Board of Directors Formal Meeting. January 25, :00 p.m. Agenda

Transcription

1 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, :00 p.m. Agenda

2 Board Members William Bruno, Chair, District 1 Susan Gerard, Vice Chair, District 3 Greg Patterson, District 2 Elbert Bicknell, District 4 Alice Lara, District 5 AGENDA Formal Meeting Board of Directors of the Maricopa County Special Health Care District Maricopa Medical Center Administration Building Navajo East and West Rooms 2601 E. Roosevelt Phoenix, AZ Clerk s Office Fax Monday, January 25, :00 p.m. If you wish to address the Board, please complete a speaker s slip and deliver it to the Clerk of the Board. If you have anything you wish distributed to the Board and included in the official record, please hand it to the Clerk who will distribute the information to the Board Members and Maricopa Integrated Health System Senior Staff. Speakers are limited to (3) three minutes. (NOTE: One or more of the members of the Board of Directors of the Maricopa County Special Health Care District will attend either in person or by telephone conference call.) Pursuant to A.R.S (A)(3), or any applicable and relevant state or federal law, the Board may vote to recess into an Executive Session for the purpose of obtaining legal advice from the Board s attorney or attorneys on any matter listed on the agenda. Pursuant to A.R.S (A)(4), or any applicable and relevant state or federal law, the Board may vote to recess into an Executive Session for the purpose of consulting with its attorneys to consider its position and instruct its attorneys regarding the Board s position regarding any contracts that are subject to negotiations, in pending or contemplated litigation, or in settlement discussions conducted in order to avoid or resolve litigation, and that are listed on the General Session agenda for discussion or action or both. The Board also may wish to discuss any items listed for Executive Session discussion in General Session, or the Board may wish to take action in General Session on any items listed for discussion in Executive Session. To do so, the Board will recess Executive Session on any particular item and reconvene General Session to discuss that item or to take action on such item. THE TIMES LISTED FOR AGENDA ITEMS ARE ESTIMATED. ITEMS MAY BE DISCUSSED EARLIER OR IN A DIFFERENT SEQUENCE. Call to Order Roll Call Pledge of Allegiance Agendas are available within 24 hours of each meeting in the Clerk of the Board s Office, Maricopa Medical Center, Administration Bldg, 2 nd Floor 2601 E. Roosevelt, Phoenix, AZ 85008, Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. Accommodations for individuals with disabilities, alternative format materials, sign language interpretation, and assistive listening devices are available upon 72 hours advance notice through the Clerk of the Board s Office, Maricopa Medical Center, Administration Bldg, 2 nd Floor 2601 E. Roosevelt, Phoenix, Arizona 85008, (602) To the extent possible, additional reasonable accommodations will be made available within the time constraints of the request. 1/23/2010 1:54 PM

3 Call to the Public This is the time for the public to comment. The Board of Directors may not discuss items that are not specifically identified on the agenda. Therefore, pursuant to A.R.S (H), action taken as a result of public comment will be limited to directing staff to study the matter, responding to any criticism or scheduling a matter for further consideration and decision at a later date. General Session Presentation, Discussion and Action: 1. Approval of Consent Agenda 15 min (total consent) Note: Approval of contracts, minutes, IGA s, proclamations, etc. Any matter on the Consent Agenda will be removed from the Consent Agenda and discussed as a regular agenda item upon the request of any Board member. a. Minutes: Review and Approve Special Health Care District Board of Directors Meeting Minutes dated: i. October 28, 2009 Formal Meeting ii. November 16, 2009 Special Meeting iii. November 23, 2009 Formal Meeting iv. December 7, 2009 Special Meeting b. Contracts: i. Approve amendment #2 to the contract (C ) between Healthcare Reports.com, LLC (Contractor) and Maricopa County Special Health Care District for Document Scanning and Indexing Services. This amendment will extend the contract term for one additional year, January 5, 2010 to January 4, The anticipated annual expense is $513,000. ii. Approve a New Contract (C ) between Integrated Health Management Services, LLC and Maricopa County Special Health Care District for Medical Eligibility and Verification Services. The initial contract term is from December 1, 2009 to November 30, 2011 and may be extended. The anticipated annual expense is $1,590,000. c. Board Governance: i. Approve Affidavits Appointing Dennis Weimer, M.D., and Diane Park, M.D., as Deputy Medical Directors in Department of Psychiatry ii. iii. iv. Approve registration fee, not to exceed rates allowable under applicable District practices or policies, for Chairman Bruno and Director Lara to attend Arizona Managed Care Newsletter s 2010 Winter State of the State Meeting in Phoenix, Arizona, February Approve attendance for Chairman Bruno to attend Safety Management Services Managing Accreditation in the Physical Environment Seminar, in Phoenix, Arizona, February 3, NOTE: Registration fee for this conference was waived. Approve travel, lodging, and meal expense, not to exceed rates allowable under applicable District practices or policies, for Chairman Bruno and Director Lara to attend The Governance Institute s Leadership Conference, in San Diego, California, March 7-10, NOTE: Registration fee for this conference was waived. v. Approve Resolution and Declaration of Official Intent Between Maricopa County Special Health Care District and Chase Equipment Finance, Inc. 2

4 General Session Presentation, Discussion and Action (cont.): 1. Approval of Consent Agenda (cont.) d. Medical Staff: i. Revisions of Privileging Criteria for Oral-Maxillofacial Privileges ii. Ongoing Professional Practice Profiles for Pathology and Surgery End of Consent Agenda 2. Approval of Maricopa Integrated Health System Medical Staff Appointments, Reappointments, FPPE, Change of Privileges/Status, and Resignations for December 2009 and January min David Wisinger, M.D., MIHS, Vice Chief of Staff 3. Approval of Maricopa Integrated Health System Allied Health Professional Staff Appointments, Reappointments, and FPPE, for December 2009 and January min David Wisinger, M.D., MIHS, Vice Chief of Staff 4. Discuss, Review and Approve the District s Position Regarding Current or Proposed State and Federal Legislative Items 15 min John MacDonald, Lobbyist, Husk Partners 5. Discussion, Consideration and Possible Action on the Employment Assignment for Melanie Talbot, Clerk of the Board 5 min William Bruno, Chair Adjourn 3

5 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.a.i.

6 Minutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 October 28, :00 p.m. Present: William Bruno, Chair, District 1 Susan Gerard, Vice Chair, District 3 Greg Patterson, Director, District 2 Elbert Bicknell, Director, District 4 Absent/Excused: Alice Lara, Director, District 5 Others Present: Guest Presenters: Betsey Bayless, MIHS, Chief Executive Officer Bill Vanaskie, MIHS, Chief Operating Officer Ken Meinke, MIHS, Chief Financial Officer Robert E. Fromm, Jr., M.D., M.P.H., MIHS, Chief Medical Officer Warren Whitney, MIHS, Chief External Affairs Officer Sherry Stotler, MIHS, Chief Nursing Officer Stephan Stapczynski, M.D., F.A.C.E.P., MIHS, Chief of Staff Louis B. Gorman, District Counsel Kote Chundu, M.D., MedPro, Chairman, MedPro Board of Directors Dan Hobohm, M.D., MIHS, Vice President of Quality & Outcomes Management Helena Whitney MIHS, Director of Government Relations and Legislative Affairs Recorded by: Melanie Talbot, Clerk of the Board Call to Order Chairman Bruno called the meeting to order at 1:06 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that four of the five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represents a quorum. Pledge of Allegiance The Pledge of Allegiance to the flag was lead by Louis Gorman, District Counsel for Maricopa Integrated Health System (MIHS).

7 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 Call to the Public Chairman Bruno called for public comment. There were no comments. General Session Presentation, Discussion and Action: 1. Opening Comments and Remarks from Chief Executive Officer Ms. Bayless reported that since launching ARK, an electronic medical records system, one month ago, the system is running smoothly. ARK was launched in the Operating Rooms and the Pediatric and Adult Emergency Departments, as well as the Chandler Family Health Center (FHC), and the Pediatric Clinic at the Comprehensive Health Center (CHC). The other FHCs are scheduled for ARK in December 2009 or January Ms. Bayless updated the Board on the federal lawsuit brought against MIHS by Mr. Robert Daniels, a former TB patient quarantined at Maricopa Medical Center (MMC). Ms. Bayless announced that a federal judge dismissed MIHS from the lawsuit. Ms. Bayless said that MIHS was offering the Intranasal Flumist H1N1 vaccine to all employees who met the criteria. MIHS was also offering the H1N1 injectable vaccine to employees. The vaccine was also offered through the CHC and the FHCs to pregnant women, children, and other high-risk patients. Ms. Bayless explained that each Board member was assigned an account in the MIHS computer learning system (CLC) for educational opportunities including corporate compliance and HIPAA training. Board members will be able to access the courses from home or at MIHS. Scott Trenter, Vice President of Business Development, has been working with MedPro and MIHS to expand the referral base. He is also working on numerous marketing projects to further business development. 2. Reports to the Board of Directors: a. Capital Expenditures for 1 st Quarter FY 2010 b. Contract Approvals and Asset Disposal for 1 st Quarter FY 2010 c. Quality Report Whole Systems Measures Dashboard Chairman Bruno acknowledged that the Board received the reports prior to the meeting. Since there were no questions or comments from the Board, the item was not discussed. 3. Approval of Consent Agenda a. Minutes: Review and Approve Special Health Care District Board of Directors Meeting Minutes dated: i. September 21, 2009 Special Meeting ii. September 23, 2009 Formal Meeting iii. September 28, 2009 Special Meeting iv. September 29, 2009 Special Meeting v. September 30, 2009 Special Meeting 2

8 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 3. Approval of Consent Agenda (cont.) b. Contracts: i. Approve amendment #1 to the Amended and Restated Lease Agreement (C ) between Maricopa County Special Health Care District and VHS of South Phoenix ii. iii. Approve a New Contract (C ) between Johnson Controls, Inc. and Maricopa County Special Health Care District for construction of the MIHS Main Campus Fire Alarm System Replacement. The anticipated annual budget impact is $900,000 for FY Expected date of completion is June 30, Approve a New Contract (C ) between Layton Interior Specialists of Arizona, Inc. and Maricopa County Special Health Care District for construction of the Angiography Renovation. The anticipated annual budget impact is $1,400,000 for FY Expected date of completion is June 30, c. Board Governance: i. Approve registration fee, travel, lodging, and meal expense, not to exceed rates allowable under applicable District practices or policies, for Chairman Bruno to attend The World Health Care Congress Leadership Summit on Project and Portfolio Management, in Boston, Massachusetts, December 3-4, ii. Approve Board Policy Statement: Medical Identity Theft d. Medical Staff: i. Approve Revision to the Department of Internal Medicine s Privileging Criteria ii. Approve Revision to the Department of Radiology s Privileging Criteria Chairman Bruno said that item 3.a.ii. would be pulled from the consent agenda and it would not be voted on by the Board today. Chairman Bruno requested that items 3.b.ii. and 3.b.iii. be removed from the consent agenda for further discussion. MOTION: VOTE: Vice Chairman Gerard moved to approve the consent agenda minus items 3.a.ii, 3.b.ii., and 3.b.iii. Director Bicknell seconded. 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. Chairman Bruno questioned why it was necessary to replace the main campus fire alarm system (consent agenda item 3.b.ii.) Clint Lord, MIHS Director of Facilities, explained that the current fire alarm system panel is the original panel from when MMC was built over 40 years ago. The system is no longer serviceable. MMC cannot meet fire code standards with the current panel. 3

9 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 3. Approval of Consent Agenda (cont.) b. Contracts (cont.): MOTION: VOTE: Chairman Bruno moved to approve consent agenda item 3.b.ii. Vice Chairman Gerard seconded. 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. Chairman Bruno asked for staff to address the need for the renovation to the angiography suite (consent agenda item 3.b.iii.). He asked how the renovation would make MIHS more efficient and able to provide better quality. In addition, he asked staff how they will assure the Board that MIHS is getting the best value. Mr. Vanaskie said the current angio suite (also known as the interventional radiology suite) has dated equipment, which at times causes the need for images to be taken multiple times. The equipment needs to be replaced in order to maintain the service. The service is required in order to maintain the Level 1 trauma designation. Replacing the equipment would necessitate renovations to the existing space because the new equipment would not fit in the current suite. There would be electrical and mechanical issues as well. Senior administration explored options for relocating the angio suite. Relocating the suite will allow the current suite to continue to operate while the new suite is constructed. This would also allow MIHS to maintain trauma designation and be open to trauma. The new location of the suite would improve efficiencies in the use of personnel because the suite would also be situated close to the cardiac cath lab. Senior administration hopes to develop the vascular services into a Vascular Center. The Board is being asked to approve a contract for the renovations required for the new equipment and to relocate the functions that are currently located in the space where the suite will be built. Chairman Bruno asked about quality and safety improvements. Mr. Vanaskie explained that state-of-the-art equipment would be purchased. The images would be digital, which would vastly improve the quality of the images produced. Director Bicknell questioned if the contract included removal of the old equipment. Mr. Vanaskie said that the contract was only for the renovations. Removal of the old equipment will be included in the contract for the purchase of the new equipment. Mr. Vanaskie added that the cost for the renovations was budgeted. Chairman Bruno commented that if the Board approved the renovations, which is anticipated to cost approximately $1.4 million, the Board will also have to approve the purchase of the equipment. The purchase of the equipment will be an additional $1.5 million. He questioned why a Return on Investment (ROI) analysis was not done on this capital project. Mr. Meinke explained that a ROI or business plan analysis is not performed on replacement or regulatory required capital projects. MIHS policy states that ROI or business plan analysis is performed for new business/services or an expansion of an existing business line. Chairman Bruno asked about the process of selecting a contractor, the construction manager at risk (CMAR) and the guaranteed maximum price (GMP). The CMAR was awarded a GMP, which eliminated a competitive bid with multiple contractors submitting bids of price. He asked for senior administration to explain how MIHS would be getting the best value using the CMAR process. 4

10 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 3. Approval of Consent Agenda (cont.) b. Contracts (cont.): Brian Maness, MIHS Manager of Contracts Administration, explained that the CMAR process was used due to Arizona Revised Statutes requirements as it relates to the selection process. The procurement was governed under Article 5 of the District s Procurement Code. Because the CMAR process was used, staff had to follow the statutory guidelines. All construction related services are governed under Article 5 of the Procurement Code. Chairman Bruno asked how the Board can be assured the District would be receiving the best value by using the CMAR process. Mr. Maness said that after the most qualified vendor is selected, staff would determine the GMP. The GMP is then negotiated with the selected vendor based on a variety of factors. Chairman Bruno questioned if the decision to procure all construction related services under Article 5 of the Procurement Code was an internal decision. Mr. Maness said that the District is bound under Article 5 to have construction services performed by the CMAR process or the Job Order Contracting process. Chairman Bruno was concerned and asked how staff can know if the District is getting the best value if the District does not have competitive bidding. Mr. Vanaskie said that design changes within the hospital could have been made over the years that do not appear on the hospital drawings or blueprints. If a contract was awarded for each piece of the renovation project (i.e., a contract for electrical, a contract for pluming, etc.), MIHS would have to manage each individual contractor. In addition, each contract could include contingencies based on what may be found once the walls were opened up due to the likelihood changes were made which do not appear on the current blueprints. MIHS is seeking the best construction manager possible. The manager would be at risk for managing the project to a cost that is agreed upon. After the selection of the CMAR, a GMP would be negotiated. MOTION: VOTE: Vice Chairman Gerard moved to approve consent agenda item 3.b.iii. Director Bicknell seconded. 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. 4. Approval of Maricopa Integrated Health System Medical Staff Appointments, Reappointments, FPPE, Change of Privileges/Status, and Resignations for October 2009 MOTION: Director Bicknell moved to approve the Maricopa Integrated Health System Medical Staff Appointments, Reappointments, FPPE, Change of Privileges/Status, and Resignations for October Vice Chairman Gerard seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. 5

11 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 5. Approval of Maricopa Integrated Health System Allied Health Professional Staff Appointments, Reappointments, and FPPE, for October 2009 MOTION: Vice Chairman Gerard moved to approve the Maricopa Integrated Health System Allied Health Professional Staff Appointments, Reappointments, and FPPE for October Director Bicknell seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. 6. Discuss, Review and Approve the Maricopa Integrated Health System Medical Staff Bylaws; the Credentials Policy; the Allied Health Professionals Policy; and the Medical Staff Organization Manual Dr. Stapczynski explained that the Medical Staff Executive Committee (MSEC) determined the need to revise the MIHS Medical Staff Bylaws, the Rules and Regulations, and the Peer Review Policy into more concise, functional documents and policies. In February 2009, the MSEC hired a law firm specializing in Medical Staff Law to work on the project and assure that the revisions would represent best practices. A four-document approach was used to replace the old, single Medical Staff Bylaws. The proposed new documents are the Medical Staff Bylaws; the Credentials Policy; a Policy on Allied Health Professionals; and the Medical Staff Organization Manual. The documents include many legal/regulatory updates such as 2009 Joint Commission (JC) Medical Staff Standards; Det Norske Veritas (DNV) requirements; and Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (COP). The documents also contain significant "best practices" updates based on the law firm's work with medical staffs and hospitals across the country. All of the documents contain a modified, more effective amendment process. The documents were reviewed by the MIHS Medical Staff Bylaws Committee, and the MSEC. In September 2009, the documents were reviewed and approved by the entire MIHS Medical Staff. Chairman Bruno said that the proposed Bylaws restricted the Chief Executive Officer s authority to remove a department chair. He asked for an explanation on the process in which the Chief Executive Officer can remove a department chair. Vice Chairman Gerard asked if the proposed process was significantly different from the current process. Dr. Stapczynski said that the proposed process in which the CEO can remove a chair is identical to the current process. Chairman Bruno said that the CEO can only remove a chair upon the recommendation of a Special Review Committee (SRC). The SRC is appointed to investigate concerns with the department chair following either a vote of the MSEC, or a petition signed by 50% of the affected department members, or by the Board of Directors. The SRC membership includes the Chief Medical Officer and three voting members of the MSEC. After the investigation, the SRC's recommendation will be forwarded to the Chief of Staff and CEO for action. They can accept, reject, or modify the recommendation. Chairman Bruno is concerned that the CEO cannot start the removal process. Vice Chairman Gerard said that the proposed process is to prevent abuse. She asked Ms. Bayless if she had any concerns with the proposed processed. Ms. Bayless did not have any concerns. 6

12 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 6. Discuss, Review and Approve the Maricopa Integrated Health System Medical Staff Bylaws; the Credentials Policy; the Allied Health Professionals Policy; and the Medical Staff Organization Manual MOTION: Director Bicknell moved to approve Maricopa Integrated Health System Medical Staff Bylaws; the Credentials Policy; the Allied Health Professionals Policy; and the Medical Staff Organization Manual. Vice Chairman Gerard seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. 7. Discuss and Review Financial Performance for September 2009 Mr. Meinke reviewed the District s financial performance for September Total admissions for the month were worse than budget. Adult emergency rooms visits were slightly better than budget. Pediatric emergency room visits were better than budget for the month, as well as better than budget year-to-date (YTD). Patient visits at the FHCs and at the CHC were slightly worse that budget for the month. Visits to the Urgent Care Center (UCC) continue to be worse than budget. Adjusted patient days (APD) were close to budget for the month and are worse than budget YTD. Mr. Meinke reviewed payor source information. The trends continued with AHCCCS as the main payor source for inpatient admissions at MMC. In September, 68% of the inpatient admissions at MMC were AHCCCS. The percentage of patient with no payor source, or self-paying patients, has decreased slightly YTD when compared to the 2009 fiscal year. The percentage of patients seen in the FHCs with AHCCCS as the payor source was 51 in September 2009, compared to 45 in June Mr. Meinke pointed out that the number of Maricopa Health Plan (MHP) patients seen in the FHCs has increased by 4% when compared to the 2008 fiscal year. The percentage of self-paying patients increased to 22 compared to 17 at June 30, Although the percentage of MHP patients seen in the FHCs has increased during the last fifteen months, the number of MHP patients seen at the CHC has decreased by 5% when compared to the 2008 fiscal year. In addition, the percentage of patients with no payor source, or were self-paying patients, continues to average 40. Chairman Bruno questioned senior administration s plan to address the decrease in MHP patients seen in the CHC and the increase in the number of patients with no payor source. Mr. Vanaskie said that referrals to the specialty clinics in the CHC come from other community providers outside the MIHS network, which explains the disparity in the number of self-paying patients at the FHCs compared to the number at the CHC. Chairman Bruno questioned if the other community providers were referring patients without insurance to the CHC. Mr. Meinke confirmed that was correct. Chairman Bruno asked if senior administration had a plan to address the issue, who would be responsible for the plan, and when the Board could expect corrective action. 7

13 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 7. Discuss and Review Financial Performance for September 2009 Mr. Meinke mentioned that senior administration has discussed a variety of strategies on how to increase the number of MHP patients seen at the CHC; however, he was not prepared to discuss any of them at this time. Ms. Bayless stated that senior administration will develop a report and present it to the Board. Vice Chairman Gerard said that the Board did not need a report, but the action plan that will be enacted in order to turn the situation around. She also suggested that senior administration develop a means of incentivizing MHP patients to utilize MIHS resources. She questioned if MHP patients received priority appointments when scheduling at the CHC. Dr. Fromm mentioned that senior administration had discussed that idea. Mr. Meinke added that the scheduling process would need to be changed. Chairman Bruno requested that the Board receive a report from senior administration on the situation. Senior administration also needs to bring a plan to the Board on how they will improve the payor mix at the CHC. The plan should include the action steps that senior administration will take to improve the payor mix as well as the action steps they considered but decided against, and why. Mr. Meinke reviewed the consolidated income statement. Total net income for MMC was $1,569,753 better than budget in September and $2,086,369 better than budget YTD. He noted that MIHS budgeted for a potential 5% decrease in AHCCCS reimbursements. However, AHCCCS reimbursement rates have not been cut yet. The impact of a 5% decrease is approximately $600,000 per month. Approximately $1.8 million of the $2.1 million variance relates to the anticipated rate decrease that has not occurred. The MHP was also better than budget for the month of September and better than budget YTD. The Maricopa Care Advantage Plan (MCA) continues to be worse than budget and is ($721,118) worse than budget YTD. Each year, MIHS has the option to either continue or opt out of the MCA. Director Patterson questioned why the MCA was performing poorly. Mr. Meinke said that the plan has had an unexpected high number of sick patients. The plan is a special needs plan that services patients who are both Medicare and Medicaid eligible. The plan has seen a high number of inpatient admissions of very sick individuals. The plan has approximately 900 members. 8. Discuss the Financial Impact of State and Federal Funding Reductions on District s 2010 Fiscal Year Budget and Senior Administration s Action Plan to Address Reductions Ms. Bayless said that in anticipation of a reduction in AHCCCS reimbursements, senior administration budgeted for a 5% cut in the 2010 fiscal year budget. Senior administration began to take steps over one year ago to reduce expenses. Those actions have lead to MIHS s stability. Senior administration has a plan to address potential further reimbursement reductions. Additional reductions to state funding is anticipated and senior administration has proposed action plans to address these potential reductions. Ms. Bayless advised the Board that she and her staff were available to brief the Board members. Vice Chairman Gerard said that in the 2008 fiscal year, senior administration budgeted for a total net income of $36.7 million. In 2009, $37 million total net income was budgeted. For the 2010 fiscal year, the total net income was budgeted to be $18.4 million. Additional cuts in state and federal funding could be detrimental to the District s bottom line. 8

14 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 8. Discuss the Financial Impact of State and Federal Funding Reductions on District s 2010 Fiscal Year Budget and Senior Administration s Action Plan to Address Reductions Mr. Meinke commented that senior administration budgeted for a net income of $37 million for the 2009 fiscal year. The District ended with $30 million net income plus an additional $13 million in indirect medical education (IME) funds. The $18 million net income budgeted for the 2010 fiscal year includes the anticipated 5% reduction in AHCCCS reimbursements. Vice Chairman Gerard said that AHCCCS reimbursements could be cut by an additional 5-10% on top of the already anticipated 5% reduction. Chairman Bruno asked Mr. Gorman if senior administration presented an action plan to the Board on how to address potential federal and state funding reductions, would the plan be protected under A.R.S , the statute that protects the District from being placed at a competitive disadvantage, and if the document could be considered executive session material. Mr. Gorman said that he would need to see the document before he could give an opinion. The document may qualify for executive session under legal advice. 9. Update on the Status of the Fiscal Year 2009 External Audit Conducted by Ernst & Young Mr. Meinke informed the Board that the MHP external audit was completed and accepted by AHCCCS. Representatives from Ernst & Young (E &Y) and Beach Fleishman gave a presentation on the MHP audit to the Audit and Compliance Committee. The District s 2009 consolidated external audit will be presented to the Board in November Break: 2:18 p.m. 2:32 p.m. 11. Legislative Report and Possible Action Ms. Whitney presented information from the Joint Legislative Budget Committee on revenue forecasts and shortfalls. While revenue collections will improve during the next few fiscal years, by 2013 the state will not be at the same collection levels it was at in Arizona s revenue collections rely heavily on sales tax, income tax, and corporate income tax. New forecasts raise the 2010 fiscal year shortfall to $2 billion. This includes a carryover shortfall of $478 million from the 2009 fiscal year. Ms. Whitney reviewed budget reduction options to AHCCCS. Chairman Bruno asked about the potential impact on MIHS if federal matching funds were lost. Ms. Whitney said that the KidsCare Program has a 3-to-1 match. Therefore, for every general fund dollar cut from the state budget, $3 dollars in federal funding is lost. The reduction to the private Disproportionate Share Hospital funds (DSH) will not impact MIHS. Due to federal stimulus funding, Graduate Medical Education (GME) also has a 3-to-1 match; therefore, for every $1 cut from the state budget, $3 dollars in federal funding will be lost. Ms. Whitney noted that the figures she presented only represented the general funding reductions and the not federal reductions. Mr. Meinke added that the elimination of the KidsCare Program equates to a $1.3 million annual impact to MIHS for payment for services. 9

15 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 11. Legislative Report and Possible Action Vice Chairman Gerard said that although the program will be eliminated, the pediatric patients who were covered by the program will still come to MIHS for medical care and services, but they will not have coverage. She asked Mr. Meinke if the estimated $1.3 million impact included those who will no longer have a payor source. Mr. Meinke said that the figure was conservative and did not take that into consideration. With regard to the reduction in GME funding, the impact to MIHS could be anywhere from $750,000 to $1 million. Vice Chairman Gerard asked how senior administration would address the cuts to GME. Mr. Meinke said that would be addressed in the action plan that Ms. Bayless mentioned earlier during the discussion of agenda item 8. Ms. Whitney reviewed budget reduction options for the Arizona Department of Health Services (ADHS), which total almost $69 million. Some of the ADHS programs also have federal funding matches. Mr. Meinke said that the reduction of various Title 19 funding would impact MIHS by $12.3 million annually. Chairman Bruno requested that the Board receive a bullet-point informational sheet on federal funding matches for all state funding cuts. He will need it when he speaks with his representatives and constituents. He questioned if senior administration was making the District s concerns known to the Governor and members of the Legislature, and how the reductions will impact MIHS. He also asked if senior administration had a strategy or plan to educate state officials on how the reductions will shifts costs back to the taxpayers. Ms. Whitney said her strategy is to spend time speaking to legislators on how the cuts to AHCCCS, ADHS and DES will impact MIHS. The Board and senior administration need to consider how caseload growth combined with lower reimbursements will impact MIHS. There are also potential policy initiatives to consider such as provider tax and behavioral health reform. Chairman Bruno reiterated that he hopes senior administration is prepared, and is proactive, not reactive. Ms. Bayless said that senior administration will represent MIHS aggressively to minimize the impact of reductions to MIHS. Vice Chairman Gerard said that Ms. Whitney needed direction and asked from whom Ms. Whitney received her direction: senior administration or the Board. Ms. Whitney needs direction before the state legislature returns to session. Ms. Bayless stated that senior administration will bring a recommendation to the Board. 10. Presentation on District Medical Group Dr. Hobohm gave a brief history on the relationship between MedPro and MIHS. He explained why MedPro began exploring the idea of transitioning from a for-profit, private organization to a not-for-profit 501(c) 3 organization. 10

16 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 10. Presentation on District Medical Group The MedPro Board researched the pros and cons of transitioning to a not-for-profit. Some of the key considerations were the closer alignment with MIHS; an easier affiliation with the University of Arizona College of Medicine Phoenix in relation to educational partnerships; and the ability to qualify for government and industry grants for clinical research and education. Dr. Hobohm explained the IRS application process began in March 2007, and was ultimately approved by the IRS in March The MedPro shareholders ratified the transition in September The name for the new not-for-profit organization is District Medical Group (DMG). DMG will be governed by a new board, consisting of nine members, five of whom are community representatives. The new board was selected by the existing MedPro Board. Dr. Hobohm reviewed the names of the people serving on the board. Director Patterson questioned if Fulton Brock, one of the community representatives serving on the new DMG Board, was serving in his capacity as one of the Maricopa County Board of Supervisors. Dr. Hobohm said he was serving as a private citizen. It was determined that he did not have a conflict of interest. Director Patterson said that Supervisor Brock will eventually vote on a Maricopa County budget and he sits on the board of a county contract. He may not have a conflict of interest with DMG, but it seems he would have a conflict with Maricopa County. Dr. Hobohm did question Supervisor Brock on that very issue and Supervisor Brock indicated it would not be an issue. Dr. Chundu added that DMG conducted a board orientation which included an educational session from attorneys on the responsibilities of being a board member. Each board member had to sign a Conflict of Interest statement. It is Supervisor Brock s responsibility to clear any potential conflicts with the Maricopa County Board of Supervisors and the County Attorney. Chairman Bruno asked if MedPro will still exist or be in the health care business. Dr. Chundu stated that MedPro will not be in the health care business and that it will cease to exist by the middle of 2010, after the transfer to DMG has been completed. Chairman Bruno said that in the past the District conducted business with an entity that owned a building and had assets. He questioned senior administration if they were concerned about doing business with a not-for-profit entity without any assets. Mr. Gorman stated that in the current contract between MedPro and MIHS, there is a provision that addresses the assignment of the contract from MedPro to DMG. MIHS was given notice on October 1, 2009 that MedPro intends to assign the contract to DMG. MIHS has 60 days to review and raise objections about the assignment, or any consequences of the assignment. Assets will be moved from MedPro to DMG. Mr. Westover added that $1.4 million in tangible assets will transfer to DMG. MedPro will not transfer unfunded liabilities to DMG. 12. Discussion, Consideration and Action on Employment Agreement with Betsey Bayless as Chief Executive Officer of Maricopa Integrated Health System Chairman Bruno recommended that the Board address this agenda item at a later date in order to allow Ms. Bayless time to fully review the proposed contract. 11

17 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 13. Discussion, Consideration and Possible Action on the Performance Evaluation for Melanie Talbot Chairman Bruno said that the Board conducted a formal, comprehensive evaluation in many different areas of Ms. Talbot s performance. Mr. Jones, Vice President of Human Resources, tabulated the results and reported that her overall rating was 4.0 or excellent. MOTION: Director Bicknell moved that the Board designate Ms. Talbot s performance as excellent. Vice Chairman Gerard seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, and Director Patterson 1 absent: Director Lara. Motion Passed. 14. Concluding Items a. Future Agenda Item/Report Calendar i. November a. Quarterly Reports: Patient Satisfaction Survey Results 3 rd Quarter CY 2009 Compliance Officer s Report on Activities, Quality and Effectiveness Internal Auditor s Report on Activities, Quality and Effectiveness Performance on Investment of Funds Report on Maricopa Foundation Activities b. Other: Presentation on MIHS Nursing and Patient Services Non-Privileged Patient Care Staff Competency Report Open and Settled Claims Report from Audit and Compliance Committee Approval of External Audit including External Audit of the Maricopa Health Plan b. Board Member Requests for Future Agenda Items or Reports c. Comments i. Chairman and Member Closing Comment ii. Chief Executive Officer Summary of Current Events As a request for a future agenda item or report, Vice Chairman Gerard requested a presentation and discussion on what priorities Mr. Trenter, Vice President of Business and Development, has identified for MIHS. Ms. Bayless said that her team will be ready with a presentation within thirty (30) days. In addition to a presentation and discussion, Mr. Trenter will also begin to provide the Board with a quarterly dashboard report on his activities. 12

18 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 14. Concluding Items (cont.) Vice Chairman Gerard requested an update on the status of when MMC will become certified as a Level I trauma center from ACS. Ms. Bayless said that she will include an update to the Board in one of her weekly Friday Reports to the Board. She added that ACS will be at MMC as early as December Vice Chairman Gerard voiced concern with the Urgent Care Center s viability. She questioned if it was marketed properly, if the Center was even needed, and if there were issues with low patient volumes. Mr. Vanaskie said that new physician and management leadership was in place at the Center. This change has had a positive impact on the Center. He suggested that senior administration report to the Board in four-to-five months to allow the changes in leadership to have a true impact. Ms. Bayless said that senior administration will be ready with a report by March Vice Chairman Gerard requested a report on how President Obama s proclamation declaring the H1N1 flu a national emergency, which will allow hospitals to seek a bed capacity waiver in the event of a surge of patients from the H1N1 flu, will affect MMC. Ms. Bayless said a report will be included in one of her weekly Friday Reports to the Board. Vice Chairman Gerard asked that the Board begin discussions in the near future on a location of a new hospital. The Board and senior administration cannot move forward with the planning of a new hospital until a location is determined. She requested that the Board receive a list of the pros and cons on various site locations. Chairman Bruno asked Ms. Bayless when she and her staff would be prepared for such a discussion. Ms. Bayless was hopeful that during the discussion of her contract with the Board, she would have an opportunity to brief them on the relationship between MIHS and the University of Arizona. She is ready to begin the discussions with the Board at any time. Director Bicknell suggested that the Board schedule a special meeting for the discussion. Ms. Bayless said that she will work with Ms. Talbot to schedule a special meeting in early December Director Bicknell requested a report on the return on investment of the Grants Department. He also requested information on the potential amount of federal stimulus funding available to MIHS. Ms. Bayless said that Ms. Whitney will provide a report to the Board. Chairman Bruno requested a report sometime early next year on CMAR and the difference between using CMAR versus open bidding with construction projects. In addition, Chairman Bruno also requested a report on the Maricopa Care Advantage Plan. The report should include an opinion from senior administration on whether or not MIHS should continue with the plan. If senior administration recommends discontinuing the plan, senior administration needs to let the Board know the date when a decision needs to be made. Chairman Bruno reiterated an earlier request for the Board to receive a report and plan from senior administration on how they will improve the payor mix at the CHC. The plan should include the action steps that senior administration will take to improve the payor mix as well as the action steps they considered but decided against, and why. Vice Chairman Gerard reiterated the request for Ms. Whitney to receive direction with regard to lobbying efforts for MIHS. 13

19 Special Health Care District Board of Directors Meeting Minutes General Session October 28, 2009 General Session Presentation, Discussion and Action (cont.): 14. Concluding Items (cont.) Vice Chairman Gerard read a letter that she received from a constituent about the care her son received at MMC. The mother was about to take her son to Ohio to meet with a team of craniofacial surgeons when she read the story about Dr. Sal Lettieri in the Arizona Republic. Her son has since seen Dr. Lettieri. Chairman Bruno mentioned that he attended the Desert Cancer Foundation of Arizona s annual luncheon. One of the Foundation s founders has a son who works at MMC. NOTE: Director Patterson excused himself from the meeting at 4:21 p.m. Ms. Bayless distributed a media coverage summary. One of the biggest stories of the month was the case of a 5 year old girl who fell through a glass coffee table, with glass piercing her rib case, lung and liver. She was brought to MMC where doctors were able to remove the glass. The girl is expected to make a full recovery. Adjourn MOTION: Director Bicknell moved to adjourn the October 28, 2009 Special Health Care District Board of Directors formal meeting. Vice Chairman Gerard seconded. VOTE: 3 ayes: Chairman Bruno, Vice Chairman Gerard, and Director Bicknell 2 absent: Director Lara and Director Patterson. Motion Passed Meeting adjourned at 4:27 p.m. William Bruno, Chair Special Health Care District Board of Directors 14

20 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.a.ii.

21 Minutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Administrative Conference Room November 16, :00 noon Present: William Bruno, Chair, District 1 Susan Gerard, Vice Chair, District 3 Greg Patterson, Director, District 2 Elbert Bicknell, Director, District 4 Alice Lara, Director, District 5 Others Present: Betsey Bayless, MIHS, Chief Executive Officer Recorded by: Melanie Talbot, Clerk of the Board Call to Order Chairman Bruno called the meeting to order at 12:04 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that all five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represents a quorum. Call to the Public Chairman Bruno called for public comment. There were no comments. General Session Presentation, Discussion and Action: 1. Motion to Recess General Session and Convene in Executive Session MOTION: Vice Chairman Gerard moved to recess the general session and convene in executive session at 12:05 p.m. Director Bicknell seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, Director Patterson. Motion passed. General Session Presentation, Discussion and Action: Chairman Bruno reconvened the general session at 3:02 p.m.

22 Special Health Care District Board of Directors Meeting Minutes General Session November 16, 2009 General Session Presentation, Discussion and Action (cont).: 2. Discussion, Consideration and Action on Employment Agreement with Betsey Bayless as Chief Executive Officer of Maricopa Integrated Health System; Discussion, Consideration and Possible Action on Fiscal Year 2010 Performance Incentive Goals for Chief Executive Officer This item was postponed. Adjourn MOTION: Director Bicknell moved to adjourn the November 16, 2009 Special Health Care District Board of Directors special meeting. Director Lara seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, Director Patterson. Motion passed. Meeting adjourned at 3:02 p.m. William Bruno, Chair Special Health Care District Board of Directors 2

23 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.a.iii.

24 Minutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditorium 1 November 23, :00 p.m. Present: William Bruno, Chair, District 1 Susan Gerard, Vice Chair, District 3 Greg Patterson, Director, District 2 Elbert Bicknell, Director, District 4 Alice Lara, Director, District 5 Others Present: Betsey Bayless, MIHS, Chief Executive Officer Bill Vanaskie, MIHS, Chief Operating Officer Ken Meinke, MIHS, Chief Financial Officer Robert Fromm, Jr., MD, Chief Medical Officer Warren Whitney, MIHS, Chief External Affairs Officer Sherry Stotler, MIHS, Chief Nursing Officer Stephan Stapczynski, M.D., F.A.C.E.P., MIHS, Chief of Staff Louis B. Gorman, MIHS, District Counsel Melanie Talbot, Clerk of the Board Recorded by: Donna Pratt, Assistant Clerk of the Board Call to Order Chairman Bruno called the meeting to order at 1:15 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that all five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represents a quorum. Pledge of Allegiance The Pledge of Allegiance to the flag was lead by Bil Bruno, Chairman of the Board of Directors for the Maricopa County Special Health Care District. Call to the Public Chairman Bruno called for public comment. There were no comments.

25 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action: 1. Opening Comments and Remarks from Chief Executive Officer Ms. Bayless announced that senior administration developed action plans to address potential budget cuts revolving around state government, which may impact Maricopa Integrated Health System (MIHS). Depending on the outcome of state budget cuts, senior administration developed several phases of cuts. She and her staff are prepared to meet with Board members to discuss the proposed cuts. Ms. Bayless requested that item 3.b.iv. be removed from the consent agenda and addressed at a future meeting. She has asked the MIHS Compliance Officer to review the various contracts and report to the Board. Ms. Bayless distributed copies a letter she received from a MIHS employee. It complimented the care and treatment the employee s daughter received while a patient at Maricopa Medical Center (MMC). 2. Reports to the Board of Directors a. Patient Satisfaction Survey Results 3 rd Quarter CY 2009 b. Compliance Officer s Report on Activities, Quality and Effectiveness c. Internal Auditor s Report on Activities, Quality and Effectiveness d. Performance on Investment of Funds e. Report on Maricopa Foundation Activities. f. Report from Audit and Compliance Committee g. Quality Report Whole Systems Measures Dashboard h. Patient Account Write Offs (more than $250K, less than $500K) Chairman Bruno acknowledged that the Board received the reports prior to the meeting. Chairman Bruno requested that future Patient Satisfaction Survey Results reports (item 2.a.) contain previous trend figures so the Board can identify areas of improvement or weakness. Mr. Vanaskie stated that the information was available and will be included in future reports. Chairman Bruno asked that the Board receive a copy of the audited financial statements for the Maricopa Health Foundation (item 2.e.) Ms. Bayless stated that the information was available and will provide a copy to the Board. 3. Approval of Consent Agenda a. Minutes: Review and Approve Special Health Care District Board of Directors Meeting Minutes dated: i. September 23, 2009 Formal Meeting b. Contracts: i. Approve amendment #2 to the contract (C ) between Healthcare Reports.com, LLC (Contractor) and Maricopa County Special Health Care District for Document Scanning and Indexing Services. This amendment will extend the contract term for one additional year, January 5, 2010 to January 4, The anticipated annual expense is $513,000. 2

26 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont.): 3. Approval of Consent Agenda (cont.) b. Contracts (cont.): ii. iii. iv. Approve a New Contract (C ) between Integrated Health Management Services, LLC and Maricopa County Special Health Care District for Medical Eligibility and Verification Services. The initial contract term is from December 1, 2009 to November 30, 2011 and may be extended. The anticipated annual expense is $1,590,000. Approve a New Intergovernmental Lease Agreement (C ) between Maricopa County and Maricopa County Special Health Care District for the purpose of allowing the Women and Infant Children Program ( WIC ) to conduct business on-site at the Avondale Family Health Center. The initial contract term is from upon execution for a period of three years and shall automatically renew for additional one year periods. The anticipated annual revenue is $44,523. Approve a contract (C ) between King and Spalding, LLP and Maricopa County Special Health Care District for legal advice related to compliance with federal and state laws and regulatory requirements for the MedPro contract. The agreement is effective June 1, 2009 through May 31, 2010 and can be terminated by either party upon written notice. The annual estimated expenses in FY 2010 are $975,000. v. Approve Amendment #1 (C ) to a Contract for Property Lease Services between Maricopa County Special Health Care District and Medical Professional Associates of Arizona (MedPro). c. Board Governance: i. INTENTIONALLY LEFT BLANK d. Medical Staff: i. Approve the Rescinding of Privileging for Fluoroscopy Utilization for Non- Radiologists in General Surgery, Neurosurgery, Orthopedic Surgery, Pediatric Surgery, ENT, Urology, Cardiology, Emergency Medicine, and Gastroenterology ii. iii. iv. Approval of Ongoing Professional Practice Evaluation Profiles for Internal Medicine, OB/GYN, and Pediatrics Approve the Professional Practice Evaluation Policy Approval of Abraham C. Kuruvilla, M.D. as the Department Chairman of Family and Community Medicine Director Bicknell requested that items 3.b.i. and 3.b.iii. be removed from the consent agenda for further discussions. Chairman Bruno also wanted to discuss item 3.b.i. In addition, he requested that item 3.b.ii be removed from the consent agenda. 3

27 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont): 3. Approval of Consent Agenda (cont.) MOTION: Director Bicknell moved to approve the consent agenda minus items 3.b.i., 3.b.ii., 3.b.iii., and 3.b.iv. Director Lara seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion Passed. Chairman Bruno requested that consent agenda items 3.b.i. and 3.b.ii. be discussed in executive session for the purpose of obtaining legal advice and to discuss the Board s position regarding these contracts, which are subject to negotiations, pursuant to A.R.S (A)(3) and A.R.S (A)(4). Director Bicknell questioned if a Request for Proposal (RFP) was done for consent agenda item 3.b.iii. Mr. Vanaskie explained that the item was not a contract but an Intergovernmental Agreement (IGA) and that the Women and Infant Children Program (WIC) would be leasing space from the District at the Avondale Family Health Center (FHC). MOTION: Vice Chairman Gerard moved to approve the consent agenda item 3.b.iii. Director Bicknell seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Patterson, Director Bicknell, and Director Lara. Motion Passed 4. Approval of Maricopa Integrated Health System Medical Staff Appointments, Reappointments, FPPE, Change of Privileges/Status, and Resignations for November 2009 Chairman Bruno mentioned a recent incident at Fort Hood, a military base in Texas, and asked Dr. Stapczynski to explain the peer review process at MIHS. Dr. Stapczynski stated that if a physician is a danger to patients or other members of staff, that person can be suspended with good cause by the Chief of Staff, Chief Medical Officer, or the Chief Executive Officer. There is a very robust behavioral peer review process in place at MIHS for physicians who have problems interacting with other physicians, patients, or staff. Quality of care issues would be handled by the Peer Review process. There is no tenure or life-time appointments to the medical staff, therefore, problems can also be handled as an employer to employee relationship. There are multiple layers of protection to prevent crisis situations from occurring. There are also measures for medical residents who have not met the educational needs for advancement. Chairman Bruno asked Ms. Bayless if she would have difficulty in suspending or terminating anyone the Chief Medical Officer or Chief of Staff deemed a potential danger to patients or other staff. Ms. Bayless stated it was MIHS s obligation to handle any situation that is a perceived danger to patients, physicians, or other staff. The Credentialing Committee will take action by termination, recommendation of counseling for physicians and residents. There is no tolerance for bad behavior. 4

28 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont.): 4. Approval of Maricopa Integrated Health System Medical Staff Appointments, Reappointments, FPPE, Change of Privileges/Status, and Resignations for November 2009 (cont.) MOTION: Vice Chairman Gerard moved to approve the Maricopa Integrated Health System Medical Staff Appointments, Reappointments, FPPE, Change of Privileges/Status and Resignations for November Director Bicknell seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion Passed. 5. Approval of Maricopa Integrated Health System Allied Health Professional Staff Appointments, Reappointments, and FPPE, for November 2009 MOTION: Vice Chairman Gerard moved to approve the Maricopa Integrated Health System Allied Health Professional Staff Appointments, Reappointments, and FPPE for November Director Lara seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion Passed. 6. Presentation on Maricopa Integrated Health System Nursing and Patient Services Ms. Stotler explained that during the past two years, the nursing strategic plan focused on the Back to Basics Philosophy. The Nursing Division is now using Evidence-Based Practice, which will allow nurses to become more involved in research and other activities. The division is utilizing the Clinical Ladder Program to encourage nursing staff to further their education. There are currently 83 nurses enrolled in advanced educational courses at Grand Canyon University. Sixty-seven nurses are working toward earning their BSN, and 16 nurses are enrolled in the MSN program. Nurses are encouraged to become certified in their area of specialty. Recently, MIHS offered a Pediatric Nurse Certification Examination. Six of the nurses passed the exam on their first sitting. Those six are now Pediatric Certified which means they demonstrated proficient skills, knowledge, and abilities in the Pediatric area. This is an aspect that builds on the infrastructure for MAGNET status. Chairman Bruno asked if there was an increase in salary once a nurse becomes certified. Ms. Stotler stated that as part of the Clinical Ladder Program, once a nurse has a minimum of two years experience in an acute care hospital and at least one year experience in their specialty, they are eligible to seek certification in their specialty. Once certified, the nurse will have achieved level two of the Clinical Ladder Program and will receive a slight salary increase. The nurses must keep certifications up-to-date. Ms. Stotler reviewed the Nurse Sensitive Indicators which are pressure ulcers, pain assessment, restraints, telephone/verbal orders, and patient education. A group of nurses developed the indicators to determine areas of weakness and to utilize the information for training. Chairman Bruno asked Ms. Stotler to explain the Nurse MAGNET status and if other hospitals in Maricopa County achieved MAGNET status. 5

29 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont.): 6. Presentation on Maricopa Integrated Health System Nursing and Patient Services (cont.) Ms. Stotler said that MAGNET status is an award given by the American Nurses Credentialing Center (ANCC) to hospitals. It is a designation of excellence. The idea is that MAGNET nursing leaders involve nurses in shaping research-based nursing practice, encourage and reward nurses for advancing in nursing practice. She and her staff have been evaluating the MAGNET status for over a year to determine what measures would be required to achieve the status and how it would benefit MIHS. One benefit to MIHS would be the ability to benchmark against facilities and nursing services that have reached that status. John C. Lincoln North Mountain Hospital, Scottsdale Healthcare Osborn and Shea, and Banner Good Samaritan Medical Center have the MAGNET status designation. A large amount of infrastructure must be in place before attempting to achieve the status. It is a long-term process to achieve and hospitals must keep current in any changes made to nursing. At this point, the cost of developing the infrastructure would be prohibitive until the inpatient ratio increase to meet the cost. She continues to research other avenues for excellence. Chairman Bruno asked how language barriers were addressed with non-english speaking patients, and the percentage of nurses who can converse with Spanish speaking patients. Ms. Stotler said that no surveys had been conducted which would provide that information. The nurses are encouraged to take conversational Spanish classes offered by MIHS. The hospital has interpreters and translators, and contracts with World Wide Interpreters if the language requested is unavailable through MIHS. She believes many nurses can speak conversational Spanish, however, they have not been certified. Mr. Vanaskie added that in addition to conversational Spanish classes, MIHS also offers a Spanish Bilingual Assistant (SBA) program. It gives employees the opportunity to learn medical terminology and to utilize their Spanish speaking abilities in clinical settings. Graduates of the SBA program are eligible for an hourly rate increase. He will provide the Board with more information on pay differential opportunities for those who have completed the SBA program. 7. Discuss and Review Financial Performance for October 2009 Mr. Meinke reviewed the consolidated income statement for October Total net income for MMC was $271,743 better than budget in October and $2,387,287 better than budget year to date (YTD). The Maricopa Health Plan (MHP) was also better than budget for the month of October and better than budget YTD. The Maricopa Care Advantage Plan (MCA) continues to be worse than budget and is ($1,107,134) worse than budget YTD. Total net income for MIHS was $243,394 better that budget for the month and was $1,764,718 better than budget YTD. Senior administration is developing an action plan to improve the performance of the MCA and anticipates presenting a report to the Board in January Board Acceptance or Approval of the Fiscal Year Annual Audit for June 30, 2009 or Direct Staff to take Appropriate Action with Regard to the Fiscal Year Annual Audit if the Board Determines that Modifications or Revisions to it are in Order Mr. Meinke introduced Matt Peel from Ernst and Young. Mr. Peel was the manager who oversaw the District s annual external audit for the year ending June 30,

30 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont.): 8. Board Acceptance or Approval of the Fiscal Year Annual Audit for June 30, 2009 or Direct Staff to take Appropriate Action with Regard to the Fiscal Year Annual Audit if the Board Determines that Modifications or Revisions to it are in Order (cont.) Mr. Peel announced the audit was clean and the auditors found no fraud, internal weaknesses, or significant deficiencies. Chairman Bruno commented to Ms. Bayless that she should be very proud of the audits and of her team. MOTION: Director Bicknell moved to accept the Fiscal Year Annual Audit for June 30, Director Lara seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion passed. MOTION: Vice Chairman Gerard moved to recess the general session and convene in executive session at 2:10 p.m to obtain legal advice on consent agenda items 3.b.i. and 3.b.ii. Director Bicknell seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion passed. General Session Presentation, Discussion and Action: Chairman Bruno reconvened the general session at 2:45 p.m. MOTION: Vice Chairman Gerard moved to recess the November 23, 2009 Formal meeting and reconvene the November 23, 2009 Executive Session meeting at 2:48 p.m. Director Bicknell seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion passed. General Session Presentation, Discussion and Action: Chairman Bruno reconvened the November 23, 2009 Formal meeting at 6:20 p.m. Chairman Bruno announced that consent agenda items 3.bi. and 3.b.ii. would not be voted on by the Board today. 9. Discuss, Review, Approve and/or Provide Staff with Direction with regard to the Documents related to the Assignment of the 2009 Maricopa Integrated Health System (MIHS)-Medical Professional Associates of Arizona (MedPro) Contract to District Medical Group (DMG) and Consent to Assignment by the District This item was not discussed. 7

31 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont.): 10. Discuss, Review and Approve the District s Position Regarding Current or Proposed State and Federal Legislative Items This item was not discussed. 11. Discussion, Consideration and Action on Employment Agreement with Betsey Bayless as Chief Executive Officer of Maricopa Integrated Health System; Discussion, Consideration and Possible Action on Fiscal Year 2010 Performance Incentive Goals for Chief Executive Officer MOTION: Vice Chairman Gerard move to approve the Employment Agreement between Betsey Bayless and Maricopa Integrated Health System, based on the document received on November 20, 2009 at 3:58 p.m., with the added corrections to the Personal Leave accumulation. Director Patterson seconded. MOTION*: Director Patterson move to amend the contract and change Section 8(d)(ii)(B) from 90 days to one year. Director Lara seconded. Chairman Bruno asked for clarification on Director Patterson s amendment. He questioned the amount of severance Ms. Bayless would receive if she was terminated with less than one year remaining on her contract. Director Patterson suggested adding the phrase or an amount equal to the Executive s Base Salary for the remainder of the current Employment Period, whichever is less to Section 8(d)(ii)(B). He reiterated that this section only applied to termination without cause. VOTE* 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Lara, and Director Patterson. 1 nay: Director Bicknell. Motion passed. MOTION**: Vice Chairman Gerard moved to approve the Employment Agreement between Betsey Bayless and Maricopa Integrated Health System as amended. Director Patterson seconded. VOTE**: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion passed. MOTION: Vice Chairman Gerard moved to approve the Fiscal Year 2010 Performance Incentive Goals for Chief Executive Officer. Director Patterson seconded. MOTION*: Director Patterson moved to amend Goal 4 by reducing the percentages by one, so the new percentages are 10.5% Threshold, 10% Target, and 9.5% Maximum. Director Lara seconded. VOTE*: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion passed. 8

32 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 General Session Presentation, Discussion and Action (cont.): 11. Discussion, Consideration and Action on Employment Agreement with Betsey Bayless as Chief Executive Officer of Maricopa Integrated Health System; Discussion, Consideration and Possible Action on Fiscal Year 2010 Performance Incentive Goals for Chief Executive Officer (cont.) MOTION**: Vice Chairman Gerard moved to approve the Fiscal Year 2010 Performance Incentive Goals for Chief Executive Officer as amended. Director Patterson seconded. VOTE**: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, and Director Patterson. Motion passed. 12. Concluding Items a. Future Agenda Item/Report Calendar i. December a. Quarterly Reports: The Joint Commission Standards Update b. Other: Monthly Quality Report Whole Systems Measures Dashboard ii. January a. Quarterly Reports: Capital Expenditures for 2 nd Quarter FY 2010 Contract Approvals and Asset Disposal for 2 nd Quarter FY 2010 b. Other: Monthly Quality Report Whole Systems Measures Dashboard Employee Satisfaction Survey Results Non-Privileged Patient Care Staff Competency Report Report from the Maricopa Health Center Governing Council b. Board Member Requests for Future Agenda Items or Reports c. Comments i. Chairman and Member Closing Comment ii. Chief Executive Officer Summary of Current Events 9

33 Special Health Care District Board of Directors Meeting Minutes General Session November 23, 2009 Adjourn MOTION: Director Patterson moved to adjourn the November 23, 2009 Special Health Care District Board of Directors formal meeting. Director Bicknell seconded. VOTE: 5 ayes: Chairman Bruno, Vice Chairman Gerard, Director Bicknell, Director Lara, Director Patterson. Motion passed. Meeting adjourned at 6:34 p.m. William Bruno, Chair Special Health Care District Board of Directors 10

34 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.a.iv.

35 Minutes Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Administrative Conference Room December 7, :30 p.m. Present: William Bruno, Chair, District 1 Susan Gerard, Vice Chair, District 3 - telephonically Greg Patterson, Director, District 2 - telephonically Alice Lara, Director, District 5 - telephonically Absent/Excused: Elbert Bicknell, Director, District 4 Others Present: Betsey Bayless, MIHS, Chief Executive Officer Bill Vanaskie, MIHS, Chief Operating Officer Ken Meinke, MIHS, Chief Financial Officer Louis B. Gorman, District Counsel Bill Sims, District Counsel, Moyes Sellers & Sims Recorded by: Melanie Talbot, Clerk of the Board Call to Order Chairman Bruno called the meeting to order at 4:34 p.m. Roll Call Ms. Talbot called roll. Following roll call, it was noted that four of the five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represents a quorum. Vice Chairman Gerard, Director Lara and Director Patterson participated telephonically. For those participating telephonically, Ms. Talbot named the individuals present at the meeting. Call to the Public Chairman Bruno called for public comment. Dr. Kote Chundu, Chairman of the MedPro Board of Directors, thanked MIHS staff and attorneys for their time and hard work during MedPro s transition from a for-profit to a not-for-profit 501c(3). The MedPro Board began exploring the idea of reorganizing as a not-for-profit organization over three years ago. A key consideration was a closer alignment with Maricopa Integrated Health System.

36 Special Health Care District Board of Directors Meeting Minutes General Session December 7, 2009 General Session Presentation, Discussion and Action: 1. Motion to Recess General Session and Convene in Executive Session MOTION: Vice Chairman Gerard moved to recess the general session and convene in executive session at 4:37 p.m. Director Lara seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Lara, Director Patterson. 1 absent: Director Bicknell. Motion passed. General Session Presentation, Discussion and Action: Chairman Bruno reconvened the general session at 4:48 p.m. 2. Discuss, Review, Approve and/or Provide Staff with Direction with regard to the Documents related to the Assignment of the 2009 Maricopa Integrated Health System (MIHS)-Medical Professional Associates of Arizona (MedPro) Contract to District Medical Group (DMG) and Consent to Assignment by the District Ms. Bayless recommended the Board of Directors approve the consent to assignment. MOTION: Chairman Bruno moved to approve the assignment of the 2009 Maricopa Integrated Health System/Medical Professional Associates of Arizona contract to District Medical Group. Vice Chairman Gerard seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Lara, Director Patterson. 1 absent: Director Bicknell. Motion passed. Adjourn MOTION: Director Lara moved to adjourn the December 7, 2009 Special Health Care District Board of Directors special meeting. Vice Chairman Gerard seconded. VOTE: 4 ayes: Chairman Bruno, Vice Chairman Gerard, Director Lara, Director Patterson. 1 absent: Director Bicknell. Motion passed. Meeting adjourned at 4:50 p.m. William Bruno, Chair Special Health Care District Board of Directors 2

37 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.b.i.

38 Maricopa Integrated Health System Procurement 2601 E. Roosevelt Phoenix, AZ Phone: (602) Fax: (602) DATE: January 8, 2010 TO: Bil Bruno, Chair, District 1 Susan Gerard, Vice Chair, District 3 Greg Patterson, Director, District 2 Elbert Bicknell, Director, District 4 Alice Lara, Director, District 5 CC: FROM: SUBJECT: Betsey Bayless, Chief Executive Office Melanie Talbot, Clerk of the Board Office of Compliance, Contracts Administration Assessment of Contractors Fulfillment of HIPAA Insurance and HIPAA Audit Requirements At the November 2009 MIHS Board of Directors meeting, the Board requested the following questions be answered regarding two proposed contracts that involved the handling of patient protected health information: A. Does the Contractor have insurance to indemnify MIHS in the event the Contractor violates HIPAA? B. Has the Contractor been audited for HIPAA Security Compliance? The following are the answers to the Board s questions. 1. Contract (C ) between Healthcare Reports.com, LLC (contractor) and MIHS: Contractor has submitted proof of Errors & Omissions (E&O) insurance coverage for HIPAA liability, $1 million for each claim, $3 million in the aggregate. (Under the HITECH Act, the maximum penalty imposed for violations of an identical provision in a calendar year is $1,500, ) Contractor has submitted a copy of its technical capabilities document. Contractor has signed the MIHS HITECH Business Associate Agreement. Contractor has not been audited for HIPAA Security. The proposed contract stipulates the Contractor will engage an outside firm to perform a HIPAA Security audit for HIPAA compliance, provide a copy of the audit report findings to MIHS, and provide documentation of any deficiencies with an action plan to

39 correct the identified deficiencies. Failure to undergo the HIPAA Security audit and/or provide proof of remediation of deficiencies can lead to termination of the contract. 2. Contract (C ) between Integrated Health Management Services, LLC (contractor) and MIHS: Contractor has submitted proof of Errors & Omissions (E&O) insurance coverage for HIPAA liability, $1 million for each claim, $3 million in the aggregate. (Under the HITECH Act, the maximum penalty imposed for violations of an identical provision in a calendar year is $1,500, ) Contractor has been audited for HIPAA Security by an independent auditor and has provided a copy of the audit report findings. Contractor has submitted a copy of its HIPAA Security policies. Contractor has signed the MIHS HITECH Business Associate Agreement.

40 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT dba MARICOPA INTEGATED HEALTH SYSTEM CONTRACT ROUTING APPROVAL FORM Approval Type: X Board of Directors CEO Article 2 CONTRACT NUMBER: C NEW CONTRACT X AMENDMENT REQUESTING DEPARTMENT: Business Office PROCUREMENT/CONTRACT OFFICER: Thomas Kealy EXT PROPOSED ACTION (MOTION): Approve Amendment #2 to the contract between Healthcare Reports.com, LLC (Contractor) and Maricopa County Special Health Care District dba Maricopa Integrated Health System (MIHS) for Document Scanning and Indexing Services to extend the contract term for one additional year. HISTORICAL BACKGROUND/DISCUSSION: Healthcare Reports.com, LLC provides staff and equipment to scan various collection documents and functions as a re-depository for active documents via secure web-based server applications. The contractor also indexes collection documents into MIHS specific work lists and tracks collections documents according to MIHS defined timetables while ensuring compliance with HIPAA and other regulatory requirement. This Amendment #2 will extend the contract term for one additional year from January 5, 2010 to January 4, 2011 for an aggregate term of January 5, 2007 to January 4, Either party may terminate the contract upon ninety (90) days written notice. EVALUATION PROCESS: The requesting department has determined that the Contractor is performing satisfactorily and is meeting the goals and objectives of the organization. The requesting department has elected that the contract should be continued and extended. FINANCIAL IMPLICATIONS: The anticipated annual expense is $513,000 and has been budgeted for operational expenditures from cost center The anticipated fiscal year budget impact is $246,000 for the remainder of FY2010. BUDGETED: X YES NO N/A THE ABOVE NAMED CONTRACT/DOCUMENT HAS RECEIVED ALL INTERNAL APPROVALS AND IS READY FOR SIGNATURE BY APPROPRIATE MIHS AUTHORITY: PROCUREMENT OFFICER DATE BOARD OF DIRECTORS ACTION: APPROVED DISAPPROVED CLERK OF THE BOARD DATE

41 Workflow Manager Review WORKFLOW MANAGER DOCUMENT REVIEW REVIEW SECTION Printer Friendly Page... Start Date: 10/15/2009 6:58:00 PM End Date: 10/18/ :22:00 AM Revised Document: (No Document Available) Attachment 1: (No Document Available) Attachment 2: (No Document Available) Attachment 3: (No Document Available) Attachment 4: (No Document Available) Comments: Received. This item will be placed on the agenda for the November 2009 Maricopa County Special Health Care District Board of Directors formal meeting. REVIEWER SEQUENCE STATUS BRIAN MANESS 1 DONE - Oct :24PM Kathy Benaquista 2 DONE - Oct :13PM Mary Lee DeCoster 3 DONE - Oct :26PM Louis Gorman 4 DONE - Oct :30PM Kenneth Meinke 5 DONE - Oct :42PM Betsey Bayless 6 DONE - Oct :58PM Melanie Talbot 7 DONE - Oct :22AM ORIGINAL DOCUMENT SECTION Subject: Category: Review Type: Time Limit: HealthcareReports.com*Contract Extension*Document Scanning and Indexing Services Board of Directors One Reviewer at a Time Keep Sending Reminders After Time Limit Expires No. of Days: 0 Notification: Each Reviewer Author: Thomas Kealy Status: Review Completed Date: Oct 15, 2009 Status Date: Oct 18, 2009 Original Attachment: Attachment 1: Attachment 2: Attachment 3: Attachment 4: HealthcareReports.com*Contract Extension*Document Scanning and Indexing Services (No Document Available) (No Document Available) (No Document Available) (No Document Available) (1 of 2)10/18/2009 8:22:42 AM

42 Workflow Manager Document Summary WORKFLOW MANAGER DOCUMENT Subject: Category: Review Type: Time Limit: HealthcareReports.com*Contract Extension*Document Scanning and Indexing Services Board of Directors One Reviewer at a Time Keep Sending Reminders After Time Limit Expires No. of Days: 0 Notification: Each Reviewer Author: Thomas Kealy Status: Review Completed Date: Oct 15, 2009 Status Date: Oct 18, 2009 HealthcareReports.com*Contract Extension*Document Scanning Main Document: and Indexing Services Attachment 1: (No Document Available) Attachment 2: (No Document Available) Attachment 3: (No Document Available) Attachment 4: (No Document Available) Comments: (No Comment Available) REVIEWER COMMENTS BRIAN MANESS -- 10/15/2009 3:24:00 PM Ok to route for approvals. Kathy Benaquista -- 10/15/2009 4:13:00 PM Approved Mary Lee DeCoster -- 10/15/2009 4:26:00 PM Reviewed and approved. ML DeCoster Louis Gorman -- 10/15/2009 6:30:00 PM approve Kenneth Meinke -- 10/15/2009 6:42:00 PM approved Betsey Bayless -- 10/15/2009 6:58:00 PM Approve Melanie Talbot -- 10/18/ :22:00 AM Received. This item will be placed on the agenda for the November 2009 Maricopa County Special Health Care District Board of Directors formal meeting. 8:23:03 AM

43 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.b.ii.

44 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT dba MARICOPA INTEGATED HEALTH SYSTEM CONTRACT ROUTING APPROVAL FORM Approval Type: X Board of Directors CEO Article 2 CONTRACT NUMBER: C X NEW CONTRACT AMENDMENT REQUESTING DEPARTMENT: Patient Registration PROCUREMENT/CONTRACT OFFICER: Thomas Kealy EXT PROPOSED ACTION (MOTION): Approve a new contract between Integrated Health Management Services, LLC (Contractor) and Maricopa County Special Health Care District dba Maricopa Integrated Health System (MIHS) for Medical Eligibility and Verification Services. HISTORICAL BACKGROUND/DISCUSSION: The purpose of this agreement is to provide Medical Eligibility and Verification Services with the intent to assist all patients and their families presented to any MIHS facility, including Maricopa Medical Center to apply for all medical assistance programs offered by the State of Arizona. The Contractor possesses the knowledge of and will provide education to patients regarding Arizona Health Care Cost Containment System (AHCCCS), Department of Economic Security (DES), Supplemental Security Income (SSI) and Medicaid requirements and regulations. The initial contract term is from December 1, 2009 to November 30, 2011 and may be extended for additional periods up to a maximum contract term of five (5) years from the Effective Date. Either party may terminate the contract upon ninety (90) days written notice. EVALUATION PROCESS: Contracts Management issued a Request for Proposals ( RFP) for Medical Eligibility and Verification Services. Proposals were due on July 31, Nine (9) responses were received. All bidders were evaluated based on the criteria set forth in the RFP. The nine proposers were then shortlisted to three (3) finalists who were then invited in to provide oral presentations to the evaluation committee. Integrated Health Management Services demonstrated their ability to best meet the RFP requirements and the evaluation committee has recommended awarding the contract to the Contractor to provide this service to MIHS. FINANCIAL IMPLICATIONS: The anticipated annual expense is $1,590,000 and has been budgeted for operational expenditures from cost center The original quoted price by the Contractor during the RFP process was $2,075,000 resulting in a cost savings of $485,000. The anticipated fiscal year budget impact is $928,000 for the remainder of FY2010. BUDGETED: X YES NO N/A THE ABOVE NAMED CONTRACT/DOCUMENT HAS RECEIVED ALL INTERNAL APPROVALS AND IS READY FOR SIGNATURE BY APPROPRIATE MIHS AUTHORITY: PROCUREMENT OFFICER DATE BOARD OF DIRECTORS ACTION (IF APPLICABLE): APPROVED DISAPPROVED CLERK OF THE BOARD DATE

45 Workflow Manager Review WORKFLOW MANAGER DOCUMENT REVIEW REVIEW SECTION Printer Friendly Page... Start Date: 10/19/2009 2:19:00 PM End Date: 10/19/2009 2:29:00 PM Revised Document: (No Document Available) Attachment 1: (No Document Available) Attachment 2: (No Document Available) Attachment 3: (No Document Available) Attachment 4: (No Document Available) Comments: Received. This item will be placed on the agenda for the November 2009 Maricopa County Special Health Care District Board of Directors formal meeting. REVIEWER SEQUENCE STATUS BRIAN MANESS 1 DONE - Oct :36AM Kathy Benaquista 2 DONE - Oct :58PM Mary Lee DeCoster 3 DONE - Oct :11PM Louis Gorman 4 DONE - Oct :31PM Kenneth Meinke 5 DONE - Oct :33PM Betsey Bayless 6 DONE - Oct :19PM Melanie Talbot 7 DONE - Oct :29PM ORIGINAL DOCUMENT SECTION Subject: Category: Review Type: Time Limit: Health Information Management Services, LLC*New Contract*Medical Eligibility and Verification Services Board of Directors One Reviewer at a Time Keep Sending Reminders After Time Limit Expires No. of Days: 0 Notification: Each Reviewer Author: Thomas Kealy Status: Review Completed Date: Oct 16, 2009 Status Date: Oct 19, 2009 Original Attachment: Attachment 1: Attachment 2: Attachment 3: Attachment 4: Health Information Management Services, LLC*New Contract*Medical Eligibility and Verification Services (No Document Available) (No Document Available) (No Document Available) (No Document Available) (1 of 2)10/19/ :29:16 AM

46 Workflow Manager Document Summary WORKFLOW MANAGER DOCUMENT Subject: Category: Review Type: Time Limit: Health Information Management Services, LLC*New Contract*Medical Eligibility and Verification Services Board of Directors One Reviewer at a Time Keep Sending Reminders After Time Limit Expires No. of Days: 0 Notification: Each Reviewer Author: Thomas Kealy Status: Review Completed Date: Oct 16, 2009 Status Date: Oct 19, 2009 Health Information Management Services, LLC*New Main Document: Contract*Medical Eligibility and Verification Services Attachment 1: (No Document Available) Attachment 2: (No Document Available) Attachment 3: (No Document Available) Attachment 4: (No Document Available) Comments: (No Comment Available) REVIEWER COMMENTS BRIAN MANESS -- 10/19/ :36:00 AM Ok to route for approvals. Kathy Benaquista -- 10/19/ :58:00 PM Approved Mary Lee DeCoster -- 10/19/2009 1:11:00 PM The document's title is erroneous. The name of the company selected is Integrated Health Management Services [not Health Information Management Services]. Please correct the reference to the Main Document. Otherwise, approved. ML DeCoster Louis Gorman -- 10/19/2009 1:31:00 PM approve Kenneth Meinke -- 10/19/2009 1:33:00 PM approved Betsey Bayless -- 10/19/2009 2:19:00 PM Approve Melanie Talbot -- 10/19/2009 2:29:00 PM Received. This item will be placed on the agenda for the November 2009 Maricopa County Special (1 of 2)10/19/ :29:26 AM

47 Workflow Manager Document Summary Health Care District Board of Directors formal meeting. (2 of 2)10/19/ :29:26 AM

48 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.c.i.

49 Maricopa Medical Center 2601 E. Roosevelt Phoenix, Arizona Comprehensive Healthcare Center 2525 E. Roosevelt St. Phoenix, AZ Desert Vista Behavioral Health Center 270 W. Brown Rd. Mesa, AZ Complete Comfort Care 2611 E. Pierce St. Phoenix, AZ Family Health Centers: Avondale 950 E Van Buren Avondale, AZ Chandler 811 S. Hamilton Chandler, AZ El Mirage W. Thunderbird El Mirage, AZ Glendale 5141 W. Lamar Glendale, AZ Guadalupe 5825 E. Calle Guadalupe Guadalupe, AZ Maryvale 4011 N. 51st Ave Phoenix, AZ McDowell 1144 E. McDowell Rd, Ste 300 Phoenix, AZ Mesa 59 S. Hibbert Mesa, AZ To: Bil Bruno, Chair, District 1 Susan Gerard- Vice Chair, District 3 Greg Patterson, Director, District 2 Elbert Bicknell, Director, District 4 Alice Lara, Director, District 5 From: CC: Louis B. Gorman, District Counsel Robert E. Fromm, M.D., MIHS CMO Carol Kline Olson, M.D., Chair, MIHS Department of Psychiatry Date: November 30, 2009 Re: Affidavit Appointing Deputy Medical Director: Dr. Dennis Weimer and Dr. Diane Park It is the practice of the Department of Psychiatry to have all attending staff on the Inpatient Services designated as Deputy Medical Directors, primarily to facilitate the signing of a myriad of documents and paperwork related to patients undergoing court-ordered evaluation and treatment. To implement this practice, the Department submits this list of the attending(s) that will be functioning as Deputy Medical Directors and sought signature approval from the CEO. As A.R.S , requires that such appointments be approved by the governing body, the Department now requests that the Board of Directors approve the attached Affidavit appointing Dr. Dennis Weimer and Dr. Diane Park, attending psychiatrists at Desert Vista and the Psychiatric Annex, as Deputy Medical Directors for these facilities. Seventh Avenue 1407 S. 9th Ave Phoenix, AZ South Central 33 W. Tamarisk Phoenix, AZ Sunnyslope 934 W. Hatcher Phoenix, AZ Affiliated with the University of Arizona College of Medicine and the Mayo Graduate School of Medicine Page 1 of 1

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54 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.c.ii.

55 HEALTHCARE COMPUTER CORPORATION OF AMERICA Managed Care Information P.O. Box Denver CO HMO-INFO FAX: ARIZONA MANAGED CARE NEWSLETTER 2010 WINTER STATE OF THE STATE MEETING Special Early Registration Expires 11/30/09 National Health Care Reform & A Tight Arizona Budget What s Next? There s a lot of action in Washington and in Arizona as the Congress is working toward having a Health Care Reform bill on the President s desk by Christmas and Arizona continues to wrestle with a declining tax base and an ongoing battle between a Republican Governor and a Republican dominated legislature over managing the State s finances. How will it affect you? Come and participate in the discussion as industry experts and those with real world experience join Arizona Managed Care s Publisher, Jim Hertel to look at what last year s elections have wrought and how Arizona is adjusting. Our sponsors for this program include: Aetna, Altius Healthcare, Arizona Foundation for Medical Care, BCBS of Arizona, Health Net, Health South, Humana, Serenity Hospice, and Sonora Quest. Join us on the National Day for Health Care Reform* (February 2 nd ) in Phoenix. We ve invited Bill Murray, of course. REGISTER EARLY AS LAST YEAR WE SOLD OUT! (* as designated by Arizona Managed Care ) ONE RESERVATION FORM PER ATTENDEE: Please check one meeting. Tucson BREAKFAST Phoenix BREAKFAST Friday, January 29, 2010 Tuesday, February 2, 2010 The Arizona Inn The Pointe Hilton at Squaw Peak Program from 7:45 to 9:30am Program from 7:45 to 9:30am Networking until 10:00am Networking until 10:00am Registration starts at 7:15am Registration starts at 7:00am Name: Title: Firm: Address: City: State: ZIP: Phone: FAX: Indicate credit card charge or amount of check enclosed: AZ Managed Care Newsletter subscriber: OR Other Interested Person*: $75 until 11/30, $90 until 12/31, $100 after $100 until 11/30 $115 until 12/31, $125 after *Want to become a Subscriber and use the Subscriber rate? Add $100 for 6 months: Total Registrations can be reassigned, BUT NO REFUNDS AFTER December 31, 2009! Fax this registration to 888-HMO-2FAX ( ), or send a check and your form to: HealthCare Computer Corporation of America P.O. Box Denver CO CREDIT CARD TYPE: Visa: MasterCard: American Express: Name on Card: Card Number: Expiration Date: Zip Code for the Address to Which Statement is sent:

56 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.c.iii.

57 Managing Accreditation in the Physical Environment 2010 Seminar Safety Management Services, Inc. Page 1 of 1 1/7/2010 Home Meet the Staff What People Say Program Objectives Agenda Registration and Fees Schedule & Locations About The Sponsor 1502 N. Arlington Heights Road Arlington Heights, IL Toll Free (877) Website Design by INT - Buffalo Grove, IL

58 Managing Accreditation in the Physical Environment 2010 Seminar Safety Management Services, Inc. Page 1 of 1 1/7/2010 Home Meet the Staff What People Say Program Objectives Agenda Registration and Fees Schedule & Locations About The Sponsor Program Objectives Managing Accreditation in the Physical Environment This seminar will focus key aspects of the accreditation processes for healthcare organizations with particular emphasis on critical components of The Joint Commission survey process as it relates to the Physical Environment [Environment of Care (EC), Life Safety (LS), Emergency Management (EM)]. Attendees will learn how to integrate these aspects of the standards into their existing programs and will be given numero sample tools for supporting their accreditation survey preparation process. The nationally-recognized faculty will provide clear and survey-proven direction for developing and implementing: The e-soc process Life Safety Code compliance Performance measurement & monitoring Organization of survey documentation Attendees will be given specific information guidance for developing processes for: Building inspection for NFPA 101 (2000 edition) Life Safety Code compliance Strategies for completing the esoc /epfi Strategies and methods of performance measurement in the Environment of Care Specific lists of potential performance measures for each of the Environment of Care areas Tools and methods for organizing survey documents Each attendee will receive an SMS Inc. CD-R Toolbox for the Physical Environment that contains numerous documents relative to the 2010 standards, including: sample Management plans, policies, data collection tools, and forms. In addition, each attendee will receive a free 60 day trial to SMS Inc. s EC-Online web site, which contains thousands of pages of sample policies, procedures, forms. This trial access will also giv the user access to the Ask the EC Expert section which will allow them to ask for expert code interpretations related to TJC, NFPA, OSHA, AOA, DNV, CMS and other regulators at no charge over the trial period N. Arlington Heights Road Arlington Heights, IL Toll Free (877) Website Design by INT - Buffalo Grove, IL

59 Managing Accreditation in the Physical Environment 2010 Seminar Safety Management Services, Inc. Page 1 of 1 1/7/2010 Home Meet the Staff What People Say Program Objectives Agenda Registration and Fees Schedule & Locations About The Sponsor Agenda Managing Accreditation in the Physical Environment 8:30 9:00 Healthcare Accreditation Options (CMS, TJC, AOA DNV) 9:00 10:00 The Joint Commission Scoring Process 10:00 11:00 Managing the esoc Process 11:00 12:00 Fundamentals of the Life Safety Code, NFPA :00 1:00 Lunch 1:00 2:00 Fundamentals of the Life Safety Code, NFPA 101 (cont.) 2:00 2:30 Performance Measurement & Monitoring 2:30 3:15 Organizing documents for survey 3:15 3:45 Questions & answers 1502 N. Arlington Heights Road Arlington Heights, IL Toll Free (877) Website Design by INT - Buffalo Grove, IL

60 Managing Accreditation in the Physical Environment 2010 Seminar Safety Management Services, Inc. Page 1 of 1 1/7/2010 Home Meet the Staff What People Say Program Objectives Agenda Registration and Fees Schedule & Locations About The Sponsor Schedule NEW YORK Thursday, January 14, :00 am 5:00 pm New York-Presbyterian Hospital: Weill Cornell 525 East 68th St New, York, NY PHOENIX Wednesday, February 3, :00 am 4:00 pm Banner Good Samaritan Medical Center 1111 East McDowell Road Phoenix, AZ ST. LOUIS - Monday, February 22, :00 am 5:00 pm St. Mary s Health Center 6420 Clayton Rd Richmond Heights, MO N. Arlington Heights Road Arlington Heights, IL Toll Free (877) Website Design by INT - Buffalo Grove, IL

61 Maricopa County Special Health Care District Board of Directors Formal Meeting January 25, 2010 Item 1.c.iv.

62 Leadership Conference for trustees, physicians, executives, & nurse executives The Grand Del Mar San Diego, California March 7 10, 2010 Toll Free (877) Greenwich Drive Suite 200 San Diego, CA GovernanceInstitute.com

63 march leadership conference Nationally recognized as the preeminent source for unbiased governance information, The Governance Institute provides essential knowledge and solutions for hospital and health system trustees, physician leaders, and executive management to achieve excellence in governance. Through our Leadership Conferences, The Governance Institute offers current information, interactive sessions, expert speakers, and the opportunity to meet others with a similar commitment to improving governance and achieving optimal board performance. The 2010 conference programs are based on The Governance Institute s 2010 Education Agenda, available for download at GovernanceInstitute.com. Conference Learning Objectives: Understand the value of an effective board and the roles and responsibilities associated with being a board member. Have greater awareness of board member accountability, the need for transparency, and how to achieve organizational integrity. Address finance, quality and patient safety, and information technology issues to create positive change in your organization. Make sound strategic decisions and develop both short- and long-term strategic goals. Discover new and practical ways to deal with the challenges of today s changing healthcare environment. featured speakers Robert M. Wachter, M.D. professor & associate chairman, department of medicine University of California, San Francisco Nathan S. Kaufman managing director Kaufman Strategic Advisors Thomas A. Atchison, Ed.D. president & founder Atchison Consulting Group, LLC Richard L. Clarke, FHFMA president & ceo Healthcare Financial Management Association Michael R. Irwin, M.B.A. managing director, healthcare finance group Citi Markets & Banking Guy M. Masters, M.P.A. senior vice president The Camden Group Anne M. McGeorge national managing partner, health care practice Grant Thornton, LLP

64 conference program 12:00 p.m. 1:30 4:00 p.m. Concurrent Sessions 4:30 6:00 p.m. General Session 6:00 7:00 p.m. 7:00 a.m. 8:00 9:30 a.m. General Session 9:45 10:45 a.m. Concurrent Sessions 11:00 a.m. 12:30 p.m. General Session 10:00 11:30 a.m. General Session 12:30 p.m. sunday, march 7 REGISTRATION GovERNANce & LEAdERShip Board Fundamentals Roger W. Witalis, FACHE, President, WITALIS & Company, Inc. Given the intense focus on board performance, accountability, and transparency, it is now more important than ever for board members to understand their fiduciary duties and core responsibilities. This session provides an update on those topics and explores recent research from The Governance Institute on recommended practices for boards. HEALThcARE TRENDS Futurescan Healthcare Trends & Implications, Thomas C. Dolan, Ph.D., FACHE, CAE, President & CEO, American College of Healthcare Executives James A. Rice, Ph.D., FACHE, Vice Chairman, The Governance Institute Developed by a panel of experts, Futurescan highlights key trend areas that are impacting the nation's healthcare organizations, such as economic outlook, payment reform, physician-hospital integration, genomic medicine, information technology, and nursing. This interactive session will demonstrate how to use Futurescan insights in new strategic visioning charrettes. governance & LEADERSHIP Effective Communication & Teamwork Skills Thomas A. Atchison, Ed.D., President & Founder, Atchison Consulting Group, LLC This session will show attendees how to use effective communication to engage various groups in your strategy, ways to avoid conflict and manage it when it happens, and why teamwork is critical today. healthcare TRENds Have We Finally Reached the Age of Rationing Healthcare? Robert M. Wachter, M.D., Professor & Associate Chairman, Department of Medicine, University of California, San Francisco Rationing was a hot button issue during the healthcare reform debate. Dr. Robert Wachter, a leading expert on health policy, safety, and quality, discusses the ethical and pragmatic arguments for and against rationing, and offers a vision of where rationing will fit into our continuing debate over healthcare needs and wants. reception monday, march 8 continental breakfast financial & capital planning The Antidote for the Perils of Healthcare Reform or What Healthcare Can Learn From the Automobile Industry Nathan S. Kaufman, Managing Director, Kaufman Strategic Advisors Under healthcare reform, Medicare reimbursement per unit of service will not keep pace with cost inflation and may actually be reduced. Traditional means of subsidizing the under-funding will not be sufficient to achieve optimal performance in the future. Hospitals and physicians must collaborate in new ways through employment and clinical integration to provide more and better care at lower cost. financial & capital planning Achieving Financial Success Through Positioning for Healthcare Reform Nathan S. Kaufman Mr. Kaufman will discuss critical success factors for successful managed care negotiations specific steps, financial modeling, appropriate targets, and planning for term. Best practices for employing physicians will be delineated including organizational structure, compensation, and other key elements. Learn pros and cons of physician engagement tactics including directorships, joint ventures, and ED call pay. SETTING STRATEGIC DIRECTION Board Ceo Strategic Relations for Enhanced Performance: New Strategies for Performance Management & Succession Planning James A. Rice, Ph.D., FACHE As the pressure builds for more transparent and accountable performance, boards and CEOs are exploring new approaches for "enhanced performance at the intersection" of board, CEO, and physician leaders. New insights will be shared about best practices for executive leadership development, appraisal, succession and continuity initiatives, and pay-for-performance incentive compensation. LEGAL & REGULATORY ISSUES Legal & Regulatory Aspects of Hospital Physician Collaboration David L. Klatsky, Esq., Partner, McDermott Will & Emery LLP Increased collaboration among hospitals and physicians in controlling costs and improving clinical outcomes is widely viewed as necessary to meaningful healthcare reform. Mr. Klatsky will discuss the principal legal and regulatory issues that hospitals must consider in structuring physician cost efficiency and quality incentives and will offer practical examples of how these challenges can be addressed. governance & LEAdERShip How Leaders Manage Change During Difficult Times Thomas A. Atchison, Ed.D. Dr. Atchison will examine the different and complimentary roles of leadership and management, why a strong culture of performance is critical to success, how to align physician leadership in a culture of performance, and what can go wrong. lunch

65 1:30 3:00 p.m. Concurrent Sessions 7:00 a.m. 8:00 9:30 a.m. General Session 9:45 11:15 a.m. General Session 11:30 a.m. 12:30 p.m. Concurrent Sessions 7:00 a.m. 8:00 9:30 a.m. General Session 10:00 11:30 a.m. General Session 11:30 a.m. governance & leadership Strengthening Your Leadership Style Thomas A. Atchison, Ed.D. Leaders inspire followers to achieve their potential for the good of the patient and the community. This session will provide simple assessments of an individual s leadership skills, and show how and why effective leadership is the most important determinant of success. SCIENCE & TECHNOLOGY Move to the Front of the Health Information Technology Revolution Maria A. Friedman, D.B.A., President, Brookside Consulting Group New legislation, federal mandates, and state activities will soon require hospitals and health systems to implement health information technologies and policies in a very short time frame. This presentation will explore the policy and implementation landscapes and what providers need to follow to be well positioned for the future. PHILANTHROPY Innovations to Expand Community Benefits: Insights from Past Winners of the Foster G. McGaw Prize James A. Rice, Ph.D., FACHE Boards and CEOs are developing more creative and expansive strategies to protect their tax exemption status and build productive relations with their communities for growth in both philanthropy and market position. Explore findings from a study of successful alliances and arrangements observed by Dr. Rice during his association with the Foster G. McGaw Award Program. tuesday, march 9 Continental Breakfast healthcare trends Payment Reform: Strategic Imperatives for Healthcare Organizations Richard L. Clarke, FHFMA, President & CEO, Healthcare Financial Management Association As healthcare reform proposals were debated during the past year, a myriad of payment strategies and tactics were constructed, and deconstructed. Now the fundamental shift is clear, and the movement from fragmented, volume-based payments to a unified, quality-driven payment system is under way. Mr. Clarke will discuss strategic imperatives for healthcare organizations to succeed under payment reform. financial & capital planning Wall Street Report Michael R. Irwin, M.B.A., Managing Director, Healthcare Finance Group, Citi Markets & Banking The capital markets have shown remarkable resiliency as the credit crisis has waned. However, challenges to capital access remain for many healthcare organizations. This session will look at the "new normal" for rating agency analysts and investors and the implications for not-forprofit hospitals and health systems. FINANCIAL & CAPITAL PLANNING The Case for Scale & Integration Michael R. Irwin, M.B.A. Even before considering the implications of comprehensive healthcare reform coming from Washington, healthcare providers were confronting challenges which support greater scale and a higher degree of integration. This session will evaluate the rationale for consolidation and discuss how some healthcare organizations are strategically adapting. SCIENCE & TECHNOLOGY What the Leadership Team Needs to Know About E-Prescribing Maria A. Friedman, D.B.A. E-prescribing is the "low-hanging fruit" of health information technology implementation. This presentation describes how it works, government mandates for its use, its multiple benefits for providers and patients, and opportunities for the future. SETTING STRATEGIC DIRECTION Key Competencies for Success Under Payment Reform Richard L. Clarke, FHFMA Every organization must outline unique strategies and actions to succeed under payment reform. Learn how to assess your organization s readiness for success, and understand how to enhance the key competencies of integration, risk management, and pricing to help your organization position itself for sustainable success in an era of payment reform. Wednesday, march 10 Continental Breakfast setting strategic direction Thriving in Turbulent Times: Seven Steps to an Extraordinary Strategic Plan Guy M. Masters, M.P.A., Senior Vice President, The Camden Group Turbulent times create chaos for some organizations and opportunity for others. What makes the difference? Will your organization simply survive, or thrive? Mr. Masters will explore strategic planning processes that capitalize on opportunities created by payment changes, market shifts, competitor activities, and new delivery models. You will never look at your strategic and financial operating plans the same way again. governance & leadership The Current Economic Crisis: Governance Strategies to Improve Your Bottom Line Anne M. McGeorge, National Managing Partner, Health Care Practice, Grant Thornton LLP This session will discuss governance imperatives to help your hospital thrive in the current economy. The Governance Institute s survey on governance structures and practices will be discussed with recommendations regarding increasing revenue streams, cost containment strategies, assessing capital capacity, realigning debt, and reexamining strategic plans. Adjourn

66 hotel information About the grand del mar Serenely nestled amidst San Diego s Los Peñasquitos Canyon Preserve and a mere five miles from the Pacific coastline The Grand Del Mar seamlessly combines the old-world charm of a Mediterranean estate with the modern luxury and comfort of an elegant resort. The result is a destination lauded by Condé Nast Traveler as one of The World's Best Places to Stay. Little wonder, given the sun-drenched climate, stunning natural beauty, championship golf course, award-winning spa and irresistible dining epitomized by Addison, Southern California's only Five Star and Five Diamond restaurant. Address The Grand Del Mar 5300 Grand Del Mar Court San Diego, California Hotel phone: (858) Hotel fax: (858) Hotel Reservations There are a limited number of rooms at The Governance Institute rate, so make your room reservations as early as possible. Hotel accommodations are the responsibility of each attendee; conference registration does not secure your room. Reservations phone: (888) Reservations fax: (858) Check in: 4:00 p.m. Check out: 12:00 p.m. Room rate: $355* (SGL/DBL) All reservations must be made by February 3, 2010 to secure this rate. Should the room block become full before February 3, reservations will be accepted on rate/space availability. *Note: Room rate includes a number of amenities and services, including fitness classes, fitness center use, in-room internet access, and courtesy transportation within a 14-mile radius. Cancellation Policy Reservations cancelled within seven days of arrival will be subject to a cancellation penalty of one night's room and taxes. All rates are subject to applicable taxes. A deposit equal to one night s stay, including tax, will be recorded seven days prior to arrival. Valid credit card is required at time of booking. Companion program golf tournament balboa park tour & lunch in old town Monday, March 8, :00 a.m. 3:00 p.m. Enjoy an informative journey through America s Finest City. The trip begins in Balboa Park with a guided tour of its many museums and galleries housed in buildings built in the Spanish-Moorish style of architecture. Next participants will head to picturesque Old Town the first European settlement in California and enjoy an authentic Mexican lunch at Fred s Cantina. There will be free time to admire the unique shops, sample local fare, and explore the historic displays. the grand golf club Tuesday, March 9, :00 p.m. Shotgun start. Lunch included. Brief reception immediately following. Melding extreme playability with the resort s serene natural setting, the 7,160-yard par-72 golf course spreads over more than 380 lush acres. Lending his legendary artistic ability to blend the challenge of championship golf with the inherent aesthetics of a given region, Tom Fazio designed an 18-hole marvel with a variety of tee locations spanning from 4,824 to 7,160 yards in length, accommodating all levels of play. Cascading water features, marble crush bunker sand, scenic valleys beyond elevated tees, and lush fairways enhance the optimum playing conditions throughout the year.

67 ongoing governance education medical leadership institute The Governance Institute is proud to provide comprehensive and timely information, practical tools, and conferences to prepare medical staffs for the challenges of leadership. At all Governance Institute Leadership Conferences, sessions will be offered to provide a specific focus for physician leaders and cover important issues for hospital board members to better understand the board s relationship with the medical staff. In addition the Medical Leadership Institute offers the following conferences: April 11 13, 2010 October 3 5, 2010 Medical Leadership Institute Spring Conference The Ritz-Carlton, Naples, Naples, Florida Medical Leadership Institute Fall Conference La Costa Resort and Spa, Carlsbad, California To register or to find more information, please visit GovernanceInstitute.com. conference moderator For the last nine years, attendees at The Governance Institute Leadership Conferences have seen moderator Lynn Phillips as he introduces the general sessions, updates attendees on ongoing educational activities at The Governance Institute, and keeps sessions on schedule. Lynn comes to The Governance Institute having served 32 years as an associate producer for fundraising for non-profit organizations, and as a senior manager for a major publishing company. He uses that experience and talent to bring attendees together, facilitate discovery, and be an ambassador for an enjoyable experience at The Governance Institute Leadership Conferences. In addition, Mr. Phillips serves as a partnership executive for The Governance Institute. In this role, he is creating partnerships to support all of our governance education, services, and products. continuing education credits available ACCME: The Governance Institute is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Governance Institute designates this educational activity for 16.5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. ACHE: The Governance Institute is authorized to award 16.5 credits of preapproved Category II (non-ache) continuing education credit for this program toward advancement, or recertification in the American College of Health Executives. Participants in this program wishing to have the continuing education hours applied toward Category II credit should indicate their attendance when submitting application to the American College of Healthcare Executives for advancement or recertification. Nursing continuing education contact hours provided by Nenner Enterprises, Inc. approved by the California Board of Registered Nursing, Provider #15191 for contact hours, depending on the number of sessions actually attended. gavel certificates The Governance Institute provides certificates of achievement for distinguished levels of participation in healthcare governance education. Acknowledge trustees and executive team members for their commitment to staying informed about key healthcare issues. Please call (877) to determine your organization s level of achievement and request your certificate: Silver Gavel: Attend 2 Governance Institute Leadership Conferences in a 2-year period. Gold Gavel: Attend 3 Governance Institute Leadership Conferences in a 3-year period. Platinum Gavel: Attend 4 Governance Institute Leadership Conferences in a 4-year period. partnership The Governance Institute thanks Premier Partners Broadlane and Kaufman, Hall & Associates, Inc. for their continuing support of excellence in healthcare governance. For more information regarding partnership, please visit GovernanceInstitute.com/Partnership. The leading cost management company for healthcare providers

68 conference REGISTRATION For registration information, call toll free (877) Tuition includes all conference materials, general and concurrent sessions, continental breakfast, a lunch, and a reception. We offer three easy ways to enroll: (1) FAX to (858) ; (2) ONLINE at GovernanceInstitute.com/Calendar; (3) MAIL to The Governance Institute, 6333 Greenwich Drive, Suite 200, San Diego, CA Tuition Fees for Leadership Conferences r The Governance Institute Members r Free Member Annual Passes Member fee 60 days before the conference Member fee within 59 days of the conference Non-Members Non-member fee 60 days before the conference Non-member fee within 59 days of the conference # # of persons x $1,450 = $ # of persons x $1,550 = $ # of persons x $1,750 = $ # of persons x $1,850 = $ Total Amount Enclosed $ Total Number of Attendees # Please select any of our 2010 LEADERSHIP Conferences: r r r r r r January 10 13, 2010, The Ritz-Carlton, Naples, Naples, Florida February 21 24, 2010, The Breakers, Palm Beach, Florida March 7 10, 2010, The Grand Del Mar, San Diego, California May 16 19, 2010, The Grove Park Inn Resort & Spa, Asheville, North Carolina September 12 15, 2010, The Broadmoor, Colorado Springs, Colorado October 17 20, 2010, The Greenbrier, White Sulphur Springs, West Virginia 5 FREE Annual Passes for Members Method of Payment: Please Print o Check enclosed (Payable to The Governance Institute) o VISA o mastercard Credit Card Number Card Holder s Name Expiration Date Signature SAFE & SECURE REGISTER ONLINE GovernanceInstitute.com Please note: Conference expenses paid for by a trustee can be claimed as a donation and listed as an itemized deduction on the trustee's income tax return. Please consult your tax advisor for more information. Please call (877) for registration information for the 2010 Chairperson & CEO Conference, June 6 8, at The Cloister at Sea Island, Sea Island, Georgia (members only). Organization information: Please print. Organization Name Name of CEO Address City State Zip Contact Name Contact Title Contact Phone Contact Names and titles of those attending the conference: Please photocopy & fax any additional names. Please print. 1. First Name Last Name Suffix Title p Special Needs First Name (as it should appear on name badge) Companion s Name (as it should appear on name badge) 2. First Name Last Name Suffix Title p Special Needs First Name (as it should appear on name badge) Companion s Name (as it should appear on name badge) 3. First Name Last Name Suffix Title p Special Needs First Name (as it should appear on name badge) Companion s Name (as it should appear on name badge) Cancellations The tuition, less a $250 administration fee per attendee, will be refunded if the cancellation is received in writing (via mail, , or fax) 30 days or more prior to the beginning of the conference. For cancellations received less than 30 days prior to the conference, the tuition, less the administration fee, will be applied toward a future conference within one year. No-shows (cancellations within 72 hours of the conference) cannot be refunded or transferred to another conference (including member passes).