STATE AGENCY REPORT. A. The State Agency finds that the proposed project does not appear to be in conformance with the provisions of Part 1110.
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1 STATE AGENCY REPORT WSKC Dialysis Services, Inc. Everest Healthcare Services Corp. West Side Health Authority d/b/a Austin Community Kidney Center Chicago, Illinois Project # I. The Proposed Project The applicants propose to establish a 16 station ESRD facility at the corner of Chicago Avenue and Cicero Avenue in Chicago, Illinois. The total estimated project cost is $3,261,393. II. Summary of Findings A. The State Agency finds that the proposed project does not appear to be in conformance with the provisions of Part B. The State Agency finds that the proposed project does not appear to be in conformance with the provisions of Part III. General Information The co-applicants are WSKC Dialysis Services, Inc., Everest Healthcare Services Corp., and West Side Health Authority. The facility will be located in HSA VI which is the planning area for ESRD services. There are 35 other facilities offering ESRD services in HSA VI, 28 of which are located within 30 minutes travel time of the proposed facility. This is a non-substantive project which is subject to both a Part 1110 and a Part 1120 review. The project has not been obligated and obligation is not requested upon permit issuance. The application states that the project should be completed in 6 months. An opportunity for public hearing was offered on this project; however, no request for a hearing was received.
2 Page 2 IV. The Proposed Project - Details The applicants are proposing to establish a 16 station ESRD facility in a new medical professional building to be constructed by West Side Health Authority in Chicago, Illinois. It will lease 7,555 square feet in the Austin Community Health and Education Center to be located on the corner of Chicago and Cicero Avenues in Chicago. As construction is being completed, the applicants will begin a tenant improvement build-out that includes treatment areas, plumbing, electrical, HVAC, life safety, and other improvements. V. Project Sources and Uses of Funds The applicant proposes to fund the project with $3,261,393 in cash and securities, leases, and a bank line of credit. The following table outlines the proposed use of funds: Table I Proposed Use of Funds Amount Preplanning Costs $ 5,000 New Construction Contracts 825,000 Contingencies 80,000 Architectural & Engineering Fees 65,000 Consulting and Other Fees 84,836 Movable or other Equipment 382,800 Net Interest Expense During Construction 75,957 Other Costs to be Capitalized 72,000 Acquisition of Leased Building (FMV) 1,670,800 Total $3,261,393 VI. Review Criteria - Chronic Renal Dialysis A. Criterion a., Data System
3 Page 3 The applicants state that an ESRD data system does not presently exist at the site. They do state that an ESRD data system will be established as is required by this criterion. B. Criterion b., Minimum Size of Renal Dialysis Facilities The applicant is proposing a facility with 16 stations. According to this criterion, the applicant must establish a facility with at least 6 stations in an MSA of more than 500,000 population. C. Criterion c., Variance to Station Need The April 15, 2000 update to the Inventory of Healthcare Facilities indicates a need for 66 stations in HSA VI. Therefore, this criterion is not applicable. D. Criterion d., Support Services The applicant will be supplying the following support services onsite: dietary counseling, rehabilitation, home/self training, social services and psychiatric services. Support services that will be provided by other entities are: tissue typing, isolation hemodialysis, and laboratory services. This criterion also specifies that blood bank services will be available. The applicants did not address the availability of this support service; therefore, a negative finding must be made. THE STATE AGENCY FINDS THAT THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE ABOVE REVIEW CRITERION. E. Criterion e., Affiliation Agreements The applicants have a signed affiliation agreement for hospital services with University of Chicago Hospital, 5841 South Maryland Avenue, Chicago. In addition, the applicants have a transplantation agreement with Rush Presbyterian Hospital, 1725 West Harrison Street, Chicago.
4 Page 4 F. Criterion f., Self-Care and Home Dialysis Training The applicants have certified that self care dialysis, self care instruction, home dialysis and home training services will be provided at West Metro Dialysis Center located at 1044 West Mozart Street, Chicago. G. Criterion g., Relocation of Facilities H. Criterion h., Addition of Stations These criteria are not applicable. I. Criterion i., Quality of Care The application states that in the 12 month period of 10/98-09/99, 79.3% of all WSKC Illinois patients had a Urea Reduction Rate of.65 or better. For the 8 month period of 10/98 to 5/99, 79.8% of WSKC Illinois patients had a hematocrit level 31% or better. These percentages surpass the State standard of 65% of the patients for both of these standards. An 8 month period was given for hematocrit since at that time WSKC started using a hemoglobin measure instead of Hematocrit. The application states that if the hematocrit and hemoglobin measures were combined to give a 12 month measure it would give a 81.7% level at 31% or better and would still be within state guidelines. VII. Review Criteria - General A. Criterion a., Location The applicants have provided a list of 69 patient referrals by zip code. The application states that these patients would come from present WSKC facilities that are running 100% or greater utilization rates. The table below lists the 28 facilities that are within a 30 minute travel time and the percent utilization they have. All but 3 show at least 80% utilization according to the 1998 Renal Network Report. There is a projected need for 66 stations in the planning area
5 Page 5 based on the April update to the Inventory of Health Care Facilites. It appears that the proposed project will not cause a maldistribution of services. Table II Facilities Within 30 Minutes Travel Time Facility 1998 Renal Network - % Utilization Neomedica North 95 Lincoln Park Dialysis Services 93 Edgewater Hospital 52 Northwestern Hospital 82 West Metro Dialysis Center* 85 Chicago Dialysis Center* 90 Logan Square 105 DCA Prairie 103 DCA Lakeshore 96 Neomedica - Southwest 99 Univ. of Chicago Hospitals 88 Rush Presbyterian 94 Neomedica Melrose Park 84 DCA Riverside 84 DCA Loop 94 Mt. Sinai 99 Neomedica West Belmont 80 West Suburban Dialysis Center* Oak Park Dialysis Center* 97 Foster McGaw Hospital of Loyola 133 University of Illinois Hospital 92 Neomedica Loop 82 Downers Grove Dialysis Center 106 Elmhurst Memorial Hospital 93 LaGrange Dialysis Center 117 Resurrection Medical Center 94 DCA Rodgers Park 93 Neomedica Niles 65 *owned by applicant
6 Page 6 B. Criterion b., Background of the Applicant The applicants have provided documentation showing that they are fit, willing and able, and have the qualifications, background and character to adequately provide a proper standard of health care services for the community. C. Criterion c., Alternatives The applicants investigated alternatives to the proposed project which are outlined in Attachment #GRC-3 of its application. Other alternatives were rejected due to high present utilization at WSKC facilities and the fact that there is a calculated need for dialysis facilities in the area. It appears that opening a new facility is a reasonable choice. D. Criterion d., Need for the Project There is a calculated need for 66 stations in the planing area according to the April 15, 2000 update to the Inventory of Health Care Facilities. E. Criterion e., Size of the Project The applicants state that they have projected their utilization rate for the new facility based on past experience in the area. The application states that they will start with 69 patients and grow by 8% a year. The 8% is stated to be a conservative estimate based on growth at nearby WSKC facilities of 17-23% for the year They project a utilization rate of 78% percent by the end of the first year and 84% at the end of the second year. This projection meets the State standard of 80% by the second year.
7 Page 7 The applicant is proposing to establish a 16 station facility in 7,555 GSF or GSF per station. This number is in excess of the State Agency guideline of 470 GSF/station. The application did not provide information as to the reasons for this excess; therefore, a negative finding must be made. THE STATE AGENCY FINDS THAT THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE ABOVE REVIEW CRITERION. VIII. Review Criteria - Financial Feasibility A. Criterion a., Financial Viability The State Agency has reviewed the latest three years financial statements that were provided. The applicants results in comparison to State standards are listed below: State WSKC Dialysis Services, Inc. Measure Standard Current Ratio 1.5 x or more NA Net Margin Percentage 3.5% or more 3.7% 2.5% 2.6% NA Debt Capitalization Ratio 80% or less 53% 65% 75% NA Debt Service Coverage 1.75 x or more NA Days Cash on Hand 90 days or more NA Cushion Ratio 5 or more NA The applicant s days cash on hand and cushion ratio did not meet State standards for the 3 years given. Net margin percentage was not met in 1998 or Also, projected ratios for 2002 were not supplied. State Everest Healthcare Services Corp. Measure Standard Current Ratio 1.5 x or more Net Margin Percentage 3.5% or more 3.7% 2.5% 3.6% 3.1% Debt Capitalization Ratio 80% or less 53% 65% 75% 71% Debt Service Coverage 1.75 x or more Days Cash on Hand 90 days or more Cushion Ratio 5 or more
8 Page 8 The applicant s days cash on hand and cushion ratio did not meet State standards for the 3 years given or the 2002 projection. Net margin percentage was not met in 1998 or State Westside Health Authority Measure Standard Current Ratio 1.5 x or more NA Net Margin Percentage 3.5% or more -3.30% 23.23% 1.06% NA Debt Capitalization Ratio 80% or less 59% 17% 14% NA Debt Service Coverage 1.75 x or more NA Days Cash on Hand 90 days or more NA Cushion Ratio 5 or more NA The applicant s net current ratio, net margin percent, debt capitalization ratio, debt service coverage, days cash on hand, and cushion ratio did not meet State standards for Net margin percentage was not met in 1999 and days cash on hand was not met in 1998 or Also, projected ratios for 2002 were not supplied. THE STATE AGENCY FINDS THAT THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE ABOVE REVIEW CRITERION. B. Criterion b., Availability of Funds The applicant proposes to fund the project with $75,957 in existing cash and securities, leases of $1670,800, and bank line of credit for $1,514,636. After reviewing Everest Healthcare Services Corporation s audited financials, it appears that there are sufficient financial resources to fund the project. C. Criterion c., Start-Up Costs The application did not contain information as to start-up costs; therefore, this criterion is negative. THE STATE AGENCY FINDS THAT THE PROPOSED PROJECT DOES NOT APPEARS TO BE IN CONFORMANCE WITH THE ABOVE REVIEW CRITERION.
9 Page 9 IX. Review Criteria - Economic Feasibility A. Criterion a., Reasonableness of Financing Arrangements The applicant has stated that the project will be funded with cash and securities of $75,957, with a lease with a FMV of $1,670,800, and a bank line of credit for $1,514,636. According to the applicant, all available cash and securities are being used to fund the project. This criterion states that the applicant must document that the project will be funded with cash and equivalents including investment securities, unrestricted funds, and funded depreciation as currently defined by the Medicare regulations (42 USC 1395) unless cash and equivalents must be retained for either of the following: 1) a portion or all of the cash and equivalents must be retained in the balance sheet asset accounts in order that the current ratio does not fall below 2.0 times; or 2) borrowing is less costly than the liquidation of existing investments. The applicant must provide documentation of the investment portfolio and evidence that supports retaining such investments. In the provided Everest financials, there appeared to be sufficient funds to fund the project without borrowing. Since the application did not address either of the two variances given above, the State Agency must make a negative finding. THE STATE AGENCY FINDS THAT THE PROPOSED PROJECT DOES NOT APPEAR TO BE IN CONFORMANCE WITH THE ABOVE REVIEW CRITERION. B. Criterion b., Terms of Debt Financing The building will be leased for $4.58 per GSF per annum in the first year with a rising rent described in attachment GRC-1. There is also a bank line of credit at the current Prime rate. The applicants state that they choose to lease rather than purchase real estate since this allows greater flexibility in expanding and relocating units and that the capital expenditures in leasing would be less than for purchasing. The terms of the debt financing appear to be at a reasonable level.
10 Page 10 C. Criterion c., Costs of Debt Financing The applicant stated that the projected total facility debt would be $1,687,949. The cost of debt financing, that is required by this criterion, was not supplied. Therefore, a negative finding must be made. D. Criterion d., Reasonableness of Project Cost Preplanning Costs - These costs amount to $5,000 or 0.39% of contracts, contingencies and equipment costs. This amount is reasonable when compared to the State standard of 1.8%. New Construction - Contracts and contingencies amount to $905,000. The area to be constructed consists of 7,555 GSF or $ per GSF. This amount appears reasonable when compared to the State standard of $ for Contingencies - These costs amount to $80,000 or 9.7% of construction contracts. This appears reasonable when compared to the State Agency standard of 10%. Architectural and Engineering Fees - These costs amount to $65,000 or 7.2% of construction and contingencies costs. This amount appears reasonable when compared to the State standard of 7.2%. Consulting and Other Fees - These costs amount to $84,836 and appear reasonable when compared to previously approved projects. Equipment - These costs amount to $382,800 or $23,925 per station. This amount appears reasonable when compared to the State adjusted standard of $26,228. Net Interest Expense During Construction - These costs amount to $75,957 or 2.3% of total project costs. Other Costs To Be Capitalized - These costs amount to $72,000 and are for a water treatment system. This is 2.2% of total project costs. Lease Of Building - The FMV of the lease amounts to $1,670,800 and appears to be reasonable when compared to previously approved projects.
11 Page 11 E. Criterion e., Reasonableness of Resultant Operating Costs The applicant has projected the following operating costs for 2001: Salaries $734,315 Benefits 94,490 Supplies 266,220 Total $1,095,025 Units of Service 11,981 Cost per Unit $91.40 The applicants have not stated if the cost of Epogen was included in the costs above. The cost shown is within the adjusted State standard of $102. F. Criterion f., Capital Costs G. Criterion g., Non-Patient Related Services These criteria are not applicable to this project.
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