|

I. Organizational Structure:

University Health Services

ANNUAL REPORT 2009-2010

.........

Tom TrionfiDirector

Penalope Cook D.O.Medical Director, Associate Director

Sarah Yonder, MD

Allan Riggs, PA-C

Marilyn McGinty, PA-CRelief

VacantAssistant Director of Clinical Operations

Lori Wangberg,Health Educator

Mary Armstrong, MLTLaboratory

Barb Elmore, RNClinical Suite

Denise Malley, LPNClinical Suite

Carol Mullet,Specialist ClerkAppointments

Jill Steffke, RNClinical Suite / Primary Care

Susan Woerle, RNRelief

Lora Zenz, RNClinical Suite

Laurie PattonMed TechLaboratory

Angela Smith,Assistant Director of Business Operations

Tiffany Stiff,Administrative Secretary

Juliann Ball,Health Information Specialist

Margie Clark,Health Information Specialist

Pam Wentworth,Specialist Clerk

Front Desk

Cherie Selles, RPhPharmacy Manager

Craig Buys, RPhPharmacist

Relief

Sue Lott,Pharmacy Tech

2

.........II. Executive Summary of the Major 2009-2010 Accomplishments:

CMU’s University Health Services mission statement is: To promote the health and wellness of CMU students and the University community by providing individualized medical care, health promotion, and disease prevention services tailored to the dynamic needs of the CMU campus.

Public Health is a main priority of the staff of UHS and we strive to make an impact for the

wellness of our campus community. UHS staff is involved in reporting directly to Michigan

Department of Community Health through the Michigan Disease Surveillance System. When

communicable diseases are noted an investigation is started here at UHS and the local health

department is also notified, we then work in conjunction with CMDHD to provide an investigation

and the treatment of exposed individuals and testing.

Of particular importance, the emergence of a new strain of influenza (H1N1 flu) presented itself

last fall, not only on the CMU campus, but of course to the community, the nation, and world-

wide. Countless hours were spent coordinating efforts with the health department and different

departments on campus to make sure that immunization clinics were held, students were

educated and patients were treated with medical excellence and care. There was a huge influx

of flu patients last October, November and December and to the staff’s knowledge they had never

seen true influenza cases before December, in the past.

There were also a large number of students and other workers exposed to asbestos during the

summer of 2009. All of the people were seen for screening here at CMU UHS.

1. Successfully handled the threat of an H1N1 outbreak by working collaboratively with various campus departments to treat, educate and communicate the impact on the campus and the strategies that were being undertaken to mitigate the spread.

2. Increased recognition with student population: In the Fall semester we opened with the support of Residence Life, a “quick clinic” within the Towers complex. Each Monday a physician and assistant will be available for students to quickly access our services without leaving their hall.

3. Have the potential to increase patient load with the strategic move to replace the vacated Asst Director of Clinical Operations with a Nurse Practioner with the credentials to see patients.

4. Enhanced Revenues: Engaged in a collaboration with ARAMARK to offer our “over the counter” items in their convenience stores (C-Stores). In addition, discussions are in place to possibly have their employees utilize our clinic, lab and pharmacy.

5. Consolidated the various health service areas onto one floor. The Pharmacy and Primary Care areas were moved up to the second floor for patient efficiencies and access.

6. Created overall recognition with new signage on Foust and customer access by adding a bus stop in front of Health Services.

3

.........

7. Undertook the International Student’s Hard Waiver Insurance Program. This responsibility used to be held by OIA. This has led to some challenges in the areas of manpower to successfully manage the program. UHS will use United’s Partner Center to track and maintain consistent compliance with this program.

8. Passed COLA (Commission on Laboratory Accreditation) Accreditation in July 2009. Made recommended changes. Passed with 100% all Proficiency Surveys.

9. HIV Tester/Training: Completed State of Michigan HIV Test Counselor training in Lansing in October. Free HIV testing clinic was offered and held in Foust 104 in collaboration with Health Department for World Aid’s Day, December 1.

10. Website training provided by Jesse Earley from I.T. which was an in service on maintenance of the Health Services website to allow for faster and more efficient updates to the website.

11. H1N1: Attended workshop provided by Central Michigan District Health Department on campus of Mid-Michigan Community College, in preparation for H1N1 flu prevention/preparedness. Provided presentations in late fall to campus community, which included students and custodial staff.

12. Alcohol Awareness Programming - Red Watch Band: New program implemented addressing binge drinking/alcohol awareness, courtesy of a grant through Prevention Network. This is a national program that began out of New York, after a young college student died of alcohol poisoning. Three workshops completed, two more planned for fall. This is a collaborative effort with the Isabella County Coalition to Reduce Underage Drinking and Becky Wang from 10/16 Recovery Network. Marketing efforts/ideas will also take place this summer.

13. Other involvement in campus activities include:

Participation in Wellness Coalition Towers Clinic opened and saw 127 patients Clinical teaching for 3 students from the PA program who rotated through health

services. Participation on search committees for the counseling department, the new

medical school in the search for associate dean positions, and participation on multiple searches for a nursing director/PA here at health services.

H1N1 clinics for Soccer, Basketball, Lacrosse, Football Participation in Get Acquainted Day Presentation to Resident Assistants Health Fair for employees with flu vaccine given on site Wellness Health Fair participation providing approximately 100 blood pressure

checks on site Fall into Health Fair providing B/P checks on site Provided Meningitis clinic during move in week at the Towers Flu Clinic for Men’s Basketball team Flu Clinic for Men’s Baseball team Presentation for International Students providing overview of Health Services. Participation in summer orientation for incoming freshman. Provided orientation lecture regarding Travel Clinic to the following groups: Faculty Students TB Clinics for PA students Immunization reviews for PA students Orientation for PA students Family Planning Advisory (CMDHD)

4

.........

Contact with the Isabella County Health Department on multiple occasions for STD tracking, emergency planning, etc.

Guest lectured to the DPT graduate students on Infectious Diseases.

III. Table of Operational and Statistical Data:

Nursing: The Primary Care clinic gave a total of 1233 immunizations (flu and H1N1 are counted

separately) and over 400 various injections such as B-12, Depo-provera, depo-medrol and other

pain medication, antibiotics and antiemetics.

Allergy Services include:

1. 783 allergy injections 2 or more injections 2. 399 single injections

Flu Clinic:

1. 899 doses of flu vaccine given 2. 984 doses of H1N1 vaccines given

Note: Due to PyraMed tracking it is difficult to determine numbers of specific procedures

performed by nursing unless it is coded as such. The following are what was determinable:

Procedure Number Performed

7/09-5/10

Number Performed

7/08

EKG 21 24

IV insertion 13 25

Centimist Tx 94 68

Peak Flow 57 87

Pulse Ox 113 59

Spirometry 1 1

Ear Irrigations Unable to assess due

to Pyramed

Nurse visits other

than immunizations

or injections

46

No charge nursing

visits

Tb reading, B/P

checks, new

depression med

check, etc.

711 1008

Telephone calls

requiring follow up

1647 1523

INFECTION CONTROL EFFORTS AND COMMUNICABLE DISEASE TRACKING:

Public Health is a main priority of the nursing staff of UHS and we strive to make an impact for the

wellness of our campus community. UHS nursing staff is involved in reporting directly to

Michigan Department of Community Health through the Michigan Disease Surveillance System.

5

.........

When communicable diseases are noted an investigation is started here at UHS and the local

health department is also notified, we then work in conjunction with CMDHD to provide an

investigation and the treatment of exposed individuals and testing. Activity includes:

DISEASE 2009-2010 2007-2008

Gonorrhea 1 0

Chlamydia 29 47

Hepatitis 0 1 A 1B

MRSA 13 12

Pertussis 2 surveillance

Mumps 0 1

TB exposure 0 0

Meningitis 0 1

Norovirus 0 0

HPV 37 (new addition to count) Unknown

Shigella 0 0

Giardia 0 0

Blood Borne Pathogen 5 6

UHS nursing staff also facilitates the Physician Assistants immunization requirements and

provides internal tracking on approximately 40 new students each year until they complete

requirements.

The summer of 2009 we also screened over 25 asbestos exposures at CMU.

Laboratory:

Performed approximately 4500 in house tests. Processed approximately 4100 patients. Performed approximately 1750 venipuntures. Performed 436 Influenza test with 89 positive for type A. (20.4%). Performed 333 Chlamydia tests with 32 positive (9.6%). Performed 300 Gonorrhea tests 3 positive (1.0%). Performed 70 HIV test with 0 positive.

Pharmacy:

Number of Prescriptions filled: 18,478

11,990 Rx’s filled for students

7,027 Rx’s filled for faculty/staff and family

Acquisition cost of prescriptions $752,551.00

Rx income: $964,761.84

6

.........

Rx margin: $212,211.04

OTC (over the counter) sales: $23,295.33 (doesn’t include otc sales from the tower’s clinic)

Deliveries: 1,935 to faculty/staff

66 to Tower’s clinic

Business Office:

For the 2009-2010 fiscal year the total aging is $47,950.83 with only $8,152.46 over 30 days. This equates to

approximately 17% of our outstanding claims over 30 days. This is an excellent percent as the average practice

has around 30%. The business office continues to strive to keep the aging at a minimum in order to maximize the

revenue cycle and ensure timely payment for Health Services and timely charging of patients. In fiscal year 2008-

2009 the aging was $108,522.40 with $20,204.41 over 30 days. This is approximately 19% over 30 days of aging.

The majority of the outstanding claims over 30 days for 2009-2010 are from Medicaid. While Medicaid is one of

our smaller payers based on patient volume, they tend to be quite slow in their payments often pending claims

several times before making a payment decision. They also switched to a new claims processing system called

CHAMPS this year which has resulted in payment delays.

During this fiscal year we began sending our electronic claims from PyraMed in X12 format instead of text format.

This has resulted in reduced rejections of electronic claims through our claims vendor Netwerkes. It also allows us

additional options in editing claims within Netwerkes.

The business office produced 34,496 invoices during the 2009-2010 fiscal year. During the 2008-2009 fiscal year

the business office created 35,226 invoices.

Charges posted between July 1, 2009 and May 31, 2010 totaled $1,178,502.00. The chart below shows the

breakdown of the total charges that were either paid by the patient at the time of service (10%), posted to the

students account (56%), -this includes amounts that were billed to commercial insurances and then bursared after

30 days-, or billed to a participating insurances (34%) (does not include pharmacy insurance charges, these are

billed through Q/S 1). The Towers Clinic was operated on Monday mornings from 8am-12pm. Charges generated

from the Towers equaled 1.3% of the total charges.

7

.........

Total Charges Insurance Charges

Bursar Account Patient Payments0

200000

400000

600000

800000

1000000

1200000

1400000$1,178,502

$396,021

$661,111

$121,370

2009-2010 Charge Summary

Towers ClinicHealth Services

Charges posted between July 1, 2008 and May 31, 2009 totaled $1,217,921.00. The chart below shows the

breakdown of the total charges that were either paid by the patient at the time of service (11%), posted to the

students account (52%), -this includes amounts that were billed to commercial insurances and then bursared after

30 days-, or billed to a participating insurances (37%) (does not include pharmacy insurance charges, these are

billed through Q/S 1).

Total Charges Insurance Charges Bursar Account Patient Payments $-

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000 $1,217,921

$454,330

$634,227

$129,364

2008-2009 Charge Summary

Below are listed the top ten insurances held by students seeking services at Health Services. Listed in order

greatest to least:

8

.........

2009-2010 2008-2009

Blue Cross Blue Shield (BCBS) Blue Cross Blue Shield (BCBS)

PPOM/Aetna (PPOM is a re-pricing company which many

different insurance plans use)

PPOM/Aetna (PPOM is a re-pricing company which many

different insurance plans use)

Medicaid United/PHP

Priority Health/Multiplan Priority Health/Multiplan

First Student First Student

Health Alliance Plan (HAP) Medicaid

United/PHP Blue Care Network (BCN)

Blue Care Network (BCN) Health Alliance Plan (HAP)

Health Plus Cigna

Cigna Health Plus

The graph below shows the write off amounts that UHS had to take due to our participation agreements with Blue

Cross Blue Shield, Medicaid, Medicare and Tricare. The BCBS write off in 2008-2009 was $47,487.47 with

$442,146.08 in total charges representing an 11% write off of billed charges.

2009-2010   BCBS MCD/MCR/TRI Student Insurance

 

Write Off Amounts

% Write Off by

Cost Center for

Billed BCBS

Charges

Write Off Amounts

% Write Off by

Cost Center

for Billed

MCD/MCR/

TRI Charges

Write Off Amounts

Cost Center 50111 $ - % $ - 0.00% $ -

  50112 $15,119.10 6.00% $5,591.26 40.00% $ -

  50113 $3,256.99 9.00% $500.34 28.00% $ -

  50114 $1,578.33 5.00% $262.43 20.00% $ -

  50115 $21,710.71 45.00% $1,480.56 59.00% $ -

Total PAR

Write Off   $41,665.13 11.00% $7,834.59 40.00% $ -

Total Billed   $374,003.77   $18,624.13   $34,138.13

Provider Appointments: The patient visit total of 7,433 represents a 4.1% drop between last

year and this year. The flu patients we saw in the fall of 2009 were from H1N1. The usual

seasonal flu cases that we usually see in the early months of the year did not materialize so even

though the fall was much busier, the lack of flu cases later in the year led essentially to a wash.

9

.........

Hopefully the economy is starting to recover and our numbers will increase this coming school

year.

Health Promotions:

PROGRAMS/PRESENTATIONS/ADVOCACY & OUTREACH # of eventsGeneral Health/Healthy Lifestyles, nutrition, sleep, etc. 7Sexual Health/STI/condom use 4Alcohol Awareness/Substance Abuse 4Mental Health/Stress & Depression Awareness/management 2TOTAL: 17

PROGRAMS/PRESENTATIONS PROMOTING UHSOrientations/Health Fairs/Business Fairs 31Immunization Clinic 4TOTAL 35

SERVICES/APPOINTMENTS # of apptsLight Therapy 38HIV Testing (test/result) 24TOTAL 62

PROFESSIONAL DEVELOPMENT/PROGRAMS ATTENDEDMihia Dashboard/webinars/Health Dept. summits/Facit, etcHIV training certification classesTOTAL 21

MEETINGSWellness coalition/Bacchus/active minds/dept/Bridges, etc. TOTAL 69

GRAND TOTAL 204

IV. Personnel Changes:

Implemented a reduction of .1 to .2 in a number of positions to reflect reduced patient traffic over the summer and academic year breaks.

With the departure of former Director and placement of Tom Trionfi, a current CMU staff member, in the Director’s position provided an immediate budget savings of $100,000.

Reinstated to full time status; the two assistant directors (from .9 FTE). With the subsequent resignation of the assistant director of clinical operations in

November (incumbent was a RN without clinical capabilities), it was determined that hiring a Nurse Practioner or Physician Assistant would provide enhanced staffing flexibility as well as the potential to generate more revenue (working as a clinic provider).

10

.........

To accomplish the use of the NP or PA in the clinic, the nursing staff and others were given the opportunity to absorb a number of the tasks of the assistant director that naturally fit with their current responsibilities. To date this has been a positive decision.

Pharmacist is resigning to take another position as of July 2, 2010. We will initially fill the position with a provisional appointment until we determine whether current staffing and operations are appropriate.

V. Fundraising:

None to report

VI. SWOT:

Strengths:

Knowledgeable and experienced staff committed to serving our students, faculty and staff with caring and compassion.

All providers are board certified and provide excellent care to their patients.

Patient focused staff.

Ability to use resources wisely.

Provision of essential health care to students and the campus community in a convenient location.

An off-site clinic in the Towers was opened to better reach our student population.

Walk-in appointments for students with acute illnesses and many other problems.

Medical care for our students with mental health problems including anxiety depression, OCD, etc.

Students do not need any money in hand to come to health services. All charges can be put on their student account and paid at a later date, including medications, X-ray, and lab fees.

On-site laboratory which performs many tests in-house and an excellent referral lab with excellent turn-around times and an on-site pharmacy which serves our students and faculty and staff, including office delivery to employees on campus.

Networking through various committees, such as Bridges Advisory, Isabella County Coalition to Reduce Underage Drinking, Wellness Coalition, Eta Sigma Gamma to name a few. This allows for better collaboration on projects when resources are limited.

11

.........

Weaknesses:

Inability to participate with additional insurance due to the time involved in doing duplicate work between the practice management system and SAP balancing/reporting.

Employee morale due to uncertainty of UHS stability.

Lack of visibility on campus. Students frequently do not seem aware that there is a clinic on campus.

Decline in patient volume, presumably due to a variety of reasons – visibility, insurance participation status, costs.

Opportunities:

New software system (Point and Click) will offer an opportunity to make our charting more complete. The built in calculator will help make sure billing levels are correct and therefore fees per visit may actually increase.

The improving Michigan economy will hopefully lead to more students having health insurance and therefore higher utilization of UHS.

Possibility to work with the Athletic department to draw athletes for new NCAA requirements if they chose us to provide drawing and testing.

Health Promotion Office is better located in Foust 205, making it more visible to students. There is a great opportunity to increase our volume for HIV testing as the word is starting to spread on this low cost but very important service. Also, various events are coming up such as orientations, health fairs which allow us the opportunity to advertise our services. There will be an article in the upcoming freshman orientation newspaper from CM Life providing an overview of the services that Health Services provides.

Revise the current SAP requirements and add additional insurance to improve patient volume and satisfaction.

Work with other departments to co-manage the International Mandatory Insurance Program.

Threats:

Continued economic stressors and high unemployment seriously impact our student’s ability to pay for their medical care. Many more are now uninsured since many of their parents are out of work. Many students are putting off seeking medical care since they can’t afford it, including prescription medications.

The economy of Michigan has led to significant cut backs to higher education, including CMU. By extension, our support from the university is always tenuous.

Financial challenges with the variation in subsidy levels.

Decreased reimbursement due to increased levels of participation discounts.

12

.........

Decreased reimbursement due to elevated numbers of Medicaid patients (Medicaid is a very poor payer).

Staff turnover and burnout.

VII. Progress with 2009-2010 Goals:

1. Successfully transitioned from using Quest as our reference lab to Lab Corp. This required re-pricing and re-entry of laboratory test codes in the PyraMed dictionary. This change was seamless to the patient but provided additional functionality to the lab and enhanced customer services for UHS.

2. Worked with Information Technology to secure the services of a technician who could be dedicated to Health Services (as well as a few other departments) in order to provide more timely and efficient services to UHS and to ensure our systems are HIPAA compliant. Since Health Services has an electronic health record, the functionality of our technology is critical. This arrangement has been extremely valuable to our daily operations.

3. Hosted three work study students. This is a milestone since UHS has not had work study students for many years. The students were strategically placed in areas that have been most affected by the reduction in FTE’s due to budget cuts. A student was placed in the laboratory, pharmacy and front desk/business office.

4. Enhanced the visual appearance and visibility of Foust and Health Services, with new paint, directional lines and outside canopies.

5. Simplified the user fee schedule to be more transparent and consistent.

6. Evaluated, selected and began the transition to a new electronic health record to improve functionality including tracking, reporting and regulatory compliance.

7. Took over the International Student’s Hard Waiver Insurance Program. This responsibility used to be held by OIA. This has led to some challenges in the areas of manpower to successfully manage the program. UHS will use United’s Partner Center to track and enforce this program.

VIII. Primary Goals for 2010-2011:

1. Successfully implement Point and Click, including web portal to allow online appointments, on-line account summaries and on-line forms completion.

2. Work with IT on implementing their scanning solution and archive old paper records.

3. Work with General Counsel to revise the retention schedule to eliminate the need to keep medical records permanently since this is not required by Michigan law and is not common to college health centers.

4. Install signature pads for patient authorizations to bill to decrease the amount of paper used, stored and scanned.

13

.........

5. Install insurance/id card scanners to link insurance card and CMU card information with the electronic medical record. Again reducing the need to photocopy ID’s and insurance cards and to make insurance information immediately available to the billers and lab.

6. Continue to evaluate the Tower’s Clinic hours and marketing to increase patient volume and utilization.

7. Continue to scrutinize spending to ensure the best use of the subsidy.

8. Go out to bid for the student insurance involving the International Student Representatives in the process for buy in and the best plan design.

SUMMARY:

In the 2010 fiscal year, the business office continued to focus on reducing its aging

through timely posting of payments and frequent review of unpaid charges. The next

fiscal year will be challenging as we implement three new projects (Point and Click,

campus wide scanning solution and International Hard Waiver). The Administrative

Secretary will be utilized to assist with tracking and verification of the hard waiver

program. The front desk receptionist will be an important part of the scanning project.

Training on the new electronic record will be an essential and time consuming project but

the improved documentation, reporting and features of the new system will make it

worthwhile. While Health Services will continue to strive for increased patient volume

and satisfaction, it is critical that an adequate subsidy is provided to allow provision of

services to students, protection of the campus through communicable disease prevention

and surveillance and education programs to teach students healthy habits and lifestyles.

IX. Primary goals for next five years:

1. Evaluate the possibility of participating with additional insurances.

2. Eliminate paper health records through the use of an interface with Lab Corp for reference labs, web portal for health histories, direct entry into the electronic record of in house lab results and direct scanning of x-ray results and other miscellaneous records.

3. Host MSA program interns, providing them with experience using a fully integrated electronic health record.

4. Evaluate the use of point of sale for the pharmacy to better manage pharmacy inventory and reduce the amount of manual entry of over the counter medications in the business office.

5. Evaluate the International Student Insurance program successes and failures following Health Service’s first year managing the program to determine where changes can be made to make the process more efficient, what staffing level is necessary and what additional options can be provided to the students.

14

.........

6. Continue to review and evaluate the services offered. To determine whether we are providing them at both a level meeting/exceeding an external provider and at or less their cost.

X. Contingencies/Risk to Achieving those Goals and Strategies to Address:

1. Costs and human resources required to implement the projects2. Limited (IT) resources3. Collaboration requirements

15