meeting dates - palomar health · 2010. 2. 23. · b oard f inance c ommittee m eeting a ttendance...

B O A R D F I N A N C E C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R & M E E T I N G M I N U T E S

C A L E N D A R Y E A R 2 0 1 0

MEETING DATES:

MEMBERS 1/26/10 2/23/10

LINDA GREER, R.N. – CHAIR P P TED KLEITER P E BRUCE KRIDER, MA P P MICHAEL COVERT, FACHE P P FRANK MARTIN, M.D. P E JOHN LILLEY, M.D. E P MARCELO RIVERA, MD – ALTERNATE E NANCY BASSETT, R.N., MBA – 2ND ALTERNATE P – 3RD ALTERNATE – 4TH ALTERNATE STAFF ATTENDEES BOB HEMKER P P GERALD BRACHT P P DAVID TAM P P TANYA HOWELL – SECRETARY P P INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS

2010-02-23 BoD Finance Minutes.doc 1

BOARD FINANCE COMMITTEE – MEETING MINUTES – TUESDAY, FEBRUARY 23, 2010

1. AGENDA ITEM

• DISCUSSION CONCLUSION/ACTIO FOLLOW UP/RESPONSIBLE PARTY FINAL?

CALL TO ORDER • The meeting–held in the First Floor Conference Room at 456 E. Grand Avenue, Escondido, CA – was called to order at 6:03 p.m. by Chair Linda Greer, RN

ESTABLISHMENT OF QUORUM

• See roster

PUBLIC COMMENTS

• There were no public comments

INFORMATION ITEM(S)

• Request to change date of April 2010 BoD Finance Meeting o Email poll of Committee members placed Thursday, April 29, 2010, as the best option o Meeting will be held at the same time and place (5:30 dinner/6:00 meeting, 1st Floor Conference

Room, 456 E. Grand Avenue, Escondido) • Updated program review schedule

o Bob Hemker distributed an updated schedule (Attachment 1) o At the request of the sponsor, the Perinatology Program review was moved to April

• Financial Performance Bonus Barometer o Bob Hemker distributed the new tool (Attachment 2) that was created as a collaborative effort

between HR, Finance and Marketing o Goal was to have a simple metric to assist staff in remaining engaged, enabling them to see

where the district stands regarding financial performance and potential for an incentive compensation payout for year end

o If you achieve the goal on the left side, the amount of money on the right side is how much we will be able to pay

o Chair Greer inquired what staff needed to do make reaching the bonus fund goal a reality We need to continue to be right on budget, then push for extra to fund the incentive payout

fund This includes getting all the charges in, not being wasteful, etc. – basically being as

efficient as we can in our daily tasks • Marketplace – bonds, interest rates, etc.

o Bob Hemker stated that the 2006 Auction Rate Securities (Revenue Bonds) are still showing favorable resets

o Based on these results and other market factors, there is still no reason for the district to exit that strategy and look for a fixed-rate alternative at this time

Information only • Forwarded to the March 8, 2010, Board of Directors meeting as Information

Y

1. MINUTES – JANUARY 26, 2010



1. AGENDA ITEM


• No discussion MOTION: By Dr. Lilley, seconded by Director Krider and carried to approve the minutes of the January 26, 2010, Board Finance Committee meeting as presented. All in favor. None opposed.

Y

2. PHYSICIAN INDEPENDENT CONTRACTOR AGREEMENTS – EHR PROJECTS – INFORMATION SYSTEMS SERVICES • Jay Federhart, MD [2/1/10-1/31/11] • Sudabeh Moein, MD [11/1/09-10/31/10] • Mikhail Malek, MD [2/1/10-1/31/11] • Rod Serry, MD [2/1/10-1/31/11] • Elizabeth Rafii, MD [2/1/10-1/31/11]

• No discussion MOTION: By Director Bassett, seconded by Director Krider and carried to recommend approval of the 1-year Physician Independent Contractor Agreements for EHR Projects with all physicians/groups for terms as listed. All in favor. None opposed.

Forwarded to the March 8, 2010, Board of Directors meeting with a recommendation for approval

Y

3. JANUARY 2010 AND YTD FY2010 FINANCIAL REPORT • Utilizing the presentation included in the revised agenda packet as Addendum B, Bob Hemker presented the January 2010 and YTD FY2010 financial statements. Only select slides were presented for discussion (listed below with any additional comments):

• BSC (ADD B-3) o Collective OEBITDA is at 10.9%

− YTD Budget is 10.8% − Above 100%, so blue indicator

o Raw dollars are ahead of budget o Productivity is just under budget

− Premium pay continues to show constant improvement

• Executive Summary (ADD B-4) o YTD

− Adjusted Discharges – negative variance of 1.5% 1) Strong outpatient business is offsetting the negative inpatient activity

− Acute Admissions – negative variance of 6.5% − Total surgeries – negative variance of 6.4%

1) Due in large part to Inpatient Surgeries – negative variance of 460 − ER Admissions were down by 298 − Acute Patient Days – negative variance of 5.4% − Births – negative variance of 7.2% − ER Visits & Admissions – positive variance of 8.7% − ER to Admission Conversion Rate – negative variance of 2%

1) Roughly 1100 admissions below what we would expect for the amount of ER volume 2) Doing really well with documentation initiative, which has an effect on conversion

MOTION: By Director Krider seconded by Director Bassett and carried to recommend approval of the Financial Report for January 2010 and YTD FY2010 as presented. All in favor. None opposed.

Forwarded to the March 8, 2010, Board of Directors meeting with a recommendation for approval

Y



1. AGENDA ITEM


rate − Net Patient Revenue – slight negative variance of .29% −

dollars up $568K

s

• nce of $299K

• D0K

o ta is a positive variance of $240K

o n−

1) rates for health coverage in January contributed to the negative variance of

• laash is up about $17M compared to prior year

is $351M vs. $329M

• e and rate efficiencies

o rate efficiency, with a positive variance of $460K

• Do

ng the business g up the delta

o

•

Total Net Revenue – negative variance of $900K ess 1) $700K of that delta is the January book of busin

− Net Income is still about a quarter million− Bottom bottom line – positive by − Cash on Hand is up to 117 day

MTD Variance Explanations (ADD B-8) o Investment Income – positive varia

YT Variance Explanations (ADD B-9) o Salaries & Wages – negative variance of $73

Contract Labor – positive variance of $970K − Net delBe efits

Group Health, FICA and pension will start normalizing though the remainder of the year Employer contribution to FICA increases at the beginning of a calendar year, and new plan$1.18M

Ba nce Sheet (ADD B-12) o Total of Cash with Board Designated Co Projects have grown by about $100M o Liabilities have dropped by about $15M o Year on year Total Fund Balance

MTD Income Statement (ADD B-13) o About half of the delta is made up in terms of volum

Negative Net Income volume variance of $19K − Opportunity column becomes

YT Income Statement (ADD B-14) Net Income – positive variance of $279K − Driving about $400K of profitability based on how we’re managi− $364 per Adjusted Discharge is more than makinNon-Operating Income – positive variance of $290K − Investment Income – negative variance of $284K

TD (ADD B-15) Income Statement vs. Prior Y



1. AGENDA ITEM


o e igures setting the stage for the FY2011 budget cycle o j

−

−

2) n units of measure, which are up about 3.6% ncy of contractual realizations

djustments

argin, which is up 9% o OEBIT om 10.3% o ve

$1.9M

• udgeted

o

− d arou 28M to achi 100% f nding of performance bonus

W are now at the 7-month mark, with fAd usted Discharges Effectively 2 years that are similar

Net Revenue has grown by $8.5M 1) Raised rates 8%, but Gross Revenues are up 9.3%

Net Revenue realization can be seen o3) Growing through Managed Care contracts and the efficie

(a) Stronger in ambulatory contracts up about 2.7% year on year o Salaries, Wages & Contract Labor –

− Consistent with union negotiations and non-union labor ao Total Expenses are up about 2.2%

er Net Income Mo Translates to a strongDA is up to 10.9% fr

In stment Income − Last year was $3.3M − Budgeted $2.2M this year and sitting at− Up another $17M in cash to invest

Income Statement – FY Projection (ADD B-16) o 7 months of actual with 5 months of b

Project about $13.8M in Operating Income o Bottom-bottom line of about $26.4M

Nee nd $ eve u

4. P R –VHA P CROGRAM EVIEW URCHASING OALITION

• Bob ground o In 2

− 1) els 2)

a) chael Covert sitting on their Board nd Gerald

Information only Forwarded to the March 8, 2010, Board of Directors meeting as Information

Y Hemker provided historical back006, the District made a decision to convert from Premier to VHA Premised on many factors

Better pricing – access to contracts available at national, regional and local levAbility to integrate into and become involved in their networking structure

PPH is a member owner, with CEO Mib) CFO Bob Hemker (leadership role)—along with CAO’s David Tam a

Bracht—sits on the CFO/COO Forum c) CHRO Brenda Turner is involved in a leadership role in their HR Forum

• Mr. Hemker then introduced Steve Ellis, Director of Corporate Supply Chain Services



1. AGENDA ITEM


o Utilizi chment 3), Mr. Ellis provided an analysis of the benefits deriv

year, not fiscal year

o PPH join

for local pricing to become better than that available

−

ng the attached presentation (Attaed since the move to VHA

− Information is based on calendar − Savings since 2006 total over $5M

ed WestPac in January 2009 − Southern California collaborative formed last year

1) Will aggregate purchasing powernationally

PPH is still part of VHA, but Westpac allows for regional purchasing opportunities − Comprised of 11 healthcare systems − We now have access to the purchasing power of the larger systems by co-oping with them

5. PROGRAM REVIEW – SAN DIEGO RADIOSURGERY LLC & STEREOTACTIC RADIOSURGERY

• Utilizing the attached presentation (Attachment 4) Gerald Bracht and Bob Hemker provided an

y (SRS) with U. S. Radiosurgery (formerly known as NeoSpine, LLC), under the

d that Sheila Brown and a member of the SDRS board might join them for future prog

• Mr. was structured, with operations beginnin in lat

o PPHTrilo ided both SRS and soft tissue capabilities

design in order to wait for and take advantage of the newer with a small

o

edures

o − 9

o Althou profit in CY2009

Information only Forwarded to the March 8, 2010, Board of Directors meeting as Information

Y

update on the first full the first full calendar year of operations for the District’s joint venture in Stereotactic Radiosurgername San Diego Radiosurgery, LLC (SDRS)

• Mr. Bracht indicateram review updates

Bracht then provided background on how the transaction g e 2008

was the first provider in San Diego County to obtain the Stereotactic upgrade to Varian gy, which prov

− Ramp up was slow bytechnology, which provided the ability to tap into the radiation therapy side capital outlay

SDRS Services – (ATT 4-2) − PPH leases back the equipment 6 hours a day for traditional radiation therapy − SDRS utilizes the equipment for 6 hours a day to perform SRS proc

Marketing was implemented exactly as that done previously for the Denver market 39 contacts translated into 32 cases

− There were many reasons for the conversion percentage (ATT 4-7) 1) A large percentage was related to the San Diego County market, which has a much

larger proportion of HMOs than that to which provider was accustomed

gh not up to expectations, the venture did turn a small


ATTACHMENT 1

ATT 1-1

DATE DUE PROGRAM FOLLOW-UP AT BOARD FINANCE SPONSOR(S)

5 April 2010 Da Vinci Gerald Bracht &Bruce Grendell

6 April 20102 Perinatology Program Sheila Brown &Lorie Shoemaker

7 June 2010 Palomar Pomerado Imaging, LLCGerald Bracht,Sheila Brown &Bob Hemker

8 August 2010 Wound Care Sheila Brown

9 TBD NICU Expansion Gerald Bracht

10 TBD PPH Retail Group, LLC Sheila Brown

11 TBD Residency Programs (e.g., Family Practice, ED, etc.) Gerald Bracht &David Tam

1 December 2009 SNF Beds to Sub-Acute1 Steve Gold

2 January 2010

February 2010

Physician Recruitment

February 2010

3 San Diego Radiosurgery, LLC & Stereotactic Radiosurgery (SRS)

Gerald Bracht &Lisa Hudson

Gerald Bracht &Bob Hemker

4 David Tam &Steve Ellis

VHA Purchasing Coalition

FY2010/2011 Program Review Schedule

1 Reviews have been completed on those topics in green font2 Topics in red font have been rescheduled from original review date(s)

ATT 1-2

ATTACHMENT 2

ATT 2-1

ATT 2-2

ATTACHMENT 3

ATT 3-1

VHA Purchasing Coalition Report to the Board of Directors

February 2010

David Tam, MDChief Administrative Officer

&Steve Ellis, MBA, CMRP

Director, Corporate Supply Chain Services

ATT 3-2

Background • PPH Joined VHA in 2006 for administrative

support and access to contracts available within the group purchasing organizations portfolio

• Additionally, In January 2009, PPH joined the VHA Southern California Purchasing Coalition (WestPac)– 10 Healthcare Systems (Cedars Sinai, Presbyterian,

Cottage, Pomona, Methodist, others)– Purpose: Leverage pricing through volume

aggregation

ATT 3-3

33

VHA Services / Benefits

3

• Capital Equipment Group Buys• Supplier & Distribution Contracts (Food, Medical/Surgical, Laboratory, Pharmacy, Laundry/Linen, Office & Administrative, & More)

• Advisory & Consulting Services • Benchmarking • Spend Analysis & Solutions• Education Programs

ATT 3-4

PPH Participation

Anesthesia Medical ProductsCapital Equipment OncologyCardiology OrthopedicDiagnostic Imaging PharmacyFacilities Mgmt. Plasma/BloodFood & Nutrition RespiratoryI.V. Therapy Systems SurgicalLaboratory Womens/Infants/Children

PPH Participates (Utilizes) 461 Contracts within the categories listed below:

ATT 3-5

Spend & Savings

2006 2007 20082009 (Q1-

Q3) Total

Contract Purchases $27,983,706 $37,995,968 $ 39,796,240 $34,778,881 $140,554,795

StandardizationRebates $27,445 $97,159 $132,097 $121,302 $378,003 AdditionalManufacturerRebates $78,615 $75,429 $85,250 $61,681 $300,975

Savings $308,433 $113,520 $2,121,016 $2,536,079 $5,079,048

ATT 3-6

ATTACHMENT 4

ATT 4-1

San Diego Radiosurgery, LLC

Board Finance CommitteeProgram Update

Gerald Bracht - CAOBob Hemker - CFO

ATT 4-2

2

SDRS Background• Linear accelerator replacement approved in FY07• Operating agreement entered into on April 10, 2008• Ownership distribution: 51% NeoSpine LLC; 49% PPH• Structure:

– Operating Agreement– Services Agreement

• Provisions for Stereotactic Radiosurgery services– Block Lease Agreement

• Lease of space occupied by SDRS• PPH use of space for Radiation Therapy

– Contribution Agreement• Site improvements by PPH for Novalis TX equipment

• Radiation Therapy operational May 2008 • Stereotactic upgrade October 2008, operational November 2008

ATT 4-3

3

SDRS Services• PPH Radiation Therapy

– M-F 6 hours/day access– Treatment of soft tissue tumors– Enhanced IMRT capability

• Stereotactic Radiosurgery– M-F 6 hours/day access– Brain tumors– Neurosurgeon directed

ATT 4-4

4

PPH Benefits• State-of-the-Art service locally• Ancillary services activity:

– MRI, CT, PET– Surgical placement of fiducial markers– Surgical tumor debulking

• Benefits neurosurgical physicians• Enhanced marketing campaign• Spin-off radiation therapy activity

ATT 4-5

5

SDRS, LLC PerformanceActivity

CY08 CY09

Budget 0 94Actual 7 32Variance 7

ATT 4-6

6

SDRS, LLC PerformanceFinancial

CY08 CY09Net Income (Bud) $52,044 $457,640

EBIDTA $410,006 $1,262,278

Net Income (Act)

Distributions 0 $200,000 *

* Distribution in June 2009, NeoSpine, LLC $110,000; PPH $90,000

ATT 4-7

7

SDRS Marketing

Contacts by category:

TV 302Radio 33Website 42Print 9MD* 8

Total 399

*through SDRS phone line

ATT 4-8

8

SDRS Contact Conversions/Treatments

• Conversions out of 399 contacts:– 24 consults– 3 Stereotactic patients (out of 32 total)– 3 Conventional Radiation Therapy/IMRT patients

• Reasons for lack of conversions call to consult and treatment– Callers have out of network insurance

• Example 58 patients that gave insurance information were Kaiser patients– Callers were not candidates for either modality

• Example no cancer, widespread disease, not a condition that is treated with Radiation of any type

– Callers were under treatment elsewhere already– Patients without certain tests completed were turned away until they had results– Lack of physician confidence in the physicist prevented the patients being treated

ATT 4-9

9

SDRS CY10 Budget

CY10Activity 60Net Income $107,749

• January actual 5• February actual 7

ATT 4-10

10

SDRS CY10Marketing Strategy

• Coordinated SDRS and PPH activities• Direct to Physician visits

– PCP’s, IM, Oncologists, Neurosurgeons, Urologists, Pulmonologist, Endocrinologists, Nephrologists, Neurologists,

– Involving Radiation Oncologist– Involving Physicist

• Community presentations• Gain access to all area contracts• Continued targeted TV campaign• CPM “Innovations” direct mail campaign• Print advertising

ATT 4-11

11

San Diego Radiosurgery, LLC

Questions

ATT 4-12

2010-02-23 BoD Finance Minutes.pdfADP5B.tmpBackground VHA Services / BenefitsPPH ParticipationSpend & Savings

ADP63.tmpSan Diego Radiosurgery, LLCSDRS BackgroundSDRS ServicesPPH BenefitsSDRS, LLC Performance�ActivitySDRS, LLC Performance�FinancialSDRS MarketingSDRS �Contact Conversions/TreatmentsSDRS CY10 BudgetSDRS CY10�Marketing StrategySan Diego Radiosurgery, LLC

ADP156.tmpBoard Finance Committee MeetingABoard Finance Committee MeetingAttendance Roster & Meeting Minutes

meeting dates - palomar health · 2010. 2. 23. · b oard f inance c ommittee m eeting a ttendance...

Documents