Richard Baum, Assistant Treasurer, and James Martin, Controller NYU Langone Medical Center

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1 New Jersey Healthcare Financial Management Association Business Continuity & Facility Readiness: Are Institutions Ready for Today s World Tuesday, April 22, 2014 and Thursday, April 24, 2014 Richard Baum, Assistant Treasurer, and James Martin, Controller NYU Langone Medical Center

2 Disclaimer The information contained in these slides and the accompanying oral presentation (collectively, the Presentation Information ) is being provided for informational purposes only and should not be relied upon in making an investment decision with respect to any security issued by NYUHC. The Presentation Information is not an offer to sell securities or the solicitation of an offer to buy securities, nor shall it constitute an offer, solicitation or sale in any state or jurisdiction in which such an offer, solicitation or sale would be unlawful. NYUHC may only sell securities by means of an offering memorandum or official statement. The Presentation Information contains forward-looking statements. All statements other than statements of historical facts contained in the Presentation Information, including statements regarding NYUHC s strategy, plans and objectives of management, prospects, future results of operations and financial position, future revenue, member growth and rate of adoption, projected costs, and market estimates and growth are forward-looking statements. The words anticipate, believe, estimate, expect, intend, may, plan, predict, project, will, would and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. NYUHC has based these forward-looking statements largely on NYUHC s current expectations and projections about future events and financial trends that management of NYUHC believes may affect NYUHC s financial condition, results of operations, business strategy and financial needs. NYUHC does not assume any obligation to update any forward-looking statements, whether as a result of new information, future events or otherwise, except as required by law. No user of the Presentation Information should place undue reliance on NYUHC s forward-looking statements because they involve known and unknown risks, uncertainties and other factors that are beyond NYUHC s control and that could materially affect actual results, levels of activity, performance, or achievement. If any of these risks or uncertainties materialize, or if NYUHC s underlying assumptions prove to be incorrect, actual results or events could differ materially from the plans, intentions and expectations disclosed in the forward-looking statements made in the Presentation Information. The Presentation Information includes both GAAP and non-gaap financial measures. NYUHC s management uses certain non- GAAP financial measures to assess NYUHC s business and operations. Non-GAAP information should not be construed as an alternative to GAAP information, as the items excluded from the non-gaap measures often have a material impact on NYUHC s financial results. NYUHC uses, and users of the Presentation Information should use, non-gaap measures in conjunction with NYUHC s GAAP results. Note: Cover image artist s rendering of future campus including NYU School of Medicine Facilities. 2

3 Unique Structure for NYU Langone Medical Center New York University NYU Langone Medical Center School of Medicine (including Faculty Group Practice) Key: Member of the Obligated Group Sole member Unincorporated division of New York University NYU Hospitals Center CCC550 Note: Neither New York University nor its School of Medicine are obligated with respect to NYUHC s Bonds or commercial debt. No assets or revenues of New York University or its School of Medicine are pledged to secure or available to pay debt service with respect to NYUHC s debt obligations. CCC550, NYU Hospitals Center s wholly owned captive insurance company, is also not obligated with respect to NYUHC s debt obligations and no assets or revenues of CCC550 are pledged to secure or available to pay debt service with respect to NYUHC s debt obligations. NYULMC is an integrated academic medical center in midtown Manhattan with outpatient centers across the region: Tisch Hospital (546 beds). Hospital for Joint Diseases (157 beds). Ambulatory care network. NYU Physician Network including NYU School of Medicine ( NYUSM ) Faculty Group Practice and private physicians: 2,300+ physicians. Over 100 medical practices. NYULMC is a virtual entity with one management team and one board of trustees making key decisions across the hospital and school of medicine. NYULMC FY 2013 operating revenues: $3.3 billion (including NYUHC ~ $1.9 billion) 3

4 Commitment to the Pursuit of Excellence Investment in Technology EPIC - First fully integrated Clinical and Billing system in New York Performance Dashboards Data Center - Key infrastructure component for the future Campus Transformation Broad System Implementation PeopleSoft - New Enterprise Resource Planning System Enterprise Data Warehouse & Business Intelligence Dedication to Clinical Quality Ranked #14 in the nation on the Best Hospitals Honor Roll with 12 nationally ranked specialties In 2013, received the Gold Seal of Approval by The Joint Commission, reflecting our commitment to high-quality care Ranked #1 for Patient Safety and Quality. Recipient of the 2013 Quality Leadership Award 4

5 Expanding Inpatient and Ambulatory Facilities in Manhattan Expanded ambulatory presence in the last three years: Musculoskeletal Center (110,000 sq. ft.) Ambulatory Center (300,000 sq. ft.) Outpatient Surgery Center (18,000 sq. ft.) An extension clinic at NYUSM s Joan H. Tisch Center for Women s Health Tisch Center for Men s Health NYU Langone Internal Medicine The Miller Practice Affiliated Hospitals (Manhattan and Brooklyn): Bellevue Hospital Center PERELMAN Gouverneur Healthcare Services New York Harbor Veterans Affairs Medical Center Woodhull Hospital Medical Center 5

6 Growing Physician Presence Across Region Expanded geographic presence beyond Manhattan through new physician relationships: Outpatient care centers (i.e. Oncology, Orthopaedics) Specialist outreach programs Acquired and opened outpatient centers outside of Manhattan: Brooklyn Endoscopy and Ambulatory Surgery Center Hudson Valley Cardiology (Westchester, NY) Columbus Medical Center (Queens, NY) 6

7 NYULMC Campus Transformation Project* Expand NYULMC patient care, research and education footprint to 3.5 million sq. ft. of facility space Tisch Hospital elevator/lobby renovation - completed April 2013; 100% funded by philanthropy Energy Building supply electricity to First Avenue campus - construction FY Science Building construction - NYUSM research facilities; University funded; construction FY (300,000 sq. ft.) ED Renovation Tisch Hospital; expected to open Spring 2014 (change from 6,900 to 16,900 sq. ft.) Kimmel Pavilion new 22-story clinical pavilion on the First Avenue Campus; expected construction FY (830,200 sq. ft.) * Artist rendering. 7

8 NYUHC Strategic Initiatives Pre-Superstorm Sandy Clinical Flexibility Ambulatory Care Expansion (added over 800,000 square feet in past two years) 7-Day Care Initiative in process before superstorm Ability to flex staffing and operations across facilities Capacity for physicians to operate and take care of patient across facilities Inpatient bed relocation to HJD campus in process Financial Readiness Balance sheet reserves established as cushion for operating volatility Fixed rate debt and lines of credit capacity of $400 million in October 2012 Issuance of Series 2012A taxable debt $250 million in July 2012 Policy to invest $10 million per month from operations into capital program & reserve fund ~ total working capital of $503 million as of November 1, 2012 Ability to access excess capital reserves from CCC550 Insurance Co. (offshore malpractice insurance company) when needed and declared by Board of Directors Information technology and Management reporting EPIC First fully integrated clinical system in NY market PeopleSoft implemented in 2010; simplified supply requisitioning and ordering Disaster Recovery Centers in New Jersey and Pennsylvania 8

9 Superstorm Sandy 9

10 Superstorm Sandy Preparation & Evacuation Friday, October 26, patients at Tisch Hospital reduced to 322 patients by Monday, October 29, 2012 Evacuation order for Tisch Hospital issued when ConEdison power plant explosion caused widespread damage and power loss to lower Manhattan Tisch Hospital patients were transferred to 14 hospitals within 13 hours 10

11 Superstorm Sandy - Evacuation 11

12 Superstorm Sandy Press conference on December 27, 2012, to announce re-opening of Tisch Hospital with NYULMC Dean and CEO Robert Grossman, Ken Langone and Senator Charles Schumer 12

13 How NYUHC Withstood Superstorm Sandy Clinical Flexibility Dispersion of inpatient volume to HJD campus which remained open during Superstorm Sandy Ambulatory Care Facilities Utilization of ambulatory locations for dispersion of outpatient volume Continued expansion of Ambulatory Care strategy acquired Brooklyn Endoscopy & Ambulatory Surgery Center Spring 2013 Urgent Care Center - In January 2013, NYUHC re-opened the Emergency Department (ED) as an urgent care center, staffed by ED clinicians, to handle walk-in and other urgent care cases (excluding 911 ambulance) Physician retention Minimal loss of physicians to competing facilities attributable to storm Physician malpractice insurance coverage extended to all physicians practicing at NYUHC facilities only 13

14 How NYUHC Withstood Superstorm Sandy (continued) Commitment to Nursing and Staff No terminations of staff; continuous pay provided throughout storm and recovery Redeployment of employees to active sites Ambulatory Surgery Center 34 th Street Clinical Cancer Center Center for Musculoskeletal Care Hospital for Joint Diseases NYUSM Faculty Group Practice off-site locations Operational downtime utilized to train staff on Epic inpatient installation; implemented at HJD on December 2, 2012, Schwartz Health Care Center on December 15, 2012 and Tisch surgical suites on December 27, 2012 Financial Capabilities Continued investment of $10 million per month from operations into capital program & reserve fund total working capital of $709 million as of February 28, 2013 Increase in total working capital lines of credit to $500 million CCC550 Insurance Co. (offshore malpractice insurance company) ~ $51 million dividend declared and paid to NYUHC in November 2012 Philanthropic support - $45 million received for construction of Kimmel Pavilion in November 2012 Quick, coordinated action for initial FEMA funding and continuing strong FEMA support 14

15 NYUHC Operational Timeline in Response to Superstorm Sandy* Oct 29: Superstorm Sandy Strikes NY Metro Area Tisch evacuated HJD remains open Oct 31: Center for Musculoskeletal Care re-opens Nov 1-9: 34 th Street Cancer Center, Ambulatory Care Center, and Ambulatory Surgery Centers re-opens Dec 17: HCC reopens for procedural and surgical services Dec 27: Tisch Hospital begins phased re-opening including inpatient and outpatient surgery Jan 14: Inpatient services such as Medicine, Pediatrics, Neurology, Epilepsy are operational; Emergency Department is re-opened as an Urgent Care Center for handling of walk-in and other urgent care cases (excluding 911 ambulance) Mar 2013: Infusion services opened at ACC Apr 2013: Infusion center opens in Long Island in conjunction with existing physician practice May 2013: Rusk Rehab beds opened at HJD Summer 2013: NYUHC inpatient psychiatry and complex rehab services reopen Apr 2014: NYUHC Emergency Department planned to reopen October 2012 November December January 2013 March - August January March 2014 * All planned future events are subject to change. 15

16 NYUHC Investor Communication Post Superstorm Sandy Nov 16: NYUHC publishes voluntary disclosure filing on DAC/EMMA related to Sandy Nov 30: NYUHC publishes FY2012 annual disclosure on DAC/EMMA Dec 14: NYUHC publishes FY2012 audit report on DAC/EMMA Jan 7: NYUHC presents at JPMorgan Healthcare Conference; publishes presentation on EMMA Jan 28: NYUHC publishes FY2013 Q1 disclosure on DAC/EMMA (quarter end 11/30/12) Feb 1: NYUHC holds investor update call and publishes voluntary disclosure filing on DAC/EMMA Spring 2013: Rating agencies affirm NYUHC ratings (A3/A-/A-, stable outlook) Summer 2013: NYUHC issues $350 million taxable bonds in line with its campus transformation plan October 2012 November December January February 2013 March - August NYUHC has been out front in its communications to the investor community Repeated market updates on implications of Superstorm Sandy Investment banking conferences Transaction marketing (net roadshow, tour of NYUHC facility) Involvement of entire executive team in communication strategy 16

17 NYUHC Financial Performance ($000) Fiscal Year Ended August 31, (Audited) Three Months Ending November 30, (unaudited) (3) 2013 Net Patient Service Revenue $1,625,839 $1,830,158 $1,662,617 $385,837 $481,253 Other Operating Revenue 75, , , ,822 79,118 Total Operating Revenue 1,701,219 1,971,445 1,931, , ,371 Total Operating Expenses 1,515,456 1,722,693 1,884, , ,389 Gain from Operations 185, ,752 47,808 33,728 52,982 Other (1) 460 (1,803) (41,252) (31,847) 5,981 NYUSM Mission Support (45,000) (27,750) (35,735) (35,735) (22,500) Excess (deficiency) of Revenue Over Expenses 141,223 $219,199 $(29,179) $(33,854) $36,463 Other changes in unrestricted net assets (2) 21,551 (94,567) 169,200 10,306 8,995 Net increase (decrease) in unrestricted net assets $162,774 $124,632 $140,021 $(23,548) $45,458 (1) FY 2013 amount consists of ($33.7 million) in impairment on disposal of property, plant and equipment related to Superstorm Sandy and other non-storm related disposals and ($7.6 million) investment return on underlying asset portfolio. (2) Other changes in unrestricted net assets includes valuation changes to pension and postretirement obligations and contributions/net assets released for capital acquisition. (3) Superstorm Sandy occurred on October 29, Inpatient services at Tisch Hospital were closed for 60 days and resumed on December 27, An Urgent Care Center has been operating in absence of a functioning Emergency Department. Thus, results for FY 2013 (inclusive of the three months ended November 30, 2012) include materially reduced operations. 17

18 NYUHC Financial & Volume Metrics Operating Margin (2) EBIDA Margin (2) Cash to Debt (%) (2/3) 12.5% 10.9% 12.6% 6.7% 9.5% 17.8% 15.8% 17.6% 8.4% 12.5% 16.0% % FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 Days Cash on Hand (1/2) Outpatient Visits (2) Discharges (2) , , , ,770 37,408 37,929 38,045 26,676 63,381 72,823 6,540 7,998 FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 FY10 FY11 FY12 FY13 Nov-12 Nov-13 (1) Based on Master Trust Indenture methodology. (2) Superstorm Sandy occurred on October 29, Inpatient services at Tisch Hospital were closed for 60 days and resumed on December 27, An Urgent Care Center has been operating in absence of a functioning Emergency Department. Thus, results for FY 2013 (inclusive of the three months ended November 30, 2012) include materially reduced operations. (3) FY 2013 & November 2013 figures above are inclusive of NYUHC s Series 2013A $350 million taxable bond issuance. 18

19 Conclusion NYUHC is a highly integrated academic medical center with close ties to New York University Tireless Pursuit of Excellence Patient care quality focus Commitment to invest in technology Positioning the Medical Center for the future of healthcare Solid execution of ambulatory care strategy Strong physician recruitment efforts Moving forward on campus transformation plan Updated infrastructure with storm mitigation Maintaining strategic agility to execute plan Balance sheet reserves provide operating flexibility Issuance of fixed rate bonds and utilization of lines of credit for quick access to fund capital plans Philanthropy continued support by NYC community for combined medical center enterprise 19

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