1. Resource Planning Committee May XX, 2015
2014/15 Q4 Financial Review
Resource Planning Committee
May XX, 2015

2. Financial Results – March 31, 2015

3. Overall Commentary
Deficit at end of 14/15 fiscal year $957K compared to budget of $5,560K and prior year deficit of $19K
Unfavourable cost pressures and volume variances offset by favourable variances in revenue due to additional funding, favourable rates and meeting Quality Base Procedure (QBP) targets
Overall, Patient Days are 6,840 greater than budget and 4,876 more than the prior year
Emergency visits are 2,781 less than budget and 1,271 less than prior year
Additional funding, efficiencies and supports are required to get to and sustain a sufficient surplus position given the continued overcapacity pressures

4. Revenue Analysis

5. LHIN/MOHLTC Revenue
Global base is less than budget due to the HBAM 14/15 allocation of $678K vs budget of $1,184K
Net gain of $2.3M in QBP is due to favourable funded rates vs carve out rates & meeting allocation targets
CCO CKD funding was increased based on Q3 volumes and now includes $541K for Kenora
CCO ICP & Other includes $1.7M favourable variance in Chemo drug funding with a like drug expense
1x from LHIN includes ALC Unit $1.6M & Forensics $1M funding not budgeted and $422K favourable variance in Neuro funding and other favourable variances in ER P4R and Nurse Led Outreach funding
1x from MOH includes $1.2M for new drug Myozyme with like drug expense

6. Other Revenue Observations
Ward room revenue is $484K less than anticipated and $325K less than the prior year due to WSIB, Out-of- Province & Out-of-Country days less than budgeted
Other revenues net to $1.7M favourable variance and include the following favourable variances:
Inter-facility recoveries $748K (offset by related expense variance),
IT/IS NW initiatives $516K
Other compensation recoveries of $377K
Refer to next slide for additional detail

7. Other Revenue

8. Expense Analysis

9. Salaries and Wages
Unfavourable volume variance of $5,239,485 (142,073 hours x $36.88 budget rate, rounded) in overtime hours and benefit hours, detail in next slide
Favourable rate variance of $1,187,066 (4,103,834 hours x $0.29 per hour, rounded) due to favourable settlements offset by unfavourable overtime rate variance
Additional detail of the unfavourable hours variance follows

10. Hours Summary
Additional information re Paid Sick and Overtime trends follows

11. Paid Sick and Overtime Indicators
Although TBRHSC has historically benchmarked favourable in Paid Sick hours, in current and prior year Paid Sick as a % of full-time hours has exceeded provincial averages
Overtime was identified as an opportunity for improvement and efficiencies in prior years and has improved with the implementation of the Nursing Resource Team but continues to benchmark higher than the province due to overtime among the part-time employee group

12. Other Expense Analysis
Employee Benefit Contributions have a $1.5M favourable variance due to WSIB and Extended Health Care
In the current year a WSIB rebate of $401,672 was received and in the prior year it was $676,406.
Medical & Surgical Supplies have an unfavourable variance of $1.3M mostly due to supplies greater than budget by $814K in Renal and $425K in Operating Room
Drugs are over budget by $3.4M and include $1.2 for Myozyme not budgeted and $1.2 for Chemo greater than budget
Both Myozyme and Chemo drugs have offsetting favourable variances in revenue

13. Financial Report Including Amortization and Interdepartment Program Management Groups

14. Net Position – Including Amortization and Interdepartmental

15. Overtime/Sick Time Utilization

16. Worked Hours per Patient Day
With Budget based on benchmark data per patient type, Worked Hours per Patient Day is an important indicator to monitor especially during times of changing occupancy, staffing and management. If resources at regular rate are not available, overtime might be incurred for hours required to serve occupancy over anticipated levels. However, worked hours per patient day, measured regardless of rate paid, should be on target based on patient types and acuity. Overall there is less than 1% unfavourable variance compared to budget and less than 1% increase over the prior year. Medical units will be higher than budget due to the ALC unit that was not budgeted.

17. Inpatient Unit Overtime
Data from above can be used to demonstrate how additional overtime hours could be incurred if there is a lack of resources available at regular rate. Patient days are 6,840 more than budget, deduct 3,650 days for ALC unit staffed at regular rate, then 3,190 additional patient days require 7.19 budget worked hours on average or 22,936 hours. The overtime hours of the units in the tables above are 25,124 more than budget. Increased inpatient activity impacts support services & diagnostics as well.

18. Activity Analysis

19. Occupancy Summary as at March 31, 2015

20. Inpatient Activity to March 31, 2015

21. Surgical and Ambulatory Care Activity to March 31, 2015

22. Diagnostic and Other Activity to March 31, 2015

23. Activity Summary and Conclusions
The following slide groups revenue and expense by type or area of variance and demonstrates:
An additional $6.6 million in expenses incurred for volumes & cost pressures above budget and is offset by favourable MOHLTC revenue of $8.1 million (excluding drug specific funding)
Net $1.5 million favourable due mostly to QBP rates & allocation targets met that is assisting in right sizing TBRHSC funding
Additional favourable variances of $1.2 million in salaries & wages rate and $1.7 million in benefits expense
Above explains $4.4 million of overall $4.6 million favourable bottom line variance
However, additional funding, efficiencies and supports are required to get to and sustain a sufficient surplus position

24. Activity Summary and Conclusions

25. Questions/Discussion