Department of Pediatrics Meeting October 29, 2020 Topic: - PowerPoint PPT Presentation

Department of Pediatrics Meeting October 29, 2020 Topic: Department of Pediatrics Year-End Finance Presenters: Michael Propst, Associate Chair and Director of Finance and Administration Surabhi Agrawal, Director of Finance 1

4 Exciting Maternal & Child Health Sessions  Emerging Stem Cell and Gene Therapies  Scientific Advances in Diversity, Health Equity, and Social Justice  The COVID-19 Pandemic and Innovations in School- Age Learning  Groundbreaking Research KEYNOTE SPEAKER Lisa Chamberlain, MD, MPH Amy R Gerstein, PhD Natalia Gomez-Ospina, MD, PhD Hiromitsu Nakauchi, MD, PhD Pediatrics, David A. Williams, MD Pediatrics, John W. Gardner Center for Youth & Genetics, from Rising Scientists Senior Vice President and Chief Scientific Stanford School of Medicine Their Communities, Stanford Stanford School of Medicine Stanford School of Medicine Officer, Boston Children’s Hospital Graduate School of Education REGISTER NOW! Juno Obedin-Maliver, MD, MPH Fernando S. Mendoza, MD, MPH Kristy Red-Horse, PhD Lee Sanders, MD C. Jason Wang, MD, PhD Yvonne (Bonnie) Maldonado, MD https: s://mchri ri-sy symposi sium.ev even entbrite. e.com Pediatrics, Biology, Stanford School of Pediatrics, Pediatrics and Medicine, Obstetrics & Gynecology, Pediatrics and Health Research & Policy, Stanford School of Medicine Humanities & Sciences Stanford School of Stanford School of Stanford School of Medicine Stanford School of Medicine Medicine Medicine

Lance Prince, MD, PhD Chief, Division of Neonatal and Developmental Medicine 3

Packard Clinical Pathway Program Congratulations to the owners on recently posted clinical pathways! Multisystem Inflammatory Syndrome in Children (MIS-C) Saraswati Kache, Hayden Schwenk, Roshni Mathew, Dana Gerstbacher, Rebecca Ivancie, Clara Lo, May Chien, Shiraz Maskatia Acute Care Use and Weaning of High Flow Nasal Cannula Lauren Destino, Kathy Mykytiuk, Amy Chapman, Kate Steffen, Mike Tracy, David Cornfield, Felice Su Post Cardiac Arrest Targeted Temperature Management Elizabeth Mayne, Lindsey Rasmussen, Jeffrey Moss, Felice Su, Sarah Lee Inhaled Nitric Oxide Initiation and Weaning Kate Ryan, Kathleen Mykytiuk, Kate Steffen, Sonia Bonifacio, May Wu Aortic Arch Watch Shiraz Maskatia, David Kwiatkowski, Shazia Bhombal, Alexis Davis

Accessing the Packard Clinical Pathway Program Platform

Congratulations, Whitney Chadwick!! Tzielan Lee, MD Natalie Pageler, MD Whitney Chadwick, MD Ambulatory Associate CMIO CMIO Inpatient Associate CMIO

Dennis Wall, PhD American College of Medical Informatics Fellow

Allison Marsden, PhD American Physical Society Fellow

I am particularly excited that this bill also includes the Kids’ Access to Primary Care Act , a bipartisan bill I introduced to expand primary care access for children and families on Medicaid. By matching Medicaid reimbursement rates to higher Medicare rates, Medicaid patients will have access to more physicians, and children will get the care they need from their own primary care physician.

Fernando Mendoza, MD Lee Sanders, MD Immigrant Families and Children’s Health: the Intergenerational Health Impact of Federal and State Immigration Policy proposal funded for 4 years National Institute on Minority Health and Health Disparities (NIHMD)

Study Results State-level expansion of public health insurance coverage to non-US born children and pregnant women was not associated with in-migration of eligible “The medical community is inexorably linked to current immigrant policy issues. Making it easier immigrant families from other states for immigrant communities to connect to and seek care from physicians will not radically shift migration patterns. Instead, allowing access to the basic human right of health care shows a common commitment to human decency for all who are in the United States.” 13

Lisa Chamberlain, MD Eric Sibley, MD Manuel Amieva, MD Becky Blankenburg, MD

Steve Alexander, MD Ron Cohen, MD Susan Hintz, MD, MS For more than 12 years of service each to the Department of Pediatrics Committee on Appointments and Promotions.

Pediatri trics F Fina nanc nce O Overview Past, Present & Future October 2020

Appointment Line FTEs 300 250 200 150 100 50 0 FY19 FY20 FY21 UTL 30 29 33 MCL 65 66 68 NTL 11 13 15 CE 238 251 289 Instructor 23 27 37

MD/Funds Flow wRVUs Per cFTE 12,000 10,000 8,000 6,000 4,000 2,000 0 ADOL ALGY CARD CVICU DBP ENDO GI GPED GENE H/O ID CCM NEO NEPH PULM RHEU SCT FY19 FY20 AAAP Benchmark (FY20)

Department Telehealth Usage in FY20 5,000 4,000 3,000 2,000 1,000 0 Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Total Outpatient Office Visit Charges 3,648 4,181 3,649 3,832 3,774 3,541 3,750 3,292 3,285 4,091 4,288 4,303 Telehealth Charges (of total charges) 72 111 105 109 105 97 708 2,243 2,153 2,038 1,965 1,961

Clinical Profit $148.4M $139.8M $135.2M $125.6M $12.2M $9.3M Total Revenues Total Expenses Real Bottom Line 2019 2020

Clinical Profit by Division $4M $3M $3M $3M $2M $2M $1M $793K $714K $659K 562K $400K 334K 295K $271K $273K $193K $152K $85K $77K $68K -43K -44K -62K -82K -118K -146K -$174K -186K -$224K -$245K -350K -355K -1177K 2019 2020

Department of Pediatrics P&L 12 FYTD Aug 2020 FYTD Aug 2019 FY20 to FY19 Dept of Peds Dept of Peds Variance Total RVUs 647,249 649,932 -0.4% cFTE 290.08 264.39 9.7% RVU Generating cFTE 195.09 189.36 3.0% Revenues Total RVU Payment $ 98,475,791 $ 95,381,138 3.2% LPCH Strategic Support $ 46,948,707 $ 42,494,252 10.5% Total Revenues $ 147,431,628 $ 139,835,739 5.4% Controllable Expenses $ 131,125,494 $ 119,631,094 Faculty Salaries $ 73,217,194 $ 66,274,661 10.5% Staff Salaries $ 10,753,913 $ 8,755,895 22.8% Total Benefits $ 25,773,424 $ 23,353,080 10.4% Bonus $ 5,814,268 $ 5,799,500 0.3% Bonus Accrual $ 8,007,680 $ 7,474,667 7.1% Non-Salary $ 4,329,164 $ 4,804,604 -9.9% Non-Controllable Expenses Dean's Tax $ 5,999,592 $ 5,807,005 3.3% Total Expenses $ 137,125,086 $ 125,598,107 9.2% Bottom Line $ 5,640,026 $ 12,192,463 -53.7% LPCH Patch $ 1,519,975 Dean's Tax Rebate $ 1,925,520 wRVU Rate Mitigation $ 953,152 Real Bottom Line $ 9,258,088

Support for Tripartite Mission $12.2M $11.6M $11.3M FY19 FY20 FY21 Department Support $11,263,574 $11,620,169 $12,224,350 Diversity Support $500,000

Faculty Bonus (DRAFT) Variance for FY20 and Bonus FY20 Projection FY19 FY19 Clinical 4.4M 4.2M 6.1% Research 1.2M 1.0M 13.1% Education 421K 408K 3.2% Chief Disc 1.9M 1.3M 45.5% Chair Disc 210K 209K 0.7% Chief Bonus 600K 605K -0.9% Grand Total 8.7M 7.7M 13.0%

Refresh of Faculty Bonus  Clinical Individual RVUs – Group “Targets” –  Research  Education  Division Chief Discretionary  Department Chair Discretionary

Individual Clinical Targets  75% of Target: $5,000  90% of Target: $10,000  100% of Target: $20,000  Prorated by cFTE  Under 0.3 CFTE: Cap at $10,000  $50 per RVU above target

Research  Publications: 0 – 5 points  Sponsored Points = [(Indirect costs x 2) + MTDC]/$125,000  Appointment FTE ≥ 50%  Each research bonus point is paid $1,250

Education  Each activity assigned EVUs based on time and effort  Faculty survey responses are reviewed, and total points tallied  Per the survey design, there is no maximum number of points  Each education value unit (EVU) is paid $12

Chief’s Discretionary  Discretionary pools larger this year to compensate for reduced clinical-based bonus

FY20 and Prior Years FY20 FY19 FY18 Amount N Amount N Amount N Clinical Ind $851,896 62 $961,052 64 $589,050 27 Research $1,237,444 248 $1,094,296 230 $875,397 109 Education $420,750 288 $407,820 255 $279,852 207

Who is this COVID Task Force anyway?  Scott Sutherland, Surabhi Agarwal, Michael Propst, Lana Henthorn, Nam Ly-Sarmiento, David Maahs, Steve Roth

Financial Impact of COVID on Department Original Projection; Revised June 2020; Revised Aug 2020  [FY20] Inpatient – actual v. pre-COVID trajectory: -$3.1M; -$2.6M; Actual: -$2. $2.2M [FY20] Inpatient – actual FY20 increase over FY19: +$600k 00k –  [FY20] Outpatient – actual v. pre-COVID trajectory: -$4.1M; -$3.4M; Actual: -$2. $2.8M [FY20] Outpatient – actual FY20 decrease compared to FY19: -$2.2 $2.2M –  [FY21] Inpatient + Outpatient – projected lower than “expected”: -$4.8M; -$3. $3.3M  [FY20] Lost research revenue: -$1.3M  [FY21] Endowment payouts reduced by 15%: -$1.9M 10%: -$1. $1.3M  [FY21] Gift income reduced by 10%: -$2.4M  Total gap = $17.6M; $15.8M; $13. 3.3M 3M