Illinois Safety-Net Hospitals Caring for our state s most vulnerable citizens Illinois 36 safety-net hospitals representing 17.1% of Illinois hospitals 1 are a major source of medical care for low-income, uninsured and vulnerable populations. Illinois safety nets include a mix of both public and private hospitals; and provide essential health services including specialty services to individuals who otherwise would lack access to health care. Our state s safety nets reflect the communities they serve, and are influenced in large part by economic and other characteristics of their local communities. 1 Excludes federal and state psychiatric hospitals Illinois Safety-Net Hospitals Treat a Disproportionate Share of Medicaid Patients Medicaid Inpatient Utilization Rate (MIUR) 2 of at least 5; OR MIUR of at least 4 and a charity percent 3 of at least 4% 23 qualify as safety nets based on state statute (PA 097-0689) Licensed by the Illinois Department of Public Health as a general acute care or pediatric hospital 13 meet the criteria, but were excluded from the statutory» definition because they are: Specialty hospitals (10) Cook County Health and Hospitals System (2) University of Illinois Hospital and Health System (1) 2 Medicaid Inpatient Utilization Rate (MIUR) = Medicaid inpatient days/total inpatient days 3 Charity percent = charity charges/total hospital charges Invest in Health April 2015 Page 1
Care Profile Illinois Safety-Net Hospitals represent 17.1% of all hospitals, but care for 44.1% of all patients hospitalized for a behavioral health condition mental health or substance abuse Top 5 reasons for inpatient treatment Excludes freestanding psychiatric hospitals Safety-Net Hospitals (Non-Psychiatric) 1. Psychoses 13.7% 2. Normal newborn 5.1% 3. Vaginal delivery w/o complications 4.8% 4. Alcohol/drug abuse or dependence w/o rehab w/o complications 4.2% 5. Esophagitis, gastroenteritis & miscellaneous digestive disorders w/o complications 1.9% Source: IHA COMPdata, 2013 (based on MS-DRGs) Non Safety-Net Hospitals (Non-Psychiatric) 1. Normal Newborn 7.3% 2. Vaginal delivery w/o complications 6.1% 3. Psychoses 3.2% 4. Major joint replacement or reattachment lower extremity w/o complications 3.2% 5. Septicemia or severe sepsis w/o mechanical ventilation 96+ hours w/ complications 2.3% Changing Utilization Between 2009 and 2013: Inpatient utilization dropped 19.4% compared to a 7.4% drop for all other hospitals Outpatient services increased by 6.9% compared to a 9.9% increase for all other hospitals Observation care rose 36.7% compared to 25.8% increase for all other hospitals Safety Net Hospitals Other Hospitals Margins More than half 56.3% operate on negative or slim margins 6 5 4 43.8% 37.6% Hospital Operating Margins 43.7% 55.7% 4 36.7% 25.8% 2 6.9% 9.9% 2 12.5% 6.7% - -7.4% -2-19.4% Admissions Outpatient Services Observation Stays Source: IDPH Annual Hospital Questionnaire, 2009 and 2013 Negative 0 1.9% 2% or Higher Safety Net Other Hospitals Source: Medicare Cost Reports, Sept. 2014 release Invest in Health April 2015 Page 2
Payer Mix 4 Only 27.6% of patients in safety-net hospitals are covered by COMMERCIAL PAYERS compared to 42.9%» of patients in all other hospitals. Safety-net hospitals treat more self-pay patients 10.5% vs. 4.9%; have more patients covered by public payers» 53.3% vs. 47.2%; and provide more charity care 8.7% vs. 5. than other hospitals. Patients Served by Payer (Inpatient and Outpatient) Safety-Net Hospitals 53.3% 27.6% 10.5% 8.7% Other Hospitals 47.2% 42.9% 4.9% 5. 0 10 20 30 40 50 60 70 80 90 100 % of Patients Public Payers Commercial Payers Self Pay Charity 4 Payer mix based on number of patients (inpatient and outpatient) served by payer Source: IDPH Annual Hospital Questionnaire, 2013 economic engines $11.6 70,000+ Billion Had a $11.6B total economic impact 5 on their communities and the state Billions ($) $7 $6 $5 $4 $3 $2 $1 $0 $6.0B $3.5B $2.5B Payroll $4.4B $2.5B $1.9B Goods & Services $1.2B $0.7B $0.5B Capital Direct Impact Indirect Impact 6 Responsible for more than 70,000 jobs in their communities and in the state 38,877 Other jobs generated 31,181 Employed FTEs Source: IHA Economic Impact Study, 2014 5 Total economic impact includes direct spending and the ripple effect of that spending within the local economy 6 Indirect impacts are calculated by using a modeling system developed by the U.S. Bureau of Economic Analysis (BEA). BEA multipliers are applied to Medicare cost report data on jobs and spending to obtain the ripple effect of jobs and spending throughout the economy Invest in Health April 2015 Page 3
BEYOND ACUTE CARE Illinois safety-net hospitals: Provided $646.3 Million in Community Benefits (2013) In addition: $173.1 Million in services was provided for which payment was expected, but not received. $91.8 Subsidized Services $401.9 $99.7 Charity Care 7 Government Sponsored Care Shortfall 8 $6.5 Other $8.5 Research $29.3 Education $0.7 Volunteers $4.1 Donations $3.7 Language Assistance Sources: Community benefits reports filed with the IL Attorney General and IHA survey of investor-owned hospitals; and IDPH Annual Hospital Questionnaire (2013) 6 John H. Stroger, Jr. Hospital of Cook County and Provident Hospital of Cook County provide $256.8M in charity care. 7 The shortfall between cost of services provided to Medicare and Medicaid beneficiaries and the payment received. % of safety nets providing Selected Community-Based Services Immunization Programs 34.3% Transportation Services 31.4% Hospice 31.4% Indigent Care Clinic 22.9% Ambulance Services 17.1% Dental Services 11.4% Home Health 11.4% Long-Term Care 11.1% Adult Day Care 5.7% Source: AHA/Health Forum Annual Survey of Hospitals, 2013, IHA Profile Database Invest in Health April 2015 Page 4
TRANSFORMATIONAL INITIATIVES Creating new models of care Illinois safety-net hospitals are creating new models of care 6 of safety nets participate in one or more TRANSFORMATIONAL INITIATIVES Because of the populations they serve, safety net hospitals are: More likely to participate in Coordinated Care Entities 41.7% compared to 4.7% for all other hospitals Less likely to participate in Medicare Shared Savings programs Participation in Transformational Initiatives 45% 4 41.7% 41.9% 35% 30.6% 30.8% 25% % of Hospitals 2 15% 5% 11.1% Safety Net 19.4% 4.7% All Others 16.3% Accountable Care Entities Coordinated Care Entities Medicare Shared Savings Commercial Accountable Care Organizations Source: IHA Member Database Illinois Safety-net Hospitals Adventist GlenOaks Hospital, Glendale Heights Ann & Robert H Lurie Children s Hospital, Chicago Chicago Behavioral Hospital, Des Plaines Chicago Lakeshore Hospital, Chicago Gateway Regional Medical Center, Granite City Hardin County General Hospital, Rosiclare Hartgrove Behavioral Health System, Chicago Holy Cross Hospital, Chicago Jackson Park Hospital & Medical Center, Chicago John H Stroger, Jr Hospital of Cook County, Chicago Kindred Chicago Central Hospital, Chicago Kindred Hospital Chicago Northlake, Northlake La Rabida Children s Hospital, Chicago Lincoln Prairie Behavioral Health Center, Springfield Loretto Hospital, Chicago Mercy Hospital & Medical Center, Chicago Methodist Hospital of Chicago, Chicago Mount Sinai Hospital, Chicago Norwegian American Hospital, Chicago Presence Mercy Medical Center, Aurora Presence Saints Mary & Elizabeth Medical Center/Saint Elizabeth Campus, Chicago Presence Saints Mary & Elizabeth Medical Center/Saint Mary Campus, Chicago Provident Hospital of Cook County, Chicago Riveredge Hospital, Forest Park Roseland Community Hospital, Chicago Saint Anthony Hospital, Chicago Schwab Rehabilitation Hospital, Chicago South Shore Hospital, Chicago St Bernard Hospital & Health Care Center, Chicago St Mary s Hospital, Centralia Streamwood Behavioral Healthcare System, Streamwood Swedish Covenant Hospital, Chicago The Pavilion, Champaign Thorek Memorial Hospital, Chicago Touchette Regional Hospital, Centreville University of Illinois Hospital & Health Sciences System, Chicago IHA Headquarters 1151 East Warrenville Road Naperville, IL 60563 630.276.5400 Springfield Office 700 South Second Street Springfield, IL 62704 217.541.1150 Washington, DC Office 400 North Capitol St. N.W., Suite #585 Washington, DC 20001 202.624.7899 Invest in Health April 2015 Page 5