BOARD OF DIRECTORS AGENDA PACKET - Palomar Health · 9/12/2011 · • Board Quality Review Director Bassett stated that the Board Quality Review Committee summary is included in

BOARD OF DIRECTORS AGENDA PACKET

September 12, 2011

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

in the communities we serve.

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

PALOMAR POMERADO HEALTH BOARD OF DIRECTORS

T.E. Kleiter, Chairman

Nancy L. Bassett, RN, MBA, Vice Chairman Jerry Kaufman PTMA, Secretary

Linda C. Greer, RN, Treasurer Bruce Krider, MA

Marcelo Rivera, MD Stephen P. Yerxa

Michael H. Covert, FACHE, President and CEO

Regular meetings of the Board of Directors are usually held on the second Monday

of each month at 6:30 p.m., unless indicated otherwise For an agenda, locations or further information

call (858) 675-5106, or visit our website at www.pph.org

MISSION STATEMENT

The Mission of Palomar 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

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

Professionalism

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

Highest Quality

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

Affiliated Entities

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

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

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Time PageI. CALL TO ORDER 2

II. OPENING CEREMONY 5A. Pledge of Allegiance

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

IV. MINUTES * 5 5-10A. Regular Board Meeting - August 8, 2011

V. APPROVAL OF AGENDA to accept the Consent Items as listed * 5 11-23A. July 2011 & YTD FY2011 Financial Report (Addendum A)B. Approval of Revolving, Patient Refund & Payroll Fund Disbursements– July 2011

1. Accounts Payable Invoices2. Net Payroll

TotalC. Ratification of Paid BillsD. Bloom Energy - Fuel Cells

VI. REPORTS A. Medical Staffs

*1. Palomar Medical Center - John Lilley, M.D. 5 24-56A. Credentialing and ReappointmentsB. Department of Surgery Rules and RegulationsC. Department of OB/GYN Clinical Privilege Checklist

*2. Pomerado Hospital - Roger Acheatel, M.D. 5 57-58A. Credentialing and Reappointments

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

A. Update on PPHF Activities

2 Chairman of the Board - Ted Kleiter 10 Verbal Report

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

F. Arch Health Partners – Request for Equity Transfer to Open a San Marcos Office

$45,064,971.00$12,091,497.00$57,156,468.00

E. BridgeSpine Supply Agreement

E. Physician Independent Contractor Agreement - Information Systems Services

PALOMAR POMERADO HEALTH

BOARD OF DIRECTORS REGULAR MEETING AGENDA

Monday, September 12, 2011 Pomerado Hospital Commences 6:30 p.m. Meeting Room E 15615 Pomerado Road Poway, CA 92064

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.”

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VII. INFORMATION ITEMS 5 59-71A. Program Review – Perinatology Program

VIII. COMMITTEE REPORTS 40 72-77A. Audit and Compliance Committee - Did not meet in AugustB. Governance CommitteeC. Human Resources CommitteeD. Community Relations CommitteeE. Facilities and Grounds CommitteeF. Quality Review CommitteeG. Strategic Planning Committee

* H. Finance Committee

I. Other Committee Chair Comments on Committee Highlights

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

X. ADJOURNMENT

A. Resolution No. 09.12.11(03)-01 Designating Subordinate Officers of the District

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Palomar Pomerado Health BOARD OF DIRECTORS

REGULAR BOARD MEETING Palomar Medical Center / Graybill Auditorium

Monday, August 8, 2011

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY

CALL TO ORDER 6:30P.M. Quorum comprised Directors Bassett, Kaufman, Kleiter, Krider, Rivera and Yerxa Excused: Director Greer

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 Pacita Balcom spoke about layoffs. Sara Gurling spoke about layoffs. Danny Thomas spoke about the CCU/ICU at Palomar Medical Center West.

APPROVAL OF MINUTES • Regular Board Meeting

July 11, 2011 • Closed Board Meeting July 11, 2011 • Closed Board Meeting July 11, 2011

MOTION: by Bassett, 2nd by Kaufman and carried to approve the regular Board meeting minutes of July 11, 2011, and the closed Board meeting minutes of July 11, 2011 as submitted. All in favor. None opposed.

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APPROVAL OF AGENDA (to accept the Consent Items as listed) A. June 2011 & YTD FY2011 Pre- Audit Financial Statement Close B. Approval of Revolving, Patient Refund and Payroll Fund Disbursements–June 2011

Accounts Payable Invoices $59,253,413.00 Net Payroll

$11,990,811.00 Total $71,244,225.00

C. Ratification of Paid Bills D. Physician Recruitment Agreement - Paul Kim, M.D. E. Physician Recruitment Agreement - Oliver Lee, M.D. F. Physician Recruitment Agreement - Ranjini Madhavan, M.D.

MOTION: by Rivera, 2nd by Kaufman and carried to approve the Consent Items A – F, as submitted. All in favor. None opposed.

PRESENTATIONS Kay Stuckhardt and Nancy Roy Ms. Stuckhardt and Ms. Roy presented an

update of the community action council projects. A list of all the community action council partners was distributed to the Board. The community outreach chairs and vice chairs presented the Board with a “check” to represent the dollar amount of the volunteer hours contributed to the community action projects.

REPORTS Medical Staff Palomar Medical Center

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

MOTION: by Bassett, 2nd by Krider and carried to approve the Palomar Medical Center Medical Staff Executive Committee credentialing recommendations for the Palomar Medical Staff, as presented.

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All in favor. None opposed.

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

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

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

Administrative Chairman - Palomar Pomerado Health Foundation

John Forst

Mr. Forst stated that the Foundation Ad Hoc Investment committee is in the process of transitioning the portfolio report to Merrill Lynch. Mr. Forst stated that there will be a new Foundation Board member orientation. Mr. Forst has asked Mr. Hemker to speak at the orientation. Mr. Forst will be chairing the Ad Hoc committee for the Night of Night’s Gala and the PMC West grand opening. Dr. Kovner will be hosting a fireside chat on Wednesday, August 10th. Dr. Kovner has asked Mr. Bracht to speak at the event. John and Mary Clark will be hosting their annual Summer Social on Wednesday, August 31st at 6:00P.M. Mr. Forst stated that Anita Fraley will be filling in for Terry Green after his last day on September 2nd.

Chairman of the Board Ted Kleiter Chairman Kleiter stated that he will be

attending the ACHD retreat later this month.

President and CEO Lorie Shoemaker (standing in for Michael

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Covert) Ms. Shoemaker thanked the Board, Executive

Management Team and Nursing Executive Team for their support while filling in as CEO. Ms. Shoemaker announced that Brenda Turner was voted the HR Professional of the Year for San Diego County by the San Diego Business Journal. Ms. Shoemaker congratulated Kim Colonnelli on her recent graduation from the Wharton Nursing Fellowship Program. Ms. Shoemaker stated that a search firm has been hired to recruit for the Chief Development Officer position. Ms. Shoemaker stated that candidates for the Compliance Officer position are actively being sourced. Ms. Henderson provided a brief updated on Clarity. Ms. Henderson stated that the staffing of Clarity champions is continuing. Staff is continuing to prioritize and work through ongoing operational issues. Thursday meetings with physicians are continuing. The physician specific help line is available 24hrs a day. Ms. Henderson stated that 45 specific issues have been resolved in the past two weeks.

COMMITTEE CHAIR COMMENTS

• Audit and Compliance Director Bassett stated that the Board Audit and Compliance committee summary is included in the packet for review.

• Governance Director Krider stated that the Board Governance committee summary is included in the packet for review. Succession Policy – GOV 30 will be revisited by the Governance committee at the August 16th meeting.

• Human Resources Director Yerxa stated that the Board Human

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Resources committee did not meet in July. • Community Relations Director Kaufman stated that the Community

Relations committee reviewed the results of the Community Survey.

• Board Facilities and Grounds

Director Rivera stated that the Board Facilities and Grounds committee met earlier today. Director Rivera stated that PMC West is on schedule. The potential change in landscaping will be compensated with other areas on site. The flag pole will be brought back to the committee for further review. Director Rivera stated that the community room will be shelled out to start. The Bloom energy fuel cells were approved and will go to the Finance committee for approval. The Ramona project was approved by the County and will now go to the Planning committee in Ramona.

• Board Quality Review Director Bassett stated that the Board Quality Review Committee summary is included in the packet for review. Ms. Bassett stated that she met with Ms. Reinbold to revise the way information is currently being presented at the committee meetings. There will now be ten minutes for presentation and then ten minutes for questions or follow up. The Board Quality Review committee will meet tomorrow evening at 6:00P.M. at Grand.

• Finance Mr. Hemker stated that the Board Finance Committee summary is included in the packet for review. Mr. Hemker asker for a motion to adopt Resolution No. 08.08.11 (01) – 01 authorizing the County of San Diego to levy and collect the required ad valorem taxes for the 2011-

MOTION: by Kaufman, 2nd by Krider and carried to approve the adoption of Resolution No. 08.08.11 (01) – 01 authorizing the County of San Diego to levy and collect the required ad valorem taxes

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2012 tax roll in the amount of $23.50/$100,000 of assessed value. Mr. Hemker asked for a motion to approve Resolution No. 08.08.11(02) – 02 Establishing the Appropriations Limit of the District for Fiscal Year July 1, 2011 – June 30, 2012 Pursuant to Article XIII(B) of the California Constitution.

for the 2011-2012 tax roll in the amount of $23.50/$100,000 of assessed value. All in favor. None opposed. MOTION: by Kaufman, 2nd by Krider and carried to approve Resolution No. 08.08.11(02) – 02 Establishing the Appropriations Limit of the District for Fiscal Year July 1, 2011 – June 30, 2012 Pursuant to Article XIII(B) of the California Constitution.

• Strategic Planning Chairman Kleiter stated that the Board Strategic Planning committee did not meet in July.

ADJOURNMENT 7:40P.M. SIGNATURES

Board Secretary

Board Assistant

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

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July 2011 & YTD FY2012 Financial Report

Form A - Financial Report.doc

TO: Board of Directors

MEETING DATE: Monday, September 12, 2011

FROM: Robert Hemker, CFO

BY: Board Finance Committee Monday, August 29, 2011

Background: The Board Financial Reports (unaudited) for July 2011 and YTD FY2012 are submitted for the Board’s approval.

Budget Impact: N/A

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Board Financial Reports (unaudited) for July 2011 and YTD FY2012.

Motion: X

Individual Action:

Information:

Required Time:

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Bloom Energy Fuel Cells

Form A - Bloom Energy.doc

TO: Board of Directors MEETING DATE: Monday, September 12, 2011 FROM: Barbara Hamilton, System Sustainability Manager BY: Board Finance Committee Monday, August 29, 2011 Background: In addition to Energy Efficiency measures across the health system, Facilities and Sustainability have reviewed opportunities for alternative energy generation. With current Federal and State incentives, a Bloom Energy Solid Oxide Fuel Cell project for PPH (1 MW at each of the three hospital campuses) would save millions of dollars over the life of the project, as well as reduce the human health and environmental impacts of our high energy demands. Budget Impact: Positive – $7,560,000 (potentially as much as $8.5 million) California Public Utilities Commission (CPUC) incentive paid directly to PPH. Estimated $54.5 million in cumulative cash savings over 20-year life.

Staff Recommendation: Approval of the Bloom Energy Fuel Cell project


COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of a request to move forward with a project to install Bloom Energy Solid Oxide Fuel Cells as an alternative energy solution at all three campuses, subject to Management’s finalization of due diligence, including the accounting structure and the ability to finance the project without affecting the District’s cash flow or debt capacity. Motion: X Individual Action: Information: Required Time:

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Bloom Energy Fuel Cells

PPH Board of Directors

Finance Committee

August 29, 2011

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What is a Fuel Cell?

Fuel Cell25 W

Stack1 kW

Module25 kW

System200 kW

Solution200 kW to

MW’s

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How does it work?

Fuel

Air

e- e- e-

Fuel Passes Over the Anode Oxygen Ions React with Fuel in Fuel Cell Reaction Produces Electricity

Air Passes Over the Cathode

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Three PPH Campuses

• 1MW installation site identified on each hospital campus

• Performance of the systems monitored and measured by Bloom’s Remote Monitoring Center

• Performance Guarantee

– Systems are typically performing at 99% for total output and 53% for efficiency

– If performance falls below 95% total output factor or 50% efficiency, then Bloom will provide monetary compensation

Total Annual kWh Electric Consumption 58,435,128Annual kWh from 3MW Fuel Cells 25,491,600% Power from Fuel Cells 43%

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Calculation for Operational Savings

Savings and Costs based on a 2011 Start (all numbers in 2011 Dollars)

20 Year Total ($)

Total Upfront Cost(Financed amount is $26,568,000) ($0)

Less CA Rebate (Self Generation Incentive Program) $7,560,000

Less Total FITC ($7,997,625 to lessor; applied to principle) $0

Total Net Upfront Cost $7,560,000

Value of Avoided Electricity Costs and Benefits (20 yrs) $130,923,322

Less Operating Costs ($59,059,740)

Less Lease Payments + Closing Costs (10 yr term)* ($24,880,821)

Total Operational Savings $46,982,761

Total Net Cash Flow $54,542,761

Total NPV @ 5.1% $28,982,635

Lifetime Average Cost per kWh $0.086

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Why now?

• Real Cost Savings

• Real Value

• Hedge against rising costs of electricity

• Energy Security

• Thought Leadership (Being First)

• Environmental Stewardship

• Media Benefit

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BridgeSpine Supply Agreement

Form A - BridgeSpine.doc

TO: Board of Directors MEETING DATE: Monday, September 12, 2011 FROM: Natalie Bennett, Manager Program Development BY: Board Finance Committee Monday, August 29, 2011 Background: Currently at PPH, any spine implant vendor can do business at PPH as long as the vendor is willing to meet our annually established construct pricing. BridgeSpine is a Physician Owned Distributor (POD) that is interested in doing business at PPH. This contract is a supply vendor agreement for spinal implants that would initiate on October 1, 2011. As the vendor is a physician-owned company, with the physician owners also practicing professionally at PPH, the agreement is being brought forth through the Board Finance Committee, consistent with policy, for consideration.

Budget Impact: No additional budget impact to PPH, as the costs associated will meet the established construct pricing parameters applicable to all vendor agreements.

Staff Recommendation: Staff recommended approval of the agreement.

Committee Questions: The Board Finance Committee questioned the legality of PODs and was assured by counsel that they are legal entities under current laws; however, that designation is under review and may change in the future.

COMMITTEE RECOMMENDATION: Reviewed and recommended approval of a request to enter into a legally formed agreement with the physician owned distributor (POD) BridgeSpine, such agreement to be reasonable and consistent with fair market value and to be entered into with the understanding that it must contain an immediate cease and desist clause in the event that PODs become illegal. Also supportive of the business reasons behind PODs and recommended that a Board policy be developed through the Board Governance Committee to cover these arrangements on a go-forward basis. Motion: X Individual Action: Information: Required Time:

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Arch Health Partners Request for Equity Transfer

to Open a New Office Location in San Marcos

Form A - San Marcos.doc

TO: Board of Directors MEETING DATE: Monday, September 12, 2011 FROM: Vicky Lister, FACHE, Executive Director, Arch Health Partners BY: Board Finance Committee Monday, August 29, 2011 Background: Arch Health Partners (AHP) continues to recruit Primary Care Physicians to achieve its long-term strategic plan of growing primary care to support PPH specialists and service lines. Recently, AHP recruited Cheng Lin (Oliver) Lee, M.D., to begin practice in San Marcos. Dr. Lee’s recruiting assistance agreement was approved at last month’s Board Finance Committee and Board meetings. AHP plans to lease Suite 205 of the SMACC Building from PPH to open a new office location. The suite is adjacent to PPH’s Corporate Health office. The addition of X-ray equipment in the office will also benefit Corporate Health patients. In addition to Dr. Lee, AHP will staff the office with either a combination of a Nurse Practitioner, a Physician’s Assistant or another physician.

Budget Impact: The opening of an office in San Marcos, in Suite 205 of the SMACC Building, requires an equity transfer from PPH in the amount of $268,000. This funding will be used for tenant improvements, as well as for the purchase of hardware/software, furniture and equipment, including an X-ray unit, for the office.

Staff Recommendation: PPH Management recommended approval at the Board Finance Committee meeting.


COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval for an equity transfer of $268,000 to assist Arch Health Partners in the opening of an office in Suite 205 of the SMACC Building, located at 120 Craven Road in San Marcos, for the provision of primary care services. Motion: X Individual Action: Information: Required Time:

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PALOMAR POMERADO HEALTH PHYSICIAN INDEPENDENT CONTRACTOR AGREEMENT

INFORMATION SYSTEMS SERVICES

Physician Independent Contractor Agreement - Form A - 9-12-11

TO: Board of Directors MEETING DATE: Monday, September 12, 2011 FROM: Ben Kanter, MD, CMIO, Paul S. Peabody, CIO Background: Palomar Pomerado Health (PPH) requires the active involvement of physicians in many aspects of Information Systems programs. A Physician Advisor Council was active during the development phase of the Clarity Electronic Health Record. Now that Clarity has been implemented the Physician Advisor Council will reconvene to assist PPH in improving the efficient and effective use of Clarity. The physicians indicated below will be reimbursed for their work effort according to standard and customary manners and rates. This contract refers to all of these physicians:

• Tom Velky, M.D. • George Moore, M.D. • Sabiha Pasha, M.D. • Greg Hirsch, M.D. • David Cloyd, M.D.

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: Motion: Individual Action: Information:

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PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT

Section Reference

Term/Condition

Term/Condition Criteria

TITLE Independent Contractor Agreement between Tom Velky, M.D., George Moore, M.D., Sabiha Pasha, M.D., Greg Hirsch, M.D., David Cloyd, M.D. and Palomar Pomerado Health

AGREEMENT DATE Last date of signature.

PARTIES Tom Velky, M.D., George Moore, M.D., Sabiha Pasha, M.D., Greg Hirsch, M.D. and David Cloyd, M.D.

PURPOSE To assist PPH in improving the efficiency and effectiveness of the Clarity Electronic Health Record System particularly as it pertains to Physician Order Entry and documentation.

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

PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year

RENEWAL No automatic renewal

TERMINATION 10 day notice by either party without cause

COMPENSATION

METHODOLOGY Hourly

BUDGETED YES NO – IMPACT: None

EXCLUSIVITY NO

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

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

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

development COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee ____________

BOD

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TO: Board of Directors MEETING DATE: Monday, September 12, 2011 FROM: Sheila D. Brown, Chief Clinical Outreach Officer Thomas Kelly, MD, Medical Director, Perinatology Program BY: Board Finance Committee Monday, August 29, 2011 Background: In 2006, the Departments of OB/GYN at Palomar Medical Center and Pomerado Hospital were presented the recommendation to proceed with an agreement with UCSD for Perinatology Professional and Medical Director services, including on-call coverage, inpatient consultation, diagnostic and therapeutic perinatal services, and administrative oversight for the Palomar Pomerado Health Perinatal Program. The Perinatology Professional Services and Medical Director Agreement was implemented in July 2006, providing 24-hour, 7-day-a-week Perinatology consultation services for the Palomar Pomerado Health district. In November 2006, the Perinatal Testing Center opened at Palomar Medical Center, providing outpatient services, including perinatal consultation, obstetrical ultrasound, genetic counseling, and diabetes management. The Perinatology Program performance evaluation will be presented. Budget Impact: Positive financial performance based on a 5-year comparison to original projections. Staff Recommendation: Continue provision of service and continue to evaluate future expansions to accommodate the district as needed Committee Questions:

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

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Palomar Pomerado HealthPerinatology Program Review

Sheila Brown, FACHE, Chief Clinical Outreach OfficerDr. Thomas Kelly, Medical Director, Perinatology Program

Board Finance Committee Meeting August 29, 2011

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Perinatology Services Review

Perinatology Services Available

Palomar Pomerado Health, in collaboration with the University of California San Diego Perinatal Associates, provides a full spectrum of antenatal assessment at Palomar Medical Center, including:

High-resolution ultrasound testing to provide a detailed view of fetal anatomy, growth and overall well-beingFetal diagnosis and case coordination for those with anomaliesConsultative assessment and coordination of care for fetuses with growth disorders, multiple gestations and women at risk of preterm birthClinical case management for women with diabetes as well as consultative management for those with other medical or surgical conditions during pregnancy

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• 24 hour on call availability for telephone and/or bedside consultation

• 3 days/week on-site clinic at Palomar– Fetal imaging

– Consultative management

• Inpatient consultations to assist the obstetrician for the care of the admitted high risk mother

• Quarterly Morbidity and Mortality Conferences

• Monthly Fetal Heart Tracing education meetings for nursing

• Assistance in developing policies and procedures

Perinatology Services Available


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Palomar Perinatology Imaging Volume and Evaluation Management CPTs for CY 2007-2010

Palomar Medical Center Out Patient Services

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• 99 cases followed– 74% Gestational Diabetes Mellitus– 26% Type II– 80% required medication

• Prepregnant Body Mass Index 31– Range 22-58– 44% Obese– 22% Class II & Class III

• Gestational Age (avg)– At referral 26 week (range 7-38 week)– At delivery 38 week (range 33-40 week)

PPH Diabetes in Pregnancy (2010-2011)


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• Gestational Age Delivery 37.9 wk– Preterm Delivery 8%

• Primary Cesarean Section 29%

• Repeat Cesarean Section 21%

• Average Body Weight 3.5 Kg

– Macrosomic 15%

• Neonatal– NICU admits 8.7%– Hypoglycemia 18%

Diabetes Outcomes (2010-2011)

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Average A1C Measurement Data January to December 2010

• 93 Women having A1C results available• 33 Women

with initial A1C ≥ 6%

0

1

2

3

4

5

6

7

8

1 2 3

7.7 % InitialA1C

6.3 % 2nd A1C

6.2 %3rd A1C

99 Women followed

Results• A1C decrease

7.7 to 6.2% 1.5%

decrease

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• Improved access for Perinatal care– Reduced need for travel to San Diego

• Improved coordination of care– Diabetes

– Inpatient

– Facilitate appropriate transfers to tertiary facility as needed

• Best Practices– Tocolysis for preterm labor

– Magnesium for neuroprotection

– Progesterone for patients with prior preterm birth

• Quality / Safety– Fetal heart monitoring exercises

Program Advantages


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PALOMAR MEDICAL CENTER

PERINATOLOGY FINANCIAL EVALUATIONYears 1 thru 5 Results Compared to Original Projections

Projected Year 1

Projected Year 2

Projected Year 3

Projected Year 4

Projected Year 5

Projected Total Years

1 Thru 5Actual

FY 2007Actual

FY 2008Actual

FY 2009Actual

FY 2010

Annualized FY 2011

Based on 11 Mos

Actual Total Years

1 Thru 5

Actual Results Better / (Worse)

Than Projected

OUTPATIENT SERVICESOPERATING REVENUEInpatient Revenue 0 0 0 0 0 0 0 0 0 0 0 0 0Outpatient Revenue 2,221,134 2,518,766 2,856,281 3,239,022 3,673,051 14,508,254 2,081,432 3,560,666 3,943,457 4,572,055 5,132,458 19,290,068 4,781,814 Gross Patient Revenue 2,221,134 2,518,766 2,856,281 3,239,022 3,673,051 14,508,254 2,081,432 3,560,666 3,943,457 4,572,055 5,132,458 19,290,068 4,781,814

Less Deductions From Revenue 1,763,028 1,999,273 2,267,176 2,570,978 2,915,489 11,515,944 1,644,331 2,859,215 3,209,974 3,703,365 4,080,304 15,497,189 (3,981,245)

Total Net Revenue 458,106 519,492 589,104 668,044 757,562 2,992,310 437,101 701,451 733,483 868,690 1,052,154 3,792,879 800,570

OPERATING EXPENSESDirect ExpenseSalaries and Wages (1) 218,847 227,600 236,705 246,173 256,020 1,185,344 135,089 326,239 369,123 384,411 417,014 1,631,876 (446,532)Employee Benefits 32,827 34,140 35,506 36,926 38,403 177,802 11,255 49,857 42,491 50,548 61,763 215,914 (38,113)Unassigned Benefits 24,073 25,036 26,037 27,079 28,162 130,388 13,509 32,624 36,912 38,441 41,701 163,188 (32,800) Total Salaries and Benefits 275,747 286,777 298,248 310,178 322,585 1,493,533 159,853 408,720 448,527 473,400 520,479 2,010,978 (517,445)Professional Fees 150,000 150,000 150,000 150,000 150,000 750,000 156,006 208,010 208,010 208,010 208,010 988,046 (238,046)Supplies 18,455 19,845 21,341 22,950 24,680 107,271 8,314 6,706 9,998 7,569 17,004 49,591 57,680Purchased Services / Maintenance / Repair 0 8,200 8,200 8,200 8,200 32,800 6,851 832 3,519 110 7,202 18,514 14,286Depreciation and Amortization 70,019 70,019 70,019 70,019 70,019 350,097 6,371 8,494 11,980 16,486 12,382 55,712 294,385Other Direct Expense 10,000 10,000 10,000 10,000 10,000 50,000 0 645 324 291 515 1,775 48,225 Total Direct Expense 524,221 544,841 557,808 571,347 585,484 2,783,702 337,394 633,407 682,358 705,866 765,592 3,124,617 (340,915)

Direct Margin (66,115) (25,349) 31,296 96,698 172,078 208,608 99,706 68,044 51,125 162,824 286,562 668,263 459,655

Statistical SummaryOutpatient Procedures 6,396 6,716 7,052 7,404 7,774 35,342 7,603 9,172 8,738 9,199 8,722 43,434 8,092

Deductions As % of Net Revenue 79.38% 79.38% 79.38% 79.38% 79.38% 79.38% 79.00% 80.30% 81.40% 81.00% 79.50% 80.34% -0.96%

Total Direct Expense as % of Net Rev 114.43% 104.88% 94.69% 85.53% 77.29% 93.03% 77.19% 90.30% 93.03% 81.26% 72.76% 82.38% 10.65%

Direct Margin % of Net Revenue -14.43% -4.88% 5.31% 14.47% 22.71% 6.97% 22.81% 9.70% 6.97% 18.74% 27.24% 17.62% 10.65%

Paid FTE's 3.20 3.20 3.20 3.20 3.20 3.20 2.74 4.24 4.72 5.05 5.29 4.41 (1.21)

CAPITAL EXPENDITURESUltrasound Equipment 164,000 0 0 0 0 164,000 160,499 - - - - 160,499 3,501 Office and Program Furnishings 108,410 0 0 0 0 108,410 32,770 3,428 - - - 36,198 72,212 Total Capital Equipment 272,410 - - - - 272,410 193,269 3,428 - - - 196,697 75,713 Construction - Renovations 217,726 - - - - 217,726 - - 57,500 - - 57,500 160,226 Total Capital Expenditures 490,136 - - - - 490,136 193,269 3,428 57,500 - - 254,197 235,939

NET INCREMENTAL CASH FLOW (486,232) 44,670 101,316 166,717 242,097 68,569 (87,192) 73,110 5,605 179,310 298,944 469,778 401,209 68

• Ultrasound machine– Poor visualization in obese patients

– Cannot utilize for first trimester aneuploidy screening

– Having to send patients to UCSD or San Diego perinatal

Program Needs


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Program Outcome

Exceeded 5 year projection by:460K in direct margin401K in Net Incremental Cash Flow

• Program quality indicators demonstrate positive results

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Next Steps

• Continue Perinatology services at PMC to meet the needs of the community

• Explore expansion of Perinatology Services to Pomerado Outpatient Pavilion

• Evaluate Capital Request needs to meet the demand for the obese population

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PPH Board Committee Activity Summary

August 16, 2011 Governance Committee

ACTION ITEMS:

• Annual Adoption of Statement of Investment: was approved.

INFORMATION ITEMS:

• Media Relations – GOV21:was reviewed. The revised policy will be brought

back to the September meeting for approval. • Succession Policy – GOV30: was reviewed. The revised policy will be brought

back to the September meeting for approval. • Disposition of Surplus Property – FIN07: was reviewed. The revised policy

will be brought back to the September meeting for approval. • Expense Reimbursement and Advances – FIN04: was reviewed. The revised

policy will be brought back to the September meeting for approval.

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Board Quality Review Committee August 9, 2011

ACTION ITEMS: No Action Items

INFORMATION ITEMS:

• Regulatory Update: Opal Reinbold announced we received official accreditation from the Joint Commission Survey for all sites.

• Patient Safety Update: Jerry Kolins, M.D., presented an overview of the

Physician Peer Review Performance Pyramid and the goal of the next Medical Leadership Education meeting to prepare each Department Chair and Chair Elect for one-on-one interviews with physicians using their knowledge of conflict management and personality styles.

• FY11 Initiates: The following FY11 Initiatives were reviewed for year end

results: o 1.1(d) Publicly Reported Data – On Target – Continue as FY12 Initiative o 2.1(b) Enhance the Patient Safety Culture – Maximum – Continue as

FY12 Initiative Management Support for Patient Safety

• 2010 results - 44% • 2011 results – 71.9%

Supervisor/Manager actions promote patient safety • 2010 results – 43% • 2011 results – 73.2%

o 2.1(c) Integrate, coordinate, and redesign key processes – On Target o 2.1(d) Adaptive Design – On Target – Continue as FY12 Initiative o 3.2(c) Physician On-Boarding and Mentorship – On Target Date –

Continue as FY12 Initiative

• Service Excellence Update: Lorie Shoemaker informed the committee of the new reporting format for our Patient Satisfaction data. The new reporting structure involves the 37 questions that patients answer after their stay. These questions are broken down into 10 domains (Admission, room, meals, nurses, tests & treatments, visitors & family, physician, discharge, personal issues and overall assessment). The reports will be a 3 year Ranking Trend from the American Hospital Association Region 9 Rank (AHAR) and reported to this committee on a quarterly basis by each accountable EMT member.

• Performance Improvement Update: Mark Reyes and Paul Patchen presented

their Ancillary Services Performance Improvement Report highlighting PCR testing at PPH, Out-Patient EKG and Lab Draws, and PPH Interventional Services.

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August 16, 2011 Strategic Planning Committee

ACTION ITEMS:

• None

INFORMATION ITEMS:

• FY11 Q4 Initiatives: were reviewed. • Rehab Care Update: Sheila Brown presented an update on Rehab Care. • Innovation Update: Orlando Portale provided an update on current and potential

future innovations.

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MEMORANDUM

TO: Nicole Adelberg, Executive Assistant to the Board

FROM: Tanya Howell, Assistant to the Board Finance Committee

DATE: September 6, 2011

RE: Board Finance Committee – August 29, 2011, Meeting Summary

INFORMATION ITEMS:

Intergovernmental Transfer Funds: The Committee was updated on the ongoing process regarding receipt of Federal matching Medicaid funds via Intergovernmental Transfer (IGT), which will be finalized once a satisfactory agreement is reached between the State and Federal governments.

Program Review – Perinatology Program: Sheila Brown, Chief Clinical Outreach Officer, and Dr. Thomas Kelly, Medical Director, Perinatology Program, presented an update on the status of the program, which has shown positive financial performance based on a 5-year comparison to original projections.

ACTION ITEMS:

Bloom Energy – Fuel Cells: Reviewed and recommended approval of a request to move forward with a project to install Bloom Energy Solid Oxide Fuel Cells as an alternative energy solution at all three campuses, subject to Management’s finalization of due diligence, including the accounting structure and the ability to finance the project without affecting the District’s cash flow or debt capacity.

Resolution Designating Subordinate Officers of the District: Reviewed and recommended approval of Resolution No. 09.12.11 (03) – 01 Designating Subordinate Officers of the District, updated based on a change to the title of one of the officers.

BridgeSpine Supply Agreement: Reviewed and recommended approval of a request to enter into a legally formed agreement with the Physician Owned Distributor (POD) BridgeSpine, such agreement to be reasonable and consistent with fair market value and to be entered into with the understanding that it must contain an immediate cease and desist clause in the event that PODs become illegal. Further, it was also decided to recommend the development of a policy to cover these types of relationships going forward.

Policy – Development of a Policy Approving Management to Enter Into Agreements with PODs: Supportive of the business reasons behind PODs and recommended that the Board Governance Committee develop a policy approving Management to enter into any legally formed agreement with PODs, said policy to include requirements for cease and desist language within any such agreements, should PODs become illegal.

Arch Health Partners Request for Equity Transfer to Open a New Office Location in San Marcos: Reviewed and recommended approval for an equity transfer of $268 thousand to assist Arch Health Partners in the opening of an office for the provision of primary care services in Suite 205 of the SMACC Building, located at 120 Craven Road in San Marcos.

July 2011 and YTD FY2012 Financial Report: Utilizing the standard Financial Reporting Packet, reviewed and recommended approval of the July 2011 and YTD FY2012 financial performance, which reflected a $2.26 million bottom line net income YTD, which is approximately $654 thousand short of budget.

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DESIGNATION OF SUBORDINATE OFFICERS OF THE DISTRICT

Form A - Desig Subordinates.doc

TO: Board of Directors MEETING DATE: Monday, September 12, 2011 FROM: Bob Hemker, CFO BY: Board Finance Committee Monday, August 29, 2011 Background: Attached for the Board’s review and approval is a Resolution designating current officers of the District. This Resolution supersedes previous such Resolutions. The designation begins with the President and CEO and includes those members within the Executive Management Team who have been granted signature authority for the District. In addition, for certain banking matters, specified individuals from the Finance Department need to be designated as authorized non-officer signatories.

There are various requests for the production of this designation of officers of the District, including that for “corporate” officers. The CEO is granted authority by District Bylaws to designate officers; the State of California requires approval by the Board.

The update request is based on a change in the title of one of the named non-officer signatories, from Manager General Accounting to Director Finance.

Budget Impact: N/A

Staff Recommendation: Staff recommended approval of the Resolution of the Board of Directors of Palomar Pomerado Health Designating Subordinate Officers of the District.


COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of Resolution No. 09.12.11 (03) – 01 Designating Subordinate Officers of the District. Motion: Individual Action: X Information: Required Time:

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RESOLUTION NO. 09.12.11 (03) – 01

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR POMERADO HEALTH

DESIGNATING SUBORDINATE OFFICERS OF THE DISTRICT

WHEREAS, Palomar Pomerado Health (the “District”) is a local health care district duly organized and existing under The Local Health Care District Law, constituting Division 23 of the Health and Safety Code of the State of California (the "District Act"); and

WHEREAS, the Board of Directors (the “Board”) has the authority to designate subordinate officers under Section 7.9 of the District Bylaws; and

WHEREAS, for purposes of conducting District business and to meet certain operational requirements, the Board desires to designate the subordinate officers described herein; and further designates other non-officers described herein;

NOW, THEREFORE, BE IT RESOLVED, that the following subordinate officers and non-officer subordinates of the District are hereby designated, which designation supersedes previous such resolutions:

President and CEO Chief Administrative Officer – Palomar Medical Center

Chief Administrative Officer – Pomerado Hospital Chief Financial Officer Corporate Controller

Director Finance

PASSED AND ADOPTED at a meeting of the Board of Directors of Palomar Pomerado Health held on September 12, 2011, by the following vote:

AYES:

NOES:

ABSTAINING:

ABSENT:

Dated: September 12, 2011

BY: T.E. Kleiter Chair, Board of Directors ATTESTED:

Jerry Kaufman, PT, MA Secretary, Board of Directors

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Documents

BOARD OF DIRECTORS AGENDA PACKET - Palomar Health · 9/12/2011 · • Board Quality Review Director Bassett stated that the Board Quality Review Committee summary is included in