HomeMy WebLinkAbout1985
VWW MrMRIAL IIOSPML
TNCOI.E STATEI4W
MAY 31, 1985
MONTH Yrm 117 DNMI
16 PIMOR PRIOR
ACTUAL BUDGET VAR. Y AR ACTUAL BUDGET VAR, M
PATTINP SERVICE MWINM
TnpaL•ient Revenue $ 105781250 $ 113921505 13,3 $ 1,329,608 $11,280,063 $11,2.63,594 .2 $10,412,56.
Outpatient Rovanuo 235,674 1591580 47,7 ].75,075 1.,468,408 1,259,752 16,6 1,271,55(3
Total Patient. Rovonue $ 1,8131924 $ 1,552009.i 16.9 $ 1,504,683 $12,748,471 $12,523,346 1,8 $11,684,11(,
DEDUCTIONS FROM REWNM
Contractual Adjs, 201,900 84,379 139.3 224,788 863,900 680,756 26,9 783,000
Dad Debts 228,016 166,074 37.3 281,645 21184,162 11339,998 63,0 11704,196
Other 9417'16 811532 16.22 43,361 693,504 657.,853 5.4 442,591
Total Deductions $ 524,692 $ _ 331,985 58.1 $ 549,794 $ 3,741,566 $ 2,678,607 39.7 $ 2,929,79_
:Jet Patient Itevenuos .1,289,232 11220,108 5.7 954,889 91006,905 91844,739 (8,5) 8,754,323
Other Rovenues 41,553 29,521 40,8 39,965 370,483 234,620 5719 194,471
Total Not Revenues $ 11330,785 $ 11249,629 6.5 $ 9940854 $ 913771388 $10,079,359 (7,0) $ 819480790
OPCRATM EXPENSESi
Salaries & Wages $ 524,764 $ 572,343 (8,3) $ 604,166 $ 4,2891251 $ 41492,440 (4,5) $ 40688085D
EaVloyce Benefits 84,942 83,815 1.3 78,862 612,728 662,699 (7,5) 463,435
Professional Fees 156,290 1210524 28,6 163,932 11200,407 972,985 23,4 11096,056
Operating Supplies 203,974 1940732 4,8 208,777 10475,702 11559,676 5.4 1,410,842
Wier 202,606 179,883 12,61 1731896 11214,499 .11413_,929 (14.1) 1,274,669.
Total Operating Expenses $ 1,1.72,5 76 $ 1 13.52,297 118 $ 11229633 $ 8,792,587 $ 9,101,729 (3,4) $ 8,993_,857,;
Income (Loss)
before Deprici.ation $ 158,209 $ 97,332 62,6 $ (234,779) $ 5841801 $ 9770630 (40,2) $ (451061,
Depriciation (37,538) (37,558) (,1) (39,285) (302,603) (3240558) (6,8) (31,2126%
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Non-Operating Revenue 203,283 31691 251,972 725,191 29,528 271,091
Total Income (Loss) $ __323,954 $ _ 631165 ~ $ (22,092) $ 11007,389 $ 682,600 47,6 $ (86,23-
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rLA{4 MEMORIAL HOSPITAL
BN ANC:r SWET
hhy 31, 1985
r'URRENTi 1985 1984
CURRENTt 1985 ~ 1984
Cash 6 Investments $ 943,544 $ '788,189 Current Notes Payable $ 331,723
Accounts Payable 1,056,467 $ 950,904
Patient Receivables 51386,730 404990655 Accrued Cxpenses 425,205 560 418
Less Allowance (2 241 802) {2 0$ 22 018 Due Govern, Agencies 227,368 622 549
Net Patient Rec. ,a t 1$ 2, , 3
Other Current Assets 431,98b 6281924 Total Current Liabilities $2,040,763
$2;352,046
Total Current Assets $ 41520,458 $ 318940750 Long Term Debt' -.7251034
987,648
Total Liabilities $2,765,797 $3,339,694
Protx3rty Plant & Eut p-.
land lmprovements $ 183,242 $ 183,242 Fund Bnluncet
Building 21951,987 21943,464 Donated Capital $4 455 779
$4,955,779
Ecauinont 5 134 112 4 891 678 Pledges & Gists 908,262 608,
e,OL8,38Fund "~d Dal, f3' 500
t,esst Accum, Dep. 5 173 863} 4 775 798 eg. of yr, (1,521,291) {1,180,404}
Not P.P. & L. g ,2 4 27M , ) Inc, & rxp, stmmary 1 007 389 {86 233)
Total Fund Balance no',m
Total Unrestricted Fund$ 7,615,936 $ 737,336 Total Unrestricted Funds $7,615,936
L711371336
rIJDW bII'.bYMAT, HOSPITAL
&IINVISPICAL STATCMCNP
AIiy 31, 1985
CURRENT MWPH YCAR TO DATC
PATIENT UTILIZATION; ACTUAL ~Dt743
YEAR
R, PRIOR YEAR ACIIJAL D F""-
Adult Patient; Days _ - _ - - 2,102 ) 2,826 18,283 22,030 26 Averago Per DaY G7, B y~ 91.1 `7x2` g~ T Nowlorn Pationt
Days 353 - nT 22jo - 3nIT Average Per Day_ _ _ - _ _ 11.4 T2, 5i9.0 1T.0 - Q7; ` r, 1~. ~5~
M=W I(D-.,
ICU Patient Days - T03 _ n -145~ -(29,0 122 6 Percent of Occupancy - ` - _ 43,5 " j ~(23;3f (I7:0~ 5'7:G `
Admissions - - ` - 472 - 546- `(13;6 -4 Sb - T,ZnT T4 ;'7
3- 4;270_ _
Discharges - _ _ _ _ - T7 0 _ 549- -(f4;4 586 4,07b - T 2'46' 7h~f 4;255`
*.vorage Longs, Jr. Stay - - - _ T,0 _ `5:0- -(20;0 ` - T.6 ' 4:4 " 5'.()'
Medicare & Meaicaid Uti1.- _ 35.1 - - To-.()J' _ J' -;o - 3T. W - 3x.6 IT. 5-% -573- R 7J W'
{J drIICR UTILIZATIONt
0,R, Procedures _ 194 174 11,5 266 1,351 I j492 Laboratory Tests- - _ _ - 13-287 i5, 082 ill,-9) - 15-564_ - 111,835 -121~1t33J (g
5) 1,830
_ `(2,8) 118,337 -
Respiratory Thor. Treatmts. _ _111538 ~ 2,058 725,31 24425- „ `16,616 - 16,525 - i.D 20,235
Ihidiology Exams - - W ,363 _ 1,509 _(9,7) - 14583- _ 1.01798 12,115, 110,9) ]2,256 _
Inorgency Room Visits -1,095 - 1,046 s.7 - -14162 9
_ ,210 - -7,872- 17,0 - 81233 -
Physical Thar, 'Ireatmts. _ -1,-095-
630 76T 120.11) 895 4 N9 6-.2J8` T27, 9*)' 6,584
Dietary Meals Served T4- U7 18,07$ TIU.9) _ 18-422- - T20,097_ _197'601- J13,2) 148,143
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PIP,;R ADULT PATILSPC DAY;
Gross Patient Revenue _ '862,95 $565,84 52,5 $532.44 $697,29 $568.47 22.7 532,89
Not Operating Revenue - - 633,7.0 455.57 40.0 35,,04- 512,90 457,53- -12`,1 8,14
Operating Upenses 575,70- 433,78 32,7 - A49.02~ _497.47 423,08, 16.3 -424743
Income from Operations- _ _ -51. '1_ - 21-79 163,5 - 796.98 ` 15-43 -29,64- i_43,6) (1673-
I,ADOR COST MANAMM-ri
rull.Timo Mquiv, rmployee _ 334,9 370.8 (9.7) 400,5 _ 362,7 370.8 _(27,~ 496.5
F,T,C, Per Adult Pt. Day - - - 4,9 -4,2 ,1 4
36 7 T,4 _47 ,7~ - -
,5
Payroll as a L' of TotalExp, 43,4%- - 48-18 ;ff _ .4T7-28 _1(o.1 5_0,68
" V Of OccupanCy based on operations/bodo Current Mbntth - 49.1%
rtAW MEMRIAL HOSPITAL
CAVARATIVE ANALYSIS ACCOUNTS RECEIVABI-B
NVtY 31, 1985
AGING BY DISCHARGE DATE
% of % of
DAYS CURRENT MONTH 'IYY1'AI. PRIOR MONTH 'ICYI'AI,
0-30 $ 1,806,164 33.4% $ 1,7960738 36.1%
31-60 1,0801640 20.0 11041,956 20.9
G1-90 734,072 13.6 603,788 12.1
91-120 493,339 9.1 432,787 8.7
1.21-150 300,021 516 151,278 3.1
151+ 986 297 18.3 952 418 19.1
IW79 4,97;96 1d0OB
51.4a~ 0
AGING BY PAYMENT' DATE
0-30 $ 21743,471 50.8% $ 21388,895 48.0%
31-60 1,112,510 2016 11187,764 23.9
61-90 739,873 13.7 710,494 14.3
91-120 372,G36 6.9 333,996 6.7
121-150 172,817 3.2 99,778 2.0
151+ 259,226 4.8 258,038 5.1
$ 8,400,533 100.03 $ 4_1978,965 100.08
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R1VENUL BY FINANCIAL CLASS
CURRENT MONTH 5/85 4/85 3/85 2/85 1/85 12/84
Mudicare $ 51.81918 28.6% 25.45 24.5% 28,32 30.8% 28.18
Medicaid 75,159 4.2 7.1. 4.6 2.9 2.5 3.1
Blue Cross 1210273 6.7 5.1 3.3 3.3 5.4 5.2
Commercial Ins. 710,448 39.2 41.5 44.5 44.1 37.4 41.4
Self Pay 306 871 21..3 20.9 23.1 21.4 23.9 22.2
`ital" z ~ 00 0% ~b0 0% WOM TO-N% 03"0.,'% -0. ON
DAYS Or RCVCN_UE IN A/R COMM, MONTH 4/85 3/85 22//885_ 11//85
Cross 0
Not 60 60 60 60 69
WRITE OPPS ~ RECOVERIES CURRENT rlOMH YEAR TO DA'I'S DRG OUTLIERS CURRC.N'C mWill YT-All TO DAM
Charity $ 17,677 $ 610,933 4 Discharges 5 22
Marl Debt 36,604 21330,227 over $18,000
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Panhandle Pooled Health Care Financing Program
2710 Stemmons rreewe.Y, Salto 910, North Tower, Defies, Texes'15207 (214) 631.2710
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TABLE OF CONTENTS
Introduction to The First Boston Corporation
List of Pooled Health Care Program Clients Schedule 1
The Pooled Healtp Care Financing Program Schedule 2
Schedule 3
Comparison of Tax-Exempt Financing Alternatives
Comparison of Tax-Exempt Indices; Key Borrowing Schedule 4
Rates and Investing Rates
Services Provided by First Boston Schedule 6
Schedule 6
Market Risk Minimization; Hedges and Interest
Rate Swaps
Schedule 7
Panhandle Pool Demand Questionnaire and Quarterly
°Report
Schedule 8
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A. IohM Knft !hams Allen Moon
Vice Praident WINlenl F. 1181,111
The Plrit 1laton, Bond Counsel Proanim Adminhtruor
corporegon Boyle
220.67)5 Boyle son Price Inte6rged Ne1NN xeraurcee
ky) 1715) (214) 7518 8600 600 Inn.
(2!14) 11) 631-2110
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INTRODUCTION TO TH8 FIRST BOSTON CORPORATION
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THE FIRST I30ST011 CORPORATION
First Boston is a leading international investment banking firm, with
capital exceeding $067 million, while headquartered in New York, First Boston
has domestic branch offices in Atlanta, Boston, Chicago, Cleveland, Dallas,
Denver, Houston, We Angeles, Philadelphia, Puerto Rico and San Francisco, in
addition to five offices overseas. Its employees number approximately 2700
with 2200 located in the New York headquarters, we have 33 employees in our
Dallas and Houston offices, First Boston is recognized as a major participant
in the domestic capital markets and, through its affiliate, Credit Suisse
First Boston Limited, is also a leader in the international financial markets,
capable of offering its clients unparalleled capital raising and distribution
services worldwide,
As an investment bank, First Boston engages in activities that facilitate
the flow of capital between investors and borrowers, First Boston manages and
participates In the public offering of stocks and bonds, as well as the direct
placement of debt and equity securities in the U.S. and major international
" pital markets. First Boston also advises clients on a wide range of
financial matters, including project financing, financial planning, mergers
and acquisitions, real-estate, leasing, and the issuance of commercial paper,
Finally, as a member of the nation's major stock exchanges and one of wall
Street's most active broker-dealers, First Boston trades and makes markets in
the securities of state and local governments and authorities, industrial
corporations, publir istilities, the United States Government and a variety of
federal agencies,
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Ti{E TAX _~~pT PRODUCT_GROUP
For the past decade, Fi
firms in rst Boston has consistent)
-Exempt consistently ranked
overall municipal bond and note underwritin
The Tax among the top
private entities Product in Group has responsibillt g on a national basins,d
grou is pia "ing, structurin y for assisting public a
p comprised of two departmentsi the Public marketing
is responsible for debt issues, The
Department, wh~,h
and negotiated the Tax-Exempt Se underwriting and financial advisor
curities Department, which
y services,
underwriting and all tax-exempt sales, trading,
Tax-Exempt Product Group manages competitive The
Finance Department and Thomas o t na a by John R;cation and research, Public
The Interaction between the Tax-Exempt Securities Department,
receive full both Departments ensures that First Boston's chants
a financial Y coordinated financial services, from the initial structuring of
Instrument through its fi ultimately, to the secondary market, nal marketing and underwriting and,
John Kraft is responsible for First Boston's
the Southwest. Prior to PubOf 1984, r K ft lic Finance Joining First Boston in May
the past five practice in
specializin years with two Houston-based regionalinvestmentMbankre spent
g in tax-exempt financing, lie has been the project manager on over
g firms,
$1,50 billion of tax-exempt financing for cent
$1,25 billion of tax-exempt financing for Tsxaslihossitals Texas includin
a B, S, degree In economics from Mr. University and an M,B e g over
from The p Kraft received
Wharton School, University of Pennsylvania, Ile has lectured widely
on a variety of health care financing issues, •
First Boston's tax-exempt note desk consists of five
are responsible for First Boston's substantial underwriting,
activities in all areas of the phort term tax-exam t professionals who
the proposed pooled health care loan program for West Texas sales and trading
would be responsible for the p Market , With regard to Be Individls
pricing, marketing and trading ofttheesecuritiies,
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PRQ7DCT FINANCING TFAM
The following Lndividuals will se
~i establishing the Panhandle as
Pooled Health Carve re Goanthe core
working group in
Program,
THE ADMINISTRATOR,
i...' Hr; William E.
Parisi of serve aye Administrator of the Programranddwilllbe responsible nEornctio 1 will
efforts b' r~a
ffort Y health Care organizations to borrow funds under the Including the submission and timely processing of Goon Approval Applications
the arrangements for Goan Closings, program,
Integrated Health Resources
International, Inv,
2710 Ste,mons Freeway
Suite 710 North Tower
Dallas, TX 75207
William R. Parigi, President
(214) 631-2710
THE UNDERWRITER, MAMMINO AGWr
AND INDEXINO AQENTj*
~j As managEnq underwriter in
marketing the bonds, First structuring the Pooled Looa team 09 people that set u Boston
and
will be responsible for Coonrdinntinmq the
progra
P fwation during the life ofpthe programe r"r#M,n' It will continue to perform
j~ responsible, as Indexing , In addition, First this
Adjustable Agnt, for setting the weekly Interestsratewonlthe
Rate Bonds, En
Participating hospitals, Finall turn , will be paid from Goan Re
anytime Bondholders exercise y' First Boston will remerket P dente by r option Queatione on any aspoct of the Pre1ram may b to have
their Bonds Bonds
oq may be addressed for purchased,
The Virst Boston Corporatlt i
3030 Texas G
600 Travis St eetoe Tower
Houston, Texas 77002
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I' y A. John Kraft, Vice President
r 0653Y Charles R, Sena, Associate (713) 220-6700
(713) 220-6700
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BOND COUNSEL;
Ae Bond Counsel, Hutchison Price Boyle & Brooks the financing
will draft s.for
the Bo con exttof federal andnst to statautndts/reviewregulother documents in the
program in the
Hutchison Price Boyle & Brooks
3400 First City Center
Dallas, Texas 75201-4622
Allen Moon (214) 754-8600
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COUNSEL TO THE UNDERWRITER;
Kelly, Appleman, Hart & Hallman, as Counsel to the Underwriter, will advise
i First Boston on legal issues associated with the implementation of the program and
the marketing of the Bonds,
Kelly, Appleman, Hart & Hallman
2500 First City Bank Tower
201 Main Street
Fort Worth, Texas 76102
James D. Holland
S817f 332-2500 '
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FIRST BOSTON'S MARKETING CAPABILITIES
E'1rsC Boston can apply
c4cbillties to the short-termfinancing needs of ltskclients and distribution
• In a recent independent survey of over 700 majq>r institutional
I~ investors, First Boston ranked first in overall tax-exempt sales
performance among institutionally-oriented firm9 and second 4n
the overall securities industry.
• First Boston's marketing system is staffed to ensure a wide
distribution of variable rate securities! We currently have nine
domestic offices with over 250 registered salespersons,
approximately 23 of whom specialize in the sale of tax-exempt
money market instruments.
• With more than $867 million in capital, First Boston has the
ability to commit its funds for to purchase of unsold securities.
In summary, First Boston has extensive experience in structuring
variable rate demand notes and tax-exempt commercial paper programs and has
been a leader in the dvelopment of pooled equipment loan programs for health
care institutions. Our record and the marketing and administrative resources
we have committed to this area are evidence of the quality of investment
banking services that we provido,
REMARKETING d leader in of taxable andirst
t x-exempt variablecrratezQ in truments. tDespite the volume tang
and
variety of these instruments, we have maintained a record of which we are
' extremely proudi NO FIRST BOSTON CLIENT HAS EVER BEEN FORGED TO ACCESS A BANK
LINE. First Boston's policy is to undarwrite on bonds tendered back to the
tinder agent. As long as the capital markets are functioning, we assume this
remarketing risk. In summary, First Boston has never failed to remarket bonds,
It is important to note that the short term variable rate market
is appr0xL41etely $250 billion, First Boston is one of the top 5 dealers in
this market. We are remarketing agents on approximately $20 billion of
floating rate notes and commercial paper,
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INNOVATIONS IN POOf.ED FINANCIN__ G PROGRAMS
In 1982, First Boston was asked to explore financing alternatives for
pooled financings, At that time, fixed rate bonds had been "he only vehicle
for financing pooled programs, While fixed rate programs were more attractive
than previous alternatives, their .10ficiencies became apparent to the major
issuers of pooled equipmant sec+rities. High cost and inflexibility
as the major disadvantages, The costs associated with developingecand
marketing a fixed rate program ensured a high loan rate and reduced the amount
of loanable funds as a percentage of the tax-exempt borrowing. Narrow spreads
between the tax-exempt bond borrowing rate and taxable relniestment rates
reduced the potential to maximize loan subsidies from arbitrage income,
f Hospita.ts that borroi.ed from the pool were locked in until maturity unless
they paid a substantial prepayment penalty, Fixed rate programs were sold in
the intermediate term market (5-7 years) which was 2% to 3: less attractive
than funds available in the short term market,
In 1983, First Boston responded with a pooled financing program utilizing
tax-exempt commercial paper (TFiCP) which addressed each of the disadvantages
of the fixed rate programs, We followed up our TECP programs with a variable
rate hospital pooled loan program (which we named "ACES", for Adjustable,
Convertible, Extendable Securities) which greatly expanded the uses of pooled
loan funds and preserved the dramatic advantages as compa
programs, red to fixed rate
L?iMEpIN REALTH CARE FINANCING
First Boston is lead manager on 65.4% of the $788 million of all hospital
commercial paper programs currently outstanding, In addition, Flrat Boston
has been lead manager on 57.2% of the $1,949 billion of variable rate hospital
pooled loan programs that have been completed, First Boston is also the
largest issuer of Hsalth Care variable rate financings, with $1.4 billion of
'A issues since 1983, giving us a 24.7% market share, And in terms of the total
volume of all hospital debt issues completed during 1984, First Boston ranks
third in the securities industry amoung lead managers, having been lead
19 manager on $1.036 billion or 11% of the $9.445 billion of hospital financings
10 that hay-„ been completed nationwide.
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HEALTH CARE COMMERCIAL PAPER PROGRAMS
FULL CREDIT TO LEAD MANAGER
SOURCE: SECURITIES DATA BASE
JUNE 24, 1985
FIRST BOSTON
S 5154 MILLION
65,4%
OTHERS
S 2 '2.0 MILLION
34,6%
HEALTH CARE VARIABLE BATE POOLED FINANCING PROGRAMS
FULL CREDIT TO LEAD MANAGER
SOURCE= SECURITIES DATA BASE
01/01/84 THROUGH 07/10/85
FIRST BOSTON
$1115.OMILLION
57.2%
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OTHERS
$ 834.3MILLION
42.8%
TOTAL HEALTH CARE VARIABLE RATE ISSUES
FULL CREDIT TO LEAD MANAGER
SOURCE= SECURITIES DATA BASE
01/01/83 THROUGH 06/24/85
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FIRST BOSTON
$141160MILLION
24.7
OTHERS
$430140MILLION
75M,
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LIST OF POOLED HEALTH CARE PROGRAM CLIENTS
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PULELREALTH CARERFIHAHCIN~
C+-~,URAtL.EXI1SlENLL ~
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` Site of Issue Credit And ,
r+311 !?IILA Issuer ~~0001 liquidity
May Pinellas County Uutatlonal [ns ~--F m.~n-5--- _$ypflort
1985 facilities Authority = 61.200 Tax-Exempt
Commerc MOIA/Credit
Paper ial Suisse
February Colorado Health fa0111t1es
19a5 Authority i3.32S Fixed Rate MBIA
Mote
Oecefter Alabama Special Care Facilities
1994 Authority of Birmingham 100,000 Variable Rate MOiA/Credit
Demand Bonds Suisse
November Wisconsin Health facilities
1904 Authority $2,500 OVUM Variable Rate HGIA/Crodlt
Demand Bonds Suisse
November McAllen Health Facilities 112,000 variable Reto Citibank
1984 DeveloDment Corporation (Texas)
Demand Bonds
November Amarillo Health Fatllftles
1904 Corporation (Texas) 25,000 variable Rate Citibank
Demand Bonds i
September Jacksonville Health Facilities r
` 1984 Authority (Florida) 52.800 TAX-Exempt MBIA/Credit
Commercial Suisse
Paper
August Orange County Health Facilities
1904 Authority (rTorlda) 94,306 TAX-Exempt HOIA/;redlt
Commercial Suisse
Paper
i July The Health and Educational
1984 facilities Board of the County 63,000 Tati-Cxempt MBIA/Credit
of Anderson, Tennessee COmmarcIaI Suisse
Paper
July Pinellas County Health facilities 50,000
1984 Authority (Florida) Commercial Chemical
Commercial Bank
Paper
June Palm Beech County Health
1904 facilities Authority (Florida) 69,900 Tax-Exempt MOTA/Credit
) Commercial
' Paper Suisse
June Illinois Health facillles
1984 Authority 50,000 tax-Exempt the first
COmmercial National Bank
May Texas Health Facilities Paper OF Chicago ir'' 1984 Development Corporation +r0,000 Variable Rate Citibank
Oemand Bonds
H984 Harris county Health facilities $0,000
009010peient Corporaton (Texas) variable Rate Texas Commerce
November Colorado Health Facilities Demand Bonds Bank
ia 1980 Authority 311000 Tax-Exompt MBank
Commercial Dallas/
pAper Credit
Suisse
fix
October Illinois Health Facilities
P 198) Authority 150.000 Tax-Exempt the First
Commercial National
Paper Bank
II11AL_dt101IN! Of Chicago
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THP POOLED HEALTH CARE FINANOTNG PROGRAM
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OVERVI1:47 -OF-THE ~POQLEILLW_hL~ILCA
ProgramStructure
Under our pooled health care financing program, the Issuer will
issue Adjustable, Convertible, Extendable Sercurities ("AGES"I on behalf
participating health care institution to finance equipment purchases, related
ed
amountusufficient ttormeetitth@f;n8titutionsas financinES will be issued in an
' certain time interval (e.g, three g requirements within a
years), the Issuer will instruct theTrusteeeto treleaseathe g funds projetoct is
health care institutions, The ACES can be paid down on either a level debt or
the
level principal basis, The program is flexible enough that the program size
may be increased or decreased quickly enough to meet the diverse needs of
participating hospitals or new program participants,
E1. ioibili y
Loans from the pooled health care loan program may be obtained by
non-profit health care institutions
wholly (hospitals, nursing homes)
-owned subsidiaries of such non-profit organizations,
percent of the funds available in the or by
five
institutions for pool may be borrowed b Up for-profit
joint venture projects between non-profit and for-profit
health care organizations,
Loan proceeds may be used to acquire, construct and install
Improvements (i.e. health care facilities and equipment, including financing
expenses). Loans may also be used to refinance the cost of Improvements, In
addition, loans may be used to reimburse a hospital for equity that was
previously invested in Improvements
the bonds, Loans may be used to refund htax blew and atax exempttdebteexcept In
those cases prohibited by bond counsel due to Fodaral tax regulations,
Sources of_Pa ent
The ACES issue will be a special limited obligation of the Issuer
payable solely from the loan repayment
pledged to the Trustee, s and other funds and assets held by or
State of Chet her thewi Issuer "liableyto county or
political subdivision of the
Issuer ll be ereak ed the
issue. The sources of payment for the isspay ue will Include (ir) thep e
s of
sale of tile ACES issue, (it) moneys payable under the Loan Agreements, (Ili)
earnings on all moneys hold by the Trustee, and O v) the liquidity andcredit
supports under the Credit Support AgroemenL, as described below,
iu
i•e SaCUri-1y
a The ultimate security for the issue will be a Credit Support, which
may be either an insurance policy or a letter of credit, The Credit Support
entity will pay the holders of the ACES issue if market conditions prevent it
from being remarketed or rolled over, The Credit Support would
0653X
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„ also pay if one or more of the hospitals defaulted on its obligations to make
payments when due, so that the program may continue unimpinged with the
remaining participants, To date, however, no First Boston client has ever had
to draw on its Credit Support,
In addition, depending upon the requirements of the Credit Support
entity, a reserve fund may he funded in an amount up to 15% of the par amount
of the issue. This fully funded reserve fund produces maximum arbitrage
earnings for the Issuer,
l ~
Fx enses
Certain fees and expenses associated with the initial issuance of
the ACES will be paid from proceeds of the initial sale of the ACES issue,
initial issuance expenses as well as annual ongoing expenses will be recovered
and paid by earnings on funds held by the Trustee,
is 0653X
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MORE ON "ACES"
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Adjustable, Convertible, Extendable Securities ("ACES") are variable
w rate securities which are supported in the market by a bank liquidity and/or
credit facility. ACES have become extremely popular because they offer low
coat funds and future flexibility, ACES are structured to provide; (1) an
adjustment privilege which will allow the issuer to extend or shorten the
tender/pricing period, includinq daily or weekly repricing; (2) a tender
option for investors, also adjustable at the issuer's option, including either
one or seven days notice; (3) monthly interest payments, and (4) the ability
It convert to a fixed rate obligation. This structure maximizes market
acceptance, minimizes exercise of the tender option and interest expense, and
permits the issuer to respond quickly to changing conditions in the market
place,
The conversion privilege to extend or shorten the tender/pricing period
is the important feature which distinguishes ACES from other variable note
programs. ACES provide the issuer with the option to reprice daily or weekly,
and to shorten or extend that period to a semi-artnual, annual, or longer
tender period. The issuer also has the option to convert to a fixed rate
effective on any interest payment date, In addition, it is possible to
convert to a TECP structure, if desired.
This instrument affords an issuer maximum flexibility to change both the
pricing structure and the pricing period according to its needs and market
demand. As the tender date approaches, the issuer, in consultation with First
Boston and the financial advisors, would decide upon an appropriate future
tender date and corresponding interest rate, In setting the ACES interest
rate initially on a daily or weekly basis, the objective is to keep the rate
in line with market changes so that bonds that are tendered can be remarketed
and so that holders who do not exercise the tender option are comfortable that
J the ongoing rate will fairly compensate their investment,
J As with the vast majority of our variable rate instruments for capital
purposes, ire suggest that the issuer's ACES have an optional conversion to a
fixed rate effective on any Interest payment date, Although exercise of this
flexibility may be limited by notions of reissuanoe based on tax
considerations, we propose that the issuer retain the option to change both
the rate and Its duration according to its needs and market demand, Thus,
with appropriate notice, the issuer could choose to extend the repurchase
option to one year beyond an upcoming interest payment date, announce a rate
for the one year and eliminate the weekly remarketing for that year, As the
new tender date approaches, the issuer, in consultation with Its Financial
Advisor and First Boston, would again decide upon an appropriate future tender
date and corresponding interest rate,
In actually taking advantage of the conversion option, the issuer and
its Financial Advisor will need to consider (i) placement costs, (ii) market
demand and (iii) yield curve dynamics at the desired interim maturity, Since
initial purchasers of the ACES are strictly short-term investors, they have
exhibited little interest in conversion features except to assure themselves
0653K
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of a tender option when and if the debt is converted to a longer effective
term. The short-term market having been continuously attractive since
variable rate Convertible bonds were first introduced, First Boston clients
have not yet exercised their conversion options, However, reserving the
issuer's right to select various pricing/tender durations enhances the
li
flexibilitty would allow the issuer to maintain aesubstantial t degree This
control
over its market exposure on the debt aide of its balance sheet.
i
Objective c To raise low interest rate capital Ifor the Issuer utilizing
a flexible financing structure that permits rapid response
to market conditions.
Descriptions The Issuer desires to raise long term capital in the
tax-exempt market and to take advantage of current and
historic yield curve benefits of short term borrowing. An
issue of multiple series Adjustable Convertible Extendable
Securities (ACES'"`) can be sold with various Interest Rate
Periods extending from one day to any multiple of a month,
The ACES can be tendered by investors for repurchase at 100:
of their principal amount at the and of any applicable
interest Rate Period and will be remarketed to new Investors
by First Boston, The Issuer may change the Interest Rate
Period of any Series of the ACES subject to proper notice,
Benefits; For tax-exempt iasuers, the ACES Programs
a Retains the low interest rate advantage of variable rate
i debt.
• Offers the ability to price individual Series at' various
points along the yield curve.
• Permits timely hedging of interest rate exposure through
the extendable and convertible features for individual
Series of ACES.
• Reduces the time requirements and financing costs
associated with refunding issues.
s, Examples Step 1.
The Issuer has a $100 million construction financing
requirement that will amortize over 30 years. Series A, B,
C, and O of ACES are scheduled for sale with $25 million in
each Series and maturities in years 14, 20, 25 and 30,
respectively, One Official Statement is prepared describing
the Initial pricing alternatives available for each Series
b• and the extension and conversion options available to the
issuer.
06539
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i
Step 2.
On the sale date, the Issuer can establish the respective
Interest Rata Period for each Series and the( corres
' prices either together or individually, pondinq
Initial Sale and Subsequent Repricing,) See table of
Step 3.
One year after the initial sale, the Issuer recognizes that
f a strong market rally is underway and desires to take
li advantage of the move to lower interest rates while reducing
futk're interest rate exposure. The Series A ACES, with the
earliest maturity date, are converted to a fixed interest
rate to maturity (now 13 years) at prevailing interest rates
for issues of comparable size and credit quality, The
Issuer extends the Interest Rate Period of the Series B ACES
to three years at the appropriate interest rate.
Stop 4.
At the end of the second year, the construction program is
Issuergdesires ttontakand the e furthers advantage of the deteriorating, yield curve
and achieve some savings by retiring a portion of the Series
D ACES from unexpended proceeds of the original issue. The
Issuer gives proper notice and changes the Interest Rate
Period corresponding to daily pricing/tender bonds,
59 In ia1 Sale and Subseauent Renricina
Series Principal Initial Sale/
Amo~n~ One Year Two Years
Interest Rato Period Later Later
A $25 MM Weekly Conversion to
Fixed Interest
Fixed Interest Rate Maintained
Rate
B $25 MM Weekly Change to 3 Years 2 Years remaining
C $25 MM Weekly Maintain Weekly Maintain Weekly
D $2S MM 2 Years 1 year remaining Change to Daily
„o
' 06539
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COMPARISON OF TAX-EXEMPT FINANCING ALTERNATIVES
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COMPARISON OF TAK-E%EHPT FINANCING ALTERNATIVES
I J ~ ~
I FINANCING VEHICLE I ADVANTAGES I DLSADVANTACES I
_ I I I
I
f Fixed Rate Oends I • No market risk I • Substantially higher I
I • Na administrative burden I borrowing rate
I I • Substantial loan J
+ I I prepayment penalty
J t • No Flexibility I
I • Limited arbitrage I
I I I earnings
I I I I
I Adjustable, Convertible I • lower cost J • Market risk
Extendable Securities
I • Program flexibility I • Some edmin4stratico I
I • possibility for I required
I I Arbitrage earnings I • marginal risk of Change I
I • No proPSAMnt penalties I in law I
i ' I I • Loans are always made at I
I I prevailing market rate I i
I • Can be converted to I I
i fixed rate I
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COMPARISON OF TAX-EXEMPT INDICESt MY BORROWING
RATES AND INVESTING RATES
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ATY /NVESTINO PATES
16
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14.5
14
13i~
1215
12-
,_5
10 5 w,,r~/y~~a N 8
to-
9.6-
9-
8.5
7.5
8 M NN Y"N
5.6- N•NI.~1 111NNIN 1 M
NI~,'•I~NIIN. MIj1 ~~~INN MI.I~N~,
yNN N1. %10j, N.. N
6- \6 1
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4-
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2
1.5
1 J r h R M J J A S O N Q J P h h !S J J R 8 0 N Q 1966 F M A n J J A
1983 1984
3-Year Treasury Bbl.(, Fate
6-Month Treasur. BLLL Rate
F',pC,.7-OMU..VarLabLe„Rate „Demand .,,Note „Index
..n fPaM~i'.
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SRRVTCLS PROVIDED BY P7:ABT BOSTON
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SERVICES PROMVD By FIRST BO;iTOM
AS A MAJVAGING UNDBRWR 1TI 'R
As a managing underwriter,
services required First Boston would provide all
~ to accomplish a successful financing,
provided are as follows: The main services
Financing Plan Development
The development of a Financing Pian requires the coordinated attention
of the Underwriters, the Issuer, passibility
Counsel, Bond Counsel, and Auditors, Consultants, the Underwriter's
The Plan is
considerations, feasibility studies relatin based u
existing legal statutes 9 to revenue upon market
governing the issuance of debt securitiese~tlons, and
First Boston's services in developing the Financing Plan will
all of the following;
encompass
• A thorough review of the financial objectives of our
existing and proposed financing resources, client,
the feasibility study,
as well as all relevant plans, leases and agreements pertaining to
the proposed project;
• Recommendations relating to possible changes or additions
existing financing resources and legal structures;
to
• Determination of the amount necassary to be issued to finance the
proposed project, Aleo, the amounts needed for debt service
reserve requirements, amounts
and all other expense for contingencies, financing costs
s i ncidental to the project(s); and
• Evaluations and recommendations of financing and
options, Including recommendations as alternatives
intermediate-term tfinancing prior to, or in con
n
junction with, financing, or
Ratin A enc Presentation
To ensure a fair and favorable rating review, First Boston's
preparatory activities will include the following;
h+.
• Preparing detailed summaries of recent agency evaluations of other
similar credits, so that our client representatives will be aware
IYY
of the current concerns of the rating agencies;
• Developing a detailed list of
the issuer's consideration questions and areas of inquiry for
agencies, Including video to prior to any meetings with the rating
ping rehearsals of the presentation; and
• Providing oxplanatory material to the rating agencies
enable them to evaluate in order to Possible light, our client's financing program in the beat
0653K
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Role in Pre arin the Official Statement
First Boston will
distributi assume full responaibilit
distributing the Official Statement,
Y for preparing
and
OT)(ER SER_ _UICES
In addition, First Boston will, as managing underwriter
following other services;
. provide the
1
• Pre arin a reliminar timetable for the financin
will be drafted to facilitate coordination and Planning timetable
parties involved in the financing; P g among all
• Conductin an indenture $ ud An indenture study of covenants, terms, and conditions that have been used eyin1nrecent
similar offerings will be conducted, This study will provide a
basis for determining those financial covenants
appropriate for our client's particular needs; which will be
• Anal zin financin alternatives and structurin
Specialized financial analyses will be conduct dins nci r er to
achieve the best terms for the issue;
• esi Wing and im Jementing a marks art Q ram- and Implement a marketin We will design
education of g program which potential investors includes (i) presale
(iii) , fii) appropriate advertising,
Preparation of a Sales points Memorandum summarizing F):e
offering's most salient facts and attractive investment features
and (iv) effective coordination with regional securities dealers;
• Pri,cia new issues, We will keep our client's
of market trends and economic conditions which may have impact
on its financing programs. On the day of the sale,iuwdeawill utiize
a variety of pricing tools and the combined
investment banking team to determine final offering gment of our
• Mara In termer te- or form ands lead 1Caas needed ~i roc of
;~ndery~rit~, We will
underwriters who can provide an opt mumCdistrl
or seling butionlcapabil! y to
r each of the our client's issues;
• Provid~bt-salrv1e, We will
'reinvestment in the provide a tailored plan for
Anin est of DlstribUtiony to d government securities markets, an
r~ financing programs and seconder aid in the development of future
of the our client's Securities;yandrket support to ensure liquidity
ke • Provid cent--- ~nuina investment ankiny
continuing rekatlonshiN wlt~ ou clankkit F~ atonA p
Ir a substantial number of financial advisor art of a
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MARKET RISK MINIMIZATIONS HEDGES AND INTEREST
RATE SWAPS
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MARK6`f RISK MINIMIZATION: F{EAGES NJD INTEREST RATE SWAPS
Inherent in the structure are a number of safety features designed to
mitigate risks which face a borrower in its variable rate financing, In
order to analyze and avert (insofar as possible) those risks, it is useful to
divide them conceptually into two related categories: market risks and rate
risks. The first category represents the risk that bonds will be tendered by
investors and that substitute investors cannot be found. The second category
thanoasborrower can eco omically afford ~to pay ndAsrattoseacin the futur
h "tegoryrofhrisk,
our proposed structure provides what we perceive as adequate protection to a
borrower, particularly in light of the substantial advantages presented by
this borrowing,
1. Levels of Protection Against Market Risk
a. design to assure broad market acceptance
b, placement in strong hands with appropriate
investment objectives
c. continuously current market pricing
d, experienced and able remarketing
e1 contractual underwriting commitment of FBC
f. ultimate availability of bank funding
9. continuing attempt at market reentry even if
bonds go to the letter of credit hank
2. Levels of Protection Against Rate Risk
a, historic relationships among instruments in
debt market favoring similar variable rate
instruments
b, current outlook for and behavior of interest
rates
c, continuing ability to convert from daily or
weekly to longer pricing periods
d, the cap rate of 15%
Reviewing these risks and protections we conclude that a borrower is
adequately insulated against market risks but that rate risks should be further
limited through additional means. There~iore, we would propose for
consideration a variety of additional protections:
1. Shift ultimate rate risk to the bank, we have
10 successfully negotiated LOCs under which the bank
I agrees to fund at a rate no higher than 15%, even
1-4 where their funding formula would call for higher
rates, The bank can he compensated during such
11 periods by future "claw back" rights when rates
ki retreat. Nonetheless, First Boston's underwriting
commitment and the "cushion" berween current rates
r~ and the cap should provide an opportunity to shift
h* this upside portion of this risk.
Q653K
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2. fledge rate risk in volatile markets when the pool
perceives its position as particularly sensitive.
The Chicago Board of Trade trades a new municipal
bond futures contract based on The Bond Buyer
Municipal Bond Index. The futures contract settles
in cash and thus provides a realistic vehicle for
hedging short-term market exposure, First Boston
has been closely involved in development of this
vehicle and can assist in evaluating the contract
and using it when, as and if appropriate.
3. Swap variable rate exposure for fixed rate ex osure_
Under certain circumstances (for instance, to take
advantage of an inter-market anomaly), it might be
more advantageous for a borrower to fix its rate
exposure through a swap rather than through
conversion. Also, this form of "conversion"
carries none of the tax-related new issuance
concerns which bond counsel may have with an
optional conversion to new tender/pricing periods.
As a leader in the tax-exempt swap market, first
Boston can either arrange such a swap or act as
principal in a swap.
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PANHANDLE POOI. DEMAND QUESTIONNAM AND QUARTERLY REPORT
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Panhandle Pooled Health Care Financing P
4710 Stommons Hreeway, Suite 710, North Tower, b811as, TexB. 75207 c 214) 6)r~~rarn
1985 DEMAND QUESTIONNAIRE
Please send me additional information concerning anhandle
Pooled Health Care Financing Program, "The P
institution
I understand that an
any cos
ireceiveeae PP ra lo'an under the program, is not obligated to
we 07,1 Ssuance until and unless
r questionnaire is an expression of our Ho However$ upon trupleti ntof
~ this
This information should be sent to;
Name
Title -
Facility Name
Address tal doll Duringothe nextathreegyears,
A In, the a fundstestimat $
follows: estimated to a use are as
~ % of $
Equipment Requiring Construction Re uirin % of S
CON' New q g Construction Requiring
Approval CON Remodel CON
Approval 1985 Approval
1986
1987
Note, if your hospital would be interested in rcfinW ing-existing Y. -
debt either equipment or construction, through "The Panhandle Pooled
F„ Health Care Financing Program,,
attached sheet the terms and cond
(
refinanced,
Please itionsdofctheeflnancingbto°~e°r on an
FM
F
FxY
A, John Keelt 0
Vice President Thomas Allen Moon
The PIrs1 Roston, Pond counsel William E, Park,
Corpontloa Hutchison price Program Administrator
(7131220,673$ Rayle & Rraoks Imegraled Health Kesourca
(214) 1548600 In(arnattonal, Ina
1214) 6)1.4910
i
FLOW MEMORIAL HOSPITAL
THIRD QUARTER REPORT
10/01/84 - 06/30/85
The third quarter report encompasses the operations of the first
Irk, nine months.
I, Financial
Net income from operations is $405,706. When non-operating
revenue is included, the not income increases to $1,137,456.
Non-operating revenue is comprised of $700,000 from the City and
County and $31,670 miscellaneous, The County also provided
$250,000 for capital expenditures. The donated capital on the
balance sheet includes $250,000 in restricted funds. The capital
fund balance is $163,510 which has been committed for specific
projects and equipment.
The contingent liabilities are the bad debt allowance and
contractual overpayments. The deductions from revenue (bad debt
and contractual allowances) were 28.5 percent of revenue for FY
1984. The current deductions from revenue are 30.4 percent of
revenue reflecting a more conservative approach than prior year,
Days in accounts receivable have decreased fr,,jm 121 to the
current level of 84 days. The hospital has provided $628,238 in
charity care and has written off $2,512,903 in bad debts. The
accounts receivable is reserved for bad debts at 44.8 percent
compared to 46.9 percent for FY 1984. The six month cost report
indicated an overpayment by Medicare and Blue Cross. A restric-
ted fund has been established for repayment of this liability.
The current fund balance is $270,000 and is being funded at
$45,000 per month.
II. Utilization
Adult patient days are 15 percent ')elow prior year; however, the
month of June was higher than the same time last year. The main
factor in the decrease in patient days is the average length of
stay (ALOE) decrease from 5.1 in FY 1984 to 4.4 days, which
equals a 13.7 percent decrease. Discharges have only decreased
by 3.0 percent. Emergency room visits have increased by 9.7
percent from prior year. Most of the other ancillary services
have decreased activities corresponding to the census decrease.
Full time equivalents (FTEs) have decreased from 406.9 in 1984 to
306,8 for the first nine months. The PTE decrease represents a
24.6 percent reduction.
i„
Flow Memorial Hospital
Third Quarter Report
July 18, 1985
Page 2
III. charge structure
Charges for services have been increased with the objective to be
five percent below competition while i
bility mproving financial via-
. Room rates were increased in March by $10. New charges
have been developed for emergency :all back, cardiac arrest,
r 9ujorequipment, nutritional services, trauma rooms, central
pplY items, and monitors. The Emergency Service Program (ESp)
has been developed with a minor emergency charge of $25.
Procedures havE been written and implemented for lost and late
charges. The lost/late charges have beer decreased; therefore,
percent, The decrease in
lateechargesefacilitates asdecrease)in correcting itemized state-
ments and manual billing. New charge sheets have been developed
and implemented for labor and delivery, anesthesia, emergency
room, operating room, and recovery room. A new charge system has
been developed for the pharmacy, thus providing for daily charge
entry. Miscellaneous charges have been eliminated with all
departments except pharmacy. With the multitude of different
pharmaceuticals, miscellaneous charges cannot be eliminated in
the pharmacy.
The combined effect in the charge increases, new charges, lost/
late charge decrease is estimated at a $5.9 million revenue
increase over prior year level.
IV. Cash rmow
The Statemew of Changes in Financial Position developed for the
end of February and presented to Elie Board in March has changed.
The County has removed the restriction on $250,000 of the origi-
nal $500,000 capital fund plus an additional $200400 has been
contributed. The City will be contributing an additional
$200,000. Net income had been
current net income from nine monthseoperations3is8$405786. As-
suming net income from operation to be $534,832, the financial
position including City/County funds is:
Current Year Projected Gain $ 534,832
Less Prior Year Deficiency (340 887
Plus Depreciation
Plus city/county 451,686)
Plus Non-Operating Revenue 900,000
Net Increase in Operating Fund $1,57
(Does not include restricted funds.)
li
Flow Memorial Hospital
Third Quarter Report
July 18, 1985
page 3
V.
Reorganization
Several organizational changes have occurred. Ground maintenance
and security have been combined into maintenance, In-Service
education, public relations, and marketing were developed into
the new Department of Health Promotion. Centralization of re-
sponsibility has occurred for inpatient, outpatient, and emergency
room registrations into patient registration. Housekeeping, linen,
central supply, receiving, and purchasing are now directed through
general purchasing. Nutritional services and dietary have been
combined. The purposes of the reorganization have been to cen-
tralize responsibility, increase efficiency, and reduce full time
equivalent (FTE) levels.
VII Ma or Egui ment/Renovation
The following major equipment has been procuredi
Anesthesia EKG monitor
Anesthesia machines (2)
Eye instruments
Phaco-emulsifier
Obstetric ultrasound unit
Mammography
Hill-Rom beds and furniture (4)
TENS units (3)
Nephro cystoscopy
Automated blood pressure cuffs (on order)
Television and audiovisual system
Dermatone (to be ordered)
Tel-Med systems (tapes to be ordered)
Operating room stretchers (3 on order)
Recovery room stretchers (3 on order)
Fetal monitor (on order)
Several renovations have occurred or are in process. Linen
service has been contracted and central receiving is located in
the former linen area. The awning repair is in process. Sixty
patient rooms have been completely renovated. Projects for
the renovation of 38, the second floor nurses station, emergency
room, and front lobby are being analyzed. The new elevator and
roof overlay have been contracted,
VII, Recruitment
The professionals who have been hired as irectors are:
Certified nurse-midwife
Director of medical records
Clow Memorial Hospital
Third Quarter Report
July 18, 1985
page 4
Director of Home Health Services
Business Office Manager
Chief Financial Officer
Materials Manager
VIII. Service Enhancements
A consultant has been hired for Home Health Services (HHS). The
objectives for HHS are to obtain within 120 days organizational
efficiency, waiver status, and Medicare Part B certification.
The certification will allow HHS to provide private services,
Pharmaceuticals, respiratory therapy, and durable medical equip-
ment rental.
The hospital's implemented. TherhospitalCs acredit admission policy a been einitiated
allowing the hospital to charge interest. A system has been pro-
cured to transmit by telephone all claims for Medicare and Blue
Cross. A professional collection agency has been contracted on a
contingency fee for internal collections. Outpatient surgery and
registration center have been developed and are operational.
IX. Projects in Process
Computer - Request for Proposal
CT Scan - Review with cost/benefit analysis
Renovations - Second floor nurses station
Behavioral Medicine Unit
Front lobby
Roof overlay - Contracted
HVAC energy grant
Physician recruitment
TWU affiliation
First Texas Medical Certificate of Need
Elevator - Contracted
Collection agencies - Consolidation for second placement
Five year plan
Signage
Wage and flour Law compliance
Nurse-Midwifery Program
MaxiCare - Agreement formulated
r X. Purchased Professional Services
The following listing does not include physician services.
a
IS
G
Flow Memorial Hospital
Third Quarter Report
July 18, 1985
page 5
10/01/82 10/01/83 10/01/84
to to to
09/30/83 09/30/84 09/30/85
Don Windle $ $ 5,366.90 $ 21609.49
Bright, Fuller
and Associates 3,541.27
Walter Dick 2,030.52 2,144,00
2atopek & Associates 57,720.07 17,742,46
i
Sharp & Morse 6,000.08 24,209.93
Peat, Marwick, 91500.00 14,718.00 l8412.00
Mitchell & Company '
Natkin 2,500.00
Baylor 1,063.34 27,390.00
Thomas Reprographics 11956.12
Harwood K. Smith 67,150.91
FEULS 11250.00 29,180.00
Fields, Edwards
and Associates 10946.50 4,500,00
L. A. Nelson 350.00
Gardere & Wynne 51673.74
Southwestern Lab 2,146,00
Amherst & Associates 14,791.63
Dick Foster 518.20
Davis & Davis 1,669.03
Summit (accrued) 42,000.00
$ 12,037.23 $ 96,136.68 $ 259006.29
t
Flow Memorial Hospital
Third Quarter Report
July 18, 1985
page 6
i
During the first nine months of the current year, expenditure
for the service were $259,906.28 which is an increase of
$163,769.60 from last year.
3
A Position Paper Regarding the Direction
of Flow Memorial Hospital
presented to '
Denton City Council
and
Denton County Commissioners Court
by
Board of Directors
Flow Memorial Hospital
Denton, Texas
February 4, 1985
i
I, Executive Summary
For the purpose of concisely stating the basic premises contained
in this position paper, the following summation is offered.
A. Premise! Flow Memorial Hospital cannot hope to exist by
continuing its present course.
B. Problems with Present Course:
1, operating losses due to decreased reimbursement from
traditional sources
a. Medicare payments down (DRG system - 1984)
b, decreased patient admissions
c. decreased length of patient stay
d. new providers of traditional hospital services
reducing share of profitable services (e,g „
ambulatory surgery centers, urgi-centers, etc.)
e, business' intent to reduce costs of health
benefits
2. Uncompensated care
a. Flow's uncompensated care equals 29%,
approximately three times the national average
b, current funding available for uncompensated
care m $0
C. competitive hospitals referring uncompensated
cases to Flow
d, percentage of uncompensated care is increasing
3. Image of public hospital
a, difficult to recruit physicians
b. tendency for patients with adequate financial
resources to shy away from a public hospital
c* stigma created by exposure of problems due to open
nature of board meetings and meetings of city or
county where hospital is discussed
9. Limited access to capital funding
a. Flow unable to generate profit sufficient to meet
capital needs
b, poor financial condition restrains abilities to
borrow funds or to repay loans which might be
approved
c. significant needs for capital funding
1) ongoing replacement of equipment
2) renovations per master plan
l
. `s
3) medical office building
4) psychiatric facility
5) outpatient services facility
G) other possibilities (e.g., hostel, skilled
nursing facility, hospice, etc.)
C. Potential Solution
1. No action - unacceptable
2. Strengthen present system - unlikely and less than
optimal
3. Management contract - does not significantly effect
major concerns
4. Lease - can be optimal with appropriate contractual
arrangement
5. Sale - could be as effective as lease but more difficult
to accomplish and at no noted advantage over lease
0. Recommendation
1. Decide optimal direction among alternatives
2. Pursue information and/or proposals to be considered
3. Develop an action plan for specific steps to occur
per decision on direction
2
a
t~
II. Introduction
The purpose of this position paper is to document the current
state of organization of Flow Memorial Hospital, focusing upon
the concerns related to that organizational form and suggesting
an array of alternatives for the future. It is the hope of its
authors that this paper will in no way be perceived as criticism
of individuals or entities involved in the ownership or operation
of Flow Memorial Hospital.
The authors of this paper believe that Flow has a number of
significant areas of concern which need to be addressed for the
viability and effectiveness of operating the hospital in the best
interest of our citizenry. To fail to address these issues in a
timely manner would seem to indicate that Flow Memorial Hospital
would most certainly fail financially and therefore would not be
available to serve our citizenry in the future.
Therefore, it is the desire of the authors of this paper to
in?orm the respective parties of the concerns of Flow Memorial
Hospital and to explain the alternatives. Those alternatives
which seem most appropriate to the authors to redirect the hospital
in a way that could best accomplish the mission of the hospital
will also be addressed.
The authors of this paper offer its contents as a catalyst for
change necessary to optimize the balance of serving the intended
mission and dealing with the realities of the current and future
environment.
3
P
i
M
III The Current Concerns of Flow Memorial Hospital
In summary form, the concerns relating to the future viability of
Flow Memorial Hospital can be categorized as follows:
A. Poor current financial position
B. Limited capability to access capital
P C. Inabilty to effectively compete
l~ D. Chanqing patterns of health care delivery
While these categorical designations interrelate significantly,
let us undertake a discussion of each separately to illustrate
the concerns of Flow Memorial Hospital.
Financial) position - Flow Memorial Hospital suffered a $1,002,952
Toss for the kcal year ended September 30, 1983 (which as of
this writing is the most recent complete fiscal year which has
been subject to an independent financial audit). The fact that
the financial statements are audited is significant because of
the high potential for reversing entries due to the proportion-
ately high ratio of allowed deductions from revenue in our
facility's statements. By adhering to the philoscphical stance
of accepting all patients regardless of their abilit; to pay, FMH
has a very high proportion of accounts which are questionable in
terms of payment.
For fiscal year 1983, the percentage of gross revenues attributable
in the audited version of Flow's financial statements amounted to
29% or $4,909,366, compared to a figure less than ten percent in
comparable hospitals. The components of deductions from revenue
includes
1,) contractual allowances to federal governmental reimburw
sers (i.e., the difference between our established
charges incurred in caring for Medicare and Medicaid
patients, and the amount actually paid to Flow for the
care rendered patients under these federal programs),
2) bad debt allowances,
3) write-offs due to care delivered to the indigent
(including Flow's obligation under the Hill-Burton
program), and
4) miscellaneous allowances (such as discounts and
administrative allowances).
Due to the relative insignificance of item 00 only the first
three areas will be further discussed herein.
In regard to contractual allowances to Medicare and :Medicaid, the
percentage of deduction to total federal program revenue of 258
4
is in an acceptable range. This item would become a significant
concern only if left without analysis. Unanalyzed management
decisions regarding maintenance of proportionment of expenses to
net revenues would be sheer guesswork. In prior years and in-
cluding FY 1983, the analysis of this contractual allowance
during the year was very difficult to ascertain and only a
certainty after the conclusion of the fiscal year and completion
of the cost report. Beginning October, 1983, the new Medicare
reimbursement system allowed for a much more accurate concurrent
analysis of the actual contractual allowance. Flow Memorial
Hospital's
percentage of patient volume attributable to Medicare
has consistently run at 30% which is well below national averages;
therefore, contractual allowances, while a significant factor,
are quite managable and tolerable at current levels.
While the year ended September 30, 1984 (FY 1984) remains yet
unaudited, it appears contractual allowances under the now Medi-
care reimbursement system (abbreviated DRGs for Diagnostic
Related Groups) has not significantly altered the financial
position of Flow compared with recent yearst however, IT SHOULD
BE NOTED THAT THE NEW SYSTEM HAS THE POTENTIAL FOR THE FEDERAL
GOVERNFIENT TO CONTROL MEDICARE PROGRAM EXPENSES THROUGH THEIR NEW
MECHANISM AND IT IS PROJECTED THAT FUTURE YEARS' MEDICARE REIM-
SURSEMCNT TO FLOW AND ALL HOSPITALS WILL BE LOWER, CAUSING YET
FURTHER DIFFICULTY FOR FMH.
The remaining two components of deductions from revenue--bad
debts and indigent care--are actually not clearly distinguishable
from each other, primarily due to lack of definition of indigence.
It is not necessarily important for the purposes of this paper
that a distinction be made, but note that this care is entirely
uncompensated, it is significant at uncompensated care pro-
vicd~by FMH is extraordinarily high for a hospital of its size
at $4,363,040 for fiscal year 1983 and apparently in that propor-
tionate range for fiscal year 1984. WHAT IS CLEAR IS THAT
WITHOUT A SIGNIFICANT SUBSIDY FOR THIS "FREE" CARE PROVIDED AT
SUGH A PROPORTIONATELY HIGH VOLUME, THIS FACTOR MAKES AN OTHERWISE
PO'.i5NTIALLY PROFITABLE OPERATION A FINANCIAL LOSER.
Curren:ly there exists no subsidy for uncompensated care, such
as a reliably consistent tax-based subsidy where citizenry,
through respective governmental entities, meet responsibilities
for this uncompensated care. The burden of this care should not
be borne by a hospital but rather by the public.
Other factors having a bearing on the financial status of FMH
will be addressed in other sections of this paper.
Limited Accessibility of Ca ital Flow's needs for capital funding
are significant. While there exists no business rulo of thumb
concerning the appropriate level of annual finds typi^a1 for the
replacement of equipment and other capital expenses, 59 of the
operating budget is often used. This estimate is reinforced by
the fact that the average operating margin for not-for-profit
hospitals has consistently fun between 4% and 58 for several
5
~a
r
{E
I
years and commonly operating margin has been the primary source
of capital funding for these hospitals. Given the extraordinarily
excessive burdens of uncompensated care, Flow has not had a
significant operating margin to fund its capital equipment re-
placement needs for at least the last several years, thus, FMH
has some cumulative needs in excess of the typical 5% projection.
The capital budget for the current year is $1,438,785, indicative
of the need for some "catch up" in replacement of capital equipment.
,h
In addition to needed capital equipment on a catch-up basis and
then ongoing into future years, Flow has several structural needs
which will require capital. Flow's planning consultants have
roughly estimated $13 million needed to renovate the existing
hospital structure to gain some operating efficiencies, alter an
older design for today's delivery patterns, and correct some
existing deficiencies. Also, there is need for a medical office
building estimated at $3 million, and a psychiatric facility at
around $5 million, Other potential capital project needs exist
but such discussion would be quite speculative at this point.
While some funding has been made available from the City and
County since October It 1984, there is no clear assurance of
commitment that such funds will be made available beyond the
current fiscal year. Flow's public role would significantly
limit its access to the capital market even if its financial
position were better. Consistent disagreement between the City
and County create an atmosphere that effectively eliminates the
possibility of either a successful bond issue or borrowing under-
written jointly by the two bodies in a position to do so.
Therefore, Flow's access to capital is extremely poor and capi-
talization will be necessary for Flow to remain viable in the
future.
Inability to Effectively Compete - in addition to the financially
'relatee Problems already noted in this paper, the existing organi-
zational structure creates.encumbrauces to effective competition
in the marketplace. Entities holding a responsibility to make
significant decisions on behalf of the public regarding Flow are
a natural.. encumbrance. Dealing with multiple parties to secure
decisions is often counterproductive. Differences cause decisions,
which should otherwise objectively be made in the best interest
of Flow, to go askew, Dealing with individuals or entities whose
responsibilities for Flow are but a minute portion of their other
responsibilities of office severely dilutes the interest, commit-
ment, and abilities of those who are called upon to make extremely
important decisions. In this arena, the competition is leaving
Flow far behind,
Many other entities in the environment today are capable of
swift, well-educated, business minded, objective, goal-oriented
decisions, in addition, these facts are quite visible due to the
public nature of the entities involved and of the hospital itself.
while the Open Meetings Act is conceptually sound for public
entities, its impact on an entity in a highly competitive environ-
ment can be quite devastating. Our competitors can and do ;snow
6
low
s
.;r
0
Of our every significant move quite early in any process, while
those pri-ate entities in the same marketplace have no responsi-
bility to share their plans, objectives, anomolies, or anything
other than what they might strategically want to share with the
public to enhance their competitive position. Curther, the
impact of erroded confidence in a public hospital must certainly
be a fact, Physicians, patients, citizens and employees are
exposed to many negative (and positive) aspects of the organiza-
tion while private competition needs share only the positive.
The image created of our hospital is not comparable when comparing
our public hospital with private concerns who have negative
aspects which are never disclosed to the public. The importance
of this mispercoption should not be underestimated and may in
fact be the single most important contributing factor to our
other problems.
Chancin Patterns of Health Care Deliver and .Reimbursement -
e e nave evo Vedclurccc y an con nue n drama c c ange. Our
w
marked eak organizational structura and financial position create a
inability
care is definitely shifting cto again in
cost these patterns environs,
i
delivery. Increasing outpatient services, many now delivered in
physicians' offices or clinical facilities, are causing shifts
i:i historical patterns of hospital utilization. tn-patient
census has turned downward in response to consumer trends and
pressures through insurers, most significantly Medicare, toward
less expensive cervices. Health maintenance organizations
(HMos), preferred provider organizations (PPos), and other muta-
tions are gaining ground as insuring mechanisms, Providers need
to think toward affiliatiot, with such entitia:jt however, Flow's
position organizationally and financially make it less attractive
for such affiliations, Flow's effective response to these trends
is essential.
7
Alternative to Existing Concerns of Flow Memorial Hospital
in this section we shall suggest alternatives to the many concerns
stated iri the Previous section.
First, and always an option in any decision, could be to do
not~~hin2~ at nil and let F'low's fate take its own course. TTiis
would recuire minimum conviction on everyone's
obvious b discussion Previously in this part but as seams
certain failure of Flow Memorial HospitalpapAs~reespolnsib~eeoffi-
cials with respective responsibilities and trust of the public,
to do nothing seems inconceivable.
Secondly, the su ort renbase as it exists could be stren thened.
This would requ reewed c`amm` "tment, coopera _'on an un er-
staAding on the part of the hospital officials
the Commissioners Court, Dedication to financial istabilitylinand
operations would have to be agreed upon by all and avenues
capital funding would have to be undertaken. Purpoae nu thof
e
hospital Ind concise objectives would have to be agreed upon by
e.ll, Major undertakings would have to occur on a swift basis.
Responsibilities for all parties would have to be clear and
agreed upon. Differences of opin,`,on that have
years would havo to be set aside, This option could sbed for
uit
attract!-/a in many respects but would only partially resolveesome
problems inherent in a public entity such as ours, spelled out in
previous sections. Ile would be moderately competitive in the
marketplace. Capital accessibility would be less than opt.tmal.
Reconciliation on the part of the current entities involved would
seem to be most difficult to achieve and then significant com-
promise would exist in the organizational structure.
Thirdly, we could contract for management of Flow. By doing in esions
such, we could intro uce a'rd
made regarding operation and remove rmuchenon-professionaliinvolve-
ment in the decisions of Flow. Me option would broaden the
managerial resources of Flow and ,ain some economies of scale in
group purchasing, but capital positioning would not be enhanced
and management services would be charged on a fee-for-service
basis The perceived identity would remain unchanged and the
inability to effectively compete would be only
A management contract' could be negotiated with anrexistinq peviated.
prietary or a nonproprietary management service firm, or an
entity could be formed combining local resources and talents and
charging this management entity with the significant decisions
regarding Flow and thereby creating increased distance between
the existing entities and hospital detlaiohs,
Fourth, a lease of Flow could be transacted. Leasing of the
facility to an entity with a negotiated contract could shift all
financial responsibilities for operation to the lessee. Through
8
Si
i
d
proper negotiation of lease documents or contractual documents,
some philosophical base] of Flow as a community hospital could be
maintained. Outcomes could include optimization of all concerns
of Flow. Ownership of the structure could be maintained by city
and County, and some input could be maintained as desired. A
lessee would provide necessary capital for upgrading facilities
and equipment and all financial risk would be the operator's, not
not the owners'. Success of a lease transaction would be highly
dependent upon the quality of the lease documents. A lessee
could be organized in either a proprietary or a non-proprietary
nature, each form with respective advantages and disadvantages.
I
Finally, the sale of Flow could be an alternative., The advantages
and disadvantages of a sale closely parallel a lease except that
dissolution of the public's interest would be final. A sale
f might be less acceptable than a lease.
Any variation or combination thereof might then also be considered
a viable option and the specific possibilities might be infinite
in number. of many such options, it would seem desirable to
include in any contract a relatively short term reversion clause
so that the current owners would have an opportunity to regain
absolute control of the hospital's operations should the arrange-
ment prove unsatisfactory. Such a clause must, however, be in
some balance with the acquiring parties' needs for some reasonable
assurance of long term commitment to a successful arrangement.
9
i°
b4YY In
tR
$I
A
r
V. Recommendation
Based upon the content of the previous sections of this report,
it is the conclusion of the Board of Directors of. flow Memorial
Hospital that specific action Is Indicated.
Given agreement by the City and the County as to the scope and
severity of concerns expressed herein, it would seem apparent
that viable solutions to these problems should be selected. Once
all were in agreement as to those methods which would enhance
Flow's position, the parties should undertake an educational
i phase to pursue information through proposals from and discussions
deemed
with . At entities specializing in
seem respective appropriate t to n develop
point, it would the
viable
specific plans for action to accomplish any solutions agreed upon
by the parties.
The Board members strongly feel that involvement and support of
the City and County at this point would be desired so that the
Board might logically proceed, jointly to the extent desired by
the City and County, to achieve outcomes desired by all,
Respectfully submitted,
Board of Directors
Clow Memorial Hospital
10
EXECUTIVE SUMMARY OF TASK FORCE REPORT
i. Transmittal Letter
A. City and County initiate the creation of a
community-based, non-profit corporation for the
purpose of leasing and operating FMH.
a. City and County develop terms of lease concurrent
with processes qualifying PMH for Texas and IRS
tax-exempt status.
C. Lease would set term of the lease, "consideration"
,(financial terms of the lease), specify City/County
obligations and protections during term of lease,
and set forth lease restrictions and requirements,
i
D, Focuss community-based corporation, management
capicity, continuity of FMH, capital requirements,
indigent care policy,
E, Criteria for assessing options feasible time
frame, fiscal/management development, hospital
image, county-wide support, capital structure,
physician recruitment/retention, patient carat
diversification, pompetitive position, indigent
health care, smoothness of transition.
F. Optionss lease to proprietary corporation with a
management contract, sale, management contract with
a proprietary hospital, management contract or
lease to non-profit corporation, lease to
community-based, nonprofit corporation.
4, Option Chosen and Reasons lease to community-
based, non-profit corporation. Local Controll
indigent Carol Flexibility and Autonomy; Corporate
Diversifications Fiscal/management Improvementl
Rights/privileges of Employeesl Capital Structural
k Physician/patient Attractivenesel Hospital Image
and Community Support,
.1,
f~
~i
page 2.
II. Proposals
A. Community-based corporation Lo lease and operate
r~ FMH under direction of Corporation Board and Its
Executive Committee (Governing Board). The
Statutory Board (4494-1-1) functions are retained
for bond issuance and, if required, rate setting.
B. Corporation Boards overall policy, selection of
executive committee (Gtiverning`Bo~,rd), reporting,
professional manage.nf7t team, subsidiary cor-
porations.
CO Problem at FMHs Current financial position, access
to capital, ability to :ompete effectively, changes
in health care delivery.
D. Yssuess industry-wide, institutional, organiza-
tional and managerial.
E. Solution Proposeds City and County of Denton orga-
nize and incorporate a Texas non-profit management
corporation (301 C/3) to operate and manage FM111
fiscally sound and socially responsible hospital
for the entire county.
Proposed Schedules 8-12 montbe with lease negotia-
tion process under the guidance of a Blue Ribbon
Committee (whose function would cease once the man-
agement agreement was agreed to by City and
County).
1
R
=s
page 3.
Program
As Local Control and Corporate philosophy
f~1 1. Blue Ribbon Committee to oversee lease
negotiation process (establish criteria
for leaser report to City and County on
progress),
2. CitY/County Board appointment and Beard
continuity) Board functions for the
Corporation Board (and Executive Committee
or Governing Board) and Statutory Board
(4494.1-1).
3, Corporate Philosophyt community control,
quality of health care, expanded programs,
management system enhancement, outreach in
Denton County,
B, Hospital Employees retain current rights and
privileges to avoie service disruption,
stabilize morale and provide equitable
employee relations.
C. Medical Staffc attract and retain superior
physicians into the community on the basis
of long-term strategic plans.
D. Indigent Care. to form a part of the lease
agreement.
E. Management Systems and Servicesi
1. Management Systems depend upon both improved
capital structure and expertise, Strategic
and marketing plans for the hospital must
guide the role of capital and technical
development in this area,
r{
i'
II
page 4,
2. Education and Staff Training must be a vital
part of management system improvement at FMH.
3. Quality Assurance programs must be active and
prominent at the institution.
Contracts and Current Programs of PMH must be
honored and maintained.
a. Interim Funding appropriate for the hospital's
transt.tion to 501 C-3 status is an obvious need
for VMH.
r,
71
E~
ACTIONS REQUIRED FOR INITIATING 501 C/3 RECOMMENDATION
(jointly Performed by City and County)
1. Aproval of the concept as set forth in the report,
"Task Force on Flow Memorial Hoaptialo" July 15, 1985.
2. Authorization of Blue Ribbon Committee to oversee the
negotiation of a lease agreement for the new $01 C/3
corporation and charging it with specific duties.
3. Designation of legal counsel to represent both the City
and the County in the creation of a lease agreement for
the new 501 C/3 corporation.
4. Approval of a timetable for creating the new 501 0/3 f
corporation.
5. Adopting legal measures required to initiate tho process
of creating a $01 C/3 corporation in accord with legal IN I
advice of counsel for the City and Cotinty.
t
4
Proposal
page 20
APPENDIX I
501 C/3 GOVERNANCE STRUCTURE
-----------------HOSPITAL CORPORATION BOARD------------------
I -setting Overall Hospital Policy
I -Selects Chief Operating Officer of Hospital
I -Chosen Executive Committee (Governing Board) i
I -Patient and Community Relations
-Hospital Endowment Program I
j I
I
I
I HOSPITAL GOVERNING BOARD
I (Executive Committee of Hospital Corporation Board) j
Responsible for Day-to-Day Operations at the Hospital
I I
! I
I I
I
I I
I I
I
I I
STATUTORY BOARD (4494-I-1 BOARD) I j
(statutory Functions) I
I
I
I I
I CM uF DENTON AND DENTON COUNTY
-Appoint initial Corporation Board
Can revoke lease for cause and after reasonable notice,
Retain assets of the hospital Corporation,
-Receive audit reports and hospital performance reports,
a
it
'a,Il
.
11
Yi
Y
FLOW MEMORIAL, HOSPITAL
INCOME STATEMENT
June 30, 1985
MONTH YEAR TO DATE
PRIOR PRIOR
ACTUAL BUDGET VAR. YEAR ACTUAL BUDGET VAR. Y71D
PATIENT SERVICE REVENUEt _
Inpatient Revenue $ 1,690,733 $ 1,367,865 23.6 $ 1,220,012 $12,970,797 $120631,459 2.7 $11,632,578
Outpatient Revenue 191,483 160,112 19.6 162,901 1,659,892 _ 1,419,864 16.9 1,434,451
Total Patient Revenue $ 1,882,216 $ 1,527,977 23.2 $ 1,382,913 $14,630,689 $14,051,323 4.1 $13,067,029
DEDUCTIONS FROM REVENUE;
Contractual Adjs. $ 202,420 $ 83,083 143.6 $ 61,832 $ 1,066,320 $ 763,839 39.6 $ 844,838
Had Debts 403,069 163,494 146.5 292,532 2,587,231 1,5039492 72.1 19996,728
Other 105,797 _ 80,265 31.8 _ (7G_L973' _ 799,301 _ 738,118 8.3 367,618
Total Deductions $ 711,286 $ 326,842 117.6 $ 279_:391 $ 414521852 $ 3005,449 48.2 $ 3,209,184
Net Patient Revenues $ 1,170,930 $ 19201,135 ( 2.5) $ 1,103,522 $10,177,837 $11045,874 ( 7.9) $ 9,857,845
Other Revenues 48,.966 291134 68.:_ 350578 _ 419,449 263,754 . 59.0 230yO51
Total Net Revenues $ 1,219,896 $ 1,230,269 ( .8) $ 1,139,100 $10,597,286 $11,309,628
( 6.3) $10,087,896
OPERATING EXPENSES:
Salaries 6 Wages $ 527,139 $ 554,644 ( 5.0) $ 577,999 $ 41816,390 $ 5,047,084 ( 4.6) $ 59266,859
Employee Benefits 51,734 81,844 (36.8) 64,805 6641462 744,543 (10.8) 528,240
Professional Fees 146,241 121,837 20.0 134,910 1,3469648 19094,822 23.0 1,230,965
Operating Supplies 175,120 194,846 (10.1) 191,332 11650,822 1,754,522 ( 5,9) l,602,174
Other 158,474 _177.1840 (10.91 _ 155,081 1,372,973 11591,769 3._8), 11429,746
Total Operating Expenses $ 11058,708 $ 11131,011 ( 6.4$ 10124,17.7 1_9.t851$295 10 232,740 _L 3.7) $l0,I17,984
Income (Loss)
before Depriciation $ 161,188 $ 99,258 62.4 $ 14,973 $ 745,991 $ 1,076,888 (30.7) $ (30,088
Depricintion (37,602) (37,558) (39,081 (340,205 (3621116) ( 6.0) (351,348)
Non-Operating Revenue 6,479 31691 _75.5 1,843 731,670 33,219 272_,938
Total Income (Loss) $ 130,065 63,391 98.9 (22,265 1.1013 71456 1 7479991 52.1 $ (108,498)
t '
71
Mk
FLOW KNORIa„ HOSPITAL
STATISTICAL STATEMENT
June 30, 1985
CURRENT MONTH YEAR TO DATE
PATIENT UTILIZATION: ACTUAL BUDCLT_ _ % VAR._ 'RIOR YXA ACTUAL BUDGET 7 VAR. 'RIOR YEA
Adult Patient Days.- - _ - - _ - - r 2,371 _ _ _21685_- _ _(11,71 - 2,367 201654- 26,715 (16,4) 241,293
Average Per Day _ _ _ _ _ - . - - 79.0 89..5._ 1-1 7.Z 78.9 - - - 75_7_ ~ 90.5 ~ 8910
Newborn Patient Days- - _ - - _ _ _ 513 380 _ 35.0__ _ 435 - - _3.1463_ _ 3,798 1
- -(_881 3752_
Average Per Day _ _ _ _ _ _ _ _ _ .17.1 2.7 _ 35.0 14.5 - 12.7 _ 13.9 8.83 13, ICU Patient Dayu_ _ _ - - - - - -
_ 9-0 141- - -(36.-2-Z 122 - 9fi1,297 _ ~(25.6)1.1222+
Percent of Occupancy- _ _ _ _ _ _5172; 57..4% .-.(11,7) 50.6/- - 48.0"/, (16.4) J 57.07
Admissions 5:15-- ( 3 G) 471 _ _4=574- - 4 2f - (7.1). 41741
Discharges 517 _ _ - -537.. 3._7) 473 _ - -41587_ _ 4,943 ( 7ez~ 41728-
-
Average Length of Stay- 4.3 5.0 _ (11,0) 5.0 _ 4.4 5.0 W_ (12,0). 5.1
Medicare & Nadicald UC11. 33.7% 30
_ _ ,(1% 2l_.3 _ _30.6% `30.0% _ __G.0- 33_,9Y
OTHER UTILIZA'rIONi
O,R. Procedures 171 _ _ _ . 180. _ _(_1171 _ _ 233 _ _ -••11,528_ 1,,¢32 _ (_6_L41 _2.LOJ _
Laboratory Tests- 14,1763_ _ _13,856 1311.633 _ 135,.966 _ _.L 3121 _1.9211_.93_
Respiratory Thor, Treatments 1,498 _ _ _2.1013 - _ _15161 2,111 _ 181,046 - -18,53E _ _(„21,41 221346 .
Radiology Examinations __11417__ _ _(.413)_ _ 1,63.2 1212;.,_ _ _13,59,2 _ _10.12) 1313$6.
Emergency Room Visits _ _ _ _ 10.9 90 _ _ _1.1082_ - 17 1,153 _ 101.300 8,954 _ 1510- _9138b
Physical Therapy Treatments 709 _ _ _ _853_ _ _(1619) - 141 _ _5,135-2_ 2,151 _(25121 _71325_
Dietary Heals Served- _ _ _ _ - _ 13,683 _ _ 17.1989 _ (2 319) 16,046 _ _I4I~1780_ 165,590 (1414) , 16141-199
PER ADULT PATIENT DAYI
Gross Patient Revenue _ _ _ _ _ _ 8'123,85 _ _$569..98 . _ 39.15_ 3584 ,25 _ _$)08.37_ _ 15_6 .5-2 26y0_ i _$532 $9
Not Operating Revenue - _514151 _ _ 458,20 - _ 12.3_ .,481124 _ - 513.09 _ -457-LOO 12,1_i ,415.26
Operating Expenses _ 462138 _ 435.22_ _ _ _61!.Z.. _491143 0
Income from Operations _ _ - _ _ - 52112 _ _ _22.98_ _ _12618 - 4.3.44_ _ _428168 .1511_ _ -(30 .96
(L01 1.2)Y _ _19.65 _ ~ 28192 __.(32111 , 515101.
LABOR COST MANAGEMENTi
Full Time Equivalent Employee _ - 345.2 _ _ _3%018 _ 7_2) 409.2 _30618_ _ 307.8 _(_217) _406.0
F.T.E. Per Adult Patient Day. _ _411-.. _ _ _713 5.2 _4.18 4,1 W 17,11_ _4.6W
Payroll as a % of Total Expenses- _ 48,0% 47,5% 1.1 49.77. 47,3`7. 47.6%
2 of Occupancy based on operations/beds Current Month - 57.3
Y. ,
FLO14 !MEMORIAL HOSPITAL
BALANCE SHEET
June 30, 1985
ASSETS LIABILITIES & FUND BALANCE
CURRENT: 1985 1984 CURRENT: 1985 1984 _
Cash & Investments $ 989,762 $ 335,470 Current Notes Payable $ 322,182 $ 203,701
Accounts Payable 893,417 995,095
500,859 342,245
Patient Receivables 5,864,078 41424,987 Accrued Expenses
Less Allowance (2,626,214) (2,022,375) Due Government Agencies 272,368 69,447
Net Patient Recievables $ 3,237,864 $ 2,402,612
Other Current Assets 390,065 464,843 Total Current Liabilities $ 1,988,826 $ 1,610,486 ,127
Total Current Assets $ 4,617,691 $ 3,202,925 Long Term Debt - 714- 11017,907
Total Liab111tles $ 2,702,953 $ 2,628,:'95
Property Plant & Equipment
Land/Improvements $ 183,242 $ 183,242 Fund Balance!
Building 2,951,987 2,943,464 Donated Capital $ 4,455,779 $ 4,455,779
908
Equipment 5,141,703 418920383 Pledges & Gifts ,262 611,863
$ 8,276,932 $ 8,019,089 Fund Bal., begin. of year (1,521,291) (1,180,404)
Less! Accum. Dep. (5,211,464) (4t814079) Inc. & Exp, summary 1, 137,45b !108,498)
Net P.P. & E. ~S 31065,468 $ 3,204,210 Total Fund Balance $ G,980,206 $ 3,778,74U
Total Unrestricted funds 7,683,159 $ 6,407,135 Total Unrestricted Funds $ 7,683,159 $ 6,4071135
FLOW MkMORIAL HOSPITAL
COMPARATIVE ANALYSIS ACCOUNTS RECEIVABLE
June 30, 1985
AGING BY DISCHARGE DATE
DAYS CURRENT MONTH TOTAL PRIOR MONTH TOTAL
0-30 $ 21029,357 34.5% $ 1,806,164 33.4%
31-60 11127,968 19.2% 11080,640 20.0%
61-90 687,947 11.7% 734,072 13.6%
91-120 565,465 9.6% 493,339 9.1%
1 121-150 413,484 7.0% 300,021 5.6%
151+ 1,054,894 18.0% 986,297 18.3%
$ 5,879,115 100.0% $ 5,400,533 100.0%
AGING BY PAYMENT DATE _
0-30 $ 2,803,918 47.7% $ 2,743,471 5018%
31-60 1,375,118 23.4% 1,112,510 20.6%
61-90 689,858 11.7% 739,873 13.7%
91-120 464,453 7.9% 372,636 6.9%
121-150 235,389 4.0% 172,817 3.2%
151+ 310,379 5.3% 259,226 4.8%
$ 5,8791115 10010% $`5,400,533 100.0
""WMEMNUES_ BY FINANCIAL CLASS "
CURRENT MONTH 6/85 5185 4/85 3/85 2/85 1/85
Medicare $ 468,622 24.9% 28.6% 25.4% 24.5%. 28.3% 30.8%
Medlen1d 69,194 3.7% 4.2Z 7.1% 4.6% 2,9% 2,5%
Blue Cross 76,377 4.1% 6.7 511% 3,3% MY. 5.4%
Commerical Ins. 813,708 43.3% 39.2% 41.5% 44,52 44,1% 37.4%
Self Pay 453,005 24.0% 21.3% 20,92 23.1% 21.4% 23.9%
$ 1,880,06 10010% 10010% 100,0% IOO &Y, 10010%. 100 _0%
DAYS OF REVENUE IN A/R CURRENT MONTH 5/85 4/85 3/85 2185 1/85
Gross 84 84 101 110 114 121
Net 60 60 60 60 60 69
WRITEOFFS S RECOVERIES CURRENT MONTH YEAR TO DATE DRO OUTLIERS CURRE T tONTH YEAR TO DATE
Charity $ 17,305 $ 628,238 # Discharges 2 23
Bad Debt 182,676 295120903 over $18,000
Bad Debt Recoveries 35,418 296,410
G
FLO14 MEMORIAL HOSPITAL
BALANCE SHEET
February 28, 1985
i
ASSETS LIABILITIES & FUND BALANCE
CURRENTI 1985 1984 _ CURRI?NT: 7~9P5 1984
Cash & Investments $ 511.,906 $ 344,797 CurronL Notes Payable $ 283,639 $ 1870283
Accounts Payable 1,637,429 11124,745
Patient Receivnbles 51864,606 51166,782 Accrued Expenses 452,721 389,915
Loss Allovance (20790.104) 52,338,9771 Due Govern. Ageneles 47,368 644,802
Net Patient Rec. 31070,502 $ 21827,805
Other Current Assets 7440670_ 938:697 Total. Current Liabilities $ 2,421,157 $ 2,346,745
Total Current Assets $ 4,331,078 $ 4.111,299 Long Term Debt _1027 0,.23 1,3141308
Total Liabilities $.j, 448180 $ 31661,03
Pro ert Plant & E ui ,
Land Improvements $ 1830^42 $ 183,242 Fund Balances
Building 2,951,987 2,9430464 Donated Capital $ 4,4551779 $ 4,455,779
Equipment 5,067L237 4,892,066 Pledges & Gifts 836,702 5860211
81202,466 $ 8,0189772 Fund Bal. beg, of yr. (1)5213291) (1,1801404)
:
Least Aeeum, Dep 5 072 389) 16581277) Inc. & Exp Summary 241,785 ; 50,845)
Not P.P.& E. $.3_,130,077 $:j 39-0-49-5Total Fund Balance 44 012,975 $ 3,810,741
'total Unrestricted Funds $ 7,461,155 $ 7,477.1794 Total. Unrestricted Funds ~7 461 155 $ 71471,794
FL011 111:111)1! IAI. If0S1'11'AI,
111OPF STATI)W[11'
February 28, 1985
lt0il'CII YEAR TO DATE
ACTUAL. ISUIICI:1' VAR. Y.I:AII ACTUAI. ISUII(,i'i' VA[!.
PATIF.:IT .SMVICI, IIrVI!lIIl1::
111paticnt Revanue $ 1,54317,U6 $ 1,433,862 7,7 $ 1,308,024 $ b,643,760 $ 6,998,767 ( 5.1) $ 61533,376
t Outpatient Revenue _ 172,497 161 (,t2fi -6'9-- 1461141 ____836e,5~7 787 213 7560295
Total Pattent Rcvcnuc $ 1,716,203 $ 1,595,288 7.6 $ 1,454,165 $ 7,480,267
$ 7,785,980 (3.9) $ 7,289,671
URDUCTlO115 FRCI-I IMI:3RIii s
Contractual Ad)u, $ 85,680 $ 86,699 ( 1,2) $ 413081 $ 429,752 $ 427,263 1.5 $ 395,910
Had Debts 552,744 170,696 323.8 191,331 1,2000790 833,100 44.1 995,056
Other 94,998 83,800 X13.4- _ 52,837 _402918 4081998 ( 1.5) 3651728
Total Deductions; $ 733,422 $ 4_)~ll}l95 214.9 $ 3521549 $ 2 033 460 S G65 361 22.1
_t___ $__1~__s_ _ _ $_l j_Z56,694
;let Pat(cnt Revenues $ 982,781 $ 1,254,093 ( 21.6) $ 1,121,616 $ 5,446,807 $ 6,120,619 (11.0) $ 5,532,977
Other Revenues _A81, 68 378 u 28 747 237.9 _ 22,435 2231205 166,4441 52.4 97,177
Total Oct Rovanuan $ 1,051,.159 $ 112820840 { 18.1) $ 1044051 $ 51670,012 $ 6,267,063 ( 9.5) $ 5,630,1S4
01TRAT1110 EXPENSES:
Salarins 6 Unges $ 4909737 $ 521,437 ( 5.9) $ 5700453
$ 2,7150950 $ 2, 793,!20 (2,8) $ 21925,262
Employee Boneflts 64,881 80,003 ( 18.9) 67,539 3731536 413,392 ( 9.6) 393,222
Professional Peen 147,431 121,948 2019 123,424 7961868 608,237 31.0 6281288
Oparotinp 5upplias 190,182 193,565 ( 1.8) 198,314 9011013 9730945 ( 7.5) 9061912
Other 728,654 $ 171,,6!15 1!2,653 _ f>88~821 $ 8840242 (22,81 $ 637,890
Total OpdretinG t?xpenses $ 11021,085 $ 110911598 ,
_i 6.111 v 1.,0721183 $ 51472 8~0 $ 5.1672,926 3.5) $ 51491574
Incoma (1,08a) -
boforo Dupriciation $ 291274 $ 191,242 (84.61) $ 711668 197,122
Dopricintion (38,598) { 41,000) ( 5.9) (39,275 $ 594, (66.8) $ 1381580
1?A 943 (189,160) (205,0000 00) (7.7) (!94,746)
Isom-Oporatinr Revenue s_.._.. 3sALI -0- _ 2331823, 181455 51321
Total Incoma (1,osn) I $ 119,019
$ _]53 933 241,785 Y 4O7 5 2 40.7)
Vj,nil 141:1nRIAL IinST'ITAi,
CUIPARATIVIi AlIA1,YRiS ACrOU1ITS 11ECFIVA(3LE
FL'UItl1ARY 211,1905
AnVIO BY OISCIIARCL DATE
W- % 01, z 01l
DAYS CURRMIT I] INN TOTAL PRIOR IfON11,11 TOTAL.
0-30 $ 21032,595 34.7% $ 1,650,591 29.5%
31-60 984,081 16.8% 926,211 16.57
61-90 591,620 10.1% 773,221 13.87
91-120 5150471 8.8% 582,401 10.4%
121-150 380,745 6.5% 339,657 6.o
151+ 1,353,111 23.1% 1_.338,457 23.8%
$_5,61(3,550. Qf1.0
AOIMO by PAY14E!1T IMr,
0-30 $ 2,742,047 46.2;.' $ 2,489,291,
43.9%
31-60 1,208,308 20.47 1,7.302 158 20.0%
61-90 714,447 1.2.0% 711,349 12.67
91-120 431,362 7.3°; 454,171 0.0"~
121-150 279,630 4.6% 271,810 4.8%
151+ 561 289 _ 9.557, 6,15 551. _ 10.7Y,
S 5 931,023__ 100.0% $ _5,664,330 100M,
RFVEMIES BY V111,VICIAL CLASS
CURREuT 11011TH 2/G5 1/135 12/84 11[j4 10/84
liedicaro $ 485,350 28.3% 30.3% 28. 19, 20.137 22.2%
Medionld 49,475 2.9% 2.5% 3.1% 2.5"1,, 311%
Rluo Cross 560446 3.3% 5.4;; 5.25; 6.6% 6.9%
Commoricnl Inv, 7571073 44.1% 37.47,, 41.1, 4t.4'/. 41,1%
Self Pay 11i7y.372 21.4% 23,97, 22.27,' 28.77 26.77
$ 1~77~S~717 10A.0% 1(l0,fl% 1.00.07 1(1`(I;O: 3•tlf~~~;r<
DAYS OF Rb:V1,NUE III A/_R 2/85 1/85
Orooa 114.3 121.1
Net 60.0 69.4
IMMOF S 1, PVCOVCR1rS CURIMIT HO31T11 YEAR TO DAT14 DRO OUTLIERS CURRENT 11011T11 YEAR TO DATE
Charity $ 91,982 $ 203,554 # Discharges
Dad Debt 226,941 1,0179954 over $18,000 3 11
Dad Dobt Recoveries 56,134 160,007
low
1
FUM MEMORIAL HOSPITAL
STATIS'I'TCAL STATEMENT
FebrUary 28, 1985
CURRENT MOUI'Fl _ YEAR TO D TE
PATIENT UTILIZATION: [ACT AL 8IIDUT VAR. PRTOR YYEAR _ACTI81MM-''% VAR.PR10R AR
Adult Patient Daye_ _ _ _ _ 0_ C16,01 _?,84~ 11,395 _ _13,34a72 (12, 71 _ 13 Il
Averago Par Dny_ _ _ _ _ - 100.7 (16_0) ,Q7j9_ 7.9 D _ _ _9.M (12,7) _ _90.b_
Newborn Pati ent Days 382 U5„j4) 318 179 _ _ 1,293
Average Per Day _ _ _ _ _ _ _ r 3,7- U511i) 1,,_1,1.2 ICU Patient Days _ _ _ 7 _ `14914.21 130529 _ 120 _(13.91 _
_ X12.5
.5 Percent of Occupancy. _ _ _ . 1/ 64-64 (15,9) x,2,85 (3.I-5$.0%_ _(12..61
Discha 24 Admissions - - - _ 6 _ ` 56 2,,5) 502_ _ X,59) 2,224 _ _(_4,.8)
A e Length o rges _ _ _f_S_ta_ _ ` - - 3 4 - - _ 564 4 ` (_7a1) _ _513_ - 2,134 _ _(_611 R UTI McJicnro b F1eJicaid Util,-
_ - 9/_ 30 0 w 5~3% 5,0 _(1410) 4,9
OTiIER UTILIZATION;
0. R. Procedures _ 8 188 5,71 B2~ _
Laboratory Tosts ` ` ` " " 1` 15 4"~7` :6_2G 825 71173 _ _75,222 _ (_2,51 _7X,242 _
RodiRespiratory Ther,`Treatments` 6 ` ' - „ 2a 115 _ 19u2 _2,748_ _ _11,26§ _ _14,252 _ _ 9,9_ _12,862 _
oloBY Exams _ _3 - `1,550 (1771 1,439 _ ¢,I13 _ z,SIZ - _(10,71 _ X bb$
Emergency Room Vfsits T M13 r _7~
Physical Thar, Treatmenes` ` `'~9I `1=807 14,11, _1,4017_ 2,400 _ 26,8 _ 41921
j ,
Dietary Heals Served 15,03I - - _755 2,$fi1 _ 3,253 _ 25,81 2,.466
- _ _ _ _ _ 181894- ('15,75 18,453_ _85,139 _ _911201 _ -`_4121 _921208 _
'ER ADULT PATIENT DAY:
Cross Patient Revenue $724.14 565,70_ 28.0 5512,03 _ _$626.75 4529,38 _
Not Operating Revenue 423.53 ` 257,,91 S`2,5~- _402eg _ 495.09 _ _458,3Q 13, g_ 408.81 _
Operating Expenses 44.42 40116] i1.4 _321,43 _ `474140
T _429,92 _ .11.1-- _41249$ _
Income from Operations 63:855 53.28 10732` - 1
-41 .67 _ 28445 _ (92.2)_ _1 6.A81_
,ABOR COST MANACEMENTi
Full Time Eauivalent Employee_ 359,(,_ 370.8 (.3_2) 612.5
P.T.E. Per Adult Patient Day 317r 13_5 _ 4.3 _ Z _ _ 6 1 _ 14,5
Payroll as a % of Total Expenses 46.0% 77` r51:3`G '41,13'G` 47,57 1.0 51.42
X of Occupancy based on operational bads Current Month-61.3Y.
4
PLOW MEMORIAL HOSPITAL
BALANCE SIII:ET
Aril 30, 1985
CURRENTI 1985 _ 1984 CURRENT: 1985 1984
Cash & Investments $ 784,940 $ 478,788 Current Notes Payable $ 332,831 222,507
Accounts Payable 1,078,907 849,474
Patient Receivables 4,963,436 4,416,655 Accrued Expenses 497,512 477,379
Less Allowance (2,017 129) (1,853,152) Due Covern. Agencies 182,368 585,636
Net Patient Rec. $ 2,946,307 $ 2,563,503
Other Current Assets 451,504 794,081 Total Current Li.nbilities $ 2,091,638 $ 2,134,996
Totnl Current Assets $ 4,182,751 $ 3,836,372 Long Term Debt 710,193 1,180,255
Total Liabilities $ 2,801,831 $ 3,315,251
Prn crty Plant &_Equtp.
Land Improvements $ 183,242 $ 183,242 Fund Balances
Building 2,951,987 2,943,464 Donated Capital $ 4,455,779 $ 4,455,779
Equipment 5,129,567 45892,857 Pledges & Gifts 891,469 592,937
$ 8,264,796 $-8 t-61-9 5 6 3 Fund Bel. beg. of yr. (1,521,291) (1,180,404)
Lessi Accum. Dep. (511360324) -(4,73615131 Inc. & Up. Summary 603,435 ( 6411412
Net P.P. & E. $ 31128,472 1-3 ,283 0 050 Total Fund Balance $ 41509,392 $ 31804,171
Total Unrestricted Funds $ 7,311,223 $ 7,119,422 Total Unrestricted Funds $ 7,3110223 $ 7,719 4, 22
~1
NS I
PLOW HEM0 HOSPITAL
INCOME ATENrNT
April 30, 1985
MONTH YEAR TO DATE
PRIOR %
ACTUAL BUDGET VAR. YEAR ACTUAL PRIOR
BUDGET VAR. PRIOR
PATIENT SERVICR REVNEUE: YTD
lupatient Revenue $ 1,387,653 $ 1,422,841 ( 2.5) $ 1,210,545 9,701,815 $ 9,871,089 ( 1.7) $ 9,482,958
Outpatient Revenue 204,908 155,316 31.9 173,142 11231,353 1,100,164 11.9 1,096,475
Total Patient Revenue $ 1,592,561 $ 1,578,157 .9 $ 1,383,687 10,933,168 $10,971,253 ( .4) $10,179,433
DEDUCTIONS PROM REVENM
Contractual Ad,js, $ 156,144 $ 85,779 82.0 $ 62,126 662,000 $ 596,377 11.0 $ 558,218
Bad Debts 180,697 168,863 7,0 210,428 1,956,145 1,173,924 66.6 1 1,422,551
Other 86,702 82,901 4.7 17 612) 598,728 576,32F 3.9 399,230
Total Deductions $ 423,543 $ 337,543 2515 $ 254,942 3,2161873 $ 2,346,622 37.1 $ 2,379,999
Vet Patient Revenues $ 1,169,018 $ 1,240,614 ( 5,8) $ 1,128,7145 $ 7,716,295 $ 81624,631 (10,5) $ 7,794,434
Other Revenues 70,788 29,134 143.0 32,100 330,308 205,099 61,1 154,508
focal Net Revenues $ 1,239,806 $ 1,269,748 ( 2.4) $ 1,1601845 $ 8,046,603 $ 8,829,730 ( 8,9) $ 7,953,942
)PERATING EXPRNSEs'
h Salaries & low'd $ 511,070 $ 554,644 ( 7.9) $ 559,757 $ 3,764487 Employee Benefits 9 $ 3,920,097 ( 4.0) $ 4,084,693
62,439 90,819 (22,7) 479753 5279786 578,884 (8.8) 3849573
Professional Pees 141,860 121,568 16,7 154,916 1,044,117 851,461 22.6 932,124
Operating Supplies 171,957 194,909 (11,8) 169,296 1,2719728 1,364,944 ( 6.8) 1,2629065
Other 166!325 174,358 (4.6) 1811202 1,011,893 10234,046 (18.0 1,100,769
Ibtal Operating Expenses $ 1,053,651 $ 1,126) 298 (G.5) $ 1 s 1121924 $ 71620,011 $ 7,949,432 (-4 --11 $ 7,764,224
Income (1,088)
before Depriclation $ 186,155 $ 143)450 29.8 $ 47,921 $ 426,592 $ 880,298 (51.5) $ 189,716
Depriciation (37,558) (41,000) ( 8.4) (38,961) (265,065) (287,000)( 7.6) (272,982}
Non Operating Revenue 11959 _ 3,691 (4G.9) 1,952 521,908 ?.5,83! 19,123
Dotal Income (Lose) $ 150,556 $ 106,141 41,9 $ 10,912 $ 683.435 $619,1.15 10.4 $ X64,141)
rr ~ ~
PLOW M HORIAL HOSPITAL
STATISTICAL STATEIMENT
Apr11 30, 1985
CURRENT MONTH YEAR TO DATE
PATIENT UTILT'LATION, ACTUAI. BUDGET % VAR. PRIOR YEAR ACTUAL BUDGET % VAR. PRIr,' YEAR
Adult Patient Days _ _ - _ 1,929 2j_804_ _(31.2) 2,670 16,181 19,287 (16.1) _19,100 _
Average Per Day_ _ _ - _ - _ - 64.3 93.5 _(31,2} _ _8`9.0 76.3 91,0 (16`11 89.7
Newborn Pntient Days _ - _ _ 396 ~384~ ~3.1 _ _ _ 342 _ 2,597 _33030_ 114.3) -2,884
Average Per Day_ _ _ _ _ _ _ _ _ _13.2 -12.8 J 3.l_ _ 11.4_ 12.3 14.31 _(14.31 13.5
ICU Patient Days_ _ - - _ _ - - - 63 J 145 56.6 ~!Ol _ 772 - - 911 -
_ ~ _ _ 615.3) _ 977 _
Percent of Occupancy- - - - 41,2 _59.9% (31.2) - 57.1% -48.91 ~ 58.3% 616.1) _57.5X_ j
Admissions _ V 493 560 _(12.0)- 517 3,586 _ _3,_713 _ 3.4)_ _ 3,705 _
Discharges- - - - ^ - - - r 482 ~561J_ (14.1! y -497 2,600 3,691 (W2.5) 3,669
Average Lengtb~of Stny__ _ _ - v ~4.7- - - 5.0 ( 6.U)-- - - 5.4 _ 4.5 _ 5.0- J (10.0) - 5.2 -
Aledlcare h MedlCald Util._ y _ LL35.9 _-30.OIG 19.7 _ -30.8%- _31.11 V 30.OR _ 3.1 y _34.5%
OTHER UTILIZATION,
O.R. Procedures _ 170 226 (24.8) 213 _ 1,157 _ 1,318 (12.2)_ 1,.564
Luhoratory 'Costs _ - - - y15L170 ^15,417 _ (~1.6) 10,843 104,548 10G~10]` J (1.5) 102 73
Respiratory Ther, Treatments 1,688 2,103 _ (19.7)_ _r 2,583 W _15,078 _14,467 _ 4.2 17,810 _
Radiology L'xama_ _ .1,356 _ 1 543 1.2.1) _ 1,505 - 9,435 10,606 120.52 10,673_ _
Emergency Room Visits _ _ J 1,311 902 45.0 _ `I.L101_ _ 8,11'5 _ `b,926 18.9 -7,071
Physical Trier, Treatm~~n-tts_ 595 - V763- _(22.0)_ 763 3,935 5,535 _ 128.9) 5,689 _
U~etary lfeals Served- _ _ _ 13,709_ _18,78 6 (27.0) _18,193 _ 113,190 129,223 _ (12_41 1292721_
PER ADULT PA'T'IENT DAYI
Geoas Patient Revenue _ $825.59 $562.82 46.7 _$518.23 3675.68 $568.84 18.8 $532.95
Kot Operating Reveeue - - - 642.72 452.113- 41.9 _ 422.75 497.29 _ 457.81- - Y 8.6 416.44
Operating Expenses- _ 565.69 416.30- 35.9 431.42 - 487.30 427.05 + _14,1 _420.80 _
Income from Operations- J _ 82.22 36,.51, 125.0 _ _3.36 _9.98 _36.76 _ 167.6) -(_4136 _
LABOR COST MANAGEMENTI
Pull Tima Equivalent Employee _ _ 336.7 _370.8 ( 9,~2), W401.1 365.9 370.8 _ 6 l.3) _ 407.3 _
F.T,E, Per Adult Patient Day_ _ 5.2 _ _ 4.0~ 30.0 4.5- + _ 4.$ J ` 4,tr 17.1 ~i.5
Payroll as a % of 'Coral lxpenses - 46.8 47.'SX - 1.5 48.7% -47,'7_ ~ - 47.6Y 0.2- - 5U.9X
a % of Occupancy based on operations/beds Current Month - 46.6%
FLOW MEMO,. HOSPITAL
COMPARATIVE ANALYSIS ACCOUNTS RECEIVABLE
April 30, 1985
AGING BY DISCHARGE DATE % of % of
DAYS CURRENT MONTH TOTAL PRIOR MONTH TOTAL
0-30 $ ],796,738 36.1% $ 1,898,220 35.2%
31-60 1,(" 1,956 20.9% 1,123,193 20.9%
61-90 603,788 12.1% 684,882 12.7%.
91-120 432,787 8.7% 372,461 6.9%
121-150 151,278 3.1% 240,57P. 4.5Y
151+ 952,418 19.1% 1,069,006 19.8%
$ 4078,965 100.0% $ 5,388,334 100.0%
ACING BY PAYMENT DATE
0-30 $ 2,388,895 48.0% $ 2,576,419 47.8%
31-60 1,187,764 23.9% 1,303,329 24.2%
61-90 710,494 14.3% 685070 12.7%
91-120 333,996 6.7% 322,769 6.0%
121-150 99,778 2.0% 199,565 3.7%
151+ 258,038 5.i% 301 tM 5.6%
$ 4,978,965 100.0% 5,388,334 100.0%
REVENUE BY FINANCIAL. CLASS
12/84 11/84
CURRENT MONTH 4/85 3/85_ 2/85 1/85
Medicare $ 405,004 25.4% 24.57 28.3% 30.8%. 18.1% 20.8%
Medicaid 113,587 7.1% 4.6% 2.9% 215% 311% 2.5%
Blue Cross 80,244 511% 3.3% 3.3% 5.4% 5.2% 6.6%
Commerical Ins. 661,170 41.5% 44.5% 44.1% 37.4%. 41.4% 41.4%
Self Pay 332,253 2019% 23.1% 21.4% 23.9% 22,2% 28.7%
S~ 115920258 10010% 100.0%. 100.0% 100.0" 10010% 100.0%
BAYS OF RRVENUE IN A/R CURRENT MONTH 3/85 2/85 1/85
Gross 101 110 111, 121
Not 60 60 60 69
WRITEOFFA & RECOVERIES CURRENT MONTH YEAR TO DATE DRG OUTLIERS CURRENT MONTH YEAR TO DATE
Charity $ 100,054 $ 593,256 # Discharges 2 17
Dad Debt 494,758 2,293,623 over $18,000
Bnd Debt Recoveries 530058 2319895
INTERIM MANAGEMENT RECOMMENDATIONS
ON
FLOW MEMORIAL HOSPITAL.
DENTON, TEXAS
1
Summit Health, Ltd.
May 1986
C
C TABLE OF CONTENTS
Page
Introduction 1
Business Office Report y
i
Admitting 6
Insurance Billing g
Collections 10
Contracts Analysis 13
Data Processing Report 14
DRG Management Report 21
Reimbursement aaW ew Report 28
Summary of ar,. . ~4.viewed for Joint Commission 30
Personal letters 38
T
E
I
FLOW MEMORIAL HOSPITAL
INTRODUCTION
Summit Health Ltd. has been contracted to provide 90 days of management
consulting services to Flow Memorial Hospital. During this time a variety of
specialists in hospital management fields have visited Flow Memorial to analyze
and report upon services in various departments.
This report serves as an interim report updating the hospital on problems
identified and recommendations for corrective action to be taken, This report
encompasses the evaluations of the Business Office, Data Processing, reimburse-
ment program of the hospital, Medical Staff function, Quality Assurance, -
diagnostic related grouping departments such as Medical Records, Utilization
Review, Business Office and other departmental relations,
Reviews of the hospital services have been conducted in the areas of,
Nursing, Engineering, and marketing services in the community, and will be
• included in the final report to the.hospltal's Board of Directors,
Overall, Flow Memorial Hospital enjoys an excellent reputation in the .
commdnity; however, there appears to be a lack of confidence by the Medical
Staff in the hospital's ability to survive should it not significantly adjust
its current course of action. While there is a Master Plan as provided by
the architect, Howard K. Smith, there is no overall-long-range plan and
roadmap for the future 'indicating how the hospital is to not only survive
but prosper in the coming years. A,major component in the success of most
Summit Health hospitals has been the development of a long-range five year
plan which has been used as a roadmap for successful development of each of
the facilities. This includes priority objectives and action strategies
'that carry the hospital through the next five year planning period.
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The Master Plan includes only a physical analysis of hospital growth and
expansion.
In the final consulting report, an analysis of the existing Master
Plan will be made by Summit Health architects. There is a concern at this
time that the Master Plan calls for a costly redevelopment of the hospital
that can, perhaps, be accomplished at half of the proposed cost made by
the existing architects.
Immediate attention must be given the fact that the hospital will lose
at least 33 percent of its revenue with the construction of the new hospital
by the First Texas Medical Group. This has caused a great deal of fear and
consternation on the part of the existing Medical Staff and hospital staff.
Many employees are concerned regarding a long-term probability of maintaining
their positions as they recognize the hospital will have to severely curtail
( services and staffing with the proposed loss of revenue and patient admissions.
An aggressive program of medical office building construction, physician
recruiting, new program development and major marketing must be undertaken
in the coming months to insure future success of the hospital.
The major competition in town, Westgate Hospital owned by AMI, has been
successful in recruiting physicians to their new medical office building.
With increased competition from Flow, AMI is expected to become much more
aggressive in securing their relationships with physicians and census building.
Interviews with physicians on the Medical Staff indicate no long-term
loyalty to Westgate; however, due to a lack of an appropriate alternative
for them, they have shifted their practice, They will only consider moving
their patients back to Flow Memorial Hospital if an adequate physical plant
and staff is provided for the care of their patients. The nucleus of the
recruitment of physicians will be an on-site medical office building.
Once again, in the final report to the Board, the strategy for long-term
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growth, survival and expansion will be made to the Board detailing those
steps that need to be taken.
The focus of this report is certainly more operational at this point
in time. The hospital will be undergoing an inspection by Joint Commission
on Accreditation of Hospitals within 60 days, ane Summit Health has made
available to Flow Memorial Hospital its pre-accreditation survey team,
This is a group of experts in hospital administration and governing body,
nursing administration, engineering, and medical staff functions including
credentialling, chart review, quality assurance, and other related functions.
Overall, it appears that significant effort must be undertaken in
preparedness for Joint Commission. Significant record-keeping in the areas
of engineering need to be developed, Additionally, efforts must be undertaken
on behalf of the Medical-Staff to fully document the credentialling and the
granting of privileges, along with the documentation necessary in the Medical
Staff committees regarding quality of care and chart review, There are
significant deficiencies in the area of quality assurance and the Joint
Commission places a great deal of emphasis on this area.
The area and biggest concern of the hospital at this time is in the
Business Office, There appears to be a lack of continuity and disorganization'
which needs to be rectified immediately. There is also poor communication
between the Business Office, Medical Records, Utilization Review and duality
Assurance, For an effective ORG functioning program, proper communication
between these departments is crucial.
We understand the hospital has been seeking a qualified Business office
manager, and we recommend that hiring of a qualified candidate be achiaved
as soon as posoible,
In the area of Data Processing there are significant deficiencies
which are detailed in this report which also must be rectified. The short-term
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upgrade for Micado should be acquired; however, the long-term solutions
C rests with the development of a full-capability in-house system such as
one provided by the IBM 36.
This interim report is provided to give the Board an update on overall
progress. Each'of the individual specialists in the areas detailed in this
report are available for further consultation and can be contacted through
r the offices of Summit Health at any time for followup information and specific
input as to how to achieve the attached recommendations.
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BUSINESS OFFICE REPORT
A thorough review of the Business Office was performed by Harvey Quinn,
Regional Business Office Manager, for the Central Region, Texas, of Summit
Hospital Corporation,
r- - Mr, Quinn did receive and review the Baylor Study and determined that
some of the recommendations had begun to be implemented, most specifically,
by the new controller.
After a review of all Business Office functions, the following areas
of concern need to be addressed to enhance the operational and productivity
levels in all areas of the Business Office.
It was noted that a pr6btem with supervision in this area accounts for
less than optimal employee morale and productivity. The sheer volume of
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accounts and files located in the Business Office also adds to employees'
frustration when accounts cannot be readily located for followup or patient
request.
The office arrangement for the collection department tends to create
a poor environment for productivity and confusion, thus leading to low
productivity at a time when the department needs to maximize its efforts,
It was noted that the collection effort is poor and is in no way sufficient
for the goals this department must achieve. It was found that accounts are
boing followed up once every 30 days, but there are no productivity reports
'k to substantiate this,
The Admitting Department is equipped for on-line processing of admissions,
but this is not the case; all admissions are pre-processed manually thus
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creating double work for each patient admitted bot as in-or outpatients,
The data processing system is not adequate for true on-line applications
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In the Admitting area, It is recommended that data processing be upgraded
immediately to solve this problem,
I Wile it is noted that the staffing of the Business Office may be
in excess of the needs for a facility pf this size, this is resulting in
low individual productivity. It is imperative that a forceful Business
Office Manager be hired immediately to reorganize this department and to
assure cross-training of all employees be implemented at all levels.
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Insurance bailing will still continue to be a major issue until
proper UB-0 data processing is implemented and controls put in place to
assure timely billing of all accounts. There are approximately 60 files
being held for diagnosis, Report of Eligibility or an incorporation of both,
and this area must be addressed. Bad debt exposure must 6e reduced througF
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a major and concerted front end collection policy, although the indigent
patient issue cannot be addressed at this level. It will still be possible
to reduce bad debt through a very thorough followup system when implemented,
It is our belief that if the above areas are addressed in the near future,
accounts receivables for this facility can be decreased significantly,
The following is a list of problems and recommendations for each of the
Business Office areas;
ADMITTING
Overview; The admitting function'has adequate staffing and supervision
at this time.
PROBLEM; Data entry needs
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RECOMMENDATION: The total admission process must be reviewed and
upgraded to contain critical information for insurance billings and
x~ col.lections. At present, it is necessary to dual process patients
first in a manual mode then re-entered in a data processing mode. The
system, as it now exists, is slow and does not contain adequate screen
for complete patient processing.
PROBLEM: Insurance vertification certified
RECOMMENDATION: Insurance verification must occur prior to or at the
time of admission, but not to exceed 24 hours past admission with the
exception of weekends. A very critical area of verification is pre-
existing condition, and this is not addressed on the presenOnsurance
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verification form. It is, therefore, recommended that this form be amended
to contain the following information:
1. Are there pre-existing insurance clauses? If so, what are they?
2. By whose authority do you verify this information?
3. Are there any additional forms or information needed?
4. Does this policy require a second opinion?
PROBLEM: Deposits on admission
RECOMMENDATION: High priority should be given to front end collection of
all deductibles and co-insurance prior to the patient being admitted to
the room. This will reduce the need for a strong after-the-fact collection
effort when it is much more difficult to collect monies.
PROBLEM: Financial agreement
RECOMMENDATION: Financial agreements should not exceed six months for
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accounts with a balance of $1,000 or less and one-third of this amount
should be collected on admission,
PROBLEM: MediCare admissions payment refusal
RECOMMENDATION: All MediCare patients ''should be asked if they have been
hospitalized in the last seven days to forestall loss of ORG payments for
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prior stays. This was not in evidence and could result in denied reimbursement.
PROBLEM: On-line entry
RECOMMENDATION: Upgrade or replace present DP system to facilitate on-line
processing, This will also increase patient satisfaction during the admitting
process and provide a more consistent patient tracking, This is addressed
further in the section on data processing.
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PROBLEM: Pre-admission
RECOMMEDATION: System should be revised to increase productivity. It is
imperative that the burden of pre-admissions not be pAaced on the doctor or
his staff, The pre-admit clerk should call the doctor's office daily to
secure the name and telephone number of any possible admits, but not request
any additional information, The patient then should be contacted between the
hours of 6 and 9 p.m. when most people are available at home to obtain
admitting information.
GENERAL PROBLEMS AND CONCERNS
RECOMMENDATION: All admission personnel should be trained in proper data
questioning techniques. A copy of all insurance, Medicare, Medicaid
and driver's license should be obtained. An admission check-off sheet
'Should be developed to assure compliance with the above.
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INSURANCE BILLING
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GENERAL COMMENTS: The number of bills processed is not coordinate to the
number of personnel in the department. There should be more bills processed
or reduction in staff,
PROBLEM: Billing of MediCare/B/C and Medicaid
RECOMMENDAITON: One clerk should be responsible for the above three areas
once on-line processing is in place. A data entry productivity log is
recommended to assure processing. On-line Report of Eligibility should
also be the responsibility df this clerk,
PROBLEM: MediCare billing
C RECOMMENDATION: MediCare should be monitored daily for diagnosis and
Report of Eligibility to insure prompt billing. The billing time should
not exceed 10 days past discharge when the automated system is in place,
PROBLEM: UB-82
RECOMMENDATION: An automated ORG grouper or system should be in place as
soon as possible to maximize reimbursement and turnaround billing of claims
in the shortest possible time, Also, data processing capability needs
improvement to insure a more complete form and less manual processing,
GENERAL INSURANCE BILLING PROBLEMS
RECOMMENDATION:
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1. All bills over $1,000 sent certified mail to assure delivery,
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2, Institute daily billing reports by number and dollar value,
3. Transfer the responsibility for insurance foliowup to the
collection department,
COLLECTIONS
PROBLEM: Overall collections
RECOMMENDATION: Major reorganization is needed in this area. With
staffing of three collectors and one supervisor, the installation of
a CRT for each collector with the ability to access data base to improve
speed and timing of calls is needed, The institution of a 10-day followup
on all accounts of $1,000 or more with foliowup every 15 days on balances
less than $1,000. Collectors should work all accounts from date of billing
on this system,
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PROBLEM: Followup methodology
RECOMMENDATION: Tracer card systems should be installed immediately to
increase productivity of collectors, Do not have collectors use file folders
to work accounts as this decreases productivity. Tracer cards should contain
all pertinent information on account'from admission to final payment.
PROBLEM: Documentation
RECOMMENDATION: Be more specific as the responses by patients and document
in a clear and concise manner on all tracer cards all insurance and self-pay
information,
PROBLEM: Large volume of accounts over 90 days old
RECOMMENDATION: It is recommended that an outside collection agency be
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contacted to institute cleanup of all self-pay accounts over 90 days
C Old- This agency should work on-site for a minimum period of 120 days
to rectify this situation. After 120 days, the agency should issue a
Report of Collectability of all outstanding accounts and a decision be
made to place the remaining accounts for bad debt collection at that time.
The fee for these services should be in the 10 percent to 14 percent
f range to assure adequate effort,.
PROBLEM: Accountability
RECOMMENDATION: Establish a collector report system with minimum acceptable
standards of 40 hard contacts a day by each collector or supervisor,
PROBLEM Other collection procedures
RECOMMENDATION:. Contact a local attorney and discuss the feasibility of
C filing court action againstdebtors who have assets over and criteria. This will make other debtors realize the facility Is serious
about payment of bills,
GENERAL RECOMMENDATIONS-
1. Reduce eye contact for personnal working in the collection
department so they may concentrate better on workload, Suggest
use of partitions,
2. Provide collectors with telephone head sets to increase
productivity,
3. Monitor collectors as they make collection calls.
4. Work all insurance followup between the hours of 8.30 a.m, and
4 p,m, Work all self pay accounts from 1 to 9 p,m.
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5, provide privacy screens for all collectors to insure confidAntality
of information,
6. It is recommended that an outside collection agency be retained
to conduct training of all collection personnel.
GENERAL COMFiENTS:
Employee dissatisfaction should be addressed and resolved to increase
productivity. All forms now in place should be evaluated in light of a
true on-line processing system and a better system of filing devised.
NOTE; The Business Office manager and controller should review all
accounts to be written off to bad debt to assure that all prudent collection
action has been taken by the in-house staff. At the present time, adequate
C collection followup is not in place, therefore, accounts now being written
off should be closely monitored prior to writeoff,
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FLOW MEMORIAL HOSPITAL ANALYSIS OF CONTRACTS
MEDICAL
Department Contractor Term Expiration Payment Termination Comments
Anesthesia Dr. Wayne Via 1-year 6-6-85 $25,000/ 30 days Separate bill for
automatic year written clinical fees
renewal notice
Nuclear Medicine NuMed, Inc. 1 year 9-23-85 $2,368/ 60 days
automatic month written
renewal notice
Cardiology Dr. ditendra 1-year 9-30.85 $1,000/ 60 days
Bhatt automatic month written
renewal notice
Emergency Room Dr. Bridger 1-year 3-1-86 $24,820/ 60 days 1 full-time physican '
Little year plus written 24 hours/day, seven
$34/hr, notice days a week
Pathology Affiliated 1-year 10-19.85 separate 90 days
Pathologists automatic bill written
renewal notice
Clinical Lab Medical Lab 1-year 10.19-85 Defined 90 days Approximately $80,000.
(Dr. Ford) automatic cost written month
renewal notice
Respiratory Dr. Dinesh 1-year 10-15-85 separate 30 days
Therapy Kagal automatic bill written
renewal notice
Physical Therapy (Hospital Services patient department)
Radiology Dr. Lockwood 1-112 years 9-30-86 $1501000/ 9-30-86 Hospital will receive
year Dr. Lockwood's out-
patient business,
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approx. $60,000 more
revenue to the hospit
Net expense about
$110,0001year
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DATA PROCESSING REPORT
Flow Memorial's computer system is "McAuto's" - mini-based hospital.
system. A five year lease from October 1982 to September 1987 is currently
in effect, The following is a general overview of the current system:
Hardware
Microdata model R6765
with 45 IPA and 16008P1 tape drive
96K memory
96 mg disk storage
r 8 - prism II terminals
1 - 300 1 pm printer
1 - 120 cps serial printer
Hardware is leased from McAuto for five years
Software
Patient registration and control
Patient billing and A/R
General Ledger
Payroll and personnel
Accounts Payable
Materials management
Fixed assets
Software is leased from McAuto for five years
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PROBLEMS:
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Time constraints;
Nine hours to complete daily processing
16 hours to complete daily processing
24 hours to complete daily processing
Storage capacity;
Thu system capacity is not adequate to support the current system
applications of the hospital.
There is need for an additional goo megabitts of storage
capacity,
There is no grouper sytem application regarding control over the
C hospital DRG system and reporting process. In addition, the system is
unable to process DRG outlier admissions,
The physical security controls over data processing hardware and
software are inadequate.
The US-82 billing and reporting system is inadequate to meet the
needs of the hospital,
Vendor support for software enhancements is unreliable,
An unfavorable contract in regards to flexibility of change and
early termination of the contract,
Lack of operational user equipment, i,e. CRT terminals that are
necessary to improve efficiency in the Data Processing and Business office
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OVERVIEW;
The current data processing System I,' use at Flow Memorial Hospital
is inadequate to meet the management information needs of the hospital.
There are problems related to the computer hardware configuration that
needs immediate resolution. In addition, there are problems related to
the flexibility and maintenance of the software function that cannot be
resolved with the current or planned enhancement of the McAuto (MHS) system,
The cost of the system relative to the benefits derived is high when
compared to more adequate hardware that is available in the marketplace,
The current vendor does not appear responsive to the specific needs of
Flow Memorial Hospital nor does it provide the enhancements to its software
system tlratthe changing environment of the hospital information system
requires.
There is no data processing plan or policy for the hospital that would
provide a guide for making decisions on such topics as; "Is there need for
personal computers?" If so, which applications would be on the personal
computer and what would be on the McAuto? Can they interface? Is there
a need for interface? If there was a plan in place, the current hardware
inadequacies would not exist.
The operation's staff is capoble, conscientious and hard working,
THe F.T.E. level is 3,5, quite adequate,
The hardware problem is due becauso the system is too small and slow,
At present, the bad debt files are removed from the system in order to provide
capacity for daily, weekly and monthly billing and accounts receivable
processing.
The current billing system does not provide for U6-82 reporting and
billing forms as required by MediCare; therefore, all of the MediCare bills
require manual adjustments which is operationally inefficient and costly.
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The enhancements to improve the system cannot be installed until the current
hardware is upgraded at a cost of approximatley $36400; however, if the
upgrade is purchased, certain software problems would still remain,
The admission process is too slow causing admitting personnel to type
forms and input the data into the computer at a later time. The causes dup-
lication of work and increases the possibility of error, The billing applicatinn
is still not complete in that it lacks the capability to produce the MediCare
outpatient laboratory bills in the required format. Other functions such as
a DRG group and case mix reporting or DRG tracking would need to be purchased.
A problem exists that these functions need to interface with the current McAuto
system and if the programming is rot provided by or approved by McAuto the
hospital would risk losing all of the McAuto software support.
The direct cost of approximately $8,000 per month for hardware and
software should be considered a rent. At the end of the five year contract,
C all equipment and software remains the property of McAuto. The hospital would
have invested $250,000 in the software and another $180,000 to $2000000 in
equipments costs. This amount of expenditure should result in a purchased
hardware and software system. There are canned packages.available for
$60,000 to $100,000 on a one-time cost basis that would provide the hospital
with a faster and more comp.le.te software system, The hardware necessary to
perform to the requirements of this hospital would cost approximately
$110,000 on a one-time cost and resulting in the hospital owning and having
equity in the hardware.
McAuto has been slow in responding to DRGs and 08-82s. As previously
stated, some requirements in billing have not been met,
RECOMMENDATIONS:
The following options are presented in order to address the overall
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r data processing needs of the hospital.
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The purchase of the hardware upgrade from McAuto would solve the
immediate hardware problems. The daily, weekly and monthly processing
on the current system could continue without space problems. The Bad Debt
accounts could be restored, the Fixed Assets and Inventory systems could
reside on the system. The enhancements from McAuto software would be
implemented 'thus' retaining software support from the vendor.
This option, however, does not provide for the Medical Records and
ORG applications and reports that would maximize the MediCare reimbursement
and provide for concurrent utilization review of patients. This option
would be recommended as a very short term solution and only if the hospital
is unable to purchase a new system within a six month time frame.
0 Lion 2
The purchase of a new mini-computer and software system that would
include Billing and Accounts Receivable, General Ledger, Accounts Payable,
Payroll, Fixed Assets, Materials Management and DRG grouper/case mix
reporting the software cost should approximate $80,000.
The hardware cost should approximate $120,000 and should consist of the
following:
CRTs 2 Inpatient Admitting
1 Outpatient Registration
1 Emergency Room
3 in Data Processing
1 in Accounting
1 in payroll
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CRTs continued
1 in Warehouse
1 in Medical Records
4 in Business Office
15 CRTs Cost $ 25,000
Printers 1 in op at 600 fpm $ 12,000
1 in Inpatient Admitting 3 000
1 in Outpatient Registration 180 cps 31000
1 in Emergency Room Registration 120 cps 30000
1 in Business Office 200 ipm 7 000
$ 28,000
CPU 400 Megable fixed disk
512K memory
$ 67,000
We would recommend an IBM system-36 due to a large degree of software
availability and high resale value of the hardware, A system of this type
'would be flexible for future expansion of the hospital as needs arise, In
addition, the system would be highly efficient which would enhance the overall
operations of the entire hospital, including the Business Office, Medical
Records, Purchasing, etc,
The Medical Records function would provide for maximizing of the DAG
reimbursement and more accurate and complete information on the 09-82
bills, The current OP staff is capable of learning a new system and providing
for effective operations; however, to insure the Management Information needs
of the hospital are met, we suggest that the hospital contract with the vendor
or an experienced consultant with the specific experience of installing the
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chosen software in order to monitor the implementation of the system
for a period of one year, This cost should not exceed $25,000,
ADDITIONAL RECOMMENDATIONS:
Mana ement Information System Plan
The development of a management information system plan would include
hardware and software, It should serve as a guideline for the implementation
of new applications and enhancements to existing systems, The purchase of
personal computers should be stopped until such an overall plan is developed
and agreed to,
Security_ C_~15
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Improvements are needed to safeguard data processing hardware and
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software. At present, there is not a system in place to control access
C into the computer room. Intentional and unintentional destruction of
equipment and files could result in a devastating loss to hospital operations.
Access to the computer room should be limited to employees who are involved
with data processing operations. In addition, an off-site storage location
should be utilized for retention of backup tapes and files.
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C DRG MANAGEMENT REPORT
The following areas were reviewed by Patrick Small, DRG Coordinator
for Summit Health,
Department operations in DRG related departments including
Medical Records, Utilization Review, Business Office, Nursing
and Administration
Medical Staff involvement in the hospital DRG program
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Overall hospital performance related to the ORG program
Areas needing attention or improvement
Personnel from Administration, Medical Records, Utilization/Quality
Assurance, Nursing, Medical Staff office and the Chairman of the Utilization
Review Committee were interviewed for this report, We observed operations'
In these departments, reviewed minutes and other documentation related to
operational performance, The following is a report of our evaluation.
Staffing Resources
The Medical Records Department is staffed with elghtF. T,E,s and a '
director, The department is responsible for routine Medical Records
functions, including transcribing and DRG assignment, Based upon the hospital
occupancy rate of approximatley 40 percent, which seems to be consistent at
this time, the Department is not efficiently being utilized and should
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have the staffing reviewed,
Discussions with the director of Medical Records indicates agreement
i with the above assessment,
The Utilization Review/Quality Assurance department consists of three
F.T,E,s and a director. Discussion with the director indicates approximately
1.25 F,T.E,s are devoted to U,R, The remainder of the staff is devoted to
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Q.A., Infection Control and Risk Management, Hospital percentage of
occupancy and the percentage of MediCare-Medicaid patients U,R, responsibilities
could probably be carried out by less F.T.E.s,
Non-Staff Resources
There seemed to be adequate physical space allocated to each department
visited.
Data Processing resources devoted to DRG related operations are totally
'inadequate. Medical Records contracts with McAuto for standard Medical
Record reports, but has no resource for DRG assignment, management or analysis,
DRGs are manually assigned, which is both time consuming and of questionable
accuracy. In addition, increased D.P. resources devoted to DRG assignment
would undoubtedly present an opportunity to maximixe DRG resimbursement
above the level the hospital now receives,
Utilization Review suffers the some lack of D.P, resources regarding
DRG management, The manually assigned DRGs are communicated to U.R. personnel,
who post the information on the Medical Record, Such data is updated period-
ically and is supplemented by financial information provided by the Business
Office, Such updating is not done emery day and thus somewhat limits daily
DRG management, The U,R. Department does not have reliable cumulative data to
evaluate hospital performances with specific DRGs or individual performances
under PPS. At best, U,R, has data available related to those cases which
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have been billed and paid since October 1979. Confidence in the Information
C is quite low and is seldom utilized to inform the Medical Staff of hospital
performance.
Educational efforts for both hospital staff and Medical Staff have been
quite limited. Hospital personnel have attended few workshops or seminars, and
are not receiving any periodical literature related to PPS/ORGs. Medical
Staff has not been exposed to hospital sponsored educational efforts, and
contracts with Medical Staff members seems to be on a one-to-one basis.
Upgraded technological support in the form of an automated grouper ORG
management report generator and daily resource consumption monitoring reports,
would allow for considerable improvement in case ml;, management. Staff
participating in both in-house and outside educational seminars/workshops
would compliment the technological upgrading and insure reimbursement
maximmization. Educational efforts directed toward the Medical Staff should
C be able to increase physican understanding of PPS and the level of Medical
Involvement in the ORG program.
Staff Knowledgeabllit
In general, staff knowledgeability and understanding of PPS/ORGs is
quite good, The director of Medical Records is very aware of the importance
of complete, timely medical record information, There have been considerable
reductions in the number of existing delinquent Medical Records. There are
currently only 91 delinquent records, which is more than appropriate for a
166-bed hospital.
There are only 40 cases awaiting ORG attestation, with none prior to
March 1985. The total dollar amount unbilled because of incomplete attestat'on
is approximately $131,000. The director of Medical Records has obtained
considerable cooperation from the Medical Staff and has made ample progress
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y physicians,
al The director of Utilization Review is also quite knowledgeable
regarding DRG operations as well as U.R, concepts, U,R, staff seems to be
well-trained and competent, The U,R, director appreciates the potential
benefit of upgraded technological resources, particularly regarding data for
tracking DRGs, resource consumption and cumulative data which could be shared
with the Medical Staff,
With limited resources available, efforts have been made to document
for physicf. n anticipated DRGs, reimbursement levels, ALAS and hospital
resources consumed.
The director also understands the importance of Medical Staff Involvement
in a DRG program and has attempted to involve Individual.phys.tcfans in the_.
review and evaluation of hospital utilization on a case-by-case basis for
both MediCare and Medicaid patients, In all of these efforts, U.R. has been
somewhat hampered by a lack of complete, timely and credible data,
Interdepartmental Relations '
The relationship between Medical Records and Utilization Review seems
to be excellent. Directors of both departments understand the importance
of effective communication and have maintained productive working relation-
ships between their department,
Both Medical Records and U.R. directors seem to have a negative opinion
regarding their relationship with the Business Office, There have apparently
been inconsistencies in Business Office I staffing which has complicated the
relationship with Medical Records and U.R. There seems to be little or no
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confidence in the accuracy of data obtained by U.R. and M.R. from the Business
Office.
The relationship between U,R „ M.R. and other departments seems to be
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good. We believe there should be a clearer definition of responsibility 25
for coordination of a hospital-wide DRG program, and that U.R. and M.R.
directors should be more involved in educating the hospital
staff to the
DRG program, Both directors have very good ideas about communicating per-
tinent information to the Medical Staff and the hospital staff, but there
is no evidence of specific design or direction for a hospital-wide, compre-
hensive DRG program. We believe U,R, would benefit.from greater involvement
of ancillary service departments and Nursing in an organized approach to
hospital resource management, cost containment, and DRG/PPS related educational
efforts.
Medical Staff Involvement
Although the Medical Staff seems cooperative with Medical Records,
Utilization Review and Administration, there have been limited involvement
in DRG related activities. Personnel in various departments agree there is
a need for Medical Staff education, especially related to Prospective Payment
Systems and the DRGs, and that there needs to bq greater Medical Staff
involvement in DRG related hospital operations.
The director of O.R. feels that the few physician advisors available
for review activities are not very strong or aggressive. Review of U.R.C,
minutes fails to document action by the Committee and seems to indicate little
or 'rro~ chart review. Discussion with the Medical Staff secretary revealed
that there is some concern about the confidentiality of Committee minutes
in the City-Council hospital setting, and it is advised that a legal opinion `
regarding such confidentiality should be obtained.
Discussion with the chairman of the U,R, Committee indicated a
willingness exists on the part of the Medical Staff to increase involvement
in U.R. ar;d DRG related issues but
that more education of the Medical Staff
,
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26
was needed,
There does Seem to be a number of questionable admissions among
Medicare and Medicaid patients, and denials of admissions has resulted
in the hospital's loss of waiver in November 1984. Given the small volume
of MediCare patient, the limited knowledge and involvement of the Medical
Staff and the Federal Government's aggressive stance regarding waivers, it
is unlikely that the hospital will be able to regain the waiver 1
near future, In the
i
Relationship with the PRO
As noted, the hospital's loss of waiver occurred in November 1984,
Because of this, the hospital is under 100 percent review of MediCare and
Medicaid. Discussions with hospital staff indicated that there is a
cooperative relationship existing between Flow and the PRO. Discussion
C with the representatives indicate that the major problem
seems to be inapprop-
riate admissions,
ORG surveys have resulted in few DRG assignments being questioned, and
that documentation is adequate to support DRG assignment identified among
the Medical Staff, and no physician or group of physicians have been targeted
for special or intensified review activities. The general evaluation of
the PRO is that the hospital provides adequate quality care, and is generally
appropriate in utilization with the exception of some admissions. The denial
rate for admission during the last PRO survey, during the last quarter of
1984, was 14 percent, causing the loss of waiver, This is a high denial
rate that needs attention,
DRG Related Recommendations
1. Upgrade technical resources for DRG Management. This is necessary
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for Medical Records and U.R. state-of-the-art data processing and
C must be obtained. Greater efforts at educating hospital personnoi
and Medical Staff should be initiated,
2, Increase Medical Staff involvement and education, This is necessary
with regard to DRG activities, but attention must also be paid to
Medicaid and to the problem of indigent care, Physicians must be
rr~
made to understand the implications of Prospective Payments Systems,
Medicaid reimbursement and uncompensated care and the devastating
financial effect these have upon the hospital,
3. Development of an organized, well-directed DRG management program.
DRG coordination responsibility must be clearly defined and action
plans developed. A DRG Committee or Taa'sk Force should be developed
C which will provide evaluation and analysis of performance under
DRGs. Such a group could develop strategies for addressing problems
and for educating the hospital staff and the Medical Staff.
4. Hospital-wide cost containment efforts should be initiated.
Department managers should be required to evaluate their department
and develop suggestions for cost containment,
5. Improve inter-departmental communications. Each department must
see itself as a member of the hospital maangement team, Department
must resolve any existing problems and must establish credibility
with other hospital departments, Participating in such things as
a DRG Task Force could be an excellent forum for this activity.
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REIMBURSEMENT REVIEW REPORT
Flow Memorial Hospital has very little problem where reimbursement
1
Is concerned, The hospital keeps and maintains billing logs that are
reconciled to remittance advices for both MediCare and Medicaid. They
also keep a log on the uncompensated care patient population which appears
to be quite large at Flow Memorial Hospital,
The hospital also maintains a log of employee discounts,
The hospital is a 9/30 provider, which means they are currently entering
the second year under PPS. Their target rate is well below the national
rate, $2,066.92, as compared to $3,000.60. The movement to the national
rate would be beneficial to Flow Memorial and would mean increased MediCare
revenues.
C The Hospital's 1987 and 1982 MediCare settlements were approximately
$10400 and $26,000 respectively due the facility-. The 7983 cost report
was filed with a $527,000 amount payable to MediCare, This cost report
has not yet been audited by MediCare; however, MediCare has withheld
$490,000 of this overpayment to-date. The hospital booked the liability
of the filed cost report on their books per Wilma Fritz, Director of Fiscal
Affairs, If this is true, the hospital may he under-provided for 1983
(Tofra year) if MediCare performs an aggressive audit. Without a conser-
vative cost report or a review of their financial auditors workpapers,
it would be difficult to assess an f
Y possible anderprovision. Also, the
current balance of the due to/from account is $47,367, of which approximately
$37,000 relates to the 1983 MediCare cost report and the balance to 7982,
r
There is no liability for Medicaid on the books,
MediCare and Medicaid utilization based on days over the past three
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r years is as follows:
l
Year MediCare Medicaid
1983 31.37% 4.40%
1982 28,65% 3,64%
1981 32.62% n/a
No data was ava11'ab-TT for 1984 as the cost report data was not made
available to me by Peat Marwick, Mitchell and Company. PMM and Co. prepare
the hospital's cost reports. Only through a thorough review of the cost
report can further specific recommendations be made. Per Karl Eason,
Financial Officer, current Medicare utilization is 26% and Medicaid is
from 3-5%. Also, MediCare length-of-stay is fluctuating between 7.5 days
and 8,86 days over the past three years.
IM ` Based on a review of the 9/30/83 cost report, Flow Memorial Hospital
could have reduced its liability on the filed cost report by approximately
$30,000 by using the correct target rate for Tefra off the TAC run dated
9/25/83. Also, calculated pass-through costs are approximately $15,000
per month.
The hospital did not have a current Hospital Based Physician rationale,
From the 9/30/83 cost report, only ER and EKG are compensated for Part B
costs.
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C SUMMARY OF AREAS REVIEWED FOR JOINT COMMISSION SURVEY
The following areas were reviewed and specific deficiencies are detailed
in this report:
Medical Staff
a. Credentials
b. Reappointment/reappraisal
c. Clinical Privileges
d. Direction/Staffing
e. Enforcement of Medical Staff Bylaws, Rules and Regulations
Lack of Documentation on Patient Care Monitoring Functiuns
a, Antibiotic Review
b. Blood Utilization Review
c. Pharmacy and Therapeutics Redrew (specific reference to Drug
Utilization Review)
i
d. Surgical Case Review
e. Executive Committee minutes
f. Monthly Staff/Departmental Review of patient care
Implementation of the 1985 Quality Assurance Standard
a. Anesthesia Services
b. Dietetic Services
c. Emergency Services
d. Nuclear Medicine Services
e. Nursing Services
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f, Pathology and Medical Laboratory Services
g. Pharmaceutical Services
h, Radiology Services
i, Rehabilitation Programs/Services
J. Social Work Services
k, Special Care Units
Utilization Review
The Utilization Review Plan 011 need to be updated and approved
by the Medical Staff,
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FLOW MEF1O*~t HOSPITAL
PROBLEM IDENTIFIED ACTIONS NEEDED
CREDENTIALS; REAPPOINTMENT/REAPPRAISAL; CLINICAL PRIVILEGES:
1. Credential files were outdated and need to be reorganized. 1. Review and revise Bylaws to reflect current
Inventory needs to be done on physician licenses and DEA practice or revise current practice to
cards. comply with provisions in Bylaws.
2. Procedure for appointment/reappointment and granting of 2. Mechanism for communication between Medical
clinical privileges needs to be reviewed by Medical Staff Staff and Governing Body is not documented
Coordinator as outlined in the Medical Staff Bylaws on in terms of Reappointment/Reappraisal. The
Pages 9-18. Privilege forms were outdated and missing names of the physicians will need to be listed
signatures and the procedures described in the Bylaws are in the minutes,
not being enforced.
3. Previous JCAH deficiency: Inadequate documentation 3a. Medical Staff Coordinator will need to update
of the delineation of clinical privileges for emergency the privilege forms on the delineation of
room physicians and radiologists, as previously recom- clinical privileges for emergency room phys- f
mended. icians and radiologists, as previously
recommended.
3b. Reappointment needs to be based on an appraisal
of the individual at the time of reappoint-
ment Reappraisal includes information con-
cerning the individual's current licensure,
health status, professional pert',wrmanca,
Judgment, clinical/technical skills, as
indicated by the results of quality assurance
activities and other reasonable indicators of
continuing qualifications.
3c. Privileoes will need to be hosoital soecific.
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FLOW MEHOPONL HOSPITAL
PROBLEM IDENTIFIED ACTIONS NEEDED
MEDICAL DIRECTION AND STAFFING:
1. JCAH Standards require medical direction for the following 1.' A director will need to be appointed for
areas; the following departments;
a, Rehabilitation Services a. Rehabilitation Services
b. Respiratory Care Department/Service b. Respiratory Care Department/Service
r--~ c. Special Care Unit c. Special Care Unit
d. Pathology d. Pathology
e. Anesthesia e. Anesthesia
f. Emergency Services f. Emergency Services
g. Nuclear Medicine g, Nuclear Medicine
h. Radiology h. Radiology
2. This will need to be documented in the
Medical Staff Committee Minuties.
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FLOW MEMOP"". HOSPITAL
PROBLEMS IDENTIFIED ACTIONS TAKEN
ENFORCEMENT OF MEDICAL STAFF BYLAWS, RULES &
REGULATIONS/MONTHLY DEPARTMENTAL Rgyl W OF CARET
1. Some departments of the medical staff do not meet 1. Departments will need to meet as specified
monthly. Specific reference is made to; in the Medical Staff Bylaws,
a. OWYN
b, Pediatrics
c, Surgery
d, Department of Medicine
2. Review of patient care is not planned, systematic, la, Consider the establishment of screening
comprehensive or objective, criteria to focus on potential problems
in patient care.
11b. Revise the format for the meeting's agenda
and minutes, Begii with quality assurance F
information. Hi Hight conclusions and
actions taken. Note: The key to compli-
ance-with this function is to get the
physicians to discuss patient care prob-
lems as identified from other committees,
screening criteria or studies performed by
other areas, This is the place where peer
review is supposed to take place, Problems
that address a specific individual or relate
to policies and procedures of one department
should be referred to that department by
the relevant committee for handling. For
example, problems in the prophylactic use of
antibiotics for abdominal surgery should be
referred by the pharmacy and therapeutics
committee to the Department of Surgery for
discussion at their monthly meeting and for w
their resolution), '
3 ic. Clinically valid criteria should be used to
identify problems or assess the cause of
problems.
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FLOW MEMOPP4L HOSPITAL
PROBLEMS IDENTIFIED ACTIONS NEEDED
LACK OF DOCUMENTATION ON PATIENT CARE MONITORING
FUNCTIONS:
1. Antibiotic Review:
a. There is a lack of review for the appro- a. The medical staff will need to review the appro-
priateness, safety and effectiveness of the priateness, safety and offectiveness of the pro-
prophylactic, empiric and therapeutic use phylactic, empiric and therapeutic use of
of antibiotics, antibiotics,
b. Results of antibiotic usage are not docu- b. Results of antibiotic usage review will need to
mented, be documented at least quarterly.
c. Objective criteria are not used for pro- c. ObJective criteria will need to be used for pro-
phylactic, empiric and therapeutic use, phylactic, empiric and therapeutic use.
d. Conclusions, recommendations and actions are d. Conclusions, recommendations and actions will need
not being documented in minutes of committee to be documented in the minutes of committees
performing this function. performing this function,
e. When problems in antibiotic use are identified, e. When problems in antibiotic use are identified,
no actions are being taken by the medical staff, actions must be taken by the medical staff.
2. Blood Utilization Review;
a. There is a lack of documentation on conclusions, a. Conclusions, recommendations and actions taken for
recommendations, and actions taken for Blood .•Blood Transfusion Review will need to be documented
Transfusion Review in the Medical Staff Committee in the Medical Staff Committee minutes.
minutes. It is difficult to determine that blood
transfusions are being done, although pre-established
! criteria have been developed.
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PROBLEMS IDEN;-T ED
LACK OF DDCUMENTATION ON PATIENT CARE NON17ORING
FUNCTIONS continued
3, Pharmacy and Therapeutics Review:
a. There is a lack of documentation on quarterly a. Documentation of the quarterly review on the
reviews of the appropriateness of drug therapy appropriateness of drug therapy practices and
practices and drug utilization in the hospital, drug utilization in the hospital.
b. Written reports of conclusions, recommendations, b, Written reports of conclusions, recommendations,
ntaand the results of actions taken
actions taken and the results of actions taken actions taken
are not being maintained,
c. Hospital does not identify drug reactions, c, Drug reactions need to besdoumented in a
commIttee of the medical ff,
d. When problems are identified in the use of drugs, d. All problems identified in the use of drugs,
no conclusions are documented or actions taken by need to be documented with conclusions or actions
the medical staff, taken by the medical staff. ;
4. Surgical Case Review: (Previous JCAH deficiency):
a. Surgical case review does not include s review of a. Surgical case review needs to include a review
procedures in which no specimen was removed, of procedures in which po specimen were removed
Although criteria have been established for non- and needs to be noted in the Department of Surgery
tissue review; it is not clearly documented in the minutes.
Department of Surgery minutes.
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PROBLEMS IDENTIFIED ACTIONS NEEDED
IMPLEH NTATION OF 7NE 1985 QUALY7Y ASSURANCE STANDARD•
1. Lack of the implementation of the 1985 Quality 1, The 1985 Quality Assurance Standard needs to be
Assurance Standard for the following departments; implemented for the departments listed under Problems
a. Anesthesia Services Identified Nla-k.
b. Dietetic Services 2. There needs to be an ongoing system for monitoring
c. Emergency Services and evaluating information about important aspects
d, Nuclear Medicine Services o patient care,
e, Nursing Services
f. Pathology and Medical Laboratory Services 3, There needs to be documentation on issues addressing
g. Pharmaceutical Services the quality of care and the appropriateness of care,
h. Radiology Services
i, Rehabilitation Programs/Services 4, There needs to be a system for providing the ongoing
J. Social Work Services collection of information about important aspects
k. Special Care Units of patient care.
2. There is a lack of an ongoing system for monitoring 5. There needs to be pre-established criteria used to
and evaluating information about important aspects o€ monitor and evaluate patient care inforoation,
pat"rent care.
6. There needs to be objective criteria that reflect
3. There is a lack of documentation on issues addressing the current knowledge and practice and are agreed upon
guality of care and the appropriateness of care provided, by the department/service.
4. There is a lack of a system for providing the on oin 7. Findings, conclusions and actions taken needs to be
collection of lnformotion about important aspects o documented.
patient care.
5. There is a lack of pre-established criteria used to monitor
and evaluate patient care Information,
6. There is a lack of objective criteria that reflect cur-
rent knowledge and practice and are agreed upon by the
department/service,
7. Findings, conclusions, and actions taken need to be docu-
mented when problems are identified,
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WHITTIER HOSPITAL IPALb1CAL CE
V 15151 Janine Drive . Whittier, California 9o6o5 . 12j3)945-3661
April 30, 1985
Robert M, Gorton
Director of Physical Therapy
Flow Memorial Hospital
1310 Scripture
Denton, Texas 76201
Dear Mr, Gorton:
It was a pleasure meeting with you during my visit to Flow Memorial
Hospital, 1 appreciated the time and the hospitality you extended
to me.
Enclosed please find the following information:
1. Safety Policy & Procedure Manual
If you should have any questions, or if I can assist you further, please
C feel free to contact me at (213) 945-3561, extension 262,
Sincerely,
Lynn 8arkhaus, R.N,
LB:xlw
Enclosures
cc: Jeff Hausler (w/o enclosures)
Administrator
Flow Memorial Hospital
egional Vice Presidentures)
Summit Health, Ltd
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914
' 'Y01'HITTIEdtWHOSPITAL MEDICAL CENTER
90605 {4131 946.3561
April 30,1985
Patricia N. Griffith, R.N.
Director of Nursing
Flow Memorial Hospital
1310 Scripture
Denton, Texas 16201
Dear Ms. Griffith:
It was a pleasure meeting with you during my visit to Flow Memorial
Hospital. I appreciated the time and the hospitality you extended
to me.
Enclosed please find the following information:
1. Nursing Quality Assurance Plan and Minutes
2. 08/GYN Manuals (Labor & Delivery, Nursery, Alternative
Birth Center, Family Centered Maternity Care Unit)
3. Policy & Procedure Form
i 4. Pediatrics Manual
5. Standardized Requirements for Policy & Procedure Manuals
6. Criteria-based Job Descriptions
If you should have any questions, or if I can assist you further, please
feel free to contact me at (213) 945.35611 extension 262.
Sincerely,
Lynn Barkhaus, R.N.
Quality Assurance Director
LB:Siw
Enclosures
cc: Jeff Hausler (w/o enclosures)
Administrator,
Flow memorial Hospital
Regional ice(presIdent ures)
Summit Health, Ltd
L
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WHITTIM HOSPITAL MEDICAL CENTER
® 15151 Janine Drive . Whittier, Calffornla 90805 , (213) 946.3661
April 30, 1985
Robert A. Vento, R.N.
Director of Quality Assurance
r~ 1 Flow Memorial Hospital
1310 Scripture
Denton, Texas 76201
Dear Mr. Vento;
It was a pleasure meeting with you during my visit to Flow Memorial
Hospital. I appreciated the time and the hospitality you extended
to me,
Enclosed please find the following information;
1. DRG Books for Departments
2. Quality Assurance Plan
3, Utilization Review Plan
4. Continuous Monitoring Book
5. Information on JCAH Tape
6. Quality Assurance Indicators (Samples from other departments only)
7. Incident Report Summary
8. Criteria for Blood & Tissue Review
If you should have any questions, or if I can assist you further, please
feel free to contact me at (213) 945.3561, extension 262.
Sincerely,
Cgtt-rr "r tQ , N
Lynn Barkhaus, R.N,
Quality Assurance Director
LBoslw
Enclosures
cc; Jeff Hausler (w/o enclosures)
Administrator
Flow Memorial Hospital
(w/o enclosures)
L SummitaHealth,PLtdident
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FLOW MEMORIAL HOSPITAL
1310SCRIPTURE (817) 387-5861 DENTON, TEXAS 7620f
Jeffrey E.
Mausler
Adminlst rslor 17
minl
~l
r r
UAL A-0
o All?*
u
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aor
74 to
r
SERVING DENTON COUNTY SINCE 1050
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HOW 13 10 Scripture Street
MSMORIAL HOSPITAL Denton, TX 7611
(817) 387.8861
PERCENTAGE OF REVEOUB By PAYOR CLASS:
1 10/84
FY 81 FY 82 PY 83 FY 84 -5/85 Budget
Commercial 38.17 39.2% 41,6% 42.1% 42.0% 42.0%
Medicare 28.6 25.6 27.8 25.5 25.7 27,0
Medicaid 3.1 3.6 3.2 3.8 3.9 4.0
Blue cross 12.8 12.5 6.5 5.5 5,2 5.0
Self Pay 17.4 1911 20.9 23.1 23,2 22.0
PERCENTAGE COLLECTABLFr
1. COmmercialt Historical Is 57 bad debt, but with increase in price, a6
was individual's deductible and co-insurance, increasing bad debt to 6%.
2. Medicare: With a budget decrease in patient days of 19% (63 pte/day)
ratio of Medicare patients will Increase due to their severity of illness.
A price increase is reflected in the 242 allowance,
3. Medicaidt Price increase
4. Blue Cross: Fixed payment system. Being optomistic about the 14%
price increase,
5. Self-Pays With the admitting policy, i budgeted a decrease from 23.3%
to 22,OY With the price increase the collectnbility will decreasd while
dollars collected remains relatively consistent.
6. Others Prior years did not include charity, During current year and
budget, Other includes charity siree charity is not being funded,
PLOW MRMORIAL HOSPITAL
ORGANIZATIONAL CHART
Doard of Directors
Auxiliary tdedical Staff
- - - - - - - - - - - - - - - - Administrator - - - - - - - - - - - - - - - - - - I I
_ I I
I t
Administrative Aasletant - - J ~
I
Seeretary? I
Assistant Administrator Chief Financial Officer Director of Nursing Medical Director
Voluntoor Svc
Physical Therapy Anasthoaia Dusinass Offica Surgery
Diotary
Cardiopulmonary Accounting Outpatient Services
Chai lain
Medical Records Data Processing Pediatriae
Laboratory
Materials Management Pharmacy Medical/surgloal
Personnel
Purchasing Postpartum ,
Radiology
Ilouaokeeping Labor and Delivery
Homo Health
j
Central Supply Maintenance Nursery
Health Promotion Supervisors
Linen Service
behavioral Medicine
Critical Care
Quality Assurance]
Emergency Room
Nurse-Midwifery Service
A/gg ICU/CCU/PCU
Suulnl 8ervlaes
i3
PEAT cecn rlit, Nlarokk, Oed Public Accountants blic Co.
MARW,CK .1000 Kopubliclinnk Cenha
P.O. BDx 4545
floUSton,Texas 77210
May 15, 1985
n RE R0WG
Mr. Jeff Hauslar, Executive Director {J ,
Flow Memorial Hospital 3 1985
1310 Scripture Street
Denton, Texas 76201
Dear Jefft
Peat Marwick is pleased to submit our final report to Flow Memorial
Hospital on our assistance in achieving certain improvements in the
accounts receivable areas. This report and our detailed progress report
dated April 15 conclude our progress reporting to you.
Consistent with our agreement with you, we assisted the Hospital by
functioning in a Limited role of project oversight and task assignment
coordination. The following are the major accomplishments achieved
during the period of our assistance to you, from January through April
30, 1985, and is based upon the operating data provided from Hospital
recordat
o Days of revenue outstanding in accounts ruceivable
have decreased from 117 days to 82 days as of April
30, representing an improvement of 35 dayel
o Average cast, receipts from patient accounts have
exceeded the target of $320,000 for the last eight:
weeks;
o Commercial insurance billing backlog, which was
substantial., has been eliminated;
o Cash receipts and collections at the time service
is rendered have improved significantly;
o A standard procedure for actively working aLL
accounts that reach certain outstanding day
thresholds has been instituted and appears to func-
tion weLL;
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Mr. Jeff Hausler, Executive Director
Flow Memorial Hospital
May 15, 1985
2
o An outpatient protocol has been implemented to bill
and disposition outpatient accounts in a more
effective and timely manners and
o A monitoring and control weekly reporting cycle has
been established for all key result areas of the
billing and accounts receivable processes.
In summary, as we have previously discussed with you, the outstand-
ing tasks that need to be accomplished in approximate order of signifi-
cance aret
1. Recruit and employ a trained business office
manager.
2. Install and get operational the Medicare claims
processing terminal.
3. Implement a comprehensive Admissions and Financial
I' Payment Policy with a well documented financial
counseling program for entry points for patient
service.
4. Develop a policy and procedure manual with the
attendant training programs to ensure that all
employees are well versed in the steps required to
effectively deal with billing and accounts
receivable.
5. Perform an information requirements definition
outlining the necessary data processing needs to
support an effective accounts receivable system. ,
Using these requirements, explore your data pro-
casing alternatives and select a system that can
coat effectively support your needs.
6. Conduct ongoing training and development programs
of your business office staff.
7. Redesign your account folders to more effectively
use them as a quick reference point for the status
of the account and tasks to be accomplished.
F
Mr. Jeff Hausler
FLOW Memorial Ho, Executive Director
may 15, 1985 spital
3
8. After achieving the above tasks, evaluate You
r~~~ organisational structure and staffing requirements,
If the above tasks are aggressively pursued, as outlined, and you
maintain the necessary supervisory and clerical pereonnel, you should be
able to achieve an accounts receivable level (in terms of revenue days
outstanding) comparable to the industry average.
We appreciate the opportunity to serve Flow Memorial Hospital in
this important project.
Very truly yours,
PEAT
MARWICK Pool, ~Inr+r Eck, ?!I ]ell & CO.
CcrlfOed P+rlrllc ACCgn+llnl Its
RepubticNnnk Cenlcr
P.o. nox 4sa
Ifousto,,, Te•sns »Zto
ApriL 5, 1985
Mr, Jeff Hausler
Executive Director
Flow Memorial ffuspital
1314 Scripture Street
Denton, Texas 76201
Dear Jeff,
The purpose of this status
"p' is o has been accomplished though Marchrt31st tb outline the
project task force and
ac Y the sccountsrogress that
achieved, Consistent with our outline the ke receivable
Memorial Noap[tai b assignment p y tasks remaining to be
and task assignment coordination. in a itmitedt olew of is assisting Flow
project oversight
The following are highlights
a of the key results t
Januarys our assistance to Flow Memorial
have been
beg hat an in early
° Days of Revenue Outstanding in gross from 117 days to 84 days as of March 31, representing
a significant improvement toward achieving accounts receivable have
achieving the initial target
of your 76 size{ days which is the industry average for an institution of
o Insurance billing backlog on all third party insurance accounts
except Medicare has been eliminated
o All inpationt accounts oiler 105 days from discharge have been
actively worked for proper account disposition;
° A monitorin
established g aild control weekly reporting cycle has for accounts all key
cesses~ault areas cf the been
billing
and
o Cash receipts and collections at the time service
has improved aignificantlyl and
is rendered
° An outpatient
and tmal protocol has been implemented to more effactiveLy
timely, bill and disposition outpatient accounts.
The following information summarizes the activities of Important key
selected areas to datel
231
Mr, Jeff Hausler
Floes Memorial Hospital
April 5, 1985
2
o Business Office Manager, it is our understanding that several
a
two pplicants have been interviewed and serious discussions with
~y\ week,`we were advised that nboth ccandidates have withdrawn their
f interest from the position. It remains our riorit
recommendation that an experienced business office manager be
employed as quickly as possible, While we recognize the
recruiting difficulties you are encountering as a result of the
historical accounts receivable situation and the potential I
changes occurring in hospital management, the need to provide I
more Leadership and day to day supervision in the accounts
receivable area is critical to achieving success both in the
short and long run. The strength and experience of your first
line supervisors in the business office is not sufficient to
function without a business office manager for any period of
time.
o Medicare Claims Transmission 'terminal. The dedicated line for
this service has been delayed again until mid April, While we
recognize the transmission line installation is out of your
immediate control, the current delays encountered in processing
Medicare claims represents a significant lock-tip in accounts
receivable. Our experience in other hospitals is that with a
terminal in place, this Lock-up can be reduced to one-half to
one-third of your current lock-up,
The claims processing terminal and Business Office Manager remain as
two key elements necessary to be ace"plished to enable the Hospital to
achieve both short and long run improvements in the Hospital's accounts !
receivable situation.
information from the monitoring and control report indicates the
following by key areal
o Admissions section has undertaken substantial training and
rev ew efforts to ensure that the quality and completeness of
patient information is properly secured. Efforts to improve
deposits and payments at the time of service have increased
with noted results, Heavy direct inpatient admissions through
the EE (40-50%) in the evening (primarily unregistered on
patients) continue to present difficulties in accomplishing i
proper financial counseling before service is rendered.
Efforts to achieve increased pre-admissions a-3 underway b
establishing working liaison relationships withrthe offices of
the principal physicians who admit the majority of the patients
and the surgery scheduler.
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Mr. Jeff flausLer
Flow Memorial Hospital
April 5, 1985
3
r o Billing has baon able to achieve current status on all
npatiant commercial accounts. All accounts which are ready to
bill are billed on a timely basis. Remaining in significant
arrears due to Intermediary delays are inpatient Medicare and
4adicaid accounts which represent a large lock-up of dollars.
All zero balance accounts, balance after insurance, and denials
have been transferred from the billing section to the appro-
priate files. The Medical Records Department and phyaic+ n's
support on processing And records completion will become an
lncroasingly important factor in minimizing billing delays as
the billing section achieves current billing on all accounts.
o Cash Receipts indicate that improved results are being
accomplished in collecting payments at the time of service and
discharge. A preliminary weekly cash target of $320,000 per
week has been established At the business office level with the
most recent four week average reaching $317,500 (without
consideration of the $250,000 lump sum pnyment). Without a
well daLinentsd and Board Approved comprehensive Admission and
Financial Payment Policy, it will be incranaingly difficult to
effectively achieve collection improvements with the continual
admission of patients with bad debt histories or the intent not
to pay for services rendared. This assumes the hospital will
continue to Accept patients who have no resources.
o Bad Debts and other non-paying, patient accounts Are being
d spoa tioned on a much more timely bAeie. Substantial efforts
have been made to isolate bad debt and small balance (including
zero balance) accounts. Although this will not yield immediate
cash flow benefits, it will, nevertheless, clean up the file
and disposition to the collection agency older, unpaid accounts
on a more timely basis to enable them An opportunity to
generate payments if resources are available. ,
a Account Status results reflect significant Improvements in the
number of days In accounts receivable and the current atntus of
the various categories of Accounts. With the processing and
file update cycles of your current data processing sygtam, It
Is difficult to arcertain an accurate status of your accounts
receivable position until at month and. The collections
section will remain a chronic problem area until the necessary
per'nAnent and training personnel are in place. Substantial
focus and attention In this area are required if progress is to
Mr, Jeff hausler
Flow Memorial hospital
April S, 1985
4
be made and increased cash is to result. It is our under-
standing that one and possibly two of the four poaiticns in
this section will become vacant during the next two weeks. A
50 percent vacancy rate will present an increasingly difficult
situation for the hospital to continue to make significnnt
improvements in this area,
In summary, as we have previously discussed with you, the
outstanding tasks that need to be accomplished in npproximate order of
Significance area
11 Recruit and employ a trained business office manager,
2, Install and get operational the Medicare claims processing
terminal.
3. Implement a comprehensive Admissions and Financial Payment
Policy with a well documented financial counseling program for
entry points for pntleut service,
4. Develop a policy and procedure manual with the attendant
g programs to ensure that all employees are well versed
in the steps required to effectively deal with billing and
accounts receivable,
S, Perform an information requirements definition outlining the
necessary data processing needs to support an effective
accounts receivable system. Using these requirements, explore
your data processing al,ternativee and select i system that can
cost effectively support your needs.
6, Conduct ongoing training and development programs of your
busineag office staff.
7. Redesign your account folders to more effectively use them no a
quick reference point for the statue of the account and tasks
to be accomplished,
8. After achieving the above tasks, evnLuate your organizntional
structure and staffing requirements,
1
Mr. Jeff Hausler
NOW Memorial ffospitaL
April 5, 1985
5
(l
Tf the above tasks are aggressively pursued as outL[ned, and you
maintain the necessary supervisoryeivablande clerical cal (in pe terms onnal, of reyouvenshould ue days
able to achieve an accounts rec
be
outstanding) comparable to the industry average within the next four to
six weeks.
Very truly yours,
PEAT, MARWICK, MITCHBtL & CO.
.
William R. Richards, Partner
WRRIKEW
Enclosure
cct tarry Rayburn
Peat Marwick, Dallas
i
ROW
131
MEMORIAL HOSPITAL Denton, 0 Scrlcnlon, 1 TX 'X 76E320201
1
(817) 387.5881
JEFFREY E,HAUSLER
ADMINISTRATOR
June 12, 1985
i
M E M O R A N D U M
TOj The City of Denton
FROM: Jeffrey B. Hausle
Administrator Oau4
fundshinfthOf Flow e amount eofr$2imillion afor the I am requesting
beginning October It 1985. This request for capital
equipment funding is made to the City of Denton and
Denton County for Flow Memorial Hospital.
We would also request consit:kration for inclusion in
the City's budget for this time period. Our budget
for the next fiscal year is enclosed, and Y would be
glad to appear, before any decision making body at your
request to address these matters.
JFH/kt
enclosure
rlr~~
f
C;
r
i
t'IOSd MF~WItM HOSPITAL
MA N A G 9 M E N T PLAN
FISCAL YEAR
1986
1
'j
TABLE OF CONTENTS
r
I. F'INAtrML CW(M- 1
TI. OYEMMIG B=T » 2 - g
III. STAF'F'ING 9
IV. CAPITAL 8UD(MT 10 - 20
FLAW M 211ORMI, HOSPITAL
fy 1986 Bt=,T
Statement Of Changes in Financial Position
Net Income from Operations $ 330,710
Plus Depreciation 5500000
Plus City/County 21000,000
Plus Other Non-Operating Revenues 50,000
Net Increase in Financial
Position $ 2,930,710
Capital Requlrementst
Equipment and Repair $ 213120040
Medical Office Building
(Master Plan) 2,9001000
Renovation (Master Plan) 12,950,000
Total Capital Requirarent 10,162,040
Net Capital Requiring Financing
S 15,231,330
' r 1~
FLOW AiFMORIAL HOSPITAL,
1NCO,%IE STATB;%ffNT
FISCAL YEAR 1986 DVDMT
FISCAL YRAR 1986
BUDGET
Revenue from patient Services
Inpatient {Page 3) $ 1,,612,98,520 050
out patient (page 3)
3.
Total Patient Revenue
Deductions from Revenue $ 20,010,560
Contractual Allowance
Dad Debts (page 4) (page 4) $ 1,5031620
Other (page 4) 4,3781300
Total Deductions
6w.,. , 967, 4l~
Net patient Revenue
Other $ 13,0431150
Operating Revenue (page 5)
Total Operating Revenue 514 600
$ 13,557,750
Operating EXrenses (page 6 & 7)
Salaries
Benefits $ 5,987,470
Professional Fees 856,210
Supplies 1,756,050
Other 21290,780
786'530
Total Operating Expense
$ 12___z6771Og0
Income Before Depreciation
Depreciation $ 880,710
SSD---tea
Net Profit (Loss)
from Operations $ 330,710
Non-Operating Revenues
2,---- O50,,d00
Not .Profit
$ 2,380,710
-2-
FLOSV MNIJRIAL 110SPITAL
PATIMT REVENUE COMPARATIVE
FISCAL YEAR 1985-1986
RFMWE riSG~I, MR 1955
CAPER ESTD ATED ['ISCAL YEAR 1986 VARIAN
PERCTx1T
I/P 0/P I/P BUDGET
O/P
f ~ Pled/Sung (2A/2C) $1,885,450
P1ed/Burg (3A) 479 090 $1,292,830 $ -0- f31.4
Pled/SUr (2II) ,_p 352,590 -0_ 626.4
g 422,140 -0- 383,100 -0_
Ob/Gyn 468,640 21960 9.2
588,800 5095D 26.1
Nursery/NICU 785,550 -p_
ICU/CCU 968,150 ..n, , 23.2
547,920 -0- 634,500 p_
Mid-Wivos _ 15.8
-0_ -0- 192,000 480000
Labor & Delivery 774,710 85,430
884,250 67,450 13.0
OR/RR 669,880 146,840 821,160 198,240 24.8
Emergency Room 960630 584 300
Central supply 1+500 100 ~ 99,680 612,320 9,6
142,350 11673,760 182,040 13.0
Pharmacy/iv 3,154,900 6710()o
3,6191200 187,920 18,2
L.ab/131ood 21071,320 1831040 117361670 201,530 Cardiopulmonary 1,+139,020 64/870 f 14.0
nadiolagy 767,420 428096 1,832,640 92,540 28,0
+ 640,860 376,140 f 14.9
Behavioral MW 971,620 -0-
Anesthesia 1,118,280 -0- 15.1
458,440 69,434 665,580 101,220 45.3
Physical Therapy 132,340
Aorta Health service 43,200 I08,OG0 46,200 { 12.2
-0- 169,770 -0- 235,6,80 38.8
Health Promotions -0- 13,000 _p.
__LL, 284 79.1
TOTAL $16,625,120 $1.,000,3- 40 A50 $?.,398,510 7 4
4
-3-
I
ORMT
FLAW MEIORLU ElOSPITAL
DEDUCTIONS rRQ14 REVL\=.
FISCAL YEAR 1986 BUWrT
PERCENTAGE
OF PrRCENTAGE
TOTAL RE~R1E COLLECTIBLE
Camiercial 42.08
Blue Cross S.0% 94.0%
Self Pay 22.08
1 Medicare 27.0% 12.08
Medicaid 4.0% 76.08
76.08
Blue Cross' Fixed Pricing with a Projected 149 Rate Increase
1984 131.ue Cross Revenue $ 864,637
Rate increase ` 4%
Blue Cross Reimbursement
Revenue Budget $20,010,560 $ 985,690
Blue Cross Revenue Percent
Blue Cross Revenue 5$
Blue Cross Allowance 1~0,-- 00r ;53D
Medicare and Medicaid Contractual Allowance Rstimatod at 248 $ 14,840
Revenue Budget
Revenue Percentage $20,010,.560
Medicare/Medicaid Revenue Z:31%
Allowance Percent $6,203,270
Medicare/Medicaid Allowance 248
TCYTAL CONTRAMAL ALLOW qq; 1, 488 780
Bad Debi
Revenue Budget
COMOrcial Revenue Percent $20,010,523
Conmercial Revenue
Cc morcial Bad Debt Percent $B,~~D4,43D
Ccrtmercial Bad Debt 63
Revenue Budget $ 504,260
Self Pay Revenue Percent '`J,010,560
Self Pay Revenue
Self Pay Bad Debt Percent $4,402,320
Self Pay Bad Debt 883
TOTAL BAD DCBT $3 874 040
Other
Projected 64 Increase -
Fiscal Year 1985 rstimatcd $1,024,050
Increase
G'E
Fiscal Year 1986 Budget ~w
-4.
rLOd '!E`-'ORIAL IIOSPITNt,
011 ER OPERNrn'o R&VP'VUt CONPMATIVE
fICCAL YEAR 1985 - 1986
Fiscal Year 1985 Fiscal Year 298& Variance
Estimate, Budget Percentile
Cafeteria
ll9 $107,400
~
Medical 11~.~1~j
l4edical Records
7,640 61900 ( 10.7 J
Gift shop 21,420
19,300 ( 11.0 j
Recovery of bad Debts 360,160
375,000 4.0
hiisce]laneous 6 840
7ota1 _.__.L6,00Q ~I 14.11
5515,?' 514,600
^`5-
FLOW M Z)ORIAL HOSPITAL
OPERATING EXPENSE COMPARATI%m
FISCAL YEAR 1986 BUDGET
FISCAL MAP 1985 FISCAL YEAR 1986
,COST Cr-=R EST IN• ,,Z BUCG[TP VAI2IAAICE
Nursing Administration PERCiNTIiC
.red/Sung (2A/2C) ' 151,200 $ 167,250
Med/sur (3A) 855,940 617 10.6 %
320,770 0050 27,9 J
MOd/Surg (2A) 4~0 279,600 [ 12.8 )
7 r
J
OB/Gyn 78 253 800 6,,..,0 ~ 3.8
Nursery/NICU 252,420
ICU/CCU , 391,230 406,320 ( . 3.9
J
281,910 277,980 3.9
Labor and Delivery
OR/RR 425,650 427,740 f 1.4 J
5
Emergency Room 357,940 364,930 2,0
Central, supply 540,260 562,800 4.2
Lab/13lcac 839,070 999,240 19.1
Cardiopulmonary 907,860" 7890060 113.1 )
Radiology 380,020 357,280
582 730 I 6. J
Phar~c},/IV 670,280 597'640 13.2 2
Behavorial Medicine 459 830 ,160 [ 10.9
Anesthesia 447,920 2.6
Physical Therapy 291,470 241,240 [ 17,2 j
bbdical Records 1':4,860 112,320 ( 10.0 J
Dietary/Nutrition 153,300 160,850 [ 1.5 )
Plant/security 658,620 541,440 ( 1.7.8 J
Housekeeping 334,900 334,680
Laundry 276,300 250,200
120,000 1260840 [ 9.4
d-SJives
Fiscal Affairs 67,200 5,7
Business office 230,000 242,970 5.6
Administration 411,470 352,560 ( 14,3
Purchasing 2280500 212,280 ( 7,1
Personnel 5(`,t00 67,320 33.1
Healt!', Pr=tions 64,120 64,060 [ .6 J
Quality Assurance 97,890 104,940 7.2
Home Health ser.lice 71,810 580980 ( 17.9 )
Auxiliary 167,380 169,410 1.2
Benefits (14,3%) 230850 30,240 26.8
Utilities 930,690 8560210 [ 8.0
Telophone 640,020 665,040 3.9
11,050 126,000 9.5
TOTAL 81 698,070 512,259j-100
L -3'r'lf
_G-
rLOW 1ND)ORIAL HOSPITAL
GI.'FSAL, AND ADMINISTRATIVE EXPENSE C0,MPAPATIVE
FISCAL M-M 1986 BUDGET
FISCAL YEAR 1985 FISCAL YEAR 1986 VARIANCE
ESTDIATE BUDGET PER=.7TILF
Interest $108,930 $ 99,000 ( 108
Consultants 139,650 50,000 ( 64 )
Rental 76,850 84,540 10
, Insurance - Liability 61,680 1070900 75
Insurance.- Otter 22,550 23,700 5
Dues 18,880 19,800 5
Postage 30,950 34,000 10
Total General and Admin, $459,490 $417,940 98
i
i
j
I
y
}L
FWI MnRIAL HOSPIT..
NON - OPERA\Tr,,G REVFRTUE
FTSCIL PEAR 1986 13=-T
FISCAL YEAR 1986
DUE=
Interest Inane $ 50,000
Capital Funds from City/County 21000,000
TOM $2,050,000
rLOW AiEeII1ORLv, 110spIam,
SVVrPMG - M,, i s
FISCAL ITM 1985 - 1986
April, 1984 rI5C<'1L YEAR 1986 ACTUAL,
to LtUCC,G'T VARIANCE
Nursing Administration March-- 85
Med/Sung (2A/2C) 577.6 ,6
Med/Sung (3A)
ICU/CCU/PCU 10.8 10.3 [ 29,8 ]
OB/Gyp 27.5 19.2 f .5 ]
Niirsery/NICU 12.1 10.3 f 8.3 J
Labor and Delivery 19.1 14.6 f 4.8 J
]
14.6 f 4.5
Operating and.Recvery Room 114.8 3.0 f .2 j
4!nergency Room 9.8 1 3 J
Total Nursing 170.7
123. 47.6 J
Central Supplies 8.3
Cardiopulmonary 3.5 ( 4.8
]
Radiology 14.9 910
Pharmacy 1015 7.0 [ 3.9 J 14 1
Behavioral MediciJ~e 8.3 5.0 I 3.5 J
Physical. Therapy 22.3 17.3 f 3.3 j
5.2 310 I 5.0 J
Medical Records 9.1 [ 2.2 ]
Dietary/Nutrition 7.0 f 2.1.J
Plant/Security 31'9 22.0 I 9.9 ]
Housekeeping 1811 10.5
28.7 20.0 [ 7.6
Laundry ]
f 8.7 Fiscal/Businoss office 6.6 j
34.9 110 [ 5.6 J
Administration 25.0 ( 9.9 J
Ulli~ty Assurance 3'e 4.0 2
2.9 2.5
[ . J
Purchasing 7 5
2.G [ .2 2 J
Personnel 2.5 [ 1 ]
Health Promotions 3.7 2.0 f 1.7 ]
2.3 1.5
Total Non - Nursing 214.8
143.3
f 7~ 1 5 1
Total I'1'C
385.5 266.4 118.
FTE / Pationt Day
4.2 .
HUS y
CRNA 5.5 ]
5.0 I 4.0
Midwives 0.0 3.0 [ 2.0 j
2.0 2.0
Total ilsp, M 400.0 "
276,9 f 122.6 ]
/ Patient Day 4
PLOW MEMORIAL HOSPITAL
Three Year Capital EquiPmentBudget Summary
OVER $500
Dept, Name/
Priority Description Cost
1985-86 1986-87 1987-82
Home Health
A Chart Storage S 11070, $ 1,070,
8 IBM Selectric 1I 970,
X70.
$ 2,040, $ 11070, $ 970,
Mad/Surg
8., Bad Scales $ 31 60(,,
L3 , 6oo.
3,600, $ 3,GCC,
Labor & Delivery
8 Corometrics 115
Fetal Monitor $33,000, $11,000, $11,000, $119000,
8 Neonatal Care
Unit 89500. 8,500.
8 Open Crib w/Infant
WarMrr 10,000. 5 000,
C 5,000,
Hugh arilizer 14,000, 14,000,
Birtning Bed 5 000,
B 5,000.
Delivery/Surg.
Table 12,000,
12,000,
$829500, $24$00, $25,000,
$33,000,
Post Parf,"o
B Hewlett Packard +
Fetal Monitor $ 1,000, $ 1,000,
$ 11000, $ 1,000,
-10•
a
FMi MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept. Name/
Priority Description Cost
1985-86 1986-87 1987-88
ICU
8 Her+lett Packard
Monitor $40,O0o,
C $40,COo,
~ Cardiac output
Monitor LS 1200,
- $ 5,200,
$45,200. $ 5,200.
$40,00o,
Nursery
A Portable Radiant
harmer $ 31500, r
$ 3,00,
A 8111-00simeter
21100. 2,100,
A Armstrong
Incubator 12,000, 30000, $ 6,000,
A Stainless Steel $ 3,000,
Crib 11,250, '
3,750. 3,750. 3,750.
8 PhOto therapy
Unit 1,500,
8 1,500,
Double wall C-100
Isolette 5,800,
5,800,
$369150. $12$50. $17,050. $ 6s750,
NICU
A Neo-Trak Spacelab
Monitor $120000, 6
A $ ,000. $ 6000,
Auto Syringe
Pump $ 1,900, $ 1,900,
8
Stafnles.; Steel
Crib $ 1,7ao,
$ 875. $ 875.
0 6 Icon Pulse
Oxymetor $ 8,000.
$ 8,000,
u
r
FLN MEMORIAL HOSPITAL
1936, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept. Name/
Priority Description Cost 1985-36 1986-87 1987-38
NICU cont.
C Ohio IC incu-
bator $ 6,500, 6,500.
$30,140, $ 7,900. $ 15,370,
$ 6,370,
Birthing Center
a Imex Dopplar $ 1,100. $ 1,100,
C Day Bed for
Birth. Room 950. 950,
$ 2,050, $ 1,100, $ 950,
O.R.
A Olympus Heater
Probe $ 59300. $ 59300,
B Dermatone &
Meshgrafter $ 31600, $ 3,600,
B Mini Fragment
Set $ 41060, $ 49060,
B Flash Sterili2er $130000, $13,000,
B O.R. Table $ 179000, $ 17,000,
B O.R. Lights $15,000, $ 71500, $ 7,500,
C Cystoscopy Table 2$ 0,000, 2$ 1000-
$77,960, $ 20,460, $37,500, $ 20,000,
Recovery Room
A Dafibrillator $ 9,370, $ 9,370,
C Blankot Warmer 31000, 3,000,
$12,370, $ 90370, $ 30000,
-12-
I
FLOU MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept. Flame/
Priority Description Cost 1985-86 1986-87 1987-08
E.R.
8 Overhead Light
2 Exam Rms. $ 7,000. $ 7,000,
A Pediatric Stret-
cher $ 21600, $ 2,600,
C Stryker Adult
Stretcher $ 39750, $ 31750,
C Autotransfuser $ 16,300. $ 16,300.
8 Surgi-Bed $ 4,500, $ 40500,
$34,150, $ 17,850. $16,300.
X-Ray
A RA & Theon
RhF System $128,000. $128,000.
B 600 11A Generator
Photo-Time 23,680. $ 23,680,
8 Tube Stand 35,750. 35,750,
8 Digital Image Tube
& T.V. 11,10000. 111,000,
B Port. X-Ray(Plsy) 14,000, 14,000,
B Film Processor 17,500, $ 17,500,
B Generator for
Cysto 14,000. 14,000,
A Film Cabinets 960, 960, ,
C Transducer 41000. 4,000,
$348,890, $132,960. $184,430. $ 31,500,
Behavioral Medicine
A VCR $ 700. $ 700.
A VCR Camera $ 11000, $ 10000,
-13- ;
i'
FLU MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year CapovitaERl Equs5ooipment Budget Summary
Dept. Name/
Priority Description Cost 1985-86 1986-87 1937-86
Behavioral Medicine cont.
A VCR Monitor $ 700, $ 700,
A Heavy-Duty
(dasher 750. $ 750,
( A Heavy-Duty
If Dryer 600, 600,
B M1 Corr, Set.
Typewriter 1,200, 11200,
A 1614 P.C. 256K 30500, 3$500,
A Computer Soft- r
ware 10,000, 105000,
C 10.12 Passenger
Van 15,000, 15,000,
C Rio-Foedback
Equip, 41000,
$ 4,000,
C ECT Equipment 9,000, 91000,
E Privacy Fencing 2,500,
2,500.
$ 48,950. $ 3,600. $ 380850. $ 69500.
EKG
A 20 Echo $ 87,000,
$ 81,000,
A Interpretive
Cardiograph 8,000, $ 85060.
95,000, $ 87,000. $ 81000, '
R, T,
A Treadmill $ 40,000, $ 40,000,
8 Equip, Dryer $ 8,000,
$ 8,000,
-14-
1
FLOW MEMORIAL HOSPITAL
Three Year Capital ~ Equipment 1987, B
Budget Summary
OVER 5500
Dept. "lame/
Priority Description Cost 1985-86 1986-87 1987-88
R.T. cont.
A Patient Table $ 800, $ 800
C Croupette $ 31000, $ .1,000,
8 Air Compressor $ 500.
+ $ 2,500,
$ 54,300, $ 48,800, $ 51500,
Pharmacy
C Night Locker Decent-
ralize Cart $ 1,800. $ 1000,
B Memory TypeWriter $ 1,500, $
1,500,
C Sargart Unit Dose
Pkg. Machine $ 20100. $ 21100.
C 1814 Typewriter 1,000, $ 1 000,
$ 60400. $ 3,300, $ 31100,
Physical Therapy
A CPM Lower Ext. $ 31200. $ 31200.
A CPM Upper Ext. $ 3,200. $ 3,200.
B Cold-Pack Unit $ 10890.
$ 1,890,
B Parallel Bars Dol.
Adj. $ 520. $ 520.
B Galvanic Stimulator 11100. $ 11100,
C Unex 11 weight ,
Machine $ 11060. $ 11060,
C Arm, Leg, llip 1.Ihirl-
pool $ 19820, $ 1,920,
• -15-
FLOW MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept. Flame/
Priority Description Cost 1985-86 1986-87 1937-38
Physical Therapy cont,
C Ada, High Chair $ 570, $ 570.
_ 8 Ergometer Adj.
Del, Clin, 850, $ 850,
8 Treatment Table 1,600,
1,600,
C Ultrasound Port. 1,200.
1,200,
C Podiatry Whirl.
pool 11200, $ 1,200,
8 Tens Unit 10800,
1,800,
C Tilt Table 11000,
1,000,
C Hot Pack Unit 1,200,
- 1, 200.
$ 220210, $ 13,360, $ 3,650, $ 5,200,
Medical Records
A Master Pat.-Rotary
File $ 6,500. $ b,500,
8 Word Processor Acous.
Covers 11000. $ 19000,
C 18M Selectric II 21000,
2,000,
C Lanier Word Pro-
cossor 14,000, 14,000,
$ 23,500. $ 61500, $ 1730001
Plant
A Chillers, Towers, Piping
& 0ec, $,,20,000, $3201000, $200,000.
8 Steam Generator $ 48070, $ 48,870,
-16-
1
FLOW MEMORIAL HOSPITAL
Three Year Capi
1986, 1987, tal Equipment Budget Summary
OVER $500
Dept. Name/
Priority Description Cost
1985-36 1986-87 1981-82 '
Plant cont.
8 Convert Double system
to VAV convert
mixing boxes $95,340. 5950,
Cogeneration
Plant $ 92,540, $ 92,540,
8 Resaturate Roof $ 71000, $79000,
.8 Exit doors by
Maint, $ 11700. $ 1,700,
A Rebuild Air
Handler $ 1,500, $ 1,500.
8 Replace Refractory in
Incinerator $ 2,500. $ 2,SC0,
8 Resaturate Roof $20,000,
$20,000,
A Hospital Van &
Pickup $15,000, $151000,
A Building over H2O
Storage $ 550, $ 550,
8 Seal Visitor Parking
Lot $ 9,000,
$ 9,000. '
8 Seal Doctors & Directors
Park, Lot $ 60500, $ 6,500.
A Seal Circle Drive
A Patch $ 2,000. $ 2,000,
B Copper wiring in Panels
1C ,2C,38,10,
3A, & B1 $ 11000, $ 7,000,
B Doors for Loading
Dock $ 1,750. $ l s750.
,
-17-
fL0'rl F1EIdOR3AL HOSPITrtiL
1986, 1987, 1983
Three Year Capita3 Equipment Budget Summary
OVER 5500
Dopt. Hame/
Priority Description Cost 1985-36 1936-37 198J-88 ~
Plant cont.
C ~ Motorized Ch113ing
Tube brush $ 1,500, .S 1,.5.00,
C Transfer Switch
~ Generator $ 10,300,
$ 10,300,
B Med/Burg Nurse-
Ca11 System $ 20,000, $ 20,000.
C 26 Nurse-Ca13
System $ 7.,670. $ 7,670,
8 3A hlurse Ca13
System $14,880, $ 14,880.
C 36 Nurse Ca11
System $ 9,520, $ 9,52D, '
D 08-LSO Ilurse Ca11
System $ 7,620, $ 7,820,
B L"D Ilurse Call
System $ 7,850, $ 7,850,
C O,R. Nurso Calt
System 8,380, $ 8,380,
$918,970, $ 403,620. $ 345,840, $ 169,51 D,
Quality Assurance
. C IBM So3octric $ 970, $ 970,
$ 970, $ 970,
' HeaPth Promotion
A Kodak C:ktagraphic
Viewer $ 675, $ 675,
A 16mm Aro~ector $ 1,3u0; $ 1,300.
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.j
FLOW MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept, Name/
Priority Description Cost 1985-86 1986-87
1987-88
Health Promotion cont.
8 Recording Annie $ 10600. $ 10600,
C Anatomic Annie
420, $ 4?0,
C Opaque Protector 790,
790.
A IBM Selectric 970,
970,
Resurci Anne 570,
570.
$ 6$20. $ 49540. $ 1,780,
Anesthesiology
8 Auto B,P, Monitor $ 8,800,
$ 41400, $ 4,400,
8 Ohio Anesthesia
Machine 8000 441060, 22,000
$ 22,000.
C Blood Warmer 1,280,
640, 640,
C Warming Blankat 4,000,
29000, 2,000,
8 CritIcOn Oximeters 3,850, 1 650,
1,100, _ 1,100,
$ 61,930, $ 60690, $ 29,500, $ 25,740,
Pathology
A Body Lifter 10500.
1_, 500 ,
$ 1,500, $ 1,500.
Genaral & Administrative
a '
Room Furnishings $ 2100 000 $ 150,000 $ 30, 000 30,000
A Refurbishing 650,000 35__-0_000 150,000 150 0 C
$860,npo $500,000 $.1901000 $180,000
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PLOW MORTAL NSOPITAL
1986, 1987, 1988
Three Year Capital Equipment Budgot Sumtury
OVER $500
Dept. Name/
Priority Description Cost 1985-86 1986-87 1987-88
A Cat Scan $ 500,000 $ 500,000
A Ccrttputer 5000000 500, 000
$1,000,000 $1,000,000
HOSPITAL TOMS $3,776,100 $21312,090 6 -935,990 $ 528,070
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FT OW MEMORIAL HOSPITAL
M A N A G E M E N T P L A N
FISCAL YEAR
1986
i
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TABLE OF CONTENTS
1. FINANCIAL CfANGE 1
II. OPERATING BUDGET 2 - g
III. STAFFING 9
IV. CAPITAL BUDGET 10 - 20
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rLOSV P'MY)RIAL HOSPITAL
rY 1986 DUDmT
Statement of Changes in rinancial Position
Net Income from Operations
$ 330,710
Plus Lupreciation
550,000
Plus City/County
2,000,000
Plus Other Non-Operating Revenues
50,000
Net Increase in Financial
Position
$ 2,930,710
Capital Requirements:
FcNipment and Repair $ 2,312,040
t
Medical Office Building
(Master Plan) 2,900,000
Renovation -(Master plan) 12, 000
Total Capital Requirement
$ 18,162,040
Net Capital Requiring rinancing
$ 15231,330
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rLal W14ORIAL, HOSPITAL
rNCOW STATME4T
rISCAL YEAR 1986 BUDGET
rIBCAL YEAR 1986
BUDGET
Revenue from patient Services
Inpatient (page 3) $ 171612,050
Out Patient (page 3)
2-----3910
Total Patient Revenue
Deductions from Revenue $ 20,010,560
Contractual A1l(Mance (page 4) $ 11503,620
Bad Debts (page 4)
Other (page 4) 41378,300
1-- 0- s5=490
Total Deductions
d,~67,410
Not Patient Revenue
Other Operating Revenue (page 5) $ 13,0430150
519,600
Total Operating Revenue
Operating Expenses ( S 13,557,750
Salaries age b & 7)
Benefats $ 5,987,470
rrofessional Tees 856,210
Supplies 11756,050
Other 2,290,780
Total Operating rxpense
$ 12'677, 040
:ins Before Depreciation
Depreciation $ 8801-710
Not Profit (Loss) - --550 r 000
from Operations $ 330,710
Non-Operating Revenues ,
----20 00
Not profit
$ 2,380,710
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FIAW MEMORIAL HOSPITAL
PATIENT REVENUE COMPARATIVE
FISCAL YEAR 1985-1986
REVENUE FISCAL YEAR 1985 FISCAL YEAR 1986
CDM,'R ESTIMATED
BUDGET PERCENTI!
I/P _ O/P I/P 0/P
Mod/Surg (2A/2C) $1,885,450 $ -0- $1,292,830 $
Med/Surg (3A) 479,040
`0- 352,590 -0- [26.4 '
Med/Surg (2B) 422,140 -0- 383,100 -0-
Ob/G [ 9.2 ;
yn 468,640 21960 588,800 Sew 26.1
Nursery/NICU 785,550 -0- 9680150 `
ICU/CCU 0` 23.2
547,920 -0- 6340500 -0- 15.8
Mid-Wives -0- -0- 192,000 48,000
Labor & Delivery 774,710 850430
OR/RR 884,250 87,450 13,0
669,880 146,840 821,160
198,290 29,8
Emergency Room 96,630 584,300 99,680 612,320 4.6
Central Supply 10500,100 ].42,350 1,673,760 182,040 13.0
Pharmacy/IV 3,154,900 670060 31619,200 187,920 1812
Lab/Blood 21071,320 1830040 1,736,670 201,530
Cardiopulmonary 0 1,439,020 64,870 11832,690 92,540 28 28.,0
Radiology 767,420 428,090 640,860 376,140 Behavioral Med ( 14.9 )
971,620 -0- 1,1181280 -0- 15.1
Anesthesia 458,440 69,430 665,580 101,220 45.3
Physical Therapy 132,340 43,200 108,000 46,200
[ 12.2 )
Home Health service -0- 169,770 -0- 235,680 38.8
Health Promotions -0- 131000 -0- 23,280 79.1
tOT _$16,67,5,120 $2 000,340 $17,612,050 $2,398,510 7.4%
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FLOW MCMORTAL HOSPITAL
DEDUCTIONS FROM REVENUE
FISCAL YEAR 1986 BUDGET
PERCENTAGE.
of PERCENTAGE
TOTAL REVENUE COLLECTIBLE
Cotmercial 42.0% 9410%
Blue Cross 5.0%
Self Pay 22.0% 12.0%
Medicare 27.0% 76.0%
Medicaid 4.0% 76.0%
Blue Cross: Fixed Pricing with a Projected 14% Rate Increase
1984 Blue Cross Revenue $ 864,637
Rate Increase 14%
Blue Cross Reimbursement $ 985,690
Revenue Budget $20,010,560
Blue Cross Revenue Percent 59
Blue Cross Revenue 1,000,530
Blue Cross Allowance $ 14,840
Medicare and Medicaid Contractual Allowance Estimated at 24%
Revenue Budget $20,0101560
Revenue Percentage 31$
Medicare/Medicaid Revenue $6,203,270
Allowance Perc-)it
24~
Medicaro/Medicaid Ayl.-wance
TOTAL CONTRACTUAL ALLOM= 1488 780
Bad Debt
Revenue Budget $20,0101560
Commercial Revenue Percent 42%
Commercial Revenue $6,404,430
Commercial Bad Debt Percent 6%
Commercial Bad Debt $ 504,260
Revenue Budget $20,010,560
Self Pay Revenue Percent 22%
Self Pay Revenue $4,402,320
Self Pay Bad Debt Percent :;8%
Self Pay Bad Debt $3 874 040
Other TOTAL BAD DEBT
Projected 68 Increase $1,024,050
Fiscal Year 1985 Estimated
Increase 68
Fiscal Year 1986 Budget $1,0854490
,
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PLOW MEMORIAL HOSPITAL
OTHER OPERATING REVENUE C05IPARATI%E
FISCAL YEAR 1985 - 1986
Fiscal Year 1985 Fiscal. Year 1986 Variance
Estimates Budget Percentile
Cafeteria $119,330 $107,400 L 11.1¢1
Medical Records 7,640 61900
( 10.7 ~
Gift Shop 21,420 19,300 ( 11.0
Recovery of Dad Debts 360,160 375,000 4,0
Miscellaneous 61840 60000 ( 14,1 1
Total $515,390 $514,600
I .2%)
5-
FLAW M[.MORIAL HOSPI'T'AL
OPERATING FXPMSE COMPARATIVE
FISCAL YEAR 1986 BUDM,,T
FISCAL YEAR 1985 r.TSCAL'YEAR ''1986 VARIANCE
COST CJWTER ESTIMATED ME
Nursing Administration PE-- RCL ML8
Med/Burg (2A/2C) $ 151,200 $ 167,250 1016%
Med./Sung (3A) 855,940 617,050 ( 310,770 27.9
-Mad/Burg (2B) J
..279,600 [ 12.8 J
OB/Gyn 278,450 267,930
Nursery/Nicu 253,800 252,420 j ,.5 j
F. ICU/CCU 391,230 4060320 3.9 i
! . Labor and Delius ,910 277,980
OR/RR 425f650 427,740 { 1.5
Emergency Room 317,940 364,930 2.0
Central supply 540,260 562,800 4.2
:Lab/blood 839,070 999,240
307,860 19.1
Cardiopulmnary r
.789,060 ( 13.1 J
Radiology 380,020 357,280 [ 6.0 J :
Pharmacy/1v 582,730 659,690
Pharmacy/ 13.2
Behavorial Wicine 670,280 597,160 ( 10,9 J
Anesthesia 459,830 447,920 2.6
Physical Therapy 291,470 241,240 [ 17.2
Medical Records 124,860 112,320 ( 10.0 )
Diatary/Nutrition 163,300 160,850 [ 1.5 }
Plant/Security 658,620 541,440 [ 17.8 )
Housekeeping 334,900 334,680
Laundry 276,300 250,200 0
120,000 126,840 [ 9,4 J
" Diid-Wives 5,7
Fiscal Affairs 230000o 670200
! Business Office 242,970 5.6
Administration 911,470 352,560 ( 1.4 ,3
Purchasing 228,500 2120280 ( 7,1
Parsonnel 50,600 67,320 33.1
Health Prawtions 64,420 69,060 [ .6 J
Quality Assurance 97,890 104,940 7.2
Home Health Service 71,810 58t980 [ 17.9
Auxiliary 167,380 169,410 1.2
Daneflts (14.38) 23 850 30,240 26.8
Utilities 930,690 856,210 [ 8.0
' Telephone 640,020 665,040 3.9
115,050 1 .6 000 915
T(YIAI $121698,070 $12,259100~
_.L 3..'?1
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FLal hT:NIOI IAL HOSPITAL
GENGRP.L AND ADMINISTRATIVE EIVINSE COMPARATIVE
FISCAL YEAR 1986 BUDGET
FISCAL YEAR 1785 FISCAL YEAR 1986 VARIANCE
ESTU-JAM stmGC r
Interest $1081930 ~ $ 98~ p~ Op ~ f 10%)
Consultants 139,650
50,000 64
Rental 76,85o }
84,540 1U
Insurance - Liability 62,680 107,900 75
I Insurance - Other 22,550
23,700 5
Dues 18,880 19,800 5
Postage 30,950
34,000 10
Total General and Admin. $459,490
- _ $417,940 96
-7-
T7OtV LIMIUiAL HOSPITAL
NON - OPERATIAIG REVmM.
FISCAL YEAR 1986 BUDGET
?ISCAL YEAR 1986
8UCGET i
Interest In¢are
( $ ~u,oon
Capital Funds. from City/County, 2,000,000
l
TOTAL $2,0501000
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FLOSV MEMORIAL HOSPITAL
STAFFING - FTC's
FISCAL YEAR 1985 - 1986
April, 1984 FISCAL YEAR 1986 ACTUAL
to BUDGET VARIANCE
March, 1985
NursLz g Administration 610 - i
Mod/Surg (2A/2C)
i- Med/Sung (3A) 5716 .3 (29.8 J
( ICU/CCU/PCU 2710.5 1 1b0.3 ( .5 1
.5 19.2
OB/Gyn 12.1 10.3 f 8.3 ]
I Nursery/NICu 1911 ( 1.8 j j
Labor and Delivery 14.8 I.4.6
[ 4.5
]
Operating and Recovery Room 13.0 14.6 [ 2 ]
Emergency Room 9.8 191. 2 f 1.3 1 l
Total Nursing 170.7
123.1 f 4'.G ]
Central Supplies 8.3 '
Cardiopulmonary 14 3.0 [ 4.8 J
Radiology .9 9,0 [ 5.9 J
Pharmacy 8 Z8.3 7.0 [ 3.5 )
Behavioral Medicine 2.3 5.0 ( 3.3 j
Physical Therapy 5,3 17.3 ( 5.0 ]
Medical Records 3.0 ( 2.2 J
Dietary/Nutrition 3119 9'1 7.0 [ 22 92.1
19 ]
Plant/security 1 28.8.1 .0 j 9.9 ]
Housekeeping 10.5 [ 7.G j
Laundry 28.7 7 20.0 j 8.7 j
Fiscal/Business office 6.6 1'0 f 5.G j
Administration 34'9 25.0 ( g 9 ]
Quality Assurance 3.8 4'0 .2
Auxiliary 2.9 215 [ .4 ]
Purchasing .7 .5 ( .2 j
2.6 2.5 [ .l Personnel j
Health Prunotions 3.7 2.0 ( 1.7 J
2.3 1.5 __..:.8
'Dotal Non - Nursing 214.8 143,3
1771.5 J
Total ME 385.5 266.4
118.6
FTC / Patient Day 4.2
FQIS
CRNA 915 515 ! 4.0 ]
M16lives 5.0 3.b [ 2.0 J
0.0 2.0 2.0
Total lisp. C'I2; 400.0 270.9
( 122.6 1
I"TL / Patient bay 4.4
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FLO14 MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept, Name/
Priority Description Cost 1985-86 1986-37 1;87-83
Home Health
A Chart Storage $ 1,070, $ 1,070
B IBM Selectric II 970, 970
$ 2,040. $ I,O70, 5 970.
r I Mad/Surg
„ 8 Bed Scales $ 3,600, $ 3,600.
$ 3,600, $ 3,600.
Labor & Delivery
B Corometrics 115
Fetal Monitor $33,000, $111000, $11,000, $110000,
B Neonatal Care
Unit MOO, 89500,
B Open Crib w/Infant
Warmer 100000, 51000. 5,000,
C Hugh Sterilizer 14,000. 14,000,
C Birthing Bed 59000,
5,OOU,
B Delivery/Surg,
Table 12,000. 12,000,
$820500, $24,500, $25,000, $335000,
Post Partum
B Hewlett Packard
Fetal Monitor $ 1,000, s.14000,
$ 1,000. $ 1,000, '
,
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FLOW MEMORIAL HOSPITAL
Three Year Capital Equipment 8
Budget Summary
OVER $500
Dept, Name/
Priority Description
Cost 1985-86 1986-87
1987-,8
ICU
8 Heivrlett Packard
! Monitor
$40,000,
C Cardiac output ,40,Oo0,
Monitor $ 5,200,
$ 5,200,
$45,200. !
$ 5,200, $401000. I
Nursery
I A
Portable Radiant
Harmer 30500,
A $ 3,500,
Bill-Dosimeter 20100,
A 2,100,
Armstrong
Incubator 12,000,
i A 3,000• $ 6,000,
Stainless steel $ 3,000,
Crib 11,250,
8 3,750, 3,750,
Phototherapy 3,7$0,
Unit 1,500,
8 Double Wail C-100 1,506,
Isolette X800,
_-W 5--'800,
$3&,150, $12,350, $17,050, $ g,75,
HICU
A -Nao-Trak Spacelab
Monitor $125000,
A Au $ 69000, $ 61000,
Auto Syringe
Pump $ 1,900,
0 $ ],900,
Stainless steel
crib $ 1$740,
8 Nelcon Pulse $ 875' $ 875,
Oxymeter $ 85000,
$ 8,000.
• -11-
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FLOW MEMORIAL HOSPiT1L
1986, 1987, 198a
Three Year Capital Equipment Budget Summary
OVER $500
Dept, Name/
Priority Description Cost 1985-86
1486-87 1487-88
NICU cont,
C Ohio IC incu-
bator 6,500, 6 500.
$ 30,140. $ 7,900, $ 15,370, 61870,
f' Birthing Center
i
B Imex Dopplar $ 11100,
$ 1,100,
C Day Bed for
Birth, Room 950,
. 950.
,
$ 21050, $ 1,100, $ 950.
O.R.
A Olympus Heater
Probe $ 5,300. $ 5,300.
B Dermatone &
Meshgrafter $ 3,600, $ 3,600,
B Mini Fragment
Set $ 4,060, $ 4,060,
B Flash Sterilizer $139000,
$ 13,000,
B O.R. Table $ 17,000,
$ 17,000,
8 O.R, Lights $15,000,
$ 79500, $ 79500.
C Cystoscopy Table 2$ o,aoo,
2$ 1000.
r $77,960. $20,460. $37,5,00. $ 20,000,
Recovery Room
A Deribriilator $ 9,370, $ 91370,
C Blanket blarmer 31000;
- 3,000,
$12,370, $ 9,370,
$ 3,000.
.12-
FLO14 MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary I
OVER $500
Dept, Name/
Priority Oescriptfon Cost
1985-86 1986-87 1987-38
EA.
8 Overhead Light
•2 Exam Rms. $ 7,OOD, $ 7,000.
f A y
Pediatric Stret-
Cher $ 20600. $ 2,600.
f C Stryker Adult
Stretcher $ 3,750, $ 3,750,
C Autotransfuser $16,300,
$ 16,300, ~
Surgi-Bed $ 4,500, $ 41500,
$34,150. $17,850, $ 16,300,
s
X- Ray
A RA & Theon
R&F System $128,000, $128,000,
8 600 MA Generator
Photo-Time 23,680, $ 23,680,
8 Tube Stand 35,750,
35,750,
9 Digital Image Tube
& T.V. 1111000, 1111000.
B Port, X-Ray(Nsy) 14,000.
14,000.
8 Fflm processor 17,500.
$ 17,500,
8 Generator for
Cysto 14,000, 14,000,
A Film Cabinets 960,
960, ~
C Transducer 4,000,
4,000,
$348,890, $132,960, $184,430, $ 31,50D,
Behavioral Medicine
A VCR
$ 700. $ 700.
A VCR Camera $ 11000.
$ 1,000,
-13-
FLOW MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
i
Dept. Name/
Priority Description Cost 1985-86 1986-87 1937-38
Behavioral Medicine cont.
A VCR Monitor $ 700. $ 700,
A Heavy-Duty
Washer 750. $ 750.
A Heavy-Duty
Dryer 600. 600,
B IBM Corr, Set.
Typewriter 11200. 10200.
A. IBM'P.C. 256K 31500. 3,500.
A Computer Soft-
I ware 101000. 10,000.
` C 10-12 Passenger
Van 15,000. 15,000.
C Bio-Feedback
Equip. 41000. $ 4,000.
C ECT Equipment 9,000. 91000.
E Privacy Fencing 2,500, 2,500.
$ 48,950. $ 3,600. $ 389850. $ 66500.
EKG
A 2D Echo $ 87,000. $ 87,000.
A Interpretive
Cardiograph 8,OG0, $ 8,060.
$ 959000, $ 87,000. $ 80000.
R.T.
A 'treadmill $ 40,0001 $ 40,000,
B Equip, Dryer $ 80000. $ 8,000,
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rLOW MEMORIAL HOSPITAL
Three Year Capital~ Equipment8
Budget Summary
OVER $500
Dept. Name/
Priority Description Cost
1985-86 148f,_g7 1987-88
R.T. cont.
A Patient Table $ 800, $ 800,
C Croupotte
$ 3,000. $ 3,000.
B Air Compressor $ 2 500,
$ 54,300. $48,800. $ 5,500,
I
Pharmacy
C Night Locker Decent-
ralize Cart $ 1,800, $ 1,800,
B Memory Typewriter $ 10500, $ 10500.
C Sargart Unit Dose
Pkg, Machine $ 2,100,
5 2,100.
C IBM Typewriter 1,000, $ 11000.
$ 61400. $ 3,300, $ 3,100•
Physical Therapy
A CPM Lower.Ext, $ 30200,
$ 3,200,
A CAM Upper Ext.
$ 31200, ey 31200,
9 Cold-Pack Unit
$ 11890• $ 10890,
8 Parallel Bars Del,
Adj, $ 520. $ 520,
B Galvanic Stimulator 10100, $ 11100.
C Unex II Weight
machine $ 10060, $ 1,060, '
C Arm, Leg, Hip '01hirl_
pool $ 1,820, $ 1,820.
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FLOW MEMORIAL HOSPITAL
1986s 1987, 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept. Name/
Priority Description Cost 1985-86 1986-87 1987-88
Physical Therapy cont.
C Afl. High Chair $ 570, $ 57r,
8 Ergometer Ad,i,
Del, Clin, 850, $ 850.
i B .Treatment Table 1,600, 1,600,
C Ultrasound Port, 10200, 1,200.
C Podiatry Whirl-
Pool 11240, $ I1200,
B Tens Unit 11800, 19800
C Tilt Table 10000, 1,000,
C Hot Pack Unit 1,200, 1,200.
$ 229210, $ 13,360. $ 3,650, $ 5,200.
Medical Records
A Master Pat.-Rotary
File $ 61500, $ 6,500,
B Word Processor Acous.
Covers 19000, $ 11000.
C IBM Seloctric 11 2,000. 2000,
C Lanier Word Pro-
cessor 14,000, 14,000,
$ 23,500, $ 60500, $ 17,060,
Plant
A Chillers, Towers, Piping
& Clec, $520,000, $320,000, $200,000.
8 Steam Generator $ 48,870, $ 48,870,
-16-
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F
FLOW MEMORML HOSPITAL
1986, 1987, i988
Three Year Capital Equipment Budget Summary
OVER $500
Dept. Name/
Priority Description Cost 1985.36 1986-87 1987-83
Plant cont.
B Convert Double System
to VAV convert
mixing boxes $95,340.
C Cogeneration
Plant $92,540, $92,540,
Resaturate Roof $ 7,000, $7,000, E
B Exit doors by
Maint. 1,1.00. $ 1,700.
A Rebuild Air
Handler $ 19500. $ 19500.
B Replace Refractory in
Incinerator $ 2,500. $ 2,500,
B Resaturate Roof $20,000. $20,000,
A Hospital Van &
Pickup $15,000, $150000,
A Building over H2O
Storage $ 550. $ 550,
8 Seal Visitor Parking
Lot $ 9,000,
$ 9,000.
B Seal Doctors & Directors
Park. Lot $ 61500. $ 6,,00,
A Seal Circle Drive
& Patch $ 20000. $ 21000.
B Copper wiring in Panels
1C92C,3B,1D,
3A, & B1 $ 7,000, $ 70000,
B Doors for Loading
Dock $ 15750, $ 1,750.
,r
•17-
FLOW MEMORIAL HOSPITAL
1986, 1987, 1988
Three Year Capital EquiPment Budget Summary
OVER $500
Dept, Name/
Priority Description Cost
1985'86 1986-87 1987-88
Plant cont.
C Motorized Chilling
Tube brush $ 1,500.
j $
:1,800,
C Transfer Switch
Generator $ 100300.
~ 8 $ 10,300,
Mad/Surg Nurse-
Call System $ 20,000,
$ 20,000.
C 26 Nurse-Ca11
-System $ 7,670,
8 7,670,
3A Nurse Call
System 814,880,
C S 14,880.
3B Nurse Call
system $ 91520,
B $ 9,520,
08-L&D Nurse Call
System $ 70620,
8 Y
L&D Nurse Call 7,620.
System $ 7,850,
C $ 1,850,
O.R. Nurse Call
system $ 8,380.
- - S 80.
$ 918,970. $403,620. $ 3451840,
$ 169,510.
Quality Assurance
C IBM Selectric L _g70. $ 970,
$ 970, $ 970,
Health Promotion
A Kodak Ektagraphfc
Viewer $ 675, $ 675,
A 16mm Projector $ 1,300;
$ 1,300.
' -18-
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r•
rLOW MEMORIAL HOSPITAL
1986, 19870 1988
Three Year Capital Equipment Budget Summary
OVER $500
Dept, Name/
Priority Description Cost 1985-86 1986-87 1987-88
Health Promotion cant.
B Recordinn Annie $ 1,600. $ 1,600,
C Anatomic Annie 420, $ 420,
C Opaque Projector 790. 790, ~
A IBM Selectric 970, 970,
B Resurci Anne "80" 570, 570,
f• $ 6,320. $ 4,540. $ 11780. j
Anesthesiology
B Auto B.P. Monitor $ 8,800, $ 4,400, $ 4,400,
B Ohio Anesthesia
Machine 8000 449000. 22,000, $ 22,000,
C Blood Warmer 11280, 640, 640.
C Warming Blanket 41000, 20000, 29CO0,
B Criticon Oximeters 3,850, 1,650, 1,100, 1,100.
$ 61,930, $ 6490. $ 29,500, $ 259740,
Pathology
A Body Lifter 11500, 10500,
$ 19500. $ 10500.
General & Administrative
G A Room Furnishings $ 210; 000 $ 150,000 $ 30)000 $-."30, 000
A Refurbishing 650,000 350,000 150,000 150 0
$860,n00 $500,000 $ 180,6)0 $180,000
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1
FL(iSV MEMORM IISOPITAL
1986, 19870 1988
Three Year Capital EWiLnent Budget Summary
OVER $500
i
Dept. Name/
Priority Description Cast 1985-86 1986••87 1987'-88
A Cat Scan $ 500,000 $ 500,000
A Carputer 500,000 500,000
$1,000,000 $1,0000000
`HOSPITAL TOTALS $3076,100 $2,312,090 $ 935r990 $ 528,070
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~70-