AFRAMEWORKANALYSISOFTHEFUNDINGGAPFACING

UFHEALTHJACKSONVILLEANDTHEJACKSONVILLECOMMUNITY

CONFIDENTIAL
January 2015

Objectives
Interviewashortlistofrelatedstakeholders
Mapthecurrentlocalissueagainstourknowledgeof
similarissuesaroundthecountry
Performcertainreimbursementanalysesindevelopment
ofourviewoftheperceivedfundinggap
Facilitateameetingwherewewouldreadoutourfinal
perspectivestotheCouncil

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ProcessDeployed
Interviewedapproximately15individualsincludingleadersfrom
UFHealthJacksonvilleaswellastheCivicCouncilandtheTask
Force
Completedthreedistinctbenchmarking/financialanalytics
exercises
CompletedselectreimbursementanalysescomparingUFHealth
Jacksonvilletoothersimilarinstitutions
ComparedoutcomesofFoundationeffortstoothercomparative
organizations
ConvenedcertaininternalDHGHealthcareleaderstodiscuss
situationalcomparativeswithotherinstitutionssimilartoUF
HealthJacksonville
Note:UFHealthJacksonvillebasedprogramswhererevenuesflow
elsewhere(Gainesvilleforexample)notassessedindetail
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AFRAMEWORKANALYSISOFTHEFUNDINGGAPFACING
UFHEALTHJACKSONVILLEANDTHEJACKSONVILLECOMMUNITY
EXECUTIVESUMMARY

CONFIDENTIAL

ExecutiveSummary InterviewThemes
Fundinggapgenerallybelievedtobearevenueissue,notanexpenseissue:
expectedtogetworse
UFHealthJacksonvillessurvivalisamust criticalcareneedforcommunity;
MedicalSchoolcouldntbesupportedbyotherproviders
6th largestemployer includinghigherpayingjobs
Taxingoptionnotlikelytobewidelysupported
Newfacilityviewedbothasopportunityandrisk howcanitwork?
Significantknowledgeandunderstandinggapwithcommunity
UFHealthJacksonvillesituationnotunlikewhatothertertiarycarefacilities
face
Requirescomprehensiveandconsistentnewmessaging
Businesscommunityinvolvementisamust philanthropicleadership?

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ExecutiveSummary Benchmarking
WebenchmarkedUFHealthJacksonvilleagainstthe
followinginstitutions:
BrowardHealthMedicalCenter
ErlangerMedicalCenter
GradyMemorialHospital
JacksonHospital Miami

16differentcomponentswerecompared,inthree
distinctareas:RevenuesandExpenses,BalanceSheet
andServiceMakeup
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ExecutiveSummary Benchmarking
UFHealthJacksonvilletoCompareGroup

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ExecutiveSummary Reimbursement
MedicaidLIPpaymentsanticipatedtoendin2015
CMSwantsstateMedicaidprogramstoprovideupfrontcoverageviaMedicaid
expansion
AtthispointFloridahasdecidednottoexpandMedicaid
Jacksonvillecommunityleadershipperceivesthereisa$40millionsafetynetfunding
gap
UFHealthJacksonvilleisinthetop5forTotalMedicaidCostsinthestate(seenext
slides)
UFHealthJacksonvilleisinthetop5for%ofMedicaidfundingpaymentstoTotal
Medicaidcosts
UFHealthJacksonvilleisnotinthetop10for%ofIGTstoTotalMedicaidcosts
ShouldDuvalincreasetaxestocoverfundinggap?

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ExecutiveSummary Reimbursement
Top10hospitals%MedicaiddistributionstototalMedicaidcosts

ProviderName
BAYMEDICALCENTER
UNIVERSITYOFMIAMIHOSPITAL&CLINICS
UFHEALTHJACKSONVILLE
MT.SINAIMEDICALCENTER
H.LEEMOFFITCANCERCENTER
JACKSONMEMORIALHOSPITAL
MEMORIALHOSPITALMIRAMAR
TAMPAGENERALHOSPITAL
ALLCHILDREN'SHOSPITAL
LEEMEMORIALHOSPITAL

NetMedicaid
Payments
12,825,220
10,079,550
103,213,344
19,541,999
20,301,535
270,514,847
11,777,748
90,854,205
55,947,148
38,275,813

%Mcd
Total
Pymts/Total
MedicaidCosts McdCosts
33,337,243
26,850,590
294,520,779
56,689,624
61,267,669
882,483,751
39,669,645
309,153,661
204,004,358
141,131,472

Themedian%MedicaidPaymentstoTotalMedicaidCostsis14%

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38%
38%
35%
34%
33%
31%
30%
29%
27%
27%

ExecutiveSummary Reimbursement
Top10hospitals%IGTs(Taxes)toTotalMedicaidCosts

ProviderName
BROWARDHEALTHIMPERIALPOINTHOSPITAL
BROWARDHEALTHBROWARDGENERALMEDICALCENT
JACKSONMEMORIALHOSPITAL
MEMORIALREGIONALHOSPITAL
CITRUSMEMORIALHEALTHSYSTEM
INDIANRIVERMEDICALCENTER
BROWARDHEALTHNORTHBROWARDMEDICALCENTER
SARASOTAMEMORIALHOSPITAL
MEMORIALHOSPITALMIRAMAR
BROWARDHEALTHCORALSPRINGSMEDICALCENTER

UFHEALTHJACKSONVILLE

TotalAllIGTs
32,529,319
124,396,457
407,806,637
113,996,106
8,561,920
11,760,436
23,859,981
26,460,414
10,146,635
17,085,447

%
Total
IGTs/Total
MedicaidCosts McdCosts
36,757,048
258,807,329
882,483,751
319,534,597
26,282,968
43,153,063
87,833,588
100,689,346
39,669,645
67,974,632

88%
48%
46%
36%
33%
27%
27%
26%
26%
25%

29,923,988 294,520,779

10%

Themedian%IGTs(Taxes)toTotalMedicaidCostsis7%

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ExecutiveSummary Reimbursement
StateMedicaidFundingExamples:
Florida
Hospitalsdividedintocounty/taxingdistrictsforMedicaidfunding
ProviderAssessmentTax=basedonlegislationandamountspercounty/taxingdistrict
Fedsmatch=59%(FMAP)
Medicaidpaymentcomponents:
InpatientpaidonDRG
Outpatientperdiem
MedicaidDSH
LowerIncomePayments(LIP)
RateEnhancements(IPandOP)
Georgia
Hospitalsdividedinto2categoriesforMedicaidDSHfunding
ProviderAssessmentTax=1%ofhospitalsnetpatientrevenue
Fedsmatch=66%(FMAP)
Medicaidpaymentcomponents:
InpatientpaidonDRG
Outpatientpaidoncost
MedicaidDSH

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ExecutiveSummary Reimbursement
StateMedicaidFundingExamples(contd):
Alabama
Hospitalsdividedinto3categoriesforMedicaidfunding(state,privateandpublic)
State/Public InternalGovernmentalTransfer(IGT)=paymenttransferof31.8%ofMedicaidclaims
Private ProviderAssessmentTax=5.5%ofhospitalsnetpatientrevenue
Fedsmatch=68%(FMAP)
Medicaidpaymentcomponents:
Inpatientpaidonperdiem
Outpatientpaidonperencounter
Accesspayments
MedicaidDSH
AlabamaMedicaidiscurrentlyworkingtorevampthecurrentpaymentmethodologyandconvertto
APRDRGbyOctober2015
BeginninginOctober2016,thestatewillbedividedinto5regionsthatwillberesponsiblefor
coordinatingthehealthcareofMedicaidpatientsineachregion. Communitylednetworkswillbe
developedthatultimatelybeartheriskofcontractingwiththestateofAlabamatoprovidecareto
thesepatients.

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ExecutiveSummary Reimbursement
NorthCarolina
Hospitalsdividedinto5categoriesforMedicaidfunding(NonPublicCAH,NonPublic,Public,Public
CAH,andUNCHospitals)
CertifiedPublicExpendituresbasedonprojectedDSHlimit
Fedsmatch=66%(FMAP)
Medicaidpaymentcomponents:
InpatientpaidonDRG
Outpatientpaidoncost
MedicaidDSH
SupplementalPayments
MRI/Gap

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ExecutiveSummary FoundationComponent
Fundraisingnotoutoflinewithcomparegroup
Perhapssomeopportunityforspecialeventfundraising
Additionalresearchrequiredinthisareatodeterminehowbesttorefine
approach
THINKBIG Philanthropy

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ExecutiveSummary FundingGapChallenge
ItdoesnotappeartheStateisgoingtohelpwiththeMedicaidfundinggap.
HealthyFloridaWorks(HFW)isabusinesscoalitionfightingfortheuninsuredFlorida
population.Theprogramisdesignedtoincreaseaccesstohighquality,affordable
healthcarewhilepromotingpersonalaccountability. HFWshouldbeconsideredasa
possibleoptiontohelpdriveaccesstoanewpaymentstreamforhistorically
categorizedindigentpatients.
ItisimperativetheStateunderstandswhatproviderslikeUFHealthJacksonvilleare
goingtohavetodotosurviveinthefuture.
AHCAhashiredaconsultanttolookattheStatefundingissues.
Localstakeholders/leadersmustengageinreenergizedphilanthropicefforts.
UFHealthJacksonvilleneedstocompleteaserviceportfolioanalysisinthecontextof
possiblefuturestatebrandingofdistinctserviceofferings.
Newfacilitywillrequiredeliberate brandpositioning.

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