UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
February 25, 2010
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
Thursday, February 25, 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.
III.
ACTION ITEMS
A.
Nutrition Services Contract
B.
Environmental Services Contract
REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEDICAL CENTER (Mr. Howell)
A.
Vice-President‟s Remarks
B.
Finance, Write-offs, and Operations (Mr. Howell
to introduce Mr. Larry F. Fitzgerald and Mr.
Robert Cofield; Mr. Fitzgerald to report on
Finance and Write-offs; Mr. Cofield to report on
Operations)
C.
Capital Projects
D.
Graduate Medical Education (Mr. Howell to
introduce Susan E. Kirk, M.D.; Dr. Kirk to
report)
E.
Health System Development (Mr. Howell to
introduce Ms. Karen Rendleman; Ms. Rendleman to
report)
REPORT BY THE PRESIDENT OF THE CLINICAL STAFF OF THE
MEDICAL CENTER (John B. Hanks, M.D.)
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3
4
5
26
29
41
45
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 Medical Center performance measures and
metrics, a proprietary report on a health care
information management system and performance of a
contract, long range financial plan, fiscal year 2011
budget assumptions, business plans for clinical growth,
and Medical Center market strategies and potential joint
ventures;
-
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 federal and
state investigations, the Medical Center‟s compliance
with relevant federal reimbursement regulations,
licensure and accreditation standards, and negotiations
concerning performance of a contract and related
litigation, all of which will also involve proprietary
business information of the Medical Center.
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 25, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.A. Nutrition Services Contract for the
Medical Center
BACKGROUND: The Board of Visitors is required to approve the
execution of any contract where the amount per year is in excess
of $5 million.
DISCUSSION: The Medical Center and Morrison Management
Specialists, Inc., (Morrison) are currently parties to a
contract whereby Morrison provides food and clinical nutrition
services to the Medical Center. The contract was entered into
in 2003 for an initial five year term, with an option to extend
for an additional five year period.
In 2008, the Medical Center and Morrison agreed to a one
year extension of the contract, and in 2009 the parties extended
the contract through March 2010 pending further negotiations.
The Medical Center and Morrison now desire to extend the
contract for the full five year renewal term through September
30, 2013, and further desire to amend the contract to add an
additional five year renewal option, which if exercised will
permit the Medical Center to extend the contract through
September 30, 2018. In exchange Morrison has agreed to certain
upgrades of the Medical Center West Cafeteria and the Medical
Center Main Hospital Cafeteria. The total projected cost of the
additional renewal option is $32,916,000, with negotiated
increases and decreases based on the actual needs of the Medical
Center.
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Finance Committee, and by the Board of Visitors
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APPROVAL OF SIGNATORY AUTHORITY FOR AMENDMENT TO NUTRITIONAL
SERVICES CONTRACT FOR THE MEDICAL CENTER
RESOLVED, the Board of Visitors authorizes the Executive
Vice President and Chief Operating Officer of the University to
execute an amendment to an existing contract for nutrition
services for the Medical Center, providing for an option to
extend the contract through September 30, 2018, if exercised by
the Medical Center, based on the recommendation of the Vice
President and Chief Executive Officer of the Medical Center in
accordance with Medical Center procurement policy.
2
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.B. Environmental Services Contract for
the Medical Center
BACKGROUND: The Board of Visitors is required to approve the
execution of any contract where the amount per year is in excess
of $5 million.
DISCUSSION: The Medical Center and Crothall Services Group,
Inc., (Crothall) are currently parties to an environmental
services contract whereby Crothall provides, inter alia,
housekeeping and waste management services to the Medical
Center. The contract was entered into in 2005 and expires June
30, 2010.
The Medical Center and Crothall now desire to extend the
contract for an additional one year period through June 30,
2011, during which time the Medical Center will pursue a
competitive procurement. During the extension period Crothall
has agreed to a performance-based contract, wherein its fee is
at risk if certain performance standards are not met. The total
projected cost of the one year extension is $9,500,000, with
negotiated increases and decreases based on the actual needs of
the Medical Center.
ACTION REQUIRED: Approval by the Medical Center Operating
Board, the Finance Committee, and the Board of Visitors
APPROVAL OF SIGNATORY AUTHORITY FOR AMENDMENT TO ENVIRONMENTAL
SERVICES CONTRACT FOR THE MEDICAL CENTER
RESOLVED, the Board of Visitors authorizes the Executive
Vice President and Chief Operating Officer of the University to
execute an amendment to an existing contract for environmental
services for the Medical Center to extend the contract through
June 30, 2011, based on the recommendation of the Vice President
and Chief Executive Officer of the Medical Center in accordance
with Medical Center procurement policy.
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UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 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.
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UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.C. 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 the first five months of Fiscal Year 2010,
the operating margin for all business units was 5.7 percent,
which was above the budget of 5.2 percent. Total operating
revenue was below budget by 3.4 percent, and total operating
expenses were below budget by 3.9 percent. The operating margin
for the Medical Center business unit was 3.3 percent against a
budget of 3.6 percent. All other business units (UVA Imaging,
UVA Outpatient Surgery Center, Off-Campus Dialysis and Community
Medicine) posted operating margins which exceeded expectations.
Inpatient activity in the first five months of Fiscal Year
2010 continues to mirror the trends of Fiscal Year 2009, with
admissions below budget, observation patients above budget, and
average length of stay higher than expected. The high average
length of stay (6.24 days) can be partially explained by a high
case mix index. The case mix index for all acute inpatients was
1.88, which was above the budget of 1.85 and was higher than we
have experienced in any five month period in at least the past
ten years.
Inpatient admissions for Fiscal Year 2010 through November
were 7.1 percent below budget and 6.0 percent below prior year.
While many services continued to experience declining
admissions, the most significant decrease in the first five
months occurred in general medicine. Adult surgical and
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pediatric general admissions have also decreased. Obstetrics
admissions have decreased and the number of babies born at the
Medical Center has decreased by 9.3 percent from the prior year.
Although births have declined, admissions of newborns with
complications have increased by 35.2 percent over the prior
year, while normal newborn admissions have decreased 14.1
percent. Other services which have experienced increased
admissions over the prior year include hematology oncology,
pulmonary critical care, and otolaryngology.
Total labor expenses (including salaries and wages, fringe
benefits and contract labor) were 2.1 percent below budget.
Total supply cost was 0.9 percent below the $93.3 million
budget. All other expense categories, including purchased
services, depreciation and bad debt, were below budget.
Total paid employees, including contracted employees, were
33 below budget.
FY 2009
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2010
2010 Budget
6,162
6,018
6,051
$67,490
$69,728
$70,954
246
176
177
6,408
6,194
6,228
OTHER FINANCIAL ISSUES
For over two years the Medical Center has been working with
the Virginia Commonwealth University Health System in a
collaborative effort to lower supply costs for both
organizations. The supply chain collaborative between our two
Health Systems, the University HealthSystem Consortium, and
Novation, has recorded approximately $5.4 million in estimated
annualized savings since its inception in 2007, and is currently
developing a long-range procurement plan to align local
contracts for high-cost physician preference items in order to
facilitate additional cooperative procurements. We have
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identified an additional $8.0 million opportunity in total for
the two organizations.
The Medical Center recently received the University
HealthSystem Consortium (UHC) Supply Chain Optimization Top 10
Award for 2009. UHC gives this award annually to 10 member
organizations that model best practices in supply chain by (a)
optimizing UHC and Novation contracts, (b) focusing on
efficiency and cost reduction while ensuring end-user
satisfaction, and (c) using informatics tools to identify
savings opportunities.
The clinical documentation improvement program began in
September. Since that time, approximately two-thirds of all
active attending physicians and residents have attended one of
the physician led education sessions. More sessions have been
scheduled for those not able to attend in the fall. The program
has been well received and results have been positive. Four
nurse documentation specialists have been hired and trained, and
they are assisting physicians on the units with best
documentation practices. Early indications are that the patient
severity and mortality scores have increased as we had
anticipated.
Based on numerous legislative initiatives, including the
Medicare Prescription Drug Improvement and Modernization Act of
2003, the Deficit Reduction Act of 2005 and the Fraud
Enforcement and Recovery Act, federal agencies have authorized
independent contractors to audit healthcare providers for
appropriate billing, coding and documentation. The primary
purpose is to reduce healthcare costs by recovering improper
payments. State agencies are also commencing similar audits for
Medicaid services. In response to these initiatives, the
Medical Center has created a Payer Audit Response Department to
provide a centralized response to the myriad of audit
initiatives, the most prevalent of which are RAC (Recovery Audit
Contractors) and MIC (Medicaid Integrity Contractors) audits.
An oversight committee has been created including
representatives from Finance, Coding, Patient Accounting, and
Patient Care Services. An electronic system which will track
each account being audited has been acquired. Workflows are
being developed and contracts have been initiated with
consulting firms specializing in audit defense.
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WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $85.6 million for the period
July 1, 2009, through November 30, 2009, have been written off.
Recoveries during this period totaled $19.1 million.
Bad debt charges totaling $15.6 million have been written
off in the first five months of Fiscal Year 2010. During this
same period, $6.7 million was recovered through suits,
collection agencies, and Virginia refund set-off.
OPERATIONS REPORT
Clinical Operations
Ambulatory Operations
A new concierge services program, the UVA Employee
Connection, was launched to provide University of Virginia
faculty, staff, and their families a link to high-quality
healthcare through a single point of contact. UVA Employee
Connection commenced operations on January 4, 2010, for Health
System faculty, staff, and their families and will be 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
Health System employees. Positive feedback has been received
from satisfied employees about the helpfulness and timeliness of
the service and the exceptional customer service delivered by
the Ambassadors.
The first meeting of the Ambulatory Operations Oversight
Committee was held on December 10, 2009. Discussion focused on
improving quality and service in the Health System‟s ambulatory
clinics. The Committee was charged with setting the direction
for ambulatory services throughout the Health System, with a
focus on standardization wherever possible and customization
when absolutely essential.
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An Epic Ambulatory Implementation Committee comprised of
physicians, managers, administrators, and Epic project staff
convened for the first time on December 1, 2009. This group
will work to put the plans of the Epic Oversight Committee and
the various Epic workgroups into practice in Ambulatory
Services. This group will focus on achieving standardization in
the use of the electronic medical record across Ambulatory
Services, with customization only where necessary. The
Committee will also provide feedback to the Oversight Committee
on the identified operational needs for a successful
implementation.
Inpatient and Emergency Department Operations
The Digestive Health Center Bariatric Surgery Program was
surveyed by the American College of Surgeons in early December.
The program received verbal notification of a two year
recertification as an approved Center of Excellence for
Bariatric Surgery. A formal written notice is expected by March
2010. Bruce Schirmer, M.D., and his team deserve credit for
this achievement.
Patient satisfaction continues to be a primary focus for
all clinical departments. Third quarter metrics gave cause for
celebration regarding improvements in our patient satisfaction.
Five inpatient units scored at the 50th percentile and seven
units scored at the 75th percentile.
Length of Stay Initiative
In the past year the Medical Center has focused attention
on the gradual increase in inpatient length of stay. While the
influencing factors are many, solutions have been approached
through a quality improvement process. Initially, five
diagnoses were identified for assessment by multi-disciplinary
groups to identify things that could be “fixed” immediately.
For example, a multidisciplinary algorithm was implemented for
patients on 5 Central with hepatic encephalopathy that decreased
fall rates from 4 to 1.2 and ICU length of stay from 5.2 days to
4.1 days.
Ten teams are currently using a deliberate quality
improvement process to fully understand the issues that prevent
the Medical Center from achieving a length of stay in the top
quartile for the University HealthSystem Consortium peer group.
One tool that has been implemented is the addition of an
expected length of stay to every patient record, the patient
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list, rounds report, and patient treatment plan. Rounding teams
use the expected length of stay to manage a patient‟s stay, and
length of stay reports are generated for each patient care unit
and medical director. The Medical Center target for average
length of stay is 5.9 days. The average for December 2009 was
6.1 days.
Ten multidisciplinary quality improvement teams are also
working on a number of diagnoses, including very low birthweight infants, pediatric and adult asthma, pneumonia,
cellulitis, and joint replacement. The goal is to create best
practice care guidelines and to see improvement by the fourth
quarter of Fiscal Year 2010.
H1N1 Flu Pandemic Planning
Operational planning and communication for H1N1 vaccinations
will continue throughout the flu season. An employee flu clinic
was operational during the height of the outbreak to provide
care for symptomatic employees, and a flu hotline was also
available. H1N1 vaccination was initially available only on a
priority basis, but vaccine inventory is now adequate to provide
vaccinations to everyone. A regional hospital planning
workgroup developed a triage consensus statement and operational
plan with input from the state regional operations center. The
Medical Center will continue surveillance throughout the flu
season and take action as necessary.
Culpeper Regional Hospital
At the November meeting of the Culpeper Regional Hospital
Board of Trustees, the Board approved a recommendation to
purchase tomotherapy radiotherapy equipment for the new
Radiation Oncology service. The Board also approved a
recommendation to move forward with negotiations to purchase the
Rappahannock Electric Company land adjacent to the Hospital.
The land will provide opportunities for the Hospital‟s future
growth.
UVA Specialty Care at Culpeper Regional Hospital opened at
the beginning of December with Endocrinology, Physical Medicine
& Rehabilitation, and Pediatric Cardiology services available to
the community. Infectious Disease services will be available at
the clinic in January.
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Culpeper Regional Hospital received a certificate of public
need to open an additional general purpose operating room. This
will be the third operating room at the Hospital.
As of January 1, 2010, Culpeper Regional Hospital is a
smoke free and tobacco free campus. Since the first public
announcement in early 2009, Culpeper has made great efforts to
inform the community of this policy change. The new policy
extends to all Culpeper Regional Health System entities.
EpicCare: Electronic Medical Record
The EpicCare project continues on schedule and within
budget. Sixteen nurse builders are meeting regularly with
medical directors and nurse managers in the clinics to design
documentation templates and order sets. Over one hundred
clinicians, from ambulatory and inpatient settings, are working
with the EpicCare build team to develop documentation tools and
order sets to be incorporated into the EpicCare software.
EpicCare builders are working with each clinic to identify
specialty workflows and hardware needs.
A Hardware Fair was held in December, with enthusiastic
participation by many members of the clinical staff. Clinicians
were able to “test drive” workstations on wheels, wall-mounted
units, and bar code scanners. EpicCare build team members were
also on hand to demonstrate the EpicCare system.
A delegation of nine people from the Health System visited
the Stanford Hospital and Clinics and the Palo Alto Medical
Foundation in January 2010 to study their implementation of
EpicCare.
Mark Lepsch, M.D., continues to offer two hour introductory
classes for EpicCare Ambulatory. Upon completion, attendees
receive access to the Epic Playground, the development
environment the Medical Center is using to create its software.
Reviews from the program have been very positive.
The Clinical Staff Retreat held on January 22 and 23, 2010,
featured the leaders of a successful implementation of EpicCare
Ambulatory at Evanston-Northwestern Medical Center and the Chief
Medical Information Officer of the Weill Cornell Physician
Organization. The speakers addressed productivity improvements
achieved for physicians and clinics after conversion from paper
record to EpicCare.
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Human Resources
Inclement Weather Response
The weekend before Christmas found Charlottesville
blanketed by nearly two feet of snow. Throughout the weekend
and the days that followed, Health System physicians, nurses,
and other employees stepped up to insure that patients continued
to receive high quality care. Faculty physicians, residents,
and staff covered shifts for employees who could not get to
work, often working for two or three days to make sure patients
received care. Other employees navigated treacherous roads to
provide transportation for colleagues, deliver essential labs
and prescriptions, and insure that patients, families, and staff
had hot food and fresh linens. Medical Center employees
demonstrated dedication, tenacity, and compassion, and performed
countless acts of selflessness. Everyone was commended for the
incredible effort that was extended during this period and for
the care and services they provide every day to our patients.
Employee Engagement
Many steps have been taken to improve the commitment of
Medical Center employees since the 2009 survey was administered.
A comprehensive analysis of the survey results was shared with
the Medical Center management team in September 2009. Managers
communicated organizational and work unit results to employees
during October and November 2009. In December, work units
developed action plans to address specific employee concerns
regarding their managers, their colleagues, and their individual
roles. In addition, Medical Center Senior Leadership and
Clinical Care Services are engaged in strategic discussions
concerning effective leadership, making personal connections
through direct communications to staff, and timely recognition
of staff for their accomplishments.
Leadership Appointments
Robert (Bo) Cofield, the Medical Center‟s new Associate
Vice President for Hospital and Clinics Operations, assumed his
new role on January 21, 2010. Mr. Cofield holds a Doctor of
Public Health degree as well as a Master of Health
Administration degree from Tulane University. He received his
Bachelor‟s degree from Hampden-Sydney College in Virginia. Most
recently Mr. Cofield served for ten years in a variety of roles
at the University of Alabama Health System in Birmingham.
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Michelle Hereford was recently welcomed in her new role as
the Associate Chief for the Long Term Acute Care Hospital. Ms.
Hereford comes to the Medical Center as an experienced long term
acute care hospital administrator, and she previously served as
the Chief Executive Officer of Kindred Hospital Richmond, a long
term acute care facility.
2009 Performance Appraisal Program Summary
A new performance appraisal schedule was introduced in
2009, giving managers an additional month to complete the
appraisal process. Managers also had the opportunity to use an
on-line tool to track the completion and receipt of their staff
appraisals. The program was very successful with 95% of staff
appraisals received on time. The ratings distribution was as
follows:
0.5%
70.0%
29.5%
Below Expectations
Fully Meets Expectations
Consistently Exceeds Expectations
Merit Increases
The Medical Center budgeted 2% of payroll to fund
performance based increases effective January 10, 2010. Each
Chief was given a merit increase budget, along with a suggested
range of increases. Employees who were rated “Fully Meets
Expectations” received an increase of 1.5% to 2.0% and employees
rated “Consistently Exceeds Expectations” received an increase
of 2.5% to 3.0%. The average increase was approximately 2.0%.
Directors and managers received increases averaging 1.5%.
Because of the current financial challenges, Associate Vice
Presidents, Chiefs, Associate Chiefs, and Administrators will
forgo increases this year.
The Medical Center provides employees who receive benefits
with a personalized total compensation statement that details
the value of the employee‟s compensation and benefit package.
These statements will be distributed at the end of January.
Quality and Performance Improvement
Survey/Accreditations
In February 2010, the Heart Center will be surveyed by the
Joint Commission for Advanced Ventricular Assist Device Disease
Specific Certification (DSC). This will be the Medical Center‟s
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third Disease Specific Certification. The other two are Stroke
and Chronic Obstructive Pulmonary Disease.
The Medical Center will also undergo a Point of Care
Laboratory Testing Survey by the Joint Commission. Two
surveyors will be on site for four days between now and midApril 2010.
Quality and Performance Improvement
The Charles L. Brown Award Winner for 2009 is Heather
Turner, RN, and numerous team members from 6 Central and the
Stroke Unit. The award winning project is “An Interdisciplinary
Team Approach to Quality and Performance Improvement.”
Established in 2001, The Stroke Quality Support Team is a
multidisciplinary group that meets monthly to review current and
potential practice in the care of stroke patients, performance
improvement data, and staff education. In 2004, the Joint
Commission recommended ten performance measures to be followed
in the stroke population. The Stroke Center used these ten
measures to develop a quality and performance improvement plan,
with a goal of greater than 90% compliance in all measures.
Retrospective data going back to the first quarter of 2003
showed that our institution was below target in four of the
measures: lipid profile collection (22%), stroke education
(66%), smoking cessation (27%) and screening for dysphagia
(71%). By second quarter of 2005, our multidisciplinary
performance improvement process had brought all four of these
measures to above goal (>90%) and the team has worked to keep
these measures above goal since.
Quality Recognition
Continuum Home Health received notification from Outcome
Systems that for the third year in a row Continuum has been
ranked as a top 500 agency and in the top 25% of highest
performing agencies. Outcome Systems performs the mandatory
benchmarking reporting to the Centers for Medicare and Medicaid
Services for some 9,000 home health agencies nationwide.
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Technology Services
Health Information Services
Inpatient chart control audit, a process for documenting
and reporting missing inpatient medical charts, has been
implemented. All tasks assigned from internal audit regarding
inpatient chart control have been completed and the Health
Information Systems department is currently participating in a
follow-up audit.
Health System Computing Services
In support of operational planning for H1N1, Computing
Services provided a rapid response to set up workstations and
printers in Employee Health to support the Medical Center‟s flu
clinic. In addition, a new interface to the Commonwealth of
Virginia‟s statewide immunization system was implemented to
provide immunization information charted in MIS or in Employee
Health. Telemedicine hosted weekly meetings with Dr. Jonathon
Truwit, two regional hospitals, and the Virginia Department of
Health.
PeopleSoft
With continual focus on enhancing employee satisfaction,
the Medical Center‟s PeopleSoft team and the University‟s
employee benefits department implemented eBenefits on November
2, 2009. Medical Center employees are now able to access Open
Enrollment in PeopleSoft and make benefit elections
electronically. This significantly decreases the administrative
burden associated with open enrollment. In addition, this
year‟s "PTO Cash out" was conducted electronically, eliminating
a paper form that used to be submitted by over 5,000 employees.
Enabling on line 'self service' for Health System managers and
employees continues to be a strategic focus of the health system
computing team.
Web Development Center
A new School of Medicine web site was launched in December
on time and within budget. Approximately 12,000 pages and 232
web sites were moved into the new site.
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Radiology Department
CT Fluoroscopy guidance was installed in late October 2009
on a second CT scanner to expand capacity for performing the
growing number of CT guided procedures. A facilities renovation
project is underway to upgrade our current PET/CT scanner.
Environment of Care
Construction Projects
Refurbishment of ten adult inpatient units has been
completed, and the 11th and final unit will be completed by the
third week of January.
As part of the West Main Street Improvement Project, a
section of Jefferson Park Avenue and West Main Street has been
repaved, and a new traffic signal has been installed at the
intersection. Improvements to the sidewalk and pedestrian
crossing in front of 1224 Jefferson Park Avenue have been
completed and the old pedestrian bridge between 1222 and 1224
Jefferson Park Avenue has been demolished.
In October construction crews began delivering and
assembling sections of the Primary Care Center Annex. The
building is expected to be completed in February 2010.
The renovation of the Radiology areas at University
Hospital East on the first floor of University Hospital is
actively under way. The current phase of the project is the
most substantial and entails renovation of the former waiting
room, creation of pre and post procedural patient care areas,
and construction of a new ultrasound area. The project team is
working to minimize operational disruption during this period.
This phase of the renovation is expected to last until late
spring 2010.
Interviews with architectural firms were conducted in
December in order to begin the design phase of the Emergency
Department Renovation and Expansion Project.
Environment of Care Rounds
Environment of Care Constant Readiness Rounds are being
conducted bi-weekly in order to insure a constant state of
readiness to meet Environment of Care standards, raise staff
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awareness, and achieve compliance with Medical Center policies
and regulatory requirements.
Nutrition Services
A new menu focusing on healthier foods and a healthier
environment is now being offered in both cafeterias. Items
being offered include a daily local food item, Weight Watchers
Grab & Go salads and sandwiches, a daily vegetarian entrée, and
“Yan Can Cook” recipes at the action station in the East Café.
In addition, parfaits are now served in "green ware"
biodegradable containers.
Sustainability
A policy on Environmental Management and Sustainability
Practices was developed for the Medical Center in order to
demonstrate that we are operating in an environmentally
responsible manner by striving to reduce energy demand,
conserving resources, reducing solid waste (trash) generation,
increasing recycling and reuse, and supporting and monitoring
various “green” initiatives undertaken within the Medical
Center.
Smoke-Free Campaign
On October 1, 2009, the Medical Center extended its smoking
ban to include all buildings and grounds where patient care is
provided, including Student Health, the Outpatient Surgery
Center, Fontaine Medical Park and Northridge, as well as the
University Hospital and the West Complex. The clean air
campaign included outreach to employees, patients, and visitors
who smoke to make them aware of smoking cessation resources.
Items such as nicotine lozenges and “comfort kits” have been
made available through the Hospital Gift Shop to those who are
not ready to quit smoking. Employee compliance with the smoking
ban has been excellent, and the response from patients and
visitors has been extremely positive. There have been inquiries
from other hospitals and organizations seeking to emulate the
Medical Center‟s approach to going smoke-free on grounds.
Patient & Guest Services
In November 2009, the leadership of the Culpeper Regional
Hospital Auxiliary and Medical Center‟s Hospital Auxiliary and
were welcomed by Mr. Howell. Highlights of the day included
visits to the Hospitality House and to the Primary Care Center
17
Heart Center Clinic to share the results of a Venture Award for
Patient Education. This was the second meeting of the two
groups, and it may become an annual event, alternating between
the two hospitals.
Arts Committee
An exhibit of Olga Morgan‟s work entitled “Night Blossoms”
was on display from November 6, 2009, to January 8, 2010, in the
lobby of University Hospital.
The installation of work by local photographers in both
patient rooms and unit corridors was accomplished simultaneously
with the unit refurbishments, and feedback from patients and
staff has been very positive.
Health System Parking and Transportation
New LED signs have been installed in the Lee Street Garage
to direct patients and their visitors to available parking on
the upper levels of the garage. Additional spaces for patients
and visitors with disabilities have also been added to the
garage.
18
University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Net patient revenue
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Total operating expenses
Operating income (loss)
Nov-07
Nov-08
Nov-09
Budget/Target
Nov-09
$385.5
$402.0
$408.4
$424.4
10.3
10.7
12.0
10.8
$395.8
$412.7
$420.4
$435.2
356.4
372.1
371.5
385.1
20.9
21.9
22.5
23.7
3.3
3.2
2.5
3.7
$380.6
$397.2
$396.5
$412.5
$15.2
$15.5
$23.8
$22.7
Non-operating income (loss)
$21.2
($54.3)
$41.3
Net income (loss)
$36.4
($38.8)
$65.1
$48.5
Principal payment
$4.5
$5.3
$6.0
$5.8
19
$25.8
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Nov-07
Nov-08
Nov-09
Assets
Operating cash and investments
$62.6
$17.4
$79.3
Patient accounts receivables
56.5
58.9
51.4
Property, plant and equipment
406.3
446.6
499.7
Depreciation reserve and other investments
433.4
364.0
352.5
Endowment Funds
160.5
263.8
316.7
Other assets
124.3
112.0
155.2
$1,243.6
$1,262.7
$1,454.8
Current portion long-term debt
$13.9
$11.6
$16.2
Accounts payable & other liab
75.0
87.8
77.2
Long-term debt
152.9
229.7
341.3
Accrued leave and other LT liab
128.5
90.2
115.4
$370.3
$419.3
$550.1
$873.3
$843.4
$904.7
$1,243.6
$1,262.7
$1,454.8
Total Assets
Liabilities
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
20
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
Nov-07
Nov-08
Nov-09
Budget/Target
Nov-09
Operating margin (%)
3.8%
3.7%
5.7%
5.2%
Total margin (%)
8.7%
-10.8%
14.1%
10.5%
Current ratio (x)
1.3
0.8
1.4
2.0
203.0
189.0
178.0
190.0
Gross accounts receivable (days)
50.4
50.2
45.6
60.0
Annual debt service coverage (x)
7.8
(1.6)
10.6
8.0
17.7%
28.4%
36.7%
20.0%
6.4%
6.3%
6.3%
6.6%
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
21
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Nov-07
Nov-08
Nov-09
Budget/Target
Nov-09
Acute Admissions
12,607
12,045
11,317
12,179
Patient days
73,391
74,269
69,630
71,820
3,061
3,235
3,516
3,253
5.85
6.19
6.24
5.90
273,187
268,453
283,572
275,558
25,788
25,249
25,602
25,868
SS/PP Patients
Average length of stay
Clinic visits
ER visits
Medicare case mix index
Occupancy %
1.95
76.1%
FTE's (including contract labor)
6,332
22
1.96
76.0%
6,408
2.03
72.1%
6,194
1.94
72.6%
6,228
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 FY2010
OPERATING STATISTICAL MEASURES - November FY 2010
ADMISSIONS and CASE MIX - Year to Date
Actual
Budget
% Variance Prior Year
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Subtotal Acute
Short Stay/Post Procedure
Total Admissions
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
9,553
1,192
572
10,300
1,243
636
(7.3%)
(4.1%)
(10.1%)
10,226
1,201
618
11,317
12,179
(7.1%)
12,045
3,516
3,253
8.1%
3,235
14,833
15,432
(3.9%)
15,280
1.88
2.03
1.85
1.94
1.6%
4.6%
1.81
1.96
OTHER INSTITUTIONAL MEASURES - Year to Date
Actual
Budget
% Variance
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
69,630
6.24
455
684
71,820
5.90
456
786
(3.0%)
(5.8%)
(0.2%)
(13.0%)
74,269
6.19
485
754
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
283,572
2,944
25,602
275,558
2,870
25,868
2.9%
2.6%
(1.0%)
268,453
2,797
25,249
7,829
3,344
11,173
7,914
3,374
11,288
(1.1%)
(0.9%)
(1.0%)
7,811
3,307
11,118
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
19
23
OPERATING FINANCIAL MEASURES - November FY 2010
REVENUES and EXPENSES - Year to Date
Actual
Budget
% Variance Prior Year
($s in thousands)
NET REVENUES:
Net Patient Service Revenue
Other Operating Revenue
Total
408,412
11,955
$ 420,367
EXPENSES:
Salaries, Wages & Contract Labor
Supplies
Contracts & Purchased Services
Bad Debts
Depreciation
Interest Expense
Total
Operating Income
Operating Margin %
Non-Operating Revenue
181,719
92,447
82,664
14,683
22,490
2,531
$ 396,534
$ 23,833
5.7%
$ 41,317
$
Net Income
$
65,150
424,432
10,796
435,228
(3.8%)
402,062
10.7%
10,653
(3.4%) $ 412,715
2.1%
0.9%
7.8%
10.6%
5.0%
32.9%
3.9%
5.1%
$
185,690
93,294
89,692
16,418
23,686
3,770
412,550
22,678
5.2%
25,852
59.8%
183,231
91,486
83,278
14,074
21,921
3,253
$ 397,243
$ 15,472
3.7%
$ (54,312)
$
48,530
34.2%
$
$
$
$
(38,840)
OTHER INSTITUTIONAL MEASURES - Year to Date
($s in thousands)
Actual
Budget
% Variance
NET REVENUE BY PAYOR:
Medicare
$ 132,241 $
132,100
0.1%
Medicaid
53,255
48,892
8.9%
Commercial Insurance
67,719
80,228
(15.6%)
Anthem
67,627
77,959
(13.3%)
Southern Health
22,484
22,251
1.0%
Other
65,086
63,002
3.3%
Total Paying Patient Revenue
$ 408,412 $
424,432
(3.8%)
OTHER:
Collection % of Gross Billings
Days of Revenue in Receivables (Gross)
Cost per CMI Adjusted Discharge
Total F.T.E.'s (including Contract Labor)
F.T.E.'s Per CMI Adjusted Discharge
$
37.53%
45.6
10,001 $
6,194
24.82
39.57%
60.0
9,911
6,228
23.84
Prior Year
(5.2%)
24.0%
(0.9%) $
0.5%
(4.1%)
128,352
48,088
74,292
71,984
20,651
58,694
402,062
41.47%
50.2
9,978
6,408
25.53
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, 2009
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
24
Assumptions - Operating Financial Measures
Revenues and Expenses Assumptions:
Medicaid out of state is included in Medicaid
Medicaid HMOs are included in Medicaid
Physician portion of DSH is included in Other
Non-recurring revenue is included
Other Institutional Measures Assumptions
Collection % of Gross Billings includes appropriations
Days of Revenue in Receivables (Gross) is the BOV definition
Cost per CMI Adjusted Discharge uses All Payor CMI to adjust, and excludes bad debt
MEDICAL CENTER
ACCOUNTS COMMITTEE REPORT
(Includes All Business Units)
(Dollars in Thousands)
Year to Date
September
2009-10
INDIGENT CARE (IC)
Net Charge Write-Off
75,514
Percentage of Net Write-Offs to Revenue
6.94%
Annual Activity
2008-09
2007-08
152,552
133,320
6.49%
6.34%
Total Reimbursable Indigent Care Cost
28,544
57,665
54,558
State and Federal Funding
28,544
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
August
2009-10
BAD DEBT
Net Charge Write-Offs
14,683
Percentage of Net Write-Offs to Revenue
1.35%
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 collectability of the patient accounts receivable. These provisions differ from the actual write-offs
of bad debts and indigent care which occur at the time an individual account is written off.
25
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 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:
26
The University of Virginia Medical Center
Capital Projects Report
February 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
$7.6 M
Bonds
Feb 2008
2011
$2.5 M
Bonds
Feb 2008
2011
Bonds
Feb 2008
2012
General Fund
Appropriation ( @
$25 M) , Bonds
and Outside
Fundraising
Oct 2004
2010
Design started on December 12,
2008. Submit to Buildings and
Grounds Committee November
2009
*University Hospital:
Add two Operating Rooms and
Magnetic Resonance Imaging
Room (with equipment) – design
nearing completion.
(2,330 GSF)
*Modifies original HEP project
University Hospital:
Add elevators – design complete.
Moser Radiation Therapy
Center:
(3,000 GSF)
Construct addition for 2nd linear
accelerator – project put on hold
for FY10.
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
substantially closed in.
July 2006
(B&G
Committee)
June 2007
27
The University of Virginia Medical Center
Capital Projects Report
February 2010
Scope
Funding
Source
Budget
BOV
Approval
Date
Projected
Completion
Date
2. Under Construction
University Hospital Bed
Expansion:
$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.
Installation of curtainwall system is
nearing completion. Interior
framing and MEP rough-ins are
progressing.
Primary Care Center:
Sept 2005
2011
June 2007
$6.6 M
Bonds
Feb 2008
2010
$8 M
Bonds
Jan 2003
2010
Repair brick façade and replace
roof. Brick repair is complete.
Replacement of the roof
commenced in late September
2009.
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 scheduled for
Spring 2010.
*University Hospital:
Renovate Heart Center invasive
procedure areas – design complete
for several phases. Construction
underway for the first phase.
Feb 2008
$15.6 M
Bonds
(21,600 GSF)
28
Feb 2008
2010
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.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 the Medical Center has the
opportunity to secure the future of medicine with those we are
educating and training. As the Medical Center develops 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
critical. The Medical Center has over 750 residents and fellows
participating in 96 training programs: 64 programs accredited by
the Accreditation Council for Graduate Medical Education
(ACGME), thirty one additional fellowships (non-accredited or
accredited by other than the ACGME), one dentistry program
accredited by the American Dental Association, and five
paramedical programs in chaplaincy, clinical laboratory
medicine, clinical psychology, pharmacy, and radiation physics.
Because of recent recommendations by the Institute of
Medicine, it is expected that a key area of change in the coming
year in Graduate Medical Education will be resident duty hour
restrictions. The Medical Center continues to endeavor to meet
the current challenges of the Accreditation Council for Graduate
Medical Education regulations and ensure that our trainees work
and learn in an environment where education is emphasized over
service. This requires continual oversight of every aspect of
all programs, including compliance with duty hours. In 2009,
the Graduate Medical Education Committee formed a task force to
enhance oversight and compliance with duty hours. The Graduate
Medical Education Committee endorses the ACGME principle that
“duty hour violations are unacceptable regardless of specialty
or sponsoring institution”. The Graduate Medical Education
Office and Graduate Medical Education Committee analyze data
from multiple sources (New Innovations electronic duty hour
logs, routine and mid-cycle audits by the Graduate Medical
Education Office, citations from the ACMGE, and trainee reports
of duty hour violations through the annual exit survey, the
29
annual anonymous survey by the ACGME, or the Housestaff Advocacy
Hotline). In addition, program directors are now required to
come before the Graduate Medical Education Committee to discuss
duty hour violations of their trainees, and provide both action
plans and deadlines for correcting any problems. Finally, the
Medical Center hired additional physician extenders in two high
risk areas in 2009 to help meet service demands and prevent duty
hour violations.
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 2009 are as follows:
Departing Housestaff:
Completed training program*
Transferred to another program
Not reappointed for academic reasons
Resigned for personal or academic reasons
Terminated from program
239
9
0
7
3
* Of the 239 residents completing training, 19 were
appointed to faculty positions.
New Appointments
240
Reappointments
499
Accreditation Status
Accreditation of graduate medical education programs is
provided by the ACGME. Accreditation is accomplished through a
peer review process and is based upon standards and guidelines
established by twenty-six specialty-specific committees known as
Residency Review Committees. The accreditation (or
reaccreditation) process occurs periodically on a schedule set
by the Residency Review Committees 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:
30
All 64 programs accredited by the Accreditation Council for
Graduate Medical Education and the Institution have full
accreditation
– 21 core residency programs
– 43 subspecialty/fellowship programs
Program success can be measured in part by the length of
the accreditation provided. Of the 64 accredited programs, 75%
have a 4-6 year cycle length, an increase of 5%.
•
•
•
•
•
•
6
5
4
3
2
1
year
year
year
year
year
year
accreditation
accreditation
accreditation
accreditation
accreditation
accreditation
– 7 programs
-- 26 programs
-- 15 programs
-- 8 programs
-- 7 programs
– 1 program
Programs in Internal Medicine with a five year cycle became
eligible to have their accreditation extended by an additional
year. The Medicine program and six of the subspecialty
fellowship programs were awarded this cycle length. Of the
twelve programs that received an official Letter of Notification
in 2009, six received 5-year cycles, one received a 4-year
cycle, two received 3-year cycles, two received 2-year cycles,
and one received a one-year cycle.
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:
Insufficient Volume – Programs did not document sufficient
exposure to certain cases or areas of medicine.
Evaluations – Programs failed to document compliance with one
of the required competencies.
Duty Hours – Residents need to be provided rest periods
between shifts (10 hour rule).
Faculty Qualifications – Faculty were not Board Eligible or
Certified, or the program had insufficient faculty to meet
with the program‟s procedural requirement.
Curriculum – Goals and objectives were not clearly stated or
not stratified by year.
31
Lack of Institutional Support - Three programs were cited for
not having sufficient technical or clerical support, space, or
equipment to carry out educational activities.
All programs which received citations were required to report
corrective action plans to the Graduate Medical Education
Committee.
A significant positive achievement for 2009 was the timely
completion of all Internal Reviews, the mandatory mid-cycle
audits by the Graduate Medical Education Committee of all
programs. This had been a major concern at the Institutional
Review in 2005, and one of two citations in our last
Institutional Letter of Notification from 2006. The institution
remains on a rigorous schedule with 17 Internal Reviews
completed in 2009 and an additional 17 scheduled in 2010.
National Match
The Medical Center participates in the National Residency
Matching Program. Participation is required for programs
offering Post Graduate Year 1 positions and available to
programs offering Post Graduate Year 2 positions. Twenty-nine
programs offering 147 positions participated in the 2009 Match
(sixteen categorical programs, four preliminary programs, one
primary program, and eight advanced programs). Five programs
(ten positions) remained unfilled at the time of the Match, but
successfully filled all open positions within one day. As this
number was higher than previous years, the Graduate Medical
Education Office conducted a post-Match survey which revealed
that the major reason that candidates did not match at the
University of Virginia was concern about living in
Charlottesville, which was considered to be small and lack the
features of larger, more urban cities. We will closely watch
the rate of unfilled positions during the upcoming Match in
March 2010 and take action if this appears to be a growing
trend.
32
Finance
The total direct budget for Graduate Medical Education
programs for fiscal year 2010 is $48,249,029. Funds to support
this program come from Medicare, Medicaid, other government or
industry sources, and the Medical Center.
In addition to continuing to fund innovative programs to
support education, such as the Master Educators Award, the
Graduate Medical Education Innovative Grant Program, and the
Certificate Program, the Medical Center increased salaries and
benefits for all graduate medical trainees in July 2009, in
order to remain competitive with Graduate Medical Education
programs nationally.
University of Virginia Housestaff Salaries
Effective July 1, 2009 - June 30, 2010
50th
Percentile
All Regions*
Median
Southeast
Region*
Program
Level
UVA
Annual
Salary
Medical/Dental
PGY 1
$49,134
$46,717
$45,123
PGY 2
$49,823
$48,406
$46,594
PGY 3
$51,807
$50,406
$48,196
PGY 4
$55,543
$52,599
$49,962
PGY 5
$56,089
$54,689
$51,870
PGY 6
$57,428
$57,000
$54,029
PGY 7
$59,303
$58,909
$55,029
PGY 8
$61,361
$61,059
$57,540
PGY 1
$30,001
PGY 2
$30,942
PGY 3
$31,882
PGY 4
$32,785
PGY 1
$44,326
PGY 2
$46,834
PGY 1
$32,204
PGY 2
$33,965
Chaplain
Pharmacy
Clinical
Psychology
*2008 AAMC Survey on Stipends, Benefits and Funding
33
Mandatory Reporting of ACGME Requirements
Duty Hour Compliance
The Medical Center has had minimal issues with duty hour
compliance over the past year. Because of anticipated changes
from the ACGME, a task force was initiated to examine oversight
by the Graduate Medical Education Committee.
The New Innovations Residency Management Suite software has
been in place for the last academic year, and the Graduate
Medical Education Office continues to provide upgrades and
training. The Graduate Medical Education Office staff member
responsible for oversight of New Innovations attended a week of
training this autumn and provided program updates and
enhancements to the training program staff upon her return. All
training programs have been mandated to use a number of the
modules, including duty hour monitoring, evaluation, and
scheduling. Individual programs are better equipped to track
duty hour violations and address them in real time. They are
also better able to collect the data required to assist in
identifying the systems-based causes of violations.
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
for assigning responsibilities to residents, and for evaluating
trainees to determine proficiency in all competencies, including
patient care and medical knowledge. Jeff Young, M.D., Chief
Quality Officer for the Medical Center, 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 now being used to 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 reference. The checklists are updated
34
annually and are in compliance with Joint Commission standards.
This year the database was digitalized to enable the Graduate
Medical Education Office to provide the most current
information.
All programs must evaluate trainees regularly and use New
Innovations to document the evaluations. Moreover, each program
must evaluate and provide written feedback to each 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 paperless evaluation process and the 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 their standard
curricula. 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 items such 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 both
the standing committees of Quality and Patient Safety. The
Housestaff Council Co-Presidents also represent the trainees in
key leadership committees, such as the Clinical Staff Executive
Committee, where Quality and Patient Safety issues are discussed
monthly.
Innovations in Graduate Medical Education
The Graduate Medical Education Innovation Grant Program,
created in July 2003, encourages creative projects in
restructuring resident education. Funds are available for pilot
programs, demonstration projects, and proof-of-concept efforts
relating to improvements in resident and fellow training. Grant
proposals are submitted for consideration by faculty,
housestaff, and other staff involved in Graduate Medical
Education. The principal focus is on the development or
evaluation of new initiatives related to competency-based
education and the development of new educational techniques,
specifically simulation. Graduate Medical Education Innovation
Grant Awards were made to two projects in November of 2008:
“Sign-out Training Development and Evaluation” (Pediatrics) and
“Development of Web-Based and Surgical Simulation Learning
Modules for Orthopaedic Conditions and Emergencies”
(Orthopaedics). Both programs presented updates on their
progress in November 2009. 2010 winners will be announced by
January 15.
Support continues to be provided for presenting these and
other innovative practices at national graduate medical
education conferences. The Graduate Medical Education Office
held its second annual Research Day in November 2009 to provide
a venue for local presentation of results from these awards.
For the fifth year, two Master Educator Awards were
presented to outstanding teaching faculty members who have been
leaders in Graduate Medical Education. The 2009 Master Educator
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Award winners were Mitch Rosner, M.D. (Nephrology/Medicine) and
Spencer Gay, M.D. (Radiology).
The Graduate Medical Education Certificate Program began in
July 2007. The first graduates of the program finished their
requirements and earned certificates in either Clinical Research
or Public Health Policy on June 1, 2009. The eight graduates
represented the following Departments: Medicine, Pathology,
Pediatrics, Psychiatry and Neurobehavioral Science and
Radiology. Courses include Epidemiology, and Biostatistics,
Methods of Clinical Research and Public Health Policy, and
Research Methods & Grant Writing in Community Health. In 2010,
two new Certificate Program tracks will be offered in Global
Health and Leadership.
The Graduate Medical Education Office continues to expand
its Institutional Graduate Medical Education Curriculum. The
evening programs with dinner and didactic lectures are offered
quarterly and cover topics relevant to all training programs,
such as Fatigue Awareness, Physician Wellness, Ethics, and the
Business of Medicine. In 2009, programs on healthcare reform
and sleep deprivation were offered, with lectures videotaped to
ensure all graduate medical trainees have the opportunity to
participate in the program. The Graduate Medical Education
Office has planned a week of development activities for faculty,
staff and trainees in April 2010. Included are plans for a full
day program coordinator retreat (to which coordinators from
other institutions state-wide have been invited), a rising Chief
Resident leadership workshop, and multiple faculty and trainee
development lectures. Finally, the calendar of Graduate Medical
Education Institutional Curriculum offerings is now in
electronic format.
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 will host a retreat
for Program Coordinators with their peers from Virginia
Commonwealth University and Eastern Virginia Medical School in
April 2010. In addition, the Graduate Medical Education Office
38
provides funding for two program coordinators to attend national
meetings to enhance their professional development.
The Graduate Medical Education Office provides additional
support through its continued participation in the robust
monthly Graduate Medical Education Coordinator Council meetings,
Graduate Medical Education Committee meetings and Housestaff
Council meetings. The Graduate Medical Education Office has
initiated process improvement programs in the following areas:
program coordinator professional development, program scheduling
process simplification, and increased access for housestaff to
resources from 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 the
academic files for residents and fellows. Traditionally the
complete files were scanned inside one PDF document. The
organization of the scanned files was modified to make
retrieving records easier.
Review of Graduate Medical Education Committee
Activities during the Past Year
The Internal Review Subcommittee includes 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
Accreditation Council for Graduate Medical Education.
Preparation of individual programs for their Internal Review and
Residency Review Committee visits 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.
The Research Subcommittee continues 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 subcommittee 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
Enhanced Professional Track in the Department of Urology) and
39
provides recommendations to the full Graduate Medical Education
Committee. In 2009, the subcommittee recommended, and the
Graduate Medical Education Committee subsequently approved, six
new programs, three new tracks, and over 50 off site rotation
applications for the 2009-2010 Academic Year.
Resident salaries and benefits were reviewed by the
Subcommittee on Program Director and Resident Support and
recommendations were presented to the Medical Center. Stipend
levels were again increased by 2.9% with a larger increase given
to residents in Chaplaincy, whose stipends were substantially
lower than other programs in the region.
40
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 2010
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.E.
ACTION REQUIRED:
None
Health System Development
BACKGROUND: Health System Development provides reports of
recent activity to the Medical Center Operating Board from time
to time.
DISCUSSION:
SIGNIFICANT GIFTS
A Health Foundation board member and his wife have pledged
$675,000 to the Cancer Center for unrestricted use.
An anonymous donor has offered a 1:1 match for all funds
raised up to $500,000 for lung cancer research being conducted
by Dr. David Jones in the Department of Surgery.
The Ivy Foundation governing committee voted to fund seven
Biomedical Innovation grants totaling $290,000: $190,000 from
the Ivy Foundation and $100,000 from Johnson & Johnson.
The School of Medicine received a realized bequest of two
distributions of $132,408 to support cancer research at the
University of Virginia Cancer Center and retinal research in the
Department of Ophthalmology.
Other gifts and pledges received include:
A $108,000 pledge for graduate fellowships in the School
of Nursing;
A $102,000 gift for radiation oncology research;
A $100,000 gift for mitochondrial genetics research in
the Department of Neurology;
A $100,000 gift to the Barry and Bill Battle Building;
A $100,000 gift to the University of Virginia‟s multiple
sclerosis program;
A $100,000 pledge for the University of Virginia
Children‟s Hospital in support of Jeffrey‟s Gifts;
41
A $100,000 pledge for a fellowship in palliative care;
A $100,000 bequest for pancreatic cancer research;
A $100,000 bequest for nursing scholarships;
A $73,000 realized bequest to the School of Nursing for
the dean‟s discretionary use;
A $54,000 gift to the Thaler Center for AIDS and Human
Retrovirus Research;
A $50,000 gift for lung cancer research;
A $50,000 pledge for the Hematologic Malignancies Program
in the Cancer Center;
A $50,000 expectancy for the W. Harry Muller Scholarship
in the School of Medicine; and
A $50,000 gift for humanitarian cardiology initiatives
and collaborations in the Dominican Republic.
OTHER DEVELOPMENT INITIATIVES
On September 14, the Focused Ultrasound Surgery Foundation
celebrated the opening of the Focused Ultrasound Surgery Center.
This event provided an opportunity to steward foundation members
for their $3 million contribution and to set the stage for
future philanthropy.
On September 20, Mr. and Mrs. John Kluge hosted a luncheon
at their home to celebrate their recent $3 million commitment
for professorships in the Schools of Nursing and Medicine. Dean
DeKosky and Dean Fontaine were among the participants.
The School of Nursing Alumni Council and Advisory Boards
met on September 25, and 26. On the evening of September 25,
the School held its annual benefactors event for leadership
donors and volunteers.
At its fall meeting on October 9, the Health Foundation
board welcomed new trustees Ms. Rebecca Ruegger and Mr. Mike
Russell, and confirmed Dr. George Hurt as its new vice chair.
Following the meeting, the board elected Mr. Charles “Hill”
Ewald and Dr. Charles Henderson as new trustees, with terms
commencing in the spring of 2010.
On October 10, Health System Development staff hosted key
alumni, prospects, and donors for the University of Virginia
football game against Indiana University. The School of Nursing
and the Medical Alumni Association also co-hosted a pre-game
event.
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On October 19, more than 100 alumni and guests attended a
reception in Roanoke jointly hosted by the Medical Alumni
Association, the School of Nursing, and members of the Roanoke
National Committee on University Resources. Dean DeKosky and
Dean Fontaine provided school updates.
On October 21, Health System Development staff hosted a
site visit, including updates on selected faculty research, for
representatives of the Juvenile Diabetes Research Foundation and
other key prospects.
On October 23, Claude Moore Foundation trustees toured the
Claude Moore Medical Education Building construction site with
Health System Development staff.
On October 30, the Patients & Friends Research Fund
Steering Committee hosted the third “Hot Topics in Cancer” panel
discussion. The event, moderated by Peyton Taylor, M.D.,
featured the lung cancer research of David Jones M.D., and James
Larner, M.D.
On October 30, emeritus School of Nursing Advisory Board
member Ms. Cathy Gorrell hosted an event for key donors with
Dean Fontaine.
On November 12, a Cancer Center Advisory Board member
hosted a reception for the Cancer Center and the Patients &
Friends Research Fund in Arlington, Virginia.
On November 19, a Cancer Center Advisory Board member
hosted a reception for the Breast Care Program in
Charlottesville.
On November 26, Mr. Howell kicked off the 28th Annual
Children‟s Hospital Turkey Trot, which attracted more than 1,300
participants and raised an estimated $35,000.
The Communications team completed the fall issue of
Virginia Legacy, the School of Nursing‟s alumni magazine. An
e-mail blast was sent to more than 5,000 friends of the
University of Virginia Children‟s Hospital and a Facebook fan
page was established to promote upcoming fundraising events.
New stewardship materials were developed, including annual
reports to foundations, and special topics inserts were created
for development officer use. The team assisted in creating
several Health System press releases.
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CAMPAIGN PROGRESS THROUGH 2009
Through the end of November 2009, the Health System
campaign total is $489,084,303. This represents 98% of the
campaign goal achieved, with 74% of the campaign period elapsed.
The following table shows the Fiscal Year 2010 totals as of
November 30, 2009 for new commitments, including gifts and
pledges, as compared to this same time frame in FY ‟09.
Total new commitments
(excludes pledge payments on previously
booked pledges)
New gifts
New pledges
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FY „10
FY ‟09
$25,726,013
$15,486,818
$20,551,267
$14,907,997
$5,174,746
$578,821
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
February 25, 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.
45