Chinese Hospital IMP Update Analysis Final Report Presented to: San Francisco Health Commission April 5, 2011 Prepared by Resource Development Associates
2 Outline 1 Projected Community Health Impact 2 Additional Community Health Assessment Findings 3 Recommendations to the Commission Prepared by Resource Development Associates
3 1 Projected Community Health Impact 2 Additional Community Health Assessment Findings 3 Recommendations to the Commission Prepared by Resource Development Associates
Four Community Health Domains 4 1 2 3 4 Prepared by Resource Development Associates
Domain 1: Access to Services 5 Finding: Proposed rebuild will improve patient access; timely communication with patients is important • Proposed rebuild expands CHASF bed numbers by more than 40% Staggered, partial-offsite construction affords service continuity throughout • rebuild • Given timeline, most patients are unaware of proposed rebuild Patients are enthusiastic about rebuild and believe it will improve their • access to services Among CHASF Patients… Will the rebuild make it easier or harder to get care at Little Knowledge Chinese Hospital? Concerned No Knowledge About Don't Rebuild Know Not No 33% Concerned Knowledge About Rebuild Very Harder Little Familiar Easier 0% Knowledge 67% Prepared by Resource Development Associates
Domain 1: Access to Services 6 Finding: No CHASF service disruption anticipated; other SF hospitals have sufficient surplus capacity; no disproportionate burden to SF General Citywide GAC beds • have ample excess capacity • Small overlap between CHASF and SF General CHASF patients more • likely to use CPMC or St. Francis • Few survey respondents indicated desire for services at a Western clinic (in the absence of CHASF) Prepared by Resource Development Associates
Domain 1: Access to Services 7 Finding: Proposed rebuild offers potential to draw new patient populations • Traditional demographic: Proportion of 2008 CHASF older, monolingual, Discharges by Age 45.6% 43.0% Chinese patients • Potential demographic: Younger Chinese – including recent immigrants – seek linguistically-competent services 9.5% Upgraded facilities would • 1.6% 0.2% be more attractive to wider community 0 - 19 20 -39 40 - 59 60 - 79 80+ Prepared by Resource Development Associates
Domain 1: Access to Services 8 Finding: CHASF partners with other medical facilities to provide full range of services; partnerships continue to be important • Inter-hospital linkages ensure a range of high-quality services for CHASF patients • Obstetrics & Gynecology, Mental Health, Home Care, Post Acute Care • No change to service mix; partnerships remain important Have you been referred to Which services were you seeking? another hospital for services? 55% Yes, this has No, this happened has not a lot happened 18% 14% 9% 5% Yes, this 0% has happened Maternity Mental Pediatrics Skilled Emergency Other once or health nursing or trauma twice services care Prepared by Resource Development Associates
Domain 1: Access to Services 9 Finding: CHASF demonstrates high-level cultural and linguistic competencies; no impact from renovation expected • Bilingual / cultural sensitivity Proportion of SF Hospital Patients, Patients 98% API • CHASF Patients and Staff by Race, 2009 • Niche provider for Mandarin and Cantonese-speakers 98% All Citywide Hospital 90% Patients First language? CHASF Hospital Cantonese Patients CHASF Staff 50% Mandarin English 22% 12% 11% 7% Other 2% 1% 1% 0% 0% Chinese API White Hispanic Black Prepared by Resource Development Associates
10 Domain 1: Access to Services Finding: There is room for improvement in meeting the needs of subpopulations within its target geographic and demographic markets Stakeholder Quote Particular deficits noted by stakeholders included Chinese youth, Chinese “Its as simple as having a staff LGBTQ, and non-Chinese API persons person who makes sure to welcome and smile to trans[gender] individuals when Stakeholder Quote they come for help” We can’t start with the given that everyone is -Community member friendly. Our own families don’t accept us… If our own families don’t accept us, why would we think providers are accepting? Its hard for providers to understand this… That is why it is so important to have visible safe spaces with signage.” -Community health provider Prepared by Resource Development Associates
11 Domain 2: Appropriateness of Services Finding: CHASF will continue to provide appropriate services given its patient population demographics • Patients are mostly older and Asian Proportion of Ambulatory Surgery Services - Principal Services provided match • Diagnosis demographics of patient base Nervous System • Rebuilding will not affect the match of 25% CHASF services to patient base Digestive System 23% Average Resident Age Cancer 20% Projections 55 52 Asian SF residents Circulatory System 13% 50 49 Genitourinary System 4% All SF residents 43 45 41 40 All Ca residents 40 All Other Diagnoses* 15% 36 35 2000 2010 2020 2030 2040 2050 Prepared by Resource Development Associates
12 Domain 2: Appropriateness of Services Finding: Additional SNF beds match CHASF patient demographics and projected citywide needs • SF patients use 13x more SNF bed days per year than State average CHASF addition reverses trend in lost SNF beds citywide • • Addition is a small step to meeting full SNF demand SNF Demand Model Projected Actual and Needed SNF Beds Citywide, 2002 - 2050 Sources: RDA analysis using data from OSHPD, CA Dept of Finance 2,321 2250 Number of beds needed to maintain Actual SNF 20% citywide SNF bed availability SNF Beds Beds Citywide 2000 Demand Model Notes: assumes Projected actual 365 licensed bed days per bed SNF Beds 1750 Projected actual SNF Beds after per year, 0.79 patient days per 1619 CHASF rebuild city resident per year, and continuous 80% bed utilization 1500 2002 2010 2018 2026 2034 2042 2050 Year Prepared by Resource Development Associates
13 Domain 3: Quality of Services Finding: CHASF currently underperforms inpatient service standards; rebuild addresses shortcomings Facility not up to • Patients noted: lack of heating; deficient • current medical seating in waiting areas; crowded rooms standards • Upgraded technology will improve services • Impacts patient comfort, standard of care Will planned changes increase or decrease the quality of care? Stakeholder Quote Decrease “Our current building was changed at the 11th Increase hour from office building to hospital – it has always been a poor design for infection control, privacy, discussions with clergy, and family.” Not sure -CHASF Staff Member Prepared by Resource Development Associates
14 Domain 3: Quality of Services Finding: CHASF rebuild is consistent with industry-wide trend towards moving inpatient services to outpatient • CHASF presently operates an Outpatient Surgery Services ambulatory surgery unit Provided, 2009 Integument ary • Upgraded technology will Surgery Eye Surgery increase efficiency and Pathology / coordination Lab Digestive • More patient friendly, cost Surgery effective Radiology Other Surgery Stakeholder Quote “Because of medical and technological advances, services [in general] are going to shift more to outpatient care. Already we are seeing eye surgery and others … that are not hospital based. This seems to be a growing trend. ” -Community clinician Prepared by Resource Development Associates
15 Domain 4: Efficiency of Service Delivery Finding: CHASF demonstrates industry-leading operating and billing margins; no impact from rebuilding • CHASF among most profitable Cost-to-Charge Ratios citywide despite highest cost-to- 46% 41% charge ratio 27% 27% 26% • Low service charges to payors offset 24% 24% by managed care premiums CHASF 2009 Income Statement Chinese SF UCSF CPMC St. St. St. Gross Patient Revenue 176,961,364 General Lukes Francis Mary's - Deductions from Revenue (137,421,271) 17% Net Income Margins + Capitation Premium Rev. 50,864,577 10% Net Patient Revenue 90,404,670 5% + Other Operating Revenue 1,386,824 T otal Operating Revenue 91,791,494 St. Lukes SF St. St. UCSF Chinese CPMC - Operating Expenses (83,148,390) General Francis Mary's (3%) (7%) Net from Operations 8,643,104 (13%) + Non-Operating Revenue 780,240 - Non-Operating Expense (154,194) (24%) 2009 Net Income $ 9,269,150 Prepared by Resource Development Associates
16 Domain 4: Efficiency of Service Delivery Finding: Plan for financing construction unlikely to negatively impact operations; CHASF experienced in fundraising • Current ratio is 1.1 Current Ratios (assets / liabilities) CHASF processes claims more • efficiently than other hospitals CPMC 2.9 • $50 million in bonds; $50 million in UCSF 2.2 St. Mary's 2.2 capital reserves; $50 million in SF General 1.8 capital campaign St. Francis 1.5 Chinese 1.1 St. Lukes 0.2 Stakeholder Quote Days in Accounts Receiveable 70.8 65.7 “The fundraising, from what I 59.8 56.6 can tell, is on pace. I am not 46.0 34.2 hugely concerned. It is a project that has to get done.” 14.3 -CHASF Board Member Chinese SF General St. Mary's St. Lukes St. Francis UCSF CPMC Prepared by Resource Development Associates
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