AZ-CAH Operational Performance Review. Howard J. Eng, Stephen Delgado and Kevin Driesen

Transcription

1 AZ-CAH Operational Performance Review Howard J. Eng, Stephen Delgado and Kevin Driesen

2 Financial Indicators Summary Howard J. Eng, DrPH 2

3 Overview CAH Profitability Trends Net Income (Total Revenue Total Expense) Total Margin Outpatient versus Inpatient Revenue Mix AHCCCS CAH and SAVE Supplements CAH Liquidity Trends Days Cash on Hand Net Days Revenue in Account Receivable Arizona CAHs Meeting National Benchmarks 3

4 Arizona CAHs Profitability Summary: Number of CAHs Year CAH# (+ Profitability) CAH# (- Profitability) Source: Arizona Department of Health Services: Hospital Cost Reports ( ) 4

5 Total Margin (Percent) Arizona and U.S. CAH Total Margin Trend: U.S. Median CAH Ariz. Median CAH Source: Cecil G. Sheps Center CAH Financial Indicators Reports 5

6 Outpatient Revenues to Total Revenue (Percent) Arizona and U.S. CAH Outpatient Revenue to Total Revenue Trend: U.S. Median CAH Ariz. Median CAH Source: Cecil G. Sheps Center CAH Financial Indicators Reports 6

7 Arizona CAH Revenue Gross Inpatient and Outpatient Charges and Gross Patient Revenue Five Year Average: ,000,000 60,000,000 50,000,000 40,000,000 30,000,000 20,000,000 10,000,000 0 A B C D E F G H I J K All Avg Inpatient Charges Outpatient Charges Source: ADHS Cost Report 7

8 Arizona CAHs AHCCCS Total, SAVE, and CAH Supplement Dollars: SAVE CAH Source: AHCCCS Report 8

9 Arizona CAHs AHCCCS Total, SAVE, and CAH Supplement Dollars by Hospital: ,000,000 7,000,000 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 1,000,000 0 A B C D E F G H I J K L SAVE CAH Source: AHCCCS Report 9

10 Days Cash on Hand (Days) Arizona and U.S. CAH Days Cash on Hand Trend: U.S. Median CAH Ariz. Median CAH Source: Cecil G. Sheps Center CAH Financial Indicators Reports 10

11 Days Revenue in Account Receivable (Days) Arizona and U.S. CAH Net Days Revenue in Account Receivable Trend: U.S. Median CAH Ariz. Median CAH Source: Cecil G. Sheps Center CAH Financial Indicators Reports 11

12 Arizona CAH Account Receivable Dollars Five Year Average: ,000,000 4,500,000 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000 1,000, ,000 0 A B C D E F G H I J K All Avg. Accountable Received Dollars Source: ADHS Cost Reports 12

13 Arizona Critical Access Hospital Sheps Center Eight Selected National Benchmark Financial Indicators Profile: 2010 CAH Financial Indicators Bench A B C D E F G H I J K Ariz. % U.S.% Profitability Indicators Total Margin >3 N N N Y N N Y Y N Y N 36% 41% Operating Margin >2 N N N Y N Y Y Y N Y N 45% 41% Cash Flow Margin >5 N N N Y N N Y Y N Y N 36% 56% Liquidity Indicators Current Ratio >2.3 Y Y N NA N N Y Y N Y N 56% 51% Days Cash on Hand >60 Y Y N N N N Y Y N Y N 45% 54% Days Rev. in Acct. Rec. <53 Y N N NA N N N N Y Y Y 40% 52% Capital Structure Indicator Debt Service Coverage >3 Y Y N NA NA Y Y N N Y N 50% 45% Long-Term Debt to Cap. <25 N Y N Y Y Y N N Y Y Y 64% 48% Source: Cecil G. Sheps Center CAH Financial Indicators Reports 13

14 Arizona CAHs Meeting the Eight National Benchmark Financial Indicators: 2010 Number of Indicators A B C D E F G H I J K Meet Benchmark Not Meet Benchmark Source: Cecil G. Sheps Center CAH Financial Indicators Reports 14

15 Arizona Critical Access Hospital Inpatient Bypass, Stephen Delgado, PhD 15

16 Overview Objectives and overview of Bypass Reports Market share/bypass estimates, 2011 Discharges/charges, Payer mix, Top 10 diagnoses,

17 Arizona Critical Access Hospital Inpatient Bypass Reports 1. Evaluate the extent of and factors associated with inpatient bypass 2. Help CAHs minimize bypass and its impacts 17

18 Bypass Report Overview 1. Market share/bypass estimates How much Which diagnoses Which healthcare facilities 2. Socio-demographic profile of hospital service area 3. Profile of hospital inpatient population Socio-demographic characteristics Inpatient stay characteristics Financial characteristics 4. Profile of service are inpatient population: CAH versus other healthcare facilities 18

19 Market Share/Bypass,

20 Discharges and Charges,

21 Inpatient Discharges,

22 Inpatient Charges,

23 Payer Mix,

24 Payer Mix,

25 Top Ten Diagnoses,

26 Conclusion Substantial opportunity to increase market share within current service area and service line Flex Program available to provide analytical support Questions? Thank you! 26

27 Tracking Quality Metrics Kevin Driesen, PhD 27

28 Tracking Quality Metrics Medicare Beneficiary Quality Improvement Program (MBQIP) CMS, Hospital Compare Measures o Phase I: Pneumonia, CHF, o Phase II: Outpatient (ED), HCAHPS o Phase III: Pharmacist CPOE / Verification of medication orders within 24 hours; ED Transfer Communication Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient satisfaction 28

29 Source: White Mountain Independent Online, WMIcentral.com, July 30,

30 National: Arizona MBQIP Progress 1230 CAHs participating (92% of all 1331 CAHs) 12 signed Memorandum of Agreements First MBQIP report distributed, Feb Flex $ support for HCAHPS vendors (increase from 5-to-9 hospitals) Current AZ-CAH participation table: Discharge Instructions Assessed LVS ACEI / ARB for LVSD * Blood Culture Before Antibiotic Appropriate 1 st Antibiotic Arizona 57.1% 57.1% 42.9% 71.4% 64.3% * Use of an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB) in patients with left ventricular systolic dysfunction 30

31 2 nd MBQIP Report July 2013 MBQIP performance statistics and national benchmarks: Percent Patients Receiving Recommended Care Discharge Instructions Assessed LVS ACEI / ARB for LVSD Blood Culture Before Antibiotic Appropriate 1 st Antibiotic Arizona 73.9% 85.7% 100% 89.7% 90.7% All CAHs - National All Hospitals - National 82.4% 85.5% 86.9% 94.5% 88.3% 93.6% 98.8% 96.6% 97.5% 95.0% 31

32 MBQIP Report #2: Arizona CAHs Aggregate Quality Scores MBQIP Quality Measure 1Q2012 2Q2012 3Q2012 4Q2012 Discharge Instructions 58% of 12 Patients Aggregate Rate for All Four Quarters 67% of 6 87% of 31 89% of 27 82% of 76 Evaluation of LVS Function 93% of 15 43% of 7 97% of 34 90% of 31 90% of 87 ACEI or ARB for LVSD 100% of 7 100% of 1 100% of 9 100% of 5 100% of 22 Blood Cultures Performed in the Emergency Department Prior to Initial Antibiotic Received in Hospital Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients 92% of 38 77% of 22 88% of % of 72 89% of % of 32 89% of 9 89% of 26 90% of 59 91% of

33 AZ-CAH Performance: MBQIP Quality Measures 33

34 Hospital Performance on MBQIP Quality AZ- CAH 34

35 HCAHPS Pt. Satisfaction Source: AZ-CAH Quality Network, Bullock (2013) 35

36 Hospital Recognition Page Hospital Demonstrating Excellence and Innovation in Quality March2013, National Rural Health Resource Center Cobre Valley Regional Medical Center Top 100 Critical Access Hospital June 2013, ivantage Health Analytics Copper Queen Community Hospital Excellence in Patient Satisfaction June 2013, ivantage Health Analytics Wickenburg Hospital Excellence in Outcomes June 2013, ivantage Health Analytics 36

37 Summary (Financial) AZ-CAHs experienced significant distress in period due to the state economic downturn. Five CAHs with negative margin (2010) One AZ-CAH closure (2012) One bankruptcy (2013) Several AZ-CAHs compare well to peers on operational performance but, the majority do not meet operational benchmarks. 37

38 Summary (Hospital Discharge) There is variation among AZ-CAHs in: Charge rate increase (most AZ-CAHs charges are less compared to urban hospitals although we have not evaluated severity differences.) Physician panel size Payer mix Clinical service profile Opportunities exist to expand services to local communities, capture greater market share. 38

39 Summary (Quality) AZ-CAHs Variation exists in individual hospital quality performance metrics. As a group, AZ-CAHs are similar to other all CAHs on CHF and Pneumonia metrics with the exception of patients receiving CHF discharge instructions. As a group, AZ-CAHs perform less well on Hospital Compare metrics compared to all hospitals nationally or to national benchmarks. But AZ-CAHs compare favorably to urban hospitals on most patient satisfaction metrics. Your Resource: AZ-CAH Quality Network. 39

40 Comments & Requests Howard Eng, DrPH Stephen Delgado, PhD Kevin Driesen, PhD 40