Transcript Slide 1

Garland
Chamber of Commerce
October 27, 2008
A NEW PARKLAND: YOU DECIDE
Commissioner Mike Cantrell
Dallas County, District 2
Parkland Then
1893 - voters approved $40,000 in bonds for a new
hospital
1936 - Dallas City-County Hospital System was
founded
1954 - Voters approved creation of a Dallas County
Hospital District & Parkland was opened on
Harry Hines
1974 - Hospital on Maple and Oaklawn closed
Parkland Today
 $1 billion health system with 8,956 employees
 685-bed hospital, not including 65 neonatal beds
 11 Community-Oriented Primary Care health centers and
school-based clinics
 Mobile health delivery fleet
 Medicaid managed care health plan
 Health service provider for the Dallas County Jails
 Level I trauma center
 Region’s only Burn Center
 Regional resource for disaster preparedness
 10 Centers of Excellence
Parkland’s Mandates
• As the payer of last resort, Parkland is mandated by Federal
law to treat those who are in need, whether indigent, uninsured,
undocumented or legal citizens
• Under the Federal Emergency Medical Treatment and Labor
Act (EMTALA), a hospital with an emergency department
must provide any individual who comes to its emergency
department with an appropriate medical screening to
determine whether or not an emergency condition exists, and if
it does the hospital must stabilize and treat the patient (42
U.S.C. § 1385dd(a) & 42 U.S.C. § 1395dd(b) and (c))
• By law (42 U.S.C. § 1395dd(g)), hospitals with specialized
facilities such as burn units, shock-trauma centers, or neonatal
intensive care units shall not refuse to accept an appropriate
transfer of an individual who requires such specialized
capabilities or facilities if the hospital has the capacity to treat
the individual
Parkland’s Role in Our Community
Proactive Public Health Service
Public Health System
Safety-Net Provider
Academic Medical Center
Regional Provider of Care
Parkland’s Challenges
 Age of current facility
 Functionality and space constraints
 Code compliance issues
 Increase in patient population
1990 – 1,852,810
2006 – 2,345,815
2000 – 2,218,899
2035 – 3,600,000
 Patient mix (indigent (uninsured/underinsured),
undocumented, and out of county)
 Attracting 3rd party payers
Parkland’s Challenges
INDIGENT (Uninsured/Underinsured)
• Uninsured and underinsured population is growing
• Local tax dollars are expected to bear more of the
burden of indigent healthcare due to Federal and State
cuts
• As of 2007, the Commonwealth Fund study estimated
there are 25 million underinsured adults in the U.S.,
which is a 60% increase from 2003
• According to The Families USA report, healthcare
premiums for Texas’ working families rose by 70.7%
while the median earning rose by only 10.3% from
2000-2006
• Persons in Dallas County without insurance were
estimated at 530,000 in 2000; 633,522 in 2005; and are
projected to be 829,000 by 2011
Parkland’s Challenges
CHARITY CARE REQUIREMENTS
The Health & Safety Code Section 311 requires nonprofit
hospitals to provide community benefits, which include charity
care and government-sponsored indigent health care.
Parkland
Methodist
Meth Charlton
Baylor Garland
BUMC
Children's
Presbyterian
UTSW
0.00%
5.00%
10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%
Source: Center for Health Statistics, DSHS - 2006 Data
Parkland’s Challenges
UNDOCUMENTED
Reimbursement for undocumented patients come from
three sources.
• MEDICAID, under federal law, pays for the
delivery of children to mothers who cannot provide
citizenship
• TITLE V federal program pays for prenatal care
• SECTION 1011 of the Medicare Modernization Act
of 2005 provides for federal reimbursement of
emergency healthcare for undocumented and
certain other specified aliens
Parkland’s Challenges
OUT OF COUNTY
The 1985 Indigent Healthcare and Treatment Act
established that counties are responsible to
(1) create a hospital district/taxing unit;
(2) operate a public hospital; or
(3) operate a County Indigent Health Care Program
by contributing up to 8% of the county’s general
levy for resident’s healthcare.
Parkland’s Challenges
2008 Federal Poverty Level
% Gross Monthly Income
Family Size
21%
100%
150%
200%
1
$393
$10,400
$1,300
$20,800
2
$488
$14,000
$1,750
$28,000
3
$582
$17,600
$2,200
$35,200
4
$677
$21,200
$2,650
$42,400
County or Hospital District’s Federal Poverty Level:
Parkland
200%
Denton County
Collin County
100%
Rockwall County
Tarrant County 200%
150%
21%
Parkland’s Challenges
FY2007 Contribution Margin
$ in
Millions
Inpatient
Emergent
Outpatient
Non-Emergent Emergent
TOTAL
Non-Emergent
Insured
16
2
1
0
19
Medicare
4
1
0
0
5
Medicaid
1
1
0
0
2
Unfunded
-2
0
0
-2
-4
TOTAL
19
4
0
-2
21
Parkland’s Future
Preparing for a New Hospital
• Parkland engaged consultants to conduct a feasibility
study, review demographic assumptions, and develop a
strategic plan
• Dallas County Commissioners court appointed a Blue
Ribbon Master Capital Plan Advisory Committee to
develop a Master Capital Plan
• Parkland hospital is not only debt free but they are in a
good financial position
Parkland’s Future
New Campus to Include:
546 Medical/Surgical/Trauma Beds
280 Women & Infants’ Specialty Health Beds
106 Strategic Investment Beds
36 Programmatic Investment Beds
Teaching & Non-Teaching Clinics
Cost
$1,217 million
Parkland’s Future
Financing
Debt - Revenue Bonds
$747 million (maturing in 25 years)
Philanthropy
The Parkland Foundation projects the
community to contribute $150 million
Cash
The Dallas County Hospital District Board of
Managers intend to use $250 million of
existing cash and $100 million from future cash
Interest on Proceeds
$24 million
Parkland’s Future
Property Tax Rate
Past & Current:
FY96
0.1996
FY99
0.1799
FY97
0.1941
FY00
0.1960
FY98
0.1855
FY01 – FY09
0.2540
Future:
FY2010 - 2¢ increase for G.O. bond support = .274¢
FY2011 - .05¢ increase for G.O. bond support = .279¢
FY2014 - 1¢ increase for operational support = .289¢
Parkland’s Future
FY2009 Revenues $1,109,000,000
Other
$107,000,000
10%
Patient
$400,000,000
36%
Taxes
$431,000,000
39%
Government
Subsidies
$171,000,000
15%
Parkland’s Future
Construction
Opening 2011
• Office Building (269,000 sq. ft. )
Opening 2014
• 816 Adult Beds & Shell 46 (1.68 million sq. ft.)
• Clinic Buildings (387 sq. ft.)
• Parking (2,035 new garage spaces and 2,800 new
surface spaces)
Healthcare in Dallas County Without Parkland
Without Parkland Hospital the private area hospitals
will be inundated with additional patients including the
uninsured, underinsured, and undocumented.
Hospital Discharges for Dallas County Residents
45,000
Parkland
Baylor
Presbyterian
Methodist Dallas
Medical City
St. Paul
36,000
27,000
18,000
9,000
0
2003
2005
2007
Healthcare in Dallas County Without Parkland
Parkland provides annually:
• over 140,000 emergency room visits
• over 260,000 specialty outpatient service visits
• over 420,000 Community-Oriented Primary Care
visits
• over 16,000 deliveries
• over 5 million prescriptions filled
Parkland’s Future
The ballot proposition will state:
BOND ELECTION BY DALLAS COUNTY HOSPITAL
DISTRICT
d/b/a PARKLAND HEALTH AND HOSPITAL SYSTM
Proposition
“Authorizing the Dallas County Hospital District [d/b/a Parkland
Heath & Hospital System] to pledge the revenues from its hospital
system and from ad valorem tax that was previously approved by
the voters to the payment of combination tax and revenue bonds
and other obligations that will be issued and executed for the
capital purpose of the hospital system.”
For
□
Against
□
Parkland’s Future
Early Voting: 10/20/08 – 10/24/08
8a.m.-5p.m.
10/25/08
7a.m.-7p.m.
10/26/08
1p.m.-6p.m.
10/27/08 – 10/31/08
7a.m.-7p.m.
Election Day: 11/4/08
7a.m.-7p.m.
Visit www.dalcoelections.org for times & locations
Parkland’s future is up to you… YOU
DECIDE