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HomeMy WebLinkAboutMINUTES - 12101985 - FC.1 T BOARD OF SUPERVISORS FROM: Finance Committee Contra CWLQ DATE: December 9, 1985 County SUBJECT: Follow-up to Health Services Department First Quarter Budget Report SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDATION 1. Acknowledge receipt of this report on the Health Services Department First Quarter Budget Report and related matters. 2. Clear this item as a referral to our Committee. BACKGROUND During the first quarter of the 1985-1986 fiscal year, the Health Services Department experienced an overall $127,644 loss. This loss was generally the result of a declining census in hospital inpatients, a declining enrollment in the Health Plan, and a declining volume in the Home Health Agency. The Health Services Director has indicated it is most likely that the department will require additional County subsidy for the 1985-1986 year. For the first quarter of the year deficits occurred in several of the department' s divisions but the major deficit occurred in Enterprise Fund I , Hospital Care. Expenditure savings of $367, 116 realized in this budget unit were more than offset by a revenue shortfall of $524,991 in all major revenue categories, i.e. , Medicare, Medi-Cal, and private insurance and resulting in a net deficit of $157 ,883 . Enterprise Fund II, the Health Plan, realized expenditure savings of $17,198, a revenue shortfall of $64,075 resulting in a program deficit of $46,877 for the first quarter. The revenue shortfall is a result of a drop in Medi-Cal enrollees. First quarter deficits were also realized in the Home Health Agency and the detention facility. Expenditure savings were realized in the divisions of Alcohol/Drug Abuse/Mental Health, Environmental Health, and California Children' s Services. Overall the department realized a first ,quarter deficit of $127 ,644 . At the November 4, 1985 Finance Committee meeting, the Health Services Department was requested to provide further information on several items including accounts receivable, administrative days, cost per patient by pay or classification, and hospital transfers. This additional information CONTINUED ON ATTACHMENT: i YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATI N OARD COMMITTEE _ APPROVE OTHER SIGNATURE(S): Supervisor S. W. McPeak s I. Schroder ACTION OF BOARD ON December 10.,. .1 985 APPR ED 'AS RECOMMENDED X— OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. cc: County Administrator ATTESTED December l 0 r_ 1 985__ Health Services Director PHIL BATCHELOR, CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR M382/7-83 By DEPUTY 2. was reviewed by the Committee at its meeting of December 2, 1985. With regards to accounts receivable, it was noted that the average age of outstanding accounts has decreased from 231 days in June, 1984 to 149 days in October, 1985. The department' s goal is to reduce the average age of such accounts to 120 days by June, 1986. Administrative days are days during which the hospital patient no longer requires acute care but must remain in the hospital due to the lack of another available placement. The object, of course, is to maintain administrative days to an absolute minimum. For the six month period, May through October, 1985, the total administrative days compared to total days was 13 . 5% for psychiatric patients and 2. 2% for medical patients. Inasmuch as not all hospitals provide psychiatric care, it is not easy to compare the County' s experience with other hospitals. However, with regard to medical patients, the 2. 2% ratio compares favorably with the industry standard. With regard to cost per patient by payor classification, the Health Services Department provided information indicating that the County cost per patient day for inpatient services runs from $26 for a Medicare patient to $467 for a private pay patient. For outpatient services the County cost per visit runs from $23 for a patient covered with health insurance to $113 for a private pay patient. Overall Medicare is the best payor source. The County suffers the greatest loss with private pay patients. This category includes patients having no medical insurance or means to pay for services. The Committee reviewed information on the monthly net cost for the various categories of Contra Costa Health Plan members. The net cost various widely with Medicare being the best payor. The Committee is interested in obtaining additional information on this matter in order to compare the net costs of plan and non-plan patients. Additional information on this matter will be included in the department' s second quarter budget report. In response to a previous request by the Committee, the Health Services Department provided information on the subject of transferring patients between different hospitals. Specific questions addressed were the circumstances under which transfers from other hospitals are made to Merrithew Memorial, who pays for the transfers, and who pays for the County' s costs once a transfer is made. All patient transfers from other facilities are processed through the emergency room. Merrithew experiences an average of 2,000 emergency room visits per month with about 160, or 8%, of these representing patient transfers. The Merrithew Memorial transfer policy, as approved by the Medical Staff, states the following as circumstances under which transfers from other hospitals will be allowable: 1. The patient must be a documented Contra Costa County resident, with the exception of 5150 ' s and 51701s. 2. The patient must require further acute medical care. 3 . The patient must not require care the hospital cannot provide. 4. The patient must not need neuro-surgical care or observation. 5. The patient must be medically stable for the transfer. 6 . The Emergency Room must be notified in advance by the transferring physician. 3 About one-half of the transfers received by Merrithew Memorial represent patients who have no money or insurance, or patients on whom there is no data. The other half of the transfers include jail patients, psychiatric care ( 5150/5170) , medicaltreatment, BAC/CCHP, and patients for whom doctors or beds were not available elsewhere. All transportation arrangements and costs associated with the transfers are the responsibility of the transferring hospital. Once a transfer has been made, Merrithew Memorial assumes responsibility for all subsequent costs including any future transportation costs.