1. Clinical Investment Fund FY 2020 Requests
Department of XX
Slides 2 and 4 should be submitted for each funding request, Slides 6-7 may be used if additional detail is required for requests
Month DD, 2018
Department should submit no more
than 4-5 slides per request

2. Clinical Investment Fund Request [Name of Funding Request]
[Type brief description of funding request here]
[Department Name ]
Request
Strategic Alignment: xx
Operations: xx
UPDATE PER REQUEST
[Other impacts, such as market need] : xx
(do not reference financial benefit to hospital)
Total FY 2020 Request Amount: $

3. Clinical Investment Fund Request Hillsborough Emergency Department
EXAMPLE
Clinical Investment Fund Request Hillsborough Emergency Department
Continuation of HBH Emergency Medicine subsidy to support 24/7 coverage and support of HBH IP and OP services
Emergency Medicine
Request
Strategic Alignment: Subsidy aligns with the academic mission of the hospital as well as Triangle strategy goals
Operations: HBH EM supports Med Center decompression and helps with access and LOS goals
UPDATE PER REQUEST
Total FY 2019 Request Amount: $200K

4. Clinical Investment Fund Request [Name of Funding Request]
Initiative Name/Description Initiative Value Proposition (“Elevator Pitch”)
Criteria
Assessment
Explanation of Assessment A.
Requested Financial Support for FY20
$ $$ $$$ $$$$
($0) (<$100K) ($100-$500K) ($500K-$1M) ($1M+)
Investment needed to launch or sustain the initiative
FY20 request amount: $
Annual amount likely needed for FY21 and beyond: $
Further explanation: B.
Financial Return (Low, Medium, High)
Perceived financial impact (anticipated revenue minus steady state costs) to UNCFP C.
Capacity Needs (Low, Medium, High)
Projected resources required for full initiative deployment (staffing, coordination, bed/OR capacity, marketing, etc.) D.
Implementation Risk (Low, Medium, High)
Potential risk of implementation failure; ability to execute successfully E.
Strategic Alignment (Low, Medium, High)
Perceived alignment with system and UNCMC mission, and Triangle Strategy goals; opportunity for collaboration(s) within and across UNCMC F.
Defined Success (Metrics)
What metrics should be used to ensure that funds are used as intended and the investment is a success?
Metrics
e.g., productivity, access, LOS, etc.
Please propose values for achieving metrics (e.g., dept./division exceeds MGMA median wRVU benchmark for fiscal year); furthermore, please describe qualitative aspects of success for the department, UNC Hospitals, and/or UNC Medical Center
UPDATE PER REQUEST

5. Clinical Investment Fund Request Hillsborough Emergency Department
EXAMPLE
Clinical Investment Fund Request Hillsborough Emergency Department
Initiative Name/Description Initiative Value Proposition (“Elevator Pitch”)
Continuation of HBH Emergency Medicine funding
Emergency Medicine was asked in 2015 to staff HBH ED with 24/7 coverage and an annual renewal option
Acuity (and reimbursement) of patient population lower than at UNCMC ED
Criteria
Assessment
Explanation of Assessment A.
Requested Financial Support for FY20
$ $$ $$$ $$$$
($0) (<$100K) ($100-$500K) ($500K-$1M) ($1M+)
Investment needed to launch or sustain the initiative
$$ 
Please explain any anticipated support needed over a 5 year horizon beyond FY19
FY19 request: $XXM/K
Anticipated Cumulative Support of $XXM/K over X year horizon B.
Financial Return (Low, Medium, High)
Perceived financial impact (anticipated revenue minus steady state costs) to UNCFP
Med
Subsidy supports ED providers and supports downstream departments C.
Capacity Needs (Low, Medium, High)
Projected resources required for full initiative deployment (staffing, coordination, bed/OR capacity, marketing, etc.)
 Low
Support will be committed to existing facilities at Hillsborough Hospital
Request for funding to continue operations D.
Implementation Risk (Low, Medium, High)
Potential risk of implementation failure; ability to execute successfully E.
Strategic Alignment (Low, Medium, High)
Perceived alignment with system and UNCMC mission, and Triangle Strategy goals; opportunity for collaboration(s) within and across UNCMC
 High
 Aligns with Triangle Strategy priorities to “Improve Health” and “Increase Value”
Supports system mission to be “the leading AMC” F.
Defined Success (Metrics)
What metrics should be used to ensure that funds are used as intended and the investment is a success?
Door to doc (min)
Doc to dispo (min)
Overall LOS (min)
UPDATE PER REQUEST

6. Data Backup
Please include 1-2 slides with any data that supports your request and/or describes the program(s) that would receive support
Any backup that you would like to include related to your request.

7. Metric(s) of Success
Please propose how success will be measured based on any investment from the CIF; the CIC intends to hold each department accountable based upon appropriate metrics
How would we measure success with the investment requested? Only include if you need to add additional data.

8. Summary of Requests Initiative Name/Description FY 2019 Amount
If the department is submitting multiple requests, please summarize all requests in table format
Initiative Name/Description
FY 2019 Amount
Requested XX
TOTAL
$XX
If there are multiple CIC application request for $$ please summarize them into a table with the totals.

9. Department of XX Scorecard Funds Flow Impact & Operating Performance
TO BE COMPLETED BY UNCFP ADMIN
Department of XX Scorecard Funds Flow Impact & Operating Performance A B C
D = A+B+C E
F = D + E
UME
GME
Clinical
Total Funds Flow Change
FY17 Change in Net Assets
FY17 Change in Net Assets in Funds Flow
Funds Flow Impact
Reserves
Expense per Day
Days of Cash
Inpatient Visits
Outpatient Visits
Total Visits
Prior YTD November
Current YTD November
Increase / (Decrease)
Charges
Net Receipts
Adjustments
Net wRVU
Days in AR
GCR
NCR
Increase/ (Decrease)
FTE
cFTE

10. Department of XX Scorecard Compensation & Productivity
TO BE COMPLETED BY UNCFP ADMIN
Department of XX Scorecard Compensation & Productivity
FY 2017
Compensation
Total Department Comp
Dept. Incentive or Other Payment
% Incentive to Total Comp
Dept. FTEs
Dept cFTE
Total Department Comp per FTE
AAMC Median Total Comp per FTE
% of AAMC Median
Emergency Med
Chair
Professor
Associate
Assistant
Instructor
Grand Total
Productivity
Department net with RVUs
MGMA wRVU Median
% of MGMA wRVUs not Adj for cFTE