University of Iowa Health Care - PRESENTATION TO THE BOARD OF REGENTS, STATE OF IOWA
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Pres enta tion to The Boa rd of Regents , Sta te of Iowa | April 2021
University of Iowa
Health Care
PRESENTATION TO THE BOARD OF REGENTS, STATE OF IOWA
April 14, 2021
CHANGING MEDICINE.
CHANGING LIVES.®
Agenda
• Opening Remarks
• Operating and Financial Performance
• Faculty Presentation: Respiratory Illness Follow Up Clinic:
Meeting the Needs of Iowa During the Pandemic
Presentation to The Board of Regents, State of Iowa | April 2021
Opening Remarks Presentation to The Board of Regents, State of Iowa | April 2021 Brooks Jackson, MD, MBA Vice President for Medical Affairs & Tyrone D.Artz, Dean, Carver College of Medicine
Operating and Financial Performance Presentation to The Board of Regents, State of Iowa | April 2021 Suresh Gunasekaran, MBA Bradley Haws, MBA Associate Vice President, UI Health Care Associate Vice President & & CEO, UI Hospitals & Clinics Chief Financial Officer, UI Health Care
Volume and Financial Highlights –FY21 THROUGH FEB 2021
Operating Margin Revenues
• Fiscal Year actual 4.7% vs goal (before COVID • 2.7% above budget year-to-date
risks) of 4.4% ‒ Inpatient above budget 3.0%
‒ Outpatient above budget 2.5%
‒ HHS Cares Funding of $32.4M
Volume Change
• Year-over-year: Inpatient Discharges -9.7%, Payer Mix
Acute Patient Days -0.5%, Surgeries-2.1%, • Medicare well below historical average
Clinic Visits 16.2% and Clinic Visits • FY20 YTD: 38.0%, Feb YTD FY21: 36.8%
excluding ILI -6.7%.
Accounts Receivable
• Days in Net AR– 48.7 days
Acuity
• Case Mix Index 2.24 Salary Expenses
• 5.1% above budget year-to-date
Length of Stay Index • Unpaid Time of $11.2M
• Adult at .96
Non-Salary Expenses
• Pediatrics at .96
• 5.9% above budget year-to-date
• Supply and drug costs above budget
Presentation to The Board of Regents, State of Iowa | April 2021
Comparative Financial Results FISCAL YEAR TO DATE: FEB 2021
NET REVENUES Actual Budget Prior Year Variance to Budget % Variance to Budget Variance to Prior Year % Variance to Prior Year
Patient Revenue $1,377,347 $1,332,027 $1,283,397 $45,320 3.4% $93,950 7.3%
Other Operating Revenue 64,391 33,751 33,870 30,640 90.8% 30,521 90.1%
Total Revenue $1,441,738 $1,365,778 $1,317,267 $75,960 5.6% $124,471 9.4%
EXPENSES
Salaries and Wages $593,543 $564,728 $550,029 $28,815 5.1% $43,514 7.9%
General Expenses 709,777 668,703 617,258 41,074 6.1% 92,519 15.0%
Operating Expense before Capital $1,303,320 $1,233,431 $1,167,287 $69,889 5.7% $136,033 11.7%
Cash Flow Operating Margin $138,418 $132,347 $149,980 $6,071 4.6% ($11,562) -7.7%
Capital- Depreciation and Amortization 70,556 72,214 68,671 (1,658) -2.3% 1,885 2.7%
Total Operating Expense $1,373,876 $1,305,645 $1,235,958 $68,231 5.2% $137,918 11.2%
Operating Income $67,862 $60,133 $81,309 $7,729 12.9% ($13,447) -16.5%
Operating Margin % 4.7% 4.4% 6.2% 0.3% -1.5%
Gain (Loss) on Investments 63,978 7,388 32,225 56,590 766.0% 31,753 98.5%
Other Non-Operating (7,604) (9,238) (9,062) 1,634 17.7% 1,458 16.1%
Net Income $124,236 $58,283 $104,472 $65,953 113.2% $19,764 18.9%
Net Margin % 8.3% 4.3% 7.8% 4.0% 0.5%
Above is the internal budget, based upon pre-COVID performance. Given the ongoing COVID and economic risks, the final annual budget is lower than shown.1.9% annual and 0.8% for YTD February.
Presentation to The Board of Regents, State of Iowa | April 2021Key Metrics: Preliminary Moody’s Medians
FY21 YTD Through February Moody’s Median
Financial Operations
Operating Margin 4.1% 1.1%
Financial – Liquidity
Days Cash on Hand 228 305
Financial – Leverage
Debt to Capitalization 16.0% 21.4%
Presentation to The Board of Regents, State of Iowa | April 2021University of Iowa Hospitals & Clinics: The Hospital for the State of Iowa Presentation to The Board of Regents, State of Iowa | April 2021
We Continue to be the Hospital for the State of Iowa
• We operate an 850-bed hospital in Iowa City, Johnson County, Iowa
• In CY2020, UI Hospitals & Clinics had over 37,000 inpatient discharges
and almost 1,000,000 outpatient visits.
• Johnson County patients comprise the minority of all patients served
by UI Hospitals & Clinics (22% of discharges, 36% of clinic visits, and
only 15% of surgical cases).
• The majority of patients at UI Hospitals & Clinics are:
– From outside Johnson County
– Transferred from other Iowa hospitals (1/3 of inpatients nightly)
– Highly sick and complex patients
Presentation to The Board of Regents, State of Iowa | April 2021Inpatient Volume and Acuity
GEOGRAPHIC AREA CY2020 AVG CASE MIX INDEX CY2020 SUM OF DISCHARGES PERCENT OF DISCHARGES
Primary Service Area 1.95 14,438 45.4%
Quad Cities Area 2.63 2,894 9.1%
Dubuque Area 2.60 1,655 5.2%
Grinnell Area 2.57 1,433 4.5%
Waterloo Area 2.75 2,392 7.5%
South East Iowa 2.33 3,625 11.4%
North East Iowa 2.35 74 0.2%
North Central Iowa 2.82 329 1.0%
Des Moines Area 2.97 1,184 3.7%
Western Iowa 2.77 922 2.9%
Out of State 2.65 2,837 8.9%
GRAND TOTAL 2.31 31,783 100.0%
Presentation to The Board of Regents, State of Iowa | April 2021Clinic Visit Patient Origin CY2020
Johnson County
Out of State: 65,011 is 36.5%
Presentation to The Board of Regents, State of Iowa | April 2021Emergency Department Patient Origin CY2020
Johnson County
Out of State: 3,698 is 44.4%
Presentation to The Board of Regents, State of Iowa | April 2021Surgical Patient Origin CY2020
Johnson County
Out of State: 3,382 is 15.6%
Presentation to The Board of Regents, State of Iowa | April 2021Inpatient Discharge Patient Origin CY2020
Johnson County
Out of State: 2,837 is 22.0%
Presentation to The Board of Regents, State of Iowa | April 2021Why does Iowa depend on UIHC?
North Central
LYON OSCEOLA DICKINSON EMMET WINNEBAGO WORTH
North East Iowa
MITCHELL HOWARD
WINNESHIEK ALLAMAKEE
Iowans have ever Iowa
KOSSUTH
2.35
more complex
SIOUX O’BRIEN CLAY PALO ALTO HANCOCK CERRO GORDO
2.82
FLOYD CHICKASAW
health care FAYETTE CLAYTON
needs and UIHC
PLYMOUTH CHEROKEE BUENA VISTA POCAHONTAS
HUMBOLDT
WRIGHT FRANKLIN
Waterloo Area
BUTLER
BREMER
Dubuque Area
is uniquely s uited 2.75 DUBUQUE
2.60
WEBSTER GRUNDY BLACK HAWK BUCHANAN DELAWARE
IDA SAC CALHOUN
to meet thos e
WOODBURY HAMILTON HARDIN
needs . Western Iowa
2.77 JACKSON
Grinnell
MONONA CRAWFORD CARROLL BOONE STORY MARSHALL TAMA BENTON LINN JONES
Primary CLINTON
Area Service Area
Des 2.57 1.95
GUTHRIE DALLAS POLK CEDAR
HARRISON SHELBY AUDUBON JASPER POWESHIEK IOWA JOHNSON
Moines
SCOTT
Quad Cities Area
Area
MUSCATINE
POTTAWATTAMIE CASS ADAIR MADISON
2.97
WARREN MARION MAHASKA KEOKUK WASHINGTON
2.63
*Case Mix Index (CMI) is a LOUISA
measure of medical acuity and MILLS MONTGOMERY ADAMS UNION CLARKE LUCAS MONROE WAPELLO JEFFERSON
complexity. Higher case mix
HENRY
index is indicative of greater South East Iowa
complexity .
FREMONT PAGE TAYLOR RINGGOLD DECATUR WAYNE APPANOOSE
2.33
DAVIS VAN BUREN
LEE
Presentation to The Board of Regents, State of Iowa | April 2021Clinic volume growth remains strong
1,000,000 976,141
960,437
950,000
911,834
900,000 872,075
850,000 835,996
800,000
750,000
700,000
650,000
600,000
550,000
500,000
2016 2017 2018 2019 2020
Total clinic vis it volume has increas ed 17% over the pas t five years .
Larges t vis it growth in cancer, diges tive dis eas e, neurology, urology, and orthopedics .
Presentation to The Board of Regents, State of Iowa | April 2021However, total surgical volume declined in 2020
Total Surgical Cas es
35,000
34,000 33,817
33,000 32,673
32,000
31,380
31,092
31,000
30,043
30,000
29,000
28,000
2016 2017 2018 2019 2020
Presentation to The Board of Regents, State of Iowa | April 2021Even with fewer visits, acuity growth is
driving long stays in Emergency Department
Emergency Department Vis its and Length of Stay
6.05 6.1
60,000
Media n Admit Length of Sta y
5.90 6
Emergency Depa rtment Vis its
5.88
50,000 5.9
5.8
40,000 5.7
(Hours )
5.6
30,000 5.47
5.43 5.5
20,000 5.4
5.3
10,000
59,809 59,679 56,616 55,359 47,023 5.2
0 5.1
2016 2017 2018 2019 2020
Total ED Visits Median ED Length of Stay (Hrs)
Total emergency department volume is decreas ing, but patient length of s tay is increas ing
due to delays in our ability to admit patients when the hos pital is full.
Presentation to The Board of Regents, State of Iowa | April 2021Capacity challenges remain even though fewer
Emergency Department patients waiting for beds
Emergency Department Average Midnight Census: Adults 18+
35
30 29 29 29
28
27
25 24
20
15
10
5
0
CY2015 CY2016 CY2017 CY2018 CY2019 CY2020
Presentation to The Board of Regents, State of Iowa | April 2021Despite the pandemic, inpatient occupancy
remains highest in Eastern Iowa
Inpatient Cens us : Adults 18+
620 96.4% 96.5% 97.0%
600 96.0%
94.6% 94.6%
580 95.0%
Occupa ncy Ra te
Number of Beds
560 94.0%
610
540 601 93.0%
586 580 92.7%
577
520 562 565 566 92.0%
546
532
500 91.0%
480 90.0%
CY2016 CY2017 CY2018 CY2019 CY2020
Average Midnight Census Staffed Beds Occupancy
Presentation to The Board of Regents, State of Iowa | April 2021If not for COVID, demand and capacity
challenges would have increased in 2020
Clinic Volumes Still Increasing Emergency Department Average Midnight Census Continues to Increase
1,100,000 1,058,285 30
29 28 29 29
1,000,000 960,437 30
911,834 24
900,000 835,996 872,075
20
800,000
700,000 10
600,000
500,000 0
CY2016 CY2017 CY2018 CY2019 CY2020 CY2015 CY2016 CY2017 CY2018 CY2019 CY2020
Surgical Volumes Inpatient Census Continues to Increase (Adults 18+)
620 110%
40,000 597
600
Occupa ncy Ra te
34,690 580
35,000 33,817 580 105%
32,673 565
31,380
Cens us
30,043 560 546
30,000 532 100%
540 97.5%
25,000 520 95%
96.5%
500 94.6% 94.6% 96.4% 92.7%
20,000 480 90%
CY2016 CY2017 CY2018 CY2019 CY2020 CY2016 CY2017 CY2018 CY2019 CY2020
CY Volume COVID-19 Adjus tment Occupa ncy COVID-19 Adjus ted Occupa ncy
Presentation to The Board of Regents, State of Iowa | April 2021Game Plan to Improve Operations
Quality Workforce Finance Inpatient/ED Outpatient Surgical Growth and
and Safety Performance and Capital Efficiencies Efficiencies Efficiencies Service Lines
Culture
Continue to Improve Partnerships
With post-acute providers to ensure more timely discharge of our patients to care closer to home.
With community providers to manage patients locally, when clinically appropriate, instead of transferring to UIHC.
Presentation to The Board of Regents, State of Iowa | April 2021Quality and Outcomes Presentation to The Board of Regents, State of Iowa | April 2021
Infections Following Colon Surgery IMPROVEMENT
Mea s ured a ccording to “Sta nda rdized Infection Ra tio” where the SIR= number of obs erved infections / number of expected infections
SIR>1.0 = # of infections exceeded expecta tions
Des ired direction of
improvement
1.9
1.3
SIR = 1.0
1
0.6
FY18 FY19 FY20 FY21
CMS Colon SIR is publicly reported a nd included in the Hos pita l-Acquired Condition Reduction Progra m
Pres entation to The Board of Regents , State of Iowa | April 2021CLABSIs OPPORTUNITY FOR FOCUS
Ca theter-As s ocia ted Bloods trea m Infections (CLABSIs ) a re mea s ured a ccording to COVID-19 Pandemic
“Sta nda rdized Infection Ra tio” where the SIR= number of obs erved infections / • Res ulted in cha nges to infection
number of expected infections prevention a nd control pra ctices
SIR>1.0 = # of infections exceeded expecta tions • U.S. hos pita ls s a w s ubs ta ntia l
increa s es in CLABSI ra tes *
1.2 1.2
SIR = 1.0
0.9
0.7
FY18 FY19 FY20 FY21
Non-MBI CLABSI SIR is publicly reported a nd included in the Hos pita l-Acquired Condition Reduction Progra m
*Reference: Fa kih MG, Bufalino A, Sturm L, et a l. COVID-19 Pa ndem ic, CLABSI, a nd CAUTI: The Urgent Need to Refocus
on Ha rdwiring Prevention Efforts . Infection Control & Hospital Epidemiology. 2021:1-22. doi:10.1017/ ice.2021.70
Pres entation to The Board of Regents , State of Iowa | April 2021Patient Vaccination Campaign Presentation to The Board of Regents, State of Iowa | April 2021
COVID-19 Patient Vaccinations
Multiple vaccination locations trialed Large-scale patient vaccination
• Main Campus Fountain Entrance location at UI Health Services
Support Building (HSSB)
• UI Quick Care East
• Non-patient care facility designed to house
• UI Urgent Care– Coralville
finance, information technology, and billing
• UI Health Services Support Building
• Repurposed first floor of facility to support
• UI Muscatine patient vaccinations
University of Iowa Health Care launches Phase 1b COVID-19 vaccinations
University of Iowa Health Care on Feb. 3, 2021, took its next big step in continued efforts to keep the
community safe from COVID-19. UI Health Care administered 1,004 pre-scheduled doses at one
location in a single day to Johnson County residents age 65 or older who were newly eligible under
Phase 1b of Iowa’s vaccination criteria.
Presentation to The Board of Regents, State of Iowa | April 2021Patient Satisfaction: COVID Vaccine Survey
• Survey added February 3 Additional vaccine percentile ranks will Patient Comments
become available as other organizations
• 26% Survey Return Rate add survey.
PERCENT RESPONSES PERCENTILE RANK
QUESTIONS
VERY GOOD (n) IN NATION
I was very impressed by
the UIHC setup to
Likelihood of recommending 96.2 1,007 99th efficiently administer the
COVID-19 vaccine.”
Ease of obtaining COVID vaccine 83.2 940 Not yet available
Courtesy of COVID vaccine staff 97.5 943 Not yet available
Cleanliness of COVID vaccine facility 94.7 944 Not yet available Everything was perfect
from directions in the
Safety when receiving COVID vaccine 95.2 937 Not yet available parking lot upon arrival
to exiting the parking lot
Explain COVID vaccine side effects 87.9 934 Not yet available upon leaving. Bravo!”
Presentation to The Board of Regents, State of Iowa | April 2021Respiratory Illness Follow -Up Clinic: Meeting the Needs of Iowa During the Pandemic Presentation to The Board of Regents, State of Iowa | April 2021 Alejandro P. Comellas, MD Director of the ICTS Clinical Research Unit at the University of Iowa Professor of Medicine
Long term consequences of COVID-19
• Despite evidence of viral clearance, patients with severe acute
SARS-CoV-2 infection experience a more prolonged period of
recovery compared to patients with severe disease due to other
respiratory viruses
• The constellations of symptoms is considered a syndrome
defined as Post-Acute Sequelae SARS-CoV-2 Infection (PASC)
Presentation to The Board of Regents, State of Iowa | April 2021Respiratory Illness Follow -Up Clinic
• In response to COVID-19, the University of Iowa established a
post-acute COVID-19 ambulatory service for patients with
confirmed SARS-CoV-2 infection who remained symptomatic
more than thirty days following initial diagnosis
• Criteria for referral, including self referral
– 16 y/o and older
– Proven diagnosis of SARS-CoV-2 infection (Nasal swab or blood
antibodies)
– All symptomatic, independent of organ system
Presentation to The Board of Regents, State of Iowa | April 2021Respiratory Illness Follow -Up Clinic Operation
• Every Friday from 8 am to 4 pm
• Staffed by 10 faculty members
– 7 Pulmonologists and Critical Care Physicians
– 3 General Medicine Physicians
• Out of the 10 physicians, 4 are fluent in Spanish
• 1 physician is double board certified in Adult Medicine
and Pediatrics
• Follow up within 1, 3 or 6 months
Presentation to The Board of Regents, State of Iowa | April 2021Respiratory Illness Follow -Up Clinic Protocol
• All patients are evaluated by the following protocol
– Pulmonary Function Tests
– Lung Computed Tomography Imaging
– Blood work that includes:
• Total cell count (white blood cells, hemoglobin and platelets)
• Basic Metabolic Panel (kidney function and electrolytes)
• Liver function test
– Standard clinic evaluation including resolution assessment of initial
COVID-19 symptoms
Presentation to The Board of Regents, State of Iowa | April 2021Multidisciplinary Respiratory Illness Follow -Up Clinic
• Cardiology • Rehabilitation Therapies
• Immunology • Physical Therapies
• Infectious Diseases • Respiratory Therapy
• Occupational Medicine
• Family Medicine
• Neurology
• Otolaryngology
• Psychiatry
• Psychology
Presentation to The Board of Regents, State of Iowa | April 2021Respiratory Illness Follow -Up Clinic Research
• All patients are invited to participate in a Post COVID-19
Registry. If interested, on the same day patients are consented
by a research coordinator
• All patients are consented to use their clinical data for research,
obtain blood samples to study their immune system and collect
cells from the nose as a surrogate of lung cells
Presentation to The Board of Regents, State of Iowa | April 2021What have we learned?
• We have seen > 200 patients
• The constellation of symptoms is broad. However the most
common chief complaints are:
– Shortness of breath (73%)
– Fatigue (56%)
– Cough (34%)
• Another constellation of debilitating problems are Psychiatric
and Neurocognitive such as memory, concentration, anxiety,
depression, mood changes
Presentation to The Board of Regents, State of Iowa | April 2021What have we learned?
• The more severe the disease, the more lung damage
• The lung diseases are a combination of lung fibrosis and airway
diseases such as Asthma and COPD
• Symptoms in the clinic do not correlate with disease severity
– Patients treated in the ambulatory setting are sometimes more
debilitated than patients treated in the hospital
Presentation to The Board of Regents, State of Iowa | April 2021ICU patient with COVID-19 pneumonia Same patient 6 weeks later
Presentation to The Board of Regents, State of Iowa | April 2021Where do we go from here?
• Continue to meet the demands of the community by keeping
this clinic open
• Identify best specialties for referrals to continue patient care
• Continue research in this area to identify mechanisms of
disease so we can discover potential therapies that can be
tested in clinical trials
• Engage with the community to understand better their suffering
Presentation to The Board of Regents, State of Iowa | April 2021Pres entation to The Board of Regents , State of Iowa | April 2021
Thank you
uihc.org
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