HARRIS COUNTY HOSPITAL DISTRICT

Transcription

1 HARRIS COUNTY HOSPITAL DISTRICT dba HARRIS HEALTH SYSTEM FINANCIAL STATEMENTS As of October 31, 2015

2 FINANCIAL STATEMENTS As of October 31, 2015 TABLE OF CONTENTS PAGE FINANCIAL STATEMENT HIGHLIGHTS 1 VARIANCE ANALYSIS NARRATIVE 2 STATISTICAL HIGHLIGHTS. 3 OPERATING STATEMENT.. 4 BALANCE SHEET.. 5 CASH FLOW SUMMARY. 6 ANALYSIS OF CASH RECEIPTS. 7

3 FINANCIAL STATEMENT HIGHLIGHTS As of October 31, 2015 Month Year-to-Date Actual Budget Variance Actual Budget Variance 1. Adjusted Patient Days 53,470 57, % 413, , % 2. Total Clinic Visits 107, , % 844, , % 3. Total Emergency Room Visits 14,303 15, % 118, , % 4. Total Patient Days 19,079 20, % 154, , % 5. Unfunded Payor Mix (% of Charges) 62.5% 63.1% -1.0% 62.7% 63.1% -0.6% Revenues ($ in millions): 6. Ad Valorem Taxes $ 51.7 $ % $ $ % 7. Net Patient Revenue % % 8. DSH and UC Revenue % % 9. DSRIP Waiver Revenue % % 10. Other Revenue % % 11. Total Revenue % % Expenses ($ in millions): 12. Salaries and Wages % % 13. Employee Benefit Costs % % 14. Supply Expenses % % 15. Physician & Purchased Services % % 16. Depreciation & Interest % % 17. Total Expenses % % 18. Operating Income (Loss) $ (9.0) $ (8.6) $ (8.2) $ (22.0) 19. Margin % -8.9% -8.3% -1.0% -2.6% 20. Total Expense / Adj Patient Day $ 2,054 $ 1, % $ 2,102 $ 1, % 21. Full-time Equivalent Employees 8,169 8, % 8,033 8, % 22. Unrestricted Cash ($ in millions) $ $ % 23. Days Cash on Hand % 24. Days Revenue in Accounts Receivable % Page 1

4 HARRISHEALTH SYSTEM October 2015 Financial Statement Summary Variance Discussion Operating Income for October was a loss of $9.0 million compared to a budgeted loss of $8.6 million, an unfavorable variance of $0.4 million. The October year-to-date Operating Income is a loss of $8.2 million, a favorable variance of $13.7 million. Total October Revenue of $100.8 million was $3.3 million or 3.2% less than budget. Year-to-date, Total Revenue is $4.6 million or 0.5% favorable to budget. Notable variances from expected revenue for the month were a $1.6 million favorable variance in Other Operating Revenues due to NAIP (Network Access Incentive Program) funding, an unfavorable $1.9 million variance in Net Patient Revenues, and an unfavorable $2.4 million variance in DSH/Section 1115 Waiver Revenues reflecting a decrease in estimated Uncompensated Care funding during the federal October 2015 September 2016 fiscal year. Total October expenses of $109.8 million were $2.8 million less than the budget of $112.7 million. Year-to-date, Total Expenses are $9.1 million or 1.0% favorable to budget. Salary costs and FTEs were favorable to budget for the month by $1.4 million due to the lower than expected volumes. Supply costs were also $1.4 million favorable to budget for the month. Adjusted patient days were 6.8% less than budget for the month as clinic visits were below budget by 13.4% and inpatient days were below budget 4.7%. Emergency room visits were 10.5% less than target; total surgery cases were 8.5% less than budget, and both inpatient and outpatient utilization (revenue) were less than planned. Year-to-date adjusted patient days are 7.9% less than budgeted, and 4.6% less than prior year. As a result, the volume adjusted expense per adjusted patient day for the first eight months of Fiscal Year 2016 was $2,103 per day compared to the budget of $1,957 per day, and the prior year expense of $1,990 per adjusted patient day. Fiscal year-to-date cash receipts totaled $580.4 million compared to the budget of $501.1 million. The System has $214.5 million in unrestricted cash, cash equivalents and investments, representing 63 days cash on hand compared to budgeted cash of $180.6 million and budgeted days cash on hand of 53. Harris Health System has $66.3 million in net accounts receivable, representing 66 days of outstanding patient accounts receivable at October 31. The System received $80.8 million in DSH and Section 1115 Uncompensated Care funds during the month of October and $4.2 million under the NAIP Program. The System also funded a $94.5 million IGT in October for the Harris Collaborative. Harris Health System s October 31, 2015 balance sheet reflects estimated receivables of $136.8 million under the Section 1115 Supplemental Medicaid Programs and an $18.9 million liability related to the Harris regional collaborative program. 2

5 STATISTICAL HIGHLIGHTS As Of October 31, 2015 MONTH-TO-MONTH YEAR-TO-DATE CURRENT CURRENT PERCENT CURRENT CURRENT PERCENT PRIOR PERCENT YEAR BUDGET CHANGE YEAR BUDGET CHANGE YEAR CHANGE HEALTH SYSTEM FACILITIES 1. Adjusted Patient Days 53,470 57, % 413, , % 433, % 2. Outpatient % of Adjusted Volume 68.9% 69.6% -1.1% 67.3% 69.0% -2.4% 67.4% 0.0% 3. Primary Care Clinic Visits 78,199 92, % 611, , % 594, % 4. Specialty Clinic Visits 29,629 32, % 232, , % 237, % 5. Total Clinic Visits 107, , % 844, , % 831, % 6. % Primary Care Visits 72.5% 74.1% -2.1% 72.4% 72.6% -0.2% 71.5% 1.3% 7. Emergency Room Visits - Outpatient 11,654 13, % 97, , % 100, % 8. Emergency Room Visits - Observation 971 1, % 7,225 8, % 8, % 9. Emergency Room Visits - Admitted 1,678 1, % 13,635 14, % 14, % 10. Total Emergency Room Visits 14,303 15, % 118, , % 123, % 11. Surgery Cases - Outpatient 1,091 1, % 8,052 9, % 7, % 12. Surgery Cases - Inpatient 975 1, % 8,256 7, % 7, % 13. Total Surgery Cases 2,066 2, % 16,308 16, % 14, % 14. % Outpatient Cases 52.8% 55.0% -4.0% 49.4% 54.8% -9.9% 48.3% 2.3% 15. Total Outpatient Visits 167, , % 1,310,519 1,422, % 1,314, % 16. Inpatient Cases (Discharges) 3,068 3, % 24,891 24, % 25, % 17. Outpatient Observation Cases 1,339 1, % 10,486 10, % 11, % 18. Total Cases Occupying Patient Beds 4,407 4, % 35,377 35, % 36, % 19. % of Total Cases from Emergency Room 60.1% 65.2% -7.8% 59.0% 64.3% -8.3% 62.1% -5.0% 20. % of Outpatient Cases 30.4% 30.5% -0.3% 29.6% 30.3% -2.2% 30.3% -2.2% 21. Births % 4,416 4, % 4, % 22. Inpatient Days 16,644 17, % 135, , % 141, % 23. Outpatient Observation Days 2,435 2, % 19,865 20, % 20, % 24. Total Patient Days 19,079 20, % 154, , % 162, % 25. % of Outpatient Days 12.8% 12.9% -1.1% 12.8% 12.8% -0.2% 12.8% 0.3% 26. Average Daily Census % % % 27. Average Operating Beds % % % 28. Bed Occupancy % 79.1% 83.0% -4.7% 80.5% 82.8% -2.8% 83.2% -3.3% 29. Inpatient Average Length of Stay % % % 30. Inpatient Case Mix Index (CMI) % % % Payor Mix (% of Charges) 31. Charity & Self Pay 62.5% 63.1% -1.0% 62.7% 63.1% -0.6% 63.6% -1.4% 32. Medicaid & Medicaid Managed 20.6% 20.8% -1.0% 20.3% 20.8% -2.4% 20.8% -2.4% 33. Medicare & Medicare Managed 9.3% 9.4% -1.1% 9.5% 9.4% 1.1% 9.4% 1.1% 34. Commercial & Other 7.6% 6.7% 13.4% 7.5% 6.7% 11.9% 6.2% 21.0% NETWORK REFERRAL SERVICES 35. Primary Care % 1,044 2, % 5, % 36. Specialty Care Visits % % % 37. Surgery Cases % % 1, % 38. GI Procedures % % 1, % 39. Hemodialysis Treatments % 2,611 4, % 4, % HEALTH SYSTEM TOTALS 40. Primary Care 78,343 92, % 612, , % 600, % 41. Specialty Care Visits 29,629 32, % 232, , % 238, % 42. Surgery Cases 2,066 2, % 16,594 16, % 16, % 43. Total Unduplicated Patients - Rolling , , % 44. Total New Patient - Rolling , , % Page 3

6 OPERATING STATEMENT As Of October 31, 2015 (In Thousands) MONTH-TO-MONTH YEAR-TO-DATE CURRENT CURRENT PERCENT CURRENT CURRENT PERCENT PRIOR PERCENT YEAR BUDGET CHANGE YEAR BUDGET CHANGE YEAR CHANGE PATIENT REVENUES: 1. Routine Services 17,956 19, % 146, , % 154, % 2. Inpatient Ancillary 63,563 70, % 538, , % 545, % 3. Outpatient Ancillary 177, , % 1,393,933 1,516, % 1,426, % 4. Physician Services 2,452 2, % 18,181 19, % 18, % 5. Gross Patient Charges 261, , % 2,097,040 2,225, % 2,145, % REVENUE DEDUCTIONS: 6. Charity Care (130,416) (142,187) 8.3% (1,048,503) (1,081,144) 3.0% (1,043,899) -0.4% 7. Contractual Allowance/Other Discoun (90,716) (104,835) 13.5% (723,460) (797,128) 9.2% (753,602) 4.0% 8. Provision for Bad Debt Expense (9,623) (12,945) 25.7% (77,729) (98,433) 21.0% (100,506) 22.7% 9. Total Patient Revenue Deductions (230,755) (259,968) 11.2% (1,849,692) (1,976,705) 6.4% (1,898,006) 2.5% 10. Net Patient Service Revenue 31,127 32, % 247, , % 247, % OTHER OPERATING REVENUE: 11. DSH/UPL/1115 Waiver 14,416 16, % 141, , % 163, % 12. Other Operating Revenue 3,508 1, % 22,727 16, % 18, % 13. Total Other Operating Revenue 17,924 18, % 164, , % 181, % 14. Total Operating Revenue 49,051 51, % 411, , % 428, % NONOPERATING REVENUE: 15. Net Ad Valorem Tax Revenue 51,701 51, % 414, , % 377, % 16. DSRIP % 22,510 22, % 21, % 17. Net Tobacco Settlement Revenue % 10,944 9, % 9, % 18. Interest Income % 1,079 1, % 2, % 19. Other (28) % % % 20. Total Nonoperating Revenue 51,734 52, % 449, , % 410, % 21. Capital Contributions % % 0 0.0% 22. Total Capital Contributions % % 0 0.0% 23. Total Net Revenue 100, , % 861, , % 839, % SALARIES, WAGES, AND BENEFITS: 24. Regular Salaries 37,888 37, % 283, , % 291, % 25. PTO & Seconday Sick Leave 4,109 5, % 39,307 39, % 39, % 26. Contract Salaries % 2,569 5, % 7, % 27. Registry Salaries 1,895 2, % 15,298 16, % 18, % 28. FICA and Benefits 15,554 15, % 127, , % 122, % 29. Total Salaries, Wages, and Benefits 59,653 61, % 468, , % 480, % 30. Supplies 17,186 18, % 139, , % 141, % SERVICES: 31. Physician Services 17,695 16, % 140, , % 120, % 32. Other Purchased Services 9,620 9, % 74,348 75, % 72, % 33. Depreciation and Amortization 4,453 4, % 37,568 39, % 37, % 34. Interest 1,216 1, % 9,743 9, % 9, % 35. Total Services 32,984 33, % 261, , % 240, % 36. Total Operating Expenses 109, , % 869, , % 862, % 37. Operating Income (Loss) (9,038) (8,590) - (8,270) (21,997) - (23,331) - Page 4

7 BALANCE SHEET As Of October 31, 2015 (In Thousands) ACTUAL PRIOR YEAR ASSETS CURRENT ASSETS: 1. Cash, Cash Equivalents and Short Term Investments 167,836 (171,801) 2. Net Patient Accounts Receivable 66,274 80, Net Ad Valorem Taxes, Current Portion 413, , Prepaid Expenses, Inventories, and Other Current Assets 158, , Total Current Assets 805, ,455 ASSETS LIMITED AS TO USE OR RESTRICTED, CURRENT PORTION: 6. Debt Service and Bond Covenants - Restricted 7,657 7, Board Designated for Future Expansion 0 2, Phase 1 Project Fund Board Designated for Legal Reserves 0 2, Board Designated for Self-Insured Programs 0 25, Total Assets Limited as to Use or Restricted, Current Portion 7,657 36,986 PLANT, PROPERTY AND EQUIPMENT: 12. Plant, Property, & Equipment, Net of Accumulated Depreciation 406, , Construction in Progress 24,713 29, Total Plant, Property and Equipment 431, ,988 ASSETS LIMITED AS TO USE OR RESTRICTED, NET OF CURRENT PORTION: 15. Debt Service and Bond Covenants - Restricted 23,302 24, Board Designated for Future Expansion 0 95, Phase 1 Project Fund Board Designated for Self-Insured Programs 0 192, Other - Restricted Total Assets Limited as to Use or Restricted, Net of Current Portion 24, ,991 OTHER ASSETS: 21. Net Ad Valorem Taxes, Delinquent 1,142 1, Net Deferred Bond Issue Costs 1,405 1, Net Pension Asset 12,766 12, Long-Term Investments 46, Security Deposit Derivative Asset Deferred Outflow - Derivative Financial Instrument 13, Total Other Assets 75,042 15, Due to/from CHCI 11,700 3, TOTAL ASSETS 1,355,846 1,403,984 LIABILITIES AND NET ASSETS CURRENT LIABILITIES: 31. Accounts Payable and Accrued Liabilities 58, , Interest Payable 2,242 2, Employee Compensation & Related Benefit Liabilities 49,150 46, Compensated Absences 37,731 42, Estimated Third-Party Payor Settlements 6,700 7, Current Portion Long-Term Debt and Capital Leases 5,415 5, Total Current Liabilities 159, ,600 OTHER LONG-TERM LIABILITIES: 38. Post Employment Health Benefit Liability 212, , Borrowing Payable 13,015 13, Derivative Liability 13, Arbitrage Rebate Liability Total Other Long-Term Liabilities 238, ,629 LONG-TERM DEBT: 43. Series 2007 Revenue Bonds, Including Premium & Deferred Loss 181, , Series 2010 Revenue Bonds, Including Deferred Loss 81,605 81, Other Long-Term Obligation Total Long-Term Debt 262, ,927 TOTAL LIABILITIES 661, ,157 NET ASSETS: 47. Invested in Capital Assets, Net of Related Debt 150, , Restricted Net Assets 31,780 32, Unrestricted Net Assets 512, , Total Net Assets 694, , TOTAL LIABILITIES & NET ASSETS 1,355,846 1,403,984 Page 5

8 CASH FLOW SUMMARY As of October 31, 2015 (In Thousands) CURRENT PRIOR YEAR FISCAL PRIOR FISCAL CASH RECEIPTS: MONTH MONTH YTD YTD 1. Ad Valorem Taxes $ $ 30,052 $ 29, Collections on Patient Accounts 30,347 36, , , DSH & UC Waiver 80,840 (5) 224, ,075 3a DSRIP Waiver ,509 21,189 3b NAIP Program 4, , Tobacco Settlement ,944 10, Trauma Fund 0 0 1,554 1, Other Sources (Includes Cost Reimbursement) 6,846 3,165 37,095 32, Total Cash Receipts $ 122,760 $ 40,156 $ 580,449 $ 481,246 CASH DISBURSEMENTS: 8. Salaries and Wages $ 27,837 $ 28,485 $ 236,630 $ 244, Benefits and Employee Deductions 26,289 25, , , Drugs and Supplies 20,126 21, , , Physician Services 96,121 1, , , Purchased Services 12,153 12,057 94,371 92, Capital Expenditures 1,869 2,442 19,542 40, Debt and Interest Payments ,095 8, Other Uses 1,118 (5,670) (36,572) (36,286) 16. Total Cash Disbursements $ 186,034 $ 86,514 $ 917,636 $ 868, Net Change $ (63,274) $ (46,358) $ (337,187) $ (387,265) Unrestricted Cash, Cash Equivalents and Investments - February 28, 2015 $ 551,643 Net Change (337,187) Unrestricted Cash, Cash Equivalents and Investments - October 31, 2015 $ 214,456 Page 6

9 ANALYSIS OF CASH RECEIPTS October 31, 2015 MONTH TO MONTH YEAR TO DATE ACTUAL BUDGET ACTUAL BUDGET CURRENT PRIOR CURRENT CURRENT PRIOR YTD VAR VAR % PATIENT REVENUE: 1. Medicare $4,774 $7,007 $6,626 $49,149 $55,212 $51,410 ($2,261) (4.4) 2. Medicaid 7,940 10,332 8,301 64,616 66,036 64, Texas vendor drug/medicare Part D 2,576 3,335 3,040 20,710 22,324 23,586 (2,876) (12.2) 4. Managed Care - Medicaid 6,801 8,842 7,386 61,947 56,647 57,309 4, Commercial insurance 3,316 2,895 2,247 22,582 16,835 17,432 5, Liens ,640 1,787 2,167 (527) (24.3) 7. Patient pay 2,283 2,383 1,592 18,205 15,715 12,354 5, Business office ,719 2,563 7,410 (4,691) (63.3) 9. Other governmental projects/grants 2,148 1,454 1,407 10,761 11,313 11,118 (357) (3.2) 10. SUBTOTAL 30,347 36,595 31, , , ,190 5, a.Cost Reimbursements 3, ,489 5,251 4,439 6, b.Recoupments Net Patient Revenue Receipts 34,244 37,303 32, , , ,629 11, DSH & UC Waiver 80,840 (5) 0 224, , ,152 63, a.DSRIP Waiver ,509 21,189 22,725 (216) (0.9) 13b.NAIP Program 4, , , Tobacco Settlement ,944 10,984 9,512 1, a Trauma Fund ,554 1,767 1,600 (46) (2.9) 15. Total Patient Revenue Receipts 119,320 37,298 32, , , ,618 77, NON-PATIENT OPERATING REVENUE: 16. Parking ,600 1,823 1, Cafeteria ,408 2,043 2, Grants 1, ,141 7,697 6,207 6, Miscellaneous ,382 12,877 16,100 11,055 1, Total Non-Patient Operating 2,905 2,417 4,020 25,582 26,173 21,940 3, Interest income , Total Non-Tax Receipts 122,269 39,755 36, , , ,104 81, Ad valorem tax receipts/note ,052 29,656 31,949 (1,897) (5.9) 24. Commercial Paper Proceeds Total Receipts $122,760 $40,156 $36,909 $580,449 $481,246 $501,053 $79, Page 7