FY 2011 S AN F RANCISCO C HARITY C ARE R EPORT San Francisco Department of Public Health Presentation to Health Commission Tuesday, October 16, 2012
B ACKGROUND ON SF C HARITY C ARE O RDINANCE Charity Care Ordinance (Ordinance 163-01) was passed by the SF Board of Supervisors in 2001 Requirements: Hospitals provide patients with notification of policies on charity care Non-profit hospitals must report charity care-related data to the SF Department of Public Health on an annual basis Charity Care definition: Emergency, inpatient, and outpatient medical care, including ancillary services, provided to those who cannot afford to pay and without expectation of reimbursement 2 10/11/2012
F INDINGS /C ONCLUSIONS Local hospitals now care for more than 100,000 charity care patients annually (Number is duplicated among hospitals) Total citywide charity care expenditures have been rising over time Private hospitals and UCSF have been increasing their share of charity care The shift from traditional charity care to care provided through Healthy San Francisco continues While the need for charity care will continue San Francisco may wish to reconsider its local reporting 3 10/11/2012
R EPORTING H OSPITALS All San Francisco Hospitals (except VA) report: Chinese Hospital Association of San Francisco (CHASF) Dignity Health: Saint Francis Memorial Hospital (SFMH) Dignity Health: St. Mary’s Medical Center (SMMC) Kaiser Permanente: Kaiser Foundation Hospital, SF (KFH-SF)* San Francisco General Hospital (SFGH)* Sutter Health: California Pacific Medical Center (CPMC) Sutter Health: St. Luke’s Hospital (STL) University of California, San Francisco Medical Center (UCSF)* *report voluntarily 4 10/11/2012
H OSPITAL C HARITY C ARE P ROGRAMS 10/11/2012 Single Person - State Charity Care CPMC/ SFMH/ Monthly FPL Limit Policy STL CHASF SMMC KFH - SF UCSF SFGH 450% to 500% FPL $4,086 - $4,540 400% to 450% FPL $3,632 - $4,086 350% to 400% FPL $3,178 - $3,632 State law 300% to 350% FPL $2,724 - $3,178 requires non- profit 250% to 300% FPL hospitals $2,270 - $2,724 Discount Discount Discount Discount provide free or (Sliding 200% to 250% FPL discounted $1,816 - $2,270 Free Scale) care to or 150% to 200% FPL patients in $1,362 - $1,816 Discount households (case by <350% of the 100% to 150% FPL $908 - $1,362 case) federal poverty level 0 to 100% FPL (FPL). 5 0 - $908 Free Free Free Free Free
L OCAL H OSPITALS N OW C ARE FOR M ORE T HAN 100,000 C HARITY C ARE P ATIENTS A NNUALLY Over 11 years local hospitals have cared for 91,500 to 117,500 charity care patients annually In FY 2011, highest number of patients served – 117,500 20% increase in number of charity care patients served from FY 2010 to FY 2011 Six hospitals (CPMC, STL, KFH, UCSF, SFMH) saw more unduplicated patients between FY 2010 and FY 2011, two (CHASF, SMMC) saw fewer (Note: Number is not unduplicated across hospitals) 6 10/11/2012
C HARITY C ARE P ATIENTS – FY 10 & FY 11 9000 '11 8000 '10 7000 6000 5000 '11 '11 '11 4000 '11 '10 '10 '10 3000 '10 '11 '10 2000 1000 '10 '11 0 CHASF SMMC SFMH CPMC STL KFH UCSF HSF CC Patients Traditional CC Patients For all reporting hospitals excluding SFGH 7 10/11/2012
T OTAL C ITYWIDE C HARITY C ARE E XPENDITURES H AVE B EEN R ISING O VER T IME In every year since local reporting began, total citywide charity care expenditures have risen Total citywide charity care expenditures surpassed $100 million annually in FY 2006 Total expenditures by year: FY 2011 - $175,742,502 (1.2% increase from FY 2010) FY 2010 - $173,648,636 (14.6 % increase from FY 2009) FY 2009 - $151,501,396 Five hospitals (CHASF, CPMC, KFH, SFMH, STL) increased expenditures from FY 2010 to FY 2011, while three (SFGH, SMMC, UCSF) decreased 8 10/11/2012
C HARITY C ARE E XPENDITURES – FY10 & FY11 $16,000,000 '11 $14,000,000 '10 '10 $12,000,000 '11 $10,000,000 '11 '10 $8,000,000 '11 '10 '11 '11 '10 $6,000,000 '10 $4,000,000 $2,000,000 '11 '10 $0 CHI SMMC SFMH CPMC STL KFH UCSF HSF Expenditures Traditional CC Expenditures For all reporting hospitals excluding SFGH 9 10/11/2012
R ATIO OF C HARITY C ARE TO N ET P ATIENT R EVENUE • Net patient revenue 5.00% = the amount received 4.50% or expected from 4.00% third-party payers 3.50% (insurers) and 3.00% patients for hospital 2.50% Ratio of CC to Net Pt Revenue (FY11) services provided 2.00% State Average (FY11) minus any deductions; 1.50% it includes payments 1.00% received for inpatient 0.50% and outpatient care, 0.00% including emergency services. 10 10/11/2012
P RIVATE H OSPITALS & UCSF H AVE B EEN I NCREASING T HEIR S HARE OF C HARITY C ARE SFGH remains the primary safety-net institution, but the other hospitals have seen an increasing percent of patients and assumed a greater financial share Charity care patients seen by private hospitals/UCSF: FY 2011 – 21.5% FY 2010 – 20.0% FY 2009 – 14.9% Charity care expenditures by private hospitals/UCSF: FY 2011 – 28.5% FY 2010 - 27.5% FY 2009 – 23.5% 11 10/11/2012
C HARITY C ARE P ATIENTS BY Y EAR ( EXCLUDING SFGH) FY 2009 FY 2010 FY 2011 Non-HSF Patients 11,269 14,481 19,171 HSF Patients 3,233 6,122 6,086 Total Patients 14,502 20,603 25,257 C HARITY C ARE E XPENDITURES BY Y EAR ( EXCLUDING SFGH) FY 2009 FY 2010 FY 2011 Non-HSF Expenditures $31,223,014 $33,666,296 $33,001,352 HSF Expenditures $4,430,141 $13,954,261 $17,297,376 Total Expenditures $35,653,155 $47,620,557 $50,298,728 12 10/11/2012
T HE S HIFT FROM T RADITIONAL C HARITY C ARE TO C HARITY P ROVIDED THROUGH HSF C ONTINUES Since FY 2009, the share of charity care provided through HSF has continued to increase Percent of charity care patients in HSF: FY 2011 – 50.1% FY 2010 – 37.5% FY 2009 – 31.4% Percent of charity care expenditures through HSF: FY 2011 – 53.2% FY 2010 – 52.0% FY 2009 – 45.4% As HSF charity care has increased, charity care services have shifted from inpatient to outpatient. From FY 2010 to FY 2011: Total charity care patients accessing outpatient care up 31.6% Total charity care patient accessing inpatient care down 5.0% 13 10/11/2012
B REAKDOWN BY S ERVICE – FY 10 & FY 11 FY 2010 FY 2011 Emergency Pts. Emergency Pts. Inpatients Inpatients Outpatients Outpatients 14 10/11/2012
T HE N EED FOR C HARITY C ARE WILL C ONTINUE THOUGH S AN F RANCISCO M AY W ISH TO R ECONSIDER L OCAL R EPORTING Since 2001, State and federal changes now exceed San Francisco’s requirements AB 774 (2006) requires that hospitals: Maintain charity care/discount policies Submit to the State charity care/discount policies, procedures & applications Limit expected payments for services from low-income patients Make “reasonable efforts” before initiating collection efforts Federal provisions require: Report to the IRS levels & types of charity care provided Annual Treasury Dept. report on hospitals’ charity care Review of each hospital organization’s tax-exempt status every three years 15 10/11/2012
I NTERSECTION OF L OCAL , S TATE & F EDERAL C HARITY C ARE R EQUIREMENTS Source of Requirement Key Charity Care/Community Benefit Requirements for Non-Profit Hospitals SF CA US Hospitals to conduct a community needs SB 697 ACA assessment at least once every 3 years Hospitals to submit a community benefits SB 697 ACA plan annually Hospitals to maintain charity care and CCO AB 774 ACA discount payment policies Hospitals to submit charity care & discount CCO AB 774 payment policies, procedures & applications Hospitals to limit expected payment for AB 774 ACA services for low income patients Hospitals to make “reasonable efforts” AB 774 ACA before initiating collection process Hospitals to submit annual reports on the CCO IRS levels and types of charity care provided Annual report of hospital charity care to be CCO ACA compiled & prepared by governing agency Mandatory review of tax exempt status by ACA 16 Treasury Dept. at least once every 3 years 10/11/2012
C OMMENTS , Q UESTIONS & D ISCUSSION 17 10/11/2012
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