ANNUAL REPORT 2010-2011
University Health Services • | PREPARED BY: Tom Trionfi, Director, 301 Warriner, 774.3166
I. Organizational Structure:
Sarah Yonder MD Vacant
Nurse Eric Curtiss, RPh
Medical Director, Assistant Director of
Practioner/Physicians Pharmacy Manager
Associate Director Business Operations
Tiffany Stiff, Craig Buys, RPh
Penelope Cook, D.O Administrative Pharmacist
Mary Armstrong, MLT Sue Lott,
Allan Riggs, PA-C Health Information
Laboratory Pharmacy Tech
Marilyn McGinty, PA-C Barb Elmore, RN
Relief Clinical Suite
Denise Malley, LPN
Jill Steffke, RN
Clinical Suite / Primary
Susan Woerle, RN
Lora Zenz, RN
II. Executive Summary of the Major 2010-
CMU’s University Health Services mission statement is: To promote the health and wellness
of CMU students and the University community by providing individualized medical care,
health promotion, and disease prevention services tailored to the dynamic needs of the
Over the past academic year, UHS has strived to uphold its vision statement:
To promote the health and wellness of CMU students and the University community by providing
individualized medical care, health promotion and disease prevention services tailored to the dynamic
needs of the CMU campus.
We have done this in a variety of ways. As we continue to see increases in the number of patients we
care for at our main clinic at Foust Hall, we have also been able to increase the number of patients we
care at our Towers clinic in Cobb Hall. We have been able to reach out in this way so freshmen are more
aware of UHS services at both sites.
Additional endeavors this year include:
1. Increasing coverage at the Cobb Hall/Towers clinic to include Monday through Thursday
afternoons during the fall and spring semesters. Our staff held open houses at the Cobb clinic
for residence life staff to increase awareness of our services.
2. Holding various vaccine clinics on campus and educating students about vaccines protecting
against influenza, meningitis, and HPV among others.
3. Keeping abreast of influenza cases for 2010 and 2011 and continuing education in light of the
H1N1 epidemic of last year.
4. Reaching out and continuing to work with the local Central Michigan District Health
Department for communicable disease reporting, tracking, and collaboration.
5. Continuing a collaborative partnership with CMU’s counseling department for the mental
health needs of the campus.
6. Updating campus Listservs on our preventive health efforts and updates.
Programs/Outreach & Educational Provided:
1. Programs provided have increased in number since previous year. Programs and outreach
included freshman, new hire and graduate student orientations, drunk driving simulator and
alcohol awareness training. Outreach included flu shot clinics for students and staff, and a
variety of health and wellness fairs as well as all of the welcome back events such as main
stage, get acquainted day, RA/MA, pizza with professionals, Move in day, Business Expo for
employees, and CMU & You day, and a Towers Clinic Open House which was well received.
2. Presentations on various health topics were up this year from last. Request for presentations
included both classroom and residence hall requests. Classroom requests came primarily
from the Health Professions Building professors.
3. HIV tests/Light Therapy appointments have increased since last year (doubled).
4. Marketing – Purchased lip balm for outreach events, which was a very popular item.
Delivered doorknob hangers to all residence halls as a marketing tool. Denise Malley
assisted. UHS brochures delivered to all surrounding apartment complexes. Continue to
market UHS through networks and outreach events.
1. Meeting attendance was up as well. Some of the committees I sit on are the Together We
Can Advisory Board, Wellness Coalition, Active Minds mental health R.S.O, ICCRUD
(Isabella County Coalition to Reduce Underage Drinking-Social Norms as well as random
health related meetings. Temporarily attended Crisis Response Team meetings in the fall of
2. MSA students – Helped coordinate schedules for MSA interns with Angela and Denise (MSA
3. Open Communicator – Worked with and still a work in progress. Open Communicator is our
electronic medical records portal, patients will be able to submit medical records
electronically and in the future online scheduling is planned.
4. UHS website –CMS – update website for department.
5. Web Content Project – Assisting with project for UHS (new CMU website)
1. Improved profit margins on both OTC and RX
2. Developed a more efficient system of processing of OTC’s (electronically) to minimize
paperwork and walking-in of charges
3. Implemented a new reordering system to minimize the time expensive inventory items sit on
shelf thus effectively keeping inventory lower and achieving the optimal number of turns on
overall inventory (12)
Nursing Services at CMU maintained excellent campus community service despite budget reductions to
the Health Services Department.
Health Services has been striving to become involved in campus activities despite staff restrictions and
budget restraints. Some activities include:
1. Towers Clinic expanded to 4 afternoons a week. Nursing staff rotated weeks to cover.
2. Advisory committee meetings (CMDHD)
3. Health Fair for employees with flu vaccine given on site
4. Wellness Health Fair participation providing approximately 100 blood pressure checks on
5. Presentation to faculty/staff study abroad program
6. Provided Meningitis clinic during move in week at the Towers
7. Flu Clinic for Men’s Basketball team
8. Flu Clinic for Men’s Baseball team
9. Immunization coalition (CMDHD).
10. Participation in summer orientation for incoming freshman.
11. Provided orientation lecture regarding Travel Clinic to the following groups:
12. TB Clinics for PA students
13. Immunization reviews for PA students
14. Orientation for PA students
15. Family Planning Advisory (CMDHD)
The Nursing Staff participated in and completed
Infection Control update and testing
HIPPA training and testing
Blood borne pathogen update
Pertussis inservice at CMDHD
2 staff members attended the Michigan Immunization update
Participation in MICR program
Rotavirus inservice at CMDHD
1. The Assistant Director of Business Operations directed/coordinated the implementation of a new
EMR application called Point and Click (PNC). An extraordinary amount of time and effort was
put in this past year to set up and implement Point and Click. This transition required countless
hours of meetings with Point and Click staff as well as Health Services staff training and
software redesign. Because the billing capabilities of PNC were not at the level we deemed
acceptable, a complete redesign was agreed to and undertaken by Point and Click to allow
double entry posting. This required planning, development, testing and redesign. While we
continue to work on a few small issues, the implementation is largely complete and has been
very successful. The transition to PNC has provided greater functionality for the providers,
enhanced reporting capabilities and a higher level of documentation compliance than was
possible under our previous EHR. The Open Communicator web portal has been deployed for
students to complete their health histories, immunization review forms, insurance forms and
notice of privacy practices agreements.
2. UHS has transitioned to a nearly paperless medical record environment. We began scanning
any documents that are not directly linked to PNC. We have also enhanced our registration files
to include student photos to improve patient identification and safety.
3. UHS went out to bid for student insurance. Health Services began working with Collegiate Risk
Management to create an RFP for student insurance including quotes for disability insurance as
will be required by the College of Medicine. From the RFP bids, Starr Indemnity has been
selected as the 2011-2012 carrier. Benefit levels have been maintained or increased and
premium has been decreased $100.00 from current pricing and nearly $500.00 less than the
proposed renewal rate from the 2010-2011 carrier.
4. The administrative office efficiently tracked and processed all international students’ proof of
insurance for the 2010-2011 academic year. This project was very time consuming and involved
working with the SAP team to create reporting, receivable accounting to create an interface for
charging, setting up an online waiver site, providing numerous communications with international
students as well as the OIA and Graduate Studies offices, verifying and evaluating insurances,
and working closely with the international student representatives and international students.
While in spring 2011 it was decided to terminate the program beginning with the 2011-2012
academic year, the project was a success from the standpoint of meeting the stated goal of
having all international students insured for 2010-2011.
III. Table of Operational and Statistical Data:
Primary Care clinic gave a total of 1506 immunizations. (flu counted separately)
The nurses also gave 478 various injections such as B-12, Depo-provera, depo-medrol and other pain
medication, antibiotics and antiemetics.
84 Travel Health Visits
46 PA immunization reviews
28 Pregnancy tests done in Primary Care
Allergy Services include:
1. 541 allergy injections 2 or more injections
2. 279 single injections
3. Countless telephone calls regarding dosing instructions and follow up.
4. Facilitation of ordering serum and timing of ordering.
1. 730 doses of flu vaccine given (including students/faculty/staff/dependents/retired faculty
Note: Due to PyraMed tracking it is difficult to determine numbers of specific procedures performed by
nursing unless it is coded as such. The following are what was determinable:
Procedure Number Performed Number Performed
EKG 21 29
IV insertion 13 9
Centimist Tx 94 79
Peak Flow 57 32
Pulse Ox 113 61
Spirometry 1 1
Ear Irrigations 70
Nurse visits other 46
No charge 711 746
Telephone calls 1647 1332
requiring follow up
INFECTION CONTROL EFFORTS AND COMMUNICABLE DISEASE TRACKING:
Public Health is a main priority of the nursing staff of UHS and we strive to make an impact for the
wellness of our campus community. UHS nursing staff is involved in reporting directly to Michigan
Department of Community Health through the Michigan Disease Surveillance System. When
communicable diseases are noted an investigation is started here at UHS and the local health
department is also notified, we then work in conjunction with CMDHD to provide an investigation and the
treatment of exposed individuals and testing. Activity includes:
DISEASE 2009-2010 2010-2011
Gonorrhea 1 1
Chlamydia 29 26
Hepatitis 0 0
MRSA 13 20
Pertussis 2 surveillance
Mumps 0 0
TB exposure 0 0
Meningitis 0 0
Norovirus 0 0
HPV 37 (new addition to count) 17
Shigella 0 0
Giardia 0 0
Blood Borne Pathogen 5 2
UHS nursing staff also facilitates the Physician Assistants immunization requirements and provides
internal tracking on approximately 40 new students each year until they complete requirements.
We also handled one chicken pox case this spring in conjunction with CMCHD.
To date, the lab has seen 3700 patients and performed 2000 venipuncture. 4500 tests were run in-house
and additional 4800 tests were sent to Lab Corp.
We are working with John Mason and the Athletics Department for testing the athletes in compliance with
the NCAA guidelines.
Self-ordered tests 354
Outside orders (students) 230
Chlamydia tests 363 (27 positive)
GC tests 322
Total Patients 3700
Testing performed 4500
Testing sent out 4800
Prescriptions filled: 19,350
11,688 Rx’s filled for students
7,662 Rx’s filled for faculty/staff and family
Prescription Costs: $757,070.86
Rx Revenue: $1,001,053.62
Rx margin: $243,982.76
OTC (over the counter) Sales: $21,868.59 (doesn’t include OTC sales to C-stores)
Deliveries: 1,819 to faculty/staff
482 to Tower’s clinic
For the 2010-2011 fiscal year the total aging is $71,722.92 with only $11,294.73 over 30 days. This
equates to approximately 16%. This is an excellent percent as the average practice has around 30%.
The business office continues to strive to keep the aging at a minimum in order to maximize the revenue
cycle and ensure timely payment for Health Services and timely charging of patients. In fiscal year 2009-
2010, the total aging was $47,950.83 with only $8,152.46 over 30 days. This equated to approximately
17% of outstanding claims over 30 days. Due to being short a biller for two months, invoicing was
delayed. This accounts for the higher overall aging as a large volume of claims were invoiced in April and
The business office produced 30,315 invoices during the 2010-2011 fiscal year. During the 2009-2010
fiscal year the business office created 34,496 invoices.
Charges posted between July 1, 2010 and May 31, 2011 totaled $1,159,352 (does not include pharmacy
insurance charges, these are billed through Q/S 1). The chart below shows the breakdown by location –
Towers and Foust Clinic. It also shows the amount of payments posted during this time by patient and
insurance. Patient payments are those that were taken at the time of service. Bursared amounts include
amounts that were billed to commercial insurances and then bursared after 30 days. The Towers Clinic
was operated Monday-Thursday from 12:30 p.m.-4:30 p.m. Charges generated from the Towers equaled
4.5% of the total charges. This is up from 1.3% last fiscal year when the Towers was only open 1 day per
week for 4 hours.
2010-2011 Charge/Payment Summary
Foust Hall Clinic
Charges posted between July 1, 2009 and May 31, 2010 totaled $1,178,502.00. The chart below shows
the breakdown of the total charges that were either paid by the patient at the time of service (10%),
posted to the student account (56%), - this includes amounts that were billed to commercial insurances
and then bursared after 30 days-, or billed to a participating insurance (34%) (does not include pharmacy
insurance charges, these are billed through Q/S 1). The Towers Clinic was operated on Monday
mornings from 8:00 a.m.-12:00 p.m. Charges generated from the Towers equaled 1.3% of the total
2009-2010 Charge Summary
$396,021 Health Services
Below are listed the top ten insurances held by students seeking services at Health Services. Listed in
order greatest to least:
Blue Cross Blue Shield (BCBS) Blue Cross Blue Shield (BCBS)
PPOM/Aetna (PPOM is a re-pricing company which many PPOM/Aetna (PPOM is a re-pricing company which many
different insurance plans use) different insurance plans use)
Priority Health/Multiplan Medicaid
Blue Care Network (BCN) Priority Health/Multiplan
Health Alliance Plan (HAP) First Student
Medicaid Health Alliance Plan (HAP)
First Student (Student Insurance) United/PHP
United/PHP Blue Care Network (BCN)
Health Plus Health Plus
The graph below shows the write off amounts that UHS had to take due to our participation agreements with
Blue Cross Blue Shield, Medicaid, Medicare and Tricare. The BCBS write off in 2009-2010 was $41,665.13
with $374,003.77 in total charges representing an 11% write off of billed charges.
2010-2011 BCBS MCD/MCR/TRI Student Insurance
% Write Off by % Write Off by Cost
Cost Center for Center for Billed
Write Off Amounts Write Off Amounts Write Off Amounts
Billed BCBS MCD/MCR/ TRI
Cost Center 50111 $ - % $ - 0.00% $ -
50112 $13,765.58 4.40% $5,057.15 33.00% $ 51.74
50113 $3,113.93 9.80% $240.15 23.00% $ -
50114 $2,797.41 9.50% $101.50 5.3% $ -
50115 $22,675.09 44.10% $1,407.31 54.00% $ -
Write Off $42,352.01 10.00% $6,806.11 32.00% $ -
Total Billed $426,990.52 $21,373.38 $28,437.80
In the 2010-2011 fiscal year, the administrative and business office was focused on the implementation of
the new electronic health record and international student hard waiver program as well as working to
keep the aging low and the invoicing up to date with the loss of a Health Information Specialist. Several
new features, such as the web portal, insurance card scanners, picture id import and weekly registration
import, were added to improve our work flow and accuracy. Improvements have been made to our
reporting abilities which have reduced the manual labor involved in balancing between PNC and SAP.
Next fiscal year will bring continued focus on making work flow improvements, patient satisfaction
improvements, increased usage of features of our EHR and projects with the College of Medicine. This is
an exciting time for Health Services as we have the opportunity to evolve our services to better meet the
needs of the students and the campus population.
FY 2010: The patient visit total of 7,433 represents a 4.1% drop between last year and this year. The flu
patients we saw in the fall of 2009 were from H1N1. The usual seasonal flu cases that we usually see in
the early months of the year did not materialize so even though the fall was much busier, the lack of flu
cases later in the year led essentially to a wash. Hopefully the economy is starting to recover and our
numbers will increase this coming school year.
FY 2011: The patient visit total of 7,267 represents a 4.7% decrease from the 2009-2010 totals of 7,433.
Possible explanations for the reduction are: Mild influenza season, increased number of extended visits
requiring two appointment slots, the transition to a new electronic health record and a reduction of booked
appointments during go live phase to allow providers to learn the system, training and shadowing of the
nurse practitioner which pulled a physician from seeing patients, continued economic hardship resulting in
fewer patients seeking medical care, lack of insurance participation, lack of visibility on campus.
We will continue to monitor the provider appointments this coming year to determine the appropriate
staffing levels and mix of providers.
PROGRAMS/PRESENTATIONS/ADVOCACY & OUTREACH # of events
General Health/Healthy Lifestyles, nutrition, sleep, etc. 5
Sexual Health/STI/condom use 11
Alcohol Awareness/Substance Abuse 9
Mental Health/Stress & Depression Awareness/management 5
PROGRAMS/PRESENTATIONS PROMOTING UHS
Orientations/Health Fairs/Business Fairs 43
Immunization Clinic 7
SERVICES/APPOINTMENTS # of appts
Light Therapy 56
HIV Testing (test/result) 58
PROFESSIONAL DEVELOPMENT/PROGRAMS ATTENDED
Mihia Dashboard/webinars/Health Dept. summits/Facit, etc
HIV training certification classes
Wellness coalition/Bacchus/active minds/dept/Bridges, etc.
GRAND TOTAL 290
IV. Personnel Changes:
Implemented a reduction of one physician’s FTE from 1 to .8 to better balance patient loads. With
the college of medicine there is a good potential that we will only need one Physician in the
Hired a Nurse Practioner, in November to enhance staffing flexibility. The Nurse Practioner
resigned in May and we are going to wait to fill the position until the spring of 2012.
Hired a replacement Pharmacist.
In August 2010 UHS re-hired Gina Carman as a temporary employee to work as the
Administrative Secretary to allow Tiffany Stiff to focus on the International Student Hard Waiver
Carol Mullet who was formerly supervised by the Assistant Director of Clinical was moved under
Angela Smith when the Assistant Director of Clinical position was changed to NP/PA.
In January 2011 Margaret Clark, resigned to take a position as a medical biller with Dr. Blieberg’s
office. This change presented a major challenge as this was during the go-live phase of Point
and Click in which the billing piece was not fully functional. As a result invoicing and payment
posting was delayed. On March 10, 2011 Amy Bourns, RHIT started as the new Health
Information Specialist. Amy has worked for many years in Health Care Patient Services
(reception, scheduling, coding, billing, medical records) and is a Registered Health Information
None to report
Knowledgeable and experienced staff committed to serving our students, faculty and staff
with caring and compassion.
All providers are board certified and provide excellent care to their patients.
Patient focused staff.
Ability to use resources wisely.
Provision of essential health care to students and the campus community in a convenient
An off-site clinic in the Towers was opened to better reach our student population.
Walk-in appointments for students with acute illnesses and many other problems.
Medical care for our students with mental health problems including anxiety depression,
Students do not need any money in hand to come to health services. All charges can be
put on their student account and paid at a later date, including medications, X-ray, and
On-site laboratory which performs many tests in-house and an excellent referral lab with
excellent turn-around times and an on-site pharmacy which serves our students and
faculty and staff, including office delivery to employees on campus.
Networking through various committees, such as Bridges Advisory, Isabella County
Coalition to Reduce Underage Drinking, Wellness Coalition, Eta Sigma Gamma to name
a few. This allows for better collaboration on projects when resources are limited.
Inability to participate with additional insurance due to the time involved in doing duplicate
work between the practice management system and SAP balancing/reporting.
Employee morale due to uncertainty of UHS stability.
Lack of visibility on campus. Students frequently do not seem aware that there is a clinic
Decline in patient volume, presumably due to a variety of reasons – visibility, insurance
participation status, costs.
New software system (Point and Click) will offer an opportunity to make our charting
more complete. The built in calculator will help make sure billing levels are correct and
therefore fees per visit may actually increase.
The improving Michigan economy will hopefully lead to more students having health
insurance and therefore higher utilization of UHS.
Possibility to work with the Athletic department to draw athletes for new NCAA
requirements if they chose us to provide drawing and testing.
Health Promotion Office is better located in Foust 205, making it more visible to students.
There is a great opportunity to increase our volume for HIV testing as the word is starting
to spread on this low cost but very important service. Also, various events are coming up
such as orientations, health fairs which allow us the opportunity to advertise our services.
There will be an article in the upcoming freshman orientation newspaper from CM Life
providing an overview of the services that Health Services provides.
Revise the current SAP requirements and add additional insurance to improve patient
volume and satisfaction.
Work with other departments to co-manage the International Mandatory Insurance
Pursue a partnership with a 3 party and implementing an incentive-based program to
get staff and faculty to use the UHS pharmacy.
In the event that this were adopted, we would have to look into extending hours of
operation, hiring more staff to accommodate the increased volume of prescriptions
and deliveries, along with other possible changes.
Continued economic stressors and high unemployment seriously impact our student’s
ability to pay for their medical care. Many more are now uninsured since many of their
parents are out of work. Many students are putting off seeking medical care since they
can’t afford it, including prescription medications.
The economy of Michigan has led to significant cut backs to higher education, including
CMU. By extension, our support from the university is always tenuous.
Financial challenges with the variation in subsidy levels.
Decreased reimbursement due to increased levels of participation discounts.
Decreased reimbursement due to elevated numbers of Medicaid patients (Medicaid is a
very poor payer).
Retail pharmacies are a threat to UHS business due to convenience of having a drive
thru and also extended hours.
Staff turnover and burnout.
VII. Progress with 2010-2011 Goals:
1. Successfully implement Point and Click, including web portal to allow online appointments,
on-line account summaries and on-line forms completion.
2. Work with IT on implementing their scanning solution and archive old paper records.
3. Work with General Counsel to revise the retention schedule to eliminate the need to keep
medical records permanently since this is not required by Michigan law and is not common to
college health centers. Retention will be ten (10) years from last visit.
4. Install signature pads for patient authorizations to bill to decrease the amount of paper used,
stored and scanned.
5. Install insurance/id card scanners to link insurance card and CMU card information with the
electronic medical record. Again reducing the need to photocopy ID’s and insurance cards
and to make insurance information immediately available to the billers and lab. Still
6. Continue to evaluate the Tower’s Clinic hours and marketing to increase patient volume and
7. Continue to scrutinize spending to ensure the best use of the subsidy. Ongoing, we should
realize a surplus of an additional $50,000 an increase of nearly 25% from the $195,000
realized at the end of last year.
8. Go out to bid for the student insurance involving the International Student Representatives in
the process for buy in and the best plan design. Completed
VIII. Primary Goals for 2011-2012:
1. Increase outreach opportunities as a department.
2. Open Communicator – Work with Angela to expand Open Communicator portal to include on line
scheduling accessibility for students.
3. Increase HIV testing – working with lab and clinic.
4. Develop closer working relationship with Eta Sigma Gamma to promote health services, reaching
5. Continue to investigate low cost options to promote services, ie: outreach/face book/website/word
IX. Primary goals for next five years:
1. Participating with more insurance.
2. Eliminate paper health records through the use of an interface with Lab Corp for reference labs,
web portal for health histories, direct entry into the electronic record of in house lab results and
direct scanning of x-ray results and other miscellaneous records.
3. Host MSA program interns, providing them with experience using a fully integrated electronic
4. Evaluate the use of point of sale for the pharmacy to better manage pharmacy inventory and
reduce the amount of manual entry of over the counter medications in the business office.
5. Continue to review and evaluate the services offered. To determine whether we are providing
them at both a level meeting/exceeding an external provider and at or less their cost.
6. Continuing to care for and educate our students, and helping students become their own health
7. Partnering with the College of Medicine on future projects.
8. Maintaining and furthering the development of the Cobb Clinic.
9. Strengthening our ongoing relationships with various campus organizations and departments.
10. Obtaining clinical accreditation.
X. Contingencies/Risk to Achieving those
Goals and Strategies to Address:
1. Costs and human resources required to implement the projects
2. Limited (IT) resources
3. Collaboration requirements of the College of Medicine