FY 2011 S AN F RANCISCO C HARITY C ARE R EPORT San Francisco - - PowerPoint PPT Presentation

FY 2011 SAN FRANCISCO CHARITY CARE REPORT

San Francisco Department of Public Health Presentation to Health Commission Tuesday, October 16, 2012

BACKGROUND ON SF CHARITY CARE ORDINANCE

 Charity Care Ordinance (Ordinance 163-01) was

passed by the SF Board of Supervisors in 2001

 Requirements:  Hospitals provide patients with notification of policies on

charity care

 Non-profit hospitals must report charity care-related data

to the SF Department of Public Health on an annual basis

 Charity Care definition:  Emergency, inpatient, and outpatient medical care,

including ancillary services, provided to those who cannot afford to pay and without expectation of reimbursement

10/11/2012

2

FINDINGS/CONCLUSIONS

 Local hospitals now care for more than 100,000 charity

care patients annually (Number is duplicated among hospitals)

 Total citywide charity care expenditures have been

rising over time

 Private hospitals and UCSF have been increasing

their share of charity care

 The shift from traditional charity care to care provided

through Healthy San Francisco continues

 While the need for charity care will continue San

Francisco may wish to reconsider its local reporting

10/11/2012

3

REPORTING HOSPITALS

10/11/2012

4

All San Francisco Hospitals (except VA) report:

 Chinese Hospital Association of San Francisco (CHASF)  Dignity Health: Saint Francis Memorial Hospital (SFMH)  Dignity Health: St. Mary’s Medical Center (SMMC)  Kaiser Permanente: Kaiser Foundation Hospital, SF (KFH-SF)*  San Francisco General Hospital (SFGH)*  Sutter Health: California Pacific Medical Center (CPMC)  Sutter Health: St. Luke’s Hospital (STL)  University of California, San Francisco Medical Center (UCSF)*

*report voluntarily

HOSPITAL CHARITY CARE PROGRAMS

10/11/2012

5

Single Person - Monthly FPL Limit State Charity Care Policy CPMC/ STL CHASF SFMH/ SMMC KFH - SF UCSF SFGH

450% to 500% FPL $4,086 - $4,540 400% to 450% FPL $3,632 - $4,086 350% to 400% FPL $3,178 - $3,632 300% to 350% FPL $2,724 - $3,178

State law requires non- profit hospitals provide free or discounted care to patients in households <350% of the federal poverty level (FPL).

250% to 300% FPL $2,270 - $2,724

Discount Discount Discount Discount

200% to 250% FPL $1,816 - $2,270

Free

(Sliding Scale)

150% to 200% FPL $1,362 - $1,816

• r

Discount

100% to 150% FPL $908 - $1,362

(case by case)

0 to 100% FPL 0 - $908

Free Free Free Free Free

LOCAL HOSPITALS NOW CARE FOR MORE THAN 100,000 CHARITY CARE PATIENTS ANNUALLY

 Over 11 years local hospitals have cared for 91,500 to

117,500 charity care patients annually

 In FY 2011, highest number of patients served –

117,500

 20% increase in number of charity care patients served

from FY 2010 to FY 2011

 Six hospitals (CPMC, STL, KFH, UCSF, SFMH) saw

more unduplicated patients between FY 2010 and FY 2011, two (CHASF, SMMC) saw fewer

 (Note: Number is not unduplicated across hospitals)

10/11/2012

6

CHARITY CARE PATIENTS – FY 10 & FY 11

10/11/2012

7

For all reporting hospitals excluding SFGH

1000 2000 3000 4000 5000 6000 7000 8000 9000 CHASF SMMC SFMH CPMC STL KFH UCSF

HSF CC Patients Traditional CC Patients

'11 '10 '11 '11 '11 '11 '11 '10 '11 '10 '10 '10 '10 '10

TOTAL CITYWIDE CHARITY CARE EXPENDITURES HAVE BEEN RISING OVER TIME

 In every year since local reporting began, total

citywide charity care expenditures have risen

 Total citywide charity care expenditures surpassed

$100 million annually in FY 2006

 Total expenditures by year:  FY 2011 - $175,742,502 (1.2% increase from FY 2010)  FY 2010 - $173,648,636 (14.6 % increase from FY 2009)  FY 2009 - $151,501,396  Five hospitals (CHASF, CPMC, KFH, SFMH, STL)

increased expenditures from FY 2010 to FY 2011, while three (SFGH, SMMC, UCSF) decreased

10/11/2012

8

CHARITY CARE EXPENDITURES – FY10 & FY11

10/11/2012

9

$0 $2,000,000 $4,000,000 $6,000,000 $8,000,000 $10,000,000 $12,000,000 $14,000,000 $16,000,000 CHI SMMC SFMH CPMC STL KFH UCSF

HSF Expenditures Traditional CC Expenditures

'10 '10 '10 '11 '11 '11 '10 '11 '11 '11 '10 '10 '10 '11

For all reporting hospitals excluding SFGH

RATIO OF CHARITY CARE TO NET PATIENT REVENUE

10/11/2012

10

• Net patient revenue

= the amount received

• r expected from

third-party payers (insurers) and patients for hospital services provided minus any deductions; it includes payments received for inpatient and outpatient care, including emergency services.

0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% 4.00% 4.50% 5.00%

Ratio of CC to Net Pt Revenue (FY11) State Average (FY11)

PRIVATE HOSPITALS & UCSF HAVE BEEN INCREASING THEIR SHARE OF CHARITY CARE

 SFGH remains the primary safety-net institution, but

the other hospitals have seen an increasing percent of patients and assumed a greater financial share

 Charity care patients seen by private hospitals/UCSF:  FY 2011 – 21.5%  FY 2010 – 20.0%  FY 2009 – 14.9%  Charity care expenditures by private hospitals/UCSF:  FY 2011 – 28.5%  FY 2010 - 27.5%  FY 2009 – 23.5%

10/11/2012

11

CHARITY CARE PATIENTS BY YEAR (EXCLUDING SFGH)

12

FY 2009 FY 2010 FY 2011 Non-HSF Patients 11,269 14,481 19,171 HSF Patients 3,233 6,122 6,086 Total Patients 14,502 20,603 25,257

CHARITY CARE EXPENDITURES BY YEAR (EXCLUDING SFGH)

FY 2009 FY 2010 FY 2011

Non-HSF Expenditures

$31,223,014 $33,666,296 $33,001,352

HSF Expenditures

$4,430,141 $13,954,261 $17,297,376

Total Expenditures

$35,653,155 $47,620,557 $50,298,728

10/11/2012

THE SHIFT FROM TRADITIONAL CHARITY CARE TO CHARITY PROVIDED THROUGH HSF CONTINUES

 Since FY 2009, the share of charity care provided through HSF

has continued to increase

 Percent of charity care patients in HSF:  FY 2011 – 50.1%  FY 2010 – 37.5%  FY 2009 – 31.4%  Percent of charity care expenditures through HSF:  FY 2011 – 53.2%  FY 2010 – 52.0%  FY 2009 – 45.4%  As HSF charity care has increased, charity care services have

shifted from inpatient to outpatient. From FY 2010 to FY 2011:

 Total charity care patients accessing outpatient care up 31.6%  Total charity care patient accessing inpatient care down 5.0%

10/11/2012

13

BREAKDOWN BY SERVICE – FY 10 & FY 11

10/11/2012

14

FY 2010 FY 2011

Emergency Pts. Inpatients Outpatients Emergency Pts. Inpatients Outpatients

THE NEED FOR CHARITY CARE WILL CONTINUE THOUGH SAN FRANCISCO MAY WISH TO RECONSIDER LOCAL REPORTING

 Since 2001, State and federal changes now exceed San

Francisco’s requirements

 AB 774 (2006) requires that hospitals:  Maintain charity care/discount policies  Submit to the State charity care/discount policies, procedures &

applications

 Limit expected payments for services from low-income patients  Make “reasonable efforts” before initiating collection efforts  Federal provisions require:  Report to the IRS levels & types of charity care provided  Annual Treasury Dept. report on hospitals’ charity care  Review of each hospital organization’s tax-exempt status every

three years

10/11/2012

15

INTERSECTION OF LOCAL, STATE & FEDERAL CHARITY CARE REQUIREMENTS

10/11/2012

16

Key Charity Care/Community Benefit Requirements for Non-Profit Hospitals Source of Requirement SF CA US

Hospitals to conduct a community needs assessment at least once every 3 years SB 697 ACA Hospitals to submit a community benefits plan annually SB 697 ACA Hospitals to maintain charity care and discount payment policies CCO AB 774 ACA Hospitals to submit charity care & discount payment policies, procedures & applications CCO AB 774 Hospitals to limit expected payment for services for low income patients AB 774 ACA Hospitals to make “reasonable efforts” before initiating collection process AB 774 ACA Hospitals to submit annual reports on the levels and types of charity care provided CCO IRS Annual report of hospital charity care to be compiled & prepared by governing agency CCO ACA Mandatory review of tax exempt status by Treasury Dept. at least once every 3 years ACA

COMMENTS, QUESTIONS & DISCUSSION

10/11/2012

17