San Mateo Medical Center (6600D)

5-88 San Mateo Medical Center FY 2004-05 Recommended Sources Intergov ernmental Rev enues 21% Interfund Revenue 2% Miscellaneous Revenue 1% Charges for Services 53% Other Financing Sources 23% FY 2004-05 Recommended Requirements Ambulatory and Medical Services 18% Long Term Care Services 11% Quality Management 4% Administration and Financial Services 28% Patient C are Serv ices 18% Ancillary and Support Services 21%

5-89 Department Locator County Administration and Fiscal Criminal Justice Environmental Services Public Works Services Agency San Mateo Medical Center Operating Budget San Mateo Medical Center Capital Purchases General Fund Contributions to Medical Center Human Services Non-Departmental Services Department Measures 100% 80% 60% 40% 20% $500 $400 $300 $200 $100 $0 0% Quality and Outcomes Measures Meeting Performance s 01-02 83% 89% 89% 89% 02-03 03-04 Estimate 04-05 San Mateo Medical Center Cost Per Capita $219 01-02 $201 02-03 $224 03-04 Estimate $234 04-05 05-06 $234 05-06 Department Mission Statement The mission of the San Mateo Medical Center (SMMC) is to open doors to excellence in health care. To live its mission, SMMC offers its services to all residents of San Mateo County, regardless of ability to pay. SMMC serves the entire community; by setting a standard of excellence, SMMC aspires to be the best public hospital and clinic system. SMMC works to improve the health of the community by: Providing holistic care body, mind and spirit Promoting the effective use of technology Ensuring best practices-clinical quality, highest and best use of resources Providing timely access to care Ensuring cultural competency Expanding an already robust and compelling philanthropy program Serving as an employer of choice, with a waiting list of employees Continually improving the research and education components Maintaining a culture of service, innovation, satisfaction and safety Providing an integrated delivery system Providing community care management with chronic disease management programs Improving financial strength Contributions to Shared Vision 2010 Goals The San Mateo Medical Center contributes to achieving the following Shared Vision 2010 Goals: Goal 1: SMMC serves a diverse population at the Medical Center and in the twelve accessible, community-based clinics across the county, providing over 200,000 ambulatory visits to over 40,000 residents. Goal 2: SMMC employees volunteer and contribute to numerous organizations including Chope Champions, the Charitable Contributions Campaign, and the San Mateo Medical Center Foundation, providing volunteer opportunities to the community through the Auxiliary and American Heart Association. Goal 5: SMMC is the safety net hospital for County residents and provides Emergency, Psychiatric, Acute Inpatient Medical/ Surgical Services, Ancillary Services and Ambulatory Services to anyone without regard for ability to pay. Holistic care includes prevention, early diagnosis and treatment of disease. Goal 7: The Keller Center for Family Violence Intervention serves victims of violent crime not only at the time of crime, but also during the recovery period. Staff has provided numerous community outreach/educational classes and testifies to ensure perpetrators are prosecuted, thereby assuring a safer community.

5-90 Goal 8: SMMC helps the vulnerable through prevention, early detection and treatment, providing services for the aged, disabled, mentally ill and at-risk youth. SMMC has broadened its service offerings for the fastest growing segment of the County s population, seniors, through assuming management of Burlingame Long Term Care and opening the new Ron Robinson Senior Care Center. Goal 9: SMMC works with the Human Services Agency, Shelter Network and Samaritan House to place homeless patients in safe housing upon discharge. Goal 14: An active recycling program has been established at SMMC to help preserve our natural resources. Goal 19: SMMC actively participates in volunteer, internship and training programs for students interested in healthcare. SMMC serves as a training site for nursing students, radiology technology students, and psychiatry residents. Through the Hospital Consortium and countywide task forces, SMMC is actively working to increase training opportunities in San Mateo County. Goal 20: The County and Medical Center Vision are promoted consistently throughout SMMC programs, services and communication mechanisms. Goal 21: SMMC works in collaboration with the Sheriff to ensure a safe environment; with the Human Services Agency on housing and drug and alcohol problems; with Services on mental health issues, long term care and public health; and with the Shelter Network and Samaritan House on housing. Patient Volume at San Mateo Medical Center 250,000 200,000 150,000 100,000 50,000 0 01-02 02-03 03-04 Estimate 04-05 05-06 Inpatient Day s 47,634 45,687 102,611 136,915 136,915 Outpatient Visits 186,259 194,019 206,152 216,553 216,553 *03-04 Estimate includes Burlingame Long Term Care and Ron Robinson Senior Care Center. Story Behind Baseline Performance The San Mateo Medical Center includes the following programs: Administration and Financial Services Quality Management Patient Care Services Ancillary and Support Services Long Term Care Services Ambulatory and Medical Services Accomplishments that have contributed to improved performance and progress this past year include: Opened the Ron Robinson Senior Care Center on March 15, 2004. The Center fills a void in health care services for senior citizens of San Mateo County by providing both primary care and complete geriatric assessment of physical and mental health needs. The Center is projected to provide over 3,200 patient visits in FY 2003-04, increasing to over 13,600 in FY 2004-05, its first full year of operation. Assumed operation of the Burlingame Long Term Care facility to prevent bankruptcy and the potential displacement of those seniors to facilities across the state. Since fully assuming operations on October 15, 2003, SMMC has diligently worked to increase capacity in order to reap programmatic and financial benefits. Of a total 281 licensed beds, the average daily census is expected to reach 172 for FY 2003-04, increasing to 249 in FY 2004-05. Increased capacity utilization, with over 2,000 surgeries expected to be performed in FY 2003-04, nearly a 4% increase over the previous year. Discharges increased over 5%, from 3,610 to nearly 3,800. Administrative days are expected to be reduced to 5,000, down from 5,522 the previous year, a reduction of over 9%. Outpatient clinic volume increased over 5% from last year and is projected to reach 203,000 visits. Improved payor mix due to an increase in clinic visits covered by y Kids, accounting for a 4% decrease in self-pay and county indigent categories. Continued the Workforce Engage program for employee satisfaction that was initiated in FY 2002-03. Compared to last year s average satisfaction score, this year the organization registered a 5% improvement as a result of work by three task forces: Human Resource Development, Recognition, and Communication. Employee satisfaction will continue to be an important focus at SMMC, as it contributes to recruitment and retention. Began a robust philanthropy initiative to generate capital contributions totaling $12M. To date, the San Mateo Medical Center Foundation has received a generous gift of $4M from George and Adelaide Keller for the development of a Labor and Delivery Service. The gift is a challenge donation that will be matched through Foundation fundraising efforts.

5-91 Major challenges over the next two years will be: To achieve compliance with new nursing ratios established by the State and made effective beginning January 1, 2004, which will require more nurses effective January 1, 2005, increasing staffing costs and further exacerbating recruitment challenges To maintain an adequate workforce. It is estimated that by the year 2010, there will be a need for three million new health care workers. The labor force is aging, careers in health care are seen as less attractive and many hospital workers are dissatisfied with their work. Many SMMC employees are nearing retirement age, further challenging staffing and recruitment efforts. To meet SMMC s mission and financial health objectives. State budget cuts, particularly those that decrease Medi-Cal eligibility, will have a significant negative impact. Rationing of care could be an outcome. To continue to improve efficiency and innovate to fulfill SMMC s mission, faced with rising numbers of uninsured citizens and a lean budget outlook To manage increases in drug costs and medical supplies, which continue to significantly outpace inflation and reimbursement rates To navigate increased competition among area hospitals. New hospitals and increased competition for patients will likely make it more difficult to diversify payor mix, thereby limiting the ability to diversify funding sources for improving the financial health of SMMC. Increased competition for employees will add to the difficulties in attracting and retaining employees. To fund new technology and develop new lines of business within the challenging fiscal and competitive environment To respond to often unpredictable organizational challenges brought about by the economy and bioterrorism/disasters Department Priorities The San Mateo Medical Center will meet performance targets by doing the following: Cultivate Growth and Development Implement operational plan for Burlingame Long Term Care Develop and implement formalized programs for seniors Develop operational plans for labor and delivery services Provide an expanded array of imaging services Further expand volume of patients served Improve customer service Enhance Utilization of Human Resources Develop new recruitment strategies and approaches for hard-tofill positions Continue management training program and communications initiatives Assure Service Excellence Improve patient satisfaction levels Refine key clinical indicators Improve Quality Assessment/Utilization Management Reduce administrative days Move to a state of ongoing regulatory readiness Monitor WELL program-specific utilization Conduct evaluations of high cost outsourced services for potential cost reduction and conversion to in-house programs Ensure Financial Strength Achieve net income target Improve the revenue management cycle Reduce the Net County Cost of indigent care Budget Reduction Summary The following adjustments were made to balance the Medical Center budget: Revenue estimates for SB1255 and AB915 funding were removed until State negotiations are completed Overtime was reduced by $1,200,000 resulting in 9.2 less Full Time Equivalent positions Extra Help was reduced by $1,400,000 resulting in 22.4 less Full Time Equivalent positions Contract Services was reduced by $2,900,000; the majority of this expense is for contract physicians, which means that available physician hours will need to be reduced, resulting in less access to care These reductions were made to balance the budget in view of the uncertainty of potential new SB1255 and AB915 funding, which has been deferred in this budget. An estimated $7 million in additional funding would be realized if the County terminated the SMMC s Medi-Cal contract with the Plan of San Mateo. Negotiations with the State are ongoing. Should the State increase funding to the Plan and ultimately to the Medical Center, these reductions could be restored.

5-92 Medical Center Enterprise Fund FY 2004-05 and 2005-06 Budget Unit Summary SOURCES 2001-02 2002-03 Revised 2003-04 Recommended 2004-05 Change 2004-05 Recommended 2005-06 Taxes 120 9 28,463 28,463 28,748 Use of Money and Property 1,896 4,972 1,900 1,368 (532) 1,382 Intergovernmental Revenues 57,731,129 24,984,267 26,778,059 38,046,505 11,268,446 39,948,831 Charges for Services 57,952,413 63,337,896 86,596,436 97,416,052 10,819,616 102,286,854 Interfund Revenue 18,473,950 4,414,559 7,341,332 3,511,220 (3,830,112) 3,581,444 Miscellaneous Revenue 11,756,135 11,423,347 3,585,773 2,506,693 (1,079,080) 3,419,868 Other Financing Sources 3,248,735 43,514,222 46,171,281 43,152,000 (3,019,281) 43,152,000 Total Revenue 149,164,377 147,679,272 170,474,781 184,662,301 14,187,520 192,419,127 Fund Balance (3,307,280) (2,813,509) 2,813,509 TOTAL SOURCES 149,164,377 144,371,992 167,661,272 184,662,301 17,001,029 192,419,127 REQUIREMENTS Salaries and Benefits 67,953,251 71,068,928 93,521,719 104,835,885 11,314,166 109,804,469 Services and Supplies 55,648,441 45,362,516 41,164,692 47,578,595 6,413,903 49,481,740 Other Charges 16,211,359 18,231,558 18,723,333 21,747,272 3,023,939 22,617,163 Fixed Assets 3,114,827 300,000 4,388,429 151,345 (4,237,084) 166,551 Other Financing Uses 9,543,779 12,222,499 9,818,477 10,349,204 530,727 10,349,204 Net Appropriations 152,471,657 147,185,501 167,616,650 184,662,301 17,045,651 192,419,127 Non-General Fund Reserves (3,307,280) (2,813,510) 44,622 (44,622) TOTAL REQUIREMENTS 149,164,377 144,371,991 167,661,272 184,662,301 17,001,029 192,419,127 AUTHORIZED POSITIONS Salary Resolution 890.0 885.0 1,206.0 1,233.0 27.0 1,233.0 Funded FTE 816.0 811.5 1,039.8 1,112.2 72.4 1,112.2

5-93 FY 2004-05 Budget Overview TOTAL SOURCES Total Sources increased by $17,001,029 or 9.2% from the FY 2003-04 Revised to the FY 2004-05 due to the following changes: Taxes There is an increase of $28,463 in this funding source due to the transfer of cafeteria operations from Services to the Medical Center. This revenue source represents the sales tax on food/catering sales. Intergovernmental Revenues There is an increase of $11,268,446 in this funding source primarily due to Long Term Care Supplemental funding resulting from the increased census at Burlingame Long Term Care and increased funding from the Plan of San Mateo. Charges for Services There is an increase of $10,819,616 in this funding source due to increased patient volume, including higher census at Burlingame Long Term Care and visits at the Ron Robinson Senior Care Center; reduction of bad debt; and increases in Med-Cal Inpatient Per Diems, Medi-Care Case Rates and co-pay revenue. Interfund Revenue There is a decrease of $3,830,112 in this funding source due to the elimination of one-time funding for capital purchases. New capital purchases have been appropriated in a separate budget unit. Miscellaneous Revenue There is a decrease of $1,079,080 in this funding source due to reduced revenue from accounts sent to Revenue Sources. Other Financing Sources There is a decrease of $3,019,281 in this funding source due to the removal of one-time return of loan repayment to the General Fund as a result of prior year audit adjustments. Fund Balance There is an increase of $2,813,509 in this funding source. Negative Fund Balance has been eliminated. Fund Balance will be included in September after year-end closing activities are completed. TOTAL REQUIREMENTS Total Requirements increased by $17,001,029 or 9.2% from the FY 2003-04 Revised to the FY 2004-05 due to the following changes: Salaries and Benefits There is an increase of $11,314,166 in this expenditure category. The increases are to meet new State-mandated nursing staff ratios, add staffing related to increased census at Burlingame Long Term Care with full operation of that facility, convert four positions from Extra Help to permanent status, and delete vacant management positions to meet budget targets. This budget deletes one filled Clinical Services Manager II Nursing, four vacant Medical Services Assistant IIs, and two vacant Management Analyst IIIs; adds 20 Staff Nurses, two Staff Physicians, three Patient Services Assistant IIs, two Medical Services Assistant IIs, two Medical Techincian IIs, two Laboratory Assistant IIs, one Therapy Aide, one Supervising Therapist-E, and one Imaging Specialist for a net increase of 27 positions. In addition, significant increases are included for negotiated labor increases and retirement costs. Services and Supplies There is an increase of $6,413,903 in this expenditure category primarily due to related expenses for the increased census at Burlingame Long Term Care, medical and pharmaceuticals inflation and annualized costs for the cafeteria. Other Charges There is an increase of $3,023,939 in this expenditure category due to increased facility improvement projects and lease payments, and increased depreciation reflecting additional capital purchases. Revenue Collection charges are anticipated to increase as a result of additional accounts being referred to Employee and Public Services. Fixed Assets There is a decrease of $4,237,084 in this expenditure category due to the elimination of one-time funding for capital purchases. New capital purchases are now appropriated in a separate budget unit.

5-94 Other Financing Uses There is an increase of $530,727 in this expenditure category, which reflects an adjustment to debt service payments for the Medical Center and North County Clinic in accord with the current payment schedule. Contingencies/Departmental Reserves There is a decrease of $44,622 in this expenditure category. No operating reserves have been established in the budget. NET COUNTY COST Net County Cost increased by $898,633 or 3% from the FY2003-04 to the FY 2004-05. The County s General Fund contributions are shown as revenue sources in the Medical Center s Administration and Finance budget. FY 2005-06 Budget Overview TOTAL SOURCES Total Sources increased by $7,756,826 or 4% from the FY 2004-05 to the FY 2005-06 due to the following changes: Intergovernmental Revenues There is an increase of $1,902,326 in this funding source using a general inflation factor of 5%. Charges for Services There is an increase of $4,870,802 in net patient revenue using a general inflation factor of 5%. Interfund Revenue There is an increase of $70,224 in this funding source using a general inflation factor of 2%. Miscellaneous Revenue There is an increase of $913,175 in this funding source, reflecting an accounting adjustment as part of balancing the budget and also use of a general inflation factor of 2%. TOTAL REQUIREMENTS Total Requirements increased by $7,756,826 or 4% from the FY 2004-05 to the FY 2005-06 due to the following changes: Salaries and Benefits There is an increase of $4,968,584 in this expenditure category due to negotiated labor increases and annualization of position changes from the prior year. Services and Supplies There is an increase of $1,903,145 in this expenditure category using a general inflation factor of 4%. Other Charges There is a increase of $869,891 in this expenditure category using a general inflation factor of 4%. Fixed Assets There is a increase of $15,206 in this expenditure category due to equipment purchases for Burlingame Long Term Care. NET COUNTY COST No change.