Key Messages: Clinical Chairs Committee Meetings

March 2018

This meeting was held in Closed Executive Session.


April 2018

UPG President Bobby Chhabra, M.D. chaired the meeting, opening with remarks thanking chairs for their diligent efforts to resolve the budget deficit for FY19.

Ms. Rumsey presented Financial Results through February 2018, and Operations Results through March 2018. The Consolidated Balance Sheet shows no change in Total Assets and a 2% negative change in Total Net Assets which reflects an operating loss of $17.0M through February, offset by market gains of $15.2M. The Consolidated Income Statement shows a 3% decrease in total revenue relative to budget, and a 2% increase from prior year. Total expenses show a 2% decrease relative to budget and a 4% increase from prior year. Contributions to the School of Medicine are 8% over prior year, which includes a $2M endowment transfer. Ms. Rumsey explained the UPG Administrative Fee Structure, noting that the 8.25% rate on Collections would be reduced to 8.0% effective July 1, 2018. Expectation is that this will reduce the overall weighted collection fee (after discounts) from 7.7% to 7.45%. FY18 YTD Workload March results are 0.6% over budget. However, the FY18 budget did not contemplate a change in CRNA billing to Medicare; adjusting for that change, WRVUs are 0.7% below budget through March FY18 YTD Patient Collections are 0.9% above prior year and 2.7% below budget. After adjusting for $3.6M overstatement of FY18 budget, Patient Collections are 1.1% below budget.  Days in AR remains below 40 days, ending March at 39.2 Days.

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UPG Director of Audit and Billing Quality Robert Duggan and UPG Continuous Improvement Manager Luke Heneghan presented an update on the Continuous Improvement project with the Department of Surgery. In December 2017, three (3) focused Surgery Assistance teams were formed to review key department metrics in Process, Reporting and Denials. The goal was to conduct this review and build an assistance model to take to other departments, identifying corrections and deploying process improvements as quickly as possible. Mr. Duggan and Mr. Heneghan reviewed the status and deliverables of each of the three (3) teams and discussed next steps which include priority assistance to departments on a rolling basis based on top-side metrics. Department of Surgery Chair Martha Zeiger, M.D. complimented the work and the team on this project, noting that many improvements happened in real time. UPG has incorporated this work into its goals for the next fiscal year including scaling best practices across the clinical departments.

UPG COO Corey Feist presented an update on the UPG Cost Survey, developed and administered by UVA Center for Survey Research. The survey measured the following categories of questions: Size and structure of practice plan, services provided, fees for services and academic fees. It was distributed in January 2018 via Qualtrics and hard copy to 23 Academic Practice Plan Directors (APPD) members and saw a roughly 50% response rate. Next steps include analysis of raw data and follow-up conversations with respondents. Mr. Feist solicited volunteers to form a committee charged with reviewing the data and participating in follow-up calls.


An error was made in the February 2018 Clinical Chairs Committee Key Messages, in the section regarding Provider-Based Clinic Cost Allocation. The alternate (collection-based) methodology will begin in FY19.


May 2018

Ms. Southerland presented an overview of the proposed revisions to UPG bylaws. The intended aims of the revisions are to include representation from the UPG-employed Advanced Practice Provider population, and to rotate the opportunity for UPG BOD representation to all clinical chairs to enhance understanding of UPG operations and allow for greater engagement in the organizational structure.

Ms. Rumsey presented a Financial and Operations update, including information on Bad Debt and Indigent Care trends. FY2018TD April results show an inverse relationship between Indigent Care and Bad Debt, with Indigent Care 7.1% below prior year and Bad Debt 1.9% over prior year. Several issues have been identified around Financial Screening and Self Pay.

Mr. Feist presented an update on the Merit-Based Incentive Payment System (MIPS) results. MIPS participants receive a payment adjustment based on performance in four (4) categories: Quality, Cost, Improvement Activities and Advancing Care Information. UPG submitted documentation from patient records by the March 16 deadline to avoid potential penalty; a task which required manual extraction from approximately 4,500 patient chart reviews. Final performance scores will be reported in July, and used in determining the annual increase.

Mr. Feist presented an update on the CMS Open Payments Program, which collects information about the payments drug and device companies make to physicians and teaching hospitals. Types of payments include consulting fees, compensation for services other than consulting, honoraria, gifts, entertainment, food & beverage, and travel & lodging. Chairs were requested to review the CMS online draft report by May 15; the final draft of which would be published in June.

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