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Annual Report / 2009-2010 - - Central Michigan University


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Annual Report / 2009-2010 - - Central Michigan University

  1. 1. 6/11/2010 University Health Services • | PREPARED BY: Tom Trionfi, Director, 301 Warriner, 774.3166 UNIVERSITY HEALTH SERVICES ANNUAL REPORT 2009-2010
  2. 2. I. Organizational Structure: Tom Trionfi Director Penalope Cook D.O. Medical Director, Associate Director SarahYonder, MD Allan Riggs, PA-C MarilynMcGinty, PA-C Relief Vacant Assistant Director of Clinical Operations Lori Wangberg, HealthEducator MaryArmstrong, MLT Laboratory Barb Elmore, RN Clinical Suite Denise Malley, LPN Clinical Suite Carol Mullet, Specialist Clerk Appointments Jill Steffke, RN Clinical Suite / PrimaryCare Susan Woerle, RN Relief Lora Zenz, RN Clinical Suite Laurie Patton Med Tech Laboratory Angela Smith, Assistant Director of Business Operations TiffanyStiff, Administrative Secretary JuliannBall, HealthInformation Specialist Margie Clark, HealthInformation Specialist Pam Wentworth, Specialist Clerk Front Desk Cherie Selles, RPh PharmacyManager Craig Buys, RPh Pharmacist Relief Sue Lott, PharmacyTech
  3. 3. 2 II. Executive Summary of the Major 2009- 2010 Accomplishments: CMU’s University Health Services mission statement is: To promote the health and wellness of CMU students and the University community by providing individualized medical care, health promotion, and disease prevention services tailored to the dynamic needs of the CMU campus. Public Health is a main priority of the staff of UHS and we strive to make an impact for the wellness of our campus community. UHS staff is involved in reporting directly to Michigan Department of Community Health through the Michigan Disease Surveillance System. When communicable diseases are noted an investigation is started here at UHS and the local health department is also notified, we then work in conjunction with CMDHD to provide an investigation and the treatment of exposed individuals and testing. Of particular importance, the emergence of a new strain of influenza (H1N1 flu) presented itself last fall, not only on the CMU campus, but of course to the community, the nation, and world-wide. Countless hours were spent coordinating efforts with the health department and different departments on campus to make sure that immunization clinics were held, students were educated and patients were treated with medical excellence and care. There was a huge influx of flu patients last October, November and December and to the staff’s knowledge they had never seen true influenza cases before December, in the past. There were also a large number of students and other workers exposed to asbestos during the summer of 2009. All of the people were seen for screening here at CMU UHS. 1. Successfully handled the threat of an H1N1 outbreak by working collaboratively with various campus departments to treat, educate and communicate the impact on the campus and the strategies that were being undertaken to mitigate the spread. 2. Increased recognition with student population: In the Fall semester we opened with the support of Residence Life, a “quick clinic” within the Towers complex. Each Monday a physician and assistant will be available for students to quickly access our services without leaving their hall. 3. Have the potential to increase patient load with the strategic move to replace the vacated Asst Director of Clinical Operations with a Nurse Practioner with the credentials to see patients. 4. Enhanced Revenues: Engaged in a collaboration with ARAMARK to offer our “over the counter” items in their convenience stores (C-Stores). In addition, discussions are in place to possibly have their employees utilize our clinic, lab and pharmacy. 5. Consolidated the various health service areas onto one floor. The Pharmacy and Primary Care areas were moved up to the second floor for patient efficiencies and access.
  4. 4. 3 6. Created overall recognition with new signage on Foust and customer access by adding a bus stop in front of Health Services. 7. Undertookthe International Student’sHardWaiverInsurance Program. Thisresponsibility usedto be heldbyOIA. This hasledto some challengesinthe areasof manpowerto successfullymanage the program. UHSwill use United’sPartnerCentertotrack and maintainconsistentcompliancewiththisprogram. 8. Passed COLA (Commission on Laboratory Accreditation) Accreditation in July 2009. Made recommended changes. Passed with 100% all Proficiency Surveys. 9. HIV Tester/Training: Completed State of Michigan HIV Test Counselor training in Lansing in October. Free HIV testing clinic was offered and held in Foust 104 in collaboration with Health Department for World Aid’s Day, December 1. 10. Website training provided by Jesse Earley from I.T. which was an in service on maintenance of the Health Services website to allow for faster and more efficient updates to the website. 11. H1N1: Attended workshop provided by Central Michigan District Health Department on campus of Mid-Michigan Community College, in preparation for H1N1 flu prevention/preparedness. Provided presentations in late fall to campus community, which included students and custodial staff. 12. Alcohol Awareness Programming - Red Watch Band: New program implemented addressing binge drinking/alcohol awareness, courtesy of a grant through Prevention Network. This is a national program that began out of New York, after a young college student died of alcohol poisoning. Three workshops completed, two more planned for fall. This is a collaborative effort with the Isabella County Coalition to Reduce Underage Drinking and Becky Wang from 10/16 Recovery Network. Marketing efforts/ideas will also take place this summer. 13. Other involvement in campus activities include:  Participation in Wellness Coalition  Towers Clinic opened and saw 127 patients  Clinical teaching for 3 students from the PA program who rotated through health services.  Participation on search committees for the counseling department, the new medical school in the search for associate dean positions, and participation on multiple searches for a nursing director/PA here at health services.  H1N1 clinics for Soccer, Basketball, Lacrosse, Football  Participation in Get Acquainted Day  Presentation to Resident Assistants  Health Fair for employees with flu vaccine given on site  Wellness Health Fair participation providing approximately 100 blood pressure checks on site  Fall into Health Fair providing B/P checks on site  Provided Meningitis clinic during move in week at the Towers  Flu Clinic for Men’s Basketball team  Flu Clinic for Men’s Baseball team  Presentation for International Students providing overview of Health Services.  Participation in summer orientation for incoming freshman.  Provided orientation lecture regarding Travel Clinic to the following groups:  Faculty  Students
  5. 5. 4  TB Clinics for PA students  Immunization reviews for PA students  Orientation for PA students  Family Planning Advisory (CMDHD)  Contact with the Isabella County Health Department on multiple occasions for STD tracking, emergency planning, etc.  Guest lectured to the DPT graduate students on Infectious Diseases. III. Table of Operational and Statistical Data: Nursing: The Primary Care clinic gave a total of 1233 immunizations (flu and H1N1 are counted separately) and over 400 various injections such as B-12, Depo-provera, depo-medrol and other pain medication, antibiotics and antiemetics. Allergy Services include: 1. 783 allergy injections 2 or more injections 2. 399 single injections Flu Clinic: 1. 899 doses of flu vaccine given 2. 984 doses of H1N1 vaccines given Note: Due to PyraMed tracking it is difficult to determine numbers of specific procedures performed by nursing unless it is coded as such. The following are what was determinable: Procedure Number Performed 7/09-5/10 Number Performed 7/08 EKG 21 24 IV insertion 13 25 Centimist Tx 94 68 Peak Flow 57 87 Pulse Ox 113 59 Spirometry 1 1 Ear Irrigations Unable to assess due to Pyramed Nurse visits other than immunizations or injections 46 No charge nursing visits Tb reading, B/P checks, new depression med check, etc. 711 1008 Telephone calls requiring follow up 1647 1523
  6. 6. 5 INFECTION CONTROL EFFORTS AND COMMUNICABLE DISEASE TRACKING: Public Health is a main priority of the nursing staff of UHS and we strive to make an impact for the wellness of our campus community. UHS nursing staff is involved in reporting directly to Michigan Department of Community Health through the Michigan Disease Surveillance System. When communicable diseases are noted an investigation is started here at UHS and the local health department is also notified, we then work in conjunction with CMDHD to provide an investigation and the treatment of exposed individuals and testing. Activity includes: DISEASE 2009-2010 2007-2008 Gonorrhea 1 0 Chlamydia 29 47 Hepatitis 0 1 A 1B MRSA 13 12 Pertussis 2 surveillance Mumps 0 1 TB exposure 0 0 Meningitis 0 1 Norovirus 0 0 HPV 37 (new addition to count) Unknown Shigella 0 0 Giardia 0 0 Blood Borne Pathogen 5 6 UHS nursing staff also facilitates the Physician Assistants immunization requirements and provides internal tracking on approximately 40 new students each year until they complete requirements. The summer of 2009 we also screened over 25 asbestos exposures at CMU. Laboratory:  Performed approximately 4500 in house tests.  Processed approximately 4100 patients.  Performed approximately 1750 venipuntures.  Performed 436 Influenza test with 89 positive for type A. (20.4%).  Performed 333 Chlamydia tests with 32 positive (9.6%).  Performed 300 Gonorrhea tests 3 positive (1.0%).  Performed 70 HIV test with 0 positive.
  7. 7. 6 Pharmacy: Number of Prescriptions filled: 18,478 11,990 Rx’s filled for students 7,027 Rx’s filled for faculty/staff and family Acquisition cost of prescriptions $752,551.00 Rx income: $964,761.84 Rx margin: $212,211.04 OTC (over the counter) sales: $23,295.33 (doesn’t include otc sales from the tower’s clinic) Deliveries: 1,935 to faculty/staff 66 to Tower’s clinic Business Office: For the 2009-2010 fiscal year the total aging is $47,950.83 w ith only $8,152.46 over 30 days. This equates to approximately 17% of our outstanding claims over 30 days. This is an excellent percent as the average practice has around 30%. The business office continues to strive to keep the aging at a minimum in order to maximize the revenue cycle and ensure timely payment for Health Services and timely charging of patients. In fiscal year 2008-2009 the aging w as $108,522.40 w ith $20,204.41 over 30 days. This is approximately 19% over 30 days of aging. The majority of the outstanding claims over 30 days for 2009-2010 are from Medicaid. While Medicaid is one of our smaller payers based on patient volume, they tend to be quite slow in their payments often pending claims several times before making a payment decision. They also sw itched to a new claims processing system called CHAMPS this year w hich has resulted in payment delays. During this fiscal year w e began sending our electronic claims from PyraMed in X12 format instead of text format. This has resulted in reduced rejections of electronic claims through our claims vendor Netw erkes. It also allow s us additional options in editing claims w ithin Netw erkes. The business office produced 34,496 invoices during the 2009-2010 fiscal year. During the 2008-2009 fiscalyear the business office created 35,226 invoices. Charges posted betw een July 1, 2009 and May 31, 2010 totaled $1,178,502.00. The chart below show s the breakdow n of the total charges that w ere either paid by the patient at the time of service (10%), posted to the students account (56%), -this includes amounts that w ere billed to commercial insurances and then bursared after 30 days-, or billed to a participating insurances (34%) (does not include pharmacy insurance charges, these are billed through Q/S 1). The Tow ers Clinic w as operated on Monday mornings from 8am-12pm. Charges generated from the Tow ers equaled 1.3% of the total charges.
  8. 8. 7 Charges posted betw een July 1, 2008 and May 31, 2009 totaled $1,217,921.00. The chart below show s the breakdow n of the total charges that w ere either paid by the patient at the time of service (11%), posted to the students account (52%), -this includes amounts that w ere billed to commercial insurances and then bursared after 30 days-, or billed to a participating insurances (37%) (does not include pharmacy insurance charges, these are billed through Q/S 1). $1,178,502 $396,021 $661,111 $121,370 0 200000 400000 600000 800000 1000000 1200000 1400000 Total Charges Insurance Charges Bursar Account Patient Payments 2009-2010 Charge Summary Towers Clinic Health Services $1,217,921 $454,330 $634,227 $129,364 $- $200,000 $400,000 $600,000 $800,000 $1,000,000 $1,200,000 $1,400,000 Total Charges Insurance Charges Bursar Account Patient Payments 2008-2009 Charge Summary
  9. 9. 8 Below are listed the top ten insurances held by students seeking services at Health Services. Listed in order greatest to least: 2009-2010 2008-2009 Blue Cross Blue Shield (BCBS) Blue Cross Blue Shield (BCBS) PPOM/Aetna (PPOM is a re-pricing company w hich many different insurance plans use) PPOM/Aetna (PPOM is a re-pricing company w hich many different insurance plans use) Medicaid United/PHP Priority Health/Multiplan Priority Health/Multiplan First Student First Student Health Alliance Plan (HAP) Medicaid United/PHP Blue Care Netw ork (BCN) Blue Care Netw ork (BCN) Health Alliance Plan (HAP) Health Plus Cigna Cigna Health Plus The graph below show s the w rite off amounts that UHS had to take due to our participation agreements w ith Blue Cross Blue Shield, Medicaid, Medicare and Tricare. The BCBS w rite off in 2008-2009 w as $47,487.47 w ith $442,146.08 in total charges representing an 11% w rite off of billed charges. 2009-2010 BCBS MCD/MCR/TRI Student Insurance Write Off Amounts % Write Off by Cost Center for Billed BCBS Charges Write Off Amounts % Write Off by Cost Center for Billed MCD/MCR/ TRI Charges Write Off Amounts Cost Center 50111 $ - % $ - 0.00% $ - 50112 $15,119.10 6.00% $5,591.26 40.00% $ - 50113 $3,256.99 9.00% $500.34 28.00% $ - 50114 $1,578.33 5.00% $262.43 20.00% $ - 50115 $21,710.71 45.00% $1,480.56 59.00% $ - Total PAR Write Off $41,665.13 11.00% $7,834.59 40.00% $ - Total Billed $374,003.77 $18,624.13 $34,138.13
  10. 10. 9 Provider Appointments: The patient visit total of 7,433 represents a 4.1% drop between last year and this year. The flu patients we saw in the fall of 2009 were from H1N1. The usual seasonal flu cases that we usually see in the early months of the year did not materialize so even though the fall was much busier, the lack of flu cases later in the year led essentially to a wash. Hopefully the economy is starting to recover and our numbers will increase this coming school year. Health Promotions: PROGRAMS/PRESENTATIONS/ADVOCACY & OUTREACH # of events General Health/Healthy Lifestyles, nutrition, sleep, etc. 7 Sexual Health/STI/condom use 4 Alcohol Awareness/Substance Abuse 4 Mental Health/Stress & Depression Awareness/management 2 TOTAL: 17 PROGRAMS/PRESENTATIONS PROMOTING UHS Orientations/Health Fairs/Business Fairs 31 Immunization Clinic 4 TOTAL 35 SERVICES/APPOINTMENTS # of appts Light Therapy 38 HIV Testing (test/result) 24 TOTAL 62 PROFESSIONAL DEVELOPMENT/PROGRAMS ATTENDED Mihia Dashboard/webinars/Health Dept. summits/Facit, etc HIV training certification classes TOTAL 21 MEETINGS Wellness coalition/Bacchus/active minds/dept/Bridges, etc. TOTAL 69 GRAND TOTAL 204
  11. 11. 10 IV. Personnel Changes:  Implemented a reduction of .1 to .2 in a number of positions to reflect reduced patient traffic over the summer and academic year breaks.  With the departure of former Director and placement of Tom Trionfi, a current CMU staff member, in the Director’s position provided an immediate budget savings of $100,000.  Reinstated to full time status; the two assistant directors (from .9 FTE).  With the subsequent resignation of the assistant director of clinical operations in November (incumbent was a RN without clinical capabilities), it was determined that hiring a Nurse Practioner or Physician Assistant would provide enhanced staffing flexibility as well as the potential to generate more revenue (working as a clinic provider).  To accomplish the use of the NP or PA in the clinic, the nursing staff and others were given the opportunity to absorb a number of the tasks of the assistant director that naturally fit with their current responsibilities. To date this has been a positive decision.  Pharmacist is resigning to take another position as of July 2, 2010. We will initially fill the position with a provisional appointment until we determine whether current staffing and operations are appropriate. V. Fundraising: None to report VI. SWOT: Strengths:  Knowledgeable and experienced staff committed to serving our students, faculty and staff with caring and compassion.  All providers are board certified and provide excellent care to their patients.  Patient focused staff.  Ability to use resources wisely.  Provision of essential health care to students and the campus community in a convenient location.  An off-site clinic in the Towers was opened to better reach our student population.  Walk-in appointments for students with acute illnesses and many other problems.  Medical care for our students with mental health problems including anxiety depression, OCD, etc.
  12. 12. 11  Students do not need any money in hand to come to health services. All charges can be put on their student account and paid at a later date, including medications, X-ray, and lab fees.  On-site laboratory which performs many tests in-house and an excellent referral lab with excellent turn-around times and an on-site pharmacy which serves our students and faculty and staff, including office delivery to employees on campus.  Networking through various committees, such as Bridges Advisory, Isabella County Coalition to Reduce Underage Drinking, Wellness Coalition, Eta Sigma Gamma to name a few. This allows for better collaboration on projects when resources are limited. Weaknesses:  Inability to participate with additional insurance due to the time involved in doing duplicate work between the practice management system and SAP balancing/reporting.  Employee morale due to uncertainty of UHS stability.  Lack of visibility on campus. Students frequently do not seem aware that there is a clinic on campus.  Decline in patient volume, presumably due to a variety of reasons – visibility, insurance participation status, costs. Opportunities:  New software system (Point and Click) will offer an opportunity to make our charting more complete. The built in calculator will help make sure billing levels are correct and therefore fees per visit may actually increase.  The improving Michigan economy will hopefully lead to more students having health insurance and therefore higher utilization of UHS.  Possibilitytoworkwiththe Athleticdepartmenttodraw athletesfornew NCAA requirementsif theychose ustoprovide drawingandtesting.  Health Promotion Office is better located in Foust 205, making it more visible to students. There is a great opportunity to increase our volume for HIV testing as the word is starting to spread on this low cost but very important service. Also, various events are coming up such as orientations, health fairs which allow us the opportunity to advertise our services. There will be an article in the upcoming freshman orientation newspaper from CM Life providing an overview of the services that Health Services provides.  Revise the current SAP requirements and add additional insurance to improve patient volume and satisfaction.  Work with other departments to co-manage the International Mandatory Insurance Program.
  13. 13. 12 Threats:  Continued economic stressors and high unemployment seriously impact our student’s ability to pay for their medical care. Many more are now uninsured since many of their parents are out of work. Many students are putting off seeking medical care since they can’t afford it, including prescription medications.  The economy of Michigan has led to significant cut backs to higher education, including CMU. By extension, our support from the university is always tenuous.  Financial challenges with the variation in subsidy levels.  Decreased reimbursement due to increased levels of participation discounts.  Decreased reimbursement due to elevated numbers of Medicaid patients (Medicaid is a very poor payer).  Staff turnover and burnout. VII. Progress with 2009-2010 Goals: 1. Successfully transitioned from using Quest as our reference lab to Lab Corp. This required re- pricing and re-entry of laboratory test codes in the PyraMed dictionary. This change was seamless to the patient but provided additional functionality to the lab and enhanced customer services for UHS. 2. Worked with Information Technology to secure the services of a technician who could be dedicated to Health Services (as well as a few other departments) in order to provide more timely and efficient services to UHS and to ensure our systems are HIPAA compliant. Since Health Services has an electronic health record, the functionality of our technology is critical. This arrangement has been extremely valuable to our daily operations. 3. Hosted three work study students. This is a milestone since UHS has not had work study students for many years. The students were strategically placed in areas that have been most affected by the reduction in FTE’s due to budget cuts. A student was placed in the laboratory, pharmacy and front desk/business office. 4. Enhanced the visual appearance and visibility of Foust and Health Services, with new paint, directional lines and outside canopies. 5. Simplified the user fee schedule to be more transparent and consistent. 6. Evaluated, selected and began the transition to a new electronic health record to improve functionality including tracking, reporting and regulatory compliance.
  14. 14. 13 7. Took over the International Student’s Hard Waiver Insurance Program. This responsibility used to be held by OIA. This has led to some challenges in the areas of manpower to successfully manage the program. UHS will use United’s Partner Center to track and enforce this program. VIII. Primary Goals for 2010-2011: 1. Successfully implement Point and Click, including web portal to allow online appointments, on- line account summaries and on-line forms completion. 2. Work with IT on implementing their scanning solution and archive old paper records. 3. Work with General Counsel to revise the retention schedule to eliminate the need to keep medical records permanently since this is not required by Michigan law and is not common to college health centers. 4. Install signature pads for patient authorizations to bill to decrease the amount of paper used, stored and scanned. 5. Install insurance/id card scanners to link insurance card and CMU card information with the electronic medical record. Again reducing the need to photocopy ID’s and insurance cards and to make insurance information immediately available to the billers and lab. 6. Continue to evaluate the Tower’s Clinic hours and marketing to increase patient volume and utilization. 7. Continue to scrutinize spending to ensure the best use of the subsidy. 8. Go out to bid for the student insurance involving the International Student Representatives in the process for buy in and the best plan design. SUMMARY: In the 2010 fiscal year, the business office continued to focus on reducing its aging through timely posting of payments and frequent review of unpaid charges. The next fiscal year will be challenging as we implement three new projects (Point and Click, campus wide scanning solution and International Hard Waiver). The Administrative Secretary will be utilized to assist with tracking and verification of the hard waiver program. The front desk receptionist will be an important part of the scanning project. Training on the new electronic record will be an essential and time consuming project but the improved documentation, reporting and features of the new system will make it worthwhile. While Health Services will continue to strive for increased patient volume and satisfaction, it is critical that an adequate subsidy is provided to allow provision of services to students, protection of the campus through communicable disease prevention and surveillance and education programs to teach students healthy habits and lifestyles.
  15. 15. 14 IX. Primary goals for next five years: 1. Evaluate the possibility of participating with additional insurances. 2. Eliminate paper health records through the use of an interface with Lab Corp for reference labs, web portal for health histories, direct entry into the electronic record of in house lab results and direct scanning of x-ray results and other miscellaneous records. 3. Host MSA program interns, providing them with experience using a fully integrated electronic health record. 4. Evaluate the use of point of sale for the pharmacy to better manage pharmacy inventory and reduce the amount of manual entry of over the counter medications in the business office. 5. Evaluate the International Student Insurance program successes and failures following Health Service’s first year managing the program to determine where changes can be made to make the process more efficient, what staffing level is necessary and what additional options can be provided to the students. 6. Continue to review and evaluate the services offered. To determine whether we are providing them at both a level meeting/exceeding an external provider and at or less their cost. X. Contingencies/Risk to Achieving those Goals and Strategies to Address: 1. Costs and human resources required to implement the projects 2. Limited (IT) resources 3. Collaboration requirements