Transcript Slide 1

PROPOSED
EL PASO
CHILDREN’S HOSPITAL
NEW CLIMATE NEW PROMISE
JOBS • RESEARCH • INDUSTRY
JAMES N. VALENTI, CEO
2+ YEARS
IN THE
BLACK
PROMISE OF A
CHILDREN’S
HOSPITAL
COMMITMENT
TO FOUR YR
MEDICAL
SCHOOL
MEDICAL CENTER OF THE AMERICAS
KMD ARCHITECTS
JIM DIAZ, AIA
AN EL PASOAN
LARGEST
EXPANSION OF
ANY HOSPITAL
IN EL PASO
IN 90 YRS
BRAC
INFLUX OF
TROOPS
FOUNDING DEAN
ROBERT SUSKIND, MD
TRUE REGIONAL MEDICAL CENTER
JOBS ● RESEARCH ● INDUSTRY ● CLEAR ECONOMIC DRIVER
ECONOMIC IMPACT OF
ACADEMIC TEACHING HOSPITALS
The economic “multiplier effect”
averages 2.3 for teaching hospitals.
For every dollar spent
an additional $1.30 is generated.
Texas Medical Association January 2007
ECONOMIC IMPACT OF EL PASO
MEDICAL SCHOOL
“$1.2 TO $1.3 billion...Over 4200 new jobs”
Founding Dean Robert Suskind, MD, March, 2007
EL PASO MEDICAL SCHOOL FUNDING
APPROVED BY LEGISLATURE
Accreditation in 2008 ● Classes begin in 2009
UTEP Impact Study
THERE HAVE BEEN FOUR PREVIOUS
CHILDREN’S HOSPITAL STUDIES
1993
1995
2003
2004
Providence Hospital, Ernst & Young
Columbia HCA, Ernst & Young
EPICH Foundation, Katz Group
Thomason, Deloitte
None of the previous studies utilize
the economic business model of the 2007 study.
2007
Thomason, Kurt Salmon Assoc
ALL STUDIES AGREED:
 There is a need for a specialized Children’s Hospital;
 A Children’s Hospital could be financially viable
if affiliated with an existing acute care general hospital;
 The Pediatric inpatient market would consolidate over a
period of time as the Children’s Hospital achieved critical
mass to provide a full range of specialty services; and,
 It is essential to increase the supply of Pediatric
manpower in the community.
TEAM OF EXPERTS
•
•
•
•
•
•
•
•
•
•
•
Kurt Salmon Associates, Lydia Hammer & George Westfall
Gjerset & Lorenz, Lance Ramsey, DSH & UPL, governance
John Wendling, Cost reimbursement
Sellers Feinberg, Scott Reasonover, reimbursement of capitalized cost
Bob Evans, state licensing and CMS
Paul Braden, Delgado Acosta & Braden, governance and bonding
KMD, Jim Diaz and team, design
Bruce Crockford, Jones Lang Lasalle, construction costs
Kaufman Hall, Charles Kim, review and validation of assumptions
Thomason Administration: Valenti, Rivera, Cassidy, Zampini
Eddie Sosa, Legal counsel
VALIDATED. VERIFIED.
WHAT DRIVES FEASIBILITY?
VOLUME
COST BASED REIMBURSEMENT
GOVERNANCE MODEL
PROVIDER BASED
SEPARATELY LICENSED TAX EXEMPT
ABILITY TO USE
TAX BACKED DEBT
SUBSIDIES
CMS REQUIREMENTS FOR
LICENSING
PROTECT BONDING
ABILITY
GROWTH IN PEDIATRIC POPULATION
The pediatric population in the El Paso area is projected to
increase by:
3.60% between 2005 and 2010, and
2.67% between 2010 and 2015
PROJECTED POPULATION CHANGES BY SERVICE AREA
SERVICE AREAS
2005
2006
2007
Primary Service Area
226,094
230,614
234,097
79,133
80,486
82,359
International Service Area
388,232
407,294
421,127
Total Pediatric Population
693,458
718,394
737,584
Secondary Service Area – Southern NM
UNDERSERVED
PEDIATRIC COMMUNITY
Pediatrician to Child Population Ratio
(PCPR)
Area
Ratio
US Average
1 to 1769
Texas Average
1 to 2421
El Paso Average
1 to 3532
UNDERSERVED
PEDIATRIC COMMUNITY
Fragmented market
Subspecialists on staff at multiple hospitals
Lack of comprehensive service
CHILDREN’S HOSPITALS
TRAIN NEARLY 30%
OF ALL PEDIATRICIANS
AND NEARLY HALF OF
ALL PEDIATRIC SUBSPECIALISTS
TOTAL PEDIATRIC DISCHARGES 2004
HOSPITAL
TOTAL PEDIATRIC
DISCHARGES
MARKET
SHARE
Providence Memorial Hospital
4,646
41.12%
Thomason Hospital
2,675
23.67%
Del Sol Medical Center
2,149
19.02%
Las Palmas Medical Center
1,337
11.83%
473
4.19%
15
1.30%
4
4.00%
11,299
100.00%
Sierra Medical Center
Physicians Hospital
El Paso Specialty Hospital
GRAND TOTAL PEDIATRIC DISCHARGES
TOTAL NEONATAL INTENSIVE CARE
NICU DISCHARGES 2004
HOSPITAL
Thomason Hospital
TOTAL NICU
DISCHARGES
MARKET
SHARE
1,220
34.08%
Providence Memorial Hospital
796
22.23%
Del Sol Medical Center
759
21.20%
Sierra Medical Center
405
11.31%
Las Palmas Medical Center
400
11.17%
3,580
100.00%
GRAND TOTAL NICU DISCHARGES
PROJECTED ADMISSIONS FOR NEW CHILDREN’S HOSPITAL
SOURCE
2004
2010
2011
2012
2013
2,675
2,753
2,763
2,773
2,781
2,791
2,799
Ft. Bliss Growth
118
235
353
471
589
589
Curb Outmigration
by 20%
82
96
109
123
137
151
Market Share
Growth at .5% per
year
347
413
481
549
615
755
3,300
3,507
3,716
3,924
4,132
4,294
Base Adjusted for
Population Growth
TOTAL PROJECTED
ADMISSIONS
2014 2015
PROJECTED ADMISSIONS FOR NEW CHILDREN’S HOSPITAL
SOURCE
2004
2010
2011
2012
2013
2,675
2,753
2,763
2,773
2,781
2,791
2,799
Ft. Bliss Growth
118
235
353
471
589
589
Curb Outmigration
by 20%
82
96
109
123
137
151
Market Share
Growth at .5% per
year
347
413
481
549
615
755
3,300
3,507
3,716
3,924
4,132
4,294
Base Adjusted for
Population Growth
TOTAL PROJECTED
ADMISSIONS
2014 2015
CRITICAL SUCCESS FACTORS
• Public support, positive vote of the electorate
• Children’s Hospital is the provider of choice
• Community Pediatricians refer to the Children’s
Hospital for ambulatory diagnostic testing
and treatment
• Thomason/Texas Tech Partnership
• Academic Teaching Hospital & Open Medical Model
• Pediatric Center of Excellence
• Continued growth of obstetrics & NICU
• Aggressive Recruitment of Pediatric Subspecialists
TIMELINE
FOR CHILDREN’S HOSPITAL
Nov. 6, 2007
2008
2009
2010
2011
Public vote of the community
Make ready
RECRUITMENT
PEDIATRIC
Construction
PROGRAM DEV.
Construction
Open 2nd Quarter of 2011
PEDIATRIC SERVICE LINE
PLANNING HAS ALREADY BEGUN
COLLABORATIVE COMMITTEE
Thomason/TTUHSC/Community Peds & Subspecialists
Business plan for pediatric program development
Determine Centers of Excellence
Set priorities for recruitment
Specific timelines for service line development
RECRUITMENT OF SUBSPECIALISTS &
PEDIATRIC PROGRAM DEVELOPMENT
Beginning in 2008, Thomason has committed
between $5.0M and $6.4M each year,
almost
$18 million of support
for
pediatric physician recruitment and program development.
These dollars will be repaid to Thomason
by the Children’s Hospital in the first five years.
Oncology
Intensivist/Critical Care
General Surgery
Emergency Medicine
Endocrinology
Pulmonary Medicine
Anesthesiology
Gastroenterology
Urology
Radiology
Psychiatry
Rheumatology
Nephrology
Cardiology
Otolaryngology
Developmental Specialist
KEY OPERATING ASSUMPTIONS
FOR FINANCIAL FEASIBILITY
Low cost financing for construction.
Qualify for non-traditional revenue to support unfunded care.
Separately licensed Children’s Hospital eligible for full
Medicaid reimbursement.
Availability of pediatric program support and working
capital.
IMPACT OF ENHANCED MEDICAID PAYMENT AS
SEPARATELY LICENSED CHILDREN’S HOSPITAL
2005
Projected Future
Reimbursement Reimbursement Difference
Medicaid
Reimbursement
New Capital Cost
Reimbursement
$11,300,000
$12,300,000
$1,000,000
$0
$6,500,000
$6,500,000
TOTAL DIFFERENCE IN REIMBURSEMENT
$7,500,000
$ in millions
CONCLUSION – FINANCIAL FEASIBILITY
$7.0
$6.0
$5.0
$4.0
$3.0
$2.0
$1.0
$0.0
($1.0)
$6.58M $6.62M
$6.03M
$2.3
$5.45M $5.46M
$2.0
$6.04M
$1.8
$1.7
$4.89M $4.92M
$4.26M
$(1.5)
$(0.6)
$(1.0)
($0.1)
$(1.5)
$(2.2)
$-.82M
Year 1
Cash Generated
Year 2
Year 3
Year 4
Year 5
Revenues in excess of (less than) expenses
The Children’s Hospital is expected to generate operating profit in
each of the first five years of operation.
The Children’s Hospital will generate positive cash flows in
each of the first five years of operations,
except for the initial year.
24
FIVE SITES WERE CONSIDERED
Parking
on Alberta
Boll St
Central
Plant
#2
Anywhere
Free
standing
Texas Tech
Clinics
Raynolds St
Staff Parking
#4
#3
#1
Texas
Tech Bldg
El Paso
Psych Ctr
Hospital
Annex
#5
New
Tower
Parking
WOMEN/INFANT’S HEALTH CENTER
EL PASO CHILDREN’S HOSPITAL
CURRENT EXPANSION
Existing
Parking
Main
Hospital
Entrance
Children’s
Hospital
Entrance
3D Thomason Campus Model
SW Aerial View - Campus
Ambulatory
Surgery
Women’s/
Children’s
Emergency
COMPARISON OF FIVE OPTIONS
I.
Building/Land Acquisition
II.
Construction Cost
Demolition
Site Improvements
Off-Site Improvements
Landscaping and Irrigation
Building Cost
Payment and Performance Bonds
Contractor's Fees
Administrative Costs
Professional Fees
Owner's Contingency
Sub Total Construction Cost
Option1
Texas Tech Building
Option 2
Option 3
Psychiatric Center Parking Lot, Alberta
Option 4
Freestanding
Option 5
Expand New Tower
$
$
$
$
750,000
2,650,000
80,000
90,000
79,926,000
1,598,520
4,334,652
1,870,800
13,011,253
9,602,417
$
III. Major Movable Equipment
Total Project Cost--See Schedules
19,200,000
113,913,642
164,358,642
$
250,000
850,000
80,000
11,000
55,726,000
1,114,520
2,957,302
1,695,000
10,419,840
6,758,382
$
31,245,000
$
21,350,000
79,862,044
70,000
2,650,000
80,000
90,000
79,926,000
1,598,520
4,300,652
1,870,800
12,709,248
9,539,017
$
30,145,000
$
131,357,044
-
112,834,237
2,650,000
80,000
90,000
84,599,770
1,691,995
4,540,188
1,870,800
13,146,372
10,024,695
$
31,095,000
$
143,929,237
6,720,000
118,693,820
1,000,000
2,000,000
71,439,620
2,199,662
10,892,804
10,306,000
$
36,145,000
$
161,558,820
-
97,838,086
19,878,534
$
117,716,620
IV. Add to Construction Cost for Total Capital Expenditures
Loan Acquisition Costs @ .02059
-
-
-
-
Total Financing
$
164,358,642
$
131,357,044
$
143,929,237
$
161,558,820
BENEFIT OF OPTION 5
$
44,218,642
$
11,217,044
$
23,789,237
$
41,418,820
2,423,380
$
120,140,000
Option 5 – New Tower $120,140 million
CONSTRUCTION
COMPARABLES
Children's Hospital Construction Cost Comparisons
Recent Projects in Area
Year
Total
Square
Hospital
Complete Cost (mill) #Beds footage
Dell Children's in Austin
2007 $200.00
169 500,000
University of New Mexico
2007 $233.80
267 476,555
El Paso Children's Hospital
2011 $117.70
135 217,036
$ per
sq ft Cost per bed
$400 $ 1,183,000
$501
$875,655
$542
$871,852
BUILT FOR FUTURE GROWTH
NICU
PICU
Gen Peds
TOTAL
#Beds
Neonatal Intensive Care 50
Pediatric Intensive Care 12
General Pediatric Beds
78
TOTAL
140
50
12
78
140
ROOF
30
FLOOR 9
PEDIATRIC NURSING
30
FLOOR 8
PEDIATRIC NURSING (18) PICU (12)
30
FLOOR 7
PEDIATRIC NURSING
55
FLOOR 6
NICU
FLOOR 5
MECHANICAL
30
FLOOR 4
MOTHER/BABY & NURSERY POSTPARTUM
30
FLOOR 3
MOTHER/BABY (POSTPARTUM) & NURSERY
26
FLOOR 2
L&D (18 LDRs) + ANTEPARTUM (8)
PEDIATRIC SURGERY
FLOOR 1
OP SERVICES/ANCILLARY SUPPORT
PEDIATRIC IMAGING
BASEMENT
OP SERVICES/ANCILLARY SUPPORT
Roof
MECHANICAL
Not asking for additional dollars for operations.
$120.1 MILLION BOND
to finance construction only
Per
$100,000
Home
Value
2009
2015
$ 2.38 mo. $ 1.99 mo.
$28.56 yr. $23.88 yr.
SEPARATELY LICENSED EXEMPT
CHILDREN’S HOSPITAL
To qualify for reimbursement and licensing
as a separately licensed exempt children’s hospital,
Center for Medicaid (CMS) requires
separate books,
separate control,
separate staff,
separate services.
The Children’s Hospital would be controlled by
a separate, independent 501(c)(3) corporation.
EL PASO CHILDREN’S HOSPITAL
WOULD BE ORGANIZED AND OPERATED
AS AN INDEPENDENT 501(c)3
AS DICTATED BY FEDERAL TAX LAW
•Board of Directors must be independent, no entity can have
veto power over Children’s Hospital operations
•Requires board, management and staff to act solely in the
interest of the charity IRS
•Good Governance Practices include adoption of code of
ethics for the Board and conflict of interest policy
CHILDREN’S HOSPITAL
BOARD COMPOSITION
• THOMASON - 2 members
• COMMISSIONERS COURT – 2 members
11
MEMBERS
• TECH – 1 member
• PEDIATRIC SPECIALISTS – 1 member
• PEDIATRIC PHYSICIAN – 1 member
• WILLIAM BEAUMONT – 1 member
• EPICH FOUNDATION – 1 member
• AT LARGE – 2 members
• THOMASON CEO & CFO – Ex-officio non-voting
4 One year terms ● 4 Two year terms ● 3 Three year terms ● Can serve
maximum of six years ● Self-perpetuating ● 3 nominees for each vacancy
CONTROL AND ACCOUNTABILITY
EL PASO
CHILDREN’S HOSPITAL
EL PASO COUNTY
HOSPITAL DISTRICT
OWNS PHYSICAL
STRUCTURE
SETS TERMS OF
SERVICE AGREEMENT
CHILDREN’S
HOSPITAL
CHILDREN’S
HOSPITAL
INDEPENDENT
501(c)3
LEASES BLDG FROM DISTRICT
PAYS FOR INDIGENT CARE
PROVIDES INDIGENT CARE
GOVERNS
CHILDREN’S
HOSPITAL
AGREEMENTS BETWEEN
HOSPITAL DISTRICT
District would build and own the
physical structure and all
improvements.
Multi-year management agreement
for turn-key services co-terminus
with lease includes performance
standards and milestones.
District would compensate
Children’s Hospital for indigent care
of certain pediatric patients of the
District.
CHILDREN’S HOSPITAL
Exclusive lease on newly constructed
facility
Children’s Hospital would hold all
licenses, permits, hire or contract for
all employees
Agree to repay the District for start-up
costs (recruitment dollars and working
capital)
Minor agreements for dietary,
housekeeping, maintenance as
permitted by regulations.
USE OF FACILITIES • DAILY OPERATIONS • INDIGENT CARE
SO IF THOMASON CAN DO IT WHY HASN’T
ANOTHER HOSPITAL DONE IT?
 $3.9 million in property taxes for indigent pediatric
care
 $7.5 million in increased reimbursement as
licensed Children’s Hospital
 $120.1 million bond for construction through
community support
 Ability to meet stringent CMS requirements for
separately licensed Children’s Hospital
THOMASON HOSPITAL
IS EL PASO’S
ONLY REMAINING
NOT-FOR-PROFIT HOSPITAL
WITH
A CHARITABLE MISSION
THOMASON’S MISSION SINCE 1915
To enhance the
health and wellness
of the El Paso
community by
making high quality,
affordable health
care services
available to all.
THOMASON IS A SAFETY NET HOSPITAL
Not for profit hospitals are mandated
to provide a specified amount
of charity care and community benefits
as a safety net to the medically
vulnerable, the poor, the uninsured and
underinsured, at least as great as the
local and state tax exemptions they
receive.
This does not apply to for-profit hospitals.
2006
Thomason received $45.8 million
from El Paso taxpayers.
Thomason delivered $196.1M+
to El Paso in uncompensated care.
THOMASON HAS 2+ YEARS IN
THE BLACK
FINANCIAL
STABILITY
CHARITABLE
MISSION
DELICATE BALANCE
AT THOMASON EVERY PENNY OF PROFIT
STAYS IN EL PASO
PROFITS ARE REINVESTED IN CLINICAL PROGRAMS
& INFRASTRUCTURE
PROFITS ARE REINVESTED IN TECH RECRUITMENT;
IN 2006 THOMASON PAID TECH $35 MILLION DOLLARS
FOR FACULTY
FUNDED PATIENTS PAY FOR UNFUNDED PATIENTS,
PROFITS REDUCE THE NEED TO GO BACK TO TAXPAYERS $$$
AVERAGE CHARGES P/DAY FOR CARDIAC CARE
Average Charges in El Paso Hospitals for Cardiac Care
Source: The Texas Hospital Checkup
Texas Business Group on Health and the Dallas-Fort Worth Business Group on Health,
http://www.tbgh.org/checkup/index.htm
AVERAGE CHARGES FOR DELIVERY
Average Charges in El Paso Hospitals for Delivery
Source: The Texas Hospital Checkup
Texas Business Group on Health and the Dallas-Fort Worth Business Group on Health,
http://www.tbgh.org/checkup/index.htm
100 MOST EXPENSIVE HOSPITALS
NATION’S HOSPITALS WITH
THE HIGHEST CHARGES COMPARED TO COSTS
Total
Rank
Charges to
in the Hospital
Cost Ratio- Net Income
Nation Name
City
State System Total
(or loss)
37th
Sierra
El Paso TX
Tenet
697.73% $40,540,673
46th
Providence El Paso TX
Tenet
675.49% $70,841,238
IHSP Hospital 200, 2005 Ver 1.2
COMPARISON OF UNFUNDED CARE
BY EL PASO HOSPITALS
CORP
Tenet
Tenet
HCA
HCA
EPCHD
Total Gross
Patient
Revenue
Unfunded
Care as % of
Gross
Net Patient
Patient
Revenue
Revenue
Total Unfunded
Care
TYPE
HDQTRS
HOSPITAL
For-profit
Dallas, TX
Sierra
$45,623,530 $1,095,488,713 $215,861,759
For-profit
Dallas, TX
Providence
$45,619,963 $1,241,435,264 $294,834,585
For-profit
Nashville, TN Del Sol
$62,977,700 $859,853,506 $216,642,826
For-profit
Nashville, TN Las Palmas
$24,263,258 $575,872,965 $151,982,356
Not-for-profit El Paso, TX Thomason
$177,281,952 $473,241,982 $178,507,250
http://www.dshs.state.tx.us/chs/hosp/char2005.pdf
4.20%
3.70%
7.30%
4.20%
37.50%
A DIFFERENCE IN MISSION
A FOR PROFIT HOSPITAL
PROVIDES A SERVICE
TO MAKE A PROFIT
A NOT-FOR-PROFIT HOSPITAL
MAKES A PROFIT
TO PROVIDE A SERVICE
YESTERDAY’S INDIGENT IS
TODAY’S UNFUNDED.
El Paso 4th poorest
county in the nation
Poorest American cities with a
population of 250,000 or greater
Rank
City
Median household income, 2004
1
Miami, FL
$24,031
2
Newark, NJ
$26,309
3
Cleveland, OH
$27,871
4
Detroit, MI
$27,871
5
Buffalo, NY
$28,544
6
St. Louis, MO
$30,389
7
Philadelphia, PA
$30,631
Rank
8
Milwaukee, WI
$31,231
9
New Orleans, LA
10
Poorest American counties with a
population of 250,000 or more
City
Median household income,
2004
1
Hidalgo County, TX
$24,778.00
$31,369
2
Cameron County, TX
$26,290.00
El Paso, TX
$31,764
3
Bronx County, NY
$28,705.00
11
Tucson, AZ
$31,901
4
El Paso County, TX
$28,925.00
12
Pittsburgh, PA
$31,910
5
St. Louis city, MO
$30,389.00
6
Philadelphia County, PA
$30,631.00
7
Caddo Parish, LA
$31,317.00
8
Orleans Parish, LA
$31,369.00
9
Baltimore city, MD
$34,055.00
10
Mahoning County, OH
$34,132.00
11
Polk County, FL
$34,206.00
13
Cincinnati, OH
$31,960
14
Memphis, TN
$32,399
15
Baltimore, MD
$34,055
16
Toledo, OH
$35,239
17
Tulsa, OK
$36,255
18
Oklahoma City,
OK
$36,347
12
Luzerne County, PA
$34,341.00
19
San Antonio, TX
$36,598
13
Oklahoma County, OK
$35,182.00
20
Stockton, CA
$37,322
14
Mobile County, AL
$35,512.00
15
Lake County, FL
$35,856.00
16
E. Baton Rouge Parish, LA
$35,954.00
17
Pasco County, FL
$35,997.00
18
Kings County, NY
$36,030.00
19
Nueces County, TX
$36,050.00
20
Marion County, OR
$36,591.00
El Paso 10th poorest
city in the nation
UNINSURED CONTINUES
TO GROW
US
TX
EP
1 out of every 9
1 out of every 4
1 out of every 3
U.S. Census Bureau, Texas State Comptroller’s Office
THE WORKING POOR
79%
OF UNINSURED ADULTS
IN TEXAS WORKED ALL OR PART OF LAST YEAR
OR HAVE A FAMILY MEMBER WHO WORKED
BETWEEN 2000 AND 2006
HEALTH CARE INSURANCE
ROSE 7 ½ TIMES FASTER
THAN FAMILY INCOMES
For a family of four at the Federal Poverty Level $20,000
private health insurance in 2005 was $9,100 a year.
Close to half their income.
Families USA October 2006
Task Force on Access to Health Care in Texas: Challenges of the Uninsured and Insured
April 2006
IN EL PASO THE UNFUNDED ARE:
 People employed at small firms that
don’t offer employer sponsored coverage
 Part time workers, 38 hr workers cut short
of benefits
 Those employed less than a yr
 Unemployed
TEXAS HAS STRICT
MEDICAID QUALIFICATIONS
Work full time
minimum wage
at $5.15 hr.
$10,712 a yr
Single
Family of three
Non pregnant
Non-disabled
Under 65
FEDERAL
POVERTY
LEVEL
(FPL)
For a
family
of 3
is $17,170
In TX in 2006,
a working parent
of two has to
make less than …
$3,696 p/ yr
or
24% of the FPL
to qualify
for Medicaid.
“Code Red: Critical Condition of Health in Texas” Task Force on Access to Healthcare
Today, El Paso has the
distinction of being
the most uninsured
city in the nation at
34%
Health Leaders-InterStudy November 2006
That’s every third home…
WHAT HAPPENS WHEN
PARENTS ARE UNINSURED?
THE KIDS ARE UNINSURED.
MORE UNINSURED KIDS IN TEXAS THAN ANY OTHER STATE.
VERMONT #1 8%
USA #39 12%
TEXAS #52 23%
% UNINSURED
CHILDREN
BY STATE
“People who are
uninsured receive less
care and experience
worse outcomes.”
Study by Kaiser Family Foundation, March, 2007
Journal of the American Medical Association
INDIGENT &
WORKING POOR
INCREASED
COST
OF CARE
NEGATIVE
HEALTH
INDICATORS
THOMASON
IS A
SAFETY NET
HOSPITAL
NO INSURANCE
UNDERINSURED
NO CARE OR
DELAYED CARE
TODAY, EL PASO IS STILL
THE LARGEST
METROPOLITAN AREA
IN THE UNITED STATES WITHOUT
A SEPARATELY LICENSED
CHILDREN’S HOSPITAL
YOU DECIDE.