San Francisco Department of Public Health Office of Policy & Planning CHARITY CARE FY 2013 AND FY REPORT Presentation to San Francisco Health Commission
Presentation Outline 2 1. Charity Care Ordinance 2. Charity Care Landscape 3. FY 2013 & FY Findings Decline in Patients and Expenditures HSF and Traditional Charity Care Variation among Hospitals Medi-Cal Shortfall Stable Residential Trends
Charity Care Ordinance 3 San Francisco Charity Care Ordinance 163-01 passed in 2001 Charity Care is emergency, inpatient, and outpatient medical care, including ancillary services, provided to those who cannot afford to pay and without expectation of reimbursement Two Main Requirements: Hospitals to notify patients about free and discounted medical services Hospitals to annually report to SFDPH on the amount of charity care provided Source: Charity Care Ordinance
4 Charity Care Ordinance Reporting Hospitals 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
5 Reporting Hospitals: Charity Care Policies Single Person Monthly FPL Limit State Charity Care Policy CPMC/ STL CHASF SFMH/ SMMC KFH SF UCSF SFGH 450% to 500% FPL $4,190 $4,655 400% to 450% FPL $3,723 $4,190 350% to 400% FPL $3,259 $3,723 300% to 350% FPL $2,793 $3,259 250% to 300% FPL $2,327 $2,793 State law requires nonprofit hospitals Discount Discount Discount Discount 200% to 250% FPL provide free (Sliding $1,862 $2,327 or discounted Free Scale) 150% to 200% FPL $1,396 $1,862 care to patients in or discount 100% to 150% FPL $931 $1,396 households <350% of the (case by case) 0 to 100% FPL federal poverty level 0 $931 (FPL). Free Free Free Free Free
Main FY 2013, FY Findings 6 Decline in Number of Charity Care Patients HSF and Traditional Charity Care Variation among Hospitals Medi-Cal Shortfall Residential Patterns Unchanged
Finding: Decline in Number of Charity Care Patients 7 Number of HSF and Non HSF Charity Care Patients, FY 2009 to FY 2009: First year HSF and Non HSF (Traditional) Charity Care Patients 2010 ACA reported separately Signed into law Preparation for ACA: State Exchange and Medi Cal Expansion 2013: Open Enrollment for Covered California : ACA initiated insurance 80,000 70,000 60,000 66,925 65,305 HSF Non HSF (Traditional) 59,204 59,053 61,360 50,000 40,000 39,218 58,308 54,052 51,654 48,912 45,556 30,000 20,000 30,660 FY09 FY10 FY11 FY12 FY13 FY14
Finding: HSF and Non-HSF 8 Total Charity Care Expenditures (in Millions) from FY 2009 to FY 2009: First year HSF and Non HSF (Traditional) Charity Care Patients reported separately 2010 ACA Signed into law Preparation for ACA: State Exchange and Medi Cal Expansion 2013: Open Enrollment for Covered California : ACA initiated insurance $140.0 $120.0 HSF Non HSF (Traditional) $118.0 $126.3 $100.0 $84.6 $92.2 $93.6 $94.8 $80.0 $60.0 $70.4 $85.3 $82.2 $85.6 $72.9 $83.1 $40.0 FY09 FY10 FY11 FY12 FY13 FY14
Charity Care Patients 9 $2,500 Inflation Adjusted Average Expenditures per Charity Care Patient, FY 2010 FY Charity Care Patients by Service Line FY Emergency Inpatient Outpatient 18% $2,000 $1,500 $1,896 $1,663 $1,960 $1,915 $1,831 77% 5% $1,000 $500 FY 10 FY 11 FY 12 FY 13 FY 14
Finding: Hospital Variations 10 No Clear Hospital-Specific Trends: non-uniform changes in charity care from FY 2013 to FY City and County in Very Unique Transition Period Important Hospital Factors Geographic location Patient migration patterns Insurance enrollment programs
Finding: Hospital Variations - Expenditures 11 CPMC St. Luke's Chinese Kaiser *St. Francis *St. Mary's *UCSF *SFGH 2010 $12.4 2011 $14.4 2012 $12.9 2013 2013 $8.8 $4.2 $5.4 $5.0 $7.8 $2.5 $0.3 $0.5 $1.0 $2.3 $3.1 $5.5 $9.1 $8.0 $4.7 $5.0 $7.8 $8.5 $9.8 $10.1 $8.7 $6.1 $5.8 $5.6 $6.2 $5.1 $11.3 $6.7 $7.5 $9.0 $14.6 $17.9 Charity Care Expenditures (in Millions) by Hospital FY 2010 to FY $129.8 $125.4 $130.3 $141.2 $153.9 $141,159,972* $130,271,621* * Asterisks denote hospitals on a fiscal year calendar, i.e. July 1st to June 30th. For example, FY 2012 would begin on July 1, 2011, and end on June 30, 2012.
Finding: Medi-Cal Shortfall 12 CPMC 2013 $81.4 $86.2 St. Luke's 2013 $33.9 $28.5 Chinese 2013 Kaiser 2013 $3.4 $5.0 $8.6 $9.6 Medi-Cal Shortfall and Charity Care Expenditures (in Millions) by Hospital, FY13-FY14 Saint Francis 2013 $25.6 $29.5 St. Mary's 2013 $19.5 $17.9 UCSF 2013 $94.9 $113.4 $243.5 SFGH 2013 Charity Care Expenditures Medi-Cal Shortfall $262.8 $0 $50 $100 $150 $200 $250
Finding: Stable Residential Trends 13 Very little change in the residential trends for Traditional Charity Care Patients Districts 6, 9, 10, 11 continue to have highest proportions of Charity Care Patients in San Francisco Traditional Charity Care Patients Pool: Greater proportion of San Franciscans Decreased proportion of out-of-county residents Consistent proportion of homeless and out-ofstate residents
Conclusions: Charity Care in the Health Reform Era 14 1. ACA Likely Had a Significant Effect on Charity Care Landscape in San Francisco Decreased Number of Patients and Expenditures 2. SFGH Continues to Provide the Majority of Charity Care in San Francisco ~70% of Charity Care Expenditures 3. Continued Need for Charity Care and Safety Net Services Remaining Uninsured Holistic and City-Wide Approach to Community Wellness Services 4. Traditional Charity Care Patients May Not be as Able to Take Advantage of ACA Residential Locations Remain Consistent
15 Thank you & Questions