BOARD OF DIRECTORS AGENDA PACKET

Transcription

1 BOARD OF DIRECTORS AGENDA PACKET December 12, 2011 The mission of Palomar Pomerado Health is to heal, comfort and promote health in the communities we serve. 1

2 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) , or visit our website at 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* u:templates\bd agenda inner cover sheet template:nla 2

3 Monday, December 12, 2011 Commences 6:30 p.m. PALOMAR POMERADO HEALTH BOARD OF DIRECTORS REGULAR MEETING AGENDA 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. Palomar Medical Center Graybill Auditorium 555 E. Valley Parkway Escondido, CA I. CALL TO ORDER 2 Time Page II. OPENING CEREMONY 5 A. Pledge of Allegiance III. PUBLIC COMMENTS 5 (5mins allowed per speaker with cumulative total of 15mins per group - for further details and policy see Request for Public Comment notices available in meeting room.) IV. MINUTES * A. Regular Board Meeting - November 14, 2011 B. Closed Session Board Meeting - November 14, 2011 V. APPROVAL OF AGENDA to accept the Consent Items as listed * A. August 2011 & YTD FY2011 Pre-Audit Financial Statement Close (Addendum A) B. Approval of Revolving, Patient Refund & Payroll Fund Disbursements August Accounts Payable Invoices 2. Net Payroll Total $44,082, $11,890, $55,973, C. Ratification of Paid Bills D. Annual Budget Approval Policy - FIN01 E. ICOC Annual Report F. IT Strategic Plan G. Proposed Amendment of the MSA Agreement between PPH and PPHF VI. PRESENTATIONS 20 Verbal Report A. "Hear for the Holidays" Announcement and Presentation to Winner for 2011 by David Illich, AuD., FAAA, Chief Audiologist for PPH B. Patient Satisfaction Update - Roger Acheatel, M.D. VII. REPORTS A. Medical Staffs *1. Palomar Medical Center - John Lilley, M.D A. Credentialing and Reappointments B. Waiver of Eligibility Criteria for Board Certification - Patricia Wu, M.D. C. Dept. of Orthopaedic Surgery & Rehabilitation Rules & Regulations D. ExpressCare Nurse Practitioner Privilege Checklist E. Clarification of Application of Li Liang, M.D. 3

4 *2. Pomerado Hospital - Roger Acheatel, M.D A. Credentialing and Reappointments B. Administrative 1 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 * A. Resolution No (09) 05 Establishing Board Meetings for Calendar Year 2012 * B. Election of Officers President and CEO - Michael Covert, FACHE 10 Verbal Report VIII. INFORMATION ITEMS A. Physician Board Summary Report IX. COMMITTEE REPORTS A. Audit and Compliance Committee B. Governance Committee C. Human Resources Committee D. Community Relations Committee E. Facilities and Grounds Committee F. Quality Review Committee G. Strategic Planning Committee H. Finance Committee * Resolution No (05) 01 Naming Additional Authorized Signatory * Resolution No (06) 02 Removing Authorized Signatories * Resolution No (07) 03 Opening of Bank and Investment Accounts * Resolution No (08) 04 Closure of Bank and Investment Accounts I. Other Committee Chair Comments on Committee Highlights X. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT 5 MONTH XI. ADJOURNMENT 4

5 Palomar Pomerado Health BOARD OF DIRECTORS REGULAR BOARD MEETING Pomerado Hospital/Meeting Room E Monday, November 14, 2011 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY CALL TO ORDER 6:40P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa 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. NOTICE OF MEETING APPROVAL OF MINUTES Regular Board Meeting October 10, 2011 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 was mailed consistent with legal requirements MOTION: by Greer, 2 nd by Kaufman and carried to approve the regular Board meeting minutes of October 10, 2011 as submitted. APPROVAL OF AGENDA (to accept the Consent Items as listed) A. Sept 2011 & YTD FY2011 Pre- Audit Financial Statement B. Approval of Revolving, Patient Refund and Payroll Fund Disbursements August 2011 Accounts Payable Invoices $48,496, Net Payroll $ 17,889, All in favor. None opposed. MOTION: by Rivera, 2 nd by Kaufman and carried to approve the Consent Items A I, as submitted. All in favor. None opposed. 5 1

6 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY Total $66,386, C. Ratification of Paid Bills D. Recording of Governing Board Meetings - GOV25 E. Media Relations - GOV21 F. Succession Policy - GOV30 G. Amended ALPHA Fund Joint Powers Agreement H. New Procedure - Physician Agreements Board Approval Process I. Pathology Department Services Agreement PRESENTATIONS Deloitte and Touche Mark Kawauchi and Hiral Shah of Deloitte and Touche presented the 2011 audited Financial Statements. Deloitte and Touche issued an unqualified opinion on the Financial Statements. 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, 2 nd by Kaufman and carried to approve the Palomar Medical Center Medical Staff Executive Committee credentialing recommendations for the Palomar Medical Staff with Li Liang, M.D. deferred for further review. All in favor. None opposed. MOTION: by Yerxa, 2 nd by Bassett and carried to approve the Modified Core Privileging Checklist, as presented. All in favor. None opposed. MOTION: by Bassett, 2 nd by Yerxa 6 2

7 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY and carried to approve the Plastic Surgery Checklist, as presented. Pomerado Hospital Credentialing Rodger Acheatel, M.D., Chief of Pomerado Medical Staff, presented Pomerado Hospital s requests for approval of Credentialing Recommendations. All in favor. None opposed. MOTION: by Bassett, 2 nd by Greer and carried to approve the Pomerado Hospital Medical Staff Executive Committee credentialing recommendations for the Pomerado Medical Staff with Li Liang, M.D. deferred for further review. Administrative Chairman - Palomar Pomerado Health Foundation John Forst Mr. Forst stated that the Foundation Board would be meeting on Thursday, November 17 th. Mr. Forst stated that the audit report will be reviewed for approval at the Foundation Audit Committee meeting in January. The Gala committee has started preparations for the May 19 th Night of Night s Gala. The Foundation will be offering higher levels of sponsorship this year. The PHT Board met on October 7 th to discuss service agreements for financial and legal services. The PPH employee campaign met its $2million goal with 67% participation. The Foundation held a pie tasting to thank the employees for their contributions. Mr. Forst stated that the search for a Chief Development Officer is continuing. Freeman Philanthropic has been retained to aid in the search. All in favor. None opposed. 7 3

8 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY Chairman of the Board Ted Kleiter Chairman Kleiter stated that he and David Tam, M.D. made a presentation regarding the PMC West campus at the Lake San Marcos Kiwanis Club. President and CEO Michael Covert Mr. Covert stated that Chairman Kleiter received the 2011 Leadership in Governance award from the California Hospital Association. Earlier this year, Chairman Kleiter also received the Association of California Healthcare Districts (ACHD) Trustee of the Year award for his contributions to health care governance. Brenda Turner presented the Board with the SHRM grand prize award in work place excellence for Human Resources. Mr. Covert thanked those who participated in the Compliance Officer candidate interviews. The interview feedback is being reviewed and will be discussed with the Audit and Compliance committee. Mr. Covert will visit with the Foundation leadership to discuss candidates for the Chief Development Officer position. Mr. Covert thanked Anita Fraley for filling in during the interim. Beginning December 5 th the Holiday Meals for staff will be served. Mr. Covert asked that leadership sign up to help serve the meals. The Strategic Planning committee will be meeting tomorrow evening to review the results of the 1 st quarter FY12 initiatives. Dr. Acheatel stated that there will be a schedule of dates released for the Joint Conference Committee meetings. If a member cannot attend, a representative needs to be sent in their place. The meetings will alternate 8 4

9 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY between PMC and POM. Dr. Acheatel thanked Mr. Covert for his leadership in addressing the issue of the Trocars. COMMITTEE CHAIR COMMENTS Audit and Compliance Director Bassett stated that Deloitte and Touche presented the audited financial statements. No material misstatements were reported. Governance Director Krider stated that four policies approved on this evening s consent agenda were reviewed and approved at the Governance committee meeting. Human Resources Director Yerxa stated that HR did not meet in October. Community Relations Director Kaufman stated that the marketing department is putting together information for Night of Night s Gala on May 19 th. Board Facilities and Grounds Director Kaufman stated that the committee reviewed the media plan, including television, print and an insert in UT Sunday edition. Director Rivera stated that the Board Facilities and Grounds committee met earlier today. Director Rivera discussed the Ramona report. The plans will go back to the Ramona planning board this Thursday with minor changes. The planning board asked for more angles and curves in the design. Director Rivera stated that April 9 th is turn over date for the PMC West campus. The campus should be operational by August. Director Rivera discussed the location of the flagpole. The flagpole will be located on the Northeast side of the building near the healing garden area. This may also be a potential site for the plaque. Permanent lights will be added so that the flag does not have to come down. The flagpole may potentially be sponsored. 9 5

10 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY Director Rivera stated that there had been a meeting with Kindred and developer last Friday. Board Quality Review Director Bassett stated that the committee reviewed the regulatory update and the results of the 1 st quarter FY12 initiatives. The committee reviewed Behavioral Health Services key quality activities. Arch Partners Medical Foundation highlighted their quality goal to maintain Top Performing Medical Group status. Finance Director Greer stated that the committee activity summary is included in the packet for review. Strategic Planning Chairman Kleiter stated that it was a closed session meeting. ADJOURNMENT 7:45P.M. SIGNATURES Board Secretary Jerry Kaufman, P.T.M.A. Board Assistant Nicole Adelberg 10 6

11 Palomar Pomerado Health BOARD OF DIRECTORS Closed Session Pomerado Hospital / Meeting Room E Monday, November 14, 2011 AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW- UP/RESPONSIBLE PARTY CALL TO ORDER NOTICE OF MEETING ADJOURNMENT TO CLOSED SESSION CLOSED SESSION OPEN SESSION RESUMES FINAL ADJOURNMENT SIGNATURES 6:00P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa Notice of Meeting was mailed consistent with legal requirements. Pursuant to Gov Code Subdivision (a) of Section Conference with Legal Counsel Existing Litigation Quarterly Claims/Risk Management Report Pursuant to Government Code Subdivision (a) of Section : Conference with Legal Counsel Existing Litigation Quarterly Claims/Risk Management Report MOTION: by Director Kleiter to adjourn to closed session. All in favor. None opposed. MOTION: by Director Kleiter to resume open session MOTION: by Director Kleiter for final adjournment at 6:30P.M. Board Secretary Jerry Kaufman, P.T.M.A. Board Assistant Nicole Adelberg 11 1

12 October 2011 & YTD FY2012 Financial Report TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Robert Hemker, CFO Board Finance Committee Monday, November 28, 2011 Background: The Board Financial Reports (unaudited) for October 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 October 2011 and YTD FY2012. Motion: X Individual Action: Information: Required Time: Form A - Financial Report.doc 12

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14 Policy Annual Budget Approval Official (Rev: 4) Source: Board of Directors Board of Directors Policies Applies to Facilities: Applies to Departments: I. PURPOSE: To establish policy, as a part of the Board's fiduciary obligation expressed in the Local Health Care Law and the Board Bylaws, and in compliance with the standards of the Joint Commission on Accreditation of Health Care Organizations, the Governing Board is responsible for the Health District's annual budgets, both operating and capital budgets, develops a long-term capital expenditure plan and monitors the implementation of same. II. DEFINITIONS: III. TEXT / STANDARDS OF PRACTICE: A. The board has delegated certain responsibilities to the Finance Committee; the committee serves as an advisor to the board for budgetary purposes. Those responsibilities include: 1. Review the purposed, annual operating budgets for the District and its entities; 2. Review and make recommendations for the final consolidated operating budget. 3. The development and recommendation of an annual capital budget spending limit by category of expenditure: medical equipment > $100,000, routine less than < $100,000 facility renovations and improvement, information technology and reserve funds. In addition to the annual capital budget, a three-year capital expenditure plan which is updated at least annually and includes and identifies the anticipated source of financing for and objective of each proposed capital expenditure in excess of $100,000. B. A system of incremental reporting on the budget process is done, to ensure Board approval and adoption of the annual budget is completed prior to the commencement of the fiscal year. C. Prior to the full board approval, a thorough presentation is to be made to the board with opportunity for questions. D. This policy will be reviewed and updated as required or at least every three years. DOCUMENT / PUBLICATION HISTORY: Original Document Date: 2/94 Reviewed: 4/18/95; 1/99; 6/05 Revision Number: 1 Dated: 9/07 Document Owner: Michael Covert Authorized Promulgating Officers: Marcelo R. Rivera, Chairman CROSS REFERENCE DOCUMENTS: Prior to 2005 this policy was Board Policy IV. ADDENDUM: V. PUBLICATION HISTORY: Revision Number 4 (this version) Effective Date Document Owner at Publication Version Notes 11/14/2007 Bob Hemker, Chief Financial Officer Changes as part of review cycle Added at review: No material change made to text of document. Updated signatures 14

15 to current signers. 3 (Changes) 2 (Changes) 1 (Changes) Added at review: No changes at this time [This document revision was generated to track review signatures and does not contain any changes from the previous revision.] [Reviewed on 11/5/2010 by Bob Hemker: Extended review to 11/5/2011] 11/14/2007 Ofer Barlev Changes as part of review cycle Added at review: No material change made to text of document. Updated signatures to current signers. 11/14/2007 James Neal, Director of Corporate Integrity 06/01/2005 James Neal, Director of Corporate Integrity Changes as part of review cycle Original Document Date: 2/94 Reviewed: 4/18/95; 1/99; 6/05 Revision Number: 1 Dated: 6/05 Document Owner: Michael Covert Authorized Promulgating Officers: Marcelo R. Rivera, Chairman Authorized Signer(s): ( 01/07/2011 ) Bruce G Krider, Board Chairman, PPH Board ( 01/10/2011 ) Janine Sarti, General Counsel VI. REFERENCES: Reference Type Title Notes Source Documents Prior to 2005 this policy was Board Policy Paper copies of this document may not be current and should not be relied on for official purposes. The current version is in Lucidoc at. 15

16 Independent Citizens Oversight Committee Review of Annual Report for District Fiscal Year TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Bob Hemker, CFO Board Finance Committee Monday, November 28, 2011 Background: On Tuesday, November 15, 2011, the Palomar Pomerado Health Hospital, Emergency Care, Trauma Center Improvement and Repair Measure Bonds Independent Citizens Oversight Committee (ICOC) held their final meeting. At that meeting, the ICOC reviewed the District Expenditure Report, which details the reconciliation of funds expended from the proceeds of the General Obligation Bonds issued pursuant to Measure BB. Also reviewed was the General Obligation Bonds Disbursement Audit conducted and certified by the Palomar Pomerado Health Construction Auditor. Following the document review, the ICOC concluded that PPH is in compliance with the requirements of Measure BB. Pursuant to 3.2 of the ICOC Procedures, Policies & Guidelines (PP&G), the Annual Report of the ICOC for District Fiscal Year is herewith submitted to the District Board for consideration and response 1 When approved, the report will be considered final and will be posted (including the ADDENDUM referenced below in the footnote) on the ICOC page of the District Board s public web site: As all proceeds from the General Obligation Bonds have now been expended, the approval of the Annual Report was the last official act of the ICOC, and a motion to disband was approved at the meeting. Budget Impact: N/A Staff Recommendation: Based on the findings of the ICOC, staff recommended approval of the Annual Report of the ICOC for District Fiscal Year Committee Questions: COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Annual Report of the ICOC for District Fiscal Year Motion: X Individual Action: Information: Required Time: 1 In the interests of space, the 328-page ADDENDUM to the ICOC s report is not reproduced here. It is comprised of pages of the ICOC agenda packet, which can be reviewed at Form A - ICOC Annual Report.doc 16

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21 IT Strategic Plan TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Background: Connecting PPH Paul S. Peabody, Chief Information Officer Board Finance Committee Monday, November 28, 2011 The FY Information Technology (IT) Strategic Plan outlines how the IT Department will support Palomar Pomerado Health's (PPH) mission objectives and goals. It identifies 5 major areas, Technical Infrastructure, Applications, including regulatory requirements, Information Security, Data Analytics, as well as a Web Strategy. These areas were defined as a result of a thorough analysis of the external landscape including emerging health industry business and technology trends, as well as the capabilities of the current internal environment needed to support the systems. The I.T. strategic plan was developed over a four-month period in partnership with key stakeholders across the organization. PPH Long Term goals and Future Fiscal Year Initiatives served as a primary input for understanding the overall PPH business objectives. A preliminary market assessment was provided by Gartner which highlighted potential opportunities. Lastly, an analysis of the potential impact of key emerging trends in the healthcare industry were validated against the PPH Long Term Goals and the goals identified in the IT strategic plan to ensure that future business requirements were taken into account. The IT strategic plan foundation is a base plan that comprehends all regulatory requirements including meaningful use, ICD10, 5010, and data security. An enhanced plan to connect PPH and enable collaboration with our trading partners has also been developed to include health data analytics, decision support, a uniform web structure for patients, physicians and employees, and physician connectivity. The enhanced plan will constitute a starting point for a re-engaged IT Governance committee to recommend the future direction of IT initiatives and budget. Budget Impact: For details, see attached presentation Staff Recommendation: Cerner MU Applications $14,499,927 over 7 years Implementation Expense $ 3,532,275 over 7 years $18,032,202 Less MU Reimbursement $10,526,091 over 5 years Net Investment $ 7,506,111 Committee Questions: COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval to facilitate the ongoing IT strategy, including achievement of meaningful use criteria, for Fiscal Years , by expending $5M of capital/year for 5 years; with an additional Cerner multiple-year contractual relationship through Fiscal Year 2018 in the amount of $14.5M; additional implementation expenses of $3.53M through Fiscal Year 2018; and anticipated meaningful use reimbursements totaling $10.5M through Fiscal Year Motion: X Individual Action: Information: Required Time: Form A - IT Plan.doc 21

22 Connecting PPH Information Technology Strategic Plan FY

23 Information Technology Base Plan FY Achieves Regulatory Compliance 23

24 Overlapping Timelines of ICD-10, Meaningful Use of EHRs, and Health Reform Initiatives Federal Fiscal Year FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 Transition to ICD-10 Transition to ICD-10 requires extensive system changes NPRM comments indicated four years to complete requires partial ICD code freeze during transition Transition to ICD-10 Partial ICD Code Set Freeze ICD-10 Implementation (FY 2014) Administrative Simplification Transition to new version of HIPAA transaction standards (5010) followed by adoption of operating rules to further standardize business rules for electronic exchange of claimsrelated transactions, including insurance eligibility. Also invoices introduction of Health plan ID and other changes to administrative transactions over time. Meaningful Use of EHRs The Meaningful Use program imposes increasingly stringent EHR use and reporting requirements, as well as future payment penalties if metrics are not met. Stage 1 implementation undertaken at the same time that the transition to ICD-10 is taking place. Meaningful Use Stage 2 currently planned to span transition to ICD-10 (2013/2014) and would create duplicate rework effort (ICD9 and then ICD-10), adding additional costs for rework. IT resources are already thin internal as well as vendor support. Transition to 5010 (Jan, 2012 start) Base/performance period MU Stage 1 (starts FY 2011) 5010 Operational Open Rules Eligibility and Claim Status (Jan. 2012) Health Plan ID (tent. Start May 2012) MU Stage 2 (starts FY 2013) Accountable Care Organizations (Jan. 2012) Transition to Next Standard Value-Based Purchasing (FY 2013) Open Rules Remittance and Claims (FY 2015) MU Stage 3 (starts FY 2015) Health Reform Initiatives Health reform introduced accountable care organizations value-based purchasing. Readmission payment penalties, bundled payments, and penalties for hospital-acquired conditions that will require new IT systems to support procedural changes to operations. In addition, each new program requires reporting of metrics that will need to be redefined based on ICD-10. Many of these programs also require development of baseline and early performance metrics using data from prior years. HIPAA Privacy Changes The stimulus bill introduced changes to the HIPAA privacy provisions. Covered entities will need to revise their IT systems to account for a broader scope of disclosures of PHI and to provide individuals with an electronic copy of health information held in electronic form. Start dates for both programs are unknown, as rulemaking is ongoing. Base/performance period Base/performance period Readmission Payment Penalties (FY 2013) Bundled Payment (Jan. 2013) Accounting for Disclosures (start date dependent on rulemaking) ICD-10 Implementation Required Oct. 1, 2013 Hosp-Acquired Conditions (FY 2015) Patient Copy of Electronic Records (start date dependent on rulemaking) 24

25 Information Technology Base Plan FY Information Technology Readiness for PMC-West 25

26 11-Sep 11-Oct 11-Nov 11-Dec 12-Jan 12-Feb 12-Mar 12-Apr 12-May 12-Jun 12-Jul PMCW Project/Application Name W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W5 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W5 W1 W2 W3 W4 W1 W2 W3 W4 W1 W2 W3 W4 W5 W1 W2 W3 W4 W1 W2 W3 W4 Infrastructure and New Applications/Devices Network Infrastructure Distributed Antenna w/cellular Services Domain/Server Infrastructure Building Systems Server Install/Config VOIP/Unified Communications Device Deployment RIVA Robot SwissLog Boxpicker and Packager Nurse Call Alert Management Vision Dietary Room Service PPH/Facility Name Change (Schedule/Scope Unknown) Existing Applications to be Retrofit 3M HDM Audit Expert (Coding) Active Directory (Domain) API Payrollmation ARUP Interfaces (Lab Equipment) Avega BottomLine (QuickChart) Cerner Build for PMCW - All NETS Core / PowerChart / MPI (Pre Req for all NETS) Custom CCL, Scripting, Reports, Rules for Each NET Interfaces (Retrofit) Charge Services ProFit Registration ProFile MRP / XR ProVision Document Imaging (CPDI / ESIG) SurgiNet Scheduling Lab (AP) Lab (Micro) Lab (Blood Bank) Lab (Gen Lab) RadNet Pharmacy FirstNet PowerNote ED with Lynx Orders / CPOE PPOC Bar Code Med Admin Handheld Specimen Collection Iview ibus / CareAware LightHouse NHIQM PowerInsight Dictaphone (Transcription) GHX (PO/Invoice EDI Broker) HIE Interface Engine Lawson Accounts Payable Lawson Business Intelligence (LBI) Lawson EDI Lawson General Ledger Lawson HR/Payroll Lawson Mobile Supply Chain Lawson Procurement Lawson Requisition Center Lenel (Security/Badges) McKesson PACS Medical Device Interfaces Medicity (Cerner Data to Physician Offices) MHC Document Express (Check/PO Printing) Midas Press Ganey Reports Pyxis Med Stations RALS Plus and RALS Web ResQ (Nurse Staffing) Service Desk Express (IT Asset Management) Stix (Corporate Health) TeleTracking BedTracking and PatientTracking Varian Rad Therapy Vision Dietary Web Ehcoview (Report Portal) Xcelera (Echo/Cath Lab System) Legend: Design & Analysis Build & Configuration Testing 26 Ready for Use / Final Configurations with Equipment

27 Information Technology Base Plan FY Information Technology Infrastructure Upgrades 27

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29 Information Technology Base Plan FY Information Technology Base Plan Financials 29

30 Information Technology Base Plan Financials IT Base Plan Palomar Pomerado Health - Information Technology Forecast for 2012 through Budget Projection Projection Projection Projection Projection Projection Approved Capital Expenditures $ 5,700,000 $ 5,000,000 $ 5,000,000 $ 5,000,000 $ 5,000,000 $ 5,000,000 $ 5,000,000 Operating Expenditures $ 25,691,943 $ 30,031,081 $ 35,147,181 $ 37,482,008 $ 38,887,329 $ 40,831,696 $ 42,873,280 Meaningful Use 'Projected Reimbursement $ 1,944,304 $ 2,654,885 $ 3,157,746 $ 1,716,304 $ 1,052,852 $ - $ - Net Operating Expenditures $ 23,747,639 $ 27,376,196 $ 31,989,435 $ 35,765,704 $ 37,834,477 $ 40,831,696 $ 42,873,280 Cerner Contract Current $ 9,494,042 $ 10,686,052 $ 10,753,728 $ 10,823,436 $ 9,565,232 $ 5,669,964 $ 4,301,069 $ 61,293,523 Proposed $ 1,166,590 $ 429,649 $ 2,716,566 $ 2,716,566 $ 2,716,565 $ 2,716,566 $ 2,037,424 $ 14,499,926 Total $ 10,660,632 $ 11,115,701 $ 13,470,294 $ 13,540,002 $ 12,281,797 $ 8,386,530 $ 6,338,493 $ 75,793,449 Key Assumptions Risks Benefits Applications Applications Applications Certified Meaningful Use Systems in place Meaningful Use reimbursement and penalties Meaningful Use $10.5m Supports for Meaningful Use into the future (Stages 1-3) 5010 Claim output Avoid Meaningful Use penalties Maintain regulatory compliance ICD10 Required for billing ICD10 Compliance Includes continued contractual support for Revenue cycle optimization Computer based training current Cerner production applications Improved electronic training Revenue cycle improvement Integrated OB, SNF into Clarity Infrastructure Infrastructure Infrastructure Outsource mission critical applications, i.e. Lawson API Cerner remote hosting for Lawson/API Improved data center operations Establish core computing at West data center Data center - POM upgrade/west center VOIP telephone & video conferencing Enable technology convergence Telephone Voice Over IP Upgraded infrastructure at POM & PMC downtown Upgrade campuses to standard level Ongoing server, storage, PCS Indentity management & virtualized desktop Data Security Data Security Data Security HIPAA compliance Data loss, prevention, discovery Minimize PHI leakage risks Minimize exposure/data breach Mobile device/secure PHI Identity management Improved security infrastructure Data encryption Single sign-on Mobile device security management for BYOD Data at rest encryption 30

31 Information Technology Base Plan Meaningful Use The Electronic Health Record (EHR) is required to support PPH strategic objectives including the requirements around Meaningful Use Stages 1 3. Recommendations: Board Approval to extend Cerner Master Agreement through 2018 to include the additional components required. Timeliness of decision making is critical to meet Meaningful Use attestation timelines. 7 year Investment Request Cerner $14,499,927 Implementation Expense $ 3,532,275 $18,032,202 Less MU Reimbursement $10,526,091 Net Investment $ 7,506,111 31

32 Information Technology Base Plan Projects Women s Health PowerChart Maternity Long Term Care EHR (BeyondNow) Physician Documentation (PowerNote) Meaningful Use Core Measures (Stroke, VTE, ED- Throughput Patient/Provider Connectivity (IQHealth) Public Health Objectives Electronic Submission to Pharmacies (eprescribe) Enhanced Computer Base Training (LearningLIVE) ICD-10/5010 (regulatory) Revenue Cycle Enhancements Finance Remote Hosting 32

33 Information Technology Base Plan Infrastructure Data Center Network Data Storage Servers Converging Voice and Data Devices 33

34 Information Technology Base Plan 34

35 Information Technology Base Plan Network Storage Network Data Center Servers Infrastructure Storage Devices Phones 35

36 Information Technology Base Plan Data Center Hosted application systems Migrate Critical Systems to PMC-W Upgrade POM Data Center Upgrade Downtown Server Room Distributed Data Center Model 36

37 Network Establish network core Build out distribution Extend to branch locations 37 16

38 Information Technology Base Plan Data Storage Centralize production Storage Consolidate systems Connect storage environments 38

39 Information Technology Base Plan Servers Move critical applications to PMC-W Upgrade application servers Virtualize and consolidate servers 39

40 Information Technology Base Plan Converging Voice and Data Implement Voice Over IP (VOIP) Integrate voice and data networks Enable mobile devices 40

41 Information Technology Base Plan Device Refresh Device Deployment PMC-W Device Refresh system-wide Implement Virtual Desktop technology 41

42 Information Technology - Enhanced Plan Establish Information Technology Governance Committee EMT Membership Provide Information Technology Plan Oversight Review and Approve All Significant Ongoing IT Expenditures Develop Value Proposition For important IT/Business Initiatives Healthcare Data Analytics/Decision Support Web Portal Uniform Structure for Patients, Physicians, Employees Social Media Channels Connecting our Trading Partners HIE, NHIN, Health Information Portability Innovation Project Operational Support 42

43 Proposed Amendment of the MSA Agreement between Palomar Pomerado Health and Palomar Pomerado Health Foundation TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Stephanie Love, PPH Director of Finance Anita Fraley, PPHF Director of Major Giving Board Finance Committee Monday, November 28, 2011 Background: The proposed third amendment to the Management Services Agreement (MSA) between PPH and PPHF consists of two parts: A) A retainer agreement is to be incorporated for legal and financial services, at the rate of $1500 and $1875 per month, respectively, to be paid by PPHF, for services provided to Palomar Health Technology, Inc. (PHT), the new for-profit entity of PPHF. Said services will be under a retainer basis between PPHF and PHT, but PPHF s obligations will be provided by PPH under the MSA. B) It is being recommended that the interest and non-interest bearing portions of the Line of Credit (LOC) between PPH and PPHF be consolidated beginning in FY2012. Upon consolidation, the parties would record any revenue identification as appropriate. Further, the non-interest bearing portion of the LOC would be increased to $3 million to allow for periodic fluctuations in the use and transfer of funds between the parties, with the maximum LOC to remain at $5 million. Budget Impact: A) Positive budget impact for PPH of $3,375/mo B) Budgetary impact for both PPH and PPHF will be minimal Staff Recommendation: approval. PPHF staff, the PPHF Board, and PPH staff recommend Committee Questions: COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the third amendment to the Management Services Agreement between Palomar Pomerado Health and the Palomar Pomerado Health Foundation. Motion: X Individual Action: Information: Required Time: Form A - PPHF MSA.doc 43

44 THIRD CONTRACT AMENDMENT BETWEEN PALOMAR POMERADO HEALTH AND PALOMAR POMERADO HEALTH FOUNDATION 1.) This Amendment is made by and between PALOMAR POMERADO HEALTH, a local healthcare district organized under Division 23 of the California Health and Safety Code ( PPH ), and PALOMAR POMERADO HEALTH FOUNDATION, a California 501(c)(3) not for profit corporation ( PPHF ) on this day of, 2011 ( Effective Date of Amendment ). 2.) In consideration of the mutual promises of the parties, the receipt and sufficiency of which are hereby acknowledged, the MANAGEMENT SERVICES AGREEMENT between the parties ( Agreement ), dated 1 st day of September, 2005 is hereby amended as follows: 3.) In accordance with EXHIBIT A, enclosed below and incorporated herein, Financial and Legal services provided by PPH to PPHF shall accommodate PALOMAR HEALTH TECHNOLOGY, INC. ( PHT ), and shall be paid by PHT through a retainer agreement between PHT and PPHF. The retainer rates for financial services between PPHF and PHT shall be charged at $1,875 per month, while rates for legal services shall be charged at $1,500 per month. 4.) This Agreement is hereby amended to allow for the interest and non-interest bearing portions of the line of credit between PPHF and PPH be consolidated. Notwithstanding consolidation, the parties will continue to recognize the intent of the non-interest bearing line of credit s existence was to motivate PPHF to continue to transfer both capital and operating expense types of funds to PPH, therefore any operating expense-type contribution from PPHF to PPH in a given month will result in an equal reduction in the loan principal amount utilized as the basis for the monthly interest calculation. Upon consolidation, the parties will reflect any revenue identification, as applicable, consistent with accounting guidance. The line of credit will remain at Five Million ($5M) with the non-interest bearing portion comprising the first Three Million ($3M) advanced to allow for periodic fluctuations in the use and transfer of funds between the parties. 5.) This Amendment supersedes the First Amendment respective to the limits of the line of credit. 6.) To the extent the line of credit exceeds Three Million ($3M), interest will be calculated at the stated interest at each month s end. All other terms of the Agreement remain in full force and effect. In the event of a conflict, the provisions, terms and conditions of this Amendment shall prevail. 44

45 The parties have executed the Amendment as of the date set forth below. PALOMAR POMERADO HEALTH FOUNDATION By: Date: PALOMAR POMERADO HEALTH By: Robert A. Hemker Chief Financial Officer Date: 45

46 October 4, Palomar Health T6chnology, Inc. Attn: Craig Brown, Board Chair 960 Canterbury Place, Suite 200 Escondido, CA RE: Proposal for Financial, Accounting, and Legal Services The Palomar Pomerado Heafth Foundation (pphf) is pleased to submit a proposal for financial, accounting, and legal services to palomar Health reihnology, Inc. (pht). In addition to our extensive experience, the finance and legal teams have an intimate understanding of pht and its organizational needs and will strive to enhance the partneehip. our understa;ding of the services requir6d by PHT commands a certain level of quailfied staffiirg ano the managemlnt fee is presented for your review. As a courtesy to PHT, the fee is ba$ed on the average fully-burdened staff wage. We propose th financial and accounting service fee to be gl,g75 per honth, and the legaifee to be $1,500 per month. lt is agreed that pphf and pht wi revisit ihe proposal at ttre en? of ttre pht fiscaf year on June 30,2012. The valuation consists of the qualification and time estimated to fulfill the following job requ irements: Reconcile bank accounts Prepare and enter alljournal entries Prepare check requests for pht Produce monthly flnancial statements Prepare monthly financial reports for board and committee packets Prepare allwork papers for annual audit Review audit and enter all audit adiustments Prepare allwork papers for g90 tai return Enter approved budget Into pphf system Monitor expenses to budget Produce budget reports per proj ct on request Administrate Bank of America online account Produce 1099's Legal Services: Filing Forms with State and Federal Agencies Legal SeNices: Protecting the Corporation against potential lawsuits o Legal Services: Handling day to day licensing issues and research ll.tl,_. proposal meets your approval, please sign below. lf you have any questions please call Stephanie Love at , or Janine Sarti at We appreciate this opportunity and look fomard to working with you so that you and your staft can concentrate on PHT'S primary focus; developing innovated techiology. [Signatures on next page] I lpphf-pht: Proposal for Financial and Legal Services 46

47 Craig Brown Boad Chair 2IPPHF-PHT: Propo sal for Financial and Legal Services 47

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68 Budgeted Routine Physician Agreements Board Summary Report TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Bob Hemker, CFO Board Finance Committee Monday, November 28, 2011 Background: The following Budgeted Routine Physician Agreements were approved and became effective during the month of October. The standard Form A and Abstract Table for each signed Agreement is attached. PHYSICIAN AND/OR GROUP Clarity Physician Advisory Council Thomas Knutson, MD Sabiha Pasha, MD TYPE OF AGREEMENT Physician Independent Contractor Agreements Budget Impact: N/A Staff Recommendation: Information only Committee Questions: COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time: Form A - Physician Board Summary Report.doc 68

69 TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Ben Kanter, MD, CMIO; Paul S. Peabody, CIO Board Finance Committee Monday, November 28, 2011 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. There are separate agreements with all of the following physicians: Thomas Knutson, MD Sabiha Pasha, MD 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: X Required Time: 69

70 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Thomas Knutson, MD and Palomar Pomerado Health AGREEMENT DATE October 30, 2011 PARTIES PURPOSE SCOPE OF SERVICES Thomas Knutson, MD 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. 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 TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly YES NO IMPACT: None NO 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 70

71 PALOMAR POMERADO HEALTH - AGREEMENT ABSTRACT Section Reference Term/Condition Term/Condition Criteria TITLE Independent Contractor Agreement between Thomas Knutson, MD and Palomar Pomerado Health AGREEMENT DATE October 1, 2011 PARTIES PURPOSE SCOPE OF SERVICES Sabiha Pasha, MD 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. 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 TERMINATION COMPENSATION METHODOLOGY BUDGETED EXCLUSIVITY JUSTIFICATION No automatic renewal 10 day notice by either party without cause Hourly YES NO IMPACT: None NO 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 71

72 PPH Board Committee Activity Summary November 17, 2011 Audit and Compliance Committee ACTION ITEMS: None INFORMATION ITEMS: Quality Assessment Review (QAR) Update: Tom Boyle reviewed the results of the Quality Assessment Review. Internal Audit Capability Model: was discussed. Internal Audit Activities were reviewed. 72

73 PPH Board Committee Activity Summary November 15, 2011 Governance Committee ACTION ITEMS: Annual Budget Approval Policy FIN01: was approved INFORMATION ITEMS: Board Manual: The committee reviewed the 2011 Board Manual. 73

74 PPH Board Committee Activity Summary November 9, 2011 Community Relations Committee ACTION ITEMS: None INFORMATION ITEMS: Gustavo Friederichsen provided an update on the PMC West Grand Opening events. Leonel Sanchez, PPH Marketing Media Manager, provided a media placement update. 74

75 PPH Board Committee Activity Summary Board Quality Review Committee November 8, 2011 ACTION ITEMS: No Action Items INFORMATION ITEMS: Service Excellence Update: Sheila Brown presented the FY2012 Q1 Press Ganey Patient Satisfaction Scores along with the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS) Data. Our strategic focus to increase patient loyalty includes Patient Centric Training, SMILE, Service Recover and Environment of Care. Patient Complaint Data: Donita Phillips provided an overview of the Patient Complaint / Grievance implementation. Pilot testing was done on Tower 8 and CCU. The next step is to rollout by unit/area across the organization. 75

76 PPH Board Committee Activity Summary November 15, 2011 Strategic Planning Committee ACTION ITEMS: None INFORMATION ITEMS: FY12 Initiatives - 1st Quarter Update: The committee reviewed the progress of the FY12 initiatives. Closed Session - Pursuant to California Government Code (h) Report Involving Trade Secrets 76

77 TO: Board of Directors MEETING DATE: Monday, December 12, 2011 FROM: BY: Bob Hemker, CFO Bank and Investment Accounts Board Finance Committee Monday, November 28, 2011 BACKGROUND: Since enactment of the last Banking Resolutions, the following changes to the District s Bank and Investment Accounts have been made or are in process. All Bank Accounts (Except Health Development Account) All Investment Accounts (Except PPH General Obligation Bond Accounts) NAMING OF AUTHORIZED SIGNATORY Information Only 1 Chief Human Resources Officer Director of Finance Chief Human Resources Officer Director of Finance ADDITIONAL AUTHORIZED SIGNATORY RESOLUTION NO (05) 01 2 Palomar Pomerado North County Health Development, Inc. Bank Account PPH Corporate Controller REMOVAL OF AUTHORIZED SIGNATORIES RESOLUTION NO (06) 02 3 All Currently Active Bank Accounts (Except Health Development Account) All Currently Active Investment Accounts (Except PPH General Obligation Bond Accounts) Chief Planning Officer General Accounting Manager Cash Control Manager Chief Planning Officer General Accounting Manager Cash Control Manager Brenda Turner Stephanie Love (nee Schulte) Brenda Turner Stephanie Love (nee Schulte) Tim Nguyen OPENING OF BANK & INVESTMENT ACCOUNTS RESOLUTION NO (07) 03 4 ACCOUNT NAME TYPE OF ACCOUNT INSTITUTION ACCOUNT # expresscare Clinics 5 Banking U.S. Bank expresscare Clinics 5 Banking Chase Bank PPH General Obligation Bond Election of 2004 Series 2009A PPH General Obligation Bond Election of 2004 Series 2010A Funded Interest Account Certificates of Participation 2006 Issue Certificates of Participation 2009 Issue Investment Investment Investment Investment Wells Fargo Bank Wells Fargo Bank U.S. Bank Corporate Trust U.S. Bank Corporate Trust Certificates of Participation Investment U.S. Bank Corporate Trust 2010 Issue 5 expresscare: To facilitate the depositing of business receipts for expresscare clinics, it has become necessary to open deposit accounts within the retail spaces in which the clinics are located. The current practice has been problematic not only due to loss of revenue when the Clinics shut the doors early to transport deposits, but also due to the risk to the courier of cash. Other solutions that have been ruled out: PPH couriers do not wish to carry cash; Brinks courier proved to be too costly; and Bank of America does not have branches located in these retail spaces. By allowing a small business deposit or money market account to be opened at U.S. Bank and Chase Bank, the cash and checks can be deposited daily with minimal impact to business operations. 1 Authorized Signatory Names are informational only, as the authority granted under the previous Resolution was by Job Title 2 Based on procedural changes necessitated by the staffing of Health Development with PPH personnel 3 These positions are no longer active 4 Resolution includes designation of authorized signatories by Job Title as listed 5 See further background regarding opening of expresscare Clinic accounts above and on following page 77