room h6/215 may 26, 2016, 1:30 - 4:30 pm uwhca board of … · 2016-05-23 · 1 university of...

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UWHCA Board of Directors

May 26, 2016, 1:30 - 4:30 PM

Room H6/215

Meeting MinutesMeeting Minutes

Medical Staff Membership and Clinical PrivilegesMedical Staff Membership and Clinical Privileges

Attachment - Dept of Ophthalmology & Visual Sciences TransferRequest to UWF

Department of Ophthalmology and Visual Sciences Transfer Request toDepartment of Ophthalmology and Visual Sciences Transfer Request toUWFUWF

Financial Assistance Policy and Billing and Collection PolicyFinancial Assistance Policy and Billing and Collection Policy

Code of Ethics on Conflicts of InterestCode of Ethics on Conflicts of Interest

Attachment - Minutes from April 21, 2016Joint Meeting With UWMF Board of Directors

Attachment - Medical Staff Membership and Clinical Privileges 042016

Attachment – Resolution Authorizing UWMF to Transfer Dept ofOphthalmology Reserve Fund

Attachment - Financial Assistance Policy and Billing and CollectionPolicy

1:30 PM IIIIII. . Consent AgendaConsent AgendaChair Robert Golden

Approval

FY17 UW Health BudgetFY17 UW Health Budget

Presentation/Discussion

UWHCA FY17 Hospital Rate IncreaseUWHCA FY17 Hospital Rate Increase

Approval

Attachment - FY17 UW Health Budget Report

VV. . UW Health Financial MattersUW Health Financial MattersMr. Bob O'Keefe/Mr. Robert Flannery

1:30 PM II. . Call to Order of Board MeetingCall to Order of Board MeetingChair Robert Golden

IIII. . UW Health CEO IntroductionUW Health CEO IntroductionChair Robert Golden

Introduction

Attachment – Resolution Approving Change to the Code of Ethicson Conflicts of Interest

IVIV. . UW Health CEO UpdateUW Health CEO UpdateDr. Alan Kaplan

Informational

UWHCA Board of Directors - May 26, 2016UWHCA Board of Directors - May 26, 2016

AgendaAgenda

Page 4

Page 8

Page 17

Page 19

1

Page 24

Page 27

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Attachment - UW Health Enterprise and Debt/MTI Structure

Resolution - Approve MTI Integration

Joint Obligated Group - MTI Restructuring PlanJoint Obligated Group - MTI Restructuring Plan

Discussion/Approval

UW Health Consolidated Financial ReportUW Health Consolidated Financial Report

Informational

Resolution - UWHCA FY17 Hospital Rate Increase

Resolution - Approve MTI Reserved Powers

Attachment - UW Health Consolidated Financial Report

VIVI. . Closed SessionClosed Session Motion to enter into closed session pursuant to Section 19.85(e), WisconsinStatutes, for the discussion of confidential strategic matters, which forcompetitive reasons require a closed session, including but not limited toterms under negotiation for a potential partnership with Unity PointHealth/Unity Point Health-Meriter; pursuant to Section 146.38, WisconsinStatutes, for the review of services of health care providers; and, pursuantto Section 19.85(1)(g), Wisconsin Statutes, to confer with legal counselregarding these and other matters.

4:30 PM VIIVII. . AdjournAdjourn

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Page 51

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Attachment

Open Session Minutes

April 21, 2016

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UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY Minutes of Board of Directors Meeting

Open Session

April 21, 2016, 1:30 PM UWHCA & UWMF Joint Board, HSLC - Room 4201

UWHCA BOARD MEMBERS PRESENT: Dean Robert Golden (Chair), David Ward (Vice Chair), Chancellor Rebecca Blank

(left at 3:45 pm), Dr. Thomas Grist, Michael Heifetz, Regent Tim Higgins, Andrew Hitt, Rep. Dale Kooyenga (left at 3:50 pm), Regent Janice Mueller, Senator Luther Olsen, Regent Drew Petersen, Pablo Sanchez, Gary Wolter

UWHCA BOARD MEMBERS EXCUSED: John Litscher, Dean Katharyn May, Lisa Reardon LIAISON: Dr. Lee Faucher (left at 2:30 pm) BOARD EXECUTIVE COMMITTEE (Non-Voting): Patricia Brady, Dr. Jeff Grossman, Dr. Jon Matsumura, Dr. Richard Page UWMF BOARD MEMBERS: PRESENT: Dr. Jeff Grossman (Chair), Dr. Nizar Jarjour (Vice Chair), Jennifer Alexander,

Ron Anderson, Pat Brady, Robert Flannery, Dr. Ben Graf, Dr. Craig Kent, Dr. Jon Matsumura, Dr. Steve Nakada, Dr. Richard Page, Dr. Laurel Rice, Dr. William Schwab, Mr. Fritz Wenzel

UWMF BOARD MEMBERS EXCUSED: Dr. Terry Young UW HEALTH STAFF: PRESENT: Elizabeth Bolt, Mike Dallman, Jocelyn DeWitt, Beth Houlahan, Dr. Jonathan

Jaffery, Patti Meyer, Dr. Pete Newcomer, Bob O’Keefe, Jay Robaidek, Ron Sliwinski, Tina Whitehorse, Kelly Wilson (Secretary)

GUESTS: Ken Mount, Tim Stumm (WI Health News) 1. Call to Order

Chair Robert Golden called the open session of the Board of Directors meeting to order at 1:30 p.m. Roll call was taken and a quorum was present.

2. ACTION: Resolution of Gratitude for Service of Dr. Jeffrey Grossman Chair Golden read a Resolution honoring Dr. Grossman for his distinguished service and exemplary leadership while UW Health Interim Chief Executive Officer, as well as the many other roles he has held within the organization, and thanking him for his unflagging efforts to make “One UW Health” a reality for the benefit of our patients, our community, and our many dedicated physicians and staff. Chancellor Rebecca Blank moved to approve the resolution; Dr. Thomas Grist seconded the motion; the resolution was approved unanimously. Resolution 16-021.

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Chair Golden presented Dr. Grossman with a gift and plaque on behalf of the UWMF and UWHCA Boards.

3. ACTION: Approval of UWHCA Consent Agenda

Regent Drew Petersen moved approval of the items on the consent agenda, including: UWHCA February 25, 2016 Open Minutes; Medical Staff Membership and Clinical Privileges; Resolution approving the transfer of UWMF Department of Surgery reserve funds to the UW Foundation Endowed Chair of Education in Plastic Reconstructive Surgery [Resolution 16-022]; Mr. Andrew Hitt seconded the motion; it passed unanimously.

4. ACTION: Approval of UWMF Consent Agenda

Dr. Jon Matsumura moved approval of the items on the consent agenda, including: UWMF February 25, 2016 Open Minutes and Department of Surgery transfer request to UW Foundation Endowed Chair of Education in Plastic Reconstructive Surgery; Ms. Jennifer Alexander seconded the motion; it passed unanimously.

5. UW Health Support to UWSMPH

Vice Chair David Ward provided a brief background of the original funding model adopted by UWHCA to support UWSMPH. He reviewed goals for the proposed revised UWSMPH funding update for FY2016 to include: a) consolidate historical support to UWSMPH; b) facilitate intent of the Integration Agreement to make past UWMF reserves consistently available to UWSMPH; and c) trade off “below the line” up-side for “above the line” reliability for UWSMPH.

Comparing current model to proposed, Vice Chair Ward reviewed recommended changes for Annual Support, ICTR, AAA (academic portion elimination) and Earn-out on $90M UWMF funds. Specifically, annual support (MSDF, UW Health, Library and Health Innovations) will be aggregated as UW Health Support and increased 2% each year; the amount will be adjusted every three years in line with growth or contraction of revenue. ICTR annual funding will continue as long as grant does (with bridge funding). The Academic portion of AAA is eliminated. Department and Project portions of AAA will stay intact until a new funds flow model is in place. The Earn-out on $90M UWMF funds will be converted to $13M/year with no contingency, plus 2% growth per year (subject to circuit breaker).

Senator Luther Olsen moved to approve the resolution authorizing Amendments to the Integration Agreement and AAA Agreement; Gary Wolter seconded the motion; the resolution was approved with majority vote. Chair Golden abstained. Resolution 16-023

6. Joint Obligated Group Consolidation: MTI Integration

This agenda item was deferred. The UWHCA Finance Committee deferred the item due to time constraints.

7. UW Health CEO Report

Dr. Grossman provided the UW Health CEO Report including organizational updates: Dr. Nizar Jarjour named UWMF President; Kevin Moore, State Medicaid Director Visit, UW Health, UnityPoint Health and Agrace Clinical Affiliation discussions, and Funds Flow Development Process.

8. The Cost of Care

Dr. Grossman introduced the topic to be explored in closed session regarding Cost of Care.

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9. Closed Session

There being no other matters for the open session, Chair Golden proposed to take the meeting into closed session through a motion to enter into closed session pursuant to Section 19.85(e), Wisconsin Statutes, for the discussion of strategic, financial and other proprietary matters which for competitive reasons require a closed session, including but not limited to review of confidential terms of payer contracts and updates to a proposed partnership between Unity Insurance Company and Gundersen Health Plan; pursuant to Section 146.38, Wisconsin Statutes, for the review of the services of health care providers; and pursuant to Section 19.85(1)(g), Wisconsin Statutes, to confer with legal counsel regarding strategy with respect to each of these matters.

Sen. Olsen moved to go into closed session; Dr. Grist seconded the motion; there was a unanimous roll call vote approving entering into closed session. The following UWHCA members voted for the motion: Chair Golden, Vice Chair Ward, Chancellor Blank, Dr. Grist, Michael Heifetz, Regent Tim Higgins, Andrew Hitt, Rep. Dale Kooyenga, Regent Janice Mueller, Sen. Olsen, Regent Petersen, Pablo Sanchez, and Gary Wolter.

10. ACTION: Endorsement of Partnership Capital Contribution

After returning to Open Session, Chair Golden requested motions to endorse a resolution authorizing capital contributions to UHC. Regent Petersen moved to approve the resolution regarding UWHCA’s partnership capital contribution to UHC; Mr. Hitt seconded the motion. The following members voted for the motion: Chair Golden, Vice Chair Ward, Dr. Grist, Michael Heifetz, Regent Tim Higgins, Andrew Hitt, Regent Janice Mueller, Sen. Olsen, Regent Petersen, Pablo Sanchez, and Gary Wolter. Resolution 16-024

Dr. William Schwab moved to endorse UWMF’s partnership capital contribution to UHC. Dr. Jon Matsumura seconded the motion. The following members voted for the motion: Jennifer Alexander, Ronald Anderson, Pat Brady, Robert Flannery, Dr. Jeff Grossman, Dr. Nizar Jarjour, Dr. Craig Kent, Dr. Jon Matsumura, Dr. Stephen Nakada, Dr. Laurel Rice, Dr. William Schwab, Fritz Wenzel.

11. Adjournment

A motion was made and seconded to adjourn the meeting. The meeting was adjourned in Open Session at 4:30 p.m.

Respectfully Submitted, Kelly Wilson, Secretary

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Attachment

Medical Staff Membership

and

Clinical Privileges

April 2016

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Attachment

Department of

Ophthalmology & Visual Sciences

Transfer Request to UWF

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Attachment

Resolution

Authorizing UWMF to Transfer

Dept of Ophthalmology and Visual

Sciences Reserves to UWF

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RESOLUTION OF

THE BOARD OF DIRECTORS OF

UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY

Authorizing UWMF to Transfer Department of Ophthmalogy

and Visual Sciences Reserves to UWF

WHEREAS, the Department of Ophthmalogy and Visual Sciences of the University of

Wisconsin (“UW”) School of Medicine and Public Health requested in a letter dated March 9,

2016 (attached) that the UW Medical Foundation (“UWMF”) transfer UWMF Department of

Ophthmalogy and Visual Sciences reserve funds to the University of Wisconsin Foundation

(“UW Foundation”) to support FY16 research and development (the "Transaction"), and

WHEREAS, the Board of Directors of UWMF unanimously approved the Transaction

on May 26, 2016, and the Board of Directors of the University of Wisconsin Hospitals and

Clinics Authority (“Authority Board”) desires to approve the Transaction pursuant to

Section 4.3.2(a) of the Integration Agreement between the parties;

NOW, THEREFORE, BE IT RESOLVED, that the Transaction is hereby authorized

and approved, and UWMF is authorized and empowered to take all other actions necessary or

appropriate to effectuate the Transaction.

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Attachment

Resolution

Approving Change to the Code of

Ethics on Conflicts of Interest

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RESOLUTION OF THE BOARD OF DIRECTORS OF


Approving Change to the Code of Ethics on Conflicts of Interest

WHEREAS, the last of several contracts between the University of Wisconsin Hospitals

and Clinics Authority (“UWHCA”) and employee unions ended as of January 2015. WHEREAS, on and prior to January 2015, UWHCA’s Board-approved Code of Ethics

on Conflicts of Interest (“COI”) required “all non-represented” (i.e., non-unionized) UWHCA employees to complete an annual report of outside interests and activities as part of UWHCA’s conflict of interest management program.

WHEREAS, on May 6. 2015, the UWHCA Board resolved that data gathering from

100% of employees (which requirement technically resulted from the elimination of unions at UWHCA) was not the intent of the Code of Ethics and was not warranted; and, further resolved a one year stay on gathering data from non-management employees (Attachment I).

WHEREAS, on July 1, 2015, UWHCA integrated with the University of Wisconsin

Medical Foundation (“UWMF”), and a multiprong process of operationalizing that integration began in earnest. The COI processes of legacy UWMF, done in coordination with the University of Wisconsin School of Medicine and Public Health (“SMPH”) and legacy UWHCA were separate at that time and presently are separately operated.

WHEREAS, UWHCA and SMPH leaders are evaluating the viability of a joint UW Health / SMPH program for identifying outside interests and managing conflicts of interest. It is anticipated that a new integrated approach to COI will be presented to the Board not later than May 2017; and

WHEREAS, until that time the UWHCA Board wants to continue the intent of the

current approach to COI, but does not want to subject all employees to requirements that were originally intended only for management.

NOW, THEREFORE, BE IT RESOLVED, the UWHCA Board resolves that the effective immediately, the UWHCA Code of Ethics on Conflicts of Interest be amended such that the reference to “All non-represented employees” be stricken and replaced with “All managers and others as determined by UWHCA leadership.”

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Attachment

Resolution

Approving Change to the Code of

Ethics on Conflicts of Interest

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RESOLUTION OF THE BOARD OF DIRECTORS OF


Approving Change to the Code of Ethics on Conflicts of Interest

WHEREAS, the last of several contracts between the University of Wisconsin Hospitals

and Clinics Authority (“UWHCA”) and employee unions ended as of January 2015. WHEREAS, on and prior to January 2015, UWHCA’s Board-approved Code of Ethics

on Conflicts of Interest (“COI”) required “all non-represented” (i.e., non-unionized) UWHCA employees to complete an annual report of outside interests and activities as part of UWHCA’s conflict of interest management program.

WHEREAS, on May 6. 2015, the UWHCA Board resolved that data gathering from

100% of employees (which requirement technically resulted from the elimination of unions at UWHCA) was not the intent of the Code of Ethics and was not warranted; and, further resolved a one year stay on gathering data from non-management employees (Attachment I).

WHEREAS, on July 1, 2015, UWHCA integrated with the University of Wisconsin

Medical Foundation (“UWMF”), and a multiprong process of operationalizing that integration began in earnest. The COI processes of legacy UWMF, done in coordination with the University of Wisconsin School of Medicine and Public Health (“SMPH”) and legacy UWHCA were separate at that time and presently are separately operated.

WHEREAS, UWHCA and SMPH leaders are evaluating the viability of a joint UW Health / SMPH program for identifying outside interests and managing conflicts of interest. It is anticipated that a new integrated approach to COI will be presented to the Board not later than May 2017; and

WHEREAS, until that time the UWHCA Board wants to continue the intent of the

current approach to COI, but does not want to subject all employees to requirements that were originally intended only for management.

NOW, THEREFORE, BE IT RESOLVED, the UWHCA Board resolves that the effective immediately, the UWHCA Code of Ethics on Conflicts of Interest be amended such that the reference to “All non-represented employees” be stricken and replaced with “All managers and others as determined by UWHCA leadership.”

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Attachment

UW Health FY17 Budget Status Report

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2017 UW Health Budget Status Report

May 26, 2016

UWHCA Finance Committee

and Authority Board

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FY2017 UW Health Budget Progress Report

1. UW Health entities with July 1 budgets

2. Combined budget

3. Significant observations :

– UWHCA

– UWMF

– Swedish American

4. Budget calendar

– Final approval of price increase

– No action on total budget today

– Final budget approval June 23, 2016

WISCONSIN

ILLINOIS

Hospitals

Clinics

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UW Health Financial Structure

Affiliation Agreement

University of Wisconsin Hospitals and Clinics Authority

University of Wisconsin Medical Foundation

Regional Division, Inc.1

Swedish American Health System

Unity Health Plan

UHC, Inc.2

Equity-Based Joint Ventures

Consolidated Ventures

Majority-Owned Ventures

Non-Consolidated Joint Ventures

University Hospital American Family Childrens Hospital

The American Center Ambulatory Clinics

InnTowner, LLC

Faculty Practice Plan 17 Clinical Departments

Ambulatory Clinics

Swedish American Hospital Belvidere Hospital

Swedish American Foundation Other Entities

Unity Health Plan Quartz TPA

Unity Health Plan merged with

Gundersen Health Plan effective May 2, 2016

Madison Surgery Center Wisconsin Dialysis

Chartwell Enterprises Generations

UW Health ACO

UWH Rehabilitation Hospital Madison United Linen

Madison Environmental Transformations Surgery Center

Wisconsin Sleep Madison Medical Center

1 Includes minority investments in UW Cancer Center Johnson Creek and AboutHealth

2 Includes Health Professionals of Wisconsin and eCare of Wisconsin

These entities were integrated on July 1, 2015.

UW Health Enterprise and Budget Overview

July 1, Fiscal

Year Budgets Various Fiscal Year

Budgets

3

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Executive Summary FY17 Budget

UWHC UWMF SAHS

Price/fee increase* + 4.9% + 3.0% + 5.0%

Volume growth:

Discharges + 2.2% - + 0.0%

Clinic visits / wRVUs + 2.6% + 2.0% + 4.3%

Surgeries + 1.8% - + 1.0%

Expense growth:

FTEs + 7.5% + 4.4% + 2.5%

Staff salary increases + 2.9% + 2.9% + 0.0%

Non-salary expense growth + 11.3% + 2.9% + 4.2%

Operating results:

Operating income (millions) $ 89 $ 3 $ 4

Operating margin 5.0% 0.4% 0.8%

4 * UWMF increase 1/1/16

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7.7%

2.3% 2.1%

7.0%

1.8%

0.6%

5.0%

0.4% 0.8%

UWHCA UWMF* SAHS

FY15 FY16P FY17 target

UW Health YTD Operating Margin

* $90 million transfer to UWSMPH reclassified for this report to non operating expense

FY17 UW Health Budgets for July 1 Fiscal Year Entities**

Combined FY17

operating margin ~

3.0%**

** Excluding Unity/Gundersen and various joint ventures. Accounting and reporting for the newly merged Unity/GHP is uncertain at this time.

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FY2017 UW Health-Madison Compensation Plan

1. 2.9% pay increase pool to be allocated by Directors

2. Increase minimum wage to $15 (from $14.15)

3. Delay UWHC pay increases to match timing of UWMF

– From July 1 to October 2

– One-time retroactive lump sum to UWHC staff

4. Performance Recognition Compensation Program

– For exceptional performance of staff on a project

– Estimated amount = 0.1% of compensation (i.e. $500,000 - $750,000)

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Affiliation Agreement Funding

7

Percentage is total affiliation costs as a % of total UWHCA and UWMF combined net revenues

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UWHC BUDGET FACTS

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9

Patient Volume Growth FY13-FY17

Unity membership growth

29% growth

over 4 years

Cumulative UWHC volume growth

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UWHC Proposed Rate Increase

10

• Recommended increase is 4.9% (to yield 2.2% - 2.5% net revenue)

• Few payors’ rates have any connection to charges, but:

- Charges do impact PPO payment rates

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Proposed Notice of Hospital Rate Increase

Wisconsin State Journal May 28, 2016

11

Annual average gross percentage price increase: 4.9%

Effective date of increase: 7/1/16

Date of last reported increase: 7/1/15

Last reported annual gross percentage price increase: 5.0%

Previous New Increase Increase

Charge Element Price Price (Decrease) (Decrease)

Room & Board

Adult 1,942.00$ 2,037.00$ 95.00$ 4.9%

Pediatric 2,648.00 2,778.00 130.00 4.9%

Adult Intermediate Care 4,580.00 4,804.00 224.00 4.9%

Trauma/Burn Intensive Care 7,324.00 7,683.00 359.00 4.9%

Surgical Intensive Care 7,324.00 7,683.00 359.00 4.9%

Medical Intensive Care 7,324.00 7,683.00 359.00 4.9%

Pediatric Intensive Care 7,775.00 8,156.00 381.00 4.9%

Neonatal Intensive Care Level 4 8,161.00 8,561.00 400.00 4.9%

Mammography - Unilateral 294.00 308.00 14.00 4.9%

Mammography - Bilateral 376.00 394.00 18.00 4.9%

Mammography - Bilateral Screen w/CAD 360.00 377.64 17.64 4.9%

Emergency Room Level 3 Visit 1,175.00 1,233.00 58.00 4.9%

Psychotherapy, 38-52 Min w/PT and/or Family 89.20 89.20 0.00 0.0%

ECT 159.00 167.00 8.00 4.9%

Reason for increase: These increases have been approved by the University of Wisconsin Hospitals

and Clinics Authority Board. Cost increases in the form of new technology, drugs, supplies expenses,

and higher wage rates for personnel are primarily responsible for these increases in payment rates.

Madison, WI 53792

Fiscal Year 7/1/16 to 6/30/17

NOTICE OF HOSPITAL RATE INCREASE

FOR UNIVERSITY OF WISCONSIN

HOSPITALS AND CLINICS AUTHORITY

600 Highland Avenue

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Reconciliation of FY16 Projected to FY17 Budget

12

Millions Margin

Data $$ %

FY17 income/margin at FY16 YTD March level - $139.6 7.9%

Growth in FTEs beyond FY17 patient volume growth % 257 FTEs* (23.1) -1.3%

IT costs beyond FY17 inflation assumption - (17.8) -1.0%

Increase in depreciation and interest, including TAC - (20.0) -1.1%

All other, including anticipated supply chain and pharmacy savings - $10.3 0.6%

FY17 operating income/margin $89.0 5.0%

* After considering 300 FTEs covered by vacancy credit; would otherwise be 557. Requested FTEs are subject

to review by the UW Health FTE Committee.

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Annual and Cumulative Growth in

CMI Adjusted Equivalent Discharges

13

Volume and FTE Growth FY13-FY17

Annual and Cumulative Growth in FTEs

4 years = 4 years =

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UWMF Budget Overview

FY15 Actual FY16 Est* FY17 Budget

wRVU Growth 5.0% 3.4% 2.0%

Fee Increase 3.1% 3.3% 3.0%

Charges $1.69B $1.78B $1.87B

Net Payments (HealthLink)

$620M $667M $688M

Operating Revenue $752M $797M $836M

Operating Margin $17.6M $14.4M $3.1M

Operating Margin % 2.3% 1.8% 0.4%

Non-Operating Income

$189.8M $1.3M $10.5M

14

*Excludes $90M Integration Agreement Commitment.

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* Payment growth rates exclude Unity risk distributions (8.4%, 8.1%, 7.5% and 3.1% when included, respectively)

15

UWMF Activity Growth Rate Comparison

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HealthLink Revenue by Department dollars in millions

* FY16 excludes Unity 2015 risk-payment distributed in May

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FY17 Revenue Growth by Department

17

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$’s in millions

18

Revenue and Physician Compensation Trend

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SWEDISH AMERICAN BUDGET

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SwedishAmerican Health System

FY17 Operating Profit $967,000 increase

– Revenue $20 million increase

• Volume increases at Cancer Center and Belvidere Hospital

• Volume increases for physician additions and provider based billing

• 5% price increase for hospital billing, nets 1.5% and $2.9 million

– Expenses $19 million increase

• Includes 2.5% and 69 FTE increase primarily for physician practice

expansion

• Includes elimination of 40 FTE’s primarily from open positions and

retirements

• Includes no anticipated merit and $1.5 million in equity adjustments

• Supply inflation and volume increases

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Requested Actions

– Approve UWHC price increase (see resolution)

– Final budget approval to be requested June 23, 2016

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Attachment

Resolution Approving

the

UWHC Rate Increase for FY2017

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1

PROPOSED RESOLUTION SUBMITTED MAY 26, 2016

BOARD OF DIRECTORS OF THE UNIVERSITY OF WISCONSIN HOSPITALS AND CLINICS AUTHORITY

(UWHC)

RESOLUTION APPROVING THE HOSPITAL RATE INCREASE FOR FY 2017,

WHEREAS, the Finance Committee of the Board of Directors of UWHC has reviewed the UWHC Hospital Rate Increase document for FY 2017 as prepared by management and has recommended its approval to this Board; and

WHEREAS, this Board has reviewed the Hospital Rate Increase document for FY 2017 as presented by management.

NOW THEREFORE BE IT RESOLVED THAT,

The Board of Directors of the University of Wisconsin Hospitals and Clinics Authority approves an average gross percentage price increase of 4.9% effective July 1, 2016.

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Attachment

UW Health Enterprise and Debt/MTI Structure

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UW Hospitals and Clinics Authority

UW Medical Foundation

SwedishAmerican

• Current documents prohibit “note substitution”

• Debt can be called in 2022. • UWHCA can issue debt on

behalf of SAHS currently and loan proceeds to them

Unity Health Insurance

No debt.

Majority- Owned Joint

Ventures

No debt.

Non-Consolidated

Joint Ventures

No debt.

Integrated on July 1, 2015

Debt and MTI to be integrated effective July 1, 2016

1

UW Health Enterprise and Debt/MTI Structure

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Attachment


MTI Integration

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________________________________________________________________

RESOLUTION

OF THE BOARD OF DIRECTORS OF


________________________________________________________________

Approved May 26, 2016

WHEREAS, the University of Wisconsin Hospitals and Clinics Authority (the

“Authority”) was created by 1995 Wisconsin Act 27 and exists under the authority of and

pursuant to the provisions of Chapter 233 of the Wisconsin Statutes, as amended (the “Act”), and

other applicable statutes of the State of Wisconsin; and

WHEREAS, the Authority was organized to operate and maintain the University of

Wisconsin Hospitals and Clinics and other health-related facilities in connection therewith; and

WHEREAS, the Authority has previously completed integration/affiliation transactions

with University of Wisconsin Medical Foundation, Inc. (“UWMF”) whereby the Authority

became the sole corporate member of UWMF and with SwedishAmerican Health System

Corporation (“SAHSC”) whereby the Authority and UWMF are now the corporate members of

the sole member of SAHSC; and

WHEREAS, the Authority has previously entered into a Master Indenture of Trust dated

as of April 1, 1997, as amended to date, with U.S. Bank National Association, as master trustee

(the “Authority Master Indenture”) under which the Authority has pledged certain revenues and

agreed to certain covenants for the benefit of all bonds issued under the Authority Master

Indenture; and

WHEREAS, UWMF has previously entered into a Master Trust Indenture dated as of

May 1, 2000, as amended to date, with U.S. Bank National Association, as master trustee (the

“UWMF Master Indenture”) under which UWMF has pledged certain revenues and agreed to

certain covenants for the benefit of the holders of master notes issued under the UWMF Master

Indenture; and

WHEREAS, SwedishAmerican Hospital (“SAH”) and SwedishAmerican Foundation

(“SAF”), affiliates of SAHSC, have previously entered into a Master Trust Indenture dated as of

October 15, 1993, as amended to date, with BNY Mellon Trust Company National Association,

as current master trustee (the “SAHS Master Indenture”) under which SAH and SAF have

pledged certain of their revenues and agreed to certain covenants for the benefit of the holders of

master notes issued under the SAHS Master Indenture; and

WHEREAS, in order to further the desired goal of integration among the Authority,

UWMF, SAH and SAF and to move toward a singular financial credit for accessing capital and

the capital markets, it is in the best interest of the Authority to enter into a new master trust

indenture with UWMF as one obligated group (“New MTI”); and

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WHEREAS, the Authority and UWMF will each be jointly and severally liable for all

obligations issued under the New MTI; and

WHEREAS, the New MTI would contain a pledge of revenues and covenants similar to

what is currently contained in the Authority Master Indenture, but may also contain certain

financial and operational covenants that reflect current market and credit considerations, such

covenants to be in effect when eligible under the terms of the documents; and

WHEREAS, no new debt would be issued in connection with the creation of the New

MTI, all bonds of the Authority would remain outstanding under the existing Authority Master

Indenture and obligations of the new obligated group would be issued under the New MTI to

secure such bonds thereby providing the credit of the obligated group and the terms and

covenants of the New MTI as the security for the existing outstanding bonds of the Authority;

and

WHEREAS, all bonds and other indebtedness of UWMF currently outstanding and

secured by a master note issued under the UWMF Master Indenture will remain outstanding but

a replacement obligation of the new obligated group would be issued under the New MTI to

secure such debt (and upon substitution of all existing master notes, the UWMF Master

Indenture would be cancelled) thereby providing the credit of the obligated group and the terms

and covenants of the New MTI as the security for the existing outstanding debt of UWMF; and

WHEREAS, all bonds and other indebtedness of SAH and SAF currently outstanding and

secured by a master note issued under the SAHS Master Indenture will remain outstanding under

the SAHS Master Indenture, however, as applicable and appropriate under the New MTI and

SAHS Master Indenture, the health system may be presented as a whole to the financial markets

(without currently creating any liability or guaranty of debt) as the organizations continue to

move toward financial and credit integration; and

WHEREAS, management of the Authority has determined the formation of an obligated

group and entry into the New MTI would be in the best interest of the Authority and further the

desired goal toward integration into a singular financial credit structure;

WHEREAS, the Finance Committee of this Board of Directors has determined it is in the

best interest of the Authority to proceed with this plan for the obligated group structure and the

entry into the new MTI and now desires the approval of the Board of Directors.

NOW, THEREFORE, THIS BOARD OF DIRECTORS RESOLVES AS FOLLOWS:

1. That the Board of Directors hereby approves the plan for the obligated group

structure and the Authority’s entry into the New MTI.

2. That the Board of Directors hereby authorizes management of the Authority to

carry out the plan in the best interest of the Authority, to prepare the New MTI, to negotiate with

and obtain consent from exiting bondholders and other lenders as necessary, to discuss and

present the plan documents to the rating agencies and make disclosures to the capital markets as

appropriate and necessary.

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3. That each of the President and Chief Executive Officer, the Chief Financial

Officer or the Chief Legal Officer of the Authority (each an “Authorized Officer”), each acting

singly, is hereby authorized to exercise any discretion as may be necessary to execute and deliver

on behalf of the Authority the new MTI and any supplemental master indenture(s) creating the

obligations to secure the existing outstanding bonds under the Authority MTI, to execute and

deliver one or more consent documents as may be necessary to complete the transaction, to

execute and delivery any amendments to credit agreements or other finance documents currently

secured by the Authority Master Indenture, to execute and deliver one or more contracts (or

amendments to contracts) with respect to continuing disclosure obligations and any other

agreements evidencing the Authority’s obligations in relation to its outstanding bonds, and any

other documents, certificates or instruments necessary to the transaction described herein, all in

such form and upon such terms as such Authorized Officer shall approve, such approval to be

conclusively evidenced by the execution and delivery of said agreements by any Authorized

Officer.

4. That all Authorized Officers of the Authority acting singly are hereby authorized

to execute and deliver on behalf of the Authority such other related agreements, certificates and

documents and take such other further action as may be necessary or desirable to carry out the

transactions authorized by these resolutions.

5. That all acts authorized by each of the foregoing resolutions taken heretofore by

any Authorized Officer are hereby ratified as the authorized act of the Authority.

6. That all prior resolutions of the Finance Committee or the Executive Committee

of the Board of Directors or any parts thereof in conflict with any or all of the foregoing

resolutions are hereby repealed to the extent of such conflict.

This is a true copy of the Resolution adopted by the Board of Directors of the University

of Wisconsin Hospitals and Clinics Authority on May 26, 2016.

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Attachment


MTI Reserved Powers

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________________________________________________________________

RESOLUTION

OF THE BOARD OF DIRECTORS OF


(as sole corporate member of University of Wisconsin Medical Foundation, Inc.)

________________________________________________________________

Approved May 26, 2016

WHEREAS, the University of Wisconsin Medical Foundation, Inc. (“UWMF”) is a

nonstock nonprofit corporation organized under the laws of the State of Wisconsin; and

WHEREAS, the University of Wisconsin Hospitals and Clinics Authority (the

“Authority”) is the sole corporate member of UWMF; and

WHEREAS, this Board of Directors has reserved powers with respect to certain actions

to be taken by UWMF; and

WHEREAS, UWMF has previously entered into a Master Trust Indenture dated as of

May 1, 2000, as amended to date, with U.S. Bank National Association, as master trustee (the

“UWMF Master Indenture”) under which UWMF has pledged certain revenues and agreed to

certain covenants for the benefit of the holders of master notes issued under the UWMF Master

Indenture; and

WHEREAS, the Authority has previously entered into a Master Indenture of Trust dated

as of April 1, 1997, as amended to date, with U.S. Bank National Association, as master trustee

(the “Authority Master Indenture”) under which the Authority has pledged certain revenues and

agreed to certain covenants for the benefit of all bonds issued under the Authority Master

Indenture; and

WHEREAS, in order to further the desired goal of integration among the Authority and

UWMF, to avoid limitations imposed by operating under different master trust indentures, and to

create a singular financial credit for accessing capital and the capital markets, it is in the best

interest of UWMF to enter into a new master trust indenture with the Authority as one obligated

group (“New MTI”); and

WHEREAS, UWMF and the Authority will each be jointly and severally liable for all

obligations issued under the New MTI; and

WHEREAS, the New MTI would contain a pledge of revenues and covenants similar to

what is currently contained in the Authority Master Indenture; and

WHEREAS, no new debt would be issued in connection with the creation of the New

MTI; and

WHEREAS, all bonds and other indebtedness of UWMF currently outstanding and

secured by a master note issued under the UWMF Master Indenture will remain outstanding but

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a replacement obligation of the new obligated group would be issued under the New MTI to

secure such debt (and upon substitution of all existing master notes, the UWMF Master

Indenture would be cancelled) thereby providing the credit of the obligated group and the terms

and covenants of the New MTI as the security for the existing outstanding debt of UWMF; and

WHEREAS, all bonds of the Authority would remain outstanding under the existing

Authority Master Indenture and obligations of the new obligated group would be issued under

the New MTI to secure such bonds thereby providing the credit of the obligated group and the

terms and covenants of the New MTI as the security for the existing outstanding bonds of the

Authority; and

WHEREAS, management of UWMF and management of the Authority have determined

the formation of an obligated group and entry into the New MTI would be in the best interest of

UWMF and further the desired goal toward integration into a singular financial credit structure;

WHEREAS, the Board of Directors of UWMF and the Finance Committee of this Board

of Directors have determined it is in the best interest of UWMF to proceed with this plan of

financial credit integration and obligated group structure and the entry into the new MTI and

now desires the approval of this Board of Directors.

NOW, THEREFORE, THIS BOARD OF DIRECTORS RESOLVES AS FOLLOWS:

1. That the Board of Directors of the Authority, as the sole corporate member of

UWMF, hereby approves the plan for the obligated group structure and UWMF’s entry into the

New MTI.

2. That the Board of Directors hereby authorizes management of UWMF to carry

out the plan in the best interest of the UWMF, to prepare the New MTI, to negotiate with and

obtain consent from exiting bondholders and other lenders as necessary, to discuss and present

the plan documents to the rating agencies and make disclosures to the capital markets as

appropriate and necessary.

3. That each of the President and Chief Administrative Officer of UWMF (each an

“Authorized Officer”), each acting singly, is hereby authorized to exercise any discretion as may

be necessary to execute and deliver on behalf of UWMF the new MTI and any supplemental

master indenture(s) creating the obligations to secure the existing outstanding debt of UWMF, to

execute and deliver one or more consent documents as may be necessary to complete the

transaction, to execute and delivery any amendments to credit agreements or other finance

documents currently secured by UWMF Master Indenture, to execute and deliver one or more

contracts (or amendments to contracts) with respect to continuing disclosure obligations and any

other agreements evidencing UWMF’s obligations in relation to its outstanding bonds, and any

other documents, certificates or instruments necessary to the transaction described herein, all in

such form and upon such terms as such Authorized Officer shall approve, such approval to be

conclusively evidenced by the execution and delivery of said agreements by any Authorized

Officer.

4. That all Authorized Officers of UWMF acting singly are hereby authorized to

execute and deliver on behalf of UWMF such other related agreements, certificates and

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documents and take such other further action as may be necessary or desirable to carry out the

transactions authorized by these resolutions.

5. That all acts authorized by each of the foregoing resolutions taken heretofore by

any Authorized Officer are hereby ratified as the authorized act of UWMF.

6. That all prior resolutions of the Finance Committee or the Executive Committee

of the Board of Directors or any parts thereof in conflict with any or all of the foregoing

resolutions are hereby repealed to the extent of such conflict.

7. That the foregoing resolutions are conditioned upon, and are only effective upon,

the approval by the Board of Directors of the Authority, as sole corporate member of UWMF.

This is a true copy of the Resolution adopted by the Board of Directors of the University

of Wisconsin Hospitals and Clinics Authority on May 26, 2016.

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Attachment

UW Health Consolidated Financial Report

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UW Health Financial Reports

UWHC Authority Board

and Finance Committee

FY16

Consolidated Financial Review Year to Date Final March 31, 2016

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UW Health Financial Structure


University of Wisconsin Hospitals and Clinics Authority

University of Wisconsin Medical Foundation

Regional Division, Inc.1

Swedish American Health System

Unity Health Insurance

UHC, Inc.2

Equity-Based Joint Ventures

Consolidated Ventures

Majority-Owned Ventures

Non-Consolidated Joint Ventures

University Hospital American Family Childrens Hospital

The American Center Ambulatory Clinics

InnTowner, LLC

Faculty Practice Plan 17 Clinical Departments

Ambulatory Clinics

Swedish American Hospital Belvidere Hospital

Swedish American Foundation Other Entities

Unity Health Plan Quartz TPA

Madison Surgery Center Wisconsin Dialysis

Chartwell Enterprises Generations

UW Health ACO

UWH Rehabilitation Hospital Madison United Linen

Madison Environmental Transformations Surgery Center

Wisconsin Sleep Madison Medical Center

1 Includes minority investments in UW Cancer Center Johnson Creek and AboutHealth

2 Includes Health Professionals of Wisconsin and eCare of Wisconsin

These entities were integrated on July 1, 2015.

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UW Health YTD Operating Margin March 31, 2016 Final

* $90 million transfer to UWSMPH reclassified for this report to non operating expense

** Combined HC/MF without eliminations, which ties to the Incentive Plan metric

7.7%

1.3%

5.6%

0.6%

-0.8%

16.7%

4.4% 5.1%

-0.6%

3.2% 3.0%

1.1%

10.1%

3.3%

5.8%

2.2%

4.6%

3.8%

1.2%

14.1%

4.6%

UWHCA UWMF Combined HC/MF ** SAHS Unity All other Total *

Actual Budget Prior Year

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Selected Hospital Volume Statistics – YTD Mar 31, 2016

Swedish

American

Madison

Hospitals

(UWHC, TAC, and

AFCH)

4

2.4%

0.9%

5.9% 5.5% 4.9%

9.6%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Adult and peds admissions Clinic visits Surgeries

Versus budget Versus prior year

-0.4%

2.1%

-2.4%

-0.1%

7.9%

2.4%

-4.0%

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Adult and peds admissions Clinic visits Surgeries


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UWMF wRVU’s through March 31, 2016

Work Relative Value Units (wRVUs) are a measure developed by CMS as part of the Medicare reimbursement formula for physician

services. wRVUs reflect the time, skill, training and intensity to provide a given service. For example, a surgical code will typically have

a higher value (and corresponding payment) than a routine appointment code. wRVUs are also used by UW Health and other practice

plans to measure provider productivity (volume). When payors determine payments based on RVU’s, they typically include two

additional RVU components to reflect the practice expense costs (technical) and malpractice insurance costs.

Specialty care wRVUs grew 3.6% and

primary care wRVUs declined 3.6% YTD Variance

5

-1.6%

2.4%

-2.0%

-1.5%

-1.0%

-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%


561 541

2,666 2,762

0

500

1,000

1,500

2,000

2,500

3,000

wRVUs FY15 wRVUs FY16

Th

ou

san

ds

Primary Care Specialty Care

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UWMF Primary Care Volumes YTD through March 31, 2016

Clinic visits year over year are up by 2.4% while non face-to-face encounters are up by 6.2%. Clinical FTE

are down by .3% and head count is up by 1% while number of active panels are up by 3.9%.

Note: Clinic visits are defined as any arrived or completed appointment at a scheduling department with the specialty of Fam Med, GIM, or

Peds. This includes nurse only visits. Clinic Visits/Non face-to-face Encounters exclude Augusta, Eau Claire, Fox Valley & Wingra ACHC.

Non face-to-face encounters include MyChart, Telephone and Refill encounters logged in Health Link. Clinical FTE, Head Count and

Active Panel are for MD faculty only excluding Augusta, Eau Claire & Fox Valley (includes Wingra ACHC).

Data source: Ambulatory Encounters dashboard and Panel Activity Report. of 75

93,500 96,200

115,700

142,000

162,064 176,257

182,339

2010 2011 2012 2013 2014 2015 March 2016

Unity Health Plans Membership

7

2010-2013 are rounded

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Unity Health Plans Membership (Dane vs. Non-Dane)

8

115,406 123,494 126,305 129,520

46,658 51,287 49,952 52,819

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

June 2014 June 2015 December 2015 March 2016

Dane Membership - YTD Non-Dane Membership - YTD

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Summary of Enterprise-Wide March 31, 2016 YTD Operating Results

Volume Margin

9

1.4% 1.3%

5.4%

3.4%

6.0% 7.0%

0.0%

2.0%

4.0%

6.0%

8.0%

Adult and PedsAdmissions Clinic Visits Surgeries


Actual YTD

March 2016

Operating Revenue 2,521.4$

Operating Expenses:

Salaries and fringe benefits 1,141.3 Medical materials and supplies 400.2 Other expenses 869.4

Total Operating Expenses 2,410.9

Income from Operations 110.5

Nonoperating Income * (120.9)

Net Income (10.4)$ *Includes Income Tax (Expense) & $90M commitment to

SMPH from Integration Agreement

4.4%

3.3%

4.6%

Actual Budget Prior Year

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Enterprise-Wide Mar 31, 2016 YTD Performance Ratios

10

Favorable

Direction FY 16

S&P "A+"

Rated

Moodys

"Aa3" Rated

Operating Margin 4.4% 2.9% 3.7%

Total Margin -0.3% 5.1% 7.4%

Total Margin less $90M SMPH contribution 3.3% 5.1% 7.4%

Days Cash on Hand * 168.4 190.6 267

Days Cash on Hand excluding Unity * 221.5 190.6 267

Days in Accounts Receivable ** 39 46 48

Long Term Debt to Capitalization 25.1% 33.7% 29.6%

Operating Cash Flow 8.3% 10.1% 10.0%

Cash-to-Debt 220.8% 153.4% 199.1%

* excludes provision for bad debt and retiree health insurance

** average for 9 months

Industry Comparisons

Healthcare System

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UW Health at The American Center YTD Results

March 31, 2016

11

Actual Budget Variance

Operating Revenue (net) 70,484,431 79,321,941 (8,837,510)

Operating Expenses:

Salaries & benefits 31,973,480 38,712,825 6,739,345

Professional fees 2,663,250 3,903,137 1,239,887

Purchased services 2,696,513 4,221,254 1,524,741

Medical supplies & drugs 15,335,549 14,270,709 (1,064,841)

Depreciation 6,205,778 7,880,885 1,675,107

Interest 4,726,443 4,709,427 (17,016)

Other 3,232,754 3,535,931 303,176

Total operating expenses 66,833,767 77,234,166 10,400,399

Operating Income (Loss) 3,650,664 2,087,774 1,562,889

15.2%

-6.4%

-0.6% -8.0%-4.0%0.0%4.0%8.0%

12.0%16.0%20.0%

Adult Admissions Clinic visits Surgeries

Versus budget

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UW Health Non-Operating Revenue

Year-to-Date March 31, 2016 (Amount in $$ Thousands)

12

Actual

13,878

89

(20,376)

2,003

(115,377)

(1,078)

(120,861) Total revenues (expenses)

* Includes Income Tax (Expense)

Other, net *

Earned Investment Income

Equity in earnings of joint ventures

Unrealized gain (loss) on investments

Non-capital grants and contributions

Contributions to UWSMPH

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UW Health Consolidating Balance Sheet

YTD March 31, 2016

13

UWHCA UWMF RDI/SAHS UHC/Unity Other Eliminations

UW Health

Consolidated

Cash & Investments

Unrestricted 812,293,135 287,271,712 235,225,941 72,703,952 18,784,891 - 1,426,279,631

Restricted by Trustee & Donors 12,806,625 - 20,353,208 - - - 33,159,833

Accounts Receivable 218,904,072 65,326,055 68,912,794 - 8,792,814 (330,565) 361,605,171

Property, Plant & Equipment, Net 755,988,810 60,825,230 331,501,601 10,179,070 5,929,803 - 1,164,424,514

Other Assets & Deferred Outflows of Resources 284,269,078 254,861,928 47,876,718 153,823,010 5,763,817 (313,774,941) 432,819,610

Total Assets & Deferred Outflows of Resources 2,084,261,721$ 668,284,925$ 703,870,262$ 236,706,032$ 39,271,325$ (314,105,506)$ 3,418,288,759$

Current Liabilities 265,658,369 191,043,388 98,940,708 165,579,799 5,647,981 (37,090,213) 689,780,033

Long-term Debt & Deferred Inflows of Resources 540,152,287 39,745,000 148,669,115 411,545 428,328 - 729,406,275

Net Position

Unrestricted 1,125,202,840 437,496,537 446,136,769 70,714,688 33,195,016 (277,015,293) 1,835,730,556

Restricted 153,248,225 - 10,123,670 - - 163,371,895

Total Liabilities, Deferred Inflows of Resources

& Net Position 2,084,261,721$ 668,284,925$ 703,870,262$ 236,706,032$ 39,271,325$ (314,105,506)$ 3,418,288,759$

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UW Health Consolidating Income Statement

YTD March 31, 2016

*Includes $90M commitment to SMPH from Integration Agreement

14

UWHCA UWMF RDI/SAHS UHC/Unity Other Eliminations

UW Health

Consolidated

Net Patient Service Revenue (net of provision for

bad debts) 1,209,692,932 509,929,401 336,954,652 - 48,861,357 (262,057,552) 1,843,380,790

Premium Revenue - - - 624,270,552 - (22,095,079) 602,175,473

Other Revenues 19,622,934 83,185,000 27,141,310 16,751,204 3,476,715 (74,357,296) 75,819,866

Total Revenue 1,229,315,866 593,114,401 364,095,962 641,021,756 52,338,072 (358,509,928) 2,521,376,129

Operating Expenses:

Salaries & Benefits 541,506,066 386,545,140 182,302,198 28,421,871 17,629,821 (15,123,448) 1,141,281,647

Supplies, Drugs and Other Expenses 527,294,362 192,644,419 151,937,226 36,925,444 24,979,700 (83,433,357) 850,347,794

Interest 12,655,226 697,436 2,487,616 3,676 338 - 15,844,292

Depreciation 52,921,837 5,487,897 20,054,972 2,386,166 1,012,509 - 81,863,381

Health Care Expenses - - 5,228,463 578,212,783 - (261,870,126) 321,571,120

Total Operating Expenses 1,134,377,490 585,374,892 362,010,475 645,949,940 43,622,368 (360,426,932) 2,410,908,233

Operating Income 94,938,376 7,739,509 2,085,487 (4,928,184) 8,715,703 1,917,004 110,467,896

Total Non-operating Revenue and Income Tax

Expense * (27,636,972) (92,045,479) 1,291,441 (648,772) 8,933 (1,830,606) (120,861,454)

Net Income 67,301,404 (84,305,970) 3,376,928 (5,576,956) 8,724,636 86,399 (10,393,558)

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