Tallahassee Memorial HealthCare, Inc. and Subsidiaries Hospital Utilization, Select Statistics and Management Discussion of Financial Operations September 30, 2012
TALLAHASSEE MEMORIAL HEALTHCARE City of Tallahassee, Florida, Health Facilities Revenue Bonds (Tallahassee Memorial HealthCare, Inc. Project), Series 2000, $100,100,000, Dated: October 15, 2000 Hospital Utilization Primary Service Area Hospitals Fiscal Years Ended September 30 2011 2012 Percent Change Admissions Tallahassee Memorial Healthcare 23,920 25,184 5% Capital Regional Medical Center 12,957 11,786-9% Patient Days Tallahassee Memorial Healthcare 115,762 115,889 0% Capital Regional Medical Center 53,930 48,892-9% Average Length of Stay Tallahassee Memorial Healthcare 4.8 4.6-5% Capital Regional Medical Center 4.2 4.2 0% Percent Occupancy Tallahassee Memorial Healthcare 48% 48% 0% Capital Regional Medical Center 75% 68% -9%
Selected Ancillary Service Statistics (Inpatient and Outpatient) Fiscal Years Ended September 30 Ancillary Services 2009 2010 2011 2012 Outpatient Visits 120,066 123,106 126,097 121,123 Emergency Room Emergency Room Visits 67,578 67,491 70,110 71,952 Urgent Care 26,536 28,354 30,778 32,880 Total 94,114 95,845 100,888 104,832 Admissions 10,827 11,446 11,926 13,406 Surgery Inpatients 6,916 6,778 6,620 6,720 Outpatients 12,910 12,391 12,153 10,399 Outpatients - Joint Ventures 2,544 2,689 3,077 5,590 Total 22,370 21,858 21,850 22,709 Surgical Hours 29,849 29,889 29,433 28,672 Laboratory Inpatient 747,507 769,077 782,915 812,870 Outpatient 429,304 431,968 450,444 467,720 Total 1,176,811 1,201,045 1,233,359 1,280,590 Radiology Inpatient 56,868 55,721 55,577 57,751 Outpatient 70,845 65,352 65,985 65,831 Total 127,713 121,073 121,562 123,582 Nuclear Medicine Inpatient 2,868 1,018 1,016 1,068 Outpatient 6,842 2,189 2,231 2,155 Total 9,710 3,207 3,247 3,223 Radiation Therapy Inpatient 408 668 374 316 Outpatient 47,733 47,878 54,138 50,014 Total 48,141 48,546 54,512 50,330 Home Health Care Number of Visits 11,616 16,562 15,372 12,980
Selected Inpatient Statistics By Department Fiscal Years Ending September 30 2009 2010 2011 2012 Medical / Surgical Admissions 15,229 15,894 15,921 17,259 Average Length of Stay 4.8 4.8 4.8 4.6 Patient Days 73,043 76,589 76,564 79,128 Pediatrics Admissions 1,635 1,515 1,503 1,481 Average Length of Stay 3.8 3.9 3.7 3.6 Patient Days 6,263 5,842 5,490 5,305 Obstetrics Admissions 4,418 4,154 4,033 3,913 Average Length of Stay 3.0 3.0 3.2 3.1 Patient Days 13,188 12,476 13,034 11,978 Psychiatric Admissions 1,675 1,836 1,945 2,088 Average Length of Stay 6.2 5.5 5.8 5.2 Patient Days 10,350 10,022 11,330 10,808 Neonates Admissions 524 505 518 443 Average Length of Stay 16.7 18.0 18.0 19.6 Patient Days 8,772 9,097 9,344 8,670 Totals (Acute Care) Admissions 23,481 23,904 23,920 25,184 Average Length of Stay 4.8 4.8 4.8 4.6 Patient Days 111,616 114,026 115,762 115,889 Total beds available 657 657 659 659 Percent occupancy 47% 48% 48% 48% Newborns: Admissions 3,681 3,297 3,234 3,212 Average Length of Stay 2.3 2.4 2.4 2.3 Patient Days 8,638 7,969 7,688 7,423 Sub-Acute (Extended & Long Term Care) Patient Days 13,456 14,525 14,096 14,179 Total Licensed Beds 770 770 772 772 Percent Occupancy 45% 46% 46% 46% Case-Mix Index 1.3728 1.3966 1.4515 1.4438 Case-Mix Index-Medicare 1.6377 1.6588 1.7074 1.6700
Sources of Patient Revenues Fiscal Years Ending September 30 2009 2010 2011 2012 Medicare 36.3% 37.8% 38.3% 39.3% Medicaid 11.7% 12.0% 12.2% 11.4% Commercial Insurance 16.8% 16.3% 16.2% 16.5% Self Pay 10.5% 10.2% 9.8% 10.4% HMO / PPO 22.2% 20.8% 20.6% 19.7% Other 2.5% 2.9% 2.9% 2.7% Total 100.0% 100.0% 100.0% 100.0%
Management Discussion of Financial Operations Year Ended September 30, 2012 compared with 2011 Revenue, Utilization and Payor Mix Fiscal year 2012 net patient service revenue less provision for bad debt increased 5% ($22.7 million) over fiscal year 2011. The increase is substantially attributable to the acquisition and expansion of hospital operated physician practices in the areas of internal medicine, cardiology, hematology, oncology, endocrinology, general surgery, intensivist and hospitalist services. Substantial rate reductions by the Florida Medicaid program on July 1, 2011 and July 1, 2012 affecting traditional Medicaid patients and Medicaid HMO patients were partially offset by rate increases in commercial contracts. A slight shift in payer mix occurred year over year with a 1% increase in Medicare, and a 0.8% decrease in Medicaid. Fiscal year 2012 admissions of 29,263 exceeded fiscal year 2011 admissions by 4.7%. In addition, fiscal year 2012 combined emergency room and urgent care visits increased 4% over fiscal year 2011 to 104,832. Surgical caseload improved 4% year over year to 22,709 cases including cases performed in joint ventures in which TMH, Inc. has a controlling interest. Expenses Fiscal year 2012 total expenses increased by 14.5% ($57.7 million) compared to fiscal year 2011 total expenses. Approximately two thirds of the increase in operating costs ($35.6 million) is attributable to the operating costs of the physician practices acquired during the fiscal year including salary and benefits for physician and office staff, professional fees for contracted physicians and supply expense for the acquired physician practices. The remaining operating cost increase ($22.1 million) is attributable to the acute hospital operations. Labor cost for the acute hospital increased a modest 3.36% or $4.8 million year over year. Benefit costs in the acute hospital increased 17.2% year over year due primarily to a $5.7 million increase in defined benefit pension cost for fiscal 2012. Supply cost for the acute hospital increased 2.6% or $2.6 million year over year due primarily to additional surgical caseload and improved volume in cardiac diagnostic and interventional services. Changes in Cash, Accounts Receivable and Liabilities Cash remained steady year over year at $162.4 million and days cash on hand increased from 128.9 to 134.5, while net accounts receivable increased $4.9 million. Fiscal year 2012 marked the sixth consecutive year of improved cash collections on patient accounts. The average number of days in accounts receivable increased slightly to 35.5 at September 30, 2012 from 34.0 at September 30, 2011. Other liabilities decreased $11.6 million due to a reduction in professional and general liability self insured retention based upon the year end actuarial study. The settlement value and number of professional and general liability claims have decreased causing the accrued liability to decline. Other liabilities also declined due to repayment of Medicaid funds that had been accrued for prior years cost report settlements.
Capital Expenditures Property, plant and equipment, net of accumulated depreciation increased $17.3 million at September 30, 2012 compared to September 30, 2011 due to continuing investment in electronic medical records, acquisition of real property for construction of a free standing emergency room, replacement of substantially all beds throughout the acute hospital, completion of the second floor build out in the cancer center to relocate infusion therapy services and hematology/oncology physician services, acquisition of an additional electrophysiology lab, acquisition of a new neurovascular lab and acquisition of a TAVR lab.