BOARD OF DIRECTORS AGENDA PACKET - Palomar Health · 2012. 8. 13. · Michael H. Covert, FACHE,...

BOARD OF DIRECTORS AGENDA PACKET

August 13, 2012

The mission of Palomar Health is to heal, comfort and promote health

in the communities we serve.

u:templates\bd agenda inner cover sheet template:nla

BOARD OF DIRECTORS

T.E. Kleiter, Chairman Nancy L. Bassett, RN, MBA, Vice Chairman

Jerry Kaufman PTMA, Secretary Linda C. Greer, RN, Treasurer

Bruce Krider, MA Marcelo Rivera, MD

Stephen P. Yerxa

Michael H. Covert, FACHE, President and CEO

Regular meetings of the Board of Directors are usually held on the second Monday of each month at 6:30 p.m., unless indicated otherwise

For an agenda, locations or further information call (858) 675-5106, or visit our website at www.pph.org

MISSION STATEMENT

The Mission of Palomar Health is to: Heal, Comfort, Promote Health in the Communities we Serve

VISION STATEMENT

Palomar Health will be the health system of choice for patients, physicians and employees, recognized

nationally for the highest quality of clinical care and access to comprehensive services

CORE VALUES

Patient’s Well-Being We passionately give and support heartfelt care that encourages patient comfort and safety

Professionalism

Each of us takes pride in teamwork, self-discipline, our skills and trustworthiness

Highest Quality

We are each accountable for providing the safest, most effective and innovative care

Affiliated Entities

*Escondido Surgery Center * Palomar Medical Center * Palomar Medical Auxiliary & Gift Shop * Palomar Continuing Care Center * *Palomar Pomerado Health Foundation * Palomar Pomerado Home Care * Pomerado Hospital * Pomerado Hospital Auxiliary & Gift Shop *

*San Marcos Ambulatory Care Center * Villa Pomerado Palomar Pomerado Health Concern* Palomar Pomerado Health Source* *Palomar Pomerado North County Health Development, Inc.* North San Diego County Health Facilities Financing Authority*

Time PageI. CALL TO ORDER 2

II. OPENING CEREMONY 5A. Pledge of Allegiance

III. PUBLIC COMMENTS 5(5mins allowed per speaker with cumulative total of 15mins per group - forfurther details and policy see Request for Public Comment notices availablein meeting room.)

IV. MINUTES * 5 1-9A. Regular Board Meeting - July 9, 2012

V. APPROVAL OF AGENDA to accept the Consent Items as listed * 5 10-31A. June 2012 & YTD FY2012 Financial Report - Addendum AB. Approval of Revolving, Patient Refund & Payroll Fund Disbursements– June 2012

1. Accounts Payable Invoices2. Net Payroll

TotalC. Ratification of Paid BillsD. Budgeted Routine Physician Agreements Board Summary ReportE. Approval of FY13 Initiatives - as presented at Board Strategic Planning - June 19, 2012

VI. PRESENTATIONS - None

VII. REPORTS 32-66A. Medical Staffs

*1. Palomar Medical Center - Richard C. Engel, M.D. 5A. Credentialing and Reappointments

Palomar Medical Center - Richard C. Engel, M.D. B. Department of Surgery Rules and Regulations 5

Palomar Medical Center - Richard C. Engel, M.D. 5C. Department of Radiology Rules and Regulations

*2. Pomerado Hospital - Roger Acheatel, M.D. 5A. Credentialing and Reappointments

$41,538,538.00$12,936,189.00$54,474,727.00

PALOMAR HEALTH

BOARD OF DIRECTORS REGULAR MEETING AGENDA

Monday, August 13, 2012 Palomar Medical Center Commences 6:30 p.m. Graybill Auditorium 555 E. Valley Parkway Escondido, CA 92025

Mission and Vision “The mission of Palomar Health is to heal, comfort and

promote health in the communities we serve.”

“The vision of Palomar Health is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality

of clinical care and access to comprehensive services.”

*3. Palomar Medical Center and Pomerado Hospital 5Richard C. Engel, M.D. and Roger Acheatel, M.D.A. Credentialing Process

Palomar Medical Center and Pomerado Hospital 5Richard C. Engel, M.D. and Roger Acheatel, M.D.

B. B. Ortho Checklist

1 Chairman of the Palomar Pomerado Health Foundation - John Forst 5 Verbal ReportA. Update on PPHF Activities

2 Chairman of the Board - Ted Kleiter 10 Verbal Report

3 President and CEO - Michael Covert, FACHE 10 Verbal Report

VIII. INFORMATION ITEMS 67-70A. 4th Quarter Update - FY2012 Initiatives - Finance

IX. COMMITTEE REPORTS 40 71-83A. Audit and Compliance Committee - no meeting in JulyB. Governance CommitteeC. Human Resources Committee - no meeting in JulyD. Community Relations CommitteeE. Facilities and Grounds Committee - no meeting in JulyF. Strategic Planning Committee - no meeting in JulyG. Quality Review Committee - no meeting in JulyH. Finance Committee

*1. 08.13.12 (06) - 01 - Concerning the Levy and Collection of Taxes by the Boardof Supervisors of the County of San Diego for FY2012-2013 to Pay Principaland interest on General Obligation Bonds and Authorizing the Taking of All Actions Necessary in Connection Therewith

*2. 08.13.12 (07) - 02 - Establishing Appropriations Limit of the District for theFiscal Year July 1, 2012 - June 30, 2013 Pursuant to Article XIII (B) of theCalifornia Constitution

I. Other Committee Chair Comments on Committee Highlights

X. BOARD MEMBER COMMENTS/AGENDA ITEMS FOR NEXT 10MONTH

XI. ADJOURNMENT

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BOARD OF DIRECTORS REGULAR BOARD MEETING Pomerado Hospital/Meeting Room E

Monday, July 9, 2012

AGENDA ITEM DISCUSSION CONCLUSIONS/ACTION FOLLOW-UP RESPONSIBLE PARTY

CALL TO ORDER 6:30P.M. Quorum comprised Directors Bassett, Greer, Kaufman, Kleiter, Krider, Rivera and Yerxa

OPENING CEREMONY The Pledge of Allegiance was recited in unison.

MISSION AND VISION STATEMENTS

The Palomar Health mission and vision statements are as follows: The mission of Palomar Health is to heal, comfort and promote health in the communities we serve. The vision of Palomar Health is to be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services.

NOTICE OF MEETING Notice of Meeting was mailed consistent with legal requirements

APPROVAL OF MINUTES Regular Board Meeting

June 11, 2012 Special Board Budget

Workshop Meeting, June 4, 2012

Full Board Strategic Planning Meeting, June 19, 2012

MOTION: by Kaufman, 2nd by Bassett and carried to approve the board meeting minutes as submitted. All in favor. None opposed.

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APPROVAL OF AGENDA (to accept the Consent Items as listed) A. May 2012 & YTD FY2012

Financial Report B. Approval of Revolving, Patient

Refund & Payroll Fund Disbursements– May 2012

Accounts Payable Invoices $ 44,048,317.00 Net Payroll

$12,426,915.00 Total $56,475,232.00

C. Ratification of Paid Bills D. Budgeted Routine Physician Agreements Board Summary Report E. Release of FY2012 Board Strategic Capital – PMC Downtown Urgent Care F. Investment in Rancho Bernardo Surgery Center G. Media Relations Policy GOV 21 H. Physician Recruitment and Retention Policy – GOV 35 I. Political Activities on Palomar Health Property – GOV 27 J. Physician Owned Medical Device Company Arrangements 44692

MOTION: by Krider, 2nd by Kaufman and carried to approve the Consent Items A – F and H - J, as submitted. All in favor. None opposed. G. Media Relations Policy (GOV 21) was pulled for further discussion at a later point in the meeting at the request of Director Rivera.

PRESENTATIONS Pipeline Career Services Update

Brad Krietzberg, Manager Career Development Mr. Krietzberg reported that Pipeline Career Services is San Diego’s leading healthcare internship whose purpose is to 1) contribute to the health and well-being of our patients; 2) provide support to Palomar Health staff and services; 3) create a development and recruitment pipeline for future Palomar Health healthcare professionals. Growth over the last

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three fiscal years was noted. In FY12 there were 800 interns participating in the program. Service is primarily at the CNA or tech level. Over 300 applicants are interviewed every three months. 180 new students join the internship every quarter. Mr. Krietzberg reported that 91% of CCEs consider themselves a valued member of the Patient Care Team with 22% reporting that they have found a new career path while 69% believe the internship helped confirm their career goals. Approximately 97% of students have affirmed that the internship has met or exceeded their expectations. Going forward the program will re-brand; move beyond the bedside and engage in career development. Director Greer stated she started as a volunteer and it was valuable in setting her on the path to a career in health care. She praised the program as being instrumental in helping students to discover and /or confirm their interest in a healthcare career. Director Bassett asked how many staff members lead the program. Brad Krietzberg and Joseph Molinoski are the staff members who manage the program. Director Kaufman asked if there are opportunities for those students who might be interested in a career in healthcare administration. Mr. Krietzberg commented that there is a potential to develop a pathway for those who are interested in this aspect of health care. Director Rivera asked how students were recruited. They are recruited through word of mouth, teams which go to schools to make presentations, flyers in career offices, etc. GO Med is still a program through INTERLINK pathway. Palomar Health is currently a partner with Orange Glen, San Marcos, Mission Hills, Valley Center High Schools and San Pasqual Academy. Additionally, Director Rivera asked if there is an opportunity for college students to interact with physicians. Mr. Krietzberg commented

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that this is an opportunity to explore. Director Rivera stated his strong support for the program. Mr. Covert also praised the program and the level of service it provides to Palomar Health. Director Kleiter reported that he has received great feedback from members of the public recently about the program.

Clarity (Cerner) Update Kim Colonnelli, RN, Chief Nursing Officer Ms. Colonnelli reported on Clarity one year post-installation. The goals of the installation were to make Palomar Health a more knowledge enabled organization; expand information management capability; implement technologies to improve quality/safety and collect defined data for performance improvement; position ourselves for Meaningful Use compliance. Approximately 20 new applications have been installed; over 1200 devices deployed; wireless infrastructure remediation, VPN access; guest network; McKesson installed for PACS. Clarity updates are provided at least once a week for immediate issue resolutions. Prior to Clarity 12% verbal and telephone orders by medical staff; currently less than 9% with 91% of the orders placed by the physicians on Clarity. Next phase – Meaningful use will drive full adoption of Clarity Electronic Health Record; Analyze MU gaps in compliance and engage process owners; close to 90% at PMC and Pomerado and puts us at the top of CPOE per Dr. Kanter – better than when on paper.; planning for accelerated MU stages 2 and 3; Suggest Board and EMT Meaningful Use education session to provide an opportunity to the Board to get an in-depth briefing. Director Rivera asked if the implementation of Clarity has been able to free nurses to spend more time at the bedside and if there is a way to track equipment service calls with IT. Ms.

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Colonnelli reported that some things are now being done faster since implementing Clarity. Mr. Paul Peabody, Chief Information Officer, said that equipment issues should improve significantly in the near future. Director Rivera asked about the current challenges for Nursing. Ms. Colonnelli reported that nursing staff are now familiar with the use of Clarity and there is an opportunity to continue to bring down the number of voice and telephone orders. Director Bassett asked if physicians can enter orders from their offices. Access to Clarity is available to physicians from their offices.

REPORTS Medical Staff Palomar Medical Center

Credentialing Jeffrey Rosenburg, M.D., Chief of Staff-elect for Palomar Medical Center, presented requests for approval of Credentialing Recommendations.

MOTION: by Kaufman, 2nd by Bassett and carried to approve the Palomar Medical Center Medical Staff Executive Committee credentialing recommendations for the Palomar Medical Staff as presented. All in favor. None opposed.

Credentialing Roger Acheatel, M.D., Chief of Staff for

Pomerado Hospital, presented requests for approval of Credentialing Recommendations.

MOTION: by Bassett, 2nd by Krider and carried to approve the Pomerado Hospital Medical Staff ‘s Executive Committee credentialing recommendations for the Pomerado Medical Staff as presented. All in favor. None opposed.

Administrative Palomar Pomerado Health Foundation

John Forst, Palomar Health Foundation, Board Chair

Mr. Forst reported that the Executive and Finance Committees will meet July 16. The

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Annual Board Meeting is July 24. Gala revenue for 2012 was $829,000 of which $311,000 was for expenses resulting in a net profit of approximately $517,000. This was an increase of 30% increase over 2011. The Donor Celebration is scheduled for July 26. The Physician Tour is July 17. The Donor Wall Project is moving along. The portable digital display will be available during the celebration events. There is a potential donor for the donor recognition wall. $130,000 has been raised by the Employee Chapel Campaign toward construction of the chapel at the new hospital. The Medical Staff Campaign has reached $3.2M in donations. Foundation activities in June included - 7 VIP tours (with resulting gifts); Vital Matters series with Dr Roger Acheatel as guest presenter; FY12 donations totaled over $3.8M. Staff is working hard to increase the number of donors in database.

Chairman of the Board Ted Kleiter Chairman Kleiter represented Palomar Health

at the July 4 celebration at Grape Day Park. He was part of the program and let everyone know about the Grand Opening Celebration of the new hospital on July 28. Chairman Kleiter opened a discussion on item G. from the Consent Agenda – Media Relations Policy (GOV 21). Director Rivera requested that III. (7.) of the policy be removed.

MOTION: by Rivera, 2nd by Greer to remove Item III (7.) from the Media Relations Policy (GOV 21). Upon further discussion by the Board, Director Krider, Chair of the Board Governance Committee, suggested that the policy be taken back to the Governance Committee to review options for alternative language. The Board agreed with this recommendation and the motion was withdrawn. The policy will be returned to the Board for their review and approval at a later date.

President and CEO Michael Covert Mr. Covert reported that Drs. Tam and

Trifunovic, Board members Steve Yerxa and Ted Kleiter joined him for a meeting with the leadership from Loma Linda University Medical Center. The meeting was held to

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explore opportunities for collaboration between the two health systems. There was good discussion about developing a partnership. Director Yerxa commented that the meeting was positive and there was interesting discussion. More to follow. Mr. Covert also reported that a meeting is scheduled with UCSD to discuss collaboration opportunities. The Administrative Fellow dinner for Vicki Shumulinsky is planned for July 23. Interviews of candidates for the Assistant to the Board of Directors position are underway. Dr. Tam was thanked for stepping in to provide leadership for the Marketing and Communication staff while the search is being conducted for the new Chief Marketing and Communication Officer.

COMMITTEE CHAIR COMMENTS

Audit and Compliance Director Bassett reported that among the topics at the meeting, Enterprise Risk Management was discussed and how it affects the Palomar Health Strategic Plan. She suggested that this topic be used as a Board education session in the future.

Governance Director Krider reported that several policies were brought forward for review and approval by the Board at tonight’s meeting.

Human Resources Director Yerxa reported that the CCE (Clinical Care Extender) Program and Transformation and Orientation topics were discussed. A graphic highlighting the location of employees by location was included.

Board Facilities and Grounds

Director Rivera reported on the recent Ground Breaking Celebration for the Ramona Outpatient Facility recently. He emphasized the importance of having Arch Health Partners as a key part of that facility. He stated that

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there is great excitement on the part of the Ramona residents to see this facility built.

Board Quality Review Director Bassett stated that consideration is being given to canceling the July and August meetings because of the number of activities and meetings scheduled surrounding the opening of the new hospital. She asked the committee members to please review any presentations and be ready for discussion at the next meeting.

Strategic Planning Chairman Kleiter reported that the June meeting was a full Board meeting and all Board members were present.

Finance Director Greer thanked Director Yerxa for chairing the Board Finance Committee meeting in her absence. She commented on Arch Health Partners Business Review, which was a part of the Board packet this month. Highlights included a 37% increase in the number of physicians; qualifying 25 physicians for receipt of Meaningful Use dollars; office location expansion; addition of 15,000 new patients and receipt of several awards for quality and patient service.

Community Relations Director Kaufman reported on the number of events coming up relating to the opening of the new Palomar Medical Center. Parking for the July 28 event will be available near the new hospital and will be publicized. He recognized the Marketing and Communication Department staff members for the outstanding job they have done getting ready for these events.

Additional Comments

Director Rivera will be absent for the next meeting. Additionally, he recalled the nine years of service to Palomar Health by Gustavo Friederichsen, Chief Marketing and Communication Officer, and wished him well in the future.

ADJOURNMENT 8:00 P.M. SIGNATURES

Board Secretary

__________________________________ Jerry Kaufman, P.T.M.A.

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Interim Board Assistant

___________________________________ Nancy Wood

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TO: Board of Directors MEETING DATE: Monday, August 13, 2012 FROM: Robert A. Hemker, CFO BY: Board Finance Committee Monday, July 30, 2012 Background: As the June 2012 financial close was extended to assure all FY2012 business transactions were recorded in the pre-audit financial statements, and consistent with prior year year-end closings, the attached documents were presented at the Board Finance Committee meeting.

Budget Impact: N/A

Staff Recommendation: Staff recommended approval

Committee Questions:

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the FY2012 Pre-Audited Financial Statements. Motion: X Individual Action: Information: Required Time:

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Budgeted Routine Physician Agreements Board Summary Report

Form A - Physician Agreements.doc

TO: Board of Directors MEETING DATE: Monday, August 13, 2012 FROM: Robert A. Hemker, CFO

BY: Board Finance Committee Monday, July 30, 2012 Background: The following Budgeted Routine Physician Agreements became effective during the month of June 2012. The standard Form A and Abstract Table1 for each signed Agreement are attached.

COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of the Budgeted Routine Physician Agreements as presented.

Motion: X

Individual Action:

Information:

Required Time:

1 Short extension due to transition to new campus – no Form A or Abstract Table required

PHYSICIAN AND/OR GROUP TYPE OF AGREEMENT

Arch Health Partners Agreement for Management and Related Services For Behavioral Health Services Jeffrey Chen, MD Keyvan Esmaeili, MD Bassem Georgy, MD Jeffrey Schiffman, MD Mark Stern, MD

ActivCentre Provider Panel Agreements

Ronald Feldman, MD Agreement for Items – Contract for Purchase of Medical Imaging Pill Cam FunctionMD Medical Center Physician Advisor Agreement – ActivCentre Mission Infectious Disease & Infusion

Consultants, Inc. Agreement for Services – Consultations

Poway Women’s Care, Inc. and Victoria Young, MD Physician Recruitment Agreement – OB/GYN

Southern California Permanente Medical Group – George Moore, MD

Independent Contractor Agreement – Information Systems Services

Anesthesia Consultants of California, Inc.1 Professional Services & Medical Director Agreement – Anesthesiology Services

Escondido Pulmonary1 Medical Directorship – Critical Care, Respiratory Therapy, Pulmonary Rehab, Sleep Lab and Pulmonary Services

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TO: Board Finance Committee MEETING DATE: Monday, July 30, 2012 FROM: Sheila Brown, FACHE, Chief Clinical Outreach Officer

Susan Linback, R.N., M.B.A., Director, Behavioral Health BACKGROUND: This is a request to approve the Contract Amendment No. 2 to the Agreement for Management and Related Services for Behavioral Health Services Between Palomar Health and ARCH Health Partners effective date July 1, 2012. Arch Health Partners will continue to employ (through PIMG) and provide psychiatrists for On-Call and coverage for all Inpatient and Outpatient Behavioral Health Programs, Consultation services for the Acute Care Units at all Palomar Health Hospitals as well as Skilled Nursing Facilities. This Amendment revises the physician compensation, delineates the services and hours, adds a description of the responsibilities of the Palomar Health Psychiatrist as well as the Palomar Health Physician Code of Conduct. BUDGET IMPACT: Minimal Budget Impact STAFF RECOMMENDATION: Approval COMMITTEE QUESTIONS:

COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

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PALOMAR HEALTH - AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Amendment 2 to the Agreement for Management and Related

Services for Behavioral Health Services between Palomar Health and ARCH Health Partners (AHP)

AGREEMENT DATE Amendment No. 2 – 07/1/2012 Amendment No. 1 06/07/12 Original Agreement 1/1/2012

PARTIES 1) Palomar Health 2) ARCH Health Partners

PURPOSE This Contract Amendment 2 revises the physician compensation, delineates the services and hours, and adds a description of the responsibilities of the Palomar Health Psychiatrist as well as the Palomar Health Physician Code of Conduct.

1.1. 1.1.6

SCOPE OF SERVICES ARCH Health Partners will continue to provide Palomar Health with the professional services of psychiatry. AHP will contract with or provide an employment vehicle thru PIMG for physicians to provide adequate coverage to Palomar Health’s Behavioral Health Services 24 hours a day 7 days a week, as defined by the Medical Director of the Service. In addition, AHP provides physician practice management, IT infrastructure, reporting, coding, claims management, billing and collections, and payroll for the services and physicians.

PROCUREMENT METHOD

Request for Proposal Discretionary

15.1.1.

TERM

Management Agreement: January 1, 2012 to December 31, 2012 Amendment 2: July 1, 2012 to December 31, 2012

15.1.1. RENEWAL Annual renewals at agreed upon rates on the anniversary date unless notice given to terminate the agreement by one of the parties.

15.1.2. TERMINATION a. Upon 90 days prior written notice 12.2.1. 12.2.2.

COMPENSATION METHODOLOGY

Monthly payment for the current month on the 5th day of the month. Payment for variable invoices within 15 business days of the receipt thereof.

BUDGETED YES NO - IMPACT: Minimal.

EXCLUSIVITY NO YES – EXPLAIN:

JUSTIFICATION

AGREEMENT NOTICED YES NO METHODOLOGY & RESPONSE:

ALTERNATIVES/IMPACT . Exhibit B DUTIES COMMENTS APPROVALS REQUIRED Officer CFO CEO BOD Finance Committee BOD

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TO: Board Finance Committee MEETING DATE: Monday, July 30, 2012 FROM: Natalie Bennett, Manager, Program Development Background: For a provider to serve on the ActivCentre panel he must sign a provider panel agreement. In June, the five provider panel agreements listed below expired, and the physicians decided to continue their participation on the panel through an amendment to their original agreement. The provider panel agreements focus on delivering a standard of care when patients are referred to a provider from the ActivCentre. There is no budgetary impact of these agreements, this is for information only.

• Jeffrey Chen, MD • Keyvan Esmaeili, MD • Bassem Georgy, MD • Jeffrey Schiffman, MD • Mark Stern, MD

Budget Impact: None

Staff Recommendation: Approval



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Reference

Term/Condition

Term/Condition Criteria TITLE ActivCentre Provider Panel Agreement Amendment

AGREEMENT DATE 6-6-2012

PARTIES Palomar Health and Jeffrey Chen, MD

PURPOSE To serve as a panel physician for the outpatient spine center.

SCOPE OF SERVICES Provider agrees to meet certain program standards to participate. The standards are focused around access, triage, nurse navigation, outcomes tracking, quality and education/marketing.

PROCUREMENT METHOD

Request For Proposal x Discretionary

TERM 1-year

RENEWAL Automatic renewal unless otherwise terminated

TERMINATION 30-day written notice


N/A

BUDGETED YES NO – IMPACT: N/A

EXCLUSIVITY xNO YES – EXPLAIN:

JUSTIFICATION

AGREEMENT NOTICED YES xNO Methodology & Response: any new providers on the staff are given an opportunity to be on the panel for the ActivCentre

ALTERNATIVES/IMPACT

Duties Provision for Staff Education Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS

APPROVALS REQUIRED VP CFO CEO BOD Committee ____________ BOD

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Reference

Term/Condition



PARTIES Palomar Health and Keyvan Esmaeili, MD



PROCUREMENT METHOD


TERM 1-year




N/A



JUSTIFICATION


ALTERNATIVES/IMPACT


COMMENTS


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Reference

Term/Condition



PARTIES Palomar Health and Bassem Georgy, MD



PROCUREMENT METHOD


TERM 1-year




N/A



JUSTIFICATION


ALTERNATIVES/IMPACT


COMMENTS


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Reference

Term/Condition



PARTIES Palomar Health and Jeffrey Schiffman, MD



PROCUREMENT METHOD


TERM 1-year




N/A



JUSTIFICATION


ALTERNATIVES/IMPACT


COMMENTS


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Reference

Term/Condition



PARTIES Palomar Health and Mark Stern, MD



PROCUREMENT METHOD


TERM 1-year




N/A



JUSTIFICATION


ALTERNATIVES/IMPACT


COMMENTS


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Palomar Medical Center Agreement for Items

Form A - Dr Feldman 7-11-12.doc

TO: Board Finance Committee MEETING DATE: Monday, July 30, 2012 FROM: Gerald Bracht, Chief Administrative Officer Palomar Medical Center Background: Dr. Feldman provides Gastroenterology services to his patients at Palomar Medical Center. Under certain situations Dr. Feldman uses a specific medical imaging Pill Cam that is not a stocked item at PMC. We have entered into an agreement with Dr. Feldman to reimburse the cost of the Medical Imaging Pill Cam. Appropriate invoices detailing the item provided to include a breakdown of charges are provided.

Budget Impact: None

Staff Recommendation: Approval



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Reference

Term/Condition

Term/Condition Criteria Preamble TITLE Physician Agreement for Items

Preamble AGREEMENT DATE June 6, 2012

Recital PARTIES 1) Ronald Feldman, M.D. Section 1 SCOPE OF SERVICES 1) Reimbursement for Medical Imaging Pill Cam PROCUREMENT

METHOD Request For Proposal Discretionary

Section 5 TERM One Year Effective June 6, 2012 thru June 11, 2013

Section 5 RENEWAL Term shall automatically roll-over for one additional year

Section 5.1

TERMINATION 1) As described under section 5.1

Section 2 COMPENSATION METHODOLOGY

Per Invoice, detailing the item provided

BUDGETED YES NO – IMPACT:

EXCLUSIVITY NO YES – EXPLAIN: JUSTIFICATION This is a non-stocked item that is used for patient care AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT N/A

Duties N/A COMMENTS None APPROVALS REQUIRED VP CFO CEO BOD Committee ____________ BOD

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TO: Board Finance Committee MEETING DATE: Monday, July 30, 2012 FROM: Natalie Bennett, Manager Program Development Background: In April 2012, an ActivCentre Physician Advisor agreement was executed between Palomar Health and Jeffrey Chen, MD. That agreement was presented and approved at the March 2012 Board Finance Committee meeting. Dr. Chen has since requested that the agreement be entered into with his professional S Corporation. Therefore, in June 2012, the agreement between Palomar Health and Dr. Chen was terminated and replaced with an agreement between Palomar Health and FunctionMD Medical Center. The physician rendering services through this new Physician Advisor Agreement (Jeffrey Chen, MD) remains the same.

Enter into Budget Impact: The dollars are already included in the FY13 budget.

Staff Recommendation: This contract is already budgeted and approved, so this communication is for information only.



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Reference

Term/Condition

Term/Condition Criteria TITLE Physician Advisor Agreement AGREEMENT DATE June 1, 2012 PARTIES (1) FunctionMD Medical Center

(2) Palomar Health PURPOSE To provide a comprehensive and integrated spine center program

that encompasses the evaluation, management and treatment of patients with back pain. The program focuses on outpatient services and the coordination of care across the continuum.

SCOPE OF SERVICES Management of care pathways and ongoing establishment of the outpatient spine center Partner with PH administration and medical staff regarding efficiency and service delivery Involvement in community education and marketing events promoting the benefits of the program- additional duties outlined in contract.

PROCUREMENT METHOD


TERM 1 year- June 1, 2012 – May 31, 2013 RENEWAL After renegotiation of contract between parties TERMINATION 1) Either party may terminate without cause or penalty with a

90-day notice. 2) Either party may terminate with material breach with a 30-

day notice. COMPENSATION

METHODOLOGY The hourly rate is based upon Fair Market Valuations for the delivery of this service by this specialty physician.

BUDGETED x YES NO – IMPACT:


JUSTIFICATION

AGREEMENT NOTICED x YES NO Methodology & Response: Original agreement was posted in the medical staff office.

ALTERNATIVES/IMPACT Duties x Provision for Staff Education

x Provision for Medical Staff Education Provision for participation in Quality Improvement x Provision for participation in budget process development

COMMENTS APPROVALS REQUIRED VP CFO CEO x BOD Committee Finance__ x BOD

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TO: Board Finance Committee MEETING DATE: Monday, July 30, 2012 FROM: Shannon Brown R.N, M.S.N, Director of Clinical Resource

Management Background: Unfunded infectious disease patients who require follow up visits per county regulations will be seen by Mission Infectious Disease and Infusion Consultants Inc.

Budget Impact: None

Staff Recommendation: Approval of the Agreement for Services – Consultations, with Mission Infectious Disease and Infusion Consultants, Inc., and recommend approval by the full Board of Directors.



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PALOMAR HEALTH – AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Mission Infectious Disease & Infusion Consultants, Inc. –

Agreement for Services – Consultation AGREEMENT DATE 6/19/12

PARTIES Mission Infectious Disease & Infusion Consultants, Inc.

PURPOSE Unfunded infectious disease patients who require follow up

visits per county regulations will be seen by Mission Infectious Disease and Infusion Consultants, Inc.

SCOPE OF SERVICES Unfunded patients

PROCUREMENT METHOD

Request For Proposal Discretionary

TERM One Year

RENEWAL Upon expiration of the Initial Term, the term shall automatically continue to roll over for additional one (1) year terms.

TERMINATION 30 days after written notice of termination is received by the other party.


Per Visit

BUDGETED YES NO – IMPACT:


JUSTIFICATION

AGREEMENT NOTICED YES NO Methodology & Response:

ALTERNATIVES/IMPACT


COMMENTS


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TO: Board Finance Committee MEETING DATE: Monday, July 30, 2012 FROM: Lisa Hudson, Director, Physician & Business Development Background: The Palomar Health community lacks an adequate number of Obstetric/Gynecology physicians as verified by Medical Development Specialists, a national consulting firm that specializes in physician manpower studies. PPH has an established physician recruitment program and has allocated resources to attract additional OB/GYN’s to relocate to Inland North San Diego County. Poway Women’s Care, Inc., and Victoria Young, MD, have signed the Palomar Health Physician Recruitment Agreement, which provides a qualified physician, new to the service area, who established her practice in June of 2012.

Budget Impact: None

Staff Recommendation: Approval of the Physician Recruitment Agreement with Poway Women’s Care and recommend approval by the full Board of Directors.



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PALOMAR HEALTH – AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Practice Recruitment Agreement Between Palomar Health,

Poway Women’s Care, Inc. and Victoria Young, M.D.

AGREEMENT DATE April 13, 2012

PARTIES Palomar Health, Poway Women’s Care, Inc. and Victoria Young, M.D.

Recitals PURPOSE Provide recruitment assistance to enable Dr. Young to establish a practice within Poway Women’s Care Group

Article 4 SCOPE OF SERVICES Dr. Young will establish a full-time OBGYN practice in Poway Women’s Care office and will participate in government-funded programs.

PROCUREMENT METHOD

N/A

Article 8 TERM 1 year of income assistance; two year repayment/forgiveness period

RENEWAL None Available

Article 2 TERMINATION Contract stipulates conditions for termination

Article 2 COMPENSATION METHODOLOGY

For monthly income guarantee physician will submit monthly report of expenses and collections. For relocation and start-up cost assistance physician will submit receipts.

5.1; 9.19 BUDGETED X YES NO – IMPACT:

EXCLUSIVITY X NO YES – EXPLAIN: : Government prohibits hospitals from requiring physician to exclusively have privileges or make referrals only to their hospital. The contract does include a non-compete clause.

JUSTIFICATION Medical Development Specialists, a national consulting firm who performed our Physician Manpower Study, completed an analysis which confirmed there is a justifiable community need for this recruitment

AGREEMENT NOTICED YES NO Methodology & Response:

ALTERNATIVES/IMPACT Duties Provision for Staff Education

Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS

APPROVALS REQUIRED VP XCFO XCEO XBOD Committee ____________ X BOD

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TO: Board of Directors MEETING DATE: Monday, July 30, 2012 FROM: Ben Kanter, MD, CMIO, Paul S. Peabody, CIO Background: Palomar Health requires the active involvement of physicians in many aspects of Information Systems programs. A Physician Advisor Council was active during the development phase of the Clarity Electronic Health Record. Now that Clarity has been implemented, the Physician Advisor Council will reconvene to assist Palomar Health in improving the efficient and effective use of Clarity. The physician(s) indicated below will be reimbursed for their work effort according to standard and customary manners and rates. This contract refers to this physician:

• Southern California Permanente Medical Group – George Moore, MD Budget Impact: After discussion with many different sites across the U.S., a fair market value was established for the mean value hourly reimbursement for such work. All fees payable to medical staff members have been budgeted within the IT projects listed above. Staff Recommendation: Approval. Committee Questions:


29

PALOMAR HEALTH - AGREEMENT ABSTRACT

Section Reference

Term/Condition

Term/Condition Criteria

TITLE Independent Contractor Agreement between Southern California Permanente Medical Group - George Moore, MD and Palomar Health

AGREEMENT DATE June 20, 2012

PARTIES Southern California Permanente Medical Group - George Moore, MD

PURPOSE To assist Palomar Health in improving the efficiency and effectiveness of the Clarity Electronic Health Record System particularly as it pertains to Physician Order Entry and documentation.

SCOPE OF SERVICES The physician will work as a subject matter expert providing information to Clarity development teams.

PROCUREMENT METHOD Request For Proposal Discretionary TERM 1 year

RENEWAL No automatic renewal

TERMINATION 10 day notice by either party without cause

COMPENSATION

METHODOLOGY Hourly

BUDGETED YES NO – IMPACT: None

EXCLUSIVITY NO

JUSTIFICATION Medical and IT subject matter expert required to assist in the planning and design of the electronic record. Fee is standard for this process and is based upon analysis from similar projects across the U.S.

AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT n/a Duties Provision for Staff Education

Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS APPROVALS REQUIRED VP CFO CEO BOD Committee ____________

BOD

30

TO: Board of Directors MEETING DATE: August 13, 2012 FROM: Michael Covert, President and CEO Background: For documentation purposes, it is requested that the Board of Directors formally approve the FY13 strategic initiatives which were presented at the Board Strategic Planning meeting on June 19, 2012.

Budget Impact: Staff Recommendation:

Committee Questions/Suggestions/Requests: COMMITTEE RECOMMENDATION: Motion: x Individual Action: Information: Required Time:

31

TO: Board of Directors MEETING DATE: Monday, August 13, 2012 FROM: Bob Hemker, CFO BY: Board Finance Committee Monday, July 30, 2012 Background: Pursuant to direction of the Board upon adoption of the FY2012 Initiatives, those associated with Finance Committee oversight were reviewed at the meeting:

• 1.1(a) – Grow Volume in Key Areas • 1.1(b) – Grow Net Primary Care Base • 1.2(b) – Implement Infrastructure to Support an ACO (On HOLD) • 1.3(a) – Realize Year 4 Capital Campaign

This was the Fourth and final quarterly review by the Finance Committee of the FY2012 Initiatives (attached). Budget Impact: N/A

Staff Recommendation: Information only


COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: X Required Time:

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FY12 Initiative: 1.1 (a) Grow volume in key areas

Outcome Measure: Contribution Margin Initiative Final Status: 1. Secured new medical staff specialists interested in using Palomar

Medical Center including CVT surgeon, Neurology Group 2. Business Plan in process and slated to complete by June 30 ASC

JV; Palliative Care completed and approved; Vascular Lab reviewed and rejected.

3. Secured Contracts with NAMM - October and Easy Choice-June 4. Clinical Trial participation results showed $440,000 in billings. 5. PPI Volumes in new JV at 3,700 encounters YTD thru May 6. ActivCentre Back and Neck achieved Year One Goals for CM 7. Areas of Focus progress as of end of May showed cm at 4.07 M

over target of $2.5M with greatest growth in Vascular Surgery, Spine, IR, Robotic Urology, Cardiology. Volume for Areas of Focus is at 1.0% of target. Final end of Year Data will be available in August.

Milestones: 1. Facilitate medical staff membership of specialists in

North County not presently on PPH medical staff with interest in utilizing Palomar Health

2. Prepare business plans and recommendations for Palliative Care Program, Vascular Lab JV, POM ASC JV.

3. Facilitate contracts with other IPAs, medical groups and health plans

4. Expand PPH and Medical Staff participation in clinical trials

5. Grow Outpatient Imaging at hospitals and new JV 6. Achieve Areas of Focus targets for FY12 (IP & OP) 7. Achieve Year one goals for the new Back and Neck

Center program

Report Date: July 16, 2012 Reporting Committees: Board Finance; EMT Finance

EMT Sponsor: Gerald Bracht Initiative Manager: Lisa Hudson

Initiative Risks:

6 Jul 11 Jun 12

Initiative Budget: Included in FY12 Operating Budget Budget Status: Within budget

Outcome Measure: FYTD Volume thru June +1.0% to target for 4.0% Growth overall and Contribution Margin $4.07M over Target of $2.5M=$6.6M thru May

Threshold – 2.0M or volume increase of 4% overall Target – 2.5M or volume increase of 5% Maximum – 3.0M or volume increase of 7%

Sept 11 Nov 11 Jan 12 Mar 12 May 12

1 5 4 7 2 3

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FY12 Initiative: 1.1 (b) Grow net primary care base

Outcome Measure: Number of new Primary Care Physicians (PCP)

Initiative Status: 1. Recruitment of a total of +11 primary care physicians net to the District with

Medical Staff and non-Medical Staff Palomar Health aligned physicians. 2. Completed assessment of the list of primary care physicians on medical staff and

those not on staff but employed by groups that refer to PPH and friendly to PPH for patients care choices. - completed

3. Arch Health Partners have approved the creation of two primary care sites. One in the SMACC building on Craven in San Marcos and the other in the 4S Ranch. Craven has gone live and operational and 4S has signed the lease and is proceeding to be opening July, 2012. This 4S site is off timeline by two months.

4. Narrow networks are being explored with the first one completed with PPH employees being placed within the Sharp Health Plan due to the exceptional diligence of Margie’s team. Update: PPH employees have rolled their choices into Sharp Healthplan and began January 1, 2012.

Milestones: 1. Continue recruitment of primary care physicians to

serve the community through new recruitment and affiliation with existing groups

2. Complete assessment of all PCPs in the service area and their affiliated health systems and outreach as appropriate along with clarification of group relationships.

3. Establish two new PC sites in the Primary Service Area

4. Explore participating in narrow networks as it relates to managed care membership growth

Report Date: July 16, 2012 Reporting Committees: Board Finance; EMT Finance

EMT Sponsor: Gerald Bracht Initiative Manager: Lisa Hudson, Robert Trifunovic,

Vicky Lister, Margie Drobatschewsky

Initiative Risks: • Economic conditions impacting retirement plans of PCPs • Site development is depending on construction schedules

3 Jul 11 Jun 12

Initiative Budget: Included in FY12 Operating Budget Budget Status: Within Budget

Outcome Measure: (FYTD at +11 Primaries) Threshold – 2 net core PCPs Target – 3 net core PCPs Maximum – 4 net core PCPs


4 2 1

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Report Date: July 16, 2012

Reporting Committees: Palomar Health Board Finance; Palomar Health Foundation Board; EMT Finance EMT Sponsor: Ann Braun Initiative Manager: Anita Fraley and Kurt Hinrichsen

FY12 Initiative: 1.3(a) Realize Capital Campaign Goals

Outcome Measure: Total Productivity

Initiative Status: 1. Completed. 2. Audit was completed during the first quarter. New procedures are being

developed to achieve greater efficiency. 3. Master plan and time line have been completed. The Donor event will take

place July 26 and the Community event will take place July 28. 4. One additional director was nominated and accepted on 4/26/12, which

brings the total to 19. Two additional candidates have been invited to join to board.

5. Over $100,468 was raised thru annual giving and ePhilanthropy exceeding the $100,000 goal.

6. Over $3.2 million raised exceeding the initial goal of $3 million with the ultimate goal being $5 million.

7. 375 face-to-face visits completed for FY12. 8. 135 major gift solicitations made for FY12. 9. Presentation hosted by Dr. Acheatel attended by 50 guest on June 27. 10. 72% employee participation exceeding the goal of 60%. 11. Raised $828,587 in revenue from the gala exceeding the goal of $700,000. 12. Ann Braun’s first day was 4/16/12. 191% Increase in cash and pledges and

153% increase in the number of gifts for April and May.

Milestones: 1. Establish a Planned Giving Council of Advisors. 2. Review and develop policies and procedures for database

systems and complete database audit and recommendations.

3. Create a master plan of opening fundraising events for PMC West in coordination with the Marketing Department.

4. Increase PPH Foundation board to 20-25 fully-engaged members.

5. Create mechanisms to attract greater community participation through Social Media, ePhilanthropy and direct mail to generate $100,000.

6. Complete the Medical Staff Campaign initial goal of $3 million, working towards the ultimate goal of $5 million.

7. Conduct a minimum of 500 face-to-face visits. 8. Complete a minimum of 100 major gift solicitations to

individuals, corporations, foundations and organizations. 9. Conduct four planned giving group presentations. 10. Increase employee giving participation to 60%. 11. Generate $700,000 in revenue from the gala.

Initiative Risks: 1. State of the economy 2. Competition for philanthropic dollars 3. Staff reductions

1

Jul 11 Jun 12

Initiative Budget: Included in FY12 Operating Budget Budget Status: Within FY12 Budget

Outcome Measure: Actual: $3,798,938 Threshold – $6,000,000 Target – $8,000,000 Maximum -$10,000,000


3 5, 6, 8,10,11

2, 4, 7, 9

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Board Committee Activity Summary July 17, 2012

Board Governance Committee

CONSENT ITEMS:

• Continuous HR Standards Compliance Policy – 10366 – was reviewed and

approved with changes.

• Employee Problem Resolution Process – 10560 – was reviewed and approved with changes.

• Succession Policy - GOV30 – was reviewed and approved with changes.

• Media Relations – 21789 - was reviewed and approved with changes.

• Media Relations and Relaying of PPH Information to the News - was reviewed and approved with changes.

71

Palomar Health Community Relations Committee

Summary—July 5, 2012 Bobette Brown provided a final detailed update on the Palomar Medical Center Grand Opening Celebration scheduled for Saturday, July 28th, 2-4 p.m. – Employee Event, 4-9 p.m. Community Event. Set Up Tent and Tour set up will begin Wednesday for Thursday evening’s Foundation Donor event. Parking We have secured two additional parking lot options. Jamie McCann, the developer of the ERTC, will allow us to use two vacant parcels for parking. These two lots will accommodate approximately 1000 more cars. Bobette provided a brief overview of the offsite parking options: Cal State University San Marcos Lot (Satellite Lot) Citracado & Andreasen Intersection (Shuttle Stop) Enterprise & Andreasen Intersection (Shuttle Stop) Andreasen & Auto Park Way Intersection (Shuttle Stop) Palomar Health San Marcos Lot (Satellite Lot) Nordahl Market Place (Breeze 353) Sprinter Station (Breeze 353) 9th Avenue and Valley Parkway (Breeze 353) Escondido Transit Center (Breeze 353) Palomar Health Downtown Campus (Breeze 353) There will be five large Sun Diego 56-passenger buses available to provide FREE shuttle service from the designated Shuttle Stop Parking Lots (see list above). There will also be 8 eight-passenger golf carts providing shuttle service in the PMC parking lot and up and down Citracado Pkwy. We have also designated parking lots with easy access to the Breeze 353 Bus Route. Security will be available at the bottom of Citracado and Auto Parkway distributing maps to available shuttle parking lots. Food There will be free food available throughout the event including turkey dogs, apples, carrots, cookies, cupcakes churros, pizza from Pizza Hut, Subway Sandwiches, granola bars and water Taste of North County The Taste of North County will be available from 6-8 p.m. At this time, there are nine confirmed food vendors i.e., Aramark, Stone Brewery Co., Capriotti’s and Chick-fil-a. We anticipate approximately 20 vendors to participate in the Taste of North County. These food vendors are providing food and personnel. Security Elite Security has been hired to assist with parking, crowd control, and tours. They will wear red polo shirts and black pants.

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Palomar Health Community Relations Committee

Summary—July 5, 2012 Page 2

Volunteers We have over 200 volunteers. According to our needs assessment, we need over 150 volunteers at all times. We will have two volunteer training sessions. Tours Educational signage and videos will accompany the tours. All rooms will be stanchioned off for viewing purposes. David sought clarification, are people allowed to go in patient rooms or are they to stay behind stanchions? Linda, Bruce and Ann agreed that the tours should be conducted similar to a “White House Tour”. The July 26th Donor Event will be conducted in the same fashion. Tour Registration A simple form will be distributed at the Tour Registration tables. We anticipate providing 1000 tours/hour. The tour registrants will be assigned a color and will be notified via signs and the event emcees as to when their “designated tour” is available. Individuals who pre-registered for the tours will receive a “gold” ticket which will allow them to join any tour group. Ribbon Cutting Ceremony The Committee discussed who should be a part of the ribbon cutting ceremony. Emcees Michael requested that we invite a male anchor counterpart to assist Carol LeBeau. We have extended an invite to Hal Clement. Timeline for Celebration Nina Kim provided a timeline for the Celebration

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ME M O R A N D U M

TO: Nancy Wood, Acting Executive Assistant to the Board FROM: Tanya Howell, Assistant to the Board Finance Committee DATE: July 31, 2012 RE: Board Finance Committee – July 30, 2012, Meeting Summary

INFORMATION ITEMS: Fourth Quarterly Update of FY2012 Initiatives: The FY2012 Initiatives associated with

Board Finance Committee oversight – 1.1(a)-(b) and 1.3(a) – were reviewed and discussed. Updated Program Review Schedule for Calendar Year 2012: The CY2012 Program

Review Schedule, listing new or ongoing programs that the Committee has requested be presented for ongoing monitoring reviews, was updated to reflect a new date for the Palomar Health Foundation review (copy attached).

ACTION ITEMS: Summary of Prior Month’s Approved Budgeted Routine Physician Agreements:

Reviewed and recommended approval of the budgeted routine Physician Agreements that had been approved and became effective during the month of June 12 (full list and background materials may be reviewed elsewhere in the agenda packet).

General Obligation Bonds – Tax Levy 2012-2013: Reviewed the effect of current economic conditions, the resultant assessed values of properties in the district, and the impact on the tax levy. Recommended approval by the Board of the Resolution Concerning the Levy and Collection of Taxes by the Board of Supervisors of the County of San Diego for Fiscal Year 2012-2013 to Pay Principal and Interest on General Obligation Bonds and Authorizing the Taking of All Actions Necessary in Connection Therewith, which recommended maintaining a tax levy of $23.50/$100,000 of assessed value as approved for FY2011-2012.

Establishment of Appropriations Limit for FY2013: Reviewed and recommended approval by the Board of the Resolution Establishing the Appropriations Limit for Palomar Pomerado Health for Fiscal Year 2013.

Policy – Annual Adoption of Statement of Investment: Reviewed and recommended to the Board Governance Committee the adoption of the Policy, updated to reflect the name change of the District.

FY2012 Pre-audited Financial Statement Close: Following review of the pre-audit close Financial Statements, which will be turned over to the auditors and updated following their review, recommended acceptance by the Board of the FY2012 Pre-audited Financial Statement Close, which reflected a $27.4 million bottom line net income YTD, which was $1.26 million higher than FY2011. FY2012 actual includes significant expenditures related to transformation and fit up of the new PMC, thus demonstrating improved performance on flat adjusted discharges.

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TO: Board of Directors MEETING DATE: Monday, August 13, 2012 FROM: Robert A. Hemker, CFO BY: Board Finance Committee Monday, July 30, 2012 Background: In July 2005, the first tranche of General Obligation (“GO”) Bonds was issued. The Series was priced in a negotiated sale on June 22, 2005, for $80 million PAR in Bonds. The Bond transaction closed on July 7, 2005.

In December 2007, the second tranche of GO Bonds was issued. The Series was priced in a negotiated sale on December 4, 2007, for $241.08 million PAR in Bonds. The Bond transaction closed on December 20, 2007.

In March 2009, the third tranche of GO Bonds was issued. The Series was priced in a negotiated sale on March 11, 2009, for $110 million PAR in Bonds. The Bond transaction closed on March 18, 2009.

In November 2010, the fourth and final tranche of GO Bonds was issued. The Series was priced in a negotiated sale on November 9, 2010, for $64,916,678.80 PAR in Bonds. The Bond transaction closed on November 18, 2010.

On an annual basis, Palomar Health has requested that the County of San Diego levy and collect the taxes necessary to pay the debt service on the GO Bonds. Palomar Health calculates the tax amount to levy based upon the debt service amortization and the assessed value of the District. The assessed value is provided by the County. The County then puts the required tax onto the tax roll, collects the taxes, and remits the collected amounts to the Paying Agent, Wells Fargo, on a monthly basis. The Paying Agent makes the required principal and interest payments on a semi-annual basis.

The attached resolution will authorize the County of San Diego to levy and collect the required ad valorem taxes for the 2012-2013 tax roll.

Budget Impact: N/A

Staff Recommendation: Management recommended approval


COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of Resolution No. 08.13.12 (06) – 01 Concerning the Levy and Collection of Taxes by the Board of Supervisors of the County of San Diego for Fiscal Year 2012-2013 to Pay Principal and Interest on General Obligation Bonds and Authorizing the Taking of All Actions Necessary in Connection Therewith, with a recommended tax levy of $23.50/$100,000 of assessed value. Motion:

Individual Action:

Information:

Required Time:

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PALOMAR HEALTH

RESOLUTION NO. 08.13.12 (06) – 01

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR HEALTH CONCERNING THE LEVY AND COLLECTION OF TAXES BY THE BOARD OF SUPERVISORS OF THE COUNTY OF SAN DIEGO FOR FISCAL YEAR 2012-2013 TO PAY PRINCIPAL AND INTEREST ON GENERAL OBLIGATION BONDS AND AUTHORIZING THE TAKING OF ALL ACTIONS NECESSARY IN CONNECTION THEREWITH.

WHEREAS, as authorized by a ballot measure ("Measure BB"), approved by more than two-thirds of the votes cast on such ballot measure at an election held in Palomar Pomerado Health, now known as Palomar Health (the "District") on November 2, 2004, the Board of Directors of the District (the "Board of Directors") is authorized to issue $496,000,000 aggregate principal amount of general obligation bonds for the purpose of financing a portion of the hospital and health care facilities projects as referenced and described in Measure BB;

WHEREAS, in accordance with the provisions of The Local Health Care District Law of the State of California (constituting Division 23 of the California Health and Safety Code) (the "Local Health Care District Law"), the District issued:

(i) $80,000,000 aggregate principal amount of such general obligation bonds, designated as "Palomar Pomerado Health General Obligation Bonds, Election of 2004, Series 2005A" (the "Series 2005A Bonds") on July 7, 2005;

(ii) $241,083,318.80 aggregate principal amount of such general obligation bonds, designated as "Palomar Pomerado Health General Obligation Bonds, Election of 2004, Series 2007A" (the "Series 2007A Bonds") on December 20, 2007;

(iii) $110,000,000 aggregate principal amount of such general obligation bonds, designated as "Palomar Pomerado Health General Obligation Bonds, Election of 2004, Series 2009A" (the "Series 2009A Bonds") on March 18, 2009; and

(iv) $64,916,678.80 aggregate principal amount of such general obligation bonds, designated as "Palomar Pomerado Health General Obligation Bonds, Election of 2004, Series 2010A" (the "Series 2010A Bonds") on November 18, 2010;

WHEREAS, as provided by the Local Health Care District Law, principal and interest on the Series 2005A, 2007A, 2009A and 2010A Bonds as the same becomes due are payable from the levy and collection of ad valorem taxes within the District;

WHEREAS, pursuant to Section 32312 of the Local Health Care District Law, the Board of Supervisors of the County of San Diego (the "Board of Supervisors of the County") is required to levy and collect annually each year until the Series 2005A, 2007A, 2009A and 2010A Bonds are paid a tax sufficient to pay the principal of and interest on such Series 2005A, 2007A, 2009A and 2010A Bonds as the same becomes due and payable;

WHEREAS, in order to facilitate the levy and collection of such ad valorem taxes by the Board of Supervisors of the County as provided in Section 32312 of the Local Health Care District Law, the Board of Directors hereby notifies the Board of Supervisors of the County that principal and interest on the Bonds in the amount of $14,338,675 will become due and payable during the fiscal year commencing July 1, 2012, and ending June 30, 2013;

76

WHEREAS, the Board of Directors has been advised that the total net secured assessed valuation of the District is now estimated at $59,432,937,561 full value; and,

WHEREAS, also in order to facilitate the levy and collection of such ad valorem taxes by the Board of Supervisors of the County as provided in Section 32312 of the Local Health Care District Law, a rate of taxation of $23.50 on each one hundred thousand dollars' valuation of taxable property (full value) within the District for fiscal year commencing July 1, 2012, and ending June 30, 2013, is hereby established;

NOW, THEREFORE, BE IT RESOLVED THAT:

Section 1. Recitals. The foregoing recitals are true and correct, and this Board of Directors so finds and determines.

Section 2. Further Authorization; Ratification of Actions. The Chair of the Board of Directors, any member of the Board of Directors, the President and Chief Executive Officer of the District or any designee of the President and Chief Executive Officer of the District or the Chief Financial Officer of the District or any designee of the Chief Financial Officer of the District (each, an "Authorized District Representative") is hereby authorized and directed, for and in the name of and on behalf of the District, to do any and all things and to execute and deliver any and all documents, instruments and certificates, and to enter into any and all agreements, which such Authorized District Representative may deem necessary or advisable in order to carry out, give effect to and comply with the terms and intent of this Resolution. All such actions heretofore taken by any such Authorized District Representative are hereby ratified, confirmed and approved.

Section 3. Effective Date. This Resolution shall take effect from the date of adoption hereof.

PASSED AND ADOPTED by the Board of Directors of Palomar Health on the 13th

AYES:

day of August, 2012, by the following vote:

NOES:

ABSENT:

ABSTAINING:

DATED: August 13, 2012

BY: ______________________________ T.E. Kleiter Chair, Board of Directors ATTESTED:

______________________________ Jerry Kaufman, PT MA Secretary, Board of Directors

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STATE OF CALIFORNIA ) )ss COUNTY OF SAN DIEGO )

I, Jerry Kaufman, PT MA, the Secretary of Palomar Health (the "District"), do hereby certify that the foregoing is a true copy of a resolution adopted by the District on August 13, 2012, at the time and by the vote stated above, which resolution is on file in the office of the District.

DATED: August 13, 2012

______________________________ Jerry Kaufman, PT MA Secretary, Board of Directors

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COMMITTEE RECOMMENDATION: The Board Finance Committee recommends approval of Resolution No. 08.13.12 (07) – 02, Establishing Appropriations Limit of the District for the Fiscal Year July 1, 2012 – June 30, 2013 Pursuant to Article XIII(B) of the California Constitution. Motion:

Individual Action: X

Information:

Required Time:

TO: Board of Directors MEETING DATE: Monday, August 13, 2012 FROM: Robert A. Hemker, CFO BY: Board Finance Committee Monday, July 30, 2012 BACKGROUND: The Board of Directors of Palomar Health annually adopts the Appropriations Limit for the district, pursuant to Article XIIIB of the California Constitution. This action requests approval of the County’s Appropriations Limit for Fiscal Year 2013. This limit applies only to unrestricted appropriations and is not related to any appropriations that are restricted for the General Obligation Bonds. The Appropriations Limit is calculated to be $73,218,397 for Fiscal Year 2013. The District is substantially under that limit and is expected to receive approximately $13,300,000 in unrestricted property tax revenues in Fiscal Year 2013. (See attached for further information) BUDGET IMPACT: None STAFF RECOMMENDATION: Approval of Appropriations Limit for Palomar Health. COMMITTEE QUESTIONS:

79

80

tlhdPosted

RESOLUTION NO. 08.13.12 (07) - 02

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR HEALTH

ESTABLISHING APPROPRIATIONS LIMIT OF THE DISTRICT FOR THE FISCAL YEAR JULY 1, 2012 - JUNE 30, 2013

PURSUANT TO ARTICLE XIII(B) OF THE CALIFORNIA CONSTITUTION _____________________________________________________________________

WHEREAS, Government Code Section 7910 requires that each year the Board of

Directors of this District shall, by resolution, establish the District’s appropriations limit for the following fiscal year pursuant to Article XIII (B) of the California Constitution; and

WHEREAS, for not less than fifteen days prior to this meeting the documentation attached hereto as Exhibit “A” used in the determination of the appropriations limit has been available to the public in accordance with Government Code 7910.

NOW THEREFORE, IT IS HEREBY RESOLVED by the Board of Directors as follows:

Section 1. The appropriations limit of Palomar Health for fiscal year July 1, 2012 - June 30, 2013, pursuant to Article XIII(B) of the California Constitution is hereby established at $73,218,397.

Section 2. This resolution is effective immediately upon its adoption by the Board of Directors.

PASSED AND ADOPTED at the meeting of the Board of Directors of Palomar Health, held August 13, 2012, by the following votes:

AYES:

NOES:

ABSENT:

ABSTAINING: ATTEST: ________________________________ T.E. Kleiter Chair ______________________________ Jerry Kaufman, PT MA Secretary

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2011/2012 APPROPRIATIONS LIMIT $64,397,770

PRICE FACTOR 3.77%

-- OR --

CHANGE IN LOCAL ASSESSMENT ROLL DUE TO NON-RESIDENTIAL NEW CONSTRUCTION 12.75% = 1.1275

-- AND --

POPULATION FACTOR 0.84% = 1.0084

CALCULATION OF FACTOR FOR FY 2012/2013 1.1275 x 1.008 = 1.1370

$64,397,770 x 1.1370 = $73,218,397

2012/2013 APPROPRIATIONS LIMIT $73,218,397

EXHIBIT "A"

PALOMAR HEALTHAPPROPRIATIONS LIMIT

2012/2013

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NARRATIVE ON THE RECENT HISTORY OF TAXATION

Palomar Health has two types of property taxes available as follows:

SPECIAL ASSESSMENT FOR GENERAL OBLIGATION BONDS

The taxes necessary to pay the interest and principal for Election of 2004, Series 2005A, 2007A,2009A and 2010A, Palomar Pomerado Health General Obligation Bonds that were approved by atwo thirds majority of the voters in November, 2004. These tax revenues are restricted for thespecific purpose of the election campaign of 2004.

OTHER PROPERTY TAXES

A tax equal to 1% of the full cash value of property is levied each fiscal year by the countyand distributed to governmental agencies within the county according to a formula mandatedby the state legislature. (California Constitution Article XIII(A); Revenue and Taxation CodeSection 97). The state legislature and the county place no restrictions on the tax moniesgranted to local government agencies, such as Palomar Health. (Part 0.5, Division1 of theRevenue and Taxation Code.) Since these tax revenues are unrestricted, it is not necessaryto inform the public regarding the intended use of the funds.

The following is a schedule reflecting our total tax revenues by fiscal year for the pastthirty-five years.

Total Restricted for Fiscal Received Bond Interest Increase (Decrease) Year Cash Basis & Principal Unrestricted $ %

1977/78 $2,460,384 $445,211 $2,015,173 ------- -------1978/79 1,513,554 518,736 994,818 (1,020,355) -50.63%1979/80 1,621,350 428,585 1,192,765 $197,947 19.90%1980/81 1,914,882 458,941 1,455,941 263,176 22.06%1981/82 2,157,298 425,948 1,731,350 275,409 18.92%1982/83 2,245,799 431,669 1,814,130 82,780 4.78%1983/84 2,453,236 454,544 1,998,692 184,562 10.17%1984/85 2,618,899 429,139 2,189,760 191,068 9.56%1985/86 2,922,025 400,336 2,521,689 331,929 15.16%1986/87 3,325,080 476,027 2,849,053 327,364 12.98%1987/88 3,590,335 415,348 3,174,987 325,934 11.44%1988/89 4,009,992 389,724 3,620,268 445,281 14.02%1989/90 4,644,106 451,969 4,192,137 571,869 15.80%1990/91 4,898,609 404,912 4,493,697 301,560 7.19%1991/92 5,305,810 435,226 4,870,584 376,887 8.39%1992/93 5,230,679 455,415 4,775,264 (95,320) -1.96%1993/94 5,405,901 429,917 4,975,984 200,720 4.20%1994/95 5,589,446 422,427 5,167,019 191,035 3.84%1995/96 5,604,306 452,813 5,151,493 (15,526) -0.30%1996/97 5,641,183 473,160 5,168,023 16,530 0.32%1997/98 5,862,721 358,706 5,504,015 335,992 6.50%1998/99 5,915,399 0 5,915,399 411,384 7.47%1999/00 6,432,482 0 6,432,482 517,083 8.74%2000/01 7,061,136 0 7,061,136 628,654 9.77%2001/02 7,693,200 0 7,693,200 632,064 8.95%2002/03 8,391,961 0 8,391,961 698,761 9.08%2003/04 9,077,863 0 9,077,863 685,902 8.17%2004/05 10,180,831 0 10,180,831 1,102,968 12.15%2005/06 20,853,221 9,303,843 11,549,378 1,368,547 13.44%2006/07 23,604,928 11,040,737 12,564,191 1,014,813 8.79%2007/08 25,130,428 11,730,239 13,400,189 835,998 6.65%2008/09 25,440,143 11,975,665 13,464,478 64,289 0.48%2009/10 24,580,410 11,621,467 12,958,943 (505,535) -3.75%2010/11 27,616,427 14,995,884 12,620,543 (338,400) -2.61%2011/12 28,028,448 15,345,381 12,683,067 62,524 0.50%

From Prior Year (Unrestricted)

83

Form A - Physician Agreements - Consent.pdfAddendum F.pdfADP3C.tmpPalomar Health - Agreement AbstractDutiesApprovals Required

ADP3F.tmpDutiesApprovals Required

ADP66.tmpDutiesApprovals Required

ADPA2.tmpDutiesApprovals Required

ADP9F.tmpDutiesApprovals Required

ADP9C.tmpDutiesApprovals Required



ADPA5.tmpDutiesApprovals Required

ADPBE.tmpDutiesApprovals Required

ADPBB.tmpDutiesApprovals Required

ADPB8.tmpDutiesApprovals Required



Form A - Initiatives - Info.pdfADP48.tmpFY12 Initiative: 1.1 (a) Grow volume in key areas FY12 Initiative: 1.1 (b) Grow net primary care baseFY12 Initiative: 1.3(a) Realize Capital Campaign Goals

ADP4B.tmpBackground: Pursuant to direction of the Board upon adoption of the FY2012 Initiatives, those associated with Finance Committee oversight were reviewed at the meeting: 1.1(a) – Grow Volume in Key Areas 1.1(b) – Grow Net Primary Care Base 1.2(b) – Implement Infrastructure to Support an ACO (On HOLD) 1.3(a) – Realize Year 4 Capital CampaignThis was the Fourth and final quarterly review by the Finance Committee of the FY2012 Initiatives (attached).

Form A - App Limit - Resolution.pdfADP56.tmpExhibit A

ADP59.tmpA

Form A - App Limit - Resolution.pdfADP56.tmpExhibit A

ADP59.tmpA

ADPF8B.tmpSheet1

ADPF9E.tmpSheet1

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BOARD OF DIRECTORS AGENDA PACKET - Palomar Health · 2012. 8. 13. · Michael H. Covert, FACHE,...

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