Read Chapter 33 Case Study and Review Exhibits included.

Summarize

Study: Metropolis * System 33 OVD pleasurem There Services www.die hospital. Although MHS has the power to the Health System (MIS) offers comprehensive healthcare edge and a modest number of environmentally chean ated in the town of Metropolis, which has a population of 50,000. Theo w These services are wellness oriented in that they strive for prevention rather than array of services that are accessible, cost-effective, and response to the co's AT Rear since 2010 whereas outpatient/same-day surgery visits have had an increase of Amber of programmatic, service, and facility enhancement Support this major tram in the community's institutional health care. They are geared to provide the quality. enience, affordability, and personal care that best suit the health needs of the people . Rehabilitation and Wellness Center for outpatient physical therapy and return-to- work services, plus cardiac and pulmonary rehabilitation, to get people back to a no Home Health Services-bringing skilled care, therapy, and medical social services into the home; a comfortable and affordable alternative in longer-term care Same-Day Surgery (SDS)-eliminating the need for an overnight stay. Since 2010 same day surgery procedures have doubled at MHS. . Skilled Nursing Facility-inpatient service to assist patients in returning more fully to an independent lifestyle. mal way of living. 459 WATER GS Metropolis Health System MIS Metropolis MIN coin undation and for Parade ar M MISTE what we www with the Health Services to reduce workplace with what an injury avoidance and we mental health services, including wire building is to the west Two administrative offices, converted from The building the hospitals in the center of a two-suareback sking on the extreme hack of the property A four-story parking garage Belpad is the extreme western edge of the property behind the physicians ne building. Visitor parking lots fill the front eastern portion of the poem Trustees generously volunteer their time to plan the strategic direction of MS. High local community leaders who bring diverse skills to the board govern MST uring the stem's ability to provide quality comprehensive health care te Achief executive officer manages MHS. Seven senior vice presidents report to the There These and mon In al paar 11 is communi MHS s organised into 23 major responsibility centers, 7. MHS All 500 team members employed by MHS are integral to achieving the high standards which the system strives. The quality improvement program, reviewed and reestablish in 2010, is aimed at meeting client needs sooner, better, and more cost-effectively. Part pants in the program are from all areas of the system. & MHS Physicians The MHS medical staff is a key part of MHS's ability to provide excellence in health care Over 75 physicians cover more than 30 medical specialties. The high quality of their train, ing and their commitment to the practice of medicine are great assets to the health of the community The physicians are very much a part of MHS's drive for continual improvement on the quality of healthcare services offered in the community. MHS brings in medical experts from around the country to provide training in new techniques, made possible by MHS) technologie advancements. MHS also ensures that physicians are offered seminars, St posiums , and continuing education programs that permit them to remain current with changes in the medical field. M Marathon ca Ya means for din yorduplicate of waders and apported by a 15 met Health Foundationin rendbe we providing comprehensive health care for outreach programs, continuing education for me these men and women assist in virtually every part of the W. They The auxiliary funds its programs and makes financial contri Arabe partits donations to MHS have generally been designed to co The MHS has identified five areas of desired service and program and capital . MW Auxiliary pen , as. The S. the to the uses. The auxiliary has given $250.000 Pileting the Future for MHS I Ambulatory Services IL Cardiovascular Services Oncology Services Community Health Services Physical Medicine and Rehabilitative Services CEO wed 10 MHS has set out to answer the most critical health needs that are specific to.com sin. Over the next five years, the MHS strategic plan will continue a tradition of quality community oriented health care to meet future demands. MHS has established a corporate depreciation fund. The Fund's purpose is to ease the Senancial burden of replacing fixed assets. Presently, it has almost $2 milion for needed Financing the Future equipment and renovations, LES CASE STUDY Financial Statements Balance Sheet (Exhibit 33-1) Statement of Revenue and Expense (Exhibit 33-2) CHAPTER 33 Ca Sud Metropolis Health System Sorah Flos (Exhibie 35-3) State of changes in Fund Balance (Exhibit33) Schedule of Properts Plant, and Equipment (Exhibit 33-6) Schedule of Operating Expenses (Exhibit 33-7) Reves N - Aalance Sheet Metropolis Health System Balance Sheet March 31, 2 Tos EE Liabilities and Fund Balance Current Liabilities Current Maturities of long-term Debt Accounts Payable and Accred AS Current Assets Cash and Cab Equivalents $1.150,000 Assets Whore Use Is Limited 825,000 Patient Accounts Recehable 7.400,000 (Ner of $1,300,000 Allowance for Had Debts) Other Receivables 150,000 Inventories 900,000 Prepaid Expenses 200,000 Total Current Assets 10,625,000 Assets Whose Use Is Limited Corporate Funded Depreciation Expenses Bond Interest Payable Reimbursement Settlement Payable Total Current Liabilities Long-Term Debt Less Current Portion of Long-Term Debt Net Long-Term Debt Total Liabilities 6503 1.950,000 5.47555 11.30 Fund Balances General Fund Held by Trustee Under Bond Indenture Agreement 1.425,000 Total Assets Whose Use Is Limited 3,375,000 Less Current Portion (825,000) Net Assets Whose Use Is Limited 2,550,000 Property, Plant, and Equipment, Net 19,300,000 Su 21.500 21,500 Total Fund Balances Total Liabilities and Fund Balances $32,800,000 Other Assets Total Assets 325,000 $32,800,000 MISC w of Revenue and Expense Metropolis Health System Statement of Revenue and Expen for the Year Ended March 31,2 $31.00 e revenge $5.025.000 13.100.000 er professional services ating Kerente Services cameral services potrices aymilation ration 8.300.000 1.900,000 50,000 325.000 1.500.000 for doubtful accounts 33.400.000 cal Expenses $1.700.000 $20,000 80,000 e from Operations Keperating Gains (Losses) Interest income Manoperating Gains, Net Linrestricted gifts and memorials 100,000 $1.800,000 Rescue and Gains in Excess of Expenses and losses usand Organizational Structure Sigital Statistical Data (Exhibit 33-8) Es Nursing Practice and Administration Organization Chart (Figure 331) 13 Executive Level Organization Chart (Figure 33-2) 172 CHAPTER 33 Case Study: Metropolis Health System w Exhibe 3.5-3 Statement of Cash Flows Metropolis Health System Statement of Cash Flows for the Year Ended March 81.2 Statement of Cash Flows $1,700.00 Operating Activities Income from operations 1,950.00 Adjustments to reconcile income from operations to net cash flows from operating activities Depreciation and amortization Changes in asset and liability accounts Patient accounts receivable Other receivables Inventories Prepaid expenses and other assets Accounts payable and accrued expenses Reduction of bond interest payable Estimated third-party payer settlements Interest income received Unrestricted gifts and memorials received Net cash flow from operating activities 250.000 (50.000) (50.0%) (50,000) (400,000) (25,000) (75,000) 80,000 20,000 $3,350,000 Cash Flows from Capital and Related Financing Activities Repayment of long-term obligations (500,000) Cash Flows from Investing Activities Purchase of assets whose use is limited Equipment purchases and building improvements (100,000) (2,000,000) Net Increase (Decrease) in Cash and Cash Equivalents $750,000 Cash and Cash Equivalents, Beginning of Year Cash and Cash Equivalents, End of Year 400,000 $1,150,000 MISC. or changes in Fund Balance Metropolis Health System Statement of Changes in Fundance for the Year Ended March 31.2 uw Balance April 1, 2 $19,700 and Gains in Excess of Expenses and Losses 100 20 Fund Balance March 31, 2 $21.500.000 of Schedule of Property. Plant, and Equipment Metropolis Health System Schedule of Property, Plant, and Equipment for the Year Ended March 31, 2 $14,700,000 Reildings and Improvements Land Improvements 1.100,000 Equipment 28,900,000 Total $44,700,000 Less Accumulated Depreciation (26,100,000) Net Depreciable Assets $18,600,000 Land 480,000 Construction in Progress 220,000 Net Property, Plant, and Equipment $19,500,000 Case Study: Metropolis Health System 166 CHAPTER 33 Exhibit 58-6 Schedule of Patient Revenue $9,8504 7.37530 5.825 450. 3.175,00 Metropolis Health System Schedule of Patient Revenue for the Year Ended March 31, 2 Patient Services Revenue Routine revenue Laboratory Radiology and CT scanner OB-nursery Pharmacy Emergency service Medical and surgical supply and IV Operating rooms Anesthesiology Respiratory therapy Physical therapy EKG and EEG Ambulance service Oxygen Home health and hospice Substance abuse 2.200.58% 5,050.000 5,250.000 1.600.000 900.000 1,475,000 1,050,000 900,000 575,000 1.675,000 375,000 775,000 Other Subtotal $48,500,000 Less allowances and charity care Net Patient Service Revenue (14,500,000) $34,000,000 MUSC Operating Expenses Schedule of Metropolis Health System Schedule of Operating Expenses for the Year Ended March 31,2 Medical Surgical $3,880,000 300,000 395,000 150.000 300,000 $5,025,000 General Services Dietary Maintenance Laundry Housekeeping Security Medical Records Total Care Units SA $320000 ronal Services and CT Scanner $2,375,000 1,700,000 1,375,000 950,000 1,800,000 Support Services General Insurance Payroll Taxes Employee Welfare Other Total wgen Service $1.500 240.000 1.130x00 1.900.000 430,000 $8.500.000 Ataland Surgical Supply Rooms and wat undera yang Therapy Therapy Depreciation Amortization 1.900.000 50,000 CEEG 1.525,000 525,000 700,000 185,000 80,000 460,000 1.295,000 130,000 $13,100,000 cance Service ance Abuse Interest Expense 325.000 ne Health and Hospice Provision for Doubtful Accounts 1,500,000 Total Operating Expenses $3,400,000 CAPTERS C Seady Metropolis Health System 1.00 Exhible - Hopital Santial Dutt Metropole Health System Schedule of lampical Static for the audied March 31,2 Inpatient Indicator Departmental Volume Indir Patient Day Medical and surgical Respiratory therapy treatment Obstetrics Physical therapy treatments Skilled nursing unit 4.500 Laboratory workload units in the sands) Admissions Adult acute care CT scans Newborn MRI scans Skilled nursing unit Emergency room visits Ambulance trips Discharges Home health visits Adult acute care 3.580 Newborn Approximate number of employees Skilled nursing unit (FTE) 3.610 315 140 1130 14 315 445 510 HA 4.1 Average Length of Stay (in days) Director of Nurses Finance Information Systems Support TCA Education Recruitment Support Medical Surgical Emergency Nursing Ambulatory Nursing Women's Health Pediatric Nursing OB/GYN Children's Medicine MRI Medical Pediatric Medicine Dialysis Surgical Health & Development Oncology Emergency Cardiac Rehab Figure 33-1 MHS Nursing Practice and Administration Organization Chart. Courtesy of Resource Group, Ltd., Dallas, Texas. Study: Metropolis * System 33 OVD pleasurem There Services www.die hospital. Although MHS has the power to the Health System (MIS) offers comprehensive healthcare edge and a modest number of environmentally chean ated in the town of Metropolis, which has a population of 50,000. Theo w These services are wellness oriented in that they strive for prevention rather than array of services that are accessible, cost-effective, and response to the co's AT Rear since 2010 whereas outpatient/same-day surgery visits have had an increase of Amber of programmatic, service, and facility enhancement Support this major tram in the community's institutional health care. They are geared to provide the quality. enience, affordability, and personal care that best suit the health needs of the people . Rehabilitation and Wellness Center for outpatient physical therapy and return-to- work services, plus cardiac and pulmonary rehabilitation, to get people back to a no Home Health Services-bringing skilled care, therapy, and medical social services into the home; a comfortable and affordable alternative in longer-term care Same-Day Surgery (SDS)-eliminating the need for an overnight stay. Since 2010 same day surgery procedures have doubled at MHS. . Skilled Nursing Facility-inpatient service to assist patients in returning more fully to an independent lifestyle. mal way of living. 459 WATER GS Metropolis Health System MIS Metropolis MIN coin undation and for Parade ar M MISTE what we www with the Health Services to reduce workplace with what an injury avoidance and we mental health services, including wire building is to the west Two administrative offices, converted from The building the hospitals in the center of a two-suareback sking on the extreme hack of the property A four-story parking garage Belpad is the extreme western edge of the property behind the physicians ne building. Visitor parking lots fill the front eastern portion of the poem Trustees generously volunteer their time to plan the strategic direction of MS. High local community leaders who bring diverse skills to the board govern MST uring the stem's ability to provide quality comprehensive health care te Achief executive officer manages MHS. Seven senior vice presidents report to the There These and mon In al paar 11 is communi MHS s organised into 23 major responsibility centers, 7. MHS All 500 team members employed by MHS are integral to achieving the high standards which the system strives. The quality improvement program, reviewed and reestablish in 2010, is aimed at meeting client needs sooner, better, and more cost-effectively. Part pants in the program are from all areas of the system. & MHS Physicians The MHS medical staff is a key part of MHS's ability to provide excellence in health care Over 75 physicians cover more than 30 medical specialties. The high quality of their train, ing and their commitment to the practice of medicine are great assets to the health of the community The physicians are very much a part of MHS's drive for continual improvement on the quality of healthcare services offered in the community. MHS brings in medical experts from around the country to provide training in new techniques, made possible by MHS) technologie advancements. MHS also ensures that physicians are offered seminars, St posiums , and continuing education programs that permit them to remain current with changes in the medical field. M Marathon ca Ya means for din yorduplicate of waders and apported by a 15 met Health Foundationin rendbe we providing comprehensive health care for outreach programs, continuing education for me these men and women assist in virtually every part of the W. They The auxiliary funds its programs and makes financial contri Arabe partits donations to MHS have generally been designed to co The MHS has identified five areas of desired service and program and capital . MW Auxiliary pen , as. The S. the to the uses. The auxiliary has given $250.000 Pileting the Future for MHS I Ambulatory Services IL Cardiovascular Services Oncology Services Community Health Services Physical Medicine and Rehabilitative Services CEO wed 10 MHS has set out to answer the most critical health needs that are specific to.com sin. Over the next five years, the MHS strategic plan will continue a tradition of quality community oriented health care to meet future demands. MHS has established a corporate depreciation fund. The Fund's purpose is to ease the Senancial burden of replacing fixed assets. Presently, it has almost $2 milion for needed Financing the Future equipment and renovations, LES CASE STUDY Financial Statements Balance Sheet (Exhibit 33-1) Statement of Revenue and Expense (Exhibit 33-2) CHAPTER 33 Ca Sud Metropolis Health System Sorah Flos (Exhibie 35-3) State of changes in Fund Balance (Exhibit33) Schedule of Properts Plant, and Equipment (Exhibit 33-6) Schedule of Operating Expenses (Exhibit 33-7) Reves N - Aalance Sheet Metropolis Health System Balance Sheet March 31, 2 Tos EE Liabilities and Fund Balance Current Liabilities Current Maturities of long-term Debt Accounts Payable and Accred AS Current Assets Cash and Cab Equivalents $1.150,000 Assets Whore Use Is Limited 825,000 Patient Accounts Recehable 7.400,000 (Ner of $1,300,000 Allowance for Had Debts) Other Receivables 150,000 Inventories 900,000 Prepaid Expenses 200,000 Total Current Assets 10,625,000 Assets Whose Use Is Limited Corporate Funded Depreciation Expenses Bond Interest Payable Reimbursement Settlement Payable Total Current Liabilities Long-Term Debt Less Current Portion of Long-Term Debt Net Long-Term Debt Total Liabilities 6503 1.950,000 5.47555 11.30 Fund Balances General Fund Held by Trustee Under Bond Indenture Agreement 1.425,000 Total Assets Whose Use Is Limited 3,375,000 Less Current Portion (825,000) Net Assets Whose Use Is Limited 2,550,000 Property, Plant, and Equipment, Net 19,300,000 Su 21.500 21,500 Total Fund Balances Total Liabilities and Fund Balances $32,800,000 Other Assets Total Assets 325,000 $32,800,000 MISC w of Revenue and Expense Metropolis Health System Statement of Revenue and Expen for the Year Ended March 31,2 $31.00 e revenge $5.025.000 13.100.000 er professional services ating Kerente Services cameral services potrices aymilation ration 8.300.000 1.900,000 50,000 325.000 1.500.000 for doubtful accounts 33.400.000 cal Expenses $1.700.000 $20,000 80,000 e from Operations Keperating Gains (Losses) Interest income Manoperating Gains, Net Linrestricted gifts and memorials 100,000 $1.800,000 Rescue and Gains in Excess of Expenses and losses usand Organizational Structure Sigital Statistical Data (Exhibit 33-8) Es Nursing Practice and Administration Organization Chart (Figure 331) 13 Executive Level Organization Chart (Figure 33-2) 172 CHAPTER 33 Case Study: Metropolis Health System w Exhibe 3.5-3 Statement of Cash Flows Metropolis Health System Statement of Cash Flows for the Year Ended March 81.2 Statement of Cash Flows $1,700.00 Operating Activities Income from operations 1,950.00 Adjustments to reconcile income from operations to net cash flows from operating activities Depreciation and amortization Changes in asset and liability accounts Patient accounts receivable Other receivables Inventories Prepaid expenses and other assets Accounts payable and accrued expenses Reduction of bond interest payable Estimated third-party payer settlements Interest income received Unrestricted gifts and memorials received Net cash flow from operating activities 250.000 (50.000) (50.0%) (50,000) (400,000) (25,000) (75,000) 80,000 20,000 $3,350,000 Cash Flows from Capital and Related Financing Activities Repayment of long-term obligations (500,000) Cash Flows from Investing Activities Purchase of assets whose use is limited Equipment purchases and building improvements (100,000) (2,000,000) Net Increase (Decrease) in Cash and Cash Equivalents $750,000 Cash and Cash Equivalents, Beginning of Year Cash and Cash Equivalents, End of Year 400,000 $1,150,000 MISC. or changes in Fund Balance Metropolis Health System Statement of Changes in Fundance for the Year Ended March 31.2 uw Balance April 1, 2 $19,700 and Gains in Excess of Expenses and Losses 100 20 Fund Balance March 31, 2 $21.500.000 of Schedule of Property. Plant, and Equipment Metropolis Health System Schedule of Property, Plant, and Equipment for the Year Ended March 31, 2 $14,700,000 Reildings and Improvements Land Improvements 1.100,000 Equipment 28,900,000 Total $44,700,000 Less Accumulated Depreciation (26,100,000) Net Depreciable Assets $18,600,000 Land 480,000 Construction in Progress 220,000 Net Property, Plant, and Equipment $19,500,000 Case Study: Metropolis Health System 166 CHAPTER 33 Exhibit 58-6 Schedule of Patient Revenue $9,8504 7.37530 5.825 450. 3.175,00 Metropolis Health System Schedule of Patient Revenue for the Year Ended March 31, 2 Patient Services Revenue Routine revenue Laboratory Radiology and CT scanner OB-nursery Pharmacy Emergency service Medical and surgical supply and IV Operating rooms Anesthesiology Respiratory therapy Physical therapy EKG and EEG Ambulance service Oxygen Home health and hospice Substance abuse 2.200.58% 5,050.000 5,250.000 1.600.000 900.000 1,475,000 1,050,000 900,000 575,000 1.675,000 375,000 775,000 Other Subtotal $48,500,000 Less allowances and charity care Net Patient Service Revenue (14,500,000) $34,000,000 MUSC Operating Expenses Schedule of Metropolis Health System Schedule of Operating Expenses for the Year Ended March 31,2 Medical Surgical $3,880,000 300,000 395,000 150.000 300,000 $5,025,000 General Services Dietary Maintenance Laundry Housekeeping Security Medical Records Total Care Units SA $320000 ronal Services and CT Scanner $2,375,000 1,700,000 1,375,000 950,000 1,800,000 Support Services General Insurance Payroll Taxes Employee Welfare Other Total wgen Service $1.500 240.000 1.130x00 1.900.000 430,000 $8.500.000 Ataland Surgical Supply Rooms and wat undera yang Therapy Therapy Depreciation Amortization 1.900.000 50,000 CEEG 1.525,000 525,000 700,000 185,000 80,000 460,000 1.295,000 130,000 $13,100,000 cance Service ance Abuse Interest Expense 325.000 ne Health and Hospice Provision for Doubtful Accounts 1,500,000 Total Operating Expenses $3,400,000 CAPTERS C Seady Metropolis Health System 1.00 Exhible - Hopital Santial Dutt Metropole Health System Schedule of lampical Static for the audied March 31,2 Inpatient Indicator Departmental Volume Indir Patient Day Medical and surgical Respiratory therapy treatment Obstetrics Physical therapy treatments Skilled nursing unit 4.500 Laboratory workload units in the sands) Admissions Adult acute care CT scans Newborn MRI scans Skilled nursing unit Emergency room visits Ambulance trips Discharges Home health visits Adult acute care 3.580 Newborn Approximate number of employees Skilled nursing unit (FTE) 3.610 315 140 1130 14 315 445 510 HA 4.1 Average Length of Stay (in days) Director of Nurses Finance Information Systems Support TCA Education Recruitment Support Medical Surgical Emergency Nursing Ambulatory Nursing Women's Health Pediatric Nursing OB/GYN Children's Medicine MRI Medical Pediatric Medicine Dialysis Surgical Health & Development Oncology Emergency Cardiac Rehab Figure 33-1 MHS Nursing Practice and Administration Organization Chart. Courtesy of Resource Group, Ltd., Dallas, Texas