COO Report to the Board For Reporting Month - March 2020 May 08, - - PowerPoint PPT Presentation

COO Report to the Board For Reporting Month - March 2020

May 08, 2020

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Patient Revenue Enhancement Strategy: Update

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Initiative Strategy/ Update Vol Var YTD $ Var YTD Issues Trend

Optometry: 2 additional clinic days at EWC

• UC Berkeley Optometry started one lane in

January w/ improvement in volumes

• Are pursing additional FTE in FY 21 contracting.

(1,280) ($148,464) * Optometry students no longer at Wellness Centers, which has reduced clinical capacity.

Primary Care Clinic: 3% Volume increase

• Tactics include overbooking, group visit,

accepting walk in visit

• Peds/Adult med/Family Med adding extra slot

each AM session effective 11/15

• Provider-level productivity improved and close

to targets since December (15,328) ($1,816,590) * Physician recruitment at Eastmont Wellness has been challenging but continues.

Labor & Deliveries: 200 new births

• Actively working with community clinics in

efforts to increase CHCN referrals/ patients

• Lifelong – Other clinical rotations desired

(Medical specialties); Recommend urging Obstetric referrals as part of MOU

• Provided prenatal and lactation consultant

capabilities

• Provided updated FBC brochures/fact sheets

(164) ($856,653) Will not meet established target for the year. Looking at need to re-structure some clinics and services based on patient need/demand

OP Women Services: 5% volume increase

• Provider templates to include 2 additional

visits/ day- implemented August

• New templates with 2 additional visits/day and
• pen-access principles implemented February

17th

• Working with Alameda Alliance to outreach to

members requiring Pap Smear/ Cervical screenings—10k letters sent

• LEAN office involved to help with daily huddles;

provider engagement (7,797) ($1,156,470) * Plan to right-size clinical capacity in FY21 to meet patient demand. Using utilization data pre-COVID.

SLH Med-Surg Days: 5 additional ADC

• Continue to partner with the System Admission

Transfer Center (ATC) to facilitate transfers from Highland (692) ($1,236,935) With COVID-19 pandemic, elective surgeries were cancelled and census decreased. Will be difficult to meet year-end

Patient Revenue Enhancement Strategy: Update

* Ambulatory revenue impact assumes that 25% of volume are non-billable visits

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Initiative Strategy/ Update Var YTD $ Var YTD Issues Trend

HGH IOP

Leverage operational resources between HGH and FMT campuses and decrease of 2 therapist FTE by year end. One of the 2 FTEs has been transitioned out. 3.10 $262,757 Complete

BHS Contract: 1 time payment to BHCS

Received confirmation from Alameda County that payment will be made in January, 2020. Complete

EPIC Charge Capture: 2% improvement

Charge capture will be realized in the last quarter of FY 20. Daily HB & PB calls tracking revenue capture activity and addressing work queues real time. Hiring EPIC consultant to assist in finding solution for charge issues in EPIC. Working with Epic to improve charge capture and revenue

• collection. 93% of hospital billing

submitted within 3 days of service.

Patient Revenue Enhancement Strategy: Update

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Population Health - Financials

ACTIONS

• Catch up with past invoicing dating back to 2017 for Royal Ambulance increased costs in Outside Medical Services
• Patient Financial Services has instituted changes in claims processing to help realize better UCSF payments associated

with timely claims.

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 1,213 1,398 184 13.2% 10,277 12,444 2,167 17.4% Registry 129 34 (96) (283.2)% 2,302 299 (2,003) (669.4)% Purchased services 190 327 137 42.0% 2,457 2,946 489 16.6% Medical Supplies (0) (4359.0)% 2 (2) (2365.4)% Materials and supplies 44 9 (34) (364.3)% 345 85 (260) (307.3)% Outside medical services 1,046 351 (695) (197.7)% 4,844 3,162 (1,682) (53.2)% General & administrative expenses 32 17 (16) (93.7)% 585 149 (436) (292.4)% Total operating expense 2,655 2,136 (518) (24.3)% 20,818 19,088 (1,730) (9.1)%

• FTEs

116 132 15 11.5 % 118 132 13 10.1 %

SYS Adjusted Patient Days

24,774 28,532 (3,758) (13.2)% 237,126 245,037 (7,911) (3.2)%

FTEs / SYS Adj Occupied Bed 0.15 0.14 0.00 1.9% 0.14 0.15 (0.01) (7.1)% Expense / SYS Adj Patient Day 107.16 $ 74.88 $ 32.28 $ 43.1% 87.79 $ 77.90 $ 9.90 $ 12.7%

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Provider Delivery - Financials

ACTION

• Provider Delivery remains favorable to budget as many newly hired MDs have start dates in FY21. Continue working to
• ptimize professional billing and charge capture to reflect accurate wRVU.

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,226 4,386 160 3.6% 34,727 37,955 3,228 8.5% Registry 20 1 (19) (1691.5)% 224 10 (215) (2177.9)% Employee benefits 341 379 37 9.9% 2,823 3,186 363 11.4% Contracted physician services 6,090 6,353 263 4.1% 56,614 57,180 566 1.0% Purchased services 278 429 151 35.2% 2,330 3,860 1,529 39.6% Materials and supplies 108 77 (31) (40.0)% 670 696 26 3.7% General & administrative expenses 132 242 111 45.7% 1,894 2,179 285 13.1% Total operating expense 11,195 11,868 672 5.7% 99,285 105,068 5,784 5.5%

• FTEs

287 315 28 8.9 % 278 311 34 10.8 %

Worked RVUs (wRVU)

75,386 83,573 (8,187) (9.8)% 714,126 752,158 (38,032) (5.1)%

wRUVs/ Physician FTE 263 265 (291) (1) 2,572 2,415 (1,128) (0) Expense / wRVU 148.51 $ 142.00 $ 6.51 $ 4.6% 139.03 $ 139.69 $ (0.66) $ (0.5)%

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Ambulatory Care – Volumes

ACTIONS

• Ambulatory leadership is pushing the adoption of telephone and video visits to provide patient care during COVID,

and are looking at provider utilization and access on a weekly basis.

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Ambulatory Care – Financials

ACTIONS

• Active recruitment of Primary Care providers for EWC. (Currently, 4 provider vacancies with their equivalent support

staff.)

• Registry use to backfill a Practice Manager on leave.

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,160 4,491 331 7.4% 37,486 38,984 1,497 3.8% Registry 62 10 (52) (510.5)% 978 90 (888) (992.4)% Purchased services 77 114 36 32.0% 1,019 1,024 5 0.5% Pharmaceuticals 147 106 (41) (38.2)% 870 911 41 4.5% Medical Supplies 246 269 23 8.5% 1,871 2,338 467 20.0% Materials and supplies 44 72 28 38.3% 431 648 218 33.6% General & administrative expenses 4 17 13 74.5% 66 154 88 57.2% Repairs/maintenance/utilities 24 33 8 25.7% 236 306 70 22.8% Building/equipment leases & rentals 192 195 3 1.4% 2,143 1,752 (391) (22.3)% Depreciation 66 81 15 18.3% 603 729 126 17.3% Total operating expense 5,027 5,391 364 6.8% 45,731 46,963 1,232 2.6%

• FTEs

479 537 59 10.9% 493 523 30 5.7% Clinic Visits 21,737 28,212 (6,475) (23.0)% 220,157 240,226 (20,069) (8.4)% FTES / Clinic Visit 2.20 1.91 0.30 15.6% 2.02 1.96 0.06 2.9% Expense / Clinic Visit 231.26 $ 191.10 $ 40.16 $ 21.0% 207.72 $ 195.49 $ 12.23 $ 6.3%

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Acute Care – Volumes

ACTIONS

• Overall, patient activity trended downward in the month due to COVID-19 pandemic, and will continue to be below

budget in the next several months. Management will track and flex staff down as needed

• Created a PIT model (provider in triage) in the ED to increase patient flow and reduce LWBS (SLH).
• Continue collaboration with S-ATC to increase transfers from HGH ED to SLH when appropriate

March BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD % Var

DISCHARGES 1,188 1,299 (111) (9)% 11,370 11,746 (376) (3)% 11,142 2 % ALAMEDA 216 219 (3) (1)% 1,960 1,748 212 12 % 1,978 (1)% HIGHLAND 755 842 (87) (10)% 7,373 7,977 (604) (8)% 7,209 2 % SAN LEANDRO 217 238 (21) (9)% 2,037 2,021 16 1 % 1,955 4 % AVERAGE DAILY CENSUS 185.9 233.9 (48.0) (21)% 204.2 216.5 (12.3) (6)% 220.6 (16)% ALAMEDA 28.0 38.4 (10.4) (27)% 31.0 32.2 (1.2) (4)% 34.1 (18)% HIGHLAND 130.3 154.4 (24.1) (16)% 144.5 151.3 (6.8) (4)% 157.0 (17)% SAN LEANDRO 27.7 41.2 (13.5) (33)% 28.8 33.1 (4.3) (13)% 29.5 (6)% Average Length of Stay 4.9 5.6 (0.7) (13)% 4.9 5.1 (0.2) (4)% 5.4 (9)% ALAMEDA 4.0 5.4 (1.4) (26)% 4.3 5.1 (0.8) (16)% 4.7 (15)% HIGHLAND 5.4 5.7 (0.3) (5)% 5.4 5.2 0.2 4 % 6.0 (10)% SAN LEANDRO 4.0 5.4 (1.4) (26)% 3.9 4.5 (0.6) (13)% 4.2 (5)% Case Mix Index ALAMEDA 1.354 1.347 0.007 1.320 1.347 (0.027) 1.347 HIGHLAND 1.516 1.432 0.084 1.438 1.432 0.006 1.432 SAN LEANDRO 1.486 1.657 (0.171) 1.471 1.657 (0.186) 1.657 Occupancy 62% 78% (16)% 68% 72% (4)% 74%

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Acute Care – Volumes

ACTIONS

• Increased efforts to streamline the OR processes. This includes overhauling the booking process, weekly meetings and

dashboard validation discussion.

• Implement a billing procedure for Capstone (implant revenue).
• Continue to review and track revenue capture activity for accuracy and timeliness.

March BUDGET # VAR % VAR YTD BUDGET # VAR % VAR PYTD % Var

SURGERIES 604 744 (140) (19)% 6,758 6,667 91 1 % 6,689 1 % ALAMEDA 150 199 (49) (25)% 1,654 1,654

• 0 %

1,711 (3)% HIGHLAND 361 425 (64) (15)% 4,020 3,893 127 3 % 3,936 2 % SAN LEANDRO 93 120 (27) (23)% 1,084 1,120 (36) (3)% 1,042 4 % EMERGENCY VISITS 6,923 8,779 (1,856) (21)% 76,538 77,928 (1,390) (2)% 74,145 3 % ALAMEDA 1,154 1,468 (314) (21)% 11,895 12,559 (664) (5)% 12,228 (3)% HIGHLAND 3,760 4,877 (1,117) (23)% 44,726 44,092 634 1 % 42,726 5 % SAN LEANDRO 2,009 2,434 (425) (17)% 19,917 21,277 (1,360) (6)% 19,191 4 % IP ER 922 1,086 (164) (15)% 9,013 9,064 (51) (1)% 9,083 (1)% ALAMEDA 152 166 (14) (8)% 1,484 1,372 112 8 % 1,478 0 % HIGHLAND 584 674 (90) (13)% 5,773 5,695 78 1 % 5,877 (2)% SAN LEANDRO 186 246 (60) (24)% 1,756 1,997 (241) (12)% 1,728 2 % OP ER 6,001 7,693 (1,692) (22)% 67,525 68,864 (1,339) (2)% 65,062 4 % ALAMEDA 1,002 1,302 (300) (23)% 10,411 11,187 (776) (7)% 10,750 (3)% HIGHLAND 3,176 4,203 (1,027) (24)% 38,953 38,397 556 1 % 36,849 6 % SAN LEANDRO 1,823 2,188 (365) (17)% 18,161 19,280 (1,119) (6)% 17,463 4 % DELIVERIES 99 106 (7) (7)% 979 1,143 (164) (14)% 984 (1)%

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ACTIONS

• Continue to collaborate with HR to fill open positions to reduce higher premium pay (OT/Double OT and registry).
• Standard work process for sick call review with appropriate action.
• Monitor and flex staff daily when units have low census.

Acute Care – Financials

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 19,221 20,750 1,529 7.4% 176,585 180,149 3,563 2.0% Registry 1,862 972 (890) (91.5)% 18,297 8,699 (9,598) (110.3)% Purchased services 1,700 1,293 (407) (31.5)% 11,711 11,637 (74) (0.6)% Pharmaceuticals 2,188 2,234 46 2.0% 20,782 19,517 (1,266) (6.5)% Medical Supplies 2,650 2,635 (15) (0.6)% 23,735 23,453 (282) (1.2)% Materials and supplies 996 916 (80) (8.7)% 7,611 8,232 621 7.5% General & administrative expenses 59 228 169 74.1% 399 2,050 1,651 80.5% Repairs/maintenance/utilities 977 712 (265) (37.1)% 7,913 7,096 (818) (11.5)% Building/equipment leases & rentals 290 127 (163) (128.9)% 1,877 1,139 (737) (64.7)% Depreciation 447 286 (161) (56.5)% 3,656 2,572 (1,084) (42.1)% Total operating expense 30,390 30,152 (237) (0.8)% 272,567 264,544 (8,023) (3.0)%

• FTEs

1,740 1,828 89 4.9% 1,794 1,775 (19) (1.1)% Acute Adj patient days 8,550 10,766 (2,216) (20.6)% 86,559 89,921 (3,362) (3.7)% FTEs / SYS Adj Occupied Bed 6.31 5.26 1.04 19.8% 5.70 5.43 0.27 5.0% Expense / Acute Adj Pt Day 3,554.29 $ 2,800.76 $ 753.52 $ 26.9% 3,148.91 $ 2,941.94 $ 206.97 $ 7.0%

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Behavioral Health – Volumes

ACTIONS

• New PES charge by hour has been established to track true length of stay for PES patients.
• Workflow changes in PES with Social Work and Providers underway focusing on patient disposition upon presentation.

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Behavioral Health- Financials

ACTIONS

• Continue to work with the County in finding solutions for the non-acute Behavioral Health patients who are not able to

be discharged from the units resulting a throughput issue in the unit as well as in the PES department.

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 4,617 4,026 (591) (14.7)% 41,034 35,948 (5,086) (14.1)% Registry 117 124 7 5.8% 1,961 1,108 (853) (77.1)% Contracted physician services 624 1,035 411 39.7% 7,381 9,312 1,931 20.7% Purchased services 145 95 (50) (53.2)% 990 852 (138) (16.2)% Pharmaceuticals 20 23 3 14.1% 216 202 (13) (6.5)% Medical Supplies 17 11 (6) (59.3)% 121 94 (27) (28.4)% Materials and supplies 102 64 (38) (59.9)% 632 573 (59) (10.3)% General & administrative expenses 4 3 (2) (58.9)% 72 23 (48) (205.8)% Repairs/maintenance/utilities 88 90 2 2.3% 1,270 913 (357) (39.1)% Building/equipment leases & rentals 13

• (13)

(100.0)% 63

• (63)

(100.0)% Depreciation 15 8 (6) (79.8)% 131 73 (58) (79.4)% Total operating expense 5,762 5,478 (284) (5.2)% 53,870 49,097 (4,772) (9.7)%

• FTEs

398 364 (34) (9.5)% 387 361 (25) (7.0)% BHS Adj patient days 2,624 3,447 (822) (23.9)% 26,430 28,560 (2,130) (7.5)% FTEs / BHS Adj Occupied Bed 4.70 3.27 1.43 43.8% 4.03 3.48 0.54 15.7% Expense / BHS Adj Pt Day 2,195.67 $ 1,589.31 $ 606.37 $ 38.2% 2,038.21 $ 1,719.10 $ 319.11 $ 18.6%

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Post Acute Care – Volumes

ACTIONS

• Throughput continues to be a focus as well as safe placements in the community. Rehab clinic visits are down as

with the shelter in place and with physician input, patients are staying home and we have limited services during Covid-19.

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Post Acute Care - Financials

ACTIONS

• Weekly review of sitter usage with each site and interventions for potential sitter reduction.
• Materials and supplies over due to census being higher than budget.

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 3,836 4,017 181 4.5% 36,140 36,343 202 0.6% Registry 96 127 30 24.0% 650 1,097 447 40.7% Purchased services 397 311 (86) (27.7)% 2,992 2,797 (195) (7.0)% Pharmaceuticals 124 111 (13) (11.9)% 1,063 942 (122) (12.9)% Medical Supplies 182 163 (19) (11.7)% 1,505 1,587 82 5.2% Materials and supplies 246 210 (36) (17.0)% 2,082 1,889 (193) (10.2)% General & administrative expenses 11 11 (0) (0.2)% 74 96 22 22.5% Repairs/maintenance/utilities 137 49 (88) (181.3)% 969 426 (542) (127.2)% Building/equipment leases & rentals 99 100 1 1.0% 1,057 898 (159) (17.7)% Depreciation 21 5 (16) (361.6)% 171 41 (130) (317.6)% Total operating expense 5,149 5,103 (47) (0.9)% 46,703 46,115 (588) (1.3)%

• FTEs

513 531 18 3.5% 523 534 10 1.9% Post Acute Adj patient days 9,606 9,817 (211) (2.1)% 85,425 85,949 (524) (0.6)% FTEs / Post Acute Adj Occu Bed 1.65 1.68 (0.02) (1.4)% 1.69 1.71 (0.02) (1.3)% Expense / Post Acute Adj Pt Day 536.08 $ 519.80 $ 16.28 $ 3.1% 546.72 $ 536.54 $ 10.18 $ 1.9%

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System Support Services - Financials

ACTIONS

• Fairmont and Highland housekeeping required temporary staff to assist with Covid-19 pandemic efforts, which have

required more frequency of cleaning as well as supplementing staff that are on leave

• Continued Registry support for Revenue Cycle impacting purchased services

Stated in $000's March, 2020 BUDGET $ Var % Var YTD BUDGET $ Var % Var Salaries and wages 6,775 6,841 66 1.0% 50,155 60,510 10,356 17.1% Registry 308 149 (159) (107.1)% 3,112 1,684 (1,428) (84.8)% Purchased services 5,165 3,105 (2,059) (66.3)% 34,206 27,947 (6,259) (22.4)% Pharmaceuticals 16 15 (1) (9.6)% 43 132 89 67.5% Medical Supplies 40 (35) (75) (211.6)% (617) (307) 310 100.8% Materials and supplies 195 194 (1) (0.6)% 1,980 1,749 (231) (13.2)% General & administrative expenses 1,531 1,435 (96) (6.7)% 10,908 12,918 2,010 15.6% Repairs/maintenance/utilities 505 798 293 36.8% 6,335 7,182 847 11.8% Building/equipment leases & rentals 426 360 (67) (18.5)% 2,733 3,237 504 15.6% Total operating expense 14,961 12,861 (2,099) (16.3)% 108,856 115,053 6,197 5.4%

• FTEs

734 780 46 5.9% 689 781 92 11.7% SYS Adjusted Patient Days 24,774 28,532 (3,758) (13.2)% 237,126 245,037 (7,911) (3.2)% FTEs / SYS Adj Occupied Bed 0.92 0.85 0.07 8.4% 0.80 0.88 (0.08) (8.8)% Expense / SYS Adj Patient Day 603.89 $ 450.77 $ 153.12 $ 34.0% 459.06 $ 469.53 $ (10.47) $ (2.2)%