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

Transcription

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

2 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 2

3 CCHHS Systems-wide Financial Statements 3

4 Income Statement for the Ten Months ending September 2018(in thousands) Operating Revenue Year-To-Date Variance Actual Budget $ % Net Patient Service Revenue 523, ,294 $ (7,215) -1% CountyCare Capitation Revenue 1,583,958 1,412,192 $ 171,765 12% Access Payments 93,873 93,873 $ - 0% Other Revenue 12,372 9,167 $ 3,205 35% Total Operating Rev 2,213,281 2,045,526 $ 167,755 8% Operating Expenses Salaries & Benefits 532, ,572 $ 22,266 4% Overtime 36,564 30,184 $ (6,380) -21% Pension* 202, ,802 $ - 0% Supplies 62,747 51,143 $ (11,603) -23% Pharmaceutical Supplies 70, ,381 $ 37,686 35% Purch. Svs., Rental, Oth. 233, ,618 $ (30,232) -15% External Claims Expense 1,340,051 1,126,527 $ (213,525) -19% Insurance Expense 18,638 21,942 $ 3,304 15% Depreciation 28,753 27,209 $ (1,543) -6% Utilities 10,675 9,747 $ (928) -10% Total Operating Exp 2,537,080 2,336,125 $ (200,956) -9% Operating Margin (323,800) (290,599) (33,201) -11% Operating Margin % -15% -14% 0% -3% Non Operating Revenue 210, ,765-0% Net Income/(Loss) (113,035) (79,834) (33,201) -42% *Year to Date (10 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 7% 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 $170M to CCHHS 5

6 Financial Metrics Metric As of end Sep-16/YTD As of end Sep-17/YTD As of end Sep-18/YTD Target Days Cash On Hand** * Operating Margin*** -12.6% -20.6% -5.5% -5.4% Overtime as Percentage of Gross Salary 8.0% 7.8% 7.4% 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 Sept-18 Oct-18 Benchmark * NA 29% 18% 19% 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 2014 Unaudited Financial Statement 7

8 CCHHS Provider Services Financial Statements & Operational Stats 8

9 Income Statement for the Ten Months ending September 2018(in thousands) *Year to Date (10 months) Pension Liability per GASB Unaudited Financial Statement 9

10 Revenue Statement for the Ten Months ending Sept. 2018(in thousands) CCHHS Providers Year-To-Date Actual Gross Revenue 1,417,085 Adjustments Contractual Adjustments (492,322) Charity Adjustments (450,525) Total Adjustment (942,847) Gross NPSR 474,238 Bad Debt Allowance (192,023) Adjusted NPSR 282,214 DSH 130,583 BIPA 110,281 Adjusted NPSR plus DSH and BIPA 523,079 Adjusted NPSR plus DSH and BIPA as a % of Gross 37% NPSR: Net Patient Service Revenue DSH: Disproportionate Share Hospital revenue Unaudited Financial Statement 10

11 Stroger Operation Overview for Ten Months ending September 2018 EMPLOYEE Unknown HEALTH 2% 0% UNINSURE D 44% OTHERS 3% INSURED 4% MEDICARE 9% MEDICAID 8% MEDICAID MANAGED CARE 27% MEDICARE MANAGED CARE 3% Comments: Sustained surgical cases growth Leadership continues to work on Observation days and discharges via UM committee Leadership continues to review the LWBS Trauma cases impacts 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 Inpatient/Observation-FYTD Measure FYTD2018 FYTD Target FYTD2017 Inpatient Discharges 14,899 16,880 16,853 - Long Stay Admissions 2,992 3,150 3,166 - One Day Admissions 827 1,020 1,026 Inpatient Days 72,655 79,710 79,913 Observation Discharges 8,566 7,190 7,143 Observation Days (Observation Discharge) 15,665 7,190 15,513 Avg LOS (Inpatient Discharge) Surgical Cases 10,325 10,970 9,976 Radiology Tests 69, ,903 Deliveries 834 1, Emergency- FYTD Measure FYTD2018 FYTD Target FYTD2017 Emergency Visits 101, , ,576 Adult Emergency Visits 84,115 83,830 83,714 Peds Emergency Visits 5,876 5,730 5,788 Trauma Visits 6,644 6,630 6,672 LWBS 5,315 5,310 5,402 Radiology Tests 51, ,820 Outpatient Clinic- FYTD Measure FYTD2018 FYTD Target FYTD2017 Total Registrations* 458, ,330 Total Provider Visits* 282, , ,260 Specialty/Diagnostic/Procedure Provider Visits - Hospital-Based 9,620 - Specialty Care/Fantus 180, , ,927 - CORE 7,246 7,180 6,481 - Behavioral Health/Psych** 15,609 16,940 15,674 Primary Care Provider Visits - GMC 36,584 43,000 39,428 - Peds Primary 3,429 4,040 3,642 - CORE primary 15,713 17,750 16,105 11

12 Provident Operation Overview for Ten Months ending September 2018 UNINSURE D 34% MEDICARE MANAGED CARE 5% Unknown 0% 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 Provident includes Sengstacke numbers Inpatient/Observation-FYTD Measure FYTD2018 FYTD Target FYTD2017 Inpatient Discharges Long Stay Admissions One Day Admissions Inpatient Days 2,478 2,400 2,571 Observation Discharges Observation Days (Observation Discharge) 1, ,092 Avg LOS (Inpatient Discharge) Surgical Cases 2,313 1,900 1,933 Radiology Tests 1, ,655 Emergency- FYTD Measure FYTD2018 FYTD Target FYTD2017 Emergency Visits 25,929 24,800 24,705 Adult Emergency Visits 22,827 22,260 22,194 Peds Emergency Visits 1,421 1,510 1,505 LWBS 1,681 1,030 1,006 Radiology Tests 12, ,253 Outpatient Clinic- FYTD Measure FYTD2018 FYTD Target FYTD2017 Total Registrations 19,903 18,660 16,679 Specialty/Diagnostic/Procedure Provider Visits 310 Sengstacke Primary Care 13,739 15,250 14,280 Sengstacke (excludes psych) Specialty Care 16,759 13,880 13,091 Radiology Tests 7, ,596 12

13 UNINSURE D 42% Unknown 0% OTHERS 1% ACHN Operation Overview for Nine Months ending September 2018 INSURED 4% MEDICAID 6% MEDICAID MANAGED CARE 29% MEDICARE MANAGED MEDICARE CARE 14% 4% ACHN Total- FYTD Measure FYTD2018 FYTD Target FYTD2017 Total Registrations* 249, ,430 Total Provider Visits* 169, , ,988 Comments : Vista, Logan Square and Oak Forest exceed FY2018 primary care visit targets. Provider vacancies, especially in smaller clinics could be a factor ACHN Primary- FYTD Measure FYTD2018 FYTD Target FYTD2017 Austin 10,449 11,891 10,479 Children's Advocacy Cicero 9,126 10,401 9,569 Cottage Grove 8,054 8,847 8,100 Englewood 9,540 11,010 10,223 Logan Square 11,317 11,190 9,873 Morton East Near South 11,465 12,605 11,396 Oak Forest 12,505 12,196 11,058 Prieto 13,719 17,767 16,148 Robbins 8,262 9,176 8,477 Vista 9,243 8,192 6,998 Woodlawn 7,407 8,420 7,550 Total Primary Care Provider Visits 112, , ,026 ACHN Specialty- FYTD Measure FYTD2018 FYTD Target FYTD2017 Ambulatory of Provident Austin (OBGYN) Cicero (OBGYN & Fam Plan) 1,249 1,330 1,218 Logan Square (OBGYN) Oak Forest 22,738 21,470 21,593 Oral Health (reg count only) 4,246 3,520 3,791 Total Specialty Care Provider Visits 29,859 27,750 27,939 *excludes Roseland, Fantus, Stroger Specialty Care, CORE, Stroger-Hospital Based Clinics, Sengstacke GMC & Psych, Austin Behavioral Health, add Oral Health assuming all registrations are provider visits 13

14 CountyCare Health Plan Financial Statements & Operational Stats 14

15 CountyCare Income Statement for the Ten Months ending September 2018(in thousands) Actual Budget* Variance Member Months 3,363 2,250 1,113 Total Revenue 1,614,381 1,037, ,214 Expense Total Admin Expenses 66,345 49,471 (16,874) CCHHS Clinical Expenses Claims 139,065 89,858 (49,208) Pharmacy Claims 24,380 64,553 40,173 Care Management 6,526 12,750 6,224 Total CCHHS Clinical Expenses 169, ,160 (2,811) *Not including Appropriation Adjustments Year to Date External Clinical Expenses Claims 868, ,962 (345,195) Hospital Supplemental Access Pmt 108,975 - (108,975) Pharmacy Claims 252, ,610 (55,074) Care Management 53,845 23,325 (30,520) Dental Claims 35,702 16,650 (19,052) Transportation Claims 12,635 11,250 (1,385) Optical Claims 6,790 1,913 (4,878) Member Incentives 1,264 - (1,264) Total External Clinical Expenses 1,340, ,709 (566,342) Total Clinical Expenses 1,510, ,869 (569,154) Total Expenses 1,576, ,340 (586,028) Net Income Before Rate Adjustment 38,013 46,828 (8,814) Medical Loss Ratio (MLR) 94% 91% 3% Net Income Before Prior Period Adj/IGT 38,013 46,828 (8,814) IGT 30,424 28,418 2,006 Amortization 7,564 7,564 - Net Income After IGT And Amortization 25 10,846 (10,820) 15

16 CountyCare Operational Stats for the Ten Months ending September 2018 Comments: NATIONAL REGION ILLINOIS 9% 12% 12% CountyCare Medical Loss Ratio is better than National and Regional, sustained at 94% YTD. With 335,000 members in September 2018, CountyCare is the still largest Medicaid Managed Care plan in Cook County. COUNTYCARE 6% CountyCare contributed $170M to CCHHS 0% 2% 4% 6% 8% 10% 12% 14% ALR 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 Ten Months ending September 2018(in thousands) *Year to Date (10 months) Pension Liability per GASB Unaudited Financial Statement 18

19 Correctional Health Operation Overview for Nine Months ending August ,000 Total Intakes 4,000 3,000 2,000 1,000 - FY2018 YTD: 35,213 FY2017 YTD: 37,923 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual Cermak Financial Counseling Application Intakes Seen Submitted YTD 28,726 2,770 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 Ten Months ending September 2018(in thousands) *Year to Date (10 months) Pension Liability per GASB Unaudited Financial Statement 21

22 Public Health Lead Poisoning Prevention TB Program CCDPH Overview for Ten Months ending September 2018 Program Title Metric YTD Thru Sep 18 Administration Environmental Health Percent of high-risk infant APORS (Adverse Pregnancy Outcome Reporting 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 Cost per Inspection Efficiency $ Time from receipt of Chlamydia or gonorrhea report to field (days) 5 Percent of food establishments with isolated illness complaints within a contracted community or unincorporated Suburban Cook County that are inspected within 2 business days of receipt of complaint 100% Communicable Diseases Program Title Metric YTD Thru Sep 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 Sep 18 TB Program Number of completed Direct Observation Treatments (DOT) Outcome 92% 22

23 CCHHS Administration Financial Statements 23

24 Income Statement for the Ten Months ending September 2018(in thousands) *Year to Date (10 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 6% UNINSURED 42% MEDICAID MANAGED CARE 29% OTHERS 2% MEDICARE 12% MEDICARE MANAGED 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: 181,520 FY2017 YTD: 183,393 FY2018 Target: 201,732 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: 15,343 FY2017 YTD: 17,405 FY2018 Target: 17,405 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: 5.57 FY2017 YTD: 5.21 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: 127,996 FY2017 YTD: 127,056 FY2018 Target: 127,056 Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target 31

32 200 Total Deliveries Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2018 Actual 2017 Actual 2018 Target FY2018 YTD: 834 FY2017 YTD: 930 FY2018 Target: 1,023 32

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: 12,604 FY2017 YTD: 12,054 FY2018 Target: 12,657 33