UT Health Physicians Carlos A. Rosende, M.D., F.A.C.S. Executive Vice Dean for Clinical Affairs Executive Director, UT Health Physicians
UT Medicine
UT Health Physicians
Our New Name UT Health San Antonio UT Health Physicians Better aligns with the new name of our institution Emphasizes our academic foundation Demonstrates our focus on Health Significance for marketing: patients seek doctors to lead their healthcare We can also be referred to as The Physicians of UT Health The Physician Practice of UT Health Our Domain www.uthealthcare.org
UT Health UT HEALTH School of Dentistry Graduate School of Biomedical Sciences School of Medicine School of Health Professions School of Nursing The Clinical Enterprise MSRDP UT Health Physicians Membership is clinical faculty; board provides strategic planning and financial decisions. The Clinical Practice and Administrative Support
MSRDP The Clinical Enterprise Medical Services, Research and Development Plan The official name of the clinical practice of the School of Medicine Membership Faculty of the School of Medicine who generate revenue through the provision of clinical care Board of Directors All clinical chairs and center directors Three at-large members Ex officio members Appoints members to 17 committees and subcommittees Officers: Chair: President of UT Health Vice Chair: Dean of the School of Medicine Treasurer: VP for Business Affairs Secretary: Executive Director of UT Health Physicians
The Clinical Enterprise UT Health Physicians The operational component of MSRDP The component that cares for patients Carries out the strategy of the Board Composed of over 700 physicians and 200 advanced practice providers Includes all clinical and administrative support personnel Clinical IT Revenue Cycle Communications Managed Care Education and Training Quality
What We Do Mission Statement Our mission is to offer excellent, evidenced-based, patientcentered care that is founded on what we teach and discover. Vision Statement With a focus on our patients and a commitment to excellence, UT Health Physicians will be the healthcare provider of choice for Central and South Texas. Patient Promise The patient is our FOCUS: we will render friendly, outstanding and compassionate healthcare, giving our patients our undivided attention and being sensitive to their needs.
Our Core Values Quality Integrity Compassion Diversity Innovation
Our Emphasis Excellence in clinical care Superior patient experience Patients First Patient Access: today, tomorrow, next week Patient-centered, efficient clinic operations Optimization of resources space, equipment, time, personnel Productivity Documentation of Quality and Value CMS and private insurance mandates Employers Current and future partners Patients!! Staff and faculty retention
Where We Practice
FY 2016 Patient Encounters by Location Other locations: 3% UT HEALTH locations (ambulatory only) 31% UHS locations: 66%
UT Health Practices MARC Audiology Cardiology Cardiothoracic Surgery Comp. Kidney Stone Center Cosmetic Surgery Group Day Surgery Center Digestive Diseases/GI Ear, Nose and Throat Head and Neck Oncology Head and Neck Surgery Fertility Center Electromyelography Endocrinology Family & Community Medicine (PCC) Fertility Center General Surgery Geriatric Medicine (PCC) Gynecologic Oncology Imaging Center/Radiology Infectious Diseases Internal Medicine (PCC) Lab Services Nephrology Neuro-Ophthalmology Neurology Neuropsychology Neurosurgery Obstetrics/Gynecology Occupational Therapy Ophthalmology & Optometry Orthopedics Pancreas Center Pelvic Floor Center Pharmacy Physical Therapy Podiatry Pulmonary Medicine Rheumatology Travel Medicine Urology Urologic Oncology Vascular Surgery
UT Health Practices Other Locations Cancer Center Hematology Oncology Medical Oncology Radiation Oncology Neurosurgery Oncology CT Oncology Pancreatic Cancer Breast Cancer Surgical Oncology Dermatology Christus Santa Rosa MC Senior Health (PCC) Hill Country Primary Care (PCC) Orthopaedics Physical Therapy Radiology Urology Medical Drive Primary Care (PCC) Westover Hills Primary Care (PCC) General Surgery Bariatric Surgery Westgate Center Pain Center University Hospital Ophthalmology North Central Baptist Neurosurgery School of Medicine Psychiatry Rehab/Prosthetics Robert B. Green (UHS/UHCD) Urology Pediatric Ophthalmology Texas Diabetes Institute (TDI/UHS) Ophthalmology Rehab/Prosthetics
Strategic Plan 2017 Build a primary care network consisting of employed and associated physicians. Expand our specialist network by selective associations and employment of community specialists. Increase our geographic footprint. Create more nationally recognized clinical programs.
1. Access 2. Access 3. Access Our Priorities 4. Communicate with referring physicians 5. Implement processes for transition of care 6. Return to basics a) Identify cfte for each provider b) Assign clinical time consistent with cfte i.e., the appropriate number of sessions c) Ensure utilization of full session (no late starts or early stops) d) Establish target number of visits per session and enforce it e) Track bumps and template changes minimize them f) Work with Patients First to improve clinical operations implement recommendations g) Address problems with closing encounters
Our Challenges Irrespective of what becomes of the Affordable Care Act, the following are certainties that will have profound impact on our practice: Reimbursements will transition away from fee-for-service. Payers will be looking for value. Patients will be looking for quality, convenience and service. It will not be sufficient that we claim to provide these we will have to demonstrate our excellence, service and value through documentation that will be shared with patients employers and payers. We will have to compete for patients.
University Health System Financially, our most important relationship Greatest contract revenue Main source of our fee-for-service revenue Clinically, our most important relationship Site of two-thirds of our clinical activity Source of many referrals to UT Health All of our pediatric activity Strategically, our most important relationship Most significant education venue for UME and GME Site of most of our clinical research Has consistently invested in our faculty for projects of mutual importance Centers of Excellence Trauma Transplant Neurosciences Texas Diabetes Institute Future: Heart-Vascular, Women s and Children s Health
Questions?
$600.0 $500.0 $400.0 $300.0 School of Medicine Major Sources of Revenue $506.9M $49.8 $39.2 $141.6 $501.7M $57.8 $55.8 $124.1 $529.0M $56.8 $38.0 $118.6 $550.1M $53.5 $40.9 $117.1 $200.0 $100.0 $257.7 $282.6 $315.6 $338.6 $- FY2013 FY2014 FY2015 FY2016 Practice Plan Grants & Contracts Gifts, Interest & Other State
MSRDP Total Operating Revenue Actual FY2010 FY2016; Budget 2017 Millions 400 350 300 250 200 150 100 50-215.6 235.6 248.2 257.7 282.6 315.6 338.6 350.0 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 Budget
MSRDP Financial Activity (in millions of $ s) Operating Revenue FY2015 Actual FY2016 Actual FY2017 (Dec YTD) Fee For Service 156.1 174.8 54.8 Contract & Other 159.5 163.8 51.8 Total Operating Revenue 315.6 338.6 106.6 Operating Expenses Salaries & Benefits 227.9 240.7 84.9 Maintenance & Operations 54.4 66.7 20.5 Other Operating Expenses (.5) (.4).4 Total Operating Expenses 281.8 307.0 105.8 Operating Income (Loss) 33.8 31.6.8 Non-operating items Capital Outlay <1.7> <2.7> <0.3> Debt Service (Principal & Interest) <5.5> <5.8> <1.9> Net Change in Fund Balance 26.7 23.1 (.2)
UTM Administrative Assessment Actual FY2010 FY2016; Budget 2017 Millions 35 30 25 20 21.1% 17.4% 15.7% 16.9% 15.9% 15.9% 14.8% 17.1% 25.0% 20.0% 15.0% 15 10 5 10.9% 9.4% 8.7% 9.0% 8.2% 7.9% 7.7% 8.8% 10.0% 5.0% 0 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 Budget 0.0% Expenses % of FFS Revenue % of Total Revenue Assessment: 8.7% per RVU ($65.10) + 5.54% of clinical revenue
MSRDP Statistics FY2014 FY2015 FY2016 FY2017 Variance Total Patient Encounters 1,193,873 1,246,040 1,320,426 218,675 % from UHS Sites 64% 67% 66% 67% % from UT Med 30% 31% 31% 31% % from Other Sites 6% 3% 3% 2% Work RVUs Billed 2,251,472 2,441,973 2,585,841 641,693 Commercial** 23% 27% 27% 27% Medicare 25% 26% 27% 27% CareLink 19% 14% 11% 11% Medicaid/Govt (less Tricare) Years Ended 8/31 2014, 2015 and 2016; 2017 (Dec YTD) 19% 20% 20% 20% Tricare 1% 1% 1% 1% Self-Pay 13% 12% 14% 14% ** 4% upward swing in Commercial mix results in $8.7M increase in revenue. 6% FY16 4% FY15 6% FY16 8% FY15
UT Medicine Payor Mix for UHS & UTM Sites UHS Sites FY2014 FY2015 FY2016 FY2017 (Dec) Commercial 18% 22% 23% 22% Govt/Self 21% 19% 20% 21% CARELINK 23% 16% 13% 13% MEDICAID 18% 20% 21% 21% MEDICARE 20% 22% 23% 23% UTM Sites FY2014 FY2015 FY2016 FY2017 (Dec) Commercial 36% 40% 40% 40% Govt/Self 6% 5% 6% 7% CARELINK 13% 9% 8% 8% MEDICAID 10% 10% 9% 9% MEDICARE 34% 36% 37% 36%
FY16 Metrics: Revenue Cycle Revenue Cycle Performance FY2014 FY2015 FY2016 FY2017 (Dec YTD) Initial Denial Rates as a % of Gross Charges 7.4% 7.8% 7.5% 7.4% Controllable Write-Off Rate 2.2% 2.0% 2.0% 2.2% Days in Accounts Receivable without Self-Pay 29.2 30.2 30.9 30.0 Charge Lag days UTM sites 11.6 10.7 9.5 8.1 The controllable write-off of 2% was about $10.1M in gross charges in FY2016, which resulted in approximately $3.1M in lost collections. The number one reason for the write-offs is failure to obtain appropriate authorization for the procedures performed.
Where the Money Comes From Fiscal Year 2017 (Revenue Budget)
Where the Money Goes Fiscal Year 2017 (Budget by Expense Function)
Where the Money Goes Fiscal Year 2017 (Budget by Expense Type)
Organized Research Awards Organized Research Awards - Percent decline since 2012: -7% - Percent increase over 2015: 12%