VTH Board Minutes 2/25/2021

Updates: Info Only

Personnel Updates

• Farrier – hiring 2 intern farriers as extra help
• Ophthalmology – Dr. Myrna; offer made
• IFAMS Instructor – 3 interviewed – search committee meeting tomorrow.
• S/N, Community Outreach, Shelter – 5 applicants, Loukia is meeting mid-March
• Anesthesia – 3 applicants to be scheduled for interviews
• Dermatology – 1 candidate
• SAS – possible candidate being recruited
• ER instructor –
• IFAMS tenure-track – 3 applicants, none may be acceptable
• Radiologist – possible recruitment from Purdue
• Onc. Surg. – 1 applicant (interview March)
• H/O updates – Match Day March 1st, will be posting 1 Imaging internship, 1 Ophthalmology internship, 2 S/N-1° Care internships

Facilities

• Expansion project – Phase 2 underway. 
  • Heat in SAC second floor offices dt uninsulated steam pipe – negotiation with campus/contractors re resolution. 
  • SAIM to move mid-March to SAC basement, will also have access to micro-sx lab for procedures.
  • ER to move mid-March to SAIM treatment ward.
• Remodel plans underway for S. wing SAC for SAIM.
• Purina kitchen – plans finalized, Purina providing casework/furnishings.
• Lameness Arena – equine therio, farrier
• Equine OR

Programs

• Spay/Neuter/Comm Outreach/Shelter model
• WMC defined

Other

• Updated Policies
  • Pthand911_DOA Necropsies Care of Remains – New policy, defines current process.
  • MedRec205_Change in Ownership – New policy, not new process.
  • Bill308_Necropsy Adjustment - NSC
  • Bill 309_Euthanasia Fees - NSC

Budget Report 

• Financial summary reports for MWE and MDVC have been provided to the VTH Board members for informational purposes only.

Veterinary Teaching Hospital
Review of financial statements – January 2021
Reviewed by: Stephanie Camp

Overall:

• The VTH recognized a $75,178.15 operating revenue over expenses for the month of January.

Revenue:

• Revenue for the month of January was $1,585,757 for VTH operations. There was overall favorability in revenue for month of $158,302. YTD revenue (including storeroom figures) is favorable compared to budget by $597K. 
• Overall revenue was favorable compared to prior year by $209,209, while registrations show an unfavorable variance of 147. See registrations and revenue per service for additional details per service.

Expenses: 

• Operating expenses were unfavorable by $297,245 for the month and $548,744 over budget for fiscal year to date.
  • Wages are unfavorable by $28K compared to budget due $11K locum coverage and front desk wages of $22K ($13K over budget for front desk staffing).
  • Cost of goods sold shows significant deviation compared to budget for January ($202K). This is due to $108K account code reclass, YTD appears reasonable compared to positive variance in clinical sales.
  • Facilities repairs and maintenance costs are unfavorable compared to budget due to the following: $72K pharmacy clean room (plant) & $40K deferred maintenance.
  • Equipment/software maintenance expense was unfavorable compared to budget due to the following: service agreements of $82K to specialty underwriters for 
    CT and x-ray equipment and $34K to ATC/VetStar for our annual contract.
  • Laundry expense is showing a slight unfavorable variance for the month ($6544) due to an invoice catch-up over the holidays. YTD expense is favorable compared to budget.
  • Other/misc expense is unfavorable compared to budget by $10K. Included in this expense are the following: $2475 excavating, $1160 stericycle, $2K various carpool/auto expenses.

Transfers: 

• $700K transfer from energy recovery fund to fund increased costs allocations from campus budget model changes.

COVID Updates

• 2nd doses are being scheduled currently.
• Pods - No discussion on dissembling pods yet. The VM2022 students to clinics in May. How many students are on/vs out of VTH at any given time. Is there room to have the students back into the rounds rooms; service specific. Need to determine on-going recommendations (e.g. social distancing). 
• Reopening to clients – A question was posed regarding when the VTH would allow clients back into waiting areas/exam rooms. Data from other VTHs around the country indicate no one is moving to open currently. The VTH Board members were not in favor of moving to reopen the lobby for waiting room purposes.
• Dr. Lowery suggested that every service have an individual that is WSA trained to check COVID apps. The training is easy and he has identified at least one VM4 student who was non-compliant. Dr. Keating also described the process anesthesia uses to monitor compliance.
• JW will have Lisa Moore resend info about training

VTH Communications

• Intra and Extra VTH communication is hampered by cellular receptivity deficits. Previous discussions have identified 3 potential solutions: 1. Erecting cell towers for all cellular providers to enhance receptivity. This would be very expensive and not guaranteed to be effective. 2. Work to train VTH personnel how to set cellular phones to default to wi-fi calling. This relies on the user to be effective. 3. Implement TEAMS throughout the VTH for intra and inter service communications. Not good for external communications. 
• Jeff Fox has established TEAMS channels for all VTH services. Some services are currently using TEAMS already.
• Neuro – uses TEAMS and finds it very useful, especially with students.
• Would advocate for service members to have their own work devices/phones for the services. Use the chat function, not the call function. Takes some time to set up at beginning of block – set up separate channels to direct communications to relevant parties (e.g. all, Drs. only, Drs. And staff, etc.).
• Anesthesia – uses TEAMS but finds that calls drop constantly.
• Oncology – looked into using it for student interactions but found it cumbersome for whole service communication.
• Skype for business on the phone may also be an option.
• Some services have been using wi-fi calling successfully.
• JW is pursuing TEAMS training and will work with J. Fox to develop a TEAM user guide. Those services that which to use it, may do so.
• Will also ask J. Fox to put together a guide to instruct personnel how to set phones to default to wi-fi calling.

HO PD Funds

During the December 2020 VTH Board Meeting the board members discussed ER, Consult, and Transfer Fees. Pursuant to the discussion, the Resident Professional Development Funds policy (ProDev702) was updated to reflect the board’s recommendations. 

The salient points of the policy are as follows:

1. The VCM Dept. provides each resident with $500 annually for Professional Development. Beginning this next fiscal year, the VTH will match that so that each resident will receive $1000 annually. The money may be rolled over annually if not used. Any funds not used by the end of the residency will go back to the funding source. These funds should be used first to support resident professional development. The use of these funds is limited to those uses outlined in the policy but include certification exam fees and associated travel as long as the money is spent while the resident is still employed (even if the exam is scheduled after the resident has left the university).
2. Transfer fees will be renamed Transfer Exam. Transfer exam fees will be credited to the service’s operating fund. *The VTH Business Office will be working with services to determine if the transfer fee still needs to be charged or if the service will use an existing exam fee with/without fee adjustment.
3. Each resident will be provided an associated VetStar charge when they are hired to be entered into the client’s account when the resident responds in person, outside of their normal scheduled work duties, to care for or consult on the case of a patient. This will be the ER fee. ER fees will be placed in an ER Fee fund for the service. *The VTH Business Office is creating ER fee fund accounts for each VTH service. It is the responsibility of the resident to charge the ER when they respond for an emergency. ER Fee funds are available for use to support resident professional development at the discretion of the Service Head and should take into account the share of funds generated by the particular resident asking for support. The ER Fee fund balance will be rolled over annually if not spent. The use of the these funds is limited to those uses outlined in the policy.
4. Services that perform consults will charge a Consult Fee. The Consult Fee is divided so that 75% of the fee is credited to the service’s operating fund and 25% goes into the service’s Consult Fee fund. The Consult fee fund may be used at the discretion of the Service Head to support house officer development including support for the service training the resident.
5. Professional Development funds are not intended to support research. The VTH already has a policy to significantly support research initiatives and clients should not be funding VTH research.

Current service account balances will be grandfathered in and will not be swept into VTH operations. However, funds currently kept in Section based funds will be divided out into individual service accounts once the policy is enacted.

In addition to the VTH Business Office measures stated above, we will be working with services that have been charging a resident ER fee for work performed during the course of the resident’s work shift to adjust exam fees to be appropriate. Services that do not have Consult Fees or a consultation process will also be assisted in creating them.College guidelines – It appears that campus allows for the use of these and gift funds to be used to support resident exam fees, however, there is concern at the college level that doing so does not benefit the university. This was discussed and the board members agreed that paying for exam fees for residents benefits the university in a multitude of ways. The Board will submit a position statement to the 
Dean. JW to put together argument.

Consultation fees have more discretion so could be used for faculty support.

Policy was approved unanimously (Hague moved, Lowery second). 
Will be implemented for FY22.

Dentistry

• Core competency as per COE. Exploring opportunities to have Dr. Somrak spend some time in VMSC to help teach VM4 Primary Care students

SAC Lobby

• SAC Lobby Renovation Plan – a proposal for renovating the SAC lobby has been provided. Would provide clear public vs. private spaces for VTH security. Provides expanded seating, refreshment area. No net loss of exam room space, expanded onc/sts tech space. Section Heads to take plan back to service members for review. 
• Total project cost ~$740K, need to start budget planning. Project duration ~7 months

ER / Urgent Care 

• Preliminary plans – ER is over stretched with caseload. Monthly case numbers ranging from 369-808 in the past 13 months. VTH Admin will be working directly with RDVMs to find solutions to allow management of cases outside of ER. VTH Services already have long waitlists. Need to find relief valve for ER.
• ER visits with patient sent home: range 164-471/month, average 340, median 381 (11/day)

• Times patients seen: difficult to ascertain based on reporting. Similar numbers when looking at daytime vs evening for all 7 days. 
• Daytime (8am-5pm): Avg. 311 patients/month (154 M-Th, 157 F-Su)
• Evening (5pm-12am): Avg. 241 patient/month (135 M-Th, 107 F-Su)
• Developing preliminary plans to implement an Urgent Care Clinic in VMSC. Start with daytime hours M-F. Hire 1 DVM, 1 triage CVT. Utilize students on primary care/ER. Incorporate 2 Shelter/Primary Care Interns. 
• Dr. Pavlovsky writing program proposal. Board members were in support of developing this service