public health trust board of trustees€¦ · 17-04-2014 · recommendation to the pht board of...

PUBLIC HEALTH TRUST BOARD OF TRUSTEES

ONE-DAY COMMITTEE MEETINGS AGENDAS

Thursday, April 17, 2014 9:00 a.m.

Jackson Memorial Hospital West Wing Board Room 1611 N. W. 12th Avenue Miami, Florida 33136


ONE-DAY COMMITTEE MEETINGS SCHEDULE

Thursday, April 17, 2014 9:00 a.m. to adjournment

Jackson Memorial Hospital West Wing Board Room 1611 N. W. 12th Avenue Miami, Florida 33136

The One-Day Committee Meeting Schedule will commence at 9:00 a.m. with the Reasonable Opportunity for the Public to be Heard as required by Section 286.0114, Fla. Stat. (Chapter 2013-227, Laws of Florida), and then followed by the Chairperson’s Remarks, Presentations and Discussion. The Joint Conference and Efficiencies Committee meeting will follow the Chairperson’s Remarks, Presentations and Discussion which will then be followed by the Strategy and Growth Committee, then the monthly scheduled subcommittees and standing committee meeting. The meetings will be held in the West Wing Board Room. Reasonable Opportunity to be Heard 9 a.m. Please be advised that those members of the public wishing to speak on a proposition before the Board of Trustees or its committees will be called in the order in which they registered with the Secretary of the Board of Trustees. A speaker shall be limited to no more than two (2) minutes on a proposition before the Board of Trustees or its committees. Chairperson’s Remarks, Presentations Following the Reasonable Opportunity to be and Discussion Heard Joint Conference and Efficiencies Committee Following Chairperson’s Remarks, Presentations

and Discussion

Strategy and Growth Committee Following the Joint Conference and Efficiencies Committee meeting Audit and Compliance Subcommittee Following the Strategy and Growth Committee

meeting Purchasing and Facilities Subcommittee Following the Audit and Compliance

Subcommittee meeting

Fiscal Committee Following the Purchasing and Facilities Subcommittee meeting

April 14, 2014

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE

AGENDA

April 17, 2014

of 2


JOINT CONFERENCE AND EFFICIENCES COMMITTEE AGENDA

Thursday, April 17, 2014 Following Chairperson’s Remarks, Presentations and Discussion

Jackson Memorial Hospital

West Wing Board Room

Joint Conference & Efficiencies Committee Marcos J. Lapciuc, Chairperson Irene Lipof, Vice Chairperson Joe Arriola Michael Bileca Mojdeh L. Khaghan Darryl K. Sharpton

Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls.

1. Meeting Call To Order

(a) Previous committee meeting minutes (February 20, 2014)

Motion to approve the previous committee meeting minutes

Marcos J. Lapciuc, Chairperson

of 2

JOINT CONFERENCE AND EFFICIENCES COMMITTEE AGENDA – April 17, 2014

2. Reports

(a) Chief Medical Officer

Presented by Peter Paige, M.D., Senior Vice President and Chief Medical Officer

(b) Executive Medical Committee of the Medical Staff

Presented by Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff

(c) Credentials Committee Activity as of April 2014

Presented by Joshua Lenchus, DO, RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff

Motion to accept the Credentials Committee Activity report with a favorable recommendation to the PHT Board of Trustees


3. Adjournment

of 5

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES

Thursday, February 20, 2014 9:00 a.m. to Adjournment


West Wing Board Room First Floor

1611 N. W. 12th Avenue Miami, FL 33136

Joint Conference and Efficiencies Committee Marcos J. Lapciuc, Chairperson Irene Lipof, Vice Chairperson Joe Arriola Michael Bileca Mojdeh L. Khaghan Darryl K. Sharpton

____________________________________________________________________________________________________________ Members Present: Irene Lipof, Vice Chairperson, Joe Arriola, Mojdeh L. Khaghan and Darryl K, Sharpton Member(s) Excused: Marcos J. Lapciuc and Michael Bileca In addition to the Board of Trustees, the following staff members, University of Miami Miller School of Medicine Representative and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Michael Butler. M.D., Joshua Lenchus, D.O., Mark T. Knight, Peter Paige, M.D., Kevin Andrews, Lynn M. Barrett, Magdy S. Mossaad, and Don S. Steigman, and Steven Falcone, University of Miami Miller School of Medicine, and Christopher Kokoruda, Laura Llorente and Jeffrey Poppel, Assistant Miami-Dade County Attorneys ____________________________________________________________________________________________________________ PHT BOARD OF TRUSTEES ONE-DAY COMMITTEE MEETINGS OPENING REMARKS Darryl K. Sharpton, Chairperson, Public Health Trust Board of Trustees (PHT BOT) opened the PHT BOT One-Day Committee Meetings stating that the committees and subcommittees will conduct meetings based on the agendas and items recommended for action. In the absence of Marcos J. Lapciuc, Chairperson, Joint Conference and Efficiencies Committee, Mr. Sharpton requested Irene Lipof, Vice Chairperson, Joint Conference and Efficiencies Committee to conduct the meeting. 1. Meeting Call to Order Irene Lipof, Vice Chairperson at 9:10 a.m.

(a) Previous committee meeting minutes (January 15, 2014)

Motion to approve the previous committee meeting minutes Irene Lipof, Vice Chairperson

Darryl K. Sharpton moved approval; seconded by Mojdeh L. Khaghan,

and carried without dissent.

of 5

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES – February 20, 2014 2. Reports

(b) Executive Medical Committee of the Medical Staff

Joshua Lenchus, D.O., RPh, FACP, SFHM, President, Executive Medical Committee of the Medical Staff (EMCOMS) stated that the EMCOMS met in the month of February 2014. The Committee was briefed regarding the discussions held during the meeting. Florida International University College of Medicine Hospitalist Service Program is scheduled to begin within the next six months; in an effort to provide a formalized oversight regarding subcommittees of the EMCOMS the Pharmacy and Therapeutics Subcommittee will provide quarterly reports and Infection Control Subcommittee will provide monthly and quarterly reports; and the Miami Transplant Institute Quality Assessment and Performance Improvement Plan was approved.

(c) Credentials Committee Activity Report Dr. Lenchus presented the Credentials Committee Activity Report (Credentials Report) for the month of February 2014 with a favorable recommendation to the PHT BOT. Dr. Lenchus requested that the Credentials Report be amended to show the removal of Claudia Bermudez, M.D. from the Non-Return of Reappointment Resignations-Medical Staff section of the Credentials Report. At this time there is no desire to resign Dr. Bermudez. Dr. Lenchus reminded everyone that the Credentials Activity Report was fully vetted in the appropriate committee(s). With the exception of the removal of Dr. Bermudez from the Non-Return of Reappointment Resignations-Medical Staff there was no insignificant information to report. A detailed copy of the report was distributed at the meeting.

3. Resolution Recommended to Be Approved (a) Resolution approving the Medical Staff and Health Professional Affiliate Staff Membership and Clinical

Privileges; approving Initial Appointments, Reappointments and Clinical Privileges and Activities; approving Modifications to Medical Staff Membership Category and Clinical Privileges; accepting Resignations and Leaves of Absence – February 2014

Sponsored by Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System

Motion to accept the resolution as amended with a favorable recommendation to the Public Health Trust Board of Trustees

Irene Lipof, Vice Chairperson

Mojdeh L. Khaghan moved to accept the Credentials Committee Activity Report as amended; seconded by Joe Arriola, and carried without dissent.

2. Reports cont…

(d) JMH Health Plan Quality Improvement Committee

No report

of 5

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES – February 20, 2014

2. Reports cont…

(e) Miami Transplant Institute

Kevin Andrews, Vice President, Quality and Patient Safety Division presented with a recommendation for approval the Quality Assessment and Performance Improvement Plan November 2013-2014 (QAPIP) which is part of the reorganization of Miami Transplant Institute (MTI). A copy of the current goals and objectives and copy of the QAPIP was included with the agenda. Mr. Sharpton questioned how the item is in compliance with statutory requirements. In a response to Mr. Sharpton’s question, Mr. Andrews stated the following: the objective of the MTI quality plan is to sustain minimum volume requirements, sustain graft and patient survival that exceeds SRTR expected rate, incorporate QAPI into the daily operations of MTI, comply with CMS regulations, OPTN/UNOS requirements, Joint Commission standards, Florida State Health Department and other applicable standards and requirements, and complete a successful Focused Quality Assessment and Performance Improvement (F-QAPI) if identified for survey.

Besides the Joint Commission and CMS, Ms. Khaghan questioned if there are other ongoing accreditation processes. Mr. Andrews yes. He stated other ongoing accreditation processes include UNOS and the State of Florida.

3. Resolution Recommended to Be Approved cont…

(b) Resolution approving the Miami Transplant Quality Assurance and Performance Improvement Plan and

supporting documents

(1) Current goals and objectives (2) Quality Assessment and Performance Improvement Plan November 2013-2014

Sponsored by Kevin Andrews, Vice President, Quality and Patient Safety Division, Jackson Health System

Motion to approve the resolution and supporting documents with a favorable recommendation to the Public Health Trust Board of Trustees Irene Lipof, Vice Chairperson

Mojdeh L. Khaghan moved approval; seconded by Joe Arriola, and carried without dissent.

of 5

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES – February 20, 2014 2. Reports cont…

(a) Chief Medical Officer Report

Peter Paige, M.D., Senior Vice President and Chief Medical Officer reported that the process of raising the bar of the Critical Care Program is moving toward a different level of expertise particularly as it relates to critical care medicine. An internationally known consultant was bought in to review the critical care medicine program which resulted in specific recommendations to further enhance the program. Among the recommendations include identifying a critical care leader with expertise in academics, link critical care medicine with quality, and capitalize on the evidence-based practice guidelines to be able to standardize processes across Jackson Health System (JHS). Ms. Khaghan questioned the growth and scope of critical care. Dr. Paige stated that the Critical Care Delivery System is a system that will evolve around and manage independent care units such as Trauma, Surgical ICU, Cardiac Care, Medical ICU and Step-Down Beds which is essentially transitioning patients from an ICU setting to a patient floor. A critical care leader will be responsible for managing the care of critical care patients. Ms. Khaghan requested that the Committee receive follow-up reports regarding the success of the critical care initiative.

(f) Fiscal Year 2014 Strategic Plan – Quality Care and Patient Safety With regards to JHS moving forward in terms of strategy from a quality and safety perspective, Mr. Andrews presented a summary of the Quality Care and Patient Safety Business Plan and high level overview of the four (quality care, patient safety, service excellence and advanced technology) key strategic drivers of the patient experience under a single brand identity . During fiscal year 2014 there will be an ongoing process of unifying measurement and improvement of the key indicators, elevating and aligning the work necessary to continue moving away from reactionary and defensive action toward a more effective goal-and data-driven proactive approach. The objective is a team approach across JHS facilities with agreed upon standards of practice that drive excellence and readiness; sensitive to the needs and contributions of nurses, physicians and the other clinical and non-clinical staff who participate in patient care. Mr. Andrews defined the structures, goals and objectives for two of the four elements; patient safety and quality care. He described the following seven (7) goals how the goals will lead to success of the patient safety and quality care business plan:

• Improve clinical informatics • Evidence-based medicine measures in the top ten percent (10%) nationally among hospitals • Compliance with notational patient safety goals • Increase patient satisfaction • Reduce hospital-acquired conditions • Reduce number of events • Successful surveys (move to a continuous readiness)

Mr. Sharpton reminded everyone that the presentation is geared more toward a cultural change; much of what was mentioned in the presentation will be continual with ongoing training for all participants in patient care. As part of the presentation, Mr. Andrews presented a diagram showing a system-wide team approach made up of a new network of quality councils across JHS that will report to the PHT Board of Trustees through the Medical Executive Committee. At every level, the quality councils will be key gears needed to empower physicians, engage employees and hardwire proper behavior.

of 5

JOINT CONFERENCE AND EFFICIENCIES COMMITTEE MEETING MINUTES – February 20, 2014 Mr. Andrews presented a brief overview of tactic initiatives including Evidence-Based Medicine which is a real time data collection and huge help to monitor progress and delivery of care; improved Case Management process that will reduce lengths of stay; improved Data Management to be able to develop standardized progress reports to measure; improve Infection Control rates and improve practices standards across JHS; improve Medication Safety to reduce medical errors; prevent Hospital-Acquired Pressure Ulcers; reduce the number of Patient Falls; and develop an infrastructure to reduce Readmission Rates. With regards to surveys and continuous readiness, Mr. Andrews stated that unannounced mock surveys will be conducted across JHS. When talking about utilizing and developing toolkits and encouraging “Best Practice” the goal is to monitor implementation within JHS facilities as well as monitor compliance with CMS and Joint Commission standards. Mr. Andrews presented a detailed implementation timeline for every 30 days, beginning April 1, 2014 and running through the fiscal year. The timeline was presented follows:

By Apr 1 Recruit Quality Council members Schedule weekly data review meetings

By May 1 Update job descriptions Review existing toolkits; schedule updates and additions

By June 1 Standardize reports Define and develop audit tools

By Jul 1 Begin reviewing and rewriting policies

By Aug 1 Finalize toolkits

By Sep 1 Begin toolkit orientation

Mr. Andrews thanked members of the Quality and Patient Safety Team including Dr. Paige who provided a great deal expertise Matthew Pinzur, Associate Vice President, Communications and Outreach and the Public Relations Team. Mr. Sharpton questioned the reporting process going forward of the Quality Care and Patient Safety Strategic Plan. With regards to updates and sharing information going forward, Mr. Migoya stated within a 90-day period of time improvements could be better tracked and predictions can be made regarding the level of improvements which will then be followed by monthly and/or quarterly update reports to the Committee.

4. Adjournment Irene Lipof, Vice Chairperson at 9:56 a.m.

Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant Public Health Trust Board of Trustees

2. Reports

2 (a) Chief Medical Officer

2 (b) Executive Medical Committee of the Medical Staff

2 (c) Credentials Committee Activity as of April 2014

3. Adjournment

STRATEGY AND GROWTH COMMITTEE

AGENDA

April 17, 2014

of 1


STRATEGY AND GROWTH COMMITTEE AGENDA

Thursday, April 17, 2014 Following the Joint Conference and Efficiencies Committee Meeting



Strategy and Growth Committee Joe Arriola, Chairperson Marcos J. Lapciuc, Vice Chairperson Michael Bileca Mojdeh L. Khaghan Irene Lipof Darryl K. Sharpton

Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call To Order



Joe Arriola, Chairperson

2. Repor ts

(a) Facility Master Plan Update

Presented by Don S. Steigman, Executive Vice President and Chief Operating Officer (b) Dixon Hughes Update

Presented by Mark T. Knight, Executive Vice President and Chief Financial Officer (c) AOA Update

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

3. Adjournment

of 2

STRATEGY AND GROWTH COMMITTEE MEETING MINUTES

Thursday, February 20, 2014 Followed the Audit and Compliance Subcommittee Meeting




Strategy and Growth Committee Joe Arriola, Chairperson Marcos J. Lapciuc, Vice Chairperson Michael Bileca Mojdeh L. Khaghan Irene Lipof Darryl K. Sharpton

____________________________________________________________________________________________________________ Members Present: Marcos J. Lapciuc, Vice Chairperson, Mojdeh L. Khaghan, Irene Lipof, and Darryl K. Sharpton Member(s) Excused: Michael Bileca and Joe Arriola In addition to the Board of Trustees, the following staff members and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Mark T. Knight, and Eugene Shy, Jr., Laura Llorente and Christopher Kokoruda, Assistant Miami-Dade County Attorneys ____________________________________________________________________________________________________________

1. Meeting Call to Order Darryl K. Sharpton, Chairperson, PHT Board of Trustees at 12:23 p.m.


Motion to approve the previous committee meeting minutes Darryl K. Sharpton, Chairperson, PHT Board of Trustees Mojdeh L. Khaghan moved approval; seconded by Irene Lipof, and

carried without dissent.

of 2

STRATEGY AND GROWTH COMMITTEE MEETING MINUTES – February 20, 2014

2. Reports

(a) Facility Master Plan

Mr. Migoya reported that the Facility Master Plan (FMP) is on schedule for completion within the next sixty (60) days. The Committee will be kept informed as the process to complete the FMP continues.

(b) Strategic Planning Retreat Mr. Migoya reminded everyone that the Strategic Planning Retreat (Retreat) is scheduled for February 28, 2014 located at the Miami Marriott Biscayne Bay Hotel. The Retreat will be conducted in both open and close sessions. An overview of JHS past and present, review of the Miami-Dade County market and review of JHS eleven key strategies will be conducted in an open session; and discussion regarding the selected centers of world strategies and next steps will be discussed in a closed session. As a follow up from the Retreat it is anticipated that within a 90-day period of time the Committee will be presented with information to review.

3. Resolution Recommended To Be Forwarded To The Public Health Trust Board of Trustees

(a) Resolution urging the Board of County Commissioners of Miami-Dade County to enact Ordinance Amending Section 30-388.2 of the Miami-Dade County Code providing that, consistent with state law, parking charges may be imposed on vehicles displaying a disabled parking permit or license tag at Public Health Trust facilities under specified circumstances

Sponsored by Mark Aprigliano, Corporate Director, Public Safety Division, Jackson Health System Motion to forward the resolution to the Public Health Trust Board of Trustees with a favorable recommendation Darryl K. Sharpton, Chairperson, PHT Board of Trustees

Irene Lipof moved approval; seconded by Mojdeh L. Khaghan, and carried without dissent.

4. Adjournment Darryl. K. Sharpton, Chairperson, PHT Board of Trustees at 12:29 p.m.

Meeting Minutes Prepared by Ivenette Cobb-Black

Executive Assistant Public Health Trust Board of Trustees

2. Reports

2 (a) Facility Master Plan Update

2 (b) Dixon Hughes Update

2 (c) AOA Update

3. Adjournment

AUDIT AND COMPLIANCE SUBCOMMITTEE

AGENDA

April 17, 2014

of 2


AUDIT AND COMPLIANCE SUBCOMMITTEE AGENDA

Thursday, April 17, 2014 Following the Strategy and Growth Committee Meeting



Audit and Compliance Subcommittee Mojdeh L. Khaghan, Chairperson

Marcos J. Lapciuc, Vice Chairperson Michael Bileca Irene Lipof

Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringers must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls. 1. Meeting Call To Order



Mojdeh L. Khaghan, Chairperson

2. Review and Recommend to Accept KPMG FY13 JMH Health Plan Audited Financial Statements and Management letter

(a) KPMG FY13 JMH Health Plan Audited Financial Statements (b) KPMG FY13 JMH Health Plan Management Letter

Presented by Mark T. Knight, Executive Vice President and Chief Financial Officer

Motion to accept KPMG FY13 JMH Health Plan Audited Financial Statements and Management letter with a favorable recommendation to the Fiscal Committee


of 2

AUDIT AND COMPLIANCE SUBCOMMITTEE AGENDA – April 17, 2014

3. Repor ts

(a) Corporate Compliance Presented by Lynn M. Barrett, Vice President and Chief Compliance Officer, Corporate Compliance Department

(1) FY14 Progress Gantt Chart (January 1, 2014 to March 31, 2014) (2) Revised FY14 Compliance Program Work Plan and Compliance Blocks (3) Referral Source Training (April 1, 2014)

(b) Internal Audit

Presented by Magdy Mossaad, Vice President of Internal Audit Department

(1) FY14 Audit Plan Update

(2) Review of Finalized Audit Reports

(a) 2014 JNMC Patient Intake and Revenue Cycle - Operating Room Unit (b) 2014 Cash Audit - Jackson Health System

(3) Audit Follow-up Summary

4. Adjournment

of 3

AUDIT AND COMPLIANCE SUBCOMMITTEE MEETING MINUTES

Thursday, February 20, 2014 Followed the Fiscal Committee Meeting




Audit and Compliance Subcommittee Mojdeh L. Khaghan, Chairperson

Marcos J. Lapciuc, Vice Chairperson Michael Bileca Irene Lipof

____________________________________________________________________________________________________________ Members Present: Mojdeh L. Khaghan, Chairperson, Marcos J. Lapciuc, Vice Chairperson, and Irene Lipof Member(s) Excused: Michael Bileca Board of Trustees Member(s) Present: Darryl K. Sharpton In addition to the Board of Trustees, the following staff members, KPMG Representative and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Mark T. Knight, Don S. Steigman, Magdy S. Mossaad, and Lynn M. Barrett, and Karen Mitchell, KPMG Representative, and Eugene Shy, Jr., Jeffrey Poppel, Christopher Kokoruda and Laura Llorente, Assistant Miami-Dade County Attorneys ____________________________________________________________________________________________________________

1. Meeting Call to Order Mojdeh L. Khaghan, Chairperson at 11:46 a.m.

(a) Previous committee meeting minutes (December 15, 2013)

Motion to approve the previous committee meeting minutes Mojdeh L. Khaghan, Chairperson Darryl K. Sharpton moved approval,

seconded by Irene Lipof, and carried without dissent.

of 3

AUDIT AND COMPLIANCE SUBCOMMITTEE MEETING MINUTES – February 20, 2014

2. Review of KPMG Fiscal Year 2013 Audited Financials Statements and Management Letter

(a) KPMG Fiscal Year 2013 Audited Financial Statements (b) KPMG Fiscal Year 2013 Management Letter

Karen Mitchell, Partner, KPMG presented an overview of the Fiscal Year 2013 Audited Financial Statements (“Financial Statements”) that included an accrual related to the Gain Sharing Plan. A detailed copy of the Financial Statements was included with the agenda. Ms. Mitchell stated that the Financial Statements report is an unqualified report with pending administrative items that are scheduled for completion in the near future. The Audited Financial Statements was reported in accordance with professional and government auditing standards. Highlights of the Financial Statements included time dedicated to accounting estimate, allowance for doubtful accounts, collectability of accounts receivable, and process for determining the net value of receivables. In an addition with regards to third-party settlement accounts the services of a specialist provided assistance to assure that detail transactions from all prior year accounts were tested, review of several actuaries including medical malpractice, workmen’s compensation, pension, HMO claims and focused on reviewing alternative investments for the Trust’s pension fund. There were no material adjustments regarding uncorrected and corrected statements, and received full cooperation from Jackson Health System (JHS) staff and Management Team with no disagreements. Highlights of the Fiscal Year 2013 Management Letter noted certain matters involving internal control and other operational matters including the Contractual Allowances Model, Management Responsibility for Alternative Investments, and Consideration of the Upcoming Accounting Pronouncements with the Governmental Accounting Standards Board (“GASB”). Based on the observations and recommendations JHS Management provided written responses to the observations identified. Ms. Mitchell invited PHT BOT’s and members of JHS staff to attend an upcoming event regarding some of the implementation criteria for pension plans. More information will be forwarded regarding the event. With regards to the issuance of several statements by GASB that may impact the Trust, Mr. Sharpton stated that he expects that representatives from KPMG, Mark T. Knight, Executive Vice President and Chief Financial Officer, and JHS Internal Audit Department staff will ensure that the GASB statements that will be effective in the upcoming years and may impact JHS are implemented. Mr. Sharpton questioned the last time KPMG reviewed JHS actuarial report and found significant differences or issues. Ms. Mitchell stated that based on the different ranges and views on assumption, JHS have fallen within the acceptable ranges. Mr. Knight stated that the comments that were heard are recommendations from KPMG, there were no findings, no material weaknesses and efficiencies. The other item is that with the acceptance of the audited financial statements and moving those forward for approval per Mr. Migoya’s employment agreement this will generate the payment of his performance bonus. Mr. Knight reminded everyone that as part of Mr. Migoya’s employment agreement performance bonus has been incorporated into the audited financial statements this period and is recorded as part of the operating expenses for fiscal year 2013. As a result of the Fiscal Year 2013 Audit, Mr. Migoya thanked the Finance Team for not having any deficiencies to report. Motion to accept KPMG Fiscal Year 2013 Audited Financial Statements and Management Letter with a favorable recommendation to the PHT Board of Trustees

Mojdeh L. Khaghan, Chairperson Marcos J. Lapciuc moved approval; seconded by Irene Lipof, and carried without dissent,

of 3

AUDIT AND COMPLIANCE SUBCOMMITTEE MEETING MINUTES – February 20, 2014

3. Reports

(a) Corporate Compliance

(1) Compliance Program Work Plan Progress Fiscal Year 2014 – Compliance Blocks (2) Fiscal Year Progress Gantt Chart – October 1, 2013 to January 31, 2014

Presented by Lynn M. Barrett, Vice President and Chief Compliance Officer, Corporate Compliance Department

For purposes of information, the Subcommittee was presented with a progress report with respect to Fiscal Year 2014 Compliance Work Plan (“Work Plan”). The report highlighted information having to do with how the Work Plan items fit into the Compliance Blocks which is the result of an assessment of the Compliance Program that was conducted last year by Cheryl L. Wagonhurst. A detailed copy of the Work Plan was included with the agenda. With regards to the Corporate Compliance Department’s activities, a Gantt chart was presented which demonstrated the department’s progress to date. There is an approximate overall 30% average of completion in various projects, and much work has been done in the HIPAA areas particularly in the HIPAA Notice of Privacy Practice Manuals and training. A detailed copy of the progress report was included with the agenda. Ms. Barrett stated that the Office of Inspector General (“OIG”) released its Work Plan and the Corporate Compliance Department will review its Work Plan in conjunction with OIG Work Plan to determine whether or not to organize its priorities or keep them the same.

(b) Internal Audit

(1) Fiscal Year 2014 Audit Plan Update (2) Review of Finalized Audits

(a) 2013 Medical Oncology Outpatient (ACC East) Audit (b) Audit Follow-up Summary

Presented by Magdy S. Mossaad, Vice President, Internal Audit Department

Mr. Migoya thanked Andre Reid, who served as Interim Director, Internal Audit Department for doing a great job during the external audit process and as Interim Director.

Mr. Mossaad reported that 3 out of the 26 scheduled fiscal year 2014 audits have been completed which represents 12% of the Audit Plan being completed. For purposes of information, Mr. Mossaad presented results of the 2013 Medical Oncology Outpatient (ACC East) Audit and follow up information regarding prior year audits as of December 31, 2013. Detailed copies of the reports were included with the agenda.

Adjournment Mojdeh L. Khaghan, Chairperson at 12:06 p.m.

Meeting Minutes Prepared by Ivenette Cobb-Black Executive Assistant

Public Health Trust Board of Trustees

2. Review and Recommend to Accept KPMG FY13 JMH Health Plan Audited Financial Statements and Management Letter

3. Reports

3 (a) Corporate Compliance

*In Coordination with Internal Audit

Page 1 of 9

FY 2014 Jackson Health System Compliance Program Work Plan

PRIORITY FOCUS SOURCE OF RISK IDENTIFICATION

CURRENT ACTIVITIES (Assessment /Policies & Procedures / Training / Audits & Monitoring)

WORK PLAN RESPONSIBLE PERSON

TIME FRAME

STATUS

INPATIENT ADMISSION PROCESS There is an increased focus by governmental regulatory agencies as well as other payers of the accuracy, integrity and quality of patient data to ensure the proper inpatient admission process

Based on internal risk assessment by departments:

This issue is a CMS Recovery Audit Contractors (RAC) approved issue and on the Office of Inspector General’s Work Plan

Policy: Case Management Protocol for inpatient admission at Jackson Memorial Hospital and Holtz Children’s Hospital.

Assessment and Policy Review: Assess inpatient admission process, including areas such as scheduling and registration, financial assessment, and bed placement. Conduct gap analysis. Review all current policies governing inpatient admission process and provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry.

Erma McRae Sharon Powell Telisa Lyons Pat Kelly Carmen Pla

Q2/Q3

Training: There is internal departmental training conducted by department heads Siemens is on the ground assessing workforce needing ICD – 10 – CM training

Training: As the policies mentioned above are reviewed and, where appropriate, revised and/or implemented, policy-specific training will be rolled out to the appropriate divisions/units as identified and as needed. Training to transition to ICD – 10- CM will be assessed and conducted by Siemens

Erma McRae Sharon Powell Carmen Pla Siemens

Q4 Q1, Q2, Q3, Q4

Auditing and monitoring: Compliance conducts ongoing auditing and monitoring as scheduled on the annual audit plan

Auditing and monitoring: Conduct compliance audits for Inpatient Admission Process subsequent to training prioritized by medical service

Erma McRae Q4

OUTPATIENT ADMISSION PROCESS There is an increased focus by governmental regulatory agencies as well as other payers on outpatient hospital department care

Based on internal risk assessment with departments.

Policy: Assess outpatient admission process relating to radiology and pathology services and conduct gap analysis. Review case Management Protocol for observation and surgery, Clinical Documentation and coding as well as Revenue Cycle Financial Services policies relating to radiology and pathology services.

Assessment and Policy Review: Assess outpatient admission process, including scheduling and registration, financial clearance, clinical/physician documentation and charge capture. for the technical component of radiology and pathology services. Review all current policies governing outpatient admission process and provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry. Complete gap analysis

Erma McRae Patrice McKenzie Roleen Alvarez Telisa Lyons Pat Kelly Carmen Pla

Q2/Q3


Page 2 of 9




TIME FRAME

STATUS

Training: There is internal departmental training conducted by department heads

Training: As the policies mentioned above are reviewed and, where appropriate, revised and/or implemented, policy-specific training will be rolled out to the appropriate divisions/units as identified and as needed

Erma McRae Pat Kelly Carmen Pla

Q3


Auditing and monitoring: Conduct compliance audits for Outpatient Admission Process subsequent to training prioritized by medical service dependent on risk for payment denial

Renee Baine Erma Mcrae Siemens Cerner

Q4

*TRANSPLANT General and Organ Procurement Organization (OPO) to be reviewed

Based on internal risk assessment with departments,; ensure compliance of financial relationship between the institutions and review cost reports

Policy: There are internal departmental reviews by department head

Assessment & Policy Review: Review current policies and provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry. Assess transplant program for compliance with policies, regulatory requirements and complete gap analysis. Review financial relationship with UM and cost reporting processes.

Amber Thomas Andre Reid Maggy Dickens Carmen Fernandez Carmen Pla

Q3/Q4

Training: There is internal departmental training by department head

Training: As the policies mentioned above are reviewed and, where appropriate, revised and/or implemented, policy-specific training will be rolled out as identified and as needed

Amber Thomas Andre Reid

Q4

PHARMACY Single dose, multi-use vials and payments for outpatient drugs and administration is a risk identified by both the OIG and RAC as it relates to inappropriate billing and coding procedures for dose and administration

Based on internal risk assessment with departments. Additionally, this issue is on the CMS Recovery Audit Contractors (RAC) approved issues and on the 2013 HHS Office of Inspector General’s Work Plan

Policy: Departmental policies are reviewed during each compliance audit

Policy: Review current policies and provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Renee Baine Venessa Price-Goodnow

Q1/Q2

Training: Internal departmental training


Renee Baine Venessa Price-Goodnow

Q3


Auditing and monitoring: Conduct compliance audits by biological subsequent to training and prioritized by risk as it relates to the RAC approved list of issues

Renee Baine Erma Mcrae Venessa Price-Goodnow

Q3


Page 3 of 9




TIME FRAME

STATUS

CLINICAL TRIALS Patients who are enrolled in a clinical trial must be advised of their participation via an informed consent in order to participate To ensure the accuracy, integrity and quality of patient data to ensure appropriateness of coding and billing

Internal Risk Assessment by Compliance On the Office of Inspector General’s Work Plan

Policy: Departmental policies

Assessment and Policy Review: Review current policies and provide recommendations to ensure compliance with regulatory requirements and best practice standards in the industry. Areas to review are IRB and CRRC approval, participant consent, Medicare Coverage Analysis (MCA), coding and PI compliance with enrollment notification to the JHS Clinical Trials Office (CTO)

Erma McRae Angelique Johnson Eve Sakran

Q4

Training: None specific


Erma McRae Eve Sakran

Q1/Q2

Auditing and monitoring: Ongoing compliance auditing and monitoring as scheduled on the annual audit plan

Auditing and monitoring: Conduct compliance audit as needed subsequent to training

Erma McRae Eve Sakran

Q4

MEDICAL DEVICE CREDITS/WARRANTIES

Hospitals—Inpatient and Outpatient Hospital Claims for the Replacement of Medical Devices submitted that include procedures for the insertion of replacement medical devices in compliance with Medicare regulations. Medicare does not cover items or services for which neither the beneficiary nor anyone on his or her behalf has an obligation to pay. (Social Security Act, §1862(a)(2).) Medicare is not responsible for the full cost of the replaced medical device if the hospital receives a partial or full credit from the manufacturer either because the manufacturer recalled the device or because the device is covered under warranty. When hospitals receive full or partial credits, their Medicare

Based on internal risk assessment with departments and on the 2013 HHS OIG Work Plan

Compliance in this area is a struggle because it requires coordination among various departments — coding, billing, cardiac services, and account receivables, finance and materials management

Policy: Commenced gap analysis to ensure compliance with regulatory requirements and business practices and identify gaps

Assessment and Policy Review: Complete gap analysis and provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Erma McRae Ana Sanchez Laura Scott Charles Bearham Carmen Fernandez

Q1/Q2


Training: As the gap analysis is completed and where appropriate, revised and/or implemented, policy-specific training will be rolled out as identified and as needed

Erma McRae Q3


Page 4 of 9




TIME FRAME

STATUS

payments for procedures to replace devices are often reduced. But Medicare won’t know to reduce payments unless hospitals report credits using a combination of modifiers, condition codes and value codes on claims for procedures to implant replacement devices, such as defibrillators and pacemakers. Failure to pass on medical-device credits to Medicare results in overpayments

(OAS; W-00-13-35516; various reviews; expected issue date: FY 2013; new start)

Auditing and monitoring: None specific

Auditing and monitoring: Conduct compliance audit subsequent to training as needed

Erma McRae Q4

EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA) Congress passed EMTALA in April 1986 to address the problem of “patient dumping.” The term “patient dumping” refers to certain situations where hospitals fail to screen, treat, or appropriately transfer patients. According to Section 9121 of COBRA, Medicare participating hospitals must provide a medical screening exam to any individual who comes to the emergency department and requests examination or treatment for a medical condition. If a hospital determines that an individual has a medical emergency, it must then stabilize the condition or provide for an appropriate transfer. The hospital is obligated to provide these services regardless of the individual’s ability to pay and without delay to inquire about the individual’s method of payment or insurance status

Based on internal risk assessment with departments.

This issue is a CMS Recovery Audit Contractors (RAC) approved issue and on the Office of Inspector General’s Work Plan

Policy: Internal departmental review

Assessment and Policy Review: Review all current policies to ensure compliance with regulatory and business practices to identify gaps. Areas to review included ER-on call, medical screening examination, central log, EMTALA signage and transfers. Conduct gap analysis. Provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Lynn M. Barrett Jerry Del Amo Deidre Bethel CAO of each hospital Risk Management

Q1/Q2

Training: Orientation and annual online training modules

Training: As the policies mentioned above are reviewed and, where appropriate, revised and/or implemented, policy-specific training will be rolled out to the appropriate divisions/units

Lynn M. Barrett Jerry Del Amo ER Director (by facility) Risk Management

Q3

Auditing and monitoring: Conducted gap analysis at JNMC and JSCH

Auditing and monitoring: Subsequent to training

Jerry Del Amo Q4

LONG TERM CARE FACILITIES The risk of inappropriate use of federal requirements related to quality of care and questionable billing practices are some of the risk

Based on internal risk assessment with departments. To develop a plan to access preventable adverse events in the nursing facility. We will conduct a review of the extent to which an identified medication

Policy: Internal departmental review by department heads

Assessment and Policy Review: Review the standard protocols for reporting adverse events by the National Council for Medication Errors Reporting and Prevention (NCC MERP) in conjunction with JHS internal policies as part of the effort to identify and classify events. Utilize the NCC MERP Index for

Erma McRae Jerry Del Amo Andrew Figueroa

Q3


Page 5 of 9




TIME FRAME

STATUS

areas being addressed by regulatory agencies

error was preventable and an analysis on the resulting number of inpatient hospital stays and emergency room visits resulting from the preventable adverse event.

Categorizing Errors tool to access the events and the preventability of them.

*REFERRAL SOURCE COMPENSATION Recent statutory changes codified that any claim submitted resulting from a referral made in violation of the Anti-Kickback Statute automatically “constitutes a false or fraudulent claim” under the False Claims Act. Non-compliant referral arrangements now carry heavier penalties

Based on internal risk assessment with departments and risk areas highlighted by outside consultant, Berkeley Research Group (BRG)

Policy: JHS Policy 283 - Medical Directorship Physician Compensation JHS Policy 273 – Acquisition of Physician Services

Assessment: Identify all referral source arrangements system wide and obtain all forms of remuneration provided to each such referral source

Lynn M. Barrett Neil McKay Andre Reid Alan Goldsmith

Q3/Q4

BUSINESS ASSOCIATE AGREEMENTS Recent changes to the Privacy and Security regulations within HIPAA have caused a need for relevant adjustments to the JHS Business Associate Agreement (BAA) template Additionally, subcontractor relationships are a focus because of the high risk for large data breaches

Omnibus Rule changes will require a review of our vendors, but the language of our agreements must also be reviewed

Templates: 2010 templates meet old and new guidelines but should be optimized Policy: JHS Policy 523 – Business Associate Addendum

Templates: Once the language is reviewed, the vendors and their subcontractors must be reviewed and brought into compliance with new agreement language. Policy: Included in NEW HIPAA Privacy Manual – Section 504 – Business Associates Provide recommendations as needed to ensure compliance with HIPAA Omnibus Rule and best practice standards in the industry

Luis F. Martinez Michelle Romano Department Head Luis F. Martinez Michelle Romano

Q1

Q1

Training: Privacy Officer provides ongoing face to face trainings and when an incident occurs

Training: Provide in-service for Procurement department to ensure they can differentiate any of the new changes made to the template with the HIPAA Omnibus Rule

Luis F. Martinez

Q2

Auditing and monitoring: Compliance conducts auditing and monitoring as scheduled on the annual audit plan

Auditing and monitoring: BAA audit subsequent to training Work with Procurement to ensure that all subcontractors have appropriate safeguards in place to ensure protection of JHS patient data

Luis F. Martinez

Q3


Page 6 of 9




TIME FRAME

STATUS

HIPAA MANUAL Recent changes to the Privacy and Security regulations within HIPAA have caused a need for relevant adjustments and an easy-to-use manual for policies and procedures. In addition, the previous format of the Privacy policy and procedure set (500 administrative series) did not reflect the flexible nature of the evolving JHS Privacy Office

HIPAA Based on an assessment of current policies and procedures vis-à-vis the Federal “Omnibus” Rule. The priority of all JHS employees will be to understand how regulatory changes apply to their specific role

This issue is enforceable by Health and Human Services, Office of Inspector General, in the coming fiscal year

Policy: JHS Policies Section 500 – Privacy & Confidentiality Policies 501 – 523

Policy: NEW HIPAA Privacy Manual; provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Luis F. Martinez

Q1

Training: Online training provided to all JHS employees

Training: Identification and ranking of Health System areas based on risk. Generate a list of department to be trained pursuant to their use and access to Protected Health Information (PHI)

Luis F. Martinez

Q1,Q2, Q3, Q4

PATIENT MEDICAL RECORD AMENDMENTS Recent changes to the Privacy and Security regulations within HIPAA have caused a need for relevant adjustments and oversight of patient access

Based on an assessment of ongoing amendment protocol and issues between Health Information Management (HIM) and the clinical staff that have caused delays in execution

Policy: JHS Policy 506 – Request to Amend Protected Health Information

Policy: New HIPAA Privacy Manual – Section 502.7 – Patient Right to Request Amendment Provide recommendations as needed to ensure compliance with and best practice standards in the industry

Luis F. Martinez HIM CMAO: Dr. Michael Butler ACMO’s: M. Multach M. Averhoff C. Mata

Q2

Training: None specific, and incident driven by HIM

Training: Privacy Officer to provide training as needed Medical Executive training and outreach regarding their piece of the protocol

Luis F. Martinez Q2

Auditing and monitoring: Review current protocol bottlenecks and create corrective actions


Luis F. Martinez Q4

HIPAA NOTICE OF PRIVACY PRACTICE Recent changes to the Privacy and Security regulations within HIPAA have caused a need for relevant training and a gap analysis vis-à-vis the JHS Notice of Privacy Practices

With a compliance enforcement date of September 23, 2013, JHS must include all relevant changes from the HIPAA Omnibus Rule. Additionally, staff must be trained to ensure proper execution of the existing JHS policy

Policy: JHS Policy 504 – Privacy Notice and Acknowledging Receipt of the Notice

Policy: New HIPAA Privacy Manual – Section 502.3 – Notice of Privacy Practices; provide recommendations as needed to ensure compliance with HIPAA Omnibus Rule and best practice standards in the industry

Luis F. Martinez CAO Patricia Sechi Neil McKay

Q1


Page 7 of 9




TIME FRAME

STATUS

CLIA changes require that the Notice of Privacy Practices must include patient notification of the right to access LAB reports directly. This needs to be done by October 6th.

Training: Online training provided to all JHS employees as well as incident driven

Training: In-service specific areas that execute the Notice of Privacy Practice. Work with patient registration and intake units to ensure proper handling of the Notice of Privacy Practices into the medical record

Luis F. Martinez Telisa Lyons Carmen Pla

Q2, Q3

Auditing and monitoring: None specified


Luis F. Martinez Q4

HIPAA SECURITY Recent changes to the Privacy and Security regulations within HIPAA have caused a need for a robust Security Assessment

Our current Security Risk Assessment document requires update to meet the new Omnibus regulations and new regulatory environment

Policy: JHS Policies Section 900 – IT Security - Policies 901 – 955

Policy: IT Security to provide gap analysis and recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Mike Garcia Scott Judd Connie Barrera

Q1

Training: Online training provided to all JHS employees as well as incident driven

Training: Provide face-to-face training based on corrective action plan

Connie Barrera

Q2, Q3

Auditing and monitoring: Ongoing privacy access and same name audits

Auditing and monitoring: IT Security to audit subsequent to training

Connie Barrera

Q4

RESIDENT COMPLIANCE TRAINING PROGRAM The development of a Resident Compliance Training Program is essential in ensuring they are equipped with the knowledge of billing guidelines, fraud and abuse (including Stark and Anti-Kickback statutes), HIPAA and how to appropriately document the care that they give to support their billing to payers

Based on an internal risk assessment with senior residents and revenue cycle employees

Policy: JHS 282 - Resident Supervision Policy

Policy: Provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Lynn M. Barrett Renee Baine University of Miami Compliance Office University of Miami Residency Program Coordinators Lourdes Boet Luis Martinez

Q3

Training: Training provided to all JHS Residents

Training: Training schedule to be designed in collaboration with University of Miami Compliance officer and provide face to face training by department. Training schedule to be designed and announced

Lynn M. Barrett Renee Baine University of Miami Compliance Office University of Miami Residency Program Coordinators Lourdes Boet Luis Martinez

Q3/Q4


Page 8 of 9




TIME FRAME

STATUS

In addition, ensure compliance with the current CMS Cost Reporting allocations and regulatory guidelines of directed GME funds

Review and conduct analysis of all rotation contracts and appropriate cost reporting practices

Lynn M. Barrett Renee Baine Carmen Fernandez

Q4


Training: Provide as identified and needed

Renee Baine Carmen Pla Charles Bearham Pam Fell

Q4

CORRECTIONS HEALTH SERVICES To ensure compliance with the Settlement Agreement issued by the Department of Justice for certain conditions in the Miami-Dade County Corrections and Rehabilitation Jail facilities

This was identified as a risk by external agencies based on a Settlement Agreement initiated with Department of Justice (DOJ), Miami Dade County and the Board of County Commissioners of Miami-Dade County which operates the Miami Dade County Corrections and Rehabilitation Department

Policy: Departmental policies

Policy: Have oversight of the settlement agreement, review current policies as needed, determine gaps and provide recommendations as needed to ensure compliance with regulatory requirements, best practice standards in the industry, and settlement agreement obligations

Lynn M. Barrett Kevin Andrews

Q1, Q2, Q3, Q4

Training: General online training provided to all JHS employees

Training: Provide as identified and needed

Lynn M. Barrett Kevin Andrews

Q3/Q4

*JHS INTERNATIONAL PROGRAM To ensure compliance with the Stark and Anti-kickback laws regulating financial relationships with referral sources of Federal Health Care Program beneficiaries living abroad and accessing services at JHS through the International Program as well as HIPAA regulations

Based on internal risk assessment with department

Policy: Review all current policies to ensure compliance with regulatory and business practices to identify gaps

Assessment and Policy: Conduct assessment and gap analysis of International Program. Provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Lynn M. Barrett Angelique Johnson Gino Santorio Andre Reid Dr. Roberto Heros

Q3/Q4

Training: General online training provided to all JHS employees as well as incident specific

Training: As the policies mentioned above are reviewed and, where appropriate, revised and/or implemented, policy-specific training will be rolled out to the appropriate areas

Luis Martinez Q4

PROVIDER-BASED BILLING To ensure compliance with CMS regulations regarding when JHS clinics may bill as provider-based

This risk was identified during an OIG survey in May 2013 and subsequent internal review This issue is also on the 2013 HHS Office of Inspector General’s Work Plan

Policy: Billing attestation provided to McKesson

Policy: Provide recommendations as needed to ensure compliance with regulatory requirements and best practice standards in the industry

Amber Thomas Sharon Powell Charles Bearham

Q1/Q2


Page 9 of 9




TIME FRAME

STATUS

Training: McKesson provides training to clinic employees and physicians from JMG group. Also, incident driven training by Compliance

Training: Subsequent to development of policies as needed

Amber Thomas Sharon Powell

Q3

Auditing and monitoring: Compliance conducts ongoing auditing and monitoring as scheduled in the annual audit plan

Auditing and monitoring: Subsequent to training as needed

Sharon Powell Charles Bearham

Q4

3 (a) (3) Referral Source Training (April 1, 2014)

3 (b) Internal Audit

INTERNAL AUDIT - FY14 AUDIT PLAN

Risk Level Audit Summary Total

High

Total Audits Completed 5

MediumIn Progress 3

Low Not Started 0

Total Audits on Plan 25

% of Plan Completed (% hours) 30%

New audits added to Original Plan 2

Audit # Audit Name Risk Assessment Status Audit RatingTotal Planned

Hours

For % of

Completion Cal.

Total Actual

Hours%

1 External Audit Assistance n/a In progress n/a 800 496 496 62%

2 North Dade Health Center medium Completed Satisfactory 250 250 300 120%

3 South Florida AIDS Network ("SFAN") DOH-Monitoring

low New to the Plan - Completed Satisfactory 160 160 160 100%

4 Medical Oncology Outpatient Review

(Collaboration w/ Compliance)

high Completed Needs Improvement 300 300 490 163%

5 Cash Audit (initially audited in FY11 - deferred from FY13 Audit Plan pending new policy)

Audit performed in FY11; control deficiencies were identified in cash collection, internal cash transportation, and overall access to cash.

high Completed Needs Improvement 350 350 500 143%

6 JNMC Patient Intake & Revenue Cycle - Operating Room

high Completed Satisfactory 300 300 360 120%

7 Accounts Payable high In progress (10%) 300 30 30 10%

8 Malpractice and Claims Management medium New to the Plan - In progress (9%) 200 17 17 9%

9 Century Radiology Physician Contract Review - Billing & Collections

Low In progress (29%) 140 23 23 16%

Evaluate controls over vendor onboarding, invoice approval and payment (manual, EDI, and GHX AP On-Demand), general computer controls, credit processing, and non-P.O. purchasing process. In additional, assess the reasonableness of the accrual process.

Evaluate the effectiveness of internal controls related to processing/settling claims, establishing reserves, and GL reconciliation. In addition, assess the effectiveness of administration and management of claims within the Quantros system, claim’s system basic data integrity, and system access.

Perform a review to ensure that physician requirement for collections is being met for the first year of the contract period.

Determine completeness, accuracy and efficiency of the revenue cycle process by assessing controls, risks, process breakdowns, and deficiencies in the patient care process flow for the following areas:

1. Registration2. Financial Assessment3. Medical Records/Coding4. Charge Capture

as of 03/31/14

Definition

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

Scope & Objectives

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

General controls review of stand alone function.

Perform a review to ensure that the action plans relating to the DOH "Administrative Monitoring Review" were adequately and effectively implemented.

General controls review of administrative and operational functions to include the following:1. Patient Intake Process2. Revenue Cycle3. Pharmaceutical Administration Process4. Inventory management5. Procuring Process (340B Fed Pricing)

Identify risks associated with cash collection processes and practices unique to JHS’ cashier function, ascertain whether controls adequately mitigate identified risks, ensure that cash is properly safeguarded, and determine if proper segregation of duties and access exist. In addition, ensure that financial process controls are in place to properly accounting for cash transactions.

Areas of Focus:


Hours

For % of

Completion Cal.

Total Actual

Hours%Scope & Objectives

10 Revenue Cycle - Charge Capture


high 400 0%

11 Transplant


high 300 0%

12 JMH Patient Intake & Revenue Cycle - Emergency Care Center & Trauma


high 250 0%

13 Physician Services(Collaboration w/ Compliance)

medium 250 0%

14 Clinical Services - Patient Intake & Revenue Cycle - REHAB


high 250 0%

15 Community Health Inc. ("CHI") medium 250 0%

16 Logical Access high 250 0%

17 Network Security Audit high 200 0%

18 JHS Inventory & Supply Management Audit medium 300 0%

19 Siemens Application Audit - Revenue Capture high 300 0%

20 International (FCPA)


medium 200 0%

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 quantitative and qualitative information captured; to include a control review of all related systems for revenue and charge capture that interface to/from Siemens (i.e. Cerner, QwickPay, Lawson, etc...).

Assess the overall effectiveness and efficiency of the department's operations as it relates to compliance with established internal and regulatory policies, and procedures.

The objectives of the network perimeter security audit are to: 1. Provide management with an independent assessment relating to the effectiveness of the network perimeter security and its alignment with the IT security architecture and policy 2. Provide management with an evaluation of the IT function’s preparedness in the event of an intrusion 3. Identify issues which affect the security of the enterprise’s network

Scope—The review will focus on the network perimeter security,

Determine completeness, accuracy and effectiveness of the revenue cycle process by assessing controls, risks, process breakdowns, and deficiencies in the patient care process flow for the following areas: 1. Charge Capture2. Charge Reconciliation & Unposted Charges Management3. Manage Care Contract Updates to Siemens4. Clinical Documentation (Compliance Review)5. Medical Necessity (Compliance Review)6. Medical Records/Coding (Compliance Review)7. Billing and Collections ("CBO")8. G/L Posting and Reconciliation

General controls review of administrative and operational functions to include the following:1. Patient Intake ProcessDetermine completeness, accuracy and efficiency of the revenue cycle process by assessing controls, risks, process breakdowns, and deficiencies in the patient care process flow for the following areas:

Review contract management process to determine if effective contracting controls exist for physician services, proper procurement processes were followed, and effectiveness of payment controls. Review physician billing practices for JMG physicians and credentialing process.

Determine completeness, accuracy and efficiency of the revenue cycle process by assessing controls, risks, process breakdowns, and deficiencies in the patient care process flow for the following areas: 1. Registration2. Financial Assessment3. Clinical Documentation4. Charge Capture

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

The objective of the review is to assess the design and effectiveness of controls and processes around logical access for the aforementioned systems. IA reviewed various aspects of logical access, including, creation, modification and inactivation of user accounts; identity management; password management; and policy management.


Hours

For % of

Completion Cal.

Total Actual

Hours%Scope & Objectives

21 JMH Contractual and Purchased Services Management - (Kidney Acquisition, Housekeeping, and Emergency Room)

medium 250 0%

22 Annual Physical Inventory Count Observation medium 100 0%

23 Audit Follow-up n/a In progress 500 250 50%

24 External Audit Assistance n/a 200 0%

Planned Assurance Serv. 6,800 1,926 2,626 39%

Process Life Cycle ("PLC) 1,500 682 682 45%

Continuous Monitoring 1,250 268 268 21%

Unplanned Assurance Serv. 1,100 350 350 32%

Total 10,650 3,226 3,926 30%

Actual Hours Frequency Actual Hours1 Cerner upgrade project 140 Surprise Cash Counts Quarter 60

2 ICD - 10 96 On-going review of emergency procurement process Weekly 40

3 Accounts Payable - GHX/AP on demand 36 Purchase Orders Created After the Fact Analysis Monthly 30

4 OR inventory, charge capture, CDM, billing 100 999 Vendor Monthly De-activation Monthly 30

5 Cerner reference Lab Interface with Quest

Diagnostics

20 340B Quarterly Review TBD 48

6 3M Encompass 360 Computer Assisted Coding 20 System Access (On-going review) TBD -

7 Critical Situations-Department Roles

Development

40 Pharmacy Drug Override Process Review - ED/ER TBD 60

8 Capital Projects - Project Initiation, Change Order

and Invoicing Approval Process

120 System Access (On-going review) TBD -

9 HIPPA - Security & Privacy - Financial Processes TBD -

10 Corrections Health Services ("CHS") 110 Total 268

Total 682

Perform follow-up review of prior year's audit findings to ensure corrective action is completed as stated and adequate.On an annual basis, provide 200 hours audit assistance to KPMG.

Current Systems Development/Process Change Process

Review contract management process to determine if contracts exist for services, proper procurement processes were followed, and effectiveness of payment controls.Observe annual physical inventory count to determine adequacy of procedures.

Continuous Assurance/MonitoringProcess Life Cycle (PLC)

3 (b) (2) 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

Audit Team on the Engagement: Carline Etienne, Internal Audit Staff

Priya Kiswani, Internal Audit Senior

Magdy Mossaad, Vice President of Internal Audit

Andre Reid, Corporate Director of Internal Audit

2014 JNMC Patient Intake & Revenue Cycle – Operating Room Audit

April 17, 2014

1 2014 JNMC Patient Intake & Revenue Cycle- Operating Room See Page 5 for Abbreviations

To: Elena Barberis, Associate Chief Financial Officer – JNMC Alicia De Leon- Sanchez, Interim Chief Nursing Officer – JNMC Giso Johnson, Director of Surgery – JNMC

Date: April 17, 2014

Re: Final Report – 2014 JNMC Operating Room Patient Intake & Revenue Cycle Audit

Background As part of the fiscal year (“FY”) 2014 Audit Plan, the Office of Internal Audit (“IA”) performed a review of Jackson North Medical Center (“JNMC”) Patient Intake and Revenue Cycle for the Operating Room (“OR”). The review covered the processes from the point of initial patient contact to posting patient charges in Siemens, the patient accounting system. The JNMC OR net revenue and number of patients for FY 2013 totaled $16.4M and 2,327 respectively. Objectives The review was to assess the adequacy and effectiveness of controls over JNMC OR Patient Intake & Revenue Cycle. Scope This review included JNMC OR Patient Intake & Revenue Cycle process flow as it relates to scheduling, admission and registration, financial assessment, clinical documentation and charge capture. The review focused primarily on process designs and tests of controls in place during FY 2013. The field work commenced on December 9th 2013 and ended on February 10, 2014. Summary of Findings JNMC Patient Intake & Revenue Cycle OR processes revealed overall that internal controls are working as intended. However, we noted that emphasis should be placed on the process to ensure completeness and accuracy of medication charge capture. Conclusion Based on our review, we believe that overall processes and controls related to JNMC OR Patient Intake & Revenue Cycle controls are operating as intended. However, opportunity exists to improve the charge capture process for patient administered medication. Patient Care Services and Finance worked collaboratively with IA to develop the action plans.

IA would like to extend our appreciation to JNMC personnel who assisted and cooperated with us during the audit.


Cc: Carlos A. Migoya, President and Chief Executive Officer Lynn M. Barrett, Vice President of Compliance & Chief Compliance Officer – JHS

Steven Burghart, Senior Vice President & Chief Administration Officer – Holtz Hamiltion Clark, Chief Financial Officer – JMH Alex Contreras, Senior Vice President and Chief Administration Officer – JMH Iris Drelich, Assistant Director of Pharmacy – JNMC Martha Garcia, Director of Operations – JMH Venessa Goodnow, Director of Pharmacy Administration – JMH Don Jaffee, Vice President of Finance – JHS Jay Miranda, Senior Vice President and Chief Administration Officer – JSH Mark T. Knight, Executive Vice President and Chief Financial Officer – JHS Telisa Lyons, Corporate Director of Patient Access Service – JMH Carmen Pla, Vice President of Revenue Cycle – JHS Sandra Sears, Senior Vice President and Chief Administration Officer – JNMC Don S. Steigman, Executive Vice President and Chief Operating Officer – JHS Myriam Torres, Associate Chief Financial Officer – JSH Marlys Yu, Chief Nursing Officer – JSH


2014 JNMC Patient Intake & Revenue Cycle – Operating Room Audit Findings and Management Responses

1. Lack of Consistency in Medication Charge Capture Review of a sample of OR patient medical records revealed that 7 of 34 (21%) patients noting drugs administered, with physician orders, were not charged. All drugs administered to patients should be documented in Cerner and/or Omnicell to initiate patient charges in the Siemens billing system. The observations were due to the following reasons:

Three of 7 (43%) patient medical records revealed drugs administered to patients were not charged due to the nurse(s) not having access to Siemens system in order to reconcile charges for drugs;

Four of 7 (57%) administered drugs not charged to patients were due to lack of knowledge by the assigned nurse (s) for subsequent use of the same drug;

Recommendation We recommend management to continue educating and training nurse(s) on how to document, for billing purposes, charges including multi use of vials administered to other patients. Also, to ensure completeness and accuracy of the information captured, we recommend that assigned nurses be granted access to Siemens, and be trained on how to reconcile all drugs being administered to patients. In addition, the charge champion should review and reconcile all manual forms against Siemens for drugs administered.

Management Response: We agree with the above observations and have implemented the following action plan: A portion of the finding reflects the medication used and documented by anesthesia

providers. A meeting with Dr. Schultz, Chief of Anesthesia was held late February, 2014. Dr. Schultz spoke with all providers on 3/17 regarding the importance of the accuracy of documentation on patient’s medical record and charge sheet.

A multivial medication (e.g. Labetalol) is to be used on single patients. When small amount of multivial medication is given, the staff will be charging the exact amount with documentation of waste. Registered Nurses (RNs) will be signing off on this requirement by latest 3/31/14.

Anesthesia Tech will review the charge sheet against the anesthesia record and validate the accuracy of the medication used and will be documented by the anesthesia providers prior to submission. Chief of Anesthesia has reviewed in detail the expectation and the flow process with the Tech responsible on 2/27/14.

The Surgery department will obtain individual Omnicell cabinets for medication used during surgery. The medication in the new Omnicell cabinets will be charged directly by the anesthesia provider when being pulled for use on individual patient. The requisition order for procuring the new Omnicell is pending final authorization. The estimated completion date for the purchase, installation, and training of the new Omnicell is September 2014.

Responsible Party: Elena Barberis, Associate Chief Financial Officer – JNMC Alicia De Leon, Interim Chief Nursing Officer – JNMC Giso Johnson, Director of Surgery – JNMC

Completion Date: September 30, 2014


Process Improvement Opportunities and Management Responses Process improvement opportunities are enhancements to existing operational and financial processes, resulting in a more efficient and effective control environment. See below for an area of improvement:

2. Process Design for Charging “OR” Supplies without CDM Numbers

For fiscal year 2013, there are manual “free texted” OR supply charges totaled $4.8M with 872 transactions. The Charge Description Master (“CDM”) numbers do not exist for implant supplies which are manually charged to patient accounts using a “free texted” field to input the item description with missing pricing information in the Surginet system. This system is a Cerner module used within the Operating Room to document clinical information and post charges for procedures and drugs administered to patients. On a daily basis, the Charge Champion downloads all “free texted” supplies from the Surginet system and assigns a generic CDM number. The Charge Champion also posts charges related to the manual “free texted” supplies to the patient account, using a cost mark up. This manual process may expose JNMC to incorrect charging due to human error. Jackson Memorial Hospital (“JMH”) has incorporated an on going project life cycle (“PLC”) in order to reduce the number of manual free texted items, which increases efficiency. As part of this initiative, Charge Champions are required to identify repeat supplies greater than 4 items. These supplies should be communicated to the Revenue Cycle department to create a CDM code in order to reduce/ eliminate the volume of manual free texted. Recommendation We recommend that JNMC collaborate with JMH of this on going project life cycle in order to reduce/ eliminate the number of free texted supply charges.

Management Response:

We agree with this ongoing issue and have discussed in recent meetings the challenges we are currently facing in regards to the charge masters use of “free texted.” An example of some of the challenges include supplies from outside vendors that are not appropriately evaluated are vetted through the Value Analysis Team (“VAT”) committee, prior to receiving CDM numbers. Majority of these supplies are high ticketed items requested by the surgeons or based on patient clinical needs.

Representation from JNMC surgical team and Associate Chief Financial Officer will

attend the CDM committee meetings held at JMH. This will assist us in identifying the changes needed to reduce the number of “free texted” items and facilitate the transition of the information and process to JNMC.

Responsible Party: Elena Barberis, Associate Chief Financial Officer – JNMC Alicia De Leon, Director of Patient Care Services – JNMC

Completion Date: The same date determined for JMH by the OR Supply committee.


Abbreviations Used Throughout the Report

CDM Charge Description Master FY Fiscal Year IA Internal Audit JHS Jackson Health System JMH Jackson Memorial Hospital JNMC Jackson North Medical Center JSH Jackson South Hospital OR Operating Room PLC Process Life Cycle RN Registered Nurse VAT Value Analysis Team

www.JacksonHealth.org

305-585-2901

Office of Internal Audit

1500 N.W. 12th Avenue • Suite 102

Miami, FL 33136

Audit Team on the Engagement: Carline Etienne, Internal Audit Staff

Priya Kiswani, Internal Audit Senior

Magdy Mossaad, Vice President of Internal Audit

Andre Reid, Corporate Director of Internal Audit

Maria Santiago, Internal Audit Senior

2014 Cash Audit – Jackson Health System

April 17, 2014

1 2014 Cash Audit – JHS See Page 9 for Abbreviations

To: Elena Barberis, Associate Chief Financial Officer – JNMC Lissett Bassas-Prado, Associate Administrator – JSCH David Castillo, Associate Administrator – JNMC Carlos Diaz, Director, Eligibility & Patient Access – JMH Pamela Fell, Corporate Director, Corporate Business Office – JHS Telisa Lyons, Corporate Director, Patient Access – JHS

Mayra Perez, Associate Administrator, Corporate Business Office – JHS Carolina Rodriguez, Associate Administrator – JMH Edgar Rodriguez, Controller – JHS

Myriam Torres, Associate Chief Financial Officer – JSCH

Date: April 17th, 2014

Re: Final Report – 2014 Cash Audit

Background As part of the fiscal year (“FY”) 2014 Audit Plan, the Office of Internal Audit (“IA”) performed a Cash Audit for Jackson Health System (“JHS”). This review covered the processes from the point of collections to posting transactions in the General Ledger (“GL”) for Calendar Year (“CY”) 2013. JHS had 211K points of service collection transactions system-wide totaling $24.6M for CY 2013. The cash collections by facility are as follows:

Objectives The review was to assess the adequacy and effectiveness of controls over JHS Cash processes. Scope The review included JHS Cash processes as it relates to points of service collections, petty cash handling, internal banking, treasury and accounting. The review focused primarily on the adequacy of process design and tests of controls in place during CY 2013. The audit field work commenced on December 2nd, 2013 and ended on April 1st, 2014.

22,436 7,173

10,563

171,278

Point of Service Transactions

Clinics

JNMC

JSCH

Main Campus

$940,033

$2,043,235

$4,477,715

$17,169,268

Point of Service Collections

Clinics

JNMC

JSCH

Main Campus


Summary of Findings and Management Responses JHS Cash audit revealed significant control deficiencies in the areas of cash collection, security and transportation of cash, manual receipts inventory, petty cash and system access. Our detailed observations are outlined below:

Conclusion Based on our review, we believe the overall process related to JHS cash controls need improvements. Opportunities exist to improve the collections, security and transportation of cash, manual receipts inventory, petty cash and system access. Patient Access, Security, Information Technology (“IT”) and Finance worked collaboratively with IA to develop the action plans.

IA would like to extend our appreciation to JHS personnel who assisted and cooperated with us during the audit.

Cc: Carlos Migoya, President and Chief Executive Officer Pedro Alfaro, Chief Financial Officer – Holtz Women & Children Hospital Lynn Barrett, Vice President of Compliance & Chief Compliance Officer –JHS Charlie Bearham, Corporate Director Revenue Cycle Management, JMH

Steven Burghart, Senior Vice President & Chief Administration Officer – Holtz Hamilton Clark, Chief Financial Officer - JMH Alex Contreras, Senior Vice President and Chief Administration Officer – JMH Andrew Figueroa, Director of Finance – LTCN, HRHC, IT, and Quality Don Jaffee, Vice President of Finance – JHS Zuzel Jimenez, Chief Financial Officer/Director of Finance – BH, ACCs, and PCCs Jay Miranda, Senior Vice President and Chief Administration Officer- JSCH Mark Knight, Executive Vice President and Chief Financial Officer – JHS Carmen Pla, Vice President of Revenue Cycle – JHS Sandra Sears, Senior Vice President and Chief Administration Officer – JNMC Don Steigman, Executive Vice President and Chief Operating Officer – JHS


2014 Cash Audit for Jackson Health System Audit Findings and Management Responses

1. Cash Collection Control Inconsistencies

Review of 35 cash collection transactions throughout JHS for CY 2013 revealed the following:

Lack of documentation: o Twenty-one of 35 (60%) daily cash collections did not have the cashiers' and security

escorts’ signatures on the “Cashier Deposit Record” log. The log provides evidence of the security specialist escort when the cash is delivered to the Main Cashier;

o Seven of 13 (54%) credit card transactions did not have the credit card holder’s signature on the receipt;

o Seventeen of 35 (49%) cash receipts were not scanned into the patient account within Siemens Electronic Data Management (“EDM”) that is required by policy.

We acknowledge that Revenue Cycle is in the process of implementing DCS Global System, a patient access tool that will address the last two bullet points. Lack of reconciliation between QwickPay and Daily Cash Deposit

o The QwickPay system is used to issue receipts when collections are received. Thirty-one of 35 (89%) daily cash deposits were not reconciled to QwickPay reports, as in some cases the QwickPay collections were received late in Internal Banking.

Lack of review and approval of daily cash collection reports o Seven of 35 (20%) “Daily Cash Reports”; were missing the cashier/preparer's

signature; o Four of 35 (11%) daily cash collections were missing the receiving cashier's

signature on the “Daily Cash Reports”. Unlocated cash collection records

o Two of 35 (6%) Daily Cash Reports, which are used to reconcile the daily cash activity, could not be located.

The above observations were a result of a lack of training and monitoring of tasks performed by collectors. Recommendations: We recommend that management periodically re-train employees on the current policies and procedures. In addition, management should monitor compliance with policies and procedures relating to the cash processes in regards to documenting, reconciling, reviewing and approving daily cash collections and deposits, and documenting security transportation.

Management Response: Implementation of the DCS Global ecashiering and electronic signature solution will automate document imaging of receipts into Siemens EDM and system-generated reports will be utilized for cash reconciliation. In addition, the cash collection policy and procedure will be updated to reflect security escort as needed. Although two of the Daily Cash Reports were not located, the Internal Banking department was able to reconcile utilizing the QuickPay Total By Facility report. Internal Banking will ensure the Daily Cash Report is received from cash handling areas with appropriate signatures.

Responsible Party:


Lisset Bassas-Prado, Associate Administrator, JSCH

David Castillo, Associate Administrator JNMC

Carlos Diaz, Director, Eligibility & Patient Access, JMH

Telisa Lyons, Corporate Director, Patient Access, JHS

Carolina Rodriguez, Associate Administrator JMH

Completion Date: June 30, 2014

2. Inappropriate access to Lawson (General Ledger Forms)

Review of the Lawson General Ledger (“GL”) forms GL 190 (ability to post journal entries), GL 165 (ability to release interface), and GL 45 (ability to release journal entries), and GL 40 (ability to enter journal entries), revealed the following:

o Seven of 24 (29%) individuals outside of Finance have inappropriate access to GL190; o Eighteen of 64 (28%) individuals outside of Finance have inappropriate access to GL40; o Eight of 44 (18%) individuals outside of Finance have inappropriate access to GL 45; o Two of 24 (8%) individuals were terminated contractors who had inappropriate access to

GL190, GL45, and GL40 (Corrected during audit); o Two of 27 (7%) individuals outside of Finance have inappropriate access to GL165; o One of 24 (4%) individuals could not be found in the active employee list and/or Account

Identity Management, have inappropriate access to GL190.

The above observations were due to a lack of on-going review and monitoring of access to Lawson. Recommendations: We recommend that the Finance Department periodically review system access, including that of contractors, for appropriate access to the Lawson General Ledger Forms.

Management Response: The Finance Department together with IT agreed with the recommendations from the Internal Audit review. Even though a small group of users were found with improper access to GL190, GL165 and GL40, none of the users with improper access were aware of their access to those menus and none of them ever use these menus in Lawson. Also, we agreed with the Internal Audit to limit the access to release journal entries to some of the users in GL45. Our policy is that all journal entries need to be reviewed and signed by the employee’s Supervisor, Manager, Director or CFO. As recommended by Internal Audit we are going to change these processes and limit the access to release in GL45 to those Supervisors, Managers, Directors or CFO’s currently reviewing and signing journal entries and replace the physical signing of the journal entry to an electronic signing. Effective May 2014 the Finance department with the help of IT department will create new Lawson roles to better classify the GL Lawson users and provide them the proper security access to the menus mentioned before and ensure appropriate access. Also, IT department will create a new monthly report listing all users and their Lawson GL access. This report will be sent to the Corporate Controller for his review to ensure proper security access. After the Internal Audit review, IT department provided the Corporate Controller with a new list of users with access to the menus mentioned above. The Corporate Controller has carefully reviewed the list and has submitted to IT the access changes needed to comply with the Internal Audit recommendations. Responsible Party:


Mahnaz Parsi, Director Business Systems

Edgar Rodriguez, Controller, JHS

Completion Date: April 30, 2014

3. Lack of reconciliation of the Patient Suspense Account The General Ledger (“GL”) Suspense Account is used to record all payments received for patients. Once the payments are posted to the Patient Accounts Receivable, the Suspense Account is subsequently adjusted. Review of this account revealed that Corporate Business Office (“CBO”) management does not review and approve the monthly Suspense Account reconciliation provided to Finance. In addition, there is lack of supporting documentation for items listed on the reconciliation. Furthermore, $277K of $2.4M (11%) with average aging of 1,684 days related to payments received in 2008 which have not been posted (corrected during audit.) The observations noted above were due to a lack of review, monitoring, and approval of the account reconciliation. Recommendations: We recommend that CBO management develop policies and procedures to set the expectations, assign roles, and responsibilities to properly reconcile the Suspense Account. In addition, substantiate all items within the Suspense Account, as well as retain supporting documentation. Furthermore, CBO management should review, monitor, and approve monthly reconciliations prior to submitting the information to the Finance Department. CBO should also track the aging of the Suspense Accounts for pending items to be investigated or cleared. Finally, Finance should ensure that the Suspense Account reconciliation submitted by CBO have appropriate supporting documentation and evidence of management approval.

Management Response: As previously agreed with the Internal Auditor on March 5, 2014, the following procedures are being implemented by the CBO:

1. All variances between interface and suspense will be posted to a Siemens Unapplied

Account prior to month end facilitating better controls of posting and pending items to be investigated or cleared.

2. Balances in the Suspense Account will include only the variances in the posting for the last day of the month with each item listed to be well documented to ensure an audit trail.

3. The CBO Corporate Director or designee will review and approve the Suspense Account reconciliation prior to submission to Revenue Control.

4. Revenue Control will review and ensure that the Patient Suspense reconciliation received from CBO includes all the necessary back-up that tie back to the reconciliation. Also Revenue Control will ensure that the reconciliation was signed and reviewed by CBO Corporate Director or designee. If the information received from CBO Corporate Director or designee doesn’t meet the required documentation mentioned before, Revenue Control will not record the suspense entry until the proper documentation is provided for reconciliation.

The $277K is related to insurance take backs, from 2008 that could not be identified. During the internal audit review, it was recommended to clear this amount through a journal entry against the reserve. The $277K was corrected as recommended during the audit, on 02/28/2014. These procedures are to be fully implemented by April 30, 2014.


Responsible Party:

Pamela Fell, Corporate Director, Corporate Business Office, JHS



4. Track and monitor the disbursement and use of manual receipts QwickPay system is used to process patient collections. When QwickPay is down, manual receipts are used in lieu of the system generated receipts that are provided to patients as proof of payments. Issued and inventoried manual receipts are not in sequential order and there is a lack of reconciliation process over the manual receipts (used and unused). We acknowledge that Patient Access Service (“PAS”) is currently switching from QwickPay to DCS Global to improve the accuracy of patient registration and cash collection functions. Recommendation: We recommend that PAS improve control for patient collections by creating a new format for manual receipts to address sequential tracking by location and individuals, enhance controls over inventory of the manual receipts, and review/reconcile manual receipts.

Management Response: An alphanumeric nomenclature will be developed, as recommended, to track receipting by location; and will be maintained by the facility’s Accounting or Internal Banking departments for distribution and utilization management. The existing unused receipt inventory will be reconciled at each facility by Accounting or Internal Banking, whichever applicable, and maintained in the department. When utilized, manual receipts will be logged on a receipt journal and submitted to Accounting for daily reconciliation. Responsible Party: Elena Barberis, Associate Chief Financial Officer, JNMC

Hamilton Clark, Chief Financial Officer, JMH

Telisa Lyons, Corporate Director of Patient Access

Myriam Torres, Chief Financial Officer, JSCH


5. Petty Cash Controls

Lack of Periodic Petty Cash audits performed o Periodic petty cash audits are not performed by JMH Patient Access to ensure actual

cash balances agree with the general ledger.

Discrepancies noted during surprise cash counts o The GL petty cash imprest for the ACC Pharmacy was recorded as $1,300.

However, we noted that the actual cash on hand was $3,275, resulting in an overage of $1,975. Management was unable to provide an explanation for the source of the excess cash;

o Ten of 13 (77%) missing signatures acknowledging transfer of funds within the “change of shifts form” in Jackson Main Emergency department.

o We observed that the custodian of the petty cash fund is signing and documenting the petty cash voucher as the requestor of petty cash funds, rather than the individual requesting / receiving the funds;

o Petty cash expenses exceeding $50.00 did not have the approval of a Senior Vice


President, as required by policy. Furthermore, we noted that one transaction did not have the required form to withdraw funds from petty cash.

These control deficiencies are a result of lack of adherence to policies and procedures, monitoring the petty cash functions, and performing surprise cash counts. Recommendation: We recommend management provide guidance to those responsible for the petty cash to ensure compliance with current policies and procedures. In addition, management should perform periodic surprise petty cash counts to ensure that the imprest balances are maintained accurately at all times.

Management Response: Patient Access will work in conjunction with JHS Finance to develop a routine audit process for imprest and/or petty cash funds. Additionally, the petty cash policy will be revised to include a facility level designee for approving petty cash expenses exceeding $50.

Responsible Party:



Carolina Rodriguez, Associate Administrator, JMH



6. Accuracy of posting manual receipt payments to patient accounts

Review of the process for posting manual receipts transactions to the Patient Accounts Receivable revealed the following:

Two of 105 (2%) manual receipts transactions were not posted to the patient accounts; Two of 105 (2%) manual receipts transactions were posted to the incorrect patient accounts.

We recommend that the daily report of collections provided to Corporate Business Office (“CBO”) be reviewed and posted completely and accurately within the general ledger. Management should establish a process to review the completeness and accuracy of the posting.

Management Response: The cash collection policy and procedure will be revised to include the downtime receipt reconciliation process. The Patient Access Associate Administrators will provide education to frontline staff upon completion. Responsible Party:


Mayra Perez, Associate Administrator, Corporate Business Office, JHS



Process Improvement Opportunities and Management Responses

Process improvement opportunities are enhancements to existing operational and financial processes, resulting in a more efficient and effective control environment. See below for an area of improvement:

7. Manual receipt cash collection and posting lag analysis

Jackson Health System (“JHS”) uses manual receipts in lieu of QwickPay when the system is down. This information is then entered within the Daily Report of Collections which is then sent to the CBO Data Control for posting within Siemens. Based on a System-wide analysis, on average it takes 9 days to post manual receipt collections to patient accounts within Siemens. Jackson South Community Hospital (“JSCH”) and JMH average lag days of 16 and 7 respectively significantly attributed to the System-wide lag. We recommend that manual receipts and the report of collections be sent to CBO Data Control department on a daily basis and all information provided should be complete and accurate. In addition, Data Control should post all collections within two business days.

Management Response: The CBO Data Control unit will provide a notification to the facility Patient Access administrator and CFO on pending items to reduce the lag time in posting manual receipts when utilized.

Responsible Party:

Lisset Bassas-Prado, Associate Administrator, JSCH

Elena Barberis, Associate Chief Financial Officer, JNMC



Mayra Perez, Associate Administrator, Corporate Business Office, JHS

Carolina Rodriguez, Associate Administrator, JMH


Myriam Torres, Associate Chief Financial Officer, JSCH



Abbreviation Used Throughout the Report

ACC Ambulatory Care Centre BH Behavior Health CBO Corporate Business Office CY Calendar Year EDM Siemens Electronic Data Management FY Fiscal Year GL General Ledger GL 40 General Ledger 40 (a form within Lawson for entering journal

entries) GL 45 General Ledger 45 (a form within Lawson for releasing journal

entries) GL 190 General Ledger 190 (a form within Lawson for posting journal

entries) HRHC Human Resources Human Compensation IA Internal Audit IT Information Technology JHS Jackson Health Systems JMH Jackson Main Hospital JNMC Jackson North Medical Center JSCH Jackson South Community Hospital LTCN Long-term Care Centre

PAS Patient Access Services PCC Primary Care Centre PFS Patient Financial Services

Completed On-track of Concerns

2011 Charity Care Process Audit Accounting/Revenue Cycle/Quality 4 3 12011 JMH Inventory Management Various 12 10 22011 Palmar Report Accounts Payable 4 3 12011 Payroll HR IT Payroll 8 7 12013 2013 JNCMHC General Controls Audit JNCMHC 5 3 22013 2013 JNMC Radiology Inventory and Supply Control

a/o 5/2/13JNMC Interventional Radiology 2 1 1

2013 2013 OR - Patient Intake & Revenue Cycle Audit JMH OR 2 22013 2013 Summarized General Controls Audit Final Report

– Perdue Medical Center (“PMC”) & Jackson Long-term Care Center (“JLTC”)

Long Term Care 8 7 1

2013 JSCH Laboratory Inventory & Supply Control JSCH Laboratory 1 12014 2014 JMH Outpatient Medical Oncology Ambulatory

Care Center - East OutpatientPharmacy Administration/Ambulatory Care Center/Patient Access Service

4 1 3

50 35 15 0100% 70% 30% 0%

Completed:

On-track:

of Concerns:

Status of Audit Observations as of March 31, 2014

Total%

Audit Year Audit Report Name Area/Department

Management has completed action plans and Internal Audit is satisfied with the action(s) taken to address the risk identified.

Action plans are not expected to be completed on time, no other action was taken to mitigate the risk, or no extension of the due date was requested/discussed with Internal Audit.

Management expects that the action plan(s) will be completed on time, or the due date has been extended for good reasons.

Total # of Observations

Status of Observations

4. Adjournment

PURCHASING AND FACILITIES SUBCOMMITTEE

AGENDA

April 17, 2014


PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA

Thursday, April 17, 2014 Following the Audit and Compliance Subcommittee Meeting



Purchasing and Facilities Subcommittee Marcos J. Lapciuc, Chairperson

Joe Arriola, Vice Chairperson Michael Bileca Mojdeh L. Khaghan



Motion to approve the previous subcommittee meeting minutes Marcos J. Lapciuc, Chairperson 2. Reports

(a) Purchasing

(1) Purchasing Report as of April 2014

Presented by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division

(2) Competitive Contracts Awarded or Renewed Under the Chief Procurement

Officer Authority as of March 2014


(3) Non-Competitive Contracts Awarded or Renewed Under $250,000 and Modifications Allowed Under CPO Authority as of March 2014


PURCHASING AND FACILITIES SUBCOMMITTEE AGENDA - April 17, 2014 2. Reports cont…

(4) Key Performance Indicators (KPI) for Procurement

(1) Monthly KPI (2) Procurement KPI Report Card (April 2013 to March 2014)


(5) Direct Payments as of March 2014


(b) Facilities

(1) Construction Projects Presentation

Presented by Isa Nunez, Vice President, Facilities Design and Construction, and David Clark, Director, Capital Projects

3. Resolution Recommended To Be Approved

(a) Resolution authorizing and approving award of bids and proposals, waiver of bids, and

other purchasing actions for April 2014, in accordance with the Public Health Trust’s Procurement Policy, Resolution No. PHT 10/12-078

Sponsored by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division.

Motion to approve the resolution with a favorable recommendation to the Fiscal Committee


4. Adjournment

of 4

PURCHASING AND FACILITIES SUBCOMMITTEE MEETING MINUTES

Thursday, February 20, 2014 Followed the Joint Conference and Efficiencies Committee Meeting




Purchasing and Facilities Subcommittee Marcos J. Lapciuc, Chairperson

Joe Arriola, Vice Chairperson Michael Bileca Mojdeh L. Khaghan

____________________________________________________________________________________________________________ Members Present: Joe Arriola, Vice Chairperson, and Mojdeh L. Khaghan Member(s) Excused: Michael Bileca and Marcos J. Lapciuc PHT Board of Trustees Present: Irene Lipof and Darryl K. Sharpton In addition to the Board of Trustees, the following staff members, University of Miami Miller School of Medicine Representative and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Mark T. Knight, Rosa Costanzo, Madeline Valdes, David Clark, Lynn M. Barrett, and Steven Falcone University of Miami Miller School of Medicine, and Jeffrey Poppel, and Eugene Shy, Jr., Assistant Miami-Dade County Attorneys ____________________________________________________________________________________________________________ 1. Meeting Call to Order Joe Arriola, Vice Chairperson at 9:57 a.m.

(a) Previous subcommittee meeting minutes (January 15, 2014)

Motion to approve the previous subcommittee meeting minutes Joe Arriola, Vice Chairperson Darryl K. Sharpton moved approval; seconded by Mojdeh L. Khaghan,


of 4

PURCHASING AND FACILITIES SUBCOMMITTEE MEETING MINUTES – February 20, 2014 2. Reports

(a) Purchasing

(1) Review of the Purchasing Report as of February 2014

Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division presented the following items listed in the Purchasing Report as of February 2014. A detailed copy of the report was included with the agenda. Ms. Costanzo stated that the items listed in the Purchasing Report was fully vetted and the due diligence process was completed by the Procurement Department staff. 1. (636137/638791-MT) The Quality and Patient Safety Division’s Clinical Resource Management Department

requests a modification to the contract with Bioscrip Infusion Services, LLC for Home Infusion Services (ongoing purchase).

Bioscrip Infusion Services, LLC

Previously approved funding: $ 895,000 This request for funding: $ 460,059 Total approved funding: $1,355,059

2. (618042-MT) The Clinical Resource Management Department which includes Case Management/Social Work and

Discharge Planning requests a modification to the contract with Salvation Army for guaranteed emergency shelter beds as associated services (ongoing purchase).

The Salvation Army

Previously approved funding: $ 596,500 This request for funding: $ 169,600 (for six months) Total approved funding: $ 766,100

3. Resolutions Recommended To Be Approved

(a) Resolution authorizing and approving award of bids and proposals, waiver of bids and other purchasing actions for

February 2014, in accordance with the Public Health Trust’s Procurement Policy, Resolution No. PHT 10/12-078

Sponsored by Rosa Costanzo, Vice President and Chief Procurement Officer, Strategic Sourcing and Supply Chain Management Division, Jackson Health System

Motion to accept the resolution and forward to the Fiscal Committee with a favorable recommendation

Joe Arriola, Vice Chairperson

Mojdeh L. Khaghan moved to accept the resolution and forward it to the Fiscal Committee with a favorable recommendation; seconded by Darryl K. Sharpton, and carried without dissent.

of 4

PURCHASING AND FACILITIES SUBCOMMITTEE MEETING MINUTES – February 20, 2014

2. Reports cont…

(a) Purchasing cont…

(2) Competitive Contracts Awarded or Renewed Over the Chief Procurement Officer Authority as of December 2013

No verbal report was presented. A detailed copy of the report was included with the agenda.

(3) Non-Competitive Contracts Awarded or Renewed Under $250,000 and Modifications Allowed Under Chief Procurement Officer Authority as of December 2013 No verbal report was presented. A detailed copy of the report was included with the agenda.

(4) Key Performance Indicators (KPI) for Procurement

(1) Monthly KPI (2) Procurement KPI Report Card (January 2013 to December 2013)

With regards to the KPI Report, Ms. Costanzo stated that the month of January reflected an unusual 9-day cycle time

and is attributed to 46 contracts that were completed and had a small dollar value totaling approximately $140,000. The savings for the month of January was approximately $794,000, and the savings continue with a twelve month trend totaling approximately $35 million. A detailed copy of the reports was included with the agenda.

(5) Direct Payments as of December 2013 No verbal report was presented. A detailed copy of the report was included with the agenda.

Announcement Ms. Costanzo announced that a Small Business Vendor Fair is scheduled for Wednesday, February 26, 2014 from 8:30 a.m. to noon at Jackson Memorial Hospital. Topics to be discussed include opportunities at JHS, the new JHS bond program and Miami-Dade County Small Business certification. Time will be made available for owners of small businesses to build relationships with JHS Procurement professionals. The PHT BOT will receive a follow up report regarding the Small Business Vendor Fair including an analysis showing the number of Small Business Vendor Fair attendees, those seeking partnerships with JHS, and awarded contracts.

(b) Facilities

(1) Construction Projects Update as of February 2014

David Clark, Director, Capital Projects Department presented an update report regarding substantial completions of the Trauma construction project at Jackson South Community Hospital (JSCH). As part of the update report Mr. Clark presented photos showing the progress that has been made to complete the elevated helipad construction project, including photos of the elevator lobby, front entrance of the new Trauma Center, and ground level view of the helipad.

of 4

PURCHASING AND FACILITIES SUBCOMMITTEE MEETING MINUTES – February 20, 2014 Mr. Arriola questioned when the new Trauma Center at JSCH becomes operational. Mr. Migoya stated that it is anticipated that the helipad will become operational within thirty (30) days. With regards to the new Trauma Center and matters necessary to complete prior to completion it is anticipated that the new Trauma Center will become operational within six (6) to nine (9) months.

3. Resolutions Recommended To Be Approved cont… (b) Resolution authorizing the President or his designee to execute an Access and Indemnification Agreement with FPL Fibernet, LLC, a Delaware Limited Liability Company for the purpose of installing, maintaining, repairing, replacing and operating certain communication equipment on County-owned property situated at 1801 & 1851 N.W. 19th Avenue, Miami-Dade County, Florida for an initial period of five (5) years commencing on the effective date of the agreement, with two (2) five-year options to extend.

Sponsored by Madeline Valdes, Corporate Director, Property Management Division, Jackson Health System

Motion to accept the resolution with a favorable recommendation to the Fiscal Committee

Joe Arriola, Vice Chairperson

Mojdeh L. Khaghan moved to accept the resolution and forward it to the Fiscal Committee with a favorable recommendation; seconded by Darryl K. Sharpton, and carried without dissent.

4. Adjournment Joe Arriola, Vice Chairperson at 10:13 a.m.


2. Reports

2 (a) Purchasing

of 8

PUBLIC HEALTH TRUST BOARD OF TRUSTEES PURCHASING REPORT

April 17, 2014

TO: PUBLIC HEALTH TRUST BOARD OF TRUSTEES 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 Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed 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 $3,000,000 under competitively solicited (“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities. No items to report.

of 8

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. 1. (671687-FA) The Engineering Department is requesting additional funding to the enterprise-wide clinical biomedical engineering services agreement with Aramark under the MedAssets GPO contract.

Cohr, Inc. d/b/a Masterplan (Aramark): Previously approved funding: $35,698,548 This request for funding: $11,700,000 Total approved funding: $47,398,548

Background In October 2010, the PHT Board of Trustees approved a five year agreement with Cohr, Inc. d/b/a Masterplan for enterprise-wide clinical biomedical engineering services to be performed at Jackson Main, North, South and satellite locations under the MedAssets GPO contract. In March 2011, Cohr was acquired by Aramark. The current contract includes scheduled maintenance, remedial services, coverage, parts, emergency repair, uptime guarantees and identification of mission critical equipment. The contract also includes an equipment master list (EML) covering the equipment for which Aramark provides services. The contract also provides specific procedures to modify the EML for the equipment that Aramark is responsible to maintain. When the contract took effect in October 2010, the funding requested was based on the initial EML provided to vendors. Inventory verification began upon contract inception, and final inventory validation was provided to Biomedical Engineering in August 2011. The original inventory total was 22,250 at contract inception. A substantial number of clinical equipment was identified on existing maintenance contracts with other vendors that were not listed on the EML. Upon expiration of warranty or maintenance contracts with third party vendors, JHS reviews pricing for equipment and compares against Aramark. Dependent on best price, equipment is added to Aramark or remains with the original equipment manufacturer (OEM) for maintenance. This review has resulted in additional increases to the EML which will require additional funding to allow for services through the end of the contract term in October 2015. Currently there are 25,097 pieces of equipment being serviced by Aramark system wide. The breakdown is as follows:

Aramark Equipment Inventory JMH JNMC JSCH JHS On Contract (Monthly Fee) 18,116 1,713 1,981 21,810

Pass Through 934 152 108 1,194 Time & Materials 1,917 137 39 2093

Totals 20,967 2,002 2,128 25,097 Recommendation The contract provides parts, repair and maintenance services for all biomedical and diagnostic imaging equipment. Since contract inception, there has been a reduction in response time for service and repairs with an increase in customer and patient satisfaction. However, there has been an increase to the EML which will require additional funding in the amount of $11,700,000 to take the contract through the end of its term. This additional funding represents the addition of equipment not originally included in the EML and a shift in purchases from the OEM to Aramark (pass through). This has shown a reduction in the overall maintenance cost of the equipment and has allowed for shift in expense from the OEM to Aramark.

of 8

The original contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. The contract can be terminated by the Trust for breach and includes OIG and UAP provisions. In providing an evaluation of the vendor’s performance during the current contract year, the following has been reported:

• The contracted service meets the applicable standards addressed in the Joint Commission Standards. • The overall service exceeds the required standard • There have been no complaints from patients or employees regarding this contracted service.

o The service has never caused delays. o Medical equipment is inspected within the established time frames. o Medical equipment receives preventative maintenance within the established timeframes. o Medical equipment timeliness and is safely testes before its initial use. o The vendor meets all requirements for the contracted service. o Vendor has demonstrated consistent responsiveness to all requests/issues/problems that might have arisen

during the course of the contract period. Based on the overall contract performance evaluation completed by the engineering department and various patient care areas it is recommend that the services provided by Aramark are continued. (A. Contreras) 2. (671165, 671600, 666282, 672869-PE ) The Perioperative Departments of Jackson Main, Jackson North and Jackson South Hospitals, in collaboration with Strategic Sourcing and Supply Chain, request a contract with Synergy Health North America, Inc. for the continued provision of reusable surgical gowns, basins, towels, and specialty Bariatric and Laparoscopic surgical instruments sets (Ongoing purchase).

Synergy Health North America, Inc.: $1,277,490/Yr (For three years)

Total approved funding: $3,832,470

Background Synergy Health North America, Inc. (“Synergy,” formerly SRI Surgical) is a leading provider of outsourced and managed decontamination services for reprocessing and sterilization of surgical instruments and reusable surgical linens and stainless in the United States and Europe. Through its unique service offering, Synergy provides reusable gowns, basins, towels and specialty Bariatric and Laparoscopic surgical instruments sets to Jackson Health System (“JHS”) under their MedAssets Contract. The vendor’s FDA-regulated services consist of daily processing, assembly, sterilization and delivery of all reusable surgical supplies required for surgery. Through this service, Synergy guarantees the availability and functionality of surgical products and instruments to the Trust. This enhances operating efficiency by improving OR throughput, ensuring patient safety by reducing post-op infections thus ensuring patient satisfaction and retention. Through its innovative best practice decisions, the vendor provides “greening alternatives” for JHS’ ORs and surgery centers and has helped JHS achieve and maintain its green initiatives. Delivered through its supply chain business model, the vendor provides high quality products, cost reductions and improved efficiencies. Converting to reusable gowns, drapes, towels and basins has eliminated up to 70% of the OR’s medical waste. For the years 2010 through 2013, Jackson Health System has avoided approximately 900,000 lbs. of waste at $.14/lb., this equates to approximately $126,000 worth of waste avoidance. In 2013 alone, JHS realized savings in waste avoidance of approximately $13,676 through the vendor’s “Green Wrap” Program. Recommendation Value Adds from utilizing the services of this vendor include handling and inventory reductions: 2 to 3 days of finished goods inventory at Synergy’s plant allows for uninterrupted supply and quick product changes for JHS; products are delivered to JHS’ point of use; there is a daily low unit of measure delivery; vendor provides single pack, totes, or case cart customized delivery based on JHS’ needs; hospital instruments are retrieved from returned products, decontaminated, catalogued, and returned to Jackson – a value for the instrument is assigned, validated and signed off by the OR Manager or Central Sterile Manager. Between 2010 and 2013, a total of 1401 instruments have been

of 8

processed and returned to JHS for total lost instrument avoidance of $159,984. From 2010 to 2013 JHS has realized savings of approximately $253,210 from improved efficiencies in product packaging and price reductions implemented by vendor. The projected spend for all three hospitals, maintaining prior-year utilization, is $3,832,470 over the three-year term of the contract. Based on reduced unit prices for most of the items, negotiated below the MedAssets pricing, this represents a projected annual contract cost reduction of $173,543 or $520,629 over the three-year contract term. ECRI and MD Buyline are unable to provide an analysis at this time. The contract can be terminated for convenience with a ninety (90) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Synergy Health North America, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the user departments have reported the following:

• The contracted service meets the applicable standards addressed in the Joint Commission Standards. • The overall service meets standard • There have been no complaints from patients or employees regarding this contracted service. • The vendor meets all requirements for the contracted service

Based on the overall contract performance evaluation, the Perioperative Departments of Jackson Health system, in collaboration with the Supply Chain Department, recommends the continuation of this contracted service with Synergy Health North America, Inc. (A. Contreras/S. Sears/J. Miranda). 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 3. (661993-MN) The Holtz Children’s Pediatric Respiratory Therapy Department requests approval of a one-year contract with INO Therapeutics, LLC for Nitric Oxide inhalation gas therapy (Ongoing purchase).

INO Therapeutics, LLC: $1,350,000 dba Ikaria: (for one year) Total approved funding: $1,350,000

Background The Holtz Children’s Hospital Pediatric Respiratory Therapy department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the INO Therapeutics product remains the only turnkey solution available on the market today, making this a sole source procurement.

of 8

Nitric Oxide inhalation therapy gas is used for treatment of cardio thoracic and transplant patients post-surgery. The therapy gas is used for heart and lung patients requiring pulmonary vasodilatation, post pump, transplant and pulmonary hypertension therapies and has the least side effects. The cost of using Nitric Oxide is significantly lower than costs associated with a patient’s response to a 3-5 day alternative therapy. Recommendation: If the Trust were to Purchase this service outside of any price package at INO’s hourly rate of $99.66 with an estimated utilization of 1,325 hours per month, the annual cost would be approximately $1,584,594. Alternatively, securing a Platinum package of unlimited Nitric Oxide gas usage would be at an annual price of $1,350,000. The resulting annual projected cost avoidance from securing the Platinum tier would, therefore, be approximately $234,594. In addition, the requested amount of $1,350,000 represents a negotiated $75,000 in savings over the price proposed by vendor for the Platinum tier. In summary, by entering into the Platinum agreement as opposed to paying the hourly rate outside of any plan, the Trust is realizing total savings of $309,594 ($234,594 + $75,000). Were the Trust to remain at the Bronze level, it would likely exceed the 11,000 hour cap again and then be forced to pay the remainder of the usage for the contract term at a high hourly rate likely to exceed the yearly price for unlimited usage. The total projected hours for the expiring contract year were 15,897 hours. The first 11,000 hours at the Bronze level would cost the Trust $930,380. The remaining 4,897 hours would be at the negotiated outside-of-the package rate of $95.37 per hour for a total of $467,026.19. This would bring the total estimated cost to $1,397,406.89 ($930,380 + $467,026.89), resulting in $47,406.89 more than the price negotiated for unlimited usage. INO Therapeutics is the only FDA approved vendor for this particular drug and its delivery system. The contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. The contract has been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal Sufficiency. In accordance with our Contractor Due Diligence review, INO Therapeutics, LLC has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3)The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, Pediatric Respiratory Therapy has reported the following:

• The contracted service meets the applicable standards addressed in the Joint Commission Standards. • The overall service is above standard • There have been no complaints from patients or employees regarding this contracted service. • The vendor meets all requirements for the contracted service

Based on the overall contract performance evaluation, Pedi Respiratory Therapy recommends the continuation of this contracted service with INO Therapeutic, LLC A Sole Source Justification has been provided and Conflict of Interest Declarations have been signed by Oscar Solares, Chief Respiratory Therapist, and Lori Donahue, Contracts Administrator for INO Therapeutics with no reported disclosures. The MDBuyline market analysis identified no additional potential savings. ECRI was unable to provide a direct cost comparison at this time. (S. Burghart/A. Contreras)

of 8

B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 4. (666268-MN) Pathology Services Department requests funding to exercise the second of three one-year renewal options (OTRs) for the continuation of specialty diagnostic laboratory services (Ongoing purchase).

ViraCor-IBT Laboratory, Inc.: $1,300,000 (For one year) Total approved funding: $1,300,000

Background In April 2012, the Board approved a bid waiver (Physician Preference) contract award to ViraCor-IBT in the amount of $1,300,000 for a one-year period with three renewal options (OTRs) of one year each to be exercised at the discretion of the Trust. ViraCor-IBT provides quantitative real time bacterial and viral testing that is focused on molecular testing. Although the Board approved $1,300,000 for the initial year, due to increased usage, the contract was modified for an additional $250,000 to cover the last two months of the first year. As a result, the Board approved $1,550,000 for the first OTR. This request represents the second OTR and, through negotiations, Viracor has agreed to retain its current pricing and forego CPI increases. Because the Lab will be performing some of the tests in house, the agreed-upon maximum contract value for this second OTR will be $1,300,000. JHS pediatric and transplant physicians developed protocols that call for these tests on a regular basis for all patients. The physicians are pleased with the accuracy, reliability and turnaround time of the tests results, and Viracor remains their preference. ViraCor-IBT is the only reference laboratory with the ability to deliver results of the labor-intensive quantitative Polymerase Chain Reaction (PCR) testing for viral markers within a 24 hour turn-around time of specimen receipt as required by JHS. This vendor is the most qualified provider for this level of service. Recommendation Approval for this OTR #2 is requested to avoid disruption of the real-time bacterial and viral testing services which are highly utilized by Pediatrics and Transplant Departments. Physicians would not be able to diagnose, treat and discharge patients quickly and effectively without the continuation of this service. Although the vendor is not on the MedAssets contract, a market analysis was conducted as part of a MedAssets and Procurement Management (PDM) Initiative for savings and this determined the current competitive “benchmark” pricing. The resulting negotiations with Viracor provided savings of approximately $150,000 for the initial contract year in 2012. The vendor has agreed to forego its customary CPI increase (estimated to be $45,000 in 2014) and hold existing contract pricing. Competitive pricing for the same test menu was secured from Quest Diagnostics (the current prime reference laboratory vendor on the MedAsset GPO). The price comparison showed savings to the Trust of $659,194 for one year if ViraCor is utilized for the tests. In addition, ViraCor will bear the cost of an interface currently being instituted with the Trust’s Lab (Pathology), providing cost avoidance to the Trust of $34,000. The sum of savings to the Trust in continuing to secure the services of Viracor is estimated at $738,194 for this OTR. The contract can be terminated for convenience with a thirty (30) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to insurance and liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Viracor-IBT Laboratory, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) the Company has not been

of 8

debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the Laboratory Department has reported the following:

• The average turnaround time of goods/services delivery is above standard • The deliverables are above standard for the contract requirements

Based on the overall performance evaluation, the Laboratory Department has no complaints about this vendor and recommends executing a contract with Viracor-IBT Laboratories, Inc. A Bid Waiver Justification has been provided by Maria Quintana, Lab Operations Manager and Conflict of Interest Declarations have been signed by Maria Quintana, Lab Operations Manager, Pathology, and by Michelle Altrich, VP, Clinical Laboratory Director of ViraCor-IBT, Inc., with no reported disclosures. ECRI reported that Viracor’s quoted prices per test are consistent with pricing Viracor is providing other customers. MD Buyline is unable to provide an analysis at this time (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. 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. 5. (525759-MN) The Anatomic Pathology Department requests approval of a six year contract for staining equipment and supplies from DAKO North America, Inc.

DAKO North America, Inc.: $84,525/Yr (For six years) Total approved funding: $507,150

The Anatomic Pathology Department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the DAKO North America product remains the only turnkey solution available on the market today, making this a sole source procurement. This contract replaces a DAKO slide staining instrument with a newer model. The new DAKO instrument will stain all the biopsy tissues submitted to the Histology Lab for the pathologists to analyze and provide clinicians with patient’s diagnosis. DAKO is the only vendor that offers the complete menu of tissue staining capacity for the complexity of staining currently used in the Histology lab. DAKO can provide up to 34 different stains and can stain up to 48 slides at a time, which is necessary for the volume being handled by the Lab. Competitors can stain only 25 slides at a time DAKO’s staining is of a high quality,and the vendor provides outstanding service with supplies available at all times. DAKO also provides better utilization of their dyes and reagents per kit, reducing waste and maximizing the Trust’s use of reagents purchased.

of 8

DAKO Equipment has been used by the lab for the past ten (10) years so that staff is already familiar with the use of the DAKO equipment and reagents. Without this purchase, the Lab would be faced with additional costs and delays associated with hiring and training full-time technologists to manually perform many of the stains with new equipment and supplies. Recommendation: Use of DAKO products last year was at a cost of $86,049. The proposed new contract will be for an annual negotiated price of $84,525, representing savings of $1,524 per year or $9,144 over six (6) years. DAKO agreed to reduce the price-per-slide from $8.55 to $8.05. The contract can be terminated by either party for material breach and includes the UAP and OIG provisions. In providing an evaluation of the vendor’s performance during the current contract year, the Core Laboratory Department has reported the following:

• The average turnaround time of goods/services delivery is above standard • The competencies of contracted staff is above standard • The deliverables are above standard for the contract requirements • Dako’s ability to successfully respond to emergency situations is above standard

Based on the overall performance evaluation, the Core Laboratory Department has no complaints about this vendor and recommends executing a contract with DAKO North America, LLC. A Sole Source Justification has been provided and Conflict of Interest Declarations have been signed by Raul Cortes Alday, Senior Clinical Manager, Core Laboratory and William Burkley, Sales Finance Manager, DAKO North America, with no reported disclosures. ECRI noted potential savings from additional negotiation with other vendors on the price of the reagents alone. However, this would mean utilizing the services and equipment of other vendors. (A. Contreras) 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. 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 Description Cost Center & Director/VP Contract Number Contract Date Contract Value Contract Term Procurement Method UAP

AAA Automated Door Repair, Inc.Door, Hardware, Access Control Device Repairs and Replacement for Openings Identified by Engineering

Services

80103Martha Garcia 4102657 CAPS 3/19/2014 $ 475,848.10 One Time City of Miami Beach

BID 9-11/12 Yes

ThyssenKrupp Elevator Elevator Modernization for the East Tower , and Long Term Care Center

94913Madeline Valdes 4102685 CAPS 3/25/2014 $ 647,479.62 Five Years ITB-13-10825-JE Yes

Dell Marketing LP VMWare Cloud Licenses , and Support for the IT Department

92818Mike Garcia 4102703 CAPS 3/31/2014 $ 340,192.33 Three Years Medassets Contract

# MS02614 Yes

Easyvista, Inc. IT Service Management Solution and Implementation Services

92818Mike Garcia 8108214 SERV 3/6/2014 $ 452,566.00 Three Years RFP-13-11272-MAM Yes

Mediquant, Inc. Cloud Hosting and Data Migration Services for the Finance Department

98007Alex Contreras 8108241 SERV 3/10/2014 $ 300,300.00 Three Years ITB-13-11594-MAM Yes

Cardinal Health Medical Product Radioactive Isotopes for Radiology at Jackson North Medical Center

57160Sandy Sears 8301804 SERV 3/27/2014 $ 450,000.00 One Year Medassets Contract

# MS02127 Yes

GE Radiotherapy Simulation System for Radiation Oncology

73806Alex Contreras 9100629 CAP 03/26/2014 $ 422,988.69 One Time Medassets Contract

#EG-152 Yes

Siemens Medical Solutions USA Full Digital Fluoroscopy System for the Radiology Department

73611Alex Contreras

9100632 CAP 03/28/2014 461,987.00$ One Time Medassets Contract#MS00872

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

Vendor Name Description Cost Center & Director/VP Contract Number Contract Date Contract Value Contract Term Procurement Method UAP

Omnicells, Inc. Optiflex System Installation at Jackson North Medical Center

57050 Sandy Sears 8301808 SERV 3/28/2014 $ 443,972.60 Five Years Legacy System Yes

Omnicells, Inc. Omnicells Systems for the Anesthesia Work Station at Jackson Main

73005Alex Contreras 8108298 SERV 3/28/2014 $ 1,631,781.08 Five Years Legacy System Yes

Sunquest Information Systems upgrade to original system acquisition agreement for blood bank and laboratory testing area

23538 Mike Garcia 8108271 SERV 3/20/2014 $ 434,087.00 One Year Legacy System Yes

Monthly Report of Competitive Contracts Awarded or Renewed under the Chief Procurement Officer Authority in Accordance to Procurement RegulationsMarch 2014

For Information Only (Greater than $100K)

Legacy System*

* Legacy system means a system including, but not limited to computer software, computer hardware, and biomedical equipment that are fully integrated into the daily operations of one or more departments or are considered strategic in nature or are unique to the provider, manufacturer, distributor, and / or provider. The Purchase of support, maintenance, upgrades, and necessary expansions of legacy systems shall not be subject to the requirements of the Procurement Regulation relating to competitive process.

Monthly Report of Non-Competitive Contracts Awarded Under 250K and Modifications Allowed Under CPO AuthorityMarch 2014

For Information Only

Vendor Description Cost Center & Director/VP Contract Number Contract Date Contract Value Contract Term Procurement

Method UAP

Cooper Surgical, Inc. Purchase of Colposcope for the Penalver Clinic 100Caridad Nieves 9100621 CAP 03/20/2014 $14,800.00 One Time Sole Source Yes

Kem Medical Products Corp. Environmental Chemical Exposure Monitoring 80203Mark Aprigliano 8108272 SERV 03/20/2014 $18,024.00 1 Year Bidwaiver Yes

Main Line Plumbing, Inc. Repair to Sewer Line at Mental Health 79814Alex Contreras 15577014 EMER 03/24/2014 $17,675.00 One Time Emergency Yes

Shared Technologies, Inc. Equipment Maintenance Renewal of Arrow S3 for the IT Department

92818Mike Garcia 8108268 SERV 03/19/2014 $69,225.28 1 Year Bidwaiver Yes

Trane Replace Cooling Tower Gear Box for Jackson South Community Hospital

83830Jay Miranda 2094241 EMER 03/13/2014 $18,500.00 One Time Emergency Yes

Unity Health and Rehab Center Pilot Program to Provide Nursing Home Beds for JHS Patients 98007Alex Contreras 8108277 SERV 03/21/2014 $234,000.00 4 Months Bidwaiver Yes

US Oncology Clinical Drug (Defibrotide) for the Pharmacy Department 73005Alex Contreras 15569370 EMER 03/03/2014 $50,000.00 One Time Emergency / Sole

Source Yes

Verathon, Inc. Glidescope for the NICU Department 100Steve Burghart 9100628 CAP 03/25/2014 $15,770.90 One Time Sole Source Yes

Vendor Description Cost Center & Director/VP

Contract Number

Contract Date

Contract Value

Contract Term

Procurement Method UAP

James B Pirtle Construction

Structural Repairs / Remediation of the PPW Garage

100Madeline

Valdes1557200 EMER 03/10/2014 $337,303.00 One Time Emergency 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

Emergency Procurement Exceeding $250K Threshold**Emergency request, approved by CFO and CEO and submitted here to the Board for ratification in accordance to the Procurement Regulation.

2 (a) (4) Key Performance Indicators (KPI) for Procurement

Procurement KPII. Purchase Order Activity (Monthly)

a)

November December January February March Grand Total

Average PO's November December January February March Grand

TotalAverage

LinesOptiflex & Omnicell Activity:

5,154 5,400 5,578 4,683 5,446 26,261 5,252 89,076 94,717 96,922 81,389 93,007 455,111 91,022

Total Buyers & Omnicell:

7,436 7,945 8,313 7,065 8,320 39,079 7,816 100,674 107,650 110,121 93,202 106,775 518,422 103,684

640 8,213

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

ContractsPending

Documents*Approved Documents

2-Apr-14 219 48 1726-Feb-14 153 69 2129-Jan-14 143 72 186-Jan-14 170 68 20

22-Nov-13 140 78 265-Nov-13 165 65 271-Oct-13 174 64 24

28 72 30 30-Aug-13 172 59 2517 107 3 29-Jul-13 132 76 2931 72 25 3-Jul-13 181 65 308 126 47 6-Jun-13 172 68 391 44 30 8-May-13 183 62 345 41 67 4-Apr-13 155 73 3310 162 1 7-Mar-13 129 87 402 31 0 12-Feb-13 140 90 390 0 0 8-Jan-13 110 102 41

Total: 102 Average: 159 72 29

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

2013 PO Lines 2014 PO Lines2013 PO's 2014 PO's

OR / Surgery / AnesthesiaPharmacyRevenue Cycle

IV. March 2014 Contracts Completed: 117*Average cycle time for completed projects: 10 daysSavings Approximately: $1,376,775

AdministrativeCapital / Support ServicesClinical Support ServicesHospitals (JNMC/JSCH/Holtz)Information Technology

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

Long Term Care / Quality / Safety

Average # of Weekdays in Process with

Current Activity as of 04/02/2014

# of Projects with Approved Documents*: 27# of Projects Pending Procurement Documents: 75

Average # of Weekdays in Process with# of

Contracts in Process

Pending Documents

*Approved Documents

b)

Procurement KPI Report CardApril 2013 - March 2014

61

171916

1,220,054$ 37,023,192$

Average Number of Completed Contracts:

Savings for the first year of the contract: Total Savings Approximately:

• First six months average was • Last six months average was

Average cycle time for completed projects:

0

50

Apr2013

May2013

Jun2013

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

22 26 14

25 16 13 16 17 17 9

24 10

Average cycle time for completed projects Procurement process begins upon receipt of fully completed / approved

documents, per Procurement Regulation

$0M $5M $10M $15M $20M

Apr 2013May 2013

Jun 2013

Jul 2013

Aug 2013

Sep 2013

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

$429,108

$722,132

$1,142,833

$776,556

$375,000

$4,095,763

$375,000

$8,735,795

$16,302,362

$793,833

$1,898,036

$1,376,775

$4,508,665

$767,984

$1,486,876

$1,220,054

Savings

Annual Savings Savings For The Entire Contract Term

Key: 30 Days Trendline 2013 FY Trendline was 45 Days 2014 FY Trendline improved to 30 Days

0

50

100

150

Apr2013

May2013

Jun2013

Jul2013

Aug2013

Sep2013

Oct2013

Nov2013

Dec2013

Jan2014

Feb2014

Mar2014

32 32 52

33 66 78 74 64

85

46 49

117

Completed Contracts

days days

days

Direct Payment as Approved Pursuant to Resolution No. PHT 10/12-078March 2014

Vendor Description Cost CodeVP Paid Amount

Akerman, LLP Legal Services: PHT vs. Omega Technology 99301Mark Knight $ 144.00

Armstrong Creative Consulting Community Outreach & Marketing Services 95714Matt Pinzur $ 8,400.00

AYR Consulting Group, LLC Consulting services for preparation and ongoing compliance of CMS survey

94003Kevin Andrews $ 42,678.70

Ballard Partners, Inc Professional Services: State Lobbying Services 99301Esther Abolila $ 19,583.34

Cumberland Consulting Group IT consulting services relating to the Cerner project 92815Mike Garcia $ 176,197.91

DGA Partners, Inc Consulting services to determine the fair market value of services provided by the University of Miami under the Annual Operating Agreement

99301Mark Knight $ 73,333.32

DGL And Associates Consulting services/advisory services for MOB Feasibility Analysis for JSCH

99301Jay Miranda $ 10,112.08

E Scan Data Systems, Inc Professional services to processes and monitor patient accounts for Medicaid, Medicare, TRICARE, and other payer eligibility

90900Carmen Pla $ 18,654.06

Edgar Consulting Group Consulting and staffing services for JMH Health Plan 94420Mark Knight $ 153,330.00

Eqiq Inc/Staub Leadership Training Programs 99301Mark Knight $ 52,984.58

Galezewski IT Consulting, LLC IT consulting services relating to the Cerner project 92815Mike Garcia $ 16,800.00

Gresham Smith & Partners Professional services for departmental boundary designation (8 buildings) for Main Campus

99301Mark Knight $ 13,340.88

Gropper And Associates, Inc Gap Analysis for CMS compliance 98007Alex Contreras $ 72,468.96

Healthcare Transformation, LLC Interim corporate director of Medical Staff Services (Credentialing) and consulting services for Social Work

94003Kevin Andrews $ 102,400.00

Herrera Correctional Consulting services for medical and mental health services for Correction Health Services

88900Kevin Andrews $ 20,009.53

J Wess Industries Consulting services for project management for the IT department

92815Mike Garcia $ 5,200.00

JC Strategic Management Consulting services for strategic planning 99301Mark Knight $ 78,757.77

JL Media, Inc Advertisement: Radio Media 95714Matt Pinzur $ 7,966.50

Litigation Resolution, Inc Mediation services for Labor Relations 96316Maria Huot-Barrientos $ 991.66

Miami Parking Authority Parking Administration Services 89502Mark Aprigliano $ 308,200.16

On Point Strategies, LLC Strategic direction and organization of Managed Care payor relationships

99301Mark Knight $ 12,333.33

Public Financial Management Consulting services for Hospital Valuation as required by State of Florida House Bill 711

99301Mark Knight $ 97,963.07

Reimbursement Advisory Consulting services for Medicaid / Medicare reimbursement analysis

90511Mark Knight $ 525.00

Robert J Greene Consulting services for the Trust’s applications to Department of Health for new trauma centers at JSCH and JNMC

99301Don Steigman $ 10,597.63

Strategic Management Interim compliance staffing for JMH Health Plan to meet CMS regulatory requirements

99420Mark Knight $ 117,500.00

The Doug Williams Group, Inc Consulting services for diagnostics imaging improvement initiative

99301Gila Kimmelman $ 57,849.25

The Weinbach Group, Inc Advertising and marketing services 95714Matt Pinzur $ 144,624.67

2 (b) Facilities

2 (b) (1) Construction Projects Presentation

3. Resolution Recommended To Be Approved

TO: Marcos J. Lapciuc, Chairman and Members, Purchasing and Facilities Subcommittee FROM: Rosa Costanzo Strategic Sourcing and Supply Chain Management & Chief Procurement Officer DATE: April 17, 2014 RE: Purchasing Report Recommendation The following recommendations are made in accordance with the Trust’s “Procurement Regulation.” These items fully support our business operations and help the organization in its efforts to provide an excellent world class patient experience. Scope 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. Fiscal Impact/Funding Source The items included are part of the Trust’s budget. Track Record/Monitor The Procurement Management Department along with the user departments and leadership support, will track and monitor the responsibilities and obligations set forth in the contracts. Background The entire report has been vetted and assembled by the Procurement Management Department with the direct participation of the Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney’s Office. Request is made for approval of the Purchasing Report, consisting of the following:

Vendor Amount 1 Cohr, Inc. d/b/a Masterplan (Aramark) $ 11,700,000 (Additional funding to complete term) 2 Synergy Health North America, Inc $ 3,832,470 Total for 3 Years 3 INO Therapeutics, LLC $ 1,350,000 Total for 1 Year 4 ViraCorIBT Laboratory, Inc. $ 1,300,000 Total for 1 Year 5 DAKO North America $ 507,150 Total for 6 Years

Procurement completed an orderly administrative process with each item to bring the best value (cost, quality, and outcome) with each project. Savings Total savings for the entire term of contracts #2 thru #5 presented here is $656,186. First year savings is approximately $301,404.

Agenda Item 3 (a)

Purchasing and Facilities Subcommittee April 17, 2014

RESOLUTION NO. PHT 04/14 – RESOLUTION AUTHORIZING AND APPROVING AWARD OF BIDS AND PROPOSALS, WAIVER OF BIDS, AND OTHER PURCHASING ACTIONS FOR APRIL 2014, IN ACCORDANCE WITH THE PUBLIC HEALTH TRUST’S PROCUREMENT POLICY, RESOLUTION NO. PHT 10/12-078

(Rosa Costanzo, Vice President and Chief Procurement Officer,

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

WHEREAS, bids and proposals were solicited, received and reviewed by staff; and

WHEREAS, the Purchasing and Facilities Subcommittee met on April 17, 2014 and reviewed staff’s

recommendations as submitted under the PHT’s Procurement Policy, Resolution No. PHT 10/12-078; and

WHEREAS, the Purchasing and Facilities Subcommittee forwarded the Purchasing Report to the Fiscal

Committee with a recommendation for approval for each item under the report, which is attached hereto and hereby

incorporated by reference; and

WHEREAS, upon his written recommendation, the President recommends that the Public Health Trust Board

of Trustees (Board of Trustees) waive competitive bidding for items under the heading of “Bid Waiver” and “Waiver of

Full and Competitive Bidding” in the respective Purchasing Report, finding such action to be in the best interests of the

Public Health Trust; and

WHEREAS, the President and Fiscal Committee recommend various other purchasing actions, as indicated in

the attached Purchasing Report.

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH

TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes and approves the award of bids

and proposals and all the purchasing actions as set forth in the attached Purchasing Report, under the Public Health

Trust’s Procurement Policy, Resolution No. PHT 10/12-078; and finds it in the best interest of the Public Health Trust

to waive competitive bidding for those items listed under the heading “Bid Waiver” and “Waiver of Full and

Competitive Bidding” in the respective report; and to take such action as is necessary and authorized to implement these

awards and actions.


April 17, 2014

TO: PUBLIC HEALTH TRUST BOARD OF TRUSTEES 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 Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed 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 $3,000,000 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. 1. (671687-FA) The Engineering Department is requesting additional funding to the enterprise-wide clinical biomedical engineering services agreement with Aramark under the MedAssets GPO contract.





Totals 20,967 2,002 2,128 25,097 Recommendation The contract provides parts, repair and maintenance services for all biomedical and diagnostic imaging equipment. Since contract inception, there has been a reduction in response time for service and repairs with an increase in customer and patient satisfaction. However, there has been an increase to the EML which will require additional funding in the amount of $11,700,000 to take the contract through the end of its term. This additional funding represents the addition of equipment not originally included in the EML and a shift in purchases from the OEM to Aramark (pass through). This has shown a reduction in the overall maintenance cost of the equipment and has allowed for shift in expense from the OEM to Aramark. The original contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. The contract can be terminated by the Trust for breach and includes OIG and UAP provisions.

In providing an evaluation of the vendor’s performance during the current contract year, the following has been reported:






Background Synergy Health North America, Inc. (“Synergy,” formerly SRI Surgical) is a leading provider of outsourced and managed decontamination services for reprocessing and sterilization of surgical instruments and reusable surgical linens and stainless in the United States and Europe. Through its unique service offering, Synergy provides reusable gowns, basins, towels and specialty Bariatric and Laparoscopic surgical instruments sets to Jackson Health System (“JHS”) under their MedAssets Contract. The vendor’s FDA-regulated services consist of daily processing, assembly, sterilization and delivery of all reusable surgical supplies required for surgery. Through this service, Synergy guarantees the availability and functionality of surgical products and instruments to the Trust. This enhances operating efficiency by improving OR throughput, ensuring patient safety by reducing post-op infections thus ensuring patient satisfaction and retention. Through its innovative best practice decisions, the vendor provides “greening alternatives” for JHS’ ORs and surgery centers and has helped JHS achieve and maintain its green initiatives. Delivered through its supply chain business model, the vendor provides high quality products, cost reductions and improved efficiencies. Converting to reusable gowns, drapes, towels and basins has eliminated up to 70% of the OR’s medical waste. For the years 2010 through 2013, Jackson Health System has avoided approximately 900,000 lbs. of waste at $.14/lb., this equates to approximately $126,000 worth of waste avoidance. In 2013 alone, JHS realized savings in waste avoidance of approximately $13,676 through the vendor’s “Green Wrap” Program. Recommendation Value Adds from utilizing the services of this vendor include handling and inventory reductions: 2 to 3 days of finished goods inventory at Synergy’s plant allows for uninterrupted supply and quick product changes for JHS; products are delivered to JHS’ point of use; there is a daily low unit of measure delivery; vendor provides single pack, totes, or case cart customized delivery based on JHS’ needs; hospital instruments are retrieved from returned products, decontaminated, catalogued, and returned to Jackson – a value for the instrument is assigned, validated and signed off by the OR Manager or Central Sterile Manager. Between 2010 and 2013, a total of 1401 instruments have been processed and returned to JHS for total lost instrument avoidance of $159,984. From 2010 to 2013 JHS has realized

savings of approximately $253,210 from improved efficiencies in product packaging and price reductions implemented by vendor. The projected spend for all three hospitals, maintaining prior-year utilization, is $3,832,470 over the three-year term of the contract. Based on reduced unit prices for most of the items, negotiated below the MedAssets pricing, this represents a projected annual contract cost reduction of $173,543 or $520,629 over the three-year contract term. ECRI and MD Buyline are unable to provide an analysis at this time. The contract can be terminated for convenience with a ninety (90) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Synergy Health North America, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the user departments have reported the following:




Background The Holtz Children’s Hospital Pediatric Respiratory Therapy department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the INO Therapeutics product remains the only turnkey solution available on the market today, making this a sole source procurement. Nitric Oxide inhalation therapy gas is used for treatment of cardio thoracic and transplant patients post-surgery. The therapy gas is used for heart and lung patients requiring pulmonary vasodilatation, post pump, transplant and pulmonary hypertension therapies and has the least side effects. The cost of using Nitric Oxide is significantly lower than costs associated with a patient’s response to a 3-5 day alternative therapy. Recommendation:

If the Trust were to Purchase this service outside of any price package at INO’s hourly rate of $99.66 with an estimated utilization of 1,325 hours per month, the annual cost would be approximately $1,584,594. Alternatively, securing a Platinum package of unlimited Nitric Oxide gas usage would be at an annual price of $1,350,000. The resulting annual projected cost avoidance from securing the Platinum tier would, therefore, be approximately $234,594. In addition, the requested amount of $1,350,000 represents a negotiated $75,000 in savings over the price proposed by vendor for the Platinum tier. In summary, by entering into the Platinum agreement as opposed to paying the hourly rate outside of any plan, the Trust is realizing total savings of $309,594 ($234,594 + $75,000). Were the Trust to remain at the Bronze level, it would likely exceed the 11,000 hour cap again and then be forced to pay the remainder of the usage for the contract term at a high hourly rate likely to exceed the yearly price for unlimited usage. The total projected hours for the expiring contract year were 15,897 hours. The first 11,000 hours at the Bronze level would cost the Trust $930,380. The remaining 4,897 hours would be at the negotiated outside-of-the package rate of $95.37 per hour for a total of $467,026.19. This would bring the total estimated cost to $1,397,406.89 ($930,380 + $467,026.89), resulting in $47,406.89 more than the price negotiated for unlimited usage. INO Therapeutics is the only FDA approved vendor for this particular drug and its delivery system. The contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. The contract has been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal Sufficiency. In accordance with our Contractor Due Diligence review, INO Therapeutics, LLC has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3)The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, Pediatric Respiratory Therapy has reported the following:


Based on the overall contract performance evaluation, Pedi Respiratory Therapy recommends the continuation of this contracted service with INO Therapeutic, LLC A Sole Source Justification has been provided and Conflict of Interest Declarations have been signed by Oscar Solares, Chief Respiratory Therapist, and Lori Donahue, Contracts Administrator for INO Therapeutics with no reported disclosures. The MDBuyline market analysis identified no additional potential savings. ECRI was unable to provide a direct cost comparison at this time. (S. Burghart/A. Contreras) B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 4. (666268-MN) Pathology Services Department requests funding to exercise the second of three one-year renewal options (OTRs) for the continuation of specialty diagnostic laboratory services (Ongoing purchase).


Background

In April 2012, the Board approved a bid waiver (Physician Preference) contract award to ViraCor-IBT in the amount of $1,300,000 for a one-year period with three renewal options (OTRs) of one year each to be exercised at the discretion of the Trust. ViraCor-IBT provides quantitative real time bacterial and viral testing that is focused on molecular testing. Although the Board approved $1,300,000 for the initial year, due to increased usage, the contract was modified for an additional $250,000 to cover the last two months of the first year. As a result, the Board approved $1,550,000 for the first OTR. This request represents the second OTR and, through negotiations, Viracor has agreed to retain its current pricing and forego CPI increases. Because the Lab will be performing some of the tests in house, the agreed-upon maximum contract value for this second OTR will be $1,300,000. JHS pediatric and transplant physicians developed protocols that call for these tests on a regular basis for all patients. The physicians are pleased with the accuracy, reliability and turnaround time of the tests results, and Viracor remains their preference. ViraCor-IBT is the only reference laboratory with the ability to deliver results of the labor-intensive quantitative Polymerase Chain Reaction (PCR) testing for viral markers within a 24 hour turn-around time of specimen receipt as required by JHS. This vendor is the most qualified provider for this level of service. Recommendation Approval for this OTR #2 is requested to avoid disruption of the real-time bacterial and viral testing services which are highly utilized by Pediatrics and Transplant Departments. Physicians would not be able to diagnose, treat and discharge patients quickly and effectively without the continuation of this service. Although the vendor is not on the MedAssets contract, a market analysis was conducted as part of a MedAssets and Procurement Management (PDM) Initiative for savings and this determined the current competitive “benchmark” pricing. The resulting negotiations with Viracor provided savings of approximately $150,000 for the initial contract year in 2012. The vendor has agreed to forego its customary CPI increase (estimated to be $45,000 in 2014) and hold existing contract pricing. Competitive pricing for the same test menu was secured from Quest Diagnostics (the current prime reference laboratory vendor on the MedAsset GPO). The price comparison showed savings to the Trust of $659,194 for one year if ViraCor is utilized for the tests. In addition, ViraCor will bear the cost of an interface currently being instituted with the Trust’s Lab (Pathology), providing cost avoidance to the Trust of $34,000. The sum of savings to the Trust in continuing to secure the services of Viracor is estimated at $738,194 for this OTR. The contract can be terminated for convenience with a thirty (30) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to insurance and liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Viracor-IBT Laboratory, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) the Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the Laboratory Department has reported the following:


Based on the overall performance evaluation, the Laboratory Department has no complaints about this vendor and recommends executing a contract with Viracor-IBT Laboratories, Inc. A Bid Waiver Justification has been provided by Maria Quintana, Lab Operations Manager and Conflict of Interest Declarations have been signed by Maria Quintana, Lab Operations Manager, Pathology, and by Michelle Altrich, VP, Clinical Laboratory Director of ViraCor-IBT, Inc., with no reported disclosures. ECRI reported that Viracor’s

quoted prices per test are consistent with pricing Viracor is providing other customers. MD Buyline is unable to provide an analysis at this time (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. 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. 5. (525759-MN) The Anatomic Pathology Department requests approval of a six year contract for staining equipment and supplies from DAKO North America, Inc.


The Anatomic Pathology Department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the DAKO North America product remains the only turnkey solution available on the market today, making this a sole source procurement. This contract replaces a DAKO slide staining instrument with a newer model. The new DAKO instrument will stain all the biopsy tissues submitted to the Histology Lab for the pathologists to analyze and provide clinicians with patient’s diagnosis. DAKO is the only vendor that offers the complete menu of tissue staining capacity for the complexity of staining currently used in the Histology lab. DAKO can provide up to 34 different stains and can stain up to 48 slides at a time, which is necessary for the volume being handled by the Lab. Competitors can stain only 25 slides at a time DAKO’s staining is of a high quality,and the vendor provides outstanding service with supplies available at all times. DAKO also provides better utilization of their dyes and reagents per kit, reducing waste and maximizing the Trust’s use of reagents purchased. DAKO Equipment has been used by the lab for the past ten (10) years so that staff is already familiar with the use of the DAKO equipment and reagents. Without this purchase, the Lab would be faced with additional costs and delays associated with hiring and training full-time technologists to manually perform many of the stains with new equipment and supplies. Recommendation: Use of DAKO products last year was at a cost of $86,049. The proposed new contract will be for an annual negotiated price of $84,525, representing savings of $1,524 per year or $9,144 over six (6) years. DAKO agreed to reduce the price-per-slide from $8.55 to $8.05. The contract can be terminated by either party for material breach and includes the UAP and OIG provisions. In providing an evaluation of the vendor’s performance during the current contract year, the Core Laboratory Department has reported the following:


4. Adjournment

FISCAL COMMITTEE

AGENDA

April 17, 2014


FISCAL COMMITTEE

AGENDA

Thursday, April 17, 2014 Following the Purchasing and Facilities Subcommittee Meeting



Fiscal Committee Mojdeh L. Khaghan, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Marcos J. Lapciuc Irene Lipof Darryl K. Sharpton

Public Health Trust Rules Any person making impertinent or slanderous remarks or who becomes boisterous while addressing the committee, shall be barred from further audience before the committee, unless permission to continue or again address the committee be granted by the Chairperson. No clapping, applauding, heckling or verbal outbursts in support or opposition to a speaker or his or her remarks shall be permitted. No signs or placards shall be allowed in the Board Room. Persons exiting the Board Room shall do so quietly. The use of cell phones in the Board Room is not permitted. Ringer s must be set to silent mode to avoid disruption of proceedings. Individuals, including those seated around the board table, must exit the Board Room to answer incoming cell phone calls.

1. Meeting Call to Order (a) Previous committee meeting minutes (February 20, 2014

Motion to approve the previous committee meeting minutes Mojdeh L. Khaghan, Chairperson


(a) KPMG FY13 JMH Health Plan Audited Financial Statements (b) KPMG FY13 JMH Health Plan Management Letter

Presented by Mark T. Knight, Executive Vice President and Chief Financial Officer Motion to accept KPMG FY13 JMH Health Plan Audited Financial Statements and Management Letter with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

FISCAL COMMITTEE AGENDA – April 17, 2014

3. Reports

(a) Jackson Health System Combined Financial Statements as of March 2014

Presented by Mark T. Knight, Executive Vice President and Chief Financial Officer (b) Accounts Receivable Aging Report as of March 2014

Presented by Carmen Pla, Vice President, Revenue Cycle Division

(c) JMH Health Plan Activities

Presented by Paul Marineau, Executive Director, JMH Health Plan (d) Financial and Budget Tracking Status Report as of February 2014

Presented by Mark T. Knight, Executive Vice President and Chief Financial Officer (e) Purchasing & Facilities Subcommittee

Presented by Marcos J. Lapciuc, Chairperson, Purchasing and Facilities Subcommittee

(1) Purchasing Report as of April 2014 (Forwarded to the Fiscal Committee with a

favorable recommendation from the Purchasing and Facilities Subcommittee)

4. Resolutions Recommended To Be Approved (a) Resolution authorizing and approving award of Bids and proposals, waiver of bids, and other

purchasing actions for April 2014, in accordance with the Public Health Trust’s Procurement Policy, Resolution No. PHT 10/12-078


Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees


(b) Resolution authorizing Chuck Tawwater, Director of Risk Management, to direct the Trustees of the

Public Health Trust of Miami-Dade County Risk Management Trust Account to conduct business including payment of tort claims; and removing Sandra Gorski, as required by the Trustee Agreement between Wells Fargo Bank and the Public Health Trust, superseding and replacing prior resolutions

Sponsored by Don Jaffee, Vice President, Finance Division, Jackson Health System

Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees


5. Adjournment

of 7

FISCAL COMMITTEE MEETING MINUTES

Thursday, February 20, 2014 Followed the Purchasing and Facilities Subcommittee Meeting

and Audit Compliance Subcommittee Meeting

Jackson Memorial Hospital West Wing Board Room

First Floor 1611 N. W. 12th Avenue

Miami, FL 33136

Fiscal Committee Mojdeh L. Khaghan, Chairperson Joe Arriola, Vice Chairperson Michael Bileca Irene Lipof Marcos J. Lapciuc Darryl K. Sharpton

____________________________________________________________________________________________________________ Members Present: Mojdeh L. Khaghan, Chairperson, Joe Arriola, Vice Chairperson, Irene Lipof, Darryl K.

Sharpton, and Marcos J. Lapciuc Member(s) Excused: Michael Bileca In addition to the Board of Trustees, the following staff members, University of Miami Miller School of Medicine Representative and Assistant Miami-Dade County Attorneys were present: Carlos A. Migoya, Don S. Steigman, Mark T. Knight, Carmen Pla, and Lynn M. Barrett, and Steven Falcone, M.D., University of Miami Miller School of Medicine, and Eugene Shy, Jr., Jeffrey Poppel, Christopher Kokoruda and Laura Llorente, Assistant Miami-Dade County Attorneys ____________________________________________________________________________________________________________

1. Fiscal Committee Meeting Call to Order Mojdeh L. Khaghan, Chairperson at 10:25 a.m.



Mojdeh L. Khaghan, Chairperson Irene Lipof moved approval; seconded by Darryl K. Sharpton,


2. Review of Fiscal Year 2013 Gain Sharing Program

Mark T. Knight, Executive Vice President and Chief Financial Officer reminded everyone that the issues regarding the Fiscal Year 2013 Gain Sharing Program were presented to the Fiscal Committee last month that would recognize a one-time gain sharing payment to all Jackson Health System (JHS) employees based on the results of the audited financial statements for fiscal year 2013. At the previous Fiscal Committee meeting the Committee requested that the item be deferred pending further review. Mr. Knight presented a detailed employee bonus plan payout cost estimate in the amount of 1.7% of salaries based on the audited financial statements for fiscal year 2013. A proposal of the fiscal year 2013 Gain Sharing Program would move forward a recommendation to the Board of County Commissioners that eligible JHS employees in companies 300 through 710 would receive a one-time 2% payment; there would be bonus pools created for employees in companies 100, 200 and 210 based on a schedule that was provided to the Public Health Trust Board of Trustees (PHT BOT). The 1.7% of salaries was fully accrued in the audited financial statements as well as designated cash being restricted in the JHS interim financial statements. The fiscal year 2013 Gain Sharing Program is represented by agenda items 5 (f) to (j) for discussion and action.

of 7

FISCAL COMMITTEE MEETING MINUTES – February 20, 2014

5. Resolutions to be approved and forwarded to the PHT Board of Trustees with a favorable recommendation to the PHT Board of Trustees

(f) Resolution approving a one-time non-pensionable Gain Sharing Program for eligible employees in

companies 100, 200, 210, 300 and 310 and directing the President and Chief Executive Officer, or his designee, to take all actions necessary to implement the same

Sponsored by Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System

Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

(g) Resolution amending 2011-2014 Collective Bargaining Agreement by and among Miami-Dade County, Public Health Trust and the Service Employees International Union, Local 1991 – Registered Nurses, regarding the Gain Sharing Plan

Sponsored by Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

(h) Resolution amending 2011-2014 Collective Bargaining Agreement by and among Miami-Dade County, Public Health Trust and the Service Employees International Union, Local 1991 – Attending Physicians regarding the Gain Sharing Plan Sponsored by Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

(i) Resolution amending 2011-2014 Collective Bargaining Agreement by and among Miami-Dade County, Public Health Trust and the Service Employees International Union, Local 1991 – Professionals, regarding the Gain Sharing Plan Sponsored by Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

(j) Resolution amending 2011-2014 Collective Bargaining Agreement by and among Miami-Dade County, Public Health Trust and the American Federation of State, County and Municipal Employees, Local 1363, regarding the Gain Sharing Plan Sponsored by Mark T. Knight, Executive Vice President and Chief Financial Officer, Jackson Health System Motion to accept the resolution with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

of 7

FISCAL COMMITTEE MEETING MINUTES – February 20, 2014 Prior to beginning with the discussion Ms. Khaghan requested a motion for agenda items 5 (f) to (j). Irene Lipof moved approval; seconded by Darryl K. Sharpton;

Members of the Fiscal Committee engaged in a detailed discussion regarding the Fiscal Year 2013 Gain Sharing Program. Much of the discussion was centered on gain sharing not being a new concept, concerns were raised having to do with fiscal responsibility as Trustees and stewards of JHS, recognized financial losses, recognized positive bottom line for fiscal years 2012 and 2013 and an unadjusted estimate for fiscal year 2014, questioned the kind of reserves needed to insure the future of JHS, concerns mentioned regarding a 5 to 10 year horizon in terms of doing the things that would insure the economic viability of JHS and not recognize the cumulative losses of the past, number of days cash-on-hand, how to best manage labor costs moving forward, concern regarding the process that was used to create the Gain Sharing Plan and need to be assured that JHS is not taking a financial step backward, JHS not being financially out of the woods and remain in a precarious situation moving forward however appreciate investing in JHS employees which is an investment in the future of JHS and its well-being, want the trust and confidence of JHS employees as well as efficiency, need a change in the climate in terms of actuality and perception, need a change in culture, a need to be concerned regarding JHS investing in its working capital and human capital, concern raised regarding JHS being financially sound, and the thought was mentioned to mirror the practice that other hospitals are doing to attract patients and retain employees. Mr. Knight stated for the record that the Gain Sharing Plan addresses two re-openers in the current Collective Bargaining Agreements. He reminded everyone that each of the Collective Bargaining Agreements has re-openers relative to COLA and merits and therefore the Gain Sharing Plan proposal would address the re-openers regarding COLA and merits. Mr. Knight explained that the re-openers would call for the potential re-restoration of both COLA and merits relative to the Collective Bargaining Agreements. Mr. Migoya stated that over the last two and one-half years much has been requested from JHS employees, and will need to request more from JHS employees over the next two and one-half years. He stated that in the beginning the Labor Unions leaders were not in favor of the gain sharing idea but after hearing from JHS employees the idea of sacrificing lesser benefits in the future for the exchange of some form of gain sharing became feasible. Mr. Migoya stated that JHS receives a little over $350 million in tax funds but JHS provides more than $500 million for uncompensated services for the greater good of the community. Mr. Migoya further stated that being a steward of JHS the right thing to do is to provide the 1.7% to JHS employees for last year’s efforts. He remains hopeful that there can be conversation with Union Partners to have similar gain sharing plans in the future.

On behalf of SEIU, Local 1991 and AFSCME, Local 1363, Martha Baker, R.N., President, SEIU, Local 1991 stated that the Miami-Dade County and JHS employees gave during the recession without a fight, and gave $400 million collectively in Miami-Dade County to avoid the tax payers and keep the services. Ms. Baker further stated that JHS employees are committed to Jackson, commend the leadership changes that have helped JHS employees go through this, JHS employees are the biggest resource in the fight for quality, improvement and sustainability and have been without a pay increase for four (4) years. Ms. Baker pointed out that 49% of the nurses hired since 2010 have left because other institutions are paying more for the same nursing experience. The Gain Sharing Plan is a strategy to keep employees at JHS but is nowhere near the 3 to 4 years of step raises that Miami-Dade County employees received and JHS employees did not but is a minor plus, a breath of fresh air and shot in the arm for the right work. Ms. Baker encouraged building the trust among JHS employees to be able to move forward with the quality initiatives that have been talked about, applauded Mr. Migoya for his team work with the employees and want to work together for the next decade, and remain quality driven.

With regards to the process in which an issue(s) is addressed, Mr. Sharpton stated that the PHT BOT will fine tune the time when information is presented for discussion and action. At the close of the discussion, Ms. Khaghan called the question on the motion made regarding agenda items 5 (f) to (j). With the exception of one no vote agenda items 5 (f) to (j) were approved. Mr. Arriola was the no voter.

of 7


For the purpose of the Audit and Compliance Subcommittee reviewing the KPMG Fiscal Year 2013 Audited Financial Statements and Management Letter prior to forwarding them to the Fiscal Committee with a favorable recommendation, Ms. Khaghan requested that the Fiscal Committee enter into a recess and reconvene following the Audit and Compliance Subcommittee meeting. The Fiscal Committee recessed at 11:45 a.m. The Fiscal Committee reconvened at 12:06 p.m.

3. Review of KPMG Fiscal Year 2013 Audited Financial Statements and Management Letter

(a) KPMG Fiscal Year 2013 Audited Financial Statements (b) KPMG Fiscal Year 2013 Management Letter

Mr. Knight requested the Committee to accept the KPMG Fiscal Year 2013 Audited Financial Statements and KPMG Fiscal Year 2013 Management Letter with a favorable recommendation to the Public Health Trust Board of Trustees. A detailed overview of both items was presented at the Audit and Compliance Subcommittee meeting. Motion to accept KPMG Fiscal Year 2013 Audited Financial Statements and Management Letter with a favorable recommendation to the PHT Board of Trustees


Irene Lipof moved to accept the items presented with a favorable recommendation to the PHT Board of Trustees; seconded by Marcos J. Lapciuc, and carried without dissent.

Mr. Arriola excused himself from the meeting and was not present for the vote.

4. Reports

(a) Jackson Health Systems Combined Financial Statements as of January 2014

Mr. Knight provided the Committee with an overview of the JHS Combined Financial Statements (Financial Statements) as of January 2014. The Financial Statements for the month of January 2014 showed a positive bottom line totaling $2.4 million versus a projected budget totaling approximately $300,000 despite the unfavorable trends in the payor mix, cash collections remained at projections, volumes and funded volumes were higher than projected, self-pay was higher than historically experienced, net patient revenue showed a decrease for the month, operating expenses showed a decrease for the month which attributed to a positive variance on the net gain line, salaries and benefits were favorable to budget for the second consecutive month, length of stay remained flat for the months of December 2013 and January 2014, cash days-on-hand for the month ended at 28, and days in accounts receivable for the month ended at 45 which is considered “best practice” based on industry benchmarks.

(b) Accounts Receivable Aging as of January 2014 Carmen Pla, Vice President, Revenue Cycle Division reported that the point of service cash collections remained strong across the system by surpassing the goal of $1.7 million verses an actual of $1.9 million, experienced an increase in conversion for potential Medicaid which was significantly higher than prior months, AR greater than 90-days is trending favorably, and continue to focus efforts across JHS specifically around denial rates and charge capture improvements.

of 7


(c) JMH Health Plan Paul Marineau, Executive Director, Division of Managed Care and JMH Health Plan (Health Plan) reported that the HMO membership is currently 49,687, slightly fewer than 10,000 members in the PSN, and on track with managing the orderly wind down of the Health Plan.

(d) Financial and Budget Tracking Status as of December 2013 A summary of the Financial and Budget Tracking Status as of December 2013 was included with the agenda. The report is provided as an informational item regarding sources and usage of capital funding and is consistent with the information presented at the February 20, 2014 Purchasing and Facilities Subcommittee meeting.

(e) Purchasing and Facilities Subcommittee The Purchasing and Facilities Subcommittee met on February 20, 2014, brief updates were presented regarding routine reporting items and the Subcommittee agreed to forward the February 2014 Purchasing Report (agenda item 5 (l) with a favorable recommendation to the Fiscal Committee.

5. Resolutions Recommended to be Forwarded to the PHT Board of Trustees

(a) Resolution approving the Public Health Trust Defined Benefit Retirement Plan Revised Investment Policy Statement


(b) Resolution approving the adoption of the Public Health Trust Defined Benefit Retirement Plan as amended and restated


Motion to accept the resolutions 5 (a) and (b) with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

Irene Lipof moved approval; seconded by Marcos J. Lapciuc, and carried without dissent. Mr. Arriola excused himself from the meeting and was not present for the vote.

(c) Resolution approving transfer of the Public Health Trust’s Risk Management Trust Account from SunTrust Bank, Inc. to Wells Fargo Bank, N.A. and authorizing the President or his designee to execute Trust Agreement and other documents and forms necessary to accomplish the immediate transfer thereof

Sponsored by Donald B. Jaffee, Vice President, Finance Division, Jackson Health System

of 7


(d) Resolution authorizing Sandra L. Gorski, Director of Risk Management to direct the Trustees of the Public Health Trust’s Risk Management Liability Account to conduct business including payment of Tort Claims, as required by the Trustee Agreement between Wells Fargo Bank, N.A. and the Public Health Trust, superseding prior resolution

Sponsored by Donald B. Jaffee, Vice President, Finance Division, Jackson Health System Motion to accept the resolutions 5 (c) and (d) with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

Darryl K. Sharpton moved approval; seconded by Irene Lipof, and carried without dissent Mr. Arriola excused himself from the meeting and was not present for the vote.

(e) Resolution approving and authorizing the President or his designee to execute Renewal Agreements with the following Community Mental Health Centers: Citrus Health Network, Inc.; Citrus Health Network (CCSU), Inc.; Community Health of South Florida, Inc.; Banyan Health Systems, Inc.; Jackson North Community Mental Health Center; New Horizons CMHC, Inc. for the provision of Mental Health Services in the total amount of $2,644,932

Sponsored by John Repique, Vice President and Chief Administrative Officer, Behavioral Health Hospital, Jackson Health system

Motion to accept the resolution 5 (e) with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson

Irene Lipof moved approval; seconded by Marcos J. Lapciuc, and carried without dissent.

Mr. Arriola excused himself from the meeting and was not present for the vote. (k) Resolution authorizing the President or his designee to execute and access an Indemnification Agreement with FPL Fibernet, LLC, a Deleware Limited Liability Company for the purpose of installing, maintaining, repairing, replacing and operating certain communication equipment on county-owned property situated at 1801 and 1851 N. W. 9th Avenue, Miami-Dade County, Florida for an initial period of five (5) years commencing on the effective date of the Agreement, with two (2) five year options to extend Sponsored by Madeline Valdes, Corporate Director, Property Management, Jackson Health System

of 7

FISCAL COMMITTEE MEETING MINUTES – February 20, 2014 (l) Resolution authorizing and approving award of bids and proposals, waiver of bids, and other purchasing

actions for February 2014, in accordance with the Public Health Trust’s Procurement Policy, Resolution No. PHT 10/12-78


Motion to accept the resolutions 5 (k) and (l) with a favorable recommendation to the PHT Board of Trustees Mojdeh L. Khaghan, Chairperson Irene Lipof moved approval; seconded by Marcos J. Lapciuc, and carried without dissent.

Mr. Arriola excused himself from the meeting and was not present for the vote.

Adjournment Mojdeh L. Khaghan, Chairperson at 12:23 p.m.


3. Reports

3 (a) Jackson Health System Combined Financial Statements as of March 2014

Accounts Receivable All Hospitals March 2014 (FY14)

Revenue Cycle KPI’s

Cash Collections Goal Actual

March 2014 (FY14) $84M $ 84M

KPI Best Practice /Benchmark Goal Actual Prior Month

POS 2% of net collections $1.7M $1.8M $2M

Potential Medicaid Conversion

% of approvals compared to referrals for the prior 90 days. 90% 100% 91%

AR Greater than 90 Days

Less than 20% of discharged AR 20% 19% 19%

Denial Reduce Net denial write-offs FYTD (less Benefit exhausted amounts) (FY12=10.4%)

5.5% 7.9% 7.8%

Revenue Integrity Reduce late charge (# of charges) greater than 5 days (FY12=2.4%) 1.5% 3.0% 2.6%

Benchmarks obtained by: HARA & Advisory Board ** Internal Target. No industry benchmark available

JHS CBO Cash Collections Month FY-13 Cash FY-14 Cash October $ 93,035,086 $ 90,066,863 November 90,228,516 78,353,936 December 76,727,419 83,403,788 January 93,346,075 85,370,047 February 81,386,890 82,625,970 March 77,187,713 84,343,228 April 90,399,591 May 88,103,154 June 73,764,853 July 95,914,513 August 89,819,495 September 93,202,988 Total $ 1,043,116,293 $ 504,163,832

Source: JHS Treasury Management & Revenue Control Dept.

Thank you,

3 (c) JMH Health Plan Activities

FINANCIAL & BUDGET TRACKING STATUS REPORT FEBRUARY 2014 Capital Contribution (aka funded depreciation): The FY 2014 budget programmed $40 million of capital expenditures (both equipment and projects) to occur during the year funded with Capital Contribution dollars. For the current month end active capital projects funded with Capital Contribution dollars total $15.4 million. Of this amount, $3.7 million was spent in prior years leaving $11.7 million to be spent. Of that $2.9 million was spent in the current fiscal year. $10.6 million is programmed for spending in FY 2014 with an additional $1.1 million programmed to be spent in FY 2015. Foundation: Active Foundation funded projects continue this year totaling $2.4 million of prior and current year funding commitments. The bulk of the project dollars are represented by the NICU modernization project at $2 million. $534 thousand was spent in prior fiscal years leaving $1.9 million projected to be spent during FY 2014. Of this amount $112 thousand was spent in the current fiscal year. County GOB: Included in the report was a summary of active Building Better Communities General Obligation Bond funded projects. Active GOB funded projects total $2.4 million. Of this amount, $1.7 million was spent in prior years leaving $700 thousand to be spent during FY 2014. Of this amount $143 thousand was spent in the current fiscal year. Series 2005 Revenue Bonds: Active Series 2005 projects total $38.3 million of which $3.0 million was spent in prior years, leaving $35.3 million left to spend. $3.8 million has been spent in FY 2014. $28.48 million is programmed for spending in FY 2014 with an additional $6.86 million programmed to be spent in FY 2015 Series 2009 Revenue Bonds: Active Series 2009 projects total $40.7 million of which $17.2 million was spent in prior years leaving $23.5 million left to spend. As of the end of February 2014 of the current fiscal year $2.6 million has been spent. $15.0 million of the remaining is programmed for spending in FY 2014 with an additional $8.5 million programmed to be spent in FY 2015. Trust Funds and Grants: The active projects funded by grants total $6.5 million, primarily FEMA dollars allocated to the ongoing Ryder Trauma Center Hardening project. $470 thousand was spent in prior years leaving $6.0 million left to spend. As of the end of February 2014 of the current fiscal year $75 thousand was spent. $2.6 million of the remaining balance is programmed for spending in FY 2014 with an additional $3.4 million programmed to be spent in FY 2015.

3 (e) Purchasing and Facilities Subcommittee

of 8


April 17, 2014

TO: PUBLIC HEALTH TRUST BOARD OF TRUSTEES 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 Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed 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 $3,000,000 under competitively solicited (“ITB,” “RFP” or equivalent) contracts of other public and nonprofit entities. No items to report.

of 8

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. 1. (671687-FA) The Engineering Department is requesting additional funding to the enterprise-wide clinical biomedical engineering services agreement with Aramark under the MedAssets GPO contract.





Totals 20,967 2,002 2,128 25,097 Recommendation The contract provides parts, repair and maintenance services for all biomedical and diagnostic imaging equipment. Since contract inception, there has been a reduction in response time for service and repairs with an increase in customer and patient satisfaction. However, there has been an increase to the EML which will require additional funding in the amount of $11,700,000 to take the contract through the end of its term. This additional funding represents the addition of equipment not originally included in the EML and a shift in purchases from the OEM to Aramark (pass through). This has shown a reduction in the overall maintenance cost of the equipment and has allowed for shift in expense from the OEM to Aramark.

of 8

The original contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. The contract can be terminated by the Trust for breach and includes OIG and UAP provisions. In providing an evaluation of the vendor’s performance during the current contract year, the following has been reported:






Background Synergy Health North America, Inc. (“Synergy,” formerly SRI Surgical) is a leading provider of outsourced and managed decontamination services for reprocessing and sterilization of surgical instruments and reusable surgical linens and stainless in the United States and Europe. Through its unique service offering, Synergy provides reusable gowns, basins, towels and specialty Bariatric and Laparoscopic surgical instruments sets to Jackson Health System (“JHS”) under their MedAssets Contract. The vendor’s FDA-regulated services consist of daily processing, assembly, sterilization and delivery of all reusable surgical supplies required for surgery. Through this service, Synergy guarantees the availability and functionality of surgical products and instruments to the Trust. This enhances operating efficiency by improving OR throughput, ensuring patient safety by reducing post-op infections thus ensuring patient satisfaction and retention. Through its innovative best practice decisions, the vendor provides “greening alternatives” for JHS’ ORs and surgery centers and has helped JHS achieve and maintain its green initiatives. Delivered through its supply chain business model, the vendor provides high quality products, cost reductions and improved efficiencies. Converting to reusable gowns, drapes, towels and basins has eliminated up to 70% of the OR’s medical waste. For the years 2010 through 2013, Jackson Health System has avoided approximately 900,000 lbs. of waste at $.14/lb., this equates to approximately $126,000 worth of waste avoidance. In 2013 alone, JHS realized savings in waste avoidance of approximately $13,676 through the vendor’s “Green Wrap” Program. Recommendation Value Adds from utilizing the services of this vendor include handling and inventory reductions: 2 to 3 days of finished goods inventory at Synergy’s plant allows for uninterrupted supply and quick product changes for JHS; products are delivered to JHS’ point of use; there is a daily low unit of measure delivery; vendor provides single pack, totes, or case cart customized delivery based on JHS’ needs; hospital instruments are retrieved from returned products, decontaminated, catalogued, and returned to Jackson – a value for the instrument is assigned, validated and signed off by the OR Manager or Central Sterile Manager. Between 2010 and 2013, a total of 1401 instruments have been

of 8

processed and returned to JHS for total lost instrument avoidance of $159,984. From 2010 to 2013 JHS has realized savings of approximately $253,210 from improved efficiencies in product packaging and price reductions implemented by vendor. The projected spend for all three hospitals, maintaining prior-year utilization, is $3,832,470 over the three-year term of the contract. Based on reduced unit prices for most of the items, negotiated below the MedAssets pricing, this represents a projected annual contract cost reduction of $173,543 or $520,629 over the three-year contract term. ECRI and MD Buyline are unable to provide an analysis at this time. The contract can be terminated for convenience with a ninety (90) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Synergy Health North America, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the user departments have reported the following:




Background The Holtz Children’s Hospital Pediatric Respiratory Therapy department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the INO Therapeutics product remains the only turnkey solution available on the market today, making this a sole source procurement.

of 8

Nitric Oxide inhalation therapy gas is used for treatment of cardio thoracic and transplant patients post-surgery. The therapy gas is used for heart and lung patients requiring pulmonary vasodilatation, post pump, transplant and pulmonary hypertension therapies and has the least side effects. The cost of using Nitric Oxide is significantly lower than costs associated with a patient’s response to a 3-5 day alternative therapy. Recommendation: If the Trust were to Purchase this service outside of any price package at INO’s hourly rate of $99.66 with an estimated utilization of 1,325 hours per month, the annual cost would be approximately $1,584,594. Alternatively, securing a Platinum package of unlimited Nitric Oxide gas usage would be at an annual price of $1,350,000. The resulting annual projected cost avoidance from securing the Platinum tier would, therefore, be approximately $234,594. In addition, the requested amount of $1,350,000 represents a negotiated $75,000 in savings over the price proposed by vendor for the Platinum tier. In summary, by entering into the Platinum agreement as opposed to paying the hourly rate outside of any plan, the Trust is realizing total savings of $309,594 ($234,594 + $75,000). Were the Trust to remain at the Bronze level, it would likely exceed the 11,000 hour cap again and then be forced to pay the remainder of the usage for the contract term at a high hourly rate likely to exceed the yearly price for unlimited usage. The total projected hours for the expiring contract year were 15,897 hours. The first 11,000 hours at the Bronze level would cost the Trust $930,380. The remaining 4,897 hours would be at the negotiated outside-of-the package rate of $95.37 per hour for a total of $467,026.19. This would bring the total estimated cost to $1,397,406.89 ($930,380 + $467,026.89), resulting in $47,406.89 more than the price negotiated for unlimited usage. INO Therapeutics is the only FDA approved vendor for this particular drug and its delivery system. The contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. The contract has been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal Sufficiency. In accordance with our Contractor Due Diligence review, INO Therapeutics, LLC has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3)The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, Pediatric Respiratory Therapy has reported the following:


Based on the overall contract performance evaluation, Pedi Respiratory Therapy recommends the continuation of this contracted service with INO Therapeutic, LLC A Sole Source Justification has been provided and Conflict of Interest Declarations have been signed by Oscar Solares, Chief Respiratory Therapist, and Lori Donahue, Contracts Administrator for INO Therapeutics with no reported disclosures. The MDBuyline market analysis identified no additional potential savings. ECRI was unable to provide a direct cost comparison at this time. (S. Burghart/A. Contreras)

of 8

B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 4. (666268-MN) Pathology Services Department requests funding to exercise the second of three one-year renewal options (OTRs) for the continuation of specialty diagnostic laboratory services (Ongoing purchase).


Background In April 2012, the Board approved a bid waiver (Physician Preference) contract award to ViraCor-IBT in the amount of $1,300,000 for a one-year period with three renewal options (OTRs) of one year each to be exercised at the discretion of the Trust. ViraCor-IBT provides quantitative real time bacterial and viral testing that is focused on molecular testing. Although the Board approved $1,300,000 for the initial year, due to increased usage, the contract was modified for an additional $250,000 to cover the last two months of the first year. As a result, the Board approved $1,550,000 for the first OTR. This request represents the second OTR and, through negotiations, Viracor has agreed to retain its current pricing and forego CPI increases. Because the Lab will be performing some of the tests in house, the agreed-upon maximum contract value for this second OTR will be $1,300,000. JHS pediatric and transplant physicians developed protocols that call for these tests on a regular basis for all patients. The physicians are pleased with the accuracy, reliability and turnaround time of the tests results, and Viracor remains their preference. ViraCor-IBT is the only reference laboratory with the ability to deliver results of the labor-intensive quantitative Polymerase Chain Reaction (PCR) testing for viral markers within a 24 hour turn-around time of specimen receipt as required by JHS. This vendor is the most qualified provider for this level of service. Recommendation Approval for this OTR #2 is requested to avoid disruption of the real-time bacterial and viral testing services which are highly utilized by Pediatrics and Transplant Departments. Physicians would not be able to diagnose, treat and discharge patients quickly and effectively without the continuation of this service. Although the vendor is not on the MedAssets contract, a market analysis was conducted as part of a MedAssets and Procurement Management (PDM) Initiative for savings and this determined the current competitive “benchmark” pricing. The resulting negotiations with Viracor provided savings of approximately $150,000 for the initial contract year in 2012. The vendor has agreed to forego its customary CPI increase (estimated to be $45,000 in 2014) and hold existing contract pricing. Competitive pricing for the same test menu was secured from Quest Diagnostics (the current prime reference laboratory vendor on the MedAsset GPO). The price comparison showed savings to the Trust of $659,194 for one year if ViraCor is utilized for the tests. In addition, ViraCor will bear the cost of an interface currently being instituted with the Trust’s Lab (Pathology), providing cost avoidance to the Trust of $34,000. The sum of savings to the Trust in continuing to secure the services of Viracor is estimated at $738,194 for this OTR. The contract can be terminated for convenience with a thirty (30) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to insurance and liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Viracor-IBT Laboratory, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) the Company has not been

of 8

debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the Laboratory Department has reported the following:


Based on the overall performance evaluation, the Laboratory Department has no complaints about this vendor and recommends executing a contract with Viracor-IBT Laboratories, Inc. A Bid Waiver Justification has been provided by Maria Quintana, Lab Operations Manager and Conflict of Interest Declarations have been signed by Maria Quintana, Lab Operations Manager, Pathology, and by Michelle Altrich, VP, Clinical Laboratory Director of ViraCor-IBT, Inc., with no reported disclosures. ECRI reported that Viracor’s quoted prices per test are consistent with pricing Viracor is providing other customers. MD Buyline is unable to provide an analysis at this time (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. 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. 5. (525759-MN) The Anatomic Pathology Department requests approval of a six year contract for staining equipment and supplies from DAKO North America, Inc.


The Anatomic Pathology Department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the DAKO North America product remains the only turnkey solution available on the market today, making this a sole source procurement. This contract replaces a DAKO slide staining instrument with a newer model. The new DAKO instrument will stain all the biopsy tissues submitted to the Histology Lab for the pathologists to analyze and provide clinicians with patient’s diagnosis. DAKO is the only vendor that offers the complete menu of tissue staining capacity for the complexity of staining currently used in the Histology lab. DAKO can provide up to 34 different stains and can stain up to 48 slides at a time, which is necessary for the volume being handled by the Lab. Competitors can stain only 25 slides at a time DAKO’s staining is of a high quality,and the vendor provides outstanding service with supplies available at all times. DAKO also provides better utilization of their dyes and reagents per kit, reducing waste and maximizing the Trust’s use of reagents purchased.

of 8

DAKO Equipment has been used by the lab for the past ten (10) years so that staff is already familiar with the use of the DAKO equipment and reagents. Without this purchase, the Lab would be faced with additional costs and delays associated with hiring and training full-time technologists to manually perform many of the stains with new equipment and supplies. Recommendation: Use of DAKO products last year was at a cost of $86,049. The proposed new contract will be for an annual negotiated price of $84,525, representing savings of $1,524 per year or $9,144 over six (6) years. DAKO agreed to reduce the price-per-slide from $8.55 to $8.05. The contract can be terminated by either party for material breach and includes the UAP and OIG provisions. In providing an evaluation of the vendor’s performance during the current contract year, the Core Laboratory Department has reported the following:



4. Resolutions Recommended To Be Approved

TO: Marcos J. Lapciuc, Chairman and Members, Purchasing and Facilities Subcommittee FROM: Rosa Costanzo Strategic Sourcing and Supply Chain Management & Chief Procurement Officer DATE: April 17, 2014 RE: Purchasing Report Recommendation The following recommendations are made in accordance with the Trust’s “Procurement Regulation.” These items fully support our business operations and help the organization in its efforts to provide an excellent world class patient experience. Scope 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. Fiscal Impact/Funding Source The items included are part of the Trust’s budget. Track Record/Monitor The Procurement Management Department along with the user departments and leadership support, will track and monitor the responsibilities and obligations set forth in the contracts. Background The entire report has been vetted and assembled by the Procurement Management Department with the direct participation of the Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed for legal sufficiency by the County Attorney’s Office. Request is made for approval of the Purchasing Report, consisting of the following:

Vendor Amount 1 Cohr, Inc. d/b/a Masterplan (Aramark) $ 11,700,000 (Additional funding to complete term) 2 Synergy Health North America, Inc $ 3,832,470 Total for 3 Years 3 INO Therapeutics, LLC $ 1,350,000 Total for 1 Year 4 ViraCorIBT Laboratory, Inc. $ 1,300,000 Total for 1 Year 5 DAKO North America $ 507,150 Total for 6 Years

Procurement completed an orderly administrative process with each item to bring the best value (cost, quality, and outcome) with each project. Savings Total savings for the entire term of contracts #2 thru #5 presented here is $656,186. First year savings is approximately $301,404.

Agenda Item 4 (a)

Fiscal Committee April 17, 2014

RESOLUTION NO. PHT 04/14 – RESOLUTION AUTHORIZING AND APPROVING AWARD OF BIDS AND PROPOSALS, WAIVER OF BIDS, AND OTHER PURCHASING ACTIONS FOR APRIL 2014, IN ACCORDANCE WITH THE PUBLIC HEALTH TRUST’S PROCUREMENT POLICY, RESOLUTION NO. PHT 10/12-078

(Rosa Costanzo, Vice President and Chief Procurement Officer,

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

WHEREAS, bids and proposals were solicited, received and reviewed by staff; and

WHEREAS, the Purchasing and Facilities Subcommittee met on April 17, 2014 and reviewed staff’s

recommendations as submitted under the PHT’s Procurement Policy, Resolution No. PHT 10/12-078; and

WHEREAS, the Purchasing and Facilities Subcommittee forwarded the Purchasing Report to the Fiscal

Committee with a recommendation for approval for each item under the report, which is attached hereto and hereby

incorporated by reference; and

WHEREAS, upon his written recommendation, the President recommends that the Public Health Trust Board

of Trustees (Board of Trustees) waive competitive bidding for items under the heading of “Bid Waiver” and “Waiver of

Full and Competitive Bidding” in the respective Purchasing Report, finding such action to be in the best interests of the

Public Health Trust; and

WHEREAS, the President and Fiscal Committee recommend various other purchasing actions, as indicated in

the attached Purchasing Report.

NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH

TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes and approves the award of bids

and proposals and all the purchasing actions as set forth in the attached Purchasing Report, under the Public Health

Trust’s Procurement Policy, Resolution No. PHT 10/12-078; and finds it in the best interest of the Public Health Trust

to waive competitive bidding for those items listed under the heading “Bid Waiver” and “Waiver of Full and

Competitive Bidding” in the respective report; and to take such action as is necessary and authorized to implement these

awards and actions.


April 17, 2014

TO: PUBLIC HEALTH TRUST BOARD OF TRUSTEES 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 Director and staff, all subject to review by the Chief Procurement Officer, consultation with the Executive Staff and the President, and reviewed 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 $3,000,000 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. 1. (671687-FA) The Engineering Department is requesting additional funding to the enterprise-wide clinical biomedical engineering services agreement with Aramark under the MedAssets GPO contract.





Totals 20,967 2,002 2,128 25,097 Recommendation The contract provides parts, repair and maintenance services for all biomedical and diagnostic imaging equipment. Since contract inception, there has been a reduction in response time for service and repairs with an increase in customer and patient satisfaction. However, there has been an increase to the EML which will require additional funding in the amount of $11,700,000 to take the contract through the end of its term. This additional funding represents the addition of equipment not originally included in the EML and a shift in purchases from the OEM to Aramark (pass through). This has shown a reduction in the overall maintenance cost of the equipment and has allowed for shift in expense from the OEM to Aramark. The original contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. The contract can be terminated by the Trust for breach and includes OIG and UAP provisions.

In providing an evaluation of the vendor’s performance during the current contract year, the following has been reported:






Background Synergy Health North America, Inc. (“Synergy,” formerly SRI Surgical) is a leading provider of outsourced and managed decontamination services for reprocessing and sterilization of surgical instruments and reusable surgical linens and stainless in the United States and Europe. Through its unique service offering, Synergy provides reusable gowns, basins, towels and specialty Bariatric and Laparoscopic surgical instruments sets to Jackson Health System (“JHS”) under their MedAssets Contract. The vendor’s FDA-regulated services consist of daily processing, assembly, sterilization and delivery of all reusable surgical supplies required for surgery. Through this service, Synergy guarantees the availability and functionality of surgical products and instruments to the Trust. This enhances operating efficiency by improving OR throughput, ensuring patient safety by reducing post-op infections thus ensuring patient satisfaction and retention. Through its innovative best practice decisions, the vendor provides “greening alternatives” for JHS’ ORs and surgery centers and has helped JHS achieve and maintain its green initiatives. Delivered through its supply chain business model, the vendor provides high quality products, cost reductions and improved efficiencies. Converting to reusable gowns, drapes, towels and basins has eliminated up to 70% of the OR’s medical waste. For the years 2010 through 2013, Jackson Health System has avoided approximately 900,000 lbs. of waste at $.14/lb., this equates to approximately $126,000 worth of waste avoidance. In 2013 alone, JHS realized savings in waste avoidance of approximately $13,676 through the vendor’s “Green Wrap” Program. Recommendation Value Adds from utilizing the services of this vendor include handling and inventory reductions: 2 to 3 days of finished goods inventory at Synergy’s plant allows for uninterrupted supply and quick product changes for JHS; products are delivered to JHS’ point of use; there is a daily low unit of measure delivery; vendor provides single pack, totes, or case cart customized delivery based on JHS’ needs; hospital instruments are retrieved from returned products, decontaminated, catalogued, and returned to Jackson – a value for the instrument is assigned, validated and signed off by the OR Manager or Central Sterile Manager. Between 2010 and 2013, a total of 1401 instruments have been processed and returned to JHS for total lost instrument avoidance of $159,984. From 2010 to 2013 JHS has realized

savings of approximately $253,210 from improved efficiencies in product packaging and price reductions implemented by vendor. The projected spend for all three hospitals, maintaining prior-year utilization, is $3,832,470 over the three-year term of the contract. Based on reduced unit prices for most of the items, negotiated below the MedAssets pricing, this represents a projected annual contract cost reduction of $173,543 or $520,629 over the three-year contract term. ECRI and MD Buyline are unable to provide an analysis at this time. The contract can be terminated for convenience with a ninety (90) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to Insurance and Liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Synergy Health North America, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the user departments have reported the following:




Background The Holtz Children’s Hospital Pediatric Respiratory Therapy department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the INO Therapeutics product remains the only turnkey solution available on the market today, making this a sole source procurement. Nitric Oxide inhalation therapy gas is used for treatment of cardio thoracic and transplant patients post-surgery. The therapy gas is used for heart and lung patients requiring pulmonary vasodilatation, post pump, transplant and pulmonary hypertension therapies and has the least side effects. The cost of using Nitric Oxide is significantly lower than costs associated with a patient’s response to a 3-5 day alternative therapy. Recommendation:

If the Trust were to Purchase this service outside of any price package at INO’s hourly rate of $99.66 with an estimated utilization of 1,325 hours per month, the annual cost would be approximately $1,584,594. Alternatively, securing a Platinum package of unlimited Nitric Oxide gas usage would be at an annual price of $1,350,000. The resulting annual projected cost avoidance from securing the Platinum tier would, therefore, be approximately $234,594. In addition, the requested amount of $1,350,000 represents a negotiated $75,000 in savings over the price proposed by vendor for the Platinum tier. In summary, by entering into the Platinum agreement as opposed to paying the hourly rate outside of any plan, the Trust is realizing total savings of $309,594 ($234,594 + $75,000). Were the Trust to remain at the Bronze level, it would likely exceed the 11,000 hour cap again and then be forced to pay the remainder of the usage for the contract term at a high hourly rate likely to exceed the yearly price for unlimited usage. The total projected hours for the expiring contract year were 15,897 hours. The first 11,000 hours at the Bronze level would cost the Trust $930,380. The remaining 4,897 hours would be at the negotiated outside-of-the package rate of $95.37 per hour for a total of $467,026.19. This would bring the total estimated cost to $1,397,406.89 ($930,380 + $467,026.89), resulting in $47,406.89 more than the price negotiated for unlimited usage. INO Therapeutics is the only FDA approved vendor for this particular drug and its delivery system. The contract can be terminated for convenience with a thirty (30) day notice and includes UAP and OIG provisions. The contract has been approved by Risk as to Insurance and Liability and by the County Attorney’s Office for Legal Sufficiency. In accordance with our Contractor Due Diligence review, INO Therapeutics, LLC has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3)The Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, Pediatric Respiratory Therapy has reported the following:


Based on the overall contract performance evaluation, Pedi Respiratory Therapy recommends the continuation of this contracted service with INO Therapeutic, LLC A Sole Source Justification has been provided and Conflict of Interest Declarations have been signed by Oscar Solares, Chief Respiratory Therapist, and Lori Donahue, Contracts Administrator for INO Therapeutics with no reported disclosures. The MDBuyline market analysis identified no additional potential savings. ECRI was unable to provide a direct cost comparison at this time. (S. Burghart/A. Contreras) B. Physician’s Preference Staff requests a waiver of formal competition for the contract items listed in this category because a physician and clinician have requested the particular item without which the physician and clinician cannot successfully and safely render patient care. 4. (666268-MN) Pathology Services Department requests funding to exercise the second of three one-year renewal options (OTRs) for the continuation of specialty diagnostic laboratory services (Ongoing purchase).


Background

In April 2012, the Board approved a bid waiver (Physician Preference) contract award to ViraCor-IBT in the amount of $1,300,000 for a one-year period with three renewal options (OTRs) of one year each to be exercised at the discretion of the Trust. ViraCor-IBT provides quantitative real time bacterial and viral testing that is focused on molecular testing. Although the Board approved $1,300,000 for the initial year, due to increased usage, the contract was modified for an additional $250,000 to cover the last two months of the first year. As a result, the Board approved $1,550,000 for the first OTR. This request represents the second OTR and, through negotiations, Viracor has agreed to retain its current pricing and forego CPI increases. Because the Lab will be performing some of the tests in house, the agreed-upon maximum contract value for this second OTR will be $1,300,000. JHS pediatric and transplant physicians developed protocols that call for these tests on a regular basis for all patients. The physicians are pleased with the accuracy, reliability and turnaround time of the tests results, and Viracor remains their preference. ViraCor-IBT is the only reference laboratory with the ability to deliver results of the labor-intensive quantitative Polymerase Chain Reaction (PCR) testing for viral markers within a 24 hour turn-around time of specimen receipt as required by JHS. This vendor is the most qualified provider for this level of service. Recommendation Approval for this OTR #2 is requested to avoid disruption of the real-time bacterial and viral testing services which are highly utilized by Pediatrics and Transplant Departments. Physicians would not be able to diagnose, treat and discharge patients quickly and effectively without the continuation of this service. Although the vendor is not on the MedAssets contract, a market analysis was conducted as part of a MedAssets and Procurement Management (PDM) Initiative for savings and this determined the current competitive “benchmark” pricing. The resulting negotiations with Viracor provided savings of approximately $150,000 for the initial contract year in 2012. The vendor has agreed to forego its customary CPI increase (estimated to be $45,000 in 2014) and hold existing contract pricing. Competitive pricing for the same test menu was secured from Quest Diagnostics (the current prime reference laboratory vendor on the MedAsset GPO). The price comparison showed savings to the Trust of $659,194 for one year if ViraCor is utilized for the tests. In addition, ViraCor will bear the cost of an interface currently being instituted with the Trust’s Lab (Pathology), providing cost avoidance to the Trust of $34,000. The sum of savings to the Trust in continuing to secure the services of Viracor is estimated at $738,194 for this OTR. The contract can be terminated for convenience with a thirty (30) day notice and includes the OIG and UAP provisions. The contract was approved by Risk Management as to insurance and liability and by the County Attorney’s Office for legal sufficiency. In accordance with our Contractor Due Diligence review, Viracor-IBT Laboratory, Inc. has provided a Sworn/Notarized Statement to the Trust’s Procurement Management Department that: (1) No Lawsuits have been filed against the Company within the five (5) years prior to submittal of a bid or proposal to the Trust; (2) The Company has not defaulted in the five (5) years prior to bid or proposal submittal to the Trust; and, (3) the Company has not been debarred nor has the Firm received a formal notice of non-compliance or non-performance in the five (5) years prior to proposal submittal to the Trust. In providing an evaluation of the vendor’s performance during the current contract year, the Laboratory Department has reported the following:


Based on the overall performance evaluation, the Laboratory Department has no complaints about this vendor and recommends executing a contract with Viracor-IBT Laboratories, Inc. A Bid Waiver Justification has been provided by Maria Quintana, Lab Operations Manager and Conflict of Interest Declarations have been signed by Maria Quintana, Lab Operations Manager, Pathology, and by Michelle Altrich, VP, Clinical Laboratory Director of ViraCor-IBT, Inc., with no reported disclosures. ECRI reported that Viracor’s

quoted prices per test are consistent with pricing Viracor is providing other customers. MD Buyline is unable to provide an analysis at this time (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. 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. 5. (525759-MN) The Anatomic Pathology Department requests approval of a six year contract for staining equipment and supplies from DAKO North America, Inc.


The Anatomic Pathology Department, in collaboration with the Procurement Management Department, conducted market research to determine the availability of competition. The team confirmed that the DAKO North America product remains the only turnkey solution available on the market today, making this a sole source procurement. This contract replaces a DAKO slide staining instrument with a newer model. The new DAKO instrument will stain all the biopsy tissues submitted to the Histology Lab for the pathologists to analyze and provide clinicians with patient’s diagnosis. DAKO is the only vendor that offers the complete menu of tissue staining capacity for the complexity of staining currently used in the Histology lab. DAKO can provide up to 34 different stains and can stain up to 48 slides at a time, which is necessary for the volume being handled by the Lab. Competitors can stain only 25 slides at a time DAKO’s staining is of a high quality,and the vendor provides outstanding service with supplies available at all times. DAKO also provides better utilization of their dyes and reagents per kit, reducing waste and maximizing the Trust’s use of reagents purchased. DAKO Equipment has been used by the lab for the past ten (10) years so that staff is already familiar with the use of the DAKO equipment and reagents. Without this purchase, the Lab would be faced with additional costs and delays associated with hiring and training full-time technologists to manually perform many of the stains with new equipment and supplies. Recommendation: Use of DAKO products last year was at a cost of $86,049. The proposed new contract will be for an annual negotiated price of $84,525, representing savings of $1,524 per year or $9,144 over six (6) years. DAKO agreed to reduce the price-per-slide from $8.55 to $8.05. The contract can be terminated by either party for material breach and includes the UAP and OIG provisions. In providing an evaluation of the vendor’s performance during the current contract year, the Core Laboratory Department has reported the following:


TO: Mojdeh L. Khaghan, Chairwoman

and Members, Fiscal Committee FROM: Donald B. Jaffee, Vice President, Finance Division DATE: April 17, 2014 RE: Resolution Authorizing Chuck Tawwater, Director Of Risk Management, To Direct The Trustees

Of The Public Health Trust of Miami-Dade County Risk Management Trust Account To Conduct Business Including Payment Of Tort Claims; And Removing Sandra Gorski, As Required By The Trustee Agreement Between Wells Fargo Bank And The Public Health Trust, Superseding And Replacing Prior Resolutions

Recommendation The recommendation is that the Board of Trustees approves the resolution authorizing Chuck Tawwater, Director of Risk Management to negotiate and authorize payment of tort claims in amounts up to $50,000. Background Mr. Tawwater replaces, Sandra Gorski, who initially was given authorization to approve payment for tort claims up to $50,000.

Agenda Item 4 (b) Fiscal Committee April 17, 2014

RESOLUTION NO. PHT 04/14 -

RESOLUTION AUTHORIZING CHUCK TAWWATER, DIRECTOR OF RISK MANAGEMENT, TO DIRECT THE TRUSTEES OF THE PUBLIC HEALTH TRUST OF MIAMI-DADE COUNTY RISK MANAGEMENT TRUST ACCOUNT TO CONDUCT BUSINESS INCLUDING PAYMENT OF TORT CLAIMS; AND REMOVING SANDRA GORSKI, AS REQUIRED BY THE TRUSTEE AGREEMENT BETWEEN WELLS FARGO BANK AND THE PUBLIC HEALTH TRUST, SUPERSEDING AND REPLACING PRIOR RESOLUTIONS

(Donald B. Jaffee, Vice President, Finance Division, Jackson Health System)

WHEREAS, the Trustee agreement between the Public Health Trust and Wells Fargo Bank requires that an

officer shall approve payment of tort claims from the Public Health Trust of Miami-Dade County Risk Management

Trust Account; and

WHEREAS, the Fiscal Committee recommends that the Board of Trustees authorize Chuck Tawwater to direct the

Trustee to pay tort claims of up to $50,000 and approve other actions, and remove Sandra Gorski as necessary, in

connection with the Public Health Trust of Miami-Dade County Risk Management Trust Account; and

WHEREAS, the Board of Trustees intends for this resolution to supersede and replace all prior resolutions,

including Resolution No. 05/13 – 035.

NOW, THEREFORE BE IT RESOLVED BY THE BOARD OF TRUSTEES OF THE PUBLIC HEALTH

TRUST OF MIAMI-DADE COUNTY, FLORIDA, that this Board hereby authorizes Chuck Tawwater, Director of

Risk Management, to direct the Trustees of the Public Health Trust’s Risk Management Trust Account to conduct

all related business, including payment of tort claims of up to $50,000, and removes Sandra Gorski as required by

the Trustee Agreement between Wells Fargo Bank and the Public Health Trust; and hereby intends that this

resolution supersede and replace all prior resolution, including Resolution No. PHT 05/13 – 035.

5. Adjournment