Indian River Memorial Hospital, Inc. d/b/a...Indian River Memorial Hospital, Inc. d/b/a Indian River Medical Center January 21, 2016 at 10:00 a.m. Boardroom 1000 36th Street Vero Beach,

Indian River Memorial Hospital, Inc. d/b/a

Indian River Medical Center

January 21, 2016 at 10:00 a.m.

Boardroom

1000 36th Street

Vero Beach, FL 32960

This meeting may be recorded

II. . Call to OrderCall to OrderWayne T. Hockmeyer, Ph. D.

For Information

1. Transcatheter Aortic Valve Replacement (TAVR)

2. Chilled Water & Steam Pipping RelocationProject

1. TAVR Presentation.ppt

bb. . Finance CommitteeFinance Committee

1. Physician Professional Conduct (DisruptivePhysician Policy)

2. Meeting Requirements

3. Leadership Criteria (Chief of Staff)

1. Draft Disruptive Physician Policy 7 3 Ev3.docx

1. Attendance Bylaws change 12 2015.docx

1. Eligibility Chief of Staff Bylaws 122015.docx

1. Medical Staff Bylaw Revision

cc. . Joint Conference CommitteeJoint Conference Committee

aa. . Approval of MinutesApproval of Minutes

1. Chilled Water & Steam Piping RelocationProject.pdf

IIII. . Consent AgendaConsent AgendaWayne T. Hockmeyer, Ph. D.

For Action

a. Minutes Dated December 10, 2015

Board of Directors

Board of Directors

Page 5

Page 8

Page 21

Page 23

Page 31

Page 32

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4. Leadership Criteria Vice Chief of Staff

1. Critical Care Consultations

2. Surgical Care

1. Rules and Regs CC Consults 12 2015.docx

2. Medical Staff Rules & Regulations

1. Eligibility Vice Chief Board Rep Dept Chairbylaws 12 2015.docx

1. IRMC Bylaw Revisions

dd. . Governance CommitteeGovernance Committee

1. Rules and Regs Scheduling Surgery 122015.docx

IVIV. . Foundation Chairman's ReportFoundation Chairman's ReportAnthony Woodruff

For Information

a. January 2016 President's Report

b. Program.Market 1st Quarter Strategic Goals

VV. . President's ReportPresident's ReportJeffrey L. Susi

For Information

aa. . FY 2016 YTD December 2015 Consolidated,FY 2016 YTD December 2015 Consolidated,Hospital & Physician FinancialsHospital & Physician Financials

VIVI. . Finance CommitteeFinance CommitteeJack Weisbaum

1. Section 4 2-2 2 Qualifications - 1-19-16.docx

IIIIII. . Chairman's ReportChairman's ReportWayne T. Hockmeyer, Ph. D.

For Information

a. Foundation report.docx

c. Physician.Hospital 1st Quarter Strategic Goals

Page 33

Page 34

Page 35

Page 36

Page 37

Page 39

Page 42

Page 43

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bb. . Financial Report for FY 2016 Strategic GoalsFinancial Report for FY 2016 Strategic Goals

1. YTD December 2015 Consolidated, Hospital andPhysician.pdf

aa. . Board EducationBoard Education

VIIVII. . Governance CommitteeGovernance CommitteeGerri Smith

1. Financial 1st qtr.pptx

1. IRMC Board Education Plan.docx

VIIIVIII. . Other BusinessOther BusinessWayne T. Hockmeyer, Ph. D.

For Information

IXIX. . Public CommentPublic Comment

XX. . Adjoun to the Private SessionAdjoun to the Private Session

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Page 48

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Page 4 of 49

INDIAN RIVER MEMORIAL HOSPITAL, INC. D/B/A

INDIAN RIVER MEDICAL CENTER BOARD OF DIRECTORS

MINUTES

The regular meeting of the Indian River Medical Center Board of Directors was convened by Chairman Wayne T. Hockmeyer, Ph.D. on December 10, 2015 at 4:30 p.m. in the Medical Center Boardroom. MEMBERS PRESENT: Wayne T. Hockmeyer, Ph.D.

Donald Laurie, via telephone John Lindenthal, M.D. William Kelley, M.D. Hugh McCrystal, M.D. Keith Morgan Jack Pastor Pranay Ramdev, M.D. Matthew Reiser Gerri Smith Jeffrey L Susi Jack Weisbaum Anthony Woodruff

MEMBERS EXCUSED: Charles Celano, M.D. Kathy Hendrix Fran Ross, Esq.

OTHERS PRESENT: Myra Burns Lewis Clark Jan Donlan Warren Fuller Greg Gardner Keith Ghezzi, M.D. Tim Howard Valerie Larcombe, Esq. Lisa Licitra Kim Leach-Wright Charles Mackett, M.D. Nate McCollum Ann Marie McCrystal, R.N. Ali Martin Karen Mitchell Jason Nance William Neil Bev Sanders Mindy Serafin Grace Simonson Richard Van Lith, Pham. D.

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CONSENT AGENDA The following items were previously discussed at respective committees and distributed for review to the Board of Directors as Consent Agenda:

1. Approval of Minutes

a. Minutes Dated October 28, 2016

2. Nominating Committee

a. Class of 2018 i. Appointment of William Baxt, M.D. pending approval of Bylaw revision ii. Juliette Lomax-Homier, M.D.

Dr. Hockmeyer asked the Board Members if anyone wished to remove any item under the Consent Agenda for further discussion. There were no requests Dr. Hockmeyer called for a Motion to Accept the Consent Agenda. Upon MOTION made by Mr. Woodruff, duly seconded by Dr. Kelley and unanimously carried, the Board of Directors approved the Consent Agenda as presented. CHAIRMAN’S REPORT Bylaw Revision

Section 4.2-2.2

Dr. Hockmeyer presented a revision to the IRMC Bylaws in Section 4.2-2.2 Qualifications. This revision would change the requirement from a Florida resident to a United States resident. This Bylaw revision would require approval by the Board of Trustees. Discussion ensued. Upon MOTION made by Dr. Kelley, duly seconded by Mr. Weisbaum and unanimously carried the Board of Directors approved the revision to the Bylaws Section 4.2-2.2 Qualification as presented.

Section 6.1-6 Compliance Committee

Dr. Hockmeyer presented a revision to the IRMC Bylaws in Section 6.1-6 Compliance Committee. This revision changes the membership of the Compliance Committee to all Independent Directors on the Board of Directors. Discussion ensued. Upon MOTION made by Dr. Kelley, duly seconded by Mr. Weisbaum and unanimously carried, the Board of Directors approved the revision to the IRMC Bylaws Section 6.1-6 as presented.

FOUNDATION CHAIRMAN’S REPORT Mr. Woodruff updated the Board on the recent activities of the Foundation. He was excited to kick off the season with the new addition of Dr. Grichnick as Director of the Cancer Center. Recently there was a soft opening of the Cancer Center with 180 attending the festivities. The Campaign is now at $42.5 million and growing. He reported on the various activities of the community committees.

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Ms. Donlan presented the members of the Employee Campaign Team and thanked them for the recent contribution of over $400,000 from IRMC employees who have become donors for the Caner Campaign. PRESIDENT’S REPORT Mr. Susi introduced Karen Mitchell, Vice President and Chief Human Resource Officer. She presented the annual Human Resource Report covering recruitment, employee and labor relations, benefits, compensation, occupational health, HRIS and organizational development and training. Mr. Susi presented the following items from the President’s Report which is included and made part of these minutes:

Mr. Susi explained the recent resignation of Mr. Salyer and explained his background and the limited opportunities for advancement here at IRMC. Mr. Susi noted that he had met with the Management Team to reassign the responsibilities on the Organizational Chart.

Finance Committee Mr. Weisbaum noted that Mr. Gardner had given the Finance Committee an overview of the financials through October 2015 and a snapshot of November 2015. The Committee also received a detailed presentation on the physician practices.

Investment Subcommittee

The Investment Subcommittee under Mr. Pastor’s leadership continues to look at defunding a small portion of the outstanding pension liability associated with the frozen pension plan.

There being no further business to discuss, the meeting adjourned to the private session at approximately 5:01 p.m. Respectfully submitted, Wayne T. Hockmeyer, Ph. D. Chairman

Page 7 of 49

Transcatheter Aortic Valve Replacement

Program Development

Jason Nance

Associate Vice President Patient Care Services

Finance Committee January 19, 2016

Page 8 of 49

Agenda

• Cardiovascular Outlook

• Transcatheter Aortic Valve Replacement

(TAVR) overview

• Revenue vs Expense

• Conclusion

Page 9 of 49

Cardiovascular Outlook

Nationwide

Change in CABG and PCI

Volumes2003-2012

Nationwide

Change in Number of PCI

Programs2003-2012

Page 10 of 49


Five Year Growth TrajectoriesInpatient and Outpatient, 2012-2017

Page 11 of 49


Heart Failure Center

• Requires collaboration

between medical cardiology,

electrophysiology, and heart

failure specialists

• Targets heart failure patients

and multimorbid diseases

Atrial Fib Center

• Serves as a more advanced

cardiovascular disease center

• Requires collaboration

between surgery and heart

failure specialists

• Targets electrophysiology,

heart failure, and structural

heart patients

Valve Center

• Represents progressive

cardiovascular centers,

especially with a focus on

structural heart

• Requires interventional

cardiology and surgical

collaboration

• Targets aortic and mitral

valve disease along with

other structural heart

conditions

Examples of Common Cardiovascular Disease Centers

Page 12 of 49

Current TAVR Centers

Page 13 of 49

TAVR Overview

• https://www.youtube.com/watch?feature

=player_detailpage&v=GS257ydQyiY

Page 14 of 49

https://www.youtube.com/watch?feature=player_detailpage&v=GS257ydQyiY

Physician and Infrastructure Needs

for Key CV Growth Opportunities

Facilities Key Support Staff Physician Skill Set Key Specialist(s)

TAVR

Ideal: Hybrid OR or

modified, sterile cath

lab

Ideal: Cross-trained or dedicated

hybrid room RNs, techs, and

valve coordinator (NP)

• Advanced interventional skills,

including TAVR training requirements

• 2-5 proctored cases

• CV surgeon

• Interventional

cardiologist (IC)

Radial PCI Ideal: Cath lab

Ideal: Cath lab RNs, techs with

radial case training and

experience

• Radial access experience, >50 cases

preferable

• Interventional

cardiologist

EP Ablation

Ideal: Dedicated EP

lab, potentially hybrid

OR for hybrid ablation

Ideal: Dedicated EP RNs, techs,

and AF coordinator

• RF ablation experience

• Additional cryoballoon training

• Cox-Maze experience

• EP

• CV surgeon (hybrid

ablation)

AAA and TAA

EndograftsIdeal: Hybrid OR

Ideal: Cross-trained OR, cath

staff or dedicated vascular team

• Endovascular training with open

aneurysm repair experience

• Vascular surgery

• IC

• CV surgeons

LEPAD

Interventions

Ideal: Dedicated

vascular lab Ideal: Cath lab RN, techs

• Training in variety of access points

• Experience with numerous devices

• Vascular and CV surgeon

• IC

• IR

Advanced HF

Care, VADs

Ideal: OR suite and

dedicated HF clinic

Ideal: Dedicated HF mid-levels,

VAD coordinator

• HF training, experience with high acuity

patients

• 10 VAD implants for DT certification

• HF specialist

• CV surgeon

Page 15 of 49

Volume Predictions

Year 1 Year 2 Year 3

Volume

TAVR 28 21 22

SAVR 24 26 29

TAVR Clinic Diagnostics 506 556 612

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Capital Improvements and

Program Development Cost

Initial Start Up Cost

Room Renovation, Monitoring and Contingency $770,000

Hemo System $100,000

Community Education $10,000

Hospital Education $15,000

Valve Clinic Coordinator $80,000

Initial Set-up/ Registery Fees $25,000

Total $1,000,000

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Revenue vs Expense

Revenue Year 1 Year 2 Year 3

TAVR 1,181,488$ 886,116$ 928,312$

SAVR 927,360$ 1,020,096$ 1,122,106$

TAVR Clinic Diagnostics 215,103$ 236,613$ 260,275$

2,323,951$ 2,142,825$ 2,310,692$

Direct Expense

TAVR 1,101,940$ 826,455$ 865,810$

SAVR 831,360$ 914,496$ 1,005,946$

TAVR Clinic Diagnostics 46,421$ 51,063$ 56,169$

1,979,721$ 1,792,014$ 1,927,925$

TAVR Program Expenses

Registry Fees 25,000$ 10,525$ 10,550$

Valve Clinic Coordinator 80,000$ 81,600$ 83,232$

Hospital Education 15,000$ -$ -$

Community Education 10,000$ -$ -$

Capital Depreciation

Room Renovation ($730,000) 47,000$ 47,000$ 47,000$

Hemo System ($100,000) 20,000$ 20,000$ 20,000$

197,000$ 159,125$ 160,782$

Excess (Deficit) Revenue over Expenses 147,230$ 191,686$ 221,985$

Page 18 of 49

Potential Effect of Not Having

TAVR

2015 Year 1 Year 2 Year 3

Cases 110 90 80 70

Current Margin $439,949 $359,958 $319,963 $279,968

Loss of Margin $79,991 $119,986 $159,982

Page 19 of 49

Conclusion

• Cardiovascular care is changing

• Structural heart (Valve) is an important part of

IRMC’s Heart Center

• TAVR is very important to the future of structural

heart

• IRMC is well positioned ( surgeons and

interventionists) to deliver this program from a

patient care and financial perspective

Page 20 of 49

Chill Water and Steam Piping Relocation Project CIP 15-010

Task Vendor Budget Estimate Scheduled Completion Committed to Date Owner Direct Purchased Materials

Phase 1- Temporary piping connections in order

to maintain cooling during all phases. This phase

includes using a 500 Ton portable chiller.Midstate Mechanical $58,023.13

1/23/16- 1/24/16

(6 hour outage)

Phase 2- Temporary chillers and package

equipment will be used to cool priority areas

selected by hospital staff; 16" piping connections

installed in tunnel and chiller plant to allow for

connection to permanent piping in phase 3

Midstate Mechanical $131,870.751/30/16-1/31/16

(12-14 hour outage)$55,633.81 55,633.81$

Phase 3- Install 16" Supply and Return and

Steam lines overhead from the Central Energy

Plant through exterior driveway and into Bulk

Stores to location inside of building to connect

to steel inside tunnel at point of steel

connection and bypass fibertite tunnel piping.

Midstate Mechanical $337,589.12

5/20/16 No outage

required for final phase.

The system will be

energized by opening

new valves and closing

old valves.

Electrical wiring required to support Temporary

Chillers and Air Cooled Packaged Units for

Phases 1 and 2.

Paragon Electric $9,735.00 01/20/2016

Engineering for mechanical,structural and

electrical construction drawings to include

permit set for local authority submission and

submission to Agency for Healthcare

Administration, Office of Plans and Construction.

TLC Engineering $40,000.00 01/20/2016 $40,000.00

Page 21 of 49

Construction of exterior concrete support structures,

construction of ICRA walls through Bulk Stores to

allow welding and installation of steel piping,

installation of bollards, concrete work required to

seal interior and exterior penetrations into existing

tunnel, asphalt work required to restore parking lot

and driveway, flooring work required to repair

opening in Bulk Stores. Opening of concrete floor in

bulk stores and widening of ICRA wall(completed).

Clearing of tunnel in area of reconnection, debris

removal, removal and reinstallation of ceiling grid in

area of overhead piping.

Darling Construction $147,428.00 05/20/2016 $26,867.00

Portable 1 Ton air conditioning units to cool

pharmacy and pharmacy accudose units during

outage

Carrier/Trane Rental $7,550.00 1/29/16-1/31/16 7,550.00$

Test and Balance Certification of new piping

hydronic.Total Dynamic Bal. $1,000.00 05/20/2016 1,000.00$

JCI/McQuay vendor support during phase 2

outageJCI/Daikin Services $2,600.00 1/30/16-1/31/16 2,600.00$

Local Permit IRCBD $500.00 01/29/2016 500.00$ Page 2

Task Vendor Budget Estimate Scheduled Completion Committed to Date Owner Direct Purchased MaterialsAHCA Review AHCA $2,000.00 01/06/2016 $2,000.00 2,000.00$

Sub-Total Before Contingency $738,296.00

Contingency IRMC 36,915.00$

Total Estimated Project Cost $775,211.00 124,500.81$ 69,283.81$

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1

7.E.3. DISRUPTIVE PHYSICIAN PROFESSIONAL CONDUCT BEHAVIOR POLICY

7.E.3.a. Purpose:

The practice of Medicine is a time honored profession. Professionals commit themselves

to technical and cognitive competence. Professionals also commit to clear and effective

communication, self-awareness, being available and modeling respect. Professionals

promote teamwork and demand self and group regulation. Physicans are expected to

behave as professionals and to model professional behavior for the entire patient care

team.

Each individual hasMembers of the patient care team have the right to work in a

professional atmosphere that promotes equal employment opportunity and prohibits

discriminatory practices including harassment. All individuals working in the hospital are

required to treat others with respect, courtesy, and dignity and to conduct themselves in a

professional and cooperative manner. In dealing with incidents of inappropriate conduct,

the protection of patients, employees, the Medical Staff, and others in the Hospital Patient

and staff safety and the orderly operation of the Hospital are of paramount importance.

7.E.3.b. Goals:

The goal of this policy is to ensure good Medical Staff citizenship professionalism and to

eliminate Medical Staff disruptive unprofessional behavior.

7. E.3.c. Definitions:

Examples of appropriate good medical citizenshipMedical Staff professional conduct

behavior includes, but areis are not limited to:

(1) (1) Treating others with respect and courtesy and modeling that behavior.

(2) Self-awareness and self-regulation.

(3) Being available when on-call and when caring for hospital patients

(4) Promoting teamwork, quality improvement and patient safety

(25) Cooperating effectively with other members of the health care team in a

dignified and professional manner.

(36) Managing disagreements with courtesy.

(47) Assisting in the identification of colleagues who may be in need of

assistance.

(58) Encouraging and participating in clear and effective communication with

patients, families, nurses, other hospital staff, and other Medical Staff members.

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2

(69) Addressing concerns with policies, practices, procedures, and/or behavior

through appropriate Medical Staff and administrative channels.

(710) Adherence to Medical Staff Bylaws, Rules and Regulations, and all

applicable hospital policies.

(811) Active participation in departmental and general Medical Staff meetings

and willingness to serve in Medical Staff affairs including leadership and

committee assignments.

(912) Strict adherence to policies regarding confidentiality.

Unprofessional conduct includes, but is not limited to the failure to exhibit the above-

referenced behaviors in this Section 7.E.3.c.

7.E.3.d. General Guidelines:

Medical Staff Appointees who engage in disruptive unprofessional conductbehavior will

be dealt with in accordance with this policy. This policy outlines collegial steps (i.e.

counseling, warnings, meetings with a practitioner, and continuing education) that can be

taken in an attempt to resolve complaints about Unprofessional Conduct inappropriate

conduct exhibited by practitioners. However, there may be a single incident of

inappropriate conduct or a continuation of conduct so unacceptable or egregious that

immediate disciplinary action may be required. Therefore, nothing in this policy

precludes an immediate referral to the Medical Executive Committee or the elimination

of any particular step in the policy when dealing with a complaint about inappropriate

conductUnprofessional conduct. unprofessional behavior. At no time shall this policy be

construedtaken to preclude the Chief Executive Officer (CEO) or Chief of Staff (COS)

from suspending the privileges and/or taking other actions to protect the patients and staff

in accordance with these Bylaws.

7.E.3.e. Reporting Procedures

(1) Nurses, students, and other employees who are subjected to inappropriate

conduct Unprofessional Conduct unprofessional behavior by a Medical Staff

Appointee shall notify their supervisor of the occurrence, utilizing the reporting

form on the hospital’s intrAnetintranet. The Nurse Manager/Director/Vice

President will facilitate resolution of the issue. If the matter is not resolved, the

report will be forwarded to the CEO, CEO (or designee), COS, and or the

Department Chair via the Medical Staff Services Department.

(2) Any physician who is subjected to inappropriate conductUnprofessional

Conduct unprofessional behavior should report the incident directly to the COS,

CEO,CEO (or designee) or appropriate Department Chair (or their respective

delegatesVice Chair).









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3

(3) The COS/CEO CEO (or designee)/ /Chair shall request that the individual

who reported the incident document it in writing and forward the document to

Medical Staff Services. In the alternative, the COS/CEO CEO (or designee)/Chair

receiving the report shall document the incident as reported. The documentation

shall include:

(a) The date and time of the questionable behavior;

(b) A factual description of the factual unprofessional behavior;

(c) The name of any patient or patient's family member who was involved

in the incident, including any patient or patient's family member who

witnessed the incident;

(d) The circumstances which precipitated the incident;

(e) The names of other witnesses to the incident;

(f) Consequences, if any, of the inappropriate conductunprofessional

behavior as it relates to patient care, personnel or hospital operations;

(g) Any action taken to intervene in, or remedy, the incident.

(4) Within a week of the receipt of the documentation of the incident, the

Department Chair (or designee) will verify the facts of the complaint and

subsequently continue to the review procedure, if needed.

(1) Upon receipt validation of the reports, the COS, CEO CEO (or designee), or

Department Chair (or their respective delegatesVice Chair) may elect towill as

soon as possible:

(a) Discuss the matter with the involved Medical Staff Appointee and the

complainant(s) and any other knowledgeable individuals.reaffirm the

appointee’s commitment to professionalism and patient safety. The

identity of the complainant(s) shall not be disclosed to the Medical Staff

Appointee.

(b) The Medical Staff Appointee shall be advised that any retaliation

against the person reporting a concern, whether the specific identity is

disclosed or not, will be grounds for immediate disciplinary action

pursuant to these Bylaws.

(c) If the COS, CEO CEO (or designee) or Department Chair determines

reasonable suspicion exists that the Medical Staff Appointee is impaired

by physical limitation, disease, psychiatric or emotional conditions, age

related issues, or substance abuse, the Appointee shall be referred to the

























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4

Physician Wellness Committee (PWC) in accordance with the Impaired

Health Care Provider Policy (IRMC Policy 1-36.2). Further action as

specified in this policy shall be suspended until a timely review of the

incident by PWC can be completed. For cases referred to the PWC, the

PWC will report back to Medical Staff Services and the referring Medical

Staff leader.

(2) Egregious Unprofessional Conduct unprofessional behavior that includes, but

is not limited to, alleged conduct that threatens patient or staff safety (e.g.

throwing sharps, willfully disregarding sterile technique, etc.) or that which

mandates immediate investigation (e.g. sexual boundary violations,

discrimination, physical violence, etc.) will be reported for immediate

investigation to a Ccommittee consisting of the COS, CEO (or designee),

Department Chair and PWC Chair or on-call member (the Disruption Review

Committee) for immediate investigation. Following this investigation, the

Committee will submit a report with recommendations to the CEO and/or

Medical Executive Committee.

7.E.3.g. Review Procedure: Second Third Incident within Twelve (12) MonthsFive (5)

years:

(1) Upon receipt of a third report within five (5) years, the report, Medical Staff

Services Director will verify the incident represents the second third incident of

Unprofessional Conduct within in twelve (12) monthsfive (5) years and will

convey the report and the verification to a the DistruptiveDisruptive Review

cCommittee consisting of the COS, CEO CEO (or designee), Department Chair

and PWC Chair or on-call member. The Disruptive Review Committee will meet

with the Medical Staff Appointee and provide him/her with a written summary of

the complaint(s). The names of the complainant(s) shall be removed from the

report to protect anonymity.

(2) If the Disruptive Review Committee determines that a reasonable suspicion

exists that the Medical Staff Appointee is impaired by physical limitation, disease,

psychiatric or emotional conditions, age related issues, or substance abuse, the

Appointee shall be referred to the PWC in accordance with the Impaired Health

Care Provider Policy (IRMC Policy 1-36.2) and the matter shall be closed from

the proceedings outlined in this section.

(3) The PWC representative will facilitate drug testing of the Medical Staff

Appointee and arrange a meeting for the Medical Staff Appointee with the PWC.

The PWC will review the incident, interview the Medical Staff Appointee, and

submit its recommendation back to the referring committee.



















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5

(4) The identity of the complainant(s) will generally not be disclosed to the

Appointee during this process, unless the PWC agrees in advance that it is

any retaliation against an individual the person reporting a concern, whether the

immediate disciplinary action pursuant to these Bylaws.

(5) If the PWC Disruptive Review Committee determines that an incident of

inappropriate conduct has likely occurredapparent pattern of Unprofessional

Conduct unprofessional behavior exists, the PWC Disruptive Review Committee

has several options available to it, including, but not limited to, the following:

(a) Send the Medical Staff Appointee a letter of guidance about the

incidentfor formal professional evaluation by a Florida Professional

Resources Network (PRN) certified provderprovider;

(b) Send the practitioner a letter of warning. or reprimand, particularly if

there have been prior incidents and a pattern may be developing;

(d) Refer the Medical Staff Appointee for continuing education, e.g.,

training, behavior modification or, professional counseling or formal 360

degree evaluation and feedback (e.g. PULSE).

(e) Refer the Medical Staff Appointee to the Florida Physicians

Professional Resource Network (PRN).

(6) These meetings and all others, formal and informal, will be documented in the

Medical Staff Appointee's file for twelve (12) months from the date of the

incident.

7.E.3.h. Review Procedure: Third Fourth Incident within Twelve (12) MonthsFive (5)

years:

(1) Upon receipt of the report, Medical Staff Services Director will verify the

incident represents the third fourth incident of Unprofessional Conduct within in

twelve (12) monthsfive (5) years and will convey the report and the verification to

the Disruptive Review a Committee consisting of the COS, CEO CEO (or

designee), Chair and Vice Chair of the Department where the Medical Staff

Appointee is a member, and the Chair of the PWC (or their respective designees).

The Disruptive Review Committee will discuss the matter with the involved

Medical Staff Appointee and the complainant(s) and any other knowledgeable

individuals.

(2) The identity of the complainant(s) shall not be disclosed to the Medical Staff

Appointee. The Medical Staff Appointee shall be advised that any retaliation

against the person reporting a concern, whether the specific identity is disclosed

or not, will be grounds for immediate disciplinary action pursuant to these

Bylaws.








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6







(4) If the Committee determines that the Medical Staff Appointee engaged in a

significant incident and/or repetitive pattern of disruptive behavior, the The

Disruptive Review Committee will submit a report with a recommendation to the

Medical Executive Committee.

(5) The MEC may affirm, modify, or reject the recommendation(s). The MEC,

after thorough review, will forward its final recommendation(s) in writing to the

practitioner. and the complainant(s).

(6) If the MEC determines that an incident of inappropriate conducta fourth

incident of Unprofessional Conduct unprofessional behavior has likely occurred,

the MEC has several options available to it, including, but not limited to, the

following:

(a) Send the Medical Staff Appointee a letter of guidance about the

incident;

(cb) Meet with the Medical Staff Appointee as a group to counsel and

educate the individual about the concerns and, the necessity to modify the

behavior in question, and that another violation of this policy will result in

suspension and or loss of privileges as set forth in these Bylaws.;

(c) Refer the Medical Staff Appointee to the Florida Professional Resource

Network (PRN).

(d) Refer the Medical Staff Appointee for continuing education e.g.

behavior modification or professional counseling.

(8) The Medical Staff Appointee and the complainant(s) will have seven (7) days

upon receipt of the MEC report to submit a written report to the COS if they

he/she disagrees with the MEC recommendation(s).

(9) These meetings and all others, formal and informal, will be documented in the

Medical Staff Appointee's file. for twelve (12) months from the date of the

incident.

7.E.3.i. Review Procedure: Fifth Incident within Five (5) years:

















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7

(1) Upon receipt of the report, Medical Staff Services will verify the incident

represents the fifth incident of Unprofessional Conduct within in five (5) years

and will convey the report and the verification to a the Disruptive Review

Committee consisting of the COS, CEO (or designee), Chair and Vice Chair of

the Department where the Medical Staff Appointee is a member, and the Chair of

the PWC (or their respective designees). The Disruptive Review Committee will

discuss the matter with the involved Medical Staff Appointee and the

complainant(s) and any other knowledgeable individuals.

(2) The identity of the complainant(s) shall not be disclosed to the Medical Staff

Appointee. The Medical Staff Appointee shall be advised that any retaliation

against the person reporting a concern, whether the specific identity is disclosed

or not, will be grounds for immediate disciplinary action pursuant to these

Bylaws.







(4) The Disruptive Review Committee will submit a report to the Medical

Executive Committee for evaluation of appropriate action to be taken consistent

with the fair hearing process set forth in these Bylaws. Disciplinary Action as set

forth by these Bylaws..












Page 29 of 49

8

Draft Disruptive Physician Policy 7 3 E v3


Formatted: Font: Times New Roman

Page 30 of 49

6.D.7. Attendance Requirements

Each staff member is expected to attend and participate in all Medical Staff meetings and

applicable department meetings each year. Active Staff members are required to maintain

51% attendance of combined Department and Quarterly Staff meetings to maintain

voting privileges in Department and General Elections.

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3.B. ELIGIBILITY CRITERIA

Only those members of the Active Staff who satisfy the following criteria initially and

continuously shall be eligible to serve as an officer of the Medical Staff or Medical Staff

Representative to the Board. They must:

CHIEF OF STAFF

(1) be in good standing *, and

(2) must have held a position on MEC within the past ten (10) years, and

(3) is not presently be serving as a Medical Staff officer, Board member, or department

chair or vice chair at any other hospital and shall not so serve during their term of office

and

(3) agree to meet with the Nominating Committee and Joint Conference Committee to

discuss their plans/goals prior to said posting of nomination

Page 32 of 49

3.B. ELIGIBILITY CRITERIA

Only those members of the Active Staff who satisfy the following criteria initially and

continuously shall be eligible to serve as an officer of the Medical Staff or Medical Staff

Representative to the Board. They must:

VICE CHIEF OF STAFF, MEDICAL REPRESENTATIVE AND DEPT. CHAIRS

(1) be in good standing *, and

(2) is not presently be serving as a Medical Staff officer, Board member, or department

chair or vice chair at any other hospital and shall not so serve during their term of

office, and

(3) agree to meet with Joint Conference Committee to discuss their plans/goals prior to said

posting of nomination

Page 33 of 49

PART E: CONSULTATION POLICIES

1. Critical Care Practitioners who are consulted to evaluate and treat a patient in the Critical Care Unit must see said patient every twenty-four (24) hours until the condition for which the pratitioner is consulted either resolves or the patient is discharged from the Critical Care Unit.

Page 34 of 49

PART A: SCHEDULING SURGERY

2. Specific, contemplated procedures must be designated on the schedule, with the name of the physician,

name of the patient, the patient’s age, and diagnosis.

Page 35 of 49

C:\ProgramData\activePDF\Temp\DocConverter\Folders\Default\Input\2747360_Section 4 2-2 2 Qualifications - 1-19-16.docx

4.2-2.2 Qualifications. Any adult U.S. citizen who maintains a

Florida residence Florida resident is eligible to serve as an Independent

Director other than: (1) a Public Official; (2) a member of the Medical Staff

with current clinical privileges; or (3) an employee of Indian River

Memorial Hospital, Inc. or any of its subsidiaries. and affiliates.

Notwithstanding the foregoing, the Board of Directors may waive the

requirement to maintain a Florida residence for up to two (2) Independent

Directors appointed to the Board at any given time and, provided however,

that such Independent Director possess a distinctive background deemed

desirable and necessary. The Nominating Committee or the District, as the

case may be, shall find one or more of the following characteristics in

prospective Independent Directors: demonstrated management or

professional acumen, prior experience in health care delivery, a history of

voluntary service, or a particular attribute or skill considered desirable.distinctive

competency considered desirable. All Directors should possess universal

competencies as assessed by the Board in accordance with its Guidelines

for Developing Board Competency Based Standards.

Page 36 of 49

Indian River Medical Center Foundation Report


Board of Directors

December 2015

Campaign for Excellence in Cancer Care

Mounting an effective donor and community communication program October-December, the

Foundation garnered end-of-year solicitation response significantly higher than the previous

three years. Results nearly doubled the new gifts received for the same period in 2014 and

tripled the number received in 2013. Average gift amounts increased 276 percent over 2014, 556

percent over 2013 and over 2012 is 279 percent. Greater than half the new funds were

designated to support the Campaign for Excellence in Cancer Care, bringing the total campaign

total at year-end to $44 million.

The series of communiques began with a timeline of Eagle Society accomplishments,

announcement of Dr. James Grichnik’s appointment as director of Scully-Welsh Cancer Center,

Thanksgiving messages, a draft of the donor recognition listing for the cancer center and an

impressive four-page IRMC awards recap covering just a six-month period. Interspersed with

the various communications pieces were a series of annual and cancer campaign appeals.

Pivotal to the communications plan was the donor sneak preview of the Scully-Welsh Cancer

Center in mid-November, prior to its opening for patients December 7. Having received the

announcement of Dr. Grichnik’s appointment, supporters arrived in droves, despite a powerful

rainstorm, as anxious to meet the new leader as to tour the amazing healing space that is the

Scully-Welsh Cancer Center. Seeing the spectacular results of our community’s collective

philanthropic heart certainly inspired many new gifts up to and including the six-figure level.

With this strong underpinning, Community Leadership Committees are fully engaged in the

drive to complete the campaign. Eagle Society events have begun, and the seven upcoming

Eagle Dinners all feature Dr. Grichnik.

Dedication of the Scully-Welsh Cancer Center, to be held in stages on Sunday, January 24, will

lend yet another boost as we push to meet and hopefully exceed our $48-million goal.

Planned Giving

As planned giving marketing efforts continue, the Legacy Society gained nine new member

households for fiscal year 2015. Three more have joined in the first quarter of fiscal year 2016.

Page 37 of 49

Anticipating the continuation of the IRA Rollover, donors age 70.5 and older received an email

in mid-December providing an update on the status of the of the tax code extension. Congress

voted to make the IRA Rollover permanent and the President signed the change into law. The

email update resulted in several new IRA Rollover gifts and payments on pledge.

The annual Legacy Luncheon, held December 10 at Quail Valley River Club, again provided a

well-received opportunity to steward and honor Legacy Society Members. Lisa Hedenstrom,

VP Patient Care Services/Chief Nursing Officer/Chief Patient Safety Officer, addressed an

audience of 80 long-time and long-term supporters, sharing her plans for further advancement

of nursing excellence at IRMC and the personal story behind her enthusiastic support for

elevating cancer care at IRMC.

FY16 Annual Fund

There were two Annual Fund direct mail appeals in early December, one to the non-Eagles who

did not respond to the Annual Fund appeal in October, and the other to Eagle Society members

who did not respond to the Excellence in Cancer Care appeal. The December Eagle Society Annual

Fund appeal also included a gift option for Excellence in Cancer Care. As of December 31, 2015,

the Foundation received $1,241,307 in unrestricted gifts and pledges to the Annual Fund for

FY2016 vs. $1,700,607 in unrestricted gifts and pledges for the same period last year

representing a decrease of $459,300 or 27%. This decline is not surprising due to the great

emphasis on completing the Campaign for Excellence in Cancer Care. Contributions also include

honor/memorial gifts, estate distributions, unsolicited gifts, unrestricted online, personal

solicitations, and those generated by special mailings.

May Pops

Mark your calendars for the 27th annual May Pops: Sunday, May 1, 2016 at Windsor.

Page 38 of 49

PRESIDENT’S REPORT

January 2016

Senior Vice President, Chief Operating Officer Search IRMC has selected Jena Abernathy, from the Witt Kiefer Search Firm, to lead the search for a SVP, Chief Operating Officer. Witt Kiefer is a well know and highly respected search firm with a long history of health care executive search. Ms. Abernathy is a senior partner based out of Atlanta with a residence in Florida. Ms. Abernathy began her work on the search in early January and interviewed members of the executive team on January 7th. An expedited time schedule has been developed with search completion targeted for mid-April.

Chilled Water Supply Line A final design has been completed for replacing the broken chilled water supply line. The broken pipe was located underground in a tunnel connecting the power plant with the hospital. Additional pipes in the tunnel include a chilled water return line and a steam line, along with conduit for fiber-optics. The proposed solution is to relocate all three pipes (chilled water supply, chilled water return and steam) to an above ground, overhead system. The total cost is estimated at approximately $750,000 and is expected to be mostly, if not totally, covered by insurance. Because of the cost of this leasehold improvement, both IRMC Board and IRCH District Board will need to approve the expenditure. The request for approval will first be presented to the IRMC Finance Committee.

District's Provider Collaborative The Community Health Needs Assessment for Indian River County is a cooperative effort by the Indian River County Hospital District, VNA, Florida Health, Indian River County Health Department, Treasure Coast Community Health Center, Whole Family Health Center, and IRMC. A presentation of the results will be provided at a combined meeting of the Indian River County Hospital District Board and the IRMC Board on February 19, 2016 from 10 am to 2 pm. The purpose of the meeting is to develop a common understanding and prioritization of the health care needs for our community.

Scully-Welsh Cancer Program

Medical Director Dr. James Grichnik, an international expert on the diagnosis and treatment of melanoma, started as Director of the Scully-Welsh Cancer Center at Indian River Medical Center on January 4, 2016.

Cancer Center Grand Celebration

The Scully-Welsh Cancer Center was opened, providing Chemotherapy services onsite on December 7th. The Grand Celebration on January 24th will include a donor thank-you, a dedication and an open house.

Radiation Oncology Leadership As recommended by Duke, IRMC is looking to recruit leadership in Radiation Oncology. Several conversations have taken place with Duke as well as highly respected cancer programs base in Florida. The goal is to recruit leadership willing and able to work with our current radiation oncology staff. Rick Van Lith and Dr. Grichnik are leading and facilitating this process.

Page 39 of 49

Health & Wellness Center Construction on the 3 story Health and Wellness Center continues on schedule, if not slightly ahead of schedule. A walkway will connect the center with the Scully-Welsh Cancer Center and the Medical Center. Opening is still planned for late 2016. Following completion, the loop roadway will be extended south of the parking lots of Scully-Welsh and Health and Wellness, once again allowing vehicular circulation completely around the campus.

Information Services Update A group of managers and directors from various departments collaborated over the past five months to select a new Human Resource Information System. A Request for Proposal (RFP) was sent out and five responses were received. Two companies were selected, GI-API and Kronos, for on-site product demonstrations. The IRMC Team selected Kronos Corporation to provide a suite of Labor Management Products. The new contract will include:

Human Resource Information System Payroll System Time & Attendance Staff Scheduling

Planning for the next major Paragon (Hospital Electronic Health Record) system upgrade has begun. Testing of the new release will begin in February with a targeted live date in the late Fall of 2016.

May Pops Mark your calendars for the 27th annual May Pops: Sunday, May 1, 2016 at Windsor.

Year-end Pride Celebration The Pride Team Nomination Ceremony celebration was held on Dec. 14 with four new finalists and one year-end winner. Congratulations went to Sue Nyman, RN, Labor and Delivery; and Jordan Foor, Sharon Jelks and Elaine McLeod, all of Food and Nutrition Services—this quarter’s Pride Team finalists. All of these finalists received a $100 gift certificate. These employees demonstrated going above or beyond the call of duty as well as displaying the core values of compassion, respect, teamwork, excellence and accountability. Finalists are chosen by the Human Resources Advisory Committee. At the end of the year, the names of all the employees nominated throughout the year are entered in a drawing for a $1,200 grand prize. This year’s winner is Eleanor Candido, AIS Office Coordinator, Ambulatory Infusion.

Page 40 of 49

Annual Tree of Lights Becomes Interfaith Celebration of Lights The Auxiliary of IRMC held its annual Tree of Lights program on Dec. 3. This program plays a dual role as it heralds in the holidays while at the same time raises money for worthwhile projects through donations ranging from $5 to $500 toward a light for the tree. Contributions can be made for a light in honor or in memory of a relative or friend. Over 25 years ago, Florence Booms had a vision of implementing an Auxiliary fundraising program that would provide financial support to women’s and children’s programs at IRMC. It was through her commitment and dedication that the Tree of Lights program came into existence. In recognition of the program’s 25th (Silver) anniversary, the Auxiliary Executive Board renamed the program the Florence Booms’ Celebration of Lights program. This year, the program evolved to be all-inclusive for everyone to enjoy. Florence would be happy that her vision has been enhanced to include our friends that celebrate Chanukah as well as those of Christian faith. The money raised is used to purchase necessary equipment and education programs that allow the Women’s Health Care team to continue to provide quality healthcare to the community. Past purchases include newborn cardiac monitors, infant hearing screening equipment, Hugs infant security system, the overhead lullaby system, birthing beds, infant warmers, fetal monitors, apnea monitors, thermometers, otoscopes, opthalmoscopes, a bili blanket, jaundice meters, and educational programs for nurses.

Employees Champion Philanthropy at Work – One Hour at a Time Campaign Under the leadership of the campaign co-chairs and IRMC Foundation, hospital employees showed their enthusiastic support for the Philanthropy at Work employee campaign, giving more than $431,000 since September. The funding priority for this year’s campaign was Excellence in Cancer Care. Employees were given options to support the cancer campaign or an unrestricted fund. They were encouraged to consider giving “one hour of their time” on a per pay period basis, join The Eagle Society, or support the Foundation by becoming a champion for the cause. Co-chairs Tim Howald, Manager of Cardiopulmonary Services, Ali Martin, Practice Manager, Pointe West Walk-in Care and Primary Care South, and Chaplain Mindy Serafin; and Myra Burns, Development Officer, IRMC Foundation were present when Jan Donlan honored the leadership at December’s Hospital Board meeting.

The Community Remembers IRMC during the Holidays One hundred and sixty bears arrived at IRMC’s Emergency Room in style recently thanks to the generosity of Vero Beach Yacht Club members and the local community. Each holiday season the Yacht Club collects teddy bears to deliver to IRMC where they are given to children coming into the Emergency Room. The bears help these patients through what can be a scary time. A Vero Beach family donates presents every year to patients at IRMC’s Behavioral Health Center. Up to 30 patients received gifts this year. Literacy Services of Indian River County is making sure that each new mom at IRMC gets a book to read to their little one as they get older.

Page 41 of 49

2. Program/Market Development

1

FY 2016 Goals & Objectives

Initiative Metric Target 1st Qtr. Status

• Scully-Welsh Cancer Center

• Recruit Radiation Oncologist• Radiation Oncology Market Growth

(New Referrals)

• Mar. 2016• 10% Inc. vs.

FY 15

• Underway• 37% increase

(107 vs. 78)

• Grow VRA Imaging • Increase capacity for MRI Procedures • 5% Inc. vs. FY 15

• 9% increase(1,710 vs. 1,564)

• Portable MRI Unit operational

• Community Health Needs Assessment (CHNA)

• CHNA completed and Action Planpresented for Board Approval

• Jan. 2016 • CHNA completed,Plan pending

• Gastroenterology • Initiate Endoscopic Ultrasound (EUS)Program & Communicate Community Benefit

• Nov. 2015 • Program in place

• Heart Center:Electrophysiology program

• Construct facility and install equipment

• Recruit Electrophysiologist(Under contract)

• Complete: Dec. 2016

• Aug. 2016

• Design complete• In progress

• Musculoskeletal Center of Excellence

• Recruit Orthopedic Surgeon #2• Recruit Rheumatologist

• Apr. 2016• Aug. 2016

• In progress• Offer letter pending

Page 42 of 49

3. Physician/Hospital Alignment

1


Initiative Metric Target 1st Qtr. Status

• Indian River Medical Associates (IRMA)Strategically Increase Access to and Improve Quality of Care Provided

Recruitment: Community Need• Primary Care Physicians x 2 • Neurologist • Hospitalists x 2 (Total 14)

Recruitment: Strategic• Centers of Excellence

- Heart/See Electrophysiologist- Cancer/See Scully-Welsh- Ortho/See Musculoskeletal

IRMA Infrastructure• Formalize IRMA Governance Structure

to Facilitate Integration of Practices, Promote Clinical Quality and Continuum of Care

• Revise Planning, Recruitment & Contract Negotiations Processes

• Jun. & Sep. 2016• Aug. 2016• Both by Dec. 2015

• See #3. Program/Market development

• Approval by Jun. 2016

• Implement Mar. 2016

• Recruiting• Recruiting• COMPLETE

• Recruitmentunderway

• Health & Wellness Center

• Begin Construction• Move into Facility

• Nov. 15, 2015• Dec. 1, 2016

• Construction underway

• Physician Engagement

• Physician Engagement Survey(2014: Private-22nd & Employed- 55th

percentile)

• Employed: 65th

percentile• Private: 35th

percentile

• Re-survey in Sept. 2016

Page 43 of 49

Act / Bud Act / PY

Volume Actual Budget Prior Year % Var % Var

Admissions 3,798 3,940 3,862 -3.6% -1.7%

Observation Discharges 1,327 991 882 33.9% 50.5%

Total Admissions & Observation 5,125 4,931 4,744 3.9% 8.0%

Adjusted Admissions 6,442 6,698 6,341 -3.8% 1.6%

Patient Days 15,149 16,093 15,838 -5.9% -4.4%

Adjusted Patient Days 25,696 27,358 26,005 -6.1% -1.2%

Average Daily Census 165 175 172 -5.9% -4.4%

Urgent Care Visits 4,558 4,601 4,601 -0.9% -0.9%

ER Visits 14,964 15,841 15,079 -5.5% -0.8%

Surgeries 1,969 1,938 1,770 1.6% 11.2%

FTE's - Overall 1,532.5 1,505.4 1,408.4 1.8% 8.8%

AR Days 39.6 41.0 41.7 -3.5% -5.0%

Days Cash on Hand 71.7 76.0 71.0 -5.7% 1.0%

Case Mix Index 1.59 1.56 1.52 1.9% 4.6%

Income Statement Act / Bud Act / PY

(in thousands) Actual Budget Prior Year % Var % Var

Patient Revenue 56,139 57,598 53,685 -2.5% 4.6%

DSH / UPL 866 880 898 -1.6% -3.6%

Medicaid / UPL 150 162 189 -7.7% -20.8%

Other Revenue 4,011 4,024 3,795 -0.3% 5.7%

Bad Debt (2,902) (3,391) (3,901) -14.4% -25.6%

Net Revenue 58,264 59,273 54,666 -1.7% 6.6%

Total Personnel Cost 32,486 33,009 29,713 -1.6% 9.3%

Contracted and Other Services 12,277 11,989 11,628 2.4% 5.6%

Supplies 11,391 11,086 10,435 2.7% 9.2%

Depreciation 3,250 3,293 3,010 -1.3% 8.0%

Interest 81 80 87

Total Operating Exp 59,484 59,458 54,874 0.0% 8.4%

Excess (Deficit) Revenue Over Expenses (1,220) (185) (207)


Consolidated Financial InformationYTD December 2015

Year to Date

Year to Date

1,800

2,000

2,200

2,400

2,600

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

Adjusted Admissions

Actual Budget

(2,500)

(1,000)

500

2,000

3,500


Excess (Deficit) Revenue Over Expenses to Budget (In Thousands)

Actual Budget

7,500

8,500

9,500

10,500


Operating Expense Per Adjusted Admission

Actual Budget

Page 44 of 49

Act / Bud Act / PY


Admissions 3,798 3,940 3,862 -3.6% -1.7%

Observation Discharges 1,327 991 882 33.9% 50.5%

Total Admissions & Observation 5,125 4,931 4,744 3.9% 8.0%

Adjusted Admissions 6,442 6,698 6,341 -3.8% 1.6%

Patient Days 15,149 16,093 15,838 -5.9% -4.4%

Adjusted Patient Days 25,696 27,358 26,005 -6.1% -1.2%

Average Daily Census 165 175 172 -5.9% -4.4%

ER Visits 14,964 15,841 15,079 -5.5% -0.8%

Surgeries 1,969 1,938 1,770 1.6% 11.2%

FTE's - Overall 1,297.3 1,267.3 1,206.1 2.4% 7.6%

AR Days 38.1 42.0 43.3 -9.3% -12.0%

Days Cash on Hand 71.7 76.0 71.0 -5.7% 1.0%

Case Mix Index 1.59 1.56 1.52 1.9% 4.6%



Patient Revenue 45,003 46,006 44,432 -2.2% 1.3%

DSH / UPL 866 880 898 -1.6% -3.6%

Medicaid / UPL 150 162 189 -7.7% -20.8%

Other Revenue 3,384 3,412 3,295 -0.8% 2.7%

Bad Debt (2,902) (3,391) (3,901) -14.4% -25.6%

Net Revenue 46,502 47,070 44,913 -1.2% 3.5%


Contracted and Other Services 9,885 9,553 8,785 3.5% 12.5%

Supplies 10,748 10,481 9,872 2.6% 8.9%

Depreciation 2,860 2,908 2,665 -1.7% 7.3%

Interest - - -

Total Operating Exp 46,925 46,425 43,642 1.1% 7.5%

Excess (Deficit) Revenue Over Expenses (423) 645 1,271


Hospital Only Financial InformationYTD December 2015

Year to Date

Year to Date

1,800

2,000

2,200

2,400

2,600


Adjusted Admissions

Actual Budget

5,500

6,500

7,500

8,500


Operating Expense Per Adjusted Admission

Actual Budget

(2,500)

(1,000)

500

2,000

3,500



Actual Budget

Page 45 of 49

Act / Bud Act / PY


Patient Visits 36,941 40,356 35,503 -8.5% 4.1%

Urgent Care Visits 4,558 4,601 4,601 -0.9% -0.9%

Hospital Outpatient Surgeries 510 - 323 57.9%

FTE's - Overall 235.2 238.1 202.3 -1.2% 16.2%



Patient Revenue 8,281 8,703 6,544 -4.8% 26.6%

DSH / UPL

Medicaid / UPL

Other Revenue 617 602 485 2.6% 27.4%

Bad Debt - - -

Net Revenue 8,899 9,305 7,028 -4.4% 26.6%


Contracted and Other Services 1,576 1,514 1,959 4.1% -19.5%

Supplies 340 353 299 -3.7% 13.6%

Depreciation 187 195 177 -3.9% 5.9%

Interest - - -

Total Operating Exp 10,239 10,708 9,004 -4.4% 13.7%

Excess (Deficit) Revenue Over Expenses (1,340) (1,403) (1,976)


Physician Financial InformationYTD December 2015

Year to Date

Year to Date

-

5,000

10,000

15,000

20,000


Total Patient and Urgent Care Visits

Actual Budget

(2,000)

(1,000)

0

1,000

2,000



Actual Budget

-

1,000

2,000

3,000

4,000

5,000


Operating Expense

Actual Budget

Page 46 of 49



Patient Revenue 2,854 2,889 2,710 -1.2% 5.3%

DSH / UPL 0 0 0

Medicaid / UPL 0 0 0

Other Revenue 9 15 15

Bad Debt - - -

Net Revenue 2,864 2,903 2,725 -1.4% 5.1%

Total Personnel Cost 919 880 825 4.4% 11.4%

Contracted and Other Services 816 923 884 -11.6% -7.7%

Supplies 303 253 264 19.6% 14.8%

Depreciation 202 190 168 6.6% 20.3%

Interest 81 80 87 0.9% -7.2%

Total Operating Exp 2,320 2,325 2,227 -0.2% 4.2%

Excess (Deficit) Revenue Over Expenses 543 578 498 -6.0% 9.2%


Outpatient Imaging Services Financial InformationYTD December 2015

Year to Date

Page 47 of 49

4. Financial Performance

1


Initiative Metric Target Status as of

12/31/15

• Improve Profitability • EBITDA • $16.8 Million • $2.4 M Actual• $3.5 M Budget

• Reduce Accounts Receivable Days

• Days Revenue in Accounts Receivable

• 40 Days at Sept. 30, 2016

• 39.6 Days

• Maintain Cash Balance • Cash and Cash Equivalents • $ 46.25 Million at Sept. 30, 2016

• $41.0 M

• Increase Point of Service Collection

• Upfront Cash Collection • $ 3.0 Million or Greater

• $546 K Actual vs. $545 K Budget

• Manage Operating Expense / Adjusted Admit

• Total Exp. / Adj. Adm.• Labor Exp. / Adj. Adm.• Supply Exp./ Adj.Adm.

• $7,660• $3,960• $1,730

• $7,814• $4,267• $1,490

• EMR Meaningful Use • Stage 2- Year 2 Completed • Sept. 2016 (CMS changed to Dec. 2016)

• Pending

• ICD-10 • Hospital Discharged Not Final Billed %

• 14% of Net A/R, or less

• 35% of Net A/R

• Employee Retention • Employee Turnover Rate (FY 15 – 24%)

• 20% or lower • 1st Qtr. To be Compiledweek of 1/18/2016

Page 48 of 49

IRMC Board Education Plan

General Education

1. Stewardship Report – December 2015

2. Information Systems Security & Risk

Management/Compliance – February 2016

3. Board Role in Quality – May 2016

4. TBD – October 2016

Page 49 of 49

Documents

Indian River Memorial Hospital, Inc. d/b/a...Indian River Memorial Hospital, Inc. d/b/a Indian River Medical Center January 21, 2016 at 10:00 a.m. Boardroom 1000 36th Street Vero Beach,