University and UNM Hospital Performance under Federal Contract, Amendments, and Consents Stephen McKernan, CEO, UNM Hospitals, and Vice President of Hospital Operations University of New Mexico April 17, 2009 1
Key Dates, Documents, and Definitions June, 1952 – Federal Contract between the United States and Bernalillo Board of County � Commissioners, Board of Trustees of Bernalillo County Hospital, and the State of New Mexico. This to in this presentation as the “Federal Contract.” June 1952 – Amendment No. 1 to Federal Contract. The is referred to in this presentation as � “Amendment 1.” Jan. 1957 – Amendment No. 2 to Federal Contract. This is referred to in this presentation as � “Amendment 2.” July 1957 – Amendment No. 3 to Federal Contract. This is referred to in this presentation as � “Amendment 3.” July 1999 – Agreement Regarding Consent to Lease Agreement. This is referred to in this � presentation as the “1999 Consent.” Nov. 2004 – First Amendment to Agreement Regarding Consent to Lease Agreement. This is � referred to in this presentation as the “2004 Consent.” Key Definition : The term “Indian” is a defined term in the Federal Contract, which “means a person � qualified, as determined by the Secretary, to receive medical, surgical, and hospital care and service through or from the Bureau of Indian Affairs, under the laws of the United States and the regulations of the Secretary 2
Summary of Key Terms, Performance � This presentation will focus on key terms and provisions of the Federal Contract, the amendments to the Federal Contract, the 1999 Consent, and the 2004 Consent, and will not go into every provision of these lengthy documents. 3
Analysis Federal Contract ¶ 2: Status: � � The County and the Trustees agree that Hospital has 580 Beds the equipment and operation and accredited by The Joint maintenance of the hospital and the Commission; is certified to standard of care and treatment furnished participate in Medicare and will be in accordance with the best Medicaid and is providing medical and surgical practices and will services and supplies to meet the requirements other American Indians. Additionally, Hospital medical association for registration as a is fully licensed by NMDOH. hospital and the requirements of the Joint Commission on Accreditation of Hospitals for unconditional approval so that the hospital will at all times be approved and accredited by said organization. The hospital shall also meet the requirement so the State of New Mexico for license to operate as a hospital. 4
Analysis Federal Contract ¶ 3: Status: � � The County and the Currently, UNMH employs Trustees shall furnish all 5,400 employees and UNM personnel including medical SOM furnishes and surgical staff and approximately 880 medical facilities thereof to carry out staff members. As to the this agreement. latter, IHS pays UNM Medical Group separately for professional services provided by such physicians. 5
Analysis Status: � Federal Contract ¶ 4: � Applies to “Qualified Indians” • Not a set aside of 100 beds waiting for patients or available • The county and the exclusively for Indians. Since 1957, IHS has not paid for a set aside of 100 Trustees agree to have and – beds; rather for care actually provided to Native Americans. See Amendment 3. make available at all times Subject to EMTALA, Medicare Conditions of Participation, � when required not less than JCAHO standards, NM DOH licensure rules Average daily Native American Census = 34 to 35 � one hundred (100) beds for Per 2004 Consent, if a Native American presents and UNMH is � unable to admit, and that person is treated at a non-UNM Indians; provided that facility, then IHS has the right to seek a credit from UNMH for the cost of those services. Pueblo Indians of New To date, IHS has never made a request for a credit – under this provision. Mexico shall have first call Per 1999 Consent and 2004 Consent, UNMH has established � the Office of Native American Health Services and since on and priority to the use of 8/31/2008 that Office has been located at 2211 Lomas Blvd N.E., Albuquerque, New Mexico, 87106, 1 st floor, West. said 100 beds so reserved The office offers a single toll-free point of contact � for appointment and prior auth/referral coordination for Indian use . for patients and contract health offices. The office also offers assistance navigating the � UNMH system, answers questions, problem- solves, and provides community or internal resource referrals as appropriate. UNMH does not discriminate in any way against Native � American patients. * See Key Definitions, at Slide 2. 6
Analysis Federal Contract ¶ 8: Status: � � � First 4 paragraphs of This Paragraph of the Paragraph 8 of the Federal Federal Contract consists of Contract were deleted 10 subparagraphs, dealing pursuant to Amendment 3. primarily with compensation � As to 8 th subparagraph, IHS by the IHS to UNM Hospital has from time to time indicated and the set aside of 100 some level of non- beds. performance. Matters resolved to mutual satisfaction. � Pursuant to the 2004 Consent, the IHS and UNMH developed and implemented alternative reimbursement methodologies, at IHS’ election. 7
Analysis Federal Contract ¶ 12: Status: � � Currently, UNMH employs 5,400 � Requires UNM to have � employees and UNM SOM furnishes sufficient medical staff to approximately 880 medical staff treat patients and requires members. As to medical staff certain levels of members, each must either be Board Certified or Board Eligible to specialization receive clinical privileges at UNMH. � Requires UNM Hospital to UNMH has a Chief Nursing Officer, � have a Director of Nursing Ms. Sheena Ferguson, RN Services This provision was modified by � � Requires UNM Hospital to Amendment 2 to accommodate physicians who are not on the have graduate dieticians Medical Staff providing services. for supervision of food This provision was modified by � services Amendment 2 to allow for treatment by residents and fellows. UNMH employs licensed dieticians � for the supervision of food services at UNMH . 8
Analysis Federal Contract ¶ 14 Status: � � The County and the Trustees � UNMH offers 65 specialty shall equip and maintain an clinics at 30 different sites Out-Patient Department at said both at the main hospital hospital, rendering dispensary location and in the and diagnostic clinic service to community at large. eligible Indian patients, where ambulatory patients can be � Additionally, UNMH treated and also screened for operates an outpatient hospital admission pharmacy located at 1209 University Blvd., N.E. 9
Analysis Federal Contract ¶ 16: Status: � � � This enhanced standing to seek Provides that the hospital will injunctive relief appears to be limited to not discriminate on the basis violation of the priority and non- of race, religion, color, discrimination provisions of this Section language or non-medical 16. grounds, but makes it clear � Other remedies such as termination that this prohibition does not of the Federal Contract are held apply in the context of only by the Commissioner. providing priority access to � Does not waive UNM’s sovereign Native Americans. In other immunity under Eleventh Amendment words, UNM Hospital will not to the United States Constitution, as it violate the non-discrimination relates to a damage claim. provisions of Section 16 of the Federal Contract, if it provides priority access to Native Americans. 10
Analysis Status: � Amendment 1: � � UNMH utilizes this formula Amends Paragraph 9 of the in determining the annual Federal Contract to average per diem cost per establish the formula for the bed of operation and “annual average per diem maintenance of the cost of operation and Hospital maintenance” of the Hospital 11
Analysis Amendment 2: Status: � � � Amends Paragraph 8 of the � This is the provision that Federal Contract to allow the modifies Section 8 of the Hospital to Federal Contract to accommodate physicians � have non-employed who are not on the Medical physicians treat patients at Staff providing services. the Hospital � Allow residents and fellows to treat patients at the � This is the provision that Hospital allows for treatment by residents and fellows � No separate compensation is payable for the residents and fellows but can be included in cost 12
Analysis Amendment 3: Status: � � � Deletes first 4 paragraphs � This is the base from of Paragraph 8 of the which UNM Hospital Federal Contract operates today. � IHS ceased at this point paying for a set aside of 100 beds but rather started paying for care actually provided to Native Americans 13
Analysis 1999 Consent: Status � � � One member of Board of � The University has fully Trustees is person complied with this recommended by AIPC requirement. � Requires Bernalillo � Current member of the County and UNM to UNM Hospital Board of coordinate with AIPC Trustees is Dr. and IHS in fulfilling Raymond Loretto, DVM. terms of 1999 Lease Agreement 14
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