VTH Board Minutes 10/27/22

Updates: Info Only

Personnel Updates

• Alyssa Duncan (Program Coordinator) will be retiring end of December 2022, will open position for applications
• Business Office – (Account Tech 2) service agreement/warranty/backup ordering position filled by Kara Atkins. Start date 10/31. 
Accounts receivable position – interviews being conducted.
• Faculty Searches – anesthesia (Strahl-Heldreth-chair) 2, cardio (Fries) 0, diagnostic imaging (Foss) 1, ECC (Hague) 1, SAIM (Reinhart) 1, SA ortho surg (Keller) 2, rad onc (L. Garrett) 0, med onc (Fan) 0, WMC (W. Sander) 2, ER (Haraschak) 2, clin path VSC (Schnelle) 0, anatomy path (Samuelson) 1

Service Updates
• Ophthalmology service starting back up 11/7 with Dr. Todd Marlo
• VM601 students assigned to patient care shifts LA and SA

Facilities 
• VDL Incinerator hopefully functional in next 4-6 weeks. VDL Project will not be fully complete until March-April 2023
• Equine surgery suite likely to start after Christmas/New Years 
• VTH offices moved to LAC 2nd floor (old IT offices)
• Oncology expansion schematic design phase in progress
• ECC business manager/supervisor tech office moving
• MRO ward back in use

Programs
• Lab mailouts – will revert to host services, mail out station created in south half of old MRO ward. Discussions with VDL to coordinate mailouts to occur in January.
• House officer approvals – see document in box
• Shelter Med is operational – contracts to be updated 6/23
• UCC is operational – 10A-6P M-Th
• SA ER – 2 mentored ER positions (1 filled, 1 Jan.23
• Afterhours access to clin path will be limited – plan to contract and install benchtop analyzers in SA ER. Expectation is that students will be able to run samples. Need to determine process for data input to HIS.

Other
• Reminder holiday schedule, next November 8
• VTH Vision/Mission – suggestion (D. Hague) to start with input from personnel. Culture Committee will send out a survey

Budget Review
Budget Letter Report

Excerpts from VTH Budget Letter from Dean Constable dated 09/28/22:
$288,152 in recurring state salaries will be transitioned to VTH self-supporting funds. The college is currently reviewing the affiliate fund distribution along with appropriate fund sources for faculty salaries related to state, self-supporting, and affiliate funds. 

I have reviewed and authorize the following capital and programmatic needs for 
FY23, with recommendation from the hospital director, board, and Veterinary 
Clinical Medicine department head: 
• College funding approved for Zoo Ambulatory equipment of $10,000. 
• The college will cash fund 50% of the first year expense for the medication dispensary office manager; estimate of $22,000. The remainder should be funded using self-supporting revenue. 
• The request for LAC corridor fire doors is an important safety need. This expense estimated at $160,000 will be shared with 50% from college funds and 50% from VTH self-supporting revenue. 
• Requests for the LAC ward doors and SAC exterior dock will not be funded for FY23. 
• The college will utilize an anticipated anonymous gift to cover the expense of the linear accelerator loan, estimated at $1,648,473. 
• Funding for necropsies for VTH will continue to be funded using VDL funds of $45,000. 
• Equipment requests to be paid with VTH funds, total of $81,967. This includes the request for $11,000 for replacement of the South Clinic paging system. 
• Microwave surgery equipment of $150,000, to be funded 1/3 each from VTH, VCM, and College funding. 
• South Clinic renovations of $300,000; I recommend utilizing VTH funds previously allocated for the Small Animal lobby remodel that are now available due to recent donor funding for the lobby project. Please work with Christine Dietrich and me to finalize the source and amount of funds. 
• Equine Surgery renovations of $500,000, to be funded with VTH funds. 
• Zoo Ambulatory truck at $50,000, also funded with VTH funds. 

In regard to the College’s FY23 hiring plan, I understand that you and Dr. Barger have consulted closely and that the Department’s hiring plan recommendations respond to needs for faculty recruitment in specific service specialty areas. Thank you for your contributions to this effort. I understand that there will be additional hiring required based on emerging needs and unexpected 
resignations.

Notes RE Clinical Units Financial Reports:

Veterinary Teaching Hospital
Review of financial statements –Sept 22
Overall:

• On a YTD basis, VTH revenue over expenses is $224,572 (fund 301732). This is unfavorable to last year by $(132.5k).
• Total revenue over expenses for Q1 all funds = $293,039. That compares to last year of $327,782.

Revenue:

• YTD revenue in VTH operations (fund 301732) is higher than prior year 
by $353.4k, or 7.3%.
• Please see attached for a breakdown of revenue/admissions per service. 
o There is overall unfavorability compared to budget for revenue
of -3%. 
o There is overall favorability YTD compared to prior year for 
admissions of -14% and revenue of 9% (including storeroom). 
This decrease is largely due to Shelter Medicine (decrease of 936 
cases) and Ophthalmology (decrease of 205 cases). These two 
services account for -11% of the decrease.

Expenses: 
         • YTD expenses on VTH operations (301732) are $479.2k (11%) higher than YTD prior year.

Personnel
o Academic salaries are higher than prior year by $120.7k. This includes an additional $19k intern salaries, additional allocation of clinical faculty, and instructors (Shores, Walker).
o Locums swaps have not yet been completed for Q1, so salary and benefits are higher than expected. This will be caught up in Q2.

Services
o Supplies are higher than prior year by $69.4k. This is somewhat due to timing of the payment of invoices in Q1 FY23 that relate to prior year.
o Travel is higher than prior year by $30.4k due to increase in professional development.
o It appears there are several expense categories that are higher than last year under services.
o Vet Tech salaries are $463.9k higher than prior year. 
This is due to $164k in retro pay due to new contract, an additional pay period in FY23, as well as higher salaries due to negotiated contract.
o VetCT is higher than prior year, but FY22 looks low and it is likely timing.
o There is favorability in service contracts which is likely just due to timing and the expenses will be coming in later quarters. This is not an expected favorable variance.

Midwest Equine
Review of financial statements – Sept 2022 

Overall:

• YTD revenue over expenses = $(95,555) if AR balances are not included. 
This is $(105k) unfavorable to budget and $(142.7k) unfavorable to last year. 
• Based on revenue earned (not receipts), YTD revenue over expenses = $(6,884). This is $(16.6k) unfavorable to budget, and $(54)k unfavorable to last year.
• Accounts Receivable balance per e-Vet at the end of September = $73,539.12.

Revenue:

• Patient visits are 13% higher than prior year and revenue is 21% higher 
than FY22 on a YTD basis. 
• The average transaction is higher than last year by 6.62% on a YTD basis.

Expenses: 

• YTD academic salaries were unfavorable to last year due to salary increases. 
• YTD staff salaries were unfavorable to last year due to the hire of a new technician and salary increases. The vet assistant’s salary is not included in Q1 and will be corrected.
• YTD supplies are unfavorable to budget and prior year. This is due to the resolution of purchase order issues which cause a higher expense in Q1.
• YTD carpool expenses = $7.4k, which is included in the travel category.
• Loan repayment (principal) expense of $3,866 is accrued each month in the financials to avoid a large expense in June. 

Cash Balance:

• Cash balance at the end of June of $(27,931). The deficit is related to the AR balances not collected.

Medical District Veterinary Clinic
Review of financial statements – Q1 FY23
Overall:

• YTD revenue over expenses = $(659). That is $(118,453) unfavorable to budget and $(168,035) unfavorable to last year. 

Revenue:

• YTD revenue of $670,800 is consistent with last year and $(75k) less than budget. 
• The number of patients was (557) lower than budget on a YTD basis. The number of first quarter patients is also (142) lower than last year.
• The average transaction YTD was $236.05, which was higher than budgeted by 6.8% and 5.2% higher than last year.

Expenses: 

• There was a higher increase in staff salaries than what was budgeted due to some unexpected increases as a result of the negotiated contract. A significant increase was given to the client service staff that was not fully expected/budgeted. 
• There was also a retro pay transaction for the contract increase that drove first quarter salaries higher than expected.
• Academic salaries are higher than prior year, but this increase was expected/budgeted.
• YTD drugs and supplies are unfavorable to budget and prior year. This was due to the resolution of purchase order issues with Butler, which created a large expense in the first quarter.

Cash Balance:

• Cash balance through September = $852,036.
• A three-month emergency amount (based on FY21 average expenditures) is $623K.

Initiatives 

1. No show penalty – Cancellation / No show Policy will be drafted for review
2. Lab test price adjustment planned – VDL, outside labs
3. Medication pricing adjustments planned – less uniform, market driven. Meeting will review and implement price changes
4. Inventory charter – moving forward with plan to build system and move to barcode tracking/charge entry

Sedation medication wasting

Issue: Currently, patients undergoing ultrasound exams must be presented at their designated time with sedation medication accompanying them. Sedation is used/necessary in 30% of patients undergoing ultrasound exams. The sedation medication for those not receiving it is wasted. This results in charges on clients account for unused drugs, inaccuracies in the patient record, and irresponsible drug use. 

Options for mitigation were discussed:
1) Patients requiring sedation are presented for US having already receiving the drugs. Patients not sedated that require sedation to complete the exam will be returned to service without exam. 
2) Service member will accompany patient and will retrieve sedation from Cubex if needed to complete the exam. 3) Sedation protocol will be entered into patient RIS when US exam is requested. Imaging rotation students will be trained and given access to Cubex and will retrieve sedation medication as per orders when needed to complete the exam.

VTH Board Members felt that a combination of all three possible solutions should be formed into an SOP. Action Item: VTH Administration will create SOP.

Technician promotions 

Time/skill vs operational need

Discussion was had regarding philosophy for technician promotion. Current process is that CVT’s eligible for promotion based on time in position are considered for promotion based on supervisor’s assessment. If approved, then promotion is pursued if there is an operational need for the higher level. This results in many CVT’s being capped at the VT2 level. The VTH Board Members agreed that promotion should be pursued strictly based on time in position and performance.

Student worker employment 

Dr. Barger and Dr. Whittington met with student representatives to discuss job opportunities at Vet Med and how to encourage students to apply. General discussion indicated the following priorities:
• Priorities: flexibility in work days/hours, wage, access to clinical experiences
• Potential job board with ranking (i.e., duties, wage, flexibility, clinical experience) 
Action Item: VTH will develop job board tool.

UCC / ECC Referral process 

• Issue – Referring veterinarians refer client to UCC; then client is usually sent back to referring vet. 
• Plan - Referral Coordinator (Michelle Jaeger) will facilitate UCC/ECC referral process. 
Action Item: VTH Admin will develop process and create SOP