Mr. Salter: "Analyze my managed care with the City and tell me the full cost profit / loss. Should we renew the contract at present rates, or should we ask for a rate increase and if so, how much rate increase do we need to cover our (Hays) full cost? II. Information Given and Used in Analysis III. Problem Approach A. Contract Revenue Analysis, Assumptions B. Contract Expenses Analysis, Assumptions IV. Contract Go-Forward Options A. Not Renew - Why B. Immediate (Year 2) Increase in Premium - How Much and Why C. Increase Premium Annually Over Future Years - How Much per Year and How Many Years D. Exclude Selected Services as "Carve Outs" - Estimate Dollar Amount of Added Revenue E. Institute Case Management Program - Estimate Dollar Amount of Expense Reduction F. Other Revenue Increase (e.g., Population Increase) or Expense Reduction - What and Dollar Impact on Revenue or Expense V. Recommendation and Support Discussion $ 76.725.792 7,000,000 TABLE 11 Hays County IDS Actual Expenses (S) through December 31, 2017 Wages, Taxes, Benefits (90% variable, 10% fixed) Professional Fees and Commissions (fixed) Drugs (variable) Medical and Other Supplies (variable) Food (variable) Purchased Services (variable) Repairs and Maintenance (fixed) Utilities (fixed) Interest (fixed) Depreciation (fixed) 8,000,000 8,500,000 7,500,000 6,500,000 8,000,000 9,000,000 8,021,440 TOTAL EXPENSES 3,000,000 $142,247,232 2015 TABLE IV-A Hays County IDS Discharges Service (LOS) 2013 Acute (4) 6.777 SNF (30) 239 Rehab (20) 155 Home Health 7,298 Emergency 27.915 Outpatient 16,826 2014 6,354 243 157 6,082 30,062 18,355 5.931 247 159 4,866 32,207 19,884 2016 5.931 251 162 3.650 34,354 22,942 2017 5,931 255 164 3,650 36,500 26,000 LOS - length of stay: SNF - skilled nursing facility TABLE IV-B Percentage of Discharges by Payer 2013 2014 2015 2016 2017 28 Medicare 24 25 26 27 22 24 26 28 30 5 4 3 2 1 2 39 39 39 33 32 Medicaid Commercial Managed Care-discount Managed Care-capitation Bad Debt Charity 0 0 o 5 2 2 2 3 NN NN 2 2 2 1 TABLE IV-C 2017 Charges per Discharge/Visit ($) HCH St. Teresa Acute SNF 38,200 28,000 38,000 Rehab Home Health Emergency Outpatient 40,000 30,000 40,000 400 1,600 600 300 1,500 500 Mr. Salter: "Analyze my managed care with the City and tell me the full cost profit / loss. Should we renew the contract at present rates, or should we ask for a rate increase and if so, how much rate increase do we need to cover our (Hays) full cost? II. Information Given and Used in Analysis III. Problem Approach A. Contract Revenue Analysis, Assumptions B. Contract Expenses Analysis, Assumptions IV. Contract Go-Forward Options A. Not Renew - Why B. Immediate (Year 2) Increase in Premium - How Much and Why C. Increase Premium Annually Over Future Years - How Much per Year and How Many Years D. Exclude Selected Services as "Carve Outs" - Estimate Dollar Amount of Added Revenue E. Institute Case Management Program - Estimate Dollar Amount of Expense Reduction F. Other Revenue Increase (e.g., Population Increase) or Expense Reduction - What and Dollar Impact on Revenue or Expense V. Recommendation and Support Discussion $ 76.725.792 7,000,000 TABLE 11 Hays County IDS Actual Expenses (S) through December 31, 2017 Wages, Taxes, Benefits (90% variable, 10% fixed) Professional Fees and Commissions (fixed) Drugs (variable) Medical and Other Supplies (variable) Food (variable) Purchased Services (variable) Repairs and Maintenance (fixed) Utilities (fixed) Interest (fixed) Depreciation (fixed) 8,000,000 8,500,000 7,500,000 6,500,000 8,000,000 9,000,000 8,021,440 TOTAL EXPENSES 3,000,000 $142,247,232 2015 TABLE IV-A Hays County IDS Discharges Service (LOS) 2013 Acute (4) 6.777 SNF (30) 239 Rehab (20) 155 Home Health 7,298 Emergency 27.915 Outpatient 16,826 2014 6,354 243 157 6,082 30,062 18,355 5.931 247 159 4,866 32,207 19,884 2016 5.931 251 162 3.650 34,354 22,942 2017 5,931 255 164 3,650 36,500 26,000 LOS - length of stay: SNF - skilled nursing facility TABLE IV-B Percentage of Discharges by Payer 2013 2014 2015 2016 2017 28 Medicare 24 25 26 27 22 24 26 28 30 5 4 3 2 1 2 39 39 39 33 32 Medicaid Commercial Managed Care-discount Managed Care-capitation Bad Debt Charity 0 0 o 5 2 2 2 3 NN NN 2 2 2 1 TABLE IV-C 2017 Charges per Discharge/Visit ($) HCH St. Teresa Acute SNF 38,200 28,000 38,000 Rehab Home Health Emergency Outpatient 40,000 30,000 40,000 400 1,600 600 300 1,500 500