A NEW PARKLAND: YOU DECIDE

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Garland Chamber of Commerce October 27, 2008
A NEW PARKLAND YOU DECIDE
Commissioner Mike CantrellDallas County,
District 2
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Parkland Then
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
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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
• Regions only Burn Center
• Regional resource for disaster preparedness
• 10 Centers of Excellence

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Parklands 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

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Parklands Role in Our Community
Proactive Public Health Service Public Health
System Safety-Net Provider Academic Medical
Center Regional Provider of Care

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Parklands 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

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Parklands Challenges

• INDIGENT (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

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Parklands Challenges
CHARITY CARE REQUIREMENTS
The Health Safety Code Section 311 requires
nonprofit hospitals to provide community
benefits, which include charity care and
government-sponsored indigent health care.
Source Center for Health Statistics, DSHS -
2006 Data
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Parklands 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

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Parklands Challenges
OUT 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 countys general levy for residents
healthcare.
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Parklands Challenges
2008 Federal Poverty Level Gross Monthly Income 2008 Federal Poverty Level Gross Monthly Income 2008 Federal Poverty Level Gross Monthly Income 2008 Federal Poverty Level Gross Monthly Income 2008 Federal Poverty Level Gross Monthly Income
Family 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
County or Hospital Districts Federal Poverty
Level Parkland 200 Denton County
150 Collin County 100 Rockwall County
21 Tarrant County 200
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Parklands Challenges
FY2007 Contribution Margin
in Millions Inpatient Inpatient Outpatient Outpatient TOTAL
in Millions Emergent Non-Emergent Emergent Non-Emergent TOTAL
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
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Parklands Future

• Preparing 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

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Parklands Future
New Campus to Include 546 Medical/Surgical/Traum
a Beds 280 Women Infants Specialty Health
Beds 106 Strategic Investment Beds 36
Programmatic Investment Beds Teaching
Non-Teaching Clinics Cost 1,217 million
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Parklands Future
Financing Debt - Revenue Bonds 747
million (maturing in 25 years) Philanthropy
The Parkland Foundation projects
the community to contribute 150 million
Cash The 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
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Parklands Future
Property Tax Rate Past Current FY96 0.1996
FY99 0.1799 FY97 0.1941 FY00 0.1960 FY9
8 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

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Parklands Future
FY2009 Revenues 1,109,000,000
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Parklands 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)

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

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Parklands Future
The ballot proposition will state
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 ?
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Parklands Future
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.o
rg for times locations
Parklands future is up to you YOU DECIDE