AFRAMEWORKANALYSISOFTHEFUNDINGGAPFACINGUFHEALTHJACKSONVILLEANDTHEJACKSONVILLECOMMUNITY

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January 2015

Objectives

Interviewashortlistofrelatedstakeholders

Mapthecurrentlocalissueagainstourknowledgeofsimilarissuesaroundthecountry

Performcertainreimbursementanalysesindevelopmentofourviewoftheperceivedfundinggap

FacilitateameetingwherewewouldreadoutourfinalperspectivestotheCouncil

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ProcessDeployed

Interviewedapproximately15individualsincludingleadersfromUFHealthJacksonvilleaswellastheCivicCouncilandtheTaskForce

Completedthreedistinctbenchmarking/financialanalyticsexercises

CompletedselectreimbursementanalysescomparingUFHealthJacksonvilletoothersimilarinstitutions

ComparedoutcomesofFoundationeffortstoothercomparativeorganizations

ConvenedcertaininternalDHGHealthcareleaderstodiscusssituationalcomparativeswithotherinstitutionssimilartoUFHealthJacksonville

Note:UFHealthJacksonvillebasedprogramswhererevenuesflowelsewhere(Gainesvilleforexample)notassessedindetail

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AFRAMEWORKANALYSISOFTHEFUNDINGGAPFACINGUFHEALTHJACKSONVILLEANDTHEJACKSONVILLECOMMUNITY

EXECUTIVESUMMARY

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ExecutiveSummary InterviewThemes

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Fundinggapgenerallybelievedtobearevenueissue,notanexpenseissue:expectedtogetworse

UFHealthJacksonvillessurvivalisamust criticalcareneedforcommunity;MedicalSchoolcouldntbesupportedbyotherproviders

6th largestemployer includinghigherpayingjobs Taxingoptionnotlikelytobewidelysupported Newfacilityviewedbothasopportunityandrisk howcanitwork? Significantknowledgeandunderstandinggapwithcommunity

UFHealthJacksonvillesituationnotunlikewhatothertertiarycarefacilitiesface

RequirescomprehensiveandconsistentnewmessagingBusinesscommunityinvolvementisamust philanthropicleadership?

ExecutiveSummary Benchmarking

WebenchmarkedUFHealthJacksonvilleagainstthefollowinginstitutions: BrowardHealthMedicalCenter ErlangerMedicalCenter GradyMemorialHospital JacksonHospital Miami

16differentcomponentswerecompared,inthreedistinctareas:RevenuesandExpenses,BalanceSheetandServiceMakeup

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ExecutiveSummary Benchmarking

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UFHealthJacksonvilletoCompareGroup

ExecutiveSummary Reimbursement

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MedicaidLIPpaymentsanticipatedtoendin2015

CMSwantsstateMedicaidprogramstoprovideupfrontcoverageviaMedicaidexpansion

AtthispointFloridahasdecidednottoexpandMedicaid

Jacksonvillecommunityleadershipperceivesthereisa$40millionsafetynetfundinggap

UFHealthJacksonvilleisinthetop5forTotalMedicaidCostsinthestate(seenextslides)

UFHealthJacksonvilleisinthetop5for%ofMedicaidfundingpaymentstoTotalMedicaidcosts

UFHealthJacksonvilleisnotinthetop10for%ofIGTstoTotalMedicaidcostsShouldDuvalincreasetaxestocoverfundinggap?

ExecutiveSummary Reimbursement

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Top10hospitals%MedicaiddistributionstototalMedicaidcosts

Themedian%MedicaidPaymentstoTotalMedicaidCostsis14%

ProviderNameNetMedicaidPayments

TotalMedicaidCosts

%McdPymts/TotalMcdCosts

BAYMEDICALCENTER 12,825,220 33,337,243 38%UNIVERSITYOFMIAMIHOSPITAL&CLINICS 10,079,550 26,850,590 38%UFHEALTHJACKSONVILLE 103,213,344 294,520,779 35%MT.SINAIMEDICALCENTER 19,541,999 56,689,624 34%H.LEEMOFFITCANCERCENTER 20,301,535 61,267,669 33%JACKSONMEMORIALHOSPITAL 270,514,847 882,483,751 31%MEMORIALHOSPITALMIRAMAR 11,777,748 39,669,645 30%TAMPAGENERALHOSPITAL 90,854,205 309,153,661 29%ALLCHILDREN'SHOSPITAL 55,947,148 204,004,358 27%LEEMEMORIALHOSPITAL 38,275,813 141,131,472 27%

ProviderName TotalAllIGTsTotal

MedicaidCosts

%IGTs/TotalMcdCosts

BROWARDHEALTHIMPERIALPOINTHOSPITAL 32,529,319 36,757,048 88%BROWARDHEALTHBROWARDGENERALMEDICALCENT 124,396,457 258,807,329 48%JACKSONMEMORIALHOSPITAL 407,806,637 882,483,751 46%MEMORIALREGIONALHOSPITAL 113,996,106 319,534,597 36%CITRUSMEMORIALHEALTHSYSTEM 8,561,920 26,282,968 33%INDIANRIVERMEDICALCENTER 11,760,436 43,153,063 27%BROWARDHEALTHNORTHBROWARDMEDICALCENTER 23,859,981 87,833,588 27%SARASOTAMEMORIALHOSPITAL 26,460,414 100,689,346 26%MEMORIALHOSPITALMIRAMAR 10,146,635 39,669,645 26%BROWARDHEALTHCORALSPRINGSMEDICALCENTER 17,085,447 67,974,632 25%

ExecutiveSummary Reimbursement

Top10hospitals%IGTs(Taxes)toTotalMedicaidCosts

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Themedian%IGTs(Taxes)toTotalMedicaidCostsis7%

UFHEALTHJACKSONVILLE 29,923,988 294,520,779 10%

ExecutiveSummary Reimbursement

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StateMedicaidFundingExamples:Florida Hospitalsdividedintocounty/taxingdistrictsforMedicaidfunding ProviderAssessmentTax=basedonlegislationandamountspercounty/taxingdistrict Fedsmatch=59%(FMAP) Medicaidpaymentcomponents:

InpatientpaidonDRG Outpatientperdiem MedicaidDSH LowerIncomePayments(LIP) RateEnhancements(IPandOP)

Georgia Hospitalsdividedinto2categoriesforMedicaidDSHfunding ProviderAssessmentTax=1%ofhospitalsnetpatientrevenue Fedsmatch=66%(FMAP) Medicaidpaymentcomponents:

InpatientpaidonDRG Outpatientpaidoncost MedicaidDSH

ExecutiveSummary Reimbursement

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StateMedicaidFundingExamples(contd):Alabama Hospitalsdividedinto3categoriesforMedicaidfunding(state,privateandpublic) State/Public InternalGovernmentalTransfer(IGT)=paymenttransferof31.8%ofMedicaidclaims Private ProviderAssessmentTax=5.5%ofhospitalsnetpatientrevenue Fedsmatch=68%(FMAP) Medicaidpaymentcomponents:

Inpatientpaidonperdiem Outpatientpaidonperencounter Accesspayments MedicaidDSH

AlabamaMedicaidiscurrentlyworkingtorevampthecurrentpaymentmethodologyandconverttoAPRDRGbyOctober2015

BeginninginOctober2016,thestatewillbedividedinto5regionsthatwillberesponsibleforcoordinatingthehealthcareofMedicaidpatientsineachregion. CommunitylednetworkswillbedevelopedthatultimatelybeartheriskofcontractingwiththestateofAlabamatoprovidecaretothesepatients.

ExecutiveSummary Reimbursement

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NorthCarolina Hospitalsdividedinto5categoriesforMedicaidfunding(NonPublicCAH,NonPublic,Public,Public

CAH,andUNCHospitals) CertifiedPublicExpendituresbasedonprojectedDSHlimit Fedsmatch=66%(FMAP) Medicaidpaymentcomponents:

InpatientpaidonDRG Outpatientpaidoncost MedicaidDSH SupplementalPayments MRI/Gap

ExecutiveSummary FoundationComponent

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Fundraisingnotoutoflinewithcomparegroup Perhapssomeopportunityforspecialeventfundraising Additionalresearchrequiredinthisareatodeterminehowbesttorefine

approach

THINKBIG Philanthropy

ExecutiveSummary FundingGapChallenge

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ItdoesnotappeartheStateisgoingtohelpwiththeMedicaidfundinggap. HealthyFloridaWorks(HFW)isabusinesscoalitionfightingfortheuninsuredFlorida

population.Theprogramisdesignedtoincreaseaccesstohighquality,affordablehealthcarewhilepromotingpersonalaccountability. HFWshouldbeconsideredasapossibleoptiontohelpdriveaccesstoanewpaymentstreamforhistoricallycategorizedindigentpatients.

ItisimperativetheStateunderstandswhatproviderslikeUFHealthJacksonvillearegoingtohavetodotosurviveinthefuture.

AHCAhashiredaconsultanttolookattheStatefundingissues. Localstakeholders/leadersmustengageinreenergizedphilanthropicefforts. UFHealthJacksonvilleneedstocompleteaserviceportfolioanalysisinthecontextof

possiblefuturestatebrandingofdistinctserviceofferings. Newfacilitywillrequiredeliberate brandpositioning.