BOARD OF DIRECTORS AGENDA PACKET · 2012. 5. 14. · • Audit and Compliance Director Bassett stated that the Board Audit and Compliance committee summary was included in the packet

BOARD OF DIRECTORS AGENDA PACKET

May 14, 2012

The mission of Palomar Health is to heal, comfort and promote health

in the communities we serve.

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u:templates\bd agenda inner cover sheet template:nla

BOARD OF DIRECTORS

T.E. Kleiter, Chairman Nancy L. Bassett, RN, MBA, Vice Chairman

Jerry Kaufman PTMA, Secretary Linda C. Greer, RN, Treasurer

Bruce Krider, MA Marcelo Rivera, MD

Stephen P. Yerxa

Michael H. Covert, FACHE, President and CEO

Regular meetings of the Board of Directors are usually held on the second Monday of each month at 6:30 p.m., unless indicated otherwise

For an agenda, locations or further information call (858) 675-5106, or visit our website at www.pph.org

MISSION STATEMENT

The Mission of Palomar Health is to: Heal, Comfort, Promote Health in the Communities we Serve

VISION STATEMENT

Palomar Health will be the health system of choice for patients, physicians and employees, recognized

nationally for the highest quality of clinical care and access to comprehensive services

CORE VALUES

Patient’s Well-Being We passionately give and support heartfelt care that encourages patient comfort and safety

Professionalism

Each of us takes pride in teamwork, self-discipline, our skills and trustworthiness

Highest Quality

We are each accountable for providing the safest, most effective and innovative care

Affiliated Entities

*Escondido Surgery Center * Palomar Medical Center * Palomar Medical Auxiliary & Gift Shop * Palomar Continuing Care Center * *Palomar Pomerado Health Foundation * Palomar Pomerado Home Care * Pomerado Hospital * Pomerado Hospital Auxiliary & Gift Shop *

*San Marcos Ambulatory Care Center * Villa Pomerado Palomar Pomerado Health Concern* Palomar Pomerado Health Source* *Palomar Pomerado North County Health Development, Inc.* North San Diego County Health Facilities Financing Authority*

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PALOMAR HEALTH

BOARD OF DIRECTORS REGULAR MEETING AGENDA

Monday, May 14, 2012 Pomerado Hospital Commences 6:30 p.m. Meeting Room E 15615 Pomerado Road Poway, CA 92064 Poway, CA 92064

Mission and Vision “The mission of Palomar Health is to heal, comfort and

promote health in the communities we serve.”

“The vision of Palomar Health is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality

of clinical care and access to comprehensive services.”

Time PageI. CALL TO ORDER 2

II. OPENING CEREMONY 5A. Pledge of Allegiance

III. PUBLIC COMMENTS 5(5mins allowed per speaker with cumulative total of 15mins per group - forfurther details and policy see Request for Public Comment notices availablein meeting room.)

IV. MINUTES * 5A. Regular Board Meeting - April 09, 2012 5-10B. Closed Session Meeting - April 09, 2012 11C. Closed Session Meeting - April 09, 2012 12-13g p ,

V. APPROVAL OF AGENDA to accept the Consent Items as listed * 5 14-31A. March 2012 & YTD FY2012 Financial Report (Addendum A)B. Approval of Revolving, Patient Refund & Payroll Fund Disbursements– Mar 2012

1. Accounts Payable Invoices2. Net Payroll

TotalC Ratification of Paid Bills

$51,347,729.00$18,651,034.00$69,998,764.00

C. Ratification of Paid BillsD. Budgeted Routine Physician Agreements Board Summary Report

VI. REPORTS A. Medical Staffs

*1. Palomar Medical Center - Rick Engel, M.D. 5 32-44A. Credentialing and Reappointments

*2. Pomerado Hospital - Roger Acheatel, M.D. 5 45-46p gA. Credentialing and Reappointments

B. Administrative1 Chairman of the Palomar Pomerado Health Foundation - John Forst 5 Verbal Report

A. Update on PPHF Activities

2 Chairman of the Board - Ted Kleiter 10 Verbal Report

3 President and CEO - Michael Covert, FACHE 10 Verbal Report, p

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VII. INFORMATION ITEMS 5 47-81A. Rady's AffiliationB. Program Review - Robotic SurgeryC. FY2012 Supply Spend

VIII. COMMITTEE REPORTS 40 82-84VIII. COMMITTEE REPORTS 40 82 84A. Audit and Compliance CommitteeB. Governance Committee - Did not meet in AprilC. Human Resources Committee - Did not meet in AprilD. Community Relations CommitteeE. Facilities and Grounds CommitteeF. Quality Review Committee - Did not meet in AprilG. Strategic Planning CommitteeH. Finance Committee - Did not meet in AprilpI. Other Committee Chair Comments on Committee Highlights

IX. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT 10MONTH

X. ADJOURNMENT

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BOARD OF DIRECTORS REGULAR BOARD MEETING

Palomar Medical Center / Graybill Auditorium Monday, April 9, 2012

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP

RESPONSIBLE PARTY CALL TO ORDER 6:30P.M.

Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Rivera and Yerxa Excused: Director Krider

OPENING CEREMONY The Pledge of Allegiance was recited in unison.

MISSION AND VISION STATEMENTS

The Palomar Health mission and vision statements are as follows: The mission of Palomar Health is to heal, comfort and promote health in the communities we serve. The vision of Palomar Health is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services.

NOTICE OF MEETING Notice of Meeting was mailed consistent with legal requirements

APPROVAL OF MINUTES • Regular Board Meeting

March 12, 2012 • Closed Board Meeting



MOTION: by Kaufman, 2nd by Yerxa and carried to approve the regular and closed session Board meeting minutes as submitted. All in favor. None opposed.

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AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY

March 19, 2012 APPROVAL OF AGENDA (to accept the Consent Items as listed)

A. February 2012 & YTD FY2012 Financial Report

B. Approval of Revolving, Patient Refund & Payroll Fund Disbursements– Feb 2012

Accounts Payable Invoices $ 44,131,388.00 Net Payroll

$12,406,910.00 Total $ 56,538,298.00

C. Ratification of Paid Bills D. Palomar Health Bylaws E. Public Comments and Attendance at Public Board Meetings – GOV20 F. Smoking Policy in Palomar Health Facilities – HR07 G. Development/Review of New Business Plan – 26132 H. Board Use of Outside Counsel Policy I. Budgeted Routine Physician Agreements Board Summary Report

MOTION: by Greer, 2nd by Bassett and carried to approve the Consent Items A – I, as submitted. All in favor. None opposed.

REPORTS Medical Staff Palomar Medical Center

Credentialing Richard Engel, M.D., Chief of PMC Downtown Medical Staff, presented PMC’s requests for approval of Credentialing Recommendations.

MOTION: by Bassett, 2nd by Kaufman and carried to approve the Palomar Medical Center Medical Staff Executive Committee credentialing recommendations for the Palomar Medical Staff as presented. All in favor. None opposed. MOTION: by Bassett, 2nd by Yerxa

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and carried to approve the Department of Surgery Physician Assistant Privileges as presented. All in favor. None opposed. MOTION: by Bassett, 2nd by Greer and carried to approve the Department of OBGYN Clinical Privilege Checklist as presented. All in favor. None opposed.

Pomerado Hospital Credentialing Roger Acheatel, M.D., Chief of Pomerado

Medical Staff, presented Pomerado Hospital’s requests for approval of Credentialing Recommendations.

MOTION: by Bassett, 2nd by Greer and carried to approve the Pomerado Hospital Medical Staff Executive Committee credentialing recommendations for the Pomerado Medical Staff as presented. All in favor. None opposed.

Administrative Chairman – Palomar Pomerado Health Foundation

John Forst

Mr. Forst announced Ann Braun as the Foundation’s new Chief Development Officer. The Executive Committee met March 13 and will meet again April 12.The Finance Committee met March 28 and reviewed the February Financials. The Gala Committee continues to meet monthly and review plans for the event. The kick-off wine tasting event hosted 115 Palomar Health supporters, including major donors, prospects, gala sponsors and community leaders. The event brought in over $5,000 in wine sales for the gala night auction. The Grand Opening Committee continues to meet on a monthly basis to develop strategy for the July 28 Community Event. There will be a VIP Event held on July 26. The Medical Staff Campaign has received a number of gala sponsorships for the month of

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March. The Employee Chapel Campaign Committee raised over $60,000 in the first two months towards their goal of $500,000. Las Patronas has funded 3 trauma stretchers totaling $17,868. Nine VIP tours were held in March. Tours have now been limited due to the completion of the hospital. The Foundation is still receiving grateful patient note cards in response to the Doctors’ Day mailings. The campaign included an appeal and a reminder letter as well as social media posts on Facebook and Twitter.

Chairman of the Board Ted Kleiter Chairman Kleiter stated that both he and

Director Kaufman recently attended the legislation day in Sacramento. Chairman Kleiter stated that they spoke with representatives and discussed bill AB2096 regarding District hospital funding. Assemblyman Perez is sponsoring the bill. Chairman Kleiter stated that they also spoke with Martin Garrett. Mr. Garrett is interested in the new hospital and what Palomar Health is doing in throughout the District.

President and CEO Michael Covert Mr. Covert stated that the Pomerado Hospital

35th Anniversary event will be held on Saturday, April 21st. The 9th annual Leadership dinner will be held on Friday, April 27th. Mr. Covert recognized the skilled nursing facility for their outstanding achievements over the last few years. Mr. Covert stated that recruitment of the Compliance Officer is being finalized. David Tam, M.D. stated that the temporary certificate of occupancy for PMC West has been received. OSHPOD has granted

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permission to begin staffing and stocking the facility. Dr. Tam thanked the Board, Director Rivera in particular for serving as chair of the Board Facilities and Grounds committee, Bob Hemker, Gerald Bracht, Lorie Shoemaker, Paul Peabody, Janine Sarti, Michael Covert, Brian Grace and the DPR team. Dr. Tam thanked Wendy Cohen and wished her a happy birthday. Dr. Tam presented Chairman Kleiter and Director Rivera the official TCO document. Mr. Covert thanked Palomar Health staff and the DPR team. Mr. Covert stated that while this is not quite to the finish line, it is an important milestone. Chairman Kleiter thanked all of the committees for their work, particularly Director Rivera who has chaired the Facilities and Grounds committee since the start of construction on the hospital. Director Greer thanked the community for their support on Proposition BB.

COMMITTEE CHAIR COMMENTS

• Audit and Compliance Director Bassett stated that the Board Audit and Compliance committee summary was included in the packet for review. Director Bassett stated that one of the new audit projects will be a Leadership Audit Training. Director Bassett stated that the May 17th meeting has been cancelled.

• Governance Chairman Kleiter stated that the report was included in the packet for review.

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• Human Resources Director Yerxa stated that Board HR committee summary was included in the packet for review. Director Yerxa stated that April 18th meeting has been cancelled.

• Community Relations Director Kaufman asked Gustavo Friederichsen and Chris Chase to review the roll out plan for the new District name and logo.

MOTION: by Kaufman, 2nd by Greer and carried to approve the naming policy as submitted. All in favor. None opposed.

• Board Facilities and Grounds

Director Rivera reviewed the PMC Downtown campus, POM bridge and Ramona project. Ground breaking for the Ramona project is targeted for June 2012. Director Rivera presented updated photos of PMC West site.

• Board Quality Review Director Bassett stated that she attended the patient safety conference. There were 250 attendees. 1/3 of the attendees were from outside of Palomar Health. HCAPS were reviewed. The April meeting has been cancelled. Director Bassett will not be able to attend the May meeting. Director Greer will chair the meeting on her behalf.

• Finance Director Greer stated that the Board Finance committee activity summary was included in the packet for review. The April meeting has been moved to May 7th.

ADJOURNMENT 7:20P.M. SIGNATURES

Board Secretary

Board Assistant

__________________________________ Jerry Kaufman, P.T.M.A. ___________________________________ Nicole Adelberg

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Palomar Health BOARD OF DIRECTORS

Closed Session Palomar Medical Center / Graybill Auditorium

Monday, April 09, 2012

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP/RESPONSIBLE

PARTY CALL TO ORDER

7:27P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Rivera and Yerxa Excused: Director Krider

NOTICE OF MEETING

Notice of Meeting was mailed consistent with legal requirements. Pursuant to Government Code § 54956.9 (a) Conference with Legal Counsel – Pending Litigation

ADJOURNMENT TO CLOSED SESSION

MOTION: by Chairman Kleiter to adjourn to closed session. All in favor. None opposed.

CLOSED SESSION

Pursuant to Government Code § 54956.9 (a) Conference with Legal Counsel – Pending Litigation

OPEN SESSION RESUMES

MOTION: by Chairman Kleiter to resume open session

FINAL ADJOURNMENT

MOTION: by Chairman Kleiter for final adjournment at 7:40P.M.

SIGNATURES

Board Secretary

Board Assistant

___________________________________ Jerry Kaufman, P.T.M.A. ___________________________________ Nicole Adelberg

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Palomar Health BOARD OF DIRECTORS

Closed Session Palomar Medical Center / Graybill Auditorium 555 East Valley Parkway, Escondido, CA 92025

Monday, April 9, 2012


CALL TO ORDER

7:40P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Rivera and Yerxa Excused: Director Krider

NOTICE OF MEETING

Notice of Meeting was mailed consistent with legal requirements. Pursuant to California Government Code §54954.5(h) Report Involving Trade Secret

PUBLIC COMMENTS None

ADJOURNMENT TO CLOSED SESSION

MOTION: by Chairman Kleiter to adjourn to closed session. All in favor. None opposed.

CLOSED SESSION

Pursuant to Government Code §54954.5(h): Report Involving Trade Secret. Director Rivera recused himself from the decision making process.

OPEN SESSION RESUMES

MOTION: by Chairman Kleiter to resume open session

MOTION: by Yerxa, 2nd by Kleiter and carried to approve the increase in Arch’s LOC by $5million. All in favor. None opposed. MOTION: by Yerxa, 2nd by Kleiter and carried to approve a specified LOC in the amount of $2,500,000 from July 1st – September 30th related to cash flow delays from the conversion of MSO vendors.

All in favor. None opposed. MOTION: by Yerxa, 2nd by Kleiter and carried to approve the extension of $1,000,000 for known 2012 capital items subject to

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administrative authorization by the Palomar Health CFO and CEO for release of funds.

All in favor. None opposed.

FINAL ADJOURNMENT

MOTION: by Chairman Kleiter for final adjournment at 8:46P.M.

SIGNATURES

Board Secretary

Board Assistant

___________________________________ Jerry Kaufman, PTMA ___________________________________ Nicole Adelberg

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March 2012 & YTD FY2012 Financial Report

Form A - Financial Report.doc

TO: Board of Directors

MEETING DATE: Monday, May 14, 2012

FROM: Robert A. Hemker, CFO

BY: Board Finance Committee Monday, May 7, 2012

Background: The Board Financial Reports (unaudited) for March 2012 and YTD FY2012 are submitted for the Board’s approval.

Budget Impact: N/A

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Board Financial Reports (unaudited) for March 2012 and YTD FY2012.

Motion: X

Individual Action:

Information:

Required Time:

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Budgeted Routine Physician Agreements Board Summary Report

Form A - Physician Board Summary Report - Consent.doc

TO: Board of Directors MEETING DATE: Monday, May 14, 2012 FROM: Robert A. Hemker, CFO BY: Board Finance Committee Monday, May 7, 2012 Background: The following Budgeted Routine Physician Agreements became effective during the month of March 2012. There is also one that became effective late in the month of February and, therefore, was inadvertently omitted from last month’s listing. The standard Form A and Abstract Table for each signed Agreement are attached.

PHYSICIAN AND/OR GROUP TYPE OF AGREEMENT Roger Acheatel, MD Julia Chuan, MD Physician Expenses Agreements

Tony Georgiades, DDS Agreement for Items or Services – Dentures Paul Kim, MD (effective 2/27/12) Choll Kim, MD ActivCentre Provider Panel Agreements

Mikhail Malek, MD Independent Contractor Agreement – IT Paul Milling, MD Mission Infectious Disease & Infusion Consultant Agreements for SNF Services

Budget Impact: N/A



COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Budgeted Routine Physician Agreements as presented.

Motion: X

Individual Action:

Information:

Required Time:

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Physician Expenses Agreement

Form A - Acheatel.doc

TO: Board Finance Committee MEETING DATE: Monday, May 7, 2012 FROM: Sheila Brown, Chief Clinical Outreach Officer Background: The Physician Expenses Agreement was offered to Dr. Roger Acheatel to support his efforts of performing physician engagement and patient satisfaction strategies at Palomar Health. Dr. Roger Acheatel expressed interest in attending the 2012 Press Ganey Regional Education Symposium in order to work with the Service Excellence team in establishing a physician engagement program at Palomar Health.

Budget Impact: Budgeted



COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

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PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Acheatel, Roger, M.D. Physician Expenses Agreement AGREEMENT DATE March 19, 2012 PARTIES Palomar Health and Roger J. Acheatel, M.D. PURPOSE Dr. Acheatel will be receiving training for the purpose of

performing physician engagement and patient satisfaction strategies at Palomar Health facilities.

SCOPE OF SERVICES Dr. Acheatel shall attend training for physician engagement strategies and value based purchasing/HCAPS education, for the purpose of performing these procedures and establishing a physician engagement program at Palomar Health.

PROCUREMENT METHOD

Request For Proposal x Discretionary

TERM March 19, 2012 thru September 18, 2012 RENEWAL There shall be no automatic renewal provision for this

Agreement. Any renewal or continuation of services by Contractor for Palomar Health beyond this expiration date must be negotiated between the parties and memorialized in a separate agreement.

TERMINATION This Agreement may be terminated by either party before its stated expiration date after that party provides a thirty (30) day written notice to the other party. Such notice shall be personally delivered or sent by recognized overnight courier or by certified mail, return receipt requested, and delivered.

COMPENSATION METHODOLOGY

Palomar Health shall have the right to pay vendor directly or reimburse Contractor for cost of training, not to include transportation, food, and lodging (travel expenses). Payment shall be due within thirty (30) days of Palomar Health’s receipt of each undisputed invoice.

BUDGETED x YES NO – IMPACT: EXCLUSIVITY x NO YES – EXPLAIN: JUSTIFICATION Establish a physician engagement program at Palomar Health AGREEMENT NOTICED x YES NO Methodology & Response

ALTERNATIVES/IMPACT Positive impact towards FY2012 Goals & Initiatives

*2.2(d) Create a culture of high physician engagement.

Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS

APPROVALS REQUIRED x VP x CFO CEO BOD Committee ____________ BOD

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TO: Board Finance Committee MEETING DATE: Monday, May 7, 2012 FROM: Sheila Brown, Chief Clinical Outreach Officer Background: The Physician Expenses Agreement was offered to Dr. Julie Chuan to support her efforts of performing physician engagement and patient satisfaction strategies at Palomar Health. Dr. Julie Chuan expressed interest in attending the 2012 Press Ganey Regional Education Symposium in order to work with the Service Excellence team in establishing a physician engagement program at Palomar Health.

Budget Impact: Budgeted




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Reference

Term/Condition

Term/Condition Criteria TITLE Julie Chuan, M.D. Physician Expenses Agreement – Training AGREEMENT DATE March 19, 2012 PARTIES Palomar Health and Julie Chuan, M.D. PURPOSE Dr. Chuan will be receiving training for the purpose of performing

physician engagement and patient satisfaction strategies at Palomar Health facilities.

SCOPE OF SERVICES Dr. Chuan shall attend training for physician engagement strategies and value based purchasing/HCAPS education, for the purpose of performing these procedures and establishing a physician engagement program at Palomar Health.

PROCUREMENT METHOD


TERM March 19, 2012 thru September 18, 2012 RENEWAL There shall be no automatic renewal provision for this

Agreement. Any renewal or continuation of services by Contractor for Palomar Health beyond this expiration date must be negotiated between the parties and memorialized in a separate agreement.

TERMINATION This Agreement may be terminated by either party before its stated expiration date after that party provides a thirty (30) day written notice to the other party. Such notice shall be personally delivered or sent by recognized overnight courier or by certified mail, return receipt requested, and delivered.


Palomar Health shall have the right to pay vendor directly or reimburse Contractor for cost of training, not to include transportation, food, and lodging (travel expenses). Payment shall be due within thirty (30) days of Palomar Health’s receipt of each undisputed invoice.

BUDGETED x YES NO – IMPACT:

EXCLUSIVITY x NO YES – EXPLAIN:

JUSTIFICATION Establish a physician engagement program at Palomar Health

AGREEMENT NOTICED x YES NO Methodology & Response:

ALTERNATIVES/IMPACT Positive impact towards FY2012 Goals & Initiatives *2.2(d) Create a culture of high physician engagement.


COMMENTS

APPROVALS REQUIRED x VP x CFO CEO BOD Committee ____________ BOD

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TO: Board Finance Committee MEETING DATE: Monday, May 7, 2012 FROM: Alicia Lockett, Administrator in Training Background: To provide reimbursement for lost dentures Budget Impact: n/a




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Reference

Term/Condition

Term/Condition Criteria

TITLE Tony Georgiades, DDS Agreement for Items or Services - Dentures

AGREEMENT DATE 3/26/2012 PARTIES Palomar Continuing Care Center/ Villa Pomerado

Tony Georgiades, DDS PURPOSE To ensure the right of each resident to securely retain and use

personal possessions, space permitting, as long as the possessions do not infringe upon the rights, health, or safety of other residents. Facility staff will provide assistance and education as needed regarding preventative measures t prevent the loss or damage of a resident’s personal property.

SCOPE OF SERVICES To provide reimbursement for lost dentures

PROCUREMENT METHOD

Request For Proposal × Discretionary

TERM 3/26/2012 – 3/26/2013

RENEWAL Both parties will have the option to discuss renewal of this Agreement following the end of the initial term.

TERMINATION One year unless otherwise terminated by either party


The compensation provided to Physician/Group under this Agreement is fair market value for the items/services provided to or on behalf of Palomar Health, and does not take into account the volume or value of referrals or other business generated between the parties.

BUDGETED × YES NO – IMPACT:

EXCLUSIVITY × NO YES – EXPLAIN:

JUSTIFICATION Regulatory requirement

AGREEMENT NOTICED × YES NO Methodology & Response:

ALTERNATIVES/IMPACT n/a


COMMENTS

APPROVALS REQUIRED VP CFO CEO BOD Committee ____________ BOD

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TO: Board Finance Committee MEETING DATE: Monday, May 7, 2012 FROM: Natalie Bennett, Manager Program Development Background: In February and March, the two orthopedic spine surgeons listed below were added to the ActivCentre provider panel. The provider panel agreements focus on delivering a standard of care when patients are referred to a provider from the ActivCentre.

• Choll Kim, MD – 3/10/12

• Paul Kim, MD – 2/27/12

Budget Impact: n/a




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Reference

Term/Condition

Term/Condition Criteria TITLE ActivCentre Provider Panel Agreement

AGREEMENT DATE 3-12-12

PARTIES Palomar Health and Choll Kim, MD

PURPOSE To serve as a panel physician for the outpatient spine center.

SCOPE OF SERVICES Provider agrees to meet certain program standards to participate. The standards are focused around access, triage, nurse navigation, outcomes tracking, quality and education/marketing.

PROCUREMENT METHOD


TERM 1-year

RENEWAL There is an option to renew at the one year anniversary if the contract has not been terminated prior to the contract term.

TERMINATION 30-day written notice


N/A

BUDGETED YES NO – IMPACT: N/A

EXCLUSIVITY xNO YES – EXPLAIN:

JUSTIFICATION

AGREEMENT NOTICED YES xNO Methodology & Response: any new providers on the staff are given an opportunity to be on the panel for the ActivCentre

ALTERNATIVES/IMPACT


COMMENTS


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Reference

Term/Condition

Term/Condition Criteria TITLE ActivCentre Provider Panel Agreement

AGREEMENT DATE 2-27-12

PARTIES Palomar Health and Paul Kim, MD

PURPOSE To serve as a panel physician for the outpatient spine center.

SCOPE OF SERVICES Provider agrees to meet certain program standards to participate. The standards are focused around access, triage, nurse navigation, outcomes tracking, quality and education/marketing.

PROCUREMENT METHOD


TERM 1-year

RENEWAL There is an option to renew at the one year anniversary if the contract has not been terminated prior to the contract term.

TERMINATION 30-day written notice


N/A

BUDGETED YES NO – IMPACT: N/A

EXCLUSIVITY xNO YES – EXPLAIN:

JUSTIFICATION

AGREEMENT NOTICED YES xNO Methodology & Response: any new providers on the staff are given an opportunity to be on the panel for the ActivCentre

ALTERNATIVES/IMPACT


COMMENTS


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TO: Board of Directors MEETING DATE: Monday, May 7, 2012 FROM: Ben Kanter, MD, CMIO, Paul S. Peabody, CIO Background: Palomar Pomerado Health (PPH) requires the active involvement of physicians in many aspects of Information Systems programs. A Physician Advisor Council was active during the development phase of the Clarity Electronic Health Record. Now that Clarity has been implemented the Physician Advisor Council will reconvene to assist PPH in improving the efficient and effective use of Clarity. The physicians indicated below will be reimbursed for their work effort according to standard and customary manners and rates. This contract refers to the following physician:

• Malek, Mikhail Budget Impact: After discussion with many different sites across the U.S., a fair market value was established for the mean value hourly reimbursement for such work. All fees payable to medical staff members have been budgeted within the IT projects listed above. Staff Recommendation: Approval. Committee Questions:


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PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT

Section Reference

Term/Condition

Term/Condition Criteria

TITLE Independent Contractor Agreement between Mikhail Malek, MD and Palomar Pomerado Health

AGREEMENT DATE Last date of signature.

PARTIES Mikhail Malek, MD PURPOSE To assist PPH in improving the efficiency and effectiveness of

the Clarity Electronic Health Record System particularly as it pertains to Physician Order Entry and documentation.

SCOPE OF SERVICES The physician will work as a subject matter expert providing information to Clarity development teams.

PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year

RENEWAL No automatic renewal

TERMINATION 10 day notice by either party without cause

COMPENSATION

METHODOLOGY Hourly

BUDGETED YES NO – IMPACT: None

EXCLUSIVITY NO

JUSTIFICATION Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S.

AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education

Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee ____________

BOD

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TO: Board Finance Committee MEETING DATE: Monday, May 7, 2012 FROM: Alicia Lockett, Administrator in Training Background: Contract with Paul Milling, MD, for provision of orthopedic surgery or fracture follow-up visits for unfunded patients at PCCC and Villa Pomerado. Budget Impact: n/a




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Reference

Term/Condition

Term/Condition Criteria TITLE Paul Milling, MD

AGREEMENT DATE 3/26/2012

PARTIES PCCC/VP

Paul Milling, MD

PURPOSE To provide orthopedic surgery or fracture follow-up visits for unfunded patients.

SCOPE OF SERVICES To provide orthopedic surgery or fracture follow-up visits for unfunded patients

PROCUREMENT METHOD


TERM 3/26/2012-3/26/2013 RENEWAL Both parties will have the option to discuss renewal of this

Agreement following the end of the initial term.



Payment shall be made to physician within thirty days of receipt of undisputed invoice



JUSTIFICATION n/a




COMMENTS


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TO: Board Finance Committee MEETING DATE: Monday, May 7, 2012 FROM: Alicia Lockett, Administrator in Training Background: Agreement with Mission Infectious Disease & Infusion Consultant for the provision of follow-up or consultation visits for unfunded patients at PCCC and Villa Pomerado in order to move forward with a safe discharge. Budget Impact: n/a




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Reference

Term/Condition

Term/Condition Criteria TITLE Mission Infectious Disease and Infusion Consultant SNF Services

Physician Agreement

AGREEMENT DATE 3/1/2012

PARTIES PCCC/VP Mission Infectious Disease and Infusion Consultant

PURPOSE To provide follow-up or consultation visits for unfunded patients in order to move forward with a safe discharge.

SCOPE OF SERVICES To provide follow-up or consultation visits for unfunded patients in order to move forward with a safe discharge.

PROCUREMENT METHOD


TERM 3/1/2012 – 3/1/2013

RENEWAL Both parties will have the option to discuss renewal of this Agreement following the end of the initial term.



Payment shall be made to physician within thirty days of receipt of undisputed invoice



JUSTIFICATION




COMMENTS


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April 30, 2012 TO: Palomar Pomerado Health Board of Directors MEETING DATE: May 14, 2012 FROM: Roger J. Acheatel, M.D., Chief of Staff Pomerado Medical Staff Executive Committee Richard C. Engel, M.D., Chief of Staff PMC Medical Staff Executive Committee SUBJECT: Emergency Department Physician Assistant Privilege Checklist – Modified I. At the Palomar Medical Center and Pomerado Hospital Executive Committee meetings, recommendation was made to modify the core privilege checklist for Physician Assistants Emergency Medicine specific to the criteria for maintaining privileges for lumbar puncture: Perform Lumbar Puncture Criteria: Those technical and management skills, which qualify the PA to administer highly specialized care by virtue of training and experience. Required Previous Experience: Demonstrated current competence and evidence of the performance of at least 5 procedures in the past 12 months or direct supervision is required for at least the first 5 procedures. Maintenance of Privilege: Demonstrated current competence and the performance of at least 10 5 procedures in the past 24 months based on results of ongoing professional practice evaluation and outcomes.

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MEDICAL STAFF SERVICES

DATE: April 30, 2012 TO: Board of Directors - May 14, 2012 FROM: Roger J. Acheatel, M.D., Chief of Staff, Pomerado Hospital Medical Staff SUBJECT: Medical Staff Credentials Recommendations – April 2012

Provisional Appointments: (05/14/2012 – 04/30/2014) Elena Y. Atchikova, M.D. – Internal Medicine David L. Daugherty, M.D. – Orthopedic Surgery Patrick Freyne, M.D. – Internal Medicine Bruce T. Hutchinson, D.P.M. – Podiatry (includes Villa) Paul J. Manos, D.O. – Emergency Medicine (Research Only) Payam Moazzaz, M.D. – Orthopedic Surgery Khai Nguyen, M.D. - Internal Medicine (includes Villa) Maltin Repishti, M.D. – Internal Medicine (includes Villa) Biennial Reappointments: (06/01/2012 – 05/31/2014) Francis A. Barber, M.D. – Affiliate - Dermatopathology Robert J. Belsher, M.D. – Active – Family Practice) Gregory S. Campbell, M.D. – Active – General Surgery (includes Villa) Alan J. Conrad, M.D. – Active – Internal Medicine (includes Villa) Charles J. Dinerman, M.D. – Active – General Surgery Robert B. Fortuna, M.D. – Active - Radiology Omar M. Khawaja, M.D. - Active - Anesthesiology Michael A. Kosmo, M.D. – Active – Hematology/Oncology John P. Liboon, M.D. – Active – Emergency Medicine Marshall J. Littman, M.D. – Active - Pediatrics Stefan Moldovan, M.D. – Active – General Surgery Kevin C. Owsley, M.D. – Active – Orthopedic Surgery Sandi C. Rigsby, M.D. – Active - Anesthesiology Jaime B. Rivas, M.D. – Active – Emergency Medicine Mary L. Sanfelippo, M.D. – Active – Nephrology – (includes Villa) Stephen P. Schmitter, M.D. – Active - Radiology Kevin J. Schwartz, M.D. – Active - Anesthesiology Yonina Tova, M.D. – Consulting - Radiation Oncology Jinnu A. Verma, M.D. – Affiliate – Internal Medicine (includes Villa) Advancements: Alfonso Camberos, M.D. – Active – Plastic Surgery (05/14/2012 – 03/31/2014) Bruce Friedberg, M.D. – Active – Emergency Medicine (05/14/2012-11/30/2013) Christopher Sullivan, M.D. - Active – Pediatrics (05/14/2012- 01/31/2014) Voluntary Resignation: Jesus Lao, M.D. Expiration of Membership: Jon Kelly, M.D. (effective 05/31/2012) 45

Pomerado Hospital – Credentials Memo April 30, 2012 - Page 2 Leave of Absences: Marshall Ravden (06/11/2012-05/31/2014) Jonathan E. Schoeff, M.D. (03/14/2012-02/28/2013) Allied Health Appointment: (5/14/2012-04/30/2014) Ann Lowe, N.P. – Expresscare – Sponsor Dr. Conrad Jennifer L. Schmollinger, P.A.-C – Sponsor Dr. Choll Kim Jonathan Wu, P.A.-C – Sponsor Dr. Kamshad Raiszadeh Allied Health Reappointments: (06/01/2012-05/31/2014) Nicole Johnson, P.A.-C – Emergency Medicine – Sponsors Dr. Rivas for CEP Physicians Elizabeth Kerlick, P.A.-C – Emergency Medicine – Sponsors Dr. Rivas for CEP Physicians Laurel Miller, P.A.-C – Emergency Medicine – Sponsors Dr. Rivas for CEP Physicians POMERADO HOSPITAL: Certification by and Recommendation of Chief of Staff: As Chief of Staff of Pomerado Hospital, I certify that the procedures described in the Medical Staff Bylaws for appointment, reappointment, or alternation of staff membership or the granting of privileges and the policy of the Palomar Health’s Board of Directors regarding such practices have been properly followed. I recommend that the Board of Directors take the action requested in each case.

46

Rady’s Affiliation

Form A - Rady's - Info.doc

TO: Board of Directors MEETING DATE: Monday, May 14, 2012 FROM: Gerald Bracht, CAO, Palomar Medical Center BY: Board Finance Committee Monday, May 7, 2012 Background: Palomar Health and Rady Children’s Hospital entered into an affiliation agreement resulting in the relicensing of all Pediatric and NICU beds under the Rady’s license. The affiliation commenced on the Contingency Removal Date of August 25, 2010, and will continue through June 30, 2012. Rady’s administers the programs at Palomar, and Palomar provides for ancillary and support services to the programs and receives a lease payment for use of the facilities. The intent of the parties is to grow the pediatric and NICU services in the north county, and it was determined that this could best be accomplished through an affiliation agreement. The attached presentation focuses on the results of the operation from January through December 2011.

Budget Impact: None

Staff Recommendation: Information only


COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time:

47

Palomar Health &

Rady Children’s Hospital

Pediatric and NICU Affiliated Program

Program Review January through December 2011

Gerald Bracht - Chief Administrative Officer Bob Hemker – Chief Financial Officer

48

Pros: – Risk of Growth shifted to RCH – Expanded specialist coverage – Name recognition/prestige – Improved financial performance – Resolution of POM NICU level/challenges – Preserve Peds excess capacity for adult overflow

Cons: – Disruption with staff – Coordination of services/operations – Coordination of contractual commitments (Kaiser, CAP)

RCH/PPH Joint Venture

49

Pro Forma Structure Hospital in a Hospital – Rady will operate the services as a hospital

(part of Rady) and buy ancillary and certain support services from PPH

PPH and Rady will enter into a space use lease agreement at PMC

PPH and Rady will share in the operating margins of the services based upon predefined formula and terms as defined in the Affiliated Program Agreement

Agreement will have an initial term of 2 years with renewal provisions

Rady will manage the Pomerado NICU services (Subsequently revised to reflect ALS back-up coverage and educational support only)

Rady will perform an assessment of Pomerado NICU services within 12 months and prepare recommendations for the future of those services

50

Unit Floorplan

51

Pediatric and NICU Affiliated Program PPH & Rady Children's Hospital Twelve Month Program Review 01/01/2011 through 012/31/2011

Actual Budget CY 2011 CY 2011 Variance

Patient Days 4,702 5,720 -18%

NICU Average Daily Census 9.4 13.2 Pediatric Average Daily Census 3.5 3.8 Combined Average Daily Census 12.9 17.0

Net Patient Revenue 14,340,970 (a) 15,765,639 -9% (Net Revenue per patient day) 3,050 2,756 11%

Expenses: Salaries and Benefits 5,978,935 (b) 6,841,103 13% Agency Labor 110,801 52,064 -113% Medical Fees 585,024 (c) 605,760 3% Direct Support Expenses 392,141 392,141 0% New Information Technology Depreciation 89,808 89,809 0% Other Nursing Unit Expenses 257,472 423,689 39% Ancillary Expenses 809,163 (d) 791,431 -2% Total Direct Expenses 8,223,344 9,195,997 11%

Payments to PPH: Direct support expenses 131,629 (d) 160,146 18% Depreciation New NICU Expansion 128,694 125,000 -3% Rent payment to PPH 287,669 287,646 0% Total Payments to PPH 547,992 572,792 4%

Contribution Margin 5,569,634 5,996,850 -7%

Distributions: First $500,000 to Rady's (500,000) (500,000) Total Margin available for 50% Distribution 5,069,634 5,496,850 -8%

PPH Distribution 2,534,817 2,748,425 -8%

(a) -Does not account for border babies (currently valued at ordinary payor rates) -Estimated government SB855 revenue allocation (b) Advanced life support included in RN salaries (c) Estimated amount. Actual amount in process of being confirmed. (d) Based on PPH invoices.

52

Summary of CY2011 Performance

1. Census during discussions in 2010 was 17.0 overall with an operating margin of $2,814,416 resulting in $165,554 per overall ADC

2. For CY2011 the overall ADC was 12.9, a reduction of 4.1 ADC, with an operating margin of $2,534,817 netting PH $196,497 per overall ADC

3. Reasons for the decline in activity? 4. Had PH not entered the relationship with Rady’s the operating margin

would have been $2,135,647 or $399,170 less than what we realized as a result of the relationship.

5. The operating margin of the program excludes payments to PH for support, rent and depreciation in the amount of $547,992. Including this sum with our distribution results in a total of $3,082,809.

6. Conclusion: We are doing well under this relationship and need to work to grow the activity.

53

Questions

54

Program Review – Robotic Surgery

Form A - Robotic.doc

TO: Board of Directors MEETING DATE: Monday, May 14, 2012 FROM: Natalie Bennett, Manager Program Development BY: Board Finance Committee Monday, May 7, 2012 Background: In 2008, Palomar Health established a robotic surgery program. Since the initiation, the organization has seen significant growth in the areas of GYN, GYN Onc and Urology. The attached presentation focuses on the performance of the program over the past three years as well as touching on strategies for further development of the robotic surgery program, which is a key focus of the business development team and the operational leaders that are a part of this program.

In fiscal year 2012, we have seen significant growth in Urology and GYN program with the addition of new surgeons to the program.

Budget Impact: None




55

DaVinci Robotic Surgery

Board Finance Committee Program Update

May 2012

56

Robotic Surgery Program

• Robot approved in FY2007 • Surgery started in FY2008 • Specialty focus: Urology, Gyn, Gyn-Onc

• Patient experience – Minimally invasive surgery

– Lower LOS

• Enhanced marketing campaign

• Multi-specialty approach

• Formalized Medical Director role

57

Robotic Surgery Program Strengths

• Busiest robot in San Diego last quarter

• Most experienced program in north county

• Strong physician participation

• 15 of 20 block days are allocated to physicians, the other 5 are FCFS and are utilized 80% of the time

• Robotics program to be located at new hospital

• Operational improvements related to inventory management, surgical packs

• Team development for robotics

• New physicians joining program

58

Program Growth Trend:

1

68

128 134 143

36

95 92

151 167

0 20 40 60 80

100 120 140 160 180

FY08 FY09 FY10 FY11 FY12

Urology GYN

Source: Decision support Areas of Focus Report FY 12 Data (annualized)

59

Robotic Surgery Volumes

FY08

Y1 FY09

Y2 FY10

Y3 FY11

Y4 FY12

Projections* 274 329 353 Actual 37 163 220 285 310** Variance <111> <109> <71>

*Projections: proforma in DaVinci business plan

**Annualized based on July-Feb volume 60

Robotic Surgery Financial Performance

Y1

FY09 Y2

FY10 Y3

FY11

Contribution Margin (Proj*) $587,868 $998,771 $1,244,210

Contribution Margin (Act) $306,649 $426,463 $904,552

Variance from Projection <$281,219> <$572,308> <$339,658>

*Proj: proforma in DaVinci business plan

Source: Palomar Health Decision Support 61

Robotic Surgery Growth Strategies

• Physician recruitment to program

• Marketing and Outreach – Healthsource articles

– Direct mail campaign

– Patient education seminars

• Contracting strategies outside PSA

• Continue onboarding of new physicians

62

Robotic Surgery Looking Ahead 1 year….

• Develop scheduling strategies to maximize physician access to the robot

• Potential expansion of applications- Cardiac and general surgery (single port)

• Evaluate purchase of new robot

63

Robotic Surgery Program

Questions?

64

FY2012 Supply Spend

Form A - Supplies - Info.doc

TO: Board of Directors MEETING DATE: Monday, May 14, 2012 FROM: Robert A. Hemker, CFO Steve Ellis, Director Corporate Supply Chain Services BY: Board Finance Committee Monday, May 7, 2012 Background: Attached is a detailed evaluation of the FY2012 supply costs and variances, including the four major sub-accounts that account for the bulk of those variances.

Budget Impact: YTD negative variance of $1.8M




65

FISCAL YEAR 2012

FISCAL YEAR 2012 Supply Expense Variance Overview

MARCH 2012

66

FISCAL YEAR 2012

SUPPLIES EXPENSE YEAR-TO-DATE

Account Description Actual Budget Variance634000 Supplies Surgery General 5,764,859 4,730,481 (1,034,378) 631000 Prosthesis 14,081,747 13,373,800 (707,947) 643000 Supplies Food Other 2,140,940 1,871,564 (269,376) 636000 Supplies Oxygen/Gas 282,942 67,555 (215,387) 632000 Sutures/Surgical Needles 1,720,722 1,631,898 (88,824) 641000 Supplies Other Medical 10,887,401 10,823,060 (64,341) 637000 Supplies IV Solutions 436,120 378,053 (58,067) 635000 Supplies Anesthesia Material 88,938 38,604 (50,334) 647000 Supplies Employee Apparel 172,052 145,996 (26,056) 633000 Supplies Surgical Pack 1,629,337 1,613,708 (15,629) 642000 Supplies Food/Meat 473,529 459,445 (14,084) 645000 Supplies Cleaning 369,582 361,865 (7,717) 639000 Supplies Radioactive 531,191 525,986 (5,205) 644000 Supplies Linen 22,562 25,737 3,175 649000 Other Minor Equipment 1,310,053 1,315,844 5,791 640000 Supplies X-ray Material 12,439 18,705 6,266 646100 Supplies Forms 251,522 333,421 81,899 648000 Instruments/Minor Equipment 698,962 804,140 105,178 646000 Supplies Office/Administration 726,630 839,139 112,509 638000 Supplies Pharmaceutical 8,720,128 8,907,051 186,923 650000 Other Non Medical 6,232,654 6,472,578 239,924

Total 56,554,310 54,738,630 (1,815,680) 67

FISCAL YEAR 2012

FY12 YTD – Top 4 Negative Variances

ACTUAL BUDGET VARIANCE PRIOR YEAR

Account # Account Description March March March March

634000 Supplies Surgery General 5,764,859

4,730,481

(1,034,378)

4,811,459

631000 Prosthesis 14,081,747

13,373,800

(707,947)

13,660,083

643000 Supplies Food Other 2,140,940

1,871,564

(269,376)

2,002,429

636000 Supplies Oxygen/Gas 282,942

67,555

(215,387)

90,333

68

FISCAL YEAR 2012

Surgery Supplies General Supply Acct #634000



207471 Cath Lab Supply 672,830 360,099 (312,731) 379,971

207473 Surgery Patient Supply 2,722,787 2,422,645 (300,142) 2,449,225

307475 Radiology Patient Supply 376,357 94,559 (281,798) 91,309

207475 Radiology Patient Supply 349,183 237,999 (111,184) 284,611

247473 Surgery Patient Supply 224,555 172,758 (51,797) 233,803

Other 1,419,147 1,442,421 23,274 1,372,540

TOTAL 5,764,859 4,730,481 (1,034,378) 4,811,459

69

FISCAL YEAR 2012

Surgery Supply - Variance Findings & Comments

• Inflationary costs for fuel and transportation affecting line item pricing (Over the last 12 months, the gasoline index (CPI) has risen 9.0 percent and the fuel oil index has increased 5.3 percent)

• Newer interventional device utilization with newer physicians have resulted in $300,000 additional expense

• Preliminary review of the physical inventory data shows increase in valuation due to line item price increases and item quantities on-hand (Example: POM Radiology – 20% of products had price increase and quantities on-hand have increased over prior year)

• Physician preference initiative with VHA/WestPac on endomechanical devices could produce $500K annual savings if supplier change occurs

Additional follow-up needed: • Revenues volumes do not correlate to supply % increases for each of the cost

centers – needs further analysis and investigation • Review inventory (par) levels of high priced / non-stock items

70

FISCAL YEAR 2012

Prosthesis Supply Acct # 631000



207476 Implant Patient Supply 9,882,217 9,384,311 (497,906) 9,810,587

307476 Implant Patient Supply 3,663,916 3,574,604 (89,312) 3,448,139

307076 Wound Care 95,996 40,297 (55,699) 7,348

207076 Wound Care 95,841 53,371 (42,470) 4,275

247476 Implant Patient Supply 346,353 321,217 (25,136) 388,976

307638 Mammography-POP 820 - (820) -

247420 Escondido Surgery

Center 85 -

(85) (134)

307403 Perinatology-POP 64 -

(64) 892

208880 Accrual - - - -

TOTAL 14,085,292 13,373,800 (711,492) 13,660,083

71

FISCAL YEAR 2012

Prosthesis Supply - Variance Findings & Comments

• Case Volume down 1%

• Revenue trending correlates to the implant cost increases

• Cardiology Rhythm Management (CRM) initiative has been endorsed by VHA WestPac; and recent discussions with Dr. Acheatel and Dr. Bayat have been very positive

• Need to re-examine bulk purchase strategy

72

FISCAL YEAR 2012

Food Supply Acct # 643000



208320 Food Services 866,271 630,439 (235,832) 725,991

207261 Psychiatric Outpatient 68,444 5,207 (63,237) 2,850

308320 Food Services 438,299 390,819 (47,480) 423,484

Other 767,926 845,099 77,173 850,104

TOTAL 2,140,940 1,871,564 (269,376) 2,002,429

73

FISCAL YEAR 2012

Food Supply - Variance Findings & Comments • Meals prepared 8% or $48,047 better than budget, Revenue 12% or $64,123 better than

budget, while Expenses were 27% or $151,765 worse than budget (Feb)

• Volume variance is -$44,106 and the rate variance is -$107,659

• Departmental Variance Explanation:

– $76K additional floor stock volume increase requested from nursing

– $4K additional meal coupons

– $147 food increases / inflation

2011 2012 Var$ Var%

Fruit/Veg $227k $250k +$23k +10% Groceries $465k $498k +$33k +7%

Dairy $265k $270k +$6k +2%

Baked Goods $191k $222k +$31k +16%

Beverages $339k $394k +$54k +16%

74

FISCAL YEAR 2012

Food Supply - Variance Findings & Comments (cont’d)

• According to the U.S. Department of Agriculture:

Food prices surged in the final quarter of 2011, resulting in annual price inflation above expectations for beef, veal, eggs, fats and oils. The Consumer Price Index (CPI) increased more than expected - 4.8 percent in 2011. The CPI for all food increased 0.2 percent from November to December 2011, increased 0.1 percent from October to November 2011, and is now 4.7 percent above the December 2010 level.

75

FISCAL YEAR 2012

Supplies Oxygen/Gas Supply Acct # 636000

Account # Account Description ACTUAL BUDGET VARIANCE PRIOR YEAR

636000 Supplies Oxygen/Gas 282,942 67,555 (215,387) 90,333

76

FISCAL YEAR 2012

Supplies Oxygen/Gas Supply – Variance Findings & Comments

• Contractor change to new VHA med gas supplier resulted in a one-time charge of $60,273 for lost gas cylinders with the prior contractor over the life of the contract. The cost was negotiated down from the vendor claimed / estimated cost of $150,000.

• $165,950 of rental costs and purchased services was charged to Oxygen/Gas (636000). The expense will be reclassified to correct expense classification in April.

77

FISCAL YEAR 2012

VHA Supply Benchmarking Results

Total Supply Cost per Case Mix Adjusted Discharge

MONTH PALOMAR VHA WESTCOAST BEDS >250 NATL MEAN

2010 - QTR4 1,418.00 1,729.00 1,536.00 1,433.00

2011 - QTR1 1,388.00 1,699.00 1,430.00 1,437.00

2011 - QTR2 1,412.00 1,657.00 1,412.00 1,425.00

Drug Cost per Case Mix Adjusted Discharge


2010 - QTR4 239.00 336.00 383.00 363.00

2011 - QTR1 224.00 331.00 398.00 376.00

2011 - QTR2 257.00 377.00 361.00 376.00

78

FISCAL YEAR 2012

VHA Supply Benchmarking Results – Part 2

Total Supply Cost as % of Total Operating Expenses


2010 - QTR4 16.30 18.30 18.30 17.70

2011 - QTR1 15.90 19.10 17.90 17.20

2011 - QTR2 15.40 17.00 17.70 17.10

Total Supply Cost as % of Net Operating Revenue


2010 - QTR4 15.00 16.20 16.80 16.40

2011 - QTR1 14.90 17.30 16.60 16.10

2011 - QTR2 15.30 16.20 16.50 15.80

79

FISCAL YEAR 2012

A B

C

D

E

F G

H

I

J

K

L M

N

O

P

Q

R

S

T

U

V

W

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

$22,000

$24,000

$26,000

$28,000

$30,000

Total Cost by West Coast Hospital

West Coast Cost Variation Total joint replacement – Medicare patients

West Coast 25th Percentile

National 25th Percentile

Source: 2010 MedPAR Data

Variation exists across the region. Variation also exists by physician.

15

Reported to VHA West Coast Board

M = Palomar Health

80

FISCAL YEAR 2012

81

Board Committee Activity Summary April 19, 2012

Board Audit and Compliance Committee

ACTION ITEMS:

• None

INFORMATION ITEMS:

• Compliance Hotline Report- Ms. Livingstone presented the Compliance Hotline Report on behalf of Tom Boyle.

• The May meeting has been canceled. The next meeting will be held on Thursday, June 21st.

82

Board Committee Activity Summary April 9, 2012

Board Strategic Planning Committee

ACTION ITEMS:

• None

INFORMATION ITEMS:

• Draft FY13 Initiatives: The Executive Management Team presented the five initiatives for FY13 to the Board. The initiatives are 1. Create a customer-focused accountability culture to achieve top quartile HCAHPS. 2. Stabilize and Optimize Operations PMC & Palomar Health Downtown Campus. 3. Expense Management. 4. Physician Leadership and Partnership Integration. 5. Grow Business.

83

ME M O R A N D U M

TO: Nicole Adelberg, Executive Assistant to the Board FROM: Tanya Howell, Assistant to the Board Finance Committee DATE: May 8, 2012 RE: Board Finance Committee – May 7, 2012, Meeting Summary

INFORMATION ITEMS: Reminder of Date Change: For calendaring purposes, the Committee was reminded that

the May Board Finance Committee meeting was moved to Monday, June 4, 2012, at approximately 7:00 p.m., immediately following the Special Board Budget Workshop in Graybill Auditorium at Palomar Medical Center.

Black Mountain Property: The Committee was informed that several school and religious organizations have inquired about the possibility of leasing space at the property on Black Mountain Road. Management is negotiating a potential lease arrangement that would meet Palomar Health and the potential lessee’s needs.

Program Reviews: o Rady’s Affiliation: Gerald Bracht, CAO for Palomar Medical Center, presented a report

on the status of the partnership with Rady Children’s Hospital for the administration of the Pediatric and NICU Affiliated Program at Palomar Medical Center. In its first full calendar year of operations (2011), the program achieved its business objectives with positive financial performance of 11%.

o Robotic Surgery Program: Natalie Bennett, Manager Program Development, and Chris Ghosh, MD, Medical Director for the Robotic Surgery Program, presented an update on the program, the busiest in San Diego during the last quarter. Now in its third year of operations, the program continues to expand in Urology, Gyn, Gyn-Onc, Cardiac and General Surgery procedures.

Third Quarterly Update of FY2012 Initiatives: The FY2012 Initiatives associated with Board Finance Committee oversight – 1.1(a)-(b); 1.2(b) and 1.3(a) – were reviewed and discussed.

FY2012 Supply Spend: Steve Ellis, Director Corporate Supply Chain Services, provided a detailed evaluation of the FY2012 supply costs and variances, including the four major sub-accounts that account for the bulk of those variances.

ACTION ITEMS: Physician Agreements: Reviewed and recommended approval of the budgeted routine

Physician Agreements that had been approved and became effective during the month of March 2012 (full list and background materials may be reviewed elsewhere in the agenda packet).

March 2012 and YTD FY2012 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the March 2012 and YTD FY2012 financial performance, which reflected a $23.1 million bottom line net income YTD, which is approximately $1.0 million greater than budget.

84

Documents

BOARD OF DIRECTORS AGENDA PACKET · 2012. 5. 14. · • Audit and Compliance Director Bassett stated that the Board Audit and Compliance committee summary was included in the packet