A NEW PARKLAND: YOU DECIDE

Garland Chamber of Commerce

October 27, 2008

Commissioner Mike CantrellDallas County, District 2

1893 - voters approved $40,000 in bonds for a new hospital

1936 - Dallas City-County Hospital System was founded

1954 - Voters approved creation of a Dallas County Hospital District & Parkland was opened on

Harry Hines

1974 - Hospital on Maple and Oaklawn closed

Parkland Then

Parkland Today $1 billion health system with 8,956 employees

685-bed hospital, not including 65 neonatal beds

11 Community-Oriented Primary Care health centers and school-based clinics

Mobile health delivery fleet

Medicaid managed care health plan

Health service provider for the Dallas County Jails

Level I trauma center

Region’s only Burn Center

Regional resource for disaster preparedness

10 Centers of Excellence

Parkland’s Mandates• As the payer of last resort, Parkland is mandated by Federal

law to treat those who are in need, whether indigent, uninsured, undocumented or legal citizens

• Under the Federal Emergency Medical Treatment and Labor Act (EMTALA), a hospital with an emergency department must provide any individual who comes to its emergency department with an appropriate medical screening to determine whether or not an emergency condition exists, and if it does the hospital must stabilize and treat the patient (42 U.S.C. § 1385dd(a) & 42 U.S.C. § 1395dd(b) and (c))

• By law (42 U.S.C. § 1395dd(g)), hospitals with specialized facilities such as burn units, shock-trauma centers, or neonatal intensive care units shall not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual

Parkland’s Role in Our Community

Proactive Public Health Service

Public Health System

Safety-Net Provider

Academic Medical Center

Regional Provider of Care

Parkland’s Challenges

Age of current facility

Functionality and space constraints

Code compliance issues

Increase in patient population

1990 – 1,852,810 2006 – 2,345,815

2000 – 2,218,899 2035 – 3,600,000

Patient mix (indigent (uninsured/underinsured), undocumented, and out of county)

Attracting 3rd party payers

Parkland’s ChallengesINDIGENT (Uninsured/Underinsured)• Uninsured and underinsured population is growing • Local tax dollars are expected to bear more of the

burden of indigent healthcare due to Federal and State cuts

• As of 2007, the Commonwealth Fund study estimated there are 25 million underinsured adults in the U.S., which is a 60% increase from 2003

• According to The Families USA report, healthcare premiums for Texas’ working families rose by 70.7% while the median earning rose by only 10.3% from 2000-2006

• Persons in Dallas County without insurance were estimated at 530,000 in 2000; 633,522 in 2005; and are projected to be 829,000 by 2011

Parkland’s ChallengesCHARITY CARE REQUIREMENTS

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00%

UTSW

Presbyterian

Children's

BUMC

Baylor Garland

Meth Charlton

Methodist

Parkland

Source: Center for Health Statistics, DSHS - 2006 Data

The Health & Safety Code Section 311 requires nonprofit hospitals to provide community benefits, which include charity care and government-sponsored indigent health care.

Parkland’s Challenges

UNDOCUMENTED

Reimbursement for undocumented patients come from three sources.

• MEDICAID, under federal law, pays for the delivery of children to mothers who cannot provide

citizenship

• TITLE V federal program pays for prenatal care

• SECTION 1011 of the Medicare Modernization Act of 2005 provides for federal reimbursement of emergency healthcare for undocumented and certain other specified aliens

Parkland’s ChallengesOUT OF COUNTY

The 1985 Indigent Healthcare and Treatment Act established that counties are responsible to

(1) create a hospital district/taxing unit;

(2) operate a public hospital; or

(3) operate a County Indigent Health Care Program by contributing up to 8% of the county’s general levy for resident’s healthcare.

County or Hospital District’s Federal Poverty Level:

Parkland 200% Denton County 150%

Collin County 100% Rockwall County 21%

Tarrant County 200%

Parkland’s Challenges2008 Federal Poverty Level

% Gross Monthly IncomeFamily Size 21% 100% 150% 200%

1 $393 $10,400 $1,300 $20,800

2 $488 $14,000 $1,750 $28,000

3 $582 $17,600 $2,200 $35,200

4 $677 $21,200 $2,650 $42,400

$ in Millions

Inpatient Outpatient TOTAL

Emergent Non-Emergent Emergent Non-Emergent

Insured 16 2 1 0 19

Medicare 4 1 0 0 5

Medicaid 1 1 0 0 2

Unfunded -2 0 0 -2 -4

TOTAL 19 4 0 -2 21

Parkland’s Challenges

FY2007 Contribution Margin

Parkland’s FuturePreparing for a New Hospital

• Parkland engaged consultants to conduct a feasibility study, review demographic assumptions, and develop a strategic plan

• Dallas County Commissioners court appointed a Blue Ribbon Master Capital Plan Advisory Committee to develop a Master Capital Plan

• Parkland hospital is not only debt free but they are in a good financial position

Parkland’s Future

New Campus to Include:

546 Medical/Surgical/Trauma Beds

280 Women & Infants’ Specialty Health Beds

106 Strategic Investment Beds

36 Programmatic Investment Beds

Teaching & Non-Teaching Clinics

Cost

$1,217 million

Parkland’s FutureFinancing

Debt - Revenue Bonds$747 million (maturing in 25 years)

Philanthropy

The Parkland Foundation projects thecommunity to contribute $150 million

CashThe Dallas County Hospital District Board of

Managers intend to use $250 million of existing cash and $100 million from

future cash

Interest on Proceeds$24 million

Parkland’s Future

Property Tax Rate

Past & Current:

FY96 0.1996 FY99 0.1799

FY97 0.1941 FY00 0.1960

FY98 0.1855 FY01 – FY09 0.2540

Future:

FY2010 - 2¢ increase for G.O. bond support = .274¢

FY2011 - .05¢ increase for G.O. bond support = .279¢

FY2014 - 1¢ increase for operational support = .289¢

Parkland’s Future

Other $107,000,000

10%

Taxes $431,000,000

39%Government

Subsidies$171,000,000

15%

Patient$400,000,000

36%

FY2009 Revenues $1,109,000,000FY2009 Revenues $1,109,000,000

Parkland’s Future

Construction

Opening 2011

• Office Building (269,000 sq. ft. )

Opening 2014

• 816 Adult Beds & Shell 46 (1.68 million sq. ft.)

• Clinic Buildings (387 sq. ft.)

• Parking (2,035 new garage spaces and 2,800 new surface spaces)

Hospital Discharges for Dallas County Residents

0

9,000

18,000

27,000

36,000

45,000

2003 2005 2007

Parkland

Baylor

Presbyterian

Methodist Dallas

Medical City

St. Paul

Without Parkland Hospital the private area hospitals will be inundated with additional patients including the uninsured, underinsured, and undocumented.

Healthcare in Dallas County Without Parkland

Healthcare in Dallas County Without Parkland

Parkland provides annually:

• over 140,000 emergency room visits

• over 260,000 specialty outpatient service visits

• over 420,000 Community-Oriented Primary Care visits

• over 16,000 deliveries

• over 5 million prescriptions filled

BOND ELECTION BY DALLAS COUNTY HOSPITAL DISTRICT

d/b/a PARKLAND HEALTH AND HOSPITAL SYSTM

Proposition

“Authorizing the Dallas County Hospital District [d/b/a Parkland Heath & Hospital System] to pledge the revenues from its hospital system and from ad valorem tax that was previously approved by the voters to the payment of combination tax and revenue bonds and other obligations that will be issued and executed for the capital purpose of the hospital system.”

For □

Against □

Parkland’s FutureThe ballot proposition will state:

Parkland’s Future

Parkland’s future is up to you… YOU DECIDE

Early Voting: 10/20/08 – 10/24/08 8a.m.-5p.m.

10/25/08 7a.m.-7p.m.

10/26/08 1p.m.-6p.m.

10/27/08 – 10/31/08 7a.m.-7p.m.

Election Day: 11/4/08 7a.m.-7p.m.

Visit www.dalcoelections.org for times & locations