board finance committee meeting - palomar healthjun 03, 2013 · board finance committee meeting *...

BOARD FINANCE COMMITTEE MEETING

* MONDAY, June 3, 2013 1Palomar Health Learning & Development 5:30 p.m. Meeting 418 E. Grand Avenue, Escondido, CA (5:00 p.m. – Dinner Available for Committee Members & Invited Guests) iExplore Room

∗NOTE: If you have a disability, please notify us 72 hours prior to the event so that we may provide reasonable accommodations.

Board Finance Committee Members Jerry Kaufman, PT MA, Chair T.E. Kleiter Aeron Wickes, MD Michael H. Covert, FACHE Richard Engel, MD Roger Acheatel, MD

∗ Asterisks indicate anticipated action. Action is not limited to those designated items. 1

Time Page Target CALL TO ORDER ...................................................................................................... .................. ........... 5:30 p.m. Public Comments ........................................................................................................ ................ 5 ........... 5:35 p.m.

5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room.

Information Item(s) ................................................................................................... ............... 5 ............ 5:40 p.m. 1. * Approval: Minutes – Monday, May 6, 2013 (ADD A-Pp6-14) ................................... ............... 2 .........2 5:42 p.m. 2. * Review/Approval: Summary of Executed Budgeted Routine Physician

Agreements (ADD B-Pp15-33) .................................................................................... ............... 3 .........3 5:45 p.m. 3. * Review/Approval: Arch Health Partners Request for Equity Transfer ...................... ............. 15 .........4 6:00 p.m. 4. * Approval: April 2013 & YTD FY2013 Financial Report (ADD C-Pp34-70) ............... ............. 15 ......... 5 6:15 p.m. FINAL ADJOURNMENT ........................................................................................... ................. ............ 6:15 p.m.

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1 Maps with directions to the Learning & Development Center & parking information is included as Pp1a-1c

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418 E. Grand Avenue is to the left of the Palomar Health Administration/HR Building at 456 E. Grand Avenue. Parking is available either in the lot adjacent to 456 E. Grand Avenue or in the larger lot immediately to the right (see page 3). Enter through the front lobby, and the iExplore meeting room will be the first room to the left of the reception desk. Dinner for the Board and invited guests will be laid out on the tables down the hallway to the right of the meeting room.

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Minutes Finance Committee – Monday, May 6, 2013

Form A - Minutes.doc

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: Tanya Howell, Secretary BY: Bob Hemker, CFO Background: The minutes of the Board Finance Committee meeting held on Monday, May 6, 2013, are respectfully submitted for approval (Addendum A).

Budget Impact: N/A

Staff Recommendation: Staff recommends approval of the Monday, May 6, 2013, Board Finance Committee minutes.

Committee Questions:

COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

2

Budgeted Routine Physician Agreements Board Summary Report

Form A - Physician Agreements.doc

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 BY: Bob Hemker, CFO

Background: The following Budgeted Routine Physician Agreements became effective during the months of April 2013. The standard Form A and Abstract Table for each signed Agreement is included in Addendum B.

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

PHYSICIAN AND/OR GROUP TYPE OF AGREEMENT

• Charles Callery, MD Medical Director – Bariatric Services – POM

• Maria Castillo, MD Robert Lasting, MD • Helen Chang, MD Timothy Maresh, MD • Damon Cobb, DO Nicole Nguyen, MD • Karen Kohatsu, MD Victoria Young, MD • Gregory Langford, MD

Emergency On-Call Agreements – OB Laborist – POM

• Escondido Pulmonary Medical Group (with regard to the services of Gregory L. Hirsch, MD) Interim Medical Director – ICU – PMC

• Hyun Kim, MD • Alan Larson, MD • Daniel Lee, MD • Richard Snyder, MD • Maram Zakko, MD

Emergency On-Call Agreements – Gastroenterology – POM

• Lorne Kapner, MD • Brian Le, MD • Lillian Lee, MD • Erwin Omens, MD

Emergency On-Call Agreements – Ophthalmology – POM

3

Arch Health Partners

Form A - Arch.doc

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: Vicky Lister, Executive Director, Arch Health Partners Background: A request from Arch Health Partners for an equity transfer for capital related to recent business growth, as well as a possible request for an increase in the Line of Credit, will be presented at the meeting.

Additional information will be presented at the meeting.

Budget Impact: To be discussed

Staff Recommendation: Palomar Health Management’s recommendation will be presented after the presentation.



4

April 2013 & YTD FY2013 Financial Report

Form A - Financial Report.doc

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: Bob Hemker, CFO Background: The Board Financial Reports (unaudited) for April 2013 and YTD FY2013 are submitted for the Finance Committee’s approval (Addendum C).

Budget Impact: N/A

Staff Recommendation: Approval



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ADDENDUM A

6

1

B O A R D F I N A N C E C O M M I T T E E M E E T I N G A T T E N D A N C E R O S T E R & M E E T I N G M I N U T E S C A L E N D A R Y E A R 2 0 1 3

MEETING DATES:

MEMBERS 1/28/13 2/25/13 4/1/13 5/6/13 6/3/13 6/24/13 7/29/13 8/26/13 9/30/13 10/28/13 12/2/13

DIRECTOR JERRY KAUFMAN, PT MA – CHAIR P P P P DIRECTOR TED KLEITER P P P P DIRECTOR AERON WICKES, MD P P E P MICHAEL COVERT, FACHE P P E P RICHARD C. ENGEL, MD P P E P ROGER ACHEATEL, MD P E E P BRUCE KRIDER – ALTERNATE – 2ND ALTERNATE – 3RD ALTERNATE – 4TH ALTERNATE STAFF ATTENDEES BOB HEMKER P P P P GERALD BRACHT P E P P DAVID TAM, MD P P E P LORIE SHOEMAKER, RN TANYA HOWELL – SECRETARY P P P P INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS

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2

BOARD FINANCE COMMITTEE – MEETING MINUTES – MONDAY, MAY 6, 2013

1. AGENDA ITEM

DISCUSSION CONCLUSION/ACTION FOLLOW UP/RESPONSIBLE PARTY

FINAL?

CALL TO ORDER

The meeting – held in the 1st floor conference room at 456 E. Grand Avenue, Escondido, CA – was called to order at 5:32 p.m. by Chair Jerry Kaufman

ESTABLISHMENT OF QUORUM

See roster

PUBLIC COMMENTS

There were no public comments

ADJOURNMENT TO CLOSED SESSION

Citing the following, Chair Kaufman adjourned the meeting to closed session at 5:33 p.m.

1. Pursuant to California Government Code §54954.5(h) REPORT INVOLVING TRADE SECRET Discussion will concern proposed new facility Estimated date of public disclosure: July 2013

2. Pursuant to California Government Code §54954.5(h) REPORT INVOLVING TRADE SECRET Discussion will concern proposed new service Estimated date of public disclosure: May 2013

RESUMPTION OF OPEN SESSION The resumed open session was called to order at 6:35 p.m. by Chair Jerry Kaufman

ACTION RESULTING FROM CLOSED SESSION DISCUSSION – IF ANY

1. THERE WAS NO ACTION RESULTING FROM THIS CLOSED SESSION DISCUSSION

2. THERE WAS NO ACTION RESULTING FROM THIS CLOSED SESSION DISCUSSION

1. MINUTES – MONDAY, FEBRUARY 25, 2013

Previously scheduled for presentation at April meeting, but no action could be taken due to lack of quorum

MOTION: By Director Kleiter, seconded by Director Kaufman and carried to recommend approval of the Minutes from the Monday, February 25, 2013, meeting

Y

2. CHANGE OF MEETING START TIMES CALENDAR YEAR 2013

No discussion MOTION: By Director Kleiter, seconded by Director Kaufman and carried to recommend approval of the Minutes from the Monday, April 1, 2013, meeting

Y

8

3


1. AGENDA ITEM


FINAL?

3. CHANGE OF MEETING START TIMES CALENDAR YEAR 2013


MOTION: By Director Kleiter, seconded by Director Kaufman and carried to recommend approval of the change to the start time of 5:30 p.m. for all except the June 3, 2013, Board Finance Committee meeting.

Forwarded to the May 13, 2013, Board of Directors meeting as information Revised Schedule to

be posted by Committee Secretary

Y

4. FINAL HOSPITALIST AGREEMENT


MOTION: By Director Kleiter, seconded by Director Kaufman and carried to recommend approval of the final negotiated terms of the one-year agreement with Galen Inpatient Physicians, Inc., for hospitalist services, which became effective April 1, 2013

Forwarded to the May 13, 2013, Board of Directors meeting with a recommendation for approval

Y

5. SUMMARY OF EXECUTED BUDGETED ROUTINE PHYSICIAN AGREEMENTS

No discussion MOTION: By Director Kleiter, seconded by Director Kaufman and carried to recommend approval of the executed budgeted routine physician agreements as presented.


Y

6. BANKING & TREASURY SERVICES RFP

Utilizing the attached presentation (Attachment 1), Bob Hemker reviewed the process followed to review proposals made in response to a Request for Proposal (RFP) for banking and treasury services Criteria included:

o Healthcare experience o Pricing o Financial strength of the organization o Requirement for an epayable program and value of rebates o Revenue cycle management and electronic solutions o Merchant services, including credit card and kiosk services

5 banks chose to respond o Based on involvement with bond related matters, Citibank was not a participant o Wells Fargo, Union Bank, Bank of America, US Bank and JP Morgan submitted

Based upon RFP requirements and the depth and breadth needed to meet the needs, only large institutions met the criteria

Local/regional banks did not submit partnering proposals to meet the criteria Bank of America had advantage in most but not all categories Final decision included organizational resources and costs to convert, which outweighed any

advantage gained from changing to a new banking partner

MOTION: By Director Kleiter, seconded by Director Wickes and carried to recommend approval of Management’s recommendation to accept the proposal of Bank of America to continue providing banking and treasury services as outlined in the RFP.


Y

9

4


1. AGENDA ITEM


FINAL?

7. “AUTHORIZED PERSONS & ENABLING RESOLUTIONS FOR MUNICIPALITIES & CERTAIN OTHER UNINCORPORATED ENTITIES” REGARDING MORGAN STANLEY INVESTMENT ACCOUNTS

Bob Hemker reviewed the reasons the original resolution had been pulled from Board action, noting that the two issues had been resolved to the satisfaction of the District

MOTION: By Director Kleiter, seconded by Director Wickes and carried to recommend approval of the Resolution adopting the “Authorized Persons & Enabling Resolutions for Municipalities & Certain Other Unincorporated Entities” Regarding Morgan Stanley Investment Accounts


Y

8. MARCH 2013 AND YTD FY2013 FINANCIAL REPORT Bob Hemker reviewed the financial report utilizing the slides contained within the agenda packet as the Executive Financial Performance Dashboard Adjusted Discharges

o Positive variance of 5.5% year-on-year Acute Patient Days

o Positive variance of 7.4% year-on-year Census is up nearly 8% year-on-year SNF Patient Days

o Negative variance of 3.7% vs. budget o Negative variance of 3% year-on-year o All tied to the period of time when PCCC was not taking new admissions

SWB variance of $20.5M for the year makes up the entire operating income variance and is related to the move-in and stabilization period of PMC Since December, there has been a $2.3M per month expense reduction, which results in a true cash flow improvement

o Improvement is tied to the cost reduction plan implemented in mid-January Point of Service collections were over $1M for the first time – a very notable milestone for the month

o Cash collections, while improving, have still lagged, with about $10M remaining in net A/R Director Kleiter noted that the cost reductions are a team effort, with each department focusing on reduction of costs in their own areas and exhibiting good teamwork

MOTION: By Director Kaufman, seconded by Dr. Wickes and carried to recommend approval of the March 2013 and YTD FY2013 Financial Report


Y

ADJOURNMENT The meeting was adjourned at 7:45 p.m.

SIGNATURES:

COMMITTEE CHAIR

JERRY KAUFMAN, PT MA

COMMITTEE SECRETARY

TANYA HOWELL

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ATTACHMENT 1

11

5/28/2013

1

BANKING AND TREASURY RFPMAY 6, 2013

08/12/12 Requests for Proposal notification issued.

11/19/12 – 01/14/13 Time allowed for written questions.

01/15/13 – 03/29/13 Analysis and initial interview timeframe.

04/01/13 Notifications sent to non‐finalists.

04/04/13 Second interview with finalists (Bank of America & US Bank).

4/05/13 – 14/22/13 Final due diligence of products and services.

05/06/13 Recommendation to Finance Committee

05/14/13 Award of Contract

SELECTION CRITERIA

1. Healthcare Experience

2. Pricing

3. ePayable Program and Rebate

4. Financial Strength

5. Revenue Cycle

6. Merchant Services

12

5/28/2013

2

● This category is a basic tie. However; there would be internalresource costs as well as some equipment costs to transition to new system.

2. Pricing – Analysis and General Fees

● Bank of America – Over 10,000 healthcare clients● US Bank – Less than 1,000 healthcare clients

1. Healthcare Experience

Bank of America has a small edge in this category as there is no cost to convert.

Bank of America prevails in this category.

● The two finalists were compared using online rating agencies as well as the bank’s internal reports.

4. Institution Financial Strength

● The rebate rate is very close with a 8 basis point edge to Bank of America. However; US Bank offers a substantial up front incentive for a 5‐year contract, which offsets Bank of America’s rate.

3. ePayable Program and Rebate

US Bank wins.

US Bank enjoys a wide margin for this category.

13

5/28/2013

3

● We currently use the merchant services, i.e. credit cardprocessing, of both Bank of America and US Bank.

6. Merchant Services

● Basic revenue cycle services were reviewed including lockboxservices and patient payment systems. The functionality of the Revenue cycle components appear neutral without further in‐depth review.

5. Revenue Cycle

Based on current experience, Bank of America ranks higherin service and healthcare knowledge.

Advantage goes to Bank of America on pricing alone.

CONCLUSION

RECOMMENDATION

• Highly competitive market. No major variations in pricing or services with major banks.

• Financial strength and deposit protection becomes critical considering Palomar Health’s large average deposit. No financial risk with either finalist if economic shift.

• Will continue to monitor the business environment for revenue cycle enhancement.

• Ultimate decision based strictly on cost of conversion.

• Bank of America

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ADDENDUM B

15

Medical Director Agreement for Bariatric Services Program

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: Della Shaw, Chie Clinical Outreach Officer Background: Charles Callery, M.D., will act as the Medical Director of the Bariatric Services Program of the Surgery Department at Pomerado Hospital. The Medical Director will assist PH and its bariatric surgery program in successfully maintaining its designation as a center that has achieved credentialing with the American Society for Metabolic Bariatric Surgery (“ASMBS”) Center of Excellence. Budget Impact: No Budget Impact, renewal of agreement




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PALOMAR HEALTH – AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Medical Director Between Palomar Health (Pomerado Hospital)

and Charles Callery, M.D.

AGREEMENT DATE April 1, 2013 PARTIES 1) PH

2) Charles Callery, M.D. PURPOSE Charles Callery, M.D. Medical Director shall act as the

Medical Director of Bariatric Services Program of the Surgery Dept at Pomerado Hospital and as Medical Director for Bariatric Surgery.

SCOPE OF SERVICES The Medical Director will assist PH and its bariatric surgery program in successfully maintaining its designation as a center that has achieved credentialing with the American Society for Metabolic Bariatric Surgery (“ASMBS”) Center of Excellence. The Medical Director will participate in the relevant decision-making administrative meetings of PH.

PROCUREMENT METHOD

Request For Proposal Discretionary

TERM April 1, 2013 through March 31, 2015 RENEWAL N/A\ TERMINATION A. Immediately for cause

B. Not less than 90 Days of written notice without cause COMPENSATION

METHODOLOGY Monthly Installments on or before the 15th of the month with supporting documentation of the prior month’s time record

BUDGETED YES NO – IMPACT: EXCLUSIVITY NO YES – EXPLAIN: JUSTIFICATION Medical oversight for our Bariatric Surgical Program is a

requirement of our credentialing with the American Society for Bariatric Surgery

AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT Proceeding without this agreement would cause our services to

be out of compliance with ASBS standards Duties Provision for Staff Education

Provision for Medical Staff Education Provision for participation in Quality Improvement Provision for participation in budget process development

COMMENTS

APPROVALS REQUIRED VP CFO CEO BOD Committee _Finance BOD

17

Laborist Agreement (POM) – 04/01/2013

Form A - OB Laborists.doc

TO: Board Finance Committee MEETING DATE: Monday, June 03, 2013 FROM: Kim Colonnelli, RN, POMERADO CNO Background: The Pomerado Hospital OB Department has asked for an expanded on-call agreement to allow for individuals to stay in-house at night and on week-ends to ensure medical coverage for laboring patients in the absence of the patient’s primary OB. Programs like this exist at most of the area hospitals. This will also allow someone in-house to round on all patients and write discharge orders therefore improving patient throughput. Also they will respond to all obstetrical emergencies.

There is a coverage contract with each of the following physicians:

• Maria Castillo, MD • Robert Lasting, MD

• Helen Chang, MD • Timothy Maresh, MD

• Damon Cobb, DO • Nicole Nguyen, MD

• Karen Kohatsu, MD • Victoria Young, MD

• Gregory Langford, MD

Budget Impact: Budget Neutral – budget exists for this service

Staff Recommendation: Approval of the contracts



18


Reference

Term/Condition

Term/Condition Criteria TITLE OB Laborist Agreement (POM) – 04-01-13

AGREEMENT DATE April 1, 2013

PARTIES Maria Castillo, MD PURPOSE To provide on-call coverage for OB-GYN patients in the

Pomerado Hospital Emergency and to ensure obstetrical physician availability at night and on the week-end.

SCOPE OF SERVICES The Pomerado Hospital OB Department has asked for an expanded on-call agreement to allow for individuals to stay in-house at night and on week-ends to ensure medical coverage for laboring patients in the absence of the patient’s primary OB. Programs like this exist at most of the area hospitals. This will also allow someone in-house to round on all patients and write discharge orders therefore improving patient throughput. Also they will respond to all obstetrical emergencies.

PROCUREMENT METHOD


TERM April 1, 2013 through March 31, 2015

RENEWAL Upon termination, the term shall continue to roll-over for additional one year terms, unless terminated in accordance with the terms of the Agreement or until such time as a new contract is negotiated.

TERMINATION Immediately for cause or within 30 days of written notice without cause.

COMPENSATION METHODOLOGY

Monthly payment on or before the 30th of each month with supporting documentation of the prior months’ time records.

BUDGETED × YES NO – IMPACT: EXCLUSIVITY NO x YES – EXPLAIN: Available only to participating

members of the Pomerado medical staff who are board certified in OB-GYN.

JUSTIFICATION To assist with the discharge process and ensure appropriate physician presence for laboring patients.

AGREEMENT NOTICED YES × NO Methodology & Response: On-Call is only available to members of the OB-GYN medical staff at Pomerado. It has been discussed at the monthly specialty meeting and made available to all members.

ALTERNATIVES/IMPACT Proceeding without this arrangement will limit the program to ED on-call without availability of in-house OB coverage.

Duties • Evaluation of OB-GYN patients arriving to ED with either an OB or GYN emergency

• Evaluation of unassigned OB-GYN patients arriving to the ED

• Medical oversight of laboring patients in the OB unit nights and week-ends

• Rounding on all patients to ensure timely discharge COMMENTS

APPROVALS REQUIRED VP CFO CEO BOD Committee ____________ BOD

19


Reference

Term/Condition



PARTIES Helen Chang, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















20


Reference

Term/Condition



PARTIES Damon Cobb, DO PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















21


Reference

Term/Condition



PARTIES Karen Kohatsu, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















22


Reference

Term/Condition



PARTIES Gregory Langford, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















23


Reference

Term/Condition



PARTIES Robert Lasting, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















24


Reference

Term/Condition



PARTIES Timothy Maresh, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















25


Reference

Term/Condition



PARTIES Nicole Nguyen, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















26


Reference

Term/Condition



PARTIES Victoria Young, MD PURPOSE To provide on-call coverage for OB-GYN patients in the



PROCUREMENT METHOD

















27

InInsert Subject Here

Form A - EPMG - Hirsch.doc

PALOMAR MEDICAL CENTER INTERIM MEDICAL DIRECTOR – INTENSIVE CARE UNIT (5 West)

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: Lorie K. Shoemaker, Chief Nurse Executive

BACKGROUND: The California Code of Regulations, Title 22, requires a Medical Director for any Intensive Care Unit (ICU). Dr. Robert Reichman was appointed as the Medical Director for the Cardiovascular Intensive Care Unit (CVICU) upon opening of the new Palomar Medical Center. Dr. Reichman has been on a medical leave of absence since January 1, 2013. From January 1st through March 31st, Dr. Roger Acheatel served as the Interim Medical Director of the CVICU. Through an agreement between Palomar Health and Escondido Pulmonary Medical Group, Dr. Gregory Hirsch has agreed to serve as the Interim Medical Director from April 1st through June 30th, at which time Dr. Reichman is expected to return from his leave of absence. BUDGET IMPACT: No impact. STAFF RECOMMENDATION: Approve COMMITTEE QUESTIONS:


28

PALOMAR HEALTH - AGREEMENT ABSTRACT Section

Reference

Term/Condition

Term/Condition Criteria TITLE Contract Amendment No. #1

Medical Director Agreement – Palomar Medical Center, Intensive Care Unit

AGREEMENT DATE March 28, 2013

PARTIES 1) Palomar Health 2) Escondido Pulmonary Medical Group (with regard to the

services of Gregory L. Hirsch, MD)

Recitals C. on original agreement

PURPOSE To provide medical and administrative oversight with respect to the Intensive Care Unit

Exhibit 1.1 of original agreement

SCOPE OF SERVICES Pursuant to Section 1.1 and Exhibit 1.1 of Agreement

N/A PROCUREMENT METHOD

Request For Proposal X Discretionary

TERM Ninety days beginning April 1, 2013 through June 30, 2013

RENEWAL None

TERMINATION June 30, 2013 or per the original agreement, whichever comes first

Article 1 Section 1.2 and Exhibit 2.1 of original agreement


Hourly rate paid monthly based on projected hour of 16 to 20 hours per month. Hourly rate determined in accordance with Fair Market Value of medical directorships for respective specialty.

BUDGETED x YES NO – IMPACT:

EXCLUSIVITY x NO YES – EXPLAIN:

JUSTIFICATION Physician administration and oversight is required by Title 22 California Code of Regulations

AGREEMENT NOTICED YES x NO Methodology & Response:

ALTERNATIVES/IMPACT Contract with another physician

Duties x Provision for Staff Education x Provision for Medical Staff Education x Provision for participation in Quality Improvement x Provision for participation in budget process development

COMMENTS


29

InInsert Subject Here

Form A - On Call Amendments - GI3.doc

POMERADO HOSPITAL EMERGENCY ON-CALL AMENDMENT

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: David Tam, M.D., Chief Administrative Officer, Pomerado Hospital BACKGROUND: These contracts represent the extension of the On-Call Agreements with:

• Hyun Kim, MD • Alan Larson, MD • Daniel Lee, MD • Richard Snyder, MD • Maram Zakko, MD

The Physicians shall serve as members of the On-Call Panel on a rotating basis and provide On-Call Coverage for the specialty of Gastroenterology in accordance with the Hospital bylaws, rules and regulations, policies and procedures of Palomar Health.

BUDGET IMPACT: N/A STAFF RECOMMENDATION: Approval COMMITTEE QUESTIONS:


30


Reference

Term/Condition

Term/Condition Criteria TITLE Contract Amendment - Emergency On-Call Agreement AGREEMENT DATE April 1, 2013 PARTIES 1) Palomar Health

2) Hyun Kim, M.D. 3) Alan Larson, M.D. 4) Daniel Lee, M.D. 5) Richard Snyder, M.D.

Recitals E PURPOSE To serve on the On-Call Panel as required by the medical staff bylaws, and rules and regulations, of Pomerado Hospital.

Exhibit A SCOPE OF SERVICES To provide On-Call coverage pursuant to the On-Call Agreement for the specialty of Gastroenterology at Pomerado Hospital.

PROCUREMENT METHOD


5 TERM Three (3) years [April 1, 2013 through March 31, 2016] N/A RENEWAL None 6 TERMINATION 1. Immediate for cause

2. Not less than 90 days of written notice without cause 2 COMPENSATION

METHODOLOGY Monthly payment on or before the 15th of the month with supporting documentation.

BUDGETED YES NO – IMPACT – N/A

EXCLUSIVITY NO YES – EXPLAIN: JUSTIFICATION Renewal of current On-Call Coverage Contracts. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT 1 Duties Physician shall provide On-Call Panel Coverage and professional

services in accordance with the Hospital’s bylaws, rules and regulations, policies and procedures.

COMMENTS There is a consensus that gastroenterology on-call coverage for the Emergency Department is needed to maintain current level of services and avoid problems with patient throughput.

APPROVALS REQUIRED Officers CFO CEO BOD Committee Finance BOD

31

Ophthalmology On-Call Agreement – Amendment

Form A - Ophthalmology.doc

TO: Board Finance Committee MEETING DATE: Monday, June 3, 2013 FROM: David Tam, CAO, Pomerado Hospital Background: These contracts represent the extension of the On-Call Ophthalmology Agreements with:

• Lorne Kapner, M.D. • Brian Le, M.D. • Lillian Lee, M.D. • Erwin Omens, M.D.

Each physician shall serve as a member of the On-Call Panel on a rotating basis and provide On-Call Coverage for the specialty of Ophthalmology in accordance with the Hospital bylaws, rules and regulations, policies and procedures of Palomar Health

Budget Impact: None




32


Reference

Term/Condition

Term/Condition Criteria TITLE Contract Amendment - Emergency On-Call Agreement AGREEMENT DATE April 1, 2013 PARTIES 1) Palomar Health

2) Lorne Kapner, M.D. 3) Brian Le, M.D. 4) Lillian Lee, M.D. 5) Erwin Omens, M.D.

Recitals E PURPOSE To serve on the On-Call Panel as required by the medical staff bylaws, and rules and regulations, of Pomerado Hospital.

Exhibit A SCOPE OF SERVICES To provide On-Call coverage pursuant to the On-Call Agreement for the specialty of Ophthalmology at Pomerado Hospital.

PROCUREMENT METHOD


5 TERM Three (3) years [April 1, 2013 through March 31, 2016] N/A RENEWAL None 6 TERMINATION 1. Immediate for cause

2. Not less than 90 days of written notice without cause 2 COMPENSATION

METHODOLOGY Monthly payment on or before the 15th of the month with supporting documentation.

BUDGETED YES NO – IMPACT – N/A

EXCLUSIVITY NO YES – EXPLAIN: JUSTIFICATION Renewal of current On-Call Coverage Contracts. AGREEMENT NOTICED YES NO Methodology & Response: ALTERNATIVES/IMPACT 1 Duties Physician shall provide On-Call Panel Coverage and professional

services in accordance with the Hospital’s bylaws, rules and regulations, policies and procedures.

COMMENTS There is a consensus that Ophthalmology on-call coverage for the Emergency Department is needed to maintain current level of services and avoid problems with patient throughput.

APPROVALS REQUIRED Officers CFO CEO BOD Committee Finance BOD

33

FINANCIAL PERFORMANCE FOR APRIL 2013

FISCAL YEAR 2013

!559b5¦a /

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FYTD13 APRIL - TABLE OF CONTENTS

EXECUTIVE YEAR-TO-DATE FINANCIAL PERFORMANCE DASHBOARD .................................................................................................................................... 3-4 BALANCE SHEETS EXCLUDES G.O. BONDS ........................................................................................................................................................................................... 5 INCOME STATEMENTS MONTH-TO-DATE .................................................................................................................................................................................................. 6 YEAR-TO-DATE ...................................................................................................................................................................................................... 7 CURRENT VS. PRIOR YEAR-TO-DATE .......................................................................................................................................................................... 8 CURRENT VS. PRIOR YEAR-TO-DATE .......................................................................................................................................................................... 9 MONTHLY TREND ................................................................................................................................................................................................. 10 CASH FLOW STATEMENT ............................................................................................................................................................................................. 11 BUDGET COMPARISON STATISTICAL INDICATORS STATISTICAL INDICATORS ....................................................................................................................................................................................... 12 PAYOR MIX ......................................................................................................................................................................................................... 29 CASE MIX INDEX ................................................................................................................................................................................................. 30 CASH COLLECTIONS .............................................................................................................................................................................................. 33 SUPPLEMENTAL INFORMATION HEALTHWORX DASHBOARD ........................................................................................................................................................................................ 35 BALANCE SHEETS INCLUDES G.O. BONDS ......................................................................................................................................................................................... 36 YEAR-TO-DATE SUPPLIES EXPENSE ................................................................................................................................................................................ 37

35

PATIENT DAYS - ACUTE

1,080

936

990

1,028

1,116

1,198

1,281

1,422

1,204

1,164

1,086

5,041

4,851

4,607

5,047

5,337

5,483

6,095

6,897

6,379

6,525

6,288

894

900

953

998

942

914

910

909

777

841

772

438

418

415

461

385

423

472

445

416

440

451

998

1,056

1,033

889

905

795

837

1,064

868

949

920

23

26

5

20

26

22

33

35

27

26

11

- 2,000 4,000 6,000 8,000 10,000 12,000

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

ICU/CCU PROGRESSIVE/MED-SURG LAB/DEL/REC REHAB ACUTE MHU NICU

3 FYTD13 APRIL - EXECUTIVE FINANCIAL PERFORMANCE DASHBOARD

TOTAL ER VISITS (INCLUDES EXPRESSCARE PLUS)

4,147

4,512

4,731

5,114

5,087

5,124

4,933

5,964

4,998

5,058

4,962

948

786

595

780

925

877

914

974

952

927

918

2,118

2,282

2,211

2,148

2,159

2,017

2,121

2,535

2,145

2,137

2,045

299

310

315

264

279

292

292

427

240

288

280

627

581

1,057

1,182

1,569

1,578

1,546

1,996

1,795

1,730

1,608

18

24

26

22

19

15

15

11

18

26

15

90

95

76

78

103

86

86

77

78

91

87

- 2,000 4,000 6,000 8,000 10,000 12,000 14,000

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

PMC O/P PMC I/P POM O/P POM I/P PHDC EXPRESSCARE PLUS TRAUMA O/P TRAUMA I/P

PAYOR MIX

27

26

26

25

26

26

25

26

28

26

25

10

10

10

10

14

12

12

13

12

12

14

11

11

10

9

7

8

8

9

9

7

8

5

5

6

5

5

6

5

6

6

6

6

5

5

5

6

6

5

5

4

5

4

4

29

29

29

32

29

31

33

30

29

32

31

10

10

10

9

10

9

9

9

9

10

9

4

4

4

4

3

3

3

3

2

3

3

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

MEDICARE MCAR MGD MEDI-CAL MCAL MGD SELF PAY MGD CARE CAP OTHER

EBIDA GROWTHTRAILING YTDMAR-13

EXPENSES

TOTAL SURGERIES

251

301

282

331

359

378

319

331

334

365

375

490

506

449

402

471

439

420

458

412

453

465

348

330

359

331

332

278

265

259

195

259

230

166

148

171

119

130

151

141

161

138

129

153

84

146

143

87

158

110

105

125

114

129

140

113

111

128

126

106

95

106

86

- 200 400 600 800 1,000 1,200 1,400 1,600 1,800

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

PMC O/P PMC I/P POM O/P POM I/P PHDC O/P PHDC I/P

CASH COLLECTIONS

ACTUAL BUDGET BUDGETACTUAL48.4 49.5 439.0 495.0

47.5

48.0

48.5

49.0

49.5

50.0

MTD410.0420.0430.0440.0450.0460.0470.0480.0490.0500.0

YTD

4 FYTD13 APRIL - EXECUTIVE FINANCIAL PERFORMANCE DASHBOARD

Actual Budget Variance Var % Prior YTD Var % Actual Budget Variance FYE Jun12

35,729 39,039 (3,310) (8.5%) 33,531 6.6% 32,167,306 52,756,068 (20,588,762) 52,199,662 302 332 (30) (9.0%) 277 9.0% 28,474,175 50,410,343 (21,936,168) 47,729,052

6.67% 10.04% (3.37%) 10.01%91,723 100,982 (9,259) (9.2%) 84,403 8.7% 5.90% 9.60% (3.70%) 9.15%

4.12 3.75 0.37 9.9% 3.94 4.6% 14,330 13,738 (592) 12,633 1.52 1.48 0.04 2.7% 1.48 2.7% 8,422 7,823 (599) 7,715

14,257 16,537 (2,280) (13.8%) 15,108 (5.6%) Supplies/Adj. Discharges 1,918 1,842 (76) 1,896 3,855 4,580 (725) (15.8%) 3,932 (2.0%) Productivity % 96.4% 100.0% (3.6%) 96.7%12.9% 18.2% (5.3%) (29.1%) 15.2% (15.1%) Productive FTEs 3,308.8 3,191.0 (117.8) 2,885.4

Paid FTEs 3,654.2 3,591.3 (62.9) 3,215.7 60,391 62,542 (2,151) (3.4%) 62,206 (2.9%) Days Cash-on-Hand 63.0 80.0 (17.0) 133.899,608 84,199 15,409 18.3% 82,232 21.1% Days in Gross A/R 42.2 47.9 5.7 46.651,809 52,328 (519) (1.0%) 48,236 7.4% Collections as a % of NPR 92.87% 96.05% (3.18%) 92.57%

Cash Collections Bad Debt % 24.75% 42.51% (17.76%) 27.84%

Current Month Prior Month FYE Jun12 Actual Budget Variance Var % Prior YTD Var %

1,972,377,553 2,028,633,776 (56,256,223) (2.8%) 1,665,328,959 18.4%85,452,975 102,055,725 177,883,185 472,708,938 515,379,231 (42,670,293) (8.3%) 420,740,048 12.4%

116,814,768 119,918,044 100,021,198 482,505,884 525,318,276 (42,812,392) (8.1%) 430,519,725 12.1%226,833,320 256,789,514 296,322,855

1,266,206,425 1,270,201,561 1,273,280,828 300,925,144 305,398,010 4,472,866 1.5% 256,898,345 (17.1%)1,637,606,504 1,653,997,500 1,701,807,047 68,519,809 71,903,902 3,384,093 4.7% 62,814,383 (9.1%)

46,868,273 50,342,188 3,473,915 6.9% 17,746,562 (164.1%)511,983,315 536,333,454 24,350,139 4.5% 418,673,805 (22.3%)

101,326,258 115,152,341 119,876,412 (29,477,431) (11,015,178) (18,462,253) (167.6%) 11,845,920 (348.8%)1,161,165,338 1,159,656,761 1,155,972,783 11,083,333 11,083,333 - 0.0% 10,851,017 2.1%

375,114,908 379,188,398 425,957,852 23,999,680 24,171,143 171,463 0.7% 2,374,780 (910.6%)1,258,790 1,605,061 (346,271) (21.6%) 1,837,764 (31.5%)

(38,700,647) (21,757,263) (16,943,384) (77.9%) 24,116,721 (260.5%)

Average Daily Census OEBIDA w/Prop Tax

Statistical Indicators Ratios & Indicators

Adjusted Discharges EBIDA w/Prop Tax

EBIDA Margin w/Prop TaxAcute Patient Days OEBIDA Margin w/Prop Tax

Acute Average Length of Stay Expenses/Adj. DischargesCase Mix Index w/o deliveries SWB/Adj. Discharges

Total SurgeriesBirths

ER to Admit Rate

SNF Patient DaysTotal ER Visits & Admits

OP Registrations

Balance Sheet Income Statement

Assets:Gross Revenue

Total Cash Net Patient RevenueNet A/R Total Revenue

Current AssetsNet PPE SWB

Total Assets SuppliesDepreciation

Liabil ities: Total Expenses

Current Liabil ities Operating IncomeL-T Liabil ities Property TaxFund Balance Interest Expense

Interest IncomeNet Income

37

5 FYTD13 APRIL - BALANCE SHEET CONSOLIDATED (EXCLUDES G.O. BONDS)

Current Prior Prior Fiscal Current Prior Prior Fiscal Month Month Year End Month Month Year End

Assets LiabilitiesCurrent Assets Current Liabilities Cash on Hand $6,345,130 $6,955,879 $6,432,548 Accounts Payable $16,570,195 $26,639,285 $41,855,366 Cash Marketable Securities 79,107,845 95,099,846 171,450,637 Accrued Payroll 11,020,348 13,946,700 14,498,569Total Cash & Equivalents 85,452,975 102,055,725 177,883,185 Accrued PTO 20,388,779 20,341,494 18,681,196

Accrued Interest Payable 12,895,089 10,731,813 4,368,835Patient Accounts Receivable 296,869,719 311,775,942 262,010,549 Current Portion of Bonds 7,455,000 7,455,000 7,080,000 Allowance on Accounts (180,054,951) (191,857,898) (161,989,351) Est Third Party Settlements 896,849 3,486,546 1,673,242 Net Accounts Receivable 116,814,768 119,918,044 100,021,198 Other Current Liabilities 26,045,484 27,517,998 24,333,951

Total Current Liabilities 95,271,744 110,118,836 112,491,159 Inventories 10,551,718 10,593,050 7,197,553 Prepaid Expenses 3,415,672 2,530,314 5,399,059 Long Term Liabilities Other 11,569,345 19,484,330 5,716,690 Other LT Liabilities 1,482,473 1,511,907 1,324,876Total Current Assets 227,804,478 254,581,463 296,217,685 Bonds & Contracts Payable 607,888,999 607,836,791 614,821,926

Total Long Term Liabilities 609,371,472 609,348,698 616,146,802Non-Current Assets Restricted Assets 79,679,635 67,361,390 83,077,521 General Fund Balance Restricted by Donor 328,797 328,468 326,320 Unrestricted 898,893,508 901,167,312 946,460,644 Board Designated 9,618,458 10,119,608 0 Restricted for Other Purpose 328,797 328,468 326,320Total Restricted Assets 89,626,890 77,809,466 83,403,841 Board Designated 9,618,458 10,119,608 0

Total Fund Balance 908,840,763 911,615,388 946,786,964 Property Plant & Equipment 1,513,481,249 1,513,347,291 443,081,964 Accumulated Depreciation (312,446,106) (307,269,380) (268,958,070) Total Liabilities / Fund Balance $1,613,483,979 $1,631,082,922 $1,675,424,925 Construction in Process 65,171,282 64,123,650 1,099,156,934Net Property Plant & Equipment 1,266,206,425 1,270,201,561 1,273,280,828

Investment in Related Companies 2,685,332 2,695,447 3,063,705 Deferred Financing Costs 12,693,933 12,764,473 13,399,333 Other Non-Current Assets 14,466,921 13,030,512 6,059,533Total Non-Current Assets 1,385,679,501 1,376,501,459 1,379,207,240

Total Assets $1,613,483,979 $1,631,082,922 $1,675,424,925

38

6 FYTD13 APRIL - INCOME STATEMENT: MONTH-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES

39

7 FYTD13 APRIL- INCOME STATEMENT: YEAR-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES

VarianceActual Budget Variance Volume Rate/Eff Actual Budget Variance

Statistics: Admissions - Acute 22,320 26,761 (4,441) Admissions - SNF 1,002 1,024 (22) Patient Days - Acute 91,723 100,982 (9,259) Patient Days - SNF 60,391 62,542 (2,151) ALOS - Acute 4.12 3.75 0.37 ALOS - SNF 60.82 60.14 0.68 Adjusted Discharges 35,729 39,039 (3,310)

Revenue: Gross Revenue 1,972,377,553$ 2,028,633,776$ (56,256,223)$ U (172,001,788)$ 115,745,565$ 55,203.83$ 51,964.29$ 3,239.54$ Deductions from Rev (1,499,668,615) (1,513,254,545) 13,585,930 F 128,304,325 (114,718,395) (41,973.43) (38,762.64) (3,210.79) Net Patient Revenue 472,708,938 515,379,231 (42,670,293) U (43,697,463) 1,027,170 13,230.40 13,201.65 28.75 Other Oper Revenue 9,796,946 9,939,045 (142,099) U (842,702) 700,603 274.20 254.59 19.61 Total Net Revenue 482,505,884 525,318,276 (42,812,392) U (44,540,165) 1,727,773 13,504.60 13,456.24 48.36

Expenses: Salaries, Wages & Contr Labor 240,181,041 241,981,264 1,800,223 F 20,516,867 (18,716,644) 6,722.30 6,198.45 (523.85) Benefits 60,744,103 63,416,746 2,672,643 F 5,376,916 (2,704,273) 1,700.13 1,624.45 (75.69) Supplies 68,519,809 71,903,902 3,384,093 F 6,096,517 (2,712,424) 1,917.76 1,841.85 (75.92) Prof Fees & Purch Svc 69,152,147 78,085,106 8,932,959 F 6,620,602 2,312,357 1,935.46 2,000.18 64.72 Depreciation 46,868,273 50,342,188 3,473,915 F 4,268,363 (794,448) 1,311.77 1,289.54 (22.24) Other 26,517,942 30,604,248 4,086,306 F 2,594,843 1,491,463 742.20 783.94 41.74 Total Expenses 511,983,315 536,333,454 24,350,139 F 45,474,109 (21,123,970) 14,329.63 13,738.40 (591.23)

Net Inc Before Non-Oper Income (29,477,431) (11,015,178) (18,462,253) U 933,944 (19,396,197) (825.03) (282.16) (542.87)

Property Tax Revenue 11,083,333 11,083,333 - - (939,723) 939,723 310.21 283.90 26.30 Non-Operating Income (20,306,549) (21,825,418) 1,518,869 F 1,850,512 (331,643) (568.35) (559.07) (9.28)

Net Income (Loss) (38,700,647)$ (21,757,263)$ (16,943,384)$ U 1,844,733$ (18,788,117)$ (1,083.17)$ (557.32)$ (525.85)$

EBIDA Margin 6.67% 10.04% (3.37%)OEBIDA Margin w/o Prop Tax 3.60% 7.49% (3.89%)OEBIDA Margin with Prop Tax 5.90% 9.60% (3.70%)

F= Favorable varianceU= Unfavorable variance

1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest

$/Adjusted Discharges

2

1

40

8 FYTD13 APRIL - INCOME STATEMENT: CURRENT VS. PRIOR YEAR-TO-DATE CONSOLIDATED – ADJUSTED DISCHARGES

41

FYTD13 APRIL - INCOME STATEMENT: FISCAL YEAR PROJECTION CONSOLIDATED – ADJUSTED DISCHARGES

9

42

10 FYTD13 APRIL - INCOME STATEMENT: MONTHLY TREND CONSOLIDATED – ADJUSTED DISCHARGES

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr YTDStatistics: Admissions - Acute 2,032 2,147 2,036 2,204 2,219 2,287 2,546 2,275 2,323 2,251 22,320 Admissions - SNF 101 115 100 112 100 99 85 98 94 98 1,002 Patient Days - Acute 8,187 8,003 8,443 8,711 8,835 9,628 10,772 9,671 9,945 9,528 91,723 Patient Days - SNF 6,320 6,137 5,943 6,184 5,679 6,255 5,793 5,530 6,461 6,089 60,391 ALOS - Acute 3.99 3.86 4.05 4.05 3.96 4.22 4.33 4.24 4.23 4.18 4.12 ALOS - SNF 62.57 56.82 57.70 55.21 56.79 60.14 62.29 66.63 69.47 63.43 60.82 Adjusted Discharges 3,366 3,463 3,468 3,515 3,594 3,544 3,799 3,544 3,740 3,696 35,729

Revenue: Gross Revenue 179,398,229$ 178,114,379$ 183,267,986$ 196,330,649$ 195,677,855$ 200,490,582$ 214,773,557$ 201,538,773$ 213,277,415$ 209,508,130$ 1,972,377,553$ Deductions from Rev (135,837,825) (135,695,649) (139,039,488) (152,034,200) (149,311,480) (151,104,865) (161,801,670) (152,594,512) (162,710,076) (159,538,851) (1,499,668,615) Net Patient Revenue 43,560,404 42,418,730 44,228,498 44,296,449 46,366,375 49,385,717 52,971,887 48,944,261 50,567,339 49,969,279 472,708,938 Other Oper Revenue 1,096,528 1,025,311 850,753 1,018,748 1,185,327 752,951 979,239 962,535 1,007,088 918,464 9,796,946 Total Net Revenue 44,656,932 43,444,041 45,079,251 45,315,197 47,551,702 50,138,668 53,951,126 49,906,796 51,574,427 50,887,743 482,505,884

Expenses: Salaries, Wages & Contr Labor 23,065,954 23,731,993 22,642,237 24,306,844 24,240,279 24,156,340 25,705,735 23,409,834 24,902,088 24,019,737 240,181,041 Benefits 6,057,240 5,941,559 5,816,492 6,103,417 6,121,938 5,594,958 6,530,032 5,929,023 6,478,872 6,170,571 60,744,103 Supplies 6,819,242 6,755,955 7,335,015 5,457,120 6,803,068 6,642,185 7,122,680 7,152,946 6,958,785 7,472,813 68,519,809 Prof Fees & Purch Svc 7,639,959 7,518,355 7,092,204 6,767,372 6,708,769 8,176,268 7,152,368 5,882,437 6,070,867 6,143,546 69,152,147 Depreciation 2,155,950 3,569,444 5,032,708 5,387,664 5,396,577 4,685,252 5,161,077 5,140,010 5,157,579 5,182,012 46,868,273 Other 2,773,415 2,558,730 2,390,706 3,086,747 2,792,184 3,223,028 2,782,123 2,320,399 2,198,309 2,392,302 26,517,942 Total Expenses 48,511,760 50,076,036 50,309,362 51,109,164 52,062,815 52,478,031 54,454,015 49,834,649 51,766,500 51,380,981 511,983,315

Net Inc Before Non-Oper Income (3,854,828) (6,631,995) (5,230,111) (5,793,967) (4,511,113) (2,339,363) (502,889) 72,147 (192,073) (493,238) (29,477,431)

Property Tax Revenue 1,108,333 1,108,333 1,108,333 1,108,333 1,108,333 1,108,333 1,108,333 1,108,333 1,108,333 1,108,333 11,083,333 Non-Operating Income 365,515 (283,305) (2,767,307) (2,711,132) (2,401,514) (2,689,082) (1,962,671) (2,571,639) (2,600,482) (2,684,933) (20,306,549)

Net Income (Loss) (2,380,980)$ (5,806,967)$ (6,889,085)$ (7,396,766)$ (5,804,294)$ (3,920,112)$ (1,357,227)$ (1,391,159)$ (1,684,222)$ (2,069,838)$ (38,700,647)$

EBIDA Margin 0.04% (1.96%) 1.99% 1.80% 5.04% 7.04% 12.36% 13.10% 12.07% 11.65% 6.67%OEBIDA Margin w/o Prop Tax (3.80%) (7.05%) (0.44%) (0.90%) 1.86% 4.68% 8.63% 10.44% 9.63% 9.21% 3.60%OEBIDA Margin with Prop Tax (1.32%) (4.50%) 2.02% 1.55% 4.19% 6.89% 10.69% 12.66% 11.78% 11.39% 5.90%

1= Property Tax Revenue does not include G.O. Bonds Levy2= Interest Expense does not include G.O. Bonds Interest

2

1

212

43

11 FYTD13 APRIL - CASH FLOW STATEMENT

Fiscal Year 2013 April YTD

CASH FLOWS FROM OPERATING ACTIVITIES: Income (Loss) from operations (493,238) (29,477,430) Adjustments to reconcile change in net assets to net cash provided by operating activities: Depreciation Expense 5,182,012 46,868,273 Provision for bad debts 7,592,154 79,889,113

Changes in operating assets and liabilities: Patient accounts receivable (4,488,878) (96,682,683) Property Tax and other receivables 3,350,710 (30,389,011) Inventories 41,332 (3,354,165) Prepaid expenses and other current assets 653,860 (2,471,704) Accounts payable (10,069,089) (25,285,170) Accrued compensation (2,879,067) (1,770,638) Estimated settlement amounts due third-party payors (2,589,697) (776,393) Other current liabilities 469,054 21,705,375 Net cash provided by operating activities (3,230,848) (41,744,433)

CASH FLOWS FROM INVESTING ACTIVITIES: Net (purchases) sales of investments (254,749) 86,881,125 Income (Loss) on investments 51,855 1,258,790 Investment in affiliates (3,583,896) (3,258,584) Net cash used in investing activities (3,786,790) 84,881,331

CASH FLOWS FROM NON-CAPITAL FINANCING ACTIVITIES: Receipt of G.O. Bond Taxes 4,429,209 13,576,328 Receipt of District Taxes 3,231,697 11,237,095 Net cash used in non-capital financing activities 7,660,906 24,813,423 CASH FLOWS FROM CAPITAL AND RELATED FINANCING ACTIVITIES: Acquisition of property plant and equipment (997,622) (32,639,473) Redevelopment Trust Fund Distributions 0 1,689,902 Deferred Financing Costs 112,710 1,127,287 G.O. Bond Interest paid 0 (11,908,675) Revenue Bond Interest paid (369,106) (17,848,430) Payments of Long Term Debt 0 (8,458,350) Net cash used in activities (1,254,018) (68,037,739)

NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS (610,749) (87,417)

CASH AND CASH EQUIVALENTS - Beginning of period 6,955,879 6,432,548

CASH AND CASH EQUIVALENTS - End of period 6,345,130 6,345,130 44

12 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS ADJUSTED DISCHARGES - CONSOLIDATED

PMCPOMCON

866 865 887 998 849 855 845 8,882 9,920 3,696 35,729 39,039 3,366 3,463 3,468 3,515 3,594 3,544 3,799 3,544 3,740

2,831 2,522 2,550 2,635 2,708 2,639 2,784 2,672 2,865 26,659 29,119 894 917 906

CON BUDGET2,453

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON PMC POM CON

JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

PMC POM CON

YTD

45

13 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS PATIENT DAYS – ACUTE

PMCPOMCON

8,350 2,422

10,772

7,522 2,106 9,628

7,895

9,671 9,945

BUDGETCON6,587 1,856 8,443

5,909 2,094 8,003

6,786 2,049 8,835

6,861 1,850 8,711

21,848 8,187 9,528

6,170 7,518 7,530 2,153 2,050 1,998 2,017

71,128 79,134

91,723 100,982 20,595

-

2,000

4,000

6,000

8,000

10,000

12,000



-

20,000

40,000

60,000

80,000

100,000

120,000

PMC POM CON

YTD

46

14 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS OBSERVATION DISCHARGES

126

158

130

141

146

153

155

147

141

151

138

159

218

222

204

189

205

204

235

186

241

258

122

126

143

147

145

188

171

132

142

173

181

19

18

17

16

17

11

18

12

8

11

10

23

26

34

36

25

47

46

35

46

48

43

12

13

14

9

9

27

13

19

15

23

22

4

4

4

6

5

2

5

3

10

1

8

- 100 200 300 400 500 600 700

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

Medicare Managed Care Kaiser Medi-Cal Self Pay CMS Other

47

15 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS AVERAGE LENGTH OF STAY – ACUTE

PMCPOMCON

4.29 4.23

4.09

CON BUDGET4.22

4.00 4.15 4.22 4.24 3.96 4.18 4.13 3.73

4.03 4.05 3.77 3.84 3.97 3.80

3.99 3.86 4.05 4.05 3.96 4.22 4.33 4.24

4.14 4.07 3.95 4.24 4.36 4.25

4.12 3.75 4.20 4.18

-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00



-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

PMC POM CON

YTD

48

16 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS AVERAGE DAILY CENSUS – ACUTE

PMCPOMCON 264 259

CON BUDGET199 191 220 221 226 243 269 268 255 251 234 260

65 282 281 294 311 347 345 321

68 72 318

68 62 60 68 68 78 77 66 67 302 332

-

50

100

150

200

250

300

350

400



-

50

100

150

200

250

300

350

PMC POM CON

YTD

49

17 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS SURGERIES – INPATIENT ONLY

PMCPOMCON

6,742 148 171 119 646 608 626 700 696

570 545 521 556 497 549 542 130 151 141 161 138 129 153

5,222

662 717 635 678 1,441 1,606

695 6,663 8,348

CON BUDGET498 437 507

-

100

200

300

400

500

600

700

800

900



-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

PMC POM CON

YTD

50

18 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS SURGERIES – OUTPATIENT ONLY

PMCPOMCON

CON BUDGET447 425 418 517 506 445 456 448 494 515 4,671 4,602 330 332 278 265 259 195

7,509 8,095 359 331 2,838 3,493

777 784 749 849 784 259 230

710 715 643 753 745

-

100

200

300

400

500

600

700

800

900

1,000



-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

PMC POM CON

YTD

51

19 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS SURGERIES - CVS

PMCPOMCON

8 12 8

85 94 9 10

12 4 4 8 10 10 9 - - 85 94

CON BUDGET

8 12 8 12 4 4 8 10

-

2

4

6

8

10

12

14



-

10

20

30

40

50

60

70

80

90

100

PMC POM CON

YTD

52

20 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS TOTAL SURGERIES

PMCPOMCON

9,978 11,438 953 874 933 1,099 1,055 970 1,020 955 1,053 1,066

1,449 14,257 16,537 450 462 406 420 333 388 429

1,431 1,404 1,383 1,561 1,484 1,376 1,440 1,288 1,441

CON BUDGET

4,279 478 530 383 5,099

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800



-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

PMC POM CON

YTD

53

21 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS OUTPATIENT REGISTRATIONS (EXCLUDES LAB)

PMCPOMCON

29,582 30,533

51,809 52,328 22,227 1,974 2,198 2,113 3,682 2,364 1,910 2,383

5,360 4,832 4,754 5,174 7,251 2,049

3,030 3,311 1,723 1,831

5,183 4,593 5,320 4,481 21,795

CON BUDGET3,569 2,819 2,683 2,937 2,758 2,858 2,556 3,061

4,861

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000



Oct-12 regisrations are high as "recurring" encounters were discharged on Sep 30, 2012. New encounters were created on Oct 1, 2012.

-

10,000

20,000

30,000

40,000

50,000

60,000

PMC POM CON

YTD

54

22 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS ER VISITS (INCLUDES TRAUMA & EXPRESSCARE PLUS) – OUTPATIENT ONLY

PMCPOMCONC/Day 276 337 318 287

21,800 21,634 7,399 8,022 8,451 8,784 8,680 8,567 10,456 8,893 8,900

287 285 227 239 259 282 283 289 86,751 68,912

2,148 2,159 2,017 2,121 2,535 2,145 2,137 2,045

CON BUDGET5,117 5,811 6,303 6,625 6,663 6,446 7,921 6,748 6,763 6,554 64,951 47,278 2,282 2,211

8,599

-

2,000

4,000

6,000

8,000

10,000

12,000



-

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

PMC POM CON

YTD

55

23 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS ER ADMISSIONS (INCLUDES TRAUMA) – INPATIENT ONLY

PMCPOMCON 1,340 1,528 1,333 1,357 1,316 12,857 15,287

264 279 292 292 427 240 2,987 3,354 1,191

CON BUDGET881 674 873 1,078 1,017 1,048 1,101 1,093 1,069 1,036 9,870 11,933 310 315 288 280

989 1,137 1,357 1,309

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800



-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

PMC POM CON

YTD

56

24 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS TOTAL ER VISITS (INCLUDES TRAUMA, ADMISSIONS & EXPRESSCARE PLUS)

PMCPOMCON 9,588 10,141 9,989 9,907 11,984 10,226 10,257

CON

2,592 2,526 24,787 9,915 99,608 8,590 9,011 2,325

BUDGET5,998 6,485 7,176 7,703 7,680 7,494 9,022 7,841 7,832 7,590 74,821 59,211

2,412 2,438 2,309 2,425 24,988 84,199

2,413 2,962 2,385

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000



-

20,000

40,000

60,000

80,000

100,000

120,000

PMC POM CON

YTD

57

25 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS ER CONVERSION (ER ADMISSIONS AS %-AGE OF ER VISITS)

PMCPOMCON 18.2%13.2%

12.5% 12.1% 13.4%13.9% 11.0% 11.9% 13.4% 13.1% 13.5% 12.8% 13.3% 12.9%13.0%

BUDGET14.7% 10.4% 12.2% 14.0% 13.2% 14.0% 12.2% 13.9% 13.6% 13.6% 13.2% 20.2%

10.9% 11.4% 12.6% 12.1% 14.4% 10.1% 11.9% 12.0%

CON

12.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%



0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

PMC POM CON

YTD

58

26 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS TRAUMA CASES

PMCPOMCON

CON BUDGET119 102 100 122 101 101 88 96 117 102 1,048 1,093

119 102 100 - -

117 102 101 88 96 122 101 1,048 1,093

-

20

40

60

80

100

120

140



-

200

400

600

800

1,000

1,200

PMC POM CON

YTD

59

27 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS TRAUMA ADMISSIONS

PMCPOMCON

103 86 86 77 78 91

95 76 87 857 912 78 103 86 86 77 78 91 - -

CON BUDGET95 76 78 857 912 87

-

20

40

60

80

100

120

140



-

100

200

300

400

500

600

700

800

900

1,000

PMC POM CON

YTD

60

28 FYTD13 APRIL - BUDGET COMPARISON: STATISTICAL INDICATORS DELIVERIES

PMCPOMCON 341 385 401

1,011 3,855 4,580

108 101 111 1,002 103 109 97 94 92 442 412 402 407 371 339 355

CON BUDGET300 299 334 311 291 304 262 242 261 249 2,853 3,569

85 102

-

50

100

150

200

250

300

350

400

450

500



-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

PMC POM CON

YTD

61

29 FYTD13 APRIL - PAYOR MIX

PAYOR MIX

27

26

26

25

26

26

25

26

28

26

25

10

10

10

10

14

12

12

13

12

12

14

11

11

10

9

7

8

8

9

9

7

8

5

5

6

5

5

6

5

6

6

6

6

5

5

5

6

6

5

5

4

5

4

4

29

29

29

32

29

31

33

30

29

32

31

10

10

10

9

10

9

9

9

9

10

9

4

4

4

4

3

3

3

3

2

3

3

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

PY AVG

JUL

AUG

SEP

OCT

NOV

DEC

JAN

FEB

MAR

APR

MAY

JUN

MEDICARE MCAR MGD MEDI-CAL MCAL MGD SELF PAY MGD CARE CAP OTHER

62

30 FYTD13 APRIL - CASE MIX INDEX

PMCPOMCON 1.39 1.42 1.37 1.34

1.40 1.39 1.34 1.40 1.42 1.36 1.35 1.39 1.40

1.40 1.46

CON BUDGET1.36 1.32 1.37 1.35 1.39 1.40

1.33 1.38 1.34

1.40 1.41 1.33 1.37 1.37 1.39 1.41 1.41 1.39 1.43 1.40 1.41

1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

1.40

1.45

1.50



1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

1.40

1.45

PMC POM CON

YTD

63

31 FYTD13 APRIL - CASE MIX INDEX (EXCLUDES DELIVERIES)

PMCPOMCON

CON BUDGET

1.54 1.51 1.56 1.47

1.52 1.49 1.54 1.49 1.53 1.52 1.48 1.54 1.52 1.54

1.48 1.55 1.59 1.49 1.55 1.55 1.57 1.57 1.58 1.58

1.53 1.51 1.52 1.51 1.51 1.46 1.55 1.47 1.52 1.53 1.49 1.62

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70



1.00

1.10

1.20

1.30

1.40

1.50

1.60

PMC POM CON

YTD

64

32 FYTD13 APRIL - CASE MIX INDEX MEDICARE

PMCPOMCON 1.63 1.70 1.67 1.64

1.58 1.63 1.60 1.65 1.63

1.63

1.56 1.58 1.67 1.56 1.57 1.65 1.46 1.55 1.46 1.51 1.60 1.63

1.64 1.73 1.68 CON BUDGET

1.71 1.59 1.61 1.60 1.76 1.58 1.54

1.65 1.64 1.60 1.76

1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

1.80



1.00

1.10

1.20

1.30

1.40

1.50

1.60

1.70

PMC POM CON

YTD

65

33 FYTD13 APRIL - CASH COLLECTIONS

Actual Budget

439.0 495.0

JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUNMTD 41.3 45.2 37.1 42.6 39.7 49.8 47.5 42.9 44.5 48.4 - -BUDGET 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5 49.5PY 33.8 39.5 37.0 41.6 36.4 37.7 38.2 37.3 41.0 41.6 44.1 42.7

-

10.0

20.0

30.0

40.0

50.0

60.0

-

100.0

200.0

300.0

400.0

500.0

600.0

YTD

66

SUPPLEMENTAL INFORMATION

34 67

35 FYTD13 APRIL – REVENUE CYCLE DASHBOARD

Revenue Cycle Key Performance Indicator

Current Goal Variance Current Goal Variance95% 90% 5% 83% 90% -7%

- 90% - 86% 90% -4%4 Days 5 Days 1 Day 4 Days 5 Days 1 Day59% 70% -11% 57% 70% -13%14 17 3 186 170 -16

16% 20% -4% 16% 20% -4%

CC 44 Correctly Billed Rate (Case Management)Waiting for Coding (Coding)

Clean Claim Rate (PFS)1-Day Stays Per Month (RAC)

Underpayment Recovery (Managed Care)ACTUAL VS. BUDGET FY13

MTD FYTD

Timely Charge Entry Rate (Charge Services)

$0

$10

$20

$30

$40

$50

$60

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Actual Vol Adj Budget

Cash Goal (million $)

$0

$10

$20

$30

$40

$50

$60


Net Patient Revenue (million $)

ACTUAL Vol Adj Budget

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900


POS Cash Collections (thousand $)

Actual Vol Adj Budget

0

10

20

30

40

50

60

70

80

90


Net AR Days (# of Days)

Actual

68

36 FYTD13 APRIL - BALANCE SHEET CONSOLIDATED (INCLUDES G.O. BONDS)

Current Prior Prior Fiscal Current Prior Prior Fiscal Month Month Year End Month Month Year End

Assets LiabilitiesCurrent Assets Current Liabilities Cash on Hand $6,345,130 $6,955,879 $6,432,548 Accounts Payable $16,570,196 $26,639,285 $41,855,366 Cash Marketable Securities 79,107,845 95,099,846 171,450,637 Accrued Payroll 11,020,348 13,946,700 14,498,569Total Cash & Cash Equivalents 85,452,975 102,055,725 177,883,185 Accrued PTO 20,388,779 20,341,494 18,681,196

Accrued Interest Payable 16,141,625 12,957,341 9,522,438Patient Accounts Receivable 296,869,719 311,775,942 262,010,549 Current Portion of Bonds 10,262,977 10,262,977 9,311,650 Allowance on Accounts (180,054,951) (191,857,898) (161,989,351) Est Third Party Settlements 896,849 3,486,546 1,673,242Net Accounts Receivable 116,814,768 119,918,044 100,021,198 Other Current Liabilities 26,045,484 27,517,998 24,333,951

Total Current Liabilities 101,326,258 115,152,341 119,876,412 Inventories 10,551,718 10,593,050 7,197,553 Prepaid Expenses 3,415,672 2,530,314 5,399,059 Long Term Liabilities Other 10,598,187 21,692,381 5,821,860 Other LT Liabilities 1,482,473 1,511,907 1,324,876Total Current Assets 226,833,320 256,789,514 296,322,855 Bonds & Contracts Payable 1,159,682,865 1,158,144,854 1,154,647,907

Total Long Term Liabilities 1,161,165,338 1,159,656,761 1,155,972,783Non-Current Assets Restricted Assets 95,535,153 78,787,582 99,694,421 General Fund Balance Restricted by Donor 328,797 328,468 326,320 Unrestricted 365,167,653 368,740,322 425,631,532 Board Designated 9,618,458 10,119,608 0 Restricted for Other Purpose 328,797 328,468 326,320Total Restricted Assets 105,482,408 89,235,658 100,020,741 Board Designated 9,618,458 10,119,608 0

Total Fund Balance 375,114,908 379,188,398 425,957,852 Property Plant & Equipment 1,513,481,249 1,513,347,291 443,081,964 Accumulated Depreciation (312,446,106) (307,269,380) (268,958,070) Total Liabilities / Fund Balance $1,637,606,504 $1,653,997,500 $1,701,807,047 Construction in Process 65,171,282 64,123,650 1,099,156,934Net Property Plant & Equipment 1,266,206,425 1,270,201,561 1,273,280,828

Investment in Related Companies 2,685,332 2,695,447 3,063,705 Deferred Financing Costs 21,932,098 22,044,808 23,059,385 Other Non-Current Assets 14,466,921 13,030,512 6,059,533Total Non-Current Assets 1,410,773,184 1,397,207,986 1,405,484,192

Total Assets $1,637,606,504 $1,653,997,500 $1,701,807,047

69

37 FYTD13 APRIL - SUPPLIES EXPENSE: YEAR-TO-DATE

70

board finance committee meeting - palomar healthjun 03, 2013 · board finance committee meeting *...

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