Department of Pediatrics Meeting October 29, 2020 Topic: - - PowerPoint PPT Presentation

1

Department of Pediatrics Meeting

October 29, 2020 Topic: Department of Pediatrics Year-End Finance Presenters: Michael Propst, Associate Chair and Director of Finance and Administration Surabhi Agrawal, Director of Finance

Lisa Chamberlain, MD, MPH Pediatrics, Stanford School of Medicine Amy R Gerstein, PhD John W. Gardner Center for Youth & Their Communities, Stanford Graduate School of Education Hiromitsu Nakauchi, MD, PhD Genetics, Stanford School of Medicine Yvonne (Bonnie) Maldonado, MD Pediatrics and Health Research & Policy, Stanford School of Medicine

REGISTER NOW! https: s://mchri ri-sy symposi sium.ev even entbrite. e.com

Juno Obedin-Maliver, MD, MPH Obstetrics & Gynecology, Stanford School of Medicine Kristy Red-Horse, PhD Biology, Stanford School of Humanities & Sciences Lee Sanders, MD Pediatrics, Stanford School of Medicine

• C. Jason Wang, MD, PhD

Pediatrics and Medicine, Stanford School of Medicine

4 Exciting Maternal & Child Health Sessions

Emerging Stem Cell and Gene Therapies Scientific Advances in Diversity, Health Equity, and Social Justice The COVID-19 Pandemic and Innovations in School- Age Learning Groundbreaking Research from Rising Scientists

Fernando S. Mendoza, MD, MPH Pediatrics, Stanford School of Medicine Natalia Gomez-Ospina, MD, PhD Pediatrics, Stanford School of Medicine KEYNOTE SPEAKER David A. Williams, MD Senior Vice President and Chief Scientific Officer, Boston Children’s Hospital

3

Lance Prince, MD, PhD Chief, Division of Neonatal and Developmental Medicine

Packard Clinical Pathway Program

Congratulations to the owners on recently posted clinical pathways!

Multisystem Inflammatory Syndrome in Children (MIS-C)

Saraswati Kache, Hayden Schwenk, Roshni Mathew, Dana Gerstbacher, Rebecca Ivancie, Clara Lo, May Chien, Shiraz Maskatia

Aortic Arch Watch

Shiraz Maskatia, David Kwiatkowski, Shazia Bhombal, Alexis Davis

Acute Care Use and Weaning of High Flow Nasal Cannula

Lauren Destino, Kathy Mykytiuk, Amy Chapman, Kate Steffen, Mike Tracy, David Cornfield, Felice Su

Inhaled Nitric Oxide Initiation and Weaning

Kate Ryan, Kathleen Mykytiuk, Kate Steffen, Sonia Bonifacio, May Wu

Post Cardiac Arrest Targeted Temperature Management

Elizabeth Mayne, Lindsey Rasmussen, Jeffrey Moss, Felice Su, Sarah Lee

Accessing the Packard Clinical Pathway Program Platform

Whitney Chadwick, MD Inpatient Associate CMIO Tzielan Lee, MD Ambulatory Associate CMIO Natalie Pageler, MD CMIO

Congratulations, Whitney Chadwick!!

Dennis Wall, PhD American College of Medical Informatics Fellow

Allison Marsden, PhD American Physical Society Fellow

I am particularly excited that this bill also includes the Kids’ Access to Primary Care Act, a bipartisan bill I introduced to expand primary care access for children and families on

• Medicaid. By matching Medicaid

reimbursement rates to higher Medicare rates, Medicaid patients will have access to more physicians, and children will get the care they need from their own primary care physician.

Fernando Mendoza, MD Lee Sanders, MD

Immigrant Families and Children’s Health: the Intergenerational Health Impact of Federal and State Immigration Policy proposal funded for 4 years National Institute on Minority Health and Health Disparities (NIHMD)

13

State-level expansion of public health insurance coverage to non-US born children and pregnant women was not associated with in-migration of eligible immigrant families from other states

Study Results

“The medical community is inexorably linked to current immigrant policy issues. Making it easier for immigrant communities to connect to and seek care from physicians will not radically shift migration patterns. Instead, allowing access to the basic human right of health care shows a common commitment to human decency for all who are in the United States.”

Eric Sibley, MD Manuel Amieva, MD Becky Blankenburg, MD Lisa Chamberlain, MD

Steve Alexander, MD Ron Cohen, MD Susan Hintz, MD, MS For more than 12 years of service each to the Department of Pediatrics Committee on Appointments and Promotions.

Pediatri trics F Fina nanc nce O Overview

Past, Present & Future October 2020

Appointment Line FTEs

FY19 FY20 FY21 UTL 30 29 33 MCL 65 66 68 NTL 11 13 15 CE 238 251 289 Instructor 23 27 37 50 100 150 200 250 300

MD/Funds Flow wRVUs Per cFTE

2,000 4,000 6,000 8,000 10,000 12,000 ADOL ALGY CARD CVICU DBP ENDO GI GPED GENE H/O ID CCM NEO NEPH PULM RHEU SCT FY19 FY20 AAAP Benchmark (FY20)

Department Telehealth Usage in FY20

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Total Outpatient Office Visit Charges 3,648 4,181 3,649 3,832 3,774 3,541 3,750 3,292 3,285 4,091 4,288 4,303 Telehealth Charges (of total charges) 72 111 105 109 105 97 708 2,243 2,153 2,038 1,965 1,961 1,000 2,000 3,000 4,000 5,000

Clinical Profit

$139.8M $125.6M $12.2M $148.4M $135.2M $9.3M Total Revenues Total Expenses Real Bottom Line 2019 2020

Clinical Profit by Division

$400K $3M $3M $271K

• $224K

$152K $273K $77K

• $174K

$793K $68K

• $245K

$4M $659K $714K $85K $193K 295K $2M $2M

• 62K
• 146K
• 1177K
• 186K
• 43K
• 350K

$1M

• 82K
• 44K

$3M 334K 562K

• 118K
• 355K

2019 2020

Department of Pediatrics P&L

12 FYTD Aug 2020 FYTD Aug 2019 Dept of Peds Dept of Peds FY20 to FY19 Variance Total RVUs 647,249 649,932

• 0.4%

cFTE 290.08 264.39 9.7% RVU Generating cFTE 195.09 189.36 3.0% Revenues Total RVU Payment 98,475,791 $ 95,381,138 $ 3.2% LPCH Strategic Support 46,948,707 $ 42,494,252 $ 10.5% Total Revenues 147,431,628 $ 139,835,739 $ 5.4% Controllable Expenses 131,125,494 $ 119,631,094 $ Faculty Salaries 73,217,194 $ 66,274,661 $ 10.5% Staff Salaries 10,753,913 $ 8,755,895 $ 22.8% Total Benefits 25,773,424 $ 23,353,080 $ 10.4% Bonus 5,814,268 $ 5,799,500 $ 0.3% Bonus Accrual 8,007,680 $ 7,474,667 $ 7.1% Non-Salary 4,329,164 $ 4,804,604 $

• 9.9%

Non-Controllable Expenses Dean's Tax 5,999,592 $ 5,807,005 $ 3.3% Total Expenses 137,125,086 $ 125,598,107 $ 9.2% Bottom Line 5,640,026 $ 12,192,463 $

• 53.7%

LPCH Patch 1,519,975 $ Dean's Tax Rebate 1,925,520 $ wRVU Rate Mitigation 953,152 $ Real Bottom Line 9,258,088 $

Support for Tripartite Mission

FY19 FY20 FY21 Department Support $11,263,574 $11,620,169 $12,224,350 Diversity Support $500,000 $11.3M $11.6M $12.2M

Faculty Bonus (DRAFT)

Bonus FY20 Projection FY19 Variance for FY20 and FY19 Clinical 4.4M 4.2M 6.1% Research 1.2M 1.0M 13.1% Education 421K 408K 3.2% Chief Disc 1.9M 1.3M 45.5% Chair Disc 210K 209K 0.7% Chief Bonus 600K 605K

• 0.9%

Grand Total 8.7M 7.7M 13.0%

Refresh of Faculty Bonus

• Clinical

– Individual RVUs – Group “Targets”

• Research
• Education
• Division Chief Discretionary
• Department Chair Discretionary

Individual Clinical Targets

• 75% of Target: $5,000
• 90% of Target: $10,000
• 100% of Target: $20,000
• Prorated by cFTE
• Under 0.3 CFTE: Cap at $10,000
• $50 per RVU above target

Research

• Publications: 0 – 5 points
• Sponsored Points = [(Indirect costs x 2) + MTDC]/$125,000
• Appointment FTE ≥ 50%
• Each research bonus point is paid $1,250

Education

• Each activity assigned EVUs based on time and effort
• Faculty survey responses are reviewed, and total points tallied
• Per the survey design, there is no maximum number of points
• Each education value unit (EVU) is paid $12

Chief’s Discretionary

• Discretionary pools larger this year to compensate for reduced

clinical-based bonus

FY20 and Prior Years

FY20 FY19 FY18 Amount N Amount N Amount N Clinical Ind $851,896 62 $961,052 64 $589,050 27 Research $1,237,444 248 $1,094,296 230 $875,397 109 Education $420,750 288 $407,820 255 $279,852 207

Who is this COVID Task Force anyway?

• Scott Sutherland, Surabhi Agarwal, Michael Propst, Lana Henthorn, Nam

Ly-Sarmiento, David Maahs, Steve Roth

Financial Impact of COVID on Department Original

Projection; Revised June 2020; Revised Aug 2020

• [FY20] Inpatient – actual v. pre-COVID trajectory: -$3.1M; -$2.6M; Actual: -$2.

$2.2M

– [FY20] Inpatient – actual FY20 increase over FY19: +$600k 00k

• [FY20] Outpatient – actual v. pre-COVID trajectory: -$4.1M; -$3.4M; Actual: -$2.

$2.8M

– [FY20] Outpatient – actual FY20 decrease compared to FY19: -$2.2 $2.2M

• [FY21] Inpatient + Outpatient – projected lower than “expected”: -$4.8M; -$3.

$3.3M

• [FY20] Lost research revenue: -$1.3M
• [FY21] Endowment payouts reduced by 15%: -$1.9M 10%: -$1.

$1.3M

• [FY21] Gift income reduced by 10%: -$2.4M
• Total gap = $17.6M; $15.8M; $13.

3.3M 3M

Gap Mitigation (Revised)

Gap $13,300,000 LPCH Patch $1,500,000 80% of actual FY20 clinical RVU revenue loss Remaining Gap to Mitigate $11,800,000 Use of Department Reserves $2,350,000 Division Executive Funds $1,500,000 Reduced 100 percent R01 Incentive Plan $960,000 Reducing the budgeted $1.2M by 80% Bridge to K $0 Not planning to reduce Faculty Incentives $0 Not planning to reduce Sabbatical Pool $1,817,824 Default expectation: 4 weeks per eligible faculty CE PDL Pool $980,199 Default expectation: 2 weeks per eligible faculty Central Support $400,000 Remaining Balance for Divisions $3,791,976 Split to Divisions by FTE; Operations combined w/ PHM

Sabbatical and PDL Update

• Total planned Sabbatical/PDL use: $6.5M
• COVID mitigation plan went into effect July 1, 2020
• Through September 2020

– PDL taken: $1.1M – Sabbatical taken: $2.6M

• As of now… 57% of the financial mitigation plan dealt with

Travel, Food, Morale Spending

No food No travel No employee morale expenses No holiday party