YOUR INTEGRATED DELIVERY SYSTEM 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, County's chief executive officer, a retired schoolteacher who was hired last year. Also reporting to Mr. Salter are Dr. Spok, County's medical director; Mr. Wannabe, County 's chief operating officer; Ms. Pincher, County's controller; and Ms. Care, County's 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. Teresa's, a not-for-profit Catholic-owned hospital, is the only other hospital in Hays County. St. Teresa's 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. 395 396 Case Study: Hays County Integrated Deli very System MEETING WITH DR. SPOK Dr. Spok, hospital medical director, tells you: Most doctors have been on the medical staff for at least ten years. There is little loyalty to the hospital, and most doctors also have admitting privileges at St. Teresa's, a newer hospital with better facilities. While it is a hassle for the doctors to drive the 25 miles from San Marcos to St. Teresa's to see patients, there are a few good reasons for the doctors to admit their patients to St. Teresa's. St. Teresa's has a hospitalist and pays physicians for menial service assignments like committee work (a practice that County has refused to implement). MEETING WITH MR. SALTER Mr. Salter, chief executive officer, states: 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 County. Furthermore, I've tried to establish a "family atmosphere" for our employees that stresses getting along well with others in return for job security. Everyone seems happy-everyone except Mr. Finance Myway, whom you'll be replacing. He and I both started in January 2015 and he seemed increasingly frustrated with the way I do things here-he just didn't fit in. I tried to accommodate him by implementing some of his recommendations, even though they were against my better judgment-like charging visitors for parking, which generated $100,000 in other operating revenue in 2017, but I have discontinued the practice for 2018 because no other organization in San Marcos, other than the university, charges for parking. 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-Mr. Myway threw a fit at an executive team meeting. He claimed that my decisions were driving County deeper into the red, and as a result, I had to show Mr. Myway the highway for insubordination. That happened last month.Dr. Garcia is thinking about retiring this year and has asked us if we want to buy her practice. She would like annual income of $250,000 for the next 30 years. If we can put the purchase price in an annuity that earns 4 percent per year compounded annually, what is the purchase price necessary to guarantee her desired income? What other factors should we consider before buying a physician practice? What is your recommendation?

What is the best ratio for measuring accounts receivable performance? How is our hospital doing? What are your recommendations on improving our accounts receiving performance?

Photos - Screenshot (463).png + Add to ad # Search Edit & Create Share @ ... Hays County IDS Balance Sheet as of December 31, 2016: Assets Assets 2016 Current Assets Cash and cash equivalents Marketable securities Accounts receivable less allowances Inventories at cost Other current assets Total Current Assets $ 816,875 8,100,500 17.250,000 2,368,000 8,992,500 37.527,875 Land and improvements Buildings Fixed equipment Movable equipment Property, Plant, and Equipment Less accumulated depreciation Total Property, Plant, and Equipment TOTAL ASSETS 11,250,000 50,509.500 5,063,250 4.466.750 91,289.500 (38.376,231) 52,913,269 90,441,144 Current Liabilities Current portion of long-term debt Accounts payable and accrued expenses Estimated amounts due to third-party payers Other current liabilities Total Current Liabilities Long-term debt, net of current portion TOTAL LIABILITIES $ 10,151,000 8,400,000 8,423.750 10,500,000 37.474.750 25,000,000 62.474.750 Net Assets Unrestricted Temporarily restricted Permanently restricted TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS 742,625 16,000,000 11,223.769 27.966,394 $90,441,144 4 O Type here to search 9 a $ S N @ ex @ @ 8:14 AM | 2/15/2020 Photos - Screenshot (463).png + Add to ad # Search Edit & Create Share @ ... Hays County IDS Balance Sheet as of December 31, 2016: Assets Assets 2016 Current Assets Cash and cash equivalents Marketable securities Accounts receivable less allowances Inventories at cost Other current assets Total Current Assets $ 816,875 8,100,500 17.250,000 2,368,000 8,992,500 37.527,875 Land and improvements Buildings Fixed equipment Movable equipment Property, Plant, and Equipment Less accumulated depreciation Total Property, Plant, and Equipment TOTAL ASSETS 11,250,000 50,509.500 5,063,250 4.466.750 91,289.500 (38.376,231) 52,913,269 90,441,144 Current Liabilities Current portion of long-term debt Accounts payable and accrued expenses Estimated amounts due to third-party payers Other current liabilities Total Current Liabilities Long-term debt, net of current portion TOTAL LIABILITIES $ 10,151,000 8,400,000 8,423.750 10,500,000 37.474.750 25,000,000 62.474.750 Net Assets Unrestricted Temporarily restricted Permanently restricted TOTAL NET ASSETS TOTAL LIABILITIES AND NET ASSETS 742,625 16,000,000 11,223.769 27.966,394 $90,441,144 4 O Type here to search 9 a $ S N @ ex @ @ 8:14 AM | 2/15/2020