xzy community health center 2015 -...

Performance Evaluation Profile

XZY Community Health Center 2015 - 2018

© 2019 Capital Link

Performance Evaluation Profile 2015 - 2018

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Methodology

The analysis and results contained in this report are based on two primary data sources covering the 2015 - 2018 period.

• Audited financial statements of health center corporations reported by fiscal year.

• Uniform Data System (UDS) information as self-reported by health centers each calendar year.

The comparative data sets include aggregated data from audited financial statements and UDS reports from Capital Link’s proprietary financial and operational database. The specific number of health centers included in each comparative data set is listed below.

Data Peer FQHCs

2018 National

FQHCs 2018

Financial Audits 35 988

UDS Data 35 1,353

Percentiles

Statistical measures used to describe the financial ratios and trends include the 50th percentile (median), 75th percentile, and 25th percentile. By definition, half the values in a set are greater than the median and half are less. Therefore, the median is not skewed by large or small values outside the typical range as can happen with average figures. The 75th percentile is a value equal to or greater than 75% of others in the data set. The 25th percentile is a value equal to or greater than 25% of others.

Run Date: 9/27/2019 10:16:44 AM

Contents

Notable Findings 3 Peer Comparison Dashboard 4 Financial Dashboard 5 Productivity Dashboard 6 Operations and Utilization Dashboard 7 Payer Mix Dashboard 8 Performance Detail: Financial Health

Performance and Liquidity Measures

9 Other Performance Measures

10 Financial Growth Rates

10 Performance Detail: Productivity

Productivity: Visits 11 Productivity: Patients 12 Performance Detail: Operations and Utilization

Revenue and Cost per Patient 13 Revenue and Cost per Visit 14 Staffing 15 Quality of Care 16 Service Mix 18 Utilization Growth Rate 19 Performance Detail: Financial Metrics

Billing and Collections 20



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Notable Findings

This report highlights key financial and operational performance measures over the 2015 - 2018 period for XYZ Community Health Center (XYZ). The following notable findings provide a brief review of key performance trends.

Financial Health • XYZ’s operating margins trended higher from -2.7% to -0.5% during

the review period, an improvement and in-line with peer FQHCs at the median (-0.6%), but well below national FQHCs at the median (3.2%). Capital Link recommends the operating margin be no less than 3%.

• Personnel-related expense as a percentage of operating revenue decreased four points over the period to 72.7% in 2018, approximately the same level as the Peer (74.4%) and national (72%) medians, though there is still room for improvement.

• XYZ’s liquidity—measured by days cash on hand—fell 25 days during the period to 22 days in 2018. This level in available cash is half the peer median (48 days), and significantly (2/3) lower than the national median (67 days).

• XYZ’s efficiency at collecting on outstanding patient accounts—measured as days in net patient receivables—averaged a strong 35 days. Peers at the statewide (40 days) and national (38 days) medians spent slightly more days collecting on outstanding accounts compared to XYZ.

Provider Productivity • Provider productivity—the number of visits per provider FTE—was

mixed during the review period. • Physician FTE and medical staff FTE productivity remained relatively

steady during the period at around 2,000 visits, well below the peer median (2,291 visits) and national median (2,735 visits).

• Mid-level FTE had the greatest loss in productivity during the period—a 34% drop—and significantly underperformed the peer medians in 2018—46% less productive than the peer median and 55% less productive than the national median.

• Dental FTE productivity slid 9% during the period, but at 2,113 visits remains 17% more productive than the peer median and 22% more productive than the national median.

Operations & Utilization • During the period, XYZ’s revenue per patient increased 21%, while

operating expenses per patient increased by only 19%, allowing for modest gains in the operating margins to -0.5%. Additionally, XYZ’s 330 grant dollars per uninsured patient was $967 higher than operating expenses per patient, providing a slight subsidy.

• Compared to peer FQHCs, XYZ earns 14% more revenue than the median revenue per patient but incurs 17% more expenses than the median cost. Nationally, XYZ earns 52% more revenue per patient than the national median but incurs 62% higher costs than the median.

• XYZ’s patient growth rate and visit growth rate fell to 0% and 1% during the review period—somewhat in line with peer FQHCs’ slight growth rates of 1%. Nationally, health centers are experiencing a patient growth rate of 3% and a visit growth rate of 5%.

• XYZ’s quality of care data (UDS) showed mixed results compared to the peer medians and can be further reviewed in the charts on pages 16 and 17.

Payer Mix • Uninsured patients reduced significantly over the period from 20% in 2015

to 7% in 2018 of XYZ’s total patients—slightly lower than peer FQHCs at the median (10%) and much lower than the national FQHC median (19%).

• Conversely, Medicaid patients as a percentage of total patients increased considerably by 17 points over the period to 70% in 2018, much higher than both peer groups (50% and 45%). However, Medicaid collections as a percentage of total collections only increased 4% over the same period. As one of the strongest payers for health centers, XYZ should monitor this payer for opportunities to increase collections.

• Medicare, as a payer, was in line with the peer median and privately insured remained relatively steady over the period, though in 2018 was half the patients and collections of the peer median.



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Peer Comparison

Patients Served 2018

Revenues 2018

2018

XYZ

Peer FQHCs median

National FQHCs median

Array of Services 2018 (Percentage of Total Visits)

Full-Time Equivalent Employees 2018

Total Visits 2018

Key Metrics Health Center

2018 Peer FQHCs Median 2018

National FQHCs Median 2018

Medical Visits as a Percentage of Total Visits 56% 57% 70%

Dental Visits as a Percentage of Total Visits 18% 15% 13%

Mental Health Visits as a Percentage of Total Visits 8% 9% 6%

Enabling Visits as a Percentage of Total Visits 14% 2% 2%

Other Professional Visits as a Percentage of Total Visits 5% 6% 1%

Key Metrics Health Center

2018 Peer FQHCs Median 2018


Total Revenue $39,505,264 $25,220,813 $15,167,367

Total Patients 26,728 19,148 12,626

Total Visits 152,708 83,254 47,550

Total FTEs 362 222 102



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Days Cash on Hand

Financial Dashboard

Operating Margin

XYZ Community Health Center

2015 - 2018

Capital Link Benchmark

Bottom Line Margin

Personnel-Related Expense as a % of Operating Revenue

Days in Net Patient Receivables

Key Financial Metrics Target 2015 2016 2017 2018 Peer FQHCs Median 2018


Operating Margin > 3% -2.7% -1.5% -5.4% -0.5% -0.6% 3.1% Bottom Line Margin > 3% 3.1% -0.4% -5.6% -0.8% 2.7% 4.3% Personnel-Related Expense as Percentage of Operating Revenue < 70% 76.7% 75.6% 77.1% 72.7% 74.4% 72.0%

Days Cash on Hand > 45 Days 47 34 22 22 48 67 Days in Net Patient Receivables < 60 Days 36 38 31 37 40 38

Benchmark Unmet



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Physician Visits per Physician FTEs

Productivity Dashboard

Mid-Level Visits per Mid-Level FTEs


2015 - 2018

Medical Patients per Medical FTE

Medical Patients per Medical Provider FTEs

Dental Visits per Dental Provider FTEs

Key Productivity Metrics 2015 2016 2017 2018 Peer FQHCs Median 2018


Physician Visits per Physician FTE 2,003 1,987 1,977 2,003 2,291 2,735

Mid-Level Visits per Mid-Level FTE 1,618 1,535 1,236 1,070 1,970 2,367

Medical Patients per Medical Staff FTE 171 188 170 170 233 291

Medical Patients per Medical Provider FTE 525 542 495 463 674 845

Dental Visits per Dental Provider FTE 2,329 2,209 2,036 2,113 1,806 1,737



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Operating Revenue & Expense per Patient

Operating Revenue & Expense per Visit

Operations & Utilization Dashboard


2015 - 2018

Medical Support Staff FTEs per Medical Provider FTEs

Administrative, Facilities & Patient Support FTEs as a % of Total FTEs

Annual Visits & Patient Growth Rates

Key Operations & Utilization Metrics 2015 2016 2017 2018 Peer FQHCs Median 2018


Operating Revenue per Patient $1,217 $1,394 $1,469 $1,478 $1,298 $971 Operating Expense per Patient $1,250 $1,414 $1,549 $1,485 $1,273 $917 Operating Revenue per Patient Visit $215 $244 $260 $259 $267 $253 Operating Expense per Patient Visit $220 $248 $274 $260 $274 $242 Non-Provider Medical Staff per Medical Provider 2.1 1.9 1.9 1.7 1.8 1.9 Administrative, Facilities, and Patient Support FTEs as Percent of Total FTEs 30% 27% 28% 30% 33% 37%

Patient Growth Rate 10% 0% -2% 0% 1% 3% Visit Growth Rate 23% 1% -3% 1% 1% 5%



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Payer Mix Dashboard

% of Patients % of Collection Revenue


2015 - 2018

Patient and Collection Revenue by Payer Service

Medicaid

Self-Pay or Uninsured

Private

Other

Medicare

Payer Mix 2015 2016 2017 2018 Peer FQHCs Median 2018


Self-Pay Patients as Percentage of Total Patients 20% 9% 7% 7% 10% 19%

Self-Pay Collections as Percentage of Total Collections 2% 2% 2% 1% 4% 7%

Medicaid Patients as Percentage of Total Patients 53% 68% 71% 70% 50% 45%

Medicaid Collections as Percentage of Total Collections 67% 63% 72% 71% 59% 60%

Medicare Patients as Percentage of Total Patients 12% 10% 12% 12% 10% 10%

Medicare Collections as Percentage of Total Collections 16% 16% 18% 16% 16% 11%

Other Publicly Insured Patients as Percentage of Total Patients 3% 2% 2% - 1% -

Other Public Collections as Percentage of Total Collections 9% 5% 1% 3% 1% 0%

Privately Insured Patients as Percentage of Total Patients 12% 11% 9% 11% 22% 18%

Private Insurance Collections as Percentage of Total Collections 7% 14% 7% 9% 18% 14%



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Performance Detail

Financial Health: Performance and Liquidity Measures

XYZ Community Health Center 2015 - 2018

Performance and Liquidity Measures Target 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018

Operating Margin 75 0.9% 7.8%

> 3% -2.7% -1.5% -5.4% -0.5% 50 -0.6% 3.1% 25 -2.8% -0.3%

Bottom Line Margin 75 5.7% 9.3%

> 3% 3.1% -0.4% -5.6% -0.8% 50 2.7% 4.3% 25 0.0% 0.4%

Personnel-Related Expense as Percentage of Operating Revenue

75 79.8% 77.2% < 70% 76.7% 75.6% 77.1% 72.7% 50 74.4% 72.0%

25 70.1% 65.8%

Days Cash on Hand 75 82 123

> 45 Days 47 34 22 22 50 48 67 25 22 29

Current Ratio 75 3.7 5.2

> 1.25 1.8 2.0 1.5 1.7 50 2.6 3.2 25 1.9 1.9

Days in Net Patient Receivables 75 58 54

< 60 Days 36 38 31 37 50 40 38 25 31 26

Days in All Receivables 75 58 55

< 60 Days 32 35 27 30 50 36 39 25 30 27

Days in Accounts Payable 75 49 47

< 45 Days 29 34 30 28 50 31 28 25 22 18

Debt Service Coverage Ratio 75 3.7 11.7

> 1.25 1.9 1.1 -4.4 8.0 50 1.6 3.7 25 0.5 1.1

Leverage 75 1.4 0.7

< 3.0 1.3 1.2 1.6 1.7 50 0.8 0.3 25 0.3 0.2



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Performance Detail

Financial Health: Other Performance Measures, Financial Growth Rates


Other Performance Measures 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 5.8% 10.1% Change in Net Assets as a Percentage of Expense 3.0% -0.4% -5.3% -0.8% 50 2.6% 4.5% 25 0.0% 0.4% 75 3.0 4.6 Working Capital to Monthly Expense Ratio 1.2 1.2 0.5 0.7 50 1.9 2.6 25 1.0 1.2 75 1.0 0.3 Long-Term Debt to Equity Ratio 0.8 0.8 1.0 1.1 50 0.3 0.1 25 0.1 - 75 21.5% 23.7% Fringe & Taxes to Salaries Ratio 16.8% 15.4% 17.0% 17.5% 50 18.5% 19.7% 25 17.3% 14.9% Financial Growth Rate 75 10.6% 14.9% Operating Revenue Growth Rate 16.1% 14.5% 3.1% 1.0% 50 5.6% 7.7% 25 2.2% 1.9% 75 9.1% 14.2% Operating Expense Growth Rate 17.9% 13.1% 7.1% -3.8% 50 6.5% 8.5% 25 2.2% 3.4% 75 7.4% 11.7% Grants and Contract Revenue Growth Rate 11.4% 7.8% 12.7% 5.7% 50 3.7% 4.0% 25 -0.4% -2.5% 75 10.6% 20.1% Net Patient Service Revenue Growth Rate 17.0% 17.4% -2.2% -0.2% 50 6.1% 9.1% 25 2.3% 1.0%



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Performance Detail

Productivity: Visits


Productivity: Visits 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 2,702 3,319 Physician Visits per Physician FTE 2,003 1,987 1,977 2,003 50 2,291 2,735 25 2,017 2,198 75 2,258 2,885 Mid-Level Visits per Mid-Level FTE 1,618 1,535 1,236 1,070 50 1,970 2,367 25 1,716 1,942 75 2,399 3,019 Medical Visits per Medical Provider FTE 1,841 1,789 1,628 1,555 50 2,189 2,537 25 1,800 2,147 75 1,459 1,728 Medical Visits per Non-Provider Medical Staff FTE 1,019 1,080 983 1,033 50 1,255 1,393 25 1,036 1,121 75 2,034 2,174 Dental Visits per Dental Provider FTE 2,329 2,209 2,036 2,113 50 1,806 1,737 25 1,505 1,358 75 1,211 1,308 Mental Health Visits per Mental Health Provider FTE 1,008 776 802 708 50 1,005 956 25 713 695 75 223 314 Enabling Services Visit per Enabling FTE 622 509 628 623 50 115 127 25 11 0 75 140,598 99,845 Total Visits 154,564 155,390 150,697 152,708 50 83,254 47,550 25 60,978 22,159 75 489 547 Total Visits per All FTE 440 437 419 422 50 434 454 25 393 384 75 2,246 2,917 Total Visits per Provider FTE 2,241 1,991 1,977 1,910 50 2,121 2,357 25 1,912 1,940



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Performance Detail

Productivity: Patients


Productivity: Patients 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 267 355 Medical Patients per Medical Staff FTE 171 188 170 170 50 233 291 25 198 239 75 786 1,015 Medical Patients per Medical Provider FTE 525 542 495 463 50 674 845 25 567 699 75 697 914 Dental Patients per Dental Provider FTE 709 624 632 650 50 573 722 25 481 537 75 189 370 Mental Health Patients per Mental Health Provider FTE 173 102 120 115 50 158 237 25 117 152 75 29,073 25,060 Total Patients 27,260 27,243 26,635 26,728 50 19,148 12,626 25 13,114 5,902 75 106 152 Total Unduplicated Patients per Total FTE 78 77 74 74 50 87 122 25 80 96 75 497 786 Total Patients per Provider FTE 395 349 349 334 50 428 636 25 363 497



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Performance Detail

Operations & Utilization: Revenue & Cost per Patient


Revenue & Cost per Patient 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 $1,778 $1,286 Operating Revenue per Patient $1,217 $1,394 $1,469 $1,478 50 $1,298 $971 25 $1,133 $768 75 $1,838 $1,244 Operating Expense per Patient $1,250 $1,414 $1,549 $1,485 50 $1,273 $917 25 $1,144 $736 75 $1,121 $814 Net Patient Service Revenue per Patient $793 $932 $932 $927 50 $882 $587 25 $739 $418 75 $42,918,405 $30,746,616 Total Revenue $33,165,608 $37,969,788 $39,131,942 $39,505,264 50 $25,220,813 $15,167,367 25 $16,954,708 $7,690,124 75 $43,227,195 $29,246,406 Total Expenses $34,071,850 $38,525,852 $41,259,361 $39,693,736 50 $26,275,703 $14,672,561 25 $17,043,131 $7,124,547 75 $626 $509 Direct Medical Cost per Medical Patient $684 $710 $718 $693 50 $519 $399 25 $429 $321 75 $465 $463 Direct Dental Cost per Dental Patient $307 $384 $399 $380 50 $375 $358 25 $306 $271 75 $858 $801 Mental Health Cost per Mental Health Patient $467 $528 $808 $653 50 $731 $491 25 $638 $296 75 $3,239 $2,007 330 Grant Dollars per Uninsured Patient $636 $1,528 $2,561 $2,452 50 $2,081 $1,000 25 $846 $559



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Performance Detail

Operations & Utilization: Revenue & Cost per Visit


Revenue & Cost per Visit 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 $345 $311 Operating Revenue per Patient Visit $215 $244 $260 $259 50 $267 $253 25 $250 $214 75 $339 $305 Operating Expense per Patient Visit $220 $248 $274 $260 50 $274 $242 25 $242 $204 75 $225 $195 Net Patient Service Revenue per Patient Visit $140 $163 $165 $162 50 $166 $153 25 $150 $116 75 $166 $158 Direct Medical Cost per Medical Patient Visit $171 $188 $190 $181 50 $139 $129 25 $128 $108 75 $150 $181 Direct Dental Cost per Dental Patient Visit $93 $108 $124 $117 50 $117 $145 25 $107 $116 75 $158 $167 Mental Health Cost per Mental Health Patient Visit $80 $69 $121 $106 50 $114 $119 25 $93 $88



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Performance Detail

Operations & Utilization: Staffing


Staffing 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 2.2 2.3 Non-Provider Medical Staff per Medical Provider 2.1 1.9 1.9 1.7 50 1.8 1.9 25 1.6 1.5 75 1.2 1.6 Non-Provider Dental Staff per Dental Provider 1.1 1.2 1.2 1.1 50 1.1 1.2 25 0.9 0.9 75 0.2 0.3 Non-Provider Mental Health Staff per Mental Health Provider 0.4 0.1 0.1 0.0 50 0.1 -

25 - - 75 36% 41% Administrative, Facilities, and Patient Support FTEs as Percent of Total FTEs 30% 27% 28% 30% 50 33% 37%

25 30% 32%



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Performance Detail

Operations & Utilization: Quality of Care


Quality of Care 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 64% 49% Percentage of Children Receiving Appropriate Vaccinations by Age 2 69% 80% 67% 64% 50 52% 32%

25 41% 16% 75 93% 94% Percent of Patients with Asthma Given an Asthma Treatment Plan 93% 96% 94% 91% 50 91% 89%

25 88% 80% 75 62% 53% Percentage of Patients Screened for Colorectal Cancer 32% 48% 52% 47% 50 54% 41% 25 47% 28% 75 77% 82% Percentage of Patients 3-17 with BMI, Nutrition & Physical Activity Documented 44% 47% 49% 52% 50 66% 67%

25 47% 47% 75 76% 86% Percentage of Patients 18 and over with BMI & Follow Up Documented (If BMI outside normal) 31% 55% 48% 61% 50 62% 71%

25 43% 52%



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Performance Detail

Operations & Utilization: Quality of Care (continued)


Quality of Care 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 9% 11% Babies with Low Birth Weight Born to Prenatal Patients who Delivered During the Year 9% 10% 6% 8% 50 7% 7%

25 4% 4% 75 68% 85% Percentage of Patients 12 and over Screened for Depression and Follow-up Plan Documented (If Positive) 23% 49% 44% 46% 50 59% 71%

25 46% 55% 75 64% 72% Percentage of Patients 6-9 at Moderate to High Risk of Caries Receiving Sealant on First Permanent Molar 40% 83% 83% - 50 52% 53%

25 40% 35% 75 61% 63% Percentage of Prenatal Patients who Delivered During the Year 38% 55% 57% 34% 50 57% 53%

25 48% 42% 75 71% 69% Percentage of Patients with Controlled High Blood Pressure 65% 66% 60% 67% 50 64% 63%

25 62% 56% 75 30% 39% Percentage of Patients with Diabetes and Hemoglobin A1c Poor Control 35% 19% 29% 23% 50 28% 32%

25 23% 26%



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Performance Detail

Operations & Utilization: Service Mix


Service Mix 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 72.2% 82.2% Medical Visits as a Percentage of Total Visits 61.3% 56.7% 54.6% 56.0% 50 56.5% 70.2% 25 52.1% 57.6% 75 23.6% 22.0% Dental Visits as a Percentage of Total Visits 16.1% 18.7% 17.8% 17.5% 50 15.4% 12.8% 25 11.0% 5.6% 75 15.1% 11.6% Mental Health Visits as a Percentage of Total Visits 6.0% 9.4% 8.5% 7.7% 50 9.2% 6.2% 25 6.2% 2.8% 75 5.0% 6.9% Enabling Visits as a Percentage of Total Visits 12.8% 11.9% 13.8% 13.5% 50 1.8% 2.1% 25 0.4% - 75 5.6 4.5 Total Visits per Patient 5.7 5.7 5.7 5.7 50 4.7 3.7 25 4.2 3.2



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Performance Detail

Operations & Utilization: Utilization Growth Rates


Utilization Growth Rates 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 4.5% 9.6% Medical Patient Growth Rate 9.0% -1.0% -7.1% 2.8% 50 1.5% 2.9% 25 -1.0% -2.0% 75 4.7% 11.3% Medical Visit Growth Rate 11.3% -7.1% -6.6% 4.1% 50 0.2% 3.0% 25 -3.4% -3.1% 75 8.4% 14.5% Dental Patient Growth Rate 18.1% 8.2% 1.6% -1.5% 50 3.3% 4.2% 25 -0.9% -4.8% 75 10.9% 17.1% Dental Visit Growth Rate 22.1% 16.5% -7.6% -0.6% 50 3.6% 3.5% 25 -3.4% -6.1% 75 15.5% 37.8% Mental Health Patient Growth Rate 58.3% 19.2% 0.3% -0.5% 50 5.9% 9.5% 25 1.0% -6.3% 75 15.4% 37.2% Mental Health Visit Growth Rate 40.2% 56.5% -12.4% -8.4% 50 5.2% 11.7% 25 0.1% -6.1% 75 5.1% 9.4% Patient Growth Rate 10.2% -0.1% -2.2% 0.3% 50 1.4% 3.4% 25 -0.6% -1.1% 75 4.7% 13.2% Visit Growth Rate 22.5% 0.5% -3.0% 1.3% 50 1.3% 4.5% 25 -2.5% -1.7%



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Performance Detail

Financial Metrics: Billing and Collections


Billing and Collections 2015 2016 2017 2018 Percentile Peer FQHCs

2018 National

FQHCs 2018 75 7% 14% Self-Pay Collections as Percentage of Total Collections 2% 2% 2% 1% 50 4% 7% 25 3% 3% 75 19% 16% Bad Debt Write-Offs as Percentage of Total Self-Pay Charges 7% 10% 6% 4% 50 8% 7%

25 4% 3% 75 66% 78% Medicaid Collections as Percentage of Total Collections 67% 63% 72% 71% 50 59% 60% 25 45% 40% 75 20% 19% Medicare Collections as Percentage of Total Collections 16% 16% 18% 16% 50 16% 11% 25 11% 6% 75 2% 2% Other Public Collections as Percentage of Total Collections 9% 5% 1% 3% 50 1% 0% 25 0% - 75 27% 24% Private Insurance Collections as Percentage of Total Collections 7% 14% 7% 9% 50 18% 14%

25 15% 6%

xzy community health center 2015 -...

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