November 25, 2019 8:30 AM North Port City Hall Greetings and a Look Ahead
Edward Houck, PhD Dr. Houck currently serves as Chief Executive Officer of the Health Planning Council of Southwest Florida Inc. He previously served as CEO of the Bonita Community Health Center, vice president of Mid Florida Medical Service, Inc. and as senior vice president and COO of Sarasota Memorial Hospital. Chairman Houck has a Doctorate Degree in Public Health and Hospital Administration from the University of Oklahoma Health Sciences Center. He has held teaching appointments at Florida Gulf Coast University, College of St. Frances and the University of Oklahoma Health Sciences Center. History of the Pursuit of Hospitals in North Port
Sam George Mr. George is retired from a 35-year career in the Pharmaceutical industry, where he served in sales and training management. Prior to that, he was a surgical assistant in the United States Navy. He and his wife moved to North Port 14 years ago where he has been active in the North Port Community Health Action Team, which was a major force in bringing the Sarasota Memorial Hospital Emergency Department here. He earned a Master of Science degree in Public Health, a Preceptorship in Allergy & Immunology and is a Florida Supreme Court Certified Pre-Trial Mediator and Arbitrator. Timeline of North Port’s Quest for a Hospital
2004 North Port takes Certificate of Need (CON) to Agency for Health Care Administration (AHCA)
2006 Sarasota Memorial Hospital seeks land in North Port
2007 Discussion of North Port’s Medical needs, Sarasota Memorial Hospital purchases land
2008 Sarasota Memorial Hospital breaks ground on Emergency Room Center
2009 Sarasota Memorial Hospital Emergency Room Center opens in North Port
2010 North Port continues to lobby for hospital, SMH concerned about medical infrastructure
2012 Sarasota Memorial Hospital’s long-range plans still do not include hospital for North Port
2016 North Port campaigns for AHCA to accept CON, then “pulls the plug”
2017 Universal Hospital submits a CON to build hospital in North Port, CON was denied by ACHA
2018 Cities in Florida, including North Port, lobby to remove CON requirement
2019 HB-21 is signed into law, removing CON requirement; North Port rekindles its hospital quest Timeline of North Port’s Quest for a Hospital
North Port takes Certificate of Need (CON) to Agency for 2004 Health Care Administration (AHCA) • North Port Population: 30,000 • 20,000 letters requesting ACHA approve CON for Acute Care Hospital • Administrative Judge ruled against request
2006 Sarasota Memorial Hospital seeks land in North Port • North Port Population: 50,000 • Sarasota Memorial Site Selection process Timeline of North Port’s Quest for a Hospital
Discussion of North Port’s Medical needs, Sarasota Memorial 2007 Hospital purchases land • Community Health Action Team (CHAT) and SMH explore medical needs for North Port • Commission continues to lobby for a North Port hospital • Sarasota Memorial purchases land at Sumter and I-75 • Dr. Lee Gross begins planning a state-of-the-art, regional medical building on Toledo Blade Timeline of North Port’s Quest for a Hospital
Sarasota Memorial Hospital breaks ground on 2008 Emergency Room Center • North Port officials, CHAT, and SMH visit free-standing Emergency Room Center in Ocala • SMH begins building Emergency Room Center at Toledo Blade • City considers options to attract other hospitals • SMH COO chairs North Port Economic Development Board Timeline of North Port’s Quest for a Hospital
Sarasota Memorial Hospital $20 M Emergency Room Center 2009 opens in North Port • From first year to present, daily census has been close to 100 patients per day
2010 North Port continues to lobby for hospital • SMH asserts that North Port lacks necessary medical infrastructure
2012 Sarasota Memorial Hospital plans for clinics outside Sarasota County • North Port still lacking full service hospital Timeline of North Port’s Quest for a Hospital
2016 North Port campaigns for AHCA to accept CON • Sarasota Memorial does not support request • Another letter writing campaign begins • North Port withdraws Certificate of Need application • Sarasota Herald Tribune reports on the issue Timeline of North Port’s Quest for a Hospital
2017 Universal Hospital submits a CON to build hospital in North Port • Jim Blucher and Sam George work with landowners to entice hospitals to North Port • Universal Hospital submits CON to build hospital in North Port • CON application denied by ACHA
2018 North Port joins movement against CON requirement in Florida • North Port and other Florida cities begin campaign to eliminate CON for hospital development Timeline of North Port’s Quest for a Hospital
HB-21 is signed into law, removing CON requirement; North 2019 Port rekindles its hospital quest • Florida’s House of Representatives, Senate, and Governor all sign HB-21 doing away with the need for an approved CON • City Commissioners, City Manager, and local medical professionals begin preliminary conversations with several hospital groups • Discussions of land for hospital use continue with land owners • North Port population: 73,652 (April 1, 2019 BEBR) • Today: largest city in Sarasota County and largest in Florida with no hospital
Legislative & Policy Issues in Health Care
Julio Gonzalez, M.D., J.D. Dr. Gonzalez is a local, board-certified Orthopedic physician who is active in professional Orthopaedic Societies and Associations. From November 2014 until November 2018, Dr. Gonzalez served as State Representative, District 74. Prior to his private practice, he was an active duty flight surgeon and officer in the United States Navy. While managing his practice, he also earned his law degree from Stetson University College of Law. Additionally, Dr. Gonzalez has written several books and publications. NO CON. WHAT DOES THAT MEAN???
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. How did we get into this mess?
Health Planning Resources Act in 1974.
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. HB 21: July 1, 2019: general hospitals, complex medical rehabilitation beds and “tertiary hospital services,” including neonatal intensive care units and organ transplant centers (collectively, the Non-Restricted Facilities) will no longer be required to receive CON approval
July 1, 2021: “Specialty hospitals” will become Non- Restricted Facilities defined as a facility offering the range of medical services offered by general hospitals, but restricted to a defined age or gender group of the population; diagnosis, categories of medical or psychiatric illnesses or disorders; or intensive residential treatment programs for children and adolescents. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. What does HB 21 mean for North Port?
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. OPPORTUNITY!
1. For Patients. 2. For Investors. 3. For Innovation. 4. For the Local Economy.
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. What Can We Build?
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. What Can We Build?
1. Pediatrics. 2. Orthopaedics. 3. Geriatrics. 4. Cancer. 5. Sports. 6. Veterans. 7. Medical Tourism.
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. What Can We Build?
Whatever our imaginations can envision!
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. “All great achievements begin with a vision of what could be.”
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions. Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions.
Julio Gonzalez, M.D., J.D. Center for Healthcare Policy Solutions.
An Epiphany in Health Care Delivery
Lee Gross, M.D. Dr. Gross is a family physician who has practiced in North Port since 2002. After developing the freestanding ER in North Port, Dr. Gross and his colleagues had an Epiphany about the health care needs in the community and created a health care delivery model that eliminated barriers to accessing affordable medical care. Since then, the practice model has grown to over 1,000 independent practices nationwide. Dr. Gross is the president of the Charlotte County Medical Society, delegate to the Florida Medical Association and serves on the FMA council on Medical Economics and Practice Innovation. He has consulted state and federal government agencies, the White House, private practices, hospitals and insurance companies and has testified in the US Senate on medical innovation. Lee S. Gross, MD Co-Founder, Epiphany Health Direct Primary Care President, Docs 4 Patient Care Foundation Chairman, DPC Action Freestanding ER Development An epiphany happens… What was the Epiphany?
Insuring primary care??
36 Balancing the cost of care
All other care
37 Remove the cost drivers
All other
care 38 Insurance based primary care
39 Direct Primary Care
40 What’s Included?
Typical Charge DPC Members pay Annual wellness exam $200 $0 25 additional visits $5,000 $0 Annual Pap test $350 $35 Annual PSA test $150 $10 Colon Cancer Stool Screen $25 $0 Annual blood work $500 $45 EKG $50 $0 Flu vaccine $45 $14
Approximate cost… $6,170 $94 41 What Does It Cost?
Member(s) Monthly Fees
Individual $65
Couple $130
$165 Family of 4 42 Examples of in-office savings
Service Typical Charge Actual Cost in DPC
Additional labs $50-350 each <$10 each
Joint injection (knee) $150 $0
Skin biopsy $160 $0
Drain abscess $275 $0
Lacerationrepair $260 $0 43 Examples of savings
Actual Cost in Service Typical Charge Savings DPC
Nuclear Stress Test $1,470 $520 65%
CT of the chest w/contrast $940 $211 78%
Carotid ultrasound $425 $120 72%
Colonoscopy $4,028 $1,100 75%*
Chest x-ray $220 $22 90% 44 Actual Hospital Bill
45 Hospital billed charge vs. DPC price
Service Hospital Charge DPC Price
Lab charges $38.14 $8.00
Chemistry $3524.14 $70.79
Hematology $1,782.95 $15.00
Urology $231.79 $4.50
Chest x-ray $490.94 $18.00
CT scan $10,955.13 $185
ER Level 4 $2,700.18 $0
TOTAL: $19,723.27 $301.29 46 Story of M.C.
47 Uninsured total knee replacement
$45,000-$60,000 $18,000-$22,500
$18,550
48 Cost of “coverage”
49 Cost of “coverage”
50 “Skyrocketing” cost of health care
DPC adult membership fee 80
70
60
50
40
30
20
10
0 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 51 “Coverage” versus “Care”
DPC Family of 4 = $ 1,980 per year PPO Family of 4 = $28,166 per year* Difference per year: $26,186 *2018 Milliman Medical Index 2019 ACA bronze plan max OOP $7,900 Individual $15,800 Family
52 10 year projection – Family of 4
$300,000 $281,660 Total Savings $250,000 Traditional PPO $200,000 $241,700 DPC + STLDP* $150,000
$100,000
$50,000 $39,960
$0 1 2 3 4 5 6 7 8 910
53 *2019 Golden Rule Short-term Medical Value Select A ($12.5 K ded, $22.5K max, $178/mos) Self-funded plans and DPC
DeSoto Memorial Hospital Experience Summary
2018 to 2019 saw $1.2 million in reduced claims Employee premiums reduced 20% Eliminated employee copayments and deductibles for most routine care Employee OOP at time of service reduced 30% Specialist visits reduced 60%
60% reduction in total spend by ELIMINATING BARRIERS to patient care and unnecessary middlemen!
Healthcare - simplified
58 Lee S. Gross, MD
@drleegross
Who We Are—Today’s Demographics
Pamela “Mel” Thomas Ms. Thomas is the Economic Development Manager for the City of North Port North Port Profile
• 104.2 Square Miles • Estimated at 30% built out • 73,652 Population (April 10, 2019 BEBR) • Population will reach over 100,000 residents by 2029 (3.3% year-over-year growth) • Age mix (2018) • <19 years 22.6% • 19-34 years 16% • 35-64 years 38.3% • 65+ 23.2 % Lakewood Ranch Area
City of North Port Community Comparison Basic Demographics (2018)*
City of North Port Lakewood Ranch Area • Population 68,055 • Population 63,475 • Median Age 44.5 • Median Age 48.6 • Med. Household Income $56,890 • Med. Household Income $98,429 • Education • Education • BS/Grad/Prof Degree - 22% • BS/Grad/Prof Degree - 47% • Some College - 32% • Some College - 29% • HS Graduate - 36% • HS Graduate - 19% • No HS Diploma - 9% • No HS Diploma - 5%
* Esri and Bureau of Labor Statistics Community Comparison Spending Habits (2018)*
City of North Port Lakewood Ranch Area • Income • Income • Median Household $56,890 • Median Household $98,429 • Median Net Worth $164,516 • Median Net Worth $512,058 • Disposable Income • Disposable Income • Groceries $4,785 • Groceries $7,058 • Eating Out $3,332 • Eating Out $5,108 • Travel $2,009 • Travel $3,405
* Esri and Bureau of Labor Statistics Community Comparison Healthcare Data *
City of North Port Lakewood Ranch Area • Annual Healthcare • Annual Healthcare Expenditures = $5,792 Expenditures = $8,605 • Uninsured = 13.2% • Uninsured = 5.9%
* Esri and Bureau of Labor Statistics Lakewood Ranch Area
City of North Port Manatee Memorial Hospital Blake Medical Center
Lakewood Ranch Medical Center
Sarasota Memorial Hospital Doctors Hospital of Sarasota
Sarasota Memorial Hospital – Venice Branch
Venice Regional Bayfront Health Sarasota Memorial Health Care Center ER
Bayfront Health Port Charlotte
Fawcett Memorial Hospital Englewood Community Hospital West Florida Surgery Center Riverwalk Ambulatory Center Surgery Center at Pointe West Manatee Surgical Center Bradenton Surgery Center Gulf Coast Surgery Center
Lakewood Ranch Medical Center
Premier Surgery Center of Sarasota Bayview Surgical Center Cape Surgery Center Advanced Surgery Center Sarasota Physicians Surgical Center Doctors Same Day Surgery Center Sarasota Ambulatory Surgery Center Intercoastal Surgery Center University Surgery Center Gulf Coast Surgery Center
Surgery Center at St. Andrews
Venice Healthpark Surgery Center Sarasota Memorial Health Care Center ER
Murdock Ambulatory Surgery Center Gulf Comprehensive Surgery Center Gulf Pointe Surgery Center Charlotte Surgery Center Influencing Factors
• Target population – proper patient mix • Fiscal Viability • Visibility and access (location, location, location) • Proximity to other healthcare access points (surgery centers, ambulatory care, etc.) • Convenience • Regulatory hurdles (e.g. CON) • Property with enough acreage (14 to 40 acres)
The Challenges We Face
Linda Stone, PhD. Dr. Stone, outgoing CEO for CenterPlace Health, Inc., has been in public health and related public service for low-income, culturally diverse populations since 1979. In May 2016, she assumed the role of Chief Executive Officer for Community Health Centers of Sarasota County, Inc., renamed CenterPlace Health, Inc, a not-for-profit 501c (3). She was responsible for ensuring the timely and efficient transition of Federally Qualified Health Center (FQHC) services from a public entity co-applicant arrangement with the Florida Department of Health in Sarasota County (DOH-S) to a community-based not-for-profit. Tasks included assuring a seamless transition of operations across all delivery sites and business functions. On average, CenterPlace Health serves approximately 25,000 low-income medical and dental patients. Dr. Stone earned a Bachelor of Business Administration from the University of Florida, a Master’s Degree from Stetson University and a Doctor of Philosophy from the University of Florida. Presentation to North Port City Commission
Addressing the Pressing Medical Needs of Low-income and Uninsured Populations BackgroundWhat is a Federally Qualified Health Center?
• 2005 – The North Port CHAT asked the Sarasota County Health Department to help low-income individuals access healthcare and a small facility was opened • 2008 – the North Port Health Center became a FQHC • 2011 – A renovated North Port Health Center opened A collaboration among public and private funders and agencies led to the opening of the North Port Health and Human Services complex of Pan American Dr. City of North Port; Sarasota County Government; Gulf Coast Community Foundation; Senior Friendship Centers; Sarasota County Health Department; and many others.
74 WHAT IS CENTERPLACE HEALTH?
• CenterPlace Health is a Federally Qualified Health Center (FQHC) • Along with Sarasota Memorial Hospital and Friendship Centers, we are the major primary health care safety-net and Medicaid providers for the Sarasota community. • In 2018, Sarasota County’s FQHC transitioned from a public-entity (i.e. Health Department) model to a community-based not-for profit.
75 WHATWhat IS is Aa FederallyFEDERALLY Qualified QUALIFIED Health HEALTH Center? CENTER?
• Federally Qualified Health Centers (FQHCs) are community-based and patient-directed organizations that serve populations with limited access to health care. • They provide comprehensive, culturally competent, quality primary health care services to medically underserved communities and vulnerable populations. • FQHCs are funded (in part) by the Health Resources and Services Administration (HRSA) • Services include comprehensive primary and preventive health care, including health, oral health, and mental health/substance abuse services to persons of all ages
76 CommunityWhat is a Federally Demographics Qualified Health Center?
• ALICE families - 27% (the rolling average between 2010 and 2016) of Sarasota residents, were what United Way describes as (Asset Limited, Income Constrained, Employed), and earn a bare minimum survival income.
• In 2016, the survival income in Sarasota County for two adults, with one infant and one preschooler, was $55,164. (Housing, Food, Child Care, Transportation, Healthcare, Taxes and Misc.)
• The median income for North Port is $54, 697.
• To address this situation, we provide health care on a sliding fee base on family size and income.
77 NorthWhat Port is a HealthFederally Center Qualified – Where Health We Center? Fit In
44% are on Medicaid 27% are uninsured 8% have Medicare
Federal Poverty Guidelines for 2019
% of 100% 125% 150% 175% 200% >200% Federal Poverty A B C D E F Level: Family At or At least At or At least At or At least At or At least At or At least Size Below Below Below Below Below 1 $12,140 $12,141 $15,175 $15,176 $18,210 $18,211 $21,245 $21,246 $24,280 $24,281 2 $16,460 $16,461 $20,575 $20,576 $24,690 $24,691 $28,805 $28,806 $32,920 $32,921 3 $20,780 $20,781 $25,975 $25,976 $31,170 $31,171 $36,365 $36,366 $41,560 $41,561 4 $25,100 $25,101 $31,375 $31,376 $37,650 $37,651 $43,925 $43,926 $50,200 $50,201 5 $29,420 $29,421 $36,775 $36,776 $44,130 $44,131 $51,485 $51,486 $58,840 $58,841 6 $33,740 $33,741 $42,175 $42,176 $50,610 $50,611 $59,045 $59,046 $67,480 $67,481 7 $38,060 $38,061 $47,575 $47,576 $57,090 $57,091 $66,605 $66,606 $76,120 $76,121 8 $42,380 $42,381 $52,975 $52,976 $63,570 $63,571 $74,165 $74,166 $84,760 $84,761 9 $46,700 $46,701 $58,375 $58,376 $70,050 $70,051 $81,725 $81,726 $93,400 $93,401 10 $51,020 $51,021 $63,775 $63,776 $76,530 $76,531 $89,285 $89,286 $102,040 $102,041 For each $4,320 $4,321 $5,400 $5,401 $6,480 $6,481 $7,560 $7,561 $8,640 $8,641 addtl person over 10, add: 78 NorthWhat Port is a HealthFederally Center Qualified – What Health is Missing Center?
• The Ever-growing Need for Access to Low Cost Healthcare • We are straining to serve existing patients. • The Salvation Army is opening a new facility nearby, which will expand the need to provide health care for the homeless • We have outgrown our building and capacity for parking
• Mother/Baby Services – the nearest birthing hospital in Sarasota County is SMH, 41 miles to the north
• Access to Specialty Care for North Port Health Center patients
79 HowWhat We is Helpa Federally – It is moreQualified than Health you think! Center?
• A young pregnant patient come to the NPHC for prenatal care. • She was the victim of sex trafficking and addicted to opioids. • She already had 1 child, who came to us for pediatric care. • With this pregnancy, DCF became involved and developed a safety plan for the family. We were integral in helping her follow this plan, which she agreed to. • Our substance abuse interventionist and case manager connected her to a number of services including substance abuse treatment. • We delivered her second child and provided both post-partum care for her and pediatric care for the baby. • Both children have chronic needs, which our pediatricians supervise. They are connected to specialize services at All Children’s Hospital. • Mom will be treated at our health center for HepC • She and the children are thriving and mom is studying for an AA degree.
80 RecommendationWhat is a Federally Qualified Health Center?
Convene a group of community stakeholders to assess North Port’s health care needs and recommends priorities.
Develop a (10 year) plan address priorities with timelines to address priorities in order.
81 MISSION To provide efficient and effective delivery of affordable quality health services to at risk VISION and vulnerable populations in a An engaged, healthy, and compassionate and caring prosperous community manner. where access to health care enhances the attainment of a high quality of life for our residents VALUES Accountability Honesty Care & Compassion Integrity Collaboration Respect Commitment Quality Dignity Transparency
82 THANK YOU FOR THIS OPPORTUNITY.
83
Financial & Economic Factors of a New Hospital
Kristen Gentry, MPH Ms. Gentry is the owner of Encompass Medical, which recently opened here in North Port. Prior to opening the durable medical equipment and supply store, she served as Chief Operating Officer for Community Health Systems for 12 years. She has had many opportunities to be involved with new build projects, certificate of need procedures and healthcare service line and subspecialty analysis. Ms. Gentry earned her Master of Public Health Management and Policy from the University of Michigan. The Healthcare Landscape
Presented by: Kristen Gentry Agenda
• Introduction/Personal Background • Definitions • Current Healthcare Demands • Internal and External Factors • Local Healthcare Utilization • Cost vs. Return on Investment • Where is Healthcare Going? Introduction/Background
Education: Ohio Northern University Bachelor of Science in Business Administration Minor of Biomedical Sciences University of Michigan Masters of Public Health, Management and Policy Introduction/Background
Experience: 13 Years in Hospital Administration Hospital Operations Service Line Analysis, New Program Development Physician Recruitment and Contracting Certificate of Need Investigation and Justification CMS, AHCA and TJC Proficiency Current Owner and General Manager of Encompass Medical, LLC. in North Port Durable Medical Equipment, Supplies and Uniforms (May 2019) Definitions ACO: Accountable Care Organization, a formal coordination of healthcare providers that participate in a methodology which ties quality metrics and healthcare costs to their reimbursement in an effort to provide the most cost-effective care. AHCA: Agency for Health Care Administration, Regulatory body deemed by CMS for Hospitals and Healthcare establishments in the State of Florida. CMS: Centers for Medicare and Medicaid Services, Federal regulatory body for Hospitals and Healthcare establishments. DRG: Diagnosis Related Group, the general category of a patient condition or surgery that typically guides the standard and expected length of stay as well as billing and coding for reimbursement purposes. Elective Care: Treatment that is not required for life or limb preservation either on a short term or long-term basis. Instead this care is “chosen” for wellbeing, quality of life or personal desire. EMTALA: Emergency Treatment and Labor Act, Federal Law that requires any patient presenting to an emergency room with an emergent medical condition or in active labor to receive care and treatment to stabilize the acute medical condition regardless of ability to pay. Observation Status: The placement status of a patient who is receiving care and treatment in a hospital but does not meet the Medicare definition required for hospital admission. This status has an expected stay of only 24 hours in the hospital (or “outpatient”) to diagnose and resolve the acute condition. Medicare Patients in an Observation Status cannot access their Medicare Part A benefits. Instead, payment occurs under the Medicare Part B benefits and often results in higher out-of-pocket responsibility. Payor Mix: The breakdown or separation of patients for analysis by how they will pay for healthcare services. • Land Acquisition and • Specialty Needs Development • Recruitment Costs • Building Size (Beds and • Office Space for Follow-Up Ancillary Services) Care • Fixed Costs Physicians • Retention • Regulatory Requirements Building and Employees
Equipment Patients • Electronic Medical Records • Patient Satisfaction • Compliment of Ancillary • Acuity (Emergency, Services Observation, Inpatient, • Critical Care and Surgical Critical Care) Equipment • Financial Responsibility • Elective vs. Emergent Care • Fair Market Value and Cost • Cost to Build of Living for Staff and • Reimbursement and Physicians Contractual Rates • Financial Capabilities of • Collections Patients • Cost of Care • Demand vs. Supply of Staff • Capital Investments and • Patient Satisfaction Financing for Updates • Regulatory/Legal • Regulatory/Legal Requirements Requirements Finance People
• Services Available • Confidence in Competition Services and Care • Staff Pay and • Market Saturation Retention • Regulatory/Legal • State of Art Requirements Equipment and Technology Local Healthcare Utilization
Utilization by Zip Code of Medicare Beneficiary (2018) ED Visits by 1,000 Population Zip Code Number of Days Number of of Care Discharges • Statewide Average: 540.0 34223 8,951 1,834 34224 7,055 1,494 • Sarasota County: 598.3 32486 6,121 1,015 • Charlotte County: 464.2 34287 12,967 2,394 34288 3632 698 34289 994 197 Source: Agency for Health Care 34291 1,951 369 Administration: Emergency Department Utilization Report. 2017. 34293 18,155 3,555 Total 59,826 11,826 Source: CMS Medicare Claims Data, 2018. Top 3 DRGs per Local Hospital by Medicare Discharge Source: Medicare Inpatient Prospective Payment System, FY 2017
Sarasota Memorial Doctor’s Hospital of Sarasota Englewood Hospital 470 – Major Joint Replacement 1,169 470 – Major Joint Replacement 637 871 – Septicemia/Sever Sepsis 96 (Lower Extremity) (Lower Extremity) w/ MCC 871 – Septicemia/Severe Sepsis w/ 530 871 – Septicemia/Sever Sepsis w/ 151 470 – Major Joint Replacement 75 MCC MCC (Lower Extremity) 291 – Heart Failure and Shock w/ 338 483 – Major Joint Replacement or 135 190 –COPD w/ MCC 75 MCC Reattach (Upper Extremities) Total Medicare IP Discharges 12,054 Total Medicare IP Discharges 2,817 Total Medicare IP Discharges 1,278
Venice Regional Bayfront Health Bayfront Health – Port Charlotte Fawcett Memorial 871 – Septicemia/Sever Sepsis w/ 236 291 – Heart Failure and Shock w/ 172 470 – Major Joint Replacement 375 MCC MCC (Lower Extremity) 291 – Heart Failure and Shock w/ 179 871 – Septicemia or Severe Sepsis w/ 169 871 – Septicemia or Severe 346 MCC MCC Sepsis w/ MCC 470 – Major Joint Replacement 172 190 –COPD w/ MCC 162 291 – Heart Failure and Shock w/ 223 (Lower Extremity) MCC Total Medicare IP Discharges 3,873 Total Medicare IP Discharges 2,947 Total Medicare IP Discharges 5,105 Top 3 Outpatient Services per Local Hospital by Medicare CAPC (Count of APCs Codes) Source: Medicare Outpatient Charge Data, FY 2017 Sarasota Memorial Doctor’s Hospital Englewood Hospital 8011 – Comprehensive 2,665 8011 – Comprehensive 308 8011 – Comprehensive 616 Observation Services Observation Services Observation Services 5191 – Level 1 Endovascular 925 5222 – Level 2 131 5361 – Level 1 Laparoscopy and 107 Procedures Pacemaker/Similar Procedures Related Services 5072 – Level 2 759 5114 – Level 4 Musculoskeletal 116 5375 – Level 5 Urology and 98 Excision/Biopsy/I&D Procedures Related Services Total Medicare CAPCs 11,302 Total Medicare CAPCs 1,500 Total Medicare CAPCs 1,267
Venice Regional Bayfront Health Bayfront Health – Port Charlotte Fawcett Memorial 8011 – Comprehensive 1,133 8011 – Comprehensive 830 8011 – Comprehensive 639 Observation Services Observation Services Observation Services 5072 – Level 2 340 5193 – Level 3 Endovascular 293 5302 –Level 2 Upper GI 274 Excision/Biopsy/I&D Procedure 5191 – Level 1 Endovascular 329 5191 – Level 1 Endovascular 279 5191 –Level 1 Endovascular 218 Procedures Procedure Total Medicare CAPCs 4,095 Total Medicare CAPCs 2,789 Total Medicare CAPCs 2,345 DEMAND ON INPATIENT CARE
Accountable Care Organizations
CMS Observation Status
Expected Length of Stay by DRG
Insurance Pre-Authorizations
DEMAND ON INPATIENT CARE Payor Group Adult IP Adult OP Adult Total Adult % Pediatric IP Pediatric OP Pediatric Total Ped % Visits Visits Visits Visits visits Visits
Medicaid 222,517 1,466,180 1,688,697 19.3% 44,336 1,323,490 1,367,826 69.5%
Commercial 305,375 1,987,246 2,292,621 26.2% 19,669 369,819 389,488 19.8%
Charity 36,668 145,807 182,475 2.1% 155 6,572 6,727 0.3%
Self/Under/Uninsured 146,800 1,403,288 1,550,088 17.7% 2,224 107,537 109,761 5.6%
Medicare 988,236 1,697,789 2,686,025 30.7% 237 6411 6648 0.3%
Other Or Unknown 53,885 292,596 346,481 4.0% 4,047 82,721 86,768 4.4%
Overall 1,753,481 6,992,906 8,746,387 100% 70,668 1,896,550 1,967,218 100% State of Florida – Utilization Statistics Source: Agency for Health Care Administration – Emergency Department Utilization Report 2017
“In 2017, Florida Emergency Departments experienced a total of 10,713,605 visits with 1,824,149 (17%) of those visits resulting in a hospital admission. Pediatric Inpatient Hospitalization: 3.6%; Adult Inpatient Hospitalization: 20.0%” Cost Revenue/Reimbursement
• Average New Hospital Construction • “AHA [American Hospital Association] Costs, excluding Equipment: $400.00 Data showed that hospitals only psf received $0.87 for every dollar they (ASHE 2016 Hospital Construction Survey) spent caring for Medicare/Medicaid beneficiaries.” (Revcycle Intelligence. “Medicare, Medicaid Reimbursement • Often expressed as Cost Per Bed, $76.8B Under Hospital Costs.” Jan. 2019) Average Cost: $1.0 Million - $1.5 Million • Cost Shifting Strategy: Negotiating Higher Contractual Reimbursement • Charity and Uncompensated Care: with Commercial Contracts Emergency Department EMTALA Law
• High Margin Service Lines Deloitte Insights: “Return on Capital Declined Across all Health Care Sectors between 2011 – 2017” Deloitte Insights: “Return on Capital Declined Across All Health Care Sectors Between 2011-2017”
“Hospitals and health systems are the most capital-intensive organizations in the health care sector, and their ROC [Return on Capital] levels are the lowest. Decreased losses from bad debt due to expanded health insurance coverage through the Affordable Care Act (ACA) and consolidation have contributed to relatively stable returns. Larger systems tend to have higher ROC than the industry average. ROC for the top five (5) largest health systems by revenue was double (12.3% in 2017) the ROC for the rest of the hospitals and health systems we studied.” Suggested Next Steps:
1) Deep Dive into North Port Specific Payor Mix 2) Demand Analysis: What services is the community willing to stay local for (Confidence Level) 3) Focus Group to Determine Levels of Service and Specialties 4) Cost Analysis for Service Levels 5) Reimbursement Study 6) Return on Capital/Return on Investment Education Services Primary Care Home
Mental Health Services Specialty Care
Diagnostics (Lab and Medical Imaging) What is Wound Management Health Care? Pharmaceuticals and Durable Medical Equipment Outpatient Rehabilitation Services
Home Health Care Infusion Therapy Hospital Inpatient Rehab and/or Skilled Nursing Services
Land Requirements & Possibilities
Nicole Galehouse, AICP Ms. Galehouse is the Planning Division Manager for the City of North Port.