A NEW PARKLAND: YOU DECIDE Garland Chamber of Commerce October 27, 2008 Commissioner Mike Cantrell Dallas County, District 2

voters approved $40,000 in bonds for a new hospital Dallas City-County Hospital System was founded Voters approved creation of a Dallas County Hospital District & Parkland was opened on Harry Hines 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, – 2,345, – 2,218, – 3,600,000  Patient mix (indigent (uninsured/underinsured), undocumented, and out of county)  Attracting 3 rd party payers

Parkland’s 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 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 Challenges CHARITY CARE REQUIREMENTS Source: Center for Health Statistics, DSHS 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 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 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 Challenges 2008 Federal Poverty Level % Gross Monthly Income Family Size21%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 InpatientOutpatientTOTAL EmergentNon-EmergentEmergentNon-Emergent Insured Medicare41005 Medicaid11002 Unfunded TOTAL Parkland’s Challenges FY2007 Contribution Margin

Parkland’s 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

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 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

Parkland’s Future Property Tax Rate Past & Current: FY FY FY FY FY FY01 – FY Future: FY ¢ increase for G.O. bond support =.274 ¢ FY ¢ increase for G.O. bond support =.279¢ FY ¢ increase for operational support =.289¢

Parkland’s Future FY2009 Revenues $1,109,000,000

Parkland’s Future Construction Opening 2011 Office Building (269,000 sq. ft. ) Opening 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)

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

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 Future The ballot proposition will state:

Parkland’s Future Parkland’s future is up to you… YOU DECIDE Early Voting: 10/20/08 – 10/24/088a.m.-5p.m. 10/25/087a.m.-7p.m. 10/26/081p.m.-6p.m. 10/27/08 – 10/31/087a.m.-7p.m. Election Day: 11/4/087a.m.-7p.m. Visit for times & locations