COO Report to the Board November 2018 Population Health Stated in - - PowerPoint PPT Presentation

COO Report to the Board November 2018

2

Population Health

*Excludes Benefits Expenses

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 1,051 1,056 (5) (0.5)% 5,220 5,320 (101) (1.9)% Registry 133 122 11 9.1% 712 621 91 14.7% Employee benefits

• 0.0%
• 0.0%

Contracted physician services

• 0.0%
• 0.0%

Professional Services

• 0.0%
• 0.0%

Purchased services 379 306 73 23.9% 1,270 1,529 (259) (16.9)% Pharmaceuticals

• 0.0%
• 0.0%

Medical Supplies

• 100.0%
• 100.0%

Materials and supplies 11 6 5 79.6% 43 36 7 17.9% Outside medical services 383 374 10 2.6% 1,881 1,907 (26) (1.4)% General & administrative expenses 14 23 (10) (42.1)% 64 117 (54) (45.9)% Repairs/maintenance/utilities

• 0.0%
• 0.0%

Building/equipment leases & rentals

• 0.0%

14

• 14

100.0% Depreciation 578.0% 1 1 578.0% Total operating expense 1,971 1,887 84 4.5% 9,204 9,531 (327) (3.4)% FTEs 109 117 (7) (6.2)% 108 116 (8) (6.7)% SYS Adjusted Patient Days 30,153 29,330 823 2.8% 155,163 150,221 4,942 3.3% FTEs / SYS Adj Occupied Bed 0.11 0.12 (0.01) (8.7)% 0.11 0.12 (0.01) (9.7)% Expense / SYS Adj Patient Day 65.38 $ 64.34 $ 1.03 $ 1.6% 59.32 $ 63.45 $ (4.13) $ (6.5)%

ACTIONS

• Continue recruitment for 1.0 FTE Interim Nurse Manager at Highland and 1.0 FTE at Alameda/ San Leandro for

Care Management. A new Social Work manager for Highland started in November.

• Two contractors for utilization management (Social Work and Registered Nurse) started in early December for a 90

day period to help with throughput in Highland.

3

Provider Delivery

ACTIONS

• Finance is reviewing and reconciling existing contracts and invoices to confirm alignment with contract terms.
• Bi weekly meetings between finance and CMO to review/ follow up on all pending action items

*Excludes Benefits Expenses

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 3,271 4,096 (825) (20.1)% 16,861 20,546 (3,686) (17.9)% Registry 19 3 16 488.4% 21 16 5 28.7% Employee benefits

• 0.0%
• 0.0%

Contracted physician services 6,678 6,290 388 6.2% 33,760 32,932 828 2.5% Professional Services

• 0.0%
• 0.0%

Purchased services 214 402 (188) (46.7)% 1,200 2,011 (811) (40.3)% Pharmaceuticals

• 0.0%
• 0.0%

Medical Supplies 62.9% 1 1 1 90.8% Materials and supplies 75 56 18 32.4% 388 321 67 20.9% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 210 199 11 5.4% 992 995 (3) (0.3)% Repairs/maintenance/utilities 7.5% 1 (1) (78.5)% Building/equipment leases & rentals

• 0.0%
• 0.0%

Depreciation (0) (38.7)% (0) (39.4)% Total operating expense 10,467 11,047 (580) (5.2)% 53,222 56,822 (3,600) (6.3)% FTEs 283 317 (34) (10.7)% 278 311 (33) (10.6)% Worked RVUs (wRVU) 84,932 79,341 5,591 7.0% 424,960 396,705 28,255 7.1% Expense / wRVU 123.24 $ 139.23 $ (15.99) $ (11.5)% 125.24 $ 143.24 $ (18.00) $ (12.6)%

4

Ambulatory Care – Volumes

ACTIONS

• Highland K6 updated residency templates to increase # of appointments; no impact yet.
• Eastmont Wellness hired SAN provider in December; currently going through credentialing.
• Outreach being conducted in Newark and Eastmont Primary Care is supporting a positive trend
• Expansion of specialty care: breast / neurosurgery / rheumatology in Hayward; ENT in Alameda; Ortho in HGH K7
• Perform detail analysis on clinic volume by site by physician to uncover reasons for continue lower clinic visit volume.

November BUDGET # VAR % VAR YTD BUDGET # VAR % VAR

PRIMARY CARE SUMMARY Highland 6,463 7,222 (759) (11)% 35,230 37,741 (2,511) (7)% AH Primary Care 34 90 (56) (62)% 172 250 (78) (31)% Eastmont 3,284 3,461 (177) (5)% 18,561 18,097 464 3 % Hayward 2,967 2,920 47 2 % 16,482 15,260 1,222 8 % Newark 2,184 2,394 (210) (9)% 11,244 12,171 (927) (8)% Fairmont 56 98 (42) (43)% 315 508 (193) (38)% Total primary care 14,988 16,185 (1,197) (7)% 82,004 84,027 (2,023) (2)% SPECIALTY CARE SUMMARY Highland 7,109 7,421 (312) (4)% 38,492 39,149 (657) (2)% Alameda 1,047 908 139 15 % 5,546 4,872 674 14 % Eastmont 1,093 1,536 (443) (29)% 6,774 8,274 (1,500) (18)% Total specialty care 9,249 9,865 (616) (6)% 50,812 52,295 (1,483) (3)% Total visits 24,237 26,050 (1,813) (7)% 132,816 136,322 (3,506) (3)%

5

Ambulatory Care – Financials

*Excludes Benefits Expenses

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 3,966 4,470 (504) (11.3)% 20,151 22,058 (1,908) (8.6)% Registry 64 82 (18) (22.0)% 323 453 (130) (28.7)% Employee benefits

• 0.0%
• 0.0%

Contracted physician services

• 3

(3) (100.0)%

• 15

(15) (100.0)% Professional Services

• 0.0%
• 0.0%

Purchased services 152 194 (42) (21.8)% 913 972 (60) (6.1)% Pharmaceuticals 57 108 (51) (46.9)% 428 553 (126) (22.7)% Medical Supplies 256 248 7 3.0% 1,321 1,370 (49) (3.6)% Materials and supplies 59 60 (1) (1.9)% 336 301 35 11.5% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 3 18 (15) (82.9)% 32 89 (57) (64.6)% Repairs/maintenance/utilities 32 38 (5) (14.6)% 212 188 24 12.9% Building/equipment leases & rentals 186 195 (9) (4.6)% 930 975 (46) (4.7)% Depreciation 79 81 (2) (2.8)% 417 405 12 2.9% Total operating expense 4,854 5,497 (643) (11.7)% 25,061 27,380 (2,319) (8.5)% FTEs 474 556 (82) (14.7)% 474 538 (64) (12.0)% Clinic Visits 24,237 26,050 (1,813) (7.0)% 132,816 136,322 (3,506) (2.6)% FTES / Clinic Visit 1.96 2.13 (0.18) (8.3)% 1.78 1.97 (0.19) (9.6)% Expense / Clinic Visit 200.28 $ 211.02 $ (10.74) $ (5.1)% 188.69 $ 200.85 $ (12.16) $ (6.1)%

ACTIONS

• Overages in labor costs resulting from Modified Duty and Leave of Absence to be managed by holding vacant

positions as well as managing non-payroll spend when appropriate.

• Orthopedics & Podiatry considering consolidation of Podiatry across AHS campuses to improve operational

performance and service effectiveness

• Leadership team is finalizing interventions to support success in a number of additional pay-for-performance

metrics for PRIME, QIP and HPAC contract.

6

Acute Care – Volumes

ACTIONS

• Improving operations by reducing

avoidable days with aggressive patient placement is ongoing.

• Increasing use of Interventional

Short Stay Unit for Cardiac related Observation days assigned to Medicine team is in process at Highland.

• Capturing Inpatient Room &

Board charges for ED Boarders with Admit Orders is in progress at Highland.

• Formed multidisciplinary teams

including nurses, physician, and managers to maximize efforts and communication to address the throughput issues.

• Congruent and collaborative

system process being established to optimize department billing

• Standard work process to

validate midnight census effectvie Feb 2019

November BUDGET # VAR % VAR YTD BUDGET # VAR % VAR

DISCHARGES 1,190 1,246 (56) (4)% 6,245 6,157 88 1 % ALAMEDA 207 188 19 10 % 1,018 940 78 8 % HIGHLAND 791 852 (61) (7)% 4,186 4,160 26 1 % SAN LEANDRO 192 206 (14) (7)% 1,041 1,057 (16) (2)% AVERAGE DAILY CENSUS 211.0 207.4 3.6 2 % 212.2 197.5 14.7 7 % ALAMEDA 31.0 30.5 0.5 2 % 31.1 27.9 3.2 11 % HIGHLAND 155.5 141.2 14.3 10 % 153.2 140.5 12.7 9 % SAN LEANDRO 24.5 35.7 (11.2) (31)% 27.9 29.1 (1.2) (4)% Average Length of Stay 5.3 5.0 0.3 6 % 5.2 4.9 0.3 6 % ALAMEDA 4.5 4.9 (0.4) (8)% 4.7 4.5 0.2 4 % HIGHLAND 5.9 5.0 0.9 18 % 5.6 5.2 0.4 8 % SAN LEANDRO 3.8 5.2 (1.4) (27)% 4.1 4.2 (0.1) (2)% Occupancy 84% 83% 1 % 85% 79% 6 % SURGERIES 716 735 (19) (3)% 3,756 3,848 (92) (2)% ALAMEDA 166 169 (3) (2)% 924 912 12 1 % HIGHLAND 456 455 1 0 % 2,244 2,275 (31) (1)% SAN LEANDRO 94 111 (17) (15)% 588 661 (73) (11)% EMERGENCY VISITS 8,232 9,190 (958) (10)% 43,404 47,997 (4,593) (10)% ALAMEDA 1,381 1,292 89 7 % 6,811 6,572 239 4 % HIGHLAND 4,644 5,183 (539) (10)% 24,709 27,457 (2,748) (10)% SAN LEANDRO 2,207 2,715 (508) (19)% 11,884 13,968 (2,084) (15)% IP ER 811 974 (163) (17)% 4,245 4,768 (523) (11)% ALAMEDA 152 159 (7) (4)% 693 771 (78) (10)% HIGHLAND 497 624 (127) (20)% 2,651 3,031 (380) (13)% SAN LEANDRO 162 191 (29) (15)% 901 966 (65) (7)% OP ER 7,421 8,216 (795) (10)% 39,159 43,229 (4,070) (9)% ALAMEDA 1,229 1,133 96 8 % 6,118 5,801 317 5 % HIGHLAND 4,147 4,559 (412) (9)% 22,058 24,426 (2,368) (10)% SAN LEANDRO 2,045 2,524 (479) (19)% 10,983 13,002 (2,019) (16)% DELIVERIES 103 116 (13) (11)% 570 584 (14) (2)%

7

Acute Care – Financials

*Excludes Benefits Expenses

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 19,276 19,734 (457) (2.3)% 97,675 91,814 5,860 6.4% Registry 1,363 1,814 (450) (24.8)% 6,498 10,576 (4,078) (38.6)% Employee benefits

• 0.0%
• 0.0%

Contracted physician services

• 0.0%
• 0.0%

Professional Services

• 0.0%
• 0.0%

Purchased services 1,475 1,163 311 26.8% 6,425 6,044 381 6.3% Pharmaceuticals 2,585 2,153 432 20.1% 10,535 10,463 72 0.7% Medical Supplies 2,883 2,139 743 34.7% 12,884 10,734 2,150 20.0% Materials and supplies 844 886 (42) (4.7)% 4,680 4,540 141 3.1% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 60 54 6 11.6% 318 272 47 17.1% Repairs/maintenance/utilities 884 780 104 13.3% 4,069 3,901 168 4.3% Building/equipment leases & rentals 110 171 (60) (35.4)% 629 855 (226) (26.4)% Depreciation 358 292 65 22.3% 1,869 1,466 402 27.4% Total operating expense 29,838 29,186 652 2.2% 145,582 140,666 4,916 3.5% FTEs 1,840 1,970 (131) (6.6)% 1,860 1,841 18 1.0% Acute Adj patient days 9,734 9,766 (32) (0.3)% 50,602 48,756 1,846 3.8% FTEs / SYS Adj Occupied Bed 5.67 6.05 (0.38) (6.3)% 5.62 5.78 (0.16) (2.7)% Expense / Acute Adj Pt Day 3,065.30 $ 2,988.54 $ 76.76 $ 2.6% 2,877.01 $ 2,885.10 $ (8.09) $ (0.3)%

Overall volumes are higher than budget, therefore impacting labor and supply costs. However, this SBU is optimizing resources as indicated by favorable Expense/ Adjusted Patient Day indicator. Tactics underway include:

• Rebidding schedules in various departments and aligning resources to workload.
• Reviewing overtime and sick leave bi-weekly, including incidental overtime and missed breaks/meals. Addressing

attending/OT policy to standardize across AHS system.

• Creating an equipment/ supply approval process that will be system wide to track non- labor expenses.
• Tracking and evaluating patient sitter needs daily.
• Re-evaluating patient acuity every 4 hours as standard to address 1:1 status.
• Looking into training programs for units with long term vacancies.

8

Behavioral Health – Volumes

ACTIONS

• Coordinate with physicians and Case Management to ensure timely discharge. Assess patient acuity during every

shift to reduce un-necessary 1:1 nursing care.

• Continue to work on throughput with new CN IV Intake team structure. Length of Stay and Discharges being

impacted by growing acuity (reflected in JGP Case Mix index) being revisited both at patient care levels (operations)

• Initiating Phase 2 Whole Person Care targeting high utilization patients and engaging PES discharge through

community resources, which enable the capacity and ability to assess and treat new patients.

• Pursuing Medi-Cal site authorization, which will allow for eligibility to bill for Medi-Cal patients (non-beacon)

through outpatient services.

November BUDGET # VAR % VAR YTD BUDGET # VAR % VAR

BEHAVIORAL HEALTH PATIENT DAYS 2,043 2,023 20 1 % 10,416 10,452 (36) 0 % DISCHARGES 225 245 (20) (8)% 1,157 1,240 (83) (7)% Average Daily Census 68.1 67.4 0.7 1 % 68.1 68.3 (0.2) 0 % Average Length of Stay 9.1 8.3 0.8 10 % 9.0 8.4 0.6 7 % Occupancy 99% 98% 1 % 99% 99% 0 % EMERGENCY VISITS 1,142 973 169 17 % 5,929 5,362 567 11 % CLINIC VISITS 1,547 1,437 110 8 % 8,421 7,690 731 10 % JGP Case Mix Index 1.124 1.037 0.087 8 % 1.088 1.037 0.051 5 %

9

Behavioral Health- Financials

ACTIONS

• Management team to monitor time, attendance, and overtime usage daily
• New schedules will be implemented 1/9/2019 at the IP floors
• Pending Meet and Confer & Re-bidding of SEIU schedules to lower overtime costs to commence once system-

wide FY19 labor impacts process completed.

*Excludes Benefits Expenses

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 3,844 3,978 (134) (3.4)% 19,084 19,069 14 0.1% Registry 251 53 198 374.4% 835 271 565 208.6% Employee benefits

• 0.0%
• 0.0%

Contracted physician services 996 1,000 (4) (0.4)% 5,146 5,277 (131) (2.5)% Professional Services

• 0.0%
• 0.0%

Purchased services 102 81 21 25.6% 486 407 79 19.4% Pharmaceuticals 27 29 (2) (6.5)% 142 162 (20) (12.6)% Medical Supplies 11 9 2 27.6% 53 45 7 16.3% Materials and supplies 75 71 3 4.7% 335 384 (49) (12.8)% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 7 4 4 101.0% 29 18 11 64.6% Repairs/maintenance/utilities 123 106 17 16.1% 674 530 144 27.2% Building/equipment leases & rentals 5

• 5

100.0% 21

• 21

100.0% Depreciation 10 8 2 19.6% 70 41 29 71.5% Total operating expense 5,452 5,340 112 2.1% 26,874 26,204 670 2.6% FTEs 366 369 (3) (0.8)% 356 352 4 1.1% BHS Adj patient days 3,091 3,014 77 2.6% 16,128 15,407 721 4.7% FTEs / BHS Adj Occupied Bed 3.55 3.67 (0.12) (3.2)% 3.38 3.50 (0.12) (3.4)% Expense / BHS Adj Pt Day 1,763.70 $ 1,771.68 $ (7.97) $ (0.5)% 1,666.29 $ 1,700.78 $ (34.49) $ (2.0)%

10

Post Acute Care – Volumes

ACTIONS

• Continued work with Health Care Services Agency and East Bay Innovations for community placements to

increase discharges across the Post- Acute SBU.

• New internal process implemented Dec 2018 to increase rehab clinic visits. Discharges from Acute Rehab

Unit to be referred to clinic as appropriate.

November BUDGET # VAR % VAR YTD BUDGET # VAR % VAR

POST ACUTE PATIENT DAYS 9,246 9,060 186 2 % 46,716 45,772 944 2 % DISCHARGES 81 63 18 29 % 383 356 27 8 % Average Daily Census 308.2 302.0 6.2 2 % 305.3 299.2 6.1 2 % Average Length of Stay 114.2 143.8 (29.6) (21)% 122.0 128.6 (6.6) (5)% Occupancy 98% 96% 2 % 97% 95% 2 % REHAB CLINIC VISITS 12 7 5 71 % 54 35 19 54 % FMT Case Mix Index 1.118 1.102 0.016 1 % 1.118 1.102 0.016 1 %

11

Post Acute Care - Financials

ACTIONS

• Rebid finalized – FMT SNF/ Nursing Admin starting to post vacant positions to reduce overtime and registry
• Ongoing monitoring of sitter usage for clinically complex residents
• Overtime tracking/ monitoring – new process only allows Staffing Coordinator and Supervisor to approve overtime
• n a daily basis – daily leadership oversight during morning huddles.

*Excludes Benefits Expenses

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 3,947 4,238 (291) (6.9)% 20,282 20,185 97 0.5% Registry 95 57 38 66.5% 460 291 169 57.9% Employee benefits

• 0.0%
• 0.0%

Contracted physician services

• 0.0%
• 0.0%

Professional Services

• 0.0%
• 0.0%

Purchased services 259 346 (87) (25.2)% 1,580 1,733 (153) (8.8)% Pharmaceuticals 106 117 (11) (9.2)% 560 560 1 0.2% Medical Supplies 161 142 20 13.7% 948 725 223 30.8% Materials and supplies 213 251 (38) (15.1)% 1,203 1,304 (101) (7.8)% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 13 12 2 12.9% 42 59 (17) (29.4)% Repairs/maintenance/utilities 98 110 (11) (10.3)% 383 548 (165) (30.1)% Building/equipment leases & rentals 99 93 6 6.2% 524 464 59 12.7% Depreciation 15 5 10 228.4% 74 23 51 226.2% Total operating expense 5,007 5,370 (363) (6.8)% 26,057 25,893 164 0.6% FTEs 524 572 (48) (8.4)% 532 546 (14) (2.5)% Post Acute Adj patient days 9,498 9,314 184 2.0% 47,951 47,097 854 1.8% FTEs / Post Acute Adj Occu Bed 1.66 1.84 (0.19) (10.1)% 1.70 1.77 (0.08) (4.2)% Expense / Post Acute Adj Pt Day 527.13 $ 576.55 $ (49.42) $ (8.6)% 543.40 $ 549.77 $ (6.37) $ (1.2)%

12

System Support Services

ACTIONS

• SYS BioMed –reviewing and reconciling existing contracts and invoices to confirm alignment with contract terms.
• Patient Accounting – review the effectiveness of collection agency spent in cash collection.

*Excludes Benefits Expenses * Medical Supplies shows inventory adjustment

Stated in $000's November, 2018 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 5,441 5,745 (304) (5.3)% 26,594 29,032 (2,437) (8.4)% Registry 149 317 (169) (53.1)% 1,085 1,705 (620) (36.4)% Employee benefits

• 0.0%
• 0.0%

Contracted physician services

• 0.0%
• 0.0%

Professional Services

• 0.0%
• 0.0%

Purchased services 2,494 3,463 (968) (28.0)% 15,966 17,410 (1,444) (8.3)% Pharmaceuticals 8 9 (1) (11.7)% 40 43 (3) (8.0)% Medical Supplies (79) 357 (437) (122.2)% (338) 1,787 (2,125) (118.9)% Materials and supplies 296 208 89 42.7% 964 1,056 (92) (8.8)% Outside medical services

• 0.0%
• 0.0%

General & administrative expenses 1,095 1,430 (335) (23.4)% 5,908 7,148 (1,240) (17.3)% Repairs/maintenance/utilities 1,346 636 710 111.6% 3,601 3,181 420 13.2% Building/equipment leases & rentals 181 265 (84) (31.5)% 1,229 1,324 (96) (7.2)% Depreciation 765 1,021 (256) (25.1)% 3,843 5,203 (1,360) (26.1)% Total operating expense 11,696 13,450 (1,754) (13.0)% 58,892 67,890 (8,998) (13.3)% FTEs 667 748 (81) (10.8)% 662 742 (79) (10.7)% SYS Adjusted Patient Days 30,153 29,330 823 2.8% 155,163 150,221 4,942 3.3% FTEs / SYS Adj Occupied Bed 0.66 0.76 (0.10) (13.2)% 0.65 0.76 (0.10) (13.5)% Expense / SYS Adj Patient Day 387.88 $ 458.59 $ (70.70) $ (15.4)% 379.55 $ 451.93 $ (72.38) $ (16.0)%