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Home My WebLink AboutGrant Related - BOCC (005)i-SAMARITANHEALTHCARF American Rescue Plan Act (ARPA) Guidelines +Case Statement of Need for Samaritan Healthcare Information and case guidance provided by MRSC (Municipal Research and Services Center) August 2022 BACKGROUND • In June of 2021, Samaritan CEO, Theresa Sullivan, and members of the Senor Leadership team met with the Grant County Commissioners to formally begin the conversation and application process for a distribution/award of Grant County's ARPA dollars. It had previously been announced, that Grant County was awarded $18.9 Million in ARPA funding, and based on the application parameters Samaritan Applied for $18 Million to support the development of pandemic -response and pandemic -ready infrastructure tied to the new hospital campus, as well as the operational impact to Samaritan's finances in response to the COVID-19 pandemic. • Furthermore, while we initially requested $18 Million, we've understood from multiple conversations and hosted -visits with the County Commissioners we would not be receiving the full amount, but that any amount would be helpful. CASE STATEMENT OF ELIGIBILITY FOR ARPA FUNDING I According to MRSC, ARPA funds may be used to cover qualifying costs obligated between March 3, 2021 and December 31, 2024 and expended by December 31, 2026. Funds may be used for following purposes: • 1. To respond to the public health emergency or its negative economic impacts, including assistance to households, small businesses, and nonprofits, or aid to impacted industries such as tourism, travel, and hospitality; o ADDITIONALLY: In responding to public health and negative economic impacts, the Final Rule states that Treasury will consider two eligibility requirements: (1) a negative public health impact or harm, and (2) the program, service, or other intervention that responds to the identified impact or harm. o SAMARITAN ELIGIBILITY: ■ Samaritan Healthcare has, and continues to, work closely with Public Health, outlying rural critical access hospitals and their communities and other primary care within the region to coordinate regional resources and response efforts. This role was further developed on a regional level with regards to COVID-19 vaccine distribution and administration. As an organization, Samaritan utilized data driven tools such as social determinants on COVID rates and statewide case tracking information to facilitate our initial efforts in vaccine allocation and our efforts to increase regional vaccine confidence. ■ Since the initial vaccine was administered in December of 2020, Samaritan has administered: • 301779 doses of the COVI D-19 Vaccine at Samaritan Locations N r9 1Page E �....�aw:rc:n-••:<mu::ar.�.r �r_w-.�:v tc::ura+,.:..cpmr_Tc_..=.F..c�..u.�.�z.._�..rc..-..�=-u•.s::,..s-: c.:,a•.�.sra�: SAMARITAN HEALTHCARE • Has coordinated the regional response of vaccine administration with community vaccination clinics in the following communities: Quincy, Royal City, Grand Coulee, Ephrata, Ritzville, Warden, and Mattawa. ■ Throughout the pandemic, Samaritan Hospital served as the regional medical center when it came for caring for patients needing hospitalization. While the state was often in `gridlock' when it came to transfers, Samaritan served as the regional hospital, often accepting patients from our GCHA partners who otherwise would not have been able to care for their patients in need. • From March 2020 through July 2022, Samaritan Hospital treated 1,254 patients whom were directly admitted for COVID-19. • 2. To respond to workers performing essential work during the COVID-19 public health emergency by providing premium pay to eligible workers; o Samaritan provided a one-time retention incentive to all staff. o Samaritan implemented double-time pay for staff picking up extra shifts due to staffing shortages and increased volumes. o Samaritan, like hospitals across the state and country, has seen a significant increase in the use of temporary manpower. This expense has grown by 200% over last year for Samaritan and hospitals across the state. • 3. For the provision of government services to the extent of the reduction in revenue due to the COVID-19 public health emergency relative to revenues collected in the most recent full fiscal year prior to the emergency; and o -SAMARITAN ELIGIBILITY: ■ While Samaritan received federal funding to manage the COVID-19 response, those funds fell short of our actual loss of gross patient revenue by over $15 Million. This loss occurred during the Governor's initial "Stay Home, Stay Healthy" order that was implemented on March 23, 2020 and lasted throughout the end of May 2020. ■ Throughout the COVID-19 pandemic, Samaritan Healthcare has had to adapt operations to meet the rules of the Governor's ongoing COVID-19 mandates. However, the biggest financial impact of this mandate has been the multiple pauses on elective surgical procedures. In the spring of 2020, we had to shut down our OR for surgical procedures that aren't otherwise offered by other regional Grand Columbia Health Alliance Facilities, forcing an incredible back -log of procedures for patients throughout our communities. ■ When surgery did open back up, we frequently needed to pull our surgical staff to the inpatient floors or emergency department to help support the incredibly challenging high volumes of patients. This resulted in additional delays of surgical operations for patients, and had a significant financial impact on the organization that is still felt today. 2page SAMARITAN HEALTHCARE ■ It should be noted that our hospital volumes have continued to see sustained patient need and growth. OTHER NOTES: 2018 2019 2020 25.73 26.18 25.13 201482 201478 18,18 2021 2022 I Annualized ..................................... . . .... .................................. . . . ........................ .............. 28.99 1 29.31 211199 23,450 • The GMP came in $31 Million over budget. The project is unlikely to get any cheaper. • Samaritan's expenses like healthcare across the country have increased. • We are in desperate need of additional space in order to service our growing region. Other hospitals in the county and the Grand Columbia Health Alliance region depend on Samaritan to be able to care for increasingly more patients and increasingly higher acuity. Other larger hospitals are struggling with capacity so they need Samaritan to be able to take care of patients locally. • USDA — we have 5 years (now down to 4 years) to use the USDA dollars. It is historically low rates—$96 Million at 2.25% for 30 years. We no longer qualify for the program because our population has grown beyond their definition of rural. We still retain the dollars obligation, but are unable to qualify in the future if we tried to apply again. NOW is the time for our COUNTY to make this happen for the people of our County and our region. ASK FOR SUPPORT • As the largest regional hospital in Grant County, and as a critical partner in Emergency Response infrastructure, we are calling to advocate for Samaritan to receive these crucial ARPA dollars to support ongoing pandemic operations and response readiness, as well as the development of the future hospital campus. 31 Page Talking Points: Without COVID funds that Samaritan has received, these are the financials: • 2020 Revenue down -$32 million • 2020 Expenses were $6 million below budget • 2020 Operating Income reflected a loss of -$3.9 million • 2020 Net Income reflected a loss of -$372,622 • 2020 received $5.3 million in COVID funds that is not reflected in the numbers above • 2021 Revenue we experienced $1.2 million increase • 2021 Expenses are $9 million above budget • 2021 Operating Income reflected a loss of -$1 million • 2021 Net Income reflected a gain of $1.7 million • 2021 received $2.5 million in COVID funds that is not reflected in the numbers above • 2022 Revenue we experience $6 million increase 0 2022 Expenses $1.7 million above budget • 2022 Operating Income reflected a loss of -$3.1 million • 2022 Net Income reflected a loss of -$1.3 million • Temporary Manpower costs are up 200% and this is not unique SAMARITAN HEALTHCARE OPERATING STATEMENTS W/O COVID SUPPORT 2019 2020 2021 2022 Annualized Baseline ACTUAL ACTUAL ACTUAL ACTUAL SAM HOSPITAL Inpatient Revenue 96,926,927 96,915,669 117,906,243 129,202,526 SAM HOSPITAL Outpatient Revenue 152,836,103 160,054,594 183,861,111 218,090,025 SAMARITAN CLINIC Revenue 17,484,225 20,561,776 25,122,854 27,600,013 TOTAL GROSS REVENUE 267,247,256 277,532,039 326,890,208 374,892,564 Deductions From Rev 1631528,709 170,292,384 198,168,395 238,511,365 Bad Debt Expense 21816,302 31335,795 31237,795 41235,003 Charity Care 41264,490 41265,172 31025,671 21989,567 TOTAL DEDUCTIONS FROM REVENUE 170,609,501 177,8931351 204,431,861 245,735,935 NET PATIENT REVENUE 96,637,755 99,638,688 122,458,347 1291156,629 TOTAL OTHER OPERATING INCOME 3,8381468 41398,626 4,2911986 31874,349 TOTAL OPERATING REVENUE 100,476,223 1041037,314 126,750,332 133,030,978 EBIDA 121434,343 578357679 8,387,949 479891163 EBIDA % 12% 6% 7% 4% Salaries - Non Providers 361519,261 39,245,616 4315157872 4211881428 Salaries - Physicians / Providers 819801983 1174727268 147007,189 167886,738 Temporary Manpower 176867341 115237520 314027839 87022,031 Benefits 11,6867189 13, 888,798 18,158, 573 1972507782 Total Salary & Benefits 58,8727775 6671307202 797084,473 8673471980 Physician Fees 470067676 418777598 77322,083 61188,107 Professional Fees 119637810 21084,682 1,392,910 17924,956 Supplies 1471357308 1376291223 16,514,316 177677,325 Utilities 5737909 5611993 6207555 6197001 Purchased Services 475687244 614857791 617547794 771017791 Repairs & Maint 27707239 312707246 37348,127 31540,430 Rental/Lease 1,3497213 1,154,240 174817168 178691220 Insurance 4761410 8047554 173597993 174477210 Other Expenses 3,349,230 27718,540 37200,910 311427903 Total Non Salary Expenses 3371937040 3515861869 417994,856 4375101943 TOTAL OPERATING EXPENSES 92,065,814 101,717,070 121,079,329 129,858,923 Interest 2547858 1781079 127,898 971304 Depreciation 511047482 670307222 675647041 61200,129 T' TAL CAPITAL EXPENSES 5,359,341 6,2081301 616912939 61297,433 TOTAL EXPENSES 97,425,155 107,925,371 127,7711267 136,156,356 a, O'AL OPERATING INCOME 31051,068 3 888 0571 (11020,935) (3y'1251378) Operating Income % 3.0% -3.7% -0.8% -2.3% -- �Ga�in/Loss on Investments 1 549 567 852 644 (164 088) (11345,932) r. Gain/Loss on Sale of Assets 14,187 (28,051) (257124) 21014 Property Tax Revenue 21422,312 21590,297 2,606,159 2,864,757 - Other Non -Operating Activities 370868 100,545 300,000 296,269 Total Non Operating Income (Loss) 41023,934 3,515,435 21716,946 11817,108 NET INCOME 7,075,002 (372,622) 1,696,011 (1,308,270) Net Income Margin % 7.0% -0.4% 1.3% -1.0 EBIDA 121434,343 578357679 8,387,949 479891163 EBIDA % 12% 6% 7% 4%