BOARD OF DIRECTORS AGENDA PACKET - Palomar Health · 2010-12-06 · 555 East Valley Parkway Escondido, California 92025 ... Announcement and Presentation 15 Verbal Report to Winner

BOARD OF DIRECTORS AGENDA PACKET

December 13, 2010

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

in the communities we serve.

A California Health Care District (Public Entity)

1

u:templates\bd agenda inner cover sheet template:cdm 1/11/2010

PALOMAR POMERADO HEALTH BOARD OF DIRECTORS

Bruce G. Krider, MA, Chairman

T. E. Kleiter, Vice Chairman Jerry Kaufman PTMA, Secretary

Linda C. Greer, RN, Treasurer Nancy L. Bassett, RN, MBA

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 Pomerado Health is to: Heal, Comfort, Promote Health in the Communities we Serve

VISION STATEMENT

Palomar Pomerado 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

Integrity To be honest and ethical in all we do, regardless of consequences

Innovation and Creativity

To courageously seek and accept new challenges, take risks, and envision new and endless possibilities

Teamwork To work together toward a common goal, while valuing our difference

Excellence

To continuously strive to meet the highest standards and to surpass all customer expectations

Compassion To treat our patients and their families with dignity, respect and empathy at all times and

to be considerate and respectful to colleagues

Stewardship To inspire commitment, accountability and a sense of common ownership by all individuals

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 * Ramona Radiology Center * VRC Gateway & Parkway Radiology 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*

2

PALOMAR POMERADO HEALTH

BOARD OF DIRECTORS REGULAR MEETING AGENDA

Monday, December 13, 2010 Palomar Medical Center Commences 6:30 p.m. Graybill Auditorium 555 East Valley Parkway Escondido, California 92025

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

promote health in the communities we serve.”

“The vision of PPH 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.”

“In observance of the ADA (Americans with Disabilities Act), please notify us at 858-675-5106, 48 hours prior to the meeting so that we may provide reasonable accommodations”

Asterisks indicate anticipated action;

Action is not limited to those designated items.

Time Page I. CALL TO ORDER

II. OPENING CEREMONY 5

A. Pledge of Allegiance

III. OATH OF OFFICE 10 Jerry Kaufman, P.T.M.A } Ted E. Kleiter } Administered by Bruce G. Krider } Janine Sarti, Esq. Steve P. Yerxa } IV. PUBLIC COMMENTS 5 (5 mins allowed per speaker with cumulative total of 15 min per group – for further details & policy see Request for Public Comment notices available in meeting room). V. * MINUTES 5 6-17 Regular Board Meeting – November 08, 2010 Closed Board Meeting – November 08, 2010

Closed Board Meeting – November 29, 2010

VI. * APPROVAL OF AGENDA to accept the Consent Items as listed 5 18-48 A. October 2010 & YTD FY2010 Pre-Audit Financial Report (Addendum A) B. Revolving Fund Transfers/Disbursements – October, 2010

1. Accounts Payable Invoices $52,692,884.00 2. Net Payroll $16,773,426.00

Total $69,466,310.00 C. Ratification of Paid Bills D. Leadership and Management Policy E. Revision of Policies – Gov 12

3

Regular Board Meeting Agenda, December 13, 2010

Asterisks indicate anticipated action;

Action is not limited to those designated items. u\my docs\pph board mtgs 2010\regular bd mtg 12-13-10\bdagendaPMC 12-13-10.doc:nla

F. Absenteeism by Board Members Policy G. Program Services Agreement with Arch Health Partners for Breast Health Services H. Annual Report of the ICOC for District Fiscal Year 2009-2010 I. Administrative Services Agreements for PMC Department Chairs, MSPRC Chair, Chief of Staff and Chief of Staff Elect J. Administrative Services Agreements for POM Department Chairs and MSPRC Chair K. Professional & Medical Director Services Agreement with X-Ray Medical Group Oncology, Inc. for Radiation Oncology at PMC L. Professional & Medical Director Services Agreement with Neighborhood Health Care for Medical History & Physical Exam Services for the PMC Behavioral Health Unit M. Physician Advisor Agreement with Jason Keri, MD, for Behavioral Health Services N. Professional Services Agreement with Jeffrey Chen, MD, for Employee & Corporate Health Services O. Independent Contractor Agreements for the EHR Suite of Projects with Jay Federhart, MD, Sudabeh Moein, MD, Rod Serry, MD, Mikhail Malek, MD and Elizabeth Salada, MD

VII. PRESENTATIONS

A. “Hear for the Holidays” Program : Announcement and Presentation 15 Verbal Report to Winner for 2010 by David Illich, AuD., FAAA, Chief Audiologist for PPH (coordinated by Andy Hoang) B. PPH Awards 10 49

1. SHRM Workplace Award - Brenda Turner, Chief Human Resources Officer C. PPH Pipeline Career Services – Brad Kreitzberg 10 Verbal Report D. PPH Community Outreach Services – Nancy Roy and Kay Stuckhardt 15 50

VIII. REPORTS 10 51-79 A. Medical Staffs

* 1. Palomar Medical Center – John Lilley, M.D. a. Credentialing/Reappointments

b. Core Privileging – Nephrology Clinical Privileges c. AHP – Nurse Practitioner Psychiatry Core Privileging Checklist d. Administrative Transfer to Core Privileging Forms

* 2. Pomerado Hospital – Frank Martin, M.D. a. Credentialing/Reappointments

B. Administrative 1. Chairman of Palomar Pomerado Health Foundation – John Forst 10 Verbal Report

a. Update on PPHF Activities 2. Chairman of the Board – Bruce Krider 10 80

a. * Resolution No. 12.13.10 (11) – 01 Establishing Board Meetings for Calendar Year 2011 b. * Election of Officers 2011

3. President and CEO – Michael H. Covert, FACHE 10 Verbal Report

IX. INFORMATION ITEMS 5 81-123 A. Arch Health Partners Program Review B. Wound Care Program Review C. Trocar Conversion Process

4

Regular Board Meeting Agenda, December 13, 2010

Asterisks indicate anticipated action; Action is not limited to those designated items.

X. COMMITTEE REPORTS 20 124-162

A. Internal Audit and Compliance Committee B. Governance Committee C. Human Resources Committee D. Community Relations – Did not meet in November E. Facilities and Grounds F. Board Quality Review Committee G. Finance Committee H. Strategic Planning Committee I. Other Committee Chair Comments on Committee Highlights (standing item) XI. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT MONTH

XII. ADJOURNMENT

5

u\my docs\pph bd mtgs 2010\reg bd mins 10-11-10:nla 1

Palomar Pomerado Health BOARD OF DIRECTORS

REGULAR BOARD MEETING Pomerado Hospital / Meeting Room E

Monday, November 8, 2010

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY

CALL TO ORDER 6:43 pm 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 PPH mission and vision statements are as follows: The mission of Palomar Pomerado Health is to heal, comfort and promote health in the communities we serve. The vision of PPH 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

PUBLIC COMMENTS None. APPROVAL OF MINUTES

• Regular Board Meeting October 11, 2010

• Special Board Meeting October 26, 2010

MOTION: by Kaufman, 2nd by Bassett and carried to approve the Regular Board meeting minutes of October 11, 2010 and the Special Board meeting minutes of October 26, 2010 as submitted. All in favor. None opposed.

APPROVAL OF AGENDA (to accept the Consent Items as listed) A. September 2010 & YTD FY2010

MOTION: by Kaufman, 2nd by Bassett and carried to approve the Consent Items A – N as submitted.

6



Pre-Audit Financial Report B. Approval of Revolving, Patient Refund and Payroll Fund Disbursements–September 2010

Accounts Payable Invoices $44,328,610.00 Net Payroll $11,362,288.00 Total $55,690,898.00

C. Ratification of Paid Bills D. FIN11 – Annual Adoption of Statement of Investment E. Media Relations Policy F. Conflict of Interest Policy G. Behavioral Health Services Agreement with Arch Health Partners H. Center for Back and Neck Pain Business Plan I. PPH Expresscare – Escondido Medical Directorship J. PPH Expresscare – Penasquitos Medical Directorship K. Physician Recruitment Agreement – Sue Gosh, M.D. L. Physician Independent Contractor Agreements – Information Systems Services M. Professional and Medical Director Services Agreement – Radiation Oncology Services N. Human Resources – Incentive Plan

All in favor. None opposed.

PRESENTATIONS PPH Transformation Update Lorie Shoemaker, Chief Nursing Executive Lorie Shoemaker spoke about the culture

transformation vision and the shifting PPH culture. Ms. Shoemaker spoke about the focus on safe, ideal patient care throughout the transformation process.

7



Ms. Shoemaker, along with other members of the medical staff and administration, visited Dixie Regional Medical Center to better inform PMC East decision making. Ms. Shoemaker stated that additional site visits have been scheduled with Baptist Memorial in Memphis, Tennessee and Lovelace in Albuquerque, New Mexico. Ms. Shoemaker spoke about the Acute Care for the Elderly (ACE) Unit that opened in September, 2010. The unit is a six bed unit in Tower 4 and has RN/CNA teams utilizing NICHE nurses. The goals of the unit are to reduce restraint use, falls and adverse effects of hospitalization on the elderly. The unit tries to return patients to their pre-hospital level of function. Ms. Shoemaker then spoke about the Universal Care Unit. The intermediate care unit on Tower 2 and the IMC patient population on Tower 3 began comingling in August 2010. The goals of the unit were to eliminate patient transfers, decrease adverse events associated with transfers and decrease cancellations of staff. Ms. Shoemaker spoke about the ideal patient care experience workshop. The care continuum retreat on October 29 addressed relationship based care model integration, system wide deployment of service excellence best practices and the standardization of hand offs.

PPH Trauma Services Update Dr. Steele and Debra Byrnes, Trauma Program Coordinator

Dr. Steele presented the trauma volumes by year from 1998 – 2010. The admissions by month in FY10 and the average daily trauma patients by month of admission in FY10 were reviewed.

8



The trauma team activation for FY10 reviewed the percentages of full trauma team activation, modified trauma team activation and trauma consults. Trauma patients by age, gender, and length of stay were reviewed. Dr. Steele highlighted the trauma bed utilization. Mechanisms of injury were reviewed. A 2010 Benchmark Report compared PPH with similar sized hospitals for injury severity scores. Mechanisms of injury with the injury severity scores were reviewed. Trauma deaths by mechanisms of injury, patient discharge dispositions and patient financial payer types were reviewed. A brief history of the Trauma ICU was provided. Dr. Steele discussed the current and upcoming trauma education and prevention efforts. Dr. Steele concluded the presentation with patient and family testimonials.

REPORTS Medical Staff Palomar Medical Center

Credentialing John J. Lilley, M.D., Chief of PMC East Medical Staff, presented PMC’s requests for approval of Credentialing Recommendations.

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

9



Kaufman and carried to approve the Core Privileging – Podiatry Clinical Privileges/Psychologist Clinical Privileges, as submitted. All in favor. None opposed. MOTION: by Rivera, 2nd by Bassett and carried to approve the Core Privileging Modified – Orthopedic Surgery and Emergency Medicine, as submitted. All in favor. None opposed.

Pomerado Hospital Credentialing Frank Martin, M.D., Chief of Pomerado

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

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

Administrative Chairman - Palomar Pomerado Health Foundation

John Forst

Mr. Forst thanked the Board for attending Physician’s Recognition Awards Dinner on Saturday, October 23rd. Jerry Kolins, M.D. was awarded the Philanthropist Physician of the Year. The Foundation continues to host regular site tours and has added an addition donor’s tour. Last week the Foundation hosted a tour for the area clergy. Mr. Forst stated that several new members have been added to the Foundation team. Robert Sheldon - Director of Gift Planning,

10



Sue Misner - Manager of Special Events and Angie Martinez, Communication and New Media Coordinator. Mr. Forst stated that there will be a Gala kick off at Qualcomm Stadium in early December. Invitation to follow. Al and Lisa Staley will be honored by the North County Philanthropy Council at a luncheon on Friday, November 12th at the California Center for the Arts in Escondido. The Foundation will have a table at the luncheon if the Board would like to attend.

Chairman of The Board Ted Kleiter, Vice-Chair, standing in for Bruce Krider

Director Kleiter congratulated his fellow re-elected Board members.

President and CEO Michael Covert, President and CEO Mr. Covert congratulated the re-elected Board

members. Mr. Covert stated that the Oaths of Office will be administered at the December Board meeting. Mr. Covert stated that with the completion of the 4th Culture Forum on November 3rd, approximately 2600 employees have now been able to attend. The Board will receive similar information at the Quarterly Physician Leadership meeting on Tuesday, November 9th. Mr. Covert announced that the second round of CIO interviews has been completed. Mr. Covert thanked Nancy Wood for her assistance throughout the process.

COMMITTEE CHAIR COMMENTS

• Internal Audit Director Bassett stated that the final draft of the Code of Conduct was approved and will be presented at the Governance Committee, both MECs and then to the full Board. Director

11



Bassett stated that this revised Code of Conduct will tie a new statement of values to PPH’s existing Mission and Vision. The restated values will be Patient’s Well-Being, Professionalism and Highest Quality. Director Bassett stated that the committee approved the Conflict of Interest, Commitment and Gifts procedure. The procedure defines what a gift is and what types of gifts may be accepted in certain situations, as well as requiring disclosure of financial interests in certain decision-making situations. Bob Hemker reported on the recent activities of the Compliance and Ethics committee. Mr. Hemker discussed the efforts to increase physician enrollment in PECOS and the marketing approach for Compliance and Ethics efforts under the tagline “Our Way – Doing what’s right”. The Internal Audit team gave a status report of the Internal Audit Plan for 2010.

• Governance Director Kaufman stated that the FIN 11 – Annual Adoption of Statement of Investment and Media Relations Policy were approved. Mr. Friederichsen presented the CHA key state issues, the ACHD bills with active reactions and a summary of the bills currently effecting PPH. Mr. Friederichsen discussed the two year bills and provided the current status for each of the bills. Director Kaufman stated that with the new changes in Congress, the full Board should review PPH’s legislative representation.

• Human Resources Director Kleiter stated that the Human Resources committee discussed the Culture Champions and the HR Quarterly Report. Materials from the committee meeting are

12



included in the packet under the information items.

• Community Relations The Board Community Relations Committee did not meet in October.

• Board Facilities and Grounds

Director Rivera stated that Board Facilities and Grounds committee met earlier today. The committee reviewed the facilities master plan for PMC West and Pomerado Hospital. A progress update was provided on the central plant, hospital exterior, hospital tower, and D&T. The schedule was reviewed and the project remains on schedule. Director Rivera thanked the Foundation for hosting the Physician’s Recognition Awards Dinner.

• Board Quality Review Director Rivera stated that in the regulatory update, Opal Reinbold provided update on the survey preparation/action plan and Dr. Kolins provided an update on the high level disinfection. In the patient safety update, Ms. Reinbold spoke about the CDHS patient survey and Donita Phillips provided an update on OB Tiers 1 & 2. Director Rivera stated that Ms. Reinbold provided an update to the Quality/Patient Safety Plan and Debbie Barnes previewed the Premier Knowledge Box. Virginia Barragan presented an update on the Rehabilitation Services and the Behavioral Health Services presentation was postponed. Dr. Buringrud provided an update on the education/training sessions for the medical staff leadership. Director Rivera reminded the Board that there is a Quarterly Physician’s Leadership Meeting

13



tomorrow evening at 6:00p.m. at the Rancho Bernardo Radisson.

• Finance Director Greer stated that the committee reviewed and recommended approval of a business plan in support of the development of a clinic at the POP to provide a comprehensive spine program. The committee also reviewed and recommended approval of physician agreements. Director Greer stated that the committee reviewed and recommended approval of the Financials for September 2010 and YTD FY2011 financial performance, which reflected a $6.6 million bottom line net income YTD.

• Strategic Planning Mr. Covert stated that the Strategic Planning committee reviewed the business plan for the Center for Back and Neck Pain. An update was provided on Rehabilitation Care and Behavioral Health Services at the November meeting.

BOARD MEMBER COMMENTS and AGENDA ITEMS FOR NEXT MONTH

Director Rivera stated that he will be unable to attend the December Board meeting in person but would like to participate remotely. Director Greer thanked the Board and staff for their support in her continuing Compliance and Ethics education with the Health Ethics Trust. Director Greer attended the 2010 Healthcare Best Compliance Practices Forum where she was awarded the first ever Trustee of the Year award. Director Greer stated that all of the Forum attendees were Compliance Officers. Director Greer suggested that the Compliance Officers get their Board members involved by being able to bring a Board member to attend at no cost. Director Kleiter addressed guests in the audience from National University. Director Kleiter stated that in addition to the regular

14



monthly Board meetings, each Board member is also involved in two or three Board committees as well as community activities. Director Kleiter stated that each Board member spends an average of 40 or more hours per month on Board related activities. Director Rivera asked Mr. Covert to write a letter of thanks to Dick Daniels for his participation in the Board Facilities and Grounds Committee meetings.

ADJOURNMENT 8:05p.m. SIGNATURES

Board Secretary

Board Assistant

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

15

1


Closed Session Pomerado Hospital/Meeting Room E

15615 Pomerado Road, Poway, CA 92064 Monday, November 08, 2010

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-

UP/RESPONSIBLE PARTY

CALL TO ORDER

5:30 p.m. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa

NOTICE OF MEETING

Notice of Meeting was mailed consistent with legal requirements. Pursuant to California Government Code §54954.5(h) Report Involving Trade Secret Discussion will concern medical office buildings. Estimated date of public disclosure: November 2011

PUBLIC COMMENTS None.

ADJOURNMENT TO CLOSED SESSION

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

CLOSED SESSION Pursuant to Government Code §54954.5(h): Report Involving Trade Secret.

OPEN SESSION RESUMES

MOTION: by Chairman Krider to resume open session

FINAL ADJOURNMENT

MOTION: by Chairman Krider for final adjournment at 6:30 p.m.

SIGNATURES

Board Secretary

Board Assistant


16

1


Closed Session 456 Grand Avenue, Escondido, CA 92025

Monday, November 29, 2010

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP/RESPONSIBLE

PARTY CALL TO ORDER

6:00 p.m. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa

NOTICE OF MEETING

Notice of Meeting was mailed consistent with legal requirements. Pursuant to California Government Code §54954.5(h) Report Involving Trade Secret Discussion will concern medical office buildings Estimated date of public disclosure: November 2011

PUBLIC COMMENTS None.

ADJOURNMENT TO CLOSED SESSION

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

CLOSED SESSION Pursuant to Government Code §54954.5(h): Report Involving Trade Secret.

OPEN SESSION RESUMES

MOTION: by Chairman Krider to resume open session

FINAL ADJOURNMENT

MOTION: by Chairman Krider for final adjournment at 7:33 p.m.

SIGNATURES

Board Secretary

Board Assistant


17

October 2010 & YTD FY2011 Financial Report

Form A - Financial Report.doc

TO: Board of Directors

MEETING DATE: Monday, December 13, 2010

FROM: Robert A. Hemker, CFO

BY: Board Finance Committee Tuesday, November 30, 2010

Background: The Board Financial Reports (unaudited) for October 2010 and YTD FY2011 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 October 2010 and YTD FY2011.

Motion: X

Individual Action:

Information:

Required Time:

18

19

I. PURPOSE: To�provide�directions�from�the�Board�of�Directors�to�the�Leadership�of�Palomar�Pomerado�Health�relative�to�leadership�and�management�of�the�organization.�

II. DEFINITIONS: Type your definitions here.

III. TEXT / STANDARDS OF PRACTICE: A. The Board of Directors of Palomar Pomerado Health empowers the Chief Executive Officer to be responsible for the management of PPH facilities in compliance with applicable laws and regulations. This includes responsibility for:

1. Ensuring the goals of PPH are achieved, specifically the delivery of high quality patient care.

2. Establishing effective operations.

3. Establishing information and support systems.

4. Recruiting and maintaining staff.

5. Conserving physical and financial assets.

6. Establishing appropriate PPH procedures in accordance with Board Policies.

B. Leaders within the organization will:

1. Plan and design services: Provide a collaborative process to develop a mission that is reflected in long range, strategic, and operational plans; service design; resource allocation, and organization procedures. Assess needs of patients and other users of the PPH services in this planning process.

2. Direct Services: Provide organization, direction and staffing for patient care and support services according to the scope of services offered.

3. Integrate and coordinate services: Communicate objectives and coordinate efforts to integrate patient care and support services throughout the PPH facilities including providing for clear lines of responsibility and accountability within departments and between departments and administration.

4. Improve performance:

a. Establish expectations, plans, prioritizes and manages the performance improvement processes within a culture of continuously improving performance and Shared Governance.

b. Ensure implementation of processes to measure, assess and improve the performance of the hospital's governance, management, clinical and support processes.

5. Develop the organization and it’s employees:

a. Encourage staff participation.

Palomar Pomerado Health Policy

Leadership and ManagementPolicies, BOD only 26975 (Rev: 0)Official

Applicable to: Affected Departments:

Page 1 of 2Leadership and Management

10/20/2010https://www.lucidoc.com/cgi/doc-gw.pl?ref=pphealth:26975/frame/DOCBODY20

b. Develop leaders at all levels to fulfill the District’s mission, and values.

c. Provide a mechanisms to help teach and coach staff at all levels.

6. Report to the Board of Directors regarding:

a. Recommendations from planning, regulatory and inspecting agencies and the subsequent plans.

b. Short and long term plans.

c. Operational Updates.

d. Program efficiency and effectiveness.

e. Financial status and performance.

f. Operational and capital budget recommendations.

g. Performance Improvement.

h. Staff Competence.

7. This policy will be reviewed and updated as required or at least every three years.

IV. ADDENDUM:

V. DOCUMENT / PUBLICATION HISTORY: (template)

VI. CROSS-REFERENCE DOCUMENTS:(template)

Paper copies of this document may not be current and should not be relied on for official purposes. The current version is in Lucidoc at .

https://www.lucidoc.com/cgi/doc-gw.pl?ref=pphealth:26975

Revision Number

EffectiveDate

Document Owner at Publication Description

(this version) 0

11/06/2009 Michele L. Gilmore, Executive Assistant no changes noted on rvw 9-15-09. mlg. Edited for changes requested by B. Krider on 9/16; added comments #1 in sec III. TEXT. mlg

Authorized Promulgating Officers: ( 11/06/2009 ) Bruce G Krider, Board Chairman, PPH Board ( 11/06/2009 ) Janine Sarti, General Counsel

Reference Type Title Notes

Page 2 of 2Leadership and Management


I. PURPOSE: To ensure that current practice is consistent with written policies, and in recognition of the standards of the Joint Commission on Accreditation of Health Care Organizations, timely and appropriate review of all PPH policies shall be accomplished regularly, systematically and in accordance with the following guidelines.

II. DEFINITIONS: For purposes of this policy, the term policy shall mean a Board approved statement that provides broad strategic direction and/or a governing mandate for PPH, instituting the development of procedures, as defined and provided for elsewhere.

III. TEXT / STANDARDS OF PRACTICE:

A. Governing Board 1. Each Board committee shall review, evaluate and revise as necessary the applicable policies. 2. A packet will be provided to the Assistant to the Board for Governance Committee review. This packet will

include: a. A written summary of all changes; b. Copy of the old policy; c. Copy showing redline changes; d. Copy of new policy in LUCIDOC format.

3. To assure that policies are kept current, the Board Assistant shall, on a monthly basis, peruse all Board committee minutes, extracting information as appropriate either to formulate policy statements that may be directed by the committee or to provide the information to the appropriate personnel for completion of the policy statement. The completed policy statement is to be submitted to the full Board for approval and appropriately posted and communicated following approval.

B. Central Office, Hospitals, Related Entities, Volunteer Organizations 1. The policies of PPH shall be reviewed, evaluated and revised as necessary at least once in a three-year period

beginning with the effective date of this policy and at least once in each subsequent three-year period. Evidence of that review is to be made a permanent part of the policy.

2. In the interim, any policy requiring changes warranted on safety issues, changes in the law, state of the art, current knowledge or technology or other factors, may be approved by the PPH compliance officer on an interim basis after providing a redline copy of the revised policy reflecting those proposed interim changes to each member of the Governance Committee with an explanation as to why an interim change was required. The policy with the interim changes will be approved at the next scheduled meeting of the governance committee..

3. For purposes of this policy, PPH shall include the central office, hospitals, convalescent facilitates, foundation,medical staffs, auxiliaries and all related entities

4. The Board Governance Committee will receive an ongoing brief report from PPH Compliance Officer confirming compliance with this Policy.

5. This policy will be reviewed and updated as required or at least every three years.

IV. ADDENDUM:

V. DOCUMENT / PUBLICATION HISTORY: Original Document Date: 1/93 Reviewed: 3/95; 1/99; 7/06; 3/07 Revision Number: 1 Dated: 1/20/05 Document Owner: Michael Covert Authorized Promulgating Officers: Marcelo R. Rivera, Chairman


Revision of PoliciesPolicies, BOD only GOV-12 (Rev: 3)Official

Applicable to:All PPH Entities - 00

Affected Departments:All DepartmentsBoard of Directors

Page 1 of 2Revision of Policies


VI. CROSS REFERENCE DOCUMENTS: Prior to 2005, this policy was Board Policy 10-207



Paper copies of this document may not be current and should not be relied on for official purposes. The current version is in Lucidoc at .

https://www.lucidoc.com/cgi/doc-gw.pl?ref=pphealth:21794

Revision Number

Effective Date Document Owner at Publication Description

(this version) 3

11/14/2007 Ofer Barlev Board review Added at review: No material change made to text of document. Updated signatures to current signers.

(Changes) 2 11/14/2007 James Neal, Director of Corporate Integrity Board review(Changes) 1 01/20/2005 James Neal, Director of Corporate Integrity Original Document Date: 1/93

Reviewed: 3/95; 1/99 Revision Number: 1 Dated: 1/20/05 Document Owner: Michael Covert

Authorized Promulgating Officers: Marcelo R. Rivera, Chairman

Authorized Promulgating Officers: ( 01/06/2010 ) Janine Sarti, General Counsel ( 01/07/2010 ) Bruce G Krider, Board Chairman, PPH Board

Reference Type Title NotesSource Documents Prior to 2005, this policy was Board Policy 10-207

Page 2 of 2Revision of Policies


I. PURPOSE: In recognition of the requirement for a quorum of board members to conduct District business and the desirability of the presence of all members, guidelines shall be formulated to govern absenteeism.

II. DEFINITIONS: III. TEXT / STANDARDS OF PRACTICE:

A. The term of any member of the Board shall expire if the member is absent from three consecutive regularly scheduled monthly Board meetings or from three of any five consecutive regular meetings of the Board and if the Board by resolution declares that a vacancy exists on the Board.

B. This policy will be reviewed and updated as required or at least every three yearsyour standards of practice.

DOCUMENT / PUBLICATION HISTORY:

A. Original Document Date: 3/94 B. Reviewed: 1/99; 1/05; 7/06 C. Revision Number: 1 Dated: 3/95 D. 2 Dated: 1/20/05 E. Document Owner: Michael Covert F. Authorized Promulgating Officers: Marcelo R. Rivera, Chairman

CROSS REFERENCE DOCUMENTS:

Prior to 2005, this policy was Board Policy 10-113

IV. ADDENDUM:




Absenteeism by Board MembersPolicies, BOD only GOV-09 (Rev: 2)Official

Applicable to:All PPH Entities - 00

Affected Departments:All Departments

Revision Number

Effective Date Document Owner at Publication Description

(this version) 2

11/14/2007 Ofer Barlev -Ready for Signature by Bruce Krider Board review Added at review: No material change made to text of document. Updated signatures to current signers.

(Changes) 1 11/14/2007 James Neal, Director of Corporate Integrity Board review(Changes) 0 06/14/2006 James Neal, Director of Corporate Integrity This is the original version.

Authorized Promulgating Officers: ( 03/01/2010 ) Janine Sarti, General Counsel ( 03/07/2010 ) Bruce G Krider, Board Chairman, PPH Board

Reference Type Title Notes

Page 1 of 2Absenteeism by Board Members


Palomar Pomerado Health Breast Health Service Line Contract to Arch Health Partners

Form A - Breast Health Board Finance 11 2010 v2.doc

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Lisa Hudson, Director Business & Physician Development Sheila Brown, RN, Chief Clinical Outreach Officer BY: Board Finance Committee Tuesday, November 30, 2010 Background: Currently at PPH, the Women’s Health Program is lacking access to a fellowship trained breast surgeon. A determination was made that to better serve the needs of women in the community, it would be beneficial to secure such a physician to provide coverage at the Jean McLaughlin Women’s Center through a contract with Arch Health Partner’s (APH). The contract outlines the requirements of APH to provide the necessary physician to cover PPH’s needs for breast health.

Budget Impact: Currently the FY11 budget has allocated amounts for this service within the Physician Development Department’s budget.

Staff Recommendation: Approve the Contract with Arch Health Partners to provide Breast Health Services for PPH.


COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the two-year [January 31, 2011 through January 30, 2013] Program Services Agreement with Arch Health Partners for Women’s and Breast Health Services for PPH. Motion: X Individual Action: Information: Required Time:

25

PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria Preamble TITLE Program Services Agreement Women’s and Breast Health

Services

Preamble AGREEMENT DATE January 31, 2011

Preamble PARTIES (1) Palomar Pomerado Health (2) Arch Health Partners

Recitals PURPOSE PPH’s current medical administration of its Women’s Health Services Program requires the support of fellowship trained breast surgeon to meet the community need.

Section 1&2

SCOPE OF SERVICES (1) Provide outpatient consultation at the PPH Jean McLaughlin Women’s Center in the area of breast disease (2) Provide inpatient consultation as requested at Pomerado (3) Provide surgical treatment for breast disease as needed for patients referred to the Women’s Center

PROCUREMENT METHOD

Request For Proposal X Discretionary

Section 4

TERM Two years January 31, 2011 through January 30, 2013

Section 4

RENEWAL After renegotiation of contract between the parties

Section 4

TERMINATION (1) Either party may terminate without cause or penalty with 90 day notice. (2) Either party may terminate with material breach with 30 day notice.

Section 3

COMPENSATION METHODOLOGY

The annual contract amount is based upon Fair Market Valuations to the components of the delivery of medical care.

BUDGETED X YES NO – IMPACT:

EXCLUSIVITY X NO YES – EXPLAIN:

JUSTIFICATION PPH is looking to provide the community with breast surgery services from a fellowship trained breast surgeon.

AGREEMENT NOTICED YES X NO Methodology & Response:

ALTERNATIVES/IMPACT Duties Provision for Staff Education N/A

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

N/A COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee Finance BOD

26

Independent Citizens’ Oversight Committee Review of Annual Report for District Fiscal Year 2009-2010

Form A - ICOC Annual Report.doc

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Independent Citizens’ Oversight Committee Bob Hemker, CFO BY: Board Finance Committee Tuesday, November 30, 2010 Background: On Friday, November 19, 2010, the Palomar Pomerado Health Hospital, Emergency Care, Trauma Center Improvement and Repair Measure Bonds Independent Citizens’ Oversight Committee (ICOC) held their final regular meeting for calendar year 2010.

At that meeting, the ICOC reviewed the District Expenditure Report, which details the reconciliation of funds expended from the proceeds of the General Obligation Bonds issued pursuant to Measure BB. Also reviewed was the General Obligation Bonds Disbursement Audit conducted and certified by the Palomar Pomerado Health Construction Auditor. Following the document review, the ICOC concluded that PPH is in compliance with the requirements of Measure BB. Pursuant to §3.2 of the ICOC Procedures, Policies & Guidelines (PP&G), the Annual Report of the ICOC for District Fiscal Year 2009-2010 is herewith submitted to the District Board for consideration and response. NOTE: In the interests of space, the more than 480-page ADDENDUM to the ICOC’s report is not reproduced here but will be attached to that document before it is uploaded to the District’s web site.

If approved, the report will be considered final and will be posted on the ICOC page of the District Board’s public web site www.pph.org/default.aspx?nd=2144. If the response is other than approval, the ICOC will review the District Board’s response at their next regularly scheduled meeting, will make correction, amendment and approval and will then submit the final report for inclusion in the District Board’s public records on the ICOC page of the PPH web site.

The next regular meeting of the ICOC will be scheduled in the month of March 2011.

Budget Impact: N/A

Staff Recommendation: Based on the findings of the ICOC, staff recommends approval of the Annual Report of the ICOC for District Fiscal Year 2009-2010.


COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Annual Report of the ICOC for District Fiscal Year 2009-2010.

Motion: X

Individual Action:

Information:

Required Time:

27

28

29

30

31

InInsert Subject Here

Form A - PMC Med Staff.doc

PALOMAR MEDICAL CENTER ADMINISTRATIVE SERVICES AGREEMENTS

MEDICAL STAFF OFFICERS, DEPARTMENT CHAIRS, MSPRC CHAIR TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Gerald E. Bracht, Chief Administrative Officer, PMC BY: Board Finance Committee Tuesday, November 30, 2010

BACKGROUND: Palomar Medical Center Medical Staff Officers, Department Chairs, the QMC Chair and the MSPRC Chair are provided a stipend for services performed as required by the Medical Staff By-laws. These agreements serve to document the relationship of the medical staff officers, department chairs, QMC Chair and MSPRC chair to PPH, and the duties to be performed as consideration for the stipend to assure compliance with Federal regulations.

Presented are the Administrative Services Agreements for the following Department Chairs and the MSPRC Chair for Palomar Medical Center:

Chair, Department of OB/GYN – Josue Leon, M.D. Chair, Department of Anesthesia – P. Eva Fadul, M.D. Chair, Department of Radiology – Gregory Nicpon, M.D. Chair, Medical Staff Peer Review Committee – Jeffrey Rosenburg, M.D. Also presented are amendments to the following agreements: Chief of Staff – John Lilley, M.D.

Chief of Staff Elect – Richard Engel, M.D. The attached Agreement Abstracts are the same for all individuals, with the exception of the terms. The Chair of the Department OB/GYN and the Chair of the Department of Anesthesia agreements end on 12/31/2012, while the Chair of the Department of Radiology and the Chair of the Medical Staff Peer Review Committee agreements end on 12/31/2011. The Chief of Staff and Chief of Staff Elect Amendments end on 12/31/2011.

BUDGET IMPACT: None.

STAFF RECOMMENDATION: Approval.

COMMITTEE QUESTIONS: COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval

of the Administrative Services Agreements for the Department Chairs, MSPRC Chair, Chief of Staff and Chief of Staff Elect at Palomar Medical Center, with the physicians and for the terms ofoffice as outlined above.

Motion: X

Individual Action:

Information:

Required Time:

32


Reference

Term/Condition

Term/Condition Criteria TITLE Department Chair Agreements

AGREEMENT DATE January 1, 2011

PARTIES Department Chair, Palomar Medical Center Medical Staff and

PPH

PURPOSE To provide administrative services on behalf of Palomar Medical Center Medical Staff in accordance with Medical Staff Bylaws and policies

SCOPE OF SERVICES As per duties defined in Palomar Medical Center Medical Staff Bylaws and policies.

PROCUREMENT METHOD

Request For Proposal Discretionary

TERM January 1, 2011 – December 31, 2012

RENEWAL None

TERMINATION As described under §5


Monthly.

BUDGETED ■ YES □ NO – IMPACT:

EXCLUSIVITY NO YES – EXPLAIN:

JUSTIFICATION These positions are elected by the Medical Staff in accordance with Medical Staff Bylaws.

POSITION POSTED YES NO Methodology & Response: Elected by the Palomar Medical Center Medical Staff

ALTERNATIVES/IMPACT N/A

DUTIES Defined in the Palomar Medical Center Medical Staff Bylaws

COMMENTS The agreement template was developed by legal counsel. The Department Chair positions are voted upon by Active members of the Medical Staff.

APPROVALS REQUIRED VP CFO CEO BOD Committee FINANCE BOD

33


Reference

Term/Condition

Term/Condition Criteria TITLE Chief of Staff, Chief of Staff Elect, Department Chair and MSPRC

Chair Agreements


PARTIES Chief of Staff, Chief of Staff Elect, Department Chair and MSPRC Chair, Palomar Medical Center Medical Staff and PPH

PURPOSE To provide administrative services on behalf of Palomar Medical Center Medical Staff in accordance with Medical Staff Bylaws, Plans and policies

SCOPE OF SERVICES As per duties defined in Palomar Medical Center Medical Staff Bylaws and policies.

PROCUREMENT METHOD


TERM January 1, 2011 – December 31, 2011

RENEWAL None



Monthly.



JUSTIFICATION These positions are elected or appointed by the Medical Staff in accordance with Medical Staff Bylaws.

POSITION POSTED YES NO Methodology & Response: Elected/Appointed by the Palomar Medical Center Medical Staff


DUTIES Defined in the Palomar Medical Center Medical Staff Bylaws

COMMENTS The agreement template was developed by legal counsel. The Chief of Staff, Chief of Staff Elect and Department Chair positions are voted upon by Active members of the Medical Staff. The MSPRC Chair position is appointed by the Chief of Staff.


34

nsert Subject Here

Form A - POM Med Staff.doc

POMERADO HOSPITAL ADMINISTRATIVE SERVICES AGREEMENT

MEDICAL STAFF OFFICERS, TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: David Tam, M.D., Chief Administrative Officer, Pomerado Hospital BY: Board Finance Committee Tuesday, November 30, 2010 BACKGROUND: Pomerado Hospital Medical Staff Officers are compensated for services performed as required by the Medical Staff By-laws. These agreements serve to document the relationship of the medical staff officers to PPH and the duties to be performed as consideration for the stipend to assure compliance with Federal regulations. Presented are the Administrative Services Agreements for the Chief of Staff, Chief of Staff-Elect, QMC Chair, MSPRC Chair and the Department of Radiology Chair for Pomerado Hospital. There are five agreements for implementation at Pomerado Hospital: Chief of Staff – Roger J. Acheatel, M.D. Chief of Staff Elect – Paul Neustein, M.D. Chair, QMC Committee – Franklin Martin, M.D. Chair, MSPRC Committee – Franklin Martin, M.D. Chair, Department of Radiology – Gregory Nicpon, M.D. The attached Agreement Abstracts are the same for all individuals, with the exception of the terms. The Department of Radiology Chair agreement ends on 12/31/2011, while all others end on 12/31/2012. BUDGET IMPACT: None STAFF RECOMMENDATION: Approval COMMITTEE QUESTIONS:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Administrative Services Agreements for the Department Chairs, MSPRC Chair, Chief of Staff and Chief of Staff Elect at Pomerado Hospital, with the physicians and for the terms of office as outlined above. Motion: Individual Action: Information: Required Time:

35


Reference

Term/Condition

Term/Condition Criteria TITLE Medical Staff Officers


PARTIES Pomerado Hospital Chief of Staff, Chief of Staff Elect, QMC

Chair, MSPRC Chair and Department of Radiology Chair

PURPOSE To provide administrative services on behalf of Pomerado Hospital Medical Staff in accordance with Medical Staff Bylaws and policies

SCOPE OF SERVICES As per duties defined in Pomerado Hospital Medical Staff Bylaws and policies.

PROCUREMENT METHOD


TERM January 1, 2011 – December 31, 2012 except for Department of Radiology Chair January 1, 2011 – December 31, 2011

RENEWAL None



Monthly.



JUSTIFICATION These positions are elected by the Medical Staff in accordance with Medical Staff Bylaws.

POSITION POSTED YES NO Methodology & Response: Elected by the Pomerado Hospital Medical Staff


DUTIES Defined in the Pomerado Hospital Medical Staff Bylaws

COMMENTS The agreement template was developed by legal counsel.


36


Form A - Med Director - X-Ray Medical 11-12-10.doc

PALOMAR POMERADO HEALTH/PALOMAR MEDICAL CENTER

Professional and Medical Director Services Agreement – Radiation Oncology Services

TO: Board Finance Committee MEETING DATE: Tuesday, December 7, 2010 FROM: Gerald Bracht, Chief Administrative Officer, PMC

BACKGROUND: X-Ray Medical Group Radiation Oncology, Inc. provides exclusive radiation oncology professional and medical director services to Palomar Medical Center. X-Ray Medical has provided services to PPH for a number of years and has been responsive to the medical staff and health system in meeting their clinical needs and those of patients. The physicians of X-Ray Medical are well trained bringing expertise to PPH for the full range of both traditional and contemporary methods of radiation therapy. Both the medical director and group in general have been supportive of operational efforts to maintain staff competency through training, involvement in the operating and capital budgeting process and assisting administration to expand services and grow business. This agreement represents a renegotiated agreement for a period of two years. BUDGET IMPACT: None STAFF RECOMMENDATION: Approval COMMITTEE QUESTIONS:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the two-year [January 1, 2011 through December 31, 2013] Professional and Medical Director Services Agreement with X-Ray Medical Group Radiation Oncology, Inc., for Radiation Oncology Services to PMC, subject to finalization of the contract language prior to either the December 13, 2010, or the January 10, 2011, Board meeting. Motion: X Individual Action: Information: Required Time:

37


Reference

Term/Condition

Term/Condition Criteria TITLE Professional and Medical Director Services Agreement

Radiation Oncology Services AGREEMENT DATE January 1, 2011

PARTIES X-Ray Medical Group Radiation Oncology, Inc. and PPH

Recitals D PURPOSE To provide professional radiation oncology services, clinical

oversight and certain administrative services at Palomar Medical Center.

1.3, 1.4, Exhibit 1.3(a) Exhibit 1.3(b)

SCOPE OF SERVICES Professional medical coverage available Monday through Friday, 7:00 a.m. to 7:00 p.m. and on-call 24 hours per day 7 days per week including holidays.

PROCUREMENT METHOD


7.1 Exhibit 7.1

TERM January 1, 2011 thru December 31, 2013 with a 1 year option upon execution of Agreement Continuation Addendum.

RENEWAL None

7.5 7.3 7.6

TERMINATION a. Without cause with 90 days written notice by either party following the first 12 months of the agreement.

b. Immediately for cause with 30 day written notice. c. Within 10 days of written notice by either party in the

event of Government Action.


N/A

BUDGETED YES NO – IMPACT: None

1.14 EXCLUSIVITY NO YES – EXPLAIN: Hospital based physician for Radiation Therapy Department services.

JUSTIFICATION Required for the continued operation of the radiation oncology department.

POSITION NOTICED YES NO Methodology & Response: Continuation with present provider.

ALTERNATIVES/IMPACT None

Exhibit 1.5(b)

Duties All included Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement

COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Finance Committee

38


Form A - Jason Keri Physician Advisor January 1, 2011.doc

PALOMAR MEDICAL CENTER / POMERADO HOSPITAL

PHYSICIAN ADVISOR BEHAVIORAL HEALTH SERVICES

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Sheila Brown, R.N., M.B.A., Chief Clinical Outreach Officer Susan Linback, R.N., M.B.A., Director, Behavioral Health BY: Board Finance Committee Tuesday, November 30, 2010 BACKGROUND: This is a request to approve the Physician Advisor Agreement with Jason Keri, M.D. Dr. Keri will provide Physician Advisor oversight for all Palomar Pomerado Behavioral Health Services. These Inpatient and Outpatient treatment programs provide needed services to acutely ill patients who suffer from severe mental health disorders. In this role, Dr. Keri will also provide support and mentorship for the newly added Psychiatric Hospitalists. BUDGET IMPACT: No Budget Impact STAFF RECOMMENDATION: Approval COMMITTEE QUESTIONS:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the one-year [January 1, 2011 through December 31, 2011] Physician Advisor Agreement with Jason Keri, M.D., for the provision of Medical History & Physicals as a compliment to the psychiatric assessment for each admission to the PMC Behavioral Health Unit. Motion: X Individual Action: Information: Required Time:

39

Jason Keri Abstract Physician Advisor Agreement January 1, 2011


Reference

Term/Condition

Term/Condition Criteria TITLE Agreement between Palomar Pomerado Health and

Jason Keri, M.D.


PARTIES 1) PPH 2) Jason Keri, M.D.

Recitals E PURPOSE To provide Psychiatric Physician Advisor oversight for PPH Behavioral Health Services.

Exhibit A

SCOPE OF SERVICES Jason Keri, M.D. will provide Physician Advisor oversight for PPH’s Behavioral Health Services. These Inpatient and Outpatient treatment programs located at both facilities provide needed services to acutely ill patients, both the adult and Senior populations, who suffer from severe mental health disorders. In this role, Dr. Keri will also provide support and mentorship for the newly added Psychiatric Hospitalists

PROCUREMENT METHOD

Request for Proposal Discretionary

4.1

TERM

January 1, 2011 through December 31, 2011

RENEWAL N/A

4.2.2 4.2.1.1

TERMINATION a. Immediately for cause b. Not less than 30 days of written notice without cause

3.1


Monthly payment within five (5) business days after Practitioner’s submission of the monthly time report.

BUDGETED YES NO - IMPACT: None.


JUSTIFICATION In order to remain compliant with CMS requirements for both Inpatient and Outpatient Behavioral Health Services, medical oversight is required.

AGREEMENT NOTICED YES NO METHODOLOGY & RESPONSE:

ALTERNATIVES/IMPACT Proceeding without this arrangement would cause the services to be out of compliance with CMS requirements and jeopardize ongoing mental health to a vulnerable population.

Exhibit B DUTIES PROVISION FOR STAFF EDUCATION PROVISION FOR MEDICAL STAFF EDUCATION PROVISION FOR PARTICIPATION IN QUALITY IMPROVEMENT

COMMENTS

APPROVALS REQUIRED Officer CFO CEO BOD Finance Committee BOD

40


Form A - Jeffrey Chen, MD (Board Finance 2010_11).doc

PALOMAR POMERADO CORP. HEALTH - SAN MARCOS PHYSICIAN (CLINIC CARE) – PROFESSIONAL SERVICES

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Sheila Brown, R.N., M.B.A., Chief Clinical Outreach Officer Russell Riehl, Director Corporate Health Services

BY: Board Finance Committee Tuesday, November 30, 2010 BACKGROUND: Corporate Health’s continued expansion into San Marcos requires more consistent physician coverage in order to meet client expectations and acuity level of patient care. I am requesting the addition of a part time physician (specifically at our San Marcos clinic). The 2 days (16 hours) per week of coverage would replace services currently being provided by a Nurse Practitioner, and would, therefore, represent only an incremental budgetary variance. BUDGET IMPACT: Incremental increase from current NP salary and benefits being used to cover clinic hours. STAFF RECOMMENDATION: Approve as requested COMMITTEE QUESTIONS:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the one-year [February 1, 2011 through January 31, 2012] Professional Services Agreement with Jeffrey Chen, MD, for the provision of medical care through the San Marcos Employee/Corporate Health clinic. Motion: X Individual Action: Information: Required Time:

41


Reference

Term/Condition

Term/Condition Criteria TITLE Physician Professional Services Agreement

Employee & Corporate Health Services AGREEMENT DATE 2/1/2010

PARTIES Palomar Pomerado Health & Jeffrey Chen, MD

PURPOSE Provision of Professional Services Agreement

SCOPE OF SERVICES To provide medical care through our San Marcos

Employee/Corporate Health clinic for internal and external patients under our Occupational Medicine Program.

PROCUREMENT METHOD


TERM 1-years (2/1/2011 – 1/31/2012)

RENEWAL Auto renewal of 1 year after initial term.

TERMINATION 1/30/2012 May terminate without cause by either party with written notice of 90 days.


Hourly

BUDGETED YES NO – IMPACT: $30,209 (incremental increase from current NP salary and benefits allocated to cover clinic hours).


JUSTIFICATION Provision of services to provide Occupational Medicine services at Palomar Pomerado Health.

AGREEMENT NOTICED YES NO Methodology & Response:


Duties Provision for Medical care in our outpatient Occupational Medicine clinics

COMMENTS

APPROVALS REQUIRED VP CFO CEO BOD Committee ____________ BOD

42

PALOMAR POMERADO HEALTH PHYSICIAN INDEPENDENT CONTRACTOR AGREEMENT

INFORMATION SYSTEMS SERVICES

Form A - EHR.doc

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Ben Kanter, MD, CMIO BY: Board Finance Committee Tuesday, November 30, 2010 Background: Palomar Pomerado Health (PPH) requires the active involvement of physicians in many aspects of Information Systems programs. Currently, PPH employs a CMIO (Benjamin Kanter, MD) who is solely responsible for the relationship between the medical staff and information systems. PPH is actively working on expanding the functions and features of our electronic healthcare record in order to prepare clinicians for their migration to PMC-West, to improve quality and safety, and to meet the goals set forth by the Obama administration in the ARRA of 2009. As part of the electronic healthcare record suite of projects being implemented, physician involvement is critical for success. Physician’s will be asked to participate on these projects (CPOE, physician documentation, ICU integration of monitors with the records, and more) and depending upon their work effort, will need to be reimbursed according to standard and customary manners and rates. There are contracts with each of the following physicians:

• JAY FEDERHART, MD [2/1/11-1/31/12] • MIKHAIL MALEK, MD [3/1/11-2/29/12]

• SUDABEH MOEIN, MD [1/1/11-12/31/11] • ELIZABETH SALADA, MD [2/1/11-1/31/12] • ROD SERRY, MD [2/1/11-1/31/12]

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:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Independent Contractor Agreements with the physicians and for the terms of office as outlined above, for assistance with the EHR Suite of projects. Motion: X Individual Action: Information: Required Time:

43

PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT

Section Reference

Term/Condition

Term/Condition Criteria

TITLE Independent Contractor Agreement between Jay Federhart, M.D. and Palomar Pomerado Health

AGREEMENT DATE February 1, 2011

PARTIES Jay Federhart, M.D. PURPOSE To assist the CMIO in the implementation of Computerized

Physician Order Entry, computerized physician documentation, and any other required work on the Cerner Roadmap projects.

SCOPE OF SERVICES The physician will work as subject matter experts, may be asked to lead development teams, travel with PPH employees to do off site evaluations, and to attend Cerner training sessions here and in Kansas City.

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 rate – itemized


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 Renewal of contract backdated to reflect expiration of contract

from prior year.


44


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Mikhail Malek, M.D. and Palomar Pomerado Health

AGREEMENT DATE March 1, 2011

PARTIES Mikhail Malek, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO





from prior year.


45


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Sudabeh Moein, M.D. and Palomar Pomerado Health


PARTIES Sudabeh Moein, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO





from prior year.


46


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Elizabeth Salada, M.D. and Palomar Pomerado Health


PARTIES Elizabeth Salada, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO





from prior year.


47


Section Reference

Term/Condition


TITLE Independent Contractor Agreement between Rod Serry, M.D. and Palomar Pomerado Health


PARTIES Rod Serry, M.D. PURPOSE To assist the CMIO in the implementation of Computerized






COMPENSATION



EXCLUSIVITY NO





from prior year.


48

Award Presentation

COMMITTEE RECOMMENDATION: Motion:

Individual Action:

Information:

Required Time:

TO: PPH Board of Directors MEETING DATE: December 13, 2010 FROM: Brenda Turner, Chief Human Resources Officer BACKGROUND: PPH was nominated to receive the San Diego SHRM Workplace Award for our comprehensive leadership development program. The success of an organization is often linked to the quality of its leadership team. PPH has made a commitment to develop leadership talent to prepare the organization for success in the future. On November 10, 2010, PPH received a Medallion Award and the Crystal Award from San Diego SHRM for these programs. The awards will be presented to the Board.

BUDGET IMPACT: STAFF RECOMMENDATION: COMMITTEE QUESTIONS:

49

PPH Community Outreach Bi –Annual Update Report

TO: Board of Directors MEETING DATE: Monday, January 10, 2011 FROM: PPH Community Outreach BY: Nancy Roy & Kay Stuckhardt Background: The five regional PPH Community Action Councils (CAC) support various projects to improve the well being of the communities they serve. Nancy Roy and Kay Stuckhardt will present a brief overview of the bi-annual CAC activities report of July to December, 2010. A comprehensive report of Council activities and outcomes for the period is attached. The CAC bi-monthly reports are included with the Board packets, for your review.

Budget Impact: N/A

Staff Recommendation: N/A


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

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

RESOLUTION NO. 12.13.10 (11) - 01

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR POMERADO HEALTH

ESTABLISHING REGULAR BOARD MEETINGS FOR CALENDAR YEAR 2011

WHEREAS, Palomar Pomerado Health is required, pursuant to Section 54954 of the California Government Code and Section 5.2.2 of the PPH Bylaws, to pass a resolution adopting the time, place and location of the regular board meetings; NOW, THEREFORE, BE IT RESOLVED by the Board of Directors of Palomar Pomerado Health that the following schedule of regular meetings will apply for calendar year 2011:

2010 BOARD MEETING SCHEDULE

January 10 Pomerado July 11 Pomerado February 14 PMC August 08 PMC March 14 Pomerado September 12 Pomerado April 11 PMC October 10 PMC May 09 Pomerado November 14 Pomerado June 13 PMC December 12 PMC

Each meeting will begin at 6:30 p.m. Those meetings held at Palomar will be in Graybill Auditorium; those at Pomerado will be in the Third floor meeting room. PASSED AND ADOPTED at a regular meeting of the Board of Directors of Palomar Pomerado Health, held on December 13, 2010, by the following vote: AYES: Bassett, Greer, Kaufman, Kleiter, Krider, and Yerxa NOES: None ABSENT: Rivera ABSTAINING: None DATED: December 13, 2010 APPROVED: ATTESTED: _________________________ ___ Bruce Krider, Chairman Jerry Kaufman, P.T.M.A., Secretary Board of Directors Board of Directors

80

Arch Health Partners

Form A - Arch.doc

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Vicky Lister, FACHE, Executive Director Arch Health Partners BY: Board Finance Committee Tuesday, November 30, 2010 Background: Arch Health Partners (Arch), originally Palomar Physician Network, Inc. (Centre for Healthcare), opened for business on April 1, 2010, as a PPH-developed physician foundation. The name has been changed to Arch Health Partners both with the State and the IRS. Arch is located in the POP on the campus of Pomerado Hospital, and it also has a location in Ramona. Currently, Arch has 41 physicians comprising 12 subspecialties.

Information on the financial and strategic status of Arch Health Partners is attached.

Budget Impact: N/A

Staff Recommendation: Information Only



81

Arch Health Partners6 Month Business Review

November 2010

Victoria Lister, FACHE, Executive Director, Arch Health PartnersBob Hemker, CFO, PPH

82

2010-2015 Strategic Initiatives

• Grow Primary Care—physicians, locations, patient volume

• Add Specialists as the need arises either to support AHP/PIMG or PPH Service Lines and meet community need

• Increase MSO services, particularly EMR/EPM access to other practices in the community

83

2011-2015 Strategic Initiatives

• Move from a provider centric to a patient centric practice model through the transition to the Patient Centered Medical Home (PCMH) model

• Implement an organizational infrastructure (technology/data analytics/process) to support a more creative approach to care delivery and treatment

84

Status of Strategic Initiatives

• Since April 1, 2010—Recruited and hired 1 Internist and 2 Family Medicine Physician

• Added a part-time, temporary Dermatologist and recruited a new Dermatologist fellowship trained in Mohs Surgery

• Supported PPH service lines in Behavioral Health and Women's services by bringing on three Psychiatrists and recruiting a fellowship trained Breast Surgeon

• Negotiated with ENT Specialty Center to join AHP/PIMG • Currently in talks with two other primary care groups in

PPH’s secondary market• One physician practice outside of AHP accessing EMR

application and services

85

Financial Summary

Actual(April 1, 2010-October 31, 2010)

Budget

Revenue $20,427,063 $21,081,092

MD Expense(includes outside provider expense)

$10,940,592 $11,827,866

Mgmt Expense $10,570,258 $10,283,138

Net Loss ($1,083,787) ($1,029,912)

86

Office Visits

2010 Office Visits

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Num

ber of

Visits

Arch Health Partners Urgent Care

Arch Health Partners Ramona

Arch Health Partners Peds

Arch Health Partners Orth

Arch Health Partners Optical

Arch Health Partners Ophth

Arch Health Partners Neur

Arch Health Partners IM

Arch Health Partners GI

Arch Health Partners FP

Arch Health Partners Flu Clinic

Arch Health Partners ENT

Arch Health Partners Derm

Arch Health Partners Card

87

Facility Visits

2010 Facility Visits

050

100150200250300350400450

Jan Feb Mar Apr May Jun Jul Aug Sep Oct

Num

ber

ofV

isit

s

Rancho Bernardo Surgery Center

Poway Surgery Center

Pomerado Hospital Outpatient

Pomerado Hospital Inpatient

Parkway Endoscopy Center

Escondido Surgery Center

Arthritis Care And Research Center

88

Physician Profile

Specialties RepresentedInternal Medicine (6) Family Practice (15)Pediatrics (4) Cardiology (2)Dermatology (2) Ophthalmology (1)Orthopedics (1) Neurology (2)Gastroenterology (2) Psychiatry (3)12/1—ENT (2) 1/11—Surgery (1)

Total Number of Physicians—41

89

PPH-Provided FunctionsMarketing/Advertising/PRPhysician Recruitment SupportPayer ContractingLegal Services

Arch Health PartnersBoard of Directors

Arch Health PartnersBoard of Directors

Debbie Featherstone Director

Accounting

Debbie Featherstone Director

Accounting

Diana Joyce Supervisor A/P, Payroll

Diana Joyce SupervisorA/P, Payroll

Michael Covert, FACHEPPH President and CEOMichael Covert, FACHEPPH President and CEO

Victoria Lister Executive Director

Victoria Lister Executive Director

Joanne Reilly Director

Business Services

Joanne Reilly Director

Business Services

Sylvia Garcia Manager

Front Office and Billing

Sylvia Garcia Manager

Front Office and Billing

Mary Kay PayneDirector

Information Technology

Mary Kay PayneDirector

Information Technology

Leslie Thornton (interim)Manager

Health Information Mgmt.

Leslie Thornton (interim)Manager

Health Information Mgmt.

Wayne Smith, RN Director

Urgent Care and Support Services

Wayne Smith, RN Director

Urgent Care and Support Services

Paul Scarselli Manager

Supply Chain

Paul Scarselli Manager

Supply Chain

Mary Ellen Leahy, RNDirector

Managed Care and QI

Mary Ellen Leahy, RNDirector

Managed Care and QI

Fran Chapman Manager

UM/Provider Relations

Fran Chapman Manager

UM/Provider Relations

Betsy Buzulak, RN Director

Clinic Operations

Betsy Buzulak, RN Director

Clinic Operations

Fritz Steen, RN Manager

Internal Medicine

Fritz Steen, RN Manager

Internal Medicine

Cindy Villalobos Supervisor Ramona

Cindy Villalobos SupervisorRamona

Cody Bland, LVNDepartment Supervisor

Family Practice

Cody Bland, LVNDepartment Supervisor

Family Practice

Kathy Gallagher, RN Department Supervisor

Pediatrics

Kathy Gallagher, RN Department Supervisor

Pediatrics

Marcia Pino SupervisorCoding Compliance

Marcia Pino SupervisorCoding Compliance

Fritz Steen Manager

Ambulatory Care

Fritz Steen Manager

Ambulatory Care

Eric Abernathy Network Administrator

Help Desk

Eric Abernathy Network Administrator

Help Desk

Catherine JonesConsultant

The HR Agency

Catherine JonesConsultant

The HR Agency

Lynn GeorgeManager

Pt. Experience and Outreach

Lynn GeorgeManager

Pt. Experience and Outreach

90

Palomar Pomerado Health Wound Care Centers

Financial Program Review 2010

Form A - Wound Care.doc

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Ann Z Moore, Systems Director Wound Care Centers Sheila Brown, Chief Clinical Outreach Services Officer BY: Board Finance Committee Tuesday, November 30, 2010 Background: Annual financial report and program review of the Wound Care Center programs of PPH.

Budget Impact:

Pro Forma

Year 3 Actual

Variance

Annual income to hospital from total program

$923,139 $465,655 ($457,484)

Staff Recommendation: Information only



91

Palomar Pomerado Health Wound Care Centers

Program Review 2010

Ann Z. Moore, MSN, CWCNSystem Director Wound Care CentersSheila Brown FACHEChief Clinical Outreach Officer EMT Sponsor

92

Wound Care Centers • Background:

– Pomerado Center opened in 1997– HBOT added in 2005– Palomar Center with HBOT opened July 2007

• Provide care for patients with chronic non- healing wounds– Diagnosis include – but limited to diabetic foot ulcers,

venous leg ulcers, pressure ulcers– Hyperbaric Oxygen Therapy indications – diabetic

foot ulcers, latent effects of radiation affecting soft tissue as well as bone

93

Strategic Alignment

• Grow the business– Increase contribution Margin– Increase patient volume

• Venue for excellent patient experiences– Achieve targets for employee and patient satisfaction

• Increase brand awareness– Two sites of service for our communities

94

PMC WCC Goals

• New patients 30/month 360/yr

• HBOT tx’s 100/month 1200/yr

• Visits 333/month 4,000/yr

95

280

360 340

0

50

100

150

200

250

300

350

400

2008 2009 2010

New pts Actual

PMC WCC New Pt Trends

96

PMC WCC HBOT

9911011

879

800820840860880900920940960980

10001020

2008 2009 2010

HBOT TX

97

PMC HBOT Variance Analysis

DX types Treated FY 2009 FY 2010 Variance # tx opp missed

Crush injury 0 0 0 0

CR Osteo 24 22 -2 40

Delayed rad (osteo and soft tiss) 18 16 -2 80

Comp skin graft 26 23 -3 60

Diabetic Wound Low ext 13 11 -2 40

Acute arterial insuff 8 2 -6 120

89 74 -15 340

879 + 340 = 1,219 total HBOT tx

98

PMC WCC Visits

3826

4064

3912

3700

3750

3800

3850

3900

3950

4000

4050

4100

2008 2009 2010

Visits

Variance – 152 visits99

PMC WCC Volume Variance

• New pt decline– competitive market place– No Medical oversight for Medi-Cal patients– Lack integrated horizontal service line for services

• HBOT pt decline– Payor mix – Ineligible patients for conversion– CMS D/C coverage for acute arterial insufficiency

100

POM WCC Goals

• New Pts 34/month 408/yr

• HBOT tx’s 100/month 1200/yr

• Visits 400/month 4,800/yr

101

328

338

355

310

315

320

325

330

335

340

345

350

355

2008 2009 2010

New pts actual

WCC POM New Pt Trends

102

991

1076

981

920

940

960

980

1000

1020

1040

1060

1080

2008 2009 2010

HBOT TX

POM WCC HBOT

103

POM HBOT Variance AnalysisDX Types Treated FY 2009 FY 2010 Variance

# of tx opp missed

Crush injury 1 0 -1 20

CR Osteo 8 2 -6 120

Delayed rad (osteo and soft tiss) 36 37 -1 40

Comp skin graft 16 22 6 (120)

Diabetic Wound Low ext 13 16 3 (60)

Acute arterial insuff 15 7 -8 160

89 84 160

981 + 160 = 1,141 HBOT tx

104

POM WCC Visits

45634661

4280

4000

4100

4200

4300

4400

4500

4600

4700

2008 2009 2010

Visits

Variance – 381 visits105

POM Volume Variance

• HBOT Patient Decline– Decrease in patient conversion due to

ineligible dx– CMS D/C coverage for acute arterial

insufficiency – Lack horizontal service line for services

106

Marketing StrategiesDirect Sales-• In partnership with Diversified Clinical Services hired a

second Community Educational Specialist • Increased Physician/Health Care direct contacts from an

average of 190 per month to 350 per month• Expanded sales territory to include

Murrieta/Temecula/Fallbrook and San Diego including UCSD and Sharp physicians

• Participated in Pomerado interdisciplinary rounds• Wound Care Center Tours/Inservices-average 4 per

month• Physician Dinners - 4 held August, November, March

and June with average attendance 20• Two direct MD mailing campaigns

107

Marketing StrategiesOther Marketing Activities• Media activities – Elder Talk Radio Show presentation by

R. Schechter, MD. • Featured speakers at San Diego Care Givers Alliance

and Rehabilitation Nurse Coordinators Network• Membership and Networking at San Diego Caregivers

Alliance, Senior Resource Association, Scripps Ranch Eldercare Alliance and Geriatric Caregivers Association

• Upgraded PPH Wound Care Web site-Averaging 460 hits per month

• HMO Contracts-Added SCMG, Arch

108

New Patients to PMC WCC FY 2010• Vista• Carlsbad• Cardiff • Encinitas • Del Mar• Escondido – 162 pts• San Marcos - 57 pts• Other – 12 pts

• Total Patients - 369

• Fallbrook• Valley Center• Pala• Ramona • Borrego Springs• Temecula• Murrieta• Sun City

70 pts 45 pts

23 pts

109

PPH Consolidated Income Statement

Pro formaAnnual

Year 3Actual

Variance

New Pts PMC 390 340 (50)

New Pts POM 408 355 (53)

Contribution Margin from PMC

$396,549 $68,333 ($328,216)

Contribution Margin from POM

$526,590 $397,322* ($129,268)

Annual income to hospital from total program

$923,139 $465,655 ($457,484)

* POP rent $200,000 unanticipated in original financial analysis

110

Barriers to Target Volumes• Extremely competitive market in North

– now 4 wound centers in area competing for pts

• Minimal referrals from PMC and POM to centers– Lack horizontal service line framework – Best Practice: DCS 20 – 30% in pt to out pt referrals

• MD’s performing wound care in office, particularly in view of current economic climate

• Revenue Cycle complexities

111

Next Steps• Continue aggressive marketing efforts• Develop strategy for inpatient wound care

capture• to include increased visibility of Wound MD staff• focused meetings with key hospital staff and

rounding

• Launch CPM disease management campaign

• Revenue cycle claim review monthly

112

Next Steps Continued

• Perform economic case study for potential referrals – Medical Groups

• Look at expense of program without management services contract

• Develop comprehensive plan to increase continuum referrals

• Review program again in March 2011

113

Applied Medical Surgical Trocar Conversion

Form A - Trocar Conversion.doc

TO: Board of Directors MEETING DATE: Monday, December 13, 2010 FROM: Steve Ellis, District Director Supply Chain Services Rhonda Wilson, Manager Value Analysis BY: Board Finance Committee Tuesday, November 30, 2010 Background: The VAT Steering Committee has reviewed the WestPac GPO initiative to convert surgical trocars from J & J Ethicon to Applied Medical. Product trial data shows 92% of surgeons rated Applied Medical as superior or clinically acceptable. The VAT Steering Committee voted for a product conversion with the recommendation that the CEO and the Board Finance Committee be provided background information regarding the conversion.

Budget Impact: Converting to Applied Medical trocars has a minimum annual savings of $250,000, with an additional 4% available if the majority of WestPac members also convert to Applied.

Staff Recommendation: The VAT Steering Committee’s recommendation is to convert surgical trocars from J & J Ethicon to Applied Medical. Physician support will be provided by allowing Ethicon products to be used in limited quantity for a specified period by physicians who may need additional support and training as they adjust technique. Surgeon proctoring and off-site training would also be available at no charge from Applied Medical.

This recommendation is informational only as a means of providing Board members with background regarding the conversion, enabling them to appreciate the value proposition and the conversion process, as well as to aid their understanding of the potential impact of the change on certain practitioners. Committee Questions:


114

Trocar Update Value Proposition & Product Trials

November 30, 2010

Steve Ellis, MBA, CMRP Director, Corporate Supply Chain Services

115

Background• Historically, PPH has exclusively used J&J

Ethicon trocar products• J&J Ethicon trocars are available through PPH’s

Group Purchasing Organization (GPO)• Applied Medical Trocars presented a savings

opportunity to the GPO & to the Regional Purchasing Coalition (WestPac)

• Annualized costs:J&J Ethicon $500,000Applied Medical $250,000 (est.)

116

Background (Cont’d)

• Applied Medical savings and evaluation proposal (trial) were presented at the POM & PMC OR and Medical Executive Committees in April & May

• June-August trial period at Pomerado Hospital

• July-September trial period at Palomar Medical Center

• Applied Medical and J&J Ethicon products are both currently available for use pending a final decision

117

PPH District Trial Results Applied Medical Trocars

• Evaluating Surgeons – 38– Superior Ratings Given – 14– Acceptable Ratings Given – 21– Unacceptable Ratings Given – 3

118

Hospitals/Districts That Have Converted to Applied Medical Trocars

• Cedars Sinai Medical Center• UCLA Medical Center • Mayo Clinic – All Campuses• Presbyterian Intercommunity – Whittier• Queens Medical Center – Hawaii• St. Bernadine’s – San Bernardino• California Hospital – Los Angeles• St. Mary’s – Long Beach• Glendale Memorial & Adventist – Glendale• Sharp – Grossmont & Chula Vista• Kaiser – Irvine, Anaheim, Fontana & Riverside

119

Activities Completed• OR Committees

– POM 10/14– PMC 10/26

• Med Exec Committees – PMC 10/25– POM 10/26

• PMC Dept of Surgery Committee 11/9• VAT Steering Committee 11/12• Numerous conversations with individual

surgeons regarding the trial and conversion scenario

120

Applied Medical Trocar Conversion Proposal & Recommendations

• 100% trocar conversion from Ethicon to Applied Medical by a predetermined date– Recommend early 2011 with a 90-day transition

period• Provide surgeon support during conversion

– Ethicon trocars will be available in limited quantities– Surgeon proctoring and off-site training will be

provided at no charge by Applied Medical

121

PROS

• Affords greatest cost savings opportunity ($250,000)

• Price protection until March 31, 2013

• Less inventory to stock, order & outdate

• Allows continuity of case picking, reduces staff error and waste in determining surgeon preference for Applied vs. Ethicon

• 92% of surgeons’ trialing rated Applied as superior (37%) or acceptable (55%)

• Applied Medical’s commitment to assist in the conversion process

• Applied offers industry leading state-of-the-art technology not available from Ethicon

• Local CA-based company, with product 100% manufactured in CA

• Supports VHA WestPac Initiative (+4%)

CONS

• Potential decrease in physician satisfaction

• Ethicon price increase for subsequent trocar orders beyond the 90-day transition period

• Carrying multi-sourced vendors

122

Questions?

123

PPH Committee Activity Summary November 18, 2010

Audit and Compliance Committee ACTION ITEMS: No action items were presented. INFORMATION ITEMS: Audit Activity Report: Mr. Boyle updated the committee with a status report of the

Internal Audit Activities for November 2010. The committee discussed operational controls and audit of claims in regards to the PMC construction audit.

Executive Reimbursement Audit - The conclusion of the audit confirmed all claims

made and reimbursements paid were in compliance with applicable PPH procedures. Compliance Hotline Activity - Ms. Knutson presented the quarterly compliance

hotline activity report for the months of July – September 2010. The report included allegation types on actual calls and web submissions received and a quarterly comparison of page views on the Compliance Intra and Internet sites.

Internal Survey Satisfaction Results: The committee reviewed the bi-annual internal

survey satisfaction results for the Compliance function and the Internal Audit Department.

Quality Self Assessment: Deloitte presented its methodology for reviewing the activities of Internal Audit Departments.

124

PALOMAR POMERADO HEALTH BOARD OF DIRECTORS – AUDIT & COMPLIANCE COMMITTEE Notable Accomplishments for Calendar Year 2010

Regular Business Matters:

− Internal Audit Plan – Continually review objectives, impact and status of Internal Audit Activities.

− Review the Compliance and Ethics Committee activity reports.

In addition to regular business matters, the following notable actions were taken and/or addressed by the Committee: JANUARY 2010 • Began a review of the Audit & Compliance Board Charter.

• Began a review of the Audit & Compliance Board job description. • The 2010 Internal Audit plan was presented and reviewed by the committee. FEBRUARY 2010 • Reviewed and recommended the approval of the Audit & Compliance Committee

Charter.

• Reviewed and recommended approval of the Audit & Compliance Committee job description.

• Reviewed and recommended approval of the Compliance and Ethics Committee Charter. The Compliance and Ethics Committee is designed to meet standards used by regulatory authorities to judge the effectiveness of compliance efforts.

MARCH 2010 • Deloitte presented the audit plan for the District’s financial statements for the year

ending June 30, 2010. The audit will be performed to obtain reasonable assurance about whether the financial statements are free of material misstatement caused by error or fraud.

• The Internal Audit results of the inventory audit at Arch Health Partners was

reported.

125

BOARD OF DIRECTORS – COMPLIANCE & AUDIT COMMITTEE Notable Accomplishments for Calendar Year 2010 Page 2 of 3 APRIL 2010

• The quarterly Compliance Hotline activity report was presented, along with a summary of efforts to publicize the Compliance Hotline. Ms. Knutson educates new employees about the Compliance Hotline at New Employee Orientation.

• A work group was assembled to create a Code of Conduct.

• A regulatory update was presented regarding the Healthcare Reform Act. Organizations billing the government under Medicare are now required to have a compliance program.

• The findings of the Accounts Payable Process audit was discussed. JUNE 2010

• Internally administered satisfaction survey results were reported for both Internal Audit and Compliance functions.

• The Committee reviewed and recommended revisions to the Conflict of Interest Code. The committee increased the list of designated employees required to complete the annual Conflict of Interest Form 700.

• The committee received a status update regarding the Information Technology

Internal controls as requested by Deloitte. • The committee received and reviewed the Compliance Officer’s Annual Report. JULY 2010

• The committee participated in an education session regarding healthcare reform and the Patient Protection and Affordable Care Act (PPACA).

• Deloitte presented the committee with a description of its organizational compliance program called the Power of One.

• The committee reviewed the projected internal audit requirements for the ongoing PMC-West construction project.

• The status of the Pharmacy audit at PMC and POM was discussed. AUGUST 2010

• The committee was updated on the progress of the Code of Conduct drafting workgroup.

126

BOARD OF DIRECTORS – COMPLIANCE & AUDIT COMMITTEE Notable Accomplishments for Calendar Year 2010 Page 3 of 3 • Deloitte presented their audit approach and the stages of planning, internal controls

and substantive testing, reporting and consultation. • The quarterly Compliance Hotline activity report was presented including the

tracking of page views on the Compliance internal and external webpage’s.

• Ms. Knutson spoke about the PECOS enrollment regulatory mandate. Medicare will not pay for claims submitted by physicians not enrolled in PECOS.

• The committee was given educational information relating to the Americans with Disabilities Act (ADA). The information included how the Department of Justice will likely view ADA violations.

OCTOBER 2010

• The committee approved and accepted Deloitte’s audit of the consolidated financial statements of PPH for 2010. There were no material misstatements.

• The Code of Conduct was reviewed and approved. The Code of Conduct includes the mission, vision and restated values. Commitment to the Code of Conduct will be a mandatory condition of employment. The Committee asked that the two medical staffs also commit to following the new Code.

• The Conflict of Interest Procedure was reviewed and approved. The procedure defines what a gift is and what types of gifts are appropriate to accept or decline.

NOVEMBER 2010

• The internal satisfaction survey results were reported for the Audit and Compliance functions.

• The quarterly Compliance Hotline activity report was presented.

• Webpage updates to the Compliance Intranet were viewed by the committee.

• Deloitte discussed the value of a strategic quality assessment of the Internal Audit Department.

• The outcome of the executive management reimbursement audit was presented. Claims made and reimbursements paid during the period reviewed were in compliance with applicable PPH procedures.

• The committee reviewed the Internal Audit Certification of public bond expenditures,

performed for the Independent Community Oversight Committee.

127

PPH Board Subcommittee Activity Summary

November 16, 2010 Governance Committee

ACTION ITEMS:

• Code of Conduct: The committee approved the non-retaliation language, “PPH expects you to speak up – and will not tolerate retaliation or punishment of those who do.”, to move forward in the approval process.

• Absenteeism by Board Members: The committee reviewed and approved the policy. The policy will be sent to the full Board for approval.

• Leadership and Management Policy: The committee reviewed and approved the policy. The policy will be sent to the full Board for approval.

• Revision of Policies – GOV-12: The committee reviewed and approved the policy. The policy will be sent to the full Board for approval.

INFORMATION ITEMS:

• Closed Session: Conference with Legal Counsel – Potential Litigation. Significant exposure to litigation pursuant to subdivision (b) of Section 54956.9 of the California Government Code: one potential case.

• Annual Budget Approval – FIN -01: The policy was sent to the Finance Committee. The policy will be added to the Pending Projects section in January for a status update.

• Annual Financial Audit – FIN – 14: The policy was sent to the Finance and Audit and Compliance Committees. The policy will be added to the Pending Projects section in January for a status update.

• Oath of Office – GOV – 05: The policy was sent to the Human Resources Committee. The policy will be added to the Pending Projects section in January for a status update.

128

Palomar Pomerado Health Board Governance Committee

2010 Committee Accomplishments

January – The Board Governance Committee reviewed and approved all of the Board Committee charters. The Leadership and Management Policy was reviewed and sent back for further revisions. February – The Board Governance Committee reviewed and approved all of the Board Committee job descriptions. The PPH Online Communications Policy was reviewed. The Board Member Benefits Policy was reviewed and tabled. Board Education topics were discussed. Marty Knutson updated the Governance Committee on the status of the Conflict of Interest Code. March - The Board Governance Committee did not meet in March. April – The Board Governance Committee discussed the Board Self Assessment process. The Governance Committee reviewed and approved the updated Medical Staff Bylaws. Board Education topics were discussed. Marty Knutson updated the Governance Committee on the status of the Conflict of Interest Code. May – The Board Governance Committee reviewed and approved the updated PPH Organizational Chart and the Board Manual. The Committee reviewed the PPH Policy for Public Records Requests and asked that a procedure be created to accompany the policy. Board Education topics were discussed. Marty Knutson updated the Governance Committee on the status of the Conflict of Interest Code. June – The Board Governance Committee planned the Bi Annual Board Ethics Training. The Committee reviewed and approved the revised PPH Policy for Public Records Requests. The Committee reviewed the Board Member Compensation. Board Education topics were discussed. July – The Board Governance Committee continued their discussion on Board Member Compensation. The Media Relations Policy and Protocols were tabled until after they had been reviewed by the Community Relations Committee. The Committee reviewed and approved the Conflict of Interest Code. August – The Board Governance Committee did not meet in August. September – The Board Governance Committee did not meet in September. October – The Board Governance Committee reviewed and approved the Annual Adoption of the Statement of Investment and the Media Relations Policy. Board Education topics were discussed. November – The Board Governance Committee reviewed and approved the PPH Code of Conduct. The Committee reviewed and approved the Absenteeism by Board Members Policy, Leadership and Management Policy, Oath of Office Policy and Revision of Policies Policy. The Annual Budget Approval Policy was sent to the Finance Committee. The Annual Financial Audit Policy was sent to both the Finance Committee and the Audit and Compliance Committee. The Compliance Program Policy was sent to the Audit and Compliance Committee. December – The Board Governance Committee did not meet in December.

129

HR COMMITTEE ACCOMPLISHMENTS – 2010 The HR Committee reviewed the following activities/actions of the HR, Organizational Development and Learning departments in 2010: • The first annual report on the outcome of the Passport to Health, Wellness and Safety

program was reviewed. Participation was low in the first year with lessons learned including the need to do more ongoing communication of the program. Typically wellness programs take 5+ years to demonstrate health behavior changes.

• The committee approved the revision of the Board Benefits and forwarded the recommendation to the Board Governance Committee.

• Herocare was introduced to the HR Committee as a new benefit for employees.

• An overview of the management culture change survey was presented. James O’Malley explained the four culture types (Clan, Adhocracy, Market and Hierarchy) and the direction we want to see the culture move.

• The culture transformation plan was presented. This plan included the Bridges Transition model which provides staff/individuals assistance with adjusting to the changes coming in the future. The plan included the introduction of the culture champion concept.

• Steve Inscoe presented information focused on PPH educational opportunities to learn and grow. Opportunities highlighted were: Pipeline Services, the e-library, new employee orientation, new leader orientation, the PPH Wikipedia, the various types of media-rich programs on Xpand, and the physician journal club.

• The FANS Customer Close-Up Survey feedback was presented by Jana Markley. The survey results included customer/employee feedback, food/meal purchasing trends, average amount spent for food by employees, overall perception of the cafeteria food, meal value and availability of nutritional information.

• The new employee communication plan, “In The Know” was presented. This program was developed to prioritize communications and ensure employees are receiving information in a timely manner. A stop light concept is used where red = need to know, yellow = good to know, and green = nice to know.

• Mike Shea presented a comparison of the PPH health insurance plan to national and state-wide plan design data. This is information prepared for discussion with the unions around proposed plan design changes. Discussions with the union are still on hold pending the Unfair Labor Practice charge filed by PPH.

• Mike Shea also presented information on the new branding of “Wellness for Life” benefits program. In addition to employees receiving a 5.5% discount on insurance premiums for participation in the Passport for Health, Wellness and Safety program, CIGNA also offers a Health Risk Assessment where employees receive a $30 gift certificate for completing the assessment.

130

• James O’Malley presented an overview of the Culture Champion focus and overall plan for culture transformation. All-employee culture forums were held focusing on educating staff to the culture shifts PPH has committed to including: a) moving from a provider-focused to a patient-focused culture; b) changing the focus from a silo mentality to a system mentality; c) creating a culture of innovation as well as a market driven culture that focuses on results/accountabilities.

• Quarterly updates have been presented on the two organizational initiatives of increasing employee engagement and executing phase I of the culture transformation plan.

o The employee engagement scores have increased from 3.89 in 2009 to 3.99 in April 2010. This exceeded the FY’10 maximum goal. (Ted: this wasn’t reported yet but the most recent survey indicates another increase to 4.03 as of October 2010. This is the highest employee engagement score at PPH since 2005.)

o Phase I implementation of the culture transformation plan is on target. Culture champions have been identified and trained. The all-employee culture forums and physician culture forum were held and were well received.

• The structure of the leadership and employee incentive plans for FY’11 was presented for approval by the HR Committee. The leadership incentive plan is based on achieving the target for each of the 22 organizational initiatives. The employee incentive plan is based on achievement of the organizational and the department customer service goals. The recommendation moved forward to the full Board meeting in November.

• HR metrics were presented each quarter. The key findings/trends for the year are:

o The number of applications received continues to rise; however, due to the economy and the low turnover, there were fewer new hires.

o The “days to fill” continues to fall well below the Southern California benchmark of 55 days. The PPH “days to fill” is currently averaging 32 days.

o The PPH annualized turnover continues to remain slightly higher than the benchmark. This is attributed to the Qtr 4 FY09 layoffs that are still included in the annualized number. The RN turnover rate is slightly below the benchmark.

o The most current 90-day retention rate is at 91.5% which is higher (better) than the benchmark retention rate of 89%. The 13-month and 24-month retention rates are at the highest levels since 2003.

o Employee engagement continues to rise as indicated above and is at the highest level since 2005.

I hope this report is helpful to you. If you have any questions or would like any additional information, please feel free to contact me.

131

Memorandum To: Nicole Adelberg, Executive Assistant to the Board Fr: Pam Carner, Assistant to the Board Facilities & Grounds Committee Date: December 6th, 2010 Re: Board Facilities & Grounds Committee – November 8th, 2010 –Summary Action Items:

• The minutes of 10-11-10 were reviewed and approved.

Information Items:

• The committee reviewed a more in depth Progress Update for October and what’s in the Plan for November for the PMC West Site, Central Plant, Hospital Exterior, Hospital Tower and Hospital D&T.

• The committee also reviewed the Schedule Update and Schedule & Budget Risk Areas. Wendy Cohen reported that the project schedule is still tracking to April 2012 completion and that the project is still tracking to the 956M budget, which includes the Central Plant and the additional changes (16M) approved by Michael Covert.

• The committee reviewed an update on the current status and final steps towards the current phased completion of the Pomerado Hospital work.

• Dick Daniels of the City of Escondido was asked to give an update on the Citracado Parkway extension project. Mr. Daniels reported that there has been no progress/resolution related to the archeological findings found in the area impacted by the roadway.

• Chairman, Dr. Marcelo Rivera thanked Mr. Daniels for his commitment and service to the Facilities & Grounds Committee as Mr. Daniel’s term as Council Member of the City of Escondido was set to be completed as of December 2010.

132


November 2010 Board Quality Review Committee

ACTION ITEMS: No Action Items

INFORMATION ITEMS:

• Regulatory Update: Opal Reinbold presented the 2010 PPR Action Plan • Patient Safety Update: Dr. Jerry Kolins presented on the education to Nursing

and Medical Staff Leadership on mitigated speech. • Service Excellence: Sheila Brown presented an overview of the FY11 Q1

HCAHPS scores.

• Nursing Update: Jackie Close presented on the Falls Prevention Team and Margaret Talley presented on the Hospital Acquired Pressure Ulcers and Restraints.

• Environment of Care: Dan Farrow presented an update on Hazardous materials,

Life Safety, Utilities, Medical Equipment, Security and Safety.

• Medication Usage: John Eastham presented an update on Medication Usage for PMC & POM.

• Patient Care Flow – Access to Care: Sharon Andrews and Kim Colonnelli presented on Turnaround Time and Time to Physician.

• Physician Profile Update: Dr. Jerry Kolins presented on changes in competences for the Medical Staff Credentialing.

• Operative & Other Invasive Procedures: Paul Patchen provided an update on Perioperative services for PMC and POM.

• Other: December meeting has been canceled. Next meeting will be January 17th at 12:15.

133

2010 Board Quality Review Committee Summary

December 2010

The following is a summary of oversight activities for the Board Quality Review Committee for 2010. The BQRC provides oversight and direction for the Quality/Patient Safety activities for the health system. The BQRC has a calendar of required reporting of the results of the quality assessment, analysis and improvement activities as well as focus areas as directed by the Committee. The following represents a summary of those activities: Monthly Updates to include: Regulatory Readiness/Issues for follow‐up

• Mock Survey results/follow‐up • Continuous Readiness Plan • CA Patient Safety Survey Results • Outstanding Regulatory Items

Patient Safety • Patient Safety Strategic Plan Updates • Staff on Safety • 1st Annual PPH Patient Safety Conference • Outstanding issues

Medical Staff Engagement • Peer Review • Credentialing • Medical Staff Leadership Development

Monthly Quality/Patient Safety Outcomes Reports to include: Focus Area Focus Area

Medication Usage (Quarterly) Operative and Other Invasive Procedures (Quarterly) Nursing Quality Updates (Quarterly) ‐Falls ‐Pressure Ulcers ‐Restraint Usage Infection Control (Quarterly) Environment of Care (Quarterly)

Emergency Management Access to care Skilled Nursing Access to Care Wound Care Home Care Welcome Home Baby Reba Care Behavioral Health

Quarterly Review – Strategic Initiative Results

• Publicly Reported Data • CDI

134

• Adaptive Design

Annual Full Board Meeting – Quality/Patient Safety Annual Report for Nursing Quality Special Board Meeting – Quality/Patient Safety Issues Follow‐up Special Focus Areas:

• High Level Disinfection • FMEA – Recalls • Radiation Safety Update • BETA – OB Projects Update • CA Patient Safety Survey – POM • Annual BQRC Self‐Assessment and Planning Meeting

135

MEMORANDUM

TO: Nicole Adelberg, Executive Assistant to the Board FROM: Tanya Howell, Assistant to the Board Finance Committee DATE: December 13, 2010 RE: Board Finance Committee – November 30, 2010, Meeting Summary

INFORMATION ITEMS: • Program Review Schedule for CY2011: Updated schedule is attached • Program Reviews:

o Arch Health Partners: Vicky Lister presented an update on the financial and strategic progress of Arch during its first six months

o Wound Care Program: Ann Moore presented an annual financial report and program review of the Wound Care Center Programs

• Trocar Conversion Program: Steve Ellis presented information on the VAT Steering Committee’s recommendation to convert surgical trocars from J&J Ethicon to Applied Medical

ACTION ITEMS: • Annual Report of the Independent Citizens’ Oversight Committee for District

Fiscal Year 2009-2010: Reviewed and recommended approval of the report as submitted

• Physician Agreements: Reviewed and recommended approval of the following agreements:

o Program Services Agreement: Arch Health Partners – Breast Surgery o Administrative Services Agreements – PMC:

Josue Leon, MD – Chair – Department of OB/GYN – New P. Eva Fadul, MD – Chair – Department of Anesthesia – New Gregory Nicpon, MD – Chair – Department of Radiology – New Jeffrey Rosenburg, MD – Chair – Medical Staff Peer Review Committee –

New John Lilley, MD – Chief of Staff – Amendment Richard Engel, MD – Chief of Staff Elect – Amendment

o Administrative Services Agreements – POM: Roger J. Acheatel, MD – Chief of Staff Paul Neustein, MD – Chief of Staff Elect Franklin Martin, MD – Chair – QMC Committee Franklin Martin, MD – Chair – Medical Staff Peer Review Committee Gregory Nicpon, MD – Chair – Department of Radiology

136

Board Finance Committee Summary November 30, 2010 Meeting

2

o Professional & Medical Director Services Agreements: X-Ray Medical Group Radiation Oncology, Inc. – Radiation Oncology – PPH Neighborhood Health Care – Medical History & Physical Exam – Behavioral

Health Unit – PMC o Physician Advisor Agreement: Jason Keri, MD – Behavioral Health Services –

PPH o Professional Services Agreement: Jeffrey Chen, MD – Employee & Corporate

Health Services – PPH o Independent Contractor Agreements – EHR Suite of Projects:

Jay Federhart, MD Sudabeh Moein, MD Rod Serry, MD

Mikhail Malek, MD Elizabeth Salada, MD

• October 2010 and YTD FY2011 Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the Financials for October 2010 and YTD FY2011 financial performance, which reflected a $9.4 million bottom line net income YTD, which is $475 thousand greater than budget

137

DATE DUE FORREVIEW AT

BOARD FINANCEPROGRAM SPONSOR(S)

1 January 20111 Palomar Pomerado Imaging, LLC Gerald Bracht, Sheila Brown & Bob Hemker

2 February 2011 San Diego Radiosurgery, LLC & Stereotactic Radiosurgery (SRS) Gerald Bracht & Bob Hemker

3 March 2011 Rady’s Affiliation Gerald Bracht

4 April 2011 Physician Recruitment Gerald Bracht & Lisa Hudson

5 April 20112 Arch Health Partners Bob Hemker

6 May 2011 da Vinci Gerald Bracht & Bruce Grendell

7 June 2011 Comprehensive Stroke Program Gerald Bracht & Paul Patchen

8 June 2011 Perinatology Program Sheila Brown & Lorie Shoemaker

9 September 2011 VHA Purchasing Coalition/WestPac David Tam & Steve Ellis

10 TBD PPH Retail Group, LLC Sheila Brown

CY2011 Program Review Schedule

1 Rescheduled from original review date(s)2 New date following previous review

Rev’d 10/2010138

BOARD OF DIRECTORS – FINANCE COMMITTEE Notable Accomplishments for Calendar Year 2010

The Finance Committee is comprised of three Directors from the PPH Board of Directors (identified alternates on an as needed basis), the Chiefs of Staff from Palomar Medical Center and Pomerado Hospital and the President & CEO. All members are voting members, and the Committee is a recommending body to the full Board of PPH, where final action is taken. Under the leadership of Chair Linda Greer, R.N., the 2010 seated members were:

Linda Greer, R.N. – Chair John Lilley, M.D.

Ted Kleiter Frank Martin, M.D.

Bruce Krider Michael Covert

The Committee met monthly (except for November & December which was combined into one meeting), during which time it conducted its Regular Business Matters agenda and typically other informational and/or decision making agenda items. In addition, the Committee facilitated and coordinated certain full Board special meetings. Following is a summary listing of notable accomplishments. Recaps of each meeting are appended for reference and greater detail (Attachment 1).

REGULAR BUSINESS MATTERS:

• Reviewed in detail, and recommended for approval, the District’s comprehensive monthly and Year-to-Date Financial Statements

• In conjunction with the Board Audit & Compliance Committee, reviewed and recommended approval of the Audited Financial Statements for Fiscal Year 2010 (October 2010)

• Annual review and recommendation for adoption of: o Finance Committee Bylaws o Board Member Position Descriptions o Statement of Investment o Resolution Setting Property Tax Appropriations Limits o Resolution Setting G.O. Bond Tax Levy and request to S.D. County for collection

• Review and recommendation for approval of numerous renewals and new agreements between the District and medical staff physicians: o For medical services provided to the District o For services rendered by members of the medical staff o In conjunction with physician recruitment

• Provided Administrative oversight and reporting conduit for the Independent Citizens’ Oversight Committee (ICOC) o Recommendation(s) for approval of ICOC minutes o Recommendation for appointment of members, including interviewing of candidates o Appointment of ICOC officers by Board Chair and Board Finance Chair, both of whom

sit on Board Finance Committee o Review of requests by ICOC for amendments to their Procedures, Policies &

Guidelines, and recommendation for approval of Management’s recommended changes thereto

139

Finance Committee Notable Accomplishments – Calendar Year 2010December 6, 2010 Page 2

o Review and recommendation for approval of Annual Report to the District for Fiscal Year 2010

• Quarterly reviews of, as applicable, the FY2010 & FY2011 Board Strategic Initiatives relevant to Board Finance Committee oversight. For calendar 2010, those initiatives were: o FY2010 – Initiatives 1.1(a)-(d), 1.2(a)-(g), 2.2 and 5.2(c) o FY2011 – Initiatives 1.1(a)-(b), 1.2(a), 1.3(a), 3.1(a)-(b), 3.2(a) and 3.3(b)

IN ADDITION TO REGULAR BUSINESS MATTERS, THE FOLLOWING NOTABLE ACTIONS WERE TAKEN AND/OR ADDRESSED BY THE COMMITTEE:

The Committee reviews new business and strategic programs for recommendation to approve. In addition, it reviews the actual performance of these programs against their pro forma plans. For 2010, the following new and/or existing programs were reviewed:

• Existing Program Reviews

o January − Physician Recruitment Program − Supply Optimization Committee

o February − VHA Purchasing Coalition − San Diego Radiosurgery, LLC & Stereotactic Radiosurgery

o April − da Vinci Robotic Surgery − Perinatology Services at PMC

o October − VHA Purchasing Coalition/WestPac

o November − Arch Health Partners − Wound Care Program

• Informational Reviews

o November − VAT Recommendation for Trocar Conversion

• New/Expanded Programs or Services

o January - Recommended approval for funding the investigation process for three (3)

additional expresscare centers - Recommended approval for the capitalization of Arch Health Partners (fka Palomar

Physician Network) through an equity transfer to the newly formed entity - Recommended approval of a Line of Credit to fund working capital needs of Arch

Health Partners o May

− Recommended approval for the creation of a comprehensive stroke program at PMC, to include neuro-interventional radiology procedures for early intervention for embolic strokes

o October − Recommended approval of a business plan in support of the development of a

clinic at the POP to provide a comprehensive spine program

140

Finance Committee Notable Accomplishments – Calendar Year 2010December 6, 2010 Page 3

• Strategic Matters Recommendations

o March − Recommended approval of the Strategic Capital Prioritization Matrix, developed by

Management as a tool for use in prioritizing the strategic projects on which to allocate capital

• Capital Matters Recommendations

o July − Recommended approval of the following three capital projects, utilizing a

combination of FY2011 Board Strategic Capital ($1.7 million), FY2011 Facilities Renovation Capital ($692 thousand), and a reallocation of $1.02 million from the previously Board-approved multi-year Imaging Capital Plan:

Replacement of the Villa Pomerado Nurse Call System ($970 thousand) Replacement of the Villa Pomerado Chilled Water Lines ($1.2 million) Phase II Renovation of the Patient Tower Elevators at PMC ($1.242 million)

IN CONJUNCTION WITH THE FULL BOARD OF DIRECTORS, THE FOLLOWING SPECIAL MEETINGS WERE HELD:

• June 8, 2010 – Special Board Budget Workshop o Reviewed, evaluated and approved the FY2011 Operating as presented to include:

− Operating budget performance was consistent with that needed as defined in the Board-approved Financial and Capital Plan and Plan of Finance Net income of $27 million

− Operating & Capital budgets incorporated funding of Board-approved Strategic Initiatives

o Reviewed, evaluated and approved a composite charge master rate increase of 8% for FY2011

o Reviewed, evaluated and approved the FY2011 Capital Budget as presented to include: − $15 million, with $3 million for routine capital; $5 million for the IT Strategy; and

reserves of $5 million for the Facility Master Plan, and $2 million to fund future initiatives and strategies

• October 26, 2010 – Special Board Meeting o Update of the Financial and Capital Plan: In conjunction with the proposed bond

issuance, reviewed and approved the updated Financial and Capital Plan as of October 2010, incorporating the Board-approved revision of the Facility Master Plan to $1.057 billion

o Issuance of Revenue Bonds: Reviewed and approved the documents/resolutions and delegated to Management the authority to take the appropriate action necessary to complete the documents and matters necessary to issue Certificates of Participation (Revenue Bonds) not to exceed $175 million aggregate par amount with project proceeds of approximately $125 million, said transaction to take place on or about November 18, 2010

o Issuance of General Obligation Bonds: Reviewed and approved the documents/resolutions and delegated to Management the authority to take the appropriate action necessary to complete the documents and matters necessary to issue General Obligation Bonds not to exceed $64,916,681.20 aggregate project proceeds amount, representing the final Tranche of issuance remaining for the Measure BB authority, said transaction to take place on or about November 18, 2010

141

ATTACHMENT 1

142

MEMORANDUM TO: Nicole Adelberg, Executive Assistant to the Board

FROM: Tanya Howell, Assistant to the Board Finance Committee

DATE: February 8, 2010

RE: Board Finance Committee – JANUARY 26, 2010, MEETING SUMMARY

INFORMATION ITEMS:

• Calendar Year 2009 Finance Committee Accomplishments: Reviewed a summary of the accomplishments of the Board Finance Committee for the previous calendar year.

• Annual Agenda: Reviewed and approved a schedule of recurring topics for Calendar Year 2010.

• Meeting Dates: Reviewed and approved a schedule of meeting dates for Calendar Year 2010.

• Program Review – Physician Recruitment: Lisa Hudson, Director, Physician & Business Development, provided a review of the physician recruitment efforts for FY2010 that also included information on recruitment plans and priorities for specialty areas for the remainder of FY2010 and going forward into FY2011.

• 2nd Quarterly Update – FY2010 Initiatives: Reviewed the status of the 14 FY2010 Initiatives associated with Finance Committee oversight: 1.1(a)-(d), 1.2(a)-(g), 2.2 and 5.2(c)

o Program Review – Supply Optimization Committee: Steve Ellis, Director of Supply Chain Services, presented a mid-year status report on the creation, staffing and activities of the Supply Optimization Committee, which is a component of Initiative 1.1(c).

ACTION ITEMS:

• Proposed expresscare Expansion: Reviewed and recommended approval of up to $200K to fund the design and investigation process for three (3) additional expresscare centers at potential sites in San Elijo Hills, Oceanside & Temecula

• Annual Review of Finance Committee Bylaws: Reviewed and recommended that the Board Governance Committee approve the bylaws with no revisions.

• Board Member Position Description for the Board Finance Committee: Reviewed and recommended that the Board Governance Committee approve with no revisions.


o New Physician Independent Contractor Agreements – EHR Projects – Information Systems Services

Branislav Cizmar, MD

Nabil Fatayerji, MD

Michael S. Rafii, MD

Stephen Fortus Signer, MD

Chris Wiesner, MD

Rady Children’s Specialist’s Medical Foundation

143

Board Finance Committee Summary January 26, 2010

o Amended Physician Independent Contractor Agreements – EHR Projects – Information Systems Services

Lachlan Macleay, MD

Marc Gipsman, MD

Julie Chuan, MD

Kevin Daly, MD

Steven Zgliniec, MD

o Mary J. Spencer, MD – Medical Director Agreement – Extension – Forensic Health – PPH

o Irinel Chiriac, MD – Clinical Director Agreement – Extension & Amendment – PMC Inpatient Behavioral Health

o Psychiatric Centers at San Diego – Emergency On-Call & Psychiatric Hospitalist Management Agreement – Amendment – PMC & POM – EDs, Inpatient BHUs, SNFs & Acute Care Areas

o Brian Le, MD – Ophthalmology – POM – Emergency On-Call Agreement – Extension – POM

o Administrative Services Agreements – PMC

John J. Lilley, MD – Chief of Staff

Richard C. Engel, MD – Chief of Staff Elect

Daniel C. Harrison, MD – Department Chair – Quality Management Committee

Thomas S. Velky, MD – Department Chair – Surgery Department

Norman W. Pincock, MD – Department Chair – Medicine Department

Kevin L. Metros, MD – Department Chair – Orthopaedic Surgery/Rehabilitation

Jerome L. Sinsky, MD – Department Chair – OB/GYN

Margaret Riley-Hagan, MD – Department Chair – Pediatrics

Peter M. Lucas, MD – Department Chair – Anesthesia

Julie J. Chuan, MD – Department Chair – Family Medicine

Jaime B. Rivas, MD – Department Chair – Emergency Medicine

Gregory K. Nicpon, MD – Department Chair – Radiology

Lachlan Macleay, Jr., MD – Department Chair – Pathology

John T. Steele, MD – Department Chair – Trauma

o Administrative Services Agreement – POM

Roger J. Acheatel, MD – Department Chair – Quality Management Committee

Roger J. Acheatel, MD – Department Chair – Medical Staff Peer Review Committee

Sabiha Pasha, MD – Department Chair – Medicine

Albert Lin, DDS – Department Chair – Surgery

Gary Gonsalves, MD – Department Chair – Anesthesia

Nabil Fatayerji, MD – Department Chair – Pediatrics

Jaime B. Rivas, MD – Department Chair – Emergency

144

3

Lachlan Macleay, Jr., MD – Department Chair – Pathology

Kathleen Flores-Dahms, MD – Department Chair – Radiology

• Resolution No. 02.10.01 (01) – 01 Re: Designation of Authorized Persons (Corporate Entity Accounts) – Morgan Stanley Trust, N.A.: Reviewed and recommended approval of the Resolution, which lists the PPH Officers who are authorized by the Board to provide Morgan Stanley with instructions concerning PPH’s Corporate Entity Accounts.

• Line of Credit to Palomar Physician Network, Inc. (PPN): Reviewed and recommended approval of the Line of Credit with PPN in the amount of $250,000, to fund initial capitalization of that entity.

• December 2009 and YTD FY2010 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the December 2009 and YTD FY2010 financial performance, which reflected a $13.4 million bottom line net income YTD, which is $575 thousand greater than last year and $129 thousand greater than budget.

145



DATE: March 8, 2010

RE: Board Finance Committee – FEBRUARY 23, 2010, MEETING SUMMARY

INFORMATION ITEMS:

• Date Change – April Board Finance Meeting: Due to a calendar conflict for Tuesday, April 27, 2010, the Committee agreed to move the meeting to the following date and time: Thursday, April 29, 2010, 5:30 p.m. dinner/6:00 p.m. meeting, in the 1st Floor Conference Room at 456 E. Grand Avenue, Escondido, CA. A revised schedule is attached.

• Program Review Schedule: The schedule listing the months in which program review updates are scheduled to be provided at Board Finance Committee meetings has been updated. A copy of the revised schedule is attached.

• Program Review – VHA Purchasing Coalition: Steve Ellis, Director of Corporate Supply Chain Services, provided an analysis of the benefits derived since the District became a member of the VHA purchasing coalition in 2006. He also touched on the District’s membership and participation in WestPac, a collaborative of Southern California healthcare districts formed in 2009 that provides an opportunity to aggregate local purchasing power, which will be presented in more detail at a future date.

• Program Review – San Diego Radiosurgery, LLC & Stereotactic Radiosurgery: Bob Hemker and Gerald Bracht presented an update on the first full calendar year of operations for the District’s joint venture in Stereotactic Radiosurgery with U. S. Radiosurgery (fna NeoSpine, LLC), under the name San Diego Radiosurgery, LLC. Performance was short of expectations, partially caused by a several-month delay in start up while awaiting new technology. Marketing strategies have been revised to better fit the San Diego market, and the venture is on track to meet or exceed budget for Calendar Year 2010, based upon January and February results.

ACTION ITEMS:

• Physician Independent Contractor Agreements – Electronic Healthcare Record Projects – Information Systems Services:

o Jay Federhart, MD o Sudabeh Moein, MD o Mikhail Malek, MD o Rod Serry, MD o Elizabeth Salada, MD

• January 2010 and YTD FY2010 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the January 2010 and YTD FY2010 financial performance, which reflected a $16.08 million bottom line net income YTD, which is $1.8 million greater than last year and $568 thousand greater than budget.

146



DATE: April 12, 2010

RE: Board Finance Committee – MARCH 30, 2010, MEETING SUMMARY

INFORMATION ITEMS:

• Healthcare Reform: Bob Hemker gave an early-read overview and will continue to update the Committee as more information becomes available.

ACTION ITEMS:

• Updated Medical Director Agreement Template: Reviewed and recommended approval of the templated agreement, which had been updated by the Legal Department to comply with regulatory and business practice changes.

• Physician Agreements: Reviewed and recommended approval of all the following agreements:

o Medical Director Agreements

John T. Steele , MD – Trauma Program - PMC Mikhail Malek, MD – Cardiology - PMC Steve K. Kuriyama, MD – Infectious Disease - PPH

o Physician Advisor Agreement:

Charles Callery, MD – Bariatric Surgery – POM

o Department Chair Agreement:

Chenggang Hu, MD – Department of Anesthesia – POM

o Consultant Agreement – Amendment (approved contingent upon confirmation of completion of negotiations prior to Board meeting):

Neighborhood Healthcare

o Emergency On-Call Agreements – Extension

Brian Le, MD – Ophthalmology – POM Lillian Lee, MD – Ophthalmology – POM

o Emergency On-Call Agreements – Amendments

Lorne Kapner, MD – Ophthalmology – POM Brian Le, MD – Ophthalmology – POM Erwin Omens, MD – Ophthalmology – POM Paras Shah, MD – Ophthalmology – POM

o Emergency On-Call Agreement

147

Board Finance Committee Summary March 30, 2010

2

Lillian Lee, MD – Ophthalmology – POM

• Increase in Line of Credit to Palomar Physician Network, Inc.: Recommended approval of an increase from $250K to $1.25M on the existing Line of Credit.

• Independent Citizens’ Oversight Committee (ICOC):

o Update on Pending Vacancies and Authorization to Begin Application Process: Reviewed and recommended approval for the posting of three vacancies that will be created by the expiration of the second and final terms of office of current members.

o Updated Procedures, Policies & Guidelines (PP&G): Reviewed and recommended approval of updates to the PP&G.

• Strategic Capital Allocation Criteria: Reviewed and recommended approval of the Strategic Capital Prioritization Matrix, which was developed by Management as a tool for use in prioritizing the strategic projects on which to allocate capital.

• February 2010 and YTD FY2010 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the February 2010 and YTD FY2010 financial performance, which reflected a $18.4 million bottom line net income YTD, which is $3.4 million greater than last year and $1.2 million greater than budget.

148



DATE: May 10, 2010

RE: Board Finance Committee – APRIL 30, 2010, MEETING SUMMARY

INFORMATION ITEMS:

• Independent Citizens’ Oversight Committee (ICOC): o Update on Impending Vacancies: Bob Hemker reported the resignation of an At Large

member, bringing the number of impending vacancies to four. He also requested that staff and members of the Board encourage qualified candidates to apply for the positions.

o Semi-Annual Meeting Update: Bob Hemker reported that the ICOC had reviewed and approved both of the Board-approved updates to the Procedures, Policies & Guidelines (PP&G) that govern the Committee. Due to the absence of several members at the regular meeting, the Committee postponed making nominations to the Board both for officers of the Committee and for members to the newly created Advisory Panel. They will convene a special meeting in the near future to discuss those two matters.

• Program Review – da Vinci Robotic Surgery: With the assistance of Natalie Bennett, Lisa Hudson and Gerald Bracht, Bruce Grendell presented an update on the status of the program, which has seen a significant increase in volume since the arrival of Dr. Brian Link in the first quarter of 2010. The forecast for FY2011 is for volume growth, based on an expanded marketing campaign and newly formed relationships in the secondary market, as well as anticipated growth in the area of GYN surgeries.

• Program Review – Perinatology Services at PMC: Lorie Shoemaker and Sheila Brown presented an update on the program, which is meeting the needs of the community by allowing patients to receive treatment locally. The presentation included recommendations to continue the program at PMC and to explore expansion of the services to the POP to accommodate the population in our southern service area.

• Third Quarterly Update – FY2010 Initiatives: The FY2010 Initiatives associated with Board Finance Committee oversight – 1.1(a)-(d); 1.2(a)-(g); 2.2; and 5.2(c) – were reviewed and discussed.

ACTION ITEMS:

• Physician Agreements: Reviewed and recommended approval of all the following agreements:

o Emergency On-Call Agreements for Gastroenterology – POM – Extensions

Daniel Lee, MD Alan Larson, MD Richard Snyder, MD Kim Hyun, MD Maram Zakko, MD

o Emergency On-Call Agreement for Ophthalmology – POM

Brian Le, MD

• March 2010 and YTD FY2010 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the March 2010 and YTD FY2010 financial performance, which reflected a $20.4 million bottom line net income YTD, which is $3.75 million greater than last year and $939 thousand greater than budget.

149

MEMORANDUM

TO: Nicole Adelberg, Executive Assistant to the Board


DATE: Junee14, 2010

RE: Board Finance Committee – May 25, 2010, Meeting Summary

INFORMATION ITEMS:


o Appointment of Officers: The Board Chair and Board Finance Committee Chair appointed the following officers for the ICOC for FY2011:

Alex Galenes – Chair Ron Klingensmith – Vice Chair John Amodeo – Secretary

• Program Review Schedule: The schedule for program review updates at Board Finance Committee meetings was revised, and a copy of the revised schedule is attached. As in the past, members of the Board not on that Committee are invited to attend as guests for any of the program reviews.

ACTION ITEMS:


o Applicants for Vacancies: Reviewed applications and interviewed applicants for the five vacant/impending vacant seats on the ICOC. Recommended appointment of the following seven applicants, which would bring the total membership to eleven, two more than the required minimum of nine:

Scott B. Furgerson – Business Organization – Required Seat Victor Graham – At Large David Hughes – At Large Winston F. McColl – At Large John Luis Ramirez – At Large George B. (Robin) Rowland, MD – Physician – Required Seat Stephen D. Smith, MD – At Large

o Advisory Panel Nominees: Reviewed and recommended approval of the proposal from current ICOC members that impaneling the initial seating of the newly created Advisory Panel with three members would be appropriate, and recommended that the following nominees be elected to fill those three seats:

Marguerite Jackson Dill John McIver Margaret Moir

o Minutes from Mid-Year Meeting of April 28, 2010: Reviewed and recommended approval of the minutes for inclusion in the Board’s public records.


o Medical Directorship Agreement – Wound Care Program

Roger B. Schechter, MD

o Associate Medical Directorship Agreement – Wound Care Program

Bradley B. Bailey, MD

• Physician Recruitment Agreement Amendments: Reviewed and recommended approval of two amendments to the Physician Recruitment Agreement with Sudabeh Moein, MD, FACOG, extending the forgiveness period by a total of 24 months to 48 months.

150

Board Finance Committee Summary May 25, 2010 Meeting

2

• Comprehensive Stroke Program Business Plan: Reviewed and recommended that the Board Strategic Planning Committee approve the creation of a comprehensive stroke program at Palomar Medical Center, to include Neuro-interventional radiology procedures for early intervention for embolic strokes.

• April 2010 and YTD FY2010 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the April 2010 and YTD FY2010 financial performance, which reflected a $22.7 million bottom line net income YTD, which is $4.6 million greater than last year and $1.16 million greater than budget.

151

MEMORANDUM



DATE: Julye12, 2010

RE: Board Finance Committee – June 29, 2010, Meeting Summary

INFORMATION ITEMS:

• Program Review Schedule: The schedule for program review updates at Board Finance Committee meetings was revised, and a copy of the revised schedule is attached. As in the past, members of the Board not on that Committee are invited to attend as guests for any of the program reviews.

• Changed Meeting Dates: The August Board Finance meeting was moved from August 31st to August 24th; and the September Board Finance meeting was moved from September 28th to October 5th. A revised schedule for the year is attached.

• Consolidation of PFS & Admitting: During the course of evaluating and enhancing the Revenue Cycle process, a decision was made to consolidate the leadership of Patient Access and Patient Financial Services under the leadership of Director of Patient Financial Services Traci Adair. The consolidation resulted in the elimination of the position of Director of Patient Access, which was held by Aaron McDaniel. Mr. McDaniel’s response to the situation and the assistance he provided to aid in the transition before his departure were praised.

• Investor Call: Management conducted a semi-annual call with investors who own PPH Revenue Bonds. The investors were apprised both about the FY2010 financial performance to date and also about upcoming construction activities. The call was well received and appreciated.

ACTION ITEMS:


o Minutes from Special Meeting of May 25, 2010: Reviewed and recommended approval of the minutes for inclusion in the Board’s public records.

• Medical Directorship Agreements: Reviewed and recommended approval of the following agreements:

o Donald S. Herip, MD, MPH – PPH Corporate Health Services

o Steve M. Kuriyama, MD – PPH Infectious Disease Program

o Mary J. Spencer, MD – PPH Forensic Health Services

• Physician Recruitment Agreement Amendments: Reviewed and recommended approval the following agreements:

o Alexander Salloum, MD & Surgical Associates of San Diego – Vascular Surgery

o Donald Blaskiewicz, MD & Neurosurgical Medical Clinic, Inc. - Neurosurgery

• Strategic Capital Resource Allocation: Reviewed and recommended approval of the following three capital projects, utilizing a combination of FY2011 Board Strategic Capital ($1.7 million), FY2011 Facilities Renovation Capital ($692 thousand), and a reallocation of $1.02 million from the previously Board-approved multi-year Imaging Capital Plan:

o Replacement of the Villa Pomerado Nurse Call System ($970 thousand)

o Replacement of the Villa Pomerado Chilled Water Lines ($1.2 million)

o Phase II Renovation of the Patient Tower Elevators at PMC ($1.242 million)

• May 2010 and YTD FY2010 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the May 2010 and YTD FY2010 financial performance, which reflected a $25.3 million bottom line net income YTD, which is $5.3 million greater than last year and $1.5 million greater than budget.

152

MEMORANDUM



DATE: August 8, 2010

RE: Board Finance Committee – July 27, 2010, Meeting Summary

INFORMATION ITEMS:

• Upcoming Bond Issues: Groundwork is underway by the Financing Team in preparation for the issuance of both General Obligation and Revenue Bonds in late 2010 or early 2011.

• Fourth Quarterly Review of FY2010 Initiatives: The FY2010 Initiatives associated with Board Finance Committee oversight – 1.1(a)-(d); 1.2(a)-(g); 2.2; and 5.2(c) – were reviewed and discussed.

ACTION ITEMS:

• General Obligation Bonds – Tax Levy 2010-2011: Reviewed the effect of current economic conditions, the resultant assessed values of properties in the district, and the negative impact on the tax levy. Recommended approval of the Resolution Concerning the Levy and Collection of Taxes by the Board of Supervisors of the County of San Diego for Fiscal Year 2010-2011 to Pay Principal and Interest on General Obligation Bonds and Authorizing the Taking of All Actions Necessary in Connection Therewith, with a recommended tax levy of $23.50/$100,000 of assessed value.

• Establishment of Appropriations Limit for FY2011: Reviewed and recommended approval of the Resolution Establishing the Appropriations Limit for Palomar Pomerado Health for Fiscal Year 201

• Policy – Annual Adoption of Statement of Investment: Reviewed and recommended adoption of the Policy with clarifying language as recommended by Management.

• Physician Independent Contractor Agreements – EHR Projects: Reviewed and recommended approval of the following agreements:

o Roger Acheatel, MD – Extension

o John Gregorius, MD – New Agreement

o Aria Anvar, MD – Extension

o Julie Chuan, MD – Extension

o Kevin Daly, MD – Extension

o Mark Gipsman, MD – Extension

o Steven Zgliniec, MD – Extension

o Christopher Wiesner, MD - Extension

• POM Medical Staff Officer Agreements: Reviewed and recommended approval of the following agreements:

o Franklin Martin, MD – Chief of Staff – Amendment No. 1

o Roger Acheatel, MD – Chief of Staff Elect – Amendment No. 1

• Physician Recruitment Agreement Amendment: Reviewed and recommended approval of the following agreement:

o Ranjit Shenoy, MD & Graybill Medical Group, Inc – Internal Medicine/Pediatrics

• June 2010 and YTD FY2010 Pre-Audit Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the Pre-Audit Financials for June 2010 and YTD FY2010 financial performance, which reflected a $29.8 million bottom line net income YTD, which is $18.3 million greater than last year and $3.9 million greater than budget.

153

MEMORANDUM



DATE: September 13, 2010

RE: Board Finance Committee – August 24, 2010, Meeting Summary

INFORMATION ITEMS:

• Upcoming Bond Issues: Update on the status of the groundwork underway by the Financing Team in preparation for the issuance of both General Obligation and Revenue Bonds in late 2010 or early 2011.

• Program Review Schedule: Updated schedule attached.

• Rady Children’s Hospital: Beginning August 25, the pediatric and neonatal care unit at Palomar Medical Center will be fully operated under the Rady Children’s Hospital license. Under this partnership agreement, PPH will transfer operations and management of its 17 pediatric and 12 neonatal beds to Rady Children’s Hospital.

• Customer Relationship Marketing Campaigns: Reviewed and discussed the campaigns as presented in the agenda packet.

ACTION ITEMS:


o Sudabeh Moein, MD – Independent Contractor Agreement for Women’s Service at the POP – New Agreement

o Marina Katz, MD – Amendment No. 2 to Clinical Director Services Agreement for the Psychiatric Outpatient Program – Extension

o Stephen F. Signer, MD – Amendment No. 1 to Clinical Director Services Agreement for Behavioral Health Services – Extension

• July 2010 and YTD FY2011 Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the Financials for July 2010 and YTD FY2011 financial performance, which reflected a $2.1 million bottom line net income YTD, which is $230 thousand below budget.

154



1 October 5, 2010 VHA Purchasing Coalition/WestPac David Tam & Steve Ellis

2 October 26, 2010 Arch Health Partners Bob Hemker

4 November 20101 Wound Care Sheila Brown


6 January 20112 Comprehensive Stroke Program Gerald Bracht & Paul Patchen






3 November 2010 SNF Beds to Sub-Acute - Potential for future expansion Steve Gold

9 April 2011 Gerald Bracht & Lisa HudsonPhysician Recruitment

FY2010/2011 Program Review Schedule

1 Rescheduled from original review date(s)2 Added after approval at June 2010 Board meeting Rev’d 8/2010155

MEMORANDUM



DATE: October 11, 2010

RE: Board Finance Committee – October 5, 2010, Meeting Summary

INFORMATION ITEMS:

• Upcoming Bond Issues: Update on the status of the groundwork underway by the Financing Team in preparation for the issuance of both General Obligation and Revenue Bonds. Bob Hemker provided the following targeted dates for completion of the bond issues: o Week of October 11, 2010 – Rating Agency Updates on Preliminary Audited Financials

o Friday, October 22, 2010 – To Joint Powers Authority Board for Document Approval

o Tuesday, October 26, 2010 – To Special Board Meeting for Document Approval

o Week of November 1, 2010 – Investor Update Roadshow (Personal/Internet TBD)

o Week of November 8, 2010

November 8 – To Board for Final Document Approval

November 8-9 – Retail order period, pricing and Bond Purchase Agreement signing

o Wednesday, November 17, 2010 – Pre-Closing

o Thursday, November 18, 2010 – Closing

• VHA Purchasing Coalition/WestPac: Program Review update on the contractual savings generated on medical/surgical supplies, devices, capital equipment, pharmaceuticals and purchased services through the District’s participation in the VHA Group Purchasing Organization and their regional purchasing coalition known as WestPac

ACTION ITEMS:


o Southwest Neurology Medical Group – Emergency On-Call Agreement for Neurology for District – New Agreement

o Neighborhood Healthcare Adult Medicine & Skilled Nursing Facility Hospitalists Agreement – First Amendment – Extension


o Minutes from Special Meeting of August 23, 2010: Reviewed and recommended approval of the minutes for inclusion in the Board’s public records

• Draft Audited Financial Statements for Years Ended June 30, 2010 and 2009: The Board Finance Committee reviewed the Draft Audited Financial Statements for Years Ended June 30, 2010 and 2009, found them to be consistent, voiced no questions or concerns regarding the auditors’ findings and recommended approval

• August 2010 and YTD FY2011 Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the Financials for August 2010 and YTD FY2011 financial performance, which reflected a $4.3 million bottom line net income YTD, which is $220 thousand below budget

156

M E 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: November 8, 2010 RE: Board Finance Committee – October 26, 2010, Meeting Summary

INFORMATION ITEMS: • Program Review Schedule: Updated schedule is attached ACTION ITEMS: • Center for Back & Neck Pain: Reviewed and recommended approval of a

business plan in support of the development of a clinic at the POP to provide a comprehensive spine program


o Recruitment: Sue Ghosh, MD, and Center for Gynecologic Oncology, Inc. – Gynecologic Oncologist

o Professional & Medical Director Services Agreement: X-Ray Medical Group Radiation Oncology, Inc. – Radiation Oncology – PPH

o Behavioral Health Services Agreement: Arch Health Partners – PPH o Retail Health Clinics Professional Services & Medical Director Agreements:

PIMG, Inc. – Peñasquitos Alejandro Paz, MD, MPH – Escondido

o Independent Contractor Agreements – EHR Suite of Projects: Branislav Cizmar, MD Nabil Fatayerji, MD Lachlan Macleay, MD Rady Children’s Specialist’s

Medical Foundation

Michael Rafii, MD Stephen Fortus Signer, MD Paul Polishuk, MD William Sereda, MD

• Independent Citizens’ Oversight Committee (ICOC): o Minutes from Special Meeting of August 23, 2010: Reviewed and

recommended approval of the minutes for inclusion in the Board’s public records

• September 2010 and YTD FY2011 Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the Financials for September 2010 and YTD FY2011 financial performance, which reflected a $6.6 million bottom line net income YTD, which is $79 thousand below budget

157

MEMORANDUM

TO: Nicole Adelberg, Executive Assistant to the Board FROM: Tanya Howell, Assistant to the Board Finance Committee DATE: December 13, 2010 RE: Board Finance Committee – November 30, 2010, Meeting Summary

INFORMATION ITEMS: • Program Review Schedule for CY2011: Updated schedule is attached • Program Reviews:

o Arch Health Partners: Vicky Lister presented an update on the financial and strategic progress of Arch during its first six months

o Wound Care Program: Ann Moore presented an annual financial report and program review of the Wound Care Center Programs

• Trocar Conversion Program: Steve Ellis presented information on the VAT Steering Committee’s recommendation to convert surgical trocars from J&J Ethicon to Applied Medical

ACTION ITEMS: • Annual Report of the Independent Citizens’ Oversight Committee for District

Fiscal Year 2009-2010: Reviewed and recommended approval of the report as submitted


o Program Services Agreement: Arch Health Partners – Breast Surgery o Administrative Services Agreements – PMC:

Josue Leon, MD – Chair – Department of OB/GYN – New P. Eva Fadul, MD – Chair – Department of Anesthesia – New Gregory Nicpon, MD – Chair – Department of Radiology – New Jeffrey Rosenburg, MD – Chair – Medical Staff Peer Review Committee –

New John Lilley, MD – Chief of Staff – Amendment Richard Engel, MD – Chief of Staff Elect – Amendment

o Administrative Services Agreements – POM: Roger J. Acheatel, MD – Chief of Staff Paul Neustein, MD – Chief of Staff Elect Franklin Martin, MD – Chair – QMC Committee Franklin Martin, MD – Chair – Medical Staff Peer Review Committee Gregory Nicpon, MD – Chair – Department of Radiology

158

Board Finance Committee Summary November 30, 2010 Meeting

2

o Professional & Medical Director Services Agreements: X-Ray Medical Group Radiation Oncology, Inc. – Radiation Oncology – PPH Neighborhood Health Care – Medical History & Physical Exam – Behavioral

Health Unit – PMC o Physician Advisor Agreement: Jason Keri, MD – Behavioral Health Services –

PPH o Professional Services Agreement: Jeffrey Chen, MD – Employee & Corporate

Health Services – PPH o Independent Contractor Agreements – EHR Suite of Projects:

Jay Federhart, MD Sudabeh Moein, MD Rod Serry, MD

Mikhail Malek, MD Elizabeth Salada, MD

• October 2010 and YTD FY2011 Financials: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the Financials for October 2010 and YTD FY2011 financial performance, which reflected a $9.4 million bottom line net income YTD, which is $475 thousand greater than budget

159






4 April 2011 Physician Recruitment Gerald Bracht & Lisa Hudson

5 April 20112 Arch Health Partners Bob Hemker


7 June 2011 Comprehensive Stroke Program Gerald Bracht & Paul Patchen


9 September 2011 VHA Purchasing Coalition/WestPac David Tam & Steve Ellis


CY2011 Program Review Schedule

1 Rescheduled from original review date(s)2 New date following previous review

Rev’d 10/2010160


November 04, 2010 Strategic Planning Committee

ACTION ITEMS:

• None. INFORMATION ITEMS:

• Rehabilitation Care Relationship and Building of the New Rehabilitation Hospital: Sheila Brown presented an update on Rehab Care to the Committee. The presentation is available on the Leadership Drive.

• Behavioral Health Status Update: Sheila Brown and Susan Linback presented an update on Behavioral Health to the Committee. The presentation is available on the Leadership Drive.

161

Palomar Pomerado Health Board Strategic Planning Committee

2010 Committee Accomplishments

January – The Board Strategic Planning Committee reviewed the Green House approach to SNF development in the future. February – The Board Strategic Planning Committee reviewed the second quarter update of the FY10 Initiatives. March - The Board Strategic Planning Committee reviewed the Transformation activities to date. April – The Board Strategic Planning Committee did not meet in April. May – The Board Strategic Planning Committee discussed the FY11 Initiatives. June – The Board Strategic Planning Committee reviewed and approved the business plan for the Comprehensive Stroke Program. The Committee discussed the current state of the SNF facilities capital needs versus their operational values. The Committee reviewed the status of the FY11 Initiatives. July – The Board Strategic Planning Committee did not meet in July. August – The Board Strategic Planning Committee reviewed the final status of the FY10 Initiatives. September – The Board Strategic Planning Committee did not meet in September. October – The Board Strategic Planning Committee reviewed and approved the business plan for the Center for Back and Neck Pain. The Committee reviewed the status of the FY11 Initiatives. November – The Board Strategic Planning Committee reviewed the Rehab Care relationships and the building of the new Rehab Hospital. The Committee discussed the status of the Behavioral Health services. December – The Board Strategic Planning Committee did not meet in December.

162