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MetroHealth presentation
- 1. MetroHealth County Council Briefing May 19, 2011
- 6. v Cuyahoga County Provides Average Support Source: America’s Public Hospitals and Health Systems, 2009: Results from the Annual NAPH Hospital Characteristics Survey Grady Health System Broward Health-Broward General Medical Center UMDN J-University Hospital LAC-LAC+USC Medical Center Alameda County Medical Center University Health System at San Antonio LAC-Harbor/UCL A Medical Center LAC-Olive View/UCLA Medical Center Parkland Health & Hospital System Harris County Hospital District NYC HHC-Bellevue Hospital Center Santa Clara Valley Health & Hospital System JPS Health Network University Hospital, The University of New Mexico Health Jackson Health System University Medical Center of El Paso The MetroHealth System The Health and Hospital Corporation of Marion County San Francisco General Hospital Cook County HHS-The John H. Stroger, Jr. Hospital of Cook Boston Medical Center Average of 91 NAPH Hospitals 2009 State/Local Support as % of Charity Care Charges For top 20 NAPH Member Hospitals Receiving Gov’t Subsidiary (+MH)
- 7. Value of County Subsidy Declined as Charity Care Grew MHS County Subsidy Trend 1981 - 2010 2005 2000 1995 1990 1985 2010 1981 County Subsidy ($ in 000’s) County Subsidy as % of Charity Care
- 10. MetroHealth is Linchpin of the County’s Safety Net Provider Inpatient Discharges (2009) Uninsured/Medicaid Cleveland Clinic Health System 151,286 18% University Hospitals Health System 72,867 24% MetroHealth 25,557 53% Parma Community General Hospital 15,193 9% St. Vincent Charity Hospital 8,028 27%
- 11. Uninsured Visits 2010 200,000 visits by uninsured patients in 2010, an increase of 25% since 2008 45% of County’s uninsured visits originate outside Cleveland: 42% growth in two years
- 12. County H&HS Subsidy 5.6% Ohio HCAP GAP $51m Medicare $173m 24.3% Uninsured $119m 16.7% Medicaid $243m 34.1% Commercial $177.1m 24.9% 2006-2010 Change by Payor Uninsured Support Total $712.1 million MetroHealth 2010 Operating Expense by Payor Deterioration in Payor Mix Threatens Survival – HHS Levy Subsidy Inadequate Serving insured patients is a mandatory funding source
- 22. Appendix
- 24. Note: Excludes Compliance The MetroHealth System April 1, 2011 Mark J. Moran President and CEO Daniel Lewis Vice President, HR Alfred F. Connors MD Chief Medical Officer Sharon Kelly Chief Financial Officer John McInally Vice President Information Services Phyllis Marino Vice President Marketing & Communications John Corlett Vice President, Government & Community Relations Kate Brown Vice President, Development Ronald G. Fountain Board of Trustees Thomas Goins Vice President Construction/Facilities Edward Hills, DDS Chief Operating Officer Thomas Onusko Sr. Vice President General Counsel Building Experienced, Resilient Organization
Notas do Editor
- Cook County Health and Hospitals System is the largest provider of health care to Illinois' poor and uninsured. It's struggling with rising medical costs, declining federal help, dependence on Illinois' Medicaid system and patients who can't pay their bills. The system as a whole provides $500 million annually in free care and serves more than 800,000 patients. A 2005 report by the State University of New York Downstate Medical Center on hospital care in the 100 largest U.S. cities and their suburbs found that “more public hospitals were lost between 1996 and 2002 (16 percent in cities and 27 percent in the suburbs) than for-profit (11 percent in cities and 11 percent in suburbs) and non-profit hospitals (11 percent in cities and 2 percent in the suburbs).”
- What is behind the restructuring trend? The fact is, changing governance or legal structure cannot by itself turn around a struggling system. But it can offer effective additional tools for addressing many of the pressures faced by public hospitals that are over and above those faced by your private sector colleagues and competitors. Not the least of these pressures is simply the ability to make and implement decisions quickly in a rapidly changing health care environment. As you can see from this slide, there are a range of other potential public sector obstacles and constraints that can diminish the effectiveness of a health system that is controlled in any major way by city or county government, even if there is a separately appointed governing board. Note specifically the difficulties in public entities doing joint ventures as a result of interpretations of the pledge of credit provisions in the Florida Constitution. Another question is WHEN do hospitals restructure. Some do restructure because of financial difficulty, but that is not the only reason. We are currently seeing substantial additional interest from healthy safety net systems (like Broward) as a result of the desire to be responsive to changes in the health care system. In fact, since restructuring does take resources, there are good arguments for restructuring when a system is not in crisis.
- Main Campus 42 acres 2.3 million square feet 26 buildings (1912-2004) 3,800 parking spaces Senior Health & Wellness Center (Old Deaconess Hospital) 9 acres 385,000 building square feet 9 buildings (1927-2000) 800 parking spaces Board made significant decision to install EPIC Primary care in 1999 ED in 2004 Inpatient in 2009 Partners in Care is out Patient Centered Medical Home -- 10,000 uninsured County residents enrolled Mission statement developed in the strategy effort commissioned and led by the Board in 2007
- Secure, liquid balance sheet Bond ratings upgraded Moody’s S&P Fitch Have to maintain ~4% operating margin to support A rating -- performance expectations set by bond markets Successful refinancing of capital structure Build America Bonds issued Covenants relaxed Maturities extended Continued clean up of credit balances, cost reports and reserves Contingent liabilities addressed Prepared to invest to meet patient needs
- Secure, liquid balance sheet Bond ratings upgraded Moody’s S&P Fitch Have to maintain ~4% operating margin to support A rating -- performance expectations set by bond markets Successful refinancing of capital structure Build America Bonds issued Covenants relaxed Maturities extended Continued clean up of credit balances, cost reports and reserves Contingent liabilities addressed Prepared to invest to meet patient needs
- Secure, liquid balance sheet Bond ratings upgraded Moody’s S&P Fitch Have to maintain ~4% operating margin to support A rating -- performance expectations set by bond markets Successful refinancing of capital structure Build America Bonds issued Covenants relaxed Maturities extended Continued clean up of credit balances, cost reports and reserves Contingent liabilities addressed Prepared to invest to meet patient needs
- Balance between health and human services goals and need to operate effectively (earn a margin) Issue bonds and responsible for creditworthiness of the institution Led development of strategy and transformation program that has changed direction of the System Involved in all major decisions Capital Consulting Leadership Recognition that shape of the institution has changed and more professional management is necessary Scale and scope of operations Challenges of meeting the mission Potential for misappropriation