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Currents At our Aug. 24 communications meeting, I updated our management team on our unfavorable cash position and some of the measures underway to improve our situation. While our patient volume has remained very high for a prolonged period of time, a series of events during the past couple of years has diminished our cash status. I also gave our management team a recap of capital improvements, as highlighted below, which have been approved and are in various planning stages. We recently gained approval to issue $52 million in bonds for these capital improvements. Money from bonds cannot be used to address our cash flow issue, other than for some reimbursement for capital improvements recently completed or currently underway. As I have mentioned on a number of occasions, a series of events led to our current cash situation. Following change management in 1994, we reduced staffing significantly, and hiring was difficult. We were in a holding pattern from 1995 to 1998, awaiting resolution of the proposed affiliation. During that time, major equipment purchases and capital improvements were greatly limited. At the same time, our patient activity continued to increase. The Medical Center's favorable cash status during fiscal years 1995-1998 enabled a transfer of approximately  $120 million to the university to support the overall mission. Beginning with fiscal year 1998 and continuing into fiscal year 1999, several factors led to a major reduction in the Medical Center's cash balance. We began hiring more employees to address patient care demands. We also reached a point where we had to move forward with various equipment purchases and capital improvements—using cash. In August 1998, the Medical Center incurred significant costs with the opening of Rutledge Tower. Also, we began to feel the effect of decreases in Medicaid/Medicare reimbursements resulting from the 1997 Balanced Budget Act, while we continued to provide care for a large number of unfunded patients. We are taking a number of measures to improve our cash situation. In last week's Currents, I mentioned the hiring moratorium that has been implemented. We have put procedures in place to dramatically decrease our hiring, while ensuring that patient care needs are fully met. Some limited bond funds were made available to reimburse costs for certain capital improvements recently completed. Plans are underway to ensure for appropriate federal reimbursement for graduate medical education. We also have preliminary plans to seek consultative services to improve our collections. In the future, we expect the Medical University Hospital Authority Act will enable the Medical Center to operate more efficiently. Finally, our board of trustees will review a long-term plan to ensure that we continue to fulfill our mission, while also addressing the significant financial burden of providing the majority of our area's unfunded care. W. Stuart Smith Vice President for Clinical Operations Executive Director, MUSC Medical Center Capital Improvement Projects Main operating room—Renovate most existing rooms to gain three additional rooms. Create efficient patient flow and appropriate pre- and post-operative areas. Emergency Services expansion—Allow for the separation of adult and pediatric ambulatory patients from trauma patients. Expand the number of exam rooms and creates appropriate waiting areas. Fourth floor hospital improvements—Rework ICU entrances for easier access. Rework waiting room areas, replace lighting and make aesthetic improvements. Heart cath lab (EP)—Create a lab for shared adult and pediatric procedures to meet the overflow from both services. “Backfill” (spaces vacated by the occupancy of Rutledge Tower)  MEDUCARE staff will move to the bank building.  Relocation of dialysis to allow for expansion of the nurseries on main hospital's fifth floor.  Training space for electronic medical record system on second floor of Clinical Sciences Building.  Phase I for Vascular Center for cath labs and interventional radiology on fifth floor of Children's Hospital.  Infrastructure and deferred maintenance  Main hospital and Children's Hospital air conditioning upgrade  Medical Center flooring replacement in patient care areas  Children's Hospital exterior waterproofing  Medical Center transformer substation replacement  Roof repairs  Morgue renovation  Me Issues Committee Update The Me Issues Committee has held a number of meetings to prepare recommendations for new grievance and paid-time-off policies, and to address other human resources issues related to conversion to the Medical University Hospital Authority. The committee continues to respond to questions from employees. Some questions and answers appeared in the July 30 issue of Currents, and additional questions are addressed below. You can send questions to the committee by e-mail (ME Issues) or through campus mail to: Me Issues Committee, Post Office Box 250332, Hospital Administration Mail Room  In preparation for the Columbia/HCA affiliation, an agreement was reached to allow employees with more than 15 years of service to remain in the state system. Wouldn't it be good to recognize long-term employees who now accrue maximum leave by allowing them to remain in the state's leave program? Under the proposed Columbia/HCA affiliation, the primary reason for allowing long-term employees to remain in the state system (for five years) was to safeguard employees' retirement. The authority legislation allows employees to continue participation in the state retirement plan.  Under the authority, we plan to convert all Medical Center employees to a paid-time-off policy.  Among other things, the KPMG report highlighted the fact that our state leave program creates a need for higher staffing factors. The Me Issues Committee wants to recommend a new paid- time-off plan for the authority that is aligned with industry standards, recognizes seniority, encourages prudent use of leave and provides incentives. Will employees still be able to use 360 hours of annual leave and 90 days of sick leave toward retirement? Yes. Under our current state plan, employees may improve their average final compensation (12 quarters) by having up to 360 hours annual leave payout (upon retirement) included in the calculation. The Me Issues Committee recommends that under a new paid-time-off plan, this payout of up to 360 hours should continue to be included in the average final compensation. Also, the Me Issues Committees recommends that up to 90 days of sick leave, as an “extended sick leave” provision of a paid-time-off program, should continue to be credited for retirement system benefits. Will we still be able to keep our 401(k) plans along with our regular state retirement? Yes. Will there be changes for shift differential? We don't expect any major changes to shift differential. However, under the authority, the Medical Center administration will have the discretion to change shift differential rates to address market demands as needed. Also, we expect that in the future shift differential for nonproductive hours (for periods of leave) will not be paid, since shift differential pay for nonproductive time is not an industry standard. Will holiday work time be paid at time-and-a-half like private hospitals? There is no plan at this time to pay holiday differential. However, the authority will give the Medical Center administration the discretion to align pay practices with the labor market. Will 36 hours a week or 72 hours a pay period be considered full-time, and leave earned at full-time rate instead of prorated? A full-time schedule for leave and pay purposes will continue to be 40 hours per week and 80 hours per pay period (2080 hours annually). What will happen to our accrued leave as of January 2000? Will it be rolled into our paid-time-off pool and sick leave pool if that is an option? A commitment has been made that no employee will lose any accrued leave. The Me Issues Committee will prepare recommendations on how to convert annual and sick leave into a new paid-time-off plan, but details have yet to be resolved.  The Me Issues Committee is currently debating the details and analyzing leave usage to determine how the paid-time-off programs should be structured. Recommendations will be made to the Medical Center administration, President's Council and the board of trustees once the details are resolved.  In any event, no employee will lose accrued leave. Will employees still be eligible for medical and dental insurance after serving 20 years? Authority employees will continue to be covered by state retirement and insurance programs. Currently, these state programs provide insurance after serving 20 years as long as the last five years are consecutive. We do not foresee any changes to this program by the state. Will there be more .9 FTE positions? The authority will have no direct bearing on this issue. Managers will continue to determine work loads and schedules. (Usually the .9 FTE is used for 36-hour work weeks to staff three 12- hour shifts.) The July 30 Currents included two questions and answers that need clarification. The question was asked whether the authority will offer an early retirement program. There are no plans to offer early retirement, aside from the provisions that currently exist under the state retirement system.  Another question dealt with whether sick leave can be used for early retirement. Under the state retirement system, employees who are 55 years of age, with 25 years of service, may elect early retirement, but the benefits will be reduced.  Also, up to 90 days of sick leave accrued at the time of retirement “whether full retirement or under this 55/25 plan” can be credited toward service for calculation of benefits, but may not be used to become eligible for retirement or early retirement. If you need more information about this issue, call Janet Browning at 792-1208 or Katy Kuder at 792-0858.    Announcements Upcoming bloodmobiles MUSC Horseshoe Thursday, Sept. 2: 9 a.m. - noon; Thursday, Sept. 16: 9 a.m. - noon; Wednesday, Sept. 29: 2 - 5 p.m. Harborview Tower Thursday, Sept. 16: 2 - 5 p.m.; Wednesday, Sept. 29: 9 a.m. - noon Harper Student Center Gym Tuesday, Sept. 21: 11 a.m - 6 p.m. Please call 852-2922 with any questions, to schedule an appointment to donate, or to find out how you can help American Red Cross Blood Services. We also need platelet donors to help cancer and leukemia patients. Contact the MUSC Apheresis Center in room 267 of the main hospital at 792-3340 or 852-2922.  Y2K Message Call 876-1446 to get a copy of the Year 2000 Resource Packet.