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Currents To Medical Center employees: A significant step was taken to put the planning process into motion for new clinical facilities, including the main hospital, at the recent MUSC Board of Trustees meeting. Our main hospital was constructed in 1955 and over the past two decades there have been numerous renovations. The facility has reached its “life expectancy” and a replacement is badly needed. It is very encouraging that the process for a replacement has been set into motion.  The board approved moving forward with the process to select a firm to develop a comprehensive clinical facilities plan. The plan, among other things, will describe the options for clinical facilities, including options for phasing of relocation and future use of existing facilities. The plan will be consistent with our mission and clinical enterprise strategic plan.  To underscore MUSC's commitment to this major initiative, Dr. Ray Greenberg, MUSC president, announced plans (as reported recently in The Catalyst) to give Mr. Marion Woodbury, CEO, University Medical Associates, a new role and new responsibilities. In his new position, Woodbury will work on the planning, funding and construction of future clinical facilities and expansion. He will address funding issues related to the institution’s current debt structure and recommend ways to help increase borrowing capacity. The board also approved a number of significant purchases for the Medical Center, including: computer hardware and software to upgrade radiology’s picture archive and communication system (PACS) at a cost slightly in excess of $2 million; and, lease of a neurovascular portable C-Arm system with a cardiovascular imaging table for the main operating room at a cost of approximately $293,000. Approval also was given for purchase of equipment and renovation of space for an islet cell laboratory clean room, at a total cost of approximately $1.3 million. The equipment will be purchased with funds donated by the Health Sciences Foundation. The clean room will enable cellular isolation of products for treatment of diabetes, transplants, myocardial infarction and stroke. There is reportedly no other comparable service in our state. Thanks to everyone for a job well done. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   Medical Center shows solid bottom line The MUSC Hospital Authority closed its fiscal year in June with a $6 million surplus, ending three years of losses, said Lisa Montgomery, administrator, Finance and Support Services, who addressed the management team at the Aug. 14 communications meeting. “We had a loss of $23 million last year,” Montgomery said. “To have a $6 million net increase in the fund balance—that’s fantastic!” Savings were effected largely as a result of stemming spending increases, a 2 percent increase in inpatients and renegotiated managed care contracts. Montgomery pointed out, however, that the FY 2001 financial statements are currently being audited and would probably result in some adjustments. While the FY2001-2002 projected budget holds the line in most areas, hospital salaries are the exception. Montgomery said increases in the salary budget are largely a result of the scheduled January 2002 performance pay increases and adjustments to RN salaries that were necessary to remain competitive in the marketplace. Of the authority's $464.8 million actual budget (FY 2000-2001), $136.6 million represents salaries. Budget projections show that figure will increase by $11.7 million in the current fiscal year. Currently, the FY 2002 budget is a balanced budget with no projected margin. The Medical Center just conducted a five-year financial plan for capital projects. Montgomery said the hospital needs a 4 to 5 percent margin to accomplish the capital plan. “If nothing changes, it's going to be difficult to achieve the necessary margin,” she said.  “Our challenge is building cash,” Montgomery said. The authority depends on a line of credit for cash flow, which is currently tapped at $12 million. In order for the authority to build a cash reserve that will allow the hospital to borrow money for capital projects, it needs annual surpluses of about $20 million. She said Moody’s Investor Service downgraded the hospital’s bond rating two points last year because there was no cash on hand. Other benchmark operating and financial indicators, however, that compare MUSC to other institutions show, “we fair pretty well as compared to our peers.” MUSC is one of the better performers in several categories.  Based on requests from the management team, Montgomery said a brief financial report will be presented during the communications meeting each month. Further, in trying to make the communications meetings more interactive, Montgomery invited departments to share information with the team so that individuals and departments will get to know each other better. To make arrangements, contact Montgomery at 792-4775 or Stephanie Davis at 792-3897. Compliance audit and training update A coding and billing audit conducted recently by the Office of the Inspector General (OIG) of the Department of Health and Human Services turned up no errors, according to Reece Smith, Medical Center compliance officer. The auditors also pulled a random sample of 100 employees, 50 to confirm training and 50 to confirm receipt of the Code of Conduct. According to Smith, all 50 employees included in the training audit had received training, though there were a few employees who received the training late.  Of the 50 employees selected to confirm receipt of the Code of Conduct, 49 were complete and the missing record was for a former travel nurse whose file had been discarded. The audit occurred as part of the settlement provisions from the billing lawsuit settlement reached last year. All MUSC Medical Center employees must complete a certain level of compliance training. A five-year institutional compliance agreement stipulated that all personnel involved in billing or patient care had to complete two hours of general compliance training within 90 days and two hours of billing training within 180 days of the settlement A revised Code of Conduct will be disseminated as FY02 training is accomplished. The proposed FY02 Compliance Training includes one hour of general training and two hours billing training with an April 30, 2002 deadline. The Compliance Office is in the process of putting together a packet of information that can be used during departmental competency days.  Training the trainer sessions will begin within the next three weeks.  Any training that occurs outside of this format has to be pre-approved. All employees are required to receive and sign the Code of Conduct. Compliance waivers should be issued for individuals and entire cost-centers that are not involved in patient care or patient billing. OIG’s definition of included individuals pertains to those who perform any of the following duties: Register or schedule patients; Treat patients; Document the treatment of patients; Complete test request forms; Complete charge tickets; Assign accommodation codes; Assign discharge status; Assign supply stickers; Enter charge information into a computer; Use an automated pharmacy or supply dispensing system (such as PYXIS); Submit or adjust patient bills; Process Medicare cost reports; Make decisions regarding any of the duties listed above Training materials include six elements: The submission of accurate requests for reimbursement for services rendered to federal health care program patients; Policies, procedures and other requirements applicable to the documentation of medical records; The personal obligation of each individual to ensure the information documented by each individual, whether relating to actual patient care, the type of services or items delivered, or the coding of such services or items is accurate and meets the federal and state requirements for the federal health care programs, as well as MUSC’s policies; Applicable reimbursement statutes, regulations, and program requirements and directives; The legal sanctions for improper reimbursement submissions; Relevant examples of proper and improper billing practices New employees are required to receive two hours of general compliance training and two hours of billing training within 30 days of hire. The general training is a part of the Monday MUHA Employee Orientation. New employee billing training sessions are available via the following: Bi-monthly billing orientation (Monday 8:30 a.m.) Clinical Services Orientation (Wednesday, Thursday, Friday, Monday) Finance/Support Services Orientation (Wednesday, Thursday) Pre-approved Departmental (approval form required) Travelers Packet (Travelers only) Do not use PCT Packet or Tapes for New Employees “I just want to reinforce that if you have new employees, you need to make sure they are trained.  If you are unsure of how your new employees are being trained, contact me immediately at 792-6128,” Smith said. Medical Center works to meet continued JCAHO readiness The MUSC Medical Center is committed to maintaining Joint Commission (JCAHO) readiness across the organization, according to Stuart Smith, who introduced Lois Kerr of Wilson, Cunningham and Kerr Associates. Kerr has been consulting with MUSC concerning the JCAHO accreditation process since February 1997. While the Medical Center performed very well when it was surveyed by JCAHO last year, the intense effort it took to get ready in six months was taxing. “We ought to be able to make this a way of life, so we don’t have a tremendous rush at the last minute,” Kerr said to the management team. “We need to be in a continuous state of readiness.” The goals of the new structure are: Meet and maintain continued JCAHO readiness across the organization Link JCAHO readiness with other regulatory standards Integrate readiness across the organization Minimize resources necessary to achieve and maintain accreditation Maximize knowledge and resources available across the organization Decrease crisis approach to standards preparation Build standard requirements into current and new processes as they occur Have JCAHO and other regulatory requirements be leadership-driven but employee owned Decrease fragmentation of JCAHO readiness process, i.e., clinical, operational, psych, medical staff, and ambulatory care Organize the JCAHO function to minimize logistical requirements, i.e., schedules, meetings, rooms, minutes Improve overall compliance Through training empower employees of MUSC to value continued readiness Kerr emphasized the need to identify and remove barriers to the process of continuous readiness. A steering committee was created to help with this process. Committee members will also serve as liaisons to management to help in removing barriers to the readiness process.  Kerr also recommended shifting the focus from just meeting JCAHO standards to meeting the intent of the standard as it relates to quality patient care. Kerr introduced Terri Ellis who will serve as the new JCAHO administrative coordinator.