board of directors planning full board meeting … · board of directors . planning full board...

BOARD OF DIRECTORS

PLANNING Full Board MEETING

January 13, 2011, 4:00pm Cape Coral Hospital

Auxiliary Meeting Room 636 Del Prado Blvd, Cape Coral, FL 33990

ELECTRONIC BOARD PACKET

ALL MEETINGS ARE OPEN TO THE PUBLIC AND THE PUBLIC IS INVITED TO ATTEND Any Public Input pertaining to an agenda item is limited to three minutes and a

“Request to Address the Board of Directors” card must be completed and submitted to the Board Assistant prior to the meeting.

BOARD OF DIRECTORS OFFICE

239-343-3300 FAX: 239-343-3194

P.O. BOX 2218

FORT MYERS, FLORIDA 33902

CAPE CORAL HOSPITAL

GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER

LEE MEMORIAL HOSPITAL

THE CHILDREN’S HOSPITAL

THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE

Stephen R. Brown, M.D.

Marilyn Stout

DISTRICT TWO

Richard B. Akin

Nancy M. McGovern, RN, MSM

DISTRICT THREE

Lois C. Barrett, MBA

Linda L. Brown, MSN, ARNP

DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

Any Public input is limited to three minutes and a “Request to Address ‘ the Board of Directors”

card must be completed and submitted to the Board Administrator prior to meeting.

LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS PLANNING MEETING

Thursday, January 13, 2011, 4:00 pm Cape Coral Hospital – Auxiliary Meeting Room

AGENDA

1. 4:00pm - CALL TO ORDER (Richard Akin, Board Chairman) LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS, sitting as the Lee Memorial Health System (LMHS) Board of Directors for Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and the Board of Directors of its subsidiary corporations: Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial Medical Management, Inc.; Lee Memorial Home Health, Inc.; and HealthPark Care Center, Inc.

2. Invocation and Pledge of Allegiance (Rev. Tom Brenner)

3. Public Input - Agenda Items: Any Public input is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to meeting.

4. Recognitions: (Jim Nathan, President & Richard Akin, Board Chairman)

• Retirement: Rev. Tom Brenner Planning Chairman: Linda Brown, MSN, ARNP

5. 2011 System Goals (Kevin Newingham, VP Strategic Services) (Acceptance)

6. Strategic Planning (Kevin Newingham, VP Strategic Services) (Verbal Update)

7. Children’s Hospital Leadership (Jim Nathan, President) (Verbal Update)

8. EPIC Electronic Medical Records (Mike Smith, Chief Information Officer) (Update)

9. 2011 Legislative Update (Sally Jackson, System Director of Community Projects) (Review) 10. Board Education (Nancy McGovern, RN, MSM, Board Secretary) (Discussion)

Board Chairman: Richard Akin 11. New Business

12. Old Business (All Directors) A. 2011 REVISED Board Meeting Schedule (Approval) B. Sunset Accountability Committee (Update)

13. Board of Director’s Report (All Directors)

14. Date of the next FULL BOARD OF DIRECTORS MEETING - FINANCE Thursday, January 20, 2011- 4:00 p.m. Lee Memorial Hospital – Boardroom

15. ADJOURN (Richard Akin, Board Chairman)

AGENDA - FINAL 011311 Planning Full Board Meeting

___________________ L E E M E M O R I A L HEALTH SYSTEM

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PUBLIC INPUT – AGENDA ITEMS:

Any public input

pertaining to items on the Agenda is limited to three

minutes and a “Request to Address the Board of Directors”

card must be completed and submitted to

the Board Administrator prior to meeting.

Refer to Board Policy: 10:15E: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least seven (7) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board.

______________________________________________________________________________

L E E M E M O R I A L HEALTH SYSTEM BOARD OF DIRECTORS

Recognizes with Sincere Appreciation

Rev. Thomas C. Brenner, BCC Whereas, Let It Be Known…..YYYOOOUUU HHHAAAVVVEEE MMMAAADDDEEE AAA DDDIIIFFFFFFEEERRREEENNNCCCEEE!!!

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hhhooopppee,,, fff rooorr nnnooottt ooonnnlllyyy ssshhhooowwwiii nnnggg uuuppp dddaaayyy iii ayynnn aaannnddd dddaay ooouuuttt,,, bbbuuuttt fff rooorr ttt cooouuucchhhiii vennnggg ooovveerrr 34,039 patient lives (and that is only counting the last nine years on record);

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Thank you for making Lee Memorial Health System and health care in our community a much better place!



2011 Strategic

Goals

Kevin Newingham VP Strategic Services

______________

L E E M E M O R I A L HEALTH SYSTEM BBBOOOAAARRRDDD OOOFFF DDDIIIRRREEECCCTTTOOORRRSSS

UPDATE REPORT TO THE BOARD (No Action Required)

DATE: January 13, 2011 NAME OF SERVICE LINE/ENTITY UPDATE: FY 2011 System Goals PERSON RESPONSIBLE & TITLE: Kevin Newingham, Vice President, Strategic Services KEY ACCOMPLISHMENTS The FY 2011 System Goals were originally approved effective December 2, 2010 GOALS (MET) Not applicable

GOALS (UNMET) Not applicable

FINANCIAL STATUS (including cash flow statement, projected cash flow, balance sheet and income statement) Not applicable PROBLEMS/ISSUES The LMHS Board of Directors has expressed the desire to achieve more strategic focus. ANTICIPATED NEEDS None SUMMARY/COMMENTS The FY 2011 System goals were created to identify areas of strategic focus for the System. The goals are being presented to orient all Board members with the areas of strategic focus. Administration will provide progress reports as part of future Board Planning meetings.

Keep form to one page, SUBMIT (thru SLC Member) ELECTRONICALLY to L Drive – Miscellaneous - BOD Presentations by Noon the Friday before you’re scheduled on agenda.

BOD/Forms/Board UPDATE Report to the Board Form (Blue Form) – Updated 090209cs

2011 Goals SAFETY CULTURE

Goal Meets Exceeds Overall Perception of Safety Management Support for Patient Safety Handoffs and Transitions

63% - 69% positive response 70% - 77% positive response 44% - 51% positive response

>69% positive response >77% positive response >51% positive response

QUALITY

Goal Meets Exceeds Core Measures 20% - 25% improvement in a blended indicator

including CHF, AMI, CAP, SCIP in the next year measured for FY 2011

>25% improvement in a blended indicator including CHF, AMI, CAP, SCIP in the next year measured for FY 2011

Patient Experience (HCAHPS) 70.2% - 72.7% top box 72..8% or > top box In-Patient Mortality 1.70% - 1.87% <1.7% PHYSICIAN COLLABORATION

Goal Meets Exceeds Multi-Specialty Group Practice Management structure

Physician governance structure Develop physician strategic plan

Develop physician partnerships Orthopedic co-management agreement Outpatient Surgery Center at the Sanctuary ACR Breast Center of Excellence

Heart and Vascular Institute Advanced Stroke Center

Medical Staff Satisfaction (PRC Survey) • Hospitalists % top box • Patient Safety % top box

30.8% - 35.2% top box 22.7% - 28.1% top box

>35.2% top box >28.1% top box

OPERATIONS IMPROVEMENT

Goal Meets Exceeds EPIC Implementation GCMC is complete on Epic Phase I in FY 2011 On track to complete Epic Phase I in all hospitals by

the 12/31/11 Patient Flow

• Discharge Execution For “cleared” discharges to home, cycle time is 130 minutes or less, 85% of the time

For “cleared” discharges to home, cycle time is 120 minutes or less, 85% of the time.

• Discharge Planning Develop plan to improve discharge planning process Implement plan to improve discharge planning process

Clinical Documentation Initiative $1,000,000 - $2,499,000 >$2,499,000 FINANCE

Goals Meets Exceeds Operating Margin FY 2011 Budget 2.2% -2.5% > 2.5% Increase Freestanding Outpatient Revenue 5% - 7.5% > 7.5% Cash-to-Debt Ratio FY 2011 Budget 83.7% - 85% > 85% Moody’s Upgrade A 2 A1 Philanthropy $15,000,000 - $17,500,000 >$17,500,000



Strategic Planning

Kevin Newingham

VP Strategic Services

(Verbal Update)



Children’s Hospital

Leadership (VERBAL UPDATE)

Jim Nathan President



EPIC Electronic Medical Records

Project (UPDATE)

Mike Smith Chief Information Officer

0

Lee Memorial Health System Board Update

Epic Electronic Medical Record Project

January 13, 2011

1

Update Topics-

Telephone System Replacements –

update

-

Epic Project Background, Accomplishments and Schedule

-

Economic Stimulus Plan –

update-

Questions / Discussion

1

2

Telephone System Replacements

2

3

WHY? Phone systems at LMH, HP and CCH are 20+ years old•

Parts no longer available•

Reliability concerns•

Fragmented phone numbering scheme within facilities –-

evolved over time (343-xxxx, 292-xxxx, 342-xxxx, etc.)

Opened GCMC and Sanctuary with new Cisco Phone System technology - 2009

Replaced phone systems at LMH August 2nd, HPMC December 13th 2010. CCH replacement scheduled for 2011, outlyingcampus replacements yet to be budgeted, scheduled.

Ascom wireless “zone phones” at LMH and HP will bereplaced with Cisco wireless phones in 2011 (pending budget approval)- CCH wireless phones have already been replaced

3

Telephone System Replacements

5

Discussion Outline at the Board Workshop regarding EMR - 2009

-

Clinical Information Technology (IT) at LMHS -

LMHS Clinical IT Strategy

-

Economic Stimulus package (ARRA, HITECH Act) -

Discussion of real possibilities?

. NorthShore University Health System -

Chicago-

Stakeholder Perspectives

-

Considerations and Implications -

Open Discussion/Next Steps

5

6

Issues with existing LMHS Hospital IT SystemsLMH/HP/CCH–

(Siemens/Clinicomp)Numerous IT systems lashed together – not integratedNot built for advanced functionalities

–

closed loop med management, perioperative system, etc.Not built for contemporary needs – now and future

–

nursing workflow automation, clinical alerts, outcomes, med reconciliation, etc.Systems are aging, vendor support is increasingly an issue

GULF COAST –

(HCA Meditech)Sub-optimal physician usability (not intuitive to use)Historical clinical data not sufficiently maintained on-line Not built for contemporary needs

–

nursing workflow automation, clinical alerts, outcomes, med reconciliation, etc.Revenue Cycle/Billing systems a concernOngoing operating expense - $7+ million/year to HCA (incl. billing services)

6

7

How and Why was Epic Chosen?Lee Physician Group EMR Decision Process -•

Epic has superior physician usability -

based on assessment by physicians •

Epic has superior EMR and billing functionality •

Epic has superior reputation for delivering high quality product

and service

Emergency Department Decision Process -•

Epic has equal-to-or-better functionality as compared to ED niche vendors •

Epic patient integration with physicians offices/ED viewed as very valuable•

Possibility of Epic as a candidate for next generation hospital system

Acute Care/Hospital next generation EMR decision process -•

Epic rated as superior clinical functionality by caregivers •

Integration among various Epic clinical modules key differentiator•

Epic Revenue Cycle functionality viewed as excellent ––

Seamless integration with other Epic clinical and non-clinical modules deemed a significant advantage

7

8

How and Why was Epic Chosen (cont.)?“One Patient, One Record” (not multiple interfaced records)

–

The only vendor with this capability–

Relatively new products, all modules only recently available –

LMHS uniquely positioned to capitalize on this capability

Epic is focused exclusively ...–

on large physician groups, large health systems–

on developing the best software and supporting it well

Highest customer product/service rankings in the healthcare IT industry (KLAS Research rankings)

Proven track record in large health systems

Large, growing, very stable company

8

99

HITECH Stimulus ActFinal Rule on EMR “Meaningful Use”

Issued on July 13, 2010

“Stage I”

rules only

10

Economic Stimulus Summary LMHS $$ Impact (available for payment after 2011) Update a/o January 2011

Hospitals (LMHS’ internal calculations):–

Medicaid and Medicare Incentives are not additive•

Base

$ 28,667,510 (all hospitals)•

Add for 10% Medicaid at CCH

1,056,881•

Add for LMH/HP –

if calculated separately 9,538,216 Total Possible $ 39,262,607 GCMC –

$10,962,407 LMH/HP -

$10,707,897 CCH -

$ 6,997,205 = $28,667,510

now $30 million - or $35 million (pending “Multi-Campus Hospitals Act”)

Physicians–

Up to $44,000 per non-hospital-based physician•

LPG -

70 physicians X $40k = $ 2,800,000•

Employed Specialists -

36 physicians X $40k = $ 1,440,000

Starting in 2016, reduced fee schedule for non-”meaningful use”

providers

10

11

One Time Cost Summary – Acute Care Program Approved by Board in 2009

Incremental Capital Approximately $27.7 millionIncremental One-Time Operating

Approximately $10.3 million

Total Approximately $ 38 million

GCMC

LMH/HP/CCHOutpatient Facilities

Community Physician Pilot Project

Incremental Capital Approximately $23 million

Incremental One-Time Operating

Approximately $ 7 million

Total Approximately $30 million

Grand Total Approximately $68 million

Community Pilot Approximately $ 550,000

1212

Epic EMR Rollout Program Plan - SummaryAcute Care - Phase I (2009-2012)•

System-wide, standardized design for all acute care facilitieso EVERY acute area of the health system will be affected

•

Gulf Coast Medical Center first (mid 2011)•

CCH, LMH/HP, and Outpatient facilities to follow (2011/2012 timeframe)

Acute Care - Phase II (2013) – i.e “Meaningful Use” functionality•

CPOE, Physician Documentation, Clinical Alerts, etc.

LPG Primary Care EMR implementation (now – 2010)

LPG Specialist (MSO) EMR/billing system (now - 2011)

Community Physician Pilot EMR implementation (??)

13

Epic Project Activities Timeline – Through GCMC Only Project Materially on Track to date

11/1/2009 8/31/2011

12/7/2009 - 1/29/2010Team Training

3/30/2010Validation #2

Feb-10Epic Site Visit

8/2/2010 - 12/31/2010'09 Prod Upgrade--TBD

5/3/2010 - 8/9/2010Re-Engineering

Validation SessionsEvery 3rd week as needed

9/30/2010Build Complete

11/1/2010 - 4/1/2011Testing

11/1/2010 - 12/17/2010Unit/Interface Test

1/3/2011 - 3/31/2011Integrated Test

12/09 - 1/10

Jul - 2011Gulf Coast Go-Live

11/4/2009Contract

7/1 - 8/31Support

4/18 - 6/30End UserTraining

7/1/2010Train Env Build starts

3/7/2011 - 4/15/2011Train the Trainer

6/1/2011All Build Complete

3/8/2010Validation #1

12/1/2009SME Needs

January, 2011

14

Epic ACUTE Project Status – work done or underwayIT Support processes for systems that are “going away” – using external contracting companies - Continues to work well

Data Center Computers upgraded to support Epic – The first phase of installing expanded computing infrastructure to support Epic is complete

Epic system configuration work - continues materially on track-

First phase went live –

Cadence Patient Scheduling

EPIC ACUTE PROJECT STAFFING – critical staff have been hired/contracted, additional non-critical staffing gaps remain

End User/IT Epic Demonstration/“Validation Sessions” Complete, sessions were to assess/confirm Epic customizations needed for LMHS hospitals

End User “Workflow Walkthroughs” Complete – 600+ staff attended

Physician activity spinning up

15

Key Target Dates for Acute CareNow – Epic system configuration work is underway

November 2010 – System Component Testing begins

January 2011 – Full Integrated System Testing begins

March 2011 – Super User Training begins

April/May 2011 – GCMC End User Training begins

Mid-2011 – Phase I GCMC Go-Live - (Now June 1, 2011)

TBD – Phase I LMH/HP/CCH Go-Lives – late 2011 (before season) or 2012 (after season) - (Now CCH 9/2011, LMH/HP 12/2011)

PHASE II – live all hospitals in 2013

15

16

Epic Lee Physician Group Epic Rollout Status:

♦

LPG Primary Care Epic rollout status –

All but one Primary Care Office is live, all LCC locations are live

♦

LPG Specialists Epic rollout status -All Specialists (except new ones and neurosurgery) are live

on Epic Practice Management (not on Epic EMR yet)

EMR Rollout is being sequenced based on priorities of practices

New practice acquisitions must be carefully sequenced for migration to Epic because some have already have other EMRs

Specialist EMR rollout is currently on hold due to work being addressed with “Corporate Clinic” program

17

Epic Community Physicians Pilot Project Status

Demo sessions with community physicians are continuing re. Stimulus Bill and Epic education

- More than 35 providers attended demos, 220+ providers contacted

Several physician groups are very interested–

One of these groups has committed – implementation is underway

Pricing work, business model are complete.EMR decision making structure is being developed

Have collaborated with other health systems to refine our community physician model

Interest increasing due to approaching stimulus dates

17

18

LMHS Epic Program Challenges Continued good progress thus far – ...... much “heavy lifting”

is underway

–

Compressed timeline–

Staffing challenges (exacerbated by Stimulus Bill)

–

Collectively, this program is a large complex set of concurrent projects

–

Many emerging IT needs in addition to EMR effort

Physician engagement level in Epic hospital EMRimplementation is in the process of increasing...

18

19

Questions/Discussion

19



2011 Legislative

Agenda

Sally Jackson System Director of Community

Projects

______________


UPDATE REPORT TO THE BOARD (No Action Required)

DATE: January 13, 2011 NAME OF SERVICE LINE/ENTITY UPDATE: 2011 Legislative Update PERSON RESPONSIBLE & TITLE: Sally Jackson, System Director Community Projects KEY ACCOMPLISHMENTS: 2011 Legislative Agenda approved by Board 11/4/10 and presented to delegation public hearings in Lee, Charlotte and Collier Counties. Glades/Hendry yet to be held. Nov. 17th testimony to Sen. Negron’s Medicaid Managed Care hearing. Jan. 12th testimony to Sen. Negron’s HHS Appropriations Sub-Committee on behalf of The Florida Chamber. Recent “first time” LIP Grants to LMHS: $1.5 million for low income ED deferrals/primary care/chronic conditions. $500,000 for Medical Residency implementation. GOALS (MET) Ongoing

GOALS (UNMET)

FINANCIAL STATUS (including cash flow statement, projected cash flow, balance sheet and income statement) N/A PROBLEMS/ISSUES New state and federal leadership plus the ongoing climate of health reform at both the federal and state levels mean continuing uncertainty and funding challenges. The State of Florida faces a $3.9 billion shortfall this year. The Medicaid Waiver ($1 billion plus match) expires June 30, 2011. Caseloads are forecasted to grow 9% as enhanced FMAP ends. Florida would have to generate an additional $2.1 billion just to continue the current program. ANTICIPATED NEEDS Board Members are encouraged to participate in legislative visits with FHA (March 14 – 15, 2011 in Tallahassee) and AHA (April 10 – 13, 2011 in Washington, D.C.). SUMMARY/COMMENTS We work directly with our local legislative delegations from Lee, Collier, Charlotte, Hendry and Glades Counties to familiarize them with our unique services, as well as any unique needs and opportunities. We participate in state advocacy for hospital issues through FHA and SNHAF. We are a member of The Florida Chamber of Commerce (and local Chambers) for business/economic development issues and also seek business support for our issues. At the federal level, we participate in AHA and NAPH as our primary advocacy partners. We are members of other associations for special issues such as NACHRI for TCH and SNHPA for 340b drug discounts. We prepare an annual Board approved legislative agenda as the basis for our advocacy.


1607.03 11-10

2011 Legislative Priorities

www.LeeMemorial.org


The right choices during rough economic times.

What’s at Stake for Lee Memorial Health System?

More reSponSibiLity for quaLity care7th largest public health system in the •nation 1 million patients annually •largest employer in Lee County •14% unemployment this year •95% of the hospital beds in Lee County •costs below the average for the state •no local tax support, only patient revenues •Only Trauma Center and Children’s Hospital •in the region

and feWer patientS WHo pay for tHeir care

3 out of 4 patients do not cover their costs •Patient mix: 23% commercial insurance, •21% Medicaid, 48% Medicare, 8% uninsured Medicaid reimburses 86% of cost ($18 •million loss) Medicare reimburses 87% of cost ($57 •million loss) 35% - 30% - 27% - 23% (the drop in our •insured patients over the last 4 years)

We support improvements that increase the quality and affordability of health care for our patients. any changes must be well thought out and productive or risk significant disruption.

a prescription for a healthier community…

Lee Memorial Health System board of directors

District 1Stephen R. Brown, M.D.Marilyn Stout

District 2Richard B. AkinNancy M. McGovern, RN, MSM

District 3Lois C. Barrett, MBALinda L. Brown, ARNP, MSN

District 4Diane ChampionChris Hansen

District 5Donald BrownJames Green

President & CEOJim Nathan

For more information about the priorities listed in this pamphlet, please contact…

Sally Jackson Director of Community [email protected]

1607.03 Legislative Bro 2011.indd 1 11/29/10 4:31:26 PM

Lee Memorial Health System’s 2011 Legislative priorities

Medicaid ManaGed careMedicaid Managed Care will be considered again this session. We support changes that….

Continue essential health care services •while protecting the jurisdictions that provide voluntary contributions as match for federal funds and ensuring a return on their investment.Allow safety net providers to select •managed care organizations and negotiate contracts, terms and conditions.Ensure that hospitals caring for Medicaid •HMO patients are paid fairly when caring for patients out of network. Adopt risk-adjusted rates based on the •acuity level of plan enrollees.Adopt mandatory minimum loss ratios to •ensure that Medicaid dollars are used for direct health services.Lee County• : Medicaid patients comprise 21 percent of our patients, significantly greater than the statewide average representation.

trauMa fundinG Support legislation that provides new funding sources for trauma centers…

Ensure that Florida’s trauma network •remains viable.Lee County• : Lee Memorial Health System has the only designated trauma center between Tampa and Miami, and we lost $4 million last year. We have no local tax funding in the five-county area to offset losses like this.

tort reforMImprove the civil justice process…

Reduce costs associated with litigation. •Support legislation to clarify that hospitals •are not vicariously liable for nonemployed physicians.Simplify the Florida Birth Related Neurological •Injury Compensation Association (NICA) notice requirements that hospitals and OB physicians provide to patients.

perSonaL inJury protectionPersonal Injury Protection (PIP) needs to continue for automobile registration….

Ensure this no-fault insurance continues to •cover the costs of care for patients treated in our emergency rooms and trauma center after accidents without other insurance.Safeguard the current $10,000 limit, which has •been in place for more than 30 years.Support an increase in coverage to •$25,000 with additional coverage limited to emergency services, inpatient and rehabilitative services provided by hospitals, and by physicians practicing in hospitals.

baKer act reforMWe support authorizing psychiatric ARNPs, working under a supervising psychiatrist, to perform Baker Act evaluations….

Clarify current statutory language for hospitals •that are not receiving hospitals, too.Lee County• : Our hospitals are not Baker Act receiving facilities, but do receive patients in need of emergency care.

arnp preScribinGWe support legislation that allows ARNPs to prescribe controlled substances as designated through individual protocols developed with their supervising physicians.

HoSpitaL LicenSure accreditinGWe support modifying the hospital licensure statute to allow AHCA to use other accrediting organizations that have been approved by CMS in lieu of ACHA licensure inspections.

Lee County• : Our Board of Directors has recently adopted the DNV as our accrediting organization and they are CMS approved.

Medicaid fundinG

Support full funding of hospital services funded by Medicaid, including the Medically Needy and Aged/Disabled Program…

Maximize federal funds for Medicaid. •

Extend the five-year federal Low •Income Pool waiver, set to expire June 30, 2011.

Lee County: The Lee Memorial Health •System experienced a reimbursement shortfall of $18 million for these patients in 2010.

1607.03 Legislative Bro 2011.indd 2 11/29/10 4:31:26 PM

Proposed 2011 Legislative Priorities Presented November 4, 2010 Board Planning Committee

Lee Memorial Health System Southwest Florida’s Safety Net

Providing Quality Care Lee Memorial Health System is among the largest public safety net hospital systems in the country with more than a million patient contacts each year. We have no local tax authority or tax support, only patient revenues. Our mission is to provide the best patient care services in Florida. In 2010 we have been recognized for quality programs and patient care services by the Florida Hospital Association including the Best Hospital Workplace in Florida and the Best Community Benefit Program. The American Hospital Association also recognized our successful community partnerships with the NOVA Award as a shining star for best practices. We provide unique services that otherwise would not exist between Tampa and Miami. The Level III NICU in The Children’s Hospital of Southwest Florida consistently has the best patient outcomes in the state. Our Level II Trauma Center provides life saving trauma care to a 5-county region with no local tax support. Our Changing Patient Mix and Reimbursement While we consistently keep our costs well below the average for other state of Florida hospitals, our patient mix now shows that 3 out of every 4 patients do not cover the actual costs of their care. In FY 2010, Medicaid covered 86% and Medicare 87% of our costs of patient care leaving a shortfall of $18 million from Medicaid and $57 million from Medicare. Only 23% of our patients now have commercial insurance, down from 35% a short 4 years ago. That leaves 21% Medicaid patients, 48% Medicare patients, and 8% uninsured. That 23% insured patients cover the shortfalls of Medicaid, Medicare, and the uninsured as well as any profits for future investments. The impact of government funded programs on our health system is profound. Any changes must be well thought out and productive or risk significant disruption. Therefore, we are keenly engaged in the decisions that the Florida Legislature makes in relation to health care in general and the Medicaid Program in particular. We support improvements that increase quality and affordability of healthcare for the patients we serve.

1

Our Priorities for 2011 Medicaid Funding We support full funding of hospital services funded by Medicaid, including the Medically Needy and Aged/Disabled programs. Lee Memorial Health System currently is reimbursed 86% of our real costs for Medicaid patients. Our shortfall in reimbursement for FY 2010 was $18 million. Maximize federal funds for Medicaid including full funding and continuation of the LIP program under the Medicaid 1115 Waiver. The $1 billion federal LIP program is matched by local Intergovernmental Transfers (IGTs) to reach nearly $2 billion total spending for Medicaid-related priorities. This five year waiver expires June, 30, 2011. The AHCA request for continuation has been denied. HHS is conducting a full review to determine what will be supported for the future. Early resolution of this decision is vital for smooth continuation of services. Medicaid Managed Care Medicaid Managed Care will be considered again this session. We support changes that will: ●Continue essential healthcare services financed through IGTs and Certified Public Expenditures (CPEs) while protecting the jurisdictions that choose to provide such voluntary contributions and ensuring a return on their investment. Over $800 million in public hospital and local tax dollars now support Medicaid hospital services. IGTs benefit all qualifying hospitals regardless of whether local public funds are contributed on their behalf. Current allocations include reimbursement through the Low Income Pool (LIP), exemptions, statewide priorities, DSH, and buybacks. ●Allow safety net providers to select managed care organizations and negotiate contract terms and conditions. Do not require participation with all plans. Such a mandate interferes with competitive business practices and cannot be legislated to effectively assess all issues including rates, volume of business, timeliness of payments, prior authorization, and many other elements of decision-making. ●Ensure that hospitals caring for Medicaid HMO patients are paid the “rebased” rate established by AHCA when caring for patients out of network.

2

●Implement risk-adjusted rates for managed care plans. This will

allow payment of providers based on acuity levels of plan enrollees. ●Allow safety net Provider Service Networks (PSNs) to cover their

own local service area geographically and not be required to expand beyond their own local facilities and services. Large diverse service areas may not be consistent with the focus of a PSN. ●Allow hospitals to negotiate rates. Government should not dictate rates between HMOs, PSNs and private providers. The variability and sophistication of specialized care and patient mix cannot be assessed through government rate setting. ●Protect fee-for-service PSNs with shared savings. This model is now an effective choice for some safety net hospitals and should be protected as a part of future managed care decisions. ●Support auto assignment to PSNs to achieve sufficient membership in PSNs to be viable. Auto enrollment up to 20,000 reflects the experience to date in Duval and Broward. At lower enrollments, they did not break even. After 20,000 normal assignment could resume. ●Support mandatory minimum loss ratios to ensure that Medicaid dollars are used for direct health care services. Capitation alone does not guarantee that Medicaid dollars are used for direct care.

●Implement distinct managed care options for eligibility categories such as Medically Needy, where the period of enrollment may be limited but the costs of episodic care are extraordinary, and also for high-risk populations (HIV) where a carve out for disease management will better serve the population.

Trauma Funding Support legislation that provides new funding sources for trauma centers. Our state-designated regional level II trauma district serves five counties. There is no local tax support now. We provide the only trauma center between Tampa and Miami, and operated last year at a $4 million loss including physician services and readiness costs required to operate such a regional trauma center. Tort Reform The costs associated with litigation continue to be high in the state of Florida. Improvements can still be made in the civil justice process.

3

4

We support legislation to clarify that hospitals are not vicariously liable for non-employed physicians. Simplify the Florida Birth Related Neurological Injury Compensation Association (NICA) notice requirements that hospitals and OB physicians provide to patients. The benefits of this important provision should not be lost due to overly complicated and duplicative paperwork. Support health courts as an innovative exclusive jurisdiction over lawsuits involving medical liability. Personal Injury Protection (PIP) We support the continuation of PIP as a requirement for automobile registration. This no fault automobile insurance helps to cover the costs of care for patients treated in our emergency rooms and trauma center after accidents without other insurance. The current $10,000 limit has been in existence for over 30 years in Florida. We support increasing coverage to $25,000 with the additional coverage limited to emergency services, inpatient and rehabilitative services provided by hospitals, and by physicians practicing in hospitals. Baker Act Reform We support authorizing psychiatric ARNPs, working under protocols developed by a supervising psychiatrist, to perform Baker Act evaluations and either release the patient or recommend involuntary treatment. While our hospitals are not a Baker Act receiving facility, we do receive patients in need of emergency care. Current statutory language is unclear for hospitals such as Lee Memorial Health System that are not receiving facilities too. ARNP Prescribing We support legislation that allows ARNPs to prescribe controlled substances as designated through individual protocols developed with their supervising physicians. Hospital Licensure Accrediting Organizations We support modifying the hospital licensure statute to allow AHCA to use other accrediting organizations that have been approved by CMS in lieu of AHCA licensure inspections. Our Board of Directors has recently adopted the DNV as our accrediting organization and they are CMS approved.

306 East College AvenueTallahassee, Florida 32301

(850) 222-9800 www.FHA.org

FLORIDA HOSPITAL ASSOCIATION

2011 ADVOCACYAGENDA

Manyvoices.

Commoncauses.

A consistentfocus.

– Support requirements for carriers to accept, process, and pay claims electronically in compliance with federal transaction standards, including submission of Explanation of Benefi ts (EOB) with all claims following adjudication.

Health Information Technology & Exchange

Health Information Technology– Support utilization of telemedicine to increase

access to care.

Health Information Exchange (HIE)

– Support local provider-driven HIEs and oppose any unnecessary state mandates.

– Support allocation of the AHCA State Cooperative Agreement HIE grant to local provider exchanges in communities with high Medicaid populations.

Legal/Regulatory

Tort Reform

– Support extending sovereign immunity limits of liability to hospitals, physicians, and other providers when treating Medicaid patients.

– Support legislation to clarify that hospitals are not vicariously liable for non-employed physicians.

– Support simplifying the Florida Birth Related Neurological Injury Compensation Association (NICA) notice requirements that hospitals and OB physicians provide to patients.

– Support health courts that would have exclusive jurisdiction over lawsuits involving medical liability.

Advance Directives– Support the current Advance Directive Act and ensure

any modifi cations give providers clear understanding of how various advance directives can be used, including durable power of attorney.

Hospital Licensure Accrediting Organizations– Support modifying the hospital licensure statute to

allow AHCA to use other accrediting organizations that have been approved by CMS in lieu of AHCA licensure inspections.

340 B Drug Inventory– Support elimination of the requirement to maintain

a separate physical inventory of drugs purchased at discounted 340 B prices.

Managed Care

Payment/Service Authorizations– Support legislation to prohibit health plans from

denying payment for lack of an authorization, if the service was deemed medically necessary.

Reducing Payment Delays Due to Pending Coordination of Benefi ts– Support legislation to prohibit a health plan from

denying a claim, either in whole or in part, on the basis that it coordinates benefi ts and another health plan is liable for the payment of the claim, unless it has reasonable basis to believe that the insured has other health insurance coverage that is primary for that benefi t.

Usual and Customary Charges– Oppose any attempt to defi ne “usual and customary

charges” as anything but the provider/hospital’s total billed charges.

FHA is focused on establishing and maintaining an environment in which hospitals can continue to provide high-quality and cost-effective patient care.

MANY VOICES. COMMON CAUSES.

A Consistent Focus.

Medicaid/Hospital Funding

Medicaid Programs

– Support full funding of hospital services funded by Medicaid, including recurring funding for the Medically Needy, and Medicaid Aged/Disabled Programs.

– Support full funding and continuation of the Low Income Pool (LIP) program.

Medicaid HMOs and Hospital Rate Mandates – Support legislation that defi nes the non-contracted

Medicaid rate as the rate currently paid to hospitals under Medicaid fee-for-service.

Trauma Funding– Support legislation that provides new funding sources

for trauma centers.

Rural Hospital Funding

– Support holding rural hospitals harmless from cuts to Medicaid reimbursement rates.

– Support funding of the rural hospital capital improvement fund.

– Support a Medicaid care management model for rural communities that focuses on strengthening the healthcare infrastructure.

Nursing Workforce

Mandated Nurse-to-Patient Ratios

– Oppose any preset ratios that could over or underestimate the staffi ng needs at any given time, since mandated ratios do not account for consideration of the acuity level of the patients and competency of the individual nurses and other members of the patient care team.

FHA’s advocacy priorities are driven by our vision of providing high-quality, affordable healthcare to the patients we serve. Through effective Board leadership and member participation, FHA strives to promote public policy issues at the state and federal levels to make positive changes in Florida’s healthcare environment.

The information presented here highlights the major state policy and advocacy issues FHA will address during the 2011 Legislative session. Further detail on these issues can be found at www.fha.org/advocacy.

Specifi c Legislative Issues

Nurse Staffi ng Collaborative Councils– Monitor legislation requiring hospitals to establish

Nurse Staffi ng Collaborative Councils, a shared governance model that promotes involvement from direct patient care RNs in the development of hospital staffi ng plans.

Advanced Registered Nurse Practitioners (ARNP) Prescribing– Support legislation that allows ARNPs to prescribe

controlled substances as designated through individual protocols developed with their supervising physicians.

Public Reporting for Nurse Staffi ng– Oppose mandated nurse staffi ng reporting as it

does not include patient acuity or individual nurse competencies that are critical considerations to determine adequacy of staffi ng.

Baker Act Reform

– Support authorizing psychiatric ARNPs, working under protocols developed by a supervising psychiatrist, to perform Baker Act evaluations and either release the patient or recommend involuntary treatment.

No Fault Automobile Insurance - Personal Injury Protection (PIP)

– Support the continuation of PIP as a requirement for automobile registration.

– Support expansion of coverage limits to $25,000, with the additional coverage limited to emergency services, inpatient, and rehabilitation services provided by hospitals, and by physicians practicing in hospitals.

• Provide an environment conducive to the development of hospital-owned Provider Service Networks (PSNs), Accountable Care Organizations (ACOs) and Medical Homes, as alternatives to Medicaid Health Maintenance Organizations (HMOs).

• Ensure that existing PSNs in Duval, Broward, and Dade Counties are able to continue providing services to enrollees and have opportunities to expand coverage, promoting

high-quality services while realizing cost-savings for the state.

• Maintain a level playing fi eld for hospitals when contracting with Medicaid HMOs so that vital services are available to Medicaid patients.

• Continue essential healthcare services fi nanced through Intergovernmental Transfers (IGTs) and Certifi ed Public Expenditures (CPEs).


2011 FHA ADVOCACY

PRIORITIES

Lee Memorial Health System Lee County, Florida

Summary of Information provided by Anne Rose

Background of Anne Rose Anne Rose is the Vice President of Revenue Cycle for Lee Memorial Health System and has nearly 30 years of extensive experience in healthcare provider revenue cycle programs, physician contract management, business negotiations, community partnerships, marketing, and internal and external communications for the 7th largest public health system in the United States, with four acute care hospitals, two specialty hospitals, a skilled nursing facility, home health, a 180-person employed physician group and 9,500 employees. Anne oversees extremely complex insurance contracts that impact the availability of products and carriers in the community and the billing and collections for the hospitals. Anne is member of the National Roundtable for Managed Care Executives and Chief Revenue Officers, comprised of over 30 major health systems from all around the United States and often facilitates educational programs at the biannual meetings and serves as a sounding board for her peers. Anne has also been a featured speaker at the National Roundtable for Chief Financial Officers. Anne is also a member of the Florida Hospital Association of Managed Care Professionals (FAMCP) and has been since its inception in 1995. Anne has served on the Board of Directors for FAMCP in 1995 and again from 2005-2007 and served as President during 2006. Anne continues to serve on the Legislative Committee to help address industry issues. Medicaid Managed Care for Lee County, Florida Lee Memorial Health System (LMHS) has participated in Medicaid managed care products dating back to 1994 and has held contracts with companies such as PCA Century, Physicians Healthcare Plans, St. Augustine, Frontier, Foundation, AvMed, Florida 1st, Amerigroup, and WellCare. From April 1997 to July 1999, we accepted full risk for hospital services provided to Medicaid members enrolled in the Florida 1st products. In 2008, we entered into an arrangement with Prestige, a Provider Sponsored Network (PSN), who now has enrollment of approximately 27,000 members in Lee County and in 2009 we contracted with Integral, a PSN based in Collier County. Over the years, many of the Medicaid HMOs have consolidated or been acquired by larger companies so the current Medicaid Managed care contracts held by LMHS are with Amerigroup, Wellcare, Prestige, and Integral. LMHS has always been willing to contract with Medicaid Managed care companies and remains willing to do so. LMHS holds numerous managed care agreements for commercial insurance products and for Medicare Advantage plans in addition to its Medicaid managed care agreements. We have an extremely solid track record of working with the payor community in order to provide a variety of products to our citizens and visitors. LMHS is not opposed to working with private payors who wish to furnish Medicaid products to qualifying members, provided we can use the same business tools we use in our commercial and Medicare Advantage negotiations. The negotiation process allows each party to determine the

payment terms and conditions of the contract, including such items as payment rates, authorization procedures, claims filing procedures, credentialing procedures, malpractice requirements, and other general conditions of participation. Each health system in Florida is unique and needs to have the opportunity to negotiate private contracts that it can administer and that will not undermine its financial integrity. Adverse Patient Mix for Lee Memorial Health System All health systems across our country utilize the practice of cost-shifting in order to cover the shortfalls of payments made by the Medicare and Medicaid programs. Consider in the case of LMHS that 69% of our patients have Medicare, including private Medicare Advantage plans, or Medicaid, including HMOs and PSNs for fiscal year 2010. All of these plans pay LMHS less than our cost to provide the services. An additional 8% of our patients have no insurance coverage and again we receive far less than our cost for the services we provide. Commercial managed care plans cover the remaining 23% of our patients and yet cover all of the payment shortfalls. In contrast, many large cities have patient mixes that are almost directly the opposite of the one just described, with 70% of patients being covered by commercial payors and 30% being tied to programs that pay below cost. The reason this is important is that the amount of the cost shift is directly correlated to the patient mix. For this reason, it is not always possible to replicate successes from pilot programs since the circumstances each health system faces are unique. The individuality of each market is also of concern for why “dollars follow the patient” may not be viable. The dilution of dollars that help to fund patient mix shortages by including them in a capitation rate will ultimately result in creating worse conditions for cost shifting. Florida’s fragile economy could be undermined even further if dollars are not paid directly to the entities who provide vital services to Florida’s poor. In our market, LMHS would have to try to make up shortfalls through additional cost shifting to businesses who can ill afford to bear more insurance costs. Its important to note the LMHS patient mix has been eroding steadily over the last four years, starting at 30%, then 30%, then 27% and now at 23%, reflecting the tough economic conditions in our community that have resulted in the loss of many jobs. Value to the Community LMHS is a good steward of resources and this is evidenced by our cost metrics which remain extremely low. Our FTEs per average occupied bed is at 4.7, well below what other communities experience and our operating margin is usually between 2 and 3 percent, which is certainly not excessive. LMHS also serves as a local bright spot in an otherwise struggling economy, providing over 9,500 employees with jobs and annual salaries, wages and benefits of over $500 million. In order to continue our community service and mission, we are asking that Medicaid managed care contracts remain as private transactions between the payors and providers; and that the funding source for healthcare services provided to Florida’s low income citizens remain intact and not be distributed on a per patient basis.



Board Education

Nancy McGovern, RN, MSM

Board Secretary

(Discussion)



NEW BUSINESS



OLD BUSINESS

______________


RRREEEVVVIIISSSEEEDDD RECOMMENDED ACTION FOR BOARD APPROVAL (Action includes Acceptance, Approval, Adoption, etc)


DATE: January 13, 2011 LEGAL REVIEW: Yes ___ No ___

SUBJECT: 2011 Board Meeting Schedule – Changes to Location & Finance Meetings

REQUESTOR & TITLE: Cathy Stephens, Board Administrator

PREVIOUS BOARD ACTION ON THIS ITEM (IF ANY) (justification and/or background for recommendations – internal groups which support the recommendation i.e. SLC, Operating Councils, PMTs, etc.)

The Board approved at their Jan 4, 2011 Meeting to remove all remaining dinner meetings with the medical staff for 2011. This was the main purpose of rotating the Board meetings to each campus. Other alternative creative ideas to meet with the medical staff throughout the year will be discussed. SPECIFIC PROPOSED MOTION: Approve 2011 Revised Board Meeting Schedule, changing location of all meetings to the Lee Memorial Hospital – Boardroom. Also approval of amending Finance Board Meeting Schedule as shown below in summary. FINANCIAL IMPLICATIONS Budgeted ____ Non-Budgeted ____ (including cash flow statement, projected cash flow, balance sheet and income statement) With current rotating schedule, the cost of sound equipment rental is $500 per month for after 5pm service. SUMMARY

The Finance calendar has been strategically organized, as follows: January: Audit approval, investment review, Quarterly review of Financial results April: Financial Goal Policy, Budget kick-off, budget volume approval, investment review, Quarterly review of Financial results June: Budget Compensation & Benefits, initial capital budget review, investment review, Quarterly review of Financial results September: Finalize Budget, Quarterly review of Financial results November: Investment review, Year-end review of Financial results

BOD/Forms/Board (Action) Reporting Form – updated 9/2/09 cs

PROPOSED CHANGES in REDPROPOSED CHANGES in RED

BOARD OF DIRECTORS OFFICE

239-343-3300 FAX: 239-343-3194

P.O. BOX 2218

FORT MYERS, FLORIDA 33902

CAPE CORAL HOSPITAL

GULF COAST MEDICAL CENTER

HEALTHPARK MEDICAL CENTER

LEE MEMORIAL HOSPITAL

THE CHILDREN’S HOSPITAL

THE REHABILITATION HOSPITAL

LEE PHYSICIAN GROUP

LEE CONVENIENT CARE

BOARD OF DIRECTORS

DISTRICT ONE

Stephen R. Brown, M.D.

Marilyn Stout

DISTRICT TWO

Richard B. Akin

Nancy M. McGovern, RN, MSM

DISTRICT THREE

Lois C. Barrett, MBA

Linda L. Brown, MSN, ARNP

DISTRICT FOUR

Diane Champion

Chris Hansen

DISTRICT FIVE

Donald A. Brown

James Green

2011 Proposed CALENDAR changes, Location and Finance Changes011311

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2011 MEETING SCHEDULE (PROPOSED FOR APPROVAL 1/13/11)

• Tuesday, January 4 – (4:00pm) Annual Organizational Meeting & concurrent with Lee County Trauma Services District Annual Organizational Meeting – LMH

GOVERANCE Full Board Dinner Meetings:

• Thursday, Feb 17**propose move to April 14 (Follows Finance Meeting) • Thursday, Sept 15 (Follows Finance Meeting)

Planning, Quality/Education & Trauma Full Board Meetings Proposing ALL Planning & Quality/Education MEETINGS BE HELD IN THE LEE MEMORIAL HOSPITAL – BOARDROOM

• Thurs, Jan 13 4:00pm Planning CCH • Thurs, Feb 10 4:00pm Quality/Education LMHHPMC • Thurs, March 3 4:00pm Planning LMHGCMC • Thurs, April 7 4:00pm TRAUMA District then Quality/Education LMH • Thurs, May 12 4:00pm Planning LMHCCH • Thurs, June 16 4:00pm Quality/Education LMHHPMC • July NO MEETINGS • Thurs, Aug 11 4:00pm TRAUMA District then Planning LMH • Thurs, Sept 8 4:00pm Quality/Education LMHGCMC • Thurs, Oct 6 4:00pm Planning LMHCCH • Thurs, Nov 3 4:00pm TRAUMA District then Quality/Education LMH • December NO MEETINGS

*NOTE: Followed by Dinner Meeting with the Medical Staff at designated campus

FINANCE Full Board Meetings, 4:00pm, LMH Boardroom

• Thurs, January 20 • Thurs, June 23 • Thurs, February 17 • July – NO MEETINGS • Thurs, March 24 • Thurs, August 18 • Thurs, April 14** • Thurs, Sept 15 (October–NO MEETING) • Thurs, May 19 • Thurs, November 10

LOCATIONS LMH - Lee Memorial Hospital Boardroom (1st floor)

GCMC – Gulf Coast Medical Center Community Room (Off Atrium) CCH – Cape Coral Hospital Auxiliary Room (Off Main Lobby)

HPMC – HealthPark Medical Center, Meeting Rooms 1A and 1B (Off Cafeteria)

Any person requiring special accommodations at any of the meetings because of a disability or physical

impairment should contact the Board of Directors office at (239) 334-5943 at least five calendar days prior to the meeting.

ALL MEETINGS ARE OPEN TO THE PUBLIC AND THE PUBLIC IS INVITED TO ATTEND

Any Public Input pertaining to an agenda item is limited to three minutes and a “Request to Address the Board of Directors” card must be completed and submitted to the Board Administrator prior to the meeting.



M E M O R A N D U M

TO: LMHS Board of Directors FROM: Accountability Committee (John Wiest, Jim Humphrey, Steve Brown, MD & Cathy Stephens) DATE: January 10, 2011 SUBJECT: Sunset Accountability Committee Hello, We had a meeting of the Accountability Committee today, and there was some confusion as to what our role had been, and we apologize for this. As per recommendation of the charter, we are sunsetting this committee at this time. We all enjoyed working together and we thank the Board for this opportunity.

V:\MEMOS\2011\011011 Accountability Committee SUNSET.doc



BOARD OF DIRCTOR’S REPORT



DATE OF THE NEXT REGULARLY SCHEDULED

MEETING

FINANCE Full Board MEETING

Thursday, January 20, 2011

4:00pm

Lee Memorial Hospital

Board Room 2776 Cleveland Avenue, Fort Myers, FL 33902

board of directors planning full board meeting … · board of directors . planning full board...

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