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SUMMARY OF OPERATING RESULTS February 2010

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SUMMARY OF OPERATING RESULTS. February 2010. Adult Admissions (rolling 12 months). FY2010. Adult Patient Days (rolling 12 months). FY2010. Adult Case Mix (rolling 12 months). FY2010. Adult Clinic Visits (rolling 12 months). FY2010. Pediatric Admissions (rolling 12 months). FY2010. - PowerPoint PPT Presentation

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Page 1: SUMMARY OF OPERATING RESULTS

SUMMARY OFOPERATING RESULTS

February 2010

Page 2: SUMMARY OF OPERATING RESULTS

2

1,600

1,700

1,800

1,900

2,000

2,100

Prior Actual 1,869 1,898 1,911 1,923 2,037 1,930 1,907 1,915 1,732 1,868 1,744 1,725

Current Actual 1,973 1,970 1,895 1,960 2,055 1,931 1,981 1,908 1,837 1,917 1,864 1,819

Current Budget 1,964 1,841 1,942 1,827 1,959 1,970 1,923 1,953 1,885 1,905 1,842 1,838

Mar 09

Apr 09

May 09

Jun 09

Jul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

Jan 10

Feb 10

Adult Admissions(rolling 12 months)

FY2010

YTD

14,858

15,312

15,275

Page 3: SUMMARY OF OPERATING RESULTS

3

8,000

9,000

10,000

11,000

P rior Actual 9,854 9,580 9,499 8,994 10,472 10,155 9,757 10,407 10,048 10,019 9,420 9,188

Current Actual 10,374 10,332 10,365 10,452 11,016 10,326 10,231 10,427 9,644 10,207 10,090 9,123

Current Budget 10,091 9,633 9,988 9,692 10,561 10,350 9,899 10,344 10,020 9,927 10,123 9,364

Mar 09

Apr 09

May 09

J un 09

J ul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

J an 10

Feb 10

Adult Patient Days(rolling 12 months)

FY2010

YTD

79,466

81,064

80,588

Page 4: SUMMARY OF OPERATING RESULTS

4

1.70

1.80

1.90

2.00

2.10

Prior Actual 1.84 1.81 1.78 1.87 1.83 1.90 1.85 1.94 1.97 1.95 1.86 1.88

Current Actual 1.84 1.80 1.94 1.86 2.01 1.92 1.89 1.92 2.01 1.95 1.84 1.84

Current Budget 1.90 1.90 1.90 1.90 1.9 1.90 1.90 1.90 1.90 1.90 1.90 1.90

Mar 09

Apr 09

May 09

Jun 09

Jul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

Jan 10

Feb 10

Adult Case Mix(rolling 12 months)

FY2010

YTD

1.90

1.93

1.90

Page 5: SUMMARY OF OPERATING RESULTS

5

30,000

35,000

40,000

45,000

Prior Actual 36,087 41,346 38,548 37,420 39,199 36,218 39,372 42,846 37,968 34,883 37,612 36,919

Current Actual 41,255 41,362 38,567 41,559 40,707 38,209 43,570 41,014 38,508 36,314 37,201 36,201

Current Budget 41,079 39,705 40,988 40,258 38,728 37,792 41,132 41,371 39,419 36,697 37,991 37,529

Mar 09

Apr 09

May 09

J un 09

J ul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

J an 10

Feb 10

Adult Clinic Visits(rolling 12 months)

FY2010

YTD

305,017

311,724

310,659

Page 6: SUMMARY OF OPERATING RESULTS

6

180

200

220

240

260

280

Prior Actual 222 257 226 189 245 215 241 239 213 199 253 264

Current Actual 253 234 227 211 224 222 243 240 199 205 251 257

Current Budget 229 234 232 219 251 221 246 245 218 205 231 225

Mar 09

Apr 09

May 09

Jun 09

Jul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

Jan 10

Feb 10

Pediatric Admissions (rolling 12 months)

FY2010

YTD

1,869

1,841

1,842

Page 7: SUMMARY OF OPERATING RESULTS

7

1,000

1,100

1,200

1,300

1,400

1,500

1,600

Prior Actual 1,357 1,263 1,249 1,126 1,179 1,270 1,287 1,384 1,126 1,145 1,439 1,343

Current Actual 1,551 1,427 1,275 1,359 1,364 1,228 1,384 1,379 1,082 1,177 1,401 1,418

Current Budget 1,334 1,278 1,291 1,276 1,201 1,316 1,300 1,395 1,166 1,171 1,258 1,231

Mar 09

Apr 09

May 09

Jun 09

Jul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

Jan 10

Feb 10

Pediatric Patient Days(rolling 12 months)

FY2010

YTD

10,173

10,433

10,038

Page 8: SUMMARY OF OPERATING RESULTS

8

1.10

1.20

1.30

1.40

1.50

1.60

1.70

Prior Actual 1.45 1.50 1.32 1.35 1.56 1.50 1.40 1.57 1.57 1.42 1.55 1.39

Current Actual 1.25 1.30 1.35 1.44 1.68 1.64 1.53 1.53 1.55 1.58 1.45 1.62

Current Budget 1.31 1.31 1.31 1.31 1.51 1.51 1.51 1.51 1.51 1.51 1.51 1.51

Mar 09

Apr 09

May 09

Jun 09

Jul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

Jan 10

Feb 10

Pediatric Case Mix(rolling 12 months)

FY2010

YTD

1.49

1.58

1.51

Page 9: SUMMARY OF OPERATING RESULTS

9

6,000

7,000

8,000

9,000

10,000

Prior Actual 8,223 8,194 7,906 7,447 8,047 7,718 7,840 9,758 8,511 7,148 7,746 8,301

Current Actual 8,713 8,387 8,063 8,469 8,470 7,963 9,179 10,083 9,496 8,847 9,084 8,503

Current Budget 8,532 8,167 8,217 8,481 7,841 7,820 7,899 9,787 9,384 8,085 8,310 8,619

Mar 09

Apr 09

May 09

J un 09

J ul 09

Aug 09

Sep 09

Oct 09

Nov 09

Dec 09

J an 10

Feb 10

Pediatric Clinic Visits(rolling 12 months)

FY2010

YTD

65,069

71,625

67,745

Page 10: SUMMARY OF OPERATING RESULTS

10

Other Key Ancillary Service Activity Indicators

Month of February 2010

% VariancesActual Budget Actual Actual to 2010 to2010 2010 2009 Budget 2009

Inpatient Gross Revenues 81,180,843$ 82,135,397$ 75,166,893$ -1.2% 8.0%Outpatient Gross Revenues 73,099,946$ 70,459,082$ 63,363,091$ 3.7% 15.4%154,280,789$ 152,594,479$ 138,529,984$

Surgical Procedures: Inpatient (excludes Misc/Out of OR) 856 930 812 -8.0% 5.4% Outpatient 628 565 589 11.2% 6.6% AFCH 371 325 334 14.2% 11.1% Subtotal 1,855 1,820 1,735 1.9% 6.9% Misc./Out of OR 180 172 194 4.7% -7.2% Total Surgical Procedures 2,035 1,992 1,929 2.2% 5.5%

Average Daily CensusTransplants Cadaver 20 30 32 -33.3% -37.5% Living 6 9 4 -33.3% 50.0% Total 26 39 36 -33.3% -27.8%

May 2003Cardiology Invasive Lab Procedures Cardiovascular Lab 993 1,022 814 -2.8% 22.0% Electrophysiology Lab 174 125 78 39.2% 123.1% Total 1,167 1,147 892 1.7% 30.8%

Intensive Care DaysEmergency Room Visits 3,249 3,395 3,450 -4.3% -5.8%

Patient DaysRadiology Procedures: MRI 2,237 2,309 2,178 -3.1% 2.7% CT Scans 4,233 5,011 4,717 -15.5% -10.3% Other 17,781 17,698 16,448 0.5% 8.1% Total Radiology Procedures 24,251 25,018 23,343 -3.1% 3.9%

Average Length of StayRadiotherapy Procedures 2,943 2,492 2,639 18.1% 11.5%

Page 11: SUMMARY OF OPERATING RESULTS

11

Regional Hospital Transfers and Diversions & Cancelled Hospital Transfers Due to Lack of Beds

Feb

-08

Mar

-08

Ap

r-08

May

-08

Jun

-08

Jul-

08

Au

g-0

8

Sep

-08

Oct

-08

No

v-08

Dec

-08

Jan

-09

Feb

-09

Mar

-09

Ap

r-09

May

-09

Jun

-09

Jul-

09

Au

g-0

9

Sep

-09

Oct

-09

No

v-09

Dec

-09

Jan

-10

Feb

-10

Month & Year

Inp

atie

nt

Ca

ses

MedflightDiversions

ED Diversions

Cancellations -Lack of Beds

ICUDOC Adult Peds ED MedFlight

Total: 1

1 0 0 0 0 0 0

54

6269

50

45

5744

47

47

36

44

38 36

50 39

46

49

58

66

52

63

6440

59

59

397

456

419

415

406

417

374336

343

409405

465

368345

381

370

377

429413

386

386

430

396372

416

Transfers from Local Hospitals(Admitted to UW Hosp Inpt Svc)*

Transfers from Regional Hospitals(Admitted to UW Hosp Inpt Svc)*

0 -

50 -

0 -

200 -

300 -

400 -

500 -

600 -

*Both exclude Transfers to UWHC Emergency Department, not admitted

Div

ers

ion

s

100 -

Inp

atie

nt

Tra

nsf

ers

2 14 9 10 2 1 1 2 3 7 82 2

4 14 2 1

91

0 1 33

1 1

Page 12: SUMMARY OF OPERATING RESULTS

12

Summary of Operating ResultsMonth of February 2010

Actual Budget Variance ActualFebruary 2010 February 2010 Over/(Under) % Variance February 2009

Operating Revenue 77,654,277$ 77,024,294$ 629,983$ 0.8% 69,681,360$

Operating Expenses 74,801,337 74,193,002 608,335 0.8% 70,850,382

Income from Operations 2,852,940$ 2,831,292$ 21,648$ 0.8% (1,169,022)$ (Operating Margin)

Non-Operating Income 522,955 1,142,042 (619,087) -54.2% (45,379)

Net Income 3,375,895$ 3,973,334$ (597,439)$ -15.0% (1,214,401)$ (Total Margin)

Page 13: SUMMARY OF OPERATING RESULTS

13

Non Operating Income (Loss)Month of February 2010

Actual Budget Variance ActualFebruary 2010 February 2010 Over/(Under) % Variance February 2009

Investment Income & Other Non-Operating Income 526,712$ 901,346$ (374,634)$ -41.6% 1,094,441$

Fair Value Gain (Loss) on Investments 385,859 - 385,859 100.0% (2,260,098)

Fair Value Gain (Loss) on Swap debt agreements (582,341) - (582,341) -100.0% -

Joint Venture Income/Losses:

Wisconsin Therapies/Chartwell (3,725) 16,378 (20,103) > -100% 40,684

Wisconsin Dialysis (40,521) 11,250 (51,771) > -100% 5,409

UHC/Unity 181,045 100,000 81,045 81.0% 931,432

UHC/e-Care (79,299) (70,000) (9,299) -13.3% (80,326)

Madison Surgery Center 155,438 180,000 (24,562) -13.6% 193,742

Madison United Healthcare Linen 4,285 3,068 1,217 39.7% 23,090

Madison Environmental Resourcing (24,498) - (24,498) -100.0% 6,247

Total 522,955$ 1,142,042$ (619,087)$ -54.2% (45,379)$

Page 14: SUMMARY OF OPERATING RESULTS

14

Other Key Ancillary Service Activity Indicators Eight Months Ended February 28, 2010

Actual Budget Actual Actual to FY 10 toFY '10 FY '10 FY '09 Budget FY 09

Inpatient Gross Revenues 702,516,934$ 690,188,910$ 642,144,796$ 1.8% 9.4%Outpatient Gross Revenues 602,605,511$ 582,623,509$ 526,399,582$ 3.4% 14.5%1,305,122,445$ 1,272,812,419$ 1,168,544,378$

Surgical Procedures: Inpatient (excludes Misc/Out of OR) 7,291 7,580 7,782 -3.8% -6.3% Outpatient 4,850 4,604 5,167 5.3% -6.1% AFCH 2,991 2,653 1,793 12.7% 66.8% Subtotal 15,132 14,837 14,742 2.0% 2.6% Misc./Out of OR 1,597 1,402 1,464 13.9% 9.1% Total 16,729 16,239 16,206 3.0% 3.2%

Average Daily CensusTransplants Cadaver 246 264 251 -6.8% -2.0% Living 60 75 65 -20.0% -7.7% Total 306 339 316 -9.7% -3.2%

May 2003Cardiology Invasive Lab Procedures Cardiovascular Lab 7,764 7,766 6,386 0.0% 21.6% Electrophysiology Lab 1,160 945 756 22.8% 53.4% Total 8,924 8,711 7,142 2.4% 25.0%

Intensive Care DaysEmergency Room Visits 28,511 28,221 27,965 1.0% 2.0%

Patient DaysRadiology Procedures: MRI 18,293 17,635 17,840 3.7% 2.5% CT Scans 37,580 42,103 41,359 -10.7% -9.1% Other 149,171 147,422 136,778 1.2% 9.1%

Total Radiology Procedures 205,044 207,160 195,977 -1.0% 4.6%

Average Length of StayRadiotherapy Procedures 23,587 20,566 20,642 14.7% 14.3%

% Variances

Page 15: SUMMARY OF OPERATING RESULTS

15

Summary of Operating ResultsEight Months Ended February 28, 2010

(000) Omitted

Actual Budget Actual Actual to FY 10 toFY '10 FY '10 FY '09 Budget FY 09

Operating Revenue $652,454 $640,902 611,810 1.8% 6.6%

Operating Expenses 620,493 619,541 601,909 0.2% 3.1%

Income from Operations $31,961 $21,361 $9,901 49.6% > 100%(Operating Margin of 4.9%)

Non-Operating Income 6,575 8,275 (5,556) -20.5% > 100%

Net Income $38,536 $29,636 $4,345 30.0% > 100%

% Variances

Page 16: SUMMARY OF OPERATING RESULTS

16

Non Operating Income (Loss) Eight Months Ended February 28, 2010

(000) Omitted

Actual Budget Actual Actual to FY 10 toFY '10 FY '10 FY '09 Budget FY 09

Investment Income & Other Non-Operating Income 5,329$ 6,296$ 7,686$ -15.4% -30.7%

Fair Value Gain (Loss) on Investments 5,732 0 (16,305) 100.0% > 100%

Fair Value Gain (Loss) on Swap debt agreements (8,524) 0 0 -100.0% -100.0%

UWHC portion of Joint Venture Income/Losses:

Wisconsin Therapies/Chartwell 483 232 310 > 100% 55.8%

Wisconsin Dialysis (32) 90 (61) > -100% 47.5%

UHC/Unity 2,951 800 1,837 > 100% 60.6%

UHC/e-Care (624) (560) (512) -11.4% -21.9%

Madison Surgery Center 1,152 1,390 1,449 -17.1% -20.5%

Sleep Equipment of WI - - 12 0.0% -100.0%

Madison United Healthcare Linen 96 27 25 > 100% > 100%

Madison Environmental Resourcing 12 0 3 100.0% > 100%

Total 6,575$ 8,275$ (5,556)$ -20.5% > 100%

% Variances

Page 17: SUMMARY OF OPERATING RESULTS

17

Performance Ratios

Favorable Direction FY 10

Budget or Target

S&P 500 "A" Rated

Moodys "A" Rated

Fitch "A" Rated

UWHCA Bond Covenant

Operating Margin 4.9% 3.3% 2.5% 2.2% 2.7%

Total Margin ** 6.2% 4.6% 4.2% 4.6% 3.9%

Days Cash on Hand * 156 138 175 157 171 90, 75 & 45

Days in Accounts Receivable 45 50 49 49 48

Debt Service Coverage Ratio ** 6.5 5.8 3.7 4.3 3.1 2.0, 1.25 & 1.0

Long Term Debt to Capitalization 31.0% 31.0% 34.2% 35.3% 40.3% 65%

Operating Cash Flow 10.7% 10.2% 9.6% 9.1% 8.8%

Cash-to-Debt 154.2% 138.9% 130.8% 113.9% 113.4%

* Days Cash on Hand calculated as a rolling 12 month average

** Excludes unrealized fair value gain/loss on investments and fair value loss on swap agreements

Industry Comparisons

Page 18: SUMMARY OF OPERATING RESULTS

18

Accounts ReceivableMonitoring Program

Net Net Days Accounts Revenue

Receivable Outstanding

February 09 109,241,511 48March 09 109,827,613 45April 09 108,227,909 42May 09 101,952,966 40June 09 108,195,704 41July 09 116,266,694 43August 09 121,327,701 46September 09 117,138,592 44October 09 116,650,399 44November 09 116,867,364 44December 09 109,616,395 42January 10 116,607,964 45February 10 116,658,208 45

Page 19: SUMMARY OF OPERATING RESULTS

19

Comparison of Charity Care & Bad Debt Expense

FY 10 FY 10 % FY 09 %Actual Budget Variance Variance Actual Variance Variance

Charity 31,551,249$ 25,456,248$ 6,095,001$ 23.9% 22,799,342$ 8,751,907$ 38.4%

% of Revenue 2.42% 2.00% 1.95%

Bad Debt 20,753,605 31,817,607 (11,064,002) -34.8% 21,647,927 ($894,322) -4.1%

% of Revenue 1.59% 2.50% 1.85%

Total 52,304,854$ 57,273,855$ (4,969,001)$ -8.7% 44,447,269$ 7,857,585$ 17.7%

Gross Revenue 1,305,122,445$ 1,272,812,419$ 32,310,026$ 2.5% 1,168,544,378$ 136,578,067$ 11.7%

Total Bad Debt & 4.0% 4.5% 3.8% Charity as % of Revenue

Page 20: SUMMARY OF OPERATING RESULTS

20

EBITDA Compared to Debt Service & Capital Expenditures

(000) Omitted

Actual Budget

Net Income $41,328 $29,636Market Value Gain/(Loss) on Unrestricted Investments 5,732 0Fair Value Gain/(Loss) on Swap Agreements (8,524) 0Depreciation 32,456 33,597Interest Expense 5,479 6,331

EBITDA 76,471$ 69,564$

and Working Capital:

Capital Expenditures (24,162) (21,933)Land purchase 3rd East parcel (2,608) 0Capital Contribution - Faculty Office Bldg Buy-out existing space (2,500) (2,500)Capital Contribution - Cardiology equipment & other (140) 0

Net Capital Expenditures (29,270) (24,433)

Est Annual Debt Service (6,676) (12,459)

Decrease (increase) in Working Capital 6,074 (3,608)

Total (Used) Provided ($29,872) ($40,500)

Cash Available for Temporary Investment and Future Capital Expenditures 46,599$ 29,064$

Cash (Used) for Capital Expenditures, Debt Service

Cash Provided:

Page 21: SUMMARY OF OPERATING RESULTS

21

Summary of Changes in Net Assets

Eight Months Ended February 28, 2010

Net assets at beginning of period $513,659,405

Net income 41,328,293

Change in fair value of investments 5,731,552

Change in fair value of swap agreements (8,524,048)

Capital grants, gifts and donations 691,381

Additions to permanent gift endowments 89,979

Payments to UW School of Medicine and Public Health

for capital expenditure support (2,640,000)

Increase in net assets $36,677,157

Net assets at end of period $550,336,562

Page 22: SUMMARY OF OPERATING RESULTS

22

Comparison to Local CompetitorsFebruary 28, 2010 vs. 2009

UWHC Meriter St. Mary's Total% Change in Admissions

Current Month 4.4% 4.4% (9.2)% (0.3)%

3 Month Rolling Average 4.3% 2.6% (7.6)% (0.3)%

12 Month Rolling Average 2.6% 1.2% (1.2)% 0.9%

% Change in Average Daily Census

Current Month 0.1% 5.9% (3.1)% 0.5%

3 Month Rolling Average 2.6% 3.8% (4.8)% 0.5%

12 Month Rolling Average 4.6% (2.1)% (5.3)% (0.3)%

Page 23: SUMMARY OF OPERATING RESULTS

23

UWHC Investment & Returns

February February YTDMarket Value Investment Investment

Account Balances Allocation Return Benchmark

Operating Account and Commercial Paper

US Bank & M&I Bank 92,609,637$ 24.2% 0.13% -0.03% (A)

Intermediate Bond Fund USBank/Baird 74,105,540$ 19.4% 5.58% 5.36% (D)

Capital Replacement Fund Account - UW Foundation 155,814,235$ 40.8% 0.24% 0.25% (B)

Endowment Fund - Equity Securities

UW Foundation $59,571,238 15.6% 10.16% 20.14% (C)

Total Unrestricted Funds 382,100,650$ 100.0%

(A) Average Financial and Non-Financial Commercial Paper less (B) Average 1 Month LIBOR (C) Average S & P 500 Index(D) Barclays Capital Intermediate Gov/Credit-YTD