VANDERBILT UNIVERSITY MEDICAL STAFF ANNUAL MEETING AGENDA

1. VANDERBILT UNIVERSITY MEDICAL STAFF & VANDERBILT MEDICAL GROUP ANNUAL MEETINGThursday, June 28, 20124:30 – 6 pm208 Light Hall

2. VANDERBILT UNIVERSITY MEDICAL STAFF ANNUAL MEETINGAGENDA Welcome C. Lee Parmley, MD Chair, Medical Center Medical Board (MCMB) Proposed Amendments to Medical Staff Bylaws, Rules & Regulations and Policies & Procedures MCMB Membership Elections Adjournment

3. PROPOSED AMENDMENTS TO MEDICAL STAFF BYLAWS, RULES & REGULATIONSAND POLICIES & PROCEDURES Goals of Proposed Revisions: To comply with evolving CMS, Joint Commission and NCQA standards To streamline Medical Staff Bylaws, Rules & Regulations, Policies & Procedures and VUMC policies and to create internal consistency To address and codify evolution of VUMC staffing and clinical practice

4. AMENDMENT REVIEW AND APPROVAL PROCESS • Administrative Affairs Committee • identification of CMS, Joint Commission and NCQA requirements, inconsistencies, and other needs for additions/revisions/deletions • Executive Committee of MCMB & full MCMB • review recommendations of Administrative Affairs Committee, amend and endorse as appropriate • VUMC Medical Staff • approval of amendments at Annual Meeting • Medical Center Affairs Committee (Board of Trust Committee) • final approval

5. AMENDMENTS TO MEDICAL STAFF BYLAWS AND RULES & REGULATIONS • Article XII – Corrective Action • Proposal to add verbiage requiring providers to inform their Chair of the initiation of any disciplinary action by another hospital, licensing board, etc. and to keep informed as to the progress and outcomes of such action and proceedings • Article VII – Clinical Services • Add Physical Medicine & Rehabilitation • Article VI – Privileged Professional Staff • Change all references in Medical Staff Bylaws and Rules & Regulations “Professional Staff with Privileges”

6. AMENDMENTS TO MEDICAL BYLAWS ANDRULES & REGULATIONS • Article III – General Qualifications for Appointment • Add verbiage that defines an “approved residency” as one accredited by ACGME, American Osteopathic Association, College of Family Physicians of Canada CFPC and/or Royal College of Physicians and Surgeons of Canada • Add verbiage that refers all allegations of discrimination in the credentialing decision-making process to EAD with periodic audits of all denials to ensure that providers are not discriminated against • Rules & Rags – History & Physical Section • Change verbiage to include Anesthesiologists as “attending” for the purpose of taking histories and performing physical examinations

7. AMENDMENTS TO MEDICAL STAFF BYLAW AND RULES & REGULATIONS • Article III – Appointment and Reappointment • Modify board certification requirements as indicated to become compliant with Joint Commission standards and current practice: • When the applicant possesses comparable training, experience and competence but (1) Board Certification was not applicable at the time the applicant’s training was completed or (2) the applicant is only certified in a non-U.S. or non-Canadian Board or 3) the board certification is in a specialty other than the primary division (department), the applicable Chief of Service may submit a written request for a waiver of this requirement to the Credentials Committee Chairman for action by the Credentials Committee with subsequent approval by the MCMB and MCAC. However, Physicians must maintain their Certification by board whatever re-certification process is outlined by their applicable

8. ACTION POINT • Approval of proposed amendments to Medical Staff Bylaws, Rules & Regulations, and Policies & Procedures Required

9. MCMB MEMBERSHIP UPDATES & ELECTIONS At-Large Members (3) elected annually Nominees: Andre Churchwell, MD A. Alex Jahangir, MD James “Pete” Powell, MD ACTION POINTS • At-Large Member Elections require a majority vote of the voting members present • Adjournment of Medical Staff Meeting

10. VANDERBILT MEDICAL GROUPANNUAL MEETINGAGENDA • VMGVMG Finance Committee – Roland Eavey, MD • VMG Credentialing – Steven Meranze, MD • VMG Billing Office –Meredith Marwill • Contracting Update – Beverly Coccia • VMG Quality Council – Racy Peters • Physician Council on Clinical Service Excellence – Gaye Smith • Hitch and Other Operational Initiatives – Margaret Head • Economic Repositioning – David Posch

11. VMG Finance Group 06/26/2012

12. Dan Beauchamp • Marc Bennett • Brian Carlson • Sandy Cherry • Keith Churchwell • Titus Daniels • Marilyn Dubree • Roland Eavey • Phyllis Ekdall • Janice Fruci • Denis Gallagher • Sheri Haun • Margaret Head • Stephan Heckers • Tommy Hollinden • Mack Howell • Mark Hubbard • Howard Jones • Mike Laposata • John Manning • Steve Meranze • Derek Miller • Colin Mothupi • Robin Mutz • Mike Neuss Committee Members • Jim Newman • Bill Obremskey • David Posch • Pete Powell • Margaret Rush • Warren Sandberg • Diane Seloff • Janice Smith • Robin Steaban • Cindy Sullivan • Paul Sternberg • Reid Thompson • Dell Yarbrough

13. Identity Historically - an audit committee Contemporary needs • $400M budget re-engineering over upcoming years • Comfortable conversation to align our values/missions with our economic forces • Grow revenues plus reduce expenses • Process > Product

14. November 30, 2011 Meeting 1: Provider Compensation Model • “Medicare cutting reimbursements” Sensitive elephant • “Officially” discussed compensation modeling with reduced dollars (our values, process examples, leadership)

15. Bring up the sensitive topic • Valued ingredients re compensation • Time frame

16. December 7, 2011 Meeting 2: TOOLSCost Reduction = Quality Increase • Lost/Cost Awareness Tools • (SLA) Service Line Analytics (MD level utilization) • WebMD (local/national institutions) • UHC (AMCs) • Healthcare Quality Calculator (utility)

17. January 12, 2012 Meeting 3: Strategic Growth Tools • Investment information: THA, HSDA, UHC, JAR, Thompson Reuters • Finance: Where we are/Where we want to be Medipac/Epic/TSI SLA/Crimson/UHC Tracking Team…..ROI view

18. January 31, 2012 Meeting 4: Cost Homework and Parking • Valve Data Analysis…Cost/LOS/Readmission • Parking

19. May 29, 2012 Meeting 5: Optimal Resource Management • Teams (MD/RN/MBA) • Departmental variance • Inpatient/Outpatient

20. Meeting 6: Optimal Resource Management • Why haven’t we fixed Fridays?

21. Vanderbilt University Medical Staffand Vanderbilt Medical Group MeetingJune 28, 2012 Credentials Committee Report Steven Meranze, M.D.

22. Organizational Structure • The Credentials Committee (Steven Meranze) Participating sub-committees • Children’s Hospital Credentials Committee (Gregory Mencio) • Joint Practice Committee (Clare Thomson-Smith) • Provider Support Services Office (Danielle Midgett)

23. Credentials Committee • Representation of the major clinical specialties, including behavioral health, the hospital-based specialties and the Medical Staff at large • Meets monthly • Synopsis of duties (see Bylaws): • To evaluate the credentials and performance of all applicants for Medical Staff membership and reappointment • To review recommendations from the Joint Practice Committee regarding the credentials, performance, and supervisory arrangements of all Certified Nurse Practitioners, Certified Nurse Midwives, Physician Assistants, Certified Registered Nurse Anesthetists and Allied Health Practitioners who apply for privileges to practice at VUMC. • To report to the Medical Center Medical Board on each applicant for Medical Staff or other professional staff recommendation to the Medical Center Affairs Committee (MCAC). Reports and recommendations regarding Medical Staff and other professional staff appointment and delineation of practice privileges shall include consideration of any recommendations from the Service in which the candidate requests privileges; • To investigate any breach of ethics that is reported to it. • To review reports of Medical Staff or other professional staff member performance or conduct issues that are referred to it, and to provide peer review in response to competence or performance inquiries.

26. Timeliness of File Review and Approval • Influenced by many factors • Licensure and DEA • Verification (all education, hospital affiliations and work history) • Faculty appointment • Trust coverage/ Claims history • Competency documentation • Incomplete application • Affects practice planning (personal and division) • Enrollment considerations (NCQA) • Increased need for expedited credentials committee meetings

27. National Committee on Quality Assurance (NCQA) certified Credentials Verification Organization (CVO) • Develop delegated credentialing agreements with managed care organizations (MCO) • Delegate MCO credentialing activities to Vanderbilt. VMG providers who are approved through the VUMC Credentials Committee review process are “automatically” enrolled in ~43 managed care plans versus each provider completing and submitting separate applications to each of these organizations • Creates an additional layer of complexity and scrutiny to credentialing activities • Files >120 days are considered “expired” and require re-submission and re-verification

29. Expedited Credentialing • Expedited credentialing: Provider is reviewed and approved for privileges by an agent (subcommittee) of the governing body (MCAC) • Defined exclusion criteria • Legitimate action to answer immediate needs (e.g. critical staffing issues) • Large number may reflect system limitations

31. FutureInitiatives • Paperless credentialing • E-file “secure transfer “(Accellion) • Electronic signature - “Pronto System” • Phased implementation • Improved interface with the Faculty Information System for Faculty Appointments

32. VMG Business Office Update Presented by Meredith Marwill Associate Director of Physician Billing Services

33. Faculty Practice Solutions Center Billing Office SurveyFY2010 Top 10 Performers • VMG ranked 7th overall in benchmark performance indicators reported by 56 academic institutions through University Healthcare Consortium (UHC). 1. University of Pittsburgh Medical Center 2. UMass Memorial Medical Group 3. University of Minnesota Physicians 4. Massachusetts General Physician Organization 5. The Medical College of Wisconsin 6. University of Wisconsin Medical Foundation 7. Vanderbilt Medical Group 7. University of Texas Medical Branch (Galveston) 9. University of Virginia Physicians Group 10. Fletcher Allen Health Care/University of Vermont

34. Gross Professional Charges Charges have increased 10.9% from prior fiscal year.

35. Annual Cash Collections Collections have increased 7.9% from prior fiscal year.

36. Total RVU Volume Total RVUs have increased 8.7% from prior fiscal year.

37. Collections Per RVU Collections/RVU has decreased 0.7% from prior fiscal year.

38. Days in A/R / Charge Lag UHC FY 2011 Survey Days in A/R 25th percentile = 47.4 days Median = 41.2 days 75th percentile = 36.9 days

39. Cost to Collectas percent of Net Collections 11.1% 10.8% 10.6% Cost to Collect has remained stable this past fiscal year. 9.8% 8.8% 8.3% 7.9% 7.4% 7.0% 6.3% 6.3% 2012 *2012 FYTD through May

40. Projects and Opportunities for FY 2013 • Continue to improve patient collections • Expand Point of Service collection program to address increasing patient out of pocket requirements • Develop vendor partnership to allow for combined patient collection activities with VUMC • Continue to redesign work flow processes and systems to enhance the revenue cycle • Migrate toward a paperless work environment in the revenue cycle through further development of EPIC workqueues and other technology enhancements • Developing best practice documentation to move towards more consistent work processes within all areas of the revenue cycle • ICD10 Training and Preparation

41. Contracting 2012Highlights

42. VMG Quality Reporting 2012 VMG Annual Faculty Meeting June 28, 2012

43. The Mission of VMG is to improve the health of the people in the communities we serve through evidence-based, personalized, compassionate care, research and education.

44. Hand Hygiene

45. Adult Anticoagulation Clinic

46. Adult Anticoagulation Clinic

47. New Patient Access

48. Publicly Reported Measures: OPPS • Timing and appropriateness of antibiotic prophylaxis in outpatient procedures

49. Publicly Reported Measures: PQRS • Voluntary quality reporting program • Provides incentive payments of 1% of all Medicare Part B billings for each eligible provider (EP) • Reporting Period: full calendar year 2011 • Data will not be publicly reported for 2011 or 2012

50. Publicly Reported Measures: PQRS • Incentive timeline and amounts: • 2012: 0.5 % • 2013: 0.5 % • 2014: 0.5 % • Penalty timeline and amounts: • 2015: 1.5 % (will be based on 2013 submission) • 2016 and each subsequent year: 2.0 % • Data will be publicly reported beginning 2013 or 2014 (exact year still TBD)