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1994-04-27 Regular Meetingr KODIAK ISLAND HOSPITAL ADVISORY BOARD MEETING April 27, 1994 SEP 3 01994 NANO SOROUGf l;Lctlr\ :S OFFICE BOARD PRESENT: Betty Springhill, Gil Bane, Loren Halter, Gretchen Saupe, Wayne Stevens, Alan Austerman EXCUSED: Ben Ardinger, Kevin Creelman, John Shank STAFF PRESENT: Ed Myers, Mary Munk, Kate Fitzgerald, Pam Foreman OTHERS PRESENT: With a quorum present, the meeting was called to order at 7:00 p.m. ACCEPTANCE OF AGENDA Motion made and seconded to accept the 7�ncic. APPEARANCES AND COMMUNICATIONS Kate Fitzgerald, Patient Care Administrator, reported on the TQM program, patient survey, and. Midwife protocol issues. Ms. Fitzgerald reported that the M-Team evaluated the results of last year's downsizing. The savings projected fell short of the goal. Variable staffing, as opposed to an FTE reduction, didn't work. It made the staff unhappy, while only saving around $15K ($40K was expected). To help solve the staffing problem, Jack Lua will become a floater to the Radiology, Respiratory Therapy, and Physical Therapy departments. Mr. Myers also discussed the status of the laboratory proposal submitted to local clinics. He stated that it would be difficult to compete with reference labs, even with the substantial price reduction offered in the KIH proposal. Pam Foreman updated the Board on upcoming Public Relations functions in observance of National Hospital Week, 5/8-14. She invited the Board to attend a barbecue for Hospital staff on Friday, 5/13, and informed them about a free blood pressure clinic to be held at the Hospital on Thursday, 5/12. Additionally, she announced a baby photo contest to be held at the Care Center, and asked Board members to participate and donate small prizes for bingo winners. She also renn-+ed on the status of the new Physical Therapy cl*-.nic'b urc„ i.0u5e. Staff are still moving in, and equipment deliveries are being delayed by the Teamsters' Strike. She noted that the open house will be postponed, and advised against premature advertising for the event. r MEETING MINUTES OF APRIL 13, 1994 MOTION made and seconded to accept the April 13, 1994, minutes. COM %1IT I'EE REPORTS Finance Committee: Ms. Munk reported on the Finance Committee meeting. She walked the Committee through the new budget, allowing._ for discussion, questions and comments. Mrs. Springfield indicated that she was impressed with the Operational Plan and the realistic projections. She was pleased that the plan not only set goals, but also planned ways to reach them. OLD BUSINESS A. Physical Therapy Grand opening Board members commented that the new Physical Therapy clinic looks great, and also noted the improvement in the appearance of the Hospital's floors. Mr. Myers informed the Board that the clinic is alp-.aay very busy and receiving many referrals. It was tnat ..,111. :,,.8iness may be lost, however, due to the Coast Guard's Lraiiiug of active duty personnel in Physical Therapy techniques. NEW BUSINESS A. 1995 Budget Ms. Munk directed the Board to the statistics portion of the Budget, and outlined the following assumptions affecting the projections: * 1% decrease in in -patient services * 5% increase in out -patient services * Care Center days remain the same, with at least 11 residents (break-even point); Ms. Munk used the budget statistics to illustrate the decline in demand for in -patient services, and noted that this follows the current national trend toward outpatient services. She pointed out that the Hospital's new programs and specialty clinics are geared toward providing more outpatient care. She also stated that the construction project will allow for the needed space to develop outpatient services (off-sjtP Physical Therapy clinic, for example). HOSPITAL ADVISORY BOARD MINUTES April 27, 1994 -2- r r Ms. Munk and the Board members analyzed the effects of the downsizing of the FTEs, and went over 1994 and 1995 projections, which are expected to remain stable. However, these numbers could fluctuate somewhat because of the acuity system used in some departments. The Board members examined the Payor Mix statistics, and it was pointed out that Medicare and Medicaid combined is 23%, which is low compared to other hospitals; yet, commercial insurance and self -pay numbers are high for Kodiak. The Board also reviewed the Income Statement, and Mr. Myers listed four methods to meet the Hospital's revenue goals: 1. Increase rates 2. Decrease expenses 3. Add revenue -generating services 4. A combination of these strategies The Board evaluated these options: a 7% rate increase versus a subsidy in the Budget. Members discussed the effects of such a rate hike, and Mr. Myers explained how Ms. Munk arrived at the 7% figure. He said that the figure considered a 6-8% inflation rate, and the shift from in- patient to out -patient services. Mr. Myers also mentioned that the State of Alaska coilld -i.d Tersely affect the Hospital's bottom line by reducing by 251 tbR revenue sharing pass -through funds, which currently is not factored into the budget. Board members suggested that this possibility should be included in the projections as a worst case scenario. Mrs. Springhill told the Board that Dr. Shank was opposed to a rate increase because rates had already been raised 40% over the past few years. Mr. Myers noted that the increase occurred because of a 7 year freeze on rates, and the Hospital was "catching up" to inflation. He also pointed out that the Borough chose the last rate increase in lieu of granting the Hospital a subsidy. Mr. Austerman asked if the 7% was part of the $10 million revenue figure, and Ms. Munk told him yes. Mr. Stevens remarked that the proposed rate increase falls right in the middle of the cost of living figures, and concluded that due to that, Tong with inflation, it would be unrealistic for the Hospital not to raise rates to meet inflation. Mr. Myers enumerated expenditures faced by the Hospital, the costs for which it cannot recover, such as the City of Kodiak's failure to pay bills, and flight costs not covered by Medicare. After lengthy discussion, the Board concluded that a 7% increase in funds was definitely needed; however, it was felt that the funding to balance the budget should come from the Borough. HOSPITAL ADVISORY BOARD MINUTES April 27, 1994 -3- r MOTION by Mr. Stevens Seconded by Mr. Bane AYES: yn NAYS: B. OPERATIONAL PLAN r recommending that the Board ask the Borough for a 1 mil subsidy to balance the budget. Springhill, Bane, Halter, Saupe, Stevens. Austerman. MOTION PASSED Mr. Myers gave an overview of the Operational Plan draft. He noted that it is a three-year plan, with the following components: environmental assessment, development of strategic goals, and long-term plans to achieve the stated goals. Mr. Myers also explained the relationship of this plan with long term goals of managed care and capitated programs. The Board will finalize the Operational Plan at the next meeting. ADMINISTRATOR'S REPORT Mr. Myers briefed the Board on the status of the artwork in the Llame estate. He stated that an agreement had been reached with the Historical Society, whereby the Hospital would release the artwork in exchange for a reasonable donation to the Foundation. If the Historical Society does not have cash for such a donation, the Hospital will accept signed over National Bank of Alaska stock. Mr. Myers also discussed the progress will conduct a conference call with Do the construction. He noted that the building in 1994 is unrealistic because plans, and the bidding completed. groundbreaking for the site in 1994 1 Board asked to meet with Mr. Prochaska Mr. Myers agreed to set it up. He also to view the concept schematics and process. HOSPITAL ADVISORY BOARD MINUTES April 27, 1994 -4- of the construction plans. He n Prochaska to get a timeline on goal of breaking ground for the we need specifications, complete He did say, however, that oas a more realistic goal. The on May 3 when he is in town, and promised to allow Hospital staff contribute their input to the BOARD AND AUDIENCE COMMENTS The Board discussed the possible postponement of the KIH-2000 until Fall when they know what the effects of new laws on healthcare will be. Mr. Myers discouraged postponing the meeting because it provides information the Borough should have now. The meeting is necessary now because it will give the Assembly an overview of issues that must be decided, and will allow the participants to develop a framework to address other issues when they come. _- Ms. Saupe thought the Blood Pressure Clinic should be held at Safeway, in order to reach more people. Mr. Bane also suggested that a Cholesterol Clinic be held some time. Mr. Stevens asked that the Board be reminded of the Certificate of Need Hearing on 5/3 @ 6:00 p.m. at the Borough Assembly Chambers. The Board also requested a reminder of the 5/13 picnic. Mr. Bane notified the Board that he will be out of town until August. The Board asked about the status of Psychiatrist recruitment. Mr. Myers said that he has started a low profile search, but that whether one will be hired will be decided by the Borough in the -Budget ciupo�ai. /\1�,-[Illltmo1u 1 The meeting was adjourned at 9:30 p.m. Recorded by Donna Milan. Pi i HOSPITAL ADVISORY BOARD MINUTES April 27, 1994 -5- BOARD AND AUDIENCE COMMENTS The Board discussed the possible postponement of the KIH-2000 until Fall when they know what the effects of new laws on healthcare will be. Mr. Myers discouraged postponing the meeting because it provides information the Borough should have now. The meeting is necessary now because it will give the Assembly an overview of issues that must be decided, and will allow the participants to develop a framework to address other issues when they come. Ms. Saupe thought the Blood Pressure Clinic should be held at Safeway, in order to reach more people. Mr. Bane also suggested that a Cholesterol Clinic be held some time. Mr. Stevens asked that the Board be reminded of the Certificate of Need Hearing on 5/3 @ 6:00 p.m. at the Borough Assembly Chambers. The Board also requested a reminder of the 5/13 picnic. Mr. Bane notified the Board that he will be out of town until August. The Board asked about the status of Psychiatrist recruitment. Mr. Myers said that he has started a low profile search, but that whether one will be hired will be decided by the Borough in the Budget proposal. ADJOURNMENT The meeting was adjourned at 9:30 p.m. Recorded by Donna Milan. Approved, Advisory Board Secretary HOSPITAL ADVISORY BOARD MINUTES April 27, 1994 -5- Kodiak Island Hospital & Care Center 1915 E. Rezanof Drive Kodiak, AK 99615 (907) 486-3281 FAX (907) 486-2336 Advisory Board Kodiak Island Hospital & Care Center 1915 E. Rezanoff Drive Kodiak, AK 99615 Re: FY 1995 Budget Dear Board Members: Attached with this letter is the budget for the twelve months ended June 30, 1995 as prepared by the administrative team at Kodiak Island Hospital and Care Center. As part of our team approach to this process, LHS Management Company central office staff has provided input on the preparation and completed a review of the enclosed package. Included in our review of the budget was a detailed analysis, as well as an overview of the following information: Activity Levels Allowances and Deductions Expenses Staffing Levels Revenues Additionally, we have performed an in-depth review of departmental revenues, staffing and expenses on a unit basis (i.e.: revenue per patient day, manhours per procedure and expenses per procedure). Any comments derived from this review have been communicated to the facility administrative team and changes made as appropriate. The following table represents key financial performance indicators for your facility: 1993 Proj 1994 Budget 1995 Desired Trend Operating Margin -12.1% -3.0% -1.2% Increasing Deductible Ratio 12.6% 14.4% 13.7% Decreasing Current Ratio 2.85 1 4.13 4.45 Increasing Net Days in Accts Receivable , 94.3 81.2 73.9 Decreasing Days Cash on Hand .65 23.9 27.7 Increasing Days in Inventory 92 91 73 Decreasing Days In Accounts Payable 1 35 1 37 36 Decreasing Long term Debt to Equity .07 .04 .02 Decreasing ManaoM by the I HC Manaocrncnt r,m .. Fo.en t.lna6 n�L.a. r Board of Directors Kodiak Island Hospital & Care Center Page 2 Lastly, we have compared the budget to facility goals for this budget period. 1. The budgeted operating margin is -1.2% (goal .2%). 2. Net Days in facility accounts receivable are budgeted at 73.9 (goal of 75 for hospital and 50 for care center). 3. Budgeted days cash on hand is 27.7 (goal 50). 4. Days in accounts payable are budgeted at 36 (goal 35.8). 5. The Current Ratio is budgeted at 4.45 (goal 2.9) In summary, the budget is reasonable and meets the majority of established financial goals, with variances within acceptable parameters. The original goals for days cash on hand and operating margin were based on December year-to-date information. After review of February year-to-date information the budget goals were reduced to more accurately reflect the actual and projected financial performance. Our recommendation is to approve the budget as submitted. Sincerely, LHS Management Company KODIAK ISLAND HOSPITAL AND CARE CENTER 1995 ANNUAL BUDGET TABLE OF CONTENTS ADMINISTRATIVE SUMMARY .................................. 1 BUDGET COMMENTARY ...................................... 3 COMPARATIVE STATISTICE (Schedule #1) ........................... 8 FULL TIME EQUIVALENTS (Schedule #2) ........................... 9 HOSPITAL PAYOR MIX (Schedule #3) ............................. 10 INCOME STATEMENT (Schedule #4) .............................. 11 BUDGETED EXPENSES GRAPH (Schedule #5) ........................ 12 EXPENSE DETAIL .......................................... 13 ROOM RATE SURVEYS (Schedule MA, 6B, 6C) ....................... 16 COST OF LIVING INDEX/HEALTH CARE INDEX (Schedule #7) ............ 19 CAPITAL EXPENDITURE BUDGET .............................. 20 CASH FLOW BUDGET/BALANCE SHEET BUDGET 23 ADMINISTRATIVE SUMMARY 1994 - 95 BUDGET Kodiak Island Hospital & Care Center is now completely phased into the change of fiscal year from December 31 to June 30. The following budget information is based on the Fiscal Year July 1, 1994 through June 30, 1995. The 1995 budget reflects a revenue shortfall in the amount of $613,185 or approximately a 7% increase in rates. This increase takes into consideration the continuing requirements to maintain an ongoing annual operating gain, while keeping rates reasonable. The Kodiak Island Hospital is responding to community needs by maintaining quality customer satisfaction as well as being reimbursed for our services. The National Medical Care inflation factor is 6-8o which is reflected in the budget. Kodiak Island Hospital & Care Center, like many other facilities nationwide, is experiencing declining inpatient medical workloads, as well as fewer residents in the Nursing Home. The increases reflected in the Kodiak Hospital budget are due primarily to increases in outpatient volume. As the figure 1.1 illustrates, the emphasis has moved from inpatient to outpatient services. 1 Proj. Budget 1988 1989 1990 1991 1992 1993 1994 1995 Med/Surg Admissions 836 858 726 664 761 651 532 400 Births 284 258 277 257 231 222 268 265 Surgical Procedures: Inpatient 215 152 127 205 238 172 162 160 Outpatient 142 145 107 161 214 187 200 210 ER Visits 3586 4219 4305 4184 4494 4293 3846 4038 ICF Days 6442 6598 6061 5980 5693 5908 4784 4736 figure 1.1 KIH/CC must concentrate on increasing outpatient revenue through additional specialty capabilities, new programs, and a closer working relationship with the community at large and the business sector. The construction project scheduled will greatly improve the hospital's ability to deliver these services community -wide. With the additional space provided in the new construction, we will continue to recruit for an orthopedic surgeon and improve other specialty clinics held in Kodiak to increase volume at the hospital. Cost of equipment repairs and maintenance, recruitment fees and legal fees continue to increase. Historical trends dictate that legal services and maintenance will continue as a major cost. The Full Time Equivalents are budgeted at 104.4 in 1995, reflecting a decrease over 1994 levels. Current staffing in most areas is based on patient levels and is monitored regularly. The approval to support the revenue shortfall is necessary to offset the effects of inflation, declining State Revenue Sharing, and the move of workload volume. Although Kodiak has one of the highest composite costs of living in the state, medical costs at Kodiak Island Hospital & Care Center are within the mid range statewide. 2 KODIAK ISLAND HOSPITAL & CARE CENTER FISCAL YEAR DULY 19 1994 - JUNE 309 1995 OPERATING BUDGET UTILIZATION Schedule #1 reflects the utilization that Kodiak Island Hospital & Care Center is expecting to experience in fiscal year,1995. This schedule compares the budgeted statistics for FY 1995 with projected current and actual prior year. Patient days for FY 1995 for the hospital are budgeted to be 2748. This compares to 2517 patient days in 1993 and 2776 projected patient days in 1994. Medicare utilization is expected to remain at approximately 23.2% of total patient days. (see schedule #3). overall, inpatient utilization is expected to decrease approximately 1%, outpatient utilization is expected to increase approximately 5%, and Nursing Home utilization will remain approximately the same. Ancillary utilization in most departments is budgeted to be comparable to the overall percentages. The Nursing Home is expected to experience 4736 resident days. This compares to 5908 resident days in 1993 and 4784 resident days in projected 1994. Utilization is expected to be maintained at an above break-even status. 3 WAGE AND SALARY A budgeted wage increase consistent with inflation has been implemented in this budget. Union negotiations took place in January, 1993 and a new contract was put into place February 16, 1993. This is a three year contract which implemented a pay for performance system for all union employees. Increases, awarded the staff will be controlled as a result of the contract. HUMAN RESOURCES Schedule #2 shows the full time equivalents (FTE's) broken down by service for Kodiak Island Hospital and Care Center. Total FTE's decreased substantially in July 1993 with right sizing measures being implemented, and this reduction will be maintained throughout the fiscal year 1995 budget period. The Marine Service program was down sized with some offsetting increases in Physical Therapy to accommodate the increased demand for the services. INCOME OR (LOSS) Schedule #4 illustrates the comparative income and loss statements for 1993, projected 1994, and budgeted 1995. The budget incorporates a $613,185 revenue shortfall funding necessitated by a 6% - 8% inflationary increase, declining State Revenue Sharing, as well as adjustments for volume shifts. The funding of the 4 shortfall allows for the facility to anticipate a -.1% operating gain from operations. This gain is below industry standards of a 2% to 3% operating gain. This operating gain plus non -operating revenues consisting of revenue sharing from the State of Alaska and interest income will be used for capital expenditures and remaining cash flow generated will be used for debt service repayment, as well as funding reserves for future expenses and contingencies in the budget year. ALLOWANCES AND DEDUCTIONS Over the past year, significant legislative activity has occurred which reduces Medicare and Medicaid reimbursement to health care providers. We are projecting changes in the levels of reimbursement in Medicare and Medicaid. The levels of reimbursement in these areas remain uncertain with nation wide health care reform still pending. A conservative approach will be taken to ensure budget stability in these areas. Physician fees will remain consistent with 1994 projections for contractual arrangements with Emergency Room Physicians and locum tenens physicians will continue. The anticipated inflation rate for supplies is 6% to 8%. Utilities 5 are also substantially higher as a result of inflationary factors, as well as the growing costs of operating an older building. Repair and maintenance costs are increasing as a result of increased maintenance contracts on equipment and the increased costs of repairs to older equipment and facility repairs. Insurance is expected to increase as a shift was made from self insurance to a professional liability policy covering the hospital. Other expense consists of travel and education, employee relations, telephone, postage, recruitment, moving and relocation, computer rental, office/apartment rent, freight, medical waste, public relations, medivac expense, and licenses. Items making up the major portion of this category are travel and education (15%), freight (10%) rental/lease (9%), and computer rental (8%). The other expense area has been kept relatively consistent. Schedule #5 details a pie chart of the breakdown of budget expenses for 1995. RATES Schedule #6A through 6C compare semi -private, nursery, and ICU room rate charges for the Kodiak Island Hospital with area competitors. According to this survey, taken as of December 1993, Kodiak Island P Hospital has rates that fall in the mid range of the facilities included in the graph. The hospital rates shown for Kodiak do not reflect the rate increase of 7%. Schedule #7 compares the cost of living index and cost of health care index for four areas in the state. Data is taken from the American Chamber of Commerce Researcher's Association report for the third quarter of 1993. This graph demonstrates that while Kodiak has the highest cost of living index (150.0), it also has next to the lowest health care index (181.8), among Alaska hospitals listed in the report. The above data support the validity of funding the shortfall for the Kodiak Island Hospital & Care Center. Again, this increase makes possible a small gain from operations in light of 6% - 8% overall inflationary factor, declining State Revenue Sharing, and allows for a facility budget in which non -operating revenues may be used for equipment replacement and funding reserves for the future expenses/contingencies in the budget year. SUMMARY In summary, this financial plan is our best estimate of what will happen in the future at Kodiak Island Hospital & Care Center. In order to maintain a financially viable operation, it will be necessary to monitor operations on an ongoing basis to ensure that high quality patient care is delivered in a cost effective manner and the financial objectives of the facility are achieved. 7 A KODIAK ISLAND HOSPITAL & CARE CENTER Fiscal Year Comparative Statistics STATISTICS -------------------- Patient Days Medical/Surgical OB/GYN Swing Beds ICU Total Patient Days Admissions Newborns Births Newborn Days Outpatients Total Visits DEPARTMENTAL STATISTICS Surgical Procedures Recovery Room Procedures Anesthesiology Emergency Room Visits Medivac Transfers Respiratory Treatments EKG Procedures. Laboratory Procedures Radiology Procedures CT Scan Procedures Mammograms Ultrasound Procedures IV Therapy Procedures Phys Therapy Treatments Social Sery Treatments Laundry Pounds Dietary Meals NURSING HOME ---------------- Care Center Days SCHEDULE #1 1993 1994 1995 Actual -------- Projected --------- Budget -------- 1847 1808 1790 347 456 451 217 480 475 106 32 32 2517 2776 2748 1158 1112 887 222 268 265 321 404 400 8714 8182 8591 359 362 370 249 208 211 319 354 359 4293 3846 4038 94 96 98 6027 4386 4163 899 654 535 69312 67508 69258 3620 3378 3510 337 346 358 524 486 510 1016 1140 1165 1089 1054 1043 6154 6704 6984 1583 1186 1174 162845 158094 156514 48043 46904 46435 5908 4784 4736 E SCHEDULE #2 Kodiak Island Hospital & Care Center Full -Time Equivalents FY 1993 FY 1994 FY 1995 ---------- Actual Projected ---------- Budget ---------- Direct Care Services Patient Care Services 31.60 28.40 28.60 Resident Care Services 14.70 14.00 13.10 Pharmacy 1.70 1.80 2.00 Social Services 0.80 0.60 0.60 Activities 1.00 1.00 1.00 Marine Health 2.00 1.80 0.00 ---------- Total Direct Care Services 51.80 ---------- 47.60 ---------- 45.30 Ancillary Services Diagnostic Services 8.60 8.10 7.90 Therapy Services 3.80 3.00 3.90 ---------- Total Ancillary Services 12.40 ---------- 11.10 ---------- 11.80 Support Services Dietary Services 9.00 8.60 8.10 Laundry Services 2.40 2.10 2.10 Housekeeping Services 6.40 6.30 6.40 Plant Services 3.20 3.00 3.00 ---------- Total Suport Services 21.00 ---------- 20.00 ---------- 19.60 Administrative & Fiscal Services Administration 1.20 1.00 1.00 Purchasing & CSR 2.60 2.00 2.50 Business Office 9.40 9.90 9.30 Human Resources 1.30 1.40 1.30 Finance 2.10 1.90 1.90 Medical Records 4.10 4.00 3.80 Quality Assurance 2.90 2.70 1.80 Security 3.00 2.00 2.70 Specialty Clinic 1.20 2.20 2.90 Medical Staff 0.00 0.00 0.50 Total Administrative & Fiscal Services ---------- 27.80 ---------- 27.10 ---------- 27.70 Total Organization ---------- 113.00 ---------- ---------- ---------- 105.80 ---------- ---------- ---------- 104.40 --------- -------- E r 0 KIH/CC PAYOR MIX SELF PAY 13% C�- ,) MEDICARE 13 ("�✓,�:��� MEDICAID 12% vAMERICAL 26% OTHER 3% VA 3% VC 4% �A 5% CHAMPUS 6%>.��� Total Hospital JULY 1, 1993 - DECEMBER 31, 1993 SCHEDULE #4 TOTAL HOSPITAL & YTD YTD BUDGET CARE CENTER CURRENT PROJECTED YEAR INCOME STATEMENT 7/93 - 12/93 7/93 - 6/94 7/94 - 6/95 REVENUES: GROSS PT REV $4,728,587 $9,456,364 OTHER OP REV 187,285 273,755 REVENUE SHORTFALL ------------ ............ TOTAL REVENUE $4,915,872 $9,730,119 ALLOW & DED NET REVENUE EXPENSES: SALARIES BENEFITS PHYSICIAN FEES OTHER PROF SER RAW FOOD DRUGS & IV'S MEDICAL SUPPLIES OTHER SUPPLIES UTILITIES REPAIRS & MAINT RENTAL EXPENSE INSURANCE OTHER DEPRECIATION INTEREST BAD DEBT EXPENSE TOTAL OP GAIN/LOSS NON -OP REV NET GAIN/LOSS MAN-HOURS TOTAL FTE'S STATISTICS: ADJ PT DAYS UNITS/STATISTICS: ---------------- TOTAL REV/STAT EXP/STAT MAN-HR/STAT 682,164 $4,233,708 $1,887,988 640,319 282,752 304,097 60,057 70,281 222,029 66,617 89,137 60,178 40,608 144,024 172,822 217,815 17,416 112,424 $4,388,564 1,364,329 $8,365,790 $3,657,988 1,270,082 566,154 591,074 120,114 140,562 430,996 133,510 178,274 122,520 81,450 288,048 340,444 435,630 34,832 224,849 $8,616,527 ($154,856) ($250,736) 88,565 159,326 ----------- ------------ ($66,291) ($91,410) 111,841 220,041 53.8 105.8 2,639 5,279 1,862.78 1,843.17 1,662.96 1,632.23 42.38 41.68 $9,544,893 267,335 613,185 ------------ $10,425,413 1,389,560 $9,035,853 $3,888,922 1,399,302 556,714 529,439 89,378 159,573 450,206 141,757 203,000 172,400 107,223 330,565 354,632 459,168 25,309 229,007 $9,096,595 ($60,742) ------------ 130,744 ------------ $70,002 217,057 104.4 4,644 2,244.92 1,958.78 46.74 11 r N KIH/CC EXPENSES Wages & Benfits 59% PIrcent of Tofal Budgeted 1995 Repairs & Maint. 2% isional Fees 12% Insurance 4% Depreciation 5% Rental 1% Other 4% Jtiilities 2% w Fsoodl 1%2% 9s 7% Interest 0% N Kodiak Island Hospital & Care Center Expense Detail PHYSICIAN FEES 7/94 - 6/95 Emergency Room Physician 468,576 Surgery Locum Tenens 41,138 Specialty Clinic Physicians 20,000! Intermediate Care Facility Physician 10,000' Medical Staff Physicians 4,500 Ultrasound Physicians 4,000 EKG Interpretations 2,500 Respiratory Therapy Physicians 2,000 Radiology Physicians 4,000 556,714 OTHER PROFESSIONAL FEES Pharmacy - Relief Pharmacist 7,525 Respiratory Therapy - Relief Respiratory Therapist 9,000 EKG 3,000 Speech Therapy - ICF Speech Therapist 1,250 Physical Therapy - Relief Therapist 4,500 Social Services 2,000 Occupational Therapy - ICF Therapist Contract 18,400 Nurse Inservice - Instructors 2,000 Anesthesia - Relief CRNA 32,756 Med/Surg 25,000 Administration Fees - LHS Contract 156,564 Administrator's/Financial Services Administrator's Salaries 159,790 Administration Other 7,766 Legal Fees 10,000 Collection - Attorney & collection Agency Fees 23,000 Medical Records 900 Quality Assurance 1,500 Dietary 9,900 Specialty Clinic 4.800 526,214 13 INSURANCE Professional Liability 292,443 General Liability 38.122 330,565 REPAIRS & MAINTENANCE Lab - Maintenance Contracts 38,000 Pharmacy 3,100 Respiratory Therapy 500 EKG 2,500 Radiology - Service Contracts 10,000 Ultrasound - Service Contracts 13,920 CT Scan - Service Contracts 41,880 Surgery 3,700 Emergency Room 500 Medivac 480 Nurse Inservice 500 Anesthesia 4,753 Med/Surg 1,000 Obstetrics 200 Business Office - Service contracts 10,917 Finance 500 Medical Records 450 Quality Assurance 100 Dietary 1;500 Housekeeping 400 Plant - Equipment 23,000 Plant - building 10,000 Auto 3,200 Purchasing 1,OOO Specialty clinic 300 172,4001 14 OTHER EXPENSES Travel & Education 71,700 Employee Relations 7,000 Telephone 35,000 Postage 22,000 Dues/Books/Subscriptions/Videos 33,773 Other Direct 24,097 Recruitment 30,000 Moving & Relocation 25,000 Microfilm 4,000 Computer Rental (Use Agreement) 40,000 Physical Therapy Office - Rental 26,000 Rent/Lease 42,373 Freight 50,537 Medical Waste 10,780 Public Relations 30,0W Instruments & Minor Equipment 9,750 Medivac Expense 20,600 Licenses 800 483,410 15 Room Rate Comparison Alaska Hospitals Homer Fairbanks Valdez Ketchikan Wrangel Seward Juneua Sitka Kodiak Soldotna Cordova Petersburg Anch - Providence Anch - Ak Regional As of December 31, 1993 r rn Semi -Private $434 $456 $475 $478 $490 $494 $495 $515 $517 MW $540 $550 $550 $585 $595 $0 $100 $200 $300 $400 $500 $600 $700 Room Rates Room Rate Room Rate Comparison Nursery Alaska Hospitals Valdez Anch - Providence Homer Sitka Soldotna Seward Kodiak Fairbanks Juneau Petersberg Wrangel Cordova Anch - Ak Regional Ketchikan $0 $100 $200 $300 $400 $500 $600 $700 Room Rates Room Rate Ai s of Deceber 31, 1993 r Room Rate Comparison Alaska Hospitals Homer Seward Valdez Petersberg Ketchikan Anch - Providence Kodiak Wrangel Juneau Cordova Sitka Fairbanks Soldotna Anch - Ak Regional ICU $962 $974 $975 $975 $992 $1008 $1014 $1015 $1020 $1025 IR $11oo MW $1257 �J $1430 1 $1800 $0 $500 $1000 $1500 $2000 $2500 Room Rate x h d r M rn ^3 of ppqPmp�r 31. 1993 1 200 150 100 KIH/CC INDEX Index Anchorage Fairbanks Juneua Kodiak Alaskan Cities Composite Index ® Health Care Index AMERICAN CHAMBER OF COMMERCE 3RD QTR 93 f CAPITAL BUDGET 20 CAPITAL EXPENDITURE BUDGET The attached Capital Expenditure Requests was prepared by the management team with input from department managers. Each manager was asked to identify equipment needed within the next fiscal year. They were also asked to research the cost, identify the anticipated purchase date and priority (need). Capital requests for FY 1995, by priority, are as follows: #1 "Must Have" $304,894 #2 "Should Have" $179,627 #3 "Nice To Have" $ 2,240 Total $486,762 While it is very important to routinely replace equipment to insure high quality care, good management systems (data processing) and to remain competitive with area facilities, it is equally important to build adequate reserves for future plan remodeling/replacement and unforseen emergencies. The Kodiak Island Hospital anticipates expending $180,000.00 in capital purchases in FY 95. 21 r, r Capital Expenditure Budget 7/1194 - 6/30/95 Capital Request ---------------------------------------------------------- Department Date --------- Amount ------------- Need Commodes Acute Nursing 07-01-94 21,500.00 ----- 1 IV Poles (10) Acute Nursing 07.01.94 3,000.00 1 Images -on -Call System CT Scan 07.01.94 16,000.00 1 Treadmill Electrode System EKG 07.01.94 600.00 1 Treadmill System EKG 01-01-95 18,050.00 1 Goose Neck Halogen Light Emergency Room 07-01-94 300.00 1 Physician Stool/Wheels Emergency Room 07-01-94 300.00 1 Stryker Trauma Stretcher 1020 Emergency Room 07-01.94 5,800.00 1 T-Series Analyzer for Hematology Lab 07-01-94 36,000.00 1 Orange Letters Medivacs 07-01-94 800.00 1 Corometric 115 Fetal Obsterical 07-01-94 8,000.00 1 Birthing Bed Obsterical 07-01-94 8,560.00 1 Dopplex Obsterical 07-01-94 700.00 1 Ohio Infant Warmer Obsterical 07-01-94 8,500.00 1 PC Computer Patient Information 07.01.94 1,800.00 1 Dictation System Patient Information 07-01.94 9,219.00 1 Pulmonary Function Machine Respiratory 07.01-94 28,000.00 1 Peak Flow Meter Respiratory 07.01-94 600.00 1 Instruments Specialty Clinic 07-01-94 15,000.00 1 Exam Table (2) Specialty Clinic 07-01.94 4,000.00 1 Goose Neck Halogen Light Specialty Clinic 07-01.94 500.00 1 OT/Opthalmoscope (2) Specialty Clinic 07-01.94 1,300.00 1 Head Light Hologen (2) Specialty Clinic 07-01-94 900.00 1 American Dilator System Surgery 07-01-94 3,400.00 1 Mammography Unit X-Ray 07-01-94 96,000.00 1 Laser Ouality Printer X-Ray 09-01-94 500.00 1 PC Computer, Lan Card 8 Licenses X-Ray 09-01-94 2,400.00 1 PC Computer, Lan Card 8 Licenses X-Ray 09-01-94 2,400.00 1 Label Printer X-Ray 09-01-94 300.00 1 RMSLite Software X-Ray 09-01-94 9,500.00 1 Radiographic Film Copier X-Ray 09-01-94 1,025.00 1 Must Have Total 304,894.00 PC Computer (Lan Card 8 Mouse) Acute Nursing 07.01-94 2,240.00 2 PC Computer (Lan Card 8 Mouse) Business Office 07-01-94 2,240.00 2 Printer Okidata Microline 321 Business Office 07-01-94 600.00 2 Bedside Tables (4) ICF 07-01-94 800.00 2 Desk Chairs (4) ICF 07-01-94 600.00 2 PC Computer (Lan Card 8 Mouse) ICF 07-01-94 2,240.00 2 Copier Machine ICF 07-01-94 2,000.00 2 Laerdal Airway Mngmnt Trainer Nurse Inservice 10-01-94 1,207.50 2 Pharmacy Billing Interface with PIGS Pharmacy 10-01-94 1,000.00 2 Transend Trancut. 02/CO2 Monitor Respiratory 07-01-94 1,700.00 2 Video Flexible Fiberscope Surgery 08-01-94 65,000.00 2 Imageing Upgrade Ultrasound Mach Ultrasound 07-01-94 100,000.00 2 Should Have Total 179,627.50 PC Computer (Lan Card 8 Mouse) Business Office 07-01-94 2,240.00 3 Nice To Have Total 2,240.00 Total Capital Requests 5486,761.50 22 CASH FLOW BUDGET and BALANCE SHEET BUDGET 23 I r P M m000PMONO�ENO EI � A 10: N N MVMv ^ M I� .} ryN� MM�rl Y10 N P p�mpp pp. •- O In �.O} N M yr p Ep V C: U• t\I AM fAM` O M m r M ^ P r v Z : M ... 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I N I ^ N I I 000 0 I A 1 OO M M IN P.I I vl I MOON � .O O O M • M I CIS: OP r p .ON r P I N r M I NA M i V N I N I m P p P I 24 COMPARATIVE BALANCE SHEET BUDGET YEAR 07/01/94 - 06/30/95 BALANCE SHEET 6/30/93 12/31/93 06/30/94 06/30/95 Unrestricted Funds PRIOR ACTUAL PROJECTED YEAR CURRENT CURRENT BUDGET ASSETS YEAR YEAR YEAR Operating cash & short term investments $420,418 $676,649 $519,981 $636,993 Accounts Receivable Patient & Resident Gross 3,150,926 2,657,078 2,627,078 2,517,078 (including accts a col bureaus:) (current month 0 ) (Last month 0 ) (last fiscal year an 0 ) Less: Provisions for uncoLl accts (1,125,872) (892,677) (827,020) (749,802) Net Accounts Receivable $2,025,054 $1,764,400 $1,800,058 $1,767,277 Other Receivables 193,449 249,287 209,200 350,000 Due from Affiliates 0 0 0 0 Due from Third Party Payors 9,336 9,336 9,336 9,336 Inventories 204,817 260,399 206,102 167,193 Prepaid Expenses 174,598 204,817 225,379 230,758 Due from Restricted Funds 0 0 0 0 Other Current Assets 0 0 0 0 Total Current Assets $3,027,673 $0 $3, 164,889 SO $2,970,056 $3,161,557 Board Designated Assets Funded Depreciation 0 0 0 0 Other Self Insurance Trust 440,812 180,736 170,736 176,038 Subtotal $440,812 $180,736 $170,736 $176,038 Property Plant & Equipment 6,928,315 7,020,535 7,090,036 7,270,036 Less: Accumulated Depreciation (3,731,665) (3,949,480) (4,169,061) (4,628,229) Net Property Plant & Equipment $3,196,650 53, 071,055 $2,920,975 $2,641,807 Total Other Assets $3,637,462 $3,251,791 $3,091,711 $2,817,845 TOTAL UNRESTRICTED FUND ASSETS $6,665,135 $6,416,681 $6,061,767 $5,979,402 25 r KODIAK ISLAND HOSPITAL 8 CARE CENTER COMPARATIVE BALANCE SHEET BUDGET YEAR 07/01/94 - 06/30/95 BALANCE SHEET Unrestricted Funds LIABILITIES 8 FUND BALANCE Current Liabilities Current Portion of '_ong Term Debt Other Current Loan, Payable Accounts Payable: Trade Affiliates Third Party Payors Accrued Salariee Vacation Holiday Accrued Interest F,yable Due to Restricted Funds Other Current Liabilities Total Current Liabilities Long Term Debt Other Liabilities TOTAL LIABILITIES FUND BALANCE TOTAL UNRESTRICTED LIABILITIES 8 FUND BALANCE 6/30/93 12/31/93 06/30/94 06/30/95 PRIOR ACTUAL PROJECTED YEAR CURRENT CURRENT BUDGET YEAR YEAR YEAR $0 so so so 0 0 0 0 589,820 487,102 305,206 306,471 0 0 0 0 0 0 0 0 396,075 383,328 387,214 388,887 0 0 0 0 17,182 18,906 18,906 7,050 20,505 12,170 7,899 7,899 E1,023,582 S901,505 $7 99,225 S710,307 0 0 0 0 368,836 308,931 227,708 95,279 s1,392,417 E1,210,436 $946,933 $805,586 5,272,717 5,206,244 5,114,834 5,173,816 $6,665,134 $6,416,680 $6,061,767 $5,979,402 26 Xodiak Island Boroug FI©SPTI`AL ADVISORY BOARD Term Home Work Expires Phone Phone Betty Springhill, Chairman 1996 486-5106 Box 922 Kodiak, AK 99615 Ben Ardinger 1996 486-8209 486-5554 412 Marime Way Kodiak, AK 99615 Gil Bane 1994 486-4962 486-4161 Box 224 Kodiak, AK 99615 Loren Halter 1995 486-4183 104 Center Street Kodiak, AK 99615 John Shank 1995 486-3859 486-5504 Box 827 Kodiak, AK 99615 Gretchen Saupe 1994 486-3699 Box 1194 Kodiak, AK 99615 Wayne A. Stevens 1995 486-6036 486-5557 Box 3742 Kodiak, AK 99615 Alan Austerman (Assembly Rep) 1994 486-5930 486-4782 Box 2368 Kodiak, AK 99615 Dr. Lane Rinehart -Linden, Chief of Staff 486-3281 1915 E. Rezanof 1993 Kodiak, AK 99615 Edmon Myers, Administrator (ex-officio) . 486-3281 Linda Brown, KIH Staff Fax: 486-2336 486-3281 Revised 117/94 BOARDS/ROSTERSMOSPUAL