Archives for March 2017

Anesthesiology as Perioperative Care

Jacob Raphael, M.D.

Jacob Raphael, M.D.

When Dr. Jacob Raphael came to the United States from Israel after he completed his anesthesia training, he accepted a position with the UVA Department of Anesthesiology on what he considered to be a year-by-year basis; consistently re-evaluating the alignment of his goals and philosophy with those of the department and the UVA Health System. Twelve years later, Dr. Raphael remains proudly at UVA for a variety of reasons: in particular, the sense of collaboration across surgical teams, as well as the excellence of the other anesthesiologists and specialists with whom he considers himself extremely fortunate to work. “I looked for a place where the same physicians do pediatric and adult cardiac anesthesiology,” he says. “That kind of versatility keeps you sharp.”

A common misconception is that the sole purpose of anesthesiologists is to treat patients at the time of surgery. While this responsibility is vital, they also play an important role in many other aspects of patient care. “The anesthesiologist is really a perioperative physician,” says Dr. Raphael. “We are involved in cases from pre-op evaluation through discharge, and across a broad spectrum of patient needs including pain management and critical care.”

Department of Anesthesiology Chair Dr. George Rich points out that while anesthesiology isn’t typically considered to be a research-focused field, members of his team are involved in important research. One of the most significant issues currently being addressed is the reduction of opioid use for pain management. “We have been able to decrease opioid use by 40% in the last five years, using a number of different methods including regional nerve blocks, spinal narcotics as well as non-steroidal anti-inflammatories,” reports Dr. Rich. “This is something we are very proud of.” This achievement has been chronicled by news media including The Daily Progress and MD Magazine.

George Rich, M.D.

George Rich, M.D.

The emphasis on reducing opioid use is consistent with UVA Health System’s commitment to patient safety: a standout quality of this academic medical center. “In that respect, UVA is a much different environment than what I experienced in Israel, and from what I understand it also differs from most other health systems in the U.S.,” observes Dr. Raphael. “The reality of it is that we have very strict, careful safety regulations here at UVA.”

Another critical quality for outstanding care, according to Dr. Rich, is teamwork. “If you don’t function as a team, the patient outcomes are worse – many studies demonstrate this.” Dr. Raphael adds that the OR team is hardly limited to anesthesiologists and surgeons. “During any given surgery, there are likely residents, CRNAs (Certified Resident Nurse Anesthetists), the nursing team, the support team who sets up the room and brings equipment, and other players as well. When everybody embraces each other’s roles it leads to more success all around — and in the end that means improved patient outcomes and experience, which is our shared goal.”

This trend toward collaborative care, according to UVA Executive Vice President for Health Affairs Dr. Richard Shannon, is here to stay: “Team care is the model for the future. It clearly causes significant change in outcomes for patients,” he says.



From the CEO’s Desk: Benefits Update and Opportunities to Learn More About UPG

As you may recall, planned changes to the Clinicians Supplemental Retirement Plan (CSRP), due to become effective on January 1, 2017, were delayed in order to allow time for evaluation of potential alternatives.

There were two major factors that required changes to the CSRP: First, it was in danger of failing federal non-discrimination testing, which would lead to a taxable event for all participants; and second, funding the plan was becoming increasingly costly to departments.

Throughout fall 2016, meetings were held to offer faculty members the opportunity to discuss the upcoming benefit changes. During these meetings, some faculty members indicated that they did not feel their best interests were being adequately represented. UPG executive leadership and the Board of Directors took this feedback very seriously, and determined that a pause in action was necessary so that other possible solutions could be considered.

Extensive analysis by actuarial firm AON Hewitt revealed a previously unknown option: If the CSRP is tested in aggregate with the staff pension plan, it is no longer in imminent danger of failing federal testing. Therefore, the review committee recommended to the UPG Board of Directors that all currently employed clinicians remain in the existing plan.

While this solution addressed the issue of fairness, it remained clear that the CSRP had to be changed going forward in order to mitigate departmental expense.

On January 19, 2017, the UPG Board of Directors approved a resolution stating that all clinicians hired before January 1, 2017, would remain in the existing CSRP with no change having been made to their plan or benefits, while all new hires (on or after January 1, 2017) be enrolled in the new defined contribution plan.

For UPG executive leadership, this process of working collaboratively with faculty to find a viable solution to a complex issue led to an important development on a broader scale. It became apparent that we need to do a more effective job of clearly communicating the scope of UPG’s role and services to our constituents.

In this vein, I have asked for some time on upcoming departmental faculty meeting agendas in order to provide an overview of the structure and value of UPG as it relates to Health System partners and our clinicians directly. So far I have attended seven faculty meetings and I’m pleased to report that meaningful dialogue has ensued at each.

We are planning to host a longer evening session from 5:00-7:00 on May 4, during which we will get into greater detail and offer ample opportunity for discussion and questions. In order to inform our presentation and ensure that we are addressing the issues that are most important to you, we welcome questions and feedback in advance of the May 4 event. Please send your input to:

Refreshments will be provided at the May 4 session. I look forward to having the chance to talk further with you and your colleagues there.

As always, thank you for being a member of the UPG community.

Sincerely, Brad

Brad Haws

Brad Haws

Key Messages from Board of Directors Meetings: December 2016, January 2017, March 2017

Key Messages from UPG Board of Directors Meeting December 7, 2016

The theme for this meeting was changes underway across UPG. Mr. Haws outlined external influences affecting change, and internal initiatives involving UPG. In his leadership remarks, Dr. Shannon also addressed the issue of change being the new normal in healthcare.

Representatives from UPG’s audit firm, BDO, presented information from the FY2016 Annual Audit Report, as well as consolidated financial statements and supplemental information for the past two fiscal years. There were no new notes for improvement in FY2016.

Professor DeMong, a UPG Board member, provided a financial analysis of UPG which showed that the organization has demonstrated profitability, stability and low financial risk over the past five (5) years. 2016 was an unusual year with several unique pressures to the income statements and cash flow statements; it is most likely that these will not be repeated and therefore should not be of concern for the financial outlook of UPG.

Mr. Haws provided an update on the Clinicians Supplemental Retirement Program (CSRP), outlining developments to this point: A Special Meeting of the UPG Board of Directors was convened in November 2016, during which they passed a resolution delaying changes to the CSRP in order to allow for more time to consider potential alternatives. Actuarial firm AON Hewitt was commissioned again for analysis, and their experts discovered that if the clinician pension plan were tested in aggregate with the staff plan, it would no longer be in imminent danger of failing federal testing. Investigation was still underway regarding departmental cost of maintaining the plan. The Board unanimously passed a resolution stating that all clinicians hired on or after January 1, 2017, be enrolled in the new defined contribution plan.

Key Messages from UPG Board of Directors Meeting January 19, 2017

This Special Meeting was convened to consider a resolution stating that all clinicians hired before January 1, 2017, would remain in the existing CSRP, while all new hires on or after that date would be enrolled in the new defined contribution plan. After new Board Chair Kate Acuff introduced Dr. Robert Thiele as a new faculty director to the Board, this resolution was discussed and unanimously approved.

Key Messages from UPG Board of Directors Meeting March 16, 2017

Ms. Acuff and Mr. Haws began this meeting with leadership remarks. Ms. Acuff focused on the leadership role played by UPG as a key collaborator in the clinical and academic mission of the Health System, contributing significant funds during this challenging time for healthcare financing. There is a clear need for resilience and collaboration in this uncertain climate.

Mr. Haws also stressed the importance of resilience, instead of resistance, when it comes to change. Across the UVA Health System, big changes are being implemented at a challenging time in the healthcare industry. These system-wide initiatives either involve millions of dollars or thousands of people, or both. UPG has aligned itself  with these initiatives, as a strategic partner of the Health System.

Dean Wilkes provided a research overview from the School of Medicine. Between FY15 and FY16, UVA moved from 40th to 35th in the NIH rankings of medical schools, according to total NIH grant awards. The School of Medicine has engaged in several partnerships across UVA grounds, including the Data Science Institute, the UVA Brain Institute and cluster hiring: recruiting multiple faculty members across disciplines who work in a particular interdisciplinary field with potential for broad impact. Dean Wilkes discussed three of the major initiatives underway at the School of Medicine: the Strategic Hiring Initiative, Pinn Scholars and the CTSA application. Top current priorities for the School of Medicine include executing the development of the Inova/UVA Genomics Institute, continued development of the regional Medical School campus at Inova, aggressive investment in research and faculty recruitment and increasing the NIH portfolio to $150M within 3 years.

In her last Board of Directors meeting as UPG Chief Financial Officer, Susan Rumsey provided updated financial results through January, and operations results through February. While revenues are in target range, the numbers on the expense side are not as favorable. Ms. Rumsey stated that there were two important things to consider regarding expenses: departmental incentives were over budget, and the impact of the high cost of the pension plan. The balance sheet represents a strong cash position, with liquidity having been created going into the Epic revenue conversion. Patient care volumes have been strongly above target all year, contributing to Ms. Rumsey’s optimism regarding the budget cycle.

UPG Chief of Human Resources and Development Brenda Jarrell provided an update on Ufirst operations and technology. This initiative is intended to eliminate inconsistencies across the system and define HR as a whole, and is on track to become effective in July 2018. The UPG legal team is currently working with the University General Counsel’s office to ensure that legal boundaries are carefully evaluated and keenly observed.

Mr. Haws provided an update on changes in clinical operations and proposed a resolution to enter into a management agreement with Novant for Regional Primary Care North Primary Care Clinics. Extensive discussion ensued with regard to UPG’s assumed risk under the proposed agreement, focusing on ways to ensure UPG is protected financially with an outsourced manager. The resolution passed with three opposed and one abstention.

Mr. Haws provided an update on the Epic, with focus on timeline and workflow scenarios in preparation for Go-Live. The system has been designed and built; testing is underway and end user training is scheduled for April and May.




Key Performance Indicators: Workload Trends


Key Messages from Clinical Chairs Committee Meetings: February 14, 2017 and March 14, 2017

Key Messages from Clinical Chairs Committee Meeting February 14, 2017

The focus of this meeting was Epic Phase 2 and Patient Friendly Access.

Epic and PFA Executive Leader Melanie Lewis provided an update on Epic Phase 2 and Patient Friendly Access (PFA). The Epic Phase 2 ‘Roadmap to Implementation’ illustrates key dates, including Go-Live readiness assessments on May 2 and June 6. Go-Live implementation is still scheduled for July 1; final confirmation of this date will take place after the June readiness assessment.

Ms. Lewis stated that there had been some confusion regarding PFA and Cadence, which are both separate parts of Epic Phase 2. Specifically, Cadence is the scheduling system for PFA. Ms. Lewis shared the timelines for PFA and Epic, highlighting the specific Go-Live dates for OpTime (June 12) and Cadence (June 19).

Ms. Lewis shared a list of ‘What’s Changing’ topics for Epic Phase 2, as scheduled for weekly PFA presentations; and an outline of what team members can expect during each phase of PFA readiness. During the final Go-Live readiness period from April 15 to July 1, only critical changes may be made to Cadence templates. Departments and clinics are asked to request any changes as soon as possible for consideration ahead of April 15. After July 1 the post Go-Live stabilization period begins, during which clinics may make daily changes; additional change requests will be prioritized after stabilization. This period will last through September, to be followed by the standard change process becoming effective in October 2017.

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Key Messages from Clinical Chairs Committee Meeting March 14, 2017

Current UPG President Paul Levine, M.D. provided information about the upcoming election to fill the vacancy that will be left by his impending retirement.

UPG Chief Financial Officer Susan Rumsey, in her last Clinical Chairs Committee meeting before her departure from the organization, went over the FY17 Indigent Care projection. The FY17 budget was a reduction from FY2016, with the 4.5% decline in expenses due to the shift in academic-related costs. Ms. Rumsey outlined FY17 expectations, which demonstrate a budget variance of $5M.

Ms. Rumsey discussed the impact of pension plans on FY17, breaking it down into four (4) components: Pension liability, total expense, department chargebacks and funding of plans. Factors that have a significant impact on liability and expense include population demographics, discount rates, expected return on assets, annuity conversion rate and interest crediting rate. There is a “perfect storm” of cost-increasing factors: longer life expectancy, lower market returns and market forces. Next steps include increasing FY17 chargeback expense to the clinical units by $5M, which will mitigate losses on the income statement of the practice plan and improve the funding level of the pension plan toward targeted levels.

Epic and PFA Executive Leader Melanie Lewis provided a brief update on Epic Phase 2 and overview of PB Charge Ownership. Ms. Lewis reviewed requirements of the Clinical Revenue and Charge Ownership Program as well as goals and key responsibilities roles of chairs, administrators and billing managers and tools and processes. Ms. Lewis asked the group’s approval of the PFA standard change for clinic cancellation to be changed from “Chair” to “Chair or Chair’s designee”. Approval was granted.