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CHAPTER 18 Assignment Exercise 18-1: Estimate of Loss You are the practice manager for a four-physician office. You arrive on Monday morning to find the entire office suite flooded from overhead sprinklers that malfunctioned over the weekend. Water stands ankle-deep everywhere. The computers are fried and the contents of all the filing cabinets are soaked. Your own office, where most of the records were stored, has the worst damage. The practice carries valuable papers insurance coverage for an amount up to $250,000. It is your responsibility to prepare an estimate of the financial loss so that a claim can be filed with the insurance company. How would you go about it? What would your summary of the losses look like? Assignment Exercise 18-2: Estimate of Replacement Cost The landlord carries contents insurance that should cover the damage to the furnishings, equipment, and to the computers, and the insurance company adjuster will come tomorrow to assess the furnishings and equipment damage. However, your boss is sure that the insurance settlement will not cover replacement costs. Consequently, you have been instructed to prepare an estimate of what has been lost and/or damaged plus an estimate of what the replacement cost might be. How would you go about it? What would your summary of these losses look like? Assignment Exercise 18-3: Benchmarking Review the chapter text about benchmarking. Required 1. Select an organization: either from the Case Studies in Chapters 27-28 or from one of the Mini-Case Studies in Chapters 29-31. 2. Prepare a list of measures that could be benchmarked for this organization. Comment on why these items are important for benchmarking purposes. 3. Find another example of benchmarking for a healthcare organization. The example can be an organization report or it can be taken from a published source such as a journal article. CHAPTER 18 Assignment Exercise 18-1: Estimate of Loss You are the practice manager for a four-physician office. You arrive on Monday morning to find the entire office suite flooded from overhead sprinklers that malfunctioned over the weekend. Water stands ankle-deep everywhere. The computers are fried and the contents of all the filing cabinets are soaked. Your own office, where most of the records were stored, has the worst damage. The practice carries valuable papers insurance coverage for an amount up to $250,000. It is your responsibility to prepare an estimate of the financial loss so that a claim can be filed with the insurance company. How would you go about it? What would your summary of the losses look like? Assignment Exercise 18-2: Estimate of Replacement Cost The landlord carries contents insurance that should cover the damage to the furnishings, equipment, and to the computers, and the insurance company adjuster will come tomorrow to assess the furnishings and equipment damage. However, your boss is sure that the insurance settlement will not cover replacement costs. Consequently, you have been instructed to prepare an estimate of what has been lost and/or damaged plus an estimate of what the replacement cost might be. How would you go about it? What would your summary of these losses look like? Assignment Exercise 18-3: Benchmarking Review the chapter text about benchmarking. Required 1. Select an organization: either from the Case Studies in Chapters 27-28 or from one of the Mini-Case Studies in Chapters 29-31. 2. Prepare a list of measures that could be benchmarked for this organization. Comment on why these items are important for benchmarking purposes. 3. Find another example of benchmarking for a healthcare organization. The example can be an organization report or it can be taken from a published source such as a journal article. CHAPTER 28 Case Study: Metropolis Health System BACKGROUND 1. The Hospital System Metropolis Health System (MHS) offers comprehensive healthcare services. It is a midsize taxing district hospital. Although MHS has the power to raise revenues through taxes, it has not done so for the past seven years. 2. The Area MHS is located in the town of Metropolis, which has a population of 50,000. The town has a small college and a modest number of environmentally clean industries. 3. MHS Services MHS has taken significant steps to reduce hospital stays. It has developed a comprehensive array of services that are accessible, cost-effective, and responsive to the community's needs. These services are wellness oriented in that they strive for prevention rather than treatment. As a result of these steps, inpatient visits have increased overall by only 1,000 per year since 2008, whereas outpatient/same-day surgery visits have had an increase of over 50,000 per year. A number of programmatic, service, and facility enhancements support this major transition in the community's institutional health care. They are geared to provide the quality, convenience, affordability, and personal care that best suit the health needs of the people whom MHS serves. o Rehabilitation and Wellness Centerfor outpatient physical therapy and return-to-work services, plus cardiac and pulmonary rehabilitation, to get people back to a normal way of living. o Home Health Servicesbringing skilled care, therapy, and medical social services into the home; a comfortable and affordable alternative in longer-term care. o Same-Day Surgery (SDS)eliminating the need for an overnight stay. Since 1998, same-day surgery procedures have doubled at MHS. o Skilled Nursing Facilityinpatient service to assist patients in returning more fully to an independent lifestyle. o Community Health and Wellnesscommunity health outreach programs that provide educational seminars on a variety of health issues, a diabetes education center, support services for patients with cancer, health awareness events, and a women's health resource center. o Occupational Health Serviceshelping to reduce workplace injury costs at over 100 area businesses through consultation on injury avoidance and work-specific rehabilitation services. o Recovery Servicesoffering mental health services, including substance abuse programs and support groups, along with individual and family counseling. 4. MHS's Plant The central building for the hospital is in the center of a two-square-block area. A physicians' office building is to the west. Two administrative offices, converted from former residences, are on one corner. The new ambulatory center, completed two years ago, has an L shape and sits on one corner of the western block. A laundry and maintenance building sits on the extreme back of the property. A fourstory parking garage is located on the eastern back corner. An employee parking lot sits beside the laundry and maintenance building. Visitor parking lots fill the front eastern portion of the property. A helipad is on the extreme western edge of the property behind the physicians' office building. 5. MHS Board of Trustees Eight local community leaders who bring diverse skills to the board govern MHS. The trustees generously volunteer their time to plan the strategic direction of MHS, thus ensuring the system's ability to provide quality comprehensive health care to the community. 6. MHS Management A chief executive officer manages MHS. Seven senior vice presidents report to the CEO. MHS is organized into 23 major responsibility centers. 7. MHS Employees All 500 team members employed by MHS are integral to achieving the high standards for which the system strives. The quality improvement program, reviewed and reestablished in 2010, is aimed at meeting client needs sooner, better, and more costeffectively. Participants in the program are from all areas of the system. 8. MHS Physicians The MHS medical staff is a key part of MHS's ability to provide excellence in health care. Over 75 physicians cover more than 30 medical specialties. The high quality of their training and their commitment to the practice of medicine are great assets to the health of the community. The physicians are very much a part of MHS's drive for continual improvement on the quality of healthcare services offered in the community. MHS brings in medical experts from around the country to provide training in new techniques, made possible by MHS's technologic advancements. MHS also ensures that physicians are offered seminars, symposiums, and continuing education programs that permit them to remain current with changes in the medical field. The medical staff's quality improvement program has begun a care path initiative to track effective means for diagnosis, treatment, and follow-up. This initiative will help avoid unnecessary or duplicate use of expensive medications or technologies. 9. MHS Foundation Metropolis Health Foundation is presently being created to serve as the philanthropic arm of MHS. It will operate in a separate corporation governed by a board of 12 community leaders and supported by a 15-member special events board. The mission of the foundation will be to secure financial and nonfinancial support for realizing the MHS vision of providing comprehensive health care for the community. Funds donated by individuals, businesses, foundations, and organizations will be designated for a variety of purposes at MHS, including the operation of specific departments, community outreach programs, continuing education for employees, endowment, equipment, and capital improvements. 10. MHS Volunteer Auxiliary There are 500 volunteers who provide over 60,000 hours of service to MHS each year. These men and women assist in virtually every part of the system's operations. They also conduct community programs on behalf of MHS. The auxiliary funds its programs and makes financial contributions to MHS through money it raises on renting televisions and vending gifts and other items at the hospital. In the past, its donations to MHS have generally been designated for medical equipment purchases. The auxiliary has given $250,000 over the last five years. 11. Planning the Future for MHS The MHS has identified five areas of desired service and programmatic enhancement in its five-year strategic plan: o I. Ambulatory Services o II. Physical Medicine and Rehabilitative Services o III. Cardiovascular Services o IV. Oncology Services o V. Community Health Services MHS has set out to answer the most critical health needs that are specific to its community. Over the next five years, the MHS strategic plan will continue a tradition of quality, community-oriented health care to meet future demands. 12. Financing the Future MHS has established a corporate depreciation fund. The fund's purpose is to ease the financial burden of replacing fixed assets. Presently, it has almost $2 million for needed equipment and renovations. MHS CASE STUDY Financial Statements Balance Sheet (Exhibit 28-1) Statement of Revenue and Expense (Exhibit 28-2) Exhibit 28-1 Balance Sheet Metropolis Health System Balance Sheet March 31, 2___ Assets Current Assets Cash and Cash Equivalents $1,150,000 Assets Whose Use Is Limited 825,000 Patient Accounts Receivable 7,400,000 (Net of $1,300,000 Allowance for Bad Debts) Other Receivables 150,000 Inventories 900,000 Prepaid Expenses 200,000 Total Current Assets 10,625,000 Assets Whose Use Is Limited Corporate Funded Depreciation 1,950,000 Held by Trustee Under Bond Indenture Agreement 1,425,000 Total Assets Whose Use Is Limited 3,375,000 Less Current Portion (825,000) Net Assets Whose Use Is Limited 2,550,000 Property, Plant, and Equipment, Net 19,300,000 Other Assets 325,000 Total Assets $32,800,000 Liabilities and Fund Balance Current Liabilities Current Maturities of Long-Term Debt $525,000 Accounts Payable and Accrued Expenses 4,900,000 Bond Interest Payable 300,000 Reimbursement Settlement Payable 100,000 Total Current Liabilities 5,825,000 Long-Term Debt 6,000,000 Less Current Portion of Long-Term Debt (525,000) Net Long-Term Debt 5,475,000 Total Liabilities 11,300,000 Fund Balances General Fund 21,500,000 Total Fund Balances 21,500,000 Total Liabilities and Fund Balances $32,800,000 Exhibit 28-2 Statement of Revenue and Expense Metropolis Health System Statement of Revenue and Expense for the Year Ended March 31, 2___ Revenue Net patient service revenue Other revenue $34,000,000 1,100,000 Total Operating Revenue $35,100,000 Expenses Nursing services $5,025,000 Other professional services 13,100,000 General services 3,200,000 Support services 8,300,000 Depreciation 1,900,000 Amortization 50,000 Metropolis Health System Statement of Revenue and Expense for the Year Ended March 31, 2___ Interest 325,000 Provision for doubtful accounts 1,500,000 Total Expenses 33,400,000 Income from Operations $1,700,000 Nonoperating Gains (Losses) Unrestricted gifts and memorials $20,000 Interest income 80,000 Nonoperating Gains, Net Revenue and Gains in Excess of Expenses and Losses 100,000 $1,800,000 Statement of Cash Flows (Exhibit 28-3) Statement of Changes in Fund Balance (Exhibit 28-4) Schedule of Property, Plant, and Equipment (Exhibit 28-5) Schedule of Patient Revenue (Exhibit 28-6) Schedule of Operating Expenses (Exhibit 28-7) Statistics and Organizational Structure Hospital Statistical Data (Exhibit 28-8) MHS Nursing Practice and Administration Organization Chart (Figure 28-1) MHS Executive-Level Organization Chart (Figure 28-2) Exhibit 28-3 Statement of Cash Flows Metropolis Health System Statement of Cash Flows for the Year Ended March 31, 2___ Statement of Cash Flows Operating Activities Income from operations $1,700,000 Adjustments to reconcile income from operations to net cash flows from operating activities Depreciation and amortization 1,950,000 Changes in asset and liability accounts Patient accounts receivable 250,000 Other receivables (50,000) Inventories (50,000) Prepaid expenses and other assets (50,000) Accounts payable and accrued expenses (400,000) Reduction of bond interest payable (25,000) Estimated third-party payer settlements (75,000) Interest income received Unrestricted gifts and memorials received Net cash flow from operating activities 80,000 20,000 $3,350,000 Cash Flows from Capital and Related Financing Activities Repayment of long-term obligations (500,000) Cash Flows from Investing Activities Purchase of assets whose use is limited (100,000) Equipment purchases and building improvements (2,000,000) Net Increase (Decrease) in Cash and Cash Equivalents $750,000 Cash and Cash Equivalents, Beginning of Year 400,000 Cash and Cash Equivalents, End of Year $1,150,000 Exhibit 28-4 Statement of Changes in Fund Balance Metropolis Health System Statement of Changes in Fund Balance for the Year Ended March 31, 2___ General Fund Balance April 1, 2____ $19,700,000 Revenue and Gains in Excess of Expenses and Losses General Fund Balance March 31, 2____ 1,800,000 $21,500,000 Exhibit 28-5 Schedule of Property, Plant, and Equipment Metropolis Health System Schedule of Property, Plant, and Equipment for the Year Ended March 31, 2___ Buildings and Improvements $14,700,000 Land Improvements 1,100,000 Equipment 28,900,000 Total $44,700,000 Less Accumulated Depreciation (26,100,000) Net Depreciable Assets $18,600,000 Land 480,000 Construction in Progress Net Property, Plant, and Equipment 220,000 $19,300,000 Exhibit 28-6 Schedule of Patient Revenue Metropolis Health System Schedule of Patient Revenue for the Year Ended March 31, 2___ Patient Services Revenue Routine revenue $9,850,000 Laboratory 7,375,000 Radiology and CT scanner 5,825,000 OB-nursery 450,000 Pharmacy 3,175,000 Emergency service 2,200,000 Medical and surgical supply and IV 5,050,000 Operating rooms 5,250,000 Anesthesiology 1,600,000 Respiratory therapy 900,000 Physical therapy 1,475,000 EKG and EEG 1,050,000 Ambulance service 900,000 Oxygen 575,000 Home health and hospice 1,675,000 Substance abuse 375,000 Other 775,000 Subtotal $48,500,000 Less allowances and charity care (14,500,000) Net Patient Service Revenue $34,000,000 Exhibit 28-7 Schedule of Operating Expenses Metropolis Health System Schedule of Operating Expenses for the Year Ended March 31, 2___ Nursing Services Routine Medical/Surgical $3,880,000 Operating Room 300,000 Intensive Care Units 395,000 OB-Nursery 150,000 Other 300,000 Total $5,025,000 Other Professional Services Laboratory $2,375,000 Radiology and CT Scanner 1,700,000 Pharmacy 1,375,000 Emergency Service 950,000 Medical and Surgical Supply 1,800,000 Operating Rooms and Anesthesia 1,525,000 Respiratory Therapy 525,000 Physical Therapy 700,000 EKG and EEG 185,000 Ambulance Service 80,000 Substance Abuse 460,000 Home Health and Hospice 1,295,000 Other 130,000 Total $13,100,000 General Services Dietary $1,055,000 Maintenance 1,000,000 Laundry 295,000 Housekeeping 470,000 Security 50,000 Medical Records Total 330,000 $3,200,000 Support Services General $4,600,000 Insurance 240,000 Payroll Taxes 1,130,000 Employee Welfare 1,900,000 Other 430,000 Total $8,300,000 Depreciation 1,900,000 Amortization 50,000 Interest Expense 325,000 Provision for Doubtful Accounts Total Operating Expenses 1,500,000 $33,400,000 Exhibit 28-8 Hospital Statistical Data Metropolis Health System Schedule of Hospital Statistics for the Year Ended March 31, 2___ Inpatient Indicators: Departmental Volume Indicators: Patient Days Medical and surgical 13,650 Respiratory therapy treatments 51,480 Obstetrics 1,080 Physical therapy treatments 34,050 Skilled nursing unit 4,500 Laboratory workload units (in thousands) 2,750 Admissions EKGs 8,900 Adult acute care 3,610 CT scans 2,780 Newborn 315 MRI scans 910 Skilled nursing unit 440 Emergency room visits 11,820 Ambulance trips 2,320 Home health visits 14,950 Discharges Adult acute care 3,580 Newborn 315 Skilled nursing unit Approximate number of employees (FTE) 510 445 Average Length of Stay (in days) 4.1 Figure 28-1 MHS Nursing Practice and Administration Organization Chart. Courtesy of Resource Group, Ltd., Dallas, Texas. Figure 28-2 MHS Executive-Level Organization Chart. Courtesy of Resource Group, Ltd., Dallas, Texas. CHAPTER 28 Case Study: Metropolis Health System BACKGROUND 1. The Hospital System Metropolis Health System (MHS) offers comprehensive healthcare services. It is a midsize taxing district hospital. Although MHS has the power to raise revenues through taxes, it has not done so for the past seven years. 2. The Area MHS is located in the town of Metropolis, which has a population of 50,000. The town has a small college and a modest number of environmentally clean industries. 3. MHS Services MHS has taken significant steps to reduce hospital stays. It has developed a comprehensive array of services that are accessible, cost-effective, and responsive to the community's needs. These services are wellness oriented in that they strive for prevention rather than treatment. As a result of these steps, inpatient visits have increased overall by only 1,000 per year since 2008, whereas outpatient/same-day surgery visits have had an increase of over 50,000 per year. A number of programmatic, service, and facility enhancements support this major transition in the community's institutional health care. They are geared to provide the quality, convenience, affordability, and personal care that best suit the health needs of the people whom MHS serves. o Rehabilitation and Wellness Centerfor outpatient physical therapy and return-to-work services, plus cardiac and pulmonary rehabilitation, to get people back to a normal way of living. o Home Health Servicesbringing skilled care, therapy, and medical social services into the home; a comfortable and affordable alternative in longer-term care. o Same-Day Surgery (SDS)eliminating the need for an overnight stay. Since 1998, same-day surgery procedures have doubled at MHS. o Skilled Nursing Facilityinpatient service to assist patients in returning more fully to an independent lifestyle. o Community Health and Wellnesscommunity health outreach programs that provide educational seminars on a variety of health issues, a diabetes education center, support services for patients with cancer, health awareness events, and a women's health resource center. o Occupational Health Serviceshelping to reduce workplace injury costs at over 100 area businesses through consultation on injury avoidance and work-specific rehabilitation services. o Recovery Servicesoffering mental health services, including substance abuse programs and support groups, along with individual and family counseling. 4. MHS's Plant The central building for the hospital is in the center of a two-square-block area. A physicians' office building is to the west. Two administrative offices, converted from former residences, are on one corner. The new ambulatory center, completed two years ago, has an L shape and sits on one corner of the western block. A laundry and maintenance building sits on the extreme back of the property. A fourstory parking garage is located on the eastern back corner. An employee parking lot sits beside the laundry and maintenance building. Visitor parking lots fill the front eastern portion of the property. A helipad is on the extreme western edge of the property behind the physicians' office building. 5. MHS Board of Trustees Eight local community leaders who bring diverse skills to the board govern MHS. The trustees generously volunteer their time to plan the strategic direction of MHS, thus ensuring the system's ability to provide quality comprehensive health care to the community. 6. MHS Management A chief executive officer manages MHS. Seven senior vice presidents report to the CEO. MHS is organized into 23 major responsibility centers. 7. MHS Employees All 500 team members employed by MHS are integral to achieving the high standards for which the system strives. The quality improvement program, reviewed and reestablished in 2010, is aimed at meeting client needs sooner, better, and more costeffectively. Participants in the program are from all areas of the system. 8. MHS Physicians The MHS medical staff is a key part of MHS's ability to provide excellence in health care. Over 75 physicians cover more than 30 medical specialties. The high quality of their training and their commitment to the practice of medicine are great assets to the health of the community. The physicians are very much a part of MHS's drive for continual improvement on the quality of healthcare services offered in the community. MHS brings in medical experts from around the country to provide training in new techniques, made possible by MHS's technologic advancements. MHS also ensures that physicians are offered seminars, symposiums, and continuing education programs that permit them to remain current with changes in the medical field. The medical staff's quality improvement program has begun a care path initiative to track effective means for diagnosis, treatment, and follow-up. This initiative will help avoid unnecessary or duplicate use of expensive medications or technologies. 9. MHS Foundation Metropolis Health Foundation is presently being created to serve as the philanthropic arm of MHS. It will operate in a separate corporation governed by a board of 12 community leaders and supported by a 15-member special events board. The mission of the foundation will be to secure financial and nonfinancial support for realizing the MHS vision of providing comprehensive health care for the community. Funds donated by individuals, businesses, foundations, and organizations will be designated for a variety of purposes at MHS, including the operation of specific departments, community outreach programs, continuing education for employees, endowment, equipment, and capital improvements. 10. MHS Volunteer Auxiliary There are 500 volunteers who provide over 60,000 hours of service to MHS each year. These men and women assist in virtually every part of the system's operations. They also conduct community programs on behalf of MHS. The auxiliary funds its programs and makes financial contributions to MHS through money it raises on renting televisions and vending gifts and other items at the hospital. In the past, its donations to MHS have generally been designated for medical equipment purchases. The auxiliary has given $250,000 over the last five years. 11. Planning the Future for MHS The MHS has identified five areas of desired service and programmatic enhancement in its five-year strategic plan: o I. Ambulatory Services o II. Physical Medicine and Rehabilitative Services o III. Cardiovascular Services o IV. Oncology Services o V. Community Health Services MHS has set out to answer the most critical health needs that are specific to its community. Over the next five years, the MHS strategic plan will continue a tradition of quality, community-oriented health care to meet future demands. 12. Financing the Future MHS has established a corporate depreciation fund. The fund's purpose is to ease the financial burden of replacing fixed assets. Presently, it has almost $2 million for needed equipment and renovations. MHS CASE STUDY Financial Statements Balance Sheet (Exhibit 28-1) Statement of Revenue and Expense (Exhibit 28-2) Exhibit 28-1 Balance Sheet Metropolis Health System Balance Sheet March 31, 2___ Assets Current Assets Cash and Cash Equivalents $1,150,000 Assets Whose Use Is Limited 825,000 Patient Accounts Receivable 7,400,000 (Net of $1,300,000 Allowance for Bad Debts) Other Receivables 150,000 Inventories 900,000 Prepaid Expenses 200,000 Total Current Assets 10,625,000 Assets Whose Use Is Limited Corporate Funded Depreciation 1,950,000 Held by Trustee Under Bond Indenture Agreement 1,425,000 Total Assets Whose Use Is Limited 3,375,000 Less Current Portion (825,000) Net Assets Whose Use Is Limited 2,550,000 Property, Plant, and Equipment, Net 19,300,000 Other Assets 325,000 Total Assets $32,800,000 Liabilities and Fund Balance Current Liabilities Current Maturities of Long-Term Debt $525,000 Accounts Payable and Accrued Expenses 4,900,000 Bond Interest Payable 300,000 Reimbursement Settlement Payable 100,000 Total Current Liabilities 5,825,000 Long-Term Debt 6,000,000 Less Current Portion of Long-Term Debt (525,000) Net Long-Term Debt 5,475,000 Total Liabilities 11,300,000 Fund Balances General Fund 21,500,000 Total Fund Balances 21,500,000 Total Liabilities and Fund Balances $32,800,000 Exhibit 28-2 Statement of Revenue and Expense Metropolis Health System Statement of Revenue and Expense for the Year Ended March 31, 2___ Revenue Net patient service revenue Other revenue $34,000,000 1,100,000 Total Operating Revenue $35,100,000 Expenses Nursing services $5,025,000 Other professional services 13,100,000 General services 3,200,000 Support services 8,300,000 Depreciation 1,900,000 Amortization 50,000 Metropolis Health System Statement of Revenue and Expense for the Year Ended March 31, 2___ Interest 325,000 Provision for doubtful accounts 1,500,000 Total Expenses 33,400,000 Income from Operations $1,700,000 Nonoperating Gains (Losses) Unrestricted gifts and memorials $20,000 Interest income 80,000 Nonoperating Gains, Net Revenue and Gains in Excess of Expenses and Losses 100,000 $1,800,000 Statement of Cash Flows (Exhibit 28-3) Statement of Changes in Fund Balance (Exhibit 28-4) Schedule of Property, Plant, and Equipment (Exhibit 28-5) Schedule of Patient Revenue (Exhibit 28-6) Schedule of Operating Expenses (Exhibit 28-7) Statistics and Organizational Structure Hospital Statistical Data (Exhibit 28-8) MHS Nursing Practice and Administration Organization Chart (Figure 28-1) MHS Executive-Level Organization Chart (Figure 28-2) Exhibit 28-3 Statement of Cash Flows Metropolis Health System Statement of Cash Flows for the Year Ended March 31, 2___ Statement of Cash Flows Operating Activities Income from operations $1,700,000 Adjustments to reconcile income from operations to net cash flows from operating activities Depreciation and amortization 1,950,000 Changes in asset and liability accounts Patient accounts receivable 250,000 Other receivables (50,000) Inventories (50,000) Prepaid expenses and other assets (50,000) Accounts payable and accrued expenses (400,000) Reduction of bond interest payable (25,000) Estimated third-party payer settlements (75,000) Interest income received Unrestricted gifts and memorials received Net cash flow from operating activities 80,000 20,000 $3,350,000 Cash Flows from Capital and Related Financing Activities Repayment of long-term obligations (500,000) Cash Flows from Investing Activities Purchase of assets whose use is limited (100,000) Equipment purchases and building improvements (2,000,000) Net Increase (Decrease) in Cash and Cash Equivalents $750,000 Cash and Cash Equivalents, Beginning of Year 400,000 Cash and Cash Equivalents, End of Year $1,150,000 Exhibit 28-4 Statement of Changes in Fund Balance Metropolis Health System Statement of Changes in Fund Balance for the Year Ended March 31, 2___ General Fund Balance April 1, 2____ $19,700,000 Revenue and Gains in Excess of Expenses and Losses General Fund Balance March 31, 2____ 1,800,000 $21,500,000 Exhibit 28-5 Schedule of Property, Plant, and Equipment Metropolis Health System Schedule of Property, Plant, and Equipment for the Year Ended March 31, 2___ Buildings and Improvements $14,700,000 Land Improvements 1,100,000 Equipment 28,900,000 Total $44,700,000 Less Accumulated Depreciation (26,100,000) Net Depreciable Assets $18,600,000 Land 480,000 Construction in Progress Net Property, Plant, and Equipment 220,000 $19,300,000 Exhibit 28-6 Schedule of Patient Revenue Metropolis Health System Schedule of Patient Revenue for the Year Ended March 31, 2___ Patient Services Revenue Routine revenue $9,850,000 Laboratory 7,375,000 Radiology and CT scanner 5,825,000 OB-nursery 450,000 Pharmacy 3,175,000 Emergency service 2,200,000 Medical and surgical supply and IV 5,050,000 Operating rooms 5,250,000 Anesthesiology 1,600,000 Respiratory therapy 900,000 Physical therapy 1,475,000 EKG and EEG 1,050,000 Ambulance service 900,000 Oxygen 575,000 Home health and hospice 1,675,000 Substance abuse 375,000 Other 775,000 Subtotal $48,500,000 Less allowances and charity care (14,500,000) Net Patient Service Revenue $34,000,000 Exhibit 28-7 Schedule of Operating Expenses Metropolis Health System Schedule of Operating Expenses for the Year Ended March 31, 2___ Nursing Services Routine Medical/Surgical $3,880,000 Operating Room 300,000 Intensive Care Units 395,000 OB-Nursery 150,000 Other 300,000 Total $5,025,000 Other Professional Services Laboratory $2,375,000 Radiology and CT Scanner 1,700,000 Pharmacy 1,375,000 Emergency Service 950,000 Medical and Surgical Supply 1,800,000 Operating Rooms and Anesthesia 1,525,000 Respiratory Therapy 525,000 Physical Therapy 700,000 EKG and EEG 185,000 Ambulance Service 80,000 Substance Abuse 460,000 Home Health and Hospice 1,295,000 Other 130,000 Total $13,100,000 General Services Dietary $1,055,000 Maintenance 1,000,000 Laundry 295,000 Housekeeping 470,000 Security 50,000 Medical Records Total 330,000 $3,200,000 Support Services General $4,600,000 Insurance 240,000 Payroll Taxes 1,130,000 Employee Welfare 1,900,000 Other 430,000 Total $8,300,000 Depreciation 1,900,000 Amortization 50,000 Interest Expense 325,000 Provision for Doubtful Accounts Total Operating Expenses 1,500,000 $33,400,000 Exhibit 28-8 Hospital Statistical Data Metropolis Health System Schedule of Hospital Statistics for the Year Ended March 31, 2___ Inpatient Indicators: Departmental Volume Indicators: Patient Days Medical and surgical 13,650 Respiratory therapy treatments 51,480 Obstetrics 1,080 Physical therapy treatments 34,050 Skilled nursing unit 4,500 Laboratory workload units (in thousands) 2,750 Admissions EKGs 8,900 Adult acute care 3,610 CT scans 2,780 Newborn 315 MRI scans 910 Skilled nursing unit 440 Emergency room visits 11,820 Ambulance trips 2,320 Home health visits 14,950 Discharges Adult acute care 3,580 Newborn 315 Skilled nursing unit Approximate number of employees (FTE) 510 445 Average Length of Stay (in days) 4.1 Figure 28-1 MHS Nursing Practice and Administration Organization Chart. Courtesy of Resource Group, Ltd., Dallas, Texas. Figure 28-2 MHS Executive-Level Organization Chart. Courtesy of Resource Group, Ltd., Dallas, Texas