Board of Curators Health Affairs CommitteeJune 11, 2018

Patrice “Patrick” Delafontaine, MDHugh E. and Sarah D. Stephenson Dean, MU School of MedicineProfessor of Medicine and Medical Pharmacology & Physiology

OPEN – HEALTH AFF – INFO 2 – 1

(all years shown as of January 1)

UP Finance Summary – FYTD 2018 April

Actual AprilFYTD 2017

Budget AprilFYTD 2018

Actual AprilFYTD 2018

Percent ChangeBudget FY18 vs.

Actual FY18

Percent ChangeActual FY17 vs.

Actual FY18SOMNet Work RVUs (Physician) 1,943,042 1,937,600 1,935,258 0% 0%Net Work RVUs (Non-Physician) 317,834 336,810 328,057 -3% 3%

Total Net Work RVUs 2,260,877 2,274,410 2,263,315 0% 0%

Clinic Visits 532,223 538,789 563,585 5% 6%

Total Net Charges 445,535,300$ 446,731,600$ 449,713,319$ 1% 1%

RVU-Generating Collections 159,924,928$ 162,259,864$ 160,210,761$ -1% 0%Non RVU Generating Collections less fees 4,675,936$ 4,236,214$ 4,791,974$ 13% 2%Meaningful Use/Quality Incentives 898,692$ 397,754$ 448,861$ 13% -50%

Total SOM Collections 165,499,555$ 166,893,832$ 165,451,597$ -1% 0%Total NonSOM Collections 4,474,563$ 4,340,830$ 5,881,598$ 35% 31%Total UP Collections 169,974,118$ 171,234,662$ 171,333,195$ 0% 1%

PAF FTE (Physician) 451 400 469 17% 4%Clinical FTE (Physician) 282 N/A 287 N/A 2%Clinical FTE (Non-Physician) 130 N/A 150 N/A 15%

WRVUs per CFTE (Physician) 6,895 N/A 6,748 N/A -2%RVUs per CFTE (Non-Physician) 2,445 N/A 2,191 N/A -10%

Strong top line revenue against flat fixed fee schedule payor contractsOPEN – HEALTH AFF – INFO 2– 2

Budget to ActualClinical Challenges and Opportunities

• Revenue Cycle Conversion• Value Based Care and At-Risk Contracts

– MU/Cerner Value-Based Care Retreat (04/20/18)– MPACT– Custom Network– Missouri Custom

• Directed Payments (by Managed Medicaid)• Outreach and Clinical Footprint Development

OPEN – HEALTH AFF – INFO 2– 3

(all years shown as of January 1)

UP 2018 Initiatives

• Extend Medicaid Support Funding to Managed Medicaid Eligibles• July 1 Approval - $2.5m per quarter additional payment

• Tie Staffing & Productivity to Peer Institution Performance Benchmarks

• Achieve Monthly Cash Collections Target of $16.5m

• Support Year 1 OIG CIA Review & Plan for more efficient 2018 Review

• Initiate Planning for Cerner Revenue Cycle Conversion• Project Design Phase – July 18, Projected Live Date March 2020• Includes Capital Region Medical Center EMR & Revenue Cycle

• Initiate External Documentation & Coding Review of ALL services• Coordinating with Compliance to ensure quality & reimbursement

OPEN – HEALTH AFF – INFO 2 – 4

(all years shown as of January 1)

Unique Medicaid Patients

CMS & MO Health Net Working to Provide Managed Medicaid Directed PaymentsRewards Safety Net Medical Groups & Hospitals for Medicaid Access

Transition to Managed Care Medicaid Accelerating – we accept all eligibles as 1 of 2 Designated Safety Net Hospitals in Missouri (UMKC-Truman is the other)ng top line revenue against flat fixed fee contracts

OPEN – HEALTH AFF – INFO 2 – 5

(all years shown as of January 1)

Medicaid Shift

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$3,000,000

$3,500,000

$4,000,000

Jul,2016

Aug,2016

Sep,2016

Oct,2016

Nov,2016

Dec,2016

Jan,2017

Feb,2017

Mar,2017

Apr,2017

May,2017

Jun,2017

Jul,2017

Aug,2017

Sep,2017

Oct,2017

Nov,2017

Dec,2017

Jan,2018

Feb,2018

Medicaid and MC+ Shift

MC+ Net Payments Medicaid Net Payments

Linear (MC+ Net Payments) Linear (Medicaid Net Payments)OPEN – HEALTH AFF – INFO 2 – 6

(all years shown as of January 1)

Merit-based Incentive Payment System (MIPS)

• MIPS is 1 of 2 tracks of the Quality Payment Program (QPP)• MIPS has 4 categories: Total Score 100 points

• Quality = 60%• Cost = 0%• Improvement Activities [IA] = 15%• Advancing Care Information [ACI] = 25%

• UP Total MIPS Score 93.1 points*Category % Weight UP Points

Quality 60% 53.1Cost 0% NA

IA 15% 15ACI 25% 25

100% 93.1

* Does not include the readmission measure – calculated by CMSOPEN – HEALTH AFF – INFO 2 – 7

Average undergraduate cumulative GPA 3.74Average undergraduate science GPA 3.683.8 GPA or higher 58%

Male 47%Female 53%Age range 22 - 36

Missouri residents 85%Out-of-state residents 15%

MCAT average 78% (508) MCAT Median 78% 70% MCAT or higher 79%

OPEN – HEALTH AFF – INFO 2 – 8

Accepted = 112

Rural H.S. 10%Low SES 23%African American 12.5% Hispanic 5%American Indian 1%Other Minorities 16%

OPEN – HEALTH AFF – INFO 2 – 9

URM Matriculants

2018 21 (18.75%)2017 13 (10%)2016 9 (8%)2015 6 (5%)

In State Matriculants

2018 95 (84%)2017 104 (81%)2016 89 (85%)2015 81 (77%)

Multiple Accepts, but Matriculated to Mizzou2018 38 (33%)2017 34 (26%)2016 33 (31%)2015 30 (28%)

Out of State Matriculants

2018 17 (15%)2017 24 (18%)2016 15 (14%)2015 23 (22%)

(as of 5/25/2018)

OPEN – HEALTH AFF – INFO 2 – 10

Shared Credit Research Expenditures YTD

Research Expenditures NIH Research Expenditures

$19,283,390 $21,285,689 $22,775,301

$84,198,211 $83,121,568 $86,760,004

$-

$10,000,000

$20,000,000

$30,000,000

$40,000,000

$50,000,000

$60,000,000

$70,000,000

$80,000,000

$90,000,000

$100,000,000

Research Expenditures SOM

Research Expenditures Campus

22.9%25.6% 26.3%

$12,306,115 $13,282,907

$14,361,631

$25,897,234 $27,090,445

$28,735,558

$-

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

FY16 YTD FY17 YTD FY18 YTD

NIH Research Expenditures SOM

NIH Research Expenditures Campus

47.5% 49%50%

OPEN – HEALTH AFF – INFO 2 – 11

Budget to ActualProgram Project Planning Grants

• 5 internal $75K SOM awards in March 2018, conditioned upon submission of a competitive multi-project application to NIH within 18 months (by October 2019)

• Luis Martinez-Lemus, DVM, PhD, “Novel Targets Underlying Vascular Stiffening in Type 2 Diabetes”

• Kerry S. McDonald, PhD, “Pathogenic Mechanisms & Genetic Therapy for Dystrophic Cardiomyopathy”

• Debra Parker Oliver, PhD, MSW, “Informatics to Facilitate Caregiver Engagement in Advanced Cancer Care”

• Kevin Staveley-O’Carroll, MD, “Immunotherapies to Cure Hepatocellular Carcinoma (HCC)”

• Edward T. H. Yeh, MD, “Heart Failure with Preserved Ejection Fraction (HFpEF)”

OPEN – HEALTH AFF – INFO 2 – 12

Questions

OPEN – HEALTH AFF – INFO 2 – 13