Tuesday, March 31, :00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas 78207

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REGULAR MEETING OF THE BEXAR COUNTY HOSPITAL DISTRICT BOARD OF MANAGERS 6:00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas 78207 MINUTES BOARD MEMBERS PRESENT: James R.

1 REGULAR MEETING OF THE BEXAR COUNTY HOSPITAL DISTRICT BOARD OF MANAGERS 6:00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas MINUTES BOARD MEMBERS PRESENT: James R. Adams, Chair Dianna M. Burns, M.D., Secretary Robert Engberg Ira Smith Robert A. Gilbert James C. Hasslocher BOARD MEMBERS ABSENT: Roberto L. Jimenez, M.D., Immediate Past Chair OTHERS PRESENT: George B. Hernández, Jr. President/Chief Executive Officer, University Health System Bryan Alsip, M.D., Executive Vice President/Chief Medical Officer, University Health System Felix Alvarez, Executive Director, Procurement Services, University Health System Tim Brierty, Chief Executive Officer, University Hospital Ted Day, Senior Vice President/Strategic Planning & Business Development, University Health System Theresa De La Haya, Senior Vice President, Health Promotion/Clinical Prevention, University Health System Texas Diabetes Institute Sergio Farrell, Senior Vice President, Ambulatory Services, University Health System - Robert B. Green Campus Don Finley, Senior Writer, Corporate Communications, University Health System Roe Garrett, Vice President/Controller, University Health System Brian Gibson Director, Ambulatory Call Centers, Robert B. Green Campus Michael Hernandez, Vice President/Chief Legal Officer, University Health System Barbara Holmes, Vice President/Chief Financial Officer, Community First Health Plans, Inc. Reed Hurley, Executive Vice President/Chief Financial Officer, University Health System Sherry Johnson, Vice President/Integrity & Regulatory Services, University Health System Monica Kapur, M.D., President/Chief Executive Officers, Community Medicine Associates Leni Kirkman, Vice President, Strategic Communications & Patient Relations, University Health System

2 Page 2 of 10 Priti Mody-Bailey, M.D., Vice President/Senior Medical Director, Community First Health Plans, Inc. Virginia Mika, PhD, Executive Director, CareLink, University Health System Bill Phillips, Vice President/Chief Information Officer, University Health System Kristen A. Plastino, M.D., President, Medical/Dental Staff, UT Medicine, San Antonio Steven R. Pliszka, Professor and Chairman, Department of Psychiatry, University Health System Richard Rodriguez, Vice President, Assets and Property Management, University Health System Roxanne Rosa, Administrative Director Robert B. Green Campus Sally Taylor, M.D., Senior Vice President/Chief Behavioral Medicine, University Health System Andrew Smith, Director, Government Relations/Public Policy, University Health System Roberto Villarreal, M.D., Senior Vice President, Research and Information Management, University Health System Mark Webb, Executive Vice President/Chief Operating Officer, University Health System Francine Wilson, Vice President, Materials Management, University Health System And other attendees. CALL TO ORDER AND RECORD OF ATTENDANCE: JIM ADAMS, CHAIR, BOARD OF MANAGERS Mr. Adams called the meeting to order at 6:00 p.m. INVOCATION AND PLEDGE OF ALLEGENCE: Mr. Adams introduced Mr. Jose Dimas for the invocation, and he led the pledge of allegiance. CITIZENS PARTICIPATION: CONSIDERATION AND APPROPRIATE ACTION TO ELECT A VICE CHAIR OF THE BOARD OF MANAGERS TO FILL THE UNEXPIRED TERM OF LINDA RIVAS JIM ADAMS Pursuant to the Bylaws of the Board of Managers, Mr. Adams called for nominations from the floor for the position of Vice Chairman for the unexpired term of Ms. Linda Rivas, effective immediately through September 2015, or when Board elections to occur. A MOTION nominating Mr. Ira Smith to fill the office of Vice Chairman was made by Dr. Burns, SECONDED by Mr. Engberg, and PASSED UNANIMOUSLY. APPROVAL OF MINUTES OF PREVIOUS MEETING(S): None at this time. REPORT FROM THE HEALTH SCIENCE CENTER FRANCISCO GONZALEZ-SCORANO, M.D., DEAN, SCHOOL OF MEDICINE, UTHSCSA, FOR WILLIAM HENRICH, M.D. Dr. Gonzalez acknowledged the physician leaders present and introduced Dr. Steven Pliszka, who, after a national search, is the newly appointed Chair for the Department of Psychiatry. Match Day was held on Friday, March 20, 2015, at John T. Floore Country Store, Helotes, Texas. Over 200 fourth year medical students were joined by friends and family to

3 Page 3 of 10 find out where they will go for their residencies. It was a festive occasion for the students who are wrapping up four years of rigorous medical education. The new UT System Chancellor, William McRaven made his first official visit to the UTHSCSA that day and announced the first five names. Match Day is held by the School of Medicine in conjunction with the National Resident Matching Program, an initiative sponsored by the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges and the Council of Medical Specialty Societies. Dr. Gonzalez reported that only one positon was not filled by the School of Medicine during Match Day. Another festive occasion will take place on Sunday, May 17, 2015 when the School of Medicine s commencement ceremony will be held at St. Mary s University. As customary, Mr. Hernandez will represent the Health System as member of the Platform party. This report was provided for informational purposes. None NEW BUSINESS: CONSENT AGENDA JIM ADAMS, CHAIR Consideration and Appropriate Action Regarding Medical-Dental Staff Recommendations for Staff Membership Kristen A. Plastino, M.D., President, Medical/Dental Staff Consideration and Appropriate Action Regarding the Appointment of Dr. Steven Pliszka as the Chair, Department of Psychiatry Kristen A. Plastino, M.D., President, Medical/Dental Staff Consideration and Appropriate Action Regarding a Resolution in Support of the Re-Verification of University Hospital as a Level II Pediatric Trauma Center Tracy Cotner-Pouncy/Lilliann Liao, M.D., Pediatric Trauma Medical Director/Tim Brierty Consideration and Appropriate Action Regarding the Affiliation Agreement with The University of Texas Health Science Center, San Antonio Ted Day Consideration and Appropriate Action Regarding Purchasing Activities (See Attachment A) Felix Alvarez/Francine Wilson The items above were presented for the Board s consideration Staff recommended approval of the consent agenda items by the Board of Managers. A MOTION to approve staff s recommendation by Mr. Engberg, SECONDED by Dr. Burns, and PASSED UNANIMOUSLY. Mr. Adams noted that the current affiliation agreement item is actually a 90-day extension request by staff.

4 Page 4 of 10 CONSIDERATION AND APPROPRIATE ACTION REGARDING SELECTED PURCHASING ITEMS RELATED TO THE CAPITAL IMPROVEMENT PROJECT: CONSIDERATION AND APPROPRIATE ACTION REGARDING THE GUARANTEED MAXIMUM PRICE WITH JOERIS GENERAL CONTRACTORS ACTING AS CONSTRUCTION MANAGER AT RISK FOR UNIVERSITY HOSPITAL PHASE 2 RENOVATIONS PACKAGE I TO INCLUDE: SITE SET-UP; DEMOLITION OF INTERIOR WALLS; REFURBISHMENT TO FLOORS 10 THROUGH 12 OF THE RIO TOWER; AND GENERAL CONSTRUCTION WORK FOR IDF ROOMS ON LEVELS 6, 7, 10, 11, AND 12 OF RIO TOWER AT UNIVERSITY HOSPITAL (GMP #2) MARK WEBB Staff has determined that it will be more expeditious and cost effective to use the same construction manager (Joeris) for the limited work associated with the relocation of staff from Corporate Square to the University Hospital campus, as well as the aggregation of the Transplant Offices to the 11 th floor Rio Tower. To date, the original guaranteed maximum price (GMP 1), which covered fees and managerial staffing costs, has been authorized for the Phase II Renovations project. The scope of this second GMP is as follows: For the original Phase 2 work comprising of the Specialty Clinics and Pharmacy relocations, the work will include: Installation of temporary partitions Site Set-up Demolition of Interior Walls, ducts electrical and plumbing For Corporate Square relocation and Transplant Offices aggregation, the scope will include: Limited Renovations and Finish out of Levels 10, 11, and 12 of the Rio Tower General Construction on Levels 6, 7, 10, 11 and 12 of the Rio Tower to support the IDF Room Upgrades. The estimated project cost of this GMP is $5,153,435. Commitment to date for GMP #1 and #2 is $6,699,134. These costs are currently covered in the existing allocated CIP budget. The participation goal for SMWVBE is 35% and the local participation goal is 75%. Staff recommends Board of Managers approval for an amendment to the Joeris General Contractors, Ltd. Construction Management Agreement in the amount of $5,153,435 for GMP #2. A MOTION to approve staff s recommendation was made by Mr. Smith, SECONDED by Mr. Engberg, and PASSED UNANIMOUSLY. CONSIDERATION AND APPROPRIATE ACTION REGARDING THE REDUCTION OF GUARANTEED MAXIMUM PRICE WITH ZACHRY VAUGHN LAYTON FOR PROJECT CLOSEOUT SAVINGS FOR PEDIATRIC INPATIENT CARE AT UNIVERSITY HOSPITAL (GMP #17) MARK WEBB Since the Board approved the original GMP 17 in February 2013, work has been completed on pediatric inpatient beds, pediatric outpatient

5 Page 5 of 10 dialysis and nephrology clinic, pediatric cath recovery suite as well as the upgrade of OR s 18 and 19 at University Hospital for the Children s Health program. The Children s Health Program has continued to grow and has since moved out of the pediatric inpatient beds split between the 5 th and 11 th floor of the Rio Building to the 7 th floor of the Sky Tower. An amount of $1,187,702 will be returned to the Health System and will allow the Health System to fund and implement other needed projects. All work has been completed and the Construction Manager has provided a final credit to close out GMP #17 Pediatrics. ZVL construction manager has provided a Guaranteed Maximum Price # 17f for the work associated with this package close out. The participation goal for SMWVBE is 40% and the local participation goal is 80%. To date, SMWVBE participation of awarded construction projects is 37.9% and local participation is 74%. This does not include the dollars associated with the Construction Manager s Fee or other project administrative costs (i.e., insurance, bonds, permit fees, etc.). Mr. Webb provided the SMWVBE numbers achieved to date for all construction GMPs in his written report. Staff recommends Board of Managers approval of an amendment to the Zachry Vaughn Layton Construction Management Agreement in the credit an amount of $1,187,702 for GMP #17f. A MOTION to approve staff s recommendation was made by Mr. Engberg, SECONDED by Mr. Gilbert, and PASSED UNANINIMOUSLY. CONSIDERATION AND APPROPRIATE ACTION REGARDING SELECTED PURCHASING ITEMS: CONSIDERATION AND APPROPRIATE ACTION REGARDING A CONTRACT WITH FROST TO PROVIDE DEPOSITORY SERVICES ON BEHALF OF UNIVERSITY HEALTH SYSTEM ROE GARRETT/REED HURLEY A request for proposal was issued in August 2014 as the current agreement expired on December 31, The current agreement with Frost Bank has been extended until a new agreement is approved by the Board of Managers and a transition, if needed, can be accomplished. Staff reviewed proposals from four financial institutions for depository and investment safekeeping services. The review team consisted of six staff members who scored each institution on the following criteria: (1) Ability to perform and provide the required and requested services. (2) Credit worthiness. (3) Customer service. (4) Services offered and, (5) Costs and earnings potential. The final scores ranged from a high of 92 points to a low of 84 points. The cost for depository services ranged from a low of $229,250 to $248,750 average per year. Lockbox processing operations were provided in San Antonio, Dallas and Houston. The estimated annual fiscal impact of this agreement is approximately $229,250 in banking fees for the four year time period beginning in January of 2015 and ending in December of This estimated

6 Page 6 of 10 contract cost is an increase over the previous contract of $131,696 due to the current low interest rate environment; however, our cash and investment strategy to keep higher balances in the operating account is anticipated to result in fees substantially less than $229,250 for this contract term. Based on the highest score, including the lowest cost and the ability to provide lockbox services locally, staff recommends the award of the contract for depository and investment safekeeping services to Frost Bank for a period of three years effective January 1, 2015 through December 31, A MOTION to approve staff s recommendation was made by Mr. Gilbert, SECONDED by Mr. Engberg, and PASSED UNANINIMOUSLY. CONSIDERATION AND APPROPRIATE ACTION REGARDING A CONTRACT RENEWAL WITH THE CENTER FOR HEALTH CARE SERVICES FOR SERVICES PROVIDED TO THE UNIVERSITY HEALTH SYSTEM MOMMIES PROGRAM THERESA DE LA HAYA/SALLY TAYLOR, M.D. This partnership with CHCS, established in February 2011, has resulted in providing Methadone Moms entry into early prenatal care, preparation for parenting, reduction in low birth weight, and reduction in newborn complications. From April, 2008 to March, 2013 CHCS provided evidence based and long term family counseling, child care services, intensive case management, outpatient substance abuse treatment, mental health treatment, and transportation services to Methadone Moms through the support of grant funding from the Substance Abuse and Mental Health Services Administration. The funding for these services expired in March 2013 and CHCS was not able to financially support this program without requesting funding assistance from the Health System. In April 2013, the Health System began to financially support the infrastructure to maintain the integrity of this program. From April 2014 March 2015 the health system funded $175,822. This program is considered a required component of the initial treatment plan for women who are pregnant and on Methadone at CHCS. Since its inception in February 2011 through December 2014, the Health System has experienced over 105% increase in deliveries from CHCS (36 deliveries in 2011, 58 deliveries in 2012, 70 deliveries in 2013 and 74 deliveries in 2014). The average length of stay for the babies has decreased from 38 days in 2011 to approximately 29 days in Approximately 70% of the babies are discharged to the mother without Child Protective Services involvement or with some type of supervision plan in place decreasing the percentage of babies placed in foster care or adoption to below 30%. By financially supporting this program, the Health System will increase outreach efforts in the community, increase deliveries at University Hospital, manage NICU admissions, and more importantly, improve health care outcomes for the mother and her infant. This program firmly coincides with the staff s

7 Page 7 of 10 efforts to address the Triple Aim Plus with a focus on improving the patient experience and patient outcomes. Staff recommends Board of Managers approval to renew the contract with The Center for Health Care Services in support of the Mommies Program in the amount of $207,885 for a one year period effective April 1, 2015 through March 31, A MOTION to approve staff s recommendation was made by Mr. Smith, SECONDED by Dr. Burns, and PASSED UNANINIMOUSLY. The cost of $207,885 includes an increase in the amount of $32,063 to grow the program. The increased funding is due to cost of living increases in salaries, growing operating costs related to training, incentive programs and therapy costs. The Mommies Program is starting its third year of existence and staff informed Dr. Burns that due to trust issues, the women tend to request obstetricians they have prior history with. However, Dr. Taylor described the current situation as an opportunity to partner with private physicians. Staff anticipates serving approximately 90 women in and that we will continue to see a gradual increase in these numbers. Previously, the DEA capped the number of women eligible for this program at 700, and CHCS has recently received approval for an increase to serve up 1,200 women. For this reason, staff believes the amount requested will be sufficient. In conclusion, Mr. Adams reminded the staff the Board is interested in reviewing metrics and benefits associated with contracts they are asked to review. He asked that staff to be prepared to elaborate on such data to demonstrate the value of the contract. CONSIDERATION AND APPROPRIATE ACTION REGARDING A CONTRACT FOR PROFESSIONAL ORTHOTIC AND PROSTHETIC SERVICES WITH THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO DEPARTMENT OF REHABILITATION MEDICINE ROBERTO VILLARREAL, M.D./VIRGINIA MIKA, PHD/ALLEN STRICKLAND The purpose of this agreement is to continue to secure prosthetic and orthotic services to unfunded inpatients and CareLink members. These services include the actual appliances as well as the services of certified orthotists. These prosthetic and orthotic devices are essential for stabilization, proper recovery, and timely discharge following surgical procedures and/or injury, disease processes. The orthotic devices include spine braces, upper and lower extremity devices that allow early mobilization of the patient and efficient discharge from the hospital. Select devices also assist in preventing the diabetic patient from developing foot and leg ulcerations. The orthotics accounted for the largest volume of services provided. Prior to authorizing prosthetics, CareLink assures that there is no other funding source available and the member is required to pay a co-payment towards the cost of the prosthetic device. The co-payment varies based on the individual s income and family size. In 2014, the Department of Rehabilitation provided services to 438 CareLink members, approximately 275 unfunded patients, and fabricated 215 devices at a cost of $413,566.

8 Page 8 of 10 University Hospital expenses for unfunded patients were $138,663.There has been no unresolved patient satisfaction concerns or quality of care issues during the past 12 months. This agreement includes performance standards that address quality of care, access, appropriate utilization, and patient satisfaction. Mr. Strickland also briefed the Board of the plan to move towards an internal Central Supply model for distribution of offshelf orthotics to inpatients in the near future. UTHSCSA s workforce composition data was provided in the staff s written report. This contract supports the Health System s Triple Aim PLUS goal of improving access to health care. Staff recommends Board of Managers approval to execute an Agreement with UTHSCSA through its Department of Rehabilitation for an estimated amount of $500,000 annually, or a total of $1,500,000 for a period of three years beginning May 1, 2015 through April 30, A MOTION to approve staff s recommendation was made by Mr. Smith, SECONDED by Mr. Engberg, and PASSED UNANINIMOUSLY. Staff anticipates 2015 approved claims for CareLink members will total $350,000. The anticipated amount for unfunded patients is $150,000. The total amount requested for approval is $500,000 for 2015 ($350,000 CareLink and $150,000 UHS). There is an anticipated decrease in costs over the next several years due to the decline in CareLink membership with the transition of members to federal healthcare plans. Dr. Jimenez asked if there was a demand for this type of service/supplies by pediatric patients. To date, we have not had a request for a pediatrics device, however, as the children s health program matures, staff anticipates there will be a need, and will explore those options with UTHSCSA as well. CONSIDERATION AND APPROPRIATE ACTION REGARDING OPERATIONS AND FINANCIAL REPORT FOR FEBRUARY 2015 ROE GARRETT/REED HURLEY/MARK WEBB In February clinical activity (as measured based on discharges adjusted for outpatient activity) was up 5.3% for the month compared to budget. Community First Health Plan (CFHP) fully-insured membership was down 4.6% due to lower membership in STAR Medicaid and CHIP. The bottom line gain excluding debt service was $206,000, $153,000 better than budget and was due to lower operating expense. Debt Service Revenue was $3.7 million which is equal to the budgeted portion of the Debt Service payment of $3.7 million. Mr. Hurley reviewed notable increases and decreases from the Consolidated Balance Sheet in detail with the Board. Staff recommends approval of the financial reports, subject to audit. A MOTION to approve staff s recommendation was made by Mr. Engberg, SECONDED by Mr. Gilbert, and PASSED UNANINIMOUSLY. INFORMATION ONLY ITEMS:

9 Page 9 of 10 REPORT REGARDING MEDICAL-DENTAL STAFF COMMITTEES AND DEPARTMENTS KRISTEN A. PLASTINO, M.D., PRESIDENT, MEDICAL/DENTAL STAFF UPDATE ON CAPITAL IMPROVEMENT PROGRAM ACTIVITIES MARK WEBB REPORT ON RECENT RECOGNITIONS AND UPCOMING EVENTS LENI KIRKMAN STATUS REPORT ON THE 84 TH LEGISLATIVE SESSION ANDREW SMITH Mr. Adams directed the Board s attention to the four (4) written reports above. He urged his colleagues to contact staff with specific comments, questions, or suggestions. These reports were provided for informational purposes only. No action by the Board of Managers was required. CLOSED MEETING: Mr. Adams announced the public meeting closed to the public at 7:12 p.m. pursuant to TEX. GOV T CODE, Section (Vernon 2004) to evaluate the performance and duties of the President/CEO. Board members present: Jim Adams, Robert Engberg, Ira Smith, Dr. Roberto Jimenez, Dr. Diana M. Burns, Robert Gilbert, James C. Hasslocher. Mr. George Hernandez was asked to join the closed meeting at 8:43 p.m. After discussion, no action was taken in the closed meeting and Mr. Adams reconvened the public meeting at 9:29 p.m. ONSIDERATION AND APPROPRIATE ACTION REGARDING ANNUAL EVALUATION OF THE PERFORMANCE AND DUTIES OF THE PRESIDENT/CEO JIM ADAMS, CHAIR On behalf of the Board of Managers, Mr. Adams stated that the Board members believe we have the best healthcare CEO in the State of Texas and we are proud of that. We are proud of University Hospital, which U.S. News and World Report has declared as the best hospital in San Antonio, and one of the best in Texas, with the nursing staff having attained Magnet status. The Board appreciates the sensitivity that Mr. Hernandez shows to patients; patients say they receive the best care, the staff is great and the Health System is very good at meeting their needs. Mr. Hernandez takes the same approach to those who have coverage as well as those who are indigent. He has demonstrated he appreciates the value of every patient. He knows the community and that is important to the Board and the people served. The Compensation Committee recommends a one-time payment of $60,000 to Mr. Hernandez as performance incentive compensation earned during his performance in 2014, payable immediately; and an adjustment to his base salary of $ 25,000 to bring his base salary up to $620,000, effective January 1, 2015.

10 Page 10 of 10 A MOTION to approve the Compensation Committee s recommendation was made by Mr. Hasslocher. There being NO OBJECTION, the MOTION CARRIED. Mr. Hernandez thanked the Board of Managers for their support. ADJOURNMENT: There being no further business, the public meeting adjourned at 9:30 p.m. James R. Adams Chairman, Board of Managers Dianna M. Burns, M.D. Secretary, Board of Managers Sandra D. Garcia, Recording Secretary

Wednesday, February 25, :00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas 78207

Wednesday, February 25, :00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas 78207 SPECIAL MEETING OF THE BEXAR COUNTY HOSPITAL DISTRICT BOARD OF MANAGERS 6:00 p.m. Board Room Texas Diabetes Institute 701 S. Zarzamora San Antonio, Texas 78207 MINUTES BOARD MEMBERS PRESENT: James R. Adams,