UNIVERSITY OF VIRGINIA
BOARD OF VISITORS
MEETING OF THE
MEDICAL CENTER
OPERATING BOARD
September 10, 2009
UNIVERSITY OF VIRGINIA
MEDICAL CENTER OPERATING BOARD
Thursday, September 10, 2009
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.
REPORTS BY THE VICE PRESIDENT AND CHIEF EXECUTIVE
OFFICER OF THE MEDICAL CENTER (Mr. Howell)
A.
B.
C.
D.
II.
Vice-President‟s Remarks
Finance, Write-offs, and Operations (Mr. Howell
to introduce Mr. Larry F. Fitzgerald and Mr.
James L. Rosenberg; Mr. Fitzgerald to report on
Finance and Write-offs; Mr. Rosenberg to report
on Operations)
Capital Projects
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 (Robert S. Gibson, M.D. to report on
behalf of Dr. Hanks)
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2
23
26
30
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 metrics, a
proprietary report on a health care information
management system and performance of a contract, and
Medical Center market strategies and potential joint
ventures and partnerships;
-
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:
September 10, 2009
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.A.
ACTION REQUIRED:
None
Vice President‟s Remarks
DISCUSSION: The Vice President and Chief Executive Officer of
the Medical Center will inform the Medical Center Operating
Board of recent events that do not require formal action.
1
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 10, 2009
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
I.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 eleven months of Fiscal Year 2009, the
operating margin was 3.9 percent, which was below the budget of
4.3 percent. Total operating revenue was below budget by 3.4
percent, and total operating expenses were below budget by 3.0
percent. The University of Virginia Imaging Center and
Outpatient Surgery Center continued to exceed financial
expectations and posted operating margins of 51.0 percent and
34.5 percent, respectively. The operating margin for the
Medical Center was 1.7 percent compared to the budgeted
operating margin of 3.0 percent. On a consolidated basis, the
shortfall in operating income was approximately $5 million.
Inpatient admissions remained below budget, but the
occupancy rate was relatively high as the number of observation
patients exceeded budget, average length of stay was higher than
expected, and available beds were limited by the inpatient unit
refurbishment project. On May 31, 2009, the Medical Center had
575 staffed inpatient beds in operation, compared to 589 beds in
operation at the same time last year.
Inpatient admissions for Fiscal Year 2009 through May were
6.9 percent below budget and 4.8 percent below the prior year.
While most services have experienced a decline in admissions,
Cardiology has experienced the largest decline. Both internal
and external factors continue to keep inpatient admissions below
expectations.
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Although admissions decreased by 6.9 percent, inpatient
days were only 1.8 percent below budget. This was due to a
length of stay of 6.13 days compared to the 5.80 days budgeted.
Net patient service revenue for the first eleven months of
Fiscal Year 2009 was 3.4 percent below budget, primarily because
of the admissions shortfall. In addition, the overall case mix
index was 1.81, which was lower than the 1.83 budgeted. A
project to improve coding and documentation processes will begin
in September. This project is expected to result in a decrease
in the mortality score and an increase in the case mix index and
net patient service revenue.
Total operating expenses through May were 3.0 percent below
the $897.8 million budget. Total labor expenses (including
salaries and wages, fringe benefits, and contract labor) were
0.8 percent below budget. Total supply cost was virtually equal
to the budgeted amount. All other expense categories were below
budget.
It has been widely reported that due to the current high
unemployment nationally, indigent care has been increasing
across the country. The indigent care write-off in May was
$18.1 million compared to budgeted indigent care of $12.7
million. On a year to date basis for eleven months, indigent
care has totaled $141.6 million, which is 6.6 percent of gross
revenue. The comparable budget for indigent care was $134.4
million and 6.3 percent of budgeted gross revenue. Unlike most
other hospitals, we receive cost based payments from a
combination of State and Federal sources to pay the Medical
Center and its Faculty. However, the trend in indigent care and
issues with the State budget are cause for concern as we look to
future years.
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Total paid employees, including contracted employees, were
23 below budget.
FY 2008
Employee FTEs
Salary, Wage and
Benefit Cost per
FTE
Contract Labor FTEs
Total FTEs
FY 2009
2009 Budget
6,088
6,136
6,166
$66,566
$68,466
$69,011
270
228
221
6,358
6,364
6,387
OTHER FINANCIAL ISSUES
For over a year we have been working with the Virginia
Commonwealth University Health System in a collaborative effort
to lower supply cost for both organizations. The supply chain
collaborative among our two Health Systems, the University
HealthSystem Consortium and Novation, recorded approximately $1
million in combined savings in 2008 and is projecting an
additional $2.3 million in savings in 2009. The collaborative
is currently exploring opportunities in orthopedics and
cardiology and has initiated dialogue between the physician
leaders in these areas.
The Medical Center partnered with the departments of
Orthopedics and Neurosurgery to achieve cost savings for various
implants by committing the majority of volume in each category
to a single supplier. Contracts were awarded for spinal and
trauma implants, which resulted in estimated annual savings of
$3.6 million, and a Request for Proposal has been issued for
hip, knee, and shoulder implants.
A contract was signed with a consultant for a physician
clinical documentation improvement program. Planning sessions
are underway with Dr. Jonathon Truwit and Dr. Susan Kirk, and
education classes are targeted to begin in September. Dr.
Robert Powers, Geriatrics and Palliative Care, will serve as the
program‟s physician champion. Our objective is to more
accurately identify the level of acuity of patients so that
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various publicly reported data, such as mortality, are more
accurately reported.
Discussions remain active with West Virginia‟s Department
of Health and Human Services regarding the losses that the
Medical Center is incurring in providing care to West Virginia
Medicaid enrollees. We reiterated the message that, absent a
substantial increase in reimbursement, the Medical Center may
have no alternative but to terminate participation in their
Medicaid program.
We are closely following the American Recovery and
Reinvestment Act to pursue financial opportunities for the
Health System. There is money in the package for the
Commonwealth of Virginia to assist with Medicaid funding.
However, the Virginia Department of Medical Assistance Services
has indicated no additional money will be provided to the
Medical Center. There is also funding for the adoption of
meaningful electronic health records, but complete details of
how the money will be disbursed have not been released.
Since 1996 Medicare has implemented several initiatives to
prevent improper payments to health care providers. The latest
such initiative is Recovery Audit Contractors. The overall goal
is to reduce payments due to billing errors. Recovery Audit
Contractors are private companies with whom Medicare has
contracted to perform audits. In Virginia the contract has been
awarded to Connolly Consulting Associates, a Connecticut-based
firm that participated in the initial pilot projects prior to
national implementation. The program has an effective date of
August 1, 2009, or later. Based on our patient volumes,
Connolly may review up to 286 claims every 45 days, a total of
over 2,300 claims per year. To prepare for the Recovery Audit
initiative a multidisciplinary team consisting of Audit,
Compliance, Medical Records, Revenue Cycle and Finance leaders
in the Medical Center has been building tools and workflows to
support this process.
WRITE-OFF OF BAD DEBTS AND INDIGENT CARE
Indigent care charges totaling $172.3 million for the
period July 1, 2008, through May 31, 2009, have been written
off. Recoveries during this period totaled $39.4 million.
Bad debt charges totaling $33.6 million have been written
off in the first eleven months of Fiscal Year 2009. During this
same period, $16.7 million was recovered through suits,
collection agencies, and Virginia refund set-off.
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OPERATIONS REPORT
Clinical Operations
The revised compensation plan for Registered Nurse wage
(non-benefited) staff went into effect on July 16, 2009.
Changes are designed to compensate wage staff for their
experience and provide a premium for serving in either a unitbased or a Medical Center wage (hourly) pool. Twelve Registered
Nurses left their wage positions to take full-time positions at
the Health System.
Unit refurbishments continue. Five acute care units have
been completed, and six more will be done by December. The
intensive care units and the remaining two acute care units will
be completed in 2010.
The Outpatient Pharmacy installed a new robot that
decreases medication dispensing errors through the use of bar
coded medications, increases the number of prescriptions that
can be filled per hour, and institutes work flow software that
increases patient safety.
All 28 inpatient units, the Pharmacy, and the Outpatient
Surgery Center have successfully implemented the ClairVia
staffing/scheduling software system for on-line staff scheduling
and resource management. The task of preparing and adjusting
staff schedules is being transitioned from professional staff to
to clerical staff. The amount of time spent on these tasks has
significantly decreased, and nurse time is being re-directed to
patient care. The next phase of implementation will include the
Demand Manager module, which combines staffing data with patient
throughput data (volume and length of stay) to support effective
decision-making for staffing resource management. Pam Cipriano,
Terri Haller, and Linda Dedo hosted seven leaders from the
Catholic Health Initiative on a site visit to view the software
and implementation of the project.
Culpeper Regional Hospital
A number of initiatives continue at Culpeper Regional
Hospital. The University of Virginia Multi-Specialty Clinic is
set to open in August. Thus far, Endocrinology, Infectious
Disease, Cardiology, and Gastroenterology have been identified
as services needed in the area. In the coming months, other
specialties will be identified to provide services.
6
Culpeper Regional Hospital‟s strategy is to recruit
physicians from the University of Virginia upon their completion
of residency and/or fellowship training to fulfill physician
needs in the community. Two Endocrinology Fellows, one
Infectious Disease Fellow and one Emergency Medicine Resident
will soon complete their graduate training and have been
identified to begin practicing at Culpeper Regional Hospital.
Culpeper Regional Hospital has begun to realize savings
from the partnership. The hospital has received better pricing
agreements and purchasing discounts. Culpeper has saved on
radiology equipment, new information systems, and purchasing of
laboratory and medical supplies. Culpeper Regional Hospital and
the Medical Center continue to identify ways to reduce costs and
generate additional revenue in a number of areas.
Patient
Access is supporting the migration of Culpeper Medical
Associates billing through the Health Services Foundation.
Contract comparisons for Culpeper Regional Hospital health
information systems were completed and the department is
currently working with shared vendors to provide better service
and rates.
Kathleen Rea, President of the Professional Nursing Staff
Organization, and other nurse leaders visited Culpeper Regional
Hospital to orient them to the Magnet Recognition Program. We
will work with Culpeper Regional Hospital nursing leadership to
map their strategy to achieve nursing excellence per the Magnet
Standards.
Liz Courain, Director of Volunteer Services, and Mary Ann
Himes, Administrator for Patient and Guest Services, are working
with Culpeper Regional Hospital to explore the possibilities
regarding the respective hospital‟s auxiliary functions, and
establishment of a patient representative program.
Community Relations, Outreach, and Service
Remote Area Medical Clinic
More than 1,200 patients were treated by 240 University of
Virginia Health System volunteers at this year's Remote Area
Medical (RAM) Clinic held July 24-26 in Wise. This year marked
the Health System's largest effort in ten years of participating
in the clinic. Several lab, pathology, and cytology employees
dedicated their time to analyze blood work and biopsies so
patients could receive their results in the timeliest manner.
The University of Virginia offered a wider range of services for
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patients this year, including neurology and physical,
occupational, and massage therapies. Some preliminary
statistics paint a picture of the expansiveness of this year's
effort:
135 patients received mammograms;
119 ultrasounds were performed (vaginal, neck, abdominal);
The Pharmacy team filled 1,523 prescriptions and gave out 681
vouchers;
77 patients were seen by the GI team for flex sigmoidoscopies
(twice as many as last year); and
400 patients received education on everything from diabetes to
stress management to smoking cessation.
As in past years, the University of Virginia provided lab
services for all patients and our volunteers manned an emergency
tent. Patients had the opportunity to be seen in "clinic" areas
outside of the main medical building - ENT/Audiology, Women's
Health, and Mammography. Several Emergency Department
volunteers staffed an "urgent care" area in the dental and
vision areas to treat patients with elevated blood pressures and
blood glucose levels. Seeing these patients in the dental and
vision areas allowed them to return to the waiting lines quickly
and dramatically decreased patient wait time in the medical
area.
Other Programs
Since March, 2009, the Community Relations Office has
reached 1,677 people through a variety of events and outreach
efforts:
Bike Safety and Helmet Distribution Program
Partnering with
County, this program
properly fitted bike
measured and given a
rural elementary schools in Albemarle
taught students about the importance of a
helmet. One hundred sixty students were
free helmet.
Virginia Discovery Museum – KidVention
Community Relations staff attended this event and
emphasized prevention of brain injury due to bike accidents and
bike helmet use. Three hundred children participated in the
event.
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National Volunteer Week
For the third year the office of Community Relations
sponsored events each day during National Volunteer Week.
During the week, 327 employee volunteers:
Assembled 150 First-Aid Kits for Camp Holiday Trails;
Donated over 1,200 pounds of food for the Charlottesville
Community;
Assembled 200 Smoker Comfort Kits for Health System
patients and visitors;
Donated over 100 pounds of school supplies for the After
School Programs; and
Created 100 flower arrangements for patients
Discovery Dash Training Program
Medical Center staff partnered with the Virginia Discovery
Museum and Ragged Mountain Running Shop to provide a two-day
training program for 125 Discovery Dash participants teaching
young runners the basics of running, gait mechanics, and form.
HEATline
The HEATline program was launched again this year to
promote prevention of heat stroke and heat illness. Staff
members participated in several local sporting events (sports
camps, field days, and sports tournaments, among other
offerings) to teach 420 young athletes and coaches the
importance of staying hydrated.
Hoos Healthy
This summer the Medical Center piloted the Hoos Healthy
Program with two groups from the Charlottesville/Albemarle Boys
and Girls Club. The program is an effort to prevent childhood
obesity and teach good habits to children early so they do not
have to change bad behavior as adults. Fifty children
participated in this four-part program focusing on MyPyramid,
healthy snacking, exercise, and combining them all for a healthy
lifestyle.
Orange County Health Fair
The Medical Center promoted our HEATline program and
partnered with Orange Pediatrics to provide free sports
physicals to 20 local children.
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Charlottesville/Albemarle Boys and Girls’ Club Health Fair
This is the fifth year that we have participated in this
event. Community Relations staff members provided heat injury
prevention information to the 100 Boys & Girls Club participants
who attended the event. We also screened 40 children‟s blood
pressure and Body Mass Index. Additionally, 35 children
received a free sports physical from University of Virginia
Pediatric Residents.
Human Resources
The work force management process has been implemented
throughout the Medical Center. To date, 83.2 worked FTEs have
been identified as positions that will not be filled due to
attrition. 24.6 worked FTEs have been identified as positions
that will not be budgeted going forward. Employees in these
positions have been assigned a recruiter from Human Resources to
help identify a new role for them within the University of
Virginia. As the year progresses and positions become vacant,
each position will be evaluated to determine if it should be
filled. Additionally, based on our monthly performance to
budgeted FTEs, more positions will likely be added to the work
force management numbers.
Human Resources is working with an external resource to
develop a work force management tool that combines Human
Resource position and vacancy information with Finance‟s worked
hours and FTE data. The goal is to provide a tool to help
managers better control their actual positions and worked FTEs
against their budgets by job title. Human Resources is working
closely with Finance, with input from Clinical Care Services and
across the Medical Center, to ensure the report meets managers‟
needs.
Employee self service is now accessible from non-Medical
Center computers, enabling employees to access payroll
information from home. The Federal W-4 Tax Information screen
was enhanced to allow on-line updates of withholding
information. An on-line paid time off cash-out process is in
development and on schedule for roll out in October.
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Marketing
2009 Strategic Marketing Awards – McMurray (Awarded June 2009)
Award
Category
Title
Second Place
Winner
Best Overall Publication
Best Feature Story –
Long Version
Best Feature Story –
Short Version
Most Effective
Customization of a
Masterbook Article
Best Published
Department in a Magazine
Best Publication
Integration into Website
Best Publication
Integration into Website
Vim & Vigor, Winter 2008
“A Burning Issue,” Vim &
Vigor, Winter 2008
“A Second Wind,” Vim &
Vigor, Spring 2008
“Make a Difference,” Vim &
Vigor, Winter 2008
Honorable
Mention
Winner
Winner
Winner
Honorable
Mention
“Healthy Dose,” Vim & Vigor,
2008
“Club Red,” Vim & Vigor,
Spring 2008
“Club Red,” Vim & Vigor,
Fall 2008
Patient Satisfaction
The Health System conducts patient satisfaction surveys and
reports results each month and quarter. We have seven distinct
surveys covering inpatient, outpatient, psychiatry, ancillaries,
home health, dialysis, and the emergency department. Results
are benchmarked with a regional peer group that includes both
academic medical centers and community hospitals.
We perform well in our outpatient clinic and home health
surveys and have challenges and opportunities in our Emergency
Department and inpatient units. A number of initiatives have
been implemented in the past six months to improve our patients‟
care experiences and improvement is beginning to be reflected in
the survey scores.
Finance
The Supply Chain Optimization and Process Excellence
(SCOPE) teams verified $8 million in Fiscal Year 2009 savings
and $11.5 million in savings on an annualized basis. The SCOPE
model has been adopted as the ongoing process for identifying
standardization and cost reduction opportunities, and the teams
are establishing savings targets for Fiscal Year 2010.
The Medical Storeroom has relocated from University
Hospital to a warehouse located on the Long Term Acute Care
Hospital property. The relocation will enhance space
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utilization and operational efficiency and free up space needed
for relocations that are part of the Hospital Bed Expansion.
The University and the Medical
William & Mary and Virginia Tech to
in conjunction with Restructuring.
streamline the travel process while
approvals and controls.
Center collaborated with
revise their travel policies
The revised policies
maintaining the requisite
Technology Services
Telemedicine
The department experienced a 40% increase in volume in
Fiscal Year 2009. The University of Virginia Continuing Medical
Education program received a six year reaccredidation, including
a commendation from the Accreditation Council for Continuing
Medical Education for our distance learning and rural outreach
and additional recognition by the American Association of
Medical Colleges for our innovative Continuing Medical Education
outreach efforts. Collaboration with the Mandated Benefits
Commission has begun to establish mandatory 3rd party private
payment for telemedicine in the Commonwealth. A high risk
obstetric program was initiated at the Harrisonburg Federally
Qualified Health Center, and their first high risk delivery was
completed at term. The department also provided support for the
second mobile digital mammography event in southwestern
Virginia.
Health Information Services
A plan was developed to assume responsibility of medical
record documentation contained in working files as well as
retention guidelines. The outpatient reconciliation dashboard
was completed.
Clinical Engineering
Clinical Engineering exceeded its goals for monthly
preventive maintenance completion for the fourth quarter of
Fiscal Year 2009. The average repair turnaround time was 2.3
days, 76% of repairs were completed same day, and 89% were
completed within 5 days. The GE global service agreement was
completed, which resulted in Fiscal Year 2009 SCOPE savings of
$26,581. The processing of new medical devices has been
assigned to Clinical Engineering; this was formerly handled by
Supply Chain Management.
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Radiology
In May the Medical Center installed a mammography reporting
system to facilitate and expedite the result reporting of over
20,000 mammography exams performed each year. On July 1st, the
Breast Care Center imaged its first patient with a new imaging
device, Breast Specific Gamma Imaging. This imaging technique
utilizes a radiotracer along with a dedicated breast detector
and further enhances our ability to provide diagnostic breast
imaging for cancer detection for patients for whom other imaging
techniques (mammography and MRI) may not be as effective or may
be contraindicated. The Women's 4 Miler has provided a grant to
ensure patient access to this evolving new technology.
Environment of Care/Facilities
Major Project Updates
Emily Couric Clinical Cancer Center - Occupancy is scheduled
for the first quarter of 2011.
Hospital Bed Expansion - Occupancy is scheduled for the last
quarter of 2011.
Long Term Acute Care Hospital Construction - Scheduled to be
completed in the summer of 2010.
Weekly meetings of the Long Term Acute Care Hospital
Construction Systems Integration Workgroups have begun to
address operational planning.
Other Construction Projects
Based on feedback from staff at Northridge, a walking path
was developed at the site to accommodate ambulatory traffic to
the parking lots.
Modifications to the walkway from the lower
parking lot in front of the Sieg Warehouse to the Northridge
Clinic Building will improve staff safety.
Utility work for the West Main Street Streetscape
Improvement Project began on May 19th, and traffic was reduced
to one lane in each direction. Construction barriers, signs,
and flagmen will remain in place to alert motorists at all times
while work is underway.
In early August, two projects will be completed at
University Hospital, Level Zero: Pharmacy consolidation and
Phase One of Clinical Engineering.
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Smoke Free Campaign
In a continuing effort to prepare for the October 1, 2009
deadline for the Medical Center to be smoke-free, Medical Center
representatives met with the leadership of Student Health to
discuss inclusion of Student Health grounds in the Clean Air
Zone.
Information on the Medical Center's smoke-free campaign was
presented to visitors from the University of South Carolina who
were guests of President Casteen. Information about the
hospital's health and wellness initiatives related to nutrition,
such as the Signals program, Weight Watchers, and clinical
nutrition for patients, was presented as well.
University of Virginia representatives met with the Health
Educator at Augusta Health to share information and plans
regarding each facility‟s plan to become smoke-free. Augusta
Health intends to be smoke free by August, 2009. The meeting
focused on sharing information and facilitating communication to
patients and visitors who visit both hospitals.
Disposal of Material Containing Protected Health Information
Site visits to audit the process for managing hospital
waste, specifically materials containing protected health
information (PHI), demonstrated good compliance.
Recommendations for assuring that policies and practices are in
compliance with regulations and hospital policy were made to
Senior Leadership in June. Risk factors were identified based
on a comprehensive review of current practice that included the
site visits as well as interviews with employees who generate or
process PHI. Recommendations for changes in specific areas are
being addressed.
Waste Management
A Recycling Fair was held on June 22nd, to introduce the
expanded recycling program that resulted from the Magnet
Champion Recycling Project conducted in 2008. University of
Virginia Recycling personnel were on hand to display the various
types of containers that will be provided to inpatient units and
other areas. In early July, University of Virginia Recycling
and Environmental Services personnel conducted an assessment of
inpatient areas to determine space and container requirements
for the expanded recycling program that began in late July.
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Nutrition Services
Nutrition Services is continuing to promote the health of
employees and the community by promoting fresh, locally grown
foods. For the second year a Farmer‟s Market is being held in
the Cafeterias two days a week throughout the summer.
Nutrition Services has partnered with Charlottesville‟s
Quality Community Council (QCC) to support their work with farm
and urban garden plots. Community members may work for tokens
that can be redeemed for fresh healthy produce on harvest days
(Fridays, May-September). The gardens are located on 6th Street,
where there is easy access for many low income community
residents.
Nutrition Services is also helping QCC educate
community members on healthy foods and cooking at five Saturday
presentations by registered dietitians and chefs throughout the
spring and summer.
In early June, First Impressions installed new recliners on
the 7th floor Children‟s Hospital for use by overnight guests.
The chairs were selected based on staff recommendations
following a three-month evaluation period during which various
chairs were assessed based on comfort, infection control and
safety. Reconditioned recliners from the 7th floor were
allocated to selected floors for the Care Partners program.
Artists Reception
The University of Virginia Health System Arts Committee
hosted a reception on July 10th, in honor of artist Matalie
Griffin Rivard Deane, whose artwork will be on display in the
University Hospital Lobby through September 4, 2009.
Volunteers and Auxiliary
In June the Medical Center Auxiliary Hospitality House
celebrated its one year anniversary in the new location on 14th
Street. A volunteer group, along with Patient and Guest
Services staff, is working on designing and constructing the
memorial garden in the front of the house.
A volunteer Cuddler Program for stable Neonatal Intensive
Care Unit (NICU) babies began in July 2009. The program was
suggested by the NICU manager and nurses who learned about other
successful programs that have provided meaningful support to
families and staff.
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Recognition
John Nichols, Director of Nutrition Services, was honored
for Professional Excellence at a Compass, North America event in
Washington, D.C., on June 2nd. Achievements such as consistent
growth, low turnover, and client satisfaction were cited.
Marcia L. Buck, Pharm.D., FCCP Clinical Pharmacy
Specialist, Children's Hospital Clinical Associate Professor,
Pediatrics was selected as a member of the first group of the
Pediatric Pharmacy Advocacy Group fellows in the Pediatric
Pharmacy Advocacy Group Recognition Program. Fellows in the
program serve to recognize excellence in pediatric pharmacy
practice and to grant recognition and promote public awareness
of pharmacists who have distinguished themselves in pediatric
pharmacy practice.
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University of Virginia Medical Center
Income Statement
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
Net patient revenue
May-07
May-08
May-09
Budget/Target
May-09
$813.5
$856.0
$881.6
$913.1
20.4
22.3
24.4
25.1
$833.9
$878.3
$906.0
$938.2
743.7
789.9
815.2
835.9
43.8
46.6
48.4
52.1
5.5
7.4
7.0
9.8
Total operating expenses
$793.0
$843.9
$870.6
$897.8
Operating income (loss)
$40.9
$34.4
$35.3
$40.4
Other revenue
Total operating revenue
Operating expenses
Depreciation
Interest expense
Non-operating income (loss)
$47.1
$28.3
($74.8)
Net income (loss)
$88.0
$62.7
($39.5)
$59.2
Principal payment
$8.3
$9.8
$11.3
$7.3
17
$18.8
University of Virginia Medical Center
Balance Sheet
(Dollars in Millions)
Most Recent Three Fiscal Years
Description
May-07
May-08
May-09
Assets
Operating cash and investments
$218.9
$63.8
$20.7
Patient accounts receivables
57.5
49.6
56.9
Property, plant and equipment
378.5
423.4
470.3
Depreciation reserve and other investments
276.4
430.2
339.8
Endowment Funds
143.8
243.3
243.9
Other assets
110.2
126.3
145.1
$1,185.3
$1,336.6
$1,276.7
Current portion long-term debt
$16.7
$17.3
$18.2
Accounts payable & other liab
111.0
94.1
80.0
Long-term debt
153.6
222.3
213.3
83.5
103.3
122.4
$364.8
$437.0
$433.9
$820.5
$899.6
$842.8
$1,185.3
$1,336.6
$1,276.7
Total Assets
Liabilities
Accrued leave and other LT liab
Total Liabilities
Fund Balance
Total Liabilities & Fund Balance
18
University of Virginia Medical Center
Financial Ratios
Most Recent Three Fiscal Years
Description
May-07
Operating margin (%)
May-08
May-09
Budget/Target
May-09
4.9%
3.9%
3.9%
4.3%
Total margin (%)
10.0%
6.9%
-4.8%
6.2%
Current ratio (x)
2.2
1.0
0.8
2.0
214.0
206.3
166.2
190.0
Gross accounts receivable (days)
48.8
47.6
49.0
60.0
Annual debt service coverage (x)
9.9
6.8
0.9
7.1
18.5%
25.3%
26.3%
20.0%
6.2%
6.4%
6.4%
6.9%
Days cash on hand (days)
Debt-to-capitalization (%)
Capital expense (%)
19
University of Virginia Medical Center
Operating Statistics
Most Recent Three Fiscal Years
Description
Acute Admissions
Patient days
SS/PP Patients
May-07
ER visits
May-09
27,518
26,195
28,150
158,919
162,242
160,349
163,318
6,375
7,005
7,171
5,701
5.73
5.91
6.13
5.80
578,298
590,572
593,231
614,652
54,229
56,387
55,729
56,710
Medicare case mix index
Occupancy %
FTE's (including contract labor)
May-09
27,612
Average length of stay
Clinic visits
May-08
Budget/Target
1.94
76.1%
6,183
20
1.97
76.0%
6,358
1.97
72.1%
6,364
1.94
72.6%
6,387
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - May FY2009
OPERATING STATISTICAL MEASURES - May FY 2009
ADMISSIONS and CASE MIX - Year to Date
OTHER INSTITUTIONAL MEASURES - Year to Date
Actual
ADMISSIONS:
Adult
Pediatrics
Psychiatric
Subtotal Acute
Short Stay/Post Procedure
Total Admissions
CASE MIX INDEX:
All Acute Inpatients
Medicare Inpatients
Budget
% Variance
22,246
2,594
1,355
23,838
3,096
1,216
(6.7%)
(16.2%)
11.4%
23,158
2,950
1,410
26,195
28,150
(6.9%)
27,518
7,171
5,701
25.8%
7,005
33,366
33,851
(1.4%)
34,523
1.81
1.97
1.83
1.94
(1.1%)
1.5%
2
21
REVENUES and EXPENSES - Year to Date
($s in thousands)
NET REVENUES:
Net Patient Service Revenue
Other Operating Revenue
Total
EXPENSES:
Salaries, Wages & Contract Labor
Supplies
Contracts & Purchased Services
Bad Debts
Depreciation
Interest Expense
Total
Operating Income
Operating Margin %
Non-Operating Revenue
Net Income
Actual
Budget
881,594
24,378
905,972
913,070
25,083
$ 938,153
$
403,746
201,304
182,353
27,771
48,362
7,080
870,616
35,356
3.9%
(74,862)
$ 406,989
201,338
192,502
35,069
52,057
9,802
$ 897,757
$ 40,396
4.3%
$ 18,764
$
(39,506) $
$
$
$
Prior Year
59,160
1.81
1.97
Actual
Budget
% Variance
Prior Year
ACUTE INPATIENTS:
Inpatient Days
Average Length of Stay
Average Daily Census
Births
160,349
6.13
479
1,618
163,318
5.80
488
1,691
(1.8%)
(5.7%)
(1.8%)
(4.3%)
162,242
5.91
483
1,669
OUTPATIENTS:
Clinic Visits
Average Daily Visits
Emergency Room Visits
593,231
2,828
55,729
614,652
2,925
56,710
(3.5%)
(3.3%)
(1.7%)
590,572
2,783
56,387
17,245
7,290
24,535
17,550
7,003
24,553
(1.7%)
4.1%
(0.1%)
17,098
6,871
23,969
SURGICAL CASES
Main Operating Room (IP and OP)
UVA Outpatient Surgery Center
Total
OPERATING FINANCIAL MEASURES - May FY 2009
OTHER INSTITUTIONAL MEASURES - Year to Date
% Variance
Prior Year
(3.4%)
856,009
(2.8%)
22,284
(3.4%) $ 878,293
0.8%
0.0%
5.3%
20.8%
7.1%
27.8%
3.0% $
(12.5%) $
393,663
197,645
168,514
30,102
46,587
7,347
843,858
34,435
3.9%
(499.0%) $ 28,274
(166.8%) $
62,709
($s in thousands)
NET REVENUE BY PAYOR:
Medicare
Medicaid
Commercial Insurance
Anthem
Southern Health
Other
Total Paying Patient Revenue
OTHER:
Collection % of Gross Billings
Days of Revenue in Receivables (Gross)
Cost per CMI Adjusted Discharge
Total F.T.E.'s (including Contract Labor)
F.T.E.'s Per CMI Adjusted Discharge
Actual
Budget
$ 289,379
117,996
154,904
159,007
46,946
113,363
$ 881,594
$ 298,976
126,676
158,029
166,644
47,490
115,254
$ 913,070
$
41.11%
49.0
10,048 $
6,364
25.41
42.67%
60.0
9,690
6,387
24.04
% Variance
Prior Year
(3.2%)
(6.9%)
(2.0%)
(4.6%)
(1.1%)
(1.6%)
(3.4%)
(3.7%)
18.3%
(3.7%) $
0.4%
(5.7%)
288,306
119,111
144,506
154,116
43,301
106,668
856,009
44.47%
47.6
9,502
6,358
24.95
University of Virginia Medical Center
SUMMARY OF OPERATING STATISTICS AND FINANCIAL PERFORMANCE MEASURES
Fiscal Year to Date with Comparative Figures for Prior Year to Date - May 31, 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
2
22
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
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 10, 2009
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.C.
ACTION REQUIRED:
None
Capital Projects
BACKGROUND: The Medical Center is constantly improving and
renovating its facilities. A status report of these capital
projects will be provided at each Medical Center Operating Board
meeting.
DISCUSSION: The current Medical Center capital projects report
is set forth in the following table:
23
The University of Virginia Medical Center
Capital Projects Report
September 2009
Scope
Funding
Source
Budget
BOV
Approval
Date
Projected
Completion
Date
1. Pre-Construction
West Main Street Development including Children’s Hospital:
$117 M
Bonds and
Outside
Fundraising
TBD
2013
$14.3 M
Bonds
Feb 2008
2010
Bonds
Feb 2008
2011
Design started on December 12,
2008.
*University Hospital:
Add two Operating Rooms and
Magnetic Resonance Imaging
Room (with equipment) – design
nearing completion.
(2,330 GSF)
*Project modifies original HEP project
University Hospital:
$7.6 M
Add elevators – design complete.
Bonds
*University
Hospital:
2. Under Construction
$6.5M
Renovate and relocate
University
Surgical Hospital:
Pathology
Laboratory
– design
Renovate
Radiology
Department –
underway.
phased
construction under way
(8,800
$21.2 M
GSF)
(52,000 GSF)
Emily Couric Clinical Cancer
Center :
Construction under way.
Installation of curtain wall system
commenced in July 2009.
University Hospital Bed
Expansion:
$74 M
(including
added shelled
floor)
Feb 2008
2010
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.
Structural steel was topped out in
August 2009.
24
Sept 2005
June 2007
2011
The University of Virginia Medical Center
Capital Projects Report
September 2009
Scope
Budget
Funding
Source
BOV
Approval
Date
Projected
Completion
Date
$6.6 M
Bonds
Feb 2008
2010
$8 M
Bonds
Jan 2003
2009
2. Under Construction
Primary Care Center:
Repair brick façade and replace
roof – work commenced in August
2008.
Clinical Office Building:
Board of Visitors approved project
to complete the 3rd floor fit out for
the Spine Center and Orthopaedic
Services. Construction is under
way.
*University Hospital:
Feb 2008
$15.6 M
Renovate Heart Center invasive
procedure areas – design complete
for several phases. Construction
under way for the first phase.
(21,600 GSF)
Moser Radiation Therapy Center:
$2.5 M
Construct addition for 2nd linear
accelerator – bids received on July
9, 2009. Construction contract is
awarded and construction is under
way.
(3,000 GSF)
25
Bonds
Feb 2008
2010
Bonds
Feb 2008
2010
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 10, 2009
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II.D.
ACTION REQUIRED:
None
Health System Development
BACKGROUND: Health System Development will provide reports of
recent activity to the Medical Center Operating Board from time
to time.
DISCUSSION:
SIGNIFICANT GIFTS (May 1 - June 30, 2009)
The School of Medicine received a bequest of a $1.9 million
charitable remainder unitrust for unrestricted support.
Food Lion pledged $1 million towards the Barry and Bill
Battle Building.
Klöckner Pentaplast Corporation pledged $750,000 towards
the Barry and Bill Battle Building, to be paid in installments
over six years.
A School of Medicine alumnus documented a $500,000 bequest
in support of a fellowship in radiology.
At its May 29th board meeting, the Ivy Foundation approved
$200,000 in funding for a second year of biomedical innovation
grants.
Other gifts and pledges received include:
A $50,000 gift to the School of Nursing in support of the
Dean‟s Discretionary Fund;
A $46,000 gift to the School of Nursing in support of
student summer tuition;
A $30,000 charitable gift annuity in support of the
Mulholland Society in the School of Medicine;
A $25,000 gift for the Barry and Bill Battle Building; and
A $24,000 gift for patient safety research in the
Department of Pediatrics neonatology division.
26
OTHER DEVELOPMENT INITIATIVES
On May 6, Children‟s Hospital volunteers hosted a coffee
with Dr. Meg Keeley, who led attendees in a discussion on
vaccinations, discussed the landscape of pediatric health care
at University of Virginia, and introduced the Barry and Bill
Battle Building.
On May 8, a School of Nursing Advisory Board member hosted
a reception for the school at the NASDAQ Stock Market in Times
Square. The reception followed the nationally-televised closing
bell ceremony that recognized National Nurses Week and featured
Dean Fontaine ringing the bell.
On May 9, a grateful parent of a Children‟s Hospital
patient spoke at the “Evening Under the Stars” event, held at
Ivy Creek to benefit pediatric oncology clinical trials.
The 3rd annual Patti Colletti Memorial Golf Tournament was
held on May 18th, in Spotsylvania, raising nearly $13,000 in
support of ovarian cancer research at the University of Virginia
Cancer Center.
On May 21, a dinner was held to honor the donors of a
recent $5 million pledge to the diabetes and islet transplant
research program. Attendees included Dean DeKosky and Mr.
Howell. During the dinner, the donors presented the first $1
million installment on their pledge.
The 25th Annual University of Virginia Children‟s Hospital
Telethon was held on May 30–June 1, and was kicked off by the
annual Walk for Kids. The telethon, with on-air appearances by
Mr. Howell and other Health System leadership and faculty,
capped annual giving efforts for Fiscal Year 2009, raising
$1,801,862. Major gifts included a $120,000 contribution from
Klöckner Pentaplast, $85,000 from Food Lion, and $57,000 from
Wal-Mart.
On June 3, representatives from the Accelerate Brain Cancer
Cure Foundation participated in a site visit to review neurooncology opportunities at University of Virginia and to discuss
opportunities for joint projects involving biomedical
engineering, pathology, and neuro-oncology.
On June 6, several Health System educational sessions were
featured during University of Virginia‟s Reunions Weekend. Dean
27
DeKosky presented on Alzheimer‟s disease, Dean Fontaine
presented on healthy work environments, and Dr. Dennis Templeton
and Dr. Lynn Dengel spoke about their cancer research.
On June 14, the Patients & Friends Steering Committee
hosted Melanoma Mayhem, an event to raise awareness about skin
cancer and support for melanoma research at the University of
Virginia. More than 200 people attended the event, which raised
more than $8,000 in support of the Scott Allard Memorial Fund
for Melanoma Research.
On June 18, the
University Resources
Club in Lynchburg to
alumni, friends, and
University‟s National Committee on
hosted a reception at the Boonsboro Country
introduce Dean DeKosky and Dean Fontaine to
donors in the region.
On June 26th, the Department of Orthopaedics held a
benefactors‟ dinner honoring the Reverend Alfred Shands III and
other donors.
The Health System Development Communications team created
and sent the first PULSE e-newsletter to approximately 18,000
donors, volunteers, and friends of the University of Virginia
Health System. The inaugural issue included several donor
profiles and updates on Campaign progress. The issue may be
viewed online at: www.news.clas.virginia.edu/pulse/. The team
also produced a one-page informational insert on epilepsy for
use with potential donors, and created various print and
electronic communications to promote and support the University
of Virginia Children‟s Hospital Telethon.
Between May 1, 2009, and June 30, 2009, development staff
made 236 face-to-face visits with donors and prospects, bringing
the fiscal year 2009 total to 1,891.
CAMPAIGN PROGRESS THROUGH JUNE 2009
Through the end of June 2009, the Health System Campaign
total is $460,952,188. This represents 92% of the Campaign goal
achieved, with 69% of the Campaign period elapsed. The
following table shows the Fiscal Year 2009 totals as of June
30th, for new commitments, including new gifts and pledges, as
compared to this same time frame in Fiscal Year 2008.
28
Total new commitments
(excludes pledge payments on
previously booked pledges)
New gifts
New pledges
29
FY „09
$48,039,028
FY „08
$51,525,038
$40,520,927
$7,518,101
$39,638,741
$11,886,297
UNIVERSITY OF VIRGINIA
BOARD OF VISITORS AGENDA ITEM SUMMARY
BOARD MEETING:
September 10, 2009
COMMITTEE:
Medical Center Operating Board
AGENDA ITEM:
II. 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.
30