PHT FRB One Day Committee Meeting

Transcription

PUBLIC HEALTH TRUST
FINANCIAL RECOVERY BOARD
COMMITTEE MEETINGS AGENDAS
January 20, 2012
Ira C. Clark Diagnostic Treatment Center
1080 N. W. 19th Street
Miami, Florida 33128
PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD
COMMITTEE MEETINGS SCHEDULE
(January 2012)
LOCATION SITE
Ira C. Clark Diagnostic Treatment Center (DTC)
1080 N. W. 19th Street
Miami, Florida 33136
The Purchasing Subcommittee and Facilities Subcommittee meetings are scheduled to begin at 7:15 a.m. on
Friday, January 20, 2012. The Audit and Compliance Subcommittee meeting shall immediately follow the
Facilities Subcommittee in the Diagnostic Treatment Center Conference Room 259, which will then be
followed by the Standing Committee meetings.
A special PHT Financial Recovery Board meeting is
scheduled to immediately follow the Strategic Committee meeting.
Friday, January 20, 2012
Subcommittees
Purchasing Subcommittee
Time
7:15 a.m. to adjournment
Conference Room
DTC 270
Facilities Subcommittee
7:15 a.m. to adjournment
DTC 259
Audit and Compliance Subcommittee
Immediately following the
Facilities Subcommittee meeting
DTC 259
Immediately following the
Audit & Compliance Subcommittee
meeting
DTC 259
Joint Conference Committee
Immediately following the Fiscal
Committee meeting
DTC 259
Strategic Committee
Immediately following the Joint
Conference Committee meeting
DTC 259
Special PHT Financial Recovery Board
Immediately following the Joint
Strategic Committee meeting
DTC 259
Standing Committees
Fiscal Committee
As of January 17, 2012
PURCHASING SUBCOMMITTEE
Joaquin del Cueto, Chairperson
Stephen S. Nuell, Vice Chairperson
Michael Bileca
Date and Place
January 20, 2012 – 7:15 a.m. to adjournment
Conference Room 270
AGENDA
Action Items:
1.
*Approval of the Meeting Minutes
(Joaquin del Cueto, Chairperson, Purchasing Subcommittee)
(a)
December 15, 2011
2.
*Review and Recommended Approval – January 2012 Purchasing Report (Rosa Costanzo, Vice
President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division,
Jackson Health System)
3.
*Resolution authorizing (1) retroactive payment in the amount of $95,625.00, for services
rendered from June 1, 2011 through November 30, 2011, and (2) waiver of competitive bidding
and a new agreement in the maximum amount of $255,500.00, for guaranteed emergency beds
and related services to the Salvation Army for a 1-year period effective December 2, 2011 (Kevin
Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System and Rosa
Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain
Management Division, Jackson Health System)
4.
*Resolution authorizing an amendment to Section XII D.2 of the Procurement Policy and
Regulation approved on January 25, 2010 regarding solicitations or awards in violation of laws
or policies (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and
Supply Chain Management Division, Jackson Health System)
Informational Items:
5.
*Monthly Report of Competitive Contracts Awarded or Renewed Under the Chief Procurement
Officer Authority in Accordance to Procurement Regulations – December 1, 2011 through
December 31, 2011 (Fidel Alvarez, Manager, Procurement Management Department, Jackson
Memorial Hospital)
6.
*Monthly Report of Non-Competitive Contracts Under $100,000 – December 1, 2011 through
December 31, 2011 (Fidel Alvarez, Manager, Procurement Management Department, Jackson
Memorial Hospital)
7.
KPI (Key Performance Indicators) for Procurement Update (Rosa Costanzo, Vice President and
Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson
Health System)
8.
*MedAssets Group Purchasing Organization (GPO) Update (Mark T. Knight, Executive Vice
President and Chief Financial Officer, Jackson Health System)
(Agenda item(s) noted with an asterisk (*) indicates that the supporting documents are included.)
1.
Approval of the Meeting Minutes
Joaquin del Cueto, Chairman
Stephen S. Nuell, Vice Chairman
Michael Bileca
Date and Place
December 15, 2011 – 7:15 a.m. to adjournment
Conference Room 270
ATTENDANCE
Michael Bileca
Joaquin del Cueto
Stephen S. Nuell
Marcos Jose Lapciuc
Jackson Health System
Rosa Costanzo
Mark T. Knight
Carlos A. Migoya
Miami-Dade County Attorney
Eugene Shy, Jr.
Purchasing Subcommittee Meeting
December 15, 2011
Page 2
CALL TO ORDER
With a quorum being present, the Purchasing Subcommittee meeting was called to order by Joaquin del Cueto,
Chairperson at 7:28 a.m.
ACTION ITEMS:
1.
Approval of the Meeting Minutes – November 17, 2011
Mr. del Cueto requested a motion approving the meeting minutes of November 17, 2011.
Mr. Bileca moved approval;
seconded by Mr. Nuell, and
carried without dissent.
2.
December 2011 Purchasing Report
Rosa Costanzo, Vice President & Chief Procurement Officer, Strategic Sourcing and Supply Chain
Management Division, Jackson Health System presented for review and approval the December 2011
Purchasing Report.
Mark T. Knight, Chief Financial Officer, Jackson Health System reported on the MedAssets Net
Revenue Systems Inc, (Item #2 of the Purchasing Report) having to do with the long term health
concerns related to charge capture for patient services. He stated the proposal includes on-site
meetings with Clinical Chiefs to ensure charges captured are billed accurately to optimize
reimbursement.
Peter Liu, Office of Inspector General, raised questions and expressed concerns regarding the
MedAssets Net Revenue Systems contract, (Item #2 of the Purchasing Report). He requested a
meeting with staff prior to board approval to address his concerns.
Following the discussion, Mr. del Cueto requested a motion approving the December 2011 Purchasing
Report.
Mr. Nuell moved approval;
seconded by Mr. Bileca, and
3.
Resolution authorizing retroactive payment in the amount of $108,308.75, for services rendered
prior to November 21, 2011 for actuarial services with Wakely Consulting Group (Fernando
Salgado, Interim Executive Director, JMH Health Plan)
Mr. del Cueto requested a motion for the item.
Purchasing Subcommittee Meeting
December 15, 2011
Page 3
4.
Resolution authorizing (1) retroactive payment in the amount of $119,367.64 and $24,505 to
Infusion Technologies, Inc. and Option Care Enterprises, Inc. respectively, for home infusion
services rendered during the period of April 3, 2011 through November 30, 2011, and (2) waiver
of competitive bidding and a new agreement in the maximum amount of $95,000 and $45,000 to
Infusion Technologies, Inc. and Option Care Enterprises, Inc. respectively, for a six-month
period (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)
Mr. del Cueto requested a motion for the item.
INFORMATIONAL ITEMS:
5.
Monthly Report of Competitive Contracts Awarded or Renewed Under the Chief Procurement
Officer Authority in Accordance to Procurement Regulations – November 1, 2011 through
November 30, 2011
A copy of the report was included in the agenda packet.
6.
Monthly Report of Non-Competitive Contracts Under $100,000 – November 1, 2011 through
November 30, 2011
A copy of the report was included in the agenda packet.
7.
Key Performance Indicators (KPI) for Procurement Discussion
Mr. Nuell spoke about the necessity for key performance indicators which will better manage timely
contract execution. Mr. Nuell provided historical background, not necessarily ascribed directly to the
Procurement Management Department, of untimely contract reviews and bid processes presented to
the PHT Financial Recovery Board for approval.
Ms. Costanzo stated that a weekly projects tracking list was developed and distributed to the JHS
Executive Team. As part of the projects tracking list, the total number of contracts, average number of
days to complete the contract process and contract area categories will be included. Ms. Costanzo and
Mr. Knight stated that Mr. Nuell will be provided with the National Institute of Governmental
Purchasing (NIGP) recommended KPI’s as well as other suggested KPI’s.
Adjournment
The meeting of the Purchasing Subcommittee adjourned at 8:09 a.m.
Transcribed by Terry D. Brown
Executive Assistant
Strategic Sourcing & Supply Chain Management Division
PURCHASING REPORT
JANUARY 30, 2012
TO:
FROM:
PROCUREMENT MANAGEMENT DEPARTMENT
The following recommendations are made in accordance with the Trust’s
“Procurement Policy” and it’s implementing “Procurement Regulation.” This report
includes competitively solicited contract awards over $1,000,000, waivers of formal
competition over $100,000 and other categories for Board approval as prescribed by
the Procurement Policy/Regulation. The entire report has been screened and
assembled by the Procurement Management Department with the direct
participation of the Administrator and staff, all subject to review by the Vice
President, Strategic Sourcing Division, consultation with the President as needed,
and review for legal sufficiency by the County Attorney’s Office.
SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s)
This section consists of awards under competitively solicited Invitations to Bid
(ITB’s) over $1,000,000.
No items to report.
SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s)
This section consists of awards under competitively solicited Requests for
Proposals (RFP’s) over $1,000,000.
No items to report.
SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF
OTHER PUBLIC PROCUREMENT ENTITIES
This section consists of awards over $1,000,000 under competitively solicited
(“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities.
No items to report.
January 2012 PHT Financial Recovery Board
1
SECTION IV.
CONTRACTS
AWARDS UNDER GROUP PURCHASING ORGANIZATION (“GPO”)
This section consists of awards over $3,000,000 under Group Purchasing
Organization (“GPO”) contracts. GPOs are organizations that aggregate the
purchasing volume of their members consisting of hospitals and other health care
providers to leverage discounts with manufacturers, distributors and other vendors
to realize administrative savings and efficiencies. The Trust’s GPO is MedAssets.
No items to report.
SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION
This section consists of awards over $100,000 without the formal solicitation of
competitive bids or proposals. All award recommendations in this section have the
approval of the President, are based on a finding that the waiver of competitive
bidding is in the best interests of the Public Health Trust, and require a two-thirds
affirmative vote of the Trustees present for approval.
A. Sole Source
No items to report.
B. Physician’s Preference
Staff requests a waiver of formal competition for the contract items listed in this
category because a physician or clinician has requested the particular item or
service without which the physician or clinician cannot successfully and safely
render patient care.
No items to report.
C. Standardization
Items in this category have been established as the Trust standard.
No items to report.
D. Non-Competitive Cooperative Purchasing
This subsection consists of awards under the contracts of other public entities that
were not competitively solicited.
No items to report.
2
SECTION V. (cont’d.)
E. Miscellaneous Bid Waiver
This subsection consists of awards not falling in the other categories of waiver of
formal competition but where waiver is deemed to be in the best interests of the
Trust.
1.
(334172- NA) The Quality and Patient Safety Department of Jackson Main requests
approval for a contract modification under a waiver of competition to Professional
Research Consultants Inc. (PRC) for a period of ninety (90) days for the provision of
Satisfaction Survey Services.
Professional Research Consultants Inc. (PRC):
Initial Term
(Board Approved Nov. 2005)
$ 700,000
(for three years)
OTR #1
(Approved Administratively May 2009)
$ 367,000
(for one year)
OTR #2
$ 364,212
(for one year)
Contract Modification #3
$ 91,053
(for sixty days)
(Approved Administratively – Emergency July 2011)
$ 80,000
(for ninety days)
(Approved Administratively – Emergency October 2011)
$ 80,000
(for ninety days)
This request for funding
$ 80,000
(for ninety days)
Total approved funding:
$1,762,265
3
Background
In May 2006, the Performance Improvement Department entered into Contract No.: 055052 with PRC for the provision of Patient, Employee and Physician Satisfaction and
Loyalty Research. The survey information is used to measure progress toward strategic
goals, identify improvement opportunities and fulfill regulatory requirements regarding
patient care and motivation and morale of the workforce. This contract was approved by
the PHT board in November 2005 for three years in the amount of $700,000 with two (2)
one-year options to renew. The first and second OTRs were approved administratively in
May 2009 and May 2010. After the two OTRs, the contract has been extended as
requested by department custodian to allow for the continuation of service to meet The
Joint Commission Regulatory requirements.
Recommendation
FRB approval is being requested for an additional ninety (90) day term in the amount of
$80,000 to allow the department to further define the need, budget and scope of services
in order for a competitive solicitation to be issued and awarded. (K. Andrews)
2.
(257564-MR/HT) The Trust’s Revenue Cycle Management Division is requesting
approval of funds for a five-year contract with MedAssets Net Revenue Systems, Inc,
consisting of various solutions designed to maximize efficiencies by improving business
processes and increasing cash flows. (Ongoing/replacement purchase)
MedAssets Net Revenue Systems, Inc.:
Program Subscription Fees
$ 951,608
(per year)
Total Program Fees
$4,758,040
(for five years)
Implementation Fee & Capped Expenses:
$ 813,500
(one-time)
Additional professional services available
Throughout the five-year term at rates
of $125 - $275 per hour:
$ 325,000
(not to exceed)
$ 5,896,540
4
Background
Revenue Cycle Division has been standardizing processes and systems for the past three
years. The main thrust of these changes was the consolidation of various systems, which
included significant implementation cost and training of over 700 full time JHS Revenue
Cycle employees within revenue producing departments, who access these systems on a
daily basis. Price Waterhouse Coopers had also confirmed that Jackson Health System’s
Revenue Cycle Division had selected best in class systems and endorsed their continued
use.
Recommendation
MedAssets offers a variety of revenue cycle IT-related services that are uniquely
interrelated, and these solutions are proven compatible with our existing hospital systems.
The MedAssets solution being proposed is comprised of the following products:

CDM Management: This product is currently in use to analyze charge
master and ensure information is up to date.

Knowledge Source: A web-based system currently used by Revenue
Integrity Services Unit to research questions relating to the
appropriateness of charge related issues. MedAssets is the leading
vendor of this tool and supplies most other web-based vendors with the
data.

Charge Capture Audit: A web-based tool currently used in the Revenue
Integrity Services Unit to perform post billing automated audits to
determine any loss in charges. System interfaces have been developed
and a change in vendor would require resources dedicated to write, test
and implement new interfaces with minimal disruptions to the training of
personnel on a new system.

Contract Manager / Contract Modeler: This solution is currently utilized
and adjudicates all claims down to the expected reimbursement. The
present interfaces among SSI, the Contract Manager and Siemens for
claims and contractual adjustment would be disrupted with the
introduction of a new vendor and reloading the approximately 180
profiles would cost an estimated $100k in addition to a cost of $150 –
5

$200k to develop new interfaces. A change in vendor would also disrupt
workflow and negatively impact cash collections.

Care Pricer: This product is currently used by Patient Access
departments to provide patients, upon request, an estimated cost invoice
for service rendered. This product requires Contract Manager. Changing
to a new vendor would also mean re-training over 350 FTE’s at a
prohibitive cost while slowing down the revenue cycle process.

Rapid Reserve: The Revenue Cycle Department has implemented and
has been utilizing this module which was a result of the most recent E&Y
Audit recommendation to implement a system to automate the Accounts
Receivable evaluation process critical to JHS’ financial reporting. Rapid
Reserve works in conjunction with Contract Manager and cannot be
separated.

CrossWalk Services (Supply & Pharmacy): With this Agreement, the
Revenue Cycle Department will setup CrossWalk services which will
include, among other functions: Linking of Facility’s chargemaster, item
master and closed receipt data to the MedAssets Master Item File (MIF)
as well as transforming and loading data into the crosswalk database;
configuration of application; user, systems and management setup; and,
up to 30 hours of review and cleansing of the automatically generated
links between systems.
In providing optimization services, the MedAssets service team will collaborate with the
identified stakeholders to audit and review the Client Master Item File to optimize
efficiencies.
Below are the annual recurring (five year term) fees associated with each product/solution.
The CrossWalk Service and Charging Review Products will have a one-time
implementation fee associated with them as well as capped fees for travel and expenses
that will be required to complete implementation. Additional services which include
contract loading, mapping of processes custom programming, off cycle reports, contract
negotiation support, additional Internet modeling and manual data entry of tables will be
available throughout the five-year term at rates of $125 - $275 per hour and have been
capped at a not-to-exceed amount of $325,000.
6
One-Time
Implementation
Fees
N/A
Annual
Subscription
Fee
$ 33,881
Knowledge Source
N/A
Included in CDM
Master
Charge Capture Audit
N/A
$
97,664
N/A
Contract Manager
N/A
$ 325,333
N/A
Contract Modeler
N/A
$
N/A
Care Price
N/A
$ 164,069
N/A
Rapid Reserves
N/A
$ 121,604
N/A
Product/Solution
CDM Master
50,057
Expenses
Capped At
N/A
N/A
Cross Walk Supply
$ 129,000
$
82,000
$ 34,500
Cross Walk Pharmacy
$ 122,000
$
77,000
$ 28,500
Charge Master/Pricing
Review
$ 463,500
N/A
$ 36,000
Total
$ 714,500
$ 951,608
$ 99,000
This Contract can be terminated immediately for breach of duty by either party if the
breach has not been cured within a 30-day period of notice to either party
concerning the breach. This Contract includes the OIG and UAP provisions.
The contract has been approved by Risk as to Insurance and Liability requirements
and by the County Attorney’s Office for legal sufficiency.
A Bid waiver justification has been provided and Conflict of Interest Declarations have
been signed by Amy Sebero, Senior VP of MedAssets, and Charles Bearham, RCM
Administrator, with no reported disclosures. (C. Pla/M. Knight)
SECTION VI.
OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR
CONTRACTS THAT WERE COMPETITIVELY SOLICITED
This section refers to existing contracts that were competitively bid (“ITB” or “RFP”)
at their origin and consists of either (a) the exercise of established options-to renew
or (b) the execution of contract modifications for which the Procurement Policy
requires prior Board approval.
Balance of page intentially left blank
7
SECTION VI. (cont’d.)
3. (287234-HT/MR/333101-TW) The Revenue Cycle Division requests approval to
exercise Option to Renew (OTR) No. 1 of its existing contract with Sykes Enterprises, Inc.
for “Call Center and Centralized Scheduling” services pursuant to RFP No. 06-5182
(ongoing/replacement purchase).
Sykes Enterprises, Inc.:
Revenue Cycle Funding
$12,900,000
(for two years)
JMH Health Plan Funding
$ 500,000
(for two years)
$13,400,000
Background
In June 2008, the Board approved a competitive contract award to the ICT Group for an
initial three-year term plus three two-year options to renew for call center and centralized
scheduling services. Following contract award, the Revenue Cycle Division worked with
the contractor to develop the scripting materials, process flows and system access
necessary to allow the call center agents to facilitate the intake of patient calls for
scheduling purposes.
Additionally, in 2011, the JMH Health Plan accessed the contract to allow for backup
services for the customer service center when JHS employees were not available.
Recommendation
With this request, the Revenue Cycle Division seeks to exercise the first option to renew of
two years as allowed by the provisions of the competitive contract award. The contract
provides call services for the following areas with an estimated monthly call volume of
55,400:







Scheduling of appointments for Jackson Memorial Hospital, Jackson North,
Jackson South and Mental Health
Automatic appointment reminder calls
TTY capability for the hearing impaired
Physician referral line for Holtz Children’s Hospital
Permanent disaster response line
Member preferred scheduling line
Customer Service line for all other calls
8
Jackson Health Plan is also requesting continued use of the services for an additional
period of approximately two years.
Sykes Agents will provide the following services for the Health Plan:









Benefits/Eligibility verification
Claims Inquiries
Verifying pharmacy benefits eligibility and routing point of sale RX issues
to our Pharmacy team for resolution
Authorization inquiries
Requests for materials (ID cards, Directories, Coverage documents etc.)
Disenrollment requests
Enrollment status updates
Demographic change updates
Using our current enterprise database, namely, IKA, to route issues
electronically to other departments for investigation and resolution.
Sykes Acquisition, LLC, with whom the Trust is presently conducting business, is merging
all holdings into Sykes Enterprises, Inc. as a result of reorganization. Sykes will be doing
business as and billing the Trust as Sykes Enterprises, Inc. as of January 1, 2012. All
terms, conditions and pricing will remain the same.
The contract can be terminated for convenience with a ninety (90) day notice and
includes the OIG and UAP provisions.
The original contract was reviewed and approved by the CAO for legal sufficiency
and by Risk as to Insurance and Liability. (C. Pla/ F. Salgado)
4.
(330568-NA) The Renal Management Group, Care Management and Quality and
Patient Safety Department, Jackson Health System, requests approval to exercise Option
to Renew (OTR) # 1 of RFP # 08-5198 with Miami Acutes, dba DVA Renal Healthcare
Inc., for a period of one year for the provision of Outpatient and Inpatient Dialysis
Treatment Services (Ongoing/replacement purchase).
Miami Acutes d/b/a DVA Renal Healthcare Inc:
OTR #1
$ 4,537,200
(for one year)
Total approved funding
$ 4,537,200
9
Background
As a result of the competitive RFP process, contract #08-5198 was awarded to DVA for an
initial term of Three (3) years with Two (2) one-year options to renew. The initial
competitive contract award was approved by the PHT Board in October 2008 in the
amount of $19,145,544. OTR #1 of Contract 08-5198 will: (1) Provide necessary outpatient
and inpatient dialysis services to all patients referred by Jackson Health System (JHS); (2)
Maintain a corporate compliance plan; (3) provide competent, trained, licensed and
experienced staff; (4) Maintain the facility and all equipment used; and (5) Provide financial
and social services to support the patients in obtaining appropriate insurance and/or
financial coverage for dialysis services.
Contract Modification #1 was issued to incorporate the names of the various facilities used
by DVA to provide outpatient dialysis services throughout Miami Dade County. Contract
Modification #2 was issued to extend the initial term of the contract for a period of 90 days
to allow negotiations of the rates for the upcoming OTR to be completed and to incorporate
the UAP language. Both of these modifications were executed with no change to the initial
three year value of the contract.
Recommendation
The requested funding will exercise the first OTR of Contract 08-5198. The initial three (3)
year contract stipulated that rates for service would remain fixed. However, prior to
exercising each OTR, the Trust would consider an adjustment to price based on changes
to the pricing index as stated below or a five percent (5%) increase whichever is less:
“Medical Care Service Component of the Consumer Price Index (CPI) for All
Urban Consumers (CPI-U), published by the Bureau of Labor Statistics, United
States Department of Labor. Should the Index no longer be published, the Index
shall be the Medical Care Service Component of the Consumer Price Index (CPI)
under Urban Wage Earners and Clerical Workers (CPI-W), published by the
Bureau of Labor Statistics, United State Department of Labor.”
Prior to completion of the initial term, the Contractor requested an increase of the rates for
the OTR based on the stipulation above. However, subsequent negotiations between JHS
and the Contractor regarding these rates resulted in an overall rate reduction that should
provide a projected savings of approximately $32,000.
The original contract was reviewed and approved by Risk as to Insurance and
Liability and by the County Attorney’s Office for Legal sufficiency.
The contract can be terminated for convenience with a thirty (30) day notice and
includes UAP and OIG provisions (K. Andrews).
10
SECTION VII.
OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR
CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL
COMPETITION
This section refers to existing contracts that were not competitively bid at their
origin and consists of either (a) the exercise of established options-to renew or (b)
the execution of contract modifications for which the Procurement Policy requires
prior Board approval. All contracts in this section that are renewals not previously
authorized by the Board have the written approval of the President, are based on a
finding that the waiver of full and competitive bidding is in the best interest of the
Public Health Trust, and require a two-thirds affirmative vote of the Trustees present
for approval.
5.
(333246-CS) The Division of Public Safety is requesting approval to exercise the
first Option to Renew (OTR) with the Miami Parking Authority (“MPA”) to continue
management and operational services of the parking facilities at UM/Jackson Memorial
Hospital Campus (ongoing purchase)
Miami Parking Authority (“MPA”):
This request for funding:
$1,861,000
(for one year)
$1,861,000
The Board of Trustees approved the initial contract with MPA in December 2006 in the
amount of $11,127,170 for the initial five year term. Under the contract, MPA manages and
operates twelve parking facilities throughout Jackson Memorial Hospital, twenty four hours
per day, seven days per week.
MPA has a proven track record of operational expertise, professionalism, efficiency and
customer service and manages over 29,000 parking spaces in the City of Miami, inclusive
of those at JMH. MPA has consistently worked with JHS to reduce operational costs.
During the initial five year term of the Agreement, MPA installed completely automated
parking control equipment for operations at JHS. This has resulted in increased revenues
and controls which have allowed for more efficient operation of the parking facilities which
include garages and lots. MPA has been able to reduce expenses substantially and
consistently and have provided reductions to management fee to help the hospital.
The contract can be terminated for convenience with a thirty (30) day notice.
The original contract was reviewed and approved by the CAO for legal sufficiency
and by Risk as to Insurance and Liability.
11
SECTION VII. (cont’d.)
Conflict of Interest forms have been submitted by JHS’ Corporate Director of Public Safety,
Mark Aprigliano and Alejandra Argudin, COO, Miami Parking Authority, with no reported
disclosures. (D. Steigman)
SECTION VIII. MISCELLANEOUS
This section consists of procurement actions that require Board approval not
included under any other section of the Purchasing Report.
A. Vendor Name Change
This section refers to existing contracts requiring a vendor name change under any
circumstance at any time after contract award and for the duration of contract
performance. The Chief Procurement Officer is the approving authority when the
original award of the subject contract was within the approval authority of the Chief
Procurement Officer, and the Board of Trustees is the approving authority when the
original award of the subject contract required the approval of the Board. The
County Attorney’s Office has been consulted and has provided a determination of
legal sufficiency.
No items to report.
12
Agenda Item 3.
January 20, 2012
RESOLUTION NO. PHT 1/12 –
RESOLUTION AUTHORIZING (1) RETROACTIVE PAYMENT IN THE
AMOUNT OF $95,625.00, FOR SERVICES RENDERED FROM JUNE 1, 2011
THROUGH NOVEMBER 30, 2011, AND (2) WAIVER OF COMPETITIVE
BIDDING AND A NEW AGREEMENT IN THE MAXIMUM AMOUNT OF
$255,500.00, FOR GUARANTEED EMERGENCY BEDS AND RELATED
SERVICES TO THE SALVATION ARMY FOR A 1-YEAR PERIOD
EFFECTIVE DECEMBER 1, 2011
(Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health
System and Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic
Sourcing and Supply Chain Division, Jackson Health System)
WHEREAS, the Public Health Trust (“PHT”) entered into an agreement with the Salvation Army, in March 2010
in the amount of $203,000.00, which agreement expired on May 31, 2011; and
WHEREAS, the services provided by the Salvation Army were over-utilized due to the needs of the PHT and the
PHT incurred payment obligations related to those services exceeding the initial approved agreement amount by $95,625.00
for services provided through November 30, 2011; and
WHEREAS, the services provided by the Salvation Army are required to reduce the length of stay at the Jackson
Health Systems; and
WHEREAS, the Case Management/Social Work and Discharge Planning Division of the Clinical Resource
Management (CRM) Department has requested a new contract for services for a prospective 12- month period effective
December 1, 2011, in the amount of $255,500.00, through November 30, 2012; and
WHEREAS, upon the written recommendation by the President, the Trust finds it in the best interests of the Trust
to waive competitive bidding and contract with the Salvation Army for a 12-month period; and
WHEREAS, the PHT desires to accomplish the purposes outlined in this Resolution as further described in the
memorandum attached hereto and made a part hereof; and
WHEREAS, the PHT finds that the actions described herein are in the best interest of the PHT and the President
and CEO recommend the actions described herein.
NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC
HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes (1) retroactive payment in
the amount of $95,625.00 for services rendered prior to November 30, 2011, and (2) waiver of competitive bidding and a
new agreement in the amount of 255,500.00, for guaranteed emergency beds and related services with the Salvation Army
effective December 1, 2011.
1
TO:
The Financial Recovery Board
of the Public Health Trust of Miami-Dade County
FROM:
Kevin Andrews, Vice President, Quality and Patient Safety Division,
DATE:
October 25, 2011
SUBJECT:
AUTHORIZING WAIVER OF FORMAL BID PROCEDURES AND REQUIREMENTS OF
THE PUBLIC HEALTH TRUST PROCUREMENT POLICY AND REGULATIONS;
RATIFICATION OF A PREVIOUS PURCHASE FOR GUARANTEED EMERGENCY
SHELTER BEDS AND ASSOCIATED SOCIAL SERVICES TO THE SALVATION ARMY
FOR THE PERIOD OF JUNE 1 THROUGH NOVEMBER 30, 2011 IN THE TOTAL
AGGREGATE AMOUNT OF $95,625.00 FOR SERVICE FEES
_____________________________________________________________________________________
RECOMMENDATION
Staff recommends that in accordance with the PHT Procurement Regulation, the Financial Recovery Board
ratifies, approves and authorizes retroactive payment to the Salvation Army in the amount of $95,625.00 for
services provided prior to November 30, 2011, and a waiver of competitive bidding and a new agreement, in
the amount of $255,500.00 for the continuation of services for the (guaranteed emergency shelter beds and
associated social services) effective December 1, 2011.
BACKGROUND
In 2006, The Clinical Resource Management (CRM) {Case Management/Social Work and Discharge
Planning} Department entered into an agreement with the Salvation Army to provide emergency shelter
beds and associated services to homeless patient population as part of the Early Discharge Program. This
program results in decreased costs associated with patient length-of-stay of unfunded care and homeless
patients.
In November 2008, the Trust approved award of a contract on behalf of CRM Department that continued an
existing agreement for 50 guaranteed or dedicated emergency shelter beds provided by the Salvation
Army. Although this arrangement had been in place with the Salvation Army since 2006, it was formalized
with board in 2008.
The most recent contractual arrangement was from March 1, 2010 through February 28, 2011, in which The
Salvation Army provided a guarantee of 20 emergency shelter beds per night for the one-year period at a
rate of $20.00 per night resulting in an award of $146,000.00. Prior to agreement expiration in February
2011, a three-month extension was reached, in which The Salvation Army guaranteed a minimum of 25
guaranteed beds per night at a rate of $25.00 per night for the period of March 1through May 31, 2011. The
three-month extension was for $57,000.00. The total cost of contracted services with the Salvation Army
for the 15-month period (between March 1, 2010-May 31, 2011) was $203,000.00.
CRM considers that The Salvation Army offers the bed capacity to meet the demands generated by our
volume of homeless patient discharges. The Salvation Army provides an array of services beyond
providing emergency shelter beds in an environment that is safe and secure for early discharged homeless
patients. Three meals a day during food service hours, TB testing, hygiene packages, clothing, and
assessment and referral to a transitional or permanent housing program are also provided as appropriate
by The Salvation Army.
2
Other factors that contributed to the decision to contract with the Salvation Army were its proximity to
Jackson Memorial Hospital (which helped lower fuel costs); the large size of the facility and corresponding
layout with two patients to a room; case management services that provide drug and alcohol rehabilitative
services as well as job placement and housing services. At the time, other alternative facilities such as
Camillus House, Rescue Mission, and Beckham Hall were evaluated but did not provide the spectrum of
care and services offered by The Salvation Army.
The CRM Department is currently seeking a ratification of the purchase of services from the Salvation Army
for a five-month period covering the period of June-November 2011 for an amount of $95,625.00 in order to
cover the combined amounts outstanding for the months of July, August, and September of 2011
($58,125.00) plus the anticipated combined expenses for October and November ($38,750.00).
The cost savings associated with contracting with the Salvation Army are significant, as the cost is a
proposed amount of $25.00 per bed per night versus a comparable cost of $575.00 for a one night lengthof-stay for a patient stay at Jackson Memorial Hospital.
3
Agenda Item 4.
January 20, 2012
RESOLUTION AUTHORIZING AN AMENDMENT TO SECTION XII D.2
OF THE PROCUREMENT POLICY/REGULATION APPROVED ON
JANUARY 25, 2010 REGARDING SOLICITATIONS OR AWARDS IN
VIOLATION OF LAWS OR POLICIES
(Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing
and Supply Chain Management Division)
WHEREAS, the Public Health Trust (“PHT”) has established a Procurement Policy/Regulation under the
authority of Florida Statutes, Miami-Dade County Charter and Code and the Public Health Trust Procurement Policy
Resolution; and
WHEREAS, the Procurement Policy/Regulation became effective February 1, 2006 and was last approved as
amended on January 25, 2010; and
WHEREAS, the Procurement Policy/Regulation specific and only purpose is to govern the procurement of
supplies, services and construction, including professional services for the Public Health Trust; and
WHEREAS, Section XII.D. of the Procurement Policy/Regulation is entitled “Solicitations or Awards in
Violation of Laws or Policies” and includes provisions regarding, among, other things, remedies; and
WHEREAS, the Chief Procurement Officer, with the guidance of the County Attorney’s Office requests an
amendment to Section XXI, D.2 of the Regulation as set forth in the accompanying memorandum.
WHEREAS, this action is necessary to ensure the continued efficient operation of the Public Health Trust.
NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE PUBLIC
HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Financial Recovery Board hereby authorizes
and amends Section XII, D.2, of the Public Health Trust Procurement Policy/Regulation further set forth in the
attached memorandum with such changes to take effect immediately, and to apply retroactively.
1
TO:
FROM:
Rosa Costanzo, Vice President and Chief Procurement Officer,
Strategic Sourcing and Supply Chain Management, Jackson Health System
DATE:
January 20, 2011
SUBJECT:
Amendment to the Procurement Regulation Resolution regarding Section XII.D,
Solicitations or Awards in Violation of Laws or Policies
_____________________________________________________________________________________
RECOMMENDATION
The President and CEO recommends the Financial Recovery Board approves and authorizes amending
Section XII, D.2 of the Procurement Regulation, and making such amendment effective immediately and
retroactively.
PURPOSE
The purpose of the proposed amendment is to reduce the Public Health Trust’s exposure and risk should a
contract be awarded in violation of its Law or Policies and to ensure the continued efficient operation of the
Public Health Trust
PROPOSED CHANGES
Section XII D. 2 shall be modified to read as follows (with, as compared to the existing policy, additional
language underlined and deleted language struck through):
* * *
Remedies after an Award. If after an award it is determined that a solicitation or
award of a contract is in violation of law or the Procurement Policy, then:
(a) If the person awarded the contract has not acted fraudulently or in bad faith:
(i) The contract may be ratified and affirmed, in the sole discretion of the Trust,
provided it is determined that doing so is in the best interests of the Trust;
(ii) The contract may be terminated and the person awarded the contract shall be
compensated for the actual expenses reasonably incurred under the contract,
plus reasonable profit, prior to termination; or
(iii) Take such other actions as may be authorized by law.
* * *
2
Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement Regulations
December 1, 2011 ‐ December 31, 2011
For Information Only
Vendor Name
Abbott Laboratories Pulmonary Health Network
Description
Reagents for the lab at Jackson North Medical Center (I‐Stat Analizers)
Repiratory Services for an Eight Bed Ventrilatior Care Unit at Jackson Memorial Long Term Care Center Omnicell Inc.
Service Agreement on all Omnicell Equipment located throughout Jackson Health System
3M Health Information Sysyems
Coding Software for the Health Information Management Dept Cost Center & Contract Number Contract Date Contract Value Contract Term
Director/VP 57060 3011679
12/2/2011
$ 339,000.00
One Year S Sears 88806 K Andrews 8104417 SERV
12/8/2011
$ 467,200.00
One Year ( 2nd OTR)
84610 R Costanzo
8104500 SERV
12/23/2011
$ 146,232.00
One Year
71004 M Knight
8104526 SERV
12/30/2011
$ 2,773,211.35
Three Years 1. "MedAssets" is the Trust's primary "Group Purchasing Organization" (GPO)
2. "State Contract" and "Miami‐Dade Contract" mean a contract competively awarded by the State or County as a "cooperative contract"
3. "US Communities" means a contract competively awarded by the U.S. Communities governmental purchasing alliance as a "cooperative contract"
4. "OTR" means "Option to Renew".
5. "Contract Value" corresponds to the fixed "Contract Term" that has been awarded or rewarded (not to future OTR's)
6. "RFP" means competitive Request for Proposals (or Qualifications) procurement process performed by the JHS Procurement Management Department
7. "ITB" means competitive Invitation to Bid (or Quote) procurement process performed by the JHS Procurement Management Department
8. "UAP" means User Access Program
E – Exclusion as per UAP program: ie, Federal Grant, etc.
Y – Incorporated into the purchase as either discount on invoice or discount upfront
N/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented
Procurement Method
UAP
MedAssets LB00051
Y
ITB‐07‐4972
Y
MedAssets 10604USA‐
Y
301/901LB00051
MedAssets MS0101397
Y
Monthly Report of Non‐Competitive Contracts Under 100K
December 1, 2011 ‐ December 31, 2011
For Information Only
Vendor
Description
Emergency repairs on plumbing pipes throughout Jackson
North Medical Center
Refurbishment of 6 stretchers for Jackson North Medical
Clinitek Medical Solutions, Llc
Center, needed immediately for patient care
College of American Pathologists Accreditation for Main
College Of American Pathologist
Campus
Purchase of patient beds for Jackson Memorial Perdue
Joerns Healthcare, Inc
Medical Center and Jackson Memorial Long Term Care
Center
Consulting services for the review of university of Miami
Kathlyn Buskey
proposal made to JHS
Bradford Plumbing, Llc
Morgan Joseph Triartisan, Llc
Consulting services for Jackson Health Plan
Furnish and install new sliding glass doors with side lite,
RC Construction And Investment restore finishes as required at 3 locations in DTC 1st floor
main campus, immediate need to secure exit and access
Sap America, Inc
Seico Construction
Servicemaster Clean
Valdes & Son Consulting, Inc
SAP Business Object maintenance fee enterprise and
support
Emergency repairs for the 7th floor machine room in
JNMC
Water damage mitigation due to extensive flood in PPW
on 10/31/2011
General accounting audit services
Cost Center & Contract Number Contract Date Contract Value Contract Term
Director/VP
Procurement Method UAP 58480
S Sears
58480
S Sears
71905
A Contreras
8300961 SERV
12/08/2011
$
15,000.00
One Time
Emergency
Y
8300966 SERV
12/12/2011
$
15,187.50
One Time
Emergency Y
8104400 SERV
12/01/2011
$
13,860.00
One Time
Sole Source N/A
88803
K Andrews
12340275
12/09/2011
$
35,703.00
One Time
Sole Source Y
8104517 SERV
12/29/2011
$
20,000.00
80 Hours
Miscellaneous Bidwaiver Y
8104495 SERV
12/21/2011
$
67,000.00
One Time
Emergency Y
4101112 CAPS
12/06/2011
$
20,520.00
One Time
Emergency Y
8104490 SERV
12/20/2011
$
13,140.06
1 Year
Sole Source
N
8300962 SERV
12/08/2011
$
26,400.00
One Time
Emergency Y
8104457 SERV
12/15/2011
$
32,676.01
One Time
Emergency N
8104418 SERV
12/08/2011
$
26,000.00
3 Months
Sole Source Y
72705
A Contreras
89004
F Salgado
80102
R Jordan
93113
M Knight
58480
S Sears
80102
R Jordan
90611
M Knight
Note: "Non‐competitive" procurement category includes: Sole Source, Physician's Preference, Standardization, Non‐Competitive Cooperate Purchasing, and Miscellaneous Bid Waiver.
UAP ‐ User Access Program
E – Exclusion as per UAP program: ie, Federal Grant, etc.
Y – Incorporated into the purchase as either discount on invoice or discount upfront
N/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented
GPO Update
January 3rd 2012
GPO Update _ Overall Project Status
Guaranteed Savings exceeded $25MM, with a $4.7MM actual saves as of Nov 30th
2011.
GPO Update: Service Line Detail
Guaranteed Service Line
Savings
Capital
413,967
CV
1,573,903
Imaging
1,448,914
Lab
596,308
Med Surg
8,828,407
OR/Surgery
3,364,454
Ortho/Spine
2,157,809
Pharm
2,438,741
Purchase Service 5,033,705
Grand Total
FY'12 Actuals
32,364
95,270
63
54,413
‐
86,981
14,504
(27,768)
163,324
25,856,208 4,244,837 419,151 4,663,988
Active
Capital
CV
Imaging
Lab
Med Surg
OR/Surgery
Ortho/Spine
Pharm
Purchase Servi
Grand Total
FY'11 Actuals
47,000
344,620
‐
‐
1,315,992
328,964
‐
1,994,778
213,482
Total % Actual/ Savings to Savings Date
Guarateed
79,364
19%
439,890
28%
63
0%
54,413
9%
1,315,992
15%
415,945
12%
14,504
1%
1,967,011
81%
376,806
7%
$
6 950,000
2 287,362
2
1
19
2
348,241
‐
1,169,551
613,526
15 1,870,000
47
$5,238,681
Although Med Assests fell short of the their target savings, they have $5.2MM worth of active projects which will help JHS get to the $30MM mark.
18%
Completed
$
In Queue
7
5
7
7
21
40
2
5
19
113
412,967
1,536,619
1,541,059
596,308
8,809,744
3,328,583
2,158,315
2,417,069
4,969,431
$25,770,096
1
2
2
1
3
4
1
1
5
20
$ Preliminary
139,761
133,284
105,979
1,646
156,810
137,135
9,000
21,672
471,851
$1,177,137
$
3 ‐
1 ‐
1 ‐
15 ‐
7 ‐
27
$0
Totalojected Savings
17
10
9
10
26
78
5
6
46
207
1,502,728
1,957,265
1,647,038
946,195
8,966,553
4,635,269
2,780,842
2,438,741
7,311,282
$32,185,913
% Total
5%
6%
5%
3%
28%
14%
9%
8%
23%
100%
8.
MedAssets Group Purchasing Organization (GPO) Update
FACILITIES SUBCOMMITTEE
Darryl K. Sharpton, Chairperson
Mojdeh L. Khaghan, Vice Chairperson
Joe Arriola
Date and Place
January 20, 2012 – 7:15 a.m. to adjournment
Conference Room 259
AGENDA
1.
**Approval of the Meeting Minutes
(Darryl K. Sharpton, Chairperson, Facilities Subcommittee)
(a)
December 15, 2011
2.
Chairperson’s Report
(Darryl K. Sharpton, Chairperson, Facilities Subcommittee)
3.
Real Estate and Retail Update
(Andrew Rachlin, Director, Real Estate, Jackson Health System)
4.
* Financial & Budget Tracking Status Report
(Charles Parkinson, Budget Director, Jackson Health System)
5.
*Capital Projects Construction Projects Update
(Thomas Kastner, Director, Capital Projects, Jackson Health System)
The items noted with an asterisk (*) indicates that the supporting documents are included.
The items noted with an asterisk (**) indicates that voting is required by the Committee.
1.
Darryl K. Sharpton, Chairman
Marcos Jose Lapciuc, Vice Chairman
Joe Arriola
Date and Place
December 15, 2011 – 7:15 a.m. to adjournment
Conference Room 259
ATTENDANCE
Marcos Jose Lapciuc
Joe Arriola
Excused
Darryl K. Sharpton
Financial Recovery Board Member
Mojdeh L. Khaghan
Carlos A. Migoya
Don S. Steigman
Regginald L. Jordan
Charles Parkinson
Madeline Valdes
Thomas Kastner
Andrew Rachlin
Jeffrey Poppel
Facilities Subcommittee Meeting
December 15, 2011
Page 2
CALL TO ORDER
With a quorum being present, the meeting of the Facilities Subcommittee was called to order at 7:25 a.m. by Joe
Arriola, Facilities Subcommittee member.
1.
APPROVAL OF THE MEETING MINUTES – NOVEMBER 17, 2011
Mr. Arriola requested a motion approving the meeting minutes of November 17, 2011.
Mr. Lapciuc moved approval;
seconded by Mr. Arriola, and
2.
CHAIRMAN’S REPORT
No Report.
3.
REAL ESTATE AND RETAIL UPDATE

JHS Facility Assessment Plan by Heery International
Jim Kukla and Allen Redmon, from Heery International provided an update to the Master Plan Facility
Plan. The presentation highlighted the interactive facilities map that has been created to depict all the
facilities and satellites owned and leased by Jackson Health System (JHS).
The map showed the location of leased facilities owned by Miami-Dade County (M-DC) but managed
by JHS, and/or vacant buildings. The map will be continually modified to document inventory of real
estate condition, vacant land location, lease information, square footage, and number of beds. The map
will facilitate information on buildings owned by M-DC and controlled and/or operated by JHS.
Additional features include a boundary survey to understand what services are on any part of any
inpatient campus building to determine square footage and bed capacity. The boundary survey
translates into a stacking diagram. This will provide understanding of beds and other factors such as
cost centers, square footages, areas under construction and consideration.
The data gathered is being encapsulated in the interactive map as the Strategic Plan is being developed.
December 15, 2011
Page 3
4.
*FINANCIAL & BUDGET TRACKING STATUS REPORT
Charles Parkinson, Budget Director, presented the following financial report that summarized the “Budget
Tracking Report” contained within the committee agenda package for the fiscal period ending October 31,
2011.
Capital Contribution (aka funded depreciation)
The FY 12 budget programs $20 million of expenditure to occur during the year for projects funded with
Capital Contribution. For the month end, active projects total $16.5 million. Of this amount, $6.4 million
was spent in prior years leaving just over $10 million to be spent this fiscal year; of that $10 million,
$69,361 was spent in October. The major budget change this month was a $229,400 increase in the North
Wing 3 renovation to include all restroom/bath facilities.
Foundation
Active Foundation funded projects continue this year totaling $2.4 million of prior and current year funding
commitments; $258,272 was spent in October. The bulk of the project dollars are represented by the Holtz
Pathology Lab Renovation at $2 million, which was just under one half million left to spend of the
Foundation support.
County GOB
Included in the report was a summary of active Building Better Communities General Obligation Bond
funded projects which continue with an all years’ budget of $58.9 million; prior years’ spending on these
projects including Jackson South Community Hospital (JSCH) totals $29.6 million and $3.069 million was
spent in October, most of which is due to the ongoing JSCH closeout.
Series 2005 Revenue Bonds
Active Series 2005 projects total $85 million of which $74.8 million was spent in prior years leaving just
over $10 million to spend this year. All of the funding represents earned interest on bond proceeds in the
construction and reserve fund and except for a current contingency reserve of $150,000 all of the funding is
programmed and forecast to be spent by the end of the fiscal year.
Series 2009 Revenue Bonds
Active Series 2009 projects total $64.3 million of which $24.1 million was spent in prior years leaving $39
million left to spend. Of that amount, $1.2 million was spent in October 2011.
Trust Funds and Grants
The active budgets total $6.63 million with over 97% represented by the ongoing Ryder Trauma Center
Hardening project, which remains in the early stage of implementation. No grant funds have been drawn
down as of October 2011.
Closing Points
Staff continues to undertake an extensive review of each and every active project no matter its milestone
stage that is currently funded from all sources to determine the necessity and financial viability of the
project. The end goals of this exercise include the protection and best use of operating cash resources or
reallocation of existing resources to capital projects that would yield a greater return to the organization or
to projects that must be done but remain unfunded at this time.
There is a close collaboration within the management team relative to last year at this time in terms of
capital planning. The Budget Office has begun developing the FY 2013 Capital Plan.
December 15, 2011
Page 4
ADJOURNMENT
The meeting of the Facilities Subcommittee adjourned at 7:45 a.m.
Transcribed by Monica Severiche
Executive Assistant
Support Services Division
2.
Chairperson’s Report
3.
Real Estate and Retail Update
BUDGET TRACKING REPORT FY 2012
NEW
# of
Proj.#
Proj.
Activity#
Project Name
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
status
BY FUNDING SOURCE
Start
Projected
Compl.
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
MULTIFUNDING SOURCE PROJECTS
1
C
P-00632
102,425,000
100,000
102,525,000
CO
Aug-05
Dec.10
Dec.11
Multi
Maddox
JMH
Garcia
796,236
3,802,288
100,887,570
1,637,430
2
J
P-00949 51009046 WW-B Pharmacy Phase I
52005003 J.South Community Hptal
250,927
583,669
834,596
CN
May-09
Mar.10
Apr.12
Multi
Arnaldo
JMH
Contreras
2,626
7,667
447,836
386,760
3
K
P-00952 51009047 SICU Reconfiguration
400,000
136,000
536,000
CN
May-09
May.10
Nov.11
Multi
Arnaldo
JMH
Contreras
-
1,358
513,602
22,398
4
L
P-00836 51007017 Rehab Building Renovation
16,610,791
CN
Sep-07
Aug.10
Jun.14
Multi
Frank
JMH
Contreras
-
-
158,547
16,452,244
5
M
P-00904 51008026 C-4 Cath Lab #6
2,833,500
79,984
3,990,161
6
O
P-00566
3,000,000
7
Q
P-00696 51008007 Underground Storage Tank Rep
3,000,000
8
R
S
P-00763 59007009 JMT Elevator Modern#141-146
1,057,183
9
P-00827 53008015 Jack.No Elevators 1 & 2
490,050
10
T
P-00834 51008016 ADA Compl.#Pkg1 Restrooms
991,763
11
U
P-00854 53008020 Jack.No. Window Replacement
2,057,220
51001001 Elevator Modernization
(59,620)
1,236,645
(1,689,852)
283,574
4,070,145
D
Jul-08
Oct.09
July.12
Multi
Abby
JMH
Contreras
-
153
3,000,000
CN
May-01
Mar.08
Dec.12
Multi
Maddox
JMH
Armstrong
-
-
2,022,856
977,144
1,310,148
CO
May-08
Dec.09
Dec.11
Multi
Allen
Heery
Jordan
-
-
1,166,697
143,451
1,340,757
CN
Jul-07
Sept.10
May.12
Multi
Maddox
JMH
Jordan
-
-
540,069
800,688
490,050
DEF
Feb-08
Jan.09
Oct.10
Multi
Abby
JMH
Sears
-
-
58,980
431,070
692,000
1,683,763
CN
Oct-07
Apr.08
Feb.12
Multi
Arnaldo
JMH
Jordan
1,850
3,823
726,727
957,036
1,000,000
3,057,220
CN
Jan-08
Jan.09
Nov.11
Multi
Abby
JMH
Sears
-
172,386
2,286,386
770,834
26
-
12
V
P-00606
931,591
-
931,591
D
May-04
Feb.08
Aug.12
Multi
Maddox
JMH
Jordan
23,739
907,852
13
W
P-00655 56006004 JNCMHC Emerg. Generator
331,839
-
331,839
DEF
Jul-06
Aug.07
Jun.11
Multi
Camero
JMH
Jordan
-
-
17,470
314,369
14
X
P-00724 51007008 Kitchen Equipment Modification
791,164
-
791,164
DEF
Nov-06
Jun.07
Dec.12
Multi
Rob
JMH
Jordan
-
-
79,485
711,679
15
Y
8,589,588
-
8,589,588
D
Dec-10
Aug.13
Multi
Clark
JMH
Jordan
-
18
6,003
8,583,585
700,000
2,406,000
CN
Sep-08
Sep.09
Multi
Frank
JMH
Jordan
-
26,170
743,006
1,662,994
603,500
603,500
D
Dec-10
TBD
Multi
TBD
JMH
Martinez
(4,405)
8,188,100
1,765,000
9,953,100
PIP
Aug.09
Dec.11
Multi
Niko
JMH
Martinez
153,714,336
5,350,916
159,065,252
16
Z
17
AA
18
AB
59004002 JMT Elevators Moderniz.
16,670,411
51011105 Ryder Trauma Ext Hardening
P-00928 51008032 ET- 1 Ortho Suite & ERA
51011103 IT Infrastructure Renovat
pip
31009002 Telecommunication
Total Mutifunding Source
1,706,000
-
Sep.12
26
(744)
575,303
28,197
445,721
512,552
6,817,348
3,135,752
1,242,053
4,525,696
117,151,607
41,913,645
CAPITAL CONTRIBUTION PROJECTS
1
O
P-00566
2
X
3
Q
4
T
P-00834 51008016 ADA Compliance Package#1
5
51010102 Managed Care Relocation
6
51011100 Highland Prof.Financ.Assessm
7
8
Y
-
1,608,153
CN
May-01
Mar.08
Dec.12
CC
Maddox
JMH
Armstrong
-
-
1,608,153
(0)
79,485
-
79,485
DEF
Nov-06
Jun.07
Dec.12
CC
TBD
JMH
Jordan
-
-
79,485
(0)
80,384
-
80,384
CO
May-08
Dec.09
Dec.11
CC
Allen
Heery
Jordan
-
80,384
378,757
-
378,757
CN
Oct-07
Apr.08
Feb.12
CC
Arnaldo
JMH
Jordan
-
-
378,757
952,906
CO
Jul-10
Sep.11
Dec.11
CC
Abby
JMH
Brady
-
11,714
900,822
52,084
-
740,000
D
Oct-10
Sep.11
Dec.11
CC
Clark
JMH
Contreras
-
-
59,768
680,232
51011104 WW-15 Nursing Unit Moder
2,588,568
-
2,588,568
D
Dec-10
Aug.12
CC
Clark
JMH
Contreras
385
164,736
2,423,832
2,147,397
-
2,147,397
D
Dec-10
TBD
CC
Clark
JMH
Jordan
18
6,003
2,141,394
542,625
-
542,625
D
Dec-10
Sep.11
CC
Clark
JMH
Contreras
226
782
40,174
502,451
1
-
1
D
Dec-10
Dec.11
CC
Arnaldo
JMH
Contreras
-
-
-
82,254
-
82,254
CO
Aug-06
Dec.10
CC
Maddox
JMH
Garcia
-
-
82,254
51011106 Highland Prof. 6TH Floor
10
51011107 ACC-W-1 Pharmacy Reno
Jan.12
1
P-00632
12
S
52,317
-
52,317
DEF
Feb-08
Jan.09
Jun.10
CC
Abby
JMH
Sears
-
-
52,317
-
13
U
85,608
-
85,608
CN
Jan-08
Jan.09
Nov.11
CC
Abby
JMH
Sears
-
-
85,608
-
14
W
17,470
-
17,470
DEF
Jul-06
Aug.07
Jun.11
CC
Camero
JMH
Jordan
-
-
17,470
-
15
V
P-00606
23,713
-
23,713
D
May-04
Feb.08
Aug.12
CC
Maddox
JMH
Jordan
-
-
23,713
-
16
R
24,135
-
24,135
CN
Jul-07
Sept.10
May.12
CC
Maddox
JMH
Jordan
-
-
24,135
-
368,500
D
Dec-10
TBD
CC
TBD
JMH
Martinez
(4,405)
340,303
28,197
AA
-
368,500
Dec.11
85
-
C
17
52005003 J.South Community Hptal(661)
952,906
0
-
740,000
9
11
1,608,153
Page 1 of 7
(744)
-
NEW
# of
Proj.#
Proj.
Activity#
Project Name
18
58011110 Perdue Medical Center Reno
19
51011111 NW-3 Floor Phase 1
20
51011112 DTC PET Scan
21
51011119 WW-105 Government Relat
22
NEW
23
AB
51012100 Human Resources Relocation
PIP
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
1,200,000
347,750
275,400
status
BY FUNDING SOURCE
Start
Projected
Compl.
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
D
Jan-11
May.12
CC
Maddox
JMH
Andrews
-
23,558
25,887
1,174,113
623,150
CN
Jan-11
Oct.11
CC
Frank
JMH
Contreras
12,300
20,098
212,404
410,746
1,871,429
595,571
1,200,000
2,467,000
-
2,467,000
CN
Jan-11
TBD
CC
Abby
JMH
Contreras
-
-
95,875
-
95,875
CN
Sep-11
TBD
CC
Abby
JMH
Jordan
1,346
6,371
52,734
43,141
300,000
D
Dec-11
TBD
CC
Abby
JMH
Hout-Barrientos
-
-
-
300,000
PIP
Aug.09
Dec.11
CC
Niko
JMH
Martinez
-
-
-
2,000,000
9,552
62,181
300,000
2,000,000
Total Capital Contribution
14,861,492
-
1,596,806
2,000,000
16,458,298
6,106,536
10,351,762
CAPITAL CONTRIBUTION
JACKSON NORTH
Total Jackson North
-
-
-
-
-
-
-
-
-
-
-
-
-
-
33,025
49,757
369,951
(7,946)
33,025
49,757
369,951
(7,946)
-
-
STRATEGIC INITIATIVE (PROJECTS CANCELLED)
Total Strategic Initiative
FINANCIAL SUSTAINABILITY
1
51010093
Centralized Registration
Total Financial Sustainability
362,005
-
362,005
362,005
-
362,005
CN
Feb-10
Oct.10
Aug.11
FS
Lourdes
JMH
Pla
CLOSED PROJECT FY 2010-2011
Total Closed Capital Contribution
-
-
-
Page 2 of 7
-
-
NEW
# of
Proj.#
Proj.
24
Activity#
Project Name
SUB TOTAL CAPITAL CONTRIBUTION PROJECTS
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
15,223,497
1,596,806
status
BY FUNDING SOURCE
Start
Projected
Compl.
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
16,820,303
42,577
111,939
6,476,487
10,343,816
(146,985)
111,287
FOUNDATION
1
2,000,000
-
2,000,000
CN
Jul-06
Jul.08
2
P-00659 51006005 Holtz-2 Pathology Renovat
51011117 DTC-1 Taylor Breast Ctr Reno
276,000
-
276,000
D
Jul-11
Jul.12
3
51011118 C-5 NICU Intermed.Modern
100,000
-
100,000
D
Aug-11
2,376,000
-
2,376,000
Total Foundation
Dec.11
F
Frank
JMH
Contreras
1,395,106
604,894
F
Alana
JMH
Contreras
-
-
700
275,300
JMH
Armstrong
-
-
-
100,000
F
(146,985)
111,287
1,395,806
980,194
GOB GENERAL OBLIGATION BONDS
16,400,000
D
Sep-07
Aug.10
Jun.14
GOB JS
Frank
JMH
Contreras
-
-
2
1
P-00867 51008024 Campus Wide Pneumatic Tube S
3,629,400
-
3,629,400
CN
Apr-08
Aug.10
Dec.12
GOB ED
David
JMH
Jordan
-
2,610
865,734
3
P-00879 51008025 WW-4 CCU-B Expansion
1,854,812
-
1,854,812
CO
Mar-08
Dec.08
Nov.11
GOB ED
Arnaldo
JMH
Contreras
17,129
51,917
1,812,568
P-00904 51008026 C-4 Cath Lab # 6
2,833,500
3,620,145
D
Jul-08
Oct.09
Jul.12
GOB ED
Abby
JMH
Contreras
-
-
4
5
L
M
Z
C
P-00632
C
P-00632
Total GOB Bonds
16,400,000
786,645
1,706,000
-
1,706,000
CN
Sep-08
Sep.09
Jun.12
GOB ED
Frank
JMH
Contreras
52,000,000
-
52,000,000
CO
Aug-05
Dec.10
Dec.11
GOB JS
Maddox
JMH
Garcia
(20,260,817)
(20,260,817)
CO
Aug-05
Dec.10
Dec.11
GOB JS
Maddox
JMH
Garcia
(3,074,172)
58,949,540
62,023,712
796,236
-
813,365
-
-
16,400,000
2,763,666
42,244
3,620,145
26,170
743,006
962,994
3,802,288
30,101,753
21,898,247
-
-
3,882,985
33,523,062
(20,260,817)
25,426,478
2005 REVENUE BOND
L
L
M
P-00904 51008026 C-4 Cath Lab # 6
Z
1
2
3
4
16,670,411
-
P-00932 51009033 HCH ET-5 Intake, ET-7 BMT Ph.I
1,758,649
P-00947 51009044 ET-5 Adolescen Unit
1,236,193
J
J
K
K
5
P-00953 51009048 ET-4 Fetal Surgery Office
6
P-00959 51009054 ET-4 LDOR Fetal Surg.OR's
(59,620)
(16,400,000)
450,000
250,927
400,000
700,000
(200,000)
16,610,791
D
Sep-07
Aug.10
Jun.14
RB REH
Frank
JMH
Contreras
-
-
(16,400,000)
450,000
D
D
Sep-07
Jul-08
Aug.10
Oct.09
Jun.14
Jul.12
RB REH
IRB INTER
Frank
Abby
JMH
JMH
Contreras
Contreras
-
153
158,547
16,452,244
79,984
(16,400,000)
370,016
700,000
CN
Sep-08
Sep.09
Jun.12
RB INTER
Frank
JMH
Contreras
-
-
1,758,649
CN
Dec-08
May.10
Feb.12
RB PEDI
Alana
JMH
Armstrong
31,818
46,958
1,016,131
-
742,518
700,000
1,036,193
CN
May-09
May.10
Feb.12
RB REH
Alana
JMH
Armstrong
12,694
9
159,210
876,983
470,000
720,927
D
May-09
Mar.10
Apr.12
RB ACU
Arnaldo
JMH
Contreras
2,626
2,626
442,796
278,131
113,669
113,669
D
May-09
Mar.10
Apr.12
IRB INTER
Arnaldo
JMH
Contreras
-
5,040
5,040
108,629
400,000
CN
May-09
May.10
Nov.11
RB ACU
Arnaldo
JMH
Contreras
-
-
400,000
136,000
CN
May-09
May.10
Nov.11
RB PEDI
Arnaldo
JMH
Contreras
-
1,358
113,602
CO
May-09
Feb.10
Oct.11
RB PEDI
Abby
JMH
Armstrong
-
23,573
624,576
28,973
D
May-09
Aug.10
Jul.12
RB PEDI
Alana
JMH
Armstrong
549
1,898
390,626
1,693,324
136,000
653,549
-
653,549
2,083,950
-
2,083,950
Page 3 of 7
(0)
22,398
NEW
# of
Proj.#
Proj.
Activity#
Project Name
7
51010092 Institute Annex 3rd Floor
8
51010096 WW-2 Angio Suite
9
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
-
51010097 DTC new MRI
91,620
91,620
2,000,000
2,000,000
Start
Projected
Compl.
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
CN
Jan-10
Sep.10
Dec.11
RB REH
Abby
JMH
Contreras
-
227
89,049
2,571
D
May-10
Oct.10
Mar.12
RB PEDI
Abby
JMH
Mass
-
-
60,955
1,939,045
62,079
2,437,921
2,500,000
D
May-10
Oct.10
Mar.12
RB PEDI
Abby
JMH
Mass
50,000,000
CO
Aug-05
Dec.10
Dec.11
RB JS
Maddox
JMH
Garcia
-
-
50,000,000
16,400,000
16,400,000
CO
Aug-05
Dec.10
Dec.11
RB REH
Maddox
JMH
Garcia
-
-
16,400,000
210,817
210,817
CO
Aug-05
Dec.10
Dec.11
RB ACU
Maddox
JMH
Garcia
-
-
210,817
P-00632
3,650,000
3,650,000
CO
Aug-05
Dec.10
Dec.11
RB INTER
Maddox
JMH
Garcia
-
-
3,650,000
P-00632
52005003 J South Community Hptal
100,000
100,000
CO
Aug-05
Dec.10
Dec.11
RB INTER
Maddox
JMH
Garcia
-
-
100,000
361,000
361,000
CN
Jan-10
Feb.11
Dec-11
RB INTER
Arnaldo
JMH
Sears
-
-
38,035
905,910
905,910
CN
May-10
Oct.10
Oct.11
RB INTER
Abby
JMH
Sears
5,060
5,060
894,322
11,588
Nov.11
RB INTER
Abby
JMH
Contreras
-
675
26,270
427,730
RB&Inter
Alana
JMH
Armstrong
-
-
-
258,000
52,761
87,592
C
P-00632
C
P-00632
C
P-00632
C
C
2,500,000
status
BY FUNDING SOURCE
50,000,000
10
53010091 JN Pharmacy Clean Room
11
53010095 JNMC Labor & Delivery
12
51011116 C-4 Cath Lab #5
454,000
-
454,000
D
Apr.11
Oct.11
13
51011120 ET-1 Admitting Renovation
258,000
-
258,000
CN
Sep-11
Aug.12
Total 2005 Revenue Bond
-
-
73,765,679
11,429,396
85,195,075
14
14
(0)
(0)
0
322,965
74,922,040
10,273,035
977,145
2009 INFRASTRUCTURE BOND
O
P-00566
Q
T
P-00834 51008016 ADA Compliance Package#1
1,391,847
2,919,616
613,006
-
1,391,847
CN
May-01
Mar.08
Dec.12
IRB
Maddox
JMH
Armstrong
-
-
414,702
1,229,764
CO
May-08
Dec.09
Dec.11
IRB
Allen
Heery
Jordan
-
-
1,086,314
143,450
692,000
1,305,006
CN
Oct-07
Apr.08
Feb.12
IRB
Arnaldo
JMH
Jordan
1,850
3,823
347,970
957,036
Feb.12
IRB
David
JMH
Jordan
-
(46)
1,588,581
761,419
IRB
Frank
JMH
Jordan
-
-
1,155,719
69,071
97,505
2,512,219
606,861
5,170,109
(1,689,852)
1
P-00938 51009036 WW Fire Alarm
2,000,000
350,000
2,350,000
CN
Apr-09
Sep.10
2
P-00957 51009052 PPW Cooling T.Chiller,AHU
1,496,790
(272,000)
1,224,790
CO
Sep-09
Nov.11
3
P-00958 51009053 ET A/C Repl177-180,181Inst
2,653,370
465,710
3,119,080
CN
Sep-09
Nov.10
Nov.11
IRB
Frank
JMH
Jordan
4
P-00961 51009056 Replace Paralleling Gear
4,361,250
928,122
5,289,372
D
Sep-09
Dec.12
May.13
IRB
Douglas
JMH
Jordan
119,219
119,263
5
P-00962 51009057 Utility Ctr-2 Emerg.Generat
2,135,000
116,728
2,251,728
CN
Sep-09
Jan.12
IRB
David
JMH
Jordan
133,631
121,094
2,028,010
223,718
6
P-00967 51009062 Fire Alarm Upgrade Campus
4,815,000
(385,505)
4,429,495
D
Sep-09
Dec.12
IRB
Douglas
JMH
Jordan
212
2,534
42,046
4,387,449
7
P-00969 51009064 DTC,T,Rehab,WW&ACC-W AHU
6,541,500
-
6,541,500
CN
Sep-09
Nov.12
Oct.12
IRB
Oscar
JMH
Jordan
29,953
1,960,086
4,581,414
8
P-00974 51009069 Campus Wide Roofing Repl.
1,500,000
-
1,500,000
D
Sep-09
Dec.10
Feb.12
IRB
Maddox
JMH
Jordan
-
11,614
176,252
1,323,748
9
P-00978 51009072 Fire Sprinkler Upgrade Campus
2,000,000
-
2,000,000
D
Sep-09
Dec.12
Feb.13
IRB
David
JMH
Jordan
4,132
6,725
141,035
1,858,965
10
P-00982 51009076 UC Emerg.Well Boilers
2,331,000
200,000
2,531,000
CN
Sep-09
Jun.11
Dec.11
IRB
David
JMH
Jordan
-
314,212
1,859,397
671,603
11
P-00992 51009084 BackFl.&Byp.DomWater
250,000
117,000
367,000
CN
Sep-09
Mar.10
Dec.11
IRB
Camero
JMH
Jordan
12
P-00997 51009089 4160 Volt Oil Switch Repl
3,785,000
D
Sep-09
Dec.12
Oct.12
IRB
Douglas
JMH
Jordan
66,363
66,490
7,350,000
(3,565,000)
-
(104,837)
270,649
(4)
(4)
(4)
322,662
367,004
3,462,338
13
51010098 Above Ground Tank Replacem
-
369,580
369,580
D
Jun-10
TBD
IRB
Camero
JMH
Jordan
-
-
-
14
51010099 Concrete Struct Tank Farm
-
252,150
252,150
D
Jun-10
Mar-11
Jan.12
IRB
Arnaldo
JMH
Jordan
-
-
539
251,611
15
51010100 CampusW Underg Utilities
-
3,200,000
3,200,000
CN
Jul-10
Dec.11
Jul.12
IRB
Allen
Heery
Jordan
500
779,938
2,420,062
51011102 Mainframe Retirement
-
20,176
20,176
D
Dec-10
TBD
IRB
TBD
JMH
Martinez
-
-
20,175
1
-
235,000
235,000
CN
Dec-10
TBD
IRB
TBD
JMH
Martinez
-
-
235,000
(0)
342,746
CO
Aug-06
Dec.10
IRB
Maddox
JMH
Garcia
-
-
342,746
16
AA
C
P-00632
52005003 J.South Community Hptal (661)
342,746
-
Dec.11
Page 4 of 7
78,214
369,580
-
BY FUNDING SOURCE
Proj.#
Proj.
U
Activity#
Project Name
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
1,971,612
1,000,000
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
Start
2,971,612
CN
Jan-08
Jan.09
Nov.11
IRB
Abby
JMH
Sears
-
780,680
CN
Sep-09
Sep.10
Jun.12
IRB
Arnaldo
JMH
Jordan
-
2,000,000
D
Sep-09
Jun.11
Dec.12
IRB
Abby
JMH
Sears
14,188
172,386
770,834
P-00960 53009055 Main/JNMC-outside. lights
922,500
18
P-00970 53009065 JNMC Hot Water/Boiler
630,000
19
P-00972 53009067 JNMC Remaining Roof
527,383
(14,071)
513,312
D
Sep-09
Mar.10
May.12
IRB
Abby
JMH
Sears
-
-
-
513,312
20
P-00973 53009068 JNMC Roof No.So.ICU&ER
250,000
-
250,000
D
Sep-09
Mar.10
May.12
IRB
Abby
JMH
Sears
-
-
-
250,000
21
P-00983 53009077 JNMC Med Line Isolation Panel
288,750
-
288,750
D
Sep-09
Oct.11
TBD
IRB
Abby
JMH
Sears
-
-
734
288,016
22
P-00989 53009081 JNMC ICU Commode Rep
CN
Sep-09
Mar.10
Jan.12
IRB
Abby
JMH
Sears
-
-
356,064
96,436
23
P-00996 53009088 JNMC Emer.Switchgear
Sep-09
Dec.12
IRB
Douglas
JMH
Sears
16,500
30,140
62,417
1,682,583
-
-
65,260
818,012
26
907,852
800,688
53010101 JNMC 40 Year Certification
V
P-00606
R
25
26
51011113 Reduction of NAP Utilization
AB
27
PIP
PIP
31011014 Reduction of NAP Utilization
Total 2009 Infrastructure Rev.Bond
1,370,000
-
2,200,778
17
24
(141,820)
Projected
Compl.
status
NEW
# of
115,563
110,421
670,260
835,166
1,164,834
52,500
400,000
452,500
1,650,000
95,000
1,745,000
D
883,272
883,272
D
Jul-10
Oct.11
IRB
Maddox
JMH
Jordan
907,878
D
May-04
Feb.08
Aug.12
IRB
Maddox
JMH
Jordan
CN
Jul-07
Sept.10
May.12
IRB
Maddox
JMH
Jordan
-
-
515,934
D
Apr-11
Sep.11
Feb.12
IRB
Niko
JMH
Martinez
-
(3,661)
44,282
825,542
6,629,248
1,135,752
907,878
-
1,033,048
283,574
1,316,622
300,000
569,824
869,824
6,000,000
1,765,000
7,765,000
PIP
Aug.09
Dec.11
IRB
Niko
JMH
Martinez
10,000
PIP
Apr-11
Sep.11
IRB
Niko
JMH
Martinez
300,000
57,534,796
(290,000)
6,954,888
64,489,684
26
445,721
-
675,785
26
512,552
-
1,851,484
-
25,952,979
10,000
38,536,705
2009 INFRASTRUCTURE REVENUE BOND DEFERRED PROJECTS
X
711,679
-
711,679
DEF
Nov-06
Jun.07
2,810,370
-
2,810,370
DEF
Sep-09
Dec.12
P-00965 51009060 Chilled Water Loop Valves
315,000
-
315,000
DEF
Sep-09
Dec.12
P-00975 51009070 Heat Exchangers
420,000
-
420,000
DEF
Sep-09
Mar.10
4
P-00979 51009073 Public Area Bathrooms
210,000
-
210,000
DEF
Sep-09
5
P-00981 51009075 WW & C AHU Repl (14)
1,995,000
-
1,995,000
DEF
1
P-00964 51009059 Utility Ctr Chiller Replacem
2
3
6
P-00991 52009083 J.South Repl.2 Vacuum P
S
Dec.12
711,679
-
2,810,370
Jordan
-
-
-
315,000
Jordan
-
-
-
420,000
Oct.10
IRB
TBD
TBD
Jordan
-
-
-
Sep-09
Dec.12
IRB
TBD
JMH
Jordan
-
-
95,926
210,000
1,899,074
25,000
-
25,000
DEF
Sep-09
Mar.10
Oct.10
IRB
Maddox
JMH
Garcia
-
-
-
25,000
437,733
-
437,733
DEF
Feb-08
Jan.09
Jun.10
IRB
Maddox
JMH
Sears
-
-
6,663
431,070
IRB
Abby
JMH
Sears
-
-
-
2,908,500
IRB
Abby
JMH
Sears
-
-
-
130,000
IRB
Abby
JMH
Sears
-
-
-
52,500
IRB
Abby
JMH
Sears
-
-
-
126,000
-
2,908,500
DEF
Sep-09
Dec.12
-
130,000
DEF
Sep-09
Mar.10
9
P-00977 53009071 JNMC Repl.Conden.Coils
52,500
-
52,500
DEF
Sep-09
Mar.11
126,000
-
126,000
DEF
Sep-09
Mar.10
Oct.10
Oct.10
W
-
-
JMH
130,000
P-00993 53009085 JNMC Pat.R.Fan Coils
-
-
JMH
2,908,500
P-00990 53009082 JNMC Vacuum System
-
Jordan
TBD
P-00971 53009066 JNMC Med. Air Compres
12
Jordan
JMH
Camero
P-00968 53009063 JNMC AHU Replacement
11
JMH
TBD
IRB
8
P-00988 53009080 JNMC SICU Med Gas Colum
TBD
IRB
IRB
Oct.10
7
10
IRB
78,750
-
78,750
DEF
Sep-09
Mar.10
2,940,000
-
2,940,000
DEF
Sep-09
Dec.12
Oct.10
IRB
Abby
JMH
Sears
-
-
-
78,750
IRB
Abby
JMH
Sears
-
-
-
2,940,000
314,369
-
314,369
DEF
Jul-06
Aug.07
Jun.11
IRB
Abby
JMH
Jordan
-
-
-
314,369
13
P-00994 56009086 Rose Lee W. Exp.Exam R
262,500
-
262,500
DEF
Sep-09
Mar.10
Oct.10
IRB
Camero
JMH
Contreras
-
-
-
262,500
14
P-00995 56009087 Rose Lee W Med.Record
31,500
-
31,500
DEF
Sep-09
Mar.10
Oct.10
IRB
Camero
JMH
Contreras
-
-
-
31,500
13,768,901
-
13,768,901
-
-
Total 2009 Infrastructure Rev.Bond DEFERRED
Page 5 of 7
102,589
13,666,312
NEW
# of
Proj.#
Proj.
Activity#
Project Name
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
status
BY FUNDING SOURCE
Start
Projected
Compl.
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
PIP
Aug.09
Dec.11
IRB
Niko
JMH
Martinez
-
-
188,100
-
-
-
188,100
-
-
-
-
6,442,191
-
-
-
6,442,191
TRUST FUND / GRANTS
AB
pip
188,100
-
188,100
Total Trust Fund
188,100
-
188,100
6,442,191
-
6,442,191
6,442,191
-
6,442,191
FEMA Grants
IN CONSTRUCTION
Y
Total FEMA Grants
D
Dec-10
TBD
FEMA
Clark
JMH
Jordan
ALL OTHER FUNDING SOURCES
CLOSED PROJECT FY 2011-2012 & Partially Capitalized
1
P-00941 51009038 Cooling Tower
4,100,000
150,000
4,250,000
4,100,000
150,000
4,250,000
TOTAL FOR OTHER FUNDINGS
220,199,379
15,460,112
235,659,491
1,394,926
GRAND TOTAL
235,422,876
17,056,918
252,479,794
1,437,504
Total Closed Other Fundings
48
72
LETTERS
PC
Feb-09
Sep.10
Jan.12
Denotes a new project opened in the current month
Hold:
Projects placed on hold by Capital Projects Department
Bold project numbers:
Denotes changes in the project stages i.e.. From Design to Construction etc.
Bold budget amount:
Denotes a change in the Total Project Budget
Bold date:
Denotes changes in the projected completion/ revised completion date in the current month
Status
CAN
CL
CN
CO
Camero
JMH
Jordan
-
Denotes Multi Funding Sources (The sum of all sources equals the Total Funded Commitment or Total Project Budget)
New:
IRB
Cancelled Project
Closed
Construction
Close-Out
Page 6 of 7
4,097,751
152,249
4,097,751
152,249
5,933,348
140,182,328
95,477,163
6,045,286
146,658,815
105,820,979
-
NEW
# of
Proj.
Proj.#
D
DEF
PC
Activity#
Project Name
Original
Project
Total
Budget
Total
Project
Budget
Changes
Budget
status
BY FUNDING SOURCE
Start
Projected
Compl.
Revised
Compl.
Fund.
Project
Project
V.P.
Exec.
Actuals FY12
Total YTD
Life to Date
Amount left
Date
Date
Date
Source
Manager
Manager
Spons.
Nov.11
Nov.11
thru Nov.11
to Spend
Design
Deferred
Partial Capitalization
Page 7 of 7
JACKSON MEMORIAL HOSPITAL
MONTHLY STATUS REPORT
JANUARY 2012
MASTER PLAN UPDATE
Funding Source: JHS Capital Projects
Total Project Budget: $264,500
Anticipated substantial completion date: December 30, 2011
Scope of the Work
To collect and validate volume data, update facility assessment, update planning/programming/operational
recommendations, update infrastructure recommendations, refine phasing and enabling recommendations
and update capital cost study
December 2011
 On Hold Pending Validation of Strategic Plan
January 2012
 On Hold Pending Validation of Strategic Plan
 Meet with Strategic Planning Group
February 2012
 Begin Strategic Visioning
 Begin Design Concepts
 Preliminary Cost & cash Flow Analysis
 Begin Distillation of Strategic Direction
 Finalize Design Concepts
 Validate Cost & Cash Flow Analysis
51010100 CAMPUS WIDE UNDERGROUND UTILITY SITEWORK IMPROVEMENTS
Funding Source: IRB
Total Project Budget: $ 3,200,000
Anticipated substantial completion date: July 31, 2012
(Contractors revised completion date is now Sept. 4, 2012)
Scope of the Work
To upgrade water and fire lines in and around the Alamo Plaza along with canopy replacement,
improvements to hardscape, lighting and landscape.
December 2011
 Finalize Color & Finish Selection
 Obtain Site Lighting Permit
 Continue Construction Activities
January 2012
 Submit 16th Street Entrance Drive for Permit

Continue Construction Activities
 Submit Additional Hardscape Improvements
 Complete Memorial Park Design
 Submit Memorial Park Design for Permit
February 2012
 Continue Construction Activities
JANUARY 2012
51008032 EAST TOWER FLOOR – ER-RENOVATION
Funding Source: GOB& 2005 RB
Anticipated substantial completion date Phase III: March 31, 2013
PHASE III
Scope of the Work
To refurbish and upgrade the ER-B & ER-C Patient Units including all existing bathrooms within the
Department, staff lounge, corridor connection between East Tower-Central Building, corridor connection
between East Tower-Trauma.
December 2011
 General Contractor to commence demolition of Phase 1 (New cashiers/bathroom, new physicians’
offices/bathroom and bathrooms along Pedi-ER Corridor)
January 2012
 Renovation of Phase 1 in Progress
February 2012
 Construction of Phase 1 in Progress
51006005 EAST TOWER 2ND FLOOR PATHOLOGY LAB
Funding Source: JMH Foundation
Anticipated substantial completion date: May 31, 2012
Scope of the Work:
To upgrade and refurbish the existing Pathology Laboratory. Project Designed in Five (5) construction
phases: 1.-UM Chairman Office/Bathroom, 2.-Conference Room, 3.-North Lab, 4.-South Lab/Grossing
Stations 5.-Residencies Lab.
December 2011
 Grossing Stations Equipment to be delivered
 Furniture System to be delivered to the South Core Lab
 South Core Lab Construction in Progress
January 2012
 Grossing Stations Lab construction in progress
 Substantial construction completion South Core Lab
February 2012
 Substantial construction completion Grossing Stations Lab
JANUARY 2012
51009033 ET-7 PEDIATRIC BMT
Funding Source: 2005 RB
Projected Construction Completion Date: March 2012
Scope of work
The scope of work entails the dispersement of the CCIU unit on the East Tower 7th floor in order to create a 7 bed
Pediatric Bone Marrow Transplant Unit. The renovations will provide the modernization of 7 patient rooms and the
addition of two (2) ADA Patient Restrooms, playroom and one (1) laundry facility. Upgrade of staff lounge,
corridor and adjacent support areas. Total Square footage under this contract is approximately 3,382 sq. ft.
December 2011
 Construction Continues
 Revision to Permit (6) for AHU #193 and Chemo refrigerator to City of Miami
 AHCA 80% survey
January 2012
 Demolition of existing AHU #193
 Assembling of new AHU #193
February 2012
 Installation of GE Monitors
51009044 HCH ADOLESCENT UNIT RELOCATION
Projected Construction Completion Date: June 2012
Scope of work
Renovation of an existing area on the East Tower 5th floor in the Infant Toddler Pediatric Patient Rooms for
Adolescents. Remodel existing (6) six crib nursery and convert it into four (4) Private Patient rooms including the
addition of four (4) new head walls and additional new ADA patient rest rooms by converting existing closets.
Upgrade of existing Private and Semi-Private patient Rooms, staff lounge and corridor.
December 2011

Construction Start on hold as of 8/4/11_Additional Bond Request , Asbestos Survey, Asbestos Abatement
January 2012
 Construction Start on hold pending required signatures from executive leadership
February 2012
 Issuance Of Purchase Order and NTP to Servcor
 Mobilize for construction
 Receive Permit from City of Miami
 Demolition Commences
 Construction Commences
JANUARY 2012
51011117 TAYLOR BREAST CENTER RENOVATION
Anticipated Construction Completion Date: August 2012
This scope of work entails the renovation of the Taylor Breast Center located in the Diagnostic Treatment Center
1st floor. The upgrade will include renovation of the entrance / Reception Room. The Patient Changing Rooms will
be relocated and converted into 3 Patient Intake areas. The Radiologist and Reading rooms will be relocated to
accommodate new equipment. The upgrade will also include new furniture, paint, and lighting.
December 2011
 Design Services start on hold pending required signatures from executive leadership
January 2012
 Notice to Proceed for design services to MADY & Associates
 Commencement of Design Services (Schematic Design phase)
February 2012
 Design Continues
51011118 NICU B, C AND INTERMEDIATE MODERNIZATION
Approved Project Budget: $100,000 (Design)
Estimated Project Budget: $2,000,000.
Anticipated Construction Completion Date: April 2013
The Scope of Work entails the modernization of the NICU B, C and Intermediate Units. This includes the complete
renovation of the Nursing Stations, Refurbishment of Patient Bays and Replacement of flooring and Wall protection
to match the existing NICU Unit A.
December 2011
 A/E submit proposal for services
 Design Services start on hold pending required signatures from executive leadership
January 2012
 Lawson input for A/E Purchase Order
 Issuance of PO to A/E
February 2012
 Notice to Proceed for design services to Naya Architects
JANUARY 2012
51011116 CARDIAC CATH LAB #5 EQUIPMENT REPLACEMENT
Projected Construction Completion Date: 4/12
Construction to be performed by JOC
Scope of work
Replace Cardiac Cath Lab equipment for room 5 on Central 4th floor. Existing equipment is 23 years old and has
not functioned for almost two years.
December 2011

AHCA Final review of Design

Submit to the City for Permitting
January 2012

AHCA Final review of Design

Request Pricing from JOC Contractor
February 2012

Receive PO for Contractor

Construction Commences in Room
51009054 ET-4 LABOR AND DELIVERY OPERATING ROOMS
Total Project Budget: $2,083,950
Anticipated substantial completion date: October 2012
Scope of Work
Remodeling and Renovation of 5 Labor and Delivery Operating Rooms and surrounding support areas at the East
Tower 4th Floor – Holtz Children’s Hospital. Four (4) Operating Rooms will maintain the same size and
configuration. Operating Room Five (5) will be demolished and redesigned to higher standards. Total Square
footage under this contract is approximately 5,450 Sq. Ft.
December 2011
 Contractor bids received by Procurement in November
 Evaluation of Contractor bids by Procurement on hold
January 2012
 Evaluation of Contractor bids by Procurement on hold pending required signatures from executive
leadership
February 2012
 Procurement review Contractor bids
 Contractor awarded
JANUARY 2012
51010096 WW-2 ANGIO SUITE
Anticipated substantial completion date: July 2012
Scope of work
Removal of existing C-arm and replace with a new Siemens’ Zee in Interventional Radiology room #25. Renovation
of abandoned Interventional Radiology area on WW2 to create a new recovery unit for Interventional Radiology.
December 2011
 Construction continues in IR Room #25
 Final Permit review received for Recovery area
January 2012
 Construction continues for Room #25
 New PER Signed for Project
February 2012
 Construction continues for Room #25
 ITB issued for Recovery Area Construction
51008026 CARDIAC CATH LAB #6
Funding Source: GOB & 2005 RB
Projected Construction Completion Date: TBD
Scope of work
Construction of a new EP Cardiac Cath Lab on Central 4th Floor. Includes the Relocation of the storage areas into
the unit.
December 2011

On Hold
January 2012

On Hold
February 2012

On Hold
JANUARY 2012
51009053 EAST TOWER 2 FLOOR A/C REPLACEMENT
Funding Source: IRB
Total Project Budget: $ 3,119,080.00
Anticipated substantial completion date: February 29, 2012
Scope of the Work:
To furnish the Five (5) custom Air Handling Units at the East Tower 2nd Floor of Holtz Children’s
Hospital.
December 2011
 Start Up New AHU #177.
 To remove temporary Roof Top AC Units
January 2012
 Chilled water piping insulation in progress
 Epoxy paint to be applied on the floor of the mechanical room
February 2012
 5 AHUs Replacement Project substantial completions
 City of Miami Final Inspection
51009072 FIRE SPRINKLER UPGRADE CAMPUS WIDE
Funding Source: IRB
Anticipated substantial completion date: February 15, 2013
Scope of the Work
The campus-wide fire protection upgrades are to address all existing NFPA fire sprinkler codes in addition to
installing new automatic sprinkler systems and other system components for each building as determined deficient
by state and local authority having jurisdiction. These main campus building include Central, East Tower, North
Wing, Rehabilitation, South Wing, West Wing, and Utility buildings.
December 2011
 Lawson Input for purchase order issuance (ET, WW, & NW buildings) – PENDING MDC Protest
 Incorporate JMH comments and submit to AHCA / City of Miami for 100% review (Rehabilitation
Building)
 Engage JMH Med Asset Fire Sprinkler contractors for bidding (SW , Central, Rehabilitation
Buildings) - PENDING MDC Protest
 Engage MDC / OCI for competitive pricing for construction services (SW, Central, Rehabilitation
Buildings) - PENDING MDC Protest
January 2012
 JMH Procurement to confirm direction on how to proceed from MDC and JMH CAO in regards to bid
package 1 vendor protest.
 JMH Procurement and Capital Projects to re-bid the fire sprinkler project in it entirety (all 6 patient
buildings) for public solicitation. TBD
February 2012
 Competitive proposal review for construction services (all 6 patient buildings)
 Proposal negotiations (all 6 patient buildings)
 PHT Board Approval for construction services (construction cost estimated to be over 1M)
 Lawson Input for purchase order issuance (all 6 patient buildings)
JANUARY 2012
51011105 RYDER TRAUMA CENTER EXTERIOR HARDENING PROJECT
Funding Source: FEMA (75%) / Capital Contribution (25%)
Anticipated substantial completion date: August 20, 2013
Scope of the Work
The project scope of work is to structurally retrofit the building envelope. The project will be designed to install a
wind abatement system of lightweight glass fiber reinforced concrete (GFRC) panels onto the Ryder Trauma Center.
The components used for this wind retrofit project will meet the current Florida Building Code and Miami-Dade
County specifications to withstand extreme hurricane conditions (Category IV storm conditions).
December 2011
 Solicit qualified construction managers / contractors through an RFQ process - ON HOLD Pending
Executive Approval for procurement to ITB
 Completion of 100% Design Development drawings (completed 12/30/11)
January 2012
 AHCA Stage II stand-up of drawing review schedule 1/18/2012
 Ongoing Design Services (Tracking Completion of 100% Construction Drawings by March 2012)
February 2012
 Proposal review/ negotiations - ON HOLD Pending Executive Approval for procurement to ITB
 Contract review, approval, execution - ON HOLD Pending Executive Approval for procurement to
ITB
 Lawson Input for purchase order issuance - ON HOLD Pending Executive Approval for
procurement to ITB
JANUARY 2012
51011106 HIGHLAND PROFESSIONAL BUILDING – TRANSPLANT RENOVATIONS
Funding Source: Capital Contribution
Total Project Budget: $542,625 Anticipated substantial completion date: June 2012
Scope of the Work
The scope of work is to renovate various areas of the 6th floor transplant floor of the Highland Professional Building
in order to add Patient Exams room and work station to support the 6th Floor Transplant department. Additionally
the scope of work includes interior renovations to the 1st floor lobby area, elevator lighting upgrade,
interior/exterior signage and renovations to an unoccupied area to support daily clerical activities.
December 2011
 Ongoing Construction Services – ON HOLD Pending Executive Approval for procurement to
release new/existing Purchase Orders
January 2012
February 2012
51011100 HIGHLAND PROFESSIONAL BUILDING – FINANCIAL ASSESSMENT
Anticipated substantial completion date: June 2012
Scope of the Work
The scope of work is to renovate a portion of the first floor Highland Professional Building in order to relocate the
Financial Assessment department into the renovated space. The proposed space is approximately 5,449 sq ft. The
proposed renovation will provide six (6) offices, waiting/reception area, (1) copy room, (1) ADA Bathroom, and an
open floor plan for cubicle work stations.
December 2011
 Ongoing Construction Services
January 2012
 Ongoing Construction Services - ON HOLD Pending Executive Approval for procurement to
February 2012
JANUARY 2012
51009046 WEST WING BASEMENT PHARMACY CLEANROOM PHASE I / CAROUSELS PHASE II
Total Project Budget: $ 834,596
Projected Construction Completion Date: Phase I July 2011 / Phase II May 2012
Phase I Construction Status: 100%
Phase II Construction Status: 15%
Scope of Work:
Phase I: Installation of a new USP 797 complaint pharmacy clean-room in the West Wing basement.
Phase II: Demolition of the old clean-room to create an open space within the pharmacy to receive (3) new
pharmaceutical carousel. This includes new finishes throughout the basement pharmacy.
December 2011
 JOC phase II proposal approved
 JOC phase II construction Signature Document approval
 Phase II City of Miami building permit dry-run completed
January 2012
 Phase II Construction requisition entered into Lawson
 Executive office project budget signoff
 Construction PO issued
February 2012
 Phase II construction Notice to Proceed issued
 Phase II construction underway
51010097 DTC NEW MRI
Anticipated substantial completion date: 7/12
Scope of the Work:
Replacement of existing MRI in DTC 1st floor. Includes expansion of room and new back up chiller.
December 2011
 New PER for project being processed and construction is on hold
 Trailer Site Stand Up review with AHCA
January 2012
 New PER is approved and executed
 Construction Commences in support Areas for MRI
 Issue RFP to JOC for Trailer Site
February 2012
 Construction Continues in support Areas for MRI
JANUARY 2012
51009089/E10-JMH-01 MEDIUM VOLTAGE OIL SWITCHES REPLACEMENT AND ELECTRICAL
SWITCHGEARS AT CENTRAL AND SOUTH WING REPLACEMENT:
Funding Source: IRB
Total project Budget: $3,785,000
Anticipated substantial completion date: Design March 2012 Construction October 2012
Scope of the Work
Replace medium voltage oil switches in Central, South Wing, Institute, Rehabilitation and North Building. Central
and South Wing: replace normal and emergency substations and main switchgears.
November 2011
 Comments of Stage I and II submittal received from AHCA
 75% CD submittal to JMH

December 2011
 Project is on hold
51009056/E10-JMH-02 ENERGY CENTER REPLACE PARALLELING GEAR AND NEW EMERGENCY
GENERATORS
Funding Source: IRB
Total project Budget: $ 5,289,372
Anticipated substantial completion date: Design May 2012 Construction May 2013
Scope of the Work
Replace paralleling system and emergency distribution switchboard; provide new engines with the capability to
operate in dual-fuel mode (natural gas component). Ryder Trauma Center emergency power system will be
increased, with the intention of having the entire building on emergency power.
November 2011
 The hospital decided to move the location of the generators upgrade to the Utility Center/Center
Energy Plant
 Professional fee for revised scope of work must be submitted and negotiated
December 2011
 Revised professional fee is being negotiated
 Begin field investigation
 Review power monitoring system requirements for electric design
 Define Strategic Directions: ventilation, sound attenuation etc
January 2012
 30% CD submittal to JMH
Tracking 100% CD’s PPE
JANUARY 2012
51009062/E10-JMH-03 P-00967 FIRE ALARM UPGRADE AT JACKSON MEMORIAL HOSPITAL.
Funding Source: IRB
Total project Budget: $ 4,429,495
Anticipated substantial completion date: February 2013
Scope of the Work
Design and upgrade of existing hospital and business occupancy floor for: Rehabilitation, Trauma, Mental Health
and Jackson Medical Towers buildings, replace all audio/visual devices provide new speakers, all older model
addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow
and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network.
December 2011
 Engage Simplex Grinnell for construction services for patient’s towers only
 Ongoing Design Services – Designs Complete: North Wing 1st/2nd floor, Trauma Building,
Rehabilitation Building
January 2012
 Solicit pricing from Simplex for construction services for completed designs
 Proposal negotiations w/ Simplex for (Trauma, Rehab, and North Wing 1st / 2nd floor)
 Tracking ongoing design services for remaining buildings (PPW, PPE, and Jackson Medical Towers)
February 2012
 Construction Contract review by PHT, CAO, Legal
 Lawson Input and Purchase Order Issuance (Trauma, North Wing, and Rehab)
51009036 WEST WING AND CENTRAL FIRE ALARM UPGRADE PROJECT
Funding Source: IRB
Projected Completion Date Feb 2012
Scope of Work
Design and upgrade of existing patient occupancy towers for: West Wing and Central buildings, replace all
audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors,
manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded.
Connect these building to the fire alarm loop/network.
December 2011
 Ongoing City of Miami Fire Marshall inspections for the West Wing Tower
 Ongoing FA installation at Central Building
January 2012
 Ongoing FA installation at Central Building
 Begin City of Miami Fire Marshall inspections for the Central Building
 100% AHCA re-inspection for WW Tower (5th – Basement) week of 1/9/12 TBD
February 2012
 Ongoing City of Miami Fire Marshall inspections for the Central Building
 100% AHCA inspection for Central Building week of 1/30/2012 TBD
JANUARY 2012
51009057 UTILITY CENTER (2) EMERGENCY GENERATOR REPLACEMENT PROJECT
Funding Source: IRB
Projected Completion Date February 2012
Scope of Work
Modify the existing paralleling system and replace (2) existing generators with (2) 2000KW generators; Provide
new engines with the capability to operate in dual-fuel mode (natural gas component). Patient Towers emergency
power system will be increased, with the intention of having the entire building on emergency power.
December 2011
 Ongoing Generator installation
 Tracking Generator Start-up
January 2012
 Ongoing Generator installation
 Load Bank Testing
February 2012
 Ongoing Generator installation – Final Terminations
 (2) 2000KW Generators On-line for campus support
 Begin Project Closeout
51009076 UTILITY CENTER BOILER REPLACEMENT PROJECT
Funding Source: IRB
Projected Completion Date February 2012
Scope of Work
Provide and install two (2) 1200HP boilers and associated equipment for the replacement of two (2) existing 600
HP boilers. The installation and operating capacity will function as it currently existing with a max capacity of
1200HP. If in the event for future growth and/or increase in demand an expand HP capacity will be available for
boiler infrastructure support.
December 2011
 Ongoing Boiler installation
 Boiler Start-up (1st Boiler) - Postponed
January 2012
 Ongoing Boiler installation
 Boiler Start-up (1st Boiler)
 Removal of “temporary” boiler
February 2012
 Boiler Start-up (2nd Boiler)
 Final Terminations
 Replacement Boiler On-line with campus support
 Begin project closeout
JANUARY 2012
51011104 WEST WING 15 NURSING UNIT MODERNIZATION
Projected Completion Date Aug 2012
Scope of Work
The West Wing 15 Nursing Unit Modernization project has a vision towards creating a greater offering of singleoccupancy rooms at Jackson Health System. The projects’ interior renovation would create twenty-five (25) singleoccupancy rooms, one (1) VIP room, and other clinical support areas to current codes, hospital standards, and
modernized finishes.
December 2011 – ON HOLD Pending executive approval
 Ongoing procurement process – “ITB for Qualified Contractor”
 Pre-Bid meeting and site walk through
 Cone of Silence
January 2012– ON HOLD Pending executive approval
 Received contractor proposals
 Proposal negotiations/reviews
February 2012– ON HOLD Pending executive approval
 Construction Contract review by PHT, CAO, Legal
 Lawson Input and Purchase Order Issuance for construction services
53009055 MAIN CAMPUS / JNMC CAMPUS-WIDE LIGHTING UPGRADE
Funding Source: IRB
Total Project Budget: $ 780,680
Projected Construction Completion Date: June 2012
Percentage of Construction Completed: 15%
Scope of Work:
Campus wide outdoor lighting upgrade throughout the JMH main campus and the Jackson North Medical Center
December 2011
 The JOC proposals received for the campuswide lighting will not be honored. An ITB will be issued to
execute the lighting for entire campus with the option to execute the work per areas
 ITB process placed on hold until executive office signs off on project budget
January 2012
 Executive office project budget signoff
 Requisition entered into Lawson to commence the ITB process
 Issue procurement required documentation to develop ITB package
 Submit documentation required to establish Dade County project measures
February 2012
 Dade County project measures established
 ITB procurement continues
JANUARY 2012
51009069 CAMPUS WIDE ROOFING REPLACEMENT – EAST TOWER
Funding Source: IRB
Projected Completion Date September 2012
Scope of Work
Replacement of East Tower Roof, approximately 90,000 SQFT
December 2011
 Architect submit Proposal to revise specifications
 Lawson input for A/E increase in PO for revised specifications
January 2012
 Requisition, for A/E, in Lawson require executive approval
 Issuance of PO to A/E
February 2012
 Architect revise and resubmit specifications
 Engage Procurement: Confirmation of issuing ITB
51009064 REPLACEMENT OF 30 AIR HANDLING UNITS
Funding Source: IRB
Anticipated substantial completion date: October 2012
November 2011
 Contractor selection for series 8
 Owner purchase for series 6 AHU’s
59007009 JMT ELEVATOR MODERNIZATIONS #141 TO #148
Funding Source: Capital Contribution / IRB
Projected Completion Date May 2012
Scope of Work
Modernization and cab upgrade to eight elevators in JMT
December 2011
 Permitting Infrastructure
 Elevator Modernization #142 and #146
January 2012
 Continue Elevator Modernization
February 2012
 Continue Elevator Modernization
INFRASTRUCTURE REVENUE BOND
JANUARY 2012
JACKSON NORTH MEDICAL CENTER
53008020 JACKSON NORTH WINDOW REPLACEMENT
Funding Source: Capital Contribution & IRB
Anticipated substantial completion date: 6/2012
Scope of Work:
Replacement of all windows with new hurricane windows. Unforeseen conditions have been encountered and the
wall systems on pavilion, pediatrics and Labor and delivery are being reconstructed and shored.
December 2011
 Project on holding awaiting Change Order Approval
January 2012
 Funding and Change order is approved
 Construction recommences on 2nd Floor L & D /Pedi Areas
 Construction recommences on Pavilion
 Replacement of the entrance doors continues
February 2012
 Construction continues on 2nd Floor L & D /Pedi Areas
 Construction continues on Pavilion
53009065 JACKSON NORTH MEDICAL CENTER UTILITY PLANT REPLACEMENT
Funding Source: IRB
Anticipated substantial completion date: December 2012
Scope of Work:
Replacement of three chillers, two boilers and supporting systems, installation of a new cooling tower. Installation
of new energy management system.
December 2011
 AHCA Review of final design continues
 Construction continues for emergency chiller work
January 2012
 Emergency chiller work is completed
February 2012
 Emergency chiller work is completed
INFRASTRUCTURE REVENUE BOND
JANUARY 2012
PERDUE MEDICAL CENTER
58011110 PERDUE MEDICAL CENTER RENOVATION
Projected Completion Date May 2012
Scope of Work
Provide renovation/upgrade to the center’s main entrance and lobby,
13 patient rooms and support area in the South Wing and Chapel, approximately 11,864 SQFT
December 2011
 Construction Design Phase
January 2012
 Construction Design Phase
 AHCA Review
February 2012
 Building Permitting
 Contractor Procurement
AUDIT & COMPLIANCE SUBCOMMITTEE
Marcos Jose Lapciuc, Chairperson
Mojdeh L. Khaghan, Vice Chairperson
Michael Bileca
Darryl K. Sharpton
Date and Place
January 20, 2012 – (Immediately following the Facilities Subcommittee Meeting)
Conference Room 259
AGENDA
1.
*Approval of the Meeting Minutes
(Marcos Jose Lapciuc, Chairperson, Audit & Compliance Subcommittee)
(a)
2.
December 15, 2011
Internal Audit Update
(Stephen Weimer, Corporate Director, Internal Audit Department, Jackson Health System)
(a) *FY12 Audit Plan Update
(b) Review of Finalized Audit Reports
(1) *Sheridan Healthcare Contract
(2) *Ward D (Corrections Health Services)
(3) * FY11 Audit Follow-Up
3.
Corporate Compliance Program Department Update
(Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department,
(a) *FY12 Audit Plan Update
(b) *Review of Finalized Audit Reports Executive Summary
(1)
(2)
(3)
(4)
Reassessment: One Day Stay vs. Observation status for Jackson Memorial Hospital (JMH)
Risk Assessment: Rehabilitation Outpatient Audit
Risk Assessment: Mental Health Partial Hospitalization Audit
Risk Assessment: Community Mental Health Day Treatment Audit
(c) *Recovery Audit Contractors – update
(d) *Compliance Hotline
(Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are included.)
1.
Michael Bileca, Chairman
Marcos Jose Lapciuc, Vice Chairman
Darryl K. Sharpton
Date & Place
December 15, 2011 – Immediately followed the Facilities Subcommittee meeting
Conference Room 259
ATTENDANCE
Darryl K. Sharpton
Marcos Jose Lapciuc
Michael Bileca
Financial Recovery Board Members
Joaquin del Cueto
Joe Arriola
Stephen S. Nuell
Mojdeh L. Khaghan
Mark T. Knight
Diana Salinas
Steve Weimer
Michael Butler, M.D.
Carlos A. Migoya
Don S. Steigman
Donn Szaro
Valda Christian
Laura Llorente
Audit & Compliance Subcommittee Meeting
December 15, 2011
Page 2
Call to order
With a quorum being present, the Audit & Compliance Subcommittee meeting was called to order at
8:11 a.m. by Michael Bileca, Chairman.
1.
Mr. Bileca requested a motion approving the meeting minutes of November 17, 2011
Mr. Sharpton moved approval;
seconded by Mr. Lapciuc, and
2.
Corporate Compliance Program Department Update
(a)
FY 2012 Audit Plan Update
Diana Salinas, Corporate Director and Chief Compliance Officer, Corporate Compliance
Department, presented an update of the FY 2012 Annual Audit Plan. Highlights of the
Audit Plan showed pending audits, audits in progress and scheduled audits throughout the
year. Ms. Salinas reported that 2 audits were completed during the prior months, and
currently at 24% completion of the annual Audit Plan. To date the Audit Plan is on
schedule. As part of the update were highlights of pending audits, and those audits that
have been targeted for completion in fiscal year 2012 Audit Plan. A detailed report was
included in the agenda that described each of the audits including their risk assessment,
scope and objective.
(b)
Review of Finalized Audit Reports Executive Summary
Ms. Salinas provided the Subcommittee with an overview of the audit reports that were
finalized.
(1)
RAC Approved Issue: Hospital to Hospital Transfer
The purpose of the audit was to review if the hospital incorrectly reports the
patient is discharged to home, when in fact they have been discharged to another
facility or left against medical advice, which the inpatient hospital claim from
the transferring facility falls under the Post Acute Transfer Policy. According to
the Post Acute Transfer Policy, the transferring facility should be reimbursed on
per diem basis, while the receiving facility is reimbursed at the full DRG or
respective PPS rate. All DRG’s reviewed are available in the Post Acute
Transfer Policy. A random sample of 30 inpatient medical records from Jackson
Main was retrieved from the Compass system. The dates of services reviewed
were June 7, 2011 through September 21, 2011. The primary payer was
Medicare with carious secondary payers. The UB-04 claim forms and
Remittance Advices were obtained from EDM. Clinical documentation was
retrieved from Cerner and HIM. Results of the audit showed that a review
rendered a net cost error rate of 9%. The recommendations are as follows:
Train the Business Office staff on the process of system-generated contractual
adjustments and the effect of manual adjustments to encounters, effective follow
up policies should be enforced by the Business Office, to ensure collectors are
following up with the payers regarding claims that are underpaid based on he
expected reimbursement calculated by MedAssets Contract Manager, and reeducate clinical staff on writing admission orders that clearly state “Admit as
Inpatient.” A Task Force has been developed to further address the issues that
were described in the audit.
December 15, 2011
Page 3
(2)
(c)
Reassessment: Inpatient One Day Stay vs. Observation for Jackson South
Community Hospital (JSCH)
The goal of the reassessment was to determine if JSCH is providing services in
the most appropriate setting where clinical documentation supports medical
necessity for a one day inpatient admission or if observation would have been
the more appropriate setting. A random sample of 32 inpatient medical records
from JSCH was retrieved from the Compass system. The dates of services
reviewed were June 6, 2011 through September 17, 2011. The primary payer
was Medicare or managed Medicare. The UB-04 claim forms and Remittance
Advices were obtained from EDM. Clinical documentation was retrieved from
Cerner and HIM. Results of the audit showed that a review rendered a net cost
error rate of zero percent. Compliance will continue to monitor to ensure
adherence to the policies have been established. An Executive Summary
included in the agenda packet described in detail the scope and objective,
methodology, results and recommendations of the completed audit.
Compliance 2011 Annual Report
Ms. Salinas presented the second annual report on the activities of the JHS Corporate
Compliance Program. The report establishes the responsibilities of the Corporate
Compliance Office as they relate to organizational goals and the corresponding
communications to the system’s leaders. The report also provided actions taken to
address several system wide compliance risks. An Executive Summary which outlined in
detail the annual report was included in the agenda packet. Ms. Salinas encouraged the
Subcommittee to review the report and fell free to ask questions.
Ms. Salinas stated that the Corporate Compliance Department continues to focus on
maintaining an effective Compliance Program and ensure that all federal requirements
are met in the most effective way.
Ms. Khaghan questioned the status of the electronic conversion process for medical
records.
Fernando Martinez, Chief Information Officer, Jackson Health System stated that JHS
has a fully implemented electronic health record where modules are continually
implemented of the electronic health record. He mentioned that there remains part of the
JHS process that is paper driven. JHS continues to move forward from a paper driven
process to an electronic medical record process.
Mr. Bileca thanked Ms. Salinas for creating and presenting a detailed update report which
showed the independent function of the Corporate Compliance Department.
With respect to calendar year 2012 and the ongoing initiatives particularly as it relates to
self disclosure matters, Valda Christian, Assistant Miami-Dade County Attorney stated
that the parties are moving toward discussing a possible settlement. Ms. Christian
remains hopeful that in the relatively near future the terms of a possible settlement will be
discussed. Also, in the near future the FRB will see a return of the contract for review
and discussion prior to making a decision regarding a renewal.
December 15, 2011
Page 4
3.
Internal Audit Update
(a)
Review of Finalized Audit Reports
Steve Weimer, Corporate Director, Office of Internal Audit reported on the following six
audits that have been finalized including the first follow up audit:
(1)
Inventory – Jackson Main
An internal audit review of the current inventory management processes were
reviewed in various areas throughout the hospital based upon a qualitative
analytic selection process. The following areas selected for review account for
71% of the inventory balance: Operating Room, Central Pharmacy, Central
Store Room, Maintenance Supplies, and Cath Lab Pedi. The objective of the
review was to determine if policies and procedures were being adhered to for
establishing appropriate inventory levels, warehousing, and the safeguarding of
inventory. Significant issues exist for Maintenance Supplies in regards to
inaccurate inventory valuation and inadequate physical safeguards. The results
of the internal audit showed that the Operating Room inventory management
process is ineffective and inefficient, billable inventory items are not being
consistently charged to actual patient accounts, and significant inventory
discrepancies exist. A significant positive practice identified relates to the
Central Pharmacy Omnicell Cabinet narcotic removal controls and discrepancy
notification process. The Executive Summary, which was included in the
agenda packet detailed internal audit observations, recommendations and
management action plans.
(2)
Inventory – Jackson South Community Hospital (JSCH)
An internal audit review of the current inventory management processes was
performed in various areas at JSCH upon a qualitative and quantitative analytic
selection process. The following areas were selected for review: Operating
Room and Pharmacy. The objective of the review was to determine if policies
and procedures were adhered to for establishing appropriate inventory levels,
warehousing, and safeguarding if inventory. The results of the internal audit
showed that control deficiencies exist as inventory items stored in Omnicell
cabinets are not secured and Omnicell functionality has not been enabled. As a
result of the Omnicell functionality not being enabled, deficiencies in inventory
management are present as there is no ability to management usage and utilize
par value based order management. Additionally, video surveillance does not
exist in either the Operating Room Core or Pharmacy work areas. The
Executive Summary, which was included in the agenda packet detailed internal
audit observations, recommendations and management action plans.
With regards to the discussion having to do with equipment and supplies, Don S.
Steigman, Chief Operating Officer, Jackson Health System stated that need over
demand, return on investment, review of infrastructure, and review of equipment
that is available at other JHS facilities are strongly considered prior to any new
equipment purchases. In response to the question raised regarding under
utilization, Mr. Steigman stated that the hospital does not currently have a plan
in place for under utilization.
December 15, 2011
Page 5
With regards to the question that was raised having to do with the hospital’s
fixed asset system, Mark T. Knight, Chief Financial Officer, Jackson Health
System explained that every item is tracked through the fixed asset system, all
movable items are tagged with an asset tag to be able to track the equipment
throughout JHS and allow staff to locate equipment. Prior to equipment being
purchased a return on investment analysis is completed to determine whether or
not the purchase of the equipment is justified. Once the equipment is placed in
service there is no ongoing routine evaluation of equipment utilization. Going
forward, Mr. Knight suggested that as part of the Internal Audit Plan a routine
process be implemented to review major capital expenses that will include a
review of utilization to be able to better determine the return on investment.
(3)
Inventory – Jackson North Medical Center (JNMC)
An internal audit review of the current inventory management processes was
performed in various areas at JNMC based upon qualitative and quantitative
analytic selection process. The following areas were selected for review:
Med/Surgical Supplies (OR), and Pharmacy. An assessment of internal controls
was reviewed in Med/Surgical (OR) and Pharmacy to determine if inventories
are subject to effective custodial accountability procedures and physical
safeguards. The objective of the review is to determine if polices and
procedures are being adhered to for establishing appropriate inventory levels,
warehousing, and the safeguarding of inventory. The results of the internal audit
showed that control issues exist relative to inventory system controls and
inventory area physical access. The detail finings relative to observations,
recommendations and management action plans were outlined in the Executive
Summary which was included in the agenda packet.
(4)
Malpractice/Risk Management
As part of the fiscal year 2011 Audit Plan (4th fiscal quarter) an internal audit
review of Malpractice and Claims Development process at JHS was performed.
The scope of the audit review was to assess internal controls related to
processing, establishing reserves, and settling claims. In addition, claims and
incidents were assessed to determine if they were administered and managed
effectively via the Quantros system, claim’s system basic data integrity, and
reviewed system access. The objective of the review was to ensure that policies
and procedures are being adhered to, that risk management has the proper
controls in place for claims processing, and ensure that Quantros basic system
integrity of reporting exist. The results of the internal audit showed that overall
controls are considered satisfactory. The Executive Summary, which was
included in the agenda packet detailed internal audit observations,
recommendations and management action plans.
(5)
Backup & Recovery
An internal audit of the backup and recovery was performed. The audit period
was from April 15, 2011 to October 15, 2011. The objective of the internal
audit was to evaluate the design, adequacy, and effectiveness of the backup and
recovery procedures and controls at JHS. The results of the internal audit
showed controls over backup and recovery of core systems are considered
adequate. Concerns were noted relative to excessive backup job failure rates of
non-core systems. The Executive Summary, which was included in the agenda
packet detailed internal audit observations, recommendations and management
action plans.
December 15, 2011
Page 6
(6)
(b)
Prior Audit Follow-up
The following three internal audits (Cardiac Catheterization Lab, Cash
Collections, and JSCH Construction) were reviewed that were performed last
year. The objective of the internal audits was to determine that the corrective
action that was noted in the final audit report was performed according to the
time frames that were indicated by management. There were no exceptions
noted regarding the JSCH construction audit, exceptions were noted regarding
Cardiac Catheterization Lab and Cash Collections for not performing to
mediation according to the to the target dates given. The appropriate staff
members have been met with and it is anticipated that better results will be
presented moving forward.
Presentation and Approval - Fiscal Year 2012 Internal Audit Plan
Mr. Weimer presented for approval the fiscal year Internal Audit Plan. The Internal
Audit Plan is a detailed plan that combines operational, financial, IT audits, and project
life cycle audits. A copy of the Internal Audit Plan was included in the agenda packet.
Mr. Sharpton stated that he is of the opinion that the Audit Plan was light in terms of the
total number of hours. He believes that the Internal Audit Department needs to be more
involved and/or integrated with certain other external consultants. He requested that the
Audit Plan have specific involvement in tracking strategic initiatives which would show
under the heading of project life cycles.
With regards to the Audit Plan total number of hours, Mr. Weimer stated that the number
has been increased by 1,000 hours and now show 3,000 hours applied to the Audit Plan.
He further stated that the total number hours in the Audit Plan reflect 85% of the total
staff hours for the year.
Mr. Bileca requested a motion for the item.
seconded by Mr. Lapciuc, and
Adjournment
The meeting of the Audit & Compliance Subcommittee adjourned at 9:18 a.m.
Transcribed by
Ivenette Cobb, Executive Assistant
Public Health Trust Financial Recovery Board
FY12 Internal Audit Plan Status
a/o 12/31/11
1/12/2012
FY12 Audits to be performed
Audits completed YTD
Audits currently underway
Audits completed or underway
30
2 (6%)
4 (13%)
6 (20%)
Audits to be discussed at 1/2012 Audit Committee meeting
Audit
Sheraton Anesthesia Contract
Ward D (FY11 audit)
Audit Follow-Up
Audit Scope
Determine if physician payments are consistent with the
terms of the contract and services provided.
Perform a review of CHS charge capture and billing to
determine adequacy of controls, completeness and
accuracy of charges and billings.
Perform a review of findings and management responses
from FY11 audits to determine if corrective action has
been completed.
Status
Audit Rating
complete
Good
complete
Satisfactory
complete
Needs
Improvement
a/o 12/31/11
Audit
Audit Scope
1/12/2012
Status
Audits Not Completed
Follow-up Activities
HIPAA Security
AP Analysis (Vendor, Employees,
Physicians)
Facilities Storeroom
Medicare Bad Debt
Potential Medicaid (MCD)
Perform follow-up reviews of FY11 audit findings to
ensure corrective action is completed as stated and
adequate.
Assess compliance with the required elements of the
Security Rule.
Evaluate data mining test results of vendor database,
select various vendors and invoices for review to ensure
proper onboarding, job performance, and payment
approval.
Evaluate controls over inventory, access control, and
observe inventory count process.
Review accuracy of Medicare bad debt submissions.
Review and evaluate process to monitor potential MCD.
Initiatives
Determine adequacy of methodology to monitor strategic
initiatives.
Physical Security
Evaluate physical security of hospital to ensure access is
restricted to authorized individuals and proper security
policies are in place to prevent theft of JHS assets and
protect the safety of staff, patients and visitors.
Construction/Renovation
Review ER renovation project procedures/controls.
Maintenance Contracts
Review contract management process to determine if
contracts exist for services, proper procurement
processes were followed, and effectiveness of payment
controls.
performed monthly
fieldwork underway
preliminary report issued
fieldwork underway
Audit Rating
a/o 12/31/11
Audit
Audit Scope
AOA
determine compliance with terms of AOA.
Performance Reporting
Determine accuracy and appropriateness of Performance
Reporting information provided to management
Med Assets
Admissions/Registration & Ins
Verification
Personal Leave Review
Financial Statement Close
Accounts Payable
Fixed Assets
Physician Services
Maxor OP Pharmacy Services
Revenue Cycle Review
Charge Capture
Physical Inventory Observation
analyze results achieved from Med Asset process
Verify accuracy of capturing patient information and
insurance verification; to include Siemens/Cerner related
IT controls review
Perform an analysis on capped PL (vacation and sick)
Evaluate the adequacy of internal controls over initiation,
authorization, processing, recording, and reporting of
transactions; ascertain the existence and effectiveness of
current policies and procedures, and evaluate financial
statement close activities.
Evaluate controls over vendor onboarding, invoice
approval and payment, general computer controls, nonP.O.purchasing process.
Determine effectiveness of controls surrounding fixed
assets incl. buildings, reconcilement, additions/deletions,
depreciation etc.
Evaluate FMV process.
Review and evaluate the management (Maxor) of the OP
pharmacy operations.
Review of denial management, DNFB & late charges
Evaluate effectiveness of selected department's charge
capture function.
Observe FY 12 physical inventory to determine the
adequacy of physical inventory procedures.
1/12/2012
Status
Audit Rating
a/o 12/31/11
Audit
Managed Care Contracts
Patient Referrals
Audit Scope
1/12/2012
Status
Audit Rating
Audit Scope
Status
Audit Rating
Assess internal controls related to storeroom; physical
inventory; inventory maintenance (Jackson North/South).
complete
Needs
Improvement
Determine compliance with terms, including payments
and services.
perform quarterly review and analysis of patients referred
from JHS to UM
compare census to actual room count to ensure census
accuracy and patient charts are complete and accurate.
Bed Audit
Audits of Offsite Locations: PCC, LTC Evaluate the adequacy (effectiveness and efficiency) of
and Schools
internal controls within the selected location.
Change Management
Review IT change management process to determine if
changes to production systems are properly approved,
tested, and controlled.
Audits Previously Completed and Discussed
Audit
Inventory Control
Office of Internal Audit
Jackson Medical Towers
1500 NW 12th Avenue, #102
Miami, FL 33136
To:
Barbara Ronda, VP Hospital Services-Strategic Enterprise Development
Ronald Loveless, Corporate Director Practice Management
Elena Barberis, Director of Finance
Cc:
Mark Knight, Executive Vice President and Chief Financial Officer
Don Steigman, Chief Operating Officer
Steve Weimer, Corporate Director of Internal Audit
Richard Kugler, Corporate Manager of Internal Audit
From:
Adriana Herrera, Senior Auditor
Mariela J. Reyes, Senior Auditor
Date:
December 16, 2011
Subject:
Final 2012 Sheridan Healthcorp Anesthesiology Revenue Guarantee Contract Review
Background, Scope and Objective:
Based on a request from Jackson North Medical Center (JNMC) Management, The Office of Internal
Audit (IA) performed a review of year 2 of the Sheridan Healthcorp, Inc. contract as part of the FY 12
audit plan during the first fiscal quarter.
As the Sheridan Healthcorp revenue guarantee is settled on an annual basis no later than 120 days after
the end of each contract year, the review focused on Year 2 of the contract (December 1, 2009 through
November 30, 2010).
The objective of the Sheridan Healthcorp, Inc. revenue guarantee contract review was to ascertain that
subsidy payments to Sheridan Healthcorp, Inc. for the revenue guarantee agreement for anesthesiology
services are in compliance with the contract. Specific areas of focus included:
•
•
•
•
Determine if subsidy payments to Sheridan Healthcorp, Inc. for the revenue guarantee agreement
were calculated based on contract.
Determine whether patient charge amounts used to calculate the balance due to Sheridan
Healthcorp Inc. appear reasonable and complete.
Determine if estimated total charges, contract reimbursement amount, actual charges, and actual
payments per Annual Collections Reconciliation were accurate.
Determine if collections efforts made by Sheridan to ensure appropriateness.
Entity Rating:
Overall Rating Based on Issues Identified:
Good
1
Miami, FL 33136
Executive Summary:
Subsidy payments made to Sheridan for the revenue guarantee agreement are in compliance with the
contract terms. Several process improvement opportunities were noted that can benefit the organization
with future revenue guarantee contracts. Our detail process recommendations are listed below:
Process Improvement Opportunities (“PIO”)
Timing of Annual Collection Reconciliation not sufficient
Per observation of attachment A of the contract between the Public Health Trust of Miami-Dade County
and Sheridan Healthcorp, Inc, we noted that ‘not later than one hundred twenty (120) days after the end of
each contract year during the Term and any Renewal Term, Contractor shall forward to Hospital a
reconciliation for the previous contract year.” Such reconciliation drives the amount to be paid by Jackson
North Center or to be reimbursed by Sheridan depending on the difference between the Contractor’s net
collections against the expected collections. Monies collected by Sheridan after the reconciliation is
complete are not forwarded to JHS.
We noted the amount due from JNMC to Sheridan was approximately $179K based on the collections
listed by Sheridan in the Annual Collection Reconciliation as of 3/24/2011. As of this audit November
2011 the Annual Reconciliation was revised by Sheridan due to collections made by Sheridan subsequent
to 3/24/2011. This resulted in a saving of approximately $69,000 to JMH.
We recommend that future contracts contain language that requires funds collected after the reconciliation
/payment date to be refunded to Jackson.
Management Response:
Agree: The current contract with Sheridan is up for renewal. If renewed, recommended language will be
included in contract.
Review of monthly amount billed by Sheridan Healthcorp Inc. could be enhanced
On a monthly basis, JNMC reviews the total number of cases billed by Sheridan Healthcorp Inc.
(Sheridan) by only comparing the total number of cases listed in the summary provided by Sheridan to the
information in Compass of all patients who received anesthesiology services in the same period.
We recommend an enhanced reconciliation process to be performed by Jackson North. A detailed listing
should be obtained from Sheridan related to the monthly billing, and reconciled to the Jackson North
database.
Agree. This will be included in new agreement.
2
Miami, FL 33136
Allowance for bad debt not included in month reconciliation
On a monthly basis, Sheridan Healthcorp Inc. provides JHS with a monthly reconciliation detailing
estimated collections for the past month. The estimated collection amount for year 2 (sum of monthly
amounts) differed significantly to the actual collected amount. The estimated monthly amount does not
include an allowance for bad debt for charges (i.e. copayment amounts) that Sheridan would not be able
to collect, based on history and experience, from the patients.
We recommend JNMC and Sheridan to agree on a percentage to be applied to charges and included in the
monthly reconciliation as an allowance for bad debt expense to avoid having significant variance when
the Annual Collection Reconciliation is complete.
Agree. Has been discussed with Sheridan CFO, JNMC CFO has requested detailed reporting from
Sheridan, including the JHS FIN # to streamline the monthly reconciliation process, as well as having
Sheridan include bad debit allowance in their figures with a quarterly ‘true-up’, which should minimize
having a large reconciling bill at the end of the year.
3
Miami, FL 33136
To:
Carlos A. Migoya, President and Chief Executive Officer
Don S. Steigman, Chief Operating Officer
Cc:
Carmen Pla –Vice President Revenue Cycle
Telisa Lyons-Corporate Director Revenue Cycle
Steve Weimer- Corporate Director of Internal Audit
John Repique-Mental Health Chief Nursing Officer
Rick Morse-Correctional Health Services Director
Eugene Shy- County Attorney’s Office
Eli Medina- Business Manager Correctional Health Services
Karen Lang-Administrator of Managed Care Contracting
From:
Richard Kugler-Corporate Manager Internal Audit
Renel Leone, Jr.- Senior Internal Auditor
Date:
January 6, 2012
Subject:
Final Report – Correctional Health Services Charge Capture and Billing
Background, Scope and Objective
Based on IA’s assessment of risk, materiality, and transaction volume, the objective of the Correctional
Health Services (CHS) billing and charge capture audit is to ascertain and ensure that the process is
effective and efficient.
Specific areas of focus relate to testing that patients are entered in the hospital patient clinical system, and
reported in the appropriate insurance code during the time period of January – March, 2011. In addition,
that the charges for the various CHS insurance codes are captured properly, and attest that the contracts
for services are current.
Entity Rating:
Overall Rating Based on Issues Identified:
Needs Improvement
Executive Summary:
Issues were noted with controls associated with managing contracts with entities that CHS provides
patients services for. Additionally, issues were noted relating to capturing charges associated with patient
services. As a result, we have assigned a rating of “Needs Improvement”. Our detailed observations are
outlined below.
Detailed Observations, Recommendations and Management Action Plans
1.
Agreements do not exist or have expired for entities that JHS provides Inmate services
Several issues were noted relative to contracts with entities for which JHS has provided inmate
services:
1. Contracts do not exist for six municipalities that JHS has provided inmate services,
including Miami Dade County;
2. The Florida Department of Corrections contract is expired.
Recommendation:
We recommend that management take steps to ensure that current contracts exist for entities prior
to accepting inmates for treatment.
CHS management agrees with the findings. A new director for Jackson-CHS has been appointed
and will start on 1/9/2012. Given the new director’s expertise and breadth of knowledge of
correctional health industry’s standards and trends, the new director for CHS will lead Jackson’s
efforts in aligning CHS with national industry benchmarks and norms. These organizational
efforts will include, but not limited to, review of all existing and future contractual agreements
with Jackson-CHS and other entities. In addition, Jackson-CHS is currently working on a revision
of a proposed MOU and will be presented to MDCR. (Of note, in 2008, a proposed draft MOU
between JHS and MDCR was completed but was not executed.)
Jackson-CHS, as the health services provider of MDCR, is responsible for providing medical care
to any inmate booked into Miami Dade County jails and there are no separate agreements
between the municipalities (a total of about 22) and JHS.
Action Plan Owner:
Implementation Date:
John Repique-Mental Health Chief Nursing Officer
May 31, 2012
Rick Morse-CHS Director
Eugene Shy-County Attorney Office
2.
CHS patients and services performed are not being entered in clinical system
A review of 130 inmates treated at Correctional Health revealed patient records had not been
entered into clinical system for 11 (8%) inmates.
Recommendation:
We recommend that management implement steps to ensure that accurate patient records are
compiled for all Correctional Health patients.
2
CHS Management agrees with the finding. Jackson-CHS logs inmates based on MDCR’s arrest
document (“A” form). The current log only includes arrestee’s names. Current process is to
enter every inmate that presents and a possible reason the 11 names were not found in Cerner is
due to a function of not being able to determine which “John Smith” is the correct one. As such,
we will add one more data field to the log to facilitate matching the log to what is entered into
Cerner.
3.
Action Plan Owner:
Implementation Date:
Eli Medina- Business Manager CHS
March 31, 2012
Patient daily log assigned to incorrect insurance code
A test of 130 intake cases revealed 24 (18%) did not contain the correct CHS insurance code.
Inaccurate coding could affect program reporting and reimbursement.
Recommendation
We recommend that management take steps to ensure that accurate insurance codes are entered
for each patient.
Management Response
CHS management agrees with the finding. Upon review of the 24 accounts with incorrect plan
code assignments, it was identified that the accounts registered were prior to the training provided
to the Ward D employees in October 2011.
The Patient Access Quality Assurance department will perform a random audit of accounts
beginning the month of January 2012.
In addition, a registrar has been hired specifically to handle the patient finance functions for
Correctional Health Services. The employee is currently being trained in the Patient Access areas.
Training to be completed January 2012.
Action Plan Owner
Implementation Date
Eli Medina- Business Manager CHS
February 29, 2012
Telisa Lyons-Corporate Director Revenue Cycle
3
Process Improvement Opportunity:
Automate Correctional Health Services daily Log
Presently the daily log of patients served is entered manually on a sheet. We suggest that the
process be automated by entering the data on an excel spreadsheet, or through use of an access
database. This would facilitate tracking, sorting, and monitoring of services provided.
Management Response
CHS has agreed to the process improvement and will implement the following:
•
•
•
•
•
Develop a centralized Excel Spreadsheet based on the existing written spreadsheet with
additional key variables to improve.
Provide in-service on the spreadsheet usage.
Increase access points on all Ward “D” PCs linking to the spreadsheet.
Develop a quality process to ensure accuracy of the spreadsheet.
Develop a second quality process to match spreadsheet against EMR and billing systems.
Action Plan Owner
Implementation Date
Eli Medina-Business Manager CHS
March 31, 2012
4
Prior Audit Report Follow-Up
January, 2012
Audit
Procurement
Payment Posting
Travel & Entertainment
Cash Collections
Audit
Procurement
Procurement
Audit Report Dated
FY11
FY11
FY11
FY11
Finding Summary
Emergency Repair
Procedures are not
being followed as
required.
Annual employee
Conflict of Interest
training and
certification has not
been implemented.
1/12/2012
Original Number of Comments
6
2
2
14
Follow-up Exceptions Noted
2
2
1
4
Revised Target Date
Responsible Area
corrected during audit
Facilities
2/15/2012
Compliance
1/30/2012
Corporate Business Office
1/30/2012
Corporate Business Office
3/31/2012
Accounting
Revenue Cycle Access Mgmt.
Travel & Entertainment
Performance metrics
and aging reports
have not been
developed.
Cash reconcilement is
not performed for all
locations.
Travel policy has not
been updated.
Cash Collections
Employees
transporting cash
deposits to the main
banking center are not
escorted by Security
personnel.
Cash Collections
QuickPay automated
patient payment
system has not been
fully implemented.
7/25/2012
Cash Collections
Employee access to
Cashier's offices is not
periodically reviewed
to ensure only current
and authorized
individuals have
access.
Cash Collections
Video surveillance of
the Internal Banking
and Cashier offices
does not exist; quote
for video surveillance
was not obtained.
Payment Posting
Payment Posting
Corrected during Audit?
1 of 2
no
no
3 of 4
Exception Ratio
33%
100%
50%
29%
Audit Summary
In Progress
Total Reassessments Completed
Definition
Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA
Total
5
2
Total Audits Completed
10
Not Started
24
Reassessments and by Internal Risk Assessment
Audit #
1
Audit Name
Hospital to Hospital Transfer
Scope & Objectives
RAC Approved Issue - To review if Inpatient hospital incorrectly reports the patient is discharged to home, when in fact they have been discharged to another facility (SNF, IRF, or home health) or left against medical
advice (and was later admitted to another facility on same day of discharge), which the inpatient hospital claim from the transferring facility fall under the post-acute transfer policy. According to the Post Acute Transfer
policy, the transferring facility should be reimbursed on per-diem basis (up to the DRG full payment), while the receiving facility receive the full DRG or respective PPS reimbursement. All DRG's being reviewed are
available in the Post Acute Transfer Policy.
2
Incorrect billing of J1642 Heparin, up to 10 units (HepLock, Hep-Flush) – Hospital
RAC Approved Issue - To review if claims identified where J1642 (Heparin, up to 10 units (Hep-Lock), (Hep-Flush)) was billed for patients who receives Heparin for therapeutic infusion. The therapeutic infusion of
Heparin should be J1644 (Heparin, up to 1000 units).
3
Duplicate Claims - Outpatient
AHCA - To determine if an issue may exist when duplicate services are billed and reimbursed under Medicare.
4
Inpatient Duplicate Payments
AHCA - To determine if two AHCA payments for inpatient services for the same date(s) of service were paid by Medicaid. In certain circumstances, part of each payment is correct but there is a payment for the same
date(s) of service included in each. In that case, only the duplicate per diem amount for that date is identified for recovery.
5
Service Exclusions
AHCA - To determine if JHS was paid for services that are excluded from Medicaid payments including procedure codes listed as not covered and services provided outside of the allowed place of service as listed the
Medicaid Services Coverage and Limitations Handbooks and Medicaid Fee schedules.
6
Service Limitations
AHCA - To identify payments for claims that were paid for services that are in excess of the service limitations as listed the Medicaid Fee Schedules. This includes services that are limited to a maximum number of times
per year ( calendar of fiscal), per number of days, or per lifetime, per recipient, and services that overlap with another service concomitantly for the same recipient.
7
BAA review with focus on Health
Plan, Mental Health and
International Program
HIPAA/Privacy Audit - To ensure that where a business associate agreement is required one would have been executed along with the underlying contract and that we are in compliance with JHS policies and
procedures.
8
Patient Medical Record
Amendments
HIPAA/Privacy Audit - To ensure that patient amendment requests are in compliance with JHS policies and procedures.
9
Medical Director Agreements
Risk Assessment - Review timesheets to ensure they are in compliance with contract requirements.
10
ER On-Call
Risk Assessment - To review records of ER on-call
11
Clinical Agency Agreements
Risk Assessment - Review of agreements to verify that they are in compliance with Stark and Anti-Kickback statutes.
12
Child Health Services
Reassessment - To ensure that JHS is providing appropriate Child Health Services to children who are beneficiaries of Medicaid as indicated by AHCA/CMS.
13
ABN Review
Reassessment - To determine if Medicare beneficiaries are provided with timely ABN notices for non-covered Medicare services.
14
Rehab Audit Outpatient
Risk Assessment - As per CARF (Commission on Accreditation and Rehabilitation) requirements, an audit will be performed to evaluate outpatient rehabilitation services to ensure documentation supports billing
appropriateness. The scope will focus on Prosthetics and Orthotics.
15
In-Patient Rehabilitation Facilities OIG - We will examine the appropriateness of admissions to IRFs. We will also examine the level of therapy being provided in IRFs and how much concurrent and group therapy IRFs are providing. IRFs provide
rehabilitation for patients who require a hospital level of care, including a relatively intense rehabilitation program and a multidisciplinary, coordinated team approach to improve their ability to function. Patients must
undergo preadmission screening and evaluation to ensure that they are appropriate candidates for IRF care.
16
MSP- Medicare Secondary Payer Reassessment - To determine if the online Medicare Secondary Payer questionnaire utilized by the hospital is compliant with the rules and regulations set forth by CMS for the solicitation of MSP information from the
beneficiary.
17
Monthly Short Stay Medical
Necessity - #1 Main and Holtz
RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44
was properly applied to Medicare claims per CMS guidelines.
18
Bimonthly Short Stay Medical
Necessity - #1 North
RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review condition code 44 was
properly applied to Medicare claims per CMS guidelines.
Status
Total Audits on Plan
39
% of Plan Completed
31%
Completion Date
Completed
11/20/2011
Completed
10/20/2011
In-Progress
In-Progress
Not Started
Not Started
Not Started
Not Started
Not Started
Not Started
Not Started
Not Started
Not Started
Completed
12/8/2011
Not Started
Not Started
1
Completed
10/14/2011
Completed
10/20/2011
Audit Summary
In Progress
Total Reassessments Completed
Definition
Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCA
Total
5
2
Total Audits Completed
10
Not Started
24
Reassessments and by Internal Risk Assessment
Audit #
19
Audit Name
Bimonthly Short Stay Medical
Necessity - #1 South
Status
Scope & Objectives
RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review condition code 44 was
properly applied to Medicare claims per CMS guidelines
17
Monthly Short Stay Medical
Necessity - #2 Main and Holtz
RAC/Reassessment - To evaluate patients admitted and discharged the next day to determine if a stay in observation would have been the most appropriate setting for care. If appropriate, review that condition code 44
was properly applied to Medicare claims per CMS guidelines.
20
Modifiers
Risk Assessment - To ensure that Modifiers 73, 74, 91 and 51 are being utilized appropriately. The scope will focus on the Cardiology, Radiology and Lab.
21
Transplant (Outpatient Bone
Risk Assessment - To determine if bone marrow transplants at Holtz are billed according to CMS.
Marrow)
Clinical Trials
Reassessment - To review Clinical Trial Research billing and modifier used in accordance to CMS regulations and guidelines. In addition to review that consent forms are completed in a timely manner
Community Mental Health Center - Risk Assessment - To ensure that billing meets all relevant regulations and internal policies
DTP
Community Mental Health Center- Risk Assessment - To ensure that the billing meets all relevant regulations and internal policies
PHP
Hospitalizations and
OIG - We will review the extent to which Medicare beneficiaries residing in nursing homes have been hospitalized and rehospitalized. We will also assess CMS’s oversight of nursing homes whose residents have high
Rehospitalizations of Nursing
rates of hospitalization. Hospitalizations and rehospitalizations of nursing home residents are costly to Medicare and may indicate quality-of-care problems at nursing homes. A 2007 OIG study found that 35 percent of
Home Residents (both facilities) hospitalizations during a SNF stay were caused by poor quality of care or unnecessary fragmentation of services.
Total Audits on Plan
39
% of Plan Completed
31%
Completion Date
Completed
11/4/2011
Completed
10/14/2011
Not Started
22
38
23
24
Not Started
Not Started
Completed
1/6/2012
Completed
1/6/2012
Not Started
25
Referrals and Discharges
Risk Assessment - To ensure upon discharge that all patients have a right to choose where they are discharged to according to all relevant regulations and internal policies.
26
Holtz Children's Hospital
Risk Assessment - To ensure that the respiratory billing meets all relevant regulations and internal policies
27
Hospice (Main & North)
OIG - To ensure Hospice billing and general meets all relevant regulations and internal policies
28
Ventilator Units
Risk Assessment - To review the billing for the new Jackson North contracted unit to ensure compliance with all relevant regulations and internal policies
29
Omnicell in Inpatient Surgery Main
Risk Assessment - To ensure that Omnicell dispensers are being used according to all relevant regulations and internal policies. The scope will focus on whether SurgiNet is reconciled correctly with Omnicell.
30
Pharmacy - Drug Diversion
Risk Assessment - To review the current policies and procedures related to narcotic counts and drug diversion to determine if there are any gaps or risk areas. The scope will include Holtz Oncology floor and Burn
Center.
31
JMG Providers
Risk Assessment - To determine if professional billing is correct according to CMS guidelines for six providers. The scope will include the timeliness of charges being entered.
32
Breast Center - South
Risk Assessment - Review compliance with the Susan B. Komen grant and possible compliance issues related to referrals to the Main campus.
33
Charity Care Application
Risk Assessment - To ensure that the Patient Financial Assessment is being completed appropriately according to Federal Regulations and in a timely manner.
34
EMTALA
Risk Assessment - To ensure the JHS is abiding by the EMTALA regulations
In-Progress
In-Progress
Not Started
Not Started
Not Started
Not Started
Not Started
Not Started
Completed
Not Started
35
Inpatient - Interrupted Inpatient
Psychiatry Facilities (IPF) Reassessment
Reassessment - To review IPFs Emergency Department Mental Health claims for Medicare reimbursement in cases of transfers from IPFs to the same or other IPFs. To ensure that IPFs do not discharge and then
readmit patients to obtain per diem payments with higher adjustments. Interrupted stays in which a patient is discharged and then readmitted to the same or another IPF within 3 days following the discharge will be
treated as one continuous stay.
36
Physician Signatures documented Rollover: To ensure adherence to Florida Statutes and JHS policy: physicians are required to co-sign/attest to the care as provided by Certified Nurse Midwives.
in Medical Records for Certified
Nurse Midwife encounters for
Jackson Main
Not Started
Not Started
37
Internal assessment: To ensure that the current clinical documentation and billing is appropriate prior to beginning POC (point of care) services.
TEG (Thrombelastograph
hemostatist system)
Completed
2
10/31/2011
EXECUTIVE SUMMARY
COMPLIANCE AUDIT SUMMARY REPORT
OFFICE OF COMPLIANCE
1500 NW 12 Ave, Suite 102
Miami, Florida 33136-1094
(305)585-2902
January 2012
1. Reassessment: Inpatient One Day Stay vs. Observation for Jackson Memorial Hospital (JMH)
Scope/Objective: This is a Recovery Audit Contractor (RAC) CMS approved issue and a reassessment.
The goal of this reassessment is to determine if JSCH is providing services in the most appropriate
setting where clinical documentation supports medical necessity for a one day (short stay) inpatient
admission or if observation would have been the more appropriate setting.
Methodology: A random sample of 30 inpatient encounters from JMH was retrieved from the
Compass system. The dates of services reviewed were August 29, 2011 through November 7, 2011.
The primary payer was Medicare or managed Medicare with several other payers documented as
secondary. The UB-04 claim forms and Remittance Advices were obtained from EDM. Clinical
documentation was retrieved from Cerner and HIM.
Results:
The review rendered a net cost error rate of 4.4%.
Recommendations: Jackson Main has been able to significantly improve on the issue of medical
necessity for their short (1-3 days) stay patient volume. While this is a great improvement and
produced a 4.4% cost error rate, we will now move to a quarterly review based on the results.
Compliance will continue to monitor to ensure adherence to the policies that have been established.
2. Risk Assessment: Rehabilitation Outpatient Audit
Scope/Objective:
As per CARF (Commission on Accreditation and Rehabilitation) an audit was
performed to evaluate outpatient rehab services and ensure documentation supports billing
appropriateness. This audit focused on services delivered for orthotics and prosthetics.
Methodology: Reviewed 30 rehabilitation encounters for the date of service July 1, 2011 to
September 29, 2011. Documentation and information was obtained from Cerner and Siemens
Invision as well as EDM systems and MedAssets.
Results:
The review rendered a net cost error rate of 0%
Recommendations:
All orders should be scanned into the patient’s record in Cerner or EDM.
3. Risk Assessment: Mental Health Partial Hospitalization Audit
Scope/Objective:
To ensure claims billed met all relevant CMS Regulation and Internal Policies
Methodology: Reviewed 30 patient encounters that were randomly selected from Compass for date
of service May 2011 thru October 2011. The primary insurance was Medicare with Medicaid as
secondary. Patient medical records were requested and reviewed to ensure medical documentation
for services rendered and billed. Review to ensure that the initial evaluation and re-evaluation was
documented during the CMS regulation period of 18/30 days. UB04 and Remittance Notices were
reviewed utilizing EDM Production.
Results:
Recommendations: Business Office needs to ensure that follow-up is done on accounts that have a
secondary payer to ensure that a claim either crosses over or is billed electronically for revenue that
is due on the patient account.
4. Risk Assessment: Community Mental Health Day Treatment Audit
Scope/Objective:
To determine if Medicare or other insurance was verified during the initial
verification process.
Methodology: Reviewed 30 encounters that were randomly selected from Compass for date of service of
October 15, 2010 thru October 31, 2011. This is a Medicaid-based outpatient program, however other
primary insurance coverage and Medicare should be verified during the initial registration and insurance
verification process. Medical Records were requested and reviewed to ensure medical documentation for
services rendered and billed were appropriate. Registration documentation, UB04 and Remittance Notices
were reviewed utilizing EDM Production.
Results:
Recommendations: Patient Access Services has to ensure that all patients funding sources are
verified and documented accurately when services are rendered.
Recovery Audit Contractor
1st Quarter Summary
Date of Audit
Retained by JHS
Recovered by RAC
Grand Total
% Retained by JHS
12/3/2009
$1,129,535.17
$100,040.25
$1,229,575.42
91.9%
2/25/2010
$383,839.28
$233,408.10
$617,247.38
62.2%
3/22/2010
$1,759,193.46
$260,107.07
$2,019,300.53
87.1%
5/14/2010
$1,211,603.01
$256,295.03
$1,467,898.04
82.5%
7/14/2010
$922,698.60
$133,655.39
$1,056,353.99
87.3%
12/16/2010
$2,362,564.19
$523,432.41
$2,885,996.60
81.9%
2/22/2011
$1,253,530.74
$449,606.38
$1,703,137.12
73.6%
Grand Total
$9,022,964.45
$1,956,544.63
$10,979,509.08
82.2%
Retained by JHS
2/22/2011,
$1,253,530.74
12/3/2009,
$1,129,535.17
2/25/2010, $383,839.28
12/3/2009
2/25/2010
3/22/2010
3/22/2010, $1,759,193.46
12/16/2010,
$2,362,564.19
5/14/2010
7/14/2010
12/16/2010
2/22/2011
7/14/2010,
$922,698.60
5/14/2010,
$1,211,603.01
ComplianceLine (Hotline) Call Summary
Audit and Compliance Committee FY'12
QUARTER 1
Oct‐11
Nov‐11
43
32
16
12
10
9
17
11
Dec‐11
33
14
11
8
FY '12 YTD
TOTALS
108
42
30
36
1
2
3
4
MONTH
Total calls received for each month
Calls received requesting information or redirected Calls received inquiring about the status of calls All calls resulting in Investigations 5
Calls Investigated and Closed
15
8
6
29
6
Compliance Investigations Still Open 2
3
2
7
FY'12 Calls Received via fax/walk‐in/email/letter/direct calls to Compliance department generating hotline calls: Calls generated via direct call to hotline number 1.800.684.6457
Prepared by: Corporate Compliance
2
34
Updated: 01/05/2012
Compliance Hotline Call Summary
FY'12 % of Hotline Calls for Each Category
Theft
0%
Substance Abuse/Drugs
0%
Billing/Coding
0%
COI
8%
Environmental
0%
Fraud
3%
Health Violation
0%
Policy Violation
3%
Patient Care
14%
Billi ng/Coding
Confli ct of Interes t
Environmental
Fra ud
Health Violati on
HIPAA
HR & Labor Rela ti ons
HIPAA
6%
Other/Non Compliance
25%
Maintenance Medical Sta ff
Other/Non Compliance
Patient Ca re
Medical Staff 3%
Maintenance 0%
HR & Labor Relations
39%
Policy Violation
Subs tance Abus e/Drugs
Theft
FISCAL COMMITTEE
Fiscal Committee
Joe Arriola, Chairperson
Darryl K. Sharpton., Vice Chairperson
Michael Bileca
Joaquin del Cueto
Mojdeh L. Khaghan
Marcos Jose Lapciuc
Stephen S. Nuell
Date and Place
January 20, 2012 – (Immediately following the Audit & Compliance Subcommittee meeting)
Conference Room 259
AGENDA
1.
(Joe Arriola, Chairperson, Fiscal Committee)
(a) *December 15, 2011
2.
Financial Statements Report – December 31, 2011
(Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)
(a) Interim Monthly Financial Statements
(b) Cash Flow Statements
(c) Health Plan Flash Report
(Supporting documents will be distributed at the meeting.)
3.
Cost Accounting
(Brian Dean, Vice President, Finance Division, Jackson Health System)
4.
*Accounts Receivable Aging Report – November 2011
(Carmen Pla, Vice President, Revenue Cycle Division, Jackson Health System)
5.
Contracts & Agreements
(A) *Resolution approving waiver of competitive bidding and awarding contract to AON Risk
Services to place and access insurance as the PHT Insurance Broker through (i) Zurich; (ii)
XL; (iii) Swiss RE; (iv) QBE; (v) Ironshore; and (vi) AWAC on a layered structured basis in
the aggregate premium amount not to exceed $2,106,453 (Mark T. Knight, Executive Vice
President and Chief Financial Officer, Jackson Health System)
6.
Facilities Subcommittee Report
(Darryl K. Sharpton, Chairperson)
There are no resolutions recommended for approval.
Fiscal Committee Meeting Agenda
January 20, 2012
Page 2
7.
Purchasing Subcommittee Report
(Joaquin del Cueto, Chairperson)
(A) *Review and recommend approval of the January 2012 Purchasing Report
(Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing Division,
(B) *Resolution authorizing (1) Retroactive payment in the amount of $95,625.00, for services
rendered from June 1, 2011 through November 30, 2011, and (2) Waiver of competitive
bidding and a new agreement in the maximum amount of $255,500.00, for guaranteed
emergency beds and related services to the Salvation Army for a one 1-year period effective
December 1, 2011 (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson
Health System and Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic
Sourcing and Supply Chain Management Division, Jackson Health System)
(C)
*Resolution authorizing an amendment to section XII D.2 of the Procurement Policy and
Regulation approved on January 25, 2010 regarding solicitations or awards in violation of
laws policies (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing
and Supply Chain Management Division, Jackson Health System)
(Agenda items(s) noted with an asterisk (*) indicates that the supporting documents are included.)
1.
Fiscal Committee
Joe Arriola, Chairman
Darryl K. Sharpton, Vice Chairman
Michael Bileca
Joaquin del Cueto
Marcos Jose Lapciuc
Stephen S. Nuell
Date and Place
December 15, 2011 – (Immediately followed the Audit & Compliance Subcommittee meeting)
Conference Room 259
ATTENDANCE
Finance Committee
Joaquin del Cueto
Marcos Jose Lapciuc
Michael Bileca
Joe Arriola
Stephen S. Nuell
Darryl K. Sharpton
Mojdeh L. Khaghan
Carlos A. Migoya
Donn Szaro
Mark T. Knight
Carmen Pla
Brian Dean
David Alexander
Don S. Steigman
Miami-Dade County Attorneys
Eugene Shy, Jr.
Jeffrey Poppel
Fiscal Committee Meeting
December 15, 2011
Page 2
Call to Order
With a quorum being present, the meeting of the Fiscal Committee was called to order at 9:37 a.m. by Joe Arriola,
Chairman, Fiscal Committee.
1.
Mr. Arriola requested a motion approving the meeting minutes of November 17, 2011.
seconded by Mr. Sharpton,
and carried without dissent.
2.
Financial Statements Report – November 2011
Mark T. Knight, Chief Financial Officer, Jackson Health System, presented an overview of the financial
statements ended November 30, 2011. He began with highlights of the Key Performance Indicators which
showed that net patient revenue for the month was down, operating revenue was slightly down, expenses
was on budget for the month and lower than prior months, outpatient visits was down, surgical volumes are
down which attribute to a negative variance, days cash on hand for the month ended with 26.71 days versus
22.88 from the prior month, it is anticipated that the month of December 2011 will close with 11 or 12 days
cash on hand, FTE’s continued to show a decrease during the month of November, continue to closely
monitor overtime, thoroughly review every position requested to be filled to ensure that there is a need, and
payor mix showed improvement over prior month With regards to net revenue there is a continued focus
on length of stay across the system to reduce utilization and bring cost back in line with some of the
hospital’s competitors. As part of the financial statements report, Mr. Knight reviewed the combined
balanced sheet which showed no material changes, combined statement of revenue and P &L 12 Month
Trend Analysis. Overall the month of November ended with a loss totaling approximately $9.5 million
compared to $9.6 million from the prior month. Prior to the meeting the Committee received a detailed
financial statements report. Copies of the financial report were available at the meeting.
Mr. Knight spoke about the projected cash flow report that was distributed during the committee meeting
that showed actual cash flow for the month of October 2011, preliminary cash flow for the month of
November 2011 and projected cash flow for the months of December 2011 to September 2012. With
regards to the December 2011(mid-month) projections, Mr. Knight stated that it is anticipated realizing the
value of the furlough dollars during the month and based on current trending and current net to growth that
JHS will push close to break even for the month of December.
FIU AOA Update
In response to a request by Mr. Lapciuc regarding FIU AOA, Mr. Knight presented a JNMC FIU Practice
report, which is a report tracking template that showed FIU performance under the new AOA for the month
of October 2011. The financial performance for the month of October was better than expected. It is
expected that volumes and revenues will increase going forward consistent with the employment of a
Surgeon who started November 2011 and a Primary Care Physician who is scheduled to start on January 1,
2012, as well as implementation of 340B pricing for a chemo administration.
December 15, 2011
Page 3
JMH Health Plan Update
Brian Dean, Vice President, Finance Division, presented a Flash Report, as of November 30, 2011
regarding the JMH Health Plan (Health Plan). Highlights from the report showed that the Health Plan
experienced a bottom line for the consolidated HMO totaling approximately $66,000.00, continue with
positive trends having to do with a decrease in paid claims, decrease in membership, and improvement in
claims. At the request of Mr. Lapciuc, the update report included a chart showing the enrollment trends
from June 2011 to December 2011. Mr. Dean stated that he met with representatives from AHCA to
discuss the transition process for the Medicaid lives and what plan that they can go with and keep their
same primary care physician. He also met with representatives from OIR to review the November 2011
financials and the positive trends that have been seen on the claims. He pointed out that with regards to the
required surplus that is required by the OIR the Health Plan has an amount of $1 million in excess surplus.
There also has been some discussion around the Health Plan sun setting some of its lines of business in the
transition of the Commercial lives over to AV-Med. Due to the furloughs, attrition, and layoffs the Health
Plan has experienced a decrease in overhead. Mr. Dean stated that the Health Plan continues to maintain
stability as it moves forward with the transition of care, effective January 1, 2012. The report also
included graphs showing the utilization trends in terms of inpatient, authorized days and average length of
stay over the last 5 months for the Medicare, Medicaid and Commercial lines of business.
3.
Accounts Receivable Aging Report – September 2011
Carmen Pla, Vice President, Revenue Cycle Division, Jackson Health System presented the Aged Trial
Balance Accounts Receivables, as of November 2011. Ms. Pla reported that the month of November was a
strong cash collection month. Ms. Pla pointed out that there was a mistake in AR KPI report that read the
DNFB does not include potential Medicaid. She stated for the record that the DNFB increased by $17
million primarily in the potential Medicaid (55% is related to potential Medicaid and 20% is related to Selfpay). JHS experienced approximately 81% potential Medicaid conversion rate during the month of
November, exceeded the AR greater than 90 days goal from 25% to 33%, and credit balance remains below
goal of $33 million. Ms. Pla stated that there is a continued focus on the credit balances and bringing in
maximum amounts of cash.
4.
Contracts & Agreements
There were no contracts or agreement to report.
5.
Facilities Subcommittee Report
Regginald Jordan, Corporate Director, Support Services reported that the Facilities Subcommittee met on
December 15, 2011. The Subcommittee was presented with regular monthly reports.
At the request of Mr. Arriola, Allen Redmon, Heery International who presented an update of the Facility
Master Plan (Plan) at the December 15, 2011 Facilities Subcommittee meeting presented a brief update of
the Plan at the Fiscal Committee meeting. Mr. Redmon presented a comprehensive update of the Plan as
well as an interactive map that outlined the Public Health Trust presence throughout Miami-Dade County.
The Plan also addressed to the following questions raised by members of the Facility Subcommittee and the
initial goals set forth: (1) How good are JHS assets, (2) What investment(s) is going to be subsequently
needed to ensure that JHS is competitive as an entity, (3) Where are our assets geographically located
throughout the campuses, and (4) How can JHS best leverage its assets as an entity. Mr. Redmon reminded
everyone that the Plan continues to be a work in progress.
December 15, 2011
Page 4
6.
Joaquin del Cueto, Chairman, Purchasing Subcommittee reported that the Subcommittee met on December
15, 2011. The Subcommittee was presented with regular monthly reports by staff, reviewed and approved
the Purchasing Report for the month of December 2011, and two resolutions. The Purchasing Report for
the month of December 2011 was forwarded to the Fiscal Committee as well as the following two add-on
resolutions for the Committee’s approval.
Add-on Agenda Items
(1)
Resolution authorizing retroactive payment in the amount of $108,308.75, for
services rendered prior to November 21, 2011 for actuarial services with Wakely
Consulting Group (Fernando Salgado, Interim Executive Director, JMH Health Plan)
(2)
Resolution authorizing (1) Retroactive payment in the amount of $119,367.64 and
$24,505.00 to Infusion Technologies, Inc. and Option Care Enterprises, Inc.
respectively, for home infusion services rendered during the period to April 3, 2011,
through November 30, 2011, and (2) Waiver of competitive bidding and a new
agreement in the maximum amount of $95,000.00 and $45,000.00 to Infusion
Technologies, Inc. and Option Care Enterprises, Inc. respectively, for a six-month
period (Kevin Andrews, Vice President, Quality and patient Safety Division, Jackson
Health System)
(a)
Review and recommend approval of the December 2011 Purchasing Report (Rosa Costanzo,
Vice President & Chief Procurement Officer, Strategic Sourcing Division, Jackson Health System)
(b)
Resolution regarding a conflict waiver request by Law Offices of Bacen & Jordan, P.A.
(Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)
Mr. Arriola requested a motion approving the add-on agenda items (1) and (2) and agenda items 6 (a) and
(b).
Mr. del Cueto moved approval;
Adjournment
The meeting of the Fiscal Committee adjourned at 11:12 a.m.
Transcribed by Ivenette Cobb
Executive Assistant
2.
Financial Statements Report – December 31, 2011
2 (a). Interim Monthly Financial Statements
2 (b). Cash Flow Statements
2 (c). Health Plan Flash Report
3.
Cost Accounting
Aged Trial Balance
Accounts Receivables
All Hospitals
November 2011
1
AR KPIs
Goal
Cash Collections
November 2011
KPI
POS
DNFB
$82.5M
Actual
$83.9M
Best Practice /Benchmark
1% of net collections
Target less than 5 days gross revenue
(not including potential Medicaid)
Goal
Actual
$830K
$439K
5
10.7
80%
81%
Potential
Medicaid Conversion
% of approvals compared to referrals for the prior 90 days. **
AR Greater than 90 Days
Less than 25% of discharged AR
25%
33%
Credit Balances
3 days gross revenue
$33M
$32.4M
Benchmarks obtained by: HARA & Advisory Board
** Internal Target. No industry benchmark available
Notes
•
•
•
•
•
Exceeded Cash Goal
Gross AR continues to decrease by $3.9M
DNFB increased by $17M primarily in the Potential Medicaid $8M
•
55% is related to Potential Medicaid & 20% Self‐Pay November 2011 greater than 90 Days
•
32% is related to Potential Medicaid ($90.4) & 7% Self‐Pay ($20.3M)
•
Enlisted temporary assistance from Early Out Agencies to reduce AR
Credit Balance remains below goal of $33M (3 gross days)
2
Month October November December January February March April May June July August September Total JHS CBO Cash Collections
FY‐11 Cash FY‐12 Cash $74,311,292 $90,462,107
$80,284,984 $83,962,725
$93,776,571 $86,577,244
$81,296,613 $106,251,866 $88,670,750 $90,304,771
$92,269,050
$79,590,189 $93,698,857
$97,026,774
$1,064,058,960
$174,424,832
Source: Dania Trasobares-Llópiz
Director of Treasury Management
3
5.
Contracts and Agreements
Agenda Item 5 (A)
Fiscal Committee
January 20, 2012
RESOLUTION APPROVING WAIVER OF COMPETITIVE
BIDDING AND AWARDING CONTRACT TO AON RISK
SERVICES TO PLACE AND ACCESS INSURANCE AS THE
PHT INSURANCE BROKER THROUGH (i) ZURICH; (ii) xl; (iii)
SWISS RE; (iv) QBE; (v) IRONSHORE; AND (vi) AWAC ON A
LAYERED STRUCTURED BASIS IN THE AGGREGATE
PREMIUM AMOUNT NOT TO EXCEED $2,106,453
(Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson
Health System)
WHEREAS, this Board desires to accomplish the purposes outlined in the attached agenda item;
and
WHEREAS, the President and Fiscal Committee recommend approval; and
NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF
THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby waives
competitive bidding and awards a Contract to AON Risk Services to place and access insurance as the
Public Health Trust insurance broker through (i) Zurich; (ii) XL; (iii) Swiss Re; (iv) QBE; (v) Ironshore;
and (vi) AWAC on a layered structured basis in the aggregate premium amount not to exceed $2,106,453.
TO
Financial Recovery Board of the
Public Health Trust
FROM:
Mark T. Knight
Executive Vice President and Chief Financial Officer
DATE:
January 20, 2012
SUBJECT:
Resolution Approving waiver of competitive bidding and awarding Contract to
AON Risk Services to place and access insurance as the Public Health Trust
insurance broker through (i) Zurich; (ii) XL; (iii) Swiss Re; (iv) QBe; (v)
Ironshore; and (vi) AWAC on a layered structured basis in the premium
amount not to exceed $2,106,453
_____________________________________________________________________________
RECOMMENDATION
Staff recommends that the Financial Recovery Board approves the waiver of competitive bidding
and award of a contract to AON Risk Services to place and access insurance as the Public
Health Trust insurance broker through (i) Zurich; (ii) XL; (iii) Swiss Re; (iv) QBe; (v) Ironshore;
and (vi) AWAC on a layered structured basis in the premium amount not to exceed $2,106,453.
BACKGROUND
Currently the Public Health Trust (“PHT”) real estate properties (the “Designated Facilities”) are
insured with a separate Property and Casualty policy under the umbrella of Miami-Dade County.
This has been a successful joint program over the last six (6) years. In late 2011, PHT staff
asked AON Risk Services to obtain indications from the insurance market on coverage and
premium for the total insured value of Designated Facilities and contents therein. Utilizing the
relevant data for the Designated Facilities, AON Risk Services approached the following carriers
to seek these indications: (i) Zurich; (ii) XL; (iii) Swiss Re; (iv) QBE; (v) Ironshore; and (vi) AWAC.
Similar in structure to our expiring program, multiple carriers are included in layers to provide the
full coverage needed. This is a common structure in these types of property insurance
arrangements. Coverage enhancements include: (i) Substantial rate decrease in a hardening
market; (ii) Increased loss limit from $300 million to $500 million; (iii) Service interruption
increased from $1 million to $25 million; (iv) Land improvements increased from $100,000 to $2
million; and (v) Errors and omissions increased from $10 million to $25 million.
AON Risk Services was selected through a competitive process to broker specific fee based
insurance programs such as Directors and Officers as well as stop loss insurance for the health
plan. This item seeks board approval for a bid waiver to allow us to access the markets prior to
anticipated increases in premium in calendar year 2012.
There is a cost comparison that identifies a premium savings of $186,200 from current expense
and a returned premium of $404,586. This provides a cash savings of $590,786 for fiscal year
2012.
7.
7.
PURCHASING REPORT
JANUARY 30, 2012
TO:
FROM:
PROCUREMENT MANAGEMENT DEPARTMENT
The following recommendations are made in accordance with the Trust’s “Procurement Policy” and it’s
implementing “Procurement Regulation.” This report includes competitively solicited contract awards over
$1,000,000, waivers of formal competition over $100,000 and other categories for Board approval as
prescribed by the Procurement Policy/Regulation. The entire report has been screened and assembled by the
Procurement Management Department with the direct participation of the Administrator and staff, all
subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as
needed, and review for legal sufficiency by the County Attorney’s Office.
SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s)
This section consists of awards under competitively solicited Invitations to Bid (ITB’s) over
$1,000,000.
No items to report.
SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s)
This section consists of awards under competitively solicited Requests for Proposals (RFP’s)
over $1,000,000.
No items to report.
SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER
PUBLIC PROCUREMENT ENTITIES
This section consists of awards over $1,000,000 under competitively solicited (“ITB,” “RFP” or
equivalent) contracts of other public and nonprofit entities.
No items to report.
SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION (“GPO”) CONTRACTS
This section consists of awards over $3,000,000 under Group Purchasing Organization (“GPO”)
contracts. GPOs are organizations that aggregate the purchasing volume of their members
consisting of hospitals and other health care providers to leverage discounts with manufacturers,
distributors and other vendors to realize administrative savings and efficiencies. The Trust’s GPO
is MedAssets.
No items to report.
SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION
This section consists of awards over $100,000 without the formal solicitation of competitive bids
or proposals. All award recommendations in this section have the approval of the President, are
based on a finding that the waiver of competitive bidding is in the best interests of the Public
Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval.
A. Sole Source
No items to report.
B. Physician’s Preference
Staff requests a waiver of formal competition for the contract items listed in this category because
a physician or clinician has requested the particular item or service without which the physician
or clinician cannot successfully and safely render patient care.
No items to report.
C. Standardization
Items in this category have been established as the Trust standard.
No items to report.
D. Non-Competitive Cooperative Purchasing
This subsection consists of awards under the contracts of other public entities that were not
competitively solicited.
No items to report.
E. Miscellaneous Bid Waiver
This subsection consists of awards not falling in the other categories of waiver of formal
competition but where waiver is deemed to be in the best interests of the Trust.
1.
(334172- NA) The Quality and Patient Safety Department of Jackson Main requests approval for
a contract modification under a waiver of competition to Professional Research Consultants Inc. (PRC) for
a period of ninety (90) days for the provision of Satisfaction Survey Services.
Professional Research Consultants Inc. (PRC):
Initial Term
(Board Approved Nov. 2005)
$ 700,000
(for three years)
OTR #1
$ 367,000
(for one year)
OTR #2
$ 364,212
(for one year)
$ 91,053
(for sixty days)
(Approved Administratively – Emergency July 2011)
$
80,000
(for ninety days)
(Approved Administratively – Emergency October 2011)
$
80,000
(for ninety days)
This request for funding
$ 80,000
(for ninety days)
$1,762,265
Background
In May 2006, the Performance Improvement Department entered into Contract No.: 05-5052 with PRC for
the provision of Patient, Employee and Physician Satisfaction and Loyalty Research. The survey
information is used to measure progress toward strategic goals, identify improvement opportunities and
fulfill regulatory requirements regarding patient care and motivation and morale of the workforce. This
contract was approved by the PHT board in November 2005 for three years in the amount of $700,000
with two (2) one-year options to renew. The first and second OTRs were approved administratively in
May 2009 and May 2010. After the two OTRs, the contract has been extended as requested by
department custodian to allow for the continuation of service to meet The Joint Commission Regulatory
requirements.
Recommendation
FRB approval is being requested for an additional ninety (90) day term in the amount of $80,000 to allow
the department to further define the need, budget and scope of services in order for a competitive
solicitation to be issued and awarded. (K. Andrews)
2.
(257564-MR/HT) The Trust’s Revenue Cycle Management Division is requesting approval
of funds for a five-year contract with MedAssets Net Revenue Systems, Inc, consisting of various
solutions designed to maximize efficiencies by improving business processes and increasing cash
flows. (Ongoing/replacement purchase)
MedAssets Net Revenue Systems, Inc.:
Program Subscription Fees
$
Total Program Fees
Implementation Fee & Capped Expenses:
951,608
(per year)
$4,758,040
(for five years)
$ 813,500
(one-time)
Additional professional services available
Throughout the five-year term at rates
of $125 - $275 per hour:
$
$ 5,896,540
325,000
(not to exceed)
Background
Revenue Cycle Division has been standardizing processes and systems for the past three years.
The main thrust of these changes was the consolidation of various systems, which included
significant implementation cost and training of over 700 full time JHS Revenue Cycle employees
within revenue producing departments, who access these systems on a daily basis. Price
Waterhouse Coopers had also confirmed that Jackson Health System’s Revenue Cycle Division had
selected best in class systems and endorsed their continued use.
Recommendation
MedAssets offers a variety of revenue cycle IT-related services that are uniquely interrelated, and
these solutions are proven compatible with our existing hospital systems.
The MedAssets solution being proposed is comprised of the following products:

CDM Management: This product is currently in use to analyze charge master and
ensure information is up to date.

Knowledge Source: A web-based system currently used by Revenue Integrity
Services Unit to research questions relating to the appropriateness of charge
related issues. MedAssets is the leading vendor of this tool and supplies most other
web-based vendors with the data.

Charge Capture Audit: A web-based tool currently used in the Revenue Integrity
Services Unit to perform post billing automated audits to determine any loss in
charges. System interfaces have been developed and a change in vendor would
require resources dedicated to write, test and implement new interfaces with
minimal disruptions to the training of personnel on a new system.

Contract Manager / Contract Modeler: This solution is currently utilized and
adjudicates all claims down to the expected reimbursement. The present interfaces
among SSI, the Contract Manager and Siemens for claims and contractual
adjustment would be disrupted with the introduction of a new vendor and reloading
the approximately 180 profiles would cost an estimated $100k in addition to a cost
of $150 –

$200k to develop new interfaces. A change in vendor would also disrupt workflow
and negatively impact cash collections.

Care Pricer: This product is currently used by Patient Access departments to
provide patients, upon request, an estimated cost invoice for service rendered. This
product requires Contract Manager. Changing to a new vendor would also mean retraining over 350 FTE’s at a prohibitive cost while slowing down the revenue cycle
process.

Rapid Reserve: The Revenue Cycle Department has implemented and has been
utilizing this module which was a result of the most recent E&Y Audit
recommendation to implement a system to automate the Accounts Receivable
evaluation process critical to JHS’ financial reporting. Rapid Reserve works in
conjunction with Contract Manager and cannot be separated.

CrossWalk Services (Supply & Pharmacy): With this Agreement, the Revenue Cycle
Department will setup CrossWalk services which will include, among other
functions: Linking of Facility’s chargemaster, item master and closed receipt data to
the MedAssets Master Item File (MIF) as well as transforming and loading data into
the crosswalk database; configuration of application; user, systems and
management setup; and, up to 30 hours of review and cleansing of the
automatically generated links between systems.
In providing optimization services, the MedAssets service team will collaborate with the identified
stakeholders to audit and review the Client Master Item File to optimize efficiencies.
Below are the annual recurring (five year term) fees associated with each product/solution. The
CrossWalk Service and Charging Review Products will have a one-time implementation fee
associated with them as well as capped fees for travel and expenses that will be required to
complete implementation. Additional services which include contract loading, mapping of processes
custom programming, off cycle reports, contract negotiation support, additional Internet modeling
and manual data entry of tables will be available throughout the five-year term at rates of $125 $275 per hour and have been capped at a not-to-exceed amount of $325,000.
CDM Master
One-Time
Implementation
Fees
N/A
Knowledge Source
N/A
Charge Capture Audit
Contract Manager
Contract Modeler
Care Price
Rapid Reserves
Cross Walk Supply
Cross Walk Pharmacy
Charge Master/Pricing
Review
Total
N/A
N/A
N/A
N/A
N/A
$ 129,000
$ 122,000
Annual
Subscription
Fee
$ 33,881
Included in
CDM Master
$ 97,664
$ 325,333
$ 50,057
$ 164,069
$ 121,604
$ 82,000
$ 77,000
$ 463,500
N/A
$ 36,000
$ 714,500
$ 951,608
$ 99,000
Product/Solution
Expenses
Capped At
N/A
N/A
N/A
N/A
N/A
N/A
N/A
$ 34,500
$ 28,500
This Contract can be terminated immediately for breach of duty by either party if the breach
has not been cured within a 30-day period of notice to either party concerning the breach.
This Contract includes the OIG and UAP provisions.
The contract has been approved by Risk as to Insurance and Liability requirements and by
the County Attorney’s Office for legal sufficiency.
A Bid waiver justification has been provided and Conflict of Interest Declarations have been signed
by Amy Sebero, Senior VP of MedAssets, and Charles Bearham, RCM Administrator, with no
reported disclosures. (C. Pla/M. Knight)
SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT
WERE COMPETITIVELY SOLICITED
This section refers to existing contracts that were competitively bid (“ITB” or “RFP”) at their
origin and consists of either (a) the exercise of established options-to renew or (b) the execution
of contract modifications for which the Procurement Policy requires prior Board approval.
Balance of page intentially left blank
3.
(287234-HT/MR/333101-TW) The Revenue Cycle Division requests approval to exercise Option to
Renew (OTR) No. 1 of its existing contract with Sykes Enterprises, Inc. for “Call Center and Centralized
Scheduling” services pursuant to RFP No. 06-5182 (ongoing/replacement purchase).
Sykes Enterprises, Inc.:
Revenue Cycle Funding
$12,900,000
(for two years)
JMH Health Plan Funding
$ 500,000
(for two years)
$13,400,000
Background
In June 2008, the Board approved a competitive contract award to the ICT Group for an initial three-year
term plus three two-year options to renew for call center and centralized scheduling services. Following
contract award, the Revenue Cycle Division worked with the contractor to develop the scripting materials,
process flows and system access necessary to allow the call center agents to facilitate the intake of
patient calls for scheduling purposes.
Additionally, in 2011, the JMH Health Plan accessed the contract to allow for backup services for the
customer service center when JHS employees were not available.
Recommendation
With this request, the Revenue Cycle Division seeks to exercise the first option to renew of two years as
allowed by the provisions of the competitive contract award. The contract provides call services for the
following areas with an estimated monthly call volume of 55,400:







Scheduling of appointments for Jackson Memorial Hospital, Jackson North, Jackson
South and Mental Health
Automatic appointment reminder calls
TTY capability for the hearing impaired
Physician referral line for Holtz Children’s Hospital
Permanent disaster response line
Member preferred scheduling line
Customer Service line for all other calls
Jackson Health Plan is also requesting continued use of the services for an additional period of
approximately two years.
Sykes Agents will provide the following services for the Health Plan:







Benefits/Eligibility verification
Claims Inquiries
Verifying pharmacy benefits eligibility and routing point of sale RX issues
to our Pharmacy team for resolution
Authorization inquiries
Requests for materials (ID cards, Directories, Coverage documents etc.)
Disenrollment requests
Enrollment status updates


Demographic change updates
Using our current enterprise database, namely, IKA, to route issues
electronically to other departments for investigation and resolution.
Sykes Acquisition, LLC, with whom the Trust is presently conducting business, is merging all holdings into
Sykes Enterprises, Inc. as a result of reorganization. Sykes will be doing business as and billing the Trust
as Sykes Enterprises, Inc. as of January 1, 2012. All terms, conditions and pricing will remain the same.
The contract can be terminated for convenience with a ninety (90) day notice and includes the OIG
and UAP provisions.
The original contract was reviewed and approved by the CAO for legal sufficiency and by Risk as
to Insurance and Liability. (C. Pla/ F. Salgado)
4.
(330568-NA) The Renal Management Group, Care Management and Quality and Patient Safety
Department, Jackson Health System, requests approval to exercise Option to Renew (OTR) # 1 of RFP #
08-5198 with Miami Acutes, dba DVA Renal Healthcare Inc., for a period of one year for the provision of
Outpatient and Inpatient Dialysis Treatment Services (Ongoing/replacement purchase).
Miami Acutes d/b/a DVA Renal Healthcare Inc:
OTR #1
$ 4,537,200
(for one year)
Total approved funding
$ 4,537,200
Background
As a result of the competitive RFP process, contract #08-5198 was awarded to DVA for an initial term of
Three (3) years with Two (2) one-year options to renew. The initial competitive contract award was
approved by the PHT Board in October 2008 in the amount of $19,145,544. OTR #1 of Contract 08-5198
will: (1) Provide necessary outpatient and inpatient dialysis services to all patients referred by Jackson
Health System (JHS); (2) Maintain a corporate compliance plan; (3) provide competent, trained, licensed
and experienced staff; (4) Maintain the facility and all equipment used; and (5) Provide financial and
social services to support the patients in obtaining appropriate insurance and/or financial coverage for
dialysis services.
Contract Modification #1 was issued to incorporate the names of the various facilities used by DVA to
provide outpatient dialysis services throughout Miami Dade County. Contract Modification #2 was issued
to extend the initial term of the contract for a period of 90 days to allow negotiations of the rates for the
upcoming OTR to be completed and to incorporate
the UAP language. Both of these modifications were executed with no change to the initial three year
value of the contract.
Recommendation
The requested funding will exercise the first OTR of Contract 08-5198. The initial three (3) year contract
stipulated that rates for service would remain fixed. However, prior to exercising each OTR, the Trust
would consider an adjustment to price based on changes to the pricing index as stated below or a five
percent (5%) increase whichever is less:
“Medical Care Service Component of the Consumer Price Index (CPI) for All Urban Consumers
(CPI-U), published by the Bureau of Labor Statistics, United States Department of Labor. Should
the Index no longer be published, the Index shall be the Medical Care Service Component of the
Consumer Price Index (CPI) under Urban Wage Earners and Clerical Workers (CPI-W),
published by the Bureau of Labor Statistics, United State Department of Labor.”
Prior to completion of the initial term, the Contractor requested an increase of the rates for the OTR
based on the stipulation above. However, subsequent negotiations between JHS and the Contractor
regarding these rates resulted in an overall rate reduction that should provide a projected savings of
approximately $32,000.
The original contract was reviewed and approved by Risk as to Insurance and Liability and by the
County Attorney’s Office for Legal sufficiency.
The contract can be terminated for convenience with a thirty (30) day notice and includes UAP and
OIG provisions (K. Andrews).
SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT
WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION
This section refers to existing contracts that were not competitively bid at their origin and
consists of either (a) the exercise of established options-to renew or (b) the execution of contract
modifications for which the Procurement Policy requires prior Board approval. All contracts in
this section that are renewals not previously authorized by the Board have the written approval of
the President, are based on a finding that the waiver of full and competitive bidding is in the best
interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees
present
for approval.
5.
(333246-CS) The Division of Public Safety is requesting approval to exercise the first Option to
Renew (OTR) with the Miami Parking Authority (“MPA”) to continue management and operational
services of the parking facilities at UM/Jackson Memorial Hospital Campus (ongoing purchase)
Miami Parking Authority (“MPA”):
This request for funding:
$1,861,000
(for one year)
$1,861,000
The Board of Trustees approved the initial contract with MPA in December 2006 in the amount of
$11,127,170 for the initial five year term. Under the contract, MPA manages and operates twelve parking
facilities throughout Jackson Memorial Hospital, twenty four hours per day, seven days per week.
MPA has a proven track record of operational expertise, professionalism, efficiency and customer service
and manages over 29,000 parking spaces in the City of Miami, inclusive of those at JMH. MPA has
consistently worked with JHS to reduce operational costs. During the initial five year term of the
Agreement, MPA installed completely automated parking control equipment for operations at JHS. This
has resulted in increased revenues and controls which have allowed for more efficient operation of the
parking facilities which include garages and lots. MPA has been able to reduce expenses substantially
and consistently and have provided reductions to management fee to help the hospital.
The contract can be terminated for convenience with a thirty (30) day notice.
The original contract was reviewed and approved by the CAO for legal sufficiency and by Risk as
to Insurance and Liability.
SECTION VII. (cont’d.)
Conflict of Interest forms have been submitted by JHS’ Corporate Director of Public Safety, Mark
Aprigliano and Alejandra Argudin, COO, Miami Parking Authority, with no reported disclosures. (D.
Steigman)
SECTION VIII. MISCELLANEOUS
This section consists of procurement actions that require Board approval not included under any
other section of the Purchasing Report.
A. Vendor Name Change
This section refers to existing contracts requiring a vendor name change under any circumstance
at any time after contract award and for the duration of contract
SECTION VIII. (cont’d.)
performance. The Chief Procurement Officer is the approving authority when the original award of
the subject contract was within the approval authority of the Chief Procurement Officer, and the
Board of Trustees is the approving authority when the original award of the subject contract
required the approval of the Board. The County Attorney’s Office has been consulted and has
provided a determination of legal sufficiency.
No items to report.
Agenda Item 7 (B)
Fiscal Committee
January 20, 2012
RESOLUTION AUTHORIZING (1) RETROACTIVE PAYMENT IN
THE AMOUNT OF $95,625.00, FOR SERVICES RENDERED FROM
JUNE 1, 2011 THROUGH NOVEMBER 30, 2011, AND (2) WAIVER OF
COMPETITIVE BIDDING AND A NEW AGREEMENT IN THE
MAXIMUM AMOUNT OF $255,500.00, FOR GUARANTEED EMERGENCY
BEDS AND RELATED SERVICES TO THE SALVATION ARMY FOR A
1-YEAR PERIOD EFFECTIVE DECEMBER 1, 2011
(Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson
Health System and Rosa Costanzo, Vice President and Chief Procurement Officer,
Strategic Sourcing and Supply Chain Management Division, Jackson Health System)
WHEREAS, the Public Health Trust (“PHT”) entered into an agreement with the Salvation Army, in March
2010 in the amount of $203,000.00, which agreement expired on May 31, 2011; and
WHEREAS, the services provided by the Salvation Army were over-utilized due to the needs of the PHT
and the PHT incurred payment obligations related to those services exceeding the initial approved agreement
amount by $95,625.00 for services provided through November 30, 2011; and
WHEREAS, the services provided by the Salvation Army are required to reduce the length of stay at the
Jackson Health Systems; and
WHEREAS, the Case Management/Social Work and Discharge Planning Division of the Clinical Resource
Management (CRM) Department has requested a new contract for services for a prospective 12- month period
effective December 1, 2011, in the amount of $255,500.00, through November 30, 2012; and
WHEREAS, upon the written recommendation by the President, the TRUST finds it in the best interests of
the TRUST to waive competitive bidding and contract with the Salvation Army for a 12-month period; and
WHEREAS, the PHT desires to accomplish the purposes outlined in this Resolution as further described in
the memorandum attached hereto and made a part hereof; and
Agenda Item 7 (B)
Fiscal Committee
January 20, 2012
-Page 2-
WHEREAS, the PHT finds that the actions described herein are in the best interest of the PHT and the
President and CEO recommend the actions described herein.
NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE
PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes (1)
retroactive payment in the amount of $95,625.00 for services rendered prior to November 30, 2011, and (2) waiver
of competitive bidding and a new agreement in the amount of 255,500.00, for guaranteed emergency beds and
related services with the Salvation Army effective December 1, 2011.
TO:
FROM:
Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson
Health System and Rosa Costanzo, Vice President and Chief Procurement Officer,
Strategic Sourcing and Supply Chain Management Division, Jackson Health
System
DATE:
October 25, 2011
SUBJECT:
AUTHORIZING WAIVER OF FORMAL BID PROCEDURES AND REQUIREMENTS OF
THE PUBLIC HEALTH TRUST PROCUREMENT POLICY AND REGULATIONS;
RATIFICATION OF A PREVIOUS PURCHASE FOR GUARANTEED EMERGENCY
SHELTER BEDS AND ASSOCIATED SOCIAL SERVICES TO THE SALVATION
ARMY FOR THE PERIOD OF JUNE 1 THROUGH NOVEMBER 30, 2011 IN THE
TOTAL AGGREGATE AMOUNT OF $95,625.00 FOR SERVICE FEES
____________________________________________________________________________________
RECOMMENDATION
Staff recommends that in accordance with the PHT Procurement Regulation, the Financial Recovery
Board ratifies, approves and authorizes retroactive payment to the Salvation Army in the amount of
$95,625.00 for services provided prior to November 30, 2011, and a waiver of competitive bidding and a
new agreement, in the amount of $255,500.00 for the continuation of services for the (guaranteed
emergency shelter beds and associated social services) effective December 1, 2011.
BACKGROUND
In 2006, The Clinical Resource Management (CRM) {Case Management/Social Work and Discharge
Planning} Department entered into an agreement with the Salvation Army to provide emergency shelter
beds and associated services to homeless patient population as part of the Early Discharge Program.
This program results in decreased costs associated with patient length-of-stay of unfunded care and
homeless patients.
In November 2008, the Trust approved award of a contract on behalf of CRM Department that continued
an existing agreement for 50 guaranteed or dedicated emergency shelter beds provided by the Salvation
Army. Although this arrangement had been in place with the Salvation Army since 2006, it was formalized
with board in 2008.
The most recent contractual arrangement was from March 1, 2010 through February 28, 2011, in which
The Salvation Army provided a guarantee of 20 emergency shelter beds per night for the one-year period
at a rate of $20.00 per night resulting in an award of $146,000.00. Prior to agreement expiration in
February 2011, a three-month extension was reached, in which The Salvation Army guaranteed a
minimum of 25 guaranteed beds per night at a rate of $25.00 per night for the period of March 1through
May 31, 2011. The three-month extension was for $57,000.00. The total cost of contracted services with
the Salvation Army for the 15-month period (between March 1, 2010-May 31, 2011) was $203,000.00.
CRM considers that The Salvation Army offers the bed capacity to meet the demands generated by our
volume of homeless patient discharges. The Salvation Army provides an array of services beyond
providing emergency shelter beds in an environment that is safe and secure for early discharged
homeless patients. Three meals a day during food service hours, TB testing, hygiene packages, clothing,
and assessment and referral to a transitional or permanent housing program are also provided as
appropriate by The Salvation Army.
Other factors that contributed to the decision to contract with the Salvation Army were its proximity to
Jackson Memorial Hospital (which helped lower fuel costs); the large size of the facility and
corresponding layout with two patients to a room; case management services that provide drug and
alcohol rehabilitative services as well as job placement and housing services. At the time, other
alternative facilities such as Camillus House, Rescue Mission, and Beckham Hall were evaluated but did
not provide the spectrum of care and services offered by The Salvation Army.
The CRM Department is currently seeking a ratification of the purchase of services from the Salvation
Army for a five-month period covering the period of June-November 2011 for an amount of $95,625.00 in
order to cover the combined amounts outstanding for the months of July, August, and September of 2011
($58,125.00) plus the anticipated combined expenses for October and November ($38,750.00).
The cost savings associated with contracting with the Salvation Army are significant, as the cost is a
proposed amount of $25.00 per bed per night versus a comparable cost of $575.00 for a one night lengthof-stay for a patient stay at Jackson Memorial Hospital.
Agenda Item 7 (C)
Fiscal Committee
January 20, 2012
RESOLUTION AUTHORIZING AN AMENDMENT TO SECTION XII
D.2 OF THE PROCUREMENT POLICY/REGULATION APPROVED
ON JANUARY 25, 2010 REGARDING SOLICITATIONS OR AWARDS
IN VIOLATION OF LAWS OR POLICIES
(Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing
and Supply Chain Management Division, Jackson Health System)
WHEREAS, the Public Health Trust (“PHT”) has established a Procurement Policy/Regulation under the
authority of Florida Statutes, Miami-Dade County Charter and Code and the Public Health Trust Procurement Policy
Resolution; and
WHEREAS, the Procurement Policy/Regulation became effective February 1, 2006 and was last approved
as amended on January 25, 2010; and
WHEREAS, the Procurement Policy/Regulation specific and only purpose is to govern the procurement of
supplies, services and construction, including professional services for the Public Health Trust; and
WHEREAS, Section XII.D. of the Procurement Policy/Regulation is entitled “Solicitations or Awards in
Violation of Laws or Policies” and includes provisions regarding, among, other things, remedies; and
WHEREAS, the Chief Procurement Officer, with the guidance of the County Attorney’s Office requests an
amendment to Section XXI, D.2 of the Regulation as set forth in the accompanying memorandum.
WHEREAS, this action is necessary to ensure the continued efficient operation of the Public Health Trust.
NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE
PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Financial Recovery Board hereby
authorizes and amends Section XII, D.2, of the Public Health Trust Procurement Policy/Regulation further set forth
in the attached memorandum with such changes to take effect immediately, and to apply retroactively.
TO:
The Financial Recovery Board of the
Public Health Trust of Miami-Dade County
FROM:
Rosa Costanzo, Vice President and Chief Procurement Officer,
Strategic Sourcing and Supply Chain Management Division,
DATE:
January 20, 2011
SUBJECT:
Amendment to the Procurement Regulation Resolution regarding Section XII.D,
Solicitations or Awards in Violation of Laws or Policies
_______________________________________________________________________________
RECOMMENDATION
The President and CEO recommend the Financial Recovery Board approves and authorizes amending
Section XII, D.2 of the Procurement Regulation, and making such amendment effective immediately and
retroactively.
PURPOSE
The purpose of the proposed amendment is to reduce the Public Health Trust’s exposure and risk should
a contract be awarded in violation of its Law or Policies and to ensure the continued efficient operation of
the Public Health Trust
PROPOSED CHANGES
Section XII D. 2 shall be modified to read as follows (with, as compared to the existing policy, additional
language underlined and deleted language struck through):
* * *
Remedies after an Award. If after an award it is determined that a solicitation or
award of a contract is in violation of law or the Procurement Policy, then:
(a) If the person awarded the contract has not acted fraudulently or in bad faith:
(i) The contract may be ratified and affirmed, in the sole discretion of the Trust,
provided it is determined that doing so is in the best interests of the Trust;
(ii) The contract may be terminated and the person awarded the contract shall be
compensated for the actual expenses reasonably incurred under the contract,
plus reasonable profit, prior to termination; or
(iii) Take such other actions as may be authorized by law.
* * *
JOINT CONFERENCE COMMITTEE
Stephen S. Nuell, Chairperson
Joe Arriola, Vice Chairperson
Michael Bileca
Joaquin del Cueto
Mojdeh L. Khaghan
Marcos Jose Lapciuc
Darryl K. Sharpton
Date and Place
January 20, 2012 (Immediately following the Fiscal Committee meeting)
Conference Room 259
AGENDA
1.
*Approval of the Meeting Minutes:
(Stephen S. Nuell, Chairperson, Joint Conference Committee
(a)
December 15, 2011
2.
President’s Report
(Carlos A. Migoya, President & Chief Executive Officer, Jackson Health System)
3.
Chief Medical Officer Report
(Michael Butler, MD, Executive Vice President, Chief Medical Officer and Sr. Associate
Dean for Clinical Affairs, Jackson Health System)
4.
President of the Medical Staff Report
(Michael Barron, MD, University of Miami Health System)
5.
Review of Credentials Committee Decisions:
(Michael Barron, MD, University of Miami Health System)
(a)
January 2012 Credentials Activity Report
(Supporting document will be distributed at the meeting)
6.
Standing Reports:
(a)
*Infection Control Report
(Susan Munoz-Price, MD, Infection Control, Department, Jackson Health System)
(b)
Scorecard Report
(Kevin Andrews, Vice President, Quality & Patient Safety, Jackson Health System)
(c)
*Service Excellence and Patient Satisfaction Results
(Maria Huot-Barrientos, Sr. Vice President, Human Resources Division, Ann Prendergast Director,
Leadership Development Department, and Kevin Andrews, Vice President, Quality and Patient Safety,
(Agenda item(s) noted with an asterisk (*) indicates that the supporting document(s) are attached.)
1.
Stephen S. Nuell, Chairman
Joe Arriola, Vice Chairman
Michael Bileca
Joaquin del Cueto
Marcos Jose Lapciuc
Darryl K. Sharpton
Date and Place:
December 15, 2011 – (Immediately followed the Fiscal Committee Meeting)
Conference Room 259
ATTENDANCE
Joaquin del Cueto
Marcos Jose Lapciuc
Michael Bileca
Darryl K. Sharpton
Joe Arriola
Stephen S. Nuell
Mojdeh L. Khagan
Carlos A. Migoya
Michael Butler, MD
Michael Barron, MD
Angela Burrafato, MD
Don S. Steigman
Salih Yasin, MD
Vicki Colburn
Denese McGil-Clare
Matthew Pinzur
Eugene Shy, Jr.
Valda Christian
Joint Conference Committee Meeting
December 15, 2011
Page 2 of 4
CALL TO ORDER
With a quorum being present, the Joint Conference Committee meeting was called to order by Stephen S. Nuell, Chairman at
11:26 a.m.
1.
APPROVAL OF THE MEETING MINUTES – NOVEMBER 17, 2011
Mr. Nuell requested a motion approving the meeting minutes of November 17, 2011.
The meeting minutes of November 17, 2011, was approved as presented.
2.
PRESIDENT’S REPORT
No report.
3.
CHIEF MEDICAL OFFICER REPORT
Michael Butler, MD, reported regarding the following:
 Kevin Andrews is attending the Joint Commission Exit Interview at Jackson North Mental Health
 The Service Chief Monthly Report on how quality is achieved as services are ongoing
 Received Board approval for Zynx and to be implemented in May 2012
 Migrating community practices from Allscripts to Cerner
4.
PRESIDENT OF THE MEDICAL STAFF REPORT
No report.
5.
REVIEW OF THE CREDENTIALING REPORT
The Committee reviewed for approval the Credentials Committee Activity Report for the month of December 2011. (See
attached summary report.)
Mr. Nuell requested a motion approving the Credentials Committee Activity Report for the month of December 2011.
Mr. Arriola moved approval;
seconded by Mr. Sharpton and
The Committee was provided with a complete and detailed copy of the December 2011 Credentialing Report.
Joint Conference Committee Meeting
December 15, 2011
Page 3 of 4
6.
STANDING REPORTS
A.
Caesarean Section Rates
Salih Yasin, MD, Director of Obstetrics Quality & Safety, Women’s Hospital Center, Associate Chair, OBGynecology, Miller School of Medicine and Vicki Colburn, Quality Manager, Holtz Children's Hospital &
Women's Hospital Center presented a report regarding Caesarean Section rates at Jackson Memorial Hospital.
A pregnant woman’s decision between a Caesarean Section and vaginal birth is one of the most important
choices during a pregnancy. A wide range of medical and personal factors must be applied against
evidence-based protocols to determine the right choice for each patient. The rate of Caesarean Section births at
Jackson Memorial Hospital (JMH) has increased dramatically since the mid-1990s, putting the hospital at
comparable levels with both national peers and local competitors. The report showed the circumstances
surrounding the growth in Caesarean Section at JMH and, more importantly, illustrated why Caesarean Section
rates are not a useful stand-alone indicator for positive medical outcomes and patient satisfaction. While it is
believed that vaginal birth is a better choice under circumstances, JMH primary focus must remain on
maximizing patient outcomes using whatever techniques are shown through research and regulation to provide
the best results.
ADJOURNMENT
The Joint Conference Committee meeting adjourned at 11:56 a.m.
Transcribed by
Kimberly A. Calhoun, Executive Assistant
Quality and Patient Safety Division
CREDENTIALS COMMITTEE MONTHLY ACTIVITY REPORT DECEMBER 2011 Initial Applicant(s) (13) – Community Physician(s) (16 ) – Academic Physician(s) Provisional Annual Evaluations Reappointments(s) Reappointments(s) Reinstatements Termination Modification(s) a. Extension of Clinical Privileges b. Request for Additional Privileges c. Change of Membership Category d. Change Admit Priority e. Additional/Change Sponsor f. Additional Service g. Request for Change of Service h. Delete Sponsor/Privileges i. Denial of Clinical Privileges – Modified j. Relinquish Clinical Privileges/Facility k. Request for reduction of clinical privileges l. Deceased m. Request for Leave of Absence Resignation(s) BLS Waiver(s) BLS Extension Voluntary Withdrawal and Voluntary Relinquishment of Membership and Privileges: a. Incomplete Reappointment(s) b. Incomplete Reappointment(s) No BLS c. Voluntarily Resigned due to BLS Expiration c. Reappointment Application Not Returned d. Lack of Utilization Medical Staff Health Professional Affiliate 29 19 5 0 0 0 2 2 0 0 0 2 0 0 0 17 1 0 17 0 0 4 4 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 3 0 0 0 2.
President’s Report
3.
Chief Medical Officer Report
4.
President of the Medical Staff Report
5.
Review of Credentials Committee Decisions
5 (a)
January 2012 Credentials Activity Report
(Supporting document will be distributed at the meeting)
6.
Standing Reports
TO:
and Members, Financial Recovery Board Joint Conference Committee
FROM:
Carlos A. Migoya
President & Chief Executive Officer
DATE:
January 20, 2012
RE:
Hospital Acquired Infections
Hospital-acquired infections are the perfect enemy for a healthcare provider, particularly a busy and highacuity site such as Jackson Memorial Hospital. They complicate or even eradicate positive medical outcomes.
They spread more quickly among concentrated patient populations being treated by busy staff. They create
large financial exposures through both extended lengths of stay and legal jeopardy. They threaten the
hospital’s reputation by creating unnecessary pain and suffering.
Perhaps most importantly, they are entirely self-defeating: industry study and Jackson’s own recent experience
demonstrates that hospital-acquired infections are overwhelmingly preventable. Over just two years, Jackson
has implemented interventions to transform industry-lagging outcomes and move toward model practices
that have deeply reduced infection rates.
CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS (CLABSI)
One of the most common medical tools in hospitals like Jackson is the central venous catheter, or central
line, which is used to administer medication and fluids, facilitate lab tests and monitor a patient’s condition.
Infections caused by insufficient monitoring of central lines are often serious and are responsible for a large
proportion of the country’s 248,000 annual bloodstream infections, according to a 2011 report from the
Centers for Disease Control and Prevention.
In January 2009, Jackson Memorial reported up to 40 CLASBIs per month, putting it among the worst 10
percent of hospitals in the country. That year, the hospital implemented three major interventions:



Scrub-the-hub: Cleaning the hub of the central line was not properly standardized and was
performed haphazardly. The new standard, implemented in mid-2009 (following the lead of Holtz
Children Hospital), required a 15-second scrub using chlorhexidine swab sticks prior to each
intravenous access.
Patient’s baths: The patient’s skin was traditionally cleaned daily with soap and water to minimize the
chance of infection. The new standards, implemented in late 2009 in all ICUs, changed from soap to
chlorhexidine, which is a more effective antiseptic in this setting.
Daily Rounding: As part of patient rounding, nurses in early 2010 began daily re-evaluation of the
need for central lines. Over the course of treatment, patients are often able to receive the necessary
care with fewer central lines, therefore reducing the chance for infection.
Page 2 of 5
The below figure shows the impact that the bundle of interventions had on CLASBI rates at Jackson
Memorial.
Together, these interventions eliminated approximately 90 percent of CLASBIs by the end of 2011, when the
hospital reported approximately four such infections per month. This placed Jackson Memorial close to the
top 10 percent of hospitals at preventing CLASBIs. The turnaround is the subject of a scholarly paper
currently being published by Critical Care Medicine. The estimated financial savings associated with this
reduction total nearly $7 million per year.
The hospital has now begun surveying for CLASBIs across all inpatient units, instead of just in the intensivecare units.
VENTILATOR-ASSOCIATED PNEUMONIA (VAP)
Patients whose breathing is controlled by a ventilator face a substantially increased risk of pneumonia. These
tend to be among a hospital’s most acute patients, making them especially susceptible to the germs present in
a large hospital.
In September 2009, Jackson Memorial reported approximately eight VAPs per month, putting it in the
bottom half of U.S. hospitals for infection rates. The hospital responded by implementing four significant
interventions:
Page 3 of 5




Oral Care: By cleaning the patient’s mouth every four hours with an antiseptic mouthwash, germs are
reduced in the area where the patient is most vulnerable.
Head Elevation: By elevating a patient’s head to a 35-degree angle, research suggests the patient’s
secretions are prevented of going into the lungs.
Sedation Holidays: When medically indicated, patients are weaned off sedation to determine when
they become able to breathe without assistance. As with the daily re-evaluation of central lines,
regular review of the patient’s changing needs may allow for a speedier removal of the ventilator.
Change of Equipment: The hospital began transitioning to a different type of tubing that might be
associated with a reduction of VAP.
These interventions have almost eliminated VAPs at Jackson Memorial; in October 2011, the hospital
reported zero VAPs for the first time, putting it among the best 10 percent in the U.S. These results are
shown in the figure below.
These reduction is VAP rates are estimated to save the hospital approximately $1.9 million per year.
ACQUISITION OF Acinetobacter baumannii
Antibiotic-resistant strains of bacteria are a stubborn problem in hospitals, and Acinetobacter baumannii is
among the most virulent. It can develop resistance to all available antibiotics, leading to mortality rates of
approximately 40 percent. And because it can survive for months in a hospital environment even without an
infected person, it is virtually impossible to eradicate entirely.
At the beginning of 2011, new acquisitions of Acinetobacter were as high 13per week.
Page 4 of 5
Unlike the interventions for CLABSI and VAP, which required the creation and hard-wiring of new
standardized protocols, Acinetobacter was confronted by better education and accountability for existing
infection-control procedures.
Staff used an ultraviolet powder to invisibly mark surfaces in the intensive-care units. When those areas were
tested with an ultraviolet lamp 48 hours later, only approximately 40 percent had been properly cleaned. This
indicated insufficient daily cleaning of critical surfaces. Swabs of frequently touched surfaces found high rates
of Acinetobacter in some units, particularly the Trauma/Burn ICU and Medical ICU.
Likewise, cultures of employees’ hands were found positive for Acinetobacter and other pathogens.
The hospital implemented an intensive education campaign. Leaders in administration, medicine, nursing and
environmental services received test results, including being shown the actual hand cultures that indicated the
presence of Acinetobacter. Hand-hygiene reminders were created showing departmental and hospital leaders.
All staff received reinforcement of key protocols:






Hand hygiene before contact with a patient and after contact with a patient or the patient’s room.
Daily cleaning of patient’s room.
No sharing of equipment between patients.
Quarantining of patients with Acinetobacter patients out of contact with other patients.
Attempting to limit number of staff who interact with both Acinetobacter-positive and –negative
patients.
Wearing gowns and gloves upon entry to patient’s room.
In less than a year, this campaign reduced Acinetobacter infections by more than 90 percent, with Jackson
Memorial now reporting zero or one new infection per week. The reductions are shown in the figure below.
Page 5 of 5
CONCLUSIONS
No single intervention can reduce infection rates for the full range of hospital-acquired conditions. It is
incumbent upon administration, infection-control staff, physician and nursing leaders and the members of
every team to be aware of threats, consistently adhere to protocol, monitor medical research and track
infection rates in order to constantly adapt and embrace best practices.
The dramatic reductions to CLABI, VAP and Acinetobacter infections at Jackson Memorial exemplifies the
hospital’s ability to follow such a regimen. The results include better medical outcomes, shorter lengths of
stay, lower medical and legal costs and improved hospital reputation via both patient word-of-mouth and
government and academic monitoring.
6 (b)
Scorecard Report
TO:
and Members, Financial Recovery Board Joint Conference Committee
FROM:
Carlos A. Migoya
President & Chief Executive Officer
DATE:
January 20, 2012
RE:
Service Excellence
Employee Engagement at JHS Laying the Foundation for Engagement Using Service Excellence at JHS: JHS’ Service Excellence Initiative began in March of 2011. The goal of the program was not only to boost Employee Engagement, but to enhance patient & physician satisfaction experience through an engaged employee. JHS Service Excellence Initiative: Total hours for class development and training: 1455 Hours Invested per employee in classroom: 3 Number of Employees Attended: 9351 Total time spent on Service Excellence = Attendance x number of hours per class + development Result: 29,508 hrs invested in Service Excellence resulted in: 7% jump in Likelihood to Recommend Continuous training hours invested in employees offer an opportunity to create professional development and engagement which leads to a positive patient experience. Return on Investment (ROI): Improved Quality, employees accountable for their their role in the Customer Service Experience, and a positive seven months trend in Patient Satisfaction. This positive trend shows a great gain but short of our baseline 75% percentile in likelihood to recommend. Average PRC score Likelihood to recommend before Service Excellence: 55.3% Average PRC score after Likelihood to recommend Service Excellence: 63.2% PRC Global Ratings HCAHPS Our goal for 2012 is the need for constant vigilance and reinforcement through leadership in order to hardwire the organization to the 75th percentile and beyond. ROI of an Engaged Workforce: Highly engaged employees return 120% of salary in value Engaged employees return 100% of salary in value Somewhat engaged employees returns 80% of salary Actively disengaged employees returns 60% of salary With an average salary of $64,690 per JHS employee, there is a potential loss of $25,876 per year disengaged Employee at JHS which equals to $279M loss in wasted business value. The Business Case for Engagement at JHS: Under new healthcare reform initiatives, reimbursements will be determined, in part, by patient satisfaction scores, which are clearly related to employee satisfaction. Watson Wyatt further found that companies with highly engaged employees experienced 26% higher employee productivity, lower turnover risk, greater ability to attract top talent, and 13% higher total returns to shareholders over the last five years. Additionally, highly engaged employees are twice as likely to be top performers—and miss 20% fewer days of work. They also exceed expectations in performance reviews and are more supportive of organizational change initiatives. 





Gallup reports a strong link between employee engagement and patient satisfaction: "As organizations improve their engagement levels, there is a positive linear relationship with growth in patient satisfaction and loyalty." Purdue University researchers found a direct link between worker satisfaction and customer satisfaction and between customer satisfaction and financial performance. A March 2011 study by Elizabeth H. Bradley, MD, published in The Annals of Internal Medicine, concurs. Bradley and other researchers visited 11 hospitals, half ranked in the top 5 percent and half in the bottom 5 percent based on mortality rates for heart attacks. After conducting more than 150 comprehensive interviews from all areas and job categories of each hospital, they discovered the culture of the hospital had more impact on mortality rates, including communication and support of staff, than more traditional factors such as patients' income levels, affiliation with a university, number of beds or location. A 2010 Towers Perrin showed that companies with above average employee engagement profits rose by 2.06% and operating margin rose by 3.74% over the same period. A 2010 Sirota Consulting study of 28 multinational companies found that the share prices of organizations with highly engaged employees rose by an average of 16% compared to an industry average of 6%. Building on Employee Engagement, Scripps Health in California has seen drastic improvements in financial performance, turnover rates, and employee morale. Over the past 10 years, employee results have improved by 54% while the system has realized over $70 million in cost savings and increased its annual profits by over 1200%. They accomplished this turnaround by not only focusing on the system’s financial performance, but also by making a commitment to transform the workplace culture. As workplace results have increased, Scripps has also realized drastically improved business performance. Between 2002 and 2010, their annual profits increased over tenfold, going from $9.7M to $132.6M. Key industry business metrics like Days Cash on Hand also improved, almost tripling from 72 to 205. This gave Scripps the necessary financial strength to withstand the government’s 90‐day payment cycles. Conclusion: Employee engagement starts with a strategically‐aligned recognition system that is directly tied to the strategy (mission, vision, values) of the entire organization. Successful engagement programs must be embraced company‐wide, supported by senior executives, and executed strategically. According to recently published figures from The Gallup Organization, the American workforce consists of 29% Engaged employees, 55% who are Not‐Engaged and 16% who are Actively Disengaged. That is a total of 71% of the workforce who are not “switched‐on” when they are at work, are not paying full attention, or perhaps are even working against the organization’s goals. STRATEGIC COMMITTEE
Strategic Committee
Marcos Jose Lapciuc, Chairperson
Michael Bileca, Vice Chairperson
Joe Arriola
Joaquin del Cueto
Mojdeh L. Khaghan
Stephen S. Nuell
Darryl K. Sharpton
Date and Place
January 20, 2012 (Immediately following the Joint Conference Committee meeting)
Conference Room 259
AGENDA
1.
*Approval of the Meeting Minutes:
(Marcos Jose Lapciuc, Chairperson, Strategic Committee)
(a)
2.
December 15, 2011
Committees of the Public Health Trust Financial Recovery Board
(Marcos Jose Lapciuc, Chairperson, Strategic Committee)
(a)
Admission of debt, contracting, budget approval and renaming the
Strategic Planning Committee and Joint Conference Committee
(b)
*Resolution Amending the Bylaws of the Financial Recovery Board of the
Public Health Trust with Guide to Amendments (Marcos Jose Lapciuc,
Chairperson, Public Health Trust Financial Recovery Board)
(1)
*Guide to Amendments to the Bylaws of the FRB (January 2012)
(2)
*Bylaws of the FRB, as amended (January 2012)
3.
Legislative Update
(Carlos A. Migoya, President & Chief Executive Officer, Jackson Health System)
4.
Strategy Update
(Donn Szaro, Chief Strategy Officer, Jackson Health System)
(a)
Operational/Tactical Plan
1.
Strategic Committee
Marcos Jose Lapciuc, Chairman
Darryl K. Sharpton, Vice Chairman
Joe Arriola
Michael Bileca
Joaquin del Cueto
Stephen S. Nuell
Date and Place
December 15, 2011 (Immediately followed the Joint Conference Committee Meeting)
Conference Room 259
ATTENDANCE
Strategic Committee
Joaquin del Cueto
Darryl K. Sharpton
Marcos Jose Lapciuc
Michael Bileca
Joe Arriola
Stephen S. Nuell
Mojdeh L. Khaghan
Donn Szaro
Carlos A. Migoya
Don S. Steigman
Miami-Dade County Attorneys
Laura Llorente
Strategic Committee Meeting
December 15, 2011
Page 2
Call to Order
With a quorum being present, the Strategic Committee meeting was called to order at 12:35 p.m. by Marcos Jose Lapciuc, Chairman.
1.
Mr. Lapciuc requested a motion approving the meeting minutes of November 17, 2011.
seconded by Mr. del Cueto,
2.
Committees of the Financial Recovery Board
a.
Restructuring and Focus
With regards to restructuring the PHT FRB committees, Mr. Lapciuc requested that each committee chairman align
its subcommittee and committee activities with the Operational/Tactical Plan as well as tailoring the meetings
according to their own system. He recommended that the objective of the subcommittees and committees is to focus
its attention and monthly reporting as follows:
Med Asses Report
IT Report
Oversight Budget
Capital Expense
Alignment of Corporate Expense
to Strategic Plan
Audit& Compliance Subcommittee
UM AOA Audit
Outside Legal Audit on Major Operations
Length of Stay
Emergency Room Throughput
Waiting Times
Outcomes
Patient Satisfaction
Fiscal Committee
Cost Accounting
Cost Reduction
a. Corrections
Strategic Committee
International
Physician Services
a. Service Line Volumes
b. Primary Care
Urgent Care
Alliances
JMH Health Plan
Business Units – JNMC & JSCH
Long Term Strategy – (Closed Session)
With regards to reappointments and appointments to the committees, Mr. Lapciuc requested that Michael Bileca be
reappointed as Vice Chairman of the Strategic Committee and be responsible for everything having to do with
growth particularly as it relates to Primary Care and Physician Services. Mr. Lapciuc reappointed himself as
Chairman of the Audit & Compliance Subcommittee and after 3 or 4 months Mojdeh L. Khaghan would be
appointed as Chairperson and Darryl L. Sharpton would be reappointed as Vice Chairperson of the same
Subcommittee.
b.
Resolution recommended to be approved
Resolution amending Article VI, Section 1b of the Bylaws of the Financial Recovery Board of the Public
Health Trust (Marcos Jose Lapciuc, Chairman, Public Health Trust Financial Recovery Board)
Mr. Lapciuc requested for approval the resolution to amend the PHT FRB Bylaws that in the event the Chairperson
is not present at a committee meeting at which the Chairperson is empowered to serve as an ex-officio voting
member, then the Vice Chairperson may serve as the ex-officio voting member, unless the Vice Chairperson is
already a member of such committee.
December 15, 2011
Page 3
He also proposed the following additional 3 amendments to the PHT FRB Bylaws for consideration and approval:
(1) Rename the Strategic Committee to Strategic and Growth Committee. The renaming of the committee
will align with the growth initiatives set forth for the institution.
(2) Prior to approval of the fiscal year budget by the PHT FRB the purchasing section of the budget be
first approved by the Purchasing Subcommittee and the capital expenditure section of the budget be
first approved at the Fiscal Committee.
(3) The Purchasing Subcommittee present a proposed purchasing budget and Facilities Subcommittee
present a proposed capital expenditure/property/real estate budget for approval.
Mr. Lapciuc requested that the Legal Counsel review the proposed amendments for sufficiency prior to including in
the Bylaws.
In an effort for the committee chairmen to restructure their committees to align with the Operational/Tactical Plan,
Mr. Lapciuc requested Donn Szaro, Chief Strategic Officer, Jackson Health System to provide members of the PHT
FRB via email with the balanced scorecard/benchmark timeline report that Mr. Sharpton created and the spreadsheet
that he and Mr. Szaro worked on which outlined the committee objectives.
With regards to procedural changes, Mr. Lapciuc requested that at the end of each subcommittee and committee
meetings the chairman present a summary of its balanced scorecard.
As part of the employee satisfaction, Mr. Sharpton requested a recognition considering the well-being of JHS
employees.
Mr. del Cueto reminded everyone that the former Human Resources Subcommittee of the PHT Board of Trustees
presented annual updates regarding the Employee Benefit Program. He recommended that a representative from the
Human Resources Division be invited to present an update regarding the Employee Benefit Program at the next
meeting.
Mr. Lapciuc requested that Mr. Szaro include employee satisfaction as a component of the Operational/Tactical
Plan. He also requested that in the month of February or March 2012 that a metric or benchmark be assigned to
employee satisfaction and reported to the Strategic Committee.
As part of the Strategic Committee agenda, Mr. Nuell requested that a Legislative Report be presented.
Mr. Lapciuc requested a motion approving item 2 (b), including the additional 3 amendments to the Bylaws.
December 15, 2011
Page 4
3.
University Affiliation Agreements Update
Mr. Szaro presented an update report regarding the University of Miami Miller School of Medicine (UMMSOM) Annual
Operating Agreement (AOA). As part of the update report, Mr. Szaro described the following as the JMH AOA
Methodology/JMH Proposed FY 2012 AOA Model.
Funding Category
1) Direct Patient Care
2) Education Support
3) Hospital Administration Support
4) Departmental Funding
5) Purchased Services
6) Pass-through’s
7) Dean’s Office Support
Separate – Pedi Cardiothracic Programmatic Support
Total Cash Support
FY 2012
Total
$ 17,190,185
$ 29,926,779
$ 8,709,147
$ 22,080,092
$ 31,173,047
$ 2,759,279
$ 3,397,471
Included in 4.c.
$115,236,000
FY 2011
Total
$ 20,057,576
$ 30,635,608
$ 10,828,188
$ 30,078,726
$ 30,888,409
$ 2,916,023
$ 4,697,471
$ 1,644,000
$131,736,000
Change
<$ 2,867,391>
<$ 698,829>
<$ 2,119,041>
<$ 7,998,634>
$ 284,638
<$ 156,744>
<$ 1,300,000>
<$ 1,644,000>
<$16,500,000
The total cash support includes the following:







Direct Care Support – compensation for treating indigent patients on JMH campus
Educational Support – compensation for administration and instruction of residency and fellowship
programs
Hospital Administration Support – compensation for serving in hospital administrative roles (e.g. chiefs of
service, medical directors, etc.)
Departmental Support – support for departments for recruiting, program subsidies, and incentives
Purchased Services – payment for service purchased from UM (e.g. Transplant, Bascom Palmer, Tissue
Bank)
Grants & Pass-throughs – pass through of funds received by JMH and administered by UM faculty
Dean’s Office Support – operations of the Dean’s Office in support of hospital strategy and operations
Mr. Szaro stated that both parties agreed to the reductions in the AOA both from a whole dollar perspective and also from the
value improvement initiative and in fairness to the physician partners at UMMSOM, JHS have reduced the cash payment
effective October 1. Even though the value improvement piece of the $52 million reduction hasn’t been realized JHS have
realized a total cash deficit in the amount $16.5 million which is being accrued and paid according to the AOA. Mr. Szaro
further stated that due to a low census and increased operating losses meetings have been held with representatives from both
parties to review the AOA in more detail. He pointed out that the costs associated with the AOA is not a fixed cost, it is an
agreement that must be appropriately volume adjusted.
Mr. Migoya stated that both parties have been involved in several meetings regarding the AOA. Purchased services,
attracting community physicians, increasing funded patients, assuring the continuation of the primary clinics in the
Ambulatory Care Center, and partnering with FQHC’s are some of the initiatives that attribute to the transformation process
of the AOA. He stated that the process of finalizing the AOA is near completion. Mr. Migoya reminded everyone that both
institutions can only be successful if they work together and develop a relationship with community physicians so that they
will refer patients to JHS.
With regards to the AOA, Mr. Lapciuc stated that he is somewhat skeptical because he is not sure how it is possible to
continue being partners and at the same time competitors. He expressed concerns around unanswered questions having to do
with areas of responsibility, conflicts of interest, reimbursements for physicians, and internal incentives for paying patients.
December 15, 2011
Page 5
As it relates to the AOA and service delivery, Don S. Steigman, Chief Operating Officer, Jackson Health System stated that it
has been clearly defined that service delivery is a JHS responsibility and it is the responsibility of UMMSOM to advise of
such services. He further stated that moving forward it needs to be clearly defined regarding the things that both parties can
continue to do together.
Mr. Szaro stated that he and Michael Butler, M.D., Chief Medical Officer, Jackson Health System have been working on
value and improvement initiatives to fix the problems associated with transforming the AOA. There needs to be joint
ownership where both parties can successfully complete the AOA process and reach an agreement prior to the next Strategic
Planning Committee meeting.
After the discussion regarding the AOA, Mr. Lapciuc stated for the record his level of trust is not at an all time high.
4.
Strategy Updates
a)
Mr. Szaro will forward the Operational/Tactical Plan via e-mail message to members of the PHT FRB.
b)
5-Year Strategic Business Plan
Mr. Lapciuc requested that over the next few weeks PHT FRB members meet individually with Mr. Szaro to discuss
the 5-Year Strategic Business Plan. There are plans to conduct a closed session regarding the 5-Year Strategic
Business Plan at the next meeting.
Other Discussion

SEIU, Local 1991
On behalf of the professional caregivers, nurses, and other healthcare professionals, Martha Baker, RN, President, SEIU,
Local 1991 spoke about the 1,500 signatures that were collected from a petition (“One of The Most Sacred Values in
Medicine Is to Protect Patients and Never Cause Them Harm”) related to employee furloughs. Ms. Baker stated that she and
the healthcare professionals are of the opinion that the employee furloughs has put an incredible strain on them, the safety of
the patients, and has affected service at JHS, and has resulted in a number of staff discrepancy reports. She further stated
that the employee’s furlough is an alternative to finding money, but is of the opinion that there are better strategies to be able
to achieving the goal. This is an economic answer that is going to cause more harm than good. Ms. Baker stated that she and
the healthcare professionals are willing to work with Mr. Migoya, members of the PHT FRB and the JHS Management Team
to get to the money side and found it important to present their issues and concerns to the PHT FRB.
Mark Richards, Legal Counsel, SEIU, Local 1991 encouraged Mr. Migoya, members of the PHT FRB, the JHS Management
Team, and Medical Staff to work together and fix the financial issues and other JHS related matters that are critical to the
future of the institution.

Staffing Discretion Reports
With regards to the concerns raised in Ms. Baker’s comments regarding patient safety, Ric Cuming, Chief Nursing
Executive, Jackson Health System stated that the employee furloughs are taking a lot of time and attention. He assured
everyone that patient safety and quality care is a top priority and is being tightly managed, staffing census at Jackson Main is
closely monitored on an every 4-hours basis, and staffing census at the JHS facilities are closely being monitored. With
regards to the staffing discrepancy reports, Mr. Cuming stated that he and Ms. Baker have met and reviewed a number of the
reports to assure that safety and quality care are being met.

Special PHT FRB Meeting
The PHT FRB members agreed to meet on December 23, 2011 at 9:00 a.m. for final board action on the items presented for
approval at the December 15, 2011 committees.
December 15, 2011
Page 6

Ongoing negotiations
Valda Christian, Assistant Miami-Dade County Attorney advised the PHT FRB regarding ongoing negotiations related to a
lease that the Trust has before it. She stated there is a lease for a property in Aventura that the Trust has entered into and is
bound by its terms. The Trust believes that the lease was not entered into with board authority, and therefore is not a valid
and binding agreement however, that is a point that can be argued. The lease has the Trust as a cotenant as well as a
physicians group. The landlord and the Trust have been trying vigorously to move forward with a resolution. As the
discussions continue, a resolution will be presented seeking authority for the CEO to continue negotiations with the intent of
bringing an agreement to the Committee at its next meeting for approval.
Mr. Lapciuc requested a motion approving continued negotiations between the landlord and the Trust with the intent of
bringing an agreement by the end of the moth for board approval.
seconded by Mr. del Cueto,

Miami-Dade County Board of County Commissioners
Mr. Lapciuc requested that the Board of County Commissioners (BCC) is kept informed regarding the financial position of
JHS. He reminded the PHT FRB that they have an obligation to report back to the BCC with solutions to save JHS.

Closing Remarks by the President
As it relates to a legislative update, Mr. Migoya stated that Governor Scott developed a budget to balance a $3 billion deficit
which is attributed to $1 billion increase to education and $1.4 billion decrease in Medicaid. It is also being speculated
whether or not the Medically Needy Program would be eliminated as part of the budget. He also stated that he and Ms.
Baker visited Washington, D.C., met with the lead person of the Medicaid/CMS Program to discuss alternative funding
sources for JHS. Going forward, Mr. Migoya will provide regular legislative updates to the Committee.

Closing Remarks by the Chairman, PHT FRB
Mr. Lapciuc congratulated Mr. Migoya for all of his efforts and quality management. On behalf of the PHT FRB, Mr.
Lapciuc stated that they are supportive and willing to do their best to assist him.
Adjournment
The Strategic Committee adjourned at 1:50 p.m.
Transcribed by Ivenette Cobb
Executive Assistant
2.
Committees of the Public Health Trust Financial Recovery Board
2 (a)
Renaming the Strategic Planning and
Joint Conference Committees
Agenda Item 2 (b)
Strategic Committee
January 20, 2012
RESOLUTION NO. PHT 1/12 RESOLUTION AMENDING THE BYLAWS OF THE
FINANCIAL RECOVERY BOARD OF THE PUBLIC
HEALTH TRUST REGARDING ADMISSIONN OF
DEBT, CONTRACTING, BUDGET APPROVAL AND
RENAMING OF STRATEGIC PLANNING
COMMITTEE AND JOINT CONFERENCE
COMMITTEE
(Marcos Jose Lapciuc, Chairperson, Public Health Trust,
Financial Recovery Board
WHEREAS, on July 21, 2011, the Financial Recovery Board (“FRB”) of the Public Health Trust adopted
its Bylaws pursuant to its passage of Resolution No. PHT 07/11-024; and
WHEREAS, on December 23, 2011, the FRB adopted an amendment to the Bylaws pursuant to its passage
of Resolution No. PHT 12/11-060; and
WHEREAS, the Financial Recovery Board presently seeks to amend its Bylaws, as set forth in the
attachment, regarding admission of debt, contracting, budget approval and renaming the Strategic Planning
Committee and Joint Conference Committee; and
NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF
THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby amends the
Bylaws of the Financial Recovery Board as set forth and incorporated into the attached Bylaws regarding admission
of debt, contracting, budget approval and renaming the Strategic Planning Committee and Joint Conference
Committee. GUIDE TO AMENDMENTS TO THE BYLAWS OF THE FINANCIAL RECOVERY BOARD (JANUARY 2012) PAGE NUMBER 8 11 18 22 23 27 29 30 33 34 34, 35 39 40 41 AMENDMENT Addition of Section 9 re: Admission of Debt Addition regarding Secretary authority to execute contracts on final action Addition regarding execution of contracts and documentation of final action
Change of name of Strategic Planning Committee Addition regarding input of Facilities Subcommittee and Purchasing Subcommittee in budget approval process Change of name of Joint Conference Committee Change of name of Joint Conference Committee and Strategic Planning Committee Change name of Strategic Planning Committee Change name of Strategic Planning Committee Change name of Joint Conference Committee Addition regarding President authority to execute contracts on final action Change name of Joint Conference Committee Change name of Joint Conference Committee Change name of Joint Conference Committee BYLAWS OF THE FINANCIAL RECOVERY BOARD OF THE
PUBLIC HEALTH TRUST OF
MIAMI-DADE COUNTY, FLORIDA
PREAMBLE
The Financial Recovery Board was established as the governing body of the Public Health Trust
of Miami-Dade County by the Board of County Commissioners pursuant to Resolution No. R392-11, passed and adopted on May 3, 2011, and Section 25A-9(c)(5) of the Code of MiamiDade County. The Financial Recovery Board shall exist for a period of twenty-four (24) months,
which may be shortened or extended at the discretion of the Commission. The purpose of the
Financial Recovery Board is ensure the financial sustainability of the Public Health Trust. These
Bylaws shall terminate and be of no further force and effect upon expiration of the existence of
the Financial Recovery Board and the reestablishment of the Board of Trustees of the Public
Health Trust.
Amendments: December 23, 2011; January , 2012
ARTICLE I
DEFINITIONS AND CONSTRUCTION
Definitions. As used in these Bylaws, the following terms shall have the
meanings described:
A.
Board
or Financial Recovery Board-- the Financial Recovery
Board of the Public Health Trust of Miami-Dade County, Florida.
B.
Commission -- the Board of County Commissioners of MiamiDade County, Florida.
C.
Health Professional Affiliate -- an individual other than a licensed
medical or osteopathic physician, dentist, podiatrist, oral surgeon
or psychologist who provides direct patient care services in a Trust
facility under a defined degree or supervision, exercises judgment
within the areas of documented professional competence and
consistent with applicable law and is granted clinical privileges to
provide specified patient care activities through the credentialing
process established in the Medical Staff Bylaws.
D.
Medical Staff -- licensed medical and osteopathic physicians,
dentists, podiatrists, oral surgeons and psychologists who have
clinical privileges in accordance with the Medical Staff Bylaws
and shall serve as the medical staff for and attend to patients at
Trust facilities.
E.
Office of Internal Audit -- the Office of Internal Auditor, Public
Accountability and Information created pursuant to the Trust
Ordinance.
2
F.
President -- the Chief Executive Officer of the Public Health Trust
of Miami-Dade County, Florida.
G.
Trust -- the Public Health Trust of Miami-Dade County, Florida.
H.
Member -- a member of the Financial Recovery Board.
I.
Trust Facilities -- Jackson Memorial Hospital, Jackson South
Community Hospital, Jackson North Medical Center and, where
appropriate, all other health care facilities which have been or may
in the future be designated by the Board of County Commissioners
for governance, operation and maintenance by the Trust.
J.
Trust Ordinance -- the Ordinance establishing the Trust: Ordinance
No. 73-69, codified in Chapter 25A of the Code of Miami-Dade
County, as it may be amended from time to time.
3
ARTICLE II
POWERS AND DUTIES OF THE TRUST
During its existence, the Financial Recovery Board shall have all of the powers and duties set
forth in the Trust Ordinance.
4
ARTICLE III
FINANCIAL RECOVERY BOARD
Section 1.
Composition of the Financial Recovery Board.
In accordance with Commission Resolution No. R-392-11, the governing
body of the Trust shall be the Financial Recovery Board. The structure of
the Financial Recovery Board shall be as set forth in Section 25A9(c)(5)(iii) of the Trust Ordinance.
Section 2.
Conflict of Interest and Code of Ethics.
Members shall strictly comply with the Miami-Dade County Conflict of
Interest and Code of Ethics Ordinance, Section 2-11.1 of the Code of
Miami-Dade County, Florida, and all amendments thereto, as that
Ordinance has been modified in its applicability to the Trust by the Trust
Ordinance.
Members also shall comply with applicable sections of
Chapter 112, Part III, Florida Statutes, the Code of Ethics for Public
Officers and Employees.
Section 3.
Heightened Conflict of Interest Standard.
In establishing the Board, the Commission mandated that the Members of
the Financial Recovery Board shall be held to a heightened conflict of
interest standard. With respect thereto, this Board hereby empowers the
Miami-Dade County Ethics Commission to issue opinions concerning this
heightened standard, including perceived conflicts of interest or
appearances of impropriety related thereto. In appointment to this Board
and while in service, Members shall be guided by factors, including but
5
not limited to: (a) the likelihood of degree of public suspicion aroused as
a result of a Member’s act; (b) the extent of the private interest involved;
(c) the possible benefit to the public resulting from the Member’s act; and
(d) the intent of the Member.
Section 4.
Automatic Suspension of Members Charged with Commission of a
Felony.
In the event that a Member is charged with committing a felony under the
laws of the State of Florida or the United States by indictment or
information, the provisions of Section 2-11.3 of the Code of Miami-Dade
County, Florida, and all amendments thereto, shall be applicable to the
Member, including, but not limited to, provisions regarding the automatic
suspension of such Member and temporary appointment of a successor
Member for the remainder of such Member’s unexpired term.
Section 5.
Sunshine and Public Records Laws.
Members shall strictly comply with the statutory provisions pertaining to
public meetings and records contained in Chapter 286, Florida Statutes,
the "Government in the Sunshine Law" and Chapter 119, Florida Statutes,
the "Public Records Law."
Section 6.
Indemnification.
The Members shall be included as insured persons within the terms of the
comprehensive general and professional liability insurance policies of the
County for the protection of individual members of County boards while
such members are acting within the scope of their duties. The Members
6
shall, while acting within the scope of their duties, also be entitled to
personal liability protection, to the same extent that members of other
County boards have such protection, from funds set aside by the County to
satisfy claims not payable from insurance proceeds by virtue of loss
deductible clauses in liability insurance policies. The Board shall be
empowered to obtain such additional liability insurance and the expense of
such insurance shall be an expense of the Trust.
Section 7.
Restrictions on Board Members.
a.
Neither the Board nor any of its Members shall direct or request
the appointment of any person to, or the removal from, office by
the President or any of his or her subordinates, or take part in the
appointment or removal of officers and employees in the
administrative services of the Trust. Any willful violation of the
provisions of this Section by a Member shall constitute cause for
his or her removal from office.
b.
The Board and its Members shall deal with the administrative
service solely through the President.
Section 8.
Designation of Office Space and the Hiring of Staff.
It shall be within the discretion of the Trust to designate office space and
to hire staff to direct and coordinate Trust activities. The Chairperson
shall have the discretion to appoint a Trust employee to assist him or her
in performing the Chairperson’s duties and any other responsibilities
related thereto. This employee shall report directly to the Chairperson. In
7
addition, the Chairperson shall have the discretion to appoint two (2)
additional Trust employees to assist the Financial Recovery Board
(including the Chairperson) in the performance of the duties and
responsibilities of the Members of the Board. These two (2) employees
shall report directly to the Financial Recovery Board.
>>Section 9.
Admission of Debt/Admission of Liability.
Except as hereinafter provided, no employee of the Trust shall
execute, sign or submit to another person or entity a document that is
or is tantamount to an admission of debt or admission of liability
(“Admission of Debt”) pursuant to which the Trust is accepting the
legal and/or financial liability or responsibility for a matter affecting
another person or entity. Notwithstanding the foregoing, the Chief
Financial Officer together with the Controller of the Trust shall have
authority to provide an Admission of Debt to another person or entity
in a sum not greater than $500,000; the President and Chief Executive
Officer of the Trust shall have authority to provide an Admission of
Debt to another person or entity in a sum greater than $500,000 but
not exceeding $1,000,000; and any Admission of Debt greater than
$1,000,000 shall require approval of the Board by resolution. The
provisions of this Section are not intended to apply to settlement of
contract, medical malpractice or other litigation to which the Trust is
a party.<<
8
ARTICLE IV
OFFICERS OF THE FINANCIAL RECOVERY BOARD
Section 1.
Officers: Election, Term, Removal.
The officers of the Board shall be the Chairperson, Vice-Chairperson,
Treasurer, Secretary and such other officers as the Board may determine to
be necessary.
Each officer shall be elected by majority vote of the
Members attending a duly constituted meeting of the Board. An officer
may be removed from his or her office by the Board upon the affirmative
vote of two-thirds (2/3) of the Members attending a duly constituted
meeting of the Board and such officer shall cease to hold office at the time
such removal action shall have passed. Notice of such proposed action
shall be given to each Member of the Board not less than four (4) days
prior to the meeting at which such removal shall be considered. In the
event an officer of the Board shall be absent, or temporarily unable to
carry out the duties of such office, the Board may temporarily assign the
powers and duties of such officer to any other properly qualified Member
until that officer is able to resume his or her duties or until replaced.
Section 2.
Chairperson.
In addition to other powers and duties set forth in the Trust Ordinance and
in these Bylaws, the Chairperson of the Board shall have the following
powers and duties:
a.
Preside at all meetings of the Board;
b.
Subject to the approval of the Board, appoint the chairpersons and
members of all committees, except as provided to the contrary in
the Trust Ordinance or these Bylaws;
9
c.
Subject to the approval of the Board, appoint the Chairperson of
the committees required by the Trust Ordinance, unless otherwise
provided therein.
d.
Officially represent the Trust whenever necessary or proper.
e.
Enforce all regulations and policies of the Board and perform such
other duties as are usual to this office or that shall be imposed upon
him or her by resolution of the Board.
f.
In his or her discretion, confer with the President at least quarterly
concerning the President’s performance and evaluation.
The
Chairperson shall report to the Board the occurrence of any
conferences held at the next regular meeting of the Board.
Section 3.
Vice-Chairperson.
The Vice-Chairperson of the Board shall have the following powers and
duties:
a.
Act as Chairperson of the Board in the absence of the Chairperson
and when so acting shall have the responsibilities and powers of
the Chairperson; and
b.
Perform such other duties as shall from time to time be imposed
upon him or her by the Board and which are usual to his or her
office.
Section 4.
Treasurer.
The Treasurer of the Board shall have the following powers and duties:
a.
Serve as Chairperson of the Fiscal Committee;
b.
Have those duties required by law and assigned by the
Chairperson; and
c.
Participate along with the Chairperson and the President in the
presentation of accountings required by the Trust Ordinance.
10
Section 5.
Secretary.
The Secretary of the Board shall have the following powers and duties:
a.
Have those duties required by law and assigned by the
Chairperson; and
b.
Sign contracts as required by law or as requested by the parties
contracting with the Trust. >>Notwithstanding the foregoing, the
Secretary shall have no authority to execute any contract for
the expenditure of Trust funds in excess of $__________ unless
there has been final action and is otherwise in compliance with
Article V, Section 6 of these Bylaws.<<
11
ARTICLE V
MEETINGS OF THE FINANCIAL RECOVERY BOARD
AND ITS COMMITTEES
Section 1.
Regular Meetings.
The Board shall hold regular meetings at such time and place as shall be
determined by the Board or by the Trust Ordinance. The Board shall hold
and televise regular meetings of the Board in Commission chambers. The
regular meetings shall not conflict with the meeting schedule for the
Commission or its committees. At the discretion of the Board, other
meetings may be held and televised in the Commission chambers. The
Trust shall request use of Commission chambers for regular or other
meetings of the Board through the Chairperson of the Commission. The
Chairperson of the Commission shall have final authority to approve the
scheduling of such regular or other meetings of the Board in the
Commission chambers. Except as provided by law, all meetings of the
Board shall be public and audio recorded and written minutes of the
proceedings thereof shall be maintained by the Office of Internal Audit, as
such term is defined herein. All action taken at the meetings of the Board
shall be promptly and properly recorded. Copies of all minutes and
resolutions of the Board shall be forwarded to the Clerk of the
Commission no later that ten (10) days subsequent to any meeting of the
Board.
12
In the discretion of the Chairperson, the Board may hold no meetings
during the months of July and/or December.
Section 2.
Special Meetings.
Special meetings of the Board may be called by the Chairperson of the
Board or shall be called upon the written request of three (3) Members of
the Board. Notice of a special meeting shall be given to each Member of
the Board not less than two (2) days prior to the date of such special
meeting. The notice shall state the purpose for which the meeting has
been called, the time and place of such meeting and no other business shall
be considered.
Section 3.
Public Meetings, Minutes, Agendas.
a.
Except as provided by law, all meetings of the Board and its
committees shall be public audio recorded meetings and shall be in
strict compliance with Chapter 286, Florida Statutes, the
"Government in the Sunshine Law."
b.
Members of the public wishing to address the Board or any of its
committees shall in writing notify the Chairperson of the Board or
Chairperson of the committee or the President prior to the meeting
and shall state therein the subject matter they wish to address.
However, the Chairperson of the Board or chairperson of the
committee of jurisdiction or those presiding in their absence, may
waive the written requirement. The presiding officer of the Board
or of the committee may in his or her discretion impose a
reasonable time limit on presentations and may limit the number of
speakers on any issue. Upon approval or the Board, a standing
13
committee chairperson may hold public hearings to solicit
comments regarding issues under the jurisdiction of the specific
committee. No Trust employee shall be permitted to address the
Board on matters concerning his or her employment status.
c.
Written minutes of the proceedings of the Board shall be
maintained and shall be promptly and properly recorded and
forwarded to the Clerk of the Commission not later than ten (10)
days subsequent to any such meeting of the Board. Minutes shall,
where reasonably possible, be delivered to Board members in
advance of the next scheduled Board meeting.
The names of
Board members present, absent and excused and the total number
of unexcused absences shall be recorded in the minutes.
d.
Written minutes of the proceedings of the committees shall be
maintained and, where reasonably possible, shall be delivered to
the committee members at least four (4) days in advance of the
next succeeding committee meeting. The names of the committee
members present, absent and excused and the total number of
unexcused absences shall be recorded in the minutes.
e.
A copy of each agenda item for regular meetings of the Board shall
be furnished to the Members of the Financial Recovery Board not
later than four (4) working days before a vote may be called on the
item. The provisions of this four (4) day requirement shall be
deemed waived unless asserted by a Member of the Financial
Recovery Board before the Board takes action on the resolution,
motion or other item in question.
f.
A written agenda of the matters to be considered at a regular
committee meeting shall be delivered to committee members at
14
least four (4) days prior to such meeting, provided, however,
committee proceedings shall not be limited to matters set forth in
said agenda.
g.
Section 4.
All Members shall receive notification of each committee meeting.
Quorum, Voting.
a.
The presence of a majority of the Members of the Board then in
office shall be necessary and sufficient to constitute a quorum for
the transaction of business at all meetings of the Board. Except as
otherwise provided herein or as provided by the rules of procedure,
the Board shall not act except by resolution of at least a majority of
those Members present and voting at a duly constituted meeting of
the Board.
b.
The presence of a majority of the members of a committee of the
Board shall be necessary and sufficient to constitute a quorum for
the transaction of business at all meetings of a committee of the
Board.
Section 5.
Committee Deliberations
Unless otherwise provided in these bylaws, no item shall be place on an
agenda of a regular meeting of the Board or considered by the Board,
unless the item has been considered first by a committee of the Board
and forwarded after such consideration to the full Board as hereinafter
provided. A committee of the Board may take one of the following
actions with respect to each matter before the committee for action:
(a)
Recommend favorably;
15
(b)
Recommend favorably with committee amendment(s);
(c)
Forward without recommendation, upon the unanimous vote of the
members of the committee who are present;
(d)
Receive a report;
(e)
Lay the matter on the table resulting in the matter not being placed
on an agenda of the Board; or
(f)
Defer or take no action on an item for a maximum of two
consecutive committee meetings. Deferral of or failure to act on a
matter beyond two consecutive meetings shall cause the matter to be laid
on
the
table,
as
set
forth
in
the
preceding
subparagraph.
Notwithstanding any other provision of this section, whenever action
can not be taken because the vote of the committee members on an item
has resulted in a tie, and no other available motion on an item is made
and approved before the next item is called for consideration or before a
recess or adjournment is called, whichever occurs first, the item shall be
deemed to be laid on the table, as set forth in the preceding
subparagraph; such item shall be reintroduced only in accordance with
the renewal provisions of subparagraph (j) of this section.
(g) An item that has not been considered by a committee may be placed
on the agenda of the Board if the chairperson of the committee to which
the item has been referred requests a waiver in writing and the
Chairperson of the Board concurs.
(h) A matter that has not been considered by a committee may be placed
on the agenda of the Board to meet a public emergency of the Trust as
determined in writing by the Chairperson of the Board. Time sensitive
matters with little or no financial impact may be placed on an agenda of
16
the Board by the Chairperson of the Board without having been
considered by a committee.
(i)
Any committee action taken pursuant to subparagraph (a) through
(e) of this section may be reconsidered only at the same meeting at
which the action was taken. A motion to reconsider an item resulting in
a tie vote is out of order and no such motion may be reconsidered.
(j)
Once an item is laid on the table in a committee, the proposed item
may not be brought before that committee again during the three (3)
month period following the date the item is laid on the table (subject to
the provisions of subparagraph (ix) hereof), unless an application for
renewal made by two-thirds (2/3) of the committee members is first
submitted to the chairperson of the committee.
(k)
The following matters may be heard directly by the Board of
Trustees: special or citizen’s presentations; resolutions recommending
to the Commission the naming or renaming of Trust designated
facilities; settlements; resolutions related to contract lobbyist conflict
waiver requests; and resolutions expressing intent.
Section 6.
Final Action
No resolution or action of the Trust shall be final until it is passed and
adopted by the Board at its monthly televised regular meeting. In the
event that the Board shall not hold a televised regular meeting because it is
on hiatus for the months of July and/or December, then the Chairperson, in
his or her discretion, may call a special meeting of the Board as provided
in these Bylaws for final action, or, alternatively, may place such
resolutions on an agenda of the Strategic Committee, which shall meet for
the Board in accordance with Article VI, Section 2c(6) of these Bylaws.
17
>>In addition, the President or any officer of the Board shall have no
authority to execute any contract for the expenditure of Trust funds
in excess of $__________unless there has been final action of the
Board as evidenced by resolution of the Board. The President shall
ensure that each contract in excess of $_______ shall contain a
standard contractual provision that at a minimum (i) sets for the
resolution number of the resolution evidencing the Board’s final
action and (ii) puts parties contracting with the Trust on notice of the
mandates and requirements of this provision. Further, the President
shall incorporate the mandates and requirements hereof into Trust
policies and place and maintain on the website of Jackson Health
System a notice of the mandates and requirements hereof. Provided,
further, that any contract failing to comply herewith, shall be an
unauthorized contract and not valid or binding on the Trust.<<
18
Section 7.
Rules of Procedure.
The applicable rules of procedure for all meetings of the Board and any
committees thereof shall be those contained in Robert's Rules of Order,
Revised Edition, except as provided herein.
a.
Parliamentarian. The County Attorney, or his or her designee,
shall act as parliamentarian and shall advise and assist the
presiding officer in matters of parliamentary law.
b.
Attorney. The County Attorney, or his or her designee shall be
available to the Board at all meetings.
c.
Call to Order. The Chairperson shall take the chair at the hour
appointed for the meeting and shall call the Board to order
immediately.
In the absence of the Chairperson or Vice-
Chairperson, the Treasurer or in his or her absence, the Secretary,
shall temporarily take the chair and call the Board to order
immediately.
In the absence of all of the above, a temporary
chairperson shall be elected and call the meeting to order
immediately. Upon the arrival of an officer in the order stated
above, the temporary chairperson shall relinquish the chair upon
the conclusion of the business immediately before the Board.
d.
Quorum, Conflict of Interest.
Any Member of the Board who announces a conflict of interest on
a particular matter and makes a decision to refrain from voting or
otherwise participating in the proceedings related to that matter
shall leave the meeting room until the consideration of the matter
is concluded. The Member having the conflict of interest shall be
deemed absent for purposes of constituting a quorum, counting the
vote and participation in discussion. Said Member shall comply
19
with applicable law in matters concerning conflicts of interest and
voting abstentions. Should no quorum attend within thirty minutes
after the hour appointed for the meeting of the Board, the
Chairperson or Vice Chairperson, or in their absence, the
temporary chairperson, may adjourn the meeting.
20
ARTICLE VI
COMMITTEES OF THE FINANCIAL RECOVERY BOARD
Section 1.
Appointment and Removal, Composition and Term of
Committees.
a.
The chairperson and members of all committees, with the
exception of those specifically appointed pursuant to the Trust
Ordinance and by these Bylaws, shall be appointed by the
Chairperson of the Board subject to the approval of the Board. A
committee chairperson or committee member may be removed
only by action of the Board.
b.
With the exception of committees created pursuant to the Trust
Ordinance, the Chairperson of the Board shall serve as an exofficio voting member of all committees unless already a member
of such committee.
Provided, further, that in the event the
Chairperson is not in attendance at a committee meeting, the Vice
Chairperson of the Board may serve as an ex officio voting
member of any such committee unless already a member of such
committee. The members of subcommittees are not required to be
a Member of the Board
c.
The chairpersons and members of all committees shall continue in
those capacities until their successors have been appointed or the
committee has been discharged.
d.
Committees shall hold meetings as determined necessary by the
committee
chairperson,
Chairperson of the Board.
21
unless
otherwise
directed
by the
e.
Special committees or subcommittees of standing committees may
be appointed by the Chairperson of the Board and shall be
discharged by the Chairperson of the Board upon completion of the
assigned tasks.
f.
Subcommittees of standing or special committees may be
appointed by the committee chairperson, subject to approval by the
g.
The President shall assign appropriate staff to each committee.
h
All Trust committees, including but not limited to subcommittees,
special committees and ad hoc committees and the chairpersons
and members thereof, shall be ratified by the Board.
Section 2.
Standing Committees.
There shall be three (3) standing committees as follows:
the Fiscal
Committee, [Strategic] >>Strategy and Growth<< Committee and Joint
Conference >>and Efficiencies<< Committee. Unless already provided
for in these Bylaws, the Chairperson is empowered, in his or her
discretion, to assign to standing committees the jurisdiction over matters
involving, but not limited to, philanthropy, human resources, pension or
other retirement programs, health plans, international program, and other
business units and service lines of the Trust and other such areas of Trust
business.
a.
Fiscal Committee.
There shall be a Fiscal Committee.
The
Treasurer of the Board shall serve as committee chairperson. The
Fiscal Committee shall:
(1)
Assist the Treasurer in performing the duties of his or her
office and shall advise and consult with staff regarding the
fiscal affairs of the Trust.
22
(2)
Keep the Board fully advised as to the Trust's compliance
with the financial duties of the Trust as set forth in the
Trust Ordinance and applicable law. In supervising the
Trust's compliance with the Trust Ordinance, the powers
and duties of the committee shall include but not be limited
to the following:
(a)
The preparation for the Board of an annual Trust
budget request which, subject to approval of the
Board, shall be submitted to the Commission
preceding each fiscal year of the Trust. >>In its
preparation of the annual Trust budget request,
(i) the Facilities Subcommittee shall make
recommendations
to the
Fiscal
Committee
regarding capital expenditures; and (ii) the
Purchasing
Subcommittee
recommendations
to the
shall
Fiscal
make
Committee
regarding expenditures in the category of
contractual and purchased services. The Fiscal
Committee shall consider the recommendations
of the Facilities Subcommittee and Purchasing
Subcommittee
in
the
preparation
of
the
budget.<<
(b)
The preparation for the Board of supplemental
budget requests to be forwarded to the Commission
subject to Board approval.
(c)
The development in conjunction with County
budget staff, of accounting, budgeting, and financial
23
management systems which will enable MiamiDade County to provide the Trust with funding in
accordance with applicable law and contractual
arrangements.
(d)
Through staff of the Trust, the preparation for the
Board of the financial reports and accountings.
(e)
The making of recommendations to the Board and,
through the Board, to the Commission for the
issuance of new bonds and for the borrowing of
money.
(f)
The approval of and recommendation to the Board
of the facilities development budget submitted by
the Facilities Subcommittee.
(3)
Supervise the preparation of, examine and forward to the
Board all financial statements which the Trust is required to
make or which are necessary and proper for carrying out
the powers and duties of the Trust.
(4)
Study the rates and charges of the Trust Facilities and make
recommendations to the Board at least annually with
regards thereto.
(5)
Within the framework of the operating agreement between
the Trust and Miami-Dade County, study and make
recommendations to the Trust/County Committee regarding
the determination by the Commission of medical indigency
status and health care delivery policies in the designated
facilities of the Trust.
The committee shall also make
studies and recommendations to the Board regarding the
24
establishment of policies for serving medically indigent
persons, extending credit and collecting patient accounts
payable.
(6)
Subject to applicable requirements of law and the Trust
Ordinance, shall develop, and present to the Board for
approval, procedures for purchasing supplies, equipment
and services, and for managing materials, and through the
Purchasing
Subcommittee
shall
supervise
the
implementation of such procedures.
(7)
At least quarterly, review and, as necessary, make
recommendations,
to
the
Board
concerning
the
management and investment of all funds of the Trust and to
monitor
compliance
with
Board
policies
regarding
investments as set forth in Resolution No. PHT 11/96-181
as amended or modified from time to time.
(8)
The committee chairperson shall appoint an Audit and
Compliance Subcommittee.
The subcommittee shall be
responsible for the oversight, guidance and completion of
the Trust’s external audit by its external auditor, and
oversight of internal audit and internal control functions
and regulatory compliance programs.
(9)
The committee chairperson shall appoint an External
Auditor Selection Subcommittee for the purpose of
recommending to the Fiscal Committee an external auditor
of the Trust. The External Auditor Selection Subcommittee
shall consist of a minimum of three (3) Members, which
shall include the chairperson of the Audit and Compliance
25
Subcommittee. A three-fourths (3/4) vote of the members
present at a Fiscal Committee meeting is required for a
recommendation to the Trust waiving the provisions of
Article VI, Section (2)(a)(10) of these Bylaws limiting the
number of years that an external auditor may serve.
(10)
An external auditor hired by the Trust to provide an audit
of the Trust’s consolidated operations and a management
letter shall serve a maximum of five (5) consecutive years
unless the Board by a two-thirds (2/3) vote of the
members present waives this requirement. If the Board
waives the five (5) year limitation on the external auditor’s
term, the managing partner in charge of the Trust’s audit
shall change.
26
b.
Joint Conference >>and Efficiencies<< Committee.
(1)
There shall be a Joint Conference Committee.
(2)
The Joint Conference >>and Efficiencies<< Committee
shall:
(a)
Be the committee of jurisdiction delegated by the
Board to consider medical-administrative matters
and be the official point of contact between the
Board, the Trust administrative staff and the
Medical Staff.
(b)
Review and make recommendations to the Board
regarding Medical Staff and Health Professional
Affiliate Staff appointments, reappointments,
modifications, resignations, suspensions,
terminations, and leaves of absence as well as
review and make recommendations regarding the
granting, renewal, modification, reduction or
revocation of clinical privileges.
(c)
Receive and review recommendations and other
input from the Medical Executive Committee of the
Medical Staff regarding the following, and shall
forward same to the Board for action as may be
necessary:
1.
Adoption, amendment and repeal of the
Bylaws, and Rules and Regulations of the
Medical Staff, including provisions for the
Medical Staff peer review process.
27
2.
Establishment of the Trust policies dealing with
patients' rights to accept or refuse medical
treatment and to formulate advance directives.
3.
Any other communications, requirements or
recommendations from the Medical Staff.
(d)
Assure the competence of all persons within the
Trust Facilities who provide patient care.
(e)
Review and forward recommendations to the Board
regarding the Trust's various accreditation and
regulatory compliance programs and review and
evaluate activities relating to the accreditation of
Jackson Memorial Hospital and other Trust
Facilities.
(f)
Receive and forward recommended procedures for
patient safety and the protection and care of Trust
patients and others utilizing the facilities of the
Trust including any event of disaster.
(g)
In closed sessions, if allowed by Florida law,
receive, review and make any necessary
recommendations to the Board with respect to
reports on the quality assessment and improvement
activities within the Trust Facilities. These reports
describe implementation, through the Trust's
Quality Assessment and Improvement and Risk
Management Programs, the various mechanisms
used by the medical, administrative, and other staff
for monitoring and evaluating the quality of patient
28
care, for identifying and resolving problems and for
identifying opportunities to improve care. Pursuant
to federal and Florida law, including, but not limited
to, Sections 395.0193, 395.0197 and 766.101,
Florida Statutes, the proceedings and records of the
Joint Conference Committee (as it relates to Quality
Assessment and Improvement and Risk
Management Programs) are not public records
under Chapter 119, Florida Statutes and meetings
held by the Committee in exercising its
responsibilities as set forth above are not open to
the public under Chapter 286, Florida Statutes.
(h)
Review and make recommendations to the Board
with respect to the Annual Quality Plan for Trust
Facilities.
(i)
The President of the Medical Staff shall have the
opportunity to address the Board through the Joint
Conference >>and Efficiencies<< Committee and
to make presentations to the committee on matter of
concern to the Medical Staff or to the Trust in
general concerning the delivery of medical services
in the Trust Facilities.
c.
[Strategic] >>Strategy and Growth<< Committee. There shall be
a [Strategic] >>Strategy and Growth<< Committee.
Strategic Committee shall:
29
The
(1)
Develop and recommend to the Board long range five (5)
year plans for the delivery of health care services in the
Trust Facilities as required by the Trust Ordinance.
(2)
Annually make recommendations to the Board
regarding long-range strategic plans and compliance with
plans approved by the Board. The President shall report
quarterly to the committee regarding his or her
recommendations and compliance with approved strategic
plans.
(3)
Establish short term priority planning for specific services,
prepare a statement of the problems of achieving short term
and strategic programs and an estimate of the financial
requirements, assess the financial ability of the community
to support the Trust's programs of services, and make
recommendations to the Fiscal Committee for said
requirements at least annually.
(4)
Determine the facilities required to meet program needs
and make appropriate recommendations to the Facilities
Subcommittee and the Fiscal Committee for provision of
said facilities at least annually.
(5)
Pursuant to Section 395.3035, Florida Statutes, the
proceedings and records of the [Strategic] >>Strategy and
Growth<< Committee are exempt and confidential as it
relates to “strategic plans” of the Trust as defined in such
statute, as amended from time to time.
(6)
The [Strategic] >>Strategy and Growth<< Committee
shall act for the Board and be empowered to take final
30
action (subject to subsequent ratification by the Board)
upon the determination of the Chairperson whenever
emergency action of the Board is required or time sensitive
matters must be addressed. If such action is taken, the
resolution or other action shall be submitted for ratification
to the Board at its next succeeding televised regular
meeting.
Section 3.
Committees Required By the Trust Ordinance.
The Financial Recovery Board shall have such other committees with the
composition that are set forth in the Trust Ordinance.
31
ARTICLE VII
ADMINISTRATION OF THE TRUST
Section 1.
Selection of Chief Executive Officer.
The Board shall appoint and employ a chief executive officer of the Trust
to be known as the President. The President shall be a full time salaried
employee at a salary fixed by the Board in accordance with the Trust
Ordinance. The President shall be an administrative officer representing
the Board in the management of the Trust and shall have the authority and
responsibility necessary for the proper management and operation of the
Trust Facilities, including all its activities, programs and departments.
Section 2.
Powers and Duties of the President.
The President shall:
a.
Act as the official representative of the Trust in all matters where
the Board has not otherwise provided and provide liaison among
the Board, the Medical Staff, and Trust Departments.
b.
Carry out policies established by the Board.
c.
Develop, coordinate and supervise all operating policies and
procedures for the Trust, organize administrative functions of the
hospital, establish formal means of accountability on the part of
subordinates, establish such Trust departments as are necessary,
provide for and attend or be represented at departmental and
interdepartmental meetings.
32
d.
Develop and submit to the Board for review and approval at the
regular meeting in January, policies and procedures regarding
outside employment; travel by employees on official business of
the Trust, including vendor-paid travel; gifts to employees; and
honorariums. The latest policies presented to and adopted by the
Board shall remain in force and effect unless the Board revises or
amends those policies and procedures by resolution.
e.
Assist the Medical Staff with its organization, in fulfilling its
responsibilities and in resolving medical- administrative problems.
f.
Annually, develop and submit to the Board for approval, a plan of
organization of the personnel and others involved in the operation
of the Trust Facilities.
g.
Develop in conjunction with the [Strategic] >>Strategy and
Growth<< Committee, and submit to the Board for evaluation and
approval, long range plans wherein the service objectives of the
Trust are defined in terms of supporting facilities, equipment,
personnel and required funding.
h.
Prepare a plan for the achievement of the Trust's specified
objectives and make progress reports at least semi-annually.
i.
Prepare, in conjunction with the Fiscal Committee, annual
operating and capital funding budgets with appropriate supporting
detail as required by the Board; develop performance reports
comparing actual operations with approved budgets, and not less
frequently than once every three months, submit a variance
analysis to the Fiscal Committee and the Board.
j.
Recommend to the Fiscal Committee and the Board a schedule of
rates and charges for Trust services and supplies.
33
k.
Submit to the Board monthly reports on the professional services
and financial condition of the Trust and submit such special reports
as may be requested by the Board.
l.
Make reports to the Board and to the Medical Staff regarding the
overall activities of Trust Facilities and Federal, State, County and
municipal developments as affect health care delivery.
m.
When directed and authorized by the Board, have charge and
custody of and be responsible for all operating funds of the Trust.
n.
Select, employ, direct, control, pay and discharge employees to the
extent such powers have been vested in the Trust, and develop and
maintain personnel policies and practices for the Trust Facilities.
o.
Maintain the physical properties of the Trust in a good state of
repair and operating condition.
p.
Supervise the business affairs of the Trust to assure that funds are
collected and expended in accordance with sound business
practices.
q.
Cooperate with the Medical Staff and with all those concerned
with the rendering of professional services, in the provision of
quality care to the patients, and periodically evaluate such care and
submit recommendations for the improvement thereof to the Joint
Conference >>and Efficiencies<< Committee and the Board.
r.
Attend all meetings of the Board and attend or be represented at all
meetings of Board committees.
s.
Designate an individual to act for the President in his or her
absence.
t.
Execute with an officer of the Board all contracts of the Trust
except as the Board shall otherwise provide. >>Notwithstanding
34
the foregoing, the President shall have no authority to execute
any contract for the expenditure of Trust funds in excess of
$__________ unless there has been final action and is otherwise
in compliance with Article V, Section 6 of these Bylaws.<<
u.
Perform such other duties as may be necessary for the best
interests of the Trust or which may be assigned by the Board.
Section 3.
Office of Internal Audit.
The President shall hire an Internal Auditor with the concurrence of the
Board who shall report directly to the Chairperson of the Board and shall
be responsible for the administration of the Office of Internal Audit. The
President is authorized to remove the Internal Auditor, but only after the
Chairperson concurs in the removal of the Internal Auditor.
The Office of Internal Audit shall (i) provide internal auditing functions,
(ii) act as the central depository for public information relating to public
record requests, (iii) review and account for any and all relationships
between the Trust and private entities, and (iv) interface and coordinate
with and serve as the Trust’s liaison to the Miami-Dade County Office of
Inspector General. The Office of Internal Audit shall report directly to the
The Office of Internal Audit through the
President shall make monthly written reports to the Board at its regular
meetings. The written reports shall also be disseminated to the Mayor,
Commission, County Manager, the Office of Countywide Healthcare
Planning, the Commission Auditor, and Miami-Dade Office of Inspector
35
General. The President shall develop written policies and procedures for
the organization and operation of the Office of Internal Audit and submit
the same to the Board for approval.
36
ARTICLE VIII
MEDICAL STAFF
Section 1.
Organization; Bylaws.
a.
The Board, through the Medical Executive Committee of the
Medical Staff, shall provide for the organization and governance of
practitioners granted medical staff membership, health professional
affiliate membership and clinical privileges in the Trust Facilities.
b.
The organized Medical Staff shall operate and be governed
pursuant to bylaws and rules and regulations which shall be
proposed and recommended by the Medical Staff to the Joint
Conference Committee, but which shall not become effective until
adopted by the Board. Nothing contained in this or any other
article of these Bylaws or the Bylaws and Rules and Regulations of
the Medical Staff shall limit the authority of the Board to make any
and all decisions and to prescribe any and all rules, regulations and
bylaws necessary for the proper operation, maintenance control
and governance of the Trust Facilities; provided, however, that the
Trust may not unilaterally amend the Bylaws and Rules and
Regulations of the Medical Staff. The Medical Staff periodically
shall review its Bylaws and Rules and Regulations to assure
consistency with Trust policies and with applicable legal,
accreditation or other requirements.
c.
The Bylaws and Rules and Regulations of the Medical Staff shall:
37
(1)
Define the duties and responsibilities of the Medical Staff
with regard to patient care, teaching and research and set
forth procedures by which the Medical Staff shall exercise
and account for its authority and responsibilities.
(2)
Provide for the qualifications for appointment and
reappointment
to
the
Medical
Staff,
and
Health
Professional Affiliate Staff and the procedures to be
followed by practitioners requesting such appointment or
reappointment
as
required
by law
and
applicable
accreditation standards.
(3)
Establish
a
procedure
for
the
granting,
renewal,
modification, or revocation of clinical privileges to
members of the Medical Staff or Health Professional
Affiliate staff as required by law and applicable
accreditation standards.
(4)
Provide a process for review of adverse decisions affecting
membership or clinical privileges of the Medical Staff or
Health Professional Affiliate staff including the right to be
heard throughout the process, when requested by the
practitioner.
This process shall comply with the
requirements of law as well as the Joint Commission on
Accreditation of Health Care Organizations. This process
shall be reviewed on an annual basis and recommendations
38
with respect thereto shall be forwarded to the Board
through the Joint Conference >>and Efficiencies<<
Committee.
(5)
Provide a method of election of officers of the Medical
Staff and a method of selection of chiefs of clinical
services, and shall prescribe powers and duties of such
officers and chiefs.
(6)
Provide for Medical Staff committees and the method of
appointment thereto.
(7)
Provide
for
compliance
with
all
applicable
laws,
regulations and applicable accreditation standards.
Section 2.
Medical Staff Membership and Clinical Privileges.
a.
Membership on the Medical Staff shall be a prerequisite to the
exercise of clinical privileges within the Trust Facilities, except as
otherwise provided in the Bylaws and Rules and Regulations of the
Medical Staff.
b.
Only members of the Medical Staff may admit patients to the Trust
Facilities, except as otherwise provided in the Bylaws and Rules
and Regulations of the Medical Staff.
c.
Each member of the Medical Staff shall have appropriate authority
and responsibility for the care of his or her patients subject to such
limitations as are contained in these Bylaws, the Bylaws and Rules
and Regulations of the Medical Staff, Trust Policies and
Procedures and any limitations to the medical staff member’s
membership or clinical privileges.
39
d.
In accordance with the Bylaws of the Medical Staff, the Medical
Staff shall make recommendations to the Board, through the Joint
Conference >>and Efficiencies<< Committee and the Board shall
take action regarding Medical Staff and Health Professional
Affiliate Staff appointments, reappointments, modifications,
resignations, suspensions, termination and leaves of absence as
well as take action regarding the granting, renewal, modification,
reduction or revocation of clinical privileges.
e.
The number of practitioners granted Medical Staff membership,
Health Professional Affiliates Staff membership and clinical
privileges shall not be in excess of the needs of the Trust.
f.
All appointments to the Medical Staff and Health Professional
Affiliate Staff shall be as set forth in the Bylaws and Rules and
Regulations of the Medical Staff and not for a period longer than
two (2) years and shall be reviewed by the Board in accordance
with the reappointment procedure outlined in the Bylaws of the
Medical Staff.
g.
No aspect of Medical Staff membership status, Health Professional
Affiliate Staff status or specific clinical privileges shall be
unreasonably limited or denied on the basis of gender, race, creed,
disability, age, familial status, sexual orientation, color or national
origin.
Section 3.
Medical Staff Responsibilities.
a.
The Board shall hold the Medical Staff responsible for providing
appropriate healthcare to Trust patients.
b.
The Medical Staff, in accordance with its Bylaws, applicable law
and accreditation standards, shall conduct continuing review and
40
appraisal of the quality of healthcare in the Trust Facilities, and
shall report the results thereof to the Board, through the Joint
Conference >>and Efficiencies<< Committee.
c.
The Medical Staff shall participate, along with appropriate
administrative and professional staff, in the development of Trust
policies regarding:
1.
Patients' rights and responsibilities, including the rights and
responsibilities of the parents and/or guardians of neonate,
child and adolescent patients; and
2.
A patient's right to accept or refuse medical treatment and
formulate advance directives.
41
ARTICLE IX
AUXILIARY ORGANIZATIONS
The Board may authorize the establishment of auxiliary organizations for the purpose of
assisting the Trust in its objectives. The Bylaws of any such auxiliary organization shall be
subject to the approval of the Board and the program of any such organization shall be subject to
the approval of the President of the Trust. Each auxiliary organization shall submit annually to
the Board a report of its operations and financial affairs.
42
ARTICLE X
ADOPTION AND AMENDMENTS
These Bylaws may be adopted, altered, amended or repealed and new Bylaws may be adopted by
a vote of two-thirds (2/3) of the voting membership of the Board then in office at any duly
constituted Board meeting provided that written notice of the proposed alterations, amendments,
repeal or new enactments shall have been given to all Members not later than five (5) days in
advance of such meeting. At the direction of the Chairperson, the Board shall provide for review
of these Bylaws on a periodic basis.
43
3.
Legislative Update
4.
Strategy Update
4 (a)

PHT FRB One Day Committee Meeting

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