Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019 1:00 p.m.
Agenda
Board Members Mark G. Dewane, Chairman, District 2 AGENDA – Formal Meeting Mary A. Harden, R.N., Vice Chair, District 1 Susan Gerard, Director, District 3 Maricopa County Special Health Care District J. Woodfin Thomas, Director, District 4 Board of Directors Mary Rose Wilcox, Director, District 5
President & Chief Executive Officer Stephen A. Purves, FACHE Mission Statement
Clerk of the Board The Valleywise Health’s mission is to provide exceptional care, without Melanie Talbot exception, every patient, every time.
Meeting Location Valleywise Health Medical Center Conference and Administration Center Auditoriums 1 and 2 2601 E. Roosevelt Street Phoenix, AZ 85008
Welcome The Board of Directors is the governing body for the Maricopa County Special Health Care District. Each member represents one of the five districts in Maricopa County. Members of the Board are public officials, elected by the voters of Maricopa County. The Board of Directors sets policy and the President & Chief Executive Officer, who is hired by the Board, directs staff to carry out the policies.
How Citizens Can Participate Each meeting is open to the public and there is a “Call to the Public” at the beginning of each meeting. An individual may address the Board of Directors at this time or when the agenda item to be addressed is reached. If you wish to address the Board, please complete a Speaker’s Slip and deliver it to the Clerk of the Board prior to the Call to Public. If you have anything that you wish distributed to the Board and included in the official record, please hand it to the Clerk who will distribute the information to the Board members and Valleywise Health Senior Staff.
Speakers will be called in the order in which requests to speak are received. Your name will be called when the Call to Public has been opened or when the Board reaches the agenda item which you wish to speak. As mandated by the Arizona Open Meeting Law, officials may not discuss items not on the agenda, but may direct staff to follow-up with the citizen.
Public Rules of Conduct The Board Chair shall keep control of the meeting and require the speakers and audience to refrain from abusive or profane remarks, disruptive outbursts, applause, protests, or other conduct which disrupts or interferes with the orderly conduct of the business of the meeting. Personal attacks on Board members, staff, or members of the public are not allowed. It is inappropriate to utilize the Call to Public or other agenda item for purposes of making political speeches, including threats of political action. Engaging in such conduct and failing to cease such conduct upon request of the Board Chair will be grounds for ending a speaker’s time at the podium or for removal of any disruptive person from the meeting room, at the direction of the Board Chair.
Agendas are available within 24 hours of each meeting in the Office of the Board, Valleywise Health Medical Center, Conference and Administration Center, 2nd Floor 2601 E. Roosevelt, Phoenix, AZ 85008, Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. and on the internet at https://valleywisehealth.org/about/board-of- directors/. Accommodations for Individuals with disabilities, alternative format materials, sign language interpretation, and assistive listening devices are available upon 72 hours advance notice through the Office of the Board, Valleywise Health Medical Center, Conference and Administration Center, 2nd Floor 2601 E. Roosevelt, Phoenix, Arizona 85008, (602) 344- 5177. To the extent possible, additional reasonable accommodations will be made available within the time constraints of the request.
9/19/2019 10:02 AM Valleywise Health Medical Center Conference and Administration Center Auditoriums 1 and 2 2601 E. Roosevelt Phoenix, AZ 85008
Wednesday, September 25, 2019 1:00 p.m.
One or more of the members of the Board of Directors of the Maricopa County Special Health Care District may attend telephonically. Board members attending telephonically will be announced at the meeting.
Pursuant to A.R.S. § 38-431.03(A)(3), or any applicable and relevant state or federal law, the Board may vote to recess into an Executive Session for the purpose of obtaining legal advice from the Board’s attorney or attorneys on any matter listed on the agenda. The Board also may wish to discuss any items listed for Executive Session discussion in General Session, or the Board may wish to take action in General Session on any items listed for discussion in Executive Session. To do so, the Board will recess Executive Session on any particular item and reconvene General Session to discuss that item or to take action on such item.
If you are carrying a cell phone, pager, computer, or other sound device, we ask that you silence it at this time to minimize disruption of the meeting.
1:00 Call to Order
Roll Call
Pledge of Allegiance
1:05 Call to the Public This is the time for the public to comment. The Board of Directors may not discuss items that are not specifically identified on the agenda. Therefore, pursuant to A.R.S. § 38-431.01(H), action taken as a result of public comment will be limited to directing staff to study the matter, responding to any criticism or scheduling a matter for further consideration and decision at a later date.
ITEMS MAY BE DISCUSSED IN A DIFFERENT SEQUENCE
General Session, Presentation, Discussion and Action:
1:15 1. Approval of Consent Agenda: 15 min Note: Approval of contracts, minutes, IGA’s, proclamations, etc. Any matter on the Consent Agenda will be removed from the Consent Agenda and discussed as a regular agenda item upon the request of any Board member.
a. Minutes:
i. Approve Special Health Care District Board of Directors meeting minutes dated August 26, 2019 Melanie Talbot, Valleywise Health, Chief Governance Officer; and Clerk of the Board
ii. Approve Special Health Care District Board of Directors meeting minutes dated August 28, 2019 Melanie Talbot, Valleywise Health, Chief Governance Officer; and Clerk of the Board
2 General Session, Presentation, Discussion and Action, cont.:
1:15 1. Approval of Consent Agenda, cont.:
b. Contracts:
i. Approve an Easement Access Agreement (90-20-029-1) for Soil Gas Sampling between the Maricopa County Special Health Care District and NXP, USA, Inc. and Honeywell International, Inc., at the Roosevelt Campus at 2601 East Roosevelt Street, Phoenix, Arizona 85008 Warren Whitney, Valleywise Health, Senior Vice President, Government Relations
ii. Approve Amendment #2 to the Intergovernmental Agreement (IGA) (90-16-070- 1-02 [ADHS16-103631]) with Arizona Department of Health Services (ADHS) for the HIV Prevention Program. This IGA will continue to provide funding for the HIV testing of individuals presenting for treatment in the Valleywise Health Medical Center Emergency Department and other Valleywise Health facilities Michael White, M.D., Valleywise Health, Executive Vice President, Chief Medical Officer
iii. Approve a new contract (90-20-028-4) between Flex Financial and the Maricopa County Special Health Care District dba Maricopa Integrated Health System (MIHS) for an Equipment Lease and related accessories for Laparoscopic and Arthroscopic procedures in the operating room Sherry Stotler, MIHS, Senior Vice President, Chief Nursing Officer
c. Governance:
i. Approve registration fee, mileage, lodging, and meal & incidentals per diem not to exceed rates allowable under applicable District practices or policies for Director Thomas to attend Arizona Hospital and Healthcare Association’s Annual Membership Conference, October 23-25, 2019, in Tucson, Arizona. Melanie Talbot, Valleywise Health, Chief Governance Officer; and Clerk of the Board
ii. Approve Affidavit Appointing Jeffrey Brichta, D.O., as Deputy Medical Directors in the Department of Psychiatry Gene Cavallo, Valleywise Health, Senior Vice President Behavioral Health Services
iii. Accept Staff’s Recommendation to Submit a Renewal of Designation Application to Health Resources and Services Administration for the Continuation of Federally Qualified Health Centers Look-Alike Status Barbara Harding, Valleywise Health, Federally Qualified Health Centers Chief Executive Officer
iv. Accept Grant Award, H80CS33644-01-00, provided by the Health Resources and Services Administration (HRSA) for the Maricopa County Special Health Care District’s Health Center Program Barbara Harding, Valleywise Health, Federally Qualified Health Centers Chief Executive Officer
3 General Session, Presentation, Discussion and Action, cont.:
1:15 1. Approval of Consent Agenda, cont.:
d. Medical Staff:
i. Approve Valleywise Health Medical Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for September 2019 Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
ii. Approve Valleywise Health Allied Health Professional Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for September 2019 Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
iii. Approve Proposed Revisions to the Pediatric Gastroenterology Privileges Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
iv. Approve Proposed Revisions to the Internal Medicine – Cardiology Privileges Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
v. Approve Proposed Revisions to the Global Robotic Surgery Privileges Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
vi. Approve Proposed Revisions to the Physician Assistant Privileges and Practice Prerogatives Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
vii. Approve Proposed Revisions to the Certified Nurse Midwife Privileges and Practice Prerogatives Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
viii. INTENTIONALLY LEFT BLANK
4 General Session, Presentation, Discussion and Action, cont.:
1:15 1. Approval of Consent Agenda, cont.:
d. Medical Staff:
ix. Approve Proposed Revisions Policy 31201 T: Medical Staff Rules & Regulations Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
x. Approve Proposed Revisions Policy 39011 T: Allied Health Professionals Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
xi. Approve Annual Peer Review Report Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
xii. Confirm William D. Dachman, M.D., Internal Medicine, as Vice Chief of Staff, (October 1, 2019 – December 31, 2019) Kevin G. Lopez, M.D., Valleywise Health, Chief of Staff, Clinical Medical Director of Avondale Family Health Center, Ambulatory Quality Medical Director of the Family Health Centers, Vice Chairman, Department of Family and Community Medicine
e. Care Reimagined Capital:
i. INTENTIONALLY LEFT BLANK
f. Capital:
i. Approve Capital Expenditure Request (20-408) for the Purchase of End User Devices for a cost of $490,798 Kelly Summers, MIHS, Senior Vice President, Chief Information Officer
ii. Approve Capital Expenditure Request (19-046A) for the Purchase of PeriWatch application, licenses, hardware and interfaces for Fetal Monitoring for a cost of $273,583 Kelly Summers, MIHS, Senior Vice President, Chief Information Officer
______End of Consent Agenda______
1:30 2. Discuss and Review Det Norske Veritas - Germanischer Lloyd (DNV-GL) Quality Management System (QM) 7: Measurement, Monitoring, Analysis 20 min Crystal Garcia, Valleywise Health, Vice President Quality Management and Patient Safety
1:50 3. Home Assist Health (HAH) Year End Report – Fiscal Year 2019 10 min Sara Wilson, HAH, President and Chief Executive Officer
5 General Session, Presentation, Discussion and Action, cont.:
2:00 4. Discuss and Review August 2019 Valleywise Health Financials and Statistical Information 15 min Rich Mutarelli, Valleywise Health, Executive Vice President, Chief Financial Officer Kris Gaw, Valleywise Health, Executive Vice President, Chief Operating Officer
2:15 5. Discuss, Review and Approve First Amendment to the Executive Employment Agreement Between Stephen A. Purves and the Maricopa County Special Health Care District 5 min Board of Directors
2:20 6. Discuss, Review and Approve the President & Chief Executive Officer’s Performance Goals for Fiscal Year 2020 5 min Board of Directors
2:25 7. Review and Possible Action on Reports to the Board of Directors 15 min
a. Monthly Marketing and Communications Report Bill Byron, Valleywise Health, Senior Vice President, Marketing and Communications
b. Monthly Care Reimagined Capital Purchases Rich Mutarelli, Valleywise Health, Executive Vice President, Chief Financial Officer
c. Monthly Valleywise Health Employee Turnover Report Justina Sanchez Cox, Valleywise Health, Senior Vice President, Chief Human Resources Officer
2:40 8. Concluding Items 15 min
a. Old Business:
June 26, 2019
Legislative Update Keep the Board apprised of any immigration issue changes as the federal level
August 28, 2019
Concluding Items Valleywise Health employee turnover report should be included in the Board packet each month
b. Board Member Requests for Future Agenda Items or Reports
c. Comments i. Chairman and Member Closing Comment ii. President and Chief Executive Officer Summary of Current Events
2:55 Adjourn
6
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.a.i.
Minutes August 26, 2019 Minutes
Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditorium 2 August 26, 2019 1:00 p.m.
Present: Mark G. Dewane, Chairman, District 2 Mary A. Harden, Vice Chairman, District 1 Susan Gerard, Director, District 3 – telephonically until 5:01 p.m. Mary Rose Wilcox, Director, District 5
Absent: J. Woodfin Thomas, Director, District 4
Others Present: Steve Purves, MIHS, President & Chief Executive Officer Kris Gaw, MIHS, Executive Vice President, Chief Operating Officer Rich Mutarelli, MIHS, Executive Vice President, Chief Financial Officer Sherry Stotler, R.N., M.S.N., MIHS, Senior Vice President, Chief Nursing Officer – left at 4:29 p.m. Barbara Harding, MIHS, Senior Vice President, Ambulatory Care Services, and Chief Executive Officer, Federally Qualified Health Center Look-Alike Clinics – left at 4:29 p.m. Stephen Blaylock, MIHS, Project Executive, Integrated Project Management Office Warren Whitney, MIHS, Senior Vice President Government Relations – left at 4:29 p.m. Gene Cavallo, MIHS, Senior Vice President Behavioral Health Services – left at 4:29 p.m. Jo-el Detzel, MIHS, Vice President Ancillary Services – left at 4:29 p.m. Todd Hanle, MIHS, Director of Marketing and Communications – arrived at 5:26 p.m. William J. Sims, Sims Mackin, Ltd., Board Counsel Martin Demos, MIHS, General Counsel
Recorded by: Melanie Talbot, MIHS, Chief Governance Officer; and Clerk of the Board Cynthia Cornejo, MIHS, Deputy Clerk of the Board
Call to Order:
Chairman Dewane called the meeting to order at 1:02 p.m.
Roll Call
Ms. Talbot called roll. Following roll call, it was noted that four of the five voting members of the Maricopa County Special Health Care District Board of Directors were present, which represented a quorum. Director Gerard participated telephonically.
For the benefit of all participants, Ms. Talbot named the individuals seated at the table, as well as those participating telephonically.
Special Health Care District Board of Directors Meeting Minutes – General Session – August 26, 2019
Call to the Public
Chairman Dewane called for public comment. There were no public comments.
General Session, Presentation, Discussion and Action:
1. Recess General Session and Convene in Executive Session
MOTION: Director Wilcox moved to recess general session and convene in executive session at 1:04 p.m. Vice Chairman Harden seconded.
VOTE: 4 Ayes: Chairman Dewane, Vice Chairman Harden, Director Gerard, Director Wilcox 0 Nays 1 Absent: Director Thomas Motion passed.
Executive Session:
E-1 Legal Advice; Contracts Subject to Negotiations; Records Exempt by Law from Public Inspection; A.R.S. § 38-431.03(A)(3); A.R.S. § 38-431.03(A)(4) and A.R.S. § 38-431.03(A)(2)1: Maricopa County Special Health Care District d.b.a. Maricopa Integrated Health System strategic plan portfolio, options, implementation, initiatives and goals, including resources, clinical, behavioral, financial, operational, business, and service line strategy options going forward
1 Exemptions based upon A.R.S. § 48-5541.01(M)(4) (c) and (d) including records or other matters, the disclosure of which would cause demonstrable and material harm and would place the district at a competitive disadvantage in the marketplace; or violate any exception, privilege or confidentiality granted or imposed by statute or common law.
General Session, Presentation, Discussion and Action:
Chairman Dewane reconvened general session at 5:26 p.m. in the Navajo East and West Rooms of the Administration Building to continue the discussion about the Maricopa County Special Health Care District’s strategic plan portfolio, options, implementation, initiatives and goals, including resources, clinical, behavioral, financial, operational, business, and service line strategy options going forward.
Mr. Byron displayed the advertising and promotional samples that would be used to announce and promote Valleywise Health to the public, including outdoor billboards, public transit shelters, and digital advertisements.
Vice Chairman Harden asked if there would be bus wraps incorporated into the plan.
Mr. Hanle said that there would not be any bus wraps, however, there would be advertisements on public transit shelters.
Mr. Byron highlighted how the organization’s Mission, Vision and Values would be displayed going forward.
Vice Chairman Harden noted that the Values needed to be reorganized to Accountability, Compassion, Excellence and Safety (ACES).
Mr. Byron outlined an upcoming promotion event, which would introduce the brand and name to the community in an interactive format. He also provided a snapshot of the redesigned website, which would allow the community to gain medical information, book appointments, and make payments.
2
Special Health Care District Board of Directors Meeting Minutes – General Session – August 26, 2019
General Session, Presentation, Discussion and Action, cont.:
He presented the plans to incorporate the Valleywise Health nomenclature and logo on existing facilities and monuments throughout the ambulatory network. The signage would provide consistency throughout the network.
Mr. Byron showed a television commercial that would be aired. There would also be radio advertisements. All advertisements would be aired in English and Spanish.
Adjourn
MOTION: Vice Chairman Harden moved to adjourn the August 26, 2019 Special Health Care District Board of Directors Executive Session. Director Wilcox seconded.
VOTE: 3 Ayes: Chairman Dewane, Vice Chairman Harden, Director Wilcox 0 Nays 2 Absent: Director Gerard, Director Thomas Motion passed.
Meeting adjourned at 5:38 p.m.
______Mark G. Dewane, Chairman Special Health Care District Board of Directors
3
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.a.ii.
Minutes August 28, 2019 Minutes
Maricopa County Special Health Care District Board of Directors Meeting Maricopa Medical Center Auditoriums 1 and 2 August 28, 2019 1:00 p.m.
Present: Mark G. Dewane, Chairman, District 2 Mary A. Harden, Vice Chairman, District 1 Susan Gerard, Director, District 3 – telephonically J. Woodfin Thomas, Director, District 4 Mary Rose Wilcox, Director, District 5
Others Present: Steve Purves, MIHS, President & Chief Executive Officer Kris Gaw, MIHS, Executive Vice President, Chief Operating Officer Rich Mutarelli, MIHS, Executive Vice President, Chief Financial Officer Sherry Stotler, R.N., M.S.N., MIHS, Senior Vice President, Chief Nursing Officer Pedro Quiroga, M.D., MIHS, Vice Chief of Staff – left at 1:10 p.m. Martin Demos, MIHS, General Counsel
Guest Presenters: Stephen Blaylock, MIHS, Project Executive, Integrated Program Management Office Melissa Kotrys, Chairman, Maricopa Health Centers Governing Council Gholamabbas Amin Ostovar, M.D., MIHS, Infection Control Officer Gene Cavallo, MIHS, Senior Vice President, Behavioral Health Services Justina Sanchez Cox, MIHS, Senior Vice President, Chief Human Resources Officer LT Slaughter, MIHS, Chief Compliance Officer Lisa Hartsock, MIHS, Foundation Relations Executive Bill Byron, MIHS, Senior Vice President, Marketing and Communications
Recorded by: Melanie Talbot, MIHS, Chief Governance Officer; and Clerk of the Board Cynthia Cornejo, MIHS, Deputy Clerk of the Board
Call to Order:
Chairman Dewane called the meeting to order at 1:02 p.m.
Roll Call
Ms. Talbot called roll. Following roll call, it was noted that all five of the voting members of the Maricopa County Special Health Care District Board of Directors were present, which represented a quorum. Director Gerard participated telephonically.
For the benefit of all participants, Ms. Talbot named the individuals seated at the table, as well as those participating telephonically.
Pledge of Allegiance
Mr. Slaughter led the Pledge of Allegiance.
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
Call to the Public
Chairman Dewane called for public comment.
Mr. Purves noted that Dr. Michael White had officially began as Executive Vice President and Chief Medical Officer. Dr. White was attending an Epic conference and would be present at the next meetings.
Ms. Gaw acknowledged Mr. Gene Cavallo, who had been selected to receive a 2019 Arizona Capitol Times Leader of the Year Award. The award recognized individuals who tirelessly work to find ways to improve the quality of life for the state’s residents.
Mr. Blaylock announced that the Maryvale Hospital renovation project had won the 2019 Best Project Award from Engineering New Record (ENR) for the Healthcare Category in the Southwest Region. He introduced team members from Gilbane and Vanir Construction and congratulated them on the successful project.
Director Wilcox expressed her appreciation to the team for completing the project so quickly, opening the services to the Maryvale community.
Mission Statement
Ms. Talbot read the mission statement aloud.
General Session, Presentation, Discussion and Action:
1. Approval of Consent Agenda:
a. Minutes:
i. Approve Special Health Care District Board of Directors meeting minutes dated June 20, 2019
ii. Approve Special Health Care District Board of Directors meeting minutes dated June 26, 2019
iii. Approve Special Health Care District Board of Directors meeting minutes dated July 19, 2019
b. Contracts:
i. Approve a new lease (90-19-198-1) between the Maricopa Medical Foundation and the Maricopa County Special Health Care District dba Maricopa Integrated Health System for lease of 61 square feet on the third floor of Maricopa Medical Center
ii. Approve Amendment #3 to the contract (90-11-152-1-03) between Iron Mountain and the Maricopa County Special Health Care District for the destruction of radiology files
2
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
1. Approval of Consent Agenda, cont.:
b. Contracts, cont.:
iii. Approve an Intergovernmental Agreement (90-20-022-1) between Arizona Health Care Cost Containment System and the Maricopa County Special Health Care District dba Maricopa Integrated Health System for the transfer of public funds for use as the Non-Federal Share of the Medicaid payment under this Agreement for Graduate Medical Education Programs for the period of July 1, 2018 through June 30, 2019 for the benefit of Maricopa Medical Center, ($16,680,478.74); Abrazo Arrowhead ($867,815.55); Abrazo Central ($964,568.85); Canyon Vista Medical Center ($945,637.51); and Mountain Vista Medical Center ($2,389,833.33)
iv. Approve Amendment #2 to the contract (90-14-188-1-02) between Cardinal Health and Maricopa County Special Health Care District dba Maricopa Integrated Health System for the drug and device recovery program
v. Approve Amendment #14 to the contract (480-90-18-1-002) with Gilbane Construction for the Courtroom Construction Project at the Maryvale Hospital Campus. This amendment will allow MIHS to retain the same construction team currently on site and proceed without delays.
vi. Approve a new contract (MCO-20-001) between United Healthcare, Inc. and the Maricopa County Special Health Care District dba Valleywise Health establishing new commercial terms effective September 24, 2019
c. Governance:
i. Approve airfare, lodging, and meal & incidentals per diem not to exceed rates allowable under applicable District practices or policies for Director Wilcox to attend the American Hospital Association’s Regional Policy Board National Meeting, September 8-10, 2019, in Washington, D.C.
ii. Approve Revisions to the Maricopa Integrated Health System Compensation Plan
iii. Approve Board Resolution No. 2019-8-28-001 Formally Updating the Designation of the Individuals Authorized to Accept Service Adding the Assistant Clerk
iv. Approve Settlement Related to Maricopa County Superior Court Cause No. CV2016-051180
v. Approve Revision to Maricopa Integrated Health System Policy 13501 S: Patient Complaints and Grievances; and Delegate Management of Process to the Quality Management Council
d. Medical Staff:
i. Approve Maricopa Integrated Health System Medical Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for July and August 2019
3
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
1. Approval of Consent Agenda, cont.:
d. Medical Staff, cont.:
ii. Approve Maricopa Integrated Health System Allied Health Professional Staff Appointments, FPPEs, Reappointments, Change of Privileges/Status, Waiver Requests, and Resignations for July and August 2019
iii. Approve Proposed Revisions to the Nurse Practitioner Family and Community Medicine Privileges
iv. Approve Proposed Revisions to the Physician Assistant Family and Community Medicine Privileges
v. Approve Proposed Revisions to the Department of Family and Community Medicine Privileges
vi. Approve Proposed Revisions to the Department of Internal Medicine – Critical Care Medicine Privileges
vii. Approve Proposed Revisions to Policy 39016 S: Credentialing Practitioners in the Event of a Disaster
viii. Approve Proposed Revisions Policy 38018 S: Maricopa Integrated Health System Medical Staff Professionalism
e. Care Reimagined Capital:
i. Approve contract (480-90-19-003) with JRC Design for the design of the enterprise wide Valleywise Health interior and exterior wayfinding and building signage for a cost of $480,000 plus an additional $200,000 for alternative additions for any unforeseen conditions as they relate to signage requirements
ii. Approve contract (480-90-19-017) with DWL Architects + Planners Inc. (DWL) for Design Professional and Engineering Services for the following facilities: Maryvale Ambulatory Clinic: 4550 N. 51st Ave., Phoenix; West Maryvale Ambulatory Clinic: 7808 W. Thomas Rd, Phoenix; Mesa Primary & Specialty Care Center: 950 E. Main St, Mesa; Chandler Ambulatory Clinic: 838 N. Alma School Rd., Chandler; Avondale Family Health Center upgrade: 950 E. Van Buren St, Avondale; and Guadalupe Family Health Center expansion: 5825 E. Calle Guadalupe, Guadalupe; for a cost of $400,000 for this Phase One (1); schematic design. Total project cost is $73,000,000
iii. Approve contract (480-90-19-018) with Okland Construction for Construction Manager at Risk (CMAR) for preconstruction services for the following facilities: Maryvale Ambulatory Clinic: 4550 N. 51st Ave., Phoenix; West Maryvale Ambulatory Clinic: 7808 W. Thomas Rd, Phoenix; Mesa Primary & Specialty Care Center: 950 E. Main St, Mesa; and Chandler Ambulatory Clinic: 838 N. Alma School Rd., Chandler. The preconstruction cost is $1,200,000. Total project cost is $69,000,000
4
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
1. Approval of Consent Agenda, cont.:
e. Care Reimagined Capital, cont.:
iv. Approve Amendments #6, #7, #10, #11, #12, and #13 (Amendments #8 and #9 are deductive changes) to the contract (480-90-18-002) with Gilbane Construction for Fire Sprinkler upgrades, operational and phased Arizona Department of Health Services (ADHS) licensing changes, Optex Laser alarm system, heating, ventilation and air conditioning changes to the building for exhaust system floors 3, 4 and 5 at the Maryvale Hospital Campus for a cost of $1,622,743. This is an increase to the Gilbane Construction contract for a new total contract of $55,546,458
f. Capital:
i. Approve Capital Expenditure Request (19-462) for the Purchase of Replacement Generators and the Maryvale Hospital Campus for a cost of $2,300,000
ii. Approve Capital Expenditure Request (20-401) for the Purchase of Alaris Infusion Devices for a cost of $2,800,000
iii. Approve Capital Expenditure Request (20-406) for Unit Renovations at the Roosevelt Campus Behavioral Health Annex Building (Annex) for a cost of $1,348,985
iv. Approve Capital Expenditure Request (20-407) for the Replacement of Tablets used in Behavioral Health for a cost of $362,278
v. Approve Capital Expenditure Request (20-300) for the Construction of a Courtroom at the Maryvale Hospital Campus utilizing Targeted Investment Program Funds in the Amount of $1,665,303 for a total project cost of $1,889,873
vi. Approve Capital Expenditure Request (20-404) for the Purchase of Valleywise Health Free-standing Monument Signs and Exterior Facility Signs for a cost of $1,000,000
vii. Approve Capital Expenditure Request (20-409) for the Purchase of Monitors and Workstations for Radiology for a cost of $279,232
Chairman Dewane removed consent agenda item 1.c.ii., revisions to the Maricopa Integrated Health System (MIHS) Compensation Plan from the consent agenda. The item would not be discussed or voted on.
MOTION: Vice Chairman Harden moved to approve the consent agenda minus item 1.c.ii. Director Wilcox seconded.
VOTE: 5 Ayes: Chairman Dewane, Vice Chairman Harden, Director Gerard, Director Thomas, Director Wilcox 0 Nays Motion unanimously passed.
5
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
2. Discuss and Review the Quarterly Quality Dashboard Including but not Limited to Patient Satisfaction Survey Results/ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores
Ms. Stotler reviewed the Quality Dashboard for the fourth quarter of fiscal year 2019 (FY19). For the Process of Care Measures, inpatient falls with injury did not meet the established benchmark on a year- to-date basis. A workgroup was still in place to implement best practices, including a falling star program, to prevent future occurrences, and each incident was thoroughly reviewed to uncover opportunities for improvement. For diabetes management in the ambulatory setting, staff continued to work with ambulatory leadership to improve hemoglobin A1c in patients. There was continued work surrounding Patient Experience, including realigning the patient advocate position, to be more proactive and address patient concerns promptly. She stated that there were two pressure ulcer cases in the fourth quarter, which caused the metric to fall outside the benchmark. Staff analyzed each case and continued to monitor.
Director Thomas asked if there was a small group of patients that were included in the metric, as one or two cases a quarter caused the metric to fall outside the target.
Ms. Stotler said that all patients were monitored for pressure ulcers, however, the goal was aggressive, and the goal was zero pressure ulcers; which had been achieved in prior quarters. Staff continually monitored patients, ensuring the equipment was properly placed, and the patient was repositioned on an on-going basis.
Vice Chairman Harden asked if patients that presented to the hospital with pressure ulcers were included in the data.
Ms. Stotler noted that the data included those patients that developed a pressure ulcer while a patient. She highlighted the declining rate in post-op pulmonary embolus (PE) or deep vein thrombosis (DVT) rate, compared to prior year, however, there was a multi-disciplinary workgroup focused on the metric. The focus of the workgroup was early identification and documentation and each case was analyzed for opportunities.
She reiterated the staff’s continued focus on patient experience, including the completion of a 100-day workout focused on impressions and implementing those practices throughout the organization. She provided an overview of the Continuous Healthcare Evaluation and Quality Improvement Tool (CHEQ-IT), which was a simplified occurrence reporting structure for staff. The data was reviewed daily, and trends were reviewed at the Patient Safety Committee to allow multidisciplinary discussion and development of action for improvement. She stated that the Patient and Family Advisory Council was active, with one member, and staff was actively recruiting individuals, as the input provided was very valuable.
3. Discuss, Review, and Approve Maricopa Integrated Health System’s Annual Quality Improvement and Patient Safety Plan for Fiscal Year 2020; Approve Indicators on Which to Measure Quality for Fiscal Year 2020
Ms. Stotler provided an overview of the Quality Improvement and Patient Safety Plan for fiscal year 2020 (FY20), which reappointed Ms. Garcia as the Patient Safety Officer and Dr. Ostovar as the Infection Control Officer for the organization. She reviewed the quality highlights for FY19, including but not limited to the decrease in hospital onset c. difficile, perinatal care and delivery under 39 weeks, a decrease in catheter associated urinary tract infections (CAUTI), improved emergency department throughput, influenza immunizations, and hand hygiene. She noted that there was an increase in central line associated blood stream infections (CLABSI), not a decrease, as the document indicated.
Opportunities for improvement in FY20 included but were not limited to continued patient engagement and satisfaction, MRSA Bacteremia, PE/DVT, hemoglobin A1c, and inpatient falls with injury.
6
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
3. Discuss, Review, and Approve Maricopa Integrated Health System’s Annual Quality Improvement and Patient Safety Plan for Fiscal Year 2020; Approve Indicators on Which to Measure Quality for Fiscal Year 2020, cont.
Ms. Stotler stated the structural flow of the document was consistent with prior years; which had been complimented during the Det Norske Veritas (DNV) survey, as it demonstrated how the information was distributed through the organization, including the Board of Directors.
MOTION: Vice Chairman Harden moved to approve the Maricopa Integrated Health System’s Annual Quality Improvement and Patient Safety Plan for fiscal year 2020. Director Thomas seconded.
VOTE: 5 Ayes: Chairman Dewane, Vice Chairman Harden, Director Gerard, Director Thomas, Director Wilcox 0 Nays Motion unanimously passed.
MOTION: Director Wilcox moved to approve the Indicators on Which to Measure Quality for fiscal year 2020. Vice Chairman Harden seconded.
VOTE: 5 Ayes: Chairman Dewane, Vice Chairman Harden, Director Gerard, Director Thomas, Director Wilcox 0 Nays Motion unanimously passed.
6. Semi-Annual Maricopa Health Centers Governing Council Report
Ms. Kotrys provided a summation of the Federally Qualified Health Center Look-Alike (FQHC Look-Alike) clinics’ activities for January 1, 2019 through June 30, 2019. She stated that there was continued focus on clinic visits, quality, and patient experience. She stated that the Maricopa Health Centers Governing Council (MHCGC) and the Finance Committee were constantly reviewing clinic visits and identifying strategies to best serve the community.
She highlighted the achievements received by the clinic staff, including a Certificate of Achievement from United Healthcare Community Plan Arizona for the outstanding work completed to meet the Clinical Integration Activities Goal – Program Year 1 for 2017. The Maryvale Family Health Center (FHC) and three staff members were also awarded by The Arizona Partnership for Immunizations for their contributions for improving the health and wellness of the community by increasing immunization rates. The Maryvale FHC was also received a Cancer Prevention Champion Award by the Centers for Disease Control and Prevention (CDC) for increasing the human papillomavirus infection (HPV) vaccination rate in adolescents from 48% to 98% over a four-month period.
Ms. Kotrys noted that the MHCGC had been engaged with respect to the change in branding and new strategies surrounding the new ambulatory network. The MHCGC was an engaged group and now contained representation from all five districts.
Vice Chairman Harden expressed her appreciation for Ms. Kotrys’ service for the past eight years.
Mr. Purves thanked Ms. Kotrys for her service and noted that aside from her role as the MHCGC Chairman, she was also Chief Executive Officer of Health Current, which was the regional health information exchange. He stated Health Current recently received two awards from Strategic HIE Collaborative; the 2019 Government Relations and Advocacy Award and the 2019 Chairman’s Award.
7
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
4. Discuss and Review the Quarterly Infection Control Quality Metrics Report
Dr. Ostovar reviewed the infection control dashboard for the fourth quarter of the fiscal year, and the collective data for the entire fiscal year. Hand hygiene compliance for the year was 95%, with the goral for the upcoming fiscal year set at 97%.
He referred to the central line associated blood stream infection (CLABSI) metric and noted that updated information was available. The absolute number remained the same, however the line days changed. The end result was 1.5; slightly above the standardize infection ratio (SIR) benchmark of .0784. During the first three quarters of the year, the metric was within the benchmark, however, there were very sick patients during the latter part of the fiscal year. Each case was reviewed multiple times and it was determined that none of the cases were associated with the quality of care provided and could not have been prevented.
Vice Chairman Harden asked if any of the CLABSI cases in the fourth quarter were burn cases.
Dr. Ostovar said that there were burn cases, however, he was unsure of the absolute number. The information would be gathered and distributed it to the Board.
He stated that catheter associated urinary tract infections (CAUTI) were within the established benchmark. Clostridium difficile (c. diff) had improved and he noted staff transitioned to a new testing method. There was one surgical site infection for colon surgery, however, there were fourteen cases, which caused the metric to exceed the benchmark. There were no surgical site infections for abdominal hysterectomy.
Dr. Ostovar stated that MRSA Bacteremia was an on-going challenge, with two cases in the fourth quarter. He outlined the various action plans in place to address, including investigating every case and providing real-time feedback with providers. As with CLABSI, it was determined that neither of the cases would have been prevented. He announced that a point-prevalent study was scheduled to begin in September and would include outside observers monitoring providers to ensure compliance with established protocols and policies. He stated that nurses and providers would continue to work collaboratively to assess the patients and conducting universal screenings for all patients entering the facility. Targeted decolonization has also been implemented for the positive patients identified through the screening, along with universal decolonization for the intensive care units. He would continue to monitor and would know within the upcoming months if the efforts made an impact.
5. Quarterly Update on Behavioral Health
Mr. Cavallo expressed his appreciation for the recognition surrounding the award from Arizona Capitol Times. He also thanked Director Gerard for taking the time to submit the nomination. He stated that expanding the behavioral health capacity at Maryvale Hospital had been the highlight of his career and stated that the impact, not only to the organization but the Maryvale community and the entire health care delivery system, was immeasurable. He announced that the DNV accreditation survey occurred that the 192 behavioral health beds at Maryvale Hospital were added to the Maricopa Integrated Health System (MIHS) accreditation status. The additional behavioral health capacity would likely change the way crisis behavioral health services were identified and care was delivered. He acknowledged all staff involved in ensuring a successful project.
Mr. Cavallo provided an overview of the inpatient behavioral health locations and noted Maryvale Hospital will have the largest capacity, once all the units opened. Desert Vista had 126 beds, the Behavioral Health Annex had 93 beds, inpatient unit at Maricopa Medical Center had 22 beds, and Maryvale Hospital currently had 48 beds. He noted that the remaining beds at Maryvale Hospital were licensed and an additional 48 beds were scheduled to open in early September, with another 48 beds scheduled to open in late 2019. Funding for the courtroom was approved and was scheduled to be operation in early 2020.
8
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
5. Quarterly Update on Behavioral Health, cont.
Mr. Cavallo outlined the various improvements planned at the Behavioral Health Annex including, but not limited to fire sprinkler upgrades, an air conditioning system, creation of a patient food serving and dining space and an expanded indoor recreation area. Patient safety upgrades were also occurring at Desert Vista, including bathroom fixtures and improved lighting.
He reviewed the various outpatient behavioral health programs offered, beginning with the Assertive Community Treatment (ACT) program, which was an intensive program available for the Seriously Mentally Ill (SMI) population and was based at Desert Vista. The program was currently serving over 80 clients and nearly 75% of the ACT members received their primary care services at MIHS. Many clients that graduated the program utilized the outpatient SMI Clinic, located at the Mesa FHC. He noted that the ACT team continued to receive high audit review scores.
The First Episode Center, which was an early interventional program for young people experiencing their first signs of psychosis, had 65 enrolled clients, with many referrals stemming from the inpatient programs. He noted that the First Episode Center was a great opportunity for young people to receive comprehensive services after their first hospitalization. He referred to the behavioral health specialty clinic for persons with SMI, which opened in February 2019 and was growing rapidly, with plans to relocate to the new site of the Mesa Community Health Center.
Director Wilcox asked if there were plans to operate an additional ACT program at the Maryvale Hospital location.
Mr. Cavallo said that authorization would have to come from Mercy Care, the Regional Behavioral Health Authority. Should that authorization be granted, there was space within the Maryvale Hospital to accommodate the services.
Integrated Behavioral Health was the largest opportunity to impact all patients within the organization, through services provided by a licensed counselor and consultations from psychiatrists. Maryvale FHC was an initial pilot site for integrated care program testing workflows and processes. MIHS was also utilizing Targeted Investment Program (TIP) funding to focus on a variety of aspects of integrated behavioral health. Justice TIP focused on changing the way care was delivered for individuals exiting the criminal justice system. Primary Care Provider (PCP) TIP enabled care coordinator at specific sites to connect individuals from the high-risk registry to a behavioral health clinician. Hospital TIP utilized social workers and care manager extenders to continue behavioral health coordination activities for individuals with identified behavioral health conditions.
Mr. Cavallo referred to future behavioral health projects and noted that the Mesa FHC would expand to accommodate Child Fellows in the Child Psychiatry Residency program, who would work in partnership with the integrated behavioral health team and the pediatric primary care providers.
7. Discuss and Review June and July 2019 Maricopa Integrated Health System Financials and Statistical Information and Quarterly Investment of Funds Report
Mr. Mutarelli reviewed the statistical information for June 2019 noted the data excluded the Maryvale Hospital. Total admissions, including behavioral health, were approximately 4% over budget. Emergency department visits were about 2.5% below budget, with pediatric emergency department visiting continuing to lag. Ambulatory visits exceeded budget by 1% for the month, with approximately 31,600 visits.
On a year-to-date basis, admissions were slightly below budget; however, exceeded prior year by 1%. Emergency department visits were also below budget; but were greater than prior year. Ambulatory visits were approximately 1.5% below budget and 1.5% greater than prior year.
9
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
7. Discuss and Review June and July 2019 Maricopa Integrated Health System Financials and Statistical Information and Quarterly Investment of Funds Report, cont.
Mr. Mutarelli referred to the patient revenue, which has been impacted by the shift between Medicaid and uninsured patients; which increased the amount in uncompensated care. He noted, moving forward, staff would monitor the uncompensated care from the Maryvale Emergency Department. He stated patient revenue from commercial payers increased, due to some burn cases. While there were no unusual items for the month of June, there were reconciliations and year-end adjustments, including Arizona State Retirement System (ASRS) pension and professional liabilities accrual.
He reviewed the income statement for June 2019. Net patient service revenue exceeded budget by 1% and was driven by the volume and case mix index. The expenses for salary, wages and contract labor were related, in part to Maryvale Hospital. As many employees had gone through orientation and training, in anticipation of the new units opening soon.
Vice Chairman Harden asked if traveling nurses were being utilized.
Ms. Stotler said that the Maryvale Emergency Department did utilize traveling nurses; however, some were finishing up their contracts or transitioning to full-time employees.
Mr. Mutarelli stated that the normalized loss was higher than budgeted, with a loss of approximately $1.5 million compared to a budgeted loss of about $463,000. On a year-to-date basis, total operating revenue was 4.5% better than budget, expenses exceeded budget by 3%, resulting in a positive increase in net assets of $12.5 million compared to a budget of $8.4 million, prior to audit. He announced that the audit had begun and would be completed and presented to the Board in November 2019.
Director Wilcox asked if staff were seeking out grant dollars.
Mr. Mutarelli said that staff was always looking for grant opportunities.
Ms. Gaw said that staff submitted an application for Health Resources & Services Administration’s (HRSA) Bureau of Primary Health Care’s New Access Points (NAP) Funding Opportunity, and if received, that would provide many opportunities for grants and were unavailable at the current time. A response to the application was anticipated in September 2019.
Mr. Mutarelli highlighted the growth in cash, year over year, with operating cash increasing to $219 million from $200 million. He expressed some concern with the days in accounts receivable, at 77 days, and attributed 20 days to some very large burn cases. Staff was working to address that and collect on those accounts.
He referred to the income statement for Maryvale Hospital and noted that there was a positive contribution margin for the month of June, and on a year-to-date period. He highlighted the growth in emergency department visits, which increased each month, and reiterated that behavioral health would soon have additional capacity.
Mr. Mutarelli referred to the statistical information for July 2019, which now included data from Maryvale Hospital. Total admissions were slightly under budget, less than 1%, due to the delayed opening of the behavioral health beds at Maryvale Hospital. Emergency department visits exceeded budget by nearly 5%.
Director Thomas suggested separating Maryvale Emergency Department, to account for the various components of emergency department visits, such as adult visits, pediatric visits, labor and delivery visits, and burn visits.
10
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
7. Discuss and Review June and July 2019 Maricopa Integrated Health System Financials and Statistical Information and Quarterly Investment of Funds Report, cont.
Ms. Gaw said that the Maryvale Emergency Department treated adult and pediatric cases. As that facility was not designated for trauma or burn. Should a trauma or burn patient present at the emergency department, the patient would be transferred to the appropriate facility.
Mr. Mutarelli reviewed the ambulatory visits and noted that outpatient behavioral health visits were 43% better than budget. He noted the payer mix had remained consistent and there were no unusual items or adjustments for the month. He referred to the income statement and noted the net patient service revenue exceeded budget by over 10%. Strong volumes and the case mix index attributed to the positive variance. Expenses were over budget by almost 8%, due to labor costs and increased cost in supplies. The normalized bottom line was $2.8 million compared to a budgeted $2 million. He reviewed the liquidity ratios and noted that the cash on hand dropped to 115 days, due to a variety of reasons, including a decrease in liabilities, there were three payrolls during the reporting period and capital equipment was purchased. The number of days in accounts receivable reached 89 days, with 25 days related to burn accounts. The current ratio was 2.6:1, excluding the bond funds.
Vice Chairman Harden referred to the increase in surgical cases and asked if there was a correlation to the admissions from the Maryvale Emergency Department.
Ms. Stotler said that there were a variety of factors that contributed to the increase in surgery cases. There were more cases received from the Maryvale Emergency Department, however, patients were presenting to the Maricopa Medical Center Emergency Department with a high acuity, and there were also improvements made after the 100-day workout.
8. Review and Possible Action on Reports to the Board of Directors
a. Monthly Marketing and Communications Report
b. Monthly Care Reimagined Capital Purchases
c. Return on Investment on Strategic & Capital Investments Reports Cath Lab/EP Equipment Assertive Community Treatment Behavioral Health Program
d. Quality Management Council Meeting Minutes (June 2019)
e. 2019 Employee Engagement Survey Results
f. Quarterly Compliance Officer’s Report; MIHS Finance, Audit and Compliance Committee Activities
g. Quarterly Maricopa Health Centers Governing Council Structure Report
h. Quarterly Maricopa Health Foundation Tasks Status Report to the Maricopa
Director Wilcox referred to item 8.a., the Monthly Marketing and Communications Report, and mentioned that MIHS received the designated as a Leader in LGBTQ (Lesbian, Gay, Bisexual, Transgender and Queer) Healthcare Equality by Healthcare Equality Index (HEI). MIHS was Maricopa County’s only hospital with that designation. She was proud of that achievement, as the designation was given to facilities that provide equitable and inclusive care.
11
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
8. Review and Possible Action on Reports to the Board of Directors, cont.
Mr. Mutarelli referred to item 8.b., the Monthly Care Reimagined Capital Purchases report, and noted that the format had been slightly adjusted, to incorporate recommendations from Moss Adams.
Ms. Sanchez Cox reference item 8.e., 2019 Employee Engagement Survey Results, and stated that the survey indicated that there was strong employee engagement, with 9 in 10 employees being proud to work for MIHS. There was a high belief that employees felt highly engaged and dedicated to the mission in which MIHS served the patients and community. There were opportunities for improvement surrounding inclusion and diversity. She noted that Senior Leadership reviewed the results and would be focusing on actions plans to address diversity and inclusion.
Director Wilcox commended staff for dedication and work done to obtain such positive results. She agreed that inclusion was important, as Care Reimagined was moving rapidly and it was important for employees to be included in all the upcoming changes.
Vice Chairman Harden asked if the response rate of 71% was average for a large organization, such as MIHS.
Ms. Sanchez Cox stated that the average response was approximately 30%.
Director Thomas stated that there was some concern with the turnover reports; however, the results from the survey indicate that employees were satisfied. He requested clarification on the contradicting reports.
Ms. Sanchez Cox said there were various ways to view turnover. The overall turnover rate was within national standards; however, there was an opportunity for improvement related to first-year turnover.
Chairman Dewane asked if there was an opportunity for staff to improve managing expectation; especially given the mission-driven environment of MIHS.
Ms. Sanchez Cox referred to the survey results and stated that the employees felt that they received training and education to effectively perform their job. She said there was an opportunity to improve communication with the employee during their first-year, to gauge their satisfaction throughout the year, and providing recognition.
Vice Chairman Harden referred item 8.f. and commended staff on the improvements in the Compliance and Health Insurance Portability and Accountability Act (HIPAA) training results.
Director Wilcox referred to the Ethics Point information and asked if the average time to close, 27 days, was industry standard.
Mr. Slaughter said that standard was for cases to be closed within 30 days. He noted that the Ethics Point information would be reorganized, to track and differentiate between the various locations within the organization.
Ms. Talbot referred to item 8.g., the Quarterly Maricopa Health Centers Governing Council Structure Report, and reiterated that MHCGC had representation from all five districts. She noted the report not only included the structure of the MHCGC but provided the patient composition and how the MHCGC compared to the patient composition.
Ms. Hartsock referenced item 8.h., the Quarterly Maricopa Health Foundation Tasks Status Report to the MIHS President and Chief Executive Officer, and announced the upcoming events, including the Women’s Luncheon, scheduled for September 18, and the CopaBall, scheduled for October 5.
12
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
General Session, Presentation, Discussion and Action, cont.:
9. Concluding Items
a. Old Business:
June 26, 2019
Legislative Update Keep the Board apprised of any immigration issue changes as the federal level
Financial & Statistical Information (Dashboard) Split out and report separately which surgeries can be attributed to transfers from the Maryvale Hospital; split out Maryvale Emergency Department visits by adult and pediatric
b. Board Member Requests for Future Agenda Items or Reports
c. Comments i. Chairman and Member Closing Comment ii. President and Chief Executive Officer Summary of Current Events
Ms. Talbot said that she received a response to a question posed during the review of the Quarterly Infection Control Quality Metrics and stated that of the eight CLABSI cases in the quarter, three cases were burn patients.
Vice Chairman Harden requested the turnover report be submitted to the Board on a monthly basis.
Director Wilcox expressed her appreciation to staff for the reports received and noted the pride she felt while reviewing the information.
Mr. Purves reflected on the advancement of behavioral health services throughout MIHS and congratulated Mr. Cavallo on the honor received. He thanked Director Wilcox for mentioning the designation MIHS received from HEI and noted the positive feedback he had received, not just locally, but nationally.
He highlighted the various activities happening within the organization and thanked staff for their contribution towards MIHS’s success: Mr. Mutarelli and the finance department for providing accurate statistical reports and developing a realistic budget; Mr. Byron and the marketing department for the excitement surrounding the Valleywise Health branding and communications; Ms. Gaw and Mr. Blaylock for their leadership within the Integrated Program Management Office (IPMO) and having over $700 million in awarded contracts without a challenge; Ms. Hartsock for her contribution to the Maricopa Health Foundation’s structure and progress outlined in the Cooperative Services Agreement; and Mr. Murphy for interacting with the media and ensuring MIHS had more earned media than any other health system. He showed a media clip, reporting on a Christmas in July event with the Phoenix Fire Department, who delivered gifts to the pediatric unit.
Mr. Purves announced that MIHS had eight finalists at the Phoenix Business Journal’s Health Care Heroes Awards Breakfast; Dr. Alicia Cowdrey for Mental Health; Mr. Boyd Smith for Volunteer; Dr. John Chen for Dental; Dr. Michael Epter for Health Care Education; Dr. Kevin Foster for Innovator, Ms. Patricia Johnson, R.N. for Lifetime Achievement; Ms. Jeanne Nizigiyimana for Non-Physician; and Ms. Tracy Brooks, R.N. for Nursing. There were three winners; Dr. Epter, Dr. Foster and Dr. Chen.
Mr. Byron provided an update on the various internal activities underway and outlined the schedule of events for September, including a Flag Raising Ceremony, a Banner Drop, and Pep Rally, all in preparation to transition to Valleywise Health on October 1, 2019. He thanked the marketing department and various others that had been involved to ensure the transition would be successful.
13
Special Health Care District Board of Directors Meeting Minutes – General Session – August 28, 2019
Adjourn
MOTION: Vice Chairman Harden moved to adjourn the August 28, 2019 Special Health Care District Board of Directors Formal Meeting. Director Wilcox seconded.
VOTE: 5 Ayes: Chairman Dewane, Vice Chairman Harden, Director Gerard, Director Thomas Director Wilcox 0 Nays Motion unanimously passed.
Meeting adjourned at 3:03 p.m.
______Mark G. Dewane, Chairman Special Health Care District Board of Directors
14
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.b.i.
Contracts 90-20-029-1 Melanie Talbot
From: Compliance 360
Message Information
From Purves, Steve To Talbot, Melanie; Subject Contract Approval Request: Access Agreement for Environmental Sampling NXP USA, Inc. / Honeywell International Inc. Additional Indicate whether you approve or reject by clicking the Approve or Reject Information button.
Add comments as necessary.
Approve/Reject Contract
Click here to approve or reject the Contract.
Attachments
Name DescriptionTypeCurrent File Access Agreement (unsigned).pdf File Access Agreement (unsigned).pdf 013932-186 (Exhibit A - Location).pdf File 013932-186 (Exhibit A - Location).pdf 013932-35 (Exhibit B - Well Construction File 013932-35 (Exhibit B - Well Boring Design).pdf Construction Boring Design).pdf
Contract Information
Division Contracts Division Folder Contracts \ Services - Consulting/Auditing & Other Status Pending Approval Title Access Agreement for Environmental Sampling Contract Identifier Board - New Contract MIHS Contract 90-20-029-1 Number Primary Responsible Melton, Christopher C. Party Departments HOSPITAL ADMINISTRATION Product/Service Access Agreement for soil gas sampling Description Action/Background Approve a new Access Agreement between Maricopa County Special Health Care District dba Maricopa Integrated Health System ("MIHS") and NXP USA,
1 Inc and Honeywell International, Inc. ("Companies") for soil gas sampling.
The purpose of this Access Agreement is for MIHS to grant Companies a nonexclusive right, easement and privilege for ingress and egress over, across and under the MIHS Property located at 2601 E. Roosevelt St., Phoenix, Arizona 85008. Under the oversight of the U.S. Environmental Protection Agency (EPA), the Companies will be conducting a soil gas sampling program in selected locations as part of a Soil Vapor Intrusion to Indoor Air Pathway Evaluation being conducted under the Administrative Order on Consent with EPA. This Access Agreement shall run for a period of eighteen (18) months, or until the earlier date of completion of the EPA- required evaluation.
This new Agreement is sponsored by Warren Whitney, Senior Vice President, Government Relations. Evaluation Process Notes Category Effective Date Expiration Date Annual Value $0.00 Expense/Revenue Budgeted Travel Type N/A Procurement Number Primary Vendor NXP USA, Inc. / Honeywell International Inc.
Responses
Member Name Status Comments Whitney, Warren W. Approved Demos, Martin C. Approved Gaw, Kris D. Approved Purves, Steve A. Approved Talbot, Melanie L. Current Melton, Christopher C. Approved Detzel, Jo-El M. Approved
2
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.b.ii.
Contracts 90-16-070-1-02 From: Compliance 360 To: Melanie Talbot Subject: Contract Approval Request: Amendment#2 - (IGA) HIV Prevention Program Arizona Department of Health Services (ADHS) Date: Monday, September 09, 2019 2:57:50 PM
Message Information
From Purves, Steve To Talbot, Melanie; Subject Contract Approval Request: Amendment#2 - (IGA) HIV Prevention Program Arizona Department of Health Services (ADHS) Additional Information Indicate whether you approve or reject by clicking the Approve or Reject button.
Add comments as necessary.
Approve/Reject Contract
Click here to approve or reject the Contract.
Contract Information
Division Contracts Division Folder Amendments Status Pending Approval Title Amendment#2 - (IGA) HIV Prevention Program Contract Identifier Board - Amendment MIHS Contract 90-16-070-1-02 (ADHS16-103631) Number Primary Responsible Melton, Christopher C. Party Departments GRANTS ADMINISTRATION Product/Service IGA for the HIV Prevention Program Description Action/Background Approve Amendment#2 to the Intergovernmental Agreement (IGA) with Arizona Department of Health Services (ADHS) for the HIV Prevention Program.
The purpose of this Amendment#1 is to extend the IGA through September 30, 2020 for its fifth and final year, for an aggregate term of October 1, 2015 through September 30, 2020. This IGA will continue to provide funding for the HIV testing of individuals presenting for treatment in the MIHS Emergency Department and other MIHS healthcare facilities. All HIV testing sessions shall be in accordance with the CDC recommendations for HIV testing and linkage to care.
The cost reimbursement remains the same as previous year at $200,000. This Amendment#2 is sponsored by Dr. Michael White, EVP & Chief Medical Officer. Evaluation Process The Contractor was determined to meet the requirements of the requesting department and MIHS. Procurement has been satisfied pursuant to HS-102B(2) of the Procurement Code in that any MIHS compliance with the terms and conditions of a grant, gift, or bequest which include Subcontracts obtained in order to fulfill requirements of a grant, gift, or bequest are exempt from the solicitation requirements of the Procurement Code. Notes Category IGA Effective Date 10/1/2019 Expiration Date 9/30/2020 Annual Value $200,000.00 Expense/Revenue Revenue Budgeted Travel Type Yes Procurement Number Primary Vendor Arizona Department of Health Services (ADHS)
Responses
Member Name Status Comments Melton, Christopher C. Approved Ok to route for approvals Joiner, Jennifer L. Approved Cox, Justina Sanchez S. Approved Demos, Martin C. Approved White, Michael Approved Purves, Steve A. Approved Talbot, Melanie L. Current Mutarelli, Richard D. Approved
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.b.iii.
Contracts 90-20-028-4 From: Compliance 360 To: Melanie Talbot Subject: Contract Approval Request: Equipment Lease-Video Equipment and Related Accessories for Laparoscopic/Arthroscopic Procedures (Schedule 004) Flex Financial, a division of Stryker Sales Corp Date: Thursday, September 12, 2019 9:48:31 AM
Message Information
From Purves, Steve To Talbot, Melanie; Subject Contract Approval Request: Equipment Lease-Video Equipment and Related Accessories for Laparoscopic/Arthroscopic Procedures (Schedule 004) Flex Financial, a division of Stryker Sales Corp Additional Information Indicate whether you approve or reject by clicking the Approve or Reject button.
Add comments as necessary.
Approve/Reject Contract
Click here to approve or reject the Contract.
Attachments
Name Description Type Current File 90-20-028-4 (redlined) File 90-20-028-4 (redlined).pdf OIG File OIG Stryker Sales 2019.pdf SAM File SAM Stryker Sales 2019.pdf Contract Information
Division Contracts Division Folder Contracts \ Group Purchasing Organization (GPO) - Supplies Status Pending Approval Title Equipment Lease-Video Equipment and Related Accessories for Laparoscopic/Arthroscopic Procedures (Schedule 004) Contract Identifier Board - New Contract MIHS Contract 90-20-028-4 Number Primary Responsible Pardo, Laela N. Party Departments Health Technology Management,PERIOPERATIVE BUSINESS SUPPORT Product/Service Equipment Lease-Video Equipment and Related Accessories for Description Laparoscopic/Arthroscopic Procedures (Schedule 004) Action/Background Approve a new contract between Flex Financial, a division of Stryker Sales Corporation and Maricopa County Special Health Care District dba Maricopa Integrated Health System (MIHS) for an Equipment Lease-Video equipment and related accessories for Laparoscopic and Arthroscopic procedures in the operating room. The current lease is ending and this new lease will provide updated equipment and accessories. Cost of this lease is $23,716.81 monthly for a total forty-four (44) months; making the total annual spend $284,601.72. Lease payments will commence upon delivery and acceptance of the equipment. This is being accessed through Vizient GPO #CE2837. This lease has been budgeted for operational expenditures from the OR department and is sponsored by Kris Gaw, Chief Operating Officer. Evaluation Process The Contractor was determined to meet the requirements of the requesting department and MIHS. Procurement has been satisfied pursuant to HS-102(B)(3) of the Procurement Code in that any agreements with professional association memberships and medical research projects are exempt from the solicitation requirements of the Procurement Code. Notes Category GPO Effective Date Expiration Date Annual Value $284,601.72 Expense/Revenue Expense Budgeted Travel Type Yes Procurement Number Primary Vendor Flex Financial, a division of Stryker Sales Corp
Responses
Member Name Status Comments Melton, Christopher C.ApprovedOk to route for approvals. Teeman, Martha J. Approved Garcia, Crystal D. Approved Stotler, Sherry A. Approved General Counsel has advised the department and Contracts that the sole termination provision in the agreement requires that the Board not appropriate funds for the agreement during the relevant upcoming fiscal year. The business side of MIHS has agreed to proceed with the Demos, Martin C. Approved agreement with that understanding. Contracts Department has an annual evaluation process in place. The agreement is evaluated by the relevant department on an annual basis which will be completed well before the fiscal year/budget approvals. Gaw, Kris D. Approved Mutarelli, Richard D. Approved Purves, Steve A. Approved Talbot, Melanie L. Current
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.c.i.
Governance Director Thomas Travel James Woodfin Thomas
Itinerary For Name
Arizona Hospital and Healthcare Association Annual Leadership Trip Description Conference
Trip Length Wednesday, October 23, 2019 – Friday, October 25, 2019
Notes/Additional Items
Conference registration fee: $250
Hotel approximate cost: $469 plus any resort overnight parking fees
Meals & Incidentals per diem: $153
Other reimbursable expenses: Mileage reimbursement of 58¢ per mile for drive to Tucson and back.
2019 AzHHA Annual Leadership Conference
Conference Agenda
2019 Annual Leadership Conference
“Back to The Future”
Wednesday, October 23, 2019
11:00 am – 04:00 pm Golf Tournament
02:30 pm – 03:00 pm Early Registration opens
03:00 pm – 04:30 pm Trustee Session: Speaker and topic: Best Practices in Succession Planning 04:45 pm – 05:45 pm General Session: Topic: Hospital Economic Impact and Development Speaker: Greg Ensell, VP Government Relations Arizona Hospital and Healthcare Association Speaker: Jim Rounds, President Rounds Consulting Group Inc. 06:00 pm – 07:00 pm Platinum and Gold Sponsor Reception (cocktails and heavy hors d’oeuvres will be served) Thursday, October 24, 2019
07:30 am – 09:30 am AzHHA Board Member Breakfast and Meeting (Board Members Only) 08:30 am Registration Opens
10:00 am – 10:30 am Welcome and Opening Ann-Marie Alameddin, President and CEO Arizona Hospital and Healthcare Association 10:30 am – 11:45 am General Session - Sponsored by AB Staffing Speaker: Paul Keckly, Ph.D, Managing Editor, Healthcare Industry Analyst, Investor and Futurist The Keckley Report 11:45 am - 12:00 pm Networking Break
12:00 pm – 01:30 pm Lunch / Salisbury Award General Session: Topic:End-of-Life Speaker: Torrie Fields Blue Cross Blue Shield of California 01:30 pm – 01:45 pm Networking Break
01:45 pm – 02:45 pm Breakout Sessions 1. Topic: Manage Care Update Speaker: Jim Hammond The Hertel Report
2. Telemedicine Speaker: Gigi Sorenson GlobalMed
3. Topic: Well-being and Resilience for Health Leaders Speaker: Dr. Teri Pipe, Chief Well-Being Officer Founding Director Arizona State University 02:45 pm – 03:00 pm Networking Break
03:00 pm – 04:00 pm Breakout Sessions 1. Topic: AHCCCS Update Jami Snyder, Director Arizona Health Care Cost Containment System 2. Topic: Diversity & Inclusive Leadership for a Changing World Speaker: Lisa Mead Arizona Women in Healthcare
3. Topic: Patient Safety and Cyber Security in the Era of Hyper-connected Healthcare Speaker: Dr. Christian Dameff University of California San Diego 04:00 pm – 04:15 pm Networking Break
04:15 pm – 05:30 pm General Session - Sponsored by AB Staffing Doug Stevenson, CSP, CEO Story Theater International 05:45 pm – 07:00 pm Reception – sponsored by HealthCare Workforce Logistics (cocktails and heavy hors d’oeuvres will be served) Friday, October 25, 2019
07:00 am – 08:45 am Breakfast / Roundtable Discussions
08:45 am – 09:00 am Networking Break
09:00 am – 10:00 am AzHHA Annual Meeting
10:00 am – 11:00 am General Session Topic: Update from Capitol Hill Speaker:U.S Senator Martha McSally 11:15 am – 12:15 pm Closing Session Topic: Medicare For All Susan Dentzer 12:15 pm – 12:30 pm Closing Comments/Raffle/Conference Adjourn
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.c.ii.
Governance Deputy Medical Director for the Department of Psychiatry
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.c.iii.
Governance Renewal of Designation Application to Health Resources and Services Administration
Office of the Senior Vice President Ambulatory Services MIHS FQHC LAL Clinics CEO • 2525 East Roosevelt Street • Phoenix • AZ • 85008 •
DATE: September 9, 2019
TO: Maricopa County Special Health Care District Board of Directors
FROM: Barbara Harding, BAN, RN, MPA, PAHM, CCM Sr. Vice President Ambulatory Services & FQHC LAL clinics CEO
SUBJECT: HRSA Look-Alike (LAL) Renewal of Designation (RD)
The purpose of the RD is to ensure that accessible and affordable quality primary health care services continue in high need geographic areas currently served by the Health Center Program. An RD application is a request for continued designation by an existing LAL.
The Maricopa County Health Centers Governing Council approved the request of Staff to request approval of the submission of the LAL RD application for LALCS00037 Maricopa County Special Health Care District on 09/04/2019. Staff request approval of the submission of the LAL RD application for LALCS00037 Maricopa County Special Health Care District.
PROJECT ABSTRACT
Project Title: Look-Alike Renewal of Designation Application
Congressional District: Organization: CD-007;
Service Area: CD-003; CD-006; CD-007; CD-008; CD-009
Type of Health Center Designation: Hospital
Applicant Organization Name: Valleywise Health
Address: 2601 E. Roosevelt St., Phoenix, AZ 85008
Project Director Name: Barbara Harding, BAN, RN, MPA, PAHM, CCM, Senior Vice President
Ambulatory Services & FQHC LAL Clinics CEO
Contact: (Ph) 602-344-1129; (Fax) 602-344-0937 E-mail Address: [email protected]
Web Site Address: www.mihs.org
Brief Overview of the Organization, Communities Services and Target Population: Valleywise Health, formerly known as Maricopa Integrated Health System (MIHS) is the only public teaching hospital and health care system in Arizona providing primary and specialty care services predominantly to underserved, low-income and ethnically diverse populations. This name change is part of the transformation of our health care system occurring due to overwhelming approval of Proposition 480 by Maricopa County voters in 2014. While our name is changing, the system is not changing. Valleywise Health will continue our rich tradition of providing quality health care, teaching, compassion and stewardship. Additionally, we will continue to train our community’s next generation of care providers in our values of compassion and dedicated service. With experience and empathy, we are building a healthier future for our community.
Over a remarkable 140+ year history, Valleywise Health has built a reputation of quality healthcare by placing compassion at the forefront of care. Currently, the organization has twelve Health Center Look- A-Like clinics within various neighborhoods in Phoenix, Arizona located in Maricopa County. Maricopa County is geographically located in the south-central portion of Arizona and spans a total area of 9,224 miles. Twenty-five cities and towns are in Maricopa County. The largest city, Phoenix, is both the County seat and the State capital. The target population within these communities are ethnically / racially diverse (73%), of which 57% are Hispanic and nearly 10% are African-American. Over 30% of patients are non-English speaking. Ethnically diverse children comprise the clear majority of Valleywise Health pediatric patients: in FY16, nearly 90% of all children were of racial / ethnic diversity, with 74% Hispanic. Adults within the target population, including parents and care-givers have high levels of unemployment and face numerous challenges and barriers in accessing health care services. Fifty to sixty percent of adults obtaining services at Valleywise Health FQHC look-a-like clinics have AHCCCS (State of Arizona Medicaid), the Valleywise Health Financial Assistance Program (sliding fee scale) or are self-pay.
Addressing the Need for Comprehensive Primary Health Care Services:
Our service area has high rates of poor health indictors with high rates of obesity, diabetes, cardiovascular disease and respiratory illness. With many individuals living within medically underserved
1 areas, access to care can frequently be a challenge for underserved residents. To combat these challenges, Valleywise Health is dedicated to addressing the social determinants of health for all patients. Valleywise Health is certified as a Level 3 NCQA Medical Home, providing patient-centered and comprehensive care. A robust care coordination program, embedded into all Valleywise Health medical clinics, helps to ensure children and families receive access to medical care and social services. The Whole Person Model of Care is an integrated care model that allows patients to receive all health care services that they need on the care continuum from Valleywise Health service providers. Whole Person Care addresses all needs of a patient (and family) including primary care, managing behavioral health care, addressing chronic disease challenges and social determinant of health factors that impact a person’s health. When care is integrated, studies have shown that patient outcomes are better, especially for patients with behavioral health needs. Strong community partnerships include providing early literacy programs at some of Valleywise Health’s FQHC look-a-like sites, supplying free lunches in collaboration with a local food bank, and a monthly food distribution program, which help patients and families address both their medical and social needs. All Valleywise Health FQHC LAL clinics are preparing to implement the Whole Person model of care with activation scheduled for the last quarter of 2019.
Patients, Visits, Providers and Services Delivery Sites and Services to be Provided: Through continuation of FQHC LAL designation, Valleywise Health will see 89,727 patients in Year 1 for 279,692 visits and 90,625 patients in Year 2 for 282,488 visits. Currently, Valleywise Health has 90 providers. These providers serve adult and pediatric patients, providing primary care services including: 1) Adolescent care; 2) Teen pregnancy; 3) Refugee care; 4) Diabetes outreach education; 5) Behavioral health care; 6) Adult and pediatric dental; 7) Cardiology; 8) Radiology; and 9) Laboratory and pharmacy services, as well as other wrap-around services. These services are offered at 12 clinic sites in various neighborhoods of Phoenix, Arizona.
Strategic Planning Initiative – Care Reimagined: A $935 million bond measure for Maricopa County’s Special Health Care District to fund new and renovate facilities for the Maricopa Integrated Health System including the FQHC LAL clinics was place on the November 2014 General Election Ballot. Proposition 480 was decisively approved by Maricopa County Voters, with a 63.42% “yes” vote. As a result, planning, building and renovation of the new facilities is underway. The Maricopa Health Centers Governing Council has been actively engaged in the planning and development of the new sites. Eight of the FQHC LAL sites will be relocated to new buildings within 5 – 10 miles of current sites. The four remaining clinics will receive renovation. Included in this endeavor is to develop new workstreams and efficiencies to improve the patient experience. Although our name is changing to Valleywise Health, we will fulfill our mission to provide exceptional care, without exception, every patient, every time.
EHB Entity: LALCS00037 Maricopa County Special Health Care District
Grant Number: N/A
Tracking Number: 167798
2
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.c.iv.
Governance Grant Award Provided by Health Resources and Services Administration
Office of the CEO FQHC Clinics • 2525 East Roosevelt Street • Phoenix • AZ • 85008 •
DATE: September 25, 2019
TO: Maricopa County Special Health Care District Board of Directors
FROM: Barbara Harding, BAN, RN, MPA, PAHM, CCM CEO FQHC Clinics
SUBJECT: HRSA New Access Points (NAP) Award
A New Access Point (NAP) application was prepared and submitted to the Health Resources and Services Administration (HRSA) for the purpose of obtaining Federal Funding and+ achieving Grantee status as a Federally Qualified Health Center (FQHC).
The purpose of the Health Center Program NAP funding opportunity is to provide operational support for new service delivery sites under the Health Center Program to improve the health of the nation’s underserved communities and vulnerable populations by expanding access to affordable, accessible, quality, and cost-effective primary health care services.
In addition to the 330 grant funds, HRSA may release additional categorical funding to target areas of health concern while improving the health of the nation. Recent funds included categorical funding for behavioral health services, substance use disease as well provisioning funds for capital expenses.
On September 11, 2019, staff received Notice of Award amounting to $650,000 for year 1. Funding will continue upon completion of an Operational Site Visit and continued appropriations of Federal Funds. The submitted application requested funds to be utilized to expand the integrated behavioral health services in the FQHC clinics. This is in alignment with Valleywise Health’s focus on improving access to behavioral health. The funding request is be utilized for Clinical Behavioral Health Specialists replicating the model of care currently being provided in 4 of the FQHC LAL Clinics: 7th Ave FHC, Avondale, Maryvale and Mesa.
In addition, the FQHC is eligible to receive Federal Tort Claims Act (FTCA) coverage. Through the Federal Tort Claims Act (FTCA), eligible HRSA-supported health centers may be granted
1 medical malpractice liability protection with the Federal government acting as their primary insurer.
Staff are requesting approval of the Notice of Award grant number H80CS33644 for Maricopa County Special Health Care District.
2
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.i.
Medical Staff Medical Staff Appointments – September 2019 Recommended by Credentials Committee: September 3, 2019 Recommended by Medical Executive Committee: September 10, 2019 Submitted to MSHCDB: September 25, 2019 MARICOPA INTEGRATED HEALTH SYSTEM CREDENTIALS AND ACTION ITEMS REPORT MEDICAL STAFF The credentials of the following individuals including, current licensure, relevant training and experience, malpractice insurance, current competence and the ability to perform the requested privileges have been verified. INITIAL MEDICAL STAFF APPOINTMENT NAME CATEGORY SPECIALTY/PRIVILEGES APPOINTMENT DATES COMMENTS Jean Khara Gonzales Casillan, M.D. Active Family & Community Medicine 10/01/2019 to 09/30/2021 Anita Wendy Eisenhart, D.O. Active Emergency Medicine 10/01/2019 to 09/30/2021 Nandni Gupta, M.D. Active Psychiatry 10/01/2019 to 09/30/2021 Thomas Dale Kummet, M.D. Courtesy Internal Medicine (Hematology/Oncology) 10/01/2019 to 09/30/2021 Vevek Prakash Parikh, M.D. Courtesy Radiology 10/01/2019 to 09/30/2021 Karnika Vinod Patel, M.D. Active Psychiatry 10/01/2019 to 09/30/2021 Curtis Dobson Qin, M.D. Active Radiology 10/01/2019 to 09/30/2021 Daniela Reid, M.D. Active Psychiatry 10/01/2019 to 09/30/2021 Robert Sean Wright, M.D. Active Internal Medicine 10/01/2019 to 09/30/2021
INITIAL/FOCUSED PROFESSIONAL PRACTICE EVALUATION NAME SPECIALTY/PRIVILEGES RECOMMENDATION COMMENTS EXTEND or PROPOSED STATUS Chair has submitted documentation demonstrating practitioner has Benjamin Bakall, M.D. Surgery (Ophthalmology) Successfully Completed FPPE successfully completed FPPE requirement for Retinal and Vitreous Surgery specific for Retinal Photocoagulation Privileges. Chair has submitted documentation demonstrating practitioner has Michael D. Dersam, M.D. Orthopedic Surgery Successfully Completed FPPE successfully completed FPPE requirement for Orthopedic Outpatient and General Orthopedic Core Privileges. Chair has submitted documentation demonstrating practitioner has Anne Margaret Floyd, M.D. Surgery (Ophthalmology) Successfully Completed FPPE successfully completed FPPE requirement for Laser Privileges. Chair has submitted documentation demonstrating practitioner has Aida Music, M.D. Psychiatry Successfully Completed FPPE successfully completed FPPE requirement for Adolescent, Adult, Geriatric Psychiatry Core Privileges. Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Ophthalmology Core, Kevin Randall Tozer, M.D. Surgery (Ophthalmology) Successfully Completed FPPE Retinal and Vitreous Surgery specific for Retinal Photocoagulation, and Laser Privileges. Chair has submitted documentation demonstrating practitioner has Leonel Antonio Urdaneta, M.D. Psychiatry Successfully Completed FPPE successfully completed FPPE requirement for Adolescent, Adult, Geriatric Psychiatry Core Privileges. Page 1 of 3 Recommended by Credentials Committee: September 3, 2019 Recommended by Medical Executive Committee: September 10, 2019 Submitted to MSHCDB: September 25, 2019
REAPPOINTMENTS/ONGOING PROFESSIONAL PRACTICE EVALUATION NAME CATEGORY SPECIALTY/PRIVILEGES APPOINTMENT DATES COMMENTS Benjamin Bakall, M.D. Courtesy Surgery (Ophthalmology) 10/01/2019 to 09/30/2021 Sunitha Bandlamuri, M.D. Active Internal Medicine 10/01/2019 to 09/30/2021 Sonja Ann Carl, D.M.D. Active Dentistry 10/01/2019 to 09/30/2021 Richard W. Carlson, M.D., Ph.D. Courtesy Internal Medicine 10/01/2019 to 09/30/2021 Anne Margaret Floyd, M.D. Active Surgery (Ophthalmology) 10/01/2019 to 09/30/2021 Pejman Hedayati, M.D. Courtesy Radiology 10/01/2019 to 09/30/2021 Mahesh Kotwal, M.D. Active Pediatrics (Neonatology) 10/01/2019 to 09/30/2021 Brandon Daniel Liebelt, M.D. Courtesy Surgery (Neurosurgery) 10/01/2019 to 09/30/2021 Tina Marie McKenzie, M.D. Active Family & Community Medicine 10/01/2019 to 09/30/2021 Lisa Dianne Mihora, M.D. Courtesy Surgery (Ophthalmology) 10/01/2019 to 09/30/2021 Steven H. Miller, M.D. Courtesy Surgery (Hand Surgery/General Surgery) 10/01/2019 to 09/30/2021 Jean Marie Moon, M.D. Courtesy Obstetrics / Gynecology 10/01/2019 to 09/30/2021 R. Geetha Nair, M.D. Active Pathology 10/01/2019 to 09/30/2021 Sylvia Ruth Nash, M.D. Courtesy Pediatrics (Emergency Medicine) 10/01/2019 to 09/30/2021 Douglas P. Nelson, M.D. Active Internal Medicine 10/01/2019 to 09/30/2021 Jayakrishna Paineni, M.D. Active Family & Community Medicine 10/01/2019 to 09/30/2021 Albert Tae-Hun Roh, M.D. Active Radiology 10/01/2019 to 09/30/2021 Shannon E. Skinner, M.D. Active Internal Medicine 10/01/2019 to 09/30/2021 Indu Srinivasan, M.D. Active Internal Medicine (Gastroenterology) 10/01/2019 to 09/30/2021 Kevin Randall Tozer, M.D. Courtesy Surgery (Ophthalmology) 10/01/2019 to 09/30/2021 Scott Andrew Ungar, D.O. Courtesy Internal Medicine (Nephrology) 10/01/2019 to 09/30/2021 Kamala Vallabhaneni, M.D. Active Pediatrics 10/01/2019 to 09/30/2021 Dane Carlisle Van Tassel, M.D. Active Radiology 10/01/2019 to 09/30/2021 Sheetal Wadera, M.D. Active Pediatrics (Gastroenterology) 10/01/2019 to 09/30/2021 Kristyn Marie Wendelschafer, D.O. Active Family & Community Medicine 10/01/2019 to 09/30/2021 Navid Mohammed Ziran, M.D. Active Orthopedic Surgery 10/01/2019 to 09/30/2021
Page 2 of 3 Recommended by Credentials Committee: September 3, 2019 Recommended by Medical Executive Committee: September 10, 2019 Submitted to MSHCDB: September 25, 2019 REAPPOINTMENTS/ONGOING PROFESSIONAL PRACTICE EVALUATION CHANGE IN PRIVILEGES
NAME SPECIALTY ADDITION / REDUCTION / WITHDRAWAL COMMENTS Rahul Bhatia, M.D. Pediatrics (Critical Care Medicine) Addition: Advanced Pediatric and Adolescent Emergency Unsupervised Medicine Privileges Katherine Elizabeth Gross, M.D. Pulmonary / Critical Care Addition: Procedural Sedation Unsupervised Medicine Pejman Hedayati, M.D. Radiology Withdrawal: Cardiac CT Angiography Voluntary Relinquishment of Privileges due to non-utilization of privileges Tina Marie McKenzie, M.D. Family & Community Medicine Withdrawal: Biopsy of Cervix, endometrium Voluntary Relinquishment of Privileges due to non-utilization of privileges Steven H. Miller, M.D. Surgery Addition: Basic Trauma Surgery Unsupervised Shannon E. Skinner, M.D. Internal Medicine Withdrawal: Pediatric & Adolescent Core Privileges Not meeting the threshold eligibility criteria (Medical Staff Credentials Policy 2.A.1.) of Board recertification requirement in Pediatrics; Still board certified in Internal Medicine Dane Carlisle Van Tassel, M.D. Radiology Withdrawal: Voluntary Relinquishment of Privileges due to 1. Mammography non-utilization of privileges 2. Percutaneous Ultrasound Guided Fasciotomy & Tenotomy 3. Therapeutic Nuclear Medicine Kristyn Marie Wendelschafer, D.O. Family & Community Medicine Subdermal Contraceptive Capsule (insertion and removal) Unsupervised
STAFF STATUS CHANGE NAME DEPARTMENT CHANGE FROM/TO COMMENTS Eric D. Katz, M.D. Emergency Medicine Active to Courtesy Reduction in hours (Effective July 16, 2019) Alan R. Frechette, M.D. Pediatrics (Emergency Medicine) Medical Leave of Absence Practitioner recognized for outstanding or noteworthy contributions to the medical (LOA) to Emeritus sciences and/or has a record of previous long-standing service to the Hospital and has resigned in good standing from the active practice of medicine at MIHS.
RESIGNATIONS Information Only NAME DEPARTMENT/SPECIALTY STATUS REASON Jonathan A.E. Bolton, M.D. Emergency Medicine Courtesy to Inactive Resigned (Effective July 31, 2019) John A. Eelkema, M.D. Radiology Courtesy to Inactive Resigned (Effective July 1, 2019) Michael Anthony Fisher, M.D. Psychiatry Active to Inactive Resigned (Effective June 30, 2019) Alan R. Frechette, M.D. Pediatrics (Emergency Medicine) Medical LOA to Emeritus Retired (March 31, 2019) Page 3 of 3 Recommended by Credentials Committee: September 3, 2019 Recommended by Medical Executive Committee: September 10, 2019 Submitted to MSHCDB: September 25, 2019 RESIGNATIONS Information Only Neil K. Goldstein, M.D. Radiology (Interventional) Courtesy to Inactive Resigned (Effective July 3, 2019) Goshtasb Javdan, M.D. Family & Community Medicine Active to Inactive Resigned (Effective August 30, 2019) Vineel Kurli, M.D. Radiology Courtesy to Inactive Resigned (Effective June 27, 2019) Paula Hannah Mayer, M.D. Emergency Medicine Courtesy to Inactive Resigned (Effective July 31, 2019) Nirmala Kumari Narla, M.D. Obstetrics & Gynecology Active to Inactive Resigned (Effective June 30, 2019) Adedayo O. Onibokun, M.D., FACOG Obstetrics & Gynecology Active to Inactive Resigned (Effective September 13, 2019) Daniel Orosco, D.O. Emergency Medicine Active to Inactive Resigned (Effective July 16, 2019) Rebecca B. Rodie, M.D. Radiology Courtesy to Inactive Resigned (Effective July 15, 2019) Ericka Lynn Scheller McLaughlin, D.O. Pediatrics (Cardiology) Courtesy to Inactive Resigned (Effective January 14, 2019) Nirmala Kumari Narla, M.D. OB/Gyn Active to Inactive Resigned (Effective June 30, 2019) Amanda Brooke Scott, D.O. Pediatrics Courtesy to Inactive Resigned (Effective September 30, 2019) Holly Marie Williams, M.D. Emergency Medicine Courtesy to Inactive Resigned (Effective July 31, 2019)
Definitions: Active > 1,000 hours/year – Active members of the medical staff have voting rights and can serve on medical staff committees Courtesy < 1,000 hours/year – Courtesy members do not have voting rights and do not serve on medical staff committees Reappointments Renewal of appointment and privileges is for a period of two years unless otherwise specified for a shorter period of time. FPPE Focused professional practice evaluation is a process by which the organization validates current clinical competence. This process may also be used when a question arises in practice patterns.
Page 4 of 3
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.ii.
Medical Staff Allied Health Professional Staff Appointments – September 2019 Recommended by Credentials Committee: September 3, 2019 Recommended by Medical Executive Committee: September 10, 2019 Submitted to MSHCDB: September 25, 2019
MARICOPA INTEGRATED HEALTH SYSTEM CREDENTIALS AND ACTION ITEMS REPORT ALLIED HEALTH PROFESSIONAL STAFF
The credentials of the following individuals including, current licensure, relevant training and experience, malpractice insurance, current competence and the ability to perform the requested privileges have been verified.
ALLIED HEALTH PROFESSIONALS - INITIAL APPOINTMENTS NAME DEPARTMENT PRACTICE PRIVILEGES/ APPOINTMENT DATES COMMENTS SCOPE OF SERVICE Zaqueena Shaunta Coleman, F.N.P. Obstetrics & Gynecology Practice Prerogatives on file 10/01/2019 to 09/30/2021 Beth J. Dolobowsky, L.C.S.W. Psychiatry Practice Prerogatives on file 10/01/2019 to 09/30/2021 Natasha LeAnn Ivey, P.A.-C. Internal Medicine Practice Prerogatives on file 10/01/2019 to 09/30/2021 Jodie Mokihana Kaalekahi, F.N.P. Internal Medicine Practice Prerogatives on file 10/01/2019 to 09/30/2021 Cori Ann Morse, N.N.P. Pediatrics Practice Prerogatives on file 10/01/2019 to 09/30/2021 Nicole Elizabeth Thurman, F.N.P. Family & Community Medicine Practice Prerogatives on file 10/01/2019 to 09/30/2021 Janet Lynn Wildemuth, P.A.-C. Internal Medicine Practice Prerogatives on file 10/01/2019 to 09/30/2021 Elise Carolyn Wise, P.M.H.N.P. Psychiatry Practice Prerogatives on file 10/01/2019 to 09/30/2021
INITIAL/FOCUSED PROFESSIONAL PRACTICE EVALUATION NAME SPECIALTY/PRIVILEGES RECOMMENDATION COMMENTS EXTEND or PROPOSED STATUS Bridget Bernadette Barron, P.A.-C Orthopedic Surgery Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Therapeutic Procedure Privileges. Brittney Savannah Gillespie, P.A.-C. Family & Community Medicine Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Family & Community Medicine Physician Assistant Core Privileges. Camilla Rae Jensen, P.A.-C Orthopedic Surgery Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Physician Assistant Core Privileges and Minor Surgery Procedure Privileges. Cathy Jean Kaplicki, A.P.M.H.N.P. Psychiatry Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Nurse Practitioner Psychiatric/Mental Health Privileges. Teresa DeJesus Loera, F.N.P. Family & Community Medicine Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Family & Community Medicine Nurse Practitioner Core Privileges. Phillip Matthew Spencer, P.A.-C Orthopedic Surgery Successfully Completed FPPE Chair has submitted documentation demonstrating practitioner has successfully completed FPPE requirement for Physician Assistant Core Privileges and Minor Surgery Procedure Privileges.
1 of 2 Recommended by Credentials Committee: September 3, 2019 Recommended by Medical Executive Committee: September 10, 2019 Submitted to MSHCDB: September 25, 2019
ALLIED HEALTH PROFESSIONALS – REAPPOINTMENTS NAME DEPARTMENT PRACTICE PRIVILEGES/ APPOINTMENT COMMENTS SCOPE OF SERVICE DATES Jonathan Bryan Burge, C.R.N.A. Anesthesiology Practice Prerogatives on file 10/01/2019 to 09/30/2021 Matthew John Gurtler, C.R.N.A. Anesthesiology Practice Prerogatives on file 10/01/2019 to 09/30/2021 Yvonne Lamos, C.N.M. Obstetrics / Gynecology Practice Prerogatives on file 10/01/2019 to 09/30/2021 Susan Daney Liebherr, N.P. Obstetrics / Gynecology Practice Prerogatives on file 10/01/2019 to 09/30/2021 Steven Edward Mouch, P.A.-C Surgery Practice Prerogatives on file 10/01/2019 to 09/30/2021
CHANGE IN PRIVILEGES
NAME SPECIALTY ADDITION / REDUCTION / WITHDRAWAL COMMENTS Richard Adam White, P.A.-C Physician Assistant (Emergency Medicine) Addition: Procedural Sedation Under personal supervision only
RESIGNATIONS Information Only NAME DEPARTMENT/SPECIALTY STATUS REASON Kimberly Faith Carroll, Psy.D. Psychiatry AHP to Inactive Resigned (Effective August 28, 2019) Daniel Fimbres, F.N.P. Family & Community Medicine AHP to Inactive Resigned (Effective September 28, 2019) Donisha Dawn Pardue, F.N.P. Family & Community Medicine AHP to Inactive Resigned (Effective August 31, 2019)
CORRECTION TO THE August 28, 2019 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT BOARD MEETING NAME SPECIALTY/PRIVILEGES CATEGORY COMMENTS Arlene Hanic Karlin, C.N.M. Certified Nurse Midwife Allied Health Professional Provider inadvertently listed as a staff removal is remaining on the Allied Health Professional Staff.
General Definitions: Allied Health An Allied Health Professional (AHP) means a health care practitioner other than a Medical Staff member who is authorized by the Governing Body to provide patient care services at a MIHS facility, and who is Professional Staff permitted to initiate, modify, or terminate therapy according to their scope of practice or other applicable law or regulation. Governing Body authorized AHPs are: Certified Registered Nurse Anesthetists; Certified Registered Nurse Midwife; Naturopathic Physician; Optometrists; Physician Assistant; Psychologists (Clinical Doctorate Degree Level); Registered Nurse Practitioners. Practice Prerogatives Scopes of practice summarizing qualifications for the respective category, developed with input from the physician director of the clinical service and the observer/sponsor/responsible party of the AHP, Department Chair, and other representatives of the Medical Staff, Hospital management, and other professionals. Supervision Definitions: (1) General Supervision The procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure or provision of the services. (2) Direct Supervision The physician must be present in the office suite or on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. (3) Personal Supervision A physician must be in the room during the performance of the procedure.
2 of 2
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.iii.
Medical Staff Pediatric Gastroenterology Privileges Maricopa Integrated Health SystemValleywise Health Pediatrics - Gastroenterology Instructions for Applicants
After reviewing the Qualification for Privileges and Privilege Description, sign the “Attestation Statement”. You may be asked to provide documentation of the number and types of cases you have performed during the past 12 to 24 months. Applicants have the burden of producing information deemed necessary by MIHS Valleywise Health for a proper evaluation of current competence and other qualifications and for resolving questions. Note that privileges granted may only be exercised at the site(s) and/or setting(s) that have the appropriate equipment, license, beds, staff and other support required to provide the services defined in this document. Site-specific services may be defined in hospital and/or department policy.
Core Privilege Lists: Core Procedure and Privilege lists represent a sampling included in the Core Privileges. They are not intended to be an all-encompassing list but rather they are reflective of the categories/types of procedures included in the core. Applicants who wish to exclude any procedures in the Core lists should strike through those procedures they do not wish to request, initial, and date.
Board Certification: It is required that board certification be attained within the time frame designated by a practitioner’s respective primary specialty/subspecialty. Practitioners are required to maintain board certification in their primary specialty or subspecialty area of practice. Maintenance of only subspecialty certification is adequate for continued hospital privileges in a primary specialty. [Physicians appointed to the Medical Staff and/or granted clinical privileges prior to December 2007, who are not eligible to become board certified, are not subject to the board certification requirement.]
Other Requirements: This document is focused on defining qualifications related to competency to exercise clinical privileges. The applicant must also adhere to any additional organization, regulatory or accreditation requirements that the MIHSValleywise Health is obligated to meet. The applicant agrees to review applicable policies every two years. See specific documents:
• Sedation for Procedures Policy and Procedure
Applicant Attestation: Applicants for initial and reappointment agree that they understand that in exercising any clinical privileges granted, they are constrained by Hospital and Medical Staff policies and rules applicable generally and any applicable to the particular situation. Any restriction on the clinical privileges granted is waived in an emergency situation and in such situation the actions taken are governed by the applicable section of the Medical Staff Bylaws or related documents
Approved 07/98; Revision approved: 8/24/2011, 6/19/ Sedation Rev: 6/2012, 11/2012, 11/2013, 8/2014, 1/2015 Page 1 of 3 Maricopa Integrated Health SystemValleywise Health Pediatrics - Gastroenterology
Criteria-Based Core Privileges: Gastroenterology
To be eligible to apply for core privileges in infectious diseases, the applicant must meet Maricopa Integrated Health SystemValleywise Health membership requirements as outlined in the Medical Staff Bylaws and the following privileging criteria: INITIAL APPLICANTS Education Successful completion of a fellowship-training program in Pediatrics Gastroenterology accredited by the Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) equivalent. Board Certification Current certification or board eligibility with achievement of certification within the time frame designated by the American Board Pediatrics in the subspecialty of pediatric gastroenterology leading to certification in Pediatrics Gastroenterology by the American Board of Pediatrics or American Osteopathic Association (AOA) equivalent. Clinical Activity Applicants for initial appointment must be able to demonstrate provision of services to 50 patients, reflective of the scope of privileges requested, during the past 12 months in an accredited hospital or healthcare facility similar in scope and complexity to MIHSValleywise Health, or demonstrate successful completion of an clinical fellowship within the past 12 months. FOCUSED PROFESSIONAL PRACTICE EVALUATION Guidelines for Initial Minimum of five (5) cases to be retrospectively reviewed. FPPE shall consist of a Appointment retrospective review of a cross-section of the privileges granted. REAPPOINTMENT Current demonstrated competence and current experience with acceptable results to demonstrate provision of care to at least 30 patients reflective of the scope of privileges requested for the past 24 months as a result of ongoing professional practice evaluation activities and outcomes.
If you wish to exclude any procedures, please strike through those procedures that you do not wish to request, initial, and date.
Requested PEDIATRIC & ADOLESCENT GASTROENTEROLOGY PRIVILEGES Admit, perform history & physical, evaluate, diagnose, consult and provide care to infants, children, adolescents and young adults with acute and chronic diseases of the digestive system (esophagus, stomach, intestines, liver and pancreas) and nutritional disorders. The core privileges in this specialty include those procedures listed and such other procedures that are extensions of the same techniques and skills. If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. • Colonoscopy • Esophagogastroduodenoscopy • Esophageal dilatation • Flexible Sigmoidoscopy • Proctoscopy • Percutaneous endoscopic gastrostomy tube placement, PEG removal with or without G-tube (button) replacement • Percutaneous liver biopsy • Variceal hemostasis
Approved 07/98; Revision approved: 8/24/2011, 6/19/ Sedation Rev: 6/2012, 11/2012, 11/2013, 8/2014, 1/2015 Page 2 of 3 Maricopa Integrated Health SystemValleywise Health Pediatrics - Gastroenterology Non-Core Special Privileges
Requested PROCEDURAL SEDATION Initial Appointment Criteria: • Successful completion of an Accreditation Council for Graduate Medical Education (ACGME) residency or fellowship training program that included training in procedural sedation and patient airway rescue or completion of formal training in procedural sedation and patient airway rescue within the past twenty-four (24) months, OR • If more than twenty-four (24) months out of residency or fellowship training, applicant must demonstrate satisfactory performance of 10 procedural sedation cases within the past twenty-four (24) months; AND • Current Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), (as appropriate to the age of the patient) or a comparable advanced life support curriculum; AND successful completion of “Hands On” Basic Airway Management Training course within the past two (2) years; OR Board Certified/Qualified in emergency medicine, pediatric emergency medicine, neonatology, or critical care; AND • Must successfully complete a knowledge-based test to demonstrate competency in procedural sedation prior to the granting of the privilege. Focus Professional Practice Evaluation: Retrospective review of at least 2 procedural sedation cases. (If applicable, the FPPE for Deep Sedation will meet this requirement.) Reappointment Criteria: • Performance of ten (10) procedural sedation cases during the past 24 months; OR Documentation of completion of a “Hands On” Basic Airway Management Training course within the past two (2) years; AND • Current Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), or Neonatology Resuscitation Program (NRP) (as appropriate to the age of the patient), or a comparable advanced life support curriculum, or Board Certified/Qualified in emergency medicine, pediatric emergency medicine, neonatology, or critical care. (The advanced life support course must be approved/designated by an American Heart Association training center/program or other training with verified comparable “hands on” basic airway training as part of recertification) OR practitioner must demonstrate successful completion of “Hands On” Basic Airway Training course within the past two (2) years.)
CHECK HERE TO REQUEST GENERAL PEDIATRICS PRIVILEGES FORM
Requested
Acknowledgement of Applicant I have requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and for which I wish to exercise at The Maricopa Integrated Health SystemValleywise Health, and I understand that: a. In exercising any clinical privileges granted, I am constrained by Hospital and Medical Staff policies and rules applicable generally and any applicable to the particular situation. b. Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of the Medical Staff Bylaws or related documents.
Signed Date Applicant
Approved 07/98; Revision approved: 8/24/2011, 6/19/ Sedation Rev: 6/2012, 11/2012, 11/2013, 8/2014, 1/2015 Page 3 of 3
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.iv.
Medical Staff Internal Medicine – Cardiology Privileges Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
Instructions for Applicants
After reviewing the Qualification for Privileges and Privilege Description, sign the “Attestation Statement”. You may be asked to provide documentation of the number and types of cases you have performed during the past 12 to 24 months. Applicants have the burden of producing information deemed necessary by MIHSValleywise Health for a proper evaluation of current competence and other qualifications and for resolving questions. Note that privileges granted may only be exercised at the site(s) and/or setting(s) that have the appropriate equipment, license, beds, staff and other support required to provide the services defined in this document. Site-specific services may be defined in hospital and/or department policy.
Core Privilege Lists: Core Procedure and Privilege lists represent a sampling included in the Core Privileges. They are not intended to be an all-encompassing list but rather they are reflective of the categories/types of procedures included in the core. Applicants who wish to exclude any procedures in the Core lists should strike through those procedures they do not wish to request, initial, and date.
Board Certification: It is required that board certification be attained within the time frame designated by a practitioner’s respective primary specialty/subspecialty. Practitioners are required to maintain board certification in their primary specialty or subspecialty area of practice. Maintenance of only subspecialty certification is adequate for continued hospital privileges in a primary specialty. [Physicians appointed to the Medical Staff and/or granted clinical privileges prior to December 2007, who are not eligible to become board certified, are not subject to the board certification requirement.]
Other Requirements: This document is focused on defining qualifications related to competency to exercise clinical privileges. The applicant must also adhere to any additional organization, regulatory or accreditation requirements that the MIHSValleywise Health is obligated to meet. The applicant agrees to review applicable policies every two years. See specific documents:
• Sedation for Procedures Policy and Procedure
Applicant Attestation: Applicants for initial and reappointment agree that they understand in exercising any clinical privileges granted, they are constrained by Hospital and Medical Staff policies and rules applicable generally and any applicable to the particular situation. Any restriction on the clinical privileges granted is waived in an emergency situation and in such situation the actions taken are governed by the applicable section of the Medical Staff Bylaws or related documents.
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
1 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
Criteria-Based Core Privileges -CARDIOLOGY To be eligible to apply for core privileges in Cardiology, you must meet Maricopa Integrated Health SystemValleywise Health membership requirements as outlined in the Medical Staff Bylaws and the following privileging criteria: INITIAL APPLICANTS Education Successful completion of an Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) accredited fellowship in cardiovascular disease. Board Certification Current certification or board eligibility with achievement of certification within the time frame designated by the by the American Board of Internal Medicine, Cardiovascular Disease, or American Osteopathic Association (AOA) equivalent. Clinical Activity Applicants for initial appointment must be able to demonstrate provision of services, of at least 75 cases that are reflective of the scope of privileges requested, during the past 12 months in an accredited hospital or healthcare facility similar in scope and complexity to MIHSValleywise Health or demonstrate successful completion of an ACGME or AOA accredited residency, clinical fellowship within the past 12 months. FOCUSED PROFESSIONAL PRACTICE EVALUATION Guidelines for Initial Retrospective review of a minimum of five (5) cases, reflective of the scope of privileges requested to be Appointment completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. REAPPOINTMENT Performance or supervision of 100 procedures reflective of the scope of privileges requested for the past 24 months as a results of ongoing professional practice evaluation activities and outcomes.
Requested BASIC AMBULATORY CARDIOLOGY CORE PRIVILEGES Admit, perform history and physical, treat, order diagnostic studies, and provide consultation to outpatients treated within the Maricopa IntegratedValleywise Health Health System (includes supervision responsibilities of residents and students.). The core privileges in non- invasive/basic cardiology include those skills listed and such other skills that are extensions of the same. ▪ Adult transthoracic echocardiography ▪ ECG interpretation, including signal average ECG ▪ Event and Holter Monitor Interpretation ▪ Evaluation of permanent pacemaker ▪ Stress testing (exercise only)
Requested CARDIOLOGY CORE PRIVILEGES
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
2 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology Admit, perform history and physical, treat, order diagnostic studies and procedures, and provide consultation to outpatients treated within the Maricopa Health SystemValleywise Health and to inpatients on the regular hospital floors and special care areas (includes supervision responsibilities of residents and students.) The core privileges in non-invasive cardiology include those procedures listed and such other procedures that are extensions of the same techniques and skills. If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. ▪ Adult transthoracic echocardiography ▪ Ambulatory electrocardiology monitor interpretation ▪ Cardiovascular Rehabilitation ▪ Cardioversion, electrical, elective ▪ ECG interpretation, including signal average ECG (basic and advanced) ▪ Event and Holter Monitor Interpretation ▪ Infusion and management of Gp IIb/IIIa agents and thrombolytic agents and anti-thrombolytic agents ▪ Insertion and management of central venous catheters, pulmonary artery catheters, right heart catheters, and arterial lines ▪ Evaluation of Cardiac Implantable Electronic Device (Including programming/reprogramming and interrogation) ▪ Non-invasive hemodynamic monitoring ▪ Pericardiocentesis ▪ Placement of temporary transvenous pacemaker ▪ Stress testing (exercise and pharmacologic stress) ▪ Thoracentesis ▪ Tilt table testing ▪ Tracheal Intubation (emergency only) ▪ Transcutaneous external pacemaker placement ▪ Central line placement and venous angiography ▪ Interpretation of coronary arteriograms, ventriculography and hemodynamics
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
3 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
Criteria-Based Core Privileges
INVASIVE/INTERVENTIONAL CARDIOLOGY INITIAL APPLICANTS Education Successful completion of an ACGME or AOA accredited fellowship in Interventional Cardiology or equivalent practice experience if training occurred prior to 2003; AND/OR Board Certification Current certification or board eligibility with achievement of certification within the time frame designated by the American Board of Internal Medicine with the added qualification in Interventional Cardiology or American Osteopathic Association (AOA) equivalent. Clinical Activity Demonstration of performance of at least seventy-five (75) percutaneous coronary intervention procedures in the past 12 months, with all seventy-five (75) cases performed as primary operator AND provide a letter from Director of Catheterization Laboratory or Chief of Cardiology from previous affiliation attesting to physician competency and satisfactory performance. FOCUSED PROFESSIONAL PRACTICE EVALUATION Guidelines for Initial Retrospective review of the first five (5) cases in any combination of core invasive/interventional procedures with an Appointment active member of the medical staff with those privileges, with satisfactory performance and completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. REAPPOINTMENT Performance or supervision of one hundred (100) percutaneous coronary intervention procedures in the past twenty-four (24) months with acceptable results based on results of ongoing professional practice evaluation and outcomes and documentation of approved continuing medical education.
Requested INVASIVE/INTERVENTIONAL CARDIOLOGY CORE PRIVILEGES Admit, perform history and physical, treat, order diagnostic studies and procedures, and provide consultation to outpatients treated within the Maricopa Health System Valleywise Health and to inpatients on the regular hospital floors and special care areas (includes supervision responsibilities of residents and students.) The core privileges in interventional cardiology include those procedures listed and such other procedures that are extensions of the same techniques and skills. If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. ▪ Endomyocardial biopsy ▪ Endovascular procedures (Limited to Angioplasty/stenting of femoral/iliac or subclavian vessels to allow for catheter access to the heart and preservation of coronary grafts) ▪ Peripheral vascular access cannulation for diagnostic angiography or percutaneous coronary intervention ▪ Interpretation of coronary arteriograms, ventriculography and hemodynamics ▪ Intracoronary infusion of pharmacological agents including thrombolytics ▪ Intracoronary thrombectomy ▪ Intracoronary stents ▪ Intravascular imaging of coronaries ▪ Management of mechanical complications of percutaneous intervention ▪ Performance of balloon angioplasty, stents, and other commonly used interventional devices ▪ Use of intracoronary Doppler and flow wire ▪ Use of vasoactive agents for epicardial and microvascular spasm ▪ Aortagram and Peripheral Angiography ▪ Coronary arteriography ▪ Insertion of intraortic balloon counter pulsation device ▪ Diagnostic right and left heart cardiac catheterization ▪ Rotational Atherectomy
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
4 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
NON-CORE CARDIOLOGY PROCEDURES
Requested TRANSESOPHAGEAL ECHOCARDIOGRAPHY Initial Appointment Criteria: Requesting practitioner will be required to submit documentation to support one of the following options: • Documentation from Residency or Fellowship Program Director of at least ten (10) transesophageal echocardiography procedures, OR • If applicant is more than five (5) years out of fellowship training, documentation of experience during other affiliations that meet reappointment criteria delineated below; AND provide a letter from Director of Echo Lab or Chief of Cardiology from previous affiliation attesting to physician competency and satisfactory performance; AND • Current certification or active participation in the examination process [with achievement of certification within five years] leading to certification by the National Board of Echocardiography. Focus Professional Practice Evaluation: Retrospective review of a minimum of three (3) cases with satisfactory performance and completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of twenty (20) procedures in the past twenty-four (24) months with acceptable results based on results of ongoing professional practice evaluation and outcomes.
NON-CORONARY ENDOVASCULAR INTERVENTION PROCEDURES (EXCLUDING CAROTID Requested ARTERIES) Initial Appointment Criteria: Requesting practitioner will be required to submit documentation to support one of the following options: • Must have unsupervised Invasive/Interventional Cardiology Core privileges; AND • Documentation from Fellowship Program Director of at least 50 supervised non-coronary endovascular interventions in a variety of vascular beds, OR • If applicant is more than five (5) years out of fellowship training, documentation of experience during other affiliations that meet reappointment criteria delineated below; AND provide a letter from Director of Cath Lab or Chief of Cardiology from previous affiliation attesting to physician competency and satisfactory performance. Focus Professional Practice Evaluation: Retrospective review of the first five (5) cases with an active member of the medical staff with those privileges with satisfactory performance and completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of ten (10) non-coronary endovascular intervention procedures in the past twenty-four (24) months with acceptable results based on results of ongoing professional practice evaluation and outcomes.
Requested NUCLEAR CARDIOLOGY Initial Appointment Criteria: Requesting practitioner will be required to submit documentation to support one of the following options: • Current certification or active participation in the examination process [with achievement of certification within five years] leading to certification by the Certification Board of Nuclear Cardiology; AND • Documentation of at least ten (10) Nuclear Cardiology cases performed in the last twenty-four (24) months. If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. • Myocardial (perfusion) imaging rest/exercise/pharmacologic (Planar/SPECT); • Gated equilibrium or “first-pass” radionuclide cineangiocardiography (rest/exercise); • Myocardial infarction imaging; • Shunt studies Focus Professional Practice Evaluation: Retrospective review of a minimum of ten (10) cases with satisfactory performance and completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of sixty (60) procedures in the past twenty-four (24) months with acceptable results based on results of ongoing professional practice evaluation and outcomes.
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
5 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
NON-CORE SPECIAL PROCEDURES
Requested CAROTID ARTERY AND PERIPHERAL VASCULAR ULTRASOUND INTERPRETATION Initial Appointment Criteria: • Successful completion of an approved residency/fellowship training program with at least three (3) months of supervised diagnostic ultrasound training OR procurement of the American Registry of Diagnostic Medical Sonographers (ARDMS)’s registered vascular technologist credential, AND evidence of involvement in the evaluation and interpretation of at least one hundred and fifty (150) documented and supervised vascular ultrasound examinations within three (3) years OR fifty (50) ultrasound interpretations performed in the past year; OR • Applicant must have evidence of sixteen (16) hours of American Medical Association (AMA) Category I CME activity dedicated to diagnostic ultrasound, AND evidence of involvement in the evaluation and interpretation of at least one hundred fifty (150) ultrasound examinations within three (3) years, OR fifty (50) ultrasound interpretations performed in the past year. Focus Professional Practice Evaluation: Retrospective review of a minimum of ten (10) cases with satisfactory performance and to be completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment: Performance of twenty-five (25) carotid artery & peripheral vascular ultrasound interpretation procedures in the past 24 months with acceptable results based on results of ongoing professional practice evaluation and outcomes.
Request AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (AICD) Initial Appointment Criteria: Requesting practitioner will be required to submit documentation to support one of the following options: • Must have or qualify for Invasive/Interventional Cardiology Core privileges including permanent pacemaker placement AND fulfill the ICD implantation requirements of the Heart Rhythm Society by a non-electrophysiologist; AND provide documentation of performing at least fifty (50) AICD procedures in the past twenty-four (24) months; OR • Current subspecialty certification or active participation in the examination process [with achievement of certification within five years] leading to subspecialty certification in electrophysiology by the American Board of Internal Medicine or AOA Board. Focus Professional Practice Evaluation: Retrospective review of a minimum of five (5) cases with satisfactory performance and to be completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of ten (10) procedures in the past twenty-four (24) months with acceptable results based on ongoing professional practice evaluation and outcomes.
Request ELECTROPHYSIOLOGY STUDIES (EPS) Initial Appointment Criteria: • Current certification or active participation in the examination process [with achievement of certification within five years] leading to certification by the American Board of Internal Medicine with the added qualifications in Clinical Cardiac Electrophysiology. If you wish to exclude any procedures, please strike through those procedures which you do not wish to request, initial, and date. Includes: • Diagnostic Studies; • Mapping Studies; • AV Nodal Ablation; • Accessory Pathway and Other SVT Ablations; • VT Ablations; • Atrial Fibrillation Ablations Focus Professional Practice Evaluation: Retrospective review of five (5) cases and these must include one (1) case with Ventricular Tachycardia, one (1) case with an Accessory Pathway, which is ablated and one (1) case with AVNRT, which is ablated with satisfactory performance and to be completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of forty (40) cases during the past twenty-four (24) months with acceptable clinical outcomes results based on ongoing professional practice evaluation and outcomes
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
6 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
NON-CORE SPECIAL PROCEDURES
Request CRT (BiVentricular) PACEMAKER PRIVILEGES Initial Appointment Criteria: • Have unsupervised privileges, or meet criteria to apply for, electrophysiology privileges; AND • Must provide documentation at least ten (10) CRT pacemaker in the last 12 months. Focus Professional Practice Evaluation: Retrospective review of five (5) cases with satisfactory performance and to be completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of twenty (20) cases in the last twenty-four (24) months. CRT pacemaker/defibrillator cases may also be applied toward case numbers for permanent pacemakers and implantable defibrillators with acceptable clinical outcomes results based on ongoing professional practice evaluation and outcomes.
Requested PERCUTANEOUS PATENT FORAMEN OVALE (PFO)/ATRIAL SEPTAL DEFECT (ASD) CLOSURE Criteria to apply for privileges: • Applicants must have unsupervised Invasive/Interventional Cardiology Core privileges; and • Applicants must submit documentation of previous PFO/ASD closure device implantation training and experience of at least five (5) cases in the previous 24 months; Focus Professional Practice Evaluation: Retrospective review of the first three (3) cases with satisfactory performance and to be completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of four (4) Percutaneous ASD/PFO closure cases during the preceding twenty-four (24) months with acceptable clinical outcomes results based on ongoing professional practice evaluation and outcomes OR performance of at least two Percutaneous ASD/PFO closure cases with submission of CME that provided simulation training in the performance of Percutaneous ASD/PFO cases in the past twenty-four (24) months.
Requested PERMANENT PACEMAKER INSERTION Criteria to apply for privileges: • Successful completion of an approved fellowship training program (Cardiology and/or Electrophysiology) in which the applicant was the primary implanter in at least 25 pacemaker implants along with evidence that the training program provided didactic instruction in pacemakers and provided experience with pacemaker follow-up; AND • Documentation from Fellowship Program Director that the applicant is independently capable of implanting pacemakers. Focus Professional Practice Evaluation: Retrospective review of the first five (5) cases with satisfactory performance and to be completed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of twenty (20) cases in the last twenty-four (24) months.
Requested CARDIAC CT ANGIOGRAPHY Initial Appointment Criteria: • Applicants must meet criteria for core privileges in Cardiology or Radiology; AND • Meet Level II or III CCTA endorsed certification standards as outlined by the Society of Cardiovascular Computed Tomography (SCCT) that include 150 mentored contrast cardiac CT angiography cases for level II or 300 mentored contrast cardiac CT angiography cases for level III; AND • Minimum of 20 hours of Category I CME in cardiac imaging, including cardiac CCTA, anatomy, physiology, and/or pathology or documented equivalent supervised experience in a center actively performing cardiac CCTA in the past three years Focus Professional Practice Evaluation: Retrospective review of a minimum of 5 (five) cases with satisfactory performance. Reappointment Criteria: To maintain Level II competency, performance/interpretation of fifty (50) contrast enhanced cases in the past twenty- four (24) months and completion of twenty (20) hours of cardiac CT related category I CME over the past three (3) years.
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
7 of 7
Maricopa Integrated Health SystemValleywise Health Internal Medicine - Cardiology
NON-CORE SPECIAL PROCEDURES
Requested IMPLANTED LOOP RECORDER Criteria to apply for privileges: • Successful completion of an approved fellowship training program (Cardiology and/or Electrophysiology) in which the applicant was the primary implanter in at least 25 Loop recorder implants along with evidence that the training program provided didactic instruction in Loop recorder implants and provided experience with Loop recorder implants follow-up; AND • Documentation from Fellowship Program Director that the applicant is independently capable of implanting Loop recorders. Focus Professional Practice Evaluation: Retrospective review of the first five (5) cases with satisfactory performance and to be completed in accordance with the Valleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy. Reappointment Criteria: Performance or supervision of twenty (20) cases in the last twenty-four (24) months.
Requested PROCEDURAL SEDATION Initial Appointment Criteria: • Successful completion of an Accreditation Council for Graduate Medical Education (ACGME) residency or fellowship training program that included training in procedural sedation and patient airway rescue or completion of formal training in procedural sedation and patient airway rescue within the past twenty-four (24) months, OR • If more than twenty-four (24) months out of residency or fellowship training, applicant must demonstrate satisfactory performance of 10 procedural sedation cases within the past twenty-four (24) months; AND • Current Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), (as appropriate to the age of the patient) or a comparable advanced life support curriculum; AND successful completion of “Hands On” Basic Airway Management Training course within the past two (2) years; OR Board Certified/Qualified in emergency medicine, pediatric emergency medicine, neonatology, or critical care; AND • Must successfully complete a knowledge-based test to demonstrate competency in procedural sedation prior to the granting of the privilege. Focus Professional Practice Evaluation: Retrospective review of at least 2 procedural sedation cases. Reappointment Criteria: • Performance of ten (10) procedural sedation cases during the past 24 months; OR Documentation of completion of a “Hands On” Basic Airway Management Training course within the past two (2) years; AND Current Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), or Neonatology Resuscitation Program (NRP) (as appropriate to the age of the patient), or a comparable advanced life support curriculum, or Board Certified/Qualified in emergency medicine, pediatric emergency medicine, neonatology, or critical care. (The advanced life support course must be approved/designated by an American Heart Association training center/program or other training with verified comparable “hands on” basic airway training as part of recertification) OR practitioner must demonstrate successful completion of “Hands On” Basic Airway Training course within the past two (2) years.)
CHECK HERE TO REQUEST INTERNAL MEDICINE PRIVILEGES FORM
Requested
Acknowledgement of Applicant I have requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and for which I wish to exercise at The Maricopa Integrated Health SystemValleywise Health, and I understand that: a. In exercising any clinical privileges granted, I am constrained by Hospital and Medical Staff policies and rules applicable generally and any applicable to the particular situation. b. Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of the Medical Staff Bylaws or related documents.
Signed Date Applicant
Approved 10/98, REV. 12/99, 09/00, 06/01, 10/02, 02/04; 03/07, 08/07, 12/20/07, 04/08, 08/08, 02/09, 11/09, 05/10, 09/10, 10/13, 11/14, 11/15, 09/17, 01/18, 3/18, 6/19, 9/19 /Sedation Rev: 6/12, 8/12, 11/12, 11/13, 8/14, 1/15, 6/18
8 of 7
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.v.
Medical Staff Global Robotic Surgery Privileges
Maricopa Integrated Health SystemValleywise Health
PROPOSED REVISIONS TO GLOBAL (MULTI-SPECIALTY) ROBOTIC SURGERY PRIVILEGES Special Non-Core Privileges-
Requested ROBOTIC SURGERY Criteria to apply for privileges:
Must have unsupervised Basic laparoscopy and/or Advance Laparoscopy Privileges
Pathway #1 Applicants must have documentation of completion of training in robotically assisted laparoscopic surgery during residency or fellowship with provision of a case log detailing number and type of procedures performed, a letter of attestation from training program director affirming competence in performance of requested privileges and that residency or fellowship was completed within the last 24 months prior to applying for privileges; AND three (3) cases *concurrently observed by a robotic surgeon from their field of practice: • Low complexity • Non-obese (BMI <40) • No previous intra-abdominal surgeries • With Port placement and docking time documented • With Console start and end times documented *Exception -If the applicant was trained at Valleywise Health, they do not need to undergo the concurrent observed cases.
Pathway #2 If more than two years out of training and did not receive formal didactic and “hands on” training in robotically assisted laparoscopic surgery, applicant must show documentation of the completion of the Intuitive da Vinci Surgical System Off Site Training Program; AND • Si Modules for Surgeons (Certificate of Completion required); AND • dV System Modules for First Assistants (Certificate of Completion required) • Observation of another surgeon performing at least two (2) cases within the relevant specialty or subspecialty; AND WHEN THE ABOVE ARE COMPLETE, MUST THEN HAVE • Three (3) cases concurrently observed by a robotic surgeon from their field of practice: o Low complexity o Non-obese (BMI <40) o No previous intra-abdominal surgeries o With Port placement and docking time documented o With Console start and end times documented
Pathway #3 For applicants who maintain current unsupervised robotically assisted laparoscopic surgery privileges in another institution, only a case log demonstrating at least twenty (20) completed cases within the last two (2) years of practice is required and letter from the Chair/Chief documenting successful performance of Robotic Surgery Privileges
Focus Professional Practice Evaluation: Retrospective review by a surgeon within the relevant specialty or subspecialty with robotic privileges of a minimum of five (5) video recorded robotically assisted laparoscopic surgery procedures.
Reappointment Criteria: Successful performance of ten (10) robotically assisted laparoscopic surgery procedures reflective of the scope of privileges requested, for the past twenty-four (24) months based on results of ongoing professional practice evaluation and outcomes.
Note: To be considered as eligible for observer status for robotic surgery, practitioner must have completed a minimum of thirty (30) robotically assisted laparoscopic cases within the past twelve (12) months.
Acknowledgement of Applicant I have requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and for which I wish to exercise at The Maricopa Integrated Health SystemValleywise Health, and I understand that: a. In exercising any clinical privileges granted, I am constrained by Hospital and Medical Staff policies and rules applicable generally and any applicable to the particular situation. b. Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable Section of the Medical Staff Bylaws or related documents. Signed Date «longname_of_providers»
APPROVED 5/17, 6/17, 03/18, 11/2018, 9/2019 Page 1 of 1
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.vi.
Medical Staff Physician Assistant Privileges and Practice Prerogatives
Physician Assistant Practice Prerogatives and Privileges
______Name of Physician Assistant (Print)
To be eligible to apply for privileges the applicant must meet MIHSValleywise Health Allied Health Professional (AHP) Staff membership requirements as outlined in the AHP Policy and the following privileging criteria:
RESPONSIBLE PARTY: Department Chair/designee, or Sponsorship by physician(s) who is/are member(s) in good standing of the Maricopa Integrated Health System Valleywise Health. DEFINITION: Physician Assistants provide medical care under the guidance of a physician supervisor at the Health Centers, Comprehensive Health Clinics, other MIHSValleywise Health owned or operated ambulatory settings, and Valleywise HealthMaricopa Medical Center.
SUPERVISION: Under direction and supervision of a sponsoring physician, in accordance with Arizona statutes and regulations. Direct Supervision: Physician on site that can intervene when necessary. PRACTICE PREROGATIVES: ▪ Shall be members of the Allied Health Professional staff assigned to a Clinical Department. ▪ Shall provide inpatient and/or outpatient medical care to patients, in accordance with Arizona statutes, rules and regulations, and guidelines. ▪ Shall triage patients as well as assist nursing staff in triage. ▪ Shall maintain accurate, complete and legible patient records. ▪ Shall monitor the effectiveness of therapeutic interventions. ▪ Shall initiate emergency care when needed. ▪ Shall advise families and patients regarding types of services available and provide counseling in areas such as family planning, maternity care, child health, emotional stress, and general health problems. ▪ Shall participate in the Department's peer review and QI processes. ▪ May prescribe medications in accordance with the rules and regulations of the Arizona Board of Medical Examiners, the Arizona State Board of Pharmacy and the Drug Enforcement Administration. ▪ Shall agree to abide by applicable policies and procedures established by the Medical Staff and Maricopa Integrated Health SystemValleywise Health ▪ May participate on various committees within MIHSValleywise Health or as designated by the Department Chairman. ▪ May perform invasive procedures as delineated by the applicable clinical department based on demonstrated clinical competence and training and delegated by supervising physician.
INITIAL APPLICANTS To be eligible to apply for privileges as a Physician Assistant the applicant must meet the following criteria: • Graduate of an Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)-approved program (prior to January 2001, completion of a Commission on Accreditation of Allied Health Education Programs-approved program); AND • Current Arizona license issued by the State of Arizona’s Joint Board on the Regulation of Physician Assistants; AND Drug Enforcement Administration (DEA) Certification, if applicable; AND • Current National Certification (NCCPA) re-registration and re-certification required as specified by the National Commission on Certification of Physicians Assistants (For those Physicians Assistants practicing at MIHSValleywise Health prior to May 2001, current NCCPA certification is preferred, but not a condition for appointment to the AHP staff. Any non-certified Physician Assistant “grandfathered-in” will be required to attain certification in the ensuing two-year period.); Current active licensure to practice as physician assistant in the state of Arizona; AND • Professional liability insurance coverage issued by a recognized company and of a type and in an amount equal to or greater than the limits established by the MIHSValleywise Health Allied Health Professionals Policy/Medical Staff Bylaws; AND
FOCUSED PROFESSIONAL PRACTICE EVALUATION Minimum of five (5) cases shall be reviewed in accordance with the MIHSValleywise Health Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy (additional records may be reviewed to assess the scope of practice has been covered) to include evaluation of chief complaint; history & physical; use of ancillary services; appropriateness of diagnosis; and discharge/instruction.
Page 1
PHYSICIAN ASSISTANT CORE PRIVILEGES Assess, evaluate, diagnose, consult, and treat in either the inpatient or ambulatory setting and provide care to pediatric, adolescent and adult patients with illnesses, diseases, and functional disorders of the circulatory, respiratory, endocrine, metabolic, musculoskeletal, hematopoietic, gastroenteric, and genitourinary systems. Perform outpatient pre-admission, inpatient admission orders, history and physical, order non-invasive inpatient/outpatient diagnostic tests and services for patients of all ages; review medical records, write in progress notes for patients referred for admission/services; consult with the inpatient attending physician, and observe diagnostic or surgical procedures. Make appropriate follow-up referrals. The core privileges in this specialty include the procedures on the attached procedure list and such other procedures that are extensions of the same techniques and skills. If you wish to exclude any procedures, please strike through those procedures that you do not wish to request, initial, and date.
CORE COGNITIVE PRIVILEGES Requested Approved Not Approved Comment Examine patients and establish diagnosis by history and physical examination Order and interpret laboratory studies. Order and perform preliminary interpretations of simple plain x-ray films with second reading by supervising physician (or radiologist) and apply results. Order and perform other diagnostic tests. Develop, implement and evaluate a plan of care for a patient to promote, maintain, and restore health Order electrocardiogram and perform preliminary interpretation Order cardiopulmonary monitoring and interpret rhythm strip and pulse oximetry Order oxygen therapy and inhaled bronchodilator therapy Order intravenous fluids to be administered in clinic Order intravenous and/or intramuscular medications to be administered in clinic Order and/or administer topical medications to be administered in the clinic Prescriptive Privileges for non-controlled substances and devices within scope of specialty practice (Prescribing & Dispensing Authority required) Prescriptive Privileges for controlled substances (DEA registration required) Provide appropriate follow-up referrals to the patient upon discharge
REAPPOINTMENT REQUIREMENTS: To be eligible to renew core privileges as a Physician Assistant the applicant must meet the following criteria: • An adequate volume of experience with acceptable results for the past 24 months and demonstrated current competence based on results of ongoing professional practice evaluation and outcomes. Experience must correlate to the privileges requested. Evidence of current ability to perform privileges requested is required of all applicants for renewal of privileges, AND • Current active licensure to practice as a physician assistant in the state of Arizona, AND • Professional liability insurance coverage issued by a recognized company and of a type and in an amount equal to or greater than the limits established by the MIHSValleywise Health Allied Health Professionals Policy/Medical Staff Bylaws., AND
ADVANCED PRIVILEGES (see specific criteria) Noncore privileges are requested individually in addition to requesting the core. Each individual requesting advanced privileges must meet the specific threshold criteria as applicable to the initial applicant or re-applicant. Each time a new privilege is requested, it may be requested by the physician assistant and recommended by the supervising physician and forwarded to the MIHSValleywise Health Medical Staff Office to be approved and appended to the advanced list of privileges. Where appropriate, procedures may be performed with, or without ultrasound guidance.
Page 2
PHYSICIAN ASSISTANT ADVANCED PRIVILEGES (see specific criteria) Advanced Privileges – The applicant must provide written documentation of current competence (as noted below) for all procedures requested: a) Recent graduate (within the past two years) – A list of requested procedures performed within the educational program, signed by a representative of the program, attesting to competence.
b) All Others – A list of requested procedures performed within the previous 2 years. OR A signed statement from the collaborating physician confirming that he/she has personally observed the applicant successfully perform the procedure(s) and can attest to his/her competence.
c) If neither of the above requirements can be met, the applicant may request approval to perform the procedure(s) under personal supervision until such time as the above noted attestation can be submitted. This request must be co-signed by the collaborating physician.
ADVANCED PRIVILEGES Requested Approved Not Comment Approved MINOR SURGERY PROCEDURES: Mole removal; Skin Biopsy; Incision and Drainage; Suture minor lacerations using local anesthetics; liquid nitrogen and cryotherapy
MINOR GYNECOLOGY PROCEDURES: IUD Removal/Insertion
MINOR ONCOLOGY PROCEDUES: Bone marrow aspiration and biopsy, lumbar puncture, intrathecal drug administration
BASIC AMBULATORY CARDIOLOGY CORE PROCEDURES: Additional training or experience that demonstrates current competency. If no experience, proctoring by supervising physician under Personal/Concurrent Supervision for the first five
(5) cases for each procedure listed below.
Monitoring Stress testing (exercise) ECG interpretation, including signal average ECG Evaluation of Cardiac Implantable Electronic Device (Including programming/reprogramming and interrogation) Loop Recorder Implant (“LRI”) (Supervising Physician must hold *LRI – 1 and/or 2 Unsupervised Loop Recorder Implant Privileges)
*Comments: 1) Under Personal Supervision only (A physician must be in the room during the performance of the procedures.) 2) Must consult with attending physician prior to procedure
Acknowledgement of Applicant I have requested only those practice prerogatives for which by education, training, current experience, and demonstrated performance I am qualified to perform and for which I wish to exercise at The Maricopa Integrated Health SystemValleywise Health, and I understand that: a. In exercising any practice prerogatives granted, I am constrained by Hospital and Medical Staff/Allied Health Professional Staff policies and rules applicable generally and any applicable to the particular situation. b. Any restriction on the practice prerogatives granted to me is waived in an emergent situation and in such situation; my actions are governed by the applicable section of the Medical Staff Bylaws or related documents.
Signed____ Date Applicant
General Supervision (GS) The procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure or provision of the services. Direct Supervision (DS) The physician must be present in the office suite or on the premises of the location and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. Personal Supervision (PS) A physician must be in the room during the performance of the procedure.
Approved by Credentials Committee: 04/20/01, 07/13/01, 06/07, 11/14 Approved by Medical Staff Executive Committee: 04/24/01, 07/17/01, 07/25/01, 06/19/07, 11/14 Approved by Maricopa Hospital & Health System Board: 05/10/01, 08/09/01 Approved by the Maricopa County Special Health Care District Board of Directors (known as Maricopa Hospital & Health System Board prior to 2004): 05/10/01, 08/09/01, 06/27/07, 11/14, 09/2019
Page 3
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.vii.
Medical Staff Certified Nurse Midwife Privileges and Practice Prerogatives MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH ALLIED HEALTH PROFESSIONALS PRACTICE PREROGATIVES
NAME: ______DATE______
PERSONNEL: CERTIFIED NURSE MIDWIFE (CNM)
RESPONSIBLE PARTY: The CNM provides inpatient and outpatient services under the direction of an Attending OB/GYN physician, who is present 24 hours per day, 7 days per week.
DEFINITION: A Certified Nurse-Midwife is a provider of medical services educated in the disciplines of nursing and midwifery, and certified by the American College of Nurse-Midwives (ACNM). Nurse Midwifery Practice is the independent care of uncomplicated labor and delivery and gynecologic services. This occurs within a health care system providing medical consultation, collaborative management, and referral and is in accordance with the “Functions, Standards and Qualification of Nurse-Midwifery Practice” as defined by ACNM, and in accordance with the Arizona Administrative Code.
EDUCATION/LICENSURE/ Current license in good standing to practice as a professional registered CERTIFICATION: nurse in Arizona; Graduation from an accredited school of nurse midwifery; Certification by the American College of Nurse-Midwives; Prescribing and Dispensing authority from the Arizona State Board of Nursing; if applicable; Drug Enforcement Administration (DEA) certification, if applicable.
INSURANCE: Provide proof of general and professional liability insurance coverage at the standards specified by the Maricopa Hospital & Health System Board.
SUPERVISION: First five (5) cases; actively supervised by OB/GYN Attending physician.
PREROGATIVES: ▪ Shall initiate a patient’s entry into the Maricopa Integrated Health SystemValleywise Health, under the general care of an Attending OB/GYN physician. • Shall practice independently within his/her scope of practice, training and experience by using and adhering to departmental protocols governing patient management. • Shall provide primary care for prenatal/gynecologic patients • Shall provide maternity coverage in Labor and Delivery as needed • Shall be available to “first assist” on Labor & Delivery as needed • Shall seek appropriate consultation from Attending and Resident staff • Shall participate in teaching nurse-midwifery students, medical students, and interns. • Shall participate in CME and other OB/GYN educational conferences • May prescribe and dispense medications within guidelines approved by the State Board of Nursing and the Drug Enforcement Administration. • May assist in research activities within the MIHS Valleywise Health Department of OB/GYN • May not substitute for an attending or on-call physician for the Emergency Department
CLINICAL DEPARTMENT APPROVAL: 03/08/01, 09/25/02, 02/2007 CREDENTIAL COMMITTEE APPROVAL: 03/09/01, 10/11/02, 03/02/2007 MEDICAL EXECUTIVE COMMITTEE APPROVAL: 03/20/01, 10/15/02, 03/12/2007 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT BOARD OF DIRECTORS APPROVAL: 04/12/01, 12/12/02, 09/24/2006, 03/28/2007 (supersedes 09/24/2006, 03/24/2008
Page 1 of 2 MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH CERTIFIED NURSE MIDWIFE Practice Prerogatives
Name:______New Appointment Reappointment (Please Print Name)
REQ CORE PROCEDURES APPROVE TABLE Perform history and physical examination* Normal Spontaneous Vaginal Delivery Perineal Repairs 1st degree- 3rd degree Fetal Scalp Electrode Intrauterine Pressure Catheter Placement Episiotomy Prostaglandin gel insertion Amniotomy Non Stress Test and Contraction Stress Test Interpretation Vaginal Birth After Cesarean with Trial of Labor approval – in consultation with OB/GYN physician. Pitocin augmentation, induction - in consultation with OB/GYN physician Vacuum extraction - in consultation with OB/GYN physician Intrauterine Device Insertion/Removal Subdermal Contraceptive Capsule (Insertion/Removal) Educate, counsel and prescribe contraception Perform interval women’s health surveillance examination & procedures Prescriptive Privileges for non-controlled substances and devices within scope of practice (Prescribing & Dispensing Authority required) Prescriptive Privileges for controlled substances (DEA registration required) *Inpatient history and physical examinations are the responsibility of and require review and countersignature by a member of the Valleywise Health medical staff.
SPECIAL PROCEDURES (The following procedures require additional training beyond ACNM Core Competency)
REQ SPECIAL PROCEDURES APPROVE TABLE 4th degree vaginal laceration repair under the supervision of OB/GYN physician Colposcopy Endometrial Biopsy under the supervision of OB/GYN physician 1st assists Cesarean Section, bilateral tubal ligation, hysterectomy Insulin Start, Adjustments Ultrasound: Amniotic Fluid Index (AFI), Level I I have requested authorization to perform only those privileges which I am qualified to perform by education, training, current experience and competency and which I wish to exercise at Maricopa Integrated Health SystemValleywise Health.
______Applicant’s Signature Date
At this time, the Department of OB/GYN and/or Family and Community Medicine is of the opinion that the applicant’s competency, professional performance, judgment, technical skill and health status is satisfactory and falls within the limits of the clinical privileges requested, and there are sufficient resources to perform the approved privilege(s).
______Department of OB/GYN Chairman/Designee Date
Approved by the Maricopa County Special Health Care District Board of Directors:______
P:PRIVILEGES\CNW-03-01.DOC APPROVED: 04/01, 12/021, 03/2007, 03/2008, 05/2012, 09/2019 Page 2 of 2
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.viii.
Medical Staff Intentionally Left Blank
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.ix.
Medical Staff Policy #31201 T: Medical Staff Rules and Regulations September 2019 SUMMARY OF PROPOSED AMENDMENTS MIHS MEDICAL STAFF RULES AND REGULATIONS
Summary of the revisions for consideration by Medical Executive Committee in September 2019:
Section 3.4, (d) Added language to better clarify the history and physical being required in all surgery cases and procedures requiring anesthesia services.
Section 3.5., (a) Replaced ‘his/her covering practitioner’ with the word ‘designee’ to be consistent with the rest of policy and clarified that ‘custodial patients’ do not have a daily progress note documented.
Section 3.5., (b) Added necessary language to define patients who remain in the Acute Hospital pending placement in a facility with lower level of care (e.g., skilled nursing facility) deemed “Custodial Patients” and the transition of documenting a daily progress note to documenting a weekly progress note (to be conducted Monday – Friday, excluding holidays) by an Attending Physician or designee.
Section 3.5., (d) Replaced ‘his/her covering practitioner’ with the word ‘designee’ to be consistent with the rest of policy and remove ambiguity by referring to Section 3.5 (a – c) of the policy.
MARICOPA INTEGRATED HEALTH SYSTEM Medical Staff Professionalism Policy – Draft August 2019
MEDICAL STAFF BYLAWS, POLICIES, AND RULES AND REGULATIONS OF MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH
MEDICAL STAFF RULES AND REGULATIONS
DRAFT September 2019
TABLE OF CONTENTS
PAGE
I. GENERAL ...... 1
1.1. Definitions...... 1 1.2. Delegation of Functions ...... 1 1.3. Medical Student Notes ...... 1
II. ADMISSIONS, ASSESSMENTS AND CARE, TREATMENT AND SERVICES ...... 2
2.1. Admissions ...... 2 2.2. Responsibilities of Attending Physician ...... 2 2.3. Availability and Alternate Coverage ...... 3 2.4. Continued Hospitalization ...... 3
III. HEALTH RECORDS ...... 4
3.1. General ...... 4 3.2. Access and Retention of Record ...... 4 3.3. Content of Record ...... 5 3.4. History and Physical ...... 8 3.5. Progress Notes ...... 10 3.6. Authentication ...... 10 3.7. Informed Consent...... 11 3.8. Physician Attestation Statements...…………………….………………………...11 3.9. Completion of Health records ...... 11
IV. MEDICAL ORDERS...... 13
4.1. General ...... 13 4.2. Verbal Orders ...... 14 4.3. Standing Order Protocols ...... 15 4.4. Orders for Drugs and Biologicals ...... 15 4.5. Orders for Radiology Services and Diagnostic Imaging Services ...... 15 4.6. Orders for Respiratory Care Services ...... 16
a
PAGE
V. CONSULTATIONS ...... 17
5.1. General ...... 17 5.2. Contents of Consultation Report ...... 17 5.3. Required Consultations ...... 18 5.4. Psychiatric Consultations ...... 18
VI. SURGICAL SERVICES ...... 19
6.1. Pre-Procedure Protocol ...... 19 6.2. Post-Procedure Protocol...... 19
VII. ANESTHESIA SERVICES ...... 22
7.1. General ...... 22 7.2. Pre-Anesthesia Procedures ...... 22 7.3. Monitoring During Procedure ...... 23 7.4. Post-Anesthesia Evaluations ...... 24 7.5. Minimal or Moderate ("Procedural") Sedation ...... 25
VIII. PHARMACY ...... 26
8.1. General Rules ...... 26 8.2. Storage and Access ...... 26 8.3. Patient's Own Medications ...... 27
IX. RESTRAINTS, SECLUSION, AND BEHAVIOR MANAGEMENT PROGRAMS ...... 28
X. EMERGENCY SERVICES ...... 29
10.1. General ...... 29 10.2. Medical Screening Examinations ...... 29 10.3. On-Call Responsibilities ...... 30 10.4. Emergency Medical Certified Technicians (EMCT) ………..…………………. 30
b
PAGE
XI. DISCHARGE PLANNING AND DISCHARGE SUMMARIES ...... 31
11.1. Who May Discharge ...... 31 11.2. Identification of Patients in Need of Discharge Planning ...... 31 11.3. Discharge Planning ...... 31 11.4. Discharge Summary ...... 32 11.5. Discharge of Minors and Incompetent Patients ...... 32 11.6. Discharge Instructions ...... 32
XII. TRANSFER TO ANOTHER HOSPITAL OR HEALTH CARE FACILITY ...... 33
12.1. Transfer ...... 33
XIII. MISCELLANEOUS ...... 34
13.1. Patient Death and Death Certificates ...... 34 13.2. Autopsies...... 34 13.3. Treatment of Family Members ...... 35 13.4. Self Treatment ...... 35 13.5. Investigational Research ...... 35 13.6. End of Life/DNR Policy ...... 35 13.7. Emergency Preparedness ...... 35
XIV. AMENDMENTS ...... 36
XV. ADOPTION ...... 37
c
ARTICLE I
GENERAL
1.1. Definitions:
The definitions that apply to terms used in these Medical Staff Rules and Regulations are set forth in the Medical Staff Bylaws.
1.2. Delegation of Functions:
(a) When a function is to be carried out by a member of Hospital management, by a Medical Staff member, or by a Medical Staff committee, the individual, or the committee through its chair, may delegate performance of the function to one or more designees unless such delegation is expressly prohibited elsewhere in any of the Medical Staff documents.
(b) When a Medical Staff member is unavailable to perform a necessary function, one or more of the Medical Staff Leaders may perform the function personally or delegate it to another appropriate individual.
1.3. Medical Student Notes
Medical Student notes shall be managed in accordance with MIHS Valleywise Health Policy #01033.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 1 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE II
ADMISSIONS, ASSESSMENTS AND CARE, TREATMENT AND SERVICES
2.1. Admissions:
(a) A patient may only be admitted to the Hospital by order of a Medical Staff member who is granted admitting privileges.
(b) Except in an emergency or court-ordered admissions, all inpatient health records will include (i) evidence of informed consent via a signed "Conditions of Admission" form and (ii) an admitting diagnosis before or at the time of admission. In the case of an emergency, the admitting diagnosis, along with the fact that there was a lack of consent, will be recorded in the health record as soon as possible.
2.2. Responsibilities of Attending Physician:
(a) Patients admitted to the Hospital must have a specific Attending Physician of record assigned to them throughout the patient’s hospital stay. The Attending Physician must be a physician member of the Medical Staff with appropriate clinical privileges to care for the patient.
(b) "Attending Physician" means any physician on the Medical Staff who is actively involved in the care of a patient at any point during the patient's treatment at the Hospital and who has the responsibilities outlined in these Medical Staff Rules and Regulations. These responsibilities include the preparation of complete and legible health record entries related to the specific care/services he or she provides.
(c) The Attending Physician will be responsible for the medical care and treatment of the patient while in the Hospital, including appropriate communication among the individuals involved in the patient's care, the prompt and accurate completion of the portions of the health record for which he or she is responsible, and necessary patient instructions.
(d) Whenever the care of a patient is transferred between services within the Acute Hospital or to the Emergency Department, communication (preferably verbal) is made between the referring and accepting Attending Physician, or Resident Staff or Allied Health Professional designee. Upon transfer of care within the inpatient units of the behavioral health facilities, verbal communication of significant clinical issues shall be communicated between Attending Physicians or his/her physician or allied health professional designees. Transfers of patients from the behavioral health services to the Emergency Department will be accompanied by
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 2 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
verbal communication between the Attending Physician or his/her physician or allied health professional designee, and the Emergency Department physician.
(e) “Acute Hospital” means the Maricopa Medical Center inpatient facility, and does not include the behavioral health inpatient facilities, or outpatient facilities.
2.3. Availability and Alternate Coverage:
(a) The Attending Physician will provide professional care for his or her patients in the Hospital by being personally available, or by making arrangements with an alternate medical staff member who has appropriate clinical privileges to care for his or her patients.
(b) If an Attending Physician is unavailable to care for a patient, or knows that he or she will be out of town, the Department Chair will be responsible for ensuring availability of an Attending Physician through the "on-call" schedule. The "on-call" schedule is accessible through the Hospital operator.
(c) The Attending Physician (or his or her alternate) will be available to respond by telephone within 30 minutes and, if needed, be present as guided by the clinical circumstances to any reasonable request for guidance regarding the care of a patient.
(d) If an Attending Physician or his or her alternate is not available, the Chief Medical Officer or the Chief of Staff will have the authority to call on the on-call physician or any other member of the Medical Staff to attend the patient.
2.4. Continued Hospitalization:
The Attending Physician will provide whatever information requested by the Utilization Management Department with respect to the continued hospitalization of a patient, including:
(1) an adequate record of the reason for continued hospitalization (a simple reconfirmation of the patient's diagnosis is not sufficient);
(2) the estimated period of time the patient will need to remain in the Hospital; and
(3) plans for post-hospital care.
This response will be provided to Utilization Management within 24 hours of the request, in accordance with Utilization Management policies and procedures.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 3 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE III
HEALTH RECORDS
3.1. General:
(a) The Attending Physician will be responsible for the timely, complete, accurate, and legible completion of the portions of the health record that pertain to the care he or she provides.
(b) Only authorized individuals may make entries in the health record. All handwritten entries will be legible in blue or preferably black ink.
(c) All entries in the health record will be authenticated, dated, and timed.
(d) Abbreviations on the unacceptable abbreviations and/or symbols list may not be used. The Medical Staff will periodically review the policy that delineates the unacceptable abbreviations and/or symbols.
3.2. Access and Retention of the Health Record:
(a) Access to all health records of patients will be afforded to members of the Medical Staff for bona fide study and research consistent with preserving the confidentiality of personal information concerning the individual patients. All such projects will be approved by the Institutional Review Board (IRB).
(b) Medical Staff and Allied Health Professional Staff members may only access their own health records in accordance with MIHS Valleywise Health Policy 01260S and 01287S.
(c) Subject to the discretion of the Chief Medical Officer, former members of the Medical Staff may be permitted access to information from the health records of their patients covering all periods during which they attended to such patients in the Hospital.
(d) All requests for copies of health records from patients and/or their legal representative should be referred to the Health Information Management Department in accordance with MIHS Valleywise Health Policy #01287S.
(e) Any copies made from the electronic health record must be kept confidential and shall be disposed of in a manner that assures confidentiality (e.g., shredding).
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 4 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
3.3. Content of Record:
(a) Health records will contain information to justify admission and continued hospitalization, support the diagnosis, and describe the patient's progress and response to medications and services.
(b) Health record entries will be legible, complete, dated, timed, and authenticated with credentials in written or electronic form by the person responsible for providing or evaluating the service provided, consistent with the Hospital's policies and procedures. Stamped signatures are not permitted in the health record.
(c) Any documentation in the health record shall be the joint responsibility of the Attending Physician and the Hospital.
(d) All inpatient health records will include, but are not limited to, the information outlined in this paragraph, as relevant and appropriate to the patient's care:
(1) identification data, including the patient's name, sex, address, date of birth, name of authorized representative and any known allergies or sensitivities;
(2) patient's language and communication needs;
(3) medication information, including: the patient's weight; medications ordered or prescribed; and medications administered in the Hospital (including the date and time of administration, the individual administering the medication, the strength, dose, or rate of administration, administration devices used, access site or route, known drug allergies, and adverse drug reactions);
(4) evidence of informed consent when required by Hospital policy and, when appropriate, evidence of any known advance directives;
(5) admitting history and physical examination or interval note;
(6) admitting diagnosis and the names of the admitting practitioner and the Attending Physician;
(7) all orders;
(8) treatment plan and goals;
(9) record of hospital services provided to the patient;
(10) progress notes made by authorized individuals;
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 5 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(11) emergency care, treatment, and services provided to the patient before his or her arrival, if any;
(12) diagnostic and therapeutic procedures, tests, and results;
(13) documentation of restraint or seclusion;
(14) relevant observations;
(15) consultation reports;
(16) complications, hospital acquired infections, and unfavorable reactions to medications and/or treatments;
(17) discharge summary with outcome of hospitalization, final diagnosis, disposition of case, discharge instructions, and whether the patient left against medical advice
(18) completion of health records within 30 days following discharge; and
(19) any other information as required by law.
(e) All outpatient health records will include, but are not limited to, the information outlined in this paragraph, as relevant and appropriate to the patient's care:
(1) identification data, including the patient's name, sex, address, date of birth, name of authorized representative and any known allergies or sensitivities;
(2) patient's language and communication needs;
(3) medication information, including: the patient's weight; medications ordered or prescribed; and medications administered in the Hospital (including the date and time of administration, the individual administering the medication, the strength, dose, or rate of administration, administration devices used, access site or route, known drug allergies, and adverse drug reactions);
(4) evidence of informed consent when required by Hospital policy and, when appropriate, evidence of any known advance directives;
(5) diagnosis or reason for outpatient medical services;
(6) an appropriate history and physical examination;
(7) all orders;
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 6 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(8) record of hospital services provided to the patient;
(9) diagnostic and therapeutic procedures, tests, and results;
(10) documentation of restraint or seclusion;
(11) consultation reports;
(12) emergency care, treatment, and services provided to the patient before his or her arrival, if any; and
13) any other information as required by law
(f) For patients receiving continuing ambulatory care services, the health record will contain a summary list(s) of significant diagnoses, procedures, drug allergies, and medications, as outlined in this paragraph:
(1) known significant medical diagnoses and conditions;
(2) known significant operative and invasive procedures;
(3) known adverse and allergic drug reactions; and
(4) known long-term medications, including current medications, over-the-counter drugs, and herbal preparations.
(g) Health records of patients who have received emergency care will be completed promptly and will contain the information outlined in this paragraph:
(1) time and means of arrival;
(2) the patient's chief complaint;
(3) record of care prior to arrival;
(4) results of the Medical Screening Examination and the name of the individual performing the examination;
(5) known long-term medications, including current medications, over-the-counter drugs, and herbal preparations;
(6) patient’s medical history;
(7) the name of the individual(s) who provided treatment, if applicable; and
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 7 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(8) conclusions at termination of treatment, including final disposition, condition, and instructions for follow-up care, and whether the patient left against medical advice.
3.4. History and Physical:
(a) A pertinent medical history and physical examination will be performed and documented on each patient no more than 30 days before, or 24 hours after, admission or registration, but in all cases prior to surgery or a procedure requiring anesthesia services, or procedural sedation (“moderate”), by an individual who has been granted privileges by the Hospital to perform histories and physicals.
(b) For patients undergoing electroconvulsive therapy (ECT) by an individual who has been granted such privileges by the Hospital, a history and physical that has been completed within the past 30 days in a practitioner’s office (outside of MIHSValleywise Health) may be accepted provided:
(1) the pertinent data elements are present to fully assess the patients risk for the procedure;
(2) the history and physical is reviewed, the patient is reassessed, and the history and physical is authenticated by an individual who has been granted privileges by the Hospital to perform histories and physicals in accordance with paragraphs (d) below.
(c) “Registration” means registration for outpatient surgery, or a procedure requiring anesthesia services, or procedural sedation.
(d) A signed/ authenticated and dated medical history and physical examination that has been completed within the 30-day period prior to admission or registration performed by an individual who has been granted privileges by the Hospital to perform histories and physicals (except as noted in section 3.4., (b) above) may be used, provided that the patient has been reassessed within 24 hours of the time of admission or registration and in all cases prior to surgery or a procedure requiring anesthesia services in order to document (1) that the patient has been examined; (2) that the history and physical has been reviewed; and (31) any changes in the patient's condition since the date of the original history and physical, or that there have been no changes in the patient's condition.
(e) When the history and physical examination, as defined in paragraphs (a), (b) and (c) above, is not performed or recorded in the health record prior to surgery or a procedure requiring anesthesia services, the operation or procedure will be canceled unless Attending Physician (or his or her designee) states in writing as soon as reasonably possible that an emergency situation exists, or that any such delay would be detrimental to the patient. If it is an emergency situation and a history and physical has been dictated but not yet present in the patient’s chart,
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 8 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
the Attending Physician (or his or her designee) who admitted the patient shall write a statement to that effect as well as an admission note in the patient's chart. The note should include, at a minimum, critical information about the patient’s condition including pulmonary status, cardiovascular status, blood pressure, and vital signs. This requirement applies regardless of whether care is being provided on an inpatient or outpatient basis. If, in the opinion of the Attending Physician (or his or her designee), taking time to document the history and physical examination before the procedure would have a negative effect on patient care, there will be a statement attesting such in the patient’s chart after completion of the operation or procedure.
(f) The scope of the medical history and physical examination will be appropriate for the services being provided. This examination will include, as pertinent:
(1) patient identification;
(2) chief complaint;
(3) history of present illness;
(4) review of systems;
(5) personal medical history, including medications and allergies;
(6) family medical history;
(7) social history, including any abuse or neglect;
(8) physical examination, to include pertinent findings in those organ systems relevant to the presenting illness and to co-existing diagnoses;
(9) data reviewed;
(10) assessments, including problem list;
(11) plan of treatment; and
(12) if applicable, signs of abuse, neglect, addiction or emotional/behavioral disorder, which will be specifically documented in the physical examination and any need for restraint or seclusion will be documented in the plan of treatment.
(g) A focused history and physical containing the chief complaint or reason for the procedure, relevant history of the present illness or injury, and the patient's present clinical condition/physical findings, may be used for outpatient care.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 9 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(h) The Attending Physician may delegate all or part of the physical examination to other qualified practitioners (i.e., Resident Physicians, Nurse Practitioners, Physician Assistants, Nurse Midwives), but the Attending Physician must sign for and assume full responsibility for history and physicals for outpatient procedures that require anesthesia or procedural sedation, and for inpatient admissions in accordance with 3.4 (d). When such a delegation occurs for an inpatient admission, or outpatient procedure requiring anesthesia or procedural sedation, the Attending Physician must (i) review and co-sign any history and physical done by a qualified practitioner, (ii) and add his or her own note (history and physical) or approved attestation of supervision addressing the history and physical, as deemed necessary. This must be done within 24 hours after admission and prior to the outpatient procedure requiring anesthesia services or procedural sedation.
3.5. Progress Notes:
(a) A “main daily progress note” will be documented daily by the Attending Physician or his/or her covering practitionerdesignee for all patients (excluding custodial patients) who have been admitted to the Acute Hospital. It may be documented by an allied health professional as permitted by his/her clinical privileges or scope of practice. When the “main daily progress note” is documented by an allied health professional, the note shall include an attestation of supervision by, or collaboration with an Attending Physician. When the “main daily progress note” is documented by a Resident, this note shall be reviewed and co-signed by the Attending Physician with an approved attestation of supervision or a separate note. When appropriate, each of the patient's clinical problems should be clearly identified in the main daily progress note and correlated with specific orders as well as results of tests and treatments.
(b) Patients who remain in the Acute Hospital pending placement in a facility with a lower level of care (e.g., skilled nursing facility) will be deemed “custodial patients.” Custodial patients are patients who no longer meet criteria for continued care in an Acute Hospital and require a lower level of care. The Attending Physician or designee will document in the main daily progress note that the patient’s status will be transitioned to a custodial level of care. Custodial patients will have a progress note documented weekly (to be conducted Monday– Friday, excluding holidays) by an Attending Physician, or designee.
(b)(c) Behavioral Health Inpatient Facilities - A “main daily progress note” will be documented by the Attending Physician or his/or her covering practitioner for all patients who have been admitted to a Behavioral Health inpatient facility each working day (Monday through Friday, except legal holidays). It may be documented by an allied health professional as permitted by his/her clinical privileges or scope of practice. An allied health professional, in collaboration with the Attending Psychiatrist, may be responsible for of the day to day care for the patients. The Attending Psychiatrist shall meet with the Psychiatry Allied Health Professional weekly and document his/her agreement with the plan of MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 10 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
care, and shall do any legal work needed for the patient. When the “main daily progress note” is documented by a Resident, this note shall be reviewed and co- signed by the Attending Psychiatrist with an approved attestation of supervision or a separate note. As delineated elsewhere in these Medical Staff Rules and Regulations, admission history and physicals and discharge summaries that have been delegated to an allied health professional shall be authenticated by an Attending Psychiatrist.
(c) All Critical Care Units [i.e., Medical Intensive Care Unit (MICU), Surgical Intensive Care Unit (SICU), or Burn Intensive Care Unit (BICU)] patients must be seen at least once daily by an Attending Physician, from the respective Unit. If the Attending Physician does not personally complete a progress note, he/she must co-sign the note documented by the Resident physician or allied health professional and must include attestation of his/her personal examination of the patient.
(d) Progress notes will be legibly written or entered into the electronic health record, dated, timed, and authenticated by an Attending Physician or his or her covering practitioner (i.e., Resident, Physician Assistant, or Nurse Practitionerdesignee in accordance with Section 3.5 (a-c) of this policy.).
3.6. Authentication:
(a) Authentication means to establish authorship by handwritten or electronic signatures.
(b) Handwritten signatures require written signature, printed name, credential (i.e., M.D., D.O., P.A.), date, time, and personal identification number ("PAS").
(c) An electronic signature requires statement of signature (i.e., signed, authenticated), printed name, credential, date, and time.
(d) The practitioner will provide a signed statement attesting that he or she alone will use his or her unique electronic signature to authenticate documents in accordance with Hospital policy.
(e) A single signature on the face sheet of a record will not suffice to authenticate the entire record. Entries will be individually authenticated.
3.7. Informed Consent:
Informed consent will be obtained in accordance with the Hospital's Informed Consent policies and procedures and documented in the health record.
3.8. Physician Attestation Statements
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 11 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
Services performed by a Resident require an approved physician attestation of supervision statement to be documented timely in the health record.
3.9. Completion of Health Records:
(a) It is the responsibility of the physician to prepare and complete health records in a timely fashion in accordance with the specific provisions of these Rules and Regulations and other relevant policies of the Hospital.
(b) Health records will be completed within the following time frames or they will be considered delinquent:
(1) history and physical examinations – within 24 hours of admission;
(2) an operative report shall be written or dictated in accordance with Section 6.2 (a) and (b) of these medical staff rules and regulations;
(3) complete Behavioral Health (for all behavioral health inpatient facilities) discharge summary – within 10 working days of discharge;
(4) complete Acute Hospital discharge summary – within 30 days of discharge;
(5) complete outpatient health record – within 10 days of encounter; and
(6) complete inpatient health record – within 30 days of discharge.
(c) If the health record remains incomplete 30 days following discharge, or service date, as applicable; the physician, or allied health professional will be notified of the delinquency and that his or her clinical privileges have been automatically relinquished in accordance with the Credentials Policy. The relinquishment will remain in effect until all of the physician's, or allied health professional’s records are no longer delinquent.
(d) Failure to complete the health records that caused the automatic relinquishment of clinical privileges three months from the relinquishment will constitute an automatic resignation of appointment from the Medical Staff and of all clinical privileges.
(e) A health record will be considered complete when the required contents are available within the electronic health record and appropriately authenticated. In accordance with MIHS Valleywise Health policies and procedures, the health record will also be declared complete when the responsible Physician, or allied health professional is deceased, unavailable permanently, or protractedly for other reasons. The Chairman of the Department most responsible for the care provided will review the deficient record before declaring it complete due to reasons listed
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 12 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
above. The Department Chairman will annotate "This health record is declared complete for filing purposes," and sign the entry.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 13 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE IV
MEDICAL ORDERS
4.1. General:
(a) All written or computer entered orders will be dated, timed, and authenticated at the time of entry by the ordering practitioner.
(b) Orders will be entered clearly, legibly, and completely. Orders which are illegible or improperly entered will not be carried out until they are clarified by the ordering practitioner and are understood by the appropriate health care provider.
(c) Orders for tests and therapies will be accepted only from:
(1) members of the Medical Staff;
(2) members of the Resident Staff;
(3) allied health professionals who are granted clinical privileges by the Hospital, to the extent permitted by their licenses; and
(4) other individuals not on the Medical Staff (e.g., Locum Tenens), in accordance with privileges granted.
(e) The use of the terms "renew," "repeat," "resume," and "continue" with respect to previous handwritten orders is not acceptable. The electronic health record (EHR) will allow a Provider to “re-order” or “modify” an existing order.
(f) The EHR will allow a Provider to “sign and hold” an order for a period of time as allowed by Hospital policy.
(g) Orders will be reconciled when a patient is transferred from one level of service to another.
(h) Transfers to the operating room from the Emergency Department will only require documentation of care assumed by the attending surgeon.
(i) All orders for drugs and medications administered to patients will be evaluated by a Pharmacist prior to dispensing with two exceptions: (i) a Provider with prescribing privileges controls the ordering, preparation, and administration of the medication; or (ii) in urgent situations when the resulting delay would harm the patient, including situations in which the patient experiences a sudden change in clinical status.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 14 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(j) All medication orders will clearly state the administration times or the time interval between doses. If not specifically prescribed as to time or number of doses, the medications will be controlled by automatic stop orders or by protocols. When medication or treatment is to be resumed after an automatic stop order has been employed, the orders that were stopped will be rewritten. All PRN medication orders must be qualified by either specifying time intervals or the limitation of quantity to be given in a 24-hour period. All PRN medications must specify the indications for use.
(k) An allied health professional may be authorized to write medical and prescription orders as specifically delineated in his or her privileges granted.
4.2. Verbal Orders:
(a) A verbal order (via telephone or in person) for medication or treatment will be accepted only under circumstances when it is impractical for such order to be entered by the responsible practitioner.
(b) Verbal orders will include the date and time of entry into the health record, will be written in blue or preferably black ink if handwritten, and will identify the name of the individual who gave, received, and implemented the order. All verbal orders will be co-signed/authenticated by the ordering physician within 48 hours.
(c) For verbal or telephone orders, or for the reporting of critical test results over the telephone, the complete order or test result will be verified by having the person receiving the information record and "read-back" the complete order or test result.
(d) The following are the personnel authorized to receive and record verbal orders:
(1) a licensed nurse;
(2) a pharmacist who may transcribe a verbal order pertaining to medications and monitoring;
(3) a respiratory therapist who may transcribe a verbal order pertaining to respiratory therapy treatments;
(4) a physical therapist who may transcribe a verbal order pertaining to physical therapy treatments;
(5) a radiology or imaging technologist (i.e., nuclear medicine, diagnostic medical sonographer) who may transcribe a verbal order pertaining to tests and/or therapy treatments in their specific areas of expertise;
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 15 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(6) an occupational therapist who may transcribe a verbal order pertaining to occupational treatments;
(7) a speech therapist who may transcribe a verbal order pertaining to speech therapy; and
(8) a dietician who may transcribe a telephone/verbal order pertaining to diet and nutrition.
4.3. Standing Order Protocols:
(a) The Medical Executive Committee (or its designee) will review and approve any suggested written protocol(s) or standing order(s) to be utilized in the Hospital for drugs or biologicals or other forms of treatment, and under which circumstances it would apply.
(b) If the use of a written protocol or standing order has been approved by the Medical Executive Committee, initiation of such protocols or standing orders shall require an order from a practitioner responsible for the patient's care in the Hospital.
4.4. Orders for Drugs and Biologicals:
(a) Orders for drugs and biologicals may only be ordered by Medical Staff members, Resident Staff, and other authorized individuals with clinical privileges at the Hospital.
(b) All orders for medications and biologicals will be dated, timed and authenticated by the practitioner responsible for the care of the patient, with the exception of influenza and pneumococcal vaccines, which may be administered per Hospital policy after an assessment for contraindications. Verbal or telephone orders will only be used in accordance with these Rules and Regulations and other Hospital policies.
4.5. Orders for Radiology Services and Diagnostic Imaging Services:
Orders for radiology services and diagnostic imaging services must include: (i) the patient's name; (ii) the name of the ordering individual; (iii) the radiological or diagnostic imaging procedure orders; and (iv) the reason for the procedure (“rule out” should not be used).
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 16 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
4.6. Orders for Respiratory Care Services:
(a) "Respiratory treatments and interventions" means any treatment or intervention that requires the services of a respiratory therapist (i.e. initiation of mechanical ventilation, chest physical therapy and formal pulmonary function testing).
(b) Orders for respiratory care services must include: (i) the patient's name; (ii) the name and signature of the ordering individual; (iii) the type, frequency, and, if applicable, duration of treatment; (iv) the type and dosage of medication and diluents; and (v) the oxygen concentration or oxygen liter flow and method of administration.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 17 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE V
CONSULTATIONS
5.1. General:
(a) Any individual with clinical privileges at the Hospital may be requested to provide a consultation within his or her area of expertise, and these individuals will respond appropriately as a condition of their Medical Staff or Allied Health Professional Staff appointment.
(b) For inpatient consultations will be communicated/called Physician, or Allied Health Professional to Physician, or Allied Health Professional, as deemed necessary and shall always be accompanied by a documented order detailing the reason for the consult. Once the consultation is completed the results will be documented in the legal health record and conveyed to the referring Attending or covering provider.
(c) If a nurse employed by the Hospital has any reason to doubt or question the care provided to any patient or believes that an appropriate consultation is needed and has not been obtained, after having a conversation with the Attending Physician, that nurse will notify his or her nursing supervisor who, in turn, may refer the matter to the Chief Nursing Officer. The Chief Nursing Officer may bring the matter to the attention of the Department Chair in which the member in question has clinical privileges. Thereafter, the Department Chair or Chief Medical Officer may request a consultation after discussion with the Attending Physician.
(d) In circumstances of grave urgency, or where consultation is required by these Rules and Regulations, or where a consultation requirement is imposed by the Medical Executive Committee, the appropriate Department Chair will at all times have the right to call in a consultant or consultants.
5.2. Contents of Consultation Report:
(a) Each inpatient consultation report will be completed in a timely manner and prior to transfer to another facility; and will contain a dictated or legible written opinion and recommendations by the consultant that reflect, when appropriate, an actual examination of the patient and the patient's health record. A statement, such as "I concur," will not constitute an acceptable consultation report. The consultation report will be made a part of the patient's health record.
(b) When non-emergency operative procedures are involved, the consultant's report will be recorded in the patient's health record prior to the surgical procedure. The consultation report will contain the date and time of the consultation, an opinion based on relevant findings and reasons, and the authentication of the consultant.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 18 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
5.3. Required Consultations:
(a) Except in an emergency, appropriate consultations are required in all cases which, in the judgment of the Attending Physician:
(1) when a patient has attempted suicide or has taken a chemical overdose (in which case a crisis intervention assessment and treatment will be requested, offered to, or arranged);
(2) the patient requires nephrology/dialysis services and the Attending Physician is not privileged to perform the procedure; or
(3) Anesthesia consultation for airway manipulation in the patient with suspected difficult airway, in accordance with MIHS Valleywise Health Policy #39028 S.
(b) Except in an emergency, consultations are recommended in all cases which, in the judgment of the Attending Physician:
(1) the patient is a poor candidate for the operation or treatment;
(2) the diagnosis is obscure after ordinary diagnostic procedures have been completed;
(3) there is doubt as to the best therapeutic measures to be used; or
(4) unusually complicated situations are present that may require specific skills of other practitioners.
(5) patient on a non-psychiatric service exhibits severe symptoms of mental illness.
Additional requirements for consultation may be established by the Medical Staff.
5.4. Psychiatric Consultations:
(a) Psychiatric consultation and treatment will be requested for and offered to all patients who have engaged in self-destructive behavior (e.g., attempted suicide, chemical overdose). If psychiatric care is recommended, evidence that such care has at least been offered and/or an appropriate referral made will be documented in the patient's health record.
(b) A psychiatric consultation must also be obtained before any patient who has been transferred to the Hospital from a Hospital-affiliated psychiatric facility is discharged.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 19 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE VI
SURGICAL SERVICES
6.1. Pre-Procedure Protocol:
(a) Except in an emergency, the Attending Physician responsible for the patient's care will document an interval note in the health record prior to the surgical procedure, documenting the following:
(1) the provisional diagnosis and the results of any indicated diagnostic tests;
(2) a properly executed informed consent;
(3) documentation of review of relevant diagnostic tests;
(4) a complete history and physical work-up and, as necessary, appropriately updated (or completed focused history and physical form, as appropriate); and
(5) a consent or refusal for blood or blood products signed by the patient or patient's representatives.
(b) The following will also occur before an invasive procedure or the administration of moderate or deep sedation or anesthesia occurs:
(1) the anticipated needs of the patient are assessed to plan for the appropriate level of post-procedural care;
(2) pre-procedural education, treatments, and services are provided according to the plan for care, treatment, and services;
(3) an Attending Physician is in the Hospital; and
(4) the procedure site is marked and a "time out" is conducted immediately before starting the procedure, as described in the Universal Protocol.
6.2. Post-Procedure Protocol:
For every procedure performed in an operating room and/or under sedation the following will occur:
(a) A full operative procedure report shall be written or dictated and signed by the surgeon immediately following the procedure, and before the patient is transferred
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 20 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
to the next level of care (e.g. before the patient leaves the post anesthesia care area). The full operative report will record:
(1) pre- and post-operative diagnoses;
(2) date and time of the procedure;
(3) the name of the surgeon(s) and assistant surgeon(s) responsible for the patient's operation;
(4) procedure(s) performed and description of the procedure(s);
(5) description of the specific surgical tasks that were conducted by practitioners other than the primary Attending Physician (e.g., opening and closing, harvesting grafts, dissecting tissue, removing tissue, implanting devices, altering tissues);
(6) findings;
(7) estimated blood loss;
(8) any unusual events or complications, including blood transfusion reactions and the management of those events;
(9) the type of anesthesia/sedation used and name of the practitioner providing anesthesia;
(10) specimens removed; and
(11) prosthetic devices, grafts, tissues, transplants, or devices implanted (if any).
(b) When the full and authenticated operative note is not in the health record, an immediate postoperative note is required to be documented and authenticated by the surgeon. An immediate post-operative note will contain the following information:
(1) the name(s) of the surgeon(s) and assistant surgeon(s);
(2) preoperative and postoperative diagnosis;
(3) surgical techniques and procedures performed;
(5) any complications;
(5) type of anesthesia administered;
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 21 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(6) estimated blood loss and any blood administered;
(7) grafts and implants; and
(8) specimens removed, including tissues.
(c) Unless otherwise exempt by law and Hospital policy, all specimens removed during a surgical procedure will be properly labeled and sent to a laboratory for examination by a pathologist. The specimen will be accompanied by pertinent clinical information, including its source and the pre-operative and post-operative surgical diagnosis.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 22 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE VII
ANESTHESIA SERVICES
7.1. General:
(a) Anesthesia may only be administered by the following qualified practitioners:
(1) a qualified anesthesiologist;
(2) an MD or DO (other than an anesthesiologist);
(3) an oral surgeon, in accordance with state law; or
(4) a CRNA who is supervised by an anesthesiologist who is immediately available.
(b) An anesthesiologist is considered "immediately available" when needed by a CRNA under the anesthesiologist's supervision only if he/she is physically located within the same area as the CRNA (e.g., in the same operative suite, or in the same labor and delivery unit, or in the same procedure room, and not otherwise occupied in a way that prevents him/her from immediately conducting hands-on intervention, if needed).
(c) "Anesthesia" means general or regional anesthesia, monitored anesthesia care or deep sedation. "Anesthesia" does not include topical or local anesthesia, minimal or procedural sedation, or analgesia via epidurals/spinals for labor and delivery.
(d) Because it is not always possible to predict how an individual patient will respond to minimal or procedural sedation, a qualified practitioner must be available to return a patient to the originally intended level of sedation when the level of sedation becomes deeper than initially intended.
(e) General anesthesia for surgical procedures will not be administered in the Emergency Department unless the surgical and anesthetic procedures are considered lifesaving.
7.2. Pre-Anesthesia Procedures:
(a) A pre-anesthesia evaluation will be performed for each patient who receives anesthesia by an individual qualified to administer anesthesia within 48 hours prior to an inpatient or outpatient procedure requiring anesthesia services.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 23 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(b) The evaluation will be recorded in the health record and will include:
(1) a review of the medical history, including anesthesia, drug and allergy history;
(2) an interview and examination of the patient;
(3) notation of any anesthesia risks in accordance with ASA classification;
(4) identification of potential anesthesia problems that may suggest complications or contraindications to the planned procedure (e.g., difficult airway);
(5) development of a plan for the patient's anesthesia care (i.e., discussion of risks and benefits); and
(6) any additional pre-anesthesia evaluations that may be appropriate or applicable (e.g., stress tests, additional specialist consultations).
(c) The patient will be reevaluated immediately before induction in order to confirm that the patient remains able to proceed with care and treatment.
7.3. Monitoring During Procedure:
(a) All patients will be monitored during the procedure and/or administration of anesthesia at a level consistent with the potential effect of the procedure and/or anesthesia. Appropriate methods will be used to continuously monitor oxygenation, ventilation, and circulation during procedures that may affect the patient's physiological status.
(b) All events taking place during the induction and maintenance of, and the emergence from, anesthesia will be documented legibly in an intraoperative anesthesia record, including:
(1) the name and hospital identification number of the patient;
(2) the name of the practitioner who administered anesthesia and, as applicable, any supervising practitioner;
(3) the name, dosage, route, time and duration of all anesthetic agents;
(4) the technique(s) used and patient position(s), including the insertion or use of any intravascular or airway devices;
(5) the name and amounts of IV medications and fluids, including blood or blood products, if applicable;
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 24 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(6) time-based documentation of vital signs, as well as oxygenation and ventilation parameters; and
(7) any complications, adverse reactions or problems occurring during anesthesia, including the patient's status upon leaving the operating room (e.g., description of symptoms, vital signs, treatment rendered, and patient's response to treatment).
7.4. Post-Anesthesia Evaluations:
(a) A post-anesthesia evaluation will be completed and documented in the patient's health record by an individual qualified to administer anesthesia no later than 48 hours after the patient has been moved into the designated recovery area. Where post-operative sedation is necessary for the optimum care of the patient, the evaluation can occur in the PACU/ICU or other designated recovery area. For outpatients, the post-anesthesia evaluation must be completed prior to the patient's discharge.
(b) The elements of the post-anesthesia evaluation will conform to current standards of anesthesia care, including:
(1) respiratory function;
(2) cardiovascular function;
(3) mental status;
(4) temperature;
(5) pain;
(6) nausea and vomiting; and
(7) post-operative hydrations.
The post-anesthesia evaluation should not begin until the patient is sufficiently recovered so as to participate in the evaluation, to the extent possible given the patient's medical condition.
(c) Patients will be discharged from the recovery area by a qualified practitioner or according to criteria approved by the clinical leaders. Post-operative documentation will record the patient's discharge from the post-anesthesia care area and record the name of the individual responsible for discharge.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 25 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(d) Patients who have received anesthesia in an outpatient setting will be discharged to the company of a responsible, designated adult.
(e) When surgical or anesthesia services are performed on an outpatient basis, the patient will be provided with written instructions for follow-up care that include information about how to obtain assistance in the event of post-operative problems. The instructions will be reviewed with the patient or the individual responsible for the patient.
7.5. Minimal or Moderate ("Procedural") Sedation:
All patients receiving minimal or procedural sedation will be monitored and evaluated before, during, and after the procedure by a trained practitioner in accordance with the MIHS Valleywise Health Sedation for Procedures policy, guidelines, and protocols.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 26 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE VIII
PHARMACY
8.1. General Rules:
(a) Orders for drugs and biologicals are addressed in the Medical Orders Article.
(b) Blood transfusions and intravenous medications will be administered in accordance with state law and approved policies and procedures.
(c) Transfusion reactions, adverse medication reactions, and errors in administration of medications will be immediately documented in the patient's health record and reported to the Attending Physician, in accordance with MIHS Valleywise Health policies and procedures.
(d) Self-medication by patients will not be permitted, except for self-administered analgesia medication using a Patient Controlled Analgesia (PCA) pump or patients with a Continuous Subcutaneous Insulin Infusion (CSII) Pump, unless documented in the orders by the Attending Physician, in accordance with MIHS Valleywise Health policy.
(e) The pharmacy may substitute an alternative equivalent product for a prescribed brand name when the alternative is of equal quality and ingredients, and is to be administered for the same purpose and in the same manner.
(f) Except for investigational or experimental drugs in a clinical investigation, all drugs and biologicals administered will be listed in the latest edition of: United States Pharmacopeia, National Formulary, or if under a research protocol will have an approved New Drug Application by the F.D.A.
(g) The use of investigational or experimental drugs in clinical investigations will be subject to the rules established by the Medical Executive Committee and the Institutional Review Board and as outlined in the approved Hospital formulary.
(h) Information relating to medication interactions, therapy, side effects, toxicology, dosage, indications for use, and routes of administration will be readily available to members of the Medical Staff, other practitioners and Hospital staff.
8.2. Storage and Access:
(a) In order to facilitate the delivery of safe care, medications and biologicals will be controlled and distributed in accordance with Hospital policy, consistent with federal and state law.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 27 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(1) All medications and biologicals will be kept in a secure area, and locked unless under the immediate control of authorized staff.
(2) Medications listed in Schedules II, III, IV, and V of the Comprehensive Drug Abuse Prevention and Control Act of 1970 will be kept locked within a secure area.
(3) Only authorized personnel may have access to locked or secure areas.
(b) Abuses and losses of controlled substances will be reported, in accordance with applicable federal and state laws, to the individual responsible for the pharmaceutical service and to the Chief Medical Officer.
8.3. Patient's Own Medications:
Patients may not take medication from home, unless on the specific order by the Attending Physician, or designee in accordance with MIHS Valleywise Health Hospital Policy #51126 S.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 28 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE IX
RESTRAINTS, SECLUSION, AND BEHAVIOR MANAGEMENT PROGRAMS
Restraints, seclusion, and behavior management programs will be governed by the Hospital policy addressing restraints, seclusion, and behavior management.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 29 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE X
EMERGENCY SERVICES
10.1. General:
Emergency services and care will be provided to any person in danger of loss of life or serious injury or illness whenever there are appropriate facilities and qualified personnel available to provide such services or care. Such emergency services and care will be provided without regard to the patient's race, ethnicity, religion, national origin, citizenship, age, sex, pre-existing medical condition, physical or mental handicap, insurance status, economic status, or ability to pay for medical services.
10.2. Medical Screening Examinations:
Medical screening examinations, within the capability of the Hospital, will be performed on all individuals who come to the Hospital requesting examination or treatment to determine the presence of an emergency medical condition. Qualified medical personnel who can perform medical screening examinations within applicable Hospital policies and procedures are defined as:
(a) Emergency Department:
(1) members of the Medical Staff with clinical privileges in Emergency Medicine;
(2) other Medical Staff members; and
(3) appropriately credentialed Nurse Practitioners.
(b) Labor and Delivery:
(1) members of the Medical Staff with OB/GYN privileges;
(2) other Medical Staff members;
(3) members of the Resident Staff;
(4) certified nurse midwives with OB privileges; and
(5) registered nurses who have achieved competency, in accordance with Labor and Delivery Policies and Procedures.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 30 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
(c) Psychiatry:
(1) members of the Medical Staff with Psychiatry privileges;
(2) other Medical Staff members;
(3) members of the Resident Staff;
(4) Nurse Practitioners with psychiatric assessment privileges;
(5) Psychologists; and
(6) Registered Nurses or Social Workers who have achieved competency, in accordance with the Psychiatry policies and procedures.
10.3. On-Call Responsibilities:
Patient transfers from the Emergency Department will be made in accordance with Article XII of these Rules and Regulations and Hospital policies and procedures.
10.4. Emergency Medical Certified Technicians (EMCT)
(1) The Emergency Department Medical Director with specific qualifications as defined by Arizona statutes and rules and regulations provides on-line medical direction to EMCTs acting on behalf of the emergency medical services provider.
(2) The Emergency Department Attending Physicians with specific qualifications as delineated in the Arizona statutes and rules and regulations are available to provide on-line medical direction to an EMCT 24 hours a day, seven days a week;
(3) On-line medical direction provided to EMCTs acting on behalf of the emergency medical services provider is consistent with the EMCT’s scope of practice and protocols established by the EMCTs administrative medical director;
(4) Communication equipment that will allow on-line medical direction to be given to the EMCT is operational and accessible, and a plan for alternative communications in the event of a disaster has been established; and
(5) EMCTs will only perform tasks within their scope of practice.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 31 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE XI
DISCHARGE PLANNING AND DISCHARGE SUMMARIES
11.1. Who May Discharge:
(a) Patients will be discharged only upon the written discharge order of the Attending Physician or designee. Should a patient insist on leaving the Hospital against medical advice, or without proper discharge, a notation of the incident will be made in the patient's health record, and the patient will be asked to sign the Hospital's release form.
(b) At the time of discharge, the Attending Physician or his or her designee will review the record for completeness, state the principal and secondary diagnosis (if one exists) and authenticate the entry.
11.2. Identification of Patients in Need of Discharge Planning:
(a) All patients who are likely to suffer adverse health consequences upon discharge if there is no adequate discharge planning will be identified at an early stage of hospitalization.
(b) Criteria to be used in making this evaluation include:
(1) functional status;
(2) cognitive ability of the patient; and
(3) family support.
11.3. Discharge Planning:
(a) Discharge planning will be an integral part of the hospitalization of each patient and an assessment will commence as soon as possible after admission. The discharge plan and assessment, which includes an evaluation of the availability of appropriate services to meet the patient's needs after hospitalization, will be documented in the patient's health record.
(b) Discharge planning will include determining the need for continuing care, treatment, and services after discharge or transfer.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 32 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
11.4. Discharge Summary:
(a) A concise discharge/death summary will be prepared and signed by the Attending Physician discharging the patient. All discharge/death summaries will include the following:
(1) reason for hospitalization;
(2) significant findings;
(3) procedures performed and care, treatment, and services provided;
(4) condition at discharge or cause of death, if known;
(5) information provided to the patient and family, as appropriate;
(6) final diagnoses and relevant co-morbidities; and
(7) disposition, including discharge medications.
(b) A final legible progress note or MIHS Valleywise Health pre-approved form may be substituted for a discharge summary only in the case of normal newborn infants, uncomplicated vaginal deliveries, outpatient observation stays, and uncomplicated length of stay of under 48 hours. The progress note must be authenticated by the Attending Physician.
(c) Whether delegated or non-delegated, the practitioner who writes the discharge summary will authenticate, date and time his or her entry and for delegated discharge summaries the Attending Physician responsible for the patient during his or her hospital stay shall co-authenticate and date the discharge summary.
11.5. Discharge of Minors and Incompetent Patients:
Any individual who cannot legally consent to his or her own care will be discharged only to the custody of parents, legal guardian, or another responsible party unless otherwise directed by the parent, guardian, or court order. If the parent or guardian directs that discharge be made otherwise, that individual will so state in writing and the statement will become a part of the permanent health record of the patient.
11.6. Discharge Instructions:
Upon discharge, the Attending Physician, or designee, will arrange that the patient or legal guardian be given written discharge instructions.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 33 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE XII
TRANSFER TO ANOTHER HOSPITAL OR HEALTH CARE FACILITY
12.1. Transfer:
The process for providing appropriate care for a patient, during and after transfer from the Hospital to another facility shall be provided in accordance with Hospital policy and procedures.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 34 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE XIII
MISCELLANEOUS
13.1. Patient Death and Death Certificates:
(a) Pronouncement of death will be made by the Attending Physician, or the Nurse Practitioner, or Physician Assistant in accordance with their respective professional licensing requirements. In addition, appropriate entry in the health record will be made by the attending physician, Nurse Practitioner, or Physician Assistant prior to the release of the body to the Hospital morgue.
(b) Death certificates are the responsibility of the Attending Physician, Nurse Practitioner, or Physician Assistant and will be completed within 24 hours of when the certificate is available to the attending physician, Nurse Practitioner, or Physician Assistant.
(c) The body of a deceased patient can be released only with the consent of the parent, legal guardian, or responsible person, and only after an entry has been made in the deceased patient's health record by the Attending Physician or other designated member of the Medical Staff, and completion of the "Human Remains Form" by the Attending Physician or other designated member of the Medical Staff.
(d) The Medical Examiner should be informed of a death in accordance with state and local laws.
13.2. Autopsies:
(a) The Attending Physician should attempt to secure autopsies in accordance with state and local laws. The Attending Physician will be notified when an autopsy is to be performed and will be responsible for securing permission, whenever possible.
(b) Any request for an autopsy by the family of a patient who died while at the Hospital will be honored if at all possible. Difficulties or questions that arise with such a request will be directed to the Chief Medical Officer.
(c) The Medical Staff will be actively involved in the assessment of the developed criteria for autopsies.
13.3. Treatment of Family Members:
(a) No member of the Medical Staff will admit, treat or participate in the surgery of a member of his or her immediate family, including spouse, parent, child, or
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 35 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
sibling, unless otherwise approved by the Chief Medical Officer or the Chief of Staff. This prohibition is not applicable to in-laws or other relatives.
(b) An exception to this prohibition will be made (1) if the patient's disease is so rare or exceptional and the physician is considered an expert in the field or (2) in an emergency where no other Medical Staff member is readily available to care for the family member, and a transfer is believed to be detrimental to the patient's health.
13.4. Self Treatment
Members of the Medical Staff are strongly discouraged from treating themselves, except in an emergency situation or where no viable alternative treatment is available.
13.5. Investigational Research:
All research will be conducted in accordance with Hospital policies and procedures as established by the Institutional Review Board (IRB).
13.6. End of Life/DNR Policy:
The Medical Staff will administer care in accordance with the Hospital's End of Life and Do Not Resuscitate (DNR) policies and procedures for those competent adult patients who knowingly choose to forgo treatment.
13.7. Emergency Preparedness:
All members of the Medical Staff will be familiar with the Hospital Emergency Preparedness Plan and related policies as they relate to their role in disaster drills and in a real disaster. The provisions of the Hospital Emergency Preparedness Plan and related policies will supersede normal Hospital procedures.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 36 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE XIV
AMENDMENTS
An amendment to the Medical Staff Rules and Regulations may be made by a majority vote of the members of the Medical Executive Committee present and voting at any meeting of that committee where a quorum exists. Notice of all proposed amendments to this document shall be provided to each voting member of the Medical Staff at least 14 days prior to the Medical Executive Committee meeting when the vote is to take place, and any voting member may submit written comments on the amendments to the Medical Executive Committee. Adoption of and changes to the Medical Staff Rules and Regulations will become effective only when approved by the Board.
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 37 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
ARTICLE XV
ADOPTION
These rules and regulations are adopted and made effective upon approval of the Board, superseding and replacing any and all other bylaws, rules and regulations, policies, manuals of the Medical Staff, or the Hospital policies pertaining to the subject matter thereof.
Adopted by the Medical Staff:
Medical Executive Committee ______Date
Approved by the Board of Directors:
Maricopa Special Healthcare District Board of Directors ______Date
Revisions:
1980, 1981, 1982, 1/83, 08/83, 05/84, 07/87, 08/88, 11/88, 04/89, 01/91, 07/91, 12/91, 05/92, 12/92, 10/94, 11/95, 05/96, 10/96, 02/98, 07/98, 04/2000, 06/2001, 08/2001, 09/2002, 10/2004 (New Governance Change Only), 05/2005, 05/2006, 08/006, 05/2007, 08/2007, 02/2008, 09/2008, 08/2010, 01/2011, 02/2012, 06/2012, 01/2013, 09/13, 11/13, 04/2016, 01/2017, 2/2019, 9/2019
MARICOPA INTEGRATED HEALTH SYSTEMValleywise Health Page 38 MEDICAL STAFF RULES AND REGULATIONS Draft 9/2019 (Supersedes 01/25/20172/27/2019)
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.x.
Medical Staff Policy #39011 T: Allied Health Professionals September, 2019
SUMMARY OF PROPOSED AMENDMENTS ALLIED HEALTH PROFESSIONAL POLICY
Allied Health Professional Policy Section 1.A, (2, 13) Language updated to be line with Valleywise Health naming guidelines
Section 1.A, (5) Language added to “Category III Practitioner” definition to meet Arizona Statute requirements regarding Supervision of Medical Assistants and those providing the supervision (Category II practitioner) to Medical Assistants. Section 1.A, (10) Language added to “Collaboration” definition to meet Arizona Statute requirements regarding Supervision of Medical Assistants and further defining collaboration to include Collaborating Category II providers. Section 3.A.1,(c) Included language to allow providers eligible for unrestricted DEA registration with their DEA registration in pending status to meet threshold criteria requirements and maintain regulatory compliance. Section 7.A.2.(a) Language added to meet regulatory requirements regarding hearing panel consisting of a majority of whom will be peers of the individual requesting the hearing such as another Allied Health Professional.
MARICOPA INTEGRATED HEALTH SYSTEM Allied Health Professional Policy Proposed Amendments - 8/2019
MEDICAL STAFF BYLAWS, POLICIES, AND RULES AND REGULATIONS OF MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH
ALLIED HEALTH PROFESSIONALS POLICY
DRAFT September 2019
TABLE OF CONTENTS
PAGE
1. GENERAL ...... 1
1.A. DEFINITIONS ...... 1
1.B. TIME LIMITS ...... 3
1.C. DELEGATION OF FUNCTIONS ...... 34
1.D. CONFLICT OF INTEREST……………………………………………………….4
2. SCOPE AND OVERVIEW OF POLICY ...... 5
2.A. SCOPE OF POLICY...... 5
2.B. CATEGORIES OF ALLIED HEALTH PROFESSIONALS...... 5
2.C. PROCESS FOR DETERMINING NEED FOR A NEW CATEGORY OF ALLIED HEALTH PROFESSIONALS ...... 5
2.C.1. Review of Need...... 5 2.C.2. Additional Recommendations ...... 6
3. QUALIFICATIONS, CONDITIONS, AND RESPONSIBILITIES ...... 8
3.A. QUALIFICATIONS ...... 8
3.A.1. Threshold Eligibility Criteria ...... 8 3.A.2. Waiver of Threshold Eligibility Criteria ...... 9 3.A.3. Factors for Evaluation ...... 10 3.A.4. No Entitlement to Medical Staff Appointment ...... 1011 3.A.5. Nondiscrimination Policy ...... 1011
3.B. GENERAL CONDITIONS OF PRACTICE ...... 11
3.B.1. Assumption of Duties and Responsibilities ...... 11 3.B.2. Misstatements and Omissions ...... 13 3.B.3. Burden of Providing Information...... 13
MIHS VALLEYWISE HEALTH Allied Health Professional Staff Policy Page i
PAGE
3.C. APPLICATION ...... 14
3.C.1. Information ...... 14 3.C.2. Grant of Immunity and Authorization to Obtain/Release Information ...... 15
4. CREDENTIALING PROCEDURE ...... 1718
4.A. PROCESSING OF INITIAL APPLICATION TO PRACTICE ...... 1718
4.A.1. Request for Application ...... 1718 4.A.2. Initial Review of Application...... 1718 4.A.3. Notification of Application Status and Right to Reconcile Information………………………………………….1718 4.A.4. Review by Department Chair ...... 1819 4.A.5. Credentials Committee Procedure ...... 1820 4.A.6. MEC Recommendation ...... 1920 4.A.7. Board Action on AHP Applications ...... 2021 4.A.8. Notice of Final Board Action…………………………………………….2021 4.A.9. Time Periods for Processing…………………………………………..…2021
4.B. CLINICAL PRIVILEGES ...... 2122
4.B.1. General ...... 2122 4.B.2. Focused Professional Practice Evaluation ...... 2122
4.C. TEMPORARY CLINICAL PRIVILEGES ...... 2223
4.C.1. Eligibility to Request Temporary Clinical Privileges ...... 2223 4.C.2. Termination of Temporary Clinical Privileges ...... 2324
4.D. PROCESSING APPLICATIONS FOR RENEWAL TO PRACTICE ...... 2324
4.D.1. Submission of Application ...... 2324 4.D.2. Renewal Process for Category I and Category II Practitioners ...... 2324
5. CONDITIONS OF PRACTICE APPLICABLE TO CATEGORY II PRACTITIONERS ...... 2526
5.A. OVERSIGHT BY COLLABORATING PHYSICIAN ...... 2526
5.B. QUESTIONS REGARDING THE AUTHORITY OF CATEGORY II PRACTITIONERS ...... 2526
MIHS VALLEYWISE HEALTH Allied Health Professional Staff Policy Page ii
PAGE
6. PEER REVIEW PROCEDURES FOR QUESTIONS INVOLVING ALLIED HEALTH PROFESSIONALS ...... 2627
6.A. COLLEGIAL INTERVENTION...... 2627
6.B. INVESTIGATIONS ...... 2627
6.B.1. Initiation of Investigation ...... 2627 6.B.2. Investigative Procedure ...... 2627 6.B.3. Recommendation ...... 2728
6.C. ADMINISTRATIVE SUSPENSION ...... 2829
6.D. AUTOMATIC RELINQUISHMENT OF CLINICAL PRIVILEGES...... 2829
6.E. LEAVE OF ABSENCE ...... 3031
7. PROCEDURAL RIGHTS OF ALLIED HEALTH PROFESSIONALS ...... 3233
7.A. PROCEDURAL RIGHTS FOR CATEGORY I AND CATEGORY II PRACTITIONERS ...... 3233
7.A.1. Notice of Recommendation and Hearing Rights ...... 3233 7.A.2. Hearing Committee ...... 3233 7.A.3. Hearing Process ...... 3334 7.A.4. Hearing Committee Report ...... 3435 7.A.5. Appellate Review ...... 3435
8. AMENDMENTS ...... 3637
9. ADOPTION ...... 3738
APPENDIX A – LICENSED INDEPENDENT PRACTITIONERS
APPENDIX B – ADVANCED DEPENDENT PRACTITIONERS
APPENDIX C – DEPENDENT PRACTITIONERS
MIHS VALLEYWISE HEALTH Allied Health Professional Staff Policy Page iii
ARTICLE 1
GENERAL
1.A. DEFINITIONS
The following definitions apply to terms used in this Policy:
(1) "ALLIED HEALTH PROFESSIONAL" ("AHP") means a health care practitioner other than a Medical Staff member who is authorized to provide patient care services in the Hospital.
(2) "BOARD" means the Governing Body of the Maricopa County Special Healthcare District (d.b.a., Maricopa Integrated Health System ("MIHS") Valleywsie Health), which has the overall responsibility for the Hospital.
(3) "CATEGORY I PRACTITIONER" means a Licensed Independent Practitioner, a type of Allied Health Professional who is permitted by law and by the Hospital to provide patient care services without direction or supervision, within the scope of his or her license and consistent with the clinical privileges granted (e.g., Clinical Psychologists). Category I practitioners also include those physicians not appointed to the Medical Staff who seek to exercise certain limited clinical privileges at the Hospital under the conditions set forth in this Policy (e.g., moonlighting residents). See Appendix A.
(4) "CATEGORY II PRACTITIONER" means an Advanced Dependent Practitioner, a type of Allied Health Professional who provides a medical level of care or performs surgical tasks consistent with granted clinical privileges, but who is required by law and/or the Hospital to exercise those clinical privileges under the direction of, or in collaboration with, a Collaborating Physician pursuant to a written supervision or collaborative agreement (e.g., Nurse Practitioners ("NPs"), Physician Assistants ("PAs")). See Appendix B.
(5) "CATEGORY III PRACTITIONER" means a Dependent Practitioner, a type of Allied Health Professional who is permitted by law or the Hospital to function only under the direction of, or in collaboration with, a Collaborating Physician (or, in the case of Medical Assistants, a Collaborating Category II practitioner), pursuant to a written supervision agreement and consistent with the scope of practice granted, and established competencies. All aspects of the clinical practice of Category III practitioners at the Hospital shall be handled by the Hospital's Human Resources Department in accordance with applicable human resources policies and procedures, and the provisions of the AHP Policy shall specifically not apply.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 1 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(6) "CHIEF EXECUTIVE OFFICER" ("CEO") means the individual appointed by the Board to act on its behalf in the overall management of the Hospital.
(7) "CHIEF MEDICAL OFFICER" ("CMO") means the individual appointed by the CEO to act as the Chief Medical Officer of the Hospital, in cooperation with the Chief of Staff.
(8) "CLINICAL PRIVILEGES" or "PRIVILEGES" means the authorization granted by the Board to render specific patient care services, for which the Medical Staff leaders and Board have developed eligibility and other privileging criteria and focused and ongoing professional practice evaluation standards.
(9) "COLLABORATING PHYSICIAN" means a member of the Medical Staff with clinical privileges, who has agreed in writing to supervise or collaborate with a Category II practitioner and to accept full responsibility for the actions of the Category II practitioner while he or she is practicing in the Hospital.
(10) "COLLABORATION" means the collaboration with (or supervision of) a Category II practitioner by a Collaborating Physician, that may or may not require the actual presence of the Collaborating Physician, but that does require, at a minimum, that the Collaborating Physician be readily available for consultation. For purposes of supervising Medical Assistants, “Collaboration” may also refer to a Collaborating Category II practitioner. The requisite level of supervision (general, direct, or personal) shall be determined at the time each Category II practitioner is credentialed and shall be consistent with any applicable written supervision or collaboration agreement that may exist. ("General" supervision means that the physician is immediately available by phone, "direct" supervision means that the physician is on the Hospital's campus, and "personal" supervision means that the physician is in the same room.)
(11) "DAYS" means calendar days.
(12) "DENTIST" means a doctor of dental surgery ("D.D.S.") or doctor of dental medicine ("D.M.D.").
(13) "HOSPITAL" means the Maricopa Integrated Health System Valleywise Health, which includes the Maricopa Valleywise Health Medical Center and all of its affiliated inpatient, ancillary, outpatient, and licensed health services, facilities, departments and programs, including the Valleywise Behavioral Health FacilitiesCenters (Maryvale, Mesa, Phoenix), Valleywise Comprehensive Healthcare Centers (Phoenix and Peoria), Arizona Burn Center, Valleywise Emergency (Maryvale), and Valleywise Community Family Health Centers /(Federally Qualified Health Care Look Alike (FQHC-LA) Clinics).
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 2 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(14) "MEDICAL EXECUTIVE COMMITTEE" ("MEC") means the Executive Committee of the Medical Staff.
(15) "MEDICAL STAFF" means all physicians, dentists, oral surgeons, and podiatrists who have been appointed to the Medical Staff by the Board.
(16) "MEDICAL STAFF LEADER" means any Medical Staff officer, department chair, or committee chair.
(17) "MEDICAL STAFF OFFICER" means the Medical Staff elected officers consisting of Chief of Staff, Vice Chief of Staff, and Immediate Past Chief of Staff.
(18) "MEMBER" means any physician, dentist, oral surgeon, and podiatrist who has been granted Medical Staff appointment by the Board to practice at the Hospital.
(19) "NOTICE" means written communication by regular U.S. mail, e-mail, facsimile, Hospital mail, or hand delivery.
(20) "ORAL AND MAXILLOFACIAL SURGEON" means an individual with a D.D.S. or a D.M.D. degree, who has completed additional training in oral and maxillofacial surgery.
(21) "PERMISSION TO PRACTICE" means the authorization granted to Allied Health Professionals by the Board or CEO, as applicable, to exercise a scope of practice or clinical privileges.
(22) "PHYSICIAN" includes both doctors of medicine ("M.D.s") and doctors of osteopathy ("D.O.s") (or equivalent).
(23) "PODIATRIST" means a doctor of podiatric medicine ("D.P.M.").
(24) "SPECIAL NOTICE" means hand delivery, certified mail, return receipt requested, or overnight delivery service providing receipt.
1.B. TIME LIMITS
Time limits referred to in this Policy are advisory only and are not mandatory, unless it is expressly stated that a particular right is waived by failing to take action within a specified period.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 3 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
1.C. DELEGATION OF FUNCTIONS
(1) When a function is to be carried out by a member of Hospital management, by a Medical Staff member, or by a Medical Staff committee, the individual, or the committee through its chair, may delegate performance of the function to one or more designees unless such delegation is expressly prohibited elsewhere in this Policy or the related Medical Staff documents.
(2) When a Medical Staff member is unavailable to perform a necessary function, one or more of the Medical Staff Leaders may perform the function personally or delegate it to another appropriate individual.
1.D. CONFLICT OF INTEREST
Any conflict of interest that arises as a part of the credentialing and peer review procedures outlined in this Policy will be managed in accordance with the guidelines outlined in Article 8 of the Medical Staff Credentials Policy.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 4 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 2
SCOPE AND OVERVIEW OF POLICY
2.A. SCOPE OF POLICY
(1) This Policy addresses those Allied Health Professionals who are permitted to provide patient care services in the Hospital and are listed in the Appendices to this Policy. It also addresses those physicians who are not appointed to the Medical Staff, but who seek to exercise certain limited privileges at the Hospital as Category I practitioners, under the conditions set forth in this Policy (e.g., moonlighting residents).
(2) This Policy sets forth the credentialing process and the general practice parameters for these individuals, as well as guidelines for determining the need for additional categories of Allied Health Professionals at the Hospital.
2.B. CATEGORIES OF ALLIED HEALTH PROFESSIONALS
(1) Only those specific categories of Allied Health Professionals that have been approved by the Board shall be permitted to practice at the Hospital. All Allied Health Professionals who are addressed in this Policy shall be classified as either Category I or Category II practitioners.
(2) Current listings of the specific categories of Allied Health Professionals functioning in the Hospital as Category I and Category II practitioners are attached to this Policy as Appendices A and B, respectively. The Appendices may be modified or supplemented by action of the Board, after receiving the recommendation of the MEC, without the necessity of further amendment of this Policy.
2.C. PROCESS FOR DETERMINING NEED FOR A NEW CATEGORY OF ALLIED HEALTH PROFESSIONALS
2.C.1. Review of Need:
(a) Whenever an Allied Health Professional requests to practice at the Hospital, and the Board has not already approved the category of practitioner for practice at the Hospital, the CMO, and the Chief of Staff shall have the Credentials Committee evaluate the need for that category of Allied Health Professional. The Credentials Committee shall report to the MEC, which shall make a recommendation to the Board for final action.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 5 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(b) As part of the process of determining need, the Allied Health Professional shall be invited to submit information about the nature of the proposed practice, the reason access to the Hospital is sought, and the potential benefits to the community of having such services available at the Hospital.
(c) The Credentials Committee may consider the following factors when making a recommendation as to the need for the services of a specific category of Allied Health Professional:
(1) the nature of the services that would be offered;
(2) any state license or regulation which outlines the specific patient care services and/or activities that the Allied Health Professional is authorized by law to perform;
(3) any state "nondiscrimination" or "any willing provider" laws that would apply to the Allied Health Professional;
(4) the patient care objectives of the Hospital, including patient convenience;
(5) the community's needs and whether those needs are currently being met or could be better met if the services offered by the Allied Health Professional were provided at the Hospital;
(6) the type of training that is necessary to perform the services that would be offered and whether there are individuals with more training currently providing those services;
(7) the availability of supplies, equipment, and other necessary Hospital resources;
(8) the need for, and availability of, trained staff to support the services that would be offered; and
(9) the ability to appropriately supervise performance and monitor quality of care.
2.C.2. Additional Recommendations:
(a) If the Credentials Committee makes a recommendation that there is a need for the particular category of Allied Health Professional at the Hospital, it shall also recommend:
(1) any specific qualifications and/or training that must be possessed beyond those set forth in this Policy;
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 6 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(2) a detailed description of a scope of practice or clinical privileges;
(3) any specific conditions that apply to practice within the Hospital; and
(4) any supervision requirements, if applicable.
(b) In developing such recommendations, the Credentials Committee shall consult the appropriate department chair(s) and consider relevant state law and may contact professional societies or associations. The ad hoc committee may also recommend the number of Allied Health Professionals that are needed.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 7 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 3
QUALIFICATIONS, CONDITIONS, AND RESPONSIBILITIES
3.A. QUALIFICATIONS
3.A.1. Threshold Eligibility Criteria:
To be eligible to apply for initial and continued permission to practice, Allied Health Professionals must, where applicable:
(a) have a current, unrestricted license, certification, or registration to practice in Arizona and have never had a license, certification, or registration to practice revoked or suspended by any state agency;
(b) be employed by the Hospital, under contract with the Hospital, or contracted and/or employed by a contractor of the Hospital;
(c) where applicable to their practice, have a current, unrestricted DEA registration or be eligible for an unrestricted DEA registration with their DEA registration in pending status;
(d) have current, valid professional liability coverage in a form and in amounts satisfactory to the Hospital;
(e) have never been convicted of, or entered a plea of guilty or no contest to, Medicare, Medicaid, or other federal or state governmental or private third-party payer fraud or program abuse or have been required to pay civil monetary penalties for the same;
(f) have never been, and are not currently, excluded or precluded from participation in Medicare, Medicaid, or other federal or state governmental health care program;
(g) have never had a scope of practice or clinical privileges denied, revoked, or terminated by any health care facility or health plan for reasons related to clinical competence or professional conduct;
(h) have never resigned affiliation or relinquished scope of practice or clinical privileges during an investigation or in exchange for not conducting an investigation;
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 8 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(i) have never been convicted of, or entered a plea of guilty or no contest to, any felony; or to any misdemeanor relating to controlled substances, illegal drugs, insurance or health care fraud or abuse, or violence;
(j) demonstrate recent clinical activity in their primary area of practice during at least two of the last three years;
(k) satisfy all additional eligibility qualifications relating to their specific area of practice that may be established by the Hospital;
(l) agree to fulfill all responsibilities for coverage, including call coverage, for their specialty as assigned by the department chairs; and
(m) if seeking to practice as a Category II practitioner, have a written agreement with a Collaborating Physician (or Group), which agreement must meet all applicable requirements of state law and Hospital policy.
3.A.2. Waiver of Threshold Eligibility Criteria:
(a) Any individual who does not satisfy a threshold eligibility criterion may request that it be waived. The individual requesting the waiver bears the burden of demonstrating exceptional circumstances, and that his or her qualifications are equivalent to, or exceed, the criterion in question.
(b) A request for a waiver shall be submitted to the Credentials Committee for consideration. In reviewing the request for a waiver, the Credentials Committee may consider the specific qualifications of the individual in question, input from the relevant department chair, and the best interests of the Hospital and the communities it serves. Additionally, the Credentials Committee may, in its discretion, consider the application form and other information supplied by the applicant. Within 60 days of its receipt of all appropriate information, the Credentials Committee shall make a recommendation to the MEC. Any recommendation to grant a waiver must include the basis for such.
(c) The MEC shall review the recommendation of the Credentials Committee and make a recommendation to the Board regarding whether to grant or deny the request for a waiver. This shall be accomplished within 60 days of its receipt of the Credentials Committee's recommendation. Any recommendation to grant a waiver must include the basis for such.
(d) The Board may grant waivers in exceptional cases after considering the findings of the Credentials Committee, the MEC, or other committee designated by the Board, the specific qualifications of the individual in question, and the best interests of the Hospital and the community it serves. The granting of a waiver in
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 9 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
a particular case is not intended to set a precedent for any other individual or group of individuals.
(e) No individual is entitled to a waiver or to a hearing if the Board determines not to grant a waiver.
(f) A determination that an individual is not entitled to a waiver is not a "denial" of clinical privileges that entitles the AHP to request a hearing in accordance with Article 7 of this Policy.
(g) An application for permission to practice that does not satisfy an eligibility criterion shall not be acted on until the Board has determined that a waiver should be granted.
3.A.3. Factors for Evaluation:
The following factors will be evaluated as applicable, as part of a request for permission to practice:
(a) relevant training, experience, and demonstrated current competence, including medical/clinical knowledge, technical and clinical skills, clinical judgment, and an understanding of the contexts and systems within which care is provided;
(b) adherence to the ethics of their profession, continuous professional development, an understanding of and sensitivity to diversity, and responsible attitude toward patients, families, and their profession;
(c) ability to safely and competently perform the clinical privileges requested, including current health status;
(d) good reputation and character;
(e) ability to work harmoniously with others, including, but not limited to, interpersonal and communication skills sufficient to enable them to maintain professional relationships with patients, families, and other members of health care teams; and
(f) recognition of the importance of, and willingness to support, the Hospital's and Medical Staff’s commitment to quality care and a recognition that interpersonal skills and collegiality are essential to the provision of quality patient care.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 10 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
3.A.4. No Entitlement to Medical Staff Appointment:
Allied Health Professionals shall not be appointed to the Medical Staff or entitled to the rights, privileges, and/or prerogatives of Medical Staff appointment unless otherwise provided for under this Policy.
3.A.5. Nondiscrimination Policy:
No individual shall be denied clinical privileges at the Hospital on the basis of gender, race, creed, sexual orientation, or national origin.
3.B. GENERAL CONDITIONS OF PRACTICE
3.B.1. Assumption of Duties and Responsibilities:
As a condition of being granted permission to practice and as a condition for continued permission to practice, Allied Health Professionals specifically agree to the following:
(a) to provide continuous and timely care to all patients for whom the individual has responsibility;
(b) to abide by all bylaws, policies, and rules and regulations of the Hospital and Medical Staff;
(c) to accept committee assignments, participation in quality improvement and professional practice evaluation activities, and such other reasonable duties and responsibilities as assigned;
(d) to constructively participate in the development, review, and revision of clinical protocols and pathways pertinent to his or her specialty, including those related to national patient safety initiatives and core measures;
(e) to comply with all clinical practice protocols and pathways that are established by the MEC, or document the clinical reasons for variance;
(f) to maintain a current e-mail address with Medical Staff Services, which shall be the official mechanism used to communicate all relevant information to the individual other than peer review information pertaining to the individual and/or protected health information of patients;
(g) to inform the CMO and the Chief of Staff (notification may be provided to the Medical Staff Services Department to facilitate CMO and Chief of Staff review) of any change in the AHP's status or any change in the information provided on the AHP's application form. This information shall be provided with or without request, at the time the change occurs, and shall include, but not be limited to:
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 11 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
• changes in licensure status, DEA controlled substance authorization (when applicable), or professional liability insurance coverage,
• the filing of a professional liability lawsuit against the AHP,
• changes in the AHP's status (when applicable), at any other hospital,
• indictment, conviction, or a plea of guilty or no contest in any criminal matter,
• exclusion or preclusion from participation in Medicare or any sanctions imposed, and
• any changes in the AHP's ability to safely and competently exercise clinical privileges or perform the duties and responsibilities of appointment because of health status issues, including, but not limited to, impairment due to addiction, and any charge of, or arrest for, driving under the influence ("DUI") (Any DUI incident shall be reviewed by the Chief of Staff and the CMO so that they may understand the circumstances surrounding it. If they have any concerns after doing so, they shall forward the matter for further review under the Practitioner Health Policy or this Credentials Policy.);
(h) to immediately submit to a blood, hair, and/or urine test, or to a complete physical and/or mental evaluation, if the Chief of Staff and the CMO are concerned with the individual's ability to safely and competently care for patients and request such testing and/or evaluation. The health care professional(s) to perform the testing and/or evaluations shall be determined by the Medical Staff Leaders;
(i) to appear for, and participate in, personal or phone interviews as may be requested;
(j) to refrain from illegal fee splitting or other illegal inducements relating to patient referral;
(k) to refrain from assuming responsibility for diagnosis or care of hospitalized patients for which he or she is not qualified or without adequate supervision;
(l) to refrain from deceiving patients as to his or her status as an Allied Health Professional;
(m) to seek consultation when appropriate;
(n) to participate in monitoring and evaluation activities;
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 12 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(o) to complete, in a timely manner, all medical and other required records containing all information required by the Hospital, regardless of medium;
(p) to perform all services and conduct himself or herself at all times in a cooperative and professional manner;
(q) to satisfy applicable continuing education requirements;
(r) to promptly pay any applicable dues and assessments; and
(s) to participate in an Organized Health Care Arrangement with the Hospital and abide by the terms of the Hospital's Notice of Privacy Practices with respect to health care delivered in the Hospital
3.B.2. Misstatements and Omissions:
(a) Any misstatement in, or omission from, the application is grounds to stop processing the application. The applicant will be informed in writing of the nature of the misstatement or omission and permitted to provide a written response reconciling the information. The Credentials Committee will review the response and determine whether the application should be processed further.
(b) If permission to practice has been granted prior to the discovery of a misstatement or omission, clinical privileges may be deemed to be automatically relinquished pursuant to this Policy.
(c) No action taken pursuant to this section will entitle the individual to the procedural rights in Article 7 of this Policy.
3.B.3. Burden of Providing Information:
(a) Allied Health Professionals seeking permission to practice shall have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, character, ethics, and other qualifications and for resolving any doubts about such qualifications.
(b) Allied Health Professionals seeking permission to practice at the Hospital have the burden of providing evidence that all the statements made and information given on the application are current, accurate, and complete.
(c) An application shall be complete when all questions on the application form have been answered, all supporting documentation has been supplied, and all information has been verified from primary sources. An application shall become incomplete if the department chair, Credentials Committee, MEC, and/or Board request any new, additional, or clarifying information at any time. Any
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 13 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
application that continues to be incomplete 30 days after the individual has been notified of the additional information required shall be deemed to be withdrawn.
(d) It is the responsibility of the individual seeking permission to practice at the Hospital to provide a complete application, including adequate responses from references. An incomplete application shall not be processed
3.C. APPLICATION
3.C.1. Information:
(a) The applications for Allied Health Professionals shall be approved by the MEC and the Board. The applications existing now, and as may be revised, are incorporated by reference and made a part of this Policy.
(b) The applications shall require detailed information concerning the applicant's professional qualifications. In addition to other information, the applications shall seek the following:
(1) information as to whether the applicant's clinical privileges and/or affiliation has ever been voluntarily or involuntarily relinquished, withdrawn, denied, revoked, suspended, subject to probationary or other conditions, reduced, limited, terminated, or not renewed at any hospital or health care facility or is currently being investigated or challenged;
(2) information as to whether the applicant's license or certification to practice any profession in any state or DEA registration or any state controlled substance license is, or has ever been, voluntarily or involuntarily relinquished, suspended, modified, terminated, or restricted or is currently being investigated or challenged;
(3) information concerning the applicant's professional liability litigation experience, including past and pending claims, final judgments or settlements, and the substance of the allegations, as well as the findings and the ultimate disposition;
(4) current information regarding the applicant's ability to safely and competently exercise the clinical privileges he or she has requested; and
(5) a copy of government-issued photo identification.
(c) The applicant shall sign the application and certify that he or she is able to perform the clinical privileges requested and the responsibilities of Allied Health Professionals.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 14 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
3.C.2. Grant of Immunity and Authorization to Obtain/Release Information:
By requesting an application and/or applying for permission to practice, the individual expressly accepts the following conditions:
(a) Immunity:
To the fullest extent permitted by law, the individual releases from any and all liability, extends absolute immunity to, and agrees not to sue the Hospital or the Board, any member of the Medical Staff or the Board, their authorized representatives, and third parties who provide information for any matter relating to permission to practice, clinical privileges, or the individual's qualifications for the same. This immunity covers any actions, recommendations, reports, statements, communications, and/or disclosures involving the individual that are made, taken, or received by the Hospital, its authorized agents, or third parties in the course of credentialing and peer review activities.
(b) Authorization to Obtain Information from Third Parties:
The individual specifically authorizes the Hospital, Medical Staff leaders, and their authorized representatives (1) to consult with any third party who may have information bearing on the individual's professional qualifications, credentials, clinical competence, character, ability to perform safely and competently, ethics, behavior, or any other matter reasonably having a bearing on his or her qualifications for initial and continued authorization to practice at the Hospital, and (2) to obtain any and all communications, reports, records, statements, documents, recommendations, or disclosures of third parties that may be relevant to such questions. The individual also specifically authorizes third parties to release this information to the Hospital and its authorized representatives upon request. Further, the individual agrees to sign necessary consent forms to permit a qualified agency to conduct a criminal background check on the individual and report the results to the Hospital.
(c) Authorization to Release Information to Third Parties:
The individual also authorizes Hospital representatives to release information to other hospitals, health care facilities, managed care organizations, government regulatory and licensure boards or agencies, and their agents when information is requested in order to evaluate his or her professional qualifications for permission to practice, clinical privileges, and/or participation at the requesting organization/facility, and any licensure or regulatory matter. The specific process for release of information shall be coordinated by Medical Staff Services.
(d) Access to Information by Individuals:
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 15 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(i) Upon request, an individual will be informed of the status of his or her application for appointment, reappointment and/or clinical privileges.
(ii) An individual seeking initial appointment, reappointment, and/or clinical privileges has the right to review information submitted in support of his or her application, upon a request made pursuant to the MIHS Valleywise Health policy on Practitioner Access to Credential Files.
(iii) If an individual disputes any information that was obtained in the verification process during the appointment, reappointment, and/or privileging process, the individual will be notified that he or she may submit, in writing, a correction or clarification of the relevant information. Any correction or clarification submitted by the individual will be considered in accordance with the Valleywise HealthMIHS Policy on Practitioner Access to Confidential Files.
(d) Procedural Rights:
The Allied Health Professional agrees that the procedural rights set forth in Article 7 of this Policy shall be the sole and exclusive remedy with respect to any professional review action taken by the Hospital.
(e) Legal Actions:
If an individual institutes legal action challenging any credentialing, privileging, or peer review action and does not prevail, he or she shall reimburse the Hospital and any member of the Medical Staff or Board involved in the action for all costs and damages incurred in defending such legal action, including reasonable attorney's fees and lost revenues.
(f) Scope of Section:
All of the provisions in this Section 3.C.2 are applicable in the following situations:
(i) whether or not permission to practice and clinical privileges are granted;
(ii) throughout the term of any affiliation with the Hospital and thereafter;
(iii) should permission to practice or clinical privileges be denied, revoked, reduced, restricted, suspended, and/or otherwise affected as part of the Hospital's and Medical Staff's professional review activities; and
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 16 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(iv) as applicable, to any third-party inquiries received after the individual leaves the Hospital about his/her tenure at the Hospital.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 17 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 4
CREDENTIALING PROCEDURE
4.A. PROCESSING OF INITIAL APPLICATION TO PRACTICE
4.A.1. Request for Application:
(a) Any individual requesting an application for permission to practice as an Allied Health Professional shall be sent a notification (i.e., letter or electronic communication) that outlines the eligibility criteria for permission to practice and the application form.
(b) An Allied Health Professional who is in a category of practitioners that has not been approved by the Board to practice at the Hospital shall be ineligible to receive an application. A determination of ineligibility does not entitle an Allied Health Professional to the procedural rights outlined in Article 7 of this Policy.
4.A.2. Initial Review of Application:
(a) A completed application form, with copies of all required documents, must be returned to Medical Staff Services.
(b) As a preliminary step, Medical Staff Services and the CMO (if necessary) shall review the application to determine that the individual satisfies all threshold criteria. An individual who fails to meet the eligibility criteria set forth in Section 3.A.1 of this Policy shall be notified that his or her application shall not be processed. A determination of ineligibility does not entitle an Allied Health Professional to the procedural rights outlined in Article 7 of this Policy.
(c) Medical Staff Services shall also review the application to determine if all questions have been answered, all references and other information or materials have been received, and pertinent information provided on the application has been verified with primary sources. If an application is complete, it shall be transmitted, along with all supporting documentation, to the applicable department chair.
4.A.3. Notification of Application Status and Right to Reconcile Information
(a) The applicant for appointment and renewal has the right to inquire into the status of an application by contacting the Medical Staff Services Department.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 18 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(b) During the initial credentialing and recredentialing process, an applicant shall be given notice of any conflicting information and shall be given an opportunity to reconcile such information. The following process shall be followed:
(1) The applicant shall be notified of the variation (i.e., letter or electronic communication) on a case-by-case basis to correct or clarify the relevant information. The notice shall detail the information that needs correction or clarification and where the information should be submitted.
(2) It is the burden of the applicant to correct or clarify variations identified in the application, in writing, once the appropriate notification has been provided.
(3) Confirmation shall be given to the applicant upon receipt of the additional information, which shall be maintained in his or her credentialing file.
(4) Any information that continues to be incomplete, or unsatisfactorily resolved, 30 days after the applicant has been sent notification of a variation in his or her initial credentialing and recredentialing application shall be deemed to be withdrawn, or shall result in an automatic relinquishment of privileges as noted in Section 3.B.2.
4.A.54. Review by Department Chair:
(a) Medical Staff Services shall transmit the complete application and all supporting materials to the appropriate department chair. Each chair shall prepare a written report regarding whether the applicant has satisfied all of the qualifications for the clinical privileges requested.
(b) In preparing this report, the department chair has the right to meet with the applicant, and the Collaborating Physician (if applicable), to discuss any aspect of the application, qualifications, and requested clinical privileges. The department chair may also confer with experts within the department and outside of the department in preparing the report (e.g., other physicians, appropriate supervisor within the department, nurse managers).
(c) The department chair shall be available to answer any questions that may be raised with respect to that chair's report and findings.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 19 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
4.A.65. Credentials Committee Procedure:
(a) The Credentials Committee shall review and consider the report prepared by the department chair and may interview the applicant. Thereafter, the Credentials Committee shall make a recommendation.
(b) The Credentials Committee may use the expertise of the department chair, any member of the department, an outside consultant, or another Medical Staff committee, if additional information is required regarding the applicant's qualifications.
(c) The Credentials Committee may recommend the imposition of specific conditions. These conditions may relate to behavior (e.g., code of conduct) or to clinical issues (e.g., general consultation requirements, proctoring, education requirements). The Credentials Committee may also recommend that permission to practice be granted for a period of less than two years in order to permit closer monitoring of an individual's compliance with any conditions.
(d) After a determination that an applicant is otherwise qualified for permission to practice and clinical privileges, the Credentials Committee shall refer any questions about the applicant’s ability to perform the privileges requested to the Practitioner Wellness Committee for recommendations on what, if any, reasonable accommodations may be indicated in order to assure that the Practitioner is able to perform the privileges requested.
4.A.76. MEC Recommendation:
(a) At its next regular meeting, after receipt of the written findings and recommendations of the Credentials Committee, the MEC shall:
(1) adopt the findings and recommendations of the Credentials Committee as its own; or
(2) refer the matter back to the Credentials Committee for further consideration and responses to specific questions raised by the MEC prior to its final recommendation; or
(3) state its reasons in its report and recommendation, along with supporting information, for its disagreement with, and modification of, the Credentials Committee's recommendation.
(b) If the recommendation of the MEC is favorable, the recommendation shall be forwarded to the Board.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 20 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(c) If the recommendation of the MEC would entitle the applicant to the procedural rights set forth in Article 7, the CMO shall send the applicant special notice. The CMO shall then hold the application until after the applicant has completed or waived the procedural process outlined in this Policy.
4.A.87. Board Action on AHP Applications:
(a) Upon receipt of a recommendation that the applicant be granted clinical privileges requested, the Board may:
(1) grant the applicant the clinical privileges as recommended; or
(2) refer the matter back to the Credentials Committee or MEC, or to another source inside or outside the Hospital, for additional research or information; or
(3) reject or modify the recommendation.
(b) If the Board determines to reject a favorable recommendation, it should first discuss the matter with the Chair of the Credentials Committee and the Chief of Staff. If the Board's determination remains unfavorable to the applicant, the CMO shall promptly send special notice to the applicant that the applicant is entitled to request a hearing in accordance with Article 7 of this Policy.
4.A.98. Notice of Final Board Action:
(a) Notice of favorable final action shall be given as soon as possible, but at least within 30 days, by the Chief Executive Officer to the chair of each department concerned and to the applicant.
(b) Final Board action and the notice to grant or renew permission to practice shall include, if applicable: (1) the department to which the individual is assigned; (2) the clinical privileges granted; and (3) any special conditions attached to the permission to practice.
(c) Any final decision by the Board to deny, revise, limit, or revoke permission to practice and/or clinical privileges is disseminated to appropriate individuals and, as required, reported to appropriate entities.
4.A.109. Time Periods for Processing:
Once an application is deemed complete, it is expected to be processed within 60 days, unless it becomes incomplete. This time period is intended to be a guideline only and shall not create any right for the applicant to have the application processed within this precise time period.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 21 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
4.B. CLINICAL PRIVILEGES
4.B.1. General:
The clinical privileges recommended to the Board for Category I and Category II Practitioners will be based upon consideration of the following:
(a) education, relevant training, experience, and demonstrated current competence, including medical/clinical knowledge, technical and clinical skills, clinical judgment, interpersonal and communication skills, and professionalism with patients, families and other members of the health care team and peer evaluations relating to the same;
(b) ability to perform the privileges requested competently and safely, including current health status;
(c) information resulting from ongoing and focused professional practice evaluation, performance improvement and other professional practice evaluation activities, if applicable;
(d) adequate professional liability insurance coverage for the clinical privileges requested;
(e) the Hospital's available resources and personnel;
(f) any previously successful or currently pending challenges to any licensure or registration, or the voluntary or involuntary relinquishment of such licensure or registration;
(g) any information concerning professional review actions or voluntary or involuntary termination, limitation, reduction, or loss of appointment or clinical privileges at another hospital;
(h) practitioner-specific data as compared to aggregate data, when available;
(i) morbidity and mortality data, when available; and
(j) professional liability actions, especially any such actions that reflect an unusual pattern or excessive number of actions.
4.B.2. Focused Professional Practice Evaluation:
All initially-granted clinical privileges, regardless of when they are granted (initial application, renewal process, and/or during term), shall be subject to focused professional practice evaluation ("FPPE") in order to confirm competence. The FPPE
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 22 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
process for these situations is outlined in Focused Professional Practice Evaluation to Confirm Practitioner Competence Policy.
4.C. TEMPORARY CLINICAL PRIVILEGES
4.C.1. Eligibility to Request Temporary Clinical Privileges:
(a) Applicants. Temporary privileges for an applicant for initial appointment may be granted by the CEO, upon recommendation of the Department Chair and the Chief of Staff, under the following conditions:
(1) the applicant has submitted a complete application;
(2) the verification process is complete, including verification of current licensure, relevant training or experience, receipt of professional references (including current competence), ability to exercise the privileges requested, profiles from OIG Medicare/Medicaid Exclusions, and current professional liability coverage; compliance with privileges criteria; and consideration of information from the National Practitioner Data Bank and from a criminal background check;
(3) the applicant demonstrates that (i) there are no current or previously successful challenges to his or her licensure or registration, and (ii) he/she has not been subject to involuntary termination of Medical Staff membership or involuntary limitation, reduction, denial, or loss of clinical privileges, at another health care facility;
(4) the application is pending review by the MEC and the Board, following a favorable recommendation by the Credentials Committee after considering the evaluation of the department chair; and
(5) temporary privileges shall be granted for a maximum period not to exceed one hundred twenty (120) days.
(b) Locum Tenens. The CEO, upon recommendation of the Department Chair and the Chief of Staff, may grant temporary privileges to an individual serving as a locum tenens for a member of the Allied Health Professional Staff who is on vacation, attending an educational seminar, ill, and/or otherwise needs coverage assistance for a period of time. This shall be done utilizing the same credentialing process set forth in (a) with respect to applicants to the Allied Staff. The only difference shall be the time period for the grant of locum tenens privileges. Specifically, the individual may exercise locum tenens privileges for one six-month period.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 23 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(c) Compliance with Bylaws and Policies. Prior to any temporary privileges being granted, the individual must agree in writing to be bound by the bylaws, rules and regulations, policies, procedures and protocols of the Medical Staff and the Hospital.
4.C.2. Termination of Temporary Clinical Privileges:
(a) The CEO may, at any time after consulting with the Chief of Staff, the Chair of the Credentials Committee or the department chair, terminate temporary privileges for any reason.
(b) The granting of temporary privileges is a courtesy. Neither the denial nor termination of temporary privileges shall entitle the individual to the procedural rights set forth in Article 7.
4.D. PROCESSING APPLICATIONS FOR RENEWAL TO PRACTICE
4.D.1. Submission of Application:
(a) The grant of clinical privileges shall be for a period not to exceed two years. A request to renew clinical privileges shall be considered only upon submission of a completed renewal application.
(b) At least four months prior to the date of expiration of an Allied Health Professional's clinical privileges, Medical Staff Services shall notify the individual of the date of expiration and provide the individual with a renewal application.
(c) Failure to return a complete application within 60 days shall result in the assessment of a renewal processing fee. In addition, failure to return a completed application at least 60 days prior to the expiration of the individual's clinical privileges shall result in automatic expiration of such clinical privileges at the end of the then current term unless the application can still be processed in the normal course, without extraordinary effort on the part of Medical Staff Services and the Medical Staff leaders.
(d) Once an application for renewal of clinical privileges has been completed and submitted to Medical Staff Services, it shall be evaluated following the same procedures outlined in this Policy regarding initial applications.
4.D.2. Renewal Process for Category I and Category II Practitioners:
(a) The procedures pertaining to an initial request for clinical privileges, including eligibility criteria and factors for evaluation, shall be applicable in processing requests for renewal for these practitioners.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 24 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(b) As part of the process for renewal of clinical privileges, the following factors shall be considered:
(1) an assessment prepared by the applicable department chair;
(2) an assessment prepared by a peer, if possible;
(3) results of the Hospital's performance improvement and professional practice evaluation activities, taking into consideration, when applicable, practitioner-specific information compared to aggregate information concerning other individuals in the same or similar specialty (provided that, other practitioners shall not be identified);
(4) resolution of any verified complaints received from patients or staff; and
(5) any focused professional practice evaluations.
(c) In addition to the above, for Category II Practitioners, the following information shall be considered:
(1) an assessment prepared by the Collaborating Physician(s); and
(2) an assessment prepared by the applicable Hospital supervisor (i.e., OR Supervisor, Nursing Supervisor).
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 25 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 5
CONDITIONS OF PRACTICE APPLICABLE TO CATEGORY II PRACTITIONERS
5.A. OVERSIGHT BY COLLABORATING PHYSICIAN
(1) Category II practitioners may function in the Hospital only so long as they have a Collaborating Physician (or Group).
(2) Any activities permitted to be performed at the Hospital by a Category II practitioner shall be performed only in collaboration with a Collaborating Physician (or Group) as described in the Category II practitioner's grant of clinical privileges.
(3) If the Medical Staff appointment or clinical privileges of a Collaborating Physician (or Group) are resigned, revoked or terminated, the Category II practitioner's clinical privileges shall automatically terminate. The Credentials Committee may, however, recommend that the Category II practitioner be permitted to arrange for another Collaborating Physician.
(4) As a condition of clinical privileges, a Category II practitioner and the Collaborating Physician must provide the Hospital with notice of any revisions or modifications that are made to the collaboration agreement. This notice must be provided to the CMO within three days of any such change.
5.B. QUESTIONS REGARDING THE AUTHORITY OF CATEGORY II PRACTITIONERS
(1) Should any member of the Medical Staff, or any employee of the Hospital who is licensed or certified by the state, have a reasonable question regarding the clinical competence or authority of a Category II practitioner to act or issue instructions outside the presence of the Collaborating Physician, such individual shall have the right to request that the Collaborating Physician validate, either at the time or later, the instructions of the Category II practitioner. Any act or instruction of the Category II practitioner shall be delayed until such time as the individual with the question has ascertained that the act is clearly within the clinical privileges granted to the individual.
(2) Any question regarding the conduct of a Category II practitioner shall be reported to the Chief of Staff, the Chair of the Credentials Committee, the relevant department chair, the CMO, or the CEO for appropriate action. The individual to whom the concern has been reported shall also discuss the matter with the Collaborating Physician (or Group).
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 26 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 6
PEER REVIEW PROCEDURES FOR QUESTIONS INVOLVING ALLIED HEALTH PROFESSIONALS
6.A. COLLEGIAL INTERVENTION
(1) As part of the Hospital's performance improvement and professional practice evaluation activities, this Policy encourages the use of collegial efforts and progressive steps by Medical Staff leaders and administration to arrive at voluntary, responsive actions by individuals to resolve questions that have been raised. Collegial intervention efforts are not mandatory and shall be within the discretion of the appropriate Medical Staff leaders.
(2) Collegial efforts may include, but are not limited to, counseling, sharing of comparative data, monitoring, and additional training or education.
(3) Collegial intervention is a part of ongoing and focused professional practice evaluation, performance improvement, and professional practice evaluation activities.
(4) The Chief of Staff, in conjunction with the CMO, shall determine whether to direct that a matter be handled in accordance with another policy (e.g., policy on practitioner health, code of conduct policy, professional practice evaluation policy) or to direct the matter to the MEC for further review and/or investigation.
6.B. INVESTIGATIONS
6.B.1. Initiation of Investigation:
When a question involving clinical competence or professional conduct of an Allied Health Professional is referred to, or raised by, the MEC, the MEC will review the matter and determine whether to conduct an investigation, to direct the matter to be handled pursuant to another policy, or to proceed in another manner.
6.B.2. Investigative Procedure:
(a) The MEC shall either investigate the matter itself, request that it be conducted by the Credentials Committee, or appoint an ad hoc committee to conduct the investigation ("investigating committee").
(b) The investigating committee will have the authority to review relevant documents and interview individuals. It will also have available to it the full resources of the Medical Staff and the Hospital.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 27 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(c) The investigating committee will also have the authority to use outside consultants, if needed.
(d) The investigating committee may require a physical and/or mental examination of the individual by a health care professional(s) acceptable to it.
(e) The individual will have an opportunity to meet with the investigating committee before it makes its report. Prior to this meeting, the individual will be informed of the general questions being investigated. At the meeting, the individual will be invited to discuss, explain, or refute the questions that gave rise to the investigation. A summary of the interview will be prepared. This meeting is not a hearing in accordance with Article 7 of this Policy, and none of the procedural rules for hearings will apply. Neither the investigating committee nor the individual being investigated shall have the right to be represented by legal counsel at this meeting.
(f) The investigating committee will make a reasonable effort to complete the investigation and issue its report within 30 days of the commencement of the investigation, provided that an outside review is not necessary. When an outside review is necessary, the investigating committee will make a reasonable effort to complete the investigation and issue its report within 30 days of receiving the results of the outside review. These time frames are intended to serve only as guidelines.
(g) At the conclusion of the investigation, the investigating committee will prepare a report with its findings, conclusions, and recommendations.
6.B.3. Recommendation:
(a) The MEC may accept, modify, or reject any recommendation it receives from an investigating committee. Specifically, the MEC may:
(1) determine that no action is justified;
(2) issue a letter of guidance, counsel, warning, or reprimand;
(3) impose a requirement for monitoring or consultation;
(4) recommend additional training or education;
(5) recommend reduction of clinical privileges;
(6) recommend suspension of clinical privileges for a term;
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 28 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(7) recommend revocation of clinical privileges; or
(8) make any other recommendation that it deems necessary or appropriate.
(b) A recommendation by the MEC that would entitle the individual to request a hearing in accordance with Article 7 of this Policy will be forwarded to the CMO, who will promptly inform the individual by special notice. The CMO will hold the recommendation until after the individual has completed or waived a hearing and appeal.
(c) If the MEC makes a recommendation that does not entitle the individual to request a hearing, it will take effect immediately and will remain in effect unless modified by the Board.
(d) When applicable, any recommendations or actions that are the result of an investigation or hearing and appeal will be monitored by Medical Staff leaders on an ongoing basis through the Hospital's performance improvement activities or pursuant to the applicable policies regarding conduct, as appropriate.
6.C. ADMINISTRATIVE SUSPENSION
(1) The Chief of Staff, the CMO, and/or the appropriate department chair shall each have the authority to impose an administrative suspension of all or any portion of the clinical privileges of any Allied Health Professional whenever a question has been raised about such individual's clinical care or professional conduct.
(2) An administrative suspension shall become effective immediately upon imposition and shall remain in effect unless or until modified by the CMO or the MEC. The imposition of an administrative suspension does not entitle an Allied Health Professional to the procedural rights set forth in Article 7 of this Policy.
(3) Notice of the imposition of an administrative suspension shall be forwarded to the MEC, which shall review and consider the question(s) raised and thereafter make a recommendation to the Board.
6.D. AUTOMATIC RELINQUISHMENT OF CLINICAL PRIVILEGES
(1) The clinical privileges of an Allied Health Professional shall be automatically relinquished, without entitlement to the procedural rights outlined in Article 7 of this Policy, in the following circumstances:
(a) the Allied Health Professional no longer satisfies all of the threshold eligibility criteria set forth in Section 3.A.1 or any additional threshold credentialing qualifications set forth in the specific Hospital policy relating to his or her discipline;
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 29 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(b) the Allied Health Professional is charged, indicted, convicted, or enters a plea of guilty or no contest pertaining to any felony, or to any misdemeanor involving (i) controlled substances; (ii) illegal drugs; (iii) Medicare, Medicaid, or insurance or health care fraud or abuse; or (iv) violence against another;
(c) the Allied Health Professional fails to provide information pertaining to his or her qualifications for clinical privileges, in response to a written request from the Credentials Committee, the Professional Practice Evaluation Committee, the MEC, the CMO, or any other committee authorized to request such information;
(d) a determination is made that there is no longer a need for the services of a particular discipline or category of Allied Health Professional; or
(e) the Category II practitioner fails, for any reason, to maintain an appropriate collaboration relationship with a Collaborating Physician (or Group) as defined in this Policy.
(2) If the underlying matter leading to automatic relinquishment is resolved within 90 days, the individual may request reinstatement. Failure to resolve the matter within 90 days of the date of relinquishment shall result in an automatic resignation from the Allied Health Professional Staff.
(3) Request for Reinstatement.
(a) Requests for reinstatement following the expiration of a license, controlled substance authorization, and/or insurance coverage will be processed by Medical Staff Services. If any questions or concerns are noted, Medical Staff Services will refer the matter for further review in accordance with (3)(b) below.
(c) All other requests for reinstatement shall be reviewed by the relevant department chair, the Chair of the Credentials Committee, the Chief of Staff, the CMO, and the CEO. If all these individuals make a favorable recommendation on reinstatement, the Allied Health Professional Staff member may immediately resume clinical practice at the Hospital. This determination shall then be forwarded to the Credentials Committee, the MEC, and the Board for ratification. If, however, any of the individuals reviewing the request have any questions or concerns, those questions shall be noted and the reinstatement request shall be forwarded to the full Credentials Committee, MEC, and Board for review and recommendation.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 30 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
6.E. LEAVE OF ABSENCE
(1) Allied Health Professionals must report to the CMO and/or the Chief of Staff anytime they are away from patient care responsibilities for longer than 90 days. Requests must state the beginning and ending dates of the leave, which shall not exceed one year, and the reasons for the leave.
(2) The CMO, in consultation with the Chief of Staff, may trigger an automatic medical leave if: (1) the reason for a leave of absence is related to a physical or mental health issue or otherwise to the individual’s ability to care for patients safely and competently or (2) if the CMO and/or Chief of Staff become aware of circumstances where an individual will be absent from his or her patient care responsibilities because of a Health Issue, as defined in the Practitioner Health Policy.
(3) The CMO shall then determine whether a request for a leave of absence shall be granted. In determining whether to grant a request, the CMO shall consult with the Chief of Staff, and the relevant department chair. The granting of a leave of absence, or reinstatement, as appropriate, may be conditioned upon the individual's completion of all medical records.
(4) During the leave of absence, the individual shall not exercise any clinical privileges.
(5) Individuals requesting reinstatement shall submit a written summary of their professional activities during the leave, and any other information that may be requested by the Hospital. Requests for reinstatement shall then be reviewed by the relevant department chair, the Chair of the Credentials Committee, the Chief of Staff, and the CMO. If all these individuals make a favorable recommendation on reinstatement, the Allied Health Professional may immediately resume practice. This determination shall then be forwarded to the Credentials Committee, the MEC, and the Board for ratification. If, however, any of the individuals reviewing the request have any questions or concerns, those questions shall be noted and the reinstatement request shall be forwarded to the full Credentials Committee, MEC, and Board for review and recommendation. In the event the MEC determines to take action that would entitle the individual to the procedural rights set forth in Article 7, the individual shall be given special notice.
(6) If the leave of absence was for health reasons, the request for reinstatement must be accompanied by a report from the individual's physician indicating that the individual is physically and/or mentally capable of resuming a hospital practice and safely exercising the clinical privileges requested.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 31 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(7) Absence for longer than one year shall result in automatic relinquishment of Allied Health Professional’s permission to practice and clinical privileges unless an extension is granted by the CMO. Extensions shall be considered only in extraordinary cases where the extension of a leave is in the best interest of the Medical Staff and Hospital.
(8) If an individual's appointment and clinical privileges are due to expire during the leave, the individual must apply for reappointment while on leave, or his or her clinical privileges shall lapse at the end of the appointment period, and the individual shall be required to apply for appointment. If during the leave of absence reappointment is granted, the individual shall, however, remain on leave until it has been terminated through the reinstatement process outlined in Section 6.D.
(9) Leaves of absence are matters of courtesy, not of right. In the event that it is determined that an individual has not demonstrated good cause for a leave, or where a request for extension is not granted, the determination shall be final, with no recourse to a hearing and appeal in accordance with Article 7 of this Policy.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 32 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 7
PROCEDURAL RIGHTS OF ALLIED HEALTH PROFESSIONALS
Allied Health Professionals shall not be entitled to the hearing and appeals procedures set forth in Article 7 of the Medical Staff Credentials Policy. Any and all rights to which Allied Health Professionals are entitled are set forth in this Policy.
7.A. PROCEDURAL RIGHTS FOR CATEGORY I AND CATEGORY II PRACTITIONERS
7.A.1. Notice of Recommendation and Hearing Rights:
(a) In the event a recommendation is made by the MEC that a Category I or Category II practitioner not be granted clinical privileges or that the privileges previously granted be restricted for a period of more than 30 days, terminated, or not renewed, the individual shall receive special notice of the recommendation. The special notice shall include a general statement of the reasons for the recommendation and shall advise the individual that he or she may request a hearing.
(b) The rights and procedures in this Section shall also apply if the Board, without a prior adverse recommendation from the MEC, makes a recommendation not to grant clinical privileges or that the privileges previously granted be restricted, terminated, or not renewed. In this instance, all references in this Article to the MEC shall be interpreted as a reference to the Board.
(c) If the Category I or Category II practitioner wants to request a hearing, the request must be in writing, directed to the CMO, within 30 days after receipt of written notice of the adverse recommendation.
(d) The hearing shall be convened as soon as is practical, but no sooner than 30 days after the notice of the hearing, unless an earlier hearing date has been specifically agreed to by the parties.
7.A.2. Hearing Committee:
(a) If a request for a hearing is made timely, the CMO, in consultation with the Chief of Staff, shall appoint a Hearing Committee composed of up toat least three individuals (including, but not limited to, members of the Medical Staff, Allied Health Professionals, Hospital management, individuals not connected with the Hospital, or any combination of these individuals). A majority of members appointed for service on the Hearing Panel will be peers of the individual requesting the hearing, such as a member of the Medical staff or another Allied Health Professional.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 33 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(b) The CMO, in consultation with the Chief of Staff, shall appoint a Presiding Officer ("Presiding Officer"), who may be legal counsel to the Hospital. The role of the Presiding Officer shall be to allow the participants in the hearing to have a reasonable opportunity to be heard and to present evidence, subject to reasonable limits on the number of witnesses and duration of direct and cross-examination. The Presiding Officer shall maintain decorum throughout the hearing.
(c) As an alternative to a Hearing Committee, the CMO, in consultation with the Chief of Staff, may appoint a Hearing Officer to perform the functions that would otherwise be carried out by the Hearing Committee. The Hearing Officer shall preferably be an attorney at law. The Hearing Officer shall not act as a prosecuting officer or as an advocate to either side at the hearing. In the event a Hearing Officer is appointed instead of a Hearing Committee, all references in this Article to the Hearing Committee or Presiding Officer shall be deemed to refer instead to the Hearing Officer, unless the context would clearly otherwise require.
7.A.3. Hearing Process:
(a) A record of the hearing shall be maintained by a stenographic reporter or by a recording of the proceedings. Copies of the transcript shall be available at the individual's expense.
(b) The hearing shall last no more than six hours, with each side being afforded approximately three hours to present its case, in terms of both direct and cross- examination of witnesses.
(c) At the hearing, a representative of the MEC shall first present the reasons for the recommendation. The Category I or Category II practitioner shall be invited to present information to refute the reasons for the recommendation.
(d) Both parties shall have the right to present witnesses. The Presiding Officer shall permit reasonable questioning of such witnesses.
(e) The Category I or Category II practitioner and the MEC may be represented at the hearing by legal counsel. However, while counsel may be present at the hearing, counsel shall not call, examine, or cross-examine witnesses or present the case.
(f) The Category I or Category II practitioner shall have the burden of demonstrating, by clear and convincing evidence, that the recommendation of the MEC was arbitrary, capricious, or not supported by substantial evidence. The quality of care provided to patients and the smooth operation of the Hospital shall be the paramount considerations.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 34 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(g) The Category I or Category II practitioner and the MEC shall have the right to prepare a post-hearing memorandum for consideration by the Hearing Committee. The Presiding Officer shall establish a reasonable schedule for the submission of such memoranda.
7.A.4. Hearing Committee Report:
(a) Within 20 days after the conclusion of the proceeding or submission of the post-hearing memoranda, whichever date is later, the Hearing Committee shall prepare a written report and recommendation. The Hearing Committee shall forward the report and recommendation, along with all supporting information, to the CMO. The CMO shall send a copy of the written report and recommendation by special notice to the Category I or Category II practitioner and to the MEC.
(b) Within ten days after notice of such recommendation, the Category I or Category II practitioner and/or the MEC may make a written request for an appeal. The request must include a statement of the reasons, including specific facts, which justify an appeal.
(c) The grounds for appeal shall be limited to an assertion that there was substantial failure to comply with this Policy and/or other applicable bylaws or policies of the Hospital and/or that the recommendation was arbitrary, capricious, or not supported by substantial evidence.
(d) The request for an appeal shall be delivered to the CMO by special notice.
(e) If a written request for appeal is not submitted timely, the appeal is deemed to be waived and the recommendation and supporting information shall be forwarded to the Board for final action. If a timely request for appeal is submitted, the CMO shall forward the report and recommendation, the supporting information and the request for appeal to the Board. The Chair of the Board shall arrange for an appeal.
7.A.5. Appellate Review:
(a) The Board shall consider the record upon which the adverse recommendation was made. New or additional written information that is relevant and could not have been made available to the Hearing Committee may be considered at the discretion of the Board. This review shall be conducted within 30 days after receiving the request for appeal.
(b) The Category I or Category II practitioner and the MEC shall each have the right to present a written statement on appeal.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 35 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
(c) At the sole discretion of the Board, the Category I or Category II practitioner and a representative of the MEC may also appear personally to discuss their position.
(d) Upon completion of the review, the Board shall then make its final decision based upon the Board's ultimate legal responsibility to grant privileges and to authorize the performance of clinical activities at the Hospital.
(e) The Category I or Category II practitioner shall receive special notice of the Board's action. A copy of the Board's final action shall also be sent to the MEC for information.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 36 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 8
AMENDMENTS
This Policy may be amended by a majority vote of the members of the MEC present and voting at any meeting of that committee where a quorum exists, provided that the written recommendations of the Credentials Committee concerning the proposed amendments shall have first been received and reviewed by the MEC. Notice of all proposed amendments shall also be provided to all voting members of the Medical Staff at least 14 days prior to the MEC meeting and any voting member of the Medical Staff may submit written comments to the MEC. No amendment shall be effective unless and until it has been approved by the Board, which approval shall not be withheld unreasonably.
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 37 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
ARTICLE 9
ADOPTION
This Allied Health Professionals Policy is adopted and made effective upon approval of the Board, superseding and replacing any and all other bylaws, rules, regulations, policies, or manuals pertaining to the subject matter thereof.
Adopted by the Medical Staff: March 12, 2019September, 2019
Approved by the Board: March 27, 2019______
REVISIONS:
10/2009 (Complete Revision – Previous AHP Policy contained in Medical Staff Bylaws), 6/2012, 6/2014, 2/2015, 5/2016, 1/2017, 06/2018 (Appendix A only), 09/2018 (Appendix A only), 3/2019, 9/2019
MARICOPA INTEGRATED HEALTH SYSTEMVALLEYWISE HEALTH Page 38 ALLIED HEALTH PROFESSIONAL MANUAL –Draft: 9/2019 Approved: 3/27/2019 (Supersedes 01/25/20173/27/2019)
APPENDIX A
Those Allied Health Professionals currently practicing as Category I Practitioners at the Hospital are as follows:
● Clinical Psychologists
• Licensed Professional Counselor
• Licensed Marriage & Family Therapist
• Licensed Independent Substance Abuse Counselor
• Licensed Clinical Social Worker
● Optometrists
● Physicians providing limited services (e.g., moonlighting residents functioning outside their training program)
APPENDIX B
Those Allied Health Professionals currently practicing as Category II Practitioners at the Hospital are as follows:
● Audiologist
● Certified Nurse Midwives
● Certified Registered Nurse Anesthetist
● Naturopathic Physician
● Nurse Practitioners
● Perfusionist
● Physician Assistants
APPENDIX C
Medical Assistants and other applicable health care providers who are managed by the Hospital Human Resources Department.
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.xi.
Medical Staff Annual Peer Review Report
MIHS Medical Staff Peer Review Report to the
Maricopa Special Health Care District Board of Directors
September 2019
Introduction
The MIHS Medical Staff has a vigorous and active Medical Staff and Allied Health Professional Staff professional practice evaluation process. This Report to the Maricopa Special Health Care District Board of Directors (“Board”) is intended to educate the Board about the process and provide summary information regarding practice evaluation activity between July 2018 and June 2019.
Background
What is Peer Review?
Professional Practice Evaluation Process is also known as Peer Review. Medical Peer Review is defined as the review and evaluation, by a physician or other practitioners (i.e., Nurse Midwife, Nurse Practitioner, etc.) with comparable privileges, of the practitioner’s medical management of a patient, compliance with clinical guidelines, and/or use of resources for patient care.
Medical Staff Peer Review is the process whereby physicians evaluate the medical care rendered by other members of the Medical Staff to determine whether accepted standards of care have been met. Department Chairs are responsible for timely review of cases referred to them for Peer Review by the Quality Management Department, Leadership Council, or Trauma Multi-Disciplinary Peer Review Committee. Department Chairs may review cases themselves, assign the case to a single practitioner in the Department who has the clinical expertise necessary to evaluate the care provided, or may appoint several practitioners in the Department who have the necessary clinical expertise to serve on an ad hoc committee to review the care provided. If the case involves specialty care for which the clinical expertise needed to conduct the review is not available on the Medical Staff, an external review (i.e., practitioner outside of MIHS) may be authorized by the medical staff leadership. Conversations in medical peer review meetings are confidential and protected under Arizona law.
How is medical peer review information protected under the law?
With regard to hospitals and physician focused peer review, Arizona Revised Statutes define medical peer review and provide for confidentiality of the information via the following:
36-445. Review of certain medical practices
The governing body of each licensed hospital or outpatient surgical center as defined in section 36-401 shall require that physicians admitted to practice in the hospital or center organize into committees or other organizational structures to review the professional practices within the hospital or center for the purposes of reducing morbidity and mortality and for the improvement of the care of patients provided in the institution. Such review shall include the nature, quality and necessity of the care provided and
CONFIDENTIAL Page 1
the preventability of complications and deaths occurring in the hospital or center. Such review need not identify the patient or doctor by name but may use a case number or some other such designation.
36-445.01. Confidentiality of information; conditions of disclosure
A. All proceedings, records and materials prepared in connection with the reviews provided for in section 36-445, including all peer reviews of individual health care providers practicing in and applying to practice in hospitals or outpatient surgical centers and the records of such reviews, are confidential and are not subject to discovery except in proceedings before the Arizona medical board or the board of osteopathic examiners, or in actions by an individual health care provider against a hospital or center or its medical staff arising from discipline of such individual health care provider or refusal, termination, suspension or limitation of the health care provider's privileges. No member of a committee established under the provisions of section 36- 445 or officer or other member of a hospital's or center's medical, administrative or nursing staff engaged in assisting the hospital or center to carry out functions in accordance with that section or any person furnishing information to a committee performing peer review may be subpoenaed to testify in any judicial or quasi-judicial proceeding if the subpoena is based solely on those activities.
B. This article does not affect any patient's claim to privilege or privacy or to prevent the subpoena of a patient's medical records if they are otherwise subject to discovery or to restrict the powers and duties of the director pursuant to this chapter, with respect to records and information that are not subject to this article. In any legal action brought against a hospital or outpatient surgical center licensed pursuant to this chapter claiming negligence for failure to adequately do peer review, representatives of the hospital or center are permitted to testify as to whether there was peer review as to the subject matter being litigated. The contents and records of the peer review proceedings are fully confidential and inadmissible as evidence in any court of law.
How can this information be used to improve physician practice?
The Department Chair uses the results of the peer review process to monitor practice patterns and for consideration and evaluation in the reappointment process.
If the medical peer review finds that the physician departed from accepted standards, the Department Chair may:
• Address through an Informational Letter • Address through an Educational Letter • Address through Collegial Intervention • Determine that Further Review is required
Page 2
o The Department Chair can refer the matter to the Professional Practice Evaluation Committee o If a pattern has developed despite prior attempts at collegial intervention or prior participation in a performance improvement plan, or if the matter involves a very serious incident, the Department Chair may instead refer the matter directly to the Medical Executive Committee (MEC) for its review and appropriate recommendation or action pursuant to the Credentials Policy.
The Professional Practice Evaluation Committee (PPEC) may design a Performance Improvement Plan if it is determined that quality care and patient safety could be enhanced through the development of such a plan. A Performance Improvement Plan may include the following:
• Requirement for additional education or Continuing Medical Education (CME) • Requirement for prospective monitoring or review of specific number of cases • The use of second opinions or mandatory consultations • Concurrent proctoring • Participation in a formal evaluation and assessment program • Additional procedural training • A direction to refrain from practicing until additional training is complete • An educational leave of absence • More severe actions may be recommended based upon the facts of any specific matter, i.e. structured discipline, suspension, or removal of the provider from the medical staff.
How is this information used in the reappointment process?
During the reappointment process, results from Peer Review are used by the Department Chair and the Credentials Committee as part of the information upon which the decision is made to recommend reappointment. Peer Review decisions are part of the physician’s file and are incorporated into the physician-specific quality profiles.
Is the peer review process used for system-wide issues?
By design, the peer review process focuses on the care provided by the individual physician. Sometimes, during the evaluation, larger and more systemic issues are identified. If this occurs, evaluation teams or Root Cause Analysis teams are created to review the systemic issues that affect professional practices (nurse, physician or other providers) within the hospital for the purposes of reducing morbidity and mortality and for the improvement of the care of patients. When system improvements are identified through the Peer Review Process and/or by the PPEC, the matters are referred to the relevant areas for systems improvement.
Page 3
How are disagreements handled in the Peer Review Process?
The Multi-Specialty Professional Practice Evaluation Committee (PPEC), with its multidisciplinary membership, addresses and resolves disagreements. These differences can exist when two or more departments review the same case and reach different opinions, or if the individual practitioner wishes to dispute an Educational Letter, such cases are adjudicated by PPEC.
Report
PPEC Audits
On a monthly basis, one, sometimes two, department representatives present up to five cases chosen randomly from the closed cases from the last 12 months that concluded with no physician quality of care issues identified. The cases are discussed in PPEC and if PPEC determines that the goal of enhancing quality of care and improving patient safety would be advanced, they may take any action within their purview (i.e., issue an educational letter, collegial intervention, etc.). As a direct result of the PPEC audit process, PPEC had no recommendations for issuance of educational/informational letters this last academic year.
How many Medical and Specialty Peer Review Groups are there at MIHS?
There are 15 department and specialty specific physician peer review groups. The department/specialty specific peer review groups are:
Anesthesia Burn/Surgery/Trauma Dental Emergency Medicine Family and Community Medicine Internal Medicine Medical Imaging OB/GYN Orthopedics Pathology Pediatrics Psychiatry Trauma Multidisciplinary
Page 4
How are cases selected for Peer Review by the departments?
There are 4 “Universal Indicators” (reviewed by all departments): • Death • Patient/Family/Provider/Insurance plan complaint about quality of care • Procedural complication • Deviation from Core Measure Protocol
In addition, each department has specific indicators for peer review; examples include:
• Reintubation/Respiratory arrest in the PACU (Anesthesia) • Unplanned return to OR (Burn/Surgery/Trauma) • Unanticipated hospitalization of the patient immediately following a dental procedure (Dental) • Return to ED within 72 hours for similar diagnosis and admitted (Emergency Medicine) • Yearly retinal exam not done for diabetic patients (Family and Community Medicine) • Unplanned transfers to a higher level of care-ICU (Internal Medicine) • Misread scans or films (Medical Imaging) • Postpartum hemorrhage requiring blood transfusion greater than or equal to 4 units (OB/GYN) • Neurological deficits after surgery (Orthopedics) • Return to Pediatric ED within 72 hours and admitted (Pediatrics) • Readmission within 72 hours (Psychiatry)
Page 5
Total Cases Evaluated by Department or Specialty-Specific Peer Review Activities and Total Number Resulting in Informational, Educational Letters, or Collegial Interventions July 2018 - June 2019
# of cases with Informational, Educational Letters or Departments # of cases Collegial Interventions # encounters/admissions/visits/studies Anesthesia 35 5 13,679 cases
Burn/Surgery/Trauma 251 19 6724 surgeries
Dental 1 0 25,792 visits Emergency Medicine 150 25 47,374 visits Family and Community 18 8 143,394 encounters Medicine Internal Medicine 364 10 5190 admissions Medical Imaging 32 3 170,306 studies
OB/GYN 47 5 64,215 encounters Orthopedics 17 1 818 surgeries
Pathology 120 0 N/A (includes chart review) Pediatrics 24 3 21,661 (ED visits + admissions) Psychiatry 55 30 3778 admissions Trauma Multidisciplinary 41* 0 N/A Total # of cases 1114 109 N/A
Of the 1114 peer review cases that were reviewed during the 12-month reporting period, 407 of those cases were reviewed because they met the criteria for review in the 4 Universal Indicators= 36% of all cases reviewed. The remaining 64% of reviews were a result of the Department-specific Indicators and other referrals. 270 cases were deaths (24%) 7 cases were patient/family/provider/insurance company complaints (1%) 76 cases were procedural complications (6%) 54 cases were deviations from Core Measure protocols (5%)
*Trauma Multidisciplinary cases are not included in total cases reviewed as they were reviewed by and accounted for by the Department Peer Review Committees
Page 6
Examples of cases that generated an information or educational letter include:
1. A Psychiatry patient was admitted for treatment of schizoaffective disorder. The admitting provider received an information letter for not administering an FDA-approved tobacco cessation medication for compliance with CORE Measure-TOB2a.
2. A Surgery patient underwent reduction for an internal hernia. The provider received an information letter for not ordering chemical DVT prophylaxis post-operatively.
3. An Emergency Medicine patient presented to the ED 9 days post-delivery with complaints of shortness of breath. The provider received an information letter for not consulting the Obstetrical service.
4. A Medical Imaging patient underwent a kidney/ureter/bladder (KUB)/chest x-ray. The provider received an education letter for the lucent appearance under the diaphragm which was not identified.
Who serves on the Leadership Council?
The Leadership Council consists of the Chief Medical Officer (CMO), the Chief of Staff, the Vice Chief of Staff, the Vice President of Quality and Patient Outcomes, and the Chair of the PPEC. The Chief Nursing Officer and the Director of Medical Staff Services serve as ex officio members of the Council, without vote.
What are the criteria for bringing a case to Leadership Council?
1. The Vice President of Patient Quality or his/her designee determines that the case involves serious clinical issues that require expedited review. 2. Case involves a Department Chair; 3. When there are limited reviewers with the necessary clinical expertise, and medical staff leadership needs to authorize an external review; or 4. Prior participation in a performance improvement plan that does not seem to have addressed identified concerns.
Page 7
Who serves on the Multi-Specialty Professional Practice Evaluation (PPEC) Committee?
The Professional Practice Evaluation Committee ("PPEC") consists of the Immediate Past Chief of Staff (who shall serve as chair), one physician from each department, and the CMO.
Voting Members as of June 2019
Eric Katz, M.D., Immediate Past Chief of Staff and Chair/Kevin Lopez, M.D., Chief of Staff and Chair Daniel Gridley, M.D., Radiology Christopher Brendemuhl, D.M.D., Dentistry Paul Del Prado, M.D., Surgery John Hitt., M.D., MBA, Chief Medical Officer (until November 15, 2018) Samuel P. Hand, M.D./Laura Don, M.D., Psychiatry Daniel W. Hobohm, M.D., Lab/Pathology and Vice President Christopher O’Barr, M.D., Anesthesia Raina Roy, M.D., Internal Medicine Melissa Romero, M.D./Lenore Encinas, M.D., Family & Community Medicine Patricia Habak, MD, OB/GYN David E. Brodkin, M.D., Pediatrics Timothy Davie, M.D., Emergency Medicine Naftaly Attias, M.D., Orthopedics Sydney Vail, M.D./Thomas Wertin, M.D., Trauma Services
What are the criteria for bringing cases to the Multi-Specialty Professional Practice Evaluation Committee?
1. If the Department Chair or the Leadership Council determines that further review of the matter is required, the case will be referred to PPEC. 2. Cases that involve practitioners from several specialties or departments shall have the reviews from the respective Departments Chairs reviewed by PPEC for final disposition. Over the past year, the PPEC has enhanced the multi-specialty case review. The new process has shown remarkable results in breaking down silos and identifying system improvements. 3. Cases that require a Performance Improvement Plan (PIP); and 4. Each month, the PPEC audits a sampling of determinations and interventions made by at least one Department or Specialty-Specific Peer Review Committee.
Page 8
How many cases were reviewed by the Multi-Specialty Professional Practice Evaluation Committee this past 12 months?
PPEC reviewed no cases that were referred directly to the committee from Leadership Council this year and 56 cases including the department-specific annual audits that were selected by the Peer Review Coordinators for review between July 2018 and June 2019 and more complicated cases often involving multiple departments/specialties. PPEC had no recommendations for the issuance of informational/educational letters. PPEC reviews monthly all providers who have accumulated a minimum of three educational letters or a total of six letters (informational and/or educational) within the last 24 months and monitors individuals involved in Performance Improvement Plans. The PPEC initiated and completed two Performance Improvement Plans involving practitioner adherence to attention to detail and/or resident supervision and evaluation and management of at-risk patients, respectively.
In addition, PPEC continues to make referrals for system improvements as well as recommendations for the development of clinical guidelines, protocols, and policies and procedures as appropriate.
Page 9
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.d.xii. No Handout
Medical Staff Confirmation of Vice Chief of Staff
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.e.i.
Care Reimagined Capital Intentionally Left Blank
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.f.i.
Capital CER #20-408 From: Compliance 360 To: Melanie Talbot Subject: Contract Approval Request: End User Equipment Refresh - Workstations Date: Tuesday, September 10, 2019 4:36:07 AM
Message Information
From Purves, Steve To Talbot, Melanie; Subject Contract Approval Request: End User Equipment Refresh - Workstations Additional Information Indicate whether you approve or reject by clicking the Approve or Reject button.
Add comments as necessary.
Approve/Reject Contract
Click here to approve or reject the Contract.
Attachments
Name DescriptionType Current File 408 Investment Justification Memo - File 408 Investment End User Workstation Replacements Justification Memo - End (002) (002).docx User Workstation Replacements (002) (002).docx End User Equipment Refresh - Contract CER408.xlsx Workstations Contract Information
Division Capital Division Folder --- Status Pending Approval Title End User Equipment Refresh - Workstations Contract Identifier Budgeted MIHS Contract 20-408 Number Primary Responsible Hall, Mr. Charles E. Party Departments IT SERVICE MANAGEMENT Product/Service Description Action/Background Evaluation Process Notes ***Non-Bond Capital Funding Clinical Funded See CER/Quote/Memo
Due to limited warehousing space availability, we will have to order the equipment in phases (just in time). We will have our first quote available within the next week. Other quotes will be submitted throughout the next several months (up to, but not to exceed $490,798.00), as warehousing space opens up and we have room to take the delivery.
Maricopa County Special Health Care District Office of the Chief Information Officer 2601 E. Roosevelt Phoenix, AZ 85008 Phone: (602) 344-8551
DATE: September 4, 2019
TO: cc:
MIHS Board of Directors
Steve Purves, President and CEO Kris Gaw, COO Rich Mutarelli, CFO Melanie Talbot, CGO/Clerk of the Board
FROM: Kelly Summers, Senior Vice President and CIO Diane J. Wynn, Director, IT Service Management
SUBJECT: End User Workstation Replacements
Members of the MIHS Board of Directors,
On June 22, 2016, the Board approved MIHS to utilize the Prop 480 Bond issuance to address the replacement of MIHS aged workstations (PC’s). The proposal approved by the Board was to procure the equipment in three phases, with the replacement of approximately 1/3 of the end user workstations in each phase. MIHS workstations are replaced and prioritized based on greatest impact on productivity (oldest computers were/will be replaced first).
Phase 1 and 2 equipment replacements are deployed and to complete this project, we are now ready to move on to Phase 3 and request the last 1/3 of the oldest inventory of end user workstations. 1. Background / Problem Statement: At the time of the original request, MIHS had a total of 4,324 end user devices (desktop or laptop devices), of which 3,948 were 4 years old or older (91%). Of the 3,948 devices referenced, over 2,000 were 6 years old or older.
According to industry standards (Gartner; Computer World) an optimal replacement schedule for desktops is between 36 – 48 months and 36 months for laptops. However, optimum PC replacement decisions should be based on the Operating System/software needs and on functional performance /compatibility.
Total Cost of Ownership (TCO) increases as older devices require more IT support and they result in employee lost productivity due to slow performance and unavailable devices. In addition, our older devices are vulnerable to numerous virus and malware attacks, due to their inability to be upgraded.
Maintaining older devices adds cost and complexity in the areas of:
• Security – Inability to upgrade legacy devices with the newest security solutions to prevent and respond to sophisticated attacks. • Hardware/Software Compatibility – newer software compatibility issues with older systems, frequent patching and operating system updates. • Repair - reduced availability for spare parts, increased out- of-warranty repair costs. • IT/Employee resources - increased support costs, lost employee productivity.
2. Benefits / Risk Avoidance: Replacing obsolete and failing computers in MIHS would maintain usefulness to staff by providing capable machines required to run today's most complex discipline-specific software. Updated computers will reduce the organization’s risk of business and financial productivity associated with aging devices.
3. Solution Option(s): The following options are available: A. Replace / Upgrade • In order to realize operational efficiencies, MIHS will need to replace aged computer systems. • New computers offer faster speeds with multiple core processors, better graphics, improved energy efficiency, and new connectivity options. B. Do nothing, which will place the organization at risk of the following: • Increased IT security vulnerabilities due to the inability to upgrade operating systems/software to their most current versions • Increased downtime due to lack of parts availability • Increased direct and indirect (productivity) costs due to the age of devices • Increased device failure rates due to the inability of the underlying hardware to cope with increasing software demands
4. Recommendation & Next Steps: Recommend the purchase of “Phase 3,” 648 end user devices. Due to budgetary constraints, this project will not include vendor supplied services (asset tagging, imaging, warehousing and shipping) and these functions will be performed by existing staff.
5. Financial Assumptions: The total project budget for Phase 3 is $490,798.00.
For Phase 1 and 2, we negotiated reduced pricing by leveraging vendor volume discounts with our vendor, HP, Inc. HP, Inc. has validated they will honor the same level of discounted pricing for Phase 3 workstation devices.
Category Effective Date Expiration Date Annual Value $490,798.00 Expense/Revenue Budgeted Travel Type Yes Procurement Number Primary Vendor
Responses
Member Name Status Comments Wynn, Diane J. Approved Melton, Christopher C. Approved Approved Williams, Gail A. Approved Pardo, Sean P. Madhavan, Lalitha Approved Summers, Kelly R. Approved Detzel, Jo-El M. Approved Approved for FY20 Capital. Landas, Lito S. Approved Gaw, Kris D. Approved Mutarelli, Richard D. Approved Purves, Steve A. Approved Talbot, Melanie L. Current
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 1.f.ii.
Capital CER #19-046A Melanie Talbot
From: Compliance 360
Message Information
From Purves, Steve To Talbot, Melanie; Subject Contract Approval Request: PeriGen Fetal Monitoring Additional Indicate whether you approve or reject by clicking the Approve or Reject Information button.
Add comments as necessary.
Approve/Reject Contract
Click here to approve or reject the Contract.
Attachments
Name Description Type Current File PeriGen Fetal Monitoring Contract CER046A.xlsx
Contract Information
Division Capital Division Folder --- Status Pending Approval Title PeriGen Fetal Monitoring Contract Identifier Contingency MIHS Contract 19-046A Number Primary Responsible Hall, Mr. Charles E. Party Departments CLINICAL APPLICATIONS SERVICES Product/Service Description Action/Background Evaluation Process Notes Non-BOND Capital Funded - - -- - PAID FROM CONTINGENCY BUCKET
See CER/Quote/Memo
1. Background / Problem Statement:
1 The GE Centricity application is currently used by MIHS as the electronic fetal monitoring application. The GE Centricity system is a basic fetal monitoring system that is used at MIHS as a surveillance system only. The documentation of fetal strip assessments is not completed within the GE Centricity System. The fetal heart rate tracings are taken from the patient room and used to transcribe the information into the EPIC system. This workflow is cumbersome and has the opportunity for error with data entry and timing of key events. This has been cited as an issue in historic risk events. Obstetrical claims payouts have been costly to the organization.
The GE Centricity application is a license-based application. The fetal strips can only be seen on a limited number of screens due to the limited number of licenses. If additional licenses are needed or a screen needs to be moved, this incurs an additional cost with GE Centricity.
This investment memo was originally submitted and approved by executive management as it was less than $250,000. However, after further investigation and detailed research, it has been determined that additional equipment/cabling/software is required to implement the solution. These additional funds require MIHS Board of Directors’ approval.
2. Benefits / Risk Avoidance:
The benefits realized from such an investment are: a. Improved Efficiency of workflow a. Documentation of fetal heart pattern and labor pattern assessments can be documented within the PeriGen’s PeriWatch application. b. Key labor events that are time sensitive can be documented in real time on the fetal heart strip for accuracy. c. A bi-directional information integration between EPIC and PeriWatch allows for key elements to be documented in either system and appear in both. b. Augmented decision support a. PeriWatch is a NIH-validated system designed to assist with clinical decision making. b. Using PeriWatch Cues the NICHD guidelines analyzes the fetal strip and highlights areas of potential concern. c. PeriWatch Curve provides clinicians with a tool to assess labor progress compared to a reference population. d. PeriWatch HUB dashboard is a configurable notification system that highlights individual patient abnormalities in vital signs, labor progress and/or fetal tracings. c. Scalability and Growth a. PeriWatch is an enterprise-based application. End users can see the fetal strips through a Citrix based log in. b. As additional sites open the opportunity to view fetal strips in the labor and delivery unit provides additional support. c. Additional sites only incur the cost of the DAS wall units. (approx. $200)
3. Solution Option(s): a. Maintain the existing GE Centricity application a. Continue working with a surveillance only system b. Limited visibility of fetal strips. c. No clinical decision support d. Opportunity for human error and risk exposure with current workflow b. Purchase PeriGen’s PeriWatch Solution 2 a. Install PeriGen Application Licenses b. Configure and build: i. PeriWatch Server and Storage Infrastructure ii. Admit, Discharge and Transfer interface (ADT) iii. Epic ClinDoc interface iv. Replacement of current GE Centricity PC’s
4. Recommendation & Next Steps: MIHS is recommending that PeriGen’s PeriWatch application, licenses and associated hardware and interfaces be purchased and implemented to replace the GE Centricity application. This will allow for more visibility of fetal strips, a seamless workflow with reduction in data entry and timing errors, and a safer patient experience with augmented clinical decision-making support.
PeriGen will partner with MIHS to build and integrate with ADT and EPIC. The system will allow analysts, engineers, clinicians and trainers to develop and test new functionality prior to introducing those desired changes into a production environment. PeriWatch requires no additional license fees to add workstations. All software version updates are included in the annual maintenance agreement. OB/GYN, Labor and Delivery DMG providers have reviewed the PeriWatch application and have given their acceptance and approval for its use.
ADDENDUM: Additional badge swipers are needed for each of the workstations in the patient rooms to enable quick staff access to the machines. The original QS machines did not require these items as the machines were not used for medical annotations and recording. The additional PCs are required after performing a full inventory and determining all locations. A mobile cart (with PC and UPS) will be implemented which can be used throughout the hospital. Lastly, it was anticipated that the existing cabling could be used. However, two OR’s and two patient rooms will require new cabling to meet the needs of the PeriWatch system.
5. Financial Assumptions: The cost of Software Licenses, Interfaces and Installation is as follows:
Original Capital Request a. PeriWatch Hardware (wallplates, DAS units, cables) $ 42,712.00 b. PeriWatch Implementation, Training and Fees $ 57,500.00 c. Incoming ClinDoc Flowsheet Interface $ 1,550.00 d. Replacement of current GE FM PCs $ 22,500.00 e. Infrastructure Hardware & Licensing $ 122,271.00 Total Capital $ 246,533.00
Additional expenditure: f. Badge Swipe readers $ 4,276.67 g. Additional PCs $ 5,664.00 h. Uninterruptible Power Supply (UPS) for mobile cart $ 148.30 i. Outgoing Flowsheet Interface $ 1,550.00 j. Cabling (not to exceed) $ 15,390.56 Additional Capital $ 27,029.76
Total Capital for PeriWatch $ 273,582.76
Operating 3
a. PeriGen Annual Support, Licensing and Maintenance $ 75,000.00
Total Operating $ 75,000.00
Category Effective Date Expiration Date Annual Value $273,562.83 Expense/Revenue Budgeted Travel Type No Procurement Number Primary Vendor
Responses
Member Name Status Comments Spacht, Venita L. Approved Melton, Christopher C. Approved Approved Williams, Gail A. Approved Pardo, Sean P. Approved Madhavan, Lalitha Approved Stotler, Sherry A. Approved Detzel, Jo-El M. Approved Approved to utilize FY20 Routine Capital and Contingency. Approved in EOC on 09/17/19. Landas, Lito S. Approved Gaw, Kris D. Approved Mutarelli, Richard D. Approved Purves, Steve A. Approved Talbot, Melanie L. Current Summers, Kelly R.
4
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 2.
Quality DNV-GL Quality Management System 7 DNV_GL: Quality Management (QM) 7: Measurement, Monitoring and Analysis Crystal Garcia, VP of Perioperative and Clinical Services, Quality and Patient Safety September 25, 2019 QM 7 Measurement, Monitoring, Analysis Review • Threats to Patient Safety: • Patient Safety Committee meets every other month.
m te n ) ) ) ) ra a io 9 9 9 9 e g D t 1 1 1 1 t o rk c 0 0 0 0 a a o e 2 2 2 2 D Pr t ir o g m ar D FY FY FY FY a t n ch e ( ( ( ( e r ti n Y ed 1 2 3 4 Y Patient Safety r e ir r r r r o B 18 s t t t t 19 p Y e Q Q Q Q Y Re F D F Patient Safety Metrics MMC Inpatient Falls with injury per 1,000 patient days; (excludes: psych, ED, HIIN < 0.40 0.30 0.60 0.72 0.60 0.17 0.52 L&D, post‐partum, pediatrics) Numerator 787 224 Denominator 11594 11095 11727 11819 46235
Healthcare Associated Pressure Ulcers Stage 2+ (prevalence study) HIIN < 0.13% 0.30% 0.00% 0.00% 0.89% 0.77% 0.41%
Numerator 003 3 6 • DenominatorPatient Safety Improvement/risk mitigation efforts during FY201361 377 336 389 1463 9 focused on falls, hospital‐acquired pressure ulcers, prolonged restraints, 2‐patient identifiers, bar code scanning and Culture of Safety. Environmental Ligature Risk Assessment for inpatient and behavioral health area was conducted to ensure we have a safe environment. • Medication Therapy/Medication Use: No trends were identified. The following was reported during FY19 to the Patient Safety Committee: Adverse Events excessive anticoagulation, hypoglycemia events and time‐critical medication compliance. • Culture of Safety was conducted in April 2019 with an increase of participation from 2018. Results have been presented to leadership.
2 QM 7 Measurement, Monitoring, Analysis Review • Operative and Invasive Procedures: wrong site/procedure/patient surgery • No cases of wrong site/procedure/patient surgery during FY2019. • Anesthesia/ Moderate Sedation Adverse Events • A sedation workgroup was formed to evaluate the requirements for sedation monitoring, ensure that the requirements are captured, and data can be extracted for review. A process for post procedural sedation review was implemented. Sedation policy was updated. Anesthesia adverse events for reintubation in PACU and respiratory failure within 48 hours are monitored. No identified trends were determined in FY19 for sedation and anesthesia.
) te m te n ) ) 9 a ra a io 9 9 D g k D t 1 1 1 Operative & Procedural o r c 0 0 0 to r a to re 2 2 2 r P m r i Y Y Y a g ch a D (F (F (F e in n e d Y rt e Y re 1 2 3 9 o B 8 si tr tr tr 1 Services p 1 e Y e Y Q Q Q F R F D Quality /Regulatory Metrics Anesthesia / Moderate Sedation Events
01001 Total Anesthesia Adverse Events DNV
00000 Reintubation in PACU DNV
01001 Respiratory Failure within 48 hours DNV
3 QM 7 Measurement, Monitoring, Analysis Review
• Blood and Blood components‐adverse events/usage and Discrepant Pathology Reports: • Reviewed at Tissue and Transfusion Committee and Critical Care • Continue to monitor blood product wastage
m te n ) ) ) ) te ra a io 9 9 9 9 a g rk D ct 1 1 1 1 D o a o e 0 0 0 0 o r t ir 2 2 2 2 t P m r D Y Y Y Y r g ch a (F (F (F (F a Clinical Care in n e d Ye rt e Y re 1 2 3 4 o B 8 i tr tr tr tr 9 1 es 1 ep Y Q Q Q Q Y R F D F Quality /Regulatory Metrics Tissue & Transfusion
Total blood product waste DNV ‐ NIAHO < 2% 1.6% 0.82% 0.73% 0.67% 0.53% 0.67% Numerator 13 16 12 13 54 Denominator 1593 2198 1796 2470 8057
• Restraint Use/ Seclusion: • No identified trends or patterns of excessive use for FY19.
4 QM 7 Measurement, Monitoring, Analysis Review
• Effectiveness of Pain Management System: • Pain Assessment was monitored in FY19 and met benchmark at 92%.
e m te ) ) t a a on ) ) 9 9 a r k ti 9 9 1 1 D Professional Nursing r D c 01 8 01 0 9 0 rog a o e 2 2 2 1 2 to P t ir 01 Y 0 Y r r D Y 2 Y F 2 F a g chm a (F t (F ( r ( e in n e d c p 4 Y rt e Y re 1 O 2 3A r 9 o B 8 i tr tr tr t Council p 1 es Q Y1 e Y Q Q Q F R F D PNC ‐ PATIENT SAFETY
Pain reassessment > 90% 90% 91% 91% 92% 93% 92% DNV Numerator 56349 55869 53992 54096 220306 Denominator 61826 61121 58687 58153 239787
5 QM 7 Measurement, Monitoring, Analysis Review
• Infection prevention and control system: • Monitoring is done by the Infection Control Committee. Quarterly meeting reports are generated and trends monitored. • Utilization Management System: • Monitoring completed by Utilization Review Committee • In FY2019, care management met the benchmark in all cause unplanned 30‐day readmission rate.
m te n ) ) a a io 9 9 e gr k D t 1 1 ) ) t o r c 0 0 9 9 a r a to re 2 2 2 1 1 D P m r i 0 0 o g h a D FY FY FY 2 t in c e d ( ( ( FY r Clinical Care t n Y e 1 2 3 ( a r e 8 ir r r r e o B 1 s t t t 4 Y p Y e Q Q Q tr 9 e F D Q 1 R FY Quality /Regulatory Metrics Care Management
READM‐30‐HF: Heart Failure 30‐day readmission rate (CDB1531) CMS‐HIQR‐HRR < 21.7 11.2 14.0 14.5 14.8 11.1 13.6
READM‐30‐PN: Pneumonia 30‐day readmission rate (CDB1532) CMS‐HIQR‐HRR < 16.7 8.9 8.9 9.2 3.7 3.6 5.5
READM‐30‐THA/TKA: Total hip/knee 30‐day readmission rate (CDB1533) CMS‐HIQR‐HRR < 4.2 3.6 0.0 0.0 9.1 0.0 3.8 READM‐30‐COPD: Chronic Obstructive Pulmonary Disease 30‐day readmission rate (CDB1534) CMS‐HIQR‐HRR < 19.6 7.9 20.0 12.5 11.8 20.0 15.5 READM‐30‐AMI: Acute Myocardial Infarction 30‐day readmission rate (CDB1530) CMS‐HIQR‐HRR < 16.0 0.0 6.3 0.0 5.9 0.0 3.1 READM‐HWR: Hospital‐wide all cause unplanned 30‐day readmissions rate (CDB1540) CMS‐HIQR < 15.3 8.0 9.2 10.0 7.6 7.6 8.6
6 QM 7 Measurement, Monitoring, Analysis Review • Patient Flow Issues: • Monitoring completed by the Clinical Care Committee and ED Throughput Workgroup. ED throughput times and projects are reviewed. • Customer Satisfaction, both clinical and support areas: • Patient Experience surveys are monitored on a continuous basis • Weekly Leadership rounding and debriefing in MMC and CHC • Patient and Family Advisory Council met through out FY19. Council meets on a bi‐monthly basis. FY19 projects discussed were education of patients that MIHS is a teaching hospital and the patient experience calls.
7 QM 7 Measurement, Monitoring, Analysis Review • Discrepant Pathology Reports: • Monitoring completed by the Tissue and Transfusion Committee and Clinical Care Committee. There were 0 discrepant code III pathology reports during FY2019.
8 QM 7 Measurement, Monitoring, Analysis Review • Unanticipated Deaths • Reviewed as part of the Case Event Evaluation Team (CEET) • All deaths are reviewed through the peer review process. • There has not been any identified trends for FY2019. • Adverse events/near misses: Adverse events are reviewed by the Case Event Evaluation Team. • FMEA o September 2018 Inpatient Ligature Risk Assessment o May 2019 – MRI Safety
9 QM 7 Measurement, Monitoring, Analysis Review • Critical and/or Pertinent Processes, both clinical and supportive • A structured internal audit and review of the Quality Management System is an ongoing process. • Medical Record Delinquency • This measure was reported through Business Operations at Patient Care and Safety Committee. There were no identified trends. Chart delinquency rate is 0% for FY2019.
10 QM 7 Measurement, Monitoring, Analysis Review • Physical Environment Management System • The Environment of Care committee reviews OSHA VPP readiness, new regulations and determines readiness or opportunities for compliance, Equipment Management, Emergency Management, Fire/ Life Safety, Environment of Care Rounds, Employee Injuries ‐ Employee Health, Security Management, Utilities, and Safety Hazmat. • No identified trends for FY19.
11
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 3.
Home Assist Health
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 4.
Financials and Statistical Information August 2019 Maricopa Integrated Health System Financial and Statistical Information August 31, 2019 Financial Highlights – August 2019
Patient Activity Total admissions in August were 1.0% below budget, and 12.2% higher than the same period last year. Year to date total admissions were 0.7% below budget and 12.3% higher than YTD August 2018. Inpatient acute admissions for the month were 1.2% over budget and 9.2% higher than last August 2018. Behavioral health admissions were 6.6% below budget for the month and 21.2% higher than last August 2018. Emergency department visits were 3.9% over budget and 34.8% higher than last August 2018. Year to date visits were 4.3% over budget and 35.6% higher than YTD August 2018. Ambulatory visits were 1.5% over budget for the month and 1.3% over budget year to date.
Operating Revenue Net patient service revenues were 2.9% over budget for the month due to a number of high acuity patients and is 11.8% greater than last August 2018. Other operating revenue were 2.9% below budget for the month, mainly in miscellaneous revenues. Year to date total operating revenues were 6.2% over budget due to patient activity.
Operating Expense Total operating expenses were 8.4% over budget for August. Labor expense were 5.9% over budget and includes salaries, benefits and contract labor. The majority of negative variances in contract labor are in nursing (Acute & ED), IT, HIM, PAC, physical therapy and occupational therapy departments. Net medical service fees exceeded budget by 18.0%. Supplies were 25.2% over budget primarily in pharmaceuticals, human skin and various medical supplies related to high acuity patients. Lastly, all other expenses were 0.4% over budget for August, primarily in purchased services and medical equipment rental.
Non – Operating Revenue (Expense) – In total, net non-operating revenues and expenses were almost right on budget for the month of August.
Cash and Cash equivalents (including investments) August 2019 June 2019
Operating / General Fund $179.7M $218.5M Bond related – Restricted 393.0M 459.0M Total cash and cash equivalents (including investments) $572.7M $677.5M
Page 1 of 31 2018 FY2020 Moody’s YTD “A3” Select Ratios as of August 31 Medians
Liquidity Days cash on hand (unrestricted) 103.5 183.5 Days in Accounts Receivable 95.7 47.0 Current Ratio (excludes Bond funds) 3.6 1.8
FY2020 YTD Actual YTD Budget
Profitability Operating Margin (%) (11.6) (9.6) Excess Margin - normalize (%) 0.8 3.8
Productivity FTE/AOB w/o Residents 4.8 4.5
If you have any questions, please do not hesitate to contact Melanie Talbot or Rich Mutarelli (CFO).
Page 2 of 31 FY 2019 - FY 2020 Admissions
1,600
1,400
395 423 348 400 1,200 342 392
1,000
800
600 1,095 1,048 1,079 1,066 961 909 400
200
0 Actual Budget Actual Budget Actual Budget June 2019 July 2019 August 2019 Acute Behavioral Health
Page 3 of 31 FY 2019 - FY 2020 Emergency Department Visits
9,000
254 273 8,000 259 262 310 227 242 1,323 308 278 325 7,000 306 313 1,420 1,123 1,426 1,237 1,054 6,000
2,808 5,000 1,927 2,043 1,694 1,755 1,798
4,000
3,000
2,000 4,088 3,762 3,841 4,020 3,991 3,989
1,000
0 Actual Budget Actual Budget Actual Budget June 2019 July 2019 August 2019 Adult ED Maryvale ED Peds ED L&D ED Burn ED
Page 4 of 31 FY 2019 - FY 2020 Ambulatory Visits
40,000
35,000 3,622 2,442 3,526 2,471 2,337 2,073 2,203 30,000 2,487 2,407 2,091 2,036 2,156
25,000 13,651 13,839 13,017 13,464 11,776 20,000 12,572
15,000
10,000 16,446 16,658 17,054 17,382 15,295 14,168 5,000
0 Actual Budget Actual Budget Actual Budget June 2019 July 2019 August 2019 FHC CHC Dental OP Behavioral Health
Page 5 of 31 Fiscal Year 2020 Year-to-Date Volume Summary
Admissions Emergency Department Visits 3,500 18,000 16,000 521 3,000 618 505 14,000 638 2,500 743 823 2,543 2,480 12,000 Burn ED 2,000 10,000 3,970 3,449 L&D ED 1,500 BH 8,000 6,000 Peds ED 1,000 2,174 2,114 Acute 4,000 8,079 8,009 MVH ED 500 2,000 Adult ED 0 0 Actual Budget Actual Budget Fiscal YTD Fiscal YTD
Ambulatory Visits 80,000
70,000 7,148 4,913 4,410 60,000 4,294 50,000 26,668 27,303 OP Behav Health 40,000 Dental 30,000 CHC 20,000 33,500 34,040 10,000 FHC 0 Actual Budget Fiscal YTD
Page 6 of 31 Fiscal Year 2020 Patient Revenue Source by Gross Revenue
Actual Budget
17.7% 17.1%
Medicare Medicare
43.9% Other Govt. 44.8% Other Govt. 12.6% 12.4% Commercial Commercial Uninsured & Other Uninsured & Other AHCCCS/Medicaid AHCCCS/Medicaid 13.8% 13.1%
12.2% 12.4%
Prior Year Actual
16.4% Medicare Other Govt. 44.6% 12.5% Commercial Uninsured & Other Actual Gross Revenue is 14.1% AHCCCS/Medicaid YTD as of August 31, 2019
12.4% Prior Year Gross Revenue is all of fiscal year 2019
Page 7 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT Maricopa Integrated Health System (COMBINED CARE SYSTEM) Unusual Item Report For the month ending August 31, 2019
MTD Actual
Increase (decrease) in net assets as reported $ (1,917,696)
Unusual items:
$ - -
-
Normalized increase (decrease) in net assets $ (1,917,696)
Page 8 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) STATEMENT OF REVENUES AND EXPENSES For the Period Ending August 31, 2019
Prior Year Prior Year Prior Year AUG 2019 AUG 2019 AUG 2019 AUG 2019 Same Month Same Month Same Month Actual Budget Variance % Change AUG 2018 Variance % Change Net Patient Service Revenue $ 42,607,960 $ 41,398,039 $ 1,209,921 2.9 % $ 38,112,558 $ 4,495,402 11.8 %
Other Revenue 6,659,850 6,860,802 (200,952) (2.9 %) 6,583,308 76,542 1.2 % Total Operating Revenue 49,267,810 48,258,841 1,008,969 2.1 % 44,695,866 4,571,944 10.2 %
OPERATING EXPENSES Salaries and Wages 22,173,861 21,817,044 (356,817) (1.6 %) 19,512,699 (2,661,161) (13.6 %) Contract Labor 2,188,315 1,449,591 (738,724) (51.0 %) 1,614,027 (574,288) (35.6 %) Employee Benefits 6,844,739 6,359,194 (485,546) (7.6 %) 5,992,220 (852,519) (14.2 %) Medical Service Fees 7,380,157 6,253,783 (1,126,374) (18.0 %) 6,588,368 (791,789) (12.0 %) Supplies 8,682,594 6,937,210 (1,745,384) (25.2 %) 6,649,751 (2,032,843) (30.6 %) Purchased Services 2,567,071 2,327,053 (240,018) (10.3 %) 2,011,642 (555,429) (27.6 %) Repair and Maintenance 1,276,023 1,517,391 241,368 15.9 % 1,645,792 369,769 22.5 % Utilities 826,732 782,683 (44,048) (5.6 %) 789,854 (36,878) (4.7 %) Rent 538,334 449,163 (89,172) (19.9 %) 289,001 (249,333) (86.3 %) Other Expenses 1,591,892 1,654,041 62,149 3.8 % 1,143,243 (448,649) (39.2 %) Provider Assessment 652,033 652,033 (0) (0.0 %) 563,461 (88,573) (15.7 %) Depreciation 2,724,317 2,799,115 74,798 2.7 % 2,095,876 (628,441) (30.0 %) Total Operating Expense 57,446,069 52,998,300 (4,447,769) (8.4 %) 48,895,935 (8,550,134) (17.5 %)
Operating Income (Loss) (8,178,258) (4,739,459) (3,438,800) (72.6 %) (4,200,069) (3,978,190) (94.7 %)
NONOPERATING REVENUES (EXPENSES) NonCapital Grants 853,186 1,066,167 (212,980) (20.0 %) 994,575 (141,388) (14.2 %) NonCapital Transfers from County/State 295,658 295,658 0 0.0 % 295,658 0 0.0 % Investment Income 901,143 732,156 168,988 23.1 % 280,949 620,195 220.8 % Other NonOperating Revenues (Expenses) (1,869,155) (1,903,956) 34,801 1.8 % (1,317,182) (551,974) (41.9 %) Interest Expense (1,585,467) (1,580,291) (5,176) (0.3 %) (104,846) (1,480,621) (1412.2 %) Tax Levy 11,941,918 11,941,918 (0) (0.0 %) 9,922,909 2,019,009 20.3 % Total NonOperating Revenues (Expenses) 10,537,284 10,551,651 (14,367) (0.1 %) 10,072,063 465,221 4.6 %
Excess of Revenues over Expenses $ 2,359,025 $ 5,812,192 $ (3,453,167) (59.4 %) $ 5,871,994 $ (3,512,969) (59.8 %)
Bond-Related Revenues and Expenses (4,276,721) (4,131,862) (144,859) (3.5 %) (3,401,293) (875,429) (25.7 %)
Increase in Net Assets (normalized) $ (1,917,696) $ 1,680,330 $ (3,598,026) (214.1 %) $ 2,470,701 $ (4,388,398) (177.6 %)
Page 9 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) STATEMENT OF REVENUES AND EXPENSES For the Two Periods Ending August 31, 2019
YTD YTD YTD YTD AUG 2019 AUG 2019 AUG 2019 AUG 2019 Prior Year Prior Year Prior Year YTD Actual YTD Budget YTD Variance % Change AUG 2018 Variance % Change Net Patient Service Revenue $ 87,500,369 $ 81,706,658 $ 5,793,711 7.1 % $ 73,633,165 $ 13,867,203 18.8 %
Other Revenue 13,814,463 13,704,551 109,912 0.8 % 12,316,753 1,497,709 12.2 % Total Operating Revenue 101,314,831 95,411,209 5,903,623 6.2 % 85,949,919 15,364,913 17.9 %
OPERATING EXPENSES Salaries and Wages 44,528,316 42,864,186 (1,664,131) (3.9 %) 39,279,335 (5,248,981) (13.4 %) Contract Labor 4,390,301 2,895,170 (1,495,132) (51.6 %) 3,199,058 (1,191,244) (37.2 %) Employee Benefits 12,888,361 12,493,923 (394,438) (3.2 %) 11,009,517 (1,878,844) (17.1 %) Medical Service Fees 14,280,642 12,467,910 (1,812,733) (14.5 %) 12,807,877 (1,472,766) (11.5 %) Supplies 17,360,045 13,570,177 (3,789,868) (27.9 %) 12,473,017 (4,887,028) (39.2 %) Purchased Services 4,306,374 4,648,244 341,870 7.4 % 3,363,229 (943,145) (28.0 %) Repair and Maintenance 3,054,566 3,028,212 (26,354) (0.9 %) 3,180,130 125,565 3.9 % Utilities 1,495,196 1,574,835 79,638 5.1 % 1,693,855 198,659 11.7 % Rent 1,059,356 909,124 (150,232) (16.5 %) 753,433 (305,923) (40.6 %) Other Expenses 2,961,585 3,286,240 324,655 9.9 % 2,462,466 (499,119) (20.3 %) Provider Assessment 1,304,067 1,304,067 (0) (0.0 %) 1,126,922 (177,145) (15.7 %) Depreciation 5,438,906 5,546,302 107,397 1.9 % 4,228,458 (1,210,448) (28.6 %) Total Operating Expense 113,067,716 104,588,389 (8,479,327) (8.1 %) 95,577,297 (17,490,418) (18.3 %)
Operating Income (Loss) (11,752,884) (9,177,180) (2,575,704) (28.1 %) (9,627,379) (2,125,506) (22.1 %)
NONOPERATING REVENUES (EXPENSES) NonCapital Grants 1,714,608 2,154,696 (440,088) (20.4 %) 1,672,632 41,976 2.5 % NonCapital Transfers from County/State 591,316 591,316 0 0.0 % 591,316 0 0.0 % Investment Income 1,822,814 1,464,311 358,503 24.5 % 480,039 1,342,775 279.7 % Other NonOperating Revenues (Expenses) (3,711,663) (3,825,612) 113,949 3.0 % (2,491,534) (1,220,129) (49.0 %) Interest Expense (3,158,019) (3,160,582) 2,564 0.1 % (239,772) (2,918,247) (1217.1 %) Tax Levy 23,883,837 23,883,837 (0) (0.0 %) 19,845,818 4,038,018 20.3 % Total NonOperating Revenues (Expenses) 21,142,894 21,107,965 34,929 0.2 % 19,858,500 1,284,394 6.5 %
Excess of Revenues over Expenses $ 9,390,009 $ 11,930,785 $ (2,540,776) (21.3 %) $ 10,231,121 $ (841,112) (8.2 %)
Bond-Related Revenues and Expenses (8,548,479) (8,263,724) (284,755) (3.4 %) (6,802,586) (1,745,893) (25.7 %)
Increase in Net Assets (normalized) $ 841,530 $ 3,667,061 $ (2,825,531) (77.1 %) $ 3,428,536 $ (2,587,005) (75.5 %)
Page 10 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) STATEMENT OF NET POSITION August 31, 2019
08/31/2019 06/30/2019 ASSETS Current Assets Cash and Cash Equivalents Cash - Care System $ 24,451,607 $ 63,297,303 Short-Term Investment - Care System 105,443,008 105,443,008 Cash and Short-Term Investment 129,894,615 168,740,311
Cash - Bond 105,515,137 171,579,684 Short-Term Investment - Bond 287,467,114 287,467,114 Cash and Short-Term Investment - Bond 392,982,251 459,046,798
Total Cash and Cash Equivalents 522,876,866 627,787,109 Patient A/R, Net of Allowances 130,418,789 112,725,731 Other Receivables and Prepaid Items 37,724,309 35,939,021 Estimated Amounts Due from Third-Party Payors 46,153,640 39,407,781 Due from Related Parties 19,594,624 1,680,183 Total Current Assets 756,768,228 817,539,825
Capital Assets, Net 364,234,166 359,761,082
Other Assets Long-Term Investment 49,793,027 49,793,027 Investment in MCA 9,800,000 9,800,000 Total Other Assets 59,593,027 59,593,027
Total Assets 1,180,595,421 1,236,893,934
Deferred Outflows 38,134,646 38,134,646
Total Assets and Deferred Outflows $ 1,218,730,067 $ 1,275,028,580
Page 11 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) STATEMENT OF NET POSITION August 31, 2019
08/31/2019 06/30/2019 LIABILITIES AND NET POSITION Current Liabilities Current Maturities of Long-Term Debt $ 33,266,776 $ 38,484,571 Accounts Payable 34,458,814 44,455,450 Accrued Payroll and Expenses 23,975,345 25,452,394 Medical Claims Payable 18,667,428 18,520,035 Due to Related Parties 0 4,661,701 Other Current Liabilities 25,613,662 26,039,771 Total Current Liabilities 135,982,025 157,613,923
Long-Term Debt Bonds Payable 457,938,359 501,994,983 Other Long-Term Debt 1,300,267 1,300,267 Total Long-Term Debt 459,238,626 503,295,249
Long-Term Liabilities 304,258,185 304,258,185
Total Liabilities 899,478,836 965,167,357
Deferred Inflows 40,084,002 40,084,002
Net Position Invested in Capital Assets, Net of Related Debt 329,667,123 319,976,244 Temporarily Restricted 7,269,802 7,926,997 Unrestricted (57,769,695) (58,126,020) Total Net Position 279,167,230 269,777,220
Total Liabilities, Deferred Inflows, and Net Position $ 1,218,730,067 $ 1,275,028,580
Page 12 of 31 SUPPLEMENTAL INFORMATION
Page 13 of 31 Maricopa Integrated Health System Financial and Statistical Information August 31, 2019
Current Month Fiscal Year to Date Prior Fiscal Year to Date Actual Budget Variance Var % Actual Budget Variance Var % Actual Variance Var %
Acute Admissions 1,079 1,066 13 1.2% 2,174 2,114 60 2.8% 1,945 229 11.8% Length of Stay (LOS) 5.1 4.7 (0.4) (8.9%) 5.1 4.6 (0.6) (12.2%) 4.6 (0.5) (11.1%) Patient Days 5,465 4,959 506 10.2% 11,097 9,620 1,477 15.4% 8,933 2,164 24.2%
Acute - Observation Days and Admits Observation Days 555 397 158 39.8% 1,043 770 273 35.5% 663 380 57.4%
Observation Admission - Transfer to Inpatient 184 164 20 12.2% 375 317 58 18.3% 268 107 39.9% Observation Admission Only 426 339 87 25.7% 814 655 159 24.3% 563 251 44.6% Total Admissions - Acute plus Observation Only 1,505 1,405 100 7.1% 2,988 2,769 219 7.9% 2,508 480 19.1%
Behavioral Health Admissions 395 423 (28) (6.6%) 743 823 (80) (9.7%) 652 91 14.0% Length of Stay (LOS) 20.8 20.8 (0.0) (0.1%) 22.0 20.9 (1.2) (5.8%) 20.8 (1.3) (6.2%) Patient Days 8,231 8,802 (571) (6.5%) 16,383 17,160 (777) (4.5%) 13,540 2,843 21.0% Annex 3,274 2,611 663 25.4% 6,541 5,200 1,341 25.8% 6,644 (103) (1.6%) Desert Vista 3,484 3,485 (1) (0.0%) 6,892 6,896 (4) (0.1%) 6,896 (4) (0.1%) Maryvale 1,473 2,706 (1,233) (45.6%) 2,950 5,064 (2,114) (41.7%) 0 2,950 100.0%
Combined MIHS (Acute + Behavioral Health) Adjusted Admissions 2,769 2,819 (49) (1.7%) 5,289 5,627 (337) (6.0%) 4,996 294 5.9% Adjusted Patient Days 25,733 26,049 (316) (1.2%) 49,830 51,305 (1,475) (2.9%) 43,230 6,600 15.3%
Case Mix Index Total Hospital 1.55 1.44 0.11 7.3% 1.53 1.44 0.09 6.2% 1.51 0.02 1.3% Acute (Excluding Newborns) 1.77 1.67 0.10 5.7% 1.74 1.67 0.07 4.3% 1.75 (0.01) (0.5%) Behavioral Health 1.16 1.14 0.02 1.7% 1.15 1.14 0.01 1.3% 1.12 0.03 3.1% Medicare 2.25 1.96 0.29 14.8% 2.22 1.96 0.26 13.4% 2.17 0.05 2.4% AHCCCS 1.87 1.72 0.15 8.5% 1.79 1.72 0.07 3.9% 1.84 (0.05) (2.9%)
Ambulatory Family Health Centers (FHC) Visits - Including WHHs 17,054 17,382 (328) (1.9%) 33,500 34,040 (540) (1.6%) 32,518 982 3.0% Comprehensive Health Center (CHC) Visits 13,651 13,839 (188) (1.4%) 26,668 27,303 (635) (2.3%) 27,009 (341) (1.3%) Dental Clinics Visits 2,203 2,337 (134) (5.7%) 4,294 4,410 (116) (2.6%) 4,582 (288) (6.3%) 7th Ave Walk-In Clinic Visits 0 0 0 0.0% 0 0 0 0.0% 2,635 (2,635) (100.0%) OP Behavioral Health Visits 3,622 2,442 1,180 48.3% 7,148 4,913 2,235 45.5% 3,628 3,520 97.0%
Total Ambulatory Visits : 36,530 36,000 530 1.5% 71,610 70,666 944 1.3% 70,372 1,238 1.8%
Page 14 of 31 Maricopa Integrated Health System Financial and Statistical Information August 31, 2019
Current Month Fiscal Year to Date Prior Fiscal Year to Date Actual Budget Variance Var % Actual Budget Variance Var % Actual Variance Var %
Hospital Surgical Center (SURG) - Total IP & OP Surgeries 730 712 18 2.5% 1,460 1,359 101 7.4% 1,251 209 16.7% Surgical Center (SURG) - Total Surgical Minutes 80,610 81,149 (539) (0.7%) 169,125 153,688 15,437 10.0% 146,445 22,680 15.5% Surgical Center (SURG) - Minutes per Case 110 114 3.5 3.1% 116 113 (2.8) (2.4%) 117 1.2 1.0% Operating Room Utilization na 70% na na na na 70% na na na 65% na na na
Deliveries 180 175 5 2.9% 351 353 (2) (0.6%) 349 2 0.6%
Trauma Visits (subset of ED Visits) 156 141 15 10.6% 342 299 43 14.4% 299 43 14.4%
Emergency Department (ED) 8,023 7,722 301 3.9% 15,731 15,081 650 4.3% 11,602 4,129 35.6% Adult ED 3,991 3,989 2 0.1% 8,079 8,009 70 0.9% 7,975 104 1.3% Maryvale ED 2,043 1,755 288 16.4% 3,970 3,449 521 15.1% 0 3,970 100.0% Peds ED 1,420 1,426 (6) (0.4%) 2,543 2,480 63 2.5% 2,484 59 2.4% L&D ED 310 325 (15) (4.6%) 618 638 (20) (3.1%) 638 (20) (3.1%) Burn ED 259 227 32 14.1% 521 505 16 3.2% 505 16 3.2%
% of Total ED Visits Resulting in Admission Adult 14.2% 14.5% (0.4%) (2.5%) 15.0% 14.5% 0.4% 3.0% 14.6% 0.4% 2.5% % of Total ED Visits Resulting in Admission Peds 4.4% 4.0% 0.4% 11.0% 4.0% 4.0% (0.0%) (0.5%) 4.0% (0.0%) (0.3%) % of Total ED Visits Resulting in Admission Maryvale 5.2% 5.0% 0.2% 4.7% 5.3% 5.0% 0.4% 7.2% 0.0% 5.3% 100.0% % of Acute Patients Admitted Through the ED 83.0% 83.8% (0.7%) (0.9%) 85.0% 84.1% 0.9% 1.1% 82.1% 2.9% 3.5%
Left Without Treatment (LWOT) ADULT 1.3% <3% 1.7% 55.3% 1.7% <3% 1.3% 44.3% 1.4% (0.3%) (20.1%) Left Without Treatment (LWOT) PEDIATRICS 0.1% <3% 2.9% 97.7% 0.1% <3% 2.9% 96.0% 0.2% 0.0% 25.0% Left Without Treatment (LWOT) MARYVALE 1.1% <3% 1.9% 64.1% 0.7% <3% 2.3% 77.3% 0.0% (0.7%) (100.0%)
Overall ED Median Length of Stay (minutes) ADULT 232 <240 8 3.3% 236 <240 4 1.7% 217 (19) (8.8%) Overall ED Median Length of Stay (minutes) PEDS 131 <220 89 40.5% 127 <220 93 42.3% 124 (3) (2.4%) Overall ED Median Length of Stay (minutes) MARYVALE 173 <220 47 21.4% 172 <220 48 21.8% 0 (172) (100.0%)
PSYCH ED Median LOS (minutes) ADULT 545 <0 (545) (100.0%) 511 <0 (511) (100.0%) 536 25 4.7% PSYCH ED Median LOS (minutes) PEDS 3,546 <0 (3,546) (100.0%) 1,511 <0 (1,511) (100.0%) 650 (862) (132.6%) PSYCH ED Median LOS (minutes) MARYVALE 638 <0 (638) (100.0%) 634 <0 (634) (100.0%) 0 (634) 100.0%
Median Time to Treatment (MTT) (minutes) ADULT 20 <30 10 33.3% 20 <30 10 33.3% 20 0 0.0% Median Time to Treatment (MTT) (minutes) PEDS 22 <30 8 26.7% 19 <30 11 36.7% 19 0 0.0% Median Time to Treatment (MTT) (minutes) MARYVALE 16 <30 14 46.7% 14 <30 16 53.3% 0 (14) (100.0%)
Cath Lab Utilization - Room 1 15% 45% (30.0%) (66.7%) 18% 45% (27.3%) (60.7%) 24% (6.8%) (27.8%) Cath Lab Utilization - Room 2 23% 45% (22.1%) (49.0%) 34% 45% (11.1%) (24.6%) 24% 9.9% 41.5% Cath Lab Utilization - IR 73% 65% 8.4% 12.9% 78% 65% 13.1% 20.2% 53% 25.5% 48.4% CCTA/Calcium Score 11 15 (4) (26.7%) 20 30 (10) (33.3%) 10 10 100.0%
Pediatric ED Visits at Maryvale (under age 18) 340 615 Adult ED Visits at Maryvale (age 18 and over) 1,703 3,355 Maryvale ED to Inpatient OR 20 36
Page 15 of 31 Maricopa Integrated Health System Financial and Statistical Information August 31, 2019 Current Month Fiscal Year to Date Prior Fiscal Year to Date Actual Budget Variance Var % Actual Budget Variance Var % Actual Variance Var %
Operating Income / (Loss) in 000s Maricopa Integrated Heath System $ (8,178) $ (4,739) $ (3,439) (72.6%) $ (11,753) $ (9,177) $ (2,576) (28.1%) $ (9,627) $ (2,126) (22.1%)
Net Income / (Loss) in 000s Maricopa Integrated Heath System $ 2,359 $ 5,812 $ (3,453) (59.4%) $ 9,390 $ 11,931 $ (2,541) (21.3%) $ 10,231 $ (841) (8.2%)
Net Income / (Loss) in 000s Normalized Maricopa Integrated Heath System $ (1,918) $ 1,680 $ (3,598) (214.1%) $ 842 $ 3,667 $ (2,826) (77.1%) $ 3,429 $ (2,587) (75.5%)
RATIOS: Liquidity Total Cash and Investments (000s) $ 179.7 $ 232.9 $ (53.2) (22.8%) $ 218.5 $ (38.8) (17.8%)
Total Days Cash on Hand 103.5 183.5 (80.0) (43.6%) 140.6 (37.1) (26.4%)
Current Ratio 5.6 5.2 0.4 7.3%
Current Ratio without Bond-related 3.6 3.0 0.5 17.9% Assets & Liabilities
Days in Accounts Receivable (Hospital only) 95.7 18.2 (77.5) (425.0%) 77.0 (18.7) (24.3%)
Capital Structure EBIDA Debt Service Coverage 1.4 (1.0) 2.4 241.1% 16.6 (15.2) (91.5%)
Profitability Operating Margin (11.60%) (9.62%) (1.98%) (20.6%) (11.77%) 0.17% 1.5%
Labor FTE/AOB WO Residents 4.62 4.48 (0.14) (3.1%) 4.78 4.47 (0.31) (6.9%) 4.77 (0.01) (0.2%)
Current Month Rolling Last Twelve Months Actual Prior Year Variance Var % Actual Prior Year Variance Var % Turnover Rate - Voluntary 1.62% 1.24% (0.38%) (30.65%) 15.93% 14.93% (1.00%) (6.70%) Turnover Rate - Involuntary 0.40% 0.29% (0.11%) (37.93%) 4.69% 3.96% (0.73%) (18.43%) Turnover Rate - Uncontrollable 0.25% 0.26% 0.01% 3.85% 2.91% 1.79% (1.12%) (62.57%) Turnover Rate - Total 2.27% 1.80% (0.47%) (26.11%) 23.52% 20.68% (2.84%) (13.73%)
Page 16 of 31 Appendix A Definition of Financial Indicators
Desired Position Relative to Indicator Definition Trend Median
Cash + Short-Term Investments Total Days Cash on Hand = Up Above (Operating Expenses Less - Depreciation) / YTD Days
Days in Accounts Net Patient Accounts Receivable (including Due/From) = Down Below Receivable Net Patient Service Revenue / YTD Days
EBITDA Debt Service EBITDA = Up Above Coverage Principal + Interest Expenses
Operating Income (Loss) Operating Margin = X 100 Up Above Operating Revenues
All discharged accounts. Case Mix Index - = Includes normal newborns (DRG 795). Up Above Total Hospital Includes discharges with a Behavioral Health patient type.
Discharged accounts. Case Mix Index - Acute = Excludes normal newborns (DRG 795). Up Above (Excluding Newborns) Excludes discharges with a Behavioral Health patient type.
Case Mix Index - Behavioral = Discharges with a Behavioral Health patient type. Up Above Health
Discharged accounts with a financial class of Medicare or Case Mix Index - Medicare = Medicare Managed Care. Excludes normal newborns (DRG 795). Up Above Excludes discharges with a Behavioral Health patient type.
Discharged accounts with a financial class of AHCCCS or Case Mix Index - AHCCCS = Maricopa Health Plan. Excludes normal newborns (DRG 795). Up Above Excludes discharges with a Behavioral Health patient type.
For ALL Case Mix values -- only Patient Types of Inpatient, Behavioral Health and Newborn are counted (as appropriate). Patient Types of Observation, Outpatient and Emergency are excluded from all CMI calculations at all times.
New individual MS-DRG weights are issued by CMS each year, with an effective date of October 1st.
Page 17 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) VOLUMES For the Two Periods Ending August 31, 2019
Prior Year Prior Year YTD YTD YTD AUG 2019 AUG 2019 AUG 2019 AUG 2019 Same Month Same Month AUG 2019 AUG 2019 AUG 2019 AUG 2019 Prior Year Prior Year Actual Budget Variance % Change AUG 2018 % Change YTD Actual YTD Budget YTD Variance % Change AUG 2018 % Change ADMISSIONS Acute 1,079 1,066 13 1.2 % 988 9.2 % 2,174 2,114 60 2.8 % 1,945 11.8 % Behavioral Health 395 423 (28) (6.6 %) 326 21.2 % 743 823 (80) (9.7 %) 652 14.0 % Annex 136 144 (8) (5.6 %) 151 (9.9 %) 249 281 (32) (11.4 %) 305 (18.4 %) Desert Vista 198 279 (81) (29.0 %) 175 13.1 % 381 542 (161) (29.7 %) 347 9.8 % Maryvale 61 0 61 100.0 % 0 100.0 % 113 0 113 100.0 % 0 100.0 % Total 1,474 1,489 (15) (1.0 %) 1,314 12.2 % 2,917 2,937 (20) (0.7 %) 2,597 12.3 %
OBSERVATION ADMISSIONS Transferred to Inpatient * 184 164 20 12.2 % 151 21.9 % 375 317 58 18.3 % 268 39.9 % Observation Admission Only 426 339 87 25.7 % 296 43.9 % 814 655 159 24.3 % 563 44.6 % Total Observation Admissions 610 503 107 21.3 % 447 36.5 % 1,189 972 217 22.3 % 831 43.1 %
TOTAL ADMISSIONS AND OBSERVATION ONLY Total 1,900 1,828 72 3.9 % 1,610 18.0 % 3,731 3,592 139 3.9 % 3,160 18.1 %
ADJUSTED ADMISSIONS Total 2,769 2,819 (49) (1.7 %) 2,581 7.3 % 5,289 5,627 (337) (6.0 %) 4,996 5.9 %
PATIENT DAYS Acute 5,465 4,959 506 10.2 % 4,526 20.7 % 11,097 9,620 1,477 15.4 % 8,933 24.2 % Behavioral Health 8,231 8,802 (571) (6.5 %) 6,823 20.6 % 16,383 17,160 (777) (4.5 %) 13,540 21.0 % Annex 3,274 2,611 663 25.4 % 3,338 (1.9 %) 6,541 5,200 1,341 25.8 % 6,644 (1.6 %) Desert Vista 3,484 3,485 (1) (0.0 %) 3,485 (0.0 %) 6,892 6,896 (4) (0.1 %) 6,896 (0.1 %) Maryvale 1,473 2,706 (1,233) (45.6 %) 0 100.0 % 2,950 5,064 (2,114) (41.7 %) 0 100.0 % Total 13,696 13,761 (65) (0.5 %) 11,349 20.7 % 27,480 26,780 700 2.6 % 22,473 22.3 %
AVERAGE DAILY CENSUS Acute 176 160 16 10.2 % 146 20.7 % 179 155 24 15.4 % 144 24.2 % Behavioral Health 266 284 (18) (6.5 %) 220 20.6 % 264 277 (13) (4.5 %) 218 21.0 % Annex 106 84 21 25.4 % 108 (1.9 %) 106 84 22 25.8 % 107 (1.6 %) Desert Vista 112 112 (0) (0.0 %) 112 (0.0 %) 111 111 (0) (0.1 %) 111 (0.1 %) Maryvale 48 87 (40) (45.6 %) 0 100.0 % 48 82 (34) (41.7 %) 0 100.0 % Total 442 444 (2) (0.5 %) 366 20.7 % 443 432 11 2.6 % 362 22.3 %
ADJUSTED PATIENT DAYS Total 25,733 26,049 (316) (1.2 %) 22,292 15.4 % 49,830 51,305 (1,475) (2.9 %) 43,230 15.3 %
* Already included in 'Acute Admissions'.
Page 18 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) VOLUMES For the Two Periods Ending August 31, 2019
Prior Year Prior Year YTD YTD YTD AUG 2019 AUG 2019 AUG 2019 AUG 2019 Same Month Same Month AUG 2019 AUG 2019 AUG 2019 AUG 2019 Prior Year Prior Year Actual Budget Variance % Change AUG 2018 % Change YTD Actual YTD Budget YTD Variance % Change AUG 2018 % Change OPERATING ROOM SURGERIES Inpatient 375 387 (12) (3.1 %) 371 1.1 % 808 705 103 14.6 % 677 19.4 % Outpatient 355 325 30 9.2 % 289 22.8 % 652 654 (2) (0.3 %) 574 13.6 % Total 730 712 18 2.5 % 660 10.6 % 1,460 1,359 101 7.4 % 1,251 16.7 %
Inpatient Minutes 48,810 50,411 (1,601) (3.2 %) 48,555 0.5 % 109,215 91,834 17,381 18.9 % 92,820 17.7 % Outpatient Minutes 31,800 30,738 1,062 3.5 % 26,730 19.0 % 59,910 61,854 (1,944) (3.1 %) 53,625 11.7 % Total 80,610 81,149 (539) (0.7 %) 75,285 7.1 % 169,125 153,688 15,437 10.0 % 146,445 15.5 %
DELIVERIES Total 180 175 5 2.9 % 173 4.0 % 351 353 (2) (0.6 %) 349 0.6 %
ED VISITS Adult 3,991 3,989 2 0.1 % 3,972 0.5 % 8,079 8,009 70 0.9 % 7,975 1.3 % Maryvale 2,043 1,755 288 16.4 % 0 100.0 % 3,970 3,449 521 15.1 % 0 100.0 % Pediatrics ** 1,420 1,426 (6) (0.4 %) 1,428 (0.6 %) 2,543 2,480 63 2.5 % 2,484 2.4 % Labor & Delivery 310 325 (15) (4.6 %) 325 (4.6 %) 618 638 (20) (3.1 %) 638 (3.1 %) Burn 259 227 32 14.1 % 227 14.1 % 521 505 16 3.2 % 505 3.2 % Total 8,023 7,722 301 3.9 % 5,952 34.8 % 15,731 15,081 650 4.3 % 11,602 35.6 %
AMBULATORY VISITS FHC and WHH 17,054 17,382 (328) (1.9 %) 17,355 (1.7 %) 33,500 34,040 (540) (1.6 %) 32,518 3.0 % CHC 13,651 13,839 (188) (1.4 %) 14,515 (6.0 %) 26,668 27,303 (635) (2.3 %) 27,009 (1.3 %) Outpatient Behavioral Health 3,622 2,442 1,180 48.3 % 2,064 75.5 % 7,148 4,913 2,235 45.5 % 3,628 97.0 % Dental 2,203 2,337 (134) (5.7 %) 2,504 (12.0 %) 4,294 4,410 (116) (2.6 %) 4,582 (6.3 %) 7th Avenue Walk-In Clinic 0 0 0 0.0 % 1,421 (100.0 %) 0 0 0 0.0 % 2,635 (100.0 %) Total 36,530 36,000 530 1.5 % 37,859 (3.5 %) 71,610 70,666 944 1.3 % 70,372 1.8 %
** These are visits to the Pediatric Emergency Department, not ED visits under a certain age.
Page 19 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) FINANCIAL INDICATORS For the Period Ending August 31, 2019
Prior Year Prior Year Prior Year AUG 2019 AUG 2019 AUG 2019 AUG 2019 Same Month Same Month Same Month Actual Budget Variance % Change AUG 2018 Variance % Change Net Patient Service Revenue per APD $ 1,656 $ 1,589 $ 67 4.2 % $ 1,710 ($ 54) (3.2 %)
Salaries $ 22,173,861 $ 21,817,044 ($ 356,817) (1.6 %) $ 19,512,699 ($ 2,661,161) (13.6 %) Benefits 6,844,739 6,359,194 (485,546) (7.6 %) 5,992,220 (852,519) (14.2 %) Contract Labor 2,188,315 1,449,591 (738,724) (51.0 %) 1,614,027 (574,288) (35.6 %) Total Labor Costs $ 31,206,915 $ 29,625,828 ($ 1,581,086) (5.3 %) $ 27,118,946 ($ 4,087,969) (15.1 %)
Supplies $ 8,682,594 $ 6,937,210 ($ 1,745,384) (25.2 %) $ 6,649,751 ($ 2,032,843) (30.6 %) Medical Service Fees 7,380,157 6,253,783 (1,126,374) (18.0 %) 6,588,368 (791,789) (12.0 %) All Other * 10,906,708 10,866,612 (40,096) (0.4 %) 7,865,021 (3,041,688) (38.7 %) Total $ 26,969,460 $ 24,057,605 ($ 2,911,855) (12.1 %) $ 21,103,140 ($ 5,866,319) (27.8 %)
Total Operating and Non-Operating Expenses * $ 58,176,374 $ 53,683,433 ($ 4,492,941) (8.4 %) $ 48,222,086 ($ 9,954,288) (20.6 %) * Excludes Depreciation
Tax Levy Property Tax $ 6,704,949 $ 6,704,949 ($ 0) (0.0 %) $ 6,410,085 $ 294,864 4.6 % Bonds 5,236,969 5,236,969 (0) (0.0 %) 3,512,824 1,724,145 49.1 % Total Tax Levy $ 11,941,918 $ 11,941,918 ($ 0) (0.0 %) $ 9,922,909 $ 2,019,009 20.3 %
Patient Days - Acute 5,465 4,959 506 10.2 % 4,526 939 20.7 % Patient Days - Behavioral Health 8,231 8,802 (571) (6.5 %) 6,823 1,408 20.6 % Patient Days - Total 13,696 13,761 (65) (0.5 %) 11,349 2,347 20.7 %
Adjusted Patient Days 25,733 26,049 (316) (1.2 %) 22,292 3,441 15.4 % APD Ratio 1.88 1.89 (0.01) (0.7 %) 1.96 (0.09) (4.3 %)
Admissions - Acute 1,079 1,066 13 1.2 % 988 91 9.2 % Admissions - Behavioral Health 395 423 (28) (6.6 %) 326 69 21.2 % Admissions - Total 1,474 1,489 (15) (1.0 %) 1,314 160 12.2 %
Adjusted Admissions 2,769 2,819 (49) (1.7 %) 2,581 188 7.3 %
Page 20 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) FINANCIAL INDICATORS For the Period Ending August 31, 2019
Prior Year Prior Year Prior Year AUG 2019 AUG 2019 AUG 2019 AUG 2019 Same Month Same Month Same Month Actual Budget Variance % Change AUG 2018 Variance % Change Average Daily Census - Acute 176 160 16 10.2 % 146 30 20.7 % Average Daily Census - Behavioral Health 266 284 (18) (6.5 %) 220 45 20.6 % Average Daily Census - Total 442 444 (2) (0.5 %) 366 76 20.7 %
Adjusted Occupied Beds - Acute 331 303 28 9.4 % 287 44 15.5 % Adjusted Occupied Beds - Behavioral Health 499 537 (39) (7.2 %) 432 67 15.4 % Adjusted Occupied Beds - Total 830 840 (10) (1.2 %) 719 111 15.4 %
Paid FTEs - Payroll 3,652 3,654 2 0.1 % 3,238 (415) (12.8 %) Paid FTEs - Contract Labor 389 312 (77) (24.7 %) 260 (128) (49.3 %) Paid FTEs - Total 4,041 3,966 (75) (1.9 %) 3,498 (543) (15.5 %)
FTEs per AOB 4.87 4.72 (0.15) (3.1 %) 4.86 (0.00) (0.1 %)
FTEs per AOB (w/o Residents) 4.62 4.48 (0.14) (3.1 %) 4.59 (0.03) (0.7 %)
Benefits as a % of Salaries 30.9 % 29.1 % (1.7 %) (5.9 %) 30.7 % (0.2 %) (0.5 %)
Labor Costs as a % of Net Patient Revenue 73.2 % 71.6 % (1.7 %) (2.3 %) 71.2 % (2.1 %) (2.9 %)
Salaries and Contract Labor per APD $ 947 $ 893 ($ 54) (6.0 %) $ 948 $ 1 0.1 % Benefits per APD 266 244 (22) (9.0 %) 269 3 1.0 % Supplies per APD 337 266 (71) (26.7 %) 298 (39) (13.1 %) Medical Service Fees per APD 287 240 (47) (19.5 %) 296 9 3.0 % All Other Expenses per APD * 424 417 (7) (1.6 %) 353 (71) (20.1 %) Total Expenses per APD * $ 2,261 $ 2,061 ($ 200) (9.7 %) $ 2,163 ($ 98) (4.5 %)
Salaries and Contract Labor per Adj. Admission $ 8,797 $ 8,255 ($ 542) (6.6 %) $ 8,186 ($ 611) (7.5 %) Benefits per Adj. Admission 2,472 2,256 (215) (9.5 %) 2,322 (150) (6.5 %) Supplies per Adj. Admission 3,135 2,461 (674) (27.4 %) 2,576 (559) (21.7 %) Medical Service Fees per Adj. Admission 2,665 2,219 (446) (20.1 %) 2,553 (112) (4.4 %) All Other Expenses per Adj. Admission * 3,938 3,855 (83) (2.2 %) 3,047 (891) (29.2 %) Total Expenses per Adj. Admission * $ 21,007 $ 19,046 ($ 1,960) (10.3 %) $ 18,684 ($ 2,323) (12.4 %)
* Excludes Depreciation
Page 21 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) FINANCIAL INDICATORS For the Two Periods Ending August 31, 2019
YTD YTD YTD YTD AUG 2019 AUG 2019 AUG 2019 AUG 2019 Prior Year Prior Year Prior Year YTD Actual YTD Budget YTD Variance % Change AUG 2018 Variance % Change Net Patient Service Revenue per APD $ 1,756 $ 1,593 $ 163 10.3 % $ 1,703 $ 53 3.1 %
Salaries $ 44,528,316 $ 42,864,186 ($ 1,664,131) (3.9 %) $ 39,279,335 ($ 5,248,981) (13.4 %) Benefits 12,888,361 12,493,923 (394,438) (3.2 %) 11,009,517 (1,878,844) (17.1 %) Contract Labor 4,390,301 2,895,170 (1,495,132) (51.6 %) 3,199,058 (1,191,244) (37.2 %) Total Labor Costs $ 61,806,979 $ 58,253,278 ($ 3,553,701) (6.1 %) $ 53,487,910 ($ 8,319,069) (15.6 %)
Supplies $ 17,360,045 $ 13,570,177 ($ 3,789,868) (27.9 %) $ 12,473,017 ($ 4,887,028) (39.2 %) Medical Service Fees 14,280,642 12,467,910 (1,812,733) (14.5 %) 12,807,877 (1,472,766) (11.5 %) All Other * 21,050,826 21,736,916 686,091 3.2 % 15,311,341 (5,739,484) (37.5 %) Total $ 52,691,513 $ 47,775,003 ($ 4,916,510) (10.3 %) $ 40,592,235 ($ 12,099,278) (29.8 %)
Total Operating and Non-Operating Expenses * $ 114,498,492 $ 106,028,281 ($ 8,470,211) (8.0 %) $ 94,080,145 ($ 20,418,347) (21.7 %) * Excludes Depreciation
Tax Levy Property Tax $ 13,409,898 $ 13,409,898 ($ 0) (0.0 %) $ 12,820,170 $ 589,728 4.6 % Bonds 10,473,939 10,473,939 (0) (0.0 %) 7,025,648 3,448,291 49.1 % Total Tax Levy $ 23,883,837 $ 23,883,837 ($ 0) (0.0 %) $ 19,845,818 $ 4,038,018 20.3 %
Patient Days - Acute 11,097 9,620 1,477 15.4 % 8,933 2,164 24.2 % Patient Days - Behavioral Health 16,383 17,160 (777) (4.5 %) 13,540 2,843 21.0 % Patient Days - Total 27,480 26,780 700 2.6 % 22,473 5,007 22.3 %
Adjusted Patient Days 49,830 51,305 (1,475) (2.9 %) 43,230 6,600 15.3 % APD Ratio 1.81 1.92 (0.10) (5.3 %) 1.92 (0.11) (5.7 %)
Admissions - Acute 2,174 2,114 60 2.8 % 1,945 229 11.8 % Admissions - Behavioral Health 743 823 (80) (9.7 %) 652 91 14.0 % Admissions - Total 2,917 2,937 (20) (0.7 %) 2,597 320 12.3 %
Adjusted Admissions 5,289 5,627 (337) (6.0 %) 4,996 294 5.9 %
Page 22 of 31 MARICOPA COUNTY SPECIAL HEALTH DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM (COMBINED CARE SYSTEM) FINANCIAL INDICATORS For the Two Periods Ending August 31, 2019
YTD YTD YTD YTD AUG 2019 AUG 2019 AUG 2019 AUG 2019 Prior Year Prior Year Prior Year YTD Actual YTD Budget YTD Variance % Change AUG 2018 Variance % Change Average Daily Census - Acute 179 155 24 15.4 % 144 35 24.2 % Average Daily Census - Behavioral Health 264 277 (13) (4.5 %) 218 46 21.0 % Average Daily Census - Total 443 432 11 2.6 % 362 81 22.3 %
Adjusted Occupied Beds - Acute 325 297 27 9.2 % 277 47 17.1 % Adjusted Occupied Beds - Behavioral Health 479 530 (51) (9.6 %) 420 59 14.1 % Adjusted Occupied Beds - Total 804 828 (24) (2.9 %) 697 106 15.3 %
Paid FTEs - Payroll 3,670 3,590 (80) (2.2 %) 3,261 (409) (12.5 %) Paid FTEs - Contract Labor 382 312 (70) (22.6 %) 267 (115) (43.0 %) Paid FTEs - Total 4,053 3,902 (151) (3.9 %) 3,529 (524) (14.8 %)
FTEs per AOB 5.04 4.72 (0.33) (6.9 %) 5.06 0.02 0.4 %
FTEs per AOB (w/o Residents) 4.78 4.47 (0.31) (6.9 %) 4.77 (0.01) (0.2 %)
Benefits as a % of Salaries 28.9 % 29.1 % 0.2 % 0.7 % 28.0 % (0.9 %) (3.3 %)
Labor Costs as a % of Net Patient Revenue 70.6 % 71.3 % 0.7 % 0.9 % 72.6 % 2.0 % 2.8 %
Salaries and Contract Labor per APD $ 982 $ 892 ($ 90) (10.1 %) $ 983 $ 1 0.1 % Benefits per APD 259 244 (15) (6.2 %) 255 (4) (1.6 %) Supplies per APD 348 264 (84) (31.7 %) 289 (60) (20.7 %) Medical Service Fees per APD 287 243 (44) (17.9 %) 296 10 3.3 % All Other Expenses per APD * 422 424 1 0.3 % 354 (68) (19.3 %) Total Expenses per APD * $ 2,298 $ 2,067 ($ 231) (11.2 %) $ 2,176 ($ 121) (5.6 %)
Salaries and Contract Labor per Adj. Admission $ 9,248 $ 8,132 ($ 1,116) (13.7 %) $ 8,503 ($ 745) (8.8 %) Benefits per Adj. Admission 2,437 2,220 (216) (9.7 %) 2,204 (233) (10.6 %) Supplies per Adj. Admission 3,282 2,412 (870) (36.1 %) 2,497 (785) (31.4 %) Medical Service Fees per Adj. Admission 2,700 2,216 (484) (21.8 %) 2,564 (136) (5.3 %) All Other Expenses per Adj. Admission * 3,980 3,863 (117) (3.0 %) 3,065 (915) (29.8 %) Total Expenses per Adj. Admission * $ 21,647 $ 18,844 ($ 2,803) (14.9 %) $ 18,832 ($ 2,814) (14.9 %)
* Excludes Depreciation
Page 23 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
OPERATING REVENUE
Patient Days, Admissions and Adjusted Patient Days
Acute Care Actual Budget Variance %Variance MTD - Patient Days 5,465 4,959 506 10.2% YTD - Patient Days 11,097 9,620 1,477 15.4%
MTD - Admissions 1,079 1,066 13 1.2% YTD - Admissions 2,174 2,114 60 2.8%
MTD - Average Length of Stay (ALOS) 5.1 4.7 (0.4) -8.9% YTD - Average Length of Stay (ALOS) 5.1 4.6 (0.6) -12.2%
MTD - Average Daily Census (ADC) 176 160 16 10.2% YTD - Average Daily Census (ADC) 179 155 24 15.4%
Behavioral Health Actual Budget Variance %Variance MTD - Patient Days 8,231 8,802 (571) -6.5% YTD - Patient Days 16,383 17,160 (777) -4.5%
MTD - Admissions 395 423 (28) -6.6% YTD - Admissions 743 823 (80) -9.7%
MTD - Average Length of Stay (ALOS) 20.8 20.8 (0.0) -0.1% YTD - Average Length of Stay (ALOS) 22.0 20.9 (1.2) -5.8%
MTD - Average Daily Census (ADC) 266 284 (18) -6.5% YTD - Average Daily Census (ADC) 264 277 (13) -4.5%
Adjusted Patient Days (APD) Actual Budget Variance %Variance Month-to-Date 25,733 26,049 (316) -1.2% Year-to-Date 49,830 51,305 (1,475) -2.9%
Net patient service revenue
Actual Budget Variance %Variance Month-to-Date $ 42,607,960 $ 41,398,039 $ 1,209,921 2.9% Year-to-Date $ 87,500,369 $ 81,706,658 $ 5,793,711 7.1% Month-to-Date Per APD $ 1,656 $ 1,589 $ 67 4.2% Year-to-Date Per APD $ 1,756 $ 1,593 $ 163 10.3%
Other operating revenue
Actual Budget Variance %Variance Month-to-Date $ 6,659,850 $ 6,860,802 $ (200,952) -2.9% Year-to-Date $ 13,814,463 $ 13,704,551 $ 109,912 0.8%
340(B) Revenue is on budget MTD, but remains above budget YTD. Offsetting Grants/Research revenues are below budget MTD and YTD.
Total operating revenues
Actual Budget Variance %Variance Month-to-Date $ 49,267,810 $ 48,258,842 $ 1,008,968 2.1% Year-to-Date $ 101,314,831 $ 95,411,209 $ 5,903,622 6.2%
Page 24 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
OPERATING EXPENSES
Salaries and wages
Actual Budget Variance %Variance Month-to-Date $ 22,173,861 $ 21,817,044 $ (356,817) -1.6% Year-to-Date $ 44,528,316 $ 42,864,186 $ (1,664,130) -3.9%
Actual Budget Variance %Variance Paid FTE's - Payroll 3,652 3,654 2 0.1%
Actual Budget Variance %Variance Paid FTE's - Payroll (w/o Residents) 3,446 3,462 16 0.5%
Actual Budget Variance %Variance Salaries per FTE's - Payroll $ 6,072 $ 5,971 $ (101) -1.7%
Contract labor
Actual Budget Variance %Variance Month-to-Date $ 2,188,315 $ 1,449,591 $ (738,724) -51.0% Year-to-Date $ 4,390,301 $ 2,895,170 $ (1,495,131) -51.6%
Actual Budget Variance %Variance FTE's - Contract Labor incl Outsource 389 312 (77) -24.7%
FTE's - Contract Labor Actual Budget Variance %Variance Nursing operations - Acute 40 8 (31) -380.1% Revenue Cycle 27 15 (12) -77.5% Behavioral Health 4 - (4) 0.0% Information Technology 15 3 (12) -390.3%
FTE's - Outsource Departments Actual Budget Variance %Variance Food & Nutrition Services (YTD recon) 124 124 - 0.0% Environmental Services (YTD recon) 146 146 - 0.0% Laundry & Linen 8 8 - 0.0% Gift Shop 2 2 - 0.0%
Actual Budget Variance %Variance Paid FTE's - Payroll & Contract Labor 4,041 3,966 (75) -1.9%
Actual Budget Variance %Variance Adjusted Occupied Beds (AOB) 830 840 (10) -1.2%
Actual Budget Variance %Variance Paid FTE's per AOB (w/o Residents) 4.62 4.49 (0.13) -2.9%
Employee benefits
Actual Budget Variance %Variance Month-to-Date $ 6,844,739 $ 6,359,193 $ (485,546) -7.6% Year-to-Date $ 12,888,361 $ 12,493,922 $ (394,439) -3.2%
Net expenses related to our self-insured trust are over budget both MTD and YTD.
Page 25 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
Benefits as a % of salaries
Actual Budget Variance %Variance Month-to-Date 30.9% 29.1% -1.7% -5.9% Year-to-Date 28.9% 29.1% 0.2% 0.7%
Medical service fees
Actual Budget Variance %Variance Month-to-Date $ 7,380,157 $ 6,253,783 $ (1,126,374) -18.0% Year-to-Date $ 14,280,642 $ 12,467,910 $ (1,812,732) -14.5%
Net expenses are over budget MTD primarily due to DMG collections lower than expected.
Supplies
Actual Budget Variance %Variance Month-to-Date $ 8,682,594 $ 6,937,210 $ (1,745,384) -25.2% Year-to-Date $ 17,360,045 $ 13,570,177 $ (3,789,868) -27.9%
Positive variances for the month are in furniture and equipment, other supplies, GPO rebates, and physical inventory adjustments. Majority of the negative variances for the month are in OR related supplies (i.e. implants, human skin, burn supplies, etc.), radiology supplies, pharmaceuticals, laboratory supplies, and blood/plasma supplies.
Purchased services
Actual Budget Variance %Variance Month-to-Date $ 2,567,071 $ 2,327,053 $ (240,018) -10.3% Year-to-Date $ 4,306,374 $ 4,648,244 $ 341,870 7.4%
The positive variance for the month are in collection fees, other professional services, consulting & management, and employee recruitment expenses. Negative variances for the month are in other services related to advertising services, laundry services, accounting & auditing, and claims administration services.
Other expenses
Actual Budget Variance %Variance Month-to-Date $ 4,232,981 $ 4,403,278 $ 170,297 3.9% Year-to-Date $ 8,570,703 $ 8,798,411 $ 227,708 2.6%
Majority of the positive variances for the month are in repairs and maintenance, orgainization memberships & dues, patient transport services. Negative variances for the month are in utilities, rent, books & pamphlet subscriptions, risk management related expenses and other miscellaneous expenses.
Provider Assessment
Actual Budget Variance %Variance Month-to-Date $ 652,033 $ 652,033 $ - 0.0% Year-to-Date $ 1,304,067 $ 1,304,067 $ - 0.0%
Depreciation
Actual Budget Variance %Variance Month-to-Date $ 2,724,317 $ 2,799,115 $ 74,798 2.7% Year-to-Date $ 5,438,906 $ 5,546,302 $ 107,396 1.9%
Page 26 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
Total operating expenses
Actual Budget Variance %Variance Month-to-Date $ 57,446,069 $ 52,998,300 $ (4,447,769) -8.4% Year-to-Date $ 113,067,716 $ 104,588,388 $ (8,479,328) -8.1%
Operating income (loss)
Actual Budget Variance %Variance Month-to-Date $ (8,178,258) $ (4,739,459) $ (3,438,799) -72.6% Year-to-Date $ (11,752,884) $ (9,177,180) $ (2,575,704) -28.1%
Non-operating revenues (expenses)
Actual Budget Variance %Variance Month-to-Date $ 10,537,284 $ 10,551,651 $ (14,367) -0.1% Year-to-Date $ 21,142,894 $ 21,107,965 $ 34,929 0.2%
Excess of revenues over expenses
Actual Budget Variance %Variance Month-to-Date $ 2,359,025 $ 5,812,192 $ (3,453,167) -59.4% Year-to-Date $ 9,390,009 $ 11,930,786 $ (2,540,777) -21.3%
Page 27 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
ASSETS
Cash and cash equivalents - Delivery system
Aug-19 Jun-19 Change % change $ 129,894,615 $ 168,740,311 $ (38,845,696) -23.0%
Cash and cash equivalents - Bond (restricted)
Aug-19 Jun-19 Change % change $ 392,982,251 $ 459,046,798 $ (66,064,547) -14.4%
Paid $52.3M in principal and interest in July 2019 related to the 2nd and 3rd bond offerings.
Patient A/R, net of allowances
Aug-19 Jun-19 Change % change $ 130,418,789 $ 112,725,731 $ 17,693,058 15.7%
Other receivables and prepaid items
Aug-19 Jun-19 Change % change $ 37,724,309 $ 35,939,021 $ 1,785,288 5.0%
FY20 other receivables / prepaids includes: $1.0M due from Home Assist Health $18.1M in prepaids/deposits $636K in retail pharmacy receivable $8.3M in inventories $4.6M due from other receivables $1.4M due from DMG for pro-fees collections $504K due from other hospital - resident rotation $2.0M due from Wellpartner/340B program $1.2M receivables from grants & research sponsors
Estimated amounts due from third party payors
Aug-19 Jun-19 Change % change $ 46,153,640 $ 39,407,781 $ 6,745,859 17.1%
FY20 due from third party payors includes: $44.8M due from AHCCCS for GME - FY20 $87K due from Ryan White Part C program $700K due from AHCCCS for DSH - FY20 $93K due from Ryan White Part D program $462K due from First Things First
Due from related parties
Aug-19 Jun-19 Change % change $ 19,594,624 $ 1,680,183 $ 17,914,441 1066.2%
FY20 due from related parties includes: $95K due from Public Health Ryan White Part A programs $19.5M due from Maricopa County for tax levy collection
Page 28 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
Capital Assets, net
Aug-19 Jun-19 Change % change $ 364,234,166 $ 359,761,082 $ 4,473,084 1.2%
Other Assets
Aug-19 Jun-19 Change % change $ 59,593,027 $ 59,593,027 $ - 0.0%
FY20 Other assets includes: $9.8M - investment in MCA $49.8M - Long-term investments
Deferred outflows
Aug-19 Jun-19 Change % change $ 38,134,646 $ 38,134,646 $ - 0.0%
LIABILITIES AND NET POSITION
Current maturities of long-term debt
Aug-19 Jun-19 Change % change $ 33,266,776 $ 38,484,571 $ (5,217,795) -13.6%
FY20 current maturities includes: $33.3M in Bond current portion and interest payable
Accounts payable
Aug-19 Jun-19 Change % change $ 34,458,814 $ 44,455,450 $ (9,996,636) -22.5%
FY20 accounts payable includes: $4.9M due to DMG for annual recon and pass thru payments $16.9M in vendor related expense accruals/estimates $12.7M in vendor approved payments
Accrued payroll and expenses
Aug-19 Jun-19 Change % change $ 23,975,345 $ 25,452,394 $ (1,477,049) -5.8%
Medical claims payable
Aug-19 Jun-19 Change % change $ 18,667,428 $ 18,520,035 $ 147,393 0.8%
Page 29 of 31 MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM FINANCIAL STATEMENT HIGHLIGHTS For the month ending August 31, 2019
Due to related parties
Aug-19 Jun-19 Change % change $ - $ 4,661,701 $ (4,661,701) -100.0%
Timing of tax levy revenue accrual and actual collection received.
Other current liabilities
Aug-19 Jun-19 Change % change $ 25,613,662 $ 26,039,771 $ (426,109) -1.6%
FY20 other current liabilities includes: $4.5M in settlement reserved for Medicare $230K in deferred income (Health Foundation) $2.4M in deferred income for grants, research, & study residuals $350K in unclaimed/stale dated checks $5.0M in patient credit balances $8.5M in settlement reserved for SNCP and FQHC $4.6M in other deferred income (TIP, Optum, APSI)
Bonds payable
Aug-19 Jun-19 Change % change $ 457,938,359 $ 501,994,983 $ (44,056,624) -8.8%
Other long-term debt
Aug-19 Jun-19 Change % change $ 1,300,267 $ 1,300,267 $ - 0.0%
FY20 long term debt includes: $1.3M capital leases - long term portion RICOH
Long-term liabilities
Aug-19 Jun-19 Change % change $ 304,258,185 $ 304,258,185 $ - 0.0%
Pension liability per ASRS report - GASB68
Deferred inflows
Aug-19 % change $ 40,084,002 $ 40,084,002 $ - 0.0%
Net position
Aug-19 Jun-19 % change $ 279,167,230 $ 269,777,220 $ 9,390,010 3.5%
Page 30 of 31 Maricopa Integrated Health System Health Plan sale proceeds
Beginning balance - February 01, 2017 $ -
ADD: Payment received from UHC for member transfer $ 33,361,499.99 Investment income 763,151.99 Bank interest income received - YTD 42,288.04 34,166,940.02
LESS: Consulting services expense (547,601.00) Investment residual - Maricopa Health Foundation Funding (1,250,000.00) Bank charges - transfer fees (50.00)
Short - term investments (30,771,132.89) Long - term investments - (32,568,783.89)
Ending balance as of August 31, 2019 $ 1,598,156.13
Page 31 of 31
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 5. No Information Available at This Time
Executive Employment Agreement
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 6.
Chief Executive Officer Performance Goals for Fiscal Year 2019 Valleywise Health CEO FY20 Performance Goals
9/30/2019 12/31/2019 3/31/2020 6/30/2020
1 ‐ FINANCIAL (Weighted distribution: 25%; 20% 1A, 5% 1B) Objective 1A: Achieve FY20 budgeted net income excluding ASRS actuarial adjustment. Metric 1A: FY20 budget, excluding ASRS actuarial adjustment. (Minimum set at FY20 budget. Midpoint, Maximum each 5% better. Achievement measured at YTD June 30.) Quarterly Results Minimum ($3,504,911) Midpoint ($3,329,665) Maximum ($3,163,182)
Objective 1B: Implement recommendations from the "Construction and Bond Funds Review" conducted by Moss Adams that are expected to result in a positive benefit/cost ratio.* Metric 1B: Confirmation by Internal Auditor or Compliance Officer. (Minimum set at 80%. Midpoint, Maximum each 12% better. Achievement measured at YTD June 30.) Quarterly Results Minimum 80% Midpoint 90% Maximum 100%
2 ‐ SERVICE (Weighted distribution: 12.5%; 6.25% each 2A, 2B) Objective 2A: Increase percentage of patients responding favorably to HCAHPS hospital satisfaction question regarding overall rating. Metric 2A: Overall rating score for HCAHPS "Using any number from 0‐10, what number would you use to rate this hospital during your stay?" FY19 results: 70.1% (Minimum set at 4% better than FY19 results. Midpoint, Maximum each 5% better. Achievement measured at YTD June 30.) Quarter Results Minimum 73.0% Midpoint 77.0% Maximum 81.0%
Objective 2B: Achieve specialty care ambulatory appointment availability as measured by AHCCCS minimum performance standards. Metric 2B: Average time to routine specialty care ambulatory appointment as measured in days (includes new and established patients). FY19 results: 25 days (Minimum set at improvement. Midpoint, MaDRAFTximum each 5% better. Achievement measured at YTD June 30.) Quarterly Results Minimum 24 Midpoint 23 Maximum 22
9/17/2019 *New Objective and/or Metric for FY20 1 Valleywise Health CEO FY20 Performance Goals
9/30/2019 12/31/2019 3/31/2020 6/30/2020
3 ‐ GROWTH (Weighted distribution: 12.5%; 6.25% each 3A, 3B) Objective 3A: Achieve the number of ambulatory outpatient visits budgeted for FY20 excluding behavioral health and dental visits.* Metric 3A: Number of actual outpatient visits at the ambulatory outpatient clinics. FY19 results: 344,513. (Minimum set at FY20 budget. Midpoint 1% better; Maximum 2% better. Achievement measured at YTD June 30.) Quarterly Results Minimum 354,279 Midpoint 357,821 Maximum 364,978
Objective 3B: Achieve a reduction in the time from referral to admission for individuals undergoing court ordered mental health evaluations.* Metric 3C: Time from referral to admissions for individuals undergoing court ordered mental health evaluations. (Minimum set at better than state law [72 hours]. Midpoint 8 hours better; Maximum 16 hours better. Achievement measured at YTD June 30.) Quarterly Results Minimum 64 hours Midpoint 56 hours Maximum 48 hours
4 ‐ PEOPLE (Weighted distribution: 12.5%; 4.25% each 4A, 4B and 4% 4C) Objective 4A: Increase employee retention to reduce turnover costs and boost employee morale, specific to employees in their first year of employment.* Metric 4A: Percentage of 1st year voluntary turnover. FY19 results: 28.26%. (Minimum set at improvement. Midpoint, Maximum each 2% better. Achievement measured at YTD June 30.) Quarterly Results Minimum 27.69% Midpoint 27.13% Maximum 26.56%
Objective 4B: Increase positive response rate on the Culture of Safety Survey for Non‐Punitive Response to Error. Metric 4B: The Culture of Safety Survey Results in the category of Non‐Punitive Response to Error. FY19 results: 36.2%. (Minimum set lower. Midpoint, Maximum each 5% better. Achievement measured at June 30.) DRAFTJune 30 Results Minimum 36.0% Midpoint 38.0% Maximum 40.0%
9/17/2019 *New Objective and/or Metric for FY20 2 Valleywise Health CEO FY20 Performance Goals
9/30/2019 12/31/2019 3/31/2020 6/30/2020
4 ‐ PEOPLE (Weighted distribution: 12.5%; 4.25% each 4A, 4B and 4% 4C) Objective 4C: Drive organization diversity and cultural competency through the health care system.* Metric 4C: Increase in overall favorability on the employee engagement survey in the diversity and inclusion category. FY19 results: 76.9% (Minimum set at improvement. Midpoint, Maximum each 0.5% better. Achievement measured at June 30.) June 30 Results Minimum 77.3% Midpoint 77.7% Maximum 78.0%
5 ‐ QUALITY (Weighted distribution: 12.5%; 2.5% each 5A, 5B, 5C, 5D, 5E) Objective 5A: Improve the Central Line Associated Blood Stream Infections (CLABSI) measure as reported to National Healthcare Safety Network. Metric 5A: The Standardize Infection Ratio (SIR) of healthcare‐associated CLABSI infections. FY19 results: 1.01. (Minimum set at FY19 results. Midpoint, Maximum each 5% better. Achievement measured at YTD June 30.) Quarterly Results Minimum 1.01 Midpoint 0.96 Maximum 0.91
Objective 5B: Increase the percent compliance with Hand Hygiene. Metric 5B: Percent compliance with hand hygiene performed upon entry and exit to patient room. FY19 results: 97%. (Minimum set at FY19 results. Midpoint, Maximum each 0.3% better. Achievement measured at YTD June 30.) Quarter Results Minimum 97.0% Midpoint 97.3% Maximum 97.6%
Objective 5C: Decrease the number of hospital‐onset MRSA Bacteremia, as reported to National Healthcare Safety Network. Metric 5C: The Standardize Infection Rate (SIR) of hospital‐onset MRSA bacteremia. FY19 results: 2.19. (Minimum set at FY19 results. Midpoint, Maximum each 5% be er. Achievement measured at YTD June 30.) DRAFTQuarterly Results Minimum 2.19 Midpoint 2.08 Maximum 1.97
9/17/2019 *New Objective and/or Metric for FY20 3 Valleywise Health CEO FY20 Performance Goals
9/30/2019 12/31/2019 3/31/2020 6/30/2020
5 ‐ QUALITY (Weighted distribution: 12.5%; 2.5% each 5A, 5B, 5C, 5D, 5E) Objective 5D: Improve the early management of severe sepsis/septic shock. Metric 5D: Percent of patients who received all the bundle elements for early management of severe sepsis/septic shock among patients age 18 and over with a diagnosis of sepsis, severe sepsis, or septic shock. FY19 results: 60%. (Minimum set at improvement. Midpoint, Maximum each 5% better. Achievement measured at YTD June 30.) Quarterly Results Minimum 63% Midpoint 66% Maximum 69%
Objective 5E: Improve the diabetic population who has a HgA1C >9% as defined by the HRSA UDS program. Metric 5E: Diabetic patients who have a HgA1C >9% according to UDS guidelines. CY 18 results: 32%. (Minimum set at CY18 results. Midpoint, Maximum each 3% better. Achievement measured at CY19 [Dec 31, 2019] results.) CY19 Results Minimum 32.0% Midpoint 31.0% Maximum 30.0%
6 ‐ BOARD DISCRETIONARY (Weighted distribution: 25%) Objective 6: CEO effectiveness in providing leadership, developing positive relationships, responsiveness to the Board of Directors, and reflecting the Valleywise Health Mission, Vision and Values. Metric 6: Board discretion used to determine whether performance meets expectations, is above expectations or exceeds expectations. Year End Results Meets Expectations Above Expectations DRAFTExceeds Expectations
9/17/2019 *New Objective and/or Metric for FY20 4
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 7.a.
Reports to the Board Monthly Marketing and Communications Report Marketing and Communications Monthly Metrics Dashboard 08/12/19 - 09/12/19
News Coverage Impressions: 30.6M Physician Outreach Community Outreach 480,000 90 80 Print -ENG Share of News Coverage 56 6 70 Print - ESP ARIZONA 0 60 1,682 50 50 TV-ENG Banner: 32.43% 14,000,000 16,000,000 40 85 Dignity: 23.4% 16 30 TV-ESP Honor Health: 21.62% 20 78 MIHS: 18.02% 193 10 2 10 26 Mayo: 4.5% 241 - 120,000 TOTAL EVENTS TOTAL LEADS # OF VISITS REFERRALS TRANSFERS Impressions Last Measuring Period: 15.8M Pediatric Radiology Adult Specialty Events Presentations
Major Storylines
MIHS and Arizona MIHS’s Dr. Ann Khalsa Public Health appears on PBS Association join forces to Horizon, Arizona issue an alert about the Republic and Arizona dangers of vaping. Capitol Times to discuss Coverage in all major efforts to curb new HIV local media outlets. infections.
Page 1 Marketing and Communications Monthly Metrics Dashboard 08/12/19 - 09/12/19
Advertising: Curbside Care Social Media Posts New Followers Advertising and communications to promote the Valleywise Health brand and our Community Health 8 Centers with the goal of 31 driving measurable lift to new 27 patient appointment volumes. 170 Advertising to include radio (terrestrial), digital display, 14 social media, geo-targeted 15 door hangers, posters, flyers 6 and more. 11 FACEBOOK TWITTER INSTAGRAM LINKEDIN Fans: Fans: Fans: Followers: 14,959 1,376 1,368 7,277
Website Users Page Views: 85,827 Internal Communications Total Emails: 15 Returns Featured Topics Users: 28,765 22% - HEI Designation Sessions: 37,174 New Visitor 78% - Countdown to Valleywise Health 48 Avg. Open Rate Average Session % Last Measuring - Employee Forums Duration: 1:49 Period: 55% Bounce Rate: 57.68% - Blood Drive - The Vine Page Views Last Measuring Period: 88,466 AVG. OPEN RATE
Page 2
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 7.b.
Reports to the Board Monthly Care Reimagined Capital Purchases MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Functional Area - Outpatient Health Facilities ARC Products LLC $ 3,510 ARIZONA PUBLIC SERVICE 19-930 $ 2,875 $ 2,875 $ 5,749 City of Peoria $ 426 $ 985 $ 759 $ 64,220 Cushman and Wakefield of Arizona $ 16,500 $ 16,500 $ 16,500 DIBBLE ENGINEERING $ 12,570 FOLLETT 19-930 $ 23,262 $ 23,262 HILL ROM 19-930 $ 10,116 $ 10,116 Hobbs and Black Associates Inc $ 1,080,140 $ 1,080,140 $ 35,773 $ 2,628,484 Hologic 19-907 $ 659,797 $ 51,113 Maricopa County Environmental Services $ 2,200 19-930 $ 2,200 $ 615 $ (615) $ 2,200 Maricopa County Planning and Development $ 3,000 19-930 $ 3,000 $ 615 $ 165,322 Ninyo and Moore Geotechnical and Environment $ 38,350 $ 38,350 $ 2,130 $ 11,132 $ 6,515 $ 113,348 Okland Construction Company $ 465,089 19-930 $ 465,089 $ 6,886,922 $ 2,172,478 $ 25,446,968 Radiation Physics and Engineering $ 2,050 Speedie and Associates $ 2,637 Stryker Communications $ 515,073 19-921 $ 515,073 $ 257,537 TBCX $ 2,935 $ 26,413 $ 73,369 Vizient Inc $ 132,024 $ 132,024 $ 5,202 $ 23,511 $ 364,463 West Valley Fidelity National Title - Land Purchase (Grand Ave/Cotton) $ 5,595,598 $ 5,595,598 $ 5,595,598 West Valley Fidelity National Title (escrow) $ 75,000 $ 75,000 $ 75,000 TOTAL West Valley Specialty Center (WVSC) $ 7,922,974 $ 8,582,771 $ 6,936,263 $ 99,523 $ 2,179,137 $ 34,914,016 Alliance Land Surveying LLC $ 1,825 Allstare Rent A Fence 19-944 $ 212 $ 212 Great American Title (escrow) - Chandler $ 15,000 $ 1,199,345 SPEEDIE AND ASSOC 19-942 $ 3,600 $ 3,600 Ninyo and Moore Geotechnical and Environment $ 70,599 TOTAL Chandler FHC (CHAN) $ - $ 15,000 $ - $ 3,600 $ 212 $ 1,275,581 Fidelity National Title (escrow) - Miller&Main $ 25,000 $ 25,000 $ 1,977,097 SPEEDIE AND ASSOC 19-944 $ 3,600 $ 3,600 DIBBLE ENGINEERING $ 8,256 Ninyo and Moore Geotechnical and Environment $ 15,400 $ 15,400 $ 33,185 TOTAL Mesa FHC (MESA) $ 40,400 $ 40,400 $ - $ 3,600 $ - $ 2,022,138
Page 1 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Clear Title Agency (escrow) - Phoenix Metro $ 50,000 $ 50,000 $ 50,000 SPEEDIE AND ASSOC $ 3,600 $ 3,600 Clear Title Agency (escrow) - Central Phoenix Clinic $ 2,704,752 Cushman and Wakefield of Arizona Inc $ 4,750 TOTAL Central Phoenix FHC (PHXM) $ 50,000 $ 50,000 $ - $ 3,600 $ - $ 2,763,102 DIBBLE ENGINEERING 19-929 $ 6,904 DWL ARCHITECTS + PLANNERS INC 19-929 $ 238,611 $ 52,323 $ 1,026,918 Fidelity National Title (escrow) - North Metro $ 20,000 19-929 $ 20,000 $ 2,271,759 SPEEDIE AND ASSOC $ 3,300 $ 3,300 GOODMANS 19-929 $ 24,225 $ 24,225 MARICOPA COUNTY PLANNING AND DEVELOPMENT 19-929 $ 51,500 Sundt Construction Inv 19-929 $ 27,423 $ 87,631 TOTAL North Phoenix FHC (19AV) $ 20,000 $ 20,000 $ 290,258 $ 55,623 $ - $ 3,472,237 Cox Communications 19-928 $ 4,489 Centurylink 19-928 $ 24,539 $ 24,539 DIBBLE ENGINEERING 19-928 $ 7,168 DWL ARCHITECTS + PLANNERS INC 19-928 $ 68,839 $ 821,581 Fidelity National Title (escrow) - South Mountain 19-928 $ 743,456 MARICOPA COUNTY PLANNING AND DEVELOPMENT 19-928 $ 51,500 SOUTH MOUNTAIN RETAIL 19-928 $ 8,387 $ 8,387 Speedie and Associates 19-928 $ 3,600 $ 5,400 SRP 19-928 $ 8,907 Sundt Construction Inc 19-928 $ 22,438 $ 171,721 TOTAL South Phoenix FHC (SPHX) $ - $ - $ 46,977 $ 80,826 $ - $ 1,847,147 Fidelity National Title (escrow) - 79thAve&Thomas $ 50,000 $ 50,000 $ 1,873,138 DIBBLE ENGINEERING $ 6,534 SPEEDIE AND ASSOC 19-946 $ 3,400 $ 3,400 SRP 19-946 $ 24,358 $ 24,358 SIUNDT CONSTRUCTION 19-946 $ 600,275 $ 92,615 $ 692,890 Ninyo and Moore Geotechnical and Environment $ 6,600 $ 6,600 $ 10,600 $ 17,200 TOTAL West Maryvale FHC (WM79) $ 56,600 $ 56,600 $ 610,875 $ 27,758 $ 92,615 $ 2,617,520
Total Budgeted Amount $ 138,657,244 $ 8,764,771 $ 7,884,373 $ 274,529 $ 2,271,964 $ 48,911,741
Page 2 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total
Note: Prior months amount paid are hidden Functional Area - Behavioral Health Services Adams and WENDT $ 5,602 $ 102,241 ADVANCED INN VATIVE SOLUTIONS $ 11,735 $ 11,735 Airclean Systems 19-912 $ 3,850 $ 8,307 Alliance Land Surveying LLC $ 2,400 Allscripts Healthcare 18-913 $ 120,225 $ 240,450 Altura Communications 19-909 $ 157,083 $ 33,613 $ 473,187 Altura Communications 19-939 $ 11,483 $ 11,483 AMT Datasouth 19-912 $ 4,040 ARC Products LLC 19-912 $ 22,560 ARIZONA DEPT OF HEALTH 19-939 $ 150 $ 150 Arizona Lock and Safe $ 1,025 Armstrong Medical 19-912 $ 9,254 $ 9,678 $ 35,602 Arrington Watkins Architects $ 52,167 $ 52,167 $ 268,594 Arrow International 19-912 $ 598 Baxter Healthcare Corp 19-912 $ 5,368 Bayer Healthcare 18-920 $ 40,900 BEL-Aire Mechanical $ 40,215 Burlington Medical 19-912 $ 2,906 CAPSA SOLUTIONS 19-909 $ 531 $ 5,350 $ 5,881 Capsule Tech 19-912 $ 2,159 $ 109,443 Cardinal Health 19-912 $ 15,350 $ 29,382 $ 91,443 CDW Government 19-909 $ 268,039 CDW Government 19-938 $ 48,448 $ 48,448 CDW Government 19-939 $ 63,022 $ 13,116 $ 3,378 $ 79,516 CME 19-912 $ 1,068 $ 8,714 $ 178,774 Comprehensive Risk Services $ 474,403 Coviden 19-912 $ 11,736 Crosspoint Communications $ 10,058 $ 25,724 Datcard Systems 19-909 $ 18,500
Page 3 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Delynn Consultant 19-940 $ 17,657 $ 17,446 $ 10,000 $ 73,271 DLR Group Inc $ 4,222,015 EMD Millpore 19-912 $ 7,175 ENDOSCOPE SERVICES 19-912 $ 26,585 $ 26,585 Epstexas Storage 19-912 $ 423 EQ2 LLC 19-912 $ 41,000 $ 41,000 Ethos Evacuation 19-912 $ 10,130 ETL REPONSE 19-912 $ 20,888 $ 20,888 EXTENDATA SOLUTIONS $ 6,642 $ 5,004 $ 66,659 Felix Storch Inc $ 5,796 FERGUSON ENTERPRISES 19-912 $ 3,571 $ 3,571 First American Title - Maryvale Hospital $ 7,438,977 $ 7,438,977 $ 7,438,977 Follett 19-912 $ 38,837 GE Healthcare 18-915 $ 2,029,921 $ 700,431 GE Healthcare 19-901 $ 14,880 $ 14,880 GE Healthcare 18-917 $ 766,491 GE Healthcare 18-918 $ 4,172,080 $ 202,351 GE Healthcare 19-938 $ 13,999 $ 13,999 GE Medical Systems 19-912 $ 746,560 GE Medical Ultrasound 18-917 $ 139,527 General Devices 19-912 $ 47,400 Gentherm 19-912 $ 16,692 Gilbane Building CO. $ 3,908,588 $ 47,810,984 Global Equipment 19-912 $ 460 $ 125 $ 1,919 Goodmans 19-916 $ 96,476 Goodmans 19-917 $ 7,560 $ 104,809 Goodmans 19-923 $ 469,256 $ 518,500 Goodmans 19-926 $ 14,199 $ 1,250 $ 1,290 $ 146,188 Grainger 19-912 $ 15,064 $ 64,690 Graybar Electric $ 5,586 GUEST COMMUNICATIONS 19-912 $ 5,515 $ 5,515 Haemonetics 19-912 $ 4,863 $ 7,983 $ 24,546 HD Supply Facilities Maintenance Ltd 19-912 $ 40,838
Page 4 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Helmer Inc $ (5,325) $ 146,262 Hill Rom $ 20,409 HP INC 19-909 $ (26) $ 690 $ 274,383 HP INC 19-939 $ 36,365 $ 107,262 $ 143,627 HUMANE RESTRAINT 19-909 $ 35,200 Hye Tech Network 19-909 $ 35,907 $ 35,729 $ 12,392 $ 510,244 IMEG Corp $ 12,077 $ 11,500 $ 4,319 $ 66,139 Interior Solutions 19-923 $ 177,907 $ 238,194 Interior Solutions 19-926 $ 90,758 $ 90,758 Intermetro Industries 19-912 $ 3,488 $ 7,142 $ 40,327 Jensen Hughes $ 1,020 Kronos Inc $ 72,000 Lanmor Services Inc $ 1,805 LOGIQUIP 19-912 $ 1,059 $ 1,059 MARICOPA COUNTY PLANNING AND DEVELOPMENT $ 6,834 $ 271,057 MARKETLAB 19-912 $ 10,809 $ 15 $ 10,824 MCG HEALTH LLC $ 37,017 MDM Commericial 19-909 $ 40,622 Medline 19-912 $ 3,628 Medtronic 19-912 $ 7,990 Mindray 19-912 $ 9,998 Monoprice 19-909 $ 1,424 Monoprice 19-939 $ 329 $ 329 MOPEC 19-912 $ 17,220 NORIX GROUP INC 19-926 $ 11,918 NANOSONICS INC 19-912 $ 22,944 Nindray DS USA Inc 19-912 $ 85,002 Ninyo and Moore Geotechnical and Environment 19-923 $ 4,570 $ 4,570 NORIX GROUP INC $ 400,689 Olympus America $ 277 $ 32,231 OEC Medical Systems 19-904 $ 80,529 OMC INVESTERS LLC $ 11,518 Owens and Minor 19-912 $ 5,325 $ 3,231 $ 52,986
Page 5 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total PAC VAN $ 505 $ 505 Parks Medical 19-912 $ 2,130 Philips Healthcare $ 38,597 18-921 $ 38,597 $ 38,523 Physio Control 19-912 $ 19,458 PRONK TECHNOLOGIES INC $ 3,040 Radiation Physics and Engineering 18-917 $ 1,250 Radiation Physics and Engineering 18-920 $ 1,600 RETAIL MANAGEMENT SOLUTIONS $ 5,961 RICOH AMERICAS CORPORATION $ 540 $ 29,892 Ruiz Custom Upholstery 19-912 $ 5,950 $ 38,110 SCOTTSDALE RESTAURANT SUPPLY $ 5,391 Signodtics 19-912 $ 22,460 Smiths Medical 19-912 $ 9,253 SOFT COMPUTER CONSULTANT INC $ 200 $ 46,713 Speedie and Associates $ 900 $ 900 $ 2,189 SPEEDIE AND ASSOCIATES INC $ 6,703 $ 14,101 Standard Textile 19-912 $ 1,113 Stryker Communications $ 170,089 19-910 $ 170,089 $ 170,089 Steris Corp $ 13,950 Stryker $ 384,697 TBJ Inc 19-912 $ 5,654 The Cbord Group $ 15,420 $ 132 $ 18,261 THYSSENKRUPP ELEVATOR CORP $ 61,489 $ 209,448 $ 34,987 $ 472,063 Translogic 19-912 $ 3,931 Tucson Business Interiors 19-912 $ 3,000 $ 3,000 Tucson Business Interiors 19-923 $ 34,193 $ 34,193 Tucson Business Interiors 19-926 $ 39,886 $ 227,824 $ 267,709 UMF Medical 19-912 $ 11,536 Verathon 19-912 $ 14,020 VERIZON 19-909 $ 16,103 $ 16,103 WAXIE 19-912 $ 3,002 $ 3,002 World Wide Technology $ 623,431 Zoll Medical 19-912 $ 46,099
Page 6 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total TOTAL Maryvale Campus (MV) $ 7,700,731 $ 13,917,612 $ 702,056 $ 5,307,730 $ 374,418 $ 71,080,722 Adams and Wendt 19-936 $ 4,985 KITCHELL 19-936 $ 95,557 $ 95,557 TOTAL Annex HVAC Replacement (RSVT) $ - $ - $ 95,557 $ - $ - $ 100,542 $ - $ - TOTAL Annex Building Remodel (RSVT) $ - $ - $ - $ - $ - $ -
Total Budgeted Amount $ 7,700,731 $ 13,917,612 $ 797,613 $ 5,307,730 $ 374,418 $ 71,181,264
Note: Prior months amount paid are hidden Functional Area - Acute Care Facilities eSTF - Enterprise Strengthening the Foundation (see attached for detail) $ 14,000,000 17-900 $ 14,000,000 $ 14,000,000 Client & Mobility (Phase 1) $ 4,340,400 16-934 $ 1,356,068 $ 1,434,893 Client & Mobility (Phase 2) 17-906 $ 1,377,677 $ 420 $ 1,512,376 IPT (PBX Replacement) $ 3,188,083 16-909 $ 3,000,000 $ 2,430,812 Legacy Storage (DP-007) $ 2,500,000 16-910 $ 2,500,000 $ 2,478,890 Single Sign on $ 500,000 17-913 $ 90,000 $ 81,150 Fluency Enterprise $ 450,000 $ - Perimeter, Internal security $ 700,000 16-900 $ 67,176 $ 67,188 Perimeter, Internal security 18-907 $ 151,109 $ 151,310 Perimeter, Internal security 18-910 $ 44,235 $ 44,235 Perimeter, Internal security 18-912 $ 51,561 $ - Epic 2014 Monitors (Phase 1) $ 1,050,000 16-933 $ 421,500 $ 341,470 Epic 2014 Monitors (Phase 2) 17-905 $ 457,910 $ 474,480 LCM $ 200,000 16-937 $ 125,000 $ 199,936 Epic Modules $ 150,000 $ - PeriCalm or GEConnect smart tracing software $ 115,269 $ - EPCS $ 75,000 $ - New software for Contract approval routing $ 35,000 $ - Integration $ 10,000 $ - VNA & Universal PACS Viewer $ 1,200,000 $ -
Page 7 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total SEIMS $ 250,000 17-912 $ 235,134 $ 235,134 SEIMS 18-911 $ 14,468 $ - ESB Framework Enablement $ 1,280,900 18-914 $ 1,280,900 $ 1,111,233 Clinical Image Repository $ 1,262,914 18-915 $ 1,262,914 $ 1,271,214 MyChart Bedside Tablets $ 240,000 $ - Integration SOA Architecture $ 2,400,000 $ - Software Quality Assurance $ 600,000 $ - Imprivata Identity $ 576,880 18-916 $ 576,880 $ 576,880 Chartmaxx Infrastructure Upgrade $ 757,484 19-906 $ 757,484 $ 859,682 Imprivata ConfirmID $ 139,872 19-911 $ 139,872 $ 137,295 ESB (Tibco) - Infrastructure $ 176,464 19-918 $ 176,464 $ 34,861 PWIM Global Monitor Software - additional funding required to support $ 33,200 16-924 $ 35,400 $ 35,400 implementation of CER15-075, Cloverleaf Availability Patient monitors - High Acuity $ 6,979,132 16-908 $ 6,979,132 $ 6,242,292 Pyxsis upgrade 2017 $ 1,175,211 $ - Unit 10 Phase II $ 450,000 $ - Stretcher replacement $ 403,200 16-912 $ 398,013 $ 395,538 IVUS - intravascular ultrasound for placement of stents $ 160,000 16-922 $ 132,500 $ 128,048 Vigileo Monitors (8) $ 112,000 16-928 $ 111,930 $ 96,016 Balloon Pumps $ 110,000 16-920 $ 142,151 $ 146,300 Convert Unit 2 at DV to an Adolescent Unit $ 100,000 $ - Endo Tower $ 80,000 $ - Zeiss - Cirrus HD opthal camera $ 60,655 16-919 $ 60,655 $ 60,654 Vivid Q BT12 Ultrasound $ 55,750 16-931 $ 55,750 $ 55,000 Colonoscopes $ 50,000 $ - Zoll Thermoguard XP (formerly Alsius) $ 33,230 16-906 $ 33,230 $ 33,230 Replacement of tray line for room service project $ 33,000 $ - Flexible Ureteroscope (2) $ 13,390 $ - 3:1 Mesher $ 13,300 16-927 $ 13,300 $ 12,870 1:1 Mesher $ 26,600 16-927 $ 26,600 $ 26,190 2:1 Mesher $ 26,600 16-927 $ 26,911 $ 26,190 Urodynamics machine (for surgery clinic) $ 22,835 16-929 $ 17,935 $ 17,935 UltraMist System $ 20,120 16-925 $ 24,670 $ 20,195 Replace Chair in Eye Room $ 20,000 $ -
Page 8 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total EVS UV floor equipment $ 18,500 $ - Fluid Warmers $ 6,494 $ - Puffer Tenometer $ 5,200 $ - Doppler $ 3,950 16-935 $ 3,950 $ 3,950 Autostainer (Histology) $ 47,000 $ - Ultrasound (for breast clinic) $ 27,821 16-931 $ 27,821 $ 22,685 Biom 5 $ 10,513 16-930 $ 10,513 $ 8,051 HINNI Laryngoscope $ 8,645 $ - Wilson Frame $ 5,253 18-902 $ 5,322 $ 4,801 Medical Beds for Psych Units $ 209,968 16-932 $ 207,429 $ 208,879 King Tong Pelvic fx reducer $ 8,600 16-926 $ 8,600 $ 9,500 Stryker Core Power Equipment --Contract $ 369,113 16-904 $ 369,113 $ 369,113 Patient Monitoring (Low Acuity) - Formerly named Alarm Management $ 350,010 16-907 $ 350,010 $ 347,029 AIMS Upgrade $ 176,382 16-901 $ 52,482 $ 51,232 AIMS Upgrade 16-902 $ 12,000 $ 12,000 AIMS Upgrade 16-903 $ 101,500 $ 112,850 Temperature Monitoring - Non FQHC Depts $ 150,000 17-908 $ 119,219 $ 133,615 Blood Culture Instrument Lease $ 88,650 $ - 2 Pillcams for Endo $ 13,950 17-911 $ 13,826 $ 13,826 Replace 11 ultrasounds $ 1,307,000 16-931 $ 1,307,000 $ 1,142,345 POC Ultrasounds (10) $ 450,000 16-931 $ 455,128 $ 634,702 Plant upkeep and repair $ 2,420,000 $ - Ice Machine Replacement 16-911 $ 23,801 $ 23,000 Steam Condensate Return Piping Replacement 16-914 $ 62,569 $ 62,529 Laundry/Finance/Payroll/Facilities Roof Repairs 17-917 $ 82,955 $ 82,955 Minor renovations $ 1,080,000 $ - Replace OR Cabinets $ 30,000 $ - Batteries $ 12,000 $ - Roof Repair/Replacement $ 1,500,000 $ - MMC 7th Floor Roof 16-905 $ 276,425 $ 274,582 Facility upkeep $ 3,655 17-910 $ 3,655 $ 4,205 Facility upkeep $ 52,790 18-905 $ 52,790 $ 69,218 Colposcopes $ 23,421 18-909 $ 23,421 $ 24,607
Page 9 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Chandler ADA Doors $ 5,667 18-042 $ 5,667 $ 5,867 Glendale Digital X-Ray unit and Sensors (Panoramic Digital AND Nomad digital) $ 68,202 16-917 $ 68,202 $ 63,217 Chandler Dental Digital Radiology - Panoramic x-ray $ 63,564 16-915 $ 63,564 $ 63,564 CHC - Digital Panoramic x-ray $ 60,419 16-916 $ 60,419 $ 60,419 CHC Dental Replace Chairs Lights, Compressor and Deliverey Units $ 127,642 18-905 $ 127,642 $ 127,642 CHC Cost for new equipment and cost of moving existing to Avondale X-Ray $ 70,276 16-921 $ 70,276 $ 83,327 Avondale- Replace all flooring. $ 70,435 17-904 $ 70,435 $ 72,635 Temperature Monitoring - FQHC Depts $ 52,936 17-909 $ 52,936 $ 82,219 McDowell Dental $ 15,990 16-918 $ 15,990 $ 15,990 CHC Internal Medicine Clinic Renovation - Increase the number of exam rooms to $ 217,539 18-900 $ 217,539 $ 221,124 accommodate 1st, 2nd & 3rd yr residents as of July 1, 2017 plus the attendings and CHC Dental Autoclave Replacement including printer & Cassette rack $ 19,122 18-908 $ 19,122 $ 19,122 Chandler Dental Autoclave Replacement including printer & Cassette rack $ 6,374 18-908 $ 6,374 $ 6,374 Avondale Dental Autoclave Replacement including printer & Cassette rack $ 6,374 18-908 $ 6,374 $ 6,374 FHC Helmer Medical Refrigerators $ 11,110 17-714 $ 11,110 $ 11,110 FHC Helmer Medical Refrigerators $ 156,625 17-901 $ 156,625 $ 164,096 FQHC Contingency - addtl camera $ 28,500 16-936 $ 28,500 $ - Cabinet and Countertop Replacement South Central FHC $ 8,419 18-904 $ 8,419 $ 8,419 CHC Dental Refresh $ 89,374 18-905 $ 89,374 $ 96,361 POC Molecular (26 units) $ 1,069,947 19-914 $ 1,069,947 $ 362,520 $ 80,640 $ 1,049,613 Bili Meter - Draegar (10 units) $ 71,875 19-927 $ 71,875 $ 71,875 $ 71,875 Colposcope - Guadalupe $ 9,686 19-925 $ 9,686 $ - Colposcopes (2 units) $ 19,371 19-434 $ 19,371 $ - EKG machines (3 units) $ 37,278 19-922 $ 37,278 $ 37,278 Ultrasound machines (2 units) - Women's $ 208,180 19-417 $ 208,180 $ - South Central FHC Cooling Tower Repairs $ 14,548 19-707 $ 14,548 $ - South Central FHC Security Fencing Due to Vandalism $ 19,488 19-015 $ 19,488 $ - CHC Pediatric Clinic (Primary Care) Pharmacy Refrigerator $ 7,759 19-709 $ 7,759 $ - FQHC Contingency / Emergency - FQHC LAL only $ 383,434 $ - Bond related expenses (legal fees, etc.) $ 325,646 N/A $ 325,646 $ 325,646 Audiology - Astera Audiometer $ 11,326 16-913 $ 11,326 $ 11,326 3rd Floor Behavioral Health/Medical Unit Remodel $ 2,532,000 17-903 $ 2,532,000 $ 2,568,688 22 Behavioral Health Beds for 3rd Floor MMC $ 181,773 17-907 $ 181,773 $ 185,150 Replace MMC Radiology GE Fluoroscopy Imaging Equipment $ 274,145 17-914 $ 274,145 $ 262,145
Page 10 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Endura CCTV System Replacement $ 167,422 18-901 $ 167,422 $ 137,015 IT - (17-900) eSTF Project $ 92,032 17-900 $ 92,032 $ 92,032 Diablo Infrastructure Costs $ 306,662 18-903 $ 306,662 $ 275,387 Epic Willow - Ambulatory & Inventory $ 964,038 18-906 $ 964,038 $ 70 $ 348,549 Navigant - Proposition 480 planning $ 994,000 16-923 $ 994,000 $ 994,000 Kaufmann Hall - Prop 480 planning $ 370,019 16-923 $ 370,019 $ 370,019 IPv4Xchange (ARIN Based Transfer Escrow Payment) $ 7,040 16-923 $ 7,040 $ 7,040 Vanir Construction Management (Planning Phase) $ 749,971 17-915 $ 749,971 $ 749,971 Vanir Construction Management ($48M) ($48,300,501 - Entire Project) $ 6,227,840 17-916 $ 6,227,840 $ 6,227,840 IPMO Modular Building $ 305,106 17-902 $ 305,106 $ 305,106 Dickenson Wright PLLC $ 181,495 16-923 $ 181,495 $ 181,495 Sims Murrary LD $ 24,128 16-923 $ 24,128 $ 24,128 Devenney Group LTD $ 242,450 16-923 $ 242,450 $ 242,450 MTI Connect Inc $ 181 16-923 $ 181 $ 181 SHI INTERNATIONAL 19-911 $ 2,577 $ 2,577 Payroll/Supplies/Misc Expenses $ 792,042 16-923 $ 792,042 $ 792,042 EPIC replatform and upgrade to 2016 (see attached for detail) $ 9,000,000 17-900 $ 9,000,000 $ 7,480,710 Reimbursement for Capital Expenditures $ 36,000,000 N/A $ 36,000,000 $ 36,000,000 TOTAL Tranch 1 $ 117,224,854 $ 102,000,075 $ 434,815 $ 83,287 $ - $ 98,204,694 Atlantic Relocation Systems $ 16,750 $ 5,484 $ 31,576 Bond issuance costs $ 228,750 $ 228,750 $ 1,163,260 BPG Technologies LLC $ 116,183 Cable Solutions LLC $ 53,370 DH Pace $ 1,468 Dickinson Wright PLLC $ 1,200 $ 212,416 Enterprise Security 16-923 $ 13,715 FC Hospitality 16-923 $ 8,376 HD Supply Facilities Maintenance Ltd $ 1,848 Hye Tech Neywork and Security Solutions $ 41,154 Innerface Architectural Signage $ 14,761 IPMO Modular Building $ 83,504 17-902 $ 83,504 $ 4,905 $ 4,905 $ 4,905 $ 161,086 Goodmans $ 4,790 GOODMANS 16-923 $ 19,996 $ 19,996
Page 11 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total Lovitt & Touche Inc 19-934 $ 121,906 $ 884,103 $ 2,737,603 MIHS IPMO Food - Catering 16-923 $ 104 Payroll/Supplies/Misc Expenses $ 792,900 $ 792,900 $ 129,533 $ 123,155 $ 125,322 $ 2,680,275 PHOENIX FENCE $ 2,283 Sims Murrary LD $ 4,067 $ 24,182 Skyline Builders And Restoration Inc $ 122,769 Tempe Diablo LLC $ 33,132 Tucson Business Interiors $ 445,787 Vanir Construction Management ($48M) ($48,300,501 - Entire Project) $ 4,054,473 $ 4,054,473 $ 570,964 $ 511,139 $ 470,597 $ 13,103,678 World Wide Technology Co Inc $ 5,978 Zurich North America 16-923 $ 47,500 TOTAL Enterprise $ 5,159,627 $ 5,159,627 $ 865,254 $ 1,528,786 $ 604,891 $ 21,047,290 Adams and Wendt 19-935 $ 7,815 APS 19-935 $ 331,266 Affiliated Engineers Inc 19-935 $ 983,861 $ 279,974 $ 1,466,905 Affiliated Engineers Inc 19-935 $ 1,885,346 ENGINEERING ECONOMICS 19-935 $ 37,228 $ 37,228 KITCHELL 19-935 $ 123,734 $ 621,878 $ 1,627,779 $ 2,373,391 Maricopa County 19-935 $ 219,965 Soft Computer Comsultants 19-935 $ 46,513 TOTAL Central Utility Plant (RSVT) $ - $ - $ 1,144,824 $ 621,878 $ 1,907,753 $ 6,368,429 Cunningham Architect 19-947 $ 70,000 Devenney Group LTD $ 482,057 $ 482,057 $ 530,623 GOODMANS $ 2,488 $ 2,488 Innerface Architectural Signage 19-948 $ 862 $ 862 Kitchell $ 475,480 $ 682,054 $ 236,405 $ 2,532,475 Kitchell 19-937 $ 329,949 $ 329,949 MARICOPA COUNTY PLANNING AND DEVELOPMENT $ 149,500 RMJ Electrical Contractors $ 551 Thomas Printworks $ 130 $ 5,676 TOTAL Roosevelt Campus Site Development Plan (RSVT) $ 482,057 $ 482,057 $ 478,098 $ 682,054 $ 567,216 $ 3,622,124
Total Budgeted Amount $ 122,866,539 $ 107,641,759 $ 2,922,991 $ 2,916,005 $ 3,079,860 $ 129,242,536
Page 12 of 13 MARICOPA INTEGRATED HEALTH SYSTEM Care Reimagined - Spend report
Note: Prior months amount paid are hidden Description Budgeted Amount CER Number CER Amount Amount Paid Amount Paid Amount Paid Amount Paid JUN 2019 JUL 2019 AUG 2019 Cumulative Total
Bond Proceeds $ 631,287,454 $ 130,324,142 $ 11,604,977 $ 8,498,264 $ 5,726,241 $ 249,335,541
VARIANCE: Bond Proceeds amount vs CER amount issued $ 500,963,312
REMAINING Cash for disbursement #REF! $ 381,951,912.49
Page 13 of 13
Maricopa County Special Health Care District
Board of Directors Formal Meeting
September 25, 2019
Item 7.c.
Reports to the Board Monthly Valleywise Health Employee Turnover Report ;;+96-2+2#!!%()
52$=1
!"!#$%I%&'() 8"%% 8"% ,<64# @AB @AB%(%?6 @AB% +D@AB E7F27$621 94$<64 @ABC +D@ABC E7F27%C 52$=1C ./0# ./0#%(?6 (#$%?6%C J/<7<#$6=$<84 LQML& (&ML& (' O & (MNL%C L ( ( (M&Q%C 'MO&%C 'M(U%C &M(P%C G1<7 E7F27$621 52$=1%HB=#$%(&%*27$R#K 8"%% 8"% ,<64# @AB @AB%(%?6 @AB% +D@AB 94$<64 @ABC +D@ABC E7F27%C 52$=1C ./0# ./0#%(?6 (#$%?6%C J/<7<#$6=$<84 PQOML& (&&MUN (() )& NP &UML)%C && (O (& (QM&(%C NMUU%C NM''%C &NM')%C G1<7 7'<(.+=/$6>;>3456 !"#$%&'()*+'$,+-)'./$0&1&2.$3456 781+$3:;$)9$3:; Maricopa County Special Health Care District Board of Directors Formal Meeting September 25, 2019 Item 8. No Handout Concluding Items