UMC Hospital Advisory Board Meeting 08/08/12 Page 1 of 9

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1 UMC Hospital Advisory Board Meeting 08/08/12 Page 1 of 9 University Medical Center of Southern Nevada Hospital Advisory Board UMC Emerald Room 901 Rancho Lane, Suite 180 Las Vegas, Clark County, Nevada Wednesday, August 8, :00 p.m. The University Medical Center Hospital Advisory Board met in regular session, at the regular place of meeting in the Emerald Room, 901 Rancho Lane, Suite 180, Las Vegas, Clark County, Nevada, on Wednesday, August 8, 2012, at the hour of 4:00 p.m. The meeting was called to order at the hour of 4:00 p.m. by Anthony Marlon, M.D., Chair, and the following members were present, which constituted a quorum of the members thereof: SECTION 1. OPENING CEREMONIES CALL TO ORDER CALL TO ORDER Board Members: Present: Anthony Marlon, M.D., Chair Bobbette Bond [via conference phone until arrival at 4:10 p.m.] Elizabeth Gallagher Harry Hagerty Amber Lopez-Lasater Robert McBeath, M.D. Dwayne Murray [via conference phone] Abraham Nagy, M.D. Barbara Robinson Nick Spirtos, M.D. Absent/Late: Ash Mirchandani, Vice Chair [arrived at 4:08 p.m.] Ex-Officio Members: Brian Brannman, Chief Executive Officer Dale Carrison, D.O., Chief of Staff Thomas Schwenk, M.D., Dean, University of Nevada School of Medicine Marcia Turner, Ph.D., Vice-Chancellor of Health Sciences, Nevada System of Higher Education Also present: Lisa Logsden, County Counsel

2 UMC Hospital Advisory Board Meeting 08/08/12 Page 2 of 9 ITEM NO. 1 Approval of Minutes of the regular Hospital Advisory Board meeting on the July 11, (Available at the University Medical Center, Administration Office) (For possible action) There was discussion regarding Item No. 5, and whether the minutes accurately reflected the motion that was voted on. The item was regarding the potential change in governance for UMC and the approval of the FTI and Lionel Sawyer Collins consulting contracts. Item tabled until September meeting. Ms. Logsdon will review the audio recording of the July 11, 2012 HAB meeting and determine the accuracy of the motion as presented in minutes. FINAL ACTION: No action taken ITEM NO. 2 Approval of Agenda (For possible action) PUBLIC COMMENT: FINAL ACTION: A motion was made by Mr. Mirchandani that the agenda be approved. Motion carried by unanimous vote. At this time, Dr. Marlon asked if there were any persons present in the audience wishing to be heard on any item on this agenda. Speaker(s): None SECTION 2. CONSENT ITEMS Consent Agenda: (Item No. 3-4) All matters of this section were considered to be routine and were acted upon in one motion, unless requested to be taken separately. For all items left on the consent agenda, the action taken was staff s recommendation as indicated on the item. Mr. Hagerty requested that Item No. 3 be taken separately under the Finance Committee report, Item No. 5. ITEM NO. 3 Award RFP No , Pathology Services, to Laboratory Medicine Consultants, LTD d/b/a LMC Pathology Services; and authorize the Chief Executive Officer to sign the Agreement for Physician Medical Directorship and Physician Professional Services. (For possible action) (Approved by the HAB Finance Committee on August 1, 2012) DOCUMENTS SUBMITTED: Contract Executive Summary; Proposed Contract; Disclosure of Ownership FINAL ACTION: Discussion/Action under Item 5.

3 UMC Hospital Advisory Board Meeting 08/08/12 Page 3 of 9 ITEM NO. 4 Ratify the Contract for Information Security Services between FishNet Security, Inc. and University Medical Center of Southern Nevada for Information Security Staff Augmentation and Digital Forensics Investigation signed by the Chief Executive Officer. (For possible action) (Approved by the HAB Finance Committee on August 1, 2012) SECTION 3. BUSINESS ITEMS DOCUMENTS SUBMITTED: Contract Executive Summary; Proposed Contract; Certificate of Liability Insurance; Disclosure of Ownership FINAL ACTION: A motion was made by Ms. Gallagher that the recommendation be approved. Motion carried by the unanimous vote ITEM NO. 5 That the Hospital Advisory Board receive a report from the Hospital Advisory Board Finance Committee; and take action as deemed appropriate. (For possible action) Mr. Hagerty provided an overview of the August 1, 2012 HAB Finance Committee meeting. - Pathology Contract: The pathology contract with Laboratory Medicine Consultants was approved by the Finance Committee. Although this is $40,000 more than the previous contract, it is $135,000 less than the incumbent requested to continue their contract. The contract includes a clear statement of the value of the Medical Directorship ($21,000) and applicable performance standards. The contract was approved by the Finance Committee, subject to language being inserted in the contract that provided for continuity of staffing. This information is in place in the contract before the Board today, in Section 2.1.F. FINAL ACTION: A motion was made by Dr. Marlon that the recommendation to ratify the contract, under Item No. 3, be approved. Motion carried by unanimous vote. - Information Security Contract The second contract reviewed by the Finance Committee was a contract to expand IT security protection, giving the hospital new standards and procedures to reduce risk. The contract was approved by the Finance Committee, and was in today s consent agenda for approval. - Contracts in Active Preparation The Hospital Contracts Management Department is currently short-staffed. As a consequence, the contract for background checks that expires in October will be extended and brought to the Finance Committee and HAB next month for ratification. Upon questioning, Mr. Brannman stated that the vacated position will be filled and the Materials

4 UMC Hospital Advisory Board Meeting 08/08/12 Page 4 of 9 Management Director will be more involved in the management of contracts. - Impact of Transition from ICD-9 to ICD-10 - The Finance Committee received information on ICD (International Classification of Diseases) transition. They learned that while the rest of the world is currently using ICD-10 and preparing for transition to ICD-11 in 2015, the United States is just now moving to ICD-10, which has 50,000 more classifications than ICD-9. It is possible that the United States may choose to go straight from ICD-9 to ICD-11. Either way, the hospital will have to be ready to adapt. Staff reported that the new McKesson EHR includes modules for updates to both ICD 10 and ICD 11. Staff also reported that the hospital has the resources available to appropriately train the coding staff. - Presentation on IGT (Intergovernmental Transfer) Process: The Finance Committee received this presentation to clarify questions asked by the Committee during the recent budget review. In 2012, Clark County sent $109 million to the State, resulting in $160 million being sent to UMC. In this very complex IGT process, Clark County benefitted $50 million, and the State benefitted $38 million. There is currently an ongoing discussion between Clark County and the State of Nevada, alleging that the State is keeping a disproportionate share of the federal funds. IGT is essential to UMC s sustainability. - Update on Emergency and Trauma Patient Transfers: The Committee heard a report concerning Interfacility transfers. The Board had substantive discussion regarding the transfer of patients between other facilities to UMC. One of the specific concerns was in the area of urology. The Board was reminded of legislative studies that were the result of actions taken in the 2009 and 2011 legislative sessions regarding this issue. The Board asked that staff continue to monitor the situation and take action as deemed appropriate. Ms. Robinson requested a historical overview of transfers that we refused, and the resulting costs associated with legal representation and fines. FINAL ACTION: See Pathology Contract, above. ITEM NO. 6 That the Hospital Advisory Board receive a report from the Hospital Patient Care Committee; and take action as deemed appropriate. (For possible action) No report, as the Patient Care Committee has not met since the last report. FINAL ACTION: No action taken.

5 UMC Hospital Advisory Board Meeting 08/08/12 Page 5 of 9 ITEM NO. 7 That the Hospital Advisory Board receive a report from the Hospital Advisory Board Governance Committee; and take action as deemed appropriate. (For possible action) Ms. Lopez-Lasater reported that FTI Consultant Kerry Shannon has begun the process of interviewing the HAB and Board of County Commission members, as she gathers information for her governance recommendations. Ms. Lopez-Lasater wished to also clarify any misinformation about privatizing UMC. To be clear, privatizing the hospital is not the direction of this Board. UMC will remain a public safety net hospital. In order to maintain intergovermental transfers, sovereign immunity, and County financial support, all of which are necessary for UMC s survivial, we need to maintain a tie to Clark County. Dr. Marlon reiterated that it would make no sense to privatize the hospital and that is not the direction of this Board. FINAL ACTION: No action taken. ITEM NO. 8 That the Hospital Advisory Board receive a report on the status of the Electronic Health Record (EHR) system. DOCUMENT SUBMITTED: Electronic Health Record & Integrated Hospital Information System, August 8, 2012 Ernie McKinley, Chief Information Officer, and Sean Grauer, Project Manager, provided a brief update on the implementation of the Electronic Health Record. The hospital is one-third of the way through implementation and still tracking six budgets, which are all on or under budget. Thirty-two products are being implemented and tracked. Two of the 15 revenue optimization products have gone live Craneware Analyzer and Relay Health Clearance (eligibility). In three months, Craneware has found over $250,000 in missed billing opportunities that we were able to re-submit for reimbursement. In the first month, Relay Health Clearance found 700 individuals classified as self-pay that were Medicaid-eligible. Most of these would have been found, but with greater resources and time involved. Though there is not an actual dollar amount available yet, it is anticipated that this program will increase efficiency as well as result in a cost savings. Several other products will be activated December 1 st, including the remainder of revenue optimization. Implementation is on track for meaningful use to be live June 4, 2013, and also on track for mock reporting, 90 day data collection and attestation by January 2014, which should all result in an $11 million incentive patient from CMS. FINAL ACTION: No action taken.

6 UMC Hospital Advisory Board Meeting 08/08/12 Page 6 of 9 ITEM NO. 9 That the Hospital Advisory Board receive an update from the CEO; and take action as deemed appropriate. (For possible action) Brian Brannman, CEO, gave an update on the following items: - Smoke Free Campus A multi-disciplinary committee has been appointed to work toward a smoke free campus. The Committee has contacted other hospitals regarding their policies and successes. The goal is to have policies that can be enforced, and to provide assistance and incentives for our employees to quit smoking. A timeline will be provided when available. - Birthing Center Grant The hospital has received notification from the Federal Government that the $1.48 million grant originally focused on building a birthing center can be re-scoped. A formal request will be submitted to utilize the funds to remodel the L&D area and an architect feasibility study. - Sunrise Pediatrics Services Brian Brannman and Dr. Schwenk recently met with Sunrise Hospital s CEO, to discuss a collaborative effort to make sure there is a program in place that benefits the training for good pediatricians, but dosen t hurt UMC. - Oncology Services Hospital Administration has met with a number of providers in the community regarding a model to deliver oncology services at UMC. Discussions have been very positive. FINAL ACTION: No action taken. ITEM NO. 10 That the Hospital Advisory Board receive an update on UMC s Management Performance Measures; and take action as deemed appropriate. (For possible action) The management dashboard has been implemented to condense all the data that is collected hospital-wide into one document. The dashboard will be used to look at the day to day operation of the hospital, including core measures for quality, value based purchasing, patient safety, financial performance, and HR issues. Staff will be able to track performance and take necessary action early on. Mr. Mirchandani requested that the HAB Committee Chairs be given the opportunity to review the dashboard to see if there is any additional information they would like included. FINAL ACTION: No action taken

7 UMC Hospital Advisory Board Meeting 08/08/12 Page 7 of 9 ITEM NO. 11 That the Hospital Advisory Board discuss the restoration of certain powers granting power and authority to the Hospital Advisory Board; discuss the implementation of changes needed to support the restoration; and take any action as deemed appropriate. (For possible action) Dr. Spirtos stated that the point of the restoration of powers of the HAB was an attempt to streamline reporting and interaction between the Hospital CEO, the Board of County Commissioners (BCC), the County Manager and the HAB. As we look toward the future, this will allow the BCC a chance to step back and allow the HAB to act as a board that might be in transition toward a new governance, if that s the direction of the HAB and BCC. Mr. Brannman commented that the objective is to have a focused Board to help operate the hospital with agility, and to eliminate as many layers as possitlbe. He will identify areas of duplication and how the process can be streamlined. FINAL ACTION: Dr. Marlon made a motion that the Resolution establishing the powers of the HAB be amended, under No. 11, to increase the approval amount within the HAB s authority as follows: - Other professional service contracts not to exceed $5 million - Information Technology related contracts not to exceed $5 million - All other products and services not to exceed $5 million. - Construction contracts not to exceed $5 million. Motion carried by unanimous vote. ITEM NO. 12 That the Hospital Advisory Board discuss the process and HAB input for appointing new members to the Board; and take action as deemed appropriate. (For possible action) Dr. Marlon suggested that the HAB have a nominating committee to vet and nominate Board members when there is a vacancy on the Board, with ratification by the Board of County Commissioners (BCC). Ms. Robinson stated that other County Board members are appointed at the pleasure of the County Commissioners. Dr. Spirtos suggested that the Board also discuss membership criteria and the issue of conflicts on a future agenda. FINAL ACTION: Dr. Marlon made a motion that the HAB be given the authority of a self-perpetuating board, with ratification by the Board of County Commissioners (BCC). Motion passed with the following vote.

8 UMC Hospital Advisory Board Meeting 08/08/12 Page 8 of 9 Voting Aye Voting Nay Abstain Absent Ms. Bond; Ms. Gallagher; Mr. Hagerty; Ms. Lopez-Lasater; Dr. Marlon; Dr. McBeath; Mr. Mirchandani; Mr. Murray; Dr. Ruckdeschel; Dr. Spirtos None Ms. Robinson None ITEM NO. 13 That the Hospital Advisory Board receive a status report on the contract with the Nevada Cancer Institute; and direct staff accordingly. Included in CEO Update, Item No. 9. In future meetings, the update on NVCI will be included in the CEO s report. FINAL ACTION: None taken. ITEM NO. 14 That the Hospital Advisory Board identify emerging issues to be addressed by staff or by the Board at future meetings; and direct staff accordingly. - Ms. Robinson requested a report on the source of funds for governance consultants FTI and Lionel Sawyer Collins. Mr. Brannman will include this information in his CEO update next month. - Dr. Marlon requested an agenda item to discuss a dedicated revenue stream to fund uncompensated care at UMC. - Ms. Robinson requested a report on the fundraising efforts of the UMC Foundation. - Mr. Mirchandani requested that the HAB Committee Chairs review the dashboard and make recommendations of any items they would like added to the dashboard. - Mr. Mirchandani requested that the monthly EHR report included any identified cost savings. SECTION 4: PUBLIC COMMENT At this time, Dr. Marlon asked if there were any persons present in the audience wishing to be heard on any matter not posted on the agenda. Speaker(s): None There being no further business to come before the Board, at the hour of 6:30 p.m., the meeting was adjourned

9 UMC Hospital Advisory Board Meeting 08/08/12 Page 9 of 9 DATE MINUTES APPROVED: September 12, 2012 UMC HOSPITAL ADVISORY BOARD Anthony Marlon, Chair