SPECIAL MEETING OF THE BOARD OF MANAGERS. Tuesday, March 20, :30 p.m. Board Room, University Hospital 4502 Medical Drive San Antonio, Texas

Transcription

1 SPECIAL MEETING OF THE BOARD OF MANAGERS 1:30 p.m. Board Room, University Hospital 4502 Medical Drive San Antonio, Texas MINUTES BOARD MEMBERS PRESENT: Robert L. Jimenez, M.D., Chair Ira Smith, Secretary James R. Adams, Vice Chair Alex Briseño Linda Rivas Rebecca Q. Cedillo BOARD MEMBERS ABSENT: Robert Engberg OTHERS PRESENT: George B. Hernandez, Jr., President/Chief Executive Officer, University Health System Francine Crockett, Vice President, Purchased Resources, University Health System Peggy Deming, Executive Vice President/Chief Financial Officer, University Health System Roe Garrett, Vice President/Controller, University Health System Tim Geryk, Director, Strategic Planning, University Health System Karen Glenney, Director, Corporate Communications & Administration, Community First Health Plans Leni Kirkman, Executive Director, Corporate Communications, University Health System Karen McMurry, Vice President, Legal Services & Risk Management, University Health System Pamela Otto, M.D., Associate Professor, Department of Radiology, UTHSCSA; and Medical Director, Radiology Services, University Health System Bill Phillips, Executive Director/Chief Information Officer, Information Services, University Health System Nancy Ray, R.N., M.A., Associate Administrator, University Hospital Greg Rufe, Administrator, University Hospital Jean Setzer, Ph.D., Vice President, Strategic Planning, Health Policy Research, and Grants, University Health System Stephen Coulston, Vice President for Planning, Broaddus & Associates Doug Abraham, Senior Planner & Programmer, Broaddus & Associates Jodie Baldwin, Management Information Associates And other attendees.

2 Page 2 of 10 MEMBERS OF THE PRESS: CALL TO ORDER AND RECORD OF ATTENDANCE: - ROBERT JIMENEZ, M.D. Dr. Jimenez called the meeting to order at 1:45 p.m. ITEMS RELATED TO PLANNING & OPERATIONS IRA SMITH, CHAIRMAN, PLANNING & OPERATIONS COMMITTEE APPROVAL OF MINUTES OF PREVIOUS MEETING OF THE PLANNING & OPERATIONS COMMITTEE: FEBRUARY 20, 2007 (REGULAR MEETING) IRA SMITH The minutes of the regular meeting of February 20, 2007, were presented for approval. Mr. Smith recommended approval of the minutes as submitted. A MOTION for approval of the minutes was made by Ms. Cedillo, SECONDED by Ms. Rivas, and PASSED UNANIMOUSLY. 1. REPORT ON THE IMPLEMENTATION OF COMPUTERIZED PHYSICIAN ORDER ENTRY BILL PHILLIPS Mr. Phillips updated the Board of Managers on what he described as a complex implementation of the Computerized Physician Order Entry System. He reported that the Emergency Center module was acquired in December 2006, and will further enhance the CPOE system. It will be implemented later this year. The Sunrise CPOE system has been installed in all Health System primary patient care outpatient clinics, several U.T. Medicine clinics and some hospital based clinics. The remaining hospital based clinics located at University Health Center Downtown and University Center for Community Health will be converted after the installation of the next software upgrade version 4.5, which is scheduled for mid year. The original scope of the project has been exceeded from an implementation stand point as some of the clinics that went live in Sunrise were previously operated by U.T. Medicine and were not in the original conversion plans. Current planning phase includes bringing the Sunrise CPOE system up in additional areas to include the Correctional Health facilities, Metropolitan Health Clinics and other yet to be determined community healthcare organizations. Challenges identified by Mr. Phillips include clinician acceptance and workflow changes, however, this does not differ from what other organizations have experienced and is documented as the leading issues for any CPOE implementation regardless of the vendor. A list of units/clinics and dates on which they went live with CPOE including both inpatient and outpatient environments was provided for

3 Page 3 of 10 the Board s review. Mr. Phillips provided industry information and statistics regarding Computerized Physician Order Entry Systems which show that this technology is being used in 5.7 percent of U.S. hospitals and is actively being used by physicians to enter over 50 percent of patient orders electronically in 3.2 percent of hospitals. Additionally, he reported that CPOE, pharmacy dispensing and nursing medication administration systems are installed in less than 1 percent of U.S. hospitals. With the implementation of the Sunrise CPOE system, University Health System has all three of these software systems installed and operational. University Health System is currently processing approximately 76% (or 380,000) of orders electronically. As the Emergency Center and the remaining hospital based clinics are transitioned, this number will continue to increase. From the period March through December ,448,780 electronic orders were processed, and 4,583,792 electronic patient documents were created in the Sunrise CPOE system. University Health System is rapidly becoming a leader in the healthcare industry when it comes to delivering/utilizing electronic patient care systems. Graphs correlating to the implementation schedule were provided for the Board s review. As the Health System progressed with implementation efforts, the graphs illustrated the increased usage of the POE system. The CPOE system streamlines workflow across the Health System with a shared electronic medical record, single Health Data Repository, shared rules and alerts, and best-practice clinical content. Mr. Phillips discussed many direct and indirect benefits from the implementation of CPOE that relate to patient safety and improved patient care. Mr. Phillips informed the Board that a high priority is being placed on system integration, which allows various sub-systems to communicate with each other, for example, laboratory, digital radiology images, inpatient pharmacy orders, EKG results, Operating Room notes, and dictated reports are integrated directly into the Sunrise CPOE patient chart. The plan is to integrate clinical results for pulmonary function, digital anatomical pathology, endoscopy, colonoscopy, stress treadmills, and echo cardiogram images in the same manner. This integration eliminates the need for clinicians to access multiple systems to obtain essential data. By establishing a precedent of centrally located clinical information in a single point of access, the Health System will continue to see benefits in the future as new functionality and software enhancements are implemented. Recently the Joint Commission surveyors were impressed with the progress in implementing the Sunrise CPOE system. They were pleased with the legibility of physician notes and the ease of access of patient records regardless if they were inpatient or outpatient. Last month the Board of Managers approved the hardware acquisition

4 Page 4 of 10 that allows the Health System to upgrade to the most current release of the Sunrise CPOE system (version 4.5). This new release has approximately 1,500 software enhancements that are focused primarily on improved functionality for the clinician. Information Services plans to complete this upgrade by the end of May Once this upgrade is complete, the remaining hospital based clinics will be converted to the Sunrise CPOE system. This upgrade will also provide the foundation for the Health System to implement the Emergency Department module. This report was provided for informational purposes only, and no action was required by the Board of Managers. 2. OVERVIEW OF MASTER FACILITY & BUSINESS PLAN FOCUSING ON GOALS, PLANNING PROCESS, TIMETABLE, AND KEY BOARD DECISIONS JEAN SETZER Mr. Hernandez reported that the planning process is in its fourth month. The purpose of today s presentation is for the Board to consider goals for the Master Facility and Business Plan. The underlying assumptions for the planning process and the major phases with milestones were summarized by Dr. Setzer in a written report provided to the Board of Managers three days prior to the meeting, as follows: Directional Goal Setting & Assumptions underlying the MFP: Fiscal Sustainability Best Practices Efficiency & Effectiveness Competitive Facilities that Promote Growth in Market Share Prevention, Outpatient, & Behavioral Health Customer Satisfying Facilities Planning Phases & Milestones: Process Development & Directional Goal Setting (drafted by the Steering Committee, Dr. Jimenez, and Mr. Smith in January 2007). The Information & Data Gathering & Analysis phase, begun in February continues; over 60 hours of interviews with UHCD and UH departmental and clinical leaders have been completed; interviews with Board members are scheduled over the next 3 weeks. The Alternatives Analysis & Implementation Planning begins in May and ends with the final draft of the preliminary plan to the Board in late June. Finalizing the Near Team Implementation Plan (10-year Master Facility Plan) and Business Plan with final space and budget projections will continue through the summer with a final plan presentation in September Mr. Hernandez yielded the floor to Stephen Coulston, Vice President for Planning, Broaddus & Associates for an overview of the planning process and an opportunity to elicit the Board s input and guidance regarding planning assumptions, as well as the master facility planning schedule and milestones.

5 Page 5 of 10 After a brief introduction of Broaddus & Associates, Mr. Coulston yielded the floor to Dr. Jimenez for a discussion among the Board members regarding the Health System s near term needs and long term vision. Dr. Jimenez stated discomfort in that a consensus on the strategy to meet current needs has not been officially identified by staff, or reached by the Board as a whole. As the newest Board member, Ms. Cedillo cited lack of a strategic plan for the Health System among the materials she was asked to review in preparation for the Board s involvement in this project. The most relevant item she identified is the mission statement. Ms. Rivas cited the lack of a formal assessment of the University Health Center-Downtown and the long-term needs in that community. Mr. Adams agreed with the need for a coherent and clarifying study and did not argue that the Health System needed more capacity, however, he cited costly and imprecise decisions made in the past about facilities and services decisions. He urged the Board not to repeat past mistakes. He indicated that it is the lack of an agreed upon strategy to meet community needs that this Board has not addressed that is disturbing. Dr. Jimenez reiterated the need to educate local political leadership that the major obstacles for a healthy community are poverty and education. Mr. Smith disagreed with the sentiment regarding lack of collective guidance from the Board citing two Board retreats in 2006 (March 10 and August 13), the first at which staff was directed to develop a plan that meets stated goals, and then subsequently, when the Board directed staff to move forward in developing a master facility plan with options. The Board provided five guiding principles on August 22, Mr. Briseño cited the Health System s tendency to be dysfunctional in reacting to community issues, such as the recent ACCD bond election, education needs, mental health/jail needs, and the UTHSCSA s plans for a Medical Arts and Research Center in the medical center area. He urged the Board to focus on the Health System s missions and future needs. Ms. Cedillo suggested the development of a document which shows the relationship between the Health System s missions, the strategic goals, critical factors, and other variables, in the form of a flow chart or bubble diagram so that the Board members can visualize the relevancy of these drivers when planning for future needs. Dr. Setzer suggested that Broadus and Associates be allowed to continue with the individual Board member interviews planned over the next three weeks. She also suggested that the Board members tour University Hospital and University Health Center -Downtown to better understand the purpose of the Master Facility and Business Plan, which is to assure space capacity and fiscal strength in its critical missions. Mr. Coulston suggested the he be allowed to continue his presentation so that the Board could see how the process unfolded. The Board members agreed that it would be helpful to have Mr. Coulston continue with his presentation of the master facility planning process. Dr. Jimenez agreed with Ms. Cedillo s recommendation for visuals and

6 Page 6 of 10 directed Dr. Setzer to develop this depiction. Both Dr. Jimenez and Mr. Adams encouraged staff to tap into the skills and talents of Ms. Cedillo, an experienced strategic planner, during the remaining phases of this process. The Board decided that tours were not necessary, but that the hour long individual interviews by Broaddus & Associates would continue as planned. The report by Stephen Coulston was provided for informational purposes. The Board did not consider or take action on the planning assumptions at this time. See above. Staff will develop a document showing the relationship between the Health System s missions, strategic goals, critical factors, and other variables, in the form of a visual so that the Board members can better understand the inter-relationships among missions and strategies to address future needs. ITEMS RELATED TO BUDGET & FINANCE JIM ADAMS FOR ROBERT ENGBERG, CHAIRMAN, BUDGET & FINANCE COMMITTEE APPROVAL OF MINUTES OF PREVIOUS MEETING OF THE BUDGET & FINANCE COMMITTEE: FEBRUARY 20, 2007 (REGULAR MEETING) JIM ADAMS The minutes of the regular meeting of February 20, 2007, were presented for approval. Mr. Adams recommended approval of the minutes as submitted. A MOTION for approval of the minutes was made by Mr. Adams, SECONDED by Mr. Briseño, and PASSED UNANIMOUSLY. 1. CONSIDERATION OF INVESTMENT POLICY, NO PEGGY DEMING/ROE GARRETT The purpose of the Investment Policy is to govern the investment practices of University Health System to accomplish the goals of preservation of capital, liquidity to meet all obligations, maximizing earnings and maintaining public trust. By statute the Health System s investment practices are subject to the Texas Public Funds Investment Act (TPFIA) Section Staff reviewed the current TPFIA guidelines with the Board members and summarized the proposed changes consistent with this Act. Current Board approval of the Investment Policy will allow staff to access TexPool commingled accounts that may at times offer slightly higher yields than money market accounts. Staff will monitor and evaluate the yield on money market accounts versus TexPool to determine when and what funds if any would be appropriate to transfer to TexPool. Staff recommends approval of the proposed changes to the Health System s Investment Policy. A MOTION for approval of this revised policy was made by Mr. Adams, SECONDED by Mr. Smith, and PASSED UNANIMOUSLY.

7 Page 7 of CONSIDERATION OF SELECTED PURCHASING ITEMS GEORGE HERNANDEZ a. Contract for Workers Compensation with Parker & Associates (Theresa Scepanski) b. Contract for Treasury Management Services with Frost Bank (Roe Garrett) a. Staff recommended approval of the contract for Third Party Claims Administration with Parker and Associates, LLC, in the amount of $384,000 for a period of two years for a period of two years with a one year option to renew for one year thereafter. b. Staff recommended that the Board award the contract for Treasury Management Services to Frost Bank, the existing depository bank, until December 31, 2010, for an estimated dollar amount of $266, based on current transaction volumes and services. A MOTION for approval of staff s recommendation was made by Mr. Adams and SECONDED by Mr. Smith. Mr. Adams made an AMENDED MOTION directing staff to dialogue with Frost Bank officials regarding their workforce composition in the African American Professional category, in light of the Board s interest in doing business with local companies that are culturally diverse. The AMENDED MOTION was SECONDED by Mr. Smith, and PASSED UNANIMOUSLY. Brief discussion ensued regarding prior service concerns with Frost Bank which were identified by staff in Staff indicated that Frost Bank had satisfactorily resolved all issues relating to this contract and stood by their recommendation. Staff will relay the Board s message to Frost Bank executives about the Board s long standing policy on cultural diversity. 3. CONSIDERATION OF FINANCIAL STATEMENTS FOR FEBRUARY 2007 PEGGY DEMING In February, activity was up 0.7% for the Clinical Services (as measured based on discharges adjusted for outpatient activity). Staff has focused significant attention to monitoring patient lengths of stay and taken multiple actions to facilitate timely patient discharge. Community First Health Plan (CFHP) fully insured membership was up 0.9% for the month primarily due to greater than anticipated CHIP membership From operations, the Health System experience a $458,000 gain which as a $578,000 positive variance from the budgeted loss of $120,000. The positive operating performance was due to positive CFHP operating results. Investment income exceeded budget by $270,000 and included a $1,000 realized loss on the prepayment of mortgage backed securities. An unrealized gain of $962,000 was reflected due to lower interest rates

8 Page 8 of 10 resulting from uncertainty in equity markets and investors seeking the safety of the U.S. Government Securities. The bottom line for the month reflected a gain of $3.0 million which was $1.8 million better than budget. Included n the above results is CFHP which experienced a $570,000 gain from operations ($521,000 better than the budgeted gain of $49,000) and a bottom line gain of $777,000 ($636,000 better than budget) in February. Ms. Deming recommended acceptance of the financial reports subject to audit. A MOTION for approval of this recommendation was made by Mr. Adams, SECONDED by Ms. Rivas, and PASSED UNANIMOUSLY. Dr. Jimenez made important inquiries about medical protocol for determining length of stays. Mr. Adams encouraged him to visit with Dr. Hnatow and Greg Rufe. CLOSED MEETING Dr. Jimenez recessed the public meeting at 4:32 p.m. The Board of Managers met with the Health System s attorney in a closed meeting pursuant to TEX. GOV'T. CODE, Section (Vernon 2004) regarding Juan Carlos Ayus, M.D. vs. The University of Texas Health Science Center at San Antonio, Hanna E. Abboud, M.D., Paolo Fanti, M.D., and Daniel Riley, M.D., Cause No 2007-CI Present during this portion of the closed meeting was Laura A. Cavaretta, counsel for University Health System. No action was taken. Dr. Jimenez reconvened the public meeting at 5:35 p.m. BOARD ITEM ROBERT JIMENEZ M.D., CHAIRMAN, BOARD OF MANAGERS CONSIDERATION OF AGREEMENT TO CONTINUE FUNDING DIALYSIS RESEARCH GEORGE HERNANDEZ/ KAREN MCMURRY Ms. McMurry summarized a history of the frequent dialysis research and terms of the proposed arrangement as follows: o Research under the direction of Dr. Ayus regarding the efficacy of frequent dialysis and its impact in improving outcomes for end stage renal disease patients began at UHS in 2003 at Dialysis West. Research has indicated the potential for improving cardiovascular risk factors and reducing associated co-morbidities such as heart attacks in this patient population. o Dr. Ayus clinical appointment with UTHSC will end April 30, 2007 and upon his departure, his research will be going with him to a private facility in San Antonio, Texas, and will no longer be conducted in a Health System facility. Except in very limited circumstances, dialysis on more than a conventional basis, i.e., more than 3 times per week is generally only done under the auspices of a research program. Typically, there is no funding available for patients to receive dialysis more than 3 times a week. The Health System has absorbed the costs associated with the additional dialysis treatments in connection with Dr. Ayus research.

9 Page 9 of 10 Staff has negotiated a proposed agreement to provide limited supplemental funding in support of continuity of patient care for those UHS patients who are currently enrolled and participating in this research and who choose to continue in this research upon Dr. Ayus departure. UHS will provide supplemental funding for the extra treatment of up to 50 patients for up to one year. o o o o Maximum amount of dollars at risk is $312,000.00; one year period begins with the first patient transfer; Additional agreement with private facility will be drafted and payments will be made on a pertreatment basis. Current Health System patients who are participating in the frequent dialysis research will be given the opportunity to continue in the research protocol developed by Dr. Ayus at the private facility. They will have a choice with respect to their treating physician from those available at the private facility. Patients who remain at Dialysis West will be cared for by faculty physicians of the UTHSC and will transition to conventional dialysis as is medically prudent and sound per their treating physicians judgment. Residual research dollars will be deposited with the registry of the court. Operationally for Dialysis West, this agreement, if approved, will provide an opportunity to have a positive fiscal impact as it will enable the unit to increase the number of allowable billable treatments being performed on an annual basis. Mr. Adams initiated discussion by the Board members by commending the agreement for the fact that it permits the patients in the research study to have continuity of care, patients will be able to make an informed decision regarding their continued participation in this research through a dialogue with their treating physician, Dr. Ayus, and patients will continue to receive quality health care. Health care decisions will be made by the patients and their physicians and not by the Health System. Under the agreement, the Health System is providing a limited funding source and if patients wish to obtain frequent dialysis outside the research program, they will be responsible for funding of that treatment. The Board recognizes the importance of Dr. Ayus research and the impact it may have on patient care in the future. Dr. Ayus is confident that he will be able to obtain additional funding in order to continue the research after the year of supplemental funding from UHS expires. The agreement provides that Dr. Ayus will notify patients in writing, and then be available in person if the patient wishes to further explore the option to continue treatment at the private facility. Dr. Ayus is responsible for providing the information necessary for the patients to make an informed decision and for coordinating the transfer of those that

10 Page 10 of 10 wish to continue in the research. Dialysis West staff have been counseled that they are to direct all patient questions to Dr. Ayus. Legal staff and Mr. Rufe personally met with two shifts of employees to help them understand this potential agreement. The first referral for questions by patients is going to be to their physician, Dr. Ayus. Staff is committed to assuring a smooth transition for the patients. Staff has been made aware that they have sources for providing the proper answers at any time, Fernando Rodriguez and Greg Rufe As a point of clarification, Mr. Adams reminded legal counsel that the letter from Dr. Ayus to inform patients of their option to continue with the research project will be re-worded to reflect that it is being signed by Dr. Ayus. Staff recommends that the Board of Managers approve the terms described above for an agreement with Juan C. Ayus, M.D., to continue funding dialysis research in an amount not to exceed $312,000.00, for a period no longer than one year, for no more than 50 of the current research patients. A MOTION for approval of this recommendation was made by Mr. Adams, SECONDED by Mr. Smith, and PASSED UNANIMOUSLY. Last month, Mr. Hernandez informed the Board of Managers that up to $4 million in earmarked funds in a FY 2008 appropriations bill could be made available to establish a Center of Excellence in Dialysis Outcomes Research. And further, that such funding could be used to facilitate continued demonstration of the daily dialysis initiative at the proposed Southside Dialysis Center. Mr. Smith asked for an update on this funding opportunity. Mr. Hernandez reported that he had been informed by Congressman Ciro Rodriguez s office that the funds available are not research related but are for equipment only. Last week Health System staff submitted an appropriations request for equipment in the amount of $4 million. ADJOURNMENT There being no further business, Dr. Jimenez adjourned the public meeting at 5:55 p.m. Robert Jimenez, M.D., F.A.P.A. Chairman, Board of Managers Ira Smith Secretary, Board of Managers Sandra D. Garcia Recording Secretary