Problem: Imagine that it is December 2017, and you have just accepted the chief financial officer (CFO) position at Hays County Integrated Delivery System (IDS), hereinafter referred to as County. You will be reporting to Mr. Salter, Countys chief executive officer, a retired schoolteacher who was hired last year. Also reporting to Mr. Salter are Dr. Spok, Countys medical director; Mr. Wannabe, Countys chief operating officer; Ms. Pincher, Countys controller; and Ms. Care, Countys director of nursing. When announcing your appointment, Mr. Salter stated that your primary objective in the coming year (2018) would be to reverse the ominous financial trend that began in 2016 with an operating loss and continued in 2017. Previous operating losses were funded with investment income (investment income was $200,000 in 2017); however, your board recently passed a resolution discontinuing that practice and restricting investment income to capital expenditures in 2017. County is a not-for-profit county-owned urban hospital and includes a 130-bed acute care hospital, a 35-bed skilled nursing facility (SNF), a 15-bed rehab facility, a home health care agency, and an outpatient clinic. It has a 40-member medical staff that bills independently. The hospital, Hays County Hospital (HCH), is one of two hospitals in the county (population is 175,000) and the only hospital in San Marcos, Texas, with a population of 50,000. St. Teresas, a not-for-profit Catholic-owned hospital, is the only other hospital in Hays County. St. Teresas is about 25 miles from Hays County IDS. To acquire background information, you decide to meet first with each member of the executive team and then with selected members of senior management.

**You will need to use the data in the Tables given in the case. Particularly you will want to use Table II, Table IV-A, Table IV-B, and Table IV-C. You will also need to make some reasonable assumptions as you work through the problem. Your answer should consider financial analysis elements and strategy elements. For example, if you find the capitated contract with the city is losing money, don't jump to the conclusion to cancel the contract. Decide from a strategic perspective whether there is a way forward to renew the contract. There is no absolute right answer, but there are answers that meet the "test of reasonableness". **

QUESTION: Analyze my capitated managed care agreement with the city and tell me the full cost profit / loss. Should we renew the contract for the next year at present rates, or should we ask for a rate increase and if so, how much rate increase do we need to cover our full cost.

TABLE 11 Hays County IDS Actual Expenses (5) 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) TOTAL EXPENSES $76.725.792 7,000,000 8,000,000 8,500,000 7,500,000 6,500,000 8,000,000 9,000,000 8,021,440 3,000,000 $142,247,232 2016 2017 TABLE IV-A Hays County IDS Discharges Service (LOS) 2013 Acute (A) 6.777 SNF (30) Rehab (20) 155 Home Health 7.298 Emergency 27.915 Outpatient 16,826 2015 5.931 247 5.931 255 239 2014 6,354 243 157 6,082 30,062 18.355 159 164 5.931 251 162 3.650 34.354 22,942 4.866 32,207 19,884 3,650 36,500 26,000 LOS length of stay, SNF = skilled nursing facility 2014 2015 2016 2017 TABLE IV-B Percentage of Discharges by Payer 2013 Medicare Medicaid Commercial Managed Care-discount Managed Care-capitation Bad Debt Charity TABLE IV-C 2017 Charges per Discharge/Visit ($) HCH Acute 40,000 30,000 Rehab 40,000 Home Health 400 Emergency 1,600 Outpatient 600 SNE St. Teresa 38,200 28,000 38,000 300 1,500 500 SNF skilled nursing Facility TABLE 11 Hays County IDS Actual Expenses (5) 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) TOTAL EXPENSES $76.725.792 7,000,000 8,000,000 8,500,000 7,500,000 6,500,000 8,000,000 9,000,000 8,021,440 3,000,000 $142,247,232 2016 2017 TABLE IV-A Hays County IDS Discharges Service (LOS) 2013 Acute (A) 6.777 SNF (30) Rehab (20) 155 Home Health 7.298 Emergency 27.915 Outpatient 16,826 2015 5.931 247 5.931 255 239 2014 6,354 243 157 6,082 30,062 18.355 159 164 5.931 251 162 3.650 34.354 22,942 4.866 32,207 19,884 3,650 36,500 26,000 LOS length of stay, SNF = skilled nursing facility 2014 2015 2016 2017 TABLE IV-B Percentage of Discharges by Payer 2013 Medicare Medicaid Commercial Managed Care-discount Managed Care-capitation Bad Debt Charity TABLE IV-C 2017 Charges per Discharge/Visit ($) HCH Acute 40,000 30,000 Rehab 40,000 Home Health 400 Emergency 1,600 Outpatient 600 SNE St. Teresa 38,200 28,000 38,000 300 1,500 500 SNF skilled nursing Facility