Cook County Health & Hospitals System. Finance Committee Meeting October Ekerete Akpan CFO

Transcription

1 Cook County Health & Hospitals System Finance Committee Meeting October 2018 Ekerete Akpan CFO 1

2 CCHHS Systems-wide Financial Statements 2

3 Agenda 1. System-wide Financials & Stats a. Financials b. Observations c. Financial / Revenue Cycle metrics 2. CCHHS Provider Service Financials & Stats 3. CountyCare Financials & Stats 4. Correctional Health services Financials & Stats 5. Department of Public Health Financials & Stats 6. Administration Financials 3

4 Income Statement for the Nine Months ending August 2018(in thousands) Year-To-Date Variance Actual Budget $ % Operating Revenue 1,963,809 1,477,868 $ 485,941 33% Operating Expenses Salaries & Benefits 470, ,115 $ 28,363 6% Overtime 32,688 27,165 $ (5,522) -20% Pension* 182, ,522 $ - 0% Supplies 57,906 39,613 $ (18,293) -46% Pharmaceutical Supplies 70,629 62,062 $ (8,568) -14% Purch. Svs., Rental, Oth. 207, ,613 $ (27,967) -16% External Claims Expense 1,180, ,338 $ (484,390) -70% Insurance Expense 16,774 19,747 $ 2,973 15% Depreciation 25,861 25,090 $ (771) -3% Utilities 7,270 8,742 $ 1,472 17% Total Operating Exp 2,252,710 1,740,008 $ (512,702) -29% Operating Margin (288,902) (262,141) (26,761) -10% Operating Margin % -15% -18% 3% 17% Non Operating Revenue 190, ,121-0% Net Income/(Loss) (98,781) (72,020) (26,761) -37% *Year to Date (9 months) Pension Liability per GASB Unaudited Financial Statement 4

5 Observations Operating Margin - challenging to budget but drivers to watch vs. same time FY17 Primary Care visits down 1% while Specialty Care visits up 8% Surgical Cases up 5% and slightly above FY 2018 Target Inpatient Discharges down 12% and LOS 8% higher Emergency Department visits up 1% Deliveries down 10%. System-wide uninsured numbers, captured by visit held 42% (Provident 34%, ACHN 42%, Stroger 44%) System wide Financial /Revenue Cycle ratios are indicating sustained progress CountyCare contributed $153M to CCHHS 5

6 Financial Metrics Metric As of end Aug-16/YTD As of end Aug-17/YTD As of end Aug-18/YTD Target Days Cash On Hand** * Operating Margin*** -13.4% -21.1% -5.4% -5.4% Overtime as Percentage of Gross Salary 7.9% 7.8% 7.5% 5.0%* Average Age of Plant (Years) *Days Cash on Hand - CCHHS target 60 days, Moody's 198 days. Overtime as percentage of Gross Salary CCHHS target 5%, Moody's 2% ** Days Cash in Hand Point in time i.e. as of end June for each year ***Excludes Pension Expense-Target based on compare group consisting of like health systems : Alameda Health System, Nebraska Medical Center, Parkland Health & Hospital System, and UI Health Unaudited Financial Statement 6

7 Revenue Cycle Metrics Metric Average Days in Accounts Receivable (lower is better) Discharged Not Finally Billed Days (lower is better) Claims Initial Denials Percentage (lower is better) Average FYTD 2018 Aug-18 Sep-18 Benchmark * NA 29% 23% 18% NA Definitions: Average Days in Accounts Receivable: Total accounts receivable over average daily revenue Discharged Not Finally Billed Days: Total charges of discharge not finally billed over average daily revenue Claims Initial Denials Percentage: Percentage of claims denied initially compared to total claims submitted. * Source HFMA Key Hospital Statistics and Ratio Margins Posted We will continue to refine for like health systems Unaudited Financial Statement 7

8 CCHHS Provider Services Financial Statements & Operational Stats 8

9 Income Statement for the Nine Months ending August 2018(in thousands) *Year to Date (9 months) Pension Liability per GASB Unaudited Financial Statement 9

10 Revenue Statement for the Eight Months ending July 2018(in thousands) CCHHS Providers Year-To-Date Actual Gross Revenue 1,274,165 Adjustments Contractual Adjustments (437,305) Charity Adjustments (408,156) Total Adjustment (845,461) Gross NPSR 428,704 Bad Debt Allowance (181,048) Adjusted NPSR 247,656 DSH 117,525 Adjusted NPSR plus DSH 365,181 Adjusted NPSR plus DSH as a % of Gross Revenue 29% NPSR: Net Patient Service Revenue DSH: Disproportionate Share Hospital revenue Finance Committee : August 2018 Unaudited Financial Statement 10

11 Stroger Operation Overview for Eight Months ending August 2018 EMPLOYEE Unknown HEALTH 3% 0% UNINSURE D 44% OTHERS 3% INSURED 4% MEDICARE 9% MEDICAID MANAGED CARE 27% MEDICAID 7% MEDICARE MANAGED CARE 3% Comments: Sustained surgical cases growth Leadership continues to work on Observation days and discharges via UM committee Leadership will be engaging on LWBS numbers Trauma visits impacts on some scheduled visits/procedures Payor mix by charges at Stroger has more uninsured vs. Provident & ACHN *includes Fantus, CORE, Specialty Care, Hospital-Based Clinics, Sengstacke Psych, Austin Behavioral Health & all GMC locations ** 2017 volume from Fantus & 2018 volume from Specialty Care + Sengstacke + Austin Measure Inpatient/Observation-FYTD FY2018 FYTD Target FY2017 Inpatient Discharges 13,464 15,192 15,270 - Long Stay Admissions 2,732 2,835 2,863 - One Day Admissions Inpatient Days 65,350 71,739 72,163 Observation Discharges 7,692 6,471 6,345 Observation Days (Observation Discharge) 14,085 6,471 13,958 Avg LOS (Inpatient Discharge) Surgical Cases 9,332 9,873 8,973 Radiology Tests 63, ,718 Deliveries Measure Emergency- FYTD FY2018 FYTD Target FY2017 Emergency Visits 81,298 86,571 80,457 Adult Emergency Visits 76,002 75,447 75,244 Peds Emergency Visits 5,296 5,157 5,213 Trauma Visits 6,076 5,967 5,851 LWBS 4,657 4,779 4,887 Radiology Tests 46, ,626 Measure Outpatient Clinic- FYTD FY2018 FYTD Target FY2017 Total Registrations* 415, ,476 Total Provider Visits* 236, , ,191 Specialty/Diagnostic/Procedure Provider Visits - Hospital-Based 9,030 8,658 7,893 - Specialty Care/Fantus 155, , ,614 - CORE 6,535 6,462 5,694 - Behavioral Health/Psych** 14,219 15,246 14,363 Primary Care Provider Visits - GMC 33,146 38,700 35,793 - Peds Primary 3,078 3,636 3,293 - CORE primary 14,218 15,975 14,490 11

12 Provident Operation Overview for Nine Months ending Aug 2018 UNINSURE D 34% MEDICARE MANAGED CARE 4% Unknown 1% INSURED 6% MEDICARE 11% MEDICAID 7% MEDICAID MANAGED CARE 37% Comments: Payor mix by charges at Provident has less uninsured vs. Stroger & ACHN Leadership reviewing Observation days & discharges, Left without being seen Sustained growth in surgical cases and specialty services In the future Provident will include Sengstacke numbers Measure Inpatient/Observation-FYTD FY2018 FYTD Target FY2017 Inpatient Discharges Long Stay Admissions One Day Admissions Inpatient Days 2,201 2,160 2,305 Observation Discharges Observation Days (Observation Discharge) Avg LOS (Inpatient Discharge) Surgical Cases 2,091 1,710 1,760 Radiology Tests 1, ,491 Measure Emergency- FYTD FY2018 FYTD Target FY2017 Emergency Visits 21,838 21,393 21,270 Adult Emergency Visits 20,547 20,034 19,931 Peds Emergency Visits 1,291 1,359 1,339 LWBS 1, Radiology Tests 11, ,029 Measure Outpatient Clinic- FYTD FY2018 FYTD Target FY2017 Total Registrations 18,119 14,928 15,021 Specialty/Diagnostic/Procedure Provider Visits Radiology Tests 6, ,985 12

13 UNINSURE D 42% Measure Unknown 1% OTHERS 1% ACHN Operation Overview for Nine Months ending Aug 2018 INSURED 4% MEDICAID 6% MEDICAID MANAGED CARE 29% MEDICARE MANAGED MEDICARE CARE 14% 3% ACHN Total- FYTD FY2018 FYTD Target FY2017 Total Registrations* 225, ,895 Total Provider Visits* 150, , ,700 Measure Comments : 6 of 14 clinics exceeding FY17 PCP visits; including 3 of 14 - Vista, Logan Square and Oak Forest exceeding FY2018 targets. Room for improvement with visit volumes, Fantus /central campus relocations could be a factor Payor mix by charges has more uninsured vs Provident Provider vacancies, especially in smaller clinics could be a factor ACHN Primary- FYTD FY2018 FYTD Target FY2017 Austin 9,476 10,702 9,293 Children's Advocacy Cicero 8,177 9,360 8,680 Cottage Grove 7,309 7,962 7,331 Englewood 8,531 9,909 9,443 Logan Square 10,169 10,071 8,881 Morton East Near South 10,360 11,345 10,210 Oak Forest 11,309 10,977 9,814 Prieto 12,472 15,990 14,509 Robbins 7,481 8,258 7,766 Sengstacke 12,584 13,725 13,054 Vista 8,323 7,373 6,132 Woodlawn 6,656 7,578 6,660 Total Primary Care Provider Visits 113, , ,797 ACHN Specialty- FYTD Measure FY2018 FYTD Target FY2017 Ambulatory of Provident Austin (OBGYN) Cicero (OBGYN & Fam Plan) 1,143 1,197 1,120 Logan Square (OBGYN) Oak Forest 18,756 19,323 17,401 Oral Health (reg count only) 3,893 3,168 3,360 Sengstacke (excludes psych) 13,716 12,492 11,188 Total Specialty Care Provider Visits 39,000 37,467 34,198 13

14 CountyCare Health Plan Financial Statements & Operational Stats 14

15 CountyCare Income Statement for the Nine Months ending August 2018(in thousands) 15

16 CountyCare Operational Stats for the Nine Months ending August 2018 Comments: NATIONAL REGION ILLINOIS 9% 12% 12% CountyCare Medical Loss Ratio is better than National and Regional, sustained at 94% YTD. With over 335,000 members in August 2018, CountyCare is still the largest Medicaid Managed Care plan in Cook County. COUNTYCARE 6% CountyCare contribution to CCHHS is $153M, which is $2M above target 0% 2% 4% 6% 8% 10% 12% 14% ALR CountyCare leadership continues to actively engage the State around rates, assignment, quality and satisfaction metrics Milliman Research Report-Medicaid Risk-Based Managed Care: Analysis of Financial results for Region consists of Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin MLR Medical Loss Ratio, %tage of premium spent on health care quality. ALR Administrative loss Ratio - %tage spent on overhead expenses, such as marketing, profits, salaries, administrative costs etc. 16

17 Correctional Health Services Financial Statements & Operational Stats 17

18 Income Statement for the Nine Months ending August 2018(in thousands) *Year to Date (9 months) Pension Liability per GASB Unaudited Financial Statement 18

19 5,000 4,000 Correctional Health Operation Overview for Nine Months ending August 2018 Total Intakes 3,000 2,000 1,000 - FY2018 YTD: 31,598 FY2017 YTD: 34,104 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Cermak Financial Counseling 2018 Actual 2017 Actual Application Intakes Seen Submitted YTD 25,443 2,507 Comments; Fewer but more resource intense detainees, increases experienced in Heath requests per patient with top 3 referrals in Oral Surgery, Ear Nose & Throat as well as Hand Clinic Continued success around screening and financial counselling to ensure continuity of coverage 19

20 Cook County Dept. of Public Health Financial Statements & Operational Stats 20

21 Income Statement for the Nine Months ending August 2018(in thousands) *Year to Date (9 months) Pension Liability per GASB Unaudited Financial Statement 21

22 Public Health Lead Poisoning Prevention TB Program CCDPH Overview for Nine Months ending August 2018 Program Title Metric YTD Thru Aug 18 Percent of high-risk infant APORS (Adverse Pregnancy Outcome Reporting Administration System) referrals received that are contacted for follow-up by the Public Health Nurse within 14 calendar days of referral 90% Cost per county residents served $5.35 Environmental Cost per Inspection Efficiency $ Health Time from receipt of Chlamydia or gonorrhea report to field (days) 5 Percent of food establishments with isolated illness complaints within a Communicable contracted community or unincorporated Suburban Cook County that are Diseases inspected within 2 business days of receipt of complaint 100% Program Title Metric YTD Thru Aug 18 Lead Poisoning Prevention Percentage of cases with elevated blood levels visited within the timeline provided in protocols Efficiency 62% Percentage of cases with elevated blood lead levels who receive joint nursing visit and environmental risk assessment visit Outcome 52% Program Title Metric YTD Thru Aug 18 TB Program Number of completed Direct Observation Treatments (DOT) Outcome 92% 22

23 CCHHS Administration Financial Statements 23

24 Income Statement for the Nine Months ending August 2018(in thousands) *Year to Date (9 months) Pension Liability per GASB Unaudited Financial Statement 24

25 Appendix System-wide Volumes / Stats 25

26 System-wide Payer Mix by Visits Unknown 1% EMPLOYEE INSURED 4% MEDICAID 7% UNINSURED 42% MEDICAID MANAGED CARE 29% OTHERS 2% MEDICARE MANAGED MEDICARE 12% 26

27 Primary Care Provider Visits 25,000 20,000 15,000 10,000 5,000 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 164,094 FY2017 YTD: 165,477 FY2018 Target: 182,025 27

28 30,000 Specialty Care Provider Visits 25,000 20,000 15,000 10,000 5,000 - Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 194,554 FY2017 YTD: 180,320 FY2018 Target: 198,352 28

29 2,000 Total Inpatient Discharges 1,500 1, Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 13,915 FY2017 YTD: 15,798 FY2018 Target: 15,798 29

30 Average Length of Stay Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 5.60 FY2017 YTD: 5.18 FY2018 Target:

31 Total Emergency Room Visits 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 - FY2018 YTD: 115,448 FY2017 YTD: 114,048 FY2018 Target: 114,048 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target 31

32 Total Deliveries Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 747 FY2017 YTD: 822 FY2018 Target:

33 1,600 1,400 1,200 1, Total Surgical Cases Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 11,441 FY2017 YTD: 10,883 FY2018 Target: 11,427 33