BOARD OF DIRECTORS AGENDA PACKET

Transcription

1 BOARD OF DIRECTORS AGENDA PACKET June 13, 2011 The mission of Palomar Pomerado Health is to heal, comfort and promote health in the communities we serve. 1

2 PALOMAR POMERADO HEALTH BOARD OF DIRECTORS T.E. Kleiter, Chairman Nancy L. Bassett, RN, MBA, Vice Chairman Jerry Kaufman PTMA, Secretary Linda C. Greer, RN, Treasurer Bruce Krider, MA Marcelo Rivera, MD Stephen P. Yerxa Michael H. Covert, FACHE, President and CEO Regular meetings of the Board of Directors are usually held on the second Monday of each month at 6:30 p.m., unless indicated otherwise For an agenda, locations or further information call (858) , or visit our website at MISSION STATEMENT The Mission of Palomar Pomerado Health is to: Heal, Comfort, Promote Health in the Communities we Serve VISION STATEMENT Palomar Pomerado Health will be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services CORE VALUES Patient s Well-Being We passionately give and support heartfelt care that encourages patient comfort and safety Professionalism Each of us takes pride in teamwork, self-discipline, our skills and trustworthiness Highest Quality We are each accountable for providing the safest, most effective and innovative care Affiliated Entities Escondido Surgery Center * Palomar Medical Center * Palomar Medical Auxiliary & Gift Shop * Palomar Continuing Care Center * Palomar Pomerado Health Foundation * Palomar Pomerado Home Care * Pomerado Hospital * Pomerado Hospital Auxiliary & Gift Shop * San Marcos Ambulatory Care Center * Ramona Radiology Center * VRC Gateway & Parkway Radiology Center * Villa Pomerado Palomar Pomerado Health Concern* Palomar Pomerado Health Source*Palomar Pomerado North County Health Development, Inc.* North San Diego County Health Facilities Financing Authority* u:templates\bd agenda inner cover sheet template:nla 2

3 Monday, June 13, 2011 Commences 6:30 p.m. PALOMAR POMERADO HEALTH BOARD OF DIRECTORS REGULAR MEETING AGENDA Mission and Vision The mission of Palomar Pomerado Health is to heal, comfort and promote health in the communities we serve. Palomar Medical Center Graybill Auditorium 555 E. Valley Parkway Escondido, CA The vision of PPH is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services. Time Page I. CALL TO ORDER II. OPENING CEREMONY 2 A. Pledge of Allegiance III. PUBLIC COMMENTS 5 (5 mins allowed per speaker with cumulative total of 15 min per group for further details & policy see Request for Public Comment notices available in meeting room). IV. * MINUTES Regular Board Meeting May 09, 2011 Closed Board Meeting May 09, 2011 V. * APPROVAL OF AGENDA to accept the Consent Items as listed A. April 2011 & YTD FY2011 Financial Report (Addendum A) B. Approval of Revolving, Patient Refund and Payroll Fund Disbursements April, Accounts Payable Invoices $46,144, Net Payroll $17,715, Total $63,860, C. Ratification of Paid Bills D. Physician Independent Contractor Agreement Information Systems Services E. Physician Recruitment Agreement - Dongmei Jiang, MD, and Pacific Center for Neurological Disease, Inc. F. Trauma, Emergency Department and Inpatient Consultative Services Agreement VI. REPORTS A. Medical Staffs In observance of the ADA (Americans with Disabilities Act), please notify us at , 48 hours prior to the meeting so that we may provide reasonable accommodations Asterisks indicate anticipated action; Action is not limited to those designated items. 3

4 Regular Board Meeting Agenda, June 13, 2011 * 1. Palomar Medical Center John Lilley, M.D. a. Credentialing/Reappointments b. Administrative Transfers to Core Privileging Forms c. Medical Staff Bylaws (Addendum B) * 2. Pomerado Hospital Roger Acheatel, M.D. a. Credentialing/Reappointments b. Medical Staff Bylaws (Addendum B) B. Administrative 1. Chairman of Palomar Pomerado Health Foundation John Forst a. Update on PPHF Activities 5 Verbal Report 2. Chairman of the Board Ted E. Kleiter 10 Verbal Report 3. President and CEO Michael H. Covert, FACHE 10 Verbal Report a. ACHD Awards VII. INFORMATION ITEMS A. Arch Health Partners B. Affiliation with Rady s Children s Hospital VIII. COMMITTEE REPORTS (Minutes available on the Leadership Drive) A. Audit and Compliance Committee B. Governance Committee Did not meet in May C. Human Resources Committee Did not meet in May D. Community Relations Did not meet in May E. Facilities and Grounds F. Board Quality Review Committee G. Finance Committee H. Strategic Planning Committee Did not meet in May I. Other Committee Chair Comments on Committee Highlights (standing item) IX. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT MONTH X. ADJOURNMENT Asterisks indicate anticipated action; Action is not limited to those designated items. u\my docs\pph board mtgs 2011\regular bd mtg \bdagendaPMC doc:nla 4

5 Palomar Pomerado Health BOARD OF DIRECTORS REGULAR BOARD MEETING Pomerado Hospital / Meeting Room E Monday, May 09, 2011 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY CALL TO ORDER 6:30P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa OPENING CEREMONY The Pledge of Allegiance was recited in unison. MISSION AND VISION STATEMENTS The PPH mission and vision statements are as follows: The mission of Palomar Pomerado Health is to heal, comfort and promote health in the communities we serve. The vision of PPH is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services. NOTICE OF MEETING Notice of Meeting was mailed consistent with legal requirements PUBLIC COMMENTS None APPROVAL OF MINUTES Regular Board Meeting April 11, 2011 Closed Board Meeting April 06, 2011 Closed Board Meeting April 11, 2011 APPROVAL OF AGENDA (to accept the Consent Items as listed) A. March 2010 & YTD FY2010 Financial Report B. Approval of Revolving, Patient MOTION: by Bassett, 2 nd by Krider and carried to approve the regular Board meeting minutes of April 11, 2011 and the closed Board meeting minutes of April 06, 2011 and April 11, 2011 as submitted. All in favor. None opposed. MOTION: by Krider, 2 nd by Kaufman and carried to approve the Consent Items A I as submitted. All in favor. None opposed. 5 1

6 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY Refund and Payroll Fund Disbursements March 2010 Accounts Payable Invoices $47,117, Net Payroll $11, 610, Total $58,725, C. Ratification of Paid Bills D. Promulgation of PPH Procedures GOV13 E. Revision of Policies GOV12 F. Admin Services Agreement Investigational Review Committee Chair Richard Just, MD G. ICOC Minutes H. Professional Services Agreement OB-GYN On Call - Damon C. Cobb, DO I. Physician Recruitment Agreement - Rebecca Samuels, DO PRESENTATIONS The Next Stage Project Tony Rubino Mr. Rubino explained that the Next Stage Project will offer services and programs to special needs adults and their families. Mr. Rubino stated that there are few funded programs to aid special needs individuals after the age of 21. The Next Stage Project is looking to construct a facility at Big Stone Lodge, a vacant 3 acre site on Old Pomerado Road purchased by the City of Poway over 8 years ago. Mr. Rubino stated that since the facility is for young adults entering into the next stage of their lives, and with the Stage Coach stop history of the property, the facility would be named The Next Stage Center. Staff Members 6 2

7 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY would be called Stage Coaches. The Next Stage Center would provide vocational and computer training as well as rooms for exercise, therapy, art and music. The Center would also provide an outdoor area for sports and gardens. There would be a parent resources center and aid for future housing needs. Mr. Rubino spoke about the benefits of the location, the Centers involvement in the community and the possibility of providing future housing. Mr. Rubino concluded his presentation with a review of the Centers operations and funding. REPORTS Medical Staff Palomar Medical Center Credentialing John J. Lilley, M.D., Chief of PMC Downtown Medical Staff, presented PMC s requests for approval of Credentialing Recommendations. Pomerado Hospital Credentialing Rodger Acheatel, M.D., Chief of Pomerado Medical Staff, presented Pomerado Hospital s requests for approval of Credentialing Recommendations. Administrative Chairman - Palomar Pomerado Terry Green standing in for John Forst MOTION: by Bassett, 2 nd by Kaufman and carried to approve the Palomar Medical Center Medical Staff Executive Committee credentialing recommendations for the Palomar Medical Staff, as presented. All in favor. None opposed. MOTION: by Kaufman, 2 nd by Bassett and carried to approve the Pomerado Hospital Medical Staff Executive Committee credentialing recommendations for the Pomerado Medical Staff, as presented. Director Rivera abstained. All in favor. None opposed. 7 3

8 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY Health Foundation Terry Green distributed a handout from the joint Board education session. Mr. Green reminded everyone that the Night of Nights Gala was going to be held on Saturday, June 4th. Mr. Green stated that 350 tickets have been sold thus far. The Foundation will be hosting a wine tasting event at the Holiday Wine Cellar on May 11 th. Wine may be purchased as an auction item for the Gala. Mr. Green asked the Board members if they would be willing to serve as greeters at the Gala. President and CEO Michael Covert, President and CEO Mr. Covert stated that the operations side of the FY12 budget is being completed and will be brought before the Board soon. Mr. Covert stated that the budget takes into account the next two years including the move into PMC West. There will be a Board education session on May 17 th to discuss ACOs. Lloyd Bookman from Hooper Lundy will be presenting. Mr. Covert commended the staff for their tremendous efforts during the Joint Commission review. There were very few direct recommendations. CMS will be conducting a full site review at PMC Downtown for the next five days. Mr. Covert thanked Chairman Kleiter and Director Kaufman for going to represent the Board and PPH at the annual ACHD meeting. Clarity go live is scheduled for June 6. Mr. Covert stated that the census numbers may 8 4

9 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY appear lower during the first few weeks of Clarity as physicians learn to use the system. Mr. Covert stated that it is Hospital Week and next week is Nurse s Week. Mr. Covert thanked Directors Basset and Greer for taking a leadership role during Nurse s Week. Chairman of the Board Ted Kleiter, Chairman Chairman Kleiter stated that he and Director Kaufman will be attending the annual ACHD meeting on Wednesday through Friday of this week. COMMITTEE CHAIR COMMENTS Audit and Compliance Director Bassett stated that the committee activity summary was included in the packet. Director Bassett stated that committee approved the Audit and Compliance committee charter as well as the Compliance & Ethics committee charter. The Compliance and Ethics committee celebrated its one year anniversary in April. Governance Director Krider stated that Promulgation of PPH Procedures GOV13 was reviewed and approved. Revision of Policies GOV12 was also reviewed and approved. There will not be a Governance committee meeting in May. Human Resources Director Yerxa stated that the Board HR committee summary was included in the packet. Community Relations Director Kaufman stated that the Community Relations committee received a presentation on the system name change. Board Facilities and Grounds Director Rivera stated that the Facilities and Grounds committee met earlier today. Director Rivera toured the PMC West campus last Friday with Mr. Covert. The building is approximately 70% complete at this time. The 9 5

10 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY glass and cladding are up, a landscaper has been selected and SDG&E issues continue to be an ongoing discussion. Director Rivera stated that the Joint Commission had positive comments for PMC West. Discussions regarding the scale and scope of services for the Ramona satellite facility are continuing. Permits are being resubmitted for approval. It is expected that the project will break ground in January Board Quality Review Director Bassett stated that the procedure for Grievance Process and the PPH Performance Improvement / Patient Safety Plan was approved. Finance Director Greer stated that a summary of the Board Finance committee activities was included in the Board packet for review. Strategic Planning Director Kleiter stated that the April Board Strategic Planning meeting was a full Board meeting. The Board reviewed and approved the draft FY12 initiatives. BOARD COMMENTS ADJOURNMENT 7:40P.M. SIGNATURES Board Secretary Jerry Kaufman, P.T.M.A. Board Assistant Nicole Adelberg 10 6

11 Palomar Pomerado Health BOARD OF DIRECTORS Closed Session Pomerado Hospital/Meeting Room E Monday, May 09, 2011 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW- UP/RESPONSIBLE PARTY CALL TO ORDER NOTICE OF MEETING PUBLIC COMMENTS ADJOURNMENT TO CLOSED SESSION CLOSED SESSION OPEN SESSION RESUMES 6:00P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa Notice of Meeting was mailed consistent with legal requirements. Pursuant to California Government Code (h). Report Involving Trade Secret. Estimated date of public disclosure: May 2012 None Pursuant to Government Code (h): Report Involving Trade Secret. MOTION: by Chairman Kleiter to adjourn to closed session. All in favor. None opposed. MOTION: by Chairman Kleiter to resume open session MOTION: by Director Krider. 2 nd by Director Bassett and carried to approve moving forward with the memorandum of understanding and into documentation of the joint venture with Rehab Care/Kindred utilizing Option One for IRF and Option One or Option Two in LTAC. FINAL ADJOURNMENT SIGNATURES Board Secretary Board Assistant Jerry Kaufman, PTMA Nicole Adelberg All in favor. None opposed. MOTION: by Chairman Kleiter for final adjournment at 6:30P.M. 11 1

12 April 2011 & YTD FY2011 Financial Report TO: MEETING DATE: FROM: BY: Background: Budget Impact: Staff Recommendation: Committee Questions: COMMITTEE RECOMMENDATION: Motion X Individual Action Information: Required Time: 12

13 13

14 PALOMAR POMERADO HEALTH PHYSICIAN INDEPENDENT CONTRACTOR AGREEMENT INFORMATION SYSTEMS SERVICES TO: Board of Directors MEETING DATE: Monday, June 13, 2011 FROM: BY: Ben Kanter, MD, CMIO Board Finance Committee Monday, May 23, 2011 Background: Palomar Pomerado Health (PPH) requires the active involvement of physicians in many aspects of Information Systems programs. Currently, PPH employs a CMIO (Benjamin Kanter, MD) who is solely responsible for the relationship between the medical staff and information systems. PPH is actively working on expanding the functions and features of our electronic healthcare record in order to prepare clinicians for their migration to PMC West, to improve quality and safety, and to meet the goals set forth by the Obama administration in the ARRA of As part of the electronic healthcare record suite of projects being implemented, physician involvement is critical for success. Physician s will be asked to participate on these projects (CPOE, physician documentation, ICU integration of monitors with the records, and more) and depending upon their work effort, will need to be reimbursed according to standard and customary manners and rates. This contract applies to the following physicians: Roger Acheatel Aria Anvar Julie Chuan Kevin Daly Marc Gipsman Steven Zgliniec Budget Impact: After discussion with many different sites across the U.S., a fair market value was established for the mean value hourly reimbursement for such work. All fees payable to medical staff members have been budgeted within the IT projects listed above. Staff Recommendation: Approval Committee Questions: COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the one year [August 1, 2011 to July 31, 2012] Independent Contractor Agreements between all six (6) of the above listed physicians and Palomar Pomerado Health. Motion: Individual Action: Information: Required Time: X Form A - EHR.doc 14

15 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Roger Acheatel, M.D. and Palomar Pomerado Health AGREEMENT DATE September 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Roger Acheatel, M.D. To assist the CMIO in the implementation of Computerized Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects. The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City. PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year RENEWAL TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly rate itemized YES NO IMPACT: None NO Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD 15

16 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Aria Anvar, M.D. and Palomar Pomerado Health AGREEMENT DATE August 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Aria Anvar, M.D. To assist the CMIO in the implementation of Computerized Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects. The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City. PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year RENEWAL TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly rate itemized YES NO IMPACT: None NO Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD 16

17 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Julie Chuan, M.D. and Palomar Pomerado Health AGREEMENT DATE September 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Julie Chuan, M.D. To assist the CMIO in the implementation of Computerized Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects. The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City. PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year RENEWAL TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly rate itemized YES NO IMPACT: None NO Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD 17

18 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Kevin Daly, M.D. and Palomar Pomerado Health AGREEMENT DATE September 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Kevin Daly, M.D. To assist the CMIO in the implementation of Computerized Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects. The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City. PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year RENEWAL TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly rate itemized YES NO IMPACT: None NO Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD 18

19 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Marc Gipsman, M.D. and Palomar Pomerado Health AGREEMENT DATE September 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Marc Gipsman, M.D. To assist the CMIO in the implementation of Computerized Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects. The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City. PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year RENEWAL TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly rate itemized YES NO IMPACT: None NO Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD 19

20 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Steven Zgliniec, M.D. and Palomar Pomerado Health AGREEMENT DATE September 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Steven Zgliniec, M.D. To assist the CMIO in the implementation of Computerized Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects. The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City. PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year RENEWAL TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly rate itemized YES NO IMPACT: None NO Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD 20

21 Physician Recruitment Agreement TO: Board of Directors MEETING DATE: Monday, June 13, 2011 FROM: BY: Lisa Hudson, Director, Physician & Business Development Board Finance Committee Monday, May 23, 2011 Background: The PPH community lacks an adequate number of neurology physicians as verified by Medical Development Specialists, a national consulting firm that specializes in physician manpower studies. PPH has an established physician recruitment program and had allocated resources to attract additional Neurologists to relocate to Inland North San Diego County. Dongmei Jiang, MD and Pacific Center for Neurological Disease, Inc., (PCND) have signed the PPH Physician Recruitment Agreement in order for Dr. Jiang to join PCND and establish a practice in their Poway office. She intends to begin practicing in September of Budget Impact: None Staff Recommendation: Approval of the Physician Recruitment Agreement with Dongmei Jiang, MD, and Pacific Center for Neurological Disease, Inc. and recommend approval by the full Board of Directors. Committee Questions: COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Physician Recruitment Agreement with Dongmei Jiang, MD, and Pacific Center for Neurological Disease, Inc. Motion: X Individual Action: Information: Required Time: Jiang Form A 21

22 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Physician Recruitment Agreement Neurology AGREEMENT DATE June 13, 2011 Start date September 1, 2011 PARTIES 1) PPH 2) Dongmei Jiang, M.D. 3) Pacific Center for Neurological Disease, Inc. Recitals PURPOSE Provide recruitment assistance to enable Dr. Jiang to establish a practice within the Pacific Center for Neurological Disease, Inc. Article 4 SCOPE OF SERVICES Dr. Jiang will establish a full-time internal medicine practice in the Pacific Center s Poway office and will participate in governmentfunded programs. 2.1; 2.2; 6.2; 6.4; 6.5 Recruitment procedure D.2 Article 8; 9.17 Article 2 TERM RENEWAL TERMINATION COMPENSATION METHODOLOGY 1 year of income assistance; two year repayment/forgiveness period None available Contract stipulates conditions for termination For monthly income guarantee physician will submit monthly report of expenses and collections. For relocation and start-up cost assistance physician will submit receipts. BUDGETED X YES NO IMPACT: None 5.1; 9.19 EXCLUSIVITY X NO YES EXPLAIN: Government prohibits hospitals from requiring physician to exclusively have privileges or make referrals only to their hospital. The contract does include a noncompete clause. PHYSICIAN MANPOWER STUDY Medical Development Specialists, a national consulting firm who performed our Physician Manpower Study, completed an analysis which confirmed there is a justifiable community need for this recruitment EXTERNAL FINANCIAL VERIFICATION LEGAL COUNSEL REVIEW APPROVALS REQUIRED X YES NO Methodology: Medical Development Specialists (MDS) developed a pro forma for the practice to establish the contract value to cover income guarantee and cash flow needs. MDS also provided the market comparison to establish an appropriate income guarantee. X Yes NO No exceptions to the standard agreement. Legal Counsel has approved this contract. X CPO X General Counsel X CFO X CEO X BOD Finance Committee on May 23, 2011 X BOD 22

23 TRAUMA, EMERGENCY InInsert DEPARTMENT Subject Here AND INPATIENT CONSULTATIVE SERVICES AGREEMENT TO: Board of Directors MEETING DATE: Monday, June 13, 2011 FROM: BY: Gerald Bracht, CAO, Palomar Medical Center Bob Hemker, CFO Board Finance Committee Monday, May 20, 2011 BACKGROUND: The current contract between PPH and North County Emergency Medical Associates, Inc., (NCEMA) is scheduled to expire on June 30, The Board Finance Committee discussed the status of contract negotiations and the available options presented by Management. BUDGET IMPACT: Included in projected FY2012 budget STAFF RECOMMENDATION: COMMITTEE QUESTIONS: COMMITTEE RECOMMENDATION: In consideration of the options available, the Board Finance Committee recommended approval for Management to continue discussions with NCEMA for renewal of the contract, based upon specific financial parameters. The Committee further recommended exclusion of orthopedic ED on-call and trauma coverage from the contract and recommended entering into an agreement with Arch Health Partners for provision of coverage. Continued negotiation statuses will be discussed at the meeting. Motion: X Individual Action: Information: Required Time: 15 minutes Form A - NCEMA AHP.doc 23

24 24

25 25

26 26

27 27

28 28

29 29

30 30

31 31

32 32

33 33

34 34

35 35

36 36

37 37

38 38

39 39

40 40

41 41

42 Arch Health Partners TO: Board of Directors MEETING DATE: Monday, June 13, 2011 FROM: BY: Victoria Lister, FACHE, Executive Director, Arch Health Partners Board Finance Committee Monday, May 23, 2011 Background: The PPH Board approved the creation and funding of a physician foundation at the November 2009 Board meeting. The foundation began operations under the name Arch Health Partners on April 1, The presentation regarding the first year of operations as discussed at the meeting is attached. Budget Impact: See attachment Staff Recommendation: Information only Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time: Form A - Arch.doc 42

43 Arch Health Partners Annual Business Review May 2011 Victoria Lister, FACHE Executive Director Arch Health Partners 43

44 Strategic Initiatives Grow Primary Care physicians, locations, patient volume Acquire one if not two practices in San Marcos/Vista Status: Currently negotiating with an existing, successful 2 physician Family Medicine practice in Vista Also with a larger Internal Medicine practice of 8 physicians between San Marcos and Vista Add new office locations in RP/4-S and San Marcos 4-S Ranch Status: In lease negotiations for 4-S Medical Plaza will have temporary space for two physicians until 4-S Medical Plaza is built San Marcos Status: Planning to take suite 205 in SMACC in September for 2 providers (new FP and NP) and Urgent Care. Working with developer on San Elijo Hills building 44

45 Strategic Initiatives Add Specialists as the need arises to support AHP/PIMG or PPH Service Lines and meet community need Status: Acquired ENT Specialty Center in December 2010 In collaboration with PPH, hired 3 full-time and 1 per diem Psychiatrists to support PPH Behavioral Medicine program Recruited a new Dermatologist in February who will bring cosmetic and Mohs procedures In collaboration with PPH, recruited a fellowship trained breast surgeon to staff the Women s Center beginning August/September In negotiations with a group of Orthopedic surgeons loyal to PPH, will likely close transaction in July or August 45

46 Strategic Initiatives Move to a more patient centered practice through the transition to a Patient Centered Medical Home (PCMH) model PCMH implementation ongoing; expect NCQA recognition late 2012 Customer Service Plan 2011 working with PPH Organizational Development to deliver a training program in early June 46

47 Strategic Initiatives Implement a robust information and technology infrastructure to support practice growth and service enhancement Status: Went live with Medicity interface in early May New website launched May 6 th, with appointment request capability; Moving NextGen servers to an off-site hosting facility weekend of June 3-4; NextGen EPM upgrade to 5.6 scheduled for early July; NextGen EMR upgrade to 7.9 scheduled for August; Patient Portal pilot implementation scheduled for October/November 47

48 Strategic Initiatives Expand affiliation with additional network physicians through the provision of MSO services, such as EMR and Practice Management Status: Arthritis Care and Research Center, PPH Back and Neck Center; in discussions with several other physician offices 48

49 Physician Profile Specialties Represented Internal Medicine (6) Family Practice (18) Pediatrics (4) Cardiology (2) Dermatology (2) Ophthalmology (1) Orthopedics (1) Neurology (2) Gastroenterology (2) Psychiatry (4) Breast Surgery (1) ENT (2) Total Number of Physicians 43 April 1,

50 Office Visits from April 2010 to April 2011 Generated 5/17/2011 8,000 7,000 6,000 5,000 Visits 4,000 3,000 AHP PCP AHP Specialists AHP Urgent Care 2,000 1,000 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Provider Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Grand Total AHP PCP 6,518 5,972 6,374 5,978 6,666 6,061 6,385 6,461 6,264 6,773 6,514 7,080 6,037 83,467 AHP Specialists 2,655 2,515 2,766 2,617 2,530 2,896 2,893 2,818 2,571 2,973 3,317 3,775 3,497 37,823 AHP Urgent Care 1,230 1,364 1,391 1,301 1,357 1,302 1,282 1,286 1,495 1,635 1,566 1,465 1,471 18,145 Grand Total 10,403 9,851 10,531 9,896 10,553 10,259 10,560 10,703 10,330 11,381 11,397 12,320 11, ,189 50

51 Financial Summary April-Dec 2010 Actual Budget Revenue $26,440,340 $26,987,681 MD Expense (includes outside provider expense) $14,274,742 $15,170,838 Mgmt Expense $13,844,512 $13,403,096 Net Loss ($1,678,914) ($1,586,253) 51

52 Financial Summary Jan-March 2011 Actual Budget Revenue $9,264,546 $9,374,807 MD Expense (includes outside provider expense) $5,317,434 $4,887,938 Mgmt Expense $5,082,898 $4,926,427 Net Loss ($1,135,786) ($439,558) 52

53 Line of Credit Status Maximum amount: $3,750, Commencement Date: April 1, 2010 Draws: $1,225,000 during 2010 $1,300,000 ytd 2011 Available balance as of 3/31/2011: $1,199,565 53

54 Expense Reduction Management Reorganization: 12 FTEs resulting in savings of $683,580 in 2011; annual savings of $974,087 in future years 12 month hold on annual merit increases resulting in savings of $302,000 Hiring only essential positions to support strategic initiatives 54

55 Expense Reductions On-going expense reductions in supplies, pharmaceuticals and other purchased services. Immediate changes: Reduce courier service for bank deposits Reduce number of runs per week to Ramona Applying for property tax waiver--$12,000/year Discontinue providing coffee $2,000/month, savings of $14,000 this year Discontinue plant maintenance service $780//month, savings of $5,470 this year Discontinue lighting service $250/month plus bulbs, savings $1,750 this year Renegotiating linen contract quantities and utilization Hold on printing of business cards and forms Purchase Euflexxa through McKesson Specialty annual 55 savings of $16,860

56 Revenue Enhancements FFS revenues projected to increase 5% over budgeted monthly base of $792,585 to $832,214 for May to September; and increase 7.5% over budgeted monthly base to $852,029 from October to December Letter to Medicare patients regarding physicals being a covered service On-going direct marketing campaigns targeting new patient acquisition and screening and immunizations for existing patients Improved web-site Increase FFS commercial rates Additional volume from improvement in optimal scheduling Expected Meaningful Use payments in 2012 of $585,000 56

57 Managed Care World As a Risk Bearing Organization (RBO) AHP must meet certain financial and liquidity requirements set by the Health Plans and the Department of Managed Health Care (DMHC) Tangible Net Equity contributed capital less retained earnings and surplus must be positive at all times Working Capital current assets less current liabilities must be positive at all times Cash to Claims Ratio Cash, FFS A/R < 60 days, compared to IBNR must be 75% Claims Timeliness Percentage claims paid within 45 working days must be 95% AHP is at risk for all professional services provided in the hospital for all health plans 57

58 HMO Contracts 16,753 members Aetna 2,100 members; at risk for OP dialysis, Ancillary Services, RadOnc Aetna Sr. 50 members; same risk as Aetna Blue Cross 3,028 members; at risk for Ancillary Services, chiropractic Blue Cross Sr. 220 members; same risk as BC Blue Shield 1,340 members; at risk for Ancillary Services, RadOnc, Chiropractic CIGNA 1,220 members; at risk for Ancillary Services, RadOnc Health Net 4,000 members; at risk for Ancillary Services, Chiropractic PacifiCare 2,625 members; at risk for DME, Ancillary Services, Chemo injectibles, chiropractic Secure Horizons 2,170 members; same risk as PacifiCare Shared risk with PPH for acute inpatient, SNF admissions and outpatient surgery 58

59 Commercial HMO Members Generated 5/18/2011 by Decision Support Commercial HMO Members Jan Feb Mar Apr May Jun Jul-2010 Aug Total Sep Oct Nov Dec Jan Feb Mar Apr

60 Senior HMO Members Generated 5/18/2011 by Decision Support Senior HMO Members Jan Feb Mar Apr May Jun Jul-2010 Aug Total Sep Oct Nov Dec Jan Feb Mar Apr- 2011

61 Total Arch Health Partners HMO Members Generated 5/18/2011 by Decision Support Total Members Jan Feb Mar Apr May Jun Jul Aug Total Sep Oct Nov Dec Jan Feb Mar Apr- 2011

62 Managed Care Expense Reductions Outside Provider costs are projected to improve by $405,000 due to: Tighter Utilization Management, 2 MDs to authorize high cost referrals use of protocols to limit utilization (PT/DME) Referrals to high quality, low cost providers Reduce cost of high cost radiology (MRI,CT) via block time lease Renegotiating TPA rates for claims processing to avoid a 9% increase 62

63 Managed Care Revenue Enhancements Capitation revenue projected to increase 5% over budgeted monthly base of $1,873,650 to $1,967,332 HMO health plans have rate increases from 5 to 6 percent throughout the year Investigate how we can help plans reduce costs of patients with high utilization Risk Share payment from PPH for period April December 2010 improved by $300,000 over budget in first quarter

64 Affiliation with Rady Children s Hospital TO: Board of Directors MEETING DATE: Monday, June 13, 2011 FROM: BY: Gerald Bracht, CAO, Palomar Medical Center Bob Hemker, CFO Board Finance Committee Monday, May 23, 2011 Background: PPH and Rady Children s Hospital; entered into an affiliation agreement resulting in the relicensing of all Pediatric and NICU beds under the Rady s license. The affiliation commenced on the Contingency Removal Date of August 25, 2010, and will contin ue through June 30, Rady s adminis ters the programs at PPH, and PPH provides for ancillary and support services to the programs and receives a lease payment for use of the facilities. The intent of the parties is to grow the pediatric and NICU services in the north county, and this could best be acco mplished through a n affiliation agreement. Th e attached presentation focuses on the results of the first 6 months of operation. Budget Impact: N/A Staff Recommendation: Information only Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time: Form A - Rady.doc 64

65 Palomar Pomerado Health & Rady Children s Hospital Pediatric and NICU Affiliated Program Program Review April 2011 Gerald Bracht - Chief Administrative Officer Bob Hemker Chief Financial Officer 65

66 RCH/PPH Joint Venture Pros: Risk of Growth shifted to RCH Expanded specialist coverage Name recognition/prestige Improved financial performance Resolution of POM NICU level/challenges Preserve Peds excess capacity for adult overflow Cons: Disruption with staff Coordination of services/operations Coordination of contractual commitments (Kaiser, CAP) 66

67 Structure Hospital in a Hospital Rady will operate the services as a hospital (part of Rady) and buy ancillary and certain support services from PPH PPH and Rady will enter into a space use lease agreement at PMC PPH and Rady will share in the operating margins of the services based upon predefined formula and terms as defined in the Affiliated Program Agreement Agreement will have an initial term of 2 years with renewal provisions Rady will manage the Pomerado NICU services (Subsequently revised to reflect ALS back-up coverage and educational support only) Rady will perform an assessment of Pomerado NICU services within 12 months and prepare recommendations for the future of those services 67

68 Unit Floorplan 68

69 Pediatric and NICU Affiliated Program PPH & Rady Children's Hospital Six Month Program Review 08/25/2010 through 02/28/2011 YTD Actual YTD 2/28/2011 Budget Variance Patient Days 2,763 3,103-11% NICU Average Daily Census Pediatric Average Daily Census Combined Average Daily Census Net Patient Revenue 7,874,669 (a) 8,011,568-2% (Net Revenue per patient day) 2,850 2,582 10% Expenses: Salaries and Benefits 3,281,067 (b) 3,702,609 11% Agency Labor 24,273 36,700 34% Medical Fees 292,512 (c) 313,248 7% Direct Support Expenses 193, ,173 0% New Information Technology Depreciation 44,905 44,905 0% Other Nursing Unit Expenses 141, ,424 48% Ancillary Expenses 444,411 (d) 391,574-13% Total Direct Expenses 4,422,117 4,955,633 11% Payments to PPH: Direct support expenses 77,364 (d) 86,870 11% Start up costs ( severence expense) 401,570 (e) Depreciation New NICU Expansion 62,500 62,500 0% Rent payment to PPH 147, ,389-4% Total Payments to PPH 689, , % Contribution Margin 2,763,348 2,764,176 0% Distributions: First $500,000 to Rady's (500,000) (f) (500,000) Total Margin available for 50% Distribution 2,263,348 2,264,176 0% PPH Distribution 1,131,674 1,132,088 0% (a) -Does not account for boarder babies (currently valued at ordinary payor rates) -Estimated government SB855 revenue allocation (b) Advanced life support included in RN salaries (c) Estimated amount. Actual amount in process of being confirmed. (d) Based on PPH invoices. (e) Excludes RT training reimbursement (f) Proration for partial year operations not reflected 69

70 Questions 70

71 PPH Board Subcommittee Activity Summary May 10, 2011 Board Quality Review Committee ACTION ITEMS: No Action Items INFORMATION ITEMS: Regulatory Update: Opal Reinbold reported out on our Joint Commission Survey Results for PPH to include Direct and In-Direct Findings. Patient Safety Update: The 2 nd Annual Patient Safety Survey will be scheduled during the end of May / early June and will go out to the whole organization. Skilled Nursing Facility Update: Steve Gold presented on the 2011 CMS QI Indicators, readmissions, Pressure Ulcer Project, Pharmacy, and provided an overview of the 2010 Quality Indictors. Environment of Care Annual Report: Deferred due to CMS survey. Mid Year Accomplishment Report: Opal Reinbold reported on our accomplishments to date to include: o Joint Commission Accreditations o CDPH Patient Safety Surveys o CARF Certification o Joint Commission s Certificate of Distinction for Inpatient Diabetes Care o Joint Commission Primary Stroke Center of Excellence Certification 71

72 The Board Governance Committee did not meet in May. The next meeting of the Board Governance Committee will be held at 8:00A.M. on Tuesday, June 21, 2011 in the Grand Avenue conference room. The Board Human Resources Committee did not meet in May. The next meeting of the Board Human Resources Committee will be held at 5:30P.M. on Wednesday, June 15, 2011 in the Grand Avenue conference room. The Board Community Relations Committee did not meet in May. The next meeting of the Board Community Relations Committee will be held at 5:00P.M. on Wednesday, June 8, 2011 in the Grand Avenue conference room. The Board Strategic Planning Committee did not meet in May. The next meeting of the Board Strategic Planning Committee will be held at 6:00P.M. on Tuesday, June 21, 2011 in the Innovation Drive conference room. 72

73 M EMORANDUM TO: FROM: Nicole Adelberg, Executive Assistant to the Board Tanya Howell, Assistant to the Board Finance Committee DATE: June 6, 2011 RE: Board Finance Committee May 23, 2011, Meeting Summary INFORMATION ITEMS: Program Reviews: o o Affiliation with Rady Children s Hospital: Gerald Bracht, Chief Administrative Officer, Palomar Medical Center, and Bob Hemker, Chief Financial Officer, discussed the results of the first six months of operations for the hospital-within-a-hospital affiliation with Rady Arch Health Partners: Victoria Lister, Executive Director of Arch, presented an update on the first year of operations of the physician foundation created and funded by the District FY2012 Budget Status Update: Bob Hemker discussed the status of the budgeting process for Fiscal Year 2012 and reminded the Committee that the Board Budget Workshop is scheduled to be held at 5:00 p.m. on Monday, June 6, 2011, in Graybill Auditorium Federal Rulemaking Process: Bob Hemker distributed a flow chart regarding the process and timelines associated with some of the pending federal regulations whose status the California Hospital Association is tracking on behalf of the members Quarterly Investor Call: Bob Hemker reported that he would be leading a discussion with investors regarding the March quarter-end financials and an update on the progress of the new hospital construction during a conference call to be held at the end of the month ACTION ITEMS: Physician Independent Contractor Agreements EHR Projects: Reviewed and recommended approval of the agreements with the following physicians: o o o o o o Roger Acheatel Aria Anvar Julie Chuan Kevin Daly Marc Gipsman Steven Zgliniec Physician Recruitment Agreement Neurology: Reviewed and recommended approval of the following agreement: o Dongmei Jiang, M.D. & Pacific Center for Neurological Disease, Inc. Trauma, Emergency Department and Inpatient Consultative Services Agreements: Reviewed the available options and, in consideration thereof, recommended approval for Management to continue discussions with NCEMA for renewal based upon specific financial parameters of the contract that is currently scheduled to expire on June 30, 2011; recommended exclusion of orthopedic ED on-call and trauma coverage from the new contract; and recommended entering into an agreement with Arch Health Partners for provision of coverage April 2011 and YTD FY2011 Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the April 2011 and YTD FY2011 financial performance, which reflected a $23.0 million bottom line net income YTD, which is approximately $731 thousand greater than budget 73