Tulare Regional Medical
Center
Agenda
• Key data
• Why change is necessary
• Ideal solutions
• Conclusion
Key Data
• 112 bed, acute-care hospital
• 3 Rural Health Clinics, 2 more clinics opening
• Medical tower expansion
• Significant growth potential
Service Area Demographics
• Population estimate: 171, 438
• Average age: 30.3
• 57.9% Hispanic
• High poverty rates
Why Change is Necessary
• Lack of physician alignment
• Quality perception
• Disproportionate market share
• Current payer mix
Physician Alignment
• To remain competitive, physicians must be fully
integrated into TRMC
Perceived Lack of Quality
• HCAHPS lower than state and national averages
• HCAHPS lower than Kaweah Delta Medical Center
in almost every category
Metric
Patients who would
definitely recommend
hospital
Patients who
reported area around
their room was
“always” quiet at
night
TRMC
Kaweah Delta
50%
69%
37%
50%
TRMC’s Current Market Share
• 80% of patients participate in government
insurance programs
▫ 45% Medi-Cal
• Poor quality perception is hurting patient
retention
• Potential patients directed elsewhere
Key Operating Indicators
TRMC
2010 OSHPD
Net Rev/APD
1,946
3,124
Supply/APD
264
476
Labor/APD
730
1,590
Total/APD
1,915
3,082
Ideal Solutions
• Physician alignment
Renegotiate Physician Contracts
• Business development and physician
communication
▫ What do they want?
▫ What do competitors offer?
• Sizeable share of the newly insured
▫ PPACA will increase commercial payers
• Focus on community needs
Optimize TRMC’s Clinic Network
• Maintain 3 Rural Health Clinics and 2 1206(d)
clinics
• RHCs
▫
▫
▫
▫
Higher Medi-Cal reimbursement rates
PPACA increasing Medi-Cal rates 2013-2014
Patient access to care
Specialized care for the population
Optimize TRMC’s Clinic Network
• 1206(d) Clinics
• Hospitals
▫ Higher Medicare reimbursement rates
 100-113%
▫ Increased patient base
▫ Reinforce physician-TRMC alignment efforts
 Inpatient referrals
Optimize TRMC’s Clinic Network
• Physicians
▫ No overhead, focus on patients
▫ New technology
• Community
▫ Increase quality perception
▫ Bring access to health care
▫ Programs for elderly
Projected Payer Mix of 1206(d) Clinics in
2014
2%
Medicare + Managed
21%
Medi-Cal + Managed
42%
Commercial
Other (Self Pay, Indigent,
etc)
35%
Projected Payer Mix of Rural Health Clinics in
2014
5%
14%
19%
Medicare + Managed
Medi-Cal + Managed
Commercial
Other (Self Pay, Indigent,
etc)
62%
Profit & Loss
Gross Patient Revenue
(Deductions from Revenue)
Net Patient Revenue
Other Operating Revenue
Total Operating Revenue
(Operating Expenses)
Salaries & Wages
Employee Benefits
Physician Professional Fees:
Other Professional Fees:
Supplies
Purchased Services
Depreciation
Leases & Rentals
Insurance
Interest
All Other Expenses
Net From Operations
Non-Operating Revenue
(Non-Operating Expenses)
Net Income
2011
2012
2013
2014
2015
$ 267,526,211.00 $ 280,891,028.75 $ 345,882,635.02 $ 340,993,383.35 $ 327,705,586.86
188,294,053.00
197,708,755.65
227,365,069.00
238,733,322.45
250,669,988.57
$ 79,232,158.00 $ 83,182,273.10 $ 118,517,566.02 $ 102,260,060.90 $ 77,035,598.29
1,878,170.00
1,972,078.50
2,110,124.00
2,215,630.19
2,060,536.08
$ 81,110,328.00 $ 85,154,351.60 $ 120,627,690.02 $ 104,475,691.09 $ 79,096,134.37
29,771,868.00
31,260,461.40
35,609,716.77
39,882,882.78
44,668,828.71
10,747,336.00
11,542,638.86
13,536,794.14
14,538,516.91
15,614,367.16
6,471,520.00
6,795,096.00
9,940,507.52
11,133,368.42
12,469,372.63
2,643,050.00
2,510,897.50
4,267,205.20
4,779,269.82
5,352,782.20
10,779,438.00
11,318,409.90
14,810,619.09
16,587,893.38
18,578,440.58
10,392,223.00
10,911,834.15
13,121,254.25
14,695,804.76
16,459,301.33
3,125,385.00
3,281,654.25
5,273,902.39
5,801,292.63
6,091,357.26
886,336.00
930,652.80
2,042,331.14
2,287,410.87
2,561,900.18
364,469.70
382,693.19
1,863,616.37
2,087,250.33
2,337,720.37
848,042.00
800,476.00
2,460,571.20
2,386,754.06
2,315,151.44
2,409,549.00
2,530,026.45
2,412,533.06
2,702,037.03
3,026,281.47
$ 1,803,080.00 $ 2,889,511.10
$15,288,638.90
$16,053,070.84
$16,855,724.39
$ 13,897,152.00 $ 14,592,009.60 $ 16,051,210.56 $ 17,656,331.62 $ 19,421,964.78
3,872,312.00
4,065,927.60
4,879,113.12
5,464,606.69
6,120,359.50
$11,827,920.00
$13,415,593.10
$26,460,736.34
$28,244,795.77
$30,157,329.67
Projected Net Income for TRMC
$35,000,000.00
$30,000,000.00
$25,000,000.00
$20,000,000.00
$15,000,000.00
$10,000,000.00
$5,000,000.00
$0.00
2010
2011
2012
2013
2014
2015
Establish Medical Foundation
• Key component of physician alignment
• Will help facilitate recruiting and retention
• PPACA influential in the move toward
collaborative care
Conclusion
• Physician alignment with TRMC
• Care for population health needs
• Funnel patients to TRMC main campus
▫ Increase revenue generation
• 1206(d) and rural clinics are a first effort toward
long-term Foundation goals
Mission Statement
“A patient-centered organization that sets
the standard for patient experience and
quality of care by pushing the boundaries of
technology in service to our community.”
References
Abbott, D. (2009, March 12). Healdsburg hospital to partner with primary
care. Sonoma West Times and News. Retrieved from http://
www.sonomawest.com/healdsburg/news
Kaweah Delta Health Care District. (2012). Kaweah Delta welcomes second
neonatologist to NICU. Retrieved from http://www.kaweahdelta.org/
news/view_details.asp?newsid=221
Mineful Demographics. (2010). Tulare household income. Retrieved from
http://mineful.net/California/County/County_Income/
Tulare_County_CA_income_ignore.html
Schiff, A. (2010). Hospital outpatient clinics--legal considerations impacting
physicians. Retrieved from www.mdhealthlaw.com/
Studer Group. (2012). About Studer Group. Retrieved from
http://www.studergroup.com/about_studergroup
Taylor, M. (2006). California’s health care districts. Retrieved from http://
www.chcf.org
References
Tulare County Association of Governments. (2008). Tulare county. Retrieved
from http://www.tularecog.org/
Tulare Regional Medical Center. (2012). Tulare Regional Medical Center.
Retrieved from http://www.tulareregional.org
U.S. Department of Health and Human Services. (2006). Comparison of the
rural health clinic and federally qualified health center programs.
Retrieved from http://www.ask.hrsa.gov/downloads/fqhcrhccomparison.pdf
U.S. Department of Labor. (n.d.). General facts on women and job based
health. Retrieved from http://www.dol.gov/ebsa/newsroom/
fshlth5.html
U.S. House of Representatives. (2010). Compilation of patient protection and
affordable care act. Retrieved from http://housedocs.house.gov/
energycommerce/ppacacon.pdf
Weekly Probe. (2011). Hospitals use focus group to drive changes to surgical
procedures. Retrieved from http://www.weeklyprobe.com/2011/12/
hospital-uses-focus-group-to-drive-changes-to-surgical-procedures/