A NEW PARKLAND: YOU DECIDE Garland Chamber of Commerce October 27, 2008 Commissioner Mike Cantrell...
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Transcript of A NEW PARKLAND: YOU DECIDE Garland Chamber of Commerce October 27, 2008 Commissioner Mike Cantrell...
A NEW PARKLAND: YOU DECIDE
Garland Chamber of Commerce
October 27, 2008
Commissioner Mike CantrellDallas County, District 2
1893 - voters approved $40,000 in bonds for a new hospital
1936 - Dallas City-County Hospital System was founded
1954 - Voters approved creation of a Dallas County Hospital District & Parkland was opened on
Harry Hines
1974 - Hospital on Maple and Oaklawn closed
Parkland Then
Parkland Today $1 billion health system with 8,956 employees
685-bed hospital, not including 65 neonatal beds
11 Community-Oriented Primary Care health centers and school-based clinics
Mobile health delivery fleet
Medicaid managed care health plan
Health service provider for the Dallas County Jails
Level I trauma center
Region’s only Burn Center
Regional resource for disaster preparedness
10 Centers of Excellence
Parkland’s Mandates• As the payer of last resort, Parkland is mandated by Federal
law to treat those who are in need, whether indigent, uninsured, undocumented or legal citizens
• Under the Federal Emergency Medical Treatment and Labor Act (EMTALA), a hospital with an emergency department must provide any individual who comes to its emergency department with an appropriate medical screening to determine whether or not an emergency condition exists, and if it does the hospital must stabilize and treat the patient (42 U.S.C. § 1385dd(a) & 42 U.S.C. § 1395dd(b) and (c))
• By law (42 U.S.C. § 1395dd(g)), hospitals with specialized facilities such as burn units, shock-trauma centers, or neonatal intensive care units shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual
Parkland’s Role in Our Community
Proactive Public Health Service
Public Health System
Safety-Net Provider
Academic Medical Center
Regional Provider of Care
Parkland’s Challenges
Age of current facility
Functionality and space constraints
Code compliance issues
Increase in patient population
1990 – 1,852,810 2006 – 2,345,815
2000 – 2,218,899 2035 – 3,600,000
Patient mix (indigent (uninsured/underinsured), undocumented, and out of county)
Attracting 3rd party payers
Parkland’s ChallengesINDIGENT (Uninsured/Underinsured)• Uninsured and underinsured population is growing • Local tax dollars are expected to bear more of the
burden of indigent healthcare due to Federal and State cuts
• As of 2007, the Commonwealth Fund study estimated there are 25 million underinsured adults in the U.S., which is a 60% increase from 2003
• According to The Families USA report, healthcare premiums for Texas’ working families rose by 70.7% while the median earning rose by only 10.3% from 2000-2006
• Persons in Dallas County without insurance were estimated at 530,000 in 2000; 633,522 in 2005; and are projected to be 829,000 by 2011
Parkland’s ChallengesCHARITY CARE REQUIREMENTS
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%
UTSW
Presbyterian
Children's
BUMC
Baylor Garland
Meth Charlton
Methodist
Parkland
Source: Center for Health Statistics, DSHS - 2006 Data
The Health & Safety Code Section 311 requires nonprofit hospitals to provide community benefits, which include charity care and government-sponsored indigent health care.
Parkland’s Challenges
UNDOCUMENTED
Reimbursement for undocumented patients come from three sources.
• MEDICAID, under federal law, pays for the delivery of children to mothers who cannot provide
citizenship
• TITLE V federal program pays for prenatal care
• SECTION 1011 of the Medicare Modernization Act of 2005 provides for federal reimbursement of emergency healthcare for undocumented and certain other specified aliens
Parkland’s ChallengesOUT OF COUNTY
The 1985 Indigent Healthcare and Treatment Act established that counties are responsible to
(1) create a hospital district/taxing unit;
(2) operate a public hospital; or
(3) operate a County Indigent Health Care Program by contributing up to 8% of the county’s general levy for resident’s healthcare.
County or Hospital District’s Federal Poverty Level:
Parkland 200% Denton County 150%
Collin County 100% Rockwall County 21%
Tarrant County 200%
Parkland’s Challenges2008 Federal Poverty Level
% Gross Monthly IncomeFamily Size 21% 100% 150% 200%
1 $393 $10,400 $1,300 $20,800
2 $488 $14,000 $1,750 $28,000
3 $582 $17,600 $2,200 $35,200
4 $677 $21,200 $2,650 $42,400
$ in Millions
Inpatient Outpatient TOTAL
Emergent Non-Emergent Emergent Non-Emergent
Insured 16 2 1 0 19
Medicare 4 1 0 0 5
Medicaid 1 1 0 0 2
Unfunded -2 0 0 -2 -4
TOTAL 19 4 0 -2 21
Parkland’s Challenges
FY2007 Contribution Margin
Parkland’s FuturePreparing for a New Hospital
• Parkland engaged consultants to conduct a feasibility study, review demographic assumptions, and develop a strategic plan
• Dallas County Commissioners court appointed a Blue Ribbon Master Capital Plan Advisory Committee to develop a Master Capital Plan
• Parkland hospital is not only debt free but they are in a good financial position
Parkland’s Future
New Campus to Include:
546 Medical/Surgical/Trauma Beds
280 Women & Infants’ Specialty Health Beds
106 Strategic Investment Beds
36 Programmatic Investment Beds
Teaching & Non-Teaching Clinics
Cost
$1,217 million
Parkland’s FutureFinancing
Debt - Revenue Bonds$747 million (maturing in 25 years)
Philanthropy
The Parkland Foundation projects thecommunity to contribute $150 million
CashThe Dallas County Hospital District Board of
Managers intend to use $250 million of existing cash and $100 million from
future cash
Interest on Proceeds$24 million
Parkland’s Future
Property Tax Rate
Past & Current:
FY96 0.1996 FY99 0.1799
FY97 0.1941 FY00 0.1960
FY98 0.1855 FY01 – FY09 0.2540
Future:
FY2010 - 2¢ increase for G.O. bond support = .274¢
FY2011 - .05¢ increase for G.O. bond support = .279¢
FY2014 - 1¢ increase for operational support = .289¢
Parkland’s Future
Other $107,000,000
10%
Taxes $431,000,000
39%Government
Subsidies$171,000,000
15%
Patient$400,000,000
36%
FY2009 Revenues $1,109,000,000FY2009 Revenues $1,109,000,000
Parkland’s Future
Construction
Opening 2011
• Office Building (269,000 sq. ft. )
Opening 2014
• 816 Adult Beds & Shell 46 (1.68 million sq. ft.)
• Clinic Buildings (387 sq. ft.)
• Parking (2,035 new garage spaces and 2,800 new surface spaces)
Hospital Discharges for Dallas County Residents
0
9,000
18,000
27,000
36,000
45,000
2003 2005 2007
Parkland
Baylor
Presbyterian
Methodist Dallas
Medical City
St. Paul
Without Parkland Hospital the private area hospitals will be inundated with additional patients including the uninsured, underinsured, and undocumented.
Healthcare in Dallas County Without Parkland
Healthcare in Dallas County Without Parkland
Parkland provides annually:
• over 140,000 emergency room visits
• over 260,000 specialty outpatient service visits
• over 420,000 Community-Oriented Primary Care visits
• over 16,000 deliveries
• over 5 million prescriptions filled
BOND ELECTION BY DALLAS COUNTY HOSPITAL DISTRICT
d/b/a PARKLAND HEALTH AND HOSPITAL SYSTM
Proposition
“Authorizing the Dallas County Hospital District [d/b/a Parkland Heath & Hospital System] to pledge the revenues from its hospital system and from ad valorem tax that was previously approved by the voters to the payment of combination tax and revenue bonds and other obligations that will be issued and executed for the capital purpose of the hospital system.”
For □
Against □
Parkland’s FutureThe ballot proposition will state:
Parkland’s Future
Parkland’s future is up to you… YOU DECIDE
Early Voting: 10/20/08 – 10/24/08 8a.m.-5p.m.
10/25/08 7a.m.-7p.m.
10/26/08 1p.m.-6p.m.
10/27/08 – 10/31/08 7a.m.-7p.m.
Election Day: 11/4/08 7a.m.-7p.m.
Visit www.dalcoelections.org for times & locations