Resource Planning Committee August XX, 2015 2015/16 Q1 Financial Review Resource Planning Committee August XX, 2015

Financial Results – June 30, 2015

Overall Commentary $2 million deficit at end of Q1 versus $1.5 million budgeted Could result in $8 million year end deficit versus $6 million budgeted Cost pressures at Q1 are: Salaries and wages expense 5.6% over budget and hours 5.8% over budget and hours 3.4% more than prior period Q1 (spring hire orientation accounts for 1% of expense variance and 1.8% of hours variance) Medical/Surgical supplies 8.5% over budget Drugs 7.0% over budget Volumes are: Inpatient days are 2% more than budget and 2.8% less than prior period Q1 Overall occupancy is at budget Emergency visits are 1.3% under budget Operating Room cases are 15% more than budget and 4.3% more than prior period Q1, however budget has not been updated for new Bari and Vascular cases H-SAA requires implementation of $3 million in efficiencies from third party benchmarking review and participation in external review, root cause analysis, of overcapacity

Revenue Analysis

LHIN/MOHLTC Revenue Global base includes an accrual for an estimated HBAM 15/16 allocation that will be known later in the year Healthcare Funding Reform is carving out global base to convert to volume based QBP funding CCO ICP funding is more than budget due to timing of expenses as a revenue accrual to match ICP expenses & support allocations is made 15/16 CCO ICP funding agreement has been received and is less than expected and ICP will have to contract their budget by $664K to match funding One time funding from LHIN includes an accrual for ALC Unit that is being run without a budget due to capacity issues and in anticipation of a funding agreement

Other Revenue Observations Inpatient revenues are 6.5% more than budget and 15.4% more than prior period Q1 due to increased semi-private as ALC co- payment revenue days are 34.2% less than prior period Outpatient revenues are 2% more than budget and 6.7% more than prior period due mostly to OHIP Fees such as in CT and Nuclear Medicine Other revenues are 4.1% more than budget and 7.1% less than prior period detailed in the subsequent slide The loss on disposal of equipment in “Other revenues” is due to a transfer of funded IT/IS equipment to Sudbury, the new PNOP paymaster, and a like amount of grant revenue was amortized so there is nominal impact to bottom line

Other Revenues

Expense Analysis

Salaries and Wages The next slide details the hours variance by worked and benefit hours categories The main cause of the unfavourable hours variance is orientation hours of the spring hire that will smooth out over the year Otherwise as a % of budget the worked hours at regular rate are greater by 2%, overtime 25%, sick hours 38% and other benefit hours 20% Other benefit hours include stat holidays/floats, paid compassionate leave and other paid LOA

Hours Summary

New Paid Sick Day Indicator A new Paid Sick Indicator has been added to the management financial/statistical reports to help conceptualize budget and actual Paid Sick Hours in terms of Paid Sick Days per Full-Time Employee Overall Paid Sick Days per Full-Time Employees is at 13 days per year versus a budget of 9.75 days per year Budgets are based on benchmark targets of employee/union groups and ONA, RPNs and SEIU have the largest budgets at 10 to 15 days/year EVPs, Directors and Managers run and review monthly reports for their divisions and departments as applicable On a framework basis the indicator results are as follows: Administration and Support Services (711) Budget 6.7 days, Actual 9.7 days Inpatient Units and OR (712) Budget 11.5 days, Actual 17.2 days ED, Day Care, Renal & Ambulatory (713) Budget 10.0 days, Actual 15.4 days Diagnostics & Therapeutics (714) Budget 7.6 days, Actual 10.8 days

Paid Sick Time as % of all Full-Time Hours Trend

Other Expense Analysis Medical/Surgical supplies 8.2% more than budget and 4.5% more than prior period Q1 Significant unfavourable variances are: OR $153K, Renal $142K and Orthoses, orthopedic and other, $132K Drugs are 6.7% over budget and 6.3% more than prior period The most significant unfavourable variance is in Chemo drugs $146K and the remaining variance across all units & most other drug products Supplies and other expenses has a 6.2% favourable variance and is in line with prior period results Significant variances are: $183K in departmental consumable supplies such as Radiology contrast media, linen and food $193K in sundry services such as equipment maintenance $73K parking snow removal, $45K in professional fees and $42K in travel

Financial Report Including Amortization and Interdepartment Program Management Groups

Net Position – Including Amortization and Interdepartmental

Overtime/Sick Time Utilization

Worked Hours per Patient Day Important indicator to monitor especially during times of changing management, occupancy, patient type & staffing Budget is based on benchmark targets for type of patient e.g. medical, surgical, critical care etc. Although the ALC unit was not budgeted worked hours per patient day should still be in the target range Worked hours per patient day are measured regardless of rate paid and should be on target based on patient types and acuity % Occupancy does not impact this indicator assuming staffing is adjusted for number of patients and target nurse to patient ratios 2C shows the most significant change as a result of adding staffing for workload 2C staff also care tor recovering Cath Lab & PCI Angio outpatients and need to report this activity , counted as one Visit per out-patient per day, so it can be converted to equivalent patient days in order to reassess this indicator

% Occupancy Overall % Occupancy is on budget at 92% and is 2% less than prior period Q1 Areas with a variance of 5% or more include Surgical Units, IA and 2C Occupancy % in all areas except Women & Children and ICU is less than in the prior period Q1

Activity Analysis

Occupancy Summary as at June 30, 2015

Inpatient Activity to June 30, 2015

Surgical and Ambulatory Care Activity to June 30, 2015

Diagnostic and Other Activity to June 30, 2015

Activity Summary and Conclusions Overall Inpatient Days of 36,510 are 748 more than budgeted and 1,070 less than prior period Q1 % Occupancy including Emergency & Recovery Room is 95% at Q1 versus 97% in the prior period Excluding ER & RR, % Occupancy of the Inpatient Units is 92% Budget, 92% Actual and 94% Prior Period A high level calculation of Length of Stay shows a decline in Acute LOS that would impact favourably on % Occupancy The following slide depicts TBRHSC’s trend in Acute Weighted Cases reflecting acuity trends Next steps; implementation of $3 million in efficiencies from third party benchmarking review and participation in external review, root cause analysis, of overcapacity while continuing to develop and implement new surgical programs

Activity Summary and Conclusions – Five Year Trend of Acute Weighted Cases

Questions/Discussion