Emergency Physicians Integrated Care, L

EPIC, L.L.C Board Meeting December 19, 2007

Time: 9:00 am Location: EPIC Office

Conducted by: Mark Flammer, MD

Members Present: Jim Antinori, MD Ben Buchanan, MD David Cole, MD William Sheffield, MD Bart Johansen, MD

Others Present: Robert Parker, Jr, CEO Mike Hansen, CFO Ingrid Gordon Tim Wolfe, QA

Mark Flammer, MD called the meeting to order at 9: 10 am. Minutes: Minutes from the November 14, 2007 meeting were approved as written.

QA Report: Tim Wolfe, MD, QA Director asked the Board for direction on what his QA focus should be for 2008. After discussion by the Board, it was suggested that he continue to provide the journal club, as well as presenting malpractice cases for physicians to learn from.

Tim noted that he does not have as much time to devote to QA projects as he had in the past and would be willing to step down if the Board wanted to appoint someone else. The Board felt he was doing a good job and asked him to continue as QA director.

Bob reported that Roger Perry, MD, Compliance officer would like to report the results of the chest pain audit to each division at their division meeting. His presentation would take approximately 30 minutes.

Financials: Mike Hansen, EPIC CFO: presented the financial information for October 2007. It included comparative data by hospital. (see reports attached)

He noted that Molina has been behind in payments and EPBS just received a large payment this month.

James Antinori, MD asked Bob to check with EPBS to see if we can require Molina to pay interest on late paid claims, as there is a prompt pay law that requires insurance companies to pay interest on claims that are paid late.

1 Mike reported that each division will receive the entity capital funds at year end. (see report attached) He reviewed his schedule for year end distributions.

IHC Settlement: Bob reported that he has negotiated a settlement with IHC for claims that were paid incorrectly during 2005- 2007. The original money that IHC owed EPIC was around $800,000. After the patient deductibles were taken out as well as the amount for non-covered codes, the settlement he was able to negotiate was $444,000.

Bob asked the Board for a motion to approve the settlement. A motion was made and it was unanimously approved by the Board. The divisions will receive $444,000 to be distributed to the divisions by year end. (see IHC settlement report by division, attached)

The Board expressed concern that EPBS had not realized that the IHC claims were not being paid at the correct contracted rate. Bob has asked EPBS to review insurance payments quarterly to make sure we are being paid our correct contracted rate.

The Board asked Bob to prepare slides for the next Board meeting to show what our contracted rates are by payor.

ED Rate Increases for 2008: Bob reported he is working with Brian Cain at EPBS to determine what our fee schedule rate increase should be for 2008.

Electronic T: Bob reported that IASIS backed down on their promise to allow us to use the T-System electronic T at Pioneer Valley Hospital for 6 months. Most likely we will be expected to use the New Wave Electronic Template. Bob noted that Kirk Olsen, IASIS Utah Market President will be coming to report on this decision today.

Bob has requested that Jordan Valley Hospital be the first facility to use the New Wave electronic template. In addition has asked that during the roll- out, that Kirk Olsen, Bryanie Swilley as well as the CNO to be physically present in the emergency department, to Jail Update: witness first hand how inefficient the system is.

Bob will also be meeting with Brian King and Salt Lake County to negotiate attorney fees, interest, and Job Fair: charges at PEHP’s negotiated rate on December 27th 2007.

Bob reported that EPIC will be participating in a job fair being offered by UMA. It will be held in the tower Moonlighting by Senior EM Residents: at University of Utah and he would like to have some physicians there to meet with the residents. Bob will e-mail out the information on the job fair.

Bob reported he is working with Peter Taillac, MD on the language that needs to be included in each of our

2 hospital bi-law. He asked Board members to start the UIA Update: process with their medical executive committee, so that by next year the senior ED residents will be able to work in our emergency departments. (See sample of language attached).

Bob read the e-mail Rob Simmons sent him, regarding his meeting with UIA on the radiology issues we would like to resolve. The Board would like the radiologist to call the physician on a missed read, as well as document it on their report. Budget 2008: David Cole, MD asked that we start meeting regularly with the radiology group that services Pioneer Valley to improve services. He would like Bryanie Swilley, CEO for JVH and PVH to be involved with the meetings.

Bob reported that he has tied the annual budget based on revenue for 2003 for several years now. We have added several large EPIC expenses this past year and he is unable to do a budget based on the 2003 revenue. He noted he is about $50,000 short. He asked that the Board to approve increasing the revenue base. It was suggested that it could be based it on the 2005 revenue.

No final decision was made on what revenue Bob should base the budget on. He will work it several ways (increasing it by a dollar amount or by 2005 revenues) and get back to Mark Flammer on what works out best.

The final budget for 2008 will be sent out by e-mail for the Board members approval. Hospital Syndication: Bob reported that IASIS syndication offering for SLRMC will close on January 31, 2008. The second offering of JVH and PVH will also close January 31, 2008. Extender Bonus: Bart Johansen, MD reported that the increased bonus amount for the extenders for MSO RVU’s has cost his group more than they had agreed upon. There was discussion by the Board. It was agreed that the bonus for MSO’s be returned to the original formula and that extenders will receive $25 for MSO’s in addition to the standard bonus proposal. Extender Supervision Document: Bob reported the compliance committee added the following to the Extender Supervision Document: Extenders would need face-to-face supervision with the physician for procedural sedation.

No final decision was made to approve this change. IASIS Report: Kirk Olsen, IASIS Utah Market President reported that Sandra McRee went back on her promise to allow Pioneer Valley to use the T-Systems electronic record for 6 months. He noted he has not heard when the official start date will be for using the NW electronic template system.

The Board expressed their concern about the inefficiencies and risks of using the NW product. They

3 brought Kirk up-to-date with the history of Epic’s involvement to help IASIS develop a good template product. The told him the physicians are willing to use any good electronic product.

Kirk noted that he would like to go to ORMC to see the T- System at work. Bob will set up a time for that visit. Kirk will also find an IASIS facility where the NW system is actively being used and will visit that facility along with some of the EPIC physicians.

Kirk noted that our use of the MSO process is looking better and appreciated the physician’s effort. Staffing Issues at SLRMC: Ben Buchanan, MD, asked the Board if any of their division had extra shifts for Andrew Florence, as he will become a partner for the UES division but will only have half-time shifts. They would like to continue to use Andrew at SLRMC for the other half of the shifts he needs, but this will make it difficult for them to recruit someone who would be willing to come on for less then full time.

There is a possibility that Matthew Hollifield, MD would be interested in working for them at ½ or ¾ time. Dr. Buchanan will contact him to find out if this is something he is willing to do.

Bob Parker 2007 Bonus Criteria: Dr. Flammer noted that Bob’s Bonus criteria will be discussed at the January 2008 Board Meeting. He asked Board members to e-mail him suggested criteria for his bonus.

Meeting adjourned: 12:00 pm. Next meeting is scheduled for January 16, 2008 at the EPIC office.