Archives for October 2017

Epic Phase 2 Update: Summary (October 2017)

1.       System implementation is complete. The next phase is to optimize the system within our workflows and business processes.

2.       During the system transition, we are monitoring performance against other Epic implementations of the Professional Billing (PB) functionality.  Comparisons indicate that we are performing above average in most metrics, and in the top quartile for a few metrics (as of week 13, ending September 30).

3.       Based on experience with previous clients, Epic has provided expectations for Days in AR and cash collections.  We are just entering the most difficult period, when Days are highest and Collections are lowest.  Recovery is expected after the turn of the calendar year.

Key Messages: October 2017 Clinical Chairs Committee Meeting

Opening Remarks

Dr. Bobby Chhabra made opening remarks in his first meeting as President of UPG, having been elected on September 12, 2017. Dr. Chhabra stated that he was honored to have been elected and that he looked forward to using this time of transition as an opportunity to evaluate UPG’s role in UVA Health System and determine how its evolution should take shape in order to best fulfill its mission. Dr. Chhabra expressed interest in using his leadership role to help improve UPG dialogue with stakeholders, encourage transparency and a review of UPG cost structure, and ensure that UPG is the best possible advocate for clinicians. Dr. Chhabra had already met with several Health System leaders to discuss alignment in purpose and vision. Three aspects in which Dr. Chhabra would like to see UPG play a significant role as a supporting ally of the Health System are: outreach practices, improvement of ambulatory operations and developing a group practice model.

As part of his mission to improve dialogue across the Health System and seek opportunities to strengthen UPG’s position as an advocate for physicians while staying committed to its core mission, Dr. Chhabra asked Department Chairs to reach out to faculty in order to identify top issues, and bring these to the next Clinical Chairs Committee Meeting.

Dr. Chris Ghaemmaghami, Chief Medical Officer and Senior Associate Dean for Clinical Affairs, said that he and Dr. Chhabra had discussed the transition and that he was fully committed to working collaboratively with UPG in his role as liaison for clinical activities among the UVA School of Medicine, UVA School of Nursing and UPG.

Indigent Care and Medicaid Supplemental Funding 

Brad Haws presented an update on Allocation of Indigent Care and Medicaid Supplemental Funding. The two programs, Indigent Care and Medicaid Supplemental, are intended to cover 95% of costs of providing clinical care and are based on those costs. Regulations are silent on how funds are allocated internally, and internal allocation has no impact on total funding. The existing internal allocation method is based on Indigent/Medicaid patient volumes with no cost component. This method was proposed by a sub-committee of the Clinical Chairs and adopted by the Clinical Chairs in FY06.  Historically, the program covered costs for only the 21 SOM Clinical Departments but effective FY13 UPG Clinical Operations was added. The addition of these practices increased the total amount of funding; the Clinical Departments benefitted from the increase in total funding due to the internal allocation method. The question has since been raised as to whether the internal allocation should mirror the way funding is received. Such a change would align the funding with the costs, and shift funding toward UPG Clinical Operations from the 21 SOM Clinical Departments. Mr. Haws said that it was not his intention to come to a resolution during this meeting, but to begin the discussion regarding potential models: either keeping the current volume-based model, or changing to a cost-based model. Discussion on the topic included the nature of RVU valuation for different specialties as well as the suggestion of a blended formula rather than a binary decision.

Aetna Medicare UVA Health System Prime Plan 

UVA Medical Center Contract Management Administrator Milton Dunlap introduced the Aetna Medicare UVA Health System Prime Plan. UVA and Aetna have jointly established a co-branded Medicare Advantage Plan which is being offered in the market effective January 1, 2018. Open enrollment runs from October 15 through December 7. This is a UVA-only plan with a closed network of UVA providers and UVA facilities including UVA HealthSouth, the UVA Imaging Center and Culpeper Medical Center. For the first year, the plan is being offered to patients in the City of Charlottesville as well as the counties of Albemarle, Fluvanna, Greene, Louisa, Madison and Nelson. Approximately 1200 individuals are expected to enroll in the first year. Potential plan benefits for UVAHS include: Capturing new patients who aren’t currently in UVAHS and retaining them for all services, an opportunity to learn how to better manage patient populations, the possibility of influencing payment rules and gaining access to patient data we would not otherwise have had, and the potential for future gain sharing. Providers were asked to direct patients with questions to call Aetna at the phone number provided.  A handout with plan comparison data was distributed.

Ufirst/UPG HR Future State

Mr. Haws provided an update on UPG’s involvement in the Ufirst initiative. With regard to division of services, specifics were not yet available because data is still being mined and gathered to determine which services will remain at UPG after the transition and which will be shared with UVA HR. It is likely that the more “high touch” services will remain at UPG, and that the split will be roughly 50/50. Mr. Haws thanked the group for their support and data, and said that leadership would follow up with more information when it becomes available.

Epic Phase 2

Mr. Haws presented an update on Epic Phase 2. The system implementation phase of the project is complete; the next phase is to optimize the system within our workflows and business processes. During the system transition, performance is being monitored against other Epic implementations of the Professional Billing (PB) functionality. Comparisons indicate that UVAHS is performing above average in most metrics, and in the top quartile for a few metrics. Based on experience with previous clients, Epic has provided expectations for Days in AR and cash collections. We are just entering the most difficult period, when Days are highest and Collections are lowest. Recovery is expected after the turn of the calendar year.

Epic Update: Week 13 Professional Billing Metrics

Metric UVA Average  
AR Days (% change from Baseline) 19% 20%
Cumulative Charges (% of Baseline) 99% 100%
Cumulative Payments (Week variance) -0.67 -1.06

 

Summary + What to Expect

  • We are trending with other Health Systems that have undergone Epic implementation.
  • Metrics are being closely monitored so that resources and efforts can be focused on addressing issues as they arise.
  • Slowdown in revenue cycle is expected to turn around by fiscal year-end.

UPG Pension Benefit Update

  1. To recap the resolution approved by the UPG Board of Directors in January 2017: All clinicians hired before January 1, 2017, had no changes made to their existing pension benefits. All new hires as of January 1, 2017 were enrolled in the new defined contribution plan. This decision was made to address the concern of fairness for all clinicians, ensure the financial health of existing pension benefits, and continue to provide top tier benefits for new clinicians.
  2. Funding of the existing defined benefit plans (both the CRP and CSRP), is solid and viable, having experienced a strong recovery from the combination of factors that affected funding in recent years.
  3. Chargebacks to departments were unusually high in FY2017. Infusing the plans with cash, along with strong market returns, improved the funding ratios substantially — as evidenced by the table of trends below. The goal is a funding level of at least 80% – this ensures funding for the expected payouts. This 80% goal is well above the federal government minimum standard funding target. Our financial statements indicate that we are currently at 125% of the federal government minimum standard funding target.
    Funded ratios 2011 2012 2013 2014 2015 2016 2017
    CRP 84% 71% 80% 81% 73% 75% 86%
    CSRP 64% 65% 78% 80% 70% 62% 73%

    **Please don’t hesitate to contact Christine Rudge with any remaining questions: CR2J@virginia.edu

Key Messages from UPG Board of Directors Meeting September 21, 2017

Introductions and Leadership Remarks 

UPG Board of Directors Chair Kate Acuff made leadership remarks emphasizing the UPG Board of Directors’ commitment to fostering a collaborative relationship with other UVA Health System entities, while fulfilling its fiduciary duty to UPG and its constituents.

Dr. Acuff introduced new Department Chairs Martha Zeiger, M.D. (Department of Surgery), Stephen Park, M.D. (Department of Otolaryngology – Head and Neck Surgery), Susan Pollart, M.D. (Interim Chair, Department of Family Medicine) and Brian Hoard, D.D.S. (Department of Dentistry). Dr. Acuff also introduced Bobby Chhabra, M.D., who was elected President of UPG on September 12, 2017. Dr. Chhabra, via conference call, expressed intent to use his leadership role to further the success of UPG and the Health System as a whole.

In his leadership remarks, UVA EVP for Health Affairs Rick Shannon echoed Dr. Acuff’s sentiment regarding renewed conversation and collaboration between Health System leadership and UPG management in support of their shared purpose.

Dr. Shannon presented an overview of UVA Health System successes, opportunities for improvement, and strategies. UVA Health System has enjoyed unprecedented success over the past year, having been ranked the number one hospital in Virginia for the second year in a row. Dr. Shannon highlighted UVA’s capacity to respond to emergency situations, as evidenced by the response to the events of the weekend of August 12. Dr. Shannon stated that recent clinical growth in the existing footprint has been substantial, and that the operating budget and the balance sheet are strong and healthy: necessary conditions for the infrastructure investments that are underway. The positive performance and direction in which UVAHS appears to be headed is in stark contrast with many other academic medical centers. This is the result of a combination of factors including exceptional commercial rates and a unique relationship around Medicaid and indigent care, as well as growing patient volume. Dr. Shannon emphasized the strategic advantage of practice reform over payment reform and stated that looking to the future, markets outside of Charlottesville provide UVAHS with the greatest chance of relevance and long term stability – and that it is of critical importance that UVA is the first Health System to reach those markets. Good business opportunities are afforded by the newly formed partnerships with Novant and Inova.

UPG FY17 Year-End Financial Update

UPG CFO Susan Rumsey provided FY2017 Year-End, and FY2018 Year-to-Date financial updates. Ms. Rumsey’s slide deck is included for reference here.

Epic Phase 2 Update

Ms. Rumsey provided an update on Epic Phase 2. After July 1 Go-Live, the initiative is toward the end of phase 2, going into the beginning of the optimization phase with improvements scheduled to begin on October 1. Upgrades to the system are scheduled to begin in February 2018. The top five issues being tracked and addressed are: Provider schedules, system privileges, printing/labels, patient movement workflows and integration/workflow. Ms. Rumsey shared metrics showing how UVA is performing relative to other Health Systems that have gone through implementation.

Novant Health/RPC-North Primary Care Management Transition Update

UPG CEO Brad Haws provided an update on the transition in management of UPG Primary Care facilities in Culpeper (“Regional Primary Care North”) to Novant. Mr. Haws pointed out that the agreed upon administrative service fee cap at 10.3%, leaving a 5.5% service fee collected by UPG, is significantly different than the Charlottesville cost structure; data which demonstrates that UPG wants to meet the needs of clinics at lower cost while also delivering the clinics the benefit of UPG contracts. Mr. Haws outlined the Regional Primary Care-North Support Services Agreement and provided information on progress to date including the successful transition of 84 FTEs; as well as current challenges faced, of which the AXIA status of Novant employees is the most complex. Mr. Haws credited the overall smooth transition to cooperation on both sides and in particular the efforts of Alison Haines from Novant and Katie Fellows from UPG. 

UPG HR Future State/Ufirst

Mr. Haws and UVA Chief Human Resources Officer Kelley Stuck presented a framework for UPG HR Future State as a shared agreement of joint partnership to manage services: a relationship which differs from the previously discussed understanding that UPG was to treat UVA as a vendor with regard to Ufirst. In the agreed upon joint partnership of UPG HR Future State, UPG will retain its decision making role with the UPG CEO and UVA CHRO partnering to provide counsel and recommendations to the UPG Board of Directors. UPG will retain appropriate embedded staff to continue to provide localized services aligned with the new process design, while UVA Human Resources will partner with UPG to provide core services, consulting, counsel, training, strategic support and transactional support. All services will require ongoing collaboration between UPG and UVA HR, and will require memorandums of understanding (MOUs) to address specific responsibilities. UPG will adapt the Workday IT platform associated with Ufirst in response to department chairs’ requests on behalf of faculty for a more streamlined IT process with increased functionality.

UVA EVP COO Pat Hogan initiated discussion of the importance of data security as protected by UPG’s separate status from UVA. A multilevel approach to data security and protection through the use of a separate FEIN will be employed to maintain the desired confidentiality of UPG proprietary data, and UPG HR Future State MOUs will be designed with the importance of FOIA protections in mind. Due care will also be taken to ensure corporate lines are respected.

UPG HR Future State service agreements will be created in the coming months leading up to the July 2018 Go Live date. Service measures will be addressed to assess and maintain quality levels of services that are important to UPG constituents, and further study will be done on cost impact given the new joint partnership framework.