Gifford Medical Center Healthier Together Green Mountain Care Board Budget Presentation August 21, 2019
Agenda FY 2020 HOSPITAL BUDGET PRESENTATION 1. Introduction Overview Summary of Requests Related to NPR/FPP & Charges 2. 3. Hospital Issues Areas of Risk/Opportunities 4. Financial Health of the Hospital 5. 6. Financials Hospital Financial Story 7. 8. Capital Budget Plans Long Range Financial Outlook 9. Review of Historical Compliance 10.
Introduction • Dan Bennett, President & CEO • Jeff Hebert, CFO • Rebecca O’Berry, Vice President of Operations • Joshua White, MD, CMO • Katrina Lumbra, Controller
Introduction – Organization Chart Gifford Health Care (Community Health Center) Gifford Retirement Gifford Medical Center Community (Critical Access Hospital) (Senior Services)
Introduction - Organizational Structure Gifford Gifford Gifford Retirement Health Care Medical Center Community A community-based Our 25-bed Critical Access Provides services for our organization that provides Hospital offers general and elder population offering a comprehensive primary care specialty in-patient and out- continuum of care that and preventive care, patient services, as well as a includes adult day programs, including health, dental, and Birthing Center, 24-hour independent living mental health and substance emergency services, and apartments, a future assisted use services. We provide diagnostic technologies that living facility, and our necessary care to the include a 64-slice CT award-winning nursing medically underserved and scanner, a mobile MRI unit, home. vulnerable populations, a filmless radiology system, including the uninsured and digital mammography and those living in poverty. stereotactic breast biopsies. 3 Locations: 7 Practice Locations: 6 Practice Locations: • Morgan Orchards Senior Living • Gifford Primary Care & • Gifford Health Center at Berlin Community OB/GYN-Midwifery • Gifford Medical Center • Strode Independent Living • Bethel Health Center • Kingwood Health Center • Future assisted living • Chelsea Health Center • Twin River Health Center • Menig Nursing Home • Gifford Heath Center at Berlin • Sharon Health Center • Gifford Adult Day • Kingwood Health Center • Project Independence • Rochester Health Center
NPR/FPP & Charges
NPR/FPP & Charges
NPR/FPP & Charges Gross Revenue: • Inpatient - both acute and swing bed, saw decreases in patient days from FY 2019 budget projections due to lower LOS. Expect current volumes to remain stable into FY 2020 • Outpatient - Expect overall 2020 budgeted volumes to be at 2019 projected volumes • Clinic - Expect to increase slightly from projected 2019 as providers continue to get accustomed to the EMR established in 2018 and as our newer providers’ practices mature Net Revenue: • Medicare - Due to cost based reimbursement, realizing rate increase • Medicaid - Not budgeting increase revenue due to rate increase • Commercial - Budgeting increase revenue due to rate increase • Other - Gifford is decreasing net revenue due to a shift from commercial to Medicare • DSH – Decreasing by $15k from 2019 budget
NPR/FPP & Charges 5 Year Results Net Patient Revenue NPR/FPP Actuals Actuals Actuals Actuals Actuals Actuals 5-Year Budget FY2014 FY2015 FY2016 FY2017 FY2018 FY2019 CAGR FY2020 $ 58,282,092 $ 53,896,728 $ 54,787,886 $ 54,307,372 $ 48,884,171 $ 51,250,800 -2.5% $ 52,382,984 (% Change) -7.5% 1.7% -0.9% -10.0% 4.8% Corporate Restructure NPR/FPP Actuals Actuals Actuals Actuals Actuals Actuals 5-Year Budget FY2014 FY2015 FY2016 FY2017 FY2018 FY2019 CAGR FY2020 FQHC $ 2,553,117 Nursing Home $ 3,042,599 $ 1,052,558 $ 52,686,376 $ 52,844,170 $ 54,787,886 $ 54,307,372 $ 48,884,171 $ 51,250,800 -0.6% $ 52,382,984 (% Change) 0.3% 3.7% -0.9% -10.0% 4.8% History: FY 2014 - GHC created on 07/01/14 FY 2015 - GRC created on 05/26/15 FY 2017 - GHC Primary Care providers retire or depart, FTE's FY17 = 23.93 vs FY19 = 26.17 FY 2017 - GMC utilizes general surgery and orthopedic locums FY 2018 - GMC 12/17 orthopedic provider departs FY 2018 - GMC re-establishes orthopedics program FY 2019 - GMC 10/18 re-establishes general surgery program
Hospital Issues
Hospital Issues Workforce • Provider turnover (Radiology) • Utilization of locum physicians for call coverage • Traveling RN and tech staff (OR, Radiology) • Tight labor market • Difficult to find individuals to fill open positions • Wage pressures • Retention Access to Capital • Utilizing reserves to fund capital budget – FY18 & 19 • Age of plant/equipment rising Health Care Reform – All Payer Model • Participating w/Medicaid in 2019 • 2020 – Medicaid and Cigna (FQHC) • Ongoing – difficulty in assuming additional risk
Areas of Risk/Opportunities
Areas of Risk/Opportunity Risks Opportunities • Ability to expand risk-based • Connection between primary care and reimbursement agreements hospital-based services - Maintaining cash reserves in down • Community health/outreach, years population health - Our small size can result in greater • Process for identifying operational year-to-year financial volatility efficiencies • Ability to retain staff, maintain • Models of care leveraging community competitiveness in compensation, partnerships (i.e. CAH, FQHC, DA, benefits dental, other community partners) • Ability to recruit to a rural area - Post-Acute Care Clinic • Access to capital to fund capital - Substance Use Disorder – Narcan expenditures distribution site, drug take-back Kiosk • Limit to cost reduction work - Athletic Training program w/schools • Lack of understanding of FQHC/CAH - Community Health/outreach payment models by outside sources - Food Shelf programs
Financial Health of Hospital
Financial Health of Hospital Debt Service Coverage Ratio Long Term Debt to Capitalization Measures ability to pay obligations related to long-term debt Measures the % of total capital to debt U.S. Flex: 3.35, Optum: 1.39 U.S. Flex: 10.48, Optum: 23% Increasing values are favorable Decreasing values are favorable Actual FY 2018 Projected FY 2019 Actual FY 2018 Projected FY 2019 Ranking Ranking Ranking Ranking Critical Access Hospitals Result CAH State Result CAH State Critical Access Hospitals Result CAH State Result CAH State Copley Hospital 1.6 4 8 2.5 5 10 Copley Hospital 23% 4 9 23% 4 8 Gifford Medical Center -1.3 8 14 2.1 6 11 Gifford Medical Center 24% 5 10 24% 6 10 Grace Cottage Hospital 0.3 6 12 -0.8 8 14 Grace Cottage Hospital 14% 1 3 13% 2 4 Mt. Ascutney Hospital & Health Center 8 1 2 4.3 3 5 Mt. Ascutney Hospital & Health Center 28% 7 12 30% 8 13 North Country Hospital 1.1 5 9 3.8 4 6 North Country Hospital 25% 6 11 23% 5 9 Northeastern Vt Regional Hospital 4.8 3 4 5.3 2 4 Northeastern Vt Regional Hospital 21% 2 7 26% 7 12 Porter Medical Center 5.2 2 3 7.4 1 2 Porter Medical Center 22% 3 8 19% 3 5 Springfield Hospital -0.4 7 13 -0.6 7 13 Springfield Hospital 56% 8 14 -154% 1 1 Age of Plant Days in Net Receivables Measures the average age in years of the fixed assets of an organization Measures the number of days that it takes an organization to collect its receivables U.S. Flex: 10.48, Optum: 14.43 U.S. Flex: 51.34, Optum: 46.3 Decreasing values are favorable Decreasing values are favorable Actual FY 2018 Projected FY 2019 Actual FY 2018 Projected FY 2019 Ranking Ranking Ranking Ranking Critical Access Hospitals Result CAH State Result CAH State Critical Access Hospitals Result CAH State Result CAH State Copley Hospital 9.8 1 1 11.6 1 2 Copley Hospital 29.2 1 1 29 1 1 Gifford Medical Center 17.4 6 11 19.3 7 13 Gifford Medical Center 33.2 2 2 33.4 2 2 Grace Cottage Hospital 23.3 8 14 21.1 8 14 Grace Cottage Hospital 41.4 4 8 39 4 6 Mt. Ascutney Hospital & Health Center 12.8 4 7 12.6 2 5 Mt. Ascutney Hospital & Health Center 41.7 5 9 46.5 5 9 North Country Hospital 12.7 3 6 12.9 5 8 North Country Hospital 41.8 6 10 37.8 3 5 Northeastern Vt Regional Hospital 13.1 5 8 12.7 3 6 Northeastern Vt Regional Hospital 38.1 3 7 50.8 6 12 Porter Medical Center 12.5 2 5 12.8 4 7 Porter Medical Center 61.8 8 14 59.1 8 14 Springfield Hospital 17.5 7 13 17.2 6 11 Springfield Hospital 57 7 13 56.4 7 13
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