public notice city of alameda health care district board ... · august 2009 performance improvement...

PUBLIC NOTICE CITY OF ALAMEDA HEALTH CARE DISTRICT

BOARD OF DIRECTORS MEETING AGENDA

Monday, November 2, 2009 Location:

Alameda Hospital (Dal Cielo Conference Room) 2070 Clinton Avenue, Alameda, CA 94501

Office of the Clerk: (510) 814-4001

Regular Meeting

Members of the public who wish to comment on agenda items will be given an opportunity before or during the consideration of each agenda item. Those wishing to comment must complete a speaker card indicating the agenda item that they wish to address and present to the District Clerk. This will ensure your opportunity to speak. Please make your comments clear and concise, limiting your remarks to no more than three (3) minutes.

I. Call to Order (6:00 p.m. – 2 East Board Room) Jordan Battani II. Roll Call Kristen Thorson III. Adjourn into Executive Closed Session IV. Closed Session Agenda

A. Closed Session Minutes –September 14, 2009 & October 12, 2009

B. Medical Executive Committee Report and Approval of H & S Code Sec. 32155

Credentialing Recommendations

C. Consultation with Legal Counsel Regarding Gov’t Code Sec. 54956.9(a) Pending Litigation

D. Discussion of Pooled Insurance Claims Gov’t Code Sec. 54956.95 E. Instructions to Bargaining Representatives Gov’t Code Sec. 54957.6

Regarding Salaries, Fringe Benefits and Working Conditions

F. Board Quality Committee Report (BQC) H & S Code Sec. 32155 H. Consideration of Performance Evaluation of Gov’t Code Sec. 54957

District Employees G. Discussion of Report Involving Trade Secrets H & S Code Sec. 32106

City of Alameda Health Care District Agenda – November 2, 2009 2 of 2

V. Reconvene to Public Session (Expected to start at 7:30 p.m. – Dal Cielo Conference Room) A. Announcements from Closed Session Jordan Battani

VI. Consent Agenda

A. Approval of September 14, 2009 Minutes ACTION ITEM [enclosure]

B. Approval of October 12, 2009 Minutes ACTION ITEM [enclosure]

C. Acceptance of September 2009 Financial Statements ACTION ITEM [enclosure] D. Approval of Delineation of Privileges Form for Emergency Department Physician

Assistants ACTION ITEM [enclosure]

VI. Regular Agenda

A. President’s Report Jordan Battani

1. Approval of Extending District Board Vacancy

Application Deadline ACTION ITEM [enclosure]

B. Chief Executive Officer’s Report Deborah E. Stebbins

1. Overview of Employee Satisfaction Survey Results

2. Public Records Act Request

C. Strategic Planning and Community Relations Report Robert Bonta

1. Committee Report – October 19, 2009 D. Finance and Management Committee Report

1. Committee Report – October 28, 2009 Robert Bonta

2. CFO Report David A. Neapolitan

E. Medical Staff President Report Alka Sharma, MD

VIII. General Public Comments IX. Board Comments X. Adjournment

The next regularly scheduled board meeting is scheduled for December 7, 2009

Closed Session will begin at 6:00 p.m.

Open Session will follow at approximately 7:30 p.m.

Min

ute

s of

the B

oard

of

Dir

ecto

rs

Sept

embe

r 14,

200

9 D

irec

tors

Pre

sent

: Jo

rdan

Bat

tani

R

ober

t Bon

ta

Rob

ert D

euts

ch, M

D

J. M

icha

el M

cCor

mic

k St

eve

Was

son

Man

agem

ent P

rese

nt:

Deb

orah

E. S

tebb

ins

Ker

ry J

. Eas

thop

e D

avid

A. N

eapo

litan

Med

ical

Sta

ff P

rese

nt:

Alk

a Sh

arm

a, M

.D.

Leg

al C

ouns

el P

rese

nt:

Thom

as D

risco

ll, E

sq.

E

xcus

ed:

Subm

itted

by:

Kris

ten

Thor

son

A

ctio

n

1.

Cal

l to

Ord

er

Jord

an B

atta

ni c

alle

d th

e O

pen

Sess

ion

of th

e B

oard

of D

irect

ors

of th

e C

ity o

f Ala

med

a H

ealth

Car

e D

istri

ct to

ord

er a

t 6:1

0 p.

m.

2.

Rol

l Cal

l K

riste

n Th

orso

n ca

lled

roll,

not

ing

that

a q

uoru

m o

f Dire

ctor

s w

ere

pres

ent.

3.

Adj

ourn

into

Exe

cutiv

e C

lose

d Se

ssio

n

At 6

:16

p.m

. the

mee

ting

adjo

urne

d to

Exe

cutiv

e C

lose

d Se

ssio

n.

4.

Rec

onve

ne to

Pub

lic

Sess

ion

Jord

an B

atta

ni re

conv

ened

the

mee

ting

into

pub

lic s

essi

on a

t 7:5

0 p.

m.

and

mad

e th

e fo

llow

ing

clos

ed s

essi

on a

nnou

ncem

ents

.

5.

Clo

sed

Sess

ion

Ann

ounc

emen

ts

[A] M

inut

es

[B] Q

ualit

y Im

prov

emen

t Rep

ort

[A

] The

Clo

sed

Sess

ion

Min

utes

for

the

Aug

ust 1

0, 2

009

mee

ting

wer

e ap

prov

ed.

[B] T

he Q

ualit

y Im

prov

emen

t Rep

ort

was

for t

he m

onth

s of

Jun

e an

d Ju

ly

2009

ere

acc

epte

d as

pre

sent

ed.

6.

Con

sent

Age

nda

[A] A

ppro

val o

f A

ugus

t 10,

200

9 M

inut

es

[B] A

ccep

tanc

e of

Jul

y 20

09 F

inan

cial

Sta

tem

ents

[C

] App

rova

l to

Exe

cute

Fug

ro W

est P

ropo

sal f

or S

eism

ic

Liq

uefa

ctio

n M

itiga

tion

Serv

ices

[E

] App

rova

l of A

dmin

istr

ativ

e Po

licie

s an

d Pr

oced

ures

•

No.

3 –

Rol

e an

d Sc

ope

of S

ervi

ces

• N

o. 9

– A

dmin

istra

tive

Org

aniz

atio

n C

hart

• N

o. 1

1 –

Hon

orar

y N

amin

g of

Fac

ilitie

s, P

rogr

ams

and

Equi

pmen

t •

No.

12–

Adm

inis

trativ

e Li

ne o

f Res

pons

ibili

ty

• N

o. 1

3 –

Con

tract

ed S

ervi

ces

• N

o. 1

5 –

Ethi

cs C

omm

ittee

Pur

pose

and

Cas

e C

onsu

ltatio

n Pr

oced

ure

• N

o. 1

7 –

Adv

ance

Dire

ctiv

es

• N

o. 1

8 –

Info

rmed

Con

sent

•

No.

25

– W

ithho

ldin

g /W

ithdr

awin

g Li

fe S

usta

inin

g Tr

eatm

ent

• N

o. 4

0 –

Pers

onal

Use

of C

ell P

hone

s •

No.

45

– Sm

okin

g Po

licy

• N

o. 4

6 –

Empl

oyee

Mul

tilin

gual

Ros

ter

• N

o. 5

– M

edic

al S

taff

Lin

e of

Res

pons

ibili

ty

• N

o. 6

6 –

Mon

itorin

g R

egul

ator

y R

espo

nsib

ilitie

s •

No.

70

– U

se o

f Hos

pita

l Veh

icle

• N

o. 7

7 –

Use

of H

ospi

tal F

acili

ties

• N

o. 7

8 –

Proc

edur

e fo

r bid

ding

Con

tract

s

D

irect

or W

asso

n m

oved

to a

ppro

ve

Con

sent

Age

nda

Item

s [A

], [B

], [C

], an

d [E

]. D

irect

or D

euts

ch s

econ

ded

the

mot

ion.

The

mot

ion

carr

ied.

Mr.

Was

son

abst

aine

d fr

om a

ppro

ving

te

min

utes

as

he w

as a

bsen

t fro

m th

e la

st

mee

ting.

D

irect

or D

euts

ch re

mov

ed C

onse

nt

Age

nda

item

[D] f

or d

iscu

ssio

n.

• N

o. 9

1 –

Gov

erni

ng B

ody

ITEM

(S) R

EMO

VED

FR

OM

CO

NSE

NT

AG

END

A

[D] A

ppro

val t

o E

xecu

te A

gree

men

t with

Per

ot S

yste

ms

for

IT

Cap

abili

ties A

sses

smen

t D

irect

or D

euts

ch a

sked

how

man

agem

ent c

ame

to th

e de

cisi

on to

eng

age

Pero

t Sys

tem

s. M

r. N

eapo

litan

sta

ted

that

5 d

iffer

ent f

irms

wer

e as

ked

to

subm

it pr

opos

als

for a

n as

sess

men

t of A

lam

eda

Hos

pita

l’s

read

ines

s/ca

pabi

litie

s fo

r im

plem

enta

tion

of a

n el

ectro

nic

heal

th re

cord

an

d to

mee

t req

uire

men

t of A

RR

A.

Four

of t

he fi

rm p

rese

nted

to a

co

mm

ittee

of m

anag

emen

t, ph

ysic

ians

and

boa

rd m

embe

rs.

As

stat

ed in

th

e m

emor

andu

m, P

erot

Sys

tem

s w

as c

hose

n by

the

com

mitt

ee b

ased

on

thei

r exp

erie

nce

with

a s

igni

fican

t num

ber o

f Med

itech

inst

alla

tions

, the

de

liver

able

s in

thei

r pro

posa

l, st

aff b

ench

stre

ngth

ava

ilabl

e fr

om P

erot

, an

d th

e qu

ality

of t

he te

am th

at w

ould

be

onsi

te in

terv

iew

ing

and

asse

ssin

g ho

spita

l sta

ff a

nd c

urre

nt p

roce

sses

.

Bot

h D

irect

or B

onta

and

Dire

ctor

Bat

tani

sta

ted

that

they

like

d th

e fo

rmat

of

the

mem

oran

dum

as

it la

id o

ut b

ackg

roun

d, p

roce

ss, a

nd

reco

mm

enda

tion.

Ms.

Ste

bbin

s st

ated

that

this

wou

ld b

e th

e st

anda

rd

form

at fo

r mem

os to

the

Boa

rd o

f Dire

ctor

s.

Dire

ctor

Deu

tsch

mov

ed a

ppro

val f

or

man

agem

ent t

o ex

ecut

e an

agr

eem

ent

with

Per

ot S

yste

ms

for a

nd IT

ca

pabi

litie

s as

sess

men

t. D

irect

or

Bon

ta s

econ

ded

the

mot

ion.

The

m

otio

n ca

rrie

d un

anim

ousl

y.

A

. C

hief

Exe

cutiv

e O

ffic

er’s

Rep

ort

Ms.

Ste

bbin

s re

porte

d on

the

key

stat

istic

s as

indi

cate

d be

low

:

Stat

istic

s A

ugus

t (P

relim

) A

ugus

t B

udge

t Ju

ly

Act

ual

Ave

rage

Dai

ly C

ensu

s 84

84

.74

88.1

0

A

cute

30

.68

30.1

0 35

.06

Sub

acut

e 33

.61

33.1

3 31

.32

Sou

th S

hore

19

.71

21.5

2 21

.71

Patie

nt D

ays

2,60

4 2,

627

2,73

1 ER

Vis

its

1,55

0 1,

362

1,57

4 O

P R

egis

tratio

n 2,

836

2,83

6 2,

461

Tota

l Sur

gerie

s 49

3 45

8 50

9 M

s. S

tebb

ins

note

d th

at E

mer

genc

y R

oom

Vis

its w

ere

high

er b

y 14

%

com

pare

d to

bud

get a

nd th

at n

on-K

aise

r (A

lam

eda)

sur

gerie

s w

e al

so

grea

ter t

han

budg

et b

y 8%

for t

he m

onth

of A

ugus

t.

Two

new

nur

se m

anag

ers

have

bee

n hi

red.

Pam

ela

Spoo

ner,

RN

has

ta

ken

the

posi

tion

of 3

Wes

t Nur

se M

anag

er a

nd J

oyce

Will

iam

s, R

N h

as

take

n th

e po

sitio

n of

Dire

ctor

of P

erio

pera

tive

Serv

ices

. Th

e tw

o ne

w

nurs

e m

anag

ers

will

brin

g ad

ditio

nal s

treng

th a

nd le

ader

ship

to th

e N

ursi

ng D

epar

tmen

t H

ospi

tal m

anag

emen

t and

sta

ff h

ave

begu

n Jo

int C

omm

issi

on tr

acer

ac

tiviti

es to

look

at p

roce

sses

and

pre

pare

sta

ff fo

r the

sur

vey

proc

ess.

1.

Oct

ober

Boa

rd M

eetin

g D

ate

Cha

nge

to O

ctob

er 1

2, 2

009

Ms.

Ste

bbin

s re

ques

ted

that

the

Oct

ober

boa

rd m

eetin

g be

cha

nged

to

Oct

ober

12,

200

9 du

e to

a c

onfli

ct w

ith M

r. W

asso

n’s

sche

dule

. Th

ere

wer

e no

obj

ectio

ns fr

om th

e B

oard

to m

ovin

g th

e m

eetin

g da

te.

2.

Annu

al H

ealth

Fai

r M

s. S

tebb

ins

rem

inde

d th

e B

oard

and

com

mun

ity th

at th

e ho

spita

l will

be

hav

ing

its a

nnua

l hea

lth fa

ir on

Sat

urda

y, O

ctob

er 1

7, 2

009.

The

H

ospi

tal w

ill b

e gi

ving

free

flu

shot

s as

wel

l a v

arie

ty o

f hea

lth

scre

enin

gs.

B.

Stra

tegi

c Pl

anni

ng a

nd C

omm

unity

Rel

atio

ns R

epor

t

D

irect

or B

onta

repo

rted

the

com

mitt

ee w

ill b

e m

eetin

g on

Oct

ober

15,

20

09 to

whi

ch th

e m

embe

rs o

f the

Boa

rd F

inan

ce a

nd M

anag

emen

t C

omm

ittee

will

be

invi

ted.

The

maj

or to

pic

of d

iscu

ssio

n w

ill b

e an

ed

ucat

iona

l ses

sion

on

capi

tal f

inan

cing

stru

ctur

e an

d op

tions

. C

. Fi

nanc

e an

d M

anag

emen

t Com

mitt

ee R

epor

t

Dire

ctor

Was

son

stat

ed th

at th

e co

mm

ittee

met

on

Aug

ust 2

6, 2

009.

Pr

ofit

for t

he m

onth

was

$60

,966

com

pare

d to

bud

get o

f $18

,000

. A

vera

ge d

aily

cen

sus

was

88.

1 ve

rsus

85.

7 bu

dget

ed.

Tota

l gro

ss

patie

nt re

venu

e w

as g

reat

er th

an b

udge

t by

$1,7

49,0

00.

Stat

emen

t of R

even

ues

over

Exp

ense

s pe

r Adj

uste

d Pa

tient

Day

su

mm

ary

item

s:

§ G

ross

Rev

enue

s –

3.7%

bet

ter t

han

budg

eted

§

Net

Rev

enue

s –

2.8%

bet

ter t

han

budg

eted

§

Tota

l Exp

ense

s –

only

1.4

% u

nfav

orab

le to

bud

get.

§ R

egis

try –

unf

avor

able

by

$14.

00 p

er A

PD o

r 36%

§

Supp

lies

– un

favo

rabl

e by

$23

.00

per A

PD o

r 13.

8%

§ D

epre

ciat

ion

and

Am

ortiz

atio

n –

favo

rabl

e by

$8.

00

§ A

ll ot

her e

xpen

se c

ateg

orie

s vi

rtual

ly o

n bu

dget

per

A

PD

Dire

ctor

Was

son

repo

rted

that

Mr.

Nea

polit

an u

pdat

ed th

e co

mm

ittee

on

the

Med

itech

Adv

ance

Clin

ical

s U

pgra

de, T

ime

and

Atte

ndan

ce

Impl

emen

tatio

n, th

e A

dvis

ory

Boa

rd R

AC

Pro

ject

, and

the

FYE

20

09 A

udit.

D

. M

edic

al S

taff

Pre

side

nt R

epor

t

Dr.

Alk

a Sh

arm

a re

porte

d th

at th

e M

edic

al S

taff

rece

ntly

com

plet

ed a

C

ontin

uing

Med

ical

Edu

catio

n Su

rvey

(CM

E).

Alth

ough

a fi

nal

deci

sion

as

not b

een

mad

e ye

t, th

e su

rvey

or h

ad p

ositi

ve c

omm

ents

re

gard

ing

the

prog

ram

at t

he h

ospi

tal.

9.

G

ener

al P

ublic

Com

men

ts

Non

e.

10.

Boa

rd C

omm

ents

Dire

ctor

Bat

tani

com

men

ted

on th

e re

view

pro

cess

of t

he P

olic

y an

d pr

oced

ures

, sta

ting

the

revi

ew p

rovi

ded

her w

ith in

sigh

t to

oper

atio

ns a

t th

e ho

spita

l and

reco

mm

ende

d to

the

othe

r boa

rd m

embe

rs to

allo

w

plen

ty o

f tim

e to

revi

ew th

e po

licie

s. Q

uest

ions

abo

ut th

e po

licie

s an

d pr

oced

ures

sho

uld

be d

irect

ed to

Ms.

Ste

bbin

s.

11.

Adj

ourn

men

t

A m

otio

n w

as m

ade

to a

djou

rn th

e m

eetin

g an

d be

ing

no fu

rther

bu

sine

ss, t

he m

eetin

g w

as a

djou

rned

at

8:2

5 p.

m.

Atte

st:

Jord

an B

atta

ni

R

ober

t Bon

ta

Pr

esid

ent

Secr

etar

y

DIS

TR

ICT

BO

AR

D/M

INU

TE

S/R

EG

.091

409

Min

ute

s of

the B

oard

of

Dir

ecto

rs

Oct

ober

12,

200

9 D

irec

tors

Pre

sent

: Jo

rdan

Bat

tani

R

ober

t Bon

ta

Rob

ert D

euts

ch, M

D

J. M

icha

el M

cCor

mic

k St

eve

Was

son

Man

agem

ent P

rese

nt:

Deb

orah

E. S

tebb

ins

Ker

ry J

. Eas

thop

e D

avid

A. N

eapo

litan

Med

ical

Sta

ff P

rese

nt:

Alk

a Sh

arm

a, M

.D.

Leg

al C

ouns

el P

rese

nt:

Exc

used

: Su

bmitt

ed b

y:

Thom

as D

risco

ll, E

sq.

K

riste

n Th

orso

n

Act

ion

1.

Cal

l to

Ord

er

Jord

an B

atta

ni c

alle

d th

e O

pen

Sess

ion

of th

e B

oard

of D

irect

ors

of th

e C

ity o

f Ala

med

a H

ealth

Car

e D

istri

ct to

ord

er a

t 6:0

7p.m

.

2.

Rol

l Cal

l K

riste

n Th

orso

n ca

lled

roll,

not

ing

that

a q

uoru

m o

f Dire

ctor

s w

ere

pres

ent.

3.

Gen

eral

Pub

lic

Com

men

ts

Non

e at

this

tim

e.

4.

Adj

ourn

into

Exe

cutiv

e C

lose

d Se

ssio

n

At 6

:08

p.m

. the

mee

ting

adjo

urne

d to

Exe

cutiv

e C

lose

d Se

ssio

n.

5.

Rec

onve

ne to

Pub

lic

Sess

ion

Jord

an B

atta

ni re

conv

ened

the

mee

ting

into

pub

lic s

essi

on a

t 7:3

6 p.

m.

and

mad

e th

e fo

llow

ing

clos

ed s

essi

on a

nnou

ncem

ents

.

6.

Clo

sed

Sess

ion

Ann

ounc

emen

ts

[A] M

inut

es

[B] B

oard

Qua

lity

Rep

ort

- Aug

ust 2

009

Perf

orm

ance

Impr

ovem

ent

Rep

ort

[C] M

edic

al E

xecu

tive

Com

mitt

ee R

epor

t and

App

rova

l of

Cre

dent

ialin

g R

ecom

men

datio

ns

[A

] The

Clo

sed

Sess

ion

Min

utes

for

the

Sept

embe

r 14,

200

9 m

eetin

g w

ere

appr

oved

. [B

] The

Aug

ust 2

009

Perf

orm

ance

Im

prov

emen

t Rep

ort w

as a

ccep

ted

as

pres

ente

d.

[C] M

edic

al E

xecu

tive

Com

mitt

ee

Rep

ort a

nd A

ppro

val o

f Cre

dent

ialin

g R

ecom

men

datio

ns w

ere

appr

oved

as

pres

ente

d an

d in

dica

ted

belo

w.

In

itial

App

oint

men

t: N

ame

Spec

ialty

A

ffili

atio

n ?

Dee

pti H

emra

jani

, MD

In

tern

al M

edic

ine/

Hos

pita

list

AIM

?

Tsua

n, M

D

Oto

lary

ngol

ogy

Sum

mit

ENT

& A

ssoc

.

R

eapp

oint

men

ts –

Med

ical

Sta

ff

Nam

e Sp

ecia

lty

Stat

us

App

oint

men

t Per

iod

? Lo

rrai

ne B

onne

r, M

D

Inte

rnal

Med

icin

e A

ctiv

e 11

/01/

09 -

10/3

1/11

?

Cla

ude

Bur

dick

, MD

Pa

thol

ogy

Cou

rtes

y 10

/01/

09 -

09/3

0/11

?

Jose

ph C

han.

MD

R

adio

logy

C

ourt

esy

11/0

1/09

- 10

/31/

11

? G

ary

Cla

rk, M

D

Gen

eral

Sur

gery

C

ourt

esy

10/0

1/09

– 1

2/31

/10

? M

atth

ew D

ixon

, MD

G

ener

al S

urge

ry

Cou

rtes

y

11/0

1/09

- 10

/31/

11

? D

enis

Dre

w, M

D

Car

diol

ogy

Act

ive

11/0

1/09

- 10

/31/

11

? C

arol

Ger

des,

MD

G

ynec

olog

y A

ctiv

e 11

/01/

09 -

10/3

1/11

?

Mar

k G

olds

mith

, MD

R

adio

logy

C

ourt

esy

11/0

1/09

- 07/

31/1

1 ?

Suza

nne

John

son,

DO

Em

erge

ncy

Med

icin

e A

ctiv

e 11

/01/

09 -1

0/31

/11

? To

m J

osep

h, M

D

Rad

iolo

gy

Cou

rtes

y 11

/01/

09 –

10/

31/1

1 ?

Will

iam

Kam

mer

er, M

D

Emer

genc

y M

edic

ine

Act

ive

10/0

1/09

– 0

9/30

/11

? Te

resa

Kim

, MD

G

ener

al S

urge

ry

Cou

rtes

y 11

/01/

09 -1

0/31

/11

? H

on-W

ai L

am, M

D

Fam

ily P

ract

ice

Cou

rtes

y 10

/01/

09 –

09/

30/1

1 ?

Am

arde

ep M

anga

t, M

D

Inte

rnal

Med

icin

e / H

ospi

talis

t C

ourte

sy

11/0

1/09

-10/

31/1

1 ?

Mar

iaM

ilita

nte-

Mill

er, M

D

Inte

rnal

Med

icin

e / H

ospi

talis

t C

ourt

esy

10

/01/

09 –

09/

30/1

1 ?

Key

van

Nou

ri, M

D

Rad

iolo

gy

Cou

rtes

y 11

/01/

09 –

11/

30/1

0 ?

Ron

ald

Ols

on, M

D

Rad

iolo

gy

Cou

rtes

y 11

/01/

09 –

10/

31/1

1 ?

Ash

ish

Pate

l Th

orac

ic S

urge

ry

Cou

rtes

y 10

/01/

09 –

04/3

0/11

?

Dav

id P

fiste

r, M

D

Hem

atol

ogy/

Onc

olog

y A

ctiv

e 10

/01/

09 –

09/3

0/11

?

Alic

e R

eier

, MD

H

emat

olog

y/O

ncol

ogy

Cou

rtes

y 10

/01/

09 –

09/3

0/11

?

Push

pasr

ee S

ajja

, MD

In

tern

al M

edic

ine/

Hos

pita

list

Cou

rtes

y 10

/01/

09 –

09/3

0/11

?

Jaso

n Sk

alet

, MD

O

phth

alm

olog

y C

ourt

esy

10/0

1/09

–02

/28/

11

? D

wai

ne S

kinn

er, M

D

Ane

sthe

siol

ogy

Cou

rtes

y 10

/01/

09 –

09/3

0/11

?

Susa

n W

aker

lin, M

D

Inte

rnal

Med

icin

e C

ourt

esy

11/0

1/09

– 1

0/31

/11

? M

itzi W

illia

ms,

DPM

Po

diat

ric S

urge

ry

Cou

rtes

y 10

/01/

09 –

04/3

0/11

?

Ran

dolp

h W

right

, DPM

Po

diat

ric S

urge

ry

Cou

rtes

y 11

/01/

09 –

10/

31/1

1

R

eapp

oint

men

t – A

llied

Hea

lth P

rofe

ssio

nal S

tatu

s

Nam

e Sp

ecia

lty

? La

ura

Car

r, PA

-C

Phys

icia

n A

ssis

tant

11/0

1/09

– 1

0/31

/11

? K

atlin

Le,

PA

-C

Phys

icia

n A

ssis

tant

11/0

1/09

– 1

0/31

/11

R

eapp

oint

men

t – A

llied

Hea

lth P

rofe

ssio

nal S

tatu

s

Nam

e Sp

ecia

lty

? Jo

an K

ing-

Ang

ell,

MD

In

tern

al M

edic

ine

? A

dam

Sch

lifke

, MD

A

nest

hesi

olog

y (K

aise

r)

7.

A

uxili

ary

App

reci

atio

n

Mem

bers

of t

he B

oard

of D

irect

ors

publ

icly

than

ks m

embe

r of t

he A

lam

eda

Hos

pita

l Aux

iliar

y fo

r the

ir re

cent

gift

of $

40,0

00 to

the

Hos

pita

l. T

he m

oney

w

ill b

e us

ed to

buy

two

new

sur

gica

l tab

les.

The

Aux

iliar

y ha

s no

w d

onat

ed a

cu

mul

ativ

e to

tal o

ver $

1 m

illio

n to

the

Hos

pita

l. M

embe

rs o

f the

Aux

iliar

y pr

esen

t to

acce

pt th

e re

cogn

ition

wer

e:

• Jo

anne

Ser

gent

, Aux

iliar

y B

oard

Pre

side

nt

• Pa

m F

erre

ro, V

ice

Pre

side

nt

• Li

li Eu

ker,

Gift

Sho

p C

hairm

an

• M

arle

ne S

ahr,

Off

ice

Com

mitt

ee C

hairm

an

• B

etty

San

ders

on, C

ontin

uous

Impr

ovem

ent C

hair

8.

Con

sent

Age

nda

[A] A

ccep

tanc

e of

Aug

ust 2

009

Fina

ncia

l Sta

tem

ents

[B] A

ppro

val o

f Exe

cutiv

e In

cent

ive

Com

pens

atio

n fo

r FY

200

9

[C

] App

rova

l of E

xecu

tive

Com

pens

atio

n fo

r FY

200

9

[D] A

ppro

val o

f Am

endm

ent t

o M

edic

al S

taff

Rul

es a

nd R

egul

atio

ns,

Arti

cle

1-A

: Alli

ed H

ealth

Pro

fess

iona

l Sta

tus

D

irect

or W

asso

n re

view

ed th

e pr

oces

s by

whi

ch th

e ex

ecut

ive

com

pens

atio

n w

as d

evel

oped

. A

t the

beg

inni

ng o

f the

last

fisc

al y

ear a

pro

gram

was

es

tabl

ishe

d w

ith s

peci

fic g

oals

for m

anag

emen

t to

achi

eve

both

fin

anci

ally

and

th

roug

h th

e ot

her 5

pill

ars

of th

e St

rate

gic

plan

. Th

e pu

rpos

e of

this

was

to

mak

e su

re p

erfo

rman

ce o

f the

org

aniz

atio

n w

as a

ligne

d w

ith h

ow th

e m

anag

emen

t tea

m w

as p

oten

tially

bei

ng c

ompe

nsat

ed a

nd to

be

sure

that

the

succ

ess

of b

oth

was

tied

toge

ther

. D

irect

or W

asso

n st

ated

that

the

last

yea

r’s

finan

cial

per

form

ance

com

pare

d to

prio

r yea

rs is

cau

se fo

r cel

ebra

tion

but

ther

e ar

e st

ill c

halle

nges

ahe

ad.

He

is op

timis

tic th

at th

e su

cces

s w

ill c

ontin

ue

in fu

ture

yea

rs.

Dire

ctor

Deu

tsch

sta

ted

that

the

finan

cial

suc

cess

was

the

mos

t im

porta

nt o

f th

e cu

rren

t met

rics a

nd th

at th

e co

mm

unity

is a

war

e of

the

hosp

ital’s

suc

cess

an

d co

mm

itmen

t to

qual

ity.

Dire

ctor

Bon

ta th

anke

d th

e ex

ecut

ive

team

for t

heir

wor

k ov

er th

e co

urse

of

the

last

yea

r. T

he re

sults

are

ver

y dr

amat

ic a

nd th

e fin

anci

al tu

rnar

ound

ver

y no

tabl

e an

d so

met

hing

to c

eleb

rate

.

Dire

ctor

McC

orm

ick

than

ked

the

Boa

rd a

lso

for t

heir

wor

k al

so in

the

over

sigh

t of a

chie

ving

the

prop

osed

met

rics

by m

anag

emen

t. Pr

esid

ent B

atta

ni a

sked

for a

mot

ion

on th

ree

actio

ns it

ems

cont

aine

d in

the

D

irect

or W

asso

n pu

lled

Item

[C]

App

rova

l of E

xecu

tive

Com

pens

atio

n fo

r FY

200

9 fr

om

the

cons

ent c

alen

dar f

or

disc

ussi

on a

nd c

onsi

dera

tion.

D

irect

or M

cCor

mic

k m

oved

to

appr

ove

the

bala

nce

of th

e co

nsen

t age

nda

acce

ptin

g th

e A

ugus

t 200

9 Fi

nanc

ials

and

App

rovi

ng th

e A

men

dmen

t to

the

Med

ical

Sta

ff R

ules

and

R

egul

atio

ns.

Dire

ctor

Bon

ta

seco

nded

the

mot

ion.

The

mot

ion

carr

ied

unan

imou

sly

mem

oran

dum

. Fi

rst,

to a

ppro

ve th

e re

com

men

ded

met

ric s

core

s sub

mitt

ed b

y st

aff s

econ

d to

app

rove

pay

men

t of t

he C

EO e

xecu

tive

com

pens

atio

n, a

nd th

ird

to a

utho

rize

the

CEO

to p

ay s

imila

r inc

entiv

e pa

ymen

ts to

the

othe

r pa

rtici

patin

g ex

ecut

ives

.

Ms.

Ste

bbin

s th

anke

d th

e B

oard

for s

uppo

rt th

roug

hout

the

year

. D

irect

or

Bon

ta p

oint

ed o

ut th

at th

e pa

ymen

t of t

he in

cent

ive

does

not

cha

nge

the

posi

tive

botto

m li

ne a

chie

ved

for F

Y 2

009,

sin

ce th

e in

cent

ive

paym

ents

wer

e ac

crue

d as

a p

art o

f FY

200

9 ex

pens

es.

9.

Pre

side

nt’s

Rep

ort

Pres

iden

t Bat

tani

app

oint

ed D

irect

or D

euts

ch a

nd D

irect

or M

cCor

mic

k to

a

subc

omm

ittee

to re

view

the

exec

utiv

e co

mpe

nsat

ion

and

mar

ket a

sses

smen

t for

th

e C

EO fo

r FY

201

0.

Pres

iden

t Bat

tani

repo

rted

that

Dire

ctor

Ste

ve W

asso

n ha

s te

nder

ed h

is

resi

gnat

ion

effe

ctiv

e im

med

iate

ly.

Dire

ctor

Was

son’

s re

sign

atio

n st

arts

the

appo

intm

ent p

roce

ss to

fill

this

vac

ancy

. D

irect

or W

asso

n st

ated

that

he

has

truly

enj

oyed

ser

ving

the

Dis

trict

. D

ue to

fam

ily c

omm

itmen

ts a

nd th

e po

sitiv

e st

atus

of t

he h

ospi

tal,

he fe

lt it

was

a g

ood

time

to m

ake

a tra

nsiti

on.

He

than

ked

ever

yone

for t

he c

ontri

butio

ns m

ade

to h

im a

s it

has

been

a fu

lfilli

ng

expe

rienc

e fo

r him

.

9.

R

egul

ar A

gend

a A

. C

hief

Exe

cutiv

e O

ffic

er’s

Rep

ort

Ms.

Ste

bbin

s re

porte

d on

two

upco

min

g ev

ents

. Th

e A

nnua

l Hea

lth F

air w

ill b

e he

ld o

n Sa

turd

ay O

ctob

er 1

7 an

d th

e Fo

unda

tion

in c

onju

nctio

n w

ith A

ngel

a’s

Bis

tro w

ill b

e ha

ving

an

even

t on

Frid

ay, O

ctob

er 3

0, “

Frid

ay N

ight

Flig

hts”

. A

ll B

oard

mem

bers

are

invi

ted

to a

ttend

. M

s. S

tebb

ins

repo

rted

the

Empl

oyee

Sat

isfa

ctio

n Su

rvey

has

bee

n co

mpl

eted

an

d re

sults

hav

e be

en re

porte

d to

the

exec

utiv

e te

am.

Man

agem

ent w

ill b

e co

nduc

ting

Tow

n H

alls

to re

port

the

resu

lts to

the

empl

oyee

s. T

here

will

als

o be

a p

rese

ntat

ion

at th

e ne

xt B

oard

mee

ting

on th

e re

sults

of t

he s

urve

y.

Ms

Steb

bins

repo

rted

on th

e vo

lum

es fo

r the

mon

th o

f Sep

tem

ber,

notin

g th

at

both

acu

te c

ensu

s an

d em

erge

ncy

room

vis

it w

ere

abov

e bu

dget

by

13.3

% a

nd

9.5

% re

spec

tivel

y. S

urgi

cal v

olum

e w

as a

lso

abov

e bu

dget

at 5

19 c

ompa

red

to

a bu

dget

of 4

30.

Stat

istic

s Se

ptem

ber

(Pre

lim)

Sept

embe

r B

udge

t A

ugus

t A

ctua

l A

vera

ge D

aily

Cen

sus

84.7

83

.5

84

Acu

te

31.6

27

.9

30.6

8

S

ubac

ute

34.7

2 33

.17

33.6

1

S

outh

Sho

re

18.8

3 21

.5

19.7

1 Pa

tient

Day

s 2,

541

2,50

5 2,

604

ER V

isits

1,

479

1,35

1 1,

550

OP

Reg

istra

tion

2,62

3 2,

739

2,60

7 To

tal S

urge

ries

519

430

493

1.

Ad

min

istr

ativ

e Po

licie

s an

d Pr

oced

ures

Upd

ate

Ms.

Ste

bbin

s re

porte

d th

at a

new

pro

cess

for r

evie

win

g th

e A

dmin

istra

tive

Polic

ies

and

Proc

edur

es w

ill b

e pu

t int

o pl

ace.

Ins

tead

of h

avin

g th

e B

oard

m

embe

rs re

view

indi

vidu

al p

olic

es, m

anag

emen

t will

put

toge

ther

a m

emo

with

a

1-2

sent

ence

sum

mar

y of

the

polic

y an

d/or

pro

cedu

re th

at re

quire

s bo

ard

appr

oval

. If

Boa

rd m

embe

rs h

ave

ques

tions

or w

ant t

o re

view

the

polic

es, t

hey

will

be

mad

e av

aila

ble

to th

em.

B

. St

rate

gic

Plan

ning

and

Com

mun

ity R

elat

ions

Rep

ort

Com

mitt

ee R

epor

t –Se

ptem

ber

15, 2

009

Dire

ctor

Bon

ta s

tate

d th

at th

e co

mm

ittee

met

on

Sept

embe

r 15

and

the

maj

or to

pic

of d

iscu

ssio

n w

as s

eism

ic re

trofit

requ

irem

ents

. H

e re

porte

d th

at th

e co

mm

ittee

re

com

men

ded

to th

e B

oard

app

rova

l of s

pend

ing

auth

ority

of $

200,

000

to

adva

nce

the

prog

ress

tow

ards

mee

ting

the

2013

sei

smic

retro

fit re

quire

men

ts.

The

com

mitt

ee a

lso

talk

ed b

riefly

abo

ut th

e se

cond

trac

k of

see

king

legi

slat

ive

supp

ort f

or re

lief i

n th

e re

quire

men

ts. T

he C

omm

unity

new

slet

ter h

as b

een

mai

led

to re

side

nts

of A

lam

eda,

cop

ies

wer

e m

ade

avai

labl

e to

the

Boa

rd.

The

com

mitt

ee

also

vis

ited

the

Ala

med

a To

wne

Cen

tre m

edic

al o

ffic

e bu

ildin

g

D

irect

or B

onta

mad

e a

mot

ion

to

appr

ove

the

proc

ess

for r

evie

win

g th

e A

dmin

istra

tive

Polic

ies

and

Proc

edur

es a

nd a

ppoi

ntm

ent o

f th

e B

oard

Mem

bers

for s

uch

revi

ew.

Dire

ctor

McC

orm

ick

seco

nded

the

mot

ion.

The

mot

ion

carr

ied

unan

imou

sly.

Appr

oval

of C

apita

l Exp

endi

ture

Aut

hori

ty fo

r Se

ism

ic P

lann

ing

The

Stra

tegi

c Pl

anni

ng a

nd C

omm

unity

Rel

atio

ns C

omm

ittee

hav

e re

com

men

ded

that

the

Boa

rd a

ppro

ve th

e sp

endi

ng a

utho

rity

for s

eism

ic p

lann

ing

as o

utlin

ed n

th

e m

emor

andu

m.

Dire

ctor

Bat

tani

ask

ed if

this

was

a b

udge

ted

item

. M

s.

Steb

bins

sta

ted

that

the

fund

ing

for t

he p

lann

ing

will

com

e fr

om th

e co

ntin

genc

y fu

nd fr

om th

e ca

pita

l pla

nnin

g bu

dget

.

C.

Fina

nce

and

Man

agem

ent C

omm

ittee

Rep

ort

Se

ptem

ber 3

0, 2

009

Com

mitt

ee M

eetin

g D

irect

or W

asso

n re

porte

d th

at th

e co

mm

ittee

met

on

Sept

embe

r 30,

200

9. R

ick

Jack

son,

from

TC

A P

artn

ers

repo

rted

the

resu

lts o

f the

FY

200

9 Fi

nanc

ial

Stat

emen

t Aud

it an

d w

ill p

rese

nt th

at re

port

toni

ght.

The

Com

mitt

ee a

lso

revi

ewed

the

Aug

ust F

inan

cial

Sta

tem

ents

not

ing

the

follo

win

g:

•

Prof

it fo

r the

mon

th o

f $42

,000

com

pare

d to

bud

get o

f $16

,000

•

Ave

rage

dai

ly c

ensu

s of

84.

0 ve

rsus

84.

7 bu

dget

ed w

ith a

cute

and

sub

-ac

ute

prog

ram

s fa

vora

ble

to b

udge

t with

an

AD

C o

f 1.1

bet

ter t

han

budg

et.

• ER

Vis

its 1

3.8%

gre

ater

than

bud

get.

• To

tal g

ross

pat

ient

reve

nue

grea

ter t

han

budg

et b

y $1

,888

,000

or 8

%

bette

r tha

n bu

dget

ed.

Dire

ctor

Was

son

repo

rted

that

CFO

Dav

id N

eapo

litan

upd

ated

the

com

mitt

ee o

n Ti

me

and

Atte

ndan

ce Im

plem

enta

tion,

the

Alli

ance

Dec

isio

n Su

ppor

t too

l and

D

ebt F

inan

cing

. H

ospi

tal M

anag

emen

t will

be

brin

ging

a g

uest

spe

aker

to th

e Fi

nanc

e C

omm

ittee

and

Stra

tegi

c Pl

anni

ng C

omm

ittee

in O

ctob

er to

pre

sent

an

educ

atio

nal s

essi

on o

n op

tions

for d

ebt f

inan

cing

.

Dire

ctor

Was

son

repo

rted

that

CEO

Deb

orah

Ste

bbin

s re

porte

d to

the

com

mitt

ee

that

Hos

pita

l Man

agem

ent h

ad a

mee

ting

with

Kai

ser a

nd th

ere

is s

till n

o in

dica

tion

from

them

eith

er w

ay re

gard

ing

the

cont

ract

. A

lette

r was

sen

t to

Con

gres

sman

Pet

e St

ark

requ

estin

g $2

50,0

00 to

ass

ist t

he h

ospi

tal i

n its

sei

smic

pl

anni

ng a

nd th

e Fo

unda

tion

Fall

Gal

a ra

ised

$90

,000

.

Dire

ctor

McC

orm

ick

mad

e a

mot

ion

to a

ppro

ve th

e ca

pita

l ex

pend

iture

aut

horit

y to

talin

g $2

00,0

00 fo

r pla

nnin

g to

co

mpl

y w

ith 2

013

seis

mic

re

quire

men

ts.

Dire

ctor

Was

son

seco

nded

the

mot

ion.

The

m

otio

n ca

rrie

d un

anim

ousl

y.

Ac

cept

ance

of F

Y 20

09 A

udite

d Fi

nanc

ials

Dav

id N

eapo

litan

revi

ewed

the

Man

agem

ent D

iscu

ssio

n an

d A

naly

sis

cont

aine

d w

ithin

the

Aud

it.

Ric

k Ja

ckso

n fr

om T

CA

Par

tner

s pr

esen

ted

the

June

30,

200

9 au

dite

d fin

anci

al

stat

emen

ts.

Mr.

Jack

son

note

d th

at th

e ho

spita

l has

one

of t

he la

rges

t tu

rnar

ound

s he

has

see

n, im

prov

ing

from

a lo

ss o

f $2.

3 m

illio

n in

200

8 to

a

prof

it of

$73

0,30

7. T

he B

oard

Rep

ort w

as d

istri

bute

d to

the

Boa

rd m

embe

rs.

The

Boa

rd R

epor

t is

a by

-pro

duct

of t

he a

udit.

Mr.

Jack

son

revi

ewed

som

e of

th

e ge

nera

l acc

ount

ing

issu

es p

rese

nted

dur

ing

the

audi

t. T

he is

sues

and

su

gges

ted

solu

tions

will

be

revi

ewed

by

hosp

ital m

anag

emen

t. M

r. Ja

ckso

n re

view

ed a

five

yea

r tre

nd o

f ope

ratio

nal a

naly

sis,

incl

udin

g fin

anci

al ra

tios,

pa

tient

car

e in

form

atio

n an

d St

affin

g an

d pe

rson

nel d

ata.

Fin

ally

Mr.

Jack

son

revi

ewed

a c

ompa

rison

to li

ke-k

ind

hosp

itals

in C

alifo

rnia

com

pare

d to

the

Hos

pita

l. D

irect

or D

euts

ch re

ques

ted

com

paris

on d

ata

for d

educ

tions

from

re

venu

e fo

r Med

icar

e sp

ecifi

cally

. M

r. Ja

ckso

n st

ated

that

he

wou

ld p

rovi

de th

at

info

rmat

ion

to M

r. N

eapo

litan

to d

istri

bute

to th

e B

oard

of D

irect

ors.

D

. M

edic

al S

taff

Pre

side

nt R

epor

t

Dr.

Alk

a Sh

arm

a re

porte

d th

at th

e D

r. M

arzo

uk w

ill b

e up

datin

g th

e m

edic

al

staf

f com

mun

ity a

nd s

taff

rega

rdin

g in

fluen

za o

n Tu

esda

y, O

ctob

er 1

3, 2

009.

B

oard

mem

bers

are

wel

com

e to

atte

nd.

Dr.

Shar

ma

repo

rted

that

neu

rolo

gist

Dr.

Subr

oto

Kun

du h

as re

sign

ed a

nd m

ay b

e ba

ck a

s he

has

take

n a

leav

e of

abs

ence

be

fore

and

then

retu

rned

to th

e ar

ea.

D

irect

or W

asso

n m

oved

to a

ccep

t th

e Ju

ne 3

0, 2

009

audi

ted

finan

cial

sta

tem

ents

. D

irect

or

Bon

ta s

econ

ded

the

mot

ion.

The

M

otio

n ca

rrie

d un

anim

ousl

y.

9.

Gen

eral

Pub

lic

Com

men

ts

Non

e.

10.

Boa

rd C

omm

ents

Dire

ctor

Bat

tani

than

ked

Dire

ctor

Was

son

agai

n fo

r his

con

tribu

tions

to th

e B

oard

of D

irect

ors.

Dire

ctor

Bon

ta a

lso

than

ked

Dire

ctor

Was

son

for h

is w

ork

over

the

man

y ye

ars

of s

ervi

ce, b

oth

gene

rally

for h

is s

uppo

rt of

the

hosp

ital

and

spec

ifica

lly fo

r his

fina

ncia

l ins

ight

and

con

sist

ent c

omm

and

of th

e fin

anci

als.

It i

s de

serv

ing

and

fittin

g th

at h

e re

sign

s at

this

tim

e of

pos

itive

tu

rnar

ound

and

fina

ncia

l suc

cess

.

Dr.

Deu

tsch

requ

este

d th

at th

e D

istri

ct h

ave

a m

ore

form

al p

rese

ntat

ion

for

Dire

ctor

Was

son’

s co

ntrib

utio

ns a

t a fu

ture

mee

ting.

11.

Adj

ourn

men

t

A m

otio

n w

as m

ade

to a

djou

rn

the

mee

ting

and

bein

g no

fu

rther

bus

ines

s, th

e m

eetin

g w

as a

djou

rned

at 8

:29

p.m

.

Atte

st:

Jord

an B

atta

ni

R

ober

t Bon

ta

Pr

esid

ent

Secr

etar

y

DIS

TR

ICT

BO

AR

D/M

INU

TE

S/R

EG

.10.

12.0

9

THE CITY OF ALAMEDA HEALTH CARE DISTRICT ALAMEDA HOSPITAL UNAUDITED FINANCIAL STATEMENTS

FOR THE PERIOD ENDING SEPTEMBER 30, 2009

CITY OF ALAMEDA HEALTH CARE DISTRICT ALAMEDA HOSPITAL

August 31, 2009 Table of Contents Page

Financial Management Discussion 1 – 12

Balance Sheet 13

Statement of Revenue and Expenses 14

Statement of Revenue and Expenses – Per Adjusted Patient Day 15

Key Statistics for Current Month and Year-to-Date 16

Alameda Hospital September 2009 Management Discussion and Analysis

Page 1

ALAMEDA HOSPITAL

MANAGEMENT DISCUSSION AND ANALYSIS SEPTEMBER 30, 2009

The management of the Alameda Hospital (the “Hospital”) has prepared this discussion and analysis in order to provide an overview of the Hospital’s performance for the period ending September 30, 2009 in accordance with the Governmental Accounting Standards Board Statement No. 34, Basic Financials Statements; Management’s Discussion and Analysis for State and Local Governments. The intent of this document is to provide additional information on the Hospital’s financial performance as a whole. Financial Overview as of September 30, 2009 Gross patient revenue was greater than budget by $1,502,000 or 6.6%. Inpatient revenue was greater than budgeted by 4.6% and outpatient revenue was greater than budgeted by 9.2%. On an adjusted patient day basis gross patient revenue was $5,335 compared to a budgeted amount of $5,171 or a 3.2% favorable variance.

Total patient days were 2,541 compared to the prior month’s total patient days of 2,604 and the prior year’s 2,469 total patient days. The average daily acute care census was 31.6 compared to a budget of 28.8 and an actual average daily census of 30.7 in the prior month; the average daily Sub-Acute census was 34.3 versus a budget of 33.2 and 33.6 in the prior month and the South Shore unit had an average daily census of 18.8 versus a budget of 21.5 and prior month census of 19.7, respectively.

ER visits were 1,479 or 9.5% greater than the budgeted 1,351 visits and were greater than the prior year’s visits of 1,360.

Total surgery cases were 20.7% greater than budget, with Kaiser surgical cases making up 68.2% of the 519 total cases. Alameda physician surgical cases were 165 cases as compared to 159 cases in August.

Combined excess revenues over expense (profit) for September was $4,000 versus a budgeted excess of revenues over expense (profit) of $6,000.

Total assets decreased by $188,626 from the prior month as a result of a decrease in current assets of $182,912 and an increase in restricted contributions of $8,439 offset by a decrease in net fixed assets of $14,153. The following items make up the increase in current assets:

Total unrestricted cash and cash equivalents for September increased by $429,571 which resulted in our

unrestricted day’s cash on hand improving slightly to 11.0 at September 30, 2009. This was the result of the third consecutive month of strong patient account collections that totaled $5,464,932, including the monthly payment from Kaiser ($800,800) in accordance with our current contract.

Net patient accounts receivable increased slightly in September by $9,367 compared to a decrease of $76,537

in August. Day’s in outstanding receivables increased slightly to 49.7 as compared to 49.1 in August.

Estimated third-party payer settlement receivables increased by $107,280 as a result of the reclassification of AB 915 receivables from the current liabilities portion of the balance sheet.

Other assets decreased by $727,898 in September. This decrease was the result of $728,702 in stop loss

receivables that were received in September for employee health plan insurance payments that were paid in August.


Page 2

Total liabilities decreased by $118,797 compared to a increase of $365,209 in the prior month. This decrease was the result of the following:

Accounts payable increased by $248,346 from the prior month. As a result of this increase the average

accounts payable payment period increased in September to 55.7 from 53.4 as of August31, 2009.

Payroll and benefit related accruals increased by $227,160 from the prior month. This increase was primarily the result of increased accrued payroll of $283,920 resulting from the timing of the actual paid payroll.

Estimated third party payer settlement payable decreased by $86,418 as a result of the reclassification of the

AB915 accrued receivables to estimated third-party payer settlement receivables that were improperly reflected in the current liability section of the balance sheet to the current asset portion of the balance sheet.

Other liabilities decreased by $461,509 as a result of the amortization of one month’s deferred revenue

related to the 2009/2010 parcel tax revenues. Volumes The combined actual daily census was 84.7 versus a budget of 83.5. This slightly favorable variance was primarily the result of the Acute and Sub-Acute programs that had favorable variances of 2.8 and 1.1 ADC’s greater than budget respectively. The Skilled Nursing program average daily census was 18.8 versus a budget of 21.5.

35.1

30.7

31.6

32.5

31.3

33.6

34.3

33.1

21.7

19.7

18.8

20.1

0

10

20

30

40

50

60

70

80

90

100

110

Actual SNF 21.7 19.7 18.8 20.1

Actual Sub-Acute 31.3 33.6 34.3 33.1

Actual Acute 35.1 30.7 31.6 32.5

Jul Aug Sep YTD


Page 3

Total patient days in September were 1.4% less than budgeted but were 2.9% greater than the prior. The graphs on the following pages show the total patient days by month for fiscal year 2010 including South Shore:

Total Patient Days

2,735

2,622

2,018

2,723

2,535

2,441

2,5822,532

2,731

2,604

2,541

2,656 2,627

2,5052,550

2,534

2,8542,794

2,7052,763

2,543

2,234

2,473

2,770

2,712

2,7162,727

1,600

1,750

1,900

2,050

2,200

2,350

2,500

2,650

2,800

2,950

3,100

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Actual - 2009-2010 Budget - 2009-2010 Prior Year - 2008-2009

Separating the inpatient components of our volumes for the month of September we see that the acute care patient days were 9.6% (83 days) greater than budgeted and were 11.0% greater than the prior year’s average daily census. This was driven by higher than budgeted average daily census in the CCU (ADC = 4.6) and Medical/Surgical (ADC = 15.4).

Inpatient Acute Care Average Daily Census

35.1

30.7

31.631.4

30.1

28.828.0

29.6

33.3

36.5

38.6

34.435.0

34.3

28.6

33.0

29.3

32.8

31.6

27.3

31.4

37.4

33.0

35.6

33.2

34.8

28.8

20.0

22.0

24.0

26.0

28.0

30.0

32.0

34.0

36.0

38.0

40.0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Ma Jun

Aver

age

Daily

Cen

sus

Actual Acute Budget Acute Prior Year Acute


Page 4

The average length of stay (ALOS) remained consistent with the prior month at 4.35 days for the month of September and continues to be driven by a higher acuity level (CMI = 1.2937) of patients treated during the month. For the first quarter our ALOS is 4.14 which is slightly higher than our projected year to date ALOS of 4.10, and is shown in the graph below.

Average Length of Stay

3.83

4.32 4.35

4.14

3.00

3.25

3.50

3.75

4.00

4.25

4.50

4.75

5.00

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun YTD

Actual Acute Budget Acute

The Sub-Acute programs patient days were 3.3% greater than budget or 33. The graph below shows the Sub-Acute programs average daily census for the current fiscal year as compared to budget and the prior year.

Sub-Acute Care Average Daily Census

31.3

33.6

34.3

32.833.1 33.2

32.733.3 33.4

34.133.5

34.233.6

33.3

34.7

32.132.6 32.8 33.0

33.833.4

31.7

33.333.9

33.0

32.3

33.0

24.0

26.0

28.0

30.0

32.0

34.0

36.0

38.0

40.0

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr Ma Jun

Ave

rage

Dai

ly C

ensu

s

Actual Sub-Acute Budget Sub-Acute Prior Year Sub-Acute


Page 5

The Skilled Nursing Unit (South Shore) patient days were 12.4% less than budgeted for the month of September. The following graphs show the Skilled Nursing Unit average daily census as compared to budget by month and the payor mix experienced during the current month.

Skilled Nursing Unit Average Daily Census

21.7

19.718.8

21.5 21.5 21.5 21.5 21.5 21.5 21.5 21.5 21.5 21.5

0.0

10.2

20.7

22.1

19.118.0

20.3 19.8

22.4 21.9 22.223.1

21.5

21.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0


Ave

rage

Dai

ly C

ensu

s

Actual SNF Budget SNF Prior Year SNF

Skilled Nursing Unit Payor Mix

0.0%

0.0%

0.0%

25.7%

70.4%

0.0%

0.3%

0.5%

0.4%

1.0%

36.9% 40

.0%

7.6% 11

.8%

1.5%2.6

%2.3

%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Com

m -

32.4

HMO

- 51

.4

Indu

stria

l - 0

.0

Kaiser

- 0.

0

MCa

l - 3

6.7

Med

icar

e - 3

3.

Med

icar

e HMO

- 0

Self P

ay -

100.

PPO

- 64

.2

Current Month YTD


Page 6

August ER visits were 9.5% greater than budgeted for the month.

Emergency Care Center Visits

1,574

1,550

1,479

1,404

1,3621,351

1,419 1,418

1,454

1,439 1,440

1,465

1,390

1,336

1,360

1,379

1,412

1,496

1,389

1,507

1,328

1,360

1,378

1,471 1,483

1,599

1,527

1,300

1,350

1,400

1,450

1,500

1,550

1,600

1,650


Visi

ts

Actual 2009-2010 Budget 2009-2010 Prior Year 2008-2009

Surgery cases were 519 versus the 430 budgeted and 453 in the prior year. In September, Alameda physician cases increased slightly over the prior month to 165 cases versus 159 in August. Kaiser related cases in September increased to 354 as compared to the 334 cases performed in August. However, despite this increase in cases Kaiser Same Day Surgery revenue remained consistent with that of the prior month. As a result of this month’s activity, our reimbursement for Kaiser Outpatient cases in September remained at 19.2%.

Surgical Cases

52 51 53

106 108 112

333 321351

133

18

0

100

200

300

400

500

600


Cas

es

Alameda Inpatient Surgical Alameda Outpatient Surgical Kaiser Outpatient Surgical Kaiser Inpatient Surgical


Page 7

Income Statement – Hospital Only Gross Patient Charges Gross patient charges in September were greater than budgeted by $1,502,000. This favorable variance was comprised of favorable variances of $602,000 and $900,000 in inpatient and outpatient revenues respectively. On an adjusted patient day basis total patient revenue was $5,335 versus the budgeted $5,171 or an 3.2% favorable variance from budget for the month of September.

Gross Charges per Adjusted Patient Day

$5,4

22

$5,4

30

$5,1

06

$5,1

69

$5,5

32

$5,3

37

$5,2

31

$5,1

71

$3,000

$3,500

$4,000

$4,500

$5,000

$5,500

$6,000


Dolla

rs

Actual Revenue Per Adjusted Patient Day Budget Revenue Per Adjusted Patient Day

Payor Mix Medicare total gross revenue in September made up 32.7% our total gross patient charges which is slightly higer than the 30.8% in the prior month. Kaiser was again the second largest source of gross patient revenues at 18.6%. In September we did see a large spike in Medi-Cal utilization which increased to 16.7% in the month. While the combined HMO / PPO volume decreased to 14.0% in the month. The graph on the following page shows the percentage of revenues generated by each of the major payors for the current month as well as the current months expected reimbursement for each payor.


Page 8

Combined Payor Mix

1.1%

5.2%

0.8%

0.1%

18.5%

3.8%

16.7%

5.1% 6.3

%8.7

%

0.9%

0.6%

6.0%

0.6%

2.9%

19.3%

3.2%

13.4%

32.1%

4.8% 5.7

%

10.0%

1.4%

32.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Com

- 28.5

%

HMO

- 27.3

%

Ind - 2

1.4%

Kaise

r - 98

.1%

Kaise

r Con

t - 19

.5%

MCal H

MO - 1

2.0%

MCal -

22.5%

Medica

re - 2

3.2%

Medica

re HM

O - 1

9.5

Self P

ay - 1

1.4%

PPO - 3

0.7%

VA- 3

6.0%

Current Month YTD

On the Hospital’s inpatient acute care business, current month gross Medicare charges were 51.0% of our total inpatient acute care gross revenues. In September there were three cases that hit outlier thresholds which favorably impacted net patient revenues in September. Additionally, the Medicare Case Mix Index (CMI) increased to 1.4687 from 1.4064 in August. These changes to the acuity level of Medicare patients treated during the month of September and the number of outlier cases resulted in our expected reimbursement for Medicare inpatient cases to decrease from August’s estimate of 26.7% to 24.9% in September.

Inpatient Acute Care Payor Mix

1.6% 3.5

%

1.0%

0.3% 3.2

%3.5

%

14.0%

51.0%

9.1%

5.9%

5.7%

1.1%

0.4%

6.2%

0.7%

0.6%

5.0%

2.8%

7.3%

52.1%

7.5%

5.6% 9.5

%

2.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Comm

- 28.0

%

HMO

- 26.5

%

Ind - 2

3.3%

Kaise

r - 10

.6%

Kaise

r Con

t - 23

.0%

MCal H

MO - 1

5.6%

MCal -

25.2%

Medica

re - 2

4.9%

Medica

re HM

O - 2

0.8

Self P

ay - 1

0.4%

PPO - 2

5.4%

VA - 2

2.5%

Current Month YTD

In September the Sub-Acute care program again was dominated by Medi-Cal utilization of 76.4%. The


Page 9

following graph shows the payor mix for September and the expected reimbursement rate for each payor.

Inpatient Sub-Acute Care Payor Mix

1.4%

-4.0%

76.4%

0.0%

8.6%

1.1%

16.4%

65.0%

8.3%

1.7%

4.6%

2.8%13

.8%

3.8%

-10.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Comm

- 20.4

%

Kaise

r - 20

.5%

MCal -

22.5%

Medica

re - 1

8.9%

Medica

re HM

O - 0

.0

Self P

ay - 0

.0%

VA - 4

9.6%

Current Month YTD

The outpatient gross revenue payor mix for September was comprised of 39.9% Kaiser, 18.4% Medicare, 14.4% PPO and 8.4% HMO. The graph below shows the current month outpatient payor mix and expected level of reimbursement for each payor.

Outpatient Services Payor Mix

0.6%

8.4%

0.8%

1.0%

5.2%

2.9%

18.4%

2.9%

6.4%

14.4%

0.0%0.7

%

7.8%

0.8% 1.4

%

39.7%

4.6%

3.7%

18.7%

2.8%

5.7%

13.7%

0.4%

38.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Com

m -

35.0

HM

O -

27.3

Ind

- 19.

3%

Kai

ser -

43.

5

Kai

ser C

ont -

19

MCal

HM

O -

9.

MCal

- 4.

0%

Med

icar

e - 1

7.

Med

icar

e H

MO

- 16

Sel

f Pay

- 17

.1

PPO

- 32

.7

VA

- 59.

2%

Current Month YTD


Page 10

Deductions from Revenue Contractual allowances are computed as deductions from gross patient revenues based on the difference between gross patient charges and the contractually agreed upon rates of reimbursement with third party government-based programs such as Medicare, Medi-Cal and other third party payors such as Blue Cross. In the month of September contractual allowances, bad debt and charity adjustments (as a percentage of gross patient charges) were 77.6% versus the budgeted 76.5%. Net Patient Service Revenue Net patient service revenues are the resulting difference between gross patient charges and the deductions from revenue. This difference reflects what the anticipated cash payments the Hospital is expecting to receive for the services provided. The graph on the following page shows the level of reimbursement that the Hospital has estimated for fiscal year 2010 by major payor category.

Average Reimbursement % by PayorSeptember 2009 Year‐to‐Date

35.1%

27.0%

21.3%

19.4% 19.0%

11.6%

22.0%

24.0%

20.4%

13.7%

29.4%

35.1%

22.2%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Commer

cial

HMO

Indu

stria

l

Kaiser

Kaiser

Con

tract

Med

i‐Cal

HMO

Med

i‐Cal

Med

icare

Med

icare

HMO

Self P

ay

PPO VATo

tal

Other Operating Revenue Included in other operating revenue in the month of September is an accrual of $163,201 and $27,000 for FY 2009 and the first quarter of FY 2010, respectively, for the State of California Distinct Part/Nursing Facility (DP/NF) Supplemental Reimbursement Program. This Federal Medical Assistance Program reimburses participating DP/NF programs up to 50% of their allowable costs that are in excess of the average statewide rate. Total Operating Expenses

Total operating expenses were greater than the fixed budget by $237,000 or 4.0%. On an adjusted patient day basis, our cost per adjusted patient day was $1,354 which was only $9 per adjusted patient day unfavorable to budget. This variance was primarily the result of an unfavorable variance in supplies. The graph on the following page shows the hospital operating expenses on an adjusted patient day basis for the 2010 fiscal year by month and


Page 11

is followed by explanations of the significant areas of variance that were experienced in the current month.

Expenses per Adjusted Patient Day

$1,3

56 $1,3

73

$1,3

54

$1,3

61

$1,3

37

$1,3

07

$1,3

45

$1,3

29

$1,000

$1,050

$1,100

$1,150

$1,200

$1,250

$1,300

$1,350

$1,400


Dolla

rs

Actual Expenses Per Adjusted Patient Day Budgeted Expense Per Adjusted Patient Day

Salary and Registry Expenses

Salary and registry costs combined were unfavorable to the fixed budget by $123,000 but were only $4 per adjusted patient day unfavorable to budget in September. On an adjusted occupied bed basis, productive FTE’s were 2.65 in September versus the budgeted 2.59. The graph below shows the productive and paid FTE’s per adjusted occupied bed for FY 2010 by month and year to date.

FTE’s per Adjusted Occupied Bed

2.63

2.54 2.

65 2.66

3.04

2.86 3.

00 3.07

1.00

1.25

1.50

1.75

2.00

2.25

2.50

2.75

3.00

3.25

3.50

3.75

4.00


FTE'

s

P roductive FTE/Adjusted Occupied Bed Paid FTE/Adjusted Occupied Bed


Page 12

Benefits Benefit costs were $73,000 favorable to the fixed budget and $22 favorable to budget on an adjusted patient day basis in September. This favorable variance was the result of $102,000 in accrued stop loss recoveries. The following graph shows the combined salary, registry and benefit costs on an adjusted patient basis for FY 2010 by month.

Salary, Registry and Benefit Cost per APD

$928

$948

$901

$926

$915

$888

$919

$907

$800

$820

$840

$860

$880

$900

$920

$940

$960

$980

$1,000


Dolla

rs

Actual Total Salary, Registry & Beneift Expense Per Adjusted Patient Day Budget Total Salary, Registry & Beneift Expense Per Adjusted Patient Day

Supplies The supplies expense category was unfavorable to budget by $144,000. This unfavorable variance from the fixed budget was primarily the result of increased prosthetic, surgical supplies and pharmacy costs in September that were the result of the current month’s activities. The largest portion of the unfavorable variance ($69,000) was in pharmaceutical supplies and was result of greater utilization in the IVT program. Depreciation and Amortization Depreciation and amortization expense was $28,000 less than budgeted in September as a result of various pieces of equipment that were purchased in 2004 which became fully depreciated in June 2009. The following pages include the detailed financial statements for the three months ended September 30 2009.

Date: October 30, 2009 To: City of Alameda Health Care District Board of Directors From: Alka Sharma, MD, Medical Staff President Subject: Approval of Delineation of Privileges Form for Emergency Department

Physician Assistants Background: The Delineation of Privileges Form has modified to include additional privileges for Emergency Department Physician Assistants. These privileges are found to be consistent with other area hospitals. Recommendation: The Medical Executive Committee recommends approval of the revised Delineation of Privileges Form for Emergency Department Physician Assistants as presented.

ALAMEDA HOSPITAL

DELINEATION OF CLINICAL PRIVILEGES

PHYSICIAN ASSISTANT - EMERGENCY DEPARTMENT

NAME: _________________________________________

¨ INITIAL APPOINTMENT ¨ REAPPOINTMENT

I UNDERSTAND THAT PHYSICIAN ASSISTANTS APPLYING FOR PRIVILEGES IN THE EMERGENCY DEPARTMENT WILL ASSIST INTHE

CARE OF THE PATIENTS OF THEIR SUPERVISING PHYSICIAN (S) AT ALAMEDA HOSPITAL. THE EXERCISE OF ALL PRIVILEGES MAY

OCCUR ONLY IN THE CONTEXT OF PREVAILING BYLAWS, RULES AND REGULATIONS, AND HOSPITAL POLICIES. I ALSO UNDERSTAND

THAT ALL CASES MUST BE PRESENTED TO THE EMERGENCY DEPARTMENT ATTENDING PHYSICIAN PRIOR TO DISCHARGE AND/OR

DISPOSITION . I HEREBY REQUEST THE FOLLOWING PRIVILEGES: GENERAL PRIVILEGES REQUESTED APPROVED DENIED REVIEW PATIENT RECORDS o o o TAKE PATIENT HISTORY o o o PERFORM PHYSICAL EXAM o o o RECORD PERTINENT PATIENT DATA o o o MAKE ASSESSMENT AND DIAGNOSIS o o o INITIATE, REVIEW AND REVISE TREATMENT o o o AND THERAPY PLANS WRITE ORDERS AS PER SUPERVISING PHYSICIAN o o o ORDER APPROPRIATE DIAGNOSTIC STUDIES o o o ORDER APPROPRIATE CONSULTATIONS o o o PRESCRIBE MEDICATIONS AS PER PA FORMULARY o o o INITIATE ARRANGEMENTS FOR ADMISSIONS o o o WRITE DISCHARGE SUMMARIES o o o THERAPEUTIC PROCEDURES ORDER OR TRANSMIT AN ORDER FOR X-RAYS, o o o OTHER STUDIES, THERAPEUTIC DIETS, PHYSICAL THERAPY , OCCUPATIONAL THERAPY , RESPIRATORY THERAPY AND NURSING SERVICES. ORDER , OR TRANSMIT ORDER FOR, PERFORM OR o o o ASSIST IN PERFORMANCE OF LABORATORY PROCEDURES, SCREENING PROCEDURES AND THERAPEUTIC PROCEDURES. INSTRUCT AND COUNSEL PATIENTS REGARDING o o o THEIR PHYSICAL & MENTAL HEALTH [MEDICATIONS, DIETS, SOCIAL HABITS, FAMILY PLANNING, NORMAL GROWTH /DEVELOPMENT, AGING AND UNDERSTANDING LONG TERM MANAGEMENT OF THEIR DISEASE] ADMINISTER MEDICATIONS PER DEPARTMENT POLICY o o o

PERFORM SURGICAL PROCEDURES CUSTOMARILY o o o PERFORMED UNDER LOCAL ANESTHESIA AT THE REQUEST OF THE SUPERVISING PHYSICIAN [PRESENCE OF SUPERVISING MD NOT REQUIRED ] PERFORM SURGICAL PROCEDURES REQUIRING o o o OTHER FORMS OF ANESTHESIA [PRESENCE OF

SUPERVISING MD REQUIRED ] Delineation of Clinical Privileges Physician Assistant - Emergency Department Page 2. Name: __________________________________________ INSERT FOLEY CATHETERS; IRRIGATE IF INDICATED o o o PLACE NG TUBES o o o WOUND CARE o o o ASPIRATION OF SEROMAS o o o PRESSURE SORES/BURN CARE o o o REMOVAL OF SUPERFICIAL FOREIGN BODIES o o o STAPLE/SUTURE REMOVAL o o o WOUND CLOSURE o o o SOFT TISSUE INJECTION o o o SUTURING o o o PERFORM CPR AND ACLS o o o PERFORM MSE o o o DIGITAL BLOCK o o o ANTERIOR NASAL PACKING o o o SLIT LAMP EXAM o o o PERFORM TONOMETRY o o o ENUCLEATION OF THROMBOSED HEMORRHOID o o o G TUBE REPLACEMENT o o o I&D BARTHOLIN GLAND ABSCESS o o o IUD REMOVAL o o o EMERGENCY VAGINAL DELIVERY o o o CAST/SPLINT PLACEMENT o o o DISLOCATION REDUCTION o o o SIMPLE FRACTURE REDUCTION o o o NAIL TREPHINATION o o o I&D OF ABSCESSES o o o SKIN DEBRIDEMENT o o o

I CERTIFY THAT I HAVE HAD THE NECESSARY TRAINING AND EXPERIENCE TO PERFORM THE PROCEDURES I HAVE REQUESTED.. _________________________________________________ _____________________________________ SIGNATURE OF APPLICANT DATE

Signature of Approval ________________________________________________ Date _____________________

Co-Chair, IPC Committee Signature of Approval ________________________________________________ Date _____________________

Chairman, Medical Executive Committee

Date: October 30, 2009 To: City of Alameda Health Care District Board of Directors From: Jordan Battani, Board President Deborah E. Stebbins, CEO Subject: Approval of Extending Board Vacancy Application Deadline Background:

The City of Alameda Health Care District (District) was informed by Steven Wasson of his intent to resign from the Board of Directors on October 12, 2009 effective immediately. The District must appoint an individual to fill the vacant position on its Board of Directors.

Individuals interested in being considered for this appointment must submit an “Application Package”, as described in the District’s appointment process. Application Packages must be delivered to the District, at the address below, no later than 5:00 p.m., on Friday, November 6, 2009.

As of Friday, October 30, 2009, there have been no Application Packages submitted to the District. However, we have had inquiries and expressions of interest from several individuals. Recommendation: We recommend that the Board of Director take action to extend the application process to Friday, November 20, 2009 to allow additional time for interested applicants to submit their Application Package to the District. The District will conduct an Applicant Conference on December 3, 2009 at 6:00 p.m. in the 2 East Board Room at Alameda Hospital, for the purpose of familiarizing Applicants with the District and Alameda Hospital. Applicants are encouraged to attend. The Board of Directors plan to interview applicants, selected according to the procedures set forth below, at the District Board Meeting, to be held on Monday, December 7, 2009 at 5:30 p.m. The Board also plans to make the appointment on Monday, December 7, 2009 immediately following the interviews. Meetings will be conducted in the William Dal Cielo Conference Room.

public notice city of alameda health care district board ... · august 2009 performance improvement...

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