PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD · 4/18/2013 · Commission Chambers, the PHT FRB...

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD

COMMITTEE MEETINGS AGENDAS April 18, 2013

Ira C. Clark Diagnostic Treatment Center 1080 N. W. 19th Street Miami, Florida 33128


COMMITTEE MEETINGS SCHEDULE

April 18, 2013

LOCATION SITE Ira C. Clark Diagnostic Treatment Center

1080 N. W. 19th Street Miami, Florida 33128

The Audit and Compliance Subcommittee meeting is scheduled to begin at 7:15 a.m. in Conference Room 259, located in the Ira C. Clark Diagnostic Treatment Center (DTC). The Purchasing and Facilities Subcommittee meeting will follow the Audit and Compliance Subcommittee meeting in DTC Conference Room 259, which will then be followed by the standing committee meetings. A special PHT Financial Recovery Board (PHT FRB) meeting is scheduled to follow the Strategy and Growth Committee meeting in DTC 259. At an unspecific time during the Committee Day, The PHT FRB will recess to attend a meeting at the Miami-Dade County Commission Chambers to discuss a matter pertaining to Jackson Health System located at the Stephen P. Clark Center, Second Floor, 111 N. W. First Street, Miami, FL 33128. Upon completion at the Commission Chambers, the PHT FRB will resume the Committee Day in DTC Conference Room 259.

Thursday, April 18, 2013 Subcommittees Time Location Site Audit and Compliance Subcommittee 7:15 a.m. to adjournment DTC 259 Purchasing and Facilities Subcommittee Following the Audit and DTC 259 Compliance Subcommittee meeting Standing Committees Fiscal Committee Following the Purchasing and DTC 259 Facilities Subcommittee meeting Joint Conference and Following the Fiscal Committee DTC 259 Efficiencies Committee meeting Strategy and Growth Committee Following the Joint Conference DTC 259

and Efficiencies Committee meeting

Special PHT Financial Recovery Following the Strategy and Growth DTC 259 Board Committee meeting

As of April 11, 2013

AUDIT AND COMPLIANCE SUBCOMMITTEE


Audit and Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Michael Bileca, Vice Chairperson Marcos Jose Lapciuc

Date, Time and Location April 18, 2013 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. Approval of the Previous Meeting Minutes (Mojdeh L. Khaghan, Chairperson, Audit and Compliance Subcommittee)

(a) *Meeting Minutes as of March 14, 2013 2. *Review and Approval of KPMG FY12 Audited Financial Statements – Jackson Health Plan

(Karen Mitchell, Partner, KPMG and Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

3. Corporate Compliance Program Department Update (Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department, Jackson Health System)

(a) *FY13 Audit Plan Update

(b) Review of Finalized Audit Report

(1) * #22 – Physician Services – Quarter 1

(c) *Recovery Audit Contractor (RAC) - Quarterly Update

(d) *FY13 JHS Employee Sanction Report – Quarterly Update

(e) *Hotline Report – Quarterly Update

(f) *Berkeley Research Group (BRG) Update

(g) *Jackson Health Plan Compliance Update

(h) *Jackson Health Plan Employee Monthly Sanction Check Update

4. Internal Audit Update

(Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System)

(a) *FY13 Audit Plan Update

(b) Review of Finalized Audit Reports

(1) *Patient Intake – JMH Operating Room (2) *Monthly Audit Finding Follow-up

Agenda items noted with an asterisk (*) indicate that the supporting documents are attached.

1. Approval of the Previous Meeting Minutes

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Audit & Compliance Subcommittee Mojdeh L. Khaghan, Chairperson Michael Bileca, Vice Chairperson Marcos Jose Lapciuc Date, Time & Location March 14, 2013 – 7:15 a.m. to adjournment Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Audit & Compliance Subcommittee Mojdeh L. Khaghan Marcos Jose Lapciuc Excused Michael Bileca Financial Recovery Board Members

Stephen S. Nuell Darryl K. Sharpton

Jackson Health System Diana Salinas Stephen J. Weimer Brian Dean Don S. Steigman Carlos A. Migoya KPMG Karen Mitchell

Miami-Dade County Attorneys Valda Christian Christopher Kokoruda

Audit & Compliance Subcommittee Meeting March 14, 2013 Page 2 Meeting Called to Order With a quorum being present, the Audit & Compliance Subcommittee meeting was called to order at 7:23 a.m. by Mojdeh L. Khaghan, Chairperson, Audit & Compliance Subcommittee. 1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of February 21, 2013

Ms. Khaghan requested a motion to approve the meeting minutes as of February 21, 2013. Mr. Lapciuc moved approval; seconded by Ms. Khaghan, and carried without dissent.

2. Review and Approval of KPMG SAS115 - FY12 Letter of Observation and Recommendations

Karen Mitchell, KPMG representative presented the KPMG SAS115-FY12 Letter of Observations and Recommendations. The purpose of the Letter of Observation and Recommendations was to highlight certain observations during the audit and to express a recommendation(s) to management. The current year’s observation and recommendation are as follows:

1. Information Technology General Controls The condition found that management made progress towards the remediation of certain material weakness related to general information technology controls listed in a KPMG report dated March 15, 2012. Management presented to KMPG that the remediation took place throughout the fiscal year and as of October 1, 2012 all the remediation efforts were completed. As the remediation was not completed as of October 1, 2011, KPMG did not test or rely on controls in performing Jackson Health System (JHS) for the year ended September 30, 2012. It was noted that management made significant efforts to strengthen internal controls over information technology throughout the fiscal year 2012. Recommendation KPMG recommended that management continue to monitor and update JHS policies and procedures associated with information technology controls environment to ensure that the critical risks associated with information technology are adequately addressed. KPMG further recommended that the Internal Audit Department consider conducting periodic audits on the effectiveness of the newly implemented controls.

2. Small Facilities The condition found that the complex and decentralized nature of JHS operations requires a strong financial accounting function at the smaller facilities including the skilled nursing facilities and specialty centers. KPMG noted certain areas related to patient accounts receivable that need improvement.

Recommendation

KPMG recommended that JHS implement a standardized set of policies and accounting practices for the smaller facilities that is consistent with that of the main campus.

Audit & Compliance Subcommittee Meeting March 14, 2013 Page 3

With regards to internet security, Mr. Lapciuc questioned if an employee(s) been hired or appointed to serve as an internet security representative. Don S. Steigman, Executive Vice President and Chief Operating Officer, Jackson Health System stated that he will schedule a meeting with Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System and Michael Garcia, Vice President and Chief Information Officer, Information Technology Division, Jackson Health System to discuss employing and/or appointing someone to serve as an internet security representative. Ms. Khaghan stated that as part of the information technology strategic initiative, information regarding information technology will be included as part of the Subcommittee’s agenda and reported on a regular basis. Following the review of the KPMG SAS115 - FY12 Letter of Observation and Recommendations, Ms. Khaghan requested a motion approving to forward the item to the Fiscal Committee. Mr. Lapciuc moved approval; seconded by Ms. Khaghan, and carried without dissent. Ms. Mitchell stated that the KPMG Office of Civil Rights will forward to the appropriate member(s) of the JHS staff via e-mail message information regarding what the hospital should be doing regarding civil rights. With regards to the HIPAA audits and JHS compliance, Ms. Mitchell provided the Subcommittee with information regarding insights from OCR HIPAA audits analysis of 20 audits. The goal is to improve covered entity and business associate compliance with the HIPAA privacy, security and breach notification standards, through two approaches. Highlights of the audit process included a detailed overview of the program goal, outcome of the audit, description of a performance audit, initial 20 findings/users and disclosures analysis, initial 20 findings/notice and access, initial findings analysis/administrative requirements, initial 20 findings analysis security issues, initial 20 findings analysis security top issues, and preliminary observations. A detailed copy of the information was distributed during the Subcommittee meeting. Following the presentation, Ms. Khaghan questioned how can it be determined if a vendor is in compliance. Ms. Mitchell stated that in addition to a variety of mechanisms that companies use to develop a strategy for determining whether or not a vendor is in compliance is the use of third party reports prior to signing an agreement.

Audit & Compliance Subcommittee Meeting March 14, 2013 Page 4 3. Corporate Compliance Program Department Update

Diana Salinas, Corporate Director and Chief Compliance Officer, Compliance Department, Jackson Health System, presented the following updates and review of finalized audits:

(a) FY13 Audit Plan Update A summary of the Audit Plan was presented. The FY13 Audit Plan is 20% completed, as of February 28, 2013 twelve audits were completed and six audits are currently in progress. It is anticipated that the FY13 Audit Plan will be completed by September 30, 2013.

(b) Review of Finalized Audit Report (1) #49 AHCA-Emergency Medicaid for Undocumented Patients-

Quarter 1 The scope of the audit was to evaluate emergency services provided to undocumented patients who meet all Medicaid eligibility requirements except for citizenship or alien status. The results of the audit concluded as follows: Total Payment: $137,301.64; Medicaid Overpayment: $7,879.71; Medicaid Underpayment: Zero; Payment Error Rate: 5%. There were findings and observations, recommendations, corrective action plans/process improvements and manager’s response. A detailed copy of the audit results was included with the agenda.

(2) HIPAA/Privacy: Employee Access Threshold – Quarter 1 The audit was performed in response to the growing risk of identity theft and privacy breaches within the health care industry. The results of the audit confirmed that JHS audit system is a strong safeguard in response to regulatory risks and potential sanctions. However, room for further development exists to operate at maximum efficiency and be an industry leader in terms of innovation of patient privacy protection. There were findings, recommendations, and comments. A reassessment date of the audit has been scheduled in three months. A detailed copy of the audit results was included with the agenda.

(3) HIPAA Same Name Audit – Quarter 1 With an increasing risk of Privacy enforcement through regulatory fines within the health care industry, the audit was necessary to quantify and address a system risk. The JHS Privacy Office will proceed with the remaining steps to safeguard the system risk. The system and its employees will be made aware that there is an existing policy that prohibits individuals from accessing their own medical records via privileges granted into Cerner (Electronic Medical Record) because of their employee status. Once the notification is made and the existing policy is re-stated, the Privacy Office recommends enforcement activity as per system policy. There were findings, recommendations, and corrective action plan. A reassessment date of the audit has been scheduled during quarter 3. A detailed copy of the audit results was included with the agenda.

With regards to the JMH Health Plan, Ms. Salinas informed everyone that the process to develop compliance programs for the Health Plan is on schedule.

Audit & Compliance Subcommittee Meeting March 14, 2013 Page 5 4. Internal Audit Update

Stephen J. Weimer, Corporate Director, Internal Audit Department, Jackson Health System presented the following Internal Audit update reports:

(a) FY13 Internal Audit Plan Update

The FY13 Internal Audit Plan is 25% completed, 7 audits have been completed, and 5 audits are in progress.

(b) Review of Finalized Audit Reports (1) Jackson North Community Mental Health Center General

Controls Audit As part of the FY13 Audit Plan an audit was conducted on the Jackson North Community Mental Health Center (JNMHC) general controls from 10/1/11 through 9/30/12 which included the following processes: Financial Operations, Admission & Registration, Billing & Collections, Contractual & Purchased Services Management, Time Management, Disaster Recovery Plan, Physical Security, Inventory Management, and System Access. The overall rating based on the issues identified was needs improvement. Control deficiencies were noted as well as recommendations, management response, and corrective action plans with implementation dates. A detailed copy of the audit results was included with the agenda.

(2) 2013 JMH Transfusion Services Inventory Audit The objective of the audit was to evaluate the effectiveness and efficiency of internal controls as it relates to the inventory management which includes the following process: Inventory ordering/replenishment, Inventory Stocking, Inventory Valuation, Inventory System (Perpetual/Periodic), Cycle Counts, and Inventory Safeguard. The overall rating based on issues identified was satisfactory. The audit included detailed observations, recommendations, management action plans and outline for process improvement opportunities. A detailed copy of the audit results was included with the agenda.

(3) Review of Monthly Audit Follow-up Continue to follow-up and update results.

Following the Internal Audit reports, Mr. Lapciuc recognized that there are controls and work to further expand controls regarding the outlier operations. Mr. Lapciuc congratulated members of staff and encouraged them to keep up the good work.

Audit & Compliance Subcommittee Meeting March 14, 2013 Page 6 Meeting Called to Adjourn The meeting of the Audit & Compliance Subcommittee adjourned at 8:03 a.m. Transcribed by Ivenette Cobb-Black Executive Assistant Public Health Trust Financial Recovery Board

DRAFT 4/12/2013 4:18 PM 156088_12_JMHHealthPlan_FS.docx

JMH HEALTH PLAN (A Division of the Public Health Trust of Miami-Dade County, Florida)

Statutory Financial Statements and Schedules

December 31, 2012 and 2011

(With Independent Auditors’ Report Thereon)

Final Editorial Review Not Completed PLEASE COMPLETE

Date/Time Due

Services Requested: Format Revisions Editorial Review Print

Name:

Tel./Ext.:

Special Instructions:



Table of Contents

Page

Independent Auditors’ Report 1

Statutory Statements of Admitted Assets, Liabilities, Capital, and Surplus (Deficit) 3

Statutory Statements of Revenues and Expenses 4

Statutory Statements of Changes in Capital and Surplus (Deficit) 5

Statutory Statements of Cash Flows 6

Notes to Statutory Financial Statements 7

Schedules

1. Schedule of Investment Risks Interrogatories 20

2. Schedule of Investments 21


Independent Auditors’ Report

The Financial Recovery Board The Public Health Trust of Miami-Dade County, Florida:

Report on the Financial Statements

We have audited the accompanying financial statements of JMH Health Plan, a Division of the Public Health Trust of Miami-Dade County, Florida (JMH Health Plan), which comprise the statutory statements of admitted assets, liabilities, and surplus as of December 31, 2012 and 2011, and the related statutory statements of revenues, expenses and changes in capital and surplus, and cash flow for the years then ended, and the related notes to the statutory financial statements.

Management’s Responsibility for the Financial Statements

Management is responsible for the preparation and fair presentation of these financial statements in accordance with statutory accounting practices prescribed or permitted by the Florida Department of Financial Services, Office of Insurance Regulation (OIR). Management is also responsible for the design, implementation, and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement, whether due to fraud or error.

Auditors’ Responsibility

Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditors’ judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. Accordingly, we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinions.

Basis for Adverse Opinion on U.S. Generally Accepted Accounting Principles

As described in Note 2 to the financial statements, the financial statements are prepared by the JMH Health Plan using statutory accounting practices prescribed or permitted by the Florida Department of Financial , which is a basis of accounting other than U.S. generally accepted accounting principles. Accordingly, the financial statements are not intended to be presented in accordance with U.S. generally accepted accounting principles.


2

The effects on the financial statements of the variances between the statutory accounting practices described in Note 2 and U.S. generally accepted accounting principles, although not reasonably determinable, are presumed to be material.

Adverse Opinion on U.S. Generally Accepted Accounting Principles

In our opinion, because of the significance of the variances between statutory accounting principles and U.S. generally accepted accounting principles discussed in the Basis for Adverse Opinion on U.S. Generally Accepted Accounting Principles paragraph, the financial statements referred to above do not present fairly, in accordance with U.S. generally accepted accounting principles, the financial position of the JMH Health Plan as of December 31, 2012 and 2011, or the results of its operations or its cash flows for the years then ended.

Opinion on Statutory Basis of Accounting

In our opinion, the financial statements referred to above present fairly, in all material respects, the admitted assets, liabilities, and surplus of the JMH Health Plan as of December 31, 2012 and 2011, and the results of its operations and its cash flow for the years then ended, in accordance with statutory accounting practices prescribed or permitted by the Florida Department of Financial Services, Office of Insurance Regulation described in Note 2.

Emphasis of Matter

As discussed in Note 1 to the financial statements, the JMH Health Plan was instructed by the OIR to change its reporting entity effective on January 1, 2012, to include the admitted assets, liabilities, capital and surplus, the results of operations and cash flows of the Prepaid Mental Health Plan. Our opinion is not modified with respect to this matter.

Other Matter

Our audits were conducted for the purpose of forming an opinion on the financial statements as a whole. The supplementary information included in the supplemental schedule of investment risks interrogatories and the schedule of investments are presented for purposes of additional analysis and is not a required part of the financial statements but is supplementary information required by the Florida Department of Financial Services, Office of Insurance Regulation. Such information is the responsibility of management and was derived from and relates directly to the underlying accounting and other records used to prepare the financial statements. The information has been subjected to the auditing procedures applied in the audits of the financial statements and certain additional procedures, including comparing and reconciling such information directly to the underlying accounting and other records used to prepare the financial statements or to the financial statements themselves, and other additional procedures in accordance with auditing standards generally accepted in the United States of America. In our opinion, the information is fairly stated in all material respects in relation to the financial statements as a whole.

Certified Public Accountants Miami, Florida

DRAFT 4/12/2013 4:08 PM 156088_12_JMHHealthPlan_FS.xlsx

3

JMH HEALTH PLAN(A Division of the Public Health Trust of Miami-Dade County, Florida)

Statutory Statements of Admitted Assets, Liabilities, Capital, and Surplus


Admitted Assets 2012 2011

Cash and cash equivalents $ 12,171,455 40,639,667 Premium receivables — 3,529,396 Investment income due and accrued 7,000 6,898 Health care and other amounts receivable 10,014,482 3,033,571

Total admitted assets $ 22,192,937 47,209,532

Liabilities, Capital, and Surplus (Deficit)

Liabilities:Unpaid claims $ 7,900,972 20,977,497 Unpaid claims adjustment expenses 147,178 337,207 Unearned premiums 5,538 — Accounts payable 9,556,286 1,848,787 Due to related parties 357,014 511,111 Risk management reserve 535,000 535,000

Total liabilities 18,501,988 24,209,602

Capital and surplus:Contributed capital 7,749,041 27,749,041 Unassigned surplus (deficit) (4,058,092) (4,749,111)

Total capital and surplus 3,690,949 22,999,930 Total liabilities, capital, and surplus $ 22,192,937 47,209,532

See accompanying notes to the statutory financial statements.


4


Statutory Statements of Revenues and Expenses (Deficit)

Years ended December 31, 2012 and 2011

2012 2011

Revenues:Premiums $ 75,867,850 217,680,185 Investment income 28,703 53,220

Total revenues 75,896,553 217,733,405

Expenses:Medical services expenses:

Hospital and medical benefits 61,744,212 163,892,649 Other professional services — 15,171 Emergency room and out of area 300,187 2,492,047 Prescription drugs 9,017,722 38,572,145 Net reinsurance recoveries (166,841) —

Total medical services expenses 70,895,280 204,972,012

Claims adjustment expenses 414,025 1,097,065 General and administrative expenses 4,386,596 14,428,358 Change in premium deficiency reserve — (3,132,846)

Total expenses 75,695,901 217,364,589 Net income $ 200,652 368,816



5


Statutory Statements of Changes in Capital and Surplus (Deficit)


UnassignedContributed surplus Total

capital (deficit) surplus

Balance at December 31, 2010 $ 1,523,665 (5,457,960) (3,934,295)

Cash contributions 26,225,376 — 26,225,376

Net income — 368,816 368,816

Change in nonadmitted assets — 340,033 340,033

Balance at December 31, 2011 $ 27,749,041 (4,749,111) 22,999,930

Net income 200,652 200,652

Change in nonadmitted assets — (1,670,213) (1,670,213)

Dividends Paid (20,000,000) — (20,000,000)

Aggregate write-ins for gains in surplus — 2,160,580 2,160,580 Balance at December 31, 2012 $ 7,749,041 (4,058,092) 3,690,949



6


Statutory Statements of Cash Flows


2012 2011

Cash flow from operating activities:Premiums collected $ 79,620,474 216,486,617 Net investment income 28,601 50,187 Medical expenses paid (78,846,967) (207,104,491) General and administrative expenses paid (8,887,652) (17,260,794)

Net cash used in operating activities (8,085,544) (7,828,481)

Cash flow from financing activities:Capital contribution — 26,225,376 Other cash provided applied (382,668) (1,511,310) Dividends Paid (20,000,000) —

Net cash (used in) provided by financing activities (20,382,668) 24,714,066

Net change in cash and cash equivalents (28,468,212) 16,885,585

Cash and cash equivalents at beginning of year 40,639,667 23,754,082 Cash and cash equivalents at end of year $ 12,171,455 40,639,667




Notes to Statutory Financial Statements


7 (Continued)

(1) Reporting Entity

In 1984, the Public Health Trust of Miami-Dade County, Florida (the Trust), a department of Miami-Dade County, Florida formed the JMH Health Plan (the Plan). Effective September 30, 1985, the Plan was certified for operation by the State of Florida. As a state licensed Health Maintenance Organization (HMO), the Plan provides managed care services to Medicaid eligible, Medicare eligible, and commercial members. The Plan is included in the overall organizational structure of the Trust, which is responsible for its operations.

The Plan is operationally integrated with the Trust and receives significant administrative benefits as a result of this arrangement. Any changes in the Plan’s relationship with the Trust could have a significant adverse effect on the Plan.

In April 2011, the Plan was placed on a Corrective Action Plan (CAP) by the Florida Office of Insurance Regulation (OIR) due to operational losses resulting in the inability to meet the statutory surplus requirements. See note 6 for further discussion on statutory compliance. During 2011, the Trust was required to recapitalize the Plan as part of the CAP from the OIR. Additionally, on April 15, 2011, the OIR notified the Plan that it was prohibited from writing new policies without prior written approval of the OIR. In October 2011, the Plan announced that it was transitioning out of the commercial and managed Medicaid lines of business effective December 31, 2011. The Trust entered into a Consent Order with the OIR on October 24, 2011. As a condition to the OIR allowing the Plan to resume writing new policies for the Medicare line of business, the Plan agreed, among other things: (i) that if the Plan does not report year to date profitability by December 31, 2012, the Plan will wind down its operations and voluntarily surrender its Certificate of Authority; (ii) the Plan will file monthly financial statements until the OIR provides written documentation indicating monthly statements are no longer required; and (iii) the Trust will provide the necessary capital infusion should the Plan experience impaired financial statements as evidenced by the monthly financial statement reporting. Effective December 31, 2011, the Plan terminated its Medicaid and commercial lines of business. As a result of this action, the Plan has approximately 2,500 members remaining, primarily in the Medicare line of business.

On January 26, 2013, the OIR informed the Trust that the Trust is to commence reporting the financial condition of the Prepaid Mental Health Plan (PMHP) under the JMH Health Plan beginning with the December 31, 2012 reporting period. The OIR will not require JMH to amend prior financial filings to reflect the Prepaid Mental Health Plan. The Plan offered the PMHP program since 2006 and it was historically reported outside the statutory reporting requirements imposed on HMOs. The Plan’s PMHP line of business contains approximately 70,000 lives and provides managed care services to behavioral health members as an extension of the Medicaid program. The Plan has a long-standing agreement with the University of Miami Behavioral Hospital (UMBH) whereby the Plan passes along 95% of the premium revenue to UMBH, which consists of 80% to pay claims and 15% for other administrative services required under the program. If actual claims paid are less than the 80%, then UMBH will reimburse the excess to AHCA. The Plan retains 5% of the premium revenue for other miscellaneous administrative expenses. In addition, revenues and expenses attributable to PMHP for the year ended December 31, 2012 were approximately $36,882,000 and $35,037,000, respectively. The impact of reporting the PMHP was the addition of approximately $2,161,000 to unassigned surplus at January 1, 2012.





8 (Continued)

(2) Summary of Significant Accounting Policies

(a) Basis of Presentation

The accompanying statutory financial statements have been prepared in conformity with accounting practices prescribed or permitted by the Florida Department of Financial Services, Office of Insurance Regulation (the Office or OIR), which is a comprehensive basis of accounting other than U.S. generally accepted accounting principles (GAAP). The State of Florida has adopted the National Association of Insurance Commissioner’s (NAIC) Accounting Practices and Procedures manual version of statutory accounting practices (NAIC SAP). The insurance laws and regulations for the State of Florida require the Plan to comply with the NAIC SAP, except as prescribed or permitted by state law.

Prescribed statutory practices include a variety of publications of the NAIC, as well as state laws, regulations, and general administrative rules. Permitted statutory accounting practices encompass all accounting practices not so prescribed. Statutory accounting practices differ in certain respects, which in some cases may be material, from GAAP applied in the presentation of financial condition and results of operations on the “going concern” basis commonly followed by other types of enterprises. The more significant differences are as follows:

a. Assets must be included in the statutory statement of admitted assets, liabilities, and capital and surplus at “admitted asset value,” whereas GAAP requires historical cost, net book value or, in certain instances, fair value.

b. “Nonadmitted assets” (principally certain prepaid items, certain deferred tax assets, fixed assets, and certain receivables) must be excluded through a charge against unassigned surplus, while on a GAAP basis, “nonadmitted assets” are included on the balance sheets net of any valuation allowances. Changes in nonadmitted assets are recorded as direct increases and decreases to net surplus and do not enter into the determination of net income.

c. Investments in bonds with an NAlC rating of 1 or 2 are carried at their amortized cost, whereas bonds with an NAIC rating of 3 through 6 are assigned specific year-end values by the NAIC and are written down to the Securities Valuation Office (SVO) assigned values by charging statutory surplus. Under GAAP, the bonds are categorized as held-to-maturity, available-for-sale, or trading. Bonds classified as held-to-maturity are carried at amortized cost. Bonds classified as available-for-sale or trading are carried at fair value, with changes in fair value recorded in other comprehensive income or operations, respectively.

d. The statements of cash flows differ in certain respects from the presentation required by Statement of Financial Accounting Standards (SFAS) No. 95 Statement of Cash Flows. For statutory purposes, there is no reconciliation between net income and cash from operations.

(b) Use of Estimates

The preparation of statutory financial statements in accordance with accounting practices prescribed or permitted by the OIR requires management to make estimates and assumptions that affect amounts of admitted assets, liabilities, and disclosures of contingent assets and liabilities at the date





9 (Continued)

of the statutory financial statements. Such estimates and assumptions could change in the future as more information becomes known, which could impact the amounts and disclosures reported herein. Significant estimates include claims payable and liabilities for incurred but not reported claims.

(c) Cash and Cash Equivalents

Cash equivalents include short-term, highly liquid investments with original maturities of one year or less that are both (a) readily convertible to known amounts of cash, and (b) so near their maturity that they present insignificant risk of changes in value because of changes in interest rates.

(d) Premiums Receivable

Unpaid health insurance premiums from policyholders are recorded as premium receivable and considered an admitted asset due to the economic value used to pay for policyholder obligations for statutory reporting purposes. Premium receivables were approximately $3,529,000 at December 31, 2011, in the accompanying statutory statements of admitted assets, liabilities, capital, and surplus. There were no premium receivables at December 31, 2012

(e) Healthcare and Other Amounts Receivable

The Plan participates in retrospectively rated contracts and contracts subjected to redetermination. The Plan uses an outside actuary to calculate accrued retrospective revenues owed to the Plan by Centers for Medicare and Medicaid Services (CMS) for risk adjustment and Part D reconciliations related to the Plan’s membership using data reports and response files from CMS. Also included in the other amounts receivable were amounts due primarily from UMBH. The healthcare and other amounts receivable were approximately $10,014,000 and $3,034,000 at December 31, 2012 and 2011, respectively, in the accompanying statutory statements of admitted assets, liabilities, capital, and surplus. The healthcare receivable attributable to the PMHP is approximately $9,227,000, which is due from UMBH and consists of payables due on behalf of UMBH for unpaid claims of $5,235,000 and amounts due to AHCA of $3,992,000 (see Note 1).

(f) Equipment

Equipment is recorded at cost to the Plan or to the Trust or, if donated, at fair value at date of donation. Equipment is a nonadmitted asset under statutory accounting principles. Maintenance and repairs are charged to expense when incurred. Depreciation is provided using the straight-line method over the estimated useful lives of the assets. The estimated useful lives of the assets range from 5 to 10 years. The equipment, net of accumulated depreciation was $303,000 and $373,000 at December 31, 2012 and 2011, respectively. Depreciation expense for the years ended December 31, 2012 and 2011, was $70,000 and $74,000, respectively.

(g) Unpaid Claims

Unpaid claims represents the amount of payments to be made on individual claims, which have been reported to the Plan, as well as estimates of claims incurred that have not yet been reported. Unpaid claims are estimated using various statistical methods that use historical, financial, and operating data. Management has estimated the liabilities for unpaid medical claims with the assistance of a





10 (Continued)

consulting actuary. Although considerable variability is inherent in such estimates, management believes that the amounts accrued are adequate to cover claims incurred as of December 31, 2012 and 2011. Adjustments to claims payable to reflect actual experience, if any, are reflected in the statutory statements of revenues and expenses in the period in which such adjustments become known to management. Due to uncertainties inherent in the claims estimation process, it is at least reasonably possible that the claims paid in the near term could differ materially from the accrued amounts. Pharmacy claims represent the amount of payments to Pharmacy Benefit Manager (PBM) and amounts from Part D Low Income Subsidiary Reconciliation.

The following table provides a reconciliation of the beginning and ending balances of unpaid claims liabilities for the years ended December 31, 2012 and 2011:

Year ended December 312012 2011

Unpaid claims liabilities, beginning of year $ 20,977,497 23,114,636 Incurred losses:

Current period 71,517,840 204,865,029 Prior period (622,560) 106,983

Payments for claims:Current period (64,299,867) (183,887,535) Prior period (19,671,938) (23,221,616)

Unpaid claims liabilities, end of year $ 7,900,972 20,977,497

(h) Medical Services Expense

The Plan contracts with various healthcare providers for the provision of certain medical services to its members. Medical services consist primarily of physician services, inpatient and outpatient hospital services, emergency room services, and prescription drugs. The Plan reimburses the healthcare providers for services provided at current Medicaid, Medicare, and other contractual rates.

The Medical services expense also includes the 95% capitation paid to UMBH for its services provided to the PMHP members. The expenses attributable to PMHP for the year ended December 31, 2012 was approximately $35,037,000. The provision for medical services also includes estimates of payments to be made for healthcare services reported at the statements of admitted assets, liabilities, capital, and surplus date and estimates of healthcare services rendered but not reported to the Plan at the statements of admitted assets, liabilities, capital, and surplus date.

(i) Income Taxes

The Plan is a division of the Trust, which itself is an integral part of Miami-Dade County, Florida. Miami-Dade County, Florida is a governmental entity, which is not subject to income tax.





11 (Continued)

(j) Premium Revenue

Premiums are due monthly and are recognized as revenue during the period in which the Plan is obligated to provide services to members.

The Plan has contracted with the State of Florida Agency for Health Care Administration (AHCA) to provide medical assistance under the provisions of the Medicaid program. Effective September 1, 2009, the contract with AHCA was renewed for a three-year period ending August 31, 2012, with an annual cap of $178,576,000. Payments to the Plan under this contract are based on capitation rates that vary according to membership levels and the types of services provided. Approximately, 23%, of the Plan’s total premium revenue was received under the Medicaid program for the years ended December 31, 2011. Management of the Plan terminated this contract effective December 31, 2011.

In addition, 1% and 38%, respectively, of the Plan’s premium revenue was received under a contract with Miami-Dade County, including the Trust and some individual commercial policies, for the years ended December 31, 2012 and 2011. Management of the Plan terminated this contract effective December 31, 2011; however, the Plan retained certain individual policies during the year ended December 31, 2012.

Effective January 1, 2010, the Plan implemented a Medicare Advantage/Part D program. The Medicare program uses monthly rates per person for each county to determine the fixed monthly payments per member received by the Plan. These rates are adjusted under the Medicare program’s risk-adjustment model, which uses health status indicators, or risk scores, to improve the adequacy of each payment. Under the risk-adjustment methodology, the Plan must capture, collect, and submit the necessary diagnosis code information to the Medicare program within prescribed guidelines. Approximately 50% and 19% of the Plan’s total premium revenue was received under the Medicare program for the year ended December 31, 2012 and 2011, respectively.

Effective January 1, 2012, the Plan began reporting the PMHP program under the HMO. The premium revenue attributable to PMHP for the year ended December 31, 2012 was approximately $36,882,000.

Laws and regulations governing the Medicare and Medicaid programs are extremely complex and subject to interpretation. As a result, there is at least a reasonable possibility that recorded estimates will change by a material amount in the near term. Changes in the Medicare and Medicaid programs and the reduction of finding could have a material negative effect on the Plan.

(k) Reinsurance Recoveries

JMH Health Plan has held annual reinsurance for enrollees under the Medicare line of business since June 1, 2010. The 2010 reinsurance policy was written by HCC Life Insurance Company and covered the majority of non-capitated direct medical expenses with the exception of hospice care, non emergency transportation, custodial care and retail prescription medication. This policy had limits and maximum per diems identified by service type, a specific deductible for eligible expenses of $150,000 per enrollee per contract year, and an individual contract maximum of $1,000,000. For





12 (Continued)

the year ended December 31, 2012, the Plan collected approximately $166,000 under this policy. No amounts were recovered in 2011.

(3) Medicare Program

Revenues are recognized ratably over the period of coverage based on anticipated CMS reimbursement rates, number of enrollees, and expected Medicare and Medicaid eligibility. Actual amounts received from CMS are subject to adjustment based on subsequent review of members’ eligibility or retroactive adjustments of reimbursement rates. An estimate is made of such retroactive adjustments based on historical trends, premiums billed, number of members, expected eligibility, and other information. Retroactive membership adjustments result from enrollment changes not yet processed, or not yet reported by CMS. Changes in revenues from CMS resulting from the periodic changes in risk adjustment scores for the Plan’s membership are recognized when the amounts become determinable, and the collectibility is reasonably assured. Such estimates are regularly reviewed and updated, and any resulting adjustments are included in the current year’s results.

(a) Medicare Payment System

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) made numerous changes to the Medicare payment system. Under the Medicare risk adjustment formula, Medicare Advantage plans are paid by CMS based on a member’s health condition.

As of December 31, 2012 and 2011, the Plan has payables to CMS of approximately $218,000 and $8,900, respectively, for estimated risk adjustment revenue, which are reflected as components of accounts payable in the accompanying statutory statements of admitted assets, liabilities, and capital and surplus. These amounts are determined based on an analysis of the health status of the Plan’s members. The amount of Medicare risk adjustment revenue recorded is subject to future adjustment based on the final determinations by CMS of the amounts actually due to the Plan.

The Plan recorded changes in estimates of the amounts due from CMS for estimated risk adjustments and Medicare eligibility amounts as additional premiums earned of approximately $106,000 for the year ended December 31, 2012. As of December 31, 2011, the Plan recorded $2,568,000 of receivables of which $2,674,000 was collected in 2012. For the year ended December 31, 2011, the Plan recorded a loss of $46,000. As of December 31, 2010, the Plan recorded $1,237,000 of receivables of which $1,191,000 was collected in 2011.

(b) Accounting for Prescription Drugs Benefit under Medicare Part D

Medicare prescription drug coverage is available to eligible members with Medicare. As a result, the Plan renewed their contracts with CMS to offer MA-PD insurance coverage for medical and prescription drug benefits. The contract was renewed effective January 1, 2012 for a one-year period.

In general, pharmacy benefits under Part D plans may vary in terms of coverage levels and out-of-pocket costs for beneficiary premiums, deductibles, and coinsurance. However, all Part D plans must offer either “standard coverage” or its actuarial equivalent (with the Plan’s out-of-pocket threshold and deductible amounts that do not exceed those of standard coverage). These “defined standard” benefits represent the minimum level of benefits mandated by Congress.





13 (Continued)

The payment the Plan receives monthly from CMS generally represents the Plan’s bid amount for providing insurance coverage. The Plan recognizes premium revenue for providing this insurance coverage ratably over the term of the annual contract. However, the CMS payment is subject to 1) risk sharing through the risk corridor provisions and 2) reinsurance subsidy in order for the Plan and CMS to share the risk associated with financing the ultimate costs of the Part D benefit and (3) CMS coverage gap discount program (CGDP) subsidy (since January 2011).

The amount of revenue payable to a plan by CMS is subject to adjustment, positive or negative, based upon the application of risk corridors that compare a plan’s revenues targeted in their bids (target amount) to actual prescription drug costs. Variances exceeding certain thresholds may result in CMS making additional payments to the Plan (risk sharing receivable) or require the Plan to refund to CMS (risk sharing payable) a portion of the payments the Plan received. Actual prescription drug costs subject to risk sharing with CMS are limited to the costs that are, or would have been, incurred under the CMS “defined standard” benefit plan (allowable risk corridor costs). The Plan recognizes any changes in the risk sharing receivable from or payable to CMS as an adjustment to premium revenue.

Reinsurance subsidies represent payments from CMS for claims the Plan paid for which the Plan assumed no risk. Claims paid above the out-of-pocket or catastrophic threshold for which the Plan is not at risk are all reimbursed by CMS through the reinsurance subsidy for Part D plans offering the standard coverage. The Plan accounts for these subsidies, net of withdrawals, included as a healthcare and other amounts receivable in the statutory statements of admitted assets, liabilities, and capital and surplus. The Plan does not recognize premium revenue or claims expense for these CMS subsidies.

These estimates of amounts due to or from CMS are primarily determined on the prescription drug benefit claim data submitted by plans to CMS in the form of Prescription Drug Event (PDE) data records. The Plan used PDE submission reports and data, claims paid data, and actuarial assumptions pursuant to CMS risk sharing and reinsurance guidelines in order to estimate the final settlement of amounts due to or from CMS.

The Plan has a CGDP liability at December 31, 2012 and 2011 amounting to approximately $111,000 and $9,000, respectively, reported as accounts payable in the accompanying statutory statements of admitted assets, liabilities, and capital and surplus.

The Part D amounts due from (to) CMS are necessarily based on estimates and, while management believes that the amounts are adequate, the ultimate balance may be in excess or less than the amount provided. The methodology for making such estimates and for establishing the resulting Part D balances are continually reviewed, and adjustments, if any, are reflected in the current year. The final Part D amounts due to or from CMS are determined within one year after the contract year-end.

Pharmacy benefit costs are recognized as incurred. The Plan has subcontracted the pharmacy claims administration to a third-party pharmacy benefit manager.





14 (Continued)

(4) Related-Party Transactions

The Plan utilizes various divisions of the Trust to provide health services to its members. The Plan reimbursed the Trust approximately $10,357,000 and $27,824,000 for services provided during the years ended December 31, 2012 and 2011, respectively.

The Plan contracted with the Trust to provide commercial coverage to its employees effective January 1, 1989. Payments under this contract are based on monthly premium rates, which vary according to coverage chosen by the Trust employee. During 2011, premium revenue from the Trust was approximately $107,913,000. The amount due from the Trust at December 31, 2011, was approximately $1,840,000, and is included in premium receivables on the accompanying statutory statements of admitted assets, liabilities, capital, and surplus. The contract was terminated on January 1, 2012.

During 2009, the OIR agreed that receivables from the Trust could be admitted under Florida Statutes Section 641.35(2)(i)(3), as allowed in subsection (1), as the receivable relates to premiums earned and provides economic value to meet the Plan’s obligations.

With the consent of the OIR, effective March 1, 2012, the Plan transferred all administrative and staff functions to the Trust and entered into an Administrative Services Agreement whereby the Plan purchased services from the Trust at an agreed upon per-member per-month rate of $155. For the lines of business functioning under the HMO, excluding PMHP, the total amount paid for administrative services under the Administrative Services Agreement with the Trust was $3,497,000. This amount is in addition to $890,000 in expenses which includes approximately $482,000 of expenses that were recorded prior to the execution of the Administrative Services Agreement as well as approximately $408,000 which is attributable to PMHP. These costs may not be reflective of the total cost of operations in the event an agreement with the Trust was not established.

(5) Transactions with the University of Miami

The Plan, on July 20, 2006, had contracted with the University of Miami School of Medicine (the Medical School) to provide certain healthcare services to its members. The Plan reimbursed the Medical School approximately $9,591,000 and $45,868,000 for services provided during the years ended December 31, 2012 and 2011, respectively.

Effective January 1, 2012, the Plan began recording the capitated agreement with University of Miami Behavioral Hospital (UMBH) to provide behavioral health services to its PMHP members. The Plan paid $35,037,000 in capitated payments to UMBH and represents 95% of total revenue received from AHCA for provision of services to pre-paid mental health members.

(6) Statutory Compliance

The Plan is required by the Section 641.225(1) of the Florida Statutes to maintain at all times a minimum surplus in an amount that is the greatest of $1,500,000, 10% of total liabilities, or 2% of total annualized premium revenue. In addition, Section 641.35(9) of the Florida Statutes stipulates that the Plan must maintain an amount equal to its required minimum surplus in coin or currency of the United States on hand or on deposit in any solvent national or state bank, savings and loan association, or trust company, or in





15 (Continued)

eligible securities or obligations. The Plan was not in compliance with the minimum surplus requirement during 2011. The Trust approved a capital contribution to the Plan of approximately $26,225,000

The OIR limits distributions of earnings or equity transfers to no more than 10% of statutory surplus from accumulated earnings in any one year unless prior approval is received from the OIR. In addition to this payment, and to the extent accumulated statutory surplus exceeds the required amount, the Plan may make distributions out of its entire preceding fiscal year’s net operating profits. As a result of the operational improvements, elimination of the Medicaid line of business and substantial downsizing of the commercial line of business, the Plan produced statutory surpluses in excess of the required minimums during calendar year 2012. The OIR authorized the release of $20 million in excess surplus back to the Trust during 2012, which is reflected as dividends paid in the statement of changes in capital and surplus.

The Plan is required by Florida Statutes Section 641.285 to provide a deposit in the amount of $1,300,000 with the Department of Financial Services Office of Insurance Regulation as insolvency protection. In order to comply with the Florida Statutes, the Plan currently has invested $1,300,000 in a certificate of deposit, earning a variable annual rate of interest. As per the regulations, the principal balance is restricted as to use, whereas the interest earned thereon is not restricted. In addition, the Plan has invested $10,000 in a certificate of deposit as security deposit required by Section 641.227 of the Florida Statutes. These amounts are included in cash and cash equivalents on the accompanying statutory statements of admitted assets, liabilities, capital, and surplus.

The Plan is also required by AHCA Agency Insolvency Protection Section 409.912 to maintain a balance of 2% of the annual Medicaid capitation premium in a restricted account that may be drawn upon only with the authorized signatures of two persons designated by the Plan and two persons designated by the AHCA or purchase adequate insolvency insurance and reinsurance. To meet this requirement, the Plan has established a restricted access account with approximately $1,195,000 at December 31, 2012 and 2011, which is included in cash and cash equivalents on the accompanying statutory statements of admitted assets, liabilities, capital, and surplus.

The Plan is required by Title 690-191.076 of the Florida Administrative Code to ensure prior to each annual report filing that net income before taxes is no less than 2% of total revenues. If the 2% requirement is not met, the Plan is required to provide the Office, as a part of its annual report filing, a CAP. For the years ended December 31, 2012 and 2011, the Plan’s net income was approximately $201,000 and $369,000, respectively.

The Plan is subject to regulatory examinations. The Plan’s most recent examination occurred in November 2012. CMS communicated to the JMH Health Plan that numerous deficiencies were found and required the Plan to submit an immediate corrective action plan. A corrective action plan was submitted to CMS on December 3, 2012. CMS subsequently communicated that the corrective action plan submitted by the Plan was insufficient to mitigating the findings. On December 24, 2012, the Plan re-filed the corrective action plan addressing the concerns arising from the audit. CMS communicated acceptance of the re-filed corrective action plan in January 2013. The Plan has engaged consultants to assist in the implementation of the corrective action plan and remains in communication with CMS.





16 (Continued)

(7) Retirement Plans

(a) Florida Retirement System

Certain of the Plan’s full-time and part-time employees are covered by the Trust’s participation in the Florida Retirement System (the System), a cost-sharing, multiple-employer public-employee retirement plan, which covers substantially all of the Trust’s full-time and part-time employees. The System was noncontributory and is administered by the State of Florida. Effective July 1, 2011, all System investment plan and pension plan members, except those in the Deferred Retirement Option Program, were required to make a 3% pretax employee contribution. The System was created in 1970 by consolidating several employee-retirement systems. All eligible employees as defined by the State of Florida, who were hired after 1970 and those employed prior to 1970 who elect to be enrolled, are covered by the System. Benefits under the plan vest after 10 years of service. Employees who retire at or after age 62, with six years of credited service are entitled to an annual retirement benefit payable monthly for life. The System also provides for early retirement at reduced benefits and death and disability benefits. These benefit provisions and all other requirements are established by State statute.

The Plan is required to contribute amounts necessary to pay benefits when due as defined by State statute. Such contribution requirement was 7.5% and 9.4% of gross salaries for the years ended December 31, 2012 and 2011, respectively. Pension costs related to the System were approximately $6,000 and $46,000, for the years ended December 31, 2012 and 2011, respectively.

(b) Public Health Trust of Miami-Dade County, Florida, Defined Benefit Retirement Plan

The Public Health Trust of Miami-Dade County, Florida Defined Benefit Plan (the Retirement Plan) was created in 1996 and is an employee-noncontributory plan administered by the Trust. All employees working in a full-time or part-time regularly established position who were hired after January 1, 1996, are covered by the Retirement Plan. Effective April 1, 2012, all plan members were required to make a 3% pretax employee contribution. Benefits under the Retirement Plan vest after six years of credited service. Employees who retire at or after age 62 with six years credited service are entitled to an annual retirement benefit payable monthly for life. The Plan also provides for early retirement at reduced benefits, and death and disability benefits. A participant whose employment is terminated after July 1, 2001 for any reason, other than death or retirement prior to the completion of six years of continuous service shall have no entitlements under the Plan. These benefit provisions and all other requirements are set forth in the Retirement Plan Document. Benefits increase by approximately 2.5% per year for cost of living adjustments. The board of trustees of the Trust reserves the right to modify, alter, or amend the Retirement Plan subject to certain limitations. Pension costs related to the Retirement Plan were approximately $43,000 and $438,000 for the years ended December 31, 2012 and 2011, respectively. Employees of the Plan are included in this Retirement Plan.





17 (Continued)

(8) Risk Management Reserve

On January 26, 2004, the Plan established a risk management reserve as mandated by the OIR. The purpose of this reserve is to cover any potential professional and general liability claims. At December 31, 2012 and 2011, the reserve was $535,000.

(9) Health Policy Reserve

As of December 31, 2012 and 2011, the Plan was not required to establish a Premium Deficiency Reserve (PDR). However, the Plan was required to establish a PDR for Medicaid and Medicare lines of business during the operational year of December 31, 2011 and period of September 1, 2011 through December 31, 2011 as a result of a CAP entered into between the Plan and the OIR. The PDR is based on actuarial assumptions and methods, which recognize anticipated losses of a line of business for a particular period of time. In October 2011, the Plan announced that it was transitioning out of the commercial and managed Medicaid lines of business effective December 31, 2011.

(10) Fair Value of Financial Instruments

Certain of the Plan’s financial assets and liabilities are measured at fair value on a recurring basis, including money market accounts. The fair value of an asset or liability is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. The Plan’s financial assets measured at fair value have been classified, for disclosure purpose, based on a hierarchy defined by Statements of Statutory Accounting Principle (SSAP) 100, Fair Value Measurements. The hierarch gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurement) and the lowest priority to unobservable inputs (Level 3 measurement).

The three levels of the fair value hierarchy and a description of the valuation methodologies used for instruments measured at fair value are as follows:

Level 1 – Quoted prices that are obtainable at the measurement date and taken from active markets for identical assets or liabilities. Level 1 primarily consists of financial instruments such as cash and money market securities.

Level 2 – Pricing inputs other than quoted prices included in Level 2, which are either directly observable or that can be derived or supported from observable data as of the reporting date. The Plan has no financial assets or financial liabilities with significant Level 2 inputs.

Level 3 – Pricing inputs include those that are significant to the fair value of the financial asset or financial liability and are generally less observable from objective sources. These inputs may be used with internally developed methodologies that result in management’s best estimate of fair value. The Plan has no financial assets or financial liabilities with significant Level 3 inputs.





18 (Continued)

A financial instrument’s categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The fair value of financial assets that are measured at fair value on a recurring basis was as follows:

December 31, 2012Level 1 Level 2 Level 3 Total

Cash, restricted cash and certificates of deposits $ 11,559,267 — — 11,559,267

Money market fund 612,188 — — 612,188 Total $ 12,171,455 — — 12,171,455




Financial assets are reflected in the accompanying statutory statements of admitted assets, liabilities, capital, and surplus as follows:

December 312012 2011

Cash and cash equivalents, at fair value $ 10,861,455 39,329,667 Certificates of deposit 1,310,000 1,310,000

Total cash and cash equivalents $ 12,171,455 40,639,667

The fair values of the securities held by the Plan included in Level 1 were determined through quoted market prices.

The carrying value of accounts receivable and accounts payable and accrued liabilities are reasonable estimates of their fair value due to the short-term nature of these financial instruments.





19

(11) Nonadmitted Assets

Nonadmitted assets at December 31, 2012 and 2011 are as follows:

2012 2011

Due from related parties $ 1,361,162 — Healthcare and other receivable 379,233 — Equipment 303,077 373,259

$ 2,043,472 373,259

(12) Subsequent Events

In February 2013, the Plan received a notice of a Civil Monetary Penalty (CMP) as an outcome of the audit conducted by CMS in November 2012. The CMP amount is $175,000 and was paid and expensed by the Trust. The Plan remains in communication with CMS regarding the implementation of its Corrective Action Plan associated with the audit findings.

In February 2013, the Trust issued a Request for Proposal (RFP) to solicit bids to transfer the Medicare Advantage membership to a potential buyer. The RFP only covers the transfer of the Medicare Advantage membership and not the Certificate of Authority. The Plan has entered into due diligence with a potential buyer as of issuance of this audit report.


SCHEDULES


Schedule 1


Schedule of Investment Risks Interrogatories

December 31, 2012

20

1. The Plan’s total admitted assets as reported on page two of the Plan’s Annual Statement for the year ended December 31, 2012 are $22,192,937.

Interrogatories 2 through 15 are not applicable.

See accompanying independent auditors’ report.


21

Schedule 2JMH HEALTH PLAN

(A Division of the Public Health Trust of Miami-Dade County, Florida)

Schedule of Investments

December 31, 2012

Admittedassets as

Gross reported ininvestment the annual

Investment categories holdings* Percentage statement Percentage

Cash and cash equivalents $ 12,171,455 100% $ 12,171,455 100%Total invested assets $ 12,171,455 100% $ 12,171,455 100%

* Gross investment holdings as valued in compliance with NAIC SAP.


3. Corporate Compliance Program Department Update

Total5

133856

23%0

Risk LevelHighModerate or High

Audit # Audit Name Risk Assessment Scope & Objectives Status Completion Date

1

Monthly Short Stay Medical Necessity - #1 Main High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 10/26/2012

2

Monthly Short Stay Medical Necessity - #1 North High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 10/29/2012

3

Monthly Short Stay Medical Necessity - #1 South High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 11/27/2012

4

Monthly Short Stay Medical Necessity - #1 Holtz High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Completed 11/5/2012

5

Monthly Short Stay Medical Necessity - #2 Main High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

6

Monthly Short Stay Medical Necessity - #2 North High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

7

Monthly Short Stay Medical Necessity - #2 South High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

8

Monthly Short Stay Medical Necessity - #2 Holtz High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

9

Monthly Short Stay Medical Necessity - #3 Main High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

10

Monthly Short Stay Medical Necessity - #3 North High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

11

Monthly Short Stay Medical Necessity - #3 South High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

12

Monthly Short Stay Medical Necessity - #3 Holtz High RAC/Reassessment - To review documentation to validate the medical necessity of short stay admissions. Medicare only pays for inpatient hospital services that are medically necessary for the setting billed and that are coded correctly. Medical documentation will be reviewed to determine that the services were medically necessary and were billed correctly. Not started

13 Transplant - Inpatient Moderate Risk Assessment - To evaluate the inpatient Medicaid transplant program to ensure that we are in compliance to AHCA guidelines. Not started

14OIG- Inpatient Rehabilitation Facilities (IRF) - Appropriateness of Admissions and Level of Therapy

High OIG - Appropriateness of Admissions and Level of Therapy - To examine the appropriateness of admissions to IRFs. To further examine the level of therapy provided in IRFs and how much concurrent and group therapy IRFs provide. In Progress

15

Clinical Trials High Reassessment - To review Clinical Trial Research billing and modifier usage to ensure it is in compliance with CMS regulations and guidelines. In addition, review that consent forms are completed and submitted to the Clinical Trials Office (CTO) in a timely manner by the Principle Investigator (PI) per JHS policy. Not started

Audits that were identified through the CMS RAC Approved Issues, the OIG Work Plan or AHCAReassessments and by Internal Risk Assessment

Audit SummaryIn ProgressTotal Audits CompletedNot StartedTotal Audits on Plan% of Plan CompletedNew audits added to Original Plan

CORPORATE COMPLIANCE DEPARTMENT - FY 2013 ANNUAL AUDIT PLAN

Definition

1

Total5

133856

23%0






Definition

16 Primary Care Clinic: Jefferson Reaves Moderate Risk Assessment - Review Medicaid documentation, coding and billing for clinic services based on Medicaid guidelines. Completed 1/27/2013

17 Primary Care Clinic: North Dade Moderate Risk Assessment - Review Medicaid documentation, coding and billing for clinic services based on Medicaid guidelines. Not started

18 Primary Care Clinic: Rosie Lee Wesley Moderate Risk Assessment - Review Medicaid documentation, coding and billing for clinic services based on Medicaid guidelines. Not started

19

OIG- Payments for Multidose Vials of Drug Herceptin High OIG- To review claims to Medicare for the drug Herceptin, which is used to treat breast cancer, to determine whether the drug was properly billed. For drug claims involving a single-use vial or package, if a provider must discard the remainder of a single-use vial or package after administering a dose/quantity of the drug or biological, Medicare provides payment for the amount discarded along with the amount administered, up to the amount of the drug or biological as indicated on the vial or package label.

Completed 12/17/2012

20Pharmacy High RAC - Docetaxel - Dose vs. Units Issue: Docetaxel (J9171) represents 1 mg per unit and

should be billed 1 unit for every 1 mg per patient. To ensure appropriate documentation and billing for outpatient hospital services. In Progress

21 Evaluation and Management codes for ER Services Moderate Risk Assessment - Review coding and billing services for Medicare and Medicaid patients at Jackson Memorial ER. In Progress

22

Physician Services - Quarter 1 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment.

Completed 3/19/2013

23

Physician Services - Quarter 2 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment.

Not started

24

Physician Services - Quarter 3 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid: billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment.

Not started

25

Physician Services - Quarter 4 Moderate Risk Assessment - Review professional coding and billing of Medicare and Medicaid: billing for items or services not rendered or not provided, submitting claims for services that are not medical necessary or double billing, resulting in duplicate payment.

Not started

26 AHCA - Prescribed Pediatric Extended Care (PPEC) High AHCA: Review program coding and billing to ensure compliance with Florida Medicaid guidelines. Not started

27 Laboratory services High OIG - Review the appropriate use of Advanced Beneficiary Notices (ABN) for laboratory services for Medicare beneficiaries. In Progress

28HIPAA/Privacy: Same Name Audit - Quarter 1 Low Risk Assessment: Review employees access in Cerner when they access an account

that has the same name as their own, which is in violation of JHS PHI Policy.Completed 2/28/2013

29HIPAA/Privacy: Same Name Audit - Quarter 3 Low Risk Assessment: Review employees access in Cerner when they access an account

that has the same name as their own, which is in violation of JHS PHI Policy.Not started

30 HIPAA/Privacy: Employee Access Threshold - Quarter 1 Moderate Risk Assessment: Track employees access based on their assigned Cerner roles, which allow access to the application, in order to identify potential security issues. Completed 1/31/2013

31 HIPAA/Privacy: Employee Access Threshold - Quarter 2 Moderate Risk Assessment: Track employees access based on their assigned Cerner roles, which allow access to the application, in order to identify potential security issues. Not started



34 HIPAA/Privacy Security High Risk Assessment: Review employee process in logging out of applications on clinical units when away from their area. Not started

35BAA review with focus on Health Plan, Mental Health and International Program

Moderate HIPAA/Privacy Audit - To ensure that where a business associate agreement is required one would have been executed along with the underlying contract and that we are in compliance with JHS policies and procedures. Not started

36 Medical Directorship Contracts High Risk Assessment: Review existing Medical directorship contracts to ensure proper (updated) Fair Market Value analysis exist for each. Not started

37 Medical Directorship Contracts Moderate Risk Assessment: Review the timeliness of the submission of timesheets to ensure compliance with Jackson Health System Policy # 283. Not started

38 Maternal Fetal Service - Quarter 1 High Risk Assessment : To review the medical documentation, coding and billing of services provided by the Maternal Fetal Service Line. Completed 1/27/2013

39 Maternal Fetal Service - Quarter 2 High Risk Assessment : To review the medical documentation, coding and billing of services provided by the Maternal Fetal Service Line. Not started

40 Modifiers Moderate Risk Assessment: Review the use of modifiers being utilized to ensure proper usage according to CMS Medicare and Medicaid guidelines. In Progress

2

Total5

133856

23%0






Definition

41

Hospital to Hospital Transfers High RAC/Re-assessment - To review inpatient hospital stay discharges for accurate reporting whether patient is discharged to home or transferred to another facility (SNF, IRF, or home health) or left against medical advice (and was later admitted to another facility on same day of discharge) where the inpatient hospital claim from the transferring facility falls under the post-acute transfer policy. According to the Post Acute Transfer policy, the transferring facility should be reimbursed on a per-diem basis (up to the DRG full payment), while the receiving facility receives the full DRG or respective PPS reimbursement. All DRGs being reviewed are available in the Post Acute Transfer Policy.

Not started

42

Inpatient - Interrupted Inpatient Psychiatry Facilities (IPF) Moderate Re-assessment - To review IPFs Mental Health claims for Medicare reimbursement in cases of transfers from IPFs to the same or other IPFs. To ensure that IPFs do not discharge and then re-admit patients and obtain per diem payments with higher adjustments. Interrupted stays in which a patient is discharged and then re-admitted to the same or another IPF within 3 days following the discharge will be treated as one continuous stay. Not started

43OIG - Payments for Canceled Surgical Procedures High OIG - Payments for Canceled Surgical Procedures - To review Medicare claims for

inpatient stays where the canceled procedure was the principal reason for the initial hospital admission. Not started

44

OIG - Partial Hospitalization Program (PHP) High OIG - Partial Hospitalization Program - Review the appropriateness of Medicare payments for PHP psychiatric services in hospital outpatient departments and freestanding community mental health centers. To determine whether the payments met Medicare requirements. This review will focus on whether payments met Medicare requirements on the basis of documentation supporting the services, including patient plans of care and physician supervision and certification requirements.

Not started

45 OIG - Medicare Dual Eligible High OIG - Medicare Dual Eligible - Ensure that inpatient deductible payments from Medicaid were appropriately made for dual-eligible beneficiaries. Not started

46 Advance Beneficiary Notice (ABN) Review High Re-assessment - To determine if Medicare beneficiaries are provided with timely ABN notices for non-covered Medicare services. Not started

47Medicare Secondary Payer (MSP) Review High Re-assessment - To determine if the online MSP questionnaire utilized by the hospital is

compliant with the rules and regulations set forth by CMS for the solicitation of MSP information from the beneficiary. Completed 1/27/2013

48Rehab Audit Outpatient Moderate Risk Assessment - As per CARF (Commission on Accreditation and Rehabilitation)

requirements, an audit will be performed to evaluate outpatient rehabilitation services to ensure documentation supports billing appropriateness. Not started

49

AHCA - Emergency Medicaid for Undocumented Patients - Quarter 1

High AHCA - To evaluate emergency services provided to undocumented patients who meet all Medicaid eligibility requirements except for citizenship or alien status. Eligibility can be authorized only for the duration of the emergency. Medicaid will not pay for continuous or episodic services after the emergency has been alleviated. The focus of this audit will be patients who have been admitted as inpatient. Completed 2/28/2013

50


High AHCA - To evaluate emergency services provided to undocumented patients who meet all Medicaid eligibility requirements except for citizenship or alien status. Eligibility can be authorized only for the duration of the emergency. Medicaid will not pay for continuous or episodic services after the emergency has been alleviated. The focus of this audit will be patients who have been admitted as inpatient. Duplicate - same as #49 2/28/2013

51


High AHCA - To evaluate emergency services provided to undocumented patients who meet all Medicaid eligibility requirements except for citizenship or alien status. Eligibility can be authorized only for the duration of the emergency. Medicaid will not pay for continuous or episodic services after the emergency has been alleviated. The focus of this audit will be patients who have been admitted as inpatient. Not started

52



53



54

Long Term Care Hospital High RAC - Medicare pays for inpatient hospital services that are medically reasonable and necessary for the setting billed. Medical documentation will be reviewed to determine that services were medically reasonable and necessary. The beneficiary must demonstrate signs and/or symptoms severe enough to warrant the need for hospital-level medical care and must receive services of such intensity that they can be furnished safely and effectively only on an inpatient basis.

Not started

3

Total5

133856

23%0






Definition

55Observation Services - Quarter 1-2 Moderate Risk Assessment - Review Medicare and Medicaid patients in an observation status to

ensure that they did not meet inpatient criteria or other outpatient criteria based on the medical documentation. Completed 1/27/2013

56Observation Services - Quarter 3-4 Moderate Risk Assessment - Review Medicare and Medicaid patients in an observation status to

ensure that they did not meet inpatient criteria or other outpatient criteria based on the medical documentation. Not started

4

3(b) Review of Finalized Audit Reports

OFFICE OF COMPLIANCE Jackson Medical Towers, Suite #102

1500 NW 12 Ave Miami, Florida 33136-1094

305-585-2902

Compliance Audit Report April 12, 2013

Audit Name: # 22 Physician Services – Quarter 1 Scope: Risk Assessment - Review professional coding and billing of Medicare and Medicaid billing for items or services not rendered or not provided, submitting claims for services that are not medically necessary or double billing, resulting in duplicate payment. Methodology: Thirty (30) paid and or denied Medicare and Medicaid primary encounters were extracted from a universe of claims for inpatient and outpatient services, ranging from dates of service 09/01/2012 – 12/31/2012 for JMG Physician Services for the following specialties Cardiology, Gastroenterology, and Colorectal Services. The following were reviewed:

CMS-1500 billed to the payer Cerner PowerChart and Allscripts were used to verify clinical documentation for

services that were billed on the CMS-1500 Per Se was used to validate the adjustments per the payer contract for the office

visits Cerner PM Office and AllScripts used to verify documentation for benefits

eligibility Siemens EDM and AllScripts used for the accounts registered outpatient and

inpatient services to confirm registration forms were completed according to regulatory requirements and JMH policy

Relevant Regulations, Policy and Procedures and Standard Operating Procedures:

Medicare Processing Manual – Chapters 12,13, 24 & 26 Medicare Claims Submission Guide Medicare Physicians Fee Schedule CMS Publication 100-04 – Transmittal 2282 and 2140

CMS Publication 100-02 – Transmittal 147 CMS Professional Paper Claims (CMS-1500) CMS 1500 Fact Sheet CMS Evaluation & Management Service Guide CMS Evaluation & Management Service Billing Guide Patient Access Services Departmental Policy #405 JMG Physician Practice Scheduling Policy

Results: Total Payment $14,118.00 Medicare Overpayment $0.00 Medicaid Overpayment $0.00 Payment Error Rate 0 % Findings/Observations: Patient Access Services: The overall observations and findings of the area render a Medium Compliance Rating, indicating that there are opportunities for improvement JMG Physician Registration: The overall observation and findings of the area renders a Good Compliance Rating, indicating that appropriate operational, financial and compliance controls are met. Compliance Rating: We find that the services rendered to patients for the claims that were reviewed in this audit were unremarkable and have no payment error rate. Recommendations:

Ensure compliance with current Patient Access Services Departmental Policy #405 and JMG Physician Practice Scheduling Policy regarding patient identification, insurance card scanning, completion of registration documentation, and benefit documentation.

Managers Response Physician Services agrees with the findings of the audit.

RAC 2nd Quarter Report 2013Facility Dollars at Risk Number of Encounters

01/25/13Retained by Jackson 16,038$ 4Jackson Memorial ‐ Outpatient 459$ 3Jackson North Medical Center 15,579$ 1

Pending 61,923$ 401/25/13Jackson North Medical Center 13,389$ 103/13/13Inpatient Rehabilitation Hospital ‐ Inpatient 27,268$ 1Jackson Memorial ‐ Outpatient 9,687$ 1Jackson South Community Hospital 11,579$ 1Grand Total 77,962$ 8

RAC 2nd Quarter Report 2013

$16,038

$61,923

$-

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

Retained by Jackson Pending

Total

Retained by Jackson

Pending

FY 2013 JHS Employee Sanction Check

Quarter Period Checked Status Compliant

Q1 Oct-Dec 2012 Complete 100%

Q2 Jan-Mar 2013 Pending

Q3 April-June 2013

Q4 July-Sep 2013

Compliance Hotline Call Summary

QUARTER 1 QUARTER 2 FY '13 YTD

MONTH Oct‐12 Nov‐12 Dec‐12 Q‐1 Jan‐13 Feb‐13 Mar‐13 Q‐2 TOTALS

1 Total calls received for each month 27 14 25 66 14 25 30 69 135

2

Calls received requesting information or redirected 19 10 16 45 8 14 23 45 90

3 All calls resulting in Investigations 8 4 9 21 6 11 7 24 45

4 Calls Investigated and Closed 4 2 7 13 1 4 3 8 21

5 Compliance Investigations Still Open 4 2 2 8 5 7 4 16 24

www.JacksonHealth.org

305-585-6754

Executive Office

1611 N.W. 12th Avenue • West Wing 117

Miami, FL 33136

To : Diana Salinas, Corporate Director & Chief Compliance Officer From: Zari Watkins, Director, Project Coordination Date: April 11, 2013 RE: BRG UPDATE

Implementation of Third Party Risk Management Module of Compliance 360 (“C360”) Solution:

Creation of a standard, consistent process from storing contracts in C360 to management of contracts through an automated collaboration, review and approval process thereby facilitating the continued monitoring and management of each physician arrangement.

Programmable site security has been incorporated to restrict users submitting information to workflows associated with their respective departments and only allows authorized reviewers to edit contracts in the workflow.

The management leadership for Physician Services, Property Management, Revenue Cycle and others have been trained; as well as the reviewers from Corporate Compliance, Human Resources, Risk Management, and the County Attorney’s Office.

Additional resources include the Director of Contracts Management who will be directly responsible for managing the Third Party Risk Management module.

Ownership and maintenance of Physician Database within Physician Services.

Single, Comprehensive Inventory of All Physician Arrangements: Full contract life-cycle management with the capabilities to allow each reviewer to track changes, preserve

version control, as well as locking and archiving of final versions. Also allows historical information pertinent to each individual contract to be kept in one place.

Virtually all information about each individual Physician/Business Partner will be stored, including but not limited to: every agreement with the Physician/Business Partner has executed with the Trust, Business Associate Agreements, Fair Market Value Analyses, relevant regulatory documentation and business licenses and/or certificates of insurance, etc.

Each Physician/Business Partner can also be linked to other organizations, group practices, partnerships, or individuals that may also have an existing agreement or affiliation with the Trust.

Additional Functionality:

Easy, secure search and find capabilities for quick retrieval of information. Automatic audit trail shows date, time, and activity for each user including their access and changes to key

information. Configurable online dashboards and reports for monitoring activity and trends.

Implementation Date: May 1, 2013

Jackson Health Plan (JHP) Compliance Update

Jackson Health Plan approved the following during their JHP Executive Compliance Committee:

•JHP Compliance Program Plan•JHP Fraud, Waste and Abuse Program Plan•JHP Delegation Oversight Committee•Compliance Policies and Procedures review•Marketing & Sales Policies and Procedures

Marketing, Sales and Customer Service required training provided to workforce

Effective 4/10/2013, 69% of the CMS CAP items are complete and evidenced

FY 2013 JMH Health Plan Employee Monthly Sanction Check

Month Status CompliantMarch 2013 Complete 100%

April 2013 May 2013June 2013

July 2013 Aug 2013

September 2013

Note: Effective March 2013

4. Internal Audit update

INTERNAL AUDIT - FY13 AUDIT PLAN

Risk Level Audit Summary TotalHigh

In Progress 6Medium

Total Audits Completed 8Low Not Started 15

Total Audits on Plan 29% of Plan Completed 28%New audits added to Original Plan 3

Audit # Audit Name Risk Assessment Status Completion Date

1 External Audit Assistance n/acomplete 2/28/2013

2 Change Management (Patch Management) mediumcomplete 1/31/2013

3 Perdue Medical Center - operational/clinical process audit

mediumcomplete 1/31/2013

4 Long Term Care Center - operation/clinical process audit

mediumcomplete 1/31/2013

5 Patient Referrals mediumcomplete 2/28/2013

6 Community Mental Health mediumcomplete 2/28/2013

7

Inventory & Supply Control - JMH Ambulatory Care Pharmacy and Transfusion Services

medium

complete 2/28/20138 Patient Intake - JMH Main Operating Room high complete 3/31/20139 Cell phone audit low fieldwork in process

10Jackson Health Plan high

fieldwork in process

11System Development Process high


12

Contractual and Purchased Services Management - Jackson South

medium


13

Contractual and Purchased Services Management - Jackson North

medium

planning underway

Review contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.

General controls review of stand alone function.

Review new/upgrade system implementation process to include project team selection, planning, management, testing, etc.

Assess internal controls related to storing, warehousing, and the safeguarding of inventory supplies, determine if inventories are subject to effective custodial accountability procedures and physical safeguards. Determine if appropriate segregation of duties exists.

Determine completeness, accuracy and efficiency of the

Evaluate compliance with CMS audit remediation plan

At request of management, review cell phone policy,


On an annual basis, provide 800 hours audit assistance to KPMG.

Perform an analysis of patients referred from JHS to UM from 2008 - 2012.

as of 3/31/13

Impact to company's financial statements is considered material; non-financial risk, such as patient outcome and visibility, is considered high. Other considerations include significant change in associated management and/or process, and prior internal or external audit findings.Process impact to company's financial statements may be material; other risk as described above is considered less significant.

Definition

Minimal risk to organization from either a financial or operational risk.

Scope & Objectives

Evaluate internal controls related to long term care facility.

Evaluate effectiveness of controls surrounding the patch management software.

Evaluate internal controls related to long term care facility.

1

Audit # Audit Name Risk Assessment Status Completion DateScope & Objectives

14

Denial Management and Collection medium

planning underway

15

Contractual and Purchased Services Management - JHS Executive Office

medium

16Equipment Management - Core System Maintenance

medium

17

Inventory & Supply Control - Jackson North, Jackson South

medium

18Clinical Services - JMH Radiology and Respiratory Therapy

medium

19Payroll high

20

Cash Audit medium

21Omnicell high

22 Security & Privacy medium23 Annual Operating Agreement Review - UM medium

24External Audit Assistance n/a

25Registration and Admissions - Inpatient/Siemens/Cerner application audit

high

26 Physical Inventory Count Observation medium

27KRONOS application audit high

28Audit Follow-up n/a

29

Community Health, Inc. (CHI) low

Jackson Health Plan low

Removed from plan

Perform follow-up review of prior year's audit findings to ensure corrective action is completed as stated and adequate.

Observe annual physical inventory count to determine adequacy of procedures.Evaluate the effectiveness of controls over the timekeeping system.

Assess effectiveness and efficiency of the department's operation/financial processes as relates to compliance with established internal/regulatory policies and procedures.

Review contract/agreement management process to determine compliance with contract, proper procurement processes were followed and effectiveness of payment controls.

On an annual basis, provide 200 hours audit assistance to KPMG.

Determine compliance with terms of AOA.HIPPA Part II "Privacy Rule".

Determine effectiveness of controls surrounding Omnicell management.


Identify risks associated with cash collection processes and practices unique to JHS' cashier function, determine if controls adequately mitigate identified risks, determine if cash is properly safeguarded and adequate segregation of duties exist.

Review and evaluate the adequacy of internal controls surrounding payroll processes.

Determine completeness, accuracy and efficiency of the revenue process by assessing patient care process controls.

Assess internal controls related to storing, warehousing, and the safeguarding of inventory supplies, determine if inventories are subject to effective custodial accountability procedures and physical safeguards. Determine if appropriate segregation of duties exists.

Verify accuracy of capturing patient information and insurance verification; to include Siemens/Cerner related controls review.

Evaluate internal denial collection efforts to determine if adequate efforts are undertaken prior to referring accounts to external collection companies.

Evaulate effectiveness of controls surrounding management of IT equipment.

2

Audit # Audit Name Risk Assessment Status Completion DateScope & ObjectivesJackson Health Plan - Fraud & Abuse low

Removed from plan

Examine, investigate, and analyze data for the purpose of assessing compliance with various segments of PHT/JMH policies and procedures.

3

Audit # Audit Name Risk Assessment Status Completion DateScope & Objectives

Process Life Cycle (PLC)Current Systems Development/Process Change Projects designated by Internal Audit as Tier 1

1 Electronic Medical Records (EMR, CPOE) Meaningful Use requirements for attestation Stage 12 Accounts Payable - GHX/AP on demand3 ICD-104 OR inventory, charge capture, CDM, billing5 Siemens DSS6 Zynx Evidence Based Order Sets ZENX

7 PPW Datacenter Renovation/NAP Reduction

83M Encompass 360 Computer Assisted Coding.

9 EDI Process Procure to Pay

10MedAssets Revenue Cycle Project. Revenue Integrity Steering Committee

11 OTTR Implementation - Transplant Database

12Cerner reference Lab Interface with Quest Diagnostics.

13Payroll Disaster Recovery, Business Continuity Plan

14 MDI software upgrade - LTC15 Allscripts Care Management16 Cash Task Force17 Cerner Corrections Project

4

4(b) Review of Finalized Audit Reports

www.JacksonHealth.org

305-585-2901 Office of Internal Audit

1500 N.W. 12th Avenue • Suite 102

Miami, FL 33136

To: Carlos A. Migoya, President and Chief Executive Officer

Don S. Steigman, Executive Vice President and Chief Operating Officer

Cc: Mark T. Knight, Executive Vice President and Chief Financial Officer

Dr. Michael Butler, Chief Medical Officer

Dr. Wayne Wilbright, Chief Medical Information Officer

Michael Garcia, Chief Information Officer

Brian Dean, Senior Vice President of Finance

Alex Contreras, Chief Administrative Officer, JMH

Carmen Pla, Vice President of Patient Financial Services

Martha Garcia, Director of Operations, JMH

Jean Auger, Director of PCS Level 3, JMH

Steve Weimer, Corporate Director of Internal Audit

From: Andre Reid, Internal Auditor Manager

Date: 04/05/13

Subject: Final Report – 2013 OR - Patient Intake & Revenue Cycle Audit a/o 03/06/13

Background, Scope and Objective:

As part of the FY 2013 Audit Plan, the Office of Internal Audit (IA) performed an audit of the Jackson

Main Hospital Operating Room (“OR”) Patient Intake & Revenue Cycle Process, from the point of initial

patient contact to charging of the patient account in Siemens.

The objective of the audit was to evaluate the effectiveness and efficiency of internal controls for the first

quarter of FY 2013, which included the following processes: Admission & Registration, Financial

Assessment, Clinical Documentation and Charge Capture.

Entity Rating:

Overall Rating Based on Issues identified: Needs Improvement

Executive Summary:

Our audit revealed potential ineffective controls and inefficiencies in the Charge Capture process. Current

process design allows for the charging of medical supplies to patient accounts from two different systems,

which may result in duplicated and erroneous charges. Our detailed observations are outlined below.

2

Detailed Observations, Recommendations and Management Action Plans

1. Ineffective and Inefficient Charge Capture Process

Ineffective and inefficient processes exist for charging medical supplies to patient accounts for procedures

in the Operating Room (“OR”). Medical supplies can be charged from two different systems by process

design: in the OR room through Surginet and in Omnicell/Optiflex at the time the supplies are picked for

the procedure.

All medical supplies used in a surgical case can be charged to the patient account through the nursing

documentation system in Surginet, which interfaces directly with Siemens. Supplies for many surgical

cases, not a part of the Surgi-track process, are picked directly from the Omnicell/Optiflex cabinets by the

Operating Room Staff. When those supplies are accessed, the system automatically charges those items

to the patient account, which also directly interfaces with Siemens. The charges generated by

Omnicell/Optiflex are not captured in Cerner because of the lack of interface capability. This process can

result in duplicate charges.

No systematic reconciliation exists during the surgical procedure to ensure that charges from

Omnicell/Optiflex are not also charged through the nurses’ documentation process in Surginet. In

addition, items may be incorrectly charged to patient accounts due to cancellations, rescheduling, and lack

of crediting unused items back to patient accounts. As a result, manual reconciliations are performed on a

daily basis, which is very labor intensity and time consuming, resulting in numerous corrections and

opportunities for errors and duplication.

We recommend management develop a plan to designate a sole source for the initiation/origination

charges, which will reduce labor and time used to perform the daily manual reconciliations.

Management Response: Management agrees with the audit findings. As a response to the findings, the

following actions shall be implemented.

1. The patient charging functionality in Omnicell/Optiflex will be disabled.

2. OR Leaders will insure that Omnicell/Optiflex has transferred all items (Chargeable/Non-

Chargeable) to the Surginet Charge/Preference Cards to insure charging. This will be

accomplished using reports that can cross reference what is in Optiflex versus what is in Surginet.

This will require verification of CDM, Item Number and catalog. This will be accomplished

using a crossing disciplinary task force.

3. Once action #2 is complete, the charges will be done exclusively through the nursing

documentation on Surginet.

4. Daily manual reconciliations will continue each business day.

5. Any trends in discrepancies will be brought to the attention of the OR Director, with a copy of to

the JMH Operations Director.

6. As appropriate, employee education and (if necessary corrective action) shall be implemented.

7. Continue implementation of the Surgi-track project, with a goal that 70% of the OR inventory

items be included in the Surgi-track t trays/kits by December 31, 2013.

Action Plan Owner: Implementation Date:

Jean Auger, Director of PCS Level 3, JMH September 30, 2013

3

2. Incomplete Inpatient Order Documentation

Two of 34 (6%) Physician Orders reviewed from a population of In-patient status did not explicitly state

“Admit to Inpatient”. This is a Center for Medicare and Medicaid Services (“CMS”) compliance

requirement. In addition, incorrect documentation may result in delay of payment or repayment to

insurance payers.

We recommend that management establish a formal review process of every patient’s record to

ensure that all required documents are accurately completed.

Management Response: Management agrees with the audit findings. One of the two patients was an

elective admission for surgery post burn. The insurance company also approved for the inpatient

admission. The other patient was admitted through the trauma orthopedic services. The orthopedic and

trauma services have pre-printed orders that do not make provisions for “admit to inpatient” language.

We have determined that case management review exists for elective and ER admissions but does not

exist for trauma services.

As a response to the findings, the following actions shall be implemented:

1. The physicians in the trauma and OB services shall receive education on the use of the Case

management Protocol and Condition 44 Process.

2. The nursing staff in both PACU and PATU shall receive education on the use of the Case

management Protocol and Post Op Recovery conversions process.

3. Weekly audits will be done for all admissions going directly to the OR to ensure the

PACU/PATU Post Op Recovery Process is performed.

4. Modify the physician order sets in trauma services to include the “inpatient versus

observation” issue.


Martha Garcia, Director of Operations, JMH September 30, 2013

Janice Gonzalez, Director ER/Trauma Services

Process Improvement Opportunities (“PIO”)

Process improvement opportunities are enhancements to existing operational and financial processes,

resulting in a more efficient and effective control environment. See area for improvement below:

3. Surgery scheduling process not optimized

The Clinical Care Coordinators (responsible for scheduling surgeries) are each assigned to different

service lines. As a result there may be inefficiencies in the scheduling process as the requests and related

work load may not be optimized among the coordinators.

We recommend management enhance procedures whereby allowing for all coordinators to perform the

scheduling for all service lines.

4

Management Response: Management agrees with the audit findings. The manner in which surgeries

are scheduled by the clinical managers is not standardized among all services and we do have the

potential to reorganize and even reduce the number of employees responsible for this function.

In order to take advantage of this process improvement opportunity, the following actions will be

taken:

1. A flow chart depicting the scheduling process which starts at the physician

office/clinic and includes clinical coordinators, financial clearance staff and ends with

the OR schedulers will be delineated.

2. A standardized process will be developed for all services, including equipment, staff

and room requirements for cases.

3. Changes to Cerner and Schappbook will be made to accommodate the new process.

4. A productivity measure shall be established to ensure all coordinators are utilized

optimally.

5. Education of all process owners and physicians will be done.

6. Once the change is implemented, adherence to the new process will be monitored on

a daily basis by the Director of Operations. Actions will be taken when the new

process is not followed.

7. Productivity by process owner will be measured and communicated on an ongoing

basis.

Action Plan Owner: Implementation Date: Martha Garcia, Director of Operations, JMH September 30, 2013

4. Surgery request process is not standardized and inefficient

There is no standard method by which requests for surgeries are made. Currently, requests may be made

via email, fax, phone, or Cerner. As a result, there are inefficiencies in the process which requires the

Clinic Care Coordinators (“CCC”) to manage multiple sources of requests. We recommend management

implement a standard uniform procedure for requesting surgeries.

Management Response: Management agrees with the audit findings. In order to take advantage of

this process improvement opportunity, the following actions will be taken, which are very

similar to the actions listed in #3:

1. A flow chart depicting the scheduling process which starts at the physician

office/clinic and includes clinical coordinators, financial clearance staff and ends with

the OR schedulers will be delineated.

2. A standardized process will be developed for all services, including equipment, staff

and room requirements for cases.

3. Changes to Cerner and Schappbook will be made to accommodate the new process.

4. Education of all process owners and physicians will be done.

5. Once the change is implemented, adherence to the new process will be monitored on

a daily basis by the Director of Operations. Actions will be taken when the new

process is not followed.

6. Productivity by process owner will be measured and communicated on an ongoing

basis.

5

Action Plan Owner: Implementation Date: Martha Garcia, Director of Operations, JMH September 30, 2013

5. Risk assessment documentation guide not being used

The physician order “Venous Thrombus Embolism (“VTE”) Prophylaxis” form is not being used by the

physicians. The form should be used as a guide to assist the physicians in performing a risk assessment to

determine if the patient is at risk for VTE.

The VTE form was created and implemented as a core measure to comply with the National Quality

Initiative documentation requirements. These measures are used by all major payers as part of

benchmarking and contract negotiation.

We recommend management reinforce the use of all required forms.

Management Response: Management partially agrees with the audit findings. While the VTE “form” is

not being used, the Hospital has an active process in place for monitoring and promoting compliance with

core measures, including VTE prophylaxis. There is Cerner capability to perform the risk assessment

electronically and the physician can place the orders in the physician order form. We do recognize that

form does promote compliance and is a great tool for communication and standardization.

In an effort to take advantage of this process improvement opportunity and to promote compliance with

the CMS core measures, the PACU and PATU staff will ensure the patients who require this assessment

do not leave the postoperative recovery area until the form is completed by the physician. In the event the

patient bypasses the recovery area, it will be the responsibility of the TICU or SICU charge nurse to

ensure the form is completed and utilized within 4 hours of admission to the unit. If needed, a call will be

placed to the physician.


Martha Garcia, Director of Operations, JMH July 1, 2013

Jackson Health SystemPrior Audit Report Follow‐Up

March, 2013

4/12/2013

Audit Audit Report Dated Original Number of Comments Follow‐up Exceptions Noted Corrected during Audit? Exception RatioSoftware License Compliance FY11 2 0 n/a 0%

PURCHASING AND FACILITIES SUBCOMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Purchasing and Facilities Subcommittee

Darryl K. Sharpton, Chairperson Stephen S. Nuell, Vice Chairperson Joe Arriola Michael Bileca Mojdeh L. Khaghan

Date, Time and Place April 18, 2013 – Following the Audit and Compliance Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

PURCHASING 1. Approval of the Previous Meeting Minutes (Darryl K. Sharpton, Chairperson, Purchasing and Facilities Subcommittee)

(a) *Meeting Minutes as of March 14, 2013 2. Review and Recommend Approval of the Purchasing Report (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

(a) * Purchasing Report as of April 2013 3. *Monthly Report of Competitive Contracts Awarded or Renewed Over the Chief Procurement Officer

Authority in Accordance to Procurement Regulations as of March 2013 (Fidel Alvarez, Manager, Procurement Management Department, Jackson Memorial Hospital)

4. *Monthly Report of Non-Competitive Contracts Awarded or Renewed Under $250,000 as of March 2013

(Fidel Alvarez, Manager, Procurement Management Department, Jackson Memorial Hospital) 5. Key Performance Indicators (KPI) for Procurement Update (Rosa Costanzo, Vice President and Chief

Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

(a) *KPI Report Guideline (b) *Monthly KPI Report (c) *Procurement KPI Report Card (April 2012 – March 2013)

6. *Direct Payments as Approved Pursuant to Resolution No. PHT 10/12-078 (Resolution authorizing and

approving the revision of the Procurement Policy/Regulation as amended on October 29, 2012) as of March 2013 (Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

7. Vendor and Contract Performance Monitoring Report (Rosa Costanzo, Vice President and Chief

Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System)

(a) *Vendor Contract Ratings Summary (b) *Summary of Annual Evaluation of Vendor Performance

Purchasing and Facilities Subcommittee Meeting Agenda April 18, 2013 Page 2

FACILITIES

8. Financial and Budget Tracking Status Report as of February 2013 (Aurelio Gonzalez, Budget Director, Jackson Memorial Hospital)

(a) *Financial and Budget Tracking Status Report Summary (b) *Financial and Budget Tracking Status Report

9. *Interactive Map Construction Projects Update

(David Clark, Director, Capital Projects, Jackson Health System)

10. Campus-Wide Way Finding Update (Matthew Pinzur, Associate Vice President, Communication and Outreach, Jackson Health System)

11. Resolution Recommended to be Approved

(a) *Resolution authorizing the President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in Suite 230 at the Regency Medical Center Building, located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years commencing September 1, 2012, with one a (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent (3%) (Madeline Valdes, Corporate Director, Property Management, Jackson Health System)

(b) *Support document for agenda item 11 (a)

The items noted with an asterisk (*) indicate that the supporting documents are attached.


Purchasing & Facilities Subcommittee Darryl K. Sharpton, Chairperson Joe Arriola Michael Bileca Mojdeh L. Khaghan Stephen S. Nuell

Date, Time and Place March 14, 2013 – Followed the Audit & Compliance Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE Purchasing & Facilities Subcommittee

Darryl K. Sharpton Joe Arriola Mojdeh L. Khaghan Stephen S. Nuell Marcos Jose Lapciuc Excused Michael Bileca

Jackson Health System Carlos A. Migoya

Don S. Steigman Rosa Costanzo David Clark Madeline Valdes Aurelio Gonzalez

Brian Dean Miami-Dade County Attorney Eugene Shy, Jr.

Purchasing & Facilities Subcommittee Meeting March 14, 2013 Page 2 Meeting Call to Order With a quorum being present, the Purchasing & Facilities Subcommittee meeting was called to order at 8:04 a.m. by Darryl K. Sharpton, Chairperson, Purchasing and Facilities Subcommittee. 1. Approval of the Previous Meeting Minutes (a) Meeting Minutes as of February 21, 2013 Mr. Sharpton requested a motion approving the meeting minutes as of February 21, 2013. Mr. Nuell moved approval; seconded by Mr. Lapciuc, and carried without dissent.

PURCHASING Mr. Sharpton questioned how the performance of contracts being monitored compared to previous years. Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System (JHS) stated that compared to prior years before recommending a contract(s) for approval by the Subcommittee it is thoroughly vetted together with a representative from the Strategic Sourcing and Supply Chain Division and Department User. Further into the performance of contracts monitoring process appropriate members of staff reach out to the vendors as well as price analysis companies to assure that JHS receives a valued service. 2. Review and Recommend Approval of the Purchasing Report

(a) Purchasing Report as of March 2013

Ms. Costanzo presented an overview including background information, highlights and key features of the March 2013 Purchasing Report. A detailed copy of the report was included with the agenda.

Following the overview presentation, Mr. Sharpton requested a motion approving the Purchasing Report as of March 2013.

Mr. Nuell moved approval; seconded by Mr. Lapciuc, and carried without dissent.

The March 2013 Purchasing Report will be forwarded to the Fiscal Committee with a recommendation for approval.

Purchasing & Facilities Subcommittee Meeting March 14, 2013 Page 3 4. Monthly Report of Competitive Contracts Awarded or Renewed Over the Chief

Procurement Officer Authority in Accordance to Procurement Regulations – February 1 through February 28, 2013

With there being no significant information to report, Ms. Costanzo presented a summary of the competitive contracts awarded or renewed over the CPO authority. A detailed copy of the report was included with the agenda.

5. Monthly Report of Non-Competitive Contracts Awarded or Renewed Under $250,000 –

February 1 through February 28, 2013 With there being no significant information to report, Ms. Costanzo presented a summary of the non-competitive contracts awarded or renewed under $250,000. A detailed copy of the report was included with the agenda.

6. Key Performance Indicators (KPI) for Procurement Update

Ms. Costanzo reported that the items which are noted in the Key Performance Indicators update have been thoroughly vetted. A detailed copy of the update report was included with the agenda.

7. Direct Payments as Approved Pursuant to Resolution No. PHT 10/12-078 for January 1 through January 31, 2013 (Resolution authorizing and approving the revision of the Procurement Policy/Regulation as amended on October 29, 2012) As of January 31, 2013 seventy one (71) contracts were reviewed. The summary of ratings is as follows: 45% was Excellent, 42.2% was Good, 2.8% was Satisfactory, 4.2% was Fair and 5.6% was Poor. For the purpose of clarification, during the evaluation period a total of 90% (not 98%) of the contracts reviewed were found to be performing satisfactory or better. With regards to the contracts rated fair and poor, Mr. Nuell requested that the Subcommittee be provided with the dollar amounts. Mr. Sharpton requested that future reports include the dollar amounts for all contracts reviewed regardless of their rating.

Purchasing & Facilities Subcommittee Meeting March 14, 2013 Page 4

FACILITIES

10. Real Estate Update

Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System reported that the property located at 1320 N. W. 62 Street, former location of the Liberty City Health Clinic has not been occupied for some time. There have been reports by the City of Miami and Miami-Dade County regarding vandalism of the property. Ms. Valdes stated that a JHS occupied and owned properties inventory will be conducted to determine the need and hospital use for the properties. Don S. Steigman, Executive Vice President and Chief Operating Officer, Jackson Health System stated that upon completion of the JHS occupied and owned properties inventory a detailed report will be presented to the Subcommittee. It is anticipated that the inventory will be completed in the next several months.

8. Financial and Budget Tracking Status Report as of January 2013

Aurelio Gonzalez, Budget Director, Jackson Memorial Hospital presented a summary of the Financial and Budget Tracking Status Report. As of January 31, 2013 active projects totaled $26.9 million, currently working on a spending plan, Mark T. Knight, Chief Financial Officer, Jackson Health System and Mr. Gonzalez are working together with representatives from Miami-Dade County (County) to receive funding from the County and find alternative funding sources for capital projects. A detailed summary report and budget tracking report was included with the agenda.

9. Interactive Map Construction Projects Update as of March 2013

David Clark, Director, Capital Projects, Jackson Health System, presented an update regarding the capital projects as of March 2013. Mr. Clark stated that from life to date through January 13, 2013 $35.4 million represent the cost for Infrastructure Projects. A detailed copy of the status report was included with the agenda. The Subcommittee raised questions and engaged in discussion regarding the Signage Project particularly as it relate to funding allocations, Signage Project plan, on campus pedestrian locations, and on site directional assistance for patients and visitors. With regards to funds allocated for the Signage project, Mr. Sharpton requested that future status reports reflect as much detailed information as possible. Mr. Migoya informed everyone that a detailed report regarding specifics related to the Signage Project will be presented at the next scheduled Subcommittee meeting. Mr. Arriola questioned the cost of $35.4 million for Infrastructure Projects. Ms. Valdes explained that majority of the cost is for campus wide Infrastructure Projects. Ms. Valdes stated that a detailed Infrastructure Project report highlighting where the funds will be used will be presented at the next scheduled Subcommittee meeting.

Purchasing & Facilities Subcommittee Meeting March 14, 2013 Page 5

Mr. Sharpton encouraged members of the Subcommittee to visualize and anticipate the needs as it relates to Construction and Signage projects. Mr. Sharpton and members of the Subcommittee requested that a detailed and regularly updated list of expenditures be presented for fiscal year 2013 and fiscal year 2014.

Other Discussion Mr. Sharpton questioned if there is process in place to capture and report about ongoing miracles that happen at Jackson Memorial Hospital particularly as it relates to an organ transplant patient story that was published in the latest edition of the Miami Herald. Mr. Sharpton requested that reports highlighting the hospital be given shelf life. Matthew Pinzur, Associate Vice President, Communications and Outreach Division stated that fifteen (15) networks are viewing the story published in the Miami Herald and also being viewed internationally and on social medial. With regards to Mr. Sharpton’s request, Mr. Pinzur stated that a location within the Ira C. Clark Diagnostic Treatment Center will be designated to “Miracles Made Daily.”

Meeting Call To Adjourn The meeting of the Purchasing & Facilities Subcommittee adjourned at 9:02 a.m. Transcribed by Ivenette Cobb-Black Executive Assistant Public Health Trust Financial Recovery Board

2. Review and Recommend Approval of the Purchasing Report

April 2013 PHT Financial Recovery Board 1

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT

April 29, 2013

TO: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD FROM: PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust’s “Procurement Policy” and it’s implementing “Procurement Regulation.” This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review for legal sufficiency by the County Attorney’s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s) This section consists of awards under competitively solicited Invitations to Bid (ITB’s) over $3,000,000. No items to report SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s) This section consists of awards under competitively solicited Requests for Proposals (RFP’s) over $3,000,000. No items to report SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3000,000 under competitively solicited (“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities. No items to report


SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION (“GPO”) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization (“GPO”) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust’s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION

This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source No items to report B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician or clinician has requested the particular item or service without which the physician or clinician cannot successfully and safely render patient care. 1. (255077, 255069, 255074, 255072, 255073 and 255076-KD) The Perioperative Services Department requests contract awards to Stryker Spine, a Division of Howmedica Osteonics Corp. (“Stryker Spine”), Medtronic Sofamor Danek USA, Inc. (“Medtronic”) and NuVasive, Inc. for a period of two years for the continued provision of spinal implant products and related accessories (ongoing purchase).

Balance of page Intentionally left blank


SECTION V. (cont’d.) This Request for Funding

Stryker Spine: $310,000 (For two years)

Medtronic: $3,500,000 (For two years)

Nuvasive: $900,000 (For two years)

Total approved funding $4,710,000

(For the entire two-year period)

Background Stryker Spine, Medtronic and Nuvasive will continue to provide to the Trust spinal implant products, generally used to fuse the spine in the neck and lower back.

Discussions with surgeons concerning their utilization of these products were conducted by MedAssets, Procurement and the Value Analysis Team as part of a greater initiative to identify additional savings opportunities for the Trust without limiting product choices. The resulting feedback was that continued utilization of the spine products provided by the above-listed vendors was preferred, as these products offer the physicians better surgical choices. Historically, the Physicians have utilized these vendors’ products to meet the specific needs of the patient, and this has resulted in different levels of spend among the vendors. Some of the products offered by the three vendors are similar but not exactly alike. The Physicians make their choices based on the different technology types (different types of instrumentation used with spinal implant products) suited to both physician’s and patient’s need. Access to varying technology types offered by these vendors have also served Jackson’s teaching mission. The main focus of this initiative was to standardize on price in a given product category among the vendors. To this end, MedAssets and the Value Analysis Team entered into negotiations with these three existing vendors, achieving reductions by line item across the majority of vendor products to realize standardized pricing. The negotiated price reduction was effective immediately with Stryker and Medtronic. Stryker Spine’s pricing reflects an estimated $121,745 in savings. The pricing from Medtronic reflects approximately $693,673 in savings. The pricing offered by Nuvasive will be effective when the contract is executed resulting in approximately $96,047 in savings. The


SECTION V. (cont’d.) estimated dollars requested for each vendor have been capped and are stated as a maximum contract value in the individual Agreements. ECRI has reported that the new pricing provided by these vendors falls within the average competitive price point of the ECRI Price Guide database for these products. Recommendation After review of and discussions on the information presented, the Procurement Management Department recommends physician preference awards to Stryker Spine, Medtronic and Nuvasive for the provision of spinal implant products and related accessories.

These contracts have been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal sufficiency.

The underlying contracts can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. Bid Waiver Justifications were provided and Conflict of Interest Declarations were signed by: Fernando Garcia, Administrator, Medical Hospital Center; Eric Metzler, Director, MedAssets; Dr. Barth A. Green, MD., Professor of Clinical, Neuro Surgery; Dr. Nathan H. Lebwohl, Voluntary Associate Professor of Clinical for Orthopedic; Beth Caputo, Branch Manager, Stryker Spine; and, by Tamira Morris, Contract Manager, Medtronic, with no reported disclosures. Scott Duvall, Executive V.P., Strategic Sales & Operations, Nuvasive, also signed a Conflict of Interest Declaration and has disclosed that Dr. Steven Vanni currently teaches a procturing course on Nuvasive’s behalf for a stipend. Dr. Vanni has also signed a Conflict of Interest Declaration (A. Contreras). C. Standardization Items in this category have been established as the Trust standard. No items to report D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report


SECTION V. (cont’d.) E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report

SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid (“ITB” or “RFP”) at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. No items to report SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. No items to report

SECTION VIII. MISCELLANEOUS

This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. No items to report

Vendor Name DescriptionCost Center & Director/VP

Contract Number Contract Date Contract Value Contract Term Procurement Method UAP

Accura Electrical Campus Wide Exterior Lighting Upgrade 94913

Madeline Valdes4101829 CAPS 28-Mar-13 $ 430,000.00 One Time ITB 12-10665-SR Yes

Dell Marketing LpComputer Hardware for Enterprise Data Warehouse for the IT Department

92826 Mike Garcia

4101816 CAPS 20-Mar-13 $ 1,100,792.20 Two Years Medassets MS02614 Yes

GELease of Cath Lab Equipment(Innova530) for Jackson South Community Hospital

83746 Jay Miranda

8201230 SERV 27-Mar-13 1,267,668.00$ Five Years Medassets MS01102 Yes

OlympusEndoscopic Video System for Gi Station for Jackson Main

74406Alex Contreras

9100482 CAP 26-Mar-13 310,416.12$ One Time Medassets MS 01509 Yes

Phillips Medical SystemUltrasound Systems for the Radiology Echo Department

73710 Alex Contreras

9100474 CAP 14-Mar-13 294,106.00$ One Time Medassets EP132 Yes

Picis Inc.Anesthesia Manager Software and Maintenance Support for the IT Department

92826 Mike Garcia

8106854 SERV 15-Mar-13 172,129.01$ One Year ITB 13-10833-CS Yes

SHI International Corp.Software for Enterprise Data Warehouse for the IT Department

92826 Mike Garcia

4101804 CAPS 13-Mar-13 $ 1,358,289.32 Two Years State Of Florida #250-001-09-1

Yes

1. "MedAssets" is the Trust's primary "Group Purchasing Organization" (GPO)2. "State Contract" and "Miami-Dade Contract" mean a contract competively awarded by the State or County as a "cooperative contract".3. "US Communities" means a contract competively awarded by the U.S. Communities governmental purchasing alliance as a "cooperative contract".4. "OTR" means "Option to Renew".5. "Contract Value" corresponds to the fixed "Contract Term" that has been awarded or rewarded (not to future OTR's).6. "RFP" means competitive Request for Proposals (or Qualifications) procurement process performed by the JHS Procurement Management Department.7. "ITB" means competitive Invitation to Bid (or Quote) procurement process performed by the JHS Procurement Management Department.8. "UAP" means User Access ProgramE – Exclusion as per UAP program: ie, Federal Grant, etc.Yes – Incorporated into the purchase as either discount on invoice or discount upfrontN/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement RegulationsMarch 2013

For Information Only (Greater than $100K)

Monthly Report of Non-Competitive Contracts Awarded Under 250KMarch 2013

For Information Only

Vendor DescriptionCost Center & Director/VP

Contract Number Contract Date Contract Value Contract Term Procurement

Method UAP

Accredo Health Hypertension medication (Flolan) for the Pharmacy73005

Alex Contreras8106756 SERV 5-Mar-13 $ 25,000.00 One Time Sole Source No

GE Muse software support agreement for IT department92816

Mike Garcia8106768 SERV 6-Mar-13 $ 154,014.85 3 Years Sole Source Yes

IBM CorporationMaintenance for software/hardware for the AIX operating system

92826Mike Garcia

8106767 SERV 6-Mar-13 $ 29,671.88 1 Year Sole Source Yes

Medical Information Technology Information extraction from Meditech for JSCH83900

Jay Miranda8201218 SERV8201219 SERV

13-Mar-13 $ 237,304.00 One Time Sole Source No

Praxair Distribution SoutheastSterilization gas (Oxfume 2000) for Respiratory Therapy department

73906Alex Contreras

8106902 SERV 27-Mar-13 $ 120,000.00 9 Months Sole Source Yes

Redwood Software, IncMaintenance and tech support for Report2Web for IT department

92826Mike Garcia

8106898 SERV 26-Mar-13 $ 40,005.00 1 Year Sole Source Yes

Servicemaster CleanEmergency services for water damage in the following departments: SICUA, Cath Lab, and Nuclear Medicine

87007Alex Contreras

8106802 SERV 11-Mar-13 $ 19,292.44 One Time Emergency Yes

Sunshine Communication ServiceAfter hours answering services for outpatient clinics and physicians practice

88525Gino Santorio

8106821 SERV 13-Mar-13 $ 37,000.00 1 Year Bidwaiver Yes

Note: "Non-competitive" procurement category includes: Sole Source, Physician's Preference, Standardization, Non-Competitive Cooperate Purchasing, and Miscellaneous Bid Waiver.UAP - User Access Program:Exempt – Exclusion as per UAP program: i.e., Federal Grant, etc.Yes – Incorporated into the purchase as either discount on invoice or discount upfrontN/A – No, did not apply to procurement. Either an emergency purchase or contract was executed or extended before UAP was implemented

5. Key Performance Indicators for Procurement

Procurement KPI and Report Guideline

The Procurement/Strategic Sourcing KPI Report was created as a means to show the value, productivity and cycle times within the Procurement Management Department (PMD). Pursuant to the Procurement Regulation the procurement process (cycle time) begins upon the receipt of all fully completed and approved documents. This is necessary for proper control and monitoring of regulation requirements.

The KPI Report is broken down by the following sections:

I. Purchase Order Activity (Monthly)

This section shows the number of purchase orders that are created on a monthly basis. It is broken down into two areas: a) Purchase Orders (“PO”) and b) PO Lines. It tracks the activity for our supply automation technology (Optiflex & Omnicell) POs used for patient care supply replenishment. It also provides a snapshot of activity for the previous five months with an average for that period. The monthly average of POs and PO lines is provided for the current month being reported.

II. Contracting Activity (Weekly)

This section shows the contract/project weekly activity for a specific week. The data provides a summary of the number of contracts the PMD currently has in process. It shows the number of contracts being worked on by area; the average number of weekdays the contract has been in process without receipt of all approved documents from the User Departments; and the average for those in which all approved documents have been received.

III. Previous Activity

This section shows the history and progression from previous weekly cycles. It shows the previous activity per specific week and the actual number of contracts worked for each week. It reports the average number of weekdays the contract has been in progress without the receipt of all approved documents from the User Department the average for those in which all approved documents have been received. Ultimately, this section shows the average timeline of contracts, those with pending documents and those with approved documents for the weeks reported.

IV. Monthly Contracts Stat and Savings

This section shows the number of completed contracts for the previous month along with the average cycle time for completion and related savings achieved by PMD.

Procurement KPI

*Procurement process begins upon receipt of fully completed / approved documents, per Procurement Regulation

I. Purchase Order Activity (Monthly)a)

November December January February March Grand TotalAverage

PO'sNovember December January February March Grand Total

Average Lines

Optiflex & Omnicell Activity:

7,117 6,936 6,971 6,299 6,355 33,678 6,736 109,925 108,772 116,229 105,107 105,525 545,558 109,112

Total Buyers & Omnicell:

9,451 9,137 9,639 8,735 9,060 46,022 9,204 121,919 119,810 129,793 117,197 118,940 607,659 121,532

697 9,149

II. Contracting Activity (Weekly) III. Previous Activity# of

ContractsPending

Documents*Approved Documents

4-Apr-13 155 73 337-Mar-13 129 87 4012-Feb-13 140 90 398-Jan-13 110 102 415-Dec-12 128 77 31

27-Nov-12 135 77 335-Nov-12 104 83 33

27 69 27 25-Oct-12 125 75 3122 140 43 10-Oct-12 125 66 4135 66 20 4-Sep-12 129 65 3512 74 50 31-Aug-12 129 65 357 23 155 31-Jul-12 121 66 386 132 76 4-Jul-12 118 62 326 172 0 27-Jun-12 130 56 386 36 2 5-Jun-12 119 57 32

Total: 121 25-May-12 110 60 35Average: 125 73 35

Monthly Average Number of PO's by FTE for March = Monthly Average Number of PO's Lines by FTE for March =

2012 PO Lines 2013 PO Lines2012 PO's 2013

Average # of Weekdays in Process with

# of Projects with Approved Documents*: 43# of Projects Pending Procurement Documents: 78

Average # of Weekdays in Process with

# of Contracts

Pending Documents

*Approved Documents

Current Activity for the Week of 04/04/2013

IV. March 2013 Contracts Completed: 34*Average cycle time for completed projects: 17 daysSavings: $236,531.31

AdministrativeCapital / Support ServicesClinical Support ServicesHospitals (JNMC/JSCH/Holtz)Information TechnologyLong Term Care / Quality / SafetyOR / Surgery / AnesthesiaRevenue Cycle

b)

Procurement KPI Report CardApril 2012 - March 2013

0

20

40

60

Apr2012

May2012

Jun2012

*Jun2012

Jul2012

Aug2012

Sep2012

*Sep2012

Oct2012

Nov2012

Dec2012

Jan2013

Feb2013

Mar2013

43 31

59

42 36

31

58

38 45

12

28 40 38

17

Average cycle time for completed projects

$0 $100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000

Oct 2012

Nov 2012

Dec 2012

Jan 2013

Feb 2013

Mar 2013

$601,692.85

$453,685.15

$677,129.66

$564,577.63

$653,695.16

$236,531.31

Savings

Average Number of Completed Contracts: 24

Average cycle time for completed projects: 36.5 • First six months average was 43 days • Last six months average was 30 days

Total Savings: $3,187,311.76

Key: *Outliers *Average cycle time for completed projects with outliers removed : 33 *June 2012: Central Admixture Pharmacy (CAPS): Sole Source Project was completed in 272 Days Healthcare Appraisers Inc & PST Services Inc: RFP's were completed with an average of 110 Days Eliminating the 3 outliers reduced the average cycle time from 59 to 42 days in June 2012 *Sept 2012: Edwards Lifescience, LLC: Bidwaiver was completed in 238 days Weinbach Group & Alliance One: RFP's were completed with an average of 140 days Eliminating the 3 outliers reduced the average cycle time from 58 to 38 days in September 2012

Procurement process begins upon receipt of fully completed / approved documents, per Procurement Regulation

0

20

40

Apr2012

May2012

Jun2012

Jul 2012 Aug2012

Sep2012

Oct2012

Nov2012

Dec2012

Jan2013

Feb2013

Mar2013

22 23 29 29

22 22 24 24

5

27 25 34

Completed Contracts

Direct Payment as Approved Pursuant to Resolution No. PHT 10/12-078March 1, 2013 to March 31, 2013

Vendor DescriptionCost Code

VPPaid Amount

Akerman Senterfitt and Edison Legal Services: PHT vs. Omega Technology99301

Mark Knight $ 12,521.20

Edgar Consulting Group Consulting and staffing services for JMH Health Plan94420

Brian Dean $ 115,015.41

JL Media Inc Advertisement: Radio Media95714

Matt Pinzur $ 17,172.50

Kresse And Associates, Inc Legal Services: PHT vs. Miami Beach Health care99301

Mark Knight $ 100.50

Miami Parking Authority Parking Administration Services89502

Mark Aprigliano $ 123,111.58

Milyn Enterprises, Inc Consulting services/advisory services for JMH Health Plan's Medicare product line

94420Brian Dean

$ 30,000.00

Patricia Brainerd Marketing Services95714

Matt Pinzur $ 4,240.00

SNF Solutions Consulting/training for Medicare billing eligibility 88700

Kevin Andrews $ 2,000.00

Strategic Management Professional Services99420

Brian Dean $ 101,000.00

Wells Fargo Ins Services USA Insurance consulting services99420

Brian Dean $ 37,500.00

7. Vendor and Contract Performance Monitoring Report

Summary of Annual Evaluation of Vendor Performance

1

JMH(Co 1000)

JSCH(Co 2000)

JNMC(Co 3000)

A to Z 45,315.15$ -$ 10,462.00$ Plumbing Service 5 1A1A 2,128,791.61$ -$ -$ Clerical Services 4.5 2Abbott Laboratories 117,076.41$ 19,560.92$ 9,283.20$ Quantum enteral pumps 3 1Ace Plumbing Supply 48,036.14$ 10,336.00$ 68,762.19$ Plumbing Service/Labor & material 4.5 1Advanced Driver Rehab 10,470.00$ -$ -$ Disable Driver Training 5 1Air compressor Works 21,219.21$ -$ 42,776.91$ Compressor Maintenance 4 1Air Gas South Inc. 57,473.32$ 38.64$ 8,954.52$ Portable Liquid Oxygen 4 1Alexander Perez MD Psychiatric Services 5 1Allied X-Ray 173,200.00$ -$ -$ Imaging Services 5 1Aramark 3,300.00$ -$ -$ Equipment service and maintenance 4.5 4Asco Service 95,433.00$ -$ 5,130.00$ Generator Transfer Switch 1 1Becton Dickinson 148,911.25$ -$ -$ Flow Cytometry Reagents 5 1Bio-Rad 373,497.98$ 40,821.05$ 1,833.36$ Infections Disease Testing 5 1Boiler Repair Services 12,770.30$ -$ 27,672.20$ Boiler Repair 4 1C T Mechanical 752,463.60$ 78,048.75$ -$ Air Condition Service 5 1Camino Cabinet 57,945.00$ -$ -$ Furniture repair 5 1Cardinal Health 39.82$ 100,674.11$ 126,792.59$ Radiopharmaceuticals 5 1Comprehensive Care Services 1,252,607.70$ 28,770.00$ 168,870.00$ Cell Saver 4 1DC Battery 14,156.99$ -$ -$ Generator Battery Service 5 1Follet 56,574.31$ -$ -$ Ice Refrigeration Service 5 1Greater Miami Acutes 6,537,027.00$ Dialysis 4.5 1Habar & Son Plumbing 19,785.34$ -$ -$ Medical Air Service 2.5 1Hill-Rom 34,468.49$ -$ -$ Patient Bed lighting 5 1Idea Com 75,792.29$ 25,000.00$ -$ Nurse Call Service 4.5 1Instrumentation Laboratory 543,108.16$ 7,170.70$ 42,444.64$ Coagulation Equipment & Reagents 5 1J A Sexquer 27,773.16$ 10,000.00$ -$ Plumbing Services 2.5 1J.P. Moran 500,000.00$ Electrical Power Services 4 1Johnson & Johnson 173,586.45$ 677.97$ -$ Equipment service and maintenance 5 2Johnstone 2,682.61$ -$ -$ A/C Supply 4.5 1Kratos Public Safety Security 272,476.78$ -$ -$ Security Services 4.5 1Lawson Supply 8,069.62$ -$ 3,742.67$ Hardware Supply 4.5 1Lego Construction 198,586.33$ -$ -$ Construction Services 5 1M.S.C. Industrial Direct 7,480.21$ 33,500.00$ 23,810.26$ Hardware Supply 4 1Manuel Garcia MD Psychiatric Services 5 1Matheson Tri-Gas 8,556.04$ -$ -$ Bulk Liquid Oxygen 3 1

Maxor 1,552,027.00$ Management for Ambulatory Pharmacy Service

5 1

Med-Pass 2,817.75$ -$ -$ Pharmacy Forms 5 1MedRad 277,650.78$ 20,062.66$ 87,129.88$ Generator Parts & Service 4 1Merrick Horn MD Podiatry Services 5 1Mezey & Karaison -$ 100,500.00$ Respiratory Services 5 1Mobile Quality Diagnostic 11,657.60$ -$ -$ Portable X-Ray Services 4 1MTS Label System Medication Tech 800.93$ Pharmacy Labels 4 1One Blood 14,216,101.00$ Blood Product Provider 5 1Pet Net Pharmaceuticals 243,661.95$ Radiopharmaceuticals 5 1PGC Mechanical 32,000.00$ -$ -$ Plumbing Steam 4.5 1Physician Health Center 12,550.00$ -$ -$ Medicaid review Officer 4 1Plusco 173,598.26$ 15,000.00$ 73,620.82$ Plumbing, Misc, Supply 1 1Premier 109,934.81$ 4,350.00$ 1,692.00$ Air Condition Service 5 1ProCare LMS Inc. 29,424.00$ -$ -$ Therapeutic Bed Care/Mattresses 4 1Pulmonary Health Network 2,522,880.00$ -$ -$ Respiratory Staffing Service 4 1Quest Lab 1,000,000.00$ 245,112.43$ 250,000.00$ Lab Service 5 1Rad Medical Inc. 76,800.00$ -$ -$ Transportation Services 5 1Roche Diagnostic 1,498,377.33$ 1,980.44$ 87.80$ Chemistry Analyzers 4.5 1Schindler Elevator 568.08$ -$ -$ Elevator Maintenance 5 1Sea Coast Fire 35,446.20$ 380.00$ -$ Fire Extinguisher Service 1.5 1Seico Building Contractor 60,403.00$ 15,450.00$ 68,372.00$ Construction Services 4.5 1Siemens 1,049,831.95$ 391,296.86$ 66,667.72$ Immunoglobulin Quantitation 5 2

# formsEstimated Annual Expense

Contracted Organization/Vendor Description Rating


2

JMH(Co 1000)

JSCH(Co 2000)

JNMC(Co 3000)



Siemens Medical Solutions 37,201.00$ -$ -$ Service Medical Equipment 4.5 1Silvia Silva Duluc MD Psychiatric Services 5 1Sodexo Inc. 9,200,000.00$ -$ -$ Dietary Management 2 1Steris 42,133.18$ -$ -$ Autoclave Sterilizer Repair 1 1Teruno BCT 141,329.93$ -$ -$ Therapeutic aphaeresis sets 4.5 1UMS West Florida Lithotripsy -$ 67,850.00$ -$ Electro Shock Wave Lithrotripsy 4 1University of Miami Pathology Services 5 1Walgreens 5,279.13$ -$ -$ Pharmacy Provider 5 1

Total Spend: 46,111,148.15$ 1,216,580.53$ 1,088,104.76$ Average Rating: 4.2Total Contracts: 65Total Evaluation Forms: 71

Total Estimated Annual Expense: 48,415,833.44$

Vendor Name Services Provided Rating Estimated Annual ExpenseHabar & Son Plumbing Medical Air Service 2.5 $ 19,785.34 J A Sexquer Plumbing Services 2.5 $ 37,773.16 Sodexo Inc. Dietary Management 2 $ 9,200,000.00 Sea Coast Fire Fire Extinguisher Service 1.5 $ 35,826.20 Asco Service Generator Transfer Switch 1 $ 100,563.00 Plusco Plumbing, Misc, Supply 1 $ 262,219.08 Steris Autoclave Sterilizer Repair 1 $ 42,133.18

$ 9,698,299.96

Contracts rated 2.5 and lower represent 20.3% of the total estimated expense on this report. The largest contracted vendor is Sodexho which is under review. Removing the $9.2 million that's associated with Sodexho makes this category of Fair/Poor only 1% of total spend that was evaluated

Vendor Contract Rating SummaryEvaluation Contractor Performance

Related to Patient Care, Safety, and Environment of CareJanuary 2013

Key Rating CountExcellent

(45%)5 32

4.5 174 13

Satisfactory(2.8%)

3 2

2.5 22 1

1.5 11 3

Total: 712.5 and Under:

Vendor Name Services Provided RatingHabar & Son Plumbing Medical Air Service 2.5J A Sexquer Plumbing Services 2.5Sodexo Inc. Dietary Management 2Sea Coast Fire Fire Extinguisher Service 1.5Asco Service Generator Transfer Switch 1Plusco Plumbing, Misc, Supply 1Steris Autoclave Sterilizer Repair 1

In January 2013, The Procurement Management Department distributed surveys to members of the JHS Management Leadership Team to measure their satisfaction with contractor performance related to patient care, safety and environment of care.

As part of the survey, leaders were asked to assess the appropriateness, timeliness, safety and overall quality of services provided through contractual agreements.

Seventy one contracts were reviewed for January 2013. Summary of ratings is as follows: 45% were rated 'Excellent', 42.2% 'Good', 2.8% 'Satisfactory', 4.2% 'Fair' and 5.6% 'Poor', requiring immediate resolution.

Policy Code No. 248B Contract Management Regulation establishes policy and procedures to ensure accountability and consistency in the contract management and compliance process for all Jackson Health System Contracts.

Vendor Performance Monitoring takes place routinely and effectively for every contract to ensure the vendor performs satisfactorily and delivers goods and services as and when required under the contract. During this evaluation period 90% of the contracts reviewed were found to be performing satisfactory or better.

Good(42.2%)

Fair(4.2%)Poor

(5.6%)


1

JMH(Co 1000)

JSCH(Co 2000)

JNMC(Co 3000)

A to Z 45,315.15$ -$ 10,462.00$ Plumbing Service 5 1A1A 2,128,791.61$ -$ -$ Clerical Services 4.5 2Abbott Laboratories 117,076.41$ 19,560.92$ 9,283.20$ Quantum enteral pumps 3 1Ace Plumbing Supply 48,036.14$ 10,336.00$ 68,762.19$ Plumbing Service/Labor & material 4.5 1Advanced Driver Rehab 10,470.00$ -$ -$ Disable Driver Training 5 1Air compressor Works 21,219.21$ -$ 42,776.91$ Compressor Maintenance 4 1Air Gas South Inc. 57,473.32$ 38.64$ 8,954.52$ Portable Liquid Oxygen 4 1Alexander Perez MD Psychiatric Services 5 1Allied X-Ray 173,200.00$ -$ -$ Imaging Services 5 1Aramark 3,300.00$ -$ -$ Equipment service and maintenance 4.5 4Asco Service 95,433.00$ -$ 5,130.00$ Generator Transfer Switch 1 1Becton Dickinson 148,911.25$ -$ -$ Flow Cytometry Reagents 5 1Bio-Rad 373,497.98$ 40,821.05$ 1,833.36$ Infections Disease Testing 5 1Boiler Repair Services 12,770.30$ -$ 27,672.20$ Boiler Repair 4 1C T Mechanical 752,463.60$ 78,048.75$ -$ Air Condition Service 5 1Camino Cabinet 57,945.00$ -$ -$ Furniture repair 5 1Cardinal Health 39.82$ 100,674.11$ 126,792.59$ Radiopharmaceuticals 5 1Comprehensive Care Services 1,252,607.70$ 28,770.00$ 168,870.00$ Cell Saver 4 1DC Battery 14,156.99$ -$ -$ Generator Battery Service 5 1Follet 56,574.31$ -$ -$ Ice Refrigeration Service 5 1Greater Miami Acutes 6,537,027.00$ Dialysis 4.5 1Habar & Son Plumbing 19,785.34$ -$ -$ Medical Air Service 2.5 1Hill-Rom 34,468.49$ -$ -$ Patient Bed lighting 5 1Idea Com 75,792.29$ 25,000.00$ -$ Nurse Call Service 4.5 1Instrumentation Laboratory 543,108.16$ 7,170.70$ 42,444.64$ Coagulation Equipment & Reagents 5 1J A Sexquer 27,773.16$ 10,000.00$ -$ Plumbing Services 2.5 1J.P. Moran 500,000.00$ Electrical Power Services 4 1Johnson & Johnson 173,586.45$ 677.97$ -$ Equipment service and maintenance 5 2Johnstone 2,682.61$ -$ -$ A/C Supply 4.5 1Kratos Public Safety Security 272,476.78$ -$ -$ Security Services 4.5 1Lawson Supply 8,069.62$ -$ 3,742.67$ Hardware Supply 4.5 1Lego Construction 198,586.33$ -$ -$ Construction Services 5 1M.S.C. Industrial Direct 7,480.21$ 33,500.00$ 23,810.26$ Hardware Supply 4 1Manuel Garcia MD Psychiatric Services 5 1Matheson Tri-Gas 8,556.04$ -$ -$ Bulk Liquid Oxygen 3 1

Maxor 1,552,027.00$ Management for Ambulatory Pharmacy Service

5 1

Med-Pass 2,817.75$ -$ -$ Pharmacy Forms 5 1MedRad 277,650.78$ 20,062.66$ 87,129.88$ Generator Parts & Service 4 1Merrick Horn MD Podiatry Services 5 1Mezey & Karaison -$ 100,500.00$ Respiratory Services 5 1Mobile Quality Diagnostic 11,657.60$ -$ -$ Portable X-Ray Services 4 1MTS Label System Medication Tech 800.93$ Pharmacy Labels 4 1One Blood 14,216,101.00$ Blood Product Provider 5 1Pet Net Pharmaceuticals 243,661.95$ Radiopharmaceuticals 5 1PGC Mechanical 32,000.00$ -$ -$ Plumbing Steam 4.5 1Physician Health Center 12,550.00$ -$ -$ Medicaid review Officer 4 1Plusco 173,598.26$ 15,000.00$ 73,620.82$ Plumbing, Misc, Supply 1 1Premier 109,934.81$ 4,350.00$ 1,692.00$ Air Condition Service 5 1ProCare LMS Inc. 29,424.00$ -$ -$ Therapeutic Bed Care/Mattresses 4 1Pulmonary Health Network 2,522,880.00$ -$ -$ Respiratory Staffing Service 4 1Quest Lab 1,000,000.00$ 245,112.43$ 250,000.00$ Lab Service 5 1Rad Medical Inc. 76,800.00$ -$ -$ Transportation Services 5 1Roche Diagnostic 1,498,377.33$ 1,980.44$ 87.80$ Chemistry Analyzers 4.5 1Schindler Elevator 568.08$ -$ -$ Elevator Maintenance 5 1Sea Coast Fire 35,446.20$ 380.00$ -$ Fire Extinguisher Service 1.5 1Seico Building Contractor 60,403.00$ 15,450.00$ 68,372.00$ Construction Services 4.5 1Siemens 1,049,831.95$ 391,296.86$ 66,667.72$ Immunoglobulin Quantitation 5 2




2

JMH(Co 1000)

JSCH(Co 2000)

JNMC(Co 3000)



Siemens Medical Solutions 37,201.00$ -$ -$ Service Medical Equipment 4.5 1Silvia Silva Duluc MD Psychiatric Services 5 1Sodexo Inc. 9,200,000.00$ -$ -$ Dietary Management 2 1Steris 42,133.18$ -$ -$ Autoclave Sterilizer Repair 1 1Teruno BCT 141,329.93$ -$ -$ Therapeutic aphaeresis sets 4.5 1UMS West Florida Lithotripsy -$ 67,850.00$ -$ Electro Shock Wave Lithrotripsy 4 1University of Miami Pathology Services 5 1Walgreens 5,279.13$ -$ -$ Pharmacy Provider 5 1

Total Spend: 46,111,148.15$ 1,216,580.53$ 1,088,104.76$ Average Rating: 4.2Total Contracts: 65Total Evaluation Forms: 71

Total Estimated Annual Expense: 48,415,833.44$

Vendor Name Services Provided Rating Estimated Annual ExpenseHabar & Son Plumbing Medical Air Service 2.5 $ 19,785.34 J A Sexquer Plumbing Services 2.5 $ 37,773.16 Sodexo Inc. Dietary Management 2 $ 9,200,000.00 Sea Coast Fire Fire Extinguisher Service 1.5 $ 35,826.20 Asco Service Generator Transfer Switch 1 $ 100,563.00 Plusco Plumbing, Misc, Supply 1 $ 262,219.08 Steris Autoclave Sterilizer Repair 1 $ 42,133.18

$ 9,698,299.96

Contracts rated 2.5 and lower represent 20.3% of the total estimated expense on this report. The largest contracted vendor is Sodexho which is under review. Removing the $9.2 million that's associated with Sodexho makes this category of Fair/Poor only 1% of total spend that was evaluated

8. Financial and Budget Tracking Status Report as of February 2013

FINANCIAL & BUDGET TRACKING STATUS REPORT FEBRUARY 2013 Capital Contribution (aka funded depreciation): The FY 2013 budget programs $20 million of expenditure to occur during the year for all Capital items funded with Capital Contribution. For the current month end FY 2013 active projects total $29.7 million. Of this amount, $4.1 million was spent in prior years leaving just over $25.6 million to be spent. Of that $15.6 million is expected to be spent this year with $558,506 spent in so far in FY 2013. Foundation: Active Foundation funded projects continue this year totaling $3 million of prior and current year funding commitments. The bulk of the project dollars are represented by the Holtz Pathology Lab Renovation at $2 million. $25,908 was spent in the current month on all projects with additional $905,143 left to spend. County GOB: Included in the report was a summary of active Building Better Communities General Obligation Bond funded projects which continue with an all years’ budget of $57 million. Prior years’ spending on these projects including Jackson South Community Hospital (JSCH) totals $33 million with $24 million left to spend. Series 2005 Revenue Bonds: Active Series 2005 projects total $13.7 million of which $4.9 million was spent in prior years leaving $8.8 million to spend this year. All of the funding is programmed and forecast to be spent by the end of the fiscal year. $183,377 was spent in the current month with the bulk of the spending made on the JNMC helistop relocation. Series 2009 Revenue Bonds: Active Series 2009 projects total $51.0 million of which $21.6 million was spent in prior years leaving $29.4 million left to spend. Of that amount, $204,168 was spent in the current month with the bulk of the spending made on the Oil Switch Replacement. Trust Funds and Grants: The active budgets total $7.4 million with most of this resource represented by the ongoing Ryder Trauma Center Hardening project. Life to date spending as of the current month is $648,000 with an additional $6.8 million left to spend.

of 6

Original Total Total Project V.P.# of NEW Project Budget Project Approval Fund. Project Project Exec. Total YTD Life to Date Amount left Proj. Proj.# Activity# Project Name Budget Changes Budget Date Source Manager Manager Spons. Feb.13 Feb.13 thru Feb.13 to Spend

MULTIFUNDING SOURCE PROJECTS

1 C P-00632 52005003 J.South Community Hptal 102,425,000 100,000 102,525,000 CO Aug-05 Multi Clark JMH Garcia (386) (153,608) 100,776,635 1,748,365

2 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 583,669 834,596 CN May-09 Multi Arnaldo JMH Contreras - 5,433 588,227 246,369

3 L P-00836 51007017 Rehab Building Renovation 16,670,411 (111,864) 16,558,547 HOLD Sep-07 Multi Frank JMH Contreras - - 158,547 16,400,000

4 M P-00904 51008026 C-4 Cath Lab #6 2,833,500 196,500 3,030,000 HOLD Jul-08 Multi Alana JMH Contreras - 995 103,272 2,926,728

5 O P-00566 51001001 Elevator Modernization 3,000,000 253,043 3,253,043 CN May-01 Multi Frank JMH Burghart - 15,797 2,188,067 1,064,976

6 R P-00763 59007009 JMT Elevator Modern#141-146 1,057,183 243,574 1,300,757 CN Jul-07 Multi Frank JMH Valdes 2,746 (139,789) 1,066,308 234,449

7 S P-00827 53008015 Jack.No Elevators 1 & 2 490,050 (431,070) 58,980 DEF Feb-08 Multi TBD JMH Sears - - 58,980 -

8 T P-00834 51008016 ADA Compl.#Pkg1 Restrooms 991,763 692,000 1,683,763 CN Oct-07 Multi Arnaldo JMH Valdes 6,612 286,562 1,041,779 641,984

9 U P-00854 53008020 Jack.No. Window Replacement 2,057,220 1,088,750 3,145,970 CN Jan-08 Multi Arnaldo JMH Sears - 165,473 2,985,386 160,584

10 V P-00606 59004002 JMT Elevators Moderniz. 931,591 (30,291) 901,300 D May-04 Multi Frank JMH Valdes (2,756) 188,015 267,982 633,318

11 Y 51011105 Ryder Trauma Ext. Hardening 8,589,588 1,511,031 10,100,619 D Dec-10 Multi Clark JMH Valdes (12,186) (11,656) 613,078 9,487,541

12 AB PIP 31009002 Telecommunication 8,188,100 1,765,000 9,953,100 PIP Aug.09 Multi Overton JMH Garcia (118,242) 55,577 9,293,701 659,399

13 AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 - 7,350,000 D Sep-09 Multi Douglas JMH Valdes 84,471 222,649 598,607 6,751,393

14 AD 51012109 DTC-1 Linear Accelerator Relo 692,228 - 692,228 D Sep-12 Multi Alana JMH Contreras - 73 73 692,156

15 AE 52013100 Jackson South 2nd Cath Lab 692,307 - 692,307 D Oct-12 Multi Frank JMH Garcia - - - 692,307

16 AF 53012105 Jackson No.Helistop Reloc 82,841 917,159 1,000,000 D Jul-12 Multi Arnaldo JMH Sears 71,939 177,106 179,118 820,882

17 AG P-00996 53009088 JNMC Emer.Switchgear 1,650,000 5,700,000 7,350,000 D Sep-09 Multi Douglas JMH Sears 2,750 13,038 85,446 7,264,554

18 AH P-00978 51009072 Fire Sprinkler Upgrade Campus 2,000,000 316,000 2,316,000 D Sep-09 Multi Scott JMH Valdes - - 254,225 2,061,775

19 AI 51010100 CampusW Underg Utilities - 4,930,022 4,930,022 CO Jul-10 Multi Clark Heery Valdes 13,023 746,117 3,214,532 1,715,490

Total Mutifunding Source 159,952,709 17,723,523 177,676,232 47,969 1,571,782 123,473,962 54,202,270

CAPITAL CONTRIBUTION PROJECTS

1 O P-00566 51001001 Elevator Modernization 1,608,153 - 1,608,153 CN May-01 CC Frank JMH Burghart - - 1,608,153 (0)

2 P-00724 51007008 Kitchen Equipment Modification 79,485 - 79,485 DEF Nov-06 CC TBD JMH Valdes - - 79,485 (0)

3 T P-00834 51008016 ADA Compliance Package#1 378,757 - 378,757 CN Oct-07 CC Arnaldo JMH Valdes - - 378,757 -

4 AH P-00978 51009072 Fire Sprinkler Upgrade Campus - 316,000 316,000 D Sep-09 CC Scott JMH Valdes - - - 316,000

5 AC P-00997 51009089 4160 Volt Oil Switch Repl - 3,065,000 3,065,000 D Sep-09 CC Douglas JMH Valdes - - - 3,065,000

6 AI 51010100 CampusW Underg Utilities - 1,730,022 1,730,022 CO Jul-10 CC Clark Heery Valdes 13,023 14,532 14,532 1,715,490

7 51011100 Highland Prof.Financ.Assessm 740,000 - 740,000 D Oct-10 CC Clark JMH Contreras 2,100 19,697 317,015 422,985

8 51011104 WW-15 Nursing Unit Moder 2,588,568 - 2,588,568 D Dec-10 CC Clark JMH Contreras 11,266 183,515 2,405,053

9 Y 51011105 Ryder Trauma Ext Hardening 2,147,397 1,511,031 3,658,428 D Dec-10 CC Clark JMH Valdes (3,047) (2,914) 153,269 3,505,159

10 51011106 Highland Prof.6thFl Transplant 542,625 (150,000) 392,625 CO Dec-10 CC Frank JMH Contreras 224,184 266,629 125,996

11 51011112 DTC PET Scan 2,467,000 (560,790) 1,906,210 CN Jan-11 CC Alana JMH Contreras - 1,896,600 9,610

12 51012100 Human Resources Relocation 300,000 - 300,000 CN Dec-11 CC Lourdes JMH Hout-Barriento 2,200 62,594 248,134 51,866

BUDGET TRACKING REPORT FY 2013BY FUNDING SOURCE

Stat

us

Actuals FY13

of 6



Stat

us

Actuals FY13

13 51012106 Inst.Anne-5 Physician Svces 31,350 - 31,350 CO Jul-12 CC Diaz JMH Andrews 2,374 23,735 7,615

14 AD 51012109 DTC-1 Linear Accelerator Rel 213,328 - 213,328 D Sep-12 CC Alana JMH Contreras - - 213,328

15 51013101 JMH Utility Ctr Wall Enclosure 62,805 15,000 77,805 D Dec.12 CC Scott JMH Camero 2,000 2,000 75,805

16 51013103 PPW Installation 2 300K UPS 405,000 - 405,000 D Jan.13 CC Aponte JMH Mike Garcia - - 405,000

17 51013104 ET-1 Admitting Modernization 532,203 - 532,203 D Jan.13 CC Aponte JMH Pla - - 532,203

NEW 51013108 T-4 Rehab 15 Beds 308,902 - 308,902 D Mar.13 CC Frank JMH Contreras - - 308,902

NEW 51013109 WW-7 Modernizat.Neurological 1,357,904 - 1,357,904 D Mar.13 CC Armaldo JMH Marta Garcia - - 1,357,904

20 C P-00632 52005003 J.South Community Hptal(661) 82,254 - 82,254 CO Aug-06 CC Clark JMH Garcia - 82,254 -

21 52012104 Jackson South Helistop 137,101 1,321,971 1,459,072 D Jul-12 CC Clark JMH Garcia 25,326 139,542 144,329 1,314,743

22 AE 52013100 Jackson South 2nd Cath Lab 492,307 - 492,307 D Oct-12 CC Frank JMH Garcia - - 492,307

23 52013102 JSCH Behav.Health Stairwell#1 66,000 (15,000) 51,000 D Dec.12 CC Aponte JMH Garcia - - 51,000

24 S P-00827 53008015 Jack.No Elevators 1 & 2 52,317 - 52,317 DEF Feb-08 CC TBD JMH Sears - 52,317 -

25 U P-00854 53008020 Jack.No. Window Replacement 85,608 - 85,608 CN Jan-08 CC Arnaldo JMH Sears - 85,608 -

26 AG P-00996 53009088 JNMC Emer.Switchgear - 5,605,000 5,605,000 D Sep-09 CC Douglas JMH Sears - - 5,605,000

27 AF 53012105 Jackson No.Helistop Reloc 82,841 601,159 684,000 D Jul-12 CC Arnaldo JMH Sears - - 684,000

28 53012108 JNMC Cardio Cath Lab Repl 1,170,431 - 1,170,431 D Sep-12 CC Arnaldo JMH Sears 29,450 29,565 29,565 1,140,866

NEW 53013105 JNMC Kitchen Hood Replacem 239,800 - 239,800 D Feb.13 CC Scott JMH Sears - - 239,800

30 P-00655 56006004 JNCMHC Emerg. Generator 17,470 - 17,470 DEF Jul-06 CC Camero JMH Valdes - 17,470 -

31 V P-00606 59004002 JMT Elevators Moderniz. 23,713 - 23,713 D May-04 CC Frank JMH Valdes - 23,713 -

32 R P-00763 59007009 JMT Elevator Modern#141-146 24,135 - 24,135 CN Jul-07 CC Frank JMH Valdes - 24,135 -

33 59012110 PPE Main Corridor Moderniz 152,222 - 152,222 D Sep-12 CC Frank JMH Valdes 90 90 90 152,132

NEW 59013107 JMT West 8 & 14 Fl Mold Remed 105,600 - 105,600 D Mar.13 CC Scott JMH Valdes - - 105,600

NEW 59013110 JMT Apartm Mold Remediation 122,650 - 122,650 D Mar.13 CC Scott JMH Valdes - - - 122,650

36 AB PIP 31009002 Telecommunication 2,000,000 - 2,000,000 PIP Aug.09 CC Overton JMH Garcia (118,242) 55,577 1,340,601 659,399

18,617,926 13,439,393 32,057,319 (49,100) 558,506 6,971,908 25,085,412

CAPITAL CONTRIBUTION

CLOSED PROJECT FY 2012-2013

- - - - - - -

36 SUB TOTAL CAPITAL CONTRIBUTION PROJECTS 18,617,926 13,439,393 32,057,319 (49,100) 558,506 6,971,908 25,085,412

Total Capital Contribution

Total Closed Capital Contribution

of 6



Stat

us

Actuals FY13

FOUNDATION

1 P-00659 51006005 Holtz-2 Pathology Renovat 2,000,000 54,350 2,054,350 CO Jul-06 F Frank JMH Contreras (600) 85,894 1,964,871 89,479

2 51011117 DTC-1 Taylor Breast Ctr Reno 276,000 366,780 642,780 D Jul-11 F Alana JMH Contreras - 25,037 36,174 606,606

3 51011118 C-5 NICU Intermed.Modern 100,000 200,000 300,000 D Aug-11 F Alana JMH Burghart 26,508 87,755 90,942 209,058

2,376,000 621,130 2,997,130 25,908 198,686 2,091,988 905,143

GOB GENERAL OBLIGATION BONDS

1 L P-00836 51007017 Rehab Building Renovation 16,400,000 16,400,000 HOLD Sep-07 GOB JS Frank JMH Contreras - - 16,400,000

2 P-00867 51008024 Campus Wide Pneumatic Tube Syste 3,629,400 46,706 3,676,106 CN Apr-08 GOB ED Scott JMH Valdes (17,993) (39,361) 1,639,676 2,036,430

3 M P-00904 51008026 C-4 Cath Lab # 6 2,833,500 86,645 2,920,145 HOLD Jul-08 GOB ED Alana JMH Contreras - - 2,920,145

4 P-00928 51008032 ET- 1 Ortho Suite & ERA 1,706,000 700,000 2,406,000 CN Sep-08 GOB ED Frank JMH Contreras 14 1,359,952 1,046,048

C P-00632 52005003 J.South Community Hptal 52,000,000 - 52,000,000 CO Aug-05 GOB JS Clark JMH Garcia (386) (153,608) 29,990,819 22,009,181

C P-00632 52005003 J.South Community Hptal (20,260,817) (20,260,817) CO Aug-05 GOB JS Clark JMH Garcia - - (20,260,817)

60,168,900 (3,027,466) 57,141,434 (18,380) (192,955) 32,990,448 24,150,986

2005 REVENUE BOND

L P-00836 51007017 Rehab Building Renovation 16,670,411 (111,864) 16,558,547 HOLD Sep-07 RB REH Frank JMH Contreras - 158,547 16,400,000

L P-00836 51007017 Rehab Building Renovation (16,400,000) (16,400,000) HOLD Sep-07 RB REH Frank JMH Contreras - - (16,400,000)

M P-00904 51008026 C-4 Cath Lab # 6 109,855 109,855 HOLD Jul-08 IRB INTER Alana JMH Contreras 995 103,272 6,583

1 P-00932 51009033 HCH ET-5 Intake, ET-7 BMT Ph.I 1,758,649 (141,649) 1,617,000 CO Dec-08 RB PEDI Alana JMH Burghart 100 1,520,550 96,450

2 P-00947 51009044 ET-5 Adolescen Unit 1,236,193 (167,000) 1,069,193 D May-09 RB REH Alana JMH Burghart 6,229 592,459 764,886 304,307

3 J P-00949 51009046 WW-B Pharmacy Phase I 250,927 470,000 720,927 CN May-09 RB ACU Arnaldo JMH Contreras 5,433 588,227 132,700

J P-00949 51009046 WW-B Pharmacy Phase I - 113,669 113,669 CN May-09 IRB INTER Arnaldo JMH Contreras - - 113,669

4 P-00959 51009054 ET-4 LDOR Fetal Surg.OR's 2,083,950 - 2,083,950 D May-09 RB PEDI Alana JMH Burghart 9,750 9,750 411,603 1,672,347

5 51010096 WW-2 Angio Suite 2,000,000 2,000,000 D May-10 RB PEDI Alana JMH Contreras 4,806 6,806 1,328,286 671,714

6 51010097 DTC new MRI 2,500,000 2,500,000 CN May-10 RB PEDI Alana JMH Contreras 21,369 2,162,486 2,379,893 120,107

7 51011116 C-4 Cath Lab #5 454,000 - 454,000 CN Apr.11 RB INTER Alana JMH Contreras 1,307 300,697 368,357 85,643

8 51012101 WW-6 Modernization 1,553,000 - 1,553,000 CN Feb.12 RB INTER Arnaldo JMH Contreras 65,977 149,917 196,896 1,356,104

9 51012102 SW-6 Modernization 482,320 (349,000) 133,320 CO Feb.12 RB INTER Alana JMH Contreras 38,233 130,905 2,415

C P-00632 52005003 J.South Community Hptal 50,000,000 - 50,000,000 CO Aug-05 RB JS Clark JMH Garcia - 50,000,000 (0)

C P-00632 52005003 J.South Community Hptal 16,400,000 16,400,000 CO Aug-05 RB REH Clark JMH Garcia - 16,400,000 (0)

Total Foundation

Total GOB Bonds

of 6



Stat

us

Actuals FY13

C P-00632 52005003 J.South Community Hptal 210,817 210,817 CO Aug-05 RB ACU Clark JMH Garcia - 210,817 -

C P-00632 52005003 J.South Community Hptal 3,650,000 3,650,000 CO Aug-05 RB INTER Clark JMH Garcia - 3,650,000 0

C P-00632 52005003 J South Community Hptal 100,000 100,000 CO Aug-05 RB INTER Clark JMH Garcia - 100,000 -

AE 52013100 Jackson South 2nd Cath Lab 200,000 - 200,000 D Oct-12 RB Frank JMH Garcia - - 200,000

10 53010091 JN Pharmacy Clean Room - 361,000 361,000 CO Jan-10 RB INTER Arnaldo JMH Sears 8,167 348,493 12,507

AF 53012105 Jackson No.Helistop Reloc - 316,000 316,000 D Jul-12 RB Arnaldo JMH Sears 71,939 177,106 179,118 136,882

11 53012107 J.No. AHU Replacement 258,000 - 258,000 D Jul.12 RB Scott JMH Sears 2,000 5,439 5,494 252,506

12 PIP 31012001 Xcelera Enterprise Solution 150,000 - 150,000 D Feb.12 RB INTER Fuentes JMH Garcia - - 150,000

75,097,450 9,061,828 84,159,278 183,377 3,457,589 78,845,344 5,313,934

2009 INFRASTRUCTURE BOND

O P-00566 51001001 Elevator Modernization 1,391,847 253,043 1,644,890 CN May-01 IRB Frank JMH Burghart 15,797 579,913 1,064,977

T P-00834 51008016 ADA Compliance Package#1 613,006 692,000 1,305,006 CN Oct-07 IRB Arnaldo JMH Valdes 6,612 286,562 663,022 641,984

1 P-00938 51009036 WW Fire Alarm 2,000,000 350,000 2,350,000 CO Apr-09 IRB Douglas JMH Valdes 2,641 1,938,509 411,491

2 P-00958 51009053 ET A/C Repl177-180,181Inst 2,653,370 465,710 3,119,080 CO Sep-09 IRB Frank JMH Valdes 1,681 1,781 3,071,541 47,539

3 P-00961 51009056 Replace Paralleling Gear 4,361,250 928,122 5,289,372 D Sep-09 IRB Douglas JMH Valdes 11,352 199,416 681,945 4,607,427

4 P-00962 51009057 Utility Ctr-2 Emerg.Generat 2,135,000 123,215 2,258,215 CO Sep-09 IRB Douglas JMH Valdes 9,479 2,211,903 46,312

5 P-00967 51009062 Fire Alarm Upgrade Campus 4,815,000 (385,505) 4,429,495 CN Sep-09 IRB Douglas JMH Valdes (250) 386,464 684,256 3,745,239

6 P-00969 51009064 DTC,T,Rehab,WW&ACC-W AHU Rep 6,541,500 - 6,541,500 CN Sep-09 IRB Scott JMH Valdes 285 176,271 3,159,374 3,382,126

7 P-00974 51009069 Campus Wide Roofing Repl. 1,500,000 - 1,500,000 D Sep-09 IRB Scott JMH Valdes 15,285 393,705 1,106,295

AH P-00978 51009072 Fire Sprinkler Upgrade Campus 2,000,000 - 2,000,000 D Sep-09 IRB Scott JMH Valdes - 254,225 1,745,775

8 P-00982 51009076 UC Emerg.Well Boilers 2,331,000 350,325 2,681,325 CO Sep-09 IRB Clark JMH Valdes 133,317 2,657,737 23,588

9 P-00992 51009084 BackFl.&Byp.DomWater 250,000 117,000 367,000 D Sep-09 IRB Frank JMH Valdes - 7,863 359,137

AC P-00997 51009089 4160 Volt Oil Switch Repl 7,350,000 (3,065,000) 4,285,000 D Sep-09 IRB Douglas JMH Valdes 84,471 222,649 598,607 3,686,393

10 51010099 Concrete Struct Tank Farm - 100,000 100,000 CO Jun-10 IRB Arnaldo JMH Valdes 25,040 55,839 44,161

AI 51010100 CampusW Underg Utilities - 3,200,000 3,200,000 CO Jul-10 IRB Clark Heery Valdes 731,586 3,200,000 -

11 51011113 Reduction of NAP Utilization 300,000 394,769 694,769 D Apr-11 IRB Frank JMH Garcia 31,917 458,487 236,282

AD 51012109 DTC-1 Linear Accelerator Relo 478,900 - 478,900 D Sep-12 IRB Alana JMH Contreras 73 73 478,828

C P-00632 52005003 J.South Community Hptal (661) 342,746 - 342,746 CO Aug-06 IRB Clark JMH Garcia - 342,746 -

U P-00854 53008020 Jack.No. Window Replacement 1,971,612 1,088,750 3,060,362 CN Jan-08 IRB Arnaldo JMH Sears 165,473 2,899,778 160,584

12 P-00960 53009055 Main/JNMC-outside. lights 922,500 (141,820) 780,680 CN Sep-09 IRB Arnaldo JMH Valdes - 140,691 639,989

13 P-00970 53009065 JNMC Hot Water/Boiler/Chiller 630,000 2,731,272 3,361,272 CN Sep-09 IRB Scott JMH Sears 48,300 154,822 1,913,451 1,447,821

14 P-00972 53009067 JNMC Remaining Roof 527,383 (427,071) 100,312 D Sep-09 IRB Scott JMH Sears 41,001 42,776 42,776 57,536

15 P-00989 53009081 JNMC ICU Commode Rep 52,500 400,000 452,500 CO Sep-09 IRB Arnaldo JMH Sears - 447,232 5,268

AG P-00996 53009088 JNMC Emer.Switchgear 1,650,000 95,000 1,745,000 D Sep-09 IRB Douglas JMH Sears 2,750 13,038 85,446 1,659,554

Total 2005 Revenue Bond

of 6



Stat

us

Actuals FY13

16 53010101 JNMC 40 Year Certification - 185,000 185,000 D Jul-10 IRB Scott JMH Valdes 7,976 13,153 78,513 106,487

V P-00606 59004002 JMT Elevators Moderniz. 907,878 (30,291) 877,587 D May-04 IRB Frank JMH Valdes (2,756) 188,015 244,269 633,318

R P-00763 59007009 JMT Elevator Modern#141-146 1,033,048 243,574 1,276,622 CN Jul-07 IRB Frank JMH Valdes 2,746 (139,789) 1,042,173 234,449

AB PIP 31009002 Telecommunication 6,000,000 1,765,000 7,765,000 PIP Aug.09 IRB Overton JMH Garcia - 7,765,000 -

52,758,540 9,433,093 62,191,633 204,168 2,675,765 35,619,074 26,572,559

2009 INFRASTRUCTURE REVENUE BOND DEFERRED PROJECTS

1 P-00981 51009075 WW & C AHU Repl (14) 1,995,000 (1,899,074) 95,926 DEF Sep-09 IRB TBD JMH Valdes - 95,926 (0)

S P-00827 53008015 Jack.No Elevators 1 & 2 437,733 (431,070) 6,663 DEF Feb-08 IRB TBD JMH Sears - 6,663 -

2,432,733 (2,330,144) 102,589 - - 102,589 (0)

TRUST FUND / GRANTS

AB PIP 31009002 Telecommunication 188,100 - 188,100 PIP Aug.09 TF Overton JMH Garcia - 188,100 -

NEW 51013106 Trauma-1 Conf Room T-121 167,182 - 167,182 D Mar.13 Red Light Frank JMH Janice G - - 167,182

1

355,282 - 355,282 - - 188,100 167,182

FEMA Grants

IN CONSTRUCTION

Y 51011105 Ryder Trauma Ext Hardening 6,442,191 - 6,442,191 D Dec-10 FEMA Clark JMH Valdes (9,140) (8,742) 459,808 5,982,383

1 56012103 Jefferson Reaves Wind Retro 601,281 - 601,281 D Mar.12 FEMA Arnaldo JMH Valdes - 140 601,141

7,043,472 - 7,043,472 (9,140) (8,742) 459,948 6,583,524

ALL OTHER FUNDING SOURCES

Closed/Cancelled and Partially Capitalized FY 11-12

51010098 Above Ground Tank Replacem - - - D Jun-10 CAN Camero JMH Valdes - - -

- - - - - - -

Total Trust Fund

Total FEMA Grants

Total Closed Other Fundings

Total 2009 Infrastructure Rev.Bond

Total 2009 Infrastructure Rev.Bond DEFERRED

of 6



Stat

us

Actuals FY13

38 OTHER FUNDINGS 200,232,377 13,758,441 213,990,818 385,934 6,130,343 150,297,490 63,693,328

74 GRAND TOTAL 218,850,303 27,197,834 246,048,138 336,834 6,688,848 157,269,398 88,778,740

LETTERS Denotes Multi Funding Sources (The sum of all sources equals the Total Funded Commitment or Total Project Budget)

New: Denotes a new project opened in the current month

Hold: Projects placed on hold by Capital Projects Department

Bold date: Denotes changes in the projected completion/ revised completion date in the current month

Status CAN Cancelled Project CL Closed CN Construction CO Close-OutD DesignDEF DeferredPC Partial Capitalization

JACKSON MEMORIAL HOSPITAL

MONTHLY STATUS REPORT

APRIL 2013

CONSTRUCTION REPORT 51006005 EAST TOWER 2nd FLOOR PATHOLOGY LAB Funding Source: JMH Foundation Total Project Budget: $ 2,054,350 Anticipated substantial completion date: June 2013 Scope of the Work:

To upgrade and refurbish the existing Pathology Laboratory. Project Designed in Five (5) construction phases: 1.-UM Chairman Office/Bathroom, 2.-Conference Room, 3.-North Lab, 4.-South Lab/Grossing Stations 5.-Residencies Lab.

March 2013 • Construction in Progress

April 2013

• Construction in Progress

May 2013 • City of Miami Final Inspections

51008032 EAST TOWER FLOOR – ER-RENOVATION Funding Source: GOB Total Project Budget: $ 2,406,000 Anticipated substantial completion date Phase 3: July 2013 PHASE 3 Scope of the Work:

To refurbish and upgrade the ER-B & ER-C Patient Units including all existing bathrooms within the Department, discharge/cashier’s office and staff lounge.

March 2013

• ADA Bathrooms Construction in progress • Fire Alarm Upgrade in progress

April 2013

• Construction Substantial Completion May 2013

• City of Miami Final Inspections



APRIL 2013

51009044 HCH ADOLESCENT UNIT RELOCATION Funding Source: 2005 RB Total Project Budget: $ 1,069,193 Projected Construction Completion Date: March 2013 Scope of the Work:

Renovation of an existing area on the East Tower 5th floor in the Infant Toddler Pediatric Patient Rooms for Adolescents. Remodel existing (6) six crib nursery and convert it into four (4) Private Patient rooms including the addition of four (4) new head walls and additional new ADA patient rest rooms by converting existing closets. Upgrade of existing Private and Semi-Private patient Rooms, staff lounge and corridor.

March 2013

• AHCA 100% re inspection • All final tests and certification completed • Punch list issued by AOR completed by contractor

April 2013

• Furniture delivered that was being stored. Unit to be secured • Patient Restrooms damaged due to Plumbing leak above (not project related) repaired • Project closeout

May 2013

• Project Closed 51011116 CARDIAC CATH LAB #5 EQUIPMENT REPLACEMENT Funding Source: 2005 RB Total Project Budget: $454,000 Projected Construction Completion Date: March 2013 Construction to be performed by JOC Scope of the Work:

Replace Cardiac Cath Lab equipment for room 5 on Central 4th floor. Existing equipment is 23 years old and has not functioned for almost two years.

March 2013

• AHCA inspection for early March • Calibration of GE equipment • Begin Project closeout

April 2013

• Engineering complete work orders for existing conditions as per AHCA comments • Project closed



APRIL 2013

51011117 TAYLOR BREAST CENTER RENOVATIONS Funding Source: JMH Foundation Total Project Budget: $276,000 Anticipated Construction Completion Date: July 2013 Scope of the Work: Work entails the renovation of the Taylor Breast Center located in the Diagnostic Treatment Center 1st floor. The upgrade will include renovation of the entrance / Reception Room. The Patient Changing Rooms will be relocated and converted into 3 Patient Intake areas. The Radiologist and Reading rooms will be relocated to accommodate new equipment. The upgrade will also include new furniture, paint, and lighting.

March 2013

• JOC proposal review • Design Team and Contractor JOC proposal review. Proposal rejected and contractor to resubmit • Meet with end users for construction mobilization

April 2013 • Contractor resubmit JOC proposal • Lawson input JOC Proposal • PO issuance for contractor • Construction Mobilization

May 2013 • City of Miami building permit dry-run completed • Contractor Obtain Building Permit • Contractor Mobilization • Begin Construction

51010096 WW-2 ANGIO SUITE Funding Source: 2005 RB Total Project Budget: $ 2,000,000 Anticipated substantial completion date: August 2013 Construction to be performed by JOC Scope of the Work: Removal of existing C-arm and replace with a new Siemens’ Zee in Interventional Radiology room #25. Renovation of abandoned Interventional Radiology area on WW2 to create a new recovery unit for Interventional Radiology. March 2013

• JOC contractor issues proposal • JOC proposal negotiations

April 2013 • Exiting JOC contractor released due to performance • Engage new JOC contractor • JOC contractor issues proposal • JOC Proposal review

May 2013 • PO issuance to JOC Contractor • Lawson Input for JOC contractor



APRIL 2013

51011118 NICU B, C AND INTERMEDIATE MODERNIZATION Funding Source: JMH Foundation Total Project Budget: $300,000 Anticipated Construction Completion Date: December 2013 Scope of the Work: The Scope of Work entails the modernization of the NICU B, C and Intermediate Units. This includes the complete renovation of the Nursing Stations, Refurbishment of Patient Bays and Replacement of flooring and Wall protection to match the existing NICU Unit A. March 2013

• 90% documents issued for in house review • Prepare for AHCA Stage III review • End user and Design Team meeting for Design sign-off / approval

April 2013 • Submit to AHCA for Stage III review • AHCA Stage III plans approved • Incorporate JMH comments and submit 100% Construction drawings to City of Miami for Plan review • Foundation transfer remainder of committed funds for project • Submit documentation required to establish Dade County project measures

May 2013 • Dade County project measures established • Design Presentation for Interior with end users

51009054 ET-4 LABOR AND DELIVERY OPERATING ROOMS Funding Source: 2005 RB Total Project Budget: $2,083,950 Anticipated substantial completion date: August 2013 Scope of the Work: Scope of Work entails, remodeling and Renovation of 5 Labor and Delivery Operating Rooms and surrounding support areas at the East Tower 4th Floor – Holtz Children’s Hospital. Four (4) Operating Rooms will maintain the same size and configuration. Operating Room Five (5) will be demolished and redesigned to higher standards. Total Square footage under this contract is approximately 5,450 Sq. Ft. March 2013

• Contractor submits plans to City of Miami • Berchtold / Storz integration meeting

April 2013 • Construction Documents at City of Miami for Review • Berchtold meeting with end users to review Boom and surgical lights • Berchtold submit revised drawings for end user approval • A/E address City of Miami Comments for review disciplines

May 2013 • City of Miami dry run complete • PO issued to contractor • Mobilization meeting #1



APRIL 2013

53009055 MAIN CAMPUS / JNMC CAMPUS-WIDE LIGHTING UPGRADE Funding Source: IRB Total Project Budget: $ 780,680 Projected Construction Completion Date: September 2013 Percentage of Construction Completed 0% Scope of Work entails Campus wide outdoor lighting upgrade throughout the JMH main campus and the Jackson North Medical Center. The first phase of this project will cover the Alamo plaza and 16th street portion of the project. March 2013

• Bid checklist meeting with apparent low bidder, procurement, and Capital Projects • Award issued to contractor

April 2013

• Purchase Order Issued • Construction Kick-off Meetings • Construction Starts

May 2013

• Construction Continues

53008020 JACKSON NORTH WINDOW REPLACEMENT Funding Source: Capital Contribution & IRB Total Project Budget: $ 3,145,970 Anticipated substantial completion date: March 2013 Scope of Work: Replacement of all windows with new hurricane windows. Unforeseen conditions have been encountered and the wall systems on pavilion, pediatrics and Labor and delivery are being reconstructed and shored. March 2013

• AHCA final inspection approved • City of Miami approval and CC

April 2013

• 100 % Completion • Project closeout

May 2013

• Project in closeout • No Further Updates on this project



APRIL 2013

51009053 EAST TOWER 2 FLOOR A/C REPLACEMENT Funding Source: IRB Total Project Budget: $ 3,119,080 Anticipated substantial completion date: April 2013 Scope of the Work:

To furnish the Five (5) custom Air Handling Units at the East Tower 2nd Floor of Holtz Children’s Hospital.

March 2013 • Additional Exit Signs

April 2013

• Additional Fire Sprinklers heads below AC ductwork • Repair roofing leaking

May 2013 • AHCA Re-Survey

51009072 FIRE SPRINKLER UPGRADE CAMPUS WIDE Funding Source: IRB Total Project Budget: $2,316,000 Anticipated substantial completion date: March 2014 Scope of the Work The campus-wide fire protection upgrades are to address all existing NFPA fire sprinkler codes in addition to installing new automatic sprinkler systems and other system components for each building as determined deficient by state and local authority having jurisdiction. These main campus building include Central, East Tower, North Wing, Rehabilitation, South Wing, West Wing, and Utility buildings. March 2013

• Ongoing Construction – South Wing • Ongoing Construction – East Tower

April 2013


May 2013




APRIL 2013

51011105 RYDER TRAUMA CENTER EXTERIOR HARDENING PROJECT Funding Source: FEMA (75%) / Capital Contribution (25%) Total Project Budget: $8,589,588 Anticipated substantial completion date: August 20, 2013 Scope of the Work The project scope of work is to structurally retrofit the building envelope. The project will be designed to install a wind abatement system of lightweight glass fiber reinforced concrete (GFRC) panels onto the Ryder Trauma Center. The components used for this wind retrofit project will meet the current Florida Building Code and Miami-Dade County specifications to withstand extreme hurricane conditions (Category IV storm conditions).

March 2013

• Request time extension with FEMA • Re-evaluate the design standards to fit the project budget

April 2013

• Re-Design Package • Explore contractor engagement ( i.e. CM@Risk, design-bid-build, etc)

May 2013

• Re-Design Package • Explore contractor engagement ( i.e. CM@Risk, design-bid-build, etc)

51009069 CAMPUS WIDE ROOFING REPLACEMENT – EAST TOWER Funding Source: IRB Total Project Budget: $1,500,000 Projected Completion Date: December 2013 Scope of Work Replacement of East Tower Roof, approximately 90,000 SQFT March 2013

• Advertise RFP for roofing contractors April 2013

• Advertise RFP for roofing contractors May 2013

• Award project • Preconstruction Meetings



APRIL 2013

51009046 WEST WING BASEMENT PHARMACY CLEANROOM PHASE I / CAROUSELS PHASE II Funding Source: 2005 RB Total Project Budget: $ 834,596 Projected Construction Completion Date: Phase I July 2011 / Phase II May 2013 Phase I Construction Status: 100% Phase II Construction Status: 10% Scope of Work:

Phase I: Installation of a new USP 797 complaint pharmacy clean-room in the West Wing basement. Phase II: Demolition of the old cleanroom to create an open space within the pharmacy to receive (3) new pharmaceutical carousel. This includes new finishes throughout the basement pharmacy.

March 2013

• Building permit obtained • Notice to proceed issued to contractor to commence construction • Construction commencement

April 2013

• Construction continues • AHCA 80% inspection

May 2013

• Construction Substantial • Final AHCA and City of Miami Inspections

53009065 JACKSON NORTH MEDICAL CENTER UTILITY PLANT REPLACEMENT Funding Source: IRB Total Project Budget: $3,100,000 Anticipated substantial completion date: December 2013 Scope of Work:

Replacement of three chillers, two boilers and supporting systems, installation of a new cooling tower. Installation of new energy management system.

April 2013

• Prepare solicitation for remaining work April 2013

• Prepare solicitation for remaining work • Issue solicitation for remaining work

May 2013 • Issue solicitation for remaining work



APRIL 2013

51009089/E10-JMH-01 MEDIUM VOLTAGE OIL SWITCHES REPLACEMENT AND ELECTRICAL SWITCHGEARS AT CENTRAL AND SOUTH WING REPLACEMENT: Funding Source: IRB/CC Total project Budget: $7,350,000 Anticipated substantial completion date: July 2014

Scope of the Work Replace medium voltage oil switches in Central, South Wing, Institute, Rehabilitation and North Building. Central and South Wing: replace normal and emergency substations and main switchgears.

March 2013

• Phase-I AHCA’s comments included in bid documents • Phase-I ITB being prepared by Procurement • Allocate space at the basement for consultant start design at Central and South Wing: upgrade of

emergency switchboards • Retrofill of main switchgears at Central and south Wing: the consultant refused to do the work because they

specify only new equipment and that kind of liability is more hospital/maintenance responsibility April 2013

• Phase-I: Cone of silence • Negotiation with consultant phase-II Design at basement Central and South Wing: upgrade of emergency

switchboards • Investigate options and prepare scope of work for implementing the Retrofill of main switchgears at

Central and South Wing

May 2013 • Phase-I: Cone of silence • Consultant phase-II Design at basement Central and South Wing (upgrade of emergency switchboards)

51009064 REPLACEMENT OF 30 AIR HANDLING UNITS Funding Source: IRB Total Project Budget: $6,541,500 Anticipated substantial completion date: September 2014 Scope of the Work:

To furnish and install thirty one (31) custom Air Handling Units:

April 2013 • Prepare solicitation and obtain county approval for multi AHU project

May 2013

• Advertise project

June 2013 • Begin installation of AHU #9



APRIL 2013

51009056/E10-JMH-02 ENERGY CENTER REPLACE PARALLELING GEAR AND NEW EMERGENCY GENERATORS Funding Source: IRB Total project Budget: $ 5,289,372 Anticipated substantial completion date: September 2014

Scope of the Work Replace paralleling system and emergency distribution switchboard; provide new engines with the capability to operate in dual-fuel mode (natural gas component). Ryder Trauma Center emergency power system will be increased, with the intention of having the entire building on emergency power.

March 2013

• UC-Integration of the Portable unit with ASCO essential gear: in construction • ITB-Campus wide Energy Monitoring and Control System (EMCS): being prepared by Procurement • Continue with construction plans for new generator at UC, emergency power upgrades at Ryder Trauma • Due to budget constraints, the administration decided to delete the scope of work at Energy Center

April 2013

• UC-Integration of the Portable unit with ASCO essential gear: in construction • ITB-Campus wide Energy Monitoring and Control System (EMCS): being prepared by Procurement • Continue with design stage for new generator at UC, emergency power upgrades at Ryder Trauma

May 2013

• UC-Integration of the Portable unit with ASCO essential gear: Finish construction • ITB-Campus wide Energy Monitoring and Control System (EMCS): Cone of Silence • Continue with construction plans for new generator at UC, emergency power upgrades at Energy Center

and Ryder Trauma 59007009 JMT ELEVATOR MODERNIZATIONS #141 TO #146 Funding Source: Capital Contribution / IRB Total Project Budget: $1,300,757 Projected Completion Date: March 2013 Scope of Work Modernization and cab upgrade to Elevators #141-146 in Jackson Medical Towers March 2013

• Simplex Grinnell programming and testing fire alarm system • MDC Inspections

April 2013

• Simplex Grinnell programming and testing fire alarm system • City of Miami Inspections

May 2013 • Close out Project



APRIL 2013

51011104 WEST WING 15 NURSING UNIT MODERNIZATION Funding Source: Capital Contribution Total Project Budget: $2,588,568 Projected Completion Date: March 2014 Scope of Work entails The West Wing 15 Nursing Unit Modernization project has a vision towards creating a greater offering of single-occupancy rooms at Jackson Health System. The project’s interior renovation would create twenty-five (25) single-occupancy rooms, one (1) VIP room, and other clinical support areas to current codes, hospital standards, and modernized finishes. April 2013

• Awaiting PO Issuance • Pre-Construction Meetings

May 2013

• Pre-Construction Coordination June 2013

• Area move out • Construction commencement

52012104 JSCH HELIPAD Funding Source: Capital Contribution Total Project Budget: $1,459,072 Projected Completion Date: October 2013 Scope of Work Design and installation of a new helipad platform above existing emergency department. Project also includes construction of a 2-level tower that will house a double patient bed capacity elevator to service the helipad. April 2013

• Awaiting board of commissioner’s vote. • Finalize building permit • Pre-construction meeting

May 2013

• Commence Construction June 2013

• Construction Ongoing



APRIL 2013

51009062/E10-JMH-03 P-00967 FIRE ALARM UPGRADE AT JACKSON MEMORIAL HOSPITAL Funding Source: IRB Total project Budget: $ 4,429,495 Anticipated substantial completion date: March 2014

Scope of the Work Design and upgrade of existing hospital and business occupancy floor for: Rehabilitation, Trauma, Mental Health and Jackson Medical Towers buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. March 2013

• Ongoing Construction at Patient Towers o NW is 100% installed o Rehab is 90% installed o Trauma on line until the two previous buildings are complete by Simplex

• Ongoing Design Services – Track the completion of non-patient towers: o Park Plaza East - Finished o Jackson Medical Towers – 50% CD

• The administration will contact City of Miami in order of expediting the inspections.

April 2013 • Ongoing Construction at Patient Towers

o NW is 100% installed –Pending City of Miami Inspections o Rehab is 90 % installed o Trauma is pending on the line until the two previous buildings are complete by Simplex

• Ongoing Design Services – Track the completion of non-patient towers: o Park Plaza East: finished. Project must be negotiated with Simplex o Jackson Medical Towers: 50% CD

• Fiber optic pending to be submitted by Simplex • Waiting resolution from City of Miami for accelerating inspections

May 2013

• Ongoing Construction at Patient Towers o NW is 95% installed o Rehab is 90% installed o Trauma on line until the two previous buildings are done by Simplex.

• Ongoing Design Services – Track the completion of non-patient towers: Park Plaza East and Jackson Medical Towers



APRIL 2013

51009036 WEST WING AND CENTRAL FIRE ALARM UPGRADE PROJECT Funding Source: IRB Total Project Budget: $2,350,000 Projected Completion Date June 2013 Scope of Work Design and upgrade of existing patient occupancy towers for: West Wing and Central buildings, replace all audio/visual devices provide new speakers, all older model addressable ceiling smoke detectors, heat sensors, manual pull station and duct detectors must be replaced, flow and tamper annunciation modules must be upgraded. Connect these building to the fire alarm loop/network. March 2013

• Ongoing City of Miami Fire Marshall Inspections for the West Wing Tower • Ongoing Fire Alarm installation, programming, trim-out for the Central Building • Address the existing condition Central damper operations

April 2013

• Ongoing City of Miami Fire Marshall inspections for the West Wing Tower • Ongoing City of Miami Fire Marshall inspections for the Central Building • Central testing dampers

May 2013

• Ongoing City of Miami Fire Marshall Inspections for the West Wing Tower • Ongoing Fire Alarm installation, programming, trim-out for the Central Building

10. Campus-Wide Way Finding Update

11. Resolution Recommended to be Approved

Agenda Item 11 (a) Purchasing &Facilities Subcommittee April 18, 2013

RESOLUTION NO. PHT 04/13 – RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH SIKMA CORPORATION, A FLORIDA CORPORATION FOR THE RENTAL OF THREE THOUSAND EIGHT HUNDRED EIGHTY-SIX (3,886) SQUARE FEET OF OFFICE SPACE IN SUITE 230 AT THE REGENCY MEDICAL CENTER BUILDING LOCATED AT 9195 SUNSET DRIVE, MIAMI, FLORIDA 33173, FOR A PERIOD OF FOUR YEARS COMMENCING ON SEPTEMBER 1, 2012, WITH ONE (1) FOUR-YEAR OPTION TO EXTEND, FOR AN ANNUAL PAYMENT OF ONE HUNDRED THIRTY-THREE THOUSAND AND SIXTY-SEVEN DOLLARS ($133,067) WITH ANNUAL INCREASE IN BASE RENT OF THREE PERCENT (3%)

(Madeline Valdes, Corporate Director, Property Management Division)

WHEREAS, the Public Health Trust is authorized pursuant to Chapter 25A of the Code of Miami-Dade

County to lease real property either as lessor or as lessee; and

WHEREAS, the President, Facilities Subcommittee and Fiscal Committee recommend approval,

NOW, THEREFORE BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the

President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for

the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in suite 230 at the Regency

Medical Center Building located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years

commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred

Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent

(3%), in accordance with the recommendation set forth in the agenda item attached hereto and incorporated herein

by reference.

PURCHASING AND FACILITIES SUBCOMMITTEE 04-18-2013 FISCAL COMMITTEE 04-18-2013

REQUEST

Staff requests authorization for the President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in suite 230 at the Regency Medical Center Building located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent (3%). BACKGROUND

During the 2012 fiscal year, Jackson Health Systems (JHS) initiated a strategy to review and revamp the operations of hospital owned Agency and Jackson Medical Group (JMG) practices. Part of that process was to review expenses and supporting contractual obligations. During the review process, it was discovered that a final written lease for the space currently utilized by the JMG Colorectal practice had not been executed. Though the parties had agreed to the terms of a lease, and they had governed themselves in accordance with said terms, they never actually signed a final version of the lease. In addition, it was discovered that the initial duration of the lease contemplated by the parties may have expired. JHS’ Physician Services (PS) staff immediately contacted the landlord to negotiate a new lease for the space. During the process it was further discovered by PS staff that the space being leased was partially owned by the JHS employed physician (Dr. Gustavo Plasencia) who was assigned to work in the space. This fact was reported to JHS Compliance Department, which advised that a fair market valuation (FMV) needed to be conducted for both the new lease period and for the prior, unexecuted lease term. It should also be noted that landlord agreed to toll lease payments until after proper approval of the lease and a corresponding FMV was received.

RECOMMENDATION

Staff recommends authorizing the President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in suite 230 at the Regency Medical Center Building located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent (3%).

PROPERTY MANAGEMENT DIVISION

CONTRACT SUMMARY – NEW LEASE I. CONTRACT TITLE: The Sikma Corporation, a Florida Corporation (Landlord) and

the Public Health Trust of Miami-Dade County, Florida (Tenant) for use of office space in suite 230 at the Regency Medical Center Building located at 9195 Sunset Drive, Miami, Florida, 33173.

II. FINANCIAL IMPACT AND SUMMARY:

Staff requests authorization to continue to occupy at the Regency Medical Center Building suite 230, located at 9195 Sunset Drive, Miami, Florida, 33173. The existing location consists of three thousand eight hundred eighty-six (3,886) square feet of office space for a period of four (4) years commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067), with an annual increase in base rent of three percent (3%).

III. TERMS:

Description Proposed Terms Rental Rate +/- 3,886 sq. ft. @ $34.24 Annual Rent $133,067 Comm. Area Maintenance Fee No charge Rate Adjustment Annual 3% increase Lease Term Four (4) years – September 1,

2012 to August 31, 2016 Renewal Options One four-year option Utility Costs Metered separately and a cost

to the PHT Renovation Costs/Repairs No cost to PHT Parking No cost to PHT Exceptions to PHT Guidelines None

FISCAL COMMITTEE


Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Mojdeh Khaghan Marcos Jose Lapciuc Stephen S. Nuell

Date, Time and Location April 18, 2013 – To follow the Purchasing and Facilities Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. Approval of the Previous Meeting Minutes (Joe Arriola, Chairperson)

(a) *Meeting Minutes as of March 14, 2013

2. *JMH Health Plan 2012 Audited Financial Statements

(Karen Mitchell, Partner, KPMG) 3. *Jackson Health System Financial Statements as of March 2013 (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System)

4. Cost Accounting Update

(Brian Dean, Senior Vice President, Finance Division, Jackson Health System) 5. *Accounts Receivable Aging Report as of March 2013 (Carmen Pla, Vice President, Patient Financial Services, Jackson Health System) 6. Contracts and/or Agreements Recommended for Approval

(a) LIP Cost Limit Agreement

(Brian Dean, Senior Vice President, Finance Division, Jackson Health System)

(b) Conflict Waiver Request - Greenberg Traurig (Brian Dean, Senior Vice President, Finance Division, Jackson Health System)

7. Purchasing & Facilities Subcommittee Report

(Darryl K. Sharpton, Chairperson) (a) Review and Recommended Approval of the Purchasing Report

(Rosa Costanzo, Vice President Strategic Sourcing and Supply Chain & Chief Procurement Officer, Jackson Health System)

(1) *Purchasing Report as of April 2013

Fiscal Committee Meeting Agenda Page 2 April 18, 2013

(b) Resolution Recommended to be Approved

(1) *Resolution Authorizing the President or his designee to enter into a Lease Agreement With Sikma Corporation, a Florida Corporation for the Rental of three thousand eight hundred eighty six (3,886) square feet of office space in Suite 230 at the Regency Medical Center Building, located at 9195 Sunset Drive, Miami, Florida 33173 for a period of four years commencing on September 1, 2012, with a one (1) four year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty Seven Dollars ($133,067) with an annual increase in base rent of three percent (3%) (Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System)

(2) Support document for agenda item 7 (b) (1)

The items noted with an asterisk (*) indicate that the supporting documents are attached.

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Fiscal Committee Joe Arriola, Chairperson Darryl K. Sharpton, Vice Chairperson Michael Bileca Mojdeh L. Khaghan Marcos Jose Lapciuc Stephen S. Nuell Date, Time and Location March 14, 2013 – Followed the Purchasing and Facilities Subcommittee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Fiscal Committee Darryl K. Sharpton Stephen S. Nuell

Mojdeh L. Khaghan Marcos Jose Lapciuc Joe Arriola Excused Michael Bileca

Jackson Health System Carlos A. Migoya Brian Dean Carmen Pla Don S. Steigman Gino Santorio Jeffrey Crudele Rosa Costanzo

Miami-Dade County Attorneys

Eugene Shy, Jr.

Fiscal Committee Meeting March 14, 2013 Page 2 Meeting Called to Order With a quorum being present, the meeting of the Fiscal Committee was called to order at 9:20 a.m. by Joe Arriola, Chairperson, Fiscal Committee. 1. Approval of the Previous Meeting Minutes

(a) Meeting Minutes as of February 21, 2013

Mr. Arriola requested a motion approving the meeting minutes of February 21, 2013. Ms. Khaghan moved approval; seconded by Mr. Sharpton, and carried without dissent. 2. Review and Recommend Approval of FY12 Management Letter

Mojdeh L. Khaghan, Chairperson, Audit and Compliance Subcommittee reported that the Subcommittee was presented with a detailed overview of the FY12 Management Letter by Karen Mitchell, Partner, KPMG. Certain observations were identified during the audit having to do with Information Technology General Controls and Small Facilities. In response to the observations, Jackson Health System Management submitted written responses and will continue to monitor and update policies and procedures associated with the identified observations. Following the review of the FY12 Management Letter, Mr. Arriola requested a motion to accept the information as presented. Mr. Sharpton moved approval; seconded by Mr. Lapciuc, and carried without dissent.

3. Financial Statements Report as of February 2013

Brian Dean, Senior Vice President, Finance Division, Jackson Health System (JHS) presented the results of the financial statements ending February 28, 2013. A review of the Financial Statements Report included Key Performance Indicators, Combined Balance Sheet, and Combined Statement of Revenue, and Expenses & Change in Fund Net Assets. A detailed copy of the Financial Statements was distributed at the meeting. A question was raised regarding whether or not the Case Management Department could break down the length of stay and case mix numbers. Don S. Steigman, Executive Vice President and Chief Operating Officer, Jackson Health System stated that the process would be complex but have the ability to provide the information if needed for the Financial Statements Report.

• OT FTE’s Trend Report Mr. Dean presented the OT FTE’s Trend Report. Highlights of the report showed a slight increase in overtime. There was some discussion regarding the increase in overtime and review of the improvement processes that have been implemented. A copy of the report was distributed at the meeting.

Fiscal Committee Meeting March 14, 2013 Page 3

• JMH Health Plan Flash Report Update Mr. Dean presented the JMH Health Plan (Health Plan) Flash Report for the month of February 2013. Highlights of the report included a bottom line profit totaling $46,000 which is a positive trend from prior months. A positive trend continues in the Medicare line of business and length of stay. A copy of the report was distributed at the meeting.

• Line of Credit Activity Report

Mr. Dean presented an overview of the Line of Credit Activity Report as of February 28, 2013. A copy of the report was distributed at the meeting.


Mr. Dean reported that the Cost Accounting System at Jackson North Medical Center and Jackson South Community Hospital is being utilized for capital allocations as it relates to a business development pro forma. The system is undergoing testing for user acceptance as well as a procedure analysis to determine how best to allocate capital dollars. Cost models have been built into the Cost Accounting System at the Main Campus. The Cost Accounting System is fully operational at all three facilities.

5. Accounts Receivable Aging Report as of February 2013

Carmen Pla, Vice President, Patient Financial Services, Jackson Health System, presented the Accounts Receivable Aging Report as of February 2013. Cash collections for the month was $81 million versus a goal totaling $83 million, Point of Service (POS) cash collections was $1.9 million, potential Medicaid Conversion was 93%, AR greater than 90 days was 31%, denial rates showed 10%, and revenue integrity was 2.0%. Ms. Khaghan requested that future reports show the success rate of the POS in greater detail. Following the Accounts Receivable Aging Report, the Committee was engaged in discussion having to do with patients receiving care in the Emergency Room and how patients are being referred for follow up care.

6. Contract and/or Agreement Recommended to be Approved

(a) Resolution authorizing and approving the President to negotiate and execute renewal agreement for expenditures up to $1,130,000.00 out of fiscal year 2013 budget for purchase of Public Health Services with Miami-Dade County Health Department (Gino Santorio, Vice President, Ambulatory Care Services and Operations, Jackson Memorial Hospital)

Mr. Arriola requested a motion for the item. Mr. Nuell moved approval; seconded by Mr. Sharpton, and carried without dissent.

Fiscal Committee Meeting March 14, 2013 Page 4 7. Purchasing and Facilities Subcommittee Report

Darryl K. Sharpton, Chairperson, Purchasing and Facilities Subcommittee reported that the Subcommittee met on March 14, 2013. The Subcommittee received routine monthly reports, approved the March 2013 Purchasing Report and forwarded it to the Fiscal Committee with a recommendation for approval. (a) Review and Recommend Approval of the Purchasing Report (1) Purchasing Report as of March 2013

Mr. Arriola requested a motion approving the March 2013 Purchasing Report.

Mr. Nuell moved approval; seconded by Mr. Lapciuc

and carried without dissent. Meeting Call to Adjourn The meeting of the Fiscal Committee adjourned at 10:25 a.m. Transcribed by Ivenette Cobb-Black Executive Assistant Public Health Trust Financial Recovery Board







Date/Time Due


Name:

Tel./Ext.:




Table of Contents

Page







Schedules




2






Emphasis of Matter


Other Matter




3














4




2012 2011


Total revenues 75,896,553 217,733,405








5








Net income — 368,816 368,816



Net income 200,652 200,652


Dividends Paid (20,000,000) — (20,000,000)




6




2012 2011












7 (Continued)










8 (Continued)















9 (Continued)








(f) Equipment


(g) Unpaid Claims






10 (Continued)











(i) Income Taxes






11 (Continued)

(j) Premium Revenue













12 (Continued)















13 (Continued)












14 (Continued)















15 (Continued)











16 (Continued)











17 (Continued)















18 (Continued)


















19



2012 2011


$ 2,043,472 373,259





SCHEDULES


Schedule 1



December 31, 2012

20





21




December 31, 2012

Admittedassets as






PUBLIC HEALTH TRUST

JACKSON HEALTH SYSTEM

COMBINED FINANCIAL STATEMENTS

March 31, 2013

PUBLIC HEALTH TRUST

JACKSON HEALTH SYSTEM

COMBINED FINANCIAL STATEMENTS

March 31, 2013

INDEX

1. Key Performance Indicators

2. Combined Balance Sheet

3. Combined Statement of Revenues, Expenses & Changes in Fund Net Assets

3A. Combined Statement of Revenues, Expenses & Changes in Fund Net Assets

excluding Division of Managed Care

4. P &L 12 Month Trend Analysis

5. Combining Statement of Revenue & Expense Reflecting Allocated Corporate

Overhead & Public Support Funding /Month

6. Combining Statement of Revenue & Expenses Reflecting Allocated

Corporate Overhead & Public Support Funding /YTD

7. Combining Statement of Revenue & Expenses by Company

8. Combined Statement of Unrestricted/Restricted Cash Flow

9. Consolidated Portfolio Inventory Summary by Security /Account Type

10. Sales Tax Monthly Income Trend Analysis

11. Payor Mix Patient Days as % of Total Fiscal Year 2011-2012

(a) (b) (f) (g) (h) (i) (j) (k)

YTD Mar-13 Mar-13 Mar-12 Feb-13 YTD YTD YTDBenchmark Status Actual Budget Actual Budget Prior Budget Prior Actual Actual Budget 2012 Budget Prior Budget Prior

JHS Financial(1) Net Patient Revenue 80,424 88,271 91,995 (7,847) (11,571) (8.9)% (12.6)% 77,851 495,057 507,104 497,286 (12,047) (2,229) (2.4)% (0.4)%

(2) Other Operating Revenue 19,245 14,997 14,415 4,248 4,830 28.3% 33.5% 15,155 91,107 87,675 123,829 3,432 (32,722) 3.9% (26.4)%

(4) Total Operating Revenue 99,669 103,268 106,410 (3,599) (6,741) (3.5)% (6.3)% 93,006 586,164 594,779 621,115 (8,615) (34,951) (1.4)% (5.6)%

(6) Total Operating Expenses 127,286 128,231 135,497 945 (8,211) 0.7% (6.1)% 123,513 759,534 764,301 830,757 4,767 71,223 0.6% 8.6%

(7) Gain and (Loss) from Operations (27,617) (24,963) (29,087) (2,654) 1,470 (10.6)% 5.1% (30,507) (173,370) (169,523) (209,642) (3,847) 36,272 (2.3)% 17.3%

(8) Total Net Non-operating Items (before GOB & Special Contributions) 30,799 31,514 31,262 (716) (464) (2.3)% (1.5)% 33,527 183,209 182,312 180,585 896 2,624 0.5% 1.5%

(9) Excess of Revs Over (Under) Expenses before GOB & Special Contrib. 3,182 6,552 2,176 (3,370) 1,006 (51.4)% 46.2% 3,021 9,839 12,789 (29,057) (2,951) 38,896 (23.1)% 133.9%

(10) GOB & Special Contributions 437 - 4,029 437 (3,593) 0.0% (89.2)% 1,321 2,269 - 7,693 2,269 (5,425) 0.0% (70.5)%

(11) Excess of Revenues Over (Under) Expenses 3,618 6,552 6,205 (2,934) (2,587) (44.8)% (41.7)% 4,342 12,108 12,789 (21,364) (681) 33,472 (5.3)% 156.7%

(12) Unrestricted Health Care Surtax 18,331 18,772 18,470 (441) (139) (2.3)% (0.8)% 20,878 107,684 106,070 104,363 1,614 3,321 1.5% 3.2%

(13) Miami Dade County Unrestricted Funds 11,094 11,094 11,085 0 9 0.0% 0.1% 11,094 66,564 66,564 65,509 1 1,055 0.0% 1.6%

(14) Discharged Not Final Billed (DNFB) HIM 5,318 21,000 3,473 15,682 (1,845) 74.7% (53.1)% 4,087 5,318 21,000 3,473 15,682 (1,845) 74.7% (53.1)%

Financial Ratios(15) Net Patient Revenue per Adjusted Patient Day 1,648 1,882 1,958 (234) (310) (12.4)% (15.8)% 1,736 1,766 1,874 1,817 (108) (51) (5.7)% (2.8)%

(16) Total Cost per Adjusted Patient Day 2,608 2,734 2,884 126 276 4.6% 9.6% 2,754 2,709 2,824 3,036 115 327 4.1% 10.8%

Liquidity Indicators(17) Days Net in Receivable 45.9 51.96 41.83 52.09 (10.13) 0.13 (24.2)% 0.3% 48.51 51.96 41.83 52.09 (10.13) 0.13 (24.2)% 0.3%

(18) Days (Unrestricted) Cash on Hand 174.8 18.79 31.00 12.76 (12.21) 6.02 (39.4)% 47.2% 16.28 18.79 31.00 12.76 (12.21) 6.03 (39.4)% 47.2%

(19) Current Ratio 2.4 0.97 0.91 0.68 0.06 0.29 7.1% 42.7% 0.92 0.97 0.91 0.68 0.06 0.29 7.1% 43.2%

(20) Cash (Unrestricted) to Debt Ratio 1.29 0.20 0.26 0.14 (0.05) 0.06 (20.9)% 39.6% 0.18 0.20 0.26 0.14 (0.05) 0.06 (20.9)% 44.1%

Utilization(21) Admissions excl. Newborn 4,827 5,334 5,224 (507) (397) (9.5)% (7.6)% 4,602 29,163 30,892 30,722 (1,729) (1,559) (5.6)% (5.1)%

(22) Admissions % through ED 64.80% N/A 71.73% (6.9)% 0.0% (9.7)% 63.60% 64.11% N/A 71.13% 0.0% 0.0%

(22) Observation Equivalent Days 1,352 873 950 479 402 54.9% 42.3% 1,127 7,095 5,026 5,035 2,069 2,060 41.2% 40.9%

(23) Hospital Patient Census Days excl. Newborn 34,296 33,085 32,581 1,211 1,715 3.7% 5.3% 31,771 198,685 190,753 192,067 7,932 6,618 4.2% 3.4%

(24) Average Length of Stay 4.5 7.11 6.20 6.24 (0.90) (0.87) (14.5)% (13.9)% 6.90 6.81 6.17 6.25 (0.64) (0.56) (10.3)% (9.0)%

(25) Outpatient Visits 28,132 29,291 29,379 (1,159) (1,247) (4.0)% (4.2)% 26,092 167,498 168,754 164,991 (1,256) 2,507 (0.7)% 1.5%

(26) JMH Number of O/R Cases 1,116 1,343 1,261 (227) (145) (16.9)% (11.5)% 1,116 6,828 7,670 7,260 (842) (432) (11.0)% (6.0)%

(27) Overtime % of Productive Hours 3.55% N/A 3.28% 3.28% N/A N/A

FTE's(28) JHS FTE per Adjusted Occupied Bed 6.65 6.31 6.38 6.67 0.08 0.36 1.2% 5.4% 6.19 6.43 6.45 6.77 0.02 0.34 0.3% 5.0%

(29) Jackson Health System FTE's 9,929 9,658 10,102 (271) 173 (2.8)% 1.7% 9,911 9,904 9,592 10,128 (312) 224 (3.2)% 2.2%

Payor Mix Self Pay Patient Days as % of Total(30) Jackson Memorial Hospital 13.80% 16.96% 17.90% 3.16% 4.10% 18.6% 22.9% 13.10% 13.70% 17.04% 17.10% 3.34% 3.40% 19.6% 19.9%

(31) Jackson North 10.50% 14.06% 15.10% 3.56% 4.60% 25.3% 30.5% 9.60% 11.40% 14.06% 14.30% 2.66% 2.90% 18.9% 20.3%

(32) Jackson South 14.50% 19.23% 22.30% 4.73% 7.80% 24.6% 35.0% 12.50% 14.80% 19.17% 19.70% 4.37% 4.90% 22.8% 24.9%

(33) Inpatient Charges as Percent of Total 70.27% 70.54% 69.35% 0.27% -0.92% 0.4% (1.3)% 70.85% 70.87% 70.48% 70.18% 0.39% 0.69% 0.6% 1.0%

(34) Realization Rate 23.15% 24.90% 26.41% 1.75% 3.25% 7.0% 12.3% 24.37% 24.60% 24.89% 24.32% -0.29% 0.28% (1.2)% 1.2%

Key: Positive variance or no major concerns

Year-to-date numbers are ok or explained, but concern for future trend

Negative variance or area of current concern

Variance are Favorable (positive number) and Unfavorable (negative number)

NEW KEY PERFORMANCE INDICATORS Fiscal Year 2012 - 2013

(Dollars in 000)

(e) (d) (e) (l)

$ Variance % Variance $ YTD Variance % YTD Variance

FS-1

March 2013

Combined Statement of Revenue, Expenses & Change in Fund Net AssetsPublic Health Trust of Miami-Dade County

(Amounts in thousands)

Mar 13

Actual

Mar 12

Actual

Mar 13

Budget

$ Variance

Month of March 2013

Mar 13 Actual

YTD

Mar 13

Budget YTD

Mar 12

Actual YTD

6 Months Ended March 31, 2013

Budget Prior

% Variance

PriorBudget

$ Variance

PriorBudget

% Variance

PriorBudget

78,366 (7,509) 88,452 Hospital and physician services 481,911 493,051 (11,140) 477,702 85,875 4,209 1 %(2)%(10,086) (9)% (11)%

187 Community Medical Practices 221 (34) 991 1,341 1,300 41 7,126 (5,786) (81)% 3 %(804) (15)% (81)%

Primary Care Centers 148 204 (56)(128) 952 1,193 (240) 1,581 (629) (40)%(20)% 276 (27)% (215)%

1,723 Continuing Care (SNF) 1,970 (248) 2,681 10,855 11,561 (706) 10,878 (958) (13)% (36)% (23) (7)% 0 %

Net Patient Service Revenue 80,424 88,271 (7,847) 91,995 495,059 507,104 (12,046) 497,286 (2,228) 0 %(2)%(11,571) (9)% (13)%

Division of Managed Care 6,547 7,377 (830) 7,211 42,664 42,776 (112) 83,079 (664) (11)% (9)% (40,415) 0% (49)%

1,941 (17) 1,860 Grants Revenue 10,581 11,498 (917) 11,038 1,958 (457) (4)%(8)% 82 (1)% 4 %

10,757 5,095 5,345 Other Operating Revenue 37,861 33,400 4,461 29,712 5,662 8,150 27 % 13 % 5,412 90 % 101 %

(3,599) Total Operating Revenue (8,614) 99,669 103,268 106,410 586,165 594,779 621,115 (6,742) (3)% (6)% (34,950) (1)% (6)%

69,234 (3,393) 78,938 Salaries & Related Costs 401,941 384,640 (17,301) 438,723 65,841 36,781 8 %(4)% 9,704 (5)% 12 %

30,595 (1,175) 27,253 Contractual and Purchased Serv. 176,166 184,950 8,784 167,775 29,420 (8,391) (5)% 5 %(3,341) (4)% (12)%

Division of Managed Care - Paid Claims 6,335 7,174 839 4,930 42,829 43,042 213 77,616 (1,405) 12 % (28)% 34,787 0 % 45 %

15,039 1,617 14,909 Supplies 92,850 96,011 3,161 90,201 16,656 (2,649) (3)% 3 %(130) 10 % (1)%

4,641 1,167 6,085 Depreciation 28,604 35,668 7,064 35,969 5,809 7,366 20 % 20 % 1,444 20 % 24 %

1,274 247 1,447 Interest 8,596 9,126 530 8,778 1,521 182 2 % 6 % 173 16 % 12 %

168 1,642 1,935 Other Operating Expenses 8,548 10,864 2,317 11,695 1,811 3,147 27 % 21 % 1,767 91 % 91 %

127,286 128,231 944 135,497 Total Operating Expenses 759,534 764,301 4,767 830,757 8,211 1 % 6 % 71,222 1 % 9 %

(27,617) (24,963) (2,655) Gain (Loss) From Operations (173,370) (169,523) (3,847)(209,642)(29,087) 1,469 (11)% 5 % 36,272 (2)% 17 %

55 (25) 187 Investment Income 314 471 (157) 550 80 (236) (43)%(33)%(132) (31)% (71)%

1,318 (250) 1,520 Other Income 8,648 9,208 (559) 9,163 1,568 (515) (6)%(6)%(202) (16)% (13)%

11,094 0 11,085 Dade County Unrestricted Funds 66,563 66,564 0 66,509 11,094 55 0 % 0 % 9 0 % 0 %

18,331 (441) 18,470 Unrestricted Health Care Surtax 107,683 106,070 1,613 104,363 18,772 3,320 3 % 2 %(138) (2)% (1)%

30,799 31,514 (715) 31,262 Total Non-Operating Gain Net 183,209 182,312 897 180,585 (464) (2)% (1)% 2,624 0 % 1 %

3,181 6,552 (3,370) 2,176 Revenue & Gain in Excess of Exp. & Loss 9,840 12,789 (2,950)(29,057) 1,006 (51)% (46)% 38,896 23 % 134 %

0 0 0 Capital Contributions – Grants and Other 0 0 0 0 0 0 0 % 0 % 0 0 % 0 %

437 437 0 JM Foundation 568 0 568 0 0 568 0 % 0 % 437 0 % 0 %

0 0 4,029 Miami Dade County GOB 1,701 0 1,701 7,693 0 (5,992) (78)% 0 %(4,029) 0 % (100)%

3,618 6,552 (2,934) 6,205 Revenue & Gain after Extraordinary Loss 12,109 12,789 (681)(21,364)(2,587) (45)% 42 % 33,473 5 % 157 %

FS-3

March 2013

Combined Statement of Revenue, Expenses & Change in Fund Net AssetsPublic Health Trust of Miami-Dade County


excluding Division of Managed Care

Mar 13

Actual

Mar 12

Actual

Mar 13

Budget

$ Variance

Month of March 2013

Mar 13

Actual YTD

Mar 13

Budget YTD

Mar 12

Actual YTD

6 Months Ended March 31, 2013

Budget Prior

% Variance

PriorBudget

$ Variance

PriorBudget

% Variance

PriorBudget

78,366 (7,509) 88,452 Hospital and physician services 481,911 493,051 (11,140) 477,702 85,875 4,209 1 %(2)%(10,086) (9)% (11)%

187 Community Medical Practices 221 (34) 991 1,341 1,300 41 7,126 (5,786) (81)% 3 %(804) (15)% (81)%

Primary Care Centers 148 204 (56)(128) 952 1,193 (240) 1,581 (629) (40)%(20)% 276 (27)% (215)%

1,723 Continuing Care (SNF) 1,970 (248) 2,681 10,855 11,561 (706) 10,878 (958) (13)% (36)% (23) (7)% 0 %

Net Patient Service Revenue 80,424 88,271 (7,847) 91,995 495,059 507,104 (12,046) 497,286 (2,228) 0 %(2)%(11,571) (9)% (13)%

1,941 (17) 1,860 Grants Revenue 10,581 11,498 (917) 11,038 1,958 (457) (4)%(8)% 82 (1)% 4 %

10,757 5,095 5,345 Other Operating Revenue 37,861 33,400 4,461 29,712 5,662 8,150 27 % 13 % 5,412 90 % 101 %

(2,769) Total Operating Revenue (8,502) 93,122 95,891 99,200 543,501 552,003 538,036 (6,078) (3)% (6)% 5,465 (2)% 1 %

69,234 (3,393) 78,938 Salaries & Related Costs 401,941 384,640 (17,301) 435,659 65,841 33,717 8 %(4)% 9,704 (5)% 12 %

30,595 (1,175) 27,253 Contractual and Purchased Serv. 176,166 184,950 8,784 167,775 29,420 (8,391) (5)% 5 %(3,341) (4)% (12)%

15,039 1,617 14,909 Supplies 92,850 96,011 3,161 90,200 16,656 (2,651) (3)% 3 %(130) 10 % (1)%

4,635 1,167 6,079 Depreciation 28,569 35,634 7,064 35,933 5,803 7,364 20 % 20 % 1,443 20 % 24 %

1,274 247 1,447 Interest 8,596 9,126 530 8,778 1,521 182 2 % 6 % 173 16 % 12 %

168 1,642 1,935 Other Operating Expenses 8,548 10,864 2,317 11,695 1,811 3,147 27 % 21 % 1,767 91 % 91 %

120,945 121,051 106 130,561 Total Operating Expenses 716,671 721,225 4,554 750,039 9,615 0 % 7 % 33,368 1 % 4 %

(27,823) (25,160) (2,663) Gain (Loss) From Operations (173,170) (169,222) (3,948)(212,003)(31,361) 3,538 (11)% 11 % 38,833 (2)% 18 %

55 (23) 187 Investment Income 307 457 (149) 549 78 (242) (44)%(33)%(132) (29)% (71)%

1,318 (250) 1,520 Other Income 8,648 9,208 (559) 9,163 1,568 (515) (6)%(6)%(202) (16)% (13)%

11,094 0 11,085 Dade County Unrestricted Funds 66,563 66,564 0 66,509 11,094 55 0 % 0 % 9 0 % 0 %

18,331 (441) 18,470 Unrestricted Health Care Surtax 107,683 106,070 1,613 104,363 18,772 3,320 3 % 2 %(138) (2)% (1)%

30,799 31,512 (713) 31,262 Total Non-Operating Gain Net 183,203 182,298 905 180,584 (464) (2)% (1)% 2,618 0 % 1 %

2,975 6,352 (3,376)(99) Revenue & Gain in Excess of Exp. & Loss 10,033 13,076 (3,043)(31,419) 3,074 (53)% 3116 % 41,452 23 % 132 %

0 0 0 Capital Contributions – Grants and Other 0 0 0 0 0 0 0 % 0 % 0 0 % 0 %

437 437 0 JM Foundation 568 0 568 0 0 568 0 % 0 % 437 0 % 0 %

0 0 4,029 Miami Dade County GOB 1,701 0 1,701 7,693 0 (5,992) (78)% 0 %(4,029) 0 % (100)%

3,412 6,352 (2,940) 3,930 Revenue & Gain after Extraordinary Loss 12,302 13,076 (774)(23,726)(518) (46)% 13 % 36,028 6 % 152 %

FS-3A

March 2013

P & L 12 Month Trend Analysis

Public Health Trust of Miami-Dade County

Mar 13 Feb 13 Jan 13 Dec 12 Nov 12 Oct 12 Sep 12 Aug 12 Jul 12 Jun 12 May 12 Apr 12

244,119 Inpatient Services 226,302 251,495 232,232 233,610 238,341 222,392 237,745 233,008 226,910 236,055 230,623

103,280 Ambulatory Services 93,105 100,923 91,335 93,994 103,439 96,082 101,763 96,816 97,900 108,562 100,215

Gross Patient Service Revenue 347,398 319,406 352,418 323,567 327,604 318,474 339,509 329,824 324,810 344,616 341,780 330,838

195,560 Contractual Adjustments 181,026 193,444 181,197 184,877 190,412 387,022 177,993 175,101 172,262 182,144 164,165

Charity Care 32,153 27,261 30,416 27,873 29,693 32,713 29,139 34,824 30,236 31,075 34,709 31,803

Net Patient Revenue Adjustment 0 0 0 0 0 0 0 0 0 0 0 0

39,261 Provision for Doubtful Accounts 33,268 41,338 31,904 31,317 33,403 22,027 36,824 36,728 41,478 37,229 48,973

266,974 Total Deductions From Revenue 241,555 265,198 240,974 245,886 256,529 438,188 249,641 242,065 244,815 254,082 244,941

Net Patient Service Revenue 77,851 87,220 82,593 81,718 85,251 (119,714) 89,867 87,760 79,995 90,534 85,896 80,424

6,547 Division of Managed Care 7,458 6,610 7,423 7,229 7,398 7,351 7,006 8,298 7,167 7,347 7,214

10,757 Other Operating Revenue 5,657 5,447 4,904 6,242 4,855 223,884 6,114 4,708 11,206 5,535 5,980

1,941 Grants Revenue 2,041 2,217 1,581 1,094 1,707 1,357 1,535 1,617 2,525 2,146 1,882

99,669 Total Operating Revenue 93,006 101,495 96,501 96,282 99,211 112,879 104,522 102,384 100,894 105,562 100,973

69,234 Salaries & Related Costs 63,648 65,753 69,628 64,674 69,004 64,361 69,882 69,747 66,184 70,679 70,789

Contractual and Purchased Services 30,595 28,942 30,468 25,832 29,320 31,009 32,754 30,962 31,021 32,715 31,499 30,600

15,039 Supplies 15,596 16,239 14,492 16,380 15,105 13,522 16,712 16,255 17,524 17,785 14,655

Division of Managed Care Paid Claims 6,335 7,357 6,540 8,432 7,022 7,143 5,036 4,703 6,023 4,854 5,023 4,902

1,274 Interest 1,490 1,461 1,462 1,453 1,455 1,396 1,897 1,479 1,361 1,545 1,470

368 Provision for Self-Insured Claims 703 535 535 535 535 (3,942) 583 583 595 577 577

(199)Public Med/Assist. Trust F. Assess 1,090 1,096 1,090 1,102 1,141 1,245 821 1,203 1,358 1,358 1,370

4,641 Depreciation 4,684 4,684 4,648 4,688 5,259 4,451 4,666 4,947 5,035 5,690 5,556

0 Other Operating Expenses 4 0 0 0 13 1 1 6 0 (5) (7)

127,286 Total Operating Expenses 126,776 123,513 126,120 125,175 130,665 118,823 130,227 131,262 129,626 134,151 129,912

(27,617)Gain (Loss) From Operations (30,507) (25,281) (29,618) (28,893) (31,454) (5,944) (25,704) (28,878) (28,732) (28,589) (28,940)

1,162 Med. Edu. and Tert. Care Fund 1,289 1,289 1,157 1,355 1,355 621 1,355 1,355 1,355 1,355 1,355

56 Interest Income - Non. Operating 57 31 47 52 76 (360) 53 82 76 64 77

(1)Unrealized Gains and Losses (1) (1) (1) (1) (1) (65) (1) (1) (1) (1) (1)

156 Other Non-Operating 211 163 167 175 171 (415) 202 188 164 157 169

11,094 Dade County Unrestricted Funds 11,094 11,094 11,094 11,094 11,094 11,429 11,085 11,085 11,085 11,085 11,085

18,331 Unrestricted Health Care Surtax 20,878 17,855 16,172 18,144 16,304 15,853 15,895 16,256 16,571 17,252 16,292

TOTAL Non-Operating Gain Net 30,799 33,527 30,431 28,636 30,818 28,998 27,063 28,588 28,964 29,249 29,912 28,976

3,181 Revenue & Gain in Excess of Exp. & Loss 3,020 5,150 (982) 1,925 (2,456) 21,119 2,884 86 516 1,322 37

0 Capital Contributions – Grants and Other 0 0 0 0 0 0 0 0 0 0 0

437 JM Contributions 0 77 0 54 0 0 0 0 200 0 0

0 Miami Dade Cty. GOB 1,321 285 5 90 0 1,479 298 466 350 0 806

3,618 Revenue & Gain after Extraordinary Loss 4,342 5,512 (977) 2,070 (2,456) 22,598 3,182 552 1,066 1,322 843

FS-4

Jackson Health System Jackson Health SystemMarch 2013 Actual March 2013 YTD Actual

Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding

Jackson Memorial Hospital

Jackson South

Jackson North

Physician Services

JHS Health Plan

Nursing Homes

Primary Care

Corrections Health

Services

Jackson Medical Towers Total

Total Gross Inpatient Revenue 187,376 21,106 32,619 3,018 1 244,119Total Gross Outpatient Revenue 75,632 13,115 11,586 1,121 457 1,369 103,280Total Gross Revenue 263,008 34,220 44,205 1,121 3,474 1,370 347,398Total Deductions from Revenue -204,702 -24,168 -34,197 -934 -1,752 -1,222 -266,974Total Net Patient Revenue 58,306 10,052 10,008 187 1,723 148 80,424Other Operating Revenue 9,148 249 120 742 100 19 378 10,757

Managed Care Revenue 6,547 6,547

Grant Revenue 1,784 157 1,941

Total Other Operating Revenue 10,932 249 120 742 6,547 258 19 378 19,245

Total Revenue 69,238 10,301 10,128 930 6,547 1,980 167 378 99,669Operating ExpensesSalaries & Wages 46,715 3,851 3,714 966 -1 1,601 682 1,369 43 58,940

Benefits 8,085 662 644 160 1 378 111 247 6 10,294

Total Salaries & Benefits 54,800 4,512 4,357 1,126 1,980 793 1,616 49 69,234Purchased Services 16,111 1,324 2,830 616 289 365 1,063 39 111 22,747

Managed Care Paid Claims -421 6,047 5,626

UM AOA Purchased Service 8,553 -3 8 8,558

Total Purchased Service 24,242 1,324 2,830 616 6,335 362 1,071 39 111 36,930Supplies 11,911 1,389 1,323 6 263 19 117 11 15,039

Total Direct Operating Cost 90,954 7,225 8,511 1,748 6,335 2,604 1,883 1,772 171 121,203

Depreciation 3,433 844 267 10 6 49 9 4 19 4,641

Interest 1,242 2 30 1,274

Self Insurance 255 21 91 2 368

HCCB Assessment -218 -6 25 -199

Other Operating Expense

Total Other Operating Cost 4,711 859 385 10 6 49 11 4 48 6,083

Total Operating Expenses Before Allocations 95,665 8,084 8,895 1,759 6,341 2,653 1,894 1,776 220 127,286

Allocated Corporate Services:Clinical Trials Office 31 4 4 1 1 1 1 43

Corporate Administration 188 21 23 5 1 7 5 5 1 255Financial Services 713 80 88 17 3 26 19 17 2 965Human Resources 819 60 60 8 41 9 24 1 1,023

Integrity 139 15 17 3 1 5 4 3 188Information Technology 3,756 494 637 7 6 7 20 7 6 4,940

Public Safety 928 135 176 59 94 1,390Revenue Cycle Management 3,858 502 648 20 5,028

Strategic Sourcing 918 89 136 20 9 21 35 5 4 1,238Total Allocated Corporate Services 11,351 1,399 1,789 61 20 166 207 62 15 15,070

Total Expenses Subject to Allocation -15,070 -15,070Total Operating Expenses Including

Allocations 91,946 9,482 10,684 1,820 6,361 2,819 2,101 1,838 235 127,286

Excess of Operating Revenue over (under) Operating Expenses -22,708 819 -557 -890 186 -838 -1,934 -1,838 143 -27,617

Non Operating Revenue and ExpensesInvestment Income 56 56

Unrestricted Health Care Surtax 18,331 18,331

Miami Dade County Unrestricted Funds 11,094 11,094

Other Income 1,158 -1 161 1,318

JMH Foundation 437 437

Total Non Operating Revenue 31,076 -1 161 31,236Redistribution of Revenue -5,845 2,824 2,386 325 309

Total Non Operating Revenue After Redistribution 25,231 2,823 2,386 325 309 161 31,236

Excess of Revenue over (under) Expenses before GOB and County

Special Contributions 2,523 3,642 1,829 -890 186 -513 -1,624 -1,838 304 3,618

Miami Dade County GOB Contributions

Miami Dade County Special Contributions

Total Miami Dade GOB and Special Contributions

Excess of Revenue over (under) Expenses 2,523 3,642 1,829 -890 186 -513 -1,624 -1,838 304 3,618

FS-5 FS-6

Jackson Health SystemMarch 2013 YTD Actual

Combining Statement of Revenue & Expense Reflecting Allocated Corporate Overhead & Public Support Funding


Jackson South

Jackson North

Physician Services

JHS Health Plan

Nursing Homes

Primary Care

Corrections Health

Services

Jackson Medical Towers Total

Total Gross Inpatient Revenue 1,091,455 115,701 200,601 18,339 3 1,426,099Total Gross Outpatient Revenue 426,698 75,603 67,105 6,612 1,766 8,292 586,075Total Gross Revenue 1,518,153 191,304 267,706 6,612 20,105 8,295 2,012,175Total Deductions from Revenue -1,150,910 -142,066 -202,276 -5,271 -9,250 -7,343 -1,517,116Total Net Patient Revenue 367,243 49,238 65,430 1,341 10,855 952 495,059Other Operating Revenue 29,018 1,487 602 3,669 595 283 7 2,201 37,861

Managed Care Revenue 42,664 42,664

Grant Revenue 10,424 157 10,581

Total Other Operating Revenue 39,442 1,487 602 3,669 42,664 753 283 7 2,201 91,106

Total Revenue 406,686 50,725 66,031 5,009 42,664 11,608 1,235 7 2,201 586,165Operating ExpensesSalaries & Wages 265,083 21,495 22,269 5,316 -7 9,289 3,431 8,094 277 335,246

Benefits 53,558 3,910 3,903 915 7 2,315 584 1,454 48 66,696

Total Salaries & Benefits 318,642 25,405 26,172 6,231 11,604 4,015 9,548 325 401,941Purchased Services 83,263 7,372 16,288 3,744 2,149 2,179 3,698 292 557 119,543

Managed Care Paid Claims 40,680 40,680

UM AOA Purchased Service 58,615 2 1 35 121 58,772

Total Purchased Service 141,878 7,374 16,289 3,744 42,829 2,213 3,819 292 557 218,995Supplies 74,717 7,457 8,231 113 1,496 203 585 50 92,850

Total Direct Operating Cost 535,236 40,236 50,691 10,087 42,829 15,313 8,037 10,425 932 713,787

Depreciation 21,291 5,076 1,681 25 35 305 57 22 112 28,604

Interest 8,406 12 178 8,596

Self Insurance 2,532 124 544 12 3,212

HCCB Assessment 4,137 459 723 5,319

Other Operating Expense 17 17

Total Other Operating Cost 36,367 5,675 2,960 25 35 305 69 22 290 45,747

Total Operating Expenses Before Allocations 571,603 45,911 53,651 10,112 42,863 15,618 8,107 10,447 1,222 759,534

Allocated Corporate Services:Clinical Trials Office 275 30 35 7 1 10 5 7 1 372

Corporate Administration 9,766 1,077 1,259 237 51 366 187 245 29 13,217Financial Services 2,502 276 322 61 13 94 48 63 7 3,386Human Resources 5,955 429 449 60 1 298 63 167 11 7,432

Integrity 935 103 121 23 5 35 18 23 3 1,266Information Technology 20,156 2,423 3,389 40 38 41 106 40 38 26,271

Public Safety 4,485 728 950 317 507 6,986Revenue Cycle Management 23,003 2,899 4,056 126 30,083

Strategic Sourcing 5,705 536 886 139 78 133 141 32 22 7,671Total Allocated Corporate Services 72,782 8,501 11,466 566 187 1,293 1,201 577 110 96,682

Total Expenses Subject to Allocation -96,682 -96,682Total Operating Expenses Including

Allocations 547,702 54,412 65,117 10,678 43,051 16,911 9,307 11,024 1,332 759,534

Excess of Operating Revenue over (under) Operating Expenses -141,017 -3,687 914 -5,669 -387 -5,303 -8,072 -11,018 869 -173,370

Non Operating Revenue and ExpensesInvestment Income 312 7 319

Unrestricted Health Care Surtax 107,683 107,683

Miami Dade County Unrestricted Funds 66,563 66,563

Other Income 8,150 -5 499 8,643

JMH Foundation 568 568

Total Non Operating Revenue 183,277 -5 7 499 183,777Redistribution of Revenue -35,097 16,016 15,330 1,799 1,952

Total Non Operating Revenue After Redistribution 148,180 16,011 15,330 7 1,799 1,952 499 183,777

Excess of Revenue over (under) Expenses before GOB and County Special

Contributions 7,163 12,324 16,243 -5,669 -380 -3,504 -6,120 -11,018 1,367 10,408

Miami Dade County GOB Contributions

Miami Dade County Special Contributions 1,701 1,701

Total Miami Dade GOB and Special Contributions 1,701 1,701

Excess of Revenue over (under) Expenses 8,864 12,324 16,243 -5,669 -380 -3,504 -6,120 -11,018 1,367 12,109

FS-6

Combining Statement of Revenue & Expenses by Company

Public Health Trust of Miami-Dade County Consolidated


Month of March 2013

Jackson

SouthJackson

Memorial

Jackson

North

Physician

Services

JHS Health

Plan

Primary

Care

Centers

Corrections

Health

Services

Skilled

Nursing

Facilities

Jackson

Medical

Towers Total

Prior

Year

Actual

Revenue

187,376 241,603 21,106 32,619 Inpatient Revenue 0 0 1 0 3,018 0 244,119

75,632 106,792 13,115 11,586 Outpatient Revenue 1,121 0 1,369 0 457 0 103,280

348,395 Gross Patient Service Revenue 34,220 44,205 1,121 0 1,370 0 3,474 0 347,398 263,008

Deductions From Revenue:

147,424 179,962 18,627 27,384 Contractual Adjustments 934 0 394 0 797 0 195,560

Provisions For Charity Care 27,411 1,747 1,374 0 0 831 0 789 0 32,153 34,690

Net Patient Revenue Adjustment 0 0 0 0 0 0 0 0 0 0 0

29,866 41,748 3,794 5,439 Provision for Doubtful Accounts 0 0 (4) 0 165 0 39,261

204,702 256,400 Total Deductions From Revenue 24,168 34,197 934 0 1,222 0 1,752 0 266,974

58,306 91,995 Net Patient Service Revenue 10,052 10,008 187 0 148 0 1,723 0 80,424

0 7,211 0 0 Division of Managed Care 0 6,547 0 0 0 0 6,547

9,148 5,345 249 120 Other Operating Revenue 742 0 19 0 100 378 10,757

1,784 1,860 0 0 Grants Revenue 0 0 0 0 157 0 1,941

69,238 106,410 Total Operating Revenue 10,301 10,128 930 6,547 167 0 1,980 378 99,669

Operating Expenses

54,800 78,938 4,512 4,357 Salaries & Related Costs 1,126 0 793 1,616 1,980 49 69,234

24,242 32,183 1,324 2,830 Contractual and Purchased Services 616 6,335 1,071 39 362 111 36,930

11,911 14,909 1,389 1,323 Supplies 6 0 19 117 263 11 15,039

1,242 1,447 0 2 Interest 0 0 0 0 0 30 1,274

3,433 6,085 844 267 Depreciation 10 6 9 4 49 19 4,641

36 1,935 14 115 Other Operating Expenses 0 0 2 0 0 0 168

95,665 135,497 Total Operating Expenses 8,084 8,895 1,759 6,341 1,895 1,776 2,653 220 127,286

(29,087)Excess of operating revenue over (under)

operating expenses 2,217 1,233 (829) 206 (1,727) (1,776) (673) 158 (27,617)(26,427)

Other Revenues (Expenses)

56 187 (1) 0 Investment Income 0 0 0 0 0 0 55

18,331 18,470 0 0 Unrestricted Health Care Surtax 0 0 0 0 0 0 18,331

11,094 11,085 0 0 Miami Dade County Unrestricted Funds 0 0 0 0 0 0 11,094

1,158 1,520 0 0 Other Income 0 0 0 0 0 161 1,318

0 0 0 0 Miami Dade County Special Contributions 0 0 0 0 0 0 0

437 0 0 0 JM Foundation 0 0 0 0 0 0 437

0 4,029 0 0 Miami Dade County GOB Contributions 0 0 0 0 0 0 0

Total Other Revenues (expenses) 31,076 (1) 0 0 0 0 0 0 161 31,236 35,291

4,649 6,205 Excess of revenues over (under) expenses 2,216 1,233 (829) 206 (1,727) (1,776) (673) 319 3,618

FS-7

Unaudited

Current Month Year to Date Year to DateMarch 31, 2013 March 31, 2013 September 30, 2012

Cash generated (used) by operations:Funds available for working capital/facilities improvements $3,618 $12,109 $8,200

Non cash expenses:

Depreciation 4,641 28,604 66,316

Loss on disposal of capital assets - (50) 791

Total 8,259 40,663 75,307

Cash provided (used) for current assets:Decreases (increases) in:

Patient Receivable and Other Third Party payor (17,643) 52,333 (73,668)

Cash and Invst. Restricted - - -

Cash and Invst. Limited as to Use 33,075 (3,041) 28,181

Inventories, Prepaid Expenses and Other Receivables (1,651) (958) (1,132)

Total 13,781 48,334 (46,619)

Cash provided (used) for current liabilities:

Increases (decreases) in:Current Installment of Long Term Debt - - 305

Accounts Payable and Accrued Expenses 6,044 (26,771) (73,894)

Due to other third party (35,845) (44,132) 46,128

Other Liabilities (3,408) 13,926 (12,146)

Other- Restricted (1) (618) (5,531)

Total (33,210) (57,595) (45,138)

Decreases (increases) in:Cash and Invst. Limited as to Use 5,033 1,176 8,982

Cash and Invst. Restricted 1,102 7,410 20,755

Long Term Investment - - -

-

-

Cash provided (used) for Other Assets 29 (56) 695

-

Cash provided (used) for Long Term Liabilities: -

Increases (decreases) in: -

Long Term Debt 29 173 (6,980)

Other Liabilities 17,673 (4,911) (5,245)

Total 17,702 (4,738) (12,225)

Cash provided (used) for Prop., Plant and Equipment:Purchases of Prop. Plant and Equipment (2,746) (10,902) (27,697)

- -

Total (2,746) (10,902) (27,697)

- - -

Net Increase in Cash and Cash Equivalents 9,950 24,292 (25,940)

-

Cash, beginning of period 83,694 69,352 95,292

Cash, end of period 93,644 93,644 69,352

Public Health TrustJackson Health System

Combined Statement of Unrestricted / Restricted Cash FlowAs of March 31, 2013

FS-8

PUBLIC HEALTH TRUSTCONSOLIDATED PORTFOLIO INVENTORY SUMMARY BY SECURITY/ACCOUNT TYPE

March 31, 2013

# of Investments Description Par Value Avg. Interest Rate Market Value

2 Money Markets 13,747,694$ 0.010% 13,747,694

2 Total Investments Portfolio 13,747,694

Non-interest bearing account - Restricted 0.000% 1,194,844 Wells Fargo interest bearing accts 0.250% 105,005,216

Bond Proceeds Invested at Miami-Dade County 0.427% 70,898,572

Total Cash and Investments 190,846,326$

FS- 9

PUBLIC HEALTH TRUSTSALES TAX

MONTHLY INCOME STATEMENT TREND ANALYSIS

FISCAL YEAR 2011

Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11

monthly est 13,824,281 14,678,092 16,682,866 13,920,256 14,838,038 16,271,145 14,306,810 13,703,273 14,469,444 14,750,928 13,821,758 14,713,753

mo portion of qtly est: 1,000,647 1,000,647 1,000,647 1,028,196 1,028,196 1,028,196 1,059,468 1,059,468 1,059,468 1,065,225 1,065,225 1,065,225

State revision to Sales Tax Projection

+/-est vs. actual rec'd; mo of (517,641) 101,749 25,778 192,040 (226,996) (267,975) 667,173 576,264 (49,580) (574,440)

+/-est vs. actual rec'd; qt of 236,771 457,528 - - 304,129

Monthly Revenue 14,824,928 15,678,739 17,165,872 15,286,972 15,892,012 17,491,381 15,139,283 14,952,294 16,196,085 16,392,417 15,141,532 15,204,538

FISCAL YEAR 2012


monthly est 14,482,634 14,779,176 17,607,553 15,330,625 15,914,413 17,395,891 15,855,155 15,355,434 15,563,007 14,907,488 15,041,626 14,844,604

mo portion of qtly est: 1,079,571 1,079,571 1,079,571 1,180,705 1,180,705 1,180,705 1,160,844 1,160,844 1,160,844 1,143,468 1,143,468 1,143,468

State revision to Sales Tax Projection 500,000

+/-est vs. actual rec'd; mo of 10,720 1,238,686 671,986 (106,944) (724,478) 335,025 (153,187) (295,446) (757,063) 16,220

+/-est vs. actual rec'd; qt of 257,405 400,370 466,672

Monthly Revenue 15,562,205 15,858,747 18,697,844 17,750,016 18,024,509 18,469,652 16,291,521 17,251,673 16,570,664 16,255,510 15,894,703 16,004,292

FISCAL YEAR 2013


monthly est 15,096,482 16,870,407 15,156,957 15,600,201 15,600,201 15,600,201

mo portion of qtly est: 1,207,668 1,273,109 1,273,109 1,273,109 1,273,109 1,273,109

State revision to Sales Tax Projection

+/-est vs. actual rec'd; mo of (257,802) 981,343 3,665,869 1,457,919

+/-est vs. actual rec'd; qt of 338,409

Monthly Revenue 16,304,150 18,143,516 16,172,264 17,854,653 20,877,588 18,331,229 - - - - - -

Comments:

• Estimate was calculated based on same month prior year adjusted for percentage change of recent receipts

vs. recent estimates.

FS-10

Actual Budget % Variance Actual Actual Budget % Variance FC Group Mar-13 Mar-13 Budget Feb-13 YTD YTD Budget

Jackson Health System

Combined percentages:

Commercial 1.74% 2.35% -0.61% 2.00% 1.49% 2.34% -0.85%

Medicaid 16.83% 16.20% 0.63% 16.47% 17.14% 16.16% 0.98%

Medicare 17.41% 17.90% -0.49% 17.79% 16.86% 17.79% -0.93%

Other 4.30% 2.62% 1.68% 3.24% 3.24% 2.62% 0.62%

Managed Care 26.99% 26.24% 0.75% 27.70% 27.64% 26.14% 1.50%

Self Pay 13.40% 16.85% -3.45% 12.53% 13.43% 16.79% -3.36%

Potential Medicaid 19.33% 17.84% 1.49% 20.27% 20.20% 18.16% 2.04%

Total 100.00% 100.00% 0.00% 100.00% 100.00% 100.00% 0.00%


Combined percentages:

Commercial 2.06% 2.75% -0.69% 2.35% 1.73% 2.76% -1.03%

Medicaid 18.09% 17.32% 0.77% 18.30% 18.73% 17.40% 1.33%

Medicare 15.29% 14.51% 0.78% 15.27% 14.31% 14.57% -0.26%

Other 5.04% 3.04% 2.00% 3.58% 3.71% 3.05% 0.66%

Managed Care 25.17% 24.62% 0.55% 25.77% 25.63% 24.74% 0.89%

Self Pay 13.77% 16.96% -3.19% 13.06% 13.65% 17.04% -3.39%

Potential Medicaid 20.58% 20.80% -0.22% 21.67% 22.24% 20.44% 1.80%

Total 100.00% 100.00% 0.00% 100.00% 100.00% 100.00% 0.00%

Jackson SouthCombined percentages:

Commercial 0.66% 0.87% -0.21% 1.46% 1.07% 0.87% 0.20%

Medicaid 9.67% 9.40% 0.27% 7.35% 7.82% 9.37% -1.55%

Medicare 24.84% 24.90% -0.06% 24.49% 24.58% 25.12% -0.54%

Other 1.38% 2.40% -1.02% 3.13% 2.16% 2.39% -0.23%

Managed Care 38.56% 34.09% 4.47% 39.52% 38.24% 34.01% 4.23%

Self Pay 14.51% 19.23% -4.72% 12.52% 14.83% 19.17% -4.34%


Total 100.00% 100.00% 0.00% 100.00% 100.00% 100.00% 0.00%

Jackson NorthCombined percentages:

Commercial 0.57% 1.23% -0.66% 0.38% 0.43% 1.24% -0.81%

Medicaid 14.25% 14.97% -0.72% 12.10% 14.03% 14.98% -0.95%

Medicare 24.83% 30.25% -5.42% 27.43% 26.20% 30.24% -4.04%

Other 1.96% 0.52% 1.44% 1.42% 1.32% 0.49% 0.83%

Managed Care 29.91% 28.39% 1.52% 30.99% 32.27% 28.40% 3.87%

Self Pay 10.51% 14.06% -3.55% 9.63% 11.35% 14.06% -2.71%


Total 100.00% 100.00% 0.00% 100.00% 100.00% 100.00% 0.00%

Jackson Health System HospitalsPayor Mix Patient Days as % of Total

Fiscal Year 2012 - 2013

FS-11

Accounts Receivable All Hospitals March 2013 (FY13)

Revenue Cycle KPI’s

Cash Collections Goal Actual

March 2013 (FY13) $90M $ 77M◊

KPI Best Practice /Benchmark Goal Actual Prior Month

POS 2% of net collections $ 1.7M $1.9M $1.9M

Potential Medicaid Conversion

% of approvals compared to referrals for the prior 90 days. 90% 86% 93%

AR Greater than 90 Days

Less than 25% of discharged AR 25% 30% 31%

Denial Reduce Net denial write-offs FYTD (less Benefit exhausted amounts) (FY12=10.4%)

5.5% 9.6% 8.2%

Revenue Integrity Reduce late charge (# of charges) greater than 5 days (FY12=2.4%) 1.5% 2.1% 2.0%

Benchmarks obtained by: HARA & Advisory Board ** Internal Target. No industry benchmark available

◊ $7M Medicare PIP checked delayed until April

JHS CBO Cash Collections Month FY-12 Cash FY-13 Cash October $ 90,249,736 $ 93,035,086 November 83,841,693 $ 90,228,516 December 88,954,472 $ 76,727,419 January 76,200,810 $ 93,346,075 February 79,062,126 $ 81,386,890 March 96,923,009 $ 77,187,713 April 85,893,916 May 95,658,525 June 85,636,129 July 88,697,935 August 85,818,756 September 79,204,218 Total $ 1,036,141,325 $ 511,911,699

Source: JHS Treasury Management

Thank you,

6. Contracts and-or Agreements Recommended for Approval

6(a) LIP Cost Limit Agreement

6(b) Conflict Waiver Request-Greenberg Traurig

7. Purchasing and Facilities Subcommittee Report

7(a) Review and Recommend Approval of the Purchasing Report


PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD PURCHASING REPORT

April 29, 2013

TO: PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD FROM: PROCUREMENT MANAGEMENT DEPARTMENT The following recommendations are made in accordance with the Trust’s “Procurement Policy” and it’s implementing “Procurement Regulation.” This report includes competitively solicited contract awards over $3,000,000, waivers of formal competition over $250,000 and other categories for Board approval as prescribed by the Procurement Regulation. The entire report has been screened and assembled by the Procurement Management Department with the direct participation of the Administrator and staff, all subject to review by the Vice President, Strategic Sourcing Division, consultation with the President as needed, and review for legal sufficiency by the County Attorney’s Office. SECTION I. AWARDS UNDER INVITATIONS TO BID (ITB’s) This section consists of awards under competitively solicited Invitations to Bid (ITB’s) over $3,000,000. No items to report SECTION II. AWARDS UNDER REQUESTS FOR PROPOSALS (RFP’s) This section consists of awards under competitively solicited Requests for Proposals (RFP’s) over $3,000,000. No items to report SECTION III. AWARDS UNDER THE COMPETITIVELY SOLICITED CONTRACTS OF OTHER PUBLIC PROCUREMENT ENTITIES This section consists of awards over $3000,000 under competitively solicited (“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities. No items to report


SECTION IV. AWARDS UNDER GROUP PURCHASING ORGANIZATION (“GPO”) CONTRACTS This section consists of awards over $3,000,000 under Group Purchasing Organization (“GPO”) contracts. GPOs are organizations that aggregate the purchasing volume of their members consisting of hospitals and other health care providers to leverage discounts with manufacturers, distributors and other vendors to realize administrative savings and efficiencies. The Trust’s GPO is MedAssets. No items to report. SECTION V. AWARDS UNDER A WAIVER OF FORMAL COMPETITION

This section consists of awards over $250,000 without the formal solicitation of competitive bids or proposals. All award recommendations in this section have the approval of the President, are based on a finding that the waiver of competitive bidding is in the best interests of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. A. Sole Source No items to report B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician or clinician has requested the particular item or service without which the physician or clinician cannot successfully and safely render patient care. 1. (255077, 255069, 255074, 255072, 255073 and 255076-KD) The Perioperative Services Department requests contract awards to Stryker Spine, a Division of Howmedica Osteonics Corp. (“Stryker Spine”), Medtronic Sofamor Danek USA, Inc. (“Medtronic”) and NuVasive, Inc. for a period of two years for the continued provision of spinal implant products and related accessories (ongoing purchase).

Balance of page Intentionally left blank


SECTION V. (cont’d.) This Request for Funding

Stryker Spine: $310,000 (For two years)

Medtronic: $3,500,000 (For two years)

Nuvasive: $900,000 (For two years)

Total approved funding $4,710,000

(For the entire two-year period)

Background Stryker Spine, Medtronic and Nuvasive will continue to provide to the Trust spinal implant products, generally used to fuse the spine in the neck and lower back.

Discussions with surgeons concerning their utilization of these products were conducted by MedAssets, Procurement and the Value Analysis Team as part of a greater initiative to identify additional savings opportunities for the Trust without limiting product choices. The resulting feedback was that continued utilization of the spine products provided by the above-listed vendors was preferred, as these products offer the physicians better surgical choices. Historically, the Physicians have utilized these vendors’ products to meet the specific needs of the patient, and this has resulted in different levels of spend among the vendors. Some of the products offered by the three vendors are similar but not exactly alike. The Physicians make their choices based on the different technology types (different types of instrumentation used with spinal implant products) suited to both physician’s and patient’s need. Access to varying technology types offered by these vendors have also served Jackson’s teaching mission. The main focus of this initiative was to standardize on price in a given product category among the vendors. To this end, MedAssets and the Value Analysis Team entered into negotiations with these three existing vendors, achieving reductions by line item across the majority of vendor products to realize standardized pricing. The negotiated price reduction was effective immediately with Stryker and Medtronic. Stryker Spine’s pricing reflects an estimated $121,745 in savings. The pricing from Medtronic reflects approximately $693,673 in savings. The pricing offered by Nuvasive will be effective when the contract is executed resulting in approximately $96,047 in savings. The


SECTION V. (cont’d.) estimated dollars requested for each vendor have been capped and are stated as a maximum contract value in the individual Agreements. ECRI has reported that the new pricing provided by these vendors falls within the average competitive price point of the ECRI Price Guide database for these products. Recommendation After review of and discussions on the information presented, the Procurement Management Department recommends physician preference awards to Stryker Spine, Medtronic and Nuvasive for the provision of spinal implant products and related accessories.

These contracts have been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal sufficiency.

The underlying contracts can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. Bid Waiver Justifications were provided and Conflict of Interest Declarations were signed by: Fernando Garcia, Administrator, Medical Hospital Center; Eric Metzler, Director, MedAssets; Dr. Barth A. Green, MD., Professor of Clinical, Neuro Surgery; Dr. Nathan H. Lebwohl, Voluntary Associate Professor of Clinical for Orthopedic; Beth Caputo, Branch Manager, Stryker Spine; and, by Tamira Morris, Contract Manager, Medtronic, with no reported disclosures. Scott Duvall, Executive V.P., Strategic Sales & Operations, Nuvasive, also signed a Conflict of Interest Declaration and has disclosed that Dr. Steven Vanni currently teaches a procturing course on Nuvasive’s behalf for a stipend. Dr. Vanni has also signed a Conflict of Interest Declaration (A. Contreras). C. Standardization Items in this category have been established as the Trust standard. No items to report D. Non-Competitive Cooperative Purchasing This subsection consists of awards under the contracts of other public entities that were not competitively solicited. No items to report


SECTION V. (cont’d.) E. Miscellaneous Bid Waiver This subsection consists of awards not falling in the other categories of waiver of formal competition but where waiver is deemed to be in the best interests of the Trust. No items to report

SECTION VI. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE COMPETITIVELY SOLICITED This section refers to existing contracts that were competitively bid (“ITB” or “RFP”) at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. No items to report SECTION VII. OPTIONS-TO-RENEW AND CONTRACT MODIFICATIONS FOR CONTRACTS THAT WERE AWARDED UNDER A WAIVER OF FORMAL COMPETITION This section refers to existing contracts that were not competitively bid at their origin and consists of either (a) the exercise of established options-to renew or (b) the execution of contract modifications for which the Procurement Policy requires prior Board approval. All contracts in this section are renewals not previously authorized by the Board have the written approval of the President, are based on a finding that the waiver of full and competitive bidding is in the best interest of the Public Health Trust, and require a two-thirds affirmative vote of the Trustees present for approval. No items to report

SECTION VIII. MISCELLANEOUS

This section consists of procurement actions that require Board approval not included under any other section of the Purchasing Report. No items to report

7(b) Resolution Recommended to be Approved

Agenda Item 7 (b) (1) Fiscal Committee April 18, 2013

RESOLUTION NO. PHT 04/13 – RESOLUTION AUTHORIZING THE PRESIDENT OR HIS DESIGNEE TO ENTER INTO A LEASE AGREEMENT WITH SIKMA CORPORATION, A FLORIDA CORPORATION FOR THE RENTAL OF THREE THOUSAND EIGHT HUNDRED EIGHTY-SIX (3,886) SQUARE FEET OF OFFICE SPACE IN SUITE 230 AT THE REGENCY MEDICAL CENTER BUILDING LOCATED AT 9195 SUNSET DRIVE, MIAMI, FLORIDA 33173, FOR A PERIOD OF FOUR YEARS COMMENCING ON SEPTEMBER 1, 2012, WITH ONE (1) FOUR-YEAR OPTION TO EXTEND, FOR AN ANNUAL PAYMENT OF ONE HUNDRED THIRTY-THREE THOUSAND AND SIXTY-SEVEN DOLLARS ($133,067) WITH ANNUAL INCREASE IN BASE RENT OF THREE PERCENT (3%)

(Madeline Valdes, Corporate Director, Property Management Division)

WHEREAS, the Public Health Trust is authorized pursuant to Chapter 25A of the Code of Miami-Dade

County to lease real property either as lessor or as lessee; and

WHEREAS, the President, Purchasing and Facilities Subcommittee and Fiscal Committee recommend

approval.

NOW, THEREFORE BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes the

President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for

the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in suite 230 at the Regency

Medical Center Building located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years

commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred

Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent

(3%), in accordance with the recommendation set forth in the agenda item attached hereto and incorporated herein

by reference.

PURCHASING AND FACILITIES SUBCOMMITTEE 04-18-2013 FISCAL COMMITTEE 04-18-2013

REQUEST

Staff requests authorization for the President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in suite 230 at the Regency Medical Center Building located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent (3%). BACKGROUND

During the 2012 fiscal year, Jackson Health Systems (JHS) initiated a strategy to review and revamp the operations of hospital owned Agency and Jackson Medical Group (JMG) practices. Part of that process was to review expenses and supporting contractual obligations. During the review process, it was discovered that a final written lease for the space currently utilized by the JMG Colorectal practice had not been executed. Though the parties had agreed to the terms of a lease, and they had governed themselves in accordance with said terms, they never actually signed a final version of the lease. In addition, it was discovered that the initial duration of the lease contemplated by the parties may have expired. JHS’ Physician Services (PS) staff immediately contacted the landlord to negotiate a new lease for the space. During the process it was further discovered by PS staff that the space being leased was partially owned by the JHS employed physician (Dr. Gustavo Plasencia) who was assigned to work in the space. This fact was reported to JHS Compliance Department, which advised that a fair market valuation (FMV) needed to be conducted for both the new lease period and for the prior, unexecuted lease term. It should also be noted that landlord agreed to toll lease payments until after proper approval of the lease and a corresponding FMV was received.

RECOMMENDATION

Staff recommends authorizing the President or his designee to enter into a new Lease Agreement with Sikma Corporation, a Florida Corporation for the rental of three thousand eight hundred eighty-six (3,886) square feet of office space in suite 230 at the Regency Medical Center Building located at 9195 Sunset Drive, Miami, Florida 33173, for a period of four (4) years commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067) with an annual increase in base rent of three percent (3%).

Agenda Item No. 6 Purchasing & Facilities Subcommittee Meeting April 18, 2013

PROPERTY MANAGEMENT DIVISION

CONTRACT SUMMARY – NEW LEASE I. CONTRACT TITLE: The Sikma Corporation, a Florida Corporation (Landlord) and

the Public Health Trust of Miami-Dade County, Florida (Tenant) for use of office space in suite 230 at the Regency Medical Center Building located at 9195 Sunset Drive, Miami, Florida, 33173.

II. FINANCIAL IMPACT AND SUMMARY:

Staff requests authorization to continue to occupy at the Regency Medical Center Building suite 230, located at 9195 Sunset Drive, Miami, Florida, 33173. The existing location consists of three thousand eight hundred eighty-six (3,886) square feet of office space for a period of four (4) years commencing September 1, 2012, with one (1) four-year option to extend, for an annual payment of One Hundred Thirty-Three Thousand and Sixty-Seven Dollars ($133,067), with an annual increase in base rent of three percent (3%).

III. TERMS:

Description Proposed Terms Rental Rate +/- 3,886 sq. ft. @ $34.24 Annual Rent $133,067 Comm. Area Maintenance Fee No charge Rate Adjustment Annual 3% increase Lease Term Four (4) years – September 1,

2012 to August 31, 2016 Renewal Options One four-year option Utility Costs Metered separately and a cost

to the PHT Renovation Costs/Repairs No cost to PHT Parking No cost to PHT Exceptions to PHT Guidelines None

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE


Joint Conference and Efficiencies Committee Stephen S. Nuell, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Mojdeh L. Khaghan Marcos Jose Lapciuc Darryl K. Sharpton

Date, Time and Location April 18, 2013 – To follow the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA

1. Approval of the Previous Meeting Minutes (Stephen S. Nuell, Chairperson)

(a) *Meeting Minutes as of March 14, 2013

2. Chief Medical Officer Report (Michael Butler, MD, Executive Vice President, Chief Medical Officer, Jackson Health System)

3. President of the Executive Medical Committee of the Medical Staff Report (Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff, Jackson Health System)

4. Review of the Credentials Committee Decisions

(Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff, Jackson Health System)

(a) Review and Recommend Approval of the Credentials Activity Report – April 2013

(Support document will be distributed at the meeting.)

(b) Resolutions Recommended to be Approved

(1) *Resolution approving and adopting revisions to the Public Health Trust Withholding, Withdrawing and Foregoing Life-Sustaining Treatment (Adults) policy and procedure— April 2013

(Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

(a) *Policy 400.015 Withholding, Withdrawing and Foregoing Life Sustaining

Treatment (Adults)

(2) *Resolution approving and adopting to the Public Health Trust perioperative Do-Not-Resuscitate (DNR) Orders (Adults) policy and procedure— April 2013


(a) *Policy 400.130 Perioperative Do-Not-Resuscitate (DNR) Orders

(3) *Resolution approving and adopting to the Public Health

Physician Orders for Life Sustaining Treatment (POLST) (Adults) policy and procedure— April 2013


(a) *Policy 400.131 Physician Orders for Life Sustaining Treatment(POLST)

(ADULTS)

Joint Conference and Efficiencies Committee Agenda April 18, 2013 Page 2 of 2

(4) * Resolution approving and adopting to the Public Health Trust JHS -Physician Orders for Life Sustaining Treatment (POLST) for Adult Patients Form C-290ZL- April 2013 (Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System)

(a) *JHS - Physician Orders for Life Sustaining Treatment (POLST) for Adult

Patients C-290ZL POLST Order Form 5. Standing Reports

(a) Health Education Network (HEN) Quality & Safety: What Does The Future Look Like

(Kevin Andrews, Vice President, Quality and Patient Safety, Jackson Health System)

(b) Scorecard and Bridges to Quality Report (Kevin Andrews, Vice President, Quality and Patient Safety, Jackson Health System)

Agenda items noted with an asterisk (*) indicate that the supporting documents are attached.


Joint Conference and Efficiencies Committee Stephen S. Nuell, Chairperson Joe Arriola, Vice Chairperson Michael Bileca

Mojdeh L. Khaghan Marcos Jose Lapciuc

Darryl K. Sharpton

Date, Time and Location March 14, 2013 – Followed the Fiscal Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Joint Conference and Efficiencies Committee Stephen S. Nuell Joe Arriola Mojdeh L. Khaghan Marcos Jose Lapciuc Darryl K. Sharpton

Excused Michael Bileca

Jackson Health System Kevin Andrews Carlos A. Migoya Michael Butler, MD Joshua Lenchus, DO Don S. Steigman Matthew Pinzur Ed O’Dell Jeffrey Crudele Maria Huot-Barrientos Anne Prendergast Alejandro Contreras Janice Gonzalez Lilly Lee, MD Christian Mata, MD Roboam Aguirre Danny Anderson Miami-Dade County Attorneys Christopher Kokoruda Laura Llorente

Joint Conference and Efficiencies Committee Meeting March 14, 2013 Page 2 of 3 MEETING CALL TO ORDER With a quorum being present, the Joint Conference and Efficiencies Committee meeting was called to order by Stephen S. Nuell, Chairperson, Joint Conference and Efficiencies Committee at 10:25 a.m. 1. APPROVAL OF THE PREVIOUS MEETING MINUTES

(a) Meeting Minutes as of February 21, 2013

Mr. Nuell requested a motion approving the meeting minutes as of February 21, 2013.

The meeting minutes of February 21, 2013 was approved with the correction to the name of Barry Gelman. The correction of the name is as follows: Barry Gelman, MD.

2. CHIEF MEDICAL OFFICER REPORT, JACKSON HEALTH SYSTEM

Michael Butler, MD, Chief Medical Officer, Jackson Health System reported the following:

• Graduate Medical Education • Adult Bioethics Committee Summary • Credentialing Summary • Medical News & Announcements • Clinical Goals • Timely Discharges • Core Measures

3. CHAIRMAN OF THE MEDICAL STAFF REPORT

Joshua Lenchus, DO, Chairman, Medical Executive Committee, reported the following:

• Patient Safety Center – Teamwork Training Exercise • Bioethics Committee revising End-of-Life procedures • Medical Staff Bylaws being implemented

4. REVIEW OF THE CREDENTIALS COMMITTEE DECISIONS

(a) The Committee reviewed for approval the Credentials Committee Activity Report as of March 2013. (See attached

summary report.)

Mr. Nuell requested a motion for the Credentials Committee Activity Report as of March 2013.

Mr. Arriola moved approval; seconded by Mr. Sharpton and

carried without dissent. The Committee was provided with a copy of the Credentials Activity Report as of March 2013.

Joint Conference and Efficiencies Committee Meeting March 14, 2013 Page 3 of 3 5. STANDING REPORTS

(a) Follow-up Service Excellence Update Maria Huot-Barrientos, Senior Vice President and Chief Human Resources Officer, Jackson Health System (JHS) presented a follow up and Service Excellence Update explaining key aspects of leadership performance and engagement and the impact it has on the organization. Ms. Huot-Barrientos also presented a review of phase two which include launching a Uniform Policy creating a uniform look for JHS staff, the physician and employee survey, the marketing campaign for Miracles Made Daily, Guest Services formerly known as Patient Relations, and On-line Orientation.

(b) ED Task Force Update

Alejandro Contreras, Senior Vice President and Chief Administrative Officer, Jackson Memorial Hospital, and members of the ED Task Force presented a review of the new Dashboard that has been employed in all JHS Emergency Room Departments and Triage areas. Janice Gonzalez, Director, Patient Care Services and Emergency Room Department, Jackson Memorial Hospital explained how the Dashboard is used as a Throughput Management Tool to show the length of time patients receive care, assigned a patient bed, and discharged all in real-time. The Committee expressed thanks to the ED Task Force for their accomplishments.

(c) Scorecard and Bridges to Quality Report

The item was deferred.

MEETING CALL TO ADJOURN

The Joint Conference and Efficiencies Committee meeting adjourned at 12:22 p.m. Transcribed by Kimberly A. Calhoun, Executive Assistant Quality and Patient Safety Division Jackson Health System

CREDENTIALS COMMITTEE MONTHLY ACTIVITY REPORT

MARCH 2013

Medical Staff Allied Health Professionals

Initial Applicant(s) ( 19 ) – Community Physician(s) ( 12 ) – Academic Physician(s) 31 11 Provisional Annual Evaluations 8 1 Reappointments(s) 85 8 Reappointments(s) Reinstatements 0 0 Termination 0 0 Notification of Site(s) of Practice a. Correction of Clinical Privileges 1 0 b. Request for Additional Privileges 1 0 c. Change of Membership Category 1 0 d. Additional/Change Sponsor 0 1 e. Additional Service/Facility 1 0

f. Request for Change of Service/Clinical Privileges 0 0

g. Delete Sponsor/Privileges 0 0 h. Denial of Clinical Privileges – Modified 0 0 i. Relinquish Clinical Privileges/Facility 5 1 j. Request for reduction of clinical privileges 0 0 k. Deceased 0 0 l. Request for Leave of Absence 0 0 Resignation(s) 5 2 Voluntary Withdrawal and Voluntary Relinquishment of Membership and Privileges: 0 0 a. Incomplete Reappointment(s) 0 0 b. Reappointment Application Not Returned 8 3 c. Lack of Utilization 0 0

2. Chief Medical Officer Report

3. President of the Executive Medical Committee of the Medical Staff Report

4. Review of the Credentials Committee Decisions

4(a) Review and Recommend Approval of the Credentials Activity Report-April 2013

4(b) Resolutions Recommended to be Approved

Agenda Item 4 (b) (1) Joint Conference and Efficiencies Committee April 18, 2013

RESOLUTION NO. PHT 04/13 –

RESOLUTION APPROVING AND ADOPTING REVISIONS TO THE PUBLIC HEALTH TRUST WITHHOLDING, WITHDRAWING AND FOREGOING LIFE-SUSTAINING TREATMENT (ADULTS) POLICY AND PROCEDURE— APRIL 2013


WHEREAS, the Withholding, Withdrawing and Foregoing Life-Sustaining Treatment (Adults)

Policy and Procedure (“Policy”) was revised so as to be in compliance with the Joint Commission on

Accreditation of Health Care Organization standards, statutory requirements, and the current practice of

the Medical Staff; and

WHEREAS, the Medical Executive Committee of the Medical Staff reviewed and approved the

changes to the Policy; and

WHEREAS, the recommended revisions were provided to the Joint Conference Committee on

April 18, 2013; and

WHEREAS, a copy of the Policy, as amended, has been attached hereto and incorporated herein by

reference.

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF

THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that it hereby adopts the

attached comprehensive amendment to the Public Health Trust Bylaws of the Medical Staff; and that this resolution

shall be effective upon its passage.

SUPERSEDES: 12/19/08 CODE NO. 400.015

POLICY & PROCEDURE MANUAL

SECTION: 400 - CARE OF THE PATIENT

SUBJECT: WITHHOLDING, WITHDRAWING AND FORGOING LIFE- SUSTAINING TREATMENT (ADULTS)

DATE: 04/08/2013 PAGE 1 OF 5

POLICY: Purpose It is the policy of the Public Health Trust (PHT) to create an environment in which dying patients can choose a peaceful, comfortable and dignified death. It is also PHT policy to respect the rights of all patients to make decisions concerning their care, and to involve patients and their families or authorized representatives, as appropriate, in treatment and care decisions. Every competent patient has the right to determine which treatment options he or she will accept or refuse, including life-sustaining procedures and treatment.

Right of Patients to Refuse Treatment The PHT recognizes the right of competent adult patients to make oral or written declarations instructing their physicians to withhold or withdraw life-prolonging procedures, or to designate another person to make such decisions for them if they are unable to do so. Patients with capacity have the right to refuse any treatment, including life-sustaining treatment. No particular diagnosis or prognosis is required for such a refusal to be honored. Under Florida law, patients are presumed to have capacity unless the attending physician determines otherwise. If a patient is incapacitated, an advance directive, if one is available, shall take effect. Inappropriate or Futile Care On the other hand, a patient’s request for a particular treatment is not necessarily binding. A patient might, for instance, request a treatment which is medically inappropriate, physiologically impossible, illegal or dangerous. In such cases, the request does not impose a duty upon clinicians or institutions to administer the treatment. Indeed, the intentional delivery of ineffective or nonbeneficial treatment may be an affront to professional medical integrity. The question of whether a request for treatment is appropriate requires a judgment by the health care team, sometimes in consultation with the Adult Bioethics Committee and/or institutional officials. Compliance with Advance Directives Health care providers and institutions are generally required to comply with patients’ Advance Directives. (See Jackson Health System (JHS) Policy 122 regarding the procedures for Advance Directives.) For the purposes of the present policy, these include, but are not limited to, living wills, designations of a surrogate, durable powers of attorney for health care, and Florida’s pre-hospital Do Not Resuscitate Order (sometimes called “the yellow form”). A patient may have chosen not to complete an Advance Directive for many reasons and no inferences should be drawn from the absence of an Advance Directive regarding a patient’s intent to consent to or refuse life-prolonging procedures. When a patient or appropriate surrogate or proxy advises a member of the healthcare team of a wish to decline treatment, the team member shall notify the patient’s attending physician, who shall document the patient’s preferences in the medical record and who shall order the withholding or withdrawing of the treatment which the patient has refused. Under no circumstances shall the patient’s wish to forgo a particular treatment restrict the patient from receiving any other care or treatment, including pain management.





DATE: 04/08/2013 PAGE 2 OF 5

PROCEDURE:

1. Advance Directives

a. An Advance Directive shall be documented with the appropriate physician order in the medical record. This can be accomplished by completing the Physician Orders for Life Sustaining Treatment (POLST, i.e., C-290ZL) form. In the event that a patient has not completed or presented an Advance Directive, the physician should encourage the patient, if capacitated, to complete one. If the patient is no longer able to make informed health care decisions, and has failed to designate a surrogate, a proxy shall be appointed in accordance with JHS Policy 122, “Advance Directives,” and Florida law.

Under Florida law, a proxy may not make withholding or withdrawing decisions for an adult patient who has never had capacity to consent to or refuse treatment, designate a health care surrogate or execute a living will. In such situations, a guardian must be appointed by a court.

b. If presented with a Florida Department of Health pre-hospital Do Not Resuscitate

Order, health care providers shall treat the document as an Advance Directive and consider the instructions of the patient or the authorized representative. The attending physician or designee shall then write the appropriate order in the patient’s medical chart using the POLST form. (See also Section IV of JHS Policy 122, “Advance Directives,” for restrictions on health care surrogate and proxy decision making.)

c. Florida law requires that withdrawal or withholding of life-sustaining treatment under an advance directive or surrogate or proxy instructions occur after it is determined the patient has a terminal condition, has an end-stage condition, or is in a persistent vegetative state. This determination requires that “the patient’s attending or treating physician and at least one other consulting physician … separately examine the patient. The findings of each such examination must be documented in the patient’s medical record and signed by each examining physician before life-prolonging procedures may be withheld or withdrawn.” Nevertheless, patients still have the broader constitutional right of privacy – the right to self-determination – to make health care decisions, including end-of-life decisions, even when the statutory requirements are not met.

2. Cardiopulmonary resuscitation (CPR) should generally be initiated by hospital personnel at the time of a cessation of cardiac or respiratory activity unless a Do Not Resuscitate (DNR) order is in effect, as documented on the POLST form. See also “Perioperative Do-Not-Resuscitate (DNR) Orders” policy (400.130). If a DNR order is in effect, the patient’s wristband shall contain the purple alert snap which indicates the patient is a DNR.





DATE: 04/08/2013 PAGE 3 OF 5

3. The first physician arriving at a CPR attempt initiated by a non-physician must determine

(a) if death has occurred, (b) if a DNR order is in effect, (c) if death was expected but documentation to that effect has not been completed or (d) if continued treatment is or will be ineffective. In all such circumstances, the physician may direct that CPR efforts cease. In all other cases, CPR efforts shall continue until they are determined by the physician to be ineffective.

4. If a physician who is present when a patient’s cardiac or respiratory activity ceases

determines that CPR would be ineffective, inappropriate, and/or non-beneficial, then CPR need not be attempted.

5. A DNR order does not take effect until cardiac or respiratory activity fails to function at a

level sufficient to support life. All therapy and treatment, other than CPR, should continue unaffected by a DNR order unless the cessation of that therapy or treatment is warranted on separate grounds. A DNR order on a POLST form is not to be used as a substitute for less aggressive treatment. Less aggressive treatment might very well be appropriate, but it should be documented by means other than a DNR order.

6. In cases in which two attending physicians determine, according to a reasonable degree

of medical probability, that a patient is dying and that aggressive medical treatment is or would be ineffective or of no demonstrable benefit, then the patient’s, surrogate’s or proxy’s requests for such treatment do not impose an obligation on the health care team to offer or provide the treatment.

Assessments of effectiveness, benefit or futility should be made on the basis of the likelihood of medical success, and not on the patient’s current or projected quality of life. That is, the assessment should emphasize the physiologic status of the patient (e.g., “the patient will die despite the treatment”) and not the physician’s estimation regarding the quality of the life likely to follow the attempted treatment (e.g., “the patient will survive but not be restored to baseline status”). Patients and their surrogates or other authorized representatives, on the other hand, might very well want to consider quality of life in deciding whether to consent to or decline treatment. In non-emergency situations, members of the health care team shall confer with the patient, surrogate or proxy and document in the medical record (a) the goals of treatment, (b) the nature of the condition, (c) the range of options for care, including palliative care, hospice care, social work and pastoral care, (d) the patient’s wishes (or when applicable, the patient’s wishes as reasonably understood by the surrogate or proxy), (e) the prognosis, and (f) the reasons why the particular treatment(s) is (are) ineffective, inappropriate, non-beneficial or futile. Note that if there is no indication of what the patient would have chosen, the proxy or surrogate should consider the patient’s best interests in deciding whether to accept or refuse a treatment.





DATE: 04/08/2013 PAGE 4 OF 5

If a patient, surrogate, or proxy nevertheless insists that inappropriate, ineffective or non-beneficial treatment be provided, the following steps may be taken: A. The patient’s attending physician or designee should document the information

itemized in (a)-(f) above in the patient’s medical record.

B. The attending physician should attempt to increase efforts to communicate with the patient, surrogate or proxy. Communication in such cases is of paramount importance. Health care team members should explain that although the requested intervention is medically non-beneficial and therefore will not be provided; neither will the team abandon the patient. The team will continue to provide appropriate and humane medical care, including care to promote comfort, dignity and emotional and spiritual wellbeing. Gentle and supportive communication should prevail throughout the process. Patients or any surrogates or proxies should be made aware of the full range of palliative, pastoral care, social work and ethics support services available at Public Health Trust institutions.

C. Decisions to withhold or withdraw treatment based on assessments of ineffectiveness and futility, and which elicit disagreement from patients, surrogates or proxies, shall be communicated to the Adult Bioethics Committee for a formal consultation. As with other consultations, the medical team in such cases is not bound by Bioethics Committee recommendations; decision-making authority resides with the attending physician.

D. Every reasonable effort should be made by the attending physician to identify

and address disagreements between or among members of the health care team.

E. Each of these discussions and decisions shall be documented in the medical record.

7. For a patient who is in a persistent vegetative state (PVS) with no advance directive, no

indication of what the patient would have wanted under the circumstances and if, after a reasonably diligent inquiry, no family or friends are available or willing to serve as a proxy, then life prolonging procedures may be withdrawn under the following conditions: a guardian shall be appointed by a court and the guardian, the attending physician and the medical ethics committee together conclude that the condition is permanent, there is no reasonable medical probability of recovery and withholding or withdrawing treatment is in the best interest of the patient. Moreover, advice may be sought from the Adult Bioethics Committee regarding withdrawing or withholding treatment during the process to identify and appoint a guardian.





DATE: 04/08/2013 PAGE 5 OF 5

8. Efforts to minimize pain and provide comfort and quality care are always appropriate. The proper dose of pain medication is the dose that is sufficient to relieve pain and suffering, regardless of secondary consequences. This medical standard is supported by Florida law.

9. The Advance Directive of a patient who is pregnant shall have no effect once the fetus

has been determined to be viable. Florida Statutes define “viability” as the stage of fetal development when the life of the fetus may, to a reasonable degree of medical probability, be continued indefinitely after delivery.

10. The Adult Bioethics Committee is available at all times for consultations with patients,

families, and health care team members. The Adult Bioethics Committee may be contacted by calling 305-243-2222.

11. Conflicts between or among medical team members, or between health care providers and the patient, proxy or surrogate, may be referred to the appropriate Chief of Service, Risk Management and/or the Adult Bioethics Committee.

APPROVAL: Medical Executive Committee (MEC) April 8, 2013 Joint Conference and Efficiencies Committee April 18, 2013 Financial Recovery Board April 29, 2013 AUTHORIZATION: Carlos A. Migoya, President and CEO, Jackson Health System



RESOLUTION APPROVING AND ADOPTING TO THE PUBLIC HEALTH TRUST PERIOPERATIVE DO-NOT-RESUSCITATE (DNR) ORDERS (ADULTS) POLICY AND PROCEDURE— APRIL 2013


WHEREAS, the Perioperative Do-Not-Resuscitate (DNR) Orders (Adults) Policy and Procedure

(“Policy”) was reviewed so as to be in compliance with the Joint Commission on Accreditation of Health

Care Organization standards, statutory requirements, and the current practice of the Medical Staff; and


Policy; and

WHEREAS, the recommended policy was provided to the Joint Conference Committee on April

18, 2013; and


reference.





SUPERSEDES: NA CODE NO. 400.130



SUBJECT: PERIOPERATIVE DO-NOT-RESUSCITATE (DNR) ORDERS (ADULTS)

DATE: 04/08/2013 PAGE 1 OF 2

POLICY It is the policy of the Public Health Trust (PHT) and the Jackson Health System to honor and respect patients’ rights to refuse treatment, including cardiopulmonary resuscitation. Notwithstanding this commitment, there are circumstances in which a do-not-resuscitate order (DNR) might be inappropriate. This policy addresses the evaluation and re-evaluation of DNRs in the perioperative period. This policy is related to and expands on Policy 400.004, DNR Orders.

PROCEDURE 1. Scope and Documentation This procedure applies to patients for whom a DNR (or DNR/DNI – “do not intubate”) order has been written, or who have requested other limitations of treatment. When such a patient is scheduled for a surgical or other invasive procedure in an operating room, the DNR or other limitation shall be discussed with the patient (or the surrogate, proxy or guardian) by the attending anesthesiologist and attending surgeon in connection with the specific goals for the perioperative period. This discussion should include information about or otherwise address:

a) The risks and potential benefits of the procedure being performed; b) The goals for the perioperative period; and

c) The possible outcomes with or without resuscitation. A progress note as well as a physician’s order shall be made in the chart and communicated to the intraoperative and postoperative teams. The note will document the decision-making process, the role of professional staff, the role of patient/family/proxies and the information on which any decision is based. 2. Options

A key goal of this process is to determine if the DNR should remain in effect during the surgery. Emphasis should be on which resuscitative procedures will be conducted rather than on which will not be conducted. The process seeks agreement with the patient or the patient’s legal representative on the following options:

Full resuscitation – the patient will receive full resuscitation efforts regardless of clinical condition. Goal-directed resuscitation – The team will attempt to resuscitate the patient in the operating room or the post-anesthesia care unit (PACU) only if any adverse clinical events are believed to be both temporary and reversible. This decision should be made based on the judgment of the attending anesthesiologist and surgeon and should take into account the patient’s values and the goals of treatment.

SUPERSEDES: NA CODE NO. 400.130



SUBJECT: PERIOPERATIVE DO-NOT-RESUSCITATE (DNR) ORDERS (ADULTS)

DATE: 04/08/2013 PAGE 1 OF 2

Procedure directed – Resuscitation will be attempted with the exception of chest compressions or cardioversion, where either exception must be clearly documented in the chart by the attending anesthesiologist or surgeon. Note that airway management and intravenous fluids are exempt (that is, will always be provided as needed) because refusal would be inconsistent with requests for anesthesiology and surgery. Additional options – Other interventions that may be considered include, but are not limited to intra-aortic balloon pump, left ventricular assist device and extra-corporeal membrane oxygenation.

3. Specifications

1. In the event of disagreement, the care team shall have the option to seek to transfer a patient who insists on a DNR order during surgery to another institution. However, reasonable efforts should be made to avoid such a disagreement.

2. Iatrogenic causes of arrest do not deserve any special consideration; the patient’s wishes should not be overridden except as specifically specified in the medical record and in accordance the PHT policy.

3. Jackson’s Adult or Pediatric Bioethics Committees may be consulted in individual cases in which there are questions about the appropriateness of any decision.

APPROVAL Medical Executive Committee (MEC) April 8, 2013 Joint Conference and Efficiencies Committee April 18, 2013 Financial Recovery Board April 29, 2013 AUTHORIZATION: Carlos A. Migoya, President and CEO, Jackson Health System



RESOLUTION APPROVING AND ADOPTING TO THE PUBLIC HEALTH PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST) (ADULTS) POLICY AND PROCEDURE— APRIL 2013


WHEREAS, the Physician Orders for Life Sustaining Treatment (POLST) (Adults) Policy and

Procedure (“Policy”) was reviewed so as to be in compliance with the Joint Commission on Accreditation

of Health Care Organization standards, statutory requirements, and the current practice of the Medical

Staff; and


Policy; and

WHEREAS, the recommended policy was provided to the Joint Conference Committee on April

18, 2013; and


reference.





SUPERSEDES: N/A CODE NO. 400.131



SUBJECT: PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST) (ADULTS)

DATE: 0 4/08/2013 PAGE 1 OF 6

POLICY: The Jackson Health System (JHS) is committed to respecting patient rights, including appropriate expressions of preferences regarding end-of-life care. This policy is intended to help ensure those preferences are appropriately documented. The Physician Orders for Life-Sustaining Treatment (POLST) is a physician order form (C-290ZL) that complements a patient’s advance directives by converting wishes regarding life-sustaining treatment and resuscitation into physician orders. It is an authoritative medical order consistent with the patient’s wishes and medical condition. The POLST order form is portable and to be honored across treatment settings within JHS. The POLST order form supersedes all JHS forms for documenting the withholding and withdrawing of life-sustaining treatment, including do-not-resuscitate (DNR) orders. (Note that if a DNR order is in effect, the patient’s wristband shall contain the purple alert snap.) The POLST order form: Is a standardized form that is clearly identifiable in a paper chart; it should be easily

accessible in an electronic chart. May be revised as the patient’s condition or preferences change.

When signed by a physician, it is legally sufficient and recognized as a physician order. Is recognized and honored in all JHS treatment settings. Should be completed for all JHS patients, but must be completed for those who have a valid

advance directive, including a living will, or the yellow Florida “Out of Hospital DNR.”

Does not require medically ineffective health care or health care that is contrary to generally accepted health care standards. (See JHS Policy 400.015, “Withholding, Withdrawing and Forgoing Life-Sustaining Treatment.”)

The POLST order form is particularly useful for patients who are frail, elderly, have a prognosis of one year of life or less, and/or a terminal illness. The POLST order form should be executed as part of the health care planning process and should serve as a complement to a patient’s advance directive. A POLST order form may also be used for patients who do not have an advance directive. Completion of a POLST form should reflect a process of careful decision making by the patient or, if the patient lacks decision-making capacity, the patient’s legally recognized health care decision maker. Physicians completing the POLST order form must





DATE: 0 4/08/2013 PAGE 2 OF 6

confer with appropriate decision makers about the patient’s medical condition and treatment preferences. While a non-physician health care provider, such as a nurse or social worker, may explain the POLST order form to the patient and/or the patient’s legally recognized health care decision maker, the attending physician is responsible for discussing the efficacy or appropriateness of the treatment options with the patient or, if the patient lacks decision-making capacity, with the patient’s legally recognized health care decision maker. Once the POLST order form is completed, it must be signed by the attending physician. Note that the POLST order form contains important instructions, which should be reviewed. The POLST order form does not require a patient, surrogate, proxy, guardian or witness signature because it is a medical order rather than an advance directive. PROCEDURE: I. Patient in Emergency Department with a Completed POLST Order Form 1. During the initial patient assessment, a designated staff member shall document the existence

of the POLST order form and confirm with the patient or the patient’s legally recognized health care decision maker that the POLST order form in hand has not been voided or superseded by a subsequent POLST order form. (See Section V, “Conflict Resolution,” for additional guidance.)

2. A nurse or designated staff member shall inform the emergency department physician caring

for the patient of the existence of the POLST order. 3. POLST orders from previous admissions or other health care systems mayor might not

continue to be accurate, but they provide some evidence of patient preferences or of the existence of an advance directive or a proxy; this may be useful in the care and treatment of the patient, as appropriate. The physician should document his/her review of such POLST orders in the medical record.

4. If the emergency department physician, upon review of a POLST order and evaluation of the

patient, determines that a new POLST order is indicated, he/she shall review the proposed changes with the patient and/or legally recognized health care decision maker and issue a new POLST order consistent with the most current information available about the patient’s health status, medical condition, treatment preferences and goals of care. The physician





DATE: 0 4/08/2013 PAGE 3 OF 6

should document the discussion in the medical record. (See also Section IV, “Reviewing, Revising or Revoking a POLST Form,” regarding voiding a POLST order.)

5. Discussions with the patient and/or the patient’s legally recognized health care decision

maker regarding the POLST order and related treatment decisions should be documented in the medical record.

6. The ordering physician or a staff member shall copy the POLST order form for the medical

record and/or scan it into the electronic medical record. 7. The ordering physician or a staff member shall place a patient information label on the copy

of the POLST order form in the “Affix Patient Label Here” box and write “COPY” and the date on the form.

8. The ordering physician or a staff member shall place the current original POLST order form

in the appropriate and prominent section of the patient’s chart. The date and time that the POLST order form is placed in the medical record must be documented.

9. If the patient is admitted to an inpatient unit, the ordering physician or a staff member shall

send the current original POLST order form with the patient to the inpatient unit. II. Patient Admitted with a Completed POLST Order Form 1. During the initial patient assessment, a designated staff member should document the

existence of the POLST order form, and confirm with the patient or the patient’s legally recognized health care decision maker that the POLST order form in hand has not been voided or superseded by a subsequent POLST order form. (See Section V, “Conflict Resolution,” for additional guidance.)

2. A designated staff member shall communicate to the admitting physician the existence of the

POLST order. 3. POLST orders from previous admissions or other health care systems may or may not

continue to be accurate, but they provide some evidence of patient preferences or of the existence of an advance directive or a proxy; this can be useful in the care and treatment of the patient, as appropriate. The physician should document his/her review of such POLST orders in the medical record.

4. If the admitting physician, upon review of the POLST order form and evaluation of the

patient, determines that a new POLST order is indicated, he/she shall review the proposed





DATE: 0 4/08/2013 PAGE 4 OF 6

changes with the patient and/or legally recognized health care decision maker and issue a new POLST order consistent with the most current information available about the patient’s health status, medical condition, treatment preferences and goals of care. The physician should document the discussion in the medical record. (See also Section IV, “Reviewing, Revising or Revoking a POLST form,” regarding voiding a POLST.)

5. Discussions with the patient and/or the patient’s legally recognized health care decision

maker regarding the POLST order and related treatment decisions should be documented in the medical record.

6. The ordering physician or a staff member shall copy the POLST order form for the medical

record and/or scan it into the electronic medical record. 7. The ordering physician or a staff member shall place a patient information label on the copy

of the POLST order form in the “Affix Patient Label Here” box and write “COPY” and the date on the form.

8. The ordering physician or a staff member shall place the current original POLST order form

in the appropriate and prominent section of the patient’s chart. The date and time that the POLST order form is placed in the medical record must be documented.

III. Completing a POLST Order Form with the Patient 1. Physicians should discuss treatment options with patients or legally recognized health care

decision makers. The discussion should include information about the patient’s advance directive (if any) and the patient’s known statements or wishes for end-of-life care and treatments. The benefits, burdens, efficacy and appropriateness of treatment and medical interventions should be discussed with the patient and/or the patient’s legally recognized health care decision maker.

2. A non-physician health care provider, such as a nurse or social worker, may explain the

POLST order form to the patient and/or the patient’s legally recognized health care decision maker. However, physicians are responsible for discussing treatment options with the patient or the patient’s legally recognized health care decision maker. These discussions should be documented in the medical record, and dated and timed.

3. The POLST order form is to be completed based on the patient’s treatment preferences and

medical condition. If the patient lacks decision-making capacity and the POLST order form is completed with the patient’s legally recognized health care decision maker, it must be





DATE: 0 4/08/2013 PAGE 5 OF 6

consistent with the known desires of and/or in the best interests of the patient as specified by Florida law.

4. In order to be valid, the POLST order form must be signed by a physician. 5. Follow the instructions above for copying the POLST order form and putting it in the

medical record. IV. Reviewing, Revising or Revoking a POLST Order Form 1. Discussions about revising or revoking the POLST order should be documented in the

medical record, and dated and timed. This documentation should include the specific details of any relevant communications and identify the parties involved therein.

2. A physician and patient or the patient’s legally recognized health care decision maker may at

any time review or revise the POLST order, consistent with the patient’s most recently expressed wishes. In the case of a patient who lacks decision-making capacity, the attending physician and the patient’s legally recognized health care decision maker may revise the POLST order, as long as it is consistent with the known desires of and/or in the best interests of the patient as specified by Florida law.

3. During an acute care admission, care conferences and/or discharge planning, a physician

should review the POLST order form when there is a substantial change in the patient’s health status, medical condition or if the patient’s treatment preferences change.

4. If the current POLST order form is no longer suitable because a patient has changed his/her

treatment preferences, or if a change in the patient’s health status or medical condition warrant a change, the POLST order can be voided. To void a POLST order, a physician shall draw a line through Sections A through D and write “VOID” in large letters. The voiding physician shall sign and date this line.

5. If a new POLST order is completed, a copy of the original POLST order marked “VOID”

(that is signed and dated by the voiding physician) shall be kept in the medical record directly behind the current POLST order.

V. Conflict Resolution If the POLST order conflicts with the patient’s health care instructions or advance directives, then the most recently documented and legally sufficient expression of the patient’s wishes shall govern unless those wishes include requests for harmful, illegal or medically inappropriate





DATE: 0 4/08/2013 PAGE 6 OF 6

treatment. (See JHS Policy 400.015, “Withholding, Withdrawing and Forgoing Life-Sustaining Treatment.”) The Ethics Committee, the Miami-Dade County Attorney’s Office, the JHS Risk Management Department or other administrative or medical staff resources may be consulted to help address and resolve any conflicts that may arise. During conflict resolution, consideration should be given to: • Medical assessment of the patient’s current health status and the indications for care or

treatment; • Any determination by the attending physician that treatment specified by a POLST order is

medically ineffective, non-beneficial or contrary to generally accepted health care standards; and

• The patient’s most recently expressed preferences and goals for treatment. VI. Related Policies This policy is related to 400.015, “Withdrawing and Withholding Treatment.” Nothing in this POLST policy should be understood to require treatment that is regarded as nonbeneficial, dangerous or against medical standards.

APPROVAL: Medical Executive Committee (MEC) April 8, 2013 Joint Conference and Efficiencies Committee April 18, 2013 Financial Recovery Board April 29, 2013

AUTHORIZATION: Carlos A. Migoya, President and CEO, Jackson Health System



RESOLUTION APPROVING AND ADOPTING TO THE PUBLIC HEALTH JHS -PHYSICIAN ORDERS FOR LIFE SUSTAINING TREATMENT (POLST) FOR ADULT PATIENTS FORM C-290ZL — APRIL 2013


WHEREAS, the JHS-Physician Orders for Life Sustaining Treatment (POLST) for Adult Patients

form C-290ZL (“Form”) was reviewed so as to be in compliance with the Joint Commission on

Accreditation of Health Care Organization standards, statutory requirements, and the current practice of

the Medical Staff; and


Form;

and

WHEREAS, the recommended form was provided to the Joint Conference Committee on April

18, 2013; and

WHEREAS, a copy of the form, as amended, has been attached hereto and incorporated herein by reference.





MIAMI, FLORIDA 33136-1096

JHS – Physician Orders for Life Sustaining Treatment (POLST)

for Adult Patients

C-290ZL Rev. Page 1 of 3

NOTE: NURSE MUST INITIAL EACH INDIVIDUAL ORDER ALLERGIES: DATE/ TIME

NURSE INIT.

HUS INIT.

All orders to be deleted are to be crossed out with a single line and signed and dated by the physician.

This is a Physician Order Sheet based on the adult patient’s medical condition and wishes. Any section not completed implies full treatment for that section.

A. CARDIOPULMONARY RESUSCITATION (CPR) – Person has no pulse and is not breathing

� CPR/Attempt Resuscitation � DNR/Do Not Attempt Resuscitation/Allow Natural Death When not in cardiopulmonary arrest, follow orders in B, C and D.

B. MEDICAL INTERVENTIONS – Person has pulse and is breathing � Comfort Measures Only: Medication by any route, wound care, positioning and other measures to relieve pain and suffering. Use oxygen, oral suction and manual treatment of airway obstruction as needed to comfort. Transfer if comfort needs cannot be met in current location. � Limited Additional Interventions: Includes comfort measures described above. Use medical treatment, IV fluids and cardiac monitor as indicated. Do not use intubation, advanced airway interventions, or mechanical ventilation. Avoid intensive care if possible. � Additional Orders:___________________________________________________ � Full Treatment: Includes comfort measures and any of the “limited additional interventions” mentioned above. Use intubation, advanced airway interventions, mechanical ventilation and cardio version as indicated.

C. ANTIBIOTICS (check all that apply) � No antibiotics. Use other measures to relieve symptoms. � Determine use or limitation of antibiotics when infection occurs, with comfort as goal. � Use antibiotics if life can be prolonged. � Full Treatment. Always use antibiotics when infection occurs, with treatment as goal. � Additional Orders:__________________________________________________

D. MEDICALLY ADMINISTERED HYDRATION / NUTRITION – Always offer food and liquids by mouth if feasible � No hydration or nutrition by tube. � Trial period of _________ (indicate period of time) for hydration & nutrition by tube. � Long-term artificial hydration by tube. � Additional Orders:_________________________________________________

E. GOALS AND MEDICAL CONDITION DISCUSSED WITH: (check all that apply

and complete information below) DATE:____________________ � Patient � Health Care Proxy � Court Appointed Guardian � Other ____________________________ � Health Care Surrogate Goals:_______________________________________________________________ Name of individual indicated above: ______________________________________



for Adult Patients


F. CHECK APPROPRIATE BOX FOR EACH DIRECTIVE: Directive Completed, in Medical

Record Completed but Not Available

Not Completed

Advance directive Living will Health care surrogate Health care proxy Out of hospital DNR Organ donation:

Physician Printed Name: ___________________________________________ Phone Number _______________ Beeper Number_______________________ Physician Signature/I.D. Number ____________________________________

Reviewing POLST: This POLST should be reviewed periodically and a new POLST completed if necessary, especially when:

• The person is transferred from one care setting to another, or • There is a substantial change in the person's health status, or • The person's treatment preferences change, or • A new advance directive has been executed.

To VOID this form, draw a line through sections A through F and write "VOID" in large letters. The voiding physician must sign and date the line. Physician review of this POLST form: REVIEW DATE PHYSICIAN SIGNATURE & I.D. REVIEW OUTCOME � No Change

____________ __________________________ � Form Voided � New Form Completed

REVIEW DATE PHYSICIAN SIGNATURE & I.D. REVIEW OUTCOME � No Change

____________ ___________________________ � Form Voided � New Form Completed







for Adult Patients


Instructions

SEND FORM WITH PATIENT WHENEVER TRANSFERRED OR DISCHARGED HIPAA PERMITS DISCLOSURE OF POLST TO OTHER HEALTH CARE PROVIDERS AS NECESSARY FLORIDA Special Circumstances Pregnant Women: A proxy or surrogate cannot consent to withholding or withdrawing of life-prolonging procedures from a pregnant patient prior to viability of the fetus unless the surrogate or proxy has a court order or the patient provided prior express written authorization to the surrogate or proxy. Patient has Never had Capacity to Appoint a Surrogate or Execute a Living Will: For a patient who has never had the capacity to appoint a health care surrogate or execute a living will (for example, an adult patient with significant developmental disabilities) a proxy cannot consent to withholding or withdrawing of life-prolonging procedures unless the proxy has a court order authorizing such procedures or has been appointed guardian. Social Worker Proxy: A social worker proxy appointed to serve as proxy for a patient without identifiable family or friends cannot consent to the withholding or withdrawing of life-prolonging procedures until such decision is reviewed by the JHS Adult Bioethics Committee. Persistent Vegetative State: For the guardian of a patient who is in a persistent vegetative state and who does not have available family or friends to serve as proxy, the guardian cannot consent to withholding or withdrawing of life-prolonging procedures until such decision is reviewed by the JMH Adult Bioethics Committee. DIRECTIONS FOR HEALTH CARE PROFESSIONALS COMPLETING POLST: 1. POLST must be completed by a healthcare professional based on medical indications; a discussion of

risks, benefits and alternatives; and discussion of the patient’s or authorized representative’s preferences.

2. POLST must be signed by a physician to be valid. Verbal orders are acceptable with follow-up authentication by the physician in accordance with JHS policy. POLST is a Physician Order and does not require a patient or proxy signature. This does not change the signature requirements on other JHS forms and procedures.

Using POLST:

• Any section of POLST not completed implies full treatment for that section. • A semi-automatic external defibrillator (AED) should not be used on a person who has chosen "Do

Not Attempt Resuscitation". • When comfort cannot be achieved in the current setting, the person, including someone with

"Comfort Measures Only” should be transferred to a setting able to provide comfort, such as a hospice unit.

• An IV medication to enhance comfort may be appropriate for a person who has chosen "Comfort Measures Only" and if so should be documented under section B, additional orders.

• Treatment of dehydration is a measure which may prolong life. A person who desires IV fluids should indicate ”Limited Interventions” or "Full Treatment".

• A patient or his/her legally authorized health care decision maker may change his/her mind about care preferences. A new POLST should be completed to reflect any changes in care preferences.

• See PHS Policy 400.131 regarding POLST use.

5. Standing Reports

5(a) Health Education Network Quality and Safety: What Does The Future Look Like

5(b) Scorecard and Bridges to Quality Report

STRATEGY & GROWTH COMMITTEE

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Strategy and Growth Committee Marcos Jose Lapciuc, Chairperson Mojdeh L. Khaghan, Vice Chairperson Joe Arriola Michael Bileca Stephen S. Nuell Darryl K. Sharpton

Date, Time and Location April 18, 2013 – To follow the Joint Conference & Efficiencies Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

AGENDA 1. Approval of the Previous Meeting Minutes 3 Minutes (Marcos Jose Lapciuc, Chairperson, Strategy and Growth Committee) (a) *Meeting Minutes as of March 14, 2013 2. PSN ITN, and HB711 Updates 10 Minutes

(Jeffrey Crudele, Executive Vice President and Strategy Officer, Jackson Health System)

3. Trauma Update 5 Minutes (Melissa Masters, Director, Program Planning, Strategic Planning Department, Jackson Health System) 4. UM AOA Update 10 Minutes

(Jeffrey Crudele, Executive Vice President and Strategy Officer, Jackson Health System)

5. IT Update 15 Minutes (Mojdeh L. Khaghan, PHT FRB, Michael Garcia, Chief Information Officer, Jackson Health System and Wayne Wilbright, M.D., Chief Medical Information Officer, Jackson Health System)

The agenda item noted with an asterisk (*) indicate that the supporting document is attached.

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD Strategy and Growth Committee

Marcos Jose Lapciuc, Chairperson Joaquin del Cueto, Vice Chairperson Michael Bileca Mojdeh L. Khaghan Stephen S. Nuell Darryl K. Sharpton

Date, Time and Location March 14, 2013 – Followed the Joint Conference & Efficiencies Committee meeting Ira C. Clark Diagnostic Treatment Center Conference Room 259

ATTENDANCE

Strategy & Growth Committee Mojdeh L. Khaghan Stephen S. Nuell Darryl K. Sharpton Marcos Jose Lapciuc Joe Arriola Excused

Michael Bileca

Jackson Health System Carlos A. Migoya Jeffrey Crudele Don S. Steigman Michael Butler, M.D. Maria Huot-Barrientos Wayne Wilbright, M.D. Miami-Dade County Attorneys

Valda Christian Laura Llorente

Strategy & Growth Committee March 14, 2013 Page 2 Meeting Call to Order With a quorum being present, the Strategy & Growth Committee meeting was called to order at 12:44 p.m. by Marcos Jose Lapciuc, Chairperson, Strategy & Growth Committee Chairperson’s Remarks Mr. Lapciuc stated that future meeting agendas will include Information Technology updates. Effective June 1, 2013, a new Public Health Trust Board of Trustees (PHT BOT) will be appointed. Also in the month of June a PHT BOT organizational meeting will be scheduled to discuss the bylaws and appointment of officers. Mr. Lapciuc requested members of the PHT Financial Recovery Board to schedule individual meetings with a Miami-Dade County legal representative to review and discuss Public Health Trust Ordinance 25-A. Mr. Migoya, and Jackson Health System (JHS) Management Team were acknowledged for reaching a milestone and doing a good job managing the hospital activities on a daily basis. With regards to the Annual Operating Agreement between JHS and University of Miami Health System UMHS), Mr. Lapciuc stated that there needs to be a lower cost based platform and better define JHS future with UMHS. 1. Approval of the Previous Meeting Minutes

(a) Meeting Minutes as of February 21, 2013 Mr. Lapciuc requested a motion approving the meeting minutes as of February 21, 2013. Mr. Sharpton moved approval; seconded by Mr. Arriola, and carried without dissent. 2. PSN ITN, HB 711 and Medicaid Expansion Update

• Information Technology Jeffrey Crudele, Executive Vice President and Chief Strategy Officer, Jackson Health System, thanked members of the PHT FRB for requesting that the information technology issues be the front of focus for the Committee.

• PSN ITN The processes necessary to complete the PSN ITN continues to move forward in time to submit on or before the March 29, 2013 deadline date.

• HB 711 • Over the next few weeks JHS will be fulfilling the obligations of the state law approved

by the Florida Legislature in 2012. The amendment to Florida Statute Section 155.40 known as HB 711 requires every public institution in the state to undergo an evaluation of the potential benefits of selling or leasing the system to provide entity. The planning process is ongoing by the PHT FRB to schedule and conduct a Public Hearing in the month of April to hear public comments regarding HB 711.

• Medicaid Expansion The impact that the Medicaid expansion could have on JHS was discussed as well as a possible alternative to expand through the Healthy Kids program.

Strategy & Growth Committee March 14, 2013 Page 3 Health Affairs Update The Committee was provided with information entitled “Decline In Utilization Rates Signals A Change In The Inpatient Business Model.” Due to the decline in user rates for inpatient and certain hospital outpatient in many areas of the country, the health care executives and PHT FRB members were encouraged to pay full attention to the developments even if they are in geographic areas not yet affected. #11 Refine and Implement Information Technology Strategy Michael Garcia, Vice President and Chief Information Officer, Jackson Health System and Wayne Wilbright, M.D., Vice President and Clinical Chief Information Officer, Jackson Health System presented the following tactical steps related to refining and implementing the Information Technology Strategy:

a. Complete formal search for permanent CIO and CMIO b. Complete IT strategic plan and integrate with enterprise strategic plan c. Evaluate Cerner contract and certain module options d. Optimize certain existing installations-such as registration e. Determine and implement a comprehensive interface engine f. Develop enterprise wide data warehouse g. Complete our study of Health Information Exchange options h. Accelerate our development of patient and physician internet portals i. Update and formalize our business continuity and disaster recovery plan j. Evaluate strategy for achieving meaningful use state II and stage III k. Continue with plan to meet ICD-10 implementation deadline l. Formally evaluate and fund IT staffing needs

The tactical steps are based on JHS Strategic Plan. Plans are to formulate a 10-year Strategic Plan including the dollar amount. Further planning includes finalizing item b and continue work on evaluating the Cerner contract and specific module options, with regards to clinical information technology will identify process issues for long term operational improvements, appoint someone to initiate and assure all changes are completed, working along with Cerner to optimize specific existing installations, in the month of June or July determine funding for IT strategy to avoid issues that could place the hospital in a financial concern, need solid interface strategy to improve performance, and physician engagement. Following the presentation, Mr. Garcia stated that at the next scheduled meeting the Committee will be provided with an assessment showing what was done with all of the systems to determine the gaps. Meeting Call to Adjourn The Strategy & Growth Committee meeting adjourned at 1:57 p.m. Transcribed by Ivenette Cobb Executive Assistant Public Health Trust Financial Recovery Board

2. PSN ITN, and HB711 Updates

3. Trauma Update

4. UM AOA Update

5. IT Update

SPECIAL PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD


SPECIAL MEETING PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD

Ira C. Clark Diagnostic Treatment Center

Conference Room 259 1080 N. W. 19th Street Miami, Florida 33128

April 18, 2013 – To follow the Strategy and Growth Committee Meeting

AGENDA 1. Special Meeting Call To Order (Marcos Jose Lapciuc, Chairperson, Public Health Trust Financial Recovery Board) 2. CIR Ratification CBA 2012-2015

(Carlos A. Migoya, President and Chief Executive Officer, Jackson Health System)

(a) Resolution recommended to be approved

*Resolution accepting the 2012-2015 Collective Bargaining Agreement among Miami- Dade County, the Public Health Trust and the Committee of Interns and Residents (CIR), and forwarding such agreement to the Board of County Commissioners for ratification (Carlos A. Migoya, President and Chief Executive Officer, Jackson Health System)

(b) *Support document for agenda item 2 (a) – (Memorandum from Carlos A. Migoya, President and Chief Executive officer, Jackson Health System to the Chairperson and PHT Financial Recovery Board Members)

3. JMH Health Plan 2012 Audit (Brian Dean, Senior Vice President, Finance Division, Jackson Health System)

(a) *JMH Health Plan 2012 Financial Statements 4. LIP Cost Limit Agreement (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System) 5. Conflict of Waiver Request – Greenberg Traurig (Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System) 6. Special Meeting Call To Adjourn

(Marcos Jose Lapciuc, Chairperson, Public Health Trust Financial Recovery Board)

1. Special Meeting Call To Order

2. CIR Ratification CBA 2012-2015

Agenda Item 2 (a) Special PHT Financial Recovery Board

April 18, 2013


RESOLUTION ACCEPTING THE 2012-2015 COLLECTIVE BARGAINING AGREEMENT AMONG MIAMI-DADE COUNTY, THE PUBLIC HEALTH TRUST AND THE COMMITTEE OF INTERNS AND RESIDENTS (CIR), AND FORWARDING SUCH AGREEMENT TO THE BOARD OF COUNTY COMMISSIONERS FOR RATIFICATION

(Carlos A. Migoya, President and Chief Executive Officer, Jackson Health System)

WHEREAS, the President and Chief Executive Officer and representatives of the Public Health Trust have

negotiated in good faith with representatives of the Committee of Interns and Residents (CIR), which is the duly

certified collective bargaining agent representing interns and residents employed by the Public Health Trust; and

WHEREAS, such negotiations have resulted in a proposed Collective Bargaining Agreement, a copy of

which is attached hereto and incorporated herein by reference; and

WHEREAS, the President and Chief Executive Officer and the Public Health Trust Financial Recovery

Board desire to accomplish the purposes outlined in the accompanying memorandum and recommends acceptance

of the proposed agreement.

NOW, THEREFORE, BE IT RESOLVED BY THE FINANCIAL RECOVERY BOARD OF THE

PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby accepts the

Collective Bargaining Agreement among Miami-Dade County, the Public Health Trust, and Committee of Interns

and Residents (CIR), for the period of October 1, 2012 through September 30, 2015 and hereby forwards the

agreement to the Board of County Commissioners for ratification.

MEMORANDUM

TO: Chairman and Board Members Financial Recovery Board/Jackson Health System FROM: Carlos A. Migoya, President & CEO Public Health Trust/Jackson Health System DATE: April 12, 2013 SUBJECT: COLLECTIVE BARGAINING AGREEMENT BETWEEN MIAMI-DADE COUNTY, THE PUBLIC HEALTH TRUST, AND the

COMMITTEE OF INTERNS AND RESIDENTS “CIR” This memorandum summarizes the highlights of the listed Collective Bargaining Agreement. For your consideration, attached is a three (3) year Collective Bargaining Agreement for the period of October 1, 2012 through September 30, 2015 between the Public Health Trust (PHT) and the Committee of Interns and Residents (CIR). The attached agreement was ratified by members of the Committee of Interns and Residents (CIR) on April 11, 2013. Upon acceptance by the Financial Recovery Board (FRB), the agreement will be forwarded to the Board of County Commissioners (BCC) of Miami-Dade County for their approval and ratification. This contract is a product of good faith negotiations between representatives of the Trust and the Committee of Interns and Residents (CIR). I recommend that this agreement be approved by the Financial Recovery Board and forwarded to the Board of County Commissioners of Miami-Dade County for their approval and ratification. The following is a summary of the primary contractual changes affecting the 1035 bargaining unit employees covered by this Collective Bargaining Agreement: Fiscal Impact/Funding Source The total estimated fiscal impact associated with the CIR collective bargaining agreement is $1,946,317. The FY 2012-2013 Adopted Budget includes funding to support the adjustment. Term of Agreement: This is a three (3) year contract for the period of October 1, 2012 through September 30, 2015. The salary and compensation for the Committee of Interns and Residents (CIR) Collective Bargaining Agreements is estimated at $5,248,479. The conversion of interns and residents to the Jackson Health System (JHS) and Public Health Trust (PHT) Health Plan will provide a savings of $4,851,089. The Holiday Administrative Day was eliminated presenting a savings of $470,795.

1. Article 2. Salaries and Compensation Section 2: Pay rates

Until October 1, 2013, the wages of all employees in the bargaining unit classifications will be the following:

PGY 1 - $46,716.92 PGY 2 - $48,682.49 PGY 3 - $50,796.31 PGY 4 - $53,256.92 PGY 5 - $56,131.12 PGY 6 - $57,815.06 PGY 7 - $60,440.74

Effective October 1, 2013, the wages of all employees in the bargaining unit classifications will be (per the AAMC 2012-2013 academic year nationwide rates) the following:

PGY 1- $49,651.00 PGY 2- $51,428.00 PGY 3- $53,454.00 PGY 4- $55,750.00 PGY 5- $57,873.00 PGY 6- $59,991.00 PGY 7- $62,007.00

Effective July 2014, all PGY levels (PGY-1 through PGY-7) will be increased in accordance with the 50th percentile of the Resident/Fellow Stipends Nationwide as published in the AAMC (Association of American Medical Colleges) survey for the Academic Year 2013-2014. Effective July 2015, all PGY levels (PGY-1 through PGY-7) will be increased in accordance with the 50th percentile of the Resident/Fellow Stipends Nationwide as published in the AAMC (Association of American Medical Colleges) survey for the Academic Year 2014-2015.

2. Article 3. Work Hours

Clarifies that duty hours are in conformance with the ACGME (Accreditation Council for Graduate Medical Education) rules and requirements and clarifies those activities that are included in duty hours.

3. Article 4. Leave

Section 5: Bereavement Leave: Provides that “spouse” includes a significant other living in the household (Same language as other CBA’s).

Section 11: Holidays: Provides for the elimination of the Holiday Administrative Day presenting a savings of $470,795.

4. Article 6 – Group Health Benefits Insurance

Provides for continuation of the same health insurance benefits / dental benefits to bargaining unit members hired prior to the 2013-2014 academic years, until June 30, 2015. Effective academic year 2013-2014, newly hired Housestaff officers will be offered the JHS/PHT Health Plan and Dental and Vision coverage on the same terms and conditions provided to all other PHT employees with regard to premiums, plan design, co-pays, deductible and co-insurance. Effective July 1, 2015, all Housestaff officers shall be provided the same JHS/PHT Health Plan and JHS/PHT Dental and Vision coverage on the same terms and conditions provided to all other PHT employees with regard to premiums, plan design, co-pays, deductible and co-insurance. With the exception of legislatively mandated changes to health benefits, the County has the right to re-open this Agreement to negotiate the redesign of the County’s health plans for plan year 2013. Union participation shall be obtained to negotiate health plan provisions and benefits prior to establishing premium contributions.

5. Article 7 – Malpractice and Liability Coverage

Medical malpractice insurance to be provided to Housestaff directed by the Trust to work at a non-affiliated facility located outside the state of Florida but within the continental United States.

6. Article 10 - Individual Contracts and Renewals Section 4: Renewal of Appointments: All non-renewal letters must be issued no later than January 15 if a Housestaff officer is not to be renewed for the next year of a residency program. Remediation Plans to be presented where appropriate.

7. Article 16 – Housestaff Conditions Section 4: Meal Cards: Bulk purchases for food and beverages due to unused meal card balances at the end of the academic year are prohibited. Section 8: PHT Provided Transportation: If a Housestaff officer is fatigued and concerned about falling asleep while driving home from work, then transportation/sleep options are provided to the resident.

8. Article 17 – Safety and Health Section 6: Trust Facility Security: JHS will provide secure, limited access to all trust facilities to protect bargaining unit employees (same language as other CBA’s).

9. Article 21 – Housestaff Involvement, Education & Community Outreach Fund

Eliminates Patient Care Fund of $25,000 per year. Excess Patient Care Funds to be transferred to the CIR Education and Community Outreach Fund which will be funded at $125,000 per year. The Fund is established to ensure effectiveness and efficiency in patient care delivery and for the improvement of clinical outcomes and patient satisfaction. CIR to provide the JHS with fund financial statements and program activity reports annually.

10. Article 23 – Term of Agreement: October 1, 2012 through September 30, 2015

11. Side Letters of Agreement

All side letters but “Recognition/Volunteers” eliminated or incorporated into the appropriate Articles of the Collective Bargaining Agreement.

3. JMH Health Plan 2012 Audit







Date/Time Due


Name:

Tel./Ext.:




Table of Contents

Page







Schedules




2






Emphasis of Matter


Other Matter




3














4




2012 2011


Total revenues 75,896,553 217,733,405








5








Net income — 368,816 368,816



Net income 200,652 200,652


Dividends Paid (20,000,000) — (20,000,000)




6




2012 2011












7 (Continued)










8 (Continued)















9 (Continued)








(f) Equipment


(g) Unpaid Claims






10 (Continued)











(i) Income Taxes






11 (Continued)

(j) Premium Revenue













12 (Continued)















13 (Continued)












14 (Continued)















15 (Continued)











16 (Continued)











17 (Continued)















18 (Continued)


















19



2012 2011


$ 2,043,472 373,259





SCHEDULES


Schedule 1



December 31, 2012

20





21




December 31, 2012

Admittedassets as






4. LIP Cost Limit Agreement

5. Conflict of Waiver Request – Greenberg Traurig

6. Special Meeting Call To Adjourn

PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD · 4/18/2013 · Commission Chambers, the PHT FRB...

Documents

Transcript of PUBLIC HEALTH TRUST FINANCIAL RECOVERY BOARD · 4/18/2013 · Commission Chambers, the PHT FRB...