Book: Introduction to the Financial Management of Healthcare Organizations 6th edition.

Develop a 2014 statement of operations and a 2014 balance sheet (you can assume the format and numbers are correct on the 2013 balance sheet, and you can further assume that all balances carry forward to the 2014 balance sheet, with the exception of accounting for the 2014 lost from the statement of operations).

I have the dollar amt.

that's everything. how do I calculate the percentage depreciation?

8 Case Study: Bobcat Integrated Delivery System TABLE I Bobcat IDS Balance Sheet as of December 31, 2013: Assets 2013 Current Assets Cash and cash equivalents Marketable securities Accounts receivable less allowances Inventories at cost Other current assets $178,750 1,100,500 11,250,000 3.368,000 Total Current Assets 16,889.750 Land and improvements Buildings Fixed equipment Moveable equipment 3,250,000 36,485,750 8,063,250 4:466.750 52,265.750 (18,080,750) 34,185,000 $51,074.750 Property, Plant & Equipment Less accumulated depreciation Total Property, Plant & Equipment TOTAL ASSETS Liabilities and Net Assets Current Liabilities Current portion of long-term debt Accounts payable & accrued expenses Estimated amounts due to third-party payers Other current liabilities $ 2,151,000 5,400,000 1,423.750 Total Current Liabilities 10,474.750 37.000,000 47-474 75o Long-term debt, net of current portion TOTAL LIABILITIES Net Assets Unrestricted Temporarily restricted Permanently restricted 2,100,000 1,000,000 TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS 3,600,000 $ 51,074.750 eglated Delivery System 3 8 TABLE II s Actual Expenses Through December 31, 2014 Wages, Taxes, Benefits Professional Fees & Commissions Drugs Medical and Other Supplies Food Purchased Services Repairs & Maintenance Utilities Interest Depreciation $ 42,000,0o0 3,000,000 4,000,000 4,000,000 2,000,000 2,000,000 4,000,000 2,000,000 4,019,000 6,500,000 $73.519,000 TOTAL EXPENSES ASE STUDY OBCAT INTEGRATED ELIVERY SYSTEM YOUR IDS It is December 2014, and you have just accepted the CFO position at Bobcat Integrated Delivery System (IDS). You will be reporting to Mr. Salter, Bobcat IDS chief executive officer, a retired schoolteacher who was hired last year. Also reporting to Mr. Salter are Mr. Wannabe, Bobcat IDS chief operating officer; Dr. Spok, Bobcat IDS medical director; and Ms. Care, Bobcat IDS director of nursing. When announcing your appointment, Mr. Salter stated that your primary objective in the coming year (2015) would be to reverse the ominous financial trend that began in 2013 with an operating loss and continued in 2014. Previous operating losses were funded with investment income (however, invest ment income was only $200,000 in 2014 because of weakening market conditions). More- over, your board recently passed a resolution discontinuing that practice and restricting investment income to capital expendistures. Bobcat IDS is a not-for-profit corporation and includes a 120-bed acute care hos- pital, a 25-bed skilled nursing facility (SNF), a 15-bed rehab facility, a home health care agency, and an outpatient clinic. The hospital, Bobcat Community Hospital (BCH), is the only hospital in Bobcat, a rural community of 50,000 in your state. und information, you decide to meet with each member of the To acquire backgro nior management. ted members of se executive team first, then with selec Case Study: Bobcat Integrated Delivery System MEETING WITH DR. SPOK Dr. Spok, hospital medical director, told you, "Most doctors have been on the medical staf for at least ten years. There is litl loyalty to the hospital, and most doctors also have admit ing privileges at County Hospital, a newer public hospital with better facilities 30 miles away. While it is a hassle for the doctors to drive to County Hospital to make rounds, there are few good reasons for the doctors to admit their patients to Bobcat Community Hospital. Counte Hospital has a hospitalist and pays physicians large amounts of money for menial service assignments like committee work (a practice that Bobcat has refused to participa MEETING wITH MR. SALTER Mr. Salter, CEO, stated, "I just don't understand why we are losing money. I spent a considerable amount of time recruiting new doctors while keeping the existing doctors happy. The new, younger doctors just don't seem to have a sense of loyalty to Bobcat Community Hospital. Furthermore, I've tried to establish a family atmosphere' for our employees, which stresses getting along well with others in return for job security. Every- one scems happy. Everyone except Ms. Fi Nance Myway, whom you'll be replacing. She and I both started in January 2013, and she seemed increasingly frustrated with the way I do things here-she just didn't fit in. I tried to accommodate her by implementing some of her recommendations, even though they were against my better judgment-like charg- ing visitors for parking lgenerating $100,000 in other operating revenue for 20101. And when I announced that I was bringing in more business to the hospital by entering into a two-year capitated managed care agreement with the city (it expires this month)-we get $250 per month per family for taking care of the 300 city employees and their families, whether they're sick or not-Ms. Myway threw a fit at an executive team meeting. She claimed that my decisions were driving Bobcat IDS deeper into the red. I finally had to show Ms. Myway the highway for insubordination. That happened in November 2014." Each of the following 20 numbered assignments should be addressed in a one- page memo to the person(s) giving you the assignment. The memo should include a brief summary of the assignment and the results of the assignment, including your specific recommendation(s). You may include relevant attachments to your memo, but only to provide additional detail to your results and recommendations. During the interview, the board made it clear that you will be reporting to it as well as to Mr. Salter. The board has asked you for a confidential report to them on (1) the medical staff and what the board can do to keep them satisfied and (2) the financial job performance of Mr. Salter. (Reflection what kind of organizational issues does the board create in making this request?) 1. 3 86 case Study: Bobcat Integrated Delivery System MEETING wITH MR. OPERATOR Mr. Operator, chief operating officer and a recent graduate from a program in health- care administration, expressed the following concerns regarding the hospital: "Te's easy to understand how we lost money last year-Mr. Salter just won't say no to the doctors the nurses, for that matter. Our revenue is down for a variety of reasons and our expenses continue to increase. I don't know why the board ever picked a schoolteacher to run ga healthcare system." MEETING WITH Ms. PINCHER Ms. Penny Pincher, Bobcat IDS controller, in answer to your question regarding last year's loss, believes the following: "While acute care days are flat and SNF and rehab days and outpatient visits are up, our real financial problems involve our patient mix by financial class-commercial and self-pay continue to decline, and fixed payment and capitation continue to increase, and our board won't approve more than a 2 percent rate increase for 2015 (which affects collections for only commercial and managed care with discount- you need to make assumptions regarding Medicare and Medicaid collections). 2014 Collections/Discharge Acute SNF Rehab Home 6,400 ER 350 480180 800 Out Medicare Medicaid Commercial 9.600 4,000 4,300 5,200 8,000 8,300 10,000250 140 190 6,200 120 200 MEETING WITH Ms. CARE Ms. Patty Care, director of nursing, secks your support in the following proposal: "While our financial loss is serious, most of it is attributable to low rates-we need to increase our rates to reflect our quality services. Our nurses are overworked and under paid. I've been working on two solutions that I would like your support on. First, I believe strongly in primary care nursing and as a result, 90 percent of the nursing staff is RNs. RN can perform more tasks than LPNs and nursing assistants, and therefore are more efficient. This can be further justified by the acuity of our patients. Using the DRG scale as a sever- ity index, our patients are sicker than those in the average hospital. However, I am having some difficulty getting the RNs to administer meds, empty bed pans, and feed patients. Therefore, I have developed a total quality management (TQM) program designed to case study: Bobcat Integrated Delivery System the RNs that all their tasks are important. All RNs are required to attend five ng each week. Even though patient days are down, I would like to more RNs to help cover the floors when the other RNs are in training. In order es in light of the nursing shortage, we need to increase their average rate to $50, which is competitive with County Hospital (see Table VI-A). This, of would be in addition to the cost-of-living raises already announced by the person- director (Assignment #19 is to calculate the possible nurses' compensation packages). lalso would like for you to include a doctorally prepared entry-level nurse in our strategic for ten years from now. If physical therapy can require a doctorate for entry level, so to recruit bourly nel should we!" MEETING WITH Ms. PERSONAL Ms. Personal, personnel director, reluctantly admits the following to you. "Hospital prac- tice in the past has been to give the employes a cost-of-living raise equal to the previous year's percentage increase in the Consumer 5 percent of total wages to a merit on their annual Price Index. Also, historically, we have allocated ol to be awarded to meritorious employees based use Mt. Salter treats the employees like family, virtually In percent, in addition to the above raises, to keep us co see Table VI-A). Mr. Salter asked us not to announce raises giving the reason (Assignm everyone gets the raise. Because of shortages in nursing, I am o the facilities that we compete with for new hirs A). Mr. Salter ah exected raises, I need an explanation from you In the event we can't give the t #20) increase in supply and food prices for 2015 and a 10ng: Ta other prices shou EETING WITH MR. MATERIALS r. Materials, materials manager, reports the foll 388 Case Study: Bobcat Integrated Delivery System TABLE I Bobcat IDS Balance Sheet as of December 31, 2013: Assets Ba 2013 Current Assets Cash and cash equivalents Marketable securities Accounts receivable less allowances Inventories at cost Other current assets $178,750 1,100,500 11,250,000 3.368,000 Total Current Assets Land and improvements Buildings Fixed equipment Moveable equipment 16,889,750 3,250,000 36,485.750 8,063,250 4466.750 52,265.750 (18,080,750) 34,185,000 $51,074.750 Property, Plant & Equipment Less accumulated depreciation Total Property, Plant & Equipment TOTAL ASSETS Liabilities and Net Assets Current Liabilities Current portion of long-term debt Accounts payable & accrued expenses Estimated amounts due to third-party payers Other current liabilities $ 2,151,000 5.400,000 1,423.750 1.500.000 10,474.750 37,000,000 47-474-750 Total Current Liabilities Long-term debt, net of current portion TOTAL LIABILITIES Net Assets Unrestricted Temporarily restricted Permanently restricted 2,100,000 1,000,000 TOTAL NET ASSETS 3,600,000 $ 51,074.750 TOTAL LIABILITIES AND NET ASSETS Case Study: Bobcat Integrated Delivery Syster TABLE II Bobcat IDS Actual Expenses Through December 31, 2014 Wages, Taxes, Benefits Professional Fees & Commissions Drugs Medical and Other Supplies $42,000,0o0 3,000,000 4,000,000 4,000,000 2,000,000 2,000,000 4,000,000 2,000,000 4,019,000 6,500,000 $73.519.000 ood Purchased Services Repairs & Maintenance Utilities nterest Depreciation TOTAL EXPENSES 39 o Case Study: Bobcat Integrated Delivery System TABLE Ill Selected Industry Financial & Productivity Ratios Benchmark for Your Region* Financial Ratios Liquidity Ratios Current ratio Collection period ratio Days cash-on-hand, short-term sources Days cash-on-hand, all sources Capital Structure Ratios Net asset financing ratio Debt service coverage ratio Efficiency Ratios Total asset turnover ratio Age of plant ratio Fixed asset turnover ratio Current asset turnover ratio Inventory turnover ratio Profitability Ratios Excess margin Operating margin Return on net assets Operating Indicators Length of stay Occupancy rate Productivity Ratios Cost per adjusted discharge Nursing Service $8,100 Nursing hours per adjusted discharge RNs as a percent of total nursing LPNs as a percent of total nursing Nursing salary expense per adjusted discharge 50.00 32.20 21.70 $313 Full-Time Equivalent Employees Per occupied bed Per bed 6.02 3.31 85 $2,000 Total hours per adjusted discharge Compensation per discharge Find a reasonable benchmark for your region. Possible sources include Standard & Poor's, Moody's, Fitch, or Ingenix's Almanac of Hospital Financial and Operating Indicators Case Study: Bobcat Integrated Delivery System 391 TABLE IV-A Discharges 2013 Acute (4) SNF (13) Rehab (20) 8,000 130 138 7.5007,0007,0007,000 132 134 136 138 146 15,000 42,500 140 142 144 Home Health 30,000 25,00o 20,000 15,000 Emergency Outpatient 32.500 35,000 37.500 40,000 27.500 30,000 32,500 37.500 42,500 TABLE IV-EB Percentage of Discharges by Payer 2010 2011 2012 2013 Medicare Medicaid Commercial MC-dis 45 46 26 43 24 19 15 15 Bad Debt Charity TABLE IV-C 2 010 Charges per Discharge Per Discharge/Visit Acute SNF Rehab Home Health Emergency Outpatient Bobcat $9.600 5.200 10,000 250 800 County Hospital 5,200 9.500 750 180 70512 20402 19081 9000 0300 3904 Case Study: Bobcat Integrated Delivery System TABLE V Radiology Department Procedures Supply Tech Minutes Expense Machine Minutes 2010 Volume Procedure Radiology Chest 2-view Chest 4-view Hand 14 28 05 10 10 20 05 10 10 10 05 05 05 05 15 20,000 15,000 7,000 4,000 1,000 6,000 3,000 Foot Leg Fluoroscopy 05 10 30 10 30 Ultrasound Abdomen 15 10 10 5,000 Other 10 10 10 5,622 Nuclear Medicine Scan 60 30 30 2,000 CT Head w/o contrast Head w/ contrast Body w/o contrast Body w/ contrast 30 60 30 60 50 75 75 100 30 45 30 45 200 300 400 500 Case Study: Bobcat Integrated Delivery TABLE VI-A Salary Survey of Area Hospitals Average Hourly Rates (without benefits), December 2014 Position Head Nurse Staff RN Staff LPN Nursing Assistant Lab Tech Rad Tech Food Server Housekeeper Accountant Clerk Bobcat $38.00 33.50 26.00 20.70 32.00 28.00 18.40 18.40 30.00 21.00 County Hospital $35.00 32.00 25.00 18.00 30.00 25.00 15.00 15.00 15.00 10.50 TABLE VI-EB Bobcat Staffing as of December 31, 2014 FTEs Department Administration Medical Records Dietary Housekeeping Laundry Physical Plant Nursing* Laboratory Radiology Respiratory Therapy Physical Therapy tmergency Department Physicians KG/EEG contract 9o percent RNs, 10 percent clerks 50 35 25 365 16 70512 20402 19081 9000 0300 3904 394 Case Stud y: Bobcat Integrated Delivery System TABLE VII* Bobcat City and County Ad Valorem/Property Tax Schedule per $100 Assessed Value Aquifer County City ISD Special Roads Project Upper Bobcat River Watershed State sales tax This table is used only if your state requires nonprofit hospitals to provide community be .00981 35510 47000 1.23554 .06010 02000 8.25 percent benefits in relation to their potential state and local tax liabilities. 8 Case Study: Bobcat Integrated Delivery System TABLE I Bobcat IDS Balance Sheet as of December 31, 2013: Assets 2013 Current Assets Cash and cash equivalents Marketable securities Accounts receivable less allowances Inventories at cost Other current assets $178,750 1,100,500 11,250,000 3.368,000 Total Current Assets 16,889.750 Land and improvements Buildings Fixed equipment Moveable equipment 3,250,000 36,485,750 8,063,250 4:466.750 52,265.750 (18,080,750) 34,185,000 $51,074.750 Property, Plant & Equipment Less accumulated depreciation Total Property, Plant & Equipment TOTAL ASSETS Liabilities and Net Assets Current Liabilities Current portion of long-term debt Accounts payable & accrued expenses Estimated amounts due to third-party payers Other current liabilities $ 2,151,000 5,400,000 1,423.750 Total Current Liabilities 10,474.750 37.000,000 47-474 75o Long-term debt, net of current portion TOTAL LIABILITIES Net Assets Unrestricted Temporarily restricted Permanently restricted 2,100,000 1,000,000 TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS 3,600,000 $ 51,074.750 eglated Delivery System 3 8 TABLE II s Actual Expenses Through December 31, 2014 Wages, Taxes, Benefits Professional Fees & Commissions Drugs Medical and Other Supplies Food Purchased Services Repairs & Maintenance Utilities Interest Depreciation $ 42,000,0o0 3,000,000 4,000,000 4,000,000 2,000,000 2,000,000 4,000,000 2,000,000 4,019,000 6,500,000 $73.519,000 TOTAL EXPENSES ASE STUDY OBCAT INTEGRATED ELIVERY SYSTEM YOUR IDS It is December 2014, and you have just accepted the CFO position at Bobcat Integrated Delivery System (IDS). You will be reporting to Mr. Salter, Bobcat IDS chief executive officer, a retired schoolteacher who was hired last year. Also reporting to Mr. Salter are Mr. Wannabe, Bobcat IDS chief operating officer; Dr. Spok, Bobcat IDS medical director; and Ms. Care, Bobcat IDS director of nursing. When announcing your appointment, Mr. Salter stated that your primary objective in the coming year (2015) would be to reverse the ominous financial trend that began in 2013 with an operating loss and continued in 2014. Previous operating losses were funded with investment income (however, invest ment income was only $200,000 in 2014 because of weakening market conditions). More- over, your board recently passed a resolution discontinuing that practice and restricting investment income to capital expendistures. Bobcat IDS is a not-for-profit corporation and includes a 120-bed acute care hos- pital, a 25-bed skilled nursing facility (SNF), a 15-bed rehab facility, a home health care agency, and an outpatient clinic. The hospital, Bobcat Community Hospital (BCH), is the only hospital in Bobcat, a rural community of 50,000 in your state. und information, you decide to meet with each member of the To acquire backgro nior management. ted members of se executive team first, then with selec Case Study: Bobcat Integrated Delivery System MEETING WITH DR. SPOK Dr. Spok, hospital medical director, told you, "Most doctors have been on the medical staf for at least ten years. There is litl loyalty to the hospital, and most doctors also have admit ing privileges at County Hospital, a newer public hospital with better facilities 30 miles away. While it is a hassle for the doctors to drive to County Hospital to make rounds, there are few good reasons for the doctors to admit their patients to Bobcat Community Hospital. Counte Hospital has a hospitalist and pays physicians large amounts of money for menial service assignments like committee work (a practice that Bobcat has refused to participa MEETING wITH MR. SALTER Mr. Salter, CEO, stated, "I just don't understand why we are losing money. I spent a considerable amount of time recruiting new doctors while keeping the existing doctors happy. The new, younger doctors just don't seem to have a sense of loyalty to Bobcat Community Hospital. Furthermore, I've tried to establish a family atmosphere' for our employees, which stresses getting along well with others in return for job security. Every- one scems happy. Everyone except Ms. Fi Nance Myway, whom you'll be replacing. She and I both started in January 2013, and she seemed increasingly frustrated with the way I do things here-she just didn't fit in. I tried to accommodate her by implementing some of her recommendations, even though they were against my better judgment-like charg- ing visitors for parking lgenerating $100,000 in other operating revenue for 20101. And when I announced that I was bringing in more business to the hospital by entering into a two-year capitated managed care agreement with the city (it expires this month)-we get $250 per month per family for taking care of the 300 city employees and their families, whether they're sick or not-Ms. Myway threw a fit at an executive team meeting. She claimed that my decisions were driving Bobcat IDS deeper into the red. I finally had to show Ms. Myway the highway for insubordination. That happened in November 2014." Each of the following 20 numbered assignments should be addressed in a one- page memo to the person(s) giving you the assignment. The memo should include a brief summary of the assignment and the results of the assignment, including your specific recommendation(s). You may include relevant attachments to your memo, but only to provide additional detail to your results and recommendations. During the interview, the board made it clear that you will be reporting to it as well as to Mr. Salter. The board has asked you for a confidential report to them on (1) the medical staff and what the board can do to keep them satisfied and (2) the financial job performance of Mr. Salter. (Reflection what kind of organizational issues does the board create in making this request?) 1. 3 86 case Study: Bobcat Integrated Delivery System MEETING wITH MR. OPERATOR Mr. Operator, chief operating officer and a recent graduate from a program in health- care administration, expressed the following concerns regarding the hospital: "Te's easy to understand how we lost money last year-Mr. Salter just won't say no to the doctors the nurses, for that matter. Our revenue is down for a variety of reasons and our expenses continue to increase. I don't know why the board ever picked a schoolteacher to run ga healthcare system." MEETING WITH Ms. PINCHER Ms. Penny Pincher, Bobcat IDS controller, in answer to your question regarding last year's loss, believes the following: "While acute care days are flat and SNF and rehab days and outpatient visits are up, our real financial problems involve our patient mix by financial class-commercial and self-pay continue to decline, and fixed payment and capitation continue to increase, and our board won't approve more than a 2 percent rate increase for 2015 (which affects collections for only commercial and managed care with discount- you need to make assumptions regarding Medicare and Medicaid collections). 2014 Collections/Discharge Acute SNF Rehab Home 6,400 ER 350 480180 800 Out Medicare Medicaid Commercial 9.600 4,000 4,300 5,200 8,000 8,300 10,000250 140 190 6,200 120 200 MEETING WITH Ms. CARE Ms. Patty Care, director of nursing, secks your support in the following proposal: "While our financial loss is serious, most of it is attributable to low rates-we need to increase our rates to reflect our quality services. Our nurses are overworked and under paid. I've been working on two solutions that I would like your support on. First, I believe strongly in primary care nursing and as a result, 90 percent of the nursing staff is RNs. RN can perform more tasks than LPNs and nursing assistants, and therefore are more efficient. This can be further justified by the acuity of our patients. Using the DRG scale as a sever- ity index, our patients are sicker than those in the average hospital. However, I am having some difficulty getting the RNs to administer meds, empty bed pans, and feed patients. Therefore, I have developed a total quality management (TQM) program designed to case study: Bobcat Integrated Delivery System the RNs that all their tasks are important. All RNs are required to attend five ng each week. Even though patient days are down, I would like to more RNs to help cover the floors when the other RNs are in training. In order es in light of the nursing shortage, we need to increase their average rate to $50, which is competitive with County Hospital (see Table VI-A). This, of would be in addition to the cost-of-living raises already announced by the person- director (Assignment #19 is to calculate the possible nurses' compensation packages). lalso would like for you to include a doctorally prepared entry-level nurse in our strategic for ten years from now. If physical therapy can require a doctorate for entry level, so to recruit bourly nel should we!" MEETING WITH Ms. PERSONAL Ms. Personal, personnel director, reluctantly admits the following to you. "Hospital prac- tice in the past has been to give the employes a cost-of-living raise equal to the previous year's percentage increase in the Consumer 5 percent of total wages to a merit on their annual Price Index. Also, historically, we have allocated ol to be awarded to meritorious employees based use Mt. Salter treats the employees like family, virtually In percent, in addition to the above raises, to keep us co see Table VI-A). Mr. Salter asked us not to announce raises giving the reason (Assignm everyone gets the raise. Because of shortages in nursing, I am o the facilities that we compete with for new hirs A). Mr. Salter ah exected raises, I need an explanation from you In the event we can't give the t #20) increase in supply and food prices for 2015 and a 10ng: Ta other prices shou EETING WITH MR. MATERIALS r. Materials, materials manager, reports the foll 388 Case Study: Bobcat Integrated Delivery System TABLE I Bobcat IDS Balance Sheet as of December 31, 2013: Assets Ba 2013 Current Assets Cash and cash equivalents Marketable securities Accounts receivable less allowances Inventories at cost Other current assets $178,750 1,100,500 11,250,000 3.368,000 Total Current Assets Land and improvements Buildings Fixed equipment Moveable equipment 16,889,750 3,250,000 36,485.750 8,063,250 4466.750 52,265.750 (18,080,750) 34,185,000 $51,074.750 Property, Plant & Equipment Less accumulated depreciation Total Property, Plant & Equipment TOTAL ASSETS Liabilities and Net Assets Current Liabilities Current portion of long-term debt Accounts payable & accrued expenses Estimated amounts due to third-party payers Other current liabilities $ 2,151,000 5.400,000 1,423.750 1.500.000 10,474.750 37,000,000 47-474-750 Total Current Liabilities Long-term debt, net of current portion TOTAL LIABILITIES Net Assets Unrestricted Temporarily restricted Permanently restricted 2,100,000 1,000,000 TOTAL NET ASSETS 3,600,000 $ 51,074.750 TOTAL LIABILITIES AND NET ASSETS Case Study: Bobcat Integrated Delivery Syster TABLE II Bobcat IDS Actual Expenses Through December 31, 2014 Wages, Taxes, Benefits Professional Fees & Commissions Drugs Medical and Other Supplies $42,000,0o0 3,000,000 4,000,000 4,000,000 2,000,000 2,000,000 4,000,000 2,000,000 4,019,000 6,500,000 $73.519.000 ood Purchased Services Repairs & Maintenance Utilities nterest Depreciation TOTAL EXPENSES 39 o Case Study: Bobcat Integrated Delivery System TABLE Ill Selected Industry Financial & Productivity Ratios Benchmark for Your Region* Financial Ratios Liquidity Ratios Current ratio Collection period ratio Days cash-on-hand, short-term sources Days cash-on-hand, all sources Capital Structure Ratios Net asset financing ratio Debt service coverage ratio Efficiency Ratios Total asset turnover ratio Age of plant ratio Fixed asset turnover ratio Current asset turnover ratio Inventory turnover ratio Profitability Ratios Excess margin Operating margin Return on net assets Operating Indicators Length of stay Occupancy rate Productivity Ratios Cost per adjusted discharge Nursing Service $8,100 Nursing hours per adjusted discharge RNs as a percent of total nursing LPNs as a percent of total nursing Nursing salary expense per adjusted discharge 50.00 32.20 21.70 $313 Full-Time Equivalent Employees Per occupied bed Per bed 6.02 3.31 85 $2,000 Total hours per adjusted discharge Compensation per discharge Find a reasonable benchmark for your region. Possible sources include Standard & Poor's, Moody's, Fitch, or Ingenix's Almanac of Hospital Financial and Operating Indicators Case Study: Bobcat Integrated Delivery System 391 TABLE IV-A Discharges 2013 Acute (4) SNF (13) Rehab (20) 8,000 130 138 7.5007,0007,0007,000 132 134 136 138 146 15,000 42,500 140 142 144 Home Health 30,000 25,00o 20,000 15,000 Emergency Outpatient 32.500 35,000 37.500 40,000 27.500 30,000 32,500 37.500 42,500 TABLE IV-EB Percentage of Discharges by Payer 2010 2011 2012 2013 Medicare Medicaid Commercial MC-dis 45 46 26 43 24 19 15 15 Bad Debt Charity TABLE IV-C 2 010 Charges per Discharge Per Discharge/Visit Acute SNF Rehab Home Health Emergency Outpatient Bobcat $9.600 5.200 10,000 250 800 County Hospital 5,200 9.500 750 180 70512 20402 19081 9000 0300 3904 Case Study: Bobcat Integrated Delivery System TABLE V Radiology Department Procedures Supply Tech Minutes Expense Machine Minutes 2010 Volume Procedure Radiology Chest 2-view Chest 4-view Hand 14 28 05 10 10 20 05 10 10 10 05 05 05 05 15 20,000 15,000 7,000 4,000 1,000 6,000 3,000 Foot Leg Fluoroscopy 05 10 30 10 30 Ultrasound Abdomen 15 10 10 5,000 Other 10 10 10 5,622 Nuclear Medicine Scan 60 30 30 2,000 CT Head w/o contrast Head w/ contrast Body w/o contrast Body w/ contrast 30 60 30 60 50 75 75 100 30 45 30 45 200 300 400 500 Case Study: Bobcat Integrated Delivery TABLE VI-A Salary Survey of Area Hospitals Average Hourly Rates (without benefits), December 2014 Position Head Nurse Staff RN Staff LPN Nursing Assistant Lab Tech Rad Tech Food Server Housekeeper Accountant Clerk Bobcat $38.00 33.50 26.00 20.70 32.00 28.00 18.40 18.40 30.00 21.00 County Hospital $35.00 32.00 25.00 18.00 30.00 25.00 15.00 15.00 15.00 10.50 TABLE VI-EB Bobcat Staffing as of December 31, 2014 FTEs Department Administration Medical Records Dietary Housekeeping Laundry Physical Plant Nursing* Laboratory Radiology Respiratory Therapy Physical Therapy tmergency Department Physicians KG/EEG contract 9o percent RNs, 10 percent clerks 50 35 25 365 16 70512 20402 19081 9000 0300 3904 394 Case Stud y: Bobcat Integrated Delivery System TABLE VII* Bobcat City and County Ad Valorem/Property Tax Schedule per $100 Assessed Value Aquifer County City ISD Special Roads Project Upper Bobcat River Watershed State sales tax This table is used only if your state requires nonprofit hospitals to provide community be .00981 35510 47000 1.23554 .06010 02000 8.25 percent benefits in relation to their potential state and local tax liabilities