Comparative Analysis Jackson Hospital (FL House Bill 711) Patrick J. Simers, Principle Valuation

Transcription

1 Comparative Analysis Jackson (FL House Bill 711) Patrick J. Simers, Principle Valuation

2 Engagement Primary focus was to consider an objective operating comparison between Jackson and other similarly situated hospitals as required under House Bill 711 Analysis constructed from various public sources of information including Agency for Health Care Administration (AHCA) and s for Medicare & Medicaid Services (CMS) Comparison considered both operational indicators and quality of care measures Peer groups comprise 9 hospitals for operational measures and 10 hospitals for quality of care measures

3 Comparative Analysis Operating Measures Operating measures were derived from the report Florida s: 2011 Financial Data produced by the Florida Association ( FHA ). This report contains financial and utilization data for all licensed hospitals in Florida for fiscal year 2011 The report was compiled from financial reports submitted by hospitals to the Agency for Health Care Administration ( AHCA ) The report categorizes data into four key areas: Financial Payer Mix Utilization Staffing

4 Comparative Analysis Operating Measures (Cont d) The first step in performing the comparative analysis was selecting hospitals or categories to compare Jackson against Our primary criteria was hospitals with a similar service mix and comparable payer mix (with a focus on Medicaid %) We also considered management s input as to who their primary competitors are and included the majority of these facilities in our analysis as well Additional consideration was given to facility size (beds) and demographic population served Two facilities considered for the quality of care measures were not included in the operating comparison due to their location outside of the state of Florida

5 Comparative Analysis Operating Measures (Cont d) Below is a list of the hospitals we selected in our comparative analysis for Jackson : Facility Name Distance from Jackson Hosp. (Mi.) #Licensed Beds FY 2011 Net Operating Revenues ($M) Jackson N/A Northwest Florida Community Doctors Southeast Alabama Medical * Flowers * Bay Medical Healthmark Regional Medical Sacred Heart on the Emerald Coast Doctors, Inc Shands Lake Shore Regional Medical DeSoto, Inc Lk Lakeside Mdi Medical l (*) Only considered in Quality of Care Measures due to location outside of FL

6 Jackson Profile Below are some key statistics and general information regarding Jackson to be considered throughout our comparative analysis: Licensed Beds 100 (66 Operating) Employed Physicians 15 (87 total physicians with privileges) FY2011 Net Operating Revenues e - $43,927,798, 98 Staff 410 full-time employees; 35 part-time employees Specialties Served: General Medicine, Cardiology, General Surgery, Hematology/Medical Oncology, Obstetrics/Gynecology, Orthopedics, Pediatrics, Urology, Emergency Medicine, Chemical dependency stabilization, Wellness Service area is 83% rural, compared to 11% state average Population served has median income of $38,000 versus state average of $48,000 (over 20% of population p is Medicaid eligible) Over 17% of patients treated are Medicaid recipients, approx. one-third higher than state average

7 Operating Measure Comparisons The following slides are visual representations (charts) of our comparative analysis The charts have been grouped into three primary categories; financial, utilization, and staffing The operating measures were derived from the Florida s: 2011 Financial Data produced by the Florida Association ( FHA ) and as such only include hospitals located within the state of Florida We included a peer average line so that one could easily see where each facility measured against the peer average We also included an annualized estimate of wherejackson p would fall based on its YTD FY 2013 results

8 Operating Measure Comparison (Financial) $2, $1, $1, Net Revenue Per Adjusted Patient Day (Case Mix Adjusted) Peer Average FY '13 Jackson Run Rate $1, $1, $1, $1, $1, $1, $1, $1, $1, $1, $ $ $ $ $ $ $ $ $ $0.00 Sacred Heart Lakeside on the Medical Emerald Coast DeSoto, Inc Doctors Shands Lake Shore Regional Medical Northwest Florida Community Doctors', Inc. Healthmark Regional Medical Jackson Bay Medical

9 Operating Measure Comparison (Financial) $2, Cost Per Adjusted Patient Day (Case Mix Adjusted) Peer Average FY '13 Jackson Run Rate $2, $2, $1, $1, $1, $1, $1, $1, $1, $ $ $ $1, $1, $ $ $0.00 Jackson Bay Medical Healthmark Regional Medical Northwest Florida Community Doctors', Inc. Doctors Shands Lake Shore Regional Medical Sacred Heart on the Emerald Coast DeSoto Lakeside Medical, Inc

10 Operating Measure Comparison (Financial) $ Net Income Per Adjusted Patient Day (Case Mix Adjusted) Peer Average FY '13 Jackson Run Rate $ $ $ $ $ $74.25 $91.75 $ $19.32 $0.00 $50 00 Sacred Heart on the Emerald Coast Northwest Florida Community $50.00 Healthmark Regional Medical Bay Medical $4.78 Jackson $18.35 Doctors', Inc. $20.13 DeSoto, Inc Doctors Lakeside Medical Shands Lake Shore Regional Medical $6.49 $ $63.30 $79.34 $ $ $150.00

11 Operating Measure Comparison (Financial) 15.00% Return on Assets Peer Average 12.50% 11.48% 10.00% 9.40% 7.50% 5.00% 2.50% 1.76% 0.00% 2.50% 5.00% Sacred Heart on the Emerald Coast Northwest Florida Community Healthmark Regional Medical Bay Medical 0.44% Jackson Lakeside Medical 2.25% 3.19% Doctors 3.41% DeSoto, Inc 3.89% Doctors', Inc. 4.83% 483% Shands Lake Shore Regional Medical 0.52% 7.50% 10.00% 9.84% 12.50%

12 Operating Measure Comparison (Financial) 12.5% 10.0% 7.5% 50% 5.0% 11.5% 5.3% Operating Margin Peer Average FY '13 Jackson Run Rate 9.4% 2.5% 0.0% 2.5% 5.0% 7.5% 10.0% Sacred Heart on the Emerald Coast Northwest Florida Community Healthmark Regional Medical 1.7% 17% 3.5% 35% Jackson Doctors 4.6% Bay Medical 5.7% Doctors', Inc. 6.6% DeSoto Shands Lake Shore Lakeside Medical, Inc Regional Medical 6.7% 12.5% 15.0% 17.5% 20.0% 22.5% 25.0% 27.5% 14.2% 17.0% 30.0% 32.5% 30.7%

13 Operating Measure Comparison (Financial) $250.0 Uncompensated Care Per Adjusted Patient Day Peer Average $200.0 $197.2 $197.5 $173.7 $158.9 $150.0 $111.6 $114.4 $118.3 $134.8 $100.0 $79.6 $98.2 $99.0 $50.0 $0.0 Lakeside Medical Jackson Northwest Florida Community Shands Lake Shore Regional Medical Healthmark Doctors Regional Medical Sacred Heart on the Emerald Coast DeSoto Bay Medical Doctors', Inc, Inc. (1) Includes both bad debt and charity care write-offs

14 Operating Measure Comparison (Utilization) Average Length of Stay (Case Mix Adjusted) Peer Average Sacred Heart on the Emerald Coast Doctors', Inc. Bay Medical DeSoto, Inc Lakeside Medical Jackson Healthmark Regional Medical Shands Lake Shore Regional Medical Doctors Northwest Florida Community

15 Operating Measure Comparison (Utilization) 70.0% 66.6% 63.4% 62.7% 61.8% Occupancy Rate Peer Average 60.0% 59.7% 50.0% 49.4% 49.2% 40.0% 43.0% 40.2% 30.0% 24.5% 20.0% 20.7% 10.0% 0.0% Northwest Florida Community Bay Medical Doctors Sacred Heart on the Emerald Coast Jackson Shands Lake Shore Regional Medical DeSoto Lakeside Medical Healthmark, Inc Regional Medical Doctors', Inc. (2) Total Inpatient Days / Available Bed Days

16 Operating Measure Comparison (Utilization) 200.0% Adjusted Occupancy Rate 185.9% Peer Average 180.0% 160.0% 140.0% 120.0% 100.0% 151.0% 144.7% 128.3% 111.3% 102.4% 93.5% 93.1% 114.1% 80.0% 0% 74.5% 60.0% 56.5% 40.0% 20.0% 0.0% Jackson Sacred Heart Doctors Bay Medical DeSoto Doctors' Northwest Florida Shands Lake Lakeside Medical Healthmark on the, Inc Community Shore Regional Regional Medical Emerald Coast, Inc. Medical

17 Operating Measure Comparison (Staffing) Manhours Per Adjusted Patient Day Peer Average Northwest Florida Jackson Shands Lake Shore Bay Medical Doctors Sacred Heart Healthmark Community Regional Medical on the Emerald ldcoast Regional Medical DeSoto, Inc Doctors', Inc. Lakeside Medical

18 Operating Measure Comparison (Staffing) FTE Per Adjusted Occupied Bed Peer Average Northwest Florida Community Jackson Shands Lake Shore Regional Medical Bay Medical Doctors Sacred Heart on the Emerald Coast Healthmark Regional Medical DeSoto, Inc Doctors', Inc. Lakeside Medical

19 Operating Measure Comparison (Financial) 35.0% 30.0% 25.0% Medicaid As % of Revenues Peer Average State Average 30.2% 27.0% 26.2% 24.0% 24.7% 22.8% 21.9% 21.7% 20.0% 15.0% 13.8% 15.0% 11.0% 10.0% 7.9% 5.0% 0.0% Healthmark Regional Medical Bay Medical Sacred Heart on the Emerald Coast Shands Lake Shore Regional Medical DeSoto, Inc Doctors', Inc. Jackson Northwest Florida Community Doctors Lakeside Medical

20 Operating Measure Comparison (Summary) Criteria Jackson Rank Compared to (Out of 10) Peer Average (Financial Impact) Net Rev. PAPD 9 th Negative Cost PAPD 1 st Positive Net Inc. PAPD 5 th Negative Return on Assets 5 th Negative Operating Margin 4 th Positive Uncomp. Care PAPD 2 nd Positive ALOS 6 th Negative Occ. Rate 5 th Positive Adj. Occ. Rate 1 st Positive Manhours PAPD 2 nd Positive FTE Per Adj. Occ. Bed 2 nd Positive Medicaid % 7 th Negative

21 Comparative Analysis Quality of Care Measures Quality of Care Measures were taken from the Compare section on data.medicare.gov and specifically the hospital process of care measures These reports are compiled by the s for Medicare & Medicaid Services and focus on the use (expressed as a percentage) of evidence-based clinical processes that are shown to improve care for certain conditions A 95% score means a hospital provided an evidence-based practice 95 times out of 100 opportunities to provide said practice The reports categorize scores in five key treatment areas: Heart Attack Heart Failure Pneumonia Preventive Care Surgical Care

22 Comparative Analysis Quality of Care Measures Additional Quality of Care Measures considered were Outcome of Care Measures & Acquired Condition Measures. Under the Outcome of Care Measures we looked at mortality and readmission rates for heart attack, heart failure, and pneumonia and compiled those into aggregate scores. Under the Acquired Condition Measures there were eight measures that we compiled into an aggregate score. We considered all of the same facilities in the operating measure comparison, as well as two other facilities not located in Florida, but considered by management to be competitors (Southeast Alabama Medical & Flowers ) Several facilities are not included on the following charts due to insufficient data reported (ISD)

23 Quality of Care Measures Comparison Heart Attack or Chest Pain Aggregate Quality of Care Score % 99.50% % % 99.67% National Average Peer Average 99.00% 98.50% 99.00% 98.76% 98.00% 97.50% 98.00% 97.67% 97.00% 97.00% 97.00% 96.50% 96.00% 95.50% Jackson Capital Regional M.C. Gulf Coast M.C. Flowers Bay Medical Tallahassee Healthcare Southeast Alabama M.C.

24 Quality of Care Measures Comparison Heart Failure Aggregate Quality of Care Score National Average 97.00% 96.00% 96.00% 95.00% 95.00% 94.00% 93.00% 92.00% 91.33% 91.00% 90.00% 89.00% SoutheastAlabama M.C. Jackson

25 Quality of Care Measures Comparison % 98.00% 96.00% 94.00% 99.91% Surgical Care Improvement Project Aggregate Quality of Care Score National Average Peer Average 99.27% 97.91% 95.73% 95.50% 95.27% 97.09% 94.54% 92.00% 90.00% 90.73% 88.00% 86.00% 84.00% 82.00% 82.00% 80.00% Flowers Capital Regional M.C. Tallahassee Healthcare Bay Medical Jackson Southeast Alabama M.C. Gulf Coast M.C. Doctor's, Inc.

26 Quality of Care Measures Comparison % 99.50% Preventive Care Aggregate Quality of Care Score National Average Peer Average 97.50% 95.00% 94.00% 93.50% 90.00% 00% 90.00% 87.50% 90.69% 85.00% 83.00% 87.00% 80.00% 80.50% 75.00% 70.00% Flowers Bay Medical Tallahassee Healthcare Gulf Coast M.C.Capital Regional Southeast M.C. Alabama Doctor's M.C., Jackson Inc.

27 Quality of Care Measures Comparison Pneumonia Aggregate Quality of Care Score National Average Peer Average % 99.50% 99.50% 99.50% 98.00% 96.00% 94.00% 94.50% 93.50% 93.00% 92.50% 96.00% 95.44% 92.00% 91.50% 90.00% 88.00% 86.00% Flowers Gulf Coast M.C. Capital Regional M.C. Tallahassee Healthcare Jackson Bay Medical Southeast Alabama M.C. Doctor's, Inc.

28 Outcome of Care Measures Comparison Day Mortality Rates (Aggregate g of Heart Attack/Heart Failure/Pneumonia) Lower is Better National Average Peer Average BAY MEDICAL CENTER SACRED HEART HEALTH SYSTEM JACKSON HOSPITAL CAMPBELLTON GRACEVILLE HOSPITAL SOUTHEAST ALABAMA MEDICAL CENTER TALLAHASSEE MEMORIAL HEALTHCARE FLOWERS HOSPITAL GULF COAST MEDICAL CENTER NORTHWEST FLORIDA COMMUNITY HOSPITAL DOCTOR'S MEMORIAL HOSPITAL INC CAPITAL REGIONAL MEDICAL CENTER DOCTORS MEMORIAL HOSPITAL

29 Outcome of Care Measures Comparison Day Readmission Rates (Aggregate of Heart Attack/Heart Failure/Pneumonia) Lower is Better National Average Peer Average CAPITAL REGIONAL MEDICAL CENTER DOCTOR'S MEMORIAL HOSPITAL INC CAMPBELLTON GRACEVILLE HOSPITAL DOCTORS MEMORIAL HOSPITAL JACKSON HOSPITAL NORTHWEST FLORIDA COMMUNITY HOSPITAL FLOWERS HOSPITAL GULF COAST MEDICAL CENTER SOUTHEAST ALABAMA MEDICAL CENTER BAY MEDICAL CENTER SACRED HEART HEALTH SYSTEM CNTR HOSPITA CNTR SYST M TALLAHASSEE MEMORIAL HEALTHCARE (8) For period Apr 12 Sep 12 Jackson 30-Day all cause readmission rate was 17.8% (FL Avg. was 19.3%) per FMQAI and FHA

30 Acquired Condition Measure % % Acquired Condition Aggregate Score (Lower is Better) National Average Peer Average % % % % % 0300% % % % % % % % % % % % % DOCTOR'S MEMORIAL HOSPITAL INC JACKSON HOSPITAL BAY MEDICAL CENTER SACRED HEART HEALTH SYSTEM CAPITAL REGIONAL MEDICAL CENTER GULF COAST MEDICAL CENTER TALLAHASSEE MEMORIAL HEALTHCARE SOUTHEAST ALABAMA MEDICAL CENTER FLOWERS HOSPITAL

31 Quality of Care Comparison (Summary) Category Jackson Rank Compared to National Avg. Compared to Peer Average Heart Attack 2 of 7 Superior Superior Heart Failure 2 of 2 Inferior ISD Surgical Care 5 of 8 Inferior Superior Preventive Care 8 of 8 Inferior Inferior Pneumonia 5 of 8 Inferior Inferior Hosp. Acquired Condition 2 of 8 Superior Superior Mortality Rates Rt 2 of 11 Superior Superior Readmission Rates 7 of 11 In Line In Line

32 END OF PRESENTATION

33 ADDENDA Comparison Profiles Bay Medical This facility is located in Panama City, Florida, in Bay County. The hospital is licensed for 323 beds and generally services an urban population. The facility has an overall occupancy rate of 63.4% and Medicaid as a percentage of revenues at 13.8%. According to its website some primary services it offers includes ambulance/ems, infusion therapy, blood donor center, interventional radiology, cancer center, pediatrics, diabetes services, pharmacy, diagnostic services, rehabilitation, emergency medicine, stroke care, family birthing center, sleep lab, healthplex fitness, surgical services, heart & vascular institute, women s services, hyperbaric medicine, and wound healing. Campbellton-Graceville This facility is located in Graceville, Florida, in Jackson County. The hospital is licensed for 25 beds and generally services a rural population. The facility has an overall occupancy rate of 34.7% and Medicaid as a percentage of revenues at 4.04%. According to its website some primary services it offers includes coordinated services with local hospice providers, dietary planning, emergency services, hospice care (dedicated rooms), outpatient physical therapy services, pharmacy services for inpatient care, swing bed social activities, laboratory services, radiology and CT, respiratory services and ultrasound services, swing bed podiatry care and swing bed dental care.

34 ADDENDA Comparison Profiles DeSoto, Inc This facility is located in Arcadia, Florida, in Desoto. The hospital is licensed for 49 beds and generally services a rural population. The facility has an overall occupancy rate of 43.0% and Medicaid as a percentage of revenues at 22.8%. According to its website some primary services it offers includes emergency medicine, maternity care, general surgery, cardiopulmonary services, family health, diagnostic imaging, infusion therapy, physical therapy, nutritional services, laboratory, and home health services. Doctors This facility is located in Bonifay, Florida, in Holmes County. The hospital is licensed for 20 beds and generally services a rural population. The facility has an overall occupancy rate of 62.7% and Medicaid as a percentage of revenues at 27.0%. According to its website some primary services it offers includes emergency medicine, cardiopulmonary, clinical laboratory, physical therapy, radiology, general surgery, and swing bed rehabilitation.

35 ADDENDA Comparison Profiles Doctors', Inc. This facility is located in Perry, Florida in Taylor County. The hospital is licensed for 48 beds and generally services a rural population. The facility has an overall occupancy rate of 20.7% and Medicaid as a percentage of revenues at 24.0%. According to its website some primary services it offers includes cardiopulmonary, clinical, emergency medicine, home healthcare, imaging, laboratory, nursing, surgical, and physical therapy. They offer these services at their main campus and four auxiliary locations. Flowers This facility is located in Dothan, Alabama, in Houston County. The hospital is licensed for 235 beds and generally services an urban population. According to its website some primary services it offers includes allergy/immunology services, anesthesiology, bariatric surgery, cardiology, cardiovascular surgery, dermatology, ear, nose & throat, family practice, gastroenterology, general surgery, hospitalist, infectious disease, internalmedicine, nephrology, neurology/pediatric neurology, neurosurgery, obstetrics/gynecology, oncology/radiation, oncology, ophthalmology, oral/maxillofacial surgery, orthopedics/total joint surgery, otolaryngology, pathology, pediatrics, reconstructive & cosmetic surgery, rehabilitation, robotics surgery, psychiatry, pulmonary medicine, radiology, rheumatology, spine surgery, urologic surgery, urology, vascular specialists, and vascular surgery.

36 ADDENDA Comparison Profiles Healthmark Regional Medical This facility is located in Defuniak Springs, Florida in Walton County. The hospital is licensed for 50 beds and generally services a rural population. The facility has an overall occupancy rate of 24.5% and Medicaid as a percentage of revenues at 11.0%. According to its website some primary services it offers includes anesthesia, burns, cardiology, cardiovascular surgery, colon & rectal surgery, emergency medicine, endocrinology, gastroenterology, general surgery, gynecology, hematology, hyperbaric medicine, internal medicine, nephrology, neurology, neurosurgery, obstetrics, ophthalmology, oral/maxillo-facial surgery, orthopedics, otolaryngology, plastic surgery, podiatry, psychiatry, pulmonary medicine, radiology, thoracic surgery, urology, and vascular surgery. Lakeside Medical This facility is located in Belle Glade, Florida, in Palm Beach County. The hospital is licensed for 70 beds and generally services a rural population. The facility has an overall occupancy rate of 40.2% and Medicaid as a percentage of revenues at 30.2%. According to its website some primary services it offers includes critical care, emergency care, family medicine services, radiology, respiratory therapy, wound care, social services, outpatient services, and general surgery.

37 ADDENDA Comparison Profiles Northwest Florida Community ThisfacilityislocatedinChipley,Florida,in Washington County. The hospital is licensed for 59 beds and generally services a rural population. The facility has an overall occupancy rate of 66.6% and Medicaid as a percentage of revenues at 26.2%. According to its website some primary services it offers includes emergency medicine, general surgery, radiology/imaging, rehab services, long term care, would healing, lab services, sleep disorder and respiratory services. They offer these services at their main campus and one auxiliary location. Sacred Heart on the Emerald Coast This facility is located in Miramar Beach, Florida, in Walton County. The hospital is licensed for 58 beds and generally services a rural population. The facility has an overall occupancy rate of 61.8% and Medicaid as a percentage of revenues at 15.0%. According to its website some primary services it offers includes Acute care, general and specialized surgery, cardiac diagnostics, joint replacement program, cancer care, comprehensive radiology and laboratory services, rehabilitation, as well as 24-hour emergency care.

38 ADDENDA Comparison Profiles Shands Lake Shore Regional Medical This facility is located in Lake City, Florida, in Columbia County. The hospital is licensed for 99 beds and generally services an urban population. The facility has an overall occupancy rate of 49.4% and Medicaid as a percentage of revenues at 21.9%. According to its website some primary services it offers includes critical care, gastroenterology, emergency medicine, endocrinology, geriatric medicine, heart care, imaging and radiology, laboratory services, nephrology, neurological care, orthopedic center, pediatrics, rehabilitation services, respiratory care, and general surgery and robotic surgery. They offer these services at their main campus and four auxiliary locations. Southeast Alabama Medical This facility is located in Dothan, Alabama, in Houston County. The hospital is licensed for 408 beds and generally services an urban population. According to its website some primary services it offers includes a cancer center, heart & vascular care program, women's services, neurospine center, medical services, rehabilitation services, pain management center, surgery, diagnostic imaging, g, orthopedic services, a wound care center, family services, behavioral health services and neurology associates.

39 ADDENDA Comparison Profiles Tallahassee This facility is located in Tallahassee, Florida, in Leon County. The hospital is licensed for 772 beds and generally services an urban population. The facility has an overall occupancy rate of 46.1% and Medicaid as a percentage of revenues at (-2.88%). According to its website some primary services it offers includes anesthesia, burns, cardiology, cardiovascular surgery, colon & rectal surgery, emergency medicine, endocrinology, gastroenterology, general surgery, gynecology, hematology, internal medicine, nephrology, neurology, neurosurgery, obstetrics, ophthalmology, oral/maxillo-facial surgery, orthopedics, otolaryngology, plastic surgery, podiatry, psychiatry, y pulmonary medicine, radiology, thoracic surgery, urology, and vascular surgery.