Viewing Public Health Financial Information from a Different

Viewing Public Health Financial Information from a Different Perspective: Financial Ratio Analysis in Florida County Health Departments NACCHO Annual 2010 Memphis, TN July 14, 2010 Matthew J. Dillon

Lets Continue Our Journey Walking Man – source unknown….

Quick Perspective…. . Administration sets policy n Program staff deliver the services n Administrative staff are there to support the programs n Finance & Accountings role is that of the scorekeeper n

Florida Department of Health n 67 County Health Departments $834 M CHDs Statewide ¨ $208 B Department Wide ¨ n Co-managed under the State and Local Board of County Commissioners n All State Employees n Single Accounting System ¨ Unified chart of accounts

Challenges on what to collect: We collect lots of information, just depends on how and what you want to retrieve n Issues with trying to collect information from the various operations, especially clinical n ¨ i. e. What is primary care, what is core public health?

Florida Accounting and Information Resource System (FLAIR) n n n Very cumbersome but effective system Approximately 2 M accounting transactions/year Multiple Reports ¨ Okay for Finance and Accounting Staff ¨ Difficult for Department Managers to read ¨ i. e. one report shows only revenues while another expenditures but not both with a Total

Financial Information Reporting System Developed a reporting system called FIRS n Easy reports to read in similar formats n Accessible via the DOH network n ¨ All you need is an email address ¨ Access the reports for your CHD or all CHDs within the state.

FIRS n n n Good for comparing similar operations, staffing, workload, population, budget, FTEs, etc. Can provide revenues and expenditures per program or Secondly can develop reports for a division (example, you can have separate budgets for the personnel department, finance and accounting, IT, etc. and you can also have a group report for all the offices).

Gathering Information Used FIRS n This was the main foundation for our financial data gathering n

Florida Advantages: n n We use a similar codes, chart of accounts, accounting structure, format, etc. Most all financial data was in one data base We had access to the data If we pulled the data we would have control on how it was sorted ¨ Consistently right or consistently wrong n n Workload was put on limited staff Instructions were clear among those involved

Florida Disadvantages: n 2 M Transactions/ year ¨ (6 M+ transactions) to manage causing difficulty in sharing and reviewing the information collected in files via spreadsheets/email

Sources of Data • Multiple DOH/State of Florida Systems – FLAIR • FIRS – CONMAN – extracts from Department of Management Systems • External Links

Most of the demographics came from one of the 3 sites below: q http: //www. floridacharts. com/charts/chart. aspx q http: //edr. state. fl. us/ q http: //quickfacts. census. gov/qfd/states/12000. html

Results: Data pull for 45 of the 61 criteria n CHDs gathered for the remaining 16 items n

Key Players in Data Gathering Greg Ballard n Jennie Bishop n Penny Dyer n Matthew Dillon n Lil Perry n Ernesto Rubio n

Scope of CHD Clinical Services n 1 million clients served annually. n Over 250 clinic sites throughout state.

Financial and Other Related Indicators Revenues Expenditures

Financial – Revenues

Annual Comparisons 1. Captured 3 FY’s 2. Actual Amounts and 3. Added Budget for each year Revenues

Financial – Expenditures

Annual Comparisons Additional Expenditure Breakdowns

Special Revenue and Expenditures

Additional Revenue Breakdowns

Additional Expenditure Breakdowns

Additional Breakdowns

Other Financial, Demographic, Workforce, and Mission Critical

Demographic

Workforce

Mission Critical

Ratios

Revenues per Capita Total Revenues / Population = Revenues / Capita $16, 228, 647 251, 703 $64. 48 Capita

Florida Finance Ratio Analysis Initiative 2006 -2008: n Population size: ¨ ¨ ¨ 1 = <25, 000; 2 = 25, 000 -49, 999; 3 = 50, 000 -99, 999; 4 = 100, 000 -499, 999; 5 = 500, 000 -999, 999; 6 = >1, 000

Florida Local Health Agency Revenue Per Capita 2008

Florida Local Health Agency Expense Per Capita 2008

Florida Local Health Agency Days of Revenue in Accounts Receivable 2008

Florida Local Health Agency Accounts Receivables Written Off as a % of Total Collected 2008

Florida Local Health Agency Total Margin 2008

Florida’s Current Measures Revenue per Capita Expenditure per Capita Margin of revenue to expenditures

SUMMARIZE FINDINGS #1 – Showed immediate coding errors n Provided 3 FY’s to trend on a single page: n ¨ Actual Data vs. Budgeted Data Baseline data for DOH & individual county CHD n Management Decisions – Data/Evidencebased n

Next Steps………. Decide what to capture up front to reduce workload n Prioritize Key Data Elements n Review Coding Activities n ¨ Standardize n Technology ¨ Become more efficient with technology to reduce staff workload

GOALS / ACTION………. n Obtain “buy-in” from Leadership State Level ¨ Local Level ¨ n Action Taken Peggy Honore visited Tallahassee – Statewide webinar ¨ Leadership and key peer support ¨ Established a workgroup ¨ n Intent Identify 10 -20 ratios ¨ Implement seamlessly with new business plan beginning of Fiscal Year ¨ Monitor and Analyze data ¨

“The project is to develop and assess the viability of using a series of ratios to compare public health financial and administrative infrastructure information and then be able to compare the results to other CHDs/states. We all think this analysis will provide yet another resource for moving forward with making sound business decisions relative to public health. This may also play a role in a future credentialing process for local and county health departments”. Michael Sentman Assistant Deputy State Health Officer Florida Department of Health

Thank you for your time……. Questions? ?