Lafayette General Health - Healthcare Financial Management

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Lafayette General Health
Leading with purpose Serving with passion
Our Mission
To restore, maintain, and improve health
Our Vision
To build a regional healthcare system that always delivers
excellence in care & outcomes
LafayetteGeneral.com
• Flagship facility, LGMC is the largest, full
service hospital in Acadiana
• Servicing a population of more than 670,000
• 5 hospital system and 6 clinical affiliates
• Leading provider of health care services in
primary service area
• 2nd largest employer in Lafayette Parish
Lafayette, LA
• Low unemployment rate: Lafayette 4.2%; State of
Louisiana 6.3%
• 2012 #1 metro area in job and economic growth,
exceeding 10% growth for the year.
• Lafayette is one of the nation’s fastest growing
cities and was the second city in the U.S. with a
fiber optic network.
• Approximately $6 billion in retail sales last year.
At a Glance
 Net operating revenues of $475 million
 Annual inpatient discharges over 16,000
 Medical staff of over 600
 More than 2,700 FTE’s
 $140 million payroll
Achievements
• Transitioned into a “System” - Lafayette
General Health
• Acquired University Hospital & Clinics
• Launched OR/ED expansion at Lafayette
General Medical Center (LGMC)
• LGMC became a major teaching hospital
• Awarded HIMSS Level 6 Designation
Achievements
• Three LGH Affiliates: Lafayette General
Medical Center, Lafayette General Surgical
Hospital and Opelousas General Health
System recognized among the nation’s
“Most Wired”
• Lafayette General Surgical Hospital achieved
99th Percentile in patient and employee
satisfaction (Press Ganey)
• St. Martin Hospital opened a new outpatient
services area
Achievements
• Affiliations/Partnerships: Franklin Foundation
Hospital, American Legion Hospital-Crowley,
Bunkie General Hospital
• Started the region’s first Surgicalist Program
at LGMC (general surgeon on duty each day)
• Abbeville General – EMR Linkage
LGH/LSU/State Partnership
Effective June 24, 2013
 Lafayette General Health (LGH) assumed responsibilities
through a lease arrangement with LSU for the management and
operation of LSU University Medical Center.
 LGH’s primary goal in this partnership is to keep UHC open and
over time, strengthen and expand all services offered at the UHC
campus.
 This partnership will preserved and expanded GME in Acadiana
from 65 to 85 residents.
 Financing for the transaction including Disproportionate Share
(DSH) reimbursement, Medicaid reimbursement, and
supplemental payments through Upper Payment Limit funding.
 LGMC achieved major teaching hospital status July 1, 2013.
Lafayette General Medical Center
• ED visits = 65,000
• 377 staffed beds, LDR’s, and NICU bassinets
• 24-bed LBHU through CEA with State of
Louisiana
• Cancer Center of Acadiana - largest infusion
center in LA
Our Leadership System
FY 2014 LGMC Organization Goals
People
20%
Service 15%
Quality
20%
DRAFT
Funding
Our Future
35%
Growth
10%
Goals and Metrics
• ↓ Voluntary Turnover
to < 13.28%
(5% improvement
based on year end)
Weight 6%
•↑ Inpatient
Satisfaction to
> 95th percentile
Band: ↓10%, 7.5%, 5%,
FY13 final, > FY13 final
•↑ Outpatient
Satisfaction to
> 85th percentile
• ↓ First Year Turnover
to < 43.64%
(5% improvement
based on year end)
Weight 6%
Band: ↓10%, 7.5%, 5%,
FY13 final, > FY13
final
•↑ Employee
Satisfaction
> 88th percentile
(5% improvement)
Weight 8%
Band: 92,90,88,84,<84
Weight 3%
Band: 99,97,95,90,<90
Weight 3%
Band: 90, 88, 85, 83, <83
•↑ ED Patient
Satisfaction
> 80th percentile
Weight 3%
Band: 85,80,75,70,<70
•↑ Ambulatory Surgery
Satisfaction to
> 60th percentile
Weight 3%
Band: 70, 60, 50, 45, <45
•↑ Physician
Satisfaction to > 70th
percentile
Weight 3%
Band: 80, 75, 70, 66,
<66
• 27/35 Quality
Measures Green
• ↑ Operating Margin to >
9.2%
Weight 5%
Band: 31,29,27,19, <19
• ↓ AR Days to < 55
Weight 15%
• ↑ Net Revenue by
3.0%
Weight 5%
Band:
Weight 5%
•5/8 HCAHPS Domains
≥ Benchmark (90th
percentile)
Weight 5%
Band: 7,6,5,4,<4
• 3/5 Mortality
Measures Green
Weight 5%
Band: 5,4,3,2,1
• 3/6 Readmissions
Measures Green
Weight 5%
Band: 6,5,3-4,2,<2
•Acute ALOS < Expected
ALOS
Weight 5%
Band: 92,96,100,105,>105
• ↓ Labor Expense to <
32.2 % of Hospital Net
Revenue
Weight 5%
• ↓ Chargeable & Nonchargeable Supplies to <
15.1% of Hospital Net
Revenue
Weight 5%
•Successful Submission
of Baldrige Award
Application as
measured by Steps to
Success
Weight 5%
Lafayette Parish Market
Hospital
Licensed
Beds
Lafayette General Medical Center (LGH)
311
University Hospital & Clinics (LGH)
116
Lafayette General Surgical Hospital (LGH)
10
Our Lady of Lourdes Regional Medical Center (FMOL)
186
Heart Hospital of Lafayette (FMOL)
32
The Regional Medical Center of Acadiana (HCA)
142
Women’s & Children’s Hospital (HCA)
110
Lafayette Surgical Specialty Hospital (Phys. Owned)
20
Park Place (Phys. Owned)
9
LGMC Overall Market Share
Primary Service Area
FY 2010
FY 2011
FY 2012
FY 2013
Lafayette General
7,576/ 31.4%
7,823/ 3.2%
8,556/ 36.3%
8,760/38.5%
2.3%
Our Lady of Lourdes
4,648/ 19.3%
4,384/18.6%
4,636 /19.7%
4,679 / 20.6%
0.9%
Regional Medical Center
2,834 /11.8%
2,572/10.9%
2,431 /10.3%
1,995 / 8.8%
-17.9%
581/ 2.4%
594 / 2.5%
459 / 1.9%
392 / 1.7%
-14.6%
Women’s & Children’s
4,211/ 17.5%
3,932/16.7%
3,868 /16.4%
4,103 / 18.0%
6.1%
University Hospitals and Clinics
2,165 / 9.0%
2,029 / 8.6%
1,603 / 6.8%
901 / 4.0%
-43.8%
All Other
2,082/ 8.6%
2,211 / 9.4%
2,039 / 8.6%
1,927 / 8.5%
-5.5%
24,097
23,543
23,592
22,756
-3.5%
Heart Hospital
Market Volume Total
% Vol.
Change
Facility
Secondary Service Area
Facility
FY 2010
FY 2011
FY 2012
FY 2013
% Vol.
Change
Lafayette General
12,689/18.5%
12,991/19.5%
14,380/22.9%
14,892/24.5%
3.6%
Our Lady of Lourdes
7,631/11.1%
7,732/11.6%
8,479/3.5%
8,424/13.9%
-0.6%
4,64/6.8%
4,365/6.5%
4,071/6.5%
3,473/5.7%
-14.7%
Heart Hospital
1,684/2.5%
1,695/2.5%
1,411/2.2%
1,117/1.8%
-20.8%
Women’s & Children’s
8,078/11.8%
7,363/11.0%
7,220/11.5%
7,699/12.7%
6.6%
4,129/6.0%
3,905/5.9%
3,096/4.9%
1,783/2.9%
-42.4%
29,670/43.3%
28,625/42.9%
24,251/38.6%
23,405/38.5%
-3.5%
68,530
66,676
62,907
60,793
-3.4%
Regional Medical Center
University Hospital and Clinics
All Other
Market Volume Total
LGMC Overall Market Share
Physician Mix
 51 specialties and subspecialties
 639 total medical staff; 415 with active privileges
 78% board certified in respective specialties
 Average age of active medical staff: 50.3
Payer Mix FY 2013
Self Pay &
Other
11%
Medicare
47%
Managed Care
30%
Medicaid
12%
Includes: LGMC, UHC, LGSH, SMH
Payer Mix FY 2013
LGMC
Self Pay &
Other
9%
Mgd Care
Medicare
48%
31%
Medicaid
12%
UHC
Medicare
18%
Self Pay/Other
59%
Medicaid
19%
Mgd Care
4%
Strategic Priorities
 Upgrade Physical Plant
 Enhance Quality, Patient Safety & Satisfaction
 Improve Employee Morale & Retention
 Increase Market Penetration
 Financial Viability
Operational Strategies
• OR/ER Project
• Residency Programs
• Foundation Development
• EHR Meaningful Use Stage II
• UHC EMR - Cerner
• LGMC Level II Trauma Development
• Regional Network
• Integrated Cancer Center
• LGMC Baldrige Application Preparation
LGMC Inpatient Satisfaction Results
100
90
80
70
60
50
40
30
20
10
0
86 85 87
63
97 99 96 97 99 99 99 97 99 99 98
67 69
68
54
38
42
1Q09
2Q09
3Q09
4Q09
1Q10
2Q10
3Q10
4Q10
1Q11
2Q11
3Q11
4Q11
1Q12
2Q12
3Q12
4Q12
1Q13
2Q13
3Q13
4Q13
1Q14
Percentile Rank
Since Beginning J2E
Source: Press Ganey Inpatient Satisfaction Report –Large PG Database
LGMC HCAHPS Overall Rating of Care
Recommit
to Internal
Customer
Rounding
Revised
Support Card
100
88
90
77
Percentile Rank
80
96
82
70
60
50
40
30
29
32
20
10
0
Large Press Ganey Data Base
Reported by FYTD
98
97
98
98
98
97
92
92
89
LGMC HCAHPS Summary Report
August 2013- October 2013
Employee Satisfaction
FY09
100
90
80
70
60
50
40
30
20
10
0
FY10
FY12
FY13
87
77
61
65
70
69
49
38
0
0
Participation (%)
FY11
Satisfaction (%tile)
PAST
PAST RENOVATION
FUTURE
LGMC Surgery & Emergency
Department Expansion
• NEW SURGICAL PLATFORM
• 13 Large state of the art OR Suites and support services
• New Sterile Processing Department located above Surgery
• EXPANDED & RENOVATED ED
• 2 New large Trauma Rooms, 2 Critical Rooms and 33 Exam Rooms,
6 Fast Track Bays
• TRAUMA ELEVATOR
• Dedicated large capacity elevator with direct access to the helipad, the ED,
Surgery, all of the patient units and the ICU
• PARKING GARAGE
• 343 Space parking garage which also houses the Central Plant for the
expansion
• FUTURE GROWTH
• Engineered for future expansion above surgery to accommodate additional
6 patient floors with the potential to add 144 patient rooms
LGMC Surgery & Emergency
Department Expansion
• BENEFITS
• This expansion frees up approximately 22,000 sq. ft. of the
existing surgery department for relocation/expansion of other
services
• Trauma Elevator allows for Air Med to get patients to quickest
emergency treatment in the Acadiana Area
• New Surgery platform allows for all 13 OR’s to be fully utilized
by all service lines (as opposed to Ortho/Neuro only having
ability to use 3 current OR’s)
• The new ED footprint will allow for LGMC easily handle in
excess 100,000 visits.
• COMPLETION
• Parking Garage – April 2014
• Expansion New Construction – April 2014
• New Ed space to open – April 2014
• 4th Floor Central Sterile Case Care to open – May 2014
• 2nd Floor new OR to open – June 2014
• ED Renovation - October 2014
Net Patient Revenue Growth
FY 2008 - FY 2013
Growth in Millions
Net
Net = 113%
increase
550
500
450
400
350
300
250
200
150
100
50
0
422
198
213
FY 08
FY 09
248
FY 10
277
FY 11
318
FY 12
FY13
Key Statistics
FY 2008
FY 2009
FY 2010
FY 2011
FY2012
FY2013
Net Patient Revenues
198,484,000
213,287,000
248,901,000
268,699,000
308,343,000
423,247,000
Inpatient Discharges*
13,560
13,906
14,522
14,446
16,058
16,669
Inpatient Days
69,233
73,142
74,929
73,725
75,127
79,964
5.1
5.3
5.1
5.0
4.9
4.8
ER Visits
43,022
48,853
64,025
68,156
74,125
76,581
Physician Clinic Visits
41,573
60,405
86,574
90,226
89,979
131,661
Medicare Case Mix Index
1.68
1.67
1.61
1.60
1.59
1.61
Outpatient Surgeries
6,986
7,202
6,884
6,679
7,436
7,909
Total Surgeries
13,200
13,384
13,143
12,771
13,590
14,289
Average Length of Stay
*excludes nursery
Financial History
LAFAYETTE GENERAL HEALTH
Audit Fiscal Year Ending September 30,
Income Statement ($000)
Operating Revenue
2009
$ 251,998
$ 289,907
189,207
212,659
223,990
256,948
$
Deprecation and Amortization
$
Non-Operating and Other
Net Income
2012
$ 236,302
Interest Expense
Operating Income
2011
$ 205,019
Operating Expenses before Depr., Amortization & Interest
EBIDA Operations
2010
15,811
$
$
28,008
$
32,959
$
364,063
319,930
$
44,133
3,365
3,365
4,724
6,663
7,007
13,443
13,443
14,686
17,487
18,197
(997)
$
1,082
$
23,643
2013
86
6,835
$
5,581
$
12,416
8,597
$
(4,271)
$
4,327
8,809
$
8,983
$
17,792
18,929
6,276
$
25,205
Audit Fiscal Year Ending September 30,
Balance Sheet ($000)
Cash and Cash Equivalents
$
46,119
2010
$
36,356
2011
$
28,987
2012
$
26,233
2013
$
58,860
Patient Accounts Receivable
38,696
41,409
41,226
61,951
60,962
Other Current Assets
12,386
13,295
15,120
16,386
38,349
Unrestricted Long-Term Investment
59,523
64,391
65,281
74,604
81,751
118,679
150,195
188,917
199,655
215,036
9,302
35,251
12,897
14,734
29,418
$ 284,705
$ 340,897
$ 352,428
$ 393,563
Total Current Liabilities
26,588
34,538
38,679
46,980
103,549
Long-Term Debt
86,951
122,510
125,379
140,057
148,584
7,852
8,047
7,604
6,859
6,653
163,315
175,801
180,766
199,667
225,589
$ 284,705
$ 340,897
$ 352,428
$ 393,563
Property and Equipment, net
Other Long-Term Assets
Total Assets
Other Long-Term Liabilities
Net Assets
Total Liabilities and Net Assets
2009
$
$
484,375
484,375
Financial Ratios
Operating Margin
Total Margin
Days Cash on Hand
Cash to Debt
L.T. Debt/Total Assets
Debt Service Coverage
A/R Days
2009 2010 2011 2012 2013
Actual Actual Actual Actual Actual
(0.5)
2.9
3.4
3.0
5.2
1.0
5.1
1.7
5.9
6.8
183
155
138
128
136
110
78
75
72
86
31
36
37
35
30
2.8
7.3
3.7
3.0
4.1
66
61
56
75
52
Strengths
 Leading Tertiary Care Referral Center In Broadening
Service Area
 Regional Relationships
 Strategic Physician Initiatives
 Gravity Model-Physicians Moving to LGMC Campus
 Focus On Technology
 Increased Utilization and Improved Financial
Performance
 Renovation/Expansion Positions LGMC Well for
Goals of Future

Lafayette General Health - Healthcare Financial Management

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