REGULAR MEETING OF THE BOARD OF MANAGERS Tuesday, Board Room University Center for Community Health 701 S. Zarzamora Minutes BOARD MEMBERS PRESENT Robert Jimenez, M.D., Vice Chair Jeff Judson, Secretary Johnny E. Lovejoy, II Mary Beth Williamson James R. Adams Luis Roberto Vera, Jr., J.D. BOARD MEMBERS ABSENT Robert Engberg, Chair OTHERS PRESENT Jeff Turner, President/CEO, University Health System Linda Boyer-Owens, Vice President, People & Organizational Development Theresa DeLaHaya, Vice President, University Center for Community Health and Prevention Services Peggy Deming, Vice President, Financial Accounting and Managed Care Contracting, University Health System Steve Enders, Senior Vice President for Ambulatory Services, University Health System George B. Hernandez, Jr., Executive Vice President/Assistant Administrator, University Health System Ruth Lozano, Director/Pastoral Care, University Health System Gary McWilliams, M.D., Medical Director, CareLink Financial Assistance Program, University Health System Mary Ann Mote, Director, Materials Management, University Health System Nancy Ray, Vice President, Associate Administrator, University Hospital Richard Rodriguez, Assistant Administrator, University Hospital James Rogers, M.D., Vice President, Quality and Cost Improvement, University Health System Mary Rozar-Hogan, Director, Business Development & Corporate Communications, University Health System Greg Rufe, Hospital Administrator, University Hospital Jean Setzer, Ph.D., Director/Planning & Grants Management, University Health System Juanita Simmons, Executive Director, CareLink, Financial Assistance Program, University Health System
Page 2 John C. Sparks, M.D., Medical Director, Correctional Health Services, University Health System Rudy Urby, M.D., President/Chief Executive Officer, Community Medicine Associates Steven Wartman M.D., Ph.D, Dean of the Medical School, UTHSCSA Charles Davis, M.D., Medical Director, EC/Trauma Services, University Hospital Ralph De Fronzo, M.D., Deputy Director, Texas Diabetes Institute Marilyn McFarland, Administrative Director, EC/Trauma Services, University Hospital John Montalto, CND, EC/Trauma Services, University Hospital And other attendees. MEMBERS OF THE PRESS Nicole Foy, San Antonio Express-News CALL TO ORDER Dr. Jimenez called the meeting to order at 6:10 p.m. INVOCATION AND PLEDGE OF ALLEGIANCE Reverend Walter L. Starks, Grace First Baptist Church, provided the invocation and Dr. Jimenez led the pledge of allegiance. SPECIAL RECOGNITIONS PHYSICIANS OF THE YEAR 2000 JEFF TURNER Two physicians were recognized as Physicians of the Year. Mr. Turner introduced Dr. Jim Rogers, Vice President, Quality and Cost Improvement, University Health System, and Assistant Professor, Department of Anesthesiology, UTHSCSA, as Faculty Physician of the Year. Dr. Juliane Bingener-Casey, Post Graduate Level 4 Resident, Department of General Surgery, UTHSCSA, was nominated as House Staff Physician of the Year and was not present. Mr. Turner reviewed the criteria for selecting the physicians, which includes outstanding achievement through health care activities, medical school activities, and community involvement. Dr. Jimenez congratulated both physicians for their accomplishments. CITIZEN'S PARTICIPATION Joe Linson, President, Alamo City Chamber of Commerce, and Cindy Taylor, President, South San Antonio Chamber of Commerce spoke on behalf of their respective chambers in support of the La Paz TIRF. Donald Gordon, M.D. Ph.D., Medical Director, City of San Antonio EMS, cautioned the Board regarding hospital diversions through out the San Antonio community, and provided the Board with supporting statistics. Mr. Adams requested that staff conduct a thorough review of the data available on this topic and provide a complete follow-up report to the Board.
Page 3 APPROVAL OF MINUTES OF PREVIOUS MEETINGS RECOMMENDATION: The minutes of the regular Board meeting of April 25, 2000 were presented for approval. Mr. Judson recommended certain revisions to the portion of the minutes regarding the Light Rail System Proposed by VIA Metropolitan Transit System. A MOTION for approval of the recommendation was made by Mr. Adams, SECONDED by Ms. Williamson, and PASSED unanimously. REPORT FOM THE PRESIDENT OF THE HEALTH SCIENCE CENTER DR. JOHN HOWE RECOMMENDATION: On Dr. Howe s behalf, Dr. Wartman reported that The University Physicians Group has recently approved a Resolution in support of the UHS/UTHSCSA relationship. He announced that UPG has formed an Executive Committee, and that a second meeting of the Presidential Search Committee is being planned. Dr. Wartman extended an invitation to the Board to participate in a seminar for an overview of the GME program as well as hands-on experience with the students. The Board accepted Dr. Wartman s invitation. This report was presented for information and no action was required. Mr. Turner will coordinate the Board s participation in the school s seminar. REPORTS OF STANDING COMMITTEES UNFININSHED BUSINESS NEW BUSINESS A. CONSIDERATION OF APPROVAL OF RECOMMENDATIONS AND ACCEPTANCE OF REPORTS IDENTIFIED AS CONSENT AGENDA ITEMS: Four (4) items were presented for approval on the consent agenda: 1. Report from the President of the Medical-Dental Staff - William E. Strodel, M.D. (a) Consideration of Medical-Dental Staff Recommendations Regarding Staff Membership 2. Report from the President of the Health System Auxiliary - Linda Boyer-Owens 3. Report from the Community Health Services Advisory Board Alonzo Rangel
Page 4 4. Consideration of Purchasing Activities (See Attachment A) - Mary Ann Mote. RECOMMENDATION: Mr. Turner pulled from item no. 4, the medical record department transcription services award to Heartland Information Services for further evaluation by staff. Dr. Jimenez recommended approval of the remaining items listed on the consent agenda en block without discussion. A MOTION for approval of the recommendation was made by Mr. Adams, SECONDED by Mr. Lovejoy, and PASSED unanimously. Dr. Jimenez commended the Health System Auxiliary on their efforts particularly on their work with junior volunteers. He requested an overview of the summer youth program at a future Board meeting. B. ITEMS RELATED TO PLANNING & OPERATIONS 1. REPORT ON STRATEGIC PLANNING JEFF JUDSON/JEAN SETZER The Steering Committee is working to draft the University Health System s strategic direction. At the April 8 planning retreat the Board together with key administrative and medical leaders considered core variables and assumptions within the context of best and worst case scenarios. The leaders then worked in groups to propose strategic initiatives to support Board directed priorities articulated at our November 1999 retreat. At its April 26 meeting the Committee began drafting guiding principles. These emerging principles serve as decision benchmarks. Although our environment changes dramatically and often beyond our control, these principles, like our values, remain constant. The six principles identified are as follows: Alignment of UHS/UTHSC-SA values Culture of Resource Management & Financial Accountability Customer Service as a Core Competency Ongoing Evaluation of Services Against Defined Criteria Development of Population Health Management Capabilities Culture of Continuous Process Improvement & Adaptation The next steps in the planning process are to describe our educational products and to clarify our commitment to this mission. The Steering Committee meeting on June 13 will be primarily devoted to these issues. The will meet in retreat on June 19 to refine the strategic direction and articulate strategies. Guiding principles, goals and strategic initiatives are components of this direction, and decisions will be made at the upcoming meetings. Mr. Judson encouraged full participation by the. RECOMMENDATION: None This report was provided for informational purposes only and no action was required.
Page 5 2. REPORTS ON BOARD PRIORITY ISSUES DESIGNATED BOARD MEMBERS At a recent meeting between Mrs. Williamson, Theresa De La Haya and Steve Enders, discussion was focussed on the proposed new Rector Street facility and the current under-utilization of the University Center for Community Health. Alternatives to replace the leased Basse clinic, which is unacceptable from both the standpoints of marketability and in terms of efficiency of operation, include finish out of a portion of the Rector Street building, relocation to University Clinic (at University Hospital), or relocation to the UCCH. Use of either University Clinic or UCCH space will result in a significant capital savings ($2 million), but will result in a decrease in access for patients in the near north/northeast area who use the Basse clinic. The net operational cost will be roughly the same for any of these options. Staff will continue to assess the appropriateness of operating additional clinics at UCCH, and is currently working with UPG and CMA to develop a clinic plan which optimizes service delivery from the standpoints of facility utilization, cost efficiency of operation, patient access and convenience, and marketability. A communication plan will be developed in advance of any changes being implemented so that all affected constituencies will understand and support the plan. Mr. Adams requested the status of a previous assignment regarding the development of a strategy by UHS and UTHSCSA to jointly improve all aspects of the clinics. A status report was not available. Mr. Adams strongly encouraged Mr. Turner and Dr. Wartman to take follow up action. RECOMMENDATION: This report was presented for information purposes only and no action was required. Mr. Turner will work with Dr. Wartman to develop a dual strategy that improves all aspects of the clinics. 3. CONSIDERATION OF RESOLUTION RECOGNIZING ROBERT LYNN BATTS TOBIN FOR HIS SERVICE AND COMMITMENT TO THE PEOPLE OF BEXAR COUNTY JEFF TURNER Mr. Turner presented a written Resolution recognizing Robert Lynn Batts Tobin for his service and commitment to the people of Bexar County. Mr. Tobin served as a member of the from July 1957 through June 1961, and as Chairman for three of those four years. He was 23-years-old when he was initially appointed. Despite Mr. Tobin s young age, he was an effective leader and a champion for the indigent and needy of Bexar County. Mr. Tobin died on April 26, 2000.
Page 6 RECOMMENDATION: Mr. Turner recommended that the adopt the Resolution. A MOTION for approval of this recommendation was made by Ms. Williamson, SECONDED by Mr. Lovejoy and PASSED unanimously. 4. UPDATE REGARDING SPONSORSHIP OF THE CENTER FOR HEALTH CARE SERVICES GEORGE B. HERNANDEZ, JR. Mr. Hernandez reported that on May 2, 2000, Commissioners Court approved the Interlocal Agreement (attached to the written report as Exhibit A) that was approved by the in April with no substantive changes. The approval process calls for CHCS to forward the agreement to the State as a modification to its current charter and the CHCS Board is scheduled to formally address this matter on May 30, 2000. A public notice of Board vacancies will be published at least once a week for two weeks no later than Sunday, June 11, 2000, in the San Antonio Express News, and appointments of four Trustees by the can be expected at the June 27 Board meeting. Mr. Hernandez provided a proposed public notice (Exhibit B), and a timetable for review and approval of the Center s budget and Health System funding and support (Exhibit C), with appropriate action by the Board in July. RECOMMENDATION: None This report was presented for information and no action was required. 5. CARELINK PROGRAM UPDATE GEORGE B. HERNANDEZ, JR. Mr. Hernandez provided a written report on the CareLink financial assistance program, established in April 1997 to address the needs of the Health System s uninsured patients by adopting a managed care approach through responsible use of the Tax Fund. He yielded the floor to Ms. Juanita Simmons, Executive Director of CareLink, whose presentation focused on the key characteristics of the program, which include membership relationships with patients, implementation of health prevention and promotion activities, managing costs by significantly expanding the pre-authorization process, and active participation in community activities. CareLink staff is actively assisting families with applications for the Children s Health Insurance Program and Medicaid, and continues to work closely with other providers and social service agencies to direct families to services and resources. Dr. Gary McWilliams, Medical Director, described ongoing health initiatives, Medication Assistance Programs, and the connection between these programs and the cost-savings they provide.
Page 7 RECOMMENDATION: This report was presented for information and no action was required. 6. REPORT ON THE EMERGENCY CENTER GREG RUFE Mr. Rufe reported that as part of the ongoing effort to provide facility utilization and capacity analysis of the Emergency Center/Acute Care facilities, this area has been identified as one of the top six process improvement priorities for the Health System during the year 2000. He introduced Emergency Center staff for a presentation on the complex improvement efforts that go beyond the EC and impact almost every aspect of the Health System. Marilyn McFarland, R.N., and Charles Davis, M.D., reported that the EC handles 60% of the major trauma in the San Antonio area. They reviewed the patient throughput process, goals, achievements and next steps. Because communication is the central issue most effecting patient satisfaction, the new EC tracking system will greatly enhance patient satisfaction in this area. The Board engaged EC staff in dialogue regarding these issues. RECOMMENDATION: This report was presented for information and no action was required. C. ITEMS RELATED TO BUDGET & FINANCE 1. FINANCIAL/OPERATIONAL REPORTS FOR APRIL, 2000 PEGGY DEMING Ms. Deming reviewed revenues, expenses, fund balances, and adjustments made during the month of April. She reported improvement in reducing supply expenses and credited staff for their efforts in this area. The Strategic Financial Planning Subcommittee continues to assist staff in the development of a reserve policy, and Mr. Lovejoy invited all Board members to attend a future meeting. RECOMMENDATION: Mr. Adams requested an overview of the Health System s financial standing at mid-year, and Mr. Judson requested a bottom-line analysis of the Health System s debt level. Mr. Adams praised the financial discipline achieved to date and encouraged the current level of commitment. 2. QUARTERLY REPORT ON BILLING & COLLECTION PROCESS IMPROVEMENT ACTIVITIES MARY ANN MOTE
Page 8 This report was deferred until the June 2000 Board meeting. None 3. CONSIDERATION OF REDUCTION IN SCOPE OF UNIVERSITY FAMILY HEALTH CENTER NORTH (BASSE REPLACEMENT FACILITY) AND APPROVAL OF CONSTRUCTION CONTRACT STEVE ENDERS Mr. Enders presented a revised pro forma for the first full year of operation in 2001, for the UFHC-North project with a reduced scope from what was originally approved by the Board. The project team eliminated approximately 40% of the building finish out, including the geriatrics clinic, physical therapy, and administrative offices. This will leave about 12,000 square feet as unfinished. The plan is to use the front portion of the building for primary care and urgent care services, and the possibility of relocating the geriatrics clinic to UCCH is currently being explored. Mr. Enders reviewed the change in scope relative to the capital budget and compared original and reviewed property acquisition costs, A/E fees, construction fees, and equipment costs. The reduction in scope will enable the University Health System to relocate from the substandard Basse facility by January 1, 2001, provide more convenient primary access to our CareLink patients, provide an opportunity to attract additional funded patients via the urgent care service at this location, minimize negative effects on the Health System s operating budget, and reduce the previously approved capital budget for the project. RECOMMENDATION: Staff recommended that the Board approve the reduction in scope for this project and the associated reduction in the capital budget from $5,000,000 to $4,690,560. In addition, staff recommended authorization to contract with BARCOM Commercial, Inc., to construct the facility within the confines of the revised capital budget. A MOTION for approval of these recommendations was made by Mr. Adams, SECONDED by Ms. Williamson, and PASSED unanimously. None 4. CONSIDERATION OF PARTICIPATION IN THE PROPOSED LA PAZ TAX INCREMENT REINVESTMENT ZONE Mr. Turner reviewed the currently proposed project, which includes the development 732.9 acres and construction of 4,600 single-family and 1,625 multi-family homes. The proposed term of financing the project through the tax increment reinvestment zone (TIRZ) is now approximately 22.8 years. University Health System s participation at 100% over the life of the TIRZ is estimated to be $10,837,577. Mr. Turner stressed concern about the immediate financial challenges the University Health System is facing today and the threat these challenges
Page 9 pose to the mission of providing services to the indigent and needy in the community. Mr. Lovejoy expressed support for the project and asked Mr. Steve St. Claire, project developer, to address the Board regarding the value of the project to the residents, taxpayers and community. Mr. Adams advocated for a policy regarding the Board s position as a whole on the consideration of all TIRZ and TIFS. RECOMMENDATION: Mr. Turner recommended that the not approve participation in the proposed TIRZ at any level, and Mr. Vera requested additional time to further review the issues discussed. A MOTION to TABLE this item was made by Mr. Vera, SECONDED by Mr. Adams, and PASSED unanimously. None COMMUNICATIONS ADJOURNMENT There being no further business, the public meeting adjourned at 10:10 p.m., and the Board of Managers went into a closed session to evaluate the quality of medical and/or health care services as performed by Section 161.032 of the Texas Health and Safety Code. Immediately following the closed session, the proceeded with a closed meeting pursuant to TEX. GOV T CODE, Section 551.074 (Vernon 1994) to deliberate regarding the appointment of Trustees to The Center for Health Care Services. Robert Engberg Chairman Jeffrey M. Judson Secretary Sue Perdue Recording Secretary