Yale New Haven Health Greenwich Hospital 1 Waheed

Yale New Haven Health Greenwich Hospital 1 Waheed Albede Faber Carmona Aaron Dean Katherine De. Haven

Greenwich Hospital Structure • President & CEO Norman G. Roth • Part of the Yale New Haven Health - health care system ○ CT Largest HC System • 206 Bed – 501(c)(3) nonprofit acute care hospital SYSTEM HOSPITALS: Bridgeport, Greenwich, Yale New Haven, Northeast Medical, L+M, Westerly 2

Greenwich Hospital Demographics • Located in Greenwich, CT • Most affluent county in CT • Serving Fairfield County, Connecticut & Westchester • Affiliated with Yale School of Medicine a graduate medical school • World-renowned for health care, biomedical research, and education Median Income US: $55, 322 3 Greenwich Township: $134, 223

Trends in Health Care • Technological Advances • Robotic Surgery • Family Touch • Outpatient Walk-In Clinic (2016) • Anticipated to lower ED use • Improves access to care & develops new markets Only 29% of U. S. physicians maintain after hours care 4

CMS Quality Reporting 31. 8% of Greenwich Hospital outpatients had a follow-up mammogram, breast ultrasound, or breast MRI within 45 days after a screening mammogram. The national average is 8. 8% and CMS considers a rate higher than 14% as indicative of unnecessary follow-up. 5

Corporate Compliance YNNHHS Office of Privacy and Corporate Compliance • Works with all employees across the system to establish; • • • Department specific compliance policy Compliance organization structure • Development of appropriate CAPA Education and training • Development of fraud & abuse plans Reporting mechanisms Ongoing monitoring and auditing • Guidelines for the enforcement of policies 6

Payor Mix, Length of Stay, Etc. Reimbursement (In Thousands) Percent of Total 2016 Percent of Total 2015 Commercial - Anthem Blue Cross 84, 301 22% 76, 507 21% Commercial - Other 26, 866 7% 25, 601 8. 8% Managed Care 133, 636 34. 8% 132, 707 35. 7% Medicaid 13, 269 3. 5% 12, 572 3. 4% Medicare 81, 176 21% 78, 555 21% Medicare/Managed Care 10, 971 2. 9% 10, 921 2. 9% Self-Pay/Other 33, 988 8. 9% 35, 273 9. 5% Total All Payers 384, 207 100% 372, 136 100% 7

Reimbursement By Payor Type - In Thousands of Dollars 8

Pensions • Accrued Pension Benefit Obligations represent 32% of Liabilities. • • Typically a significant portion of a hospital’s liabilities. 52% increase in pension obligations from 2015 to 2016 • Possibly due to actuarial loss -- pension payments were higher than expected • Many staff retired • Could be related to hospital mergers, as retirement may be offered to shift liabilities 9

Schedule C - Lobbying • Spent $116, 429 in attempts to influence legislation and public opinion. • Direct contact with legislators (47%) • “Other Activities” (53%) • Its parent, Yale-New Haven Hospital spent $771, 458, with other subsidiaries contributing approximately $200, 000 • Direct contact reported, significantly different than lobbying through the AHA (American Hospital Association) 10

Community Benefit 1) Guaranteeing Access to Care - $44. 2 mil 2) Advancing Careers in Healthcare - $3. 7 mil 3) Promoting Health and Wellness $750, 000 4) Building Stronger Neighborhoods 11 $300, 000

Schedule H - Community Benefit • FPG family income limit for free care - 250% • FPG family income limit for discounted care - 400% • Estimated bad debt expense $12. 4 million • National average comm benefit to total expense 11% 12

Schedule J - Compensation 13

Long Term Debt Years • 1996 - CHEFA issued $62. 9 million in revenue bonds Ending (Series A) • 2006 - $56. 6 million issued for the retirement of previous bonds ( Series B) • 2008 - $53. 6 million issued for the refunding of outstanding bonds (Series C) Payment 2017 $2, 790 2018 2870 2019 2970 2020 3065 2021 3165 Thereafter 17570 $32, 430 14

Debt 2015 2016 Debt to equity Debt to capital 0. 97 0. 41 0. 68 0. 49 15

Financial Ratios ●● Quick Current Cash Ratio ratio was of between 0. 25 0. 83 inin 2015 and which 2016 increases -signifies average to 0. 97 an ofin 3. 41. increase 2016. from 2. 25 in 2016. 16

Financial Ratios ● Thenon ROE operating for Greenwich margin ●● The Greenwich ROA was 8% for 8%. Greenwich increases inis 2014 and 2015. Nationwide 7. 29%median in Critical 2014 ROA to. Asset ●● from Nationwide Hospital in 2015. Financial was 4. 8% in 2013 Net 9. 29% profit margin dipped in ● Non Indicators Operating (CAHFI) activities of 2015 to 8. 3% from 11% in are 5. 16% contributing median ROE positive for 2014. toallthe hospitals. bottom line and ● keeps Greenwich on growing. is outperforming most hospitals nationwide. 17

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Financial Ratios - Average Salary Per FTEE ● Average FTEE is $70, 881. 57 ● Median FTEE in the NY area is $47, 212 while it is $50, 845 nationwide. ● Remember median income in Greenwich CT county wide is $86, 670. Greenwich Township is $134, 223 19

Financial Ratios - Days AR & Cash On Hand ● Greenwich days cash on hand increases from 115. 33 days in 2014 to 118. 41 in 2015. ● The US median for days cash on hand is 68. 83 while it is 75. 28 for hospitals in the New York area. ● The AR days outstanding decreases from 41. 35 in 2014 to 38. 91 in 2015 ● The national median is 54. 2 and 44. 53 in the New York area. 20

Financial Ratios - Average Age of Equipment ● The average of plant for Greenwich is 9. 69 in 2014 and decreases to 10. 65 in 2015. ● This means that depreciation increases between 2014 and 2015. The national average in 2013 is 9. 77 and 10. 58 in NY. 21

Recommendations ● Change executive bonus to reflect financial performance ● Invest more in new equipment to take Greenwich to the future ● Compare financial ratios to hospital with similar resources and populations 22

Thank You! Questions, Comments ? ? ? 23