Pressure ulcers lead to increased
length of stay, additional costs, and pain and suffering for the
patient. The second quarterly survey in a row has shown a
significant decrease in incidence of the most severe pressure
ulcers.
The Heart and Vascular Center applied for and received
Joint Commission Disease Specific certification for Ventricular
Assist Devices (VADs). There were no recommendations, which
meant that the Ventricular Assist Device Program demonstrated
excellent performance and was compliant with all standards in
the first attempt at certification. Over 100 Ventricular Assist
Devices have been placed in patients at the Medical Center.
Accreditation makes the Medical Center eligible for Medicare
reimbursement for destination therapy among end stage heart
failure patients who are ineligible for a transplant.
Transplant Services is evaluating the potential expansion
of Transplant outpatient clinics to Roanoke and Culpeper. Such
expansion would improve the Medical Center’s ability to add to
its active list, an important element of accreditation. An
important milestone for the Transplant Program was recently
reached with the program’s 1000th liver transplant.
The Cancer Center opened the Access Center, the result of a
budget neutral workflow redesign to increase patient throughput,
increase patient satisfaction, reduce Infusion Center wait
times, and increase capacity for chemotherapy in the Infusion
Center. The Cancer Center has also scheduled a first patient
for Magnetic Resonance focused ultrasound for a Bone Met Trial,
using existing therapy for a new treatment.
12
Culpeper Regional Hospital
A flag raising ceremony was held at the start of the
Culpeper Regional Hospital Board meeting in March to display a
new Culpeper Regional Hospital flag with a tagline affiliating
the Hospital with the University of Virginia Health System.
Culpeper Regional Hospital was required to meet and maintain
several criteria in order to use the University of Virginia name
as a branding symbol. These included quality care processes and
demonstrable and sustainable progress toward achieving targets
with appropriate quality metrics. The ceremony was attended by
Culpeper Regional Hospital Board Members and staff.
Culpeper Regional Hospital has aligned its quality
scorecard with the Medical Center scorecard. The Hospital
continues to meet or exceed many of these metrics. Over the
last five reported quarters, the Hospital was 100% compliant
with evidence based standards of care for heart attack patients.
The Hospital has performed well in infection control and has not
experienced a central line associated blood stream infection in
its Intensive Care Unit in nearly a year.
Radiation Oncology TomoTherapy is in the planning phase at
Culpeper Regional Hospital. Drawings were presented at the
March Board meeting showing the unit located across the hall
from the HOPE Clinic. The HOPE Group has been very supportive
in agreeing to share waiting room space and registration staff
with the TomoTherapy program. Culpeper Regional Hospital is in
the process of bidding out the modular units with the
expectation of being operational this summer.
Planning is underway to redesign the Emergency Department
at Culpeper Regional Hospital with the intent of increasing bed
capacity by 20%. Other redesign elements are expected to
enhance patient flow and the Hospital’s revenue cycle
initiatives. The Hospital has also committed to fund an
Emergency Medicine resident position. This enabled the
University of Virginia’s Emergency Medicine Residency Program to
expand from nine to ten residents and allows residents to train
at Culpeper Regional Hospital for their community rotation,
providing approximately 1700 hours of coverage during the
upcoming academic year.
The UVA Specialty Clinic at Culpeper continues to grow in
terms of services and patient volume. Operational services
include Endocrinology, Allergy, Infectious Disease, Physical
Medicine & Rehabilitation, and Pediatric Cardiology. Plans are
under way to include Pediatric Urology and a Transplant clinic
this summer. Culpeper Regional Hospital has observed an
13
increase in admissions that would not have resulted without the
Specialty Clinic.
Continuum Home Health Fiscal Year 2009 Annual Report
Department Overview
Continuum Home Health Care, structured as a department of
the Medical Center, provides two primary lines of business:
home health and home infusion services. Continuum is accredited
by the Joint Commission and certified for Medicare and Medicaid
separately from the Medical Center.
Home health includes the direct provision of skilled
nursing; physical, occupational and speech therapies; home
health aides; and medical social work to patients residing
within a 10 county area including the counties of Albemarle,
Greene, Madison, Orange, Louisa, Fluvanna, Buckingham, Nelson,
Augusta, and Rockingham. Additionally Continuum offers
specialty care through its Psychiatric Service, Pediatric
Service, and an interdisciplinary Wound Care Team.
Home infusion provides services in the same 10 counties,
with Continuum providing any needed direct services, and
provides pharmaceutical services on a statewide basis and out of
state as needed to patients residing in Maryland, North
Carolina, and West Virginia. For home infusion patients
residing outside of Continuum’s direct service area, Continuum
works with another Medicare certified home health agency to
provide the required direct services.
It is important to note that Continuum internally manages
its own patient registration, insurance pre-authorization, and
coding. Continuum has implemented a stand-alone electronic
medical record system using laptop computers for patient
documentation in the home and telehome monitoring. Continuum
also has a patient specific supply ordering system developed in
concert with the Medical Center’s leading medical supply vendor,
and, with the exception of several hours of centrally provided
general orientation, internally manages orientation for its new
employees.
14
Activity Levels – I HEAL
Unduplicated
Admissions
Total UOS
(Visits)
Unduplicated
Admissions
Total UOS
(Therapy Days)
FY05
Home Health
FY06
FY07
FY08
FY09
3,124
3,400
3,876
3,748
49,575 47,981 49,748
Home Infusion
48,740
51,519
3,676
962
873
951
1,168
947
54,586
56,802
61,499
69,168
72,402
Both the home health and home infusion product lines
continue to demonstrate steady growth, since many patients are
repeat patients not reflected in the unduplicated counts.
Gaining new home health patients, while delivering fewer visits
overall is supportive of a more positive reimbursement picture
for home health and Continuum, was able to keep its average
number of visits per patient flat despite having a case weight
(acuity) of 1.582, which is higher than both state and national
with 1.372.
The reverse is true for home infusion where additional
visits generate additional reimbursement. Continuum home
infusion experienced a 5% increase in therapy days in fiscal
year 2009.
Many home infusion patients are repeat patients or
on service for life (i.e., cycles of chemotherapy, tube feeding
and Total Parenteral Nutrition patients), so this growth is
significant.
Operations – I BUILD
Significant differences in payer mix continue to exist
between the home health and home infusion business lines, adding
to the complexity of intake and pre-authorization requirements.
Traditionally Medicare Parts A and B cover very few home
infusion therapies, but the advent of Medicare Part D
prescription drug plans has significantly shifted patients to
Medicare D coverage from secondary coverage or self pay.
Both home health and home infusion continue to make a
significant contribution to the Medical Center’s bottom line,
while providing services critical to supporting the
institutional priority of timely and effective patient
discharge. This is thought in part to be a direct reflection of
the increasing acuity level of Medical Center patients being
15
discharged to home and in part a reflection of “cherry picking”
by some proprietary agencies who have moved into the local
market, leaving the more acute and resource intensive patients
for Continuum. Agency responsiveness and the skill level of
staff allows Continuum to support the discharge of hospitalized
patients that many home health agencies cannot or will not
service at home.
Quality/Outcomes – I CARE
Continuum continues to demonstrate positive movement in all
measured patient outcomes reported by CMS Home Health
Compare. For fiscal year 2009 Continuum surpassed all
local area home health agencies, both proprietary and
neighboring hospital based, in all state and national
clinical outcomes.
Extensive staff training was provided to all staff on
Continuum’s clinical and financial outcomes resulting in
improved outcomes. Continuum’s risk adjusted standing
demonstrates high patient outcomes with low visit
utilization.
Continuum continues to incrementally increase its Press
Ganey patient satisfaction scores, ending Fiscal Year 2009
with an overall mean score of 91.4 and ending Calendar Year
2009 at 91.9. Continuum exceeded the national standings
for the “all home health agencies” in the Press Ganey
database for 2009.
For the second consecutive year, home health services
achieved Tier 1 status as a leader in employee engagement.
Continuum successfully decreased its patient readmission
rate to 24%, well below the national average of 29%.
Given the high acuity level of its patients, Continuum is
especially proud of its achievement in this area.
Continuum fall rates were 0.7%, well below the national
average of 1.3% for home health patients.
Human Resources
Human Resources Customer Service Initiative
Human Resources identified “enhancing accessibility to
Human Resources services” and “responsiveness to customer needs”
as priorities for 2010 based on feedback and surveys of
customers. These priorities guided Human Resources process
improvement efforts and resulted in a number of customer service
initiatives.
16
An “Ask HR” booth is available on payday Fridays from 11
a.m. - 1 p.m. in the University Hospital cafeteria. Human
Resources representatives are available to answer employee
questions and provide resource materials. In addition, the
Human Resources Team brings HR resources and materials to
various areas of the Medical Center using a mobile cart (“HR a
la Cart”).
On April 19, a new one-stop Human Resources information
center was introduced. The new Human Resources Customer Service
Center offers employees and managers information on a wide range
of human resource services, including payroll, benefits,
employment, compensation, and training, as well as access to an
on-site benefits counselor. All services are available through
one phone number or by email.
A new Human Resources Business Partner Model was
established to align Human Resource Consultants with Medical
Center Departments and provide one key contact for human
resources support. This new service model has enjoyed a warm
reception, and customers of Human Resources have taken to the
idea of having one point of contact for their Human Resources
related needs. Human Resources representatives are also
available by pager after hours to assist managers in urgent
situations.
Employee Engagement
Medical Center Senior Leadership hosted a luncheon at the
Boar’s Head Inn for 52 managers who achieved employee engagement
Tier I status in the 2009 survey.
Each manager was given an
award and a framed certificate to display in his or her work
area.
A new WorkLife website for the University of Virginia
Health System premiered on March 15. The website contains
resources, links, articles, policies, and information about
various topics related to balancing work and life. Employees
and their families can more quickly and efficiently access
information in areas such as Children and Family, Elder Care,
Parenting, Diversity, and Stress Management. The website was
developed at the request of the Employee Engagement WorkLife
Task Force.
17
Quality and Performance Improvement
Survey/Accreditations
The Joint Commission conducted a Point of Care Testing
Laboratory Survey. Only two indirect findings were documented.
One related to competency testing for staff in a specific
laboratory, and the other related to proficiency testing. Both
issues have already been corrected.
Chaplaincy and Pastoral Education received notice that
their program has been reaccredited (Level I/II and supervisory
CPE) for another ten years by the Association for Clinical
Pastoral Education. The residency accreditation survey was held
on October 15 and 16, 2009. The three surveyors found no
notable deficiencies and commented that the program was well
integrated into the operations of the Medical Center. They
congratulated the Medical Center for providing a high quality
residency program.
The Bariatric Surgery program was reaccredited by the
American College of Surgeons as a level 1-A member of the
Bariatric Surgery Center Network. The American College of
Surgeons Bariatric Surgery Center Network Accreditation Program
accredits facilities in the United States that have undergone an
independent, voluntary and rigorous peer evaluation in
accordance with nationally recognized bariatric surgical
standards. Bariatric surgery accreditation not only promotes
uniform benchmarks, but also supports continuous quality
improvement. Level 1-A accreditation designates the elite
programs throughout the United States. Peter Hallowell, M.D.,
and Anna Dietrich-Covington, R.N., were the leaders of this
successful initiative.
The Medical Center’s Calendar Year 2009 organ donation
conversion rate was 82%, which is above the 75% benchmark. The
conversion rate is all recovered organ donors divided by
eligible deaths and positively reflects the Medical Center’s
commitment to organ donation.
Quality and Performance Improvement
The Medical Center participates in Anthem’s Quality-InSight®: Hospital Incentive Program (Q-HIP), a performance based
rewards program. Based on performance scores for 2009 related
to clinical outcomes, patient safety, and member satisfaction,
the Medical Center received a 100% payment adjustment to our
standard base rate.
18
Focused attention was placed on two key quality
initiatives: improving discharge instructions for heart failure
patients and administration of an initial antibiotic within six
hours of arrival for patients presenting with pneumonia. These
activities are directly related to clinical processes that are
nationally tracked. Teams are actively working on identifying
strategies to improve compliance.
Best practices were implemented in late 2009 with the goal
of eliminating central line associated bloodstream infections.
A multidisciplinary group continues to monitor infection rates
and compliance with best practices. While infection rates have
continued to improve, a group meets regularly to discuss
interventions to work toward the goal of eliminating these
infections.
A major initiative to improve the “I HEAL” metric was the
establishment of a new process for review of each Medical Center
death by physicians and unit personnel. The purpose of the
review is to identify opportunities for system improvements. A
Clinical Opportunity Team was chartered by the Quality Committee
to remove barriers and expedite implementation of systems
opportunities. This group has been active in approving several
actions, including development of algorithms for Emergency
Department disposition of patients with respiratory symptoms and
decision to transfer acute care patients to intensive care,
approval of purchases to support resuscitation of patients, and
development of physician oversight guidelines.
Quality and Patient Safety Recognition
National Patient Safety Week was celebrated throughout the
week of March 8. Robert Cofield DrPH, Associate Vice President
for Hospital and Clinics Operations, sent a daily e-mail to all
faculty and staff highlighting a specific patient safety issue
and the Medical Center’s commitment to performance. A patient
safety information table was set up in the East Cafeteria and
highlighted the daily patient safety messages. In addition, the
week’s Medical Center Hour focused on patient safety, with
Albert Wu, M.D., of The Johns Hopkins University discussing
“Being Open with Patients and Families about Adverse Events”.
Bernard Straube, M.D., the Chief Medical Officer and
Director of Clinical Standards and Quality at the Centers for
Medicare and Medicaid Services (CMS), and Jeannie Miller, R.N.,
the CMS Deputy Director of Clinical Standards, visited the
Medical Center on March 30. They met with Robert Cofield DrPH,
Jonathon Truwit, M.D., and Jeff Young, M.D., to discuss a number
19
of quality issues and tour the Hospital. Karen Rheuban, M.D.,
and the Telemedicine staff provided an overview of our
Telemedicine program. A discussion among Robert S. Gibson,
M.D., representatives from the Medical Center Clinical Staff
Office, and representatives from the University of CaliforniaDavis Credentials Office, was facilitated by telemedicine
technology to address CMS requirements regarding credentialing
and privileging of practitioners when care is provided via
telemedicine. Representatives from Bath County Hospital and the
National Telemedicine Association also attended the meeting.
Technology Services
Health Information Services
Health Information Services has undertaken the scanning of
millions of Medical Center patient documents into the Streamline
Health Document Management System so that these paper medical
records will be accessible through the EpicCare electronic
medical record system. In the process, a significant amount of
space that had been used to store the paper records will be made
available for other purposes.
Health System Computing Services
Health System Computing Services, which maintains all of
the major clinical and financial software applications for the
Medical Center and the Health Services Foundation, has been
actively involved in the implementation of the EpicCare
electronic medical record and will manage all the technical
functions of EpicCare. Health System Computing Services senior
management has also been involved in the design of the health
information exchange for the Commonwealth of Virginia, an
initiative being chaired by Marshall Ruffin M.D. Health System
Computing Services has also upgraded PeopleSoft, the enterprise
resource planning system for the Medical Center, to its latest
version, and has shifted the operations of the Web Development
Center to an improved software application (Plone) for web site
development. This will enhance standardization and updating of
most web sites maintained by the Health System.
Radiology Department
The Radiology Department continues to grow in many service
areas, especially in provision of magnetic resonance imaging and
interventional radiography services and expansion of locations
of service. Max Wintermark, M.D., has assumed medical
leadership for neuroradiology and has been instrumental in
20
forming close working relationships with neurology and
neurosurgery to expand collaborative services.
Medical Laboratories
The Medical Laboratories have been expanding in esoteric
genetic tests and outreach laboratory services. A feasibility
study is currently under way to assess the placement of a STAT
laboratory in the hospital for emergency laboratory studies.
Clinical Engineering
The Clinical Engineering Department is leading a study
regarding growth in procedure-based medicine services to help
the Medical Center plan for space and capital equipment for new
and often minimally-invasive procedural services. Clinical
Engineering is also leading the development of a technology
assessment program for the Medical Center to support
standardization of analyses and planning assessments for new
diagnostic and therapeutic technologies.
Program Management Office
The Program Management Office was created to reflect the
Medical Center’s commitment to standardize and modernize our
management of projects. The Project Management Office brings
value through a disciplined and standardized approach to project
management based on the methods of the Project Management
Institute (PMI). All project managers are now certified as
project managers by the PMI, which is a significant
accomplishment for a project management office only a year old.
Environment of Care
Construction Projects
Construction of the Transitional Care Hospital is scheduled
to be completed in the summer of 2010. Tours of a model room
for the hospital were conducted in February and March.
Occupancy of the Emily Couric Clinical Cancer Center is
scheduled for the first quarter of 2011.
Completion of construction of the Hospital Bed Expansion is
scheduled for the last quarter of 2011.
On February 1, refurbishment of 6 East was finished,
completing the adult acute care phase of the Refurbishment
Project.
21
Environment of Care Rounds
Environment of Care rounds in the Medical Center continue
to result in improvements to the physical environment on nursing
units and in public areas. Safety improvements are the first
priority, but aesthetics are also addressed.
Nutrition Services
March was National Nutrition Month, and Nutrition Services
sponsored special events to promote health and wellness,
including a Take the Stairs contest, a Name the Spice or Herb
contest that promoted the benefits of these nutrition
powerhouses, and a lunch session on how to create your own
vegetable garden, featuring speakers and tips for growing food
in your back yard or on the patio.
Environmental Services
Environmental Services purchased a new rapid testing system
that is able to detect contamination in the patient care
environment within 15 seconds. The system measures adenosine
triphosphate (ATP) which is present in all animal, vegetable,
bacterial, yeast, and mold cells. Detection of ATP indicates
the presence of contamination by one of those sources that can
spread due to lack of good hand hygiene or appropriate cleaning
and/or disinfection. Environmental Services has teamed up with
Infection Prevention and Control to perform pilot testing on
several inpatient units.
Sustainability
The Medical Center’s Environmental Management and
Sustainability Workgroup was initiated on March 8. Members
reviewed the Medical Center’s policy on sustainability and
viewed a brief video from “Hospitals Without Harm” about
creating a safer environment for hospital patients and employees
through the use of green cleaning products and environmentally
friendly construction materials. Environmental Health and
Safety staff also reviewed the Environmental Management System
which will be used to identify and address operational aspects
that impact the environment. The system will help document
measures taken to reduce negative impact as mandated in Virginia
Executive Order 82 on the greening of state government. Impact
will be ranked based on:
22
scale of impact
severity of impact
frequency of occurrence
employee exposure
ease of implementation and/or cost of change
associated legal requirements
Smoke-Free Campaign
The Smoke-Free Campaign continues with great success.
Periodic evaluations have been conducted to determine impact of
communications and informational resource needs. The Smoke-Free
Steering Committee met several times to discuss additional
outreach to employees who may not be aware of the array of
smoking cessation programs available. The Committee also
discussed several areas where patients and visitors are
gathering to smoke and developed strategies for engaging all
employees to help inform and redirect smokers. A presentation
was made to the Medical Center Management Group to enlist the
support of Managers in getting these messages out to employees.
Arts Committee
The Arts Committee met in March to discuss plans for
expanding the hospital’s music program, which includes
musicians-in-residence, visiting musicians and lobby musicians.
Musicians-in-residence features skilled musicians who are
certified in Music for Healing and Transitions or other
nationally recognized training programs. These Certified Music
Practitioners provide music at the patient bedside in intensive
care units, palliative care, and acute care settings. Visiting
musicians play in other patient care areas of the hospital and
clinics, and lobby musicians provide music in the lobby of
University Hospital for the enjoyment of patients, visitors and
employees.
An exhibition of the works of artist Anne deLa Tour Hopper
were on display in the hospital lobby from March 12, 2010 - May
7, 2010.
23
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Net patient revenue
Mar-08
Mar-09
Mar-10
Budget/Target
Mar-10
$692.8
$719.0
$738.4
$760.4
18.2
20.3
20.6
19.3
$711.0
$739.3
$759.0
$779.7
643.9
666.8
674.9
693.6
37.4
39.1
40.4
42.7
6.1
6.0
5.1
6.8
Total operating expenses
$687.4
$711.9
$720.4
$743.1
Operating income (loss)
$23.6
$27.4
$38.5
$36.6
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Non-operating income (loss)
$22.1
($88.0)
$57.2
Net income (loss)
$45.7
($60.6)
$95.7
Principal payment
$8.0
$9.5
$10.8
24
$28.9
$65.5
$10.5
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Mar-08
Mar-09
Mar-10
Assets
Operating cash and investments
$85.4
$33.6
$97.2
Patient accounts receivables
53.6
56.6
45.6
Property, plant and equipment
409.5
456.8
540.0
Depreciation reserve and other investments
351.5
344.5
322.5
Endowment Funds
241.1
232.0
328.0
Other assets
121.5
148.2
164.5
$1,262.6
$1,271.7
$1,497.8
$11.3
$12.6
$9.6
90.0
95.4
94.2
Long-term debt
152.5
229.4
341.1
Accrued leave and other LT liabilties
126.2
113.7
117.5
$380.0
$451.1
$562.4
$882.6
$820.6
$935.4
$1,262.6
$1,271.7
$1,497.8
Total Assets
Liabilities
Current portion long-term debt
Accounts payable & other liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
25
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Mar-08
Mar-09
Mar-10
Budget/Target
Mar-10
Operating margin (%)
3.3%
3.7%
5.1%
4.7%
Total margin (%)
6.2%
-9.3%
11.7%
8.1%
Current ratio (x)
1.4
0.8
1.4
2.0
216.0
171.0
187.0
190.0
Gross accounts receivable (days)
47.6
49.1
44.5
60.0
Annual debt service coverage (x)
6.3
(1.0)
8.9
6.6
19.2%
28.0%
36.0%
20.0%
6.3%
6.3%
6.3%
6.7%
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
26
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Acute Admissions
Patient days
SS/PP Patients
Average length of stay
Clinic visits
ER visits
Medicare case mix index
Occupancy %
FTE's (including contract labor)
Mar-08
Mar-09
Mar-10
Budget/Target
Mar-10
22,443
21,458
20,144
21,776
132,722
130,852
124,712
128,426
5,570
5,760
6,530
5,845
5.93
6.11
6.19
5.90
481,851
484,638
504,193
497,531
46,156
45,497
43,647
46,681
1.97
76.1%
6,347
27
1.96
76.0%
6,377
2.06
72.1%
6,214
1.94
72.6%
6,240
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 - April FY2010
OPERATING STATISTICAL MEASURES - April FY 2010
ADMISSIONS and CASE MIX - Year to Date
Actual
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Subtotal Acute
Short Stay/Post Procedure
Total Admissions
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
Budget
OTHER INSTITUTIONAL MEASURES - Year to Date
% Variance
Prior Year
18,964
2,334
1,133
20,489
2,472
1,265
(7.4%)
(5.6%)
(10.4%)
20,186
2,370
1,268
22,431
24,226
(7.4%)
23,824
7,388
6,505
13.6%
6,511
29,819
30,731
(3.0%)
30,335
1.88
2.05
1.85
1.94
1.6%
5.7%
1.80
1.97
Actual
Budget
% Variance
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
138,493
6.19
456
1,365
142,869
5.90
470
1,573
(3.1%)
(4.9%)
(3.0%)
(13.2%)
145,538
6.12
479
1,485
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
564,334
2,890
48,457
554,231
2,873
52,010
1.8%
0.6%
(6.8%)
541,631
2,827
50,601
15,692
6,754
22,446
15,742
6,784
22,526
(0.3%)
(0.4%)
(0.4%)
15,685
6,632
22,317
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
28
OPERATING FINANCIAL MEASURES - April FY 2010
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
826,760
843,488
(2.0%)
800,342
Medicare
$
272,691 $ 268,576
1.5%
260,930
Other Operating Revenue
22,379
21,450
4.3%
22,287
Medicaid
119,848
107,226
11.8%
105,454
Total
$
849,139 $ 864,938
(1.8%) $ 822,629
Commercial Insurance
134,988
152,991
(11.8%)
141,658
Anthem
145,500
158,038
(7.9%)
145,912
Southern Health
45,223
45,672
(1.0%)
42,383
EXPENSES:
Other
108,511
110,985
(2.2%)
104,006
Salaries, Wages & Contract Labor
368,881 $ 373,921
1.3%
366,319
Total Paying Patient Revenue
$
826,760 $ 843,488
(2.0%)
800,342
Supplies
186,119
186,013
(0.1%)
184,175
Contracts & Purchased Services
166,722
177,808
6.2%
165,664
Bad Debts
28,911
31,184
7.3%
25,518
Depreciation
45,124
47,430
4.9%
43,621
Interest Expense
5,660
7,541
24.9%
6,497
Total
$
801,417 $ 823,897
2.7% $ 791,794
OTHER:
Operating Income
$
47,722 $
41,041
16.3% $
30,835
Collection % of Gross Billings
38.00%
39.38%
(3.5%)
41.17%
Operating Margin %
5.6%
4.7%
3.7%
Days of Revenue in Receivables (Gross)
43.7
60.0
27.1%
47.4
Non-Operating Revenue
$
71,233 $
29,622
140.5% $
(82,445)
Cost per CMI Adjusted Discharge
$
10,220 $
9,932
(2.9%) $
10,108
Total F.T.E.'s (including Contract Labor)
6,220
6,249
0.5%
6,364
Net Income
$
118,955 $
70,663
68.3% $
(51,610)
F.T.E.'s Per CMI Adjusted Discharge
25.01
23.80
(5.1%)
25.52
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 - April 30, 2010
Assumptions - Operating Statistical Measures
Admissions and Case Mix Assumptions
Admissions include all admissions except normal newborns
Pediatric cases are those discharged from 7 West, 7 Central, NICU, PICU and KCRC
Psychiatric cases are those discharged from 5 East 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
29
Assumptions - Operating Financial Measures
Revenues and Expenses Assumptions:
Medicaid out of state is included in Medicaid
Medicaid HMOs are included in Medicaid
Physician portion of DSH is included in Other
Non-recurring revenue is included
Other Institutional Measures Assumptions
Collection % of Gross Billings includes appropriations
Days of Revenue in Receivables (Gross) is the BOV definition
Cost per CMI Adjusted Discharge uses All Payor CMI to adjust, and excludes bad debt
MEDICAL CENTER
ACCOUNTS COMMITTEE REPORT
(Includes All Business Units)
(Dollars in Thousands)
Year to Date
March
2009-10
INDIGENT CARE (IC)
Net Charge Write-Off
125,147
Percentage of Net Write-Offs to Revenue
6.41%
Annual Activity
2008-09
152,552
2007-08
133,320
6.49%
6.34%
Total Reimbursable Indigent Care Cost
47,305
57,665
54,558
State and Federal Funding
47,305
57,665
54,558
Total Indigent Care Cost Funding As a Percent
of Total Indigent Care Cost
100%
Unfunded Indigent Cost
-
100%
100%
-
-
Annual Activity
March
2009-10
BAD DEBT
Net Charge Write-Offs
26,989
Percentage of Net Write-Offs to Revenue
1.38%
2008-09
30,811
1.31%
2007-08
31,472
1.50%
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 indi
30
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 28, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.C. Capital Projects
ACTION REQUIRED:
None
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:
31
The University of Virginia Medical Center
Capital Projects Report
June 2010
Scope
Funding
Source
Budget
BOV
Approval
Date
Projected
Completion
Date
1. Pre-Construction
Barry and Bill Battle Building:
$117 M
Bonds and
Outside
Fundraising
TBD
2013
$14.3 M
Bonds
Feb 2008
2010
Design started on December 12,
2008. Schematic design approved
by Building and Grounds
Committee November 2009
University Hospital:
Add elevators – design complete.
Construction scheduled to
commence in June 2010.
(2,330 GSF)
2. Under Construction
University Hospital:
$21.2 M
Renovate Radiology Department.
Phased construction underway
(52,000 GSF)
Emily Couric Clinical Cancer
Center :
$74 M
(including
added shelled
floor)
Construction underway. Building is
closed in and interior finishes are
on-going.
University Hospital Bed
Expansion:
Bonds
Feb 2008
2012
General Fund
Appropriation ( @
$25 M) , Bonds
and Outside
Fundraising
Oct 2004
2010
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 taking place on all
floors.
32
Sept 2005
June 2007
2011
The University of Virginia Medical Center
Capital Projects Report
June 2010
Scope
Budget
Funding
Source
BOV
Approval
Date
Projected
Completion
Date
$6.6 M
Bonds
Feb 2008
2010
$8 M
Bonds
Jan 2003
2010
2. Under Construction
Primary Care Center:
Repair brick façade and replace
roof. Brick repair and new roofing
are complete.
Clinical Office Building:
Board of Visitors approved project
to complete the 3rd floor fit out for
the Spine Center, Hand Center,
and Radiological Services.
Construction is on going.
Hand Center opened January 11,
2010. Spine Center to open in
May, 2010.
*University Hospital:
Add two Operating Rooms and
Magnetic Resonance Imaging
Room (with equipment). Design
complete and construction began in
April 2010.
*University Hospital:
Renovate Heart Center invasive
procedure areas. Design complete
for several phases. Construction
underway for the first phase with
completion scheduled for July
2010. Phase 2 is scheduled for
completion by August 2010 and
Phase 3 by the end of 2010.
Feb 2008
$14.3 M
Bonds
Feb 2008
2010
Bonds
Feb 2008
2010
(2,330 GSF)
$15.6 M
(21,600 GSF)
* Project modifies original HEP project
33
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.D. 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
In March, the Health System Development Office achieved its
$500,000,000 goal for the Campaign for Health with 21 months
left in the University’s campaign.
The Department of Surgery received a $463,608 estate
distribution to supplement the George R. Minor Professorship in
Thoracic Surgery.
A family made a $200,000 addition to their charitable trust
for fellowships in the Division of Hematology-Oncology in honor
of Dr. Christiana Brenin.
The School of Nursing received a $100,000 pledge in support
of the McLeod Hall renovation project.
An alumnus committed a $100,000 planned gift to the School
of Medicine for a purpose to be determined at a later date.
A donor committed a $100,000 gift to the Barry and Bill
Battle Building.
Other gifts and pledges received include:
Gifts totaling $96,500 from a single donor to the School of
Nursing in support of resiliency training;
A $75,000 commitment to the Thomas G. and Dorothy H. DeShazo
Scholarship Fund in the School of Nursing;
A $72,000 commitment for the Emergency Medicine Center for
Research, Education, and Technology (EMCERT);
34
A $50,000 commitment for Patient Support Services and the
Emily Couric Clinical Cancer Center;
A $50,000 commitment in support of Dr. David Jones’ lung
cancer research; and
A $50,000 commitment to the Department of Anatomy and Cell
Biology.
OTHER DEVELOPMENT INITIATIVES
On January 16, 2010, Health System Development staff hosted
key prospects and donors for the University of Virginia
basketball game against Miami. During the event, Altria
Executive Vice President Marty Barrington discussed research
plans for the School of Medicine with Dean DeKosky and
development staff. Key Children’s Hospital Committee members
and Main Event chairs also attended the event.
On February 28, Children’s Hospital Development staff,
assisted by Drs. Sharon Hostler, Martha Carpenter, and Karen
Rheuban, hosted a tour of the hospital’s Neonatal and Pediatric
Intensive Care Units and presented plans for the Barry and Bill
Battle Building.
On March 2, the Health System Development office hosted a
Community Celebration of the UVA Children’s Hospital and Author
Reception for more than 140 friends, families, and faculty. The
event featured former Children’s Hospital patient and cancer
survivor Josh Sundquist, as well as a presentation of the Battle
Building by Mr. Howell, and received extensive media coverage.
On March 3, School of Nursing alumna Patti St. Clair hosted
an afternoon tea in Williamsburg for alumni to meet Dean
Fontaine.
On March 3, Health Foundation trustee Keith Woodard and his
wife, School of Nursing Alumni Council President Pat Woodard,
hosted a joint event for medical and nursing alumni at their
home in Virginia Beach.
On March 21, the Cancer Center held its annual Hamilton’s
Dinner, hosted by Bill and Kate Hamilton. The event honored
Michael Weber, Ph.D., and his leadership of the Cancer Center,
with proceeds benefiting the Cancer Center Director’s Fund.
35
CAMPAIGN PROGRESS THROUGH 2009
Through the end of March 2010, the Health System campaign
total is $500,393,823. This represents 100.07% of the campaign
goal achieved, with 78% of the campaign period elapsed. The
following table shows the Fiscal Year 2010 totals as of March
31, for new commitments, including gifts and pledges, as
compared to this same time frame in Fiscal Year 2009.
Fiscal Year to Date
(July 1 – March 31)
Total new commitments
(excludes pledge payments on
previously booked pledges)
New gifts
New pledges
36
FY 2010
FY 2009
$35,773,336
$36,151,152
$28,470,543
$31,664,171
$7,302,793
$4,486,982
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.E.
ACTION REQUIRED:
None
Annual Compliance Report
BACKGROUND: The Office of Corporate Compliance provides an
annual update of significant issues affecting the Medical
Center’s corporate compliance program. This year the Medical
Center can expect increased scrutiny of payments received under
Medicare and Medicaid due to enhanced program integrity
provisions and the Recovery Audit Contractor program.
Protection of patient health information will continue to be a
priority with new federal requirements regarding review of
alleged privacy breaches. The Medical Center will continue to
promote a culture of compliance, and the Office of Corporate
Compliance will be actively involved with implementation of the
Medical Center’s electronic medical record.
DISCUSSION:
Medicare and Medicaid Contractors
Medical Center Finance created a new unit which will be
responsible for the coordination of all reviews involving
payers, including Medicare, Medicaid, and commercial payers. A
software package will be used to track all such requests,
monitor the process, and track any payment adjustments.
Medicare and Medicaid are conducting payment audits through the
Recovery Audit Contractor (RAC) program. The Medical Center has
not received any audit requests related to Medicare. One
Medicaid request was received in May 2009. The requested
records were provided, and no further action has been taken.
Enhanced Medicare and Medicaid Program Integrity Provisions
Reporting and returning overpayments is now an obligation
of providers and suppliers under the Patient Protection and
Affordable Care Act (H.R. 3590). As part of the enhanced
program safeguarding provisions, providers and suppliers are
required to report and return overpayments within 60 days of the
date the overpayment has been identified. Failure to comply may
37
result in liability under the False Claims Act. This
obligation, based on the plain statutory language, appears to be
effective immediately. The legislation, however, does not
specify when an overpayment is deemed to have been “identified.”
HITECH Act
The American Recovery and Reinvestment Act of 2009 (Pub.L.
111-5) includes a section entitled Health Information Technology
for Economic and Clinical Health or HITECH. The HITECH
provisions include new penalties for violation of the privacy
and security of patient information. Under these new provisions
an individual is subject to criminal liability if he or she
intentionally and wrongfully acquires or discloses patient
information. Under the HITECH provisions health care providers
must assess every alleged violation of privacy and security
requirements to determine if a breach occurred. All breaches
must be reported to the patient involved and to the Department
of Health and Human Services. In February 2010, the Medical
Center made its first annual report to the Department of Health
and Human Services, which report included six privacy breaches.
The HITECH Act will also require modifications to the Medical
Center’s Notice of Privacy practices, mainly to include
compliance for request of restrictions. The Medical Center
created a process to comply with patient requests not to bill or
send medical records to their insurance company, and the patient
agrees to pre-pay in full for the service.
Corporate Compliance and Ethics Week
May 2-8 was Corporate Compliance & Ethics Week. The Medical
Center used this week to increase awareness of compliance and
privacy issues, to promote a culture of compliance, and to
emphasize that corporate compliance is a shared responsibility
amongst all of us. The Corporate Compliance and Privacy Office
used a questionnaire as a tool to assess the program’s
effectiveness and distributed information about the program and
methods of contact, including a new global e-mail address
(privacy*HS).
EpicCare Compliance
The Compliance, Privacy and Internal Audit EPIC Value
Achievement Committee (VAC) was established in July 2009 to
insure that the EpicCare implementation complies with all laws
and follows prudent business practices regarding electronic
medical record systems. The Committee strives to comply with
federal, state, and institutional regulations and policies
38
applicable to the EpicCare implementation and provides input and
recommendations in the design of the Medical Center’s electronic
medical record. The Committee’s goals are considered during the
design, validation, and training processes, and it provides a
venue for the design teams and other Value Achievement
Committees to request reviews and assistance with compliance,
privacy and internal control issues.
39
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.F. 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 3rd 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 one program 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 program is:
40
Advanced Cardiac Valve Center: Rapid advances in the
evaluation and treatment of cardiac valve disease have
revolutionized cardiac valve care. Non-surgical aortic and
mitral valve procedures now offer hope to patients who are not
appropriate candidates for open valve surgery. The Advanced
Cardiac Valve Center will provide comprehensive treatment,
offering both surgical options and less invasive procedures to
treat heart valve disease. The principal investigators for
this program are D. Scott Lim, M.D., John A. Kern, M.D.,
Michael Ragosta III, M.D., and Gorav Ailawadi, M.D.
A. Bobby Chhabra, M.D., Associate Professor of Orthopedics and
Vice-Chair of the Department of Orthopedics, will provide an
update on the UVA Hand Center, a prior recipient of Buchanan
Funding.
41
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.G.
Electronic Medical Record
BACKGROUND: At its February 2009 meeting, the Board of Visitors
authorized the procurement of a health care information
management system, including an electronic medical record, for
the University of Virginia Medical Center.
The Medical Center subsequently entered into a contract
with Epic Systems for an enterprise-wide clinical information
management system. In March 2009 and January 2010, the Clinical
Staff of the Medical Center, led by John B. Hanks, M.D., and
Robert S. Gibson, M.D., held Clinical Staff retreats to help the
Health System community prepare for implementation of the
electronic medical record system. These retreats were well
attended, and the clinicians were enthusiastic in their
anticipation of a single clinical information system available
in all locations of care.
DISCUSSION: The Medical Center is working closely with Epic
Systems and a few selected consultants to implement the Epic
clinical information systems on an aggressive timetable.
EpicCare Ambulatory, the electronic medical record for all
ambulatory clinics, will be installed on September 28, 2010.
Epic’s Beacon software for comprehensive cancer centers will be
implemented on December 1, 2010. EpicCare Inpatient, and
associated applications for hospital outpatient departments,
radiology, obstetrics and gynecology, and cardiology, will be
implemented on March 5, 2011. The EpicCare project is carefully
monitored by the project team and by Epic Systems, and the
project is on schedule and within budget.
Significant effort is being devoted to training of Health
System personnel for the Epic system. More than 6,000 Health
System employees will receive some training, with attending
physicians, residents, nurses, and other providers of care
receiving the most intensive preparation. In addition, some 40
Health System physicians will be super-users of the EpicCare
Ambulatory software. Super-users will assist their colleagues
to use the software more effectively during the first few weeks
after we begin using it. Epic Systems has complimented the
42
Health System many times for the extraordinary participation by
physicians in this EpicCare project, including their willingness
to receive the additional training, which is three times the
usual training for a physician, to become super-users.
43
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
June 10, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
III. Report by the President of the
Clinical Staff
ACTION REQUIRED:
None
DISCUSSION: The President of the Clinical Staff of the Medical
Center will inform the Medical Center Operating Board of recent
events regarding the Clinical Staff which do not require formal
action, but of which the Medical Center Operating Board should
be made aware.
44